요로폐쇄와 수신증을 동반한 난소의 성숙기형종에서 유래된 편평상피세포암

김시내 ( Shi Nae Kim ),이용우 ( Yong Woo Lee ),정지윤 ( Ji Yoon Jung ),문종수 ( Jong Soo Moon ),권미정 ( Mi Jung Kwon ),남은숙 ( En Suk Nam ),장봉림 ( Phong Rheem Jang ),권용일 ( Yong Il Kwon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.1

Mature cystic teratoma of the ovary is the most commom ovarian germ cell tumor and almost benign. Malignant transformation occurs in less than 2% of benign mature teratoma. Squamous cell carcinoma derived from ectoderm is the most frequent malignancy. Prognosis of squamous cell carcinoma in ovarian mature teratoma is generally poor but there is no consensus on optimal thrapy. We report one case of squamous cell carcinoma arising from mature cystic teratoma with a brief review of the literature.

만삭 전 임신부에서 분만유도 성공에 대한 임상,초음파 예측지표에 관한 연구

김시내 ( Shi Nae Kim ),박교훈 ( Kyo Hoon Park ),홍준석 ( Joon Seok Hong ),정희정 ( Hee Jung Jung ),강웅선 ( Woong Sun Kang ),신동명 ( Dong Myung Shin ),이정연 ( Jeong Yeun Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.11

목적: 만삭 전 임신부에서 분만유도 시 유도성공을 예측할 수 있는 임상적 지표와 초음파 지표를 확인하고자 한다. 연구 방법: 단태임신으로 만삭 전 (임신 37주 미만)에 분만유도를 위해 입원한 임신부 103명을 대상으로 전향적 연구를 시행하였다. 경질초음파를 사용하여 자궁경부 길이를 측정하고 내진을 통해 Bishop점수를 측정하였다. 또한 분만유도 시 임신 주수, 출산력, 나이, 체질량지수를 측정하였다. 결과: 45명 (44%)에서 성공적인 분만유도가 이루어졌다. 다변량 논리회귀분석에서 출산력, 체질량지수, 분만유도 시 임신주수는 분만유도 성공을 예측하는 데 유의한 독립변수임을 나타내었다. 그러나 분만유도 시 임신주수는 통계적인 유의성에는 이르지 못하였다 (P=0.056). 임신부의 나이와 자궁경부 길이, Bishop점수는 분만유도 성공을 예측하는 데 유의한 관련성을 나타내지 않았다. 결론: 만삭 전 임신부의 분만유도에서 출산력, 체질량지수와 분만유도 시 임신주수는 분만유도의 성공여부를 예측하는 독립적 인자이다. 그러나 자궁경부 길이와 Bishop점수는 성공 예측에 있어 유용하지는 않은 것으로 나타났다. Objective: To identify the clinical and sonographic parameters which predict the likelihood of successful labor induction in preterm women. Methods: This prospective observational study enrolled 103 consecutive preterm women (<37 weeks gestation) with singleton gestations scheduled for induction of labor. Transvaginal ultrasound for measurement of the cervical length was performed and the Bishop score was determined by digital examination. The parameters studied were gestational age at induction, parity, maternal age, Bishop score, sonographic cervical length, and current body mass index (BMI). Univariate and multivariate statistical methods were used for data analysis. Results: Successful induction of labor occurred in 45 (44%) of women. Multiple logistic regression analysis identified parity, maternal BMI, and gestational age at induction as the independent predictors of successful labor induction in preterm women, although gestational age did not reach statistical significance (P=0.056). However, maternal age, sonographic cervical length, and Bishop score did not provide independent contribution to success of induction. Conclusion: In preterm women undergoing induction of labor parity, maternal BMI, and gestational age at induction were independent parameters in predicting successful induction of labor. However, sonographic cervical length and Bishop score had poor predictive values for success of labor induction.

혈액종양 ; 미만성 거대 B세포 림프종 환자 치료 후 절대림프구수 감소율의 예후적 가치

김시내 ( Shi Nae Kim ),채의수 ( Yee Soo Chae ),김종광 ( Jong Gwang Kim ),문준호 ( Joon Ho Moon ),이수정 ( Soo Jung Lee ),김윤정 ( Yun Jeong Kim ),이유진 ( Yoo Jin Lee ),손상균 ( Sang Kyun Sohn ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

목적: 미만성 거대 B 세포 림프종에서 IPI와 절대림프구수는 예후인자로 알려져 있다. 그러나 리툭시맙을 이용한 치료에 있어 리툭시맙과 관련하여 새로운 예후인자가 필요할 것으로 생각된다. 이에 저자는 초기 병기의 미만성 거대 B 세포 림프종 환자에서 R-CHOP 요법의 생존율 관련 예후인자를 평가하였다. 방법: 2003년 8월부터 2007년 11월까지 내원한 초기병기의 미만성 거대 B 세포 림프종 환자로 계획된 R-CHOP 요법을 시행받은 마친 78명을 후향적으로 조사하였다. 생존율분석을 위해 연령, 임상수행능력, LDH, 림프절외 침범, 병기, 절대림프구수, 백혈구 감소율 및 절대림프구수 감소율에 대해 평가하였다. 결과: 초기병기의 미만성 거대 B 세포 림프종 환자 78명 중 26명(33.3%)은 병기 1기였고, 73명의 환자들은 좋은 임상수행능력을 보였으며 20명의 환자에서 LDH 증가를 보였다. IPI 분류시 저위험군은 67명(85.9%)이고, 저중등군은 8명(10.3%), 고중등군은 3명(3.8%)이었다. 전체 반응율은 100%로서 완전관해율이 94.8%였다. 생존율 분석시 전체 생존율에서는 연령이 가장 중요한 예후인자였고(p=0.006), 무진행 생존율에 있어서는 첫 R-CHOP 요법 후 절대림프구수 감소율이 유일한 예후인자였다(p=0.037). 결론: 본 연구에서 초기 병기의 미만성 거대 B 세포 림프종 환자에서 R-CHOP 요법시 나이, IPI와 함께 절대림프구수 감소율이 의미있는 예후인자임을 알 수 있었다. Background/Aims: The International Prognostic Index (IPI) and absolute lymphocyte count (ALC) are prognostic factors in diffuse large B cell lymphoma (DLBCL). Nevertheless, in the Rituximab era, a new predictive marker related to Rituximab might be needed. We evaluated prognostic factors for survival in patients with early stage DLBCL after R-CHOP (Rituximab, cyclophosphamide, adriamycin, vincristine, prednisolone) treatment. Methods: From Aug 2003 to Nov 2007, 78 patients with early stage DLBCL, who finished R-CHOP as scheduled, were reviewed retrospectively. Survival analyses were performed according to clinical parameters (age, performance status, lactate dehydrogenase (LDH), extra-nodal involvement, stage, ALC, and the rates of reduction of the white blood count (WBC) and ALC). Results: Of the 78 patients with early stage DLBCL, 26 (33.3%) were classified as stage I. Seventy-three patients (93.6%) presented with a good performance status, while LDH was elevated in 20 patients (25.6%). According to the IPI, 67 (85.9%), 8 (10.3%), and 3 (3.8%) patients were classified in the low, low-intermediate, and high-intermediate risk groups, respectively. The overall response rate was 100%, including a 94.8% complete response. Survival analysis demonstrated that the rate of reduction of ALC following the first cycle of the R-CHOP regimen was the only factor associated with time-to-progression (p=0.037), whereas age was the single most important prognostic factor for overall survival (p=0.006). Conclusions: In our study, the rate of reduction of ALC in addition to age and IPI was found to be a significant prognostic factor in patients with early stage DLBCL treated with the R-CHOP regimen. (Korean J Med 76:52-59, 2009)

원발성 중추신경계 림프종의 치료 성적에 대한 다기관 후향적 분석

문준호 ( Joon Ho Moon ),김동환 ( Dong hwan Kim ),안병민 ( Byung Min Ahn ),김시내 ( Shi Nae Kim ),전석봉 ( Seok Bong Jeon ),백진호 ( Jin Ho Baek ),김종광 ( Jong Gwang Kim ),손상균 ( Sang Kyun Sohn ),이규보 ( Kyu Bo Lee ),황정현 ( J 대한내과학회 2006 대한내과학회지 Vol.71 No.6

Background: A primary central nervous system lymphoma (PCNSL) is a rare neoplasm with a poor prognosis. The treatment of PCNSL involves a combination of chemotherapy, intrathecal chemotherapy and radiotherapy. This study retrospectively evaluated the treatment outcomes and prognostic factors of Korean patients with PCNSL. Methods: Between 1995 and 2003, 58 patients diagnosed with PCNSL from the multi-center hospitals were enrol1ed in this study. Among 56 patients who had received treatment, 16 patients were treated with radiotherapy alone, while 40 patients were treated with combined chemotherapy (CHOP; 9 cases, high-dose methotrexate; 31 cases) and radiotherapy. Results: The median age of the patients was 58 years (range, 19-76). A diffuse large B-cell lymphoma was diagnosed in 56 cases (96.6%), while a peripheral T-cell lymphoma was diagnosed in 2 cases. Of the 47 patients who could be assessed for their response after treatment, a CR and PR was observed in 32 (68%) and 11 patients (23%), respectively, giving an overall response rate of 91% (95% CI, 82~100%). The estimated 3-year overall survival rate for all the patients was 67±7.9% and the 3-year disease free survival rate was 53±8.3%. The overall survival of the high-dose methotrexate group was superior to that of the CHOP group (77±10%) versus 47±19%, p=0.05). Leukoencephalopathy was observed as a late complication in 9 patients (21%). No significant prognostic factors affecting survival were found by univariate analysis. Conclusions: Approximately half of the patients could have long-term survival after treatment in this study. High-dose methotrexate containing chemotherapy followed by radiotherapy was found to be an effective treatment. (Korean J Med 71:65i4-661, 2000)

성경험이 없는 여성의 자궁 내막에 존재한 방선균

지은정 ( Eun Jung Ji ),손혜연 ( Hyae Yeon Son ),김시내 ( Shi Nae Kim ),이용우 ( Yong Woo Lee ),장재혁 ( Jae Hyuk Chang ),정지윤 ( Ji Youn Chung ),문종수 ( Chong Soo Moon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11

Actinomyces species are anaerobic or microaerophilic non-spore-forming gram-positive rods that may reach, occasionally, the normal female genital tract. Actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). IUD and pessaries facilitate the access of the microorganisms to the pelvis. Almost 85% of cases occur in women who have had an IUD in place for 3 or more years. In fact, the detection rate of Actinomyces in patients with pelvic actinomycosis is as low as 2%. The diseases caused by Actinomyces spp. is often of difficult diagonsis. The diagnosis of actinomycosis can be confirmed by culture. However, it is often difficult to culture Actinomyces. Therefore a diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by the finding of Actinomyces-like organisms on Papanicolaou smears. The endometrial involvement is extremely rare. The authors report an unusual case of endometrial infection by Actinomyces in a 21 year-old female without intercourse, admitted into the institute with menorrhagia. She had received oral pills. Abdominal ultrasonography showed a endometrial thickening. The pre-diagnosis was endometrial hyperplasia. The endometrial biopsy was done. The sample from the endometrium developed actinomycosis. After procedure and treatment, the menorrhagia was disappeared.

조기진통 임신부에서 임상적 감염의 비침습적 예측

이성윤 ( Sung Youn Lee ),박교훈 ( Kyo Hoon Park ),오경준 ( Kyung Joon Oh ),정은하 ( Eun Ha Jeong ),김시내 ( Shi Nae Kim ),정희정 ( Hee Jung Jung ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.11

목적: 본 연구의 목적은 양막파수 없이 조기진통으로 입원한 임신부에서 비침습적 임상지표를 이용하여 입원 후 발생한 임신부 또는 신생아의 임상적 감염의 가능성을 예측할 수 있는 모형을 만들고자 하였다. 연구 방법: 양막파수 없는 조기진통(임신 20.0~35.0주) 임신부 165명에서 경질초음파로 자궁경부길이를 측정하였고 임신부 혈액에서 백혈구 수를 측정하였다. 임상적 감염은 임신부에서 분만 시 임상적 융모양막염이 발생하거나 혹은 신생아에서 선천성 패혈증이 발생한 경우로 정의하였다. 통계분석은 receiver operating characteristic (ROC) 곡선과 논리회귀분석을 사용하였다. 결과: 임상적 감염의 빈도는 5% (8/165)였다. 임상적 감염이 존재한 군은 존재하지 않는 군보다 입원 시 임신주수가 유의하게 낮았고, 자궁경부길이도 유의하게 짧았으나 백혈구 수는 유의하게 높았다. 논리회귀분석을 시행하여 최종 모형이 만들어 졌으며 이때 혈액 백혈구 수, 자궁경부길이, 임신주수가 가장 중요한 예측인자로 선택되었다. 이 모형은 Hosmer와 Lemeshow검정에서 적절한 통계적합도를 보여주었으며(P=0.202), ROC 곡선에서 area under curve값은 0.822로 측정되어 유용한 예측력을 보여주었다. 결론: 양막파수 없이 조기진통으로 입원한 임신부에서 자궁경부길이, 혈액 백혈구 수, 임신주수의 임상지표를 기반으로 한 모형을 이용하면 비침습적으로 임신부 또는 신생아의 임상적 감염을 예측할 수 있다. Objective: To develop a model based on non-invasive variables to predict the probability of subsequent maternal and/or neonatal clinical infection in women admitted to hospital for preterm labor with intact membranes. Methods: Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of white blood cell (WBC) count at admission in 165 consecutive women with preterm labor (between 20.0 and 35.0 weeks). Clinical infection was defined as the presence of clinical chorioamnionitis at delivery or early onset neonatal sepsis. Receiver operating characteristic (ROC) curves and logistic regression analysis were used for statistical analyses. Results: The prevalence of clinical infection was 5% (8/165). Women who developed clinical infection had a significantly lower median gestational age at admission, a lower shorter median cervical length, and a higher median WBC count as compared to those who did not develop clinical infection. Logistic regression analysis was performed and a final model was chosen, which included maternal blood WBC, cervical length, and gestational age as the best predictors of clinical infection. A risk score was calculated containing these 3 variables for each patient. The model was shown to have an adequate goodness of fit (P=0.202), and the area under the ROC curve was 0.822, indicating reasonably good discrimination. Conclusion: In women admitted to hospital for preterm labor with intact membranes, the risk for the subsequent maternal and/or neonatal clinical infection can be predicted non-invasively with a risk score based on cervical length at admission, maternal blood WBC, and gestational age.

만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수와 태반 염증성 병변의 관련성에 관한 연구

정은하 ( Eun Ha Jeong ),박교훈 ( Kyo Hoon Park ),오경준 ( Kyung Joon Oh ),이성윤 ( Sung Youn Lee ),김시내 ( Shi Nae Kim ),정희정 ( Hee Jung Jung ),이정연 ( Jeong Yeun Lee ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.2

목적: 만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수와 태반 염증성 병변의 존재 및 정도와의 관련성을 확인하고자 한다. 연구방법: 만삭 전 조기양막파수로 입원한 단태임신 임신부 중 양수 내 백혈구 수 측정 및 양수 배양검사를 위해 경복부 양수천자가 시행되고, 양수 천자 후 72시간 내에 조기분만(임신 24.0-35.6주 사이)되었으며, 태반의 조직학적 검사가 시행된 90명의 임신부를 대상으로 하였다. 결과: 조직학적 융모양막염의 빈도는 32%였으며 양성 양수 배양인 경우는 21%였다. 태반 염증성 병변이 존재하는 경우는 존재하지 않는 경우에 비하여 양수 내 백혈구 수가 유의하게 많았다. 양수 내 백혈구 수는 교란변수의 영향을 보정한 후에도 태반 염증성 병변의 존재와 유의한 관련성을 나타내었다. 또한 양수 내 백혈구 수는 각각의 태반 부위별 염증 정도가 심할수록 유의하게 증가하였다. 태반 염증성 병변 존재를 가장 잘 예측할 수 있는 양수 백혈구 수의 절단치는 25개/mm3였고 이때 민감도 62%, 특이도 77%를 나타내었다. 결론: 만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수는 태반의 염증성 병변의 존재 및 정도와 유의한 관련성을 가지고 있으며 산전에 이의 존재 유무를 예측할 수 있는 독립적 인자이다. Objective: To examine the relationship between amniotic fluid (AF) white blood cell (WBC) count and the presence and severity of inflammatory lesions of the placenta in women with preterm premature rupture of membranes (PPROM). Methods: This retrospective cohort study included 90 consecutive women with PPROM (24.0-35.6 weeks) who met the following criteria: singleton gestation; transabdominal amniocentesis performed to obtain AF for culture and WBC count; delivery within 72 hours of amniocentesis; placental histologic examination after preterm delivery. Results: The prevalence of histologic chorioamnionitis was 32% (29/90) and that of positive amniotic fluid culture was 21% (19/90). Patients with histologic chorioamnionitis had a significantly higher AF WBC count than those without this lesion. Logistic regression analysis demonstrated that AF WBC count had a significant relationship with histologic chorioamnionitis after controlling for gestational age and AF culture. The median AF WBC count increased significantly according to the higher severity of inflammation in each type of placental histologic section. According to receiver operating characteristic curve analysis, the best cut-off value of AF WBC count for predicting histological chorioamnionitis was 25 cells/mm3, with a sensitivity of 62% and a specificity of 77%. Conclusion: Both the presence and greater severity of inflammatory lesions of the placenta are associated with an elevated AF WBC count. AF WBC count is an important and independent predictor for inflammatory lesions of the placenta in women with PPROM.