난관결찰술후 발생한 자궁외임신 2 예

양석기(SK Yang),주영철(YC Joo),정학영(HY Chung) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.10

난관결찰술후 발생한 자궁외임신 2 예를 보고하는 바이다. Two cases of failed tubal ligation followed by ectopic pregnancy are presented with a brief review of literature.

정상출산부 오로의 임상세균학적 관찰

김현준(HC Kim),이홍균(HK Lee),양석기(SK Yang),박성구(SK Park) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.4

본원 산부인과에서 1969년 1월 초부터 동연 3월말 사이 만 3개월간 질식 분만후 12-72시간(평균 39시간)내에 무균조작으로 자궁경관 및 후질궁융뷰에서 채취한 오로를 호기성과 혐기성 조건하에서 혈액한천배지 및 Thioglycollate배지에서 배양한 후 균의 분포를 분석 관찰하였으며 몇가지 항생제에 대한 감수성검사를 Disk방법으로 일부 균주에 대하여 시행하여 다음과 같은 결과를 얻었다. 1) 총 107례 중에서 균이 배양된 례는 101례로 94.3%이었고 배양되지 않았던 례는 6례로 5.7% 이었다. 균이 배양된 경우 2종의 균이 동시에 배양된 예가 제일 많아 36례이었고 단일균이 28례, 3종의 균이 18례, 4종의 균이 16례, 5종의 균이 3례로 각각 동시 배양되었다. 단 1균종이 배양된 28례 중에서는 E.coli가 7례로 가장 많았다. 유산균의 순수 배양례는 1례도 없었다. 2) 배양균들을 그 빈도순위로 보면 Unidentified Gram negative bacilli가 40.2%, Streptococci( -hemolytic, Viridans 포함)가 33.7%, Staphylococci(S. aureus, S. epidermis)와 Lactobacillus species가 각각 19.6%, E.coli가 18.7%, Micrococcus와 Corynebacterium species (Diphtheroids 포 함)이 각각 14.0%, Enterococcus가 10.1%, Coliform bacilli와 Hemophilus species가 각각 6.5%, Yeast like cells 가 4.7%, Unidentified Gram positive bacilli와 Clostridium species 가 각각 3.7%, Neisseria species가 1.9%, Bacterium anitratum, Proteus mirabilis, Klebsiella aerogenes와 Providence group이 각각 0.9%이었다. 3) 배양균의 분포와 제요인 즉 산모의 연령, 분만횟수, 분만방법, 회음절개 및 경관 열창등의 요 인들과의 상호관계를 살펴본 결과 배양균 분포와 밀접한 관계는 찾아 볼 수 없었다. 4) 항생제에 대한 감수성검사에서 각 균주에 대하여 감수성이 있는 항생제는 다음과 같은 것들 이었다. a) E.coli는 전례에서 Neomycin, Ampicillin과 Colistin에 Sensitive하였고 대부분의 경우에 Chloramphenicol과 Streptomycin에 Sensitive하였지만 일반적으로 Kanamycin에는 Moderately sensitive하였다. b) Staphylococcus는 전례에서 Methicillin과 Cloxacillin에 Sensitive하였고 대부분은 Leucomycin 과 Erythromycin에 Sensitive하였지만 일부는 Resistant하였다. c) Enterococci는 대부분 Ampicillin과 Erythromycin에 Sensitive하였고 일부는 Chloramphenicol 과 Neomycin에 Sensitive하고 일부는 Resistant하였다. d) Coliform bacilli는 전례가 Neomycin에 Sensitive하였고 대부분은 Chloramphenicol, Streptomycin, Colistin과 Ampicillin에 Sensitive 하였지만 Kanamycin에는 Moderately sensitive 하였다. e) Clostridium species는 Tetracycline과 Erythromycin에 Sensitive하였다. During the period from January 1 to March 31, 1969, lochia was taken for the bacteriological culture and sensitivity test from 107 patient of normal afebrile postpartum women, aged 20 to 40, who had given birth vaginally at the Dept. of Obstetrics and Gynecology, Naotional Medical Center, Seoul. The specimens were taken aseptically from cervical canal or posterior vaginal fornix within postpartum 12 to 72 hours (Av. 39 hrs.) and then cultured on blood agar or thioglycollate media under aerobic and anaerobic conditions. With cultured several organisms, sensitivity test was done by Disk method to some current antibiotics. The results were obtained as follows: 1. Among 107 cases, culture was positive in 101 cases (94.3%) and sterile cultrue(negative cultrue) was in 6 cases (5.7%). Among the above 101 cases of positive culture, mixed culture of two different bacteria were found the most commonly at the same time in 36 cases, pure culture in 28 cases, mixed culture of three bacteria in 18 cased, four bacteria in 16 cases and five bacteria in three cases. Among the above 28 cases of pure culture of Lactobacillus was sepcies found. 2. the cultured organisms and its incidence in order were as follows; Unidentified anaerobic gram negative bacilli in 40.2%, Streptococci (anaerobic, beta hemolytic and viridans) in 33.7%, Staphylococci (aureus and edpidermis) and Lactobacillus species in 19.6%, respectively, E. coli in 18.7%, Bacteroides in 15.9%, Micrococcus species and Corynebacterium species including Diphtheroids in 14.0%, respectively, Enterococcus in 10.1%, Coliform bacilli and Hemophilus species in 6.5%, respectively, Yeast like cells in 4.7%, Unidentified gram positive bacilli and Clostridium species in 3.7%, respectively, Neisseria species in 1.9%, Bacterium anitratum, Proteus miarbilis, Klebsilia aerogenes and Providence group in 0.9%, respectively. 3. Relationships between the distribution of cultured organisms and several factors such as age, parity, mode of delivery and presence or absence of episiotomy or cervical repair, were analysed. However no remarkable difference in distribution of cultured organisms could be found. 4. The results of sensitivity test (as to the sensitive antibiotics) were as follows; a) E. coli was sensitive to Neomycin, Ampicillin and Colistin in all cases. Most of them were sensitive to Chloramphenicol and Streptomycin. Generally, it was moderately sensitive to Kanamycin. b) Staphylococcus aureus was sensitive to Methicillin and Cloxacillin in all cases. Most of them were sensitive but part of them were resistnat to Leucomycin and Erythromycin. c) Most of Enterococci were snesitive to Ampicillin and Erythromycin but part of them were sensitive or resistant to Chloramphenicol and Neomycin. d) Coliform bacilli were sensitive to Neomycin in all cases and most of them were sensitive to Chloramphenicol, Streptomycin, Colistin and Ampicillin. They were moderately sensitive to Kanamycin. e) Clostridium species were sensitive to Tetracycline and Erythromycin in all cases.

임신 및 분만결과에 따른 경구당부하검사의 분석

김정혜(JH Kim),송혜섭(HS Song),오말례(ML Oh),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 1. 서구인과 비교해 본 저자들의 경구당부하검사는 많은 차이점들 나타내었다. 즉 저자들이 시행한 검사치를 미국인의 것과 비교했을 때 평균치에 있어서 약30~4omg%,2S.D.에서 25~40mg%가 각각 높았다. 그러므로 식생활이 다른 한국인의 임신성 당뇨병 진단에 미국인의 기준치를 적용하는 것은 많은 오류를 범할 수 있다고 생각되므로 좀 더 많은 수의 검사로 한국인의 표준을 정하는 것이 필요하다고 본다. 2. 비정상 임신시 정상 임신에 취하여 비정상 당부하검사를 나타내는 예가 월등히 많았다. 과체중아 분만시에 고혈당치 뿐 아니라 저혈당치의 빈도도 높이 나타났으며 처체중아 분만시에도 고혈당치를 나타내는 빈도가 높았다. 또한 산과력이 나빴던 예에서도 저혈당치를 나타낸 예와 현성당뇨병을 나타낸 예가 많았으며 임신중독증 시에도 고혈당치 뿐 아니라 저혈당치도 높은 빈도를 나타내었다. 3. screening test로써의 single test는 3시간이 의의가 있는 것으로 생각되나 일부의 비정상적인 사람들을 포함하지 못할 수도 있다. 모든 임신부에게 3시간의 single test를 행하는 것이 바람직하나 비정상적인 임신이 기대될 때는 표준당부하검사를 시행하는 것이 좋을 것이다. lt has been wedely recognized that many complications in obstetrics & gynecology are asscoiated with abnormal carbohydrate metabolism. Oral glucose toIerance test is the one of the better tests in diagnsing diabetes mellitus but its value changes depending upon the basic diet, especially amount of carbonhydrate intake. Therefore we thought there may be a difference in glucose tolerance between Western and Korean peoples. Oral glucose tolerance tests were done in 159 control group people, nonpregnant 34, pregnant 59, and postpartum (baby, A.G.A.I.)66, and a group of 389 with abnormali- ties of pregnancy, L.G.A.I.215, S.G.A.I.76, stillbirth unknown cause 22, bad ㅇbstetric history 20, hypertensⅳe disorders in pregnancy 53, and fetal abnormality 3. The results are as follows; 1. There was a marked difference between Korean and American mean oral glucose tolerance test results. This study showed 30~40mg% higher value than American pre- gnancy standard, and 25~40mg% higher in comparing 2 S.D. This study would mean that it would be dangerous if the American standards are used in diagnosis and treat- ment of Gestational Diabetes in Kotea. 2. Abnormal pregnancy showed a more frequent association with abnormai G.T.T. compared to normal pregnancy. Hyperglycemia was associated with L.G.A.I. in 7.9% cases but also hypoglycemia was associated with hyperglycemia. Patients with a bad obstetric history showed 20% hypoglycemia and 15% overt diabetes, but none in the hyperglycemia, not diabetic level. Dypertensⅳe disorders in pregnancy were associated with hyperglycemia as well as hypoglycemia. 3. For singIe Ioading test a 3hr test is probably the best but it would still miss some of the patients with abnormal curves. As a screening test of all pregnant patients the 3hr single loading test could be used but when there is an abnormality of pregnancy it would be adⅵsable to do a full G.T.T.

Testicular Feminization 증후 1예

장애숙(AS Chang),송혜섭(HS Song),강경화(KH Kang),양석기(SK Yang),김영선(YS Kim) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

저자들은 본원에서 경험한 testicular feminization syndrome 1예를 보고하고 이에 대한 문헌적 고찰을 하였다. This paper describes a patient, thought to be female, who presented at age 20 for investigation of primary amenorrhea. She was found to be gentically male, with inguinal testes, but femine external genitalia. A diagnosis of male hermaphroditism with feminization was made. The relevent literature is reviewed.

Rh 음성 산모의 문제점

송혜섭(HS Song),장애숙(AS Chang),김정혜(JH Kim),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

1976년 1월 1일부터 1980년 7월 31일까지 일신부인병원 산부인과에서 분만한 Rh 음성 산모 43명과 53회의 임신으로 출생된 55명의 신생아를 대상으로 Rh 음성이 산모와 태아에 미치는 영향을 비교 관찰한 결과 다음과 같은 결과를 얻었다. 1.28,249명의 산모중 Rh 음성은 43명이었고 53회의 임신으로 그 빈도는 0.19%였다. 2.Rh 면역된 임신 5예에서 그 원인이 수혈에 의한 것으로 생각되는 것이 3예로 가장 많았고 이전의 인공유산에 의한 것으로 생각되는 것이 2예였다. 3.산후 Rhogam을 투여했던 9예에서는 모두 Rh면역이 일어나지 않았다. 4.Rh 음성 산모의 산전관리에서 Rh 항체역가치에만 의존하지 말고 양수천자에 의한 빌리루빈치의 측정이 필요한 것으로 생각되었다. 5.Rh 음성이 산모에 미치는 영향으로써 산후출혈 후 혈액공급이 어려운 것이었고, 분만전에 가족의 광범위한 혈액형 검사로 Rh 음성 혈액의 준비가 필요한 것으로 사료되었다. 6.Rh 면역된 신생아에서 주산기 사망은 없었으나 빠른 빌리루빈치의 증가가 나타남으로 제대혈액으로 혈액형, 혈색소치, 빌리루빈치, 직접쿰수치의 측정이 필요하고 출생 후 면밀한 관찰과 적극적인 처치가 요구된다. 53 pregnancies in 45 Rh neg. women who were delivered between Jan. 1st 1976 and July 30th 1980 in Il Sin Women`s Hospital were reviewed and following results were obtained. 1.The incidence of Rh neg. women among a total 28,249 patients was 0.19%. 2.5 patients were immunized. In 3 patients the immunization was probably due to previous transfusion of Rh positive blood and in 2 cases the immunization followed previously induced abortions. 3.The use of Rhogam after delivery, abortion, ectopic or possible placental trauma in the non-immunized patient prevents immunization and reduces the neonatal problem.In this series 9 patients who had been given Rhogam after previous delivery Rh immunization was not present. 4.In the management of pregnancy in a Rh negative women not only the Rh antibody titer but also amniocentesis with bilirubin absorption curve is required. 5.Danger to the mother was difficulty in obtaining Rh negative blood for transfusion after severe P.P.H. It is important to check blood grouping of many of the relatives as possible in order to have rapid collection of Rh negative blood when necessary. 6.There were no stillbirths or neonatal deaths, but 4 babies required exchange transfusion due to rapid increase of serum bilirubin. To lower the perinatal morbidity the cord blood needs to be examined in detail followed by close observation with active treatment if jaundice develops to a certain level.

임신중 혈액응고 장애에 관한 임상적 고찰

홍수명(SM Hong),윤정희(JH Yoon),윤숙희(SH Yoon),양석기(SK Yang),김영선(YS Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.1

1. 한 종류 이상의 혈액응고장애검사에서 비정상치를 보인 빈도를 보면 태바조기박리환자의 경우 72례중 47례(65%)로 가장 높았고, 그 다음 계류유산(21%)자궁내 타아사망(17%)의 순으로 나타났다. 2. 혈장 섬유소원농도와 섬유소원분해산물농도를 동시에 측정한 222례 중 두 검사 모두에서 비정상치 를 보인 빈도는 9.5%였으며, 섬유소원분해산물의 농도만 증가된 경우는 10.8%인 데 비해 저섬유소원혈 증만을 보인 것은 3.1%에 불과하였다. 실혈량이 2,000ml이상인 타반조기박리환자 25례를 분석한 결과 에서도 비슷한 양상을 나타내었다. 3. 태반조기박리의 경우 박리의 정도가 심할 수록 응고장애검사의 비정상치를 보이는 빈도가 증가하 였으며 실혈량도 많았다. 4. 태반조기박리, 자궁내 태아사망, 자궁내 태아사망, 계류유산의 경우 각 응고장애검사의 비정상치율 을 비교해 볼 때 응혈시간의 지연은 활성부분트룸보트프라스틴시간, 프로트룸빈시간, 섬유소원농도 및 섬유소원분해산물농도의 측정에 비해 현저히 낮은 비정상치율을 보였다. 5. 총 328례 중 육안적인 응고장애를 보인 경우는 3례였고, 이중 2례는 태반조기박리, 1례는 자간증 환자에서 관찰되었다. 이상의 결과를 요약하면 자궁내 태아사망이나 계류유산에 비해 태반조기박리 환자에서 현저히 높은 빈도의 비정상치율을 보였고, 혈장 섬유소원분해산물의 농도증가가 저섬유소원혈증에 비해 비교적 높은 빈도의 비정상치율을 보였을 뿐 아니라 범발성혈관내응고에 수반되는 출혈경향과도 밀접한 관련성이 있 음을 알 수 있었다. 임상에서 응고장애검사를 시행함에 있어 응혈시간의 측정외에 활성화부분트롬프라 스틴시간, 피로트롬빈시간 섬유소원농도 및 섬유소원분해산물농도의 측정이 반드시 필요하다고 생각된다. During the period September 1979 through to June 1981 328 women with complications of pregnancy in which blood coagulation defects could occur were admitted to Il Sin Women`s Hospital. The complications os pregnancy included 72 cases of abruptio placentae, 127 cases of intrauterine death, 66 cases of missed abortion and 63 other complications. The blood coagulation tests were clotting time, prothrombin time, activated partial thromboplastin time, platelet count and measurement of the plasma level of fibrinogen and fibrinogen degradation products. The resulte were as follows; 1. Of the 72 cases with abruptio placentae 65% showed abnormalities in more than one blood coagulation test compared to 21% and 17% in cases missed abortion and intrauterine fetal death respectively. 2. In 222 cases the plasma concentration of fibrinogen and fibrinogen degradation products were measured at the same time and 9.5% of them showed abnormalities in both tests. 10.8% showed an increase in the lebel of fibrinogen degradation, the higher the incidence of blood coagulation defects and the greater the amount of blood loss. 4. The percentage of patients showing a prolongation of clotting time was much lower than the percentage of patients with abnormalities of partial thromboplastion of coltting time was much lower than the percentage of patients with abnormalities of partial thromboplastion time, prothrombin time and plasma fibrinogen and fibrinogen degradation prolongation of clotting time was much lower than the percentage of patients with abnormalities of partial thromboplastion time, prothrombin time and plasma fibrinogen and fibrinogen degradation products. 5. only 3 of the total 328 cases had gross clinical blood coagulation defects and two of these were in patients with abruptio placentae, and the other was in a patient with eclampsia. In conclusion there was a hgher incidence of blood coagulation defects in cases of intrauterine fetal death and missed abortion. An increase in the concentration of plasma fibriogen degradation products was much more common than hypofibrinogenemia and these findings are consistent with suggestion that the increase of the fibrin degradation products may play the main role in bleeding tendency associated with disseminated intravasculr coagulation. This study has emphasised, that in addition to clotting time it is essential to do other tests, such as prothombin time, and plasma levels of fifibrinogen and fibrinogen degradation products, tn order to detect the coagulation defects that can accompany abruptio placentae, missed abortion and in trauterine fetal death.

자궁경관임신 16례의 임상적 관찰

강경화(KH Kang),박숙현(SH Park),홍수명(SM Hong),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

Cervical pregnancy is a rare from of ectopic pregnancy in which the fertilized ovum implants within the cervix. There is no distinctive presenting symptom as the chief complaint is painless vag inal bleeding which can also occur in other diseases. Cervical pregnancy carries a high mortality rate due to this heavy bleeding. During 10 year period from January 1, 1972 to December 31, 1981, 16 patients with cervical pregnancy were treated and a clinical review of these cases is presented. The results were as follows; 1) The incidence of cervical pregnancy was 1 in 3656 deliveries and 1 in 78 ectopic pregnancies. 2) Women over 30 years of age comprised 81.25% of the group compared to 20.28% for the same age group in the normal obstetric population. 3) Cervical pregnancy never occnrred in the first pregnancy and 75% of the women had had one or more induced abortions. 4) Gestation at termination of pregnancy ranged from 4 to 24 weeks with a mean 9.75 weeks. 5) The major presenting symptom was heavy vaginal bleeding in 11 cases, persistent spotting in 4 cases and epigastric pain, with vomiting, weight loss in 1 case. 6) The diagnosis at admission was cervical pregnancy (31.25%), incomplete abortion (31.25%), choricarcinoma(18.75%), inevitable abortion (12.5%) cervical myoma (6.25%). 7) Blood trsnsfusion was necessary in all patients ranging from 400cc to 3200cc with an average of 1600cc. 8) The majority of patients were treated by immediate hysterectomy in 6 cases but in 7 cases hysterectomy was only done after failure of conservative management. In 3 cases conservative management of dilatation and curettage and gauze packing was successful.