Lyndiol 2.5 경구용피임제가 한국부인에게 미치는 영향에 관한 연구

곽현모(HM Kwak),고봉호(BH Koh),이용배(YB Lee),이연희(YH Lee),김철영(CY Kim) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.10

We are now conducting a clinical study of lyndiol 2.5 and this is to present our brief exerience of 254 clients registered at the family planning clinic in Yonsei University Hospital for a period of 19 minths or 1764 clients cycles. Summary: 1. 254 cases were given. oral cintraceptives lyndiol 2.5 involving 1764 menstrual cycles in Korea women. 2. Age; The selected cases range between the ages 23-43. 3. Bleeding: Of 1764 cycles incidences of 1.4% 4. Nausea: Total cycles incidence of 2.7% and amenorrhea 0.4% 5. Discintinuation: 12 cases (4.7%)did so because of side effects. 8 cases (3.14%) discont- inued as they changed menthord of contraception. There were 64 cases (25.35%) lost follow up of which 17 cases did so in thefifst month. 6. None of the cases who continued to take oral pills according to our instruction under our supervision became pregnant.

분만시 Methoxyplurane ( Penthrane ) 의 영향

곽현모(HM Kwak),정순오(SO Chung),김종일(JI Kim) 대한산부인과학회 1972 Obstetrics & Gynecology Science Vol.15 No.2

분만시 Methoxyplurane(Penthrane) 의 영향에 관한 연구를 통해 강한 진통효과가 있음이 확인되었다. Most analgesics for parturients produced fetal cardio respiratory depression. diminishing uterine contractability and other side effects to mother. In view of its broad range of safety and ease of application, methoxyflurane has attracted attention as a means of overcoming these disadvantages. A clinical study was carried on at Department of Obstetrics & Gynecology, Yonsei University College of Medicine to evaluate the effects of Methoxyflurane (Penthrane) in course of the labor. There were 28 patients of primiparas and 22 patients of multiparas in this study. Methoxyflurane administered by intermittent inhalation produces satisfactory analgesis effect in the majority of patients, has a few side effects, a wide margin of safety, and no ill effects upon the fetus.

피임용 자궁내장치가 자궁내막에 미치는 영향에관한 연구

곽현모(HM Kwak) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.6

The history of intra-uterine contraceptive device (IUCD) reaches back over several decades. However it was not until 1920`s when German physicians began to use this device as the method for the prevention of pregnancy. Although there were variable responses on this method, the effectiveness of such device for contraception was well recognized. The main reason against its use was a fear for the complications which might arise after the application. Inflammation, perforation and even carcinomas were feared. Up until 1950`s only sporadic interests on this matter appeared in the medical field. With the problems of rocketing population increase, a demand for a safe, easily applicable and effective contraceptive method became very acute. The field of intra-uterine contraceptive device investigation was encouragingly enlightened by the publications of Oppenheimer and Ishihama in 1959 who reported much favorable results on the safety and effectiveness of this method. Following this, many pertinent data have accumulated in the world medical literature concerning IUCD and in many parts of the world the polyethylene loop insertion has been accepted as the method of choice. This immediately forces us to assay its hazards very care fully. It is true that there have been sporadic reports on the bacteriologic and histologic effects of such device, however, these reports are in many ways contradictory and fragmentary. Particulary there have been no reports dealing with the histochemical changes of the endometrial tissues in these situation. Furthermore, it is not yet clearly known how this device is so effective in preventing pregnancy. It is the purpose of this paper to descrive the clinical and histological effects on the endometrial tissues which might be related to insertion of IUCD and to characterize the histochemical changes so produced.

한국불임여성에 있어서 자궁난관조영술의 임상적 고찰

곽현모(HM Kwak),김성도(SD Kim),이영호(HY Lee),오기석(KS Oh) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.6

1967년 1월부터 1969년 12월까지 만 3년간 불임을 주소로 연세대학교 의과대학 산부인과 외 래에 내원하여 자궁난관조영술을 시행한 예 중 임상 및 X선 기록이 충실한 200예를 대상으 로 분석 고찰하여 다음과 같은 결론을 얻었다. 1) 자궁난관조영술을 시행한 200예 중 원발성불임은 121예, 속발성불임은 79예였다. 2) 연령분포를 보면 원발성불임군에는 25∼29세군이 58예(47.9%), 속발성불임군에서는 30∼ 34세군이 31예(39.3%)로 가장 많았다. 3) 불임기간은 월발성 및 속발성 불임 전체에서 불임 기간 7∼9년이 60예(30.0%)로 가장 많 았고, 속발성불임군에서 원발성불임군에 비해 불임기간이 다소 긴 경향을 볼 수 있었다. 4) 기왕력에 있어서 골반염증성 질환이 22예(11.0%)로 가장 많았으며 원발성불임군에서는 진단목적으로 소파수술을 받은 예가 11에, 충수절제술이 7예였고 속발성불임군에서는 최종 임신을 임신중절술로 마친 예가 25예(12.5%)로 가장 많았다. 5) 자궁상은 정상이 125예(62.5%)이고 비정상 70예 중 내강벽 불규칙상이 30예(15.0%)로 가 장 많았다. 6) 난관상에서는 팽대부 및 체부의 난관수종상이 76예(38.0%)로 가장 높은 빈도를 나타냈 다. 7) 양측난관폐쇄는 52.0%(104예)이였으며 편측폐쇄가 16.0%(32예)로 좌우측난관에서 의의있 는 차이는 없었다. 8) 난관의 폐쇄부위는 각부 30예, 협부 32예 그리고 팽대부가 71예(35.5%)로 가장 많았으며 좌우측 난관에서 차이는 없었다. 9) 복강상은 96예(48.0%)에서 출현하였다. 10) 골반내맥관상의 출현빈도는 13.5%로 타 보고자보다 높은치를 보였으며 원발성 및 속발 성에서 의의있는 차이는 없다. 11) 자궁, 난관, 복강상에 있어서 이들 전부가 정상인 것은 42예(21.0%), 하나 이상에서 비정 상인 것은 116예(58.0%)이였다. Hysterosalpingography has been universally accepted and approved method as a valuable aid in the diagnosis and treatment of infertility and tubal pathology, especially for tubal patency. A clinical analysis has been made on 200 cases of known infertile patients by the view of hysterosalpingogrm. The results were as follows : 1) In 200 cases of infertility, 121 cases were primary and remaining 79 cases were secondary infertility. 2) Age distribution showed the peak at 25-29 year old group in primary infertility and at 30-34 year old group in secondary infertility, cases of which were 58(47.9%) and 31(39.3%) respectively. 3) 60 cases of this study shows 7-9 years of duration infertility and it was longer in secondary than primary infertility. 4) In past history, pelvic inflammatory diseases were found in 22 cases (11.0%), diagnostic D & C in 25 cases (12.5%) of secondary infertility. 5) Uterine shadow revealed 125 cases of normal finding and 30 cases of irregular uterine cavity shadow, which was 15.0% and predominant abnormal finding. 6) Tubal pathology was predominent lesion in hysterosalpingogrm and bilateral occlusion was noted in 104 cases(52.0%) and unilateraltubal occlusion was 32 cases(16.0%).Tthere was no significant difference between right and left side. 7) In shape of tubes, hysterosalpinx of ampuaalr and fimbrial portion was predominant to the exclusion of patent tubes and cornual obstruction. 8) Sites of tubal occlusion were cornual in 30 cases, isthmic in 32 cases and ampullar and fimbrial portion in 71 cases. 9) Intravasation, one of complications of HSG was noted in pelvic cavity of 27 cases among 200 cases, which was 13.5%. 10) Abdominal despersion of radiopaque material appeared in 96 cases(48.0%) of this study and most common appearance was homogeneous hazzy cloudy shape. 11) Normal hysterosalpingogrm was noted in 42 cases(21.0%) and 116 cases(58.0%) was abnormal in one or more among uterine, tubal, and intraabdominal shadow.

임신중절에 관한 임상적 고찰

곽현모(HM Kwak),양영호(YH Yang),오기석(KS Oh),황민철(MC Whang) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.6

1962년 1월부터 1973년 8월까지 연세대학교 의과대학 산부인과에 입원한 총 483명의 임신중 절을 한 환자를 대상으로 조사분석하여 다음과 같은 결론을 얻었다. 1) 임신중절 실시율이 30∼39세에서 가장 높았다. 2) 초회임신을 중절시킨 것이 31%였고 평균분만 회수는 3.5였다. 3) 임신중절을 임신 12주전에 시행한 것이 70.2%, 13주 이후는 29.8%로서 대부분 소파수술 이었다. 4) 합병증 발생빈도는 임신 12주 전에는 13%, 13주 이상에서 17%로 임신주수가 상승함에 따 라 증가함을 볼 수 있다. To determine the chracteristics and complications. 483 patients undergoing abortion at Yonsei University Medical Center from January 1, 1962 to August 31, 1973 were analyzed. Most of patients had pre-existing medecal condition, incomplete or inevitable abortions. The obtained result are as follows : 1) The majority(67.21%) of the women studied were between 30 and 39 years of age, parity was 4.5 and 31% had parity 0. 2) The majority(70.2%) of patients aborted were in the first trimester of pregnancy. 3) Most of pregnancies(86.54%) were terminated by a "single method used" D & C. 4) The incidence of comlpications varited with gestational age : 13% in the first trimester and 17% in the 2nd trimester, increasing with advancing pregnancy.

융모종양

곽현모(HM Kwak),이준환(JH Lee),이재억(JA Lee),송찬호(CH Song),김형식(HS Kim) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.7

1. 빈도: 임신수 및 분만수에 대한 빈도는 포상기태가 1:113, 1:100, 침윤성기태가 1:1244, 1:1099, 그리고 융모암이 1:124, 1:110이었다. 2.호발연령 및 평균연령은 포상기태에서는 20-29세가 56.6%, 29세이고 침윤성기태는 포상기태와 비슷하였으나 융모암은 30-39세가 40%에, 36세이었다. 3. 중류 및 하류의 경제상황하의 부인층에서 빈도가 단연 높았다. 4. 주요증상; 가장 주요한 증상은 출혈로서 성기이상출혈이 포상기태에서는 96%, 침윤성기태에서는 전예 그리고 융모암에서는 80%였다. 5. 융모암의 최종선행임신은 정상분만이 37.5%, 유산이 20%, 포상기태가 40%, 자궁외임신이 2.5%였다. 6. 전이; 포상기태에선 1예에서 폐전이의 의심이 있었고 침윤성기태에선 2예(50%)에서 폐전이를 발견하였다. 융모암의 경우 87.5%에서 전이를 발견했으며 장기별 전이순은 폐, 질, 골반내장기, 뇌 및 피부 등의 순위 이였다. 7. 치료 : 포상기태; 대부분이 소파술 이었으며 자궁적출술이 11.3%, hysterotomy가 4.5%, 그리고 Methotrexate 사용이 4.5% 였다. 침윤성기태; 3례에서 자궁적출술을 1례에서 Methotrexate를 사용하였다. 융모암; 7.5%에서 자궁적출술, 2.5% 례에서 X-선요법, 25%에서 Methotrexate 요법 그리고 47.5%에서 수술 및 Methotrexate 병합요법을 시행하였으며, 치료를 받지 못한 예가 17.5% 였다. 8. 예후 : 포상기태; 근원당시 사망한 1예(2.3%)를 제외하고는 모두 양호하였으나, Follow up 이 환자들의 불협조로 불량하다. 악성률은 4.5% 였다. 침윤성기태; 근원시 모두 양호하엿으나, 그 중 1례가 재발하여 지입원치료하여 완치되었다. 융모암; 6개월-4년간의 생존률이 30%, 상망률이 45%, 재발률이 15% 였다. This article is the report by the Yonsei University College of Medicine, from June 1,1959 to October 31, 1966. A total of 88 cases were seen with the following distribution: Hydatidiform mole 44, Cho- rioadenoma destruens 4 and Choriocarcina 40. The following features were noted among the patients with hydatidiform mole. Hydatidiform mole occured once in about 113 precancies and 100 diliversies. Patients ranged in age from 22 to 49 of which majority were between 20-29. The average duration of pregnancies was 3 months. The shortest was 28 days from LMP and longest was 7 months. Toxemia was seen in 36% of patients, of which one case died of eclampsia. All cases of toxemia were occured in those moles in which uterus was elarged above the umbilicus. Half of the patients when first seen had uterine enlargement greater than expected by dates while 20% were consistent with their dates and the rest were smaller than their dates. 28% of the patients developed theca lutein cysts. The vast majority of patients were ma- naged by D & E, while hysterectomies were done in 11.3% and methotrexate therapies in 4.5%. 4.5% of patients developed true malignancies. Choriocarcinoma occured once in about 124 pregnancies and 110 deliveries. Patients with choriocarcin- oma ranged in age from 23 to 62. The average age was 36.40% of patients developed after hydatidiform moles, 37.5% after normal spontaneous vaginal delivery, 20% after abortions, and 2.5% after ectopec pregnancr. 22.5% of patients developed theca lutein cysts. 87.5% of cases showed metastatic lesions those were found in the lung in 70%, vagina in 25%, pelvic and adnexa in 10%, and brain in 7.5% Patients were managed by combined therapies as surgery and chemotherapy with methotrexates in 47.5%, chemotherapies with methotrexates alone in 25%. 17.5% of patients could receive no specific therapy for choriocarcinoma. At present 6 months to 4 years survival rate was 30%, mortality rate was 45% and recurrent rate was 15%.

월경조절법에 관한 연구

곽현모(HM Kwak),송찬호(CH Song),오기석(KS Oh),황민철(MC Whang) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.8

1. 월경조절법을 시술받은 부인의 중앙연령은 32세였고, 중앙분만회수는 2.6회였으며 교육수 준은 높았다. 2. 피임동태를 보면 월경조절법시술전에 비하여 시술후에는 좀더 효과적인 피임법을 원하거 나 불임수술을 원하는 경향이 현저하였다. 3. 무월경 기간에 따른 임신율을 보면 무월경 40-42일에 68%, 43-45일에 83.7%, 46-50일에 90.0%였다. 4. 진통진정제투여로 시술이 가능하였고 수술에 소요되는 평균시간은 6.1분이었다. 5. 총 합병증의 빈도는 4.3%였다. 그중 시술초기합병증은 1.5% 후기합병증은 2.8%였다. 6. 실패율은 0.5%였다. 이상으로 보아 월경조절법은 안전하고 효과적일 뿐만 아니라 간단하고 경제적인 방법이라고 사료된다. The present study is undertaken to analyse the sociodemographic characteristics and fertility profile of the menstrual regulation acceptors to evaluate the safety and effectiveness of menstrual regulation. A total of 695 cases were menstrually regulated at the Yonsei medical center fertility control room from February, 1974 to may 1975. Menstrual regulartion (M.R) refers to treatment of missed menstrual period before confirming evidence of pregnancy is available. The procedure consist of a simple aspiration of the endometrium with or without product of conception according to the underlying cause. For this a 4-8 mm plastic cannula is introduced without dilatation of the cervix and vacuum provided by evacuating air from a 50cc syringe or electric pump. The result of this study shows menstrual regulation acceptor were selected group of the population in Seoul. the median age was 32 years old and median parity was 2.6. Their education level was much higher than the general population in Seoul. There was no major complication. Failure rate of menstrual regulation was 0.5%. So menstrual regulation is a safe, effective, simple and acceptable low-cost procedure for preventing unwanted pregnancy.

모성기록부에 의한 한국인 산모의 분석보고

곽현모(HM Kwak),조동제(DJ Cho),정우식(WS Chung),박용원(YW Park),장상식(SS Chang) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.11

본원에서 모성기록부를 개발하여 입원당시 산모의 특성을 조사분석하여 1. 빈혈은 지역적, 경제적 요인과 출산횟수에 따라 증가하여, 인공유산횟수와는 관계가 없었다. 2. 조산아, 사산 및 낮은 아프가치 발생은 지역적, 경제적 차이와 인공유산횟수, 신생아 사망 및 사산 경력에 따른 차이를 보였으며, 3. 임신중 합병증도 산전간호를 받지 않은 산모군에 많았고, 이와 같은 산전합병증이 있을 때 조산아 사산 및 낮은 아프가치를 나타내는 경우가 많았으며, 4. 분만방법에 따른 사산 및 낮은 아프가치의 발생은 자연질식분만시 제왕절개 혹은 감자분만보다 높았고 특히 유도진통분만시 자연진통분만시보다 높았다. 5. 둔위시 미숙아의 발생이 높았고 또한 제왕절개술의 적용이 많았다. 6. 산후합병증은 자연진통후 자연질식분만시 제일 낮았으며, 유도진통후 자연질식분만시에 제왕절개술이나 감자분만보다 높았다. 7. 산모의 50%가 더 이상 자녀를 원치 않는 자녀수는 2.16명이며 3명 이상의 자녀를 원하는 이유는 남아의 선호에 따른 것보다는 그 자녀수에 기인한다. 8. 효과적인 피임방법의 선택이 필요하며 더 원치 않는 임신의 결과는 인공유산의 증가를 초래한다. 따라서, 자녀를 더 원하는 산모와 원치 않는 산모를 구별하여 효과적인 피임방법을 제시하여야 하며 이 교육에는 입원기간의 활용이 중요하다. 이와 같은 결과를 얻었으며 여기에서의 문제점은 지역적 차이 및 의료기관별 차이에 따른 분석이 필요하며 연도별 비교로 각 문제점의 개선 및 그 가능성을 볼 수 있을 것으로 사료되며 모성기록부의 확대 적용이 요구되는 것으로 생각된다. The general Objective of Maternity Care Monitoring is to provide information about the quality of martenal care in national health services, including the relevant factors that affect the outcome of pregnancies. International Fertility Research Program had developed various maternity records from 1974 to 1977 which were superceded at the end of 1977 by the 903 system. 2312 parturiants who were admitted between Jan. 1979 to Dec. 1979 in the Yonsei University Medical Center were statistically analysed in terms of Yonsei University Maternity Record which was modified IFRP 903 system. The results were as follows: 1. In developing country, socioeconomic, geographic factors take particular meanings. Anemia, prematurity, stillbirth, low Apgar score and perinatal mortality were related to above factors. 2. A major difficulty in obstetric care, especially developing countries, is the significant proportion of women who do not seek medical care until they are in labor. Many complications during labor and delivery, ie, prematurity, stillbirth and low Apgar score were occured in population who do not receive antenatal care. 3. It takes a major role to educate and emphasize the effective contraceptive practice, to improve maternity-child health. Conclusively, the most important dimension of institutional Maternity Care Monitoring is that it can provide the information needed to maximally improve the safety of the human reproductive process.

경구 피임제 Neovlar ( Neogynon ) 에 대한 임상적 연구

곽현모(HM Kwak),송찬호(CH Song) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.7

이상의 결과를 종합하여보면 경구 피임제 Neovlar(Neogynon)에 대한 임상적 연구를 통해 그효용이 안전하며 부작용도 경미하여 자연소실됨을 확인할 수있다. The Neovlar is one of the new oral contraceptives characterized by extremly low doses of estrogenic and progestational constituents -0.25mg. d-norgestrel and 0.05mg. ethinyl estradiol per tablet. This study covers general patterns of acceptance of Neovlar with 382 acceptors observed during a total of 1584 cycles from April, 1972 to April, 1973. All cases were selected from among the women registered at the seven institutions in Korea. The average age of acceptors was 32.1 year old and majority were of 30-39. The average gravidity was 4.6. The number of living children ranged 0 to 7 and average was 2.9. The continuation rate was 80.4 percent by the end of second cycle, 70.2 percent by the end of third cycle, and 28.0 percent by the end of sixth cycle. Complaints were uncommon and no serious consequences were observed. The side effects or complaints were most notable during the first two cycles, diminishing spontaneously thereafter. The common side effects were increased leukorrhea, nausea, chloasma, and complaints related to menstrual function. No unplanned pregnancy was reported.

경구피임제의 임상적 연구

곽현모(HM Kwak),송찬호(CH Song) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.2

The limitation of rapid population growth has been a part of the government policy in most developing countries. In Korea, the National Family Planning Programme was inagurated as a national policy in the early 1960s. Many contraceptive methods are available for those who wish to practice family planning. Most of them involve some interference with the normal pattern of sexual life or are not completely effective. Others, such as vasectomy and tubal ligation, are not completely reversible. The possibility of hormonal contraception was suggested in the early twentieth centry, but only became a reality in the late 1950s in the development of oral contraceptives. During the 1960s, oral contraceptives spread widely throughout the world. Recently varieties of steroidal contraceptives have been developed and their use has increased. Oral contraceptives have overcome the objections voiced in regard to intrauterine contraceptive device or traditional methods because of their high degree of effectiveness, the easy of using them, their reversibility, and the lack of interference with sexual activities. In 1968 oral contraceptives became available as a part of the national family planning program and they have recently been one of the most frequently acceped methods of contraception in Korea. Oral contraceptive pills have been used in the Family Planning Clinic of Yonsei University since 1963, when it was conducting the first trials for the method in Korea. Various kinds of oral contraceptives have been used over the past 10 years in this clinic and many clinical and experimental studies have been conducted with the steroidal contraceptives. This paper is summary of the acceptance and effectiveness of oral contraceptives for the past 9 years, from 1963 to 1971.