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곽세현 ( Se Hyoun Kwak ),박인양 ( In Yang Park ),위지선 ( Ji Sun We ),최미랑 ( Mi Rang Choi ),신종철 ( Jong Chul Shin ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.3
Medulloblastomas are rare neoplasms in adults. Medulloblastomas are treated by surgical removal of the tumor followed by radiotherapy. Because craniospinal irradiation can damage the hypothalamic-pituitary axis, uterus, and ovaries, and consequently result in infertility, the probability of pregnancy is quite low. We managed a patient who had undergone resection of a posterior fossa medulloblastoma and received craniospinal irradiation, who conceived spontaneously during follow-up. She was diagnosed with a recurrent medulloblastoma with metastasis to the spine accompanied by headaches and back pain at 26 weeks gestation. Conservative treatment measures were utilized in an effort to prolong the pregnancy. She was delivered by cesarean section due to recurrent seizure activity at 29 weeks plus 3 days gestation. The neonate made favorable progress and was discharged in good condition.
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최미랑 ( Mi Rang Choi ),곽세현 ( Se Hyoun Kwak ),천주영 ( Ju Young Cheun ),위지선 ( Ji Sun We ),이영 ( Yong Lee ),신종철 ( Jong Chul Shin ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.5
Unilateral pulmonary agenesis is uncommon congenital malformation which refers to total absence of pulmonary parenchyma and blood vessels as well as bronchia beyond the tracheal bifurcation. And, it is rarely to make prenatal diagnosis. Indirect prenatal sonographic findings in this malformation include mediastinal shift of the heart together with lack of evidence of diaphragmatic hernia. And more reliable diagnosis is obtained by Doppler sonographic finding with lack of branching of the pulmonary artery. Its prognosis depends largely on the presence of associated other congenital anomalies. But unilateral pulmonary agenesis does not result in the death of the infant and is compatible with long-term survival. So, selective termination is not recommended. In the case herein, right pulmonary agenesis of one fetus in a monochorionic twin pregnancy was diagnosed by prenatal sonography. We describe this case with a brief review of the literature.
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난관임신에서 치료방법에 따른 β-hCG의 수치변화의 비교
위지선 ( Ji Sun We ),곽세현 ( Se Hyoun Kwak ),정윤지 ( Youn Jee Chung ),최세경 ( Sae Kyung Choi ),최정수 ( Jeong Soo Choi ),안현영 ( Hyun Young Ahn ),박인양 ( In Yang Park ),신종철 ( Jong Chul Shin ) 대한주산의학회 2008 Perinatology Vol.19 No.2
목적: 난관임신의 치료에서 MTX 치료와 난관절제술에서의 혈청 β-hCG수치의 변화를 비교하여 MTX 치료의 효과를 확인하고, MTX 치료의 실패군과 성공군의 차이를 확인하여 MTX 치료의 선택기준의 결정에 도움이 되자 하였다. 방법: 2006년 1월부터 2007년 12월까지 난관임신으로 진단받은 후 강남성모병원 산부인과에 입원하여 치료를 받은 118명의 환자의 의무기록을 후향적으로 연구하였다. 결과: 총 118명의 환자 중 52명에서는 MTX요법을 시행하였고 66명은 나팔관절제술을 시행하였는데, MTX요법으로 치료를 받은 환자 중 33명은 MTX 요법만으로 치료가 종결 되었으나 19명은 수술적 처치가 필요하였다. MTX 요법의 성공군과 실패군에서 임신 일수는 차이가 없었으나, 초음파상 나팔관임신 부위의 혈종 크기와 혈복강의 양, 혈청 β-hCG 수치 등은 통계적으로 유의한 차이가 있었다(p<0.05). MTX 요법은 나팔관 절제술에 비해 치료 후 혈청 β-hCG의 감소의 비율이 적고 치료 초기에는 오히려 증가하는 양상을 보였으나 치료 후 7일 이후 급격히 감소하여 치료 후 28일에는 나팔관절제술과 같은 결과를 보였다. MTX 요법에서 치료 초기(~3일)의 혈청 β-hCG 변동 비율은 치료 실패 여부와 관련성이 유의하지 않았다. 결론: 나팔관임신 부위의 크기와 혈복강의 양 및 치료 전의(초기) 혈청 β-hCG수치는 MTX 치료의 성공 여부에 중요한 인자이다. 혈역학적으로 안정되어 있는 나팔관임신의 환자에서 특히 나팔관의 보존이 필요한 경우에 MTX 치료를 비교적 안전하고 효과적으로 사용해 볼 수 있겠다. Objective: The aims of this study were to evaluate the effect of the methotrexate (MTX) method by comparing the change of the serum β-hCG level between the MTX method and salpingectomy for treating tubal pregnancy, furthermore by analyzing differences between the MTX success group and the failure group, and to provide helps in establishing criteria for choosing the MTX method. Methods: Medical records of the 118 patients who were diagnosed with tubal pregnancy were reviewed retrospectively for the period of January 2006 to December 2007 at Kangnam St. Marys Hospital. Results: Between the MTX success group and the failure group, no difference was observed in pregnancy duration, but statistically significant differences were observed in the size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy in ultrasonography and in the serum β-hCG level (p<0.05). Compared with salpingectomy, the MTX method showed the patterns of a low decrease rate of serum β-hCG level after treatment and even its increase during the early period of treatment, but the serum β-hCG level decreased rapidly from Day 7 after treatment and became equal to that of salpingectomy on Day 28 after treatment. Conclusion: The size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy and the serum β-hCG level before treatment are important factors for success in the MTX method. The MTX method may be safe and effective relatively in hemodynamically stable tubal pregnancy patients, who need preserve the salpinx particularly.
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