임신성 융모성 질환과 Telomerase 활성도의 관계

김승조,정재근,배석년,최은아,김재선,김동주,안현영 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

완전 포상기태 제거 후 지속성 임신성 융모성 질환의 발생에 대한 텔로메레이즈 효소의 역할을 관찰하기 위해 중합연쇄반응을 이용한 효소활성도 검사에서 다음과 같은 결과를 얻었다. 1. 텔로메레이즈 활성도는 완전 포상기태 제거 후 자 연경쾌된 16명 중 2명(12.5%)에서 확인되었으나 지속성 임신성 융모성 질환으로 진단되어 항암치료를 받게된 환자 15명 중에서는 13(86.7%)명이 활성도를 보였다. 2. 전이성 융모성 종양환자 9명의 포상기태조직에서 는 모두 텔로메레이즈 활성도가 확인되었다. 3. 임신 12주 및 40주의 정상 태반에서는 텔로메레이 즈 활성을 관찰할 수 없었으나 7예의 침윤성 기태조직 과 5예의 융모상피암조직 그리고 융모상피암세포주 (JEG-3)에서는 모두가 확인되었다. 이상의 결과에서 완전 포상기태조직 내의 텔로메레 이즈의 활성은 지속성 임신성 융모성 종양, 침윤성 기태 및 융모상피암의 발생과 관련됨을 알 수 있고 이것은 지속성 임신성 융모성 질환의 예측에 이용할 수 있는 분자유전학적 지표로 이용할 수 있게 될 것이다. The purpose of this study was to evaluate the significance of telomerase activity in gestational trophoblastic disease and the association of telomerase activity in complete hydatidiform mole and subsequent development of persistent gestational trophoblastic tumor. By using the standard telomerase repeat assay, we examined telomerase activity in 2 normal placentas, 31 complete hydatidiform moles, 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). Telomerase activity was detected in 13 of 15 (86.7%) complete hydatidiform mole patients who eventually had chemotherapy for the treatment of persistent gestational trophoblastic tumor. All of the 9 patients with metastatic disease (FIGO Stage Ⅲ) had telomerase activity in their initial molar tissue. In contrast, telomerase activity was evident in only two of 16 (12.5%) complete hydatidiform mole patients with spontaneous remission. While telomerase activity was not detected in normal placentas, high level of telomerase activity was detected in all of 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). The presence of telomerase activity in a complete hydatidiform mole is associated with the development of persistent gestational trophoblastic tumor, such as invasive mole and choriocarcinoma.

Nd-YAG Laser를 이용한 가토의 미세 난관 문합술에서 문합부의 조직학적 소견

김장흡,이진우,김수평,김진홍,김은중,정기욱,권동진,고영미 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

To study tubal adhesion, tubal patency and histologic difference under light, electronic microcopy in a site of anastomosis, authors performed three anastomosis surgery in rabbit fallopian tube;1-layer and 2-layer anastomosis in splint-not-used group(group 1) and in splint-used group(group 2) and laser anastomosis in splint-used group(group 3). 10 rabbits were used in each group, therefore the total number of experimental rabbits in 3 groups were 30. The results were as follows; 1. The degree of gross adhesion in group Ⅱ was significantly high as compared with other groups but there was no difference between left and right tube in the degree of adh- esion in each group(Table 1). 2. The incidence of tubal patency in group Ⅱ was significantly high(89%) as compared with group Ⅰ(44%). Especially, the incidence of tubal patency in group Ⅲ was significantly high(100%) but there was no difference between left and right tube in incidence of tubal patency in each group. 3. Inflammatory cell infiltration appeared in each group on optical microscopic examin- ation. Especially, fibrosis and inflammatory cell infiltration appeared more in group Ⅱ but there was no statistically significant difference. And there was no significant difference between left and right tube in each group. 4. Transmission electron microscopic examination of group I, as compared with normal control group, showed increase of microvilli and secretory granules and decrease in size of epithelial cell. Epithelial cell was morphologically transformed but maintained the original structure comparatively. TEM examination of group Ⅱ, as compared with normal control group, showed decrease of microvilli and secretory granules and flattening of epithelial cell. It showed that epithelial cell vanished in it`s original structure. TEM examination of group Ⅲ, as compared with normal control group, showed decrease of microvilli and increase of secretory granules and morphological transformation of epithelial cell. Group Ⅲ showed the resemblence to normal control group. From the above results, in reversal tuboplasty and tubal factor infertility, it is consi- dered that simple splint-used anastomosis or splint-used anastomosis with Nd-YAG laser will improve the successful rate of tubal anastomosis.

Krukenberg 종양 3 예

김동진,신영관,이석환,김태웅,김준길,윤미림 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.10

저자들은 Krukenberg종양 3 예를 치료했으나 모두 수술후 20 개월이내에 사망하였다. Krukenberg tumor is comparatively rare in metastatic ovarian tumor and is almost metastasized from gastrointestinal tract. Early diagnosis and treatment is difficult. The definite diagnosis would be pathological diagnosis with surgical specimen. We experienced 3 cases of krukenberg tumor on the ovary which were metastasized from the adenocarcinoma of stomach. The first died 24months later after subtotal hysterectomy with B.S.O. The second died 9 months later after B.S.O and the third died 16 months after T.A.H. with B.S.O. All were received postoperative adjunctive chemotheraphy. We present these cases with the brief review of literature.

임신성 융모성질환의 자궁동맥과 자궁근층에서의 Doppler 연구

김승조,송승규,정재근,박태철,김은중,나덕진,김사진,이귀세라 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

1. 자궁동맥의 평균 Resistance Index 수치는 비임신군에서 0.865±0.025, 임신 2기초기군에서 0.773±0.062, 포상기태군에서 0.781±0.065, 침윤성기태군에서 0.606±0.139로 포상기태군은 비임신군과 비교하면 통계학적으로 의의있게 나타났으나 임신 2기 초기군과 비교하면 통계학적으로 의의가 없었다. 침윤성기태군은 나머지 3군과 비교시에 통계학적으로 의의있게 낮았다(p$lt;0.05). 2. 침윤성 기태군에서 자궁동맥의 RI수치는 종양측이 0.529±0.140, 비종양측이 0.667±0.154로 통계학적으로 의의있는 차이는 보이지 않았으나(p$lt;0.05), 종양측 자궁동맥의 평균 RI수치가 비종양측 자궁동맥의 평균 RI수치보다 낮은 경향이 있었다. 3. 침윤성 기태군에서 종양내에서 비정상적인 혈류를 관찰할 수 있었으나(RI=0.47), 경쾌상태에서는 비정상적인 혈류는 보이지 않았다. 이상의 결과로 GTD환자에서 자궁동맥 및 자궁내 혈류속도 파형의 분석 및 이상혈류의 측정은 진단 뿐아니라 추적검사에도 유용한 방법으로 생각된다. RI(Resistance index) values of uterine artey in 14 patient with GTD (Gestational trophoblastic desease) (10 patients with H-mole and 4 patients with invasive mole) were measured using color doppler ultrasonogram. 10 non-pregnant and 10 early second trimester pregnant volunteers were assessed in a similar fashion to act as control groups. The mean RI values were; non-pregnant group is 0.868±0.025, pregnant group is 0.773±0.062, H-mole group is 0.781±0.065, invasive mole group is 0.606±0.139. So, the mean RI values were lower in the patients with invasive mole group when compared with the non pregnant, early pregnant and H-mole group. But there is no statistically significant difference between H-mole and normal pregnant. The uterine circulation in invasive mole shows abnormal blood flow which shows high diastolic component within the tumor mass and myometrium, the RI value was 0.47. But this phenomenon is disappeared after remission by chemotherapy. The mean RI value of uterine arteries with tumor site was increased tendency from 0.529±0.140 to 0.748±0.151 after remission by chemotherapy. From these results, we concluded that the color doppler sonogram is useful in the diagnosis and follow up of invasive mole by measuring RI values of uterine artery and blood flow within tumor mass.

자궁외임신의 진단과 치료에 있어서 β-hCG의 의의

김장흡,이진우,나덕진,정기욱,권동진,김진흥,신희정,이원희 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

자궁외임신은 1970년대이후 이환율 및 사망율은 급격한 감소를 보이는 반면, 발생빈도는 증가추세를 보이고 있다. 이에 저자들은 1990년 1월 1일부터 1993년 8월 31일까지 개복수술 및 복강경 검사에의해 자궁외임신(난관임신)으로 진단된 251레를 대상으로 진단 및 치료방법에 따른 혈청 b-hCG의 진단시 값과 치료후의 변화를 관찰하여 다음과 같은 결과를 얻었다. 1. 발생빈도 같은기간중 분만수에 대한 자궁외임신의 빈도는 1:37.4였으며, 1,000분만당 자궁외임신의 발생빈도는 26.7%이었다. 2. 연령분포 연령분포는 19-46세였으며 평균연령은 29.5±4.8세였다. 또한 가장 빈번한 연령층은 25-29세로써 36.5%를 차지하였다. 3. 임신 및 유산횟수 임신횟수에 있어서 미산부는 25.9%였으며, 평균 임신횟수는 0.9±회였다. 유산횟수에 있어서 유산경험이 없는 경우는 24.3%였으며, 평균 유산횟수는 1.5±였다. 4. 임신주수 평균 임신주수는 6.9±1.5였으며, 가장 빈번한 임신주수는 6-7주로써 22.7%를 차지하였다. 5. 기왕력 가장 높은 분포를 보인 기왕력은 PID로써 23.5%를 차지하였으며, 이외에 복강경에 의한 난관결찰, 수술기왕력, 자궁내막증, 자궁근종, 불임 및 H-mole 기왕력 순서로 분포가 낮았다. 6. 착상부위 및 난관파열 가장 빈번한 착상 부위는 팽대부로써 74.4%를 보였으며, 파열형은 52.9%에서 관찰되었으며 착상부위에 따라서 자궁각 임신의 경우 93.2%로 가장 높은 파열빈도를 보였다. 7. 증상 및 검사소견 주요증상인 하복부 동통, 질출혈 및 무월경은 77.5%, 63.7% 및 71.7%를 보였으며, 초진시 혈색소 10 mg%이하가 35.4%였고 Hct값은 30%이하가 37.9%였다. 8. 진단의 양성율 진단의 양성율은 더글라스와 천자, 뇨임신 반응, 초음파검사, 복강경검사(n=31) 및 혈청 b-hCG검사에서 96.7%, 72.4%, 85.7%, 97.1% 및 100.0%를 보였다. 9. 자궁내막의 병리조직학적 검사(n=70) 및 혈청 b-hCG값 자궁내막의 병리조직학적 검사상 탈락막 변화, 증식기 변화, 분비기 변화 및 Arias-stella 반응은 각각 40.0%, 28.5%, 21.5% 및 10.0%를 보였다. 또한 임신 주수에 다른 자궁내막의 변화는 탈락막 변화 및 분비기 변화는 임신주수가 진행됨에 따라서 증가하는 양상을 보였으며 Arias-stella반응은 임신 8주까지 증가한 후에 감소하는 양상을 보였다. 그리고 자궁내막의 병리조직학적 소견과 혈청 b-hCG값과의 관계를 보면 탈락막 변화의 경우 6096.8 mIU/ml로써 다른 경우들보다 유의하게 높은 혈청 b-hCG값을 보였다. 10. 치료방법 치료방법은 개복수술 201예, 복강경검사 25예, Methotraxate(MTX)치료 5예 및 기대요법( expectant management) 20예였다. 11. 임신주수에 따른 혈청 b-hCG값 임신주수에 따른 혈청 b-hCG값의 분포는 13.5 mIU/ml였으며 평균값은 1518.3±160.7 mIU/ml로써 같은 임신주수의 정상임신과 비교하여 부위 및 파열에 관게없이 유의하게 낮았다. 또한 임신 7주에 유의하게 증가한 후 감소하였다. 12. 착상부위 및 파열 유무에 따른 혈청 b-hCG값 착상부위에 따른 혈청 b-hCG값은 자궁각이 3017.9±1465.8 mIU/ml로써 다른 부위에 비해 높은 양상을 보였으며, 비파열형의 경우 1778.3±293.7 mIU/ml로써 파열형에 비해 높았다. 13. 난관 절개술후 혈청 b-hCG값의 변화 수술전 혈청 b-hCG값은 1361.6±268.8 mIU/ml였으며 수술후 1일에 218.3 ±95.5mIU/ml로 유의하게 감소하였으며 혈청 b-hCG값이 정상으로 되는데 걸리는 기간은 평균 12.6±7.9일이었다. 14. MTX치료후 혈청 b-hCG값의 변화 MTX 치료전 혈청 b-hCG값은 378.0 ±240.4mIU/ml 였으며 혈청 b-hCG값이 정상으로 되는데 걸리는 기간은 평균 78.0±12.5일이었다. 또한 혈청 b-hCG값이 정상으로 되는데 걸리는 기간은 평균 34.8±6.5일이었다. 15. 기대요법후 혈청 b-hCG값의 변화 기대요법전 혈청 b-hCG값은 1,426.1±257.9 mIU/ml였으며 혈청 b-hCG값이 정상으로 되는데 걸리는 기간은 평균 78.0±12.5일이었다. 또한 혈청 b-hCG값이 1,000 mIU/ml이상인 경우가 이하인 경우보다 평균기간이 길었다. 16. 치료방법에 따른 난관소통율 치료후 난관소통율은 난관절개술, MTX치료 및 기대요법에서 69.2%, 80.0% 및 75.0%가 관찰되었으며, MTX치료의 경우 유의하게 높았다. 이상의 결과로써 자궁외임신의 조기진단 및 치료에 있어서 혈청 b-hCG검사 및 추적검사는 현재 다른 검사들보다 그 의의가 높은 것으로 사료된다. The incidence of ectopic pregnancy is apparently increasing in recent years, and making a quick and accurate diagnosis of ectopic pregnancy is desirable but often difficult. To evaluate the efficacy of serum b-hCG in the diagnosis and management of ectopic pregnancy, this study was undertaken on 251 patients with pathologically or laparoscopically proven diagnoses of tubal pregnancies at the Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, Catholic University Medical College from Jan. 1, 1991 to Aut.31, 1993. The results of the study were as follows; 1. The incedence of ectopic pregnancy was 1 in 37.4 deliveries. 2. The most frequent age group was in 25-29 years of ages. 3. 25.7% of patients was nullipara and 24.3% of total had not experienced artificial abortion. 4. The most frequent interval between L.M.P. and the onset of symptoms was 6 weeks in 22.7%. 5. A previous history of PID was in 23.5% and laparoscopic tubal sterilization was in 18.4%. 6. Ectopic gestation was implanted on ampullar portion in 74.4%. 7. On symptomatological analysis, lower abdominal pain was encountered in 77.5%, vaginal spotting and amenorrhea in 63.7% and 71.7% respectively. 8. In the diagnostic positive rate, culdocentesis was in 96.7%, U-hCG test in 72.4%, USG in 85.7%, laparoscopy in 97.1% and serum b-hCG test in 100.0%. 9. The histopathology of endometrium showed decidual reaction (40.0%), proliferative phase (28.5%), secretory phase (21.5%) and Arias-stella reaction (10.0%). There was correlation between serum b-hCG and endometrial patterns (decidual reaction) and correlation between gestational weeks and endometrial patterns (decidual reaction and secretory phase) was also found. 10. The range of serum b-hCG levels was 13.5-16,000mIU/ml in 100.0% of the cases and mean level of serum b-hCG was 1518.3±160.7 mIU/ml. The levels of serum b-hCG in each gestational weeks of ectopic pregnancy were below the low level of normal pregnancy and the levels of serum b-hCG increased till the 7th gestational week and after this week declined. 11. The level of serum b-hCG in each implatational portions was noted to be the highest in the cornual portion. The level of serum b-hCG in the unruptured cases was higher than that in the ruptured cases. 12. The preoperative baseline serum b-hCG in the patients was significantly declined at postsalpingostomy day 1 and the mean disappearance time of serum b-hCG($lt;5 mIU/ml) was 12.6 ±7.9days. 13. The mean disappearance times of serum b-hCG after MTX therapy and expectant management were 34.8±6.5 days and 78.0±12.5 days respectively. 14. The rates of tubal patency after salpingostomy, MTX therapy and expectant management were 69.2%, 80.0% and 75.0% respectively. Based on these results, we concluded that the early diagnosis of ectopic pregnancy is very important and the conservative tubal surgery, MTX therapy and expectant management can be successful in selected cases of ectopic pregnancy for further fertility.

Post-Transfusion Prupura 1 례

김동진,신영관,차용재,김준길,김준태,김태수 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.10

PTP는 동양인에서는 매우 드문 증후군으로서, 대부분의 경우 진단이 안되거나 ITP로 잘못 진단하는 경우가 많다. 특히 수혈을 많이하는 산부인과 의사로서 경산부에 수혈했을때 발병 가능성이 있으며 일단 PTP가 의심이 되면 즉시 치료를 시작해야 한다는 사실을 알아야 할 것으로 생각되며, 본 저자들은 경산부에서 발생된 PTP 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Post-transfusionpurpura(PTP) is believed to be a rare clinical syndrome characterized by the acute occurrence of severe purpura with thrombocytopenia approximately 1 week after blood transfusion. This syndrome occurs predominantly in patients who lack the platelet-specific alloantigen, and has been previously sensitized by prior transfusion or pregnancy. The typical patient is a middle-aged, multiparous white woman. Diagnosis may be suspected by normal clotting studies, bone marrow biopsy showing increased megakaryocytes, and demonstration of a potent antibody reactive against platelets by appropriate serologic tests. Treatment with corticosteroid and platelet transfusion is ineffective. Exchange trasfusion or plasmapheresis has led to improved survival in this disease. Recent reports indicate that IV IgG may become a effective treatment. We exprienced a case of PTP in a multiparous woman received first blood transfusion during Cesarean section. Here we report this case with brief review of literature.

제왕절개 후 발생한 태반용종 1 예

김동진,신영관,김준태,윤미림,김태수,황호민 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2

저자는 최근 본 병원 산부인과에서 제왕절개후 2년만에 발견된 태반 용종의 한 사례를 경험 하였기에 이에 대한 간단한 문헌적 고찰과 함께 보고하는 바이다. A placental polyp is an intrauterine, polypoid or pedunculated mass of placental tissue retained after an incomplete abortion or term pregnancy. While several cases of placental ployp after vaginal delivery and abortion have been reported, few cases of placental polyp after cesarian section were reported before. However, recently, we happened to meet such case, and we present here the history of the case and brief review of related literature.

자궁경부암 세포주들에서 리포좀을 이용한 종양억제 유전자 [pRcCMVp53/liposome]의 직접 이입법에 의한 세포 성장 억제 효과

김승조,이헌영,남궁성은,김수평,이준모,안웅식,김종국,박순희,박용석,김진철,한유진,양재명,신봉영,서상용,김동재 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

목적: 자궁경부암 유전자 치료를 위하여 자궁경부암 세포주들에 리포좀을 이용한 종양억제 유전자[wild-type p53 gene]의 직접 이입을 통하여 세포성장 억제효과를 보고자 하였다. 방법: 자궁암세포주들 [CaSki, SiHa, HeLa, HeLaS3, C33A, HT3]을 12 well에 104, 96 well에 5×103의 수로 triplicate를 형성한 뒤 대조군, pRcCMVp53, lipofectin, pRcCMV/lipofectin, pRcCMVp53/lipofetin이 함유되있는 것 을 각기 12 well에 20 ㎕씩 96 well에는 10 ㎕씩을 투여한 다음 7일간 배양하였다. 세포수 측정, ELISA [neutral red] assay, MTT등을 이용하여 세포성장과 cell viability를 측정하고 이를 one-way ANOVA F-test, multiple comparison Tukey method에 의해 날짜별 서로 군의 차이를 비교 하였다. 결과: p53 유전자에 의한 자궁경부암 세포주의 성장억제를 확인하기 위하여 세포 수 측정, ELISA assay, MTT assay를 시행하였으며 각각의 assay에 대한 측정 마지막날인 6일째를 기준으로 정상대조군 세포와 비교한 결과 세 포수 측정에서는 CaSki[89%], SiHa[59.2%], HeLa[86%], HeLaS3[78%], C33A[91%] 그리고 HT3[74%] 성장억제를 나타냈다. 또한 Neutral red를 이용한 세포 viability assay 에서는 CaSki[70%], SiHa[93%], HeLa[73%], HeLaS3[50%], C33A[67%] 그리고 HT3[52%]에서 는 52%의 세포감소를 보여주었다. MTT assay를 통한 각각의 자궁경부암 세포주의 세포성장억제 결과는 CaSki[38%], SiHa[72%], HeLa[53%], HeLaS3[28%], C33A[33%]그리고 HT3[53%]였다. 결론: 자궁경부암 세포주에 직접 이입법을 통한 유전자 전달 후 세포성장 억제는 매우 유익하게 감소되었으며 이와같은 결과는 향후 유전자 직접 이입법에 의한 자궁경부암 환자에 있어서 유전자 치료를 실시할 수 있는 새로운 장으 로 생각이 되어진다. Purpose: We investigated cell growth inhibitory effect of the wild type p53 gene into the cervical cancer cells via the recombinant p53 plasmid, pRcCMVp53 with lipofectin. Method: Inhibition of the growth of cervical cells as determined by a cell count assay. The cells were inoculated at density of 104 cells/well in each 12 well plate, 24 hrs before infection. At each indicated point, cells in three wells on each well plate were trypsinized and counted. The mean cell counts of triplicated well after transfection at day 1~6 was checked. Inhibition of the growth of cervical cells were checked by ELISA assay, MTT assay. The cells inoculated at densities of 5×103/well in each 96 plate 24 hrs before infection. At each indicated point cells of three wells were transfected for 6 days, harvested and counted by liquid scintillation counter the mean cpm per triplicate wells were plated for ELISA and MTT assay. One-way ANOVA F-test and multiple comparison Tukey method was used for statistical analysis. Result: Inhibition of the growth of cervical cells in cell count showed CaSki[89%], SiHa[59.2%], HeLa[86%], HeLaS3[78%], C33A[91%] and HT3[74%]. ELISA assay showed CaSki[70%], SiHa[53%], HeLa[73%], HeLaS3[50%], C33A[67%] and HT3[73%]. MTT assay showed HeLa[33%], HeLaS3[28%], SiHa[75%], CaSki[38%], C33A[33%] and HT3[53%]. Conclusion: These results indicate that transfection of cervical cancer cells with the wild type p53 gene via pRcCMVp53 with lipofectin is a potential novel approach to the gene therapy of cervical cancer.

자궁탈에 관한 임상적 관찰

김동진,진건,이석환,김태웅,차용재,김준길,김준태,윤미림 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.10

1981년 1월부터 1992년 12월까지 12년동안 지방공사 강남병원 산부인과에서 경험한 자궁탈 환자 168례(이중 수술환자 155례)에 대하여 임상적 고찰로 다음 결론을 얻었다. 1. 총 산부인과 환자에 대한 자궁탈의 발생빈도는 0.09%였다. 2. 연령분포는 25세부터 84세였고, 평균연령은 54.5세, 50세-59세군이 36.3세로 가장 높은 빈도를 나타냈다. 3. 자궁탈의 정도는 3도의 탈이 1도 15.55, 2도 35.7%에 비해 높은 48.8%빈도를 나타냈다. 4. 분만횟수는 0회에서 13회까지이고 평균횟수는 4.7회 4회이상이 70.3%로 가장 높은 빈도를 나타냈다. 5. 분만장소는 가정분만(89.85),병원분만(10.2%) 지역별분포는 시골지역(10.7%), 도시지역(89.3%)의 빈도를 나타냈다. 6. 자궁탈의 발생연령은 16세부터 78세까지이며 평균 발생연령은 46.5세였다. 7. 자궁탈의 지속기간은 3일에서부터 49년까지이며 평균 15.3년였고, 10년이상인 경우가 57.2%였다. 8. 임상증상은 자궁탈 호소가 95.2%로 가장 많았고 배뇨곤란과 빈뇨가 20.2%였다. 9. 총 168례중 과거치료 경험은 7례(4.1%)였으며 그중 질식자궁절제술이 제일 많았다. 10. 수술을 받은 155례중 145례(93.2%)에서 질식 자궁절제술과 전후질벽성형술 또는 후질벽성형술을 시행하였고 부속기병변 때문에 복식자궁절제술과 전후질벽성형술 또는 부속기제거술을 시행한 례가 5례(3.2%)였고, 4례에서는 질폐쇄술, 1례에서 Manchester op.를 시행하였다. 11. 재발된 경우는 4례(2.5%)로서 2례에서 전후절벽성형술 1례에서 Le Fort op. 1례에서 복식자궁 절제술을 실시하였다. 12. 수술후 합병증은 발열 6.4%, 요로감염 5.1%, 요저류 3.8%순이었다. 13. 자궁 및 부속기가 제거된 86례의 병리학적 소견은 만성경관염 65.8% 경관선의 편평세포화생 63.8%였으며 기타 자궁근종 3.2%, 난소낭종 4.4%였다. This clinical and statistical study was attempted to analyze 168 cases of uterine prolapse(13 cases-not operated, 155 cases-operated) at the Department of Obstertrics and Gynecology, KangNamGeneral Hospital during the perilod from Jan 1981 to Dec. 1992. The results are as follows: 1. The incidence of the uterine prolapse found at the Department of Obstetrics and Gynecology during the past 12 years was 0.09%. 2. The highest group of age distribution at the time of admission was 50 to 59 years(36.3%)and the mean age was 54.5 years old. 3. The highest group of the degree of uterine prolapse was the 3 rd degree(48.8%). 4. The parity showed that 118 cases(70.3%) was over 4 and I case(0.6%)was nullipara. 5. The delivery place was home in 151 cases(89.8%) and the urban area(89.3%)had a higher incidence than rural area(10.7%) 6. The age distribution at the time of development of uterine prolapse showed that 48 cases (28.5%) were 50 to 59years 33cases(19.6%) were 30 to 39years and mean age was 46.5years. 7. 96 cases(47.2%)was those cases who had suffered from the uterine prolapse for more than 10years and mean duration was 15.3years. 8. The feeling of a prolapsed mass was the most common symptom (95.25)and dysuria and urinary frequency were the next common symptoms(20.2%). 9. In 7 cases out of 168 cases(4.1%), previous treatment such as vaginal hysterectomy abdominal hysterectomy chemical cauterization was done. 10. Out of 155 cases of uterine prolapse, 106 cases(68.4%)were treated by the vaginal hysterectomy with either anterior and posterior repair and/or posterior repair. 11. Recurrence was 4 cases(2.5%) . 12. The fever was the most common postoperative complication(6.4%)and urinary tract infection was the next common symptom(5.1%). 13. Pathologic findings were as follows: Chronic cervicitis 102 cases(65.8%) squamous metaplasisa of cervical gland 99 cases(63.8%), associated ovarian cyst 7 cases (4.4.%) Leiomyoma 5 cases (3.2%)etc.

폐경기여성에서 호르몬대치요법으로 인한 소변내 Deoxypyridinoline량의 변화에 관한 연구

김대훈,김수평,김진홍,유영옥,김은중,노덕영,권동진,정대영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Objective: Our purpose was to determine whether the bone resorption rate is evaluated by Deoxypyridinoline(Dpd) i urine, and to evaluate the clinical utility of Dpd to monitor the hormone replacement therapy effect in postmenopausal women. Study Design: We divided the patients into three groups, the control group was the women who were postmenopausal health state, and the experimental groups were the postmenopausal hormone replacement therapy group and the podtmenopausal nontherapy group. Urinary Dpd and serum FSH, Osteocalcin was measured in the both groups. Results: The urinary Dpd and serum osteocalcin were significantly increase in postmenopausal group(6.63±3.09 pmol/μmol creatinine; 10.54±3.77 ng/ml) compared to preme- nopausal group(4.15±1.32 pmol/μmol creatinine; 7.85±2.17 ng/ml). The urinary Dpd and Serum osteocalcin were significantly decreased in the postmenopausal HRT group(3.31±1.79 pmol/μmol creatinine; 8.31±3.13 ng/ml) compared to the postmenopausal nontherapy group (6.63±3.09 pmol/μmol creatinine; 10.54±3.77 ng/ml). In postmenopausal nontherapy group, there was no correlation between urinary Dpd and serum osteocalcin. But these makers were good correlated in postmenopausal HRT group. Conclusions: It is concluded that the assay of urinary Dpd is useful for the resorption marker of postmenopausal osteoporosis and it should be useful for the monitoring of hormone replacement therapy effect in postmenopausal women. Furthermore, urinary Dpd may be an important indicator to determine when to resume the therapy during cessation of HRT.