한 농촌지역 부인들의 대하증에 관한 임상의학적 고찰

곽인평(IP Kwak),곽현모(HM Kwak) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.6

During the 6 months from January 1984 to June 1984, a clinical study on the vaginal discharges in women living in rural area was performed in 692 cases of the gynecological patients in outpatient clinic at Kang Wha Hospital. The results were as follows: 1. The causes of the vaginal discharges in 545 cases were, nonspecific vaginitis 36.5%, candida 23.5%, cervicitis 17.6%, trichomonas 9.2%, excessive but otherwise normal secretions 7.9%, and atrophic vaginitis 4.0%. 2. The prevalences of the vaginal discharges in different age groups were 74.8% in under 24, 74.5% in 25~34, 84.2% in 35~44, 90.0% in above 45. The prevalences of the nonspecific vaginitis and cervicitis were significantly more prevalent in women aged between 35 and 44. 3. The prevalences of the vaginal discharges in nonpregnant and pregnant status were 84.3% and 60.5% respectively. In nonpregnant status, nonspecific vaginits was most pervalent and during pregnancy, candida vaginitis was more prevalent than others. 4. The prevalences of the vaginal discharges in women with contraception and those without were 85.1% and 82.9% respectively. In barrier method, candida vaginitis was significantly more prevalent than others and cervicitis was significantly more prevalent than others in surgery method. 5. Vulvar itching the candida vaginitis (44.5%), foul odor in nonspecific vaginitis (19.6%), troublesome discharge in trichomonas and cervicitis (35.5%, 35.4%) were significantly more common than others. 6. Candida vaginitis in thick cheeze discharge (58.0%), nonspecific vaginitis in scanty creamy discharge (49.7), and nonspecific vaginitis in forthy discharge (55.0%) were significantly more common than others. In purulent discharge, nonspecific vaginitis and trichomonas vaginitis were significantly more prevalent than others. 7. There was a significant correlation between the vaginal pH and the casuse of the vaginal discharges. Nonspecific vaginitis was significantly prevalent in the pH value between 4.6 and 6.0, candida vaginitis in pH between 41 and 4.5, trichomonas vaginitis in pH between 5.1 and 6.0, atrophic vaginitis in pH above 6.0, atrophic vaginitis in pH above 6.0.

제왕절개술의 임상 및 통계학적 고찰

박금자(KZ Park),김재욱(JU Kim),곽인평(IP Kwak),윤태기(TK Yoon),노일병(IB Roh) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.11

1972년 1월1일부터 1980년 12월31일까지 만 8년간 연세대학교 의과대학 부속 세브란스병원 에서 입원하여 1000gm 이상의 태아를 분만한 16194예의 산모중 2875예의 제절예와 8쌍의 쌍태아를 포함한 2901예의 출산아를 대상으로 다음과 같은 결론을 얻었다. 1. 제절의 빈도는 19.1%였고 이중 일차제절은 13.5%였다. 2. 적응중은 아두골반불균형의 38.8%로 가장 많았다. 3. 수술합병증은 모성이환이 17.1%로 가장 많았으며 출혈 4.3% 그의 마취로 인한 경우, 기 타 합병증의 순이었다. 4. 선행제왕절개술시에 자궁반혼파열은 총 2875예의 제절환자중 23예였으며 자궁체부 중절 개술시 15.38%로서 자궁협부 횡절개술시 0.25%에 비해 상당히 높은 파열빈도를 보였다. 5. 제왕절개술시 자궁적출술을 병행하였던 경우는 총 2875예중 21예로 0.7%를 차지하였으며 그 원인은 자궁이완과 기왕자궁반흔파열이 대부분이었다. 6. 모성사망율은 0.2%였으며 주산기 사망률 은 35.2%였다. In recent years the use of cesarean section has increased remarkably, in large measure because of the widespread emphasis that is directed toward reconition of the impairment, acutual or suspected of fetal well-being as well as because of maternal complications. Fetal distress is diagnosed over three times more often than in previous studies as a result of improved methods of fetal heart monitoring and fetal scalp blood sampling. Moreover traumatic vaginal and forceps deliveries are no longer performed and the role of the vaginal delivery of the breech is being challenged. It is obvious that an absolute and relative increase in the primary cesarean section rate has occured for three indications, cephalopelvic disproportion fetal distress, and breech presentation. The availability of safe and adequat anethesia, whole blood and even anitibiotics may have been sighnificant factors in increasing the cesarean section rate. Much progress has been made in reducing cesarean section complications. However cesarean section can potentially represent a serious major operation with all of its risks in spite of such efforts. This retrospective study was carried out for the further prevention and reduction of complications. It was based on the clinical records of 2875 patients who had cesarean section and 2901 newborn babies, including 8 pairs of the twins, delivered at the Dept. of Ob and Gyn. Yonsei University College of Medicine, from Jan. 1 1972 to Dec 31. 1979. 1. overall incidence of cesarean section was 19.1% for the period . The primary sectiorate was 13.5%. 2. Among the indication for the cesarean section, cephalopelvic disproportion was the most prevalent. 3. Of the postoperative complications maternal morbidity was the most common (17.1%) and the others were hemorrhage (4.3%) and anesthesia problems. 4. Of 23 women who had rupture or dehiscence of the previous cesarean section scars, the rupture of the low flap incision was 0.2% in contrast to the classical incision 15.38%. 5. The incidence of cesarean hysterectomy was 0.7%. Among the indication uterine atony and previous uterine scar rupture or dehiscence were common. 6. Maternal mortality was 0.2% and the perinatal mortality rate 35.2 for 1000 births.

단일 기형아를 동반한 다태아 임신 1 례

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

저자들은 시험관아기 시술로 임신한 산모에서 선택적 유산술후 쌍태아 임신에서 발견된 단일 태아기형 1 례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. When complications arise in a multifetal gestation, management decisions can be very difficult for both parents and physicians because the fates of sibling fetuses are linked. The overall pregnancy outcome for a multifetal gestation appears to be worse when one of the fetuses has a congenital abnormality. The normal co-twin appears to have a higher risk of complications of prematurity because of the presence of an anomalous fetus. This information may affect parents` decisions about management options for the pregnancy. These options include expectant management, selective termination of the anomalous fetus, and termination of the entire pregnancy. We have experienced a case of multifetal pregnancy complicated by single anomalous fetus which was found after selective reduction. So we report this case with a brief review of literatures.

성반전 남성 1 예

이숙환,곽인평,윤태기,차광열,김현주,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 무정자증 환자에서 핵형검사상 46 , XX를 보인 성반전 남성 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. The incidence of XX male reversal is approximately 1 in 20,000 to 1 in 24,000 male births, a rare disorder. The affected individuals are non-ambiguous at birth with normal male phenotype. They have a 46,XX karyotype, are chromatin positive, and may also be H-Y antigen positive. This group of patients have been key in isolating the gene controling the formation of the testis. By restriction enzyme fragmentation of the X chromosomes and the use of DNA probes, it has been shown that the majority of the XX sex-reversed males contain fragment of DNA from the short arm of the Y chromosome in the distal end of the short arm of the X chromosome. These patients have exclusively testicular tissue and develop the wolffian system while the mullerian duct regress. The external genitalia are of nonambiguous male phenotype, very similar to Klinefelter`s syndrome, but there is a more frequent association with hypospadias and an average height below normal. The testes are small and firm but bilaterally descended. The penile length is normal or slightly shorter than normal, and these patients also develop gynecomastia and hyalinization of the seminiferous tubules at puberty with incomplete pubarche. Infertility occurs secondary to hypogonadism. We have experienced a case of sex-reversed male in azoospermic patient. So we report this case with a brief review of literatures.

비만불임여성에서 발견된 흑색극세포증 1 례

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

저자들은 비만 불임여성에서 경부후측에 생긴 흑색극세포증 1 례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acanthosis nigricans[AN] is a dermatopathy with a distinctive appearance that facilitates its diagnosis. Although an external condition, it is associated with a wide variety of less obvious internal conditions, either benign or malignant. Insulin resistance figures prominently in its benign associations and plays a primary role in its development. The development of acanthosis nigricans[AN] in malignant conditions remains to be explained. Acanthosis nigricans[AN] rarely requires treatment, although the underlying condition usually does. We have experienced a case of acanthosis nigricans[AN] in obese infertile woman. So we report this case with a brief review of literatures.

난자 공여에 의하여 성공적으로 임신한 46 , X , del(X)(q21) 순수생식선이상발생 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

저자들은 조기난소부전을 보인 46,X,del(X)(q21) 순수 생식선 이상발생(pure gonadal dysgenesis) 환자에서 난자공여에 의해 성공한 임신 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Gonadal dysgenesis represents a wide spectrum of clinical phenotypes, gonadal structures that include the presence of at least one streak gonad and a variety of X chromosome abnormalities and mosaicism. Turner`s syndrome is the best-known form of gonadal dysgenesis. The eponym should probably be restricted to those patients with the phenotype described by Turner: streak gonads or hypoplastic ovaries and an absent or abnormal X chromosome. Turner`s syndrome occurs in 1 in 3,000 live female births. Approximately 98% to 99% of pregnancies with Turner`s syndrome abort spontaneously and approximately 10% of fetuses from pregnancies that have spontaneously aborted have Turner`s syndrome. Pure gonadal dysgenesis is a term applied to a heterogenous group of disorders in phenotypic females with either XX or XY karyotypes, normal genitalia, normal mullerian duct development, bilateral streak gonads, absent or poorly developed secondary sexual development, and primary amenorrhea. In order to make an accurate diagnosis, the bilateral streak gonad must be verified histologically and karyotyping must be performed. We have experienced a case of 46,X,del(X)(q21) pure gonadal dysgenesis which has got pregnant by ovum donation. So we report this case with a brief review of literatures.

임신과 조기난소부전을 경험한 45 , X/47 , XXX 터너 증후군 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

저자들은 임신과 조기난소부전 병력이 있는 환자에서 핵형검사상 45,X/47,XXX의 터너 증후군을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Sex chromosome monosomy occurs as monosomy X or Turner syndrome (45,X). Monosomy X is prenatally lethal in most cases, occuring in many cytogenetically abnormal spontaneous abortions. The incidence of monosomy X does not appear to be associated with increased maternal age. It is usually the paternal sex chromosome that is absent, suggesting that nondisjunction in the spermatogonium may be the underlying mechanism in the majority of cases. Monosomy Y is never observed; presumably, the presence of at leats one X chromosome is required for early embryonic development. Females with one extra X chromosome (47,XXX) may be indistinguishable from those with a normal 46,XX karyotype, although decreased fertility and an increased risk for nondisjunction may lead to reproduction problems. Females with more than three X chromosomes (48,XXXX; 49,XXXXX) have an increased incidence of physical abnormalities that may be apparent at birth, and they exhibit varying degrees of mental retardation. We have experienced a case of Turner syndrome which has experienced pregnancy and premature ovarian failure. So we report this case with a brief review of literatures.

정자수정능력검사와 일반적인 체외수정과 정자직접주입법에서의 수정률과의 상관관계에 관한 연구

이재호,곽인평,윤태기,차광열,김현규,엄기붕,하정희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.3

본 연구는 정자의 기능검사와 체외수정[IVF]과 정자직접주입법[ICSI]의 수정률이 상관관계가 있는지를 알아보고자 실시하였다. 3가지의 다른 정자기능검사, 즉 morphology test, hypoosmotic swelling test[HOS], acridine orange[AO] test를 동일한 정액을 대상으로 실시하여 수치화 하였고, IVF와 ICSI를 실시한 후에 이 수치와 수정률과의 관계를 통계검정하였다. Morphology test 결과 정상정자 0∼4%와 5∼14% 범위의 IVF 결과는 각각 5.6%와 43.0%였고, ICSI의 경우는 각각 64.3%와 70.0%였다. IVF의 경우는, 정자의 형태에 따라 수정률이 많은 영향을 받는 것으로 판명되었으나 ICSI를 적용하면 정자 형태에 관계없이 높은 수정률을 얻을 수 있었다. HOS test를 실시한 결과로는 HOS 수치가 60 미만과 이상으로 구분할 때, 수정률은 각각 31.5%와 28.0%로서 낮았다. 동일한 HOS 수치에서 ICSI를 실시한 결과로는 각각 64.7%와 68.4%로서 ICSI를 실시했을 ㄸ의 수정률이 높았다. AO test 결과로는 60 미만과 이상으로 구분할 때, IVF는 23.1%와 29.9%의 낮은 수정률을 보인 반면에 ICSI를 실시했을 때는 69.9%와 67.4%의 높은 수정률을 얻을 수 있었다. 상기의 결과를 종합하면, 정자 형태와 HOS, AO의 검사수치는 상관관계 가 없었고, 정자형태와 IVF에서의 수정률은 상당히 높은 관련성을 보였으며, ICSI를 실시하면, 정자의 성상에 관계없이 높은 수정률을 얻을 수 있다고 사료된다. We compared the results of three different sperm function test ie., sperm morphology test, hypoosmotic test, acridine orange test and the fertilization rates of IVF and ICSI to evaluate whether the sperm tests correlate with the fertilization rates of IVF and ICSI. In normal sperm morphology 0∼4%, the fertilization rates of IVF and ICSI were 5.6%[3/54] and 64.3% [27/42], respectively. In normal sperm morphology 5∼14%, the fertilization rates of IVF and ICSI were 43.0%[40/93] and 70.0%[49/70], respectively. There was a significant difference in the IVF fertilization rates in normal morphology 0∼4% and 5∼14% groups, however no difference was found in the ICSI fertilization rates according to the morphology. In HOS test, the IVF fertilization rates in low and high HOS value were 31.5% and 28.0%, respectively, and no difference was found in the fertilization rates when ICSI was employed according to the HOS value. However, if we compare the IVF and ICSI fertilization rates, significant differences were found. In high[≥ 60%] and low[<60%] AO value groups, the IVF fertilization rates were generally low[23.1 and 29.9, respectively], but higher fertilization rates were achieved in ICSI groups[69.9 and 67.4%, respectively]. No difference was found in the fertilization rates of IVF and ICSI according to AO value, but significant differences were found if we compare the IVF and ICSI fertilization rates. Our results showed that only sperm morphology scoring could predict the IVF fertilization rate, and no sperm characteristics could affect the ICSI fertilization rate.

무정자증과 관련된 45 , X/46 , XY 혼합 생식선 이상발생 1 예

이숙환,곽인평,윤태기,차광열,김현주,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 무정자증 환자에서 핵형검사상 45 , X/46 , XY를 보인 혼합 생식선 이상 발생 ( mixed gonadal dysgenesis ) 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Gonadal dysgenesis traditionally has been based upon phenotypically classified syndromes in which one or both gonads become atretic or streaks. In chromosomally competent ovarian (or gonadal) failure (CCOF) the karyotypes are 46,XX or 46,XY with no cytogenetically demonstrable abnormalities. In chromosomally incompetent ovarian (or gonadal) failure (CIOF) cytogenetic abnormalities are present and include 45,X and mosaicisms (45,X/46,XX), partial deletionsof X (46,X, del[Xq], and ring X), structural abnormalities of X (46,X, i[Xq]) or Y with their mosaicisms, and mixed gonadal dysgenesis (45,X/46,XY). The gonadal phenotypes include bilateral streaks, a unilateral streak and a contralateral ovary or testis, and bilateral abdominal or scrotal testes. Somatic phenotypes range from patients with the classic Turner phenotype with short stature and sexual infantilism, though those with limited gonadal function resulting in partial or complete isosexual or heterosexual pubertal changes, to those with normal stature and sexual infantilism. We have experienced a case of mixed gonadal dysgenesis in male infertile patient with azoospermia. So we report this case with a brief review of literatures.

46 , X , t (X; 11) 을 동반한 이차성 무월경 환자에서의 조기난소부전 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Premature ovarian failure is a condition causing amenorrhea, hypoestrogenism, and elevated gonadotropins in women younger than 40 years. A karytype should be performed as part of basic laboratory evaluation for all patients with premature ovarian failure and prodromal premature ovarian failure. Although it has been suggested that the karyotype be omitted in patients who are either parous or older than 35 years, neither age nor parity rules out a chromosomal abnormality. We have experienced a case of premature ovarian failure in secondary amenorrheic patient showing chromosomal abnormality. So we report this case with a brief review of literatures.