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만삭 전 조기양막파수 임산부에서의 CRP 측정에 관한 연구
장호성,박학열,이흥관,채진호,신해수,박준철 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7
1996년 6월 1일부터 1996년 12월 31일까지 7개월간 대구 파티마병원 산부인과에 입원한 임신 24주에서 36주 사이의 조기양막파수 임산부 70예를 실험군으로, 같은 재태 기간의 임산부 20예를 대조군으로 하여 만삭전 조기양막파수 임산부에서의 CRP 측정의 의의를 조사하여, 연구한 결과 다음과 같은 결론을 얻었다. 1. 조기양막 파수군에서는 CRP 음성이 74.3% CRP 양성이 25.7%, 대조군에서는 CRP 음성이 95% CRP 양성이 5%로 나타났다. 2. 연령, 분만 횟수, 내원시 임신 주수에서는 group I, group II와 대조군 사이의 유의한 차이가 없었으나, Bishop score에서는 group I 5.5±1.6, group II 6.6±1.7 로 서 두군 모두에서 대조군 3.6±1.0보다 유의하게 높았다. 3. 입원 당시 임산부 혈색소치는 group II에서만 10.6 ±1.3 g/dl로 대조군 11.8±1.1g/dl 보다 유의하게 낮았으며, 백혈구 수치는 group I 11,417.1±2,419.0/ mm3, group II 14,016.7±3,077.1/mm3로 대조군 10,484.5±1,827.2/mm3 보다 모두 유의하게 높게 측정되었다. 4. 임신 지연기간 또한 group I 12.8±10.3일, group II 6.8±7.2일로 대조군의 54.8±17.0일보다 모두 유의하게 짧았다. 5. 분만 형태로는 조기양막파수군에서 질식분만 77.1%, 제왕절개분만 22.9%이었고, 대조군에서는 질식분 만 85%, 제왕절개분만이 15%이었다. 6. 신생아 평균체중은 group I, group II에서 각각 2,245.8±451.6 g, 2,017.8±558.0 g으로 대조군 3,332.0± 394.8 g에 비해 모두 유의하게 적었으며, 분만시 Apgar 점수에서도 1분 Apgar점수는 group I, group II 모두 대조 군보다 낮았지만, 5분 Apgar 점수는 CRP 양성인 group II 에서만 대조군보다 유의하게 낮게 나타났다. 주산기 이환 및 사망률은 group I이 9.62%, 7.69%, group II가 22.2%, 16.7%로 대조군의 5%, 0%보다 유의하 게 높았다. 7. CRP의 융모양막염의 진단에 있어서의 민감도 및 특이도는 각각 83%, 80%이었다. Objective: To evaluate the role of C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes. Study Design: The study group was comprised of seventy patients who presented to the Taegu Fatima Hospital between 24∼36 gestational weeks who had a diagnosis of ruptured membranes. The study group underwent assay of C-reactive protein in the maternal serum, and divided into two groups by the results of CRP, that is 52 cases of CRP negative PROM patients (group I), 18 cases of CRP positive PROM patients (group II), and 20 cases of intact membranes women as a control group. Outcome measures were the occurrence of preterm delivery, the admission-to-delivery interval, maternal characteristics, fetal body weight, 1min & 5min Apgar score, perinatal morbidity and mortality etc. Statistical analyses were performed by means of ANOVA test and Dunnett`s T-test. Results: 1. The prevalence of positive C-reactive protein in premature rupture of membranes was 74.3%. 2. There were no significant differences of age, parity, gestational weeks at admission between group I, II and control group. 3. White blood cell count of group I, II were significantly higher than that of control group. 4. The delay of time from admission to delivery in group I, II were significantly shorter than that of control group. 5. In perinatal outcomes, the mean birth weight, 1 min/5 min Apgar score of group I, II were significantly lower than those of control group, and perinatal morbidity and mortality of group I, II were significantly higher than those of control group. 6. Chorioamnionitis was found in 6 cases of premature rupture of membranes and the sensitivity and specificity of CRP as a test to predict of pathological placental infection were 83% and 80%. Conclusion: C-reactive protein level is a very sensitive predictor of infectious morbidity in premature rupture of membranes.
김성숙,박영세,장영우,문태식,구자남,전대준,노정석,박준혁,우영주 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7
선천성 안드로젠 불감증이 있으면 제 2차 성징은 여성으로 표현되나 월경이 없다. 이런 현상을 과거에는 고환 여성화 증후군이라고도 하였는데 사실은 남성가성 반 음양으로 유전자형은 남성[XY]이지만 안드로젠 수용체에 문제가 발생하면 결과적으로 여성표현형으로 변한다. X 염색체에 위치한 안드로젠 수용체의 결손은 안드로젠 수용체 발현 정보를 지닌 유전자가 없거나 안드로젠결합부위에 이상이 있음을 의미한다. Amrhein 등의 보고에 의하면 물론 후수용체[postreceptor]의 결손도 동반된다. 항뮐러리언 호르몬의 기능은 정상이어서 난관, 자궁, 질 등 여성 내부생식기는 발육되지 않고 Y염색체 유전자들 또한 정상이므로 복강내 또는 서혜부에 고환이 존재한다. 질은 하부에서 맹관의 형태로 존재하고 액와모나 치모는 없거나 드물게 존재한다. 유방은 어느 정도 발육하나 유두는 성숙되지 못하고 유륜은 색깔이 엷다. 유방발육 시기에 테스토스테론은 분비되지 않아 유방 발육이 억제되지 않으며, 사춘기 이후에는 테스토스테론이 에스트로젠으로 전환되어 오히려 유방 발육은 촉진시킨다. 이들은 유환관증 환자처럼 비정상적으로 키가 크다. Androgen insensitivity syndrome[testicular feminization syndrome] is a rare inherited form of male pseudohermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a blindedly ended vagina, absent uterus, and sparse or absent pubic and axillary hair,1 despite the normal karyotype of this condition in female, despite the normal male karyotype 46 XY.2 A case of complete testicular feminization syndrome is presented with a brief review of literatures.
자궁근종의 약물치료 (GnRH Agonist) 에 대한 효용성에 관한 연구
배동한,장경택,선우재근,최규연,도효신 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1
Forty five women with symptomatic uterine myomas, who had already been treated with GnRH agonist as outpatietns in Obstetrics and Gynecology of Chunan Hospital, S.C.H University from March 1995 to February 1997, were retrospected and analyzed about effect and side-effects of GnRH agonist with the results over statistical method of the pelvic ultras onography and the hormone check level in blood. The clinical study was aslo examined and studied alleviation maintenance of symptoms, degree of regrowth, and its final future for treatment. Used GnRH agonist types were Decapepty1, Leuprolide and Nafarelin, and the results of the study is as follows. 1. Size of uterine myomas of forty two(93.3%) among forty five women treated with hormone for six months showed reduction of volume as 42.8 ± 4.4% of the first-size except three(p < 0.0005). Twenty seven(60%) among forty five women could undergo easy operation and had less complications like bleeding. And the rest fifteen(33.3%) among eiteen women(40%) could get satisfactory effects only with GnRH agonist therapy. We changed GnRH agonist type for the rest three women(6.7%) after six months and it was decided the case that treatment effect was low. 2. There were no significant regression in serum LH and FSH(p > 0.05), but serum Estradiol levels fell significantly 4 weeks after first therapy(148.7 ± 20.5pg/ml to 29.7 ± 19.5pg/ml) till 24 weeks (to 17.9 ± 0.9 pg/ml)(p < 0.005). 3. Clinical symptoms due to uterine myomas decreased or disappeared 4∼8weeks after first therapy. 4. From 4 weeks after the last GnRH agonist treatment, Estradiol level was 25 ± 14.8pg/ml and showed gradual increase, and volume of the reduced myoma uteri increased gradually from 42.8 ± 4.4% at the last therapy to 49.6 ± 2.7% 8 weeks after last therapy(p < 0.005). 5. The most common side effect was hot flush(82.2%) and the others included vaginal dryness(37.8%), fatigue and interest decline(46.7%), headache and insomnia(33.3%). However, symptoms like general weakness weight loss and osterporosis were rare, and there was no case to stop treatment due to these symptoms. And these symptoms were disappeared with resumption of menstruation after the therapy. 6. There were potential advantages of GnRH agonist therapy before myomectomy or total abdominal hysterectomy such as; (1) easier and safer to isolate the myomas; (2) less intraoperative blood loss; (3) less complications after myomectomy or total abdominal hysterectomy. 7. GnRH agonist used in this study includes Decapeptyl, Leuprolide and Nafarelin, and there was no difference for effect and side-effects of each type. Considering the above results, GnRH agonist treatment for myoma uteri is regarded to be effective, but more further study and report is desirable for new hormone replacement therapy to prevent regrowth of myoma uteri after treatment stop and estrogen dependent side-effect in treatment.