Mayer-Rokitansky-Kuster-Hauser 증후군의 2 예와 williams 수술 2 예

박영순(YS Park),이정호(JH Lee),김현수(HS Kim),김종우(CW Kim) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.2

Mayer-Rokitansky-Kuster-Hauser 증후군의 2 예와 williams 수술 We descrive two case of M.R.K.H syndrome and william`s operation were reviewed briefly. The Mayer-Rokitansky-Kuster-Hauser syndrome refers to the clinical entity consisting of - Normal female secondary sex charateristics - Normal external genitalia - congenital absence of vagina - A rudimentary uterus in the form of bilateral noncanaliculated muscular buds. - Normal tubes and ovaries with normal cytogenetic and endocrine evaluation

인 유두종 바이러스 재조합 단백질을 이용한 자궁경부암 환자의 면역진단법

김승조,남궁성은,지용헌,박종섭,김현수,박순희,정노팔 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.7

자궁경부암 전구병소 및 자궁경부암 환자의 혈청에서 human papillomavirus(HPV)의 항체를 검출하는 것이 이들 병소들의 진단에 도움이 되는지 여부를 연구하기 위해 HPV-6b, HPV-16의 ORF 재조합 단백질을 합성할 수 있는 vector를 가진 대장균들을 M9배지에서 단백질 합성 유도제로 처리하여 새로운 단백질 합성을 유도하였고, 환자 혈청을 이용한 HPV ORF 단백질 항체 검사를 위하여는 각각의 재조합 단백질 clone으로 대장균 배지를 이용하여 각각 다량의 재조합 단백질 합성을 하였다. 실험대상은 자궁경부 상피에 아현성 HPV 감염병변이 있거나 자궁경부 상피이형증 또는 상피내암의 자궁경부암 전구병변 환자 25명과 자궁경부암 환자 81명의 혈청을 사용하였고, 정상대조군으로는 자궁경부의 HPV 감염이나 전암 병변이 없고 연령이 실험군과 비슷한 양성부인과 환자 40명의 혈청을 사용하였으며 그 결과는 다음과 같다. 40명의 정상대조군에서 HPV-6b ORF 재조합 단백질에 대한 항체는 E6는 4명(10%), E7는 3명(8%), L1은 7명(18%), 그리고 L2는 2명(5%)에서 양성이었다. 자궁경부 상피내 병변화자 25예에서는 E6와 E7에서 각각 7명씩(28%) 양성으로 나타났으며, L1은 2예(8%)에서, L2는 3예(12%)에서 양성이었다. 또한 81명의 자궁경부암 환자들의 혈청에서 HPV-6b ORF 재조합 단백질에 대한 항체 형성여부는 E6에서 12%, E7에서 14%, L1에서 7%, L2 단백질에서 6%로서 정상대조군에 비하여 차이를 보이지 않았다. 그러나 자궁경부 상피내 병변 환자들의 양성율(40%)는 자궁경부암 환자들의 양성율(19%)에 비하여 유의하게 높았다(p=0.027). HPV-16 ORF 재조합 단백질에 대한 항첸ㄴ 정상대조군에서 E6는 1명(3%), E7는 3명(8%)에서 양성이었으며, 그중에서 한 종류의 항체에도 양성을 보인 경우는 4예(10%)였다. 자궁경부 상피내 병변환자 25예에서는 E6에서 12명(48%), E7에서 8명(32%), L1에서는 7명(28%)이 양성으로 나타나 다른 종류의 단백질에 비하여 각각 유의하게 높은 양성율을 보였다(P$lt;0.05). 81명의 자궁경부암 환자들의 혈청에서 PHV-16 ORF 재조합 단백질에 대한 항체 형성은 E6단백질에서 27명(33%), E7에서 29명(36%), L1에서 30명(37%), L2단백질에서 9명(11%)에서 양성으로 나타났고, E7, L1단백질은 각각 유의한 증가를 보였다(P$lt;0.05). 자궁경부암 환자에 SIL환자들의 혈청내에서 한 종류의 항체라도 양성으로 나타났던 경우는 13예(52%), 54예(67%)로 정상대조군의 경우보다 각각 유의하게 높은 양성율을 보였다(P$lt;0.01). 자궁경부암 환자들의 각 임상기에서 각 HPV-15 ORF 항체들의 양성율을 비교한 바 E6 단백질은 임상기가 증가할수록 양성율이 감소함을 관찰할 수 있었으나(P=0.011), 다른 단백질은 임상기에 따라 유의하게 차이가 나는 특이한 변화를 관찰할 수 없었다. 이상의 결과로 HPV-6b, HPV-16의 재조합 단백질은 자궁경부암 환자의 혈청에서 HPV 감염에 대한 면역학적 진단에 도움을 줄 수 있고, HPV-1 E7과 L1단백질에 대한 항체는 자궁경부암 환자의 혈청에서 바이러스와 질환에 대한 특이표지물질로서 사용이 가능하리라 사료된다. Host factors are important in determining the outcome of genital human papillomavirus(HPV) infection as demonstrated by an increase in cervical cancers in immunosuppressed patients. HPV proteins may represent immunological taret such as serum antibodies against HPV infection. However, evaluation of the antibody response in patients exposed to high-risk HPV types has been hampered by the lack of a readily available source of viral proteins for use as taret antigens in serologic assays. The goals of the study presented here are 1) to determine whether serum antibodies recognized HPV fusion proteins, 2) to identify which antigens are targets of the humoral immune response, and 3) to assess the prevalence of HPV antibodies in defined populations. In this study, the assay was tested on selected group of sera from the patients with carcinomas(n=81), squamous intraepithelial lesions(SILs)(n=25) of uterine cervix and normal controls(n=40) using the purified TrpE fusion open reading frame(ORF) proteins of HPV-6b and HPV-16 by Western blot immunoassay. Restriction enzyme fragments from ORFs of HPV-6b and HPV-16 were expressed in E.Coli as tryptophan E synthetase-HPV fusion proteins through the expression vector PATH. Each fusion protein was induced by 3-indoleacrylic acid and was purified from the bacterial lysates for polyacrylamide gel electrophoresis and Western blot immunoassay. Among women with cervical cancer, 15/81 (19%) and 54/81(67%) were positive for antibodies by Western blot immunoassay to any gene products of HPV-6b and HPV-16, respectively. And in 25 patients with HPV-related SIL, 10 (40%) were positive for any of bodies(44%). The positive prevalence rate for HPV-6b in the sera of SIL patients was significantly higher than that of in the sera of cervical cancer patients(P$lt;0.05). The prevalence rates of antibodies to ORF proteins of HPV-16 in the sera of cervical cancer patients were 12%(10/81; E1), 10%(8/81; I2), 21%(17/81; E4), 33%(27/81; E6), 36%(29/81;E7), 37%(30/81; L1), and 11%(9/81; L2) respectively, while 8%(8/25) for E7, 28%(7/25) for L1, and 8%(2/25) for L2 among the patients with HPV-related cervical patients was significantly higher than that of in the sera of normal controls(P$lt;0.01). There was decreasing pattern of positivity against E6 protein of HPV-16 with the severity of cervical cancer, but there were no significant differences in positivities of other antibodies in the patients of cervical cancers according to the different stages of disease. These results suggest that the recombinant proteins from HPV-6b and HPV-16 may be useful in the immunologic diagnosis of HPV-related cervical SILs and cervical cancers respectively and antibodies to HPV-16 E7 and L1 proteins appear to be virus-specific and disease-specific markers for HPV-associated cervical neoplastic lesions.

자궁경부암 환자에서 ELISA를 이용한 HPV-16 VLP에 대한 혈청반응

김승조,남궁성은,박종섭,김현수,김찬주,박순희,안희경,황은성,정근택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

1993년 1월부터 1994년 12월까지 가톨릭대학교 의과대학 강남성모병원 산부인과 종양학부에서 진단 및 치료를 받았던 환자들에서 치료전 채취한 혈청과 자궁경부 세포를 이용한 실험결과 다음과 같은 결론을 얻을 수 있었다. 1. 자궁경부암 전구병변 환자 20명은 HPV-16에 양성이었고, 나머지 4명은 다른 아형의 DNA HPV가 있거나, 발견되지 않았다. 96명의 자궁경부암 환자에서 69명은 HPV-16 DNA, 9명은 HPV-18 DNA에 양성이었고, 그외 3명은 HPV-16과 HPV-18이 동시에 발견되었다. 또한 7명에서는 다른 아형의 HPV DNA가 있었고, 나머지 8명은 HPV DNA를 발견할 수 없었다. 2. HPV-16 L1, L2 VLP에 대한 ELISA 결과는 정상 대조군의 9%에서 양성이었고, 자궁경부 전구병변의 환자에서는 50%(12/24), 자궁경부암 환자의 62.5%에서 각각 양성으로 나타나 자궁경부의 종양성 변화가 있는 환자에서 유의한 진단적 가치가 있었다. 3. HPV-16 DNA에 양성인 자궁경부암 환자의 68%(47/69)에서 HPV-16 VLP ELISA에 양성이었고, HPV-18 DNA에 양성인 환자의 44%(4/9)에서 HPV-16 VLP ELISA에 양성이었으나 HPV-16/18이외의 다른 HPV 아형에 양성인 환자에서는 14%(1/7)에서 ELISA 양성으로 나타나서 HPV-16또는 HPV-18 DNA 양성인 환자들과 다른 종류 HPV DNA에 양성인 환자들 사이에서 항체 반응 여부는 통계학적인 차이가 있었다. 4. 자궁경부암 환자의 임상기와 조직학적 특성에 따른 HPV-16 VLP에 대한 항체 형성을 관찰해 본 결과 각 임상기와 조직형에 따른 차이를 관찰할 수 없었다. 이상의 결과로 자궁경부암과 전구 병변 환자들의 대다수에서 ELISA 방법으로 HPV-16 VLP에 대한 항체 형성을 관찰할 수 있었다. 또한 HPV-16 VLP ELISA 검사는 HPV-16 DNA 검사의 보조진단법으로 유용하며, HPV와 연관된 자궁경부 종양성 질환의 혈청학적 역학 연구에도 도움을 줄 수 있을 것으로 사료된다. Background: The late structural proteins of HPV-16 have recently been shown to self-assemble into virus-lide particles(VLPs) from baculovirus system when expressed in insect cells. The ability to generate preparative amounts of HPV-16 L1-L2 VLP may have implications for the development of a serologic assay to detect anti-HPV-16 virion immune responses to conformational epitopes and for immunoprophylasis against HPV-16 infection. Methods: We attempted to investigate serologic responses in the sera obtained from Korean women with cervical neoplasia by ELISA using HPV-16 VLPs. PCR method using L1 consensus primers and type-specific oligomer probes was used to determine the presence and type of HPV infection in the study population(normal control; 23 cases, preinvasive lesions; 24 cases, and invasive cervical cancers; 96 cases). Result: 1) The sera of 93%(21/23) of women, who didn`t have HPV-ralated cervical lesions, were negative for HPV-16 VLPs in ELISA assay. The sera of 50%(12/24) of patients with preinvasive cervical lesion and 63%(60/96) of patients with invasive cervical cancer were ELISA positive for HPV-16 VLPs(p$lt;0.01). 2) The positive reactivities for ELISA of HPV-16 VLPs in cervical cancer patients according to clinical characteristics were nor signific antly different. 3) Among women with cervical neoplasia, HPV 16 VLP was positive in 50%(10/20) of HPV-16 positive cases with preinvasive cervical lesion and 72%(50/72) of HPV-16 positive cases with invasive cervical cancer. Conclusion: These results suggest that the considerable number of patients with cervical neoplasia generated an IgG antibody response to the HPV 16 VLPs that can be detected by ELISA. These HPV-16 VLP ELISA may be useful in adjunctive diagnostic asay to HPV-16 DNA test and seroepidemiologic study of HPV-related cervical neopl-asia.

자궁경부암에서 HPV-16 단백질을 이용한 혈청내 진단물질의 임상적 효용성

김승조,남궁성은,박종섭,김현수,김찬주,박순희,안희경,정근택,박동춘,유왕돈 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Background : Most markers in current clinical use are not cancer-specific, but the ideal tumor marker should be specific for cancer, highly sensitive, clinically practicable, inexpensive, and acceptable to individual. it is still debating that SCCA and CEA are clinically useful for specific tumor markers in management of cervical cancers. Recently, a variety of HPV- related proteins have been synthesized and their utility as diagnostic and prognostic tumor markers in cervical cancers is needed to be assessed by comparing the previous tumor markers ; CEA and SCCA. The early proteins(E6 & E7) of HPV-16 which are responsible for malignant transformation could be constructed by in vitro transcription and translation and the late structural proteins(L1/L2) of HPV-16 have been shown to self-assemble into virus-like particles(VLPs) from baculovirus system when expressed in insect cells. The ability to generate preparative amounts of HPV-16 E6, E7 proteins and L1/L2 VLPs may have implications for the development of a serologic assay to detect anti-HPV-16 virion immune responses to conformational epitopes of HPV-associated cervical neoplasia. Methods : We attempted to investigate serologic response in the sera obtained from Korean women with cervical neoplasia by RIPA(radioimmunoprecipitation assay) using in vitro translated HPV-16 E6, E7 proteins and ELISA using HPV-16 L1/L2 VLPs, PCR method using E6 type-specific primers and probes for HPV-16/18 was used to determine the presence and type of HPV infection in the study population(normal controls ; 15 cases, preinvasive lesions ; 28 patients, and invasive cervical cancers; 124 cases). Result : 1) The sera of 0% of preinvasive lesions and 34%(42/124) of cervical cancers were positive for SCCA and the sera of 0% of preinvasive lesions and 18% (22/124) of cervical cancers were positive for CEA. The positivity of SCCA was increased with advancing clinical stages, but the antibody levels were not correlated with clinical outcome of disease. 2) The sera of 7%(2/28) of preinvasive lesions and 51%(63/124) of cervical cancers were positive for in vitro translated HPV-16 E6 protein(P$lt;0.05) and the sera of 11%(3/28) of preinvasive lesions and 33%(41/124) of cervical cancers were positive for in vitro translated HPV-16 E7 protein(P$lt;0.05). The levels of HPV-16 E6 proteins showed high titers in some invasive cancers, but they didn`t show any fluctuations along with clinical outcomes. In contrast, the antibody levels to HPV-16 E7 protein were correlated to clinical stage and tumor burden in a significant number of cervical cancers. 3) The sera of 7% (1/15) of normal controls, 39%(11/28) of preinvasive lesions and 56% (70/124) of cervical cancers were ELISA positive for HPV-16 L1/L2 VLPs(P$lt;0.05). The positive reactivities for HPV-16 L1/L2 VLPs in cervical cancers by clinical stage, histopathology or HPV DNA types were not significantly different. Conclusion : These results suggest that the considerable number of patients with cervical neoplasia generated positive antibody response to in vitro translated HPV -16 E6, E7 proteins and L1/L2 VLPs. These HPV-16-associated proteins might be disease-specific markers which could be useful in adjunctive diagnostic assay and seroepidemiologic study of HPV-related cervical neoplasia. Especially, the monitoring of antibody to HPV-16 E7 protein seems to be valuable in proper management of cervical cancers for specific tumor marker.

양성 난소기형종과 합병된 갑상선성유암종 1 예

이규완,김현수,김탁,장기훈,김종오 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Ovarian strumal carcinoid associated with mature cystic teratoma is rarer entity. Strumal carcinoid of the ovary is a type of germ cell tumor characterized by an intimate mixture of thyroid tissue and carcinoid. They are usually seen in postmenopausal women, and always bilateral. It is always benign, and treatment with a simple oophorectomy or salphingoophorectomy is effective. A case of strumal carcinoid with teratoma of the ovary in a 36 year old woman was presenter and reviewed briefly.

산후출혈로 인한 대량수혈로 생긴 합병증치험 1 례

서호석,이경호,김현수,김탁,문준,오민정,고희경,정경우 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Postpartum hemorrhage is a major cause of maternal morbidity. In developing nations, where maternal mortality rates are five to ten per 1,000 live birth, postpartum hemorrhage remains a leading cause of maternal death. Most cases of postpartum hemorrhage are due to uterine atony, retained placenta, maternal soft-tissue trauma, or a combination of these factors. Hemorrhage is thus often perceived as a sporadic, unpredictable event, making it difficult to counsel patients rationally. We report a case of massive transfusion and its complication following massive bleeding after vaginal delivery.

임신 38 주에 진단된 자궁경부암 1 례

강재성,김선행,김현수,김용민,이용호 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

The incidence of invasive cervical cancer associated with pregnancy was one in 2,200 pregnancies. The diagnosis of cervical cancer in pregnancy is often delayed because bleeding is attributed to pregnancy-related cmplications. All pregnant patients should have a cytology at the initial antenatal visit, and any grossly suspicious lesion should be subjected to biopsy. We experienced one case of invasive squamous cell carcinoma at 38 weeks of pregnancy, which had referred from private clinic. So we report the case and brief review of literature.

자궁경부 이형증에서 3 가지 자궁경부 원추생검법의 비교분석 (원추생검 , 레이저 원추생검 , 환상투열요법)

이은영,이규완,김현수,김용민,정윤돈,정수경,박지원 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

1992년 1월부터 1996년 6월까지 고려대학교 안암병원 산부인과에서 세포진검사 또는 착공생검을 시행한 후 자궁경부 이형성증으로 진단된 74명의 환자를 대상으로 다른 세 가지 방법의 원추생검(원추생검, 레이저원추생검, 환상투열요법)을 적용하여 이 세 방법의 유용성을 비교, 분석하였다. 1. 대상 환자는 모두 74명이며, 이 중 13명은 원추생 검, 37명은 레이저원추생검, 24명은 환상투열요법을 적용하였다. 2. 세 방법에서의 평균 수술시간은 원추생검이 30분, 레이저원추생검이 23.7분, 환상투열요법이 8.7분으로 환 상투열요법이 가장 수술 시간이 짧음을 알 수 있었으며 세 군간에도 유의한 차이를 보임을 알 수 있었다 (p=0.0001). 3. 수술 후 조직검사에서 조직의 절단면(resection margin)이 양성인 경우는 원추생검에서 2명(15.4%), 레이 저원추생검에서 2명(5.4%), 환상투열요법에서 2명(8.3%) 등으로 레이저원추생검에서 가장 낮은 빈도를 보였지만 통계적으로는 유의한 차이를 발견할 수 없었다(p=0.585). 4. 조직검사 과정에서 조직상에 레이저나 전기로 인 한 인공산물(artifact)이 발생한 경우가 레이저원추생검에 서 4명(10.8%), 환상투열요법에서 4명(16.6%) 등으로 레이저 원추생검의 경우가 가장 낮은 발생 빈도를 보였지 만 통계적인 유의성은 관찰할 수 없었다(p=0.131). 5. 수술 후 정기적으로 시행한 세포진검사에서 이상 세포가 계속적으로 발견된 경우는 원추생검에서 2명 (15.4%), 레이저원추생검에서 2명(5.4%), 환상투열요법에 서 2명(8.3%)으로 레이저 원추생검술이 가장 낮은 빈도를 보였지만 통계적 유의성은 없었다(p=0.585). 이상의 비교를 종합해 보면 세 방법에서 수술시간을 제외한 다른 비교에서 차이가 없어 조기암이나 침윤암이 의심되는 경우는 조직검사의 정밀성을 고려하여 인 공산물이 나타나지 않는 원추생검이, 그 외 전암병변이 의심되는 경우 수술시간이 짧고 환자 비용부담이 낮은 환상투열요법이 더 유용한 방법으로 보여진다. The treatment of cervical intraepithelial neoplasia ranges from total hysterectomy to local destructive methods. The need for conservative treatment has increased as more lesions are being detected in young women who have not completed their family. Laser conization has been used to manage CIN since 1976. The use of loop diathermy was first described in 1981. This study was designed to compare the treatment reliability, efficacy, and safety of laser and cold knife conization and LEEP. From January 1992 to December 1995, 74 patients were enrolled. They were all cervical intraepithelial neoplasia. They were performed three techniques of conization: Cold Kinfe, Laser, and LEEP. The results were as follows: 1. All 74 patients were examined: 13 Cold Knife cases, 37 Laser cases, and 24 LEEP cases. 2. The mean age was 40.2 years (range 18∼70 years). 3. Mean operation time was less in the LEEP group (p=0.0001). 4. During the pathological review of the conization, there were no differences in the three groups (p=0.585). 5. The major problem was difficulty in evaluating the lesion and its margins due to the coagulation induced by the laser or the LEEP: 4 cases (laser group) and 4 cases (LEEP group). 6. During postoperative follow-up, the number of abnormal Pap smear (2 cases)was the same in the three groups (p=0.585). These results suggest that LEEP is quicker, safer, and lower cost than laser and cold knife conization for the management of cervical intraepithelial neoplasia. The assessment of the margins is better with the cold knife conization than with the laser or the LEEP.

육종성 과증식을 보이는 자궁의 M llerian Adenosarcoma 1 예

이은영,이규완,김현수,염범우,박지원 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 35세의 2회 경산부에서 육종성 과증식을 보이는 자궁의 뮬러리안 선육종 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Mullerian Adenosarcoma is an uncommon variant of m llerian mixed tumors of the uterus, characterized by a benign but occasionally atypical glandular component and a sarcomatous, usually low grade stromal component. Unlike malignant mullerian mixed tumors of the uterus, most adenosarcomas are the tumors of low malignant potential. MuIlerian adenosarcomas with sarcomatous overgrowth are unusual cases that exhibited focal overgrowth by a pure, often high-grade sarcoma, and the majority of them have a malignant behavior and fatal outcome. We experienced a case of M llerian adenosarcoma of the uterus with sarcomatous overgrowth and report with a brief review of literature.

Methotrexate를 임신낭에 투여하여 치유한 자궁경관임신 1 례

강재성,최준식,박용균,김현수,민유선 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

Cervical pregnancy is a life threatening, rare type of ectopic pregnancy. Hysterectomy was considered as the only treatment for cervical pregnancy. In 1982, as a conservative treatment of ectopic pregnancy, local injection of methotrexate was tried by Tanaka et al. We reviewed a case of sucessful treatment of cervical pregnancy after 45 days from direct local injection of methotrexate into gestational sac under the guidance of vaginal ultrasonogram in department of obstetrics and gynecology, Korea university hospital.