생리적 농도의 난포호르몬이 인간자궁동맥 평활근 긴장도에 미치는 효과

박형무(Hyoung Moo Park),허민(M. Hur) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A Objective: The present study was performed to investigate whether estrogen of physiological concentration induces the change of vascular reactivity in endothelium-denuded human uterine artery by calcium modulation through receptor-and voltage-dependent calcium channels. Design: The human uterine arteries were obtained at the time of hysterectomy from 28 women followed by denudation of endothelium. After confirmation of functional integrity of endothelium-denuded uterine artery by using acetylcholine(10μM), sodium nitroprusside(10μM), tamsulosin(10μM), vascular reactivity induced by estrogen was measured by using isometric force transducer and recorded by physiograph. Contraction of uterine artery was induced by 10-14 and 10-6 M norepinephrine and 70mM and 35mM KCI solution which activated receptor-and voltage4ependent calcium channels respectively. Estradiol of 4 different concentrations including physiological concentrations, from 3 x 10-11M to 3 x 10-8M was administered, Result: 17β-estradiols from 3 X 10-11M to 3X10-8M showed no significant relaxation on contraction of endothelium-denuded uterine artery induced by 10-4 norepinephrine & extracellular potassium 70mM. But physiologic 17β-estradiol showed significant dose-dependent vascular relaxation, that is, 86.3±3.2% & 82.4±4.1% of contraetion induced by norepinephrine 10-6 & KC1 35mM at the 3X10-10M concentration of 17β-estradiol. 70.5±4.2% & 71.6±5.9% of contraction induced by norepinephrine 10-6 & KC1 35mM at the 3 x 10-9M concentration of 17β-estradiol. Conclusion; Estradiol at physiological concentration has endothelium-independent vasorelaxation effect in human uterine arteries. These vasorelaxant effects may be mediated through antagonistic action on receptor- and voltage-dependent calcium channels in vascular smooth muscle, This estrogenic mechanism may contribute to prevention and treatment for cardiovascular desease.

난포 호르몬에 의한 인체 자궁동맥 이완반응과 연령사이의 상관관계에 관한 연구

김연희(Y . H . Kim),박형무(H . M . Park),허민(M . Hur),이무열(M . Y . Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 본 연구는 난포 호르몬에 대한 혈관반응도를 연구함으로서 난포 호르몬의 혈관에 대한 칼슘 길항작용을 증명하고 연령에 따른 난포 호르몬에 대한 혈관이완반응도의 차이를 비교하고자하였다. 방법 : 본 연구는 자궁 적출술 환자에서 내경 3mm 이상의 자궁동맥을 적출하여 혈관내피를 제거한후 생리적 용액내에서 길이 10mm, 폭 2mm정도의 직사각형 모양의 혈관 평활근 절편을 만들고 용량 30ml의 실혐용기에 옮긴 후 등장성 장력변환기에 연결하여 다양한 실험 조건하에서 수축력을 측정함으로서 에스트로겐이 혈관수축에 미치는 영향을 관찰하였다. 결과 : 1) 노에피네프린에 의해 유발된 혈관경축과 고농도의 포타슘용액에 의해 유발된 혈관경축에 대하여 난포 호르몬은 농도 의존성 이완 효과를 보였고, 이는 난포 호르몬이 혈관 평활근 수용체 작동성 칼슘통로와 전압작동성 칼슘통로를 통해 칼슘 길항작용을 나타내며 이 작용은 농도 의존성 현상임을 추측케 한다. 2) 난포 호르몬의 투여는 수용체의존성 및 전압의존성 칼슘통로를 통한 혈관평활근수축에 대한 이완반응이 연령이 증가함에 따라 유의하게 감소함이 관찰되었다. 결론 : 난포 호르몬은 인간자궁동맥 평활근 세포에서 칼슘 길항작용을 가지며, 그 기전은 수용체 및 전압의존성 칼슘 이온통로를 통해서 나타나고 이로 인한 혈관이완 효과는 에스트로겐의 심혈관보호 효과에 기여할 것으로 생각되며, 연령의 증가에 따른 난포 호르몬에 대한 혈관 이완반응성의 감소는 연령에 따라 심혈관질환이 증가하는 것과 연관성이 있음을 시사한다. Objective : This study was performed to investigate whether 1) estrogen induces the vasorelaxation mediated by calcium channel in smooth muscle of endothelium-denuded human uterine artery, and 2) the degrees of vasorelaxation have some difference according to age. Methods : The uterine arteries from 18 premenopausal women were obtained at the time of hysterectomy due to various indications and endothelium was denuded. Vascular reactivity was monitored by using Isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by sequential administration of 1 μM norepinephrine(α-adrenergic stimulant) and 10 μM acetylcholine (endotelium -dependent vasorelaxant). Integrity of smooth muscle was measured by administration of 10 μM sodium nitroprusside (endotelium - independent vasorelaxant). A dose-dependent action of estrogen was measured on denuded uterine arteries, pretreated with norepinephrine and potassium chloride. Statistical tests were performed at the 5% level of significance using the SPSS PC+ package. Results : Acethylcholine have little effect but sodium nitroprusside showed marked relaxation, which suggested loss of endothelial function and adequacy of smooth muscle function. The contraction by norephinephrine(1 M) revealed estrogen induced relaxation which was concentration-dependent from 10pg/ml to 10ng/ml in concentration of 17 -estradiol. The contraction by high potassium solution 35mM was also inhibited by estrogen in concentration-dependent manner. The vasorelaxation effect of 17 -estradiol on the contraction evoked by both norepinephrine and potassium revealed reduction according to the increase of age.Conclusion : The results of this study suggested that the decrease of the vasorelaxant effect according to age might be correlated with increase of cardiovascular disease in old age group.

사산 후 병발한 급성 중증 신부전의 1례

정진안(JA Jung),허민(M Hur),박찬무(CM Park) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.5

The case reported was 36 year old multipara who had had stillbirth and develpoed acute renal failure. Theraphy was initially directed toward the control of the rapidly developed shock and of fluid and electrolyte balance. Five times of peritoneal dialysis were performed because of anuria for more than 48 hours and uremic symptoms. Diuretic phase developed 2 week after the anuric phase. The patient was discharged on the 38th hospital day with good general condition. The causes and the theraphy of the acute renal failure were reviewed.

직류 열플라즈마를 이용한 질화알루미늄 초미세분말의 합성

안현(H. Ahn),허민(M. Hur),홍상희(S. H. Hong) 한국표면공학회 1996 한국표면공학회지 Vol.29 No.1

폐경후 호르몬 보충요법시 골밀도의 감소

박형무(Hyoung Moo Park),허민(M. Hur) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A Objective: Hormone replacement therapy(HRT) with estrogen, either alone or in cambination with progestogen has been well established for preservation of postmenopausal bone loss, However actual decrease in bone mineral density(BMD) is observed in some proportion of postmenopausal woman in practice, even though the use of bone-conserving doses of estrogen. The purpose of this study is to find out the incidence of the postmenopausal women with decreased BMD on HRT, the difference in incidence of the subjects with decreased BMD between natural and surgical menopause, and whether the factors such as duration of menopause, initial BMD and mode of HRT are influencing on the incidence of subjects with decreased BMD. Methods: One hundred-twenty one natural and thirty one surgical postmenopausal women on HRT were checked spine and femur BMD by dual energy X-ray absorptiometry at 1 year interval from Jan 1995 to May 1997. Results: The incidence of the subjects with decreased and significanly decreased spinc BMD in natural menopause was 24,8% and J7.5% respectively, At femur, the incidence of decrease and significant decrease in BMD was 33,0% and 22.9%, which was not statistically different from the incidence in spine BMD. In surgical menopause, the subjects with decreased and significantly decreased spine and femur BMD were markedly increased up to around 70% and over 50% respectively, which showed significant decrease compared with natural menopause. Duration of menopause, initial BMD and mode of HRT did not influence the incidence of significant decrease in BMD in natural menopause. Incidence of significant decrease in spine BMD was elevated within first 5 years of postmenopausal period in surgical menopause, but initial BMD did not influence this incidence. Conclusion: About 20% of natural and 50% of surgical postmenopausal women suffered from significant decrease in BMD even though conventional HRT. The incidence of decrease and significant decrease in femur BMD was not significantly different from incidence in spine BMD, and duration of menopause, initial BMD, and mode of HRT did not influence these incidence in menopause, except menopausal duration which was inversely associated with these incidence in surgical menopause.

노인성 또는 위축성 질염 치료에 대한 Dienestrol 연구의 임상적효과

강천수(CS Kang),허민(M Hur),배도환(DH Pai),김두호(DH Kim) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.10

1978년 2월 1일부터 8월 10일까지 노인성 또는 위축성 질염 환자 53예에서 Dienestrol연고를 사용하여 그 임상적 경과를 관찰하였으며 그 결과 다음과 같은 결론을 얻었다. 1. Dienestrol 연고는 노인성 또는 위축성 질염에 매우 우수한 효괄ㄹ 나타내었다. 2. Dienestrol 연고는 주사나 경구 투여에 의해서 나타나는 부작용이 전혀 없었다. 3. Dienestrol 연고는 암종 또는 암전구증을 제외하고는 금기 사항이 없어 다른 전신질환이 있을 때도 사용할 수 있었다. 4. Dienestrol 연고에 의한 치료는 장기간을 요하지 않았으며, 대부분 4주 이내에 치료되었다. The effectiveness of dienestrol cream in the treatment of atrophic or senile vaginitis has been evaluated in the 53 patients. In the 53 cases, 36 cases or 67.9%, were definitely improved both subjectively and objectively, or were cured; 11 cases of 20.8%, were not cured, but better improved either clinically or symoptomatically than when they were first seen. In one case or 1.9%, the condition was aggrevated and 5 cases or 9.4% could not be evaluated because of other complications such as trichomonal infestation or monilial infection which was developed after dienestrol therapy was begun. Topical application of the dienestrol cream was prescribed 2 times a day for a one week and once a day for the next one week, and once an every other day after 2 weeks during the last 4 weeks. Total of the cases were 53 cases and the age distribution was from 23 years to 74 years, the most frequent age group was from 51 years to 60 years. Relief of symptoms had to be accompanied by clinical response before the patient was considered improved. The healthy vagina maintained in many instance by using dienestrol cream over 3 weeks. No untoward affects were noted.

폐경기 여성에서의 증상, 지질변화 및 호르몬 변화에 대한 연구

김병창(BC Kim),김동호(DH Kim),허민(M Hur) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

자연폐경군 여성 49예, 인공폐경군 여성 47예를 대상으로하여 폐경에 따른 증상, 지질 및 호 르몬 변화에 대하여 관찰한 바, 다음과 같은 결론을 얻었다. 1. 자연폐경군의 평균 페경연령은 48.8세, 인공폐경군은 46.7세였다. 2. 폐경증상은 크게 비뇨생식기와 비뇨생식기의 증상으로 대별하여 조사하였고, 양 증상 모 두 증상이 없는 경우가 자연 및 인공폐경군에서 가장 많았다. 비뇨생식기 증상이 있는 경우 는 양군 모두 질 감염, 질위축, 빈뇨 및 절박뇨의 순이엇고, 비뇨생식기의 증상은 근골격계, 혈관운동계 증상의 순이었으며, 성적, 및 정서적 증상의 빈도는 양군 모두 매우 낮았다. 3. 혈중 지질대사의 변화는 자연 및 인공폐경군 모두에서 triglyceride와 총콜레스테롤 만이 정상대조군과 비교하여 유의하게 증가하였고, 총지질, 인지질, HDL 및 LDL은 통계적으로 유 의한 감소 및 증가가 없었다. 4. 혈중 estradiol 치는 자연 및 인공 폐경군 모두에서 정상대조군과 비교하여 상당히 유의하 게 감소되어 나타났고, 자연폐경 1년후에 인공폐경군에서는 수술후 2년에 가장 적게 감소하 였고, 이후 점차 감소하는 경향을 띠었다. 5. 폐경증사의 유,무와 혈중 FSH 및 estradiol 치와는 큰 상호관계가 없었다. In the menopause the ovarian funciton is declined because of decrease in oocytes and defective synthesis of steroid hormonse. Hence there is low estrogen production, various symptoms and signs of postmenopausal syndrome may be gradually developed. And as the woman is reached to menopause, there is increased incindence of coronary heart disease due to change in serum lipid levels . So, the authors has studied for the analysis of the symptoms and signs, changes of the serum lipid and hormonal changes. These present data were derived from analysis has surveyed by interviewing and questionaires for the postmenopausal women of 49 natural and 47 artifical menopausal cases during 1 1/2 years from 1986 to 1988. The result af follows; 1. In natural menopausal population the mean menopausal age is 48.8 yrs and in artificial group , 46.7 yrs. 2. Of the both group menopausal women who complained extraurogenital symptoms , asymptomatic patients were most common and remainder were composed of in order of musculoskeletal vasomotor, sexual and emotional symptoms. The pregnancy of emotional and sexual symptom were very low in both group . Of the both group of menopausal women who complained the urogenital symptoms, asymtomatic patients were most common and the remainder were composed of in order of vaginal infection, vaginal atrophy, frequency and urgency. 3. The lipid change in both menopausal group comparing with those of premonopausal controls; 4. The serum estradiol concentration of both group was significantly decreased than that of controls. That was decreased easily at 1 year after menopause in natural group and at 2nd postoperative year in artificial group and tended to be decreased gradually year after year 5. The serum FSH concentration of both group was very significantly increased than that of controls.

비산욕기 자궁내번증

구제춘(JC Koo),조무호(MH Cho),허민(M Hur),배도환(DH Pai) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.11

1) 비산욕기 자궁 내번증은 한국에서 뿐만이 아니라 전 세계에서도 드문 부인과적 질환의 하나이다. 2) 14세된 소녀에서 발생한 원인 불명의 비산욕기 완전 자궁 내번증 1예를 보고하였다. 3) 자궁내번증의 분류는 일반적으로 다음과 같다. A. 산욕기 또는 산과적(puerperal or obstetric) a) 급성(acute) b) 만성(chronic) B. 비산욕기 또는 부인과적(Non-puerperal, or Gynecologic) ㄱ. 종양성(tumor-produced) 급성(acute) 만성(chronic) ㄴ. 원인불명(Idiopathic) 급성(acute) 만성(chronic) 4) 내번의 정도는 완전과 불완전(complete and incomplete)로 나누고 완전한 경우가 비 산욕기에 많다. 5) 종양성 자궁 내번증의 기전은 ㄱ. 종양에 의해 자궁이 팽창된 다음 갑자기 자궁의 빔(emptying) ㄴ. 종양에 의해 자궁벽의 얇아짐(thinning) ㄷ. 자궁경부의 개대(dilatation) 등이다. 6) 원인적 종양으로서 fibroid가 대부분이다. 7) 비산욕 자궁 내번증은 30세 이후에 호발한다. 8) 증상은 월경 곤란증, 월경과 다증과 냉증 등이다. 9) 진단은 대개 이학적 방법으로 쉽게 행할 수 있다. 10) 치료는 질을 통한 복구 방법으로서 Kustner와 Spinelli법이 있고 복벽을 통한 복구 방법으로서는 Huntington과 Haultain법이 있다. Nonpuerperal inversion of uterus is one of the rarest gynecological disease. A case of nonpuerperal inversion of uterus, occured in only 14-years old girl with unknown cause, experienced in thes gospital in May 1976, is reported with brieg review of the literaturew.

수술적 폐경과 자연 폐경에서 호르몬 보충요법 후 골반응의 차이

서유석(Y. S. Suh),박형무(H. M. Park),박선영(S. Y. Park),윤성준(S. J. Yoon),허민(M. Hur) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 수술적 폐경은 난소 기능의 갑작스럽고 완전한 소실로 인하여 골밀도의 변화에 있어서 자연 폐경과는 다른 양상을 보이게 되고 이로서 호르몬 보충요법에 의한 치료효과도 다르게 나타나게 될 것으로 생각하고 이를 확인하고자 하였다. 연구 방법: 중앙대학교 용산병원 폐경기 클리닉에서 수술적 폐경을 한 73명의 여성을 대상으로 하여 접합마 estrogen 0.625mg을 사용하여 호르몬 치료를 1년간 시행하고 그 전후에 척추와 대퇴경부의 골밀도를 측정하여 자연 폐경 여성과 비교하여 보았다. 28명의 환자에서는 QCT를, 43명의 환자에게는 DXA를 사용하여 골밀도를 측정하였으며 1) 골밀도의 변화 2) 폐경기간에 따른 호르몬 보충요법에의 반응 정도 3) 호르몬 보충요법에도 불구하고 골밀도의 감소를 보이는 여성의 빈도를 비교하였다. 결과 : 1) 수술적 폐경여성에서는 estrogen 단독요법으로 척추의 골밀도가 QCT에서는 6.86%가 감소하였으며 DXA에서는 1.15%가 감소하였다. DXA로 측정한 대퇴경부의 변화는 1.65% 감소한 것으로 나타났다. 2) QCT군에서 2년 이하의 폐경기간을 가진 22명의 여성의 골밀도는 7.89%가 감소하여 4.33%가 증가한 폐경여성과 유의한 차이를 보였으며 2년 이상의 폐경기간을 가진 여성에서는 폐경 경로와 관계없이 유의한 차이를 보이지 않았다. DXA군에서는 2년 이하의 폐경기간을 가진 여성에서 척추와 대퇴경부에서 2.80%와 3.08%가 감소한 것으로 나타나 2.36%와 1.84%가 증가한 자연폐경군에 비하여 유의한 차이가 있었다. 폐경기간 2년 이상에서는 수술적 폐경군에서 4.31%, 3.10% 증가로 5.00% 증가, 2.99% 증가로 나타난 자연 폐경군과 유의한 차이가 없었다. 3) 호르몬 치료에도 불구하고 유의한 정도로 골밀도가 감소한 여성의 빈도는 수술적 폐경후 2년 이내의 폐경기간을 가진 여성이 QCT에서 59.0%, DXA에서 척추가 60.6%, 대퇴경부가 56.7%로 반 이상의 여성이 호르몬 치료에도 불구하고 골밀도가 유의한 감소를 하였으며 자연 폐경 여성과 비교하여 훨씬 높은 빈도를 보였다. 결론: 수술적 폐경은 자연 폐경과 달리 급속한 골밀도의 변화가 나타나므로 좀 더 적극적이고 철저한 검사와 치료로 초기의 골밀도 감소를 예방하여야 할 것이다. Objectives: surgical menopause, state of both oophorectomy, shows some different features compared to natural menopause. The purpose of this study was to compare effectiveness of hormone replacement therapy(HRT) in surgical menopause with it in natural menopause. Methods: bone mineral density was assessed in 71 surgically menopausal women at the time of starting HRT and was repeated after one year HRT. 28 were evaluated by quantitative computed tomography (QCT) and 43 were done by dual energy X ray absorptiometry (DXA). We divided the subjects into two groups according to the intervals between oophorectomy and the start of HRT(group 1: within 2 years after surgery, group 2: more than 2 years after surgery). Results: QCT-group 1 included 22 subjects, QCT-group 2 included 6. In group using DXA, 33 subjects were in group 1, and 10 in group 2. In natural menopause, 76 subjects were included and their bone mineral densities were assessed pre- and post-HRT(QCT: group 1, n=13, group 2, n=13, DXA: group 1, n=32, group 2, n=18) 1) Incidences of significantly decreased BMD in spite of HRT in surgically menopaused women were 59.0% in QCT-group 1, 60.6% in spine of DXA-group 1. These incidences are higher than those of natural menopause. 2) After 1 year estrogen replacement in surgical menopause, BMD decreased 6.86% by QCT and 1.15% by DEXA. But, surgical menopause women in group 1, BMD by QCT decreased 7.89%, spine BMD by DXA decreased 2.80%, femur neck BMD decreased 3.08%. Contrary to these results, BMD of natural menopause women increased 4.33%, 2.36%, and decreased 1.83%, respectively. Conclusion: Usual dosages of HRT cannot prevent acute bone loss effectively after both oophoectomized women. So, additional therapy will be prescribed to surgically menopaused women.

산부인과 외래환자의 비특이성 질염에 대한 임상적 고찰

이상훈(SH Lee),김동호(DH Kim),허민(M Hur),배도환(DH Pai) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.11

1. The average incidence of H. vaginalis Vaginitis was 25.2%. that of trichomonas vaginitis was 28.0% and that of candida vaginitis was 10.7% (12.4% among pregnant women and 8.6% among non-pregnant women). 2. In relation to age distribution the majority of H. Vaginalis positive cases was found in the age groups of 24 to 34 years old. 3. Nearly 100% of the women who harbored H. Vaginalis in their vaginal exudates complained of leucorrhea 27.6% of vulva itching 17.9% of unspecified discomfort and 14.6% of recurrent vaginitis. 4. The coexistence of trichomonas and /or Candida with H. Vaginalis in the Vaginal exudates was as follows ; patients wiht H. Vaginalis alone were 81 cases (65.7%) patients with H. Vaginalis and trichomonas simultaneously, 32 cases (25.9%) patients with H. Vaginalis and Candida simultaneously, 8 cases (6.2%) and patients with H. Vaginalis trichomonas and Candida simultaneously were 2 cases (2.2%)