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자궁각임신에서 질식초음파 유도하에 KCl과 MTX의 국소투여법을 통한 치료방법
박혜리 ( Hea Ree Park ),문명진 ( Myoung Jin Moon ),신승주 ( Seung Joo Shin ),장성운 ( Sung Woon Jang ),안은희 ( Eun Hee Ahn ),정상희 ( Sang Hee Jung ),심성신 ( Sung Shin Shim ),강석호 ( Suk Ho Kang ),김현철 ( Hyun Chul Kim ),황윤 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.1
목적: 자궁각임신의 치료에 있어서 질식초음파나 복강경 유도하에 KCl과 MTX의 국소투여를 통한 치료방법의 효용성과 안정성에 대해 알아보고자 한다. 연구 방법: 2005년부터 2007년 8월까지 분당차병원 산부인과에서 자궁각임신으로 진단받은 환자에서 질식초음파나 복강경 유도하에 KCl과 MTX의 국소투여를 시행한 8명의 환자를 후향적으로 조사하였다. 결과: 처음 내원당시 평균 β-hCG는 53,331.6 mIU/mL (14,332~125,721 mIU/mL)이었다. 진단 당시 평균 임신주수는 48.3일 (40~65일)이었다. 8명 중 2명은 복합임신인 경우였다. 이 중 6명은 질식초음파 유도하에 KCl과 MTX를 국소투여 하였으며, 3명은 복강경과 질식초음파 유도하에 국소투여하였고, 2명에서는 MTX의 전신 요법을 병행하였다. 모든 시술 후에는 태아의 심박동이 완전히 정지한 것을 확인하였으며, 이후 초음파와 β-hCG혈액검사를 통해 추적 관찰하였다. 모든 경우에서 성공하였으며, 이후 β-hCG추적 조사에서 급격히 감소하는 것을 관찰할 수 있었다. 복합 임신 2예에서는 시술 이후 자궁내임신을 유지하여 모두 만삭에 성공적으로 분만을 할 수 있었다. 결론: 자궁각임신에서 혈액학적으로 안정적인 환자에 있어서 MTX나 KCl를 국소주입함으로써 안전하고 효율적으로 치료할 수 있을 뿐만 아니라 자궁각임신을 동반한 복합 임신에서는 KCl을 국소주입함으로써 자궁내임신을 유지함에 있어서 매우 효과적인 방법임을 알 수 있었다. Objective: To evaluate efficacy and safety of local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy. Methods: We retrospectively reviewed all cases of cornual pregnancy treated conservatively from 2005 through August 2007. Eight cases were identified and two cases were heterotopic interstitial pregnancy. All cases were managed with local injection of KCl or methotrexate under ultrasound guidance and 2 cases were treated with intra-muscular injection of MTX in combination. After the procedure all cases with cardiac activity was confirmed to be aborted by ultrasound. Also serial follow-up sonographic examination and serum β-hCG measurement were performed. Results: The mean initial β-hCG level was 53,331.6 mIU/mL and ranged from 14,332 mIU/mL to 125,721 mIU/mL. Mean gestational age was 48.3 days from 40 to 65 days. All cases were aborted successfully and follow up β-hCG were declined abruptly. Two cases of hetero-topic pregnancy resulted in successful deliveries at full term. Conclusion: Cornual resection or hysterectomy should no longer be the first line of treatment for hemodynamically stable patients with cornual pregnancy. They can be successfully treated through local injection of MTX or KCl by ultrasound guidance.
제대 염전을 동반한 단일 양막성 쌍태임신에서 sulindac 사용을 통한 양수감량과 초음파를 이용한 집중적 태아감시 후 양측 태아 모두 생존 출생한 1예
박혜리 ( Hea Ree Park ),김현철 ( Hyun Chul Kim ),문명진 ( Myoung Jin Moon ),장성운 ( Sung Woon Jang ),강석호 ( Suk Ho Kang ),안은희 ( Eun Hee Ahn ),백민정 ( Min Jung Baek ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10
일양막성 쌍태임신은 일란성 쌍태임신의 드문 형태로 주산기 사망률이 약 30~70%로 높다. 특히 제대 염전 발생하였을 경우에 태아의 사망률이 50% 이상에 달하기 때문에, 일양막성 쌍태아에서 제대 사고를 감소시키기 위한 적극적인 치료는 무엇보다 중요하다. 본 증례는 산전에 제대 염전이 발견된 단일 양막성 쌍태임신에서, 28주부터 sulindac을 사용한 양수 감량과 초음파 및 태아 전자감시를 이용하며 집중적 태아 감시를 시행하여, 임신 32주 4일에 계획적 제왕절개술 후 양측태아 모두 건강히 생존 출생하였기에 문헌 고찰과 함께 보고하는 바이다. Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30-70%. The major cause of fetal death is cord accident, congenital anomalies, twin-twin transfusion syndrome, and intrauterine growth restriction. Especially cord entanglement occurs; perinatal mortality is about 50%. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin pregnancy with cord entanglement and both fetuses survival by elective cesarean section at 32+4 weeks after medical amnioreduction and intensive fetal surveillance.
무심장 쌍둥이 임신에서 고주파 융해술 후 정상 태아 생존 출생한
장지현 ( Ji Hyon Jang ),문명진 ( Myoung Jin Moon ),박혜리 ( Hea Ree Park ),안은희 ( Eun Hee Ahn ),정상희 ( Sang Hee Jung ),이유미 ( Yu Mi Lee ),김은아 ( Eun A Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.5
Acardiac twin is a rare anomaly that occurs 1% in monochorionic twins and 1 in 35,000 pregnancies overall. Acardiac twin, also known as twin-reversed arterial perfusion (TRAP) sequence, involves a “pump” or donor twin perfusing a recipient or “acardiac” twin through vascular (usually arterial-arterial and venous-venous) anastomoses. Perinatal mortality rate for the pump twin has been reported to be 50~75%, mainly as a result of polyhydramnios, preterm labor, and congestive heart failure. Therefore, occlusion of the circulation to the acardiac twin has been recommended to improve perinatal outcome of the pump twin. Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. We report our experience in the treatment of patients with TRAP sequence using radio frequency ablation to stop perfusion to the acardiac twin.
신지은 ( Ji Eun Shin ),나영정 ( Young Jeong Na ),이찬 ( Chan Lee ),정상근 ( Sang Guen Jung ),박혜리 ( Hea Ree Park ),김태헌 ( Tae Heon Kim ),황윤영 ( Yeun Young Hwang ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11
Endometriosis is a common disease in women of reproductive age, intestinal involvement has been estimated to occur in 3% to 37% of women with endometriosis, in rectosigmoid colon, appendix, ileum and cecum, in order of decreasing frequency. On the other hand, endometriosis of the small bowel, especially symptomatic small bowel involvement, is very unusual. Endometriosis is a rare cause of intestinal obstruction, and preoperative diagnosis is very difficult. It should be considered in the differential diagnosis of women of reproductive age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis. We report a 34-year-old woman following up infertility and ovarian endometrioma. She had nausea, vomiting and low abdominal pain who was operated on acute intestinal obstruction. Pathologic finding was endometriosis involving the ileum, cecum, appendix We present the case with a brief review of literature.
산전진단된 중복홀배수체 염색체 이상 48, XXY, +21의
김영란 ( Young Ran Kim ),장성운 ( Sung Woon Chang ),정상희 ( Sang Hee Jung ),문명진 ( Myoung Jin Moon ),박혜리 ( Hea Ree Park ),장지현 ( Ji Hyon Jang ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.12
The occurrence of double aneuploidy in the same individual is a relatively rare phenomenon and the incidence varies according to the literature. We report an exceptional case of double aneuploidy with an additional chromosome 21 characteristic of Down syndrome and an additional XXY complement characteristic of Klinefelter syndrome. In this woman the first-trimester screening test, nuchal translucency was 3.8 mm. Then early genetic diagnosis by chorionic villi sampling was done. The result was double aneuploidy (48, XXY, +21) and the pregnancy resulted in a spontaneous abortion at 13th weeks of gestation. We report a case of double aneuploidy with a review of the literature of other cases of Down-Klinefelter double aneuploidy to determine the prevalence, phenotype, sonographic findings, and pathogenesis.