진균성 질염에 대한 Econazole Nitrate를 사용한 3일 치료 효과의 임상적 고찰

박양서(YS Park),유훈(H Yoo) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.3

1977년 4월부터 1977년 11월까지 약 8개월간 Candina albicans가 Nickerson medium 배양검사에서 확인된 126예를 대상으로 하여 Econazole 150mg 3일요법으로 다음과 같은 결과를 얻었다. 1) 제 1차 3일요법으로 118예, 제 2차 3일요법으로 3예의 환자가 완치되어 96.0%의 완치율을 보였다. 2) 자각 증상은 질 작열감이 85.4%, 질 소양감이 87.8%, 질 분비물은 63.9%에서 소실되었다. 3) 환자의 연령분포는 21~30세군에서 41.3%, 31~40세군에서 34.1%로, 가임기에 높은 감염율을 나타냈다. 4) 분만 회수는 1~3회가 66.7%로서 가장 많은 분포를 보였다. 5) 임신과 피임약 복용환자에서도 치료예는 별 차이가 없었다. 6) 치료에 따르는 부작용은 없었다. A clinical survey of the Three-day Therapy for Candidal vaginitis with Econazole Nitrate 150mg has been made on 126 patients from April, 1977 to November, 1977. The clinical results obtained were as follows; 1) One hundred and eighteen patients were cured after the first course of treatment and 3 cases were cured after the second course of treatment. Thus the cure rate for 121 patients was 96.0 percent. 2) The concomitant vaginal symptoms, burning was cured 85.4%, pruritus was cured 87.8% of cases but unlike these two symptoms, discharge responed to the treatment was no more than 64% out of the cases, because generally known this symptom can also be caused by other diseases which cannot be cured by an Antimycotics. 3) The age distribution of 126 patients showed that the group 20 to 34 year old(41.3%) and the group 31 to 40 year old(34.1%) predominated. 4) A large number of 126 patients had one to three child-births(66.7%). 5) The influence of pregnancy and hormonal contraception on therapy was not significant. 6) No undersirable side effects were present in all cases during and after treatment.

저섬유소원증으로 인한 산후출혈의 치료 1례

박양서(YS Park),이상훈(SH Lee),강연위(YW Kang) 대한산부인과학회 1972 Obstetrics & Gynecology Science Vol.15 No.12

정상분만후 저섬유소원증으로 인한 심한 산후출혈이 trasylol, fibrinogen 및 신선혈액으로 치유된 1예를 검토하고 본예에 있어서는 특히 fibrinogen에 대랑의 trasyol을 겸한것이 효과적이었음을 보고하는 바이다. So many critical cases due to hypofibrinogenemia have been saved since after clinical use of human serum fibrinogen in obstetrical practice. However its treatment is more satisfactory with human serum fibrinogen and trasylol in certain cases as reported by Beck et al. in 1963. Recently we experienced such a patient who was treated satisfactorily with the use of trasylol 950,000 K.I.U., serum fibrinogen 7gm, 18 pints of fresh whole blood, 2 pints of stored whole blood transfusion.

Testosterone Enanthate와 Estradiol Valerate를 사용한 한국부인에 있어서 산후 유즙분비억제게 관한 임상적 고찰

박양서(YS Park),김두호(DH Kim) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.6

1974년 5월6일부터 1975년 9월30일까지 약 1년 5개월 동안 산후 유즙준비를 억제한 산모 115예를 대상으로 관찰하여 다음과 같은 결론을 얻었다. 1. 산후 수유를 하지않은 산모의 빈도는 18.7%였다. 2. 산후 비수유부의 적응증을 보면, 산모가 자기의 편리를 위하여 원한 예가 77예(67.0%) 로 서 대다수를 점했고 산모의 질병이 11예(9.6%) 조산아와 미숙아가 11예(9.6%) 자궁내 태아 사망이 6예(5.2%) 직장 관계가 5예(4.3%) 신생아 사망이 3예(2.6%) 선천적 기형이 2예(1.7%) 였다. 3. 유즙분비가 전혀 없었던 예가 92.1%였으며 유방증상은 전혀 없었거나 경했던 예가 89.1% 였다. 4. 초산부와 경산부, 임신 주수에 따른 유즙분비 억제와 유방증상에는 별 효과 차이가 없었 으며 모유수유 경험이있던 산모에서도 효과의 차이는 없었던 것 같았다. 5. 부작용은 전예에서 볼 수 없었다. A Clincal survey of the suppression effects of postpartum lactation and breast symptoms has been made on 115 nonurinsing mothers using 3ml of Testosterone Enanthate combined with Estradiol Valerate out of 614 deliveries from May 6, 1974 to September 30, 1975. The clinical data obtained were as follows. 1. The incidence of nonursing mothers was 18.7%. 2. In indication the cases desiring suppression of lactation for their convenience were most common. its rate was 67.0% and others were as follows, maternal disease 9.6% premature and imature births 9.6% intrauterine fetal death 2.5%, maternal occupational problems 4.3% neonatal death 2.6% and congenital malformation 1.7% 3. Lactation was inhibited completely in 92.1% and breast symptoms were absent or mild in 89.1% 4. There appeared to be no correlation between response and parity gestational period or previous nursing experience. 5. No nudesirable side effects were present in all cases

제왕절개술에 관한 임상적 고찰

이근수(GS Lee),김재소(JS Kim),박양서(YS Park),이상훈(SH Lee) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.12

제왕절개술에 관한 임상적 고찰을 보고하는 바이다. A clinical survey has been made on 202 cases of c-section out of 2119 deliveries at the Department of Obstetrics & Gynecology, Korea General Hospital from Nov. 1, 1968 to Feb. 28, 1971. The clinical datas obtained were as follows. 1. The secton rate was 9.5%. It should be noted that the majority of cases were private patients. 2. In indication, the C.P.D was the most prevalent. Its rate was 32.2% and others were as follows; previous c-section 22.8%, malpresentation 8.4%, placenta previa 7.4%, fetal distress 5.4%, wanted c-section 5.4%, uterine dysfunction 3.9%, elderly primipara 3.0%, abruptio placenta 2.5%, toxemia of pregnancy 2.0% and so on. The wanted c-section recently became an indication of c-section but further study in various aspects will be needed. 3. The incidence of primary c-section in multipara was 2.8% and the C.P.D was the most frequent indicaton for primary c-section in multipara. We would like to emphasize the C.P.D as the complication in multipara not likely to be recognized until after considerable delay. 4. 25 cases(25.5%) of c-section out of 98 cases of breech presentation were performed. In indication, borderline contracted pelvis was the most prevalent and its rate was 12%. 5. The types of operation; lower cervical transverse type was 97%, classical type was 1.5% and cesarean hysterectomy was 1.5%. 6. The rate of vaginal delivery following previous c-setion was 6.1% but the incidence of vaginal delivery following previous c-section may be increased according to the improvement of communication in order to get correct medical information and mobility for emergency surgery. 7. The rate of postoperative complication was 16.3%. The most frequent complication was puerperal morbidity. 8. There was one case of maternal death(0.5%). This patient came in with eclamptic convulsion which was recovered by medical treatment. The c-section was performed on her 36 hrs following recovery because of unrippen cervix. She died of c.v.a. on the 5th postoperative day.

골반경수술 70 예에 대한 고찰

김두순(DS Kim),김유곤(YK Kim),조용수(YS Cho),남성원(SW Nam),장봉림(BR Jang),이우영(WY Lee),박양서(YS Park) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.11

Seventy cases of pelviscopic operation were performed at Hallym University Hospital from July 1991 to June 1992. The results of this study were summarized as follows. 1.Age ranged from 21 to 53years and the great incidence occured in 26 to 35years group. 2. The mean number of parity was 0.9 and two times and below was 94.4%. 3. The most common clinical indication was tubal pregnancy 28 cases(40.0%)and other indications were ovarian tumor 10 cases(14.3%), pelvic adhesions 9 cases(12.9%) among 70 cases. 4. Types of surgery were salpingectomy 23 cases(32.9%); adhesiolysis 9 cases (12.9%); adexectomy 7 cases(10.0%);fimbrioplasty 6 cases(8.6%) in decreasing order. 5. The mean duration of hospitalization was 3.0 days. 14 cases discharged from hospital at the operation day, 25cases(35.7%),in a day , 10cases (14.3%)in two days and 49 cases(70.0%)in three days.

정상임신 및 비정상임신에 있어서 경질초음파와 경복부초음파의 비교관찰

박양서,장봉림,신교식,고길수,정찬영,이성룡 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.3

1988년 1월부터 1988년 12월까지 만 1년간 한림대학교부속 강동성심병원 산부인과를 내원 한 정상임신군 40예, 비정상임신군 30예를 대상으로 경질 및 경복부초음파를 이용하여 다음과 같은 결과를 얻었다. 1. 정상 및 비정상임신군에서 평균연령, 평균분만 횟수, 평균 임신주수는 통계학적으로 유의 한 차이가 없었다(p$gt;0.1). 2. 경질초음파 사용시 경복부초음파 보다 임신낭은 평균 4.2일, 난황낭은 평균 6.1일, 태아심 음은 평균 5.3일 조기 감지할 수 있었으며 통계학적으로도 유의한 차이가 있었다(p$lt;0.01) 3. 경질 및 경복부초음파를 사용하여 임신낭의 크기, 돌연형태, 영양배엽반응을 관찰한 결과 정상 및 비정상임신군 사이에 통계학적으로 유의한 차이가 있었고(p$lt;0.01) 반면에 경질 및 경 복부초음파 사이에서는 유의한 차이는 없었고(p$gt;0.1), 경질초음파에서 biologic variation ±9일 을 ±3일로 줄일 수 있었다. 4. 혈청 β-hCG의 관찰결과, 경질초음파 사용시 discriminate zone의 level을 종래의 640mIU/ml 에서 760mIU/ml로 낮출수 있었으며 통계학적으로도 유의한 차이가 있었다(p$lt;0.01). 5. 난황낭의 관찰결과 정상임신군의 평균치는 경질초음파 6mm, 경복부초음파 5mm였고, 비정 상임신군인 early embryonic demise에서는 각각 3.5mm, 3.0mm로 통계학적으로는 유의한 차이가 없었으나 blighted ovum을 확진할 수 있는 시기는 각각 7주, 8주로 경질초음파에서 약1주일 조기 감지할 수 있었고, 임신 7~10주사이에서 3.5mm이하의 난황낭을 보인 전예에서 비정상 임신을 보였다. 6. 경질 및 경복부초음파를 사용하여 재태기간과 태아의 관두부길이 사이의 상관관계를 관찰한 결과 두 초음파사이에 통계학적 유의는 없었으나(p$gt;0.1), r=0.95, r`=0.93으로 경질초음파 에서 다소 strong correlation을 보였다(Fig. 4). In a recent study, methods used to assess fetal well-being in early pregnancy included ultrasonography. However, before a live embryo visualized in the intrauterine gestational sac and yolk sca, it can be difficult to differentiate between normal and abnormal pregnancy. As a result, repeat examinations after an interval were performed as an usual method. We wished to assess the usefulness of high resolution transvaginal sonography to determine whether there were any features that would enable us to tell distinction at the time of first examination. We studied normal early pregnancy 40 cases and abnormal early pregnancy 30 cases between pregnancy 4 weeks and 12 weeks. The results were summarized as follows: 1. There was no statistically significant difference between normal and abnormal pregnancy group about mean age, mean delivery number, mean gastational weeks(P$gt;0.1). 2. The transvaginal sonography (TVS) detected, on the average, the same embryonal structures about 5 days earlier (gestational sac; 4.2 days, yolk sac; 6.1 days, fetal heart beat; 5.3 days) than the generally used transabdominal sonography (TAS), and there was significant difference in two sonography (P$lt;0.01). 3. With regard to the pathologic gestational sac, there was no significant difference in size, shape and trophoblastic reaction using by TVS and TAS but biologic variation was much more decreased from ±9 days to ±3 days in TVS because of no bladder-filling. 4. With regard to the discriminatory zone using by TVS, this level has been adjusted to a much lower level, from 2640 mIU/ml to 760 mIU/ml, than that of TAS, and there was a significant difference in two sonography (P$lt;0.01). 5. The yolk sac diameters demonstrated wide biologic variation across the gestational age between normal and abnormal pregnancy using TVS and TAS, and there was no significant difference in two sonography (P$gt;0.1), but basic yolk sac structure was detected one week earlier, on the average, by TVS and TAS. All of the cases that the yolk sac size was smaller than 3.5 mm were proved to be abnormal pregnancy. 6. With regard to the growth curve of fetal crown-rump length, there was no significant difference in two sonography (P$gt;0.1) but more or less strong correlation with gestational age in TVS.

자궁외임신 환자에서 골반경수술과 개복술후의 임신율 비교

김유곤,박양서,장봉림,이우영,김두순,민술홍 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

본 한림대학교 강동성심병원 산부인과에서는 1991년 7월 1일부터 1992년 10월 31일까지 16개월동안 난관임신으로 수술후 추적이 가능했던 54예를 대상으로 골반경 수술과 개복술이 다음 임신율에 미치는 영향을 관찰하여 다음과 같은 연구결과를 얻었다. 1. 골반경 수술을 한 군과 개복술을 한 군의 연령, 임신력, 출산력, 과거불임 유무, 기왕개복술 유무, 과거 골반염증 유무 등에는 특별한 차이가 없었다(p$lt;0.05). 2. 골반경수술시 다음 임신은 11예(61.1%)이었으며 그중 자궁내임신은 9예(50.0%), 자궁외임신은 2예(11.1%)이었고, 개복수술시 다음 임신은 18예(50.0%)이었으며 그중 자궁내임신은 17예(47.2%), 자궁외임신은 1예(2.8%)이었다. 3. 수술방법에 관계없이 골반내 유착의 정도와 임신율은 역비례하였다(p$lt;0.05). 4. 복강내 출혈량은 수술방법에 따른 임신율에 별 영향을 미치지 못하였다(p$lt;0.05). 본 연구결과 좀더 많은 수술후 예후 관찰이 추가되어야 확실해지겠지만 난관임신에서 골반경 수술을 한 군은 개복수술을 한 군보다 이미 알려진 장점 외에 임신율에 있어서도 개복수술을 한 군과 비교하여 비슷한 자궁내임신율을 다음 임신에서 얻을 수 있을 것으로 사료된다. To compare pelviscopic surgery with laparotomy in the management of hemodynamically stable patients with tubal pregnancies, we reviewed 54 patients, visiting Hallym University Hospital from July 1991 to October 1992, future pregnancy rates in order to find factors that can affect pregnancy outcome. The results were as follows; 1. The demographic data of two groups including age, gravidity, parity and others were not different significantly. 2. The intrauterine pregnancy rates of pelviscopic surgery and laparotomy groups after operation were 50.0% (9/18), 47.2% (16/37) respectively.There were no statistical significance(p$lt;0.05). 3. Regardless of operation methods, pelvic adhesions were correlate to future pregnancy rates inverely(p$lt;0.05). 4. In two groups, amount of hemoperitoneum did not affect the pregnancy rates(p$lt;0.05). The results suggest that intrauterine pregnancy rates of pelviscopic surgery and laparotomy groups were not different significantly.

GnRH가 흰쥐 뇌하수체전엽 배양세포에서 FSH 분비 및 FSHβ 소단위 생합성에 미치는 영향에 관한 연구

김유곤,박양서 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

본 연구에서는 GnRH가 FSH 분비 및 FSH 소단위 생합성을 유전자 발현 수준에서 조절하는지, 뇌하수체에 직접적으로 작용하여 FSH 분비 및 FSHβ 소단위 생합성을 전이 전단계에서 조절하는지를 규명하기 위하여 뇌하수체전엽 배양세포에서 GnRH 투여가 FSH 분비 및 FSHβ 소단위 생합성에 미치는 영향을 관찰하여 다음과 같은 결과를 얻었다. 1. 뇌하수체전엽 배양세포에서 FSH의 분비는 GnRH 농도와 비례하여 증가하였으나 대조군에 비해 유의하게 증가하지는 않았다. 2. 뇌하수체전엽 배양세포내 FSH 농도는 FSH 분비량이 증가할수록 감소하였으나 모든 군에서 시간의 경과 에 따라 증가하는 양상을 보였다. 3. GnRH이 FSHβ 소단위 mRNA 수준에는 별 영향을 미치지 못하는 것으로 보아 FSH 합성에는 별 영향을 못 미치는 것으로 생각된다. Follicle stimulating hormine (FSH) is a one of the pituitary gonadotropins that plays an important role in the regulation of gametogenesis and estrogen biosynthesis. It consists of α and β subunit, which are encoded by separate genes. Pituitary release of FSH appears to be regulated by the hypothalamic GnRH and the gonadal steroid hormones. In addition, inhibin and follistatin produced by the gonad have been known to selectively inhibit FSH secretion. However, little is known about their regulation of FSH subunit synthesis at transcriptional and posttranscriptional levels. It has been shown that in vivo paradigms such as ovariectomy and ovarian steroid replacement, levels of FSH generally reflect the transcriptional activity of subunit genes, and ovarian steroids negatively regulate FSH synthesis at the pretranslational level by influencing the steady state levels of FSH α and β subunit mRNA. The present study was, therefore, attempted to determine whether GnRH regulates FSHβ subunit synthesis in the similar manner to LH at the transcriptional level by using primary pituitary cell culture. The results showed that GnRH stimulated FSHβ release from cultured pituitary cells in a dose-dependent manner as well as time-dependent manner. The treatment of pituitary cells with GnRH tended to increase FSHβ subunit mRNA level but increases were not statistically significant suggesting that, unlike LH, GnRH does not seem to play a major role in FSH synthesis by influencing the steady state mRNA level of FSHβ subunit. From these results, it is, therefore, concluded that GnRH does not seem to be a major regulator for FSH synthesis.

난소낭종흡인으로 치유한 중증 난소과배란증후군 8 예

김유곤,박양서,장봉림,이우영,김기태,김인수,박찬우,김경택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

The 8 cases of severe ovarian hyperstimulation syndrome among 78 cases of ovulation induction by gonadotropins at the Department of Obstetrics and Gynecology, Hallym university from January 1, 1993 to August 31, 1995 were treated by ovarian cyste aspiration and reviewed. The results were summarized as follows: 1. The origin of ovarian hyperstimulation syndrome is in the ovaries. 2. Aspiration of the ovarian cysts in the severe ovarian hyperstimulation syndrome was safe and not only relieved the symptoms but also shortened the disease process, and allowed outpatient treatment.

안드로겐 과잉증 , 인슐린 저항성과 흑색극세포증 (HAIR-AN) 증후군 1 례

김유곤,박양서,장봉림,김기태,김현규,박주진,김두만 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The HAIR-AN syndrome affects between 2% and 5% of hirsute women and is charactedrized by elevated insulin levels due to insulin resistance, acanthosis nigricans, and hyperandrogenemia. The insulin resistance and compensatory hyperinsulinemia is typically due to a decreased number of insulin receptors, decreased functional activity of the receptor or circulating antiinsulin receptor antibodies. Multiple, independent lines of evidence support that chronic hyperinsulinemia causes ovarian hyperandrogenism. Acanthosis nigricans is considered a marker for insulin resistance in hirsute women. Although the association between hyperinsulinemia and hyperandrogenism remains to be fully explained at the molecular level, chronic hyperinsulinemia appears to be an important cause of hyperandrogenism.