임신에 합병된 미분화배세포종의 1례

이숙인(SI Lee),조희중(HC Cho),김석화(SH Kim),이재찬(GC Lee) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.5

A Case of dyagerminoma in retroperitoneal caity of tull term pregnant woman, who was operated one year ago for dysgerminoma of right ovary, was presented, And literature of dysgerminoma are briefly reviewed.

자궁외임신의 임상적 관찰

박찬동(CD Park),함종국(JK Hahm),이재찬(GC Lee),김석화(SH Kim) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.4

There hundred and twenrty seven consecutive cases of ectopic pregnany observed at the dep- artment of Obsrerics & Gynecology, St. Mary`s Hospital, Catholie Medical College, duing the period of january 1963 through August 1967 are presenetd. A clinical analysis of these cases blood teabnsfusion to these patients were discussed. Summary and Conclusion 1. A review of three hundred and tweenty-seven cases of ectopic pregnancy revealed the higher incidence of the involvement in the right tube than in the left. Of over-all cases 7.27 percent of them were in the ampulla of the tube. The ruptured type was slightly dominated the abortive one. 2. The incidence of ectopic pregaancy tends to increase every year and it diminishes with increasing darity. The incidence of repeated ectopic pregnancy was in 4.2 percent. 3. The average age of ectopic pregnancy was 32.97 vears in comparsion with that of normal pregnancy 28.89 year. 4. Previous D. & C should be considered as a frequent factor which related to the occurance of ectopic pregnancy. But provious D. & C is not direct in proportion to the occuramce of ectopic pregnancy and infection mentioned as the complication of it 5. The maean duratio of the symptoms of L.M.P. was 6.1 wks. I think complete history taking is most important thing for diagnosis due to the variable occurance of hte symptoms. 6. It is true that variable degree of lowered hemoglobin indicated in intraabdominal blood loss due to ectopic pregnancy but in about half of the cases there was no cassity of routine blood trasfusion.

골반경수술중 주입된 복강내 CO2가스의 소실에 관한 연구

이재찬,김성호,강용기,이은숙,김동호,배도환 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

1994년 3월부터 1994년 8월까지 중앙의대부속 필동병원 산부인과에 내원하여 골반경수술을 시행한 환자 100명을 대상으로 골반경 수술중 주입된 복강내 CO2 가스의 소실에 대하여 흉부단순 방사선 검사로 연구분석한 결과 다음과 같은 결론을 얻었다. 인체와 동배(1:1)의 흉부방사선 사진상 횡격막하 free air는 수술후 1일, 3일, 5일에 각각 63%, 31%, 5%에서 검측되었고 free air의 정도는 평균 5.22+-7.42 mm, 1.99+-4.64 mm, 0.41+-2.23 mm로 나타났으며 수술후 1주일 후에는 free air가 검측되지않는 양상을 나타냈다. 수술후 1일과 3일 사이에는 CO2 가스의 의미있는 소실이 있었고(p$lt;0.01) 수술후 3일과 5일사이에는 CO2 가스의 소실이 1일과 3일에 비해 적었다(p$gt;0.05). 그러나 심한 자궁내막증으로 인한 장유착으로 장천공과 복막염이 합병된 1명의 환자에서는 수술후 5일째 횡경막하 free air의 정도가 10 mm이상으로 오히려 증가되는 양상을 보였다. 골반경 수술후 정상적으로 CO2 가스로 인해 복강내 양성 기복이 형성될 수 있다는 점을 인식하고 장손상이 의심되는 경우의 복강내 가스의 증가되는 양상을 파악함으로써 임상적으로 중요한 지표가 될 수 있으리라 생각한다. 골반경 수술후 CO2 가스 사용으로 형성된 복강내 양성기복의 정상적인 소실양상을 파악함으로써 향후 장손상의 가능성이 의심되는 경우 복강내 기복소실정도를 정상적인 소실양상을 파악함으로써 향후 장손상의 가능성이 의심되는 경우 복강내 기복소실정도를 정상적인 소실양상과 비교함으로써 임상적으로 중요한 지표가 될 수 있을 것으로 생각된다. From March 1994 to August 1994, 100 patients were checked plain chest X-ray who had underwent pelviscopic surgery including radical hysterectomy, total hysterectomy, CISH, myomectomy, adnexectomy etc. The operative indications were invasive cervical cancer, CIN, myoma uteri, intractable vaginal bleeding, ectopic pregnancy, benign ovarian mass, acute or chronic pelvic pain. Surgical techniques indluded usage of videolaparoscopy, bipolar forceps for hemostasis, endolops and endoloops and endonahts. Endo-GIAs, lasers and monopolar electrosurgical devices were not used. During the operation, pneumoperitoneum was formed by using the CO2 insufflator maintaining intra-abdominal pressure about 12 mmHg. On the postoperative(POD) 1 day, 3 day, 5 day, simple chest X-ray were checked serially. The results were as follows. The mean age of patients was 38.1 years old. Operative time ranged from 35 min. to 420 min. and mean was 122+-65 minutes. Used CO2 gas ranged 35 L to 125 L and mean was 317+-224 L. Mean hemoglobin change from preperation to postoperative first day was 1.6mg/dl. On the real size chest X-ray firm, the subphrenic vertical free air length was 5.22+-7.42 mm on POD first day, 1.99+-4.63 mm on POD third day and 0.41+-2.23 mm on POD fifth day. In a case of intestinal perforation, over 10 mm subphrenic free air was detected on the chest film on POD fifth day. We conclude that checking serial simple chest X-ray may be helpful for differential diagnosis of possible intestinal injury, when it is suspected.

분만전후 산모에서 급성반응물질로서 혈중 Lipoprotein (a) 의 농도변화

이재찬,허민,박형무,서정호 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Lipoprotein(a)[Lp(a)] represents a class of lipoprotein particles defined by the presence of apolipoprotein(a), a unique glycoprotein linked by a disulfide bond to apolipoprotein B-100 to form a single macromolecule. It was known that Lp(a) levels were associated with risk factor for cardiovascular disease and were fluctuated during pregnancy and postpartum. In the present study, plasma Lp(a) levels were estimated in two groups of women comprising 48 normal spontaneous vaginal delivery group and 52 Cesarean section delivery group. The changes of plasma Lp(a) concentrations were serially estimated before delivery, postpartum 1 weeks and postpartum 6 weeks. The result can be summarized as follows. 1. Mean ploasma Lp(a) levels were changed from 43.9 +or- 28.4 mg/dl at delivery to 68.5 +or- 35.5 mg/dl at postpartum 1 weeks, 45.6+-26.4 mg/dl at postpartum 6 weeks in total delivery group. 2. Before delivery, mean plasma Lp(a) levels were 48.9+-25.4 mg/dl in MSVD group versus 39.2+- 30.4mg/dl in C/S group, with a rising level after postpartum 1 weeks 73.1 +or- 35.7 mg/dl versus 63.7 +or- 35.1 mg/dl. And after postpartum 6 weeks, mean plasma Lp(a) levels were returned to near initial levels 48.4 +or- 21.1 mg/dl versus 42.2 +or- 16.7 mg/dl. 3. Lp(a) levels were significantly rised postpartum 1 weeks compared with before delivery(p$lt;0.05) and after postpatum 6 weeks(p$lt;0.05). In conclusion, serum Lp(a) levels were increased postpartum 1 weeks with significant value, and returned to initial levels after postpartum 6 weeks. Our findings suggests that Lp(a) has the characteristics of an acute phase reactant rather modulated by endogenous hormone.

진단 및 수술적 골반경하에서 자궁내막증의 빈도와 임상적 고찰

배도환,이재찬,김동호 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

Endometriosis is one of the most common, mysterious disease in the field of gynecology. And it affects women in the reproductive years, limits their fertility, and seriously impairs their health. The diagnosis of endometriosis is based on the gross inspection under pelviscopy, and cofirmed by microscopic examination. But, with development of pelviscopic surgery, endometriotic lesion was detected more easily, so the prevalence of endometriosis is being more increased now. 775 patients underwent pelviscopic surgery from April 1993 to August 1995 in Chung Ang university hospital. Of them 57 cases of endometriosis were detected by operative pelviscopy. And in infertility group, 40 cases of endometriosis were detected by diagnostic pelviscopy. The results were as follows; 1. The prevalence of endometriosis at diagnostic pelviscopy was 45.4% in 88 patients of infertility group. The prevalence of endometeriosis in 667 patients who underwent operative pelviscopic surgery was 8.5%. 2. The age distribution in endometriosis was 45% in 20~30, 55% in 31~40 in diagnostic pelviscopy, and 35.1% in 20~30, 56.2% in 31~40, 7% in 41~50, and 1.7% in over 51 in operative pelviscopy group. And the prevalence of endometriosis related to age was 51.4% in 20~30, 44% in 31~40 in diagnostic pelviscopy, and 13.% in 20~30, 12.5% in 31~40, 2.2% in 41~50, 1.2% in over 50 in operative pelviscopy. 3. The parity distribution in endometriosis was 92.5% in parity o, 7.5% in 1 in diagnostic group, and 42.1%, 24.5%, 28.1% according to parity 0, 1, 2 in operative group. 4. The stage distribution in endometriosis was 42.5%, 25%, 12.5%, 2% according to stage I, II, III, IV in diagnostic group, and 24.6%, 12.3%, 35.1%, 28.1% in operative group, respectively.