신장이식 수술후의 정상만삭 질식분만 1례

정기묵(KM Chung),김성수(SS Kim),은희경(HK Eun),이태호(TH Lee) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.14

쌍태가 아닌 사람으로부터 신장이식수술을 받은 부인이 술후 성공적으로 임신하여 전임신기간중 azathioprine과 prednisolone등의 면역 억제제를 투여 받았으나 합병증 없이 건강한 정상태아를 질식분만한 1례를 관계 참고문헌과 더불어 보고한다. A case of successful pregnancy and full term normal vaginal delivery with unaffected fetus following renal transplation was presented with the brief review of pertinent literature.

진행된 부인과적 악성종양에 대한 cis-Platinum과 Adriamycin 병합요법의 반응과 독성에 관한 임상적 고찰

김원규(WK Kim),정기묵(KM Chung),정재훈(JH Chung) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.3

1982년 1월부터 1984년 6월말 사이에 고신의대 산부인과에 입원핸 재발성 또는 지속성 자궁경부암 환자 18예, stage Ⅱ 이상의 난소상피암 환자 7예, 그리고 원발성불명 전이성 선암 환자 3예등 총 28예를 대상으로 cis-Platinum 50mg/m2과 Adriamycin 50mg/m2을 2~4주 간격으로 1회 1시간내 혈관내 주입법으로 투약하여 다음과 같은 결론을 얻었다. 1. 약제에 대한 반응을 관찰할 수 있었던 환자는 3회 이상 투약한 경우로 총 14예 였으며 이들은 각각 자궁경부암 7예, 난소상피암 5예, 원발성불명 전이성 선암 2예였다. 2. 전체적 반응도는 총 14예 중 7예로 50%였다. 3. 자궁경부암은 7예 중 3예에서 부분적관해(42.6%)를 보였으며 2예는 약간의 호전만 있었고 나머지 2예는 변화를 보이지 않았으나 투약기간 동안 더 이상 진행되지는 않았다. 4. 난소상피암 환자는 5예 중 2예에서 완전관해, 1예는 부분적관해를 보여 60%의 반응도를 보였고 나머지 2예는 약간의 호전과 무변화로 각각 1예씩이었다. 5. 원발성불명 전이성 선암 환자 2예는 부분적관해와 무변화 각각 1예로 50%의 반응도를 보였다. 6. 자궁경부암, 난소상피암 및 원발성불명 전이성 선암의 모든 예에서 cis-Platinum과 Adriamycin을 투약중에는 더 진행된 예는 없었다. 7. 약제의 독성으로는 골수에 대한 독성은 28예 중 8예로 29%, 신장독성은 28예중 8예로 29%, 심장독성은 28예중 7예로 21%, 위장관독성은 28예중 28예로 100%에서 나타났다. 위의 모든 독성은 환자가 견딜 수 있을 정도였으며 투약후 2주내에 모두 정상으로 회복되었다. Twenty-eight patients with advanced gynecologic malignant neoplasms who had prior surgery and/or radiation and no longer amenable with surgery and/or radiation were treated with combination chemotherapy of cis-Platinum 50mg/m2 and Adriamycin 50mg/m2 from January, 1982 to June, 1983 at the Department of Obstetrics & Gynecology, Kosin Medical College. 1) We evaluated all the 28 patients for toxicity. To evaluate response, we selected 14 patients who were treated at least three courses of chemotherapy, included 7 patients of cervical cancer, 5 patients of ovarian epithelial cancer, 2 patients of metastatic adenocarcinoma of ovary. 2) The over-all response rate 50 percent(7/14). 3) The responses in cervical cancers were 3 partial responses, 2 improvements and 2 stable diseases in 7 patients. The response rate were 42.6 percent(3/7). 4) The responses in ovarian epithelial cancers were 2 complete responses, 1 partial response and 2 improvements in 5 patients. The response rate were 60 percent(3/5). 5) The responses in metastatic adenocarcinoma of ovary were 1 partial response and 1 stable disease in 2 patients. The response rate were 50 percent(1/2). 6) There were no progressive disease in all patients during combination chemotherapy of cis-Platinum-Adriamycin. 7) Toxicity included myelosuppression(29%), nephrotoxicity(29%), ototoxicity(21%), gastrointestinal toxicity(100%), cardiac toxicity(29%) and alopecia(100%). These toxicities were generally mild to moderate and appeared tolerable.

과대아의 임상적 연구

은희경(HK Eun),정기묵(KM Chung),박일수(IS Park),이태호(TH Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.6

Among the total number of 1927 deliveries at Kyungpook National Unⅳersity Hospital during five years from Jan.1 1978 to Dec. 31 1982 fetal body weight 3800 gm or more were 100 cases. Their clinical characteristics were analysed various aspects and results obtained were summarized as follows. Frequency of excessⅳe sized baby, 3800gm or more was l00 cases out of 1927 total deliveries revealed 5.2%. Among their mean body weight by gestational age at delivery and standard deviation, the biggest were 4155gm at 42 weeks gestation and ±311.4gm at 39 weeks gestation with fetal weight 3998gm. There was no significant sex difference, revealed male 48.0% whereas female 52.0% respectively, The most frequent occurance of excessⅳe baby by gestational age was gestational age at 40~41 weeks or 60.0%. There was tendency that the more was the parity, the more was the frequency. ln relation between maternal age and fetal body weight, the age group 25~29 occupied 57.0%, the most ln medical complications of excessive baby, anemia was the most frequently encountered with 5.0% and followed by overt diabetes with 4.0%. ln obstetrical complication PROM was the most frequent with 23.2% followed by pre-celampsia 15.0%. Presentation of excessive baby, cephalic presentation was overwhelming with 86.0%. Concerning to the method of delivery non specific delivery was the most frequent with 44.0% followed by C-section with 36.0% Among indications of C-section for excessive baby CPD was the leading cause with 55.6%, previous C-section with 19.4% was the second. Indication of CPD in excessive baby was also much higher than that of control group. The perinatal mortality rate was 9.0% and it was thought unusual high rate. Among 9 cases perinatal death 7 cases were still birth with 3 cases of uterine rupture. Neonatal death was 2 cases.

폐 , 뇌 , 간 , 신 및 골에 전이된 융모상피암의 1 례

백영배(YB Beik),정기묵(KM Chung),정재훈(JH Chung) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.5

골에 전이된 전이성 융모상피암은 매우 희귀한 질환으노 저자들은 최근에 폐, 간, 신장, 뇌 및 경골의 필상돌기 주위에 전이된 융모상피암을 Methotrexate, Actinomycin-D Cytoxan의 병합 화학요법과 CHAMOCA regimen, 척수강내 MEthotrexate 및 뇌방사선 조사를 실시하였으나 치료도중 뇌출혈로 사망한 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Metastasis of choriocarcinoma to the distal end of tibia is a rare condition. We had an experience of multiple metastatic choriocarcinoma in lung, liver, kidney, brain and the distal end of tibia. The patient was treated with combined chemotherapy, intrathecal MTX and irradiation of the brain. She was eventually died of intracranial hemorrhage although generalized symptoms were gradually improved. Here, we report a case of metastatic choriocarcinoma at the distal end of tibia with a brief review of the concerned literatures.

자궁경부암에서 Human Papillomavirus DNA Detection Kit (ViraPap) 및 Southern Blot Hybridization을 이용한 Human Papillomavirus감염의 진단

정재훈,정기묵,김광혁,박연,김민수 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

본 연구에서는 우리나라 부인암중 가장 빈도가 높은 자궁경부암의 발암인자로 최근 중요하게 연구되고 있는 HPV와 자궁경부 상피내종양 및 침윤성 자궁경부암과의 연관성을 알아보고자 Southern blot hybridization 및 ViraPap HPV DNA Detection Kit를 이용하여 HPV감염을 조사한 결과 다음과 같은 결론을 얻었다. Southern blot hybridization을 사용한 경우에서는, 침윤성 자궁경부암환자 47례 중 37례에서 양성으로 나타나 78.7%의 양성율을 보였다. 병기별로는 Ia는 7명중 5명(71.4%), IIa는 6명중 4명(66.7%), IIb는 29명중 23명(79.3%), IIIa와 IIIb는 100%에서 HPV감염 양성을 보여 자궁경부암의 병기가 높을수록 높은 양성율을 나타내었다(Table 2). HPV양성군중에서는 type 6/11이 1례(2.7%), type 16이 26례(70.3%), type18이 11례(29.7%), type 52가 1례(2.7%), 혼합감염이 2례(5.4%)-1례는 type 6/11과 type 16의 혼합감염, 다른 1례는 type 16과 type 18의 혼합감염-에 에서 양성을 보여 type 16과 type 18이 다른 HPV type에 비해 높은 양성율을 나타내었다. Vira Pap HPV DNA Detection Kit를 사용한 경우에서는, 자궁경부 상피내종양 15례, 침윤성 자궁경부암 50례, 재발성 자궁경부암 6례로 총 71례중 24례에서 HPV양성으로 나타나 33.8%의 양성율을 보였다. 자궁경부 상피내종양에서는 15례중 2례(13.3%)에서, 자궁경부암은 50례중 21례(42%) 에서 재발성 자궁경부암은 6례중 1례(16.7%)에서 HPV감염을 보여 자궁경부 상피내종양에서보다는 침윤성 자궁경부암에서 HPV양성율이 높게 나타났다. 세포 형태에 따른 양성율을 보면, 편평상피암에서37.1%, 선암에서는 33.3%의 HPV양성율은 나타내어 조직학적 세포형태와 HPV감염사이에는 의의있는 상관관계는 없었다. 이상의 결과를 볼 때, ViraPap HPV DNA Detection Kit를 이용하여 HPV감염을 진단하였을때 Southern biot hybridization을 이용했을 때보다 그 양성율은 비교적 낮지만 Vira Pap HPV DNA Detection Kit의 검사과정이 Southern blot hybridization보다 비교적 간편하고 신속하여 환자의 정확한 병력, 진찰 및 Pap smear와 함께 ViraPap 을 이용한다면, 최근 자궁경부암의 발암인자로 여겨지는 HPV감염을 신속하게 진단하는데 도움이 되리라 생각한다. Human Papillomavirus (HPV) infection of the female genital tract has only recently been recognized as a widespread sexually transmitted disease that is associated with venereal warts and cervical neoplasia. The purpose of this study is to identify the relationship of HPV and CIN and invasive cervical cancer by using Southern blot hybridization technique and ViraPap HPV DNA detection kit. Using the southern blot hybridization techinque, tissue from 41 cases of invasive carcinoma of the uterine cervix, HPV DNA was detected in 37 of 42 cases (78.7%) under low stringency condition. On this positive group, high stage of the diseases revealed more high positive rate for HPV DNA than low stage of the diseases. HPV type 6/11, 16, 18, 52 and mixed infection were all detected in these sections, where as HPV type 16(70.3%) and 18(29.7%) were demonstrated distincitvely at a high rate than other HPV types among invasive carcinomas. A total of 71 cases of cervical tissues; 15 cases of cervical intraepithelial neoplasia (CIN), 50 cases of invasive cervical ancer, 6 cases of recurrent cervical cancer were analyzed by ViraPap HPV DNA detection kit. The positive rates for HPV type were 33.8% in which CIN, invasive cervical cancer and recurrent cervical cancer 13.3%, 42% and 16.7% respectively. In invasive cervical cancer, it was significantly higher than that of CIN group. According to the histological cell type, the positive rates for HPV for the squamous cell carcinoma and adenocarcinoma were 37.1% and 33.3% respectively, there was no significant difference in positive rate for HPV DNA. This study demonstrated that, the positive rates for HPV by using ViraPap HPV DNA detection kit was lower than using southern blot hybridization but ViraPap HPV DNA detection kit provides more convinent and rapid results. So that, careful medical history, physical examinations, Pap smear and ViraPap may be proride more rapid & accurate diagnosis of HPV infection.

질식자궁절제술과 복식자궁절제술의 비교 연구

정재훈,정기묵,김세환 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.11

동일한 술자에 의해 시행된 단순자궁절제술 83예를 대상으로 복식자궁절제술과 질식자궁절제술을 비교. 분석한 결과를 요약하면 1. 단순자궁절제술을 시행한 83예중 복식자궁절제술 40예, 질식자궁절제술 43예로 52%에서 질식자궁절제술이 가능하였다. 2. 질식자궁절제술을 시행한 43예중 9예(21%)에서 자궁근층심절제법(intraamyometrial coring method)을 사용하였다. 3. 수술적응증 중 자궁근종이 47예로 가장 많았고(56.7%) 그중 33예에서 질식자궁절제술이 가능하였다. 4. 질식자궁절제술시 부속기종양 이상이 있는 6예 모두에서 부속기종양절제술이 가능하였다. 5. 수술중 실혈량은 통계적으로 질식자궁절제술시 적었다. 6. 자궁의 무게가 200gm이하인 경우는 대부분 자궁근층심절제법을 사용하지 않고 질식자궁절제술이 가능하였으며 무게가 200gm이상인 경우는 모두 자궁근층심절제법을 사용하여 자궁을 적출할 수 있었다. 7. 자궁적출시간, 총 수술시간, 통기시간 및 수술후 입원기간 모두 질식자궁절제술에서 짧았다. 8. 수술 후 합병증은 양 군에서 비슷하였으며, 지금까지 인식되던 단점들을 수술방법의 개선으로 보완함으로써 질식자궁절제술의 빈도를 증강시킬 수 있을 것으로 생각한다. The transvaginal hysterectomy(TVH) has been known to have more advantages than the transabdominal hysterectomy(TAH). So we performed a prospective study from January to July in 1987 to confirm the advantages of TVH and to increase the frequency of TVH by using a new technique of intramyometiral coring. We uwed a mothod of intramyometrial coring in the cases of which the size of uterus was too large to be removed vaginally. In this study 83 patients with a surgical indication of simple hysterectomy were included. Among 83 patients, TVH were performed in 43 cases(52%), and TAH were done in the others(48%). 9 of TVH 43 were operable only by using a method of intramyometrial coring. We analized age distribution, parity, surgical indications, removing time of uterus, total operation time, concurrent surgical procedures, amount of blood loss, post-operative pathologic result, weight of removed uteri, post-operative complications, gas-out time and duration of hospital stay. The results were as follows. 1. The frequency of TVH was 52%, of hysterectomies. 2. The frequency of using intramyometrial coring was 21%. 3. The most frequent surgical indication was uterine myoma(56.7%). 55% of uterine myoma were possible to be operated by TVH. 4. Concurrent adnexectomies were possible in all 6 cases of adnexal mass found during TVH. 5. The amount of blood loss was much smaller in the TVH group than TAH one. 6. Uteri weighed over 200gm were possible to be removed transvaginaly only by using intramyometrial coring. 7. Total operation time, gas-out time and duration of hospital stay were much shorter in the TVH group than TAH one. 8. Post-operative complications were similar in both groups. Finally we think TVH has more advantages than TAH and so we have to use TVH as often as possible.