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중복자궁에 동반된 폐쇄 편측 질 및 동측 신장 무발생 증례 보고 6 예
주관영,배덕호,이영아,임정은,양광문,채난희,강옥림 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7
저자들은 일측 질폐쇄와 신장 무발생을 동반한 중복자궁 환자 6예를 경험하였기에 문헌적 고찰과 함께 보고 하는 바이며 사춘기 소녀에서 골반통이 있는 경우 항상 선천성 자궁기형에 대한 개념을 갖고 평가를 하는 것이 중요할 것으로 사료된다. Uterus didelphys is occasionally associated with obstructed hemivagina, and ipsilateral renal agenesis. The specific association was recognized as early as 1992. Since the report,these cases have been reported in the world literature. Medline search revealed, limited number of cases were reported. Early diagnosis is important, to preserve fertility, to prevent pelvic adhesion due to continued retrograde menstruation, hematometra, hematosalpinx and endometriosis which lead to genital organ injury. Common symptom triad with these patients is (1) dysmenorrhea that begins shortly after menarche, (2) increasing severity of dysmenorrhea with each subsequent period, and (3) a unilateral pelvic mass. Early diagnosis and prompt treatment are necessary to prevent genital tract injury, if patients complain above symptoms. The aims of treatment are relief of symptoms and reserve fertility. We report six cases of uterus didelphys associated with an obstructed hemivagina and ipsilateral renal agenesis with a brief review of concerned literatures.
문우남,서승우,주관영 대한골절학회 2001 대한골절학회지 Vol.14 No.1
Purpose: The objectives of this study are to observe the clinical characteristics and incidence of diastasis of symphysis pubis during vaginal delivery and to evaluate the risk factors of the lesion Methods and Materials: 16,000 vaginal delivery cases of our center from 1997 to 1999 were reviewed. The severe pain in symphysis pubis and walking difficulty after delivery were used as a diagnostic criterion. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed by t-test between diastasis group (n=55) and normal group (n=100). Results: Fifty-five diastasis of symphysis pubis were diagnosed out of 16,000 normal vaginal delivery cases during that period. The widening of the joint ranged from 4mm to 34mm. Sixteen cases accompanied vertical mobility. No factor was proved to increase the risk of the lesion. Initial body weight of infant had suggestive significance (P=0.051). Conclusion: We couldn't prove any risk factors that increased the risk of diastasis of symphysis pubis during vaginal delivery in this study. Further prospective studies with more cases would be needed to disclose the risk factors.
자궁내막증 환자에서 Microlaparoscopy를 이용한 Pain Mapping의 유용성
이경호,장영건,주관영,이인국 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.12
목적 : 자궁내막증환자의 진단에 microlaparoscopy를 이용하여 conscious pain mapping을 시행하고 자궁 내막증 병변중 어떤 유형의 병변이 가장 통증을 심하게 일으키는지 검사하였다. 연구방법 : 1999년 7월부터 12월까지 6개월간 삼성제일병원 산부인과에 만성골반통을 주소로 내원한 환자 18명을 대상으로 하였다. Fentanyl과 Midazolam으로 conscious sedation을 시행한후 2mm microlaparoscopy로 골반내를 시진한후 자궁내막증이 있는 각 부위를 촉진하고 환자에게 통증의 정도를 말하게하여 0에서 10까지 통증의 강도를 기록하였다. 결과 : 자궁내막증의 각 병변중 적색병변은 통증점수가 6.87±1.45, 백색병변은 6.54±1.68, 흑색병변은 5.41±2.38으로 적색병변이 통증이 가장 심하였다. 결론 : 자궁내막증의 병변은 적색, 백색, 흑색의 순으로 통증을 유발하므로 향후 수술적 치료시에 적색병변은 꼭 제거를 해 주어야하고, microlaparoscopy를 이용한 conscious pain mapping은 자궁내막증 환자에서 통증을 일으키는 부위를 정확하게 가려낼수 있어 진단 및 치료에 많은 도움을 줄 수 있다. Objective : This study was performed to determine which type of endometriosis lesions represent the most severe pain in conducting conscious pain mapping using microlaparoscopy. Methods : Eighteen women (28-45 years) from July to December 1999 with a history of chronic pelvic pain and clinical examination suggestive of endometriosis were enrolled. After intravenous injection of Fentanyl and Midazolam, 2㎜ microlaparoscope and probe were placed. Pain mapping was performed on each endometriosis lesion and pain score was obtained from the patients rating from 0 to 10. Results : Pain scores of each endometriosis lesion were red lesion 6.87±1.45, white lesion 6.54±1.68, black lesion 5.41±2.38, respectively. Conclusion : Of the endometriosis lesions that caused pain, red ones were associated with the most severe pain, followed by white and black lesions. Microlaparoscopy under local anesthesia with conscious sedation is effective for evaluating the type and location of pain provoking lesion in patients with endometriosis and will be helpful in making diagnosis and further surgical procedures.