계류유산에 관한 임상적 연구

심재철(JC Sim),김수용(SY Kim),김종현(JH Kim),조성진(SJ Cho),김경태(KT Kim),박인서(IS Park) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.13

Missed abortion has been one of the major problems being confronted with the physician in the midtrimester of pregnancy. This is a clinical study of 31 cases of missed abortions recruited at National Medical Center during 5 years from January 1, 1978 to December 31, 1982. The resutls were as follows: 1. The age distribution was from 22 to 45 years of age and about 50% of cases in 20 to 29 years of age. 2. According to parity, 63.3% of cases were in para 4 or more. 3. Frequent chief complaints were absence or cessation of fetal movement(50%), vaginal bleeding(36.6%), and cessation of uterine growth or decrease in uterine size(13.3%). 4. Gestational ages at the time of fetal death were from 7 to 25 weeks. 5. Seventeen cases(56.1%) retained dead fetus for 1 or 2 months and 9 cases(30%) for 3 or 4 months. 6. None of the cases had abnormal value of blood coagulation tests and fibrinogen before treatment. 7. According to the method of treatment, 13 cases were evacuated by dilatation and curettage, 9 cases by extraovular prostaglandin induction, 6 cases by metreurynter method and 2 cases by highly concentrated intravenous pitocin induction.

Fetal Hydantoin 증후군을 암시하는 치육 증식증 1례

김동명(DM Kim),심재철(JC SIM),김용철(YC Kim),박인서(IS Park) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.7

저자들은 24세 된 간질 임부의 신생아에서 발생한, Fetal Hydantoin 증후군의 한 소견으로 생각되는, 하치육 증식증 1례를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Fetal hydantoin syndrome is a birth defect and can be shown about 10% of the neonates who were exposed to diphenyl hydantoin during gestational period. This syndrome was discribed for the first time by Hanson in 1975, who reported craniofacial abnormalities, limb defects, and deficiencies in growth, developmental performance and intelligence as the most common findings. Recently we have experienced one case of gingival hyperplasia which was suggested of one of the typical findings of fetal hydantoin syndrome. We report a case of probable fetal hydantoin syndrom with the brief review of literatures.

부인과 개복수술 Indroprofen 의 진통작용 및 내성작용의 임상적 연구

지양봉(YB Ji),강순범(SB Kang),신근우(KW Shin),유명숙(MS Yoo),김용철(YC Kim),박형무(HM Park),김동명(DM Kim),심재철(JC SIM) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.2

35명의 산부인과 환자들의 개복수술후의 통증에 대하여 Indoprofen 200mg의 근육주사와 대조군 으로 Meperidine 50mg의 근육주사후의 진통효과를 비교하여 다음과 같은 결론을 얻었다. 1. 치료직전의 pain score는 양군이 모두 3.6으로 심한 또는 매우 심한 통증의 상태에 있 었다. 2. Indoprofen의 진통효과는 주사후 3시간 때 가장 높았으며 이 때의 pain score는 1.2 이었고, 반면에 Meperidine의 진통효과는 1시간후에 가장 높았으며 이때의 pain score는 1.0이었다. 3. 치료후 8시간내에 추가치료를 필요로 한 경우는 Indoprofen의 경우 전체 19예중 3 예로서 21%에 해당하였으며, Meperidine의 경우 전체 16예중 8예로 50%에 해당되었다. 4. Indoprofen을 사용한 19열에서는 뚜렷한 부작용을 발견할수 없었으며, Meperidine을 사용한 group에서는 nausea, vomiting 및 dizziness를 볼 수 있었다. 5. 이상에서 수술후 통증의 조절에 있어서 Meperidine에 대조하여 Indoprofen 사용은 대 기할 만 한 부작용이 없이 Meperidine에 상응하는 진통효과를 가지고 있음을 알 수 있었다. We Cimpared the analgesic effect of a single intramuscular infection of Indoprofen 200 mg with that of Meperidine 50 mg, given by the same route, in 35 patients with postoperative pain after gynecologic surgery. The results were sa follows. 1. The patients suffered from severe or very severe pain before medication, the pain scores of both group were 3.6. 2. The analgesic effect of Indoprofen apperared greateset 3 hours after infection and the pain score at the time was 1.2. On the other hand the analgesic effect of Meperidine appeared greatest 1 hour after injection and the pain score at the time was 1.0. 3. 3 of 10 patients(21%) who were treated with Indoprofen needed additional medication before 8 hours after first medication and 8 of 16 patients(50%) in Meperidine users. 4. There were no specific side effects in patients who were treated with Indoprofen, On the other hand, nausea, vomiting and dizziness appeared in the patients treated with Meperidine. 5. At last, we concluded that Indoprofen can replace the Meperidine without specific side effects for the treatment of postoperative pain.

난소암 환자에 대한 복합 화학요법 ( PAC Regimen ) 의 독성에 관한 연구

김두상(DS Kim),김문신(MS Kim),김용철(YC Kim),박형무(HM Park),유명숙(MS Yoo),신호문(HM Shin),김동명(DM Kim),조수현(SH Cho),조태승(TS Cho),환윤영(YY Hwang),심재철(JC Sim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.2

한양의대 산부인과학교실에서 1978년 10월부터 1982년 9월까지 PAC regimen(제1일에 adriamycin 50mg/㎡, 제2일에 cis-platinum 50mg/㎡, 제3~7일에 cyclophosphamide 150mg/ ㎡)으 로 화학치료를 받은 상피성난소암환자 16예를 대상으로 그 독성을 조사 분석하여 타 보고 자들의 성적과 비교 관찰한 바 다음과 같은 결론을 얻었다. 1. 혈액학적 독성은 총 16예중 10예(62.5%)에서 발생하였으며 혈소판 감소증은 3예 (18.8%), 백 혈구감소증 6예(37.5%), 빈혈 6예(37.5%)로 나타났으며 수혈은 1예(6.3%)에 실시하였다. 2. 신장에 대한 독성은 총 16예중 7예(43.8%)에서 각각 BUN증가 4예(25%) 혈청 creatinine 증 가 3예(18.8%)로 나타났으나, 전예가 경증이었다. 3. 가장 빈발하고 고통스러운 독성은 오심 구토로 전예에서 발생하였으며 perphenazine과 diazepam으로 어느정도 극복할 수 있었다. 4. 기타 말초신경독성은 5예(31.3%), 청력장애 1예(25%), 주관적인 시력장애 3예(18/8%), 간장 독성 1예(6.3%)였고 탈모증은 전예(100%)에서 발생하였다. The toxicity of PAC regimen was evaluated in 17 patients of ovarian epithelial carcinoma at the Edpartmane of Obstet. Nad Gynecol., Hanyang University Hospiatal from October, 1978 through september 1982. The PAC regimen consists of adriamycin 50mg/㎡ on the first day, cis-platinum 50mg/㎡ on the second day, and cyclophos-phanide 150mg/㎡ on the third to seventh day. It was repeated every 4 weeks. The results were as follow: 1. The hematologic toxicity occurred in 62.5%(10/16) of the patients, including thrombocytenia 18.8%(3/16), leukipenia 37.5%(6/16), and anemia 37.5%(6/16). For only one case, transfusion was require. 2. Nephrotoxicity occurred in 43.8%(7/160), including an elevation of BUN 25.0%(4/16) and an elevation of serum creatinine 18.8%(3/16). But all were in mild degree. 3. For the symptoms of gastrointestinal tract were nausea and vomiting which occurred in all cases and most distressing problems. All patients, however, were well tolerated with perphenazine and diazepam. 4. Peripheral neurotoxicity occurred in 31.3%(5/16), ototoxicity in 25.0%(1/4), blurred vision in 18.8%(3/16), hepatotoxicity in 6.3%(1/16) and alopecia in 100%.

풍진 유행지역의 임산부에서 풍진면역항체 양성률에 관한 조사

심재철,윤혜원,배철성,강민아,김승만,김도균,황진석,하경임 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

This study was focused on figuring out the positive rate of rubella antibody on pregnant women in epidemic area. This research was carried out from Mar., 1996 to Oct., 1996 on 303 pregnant women in Kyongju and Pohang, the epidemic area of rubella. The presence of rubella antibody was checked by ELISA method with sera collected from the first prenatal check. Also, the demographic characteristics, the history of natural infection of rubella and vaccination, and the results of pregnancy were reviewed with charts. The results obtained were summarized as followings; 1. The overall positive rates of rubella specific IgG antibody and IgM antibody were 68.6% and 1.3%, respectively. 2. The positive rate of rubella specific IgG antibody was 77.2% in Pohang and 63.5% in Kyongju which was statistically significant. 3. There were no stastically significant differences of the positive rates of rubella specific IgG antibody according to education level, occupation of gravidas, parity, at the time of examination, and gestational age. 4. There were two cases of congenital malformations associated with rubella. One case was intrauterine fetal death, who had retinal detachment and inflammatory granulation tissue and carditis. The other case was consistent with congenital rubella syndrome such as focal myocarditis and ophthalmitis in arbotus at 12weeks gestational age. We observed a low positive rate of rubella specific IgG antibody in the epidemic area as compared with non-epidemic area which means rubella occurs epidemically in a low immunity population. In order to prevent epidemic rubella infection and congenital rubella syndrome, the rubella vaccination should be given to all early reproductive women especially female high school students.

Pelvic Organ Prolapse Quantification[POP-Q]검사로 분류된 진행된 골반장기 탈출환자의 잔뇨량 측정

심재철,윤혜원,배철성,김종호,양회생,최석철,김도균,황진석,장원연 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

목적 : 1996년 공인된 골반장기 탈출에 대한 객관적인 평가 시스템인 POP-Q[Pelvic Organ Prolapse-Quantification]검사에 의거하여 골반장기 탈출의 정도를 분류하고, 환자의 연령, 분만 횟수, 절박성 요실금, 긴장성 요실금, 배뇨 후 잔뇨량과의 관계를 평가하고자 하였다. 연구 방법 : 1997년 8월부터 1998년 8월까지 본원 산부인과에 배뇨장애이외의 증상을 주소로 내원한 외래환자 및 골반이완이 있었던 환자 110명을 대상으로 POP-Q 검사를 시행하여 골반장기 탈출정도를 분류하였고, 배뇨 후 잔뇨량은 요도삽관법을 이용하여 측정하였으며, 연령, 분만횟수, 복압 긴장성 요실금 및 절박성 요실금의 빈도는 자세한 문진을 통하여 알아보았다. 이에 따라 진행된 골반장기 탈출군[Stage Ⅲ,Ⅳ] 24명과 대조군[Stage Ο,Ⅰ] 36명을 분류하였고, 통계적인 분석에 있어 평균값의 비교에는 Chi-Square test을 이용하였고 분율의 비교에는 Student-T test을 시행하였다. P$lt;0.01인 경우 통계학적으로 유의하다고 판정하였다. 결과 : 진행된 골반장기 탈출환자군은 대조군과 비교하여 통계적으로 유의하게 높은 배뇨 후 잔뇨량을 보였고, 연령, 분만 횟수, 복압긴장성 요실금 및 절박성 요실금의 빈도 또한 유의하게 높았으며 이 두 형태가 공존하는 혼합성 요실금의 빈도도 증가하였다. 결론 : 진행된 골반장기 탈출 환자로 비정상 잔뇨량을 갖는 경우, 상부 요로기능의 파악, 요역동학적 검사 등을 통한 정확한 요로기능을 파악함으로써 골반재건 및 요실금 수술로 초래될 수 있는 합병증 및 실패를 예방할 수 있어야 한다. Objectives :1] to introduce pelvic organ prolapse quantification[POP-Q] exam. 2] to evaluate the relationship between postvoid residual volume and degree of pelvic organ prolapse. 3] to evaluate the relationship between age, parity, stress incontinence and urge incontinence with advanced pelvic organ prolapse. Method :The sample for this study consisted total of 110 patients who did not complain of urinary symptoms. They were evaluated in the period between Aug. 1997 and Aug. 1998 at Pohang Hospital. The enrolled patients were examed by POP-Q and then classified a control group[n=36] as normal to mild pelvic organ prolapse[stageΟ,Ⅰ] and a study group[n=24] suffered from advanced pelvic organ prolapse[stageⅢ,Ⅳ]. The postvoid residual volume was measured by urinary catheterization. The age, parity, stress and urge incontinence symptoms were recorded by a history taking session. Results :1]High postvoid residual volume[70.20±46.23cc] was obtained in advanced pelvic organ prolapse which is classified as stage Ⅲ or Ⅳ compared to normal or mild pelvic organ prolapse[8.83±11.00cc]displayed in the control group. 2]A higher age and parity was directly related to advanced pelvic organ prolapse compared to normal or mild pelvic organ prolapse. 3]The incidence of urge incontinence and mixed incontinence was also directly related with advanced pelvic organ prolapse compare to normal or mild pelvic organ prolapse. Conclusion :The patients who have advanced pelvic organ prolapse with high postvoid residual volume should be carefully evaluate before pelvic reconstructive or antiincontinence surgery. This study suggest that advanced pelvic organ prolapse could lead to further functional loss of upper urinary tract.

자궁선근증의 질식초음파와 Color doppler 초음파검사의 유용성

심재철,양회생 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

This study was designed to evaluate the diagnostic capability of transvaginal sonography and color doppler findings in detecting adenomyosis. We compared the preoperative transvaginal and color doppler findings with the pathological findings of the surgical specimen in a series of women who underwent hysterectomy. From January 1996 to through December 1997, we studied 142 women (mean age of 48.7) with enlarged uterus and recurrent menorrhagia. The sensitivity of transvaginal ultrasonogram was 79%, the specificity 72%, the predictive value of a normal test 80%, and that of an abnormal test 72%. However, color doppler findings had no usefulness for diagnosis of adenomyosis. The mean resistance index of the flow detected within the myometrium of adenomyosis was covering the value of 0.77, while the RI of the uterine arteries was 0.57. In contrast, the mean resistant index of the myometrium was 0.75 and RI of the uterine arteries was 0.74. In conclusion, we can suggest that the transvaginal sonogram might be useful to detect the adenomyosis. But the color doppler findings were not useful to differentiate the adenomyosis and leiomyoma.

경주지역 임산부에서 실시한 E형간염바이러스 항체 (Ig G) 보유율에 대한 조사

심재철,이민석 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Hepatitis E was formerly caused enterically-transmitted, waterborne, or fecal-oral non -A, non-B hepatitis. Hepatitis E has its highest care-fatality rates in pregnant women. The study was undertaken with the objection of searching the Anti-HEV(IgG) positive rate in Kyeong Ju, Korea. A total of 500 pregnant women who visited the antenatal clinic were selected during the period from November, 1993 to June, 1994 at the department of Obstetrics and Gyneco- logy, Kyeong Ju hospital, Dongguk university and taken the test for IgG anti-HEV with ELISA kit. The positive rate of IgG anti-HEV was 2.8%. So we recommanded that anti-HEV is included in addition to HBsAg and ALT in prenatal screening tests for pregnant women, who have had clinical history of hepatitis.

여성 요실금 및 대변실금의 유병률

심재철,윤혜원,배철성,강민아,김승만,김도균,황진석,박태형 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

1997년 2월부터 1998년 1월까지 본원에 내원한 배뇨장애 이외의 주소로 내원하였던 환자 및 간호사 350명을 대상으로 여성 요실금과 대변실금의 유병률에 대한 연구를 실시하여 다음과 같은 결과를 얻었다. 1. 요실금의 전반적 유병률은 49.4%였고, 대변실금의 유병률은 19.4%였다. 2. 복압긴장성 요실금, 절박성 요실금, 대변실금을 경험한 군은 무경험군보다 평균 연령 및 평균 분만 횟수가 유의하게 높았다(p<0.01). 3. 복압긴장성 요실금, 절박성 요실금, 대변실금의 빈도는 분만을 1회 이상 하였던 군에서 분만 경험이 없었던 군보다 유의하게 높았다(p<0.01, 0.05, 0.001). 긴장성 요실금과 대변실금은 제왕절개술을 한 군보다 정상 분만을 한군에서 유병률이 유의하게 높았다(p<0.01, 0.001). 4. 요실금 단독 경험군과 요실금 및 대변실금을 동시에 경험한 군을 비교해 보았을 때 연령 및 분만 횟수가 증가할수록 요실금과 대변실금을 동시에 경험한 것으로 나타났다(p<0.01). 5. 복압긴장성 요실금, 절박성 요실금, 대변실금 모두에서 연령별 유병률은 20대에서 60대까지는 늘어나고 70대는 줄어드는 경향을 보였다. 6. 복압긴장성 요실금, 절박성요실금, 대변실금은 폐경 후 군이 폐경 전 군에 비하여 유병률이 유의하게 높았다(p<0.01). 즉, 요실금 및 대변실금은 분만 횟수, 나이, 분만 방법, 폐경 등에 의해 영향을 받는 것으로 나타났으므로 산과의는 요실금 및 배변실금의 기전을 이해함은 물론 이에 영향을 미치는 각 인자를 고려하여 이의 예방 및 개선에 노력을 기울여야 할 것이다. We have studied the prevalence of female urinary and fecal incontinence in general practices. Based from 350 case, a retrospective analysis of the prevalence of female urinary and fecal incontinence between February 1997 and January 1998, which included patients and nurses without abnormal voiding disturbance due to pregnancy, genitourinary infection, puerperal woman and anorectal disease or previous anorectal operation was done. All subjects were subjected a questionnaire about the experience of urinary and fecal incontinence through adult life. It was reported that 49.4% of the subjects had experienced of urinary and 19.4% the subjects had experienced fecal incontinence. The mean age and the mean number of delivery of symptomatic group of stress urinary incontinence, urge incontinence and fecal incontinence were significantly higher than those of asymptomatic group (p<0.01). The frequency of stress urinary incontinence and fecal incontinence increased with age and the number of delivery and parous group (p<0.01). The delivery mode of symptomatic group of stress and fecal incontinence was higher with vaginal delivery than with cesarean delivery (p<0.001). The mean age and mean number of delivery of the symptomatic group of urinary incontinence with fecal incontinence were higher than those of urinary incontinence (p<0.01). The frequency of stress, urge, fecal incontinence was significantly higher in postmenopause group than that of premenopause group (p<0.01). As a result, the prevalence of female urinary and fecal incontinence was significantly correlated with age, parity, delivery method and states of menopause.

임신시 급성 지방간 1 례

심재철,이민석,임문환 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

임신시 급성 지방간은 임신말기의 치명적인 질환이다. 저자들은 1994년 6월 동국대학교병원 산부인과에 황달을 주소로 입원하였던 임신시 급성 지방간 1예를 진단, 치료한 바 간단한 문헌고찰과 함께 이를 보고하는 바이다. Acute fatty liver of pregnancy is a rare but potentially fatal complication of the third trimester of pregnancy. The exact cause of acute faty liver of pregnancy is still debatable, but it is characterized by jaundice, coagulopathy, central nervous system disturbance, and microvesicular fatty infilteration of the liver on liver biopsy specimens. Acute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclampsia in the presence of hypoglycemia, low fibrinogen, and prolonged proghrombin time, particulary in the absence of severe abruptio placenta. Computed tomography of the liver has a high false-negative rate in patients with acute fatty liver of pregnancy. As recently as 1980 fetal and maternal mortality rate as high as 85% were reported. With increased awareness especially in less severe cases, the use of ultrasonography and computed tomography(CT) of the liver for the diagnosis of this condition, and more aggressive management, the mortality from acute fatty liver of pregnancy has been significantly reduced in the past decase. Careful monitoring of input and output is necessary because of the associated renal failure. And high caloric intake of carbohydrate, vitamins, and fluid replacement is essential. Subsequent pregnancies in an appreciable number of women who previously had severe acute fatty liver of pregnancy have proved to be totally benign. We have experienced a case of the acute fatty liver of pregnancy and it is reported with a brief review.