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만삭임신 및 만삭전 임신에서 음향자극후 태아심박동 각 변수의 변화
이재억,신호문,박문일,문형,김두상 한양대학교 의과대학 1991 한양의대 학술지 Vol.11 No.1
Various fetal heart rate (FHR) tests including nonstress test (NST) have been used for antepartum fetal surveillance. The test using FHR response to externally applied sound, namely acoustic stimulation test (AST), is currently being used as an alternative tool of NST. However, there were only few reports regarding computerized FHR analysis in the AST. Individual subjective analysis of FHR tracings can be replaced with an automated computerized objective nalysis system and the accurate recording and analysis of FHR records is now possible using personal computers. In this study, the author prospectively analyzed the FHR response after acoustic stimulation using computerized FHR analysis system, HYFM-1. Sixty five normal term and preterm pregnancies entered to this study. After coustic stimulation with 90 Decibedl and 500 Hertz using programmable acoustic stimulator (8031-CPU, 70-120 Decibel of sound intensity level range, 10-10,000 Hertz of frequency range), the changes of baseline FHR, variability, number of fetal movements and loss of signal were analyzed using HYFM-1. In normal term pregnancies, the baseline FHR, variability, and number of fetal movements were significantly increased after acoustic stimulation. In preterm pregnancies, the baseline FHR and variability were also increased significantly exceptnumber of fetal movements, although absolute value of fetal movement was somewhat increased after acoustic stimulation. Using qualitative analysis of baseline FHR, 15 of 43term pregnancies (34.9%) revealed FHR increments more than 15bpm, however there were only 13.6% (3 of 22 patients)FHR increment over 15 bpm in preterm pregnancies. This difference was statistically significant. It would be suggested that the increment of baseline FHR reflect the central nervous system maturation of fetus at least in term pregnancies.
에스트로겐과 활성형 비타민 D의 병합투여가 요추 골밀도에 미치는 영향
조석신,이재억,유중배,황윤영,조수현,문형 대한폐경학회 1996 대한폐경학회지 Vol.2 No.1
Administration of estrogen or vitamin D has been shown to increase bone mineral density in postmenopausal women. To evaluate any added beneficial effects of estrogen combined with vitamine D, 101 postmenopausal attending menopause clinic were allocated into two treatment group; group l,estrogen + progestin(n=72); group 2,estrogen + progestin + 1a-hydroxyvitamin D3 0.5ug/day(n=29). After 1 year of treatment, spinal bone mineral density(BMD) were increased 3.3% in all women. The percent increament of spinal BMD is higher in group 2 than in group 1(244±6.7 vs 5.7±9.8, p$lt; 0.05) and higher in women with osteopenia than normal BMD before treatment(3.4±2.4 vs 8.4±11.2, p$lt;0.05).The percent increasment of spinal BMD correlated with age(group 1; r=0.27, p=0.02, group 2;r=0.41, p=0.02) and menopausal duration in group 2(r=0.45, p=0.01). From the above results, it might be suggested that conbined therapy is more effective in postmenopausal women with osteopenia.
정상 여성의 자궁경앙 환자의 요추 골밀도비교에 관한 연구
김두상,문형,이재억,조수현,엄주명 한양대학교 의과대학 1990 한양의대 학술지 Vol.10 No.1
It has been suggested that the hypercalcemia found in the patients of squamous cell carcinoma is caused by increased osteoclastic bone resorption and decreased bone formation. It is expected that the bone mineral density(BMD) is altered in these patients. But there has been no report concerning measurement of the BMD in the patients with cervical cancer. Using dual photon absorptiometry, spinal BMD was measured in 82 normal women(ages 30-86 yr) and 61(ages 32-82 yr) cervical cancer patients. In normal women BMD correlated well with age(r=-0.708, P=0.l001), and was peak in age 30 to 39(1.26±0.09g/cm²). The annual decrease of BMD from age 40-69 averaged almost 0.014g/cm²(Y=1.855-0.014 X age). But BMD was not correlated with weight (r=0.236, P=0.08) and height (r=0.238, P=0.08). The mean values of BMD of the patients with cervical cancer were similar with those of normal women before age 50 and after 60 years of age, but was significantly reduced (P=0.001) in age 50-59 than that of normal women. There was no difference in the mean values of BMD according to stage of disease. The levels of serum calcium in the patients were within normal limits. From the above results it is suggested that the cervical cancer patients in age 50-59 are high risk group for the development of osteoporosis.
자궁경부암 진단에 있어 세포진 검사의 정확도에 관한 연구
김승룡,조삼현,이재억,황윤영,문형,김경태,고승희 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.2
Background: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. Objective: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. Study design: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, Results: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cervix were not associated. There were no clinical factors that were associated with false-positive rate Conclusion: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyang university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.