성염색체 이상에 관한 세포유전학적 연구

신창재(CJ Shin) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.12

염색체 이상을 의심한 환자 156명에 대하여 말초혈액 임파구의 염색체 핵형분석을 실시하였다. 말초혈액의 배양 및 염색체 표본 작성은 macro method 또는 micro method를 이용하였다. 전체 환자 156명중 44.2%(69/156)에서 성염색체이상이 있었고, 염색체 이상 환자중 85.5%(59/69)가 수적인 이상이었으며, 14.5%(10/69)이 구조적 이상이었다. 구조적 이상에는 X-염색체의 역위형, iso-chromosome X, X-단완의 부분결함(XXp-), 기원을 알 수 없는 대상구조의 부가(XXq+)등과 기원이 분명치 않은 marker chromosome의 존재(45, X, +mar)등이 포함 되어 있다. 본 연구의 결과로 임상적으로 염색체 이상이 의심되는 환자에 대한 세포유전학적 연구는 매우 중요 함을 알 수 있다. Presented in this paper the date from a chromosome study of 156 patients referred sex chromosomal abnormalities. Karyotypes were obtained using short-term blood culture. Of these 87 patients had normal chromosome complements; 69(44.2%) patients had sex chromosome abnormality. Among all patients with chromosome abnormalities, 85.5%(59/69) had aberrations of sex chromosome number, the others 14.5%910/69) had aberrations of sex chromosome structure. Among the later, paracentric inversion of the long arm of X-chromosome, partial deletion of the short arm of X-chromosome and inrease in length of the long arm of X-chromosome were observed. Thus the results of the present study indicate the importance of cytogenetic evaluation in clinically abnormal patients.

정상배란성 월경주기와 HMG 배란유도 월경주기의 혈중 Estradiol치의 지수 하수에 관한 연구

신창재(CJ Shin) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.12

1984년 6월부터 1985년 7월까지 서울대학병원 산부인과 불임상담실을 방문하여 남성인자로 인하여 치료를 받고 있는 정상 월경주기를 가진 환자 3명을 대상으로 혈중 E2치와 난소난포의 초음파검사를 실시하고, HMG와 HCG를 사용하여 배란유도가 시행된 무배란증경주기에서는 혈중 E2치가 최고치가 되었던 날을, HMG를 사용하여 배란을 유도한 월경주기에서는 HCG투여날을, 기준점 즉 0일로 하여 후향적 분석으로 다음과 같은 결과를 얻었다. 1.혈중 E2치를 반대수 눈금치에 표시해 본 결과 선상으로 표시되었으며 E2치의 회귀곡선을 E(t)=Aeλt 로 표시해 상관계수를 구한 결과 10명 모두에서 0.9이상으로 통계적으로 의미가 있었다. 2. 정상월경주기와 HMG유도월경주기에서의 E2치의 기울기는 Mann-Whitney-Wilcoxon 검정법에서 0.1수준에서도 유의하지 않아 서로 유사하다는 결론을 얻었다. 상기와 같은 연구결과로 도표 방법은 후속의 E2치를 예측하는데 있어서 유용한 방법으로 사료되 HMG/HCG를 사용하여 배란을 유도할 때 도표방법을 사용하면 E2측정의 횟수를 줄일 수 있는 유용 한 방법으로 배란 유도시에 사용할 수 있다. The accurate poediction adn detection of ovulation is important in the success of ovulation induction Especially in the monitoring of HMC- induced cycles close serial clinical and laboratory evaluations are necessary to optimize the results and minimize the adverse reactions Among these evaluation methods serum E2(estradilo) level is an improtant index of ovarian follicular growth in spontaneous and imduced cycles Recently the usefulness of the semilogarithmic plot of E2 has been described which may aid in the scheduling and possibly reduce the number of E2 sampling during monitoring of follicular growth This study was carried out to determing whether the semilogarithmic plot of serum E2 may be useful for estimating subsequent E2 concentration Wheher the slopes o serum E2 concentrations of HMG-induced cycles differ from those of serum E2 concentrations of normal cycles was also analyzed Serum E2 concentrations with ovarian follicular number and diameter by realtime sector scanner were evaluated in three patients who ovulated spontaneously and in seven patients whose ovulations were induced with HMG Semilogarithmic plots of estradilo concentrations(picograms per milliliter) versus time(days) were linear with slops ranging from 0.19 to 0.62 The rates of E2 production were similar during spontaneous and induced cycles.

클래미디아 트라코마티스 감염

신창재(CJ Shin) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.11

N/A

한국인 임산부에 있어서 임신특속 기간에 따른 양수내 포도당농도치에 관한 연구

신창재(CJ Shin),라건영(KY Rha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

Available biochemical parameters for the assessment of fetal maturity are still controversial . Since amniotic fluid glucose shows a progressive decrease with advancing gestational age, an investigation was done to see whether amniotic fluid glucose could be used as an index of fetal maturity. In 40 samples of amniotic fluid obtained from women at different gestational age, a relatively high degree of correlation was seen between gestational age and amniotic fluid glucose levels. Age, parity, and preclampsia did not have any effect on amniotic fluid glucose. While amniotic fluid glucose changes as the fetus matures , too much overlap in the values seen between the samples obtained before and after 37 weeks of gestation precluded its use as a clinically useful test of fetal maturity. It is suggested that the decrease observed in amniotic fluid glucose near term is related to the maturity of fetal kidney function.

난자 공여를 이용한 체외수정시술에 관한 연구

김석현(SH Kim),신창재(CJ Shin),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.4

It has been well recognized that both the synchronization of luteinizing hormone(LH) surge between the donor and the recipient for normally cycling women and the complex steroid replacement regimen given on a sequential and incremental basis for women with primary or secondary ovarian failure are two important aspects in oocyte donation. In oocyte donation program at our center, a simplified hormonal regimen applicable both to normally cycling women and to those with ovarian failure which consisted of administering 2 mg estradiol(E2) valerate orally three times daily augmented with 100 mg progesterone(P) in oil intramuscularly daily starting on the day preceding the oocyte retrieval from the donor was utilized. From July 1988 to April 1990, 15 cycles of oocyte donation program in 13 infertile patients were undertaken and 6 patients succeeded in pregnancy with the pregnancy rate of 46.2% per patient and 40.0% per cycle.

중합효소연쇄반응을 이용한 Y염색체의 검색

최영민(YM Choi),신창재(CJ Shin) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

We demonstrated th use of in vitro amplification of Y chromosome-specific repeated DNA sequences for rapid determination of fatal sex with amniotic fluid, chorionic villus and buccal smear samples. The oligonucleotide primers were synthesized for a 149 bp DNA segment within 3.4kb(DYZ1 family) Y chromosome-specific sequendes. The amplified DNA segments could be observed as bright bands in the expected size range of 8% polyacrylamide gel after 30 amplification cycles in samples of male DNA. No PCR products were observed in samples of female DNA under the same conditions. Polyerase chain reaction can be used as a rapid and useful method for the prenatal sex determination.

병적인 난관폐쇄 치료를 위한 미세난관문합술 35 예에 관한 고찰

박노현(NH Park),유영철(YC Yoo),신창재(CJ Shin),김정구(JK Kim),장윤석(YS Chang) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.5

Between the period from January 1, 1984 to December 31, 1986, 49 pure cases of tubal resection and anastomosis were performed in the department of Obstetrics and Gynecology, Seoul National University Hospital. Of these only the cases followed up for more than 12 months(35 cases) were included and analyzed according to age, pathology and procedure. The pregnancy rate at the end of 2 years of observation was 34.1%. The intrauterine pregnancy rate was 25.7% and the tubal pregnancy rate was 8.6%. All pregnancies were occurred during the first 24 months and the average interval from operation to conception was 12.3 months. Microsurgical tubal resection and anastomosis should be the primary approach over IVF-ET in the management of pathologic proximal and midtubal occlusion until now.

생식세포 난관내이식과 체외수정시술의 동시시술에 관한 연구

김석현(SH Kim),전종관(JK Jun),신창재(CJ Shin),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.5

To establish the clinical value of simultaneous program of gamete intrafallopian transfer (GIFT) and in vitro fertilization-embryo transfer (IVF-ET), and to evaluate the possibility of predicting pregnancy outcome of GIFT according to the result of IVF using supernumerary oocytes obtained, a retrospective study was performed in 130 patients who underwent GIFT. From October, 1989 to July, 1991, 160 cycles which comprised of 98 cycles or GIFT procedure only and 62 cycles of simultaneous program of GIFT and IVF-ET were analyzed. As a regimen of controlled ovarian hyperstimulation, gonadotropin-releasing hormone agonist (GnRHa) combined with gonadotropins was used in 71% (114/160) of cycles. There was no significant difference in age, duration and etiologic factors of infertility, and serum levels of LH and E2 on MCD #3 was significantly higher in GIFT only group and ismultaneous group. Serum FSH level on MCD #3 was not different between pregnant and non-pregnant cases (15.7±5.7mIU/ml vs 14.9±6.2mIU/ml). The number of oocytes retrieved was significantly lower in GIFT only group than in simultaneous group (6.9±4.0 vs 11.5±5.1, p<0.001). The number of oocytes tranferred was similar in both groups (4.3±1.2 vs 4.5±0.7). The number of embryos transferred was 2.71±1.30 in simultaneous group. The pregnancy rate in GIFT only group, 18.6% (18/98), was significantly lower, compared with 50% (31/62) in simultaneous group (p<0.001). Meanwhile, using fertilization in vitro of supernumerary oocytes as a test of pregnancy, sensitivity was 95.0%, specificity 32.3%, positive predictive value (PPV) 46.3%, and negative predictive value (NPV) 91.3%. If cycles is simultaneous group were excluded, sensitivity was 77.8%, specificity 61.8%, PPV 35.0%, NPV 91.3%. The most striking finding was high NPV, and it revealed that the possibility of pregnancy was below 10% when supernumerary oocytes failed to be fertilized in vitro.

자연배란 주기에서의 체외수정시술에 관한 연구

김석현(SH Kim),최영민(YM Choi),신창재(CJ Shin),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.5

Although the pregnancy rates following IVF-ET after controlled ovarian hyperstimulation are slowly but continuously improving, there are economic, religious and ethical reasons why IVF in natural ovulation cycles offers an attractive alternative. It has been also suggested that the endometrial receptivity for embryo transferred in hyperstimulated cycles is lower than that in natural cycles. From January, 1989 to December, 1993, 143 cycles of natural cycle IVF were performed in 108 infertile patients at SNUH.HCG was administered on MCD #13.5, and transvaginal oocyte retrieval was performed on MCD #15.0. The mean diameter of follicle was 18.71 mm on day of hCG administration, and 19.96 mm on day of oocyte retrieval. Out of 94 oocytes retrieved (the oocyte retrieval rate per cycle, 65.7%), the preovulatory mature oocytes were 84(89.4%). Seventy-four oocytes were fertilized in vitro and cleaved with the oocyte fertilization, and cleavage rate of 83.1%. After ET, 12 pregnancies were obtained with the pregnancy rate per patient, 11.1%; per cycle, 8.4%; per oocyte retrieval, 12.8%; per ET, 16.2%. These data suggest that the results of natural cycle IVF compare well with hyperstimulated cycle IVF and natural cycle IVF is a useful and reasonable treatment modality, particularly in well selected infertile couples.

자궁내막증치료에 있어 GnRH agonist 의 효용에 관한 연구

이진용(JY Lee),최영민(YM Choi),신창재(CJ Shin),문신용(SY Moon),장윤석(YS Chang) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.8

자궁내막증 치료에 잇어 GnRH agonist 의 효용성을 알아보기 위하여 17명의 자궁내막증 환 자를 대상으로하여 delayed-relase formulation 의 D-Trp-6-LH-RH 4.0mg을 4주간격으로 4회 투여하여 다음과 같은 결론은 얻었다. 1. 혈중 E2치는 치료시작 4주이후부터 유의하게 감소하였으며 약제의 마지막 투여 8주후에 는 혈중 E2치가 상승하기 시작하여 12주후에는 치료전 수준으로 증가하였다. 2. 치료기간 중 대부분의 환자에서 무월경이 유발되었으며, 약제의 마지막 투여 10-12주후에 월경이 회복되었다. 3. 17명환자 모두에서 치료후 endometriosis score가 감소하엿다. 4. 치료전 증상이 잇었던 환자 15명 모두에서 치료기간중 증상의 소실 내지 호전을 보였다. 5. 부작용으로는 hot flush, 발한, 질 건조감, 성교시 불편감, 유방크기의 감소, 성육의 감퇴 등이 잇었으며 부작용으로 치료를 중단할 예는 없었다. 이상의 결과로 볼 때 자궁내막증 환자에 있어 GnRH agonist 투여는 유용한 내과적치료방법 으로 사료된다. To evaluate the effectiveness of GnRH agonist for the treatment of endometriosis, seventeen women with laparoscopically proven endometriosis were recruited to the study. The patients were treated with a delayed-release formulation of D-Trp-6LH-RH in biodegradable microcapsule, administered intramuscularly at four week intervals for a period of four months. The first injection was given on day 21 of the cycle . Serum estradiol levels fell significantly to the mean value of 20.2 pg/ml 4weeks after the first injection . After the second injection all patients except one became amenorrheic then resumption of menstruation occurred at 10 to 12 weeks after the last injection. All patients had a reduction in the extent of diesase as assessed by second-look laparoscopy. The mean laparoscopic scores decreased from 30.9 to 20.5. Symptoms of endometriosis disappeared during the treatment . common side effects were hot flush sweating. and dyspareunia, which were acceptable. These data suggest that administration of a delayed release formulation of a GnRH agonist can be a worthwhile and convenient approach to the medical treatment of endometriosis.