포스타 : 산과학 ; 태아발육지연 유무에 따른 전자간증 임신태반에서의 Telomerase Activity

정영내,김세광,정현철,박규현,조현정,김재욱 대한산부인과학회 1999 대한산부인과학회 학술대회 Vol.84 No.-

태아발육지연 유무에 따른 자간전증 임신태반에서의 Telomerase 활성도

정영내(Young Nae Jung),김세광(Sei Kwang Kim),정현철(Hyun Cheol Chung),박규현(Kyu Hyun Park),김창한(Chang Han Kim),조현정(Hyun Jung Cho),박용원(Yong Won Park),조재성(Jae Sung Cho),김인규(In Kyu Kim),양영호(Young Ho Yang),김재욱(Jae Wo 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

목적: 임신 제 3기 인체 태반에서 telomerase 활성도(TA) 발현 여부를 확인하고, 자간전증임신 태반에서 태아발육지연 유무에 따른 TA 발현 빈도를 비교 분석한다. 실험방법: 임신 29∼41주 사이의 태반 조직에서 Telomeric Repeat Amplification Protocol(TRAP) 분석방법에 의해 TA를 측정하였다. 연구 대상을 크게 세군으로 나누어 1군은 자간전증과 태아발육지연이 없었던 군 21명, 2군은 태아발육지연이 없는 중증 자간전증 9명, 3군은 중증 자간전증과 태아발육지연이 있었던 16명을 대상으로 TA 발현 빈도를 비교 분석하였다. 결과: 1군에서는 16/21(76.1%), 2군은 3/9(33.3%), 3군에서는 4/16(25%)의 빈도로 TA가 발현되었다. 이상의 결과로 1군에서 2군과 3군에 비해 TA발현이 의미 있게 높았으며(p=0.003), 2군 및 3군 각각에 비해서도 높은 TA 발현 빈도를 보였다(p<0.05). 그러나 2군과 3군 사이에서의 TA의 발현 빈도에는 유의한 차이가 없었다(p>0.05). 결론: 본 연구로 임신 제 3기 태반에서도 TA의 발현이 확인되었고, 중증 자간전증 및 태아발육지연을 동반한 중증 자간전증 태반에서 TA가 현저히 감소되는 것으로 보아 중증 자간전증 및 태아발육지연의 발생은 태반 노화나 apoptosis와 관련이 있을 가능성을 제시한다. Objectives: To analyze telomerase activity(TA) in human placenta tissues and to compare TA in preeclampsia with or without fetal growth restriction(FGR) Methods: Fourty-six placenta specimens were obtained from pregnant women between 29 and 41 weeks' gestation. TA of each specimen was analyzed including 21 specimens without either preeclampsia or FGR(Group 1), 9 specimens with preeclampsia but without FGR(Group 2), and 16 specimens with both preeclampsia and FGR(Group 3). TA was analysed by radioisotope PCR based telomeric repeat amplification protocol(TRAP) assay. TA was calculated and translated into arbitrary units by computer-assisted densitometry with the control of TA in 293 cell lines. Results: TA was expressed in 16 of 21(76.1%) in group 1, and in 3 of 9(33.3%) in group 2. In contrast, only 4 patients(25%) in group 3 expressed TA. Thus, TA was expressed significantly more often in group 1 than in group 2 and group 3(p=0.003). However, compared with group 2, expression of telomerase activity in group 3 was not reduced significantly(p>0.05). Conclusion: TA was minimal in placenta from preeclamptic women with and without FGR, suggesting placental senescence and apoptosis may be associated with FGR and severe preeclampsia.

태아발육지연 임신에서 산소농도가 영양배엽세포의 telomerase 활성도에 미치는 영향

정영내(Young Nae Jung),김세광(Sei Kwang Kim),정현철(Hyun Cheol Chung),박규현(Kyu Hyun Park),김창한(Chang Han Kim),장영건(Young Kwon Chang),권자영(Ja Young Kwon),김성훈(Sung Hun Kim),노성일(Sung Il Roh),조동제(Dong Jae Cho) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8

N/A Objective : To observe the difference in telomerase activity (TA) expression in the placenta between fetal growth restriction (FGR) with preeclampsia and those without and to evaluate the effect of oxygen concentration on the TA expression in the trophoblastic cells. Methods : Telomerase activity was measured in 48 (normal pregnancies, 16; preeclampsia with FGR, 15; normotensive FGR, 17) placentas which were obtained between 32 and 41 weeks' gestations. Trophoblastic cells were extracted from 8 chorionic villi samples obtained from 8-10 weeks' placenta and were cultured in either 2%, 8%, and 20% oxygen atmosphere. Then TA was examined by using telomeric repeat amplification protocol (TRAP) assay. Results : During 3rd trimester of pregnancy, exhibited TA expression in normal pregnancy, FGR complicated by preeclampsia, and normotensive FGR groups were 11 of 16 (68.8%), 4 of 15 (26.7%), and 4 of 17 (23.5%), respectively. Significantly lower level of TA was detected in the FGR group compared to the normal pregnancies (p=0.009), whereas within FGR pregnancies, presence of preeclampsia did not seem to have statistically significant effect on TA expression. TA expression levels were measured by optical density in trophoblasts cultured under various oxygen concentration which revealed that significantly higher TA was exhibited in the cells cultured in 2% oxygen compared to 8% and 20% (p<0.001). However no significant difference was noted in TA between cells cultured in 8% and 20% oxygen. Conclusion : Decreased TA in the placenta from pregnancies with FGR was noted regardless of presence of preeclampsia indicating a probable correlation between FGR and placental senescence. Since increased TA was noted in trophoblastic cells that were cultured in hypoxic condition, we could speculate that the intervillous oxygen tension during early-stage placental development plays a certain role in the placental degeneration in pregnancies complicated by FGR and preeclampsia.

정상산모의 질식분만 및 제왕절개술에 대한 표준진료지침서의 개발과 임상 적용

박용원,배상욱,정영내,이혜우,김영란,홍순복,박현주,탁관철 한국의료QA학회 2000 한국의료질향상학회지 Vol.7 No.1

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got. the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we-expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

임신 중 발견된 자궁경부 Verrucous Carcinoma 1 예

김영한,김영태,김세광,정영내,이경진,이윤정,김재욱 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6

임신 중 자궁경부에서 발견되는 verrucous carcinoma는 매우 드문 질환이다. Verrucous carcinoma는 편평상피세포암의 변이종으로서, 임상적으로나 병리적으로 특징적 소견을 보인다. 이 종양은 전형적으로 성장속도가 느리며 국소적으로 침습하고 임파절 전이는 드문 것으로 알려져 있으며, 또한 진단이 용이하지 않다고 알려져 있다. 이 종양의 치료 원칙은 수술적 광범위 절제술인데, 그 수술 범위의 결정에 있어서 근치적 절제술 또는 골반내 임파절 절제술의 적용에 대해서는 아직 논란의 여지가 많다. 또한 이 종양은 방사선 치료에 저항성이 있으며 방사선 조사 후에 더 심한 퇴행 형태로의 전이가 있다는 보고들이 있으나 아직 충분히 검증되지는 못한 상태이다. 본 저자들은 27세의 초산모에서 임신 36주에 자궁경부에 발생한 verrucous carcinoma를 진단하여, 제왕 전자궁 적출술을 시행하였으며 10년간 추적 관찰한 결과 재발의 증거가 없었던 1예를 경험하였기에 문헌고찰과 함께 간략히 보고하는 바이다. Verrucous carcinoma of the uterine cervix is a very rare lesion, especially during pregnancy. Verrucous carcinoma is a variant of squamous cell carcinoma with distinctive clinical and pathologic features. It is a typically slow-growing, locally invasive tumor with low potential for lymphatic metastasis and diagnostic difficulties still exist. Surgical wide resection is the mainstay of the treatment. Whether to include radical resection or pelvic lymph node dissection in the extent of surgery is still under debate. Verrucous carcinoma is resistant to radiotherapy and some cases of transformation to an aggressive anaplastic form following irradiation have been reported, but further evaluation accompanying controlled case studies are needed. We report a case of verrucous carcinoma of the uterine cervix in a 27-year-old woman. It was found during pregnancy and successfully treated by surgical intervention, and there has been no evidence of recurrence for 10 years after treatment.

제왕절개 반흔 부위에 착상한 자궁벽내 임신 1 예

최안나,김인현,조진호,장성운,이용원,정영내 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

자궁벽내 임신은 자궁 내에 위치하고 초기에 특별한 증세가 없기 때문에 조기진단이 매우 어려우며 자궁 파열 및 복강내 실혈 등 위험한 쇼크 상태로 응급 개복 수술시에 발견되는 경우 자궁을 보존하면 서 치료하는 것이 매우 어렵다. 본 예에서와 같이 제왕절개 반흔 부위에 수정란이 착상한 것은 자궁 손상이 한 원인인자로 작용한 다는 Fait 및 McGowan 등의 병인론이 의미있는 것 으로 생각된다. 본 저자들은 질초음파를 이용하여 무월경 8주의 여성 환자에서 자궁벽내 임신을 조기 진단하여 자궁을 보존하면서 치료할 수 있었던 바 앞으로 자궁벽 내 임신을 조기진단 하는 데는 질초음파의 유용성을 인식하고 심각한 부작용 유발 전에 진단 및 치료하는 것이 중요하다고 사료되는 바이다. Intramural pregnancy is one of the rarest form of ectopic pregnancy, with only 16 cases reported thus far. Pathologically the pregnancy is completely isolated from the uterine cavity and entirely surrounded by myometrium. It is interesting to note that a traumatic factor is almost always implicated in the cases so far reported in the literature, including curettage, cesarean section, myomectomy salpingectomy and manual removal of placenta. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, and report with a brief review of the literatures.

정상 임신과 자궁외 임신 사이의 융모막 융모 Telomerase 활성도의 비교

정현철,김창한,김성훈,박지현,박규현,조동제,배상욱,송찬호,김정연,정영내,박기현,김세광 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.8

Objectives : To compare the presence of telomerase activity(TA) in the chorionic villi between eutopic and ectopic first trimester human pregnancies. Methods : Human chorionic villi were obtained from eleven normal eutopic pregnant women who underwent an elective abortion, and from eleven women with ectopic pregnancy who underwent a salpingectomy for tubal pregnancy. TA was analyzed by radioisotope polymerase chain reaction based telomeric repeat amplification protocol(TRAP) assay. Results : TA was expressed in 5 of 11 (45.5%) in eutopic pregnancies, and in 7 of 11(63.6%) in ectopic pregnancies. Chorionic villi in ectopic pregnancies were expressed more frequently than those of eutopic pregnancies, this difference was not significant.(p$gt;0.05) Conclusion : Our results suggest that the expression of TA in human chorionic villi was not affected according to the implantation site during early placental development.

임신 초기 융모막 융모와 탈락막에서의 Estrogen 수용체 및 Telomerase 활성도의 발현

송찬호(Chan Ho Song),김정연(Jung Youn Kim),박기현(Ki Hyun Park),배상욱(Sang Wook Bai),김세광(Sei Kwang Kim),정영내(Young Nae Jung),박규현(Kyu Hyun Park),정현철(Hyun Cheol Chung),장영건(Young Kwon Chang),권자영(Ja Young Kwon),조동제(D 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

N/A Objective : To investigate whether there is any differences between normal pregnancy (NP) and spontaneous abortion (SAB) regarding estrogen receptor (ER) expression and telomerase activity (TA) in the chorionic villi and decidual tissues. Methods : Chorionic villi and decidual tissues were obtained between 6 and 9 weeks' gestation from 14 patients with SAB and 17 normal pregnant women who have undergone an elective abortion. All tissue samples were assayed for ER with enzyme immunoassay and also TA was analysed using telomeric repeat amplication protocol. Results : A significant decrease in ER expression (2.81±2.77 fmol/mg of protein; p<.001) was demonstrated in SAB group compared to that of NP group (4.56±1.85 fmol/mg) in decidua. However, no significant difference in ER expression in chorionic villi was found between the two groups. SAB group showed significantly lower levels of TA than that of NP group in both chorionic villi (21.4% vs. 82.4%; p=.002) and deciduas (7.1% vs. 52.9%; p=.009). Conclusion : Our results suggest that decreased level of ER expression in deciduas might cause decidual senescence and eventually, spontaneous abortion.

동일산모에서 반복하여 발생한 무뇌아 2 예

유용균(Yong Gyun Yoo),김재욱(Jae Wook Kim),김세광(Sei Kwang Kim),김영한(Young Han Kim),연정은(Jung Eun Yeon),손용석(Yong Seok Sohn),정영내(Young Nae Jung),이윤정(Yun Jung Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

The etiology of neural tube defects, a category encompassing spina bifida, anencephaly and encephalocele, remains highly controversial and unclear, However, there is overwhelming evidence supporting a multifactorial etiology for this group of defects. Recent studies have shown that folic acid supplements taken periconceptionally can reduce a woman's risk of having a child with a neural tube defect. Qenetic screening could identify women who will require folic acid supplements periconceptionally to reduce their risk of having a child with a neural tube defects. Recently, we encountered two cases of recurrent anencephaly that had occurted in a same pregnant woman in our hospital. We report these two cases with brief review of the literatures.