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조기양막파수에 의한 양수내감염증 및 신생아 이환율을 진단하는데 있어서 CRP 및 LDH의 역할
김수평,이종건,김진홍,노덕영,박대순,김인재,이선희,나욱열 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.5
조기양막파수의 원인과 결과로서 양수내감염증은 논란의 여지가 있으며, 양수내감염증에 이차적으로 태아는 자궁내감염기회가 생길 수 있다. 양수내감염과 신생아 이환율을 진단하는데 있어서 신뢰도를 평가하기 위하여 조기파수된 산모와 이들 산모로부터 태어난 태아로부터 혈중 CRP와 혈중 및 양수의 LDH를 측정하여 다음과 같은 결론을 얻었다. 1. 조기양막파수 산모에서 양수내감염증은 CRP양성인 경우를 근거로 했을때 CRP양성인 경우가 8예로서 양수감염율은 28.6%였다. 2. 조기양막파수 산모에서 혈청 LDH값은 CRP양성군과 음성군간에 유의한 차이가 없었으나 400IU/L를 기준으로 한 양수내 LDH값과 양수내 LDH와 혈청 LDH비 1.5를 기준으로 구분한 경우 양 군간에 유의한 차이가 있었다.(P$lt;0.05) 3. 양막조기파수 산모에서 태어난 신생아의 체중은 2500gm이상인 경우가 CRP음성군에서 83.3%, CRP양성군에서 16.7%로 유의한 차이를 보였다. 4. 파막후 24시간이 지난 산모 22명으로부터 태어난 신생아에서 CRT양성율은 27.2%였으며,CRP양서인 신생아에서 폐염, B형 간염, 급성위장관염, 신생아고빌리루빈혈증 및 미숙아의 이환율을 보였다. Amniotic fluid infection as the cause and the consequence of premature rupture of membrane is controvertible. Following the amniotic fluid infection, the fetus was susceptible to the intrauterine infection. In order to evaluate their reliability as a diagnostic tool of amniotic fluid infection and neonatal morbidity, LDH in serum, amniotic fluid and CRP of pregnant women with premature rupture of membrane and neonates delivered from them were measured. The results were as follows: 1. CRP, microbiologic findings and amniotic fluid infection rate: Considering positive CRP as amniotic fluid infection, amniotic fluid infection rate was 28.6 % (8/28) Microorganisms were isolated from all of the amniotic fluid specimens of CRP(+) eight cases by bacterial culture, but above 20-30 WBC/ml was revealed by Gram stain in seven cases of the CRP (+) eight cases. 2. CRP, LDH and histopathological findings of placentas: There was no significant difference in the level of serum LDH between CRP (+) and CRP (-) group. LDH greater than 400 IU/L and the ratio of amniotic fluid LDH/ serum LDH greater than 1.5, have a high correlation with amniotic fluid infection. There was no correlation between histologic reports of chorioamniotis and amniotic fluid infection. Based on more than 100 WBC/ml in amniotic fluid, there was no correlation between the number of WBC and amniotic fluid infection. 3. Neonatal morbidity and mortality. There was no difference in gestational age, Apgar score at 5 min, RDS, neonatal sepsis between maternal CRP (+) group and CRP (-) group, but significant difference was found in the neonatal birth weight. 4. Neonatal morbidity from prolonged rupture of membrane: The incidence of CRP (+) in the infants delivered from mother with prolonged rupture of membrane are 27.2 % (6/22). The CRP (+) infants have neonatal morbidity such as pneumonia, hepatitis B, acute gastroenteritis, neonatal hyperbilirubinemia and prematurity. In conclusion, these results suggest that not only the measurements of CRP from the pregnant women with PROM and their neonate but also the measurements of LDH in the amniotic fluid and the rate of amniotic fluid LDH/serum LDH might be useful for a screening test of amniotic fluid infection and neonatal morbidity.
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조기진통억제재로서의 Nifedipine과 Ritodrine Hdrochloride가 심혈관 및 대사에 미치는 영향
김수평,이종건,신종철,김사진,이종승,백은정 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8
The selection of a tocolytic agent must weight both the safety and the efficacy of the treatment regimen. Ritodrine hydrochloride, a B-sympathomimetic drug, was approved for use as a tocolytic agent. However, there has been growing concern about the side effects induced by this agent. Recent investigations have indicated that nifedipine, a calcium channel entry blocker, may be useful in the treatment of preterm labor. This prospective study compared cardiovascular and metabolic effects measured in associated with nifedipine and ritodrine. Nifedipine caused generally minimal cardiovascular changes. On the other hand, ritodrine caused more pronounced cardiovascular changes than nifedipine. Nifedipine makes no significant alteration in serum electrolytes except calcium. However, ritodrine makes significant changes in serum potassium, calcium and chloride(p$lt;0.05). Nifedipine was not associated with a dramatic hyperglycemia, but ritodrine makes significant changes. Both agents had a hemodilutional effect. It was suggest that nifedipine for preterm labor management is associated with hemodilutional change, but hardly the adverse cardiovascular or metabolic effects which is often associated with ritodrine.
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조기진통의 예측지표로서 자궁경부 및 질내 태아파이브로넥틴의 임상적 유용성
김수평,이종건,나종구,김사진,김용욱,이종승,변태섭,정인광,나윤택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10
Prematurity is the major cause of neonatal mortaliy and morbidity. The prediction and early arrest of preterm uterine contractions is the mainstay of the management of the preterm labor. Several biophysical methods and biochemical markers are available, but not satisfactory for the prediction of preterm labor. The aim of this study is to determine the clinical efficacy of fetal fibronectin as a biochemical predictor of preterm labor. Fetal fibronectin was obtained at external os and posterior vaginal fornix in 118 women who have irregular uterine contractions with intact membranes and, in 113 women who complained of watery vaginal discharges without visible leakage. The cervicovaginal fetal fibronectin was measured quantitatively by fetal fibranectin immunoassay in 118 patients and qualitatively by fetal fibronectin membrane immunoassay in 113 patients. The results were considered positive when specimens had a fetal fibronectin concentration above 50 ng/ml in women who have irregular uterine contractions with intact membranes. The results obtained were as follows; 1. Fetal fibronectin concentrations in women with or without irregular uterine contractions with cervix dilatation($lt;=2cm) and intact membranes were 229.18+-68 ng/ml, 16.8+-9.2 ng/ml, respectively. 2. In the efficacy of fetal fibronectin for the prediction of preterm labor in women who have irregular uterine contractions and intact membrane, the sensitivity, specificity, positive predictive value and negative predictive value are 83.3%, 85.2%, 65.8% and 93.8%, respectively. There were significant correlation between the positivity of the fetal fibronectin and interval(diagnosis to delivery), gestational weeks at delivery and neonatal body weight. 3. In the efficacy of fetal fibronectin for the prediction of preterm labor in women who complained of watery vaginal discharges without visible leakage, the sensitivity, specificity, positive predictive value and negative predictive value are 62.5%, 93.3%, 71.4% and 90.2%, respectively. There were significant correlation between the positivity of the fetal fibronectin and interval(diagnosis to delivery), gestational weeks at delivery and neonatal body weight. 4. in the association between fetal fibronectin membrane immunoassay and nitrazine test in women who complained of watery vaginal discharges without visible leakage, the accuracy was 83.2%. This results reflect that positive cerviovaginal fetal fibronectin in women who have irregular uterine contractions or in women who complained of watery vaginal discharges maybe a useful biochemical predictor for the prediction of preterm labor.
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김수평,나덕진 대한부인종양 콜포스코피학회 1990 Journal of Gynecologic Oncology Vol.1 No.1
This study was performed to find out the relationship between DNA pattern by flow cytometry and the prognosis of cervical squamous cell carcinoma. The subjects were 71 patients who were admitted to Catholic University Medical College Kangnam St. Marys Hospital from September 1983 to May 1989 under the diagnosis of cervical squamous cell carainoma. Samples were obtained from the subjects before chemotherapy or radiation therapy, and a through follow up study was carried out an the subjects. The authors obserued the relations between flow cytometric DNA pattern and clinical stage, age of patients, histopathological findings and tumor markers, with the following results. 1. The S-phase of the cell cycle increased significantly in Stages I, ll and III-IV compared to that of Stage O.However, there was no difference between Stages in GO / Gl phase and G2 / M phase. 2. The incidence of aneuploid tumor increased significantly according to stage with the rates of increase reaching 22, 22%, 31. 57%, 44. 44% and 68. 75% respectively in Stages 0, I, II, and Ill-lV. 3. The incidence of aneuploid tumor increased significantly depending on the age of patients with the rates standing at 21. 42%, 31. 58%, 40. 90% and 68. 75% respectively in the groups of below 40, 41-50, 51-60, and 61 years and over. 4. As for the relation between histopathological findings and the incidenee of aneuploid tumor, no difference was found according to the degree of differentiation, but there were significant differences between the keratinization group(23. 07% ) and the non keratinization group(51. 11% ). 5. Among 26 patients on whom two years of post poerative study was conducted following operations in Stage Ⅰand Ⅱ, 3 of 5 patients showing recurrence and 2 of 21 patients showing non recurrence showed aneuploid tumor, indicating a significant statistical difference. 6. Among the various tumor markets, the positive ratios of CEA and β-hCG showed a significant increase according to stage, but no relation was found between tumor markers and the indicence of aneuploid tumor. From the above results it is considered that the effect of treatment in cervical squamous cell carcinoma and its prognosis can be more accurately predicted by observing flow cytometrc DNA patterns along with other clinicopathological parameters
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