자궁경부상피암의 임상 및 병리조직학적 고찰

강윤석(YS Kang),김태준(TJ Kim),조성욱(SH Cho) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.6

1968년 11월 1일부터 1978년 6월 30일가지 만 9년 8개월동안 고려병원 산부인과에서 취급한 총 50예의 자궁경부상피내암을 임상및 병리조직학적으로 고찰해 본 결과 아래와 같은 결론을 얻었다. 1. 년령별 분포는 40∼44세군이 17예934%)로 가장 많았고, 다음이 35∼39세군의 12예(24%)로 35∼44세군이 과반수 이상을 차지했다. 평균년령은 41.2세였다. 2. 결혼생활기간별 분포는 16∼20년군에 17예(34%)로 가장 많았고 다음이 21년이상군 16예(32%)였으며 평균결혼생활기간은 22년이었다. 3. 평균임신회수는 6.3였고 평균분만회수는 3.5회였으며 분만경험이 없었던 1예는 32세로서 1회의 자연유산경험이 있다. 4. Papanicolous smear가 시행된 43예중 class III가 11예(25.6%), classIV 또는 V가 27예(62.8%)로 abnormal pap smear는 38예(88.4%)였으며 나머지 5예(11.6%)는 가음성인 classI 또는 II로 나타났다. 5. 부인과적인 증상을 호소한 예는 32예(64%)였으며 이중 자궁경부 접촉출혈이 14예(43.7%), 체하(Leukorvhea)가 9예(28.1%), 자궁부정출혈이 8예(25%)의 순이였다. 6. 자궁경부의 육안적 소견은 42예(84%)에서 미란이 있었고 6예(12%)는 정상이었다. 7. 진단방법으로는 대부분 Abnormal pap smear이거나 Punch biopsy에서 상피내암으로 진단된 후 원추형생검에 의해 확진되었다. 8. 원추형생검후 척출된 자궁의 병리학적검사에서 잔유암이 없었던 것이 24예(61.5%)였으며 잔유암이 있었던 것이 15예(38.5%)였다. 9. 치료방법으로는 46예(92%)에서 전자궁척출술을 시행하였으며 1예는 임신을 더 원하므로 원추형생검후 계속 관찰중이다. 나머지 3예는 Punch biopsy 또는 원추형생검후 그 이상의 치료를 거부 하였다. 10. 소정의 치료를 받은 자중 24예(68%)가 6개월에서 5년간 계속 관찰되었는데 아직 재발된 예도 없었고 앞으로 계속 관찰하게 될 것이다. 11. 추가로 상기한 50예의 상피내암 이외에 Punch biopsy에서 상피내암으로 진단되었으나 원추형생검결과 침윤생암으로 확인된 것이 4예 있었고, 원추형생검에서 상피내암으로 진단되었으나 척출된 자궁경부에서 Microinvasion이 나온 것도 2예가 있었다. Fifty patients with intraepithilial carcinoma of the cervix were studied both clinically and pathologically in the Gynecologic ward of the Korea General Hospital, Seoul, from Nov. 1., 1968 to June 30, 1978, and the following results were obtained.

Role of NAD(P)H oxidase in the tamoxifen-induced generation of reactive oxygen species and apoptosis in HepG2 human hepatoblastoma cells

Lee, YS,Kang, YS,Lee, SH,Kim, JA 영남대학교 약품개발연구소 2001 영남대학교 약품개발연구소 연구업적집 Vol.11 No.-

Previously, tamoxiten (TAM) has been shown to induce apoptosis through elevation of intracellular Ca^(2+) in HepG2 human hepatoblastoma cells. In this study we investigated the role of reactive oxygen species (ROS) in the TAM-induced apoptosis, and interrelationship between intracellular Ca^(2+) and ROS. TAM induced a slow and sustained increase in intracellular ROS level. An antioxidant, N-acetlycysteine signlficantly inhibited both ROS production and apoptosis induced by TAM, suggesting that ROS may play an essential role in the TAM-lnduced apoptosis. In a time frame ROS generation followed lntracellular Ca^(2+) increase, and the extracellular and intracellular Ca^(2+) chelation with EGTA and BAPTA/AM, respectively, completely inhibited the TAM-induced ROS production, lndicating that intracellular Ca^(2+) may mediate the ROS generation. Inhibitors of NAD(P)H oxidase, diphenylene iodonium, phenylarsine oxide and neopterine, signlficantly blocked the TAM-induced ROS generation and apoptosis, implying that this oxidase may act as a source enzyme for the production of ROS. These results suggest that non-phagocytic NAD(P)H oxidase may paly a novelroleas a mediator of the apoptosis associated with intracellular Ca^(2+) in HepG2 cells. Cell Death and Differentiation (2000)7,925-932.

폐전이 없이 신장, 비장전이 및 자연 파열을 동반한 융모상피암 1 예

강영식(YS Kang),조정식(JS CHO),황용우(YW Hwang),임광호(KH Lim),김성용(SY Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.3

Choriocarcinoma is a highly malignant, frequently metastatic form of gestational trophoblastic disease. The most common sites of metastatic involvement with trophoblastic tumors are the pulmonary parenchyma and the vagina. But the renal and splenic involvements are rare. Therefore these involvement are rarely detected in asymptomatic patients by clinical examination. We report a case of choriecarcinoma metastasized to the Lt kidney and spleen which was diagnosed 8 months later of loss of follow-up after molar evacuation.

산부인과 수술후 감염의 예방에 있어서 cerfonicid 1 회 투여법과 cefoxitin 다회투여법의 임상 효과에 대한 비교 연구

강순범,이효표,송용상,전혜원,박창수,박노현,이동원 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

1994년 10월 1일부터 1995년 8월 20일까지 서울대학교 산부인과에 입원하여 복식 및 질식 전자궁적출술과 제왕절개설을 시행한 80예를 cefonicid 투여시험군(n=40)과 cefoxitin투여 대조 군(n=40)으로 구분하여 각각 40예씩을 대상으로 예방적 항생제요법의 효과를 비교분석하여 다음과 같은 결론을 얻었다. 1. 감염이환의 빈도 및 추가 항생제를 투여하였던 경우는 시험군이 7예(17.5%)와 대조군이 6 예(15.0%)로 각각의 예방적 항생제요법 성공률은 82.5%, 85.0%였으며 두 군사이에 통계적으로 유의한 차이는 없었다. 2. 감염이환은 시험군은 질구개 봉와직염 2예, 복부 창상감염 1예 및 하부 요로 감염 4예였으며 대조군은 복부 창상 감염 2예 및 하부요로 감염 4예였다. 3. 시험군 및 대조군 모두 요로 감염의 빈도가 가장 높았으나 대부분 무증상 세균뇨이었다. 4. 부작용으로 cefonicid군의 한 환자에서 피부발적이 나타났으나 대증요법으로 소실되었고, 그외 신기능, 간기능 이상을 보인 경우는 두 군 모두에서 없었다. 결론적으로 산부인과 영역에서 수술전 cefonicid 1일 1회 단일 투여법이 수술전 및 수술후 cefonicid 다회 투여법 만큼 효과적이며 안전함을 보였다. 예방적 항생제의 단일요법으로 투 여횟수의 감소, 약물투여비의 감소로 인력 및 시간을 절약할 수 있을 것으로 사료된다. 따라 서 수술전 cefonicid 1일1회 단일 투여법이 경제적이며 효과적인 항생제 치료법으로 확립할 것으로 기대되며 산부인과 영역의 수술의 감염 예방에서 뿐 아니라 유사한 감염위험도를 가진 다른 분야의 수술에도 그 적용범위를 넓힐 수 있을 것으로 사료된다. Eighty patients undergoing abdominal or vaginal hysterectomy for benign diseases and cesarean section were prospectively evaluated. To compare the efficacy and safety of surgical prophylaxis with a single , 1g preoperative dose of cefonicid to those with 2g of cefoxitin peroperatively and postoperatively for a total five doses. Surgical prophylaxis was successful in 33 of 40 (82.5%) patients receiving cefonicid and in 34 to 40 (85.0%) patients receiving cefoxitin . Statistically, there were no differences between the two groups in the rates of febrile morbidity, urinary track infection, and duration of hospitalization. No serious adverse effects were encountered in groups with both drugs . It is concluded that preoperative single dose intravenous cefonicid is as safe and effective as multiple dose regimen of cefoxitin in patients undergoing elective abdominal or vaginal hysterctomy and cesarean section. Preoperative antimicrobial prophylaxis with single dose of cefonicid is considered to provide a cost-effective regimen.

자궁경부암에서 선행보조 항암화학요법의 효과

강순범,이효표,송용상,김재원,박노현,고창원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Neoadjuvant chemotherapy is used as a new therapeutic modality in the treatment of locally advanced cervical cancer, but limited information is available regarding the effectiveness and survival. The aim of this study is to identify the factors concerning chemoresponsiveness and survival, and to evaluate the efficacy of neoadjuvant combination chemotherapy(NAC) for the patients with locally advanced cervical cancer in terms of 2-year disease-free survival (DFS). Between June 1987 and May 1992, 77 patients with bulky or locally advanced cervical cancer(FIGO Stage IB-III) received two or three courses of NAC. Sixty patients were treated with FP chemotherapy regimen consisting of 5-FU 1000mg/m²(day 1~day 5), CDDP 60mg/m²(day 1) and remaining 17 patients received EP chemotherapy consisting of Epirubicin 110mg/m²(day 1), CDDP 60mg/m²(day 1). After chemotherapy, patients were treated with surgery or radiotherapy according to feasibility. The effectiveness of NAC was evaluated for response by using World Health Organization criteria. Factors related to chemores ponse and survival were analyzed. The overall clinical response rate was 61%, which included a complete response(CR) in 16 patients(20.8%) and a partial response(PR) in 27 patients (40.2%). Mass size but none of the other parameters studied(age, stage, histologic type, chemotherapy regimen) was related to chemoresponsiveness. This therapy rendered radical surgery feasible in 58 evaluable cases(75.3%). Pretereatment characteristics were analyzed for response to NAC. Significantly lower response rates(38.2%) and lower 2-year DFS rates(48.7%) were found in stage II or III patients with tumor size more than 4 cm in diameter. Patients achieving CR or PR had a significantly improved 2-year DFS rate compared with those who did not respond. Lymph-node metastases were found after chemotherapy in 34.5%(20/58) of the surgically treated patients and less than 3 lymph node were involved in 10 patients. Pathologic parametrial involvement was found to be the most significant prognostic factor for recurrence. A 2-year DFS of 72% and 48.7% for stage IB-IIA, I IB-III, respectively, was found. According to chemoresponsiveness, these rate was 78% for responders and 31.6% for nonresponders, respectively. Poor chemoresponsiveness and uncertain survival benifits in stage II, III with bulky mass necessitate more effective therapeutic modalities in this group of patients.

Human Papilloma Virus Type 16 양성 유무에 따른 자궁경부암의 임상양상 및 예후인자에 관한 연구

강순범,이효표,박만철,이경희,장윤석,송계용,박상철,박재갑,안기범 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.7

서울대학교병원 산부인과를 내원하여 조직 생검상 자궁경부암으로 진단받은 51예와, 그외의 여성 생식기 암 10예 및 이상소견이 없었던 12예에서 자궁경부조직을 채취하여 HPV 16의 검출을 위한 southern blot 핵산교잡법과 단백질 분해효소의 측정을 통해 다음과 같은 결론을 얻었다. 1. HPV16 DNA는 자궁경부암에서 35.3%(18예)의 양성율을 보였으나 기타의 여성생식기암과 정상자궁경부 조직 소견을 보인 군에서는 전혀 발견되지 않았다. 2. HPV 16 DNA 양성율은 종양의 크기, 세포의 형태, 자궁경부조직 및 자궁방결합 조직의 침윤 정도 및 임파혈관의 침윤과는 유의한 상관관계가 없었으나, 골반내 임파절 전이가 된 군에서 유의하게 증가하였다(p$lt;0.05). 3. 자궁경부암이 있었던 경우에서는 HPV 16 DNA양성군에서 serine protease와 metalloprotease의 활성도가 유의하게 증가하였다(p$lt;0.001). 이상의 결과에서 HPV 16 DNA 양성군에서는 조직침윤성이 높은 것으로 추측이 되는 반면, 자궁경부암의 유발인자로서의 HPV 16의 역할에 대하여는 추후 장기적이고 더 많은 역학적, 분자생물학적 연구가 필요하리라고 사료된다. It is suspected that HPV infections, especially type 16 and 18, influence the biologic behavior of the cervical cancer. This study included 51 cases of biopsy-proven cervical cancer, 10 cases of other genital cancer, and twelve cases of negative biopsy. We have analysed for the presence of HPV deoxyribonucleic acid(DNA)by Southern blot analysis and measured the proteolytic activities of the cervical cancer tissues. Human papilloma virus DNAs were found in 18 of 51(35.3%)women with cervical cancer, but none of women with other genital cancer and negative biopsy. Human papilloma virus 16 positive rate was significantly elevated in group of positive pelvic lymph node metastasis(p$lt;0.05). In cervical tissues of HPV 16 DNA positive cervical cancer group, the activities of serine protease and metalloprotease were increased with statistical significance(p$lt;0.001). The results of this study suggest that the ability of tissue invasion may be high in HPV DNA positives group. But further epidemiological & biological study will be needed to clarify the role of HPV 16 in cervical cancer.

자궁내 피임장치와 동반된 골반 방선균증 3 례

강영순,송승훈,조재현,전명순,김경열,박은찬 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

Actinomyces is a gram positive, anaerobic, non-acid-fast bacterium which is a normal habitant of the skin, oral cavity, tonsil, and gastrointestinal tract, but not of the vagina or cervix of healthy women and its human infection is rare. Pelvic Actinomycosis is chronic, progressive, suppurative, and granulomatous disease caused by Actinomyces israelii. Many reports have indicated the possible association between the pelvic infection caused by actinomyces and the use of intrauterine contraceptive devices. Recently we are experienced three cases of pelvic actinomycosis associated with intrauterine contraceptive devices. We present three cases of actinomycotic pelvic abscess and recent literatures are reviewed briefly.

양성 난소기형종에서 발생한 편평상피세포암 2 례

강정배,김홍배,이근영,강성원,박양서,김기태,허진숙,심정원 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

The dermoid cyst is one of the most common ovarian neoplasm. Due to the wide variety of tissues present derived from all three germ layers, many different types of cancer may be anticipated. Squamous cell carcinoma is by far the most common malignancy. Histogenetically, squamous cell carcinoma in mature cystic teratoma has been considered to arise either from the epidermis or from the respiratory epithelium in a teratoma, although the exact origin remains controversial. The prognosis is generally poor. We experienced two cases of squamous cell carcinoma arising in benign cystic teratoma of the ovary, and report these cases with a brief review of the concerned literatures.

Assessment of fracture risk in patients with axial spondyloarthritis: a case–control study using the fifth Korean National Health and Nutrition Examination Survey (KNHANES V)

Kang, KY,Kwok, S-K,Ju, JH,Hong, YS,Park, S-H Almqvist & Wiksell Periodical Co 2016 Scandinavian journal of rheumatology Vol.45 No.1

여성 난소의 낭선섬유종 1예

강영순,박경희,송승훈,조재현,정상윤 대한부인종양 콜포스코피학회 1994 Journal of Gynecologic Oncology Vol.5 No.3

Cystadenofibroma of the ovary is relatively rare tumor which is histologically characterized by a prominent fibrous tissue component in addition to its epithelial elements. In spite of the obvious histogenesis of this neoplam, it occupies an equivocal position among the various ovarian neoplams. The true incidence of ovarian cystadenofibroma is uncertain but surely low. Ovarian cystadenofibroma is more common than generany believed and that is of an entirely benign nature, necessitating only conservative surgical therapy. We present a case of bilateral ovarian cystadenofibroma arising from ovary, with a brief review of the literature.