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윤성도,김택훈,김종인,박종하,이형종,서정재 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.1
저자는 1991년 1월1일부터 1991년 8월 31일까지 8개월간 계명대학교 동산의료원 산실에 입원한 임신 37/5주에서 41/5주까지의 정상산모 18례와 임신 26/2주에서 42/3주까지의 임신 전자간증 산모 51례의 임신중 혈청 CA 125농도를 측정하여 다음과 같은 성적을 얻었다. 1. 정상산모 18례의 혈청 CA 125 36.65+20.53U/ml, 임신 전자간증 산모 51례에서는 59.84+66.54U/ml였다. 따라서 임신 전자간증 산모에서는 정상산모와 비교하여 CA 125 혈중 농도가 상대적으로 높아 임신전자간의 발생 예견검사방법으로 의의가 있을 것으로 추정되었다. 2. 임신 전자간증 산모에서 임신중 혈청 CA 125의 평균농도는 임신 38주이상 28례에서 41.05+24.76U/ml, 임신 38주미만 23례에서 82.72+91.19U/ml이었다. 3. 임신 전자간증 산모에서 태반중량과 혈청 CA 125 농도와의 관계를 조사해 본 결과 태반중량 500gm이하 22례에서 혈청 CA 125평균농도가 84.13+92.99U/ml이었고, 태반중량 500gm이상 29례에서는 41.41+24.63U/ml를 나타냈다. 4. 임신 전자간증 산모에서 출산횟수와 혈청 CA 125농도와의 관계를 조사해본 결과 초산모 47례에서 혈청 CA 125평균농도가 62.61+68.58U/ml이었고, 경산모 4례에서 27.24+11.61U/ml로 나타내었다. 5. 이상의 성적을 볼 때 CA 125 혈청농도측정 단독으로는 임신 전자간증을 예측하기에 부족할 것으로 사료된다. Serum CA 125 levels were determined by means of the radioimmunoassay technique in 18 normal pregnant women and 51 women with preeclampsia at various gestational ages who were admitted at the department of obstetrics and gynecology, Keimyung University Hospital from January to August, 1991. The range of gestational ages varied from 184 days(26/2 weeks) to 297 days(42/3 weeks). Followings are the results summarized. 1. The mean levels of serum CA 125 in women with preeclampsia and normal pregnant women were 59.84±66.54U/ml, 36.56±20.53U/ml, respectively. 2. The mean levels of serum CA 125 in women with preeclampsia were 41.05±24.76 U/ml at gestational age above 38 weeks and 82.72±91.19U/ml at gestational age below 38 weeks. 3. The mean levels of serum CA 125 in women with preeclampsia were 84.13±92.99 U/ml in placental weight below 500 gm and 41.41±24.63U/ml in placental weight above 500gm. 4. The mean levels of serum CA 125 in women with preeclampsia were 62.61±68.58 U/ml in primiparous woman, and 27.24±11.61U/ml in multiparorus woman. Authors tried to determine the maternal serum CA-125 level and compared the value at various gestational ages, to see whether the elevated CA 125 level lead to predicting preeclampsia or not. But we could not have conclusive evidence from elevated maternal CA 125 level as a single factor.
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윤만수,강기주,양승홍,안영도,채호진 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5
미세침윤 자궁 경부암의 치료 방향 설정에 도움을 얻고자 1993년 3월부터 1997년 12월까지 부산대학교병원 산부인과에서 미세침윤 자궁 경부암으로 진단받은 69례를 대상으로하여 일반 적 임상 소견 및 자궁 경부 생검 조직, 원추 절제술 조직, 수술후 최종 조직 등의 슬라이드를 다시 면밀히 검사하여 다음과 같은 결과를 얻었다. 1. 조사 대상의 연령 분포는 30대가 43.5 %로 가장 많았으며, 출산력은 경산부가 97.1 %를 차지하였다. 술 전 진단적으로 시행한 자궁 경부 세포진 검사 소견은 class III가 34.8 %로 가장 많았고, 자궁 경부 생검 결과는 상피내암이 31.9 %로 가장 많이 나타나 미세침윤 자궁 경부암의 정확한 진단을 위하여서는 원추 절제술이 필요할 것으로 생각된다. 2. 미세침윤암 Ia1 환자 61례의 치료로는 37례[60.7 %]에서 단순 자궁적출술을, 16례[26.2 %]에서 변형 근치적 자궁적출술 및 골반 임파절 절제술을, 그리고 나머지 8례[13.1 %]에서는 치료적 원추 절제술을 시행하였고 Ia2 환자 8례에서는 모두 변형 근치적 자궁적출술 및 골반 임파절 절제술을 시행하였는다. 자궁적출술 후의 조직 검사에서 단순 또는 변형 근치적 자궁적출술을 시행받은 53례의 Ia1 환자 중 41례[77.4 %]에서는 술 후 잔여 병변이 관찰되지 않았으나 12례에서는 잔여 병변이 관찰되었고 12례 중 10례에서는 원추 절제술 결과상 절제 변연부에서 병변이 발견되었던 경우였다. 3. 원추 절제 조직 소견 중 절제 변연부에 병변의 침범이 있는지 유무, HPV 감염의 형태학적 증거 유무, 임파혈관 침윤 유무 등과 자궁 적출술 후 잔여 병변이 발견될 확률과의 상관 관계를 조사한 결과, 원추 절제 조직의 변연부에 병변의 침범 및 HPV 감염의 형태학적 증거 등이 자궁 적출술 후 잔여 병변이 관찰될 가능성과 유의한 상관 관계가 있었다. 이상의 결과로 볼 때 자궁 경부 미세 침윤암의 경우 원추 절제 조직의 변연부에 병변이 없고 침윤의 깊이가 3 mm 이하이며 임파혈관 침윤 및 HPV 감염의 형태학적 증거가 없을 때는 보존적 치료인 원추 절제술이 적절한 치료가 될 수 있다고 생각되며, 이러한 보존적 치료를 시행했을 때는 반드시 세포진 검사나 질확대경 등으로 주기적인 추적 관찰이 필요할 것으로 생각된다. 그러나 침윤의 깊이가 3.1-5 mm인 경우에는 보다 많은 환자를 대상으로 보존적 치료의 적합성에 대한 조사가 필요할 것으로 생각된다. Microinvasive squamous cell carcinoma of the cervix is a subject associated with decades of confusion and multiplicity of definitions. And so the treatment of microinvasive squamous cell carcinoma of the cervix is controversial. Simple hysterectomy has been performed in almost all cases, associated or not with more radical procedures. But the morbidity associated with simple hysterectomy or more radical procedures must be weighed against the possibility of residual neoplasia. Currently, there is a tendency to adopt conservative management to treat patients with microinvasion, as long as it can be assured that the whole lesion has been removed. This study was made to investigate clinical aspects of microinvasive squamous cell carcinoma of the cervix and to establish which histological informations should be obtained from the cones that would give the best possible assurance of absence of residual neoplasia in the patient. This was done by comparing cone and hysterectomy specimens from each patient. Sixty nine cases who were diagnosed with microinvasive squamous cell carcinoma of the cervix and treated at Pusan National University Hospital from 1993 to 1997 were presented. Eight of these patients have been done conization as a therapeutic modality. We evaluated the following histological features in the cones: depth of invasion, lymphovascular invasion, morphological signs of HPV infection, and free or involved cone surgical margins. Residual neoplasia in the hysterectomy specimen was more frequent when margins of the cones were involved by atypical epithelium and in cases with signs of HPV infection. In conclusion, preoperative correct diagnosis of microinvasive cervical carcinoma was not easy and diagnostic conization should be done for correct diagnosis. Patients with a depth of invasion of 3 mm or less without signs of HPV infection and lymphovascular invasion safely can be treated with therapeutic conization. It cannot be overemphasized, however, that when conservative treatment is chosen, a close follow up with cytological and colposcopic control is indispensable.
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윤성도,김택훈,김종인,이정호,배정만,강석선,전효진 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1
Genetic amniocentesis has become established as a widely used tool for the diagnosis of fetal chromosome abnormalities, neural tube defect, and a variety of metabolic disease. This is an analysis of our experience with 1,062 case that have been undergone amniocentesis at Department of Obstetrics and Gynecology, School of Medicine, Keimyung University and Dr Kim`s Ob & Gyn Clinic from Janua ry 1993 to December 1996. High maternal serum alpha fetoprotein(MSAFP) was the most common indication of amniocentesis(31.3%) and the most common age distribution at amniocentesis was 31∼35 years(35.6%). Chromosomal aberration were diagnosed in 66 cases(6.23%) of which numerical aberration was 20 cases(1.88%) and structural aberration was 25 cases(2.35%) with 21 cases (1.97%)normal varients. Autosomal aberration was observed in 15 cases(75%) and sex chromosome aberration was observed five cases(25%). Among the autosomal aberration, six cases of trisomy 21, seven cases of trisomy 18, two cases of trisomy 13 were found. Among the sex chromosome aberration, two cases of Turner syndrome, two cases of Kleinefelter syndrome , one case of triplody were found. Among the structural aberration, 46,XX,t(13:14) Robersonian translocation was the most common( four cases). No complication was found such as preterm labor, fetal death, and neonatal complication. This is a report of a relatively large series of genetic amniocentesis from a single institution, with analysis of the indication, age distribution, results and complication.
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윤기영,조부관,공은희,안수미,김경은,김희정,장문경,이수현,신연명,최경현 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1
Background/Aims: In recent years, intravenous catheters have been used in the hospitalized patients requiring fluids and medications, monitoring of the central venous pressure, and receiving the hyperalimentation. In spite of their usefulness in the management of the critically ill patients, the complications related to the intravenous catheters such as thrombosis, phlebitis, and sepsis have been well known. However, the actual incidence and bacterial pattern have not been well studied. This study was to investigate the difference in clinical way between colonized catheters and catheter-related bloodstream infections. Methods: From January 2004 to January 2005, 89 patients had done central venous catheters(CVC), receiving total parenteral nutrition(TPN) 51 and CVC for venous access 56 patients were included in this study. The patients ranged in age from 49 to 80 years, We evaluated 89 central venous catheterization patients were analyzed for blood culture, fever and catheter tip culture to identify the relationship between infectious complication and various clinical characteristics. Results: TPN formulas, indications of CVC, underlying diseases were associated with highter rates of positivity of blood cultures (P<0.05). Duration of CVC was related to the fever (P<0.05). No significant correlation was observed between duration of TPN and fever or blood cultures. Conclusions: TPN formulas and the duration of catheter dwelling time are associated with bacteremia and fever respectively. But this is more likely to be secondary to underlying diseases. Further study needs to be conducted in order to establish whether infectious complications are more related to TPN via CVC itself.
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