ABO 혈액형과 융모성질환

민보은,박은주,홍희선,이은희,박영미 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.6

본 연구는 G.T.D. 환자의 혈액형 분포에 현저한 차이가 없는 다른 보고와 비슷한 결과를 보여주었으나, G.T.T. 환자의 다른 보고와는 달리 O형으로 shift되는 양상을 보여주었다. 남편 혈액형 분포는 정상과 의미 있는 차이가 없었으나 AB형으로 약간 shift를 보여주었다. 환자와 남편의 혈액형이 같은 like mating은 uncomplicated mole로 되는 빈도가 높고 포상기태임신후에 G.T.T.가 되는 빈도는 낮음을 보여준다. Unlike mating 중에서 가장 중요한 차이는 O X A와 A X O mating중에서 molar G.T.T.의 비도가 높다는 것이다. 그러나 이러한 mating의 환자에서 사망율은 높지않다. AB형인 포상기태임신 환자 중에서 G.T.T.의 빈도는 낮으나 모든 G.T.T.환자 중에서 사망율은 가장 높았다. 포상기태임신 환자에서 만약 남편이 O형이면 G.T.T.빈도가 약간 더 높고, AB형이면 더 낮은 빈도를 보였다. O형의 남자와 결혼한 환자 중에서 사망율 또한 높았고, 이것은 G.T.T.의 사망율이, fully compatible mating일 때 더 높다는 사실을 반영한다. Studies from different parts of the world have reported differences in the ABO blood group distribution among patients with trophoblastic disease and husbands of these patients and some studies have shown definite influences of the ABO blood group on the outcome. The present study is a report on blood group and mating pattern distribution among 641 patients with hydatidiform mole and husbands of 493 of these patients. The influence of blood group and mating pattern on the prognosis of hydatidiform mole outcome was known in 474 of these patients including 385 in whom the husbands blood group was known . The same study was done on 58 patients with non molar gestational trophoblastic tumor and 25 husbands of these patients. The results were as follows: 1. In patients with G.T.D. there was no marked difference in the distribution of blood groups but in patients with G.T.T. there was a shift towards group O. 2. The distribution of blood groups among the husbands showed some shift towards group AB. 3. There was a decreased incidence of G.T.T. following hydatidiform mole in patients mated with men of the same blood group. 4. Among the unlike matings there was an increased incidence of molar G.T.T. among O x A and A x O matings. However the mortality rate in these patients was not raised. 5. There was no difference in the incidence of G.T.T. between fully compatible and possible incompatible matings but there was a higher mortality rate when the mating was fully incompatible.

임신성 융모성 종양에서 Methotrexate 단일 항암화학요법시 약제 내성의 발생에 대한 분석

민보은,김정혜,김경서,안현숙,박치희 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

1983년 1월부터 1992년 12월까지 일신기독병원에서 단일 항암화학요법인 MTX 및 folinic acid로 치료했던 임신성 융모성 종양환자 87명중 80명을 연구대상으로 그 병력지를 분석하여 약제내성발생을 에측하는 인자를 알아보았다. 1. 60명중 WHO의 예후점수제에 따라 분류하면 저위험군은 72명이고 고위험군은 1명이었다. 약제내성은 저위험군 환자 72명중 22명(30.6%)에서 발생하였고 중등도 및 고위험군은 환자 8명 모두에서(100%) 발생하였다. 2. 약제 내성의 발생과 관련하여 예측하는 인자들로서 분석되어진 인자군은 A;WHO의 위험인자점수, B;예후점수제에 사용된 각 예후인자들, C;선행하는 포상기태 임신과 관련된 3개의 인자들, D;과거의 산과력과 관련된 인자들 및 그외이다. 3. 약제 내성의 발생을 예측하는 의미있는 인자들로서는 위험 인자점수가 5이상, 치료전 HCG 치가 10^4 mIU/ml초과, 종양크기가 3 cm이상인 경우였다. 4. 중등도 및 고위험군 환자는 비포상기태 임신의 경우를 제외한 모든 환자에서 약제 내성이 발생하여 100% 내성 발생율을 보였고 저위험군에서는 위 2개의 예측인자가 각각 혹은 병합하여 존재할 경우 10명중 8명(80%)에서 내성이 발생하여 높은 유의성을 보였다. 5. MTX 및 folinic acid 단일 항암화학요법은 중등도 위험군 이상에서는 적절치 못한 것 같으며 저위험군에서 위 세개의 예측인자중 어느 하나가 존재하거나 혹은 두개 인자 모두 존재할 경우 약제 내성발생의 확실한 가능성이 논의 되어져야 할 것이며 처음부터 복합항암 화학요법치료가 고려되어야 할 것으로 사료된다. MTX with Leucovorin rescue as a single drug treatment for G.T.T. causes complications, is usually adequate but drug resistance occasionally occurs. This is a report of a study done in 80 consecutive patients (pts) treated with MTX between 1983 and 1991 at Il Sin Christian Hospital, Pusan to see if predictive factors for the development of the drug resistance could be identified. According to the 1983 WHO prognostic score 72 pts were low risk, 7 medium and high risk. Durg resistance developed in 22/72 pts (30.6%) low risk pts and in all of the medium and high risk pts. Factors analysed as possible predictive factors for developing drug resistance were total prognostic score, the seperate factors of the prognostic score, factors related to the preceeding mole, size of uterus at start of chemotherapy and factors relatd to previous fertility. The most significant factors associated with a higher risk of resistance were WHO prognostic score 5 and over, 8/8 pts(100%), HCG titer$gt;10^4 mIU/ml, 12/15 pts(85.7%), tumor size 3 cm and over, 8/8 pts(100%), and less commonly a preceeding non molar pregnancy 2/3 pts. Among the 8 medium & high risk pts the preceeding preg. was non molar in 2 pts and of the remaining 6 pts all had at least 1 of the 2 predictive risk factors and 5/6 had both of these factors. These results emphasise the reliability of the WHO prognostic score in selecting pts who need multiple therapy and also that MTX alone is usually inadequate in these pts. Among the low risk pts if either or both of these factors were present, 80% of pts (8/10) developed drug resistance compared to 22.6% (14/62) if neither factor was present.

무뇌아 임신 137 례의 산과적 고찰

김혜숙(HS Kim),김성이(SY Kim),전정희(JH Jeun),민보은(BE Min) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.3

본 일신기독병원에서 1973년 1월 1일부터 1984년 12월 31일까지 12년동안 분만한 총 77,485명에서 나타난 무뇌아 임신 137레에서 관찰된 결과는 다음과 같다 1 무뇌아의 발생빈도는 출생아 1,000에 대해서 1 8이다 2 40세 이상의 고령산모에서 무뇌아 발생빈도가 높다 3 출산 횟수와 무뇌아 발생빈도 사이에는 관계가 없다 4 태아의 위치는 안면위와 둔위가 현저히 많은 빈도를 보였다 5 무뇌아는 여아에서 높은 발생 빈도를 나타냈다 6 산과적 합병증으로 양수과다, 견갑난산, 지연분만, 과숙임신이 증가했다 7 무뇌아의 재발률은 1,000분만당 43이다 This report was based on 137 cases of anencephaly among 77,485 total births at Il Sin Christian Hospital during the period between Jan 1, 1973 and Dec 31, 1984 1 The overall incidence of anencephaly was 1 8 per 1000 births 2 The incidence of anencephaly was higher when the maternal age was 40 and over, but there was no relationship between parity and incidence of anencephaly 3 The diagnosis of anencephaly was made during or after delivery in 40% of the cases, almost all of the these patients being emergency admissions In 60% the diagnosis was made during the antenatal period but of these patients 50% were already at or postterm 4 There was a significant increase of face and breech presentation compared to the overall hospital incidence: 19 4% compared to 0 1%(p<0 005) and 12 7% compared to 6 4% respectively 5 There was a reversal of the usual sex ratio of M:F=0 93 to a preponderance of females to give a ratio of M:F=1:1 23 6 These was significant increase in some obstetric complications both during pregnancy and labor or at delivery compared to the overall hospital incidence The complications with an increased incidence were hydramnios 40 2% compared to 0 3%, postmaturity 24 1% compared to 6 6%, prolonged labor 13 9% compared to 4 3% and shoulder dystocia 5 8% compared to 0 1% 7 There was a significant increase in incidence of anencepalic pregnancy 43/1000 deliveries in the next 93 viable pregnancies after the initial anencephalic pregnancy Early diagnosis of anencephaly and termination of pregnancy could be of great benifit to the mother by reducing obstetric complications and psychological stress

Rh 음성 산모의 문제점

송혜섭(HS Song),장애숙(AS Chang),김정혜(JH Kim),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

1976년 1월 1일부터 1980년 7월 31일까지 일신부인병원 산부인과에서 분만한 Rh 음성 산모 43명과 53회의 임신으로 출생된 55명의 신생아를 대상으로 Rh 음성이 산모와 태아에 미치는 영향을 비교 관찰한 결과 다음과 같은 결과를 얻었다. 1.28,249명의 산모중 Rh 음성은 43명이었고 53회의 임신으로 그 빈도는 0.19%였다. 2.Rh 면역된 임신 5예에서 그 원인이 수혈에 의한 것으로 생각되는 것이 3예로 가장 많았고 이전의 인공유산에 의한 것으로 생각되는 것이 2예였다. 3.산후 Rhogam을 투여했던 9예에서는 모두 Rh면역이 일어나지 않았다. 4.Rh 음성 산모의 산전관리에서 Rh 항체역가치에만 의존하지 말고 양수천자에 의한 빌리루빈치의 측정이 필요한 것으로 생각되었다. 5.Rh 음성이 산모에 미치는 영향으로써 산후출혈 후 혈액공급이 어려운 것이었고, 분만전에 가족의 광범위한 혈액형 검사로 Rh 음성 혈액의 준비가 필요한 것으로 사료되었다. 6.Rh 면역된 신생아에서 주산기 사망은 없었으나 빠른 빌리루빈치의 증가가 나타남으로 제대혈액으로 혈액형, 혈색소치, 빌리루빈치, 직접쿰수치의 측정이 필요하고 출생 후 면밀한 관찰과 적극적인 처치가 요구된다. 53 pregnancies in 45 Rh neg. women who were delivered between Jan. 1st 1976 and July 30th 1980 in Il Sin Women`s Hospital were reviewed and following results were obtained. 1.The incidence of Rh neg. women among a total 28,249 patients was 0.19%. 2.5 patients were immunized. In 3 patients the immunization was probably due to previous transfusion of Rh positive blood and in 2 cases the immunization followed previously induced abortions. 3.The use of Rhogam after delivery, abortion, ectopic or possible placental trauma in the non-immunized patient prevents immunization and reduces the neonatal problem.In this series 9 patients who had been given Rhogam after previous delivery Rh immunization was not present. 4.In the management of pregnancy in a Rh negative women not only the Rh antibody titer but also amniocentesis with bilirubin absorption curve is required. 5.Danger to the mother was difficulty in obtaining Rh negative blood for transfusion after severe P.P.H. It is important to check blood grouping of many of the relatives as possible in order to have rapid collection of Rh negative blood when necessary. 6.There were no stillbirths or neonatal deaths, but 4 babies required exchange transfusion due to rapid increase of serum bilirubin. To lower the perinatal morbidity the cord blood needs to be examined in detail followed by close observation with active treatment if jaundice develops to a certain level.

실험적 지연성 뇌경색과 완성형 뇌경색에서 p53 단백질의 발현 형태의 차이

김한식,박승원,이영배,김영백,민병국 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.6

Further evidence of diel vertical migration of copepods under Arctic sea ice during summer

La, HS,Shimada, K,Yang, EJ,Cho, KH,Ha, SY,Jung, J,Min, JO,Kang, SH,Ha, HK Inter-Research 2018 Marine ecology progress series Vol.592 No.-

<P>We examined diel vertical variability of acoustic backscatter under sea ice during the midnight sun season at high latitude in the Canada Basin of the Arctic Ocean. Acoustic backscatter demonstrated that the dominant Arctic copepods (Calanus hyperboreus) consistently performed a distinct diel vertical migration (DVM) synchronized with the solar radiation cycle. DVM was mainly observed between 2 distinctive pycnocline layers at 25 and 45 m above the subsurface chlorophyll maximum (SCM) within Pacific summer water. Picophytoplankton (<2 mu m) were mainly distributed within the SCM layer, whereas diatoms (>20 mu m) were above the SCM layer. This indicated that light variation is a potential trigger for the DVM of Arctic copepods under sea ice, whereas the vertical depth of occurrence was primarily controlled by water mass stratification and food. This vertical behavior is significant to understanding how Arctic copepods adjust to their habitats relative to sea ice, water masses, and food sources in the dynamic environmental changes in the Arctic Ocean.</P>

거대 자궁근종의 1예

민부기(BG Min),최경숙(KS Choi),김학수(HS Kim),노옥균(OK Rho),구병삼(BS Koo) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.12

A case of huge multiple leiomyomatosis of uterus with secondary degeneration which was encountered in 41 year old nulliparous woman(nun) is reported and literatures concerned are reviewed briefly.

생쥐의 착상전 배아에 있어서 카드뮴독성에 대한 항산화제의 영향

김기석,민부기,홍기연,김흥곤,이희섭,이봉주,박승택 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

In order to elucidate the mechanism of oxidative damage of cadimu(Cd) on cultured mouse preimplantation embyors. The embryotoxocity of Cd was examined after cultured mouse preimplantation embryos were exposed to various concentrations of CdCl2. In addition, the protected effect of antioxidant, catalase against Cd-induced embryotoxicity was investigated. CdCl2 decreased the development of cultured mouse preimplantation embryos in dose and time-dependent manners, and also oxidative damage was involoved in Cd-induced embryotoxicity in mouse preimplantation embryos by the prevention of catalase on Cd-induced toxicity.

폐경 전 단순자궁적출술이 골밀도에 미치는 영향

김기석,민부기,홍기연,김흥곤,이희섭,이찬근 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

전북 지방에서 살고 있는 50세에서 60세까지의 폐경된 여성을 대상으로 신체적 조건이 비슷한 폐경 전 난소를 보존한 자궁적출술을 받은 여성 50명과 자궁을 보존한 자연폐경된 여성 50명을 선별하여 요추, 대퇴골, 전신 골밀도를 측정하여 다음과 같은 결과를 얻었다. 1. 폐경 전 단순자궁적출을 받은 여성 50명의 평균 연령은 56.2세, 평균 신장은 152.3 cm, 평균 체중 은 59.4 kg, 평균 체지방은 35.4%이었다. 자궁을 보존한 자연폐경군의 평균 연령은 55.8세, 평균 신장은 153.0 cm, 평균 체중은 60.4 kg, 평균 체지방은 35.6%이었다. 2. 이들에 대한 검사 항목은 Serum estradiol, Serum FSH 및 골밀도이고 골밀도는 요추(L2-4), 대퇴경부, 대퇴전자, 대퇴전자간, Femoral Ward`s triangle, 대퇴근위부, 전신골밀도를 측정하였다. 3. 골밀도 측정 결과 폐경 전 단순자궁적출술을 받은 군에서는 요추 8%, 대퇴경부 4%, 대퇴전자 9.3 %, 대퇴전자간부 2.2%, Femoral Ward`s triangle 9.0%. 근위부 대퇴 6.0%, 전신 골밀도 2%의 골밀도의 감소를 나타냈다. 이상의 결과를 볼 때 자궁을 보존한 자연폐경군 에 비해서 폐경 전 단순자궁적출술을 받은 군에서 전반적으로 골밀도의 감소의 경향을 나타냈으나 이 수치는 통계학적으로 유의한 차이가 아니였으며 이는 더 많은 대상으로 엄격한 환자의 선별과 함께 연 구해야 될 과제이다. Hysterectomy is one of the most common gynecologic surgical intervention, although there are large variation in the frequency both among and within nation. The future function of ovaries retained after premenopausal hysterectomy has been questioned. Several studies have described increased severity of menopausal symptoms and earlier onset of menopause attributed to reduced ovarian estrogen production. Bone tissue is very sensitive to steroid hormones. Estrogen deprivation as seen at the menopause and after premenopausal oophorectomy causes rapid bone loss. Also, minor disturbances in ovulatory function can influence bone metabolism. A reduction in ovarian function after hysterectomy may therefore cause advanced bone loss and increase risk of subsequent osteoporotic fractures. The purpose of this study was to investigate whether premenopausal hysterectomy has an effect on bone mass in women. This study was performed on 50 women who had undergone premenopausal hysterectomy and 50 women with natural menopause 50 to 60 years old. Bone mineral densities in lumbar spine (L2-4), proximal femur, and total body were measured by dual energy x-ray absorptiometry. The women who had undergone premenopausal hysterectomy had generally lower mineral densities in all bone compartment compared with those with intact uterus, apart from 1.2% to 9.3% lower bone mineral densities. In conclusion, premenopausal hysterectomy did not influence bone metabolism significantly, but further study is necessary continuously.

임신 및 분만결과에 따른 경구당부하검사의 분석

김정혜(JH Kim),송혜섭(HS Song),오말례(ML Oh),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 1. 서구인과 비교해 본 저자들의 경구당부하검사는 많은 차이점들 나타내었다. 즉 저자들이 시행한 검사치를 미국인의 것과 비교했을 때 평균치에 있어서 약30~4omg%,2S.D.에서 25~40mg%가 각각 높았다. 그러므로 식생활이 다른 한국인의 임신성 당뇨병 진단에 미국인의 기준치를 적용하는 것은 많은 오류를 범할 수 있다고 생각되므로 좀 더 많은 수의 검사로 한국인의 표준을 정하는 것이 필요하다고 본다. 2. 비정상 임신시 정상 임신에 취하여 비정상 당부하검사를 나타내는 예가 월등히 많았다. 과체중아 분만시에 고혈당치 뿐 아니라 저혈당치의 빈도도 높이 나타났으며 처체중아 분만시에도 고혈당치를 나타내는 빈도가 높았다. 또한 산과력이 나빴던 예에서도 저혈당치를 나타낸 예와 현성당뇨병을 나타낸 예가 많았으며 임신중독증 시에도 고혈당치 뿐 아니라 저혈당치도 높은 빈도를 나타내었다. 3. screening test로써의 single test는 3시간이 의의가 있는 것으로 생각되나 일부의 비정상적인 사람들을 포함하지 못할 수도 있다. 모든 임신부에게 3시간의 single test를 행하는 것이 바람직하나 비정상적인 임신이 기대될 때는 표준당부하검사를 시행하는 것이 좋을 것이다. lt has been wedely recognized that many complications in obstetrics & gynecology are asscoiated with abnormal carbohydrate metabolism. Oral glucose toIerance test is the one of the better tests in diagnsing diabetes mellitus but its value changes depending upon the basic diet, especially amount of carbonhydrate intake. Therefore we thought there may be a difference in glucose tolerance between Western and Korean peoples. Oral glucose tolerance tests were done in 159 control group people, nonpregnant 34, pregnant 59, and postpartum (baby, A.G.A.I.)66, and a group of 389 with abnormali- ties of pregnancy, L.G.A.I.215, S.G.A.I.76, stillbirth unknown cause 22, bad ㅇbstetric history 20, hypertensⅳe disorders in pregnancy 53, and fetal abnormality 3. The results are as follows; 1. There was a marked difference between Korean and American mean oral glucose tolerance test results. This study showed 30~40mg% higher value than American pre- gnancy standard, and 25~40mg% higher in comparing 2 S.D. This study would mean that it would be dangerous if the American standards are used in diagnosis and treat- ment of Gestational Diabetes in Kotea. 2. Abnormal pregnancy showed a more frequent association with abnormai G.T.T. compared to normal pregnancy. Hyperglycemia was associated with L.G.A.I. in 7.9% cases but also hypoglycemia was associated with hyperglycemia. Patients with a bad obstetric history showed 20% hypoglycemia and 15% overt diabetes, but none in the hyperglycemia, not diabetic level. Dypertensⅳe disorders in pregnancy were associated with hyperglycemia as well as hypoglycemia. 3. For singIe Ioading test a 3hr test is probably the best but it would still miss some of the patients with abnormal curves. As a screening test of all pregnant patients the 3hr single loading test could be used but when there is an abnormality of pregnancy it would be adⅵsable to do a full G.T.T.