비면역성 태아수종 1 례

정기호(KH Jung),장경택(KT Jang),차상현(SH Cha),조태호(TH Cho) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.9

저자들은 본원에서 경험한 비면역성 태아수종1례를 경험하였기에 문헌적 고찰과 함께 보고 하는 바이다. We have experinced a case of nonimunologic hydrops fetalis observed in a 22 year-old woman and report that with a brief review of related literatures.

재발된 난소암환자에서 Ifosfamide/Mesna와 Cisplatin 투여에 대한 임상적 연구

배동한,장경택,선우재근,김현승,최경준,심재호 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

This study was planned to evaluate the efficacy and toxicity of fosfamide/mesna plus cisplatin combined regimen in patients with recurrent and initial therapy-resistant epithelial ovarian cancer. Controversy still remains over the efficacy of cisplatin containing combined chemotherapy as the treatment of recurrent ovarian cancer and refractory to first line chemotherapy. Ifosfamide ( isophosphamide ) is an analog of cyclophosphamide. It has shown evidences of activity in ovarian cancer and lack of cross-resistance with cyclophosphamide. This study was undertaken for the clinical analysis and evaluation on 16 patients, who were admitted and treated with advanced or recurrent ovarian cancer at the Sooncheunhyang University Chunan Hospital from January 1994 to July 1996. The results were as follows: 1. The mean age of patients was 62 year old with range from 44 to 72. 2. The most frequent side effect was nausea and vomiting(75%), followed by leukocytopenia(68%), alopecia(44%), nephrotoxicity(37%), neurotoxicity(25%), and hepatotoxicity(12%). 3. The mean survival period was 24 months in clinical response cases ranged from 11 months to 36 months, 5 months in progressive cases ranged from 1 month to 14 months. 4. In clinical stages, stage Ⅱ was 6 cases(37.5%), Ⅲ was 6 cases(37.5%) and Ⅳ was 4 cases(25%). 5. Previously all patients were received debulking surgery and PAC hemotherapy. 6. Overall response rate was 44%(7/16).

자궁근종의 약물치료 (GnRH Agonist) 에 대한 효용성에 관한 연구

배동한,장경택,선우재근,최규연,도효신 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Forty five women with symptomatic uterine myomas, who had already been treated with GnRH agonist as outpatietns in Obstetrics and Gynecology of Chunan Hospital, S.C.H University from March 1995 to February 1997, were retrospected and analyzed about effect and side-effects of GnRH agonist with the results over statistical method of the pelvic ultras onography and the hormone check level in blood. The clinical study was aslo examined and studied alleviation maintenance of symptoms, degree of regrowth, and its final future for treatment. Used GnRH agonist types were Decapepty1, Leuprolide and Nafarelin, and the results of the study is as follows. 1. Size of uterine myomas of forty two(93.3%) among forty five women treated with hormone for six months showed reduction of volume as 42.8 ± 4.4% of the first-size except three(p < 0.0005). Twenty seven(60%) among forty five women could undergo easy operation and had less complications like bleeding. And the rest fifteen(33.3%) among eiteen women(40%) could get satisfactory effects only with GnRH agonist therapy. We changed GnRH agonist type for the rest three women(6.7%) after six months and it was decided the case that treatment effect was low. 2. There were no significant regression in serum LH and FSH(p > 0.05), but serum Estradiol levels fell significantly 4 weeks after first therapy(148.7 ± 20.5pg/ml to 29.7 ± 19.5pg/ml) till 24 weeks (to 17.9 ± 0.9 pg/ml)(p < 0.005). 3. Clinical symptoms due to uterine myomas decreased or disappeared 4∼8weeks after first therapy. 4. From 4 weeks after the last GnRH agonist treatment, Estradiol level was 25 ± 14.8pg/ml and showed gradual increase, and volume of the reduced myoma uteri increased gradually from 42.8 ± 4.4% at the last therapy to 49.6 ± 2.7% 8 weeks after last therapy(p < 0.005). 5. The most common side effect was hot flush(82.2%) and the others included vaginal dryness(37.8%), fatigue and interest decline(46.7%), headache and insomnia(33.3%). However, symptoms like general weakness weight loss and osterporosis were rare, and there was no case to stop treatment due to these symptoms. And these symptoms were disappeared with resumption of menstruation after the therapy. 6. There were potential advantages of GnRH agonist therapy before myomectomy or total abdominal hysterectomy such as; (1) easier and safer to isolate the myomas; (2) less intraoperative blood loss; (3) less complications after myomectomy or total abdominal hysterectomy. 7. GnRH agonist used in this study includes Decapeptyl, Leuprolide and Nafarelin, and there was no difference for effect and side-effects of each type. Considering the above results, GnRH agonist treatment for myoma uteri is regarded to be effective, but more further study and report is desirable for new hormone replacement therapy to prevent regrowth of myoma uteri after treatment stop and estrogen dependent side-effect in treatment.

난소종양의 염전에 관한 임상적 연구

배동한,김민관,장경택,선우재근,김현승 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

This study was planned to evaluate the vascular pedicle torsion of various ovarian tumors, which were made on a series of 96 cases with torsion of ovarian tumor, who were admitted, operated and confirmed with postoperative histopathological study at Department of Obstetrics and Gynecology, Soon Chun Hyan University, Chunan Hospital, during the period of 10 years from 1985 March, to 1995 December. The results were as follows: 1. The mean age of patients was 24.8 year old with range from 14 to 42. 2. The most frequent symptom was lower abdominal pain(100%), followed by intermittent pain attack(48%), nausea(21%), vomiting(17%), vaginal bleeding(8%), and dysuria(4%). 3. The mean size of tumors was 6.3 cm with range from 3 to 16. 4. The torsion occured at right side in 76 cases(76%) and at left side in 20 cases(21%). 5. The most frequent degree of torsion was one time rotation(360, 44%). 6. By histopathological classification of tumors with torsion, there were 46 cases of dermoid cyst(48%), 23 cases of simple cyst(24%), 14 cases of mucinous cystadenoma(15 %), 10 cases of serous cystadenoma(10%), 2 cases of serous cystadenocarcinoma(2%), 1 case of mucinous cystadenocarcinoma(1%).

난소에서 발생한 Hepatoid Carcinoma 1 례

배동한,서수형,장경택,선우재근,김창진 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.2

저자들은 하복부 동통을 주소로 내원한 68세 여자 환자에서 국내에서는 보고되지 않은 난소의 원발성 hepatoid carcinoma 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Several cases of a-fetoprotein producing carcinoma of the stomach, the pancreas, and the renal pelvis have been reported. Ishikura and Scully reported 5 cases of hepatoid carcinoma of the ovary as a tumor that resembles hepatocellular carcinoma morphologically and produce a-fetoprotein. They proposed that this type of carcinoma must be distinguished from hepatoid yolk sac tumor. Despite the resemblance to hepatoid yolk sac tumor histologically and the production of a-fetoprotein, the patients are elderly(usually postmenopausal), no gonadal dysgenesis or germ cell component is present. Ishikura et al. considered that hepatoid carcinoma is a variant of common epithelial carcinoma of the ovary. We report a case of primary hepatoid carcinoma of the ovary with the review of literature.

Platinum 제제를 기본으로 한 치료에 실패한 재발성 혹은 난치성 난소암 환자의 구제요법으로서 Taxol-Carboplatin요법의 효용성에 관한 연구

배동한,서수형,장경택,강준모,장진영 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

1995년 3월부터 1997년 3월까지 순천향대학교 천안병원 산부인과에서 수술받은 후 난소암으로 진단되어 Platinum 제제를 기본으로 한 항암화학요법 후 재발하거나 치료에 실패한 환자들을 대상으로 Taxol-Carboplatin제제를 투여한 후 치료반응 및 부작용을 평가하여 다음과 같은 결과를 얻었다. 1. 대상 환자는 12명이었고 이 중 1명(8%)이 완전반응, 2명(17%)이 부분반응을 보여 전체 반응률은 25%(3/ 12)이었다. 2. Grade 4의 백혈구 감소증이 전체 Taxol-Carboplatin 제제 치료 경과 중에 16%에서 나타났고 Grade 3는 41% 에서 보여 이들에게는 G-CSF를 주사하여 치료를 계속할 수 있었다. Grade 3 이상의 빈혈은 없었고, Grade 3 이상의 혈소판 감소증은 3%에서 보였고, Grade 2 소화기계 부작용은 3%이었으며 Grade 3 이상의 소화기계 부작용은 보이지 않았다. 이상의 결과로 볼 때 Taxol-Carboplatin 제제의 난치성 혹은 재발성 난소암에서 Platinum 제제를 기본으로 한 화학요법 후 재발하거나 치료에 실패한 환자들의 일부에 서 유용한 치료법으로 사용될 수 있으리라 사료된다. 그러나 장기적인 생존율의 개선은 아직도 미미한 편으로 향후 Taxol을 기본으로 한 병합화학요법의 개발, 복강내 주입법, G-CSF 및 자가골수이식술을 이용한 Taxol의 고용량요법, 수술 후 일차 화학요법으로서 Taxol의 효용성에 대한 연구와 새로운 치료제의 개발을 위한 지속적인 연구가 필요할 것으로 사료된다. The purpose of this study is to assess the efficacy and toxicity of Taxol used as a salvage therapy in patients with recurrent or drug-refractory ovarian cancer. Nonrandomized, clinical trial of patients with recurrent or drug-refractory ovarian cancer. recurrent ovarian cancer was undertaken. Twelve patients aged 35∼71 years (median 61) with recurrent or drug-refractory ovarian carcinoma were given Taxol-containing regimen. Taxol was administered at a dose of 175 mg/m2. intravenously with Carboplatin (400 mg/m2) every 21 days. The median treatment cycle was 5.4 cycles (range, 3 to 9 cycles). A premedication regimens (Dexamethasone 40mg # 2 IM, Diphenhydramine 50 mg Ⅳ, Cimetidine 300 mg Ⅳ) were used to avoid acute hypersensitivity reactions. The response of patients were evaluated with tumor markers (CA-125, CEA) and CT or MRI before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group (GOG) criteria. The overall response rate was 25% (3/12), including 1 complete response (CR) and 2 partial response (PR). The most common severe toxicity was leukopenia, with grade 2 toxicity ocurring in 65% of the courses; grade 4 leukopenia occuring in 16% of the courses. Other hematologic toxicities were anemia and thrombocytopenia, but no grade 4 these severe toxicities were noted. We observed 25% response rate with taxol for patients with drug-refractory or recurrent ovarian cancer. Taxol is the active drug in advanced ovarian cancer, numerous reports of unequivocal antineoplastic effect of Taxol, but has limited role in refractory or relapsing cases. Further study is required to evaluate the optimal dose of Taxol or combination with other agent in the management of advanced ovarian cancer.