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임신한 토끼에서 자궁내 감염 유발 후 신속한 항생제 투여 치료의 유용성
은길상 ( Gil Sang Eun ),박교훈 ( Kyo Hoon Park ),윤보현 ( Bo Hyun Yoon ),김암 ( Am Kim ),이진용 ( Jin Yong Lee ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12
Background: Although intrauterine infection, particularly subclinical amniotic infection, is known to increase the risk of preterm labor and delivery, the treatment of this disorder is not well established. Therefore, animal models are desired for elucidating the relationship between antibiotic treatments and pregnancy outcome in case of intrauterine infection, because they are not restricted to ethical concerns, confounding variables, and patient availability. Objective: In the pregnant rabbit model using hysteroscopy-guided intracervical inoculation of E. coli or saline, we investigate 1) the effects of immediate antibiotics (ampicillin-sulbactam) treatment according to inoculum size of E. coli and 2) the effects of timing of administration of antibiotics on pregnancy outcomes after inoculation of E. c.oli. Study Design: Timed-pregnant rabbits underwent hysteroscopy at 21~22 days of gestation(70 %). 1) In the first study, animals were randomly assigned to inoculation either of E. coli (inoculum size 2×10(7) cfu/ml or 2×10(4) cfu/ml) or saline and immediately(within 5 minutes) treated with antibiotics. 2) In the second study, they were assigned to a treatment with antibiotics either 4 hours after inoculation of E. coli 2×10(7)cfu/ml or within 5 minutes after inoculation. Results: 1) Among immediately antibiotics-treated rabbits, E. coli-inoculum groups had significantly fewer live fetuses, more positive cultures of amniotic fluid and/or decidua of fetuses, and more positive cultures in case of live fetuses with respect to inoculum size of E. coli(p<0.001, respectively). And even smaller E. coli-inoculum group(E. coli 2×10(4) cfu/ml) had signficantly lower fetal survival rate and higher positive cultures of amniotic fluid and/or decidua in comparison with control group(p<0.05, respectively). 2) Compared with immediately treated E. coli-inculated rabbits(2×10(7) cfu/ml of E. coli), those who treated from 4 hous after inoculation had significantly fewer live fetuses and more positive cultures of amniotic fluid and/or decidua(p<0.05, respectively), and more positive cultures of amniotic fluid in case of live fetuses (p<0.05, respectively). Conclusion: Earlier antibiotics administration improved pregnancy outcomes in E. coli-inoculated rabbits. However in spite of more increased fetal survival and decreased intrauterine infection rate, there is a possibility of presence of persistent subclinical intrauterine infection in immediately treated and smaller size of E. coli-inoculum group in comparison with noninfected control. When treating with antibiotics, it is needed to observe and monitor closely the presence of persistent subclinical intrauterine infection in patients with intrauterine infection.
E.coli 세균 내독소가 초대배양한 사람의 양막세포에서 Prostagrandin E2생성과 대사에 미치는 영향
김승욱,은길상 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.12
분만진통이 없이 제왕절개술에 의하여 분만한 정상 만삭 임산부의 태반에서 채취한 양막에서 분리하여 초대배양한 양막세포에 E.coli 세균 내독소를 첨가하고, 각각 4시간과 24시간 배양후 생성된 PGE2와 bicyclo-PGEM을 방사면역 측정법에 의하여 측정하여 다음의 결과를 얻었다. 1. 양막세포에서 생성된 PGE2는 E.coli 세균 내독소를 첨가한 실험군에서 대조군에 비하여 유의한 증가를 보였다. 2. 첨가한 세균 내독소의 농도(10 ng/ml, 100 ng/ml, 1000 ng/ml)와 배양시간(4시간, 24시간)에 따라 생성된 PGE2의 농도에는 유의한 차이가 없었다. 3. 양막세포에서 생성된 bicyclo-PGEM도 E.coli세균 내독소를 첨가한 실험군에서 대조군에 비하여 유의한 증가를 보였다. 4 . 첨가한 세균 내독소의 농도(10 ng/ml, 100 ng/ml, 1000 ng/ml)와 배양시간(4시간, 24시간)에 따라 생성된 bicyclo-PGEM의 농도에도 유의한 차이가 없었다. 이상에서 세균 내독소가, 즉 자궁내 감염이 양막으로부터 PGE2를 생성함으로써 조기 진통 유발에 기여할 것으로 사료된다. In trauteine infection was known to be related with preterm labor. Thes study was designed to evaluate the effect of E.coli endotoxin on production and metabolism of prostagrandin E2(PGE2), of which the important role in human parturition is widely accepted, by dispersed cells from human amnion. The amnion cells were established in primary monolayer culture from 5 normal term pregnant women undergoing elective cesarean sections between 38th and 40th weeks of gestation. Bacterial endotoxin were added in concentration of 10 ng/ml, 100ng/ml, 1000ng/ml to amnion cell suspensions, and the supernatant of incubation medias were obtained after incubation of 4 and 24 hours. The concentration of PGE2 and 11-deoxy-13, 14-dihydro-15-keto-11B, 16e-cyclo PGE2 ( bicyclo-PGEM) released in all bacterial endotoxin concentrations at both 4 and 24 hours of incubation. These data suggest bacterial endotosin and probably intrauterine infection contributes to preterm labor by PG production.
결체조직 질환이 의심되는 산모의 쌍생아에서 발생된 선천성 완전 심 블록 1 예
김석현,송현진,은길상,오익환,백종일,박태식,손성기 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.4
광과민성 및 FANA양성 등의소견으로 결체조직 질환이 의심되는 산모의 쌍생아에서 모두 FANA양성반응을 보이고 그중 한 신생아가 선천성 완전 심 블록을 나타낸 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Congenital complete hear block is a rare disease with an incidence of one in 15,000 to 20,000 live births. Recently the association between the isolated congenital heart block and the maternal connective tissue disease, particularly systemic lupus erythematosus is clearly established. In most such cases, antinuclear antibodies associated with sicca syndrome A antigen (anti SS-A(Ro) antibody) are present in the marernal and neonatal serum. We experienced a case of congenital complete heart block in the first twin of a mother with the positive FANA response and photosensitivity which suggest the possibility of the connective disease. We present the case with a brief review of the literatures.
초음파검사에 의한 한국인 태아의 임신주수별 대퇴골 길이 측정에 관한 연구
김승욱,신희철,윤보현,진호준,은길상,백종일 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.9
월경주기가 규칙적이고 태아성장에 영향을 미칠만한 모성 질병이나 임신합병증이 없고 분만결과 신생아 체중이 10에서 90 percentile 사이였던 임신부를 대상으로 초음파를 이용하여 총 909예의 태아 대퇴골 길이 계측을 시행하여 다음과 같은 결론을 얻었다. 1. 임신연령 예측에 있어서 태아 대퇴골 길이 계측은 아두대횡경을 대신할 수 있거나 보완할만한 방법이다. 2. 각 임신주수별로 태아 대퇴골 길이(FL)의 예측치는 Table2와 같고 서구인의 평균치보다 약간 작았으며, 임신주수(MA)와 (FL) 사이의 관계를 회귀분석하여 다음과 같은 회귀방정식을 얻었다. FL= -3.6113 + 0.4089(MA) - 0.00337(MA)2 (R2=0.971, 2 SD=0.6cm, p$lt;0.05) 3. 태아 대퇴골 길이로부터 임신주수를 예측하는 회귀방정식은 다음과 같으며 각 대퇴골 길이별 임신주수 예측치를 Table4에 구하였다. MA=8.8229 + 3.190(FL) + 0.1260(FL)2 (R2=0.962, 2 SD=11.2days, p$lt;0.05). The ultrasound measurement of the fetal femur length has been proposed as a method for the evaluation of gestational age which might be complementary to or even subsititute for the measurement of the biparietal diameter. In this study a total of 909 ultrasound measurements of the fetal femur length were carried out in 714 pregnancy Korean women, who had regular menstrual cycle, exactly known last menstrual period, no pregnant complications such as intrauterine fetal growth retradation, pregnancy induced hypertention etc. and normal pregnancy outomces, from 13 to 42 week`s gestation, All the patients have delivered babies whose birthweight were within the normal range. The average fetal femur length was slightly less than that of the western average. We calculated the mean and the standard deviation of the femur length for each gestational week, and performed a regression analysis. The results of the analysis were as follows. 1. The linear regression equation of the fetal femur lengths(FL) for the menstrual ages (MA) was, FL=-3.6113 +0.4089(MA) - 0.00337(MA)2 (R2= 0.971, p$lt;0.05) 2. The linear regression equation of the menstrual ages for the fetal femur lengths was, MA=8.8229 + 3.190(FL) + 0.1260(FL)2 (R2= 0.962, p$lt;0.05). The predicted values of the fetal femur length from the menstrual age and the menstrual age from the fetal femur length were respectively calculated with these regression equations.