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양측 난관절제술 환자에서 체외수정 후 5회째의 자궁외임신으로 발생한 병합임신 1례
윤내영(Nae Young Youn),윤태기(Tae Ki Yoon) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9
Although a higher incidence of ectopic pregnancy has been reported after in vitro fertilization(IVF) and embryo transfer(ET), five ectopic pregnancies in one patient is very rare. We experienced a case of combined interstitial and intrauterine pregnancy as fifth ectopic pregnancies after in vitro fertilization and embryo transfer in one patient with history of bilateral salpingectomy due to previous four tubal pregnancies. Repeated transvaginal ultrasound examinations confirmed heterotopic pregnancy. In IVF-ET, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.
이광주,이명환,윤내영,Lee, Kwang-Ju,Lee, Myung-Hwan,Youn, Nae-Young 한국수의병리학회 1998 한국수의병리학회지 Vol.2 No.2
This study was performed to evaluate whether the loss or overexpression of Rb, and overexpression of p53 were prognostic indicators for bladder neoplasia, 52 tumor specimens from transitional cell carcinoma of the urinary bladder were from 42 male and 10 female patients whose age ranged from 30 to 83 years old(mean age; 63,5 years old), This group included 36 superficial and 16 invasive stage bladder tumors, and grades 16-25, p53 was significantly associated with tumor stage and grade(p<0,05 in each), but not with tumor recurrence. Loss of Rb gene expression or Rb overexpression was correlated with stage, but not grade. These results suggested that changes of Rb and p53 expression might play an important role in assessing the aggressiveness of human neoplasms.
이유미,조주연,윤내영 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6
목적: 임신 초기에 배아는 있지만 유지되지 못할 자궁 안 임신을 빨리 진단하여 수술함으로 부작용을 최소화하려는 것이다. 방법: 임신 초기에 경질초음파로 양막낭과 배아[embryo]가 보이면서 태아 심박동이 없는 산모를 대상으로 하였다. 배아 두둔 길이 5 mm 이하이면서 심박동이 없지만 태낭 크기나 다른 상황으로는 객관적으로 유산 진단을 내리기 어려운 54예[1군]는 전향적으로 추적 조사를 하였다. 배아 두둔 길이[CRL]가 6-7 mm 또는 태낭 크기가 임신 7주면 유산 가능성이 거의 100% 되는 것으로 설명하고 바로 수술을 하거나 1주일 더 기다리는 방법 중 선택하도록 하였으며 배아 두둔 길이[CRL] 8 mm 이상 또는 태낭 크기가 임신 8주 이상일 때 및 전에 한 초음파검사에서는 심박동이 있었다가 이번에는 없어져서 추적검사 없이 유산을 거의 확실히 또는 확실히 진단할 수 있을 때는 바로 수술을 권유하였다. 한 번 검사로 유산을 진단한 70예[2군] 중 55예는 바로 수술을 하고 15예는 산모가 더 기다리기를 원하여 추적검사를 하였다. 결과: 모두 124예의 산모를 대상으로 1군은 1일에서 3주까지 추적검사를 하였는데 5예는 기다리는 사이에 심한 출혈이 되어 4예는 불완전유산으로 응급소파수술을 하였고 1예는 완전유산으로 확인되었으며 나머지도 모두 추적검사에서 유산을 확인하였다. 2군에서 산모가 더 기다리기를 원하여 추적검사를 하기로 한 15예 중 2예는 기다리는 사이에 심한 출혈로 응급소파수술을 하였고 나머지는 재검사에서 모두 유산을 진단하였다. 결론: 자궁 안 임신에서 태낭 안에 양막낭이 보이고 배아가 있으면서 심박동이 없으면 더 기다릴 필요 없이 바로 수술을 하는 것이 좋을 것으로 여겨진다. Objective: To minimize the side effects of intrauterine pregnancy at an early stage of intrauterine pregnancy in which an embryo can not be maintained, by early diagnosis and prompt operation. Methods: Pregnant patients, who had conditions that amniotic sac and embryo were observed with transvaginal sonography, and embryo was not in fetal cardiac activities in early pregnancy, as subject. Follow-up study was carried out prospectively on about 54 cases[GroupⅠ] that were difficult to get diagnosis of abortion objectively with G-sac size and other conditions although CRL was 5mm or below and no cardiac activities. The patients were explained that the possibility of abortion was almost 100% if CRL was 6-7mm or G-sac size corresponded to being 7 weeks pregnant, and suggested that they should choose between immediate D&E or waiting one more week. When CRL was 8mm or more and G-sac size corresponded to being 8 weeks or more pregnant, or when it is certain of diagnosis the condition as spontaneous abortion without further follow-up study due to the fact that in previous transvaginal sonography, an embryo was in cardiac activities but presently not, immediate D&E was suggested. Among the 70 cases[GroupⅡ] that got diagnosis of abortion with only one examination, D&E was done on 55 cases immediately and follow-up study was carried out with 15 cases because pregnant patients wanted to wait more. Results: Out of all 124 cases of pregnant patients, follow-up study was carried out GroupⅠ from 1 day to 3 weeks and 5 cases had profuse vaginal bleeding. Out of this 5, 4 had emergency D&E for incomplete abortion and 1 had complete abortion. The rest of the patients were confirmed of abortion through follow-up study. In GroupⅡ, among 15 cases that we did follow-up study because the pregnant patients wanted to wait some more, 2 cases had profuse vaginal bleeding and operated emergency D&E, and all the rest were diagnosed to have an abortion by re-examination. Conclusion: In case of intrauterine pregnancy, if amniotic sac is observed in G-sac and there is an embryo that does not have cardiac activities, it seems to be better to proceed with D&E immediately without waiting.
반복적 시험관아기 배아이식 실패 환자에서 정맥내 면역글로블린요법
이숙환(Sook Hwan Lee),윤내영(Nae Young Youn),윤태기(Tae Ki Yoon),곽인평(In Pyung Kwak),이은정(Eun Jung Lee),최동희(Dong Hee Choi),한세열(Se Yul Han) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1
목적: 반복적인 시험관아기-배아이식 실패 환자에서 정맥내 면역글로블린의 효과를 보고자 하였다. 방법: 총 9예의 반복적인 배아이식 실패 환자에서 새로운 시험관아기 시술시 배아이식 직전에 정맥내면역글로블린을 500mg/kg 투여하였다. 결과: 단 1예에서 착상에 성공하였고, 1예는 화학적임신이었다. 시술중 정맥내면역글로블린의 특이한 부작용은 없었다. 결론: 정맥내면역글로블린요법은 반복적 배아이식 실패환자에서 유용한 방법으로 여겨지지 않으나, 향후 면역요법에 대한 지속적인 연구가 필요할 것으로 사료된다. Objective: The implantation failure after embryo-transfer (ET) is a major continuing problem in in vitro fertilization (IVF). This study was undertaken to determine the effectiveness of intravenous immunoglobulin for treatment of individuals experiencing repeated unexplained in vitro fertilization-embryo transfer (IVF-ET) failure. Methods: A total of nine consecutive infertile patients who failed to become pregnant after previous IVF-ET replacing at least three or more normal developed embryos each were included in our study. During the subsequent new IVF-ET cycle, each women received intravenous immunoglobulin 500㎎/㎏ before the embryo transfer. Results: Only one implantation occurred. There were no remarkable side effects. A specific effect of intravenous immunoglobulin for patients with repeated IVF-ET failure could not be demonstrated. Conclusion: High-dose intravenous immunoglobulin may not be useful for patients with repeated failure of embryo transfer.