자궁경부암에서 접합분자 E - cadherin 의 발현

오기석(Kie Suk Oh),주희재(Hee Jae Joo),김선영(Sun Young Kim),유희석(Hee Sug Ryu),정태영(Tae Young Chung),장기홍(Ki Hong Chang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: The aim of the present study was to evaluate the E-cadherin expression in normal cervical epithelium, carcinoma in situ of the cervix, and invasive carcinoma of the cervix, and to define the role of E-cadlherin expression in tumor invasion with respect to clinicopathologic parameters. Methods: We conducted immunodetection of E-cadherin in 58 cases of cervical carcinoma using immunohistochemistry in formalin-fixed, paraffin-embbeded sections, Rusults: E-cadherin expression was different between normal cervical epithelium and carcinoma in situ of the cervix, and between normal cervical epithelium and invasive carcinoma of the cervix(p<0.05). However, there was no difference in E-cadherin expression between carcinoma in situ and invasive carcinoma of the cervix. In invasive cervical carcinomas, expression of E-cadherin and the intensity of cytoplasmic E-cadherin expression did not correlate with histologic type, lymphvascular space invasion, lymph node metastasis, and stage of disease. Conclusion: It is mncluded that expression of E-cadherin is related to tumor invasion in cervical tissues, but further studies with regard toE-cadherin/catenin/cytoskeleton complex are needed to clarify the prognostic role of E-cadherin with respect to clinicopathologic parameters in invasive cervical carcinoma,

태아의 이형성 신질환을 동반한 임신의 임상 양상 및 주산기 예후

오기석(Kie Suk Oh),김행수(Haeng Soo Kim),양정인(Jeong In Yang),오준환(Joon Hwan Oh),금승섭(Seung Seop Keum) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1

목적: 태아의 이형성 신질환을 동반한 임신의 산전 진단과 적절한 산과적 처치 및 산전 상담에 도움이 되는 임상적 자료를 얻고자 하였다. 연구 방법: 1994년 6월부터 1999년 7월까지 아주대학교병원 산부인과에서 산전 초음파검사를 시행하여 태아의 이형성 신질환으로 진단되고 본원에서 분만한 13예를 대상으로 산전 초음파검사 소견, 주산기 결과, 모성 합병증, 동반된 기형의 유무, 부검 소견 등에 대해 후향적 조사를 시행하였다. 결과: 다발낭성 신 이형성증은 총 분만 9,591예 중 9예로 1,066분만 당 1예의 빈도를 보였으며, 다낭종신은 4예로 2,398분만 당 1예의 빈도를 보였다. 주산기 결과로는 다발낭성 신 이형성증 9예중 임신 24주에 진단된 1예에서 심한 구개순 및 구개열을 동반하여 임신 25주경 유도 분만에 의해 임신종결이 이루어졌고, 6예는 자연진통 혹은 유도분만에 의해 질식 분만되었으며, 이중 자궁내 태아사망으로 임신 36주에 분만이 유도된 1예를 제외한 5예는 정상 분만되었다. 또한 2예에서 제왕절개수술로 분만되었다. 생존한 신생아 7명은 현재까지 생존하여 6개월 간격으로 외래 추적 관찰 중이다. 다낭종신 4예 중 3예는 인위적으로 임신 종결을 하였으며, 1예는 임신 36주에 반복 제왕절개수술에 의해 분만되었는데 비후성 심근증이 동반되었으며, 생후 24시간 이내에 사망하였다. 산과적 합병증으로는 양수과소증 4예, 양수 과다증 2예, 전치 태반 2예, 태반 조기 박리 1예, 조기 양수파막 1예, 자궁경부 열창 1예, 빈혈 1예 등이 있었다. 주산기 합병증으로는 자궁내 발육지연 2예, 요로 감염 1예, 수신증 1예, 급성 호흡부전 1예, 급성 신부전 1예, 뇌실 주위출혈 1예, 후두 연화증 1예 등이 있었다. 결론: 태아의 이형성 신질환이 동반된 임신의 경우, 정밀 산전 초음파검사 및 염색체 검사 등을 시행하여 정확한 진단을 하고 다른 동반된 기형의 유무를 확인하는 것이 산과적 처치 결정 및 주산기 예후에 중요하다고 사료된다. Objective: To obtain clinically useful data regarding prenatal diagnosis, proper antepartum counseling and obstetric management in pregnancies with fetal dysplastic kidney disease. Methods: We retrospectively reviewed 13 cases of MCDK(Multicystic dysplastic kidney) and PCDK(Polycystic dysplastic kidney), diagnosed by antenatal ultrasound and delivered from June 1994 through July 1999 at Ajou University School of Medicine, Department of Obstetrics and Gynecology, with regard to prenatal ultrasonographic findings, perinatal outcomes, maternal complications and associated fetal anomalies. Results: The incidence of MCDK and PCDK was one in 1,066 and one in 2,398 births, respectively. Of the 9 cases of MCDK, one case was terminated due to severely associated anomaly, and 6 cases were delivered by spontaneous labor or pitocin induction at term, of which 1 case was delivered by pitocin induction at 36 weeks gestation due to intrauterine fetal death. Two cases were delivered by cesarean section. There were no neonatal deaths in 7 cases of MCDK and they have been followed up to date, and alive. Of the 4 cases of PCDK, 3 cases were terminated by induced abortion or induced vaginal delivery, and 1 case was delivered by cesarean section, which was combined with hypertrophic cardiomyopathy, and the baby died within 24 hours after birth. Perinatal complications consisted of small for gestational age, urinary tract infection, hydronephrosis, acute respiratory failure, acute renal failure, periventricular hemorrhage and laryngomalacia in the neonatal period. Conclusion: It is suggested that antenatal ultrasonography and genetic analysis to evaluate accurate diagnosis and associated anomalies should be performed to manage and councel properly the pregnancies with fetal dysplastic kidney disease.

자궁경부암 환자에서 종양표지물질 CYFRA 21-1과 SCC Ag의 치료전 혈청치의 유용성

오기석(Kie Suk Oh),정태영(Tai Young Chung),정두용(Do Young Chung),유희석(Hee Sug Ryu),장기홍(Ki Hong Chang),전미선(Mi Son Chun),박찬희(Chan Hee Park),박영한(Young Han Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

목적: 폐(lung)의 비소세포암(non-small cell cancer) 뿐만 아니라 편평상피암의 진단에 사용되고 있는 CYFRA 21-1의 혈청치가 자궁경부암의 추적관찰 및 재발암을 예측하는데 있어 혈청종양표지물질로서 가장 널리 사용되고 있는 Squamous cell carcinoma antigen(SCC Ag)과 더불어 임상병리학적 변수로서의 부가적 가치에 대한 여부를 알아보고자 하였다. 연구방법: 1995년 11월부터 1997년 7월까지 아주대학교병원 산부인과에 내원한 중에서 CYFRA 21-1과 SCC Ag을 측정한 80명의 자궁경부암 환자와 정상 또는 부인과 양성질환자 59명을 대조군으로 후향적 연구를 하였다. 결과: 1. ROC curve에 의한 혈청 SCC Ag과 CYFRA 21-1의 정상 cut-off value는 각각 1.94ng/ml, 3.11ng/ml였다. 2. Cut-off point에 의한 SCC Ag의 민감도, 특이도, 양성예측율, 음성예측율은 각각 55, 95, 97, 46%, CYFRA 21-1은 각각 45, 91, 87, 55% 였으며 두 물질의 병용측정시 민감도는 62%로 증가하였고 특이도, 양성예측율, 음성예측율은 각각 72, 75, 58% 였다. 3. FIGO stage Ib-IIa 의 SCC Ag과 CYFRA 21-1의 혈청치는 각각 2.2±3.9ng/ml, 2.5±3.6ng/ml 였으며 stage IIb-IV 는 각각 12.2±15.2ng/ml, 10.8±11.2ng/ml 였다(p<0.05). 4. 종양종괴의 크기가 4cm 이하인 경우 SCC Ag과 CYFRA 21-1의 혈청치는 각각 3.3±9.0ng/ml, 4.5±7.6ng/ml 였으며 4cm 보다 큰 경우는 각각 11.8±11.9ng/ml, 7.7±9.3ng/ml 였다(p<0.05). 결론: CYFRA 21-1의 혈청치의 측정은 자궁경부암을 추적관리하는데 있어 SCC Ag 보다 민감도는 낮으나 병행측정시 보다 높은 민감도를 보이며 자궁경부암의 병기, 종양의 크기 등을 예측하는데 있어서 부가적 가치가 있는 물질로 사용가능할 것으로 사료된다. 또한 치료 후 추적관찰 중 재발암을 예측하는데 있어서도 SCC Ag 단독측정보다 CYFRA 21-1와의 병행측정시 더 효용성이 있을 것으로 생각되지만 보다 많은 환자를 대상으로 장기간에 걸친 연구가 필요할 것으로 생각된다. Objectives: SCC Ag(Squamous cell carcinoma antigen) is so far the most useful tumor marker in assisting clinical diagnosis of cervical cancer and follow-up after therapy. Elevated levels of cytokeratin 19-fragments(CYFRA 21-1) have recently been detected in large proportion of patients with non small cell cancer of the lung, and in particular those with squamous cell carcinoma. This study is to assess the clinical efficacy of CYFRA 21-1 with SCC Ag as the clinicopathologic parameter in cervical cancer. Method: Retrospective analysis of the serum tumor markers CYFRA 21-1 & SCC Ag in eighty cervical cancer patients was performed. Results: Cut off values for SCC Ag & CYFRA 21-1 were 1.94 ng/ml, 3.11 ng/ml respectively. Using the cut-off point, the sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) of serum SCC were 55, 95, 97, 46%, respectively. Serum CYFRA 21-1 showed a sensitivity of 45%, specificity of 91%, PPV of 87%, and NPV of 55%. The combination of SCC and CYFRA 21-1 increased the sensitivity to 62%, with a specificity, PPV, and NPV of 72, 75, 58%. Serum levels of both markers were compared with tumor stage, lesion size and were significantly related. In FIGO stage Ib-IIa, the serum levels of SCC Ag & CYFRA were 2.2±3.9, 2.5±3.6 ng/ml and in FIGO stage IIb-IV, 12.2±15.2, 10.8±11.2 ng/ml. In ≤4cm of lesion size the serum levels of SCC Ag & CYFRA were 3.3±9.0, 4.5±7.6 ng/ml and in >4cm of lesion size, 11.8±11.9, 7.7±9.3 ng/ml. Conclusion: These data seems to show that serum CYFRA 21-1 may be of additional value in assessing the state of disease in some patients with cervical cancer. The prediction of recurrent cervical cancer with SCC Ag were improved by the combination with CYFRA 21-1 but further investigation is needed.

중증 전자간증 임산부의 제대동맥 이완기말 혈류 속도에 따른 제대혈 혈액소견 및 주산기 예후

오준환 ( Joon Hwan Oh ),임윤경 ( Yun Kyoung Lim ),이희종 ( Hee Jong Lee ),김행수 ( Haeng Soo Kim ),양정인 ( Jeong In Yang ),유희석 ( Hee Sug Ryu ),오기석 ( Kie Suk Oh ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.4

목적 : 중증 전자간증 환자를 대상으로 제대동맥 이완기말 혈류의 유무에 따른 제대혈 유핵 적혈구의 수와 주산기 예후를 비교하고자 하였다. 연구 방법 : 1999년 1월부터 2002년 9월까지 아주대학교 산부인과에 입원한 중증 전자간증 환자중 분만 72시간 전에 제대 동맥 이완기말 혈류속도를 측정한 49예를 대상으로 하여 이완기말 혈류 속도가 있었던 42예와 혈류 속도가 없는 7예 사이의 제대혈에서의 유핵 적혈구의 수와 태아의 주산기 예후를 비교하였다. Objective : To assess the umbilical nucleated red blood cell counts and perinatal outcomes according to umbilical artery Doppler end diastolic velocity in severe preeclampsia. Materials and Methods : A prospective case-control study comparing 42 severe pr

횡경막 탈장으로 오인된 일측 선천성 횡경막 내장전위 1 예

양정인(Jeong In Yang),오기석(Kie Suk Oh),김행수(Haeng Soo Kim),이준서(June Seo Lee),홍정(Jeong Hong) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm as a result of developmental failure of muscular fibers during the fetal period. Mediastinal shift to the contralateral side may cause significant compression of the affected chest contents resulting in compromised pulmonary function especially when bilaterally involved. The differentiation between congenital diaphragmatic eventration and diaphragmatic hemia is very difficult but eventration has a better perinatal outcome compared to diaphragmatic hernia. We report a case of congenital diaphragmatic eventration on left side with good perinatal outcome after plication in which the initial prenatal diagnosis of diaphragmatic hernia was made by prenatal ultrasonography.

인간 자궁내막의 생리주기에 따른 성호르몬 수용채 , integrin , cyclooxygenase

양현원(Hyun Won Yang),오기석(Kie Suk Oh),김세광(Sei Kwang Kim),김영아(Young Ah Kim),주희재(Hee Jae Joo),유희석(Hee Sug Ryu),권혁찬(Hyuck Chan Kwon),김진영(Jin Yeong Kim),이영돈(Young Don Lee),조동제(Dong Jae Cho) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A STUDY DESIGN: Tissues were obtained from the endometrium of the posterior hmdus in 42 women (proliferative phase-25 cases, secretory phase-17 cases) with normal menstrual cycles(28-32days interval). The specimens were stained with H&E stain and classified according to the method by Noyes et al(1950) into early proliferative phase(-5~-10days from ovulation), late proliferative phase(-4days~ovulation), early secretory phase (ovulation ~5days), mid-secretory phase(6~10days from ovulation), and late secretory phase(11-14days from ovulation). Immunohistochemical staining of integrin a1, a4, b3, COX-1,-2, ER, PR expression was performed. RESULT: The expression of ER was high in the proliferative phase and low during the secretory phase. The late proliferative phase showed the highest intensity(p<0.05). On the other hand, the expression of PR in stromal cells was relatively uniform during the entire menstrual cycle. However, in epithelial cells, there was a characteristic peak intensity in the late proliferative phase and low intensity in the secretory phase.The expression of integrin a1, a4, b3 in epithelial cells showed no particular pattern in the proliferative phase but showed specific findings in the secretory phase. In the epithelial cells, the intensity of a I staining was increased after the early proliferative phase and sustained during the whole secretory phase(p<0.05), a4 was increased in the early and mid-secretory phases, b3 was increased in the mid-secretory phase to late secretory phase. But the strumal cells were weakly expressed in the whole menstrual cycle but showed no particular pattern, In glandular epithelial cells and stromal cells, COX-1 showed a cyclic pattem according to menstrual cycle; it was strongly expressed in the mid-secretory phase in glandular epithelial cells and mid-secretory and menstrual phase in stromal cells(p<0.05). But in luminal epithelial cells, COX-1 was expressed in the entire menstrual cycle but had no particular pattern. In glandular epithelial cells, stromal cells, and luminal epithelial cells, COX-2 was not expressed during the secretory phase but strongly expressed in the mid-secretory phase(p<0.05). CONCLUSION: The expression of a1, a4, b3, and COX-2 showed as stonng staining during the mid secretory phase which represents the implantation period. The PR expression in epitbelial cells was decreased during same period. These characteristic findings will provide helpful information far histological methods of endormetrial dating and will be useful in the measurement of endometrial maturation during the implantation period.

다낭성 난소 증후군 환자에서 체중과 임신이 내분비 양상 및 당 대사에 미치는 영향

황경주(Kyung Joo Hwang),오기석(Kie Suk Oh),김세광(Sei Kwang Kim),권혁찬(Hyuck Chan Kwon),박영한(Young Han Park),양정인(Jung In Yang),유희석(Hee Suk Rhyu) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: The purpose of this study attempts to determine the endocrinologic characteristics and changes in glucose metabolism before/during pregnancy according to different body weights in women with Polycystic ovarian syndrome (PCOS). Methods: 94 women dia with PCOS were evaluated through measuring serum hormone levels and oral glucose tolerance tests preconceptionally and gestationally. Results: In patients who were of normal weight showed significantly increased serum LH levels compared to those who were overweight (12.8+-0.9 Vs. 7.1+-0.8 mIU/ml, p= 0.000), and the serum levels of insulin was increased significantly in the overweight group (7.1+-0.7 Vs. 15.2+-2.8 ulU/ml, p= 0.000). the IGFBP-I (32.8+-10.6 Vs. 8.3+-2.5 ng/ml, p=0.034) and SHBG (55.8+-4.2 Vs. 37.1+-3.1 nmol/ml, p= 0.001) were significantly lower in the ovnweight group. The oral glucose tolerance test before/after pregnancy showed increased frequency of abnormal glucose metabolism, in both of the non-obese group (38.8%, 26,9%) and the obese group (64.2%, 53.9%) compared with normal population. Conclusion: It is thought that in the normal weight group with polycystic ovarian syndrome androgen production is stimulated in the theca cells by abnormally high LH secretion, while in the overweight group the hyperinsulinemia state which decreases the SHBG and IGFBP-I, lead to increase biologically active hee androgens and IGF-I and increase insulin binding to its receptor. And during/before pregnancy, women with PCOS showed that incidence of abnormal glucose metabolism was significantly increased in both of non-obese and obese groups.

임파선 전이 및 자궁방 침윤이 동반된 임상병기 IB 자궁경부암에서 Cyclooxygenase - 2 단백의 과발현

양현원(Hyun Won Yang),오기석(Kie Suk Oh),유희석(Hee Sug Ryu),정태영(Tae Young Chung),장기홍(Ki Hong Chang),권혁찬(Hyuck Chan Kwon),김명신(Myoung Shin Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: the enzymes cyclooxygenase(COX)-1 and -2 are necessary for the synthesis of prostaglandins. COX-2 is usually absent in normal cells and is upregulated and expressed as a product of the immediate early gene during inflammatory processes. In previous studies, the expression of COX-2 has been shown to be induced by prointlammatory cytockines, and suggestions have been made that overexpression of COX-2 supresses apoptosis and is directly related to tumor growth. We the authors have attempted to determine a relationship between the tumor invasion and metastasis of uterine cervical cancer and COX and apoptosis by comparing the protein expression of apoptosis and COX-I and COX-2 in tumor tissues confirmed with cytokeratin, and therefe determine the clinicopathologic risk factors. Materials and methods: The subjects were 18 patients who were FIGO stage IB uterine cervical cancer patients who underwent surgery at the Ajou University Medical Center. The 18 cases were comprised of 12 cases of squamous cell carcinoma, 3 cases each of adenocarcinoma and adenosquamous carcinoma. There were 9 cases with lymph node or prarametrial involvement and 13 cases with lymphvascular space involvement. All tissues obtained from the cases were subject to immunohistochemical staining for COX-1, -2 and TUNEL method for apoptosis detection, and the following results were obtained. Results: Tumor tissues confirmed by cytokeratin wae separated into tumor surface, tumor stroma, and invasion site portions, and in which increased apoptosis was observed in the tumor surface and tumor stmma, but not in the invasion sites. COX-2 expression was observed in all tumor tissues, which was especially strong in the tumor invasion site. Therefore, it is suggested that COX-2 expression may supress cell apoptosis at the site of tumor invasion. When COX-2 expression was investigated when the cases were divided into groups with regard to the presence or absence of lymph node or parametrial involvement, there was statistically significant (Mann-Whitney U test) COX-2 expression seen microscopically in the tumor stroma (p-value 0.028) and tumor invasion site (p-value 0.040) compared to the tumor surface (p-value 0.499). In other words, in surgically treated stage IB cervical cancer patients, COX-2 was significantly expressed when lymph node or parametrial involvement was present. Conclusions: These results suggest that the expression of COX-2 in stage IB cervical cancer patients may downregulate apoptosic processes and thus enhances tumor invasion and metastasis.

일측 태아 기형을 동반한 쌍태임신 2 례

양정인(Jeong In Yang),오기석(Kie Suk Oh),김행수(Haeng Soo Kim),안은주(Eun Joo Ahn),박현희(Hyun Hee Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

Twin pregnancy is at increased risk for congenital anomalies. Although twins were relatively infrequent, they accaunted for a disproportionately large portion of adverse pregnancy outcome, primarily as a consequence of preterm delivery, gestational diabetes, and pregnancy induced hypertension. In case of twin pregnancy with a single anomalous fetus, the clinicians are faced with difficult decision-making processes regarding the route of delivery, when to deliver, how aggressively to attempt to prevent delivery. Twin pregnancy discordant for a fetal abnormality can be managed expectantly or by selective fetocide of abnormal twin. Recently we experienced two cases of twin pregnancy with a single anornalous fetus. We reported cases with concerned literatures.

인간 체외수정 및 배아이식에 있어서 과배란 유도 과정에 사용한 GnRH Agonist가 배란 전 난포내 과립 세포의 세포자연사에 미치는 영향

양현원,권혁찬,황경주,박종민,오기석,윤용달,Yang, Hyun-Won,Kwon, Hyuck-Chan,Hwang, Kyung-Joo,Park, Jong-Min,Oh, Kie-Suk,Yoon, Yong-Dal 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.1

There have been many reports to date regarding the role of GnRH as a local regulatory factor of ovarian function as studies of human and rat ovaries revealed GnRH and its receptor. In recent studies it has been shown that GnRH directly causes apoptosis in the granulosa cells of the rat ovary, and such results leads to the suggestion that the use of GnRH agonist for more stable long term ovarian hyperstimulation in human IVF-ET programs causes granulosa cell apoptosis which may lead to follicular atresia. Therefore this study attempts to determine if granulosa-luteal cell apoptosis occurs in patients during IVF-ET programs in which GnRH agonist is employed for ovarian hyperstimulation. The quality of oocyte-cumulus complexes obtained during ovum pickup procedures were assessed morphologically and then the fertilization rate and developmental rate was determined. Apoptotic cells among the granulosa-luteal cells obtained during the same procedure were observed after staining with Hematoxylin-eosin. The fragmentation degree of DNA extracted from granulosa-luteal cells was determined and comparatively analyzed. There was no difference in the average age of the patients, the number of oocytes retrieved, and fertilization and developmental rates between the FSH/hMG group and GnRH-long group. There was also no difference in the apoptosis rate and pyknosis rate in the granulosa-luteal cells between the two groups. However, when the oocyte-cumulus complexes were morphoogically divided into the healthy group and atretic group without regard for the method of hyperstimulation, the results showed that the number of oocytes obtained averaged $11.09{\pm}8.75\;and\;10.33{\pm}4.53$ per cycle, respectively, showing no significant difference, but the fertilization rate (77.05%, 56.99%, respectively, p<0.01) and developmental rate (65.96%, 41.51%, respectively, p<0.01) was significantly increased in the healthy group when compared to the atretic group. The degree of apoptosis in the granulosa-luteal cells showed that in the healthy group it was 2.25% which was not significantly different from the atretic group (2.77%), but the pyknosis rate in the atretic group (27.81%) was significantly higher compared to the healthy group (11.35%, p<0.01). The quantity of DNA fragmentation in the FSH/hMG group was 32.22%, while in the GnRH-long group it was 34.27%, showing no significant difference. On the other hand the degree of DNA fragmentation was 39.05% and 11.83% in the healthy group and atretic group, respectively, showing significantly higher increase in the atretic group (p<0.01). The above results suggest that death of granulosa-luteal cells according to the state of the oocyte-cumulus complex is more related to pyknosis rather than apoptosis. Also, the GnRH agonist used in ovarian hyperstimulation does not seem to directly affect the apoptosis of retrieved oocytes and granulosa-luteal cells, and which is thought to be due to the suppression of the apoptogenic effect of GnRH agonist as a result of the high doses of FSH administered.