백서에서 serine protease inhibitors 가 난포성숙에 미치는 영향에 대한 연구

윤병구(BK Yoon) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

난포액의 plasminogen activator (PA) plasmin system 은 난포벽의 용해에 관계하여 배란기전 에 기여한다. 최근 정상조직과 병리조직의 연구에서 PA가 세포분화와 조직개조에 밀접한 관 계가 있음이 여러 보고자에 의해 암시되고 있다. 이에 저자는 plasminogen activator 가 배란기전 이외에 난포의 성숙에도 중요한 역할을 하는 지 알아보기 위해 미성숙, 암컷 백서를 대상으로 PMSG투여후 난포성숙의 초기에 serine protease inhibitor를 ovarian bursa에 주사하여 다음과 같은 결과를 얻었다. 1. 난소 단면적에 대한 antral follicle 의 면적비는 SPI를 투여한 난소(0.21+-0.03)에서 생리 식 염수를 투여한 난소 (0.32+-0.02)보다 현저히 감소하였으며 (P=0.001) 면적비의 비율은 평균 33%감소하였다. 2. HCG투여후 난관에서 관찰된 난포세포수는 SPI를 투여한 난관 (2.9+-0.7)에서 생리식염수 를 투여한 난관 (9.4+-0.8)보다 현저히 감소하였다. ovarian bursa에 대한 주사가 난포성숙에 미치는 역학적인 효과와 SPI가 혈류를 통하여 반대편 난소에 미치는 영향은 무시 할 수 있 었다. 이상의 결과 난소에서 생성되는 plasminogen activator 는 배란은 물론 난포성숙의 전 과정에 서 중요한 역할을 한다고 사료된다.

복막 위점액종 2 례

윤병구(BK Yoon),홍성환(SH Hong),김석현(SH Kim),강순범(SB Kang),이진용(JY Lee) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.1

저자들은 난소와 충수돌기에서 각각 유래한 복막위점액종 2례를 경험하였기에 문헌과 함께 보고하는 바이다 Two cases of pseudomyxoma peritonei are reported with the brief review of literature One case is originated from ovarian mucinous cystadenocarcinoma and the other is from appendiceal mucinous cystadenocarcinoma

무배란성 불임증환자에서 Human Menopausal Gonadotropin 치료중 임신주기에서의 배란전 혈청 17-B estradiol변화 양상에 관한연구

김정구(JK Kim),윤병구(BK Yoon),신창재(CJ Shin),문신용(SY Moon),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

서울대학교병원 산부인과에 내원한 무배란성 불임환자 47명을 대상으로 HMG로 배란을 유 도한 67치료 주기에서 배란주위 혈청 E2치 동태 및 최대 난포크기에 따른 임신율과 단태임 신과 다태임신에서 배란전 혈청 E2치 동태를 비교 검토한 결과 다음과 같은 결론은 얻었다. 1. HCG투여일의 혈청 E2치가 500 pg/ml이상인 고반응군의 경우, 제 0일부다 제 +1일의 혈 청 E2치가 상승하는 치료군에서 감소하는 치료군보다 임신율이 유의하게 높았다. 저반응군 의 경우 임신예는 없었다. 2. 제 0일의 최대난포 직경이 14mm이하인 경우 15mm이상인 경우보다 임신율이 현저히 낮 았다. 3. 제 0일의 혈청 E2치는 임신군과 비임신군에서 차이가 없었으나 난소 과작극 증후군의 경 우 현저히 상승하였다. 4. 다태임신의 경우 단태임신보다 제 -4일과 제 -3일의 혈청 E2치가 상대적으로 높은 경향 을 보였으나 통계적 유의성은 없었다. Forty-seven patients with anovulatory infertility were treated with Human Menopausal Gonadotropin to induce ovulation . Sixty-seven treatment cycles were analyzed to evaluate the effect of preovulatory serum estradiol patten on conception, and to compare pregnancy rate according to the size of maximal follicular diameter and preovulatory serum estradiol levels between single and multiple pregnancy. 1. In high responder with serum estradiol greater than 500pg/ml on day , pregnancy rate was higher in ascending group than in descending group . In low responder, there was no case of conception. 2. pregnancy rate was significantly lower in the treatment group with dominant follicle diameter not more than 14mm than in that not less than 15mm 3. serum estradiol level on day 0 was comparable between pregnancy and nonpregnancy group , but significantly higher in hyperstimulated group than in the other group . 4. There was a tendency that serum estradiol levels on day -4 and day -3 were higher in multiple pregnancy group than in single pregnancy group with no statistical significantly.

임순중 병발된 Behcet씨 증후군 치험 1 예

홍성환(SH Hong),윤병구(BK Yoon),김정구(JK Kim) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.12

저자들은 28세의 임부 제19주 임신에서 병발된 Behcet씨증후군 1예를 levamiso투여로 치료하여 양호한 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다 Behcets syndrome is classically described as featuring recurrent aphthous ulcers in the mouth, genital organs and relapsing iritis The etiology and pathogenesis of Behcets syndrome are still unknown A case of Behects syndrome during pregnancy which was treated by levamisole therapy is presented with a brief review of literature

혈중 Prolactin치가 정상인 다낭성난소질환 환자에 대한 Lisuride치료 효과에 관한 연구

이진용(JY Lee),윤병구(BK Yoon),문신용(SY Moon),장윤석(YS Chang) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.11

Polycystic ovarian disease(PCOD) represents a spectrum of disease involving contributions from the hypothalamus pituiary adrenal glands ovaries and extries and extraglandular tissues The precise etiolgy of PCOD however remains elusive Recent studies have suggested that a central deficiency or defect of dopamine may also contributes significantly to the inapprropriate gonadotropin secretion so commonly associated with PCOD To evaluate this hypothesis 0,2 to 04mg of the dopamine agonist lisuride hydrogen maleate was sdministered daily to patients with PCOD Prolactin levels were normal in all cases and there was no evidence of galactorrhea All patient had failed to ovulate while on clomiphene citrate Eight patents were treated for a total of nine cycles Ovulation occurred in one cylcle an no patient conceived In one ovaulatroy cycle LH level rose initially and then dropped to below baseline postovulation In eight anovulatory cycles LH levels did not show consistent change In both ovulatory and noovulatory cycles FSH levels remained loe These preliminary data suggest 1)lisuride apperars capable of altering gonadotropin secretion in PCOD and 2)variable results on LH level in PCOD may reflect the diverse etiology of pathophysiology of PCOD and/ of choosing inappropriate dosages of lisuride

태아곤란증에 대한 임상통계적 고찰 : 1979년 10월부터 1985년 4월까지의 통계

김승욱,윤병구 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.1

1979년 10월부터 1985년 4월까지 서울대학교병원 산부인과에서 분만한 5949명의 신생아중 1분 Apgar 점수가 7미만인 태아곤란증을 나타낸 신생아는 1278명이었다. 이중 자료수집이 가능하였던 태아곤란증 신생아 862명을 대상으로 각 임신의 위험인자에 대한 통계분석을 시행한 결과 다음과 같은 결론을 얻었다. 1. 경도, 중등도의 태아곤란증(1분 Apgar 점수 ; 64)은 532예(61.7%)이었으며, 중도의 태아곤란증(1분 Apgar 점수 ; 30)은 330예(38.3%)이었다. 2. 고위험임신이 569예(66.0%)이었으며 저위험임신은 293예(34.0%)이었다. 3. 산과력상의 위험인자는 초산임신(442예 ; 51.3%)과 2회이상의 유산이나 불임의 기왕력(185예 ; 21.5%)이 대부분을 차지하였고, 그 외 제왕절개술의 기왕력, 노령임신, 저체중아분만 난산 임신성고혈압 산후질출혈 등의 기왕력, 그리고 다산 등의 순이었다. 4. 임신과 병발된 질환으로 부인과수술의 기왕력이 18예(2.1%), 심장질환 29예(3.4%), 만성신장질환 6예(0.7%), 임신성 당뇨 4예(0.4%), 기타 내과질환 34명(3.9%) 등이었다. 5. 현 임신의 위험인자는 조산이 345예(40.0%), 조기파수 182예(21.1%), 태위이상 161예(18.7%), 임신성고혈압 150예(17.4%), 그리고 태아발육지연이 100예(11.6%) 등이었다. 그외 질출혈, 과성숙, 빈혈, 다태임신, 양수과다증, 그리고 Rh 동종면역의 순이었다. 6. 복식분만이 287예(33.3%)이었고, 질식분만이575예(66.7%)이었다. 7. 제대이상은 27예(3.1%)에서 동반되었으며 목주위 제대환 16예, 제대탈출 7예, 협착 2예, 그리고 낭종 2예 등이었다. 8. 사산은 135예(15.7%)이었고, 이중 분만중 태아 사망이 8예이었다. 17예(12.6%)에서 선천성기형이 동반되었고, 파종성 혈관내응고증과 폐혈증으로 인한 모성사망이 2예 발생하였다. The perinatal death rate has been used as the end-point to measure efficacy of antepartum fetal surveillance scheme. The role of the obsterician is to recognize those conditions causing fetal jeopardy, continuously evaluate their effect on the fetus, and determine the most adequate time for delivery of the compromised infant. A review of 862 cases of feral distress with 1 minute Apgar score less than 7 from October, 1979 to April, 1985 yields the following conclusions: 1. Midly to moderately depressed infant (1 minute Apgar score; 6-4) was 532 (61.7%), and severely depressed infant (1 minute Apgar score; 3-0) was 330 (38.3%). 2. High-risk pregnancy was 569 (66.0%), and low-risk pregnancy was 293 (34.0%). 3. With respect to risk factors in reproductive history, nulliparity was 442 (51.3%), 2 or more abortions or history of infertility was 185 (21.5%). The other risk factors in order were previous cesarean section, maternal age over 35, low birth weight, abnormal or difficult labor, pregnancy induced hypertension (PIH), postpartum bleeding, and high parity. 4. In respect of medical or surgical associated conditions, previous gynecologic surgery was 18 (2.1%), chronic renal disease 6 (0.7%), gestational diabetes 4 (0.4%), cardiac disease 29 (3.4%), and other significant medical disorders 34 (3.9%). 5. With respect to risk factors associated with present pregnancy, prematurity was 345 (40.0%), premature rupture of membrance 182 (21.1%), malpresentation 161 (18.7%), PIH 150 (17.4%), and IUGR 100 (11.6%). The other risk factors in order were bleeding, postmaturity, anemia, multiple pregnancy, hydramnios, and Rh isoimmunization. 6. Abdominal delivery was 287 (33.3%), and vaginal delivery was 575 (66.7%). 7. There were 27 cases with abnormalities of umbilical cord: nuchal cord 16, prolapse 7, sticture 2 and cyst 2. 8. Still birth was 135 (15.7%), which includes 8 cases of intrapartum fetal death. Congenital anomaly was associated with 17 cases, and 2 cases of maternal death occurred due to disseminated intravascular coagulation and sepsis.

임신성 고혈압질환과 안지오텐신전환효소 유전자의 유전적 다형성과의 연관성에 관한 연구

이제호,윤병구,배덕수,정재현,노정래,양순하,김덕경 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

Background: The angiotensin coverting enzyme(ACE) gene(encoding kininase II, EC 3.4.15.1) contains a polymorphism based on the presence(insertion [I]) or absence(deletion [D]) within an intron of a 287bp nonsense DNA domain, resulting in three genotypes(D/ I) and I/I homozygotes, and I/D heterozygotes). Alu insertion is associated with lower ACE level than deletion allele(D) and it was observed that D/D individuals have twice the ACE activity of I/I patients. Pregnancy induced hypertension(PIH) probably results from dominating pressor systems owing to loss of antagonizing vasodilator autacoids. Angiotensin II is an extremely potent arteriolar vasoconstrictor. Overactivity or failure to supress responsiveness to the increased activity of angiotensin II, which is generated by ACE, would seem to be a reasonable basis for the vasoconstriction of PIH. The aim of this study is to evaluate the relationship between ACE genotype and PIH. Methods: Blood sampling was taken from 39 patients with PIH. The hypertensive disorders, confirmed at postpartum follow up, were classified as gestational hypertension without proteinuria, preeclampsia(mild and severe) and eclampsia. The diagnosis of preeclampsia was made according to the American College of Obstetrics and Gynecology criteria of hypertension and proteinuria($gt;300 mg/24 hr urine). Genomic DNA was extracted from blood sample. After PCR amplification of the respective fragments from intron 16 of the ACE gene, size fractionation and visualization by electrophoresis were performed. Results: PIH group(including gestational hypertension, mild and severe preeclampsia : frequency of I allele 0.756 and D allele 0.244) had more I allele and less D allele when compared with normal population(frequency of I allele 0.609 and D allele 0.391)(p$lt;0.05). And PIH group had more I/I homozygote individuals showing significant distortion from Hardy-Weinberg equilibrium of ACE genotype(p$lt;0.05). Moreover, severe preeclampsia group alon(frequency of I allele 0.759 and D allele 0.241) had more I allele and less D allele when compared with normal population and had significantly more I/I homozygote individuals. Conclusion: As pregnancies with PIH had more ACE I allele and I/I homozygote individuals. PIH could be associated with I allele of the ACE gene. Considering the observed codominant association between the D-I polymorphism and plasma ACE activity, our result is in favor of the thesis that PIH primarily arises from defective synthsis of vasodilating autacoids and renin-angiotensin system exerts secondary vasoconstrictive action. However, the relationship between ACE genotype and defective vasodilating mechanism during pregnancy is unknown at present.

자궁외임신의 조기진단을 위한 혈청 황체호르몬 일회 측정의 효율성에 관한 연구

이제호,윤병구,최두석,서경용 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9

In order to evaluate the usefulness of single measurement of serum progesterone concentration in the differentiation of normal intrauterine and ectopic pregnancies, 106 patients(30 of pathologically proven ectopic pregnancies and 76 of normal intrauterine pregnancies) were analyzed. Serum progesterone levels were measured during 4-8 gestational weeks in normal intrauterine and in ectopic pregnancies preoperatively. The serum progesterone levels did not change significantly during early normal pregnancies. The serum levels(ng/ml, Mean±SEM) of progesterone with ectopic pregnancies(7.54±1.05) was significantly lower than that measured in intrauterine pregnancies(21.81±0.72, p$lt;0.05). Especially in early pregnancies with serm B-hCG$lt;1,000 mlU/ml when gestational sac is usually invisible by ultrasound examination, serum progesterone level with cut off value of 15 ng/ml can differentiate intrauterine from ectopic pregnancies with a very high sensitivity(100%). In conclusion, single measurement of serum progesterone level in early pregnancy deserves a additional diagnostic labaratory tool for the earlier detection of ectopic pregnancy.

3 년간 사춘기 여성 클리닉 (Young Lady Clinic) 을 방문한 600 명 환자의 임상 양상에 관한 연구

이제호,윤병구,최두석,안광화 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

삼성서울병원 사춘기 여성 클리닉을 방문한 600명 환자의 임상 양상을 분석하여 다음과 같은 결과를 얻었다. 1. 연령에 따라 가장 흔한 질환군 및 질환은 Ⅰ군에서 는 감염성 질환군(63명, 74%)과 질염(61명, 70.9 %), Ⅱ군 에서는 월경 관련 질환군(185명, 77%)과 기능성 자궁출 혈(75명, 31.4%), 그리고 Ⅲ군에서는 월경관련 질환군 (197명, 72%)과 무월경(72명, 26.2%)이었다. 2. 모든 환자를 대상으로 질환을 분석하였을 때 기능 성 자궁출혈이 146명(23%)으로 가장 흔한 질환이었고 이 중 65.8%의 환자에서 호르몬 치료가 필요하였다. 3. 무월경은 115명(19.2%)으로 두 번째로 흔한 질환이 었으며 특히 일차성 무월경 환자 중 21명(66%)이 M-R-K 증후군 같은 구조적 이상이나 염색체 이상 등과 같은 선 천적 이상에 의한 무월경이었다. 4. 질염은 Ⅰ군에서 가장 흔한 질환이었으며 연령에 따라 가장 흔하게 검출된 균이 Ⅰ군에서는 Staphyloco ccus, Ⅱ군에서는 E. Coli, 그리고 Ⅲ군에서는 Candida albicans로 각각 다른 양상을 보였다. 5. 월경곤란증은 78명(94%)이 일차성 월경곤란증이었 고 이 중 프로스타글란딘 억제제를 투여한 환자의 96% 에서 증상의 호전을 경험하였다. 6. 종양을 주소로 내원한 환자 26명(54%)에서 수술을 시행하였고 수술을 시행한 골반내 종양 21명(81%)이 난 소종양이었고 조직검사에서 가장 흔한 진단은 기형종이 었다(10명, 48%). 자궁내종양 중에는 자궁근종이 가장 많았다(4명, 80%). To analyze the clinical characteristics of six hundreds Korean pediatric and adolescent women visiting the Young Lady Clinic (adolescent gynecology clinic) at Samsung Medical Center, review of medical records was conducted from Feb. 1995 to Dec. 1997. The mean patient age was 17.0±5.9 years (mean±SD) with a range of 3 month to 25 years and the menarche being 12.8±1.4 years with a range of 10 to 18. The most common disease entity and disorder according to age groups were infectious disease and vaginitis in pediatric age group (group I), menstruation associated problems and dysfunctional uterine bleeding (DUB) in adole scent group (group Ⅱ) and menstruation associated problems and amenorrhea in premarital age group (group Ⅲ). Among gynecologic diseases, DUB was cited as the most common problem for visiting the Young Lady Clinic (146 cases, 23%). Ninety six patients (65.8%) with DUB were put on hormone therapy using progestin, estrogen, and monophasic oral pill etc. Of those with DUB, seven patients (4.8%) showed severe anemia with average hemoglobin level of 4.7 mg/dl, requiring admission and transfusion, and one patient had coagulopathy. Amenorrhea took second place, and twenty one patients (66%) with primary amenorrhea had a congenital defects such as structural anomaly like Mayer-Rokitansky-Kuster (M-R-K) syndrome or genetic defect like testicular feminization (TF) syndrome. Although secondary amenorrhea was usually considered as result of hypothalamic-pituitary (H-P) dysfunction, we found that 9 cases (10.8%) of premature ovarian failure and 9 cases (10.8%) of hyperprolactinemia. The most common infectious disease and the third common disorder was vaginitis. Using a catheter in catheter technique, predominantly isolated organisms varied according to age group (group Ⅰ: Staphylococcus species, group Ⅱ: E. Coli, group Ⅲ: Candida albicans). Patients considered as having primary dysmenorrhea comprised 94% (78 cases) of total dysmenorrhea patients, and treated with mefenamic acid or aceclofenac resulted in symptomatic improvement in 96% of patients. Among the patients with pelvic tumor, 26 cases (54%) of the patients underwent operation, and 21 cases (81%) was due to ovarian tumor. The most common ovarian neoplasm was teratoma (10 cases, 48%). In conclusion, the most common gynecologic problem in Korean pediatric and adolescent women is disorders related to menstruation comprising 63.7% of patients visiting adolescent gynecology clinic. And vaginitis and pelvic tumors comprise more than 25% of the patients at our adolescent gynecology clinic.

Polycystic Ovary Syndrome의 세부 분류군에서 clomiphene citrate 부하 검사 후 난소기능 및 임상 양상에 관한 연구

이제호,윤병구,최두석,안광화 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

1996년 8월부터 1997년 8월까지 본원 불임 크리닉을 방문한 35세 이하, 기저 혈중 FSH치가 10 mI U/ml 이하인 환자 103명을 대상으로 본 연구를 시행하여 다음과 같은 결과를 얻었다. 1. PCOS 환자군은 CCCT에 의한 난소 기능 평가에서 난소 기능 저하의 소견은 없었다. 2. PCOS 환자군은 대조군에 비하여 배란율이(p< 0.05) 유의하게 낮았고, CC 투여 후 월경주기 10일째 측 정한 혈중 E2치도 유의하게 낮았다(p<0.05). 3. PCOS 세부 분류군은 각 서로 다른 임상 양상을 보였다. Group I 환자군은 다른 환자군에 비해 낮은 빈도의 희발월경과 비만도를 보였고(p<0.05), Group Ⅱ 환자군은 평균 BMI가 다른 환자군과 유사한 분포를 보였지만 BMI가 25 kg/m2 이상인 환자 비율은 다른 PCOS 환자군보다 유의하게 높았다(p<0.05). Group Ⅲ 환자군에서는 다른 군에 비해 희발 월경의 빈도가 유의하게 높은 반면 배란율은 유의하게 낮았다(p<0.05). 본 연구에서는 세분화된 분류에 따른 PCOS 환자군에서 임상 증상과 생화학적 지표, CCCT 반응 양상을 분석한 결과 초음파 소견에 의해 진단된 PCOS 환자군 은 난소의 기능이 감소되지 않았으며 PCOS 환자군 간에 비만과 희발월경의 빈도, 그리고 배란율에 유의한 차이가 있다는 것을 규명하였다. 따라서 세분화된 PCOS 분류는 PCOS 환자의 개별화된 처치에 유용한 지표로 사용될 수 있을 것으로 사료된다. In this study, we investigated the ovarian reserve and clinical charateristics of the polycystic ovary syndrome patient subgroups after conducting the clomiphene citrate challenge test (CCCT). Transvaginal sonography, clinical charateristics, basal serum testosterone, DHEAS, and LH levels were assessed in 103 infertile patients who visited Samsung Medical Center from August 1996 to August 1997. Based on laboratory findings, 63 patients with sonographic PCO pattern were classified as the following subgroups. Group I: PCO pattern only, Group II: PCO pattern with elevated serum testosterone (>0.4 ng/ml) or DHEAS (>1.47 ug/ml) levels, and Group III: PCO pattern with high basal serum LH (>10 mIU/ml) levels. CCCT was performed in all patients. The results are as follows : 1. Ovarian reserve of PCOS patients assessed by CCCT did not diminish. 2. Compared with the control group , patients with PCO revealed lower ovulation rate (P<0.05) and lower serum level of E2 at 10th day of menstrual cycle (P<0.05). 3. There were significant differences among 3 subgroups that Group I showed lower rate of oligomenorrhea (P<0.05), Goup II had higher proportion of obese patients(BMI>25 kg/m2) than other PCOS subgroups (P<0.05), and Group III patients showed the highest rate of oligomenorrhea and the lowest rate of ovualtion after CCCT (P<0.05). In conclusion, the ovarian reserve of PCOS patients assessed by CCCT does not diminish. But among 3 subgroups of PCOS, there are significant differences in ovulation rate and in clinical characteristics after CCCT which might have come from the reflections of different endocrine environment of the PCOS subgroups. study suggests that the classification of PCOS could be a useful parameter in the individualized management of PCOS patients.