불임증 환자의 통계적 및 원인적 고찰

백원영(WY Paik),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

This study was presented of the 1,740 cases of infertile couple who visited and examined at the sterility clinic, the Department of Obstet. & Gynecol., Seoul National University Hospital from Sept., 1980 to May. l983, and an analysis was made of incidence, age distribution, the duration of infertility, and past medical history. The factors responsible for the infertility of 1,111 cases who completed sterility work-up were classified and discussed. The results were as follows: 1) The incidence of infertility was 7.9% of the total out-patients, and annual inci dence of infertility is increasing year by year. 2) The infertility was primary in 1,027, or 59% and secondary in 7l3, or 41%. S) The age group between 26 and 30 years of age comprised about one half of the totaal patients, and the mean age was 26.6 and 29.8 in primary and secondary infertility respectively. 4) The duration of infertility between 1 and 6 years comprised about three quar ters of the total patients, and the mean duration was 4.4 years. 5) The most common past medical history in primary infertility was tuberculous disease, and that in secondary infertility was history of previous laparotomy. 6) The major etiologic factors of infertility were male factor in 15.9%, tubal factor in 35.0%, ovulatory failure in 27.8%, uterine factor in 8.3%, cervical factor in 2.5%, peritoneal factor in 7.5%, and no demonstrable cause in 13.2%. 7) The types of male factor were azoospermia in 49.7%, oligospermia in 31.7%, 1ow motility in 17.5%, and impotence in 1.1%. 8) The types of ovulatory failure were ovarian failure in 3.6%, hypothalamo-pi tuitary failure in 2.9%, hypothalamo-pituitary dysfunction (including polycystic ovary syndrome) in 2l.7%, and hyperprolactinemia in 26.5%. 9) The types of uterine factor were endometrial tuberculosis in 34.8%, uterine synechia in 3l.5%. anomaly in 20.7%. myoma in 6.5%. and luteal phase defect in 6.5%, 10) The types of peritoneal factor were peIvic adhesion in 78% and endometriosis in 22%.

Dehydroepiandrosterone Sulfate의 자궁경부숙화효과에 관한 연구

백원영(WY Paik),김승욱(SW Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.12

In order to study the effect of dehydroepiandrosterone sulfate (DHEA-S) on cerv ical ripening, DHEA-S was given intravenously 3 times a week to 30 primiparous women at term with unfavorable cervical condition for delivery. AIso 30 primipa rous women were recruited to the control group. The condition of the uterine cervix was assessed by Bishops pelvic scoring. and the change in pelvic score was carefully recorded. The results of this study were as follows: l. There were no statistically significant differences in clinical characteristics such as maternal age, gestational weeks, and Bishop score before administration of DHEA-S. 2. The increase in Bishop score in primiparous women given DHEA-S was sipi ficantly greater than that in the control group on the 2nd, 7th. and l4th day after first injection (p<0.01). 3. The duration from the first injection of DHEA-S to deliyery was significantly shorter than that in the control group (p<0.01). 4. No significant changes were noted in laboratory findings between before and after injection of DHEA-S. 5. No significant differences in effect on neonates were observed betwreen DHEA-S treated group and the control group. 6. Side effects of any type were not obseryed in the mothers.

진공흡인에 의한 초기임신중절술에 있어서 전동식과 수동식흡인기의 효용차

백원영(WY Paik),이경희(KH Lee),김승욱(SW Kim) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.2

진공흡인에 의한 초기임신중절술에 있어서 전동식과 수동식흡인기의 효용차 Suction curettage has been shown to be an effective and safe method of performing induced abortion during the first trimester of pregnancy and the vacuum needed for the suction curettage will usually be provided by an electrically operated pump. Unfortunately electricity supply may not always be available in certain area and an alternative source of vacuum will be needed. This study was undertaken to compare the practicability and safety of using mechanical pump developed by the Battelle Foundation for the first trimester abortion and to compare the outcome with that of abortions performed by the conventional electrically operated pump. A total of 460 cases of first trimester pregnancy were recruited and randomly allocated to either the mechanical or electrically operated pump group. After performing abortion, the volume of aspirates, the duration of the procedure and the number of times the cannulae was introduced into the uterus were recorded and both the immediate and delayed complications were assessed. The mean duration of gestation was 8.6 weeks in the mechanical pump group and 8.7 weeks in the electrical pump group. The average duration of procedure from the start of dilatation was 6.1 minutes in the mechanical pump group and 5.6 minutes in the electrical pump group. The mean volume of aspirate in the mechanical pump group was 101.2ml and mean volume in the electrical pump group was 104.2ml. The incidence of complication in the mechanical pump group was 3.1% whereas the same in the electirical pump group was 3.5% and the nature of complication were similar in both groups. From the above findings, it is concluded that the mechenical pump is safe for use in performing first trimester abortion although it is not as convenient as the electrically operated pumps.

16-16 Dimethyl Trans Delta-2 Prostaglandin E1 Methyl Ester 질정의 초기임신중절효과에 관한 연구

김승욱(SW Kim),백원영(WY Paik) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 1982년 3월부터 6월까지 서울대학교병원 산부인과에 입원하여 PGE1D질정의 질내투여에 의한 초기임신중절술을 받았던 33예를 임상적으로 조사분석하여 다음과 같은 결과를 얻었다. 1) 년령은 22세에서 42세까지 였으며 25세에서 29세까지가 가장 많았다. 2) 경산회수는 2회가 가장 많았고, 임신주수는 6주에서 12주까지 였으며 6∼8주가 가장 많았다. 3) 투약후 진통유발까지의 평균소요시가은 2.35시간이었다. 4) 투약후 출혈발생까지의 평균소요시간은 3.87시간이었다. 5) 투약후 수태산물만출까지의 평균소요시간은 8.82시간이었다. 6) 투약후 자궁경관개대효과는 투여 3시간후 78.8%에서, 투여 6시간후 93.9%에서 자궁경관이 8mm이상었다. 7) 투약전과 2주후 혈액, 뇨, 간기능검사의 변화는 통계학적으로 유의한 차이가 없었다. 8) 부작용은 소화기계통의 증상이 현저하였으며 13예(39.4%), 구토 7예(21.2%), 또한 통증 4예(12.1%)였고 15예(45.5%)에서는 아무런 통증이 없었다. 9) 성공율은 87.9%로 이 중 완전유산이 78.8%로 26예, 불완전유산이 9.1%로 3예였다. Vaginal suppositories containing the 16-16 dimethyl trans delta-2 Prostaglandin E methyl ester were applied for the induction of abortion in early pregnancy. Thirty three patients were recruited to the study and 5 vaginal suppositories were inserted as high as possible into the posterior fornix of the vagina at intervals of 3 hours. The results were as follows 1. The mean interval between first insertion and onset of lower abdominal pain was 2.35 hours. 2. The mesn lnterval between first insertion and onset of uterine bleeding was 3.87 hours. 3. The mean lnterval between first insertion and expulsion of gestational product was 8.82 hours. 4. Cervical dilatation of 8mm or more was produced in 26 patients(78.8%) and 31 patients (93.9%) by 3 and 6 hours after first insertion respectively. 5. No significant changes were noted in laboratory findings beteen before and 2 weeks after treatment. 6. The most frequent side effect was gastrointestinal disturbance - vomiting in% and diarrhea in 39.4% of the patients. 7. Complete abortion was induced in 78.8% and incomplete abortion in 9.1% of the total patients.

미니랩 난관불임술 2,256례에 대한 임상적 고찰

이승재(SJ Lee),백원영(WY Paik),박재일(JI Park),김승욱(SW Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.10

Tubal sterilization is rapidly becoming one of the most important methods of family planning. Minilaparotomy is surgical entry into the lower abdominal cavity through a small transverse suprapubic incision for the purpose of tubal ligation. A clinical analysis has been made on 2,256 cases of minilaparotomy tubal sterilization which had been performed at the Dept. of Obstet. & Gynecol., Seoul National University Hospital from May 1976 to November 1982. The results were as follows: 1. The most common age group was 30 to 34 years of age and the mean age was 33.7. 2. Most of client had 2 or more living children and the mean parity was 2.7. 3. About two-thirds of the clients experienced 2 or more artificial abortions and the mean number of artificial abortion was 2.8. 4. The histories of previous laparatomy were in 1.2% but did not disturb the operative procedure. 5. Minilapatotomy tubal sterilizations were performed 4 years after delivery in about half of the clients. 6. Sterilization was performed at the time of abortion in about two thirds of the clients. 7. Most of procedures were successfully completed under the local anesthesia. 8. Most of procedures could be finished within 30 minutes and the mean operation time was 24.3 minutes. 9. Most of clients returned less than 6 hours after operation. 10. The operative complications were encountered i 1.7% but no intensive medical care were required for these complications. 11. The operative technical failure rate was 0.8% and the operative method failure rate was 0.04%. 12. Sterilization procedures were coincidentally performed with the salpingectomies(8 cases), ovarian cystectomies(7 cases), Adnexectomies(4 cases), parovarian cystectomies(4 cases), and biopsies(2 cases) through minilaparotomies. It is concluded that minilaparotomy tubal sterilization is simple, safe, acceptable, inexpensive, and widely applicable procedure for female sterilization.

사람난소에서 면역조직화확과 In Situ Hybridization을 이용한 GnRH와 GnRH mRNA의 동정

이종학,백원영,김승욱 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.7

사람 난소에서 GnRH가 국소적으로 존재 또는 합성되는가를 형태학적으로 확인하고 나아가서 GnRH 또는 GnRH mRNA가 난소내의 어느부위에 주로 분포하며 이들의 분포가 생식기에 따라 어떠한 차이가 있는지를 조사하기 위하여 난포기, 황체기,폐경이후 및 임신중의 사람난소를 대상으로 GnRH에 대한 면역조직화학과 GnRH mRNA 에 대한 in situ hybridization을 시행한 결과 다음과 같은 소견을 얻었다. 1. 과립막세포, 난포막세포,황체세포 및 간질세포 등에서 GnRH 와 mRNA가 동정되었다. 2. 난포에서 GnRH 및 GnRH mRNA의 양성반응은 주로 일부 성숙한 큰 난포에서 나타났다. 3. GnRH 및 GnRH mRNA의 양성반응의 부위와 빈도는 난포기, 황체기 및 임신시기 난소에서 유사하게 나타났으나 폐경이후위 난소에서는 거의 나타나지 않았다. 이상의 소견으로 볼 때 사람의 난소내에 국소적으로 GnRH 또는 GnRH와 유사한 물질이 생성되어 존재하며 난포-황체의 성숙 및 소실에 있어 부분비 (paracrine) 또는 자가분비(autocrine) 역활을 할 것으로 사료된다. Localization of the GnRH and mRNA were performed in the human ovaries by immunohistochemistry and in situ hybridization techniques. Ovaries in the various stages of reproductive period were obtained during the gynecologic surgery. These ovaries were fixed with 4% paraformaldehyde and embedded in OCT compound, and sectioned by cryostat. For immunohistochemical study, avidin-biotin peroxidase complex(ABC)method was employed and for in situ hybridization,35 Slabelled cDNA complementary to GnRH mRNA was used and followed by autoradiography. GnRH and its mRNA were localized in the granulosa cells, theca cells, luteal cells, and interstitial cells fo the human ovaries. In general, GnRH immunoreactivity and its mRNA signals were identified only in some of the large follicles of human ovaries The distribution or positive rate of GnRH immunoreactivity and its mRNA signals in the follicular phase seemed to be similiar to that in the luteal phase or pregnancy, but these were nearly absent in the postmenopasual ovaries.These results suggest that the local GnRH or GnRH-like substance might be synthesized in the rat and human ovaries and this may take a paracrine or atuocrine role in the follicular-luteal growth or lysis.

정상임산부 혈청 Alpha-Fetoprotein치의 동태에 관한 연구

이종학,김종화,백원영 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.1

1988년 6월부터 1989년 1월까지 경상대학교병원 산부인과에 내원한 정상임산부 71명을 대상으로 정상임산부 혈청 AFP치를 enzyme immunoassay방법으로 측정하여 다음과 같은 결과를 얻었다. 1. 임신 14주부터 임신 23주까지의 임산부혈청 AFP치는 서서히 증가하는 양상을 보였다. 2. 임신 24주부터 임신 30주까지는 임산부혈청 AFP치가 급격히 증가하였고, 임신 30주에 298ng/ml로 최고치를 나타내었다. 3. 임신 31주이후 41주까지는 임산부 혈청 AFP치가 서서히 감소하였고, 임신 42주이후 급격히 감소하는 양상을 보였다. Measurement of maternal serum alpha-fetoprotein level is accepted as an efficient way of detecting neural tube defect or certain other congenital anomalies of fetus. In order to detect such abnormalities we must establish the normal range of maternal serum alpha-fetoprotein level in Korea. Maternal serum alpha-fetoprotein levels were determine for 71 normal pregnant women with gestational age of 14 through 43 weeks by Enzyme Immunoassay (ELISA, Behring Enzygnost-AFP) from June 1988 to January 1989 at Gyeogsang National University Hospital. The results were obtained as follows: 1. MSAFP levels showed progressively increasing trend from 14 weeks gestation to 23 weeks gestation. 2. MSAFP levels showed rapidly increasing trend from 24 weeks gestation to 30 weeks gestation and the peak of MSAFP levels was at 30 weeks gestation. 3. MSAFP levels showed pregressively decreasing trend from 31 weeks gestation to 41 weeks gestation. 4. MSAFP levels showed rapidly decreasing trend from 42 weeks gestation to 43 weeks gestation.

난소갑상선종의 1 례

이종학,김종화,백원영,이순애,한성천,강태길,권성택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

Struma ovarii, an ovarian teratoma of which all or a large part is composed of thyroid tissue, is an uncommon tumor accounting for 2.7% of all ovarian teratomas. We reported a case of struma ovarii and review the literature concerning this tumor briefly.

흰쥐 뇌의 Brain Natriuretic Peptide 함유신경세포의 분포에 관한 연구

이종학,김종화,백원영,이순애 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12

Brain natriuretic peptide(BNP) is a recently discovered neuropeptide from porcine brain and is highly homologous to atrial natriuretic peptide. This study was carried out to localize the BNP containing neurons morphologically and investigate the distribution in rat brain. Colchicine injections were made into the lateral ventricle of brain, and rats were perfused with 4% paraformaldehyde-lysine periodate and brains were resected after 48 hours. By Immunohistochemical staining with Avidine-Biotin-Complex method, BNP containing neuronal cells showed strong immunoreactivity in situ. Mostly, BNP containing neurons were multipolar in shape and were localized at the areas of paraventricular nucleus, parabrachial nucleus, locus ceruleus, substantia nigra, nucleus of facial nerve, dorsal vagal nucleus, hypoglossal nucleus, raphe nucleus and nucleus ambiguus.

만성 신부전 산모의 만삭 제왕절개 분만 1 예

이종학,김종화,백원영,이성재,이순애,정영택,신정규 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

저자 등은 만성 신부전증으로 정기적인 혈액투석을 시행하고 임신기간중 양수과다증으로 인해 반복적 양수천자를 시행하였던 37세 산모에서 임신 37주 만에 2640 gm의 건강한 남아를 반복제왕절개술로 성공적인 분만을 한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Pregnancy is an unusual event in patient with chronic renal failure under going hemodialysis. When it occurs, spontaneous abortion, still birth, and neonatal death end 75% to 80% of the pregnancies. The mother is at risk for hypertension and abruptio placenta. The fetus is at risk for prematurity and growth retardation. Successful term pregnancy and cesarean delivery of a patient with chronic renal failure is presented.