난소에서 Mullerian Inhibiting Substance의 발현

김미란,김장흡,김수평,김진홍,나종구,권동진,강창석,김경미 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Mullerian inhibiting substance(MIS) has been known as a non-steroidal testicular Sertolicell product responsible for the regression of Mullerian duct in male embryos. More recently MIS was also found to be present in an bioactive form in the bovine and rat ovaries but the function of MIS in the ovary has not been fully delineated. In this study, in order to understand its function in the ovary the ontogeny of the production profile of MIS and the pattern of its localization in ovaries from adult normal cycling women were studied by immunohistochemical staining using the rabbit polyclonal antibody against human recombinant MIS that almost completely blocks its biological activity. MIS was detected specifically and exclusively in the cytoplasm of granulosa cells. The flattened granulosa cells in primordial follicles failed to stain for MIS, but the cuboidal cells of growing follicles stained intensely. The granulosa cells of both single and multiple layered growing follicles showed strong specific staining for MIS. Within the multiple layers of granulosa cells, closer to the oocyte, stained more intensely than those near the basement membrane. Similarly, in antral follicles, cumulus cells and periantral granulosa cells stained more intensely than those in the periphery. MIS staining waned in the mature follicles just before ovulation and could not be found in atretic follicles, corpus albicans. In conclusion, this specific localization suggest that MIS may act as an intraovarian regulator of follicular development and oocyte maturation during the adult reproductive cycle.

Anti-Diabetic Effects of DY-101267, A Potent PPARs Agonist

Lee CH,Kim MK,Shin CY,Chae YN,Son MH,Kim JK,Min JP,Moon HS,Kim HJ,Bae MH,Kim SH,Lee JG,Lim JI 대한약학회 2004 大韓藥學會 總會 및 學術大會 Vol.2004 No.2

과립막 세포종의 1례

김진국(JG Kim),김동옥(DO Kim),김량균(YK Kim),한문화(MH Han) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.6

Granulosa cell tumor is one of rare feminizing tumor of the ovary. A case of granulosa cell tumor in 42 year old woman was reported and a brief review of literature on granulosa cell tumor was made.

A Survey on Pesticide Residues of Commercial Agricultural Products in the Northern area of Seoul ( I )

Hwang YS,Kim YS,Lee SD,Hwang KH,Kim GS,Tu OJ,Jung BK,Jung EG,Chung AH,Kim DJ,Jang MR,Yoon.YT,Kim JG,Kim MH,Seo SH 대한약학회 2000 大韓藥學會 總會 및 學術大會 Vol.49 No.-

17 a-Hydroxylase 결핍으로 인한 남성가성반음양 1 예

김장흡,김진홍,나종구,최소영,강창석,김재훈 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

A 21-year-old phenotypic female with 46,XY genotype presented with primary amenorrhea, headache, absence of secondary sex characteristics, and hypertension. Further evaluation confirmed male pseudohermaphroditism having no nterus and adnexase. After basic hormonal study and ACTH stimulation test, we concluded 17 a-hydroxylase deficiency. Owing to the high risk of gonadal neoplasia in XY gonadal streaks, prophylactic removal of the steaks is recommended. Traditionally this procedure has been performed by laparotomy, but in this case laparoscopic gonadctomy was performed. Following treatment with hydrocrtisone, potassium, progesterone, 11-deoxycorticosterone, corticosterone and urinay pregnanediol levels were normalized. normal blood pressure measurements were achieved during treatment with hydrocortisone and estrogen with the patient. We report this case with a breif review of the literatures.

자궁육종 40 예에 대한 임상적 고찰

김병기,박상윤,김종훈,유상영,이경희,이의돈,이은희,이재규,양수진,김창원 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

결론적으로 자궁육종은 조직학적 유형별로 혼합뮬러씨종양이 가장 많았으며 5년 생존율이 가장 좋지 않았다. 자궁육종의 예후인자로서는 진단시 연령과 병기가 유의하였으나 수술 후 보조적인 치료는 생존율에 커다란 영향을 주지 않는 것으로 나타났지만 대상 수가 적어 결론을 내리기에는 제한점이 있어 향후 자궁육종의 예후인자와 보조적인 치료 방법에 관한 전향적 다 기관 연구가 필요하리라 사료된다. Objective: Uterine sarcomas are rare tumors of mesodermal origan and comprise 2∼6% if uterine malignancy. They are the most malignant group of gynecologic tumors and present intriguing problems in regard to diagnosis, and management. The purpose of this study was to investigate the clinicopathologic findings and outcome of patients with uterine sarcoma. Methods: From Jan. 1985 to Dec. 1997, 40 patients with histologically proven uterine sarcoma at Korea Cancer Center Hospital were evaluated for their clinical profiles and survival retrospectively. Results: Malignant mixed m llerian tumor [MMMT] was the most common uterine sarcoma [20/40 cases, 50%], followed by leiomyosarcoma [LMS] [12/40 cases, 30%] and endometrial stromal sarcoma [ESS] [8/40 cases, 20%]. Mean age of these patients was 52 years, and the most common presenting symptom was abnormal vaginal bleeding. There were no statistical differences in stage and presenting symptom, but MMMT was prevalent in older age than LMS and ESS. Most of the patients were treated by surgery followed by post-operative adjuvant chemotherapy or radiation [57.5%], but nine patients [30%] were treated with surgery alone. The overall 5-year survival rate was 37.9%, and MMMT showed worse prognosis than LMS or ESS [17.7%, 52.3% and 75% respectively] [p<0.01]. Age and stage were significant prognostic factors, and adjuvant treatment did not affect the survival of patients. Conclusion: Uterine sarcomas are aggressive tumors with a poor prognosis. The role of adjuvant chemotherapy or radiation still remains undeterimined and further large scaled multicenter studies are needed.

난소과립막세포 스테로이드호르몬 생성 및 증식에 대한 Mullerian Inhibiting substance의 효과

김장흡,이진우,김수평,나종구,김은중,김태응,신재인,제동성 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12

Ovarian follicular growth is a consequence of granulosa cell proliferation, and steroid production by these cells appears to be a major determinant of the endocrine microenvironment of ovum maturation. The gonadotropins, FSH ad LH, regulate directly the growth and differentiation of the granulosa cells in the ovary, but there is evidence to suggest that the gonadotropins act partly through locally produced growth factors and that this interaction is complex. A number of growth factors, such as epidermal growth factor(EGF), insulin-like growth factor-I(IGF-I), and transforming growth factor-β(TGF-β) are produced in the ovarian follicle and might act in an autocrine and/or paracrine manner to directly control granulosa cell proliferation and differentiation. While it has been demonstrated that steroid hormones, gonadotropins and growth factors regulate proliferation and differentiation of ovarian follicles, little is known concerning the fators involved in the inhibition of ovarian function. Recently, Mullerian inhibiting substance(MIS), a non-steroidal testicular Sertoli cell product responsible for the regression of Mullerian duct in male embryo, has been shown to be produced by ovarian granulosa cells in adolescnet and ault females. Although the function of MIS in the ovary has not been fullydelineated, MIS appears to be a regulator of oocyte maturation and follicular development in the rat. In this study, in order to investigate the influence of MIS on steroidogenesis and proliferation of human granulosa cells, we performed culture of human granulosa cells. The cells were cultured for 2 to 12 days under two conditions, with and without MIS(20 ng/ml). Each condition was additionally defined by the presence and absence of EGF(20 ng/ml), FSH(10 ng/ml), or LH (10 ng/ml). Estradiol, progesterone, and testosterone were mearsured form the spent media by radioimmunoassay and the cell number was determined by trypsinizing the cells and counting them with a Coulter counter. The result were as follows: 1. There was about 6-fold increase in the final granulosa cell number when the culture were maintained for 12 days in Ham`s F-10 supplemented with 10% MIS-free female fetal calf serum(control). FSH and EGF caused a significant increase in granulosa cell number compared with the control but LH significantly suppressed cell number after 8 days in culture. 2. MIS caused a significant decrease in granulosa cell number compared with the control after 8 days in culture in the 20 ng/ml dose, and on day 12 in the 2 ng/ml dose(p$lt;0.05). MIS(20ng/ml)also significantly blocked EGF induced proliferation of granulosa cells after 6days in culture and the maximum effect was observed on day 12 of culture(p$lt;0.01). 3. Estradiol production from granulosa cells was significantly stimulated by both gonadotropins, with LH having the greater effect than FSH after 6 days in culture(p$lt;0.05). However, EGF significantly suppressed estradiol production of granulosa cells, but significantly decreased FSH induced estradol production of granulosa cells after 4 days in culture(p$lt;0.05). 4. Progesterone production from granulosa cells was significantly stimulated by both gonadotropins and EGF, with LH having the greatest effect. However, MIS had no effect on basal progesterone production of granulosa cells after 4 days in culture(p$lt;0.05) with havint the greatest effect on day 10 of culture(p$lt;0.01). 5. Testosterone production from granulosa cells was not detected in all conditions. In conclusion, these experiments demonstrate that MIS may have relevant funciton in the ovay as a regulatior of follicular development and steroidogenesis maturation during the adult reprodu-ctive cycle.

임신성 고혈압 환자에서 혈소판과 적혈구 용적비의 변화

김수평,이종건,나종구,이종승,김종호,신재인,김인배 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.10

1993년 3월부터 1995년 3월까지 가톨릭 의과대학 산부인과에 입원하여 분만한 73명의 정상 산모, 16명의 경증 임신성 고혈압 그리고 79명의 중증 임신성 고혈압 환자를 대상으로 임신 성 고혈압의 조기지표로서 RAT1 변화의 가치에 대해 알아보고자 혈소판의 형태변화에 대한 관찰을 함으로써 정상 임산부와 비교하고 간 기능 검사, 신 기능 검사, 자궁내 태아 발육 지 연을 비교, 분석하여 다음과 같은 결과를 얻었다. 1. 평균 혈소판 용적은 정상 임신부에 비해 중증 임신성 고혈압군에서 유의하게 증가하였다(p$lt;0.05). 2. 평균 적혈구 용적은 정상 임신부에 비해 중증 임신성 고혈압군에서 낮은 것으로 나타났으나 통계적으로 유의한 차이는 인정할 수 없었다(p$lt;0.05). 3. 혈소판과 적혈구 용적비는 정상 임신부에 비해 중증 임신성 고혈압군에서 유의하게 증가 하였다(p$lt;0.05). 그리고 또 임신 32주 이후에 중증 임신성 고혈압에 발생했던 7례의 임신 28주이전 의 혈소판과 적혈구 용적비는 0.1004+-0.003으로 정상 임신부의 0.0987+-0.006보다 유의하게 높았다. 4. 혈소판의 정상군 임신부에 비해 중증 임신성 고혈압군에서 유의하게 감소하였다(p$lt;0.05). 5. PDW, RDW, RDW/PDW는 정상 혈압군, 경증 임신성 고혈압군, 중증 임신성 고혈압군에 서 세포간 유의한 차이가 없었다. 6. 임신성 고혈압 임신부에서 분만시 혈소판치가 감소할수록 IUGR분포는 증가하였고 RAT1 이 0.127이상이면 IUGR이 유의하게 증가하였다(p$lt;0.05). 7. 임신성 고혈압 환자에서 분만시 ALT, AST creation치와 RAT1의 관계를 보면 유의한 상관 관계를 보이지 않았고, RAT1이 증가할수록 혈소판수는 감소하는 역상관 관계를 나타냈다(p$lt;0.05). Hematologic abnormalities that accompany preeclampsia and eclampsia have long been recongnized but their clinical significance in the prediction and monitoring remains controvertial. It was noted that the erythrocyte morphologic changes take place in the severe preeclampsia and that it might be caused by altered composition of the cell membrane and microangiopathic hemolysis. The platelet activation followed by its consumption plays an active role in the pathophysiology of this disorder, Increase in platelet size was noted even though platelet count remains within the normal range. In order to investigate the clinical significance of mean platelet volume/mean corpuscular volume ratio(RAT1) in this disorder, RBC platelet morphologic parameters, RAT1 and the correlation between other laboratory and clinical marker and RAT1 were assessed. The results were as follows 1. Mean platelet volume was significantly increased in the servere preeclamptic group compared with normal pregnant controls(p$lt;0.05). 2. There was no significant difference on matermal mean corpuscular volume between normall plrenant controls and pregnacy induced hypertension group. 3. RATI(MPV/MCV) was significantly increased in the severe preeclamptic group compared with normal pregnant controls(p$lt;0.05), and the RATI measureed before 28 week's gestation in woman who developed preeclampsia after 32 week's gestation was signigicantly higher compared with the RATI measured in the same period in woman normotensive at term. 4. The platelet counts were significantly lower in the severe preeclampic group compared with normal pregnant controls(p$lt;0.05). 5. There was no significant difference in maternal platelet distribution width, RBC distribution width between normal pregnant controls and preeclamptic group. 6. There was significant inverse correlation between RATI and platelet counts, and between RATI and intrauterine growth retardation in both mild and severe preeclampic group. 7. There was no significant correlation between RATI and ALT, AST, creatinine in both mild and severe preeclamptic group.

성인 척수내 성상 세포종의 장기 추적 성적

김명수,정천기,김현집,김삼수,최기영,지제근 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.3

임신초기 조기파막 산모의 만삭아 분만 1 례

김수평,김진홍,최장길,김사진,박성모 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.7

저자들은 1988년 9월 가톨릭대학부속 성모병원에서 임신 11주 1일에 절박유산, 고위험임신으로 입원하여 임신 15주 3일에 자궁경관 무력증으로 MacDonald수술을 시행, 수술 5병일째 조기파막이 일어나 196일간의 장기간 입원으로 절대적인 안정가료 및 집중적인 항생제투여와 자궁수축 억제제의 치료로 건강한 정상적인 아이를 분만하였기에 간단한 문헌적 고찰과 함께 보고하는 바이다. Premature rupture of membrane(PROM) represents confusing and controversial dilemas at the time for terminating pregnancy and treatment in Obstetrics today. After PROM, immediate preterm delivery yioios a low-birth-weight infant and prematurity which increase neonatal morbidity and perinatal mortality but, attempt to intrauterine growth, in despire of PROM, increases the risk of infection for the mother and fetus. We experienced a case of successful term delivery in early pregnant woman with PROM and report with a brief review of concerned literatures.