갱년기 여성에서 호르몬 대체요법시 Vitamin D₃추가투여가 골밀도에 미치는 영향

유순원(Sun Won Yoo),조현희(Hyun Hee Jo),여경아(Kyeong A Yeo),유영옥(Young Ok Lew),권동진(Dong Jin Kwon),정기욱(Gi Wook Chung),김장흡(Jang Heub Kim),김진홍(Jin Hong Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

연구목적 : 갱년기 여성에서 호르몬 대체요법 실시시 Vit. D3의 추가 투여가 골밀도에 미치는 영향을 알아보고자 하였다. 연구 대상 : 1992년부터 1998년 사이에 갱년기 클리닉을 방문한 388명을 대상으로 하여 투여 방법에 따라 5군으로 나누었다. A 군 : 에스트로젠 단독요법군 (n=148), B 군 : 에스트로젠-프로제스테론 병합요법군 (n=103), C군 : 에스트로젠 + Vit. D3 투여군 (n=36), D 군 : 에스트로젠, 프로제스테론 + Vit.D3 투여군, E 군 : 비 투여군 (n=60). 연구 방법 : 호르몬 대체 요법 시작 전과 시작 후 2년 간격으로 이중에너지 방사선 흡수 계측법(DEXA, Hologic)을 사용하여 요추의 골밀도와 대퇴골 경부의 골밀도를 측정하였다. 통계 : 연구 대상군들의 골밀도 변화 비교는 paired t-test, one way ANOVA test와 student's t-test를 실시하였다. 결과 : 각 치료군간의 환자특성 및 기저 골밀도 치에 따른 환자특성은 차이가 없었으며, 프로제스테론 병합투여 여부는 골밀도에 의의있는 영향을 끼치지 않았다. Vit.D3 추가 투여시 기저 골밀도가 정상인 군은 대퇴 골두와 요추에서 단독 호르몬 치료군에 비해 모두 의의 있는 증가소견을 보이지 않았으나 기저 골밀도가 골결핍을 보인 군은 에스트로젠과 Vit.D3 투여군의 경우 요추에서 6.1±3.6% (p > 0.05), 대퇴 골두에서 8.5±3.1%(p < 0.05), 프로제스테론 병합요법과 Vit.D3 투여군의 경우 요추에서 5.9±4.1% (p > 0.05), 대퇴골두에서 6.7±4.1%(p < 0.05), 골다공증을 보인 군은 위순서대로 각각 6.7±3.4% (p > 0.05), 11.0±2.1%(p < 0.05), 6.1±1.1% (p > 0.05), 9.1±0.8%(p < 0.05)을 보였다. 결론 : 갱년기 호르몬 치료시 Vit.D3 추가투여는 기저 골밀도가 정상인 군에서는 골밀도 증가에 의의가 없으며, 골결핍증과 골다공증이 있는 여성은 Vit.D3 추가 병합투여가 골밀도 증가 도움을 준다고 할 수 있지만 요추보다는 대퇴골두 골밀도 증가에 더욱 효과가 있다고 할수 있다. Objective : To determine the effect of the addition of Vit. D3 (1,25-Dihydroxychole calciferol D3) to the conventional postmenopausal hormone replacement therapy on bone mineral density(BMD) Design : A 2-year retrospective , randomized study Setting : Department of Obstetrics and Gynecology of Catholic university hospital Patients : 388 postmenopausal women were recruited and divided into 5 groups according to treatment regimen; A: conjugated estrogens only treated group(n=146), B : conjugated estrogens and progesterone treated group(n=103), C : conjugated estrogens and Vit.D3 treated group (n=36), D : conjugated estrogens, progesterone and Vit.D3 treated group (n=41), E : control group (n=60). Methods : The bone mineral density of the lumbar spines and femoral neck were determined by dual-energy X-ray absorptiometry(DEXA) every 2 years.Statistics : The difference between before and after treatment was determined by paired t-test. The comparison among the groups were determined by one way ANOVA test and student's t-test Results : The addition of progesterone to estrogen showed insignificant increase in the lumbar and femoral neck BMD. The addition of Vit. D3 compared with conventional hormone replacement therapy insignificantly influened bone density in women with initially normal BMD, but definitely increase in women with initially osteopenic and osteoporotic BMD of femoral neck rather than lumar spine(p<0.05). Conclusion : The use of Vit. D3 combined with postmenopausal estrogen replacement effects the increase of BMD in low bone density than normal bone density, especially femoral neck.

자궁적출술시 부속기절제 유무에 따른 성호르몬의 변화

조현희(Hyun Hee Jo),유순원(Sun Won Yoo),이지은(Ji Eun Lee),권동진(Dong Jin Kwon),유영옥(Young Oak Lew),김장흡(Jang Heub Kim),김진홍(Jin Hong Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

N/A Objective : To describe the change of serum estradiol, follicul-stimulating hormone and testosterone after hysterectomy, and its difference according to the type of adnexal surgery in pre, and postmenopausal women. Materials and Method : Three hundred twenty four women presenting for hysterectomies for nononcologic reasons. We divide the women into four groups, who only hysterectomized, who with both adnexectomized, who with unilateral adnexectomized, and who with both salpingectomized. We collect the blood samples for serum estradiol and testosterone in preoperative day, 1 day after, 3 day after, 6 day after and 1 month after operation. And check FSH in a day before operation and 1month after operation. Result : Estradiol shows significant decrease in both adnectomy group compared to the unilateral adnexectomized and only hysterectomized. The both salpingectomized shows no difference with the both adnectomized. Testosterone shows no difference between groups in premenopausal women. In postmenopausal women, testosterone decreased 3 days after both adnexectomy compared to the only hysterectomized and the unilateral adnexectomized. The both salpingectomized shows no difference with the both adnexectomized. Conclusion : Testosterone decreases significantly in postmenopausal women after hysterectomy with both adnexectomy or both salpingectomy. So we think it was appropriate treatment to replace estrogen and testosterone in postmenopausal women who both adnexectomized or both salpingectomized.

자궁내막 골화생 1례

이지은(Ji Eun Lee),천연희(Yeon Hee Cheon),최형주(Hyoung Ju Choi),유순원(Sun Won Yoo),김용욱(Yong Wook Kim),김태웅(Tae Eung Kim),김장흡(Jang Heub Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

The endometrial osseous metaplasia is one of a very rare conditions which gynecologists experience clinically. The characteristics of this disease are history of irregular menstruation, recurrent abortion, infertility with histopathologic evidence of chronic inflammation, and bone formation. This is one of heterotopia(the presence of mature tissue in abnormal location) histopathologically and it is important clinically that infertility can be brought about in the reproductive age women, but the etiology and treatment about this disease are unclear. A case of endometrial osseous metaplasia diagnosed by endometrial biopsy is presented with a brief review of the literatures.

자궁경부 종양에서 p53, Proliferating Cell Nuclear Antigen(PCNA), c-myc 및 Epidermal Growth Factor Receptor(EGFR)의 발현

한구택 ( Ku Taek Han ),이형근 ( Hyung Kun Lee ),유순원 ( Sun Won Yoo ),송영훈 ( Young Hun Song ),최원영 ( Won Young Choi ),유기성 ( Ki Sung Ryu ),나종구 ( Jong Gu Rha ),송승규 ( Seung Kyu Song ),이헌영 ( Hun Young Lee ),김수평 ( S 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Expression of four biologic markers known as p53, proliferating cell nuclear antigen(PCNA), c-myc, and epidermal growth factor receptor(EGFR), was studied immunohistochemically in 121 cases of cervical tissues, which included 15 cases of normal cervical tissues, 50 cases of squamous intraepithelial lesions(SIL), and 56 cases of invasive carcinomas. This study was designed to elucidate the roles of these factors in the genesis and progression of cervical neoplasia and to identify their association with clinical parameters such as cell type, tumor size, lymph node involvement, squamous cell carcinoma(SCC) antigen level, and prognosis. In additon, this study evaluates the differences of coexpression rates in normal cervical tissues, SILs, and invasive carcinomas. (1) The intensities of p53, c-myc, and EGFR expression and the rates of PCNA, c-myc, and EGFR expression in cervical SILs and invasive carcinomas were significantly higher than those in normal tissues (p<0.05 and p<0.01). But there were no significant differences between SILs and invasive carcinomas in both of intensities and rates of p53, PCNA, c-myc, and EGFR expression. (2) The intensities and rates of p53, PCNA, and c-myc expression in the invasive carcinomas did not correlate with clinical parameters including cell types, tumor sizes, lymph node involvements, see antigen, and prognosis. But only the intensity and rate of EGFR expression were significantly higher in cases with tumor size larger than 3 cm when it was compared with cases with tumor sizes smaller than 3 cm(p<0.01), in cases with lymph node involvement when it was compared with cases without lymph node involvement(p<0.05), and in cases with SCC antigen levels more than 2.5 ng/ml when it was compared with cases with SCC antigen levels less than 2.5 ng/ml(p<0.05). (3) C-myc immunoreactivity was significantly correlated with EGFR overexpression(p<0.01). (4) The rates of simultaneous expression of four factors were decreased significantly in normal tissues and significantly increased in invasive carcinomas(p<0.01). The coexpression rate of two factors or more was 6.7% in normal tissues, 62.7% in SILs, and 70.0% in invasive carcinomas and the simultaneous expression rate of three factors or more was none in normal tissues, 34.0% in SILs, and 47.5 % in invasive carcinomas. These results show that the immunohistochemical detection of p53, PCNA, c-myc, and EGFR expression will be useful in differentiating the normal tissues and cervical neoplasia. The results of simultaneous immunohistochemical detection of these four factor expression also suggest to contribute a better understanding of the genesis of cervical carcinoma and that coexpression of more factors indicate more aggressiveness in cervical neoplasia, and show that simultaneous detection of these factors can be used in the early detection of cervical neoplasia and to predict malignant transformation of cervical lesions.

난소낭종과 관련된 말초성 사춘기조발증의 치료 1 예

김진홍,김장흡,김수평,최형주,길기철,유순원 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.4

사춘기 이전 소아에서 난소의 작은 난포성 낭종은 매우 흔한 소견이고 대부분이 비기능성으로 임상적 중요성을 가지지 않는다. 그러나 때때로 이 낭종들이 커지고 계속해서 에스트로젠을 분비하여 이차성징의 조기발달과 질출혈 증상들을 나타내기도 한다. 저자들은 난포성 난소낭종으로 인한 사춘기 조발증 1례를 외과적 적출술로 성공적으로 치료하였기에 간단한 문헌고찰과 함께 보고한다. Small follicular cysts are common findings in the ovaries of prepubertal girls, and in most cases, they are of no clinical importance. Ocassionally these cysts may enlarge and continue to produce estrogen, resulting in signs of precocious sexual development and vaginal bleeding. We have experienced a case of a precocious pseudopuberty causing ovarian follicular cyst which was treated by exploratory laparotomy. we present this case with a brief review of literatures.