정상자궁내막의 Alkaline Phosphatase 및 Acid Phosphatase 활성도의 변동에 대하여

고영우(YW Koh),장윤석(YS Chang) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.4

Acid phosphatase의 활성도는 증식기에는 거의 없었으며 분비기초부터 급속히 증가하여 월경기까지 지속되며 선상피세포에 주로 분포되어 있다. Endometrial enzymes were studied histochemically in the histologically normal endometrium of 50 control women. Alkaline phosphatase is more prominent in the proliferative phase than in the secretory endometrium showing even distribution between glandular and surface components. In glandular elements it concentrates in the lumenal tips of the cells, with scant or absent activity in the nucleus. Peak activ ityis noted around the ovulatory phase. Acid phosphatase activity remains low during the proliferative phase. There is a marked increase in acid phosphatase activity during the progestational phase with peak activity occruing premenstrually. Both glandular and surface epithelium exhibit these changes.

간 난자의 체외수정 및 태아의 자궁내 이식에 의한 임신 및 분만 - 한국최초 시험관 아기 분만 1 례 -

장윤석(YS Chang),이진용(JY Lee),문신용(SY Moon),김정구(JK Kim) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.3

저자 등은 최근 난관인자에 의한 불임부인에 clomiphene citrate를 사용하여 과배란 유도를 시행하고 2개의 성숙된 배란직전의 난자를 채취하여 체외수정시킨후에 배아를 자궁내 이식하여 쌍태임신을 확인하였다. 쌍태아는 분만예정일 18일전에 조기진통과 태아의 위치이상 때문에 제왕절개술에 의하여 정상적인 여아(2,630gm)와 남아(2,560gm)가 태어났으며, 한국최초의 체외수정아(시헌관아기)인 이들 쌍태아는 출생후 4개월이 지난 현재 2명 모두 정상적인 성장을 하고 있다. Details are given of a normal intrauterine twin pregnancy and its outcome established by implanting in vitro fertilized two-cell and four-cell embryos into the uterine cavity of an infertile woman with tubal factor. The embryos were obtained by in vitro fertilization of two prevulatory eggs aspirated at laparotomy 36 hours after the injection of hCG during the patients hyperstimulated menstrual cycle with clomiphene citrate. Progressively increasing levels of serum hCG confirmed the presence of an early pregnancy. Ultrasound examination revealed two intra-uterine gestational sacs with fetal heart beats at 8 weeks and normally growing fetuses at 10 weeks. Because of preterm labor and transverse lie of a fetus, it was elected to deliver the patient by cesarean section 18 days prior to term. A normal female infant weighing 2.63kg and a male infant weighing 2.56kg were delivered on October 12, 1985.

전기소작법에 의한 복강경불임수술

장윤석(YS Chang) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.9

* 본 논문의 요지는 1977년 11월 20~25일에 태국 Bangkok에서 개최된 The Seventh Asian Congress of Obstetrics and Gynecology에서 발표되었음. * 본 연구는 International Fertility Research Program, Research Triangle Park, North Calori na, U.S.A. (AID/pha-c-1172)의 연구비 보조로 이루어진 것임. Three hundred cases of laparoscopic sterilizations with electrocautery were performed at the Seoul National University of Korea from January to September, 1975. The patients were followed up after 7 to 21 days, six and twelve months after surgery. This paper highlights selected socio-demographic and reproductive characteristics of the women sterilized, and provides clinical evaluation of sterilization procedure by periodic follow-up. The mean age of the women undergoing sterilization was 34.3 years with mean parity of 3.1. The mean educational status from women and the husbands was 11.5 and 14.2 school years respectively. All the women were married and resided in urban areas. Fifty percent of the women preferred to have no religious affiliations. Only 11.0 percent of the women were gainfully employed. Thirty-three percent of the women had not practiced any contraception prior to sterilization. More than 90.0 percent of the women gave history of one or more induced abortions before coming for sterilization. The mean number of induced abortionwas 3.6. Seventy-three percent of the procedures were completed in less than ten minutes. Difficulty at surgery was encountered in one case only. For 99.0 percent of the cases no surgical complications were reported. In three cases uterine perforation occurred. No immediate complications/complaints were reported. Fever requiring antibiotics was the only complication/complaint reported at 7-21 day follow-up in 4.0 percent of the patients. The predominant complaint of pelvic/back pain was reported for 6.7 percent of the cases at the six-month follow-up and for 2.8 percent of the women at the 12-month follow-up. At the six-month follow-up there was one case of carcinoma diagnosed for which abdominal total hysterectomy with bilateral adnexectomy was performed. No pregnancy was reported for the women sterilized.

불임시술후 자궁난관 조영소견과 수술소견과의 비교 고찰

장윤석(YS Chang),남상윤(SY Nam),한만청(MC Han),정성훈(SH Chung) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.11

저자들은 1980년 7월부터 1981년 6월까지 불임난관 복원술과 수술전 자궁난관 조영술을 시행한 80명중 73명의 난관 146예를 대상으로 두 소견을 대조한 결과 다음과 같은 결론을 얻었기에 이에 보고하는 바이다. 1.대상환자의 평균연령은 33.9세였으며, 31~35세군이 제일 많아 73명중 41명으로 56.2%를 차지하였다. 2.대상환자의 임신역은 1~14세로 5회가 제일 많았고 생존자녀의 수는 평균 1.60이었다. 3.불임의 기간은 3개월에서 100개월이었으며 평균 불임기간은 40.1개월이었다. 4.자궁난관 조영술 실시에서 수술까지의 기간은 3일에서 11개월이었으며 1~2개월이 가장 많아 31.5%를 차지하였다. 5.자궁난관 조영술 소견과 수술 소견이 일치된 경우는 총 146예중 94예로 64.4%의 일치율을 나타내었으며 소견이 일치하지 않은 경우의 대부분에서 자궁난관 조영술 소견이 수술 소견보다 근부난관의 길이가 짧게 나와 146예중 47예 (32.2%)를 차지하였다. 특히 자궁난관 조영술 소견에서 간질부 한소로 나온 전례(21예)에서 수술후 소견이 협부 한소(19예) 또는 팽대부 한소(2예)로 나와 심한 차이를 보였다.그러므로 자궁난관 조영상자궁강의 삼각형 영상만 나오고 난관의 영상이 전혀 나오지 않은 소위 간질부 환소일수록 오판을 할 가능성이 많으므로 주의를 요한다. There are several accepted methods and tools for evaluating tubal patency. Among them, hysterosalpingography, a radiologic visualization of the uterus and tubes, is convenient and provides detailed information about the uterine cavity as well as tubal patency. Jordan et al.(1971) had studied poststerilization follow-up hysterosalpingogram, the aim of which was to confirm the efficancy of laparoscopic sterilization and to determine how best this could be performed. Recently poststerilization hysterosalpingography was performed preoperatively as a part of the routine evaluation and treatment of the patients for tubal reanastomosis. Since July of 1980, a number of tubal reanastomosis were performed in Female Sterilization Reversal Center of Seoul National University Hospital and preoperative hysterosalpingographies were checked, the findings of which were markedly different from the operative findings. Hysterosalpingograms of 73 patients among 80 patients who had undergone tubal reanastomosis from July of 1980 to June of 1981 were carefully studied and compared with operative findings. The results obtained were as follows. 1.Age distribution was ranged from 25 to 41 years old and 31~35 age group showed 56.2% (41 pts). 2.Duration of sterilization was ranged 3~100 months, mean 40.1 months. 3.Interval between hysterosalpingography and laparotomy was ranged from 3 days to 11 months and 1~2 month group was most common (23 pts.,31.5%). 4.The correlation of operative findings in 73 patients (146 tubes) with hysterosalpingograms showed that agreement between them was found in 94 tubes (64.4%) and showed marked discrepancy that all cases (21 cases) diagnosed as interstitial tubal occlusion by hysterosalpingogram revealed as isthmic(19 cases) or ampullary tubal occlusion (2 cases).

진단적 복강경술의 임상적 연구

장윤석(YS Chang),서상준(SJ Suh) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.8

진단한 복강경술을 시행한 92예를 대상으로 하여 분석한 결과 다음과 같은 결론을 얻었다. 1) 적응증은 원발 및 속발성 불임환자가 51예로 가장 많았고 자궁외 임신이 의심되는 환자가 24예로 그 다음의 순이었다. 2) 자궁난관조경술상 양측난관 폐쇄로 진단된 51예중 26예(51%)에서 난관의 양측 혹은 편측의 색소소통 즉 난관의 소통성이 확인되었다. 3) 자궁외 임신이 의심되는 24예중 8예(33.3%)에서 난관임신이 확인되었고, 10예 (41.7%)는 정상, 3예는 정상임신, 2예는 난소낭종파열, 1예는 만성골반강내염증 및 유착임이 판명되었다. 4) 원발성 무월경 12예중 1예는 부신성기증후군임이 확인되어 cortisone치료를 추천 하였고, 2예는 hormone replacement치료를 추천하였으며 그외에도 골반강내장기를 정확하게 관찰함으로써 진단 및 치료에 큰 도움을 주었다. 5) 골반 동통, 골반내종류등이 의심되는 환자에서 복강경술로 그 원인을 규명할 수 있었다. 6) 이소성 자궁 내장치 2예를 복강경술을 시행하여 제거함으로써 개복수술을 피할 수 있었다. 7) 92예의 진단적 복강경술 시행예에서 특기할 만한 합병증은 없었다. Ninety-two diagnostic laparoscopies have been performed to assess the clinical impression from June, 1974 to March, 1977. Fifty-one patients with a diagnosis of bilateral tubal occlusion on hysterosalpingography subsequently underwent laparoscopy and injection of dye through the cervix into the uterus. Bilateral tubal patency was demonstrated in 13 patients (25.5%), and unilateral patency in another 13 cases (25.5%). In the 24 cases of possible ectopic prenancy, only 8 cases (33.3%) have been proved to be tubal pregnancy. Two ectopic intrauterine devices were removen by laparoscopy without laparotomy, and in the 12 primary amenorrhea patients many useful findings for treatment have been found by this procedure. In the view of poor results from tubal plastic procedures, it is advocated that laparoscopy be carried out before tubal surgery on all patients with bilateral negative salpngograms. And thus the laparoscopy may frequently obviate unnecessary plastic tubal surgery and exploratory laparotomy for possible ectopic pregnancy.

Immunoelectrophoresis에 의한 모체 및 신생아 혈청 단백 분획상의 비교 관찰

장윤석(YS Chang) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.8

Recently, a more detailed analysis of the serum protein fractions has been developed using immu-no-chemical procedure, such as modified micro-immunc-electrophoresis. Forty samples of the maternal and fetal blood serum were analysed by means of immuno-electro phoresis to observe the differences of immune globulin system, especially β2M macroglobulin and β2A globulin. Beta2M and β2A globulin fractions were demonstrated in all samples of the maternal blood serum, while these were not demonstrated in all of the fetal blood serum. It appears that not only 19S heavy molecular weight macroglobulin but even β2A 7S globulin, same as classical γglobulin in molecular weight which is also demonstrated in the fetal blood serum, are not subjected to the placental transmission.

악성협막세포종의 1례 ( 난소 )

장윤석(YS Chang),남상익(SI Nam) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.7

Malignant thecoma is a very rare tumor of the ovary. Only 16 cases have thus far been reported in the literature. In this paper a case of malignant thecoma encountered of Ob. & Gyn. S.N.U.H. presented.

효소면역법과 형광면역법을 이용한 내인성 LH surge 발생 탐지 및 임상적 의의

장윤석 ( YS Chang ),문신용 ( SY Moon ),전종관 ( JK Jun ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.7

During controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) program, endogenous luteinizing hormone(LH) surge may have negative effects on number of oocytes retreived, fertilization rate, cleavage rate and pregnancy rate. But if it was detected at the earlier stage and human chorionic gonadotropin(hCG) was timely administered, comparable results between surge group and non-surge group were noted. Ridioimmunoassay (RIA) which has been a standard method in detecting endogenous LH surge in COH, however, is expensive, time-consuming and needs hospital facilities. This study was designed to evaluate the clinical efficacy of enzyme immunoassay (EIA) and fluoroimmunoassay (FIA) in detecting endogenous LH surge in COH. LH levels were evaluated with RIA, EIA and FIA in 38 COH cycles with exogenous gonadotropin,. Serum LH levels were measured with RIA, EIA and FIA and urinary LH levels were checked with EIA. Amerlite kit(Amersham, U.K.) with one monoclonal antibody and one polyclonal antibody was used for EIA. For FIA, Stratus kit(American Dade, U.S.A.) was used. Endogenous LH surge was defined as increase of LH level twice more than the mean value of previous RIA measurements. Incidence of endogenous LH surge was 29%(11/38). In patients with endogenous LH surge, LH levels with EIA and FIA were significantly elevated on the day of surge onset and in non-surge group, LH levels showed no differences. Significant correlation was noticed between LH levels with RIA and those with EIA(serum; r=0.66, urine; r=0.60) and FIA (r=0.70). In EIA, serum LH levels showed significant correlation with urinary LH levels(r=0.73, p<0.05). In conclusion, EIA for serum and urinary LH levels and FIA for serum LH levels are convenient and accurate methods in detecting endogenous LH surge in COH.

급성자궁경관염의 Cryocauterization ( 냉동요법 )

장윤석(YS Chang),고경용(KY Koh) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.5

The clinical experience with the use of cryocauterization for the primary treatment of chronic cervicitis in 34 patients at Seoul National University Hospital from Sep. 1972 through Jan. 1973 is reported. The patients have been observed over 12 weeks of period. Cryosurgery was performed by the use of carbon dioxide gas as the refrigerant which was delivered through a special cervical probe. The procedure was carried out in the out patient dapartment without analgesia or anesthesia. Cervical lesion has been treated at -50 C for 3 minutes. Healing was documented to be complete in 91% of all patients within 12 weeks after treatment. Healing process has been complete through a similar fashion in majority of cases. Significantly, the majority of patients experienced only mild discomfort during the freezing process. No serious complications have occurred and no patients have complained of systemic symptomatology. Cryocautery seems to be a rapid, safe, to-date and effective measures for the treatment of chronic cervicitis.

정상 만삭 임산부 양수세포의 성염색질에 관한 연구

장윤석(YS Chang),장중환(CH Chang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.12

Prenatal sex determination is important in the field of genetics and the sex linked disorders. Prenatal sex has been determined by the Barr body and the Y-fluorescent body in the amniotic fluid cells with the ease, simpliciy and rapidity. Fifty-two cases of amniotic fluid were obtained from the term pregnant women in labor. The accuracy of the sex chromatin scoring alone was 93.5% in male, and 95.2 %, in female. The acruracy of the Y-cbromatin tecbnique alone was 93.5% in male, and 100%, in female. The accuracy using both the X-chromatin and Y-chromatin techniques was 96.8% in male and l00%, in female.