포스타 : 부인종양학 ; ASCUS시 ThinPrep(TM) smear에서 Biomarker로서의 P16(INK4A)의 과발현

심일구,여소진,김태희,이해혁,남계현,이권해 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

쌍태임신중 일측태아 사망 5 예에 대한 임상적 고찰

신정옥,심일구,이항재,김희범 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1

Objective : Our purpose of this study was to evaluated the incidence of twin pregnancy with one fetal demise, predisposing factors and the maternal complications and perinatal outcomes. Patients : From January 1993 to December 1997, 5 twin pregnancy with single fetal demise after 28 weeks gestation by gestational age were observed in Soonchunhyang Kumi Hospital. Results : 1. The incidence of one fetal demise was 3.01% in twin pregnancy. 2. Maternal disseminated intravascular coagulation has not been demonstrated. 3. The predisposing factors of twin pregnancy with single fetal demise are umbilical cord torsion (40%), congenital anomaly(20%) and unknown(40%). 4. According to chorionicity, it seems that the perinatal mortality rate of monochorionic group was higher than dichorionic. Conclusion : This study suggests that monochorionic placentation is associated with increased risks of twin pregnancy with single fetal demise. But it may be partially explained due to small numbers of cases in this study.

포스타 : 일반부인과 ; 개복술의 기왕력이 있은 환자에서의 질식자궁적출술

여소진,김태희,심일구,이해혁,남계현,이권해 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

자궁경부종양에서 HPVDNAChip^(�) 및 Hybrid Capture Ⅱ^(TM)검사를 이용한 인유두종 바이러스의 검출

여소진,김달수,남계현,심일구,김태희,이해혁,이권해 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.2

목적 : 인유두종 바이러스는 자궁경부암의 의의있는 원인 인자이다. 이 연구의 목적은 HPVDNAChip??검사를 이용하여 정상, 전암병변, 침윤성 경부암의 인유두종 바이러스의 분포를 알아보고 그 결과를 Hybrid CaptureⅡ^(^(TM)) 검사와 비교하였다. 연구 방법 : 149명의 대상환자 중 57명은 병변이 없었고, 59명은 전암 병변이었으며, 33명은 침윤성 경부암이었다. HPVDNAChip??검사와 이 검사처럼 아형 66, 69를 제외한 고위험군(HPV-16/18/31/33/35/45/51/52/56/58/59/68) 인유두종 바이러스를 검사할 수 있는 Hybrid CaptureⅡ^(^(TM))검사를 이용하여 연구하였다. 결과 : 두 검사 모두 인유두종 바이러스를 검사하는 데 유용하였고, 결과가 의의있게 일치하였다(kappa value 0.721, p<0.01). Hybrid CaptureⅡ^(^(TM))검사에서 양성이나 HPVDNAChip??검사에서 음성인 경우는 18명(12.1%)으로 평균 Hybrid CaptureⅡ^(^(TM))값이 120.7±233.0 (mean±SD)이였고, 두 검사 모두 양성인 경우의 Hybrid CaptureⅡ^(^(TM))값은 448.1±732.8 (mean±SD)이였다. Hybrid CaptureⅡ^(^(TM))검사의 민감도는 94.6%이고, 특이도는 78.9%였고 HPVDNAChip??검사의 민감도는 83.7%이고, 특이도는 89.5%였다. HPVDNAChip??검사는 모두 15가지의 고위험군의 인유두종 바이러스 아형을 알아낼 수 있으며 아형 16이 전암병변(28.8%, 15/59)과 침윤성 경부암(48.5%, 19/33)에서 가장 흔한 아형이었으며 그 다음으로 흔한 아형은 58이었다. 결론 : HPVDNAChip??검사는 Hybrid CaptureⅡ^(^(TM))검사처럼 인유두종 바이러스 검사에 매우 민감하고 유용한 검사이다. HPVDNAChip??검사는 Hybrid CaptureⅡ^(^(TM))검사와 비교할 때, 인유두종 바이러스의 아형과 중복감염에 대한 정보를 준다. 앞으로 HPVDNAChip??검사의 자궁경부암의 선별검사로서의 가치에 대한 연구가 더 필요하다. Objective : Human Papillomavirus (HPV) is well known as one of the major risk HPVDNAChip?? factors for cervical cancer. The purpose of this study is to know HPV genotype distribution in women with normal cervix, precancerous lesion, and invasive cervical cancer by HPVDNAChip?? test. In addition, the result of HPVDNAChip?? test was compared with Hybrid CaptureⅡ^(TM) system for HPV detection. Methods : One hundred forty nine patients were included in this study. 57 women had normal cervix, 59 women had precancerous lesion, and 33 women had invasive cervical cancer. We tested them with two method for detection of Human Papillomavirus (HPV) by HPVDNAChip?? test and Hybrid CaptureⅡ^(TM) system. Hybrid CaptureⅡ^(TM) test can detect same high-risk HPVs (16/18/31/33/35/39/45/51/52/56/58/59/68) with HPVDNAChip?? test which can detect additional 66 & 69 high risk types of HPV. Results : Both methods for the detection of HPV were useful tests. The correlation between the results of two methods was very significant (kappa value 0.721 [p<0.01]). Positive Hybrid CaptureⅡ^(TM) test and negative HPVDNAChip?? test group were 18 women (12.1%) and average Hybrid CaptureⅡ^(TM) titer value of this group was 120.7±233.0 (mean±SD), positive Hybrid CaptureⅡ^(TM) test and positive HPVDNAChip?? test group were 84 women (54.4%) and average titer was 448.1±732.8. The Hybrid CaptureⅡ^(TM) test showed a sensitivity of 94.6% and a specificity of 78.9% and the HPVDNAChip?? test showed a sensitivity of 83.7% and a specificity of 89.5%. HPVDNAChip?? test detected total 14 genotype of HPV. HPV-16 was 28.8% (15/59) in precancerous lesion and 48.5% (19/33) in invasive cancer, most common in both groups. Next common type HPV-58 was 25.4% (12/59) in precancerous lesion and 9.1% (3/33) in invasive cancer. Conclusion : HPVDNAChip?? test is very sensitive and effective method for detection of Human Papillomavirus (HPV) infection as Hybrid CaptureⅡTMtest. In comparison with Hybrid CaptureⅡ^(TM) test, HPV genotype and multiple HPV infection information can be given by HPVDNAChip?? test. Further study will be needed to know the value of screening of cervical cancer by HPVDNAChip?? test in future.

ASCUS 시 ThinPrepTMsmear에서 biomarker로서의 p16INK4A의 과발현

여소진,이권해,남계현,심일구,김태희,김형문,조희정,권계연 대한부인종양학회 2005 Journal of Gynecologic Oncology Vol.16 No.2

Objective : The overexpression of p16INK4A is induced by human papillomavirus (HPV) and associated with the carcinogenesis of cervical epithelia. So, immunostaining of p16INK4A may be useful biomarker in detecting CIN of cervix uteri in abnormal cervical lesions. The potential of p16INK4A as a biomarker for Atypical squamous cells of undetermined significance (ASCUS) examined in liquid-based specimens. Methods : We collected samples 30 cases of ASCUS in ThinprepTM smears between March 2003 and August 2003. 23 control ThinprepTM cases were included; 10 negative for intraepithelial lesions, 13 cervical squamous intraepithelial lesions. p16INK4A immunochemial staining was performed on 53samples. At the same time, we tested another cervical swabs of patients by the Hybrid Capture ⅡTM test. The cut off value was scored positive if it contained above 5 abnormal cells with nuclear and cytoplasmic immunostaining. Results : The results of p16INK4A immunochemial staining comparing with one of HCⅡTM showed negative results with low kappa coefficient of 0.034. The sensitivity of p16INK4A immunochemial staining were 30.8% and the specificity were 82.4% respectively (p<0.01). p16INK4A is a useful marker for the detection of the cervical intraepithelial neoplasia but is not ASCUS. Conclusion : Immunostaining of p16INK4A is not useful triage test in detecting abnormal lesion of ASCUS in liquid-based specimens. 목적 : p16INK4A은 인유두종 바이러스 감염 시 과다 발현되어 자궁 경부 이형성증 및 암의 유용한 표지자로 대두되고 있다. ThinPrepTM 도말 검사를 시행한 환자 중 Atypical squamous cells of undetermined significance(이하 ASCUS)로 나온 환자에서 p16INK4A의 biomarker로서 유용성을 알아보기 위하여 연구했다. 연구 방법 : 2003년 3월부터 8월까지 ThinPrepTM 도말 검사를 시행한 환자 중 ASCUS로 나온 30명의 환자와 대조군으로 23명(Negative for intraepithelial lesion: 10명, low grade squamous intraepithelial lesions(이하 LSIL) 이상 나온 13명)의 환자를 포함 총 53명을 대상으로 하였다. ThinPrepTM 도말검사의 검체를 이용하여 p16 면역화학염색을 시행했고, 동시에 Hybrid CaptureⅡTM(이하 HCⅡ)검사를 하였다. 이 연구에서 양성은 최소한 5개 이상의 세포에서 핵과 세포질에 염색된 경우로 하였다. 결과 : ASCUS시 p16INK4A와 HCⅡ검사의 결과를 비교하니, kappa계수는 0.034이였다. p16INK4A의 민감도는 30.8%, 특이 도는 82.4%였다(p<0.01). p16INK4A염색 결과 저등급 병변 이상이 나온 도말 검사의 표본과 조직 검사에서는 유용한 표지자이나, ASCUS시 병변을 예측하는 데는 유용하지 않았다. 결론 : ThinPrepTM 도말 검사의 ASCUS 병변에서 p16INK4A면역염색검사는 이상 병변의 발견을 위한 추적 검사로 유용하지 않은 것으로 사료된다.

임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예

김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.

포스타 : 일반부인과 ; 초음파 유도하에 자궁내막 소파술로 치료된 자궁내막 골화생 1예

이동운,윤일영,김태희,심일구,이해혁,남계현,이권해,이임순,권계원 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

포스타 : 산과학 ; 부분 포상기태와 공존한 생존태아 1예

김윤숙,조인숙,김태희,심일구,이해혁,남계현,이권해,이임순,박성진,고은석 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

자궁경부암의 예후인자로서 DNA Ploidy와 Proliferating Cell Nuclear Antigen(PCNA)에 대한 연구

이해혁,남계현,이권해,심일구,진소영 대한부인종양 콜포스코피학회 1996 Journal of Gynecologic Oncology Vol.7 No.1

OBJECTIVE: The objective of this study were to clarify the significance of PCNA and DNA ploidy as a possible parameter of the prognosis in squamous cell carcinoma of the uterine cervix. STUDY DESIGN: Women with the diagnosis of cervical cancer operated between January 1987, and July 1991, composed the study group(n=35) in this case-control group. Among these 35 patients.In theese patients we chose the patients with complete follow up treatment. Also we employed 7 control paraffin-embedded cervical specimens without any specific pathologic lesions for the comparison. Immunohistochemical staining to identify PCNA was applied to case of paraffin section and PCNA indices was obtained. DNA analysis was done by using flow cytometry and S-phase fraction and DNA ploidy were obtained. RESULT: The results were summarized as follows. 1. S-phase fraction were 20±7% in cervical cancer and 16±11% in control group. There were no statistical difference. Aneuploid ratio were 26%(9/35) in cervical cancer and 0%(0/7) in control group. There were statistical difference. PCNA indices were 45±6% in cervical cancer and 5±4% in control group. There were statistical difference. 2. There were no stastistical difference in PCNA indices between large cell keratinizing type, and large cell nonkratinizing type of cervical cancer. 3. According to lymph node metastasis, there were no statistical difference in PCNA incices between positive group and negative group. 4. According to various pathologic parameters, recurrence rate was hihger in cases of parametrial involvement. 5. The correlation of coefficient was 0.747 between PCNA indices and S-phase fraction. that is a significant relationship. 6. According to recurrence, there were no statistical difference in S-phase fraction, aneuploidy and PCNA indices between group of recurrence and no recurrence. 7. There were no statistical difference between $lt;20%, group and $gt;20%, group of S-phase, aneuploid and $lt;60%, group and $gt;60%, group of PCNA index in view of recurrence rate. CONCLUSION : That is a significant relationship between S-phase fraction and PCNA indices. But, there are no statistical significance of PCNA indices, DNA ploid and a prognostic factor. So, that is a limitation in PCNA index DNA ploid when it was used as a prognostic parameter of uterine cervical cancer.

포스타 : 일반부인과 ; 임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예

김종민,김형문,김태희,심일구,이해혁,남계현,이권해,이임순 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-