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김재욱,김세광,서경,임영구,김완기,주수길,임종철,이용제 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4
The varicella during pregnancy is rare. The incidence of varicella among pregnant women is about 5 in 10,000 pregnancies. In 1947, Laforet and Lynch were the first to describe an association between maternal varicella infection in early pregnancy and congenital anomalies in the offspring. the existence of a syndrome was first postulated by Srabstein et al(1974), Brunell(1983), Kotchmar(1984), and recently Higa et al.(1987) described most of the malfomations associated with maternal varicella infection. Varicella-Zoster viurs(VZV) infections acquired during pregnancy may result in serio us disease for both the mother and the fetus. The effects on maternal health can range from a mild chikenpox exanthem to servere life-theatenig illness often complicated by viral pneumonitis. The fetus may remain unaffected, but VZV infection during early pregnancy has been associated with a congeital syndrome including muliplie defects of the skin, limb, eyes, and brain. We reports our experience with a varicella during pregnancy with a brief literature review.
김재욱,박용원,조재성,김태윤,최형민,김경수,이연혜,임영구,권혜경 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7
Objective: To evaluate the effect of fetal presentation to the measurement of amniotic fluid index(AFI) in singleton pregnancy after 20 weeks of gestation. Materials and Methods: Review of the medical and ultrasonographic records from 1992 to 1996 including AFI value and pregnancy outcomes was performed retrospectively. The inclusion criteria were (1) singleton pregnancy delivered after 37 weeks of gestation, (2) birth weight between 10th and 90th percentile, (3) no fetal anomaly, (4) 5 minute Apgar score≥7, (5) no maternal medical disease such as hypetensive disorders or diabetes, (6) and intact amniotic membranes at the time of ultrasonography. The results of 7,362 tests from 5,607 pregnancies were reviewed and analyzed. Results: In normal pregnancies after 20 weeks of gestation, the AFI value showed the peak during 25~30 week and decreased thereafter. The range of AFI during preterm pregnancy(30~36 weeks, N=2,836) were between 9.4 and 21.8 cm(5th to 95th percentile, mean value of 15.2±4.1cm). The range of AFI at term(37~40 weeks, N=1,245) were 7.7 and 21.9 cm(5th to 95th percentile, mean value of 14.2±4.5cm), which showed significant difference (p=0.000) from that of preterm. The range of AFI after 41 weeks(N=75) were within 4.3 and 26.7cm(5th to 95th percentile, mean value of 13.8±6.3cm), which showed gradual decrease. The AFI among the gravidas with breech presentation showed similar values between 20~36 weeks. At term pregnancies(after 37 weeks, N=84) with breech presentation, the AFI(range 5.2cm~22.3cm, mean value 13.5±4.8cm) was smaller than those with cephalic presentation, but statistically insignificant(p=0.103). The commonly used criteria for oligohydramnios, AFI 5.0cm, equated to 1st percentile in cephalic presentation and 5th percentile in breech pregnancies, respectively. Conclusion: In this study AFI throughout pregnancies after 20 week of gestation showed difference of distribution of AFI according to gestational age and fetal presentation in term pregnancy. Further studies would be required to establish the cutoff value of oligohydramnios in cephalic and breech presentation at term pregnancy to establish different criteria according to fetal presentation.
고위험 자궁경부암환자에서 Quick Cisplatin-VP16 을 이용한 신보조항암요법의 효과
김승조,김진우,배석년,남궁성은,박종섭,이준모,김찬주,김재훈,박동춘,박용규 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8
The potential role and determinants of response to a cisplatin-based regimen of neoadju-vant chemotherapy in women with a histologically confirmed first diagnosis of stage IB-Ⅲ cervical cancer were analyzed. From 1993 to 1996, 92 patients with bulky(designated as more than 3×3 cm2 size) mass were treated with cisplatin 60 mg/m2 and etoposide 100 mg/m2, admi-nistered intravenously at 7 day intervals. Seventy cases of radical hysterectomy with pelvic lymph node dissection and 22 cases of radiation therapy were performed 2 to 3 weeks after chemotherapy. At the end of the cycles, the overall clinical response rate of portio was 83.7 %(34.8 % with a complete response and 48.9 % with a partial response). The older ages, lower stages, and squamous cell types correlated favorably with the clinical response of the portio, but neither with the parametrium nor with the vagina. After the operation, we found the diff-erences in histologic responses, with the following parameters:lymphovascular space invasion, 3 mm below stromal invasion and lymph node metastasis. Theses parameters correlated with the clinical responses, and the down-staging of cases were 70 %. In comparison with radiolog-ical findings of pretreatment and postoperative tissue pathology, we could find a decrease in pelvic LN metastasis. The tumor-free survival rate calculated by the Kaplan-Meier product limit method was 75 % but it was 86.1 % for cases without the occurrence of persistent disease after the completion of the treatments. All patients suffered from nausea and vomiting, but grade 4 toxicity was not detected after the routine use of antiemetics. There were no events that delayed the next step in the treatment or caused difficulty during the operation. The results of this study suggest that the neoadjuvant chemotherapy should be accepted as a routine tool in treating high risk cervical cancer in order to improve the likelihood of favorable outcomes.
김정욱,김호성,김형용,박현중,강유미,신용각 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5
본 증례에서의 몇 가지 문제점을 살펴보면 과거 수술 반흔을 따라 하복부 횡 절개를 시행하여 수술시야가 확보되지 못 하였고 확장시키기에도 어려움을 겪었다. 이에 따라 태반부착부인 자궁 하절부에 절개를 시행하였으며 태반박리를 시행하여 대량의 급속 출혈이 발생하게 되었다.출혈과 유착으로 인하여 변화된 해부학적 구조하에서 응급 자궁 적출술을 시행하여 방광 표면에 한정된 태반침습에도 불구하고 방광 파열이 발생하였고 발달된 혈관 분포로 인해 출혈이 많이 발생하였으며 이로 인해 수술 시간이 증가되었다. 본 증례를 통해 적절한 산전진단의 방법과 산모 예후를 최적화 시키기위한 처치방법에 대하여 향후 좀 더 많은 연구가 필요하리라고 생각되며 고찰과 함께 보고하는 바이다. Placenta previa percreta is an uncommon and life threatening complication of pregnancy due to massive hemorrhage. And, the direct invasion of placenta to adjacent organ and/or the difficulty of surgery may raise maternal morbidity. To decrease the maternal mortality and morbidity, antepartum diagnosis and proper management is important to prevent catastrophic bleeding and the injury of adjacent organ. We experienced a case of placenta previa percreta at 38weeks of gestational age. Here, we present the case with brief review of literature.
태아 융부기형의 산전진단에서 태아심축 (Cardiac Axis) 측정의 임상적 의의
김재욱,박용원,조재성,김태윤,최형민,김경수,임영구 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1
Objectives: The objective of this study is to investigate a possible role for fetal cardiac axis in prenatal screening of congenital cardiac or extracardiac intrathoracic anomaly. Introduction: The incidence of the congenital heart disease is reported to be 8 per 1000 live births. The congenital heart disease is the most common major anomaly in newborn, and significantly affects perinatal morbidity and mortality. Because about 90% of congenital heart disease occurs in fetus without risk factors, it is important to screen congenital heart disease in low risk patients for the congenital heart disease. Method: 48 cases of cardiac(38 cases) and extracardiac intrathoracic(10 cases) anomaly and 205 cases for control were evaluated for measurement of cardiac axis and analyzed by Student`s t-test and correlation analysis with SPSS/PC+ packages. Results: The mean cardiac axis of control group was 39.4。 (SD: 9.2。, range: 20。 ~ 65。), and in the lesion group it was 42.1。 (SD: 28.9。, range: -34。 ~ 127。). If we use mean cardiac axis±2SD of normal fetuses as a range of normal cardiac axis(21。 ~ 58。), 16/48(33.3%) of the congeital heart disease or extracardiac intrathoracic anomaly will be detected and specificity, positive predictive value, negative predictive value of the fetal cardiac axis in screening cardiac or intrathoracic anomaly will be 96.6%, 69.6%, 86.1%, respectively. Conclusion: The fetal cardiac axis may be a useful parameter in screening fetal cardiac or extracardiac intrathoracic anomaly, and could be used clinically as a parameter for evaluation of the four-chamber view of the heart.