긴급입수자료공개:모택동의 사생활(하)

전종영 북한연구소 1994 北韓 Vol.- No.276

일반연제 발표 : 초음파검사에 의한 태아기형의 진단

전종영,이경림,변수환 대한산부인과학회 1984 대한산부인과학회 학술대회 Vol.53 No.-

Transabdominal Encephalocentesis of Congenitol Hydrocephalus

전종영,정순오 대한산부인과학회 1976 대한산부인과학회 학술대회 Vol.38 No.-

체외수정시술후 질식초음파로 확인된 정상임신에 있어서 산모의 연령이 임신의 결과에 미치는 영향

전종영,강인수,궁미경,손일표,백은찬,연혜정,유근재,이종표,송지홍,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

In infertile patients, the pregnancy loss rate after demonstration of fetal heart beat ranges about 7 % to 11 %, which is relatively higher than that of normal population(about 1.5∼3.3 %). But scanty data are available in evaluation of the influence of maternal age on pregnancy outcomes in IVF-ET patients. Thus, this study was done to assess the imp-act of maternal age on pregnancy loss rate after the early sonographic detection of fetal cardiac activity following IVF-ET. Pregnancy outcomes of 338 IVF-ET cycles from January 1, 1994 through December 31, 1995 were analyzed. Trans vaginal ultrasonography was done serially from the day 21 postconception and the presence of fetal heart activity was documented using a Samsung 125-MAX scanner with a 6.5-MHz transvaginal probe. Logistic regression analysis was done to determine the possible effects of various independent factors such as treatment pr- otocol, infertility factors, basal LH, FSH and E2, multifetal pregnancy reduction, and age of the wife, on probability of spontaneous pregnancy loss after confirmation of positive fetal heart beat. The overall pregnancy loss rate was 8.0 %(27/338). The probability of pregnancy loss after positive fetal heart beat increased with age of the wife(logistic regression analysis, P<0.05). The probability of spontaneous pregnancy loss at a given age was expressed as the following formula:probability=ex/(1+ex), in which χ=-3.9+0.2×age. The older women age over 35 had approximately twice the pregnancy loss rate compared to the younger women;14.9 %(7/47) vs. 6.9 %(20/291). The pregnancy loss rate after multifetal pregnancy reduction was 9.8 %(6/61), which was not significantly different from tht 7.6 %(21/277) without multifetal pregnancy reduction(p>0.05). We conclude that spontaneous pregnancy loss rate after documentation of fetal cardiac activity increases as a function of the maternal age and a profound effect was observed after age 35. Thus, older patients should be counselled on the higher risk of spontaneous pregnancy loss.

과배란유도와 동결보존배아를 이용한 체외수정시술에서 난관수종이 임신율에 미치는 영향에 관한 연구

전종영,강인수,궁미경,손일표,김계현,백은찬,연혜정,유근재,이종표,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

This study was performed to determine the effect of hydrosalpinx on the outcome with in vitro fertilization and embryo transfer(IVF-ET). Hydrosalpingeal fluid may leak into the uterine cavity during or after ovarian hyperstimulation and can cause deletorious effect on embryo or implantation. Herein, we reported the effect of hydrosalpinx on the cycle outcome of IVF in controlled ovarian hyperstimulation cycles and cryopreserved-thawed embryo transfer cycles. In controlled ovarian hyperstimulation cycles, comparisons were made between 59 IVF cycles of 54 patients having tubal disease without hydrosalpinx(control group) and 36 IVF cycles of 35 patients carrying hydrosalpinx(hydrosalpinx group). Both clinical pregnancy and implantation rates were significantly lower in hydrosalpinx group(25.4 versus 8.3%, and 11.6 versus 2.0% respectively). Four ectopic pregnancies were noted in hydrosalpinx group compared to one in the control group. In cryopreserved-thawed embryo transfer cycles, comparisons were made between 27 IVF cycles of 25 patients having tubal disease without hydrosalpinx(control group) and 13 IVF cycles of 13 patients carrying hydrosalpinx(hydrosalpinx group). There was a tendency of decreased pregnancy and implantation rates in hydrosalpinx group compared to the control (37.0 versus 15.4%, and 9.9% versus 4.0% respectively). One ectopic pregnancy was noted in the hydrosalpinx group compared to none in the control group. These data indicate that the presence of hydrosalpinx may negatively affect IVF outcome. We suggest that patients presenting with hydrosalpinx should consider surgical correction to optimize their outcome with IVF procedure.

자연유산아 573 예의 융모막세포를 이용한 세포유전학적 연구

전종영,최수경,황정혜,박소연,류현미 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.12

자연유산아 573예의 융모막세포를 이용하여 직접법과 간접법으로 핵형분석을 실시하여 다음과 같은 결과를 얻었다. 1. 임신주수는 6-16=or$gt;이며, 산모의 연령은 24-40=or$gt; 이다. 2. 573예중 368예(66.0%)에서 염색체이상을 관찰하였다. 3. 이상핵형유형은 삼체성 241예(42.0%), 다배체성형 62예(10.8%), 45,X가 38예(6.6%), 구조적이상 26예(4.5%), 기타 11예(1.91%) 였다. 4. 삼체성 가운데는 단일삼체성이 207예(전좌형삼체성 16예, inv(9)포함), 이중삼체성이 15예, 다중삼체성이 3예, 혼재형이 4예 있었다. 5. 다배체는 삼배체형이 62예, 사배체형이 24예였다. 6. 구조적이상에는 부가현상 4예, 결실이 8예, 역위5예, 전좌형 9예 등이다. 7. 기타는 Kleinefelter 3예, 표식자 염색체 2예, 단체성 5예가 있었다. 8. 산모의 평균연령이 증가함에 따라 삼체성과 다배체형의 빈도가 증가하였다. 9. 삼체성은 16번(25%), 22번(15%), 그리고 21번(9.3%)순으로 많았다. 10. 유산아의 성의 비율은 정상핵형의 유산아(남 ; 여, 0.92%), 이상핵형의 유산아(남 ; 여, 0.85) 동일하게 여아가 높았다. 임신주수는 염색체이상과 관련하여 본 실험에서는 의의는 없었다. During the years 1987-1994, spontaneous abortions were studied by analysis chromosomes from chrionic villi. The recurent losses occurred mostly in the first trimester of pregnancy. The fregnancy and the type of anormalies detected among 573 abortuses are observed by direct and cultured method. Most case were dervied from early abortions before the 13th week of gestation. Of the 573 abortuses analysed, 378(66.0%) had a chromosome anomaly. Trisomy was predominant 241(42.0%), followed by polyploidy 62(10.8%), monosomy X 38(6.6%), structural anormaly 26(4.5%), and others 11(1.9%). Trisomy for the chromosome 16was most prevalent among trisomies. Mean maternal age was gradually increased for trisomies 16,21 and 22 and it was highest for trisomies 18. However, a gestational age was not significant in our present study. Male to female sex ratio 0.92 and 0.85 for the chromosomally normal and abnormal abortuses respectively. Frequency and type of the chromosome abnormalities may serve as a prerequiste for the investigation of non-chromosomal genetic cause of pregnancy wastage.

사정 정자를 이용한 세포질내 정자주입술에서 수정률과 임신율에 영향을 미치는 요인

전종영,강인수,궁미경,김정욱,손일표,최범채,백은찬,유근재,전진현,이호준,임천규,변혜경,한미현 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

본 연구에서는 1994년 5월부터 1996년 12월까지 제일병원 불임크리닉에서 사정 정자를 이용하여 IC SI를 시행한 975 주기를 대상으로 수정률과 임신율에 영향을 줄 수 있는 여러 가지 요인들을 비교, 분석하였으며 그 결과는 다음과 같다. 1. ICSI를 시행한 975주기, 10,927개의 난자 중에 서 8,809개(69.7%)가 수정되었고, 933주기에서 배아 이식을 시행하여 213주기(22.8%)에서 태아의 심박동이 확인되었다. 2. 수정률은 채취 난자 수, 성숙 난자 수, 난자의 성숙율 그리고 정자의 상태 등에 따라 유의한 차이를 나타내었지만 모든 비교군에서 64% 이상의 양호한 수정률을 나타내었다. 3. 임신율은 환자의 연령이 낮을수록(35세 이하), 채취 난자와 성숙 난자의 수가 많을수록(6개 이상) 그리고 ICSI 후 수정률이 높을수록(61% 이상) 그렇지 않은 경우에 비해 유의하게 높게 나타났다. 결론적으로 사정 정자를 이용한 ICSI의 임신율은 정자의 상태보다는 환자의 연령, 채취 난자와 성숙 난자의 수와 ICSI 후 수정률 등에 따라 차이가 있음 을 알 수 있었다. Intracytoplasmic sperm injection (ICSI) has been reported as the most successful technique to obtain high fertilization and pregnancy rate in infertile couples who could not be helped by traditional in vitro fertilization or previously described techniques of assisted fertilization. We performed retrospective analysis, in relation to the number of retrieved (NRO) and injected oocytes (NIO), sperm parameters, maturation rate of retrieved oocytes (MRO), fertilization rate after ICSI (FRI) and age of patient (AGP) in 975 ICSI cycles using ejaculated sperm during 1994∼1996. The purpose of this study was to determine the important factors affecting fertilization and ongoing pregnancy rate in the ICSI cycles using ejaculated sperm. A total of 8,809 injected oocytes, 6,138 (69.7%) oocytes were normally fertilized and 213 (22.8%) ongoing pregnancies were achieved in 933 cycles of embryo transfer. The fertilization rates were significantly different in relation to NRO (from 67.3% to 75.0%), NIO (from 68.5% to 73.9%), sperm parameters (from 64.4% to 73.0%), MRO (from 64.6% to 73.9%)and AGP (from 67.8% to 74.4%), respectively. The ongoing pregnancy rates were significantly different in relation to NRO (from 10.0% to 26.6%), NIO (from 10.4% to 27.9%), FRI (from 18.5% to 30.6%) and AGP (from 6.7% to 25.4%), respectively. From these results, it can be concluded that ICSI using ejaculated sperm can provide high normal fertilization rates (above 64%) in all groups analyzed and NRO, NIO, FRI and AGP are important factors determining a successful ongoing pregnancy.

양막을 이용한 자궁내막증 체외 모형에서 탈락 자궁내막 조직의 유착과 침윤에 관한 연구

전종영,강인수,김은수,궁미경,전진현,고경남 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.12

목적 : 본 연구에서는 생리혈 내의 탈락된 자궁내막 조직이 손상되지 않은 양막의 상피 세포층에 어떠한 과정으로 유착하고 침윤하는 가를 밝혀보고자, 배양 기간에 따른 유착 부위의 형태학적 변화를 관찰하였다. 연구방법 : 생리 주기 제2일이나 제3일에 자궁으로부터 Wallace catheter를 이용하여 생리혈을 채취하였다. 양막은 만삭분만시의 태반으로부터 채취, 분리하여 사용하였다. 탈락된 자궁내막 조직이 포함되어 있는 생리혈을 준비된 양막 조각의 상피층 위에서 7일 동안 배양하였다. 배양 후 1, 3, 5, 7일에 해부현미경을 이용하여 자궁내막 조직과 양막 상피층의 유착 여부를 관찰하였으며, 유착 부위의 세부구조를 관찰하기 위해 투과전자현미경을 위한 시료 준비과정을 이용하여 조직 절편을 만든 후 염색, 관찰하였다. 결과 : 해부현미경을 이용한 관찰에서 체외 배양 1일 후의 양막에서 유착 부위를 관찰할 수 있었으며, 3일 동안 배양한 시료에서는 자궁내막의 상피세포가 양막의 상피세포와 유착되어 있고 자궁내막 기질세포가 양막의 상피세포 사이를 침범하고 있음이 관찰되었다. 5일 동안 배양된 양막에서는 자궁내막 조직이 양막과 더욱 견고히 유착되어, 자궁내막 상피세포들이 양막의 기저막을 따라 퍼져가고, 자궁내막 기질세포들이 양막의 기질층으로 침윤하는 양상을 보였다. 결론 : 생리혈 내에 존재하는 탈락된 자궁내막 조직은 양막 즉, 다른 종류의 상피층에 유착 및 침윤할 수 있음을 관찰하였다. 그 과정은 상피세포가 먼저 유착되고 기저막이 파괴된 후 다량의 기질세포가 침윤하는 것으로 생각되며, 탈락된 자궁내막 조직의 이러한 특성은 자궁내막증의 병인과 병변 형성에서 중요한 의미를 갖는 것으로 사료된다. Objective : The purpose of this study was to evaluate the process of adhesion and invasion of shed endometrium obtained from the menstrual fluid in an in-vitro model for endometriosis using amnion. Methods : The menstrual fluid was collected with Wallace catheter from the uterine cavity on the second or third day of the menstrual period. The shed endometrium was obtained from menstrual fluid by centrifugation and was diluted fivefold with Hams F-10 medium supplemented with 10% fetal bovine serum. The human amnion was obtained from the term placenta delivered without any complications. The cell suspension was placed on amniotic epithelial layer (AE). After 1, 3, 5 and 7 days of culture, the adhesion sites of the shed endometrium on AE were observed with a stereomicroscope. The detailed morphology of adhesion site was histologically observed. Results : After 1-day of culture, adhesion sites were detected in stereomicroscopical observation, but we could not find the adhesion sites in the histological sections. On 3-and 5 days of culture, endometrial epithelial cells adhered and invaded to the AE which appears to be intact. The endometrial epithelial cells located outside of the fragment and adhered tightly to the AE at the adhesion site. The endometrial stromal cells mainly located inside were invading into the extracellular matrix (ECM) of amnion. On the other hand, the shed endometrium composed of only stromal cells showed to invade into the ECM of amnion by penetration through the intercellular space of AE. After 7-day of culture, the endometrial epithelial cells spread out along the basement membrane of amnion following detachment of AE, and many endometrial stromal cells invaded into the ECM of amnion at the adhesion site. Conclusion : The shed endometrium in menstrual fluid can adhere and invade to intact AE. We suggest that the process of adhesion and invasion of the shed endometirum to AE occurs by adhesion of the epithelial cells and invasion of the stromal cells. This process may be substantial in pathophysiology of endometriosis.

다태임신 감수술 (Multifetal Pregnancy Reduction: MFPR) 전의 초기태아의 수가 임신결과에 미치는 영향

전종영,강인수,궁미경,손일표,김계현,백은찬,연혜정,유근재,이종표,송인옥,현우영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Multifetal pregnancy reduction(MFPR) appears to be an efficacious method for impro-ving the perinatal outcome of high order multifetal pregnancies(three or more fetuses). But it is controversial that larger initial fetal number before MFPR affects pregnancy outcomes adversely. The purpose of this study is to determine the affects of the initial fetal numbers on pregnancy outcomes and to compare the obstetrical outcomes according to the initial fe-tal numbers. Eighty four patients who conceived triplet or more by assisted reproductive technology(ART) in our infertility clinics and underwent MFPR to twins between January 1993 and December 1995. Sixteen patients were lost follow-up. Among the remaining 68 patients, four pateints were excluded from this study because of the pregnancy loss before 20 weeks gestation. The patients(n=64) were divided into three groups by the initial fetal number before reduction. 33 patients with triplet gestations(group 1), 18 patients with qua-druplets gestations(group 2), and 13 patients with quintuplet or more gestations(group 3) were retrospectively enrolled. Gestational age at delivery and birthweights were compared according to the initial fetal numbers. The mean maternal age was similar in each three groups. The results were as follows:1) Although there was a trend of decreasing gestati-onal weeks at delivery and decreased birthweight in each groups(mean±SEM:36.9±0.3, 34.7±1.3, 32.7±1.9 and 2,600±58, 2,161±215, 1,855±249 respectively), there were no stati-stical difference between group 1 and group 2, but there were significantly lower in group 3, compared with group1(p<0.05). 2) The incidence of birth before 36 weeks gestation in each group 1, group 2, and group 3 were 12.1%, 38.9%, and 53.8% respectively(p<0.05). 3) The incidence of low birthweight(<2,500gm) in each group 1, group 2, and group 3 were 30.3%, 55.6%, and 69.2% respectively(p<0.05). In conclusion, although MFPR reduced the high order multifetal pregnancy into twin pregnancy, the duration of gestation and the birth weight of newborn were still had a tendency of shortening and low respectively in high order multifetal pregnancy. Therefore strict control of the number of dominant follicles during superovulation and the number of transfered embryo in in vitro fertilization(IVF) is required for improving the pregnancy outcomes in ART.

경질초음파를 이용한 다태임신의 선택적 유산

전종영,노성일,박종민,이승재,민응기 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.3

저자들은 다태임신으로 인하여 임신의 예후가 불량할 것으로 예상되는 10례의 환자들에게 시술한 선택적 유산의 경험과 문헌고찰을 통하여 다음과 같은 결론을 얻었다. 1. 선택적 유산의 시기는 임신중기보다는 임신초기에, 또한 다태임신의 경우 생길 수 있는 일부 태아의 자연소실 가능성이 적은 약 8주~11주정도가 적당하다. 2 시술방법은 복부를 통한 방법보다는 경질초음파를 이용한 심천자가 비교적 정확하고 안전 하며, 심천자 후 공기주입이나 약물주입방법의 결과에는 큰 차이가 없는 것으로 보이나 더 많은 경험을 통하여 우월성을 평가하여야 할 것이다. 3. 시술후 대개 약 80%이상은 성공적인 임신의 진행 및 분만을 보이며, 이는 다태임신을 그 대로 지속시켰을 때의 유산이나 조산률을 고려해 볼 때 오히려 유리하다고 볼 수 있다. 4. 임신된 태아가 정당하게 태어날 권리가 있듯이, 다태임신의 경우에 모든 태아에게 불리한 사태가 유발될 수 있다면 그로부터 보호받을 권리도 있다고 볼 때, 일부의 희생으로 남은 일 부의 건강을 지킬 수 있다는 개념의 선택적 유산은 정당화될 수 있을 것이나, 적응증이나 시 술방법 시술기술 등을 충분히 고려해서 시행하여야 하며, 의학적, 정신적, 윤리적 측면 등의 신중한 숙고가 있어야 하겠다. The induction of grand multiple gestation is a known complication of infertility treatment. Various studies show that the incidence of multiple gestation as a complication of induced ovulation therapy in infertile patients ranges from 16% to 39%. Although there is a good deal of information about the gestation of twins, there is very little on triplets, and virtually nothing but case reports have been published on pregnancies involving four or more fetuses. There are so many complications as high fetal and neonatal mortality rate(31% in triplets, 43% in quadruplets and 91% in sextuplets), abortion, preterm labor, pregnancy-induced hypertension, premature rupture of membrane, post-partum hemorrhage, anemia and so on. Without any intervention, an extremely poor prognosis could be expected for viable pregnancies in the multiple gestation. Thus, we believed that an attempt to reduce the number of fetuses to a manageable number was the best possibility for a successful pregnancy outcome. We performed the selective termination (selective reduction) at first trimester (6 to 13 weeks of gestation) for 10 patients, 9 treated with human menopausal gonadotropin and 1 occurred naturally. Using the transvaginal sonoraphy, we carried out cardiac puncture in all cases, and after then, we injected the air into the fetal heart in five cases, injected the KCI solution in three cases and exanguinated the intracardiac blood in two cases. In 5 of the 10 cases, the pregnancies continued to near term without problems and resulted in the delivery of healthy babies. In 3 of the 10 cases, the pregnancy continued without problems for more than 20 weeks of gestation. Septic abortion was occurred just after procedure in 1 case and spontaneous incomplete abortion was developed 4 weeks after procedure in another 1case.