불임환자에서 초음파를 이용한 난소용적의 측정 및 난소 능력 평가의 예측인자로서의 임상적 유용성에 관한 연구

조영래,전상식,김진홍,이택후,김대한,김광수,박철민 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

본원 산부인과 불임클리닉에서 37명의 불임환자들을 대상으로 초음파를 이용하여 난소용적을 측정하고 측정한 총 난소용적과 환자의 나이, 기초 난포자극호르몬치, 기초 난포호르몬치와의 상관관계를 조사 연구하였다. 조사대상 환자의 연령 분포는 23세에서 41세였고 평균 연령은 30.27±4.79세였다. 월경주기 3일에서 5일 사이의 평균 기초 난포자극호르몬치 및 기초 난포호르몬치는 각각 7.79±2.54 mIU/ml, 47.58±30.38 pg/ml로 측정되었다. 대상 환자 중에서 초음파로 양측 난소 모두의 삼차원적인 크기 측정이 가능한 경우는 62%로써 그 외에는 어느 한 쪽의 난소만 측정이 가능하였다. 좌우측 난소의 평균값은 각각 7.99±3.63 cm3 및 7.48±4.63 cm3, 전체 난소의 평균값은 7.77±4.07 cm3였으며 총 난소용적(좌우측 난소의 합)의 평균값은 14.88±7.05 cm3로 측정되었다. 좌우측 난소용적을 비교한 결과, 양측 난소용적간에는 뚜렷한 상관관계가 있었고 양측 난소용적 사이에 큰 차이는 없었다. 본 연구에서는 총 난소용적과 환자 나이와의 관련성 에서는 어느 정도 상관관계가 있는 것으로 나타났으나 나이에 대한 난소용적의 뚜렷한 변화는 없었고 통계적으로도 유의한 차이를 보이지 않았다. 총 난소용적과 기초 난포자극호르몬치 및 기초 난포호르몬치와의 관련성 에서 기초 난포자극호르몬치와는 전혀 상관관계가 없는 것으로 나타났으나 기초 난포호르몬치와는 뚜렷한 상관 관계가 있는 것으로 나타났으며 통계적으로도 유의한 차이를 보였다. 이상의 연구 결과를 볼 때 가임기의 국내 여성-적어도 불임환자들의 경우 외국 여성에 비하여 각각의 난소용 적 및 총 난소용적이 상대적으로 적은 것을 알 수 있고 총 난소용적과 기초 난포호르몬치와는 유의한 상관관계 가 있는 것으로 보아 궁극적으로 난포의 발달 숫자와 임신율과도 연관이 있을 것으로 추정된다. 현재 이용되고 있는 많은 지표들 중에서 어느 것도 난소 기능(반응) 평 가나 보조생식술의 결과(임신)를 정확하게 예측할 수는 없으나 초음파를 이용한 난소용적 측정이 난소기능 평 가 및 보조생식술 결과 예측에 유용하게 이용될 수 있을 것으로 생각하며 한국인의 평균 난소용적을 국내 최초로 보고하는 바이다. A number of parameters such as a women`s age, basal FSH and E2 value have been identified as predictors of success with assited reproductive technology (ART) primarily by predicting ovarian responsiveness to ovulation induction but there are very few non-inavsive unstimulated outcome predictors available to patients before starting on ART cycle. The objective of our study was to determine ovarian volume in infertile women with ultrasound on cycle day 3∼5, to compare ovarian volume with patients` age, basal FSH, E2 level and to assess the usefulness of ovarian volume as a predictor of ovarian reserve. Total thirty seven infertile women met the following study entrance criteria: (1) both ovaries were present and contained no ovarian cysts ≥10 mm or greater in diameter, (2) no history of endometrioma, dermoid or PCO, (3) no recent use of infertility drugs and (4) no history of ovarian surgery. On cycle day 3∼5, the length, height, and width of each ovaries were determined by transabdominal ultrasound in the parasagittal and transverse planes. All patients had blood samples for measure of basal FSH and E2 drawn at the same day. The basal serum FSH and E2 value (mean±SD) were 7.79±2.54 IU/L and 47.58±30.48 pg/ml. The mean volume of right ovary, left ovary and total ovaries was 7.99±3.63 cm3, 7.48±4.63 cm3 and 7.7±4.07 cm3 respectively and the mean total ovarian volume (sum of right and left ovaries) was 14.88±7.05 cm3. No significant differences in volume were noted between right and left ovaries. The relationship between total ovarian volume and age was somewhat correlated (r=0.37) but did not change significantly with age in this study group. There was no correlation between total ovarian volume and basal FSH level (r=-0.03) but a significant correlation between total ovarian volume and basal E2 level (r=0.58).

산부인과 영역에 있어서 초음파장치의 임상적 이용 ( I )

박찬무(CM Park),박영세(YS Park),김용철(YC Kim),박찬용(CY Park),엄승호(SH Ohm),이우홍(WH Lee) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

저자는 자궁내 태낭의 성장속도와 태아의 성숙도 및 태아예상체중을 위한 방법으로 정상임 신부 422명중 63명에게는 태낭을 위해 1회의 초음파 단층촬영을, 359명에게는 아두대횡경치 를 위해 1회의 초음파단층촬영을 실시했고 아두대횡경치에 의한 태아 예상체중을 위해 신생 아 97명의 분만후 24시간내에 신생아 체중을 계측하여 임신월령에 따른 태아 아두 및 예상 체중의 희귀직선을 산출하여 다음과 같은 결론을 얻었다. 1. 임신재태기간 제 5주부터 12주사이의 정상임신부에서 태낭은 제 5주에 5명중 3명에서 (66%) 제 6주는 9명중 7명에서 (77%) 최초로 태낭이 보였고 7주 이후에서는 모든 예에서 태 낭이 관찰되었다. 2. 임신재태기간 제 5주부터 12주까지 임신주수에 다른 태낭의 성장은 y=0.62 X (wks) - 1.75로 0.57cm/week의 비율로 성장한다. 3. 임신재태기간 제 11주부터 40주까지 임신주수에 따른 아두대횡경치는 y=0.27 X (wks) - 0.88로 성장하고 임신재태기간 제11주부터 20주까지는 0.34cm/week로 제 21주부터 40주까지 는 0.23cm/week의 증가율을 나타낸다. 4. 임신제대기간 제 35주부터 40주까지 각 임신주수에 다른 아두대횡경치에 의한 아두대횡 경치에 의한 태아 예상체중은 y=1.14 X (mean BPD) - 7.2(kg)로 0.16kg/week의 증가율로 나타난다. The ultrasonic measurements of fetal biparietal diameter (BPD) were obtained by real time scanning (ADR 2130) from 380 times in normal 359 pregnant women between 11th to 40th gestational weeks. Before 11th gestational weeks of pregnancy, gestational sac was measured by same method from 81 times (63cases). The results of these data were as follows; 1. the regression line according to the increment of gestational sac between 5th and 12th gestational weeks; y=0.62 X (wks) - 1.75. 2. The regression line from 11th to term of biparietal diameter ; y=0.27 X (wks) - 0.88 and the growth rate of the biparietal diameter during same period (0.34cm/week) was faster than one of 21th-40th gestational weeks (0.23cm/week). 3. The expected fetal body weight was calculated from the regression line (y=1.14 X (mean BPD) - 7.2(kg)) was obtained from sonar measurement of biparietal diameter (from 35th to 40 th gestational weeks).

흡인분만과 감자분만

박찬무(CM Park) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.5

국립의료원에서 흡입분만을 시작한 것은 1962년 11월부터 이었으며, Malmstrom과의 용수흡입기를 사용하고 있으며 cap은 3,4,5의 3종으로 명명 3cm,4cm,5cm의 직경을 표변하고 있다. 먼저 임상소견을 진찰기록에 의하여 종합하여 표로 제변하고 그 성적을 검계하여 보고자 한다. 결 론 (1)흉인분만은 분명히 간편하고 안전한 방법이며 대부분의 기형분만의 적응에 있어서 감자에 대치될 수있다. (2)흉인분만은 제왕절개분만의 빈도를 감소시킬 수있다고 생각되지 않는다. (3)흉인분만은 단순히 분만제2기를 단측시키기 위하여 남용하여서는 안된다. (4)금소예를 제외하고 흉인에서 실패하면 감자를 시도할 필요없이 바로 제왕절게로 이행하는 것이 안전하다. 그러나 이상과 같이 결론이 감자분만을 부정하는 것은 아니며 각자의 경험과 수기의 숙련도에 따라 임의로 사용될 수 있으며 어느 한쪽을 부정할 수는 없다. 그러므로 아직도 감자분만이 널리 사용되고 있는 현실에 비추어 수련의사의 교육을 위하여서는 최소한 감자분만 (수로 선택적감자분만, elective forceps delivery)을 겸용하는데 성한다. 그러나 흡입문만은 조작이 용이하여 수련의 필요성이 없으므로 수련목적으로 감자만을 사용케 한다는데 대하여서는 임상의의 진료목적과 수련목적을 혼동하는 감이 불무하다.

간이동결법에 의한 운동성 불량정액과 정자감소증 정액의 정자냉동보존

박찬무,박영하,박영선,박준숙,박준영,Kaneko, S,Iizuka, R 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.5

배우자간인공수정(AIH)시의 정자동결과 냉동보존의 응용을 목적으로, 융해시의 정자소생율 향상과 동결법의 간편화를 시도했다. 정자운동율 50%이하의 정액은 Continuous-step density gradient centrifugation method를 이용해 세정 농축한 결과, 정자수와 운동율이 향상되어 정자소생율의 지표가 되는 Fertility Index{FI=정자수(/ml)X운동율(%)X10-8}가 5.6배 향상되었다. 또한, Oligozoospermia중에서도 정자수가 10X106/ml이하인 정액은 Cushion method를 이용해 농축한 결과, 정자수는 4.2 ± 2.1배, 운동율은 2.3 ± 1.9배 증가되었다. 세정과 농축시킨 정자의 간이동결법에 의한 냉동보존에 있어서, 간이동결기내에 액체질소(-196℃)를 넣고 수분간 방치시켜, 액체질소증기에 의해 동결기 내부가 온도평형(-150℃)에 도달되도록 했다. KS-II 보존액을 혼합한 0.5ml의 세정 농축정자를 냉동보존용 serum tube에 넣고, 액체질소 수면위 2cm에서 옆으로 뉘여 동결시킨 후, 액체질소저장용기(Liquid Nitrogen container)에 옮겨 보관했다. 인공 수정시에 30℃의 온수에 융해시킨 결과, 각각 70 ± 12%, 64 ± 11%의 정자소생율을 얻을 수가 있었다. 융해후에도(Continuous-step density gradient centrifugation method의 경우는 원래정자의 평균 2배 이상의 FI가 유지되었다. 이상의 결과에서 운동성 불량정액과 Oligozoospermia의 AIH에 있어서 정자의 세정 및 농축과, KS-II 냉동보존액을 혼합시킨 후 간이동결법을 이용한 냉동보존법으로 원래정액 이상의 정자수와 운동율을 얻을 수 있음이 확인되었다. It is well known that the cryopreservation of human semen plays an important role in the field of clinical Artificial Insemination by Husband semen (AIH) and Donor semen (AID). However, semen dilution with cryopreservation medium and decrease in sperm motility during freeze-thaw processes make lowering semen qualities and survival rate. The author undertook this experiments to pursue the higher survival rate of cryopreserved semen and more simple method of freezing technique. To improve the qualities of cryopreserved semen after thawing, it is effective to concentrate the sperm from whole ejaculate by two method, continuous-step density gradient centrifugation method and Cushion method, as well as to achieve higher survival rate. A : Prior to freezing, the continuous-step density gradient centrifugation method was undertaken for semen with poor motility (below 50 %) sperm. As a result of this, the semen was given 5.8 times improvement of Fertility Index (sperm density (106/ml) X motility (%) X 10-8) B : The concentration of severe oligozoospermic semen by the Cushion method was improved the sperm density 4 times than the original semen. A simple liquid nitrogen vapor freezing was employed in the present study : the concentrated sperm was mixed with KS-II cryopreservation medium and them placed at 2 cm up the surface of liquid nitrogen. After freezed by liquid nitrogen vapor at -150℃, the specimen was stored in liquid nitrogen container. At the time of AIH, thawed with shaker in 30℃ water, the sperm survival rate of A and B were found to be 7-±12 % and 64 ± 11 %, respectively. The post thaw Fertility Index was as twice as that of the original semen by the continuous-step density gradient centrifugation method, and the survival rate was also high. It is consequently suggested that simple liquid nitrogen vapor freezing method using KS-II cryopreservation medium, after sperm washing and concentration, is the very simple and convenient method with good results for cryopreservation of sperm.

여성 요루에 관한 임상적 고찰

박찬무(CM Park),최근혜(GH Choi),조인제(IJ Cho) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.2

One hundred thirty patients with urinary fistulas had been admitted in the Gynecological Ward of the National Medical Center, Seoul, during 13 years, from the beginning of 1959 through the end of 1971, of which 109 patients were actually submitted to the surgical treatment. A review of these cases indicated that complete investigation of the urinary tract should precede repair, since these abnormal communications appeared in many varieties and might be multiple. Anatomic as well as etiologic considerations were important in diagnosis. The causes of these fistulas were analysed and methods of management were reivewed. Particular attention was paid to those patients in whom surgical repair of the fistula was undertaken and an attempt was made to evaluate the factors responsible for success of repair. The results of clinical observations were summarized as follows: 1. Seventy five out of 130 patients were obstetric fistula and more than half of them belonged to the second decade(50.7%), while in 55 of the non-obstetric fistula cases the greatest incidence was observed to be in the fourth decade(47.3%). 2. Presumed etiologic agents of the fistula showed 75 out of 130 patients were caused by various types of obstetric operation and large numbers were found in prolonged labor with or without forceps delivery and craniotomy. Etiologic agents of non-obstetric fistula could be divided into 26 of hysterectomy either simple or radical, 19 of chemical cauterization for total uterine prolapse with strong acid by laymen, 3 of genito-urinary tuberculosis, 2 of irradiation after hysterectomy due to ovarian cancer and 5 others. 3. The majority of patients, both obstetric and non-obstetric, belinged to vesicovaginal fistula, comprising 72.3%. As for the ureterovaginal variety, 17 patients consisted of 15 non-obstetric and only 2 obstetric. 4. The fistulas of less than 2cm in diameter could be found most frequently both obstetric and non-obstetric. It was our general concept that the size did not influence as much as the location of fistulas. 5. In 89 of 109 patients, various types of baginal approach were undertaken with 73(82%) patients of success. Twenty patiens, all of ureterovaginal variety as well as technically difficult patients were submitted to abdominal precedures with 18 patients(90%) of success. The combined, abdominal and vaginal approach was performed for 2 cases of complicated vesicovaginal variety with 2 patients of success. Six of 109 patients had to be resorted to various types of diversion with 5 patients of success. Nine of 130 fistulas healed spontaneously. All spontaneously healed fistulas occured as the results of surgical trauma, 3 of radical hysterectomy, 4 of abdominal total hysterectomy and 2 of subtotal hysterectomy. 6. In 109 patients operarive procedures were carried out on 137 occasions. Final cure rate of surgical repair was decreased by the number of surgical attempts made. But it seemed to be worthwhile to try repeated attempts, even more that 5 times in some selected cases, with patience and deliberated evaluation. 7. Obstetric fistulas were usually poor outcome(80.3%) than non-obstetric(89.5%), because most of them were so large and fibrosis were so extensive that it was impossible to make sufficient mobilization of the surrounding tissue to make suture without tension. In the present series, overall success was 91 of 109 patients, or 83.5% of the whole, during 13 years. 8. Genito-urinary infection was the most common complication and E. coli was the most common causative organism of urinary infection. 9. Unobstructed postoperative urinary catheter drainage was of primary importance.

Synthesis and Their In Vitro Antitumor Activity of 6-Aziridinylbenztmidazole-4.7-dione derivatives

CM Ahn,JA Tak,SJ Choi,SJ Lee 대한약학회 1999 大韓藥學會 總會 및 學術大會 Vol.48 No.-

Initial Report for the Radiation Effects Research Foundation F1 Mail Survey

Milder, CM,Sakata, R,Sugiyama, H,Sadakane, A,Utada, M,Cordova, KA,Hida, A,Ohishi, W,Ozasa, K,Grant, EJ Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

To study the full health effects of parental radiation exposure on the children of the atomic bomb survivors, the Radiation Effects Research Foundation developed a cohort of 76,814 children born to atomic bomb survivors (F1 generation) to assess cancer incidence and mortality from common adult diseases. In analyzing radiation-associated health information, it is important to be able to adjust for sociodemographic and lifestyle variations that may affect health. In order to gain this and other background information on the F1 cohort and to determine willingness to participate in a related clinical study, the F1 Mail Survey Questionnaire was designed with questions corresponding to relevant health, sociodemographic, and lifestyle indicators. Between the years 2000 and 2006, the survey was sent to a subset of the F1 Mortality Cohort. A total of 16,183 surveys were completed and returned: 10,980 surveys from Hiroshima residents and 5,203 from Nagasaki residents. The response rate was 65.6%, varying somewhat across parental exposure category, city, gender, and year of birth. Differences in health and lifestyle were noted in several variables on comparison across city and gender. No major differences in health, lifestyle, sociodemographics, or disease were seen across parental exposure categories, though statistically significant tests for heterogeneity and linear trend revealed some possible changes with dose. The data described herein provide a foundation for studies in the future.

우리나라 여성 불임술에 관한 고찰

박찬무(CM Park),황영환(YW Whang) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.7

The use of female sterilization in Korea increased tremendously during the past three years, 1977 through 1979, as the government began promoting female sterilization as a mainstay of the national family planning program by providing augmented government subsidy to physicians performing female sterilizations. Of a total of 570,114 female sterilizations performed during the period under the government support, the majority of cases were done via laparoscopy technique which represents markedly high rate in comparison with other methods of sterilization. Performing a large number of sterilizations and for the implementation of the efficient voluntary laparoscopy sterilizations, it is believed that the nationwide evaluation on complications and failures as well as any problems following laparoscopic sterilization is imperative. For this evaluation, the pre-designed questionnaires were distributed to a total of 632 government-designated physicians doing laparoscopy sterilization, and 310 physicians responded as of December 1979. The completed questionnaires were analysed and the following results were obtained. 1. Of a total of 310 respondents, the greatest number of physicians having laparoscopy experience for 2-3 years shared 36.9% of the total and 47 physicians, 14.9%, have laparoscopy experience for 4 years and over. 2. Quantiatively, 24.5%, almost one quarter, of total physicians performed 3,000 to 5,000 procedures. It is noteworthy that three physicians performed even more than 10,000 procedures. 3. I`m looking at the number of physicians by their main technique used, the greatest number of physicians perferred coagulation plus division technique comprising 38.1%, while the Bipolar coagulation technique occupied the lowest rate of 17.1%. 4. Among a total number of 390,249 procedures performed by 310 respondents, the greatest number of cases was performed via coagulation-division technique, comprising 54.2% of the total procedures. 5. As to the failure rate of the laparoscopic sterilization, a total of 655 pregnacies were reported on the questinnaires, which represented 0.17%. The highest failure rate of 0.43% appeared in the Bipolar coagulation technique while the lowest failure rate of 0.02% were in the Ring application technique. The reason Bipolar technique had the highest failure rate could be attributed to the fact that the most training institutions in KOrea have not been equipped with Bipolar equipment for the suficient practical training on proper technique of Bipolar coagulation. 6. Operative complications during laparoscopic sterilization requiring explo-laparotomy were reported in 89 laparoscopic procedures, comprising 0.023% of the total; 29 bleeding cases and 60 bowel injuries. Of the bleeding cases, the highest rate of 0.012% marked in Ring application technique and the highest in bowel injuries rate of 0.022% Coagulation and division technique. 7. Ectopic pregnancy following laparoscopic sterilization was the most frequent disastrous complication reported by respondents, occurred in 163 cases comprising 0.024% of the total precedures. Bipolar coagulation represented the highest ectopic pregnancy rate of 0.005%. The high rate of ectopic pregnancy in Bipolar coagulation technuique may be caused by improper coagulation or some other technical failures owing to insufficient practical training. 8. Currently, many physicians perform laparoscopic steriilixation combined with first trimester abortion without noticeable problems. The greatest number of physicians performed 31%-40% of combined procedures of laparoscopic sterilization and MR procedure t the same time. It is remarkable that 6 physicians performed this combiend procedure in more than 91% of the total procedures and 10 physicians perfored 81-90%.

보존혈액에 관한 혈액학적 및 생화학적 연구

강치명(CM Kang) 대한산부인과학회 1962 Obstetrics & Gynecology Science Vol.5 No.2

Since the Korean War, mary blccd banks have been established in Korea. Although they have made a great contribution to the medical practice, unexpected untoward side effects following transfuion of the preserved whole blood were not infrequently experienced. The Author studied the hematological and biochemical changes, as well as the change of coagulability of the preserved whole blood in an attempt to clarify the cause of thoes adverse side effects. The hematological and biochemical changes were observed in the preserved blood in ACD. For the change of coagulability, the blood preserved in ACD and EDTA solution (25 ml. respectiveiy for 100 ml. of blood) and heparinized blood (5 ml. of heoarin for 100 ml. of blood) were used. Prothrombin time, recalcification time and heparin tolerance test were employed for coagulability test. 1) The erythrocyte count of the preserved blood decreases gradually, but its decrease is not so remarkable until after three weeks of preservation. 2) Erythrocyte sedimentation rate retards gradually and after two weeks of preservation almost no change in sedimentation is observed. 3) Hematocrit of the blood increases as the time goes on, but not remarkably. 4) Leucocytes and blood platelets decrease markedly within a week after storage of the blood. 5) Potassium, cholesterol and inorganic phosphorus in the plasma increase. 6) On the contrary, glucose, fibrinogen and sodium in the plasma decrease. 7) Protein in the plasma are almost invariably unchanged. 8) Coagulability of the preserved blood in various solutions decreases in general. The preserved blood in ACD and EDTA solutions show gradual decrease in the coagulability tests. On the other hand, the coagulability of the heparinized blood is so rapidly decreased that it becomes inert to any coagulability tests in five days.

한국 정상인, 산모, 신생아 및 우계의 혈액상

강치명(CM Kang) 대한산부인과학회 1962 Obstetrics & Gynecology Science Vol.5 No.5

The author carried out the study on the blood pictures of cattle and fowls which live in the same environment with human being and also on the blood pictures of paturient mothers and newborn infants who are quite different from those of the normal adults. The author obtained the following conclusions: 1) The platelet count, the erythrocyte count, the homoglobin, and hematocrit are decreased in paturient mothers. But leucocyte count is increasd in paturient mothers. 2) Leucocyte count is considerably increased in newborn infants. 3) The platelet count of cattle blood is lower than that of human blood. 4) The erythrocyte count, hemoglobin and plarelets of fowls blood are markedly lower than those of human blood. But normoblasts are seen in the peripheral blood of fowls and leucocyte count of fowls blood is higher than that of human blood.