임신 중 급성충수염

고봉호(BH Koh),조태호(TH Cho),손형심(HS Sohn),송상환(SW Song) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.5

The diagnosis of acute appendicitis is difficult during pregnancy particulary in order patients or obese women, and its delayed diagnosis may cause fetal and/or maternal deaths. Twenty-nine cases of acute appendicitis during pregnancy which had been admitted to the Everance Hospital during 10 years from 1958 to 1968 are analyzed clinically with reviewing references. The results are as follows: 1. The incidence of acute apendicitis during pregnancy is 0.41 per cent which is higher than those of other authors. 2. More than half of the cases(51.7%)had symptoms or sign of acute appendicitis on a least one occasion in the past and were treated conservatively. 3. Fetal wastage were 4 out of 29 cases or 13.8% mortality. Peritonitis history, and Alder`s test. the surgical treatment is recommendablw as soon as possible to prevent further complication.

치골자궁저 높이 측정시 검사자간의 변동평가에 따른 3 가지 통게학적 방법의 비교

남계현 ( KH Nam ),이권해 ( KH Lee ),조태호 ( TH Cho ),이해혁 ( HH Lee ),선우재근 ( JG Sunwoo ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.11

1990년 3월 1일부터 3월 31일까지 순천향대학교 의과대학 산부인과 외래를 방문한 임신 20주부터 40주 사이에 무작위로 선택한 41명의 산모를 대상으로 검사자 3인이 치골자궁저 높이를 측정하여 다음과 같은 결과를 얻었다. 1. 검사자 A와 B간의 변동계수는 4.9%였다. 2. 검사자 A와 B간의 상관계수는 0.968였다. 3. 상기방법은 통계적으로 유의한 결과를 나타내지만, 동의한계란 방법으로 조사시 실제 동의한계는-4.3cm에서 2.6cm로 상당한 변동을 나타냈다. 4. 검사방법간의 차이와 제삼의 검사자를 이용하여 조사했을 때도 동의한게는 비슷한 결과를 나타냈다. 치골자궁저 높이의 백분율표를 이용하여 동의한계를 적용할 때 치골자궁저 높이의 측정은 실제 정상태아와 자궁내 태아발육지연아를 충분히 감별할 수 없다는 결론이 나왔으며, 자궁내 태아 발육지연아를 발견하는 선별검사로서, 치골자궁저 높이의 측정은 한계를 갖는다. 우리는 검사자간의 변동을 조사시, 상관계수나 변동계수를 이용하는 것보다 동의한계를 이용해 검사하는 것이 타당하다고 결론지었다. The measurement of symphysis-fundal height has been considered a simple and attractive screening method to detect the intrauterine growth retardation. Yet examination of published reports of fundal height measurement show wide variation in its performance. One possible reason for this wide variation is inter-observer variation. So, we assessed the variation by three statistical methods-the coefficient of variation, the correlation coefficient, and the limits of agreement. 1. The coefficient of variation between observer A & observer B was 4.9%. 2. The correlation coefficient between observer A & observer B was 0.968. 3. Above methods were highly significant statistically but, the limits of agreement were very wide and true limits of agreement were-4.3 to 2.6cm. 4. When the method of measurement was imperfect was tested, and when one of the observers was not good was tested, the results were similar to above results. Applying these limits to centile charts of symphysis-fundal height shows that the fundal height cannot be measured by different observers with sufficient agreement to seperate small fundal heights of those which are not small, and this severely limits the usefulness of measurement of the symphysis-fundal height as a screening test for intrauterine growth retardation. We conclude that inter-observer variation should be assessed by the method of limits of agreement, and not by calculating the coefficient of variation or the correlation coefficient.

경복적 융모막융모생검의 시도

차상헌(SH Cha),이종인(JI Lee),조태호(TH Cho),유훈(H Yoo) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.9

저자등은 선별된 16례의 유전적으로 고위험군에 속하는 산모 16명을 대상으로 경복적 융모 막융모생검을 시행하여 다음과 같은 결론은 얻었다. 1. 경복적 융모막융모생검을 시행한 16례 전례에서 융모를 채취할 수 있었으며, 염색체 핵형 분석에 성공하였다. 2. 16레중 2례에서 염색체이상이 있었는데 1례는 46, XY , inv(9) (p11q21) 이었고 1례는 46,XY, -7, +der(7),t(7;15), (q36;q23 -> ter) mat 였다. 이상에서 경복적 융모막융모생검은 경경관적 융모막융모생검시 우려되는 병원체의 감염과 모체세포의 오염을 피할 수 있고 과거 임신 13-16주사이에 시행할 수 없었던 유전성질환의 진단이 이 시기에도 가능하다는 가능성을 시사해주고 있다. Transabdominal chorionic villus sampling , carried out in 16 patients under ultrasound guidance , was successful for karyotyping in all patients. 2 chromosomal abnormalities were found ; 1 in 46, XY , inv(9) (p11q21) and 1 in 46,XY, -7, +der(7),t(7;15), (q36;q23 -> ter) mat. Transabdominal chorionic villus sampling has the advantages of a reduced risk of infection complications , simplicity and wider gestational age window. The Transabdominal technique was easier, quicker and more comfortable than the transcervical approach. In our opinion this technique will be valuable and available for prenatal diagnosis of genetic disease after further investigation and experinces.

거대아의 산과적 난점

정연정(YJ Chung),이모혜(MH Lee),이규현(KH Lee),배정민(JM Pae),조태호(TH Cho) 대한산부인과학회 1972 Obstetrics & Gynecology Science Vol.15 No.9

1966.1.부터 1970.12.31까지 5년간에 걸쳐 이화여자대학교 의과대학 산부인과에 입원한 총 9032명중 출생시 체중 400gm이상의 거대아 362명에 대한 임상기록을 통해산후출혈은 23.5%로 평균 산후출혈율율 5.0%에 비하면 거의 5배였다. 산모사망예는 없었다. Obstetric management of large fetus weighing 4000gm or more is considered to be a di- fficult problem and requires special experiences. The data presented are based on 362 cases of large fetus seen in Ewha Woman`s University Hospital, Seoul, Korea among 9302 cases of total deliveries for past 5 years duration begining Jan. 1966 to Dec. 1970. The summary was as follows; 1. The incidence of large fetus weighing 4kg. or more was 3.89% of the total deliveries, and the baby weighing 4500 gm or more was 0.51% of the total. 2. Approximately two third of 59.2% of the cases of large fetus were bory between 40 and 41 week of gestation, and another one third (31.8%) of the cases were born in 42 or more week of gestation. 3. The majority of large fetus were found to be born either in the mother aged 30-34 (43%), or in 25-29 (37%), buth the fetus born in the mother aged 35 or more were less (14%). 4. There noticed a definite tendency of large fetus predominantly born in multiparous. The incidence of large fetus born in multigravida with para 1-5 was more than twice the primigravida, and when the parity increased to 6 or more the incidence was greater than 7-10 times. 5. Most cases of large fetus(69.1%) were male fetus, whereas the female fetus were 30.9 % of the cases. A largest baby in this seriese was also male fetus with 5500 gm of body weight. 6. The incidence of abnormal early postpartum oral glucose tolerance test of the mother deliveried large fetus was significantly high (45%) in the 1 hour test which is most valua- ble one, high (28%) in the 2 hours although low or insignificant in the usual fasting blood sugar test. about one third or 32% of the casesof the pregnant woman subsequently delivered large fetus showed positive glucoseuria wheras only the 4.5% cases of the control group revealed it. 7. The incidence of maternal overt diabetes was 8 cases or 1.37%. 8. Large fetus weighing 4kg or more of body weight required Cesarean section for the dystocia in 26% of total cases in comparison with only 5.2% of the average Cesarean sec- tion rate. Any mother even had previous normal ranging deliverise it does not necessary immune to cephalopelvic disproportion and needed the Cesarean section not infrequently. 9. The frequency of immediate postpartum hemorrhage following delivery of large fetus was about 24% of the case of 5 times the average incidence. The routine oxytocin intravenous drip has been instituted effectively. 10. The perinatal loss in large fetus were 9 cases or 2.5% of 362 cases in which consist of 1.2% of the stillbirth and 0.6% of the neonatal death.

제왕절개술후 반흔과 충수돌기에 발생한 자궁내막증 2 예

최규홍(KH Choi),김희진(HJ Kim),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.7

저자들은 1982년 2월 본 병원에서 한국인의 희귀한 제왕절개술 반흔에 발생한 자궁내막증과 1983년 4월 충수돌기에 발생한 자궁내막증을 각각 경험하였기에 문헌고찰과 함께 보고하는 바이다. We have experienced two cases of endometriosis of which one was found in abdominal wall scar formed after cesarean section and the other in the appendix during explorative laparotomy This paper presents those cases and a brief review of the literatures.

자궁영기경부암의 임상 및 병리조직학적 고찰

이준환(JH Lee),박도순(DS Park),황동훈(DH Hwang),조태호(TH Cho) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.10

The terms "Carcinoma in situ", "intraepithelial carcinoma", "non-in-vasive carcinoma", and "stage O cancer" have been used to denote the same pathological process in the epithelium of the cervix uteri. Since 1910 when Rubin described his first two cases of"incipient carcinoma", this condition has been accepted by increasing numbers of cliicians and pathologist as the morphological sequence of events through which the squamous epithelium of the cervix progress before it becomes of the cervix, the methods used for early detection, diagnosis, treatment, and follow-up of care- inoma in situ have heen studied by many authors. There are many reports and clinical reviews on carcinoma in situ of the cervix in other coun- tries but none yet in Korea in spite of great interest in the subject. It is the purpose of this paper to study clinical pictures and pathological findings and compare them with those of other athors. The author selected a total of 67cases of carcinoma in situ of the cervix which were admitted to the Medical Center of Yonsei University over the last five and a half years, from Jan. 1, 1961 to June 30, 196. The results were obtained as follows; 1.Most of cases were detected by Pap. smear or punch biopsy at the first visit. 2.87.2% of 47 cases showed suspicious and positive Pap. Smear and the false negative diag- nosis was 12.8%. 3. The average age incidence was 45 years and was 3 years less than that of invasive cancer. 4. There was minimal to moderate erosion of the cervix in about 50% of cases and 11.9% were normal in gross appearance. 5. 38.8% of all cases had no specific gynecological complaints and in about 70% the chief symptom was abnormal vaginal bleeding. 6. The pathological findings of post-cone bysterectomy specimens showed no residual cancer in 61.8%, residual cancer in 32.7%, atypical hyperplasia in 3.6%, and microscopic invasion in 1.9% respectively. 7. The post-operative morbidity revealed no relationship with the time interval between conization and hysterectomy. there was no significant difference in morbidity compared with the control group. Also although no effect on morbidity was achieved from prophylactic antib- iotics, it has been suggested that further study by made with more cases. 8. 36 patietns among 60 cases which received adequate treatment were followed for 1.7 years on the average, and have lived without recurrence to the present, but further close observation will be needed.

임신자궁 자연파열의 2예

고봉호(BH Koh),김용우(YW Kim),이계용(KY Lee),조태호(TH Cho),송찬호(CH Song) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.11

1. 임신자궁 자연파열의 2예는 자연파열 환자로 경산부였고 만삭임신자궁으로 분만중에 발생하였다. 2. 증례1은 1년전에 파열분만의 과거력을 가졌다는 것이 가장 큰 원인인 듯하며 증례2는 경산부란 조건외에 요인이 될만한 과거력이 없었던 자로 그원인을 조사하여 본다면 사산한 태아의 체중이 4100gm인 점으로 보아 아두골반불균형이 원인인 것으로 사료된다. Rupture of the uterus certainly is a danger both to mother and fetus. Maternal and fetal mortalities are higher in spontaneous rupture of the uterus than of rupture due to previous scar. Two cases of the uterine rupture are presented and literature on uterine rupture were reviewed. First case was a 31 year-old G-4, P-2, and L-1 housewife who had an episode of destructive delivery at pregnancy 8 months of unknown cause on year ago and who was admitted 9th Nov.1967, at term pregnancy, and was found to have uterine rupture immediately after normal spontaneous vaginal delivery. Second case was a 32 year-old G-4, P-2, and L-2 housewife who had no significant obstetric history before admission, and was admitted 2nd Nov.1967, at term with ruptured uterus in shock. Baby was dead and weighed 4,100gm. Uterine rupture seemed to be possible cephalo-pelvic disproportion.

고혈압성 질환을 동반한 임산부에서 hydralazin의 혈액동력학적 변화에 대한 연구

정구성(KS Jung),정기호(KH Jung),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.8

1985년 6월1일부터 1986년 9월30일까지 만 1년 9개월간 순천향대학병원 산부인과에 입원한 산모중, 임신말기에 고혈압을 동반한 20명의 산모를 순수한 전자간증군과 만성고혈압을 가 진 산모군으로 나누어, hydralazine혈관투여후 나타나는 혈액동력학적 변화를 M-형 초음파 심장촬영술을 이용하여 다음과 같은 결론은 얻었다. 1. 전자간증군은 만성고혈압산모군에 비해 hydralazine투여전의 심장지수는 낮고 전신혈관저 항은 높게 나타났다. 2. hydralazine투여후 전자간증군의 평균동맥압과 전신혈관저항은 각각 18%와 34%의 감소를 나타냈다. 3. hydralazine 투여후, 전자간증군에서 맥박수와 심장지수는 각각 18%와 24%의 증가를 나 타났다. 4. 만성고혈압군에서는 평균동맥압과 전신혈관저항이 각각 11% 와 19%의 감소를 나타났다. 5. 두군 전체의 hydralazine투여전, 평균동맥압과 투여후 퍼센트변화 사이에는 상관관계가 없 었다. 6. hydralazine 투여전 , 심장지수에 대한 투여후 퍼센투변화 사이에는 역상관관계를 나타났 다. 7. hydralazine 투여전, 전신혈관저항과 투여후, 퍼센트변화 사이에는 역상관관계를 나타냈다. 8. hydralazine 투여후, 평균동맥압의 퍼센트 변화와 전신혈관저항의 퍼센트변화 사이에는 높 은 상관관계를 나타냈다. The hemodynamic changes after intravenous administraion of hydralazine were assessed using M-mode echocardiography in 20 pregnancy patients with severe hypertension, who were divided into two group ; preeclampsia (group 1) and essntial hypertension and/or superimposed preeclampsia (group 2) during period from Jane, 1, 1985 to September 30, 1986. The following results were obtained; 1. group 1 had significantly lower pretreatment cardiac index (p<0.02) and higher systemic vascular resistance (p<0.05) than group 2. 2. After hydralazine injecion, a significantly decrease in mean arterial pressure (18%) an systemic vascular resistance (34%) in group 1 (p<0.001 for both). 3. A significantly increase in heart rate (18%) and cardiac index (24%) in group 2 (p<0.001 for both). 4. In group 2 the mean arteial pressure and systemic vascular resistance fell by an average of 11% and 19% (p<0.02, p<0.01) 5. Correlation was not found between the initial values of mean blood pressure and the post-hydralazine percent changes for total patients population (r=0.205, p>0.2). 6. Inversed correlation was found , between the initial values of cardiac index and the past-hydralazine percent charges(r=-0.62, p<0.01). 7. Inversed correlation was found between the post-hydralazine percent changes and the control value of vascular resistance (r=-0.48, p<0.05). 8. After injection a significantly correlation was found between the percent changes of mean arterial pressure and the percent changes of systemic vascular resistance (r=0.74, p<0.001).

복막점액종 1 례

고영철(YC Koh),신명기(MK Shin),이임순(IS Lee),조태호(TH Cho) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.12

저자 등은 40세 여자환자에게서 양성난소저액낭종으로부터 발생되었다고 생각되는 복막점액종 1예를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다 Pseudomyxoma peritonei refers to the process of mucinous ascites secondary to mucinous tumors of intra-abdominal organs It is often associated with mucinous tumors of the ovary, mucocele of the appendix, and carcinoma of the large bowel Pseudomyxoma peritonei is secondary to rupture of mucinous tumor with subsequent implantationof mucin secreting cells on peritoneum, characterized by histologically benign but clinically malignant We experienced a case of pseudomyxoma peritonei due to rupture mucimous cystadenoma This paper presents this case and a brief review of the literatures

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.