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산전 진단된 Congenital Cystic Adenomatoid Malformation of the Fetal Lung 2 예
김정희,진소자,양기환,정명자,방해미 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8
Congenital cystic adenomatoid malformation (CCAM) is a rare pulmonary lesion that can be diagnosed prenatally by ultrasonography. CCAM is a benign hamartomatous or dysplastic tumor that is characterized by overgrowth of the terminal bronchioles. It is typically unilateral and usually involves one lobe or segment with a broad spectrum of clinical presentation. In 1977, Stocker et al. examined 38 cases of CCAM and divided these lesions into three types based on the gross size of the cysts and histologic findings. The overall prognosis of an affected fetus depends on the size of the lung mass and the secondary pathophysiologic derangement. Recently we experienced two cases of congenital cystic adenomatoid malformation of the lung, which was diagnosed by prenatal ultrasonography.
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김종덕,김관식,최범석,김태실,방해미,조장철 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11
This retrospective study was undertaken to investigate the current clinical trend in the management of ectopic pregnancy. 562 patients of ectopic pregnancy were admitted and mana-ged at the Department of Obstetrics and Gynecology, Chonbuk National University Hospital fr-om Jan. 1. 1985 to Dec. 31. 1996. All cases had a reliable medical record and were divided into two groups, of which group A includes patients admitted from Jan. 1. 1985 to Dec. 31. 1990, group B from the Jan. 1. 1991 to Dec. 31. 1996. The results were obtained as follows. 1. The number of cases of ectopic pregnancy were 248 in group A and 314 in group B. 2. The age group of 20 to 29 years of age was top ranked in group A(49.6%) as well as in group B(46.8%). The age group of 30 to 39 years was 43.2% in group A and 46.6% in group B, respectively. 3. In group A, the case who experienced two deliveries was 31.9%, and nulliparous woman was 30.6%. In group B, the case who experienced two deliveries was 33.1%, nulliparous woman was 33.1%. 4. On reviewing the past medical history, ectopic pregnancy was 11.2% in group A, 10.8% in group B, respectively. Pelvic inflammatory disease was 8.1% in group A and 11.0% in group B, respectively. 5. The interval between the last menstrual period and the onset of symptoms was prevalently in 4 to 8 weeks(64.5% in group A, 61.8% in group B). The terval of 12 weeks or more was 2.0% in group A and 6.0% in group B, respectively. 6. In considering the chief complaints, low abdominal pain was 85.9% and vaginal spotting was 69.0% in group A. On the other hand, low abdominal pain was 91.4% and vaginal spotting was 76.4% in group B, meanwhile nausea & vomitting was 8.6% and dizziness was 3.5% in group A, there were 23.4% of nausea & vomitting and 9.7% of dizziness in group B, 7. In relation of the diagnostic methods, the positive rate of culdocentesis in group B was lower than the rate in group A. Diagnostic laparoscopy was done in 5.6% of group A and 14% of group B. The detection rate of adnexal mass and fluid collection in the pelvic cavity was higher in group B than in group A on the ultrasonographic examination. 8. Initial hemoglobin value of 10.1mg/dl or more was 70.9% in group A and 73.2% in group B. The value of 8.0gm/dl or less was 6.4% in group A and 7.0% of group B, respectively. Initial systolic pressure of 110mmHg or more was 74.6% in group A and 66.6% in group B. The systolic pressure of 90mmHg or less was 3.6% in group A and 8.3% in group B. 9. The conceptus was almost implantd in the fallopian tube. The ampullary portion was the most common site of ectopic implantation in both groups. 10. Intraabdominal hemorrhage of 500ml or less in amount was 52.4% in group A and 61.1% in group B, individually. However transfusion was not given in 55.6% of group A and in 71.0% of group B. 11. In the therapeutic modalities, laparotomy was performed in 96.8% of group A and in 82.8% of group B, respectively. The pelviscopic operation was done in 2.4% of group A and in 22.3% of group B. In conclusion, ectopic pregnancy was diagnosed increasingly prior to the onset of the hypovolemic symptoms according to developement of high-resolution ultrasonogram, diagnostic laparoscopy and β-hCG test, therefore the use of minimally invasive techniques in the management of ectopic pregnancy was increasing.
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두재균,서성진,박종을,방해미 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9
우리는 본 병원에서 시행된 313예의 SACSIH 수술의 결과에 대한 후향적 조사 결과 다음과 같은 결론을 얻을 수 있었다. 1. 두씨색시수술을 시행받은 환자들의 평균 연령분포 는 41.4±6.0세였고, 40∼49세사이가 184예(59%)로 가장 많았다. 2. 평균 분만 횟수는 2.28±1.01회로 2회가 157예(50%) 로 가장 많았다. 3. 수술을 결정하게된 주증상으로는 비정상적인 자궁 출혈 128예(41%), 하복부 불편감 70예(22%), 생리통 55예 (18%) 순이었으며, 무증상인 경우도 24예(8%)를 차지하였다. 4. 수술의 임상적인 적응증을 살펴보면 자궁근종 220 예(70.3%). 자궁근종과 골반내 유착증이 동반된 경우 29 예(9.3%)로 가장 많았으며, 그 외 자궁선근증, 자궁부속 기 종양, 자궁내막증, 골반내유착증, 융모성질환, 자궁내 막증식증 등이었다. 5. 수술 후 병리조직학적 소견을 보면, 자궁의 평활근 종이 184예(58.8%)로 가장 많았고 자궁 선근증 93예 (29.7%), 자궁근층비대 9예(2.9%), 자궁부속기 종양 5예 (2.2%), 자궁내막증식증, 자궁내막증 등을 보였으며 유착을 포함한 비특이소견을 보인 경우도 10예(3.2%)를 차지하였다. 6. 수술 후 발생한 합병증의 총 빈도는 66예(21.3%)였 고, 열성 유병률은 48예(15.3%), 창상감염 10예(3.2%), 자 궁경부 출혈 6예(1.9%)로 나타났으나 의미있는 합병증으로 간주될만한 것은 없다고 본다. 그 외에 질 절주암 2예 (0.6%)순 이었다. 7. 평균 입원기간은 8.47±1.06일이었다. 8. 수술 시간은 평균 97.72±22.59분이었으며, 61~90 분과 91~120분 사이가 86.9%로 대부분을 차지하였다. The 313 cases of Doo`s SACSIH operation were performed at Chonbuk National University Hospital from the 16th of November in 1992 to 30th of June in 1997. The results were as follows : 1. The mean age of patients was 41.4±6.0 years old and most common age group were ranged from 40 to 49 years old (59%). 2. The mean parity of patients was 2.28±1.01 and most common parity group was 2 (50%). 3. According to the initial chief complaints, abnormal uterine bleeding were in 128 cases (41%), lower abdominal discomfort were in 70 cases (22%),dysmenorrhea were in 55 cases (18%), and no symptoms and signs were in 24 cases (8%). 4. Preoperative clinical diagnosis were myoma (70.3%), myoma with pelvic adhesion (9.3%), adenomyosis, adnexal tumor, endometriosis, TRD, endometrial hyperplasia in orders. 5. According to the histopathologic type, there were 184 cases (58.8%) of leiomyoma, 93 cases (29.7%) of adenomyosis, 9 cases (2.9%) of myometrial hypertrophy, 5 cases (2.2%) of adnexal tumor, and 10 cases of no symptoms and signs. 6. According to the postoperative complications, there were 48 cases (15.3%) of febrile morbidity, 10 cases (3.2%) of wound infection, 6 cases (1.9%) of cervical bleeding, and 2 cases (0.6%) of stump cancer. 7. The mean hospitalization were 8.47±1.06 days. 8. The mean operation time was 97.72±22.59 minutes.
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