자궁경부암과 동반된 자궁탈출증 2 례

허창규,조경일,박철현,최기숙 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.8

우리나라에서 최근까지 보고된 자궁탈출증 환자에서 발생한 자궁경부암의 예는 소수에 불과해서 이적은 예로서 발생빈도 통계나 진단상의 정확성에 대해 거론하는 것은 무리가 있는 것으로 생각되며, 자궁탈출증 환자에서 자궁경부암의 발생이 매우 희긔하다는 종래의 주장이 잘못된 것일수도 있음을 인지 하고 좀더 적극적인 관심과 검사 등을 통해 이를 진단할 수 있도록 더 많은 노력을 기울일 필요가 있다고 생각된다. The rarity of the cervical carcinoma combined with procidentia has been generally accepted because the prolapsed uterus was considered to have immunity against cervical carcinoma in the past. But if the patients with uterine prolapse were examined more carefully without general ignorance on the part of the physician regarding cervical carcinoma, more cases of cervical cancer would probalbly be discovered among those patients. Recently we experienced two cases of uterine prolapse combined with squamous cell caricinoma of the cervix and these cases are presented with a brief review of literature.

자궁외 임신의 MTX 복강경하 국소보존치료 및 전신적인 보존치료의 임상비교

허창규,이헌수,최기숙,심재화,류상철 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.5

1993년 6월부터 1994년 6월까지 대구 가톨릭대학병원 산부인과에서 진단된 자궁외임신 82명 의 환자중 비파열형 난관임신으로 확인된 31명의 환자를 대상으로 복강경을 통한 MTX 국소 주사 및 전신주사에 의한 보존요법실시 결과 각각의 성공률은 100%, 95.5%였으며 B-HCG 정상화기간은 국소요법에서 23일, 전신요법에서 26.2일로 비슷하였다. 국소요법군의 평균입 원 기간은 3일이었으며 두 그룹 모두에서 특별한 부작용은 없었다. Thirty-one cases of unruptured tubal pregnancies from June 1993 to June 1994 were treated with systemic and local laparoscopic MTX injection. Initial serum B-human chorionic gonadotropic level before treatment were 130-29800 mIU/ml (mean 3669.6+-6628.1) in systemic injection group and 769-12,700 mIU/ml(mean 4064.2+-4935.3) in local MTX injection group. No side effects were observed in both group. In one patients a laparotomy was performed because persisting abdominal pain and vaginal spotting. There were no differences in resolution time between local and systemic MTX treatment group (p$gt;0.1). The median resolution time were 12 to 45 days (mean 26.2+-8.89) and 15 to 31 days (mean 23+-5.78) in systemic and local MTX treatment, respectively. The successful rate were 100% in local MTX treatment and 95.5% in systemic MTX treatment .

복강내 출혈을 일으킨 초기 광인대 임신-2예

허창규 최신의학사 1991 最新醫學 Vol.34 No.11

복부 초음파로 산전진단된 선천성 공장폐색증 1 예

허창규,박정돈,고석봉,한경환,지청수,홍성연 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

저자들은 1997년 9월 1일 임신 29주 5일에 처음 내원한 이후 산전초음파상 진단된 선천성 장폐쇄증을 추적 관찰하고, 임신 37주 5일에 둔위태아로 인하여 제왕절개 분만한 이후 생후 1일에 장폐쇄로 인하여 수술을 시행하여 선천성 공장폐색증으로 진단된 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Congenital intestinal atresia is one of the common causes of intestinal obstruction in the neonatal period. It is a relatively rare lesion, occuring in one of 2,710 births and results in high mortality during the neonatal period, but the survival rate has risen rapidly with the early detection on the antenatal care, the introduction of modern surgical techniques and total parenteral nutrition. This reflects the importance of neonatal intensive care on the outcome of treating. A case of congenital jejunal atresia diagnosed by ultrasonography prenatally in Hyosung-Catholic university hospital at September 1997. We experienced a case of congenital jejunal atresia diagnosed by ultrasonography at 29 weeks gestational age.

형질세포성 백혈병으로부터 유래된 전이성 난소암 1 예

허창규,이헌수,박정돈,한만식,한재수,박영길 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

About 5∼6% of ovarian malignances are metastatic from other organs. But leukemic infiltration of the ovaries is uncommon and especially one from plasma cell leukemia is extremely rare. When leukemic infiltration of the ovaries occurs, the involvement is usually bilateral. Increased immature plasma cells in peripheral blood and plasma cell infiltration of bone marrow and other organs are major characteristics of plasma cell leukemia. Ovaries can be the apparent site of involvement of the abdominal or pelvic viscera with a leukemia; if this circumstance is found, a careful surgical exploration may be necessary. We experienced one case of metastatic ovarian cancer arising in plasma cell leukemia of bone marrow on a 37-year-old multiparous women who eventually had emergent laparotomy due to twisting and hemorrhage of tumor-infiltrated ovary during chemotherapy. She was performed total abdominal hysterectomy and bilateral salpingooophorectomy.

초기 정상임신과 계류유산의 혈청내 Estradiol, Testosterone , Free Testosterone 및 Percent Free Testosterone 치

허창규,황순구,이기원 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.5

초기 정상임신군과 계류유산군을 대상으로 혈청내 estradiol, testosterone, free testosterone, % free testosterone을 측정하여 비교, 관찰한 결과 다음과 같은 결과를 얻었다. 1. 정상임신군과 게류유산군간 estradiol 측정결과 정상임신군에서 유의한 증가를 관찰하였다(p$lt;0.001). 2. total testosterone, free testosterone, % free Testosterone 측정결과 계류 유산군에서 유의한 증가를 관찰하였다(p$lt;0.01). 3. 유산율과 estradiol, total testosterone, free testosterone, % free testosterone의 관계에서 estradiol과 % free testosterone이 가장 유용한 지표로 관찰되었고, estradiol이 높을 수록, % free testosterone이 감소할수록 유산율이 감소하였다. To determine value of clinical application of endocrine study for early detection of spontaneous abortion, a retrospective study was made in 50 cases of missed abortion and 61 cases of normla pregnancy as control group by measuring serum Estradiol, Testosterone, free Testosterone and percent free Testosterone in maternal serum. The results were as follows: 1. There were significant differences in serum Estradiol between normla pregnancies and missed abortions according to the gestational age(p$lt;0.001), and serum Testosterone, free Testosterone and percent free Testosterone were also significantly different between normal pregnancies and missed abortions(p$lt;0.001). 2. The lower the Estradiol level, the higher the rate of subsequent abortion and the higher the free Testosterone and % free Testosterone levels, the higher the rate of subsequent abortion. 3. Among Estradiol, total Testosterone, free Testostrone and % free Testosterone, estradiol was the most distinctly correlated marker in predicting abortion rate.

자궁의 내림프 기질성근증 1 례

허창규,김용진,박재복,박소정,박철현,이상희,심재화 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

최근 본원 산부인과에서 경험한 용종형태로 자란 자궁내막 기질성근증(endolymphatic stromal myosis) 1례를 문헌고찰과 함께 보고하는 바이다. Endometrial stromal sarcomas are rare tumors cumposed of cell closely resembling the stromal cell of proliferative atage of the endometirum. This tumor is classified into histologically low-grade stromal sarcoma, also known as endolymphati stromal myosis, and high grade stromal sarcoma by mitotic count. While the high grade stromal sarcoma has poor morbid clinical course, the endolymphatic stromal myosis usally follows an indolent course and have a low motality rate. We experienced a case of uterine endolymphatic stromal myosis occurred in 40 years old woman, which tumor had grown in polyp from lower uterine body and protruded on uterine cervix. The pronounced adenomyosis was associated.

경계성 수포성표피박리증 1 예

허창규,박정돈,김미숙,김상원,이기원,한만식,한재수 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

unctional epidermolysis bullosa(JEB) is a rare hereditary and mechanobullous disease characterized by blistering and erosions of the skin in response to even minor trauma. We report here in a case of JEB in a 1-day-old female newborn. She was delivered by cesarean section, with normal Apgar scores and body status. Bullous and erosive lesions had distributed on the extremities, hands and feet localized at the sites of pressure since birth, and, thereafter, tended to improve gradually, with no scars. The presented case seemed to be a recessive, benign type considering the absence of family history with dinstinctive histopathologic and electron microscopic findings.

난소낭성기형종에 관한 임상병리학적 연구

허창규(CK Huh),안정자(JJ Ahn) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.1

1975년 11월부터 1983년 10월까지 만 8년간 이화여자대학교 의과대학 부속병원 산부인과 에 입원하였던 환자중 수술후 병리조직학적 검사에서 난소 낭성 기형종으로 확인된 85예를 대상으로 연구 분석한 결과 다음과 같은 결론을 얻었다. 1. 전체 난소종양 381예중 낭성 기형종은 85예로 22.31%를 차지하였다. 2. 연령별분포는 20~29세군이 46예(54.12%)로 가장 많았으며 그 다음은 30~39세군으로 26예 (30.5%)였다. 분만회수별 분포를 보면 1회 경산부가 24예(28.24%)로 가장 많았고 그다음으로는 2회 경산 부로 22예(25.88%)였다. 3. 낭성 기형종이 양측성으로 발생한 경우는 17.65%(15예)였다. 낭성 기형종의 종양의 크기 는 평균 8.9cm로 직경이 5~9cm인 경우가 48예로 가장 많았고 그 다음이 직경 10~14cm로 33예였다. 4. 낭성 기형종의 증상으로는 하복부 동통 및 불편감이 48.24%(41예)로 가장 많았고, 그 다음 은 하복부에서 종양촉지로 34.12%(29예)였다. 질출혈 및 질분비물이 각각 10.59%(9예), 요통 이 9.41%(8예) 불임증이 7.06%(6예)였고 무증상인 경우도 18.82%(16예)나 있었다. 5. 낭성 기형종과 동반된 임신은 27.06%(23예)로 이중 자궁내임신은 20예, 난관임신에 3예였 다. 또한 자궁근종은 5예, 자궁선근종 및 골반내염증이 각각 4예에서 동반되었다. 그외 자 궁내막증, 자궁경부, 폴립, 난관수종등이 동반되었다. 6. 임신 초반기에 발견된 낭성 기형종 환자중 6예는 염전의 합병증이 있거나 원하지 않는 임 신으로 인공 임신중절과 동시에 기형종 제거수술을 행하였고 4예는 임신을 계속 유지시켰으 며 이중 2예는 만삭에 가서 제왕절개술로 분만하였고 2예는 사후추적이 불가능하였다. 임 신 중반기 초(제15주)에 발견된 낭성 기형종 환자중 1예는 불완전 유산이 되었고 다른 1예 는 조산이 되었으며 만삭임신시 제왕절개술시에 발견된 기형종이 8예 있었다. 7. 낭성 기형종이 자궁근종, 충수염 및 골반농양으로 오인되었던 경우는 12.94%(11예)였다. 낭성 기형종의 합병증은 21.18%(18예)로 이중 연결이 15예(17.65%)로 가장 많았고 파열 2예 (2.35%), 화농 1예(1.18%)가 있었다. 9. 낭성 기형종의 수술적 치료는 단측 난소 또는 난소난관적출술을 한 경우가 51예(60.0%)로 가장 많았고 단측 난소적출술 및 반대측 낭종 절제술을 10예(11.76%), 양측 난소난관적출술 을 4예(4.71%)에서 시행하였다. 제왕절개술과 함께 낭종절제술은 10예(11.76%)에서 시행하 였으며 자궁 적출술 및 양측 난소난관적출술을 6예(7.06%)에서 행하였다. Clinico-pathological study was made on a series of 85 ovarian cystic teratomas admitted, operated upon and confirmed with postoperative histopathological study at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital during a period of 8 years from November, 1975, to October, 1983. The results of this study are as follows: 1) The incidence of ovarian cystic teratomas was 22.31% of all ovarian tumors. 2) The largest number of cases was found in patients between the ages of 20 and 29 years (54.12%), and 30.59% of cases with cystic teratomas was distributed between the ages of 30 and 39 years. It was commonly distributed in parity 1(28. 24%) and parity. 2(25.88%). 3) 15 cases, 17.65% were involved bilaterally. The average cyst measured 8.9cm in diameter. The majority of the cystic teratomas fell into the range of 5 to 9 cm(48 cases) and 10 to 14 cm(33 cases) in diameter. 4) The most common clinical symptom was abdominal pain (48.24%), and the rest were palpable mass (34.12%), vaginal spotting or bleeding (10.59), vaginal discharge (10.59%), lumbago(9.41%), and infertility (7.06%) in the order. There was no symptom in 18.82% of patients with cystic teratoma. 5) Cystic teratomas associated with pregnancy (including tubal pregnancy) were noted in 27.06%. Lesions found in association with cystic teratomas were myoma of the uterus (5 cases), adenomyosis (4 cases), pelvic inflammatory disease (4 cases), endometriosis (1 case), cervical polyp (1 case) and hydrosalpinx (1 caes). 6) As the timing of diagnosis of ovarian cystic teratomas during pregnancy, 13 cases were diagnosed in the first trimester, 2 cases in the second trimester, and 8 cases at the time of cesarean section at term. Among 13 cases which were diagnosed in the first trimester, 6 cases ended in artificial abortion at the time of operation of cyst, 3 cases represented tubal pregnancy, while pregnancy in another 2 cases were failed follow-up. 2 cases found in 15 weeks of gestation had incomplete abortion and premature delivery respectively. 7) 12.94% (11 cases) which thought to be non ovarian lesions clinically (myoma, acute appendicitis, and pelvic abscess) were confirmed to ovarian cystic teratomas postoperatively. 8) There were 21.18% (18 cases) of complications of cystic teratomas. The most common complication was torsion (17.65%, 15 cases), and the others were rupture (2.35%, 2 cases), and suppuration (1.18%, 1 case). 9) Unilateral oophorectomy (including salpingo-oophorectomy) was the most common operation (60.0%, 51 case), which performed for removal of cystic teratomas. Unilateral oophorectomy (including salpingo-oophorectomy) and contralateral cystectomy was performed in 10 cases (11.76%) and bilateral salpingo-oophorectomy in 4 cases (4.71%). Cesarean section with oophorectomy was done in 10 cases (11.76%) and total abdominal hysterectomy with bilateral salpingo-oophorectomy in 6 cases (7.06%).

단안증 1 례

조석재,허창규,김용진,박재복,박소정,이상희,오훈규 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.5

저자들은 최근 선천성 태아기형중 극히 희귀한 기형인 단안증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 본 예에서 동반된 기형으로는 전전뇌증, 두개저부기형, 뇌하수체 발생부전, 심장의 난원공, 동맥관개존증, 양측 부신의 형성부전 등이었으며 염색체는 정상이었다. Cyclopia is a very rare fetal ocular anomaly and incompatible with life. Recently, we have experienced a case of cyclopia, diagnosed prenatally by ultrasound examination in a 25-year-old multiparous woman who presented in our OB out-patient clinic for a routine prenatal checkup. Our case seems belong to type Ii by Sarma classification which is characterized by cyclopia, holoprosencephaly, foramen ovale, patient ductus arteriosus and bilateral agenesis of adrenal glands. Chromosomal study revealed 46,XX,normal karyotype.