자궁경부암 치료 후 재발양상과 종양표지자 SCC항원의 혈청 수치 변화의 상관관계에 관한 연구

최두호(Doo Ho Choi),김은석(Eun Seog Kim),남계현(Kae Hyun Nam) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.2

목 적 : 방사선치료를 시행한 자궁경부암 환자에서 혈중 SCC항원을 치료 전과 치료 후 추적기간 동안의 수치변화와 치료 결과의 상관관계를 조사하기 위하여 자료를 분석하였다. 대상 및 방법 : 순천향대학병원 방사선종양학과에서 방사선치료를 시행한 환자 중에서 1991∼1997년 사이에 혈중 SCC 검사를 치료 전 시행하였거나 추적관찰 중 시행한 181명의 환자를 대상으로 후향적 분석을 실시하였다. 여러 가지 통계 방법을 통하여 치료 전 농도와 무병생존기간, 예후인자 등을 비교하고 추적기간 중 수치 변화의 임상적의미를 조사하였 다. 결 과 : 혈중 SCC항원의 양성비율은 1.5ng/ml 기준으로 병기그룹에 따라 71∼91%, 2.5ng/ml 기준으로 57∼91%로 유의하 게 증가하였으며 각 그룹의 5년 무병생존율은 I B-ⅡA 79.2%, ⅡB 68.7%, Ⅲ 33.4%, Ⅳ 0% 였다. 그리고 5년 무병생존율 은 치료 전 항원농도가 5ng/ml 이상인 경우 34%로 1.5ng/ml 이하, 1.5∼5ng/ml의 55∼62% 보다 매우 낮았다. 항원 수치 추적검사 결과 임상증상보다 1∼13개월(평균 4.8개월) 재발을 빨리 발견할 수가 있었고 항원의 수치와 무병생존기간은 유의한 상관관계를 가졌고(r=-0.266) 다변량 분석상 치료전 SCC항원의 수치는 독립된 예후인자였다. 결 론 : 치료 전 혈중 SCC항원 농도는 편평상피 자궁경부암의 예후에 영향을 미치는 인자이며 치료 후 추적기간 중에 하 는 검사는 재발을 빨리 발견하는데 유용하다. Purpose : Serum squamous cell (SCC) antigen levels were examined in uterine cervix cancer undergoing radiation therapy, and authors analyzed the relationship between SCC antigen levels and treatment results. Materials and Methods : This is a retrospective st udy of 181 cervical carcinoma patients who received radiotherapy and examined serial serum SCC antigen from 1991 to 1997 at Soonchunhyang University Hospital. One hundred and eighteen patients underwent SCC antigen evaluation at diagnosis The relationship between the serum tumor marker level and disease free survival, recurrence pattern, and other prognostic factors were analyzed according to various statistical methods. Results : The positivity rate (initial serum value above 2.5 ng/ml) was increased with FIGO stage (IB-Ⅱ A 57% to IV 91%) and more discriminative than cutoff value of 1.5 ng/ml. Five year disease free survival rates for the stage IB-IIA, IIB, III and Ⅳ were 79.2%, 68.7%, 33.4% and 0%, respectively. The 5-year disease free survival rate for patients with serum SCC antigen levels above 5.0 ng/ml was 34% versus 55 ∼ 62% for patients with normal range (<1.5 ng/ml) or mildly elevated levels (1.5∼ 5.0 ng/ml). Rising SCC antigen levels preceded the clinical detection of disease by a mean of 4.8 months (range 1∼13 months). Negative linear corelation was observed between initial SCC antigen levels and relapse free survival (r= -0.226), and by multivariate analysis, initial SCC antigen level had a large impact on the relapse free survival. Conclusions : SCC antigen assay is a useful aid to predict the prognosis of squamous cell carcinoma of the uterine cervix and to detect recurrence.

초산모에서 경막외 L1-2 와 L3-4 차단 시 제통효과와 분만기간의 비교

강규식(Kyu Sik Kang),이상윤(Sang Yoon Lee),김정순(Jung Soon Kim),남계현(Kae Hyun Nam),박욱(Wook Park) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1

N/A Background: Usually, lumbar epidural block is performed on the L3-4 interspace. This study was designed to evaluate the analgesic efficacy and shortening of labor duration comparing the L-z and L3-4 interspace epidural blocks in nulliparous normal vaginal deliveries and then investigates side effects following the blocks. Methods: Eighty healthy nulliparous women were divided into two groups, L z (n = 40) and L3-4 (n = 40). Epidural blocks, lumbar epidural block were performed at the L z and L3-4 interspace with a catheter advancing 3 cm cephalad. The initial dose of 12 ml (0.167% bupivacaine, fentanyl 50㎍ and clonidine 75 ㎍) was injected epidurally at 4 cm dilatation of cervix and severe pain of labor. If a visual analogue scale (VAS) score was more than 4 points, an additional dose was administered cpidurally using the same volume as the above mentioned, but with the exception that the bupivacaine was diluted to 0.1 percentage. The maternal blood pressure, pulse rate, respiration rate and fetal heart rate were measured at 10 min intervals for the first 30 min, at 15 min interval for the next 30 min and at 30 min interval for the last one hour following the blocks. The duration of the first (active) and second stages of labor was counted and the neonatal Apgar score was recorded at one and five min after delivery. The degree of motor block, pruritus, nausea and vomiting were also noted. Results: The patients in group L1-2 had lower pain scores than group L3-4 at 5, 20, 30, 60 mins. The duration of 1st and 2nd labor stage in the L3-4 epidural block were 272 ± 33.5 min, 49.2 ± 27.4 min respectively but those in the L1-2 epidural block were 253.5 ± 32.5 min, 37.3 ± 22.3 min, respectively. Conclusions: We concluded the analgesic efficacy and shortening of labor duration in L1-2 epidural block was better than those in L3-4 epidural block. Maternal hemodynamic change, motor block. pruritus, nausea, vomiting and Apgar score showed no significant differences between the two groups.

산전 태아건강상태 평가에서 음진동자극검사의 유용성에 대한 연구

김희범 ( Hee Beom Kim ),이정재 ( Jeong Jae Lee ),김민관 ( Min Kwan Kim ),남계현 ( Kae Hyun Nam ),이순곤 ( Soon Gon Lee ),이권해 ( Kwon Hae Lee ),조태호 ( Tai Ho Cho ) 대한주산의학회 1993 大韓周産醫學會雜誌 Vol.4 No.4

Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

최두호(Doo Ho Choi),김은석(Eun Seog Kim),남계현(Kae Hyun Nam),허승재(Seung Jae Huh) 대한방사선종양학회 1996 Radiation Oncology Journal Vol.14 No.3

목적 : 상피내암, 초기 침윤성 자궁경부암, 또는 양성 질환으로 자궁적출술 받은 후 침윤성 자궁경부암으로 확인되어 방사선치료를 받은 환자의 치료 결과와 예후를 분석 하고자 하였다. 대상 및 방법 : 1985년 9월부터 1993년 12월까지 수술후 침윤성 자궁암으로 진단되어 방사선치료를 시행한 61명의 환자를 대상으로 후향적 분석을 시행하였다. 수술전 진단은 상피내암이 가장 많았으며 (38명), 초기 침윤성 자궁암 (10명), 자궁근종 (6명)등이었다. 대부분 수술후 2개월 이내에 방사선치료를 시행하였으며 3명은 추적검사중 재발암으로 확인되어 치료하였다. 8명은 강내치료만을, 47명은 외부 방사선치료만을, 그리고 6명은 강내치료와 외부 방사선치료를 같이 시행하였다. 결과 : 5년 생존율 및 무병 생존율은 각각 83.8%, 86.9% 였으며 수술 당시의 육안적 잔존병소가 있었던 경우는 38.4%로 매우 낮았다. 모두 8명의 치료실패가 있었으며 예후인자로는 후향적 병기, 잔존병소 유무, 병리조직유형이 있었다. 결론 : 조기 침윤성 자궁암은 부적절한 수술후에도 방사선치료로 효과가 좋으나 잔존병소가 있는 경우에는 예후가 불량하므로 좀 더 적극적인 치료가 필요하며, 무엇보다도 조기에 정확한 검진과 병기 결정을 시행하여 각 병기에 따른 적절한 치료가 필요하다. Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Materials and Methods : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcinoma in situ (38 cases), severe dysplasia (2), myoma (6), uterine bleeding (4), uterine prolapse (2). and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy from August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients received ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate werer 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cancer (stage IA) had no treatment related failure Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy Survivals for patients with gross disease remained after inappropriate hysterectomy was poor, So, early cancer detection and Proper management with precise pretreatment s1aging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.

Short Rib-Polydactyly Syndrome 1례

이권해 ( Kwon Hae Lee ),이길우 ( Gil Woo Lee ),남계현 ( Kae Hyun Nam ),조태호 ( Tae Ho Cho ) 대한주산의학회 1990 Perinatology Vol.1 No.1

Short rib-polydactyly syndrome(SRPS) are disorders distinguished by polydactyly, narrow thorax, and short limb dysplasia. Generally, three different types have been presented, byt some other variants have been reported subsequently. These rare lethal disorders considered to be inherited as autosomal recessive conditions. No case has been reported up to present in our national literature We recently experienced a case of short rib-polydactyly syndrome, so we present the case with a review of literature.

선천성 자궁기형 여성의 산과적 문제점에 관한 연구

이해혁(Hae Hyeog Lee),이정재(Jeong Jae Lee),남계현(Kae Hyun Nam),이임순(Im Soon Lee),이권해(Kwon Hae Lee),이효환(Hyo Hwan Lee),이석민(Seok Min Lee),정갑인(Kab In Jung),정한우(Han Woo Jung),신정옥(Jeong Ok Shin),구도형(Do Hyoung Koo) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: To evaluate the frequency and obstetric consequences of women with uterine anomalies and correlation between obstetric consequence and congenital uterine anomalies. Materials and Methods: A retrospective study was made on 65 patients with uterine anomalies in order to evaluate the obstetric consequence at department of obstetrics and gynecology, Soonchunhyang University Hospital from January 1994 to June 1997. The diagnosis of uterine anomalies was made with hysterosalpingogram or ultrasonogram, or at the time of cesarean section. The uterine anomalies were classified according to the classification of Buttram and Gibbons and compared the pregnancy outcome for each classification. The obstetric consequences were divided into preterm delivery, premature rupture of membranes, intrauterine growth restriction, and abnormal presentation of fetus. Statistical analysis was carried out using chi-square test, the significance was defined as P < 0.05. Results: 1. The incidence of uterine anomalies accounted for 1.04% (65/6,250 deliveries). 2. The most common uterine anomalies were class III (Uterine didelphys, 47.7%). 3. We noted preterm birth rate (16.9%), premature rupture of membranes rate (20%), intrauterine growth restriction rate (9.2%) in 65 patients. 4. The rate of breech presentation was 41.5% and the mean birth weight was 2,747 gram. 5. When uterine anormalies were present, the incidence of obstetric consequences was significantly increased. Conclusion: We concluded that congenital uterine anomalies were closely related to obstetric consequences, such as preterm, breech presentation, intrauterine growth retardation.

임신중기 모체 혈청 알파 태아 단백 , free β - hCG 를 이용한 산전선별검사 위양성과 주산기 예후에 관한 연구

채명관(Myung Kean Chae),이해혁(Hae Hyeog Lee),최승도(Seung Do Choi),이항재(Hang Jae Lee),이정재(Jeong Jae Lee),남계현(Kae Hyun Nam),이임순(Im Soon Lee),이권해(Kwon Hae Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: To determne whether abnormal results of doble saeening tests for Down syndrome with MSAFP and free B-hCG are associated with adverse pregnancy outcome. Methods: Between October 1994 and September 1997, 205 among 1731 who were screened had increased risk for Down screening program of CIS biointernational, Fetuses with Chromosomal abnormality or congenital anomalies and less than 35 years of maternal age were excluded from this study. Down syndrome screening test was performed between 14-22 weeks of gestation. Results: Of 1731 women, 205 (13.4%) had increased Down syndrome risk. The pregnancy outcome of women with increased Down syndrome risk were compared with those of women without such risk There were no significant difference in the incidence of preterm labor (6[2.9%] vs 112[7.3%)), premature rupture of the membranes (2[0.9%] vs 56[3.6%]), pregnancy induced hypertension (2[0.9%] vs 36[2.3%]), abruptio placentae (0[0%] vs 2[0.1%]), low birth weight (2[0.9%] vs 21[1.3%]), oligohydramnios (4[1.9%] vs 10[0.6%]), intrauterine fetal death (0[0%] vs 2[0.1%]). Conclusion: False positive results of Down syndrome screening test in the 2nd trimester do not appear to be associated with adverse pregnancy outcome. But there are statistically significant increases of adverse pregnancy outcome in wemen with elevation of MSAFP or elevation of free B-hCG.

복강임신 1례

남계현,전호용,이권해,조태호 순천향대학교 1992 논문집 Vol.15 No.2

Abdominal pregnancy is very rare and its early diagnosis is very difficult. It is classified as primary and secondary abdominal pregnancy and in the great majority of cases, it is secondary form. We have experienced a case of the abdominal pregnancy which was transvaginal ultrasonogram and treated immediately. The ectopic gestational sac and the fetal heart beat in it was detected clearly by transvaginal ultrasonogram using 5-MHz transvaginal probe. We present a case of abdominal pregnancy at 8 weeks of gestation with a brief review of the literatures.

난소암 선별진단 (Ovarian Cancer Screening)으로서 질식초음파의 가치 (I)

남계현,이권해 대한부인종양 콜포스코피학회 1993 Journal of Gynecologic Oncology Vol.4 No.1

Utrasonic evaluation has been suggested as a screening method for early ovarian cancer. This study was designed to evaluate the aceuracy of pelvic ultraesound to measure the ovarian volume as the preliminary study. The ovarian volume me ured. by ultrasound was compared with findings at. surgery. Subjects far this investigation were 25 menstruating patients and 12 climacteric patients who were scheduled for gynecologic surgery chiefly unrelated to adnexal masses. The mean nf ovarian volume with menstruating patients was 5.7±5.9cm3 and that of climacteric patients was 2.5±l.3cm3(P$lt;0.01). The eorrelation coefficient between the ovarian volurne measurement made by two examiners was 0.80. The correlation coeffieient between the ovarian volume measured by transvaginai ultrasonography and ovarian volume at laparotomy was 0. 37 and poor, The ll ovaries(52%) among the 24 ovaries of 12 climacteric tients were not visualized. So, this study suggested that the ovarian volume measurements af the postmenopauml women by transvaginal ultrasonograpy was not simple and demanded the skill and laboraus training.

인슐린 유사성장인자-I 및 인슐린 유사성장인자-I 수용체가 에토포사이드 유도 아포토시스 억제에 미치는 영향

남계현,조태호,이지은 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

The interaction of insulin-like growth factors(IGF) with the IGF-I receptor promotes cell proliferation and survival. The activation of the IGF-I receptor by its ligands IGF-I, IGF-II, and insulin plays critical role in growth and development. The specific role of the IGF-I receptor in development has been recently revealed that targeted disruption of the IGF-I receptor gene resulted in profound fetal growth retardation. Most cell types require IGF-I for growth in culture. In addition to its role in cell cycle progression. IGH-I promotes cell survival has not been clarified. IGF-I may directly prevent apoptosis. However, IGF-I could also promote cell culture survival by survival inducing the prokiferation of viable cells within a damaged cell population. When exposed to the etoposide, R+ cells that constitutively overexpressed the IGF-IR arrested in S phase and subsequently underwent apoptosis as determined by the appearance of the pre-G1 apoptotic peak when studied by the flowcytometry and the charateristic internucleosomal fragmentation of DNA. The addition of IGF-I markly inhibited etoposide-induced apoptosis in a concentration-dependant manner. IGF-I was less effective in preventing apoptosis in parental R-and TC4 cells. These results demonstrate an important role for the IGF-I receptor as an inhibitor of apoptosis, independent of its mitogenic actions. These findings establish the relationship between IGF-IR levels and the extents of apoptosis. The TC4 cells expressing the truncated IGF-I receptor with a 108-amino-acid C-terminal truncation exhibited a dramatically impared ability to prevent the apoptosis, indication that truncated IGF-I receptor lose the ability to prevent the apoptosis at the intramolecular level.