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노정래 ( Cheong Rae Roh ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.4
최근 아동기 때 발견되는 신경학적 이상의 주요한 원인으로 주산기허혈성뇌졸중이 주목 받고 있다. 신생아 시기의 동맥성 뇌졸중의 발생빈도는 성인의 그것과 유사할 정도로 높은 비율을 보이고 있다. 신생아 시기에는 발작이 흔한 증상이며, 아동기시기에는 편측마비나 발작이 있는 경우 후향적 검사에 의해 진단되고 있다. 예후는 발생 정도, 위치 등에 따라 다양하게 나타난다. 원인, 병태생리, 치료, 예후 등 많은 분야에 있어 자세히 알려진 바가 없어, 이 질환에 대한 Ischemic perinatal stroke occurring around the time of delivery is increasingly recognized as a cause of neurological disability in children. Surprisingly, the incidence of arterial infarction in neonates is as high as the annual incidence of large-vessel
정상 및 임신성 고혈압 임신의 태반 내 플라즈민 체계에 관한 연구
노정래(Cheong Rae Roh),이제호(Je Ho Lee),윤병구(Byung Koo Yoon) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3
N/A Objectives: the aim of this study was to evaluate plasmin system in placenta fiom women with normal and preeclamptic pregnancy. Methods: The levels of urokinase-type plasminogen activator(uPA), tissue-type plasrninogen activator(tPA), uPA receptor(uPAR) and plasminogen activatar inhibitor-1(PAI-1) mRNAs were measured by Northern blotting in placenta hom sixteen women with normal (n8) and preeclamptic (n8) pregnancy. The levels of tPA protein and PAI-1 protein were also measured by Westerrn blotting. Results: Densitometric measurements revealed no difference in the levels of uPA mRNA, uPAR mRNA, tPA protein and PAI-1 protein in placentas fiom normal and preeclamptic pregnancies. There was, however, a significant decrease in the level of 3.2 kb PAI-I mRNA in placentas from preeclamptic women compared to normal pregnant women. Conclusion: To the contrary of our expectation, 3.2 kb PAI-1 mRNA level was significantly lower in placenta from women with preeclampsia compared to normal pregnancy. This seems to reflect differential accumulation of PAI-1 mRNAs due to environmental intluences or decreased differentiation potential of villous trophoblasts to invasive trophoblasts in placenta from preeclamptic women compared to normal pregnant women. The mechanism that regulates plasmin system in human placenta needs further investigations.
임신중 심부전 및 조기분만진통과 합병된 근긴장성 이영양증 1 예
양순하(Soon Ha Yang),노정래(Cheong Rae Roh),정재현(Jae Hyun Chung),문종수(Zong Soo Moon),문종택(Jong Taek Moon),김병준(B . Joon Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2
Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.
임신오조와 동반된 Wernicke - Korsakoff 증후군 1 예
양순하(Soon Ha Yang),노정래(Cheong Rae Roh),이재성(Jae Sung Lee),문희수(Heui Soo Moon),정재현(Jae Hyun Cheung) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2
A 24-year-old pregnant woman started to have severe hyperemesis gravidarum at 6 weeks' gestation. Six weeks later, dizziness, ataxia, visual disturbance, diplopia and confusion were developed. On admission, she presented ophthalmoplegia, nystagmus, deaeased tendon reflex, intention tremor, ataxia, confusion and memory disturbance. She was diagnosed to Wernicke-Korsakoff syndrome and 100mg of thiamine was administered intravenously daily till 28 weeks gestation and then intramuscularly. Her ocular symptns, together with neurological signs, were gradually improved. Memory disturbance slightly improved but remained at the time of delivery. The case will be presented in more details with a brief revie of literatures.
적극적 관찰요법을 시행한 임신 2기 조기 양막파열의 주산기 예후
황종대(Jong Dae Whang),노정래(Cheong Rae Roh),양순하(Soon Ha Yang),이지수(Ji Soo Lee),김우영(Woo Young Kim),유진경(Jin Kyung Yoo) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2
목적 : 본 연구는 임신 2기 조기 양막파열에 있어서 관찰요법후의 주산기 예후를 알아보고자 실시하였다. 방법 : 임신 20-28주에 조기 양막파열된 32례에 대하여 후향적 관찰연구를 시행하였다. 산과적 처치의 목표는 일차적으로는 관찰요법을 통하여 임신 32주까지 분만을 지연시키는 것이고 이차적으로는 집중감시와 적극적인 처치를 통해 태아 안녕을 유지시키는 것이었다. 모든 산모와 신생아의 의무기록을 검토하였다. 결과 : 임신 20-28주에 조기 양막파열된 총 30명의 산모가 연구대상에 포함되었으며 조기 양막파열의 시점은 14례에서 20-25주(평균 24.2주)였고 16례에서 26-28주(평균 27.2주)이었다. 분만까지의 잠복기의 중앙값은 임신 20-25주에 조기 양막파열된 경우는 309시간, 임신 26-28주에 발생시는 234시간을 나타냈다. 전체 대상군에서 임상적 또는 조직학적 융모양막염의 발병률은 각각 10%와 72%를 보였다. 연구대상 중 태아사망은 없었으며 신생아 사망은 8명이었다. 주산기 생존율은 임신 20-25주에 조기 양막파열된 경우에서는 50%, 임신 26-28주군의 경우는 94%를 보였다. 결론 : 임신 2기 조기 양막파열에 있어서 관찰요법은 이제까지 알려져온 것 이상으로 주산기 생존율의 개선에 많은 도움을 줄 수 있을 것이다. Objective : The purpose of this study was to evaluate the perinatal outcomes in pregnancies complicated by preterm premature rupture of membranes (PROM) during the second trimester. Methods : Thirty-two consecutive pregnancies with PROM at 20-28 weeks of gestation were studied retrospectively. The goals of management were to prolong the pregnancies to 32 weeks through active expectant management and to avoid fetal compromise through close monitoring and active intervention. All medical records of mothers and neonates were reviewed. Results : Total 30 pregnant women with rupture of membranes at 20-28 weeks were included. Rupture of membranes occurred at 20-25 weeks(mean 24.2) in 14 women and at 26-28 weeks(mean 27.2) in 16 women. The median latency periods to delivery were 309 hours and 234 hours when rupture of membranes occurred at 20-25 weeks and at 26-28 weeks, respectively. Overall incidences of clinical and histologic chorioamnionitis were 10% and 72%. There were no fetal deaths and 8 neontal deaths. When rupture of membranes occurred at 20-25 weeks and at 26-28 weeks, the perinatal survival rates were 50% and 94%, respectively. Conclusion : Active expectant management of second-trimester PROM offers better perinatal survival than previously thought.
DNA분석에 기포한 표피박리성 수장족저 각피증 ( Epidermolytic palmoplantar keratoderma ) 의 산전 진단
양순하(Soon Ha Yang),노정래(Cheong Rae Roh),이제호(Je Ho Lee),정재현(Jae Hyun Chung),문종수(Zong Soo Moon),양준모(Jun Mo Yang),김승욱(Syng Wook Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1
N/A Objective: The purpose of this investigation was to establish the prenatal diagnosis for identifying the risk for epidermolytic palmoplantar keratoderma(EPPK) of a fetus by sequence analysis of fetal genomic DNA from chorionic villi. Methods: Chorionic villus sampling under transvaginal sonography at 12 weeks of gestation from a woman at risk for a child in a EPPK-affected family was perfomed. Polymerase chain reaction amplification of specific allele (PASA) assay was carried out for the detection of mutation(R162W in keratin 9 [K9] gene) previously identified in this family. Direct DNA sequencing analysis of K9 gene was accomplished to confirm the mutation. Results: We had found the point mutation, R162W of K9 gene, in affected family members and confirmed by PASA assay. Affected family members were shown to have PCR products reactive with both the mutant and wildtype specific primers. Because we could not find any expected products after PASA assay with the primers la(+)/KSmt(-) of the fetal DNA, we predicted that the fetus did not inherited the mutant allele and that the fetus could be unaffected. After PASA assay, we analyzed DNA sequences of two family members to confirm the mutation. A C-to-T substitution at bp 545 was detected in the father, instead the fetus did not have any mutant band at that base pair. Conclusion: The PASA assay and direct DNA sequencing analysis of K9 gene through chorionic villi sampling and extraction of genomic DNA had validity to early prenatal diagnosis whether fetus was affected in EPPK or not.