만기임신에 있어서 초음파적 태아체중 예측법들에 대한 평가

박미혜(Mi Hae Park),김경진(Kyung Jin Kim),양윤석(Yun Seok Yang),황인택(In Tak Hwang),정지학(Ji Hak Jung),박준숙(Jun Sook Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

목적: 임상적으로 임신만기에 있어서 분만전 태아체중예측은 분만방법등을 결정하는데 매우중요하다. 이에 저자들은 임신만기 한국인 태아에 적합한 태아체중예측공식을 산출하고, 이를 외국의 태아예측공식들과 비교분석하고자 하였다. 연구방법: 임신 37-42주에 선택적 제왕절개술을 위하여 입원한 산모중 수술당일 초음파를 이용하여 아두대횡경, 두위, 복위, 대퇴골길이를 측정한 150예를 대상으로 하여 임신만기 한국인 태아에 적합한 태아체중예측공식을 산출하였고, 이를 외국의 태아예측공식들, 즉 Campbell등(태아복위), Shepard등(아두대횡경 및 복위), Hadlock 1(복위 및 대퇴골), Hadlock II(두위, 복위 및 대퇴골), Hadlock III(아두대횡경, 복위 및 대퇴골) 그리고 Hadlock IV(아두대횡경, 두위, 복위 및 대퇴골)와 비교분석하였다. 결과: 1.본 연구에서 산출된 임신만기 태아체중예측공식은 다음과 같다. 공식 1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) 공식 2 (BPD,AC) logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) 공식 3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) 공식 4 (HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) 공식 5 (BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. 임신만기 태아체중예측공식을 산출하는데 있어 태아 아두대횡경, 복위 및 대퇴골길이의 조합이 있을 때 두위의 첨가가 태아체중예측공식의 예측력에 영향을 미치지 못하므로 해서 태아두위첨가가 의의가 없었다. 3. 본 논문의 공식과 외국저자들의 공식을 우리나라 임신만기태아에 적용시켜 비교한결과 아두대횡경 복위, 그리고 대퇴골을 조합하여 만든 본 논문의 공식 5에서 가장 높은 정확도를 보였고,외국공식중에서는 아두대횡경, 복위, 그리고 대퇴골을 조합한 Hadlock III공식에서 가장 높은 정확도를 보였다. 4. 측정인자 두개를 조합했을때는 태아의 복위와 대퇴골길이를 조합한 공식이(공식 3, Hadlock I) 태아의 아두대횡경과 복위를 조합한 공식에(공식 2, Shepard) 비하여 절대오차의 평균치가 적으며 태아체중의 예측이 비교적 정확하여 임신 만기및 진통중 태아의 머리측정이 곤란한 경우에 임상적으로 이용도가 높을것으로 사료된다. 5. 각 공식별 예측체중이 실제체중의 5% 및 200gm이내로 예측되는 율은 본 논문의 공식 5에서 82%, 89%로 가장 높았으며 외국공식들중에서는 Hadlock IV에서 79%, 88%로 가장 높았다. 6. 본 논문공식들에 의한 예측체중은 실제체중과 비교하여 과대측정과 과소측정의 균형이 잘 맞는 반면, 반면 외국 저자들의 공식들을 한국인 태아에 적용한 결과, 특히 Campbell등 공식과 Hadlock II공식에서 실제체중보다 과소평가하는 경향을 보였다. 7. 각 체중분포별로 본 논문의 태아체중예측공식들을 분석한 결과 3000-3499gm군에서 각공식들의 정확도가 가장 컸고, 3500gm이상인 군에서 각 공식들의 정확도가 가장 낮았으며, 3500gm이상인 군에서는 대퇴골길이에 의존하는 공식들이 대퇴골길이에 의존하지 않는 공식들에 비하여 현저하게 절대오차의 평균치가 적었다. 결론: 저자들의 임신만기 한국인 태아체중예측공식들은 다른외국공식들과 비교연구한 결과 예측측정과 실제체중과의 오차의 평균이 적고 과대측정과 과소측정의 균형이 잘맞아 태아발육지연아 및 거대아의 진단 및 산과적 처치를 결정하는데 많은 도움을 주어서 분만후 신생아의 사망률 및 이환율등의 감소에 큰 영향을 미칠수 있다고 사료되는 바이다. A total of 150women with singleton pregnancies who were delivered between 37 and 42weeks gestation had ultrasound scans on elective cesarean section day. The biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC) and femur length(FL) were measured in all cases. Equations of estimated fetal body weight(BWT) for Korean term fetuses using AC alone, BPD/AC, AC/FL, HC/AC/FL, BPD/AC/FL, BPD/HC/AC/FL were made by stepwise multiple regression analysis and were compared with foreign equations such as Campbell(AC), Shepard(BPD/AC), Hadlock I(AC/FL), Hadlock II(HC/AC/FL), Hadlock III(BPD/AC/FL), and Hadlock IV(BPD/HC/AC/FL). The results were as follows. 1. The equations of BWT by sonographic measurement were Equation1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) Equation2 (BPD,AC) logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) Equation3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) Equation4 (HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) Equation5 (BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. When BPD, AC and FL were measured, the addition of HC didn,t affected to accuracy of EFW 3. The best results of all equations were obtained with our equation 5(Mean error=2.36gm, Mean absolute error=96.39gm, Mean deviation + SD(%)=0.07+0.37) and among foreign equations, the best results were with Hadlock III equation(Mean error=18.35gm, Mean absolute error=107.82gm, Mean deviation + SD(%)=-0.46+0.42) 4. The equations using AC/FL (our equation 3, Hadlock I) are more accurate than those using BPD/AC (our equatione 2, Shepard) when utilizing two parameters. Therefore, equation using AC/FL is recommended when the BPD is unobtainable at term or labor 5. The percentage of cases in which the EFW was within +5% and +200gm of the actual birth weight was highest at our equation 5 for 82% and 89%, Hadlock IV equation for 79%, 88%. 6. Our equations had relatively an equal tendency to under- and overestimate fetal weight, but foreign equations, especially Campbell and Hadlock II equations tended to underestimate. 7. Analysing according to actual birth weight , our all equations gave the most accurate estimates of fetal weigh for birth weight group between 3000-3499gm, but for birth weight group above 3500gm, that was not. At birthweight group above 3500gm, the equations depend on femur length are more accurate than the equations independ on fumr length.

임신중반기 모체혈청내 융모성 성선자극호르몬증가와 자간전증과의 연관성

박미혜(Mi Hae Park),안정자(Jung Ja Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 알파태아단백치와는 독립적으로 임신중반기 모체혈청내 융모성 성선 자극 호르몬치가 상승되어 있을 때 산과적 합병증과의 관계를 규명해 보고자 이 연구를 실시하였다. 연구방법: 산부인과 외래에 내원하여 임신 14-20주사이에 다운증후군 선별검사로써 삼중검사(triple test)를 시행한 산모중 분만결과를 확인할수 있었던 단태임신 661례를 대상으로 모체혈청내 알파태아단백치가 2.5MoM(multiple of median ) 이상인 5례를 제외한 656례에서 융모성 성선자극호르몬치가 2.0MoM이상인군과 2.0MoM미만인 군으로 나누어 두군 사이의 자간전증, 조기분만, 조기양막파수, 저체중아, 태아긴박증의 발생비를 비교분석 하였다. 결과: 1. 임신 14에서 20주까지 성선자극 호르몬의 중앙치는 임신주수가 진행될수록 감소하였고 알파태아단백의 중앙치는 임신주수가 진행될수록 증가하였다. 2. 모체혈청 알파태아단백치가 2.5MoM미만인 656례중에서 모체혈청내 융모성 성선자극호르몬치가 2.0MoM이상인 군은 103례로 15.7%였고, 2.0MoM미만인 군은 553례로 84.3%였다. 3. 임신 중반기에 융모성 성선자극호르몬이 증가된군(≥2.0MoM)과 정상인군(<2.0MoM) 사이의 산과적 합병증의 발생빈도를 비교해본 결과 자간전증의 발생빈도는 융모성 성선자극호르몬이 증가된군에서 유의하게 높았으며(risk ratio : 3.4, 95%, confidence interval 1.5-7.6)), 자간전증과과 합병되지 않은 저체중아, 조기진통, 조기양막파수, 태아긴박증의 발생빈도는 두군간에 통계적 차이가 없었다. 결론: 임신중반기에 모체혈청내 원인불명의 융모성 성선자극 호르몬의 증가는 자간전증 발생의 예측적 가치가 있으며, 자간전증을 초래하는 태반의 혈관변화들이 최소한 임신중반기부터 시작된다는 이론을 뒷받침해 주고 있다. 하지만 이러한 예측적 정보가 임신 예후를 향상시키는데에 어떻게 사용될수 있는가에 대해서는 광범위한 연구가 필요하리라 사료된다. Objectives: The purpose of this investigation was to determine whether women with unexplained elevations of maternal serum human chorionic gonadotropin(hCG) at 14-20weeks gestation are at incresed risk for poor pregnancy outcomes. Methods: 661 pregnant women undergoing second trimester triple marker screening test for Down syndrome and neural tube defect and delivered at our hospital were reviewed. Of 656 pregnancies that did not have maternal serum α feto-protein≥2.5 multiples of the median(MoM), risk for poor pregnancy outcomes include to preeclampsia, preterm delivery, preterm rupture of membrane(PROM), small for gestational age(SGA) and fetal distress was evaluated in women with elevated hCG(≥2.0 MoM) compared with women without elevated hCG(<2.0 MoM). Results: Pregnancies with elevated hCG levels were at increased risk for preeclampsia (risk ratio 3.4, 95% confidence interval 1.5-7.6) but elevated hCG levels were not significantly associated with preterm delivery, PROM, and SGA and fetal ditress independent with preeclampsia. Conclusion: Pregnancies with elevated second-trimester hCG appear to be at higher risk of subsequent preeclampsia and this finding supports the theory that placental vascular changes that ultimately lead to preeclampsia begin at least by the second trimester. But further studies must be to determine how such information can be used to improve pregnany outcome.

소비자가 인지하는 제품사용 및 처분행동에 관한 연구

朴明姬(Myung Hee Park),兪惠卿(Hae Kyung Lyu),朴明淑(Myung Sook Park),朴美惠(Mi Hae Park) 가정과삶의질학회 1995 가정과삶의질연구 Vol.13 No.1

호접난의 화분 발달에 관한 연구

오해림(Hae-Rim Oh),김현정(Hyun-Jung Kim),모숙연(Sug-Yeon Mo),박미혜(Mi-Hyea Park),김두환(Doo-Hwan Kim) 한국원예학회 2002 한국원예학회 학술발표요지 Vol.2002 No.6

자간전증 임신부의 혈청 및 태반에서의 Vascular endothelial growth factor (VEGF)에 관한 연구

최혜영 ( Hae Young Choi ),이소현 ( So Hyun Lee ),류해정 ( Hae Jeong Ryu ),신은경 ( Eun Kyoung Shin ),박미혜 ( Mi Hye Park ),우소연 ( So Yeon Woo ),박혜숙 ( Hye Sook Park ),이화영 ( Hwa Young Lee ),하은희 ( Eun Hee Ha ),전선희 ( Su 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

목적: 임신 삼분기의 자간전증 임신부에서 혈청 총 VEGF, PIFG, sVEGFR-1의 농도가 정상 임신부와 비교해 어떤 차이를 보이는지 알아보고 자간전증 임신부의 태반에서 VEGF-A 단백질의 발현 정도를 정상 임신부와 비교하였다. 연구방법: 40명의 정상 임신부와 46명의 자간전증 임신부를 대상으로 임신 삼분기에 각각 혈청 총 VEGF, PIGF, sVEGFR-1의 농도를 측정하였고, 분만 후 채취된 태반에서 VEGF-A 단백질의 발현은 Western blot 방법을 이용하였다. 결과: 자간전증 임신부에서 정상 임신부에 비해 혈청 총 VEGF와 PIGF는 유의하게 낮았으며 sVEGFR-1은 유의하게 높았다. 자간전증 임신부의 태반내 VEGF-A 단백질의 발현은 정상 임신부와 비교해 낮았으나 통계학적으로 유의하지는 않았다. 결론: 혈관 성장 요소 (VEGF, PIGF, sVEGFR-1)의 농도가 변화가 자간전증의 유발이나 병태생리기전에 중요한 작용을 할 것으로 생각된다. 자간전증 임신부에서 sVEGFR-1의 증가는 총 VEGF와 PIGF의 효과를 억제하는 것으로 생각되며 자간전증 임신부의 태반내 VEGF-A 단백질의 발현이 낮은 것은 임신에 대한 모체 혈관의 적응을 감소시키는 것으로 생각된다. Objective: The goal of this study was to compare serum concentrations of VEGF, placental growth facto r(PlGF), soluble VEGF receptor-1 (sVEGFR-1) and the expression of VEGF-A in placental tissue from preeclamptic pregnancy with normal pregnancy. Methods: From pregnant women with (n=46) and without (n=40) preeclampsia, maternal serum in third trimester and placental tissue at delivery were collected. The serum concentrations of VEGF, PlGF, and sVEGFR-1 were measured. The expression levels of VEGF-A protein in placenta were assessed using Western blot. Results: The concentrations of total VEGF, PlGF were significantly decreased and that of sVEGFR-1 was significantly increased in patients with preeclampsia. The expression of VEGF-A protein was lower in preeclamptic placenta than in control placenta, but there was no significant difference. Conclusion: The abnormality of angiogenic factors (VEGF, PlGF, sVEGFR-1) may be important in the development of pathophysiology of preeclampsia. An elevation of sVEGFR-1 may lead to suppression of VEGF and PlGF effects, and also the down-regulation of VEGF-A protein in placenta may result in the decreased maternal vascular adaptation to pregnancy.

해군사관생도 생활실태 변천연구

우재홍(Woo Jae-hong),안진규(An Jin-gue),박미혜(Park Mi-hae) 해군사관학교 해양연구소 2019 海洋硏究論叢 Vol.52 No.-

This study surveyed nine areas including general characteristics of cadets, home environment, high school life, studies, discipline, interpersonal relations, values, military values, cadets' autonomous self-government honor system, a cultural level, healthy living, and welfare. Through this survey, the current situation was identified and compared with the living conditions of cadets that studied in 1994. For general characteristics, average height was decreased where weight and wearer of glasses were increased, and ratio of enrollment from metropolitan area and non-religion were greatly increased. In the field of family environment, divorced families have increased, subjective family living standards have been greatly improved, and the ratio of repeaters and students from humanities have increased. In academic fields, satisfaction with lectures by education department and satisfaction with classroom and experimental facilities have increased. The burden on learning was reduced and the large number of courses was the reason for the greatest burden. In terms of discipline, positive aspects were improved in the evaluation of the guidance of discipline officer, the expectation of personal development through discipline, and the feeling of the leadership of the discipline officer. In the field of interpersonal relations, the intimacy between contemporaries and squadrons have increased, and it has been changed to maintain a close friendship with a large number of contemporaries than past. In the field of military values, confidence in good officers and the desire to serve in the navy increased. They evaluated themselves more positive about their leadership, their role in the navy, and their future vision. The implementation of the bylaws in the cadets has been better than in the past, and the evaluation of the conduct of self-government activities and the mode of conduct of the commander cadets has changed more positively. The culture level, health fitness, and welfare were more positively evaluated for the level of literacy of students, and the understanding of reading volume and the opposite sex was improved. Absolute sleep hours for cadets were further shortened, financial shortages were reduced, and school meals were more positively evaluated.

실험 : 임신 제3분기 자궁동맥 이완기함요의 유무에 따른 임신부 혈장 ADMA농도, 태반 eNOS와 항산화스트레스 지표의 발현에 관한 연구

차영주 ( Young Ju Cha ),김나연 ( Na Yeon Kim ),김지윤 ( Ji Yun Kim ),박미혜 ( Mi Hae Park ),전선희 ( Sun Hee Jun ),정경아 ( Kyung Ah Jeong ),김영주 ( Young Ju Kim ) 대한주산의학회 2009 Perinatology Vol.20 No.4

목적: 자궁동맥 이완기함요는 자간전증, 자궁내발육부전 및 조산 등의 불량한 주산기 예후를 예측하는데 있어 유용한 결과를 보이고, 임신 시 나타나는 태반 관류의 변화를 간접적으로 반영하는 중요한 지표가 된다. 본 실험에서는 도플러 파형분석상 이완기함요와 혈장내 ADMA농도, 태반내 항산화효소의 관계를 연구하고자 하였다. 방법: 이화여자대학교 목동병원 산부인과에 2006년 1월부터 2007년 12월까지 분만을 위해 입원한 임신 27주에서 40주까지의 30명의 임신부를 대상으로 후향적 연구를 시행하였다. 자궁동맥 이완기함요의 유무에 따라 임신의 결과 및 ADMA 농도를 확인하였고, 태반의 eNOS 및 항산화효소(MnSOD, GPX 및 catalase)의 활성을 측정하여 그 관계를 분석하였다. 결과: 임신부 혈장 내 ADMA 농도는 자궁동맥 이완기함요가 없는 그룹과 비교하였을 때 자궁동맥 이완기함요가 있는 그룹에 통계학적으로 유의하게 농도가 증가되었다(P=0.04). 자궁동맥 도플러 파형 분석 상 임신 제3기 이완기함요가 있는 산모에서는 태반에서 eNOS의 발현이 통계학적으로 유의하게 증가하였고, MnSOD와 GPX 등의 항산화요소의 발현은 통계학적으로 유의하계 감소하였다. 결론: 자궁동맥 이완기 함요는 임산부의 증가된 혈장내 ADMA농도, 증가된 태반내 eNOS의 발현 및 감소된 MnSOD와 GPX의 발현 등과 연관이 있다. Purpose: We examined pregnancy outcomes and maternal plasma asymmetric dimethylarginine (ADMA) concentrations in the presence or absence of uterine artery notch, and analyzed their relationships to the expression of placental endothelial nitric oxide synthase (eNOS) and antioxidant enzymes, including manganese superoxide dismutase (MnSOD), glutathione peroxidase (GPX), and catalase. Methods: We assessed uterine artery doppler waveforms in 30 women who had been hospitalized for delivery. Plasma concentrations of ADMA were also measured. Tissue samples of placentas were obtained from 15 patients with diastolic notch and 15 patients without diastolic notch, according to uterine Doppler velocimetry analysis. We evaluated the placental expression of eNOS, MnSOD, GPX and catalase with Western blot analysis and eNOS with immunohistochemistry. Results: The maternal plasma ADMA concentration increased significantly in the group with bilateral Uterine artery notch compared with the group without uterine artery notch (P=0.04). The expression of eNOS in the placenta significantly increased and the expression of MnSOD and GPX decreased significantly in the group with uterine artery notch at the third trimester. Conclusion: Uterine artery diastolic notch in pregnant women is associated with high maternal plasma ADMA, increased placental eNOS, and decreased MnSOD and GPX.

重複障碍兒의 實態와 그 對策에 關한 硏究

이규식(Rhee Kyu-shik),배성수(Bae Sung-soo),강수균(Kang Soo-kyoon),김종현(Kim Jong-hyun),박미혜(Park Mi-hae),석동일(Suck Dong-il),권도하(Kwon Do-ha),구대회(Ku Dae-hoi),이원식(Rhee Won-shik),권요한(Kwon Yo-han) 한국재활과학회 1988 難聽과 言語障碍 Vol.11 No.1

The purpose of the present research is to identify the prevalence of multihandicapped children enrolled in special schools in Korea and to propose educational countermeasures. 12,939 subjects Were selected from 17,373 students enrolled in 94 special schools in Korea. The issues of the research were: a) The types of multiple handicaps and the prevalence of multihandicapped children in the schools for the deaf, the blind, the mentally retarded, and the physically handicapped. b) The actual states of the multihandicapped children, regardless of the kind of special schools in which they were enrolled. c) The actual states of the social-medical backgrounds of the multihandicapped children. d) The educational countermeasures for the multihandicapped enrolled in the special schools. e) The attitudes and demands of the teachers and the parents of the multihandicapped, The findings were as follows: (Prevalence of the multihandicapped) a) The prevalence of the multihandicapped enrolled in the special schools was as follows; 8.9% from the school for the deaf, 15.7% for the blind, 60.1% for the mentlly retarded, 59.5% for the physically handicapped. b) The prevalence of the types of handicaps in each school was as follows: 1) The multihandicapped students in the schools for the deaf were 3.6% deaf with blind, 49% deaf with mental retardation, 20.1% deaf with physical handicaps, 9.7% deaf with emotional disturbances. 12.0% deaf with speech impairment, and the others 5.5%. 2) The students the schools for the blind were: 16.2% blind with hearing loss, 44.3% blind with mental retardation, 16.7% blind with physical handicaps, 9.7% blind with emotional disturbances, 6.5% blind with speech "impairment, and the others 6.5%. 3) The students in the schools for the mentally retarded were: 3.1% mentaly retarded with hearing 1066, 2.7% mentally retarded with blind, 18.5% mentally retarded with physical handicaps, 22.4% mentally retarded with emotional disturbances. 49.7% mentally retarded with speech impairment, and the others 3.5%. 4) The students in the schools for the physically handicapped were: 3.2% physically handicapped with hearing loss. 3.9% physically handicapped with blind, 35.2% physically handicapped with mental retardation, 4.6% physically handicapped with emotional disturbances, 50.0% physically handicapped with speech impairments, and the others 3.0%. c) The prevalence of each type of multihandicap in the special schools was: 0.7% deaf with blindness, 5.0% mentally retarded with deafness, 1.7% physically handicapped with deafness, 0.5% mentally retarded with deafness, 1.7% physically handicapped with deafness, 0.5% emotionally disturbed with deafness, 0.7% speech impaired. with deafness, 3.4% emotionally disturbed with blindness, 0.2% speech impaired with blindness, 20.0% mentally retarded with physical handicaps, 16.2% mentally retarded with emotional disturbances, 35.9% mentally retarded with speech impairments, 9.4% physically handicapped with speech impairments, and the others 3.9%. d) There were no differences between the prevalences of the multihandicapped males and females, but the absolute number of males was larger than that of the females.(m: 64% f: 36%): also, there was no great difference between the prevalence of the place of birth and the place the child was raised. e) Among the multihandicapped enrolled in school. there were greater numbers of students in classes from the 3rd grade of primary school to the 3rd grade of middle school (8.3%) than those enrolled in an early education program( 1.69%). The fathers of the multihandicapped with educational levels equal to or higher than those of upper secondary school graduates were as follows: blind 21%, deaf 37%, physically handicapped 47%, mentally retarded 51%. The percentage of mothers with similar educational levels was: blind 9,9%, deaf 23%, mentally retarded 30%, physically handicapped 3.1%. The mothers of the multihandicapped

표준화 환자를 이용한 임상수행능력평가시험 (CPX)에서 교수와 표준화 환자의 평가 결과 비교

권복규(Ivo Kwon),김나진(Najin Kim),이순남(Soon Nam Lee),어은경(Eunkyung Eo),박혜숙(Hyesook Park),이동현(Dong Hyeon Lee),박미혜(Mi Hae Park),오지영(Jee-Young Oh),한재진(Jae Jin Han),허정원(Jung-Won Huh),유경하(Kyung Ha Ryu) 한국의학교육학회 2005 Korean journal of medical education Vol.17 No.2

Purpose: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. Methods: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students’ performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students performances as well. The results were compared and analyzed by SPSS package. Results: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like hepatitis and anemia showed better agreement than obscure clinical contexts such as bad news delivery . Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. Conclusion: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP s evaluation can replace the faculties , but for complex contexts like Dr-Pt relationship.

근치적 자궁절제술을 시행받은 자궁경부암 환자의 임상적 고찰

정성운(Seong Un Jeong),조성중(Sung Joong Cho),김장환(Jang Hwan Kim),이남우(Nam Woo Lee),김경진(Kyung Jin Kim),박미혜(Mi Hae Park),황인택(In Tak Hwang),정지학(Ji Hak Jung) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

목적: 근치적 자궁절제술을 시행 받은 자궁경부암환자의 임상적 고찰을 통해 수술 후 치료 성적을 분석해 보고자 한다. 연구방법: 1983년 1월부터 1992년 12월까지 을지 대학병원에서 광범위 근치적 자궁절제술을 시행 받은 자궁경부암 환자 중 추적관찰이 가능했던 162예를 대상으로 하였다. 결과: 나이 분포는 40대와 50대, 30대순이었고 환자의 임상 병기 분포는 Ia기가 12예(7.4%), Ib기가 84예(51.9%), IIa기가 39예(24.1%) 그리고 IIb기가 27예(16.7%)였다. 조직 병리학적 형태는 편평상피세포암이 91.9%, 선암이 4.9%, 선편평암이 3.1%이고 골반 임파절 전이 빈도는 I기가 22.9%, II기가 31.8%였으며 전체 임파절 전이 빈도는 26.4%였다. 광범위 근치적 자궁절제술 후 방사선 치료의 빈도는 I기가 63.5%, II기가 75.8%였다. 재발율은 7.4%였고 가장 흔히 재발되는 부위는 질교합부였다. 우리는 또한 환자의 5년 생존율을 평가했는데 그 결과는 Ia기는 100%, Ib기는 95.2%(4예), IIa는 87.2%(5예), IIb는 77.8%(6예)였다. 결론: 연령별 환자의 분포는 40대와 50대가 30.9%로 가장 높은 발생 빈도를 보였고 임상 병기별 분포는 Ib기가 51.9%로 가장 많은 빈도를 보였으며 병리 조직학적 분포는 편평 상피 세포암이 91.9%로 대다수를 보였고 전체 임파절 전이빈도는 26.4%였으며 가장 흔한 재발부위는 질교합부였다. 5년 생존율은 Ia기가 100%, Ib기가 95.2%, IIa기가 87.2%, IIb기가 77.8%였다. Objective: The purpose of this study was to analyze the clinical study for patients with cervical cancer who had undergone radical hysterectomy. Method: The subjects of this study were one hundred and sixty two patients with cervical cancer who had undergone radical hysterectomy at Eulji Medical College Hospital, Taejon, Korea, from January 1983 to December 1992. We reviewed the medical record retrospectively and analyzed the data. Result: The distribution of patients by age was found in the order of 50 decade and 60 decade, 40 decade. Those by the clinical stages were as follows: Stage Ia, 12 cases(7.4%); Stage Ib, 84 cases(51.9%); Stage IIa, 39 cases(24.1%); Stage IIb 27 cases(16.7%). The results of histopathologic type were distributed as follows: squamous cell carcinoma was 91.9%, adenocarcinoma was 4.9% and adenosquamous cell carcinoma was 3.1%. The histologic subtypes of squamous cell carcinoma(149 cases) were as follows: Large cell non-keratinizing type was 75.9%, large cell keratinizing type was 14.8% and small cell type was 1.2%. The frequancy of lymph node metastasis was 22.9% in stage I and 31.8% in stage II. The overall incidence of lymph node metastasis was 26.4%. The frequency of external radiation therapy done after radical hysterectomy was 63.5% in stage I and 75.8% in stage II. The 5-year survival rate was as follows: The Ia was 100%; Stage Ib, 95.2%(4cases); Stage IIa, 87.2%(5cases); Stage IIb, 77.8%(6cases). The incidence of recurrence was 7.4% and recurrent sites were vaginal stump , rectum and pelvic wall. Conclusion: The highest incidence of cervix cancer in age distribution was 50 decade(30.9%) and 60 decade(30.9%). The most common clinical stage was Ib(51.9%) and most frequent pathologic type was squamous cell carcinoma(91.9%). The overall incidence of lymph node metastasis was 26.4% and The most common site of recurrence was vaginal stump. The 5-year survival rate was 100% in the stage Ia, 95.2% in the stage Ib, 87.2% in the stage IIa, 77.8% in the stage IIb.