Decreased endothelial progenitor cells in umbilical cord blood of preeclampsia

권자영 ( Ja Young Kwon ),( Yong Son Maeng ),( Young Guen Kwon ),( Yong Won Park ) 대한산부인과학회 2006 대한산부인과학회 학술대회 Vol.92 No.-

Nicotine suppresses soluble fms-Like tyrosine kinase- 1 (sFlt- 1) expression in trophoblasts via alpha 7 nicotinic acetylcholine receptor but not in human umbilical vein endothelial cells (HUVEC)

권자영 ( Ja Youmg Kwon ),( Young Han Kim ),( Muong Hwa Kang ),( Yong Sun Maeng ),( Young Guen Kwon ),( Yong Won Park ) 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

RANDOM URINE PROTEIN/CREATININE RATIO READILY PREDICTS PROTEINURIA IN PREECLAMPSIA

권자영 ( Ja Young Kwon ),( Jung Hwa Park ),( Dawn Chung ),( Hee Young Cho ),( Young Han Kim ),( Ga Hyun Son ),( Yong Won Park ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

Objective: To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. Methods: Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. Results: Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (≥300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. Conclusion: Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.

Placenta-derived fibroblastoid cells with multipotency

권자영 ( Ja Young Kwon ),( Jung Mi Yoon ),( Young Han Kim ),( Yong Won Park ) 대한산부인과학회 2006 대한산부인과학회 학술대회 Vol.92 No.-

삼음교 지압이 분만통증 및 자궁수축양상에 미치는 영향

권자영 ( Ja Young Kwon ),박용원 ( Yong Won Park ),김유리 ( Yu Ri Kim ),김덕원 ( Deok Won Kim ),안은희 ( Eun Hee Ahn ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.8

저산소증 상태에서 정상임신과 임신중독증 환자의 태반 조직 내 endothelin-1 (ET-1) 발현의 비교

박용원 ( Yong Won Park ),권자영 ( Ja Young Kwon ),김영한 ( Young Han Kim ),김유리 ( Yu Ri Kim ),임재학 ( Jae Hak Lim ),강명화 ( Muong Hwa Kang ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.9

목적: 본 연구는 explant villous culture model을 이용하여 저산소증 상태에서의 정상 임신과 임신중독증 산모의 태반조직내의 ET-1 발현을 비교하고자 하였다. 연구 방법: 정상 산모 (n=5)와 임신중독증 산모 (n=4)로부터 얻은 태반으로부터 융모절편을 저산소 배양기에서 배양하거나 배양액에 deferoxamine (DFO)을 처리하였다. 융모절편 내 ET-1 mRNA 발현은 저산소 배양기에서 배양한 경우 0, 24, 48시간째, DFO를 사용한 경우 약물 투여 0, 2, 4, 6시간째 RT-PCR을 이용하여 측정하였다. 배양액 내 ET-1 단백 농도 측정은 enzyme immunoassay 방법을 이용하였다. 결과: 저산소 배양기에서 배양된 융모절편의 경우 두 군 모두에서 융모절편내 ET-1 유전자 발현과 배양액 내 ET-1 단백이 증가되었는데 (p<0.05), 증가 정도가 정상 산모에 비해 임신중독증 산모에서 더 큰 양상을 보였다. DFO로 처리하였을 때 ET-1 mRNA 발현은 두 군 모두에서 시간에 따라 증가되었다. DFO 투여 2, 4, 6시간째의 배양액 내 ET-1 단백 농도는 질환군에서 유의하게 높았으며 (p<0.05), DFO 투여 후 2시간까지, 2시간에서 4시간까지의 ET-1 단백의 증가의 폭이 질환군에서 유의하게 높았다. (p<0.05). 결론: 저산소 상태에서 ET-1 mRNA의 발현 및 단백 생산은 정상에 비해 임신 중독증 산모의 융모절편에서 더 증가되었을 뿐 아니라 저산소증에 대한 ET-1의 생산이 항진되어 있어, 이러한 항진성이 임신중독증 태반 내 ET-1 과발현에 기여할 가능성이 있을 것으로 보이며 이에 대한 추가 연구가 필요할 것으로 생각된다. Objective: To evaluate endothelin-1 (ET-1) expression in the villous explants from normal and preeclamptic (PE) placentae under hypoxic condition. Methods: Villous explants from normal (n=5) and PE (n=4) placentae were obtained. To obtain hypoxic culture condition, villous explants were cultured in hypoxic chamber or treated with deferoxamine (DFO). ET-1 mRNA expressions in villous explants were evaluated by RT-PCR following 0, 24, and 48 h of culture in hypoxic chamber, and 0, 2, 4, 6 h following DFO treatment. ET-1 protein levels in media were measured by enzyme immunoassay. Results: After 24 and 48 hours of incubation of villous explants from normal and PE placentae in hypoxic chamber, ET-1 mRNA and protein levels were increased in both groups, however, ET-1 production seemed to be more exaggerated in the villous explants from PE placentae. During 6 h of DFO exposure, ET-1 mRNA level was increased in the villous explants from PE placenta comparing to those from normal placentae (p<0.05). Interestingly, the increase of ET-1 mRNA expression in the villous explants from PE placentae was more exaggerated than those from normal placentae. Concordantly, increments of protein level between 0 to 2 h and 2 to 4 h were significantly higher in villous explants from PE placentae (p<0.05). Conclusion: ET-1 mRNA and protein were increased in villous explants from PE placentae compared to those from normal placentae under hypoxic condition. Furthermore, villous explants from PE placentae showed upregulated ET-1 expression upon hypoxic stimulation. This enhanced sensitivity to hypoxia may contribute to ET-1 overexpression in PE placenta in vivo and it needs further investigation for clarification.

자궁경부 상피내암 환자의 처치로써 질확대경 조준하 자궁경부 원추형 생검술 및 자궁 내구 소파술

정용욱 ( Jeong Yong Ug ),조정미 ( Jo Jeong Mi ),권자영 ( Kwon Ja Yeong ),김성훈 ( Kim Seong Hun ),박찬규 ( Park Chan Gyu ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.5

목적 : 본 연구는 자궁경부 상피내암 환자에서 원추형 생검술 후 자궁적출술 시 잔류 상피내종양과 관련된 예측인자와 질확대경 조준하 자궁경부 원추형 생검술 및 자궁내구 소파술로 종래에 시행되었던 근막외자궁적출술을 대체할 수 있는지를 조사하였다. 연구 방법 : 1997년 1월부터 2001년 12월까지 연세대학교 의과대학 부속 신촌세브란스병원에 내원하여 질확대경 조준하 자궁경부 원추형 생검술을 시행받고 자궁경부 상피내암은 진단 받은 환자들 중 추적 관찰이 가능한 169명을 대상으로 하여 근막외자궁적출술을 시행받은 환자군과 추적 관찰만을 받은 환자군으로 나누어 환자 특징, 조직 검사 결과 및 추적 관찰 결과를 조사, 비교하였다. 추적 관찰을 위해 경부 세포진 검사, 골반내진, 환자의 증상 및 이학적 소견에 따른 자궁경부 착공생검을 시행하였다. 통계 분석은 student t-test, χ^2 test, logistic regression analysis 등을 사용하였다. 결과 : 총 169예 중 근막외자궁적출술을 시행받은 군 (87명)과 추적 관찰만을 받은 군 (82명) 간의 특성에서는 추적 관찰기간과 원추형 생검술 적출물 절제연의 잔류 상피내종양 유무만이 통계학적으로 유의한 차이가 있었다. 근막외자궁적출술을 시행 받은 환자 중 자궁경부 원추형 생검술 절제연에 잔료 상피내종양 소견을 보인 환자는 28예였고 이들 중 근막외자궁적출술 적출물에서 잔류 상피내종양 소견을 보인 경우는 총 12예(20.7%)였다. 근막외자궁적출술 적출물의 잔류 상피내종양 유무에 따라 두 군으로 나누어 비교한 결과 원추형 생검술 자궁내구 절제연의 잔류 상피내종양 유무에 차이가 있었다. 추적 관찰기간 동안 비정상 세포진 소견을 보인 경우는 추적 관찰만을 시행한 군에서만 10예가 있었으나 이는 자궁경부 착공 생검 결과 2예의 경증 자궁 경부 상피내종양과 8예의 만성 자궁경부염이었다. 또한 추적 관찰하던 군 중 1예는 외음부 중증 상피내종양을 진단받았다. 결론 : 자궁경부 상피내암에서 원추형 생검술 내구절제연의 잔류 상피내종양 유무가 근막외자궁적출술적출물의 잔류 상피내종양의 예측 인자가 되며, 자궁을 보존해야 하는 환자에서 자궁경부 원추형 생검술 절제연의 잔류 상피내종양 유무와 관계없이 추적 관찰한 군과 근막외자궁적출술을 시행받은 군 간에는 예후에 차이가 없었다. Objective : The goal of this study was to evaluate the prognostic factors in relation with residual cervical intraepithelial neoplasia (CIN) in hysterectomized specimen of the patients diagnosed as carcinoma in situ of the uterine cervix (CIS) and underwent cone knife biopsies first. Also we investigated if colposcopically directed wide cone knife biospsy with endocervical curettage followed by electrocauterization could substitute for traditional hysterectomy as a conservative management of CIS. Methods : Data were collected retropectively from 169 patients who were diagnosed as CIS after colposcopy directed conization in Yonsei University Hospital from Jan 1997 to Dec 2001. The patients were divided into two groups, those who underwent colposcopically directed cone biopsy only (Group A) and those who received colposcopically directed cone biopsy and extrafascial abdominal hysterectomy (Group B). Pap smear, pelvic examination and punch biopsy of the uterine cervix according to symptoms and physical findings of the patients were performed for follow-up. Patient characteristics, histologic results and follow-up outcomes were compared using student t-test, χ^2 test, and logistic regression analysis. Results : Among 169 patients, 82 (study group) received no further treatment while 87 (control group) were hysterectomized. 58 of control group showed residual CIN in colposcopically directed cone biopsy and 12 from these patients, residual CIN were found in hysterectomized specimen. Positive endocervical margin on conization was found as a significant predictor for residual disease after conization. abnormal Pap smear results were reported in 10 patients of study group only, of whom 2 cases of CIN Ⅰ, 8 cases cervicitis. conclusion : The residual CIN in endocervical margin can predict whether hysterectomized specimen might contain residual CIN and no difference in life threatening prognosis existed between the patients received colposcopically directed cone biopsy only and hysterectomy, expectant management over hysterectomy for treating CIS patients with marginal involvement.

OK-432 흉막유착술에 의한 자궁내 조기 태아 유미흉의 치료

임가원 ( Ga Won Yim ),권자영 ( Ja Young Kwon ),박용원 ( Yong Won Park ),김영한 ( Young Han Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.7

Fetal chylothorax is a rare congenital manifestation that shows variable clinical outcome ranging from complete spontaneous resolution to progression into hydrops or lung hypoplasia. There is no consensus in the literature as to the optimal antenatal management despite several complications such as preterm delivery, pulmonary hypoplasia, and perinatal death. Pleuroamniotic shunting has been the treatment of choice in fetal chylothorax. Recently, new fetal therapy such as OK-432 (Picibanil) pleurodesis is being introduced. Herein, we present two cases of women referred at early 2nd trimester because of fetal hydrothorax by routine ultrasonography. Cytology obtained by thoracocentesis revealed abundant lymphocytes, suggesting chylothorax. Effusion was aspirated and OK-432 (Picibanil) was injected into the pleural space of fetus. On follow up ultrasonography, the pleural effusion was nearly resolved by adhesion of the intrathoracic space and resulted in the delivery of a healthy neonate. Intrapleural OK-432 injection may be feasible therapeutic option for selected cases in early 2nd trimester with persistent chylothorax for effective control of pleural effusion with no adverse effects.

선천성 회음부 지방종의 산전초음파 진단

김수림 ( Soo Rim Kim ),권자영 ( Ja Young Kwon ),이은주 ( Eun Joo Lee ),박수연 ( Su Yeon Park ),허혜원 ( Hye Won Hur ),김영한 ( Young Han Kim ),박용원 ( Yong Won Park ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.8

We report on a newborn girl presenting with a 2.0×1.5 cm sized pinkish, doughy lump arising between right labia majora and anus. We performed antenatal sonogram at 33 and 36th weeks gestation. A polypoid mass of 0.8×1.0 cm sized in size was noted on ultrasonography. After birth, we observed a skin-covered protruding mass not to detect other anatomic anomalies-spinal anomalies, anorectal malformations, etc. After 3 months, excision of the perineal mass was done at the Department of Pediatric Surgery of our hospital. Mature fat cells were noted on histopathological exam. To our knowledge, there are few studies in the English literatures about congenital perineal lipoma without combined structural anomalies.

태아의 비뇨기계 기형과 동반하는 주요 장기 기형에 대한 보고

권재현 ( Jae Hyun Kwon ),권자영 ( Ja Young Kwon ),곽동욱 ( Dong Wook Kwak ),박용원 ( Yong Won Park ),김영한 ( Young Han Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.6

목적: 태아의 비뇨기계 기형과 이에 동반되는 기형의 종류 및 발생 빈도에 대하여 알아보고자 한다. 연구 방법: 1998년 8월부터 2008년 7월까지 연세대학교 의료원에서 산전 진찰 및 분만을 시행한 산모 중 비뇨기계 기형으로 진단된 태아에서 동반된 기형의 종류와 빈도를 조사하였다. 결과: 총 12,431명의 대상군 중 236명 (1.8%)의 태아에서 비뇨기계 기형이 진단되었으며, 그 중 25예에서 동반 기형을 가진 것으로 나타났다. 동반 기형의 종류로 가장 흔한 것은 심혈관계 기형으로 9예에서 관찰되었고, 그 외에 뇌혈관계와 소화기계를 비롯한 다양한 장기에서 동반된 기형이 있었다. 9명의 콩팥 무발생을 가진 태아 중에서 6예에서 동반 기형을 가진 것으로 나타나 비뇨기계 기형 중 타장기 기형을 동반하는 비율이 가장 높았다. 결론: 태아의 비뇨기계 기형이 발견된 경우, 심혈관계를 포함한 여러 장기의 기형이 있을 수 있으므로 세심한 산전 진찰과 상담 그리고 출산 후의 적절한 태아 치료가 필요할 것으로 사료된다. Objective: Due to advances in diagnosing fetal anomalies by ultrasound, prognosis of babies with anomalies, especially in urinary tract, has improved. However, multiple anomalies with poor prognosis are still noted. We analyze congenital defects which coexist with fetal urinary tract anomalies. Methods: We identified all pregnancies complicated by fetal urinary tract anomalies which were followed and delivered from 1998 August to 2008 July at Yonsei University Health System. Fetal urinary tract defects were subdivided to hydronephrosis, multicystic dysplastic kidney, polycystic kidney disease, renal agenesis, renal duplication and horse-shoe kidney. A retrospective study was performed regarding both medical records and ultrasound findings. Results: 236 (1.8%) in total 12,431 cases were identified with urinary tract defects and 25 (12.3%) cases had coexisting other anomalies. Hydronephrosis was found in 156 (68.2%) cases. Multicystic dysplastic kidney was found in 37 (15.6%) cases, renal duplication in 11 (4.7%), renal agenesis in 9 (3.8%), polycystic disease in 6 (2.5%) and horse-shoe kidney in 2 (1.0%). In 25 cases with coexisting anomalies, the most common type was congenital heart defect which was found in 9 (27.6%) cases. They were composed of 8 (24.5%) atrial septal defect and 1 (3.1%) ventricular septal defect combined with pulmonary atresia. Other coexisting anomalies were cerebral or gastrointestinal tract associated anomalies, Mullerian duct anomalies and polydactyly. Six in 9 (66.7%) fetuses with one kidney had other anomalies. Conclusion: Urinary tract anomalies in fetus seem to be associated with a variety of other malformation, especially cardiac anomalies. Detailed ultrasound or echocardiography should be carefully performed because of frequent coexisting fetal congenital anomalies. Furthermore, comprehensive prenatal counseling and postnatal evaluation and management will be needed.