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.

임신 19 주에 선천성 후부 요도 판막 증후군 태아에서 시행된 방광 - 양막강 문합술 1 예

노정훈(Jeong Hoon Rho),박미혜(Mi Hye Park),임진섭(Jin Seob Lim),하중규(Joong Gyu Ha),오관영(Kwan Young Oh),양윤석(Yun Seok Yang),황인택(In Taek Hwang),정지학(Ji Hak Jeong),박준숙(Jun Sook Park) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173 weeks` gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194 weeks` gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384 weeks` gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.

자궁경관무력증의 임상적 고찰

양윤석(Yun Seok Yang),송치훈(Chi Hun Song),박종호(Jong Ho Park),신정환(Jung Whan Shin),홍서유(Seo Yoo Hong),박미혜(Mi Hye Park),김경진(Kyeng Jin Kim),황인택(In Taek Hwang),정지학(Ji Hak Jung),박준숙(Jun Sook Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective:Our goal was to evaluate the clinical characteristics and statistical analysis in incompetent internal os of the cervix(IIOC) Method: At Department of Obstetrics and Gynecology, Eulgi Hospital and Eulgi university Hospital from January 1, 1991 to December 31, 1997, 296 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation. Of this, 38cases were follow up lost, so 252 cases were analayzed. Diagnostic criteria was previous history of painless cervical dilatation, followed by spontaneous abortion or preterm birth, and acceptance without resistance at the internal os of No. 8 Hegar dilator. Result: Incidence of IIOC was 1.61%, 1 in 60 deliveries. Most frequent age group was in 28-30 years old group and mean age was 30 years old. Total number and mean number of gravida was 818 and 3.2. The most common contributing factor was previous artificial abortion(77%), and cervix dilatation(9%), old cervical laceration(4.3%) etc, was followed. Operation methods were McDonald operation(56%) and modified Shirodkar operation(44%). The Success rate of McDonald and modified Shirodkar was 78.1% and 88.1%. Successful fetal salvage rate was 82.5%, and the highest success rate was 86.9% in 14-18th weeks of gestation group. The more cervix dilate, the more failure occured. Causes of operation failure was premature rupture of membrane(54.5%), preterm labor(43.2%) and fetal death in utero(2.3%). Delivery method after operation was vaginal delivery(146cases, 70.9%) and cesarean delivery(60cases, 29.1%). Cause of cesarean delivery was previous cesarean section(43.3%), breech presentation(16.7%), cephalopelvic disproportion(15%), prolonged labor(6.7%), fetal disttess(6.7%), twin(5%), placenta previa(3,3%) and abruptio placenta(3.3%). Conclusion: The 14-18th weeks of gestation group & no cervical dilatation group has higher success rate, which indicate early diagnosis and appropriate timing of operation is probably associated with a greater operation

임신 중기 인간 융모성 성선자극호르몬의 원인불명 상승과 임신 예후와의 연관성

황재웅(Jae Woong Hwang),정성운(Seong Un Jeong),서정욱(Jeong Wook Seo),양윤석(Yun Seok Yang),박준숙(Jun Sook Park) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<,05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.

일산화탄소 폭로후 고압산소 재폭로시 흰쥐 신장 및 심장의 SOD 활성 변동에 관한 연구

전영희,백두진,황세진,박준숙,정호삼 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.1

Carbon monoxide is generated from the incomplete combustion of carbon-containing materials. Carbon monoxide cause muscle necrosis leading to myoglobinuria and acute renal failure. The hyperbaric oxygen exposure is increased production of active free radicals. Free radicals which promoted peroxidation of unsaturated fatty acids may destroy essential cellular components and itself cytotoxic materials. Superoxide dismutase, one of the protective mechanisms against tissue damage, catalyzed the dismutation of superoxide anion to less toxic product. The author performs the present study to investigate on Mn-SOD and Cu, Zn-SOD immunoreactivities in kidney and heart carbon monoxide (CO) and hyperbaric oxygen (HBO) exposure. The animals were divided CO exposure group, air release after CO exposure group, HBO exposure group and, CO and HBO exposure group. The specimen were sectioned in 16㎛ with cryostate. The Mn-SOD and CuZn-SOD immunohistochemistry was performed in renal corpuscle, proximal and distal convoluted tubules of kidney and, in sarcoplasm and sarcolemma of heart muscle. The results obtained were as follows: 1. The immunoreactivity of Mn-SOD were increased in renal corpuscles and distal convoluted tubules, were similar to control group in proximal convoluted tubules. 2. The immunoreactivity of Cu, Zn-SOD were increased than that of control group in renal corpuscles and distal convoluted tubules, were same that of the control group in proximal convouted tubules. 3. The immunoreactivity of Mn-SOD were increased at all experimental group of sarcoplasms of heart muscle. 4. The immunoreactivity of Cu,Zn-SOD were increased than that of control group in sarcolemma of heart muscle. These results suggest that the immunoreactivity of SOD after CO or HBO exposure is greatly increased in kidney and heart.

Nested PCR방법에 의한 연골무형성즌(Achondroplasia)의 산전진단

박미혜,윤경식,김대용,박준숙 凡石學術奬學財團 2000 凡石學術論文集 Vol.4 No.-

폐경전후 여성에서 생화학적 골대사지표의 변화양상

양윤석,박준숙,남기남 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

연구목적 : 폐경에 의한 골대사지표의 변화 양상과, 폐경후 경과 10년 이상된 고령의 여성에서 골교체율을 알아보고자 본 연구를 시행하였다. 연구방법 : 폐경전,후 여성 중 호르몬 대치용법을 받은 적이 없는 총189명의 여성에서 골대사지표와 골밀도를 측정하여 각 변수간의 카이제곱 검정과, 상관분석 및 분산분석을 하였다. 결과 : TALP, Dpd, OC, 혈중 인은 골밀도와 유의한 음의 상관관계를 가졌고, Dpd와 OC, TALP와 OC, TALP와Dpd가 서로 유의한 양의 상관관계를 나타냈으며, 혈중 칼슘과 Dpd, 혈중 인과OC가 약한 양의 상관 관계를 보였다. 골다공증군은 정상골밀도군에 비해 골대사 표지물질 5개 모두 유의한 증가가 있었고 골감소증군은 정상골밀도군보다 OC, TALP, 혈중 칼슘과 인은 증가를 하였으나 Dpd는 유의한 차이가 없어 Dpd는 골다공증과 같은 현저한 골대사가 있을 경우에 증가함을 알 수가 있었다. 폐경전 여성군에 비해 폐경후 경과 1-5년군에서 TALP, OC, Dpd와 혈중 인은 유의하게 증가가 있고 폐경후 경과 10년 이상군에서 Dpd와 OC는 가장 높은값을 나타냈다. 혈중 칼슘은 각각의 군간에 유의한 차이 없이 일정 농도를 유지하고 있다. 결론 : 폐경후 골대사 표지물질의 증가가 있었고 또한 폐경후10년 이상의 고령의 여성에서도 높은 골교체율을 보였는데(Dpd와 OC의 증가) 이는 혈중 칼슘의 농도를 정상으로 유지하기 위해서 골교체율을 계속 높은 상태로 유지하여 뼈의 칼슘을 빌려오게 됨으로써 골다공증이 생긴다고 볼 수가 있었다. Objective: This study investigated changes of Biochemical Markers of Bone turnover in Pre-, Peri-and Postmenopausal Women Method: The levels of Urinary deoxypyridinoline(Dpd), serum total alkaline phosphatase(TALP), osteocalcin(OC), serum calcium(Ca++) and phosphorus(P) were determined. Bone mineral density(BMD) were also measured by dual energy X-ray absorptiometry (DEXA) Results: There were negative correlation between Biochemical markers of bone turnover and BMD, Biochemical markers of bone turnover in osteoporosis group were significantly higher than normal groups. Biochemical marker of bone turnover except serum calcium increased after menopause and remains elevated in late postmenopausal and elderly women. An increased bone turnover rate to sustained serum calcium in constant level is related to a high rate of bone loss in postmenopausal women and to a decreased bone mass in elderly women. Conclusion: Bone turnover increased not only at the time of menopause but also in the elderly women. This subsequent abnormalities of bone resorption and formation in the elderly women suggest their potential role in osteoporosis.

원인 불명의 심한 복수를 동반한 태아에서 자궁내 복수천자 1예

황인택,박미혜,김승택,양윤석,박준숙,오관영,하중규,정지학 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

독립된 태아 복수는 산전 초음파로 발견되어질 수 있는 보기 드문 기형이다. 일시적이고 다른 장기의 기형을 동반하지 않은 독립된 복수는 특정한 원인이 밝혀지고 적절한 치료가 주어진다면 예후가 좋은 것으로 보고되어지고 있다. 독립된 다량의 태아 복수를 가진 태아는 치료될 가능성이 높고, 손상이 없는 분만이 이루어져야 한다. 저자가 경험한 증례는 다량의 태아 복수로 난산이 예견되고, 태아의 예후가 좋지 않을 것으로 예상되어 초음파 유도 하에 자궁내 복수천자를 시행하였다. 이 태아는 동반된 다른 주요 기형은 없었고 산전 복수 천자후 태아 복수가 소실되어 만삭 분만 후, 태아의 형태적 기능적 이상이 없는 원인 불명의 태아 복수 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.