Eisenmenger 증후군이 합병된 제 2, 3 삼분기 임신

강규현 ( Kue Hyun Kang ),김병재 ( Byoung Jae Kim ),손유경 ( Yoo Kyung Sohn ),이시은 ( Si Eun Lee ),김미경 ( Mi Kyung Kim ),심순섭 ( Soon Sup Shim ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보현 ( Bo Hyun Yoon ),신희철 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.4

골반경 근막하 자궁적출술의 임상적 효용성

강규현(Kue Hyun Kang),이우석(Woo Seok Lee),윤성준(Seong Jun Yoon),이상훈(Sang Hoon Lee),허민(Min Hur),배도환(Do Hwan Bae),박형무(Hyoung Moo Park),김동호(Dong Ho Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

N/A Objectives : Our purpose was to evaluate the efficacy of pelviscopic classic intrafascial supracervical hysterectomy (CISH) & compare it with total abdominal hysterectomy (TAH). Methods : We analyzed retrospectively, the clinical data of 1126 patients admitted from January 1993 to December 1998, at 11 university or general hospitals in Korea, for CISH group and 363 patients admitted from January 1993 to December 1998, at Chung-Ang university hospitals, Seoul, Korea, for TAH group. These patients were operated on with the indication of benign uterine disease without cervical malignant lesion. The patients with malignant cervical lesion were excluded in this study. Results : ① The average age of CISH group was 42.2 (range 24-63) years old and TAH group was 46 (range 31-54) years old. ② The mean operative time was 150.7±49.9 (mean±SD, range 55-395) minutes in CISH group and 133.8±35 (mean±SD, range 65-350) minutes in TAH group. The mean estimated blood loss was 206±183.6 (mean±SD, range 20-2000) ml in CISH group and 596±452.3 (mean±SD, range 100-6500) ml in TAH group. The mean hemoglobin change was 1.52±0.98 (mean±SD, range 0-7) g/dL in CISH group and 3.03±1.47 (mean±SD, range 0.2-8.4) g/dL in TAH group. The mean time in hospital was 6.3±1.43 (mean±SD, range 3-18) days in CISH group and 11.0±4.08 (mean±SD, range 7-37) days in TAH group. ③ Overall complications occured at 5.3% in CISH group and 9.1% in TAH group. ④ Pathologic findings of cervix were benign in 1121 patients (99.6%) and severe dysplasia or carcinoma in situ in 5 patients (0.4%) among CISH groups. In TAH groups, 351 patients (96.7%) had benign cervical lesion and 12 patients (3.3%) had more than moderate dysplasia or carcinoma in situ. In both groups, no invasive cervical cancer was found and the transformation zone of the cervix was included within the resection margin of the cervix in all cases. Conclusion : The pelviscopic CISH group has less operative blood loss, less postoperative hemoglobin change, shorter hospital stay and less operative complication than TAH group. Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery and coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we believe that pelviscopic CISH is preferred in cases of benign uterine diseases, because it lowers operative complications and it may have several benefits compared with total hysterectomy, especially, in women with no pathologic lesion of the cervix.

자궁경부 상피내 종양과 침윤성 편평상피암종에서 claudin-1, claudin-4, zonula occludens-1의 발현

이선경 ( Seon Kyoung Lee ),노현경 ( Hyun Kyung Rho ),박태양 ( Tai Yang Park ),강규현 ( Kue Hyun Kang ),조태일 ( Tae Il Cho ),이태진 ( Tae Jin Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.10

폐경기 호르몬 보충요법에서 골밀도 변화에 대한 골표지자의 예측능력

박형무(Hyoung Moo Park),김태철(Tae cheol Kim),강규현(Kue Hyun Kang),윤성준(Sung Jun Yoon),허민(Min Hur) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

목적: 폐경기 때 호르몬 보충 요법을 단독으로 사용한 경우와 비타민 D를 같이 복용한 경우, 단기간 (3개월)에 골표지자의 변화를 이용하여 장기간(1년)의 골밀도 변화를 예측가능한 지를 알아보고자 하였다. 연구 방법: 호르몬 보충요법만 사용한 41명과 활성 비타민 D인 칼시트리올(0.25ug/day)을 병합하여 사용한 23명, 총 64명의 자연 폐경된 환자를 대상으로 처음 내원시 혈중 osteocalcin과 요중 deoxypyridinoline, 그리고 요추부 골밀도를 측정하고 3개월 뒤 골표지자인 OC와 Dpd를 다시 측정하고 그리고 1년 뒤 요추부 골밀도를 다시 측정하여 단기간의 골표지자의 변화와 장기간의 골밀도의 변화 사이에 어떤 상관 관계와 연관성이 있는 지 알아보았다. 결과: 1.호르몬 보충 요법 후 3개월 뒤 혈중 OC와 Dpd는 각각 20.9%와 30.1%의 감소를 보였고 1년 뒤 골밀도는 3.8% 증가를 보였다. 2. 3개월 뒤에 측정한 요중 Dpd가 감소한 58명의 환자중 49명(84.5%)이 골밀도에서 증가를 보인 반면,혈중 OC가 감소한 49명 중에서는 40명(81.6%)이 골밀도의 증가를 보였다. 3. 골밀도가 증가한 그룹과 감소한 그룹간의 골표지자의 변화를 비교한 결과 증가한 그룹에서는 혈중 OC와 요중 Dpd가 18.1%, 32.6% 감소하였고 골밀도가 감소한 그룹에서는 9.2%,20.4% 감소하여 두 그룹간에 통계적으로 유의한 차이가 있게 골밀도가 증가한 그룹에서 더욱더 골표지자의 감소가 있었다. 4. 골밀도의 변화와 골표지자의 변화 사이에 상관관계는 혈중 OC가 r값 -0.174(p>0.05), 요중 Dpd가 r값 -0.091(p>0.05)로 의미 없게 나타났으나 반면,비타민 D를 투여하지 않은 호르몬 단독 요법을 사용한 경우에 요중 Dpd의 변화와 골밀도의 변화 사이에는 r값 -0.376(p<0.05)으로 역상관 관계를 보여주었다. 결론: 비타민 D를 투여하지 않은 호르몬 단독 요법을 한 경우에서만 요중 Dpd 변화와 골밀도 변화 사이에 어느 정도 역 상관관계를 보일 뿐 전반적으로 골표지자의 변화와 골밀도의 변화 사이에는 상관 관계가 없는 것으로 나타나 단기간의 골표지자의 변화로서 장기간의 골밀도의 변화를 미리 예측 할 수가 없었다. Objective: To estimate the long-term skeletal responses to hormone replacement therapy(HRT) with or without active vitamin D(VD) by using short-term changes of bone markers in postmenopausal women (PMW). Methods: Biochemical markers of bone formation(osteocalcin,OC) and (&) resorption(deoxypyridinoline, Dpd ) at 3 months & lumbar bone mineral density(BMD) at 1 year were measured in 64 natural PMW taking HRT(n=41) & HRT with calcitriol 0.25 μg/day(n=23). The correlation of percent changes of bone markers after 3 months of Tx with those in lumbar BMD after 1 year was evaluated. Results: 1. serum-OC & urine-Dpd showed decrease of 20.9% & 30.1% at 3months respectively & BMD increase of 3.8% after 1 year of Tx. 2. Among 58 PMW with decreased u-Dpd change, 49 (84.5%) revealed increase in BMD, while 40 (81.6%) among 49 PMW with decreased serum-OC change showed increased BMD. 3. Bone gainers showed significant decrease in changes of serum-OC(18.1% vs 9.2% p<0.05) & urine-Dpd(32.6% vs 20.4%, p<0.05) compared with those of bone losers. 4. No correlations of change of serum-OC (r=-0.174 p>0.05) & urine-Dpd (r=-0.091 p>0.05) at 3month with BMD changes at 1year were seen in total PMW, but urine-Dpd changes in HRT without active VD group revealed significantly inverse correlation(r=-0.376 p<0.05). Conclusion: Short-term changes of bone markers did not precisely predict the long-term changes of BMD in total PMW except urine- Dpd in HRT without active VD.

삼태아 임신의 주산기 결과

채수진 ( Soo Jin Chae ),유원정 ( Won Jeong Yoo ),강규현 ( Kue Hyun Kang ),김병재 ( Byoung Jae Kim ),이시은 ( Si Eun Lee ),손유경 ( Yoo Kyung Sohn ),심순섭 ( Soon Sup Shim ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.5

좌측 난관 임신 수술 후 진단된 겸한 임신 1례

이선경 ( Seon Kyoung Lee ),노현경 ( Hyon Kyung Rho ),강규현 ( Kue Hyun Kang ),지정석 ( Jung Suk Jee ),김상용 ( Sang Yong Kim ),조태일 ( Tae Il Joe ),윤귀옥 ( Gui Okh Yoon ) 대한주산의학회 2007 Perinatology Vol.18 No.3

Heterotopic pregnancy with coexistiong intrauterine and extrauterine pregnancy, is a rare event in natural pregnancy. However, in recent years, the increase in the incidence of pelvic inflammatory disease and use of assisted reproductive technology had led to an increase in the frequency of heterotopic pregnancy. When the diagnosis of heterotopic pregnancy is delayed, maternal mortality and morbidity may be increased, and unwanted loss of intrauterine pregnancy may occur. Therefore, the early diagnosis of heterotopic pregnancy is clinically important, and clinicians have to consider the possibility of heterotopic pregnancy and conduct careful and thorough evaluation if suspected. We experienced a case of heterotopic pregnancy in a woman in the absence of the known risk factors. She underwent underwent spontaneous abortion of intrauterine pregnancy at postoperative 4th day, after laparoscopic salpingectomy for left tubal pregnancy. We report this case with brief review of literature.

산전 초음파 검사를 이용한 거대아 및 견갑난산 예측의 유용성

윤성준,박형무,허민,임인석,강규현 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

목적 : 출생시 체중이 4,000gm이상인 신생아에 있어서 산전초음파 검사방법인 태아 상복부 횡단면(abdominal circumference, AC)을 통해 이를 예측하는 것이 가능한지를 조사하였으며, 거대아 분만과정에서 발생될 수 있는 견갑난산(shoulder dystocia)을 태아 상복부직경(abdominal diameter, AD)과 태아 두부 대횡경(biparietal diameter, BPD)의 차이를 통해 예측이 가능한지를 알아보고자 하였다. 연구대상 및 방법 : 1998년 3월부터 1999년 8월까지 중앙대학교 산부인과 산전관리 클리닉에 내원한 환자중 출생시 신생아의 체중이 4000gm이상이면서 분만 2주전에 산전 초음파를 시행하였던 거대아 산모 50명을 연구 대상군으로 하였으며, 대조군으로 신생아의 체중이 3100-3900gm이면서 분만 2주전에 산전 초음파를 시행하였던 산모 50명으로 하였다. 결과 : 자연분만으로 출산을 한 여성은 대조군은 41명이었고, 거대아군은 30명이었다. 자연분만중 견갑난산은 대조군은 41명중 1명에서, 거대아군은 30명중 7명에서 일어났다. 태아 상복부 횡단면의 초음파상 크기가 대조군은 35cm이상인 경우가 6명, 거대아군은 45명이었다. 거대아를 자연분만한 환자 30명중 태아 상복부직경과 두부 대횡경의 차이는 견갑난산이 합병된 경우는 평균 2.9 0.271cm, 견갑난산이 합병되지 않은 군은 평균 2.1 0.409cm였다. 태아 상복부 횡단면을 35cm를 기준으로 하였을때 거대아를 예측하는 민감도가 88.2%였고 특이도는 89.2%였으며, 견갑난산의 예측지표로 태아 상복부직경과 두부 대횡경의 차이를 2.6cm를 기준으로 하였을 때 민감도가 66.6%였고 특이도는 95.2%였다. 결론 : 태아 산전 초음파시 임신 삼분기의 태아 상복부 횡단면의 측정은 거대아를 선별하는데 유용한 척도가 될 수 있으며 견갑난산이 합병된 군의 태아 상복부직경과 두부대횡경의 차이는 합병되지 않은 군에 비해 2.6 cm을 기준으로 했을 때 통계학적으로 유의하게 컸다. Objective : To determine if birth weight greater than 4000gm can be predicted by ultrasound measurement of abdominal circumference(AC) and if shoulder dystocia in macrosomic infants can be predicted by ultrasound measurement of the difference between the abdominal diameter(AD) and biparietal diameter(BPD). Methods : A Retrospective study was performed of births occuring from March, 1998 to August, 1999 at department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University. Among neonates of birth weight greater than 4000 gm, 50 cases in that ultrasound examination was done within 2 weeks before delivery were selected for macrosomic group and 50 cases were selected for control group during the same period, among neonate of birth weight from 3100gm to 3900gm. Results : 1) Normal spontaneous vaginal delivery(NSVD) was 41 cases in control group and 30 cases in macrosomic group. Among NSVD, shoulder dystocia was 1 case in 41 cases of control group and was 7 cases in 30 cases of macrosomic group. 2) On ultrasound measurement, 6 cases had AC greater than 35 cm in control group and 45 cases in macrosomic group. Among 30 cases in NSVD was done in macrosomic group, difference between AD and BPD was 2.9 0.271 cm when shoulder dystocia was existed and was 2.1 0.409 cm when shoulder dystocia was not existed. Between the two groups, statistically significant difference was detected. 3) When AC(cutoff value of 35cm) was used for screening of macrosomia, sensitivity for macrosomia was 88.2% and specificity was 89.8% and when AD-BPD difference(cutoff value of 2.6cm) was used for prediction of shoulder dystocia, sensitivity for shoulder dystocia was 66.6% and specificity was 95.2%. Conclusion : In prenatal ultrasound measurement, AC measurement at third trimester of pregnancy will be a valuable indicator for macrosomia screening. The AD-BPD difference of shoulder dystocia group was greater than uncomplicated group in macrosomia and the AD-BPD difference cutoff value of 2.6cm was significant value statistically.