흉막 자궁내막증 1 예

배덕수(DS Bae),조경훈(KH Cho),홍순기(SK Hong),이병익(BI Lee),김필수(PS Kim),이효표(HP Lee) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.8

저자들은 불임과 골반 자궁내막증경력을 갖고 있는 38세 여자환자에 있어서 호흡곤란을 가 져오게한 흉막의 자궁내막증을 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Endometriosis is a vexing problem, particularly for the patients in the third and fourth decades of life. The majority of lesions are limited to the pelvis but a variety of other sites have been involved, particularly the peritoneal surfaces of the adjacent bowel and regional lymphnodes . Extraabdominal endometriosis in uncommon. Pleural endometriosis appears to be the extension of a surface phenomenon by departation of the etilogic agent from the pelvic cavity. A case of pleural endometriosis is presented here in which the patients was previously identified as having pelvic endometriosis and infertility.

원발성 난관선암 1 예

이승희(SH Lee),김형선(HS Kim),김선우(SW Kim),장재빈(JB Jang),신미경(MK Shin),배덕수(DS Bae),신경재(KJ Shin),박신근(SK Park) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.8

저자들은 수술후 병리조직학적으로 확진된 원발성 난관선암 1예를 치험하였기에 문헌적 고 찰과 함께 보고하는 바이다. primary carcinoma of fallopian tube is the least common malignancy of the female genital tract. We experienced a patients who was admitted to our Ob and Gy. Dept under the impression of the hydrosalpinx and uterine myoma and confirmed pathologically primary carcinoma on the right fallopian tube after laparotomy. We present this case with a brief review of the concerned literatures.

자궁경부암 조직에서 표피성장인자 수용체 유전자의 증폭에 대한 연구

이효표,배덕수 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.4

표피성장인자 수용체 유전자의 자궁경부암의 발생에 관여하는 기전에 대해 알아보기 위해 정상 자궁경부조직 1개 및 자궁경부암 Ib기 및 Ⅱ기 조직 6개에 대하여 EcoRI, Hing Ⅲ, Pst I을 단독 또는 이중 절단(double digestion)을 시행한 후 표피성장인자 수용체 유전자의 합성 올리고뉴클레오티드(21mor)를 소식자로하여 dot blot 및 Southern hybridization을 시행한 결과 다음과 같은 결과를 얻었다. 1. 정상 자궁경부조직에 비하여 자궁경부암조직 6개 모두에서 표피성장인자 수용체 유전자의 3∼5배의 증폭을 관찰하였다. 2. 자궁경부암 조직 2개에서 EcoRI 및 Hing Ⅲ의 이중 절단을 시행한 결과 표피성장인자 수용체 유전자의 재배열의 가능성을 확인하였다. 그러나 재배열 여부를 더욱 정확히 알기 위해서는 정상대조군을 포함한 더 많은 예에서 연구가 이루어져야 할 것으로 생각된다. The recent studies show the similarity in structure and function between the human epidermal growth factor receptor (EGF receptor) and the avian erythroblastosis virus v-erb B protein. A potential role for EGF receptor in cellular transformation and tumorigenesis is suggested by serveral observations. To investigate the possibility that EGF receptor gene is amplified as a consequence of malignant transformation, we have determined the levels of EGF receptor gene in a malignant and normal cervix using dot and Southern hybridization method. The results were as follows. : 1. EGF receptor gene was amplifeid about 3∼5 fold in each cervical cancer compared to normal cervix. 2. Although preliminary, we noticed that EGF receptor gene was rearranged in cervical cancer when double digestion with EcoRI and Hind Ⅲ was performed.

완전 포상기태와 생존 태아의 쌍태아 임신에서 병합된 지속성 임신성 융모상피종양 1 예

이제호,박창수,배덕수,주인숙,황종대,이정원,유진경 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

본 예에서는 임신 18주에 완전 포상기태와 공존한 생존 태아로 된 쌍생아 임신에서 임신중에 중증의 임신성 고혈압 증세를 보였고, 임신중절 후 추적 관찰 중 지속성 임신성 융모상피종양이 발병하여 단일 약제 항암치료를(methotrexate with folinic acid) 시행한 경우로 그 진단 및 치료에 대한 간단한 문헌 고찰과 함께 보고하는 바이다. Twin pregnancy with a complete hydatidiform mole and a coexisting fetus is a rare occurrence with a reported incidence of 1:10,000 to 1:100,000 pregnancies. This condition has an aggressive postevacuation behavior; it is, therefore, important to differentiate these cases from partial hydatidiform mole that rarely require treatment for late sequelae. Usually this case is diagnosed prenatally by ultrasonography. Following evacuation, careful hCG monitoring is mandatory since it is the most reliable and sensitive method for the early detection of gestational trophoblastic tumor. In carefully selected patients in whom the risk of developing gestational trophoblastic tumor is significant or when the availability of hCG testing is suboptimal, chemoprophylaxis has been shown to decrease the risk of gestational trophoblastic tumor. We report here a case of patient, developed persistent gestational trophoblastic tumor associated with hydatidiform mole with coexisting live fetus, treated by single agent systemic chemotherapy.

Atypical Squamous Cells of Undetermined Significance 질적 분류의 임상적 의의에 대한 연구

이제호,박창수,배덕수,주인숙,황종대,노정수,송상용 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

본 연구진은 1996년 7월부터 1997년 6월까지 삼성서울병원에서 자궁경부 세포진검사를 실시하였던 13,389명의 환자 중 ASCUS로 진단되어 추적 관리된 환자를 대상으로 각각의 재검 소견 및 조직학적 소견 등을 분석하여 다음과 같은 결과를 얻었다. 1. 전체 13,389명 중 538예(4.02%)에서 ASCUS로 진단되었고 이들 중 추적 관리가 이루어진 환자는 362명(76.1%)이었다. 2. 362명의 ASCUS 환자의 질적 분류(qualifiers) 상 반응성 경과(favor reactive process)를 보인 경우가 278예(76.8%), 종양성 경과(favor SIL)를 보인 경우가 84예(23.2%)였다. 3. 362명의 ASCUS 추적 관리 결과를 보면 정상 및 반응성 경과가 291예(80.4%), LGSIL이 16예(4. 4%), HGSIL이 24예(6.7%), 침윤성 암이 16예(4.4%)로 나타났으며, 이 중에서 ASCUS 반응성 경과인 경우는 5.6%(15/268)만이 LGSIL 이상의 병변이었던 것에 비하여 ASCUS 종양성 경과의 경우는 51.9%(41/79) 가 LGSIL 이상의 병변으로 나타나 통계적으로 유의 하게 높은 빈도를 보였다(p<0.05). 4. 362명 중 231예에서 조직검사가 이루어졌는데 정상 및 반응성 경과가 181예(78.4%), LGSIL이 12예 (5.2%), HGSIL이 24예(10.3%), 침윤성 암이 14예(6.1 %)에서 확인되었으며 이 중에서 ASCUS 반응성 경 과인 경우는 7.1%(12/168)만이 LGSIL 이상의 병변이 었던 것에 비하여 ASCUS 종양성 경과의 경우는 60.3%(38/63)가 LGSIL 이상의 병변으로 나타나 통계 적으로 유의하게 높은 빈도를 보였다(p<0.05). 이상의 결과로 ASCUS 반응성 경과의 경우에는 2 ∼3개월 간격으로 반복 자궁경부 세포진검사를 실시 하며 ASCUS 종양성 경과의 경우에는 즉각적인 조 직생검을 실시하는 추적 관리 지침을 제시하는 바 우리 의료의 현실을 고려할 때 본 연구진이 제시한 ASCUS의 추적 관리 지침을 활용할 수 있을 것으로 사료된다. 향후 ASCUS의 질적 분류와 HPV DNA 검 색을 동시에 시행하는 연구가 시행된다면 보다 정확 한 추적 관리 지침을 마련하는 데 도움이 될 것으로 사료된다. Objectives: To define the clinical significance of qualifying the cytologic diagnosis of ASCUS in an effort to provide management guidelines. Study Design: A total of 362 women with a cytologic diagnosis of ASCUS favoring either a reactive process or squamous intraepithelial lesion (SIL) evaluated by repeated Pap smear, colposcopy-directed biopsy and/or cone biopsy was reviewed retrospectively. Results: Of the 268 patients who had a cervicovaginal cytologic diagnosis of ASCUS favoring reactive process, 253 (94.4%) had a repeated smear and/or cervical tissue biopsy that was normal. Fifteen (5.6%) of 268 patients had squamous intraepithelial lesion. Of the 79 patients who had a cervicovaginal cytologic diagnosis of ASCUS favoring SIL, 38 (48.1%) had a repeated smear and/or cervical tissue biopsy that was normal. Forty one (51.9%) of 79 patients had SIL or invasive cancer. Conclusion: This study showed that a cytologic diagnosis of ASCUS favoring reactive process was associated with a very low risk that the patient was harboring SIL. But the patient whose initial smear showed ASCUS favoring SIL was associated with a relatively high risk that the patient was harboring SIL (p<0.05). So the patient whose smear showed ASCUS favoring SIL requires further active management even in the presence of a normal repeated Pap smear.

임신성 고혈압질환과 안지오텐신전환효소 유전자의 유전적 다형성과의 연관성에 관한 연구

이제호,윤병구,배덕수,정재현,노정래,양순하,김덕경 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

Background: The angiotensin coverting enzyme(ACE) gene(encoding kininase II, EC 3.4.15.1) contains a polymorphism based on the presence(insertion [I]) or absence(deletion [D]) within an intron of a 287bp nonsense DNA domain, resulting in three genotypes(D/ I) and I/I homozygotes, and I/D heterozygotes). Alu insertion is associated with lower ACE level than deletion allele(D) and it was observed that D/D individuals have twice the ACE activity of I/I patients. Pregnancy induced hypertension(PIH) probably results from dominating pressor systems owing to loss of antagonizing vasodilator autacoids. Angiotensin II is an extremely potent arteriolar vasoconstrictor. Overactivity or failure to supress responsiveness to the increased activity of angiotensin II, which is generated by ACE, would seem to be a reasonable basis for the vasoconstriction of PIH. The aim of this study is to evaluate the relationship between ACE genotype and PIH. Methods: Blood sampling was taken from 39 patients with PIH. The hypertensive disorders, confirmed at postpartum follow up, were classified as gestational hypertension without proteinuria, preeclampsia(mild and severe) and eclampsia. The diagnosis of preeclampsia was made according to the American College of Obstetrics and Gynecology criteria of hypertension and proteinuria($gt;300 mg/24 hr urine). Genomic DNA was extracted from blood sample. After PCR amplification of the respective fragments from intron 16 of the ACE gene, size fractionation and visualization by electrophoresis were performed. Results: PIH group(including gestational hypertension, mild and severe preeclampsia : frequency of I allele 0.756 and D allele 0.244) had more I allele and less D allele when compared with normal population(frequency of I allele 0.609 and D allele 0.391)(p$lt;0.05). And PIH group had more I/I homozygote individuals showing significant distortion from Hardy-Weinberg equilibrium of ACE genotype(p$lt;0.05). Moreover, severe preeclampsia group alon(frequency of I allele 0.759 and D allele 0.241) had more I allele and less D allele when compared with normal population and had significantly more I/I homozygote individuals. Conclusion: As pregnancies with PIH had more ACE I allele and I/I homozygote individuals. PIH could be associated with I allele of the ACE gene. Considering the observed codominant association between the D-I polymorphism and plasma ACE activity, our result is in favor of the thesis that PIH primarily arises from defective synthsis of vasodilating autacoids and renin-angiotensin system exerts secondary vasoconstrictive action. However, the relationship between ACE genotype and defective vasodilating mechanism during pregnancy is unknown at present.

원발성 난관의 선암 1 례

김정구,신창재,김해석,노권일,배덕수 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.1

본 저자들은 1987년 2월 stage I의 원발성 나팔관 선암 1례를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. A case of primary fallopian tube adenocarcinoma was noted incidentally in a patient who was undergoing tuboplasty for her infertility. Diagnosis was made postoperatively on the basis of the postsurgical biopsy findings. Here we present the case with a brief history and review of the literature.