자간전증에서 혈청내 혈관내피 성장인자의 연구

김신호 ( Shin Ho Kim ),최기욱 ( Gee Uook Choi ),최정호 ( Jeong Ho Choi ),조해중 ( Hae Joong Cho ),박성남 ( Seong Nam Park ),홍기연 ( Gi Youn Hong ),김흥곤 ( Heung Gon Kim ),민부기 ( Boo Kee Min ) 대한주산의학회 2004 Perinatology Vol.15 No.3

목적 : 진단 기준에 따른 경증 전자간증과 중증 전자간증 임신부에서 혈관 내피 성장 인자가 전자간증의 중등도에 미치는 영향을 평가하기 위해서 본 연구을 실시하였다. 방법 : 1999년 1월 1일부터 2001년 6월 30일까지, 임신 28~40주 사이의 경증 전자간증 46명과 28명의 중증 전자간증 임신부를 대상으로 하였다. 각각의 경증과 중증 전자간증 임신부에서 혈청 내 간 효소치, 혈소판 수, 크리아티닌를 측정하였고, 태아의 제대동맥에서 수축/이완 비와 혈관 내피세포의 손상을 확인하기 위해 혈청 혈관 내피 성장인자의 농도를 측정하였다. 결과 : 간 효소치 상승, 혈수판 수 감소, 고크레아티닌은 경증 전자간증에 비해 중증 전자간증에서 보다 높은 비율을 보였다. HELLP증후군의 빈도는 중증 전자간증에서만 높은 비율을 보였다. 제대 동맥의 수축/이완의 비는 경증 전자간증 임신부의 4/46 (8.7%)에서 >3.0 이상이고, 중증 전자간증 임신부는 15/28 (53.6%)에서 3.0~4.5로 중증 전자간증에서 높은 빈도의 태반 혈류 저항을 보였다. 혈청 내에 혈관 내피 성장인자의 농도는 경증 전자간증에서 7.5±4.9 ng/mL, 중증 전자간증에서는 19.3±8.8 ng/mL로 경증 전자간증에 비해 중증 전자간증에서 통계적으로 유의한 차이를 보였다(p<0.05). 결론 : 제대 동맥의 수축/이완 비가 증가하는 것과 미세 혈관 투과성 및 혈액 응고성을 증가시키는 혈청 혈관 내피 성장인자 농도는 경증 전자간증에 비해 중증 전자간증 임신부에서 높게 측정 되었다. 따라서 혈청 혈관 내피 성장인자 농도 변화는 전자간증 임신부의 예후와 태아 발육부전을 예측하는 지표가 된다. Objective : The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. Methods : From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. Results : Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5±4.9 ng/mL, p<0.05) and severe preeclampsia (19.3±8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). Conclusion : The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.

인간 난관세포와의 체외 공동배양과정에서 혈소판 활성요소가 생쥐배의 발달에 미치는영향

민부기,김기석,이희섭,홍기연,김흥곤,신무철,이찬근,최은하,Min, Bu-Kie,Kim, Kie-Seok,Lee, Hee-Sup,Hong, Kie-Youn,Kim, Heung-Gon,Shin, Mu-Cheol,Lee, Chan-Kun,Choi, Eun-Ha 대한생식의학회 1996 Clinical and Experimental Reproductive Medicine Vol.23 No.1

There are a number of problems during the process of culture in vitro on fertilization and embryo development compared to those on in vivo counterparts. And the platelet activating factor (PAF), which is found not only in mammalian spermatozoa but also preembryos, is implicated on reproductive process. To improve the environment of culture on in vitro fertilization and embryo development, coculture using salpingeal epithelial cells has been considered to accept the better result on pregnancy rate. This study was designed to determine if two different culture systems, coculture alone and PAF treated coculture, are positive or negative influence on process of in vitro fertilization and embryo culture in mouse. The cell cleavage rate reached to 2-4 cell stage at 24 hours of culture is 56.81% (50/88) and 48.21%(54/112) respectively, in PAF treated group which is added PAF on coculture and in coculture group. But the rate of cells cleavage was similar in both group after 48 hours of culture. The rate of unfertilization after insemination of oocytes was higher in coculture group(55..53%) than in PAF treated group(42.37%). And in assessment of undeveped embryos, the rate of equalized cell block was similar on both, coculture alone (35.3%)and PAF treated coculture(35.5%). while unequalized cell block was higher rate in PAF treated coculture(19.4%) than coculture alone (11.8%). But the rate of cytoplasmic degeneration of undeveloped embryos was significantly higher in PAF treated coculture than coculture alone. In conclusion, we have observed that PAF treated coculture is superior in the rates of in vitro fertilization and early embryo cell cleavage compared to those in coculture alone, but there is no difference on the rates of embryo develpments, cell degeneration, cell quality in both PAF treated coculture and coculture alone when the embryo cells were continuosly cultured for 48 hours or more.

Nitroprusside가 인간정자의 생존력, 운동성, Reactive Oxygen Species 발생에 미치는 영향

민부기,이희민,김기석,이희섭,김흥곤,홍기연,이봉주,Min, Bu-Kie,Lee, Hee-Min,Kim, Ki-Seok,Lee, Hee-Sup,Kim, Heung-Gon,Hong, Gi-Youn,Lee, Bong-Ju 대한생식의학회 1996 Clinical and Experimental Reproductive Medicine Vol.23 No.3

Objective: To analyze the direct effect of nitre oxide, generated from sodium nitroprusside, on sperm motility and reactive oxygen species. Design: Human sperm samples were treated to allow swim-up and washing. And the samples were devided into four aliquots. Each aliquot was incubated with either concentration at 0, 100nM, $10{\mu}M$, 1mM of nitroprusside. Intervention: Samples were measured chemiluminosence for reactive oxygen species of each aliquot with concentrations at 0, 100nM, $10{\mu}M$, 1mM of nitroprusside at allowing swim-up and washing of sperm. Main Outcome Measures: Percent motion parameters and viability were asse-ssed at 0, 3, 6, 12, 24 hours incubation. Results: The percent viablity was lower slightly in control group (50.2%) than that in sperm treated with 100nM of nitroprusside(57.5%) at 24 hours after incubation, while was reduced significantly in sperm with concentra-tion of $10{\mu}M(42.1%)$ and 1mM(21.3%)of nitroprusside at 6 hours after incubation. And the sperm treated with 1mM of nitroprusside was immotile totally at 6 hours after incubation. The straight line$(35.3{\pm}5.6%)$, the rapid forward$(37.2{\pm}6.4%)$ and the weak curvilinear velocity$(9.6{\pm}2.4%)$were more favorable comparing with those ($32.4{\pm}4.2%$, $30.0{\pm}7.8%$ and $18.0{\pm}4.6%$ respectively) in control group at 3 hours after incubation, but reduced significantly in sperm treated with $10{\mu}M$ and 1mM of nitroprusside. The levels of reactive oxygen species in control(700 c.p.m.) is lower significantly than that in each experimental groups of sperm treated with nitroprusside. And the levels of reactive oxygen species were 2200 c.p.m. in 100nM, 6200c.p.m. in $1{\mu}M$ and 12800c.p.m. in 1mM respectively. Conclusion: These results suggested that the concentration of 100nM of nitroprusside on sperm is beneficial to the maintanance of viablity and motile velocity, but detriment in high concentration of $10{\mu}M$ or 1mM of nitroprusside.

자궁내막증 치료 전후 환자의 혈청이 생쥐 난자의 수정률에 미치는 영향

김기석,민부기,이희섭,홍기연,이선영,박현진,김흥곤,Kim, Kie-Suck,Min, Bu-Kie,Rhee, Hee-Sub,Hong, Kie-Youn,Lee, Sun-Young,Park, Heon-Jin,Kim, Heung-Gon 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.3

Objective: To evaluate the effect of serum obtained before and after treatment for endometriosis on in vitro fertilization and development of two cell mouse embryo. Design: Pretreatment and posttreatment comparoson of fertilization of mouse oocyte and embryo development in serum supplement from patients with endometriosis; result were compared using Stuent T-test analysis. Method: Infertility Clinic, Department of Obstetrics and Gynecology, Collage of Medicine, Won kwang university, Korea. Patients was chosed eleven consecutive women with endometriosis. Interventions was all patient underwent laparoscopic or conservative surgery. This was followed by a 6-month course of burserelin acetate $900{\mu}g/d$. Main outcome was measured total number of fertilization and embryo that was fertilization after 24 hours and reached blastocyst stage after 72 hours of incubation were compared before and after treatment. Result: Before treatment, 47% of the oocyte were fertilized and 31% of the embryo reached blastocyst stage. After treatment, Significantly more fertilized and Significantly more embryo developed to blastocyst on the stage I and II of endometriosis. Conclusion: The fertilization and embryo toxicity of serum samples from patients with endometriosis is lost after treatment.

임신중 발생한 포진상 농가진

이승필(Seong Pil Lee),홍성진(Seong Jin Hong),오수미(Su Mi Oh),김흥곤(Heung Gon Kim),차승훈(Seung Hun Cha) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

Impetigo herpetiformis is a rare pustular eruption that may be seen in late pregnancy. It is associated with severe maternal and fetal complications in case of misdiagnosis and delayed treatment. The patient was a 25-years-old multigravida with psoriasis in her past history. At 20weeks gestation, she had been developed erythematous scaly annular patchs with papules and pustules on inner thigh. At 37weeks' gestation, the patient was suffered from a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustular abscess with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, antibiotics, systemic prednisone, steroid creams, and phototherapy(UVB) under the careful fetal well being monitoring. Cesarean section was done due to fetal distress, and a normal healthy male infant was delivered, following which the patient's condition improved rapidly.

임신 20주에 초음파로 진단된 안면 및 경부 미성숙 기형종

심재량 ( Jae Ryang Sim ),조현 ( Hyun Cho ),김인숙 ( In Sook Kim ),박현진 ( Hyun Jin Park ),이봉주 ( Bong Ju Lee ),윤기중 ( Ki Jung Yun ),홍기연 ( Gi Youn Hong ),김흥곤 ( Heung Gon Kim ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

Fetal teratomas are histologically diverse masses containing variety of tissues foreign to the anatomic site in which they reside, Sacrococcygeal teratomas are the most common and account for 50% of neonatal teratoma. Faciocervical teratomas are rare and accounts for only 5.5% of all neonatal teratoma, having an incidence of only 20,000:1 to 40,000:1 of live births. Immature teratoma was composed of poor differentiated or embryonal tissue which coexisted mature tissue and immature tissue was originated from neuroepithelium. We have experienced a large faciocervical teratoma and present this case with a brief review of literatures.

태반 부착 부위 융모상피성 종양

이선영(Sun Young Lee),박현진(Hyun Jin Park),이승필(Seong Pil Lee),이봉주(Bong Ju Lee),홍기연(Ki Youn Hong),김흥곤(Heung Gon Kim),윤기중(Kie Jung Yun) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

Placental site trophoblastic tumor(PSTT) is a rare form of gestational trophoblastic disease. This rare tumor has the potential for metastasis and death. The average age at onset of PSTT is 28 years, and the second believed to be postmenopausal at the time of diagnosis. The most common presenting complaint is amenorrhea or abnormal vaginal bleeding and rare complaints are virilization, nephrotic syndrome, uterine rupture, etc. The treatment of choice is surgical removal of the tumor, that is total abdominal hysterectomy with both salpingo-oophorectomy. We present a case of placental site trophoblastic tumor associated with spontaneous uterine rupture that is rare complication with a brief review of literature.

자궁외 임신의 임상적 고찰

김창홍,박성찬,김흥곤 圓光大學校 醫科學硏究所 1991 圓光醫科學 Vol.7 No.1-2

The incidence of ectopic pregnancy is apparently increasing in recent years. This study was undertaken for the clinical evaluation & statistical analysis on the 215 patients with ectopic pregnancy who were operated & confirmed by histopathological study at the Dept. of Obstetrics & Gynecology, Wonkwang University from Jan. 1, 1986 to Dec. 31, 1990. The results obtained were as follows. 1. The incidence of ectopic pregnancy was 1 in 25 deliveries (215/5375). 2. Ectopic pregnancy was found to occur most frequently in the age group, ranging from 26 to 30 years (40.5%). 3. Most frequent number of delivery & pregnancy was one times (30.7%) & two times (22.3%) respectively. 4. Most frequent number of artificial abortion was one times (32.4%) & nulligravida was 9.3%. 5. In the past history, 63.3% of the patients had previous artificial abortion, 17.7% had laparoscopic tubal sterilization & 6.6% had previous ectopic pregnancy. 6. The duration from LMP to onset of symptoms was 6~9 weeks (74.0%) most frequently. 7. According to symptomatological analysis, lower abdominal pain (94.4%), vaginal bleeding or spotting (55.3%), amenorrhea (86.1%) were the most common presenting signs & symptoms. 8. Urine hCG test was positive in 72.1% & culdocentesis was positive in 92.0%. 9. Ectopic pregnancy was implanted on the fallopian tube in 94.9 %. 10. The amount of intraabdominal hemorrhage was below 500 ㎖ in 40.9%, 500 ∼ 1,000 ㎖ in 24.2% & over 2,000 ㎖ in 7.9%. 11. Most commonly used surgical procedure was unilateral salpingectomy (50.7%). 12. There was no maternal death.

난소 갑상선종의 1예

홍성진,김재현,김흥곤,한원철 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.1

Struma ovarii is a mature cystic teratoma of the ovary. It is an uncommon tumor accounting for 2.7% of all ovarian teratomas and composed totally or in overwhelming proportion of thyroid tissues. When thyroid tissue constitutes more than 50% of the tumor, it is usually called a struma ovarii. Grossly, they are encapsulated, several centimeters in diameter and have a red, shiny, and meaty surface. Microscopically, the tumor is composed of mature thyroid tissue consisting of various sizes, lined by a single layer of columnar or flattened epithelium. The clinical behavior is benign and simple excision is adequate treatment. We have experienced a case of struma ovarii arising from the left ovary. So, we report this case with review of literatures.

일측성 무신장과 동반된 흔적 자궁각 1례

홍기연,최기욱,김흥곤 圓光大學校 醫科學硏究所 1993 圓光醫科學 Vol.9 No.1-2

We have experienced a case of rudimentary uterine horn associated with unilateral renal agenesis. Interestingly renal agenesis is always found on the same side of affected Mu¨llerian duct. Embryologically, it seems that they come from abnormal development of the mesonephric & Mu¨llerian duct. We report is case of this anormaly with review of the literature.