심장판막이식과 수술후의 임신에 관한 임상적 고찰

이재관(JK Lee),김종화(JH Kim),강순범(SB Kang),김종환(JW Kim),서경필(KP Suh) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.8

Patients who have had cardiac valve replacement are being seen increasingly often as candidates for antenatal care. The outcome of 23 pregnancies in 14 patients with bioprosthetic cardiac valves is analyzed and reported here. The results were summarized as follows: 1. Twenty three pregnancies in 14 patients with bioprosthetic cardiac valves resulted in 11 healthy, 2 low birth weight infants, 2 spontaneous abortions, 7 elective terminations of pregnancy, and one tubal pregnancy. 2. Pregnancy and labor seemed to have been tolerated relatively well in these patients. 3. There were 3 males and 10 females among the 13 infants born. 4. Birth weights ranged from 2,140 to 3,670g(mean 3,030). 5. Apgar scores at five minutes ranged from 4 to 10 (mean 9.1). 6. There were no instances of congenital malformations, maternal or fetal hemorrhagic complications. 7. There were 4 spontaneous vaginal deliveries, 7 elective vacuum extraction deliveries, 1 elective forcep delivery, and 1 cesarean section. 8. All patients received prophyllactic broad-spectrum antibiotics for infective endocarditis, and no nistances of endocarditis developed. 9. There were no stillbirth, no neonatal deaths, and no maternal deaths. 10. There were 2 instances of thromboembolism; one in the immediate postoperative period, and the other 5 years after valve replacement. All seemed to be unrelated to pregnancy. 11. Anticoagulants were not used in pregnancies which went to term except one patient, in whom coumarin was administered until 6th week of gestation. 12. One pregnancy was complicated with premature labor, one with gestational edema, one with preexisting chronic active hepatitis, five with worsening of cardiac status (one of the five, with newly developed atrial fibrillation). 13. 34.8% of all pregnancies after cardiac valve replacement were unwanted ones, and at the same time preventable `risk factors`.

한국형 자궁경부 촬영진 ( New Cervicography ) , 세포검사 그리고 HPV-DNA 검사를 이용한 새로운 자궁경부암 검진 모델 ( Model ) 개발

김승조(SJ Kim),박찬규(CK Park),이효표(HP Lee),남궁성은(SE Namkoong),강순범(SB Kang),서호석(HS Saw),이재관(JK Lee),김수녕(SN Kim),김재원(JW Kim),배석년(SN Bae),김찬주(CJ Kim),이근호(KH Lee),이선영(SY Lee),김인호(IH Kim),이찬(C Lee),이정노(JN Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : The false negative rate of conventional cytology is reported to range from 18 to 45%. It is necessary to develop more effective screening strategies that would ideally be more accurate than conventional cytology. This study is designed to investigate the potential of conventional cytology, cervicography, HPV-DNA testing and their combinations as primary screening techniques for cervical neoplasia. The purpose of this project is to develop the models and guidelines for screening tools of cervical cancer of the uterus by evaluating sensitivity, specificity and cost-effectiveness of all the screening methods. Study design : We conducted a screening of random sample of women who visited the department of OB-Gyn. of five different major university hospitals such as Catholic University Hospital, Korea University Hospital, Seoul National University Hospital, Yeonsei University Hospital and Pochon CHA University Bundang CHA Hospital, from May 1, 1996 to April 30, 1999. In a cohort women with an age range of 20 to 70 who underwent routine cytologic screening at Catholic University, Hospital Bundang CHA General Hospital and local clinics from April 1, 1996 to Decomber 31, 2000. cervicography (n=417,125) and testing for HPV-DNA (n=1,347) by the hybrid capture assay were studied for the ability of the cervical cancer screeuing. A new cervicography system with Kim's classification which was developed by Prof. Kim Seung Jo as an adjunctive method for the cervical cancer screening was applied in this cohort study. And then, accuracy, effectivencess, cost-effectiveness of the single or combined screening method were analysed. Result : Sensitivity and specificity of Pap smear were ranged from 55.6% to 83.1% and 72.8% to 88.3% respectively. The combination of Pap smear and cervicography had sensitivity from 89.7% to 98.6%, specificity from 68.2% to 93.2%. With combination of Pap smear, HPV DNA test and cervicography, sensitivity became also highest accuracy among all screening methods from 92.8% to 98.8%. Considering medical charges for diagnosis and social cost occurred by false positive and false negative results, the most cost-effective diagnostic modality was thought to be the combination of Pap smear and cervicography(91,433 won). In patients who were diagnosed as LSIL, colposcopic examination confirmed progression to high grade intraepithelial lesion(HSIL) in 10.7% patients, persistence of LSIL in 55% patients during the 3 year follow-up period. Accuracy of the screening for cervical cancer and CIN can significantly be improved by cytology with new cervicography rather than cytology alone. We concluded that cervicography can be important adjunctive tests for cervical cytology, improving the effectiveness of cervical screening by allowing a more sensitive detection of cervical neoplasia.

다발성 선천성 기형을 동반한 복벽균열증 1 예

김구상(KS Kim),이재관(JK Lee),손수영(SY Son),차상헌(SH Cha),이효표(HP Lee) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.7

c저자들은 조산부로 임신 35주에 사망한 다발성선청성기형을 수반한 복벽균혈증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다 Gastroschisis associated with multiple congenital anomalies is an extremely rare complication of pregnancy A case of gastroschisis associated with multiple congenital anomalies such as hydrocephalus, absence of left thumb, rudimentary right thumb, bilateral manus vara, bilateral rockerbottom feet, bilobed testes, bilateral agenesis of radius, congenital cardiac defects (ventricular septal defect, membraneous mitral valve) which we experienced recently in Seoul National University Hospital is reported here, with a brief review of the literature

소아 및 청소년기에 발생하는 악성 난소종양에 관한 임상적 연구

이규완,김영태,서호석,이재관,이낙우,이용호,박지원 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

목적: 소아기 및 청소년기에 발생하는 자궁부속기 종양중 악성 난소종양의 빈도 및 임상적, 조직학적 양상을 알아보는 것이 본 연구의 목적이다. 연구방법: 1988년부터 1997년까지 고려대학교 의과대학 산부인과에서 부속기 종물로 진단받고 수술적 치료를 통해 조직학적으로 확진된 만 20세 이하의 환자 97명에 대한 후향적 연구를 시행 하였다. 결과: 부속기 종물로 진단된 97예중 악성 난소종양은 14예로 14.4%를 나타내었고 이 중 비종양성 종물 18예를 제외한 종양성 종물 79예중에서는 17.7%의 빈도를 보였다. 악성 난소종양의 연령에 따른 빈도는 11-15세 연령군에서 28.6%, 16-20세 연령군에서 14.5%를 나타내 연령이 낮을수록 악성종양의 빈도가 증가하는 경향을 보였다. 악성 난소종양 14예중 생식세포종이 9예[64.3%], 상피종양이 3예[21.4%], 성기삭-간질종양이 2예[14.3%]의 분포를 나타내었다. 결론: 부속기 종양으로 진단된 만 20세 이하의 환자중 악성 난소종양의 발생빈도는 17.7%였으며 따라서 이 연령군의 환자에서 복부-골반 종물이 발견되는 경우에는 악성 종양의 가능성을 염두에 두고 진단 및 치료에 주의를 기울여야 하겠다. Objective: We retrospectively evaluated the frequency, clinical presentation and histopathologic findings of ovarian malignancy in childhood and adolescence. The aim was to analyze the age-specific presentation, type and distribution of adnexal mass, and corresponding patient outcome in surgically evaluated children and adolescents. Methods: The medical records of all patients aged 20 years or less with adnexal mass seen at the Korea University Medical Center from 1988 through 1997 were reviewed. Only those individuals whose diagnosis was established by laparotomy were included. Results: In females 20 years of age and under, borderline or malignant ovarian neoplasms were identified in 14[14.4%] of 97 individuals with adnexal mass and in 14[17.7%] of 79 females with ovarian neoplasms. The frequency of ovarian malignancies correlated inversely with patient age. In the 11-15 age group, 28.6%[six of 21] had malignancies, as compared with 14.5%[eight of 55] in the 16-20 age group and 0% in the 0-10 age group. Germ cell, epithelial, and sex cord-stromal malignancies accounted for 64.3%, 21.4% and 14.3%, respectively, of the 14 cases. Conclusion: The frequency with which ovarian neoplasms represents malignancy in this age group is 17.7%. Because of the potential for malignant ovarian neoplasms in young females, the presence of an abdominal-pelvic mass requires prompt and thorough attention.

난소에 발생한 이행세포상피암

이규완,이재관,김해중,장기훈,민유선,김종오 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Transitional cell carcinoma of the ovary is extremely rare tumor and the category of transitional cell carcinoma has been proposed for those tumors in which definite urothelial features are present but no benign, metaplastic, and/or proliferating Brenner tumor is identified. We report a case of primary transitonal cell carcinoma of the ovary in 48-year old woman who presented with low abdominal pain and dyspepsia. Brief literature was reviewed about the features of its behavioral aggressiveness and characteristic chemosensitivity.

임신시 급성지방간 (Acute Fatty Metamorphosis) 1 예

서호석,이재관,이광호,오민정,이용호,정경우,박재헌 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Acute fatty metamorphosis is a rare but potentially fatal complication of the third trimester of pregnancy. In 20~40% of cases, acute fatty metamorphosis is associated with preeclampsia and may be difficult to distinguish from preeclamptic liver involvement. Recent reports suggest that the mortality has decreased to 25% fo both mother and fetus, due to largely to early delivery and to the recognition of a higher proportion of mild and nonfatal cases. We experienced one case of acute fatty liver metamorphosis that caused fulminant hepatitis and complete resolution, so we report the case and review of literature briefly.

뇌졸중 환자에 있어서 체감각성뇌유발전 위에 관한 연구

조효근,김응규,이재관 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.15 No.1

The sixty-nine patients of cerebrovascular disease admitted within two days of disease onset were studied by the method of somatosensory evoked potential from November 1987 to Februarv 1989 at the Department of Neurology, Inje University, College of Medicine. The follwing results were obtained. 1. Fifteen cases in 26 patients of cerebral infarction showed abnormal SEP and 11 cases normal, and 6 cases in 18 patients of intracerebral hemorrhage showed abnormal SEP and 12 cases normal, and 4 cases in 9 patients of subarachnoid hemorrhage showed abnormal SEP and 5 cases normal, and all of the transient ischemic attack showed normal SEP. 2. In the cerebral infarction and intracerebral hemorrhage, correlation between graded SEP and mental status of patients were significant. But there was no significance in the subarachnoid hemorrhage. 3. The patients with sensory change showed more numbers of abnormal SEP than the patients wit normal sense and these were significant. 4. The grade of motor weakness correlated significantly with that of abnormal SEP. 5. in cases of cortical lesion, there was the tendency of decreased amplitude of N1-P2 than the chanees of absolute Nl latency or CN2-N1 interpeak latency, In cases of subcortical lesion, there was thtendency of changes of absolute Nl, or P2 latency or CN2-N1 interpeak latency than the changes (amplitude of N1 P2). 6. The graded SEP correlated significantly with the final outcome of the patients of cerebral infarctic and intracereboal hemorrhage. But there was no correlation between the graded SEP and final outcome in cases of subarchno hemorrhage "The results showed that the SEP was valuable method for early detection of disease ar suspecting the prognosis in cerebrovascular disease.

초음파로 산전진단된 태아와 공존한 포상기태 1 례

주갑순,박용균,조수용,서호석,허준용,이재관,이경호,고희경 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

The simultaneous occurrence of gestational trophoblastic neoplasia and a live fetus is a rare phenomenon, with an estimated incidence of one in 10,000 to one in 100,000 pregnancies. Sonography has become a crucial tool in recent years for confirming the diagnosis of such entities. When a fetus is identified in this syndrome, it is rarely alive at diagnosis, and generally manifests a constellation of congenital anomalies associated with triploidy. We report here an unusual pregnancy in which ultrasound examination revealed a markedly abnormal, diffuse molar placenta coexistent with a living fetus.

Attenuated Congenital Adrenal Hyperplasia에 의한 여성반음양 치험 1 예

주갑순,박용균,조수용,서호석,허준용,이재관,이경호,고희경 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

1995년 8월, attenuated congenital adrenal Hyperplasia로 사료되는 여성반음양 1례를 치험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. Congenital adrenal hyperplasia is an inborn error transmitted by an autosomal recessive gene and may be due to a defecto in any of the enzymatic steps in the biosynthesis of cortisol. Most affected individuals have a failure of 21-hydroxylation which prevents the conversion of 17a-hydroxyprogesterone to 11-deoxy cortisol. A defect in 21-hydroxylase leads not only to inefficient formation of cortisol but also to excessive production of adrenal androgens causing virilization. Female pseudohermaphroditism with congenital adrenal hyperplasia is the most common type of intersex problem seen in children. In females with this disorder, the internal genital organs are usually normal, but variable degrees o virilization can be abserved externally. This is a case report of a 1-0-year-old girl with attenuated congenital adrenal hyperplasia who had clitorial hypertrophy.

부인암 환자에서 골반경을 이용한 대동맥 주위 림프절 절제술의 임상적 유용성에 관한 연구

주갑순,박용균,조수용,서호석,허준용,이재관,김철용 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Accurate evaluation of para-aortic lymph node metastasis is important in planning treatment of gynecologic malignancies. For example, geographic treatment failure can be prevented by accurate staging in advanced cervical cancer. The objective of this study is to investigate the feasibility of laparoscopic para-aortic lymph node dissection as a staging procedure in patients with gynecologic malignancies. Eight patients had underwent laparoscopic para-aortic lymph node dissection from May, 1995 to August, 1996. The average operative time was 141 minutes and the mean estimated blood loss was 260 ml. An average of 5.9 lymph nodes was retrieved. Hospital stays ranged from 2days to 3days, with an average of 2.1days. There were no serious complications. Nodal metastasis was diagnosed in one patient whom had negative findings in computerized tomography(CT)scans prior to surgery. In conclusion, laparoscopic para-aortic lymph node dissection appears to be a safe and feasible staging procedure for the patients with gynecologic malignancies and it is an attractive and alternative to traditional surgical staging.