여성의 클라미디아 트라코마티스 감염에 대한 임상적 고찰

김종오(Jong Oh Kim),윤일영(Il Young Yun),정도영(Do Young Chung),조봉춘(Bong Choon Jo),송승규(Seung Kyu Song) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.10

목적 : 클라미디아는 골반내 염증성 질환을 일으키는 가장 흔한 원인균 중의 하나이다. 클라미디아 감염시 많은 예에서 증상이 없거나, 경미하지만 감염 후 난관폐색, 불임증, 난관임신, 재발성 골반내 감염 등의 합병증으로 인하여 클라미디아 감염이 차지하는 임상적 중요성은 매우 크다. 이에 본 논문에서는 클라미다아 감염의 이환율을 조사하고, 클라미디아 감염과 연관성이 있는 임상적 특성을 분석하고자 하였다. 연구 방법 : 2001년 5월부터 2002년 4월까지 대림성모병원 산부인과에 골반내 염증성 질환으로 진단받고 입원한 환자들과 외래에서 부인과적인 상용검사를 시행받은 환자들을 연구 대상으로 하여, 문진과 이학적 검사, 임상적인 검사와 함께 클라미디아 검출을 위하여 중합효소연쇄반응을 실시하였다. 결과 : 클라미다아 감염의 이환률은 골반내 염증성 질환으로 입원한 환자에서는 20.6% (14/68)이었고, 부인과적 상용검사를 시행받은 외래 환자에서는 8.6% (51/593)이었다. 클라미디아 감염은 20대에서 가장 많았으며, 증상이 없었던 경우가 40% 가까이 되었다. 클라미디아 감염은 유산에 대한 기왕력이 없을 때보다 있을 때 증가하였으나, 출산과는 관계가 없었다. 감염부위로는 자궁 경부가 가장 많았으며, 다른 세균과의 혼합감염율은 43.1%였다. 58명에서는 내과적인 치료를, 6명에서는 외과적인 치료를, 1명에서는 복강경을 시행하였다. 치료 후 모든 환자들은 혈액 검사와 이학적 검사에서 정상으로 회복되었다. 결론 : C. trachomatis 감염은 성적으로 활발한 여성에서 유병율이 높을 뿐아니라 생식 및 임신에 심각한 영향을 미칠 수 있음에도 불구하고, 증상이 미약하거나 없으며, 진단이 어렵다는 점 등으로 인하여 통제하기 힘든 질병이다. 하지만 치료에 좋은 반응을 보이기 때문에 이를 선별검사하고 효과적으로 치료하는 것은 이환률 및 합병증을 예방하고 감소시키는데 도움이 되리라고 사료된다. Objective : Chlamydia trachomatis is one of the most common causative microorganisms in pelvic inflammatory disease. The symptom of Chlamydia infection is nearly absent or weak in many cases, but its complication is clinically very important because of tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic inflammatory disease. This study was performed to investigate the prevalence rate and clinical characteristics of Chlamydia trachomatis. Methods : From May, 2001 to April, 2002, in Daerim St. Mary`s Hospital, OB-Gyn department, the 68 inpatients of pelvic inflammatory diseases and 607 outpatients of routine gynecologic examination were studied on history taking, physical examination, laboratory test, and polymerase chain reaction for the detection of Chlamydia trachomatis. Results : The prevalence rate of Chlamydia trachomatis was 20.6% (14/68) in pelvic inflammatory disease and 8.6% (51/593) in routine gynecologic examination. As regarding the age distribution of Chlamydia trachomatis positive group was the largest portion in the twenties, and symptom-free group was about 40%. Chlamydia infection was related to the history of artificial abortion, and showed no significant difference in parity. Most common site of infection was uterine cervix, and mixed infection rate with other bacteria was 43.1%. The treatments were given medically in 58 cases, surgically in 6 cases, and laparoscopy in 1 case were performed. Conclusion : Although the prevalence rate of Chlamydia infection is high in sexually active age group and Chlamydia infection has a serious bad effect on reproduction, the disease detection is difficult because symptom is weak or absent, but it reveals good cure rate. Therefore the screening and treatment of Chlamydia trachomatis are necessary to decrease the prevalence and prevention of complication.

임신 오조에 합병된 Wernicke 뇌증 1 예

최용석(Yong Seok Choi),김종오(Jong Oh Kim),이성림(Seong Lim Lee),송승규(Seung Kyu Song),조봉춘(Bong Choon Jo) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

Hyperemesis gravidarum is characterized by severe nausea, vomiting followed by weight loss, dehydration, electrolyte imbalance and acid-base derangements. Its treatment was composed of adequate fluid therapy, electrolyte replacement and nutrient supply. In severe case, it also leads to a variety of neurological symptoms including confusion, gait disturbance and nystagmus, possibly due to thiamine deficiency and may result in so called Wernicke's disease. We have experienced a case of Wernicke's encephalopathy associated with severe hyperemesis gravidarum and this case is presented with a brief review of literature.

보존적 요법으로 치유된 10주 및 8주의 자궁경부임신 2예

김성은(Seong Eun Kim),김명찬(Myoung Chan Kim),신세원(Se Won Shin),하상범(Sang Byum Ha),최용석(Yong seok Choi),조봉춘(Bong Choon Jo) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.

분만기 주위 심근증 1례

하상범 ( Sang Bum Ha ),최용석 ( Yong Suk Choi ),김종오 ( Jong Oh Kim ),이성림 ( Seong Lim Lee ),송승규 ( Seung Gyu Song ),조봉춘 ( Bong Choon Jo ) 대한주산의학회 2001 Perinatology Vol.12 No.3

난소의 출혈성 병변에 대한 임상 및 조직병리학적 연구

김명찬(Myeong Chan Kim),하상범(Sang Bum Ha),최용석(Yong Suk Choi),김종오(Jong Oh Kim),이성림(Seong Lim Lee),이헌경(Hun Kyung Lee),송승규(Seung Kyu Song),조봉춘(Bong Choon Jo) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 가임기 여성의 난소출혈은 전형적인 증상과 징후가 없어서 급성충수염이나 자궁외임신과 같은 외과적 응급 질환과 종종 혼동될 수 있다. 난소출혈 환자 101예를 분석하여 신속하고 정확한 감별 진단 및 적절한 치료에 도움이 되고자 본 연구를 시행하였다.연구방법 : 1993년부터 1997년까지 7년 동안 대림성모병원 산부인과에 급성 하복부 동통을 주소로 입원하여 수술적으로 확인된 난소출혈 환자 96예와 비수술적으로 치료한 5예의 총101예를 대상으로 발생연령, 산과력, 임상적 증상과 검사결과, 증상의 발현시 월경주기일, 병리조직학적 소견 및 수술방법에 대하여 분석하였다.결과 : 연령분포는 20대가 72예(71.3%)로 가장 많았고 평균 연령은 26.3세였으며 미산부가 58예(57.4%)이었다. 병변부위는 우측 난소가 64예(63.4%)로 더 많았으며 성교시 발생된 경우가 18예(17.8%)였고, 증상의 발현시 월경주기일은 제20∼30일 사이가 45예(44.6%)로 가장 많았다. 병리조직학적 소견상 황체낭의 파열이 31예(30.7%), 황체의 파열이 25예(24.8%), 난포낭종의 파열이 15예(14.9%), 난소임신이 9예(8.9%) 순이었다. 수술방법은 난소낭종절제술이나 난소부분절제술이 62예(61.4%)로 가장 많았다. 결론: 난소출혈은 비교적 흔한 질병으로 심한 동통과 함께 때로는 생명을 위협하는 다량의 혈복강을 동반하므로 가임기 여성의 다른 급성복증과 신속하고 정확하게 감별 진단을 하여 적응증이 된 경우는 조기에 수술적 치료를 하여 합병증을 예방하고, 미량의 출혈인 경우는 불필요한 개복수술을 하지 않고 관찰하거나 보존적 치료를 하여야 한다. Objective : Ovarian hemorrhage in a woman of reproductive age is often confused with other surgical emergencies such as acute appendicitis and ectopic pregnancy because there are no typical symptoms and signs that will make definitive diagnosis possible. The authors analyzed 101 cases of ovarian hemorrhages with the purpose of obtaining rapid and precise diagnosis and appropriate treatment. Methods : We analyzed 101 cases of ovarian hemorrhages at the Department of Obstetrics and Gynecology at Dae Rim Saint Mary's Hospital from 1993 to 1999. This analysis includes 96 preexisting cases involving finalized successful surgical treatment and 5 inpatient cases involving conservative treatment. We examined age, parity, clinical features, elapsed days of cycle, histopathologic findings, and operative methods.Results : Mean age of occurrence was 26.3 years, and 57.4% of the cases occurred in nullipara. 64 cases involved the right ovary, and 18 cases were associated with paracoital injuries. The onset of symptoms occurred most frequently between the 20th and 30th days of the menstrual cycle. The histopathologic findings were corpus luteum cyst(30.7%), corpus luteum(24.8%), follicular cyst(14.9%), and ovarian pregnancy(8.9%). The most common type of operation is ovarian cystectomy or ovarian wedge resection(61.4%).Conclusion : Ovarian hemorrhage is a relatively common disease which is accompanied by severe abdominal pain and often life-threatening surgical conditions. Therefore, differential diagnosis should be performed rapidly and precisely from other acute abdomens in a woman of reproductive age. Surgical management should be performed rapidly if indicated. If ovarian hemorrhage is minimal, it can be managed by observation or conservative treatment.

전전뇌증(Holoprosencephaly) 2예

채일현(Ill Hyoun Chae),김명찬(Myoung Chan Kim),신세원(Se Won Shin),이성림(Seong Lim Lee),김인선(In Sun Kim),김인배(In Bae Kim),조봉춘(Bong Choon Jo),최인철(In Cheol Choi),박종각(Jong Gak Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

Holoprosencephaly is a rare malformation complex or development defect including different degrees of incomplete cleavages of the embryonic prosencephalon and varying degrees of the midface defects, resulting from the defect of prechordal mesoderm, migrating forward into the area anterior to the notochord during the third week of fetal development. Early antenatal diagnosis of holoprosencephaly is important to find out its severity, to predict its prognosis, and to determine proper management according to its prognosis and severity. The possibility of early antenatal diagnosis of holoprosencephaly by ultrasound has been suggested, but occasionally missed and rarely confirmed. We present one case of lobar holoprosencephaly, diagnosed postnatally and one case of alobar holoprosencephaly, diagnosed antenatally in our hospitals.