도로교통소음의 전파특성 및 영향

박준철,김윤신,강대준,Park, Joon-Cheol,Kim, Yoon-Shin,Kang, Dae-Joon 한국환경보건학회 2008 한국환경보건학회지 Vol.34 No.4

This study was performed to investigate propagation characteristics and effects of road traffic noise generated from vehicles. Noise levels of expressway and general road were measured at four points in a straight line based on distance from the road, and analyzed. The average noise level of expressway was 78.9 dBA at 5 m, 76.4 dBA at 10 m, 72.0 dBA at 20 m, 69.0 dBA at 30 m. That of general road was lower about $3.1{\sim}3.5\;dBA$ than that of expressway. There was no significant difference in distance attenuation between expressway noise and general road noise. The farer the distance from source is, the more the attenuation is. The influence range of noise is assessed by noise environmental standards or road noise limits. Noise levels of the time zone were measured at a boundary line of apartment to grasp noise variation by time. The time zone of lowest noises was $3{\sim}4$ a.m. and that of highest noise was $8{\sim}10$ a.m. Data recorded on tapes were analyzed to understand the characteristics of frequency because these characteristics are important factors to plan the noise reduction measures, namely path measures.

난소 과자극증후군과 동반된 뇌바닥동맥 혈전증

박준철,임수연,배진곤,김종인,이정호,Park, Joon-Cheol,Lim, Su-Yeon,Bae, Jin-Gon,Kim, Jong-In,Rhee, Jeong-Ho 대한생식의학회 2008 Clinical and Experimental Reproductive Medicine Vol.35 No.1

보조생식술 시행 후 혈전색전증의 발생은 매우 드물기는 하나 치명적인 합병증이다. 과배란 유도시 중증 난소 과자극 증후군은 $0.1{\sim}0.5%$에서 발생하며, 중증 난소 과자극증후군 환자의 128명 중 한 명에서 혈전색전증이 발생하는 것으로 알려져 있다. 발병기전으로는 과배란 유도에 따른 고에스트로젠 혈증에 의한 혈액응고인자의 변화, 혈관 투과성의 증가에 따른 혈액농축 및 순환혈액의 감소 등을 원인으로 추정하고 있으나 그 정확한 기전은 알려진 바가 없다. 또한 thrombophilia나, 혈전색전증의 과거력 및 가족력이 있는 경우 발병율이 증가한다. 혈전증의 발생 부위는 정맥이 67%이나, 33%는 동맥에 발병하며 주로 뇌동맥에 발생된다고 보고되었다. 본 예는 3년간의 이차성 불임을 주소로 내원하여 시험관 아기시술을 시행하였으며 hCG 투여 8일 후 난소 과자극증후군이 중등도로 발생하였다. hCG 투여 후 11일째 갑작스런 의식 소실 및 우측 상지의 운동장애가 발생하여 시행한 MRI상 뇌바닥동맥 (basilar a.) 혈전증으로 진단되었으며, 혈관내 혈전 용해술 및 풍선 확장술 시행후 재관류에 성공하였다. 시술 2일 후 의식 및 운동장애는 완전히 회복되었으며 시술 7일 후 말더듬증 역시 회복되어 후유장애 없이 건강한 상태이다. Thrombophilic study상 Protein S결핍 소견을 보였고, 또한 vWF-associated Ag.이 증가된 양상을 보였다. 지금까지 국내에서 난소 과자극증후군 이후에 발생한 뇌경색은 5예가 보고되었으며, 이중 4예에서 protein S deficiency 소견을 보였으므로 선별 검사로 유용할 것으로 사료된다. 저자 등은 3년간의 이차성 불임을 주소로 내원한 33세 환자에서 시험관 아기시술시 hCG 투여 11일째에 발생한 뇌바닥동맥 혈전증을 간단한 문헌 고찰과 함께 보고하는 바이다. Thromboembolic disease associated with assisted reproductive techniques is considered to be extremely rare but most serious complication. The reasons for this are thought to hypercoagulable state characteristic of OHSS due to high serum levels of estrogen, hemoconcentration and reduced circulating blood volume, but is still unclear. The risk is increased those with rare hypercoagulable conditions such as antiphospholipid antibody syndrome, protein C deficiency, protein S deficiency, antithrombin III deficiency, and those with a personal or family history of thromboembolic disease. The majority of thrombosis reported were venous site but arterial thrombosis mostly intracerebral was reported 5 cases in Korea so far. We present a case of basilar a. thrombosis at 11 days after hCG injection. The patient developed the right hemiparesis, and recovered after intraarterial thrombolysis and transluminal angioplasty. Protein S activity was decreased and vWF antigen was increased. Decreased protein S activity was also found in previous reported 4 cases, so we suggest screening test for protein S in OHSS patients.

난관수종액이 생쥐 배아발달에 미치는 영향

박준철,김정아,김동자,배진곤,김종인,이정호,Park, Joon-Cheol,Kim, Jeong-A,Kim, Dong-Ja,Bae, Jin-Gon,Kim, Jong-In,Rhee, Jeong-Ho 대한생식의학회 2010 Clinical and Experimental Reproductive Medicine Vol.37 No.2

목 적: 난관수종액내의 사이토카인 농도를 측정하고, 사이토카인 농도가 다른 난관수종액을 이용하여 생쥐 배아 발생에 미치는 영향을 비교하고자 하였다. 연구방법: 난관수종액은 자궁난관 조영술에서 난관수종이 진단되어 복강경을 통한 난관 절제술을 시행하는 경우 난관 절제술 전에 난관으로부터 채취한 다음 3,000 rpm에서 10분간 원심분리시킨 후 상층액만을 $-20^{\circ}C$에서 보관하였다. 난관수종액의 사이토카인의 조성 및 농도를 확인하기 위하여 interleukin (IL)-$1{\alpha}$, IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-$\alpha$, interferon (IFN)-$\gamma$, vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), monocyte chemotactic protein (MCP)-1 등을 ELISA 방법으로 측정하였다. 기본 배양액에 난관수종액을 5%, 10%, 30%의 비율로 첨가하여 각 군별로 배반포로의 발달을 관찰하였다. 결 과: 난관수종액내에서 IL-$1{\alpha}$, IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-$\alpha$, IFN-$\gamma$, VEGF, EGF, MCP-1가 검출되었으며, 그 농도에 있어서는 큰 차이를 보였다. 정상 혈청 농도에 비하여 난관수종액-1은 IL-6, IL-10이 증가되어 있었고, 난관 수종액-2는 IFN-$\gamma$, MCP-1 및 VEGF가 증가되어 있었다. 각 난관수종액의 Th1/Th2 비는 HSF-1의 경우 IFN-$\gamma$:IL-10이 3.69로 정상인 데 비하여 HSF-2의 경우 IFN-$\gamma$:IL-10이 61.14로 크게 증가되어 있었다. 난관수종액을 포함하지 않는 배양액에서는 배반포기 발달률은 76.7%이었고, 난관수종액-1군은 74%로 대조군과 차이를 보이지 않았지만, 난관수종액-2군의 경우 27.7%로서 대조군 및 난관수종액-1군과도 유의한 차이를 보였다. 난관수종액-1의 경우 난관수종액 농도에 따른 차이는 없었으며, 난관수종액-2군의 경우 농도에 증가함에 따라 배반포로의 발달이 감소하기는 하였지만 통계적으로 유의하지는 않았다. 결 론: 난관수종액마다 사이토카인의 조성이 다르며 이에 따라 생쥐 배아발달에 미치는 영향이 다를 수 있다. 염증성 사이토카인이 증가된 난관수종액이 배아발달에 악영향을 미칠 것으로 추정된다. 특정 사이토카인에 의한 작용을 규명하기는 위해서는 향후 지속적인 연구가 필요할 것으로 생각된다. Objective: The aim of this study was to measure the concentrations of cytokines contained in the hydrosalpingeal fluid and to evaluate the effect on the mouse embryo development with the different cytokine concentration. Methods: The hydrosalpingeal fluids (HSF) were collected during the surgery for hydrosalpinx which was confirmed by hysterosalphingogram. The cytokines in HSF including interleukin (IL)-$1{\alpha}$, IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-$\alpha$, Interferon-$\gamma$ (IFN-$\gamma$), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), monocyte chemotactic protein-1 (MCP-1) were measured by ELISA method. HSF were added up to culture media with 5%, 10%, and 30% concentrations. The blastulation rates were compared. Results: IL-$\alpha$, IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-$\alpha$, IFN-$\bamma$, VEGF, EGF, and MCP-1 were detected, but the concentrations were different from each sample. IL-6 and IL-10 were increased in HSF-1 group, and IFN-$\gamma$, MCP-1, VEGF were increased in HSF-2 compared with normal serum range. The Th1/Th2 ratio of HSF-2 (IFN-$\gamma$:IL10) was highly elevated to 61.64, compared with that of HSF-1 (3.69). The blastulation rate was significantly decreased in HSF-2 group (27.7%) compared those of the HSF-1 group (74%) and control group (76.7%). It showed the trend that the blastulation rate was decreased depending on the concentration HSF of culture media in HSF-2 group, but it was not statistically significant. Conclusion: The composition and concentration of cytokines in each HSF were different, and increased proinflammatory cytokines in HSF might be associated with poor embryonic development. Further study will be needed about the effect of each cytokines in HSF.

불임 검사시 자궁난관 조영술의 진단 정확도

박준철,김종인,이정호,Park, Joon Cheol,Kim, Jong In,Rhee, Jeong Ho 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.3

Objective: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination. Methods and Material: Total 219 infertile patients were retrospectively analyzed between January 1, 2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal. Results: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity 88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II). Conclusion: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.

체외수정을 통한 대리모 출산에 대한 인식 조사

박준철,김종인,이정호,Park, Joon-Cheol,Kim, Jong-In,Rhee, Jeong-Ho 대한생식의학회 2007 Clinical and Experimental Reproductive Medicine Vol.34 No.2

목 적: 뮬러관 기형과 같이 자궁이 없는 환자들에 있어 시행되어지는 체외수정을 통한 대리모 출산에 대한 사회적 인식을 조사하기 위하여 이 연구를 계획하였다. 연구방법: 본원 산부인과를 방문한 불임 환자 및 본원에 근무하는 간호사, 사무직 여직원을 대상으로 설문지 조사를 통하여 이루어졌다. 배포된 설문지 중 회수된 211명, 즉 불임 환자 60명을 포함하여 기혼 여성이 152명, 미혼 여성이 58명을 대상으로 하였다. 대리모에 찬성한 군과 반대한 군으로 나누어 윈도우용 SPSS 10.0을 이용하여 Pearson x$^2$ test, Fisher's exact test 등으로 비교하였으며 통계적인 유의성의 판정은 p-value<0.05를 기준으로 하였다. 결 과: 전체 응답자 중 17명 (8.1%)만이 자궁이 없는 불임여성의 대리모 시술에 찬성하였으며, 125명 (59.2%)에서는 입양을 선택하였다. 대리모에 찬성하는 군은 반대한 군에 비하여 나이, 결혼 여부, 교육 정도, 수입 정도뿐만 아니라 불임 여부에 따라서도 유의한 차이가 없었다. 그러나 종교에 따라서는 기독교인에게서 찬성률이 유의하게 높았다 (p=0.023). 대리모의 대상으로는 혈연관계가 아닌 제 3자를 선택한 경우가 66.5%로 가장 많았고 친구가 0.6%로 나타났으며, 혈연관계로는 자매 24.5%, 시누이 3.9%이었으며 어머니를 선택한 경우도 4.5% 있었다. 결 론: 체외수정을 통한 대리로 출산은 뮬러관 기형과 같은 자궁이 없는 불임 부부에게는 분명한 치료 방법이 될 수 있지만, 본 연구에서 보듯이 한국 사회에서는 부정적인 시각이 더 많다고 하겠다. 앞으로 광범위 의식 조사가 이루어진 뒤, 이 시술에 대한 의사의 역할 및 여러 문제에 관한 법적, 윤리적 지침이 마련되어야 할 것으로 생각된다. Objectives: The aim of this study was to find out the attitude of Korean women towards IVF surrogacy which is not yet regulated by the law. Methods: We evaluated with a questionnaire, in how far IVF surrogacy was accepted in different groups of Korean women. Total 300 questionnaires were sent out to women who visited our infertility clinic, and to the nurses and office workers of our hospital. Among them, 246 questionnaires were returned, and 211 of them (85.7%) were complete and analyzed. The responders were 58 unmarried women and 153 married women including 60 infertile patients. Results: Only 17 (8.1%) women believed that IVF surrogacy was an acceptable treatment for infertile women without uterus (eg. MRKH or hysterectomized patients), and 125 (59.2%) women chose the adoption. There were no significant differences in response amongst different age group, marital status, or in relation to income level or educational level, or infertility status. A significantly higher level of acceptance was noted only in religious groups, especially in Christians. Most of responders (66.5%) chose unrelated and unknown women as a desirable host, and 28.4% of responders chose the sister or sister-in-law. Conclusions: Overall the different groups were critical towards IVF Surrogacy in Korea, irrespective of the infertile patient group. Despite the established clinical ability to have her own genetic child in women without uterus, this survey reveals that only minority supports the IVF surrogacy. So we need the survey with large, randomized population and then make a regulation about the IVF surrogacy in law.

조기 난소기능 부전증 환자에서 자가면역 질환과의 상관관계

박준철,김종인,이정호,Park, Joon-Cheol,Kim, Jong-In,Rhee, Jeong-Ho 대한생식의학회 2004 Clinical and Experimental Reproductive Medicine Vol.31 No.3

Objective: To assess the association with autoimmune endocrine diseases and detection rate of autoimmune antibodies and its clinical significance in patients with premature ovarian failure. Methods: Twenty eight patients with primary or secondary amenorrhea manifesting hormonal and clinical features of premature ovarian failure (primary POF: 7, secondary POF: 21) were investigated. We tested them TFT, 75 g OGTT, ACTH and S-cortisol for thyroiditis, IDDM, Addison's disease, and antithyoglobulin antibody, antimicrosomal antibody, antinuclear antibody, rheumatic factor, anti-smooth muscle antibody, anti-acetylcholine receptor antibody for non-organ specific autoimmune disorders. Results: Only one patient was diagnosed as IDDM and no patients had abnormal TFT or adrenal function test. More than one kind of autoantibody was detected in 11 patients of all (39.2%): 5 patients (71.4%) of primary POF group and 6 patients (21.4%) of secondary POF group. Eleven patients (39.3%) had antithyroglobulin antibody, 4 (14.3%) had antimicrosomal antibody, 2 (7.1%) had antinuclear antibody, 2 (7.1%) had rheumatic factor, 1 (3.6%) had anti-smooth muscle antibody, 1 (3.6%) had anti-acetylcholine receptor antibody. Conclusions: Premature ovarian failure may occur as a component of an autoimmune polyglandular syndrome, so patients should be measured with free thyroxine, thyroid-stimulating hormone, fasting glucose and electrolytes. Measurement of thyroid autoantibodies in POF patients may be important in identifying patients at risk of developing overt hypothyoidism, but other autoantibodies may not be suitable for screening test.

Assessment of Ovarian Volume and Hormonal Changes after Ovarian Cystectomy in the Different Ovarian Tumor

박준철,배진곤,김종인,이정호,Park, Joon-Cheol,Bae, Jin-Gon,Kim, Jong-In,Rhee, Jeong-Ho The Korean Society for Reproductive Medicine 2008 Clinical and Experimental Reproductive Medicine Vol.35 No.2

목 적: 난소 용적 측정 및 기저 FSH, $E_2$, CCCT 검사를 통하여 가임기 여성에서 난소 낭종 제거술후 난소 배란능의 변화를 평가하고자 하였다. 연구방법: 난소 낭종으로 내원한 환자 중 35세 이하의 여성으로서 비교적 규칙적인 생리주기를 가지며 한쪽 난소에만 낭종을 가진 22명을 대상으로 자궁내막종군과 비자궁내막종군으로 구분하여 전향적 비교 분석을 시행하였다. 질 초음파를 이용하여 수술 1개월 전과 수술 3개월 후 생리주기 3일에 난소의 용적을 측정하였다. 또한 수술 전과, 수술 후 두 번의 정상 생리가 있은 뒤 기저 FSH, $E_2$, CCCT를 시행하였다. 대상 환자 22명 중 3명은 술후 검사를 계획한 3개월 전에 임신이 됨으로써 연구대상에서 제외하였다. 결 과: 수술 후 난소 용적은 자궁내막종군에서 $4.79{\pm}2.57\;cm^3$, 비자궁내막종군 중 직경 ${\geq}10\;cm$인 경우에서 $5.21{\pm}1.33\;cm^3$로서 건측과 비교하여 유의한 감소가 있었으나, 비자궁내막종군 중 직경 <10 cm인 경우는 $6.18{\pm}2.85\;cm^3$로서 유의한 용적 감소가 없었다. 수술후 자궁내막종군의 기저 FSH는 $4.25{\pm}0.20\;mIU/ml$, CCCT 10일째 FSH는 $3.79{\pm}0.80\;mIU/ml$였고, 비자궁내막종군은 각각 $4.24{\pm}0.85\;mIU/ml$, $4.28{\pm}0.92\;mIU/ml$로서 수술 전후의 기저 FSH, CCCT 결과 비교에서 각 군 모두 유의한 차이가 없었으며, 두 군간의 비교에서도 유의한 차이가 없었다. 결 론: 자궁내막종 절제술 및 10 cm 이상의 난소 낭종 절제술 후 난소 용적은 유의한 감소를 보였으나 10 cm 미만의 난소 낭종 제거술에서는 난소 용적의 유의한 감소가 없었다. 난소 배란능을 평가하기 위하여 측정한 기저 FSH, CCCT 검사 결과는 낭종 제거술 후에도 각 군 모두 유의한 차이를 보이지 않았다. 따라서 가임기 여성에서는 난소절제술 보다는 낭종 제거술이 우선 고려되어야 하며, 세심한 주의를 기울인다면 난소 배란능의 손상을 최소화할 수 있을 것으로 사료된다. Objectives: The aim of this study was to assess the change of ovarian reserve after removal of ovarian tumor using basal FSH, $E_2$, clomiphene citrate challenge test and ovarian volume. Methods: Twenty two patients with unilateral ovarian tumor, ${\leq}35$ years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, $E_2$ and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis. Results: The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ${\geq}10\;cm$ group ($4.79{\pm}2.57\;cm^3$ and $5.21{\pm}1.33\;cm^3$, respectively), but not in the non-endometrioma <10 cm group ($6.18{\pm}2.85\;cm^3$). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were $4.25{\pm}0.20\;mIU/ml$ and $3.79{\pm}0.80\;mIU/ml$, $4.24{\pm}0.85\;mIU/ml$ and $4.28{\pm}0.92\;mIU/ml$, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups. Conclusions: Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique.

뮐러관 기형에서 유산, 조산 및 자궁내막증의 발병 위험성

박준철(Joon Cheol Park) 한국산학기술학회 2022 한국산학기술학회논문지 Vol.23 No.3

목적: 뮐러관 기형은 산과적 합병증과 자궁내막증 위험과 관련이 있는 것으로 알려져 있다. 본 연구에서는 뮐러관 기형의 유형별 빈도와 각 유형별 유산, 조산 및 자궁내막증 발병율을 분석하고자 하였다. 방법: 2008년 1월부터 2019년 4월까지 본원에서 진단된 뮐러관 기형을 대상으로, 유산, 조산, 자궁내막증의 유병률을 자궁 기형의 유형별로 평가하였다. 결과: 뮐러관 무형성증(18건), 단각자궁(15건), 쌍각자궁(98건), 중복자궁(73건), 격막자궁(69건), 질 횡격막(6건) 및 무공성 처녀막(26건)이 등록되었다. 병원을 방문한 주증상은 월경통, 불임, 무월경 및 유산이었으며, 월경통을 호소하는 여성에서 좀 더 조기에 진단되었다. 이 중 복강경 검사를 시행한 261명 중 74명(28.3%)에서 자궁내막증이 진단되었다. 자궁내막증은 단각자궁에서 가장 많았고(66.7%), 흔적자궁이나 질 격막 등의 폐쇄가 있는 경우에 흔하였다. 임신 중 방문한 82명에서 유산(34.1%)과 조산(43.9%)이 발병하였다. 결론: 뮐러관 기형의 유형에 따라 유산, 조산 및 자궁내막증의 발병 위험이 증가하였다. 합병증 발생을 예방하기 위해 뮐러관 기형의 정확한 진단과 세심한 관리가 필요할 것으로 사료된다. Objective: Müllerian anomalies have been associated with an increased rate of poor obstetric outcomes and risk of endometriosis. The aims of this study were to evaluate the prevalence of each type of congenital malformation and the association between obstetric outcomes and endometriosis. Material and Methods: All cases of Müllerian anomalies from January 2008 to April 2019 in Dongsan medical center, Korea, were enrolled. The prevalences of miscarriage, preterm birth and endometriosis in each type of anomaly were evaluated. Results: Three hundred five women with Mayer-Rokitansky-Kuster-Hauser syndrome (18 cases), unicornuate uterus (15 cases), bicornuate uterus (98 cases), uterine didelphys (73 cases), septate uterus (69 cases), transverse vaginal septum (6 cases) and imperforate hymen (26 cases) were enrolled. Common causes for visiting the hospital were dysmenorrhea, infertility, amenorrhea and miscarriage. Women who complained of dysmenorrhea were diagnosed at an early age. Among 261 women who underwent laparoscopy, 74 women had endometriosis (28.3%). It was most prevalent in women with the unicornuate uterus (66.7%) and also common in cases of obstruction, such as rudimentary horn and vaginal septum. In the 82 pregnant women, miscarriage (34.1%) and preterm (43.9%) occurred. Conclusions: Müllerian anomalies were related to the risk of miscarriage, preterm birth and endometriosis. Accurate diagnosis and meticulous management of congenital anomalies are clinical challenges to prevent serious consequences for these patients.

지속적 외래복막 투석 환자와 혈액 투석 환자에서의 임신 각

박준철 ( Joon Cheol Park ),이정호 ( Jeong Ho Rhee ),김종인 ( Jong In Kim ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8

Chronic renal failure (CRF) is associated with amenorrhea and impaired fertility, and pregnancy occurs uncommonly in patients requiring dialysis. Even though it occurs, obstetrical complications such as spontaneous abortion, still birth, polyhydramnios, preterm birth, fetal growth restriction, preeclampsia are common. So successful live birth in those patients is very rare. The intensive dialysis to maintain a predialysis BUN <50 ㎎/㎗ is very important, and the management of anemia, hypertension, electrolytes, bone minerals, and nutrition is also concerned. We report a case of successful live birth in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) and a case of preterm birth in a patient undergoing hemodialysis (HD).

배란 유도 후 발생한 난관쌍태 임신

박준철 ( Joon Cheol Park ),김동자 ( Dong Ja Kim ),배진곤 ( Jin Gon Bae ),김종인 ( Jong In Kim ),이정호 ( Jeong Ho Rhee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.10

Twin tubal ectopic pregnancy is rare. Especially the live twin tubal ectopic pregnancy is extremely rare, just 10 cases have been reported until now. There were 9 cases of live twin tubal pregnancy after spontaneous conception and one case after IVF cycle. This is the first report of live twin tubal ectopic pregnancy after ovulation induction with clomiphene citrate. A 31-year-old woman, nulligravida complained of primary infertility and irregular menstruation. After ovulation induction with clomiphen citrate, β-hCG was 1566 mIU/mL on missed period of 5 weeks 4 days. On 6+1 weeks, β-hCG was elevated to 3446 mIU/mL and transvaginal ultrasound revealed two separated gestational sacs, each containing yolk sac in the left tube. The variable dose of methotrexate therapy was tried using 1 mg/kg of methotrexate and 0.1 mg/kg of leukovorin. These were injected alternatively for 8 days. On 7(+3) weeks, β-hCG was elevated to 8,029 mIU/mL and transvaginal ultrasound revealed two fetal poles with heart beat in each gestational sacs. Laparoscopic salpingectomy was performed. The diagnosis was confirmed by the operative finding and also in the pathologic report. It is needed that careful ultrasonographic examination especially in the case of ovulation induction or IVF-ET. Methotrexate treatment in twin tubal pregnancy was usually failed. There was only one successful report by the direct injection of methotrexate to the fallopian tube combined with single intramuscular injection. Further research for dosage or route of administration will be needed.