성선 자극 호르몬에 의해 유도된 인간 난소내 세포사멸된 난자에서의 StAR 단백질의 발현

김세광 ( Sei Kwang Kim ),박철홍 ( Cheol Hong Park ),양현원 ( Hyun Won Yang ),김명신 ( Myoung Shin Kim ),정경아 ( Kyung Ah Chung ),배상욱 ( Sang Wook Bai ),박기현 ( Ki Hyun Park ),조동제 ( Dong Jae Cho ),윤용달 ( Yong Dal Yoon ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12

목적 : 인간 난자 및 배아의 퇴화에 따른 미토콘드리아 내 StAR 단백질의 존재 여부 및 변화 양상을 알아보고자 하였다. 연구 방법 : 여성 불임 환자에서 보조생식술을 통해 채취된 난자 가운데 정상 난자와 분절화를 보이는 난자를 구분하여 TUNEL 염색 방법으로 세포사멸 여부를 확인하고, immuno-labelling 방법을 적용하여 StAR 단백질 발현 정도를 측정함으로써 난자의 분절화에 따른 StAR protein의 관련 여부를 확인하였다. 결과 Objective : To determine the distribution and expression of steroid acute regulatory (StAR) protein in human oocyte and embryo in relation to apoptosis. Methods : Immuno-labelling and confocal microscopy were applied to examine the localization of StAR pr

임신중 항간질약을 사용한 간질산모의 불량한 임신예후

이성기(Sung Ki Lee),김세광(Sei Kwang Kim),김석영(Suk Young Kim),한성식(Sung Shik Han),김인규(In Kyu Kim),양영호(Young Ho Yang),김재욱(Jae Wook Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

N/A Objective: The aims of this study was to examine whether epileptic women with antiepileptic drugs(AEDs) treatment during pregnancy were associated with an increased risk of adversed pregnancy outcome. Methods: The study design was a retrospective analysis of 91 epileptic pregnant women attending the Severance Hospital Yonsei Medical Center between January 1980 and June 1998. Of the 91 women, data from 84 were available for analysis. Adverse pregnancy outcome in 66 women who were exposed to AEDs during pregnancy were compared with those of 18 controls who were not. The main adverse pregnancy outcome included spontaneous abortions, perinatal deaths, preterm deliveries, fetal growth restriction and congenital anomalies. Results: Epileptic women with AEDs treatment during pregnancy were not significantly different from their controls in the incidence of spontaneous abortions(1.5% vs, 5.5%), perinatal deaths(1.5% vs. 0%), preterm deliveries(3% vs. 5.5%), fetal growth restriction(3% vs. 0%), and congenital anomalies(3% vs 5.5%). An adverse outcome occurred in 8 of 66 women(l2%) in the study group and 3 of 18 control group(16.5%). This difference was not statisitically significant. Conclusion: Our study shows that epileptic women who were exposed to AEDs during pregnancy do not have an increased risk of adversed pregnancy outcome than the women who were not.

Urinary Profiles of the Endogenous Steroids in Pre-Menopausal Women with Uterine Leiomyoma

정병화,배상욱,정봉철,김세광,박기현,Jung, Byung-Hwa,Bai, Sang-Wook,Chung, Bong-Chul,Kim, Sei-Kwang,Park, Ki-Hyun The Korean Society for Reproductive Medicine 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.1

목 적: 본 연구의 목적은 내인성 성호르몬이 자궁근종의 성장에 미치는 영향을 알아보고자 연구를 시행하였다. 연구대상 및 방법: 폐경전 자궁근종 환자 27명과 같은 연령대의 정상여성 25명을 대상으로 하였다. 모든 대상군의 여성에서 24시간 소변을 모아서 소변내 estrogen, androgen의 대사체들을 GC-MS를 이용하여 측정하였으며 두 군에서의 차이를 비교분석 하였다. 결 과: 소변내 $17{\beta}$-estradiol, 5-androstene-$3{\beta}$, $16{\beta}$, $17{\beta}$-triol, 11-keto-ethiocholanolone, $11{\beta}$-hydroxy-androsterone, THS, THA, THE, a-cortolone, a-cortol 및 $\beta$-cortol가 환자군에서 의의있게 증가하였으며 $17{\beta}$estradiol/estrone 및 $11{\beta}$-hydroxy-ethiocholanolone/$11{\beta}$-hydroxy-androsterone도 환자군에서 의의있게 증가하였다. 결 론: 자궁근종의 성장은 요중 estrogen과 androgen의 농도와 밀접한 관련이 있으며 이는 환자의 스테로이드 호르몬 대사 감소에 기인한 것으로 사료된다.

수질증을 동반한 잔존 총배설강

이진우 ( Jin Woo Lee ),김세광 ( Sei Kwang Kim ),조재성 ( Jae Sung Cho ),전명재 ( Myung Jae Jeon ),노진래 ( Jin Lae Roh ),이현정 ( Hyun Jung Lee ),박기현 ( Ki Hyun Park ),구자승 ( Ja Seung Koo ),조상호 ( Sang Ho Cho ),한석주 ( Seok 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

Persistent cloaca is a very rare congenital anomaly with a single common perineal opening for the genital, urinary and gastrointestinal tracts, which arises from defects in the embryonal process of descent of urorectal septum or fusion to cloacal membrane. Anomalies associated with persistent cloaca are found in the upper urinary tract, gastrointestinal tract, cardiovascular system, central nervous system and respiratory system, which are not easily detected through ultrasound during pregnancy. It has been reported that if those anomalies are diagnosed early, they can be corrected surgically. We present a case of persistent cloaca with hydrocolpos confirmed by autopsy after emergency cesarean section which was initially presented as a huge abdominal cystic mass and bilateral hydronephrosis by ultrasound at 34 weeks of gestation.

임신 중기 원인불명 인간 융모성 성선자극호르몬치 상승 임신부의 임신 결과

이윤정(Yun Jung Lee),김세광(Se Kwang Kim),안은희(Eun Hee Ahn),이진우(Jin Woo Lee),권혜경(Hye Kyung Kwon),이창희(Chang Hee Lee),김영한(Young Han Kim),배상욱(Sang Wook Bai),박기현(Ki Hyun Park),양영호(Young Ho Yang),송찬호(Chan Ho Song 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.4

N/A Objective : Our purpose was to determine the association between unexplained elevation of maternal serum human chorionic gonadotropin (hCG) in the second trimester and adverse pregnancy outcomes. Material and methods : Between February 1995 and July 1999, we evaluated 1566 pregnant women who have underwent second trimester triple marker screening tests (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) and delivered at Severance Hospital, Yonsei Medical Center. Multiple pregnancies, abnormal fetal karyotypes, fetal anomalies, and abortions were excluded from the study. One hundred twenty-one women with hCG levels greater than 2.0 multiples of the median (MoM) were included in the study group while 1389 women with hCG levels less than 2.0 MoM served as the control group. Pregnancy outcomes were obtained from the delivery and neonatal records in our institution. Adverse pregnancy outcomes between the two groups were compared using chi-square test and Fisher's exact test. Results : Women with unexplained elevation of human chorionic gonadotropin levels were associated with statistically significant increased risks for preeclampsia, preterm delivery, and low birth weight (p<0.05). However, there were no significant differences between the study and control groups with respect to preterm premature rupture of membranes, abnormal fetal heart rate tracing, abruptio placentae, intrauterine fetal death, and neonatal death. Conclusion : An unexplained elevation in human chorionic gonadotropin level in the second trimester may increase the risk for preeclampsia, preterm delivery, and low birth weight but not for other adverse pregnancy outcomes such as preterm premature rupture of membranes, abnormal fetal heart rate tracing, intrauterine fetal death, or neonatal death.

인간의 착상 기전을 연구하기 위한 3차원적 자궁내막 모델 확립

박동욱,양현원,권혁찬,장기홍,김세광,조동제,오기석,Park, Dong-Wook,Yang, Hyun-Won,Kwon, Hyuck-Chan,Chang, Ki-Hong,Kim, Sei-Kwang,Cho, Dong-Jae,Oh, Kie-Suk 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.1

In order to study the implantation mechanism various methods for culture of endometrial cells in vitro have been attempted. However, a disadvantage is that primary cultures of stromal and epithelial cells do not have the ability to differentiate, and therefore cannot be reproduced in the same manner as in vivo endometrium. The object of this study is to establish a three dimensional culture of endometrial cells which are both morphologically and functionally identical to in vivo endometrium. Endometrial tissues obtained after hysterectomies were cut into thin slices and treated with collagenase and trypsin-EDTA. The stromal cells and the epithelial cells were separated by centrifugation and cultured for 24 hours in DMEM media containing 10% FCS, 100 nM progesterone, and 1 nM estradiol. The cultured stromal cells were mixed with collagen gel and solidified, after which it was covered with matrigel. Epithelial cells were inoculated on the top and then cultured for 3 days. The three dimensionally cultured endometrial cells were stained for integrin ${\alpha}1,\;{\alpha}4,\;{\beta}3$, and cyclooxygenase-l, -2 by immunohistochemistry, which all showed strong expression. The cultured epithelial cells showed the formation of microvilli, tight junctions and pinopodes by electron microscopy. Studies are currently under way utilizing this three dimensional culture model to ascertain the interaction between the embryo and human endometrial cells at the time of implantation, and it is thought that further studies into a new culture environment which would allow longer periods of culture will be necessary.

자궁선종을 동반한 자궁근종에서 자궁동맥 색전술을 이용한 치료의 효과

장진범,배상욱,임재학,이도연,김정연,정경아,김세광,박기현,Jang, Jin-Beum,Bai, Sang-Wook,Lim, Jae-Hak,Lee, Do-Yeon,Kim, Jung-Yeon,Jeong, Kyung-Ah,Kim, Sei-Kwang,Park, Ki-Hyun 대한생식의학회 2001 Clinical and Experimental Reproductive Medicine Vol.28 No.3

Objective: The purpose of this study was to make a guideline of uterine artery embolization for the treatment of uterine leiomyomas accompanying with adenomyosis in Korea. Materials and Methods : We performed the retrospective study for 37 women who had uterine leiomyomas accompanying with adenomyosis. Bilateral uterine artery embolization was performed in 37 patients (age range 25-65) during 17 months with pain, hypermenorrhea, urinary frequency etc due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure. Results: All procedures were technically successful. Mean clinical follow-up was 12.8 months. Minor complication occurred in 82% patients after the procedure. After imaging follow-up (mean, 6.9 months postprocedure), median uterine volume decreased 34.4%, and dominant myoma volume decreased 86%. There was no statistical difference in uterine volume reduction and dominant myoma size reduction whether occluding agents was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, and gelfoam, and whether ultrasound measured Resistance Index value before the procedure was low or high. Conclusion: Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas who no longer des ire fertility but wish to avoid surgery or are poor surgical risks. To our study, uterine volume reduction and dominant myoma size reduction in patients who had adenomyosis were similar to previous other studies in patients who had not adenomyosis. Therefore adenomyosis should not be considered as a contraindication for uterine artery embolization. Because there is little data about subsequent reproductive potential after this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted for occluding agents and Resistance Index.

자궁근종과 성호르몬 대사물과의 연관성

배상욱,정병화,정봉철,전진동,이현정,권한성,정경아,김세광,박기현,Bai, Sang-Wook,Jung, Byung-Hwa,Chung, Bong-Chul,Jeon, Jin-Dong,Lee, Hyun-Jung,Kwon, Han-Sung,Chung, Kyung-Ah,Kim, Sei-Kwang,Park, Ki-Hyun 대한생식의학회 2001 Clinical and Experimental Reproductive Medicine Vol.28 No.4

Objective: To elucidate 1) whether there are any differences in the urine concentrations of steroid hormone metabolites between patients with leiomyoma and normal controls 2) the correlation between urinary profiles of steroid hormones and leiomyomas of the uterus according to their type, location, volume, and weight. Materials of Methods : The study population consisted of 37 premenopausal patients with uterine leiomyoma and the control group consisted of 25 premenopausal normal volunteer women without uterine leiomyoma. Confirmation of the existence of uterine leiomyoma was done by ultrasonography and histopathological examination after surgery. The volume of the leiomyoma was estimated by trans-abdominal and/or trans-vaginal ultrasonography. The Leiomyomas were divided into 3 types (subserosal, intramural and submucosal). Seventeen patients had subserosal type of leiomyoma, 10 with the intramural type and 10 with the submucosal type. The locations of the leiomyoma were also divided into 3 groups (fundus, body and isthmus). Seventeen patients showed a fundus location, 10 in body, and 10 in isthmus. We compared urinary profiles of the endogenous steroids between patients with leiomyomas and normal controls, and also investigated the relationship between urinary profiles of the endogenous steroids and leiomyomas according to their type, location, volume and weight by using highly sensitive Gas Chromatography-Mass Spectrometry (GC-MS) system. Results: The mean ages of the patients with leiomyomas and the control group were $43.1{\pm}5.6$ and $40.6{\pm}7.2$ years, the weights were $63.4{\pm}7.3$ and $59.4{\pm}8.1\;kg$, and their heights were $155.4{\pm}4.8$ and $159.3{\pm}4.8\;cm$ respectively. Seventeen patients had subserosal, 10 had intramural, and 10 had submucosal leiomyomas. There were 17 patients with leiomyoma located in fundus, 10 in body and 10 in isthmus. $17{\beta}$-estradiol, 5-AT, 11-keto ET, $11{\beta}$-hydroxy An, $11{\beta}$-hydroxy Et, THS, THA, THE, a-cortolone, a-cortol, $\beta$-cortol, $11{\beta}$-OH Et/$11{\beta}$-OH An and E2/E1 were significantly increased in patients with leiomyoma than in the control group. $17{\beta}$-estradiol was significantly increased in the intramural and the submucosal types than in the subserosal type. There was no significant difference in the concentrations of urinary steroids according to the locations of leiomyomas. There was no significant relationship between the concentration of urinary steroids and the volume of the leiomyomas. $17{\beta}$-estradiol significantly decreased as the weight of uterus increased (r=-0.322, p=0.04). Conclusion: The concentrations of steroid hormone metabolites were generally increased in patients with leiomyoma but were not significantly related to the volume and weight of the leiomyomas. Our study suggests that steroid hormones may be involved in the initiation of leiomyomas but may not be involved in their progression. In addition, the concentrations of steroid hormone metabolites are not related to the leiomyoma type and location.

성선 이형성 환자 혈액 및 성선 조직에서 Y 염색체 모자이시즘의 진단

김진영,이상준,박기현,김정연,배상욱,이병석,김세광,김인규,조동제,송찬호,김재욱,이호준,Kim, Jin-Yeong,Lee, Sang-Joon,Park, Ki-Hyun,Kim, Jung-Yeon,Bai, Sang-Wook,Lee, Byung-Seok,Kim, Se-Kwang,Kim, In-Kyu,Cho, Dong-Je,Song, Chan-Ho,Kim, Jae- 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.3

Objective: The presence of Y chromosome in patients with gonadal dysgenesis is related to the risk of gonadoblastoma. Since the patients with abnormal sexual differentiation may have cryptic Y mosaicism, it is important to detect the presence of Y material in these patients. But sometimes it is difficult to detect Y material only with karyotyping. This study was performed to evaluate the usefulness of the SRY gene screening in blood and gonad by using PCR in detecting the presence of Y material and possible tissue mosaicism in patients with gonadal dysgenesis as Turner syndrome and 46,XY pure gonadal dysgenesis (PGD, Swyer syndrome). Method: In 26 patients with gonadal dysgenesis, we screened for Y material by using PCR for SRY gene in peripheral leukocytes and in gonadal tissues of some patients. They were 22 cases of Turner syndrome (7 45,XO, 2 46,Xi(Xq), 3 45,XO/46,XX, 5 45,XO/46,Xi(Xq), 1 45, XO/46,XY, 1 45,XO/46,Xi(Yq), 1 45,XO/47,XYY, 1 46,XX,del(X)(q24) and 1 46,X,+mar) and 4 cases of 46,XY pure gonadal dysgenesis. PCR for SRY gene in the gonadal tissue was performed in 5 Turner syndrome and 2 PGD to determine the cryptic Y mosaicism between blood and gonad. Results: By using PCR analysis for SRY, Y chromosome material was detected in the blood of 4 of 22 Turner syndrome patients (45,XO/46,Xi(Xq), 45,XO/46,Xi(Yq), 45,XO/46,XY, and 45, XO/47,XYY), 3 of 4 46,XY pure gonadal dysgenesis. Discrepancy between karyotyping and blood PCR for SRY was noted in 1 Turner syndrome (45,XO/46,Xi(Xq)) and 1 PGD. Laparoscopic gonadectomy was performed in Y containing or SRY positive cases. In addition, PCR analysis for SRY in the gonads of 5 Turner syndrome and 2 PGD showed discrepancy between blood and gonad or between both gonads in 3 Turner syndrome (45,XO/46,Xi(Xq), 45,XO/46,Xi(Y q), 45,XO/46,XY) and 2 PGD patients. Conclusion: In gonadal dysgenesis, PCR analysis for SRY gene is useful to detect the cryptic Y mosaicism that is sometimes undetected by karyotyping. And since there may be tissue mosaicism, it is necessary to evaluate Y mosaicism in various tissues even in the case without Y chromosome on karyotyping.

임신 초기 융모막 융모와 탈락막에서의 Estrogen 수용체 및 Telomerase 활성도의 발현

송찬호(Chan Ho Song),김정연(Jung Youn Kim),박기현(Ki Hyun Park),배상욱(Sang Wook Bai),김세광(Sei Kwang Kim),정영내(Young Nae Jung),박규현(Kyu Hyun Park),정현철(Hyun Cheol Chung),장영건(Young Kwon Chang),권자영(Ja Young Kwon),조동제(D 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

N/A Objective : To investigate whether there is any differences between normal pregnancy (NP) and spontaneous abortion (SAB) regarding estrogen receptor (ER) expression and telomerase activity (TA) in the chorionic villi and decidual tissues. Methods : Chorionic villi and decidual tissues were obtained between 6 and 9 weeks' gestation from 14 patients with SAB and 17 normal pregnant women who have undergone an elective abortion. All tissue samples were assayed for ER with enzyme immunoassay and also TA was analysed using telomeric repeat amplication protocol. Results : A significant decrease in ER expression (2.81±2.77 fmol/mg of protein; p<.001) was demonstrated in SAB group compared to that of NP group (4.56±1.85 fmol/mg) in decidua. However, no significant difference in ER expression in chorionic villi was found between the two groups. SAB group showed significantly lower levels of TA than that of NP group in both chorionic villi (21.4% vs. 82.4%; p=.002) and deciduas (7.1% vs. 52.9%; p=.009). Conclusion : Our results suggest that decreased level of ER expression in deciduas might cause decidual senescence and eventually, spontaneous abortion.