초음파 아두대횡경치와 대퇴골길이에 의한 태아연령에측의 정확도에 관한 통계적 비교

노의선(YS Rho),고승권(SK Koh),김현식(HS Kim),이용우(YW Lee),남주현(CH Nam),정좌구(JK Chung) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.3

월경력이 정확한 임신 제 25주에서 42주까지의 임부 269명을 대상으로, 태아연령을 예측하기 위하여 초음파를 이용한 BPD와 FL를 측정하여 다음과 같은 결론을 얻었다 1 임신주수와의 상관관계를 비교하여 볼 때 FL(r2=0 8955)가 BPD(r2=0 8255)보다 태아연령을 예측하는 척도로서 더 유의함을 알 수 있었다 2 FL가 GA의 상관관계를 나타내는 방정식중 직선방정식(r2=0 8955, t=48 7, P<0 01) 보다는 2차방정식(r2=0 9006, t=3069, P<0 01)이 태아연령의 예측에 더 정확한 model이었다 그러나 BPD에서는 직선방정식과 2차방정식(r2=0 8273, t=1 679, P>0 05)간에 태아연령예측의 정확도에서 유의한 차가 없었다 3 FL와 BPD를 함께 조합하여 산출한 새로운 방정식은 GA=-5 77+(1 8126) FL-(0 008372) FL2-(0 7453) BPD+(0 002966) BPD2으로써 r2=0 9106이었다 즉 태아연령의 예측에 있어서 FL나 BPD를 단독으로 사용하는 것보다 둘을 조합하였을때가 더 정확한 예측이 가능함을 알 수 있었다 4 GA에 대한 logarithmic function을 도입하여 산출한 회귀방정식은 LogGA =2 0068+ (0 0576) FL-(0 000288) FL2-(0 0172) BPD+(0 000065) BPD2으로 r2=0 9285로써 태아연령예측에 가장 적합한 공식이었다 Ultrasonic measurements of biparietal diameter(BPD) and femur length(FL) for estimation of gestational age(GS) were performed in 269 pregnant women between the 25th and 42nd weeks of gestation The results were as follows: 1 Femur length(r2=0 8955) was found to provide a more accurate index than BPD(r2=0 8255) for prediction of gestational age in the linear regression equation 2 The linear quadratic function for describing the relation between FL and GA was a more accurate model than the linear function(r2=0 9006, t=3 69, P<0 01) But no significant improvement in the accuracy for predicting GA was observed using the linear quadratic function in the relation between BPD and GA(r2=0 8283, t=1 679, P>0 05) 3 Combining the FL and BPD, the the new regression equation is GA=-5 77+(1 8126) FL-(0 008372) FL2-(0 7453) BPD+(0 002966) BPD2(r2=0 9106, P<0 01) It was found that this formula provided more accurate prediction of GA than that of using either FL or BPD 4 The multiple regression of log(GA) on EL, FL2, BPD and BPD2, Log(GA)=2 0068+(0 0576) FL-(0 000288) FL2-(0 0172) BPD+(0 000065) BPD2 showed the highest coefficient of determination(r2=0 9285) So it is concluded that this is the most accurate formula for prediction of GA

선천성 복벽결손을 동반한 양막대증후군 1 예

노의선,김영석,김홍기,조용,이성원,정민영,정우철,한성태 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.3

최근 본원 산부인과에서, 배란유도에 의하여 쌍태아를 임신하고 임신 35주째에 조기진통으로 인하여 제왕절개술을 시행받은 여성에서 복벽결손과 양막대증후군을 동시에 보이는 신생아 1예를 경험하였기에 이에 대한 문헌고찰과 함께 보고하는 바이다. The amniotic band syndrome is a collection of fetal malformations associated with fibrous bands that appear to entangle or entrap various fetal parts in utero, leading to deformation, malformation, or disruption. The fibrous bands are mesodermic in origin and thought to be emanated from external surface of ruptured amniotic membrane. Misdiagnosis and inappropriate family counseling are common features. We experienced one case of amniotic band syndrome in 32 years old primigravid woman who had twin pregnancy after ovulation induction with Pergonal. We report the case with a brief review of literatures.

산후 출혈로 제왕절개 자궁적출술을 시행받은 41 예의 임상적 고찰

박영세,장영우,문태식,구자남,전대준,노정석,박준혁 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

목적: 제왕절개 자궁적출술을 시행받은 환자를 대상으로 발생 양상 및 임산부 예후 등을 분석함으로써 사망률 및 이환율 감소에 도움이 되고자 본 연구를 시행하였다. 연구 방법: 1987년 1월부터 1997년 12월까지 울산대학교병원에서 시행한 41예의 제왕절개 자궁적출술에 대해 분만대장 및 의무기록을 검토하여 분석하였다. 결과: 총 19,485예의 분만 중 제왕절개 자궁적출술의 빈도는 0.21%이었다. 4,917예의 제왕절개술에 의한 분만 중 32예(0.65%)에서, 14,568예의 질식 분만 중 9예(0.063%)에서 제왕절개 자궁적출술이 있었다. 산모의 연령과 분만력이 증가함에 따라 제왕절개 자궁적출술의 빈도는 증가하는 양상을 보였다(각각 p<0.05). 제왕 절개 자궁적출술의 적응증 중 유착태반(41.4%)이 가장 많았고, 자궁이완증(36.6%), 자궁파열(9.8%), 자궁근종이 동반된 임신(4.9%)의 순이었다. 수술 후 합병증은 수술 후 발열(26%), 빈혈(17.1%), 요로감염(14.6%), 파종성 혈관내 응고(7.3%), 방광 손상 등이었다. 임산부 사망은 1예가 있었으며, 사망원인은 패혈증 및 울혈성 심부전이었다. 부분 자궁적출술을 시행한 13예 중 9예(69.2%)에서 수술 후 합병증이 있었고, 전자궁적출술을 시행한 경우는 78.6%(22/28)에서 합병증을 보여서 두 수술 방법간에 유의한 차이는 없었다(p>0.05). 결론: 제왕절개 자궁적출술의 경우 수술 후 합병증이 많은 관계로 임산부 사망과 이환을 야기하곤 한다. 그러므로 적절한 산전진찰을 통한 위험군의 예측과 수술 시행 여부에 관한 정확한 판단이 요구된다고 사료된다. Objective: To evaluate the causes and maternal outcomes in patients who received cesarean hysterectomy operation. Methods: Forty one patients received cesarean hysterectomy at Ulsan university hospital for the 11 years, from January 1987 to December 1997. Results: The incidence of cesarean hysterectomy was 0.21% (41/19,485 deliveries). Cesarean hysterectomy was performed in 32 of 4,917 cesarean sections (0.65%) and in 9 of 14,568 vaginal deliveries (0.062%). The higher the age and parity of patients, the higher the incidence of cesarean hysterectomy were noted (p$lt;0.05, respectively). The most common indication of cesarean hysterectomy was placental disorders (41.4%), and that was followed by uterineatony (36.6%), uterine rupture (9.8%), uncontrolled bleeding with placenta previa (4.9%) and uterine myoma with pregnancy (4.9%). The postoperative complications were febrile morbidity, urinary tract infection, bladder injury, disseminated intravascular coagulopathy and wound disruption. There was one maternal death, the cause was sepsis and congestive heart failure. There was no significant difference between two operation methods in the aspect of postoperative complications (p>0.05). Conclusion: Postoperative complication still remains the main cause of maternal mortality and morbidity. Therefore, careful prenatal care, momentary judgement of right operation time must be conjunction with maternal lifesaving.

항문 주위에 발생한 자궁내막증 2 예

박영세,문태식,정승관,노정석,박준혁,우영주 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

The incidence of perianal endometriosis is quite rare. We have experienced two cases of perianal endometriosis. The typical clinical history and local findings enable us to make the correct diagnosis. The treatment of choice is complets surgical excision of the lesion and the surgical excision usually obtains permanent cure. The possible pthogenesis of the perianal endometriosis and various modalities of treatment.

Thanatophoric Dwarfism 2 예

권순욱,노의선,황성한,전세현,전동호,박충기 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.2

저자들은 본 병원 산부인과에서 양수과다를 동반한 2명의 경산부에서 분만 수시간내에 사망한 Thanatophoric Dwarfism 2예를 경험하였기에 문헌 고찰과 아울러 보고하는 바이다. Thanatophoric Dwarfism is a short limb dwarf condition which usually results in death shortly after birth. It has been confused with achondroplastic and another congenital short limb dwarf condition. We present two cases of Thanatophoric dwarfism based on clinical, radiological and autopsy findings with review of literatures.

미세수술을 이용한 난관복원술 후 임신율에 대한 고찰

김용필,노의선,조용,이성원,박주진,김경택,양승권,이면우,정석희 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym Uni- versity. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24∼42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1∼17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), lapa- roscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postope- ratively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30∼34 years, 71.4 % in 35∼39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical diffe- rences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmi- cisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4∼6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5∼10 years, 44.4 % in 11∼15 years(p = 0.230).

좌각 차단 및 하향성 전기축을 보이는 특발성 심실 빈맥의 심전도 형태차이에 따른 전극도자 절제술의 성적비교

이만영,노태호,진승원,유기동,장기육,오용석,채장성,김재형,홍순조,최규보 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.9

거대아에 대한 임상적 고찰

김용필,노의선,김영석,조용,이진숙,고희주 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

1985년 1월 1일부터 1993년 7월 31일까지 만 8년 7개월동안 한림대학 춘천성심병원에서 입원 분만한 총 10,692에의 만삭분만 신생아중에서 4,000 g이상의 거대아를 대상으로 조사분석하여 다음과 같은 결론을 얻었다. 1. 거대아의 빈도는 체중 4,000 g이상에서 3.88%였고, 4,500 g이상에서는 0.45%였다. 2. 분만횟수별 거대아의 분포는 초산부가 51.08%(212예)를 차지하여 가장 많았으며 경산부는 48.92%(203예)를 차지하였다. 3. 거대아의 성별 비율 남아:여아는 178.5:100으로 남아가 더 많은 비율을 보였다. 4. 산모의 연령별 거대아의 분포는 25-29세군에서 가장 높은 분포를 보였으며 분만예정일을 지나서 분만한 경우는 65.06%를 차지하였다. 5. 임신주수별 거대아의 가장 많은 출생 빈도는 임신 40-41주에서 였다. 6. 제왕절개분만율은 47.95%였으며 제왕절개술의 가장 많은 적응증은 아두골반 불균형이었다. 7. 분만시 가장 빈번한 산모질환으로는 빈혈(26.02%)과 전자간증(3.12%)이었다. 8. 분만시 및 분만후의 가장 흔한 합병증은 산ㅎ출혈(3.61%)이었으며 모성사망은 없었다. 9. 산후 경구 당부하검사는 130예에서 행해졌는데 비정상치는 23예(17.96%)에서 보였다. 10. 신생아 합병증은 전체 415예중 12예(2.89%)에서 발생하였으며, severe depressed infants (Apgar score 0 to 3 at 1 minute)는 1.20%(5예)였으며 선천성기형은 1.20%(5예), 상완신경총마비가 0.4%(2예)이었다. 11. 주산기사망율은 0.24%(1예)이었으며 주산기 사망의 원인은 자궁내 태아사망이었다. Macrosomia predisposes the fetus to birth asphyxia and trauma. The result of such conditions, though seldom lethal, may lead to long-term sequelae. Among the total number of 10,692 full-term deliveries at our hospital between January 1,1985, and July 31, 1993, there were 415 study cases with a birth weight 4,000g or more. Their obstetric problems and neonetal outcome, maternal factors predisposing to macrosomia were studied and result obtained were summarized as follows. 1. The incidence of macrosomia weighting 4,000 g or more was 3.88% and that of macrosomia weighing 4,500 g or more was 0.45%. 2. There were 51.08% (212 cases) of primiparas and 48.92% (203 cases) of multiparas in parity distribution. 3. In the sex ratio of macrosomia, male was more common (male: female=178.5:100). 4. The highest age distribution of mother was found between 25 to 29 years of age. 5. The most frequent occurance of macrosomia by gestational age was at 40-41 weeks of pregnancy. 6. The cesarean section rate was 47.95% and the most common indication for cesarean section was cephalopelvic disportion. The cesarean section rate was 1.78 times high comparing with that of overall. 7. The frequent maternal diseases at the time of delivery were anemia (26.02%) and preeclampsia(3.12%) in oder. 8. The most common complication of intrapartum and postpartum period was postpartum bleeding (3.61%). There was no maternal death. 9. Postpartum oral glucose tolerance test was done in 130cases. Abnormal value was found in 23 cases (17.69%). 10. Noenatal complication occured in 12 macrosomic infants (2.89%) of the total of 415 babies. Severe depressed infants (Apgar score 1 to 3 at 1 minute) was 1.20% (5 cases), congenital anomaly was 1.20% (5 cases), brachial nerve palsy was 0.48%(2 cases). 11. The perinatal motrality rate was 0.24% (1 case). The cause of perinatal death was fetal death in utero.

임신중 자궁경부의 Glassy Cell Carcinoma 1 예

김용필,노의선,조용,이성원,박주진,윤창영 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

임신중 자궁경부암 진단과 병기 설정이 어렵고 태아와의 상관 관계로 치료 결정이 쉽지 않고 특히 Glassy cell carcinoma는 치료가 더 힘들고 예후도 좋지 않다. 저자들은 임신중 자궁경부의 Glassy cell carcinoma 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이며 젊은 연령에서도 자궁경부암의 가능성을 염두에 둠으로서 암의 조기진단 및 치료에 도움이 될 것으로 사료된다. Cervical cancer during pregnancy is rare and difficult to diagnose and treat. Accurate identification of the extent of cancer is more difficult during pregnancy because induration of the base of the broad ligaments, which in nonpregnant women characterizes tumor spread beyond the cervix, may be less prominent during pregnancy. If careful study of the cervix by cytology, colposcopy, and directed biopsy and occasionally by cone biopsy indicates that the disease is intraepithelial, the pregnancy may be allowed to go to term with normal vaginal delvery, and treatment deferred until the postpartum period. For more advanced cancer, the disease should be treated without regard to the pregnancy unless the pregnancy is 24 weeks or more. After 28-32 weeks, the baby can be delivered by classical cesarean section and treatment then instituted. Glassy cell carcinoma is a poorly differentiated carcinoma characterized by sheets of cells having 1) a moderate amount of cytoplasm with a ground-glass or granular appearance, 2) a distinct cytoplasmic membrane, and 3) a large nucleus containing prominent single or multiple nucleoli. Therapy is the same as for invasive squamous cell carcinoma and adenocarcinoma of the same stage, but the prognosis is not as good. We report a case of glassy cell carcinoma of the cervix during pregnancy.

양측 난관임신 1 예

권순욱,노의선,황성한,박재정,전동호 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.5

저자들은 최근 본병원 산부인과에서 양측 난관임신을 치험하였기에 문헌적 고찰과 함께 이를 보고하는 바이다. A case of bilateral tubal pregnancy which was experienced in our hospital recently, is presented with brief references.