전신성 홍반성 낭창 임산부의 산과적 고찰

한상하(S. H. Han),이희중(H. J. Lee),조형권(H. G. Cho),김재선(J. S. Kim),장병우(B. W. Jang),변태섭(T. S. Byeun),신진웅(J. W. Shin),노덕영(D. Y. Ro),신종철(J. C. Shin),김도강(D. K. Kim),김수평(S. P. Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

목적 : 전신성 홍반성 낭창의 임산부에 있어서 임신중의 혈액학적 변화와 그 결과를 통하여 이 질환의 경과와 예후를 밝히고자 함이다. 연구방법 : 이 연구는 후향적 연구방법으로 1989년 1월부터 1997년 1월까지의 전신성 홍반성 낭창에 이환된 25명의 임산부 여성의 임상기록의 검토를 통하여 시행되었다. 결과 : 전신성 홍반성 낭창에 합병된 임산부 여성에서 주산기동안의 백혈구치 증가(P<0.05), 분만후 백혈구치의 현저한 감소(P<0.05)이다. 그리고 주산기의 적혈구 침강속도의 변화는 현저히 증가하나(P<0.05) 분만후에는 자료를 얻지 못하였다. C3와 C4 보체의 혈청 수치는 주산기와 분만후기에 현저한 변화는 없었다. 그래서 이들 인자들은 임신상태에 의해 영향을 받지 않았다. 전신성 홍반성 낭창의 임신여성에서의 신장 기능은 BUN/Cr 수치에 의하여 주산기와 분만후기에 상대적으로 잘 유지되었다. 25명의 여성중 1명은 자연 조기파막에 의해 임신 2삼분기에 임신이 종결되었고(4%), 5명은 조산하였으며(20%), 나머지 19명은 만삭 분만하였다(76%). 결론 : 우리의 연구자료 결과에서 전신성 홍반성 낭창이 있는 임신에서의 위험성은 임신여성의 특히 혈액학적 지표에 있어서 해로운 영향을 주지 않았으며 이들 연구대상의 신생아의 예후도 비교적 양호하였다. Objective: The purpose of this study was to evaluate the course of Systemic Lupus Erythematosus through hematologic change during pregnancy and the outcome of pregnancy in patients with SLE. Method: This retrospective study was done by the review of medical records of 25 pregnancies complicated with SLE in patients betwen Jan, 1989 and Dec, 1997. Results: The common laboratory hematologic change in SLE with pregnant woman was elevated WBC count during peripartum period(P<0.05), significantly decreased during postpartum(P<0.05). And, during peripartum period ESR change was significantly elevated (P<0.05) but not obtained data during postpartum period. The serum level of C3 complement and C4 complement were not significantlty changed during peripartum and postpartum. So these factors are not affected by gestational condition. SLE pregnant woman's kidney function was relatively maintained during peripartum and postpartum according to BUN/Cr levels. Among 25 cases of SLE pregnant woman, there was 1 case of midtrimester termination due to spontaneous premature rupture of membranes (4 %), 5 cases of preterm birth (20 %), other were term delivery was done (19 cases, 76 %). Conclusion: Our data suggest that the risk of pregnancy with SLE is not harmful to pregnant woman, especially hematologic indicies and not to bad in pregnant outcome of newborn baby in our cases.

태아질식에 대한 임상적, 생물리학적 그리고 생화학적 지표

김수평 ( S. P. Kim ) 대한주산의학회 1994 Perinatology Vol.5 No.4

한국인 골반내 장기 탈출 환자에서 실리콘 환 페사리의 이용

김진홍 ( J. H. Kim ),이유미 ( Y. M. Lee ),김은중 ( E. J. Kim ),정기욱 ( K. W. Chung ),권동진 ( D. J. Kwon ),유영옥 ( Y. O. Lew ),김도강 ( D. K. Kim ),김수평 ( S. P. Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Pessaries have been used for centuries in the management of pelvic organ prolapse. Although surgical repair has been popularized by surgeons and gynecologists for younger women with pelvic relaxation, pessaries remain a useful palliative strategy for patients who refuse surgery as represent higher operative risks. Methods: Due to the recent advancement of material science, medical-grade silicone has replaced the traditional rubber, plastic, or Lucite, since it is more durable and non-allergenic. The authors used silicone ring pessaries in 98 Korean women with pelvic organ prolapse compromising those who are at high risks for anesthesia because of medical disease, who want to conceive in the further or those who wish to avoid surgical therapy. Results: 1. The average age of patients is 62.69±11.37 years. Period of pelvic organ prolapse is 78.64±56.23 months and duration of pessary insertion is 17.34±11.75 months. 2. The average time point of first complication was 7.91±4.25 months. The time point of complication of user group and non-user group of estrogen and lubricant was 10.06±3.31 months and 4.13±3.27 months, respecitively, which shows that complication occurred later in user group than in non-user group. 3. Pessary with support(16 out of 43 patients, 37.2 %) shows more serious complications (ulceration of vaginal wall) than pessary without support(1 out of 37 patients, 2.7 %). 4. The pessary sizes that fit best the prolapsed uteri of Korean women are #3(diameter of 63.5 mm) and #4(diameter of 69.8 mm) (60 out of 77, 77.9 %). Natural correction rate after removal of pessary(pessary insertion period: over 1 year) was 22.7 %(10 out of 44). 5. The most common complication in patient with uterine prolapse with or without cystocele is erosion. On the other hand ulceration of vaginal wall is the most common complication in those with rectocele and cystocele. 6. Among patients with pelvic organ prolapse in Korea, when there was uterine prolapse only, #3 and #4 pessary without support was the most commonly used(22 of 35, 62.9 %). When uterine prolapse was accompanied with rectocele or cystocele, #3 and #4 pessary with support fitted the best (accompanied with cystocele only: 14 of 26, 53.8 %, accompanied with cystocele and rectocele: 8 fo 9, 88.9 %). Conclusion: The above results suggest that we could recommend more utilization of proper shaped and sized pessary of patients with pelvic organ prolapse along with regular follow-up examination and proper use of estrogen, Trimosan, antibiotics, and anti-inflammatory drugs, in place of surgical therapy as the population of old aged women increases. Furthermore, education of the old aged women who are reluctant to visit Dr`s office how to do self-fitting the pessary will result in time saving and reduction of medical costs.

임신중 혈소판 감소증의 병태생리와 관리

이종건 ( J. G. Lee ),김수평 ( S. P. Kim ) 대한주산의학회 1995 Perinatology Vol.6 No.2

자간전증의 생화학적 표지물질과 유용성

이종건(J. K. Lee),이형근(H. K. Lee),김용욱(Y. W. Kim),정대영(K. Y. Jung),이종승(C. S. Yi),김사진(S. J. Kim),나종구(J. G. Rha),김수평(S. P. Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

목적: 자간전증의 병태생리를 근거로 한 생화학적 표지물질로서 VCAM-1, PDGF-AB, Antithrombin III, D-dimer의 의의와 유용성을 연구하기 위함. 방법: 정상산모 15례와 자간전증 352례의 환자에서 VCAM-1, PDGF-AB, Antithrombin-III, D-dimer의 혈장 농도를 측정하여 비교하고 자간전증 환자에서 산전,산후 농도를 비교하였다. 정상 산모에서의 각 표지물질의 평균±2표준편차 또는 평균±1표준편차의 기준값을 기준으로하여 각 표지물질의 민감도, 특이도, 양성예측값 및 음성 예측값을 구하였다. 결과: VCAM-1, AT-III, D-dimer값은 정상 산모와 자간전증 환자 사이에 유의한 차이가 있었지만 PDGF-AB의 값은 유의한 차이가 없었다. 정상 산모의 평균 ±2표준편차를 기준값으로 했을 때 VCAM-1, AT-III 그리고 D-dimer 각각의 민감도는 38%, 34% 그리고 40% 였으며 각각의 특이도는 100%, 87% 그리고 100%, 각각의 양성예측값은 100%, 86% 그리고 100%였고, 각각의 음성예측값은 57%, 36% 그리고 42%였다. 정상산모의 평균 ±1표준편차를 기준값으로 했을 때 VCAM-1, AT-III 그리고 D-dimer 각각의 민감도는 43%, 51%, 60%이고, 각각의 특이도는 80%, 87%, 80%이다. 각각의 양성 예측값은 64%, 90%, 88%이고, 각각의 음성 예측값은 50%, 43%, 46%였다. 결론: VCAM-1, AT-III 그리고 D-dimer와 같은 생화학적 표지물질의 조합은 자간전증에서 생화학적 표지물질로서 유용할 것으로 사료된다. Background and Puropse: The pathophysiologic features of preeclampsia are poorly understood. The diagnosis of preeclampsia is based not on the pathophysiology, but on the clinical symptoms. The endothelial dysfunction and the intravascular coagulopathy secondary to it, might be pivotal in the pathophysiology of preeclampsia. The purpose of this study is to investigate the significance of the potential biomarkers based on pathophysiology in preeclampsia. Methods: The vascular cell adhesion molecule-1 (VCAM-1), platelet-derived growth factor (PDGF-AB), antithrombin-III (AT-III) and D-dimer were measured in the plasma of the normotensive pregnant(control group) and preeclamptic women(study group). On the basis of the mean ±2SD or mean ±1SD cut-off value of biomarkers in control group, the sensitivity, specificity, positive predictive value and negative pred ctive value of each marker were calculated. Results: There were significant differences in VCAM-1, AT-III and D-dimer between control and study group. But the levels of PDGF were not significantly different from each other. With the mean±2SD cut-off value, the sensitivities of VCAM-1, AT-III and D-dimer were 38%, 34% and 40%, respectively. The specificities of VCAM-1, AT-III and D-dimer were 100%, 87% and 100%, respectively. Their positive predictive values were 100%, 86% and 100%, respectively. Their negative predictive values were 57%, 36% and 42%, respectively. With the mean ±1SD cut-off value, the sensitivities of VCAM-1, AT-III and D-dimer were 43% 51% and 60%,respectively Their specificities are 80%, 87% and 80%, respectively. Their positive predictive values were 64%, 90% and 88%, respectively. Their negative predictive values were 50%, 43% and 46%, respectively. Conclusion: The combination of these biomarkers such as VCAM-1, AT-III and D-dimer may be more useful as a biomarker in preeclampsia.

거대 점액성 난소낭종

이지영(J Y Lee),권용일(Y I Kwon),박태철(T C Park),이은정(E J Lee),권동진(D J Kwon),김찬주(C J Kim),이근호(K H Lee),서상용(S Y Seo),조형권(H G Cho),류진희(J H Ryu),나순숙(S S Na),이진우(J W Lee),김수평(S P Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

A case of rapidly grown, huge ovarian cyst in an 18-year old woman is presented with a brief review of literature. This tumor was measured 30x40x45 cm in size, and weighed 13kg. The pathologic diagnosis was mucinous cystadenoma, left ovary.

산부인과 영역에 있어서 Amoxicillin의 임상효과

김수평,허필형,나종구 中央醫學社 1977 中央醫學 Vol.32 No.3

Thirty-two patients admitted to Dept. of Obstet. & Gynec., St. Mary's Hospital of Catholic Medical College were treated with amoxicillin for infections, proved on culture and prophylactic use. The antibiotic was administered orally in 2 capsules of 250mg two-times a day for 5 to 14 days. Thirty out of 32 patients were cleared of infection and these were determined by clinical signs, symptoms and organism culture on those can be available. Two cases, infected by Pseudomonas and unknown organism, among 32 patients showed poor effects to amoxicillin therapy. Amoxicillin was well tolerated by all patients without serious complications. Side effects were minimal and that disappeared within 24 hours even on continuation of the therapy. No other abnormal findings on CBC, urinalysis and blood chemistry were observed.

Marc Chagall의 作品 世界 : 作品 構造의 分析을 中心으로 Particularly on the Analysis of Its Structure

金水平 西原大學校 1972 西原大學 論文集 Vol.1 No.-

Marc Chagall has a special place among the twentieth-century artists who have expressed the world of fantasic imagination. He enriched the world of art with his haunting paintings of boyhood in a Russian peasant village, Vitebsk. And the village was to remain a poetic leitmotif in his work throughout his career. He was impressed by the architectural strength of cubist painting. But the brilliant color and effusive warmth of the Fauvism and of Vincent Van Gogh and Paul Gauguin were more compatible with his temperament. His powdery colors and various forms become the most potent force in his poetic vocabularly, in part of Slavic Poignancy in part of French lyricism. And he delineated a psychological universe that fefied observable realities and physical laws. His floating brides and winged clocks oppose gravity and chronology in favour of a poetic ethos with its own laws and dimensions. The symbols in his painting reflect the flowering of a lyrical and sensual imagination. And their message is inseparable from their poetic context. The psychoanalytic 'laws of symbols' are very clearly illustrated by his work. However in his painting we are confronted not with the sensationalism of a Dali but with a true artist painting spontaneously the particular and peculiar contents of his unconscious, and reflecting the caprice, the sadness, and the power of the however tortured imagination of his people. There is more to be learned from the incessant continuity of the street scenes in his works. No tonly is there a definite style to the dream-painting just as, in every human being, there is a style to one's dreams, but over and above that there is constant bubbling up from the never quite extinct volcanoes of the obsession.

난소암의 예후 판정을 위한 혈중 hCG β-subunit 및 α-fetoprotein치의 측정

남궁성은,최형락,이준모,김기원,김수평 大韓産婦人科學會 1980 大韓産婦人科學會雜誌 Vol.23 No.1

난소암 환자에서 2차 및 3차 개복수술

문정일,한구택,이준모,김수평,남궁성은,이헌영,김승조 가톨릭 중앙의료원 가톨릭 암센터 1987 가톨릭 암센터 論集 Vol.1 No.1