융모종양에 관한 임상병리학적 고찰

김영기(YK Kim),정원영(WY Chung),(J.V.Thorborg) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.2

1958년 11월부터 1963년 9월말까지 (4년 10개월간) 국립의료원 산부인과 및 병리학과에서 취급한 융모종 73예에 대하여 병리조직학적으로 재검토분류하여 임상적으로 고찰하였다. 그 중 포상기태 35예(48%), 파회성 융모선종 10예(14%), 및 융모암 28예(38%)였으며 동기간 중 관찰한 총여성성기악성종양 540예에 대한 융모암의 발생율은 4.9%이었고, 융모종은 동기간 중 총임신(4726예)의 1.3%에 해당하며, 0.6%가 융모암이었다. 즉 77임신에 대하여 융모종이 1,169임신에 대하여 융모암이 1의 비율을 보였다. 이와같은 높은 빈도는 Asia각국의 보고-인도,중국, 대만, 홍콩, 싱가폴, 필리핀등-와는 대체로 비슷하였으며, 구미각국의 보고와는 현격한 차이를 나타내고 있다. 또한 특기할 만한 차이는 포상기태와 융모암의 빈도를 비교하면 구미에서는 포상기태가 융모암보다 적어도 10배 정도의 고율을 보이는 데 반하여 저자등의 관찰에서는 양자간에 큰 차이가 없었다. 이와같은 차이는 독일인 Huwer씨가 부산에서 경험한 융모종에 관한 발표에서도 일치된 소견을 보았다. 융모종의 발생기전에 관하여 흥미있는 면역학적 관찰을 제창한 Scott씨가 말한 바와 같이 고령, 초임부에 발생빈도가 높다던가 혈액형의 분포에 관한 뚜렷한 차이등은 본관찰에서는 발견하지 못하였다. 1)포상기태 26예의 포상기태 중 15예에서 최종정상월경후 3∼4개월에 진단되었고, 거이 전예에서 자궁출혈이 주소이었다. 무월경기간에 비하여 자궁의 크기가 이상적으로 컸던 것이 12예, 일치된 것이 4예, 오히려 적엇던 것이 10예이었다. 포상기태 가료후 파회성 융모선종 8예, 융모암 2예의 병발을 보았으며, 5예에서 정상분만을 하였고, 반복성 태상기태는 볼 수 없었다. 80%이상이 자궁소파술 실시후 4주이내에 뇨의 임신반응 검사가 음성으로 변하였으며 계속 양성이었던 2예에서는 후에 융모암으로 발전하였다. 포상기태 전예 중 10예에서 1년 이상 follow up할 수 있었다. Hertig 및 Sheldon씨의 분류법에 의하여 포상기태에 있어서 trophoblastic proliferation의 정도를 재검토조사하여 본 결과 대부분의 예에서 중등도의 증식을 관찰할 수 있었으며, 포상기태가 파회성융모선종 혹은 융모암을 병발하였던 몇 예에서만 약간의 현저한 융모세포 증식을 볼 수 있었던 사실 외에는 별다른 예후에 관한 관련성을 찾아 볼 수 없었다. 2)파회성 융모선종 10예 중 3예에서는 조직학적 진단이 불명확 하였다. 1예를 제외한 전예에서 포상기태가 선행 되었고 1예는 정상분만후에 발생 하였다.3예에서 패전이를 보았으나 융모암으로 변한 예와 사망한 예는 없었다. 9예에 자궁적출술을 시행하였으며, 패전이한 3예(그중 1예는 방광벽까지 침윤되었슴)methotrexate를 투여하여 좋은 효과를 보았다. 3)융모암 최종선행임신은 포상기태가 10예로써 가장 많으며 정상분만이 8예, 인공 혹은 자연유산이 4예였다. 융모암에서도 부정성기출혈이 주소였으며 병리조직학적으로 진단 확정된 22예 중 5예에서만 전이를 볼 수 없었고, 패전이가 가장 많았다.(16예) 5예에서 수술 혹은 methorexate 투여후 8주 이내에 뇨의 임신반응이 음성화 하였고, 16예에서는 지속적으로 양성이었으며 1예에서는 치료전부터 음성이었다. 22예 중 7예는 발병후 3개월 내지 4년이내에 사망하였고, 그 중 6예는 2년이내에 사망하였다. 전이를 일으킨 예는 대다수에 있어서 전신상태가 극히 불량하였으며, 거이 사망 직전에 있었다. 5예에서 부검

산아 손실에 관한 임상적 고찰

주갑순(KS Ju),김영기(YK Kim) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.5

An analysis of stillbirths and neonatal deaths chiefly based upon autopsy findings during the period from Jan 1, 1959, through August 31, 1962(for 3 years and 8 months) was undertaken on the obstetric ward of the NMC. There were 3,059 deliveries with 49 cases of twin births. Therefore, total number of bieths were 3,108 and of these 3,019 were livebirths. The total number of perinatal mortality was 138. But as the charts of 6 cases were missing, only 132 cases were available to study. There were 89 stillbirths and 42 neonatal deaths. The perinatal mortality mortality index was 44.4 per 1,000 deliveries, purpose of presenting this study are: 1) to investigate perinatal mortalily in NMC. 2) to determine the causes of perinatal death and point out preventable factors. 3) to improve prenatal, obstetrical and early postnatal care, in order to reduce further the number of stillbirths and neonatal deaths. The major causes of death were reviewed and tubulated. The majority of perinatal death is directly related to maternal complications. Almost half of the cases (48.5%) were associated with anoxia from abruptio were encountered most ferquently. Prematurity was a factor in 61% of perinatal deaths, and prematurity with its associated conditions accounted for two thirds of the deaths. Forty-seven cases(35.6%) of perinatal death were judged to have been preventable. Had they been prevented, the perinatal mortalty rate would have been reduced from 44.4 to 28.6. Even if it is most likely that not all of these babies could have been salvaged, it was felt that in many of these cases the outcom would have been much better if the patients could be given competent medical care from the very moment the complication started. in many cases the patients(unregistered) condition had previously been neglected, so they had to be brought to the hospital as an emergency case when serious complication developed. Unregistered cases ; 87(65.9%) Registered cases ; 45(34.1%) In oder to reduce the perinatal mortality I would like to stress the importance of conscientious prenatal care. Further still much research is needed in the many field of medicine which are related to the perinatal mortality problem. If the interest for these problems could be stimulated among the medical persons handling pregnant women, much improvement might be expected.

자궁근종에 대한 암상병리적 관찰

최근해(GH Choi),김혜경(HK Kim),김영기(YK Kim),이교웅(KW Lee) 대한산부인과학회 1966 Obstetrics & Gynecology Science Vol.9 No.5

The uterine myoma is most common tumor of the uterus, its incidence has been estimated that 1 out of 4 or 5 women over 35 years. Uterine myoma make their appearance during the reproductive era and tend to shrink after menopause. In the present clinico-pathological observation, we submitted for analysis of 252 cases of uterine myoma admitted to Gynecologic Department of The National Medical Center from the beginning of 1959 to the end of August 1964. Total number of laparotomies (excluded obstetric operation) during same period was 1,032 cases and among those cases 24.2% was performed upon women due to uterine myoma. We summarized the result as follows: 1) Age frequency of the patients when operation performed, the peak frequency period was 40~49(58%) and no cases encountered before the age of 20 years. The youngest age was 21 and the oldest was 66. 2) Majority of cases were corporeal myoma, 87.2%, whereas cervical myomas were 10.3% and mixed forms were 2.5%. 3) Intramural myomas were most common type of uterine myomas(36%), mixed forms were 22%, subserous myomas were 21.2% and submucous myomas were 20.8% as order. 4) The most common physical sign was palpable mass in the pelvic cavity, more than a half of those cases revealed 12~14 weeks pregnant size, while the largest one is frll term pregnant size. Pain in the pelvic region or lower abdomen was most frequent complaint (80.6%) and 78.4% of the patients complained uterine bleeding. In most instances of uterine bleeding associated with uterine myoma was mono-metrorrhagia(61.1%). Meno-metrorrhagia was more frequently seen in the mixed forms and submucous myomas. Pressure symptoms were not infrequently found in the myoma cases, more frequent in the mixed forms, and rarely seen in the submucous myomas. 5) Pregnancy was experienced in 76.3% of patients and average pregnancy rate was 2.9. Infertility was observed 57.2% of uterine myomy cases and among those cases primary infertility was 22.8% and secondary infertility was 34.4%. Infertility was more frequently seen in the subserous myomas and mixed forms. Spontaneous abortion has been experienced in 9.6% of total cases of uterine myoma during previous pregnancies, 3.3% of total number of pregnancies, and which was more often in submucous myomas. 6) If 베흐% hemoglobin was used as a tentative borderline for anemia, 44.6% of patients were anemic and among those cases 9.6% had severe anemia (less than 5gm.%). 7) The most common of all secondary changes of uterine myomas was hyaline degeneration, 19.8%, and sarcomatous degeneration was observed only 3 cases (1.2%), while no cases of fatty degeneration was seen. 8) Associated conditions were found in 67.1% of all patients and ovarian tumor was more often than PID. Adenomyosis associated with uterine myomas were seen in 13.1% of cases, whereas 1 case(0.4%) of endometriosis could be seen. 9) Total abdominal hysterectomy was the most common remedy for symptomatic uterine myomas, 63.2% and subtotal hysterectomy was performed in 21.4% of all cases. Mymectomy was performed in 14.3% for selected cases of child bearing age. Expectant treatment was done with effects in 1.6%, vaginal total hysterectomy was 0.8%, total hysterectomy with cesarean section and radical hysterectomy was performed in 0.4% respectively. 10) Postoperative complications were seen in 7.3%. The largest incidence of morbid cases were urinary tract infection, 3.7% and the ureter damage during operation accounted for the second greatest incidence.

냉해동 적혈구의 제조 및 동물 수혈실험의 평가

임채승 ( Cs Lim ),정현진 ( Hj Chung ),이민용 ( My Lee ),홍태의 ( Tu Hong ),김영기 ( Yk Kim ),이갑노 ( Kn Lee ),한규섭 ( Cs Han ) 국군의무사령부 1996 대한군진의학학술지 Vol.27 No.1

산후 우울증에 관한 임상적 연구

김영기,허창규,박정돈,고석봉,황진영 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

목적: 산후 우울증은 산모와 그 가족 및 아기의 발달에도 영향을 미치는 심각한 질환이다. 산모의 10-15%에서 발생하며 조기에 치료가 시작되지 않으면 불행한 결과를 초래한다. 이에 저자들은 산과의 들이 산후우울증에 대한 관심을 기울여 산후 우울증의 예방 및 치료에 도움이 되고자 산후 우울증의 발생인자에 대한 조사를 하였다. 연구 방법: 1998년 1월 1일부터 1998년 2월 28일 까지 만 2개월간 대구 효성 가톨릭 병원 산부인과에 분만을 위해 입원한 산모 138명을 대상으로 산욕기에 실시한 설문지의 내용을 바탕으로 하여 이들의 연령, 학력, 종교, 결혼방식, 직장유무, 시부모와의 동거 여부, 분만 경험 유무, 임신하기까지의 어려움 유무, 계획된 임신인지의 여부, 분만 방식, 출산아 성별, 출산아 성별의 만족 여부, 신생아 양육 계획 등을 조사하여 이들의 출산 후 우울증의 발생빈도와 연관시켜 조사하였다. 결과: 조사한 13가지 항목 중 임신이 안되어서 어려움이 있었던 군, 제왕절개술로 분만했던 군, 계획하지 않고 우연히 임신된 군에서 산후우울증의 발생빈도가 높았으며, 통계적으로도 유의한 상관관계가 있었다 [p$lt;0.05]. 결론: 위의 결과를 토대로 산과의는 산후 우울증 발생에 의미 있는 요소를 가진 환자에게 관심을 가짐으로써 산후 우울증의 예방 및 조기치료로 산모와 그 가족의 불행을 막는데 기여할 수 있을 것이다. Objective: Postpartum depression is a kind of serious problem which influences on the parturients, her family and the growth of the newborn infant. It usually arises in 10 to 15% of the parturients. If they are not treated early enough the unhappy seriousness can be resulted. This study was undertaken to motivate and help obstetrician in preventing and treatment of postpartum depression by early detection of causative factors. Methods: Beck Depression Inventory [21 questions in the questionnaire] was used to 138 parturients who visited to Taegu Catholic medical center for delivery, from January 1, 1998 to February 28, 1998. Many factors including age, education, religion, type of marriage, work during pregnancy, living with parents of husband, experience of delivery, difficulty for success of pregnancy, planned pregnancy, delivery method, sex of newborn, satisfaction with sex of newborn, and nursing plan of newborn were evaluated, and the relations with the incidence of postpartum depression was studied. Results: Among the researched 13 factors, there were significant relationship between difficult pregnancy success group, cesarean section group, unplanned pregnancy group and increased frequency of postpartum depression[p$lt;0.05]. Conclusion: Based on the above results, paying attention to the patients who had various factors for developing postpartum depression could contribute to prevent unhappiness of patients and her family.

Immunoassay분과 신빙도조사 결과보고(2002)

김현숙,임환섭,권오헌,김덕언,김영기,김영란,김진규,신섭,정영순,조한수 대한임상검사정도관리학회 2003 臨床檢査와 精度管理 Vol.25 No.1

농축 적혈구에서 백혈구 제거용 필터 Bio R02plus™의 평가

서인범,마경란,조성준,장은아,임채승,김영기,이갑노 大韓輸血學會 2002 大韓輸血學會誌 Vol.13 No.2