피부까지 전이된 Krukenbergs 종양의 1례

이정일(JI Lee),주괄(K Ju),김만성(MS Kim),황호연(HY Hwang),황익하(IH Whang),이숙환(SH Lee) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.4

위장에서 발생한 것으로 사료되는 1례로 난소뿐 아니라, 피부에까지 전이된 비교적 희귀한 양측성인 전이성 종양을 경험하였기에 보고하고 간단한 문헌적 고찰을 하였다. A extremely rare case of Krukenbergs tumor in ovary being probably primary site in the stomach, which metastatic to the skin. The patient were 49 years old woman living now after surgery, and here we represent case report and review of literatures was made being briefly.

주산기 사망에 관한 고찰

박찬규(CK Park),이충호(CH Lee),박용원(YW Park),김태효(TH Kim),이경림(KR Lee),이숙환(SH Lee) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.9

1968년 1월부터 1978년 12월까지 만 11년간 연세대학교 의과대학 부속 세브란스병원 산부인과에서 출생한 22,866예의 출산아 중 815예의 주산기사망예의 임상기록부의 자료를 대상으로 임상통계학적으로 분석하여 다음과 같은 결론을 얻었다. 1. 만 11년간 평균 주산기사망률은 1,000출산아당 35.64였다. 2. 연령별 주산기사망률은 고위험률 임신군인 19세이하와 35세 이상에서 현저히 높았다. 3. 분만회수별 주산기사망률은 회수가 증가함에 따라 증가하였다. 4. 산전관리를 받지 않은 군이 받은 군보다 주산기사망률이 4.2배 높았다. 5. 임신주수에 따른 주산기사망율은 37~40주에 9.63으로 가장 낮았다. 6. 임신중 발생한 합병증중 대부분이 태아기형을 동반한 양수과다증이 507.4로 가장 높았다. 7. 지연분만과 추락분만에서 주산기사망률이 증가하였다. 8. 파막후 분만까지의 소요 시간이 증가함에 따라 주산기사망률이 증가하였다. 9. 거대아와 저체중아에서 높은 주산기사망률을 보였다. 10. 중위감자분만이나 둔위분만에서 주산기사망률이 높았었다. 11. 주산기사망의 원인은 원인미상 및 조산아가 대부분이었다. 12. 선천성 기형으로는 복합기형이 가장 많으나 단순기형에서는 무뇌증이 가장 높은 빈도를 보였다. 13. 신생아의 대부분이 24시간 내에 사망하였다. An epidemiological review of all 815 perinatal deaths occurring in Yonsei University Medical Center from 1968 to 1978 was carried out. The results were as follows: 1. Over-all perinatal mortality rate was 35.64 per 1,000 births. 2. The perinatal mortality rate was lowest in the age group 25-29. 3. The perinatal mortality rate was highest in 4 or more parity group. 4. There was a much higher perinatal mortality rate among women who recieved no prenatal care than among women who recieved some prenatal care. 5. The perinatal mortality rate was lowest for gestations between 37 and 40 weeks. 6. In terms of relation between complication in pregnancy and perinatal mortality, the hydramnios was considered to be the cause of the highest perinatal mortality rate. 7. The prolonged and precipitate labor led to increased perinatal mortality rate. 8. The prolongation of the interval between the rupture of membrane and delivery led to increased perinatal mortality rate. 9. A striking correlation existed between high perinatal mortality rates, and low birth weight and giant baby. 10. The perinatal mortality rate was increased in mid-forceps and breech series. 11. The major causes of perinatal death were prematurity and etiology unknown. 12. The most frequently encountered single anomaly was anencephaly. 13. The majority of neonatal deaths occurred within 24 hours of life.

다운증후군 산전 선별검사방법의 효능비교

이숙환,이용원,김경률,전혜선,이정노,차광은,백진영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test. Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, β-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.

성반전 남성 1 예

이숙환,곽인평,윤태기,차광열,김현주,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 무정자증 환자에서 핵형검사상 46 , XX를 보인 성반전 남성 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. The incidence of XX male reversal is approximately 1 in 20,000 to 1 in 24,000 male births, a rare disorder. The affected individuals are non-ambiguous at birth with normal male phenotype. They have a 46,XX karyotype, are chromatin positive, and may also be H-Y antigen positive. This group of patients have been key in isolating the gene controling the formation of the testis. By restriction enzyme fragmentation of the X chromosomes and the use of DNA probes, it has been shown that the majority of the XX sex-reversed males contain fragment of DNA from the short arm of the Y chromosome in the distal end of the short arm of the X chromosome. These patients have exclusively testicular tissue and develop the wolffian system while the mullerian duct regress. The external genitalia are of nonambiguous male phenotype, very similar to Klinefelter`s syndrome, but there is a more frequent association with hypospadias and an average height below normal. The testes are small and firm but bilaterally descended. The penile length is normal or slightly shorter than normal, and these patients also develop gynecomastia and hyalinization of the seminiferous tubules at puberty with incomplete pubarche. Infertility occurs secondary to hypogonadism. We have experienced a case of sex-reversed male in azoospermic patient. So we report this case with a brief review of literatures.

비만불임여성에서 발견된 흑색극세포증 1 례

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

저자들은 비만 불임여성에서 경부후측에 생긴 흑색극세포증 1 례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acanthosis nigricans[AN] is a dermatopathy with a distinctive appearance that facilitates its diagnosis. Although an external condition, it is associated with a wide variety of less obvious internal conditions, either benign or malignant. Insulin resistance figures prominently in its benign associations and plays a primary role in its development. The development of acanthosis nigricans[AN] in malignant conditions remains to be explained. Acanthosis nigricans[AN] rarely requires treatment, although the underlying condition usually does. We have experienced a case of acanthosis nigricans[AN] in obese infertile woman. So we report this case with a brief review of literatures.

무정자증과 관련된 45 , X/46 , XY 혼합 생식선 이상발생 1 예

이숙환,곽인평,윤태기,차광열,김현주,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 무정자증 환자에서 핵형검사상 45 , X/46 , XY를 보인 혼합 생식선 이상 발생 ( mixed gonadal dysgenesis ) 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Gonadal dysgenesis traditionally has been based upon phenotypically classified syndromes in which one or both gonads become atretic or streaks. In chromosomally competent ovarian (or gonadal) failure (CCOF) the karyotypes are 46,XX or 46,XY with no cytogenetically demonstrable abnormalities. In chromosomally incompetent ovarian (or gonadal) failure (CIOF) cytogenetic abnormalities are present and include 45,X and mosaicisms (45,X/46,XX), partial deletionsof X (46,X, del[Xq], and ring X), structural abnormalities of X (46,X, i[Xq]) or Y with their mosaicisms, and mixed gonadal dysgenesis (45,X/46,XY). The gonadal phenotypes include bilateral streaks, a unilateral streak and a contralateral ovary or testis, and bilateral abdominal or scrotal testes. Somatic phenotypes range from patients with the classic Turner phenotype with short stature and sexual infantilism, though those with limited gonadal function resulting in partial or complete isosexual or heterosexual pubertal changes, to those with normal stature and sexual infantilism. We have experienced a case of mixed gonadal dysgenesis in male infertile patient with azoospermia. So we report this case with a brief review of literatures.

뇌하수체 종양을 동반한 이차성 무월경 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

저자들은 이차성 무월경 환자에서 성장호르몬을 분비하는 선종 ( adenoma ) 으로 의심되는 뇌하수체 종양을 발견하였기에 문헌 고찰과 함께 보고하는 바이다. Secondary amenorrhea is usually defined as the absence of menses for at least 6 months in a woman who previously had been having regular menses, or the absence of menses for 12 months in a patient with a history of oligomenorrhea. Before the differential diagnosis of these patients is considered, thyroid disease, diabetes mellitus, and normal or abnormal pregnancies should be ruled out. After a careful physical examination, the patient can be placed in one of the following categories: those with no clinical findings of galactorrhea or excess of cortisol or androgen, those with galactorrhea, or those with clinical signs of possible cortisol excess (Cushing`s syndrome) and/or androgen excess. Women with amenorrhea and no clinical evidence of cortisol excess, androgen excess, or galactorrhea have either an abnormality in the hypothalamic-pituitary-ovarian axis or endometrial obliteration (Asherman`s syndrome). We have experienced a case of secondary amenorrhea associated with pituitary tumor suspicious of growth hormone-secreting pituitary adenoma. So we report this case with a brief review of literatures.

난자 공여에 의하여 성공적으로 임신한 46 , X , del(X)(q21) 순수생식선이상발생 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

저자들은 조기난소부전을 보인 46,X,del(X)(q21) 순수 생식선 이상발생(pure gonadal dysgenesis) 환자에서 난자공여에 의해 성공한 임신 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Gonadal dysgenesis represents a wide spectrum of clinical phenotypes, gonadal structures that include the presence of at least one streak gonad and a variety of X chromosome abnormalities and mosaicism. Turner`s syndrome is the best-known form of gonadal dysgenesis. The eponym should probably be restricted to those patients with the phenotype described by Turner: streak gonads or hypoplastic ovaries and an absent or abnormal X chromosome. Turner`s syndrome occurs in 1 in 3,000 live female births. Approximately 98% to 99% of pregnancies with Turner`s syndrome abort spontaneously and approximately 10% of fetuses from pregnancies that have spontaneously aborted have Turner`s syndrome. Pure gonadal dysgenesis is a term applied to a heterogenous group of disorders in phenotypic females with either XX or XY karyotypes, normal genitalia, normal mullerian duct development, bilateral streak gonads, absent or poorly developed secondary sexual development, and primary amenorrhea. In order to make an accurate diagnosis, the bilateral streak gonad must be verified histologically and karyotyping must be performed. We have experienced a case of 46,X,del(X)(q21) pure gonadal dysgenesis which has got pregnant by ovum donation. So we report this case with a brief review of literatures.

Fitz-Hugh-Curtis 증후군 1 예

이숙환,곽인평,윤태기,차광열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

저자들은 난관수종을 동반한 Fitz-Hugh-Curtis 증후군 1 예를 발견하고 시험관 아기에 의한 성공적인 임신을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Five to ten percent of women with acute pelvic inflammatory disease develop symptoms of perihepatic inflammation --- the Fitz-Hugh-Curtis syndrome. The condition is often mistakenly diagnosed as either pneumonia or acute cholecystitis. Persistent symptoms and signs include right upper quadrant pain, pleuritic pain, and tenderness in the right upper quadrant when the liver is palpated. Liver transaminases may be elevated. Fitz-Hugh-Curtis syndrome develops from transperitoneal or vascular dissemination of either the gonococcus or chlamydia organism to produce the perihepatic inflammation. Currently, chlamydia produces the majority of cases. Other organisms, including anaerobic streptococci and coxsackievirus, have also been associated with this syndrome. Laparoscopy may be useful in the diagnosis of this syndrome. The liver capsule will appear inflamed with classic $quot;violin$quot; string adhesions to the parietal peritoneum beneath the diaphragm. Treatment is the same as the treatment for salpingitis. We have experienced a case of Fitz-Hugh-Curtis syndrome associated with hydrosalpinx and succeeded in pregnancy using in vitro fertilization. So we report this case with a brief review of literatures.

착상전 유전질환진단의 임신성공 1 례 ; 염색체 전좌보인자 배아의 착상전진단을 거친 임신성공

이숙환,차광열,이혜경,김언경,박성은,엄기붕,고정재 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

착상전 진단에서 FISH는 주로 반성 유전성 질환에서 성감별이나 염색체 숫적이상의 진단에 이용이 되었으나, 본 연구에서는 t(2;6)(p13;21)의 균형전좌(balanced translocation)의 배아에서 2개의 whole chromosome paining probes을 써서 정상적인 각각 2개의 signals을 보이는 배아만 골라서 이식, 임신에 ㅓㅇ공하여 문헌고찰과 함께 보고하는 바이다. 염색체 전좌의 착상전 진단의 경우 보다 적절한 분석의 판정기준이 필요하며 보다 정확한 진단을 위하여 정상 중기(metaphase) 염색체위의 DNA와 dual FISH에 의한 comparative genomic hybridization기법의 이용이 멀지않은 시기에 이루어지리라 기대된다. 그 밖에 confocal microscope을 이용한 진단방법도 앞으로 많은 도움이 되리라 생각된다. Fluorescent detection of insitu hypridization(FISH) with whole chromosome painting probe(chromosome 2 and 6) has used to assess the use of this method for preimplatation diagnosis of the carrier of a balanced traslocation t(2;6)(p13;p21) which has repeatedly led to spontaneous abortions. Interphase nuclei have been analyzed and four embryos with 2 green/red signals each for the chromosome 2 and 6 were transferred and a pregnancy resulted.