배양된 제대정맥내피세포에서 중증자간전증환자 혈청에 의한 Endothlin-1합성의 증가

나욱열,김수평 가톨릭대학 (가톨릭신학대학) 대학원 1996 가톨릭大學醫學部 論文集 Vol.49 No.2

소상사구체 경화증이 동반된 태반부착부 융모성 위종양 1 례

나욱열,채림,신세원,하상범,김대환 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

태반 부착부 융모성 위종양은 일반적인 화학요법에 저항하며 전이된 경우에는 20%의 사망률을 보이는 치명적인 종양이나 본저자들은 25세 여성에서 발생한 태반부착부 융모성위종양을 EMA 화학요법으로 완전관해시켜서 외래 추적 관찰중 1989년 6월 임신 3개월로 확인된 증례로서 간단한 문헌 고찰과 함께 보고하는 바이다. The placenta site trophoblastic pseudotumor is a rare variant of gestational trophoblastic disease, and occured in woman with reproductive age. Because this tumor is very resistant to standard chemotherapy, the most optimal treatment is the early diagnosis and aggressive surgical treatment of localized tumor. The high risk factor of pseudotumor is related to antecedent term pregnancy, high mitotic count, old age. We recently experienced a case of placenta site trophoblastic pseudotumor with focal segmental glomerulosclerosis, confirmed by pathologic diagnosis, so present this case with a brief review of corresponding literature.

Inbitory Effects of Vitamin A on Carcinogenesis of Vaginal Epithelium by Diethylstilbesterol (DES) in Rats

안웅식,윤희종,나욱열,이태순,황인수,송승규 대한산부인과학회 1988 대한산부인과학회 학술대회 Vol.62 No.-

Cell Block Technique in Enhancing Diagnostic Accuracy in Squamous Lesion of the Uterine Cervix

김진우,이상대,정해홍,나욱열,남궁성은,김승조 대한산부인과학회 1986 대한산부인과학회 학술대회 Vol.58 No.-

Endometrial Hyperplasia-Clinical Feature and Menagement

전철영,김진우,이태순,나욱열,남궁성은,송승규 대한산부인과학회 1987 대한산부인과학회 학술대회 Vol.59 No.-

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.

임신과 동반된 난소종양의 임상적 고찰

이헌영,박태철,김수평,이종건,최동수,나종구,윤희종,나욱열 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.12

1. 임신중 부속기종양은 25∼29세에서 가장 흔하였으며(49.5%), 다산보다 초산부(65.7^)에서 흔히 발견되었다. 2. 임신중 난소종양의 진단은 임신 제 2기(11.4%), 제 3기(3.8%)에서보다 임신 제 1기(82.85%)에서 가장 많이 내려졌다. 3. 임신중 난소종양은 편측성이 92.38%, 양측성이 6.66%였으며, 양측성으로 진단내려진 7예중 4예가 기형종이었다. 4. 임신중 부속기종양의 가장 흔흔 합병증은 105예중 56예(53.3%)에서 발생한 복부동통이었으며, 이중에서 54예가 임신 제 1기에 발생한 것이었다. 22예만이 증상이 없는 경우였다. 5. 전체 105예중 81예는 수술요법을 시행하였고, 24예는 보존적 요법을 시행하였다. 수술로 제거된 81예중 58예에서 종양의 크기가 6cm이상이었고, 23예에서는 6cm이하였다. 6cm이상의 종양중 89.2%는 수술로 제거되었고, 6cm이하의 종양중 42.5%만이 보존적요법으로 치료되었다. 6. 수술요법을 시행한 81예중 53예에서 복부동통이 수반되었으며, 복부동통과 연관된 53예중 36예에서 종양의 크기가 6cm이상이었다. 7. 임의적 수술을 시행한 경우는 종양의 크기가 6cm이하에서 3예, 6cm이상의 경우에서는 17예였다. 종양의 크기에 무관하게 복부동통이 수술의 가장 흔한 적응증이었으며, 증상이 없는 경우에서 임의적 수술은 대부분 종양의 크기에 관계되었다. 8. 임신중 종양제거술을 시행한 81예에서 임신이 만삭까지 유지된 경우가 45예(55.5%), 조기진통이 온 경우가 9예(11.1%), 자연유산된 경우가 12예(14.8%), 그리고 인공유산을 시행한 경우는 6예(7.4%)였다. 그리고 나머지 9예(11.1%)는 추적관리가 되지 않았다. 9. 수술 후 호르몬요법(프로제스테론)을 받은 군과 받지않은 군에서의 임신예후는 별반 차이가 없었다. 10. 가장 흔한 조직학적 진단은 단순 낭종이었으며(40.74%), 양성 난종성 기형종이 30.86%, 난소 주위 낭종이 11.11%를 차지하였다. 11. 단순 초음파촬영상 낭종형으로 보인 경우가 70.37%, 혼합형이 28.39%, 고형형이 1.23%였다. 양성낭종성 기형종 26예중에서는 20예에서 혼합형 영상으로, 5예에서 낭종성 영상으로, 1예에서 고형형 영상으로 보였다. One hundred five cases in which hospitalization and/or surgical intervention during pregnancy were required for definite therapy of adenxal mass or follow-up were reviewed. The results were as follows: 1. The adnexal masses occurring in pregnancy were the more common at 25 to 29 years old-pregnant women(49.5%) and more common in nulliparous pregnant women(65.7%) than in multiparous women. 2. The preoperative diagnoses were made more commonly in the first trimester(82.85%) than in the second trimester(11.4%) and the third trimester(3.8%). 3. The adnexal masses were found to be unilateral in 92.38% and bilateral in 6.66%. The four cases of the seven cases occurring bilaterally were diagnosed pathologically as dermoid cyst. 4. The most common complication of the adnexal mass in pregnancy was abdominal pain occurring in fifty-six cases(53.5%) and 54 cases of them were related to the first trimester. Only 29 patient(27.61%) were free from complications. 5. The surgical excision was performed from 81 women and the expectant therapy was performed from 24 women. Fifty eight of 81 masses surgically removed, were$gt;6cm in diameter and the remained 23 masses were$lt;6cm in diameter. 89.2% of masses$gt;6cm in diameter were surgically removed and 42.5% of masses$lt;6cm in diameter were conservatively treated. 6. 53 cases of 81 cases surgically removed were related to abdominal pain as a complication. 36 cases of 53 cases complicated with pain, were masses$gt;6cm in diameter. 7. The elective surgery was undergone in 3 masses$lt;6cm in diameter and 17 masses$gt;6cm in diameter. Regardless of the size of the mass, the abdominal pain was the most common indication of the surgery, but the elective surgery was most commonly related to the size of the mass. 8. Among 81 cases in which the adnexal mass was removed, delivery occurred at term in 45 cases(55.5%), premature delivery in 9 cases(11.1%) and spontaneous abortion in 12 cases(14.8%), and criminal abortion in cases(7.44%) and the prognosis of pregnancy in the remained 9 cases(11.1%)couldn't be monitored. 9. There was no significant difference in the prognosis of pregnancy after surgery between the progesterone-treated and non-treated group. 10. The histologic diagnoses of the surgically removed adnexal mass were simple cyst(40.74%),benign cystic teratoma(30.86%)and paraovarian cyst(11.11%). 11. The sonographic evaluation revealed that 70.37% were cystic appearance, 28.39%, mixed appearance and 1.23%, solid appearance. 20 cases of the benign cystic teratoma showed mixed appearance while 5 cases and 1 showed cystic appearance and solid appearance respectively.

사람난포액내 Inhibin과 Steroid농도에 의한 Follicle Viability 측정

이헌영,박태철,김장흡,김진홍,나종구,김은중,이선희,나욱열 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.4

저자들은 난포액내 존재하는 inhibin과 스테로이드 호르몬 follicular maturity 및 viability에 미치는 영향을 알기위해 inhibin containing preparation에 노출된 뇌하수체 세포배양액에서 FSH농도 변화에 의한 bioassay로 inhibin activity를 측정하였고 RIA에 의해 스테로이드 호르몬을 측정하여 월경주기에 따라 비교함으로써 다음과 같은 결과를 얻었다. 1. 사람 난포액내에서 측정된 inhibin activity는 최저 21에서 최고 193.7U/10l로 나왔으며, 난포기 동안에는 비낭성 난포가 낭성난포나 폐쇄 난포보다 inhibin activity가 높았고(p0.05). 2. 월경주기중 estradiol과 progesterone은 배란전기에 높았고 testosterone은 황체기에서 높은 농도로 존재하였으며, ADD는 낭성난포보다 viable follicle에서 더 많이 함유된 것을 알 수 있었으며 통계적으로 유의하였다. 3. 난포액내 inhibin과 estradiol은 서로 비례관계에 있었다. 4.Inhibin activity와 ADD/E2비는 서로 역관계가 있었다. 따라서 난포기의 비낭성 난포와 배란 전기에서는 높은 inbibin activity와 낮은 ADD/E2비($lt;10)로 보아 모두 다 viable follicle임을 알 수 있었다. 이상과 같은 결과를 종합해보면, inhibin은 난포과립막세포에서 생산되므로 난포액내 inhibin activity의 측정으로 난포의 생존능력을 평가할 수 있고 난소기능 상태 및 배란 시기 등을 예측할수 있을 것이다. 또한 inhibin 은 뇌하수체에서 선택적으로 FSH분비를 억제하므로 수태조절표시(fertility-regulationg marker)로도 사용될수 있을것 같다. 이 연구를 기초로 하여 inhibin의 순수분리 및 RIA를 이용한 정확한 측정이 이루어진다면 난소기능과 배란의 정확한 감시는 물론 불임의 진단 및 피임의 한 방법으로 이용될수 있을것이다. Inhibin was secreted at ovarian granulosa cell and was defined as a gonadal hormone that causes selective suppression of the secretion of FSH by the pituitary gland. But elucidation of the physiologic role of inhibin has been hampered by the lack of a reliable inhibin assay. In order to assess follicle viability by inhibin, steroid contents and elucidate the physiologic importance of inhibin, we measured follicular fluid levels of inhibin activity and steroid contents. The results were as follows: 1. Inhibin activity in human follicular fluid(FF) ranged from a lower limit of 21 to 193.7 U/10 l. FF in follicular phase of the menstrual cycle had significantly more inhibin (121.61 ± 77.8 U/10 l, n=17) compared to cystic follicles (43.02 ± 13.2 U/10 l, n=9) and atretic follicles (53.57 ± 33.63 U/10 l, n=7, P $lt; 0.05). Preovulatory FF contained 98.5 ± 37.68 U/10 l (n=10), whereas luteal phase FF contained 62.39 ± 22.1 U/10 l(n=23). 2. FF during follicular phase and preovulatory FF contained higher inhibin activity compared to atretic follicle and cystic follicle and luteal phase FF. Thus, Follicle viability was assessed by FF inhibin activity. 3. Throughout the menstrual cycle, estradiol and progesterone were the highest in FF from preovulatory phase compared to other cycles (P $lt; 0.005). FF androstenedione (ADD) value was higher in viable follicle than cystic follicle. FF testosterone values were significantly higher in preovulatory phase compared to luteal phase. 4. There was a significant negative correlation between the intrafollicular inhibin and estradiol concentrations. 5. There was a significant negative correlation between the inhibin activity and androstenedione/estradiol (ADD/E2) ratio of FF. From the above results, the viability of each follicle was assessed by FF inhibin, estradiol and ADD/E2 ratio (The more viable follicle had a lower ADD/E2 ratio, higher inhibin activity and estradiol concentration).

혼합 생식세포종양 1 예

권문기(Moon Ki Kwon),함풍도(Poong Do Ham),권민정(Min Jung Kwon),지미경(Mi Kyung Jee),나욱열(Wook Yull Na) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

Malignant germ cell tumor of ovary is very rare and one of the most malignant gynecologic neoplasms usually affecting younger women. we experienced a case of 19-year old female with mixed germ cell tumor of ovary which was composed of endodermal sinus tumor and dysgerminoma. we report this case with a brief review of the literature.

복강내 출혈을 동반한 광인대임신 1 예

권문기(Moon Ki Kwon),권민정(Min Jung Kwon),백승엽(Seung Yeop Baek),함풍도(Poong Do Ham),지미경(Mi Kyung Jee),나욱열(Wook Yull Na) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.8

A case of intraperitoneal hemorrhage of intraligamentary pregnancy is one of most unusual accidents in obstetrics and carries a high degree of maternal and fetal niorbity and mortality. The diagnosis of intraligamentary pregnancy is rarely ever made prior to lapardorny. We report a case of it with a brief review of literatures concerned.