구순 구개열 환자의 성장후 측모형태에 관한 두부계측방사선학적 연구

장익준,손우일,송재철,진병로 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

Background: Cleft lip and palate deformity have unknown patterns of maxillofacial growth and development. The maxillofacial growth can be affected either by congenital or environmental factors such as infection and trauma. Surgical repair of cleft lip and palate may interfere the subsequent growth and development of maxillofacial region. The purpose of this study is to evaluate the characteristics of maxillofacial growth patterns in adult cleft lip and palate patients. Materials and Methods: The material for this study consisted of 17 adult male patients with cleft lip and palate. Cephalometric tracing and measurements were done by one investigator. The relationship between 17 cleft lip and palate patients and Korean norms were evaluated statistically Results: There were statistically differences in Na. perpendicular to point A, SNA angle, effective maxillary length, maxillofacial differencial, Wit's appraisal and upper incisor to point A(p<0.01). Pogonion to Na. perpendicular also statistically differed(p<0.05). Other measurements didn't statistically differ. Conclusion: It was evident that in adult cleft lip and palate patients, maxilla was retruded and short. Careful cleft lip and palate repair and treatment are recommended for facilitating normal growth of maxilla.

매복 하악 제3대구치의 외과적 발거에 영향을 미치는 방사선학적 변수

김동현,박성빈,장익준,송재철,진병로 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.3

Purpose : The purpose of this study was to determine radiologic variables affecting extraction of impacted mandibular third molar. Materials and Methods : This study was investigated on 44 consecutive extractions of unilateral impacted mandibular third molars (Male;34, Female;10, Mean age;24.98, Age range;19-35). Fourteen radiologic variables, which were actual value except only one, were evaluated to establish their relation to the operation time. The Pearson correlation coefficient and Stepwise procedures for regression analysis were carried out. Results : Eight variables (depth, angulation, ramus width, relationship to the second molar, distal ramus depth, mesial ramus depth, mesial periodontal ligament width and follicle) showed a statistically significant relation to the operation time(Pearson correlation coefficient, p<0.05) . Two variables, depth and mesial periodontal ligament width, showed the most powerful and just relation to the operation time(r2 = 0.349, p<0.05). Conclusion : This study shows that our results can help general practioner to estimate the operation time of extraction of impacted mandibular third molars by measuring two radiologic variables ; depth and mesial periondontal ligament width.

자궁내막선암의 임상병리학적 고찰

송인철(IC Song) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.2

1. 자궁내막선암의 발생빈도는 전 부인암중 3.8%를 차지하였고 자궁경암에 대한 비율은 1:19.8이었다. 2. 환자의 평균연령은 52세이었고 연령분포는 51~60세에서 가장 높은 빈도를 보였다. 3. 환자의 미경산율은 25% 이었다. 4. 평균 폐경기연령은 49.8세이었고 월경력과의 관계는 폐경기 이후가 50%로 가장 많았고 폐경기가 28.6%, 性성숙기가 21.4%이었다. 5.내과적 또는 부인과적 합병증으로는 불임증 29.2%, 고혈증 16.6%, 자궁근종 및 선근증이 각각 12.2%, 비만 8.2%의 순서이었으며 당뇨병은 1예도 없었다. 6. 자각증상은 불규칙한 자궁출혈이 88.4%이었으며 이중 폐경기 후 출혈이 46.2%로서 가장 많았고, 하복통 및 대하를 호소한 예가 각각 34.6% 이었다. 7. F. I. G. O의 임상분류법에 의하면 제1기 57.8%, 제2기 15.6%, 제3기 15.6%, 제4기 11.7 % 이었으며, Broder`s 분류법에 의한 조직학적 grade는 제1도 54.0%, 제2도 11.7%, 제3 도 23.4%, 제4도 11.7%이었다. 8. 임상적 stage와 조직학적 grade 및 조직학적 grade와 자궁근층침윤은 연관성이 있는 것 으로 추측되었으나 연령과 임상적 stage 및 연령과 자궁근층침윤은 연관성이 없는 것으로 추측되었다. 9. 조직학적 진단으로서는 자궁내막선암이 88%, 선극세포암이 12%이었다. 10. 난소의 병리조직학적 소견은 낭포성변화 30.4%, 피층기질증식 13.0%, 전이성자궁내막 선암과 부난소낭종이 각각 4.2%이었다. 11. 예비적 진단법으로 세포진을 28예중 20예(71.4%)에서 시행하였으며 그 진단적 정확성은 25%이었다. 12. 최종진단방법은 진단적 자궁내소파 50.0%, 부분적 소파 35.7%, 자궁경부의 생검 7.1%, 개복술 및 용종절제술이 각각 3.6%의 순위이었다. 13. 수술요법을 시행한 24예중 복식자궁절제술 및 양측부속기절제술을 시행하였던 예가 16 예(66.6%)로 가장많았고 복식광범위자궁절제술 및 골반임파선절제술을 행하였던 예가 6예(25.0%)이었고 전장기적출술 및 시험개복을 행하였던 경우가 각각 1예(4.2%)이었다. 14. 수술을 시행하였던 24예의 수술후 추적성적은 5년생존율이 확인된 예가 5예뿐이었으며 이는 모두 임상 제1a기에 속하였다. 총괄적인 5년생존율은 례수가 많지 않고 추적불가능한 예가 많아 단언할 수 없다. A Clinico-Pathological study was made on a series of 28 endometrial cancers experienced at the Department of Obstetrics and Gynecology, National medical Center during the period from January 1, 1959 to October 31, 1975. The results obtained were as follows; 1) The incidence of endometrial cancer of all gynecological malignancies was 3.8% and the ratio of the endometrial caner to cervical cancer was 1 : 19.8. 2) Age distribution of endometrial cancer was concentrated on the age group of 51-60 and average age was 52 years. 3) The frequency of nulliparity was 25%. 4) Regarding the menstrual status, a half of all cases occurred in woman beyond monopause, the proportion being 50.0% postmenopausal, 28.6% perimenopausal and 21.4% menstruating. Average age at menopause was 49.8 years. 5) Associated medical and gynecological conditions were as follows: Infertility was noticed in 29.2%, hypertension in 16.6%, myoma and adenomyosis in 12.2% respectively, obesity in 8.2%, and no diabetes mellitus. 6) As to the presenting symptoms, abnormal bleeding was encountered in 88.4%, commonly postmenopausal in 46.2%, and lower abdominal pain and vaginal discharge were in 34.6%, respectively. 7) According to the clinical stage adopted by FIGO in 1970 and histologic grading by Broder`s classification, stage I was found in 57.8%, stage 2 in 15.6%, stage 3 in 15.6% and stage 4 in 11.7%, and grade I was seen in 54.0%, grade II in 11.7%, grade III in 23.4% and grade IV in 11.7%, respectively. 8) Clinical stage, histologic grade and myometrial invasion were seemed to be related to each other such as well differentiated tumors were found relatively in a earlier stage and the greater the degree of dedifferentiation of the cells, the greater the myometrial invasion. 9) Regarding the ovarian pathology, cystic change was found in 30.4%, cortical stromal hyperplaia in 13.0, secondary adenocarcinoma and parovarian cyst in 4.2%, respectively. 10) Vaginal cytology as a preliminary diagnostic procedure taken from 20 cases, over pap class III was found 5 cases (25%). 11) Diagnosis was made by endometrial curettage in 50.0%, fractional curettage of endometrium in 35.7%, cervical biopsy in 7.1% and laparotomy in 3.6%, respectively. 12) All cases were primarily treated by surgery. Regarding the types of operation, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 66.6 %, radical hysterectomy with both pelvic lymphadenectomy in 25.0% and total exenteration and exploratory laparotomy in, 4.2%, respectively. 13) It was very hard to get 5 yesr survoval rate because of insufficient follow-up study. Only 5 cases of stage Ia revealed over 5 year salvage.

난소임신 2 례

송인철,권현옥,손병민,남철,서호성 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.6

저자들은 최근 본 병원 산부인과에서 난소임신 2레를 경험하였기에 문헌고찰과 함게 이를 보고하는 바이다. Ovarian pregnancy is a rare form of ectopic pregnancy. We have experienced two cases of ovarian pregnancy, which are presented with a brief review of the literature.

태아심초음파로 산전 진단된 좌심 형성 부전 증후군 1 례

송찬호,박용원,조재성,이종균,설준희,최인철,한성식 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

저자들은 과거력상 심장 중격 결손증을 여아를 출산한 바 있는 경산부에서 태아 심 초음파를 이용 좌심 형성 부전 증후군을 진단하였다. 기술한 바 같이 선천성 심장질환의 과거력이 있는 산모는 심장 이상이 있는 태아를 출산할 빈도가 높으며, 좌심 형성부전 증후군의 재발 빈도도 높다. 심 초음파는 심 이상을 산전에 진단하는 유용한 방법으로 사용되고 있다. 특히 좌심 형성 부전 증후군은 임신 중반기에 높은 정확도로 산전에 진단 가능하며, 되도록 빠른 시기에 진단 임신 중절을 고려 산모의 합병증을 최소화할 수 있으며 임신 지속기는 태아의 예후를 향상 시킬 수 있다. 이에 저자들은 임신 26주에 좌심 형성 부전 증후군을 산전 진단하여 임신을 종결시키고 부검소견으로 상기 질환을 확진하였기에 문헌고찰과 함께 보고하는 바이다. We prenatally diagnosed hypoplastic left heart syndrome, generally regarded as a lethal congenital heart defect. A 30-year-old multiparous woman was referred for fetal echocardiography at 26 gestational weeks because of an bad obstetric history. She had lost first baby due to ventricular septal defect at 2 monthes age. A fetal echocardiography showed hypoplastic left ventricle with small mitral valve and enlarged pulmonary artery. And so, nosis of hypoplastic left heart syndrome.

임신부의 질세균증 (Bacterial Vaginosis) 이 임신결과에 미치는 영향

송찬호,이국,김세광,박용원,서경,조재성,최인철 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

임신부의 질세균증이 조산 발생, 저체중아 발생 및 조기파막 발생에 미치는 영향을 조사하기 위하여, 산전관리시 내원한 임신 24-32주의 임신부 167명을 대상으로 하여 질세균증 유무를 조사한 뒤 이들 임신부를 추적 관찰하여 임신의 에후를 분석하였더니 그 결과는 다음과 같다. 1. 임신부의 질세균증의 유병율은 18%였다. 2. 산전관리시 임신부의 질내에 Gardnerella 균주가 증가한 경우에는 조산 및 조기파막의 발생이 높았다(p$lt;0.05). 3. 질세균증 점수군별 임신결과를 보면 4-6점의 중간군에서 조산, 저체중아 및 조기파막의 발생이 가장 높았다(p$lt;0.01) 따라서 임신부의 질세균증은 질염이라는 단순한 부인과적 질환이라기보다는, 임신부에 있어서 조산, 저체중아 및 조기파막의 발생의 원인이 될 수 있다는 관점에서 재평가되어야 하며, 앞으로 질세균증의 임신기간중 지속적인 추적관찰 및 임신예후와의 연관성에 대해 보다 많은 연구가 필요할 것으로 사료된다. This study was designed to study the associations between the bacterial vaginosis of pregnant women and the development of preterm birth. 167 pregnant women who visited the antenatal clinic between 24 and 32 weeks of the gestation were included in the study. Bacterial vaginosis was diagnosed using Gram stain of vaginal smear. The study population were observed until delivery without interventions. The incidence of preterm birth, low birth weight and PROM were analyzed according to the presence or absence of the bacterial vaginosis. The results were as follows: 1. The prevalence of bacterial vaginosis of the pregnant women was 18%. 2. Increased Gardnerella among the vaginal flora was associated with the increased incidence of preterm birth and PROM(p$lt;0.05). 3. Bacterial vaginosis were classified by BV score. Intermediate group showed the highest incidence of preterm birth, low birth weight and PROM(p$lt;0.01). The study results suggested that the Bacterial Vaginosis of pregnant could be one of the risk factors developing preterm birth and /or PROM. Further studies will be warranted.

산전유전질환진단에 있어서 임신주수와 그 검사방법에 따른 염색체검사의 유용성에 관한 연구

송찬호,양영호,김세광,박용원,이창훈,장기홍,최인철 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.11

1. 융모막융모검사 및 양수검사의 적응증으로 모성연령증가가 가장 많았으며(36.0%), 융모검사와 양수검사의 적응증이 서로 비슷한 것으로 나타났다. 2. 태아제대혈검사와 태반생검의 적응증은 초음파상에서 태아의 기형이 의심되는 경우가 17예 (89.4%)로 가장 많았으며, 이 밖에도 임신초기, 중기에 이미 검사시기를 놓쳤거나, 양수배양에 실 패한 경우 1예(5.3%), 초음파상에서 자궁내 태아사망이 발견된 경우 1예(5.3%) 등이 있었다. 3. 태아염색체이상은 총 364예중 12예(3.3%)에서 발견되었고, 유형별로는 Turner 증후군(45, XO) 1예, Down 증후군 4예(47,XX,+21;47,XY+21 1예 ; 46,XY, -14,+t(14q21q)각 2예) Kleinefelter 증후 군 (47, XXY) 1예, Edward 증후군(47,XY,+18) 1예, 47, XY, t7 1예, 46 XY, -15+der(15)t94:15)(q27:p11) 1예, 46,XY, t(13.17) (p12) 1예, 46, XY, t(4:22) (p14:11) 1예로 나타났다. 4. 부모의 평형전좌 보인자가 적응증이 되는 5예의 검사결과 2예(40%)는 부모와 같은 핵형의 평형 전좌였고, 1예 partial trisomy 4q, 2예는 Down증후군(1421 전좌형)이었다. 5. 태아손실률은 융모막융모검사 174예중 5예(2, 9%), 양수검사 170예중 1예(0.6%)나탔났다. 이상과 같은 결과를 종합하여 보면 유전질환의 적응증이 되는 고위험군 임산부는 임신주수에 상관 없이 어느시기에서나 염색체검사가 가능하므로, 염색체이상에 의한 기형아의 출산을 예방할 수 있어 사회적으로 유전질환의 발생빈도를 감소시켜 건강한 사회를 만드는데 크게 기여할 것으로 사료된다. The increasing incidence of congenital malformations and anomalies today is giving rise to heightened awareness and interest. The diagnostic modalities currently available include chorionic villi sampling (1st trimester), amniocentesis (2nd trimester), cordocentesis, placenta biopsy (2nd, 3rd trimester) and etc. This study aims to demonstrate the effectiveness of chorionic villi sampling, amniocentesis, cordocentesis and placenta biopsy in the prenatal detection of chromosomal anomalies according to the gestational ages of the fetuses, and was conducted from January 1985 to July 1990 at Yonsei University, College of Medicine. Three hundred and sixty-four cases (175 cases of chorionic villi sampling, 170 cases of amniocentesis, 19 cases of cordocentesis and placenta biopsy0 who had underwent prenatal cytogenetic studies according to their gestational ages were selected for subjects. Analysis of indications, fetal karyotypes and fetal outcomes were performed. The indications for chorionic villi sampling and amniocentesis wer 39.7% and 32.3 for advanced maternal age, 22.8% and 28.8 for previous chromosomal abnormality, 20.1 % and 21.2% for previous congenital anomaly of the fetus respectively. The indications of cordocentesis and placenta iopsy were 94.7% for suspicious ultrasound findings and 5.3% for late booking or unsuccessful amniotic fluid cell culture respectively. Abnormal fetal karyotypes were obtained in 12 cases (3.3%). The cytogenetic results of 5 cases with parental balanced translocation were same as the parental karyotypes in 2 cases, 1 case of partial tirsomy and 2 cases of Down Syndrome. Fetal loss rates were 5/175(2.9%) in chorionic villi sampling and 1/171 (0.6%) in amniocentesis. Therefore, we hope to make it possible to apply these modalities to high-risk pregnancies regardless of the gestational ages and thus reduce the incidence of congenital anomalies.

소아에서 편도 및 아데노이드 적철술 후 비음도의 변화

김익태,송상윤,장기현,전진형,김형종 대한이비인후과학회 2000 대한이비인후과학회지 두경부외과학 Vol.43 No.6

비기능성 후복막강 부신경절종 1 예

송인철,이재호,김철범,양희동,장병곤,구본상 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 최근 지방공사 부산의료원 산부인과에서 하부 후복강내에 발생한 비기능성 부신경절종 1예를 치험하였기에 문헌 고찰과 함께 보고하는 바이다. Paraganglioma of the organ of Zuckerkandl is a rare retroperitoneal tumor that arises from the para-aortic paraganglioma around the origin of the inferior mesenteric artery. Because of relatively indolent growth characteristics and no reliable histopathologic features distinguishing malignant paraganglioma, complete surgical resection and prolonged follow up are indicated. Surgery should be aimed at complete removal, since adjunctive radiotherapy and chemotherapy can only be considered palliative measures. We present a case of paraganglioma arising from the organ of Zuckerkandl. The patient was 68-year-old woman with the complaint of palpable mass in the left lower abdomen for three years. The mass, measuring 19×16×12 cm and weighing 2500 gm, was completely resected by means of a transperitoneal approach and proved to be a paraganglioma pathologically. We experienced a case of nonfunctional paraganglioma arising in retroperitoneum and report the case with a brief review of the literature.

Methotrexate 투여로 치유한 자궁경관임신 1 례

송인철,김창수,박세준 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

Cervical pregnancy is a rare complication of the gestation in which the ovum implants in the cervical mucosa below the level of the histologic cervical os. The etioloty is unknown, but the surgical damage, abortion and multiparity are suspceted. Because of the profuse vaginal bleeding, hysterectomy usually was done in the management of cervical pregnancy. We report a case of cervical pregnancy which was treated successfully with methotrexate. We used serial beta-human chorionic gonadotropin levels, magnetic resonance imaging, and sonography to diagnose the cervical pregnancy and follow up after therapy. Hysterectomy was avoided, and the patients reprocutvie capability was preserved.