한국형 자궁경부 촬영진 ( New Cervicography ) , 세포검사 그리고 HPV-DNA 검사를 이용한 새로운 자궁경부암 검진 모델 ( Model ) 개발

김승조(SJ Kim),박찬규(CK Park),이효표(HP Lee),남궁성은(SE Namkoong),강순범(SB Kang),서호석(HS Saw),이재관(JK Lee),김수녕(SN Kim),김재원(JW Kim),배석년(SN Bae),김찬주(CJ Kim),이근호(KH Lee),이선영(SY Lee),김인호(IH Kim),이찬(C Lee),이정노(JN Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : The false negative rate of conventional cytology is reported to range from 18 to 45%. It is necessary to develop more effective screening strategies that would ideally be more accurate than conventional cytology. This study is designed to investigate the potential of conventional cytology, cervicography, HPV-DNA testing and their combinations as primary screening techniques for cervical neoplasia. The purpose of this project is to develop the models and guidelines for screening tools of cervical cancer of the uterus by evaluating sensitivity, specificity and cost-effectiveness of all the screening methods. Study design : We conducted a screening of random sample of women who visited the department of OB-Gyn. of five different major university hospitals such as Catholic University Hospital, Korea University Hospital, Seoul National University Hospital, Yeonsei University Hospital and Pochon CHA University Bundang CHA Hospital, from May 1, 1996 to April 30, 1999. In a cohort women with an age range of 20 to 70 who underwent routine cytologic screening at Catholic University, Hospital Bundang CHA General Hospital and local clinics from April 1, 1996 to Decomber 31, 2000. cervicography (n=417,125) and testing for HPV-DNA (n=1,347) by the hybrid capture assay were studied for the ability of the cervical cancer screeuing. A new cervicography system with Kim's classification which was developed by Prof. Kim Seung Jo as an adjunctive method for the cervical cancer screening was applied in this cohort study. And then, accuracy, effectivencess, cost-effectiveness of the single or combined screening method were analysed. Result : Sensitivity and specificity of Pap smear were ranged from 55.6% to 83.1% and 72.8% to 88.3% respectively. The combination of Pap smear and cervicography had sensitivity from 89.7% to 98.6%, specificity from 68.2% to 93.2%. With combination of Pap smear, HPV DNA test and cervicography, sensitivity became also highest accuracy among all screening methods from 92.8% to 98.8%. Considering medical charges for diagnosis and social cost occurred by false positive and false negative results, the most cost-effective diagnostic modality was thought to be the combination of Pap smear and cervicography(91,433 won). In patients who were diagnosed as LSIL, colposcopic examination confirmed progression to high grade intraepithelial lesion(HSIL) in 10.7% patients, persistence of LSIL in 55% patients during the 3 year follow-up period. Accuracy of the screening for cervical cancer and CIN can significantly be improved by cytology with new cervicography rather than cytology alone. We concluded that cervicography can be important adjunctive tests for cervical cytology, improving the effectiveness of cervical screening by allowing a more sensitive detection of cervical neoplasia.

임산부혈당의 태반통과에 관한 연구

김승조(SJ Kim),김영근(YG Kim) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.10

For the study of the effects of maternal hyperglycemia upon the fetal distress. estimation of blood glucose saturation were made by Somogyi-Nelson`s method on maternal and umbilical venous blood before and immediately after delivery in 30 cases of normal full term pregnancy, which were divided into two groups, the first control group 10 cases whithout glucose injection, the other study group 20 cases with injection of 50% glucose 50cc. Injection of glucose was done intravenously 15 minutes-3hr before delivery and followed by checking the blood glucose saturation immediasely before and after delivery in the study group. The results were as follows, 1) The fetal cord blood sugar at birth was found to be lower than those of maternal blood sugar, before and after delivery in the both of control and study group. 2) And the absolute mean difference between maternal and fetal cord blood sugar shows 23. 85mg, 11.1mg in control group and 30.4mg, 16.7mg in the glucose-loaded group. 3) Fetal cord blood sugar of the glucose-loaded group shows 85mg higher than those of the control group. 4) It was also shown that free transfer of glucose through the placenta in case of normal pregnancy and can make a good effect upon the fetal distress.

Steroid 복합체 ( Regulen K - I ) 투여에 의한 월경주기 및 배란 조절

김승조(SJ Kim),김경태(KT Kim),나종구(Rha CG),정구윤(KY Chung),강성원(SW Kang),김창이(CY Kim) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.7

가톨릭의과대학 부속 성모병원 산부인과 내분비크리닉에서 월경장애 환자 31명(불규칙 월경주기의 15예, 희발성 월경의 9예와 무월경의 7예)에게 배란을 억제하지 않고 월경주기를 일정하게 할 수 있으며 오히려 배란을 유발시켜 불임증을 칠료할 목적으로 Regulen K­ I을 고안하여 투여해 본 결과 다음과 같은 결론을 얻었다. 1. 월경장애별로 Regulen K­I 투여시 월경주기에 미치는 영향을 비교하여 보면 불규칙 월경주기의 15예에서 모두 27∼30일 사이로 월경주기가 정상적으로 복귀하였고 28일 형이 관찰된 25월경주기중 18월경주기(72%)로 가장 많았으며, 희발성 월경과 무월경의 예에서도 25∼45일 일사이로 월경주기가 변화됨을 알 수 있었다. 2. Regulen K­I 투여시 무월경의 2예를 제외한 29예(93.5%)에서 이상성 기초체온곡선을 나타냈다. 3. 배란 추정일을 기초체온곡선의 이상성을 기준으로 Regulen K­I 투여 첫 날부터 조사하여 본 결과 9∼16일 사이였으며, 가장 많은 배란 추정일은 불규칙 월경주기의 예에서는 9∼10일 사이였고, 희발성 월경과 무월경의 예에서는 11∼12일 사이였다. 4. 소퇴성 출혈일을 Regulen K­I 투여가 끝나는 날 부터 조사하여 본 결과 불규칙 월 경주기의 15예에서 모두 5일 이내에 소퇴성출혈을 보였으며 4∼5일 사이가 관찰된 25월 경주기중 17월경주기(68.0%)로 가장 많았다. 희발성 월경주기의 9예는 11일내 모두 소 퇴성 출혈을 보였으며 관찰된 14월경주기중 4∼5일이 7월경주기(42.8%)로 가장 많았고, 무월경의 7예는 모두 15일내에 소퇴성 출혈을 보였으며 관찰된 18월경주기중 6∼7일이 7월경주기(38.8%)로 가장 많았다. 5. Regulen K­I의 투여 환자중 4예에서 혈중 FSH치와 LH치를 방사면역측정법으로 측정하여 본 결과 3예에서 배란이 억제되지 않았음을 추측할 수 있었으나 더 확실한 Regulen K­I에 대한 FSH치와 LH치의 반응은 전월경주기중 일일변화 및 일중변화를 측정해야 될 것으로 사료된다. Regulen K-I is a combination of drugs arranged for daily intake for over 21 days for the purpose of menstrual cyclic regulation. This is done through, the induction of ovulation, based on the normal physiology of a menstrual cycle. The regulen K-I is composed of 21 capsules; 4 capsules of 0.1 mg premarin, 7 capsules of placebo and 10 capsules of 0.25 mg d-norgestrel combined sith 0.05 mg dthinyl estradiol. This clinical study was carried out to clarify the effect of Regulen K-I upon menstrual disorders. The authors administered Regulen K-I to 31 women who had menstrual disorders. These were 15 cases of irregular menstruation (25 menstrual cycles), 9 cases of oligomenorrhea (14 menstrual cycles) and 7 cases of amenorrhea (18 menstrual cycles). During the administration of Regulen K-I, the BBT curve was checked in all the cases. Radioimmunoassay of serum FSH and LH was performed in 4 cases. The results were as follows; 1) The menstrual intervals in the 15 irregular menstrual cases who received Regulen K-I ranged from 27 days to 30 days, and the most common menstrual interval was 28 days, In the cases of oligomenorrhea the menstrual interval recovered to the range of 25 days to 40 days. In the 7 cases of amenorrhea, menstrual intervals recovered of the range of 25 days to 45 days. 2) During the administration of Regulen K-I, biphasic curves of BBT were observed in 29 cases (93.5%). Two cases showed monophasis BBT; one of them was a case of uterine hypoplasia, and the other was a case of female hermaphroditism with virilization. 3) During the administration of Regulen K-I, the suspected ovulaton day was observed between the 9th and 16th day from the beginning of the administration. the most common suspected ovulation day in the cases of irregular menstruation was about the 9th to 10th day and in the cases of oligomenorrhea and amenorrhea about the 11th to 12th day. 4) The most common withdrawal bleeding after completion of Regulen K-I administration appeared in the cases of irregular menstruation and oligomenorrhea on the 4th day to 5th day and in amenorrhea on the 6th to 7th day. 5) Radioimmunoassay of serum FSH and LH showed no evidence of the ovulatory suppression by administration of the Regulen K-I.

거대난소낭종을 동반한 앙와위저혈압증후군의 1예

김승조(SJ Kim),전성규(SK Chun),오경근(KK Oh) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.1

A case of supine hypotension syndrome associated with large pseudomucinous cystadenoma of right ovary is presented and literatures pertaining to postural hypotension reviewed. There have been several reports in recent years relating to the occurrence, incidence and potential dangers of postural hypotension in the pregnant woman appreaching term. The presence, however, of both phenomena-large ovarian cyst and supine hypotension with 5 th month gestation is not known to have been previously reported. Supine hypotension syndrome was disappeared immediately after removing the large ovarian cyst and postoperative course was uneventful.

융모성상피암에 있어서의 Methotrexate 포화검사의 의의

김승조 ( SJ Kim ),송승규 ( SK Song ),이헌영 ( HY Lee ),정재근 ( JK Jung ),안웅식 ( WS An ),최원영 ( WY Choi ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.7

저자들은 융모성질환의 화학치료에 있어서 methotrexate 치료도중 문제가 될 수 있는 약제의 독성을 줄이고, 내성을 방지하기 위하여 leucovorin rescue를 주는 적절한 시기 및 용량을 결정하고자 methotrexate 포화검사를 시행하여 다음과 같은 결론을 얻었다. 1. Methotrexate혈중치는 methotrexate의 정맥내 주사후 30분에 최고 농도에 달하며, 그 반감기는 5.04±2.05 시간이었다. 2. Methotrexate정맥내 주사후 24시간후와 28시간후에 30mg이 folic acid를 줄때 혈중 methotrexate 평균농도는 24시간후에 50μmole/liter였고, 48시간후에 0.32μmole/liter이었다. 3. Methotrexate치료중 약제의 독성과 반감기를 비교해 본 결과 반감기가 평균보다 긴 경우 그 약제의 독성이 강한 것으로 보이나 통계적인 유효성은 없는 것으로 나타났다. Methotrexate 치료중 약제의 족성과 methotrexate 정맥주사후 48시간의 methotrexate 혈중치를 비교해 본 결과 간독성에 있어서는 유의한 차이가 없으나, 혈액학적 독성에 있어서는 methotrexate 혈중치가 평균보다 높은군이 낮은군에 비해 강한 독성이 나타났다. 이상과 같이 저자들은 methotrexate의 항암화학 요법에 있어서 강한 약제의 독성을 나타낼 가능성이 있는 환자를 알아내는데에 methotrexate 포화검사가 유용하게 쓰일 수 있으며, 약제의 독성을 나타낼 가능성이 큰 환자에 있어서는 methotrexate 혈중농도를 측정하여야 그에 따른 leucovorin rescue를 시행하여야 한다고 결론지었다. The clinical pharmacology of methotrexate, administered in conventional intravenous doses, has been studied extensively in man utilizing a variety of assay techniques. However, only a few studies have been undertaken to investigate the pharmacology of intermediate doses of methotrexate followed by delayed rescus with citrovorum factor. So, we have got following conclusion, which is drawn by methotrexate saturation test. With that, we may eliminate drug resistance which can be the main problem in methotrexate chemotherapy and we can figure it out the proper timing or dosage of leucovorin rescue for more efficient anticancer chemotherapy. The results as follows; 1. Methotrexate serum level reaches up to the highest point in 30 minutes after the intravenous infusion, and 5.04±2.05 hour is its half life. 2. In case leucovorin rescue is used, we give it folic acid 30mg, without regarding methotrexate serum level, within 24 and 48 hours after methotrexate intravenous infusion. 3. During the methotrexate chemotherapy, the relation with drug toxicity and half life remains longer than average, the drug toxicity is a not stronger. But there seems no strict statistical significance. In case of hepatotoxicity, there is no special difference between the drug toxicity of methotrexate chemotherapy and the serum level after 48 hours of methotrexate intravenous infusion. But in case of hematologic toxicity, the group of higher methotrexate serum level appear a stronger toxicity than the lower methotrexate serum level group. Therefore, authors made it a conclusion that methotrexate saturation test should be done to identify patients who would react to the drug toxicity in case of anticancer chemotherapy of methotrexate, and to administate the proper leucovorin rescue for preventing drug toxicity.

Tolfenamic Acid ( Clotam ) 의 임상적 치료효과 I. 부인과적 요통의 치료

김승조(SJ Kim),이헌영(HY Lee),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.12

부인과 영역에서 오래전부터 내려오는 난제중에 하나인 요통에 대한 tolfenamic acid의 진통효과를 알아 보기 위해 45명의 환자를 대상으로 placebo group과 tolfenamic acid를 각각 300mg/day, 600mg/day로 투여한 group간의 결과를 비교관찰하여 다음과 같은 결과를 얻었다. 1.진통효과는 placebo group보다 tolfenamic acid group에서 훨씬 우수했다. 2.Tolfenamic acid 600mg/day의 용량으로 준 group과 300mg/day의 용량으로 준 group간의 치료효과는 통계학적으로 의의가 없었다. 3.부작용은 거의 무시할 정도로 미소하였다. 그러나 2 case에서 복용을 도중에서 중도하였는데 이는 한환자에서는 urticaria exanthema가 나타났고 다른 한환자에서는 dyspepsia가 나타났기 때문이다. 결론적으로 tolfenamic acid는 부인과적 영역에서의 요통의 치료에 있어서 효과가 우수하고 부작용이 적은 약제라고 생각된다. A double-blind trial was carried out in 45 patients with gyencological lumbago in order to compare the analgesic effect of 300mg/day and 600mg/day tolfenamic acid with that of placebo. The effect as to pain relief was much better in the tolfenamic acid groups than in the placebo group. The effect of 600mg/day tolfenamic acid was not statistically significantly better than that of 300mg/day. Side effects were generally negligible although ghe medication was stopped due to urticaria and exanthema in one case and to dyspepsia in the other. It is concluded that tolfenamic acid is an effective and well tolerated regimen in the treatment of gynecological lumbago.

항HCG B-Subunit 혈청을 이용한 혈중 융모성 성선자극호르몬의 특이방사면역측정

김승조(SJ Kim),최성기(SK Choi),김철성(CS Kim),김응호(YH Kim) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.7

항 hCG B-subunit혈청을 융모성 성선자극호르몬의 방사면역 측정에 이용하여 일반 단백호 르몬의 방사면역 측정이 갖는 교차반응을 극복할 수 잇는 특이 면역측정법에 대한 검토를 한 바 다음과 같은 결론을 얻었다. 1. 125 I-hCG와 표지하지 않는 hLH를 여러항 혈청에서 경쟁결합시킨 결과 항 hLH Batch 1 혈청과 항 hTSH혈청에서 유의한 교차반응을 보였다. 2. 항 hCG혈청에서 125I-hCG와 표지하지 않은 hCG, 2nd IRP-HMG그리고 hLH를 경쟁결합 시킨결과 상호 교차 반응을 관찰할 수 잇었고 hCG와 2nd IRP-HMG는 거의 유사한 결합반 응을보였다. 3. 항 hCG B-subunit혈청에서 125 I-hCG와 표지되지 않는 hLH, 2nd IRP-HMG, hCG 그리고 hCG B-subunit를 경쟁결합 시켰을 때 특이 결합반응을 hCG, hCG B-subunit에서 관찰할 수 있었다. 4. 항 hCG B-subunit 혈청을 이용한 hCG의 방사면역 측정을 소수의 환자에서 시행한 결과 항 hCG 혈청을 이용한 환자의 혈청중의 hCG보다 낮은 수치를 보엿고 특이 측정이 된 것을 볼 수 잇었다. 5. 이상으로서 좀더 hCG B-subunit에 대한 연구가 진척되면 교차반응을 감별할 수 잇는 특 이 방사면역 측정법이 개발되리라 생각된다. Assay of glycoprotein hormones have wide and numerous applications in research of human reproduction and clinical practice. Because it is cheaper, easier to replicate, and more sensitive, immunoassay is rapidly replacing bioassay for these human hormones in research and in clinical practice. Radiommunoassay varies widely in their degree of specificity for different molecular forms, so the specificity of assay systmes for each hormone should be rigorously assessed. The problem is especially complex with the glycoprotein hormones because of their close structural similarity . Recent researches reveal that the a-subunit, comprising about half the molecule of pituitary FSH, TSH, LH and hCG are very similar to each other for these hormones. Hence one method might be the use of a specific antiserum to the B-subunit of hCG, which would react with both the B-subunit and intact hCG, but not with LH. 1. Binding of 125I-hCG after iodination with anti hCG serum were 23.34+-1.62% at the 3rd week, 13.66+-1.02% at the 4th week, and 6.90+-1.11% at the 6th week. 2. In the displacement study of 125 I-hCG unlabelled hormones from anti-hLH and anti-hTSH sera native hCG cross-reacted with both antisera. 3. Antisera to the B-subunit of hCG discriminated hCG from hLH and hMG while most of antisera produced by immunization with intact hCG did not. 4. None of glycoprotein hormones preparation tested cross reacted at physiological levels in the patients by the hCG B-subunit radioimmunoassay system. The development of that radioimmunoassay and some applications will reflect the potential clinical usefulness of the specific hCG radioimmunoassay.

산후에 일어난 난소동맥류 자연파열의 1예

김승조(SJ Kim),노영철(YC Roh),오경근(KK Oh) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.7

1. 산후 14일에 발생한 우측난소동맥류자연파열의 1예를 치험하였던 바 수술후 경과가 양호하여 술후 4주에는 완쾌되었다. 2. 임신에 합병된 동맥류에 대한 문헌적 고찰을 하였다. Spontaneous rupture of an ovarian artery aneurysm has not been reported in Korean literatures, which only 3 cases have been reported in world literatures. Since the disease accompanies a high maternal mortality, unless treated adequately, obstetrician must always be aware of the existence of this phenomena, and be ready to present a clear cut method of manage-ment for progressive retroperitoneal hemorrhage. Recently we operated on an ovarian arterial aneurysm with proximal and distal ligation of the ovarian artery. The post-operative course was uneventful.

임신 혈장 CBG를 이용한 황체 홀몬의 Competitive Protein Binding Assay에 관한 연구

김승조(SJ Kim),전정일(CI Chun),홍창수(CS Hong) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.3

In order to get available corticosteroid binding globuline (CBG or Transcortin) for the measurement of plasma progesterone, competitive binging analysis with standard progesterone after making tritiated corticosterone-CBG complex was done for the binding specificity and affinity. Preparation and isolation of CBG from the blood plasma of human pregnant women in the third trimester was accomplished with filtration by Whatman 50 and precipitation by neutral salt followed ultracentrifuge. The results was as follows. (1) The presence of CBG with high affinity and specificity for binding progesterone has established in human pregnant women. (2) Competitive binding reaction of progesterone with tritiated corticosterone-CBG complex was satisfactory for the standard curve in which obtained over the useful range of bound percent from 90%(0.5ng) to 30%(16.0ng). (3) Eventhough disc electrophoresis have suggested the presence of albumin and other protein in the stripped and precipitated plasma with neutral salt, the CBG was highly specific and strong affinity to bind with steroids.

항 황체화 호르몬 및 갑상선 자극호르몬 혈청의 면역학적 및 생물학적 특성에 관한 연구

김승조(SJ Kim),최성기(SK Choi),나종구(Rha CG),정구윤(KY Chung),남궁성은(SE Namkoog),김수평(SP Kim) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.10

Although major contributions to protein structure have been made by studies on such protein and carbohydrate containing hormones of the pituitary gland, thyrotropin(TSH), luteinizing hormone (LH or ICSH) and related placental glycoproteins, presents chemists and endocrinologists with more difficulties Certainly of major biological importance and of possible importance in clinical investigation is the discovery that one of the TSH chains TSH-a is so similar to one of the chains of LH, the LH-a chain , that they are indistinguishable in amino acid composition and probably, in amino acid sequence These similar chemical and physical properties of the two hormonoes perphaps make immunological cross reaction with some antisera to TSH and LH in vivo. petrusz et al. had made the polymorphism of protein hormone as antigen, clear by doing the biological assay for the neutralizing potency of the anti-gonadotropin serum. Lauternce and Kim investiaged that the biological action and histochemical activity in the ovary was restrained as the endogenous LH is neutralized in the rats and rabbits as the result of passive immunization with anti-LH serum Rats have two clear peak of progesterone release at proestrus and diestrus. High peak of progesterone concentration usually occur about 2 hours after LH surge during proestrus in the rats. The present experiment were desinged to determined how anti-LH and TSH antibody would react with endogenous hormones in the rat and would alter the reproductive system of the treated animals, and how was differences between Anti-LH and Anti-TSH serum on immunologic neutralizing potency of endogenous TSH in the mice and progesterone synthesis in the antibody treated rats.