자궁경부 상피내종양 환자에서 종양 표지 물질로서 혈청 SCC항원과 CEA에 관한 연구

박충학,오현양 단국대학교 1998 論文集 Vol.33 No.-

Objective : The objective of the study was to evaluate the efficacy of serum squamous cell carcinoma(SCC) antigen and carcinoembryonic antigen(CEA) as tumor maker in patients with cervical intraepithelial neoplasm(CIN) Study design: We analyzed serum levels of SCC antigen and CEA in 31 patients with the pathologic diagnosis of CIN by conization of the cervix using “Traditional broad deep cone method”from August 1994 to April 1997. Serum SCC antigen level of 2.0 ng/㎖ and CEA level of 5.0 ng/㎖ were determined as cut-off levels. Result : The results were as follows: 1. The mean age was 39.9 year old and the mean gravidity/parity were 3.9/2.6. 2. The mean serum level of SCC antigen in CIN patients was 0.68±0.72 ng/㎖ (0.73 ng/㎖ for mild dysplasia, 0.65±0.42 ng/㎖ for moderate dysplasia, 0.73±0.91 ng/㎖ for server dysplasia and 0.66±0.70 ng/㎖ for carcinoma in situ(CIS)). The positive rate was 9.7%(3/31). 3. The mean serum level of CEA in CIN patients was 1.90±0.75 ng/㎖(1.21 ng/㎖ for mild dysplasia, 1.56±0.45 ng/㎖ for moderate dysplasia, 2.09±1.00 ng/㎖ for severe dysplasia and 1.91±0.71 ng/㎖ for carcinoma in situ(CIS)). The positive rate was 0%(0/31). 4. There were no significant correlations between volume of conization of the cervix and serum level of SCC antigen or CEA in patients with CIN. Conclusion: These results indicate that measurement of SCC antigen and/or CEA have little efficacy considering its love rate of positivity as tumor market in patients with CIN.

急激히 進行된 卵巢 顆粒膜細胞腫 1例

박충학 단국대학교 1997 論文集 Vol.31 No.-

Sex cord-stromal tumors of the ovary are the third most common types of neoplasms that develop in the ovary and account for about 5-8% of all ovarian malignancies. This group of ovarian neoplasms is derived from the sex cords and the ovarian stroma or mesenchyme. Granulosa-stromal cell tumors include granulosa cell tumors, thecomas, and fibromas. Granulosa cell tumor s a low-grade malignacy and accounts for about 2-3% of all ovarian malignancies. Granulosa cell tumors have a prolonged natural history and a tendency toward late relapse, reflecting their low grade biology. I have experienced one case of rapidly progressing granulosa cell tumor with poor prognosis in a 33-year-old woman, which is presented with a review of the literatures.

부인과 골반경 수술의 임상경험

朴忠學 단국대학교 1995 論文集 Vol.29 No.-

The objective of this study is to analyze clinical evaluation of 7 cases who were admitted and treated by pelviscopic surgery at the Department of Obstetrics and Gynecology in Dankook University Hospital from September, 1994 to January, 1995. Today, endoscopy has revolutionized the practice of gynecology. The skills of the gynecologist have been enhanced far beyond anyone's expectations with the creation and utilization of new endoscopic equipments, instruments, video and laser systems, technology, and various surgical procedures. Laparoscopic surgery(pelviscopy) as an alternative to traditional laparotomies has become an important modality in the management of gynecologic diseases. Operative laparoscopy(pelviscopy) is known to have many advantages, compared with laparotomy as follows : reducing unnecessary laparotomy, shortening the operation time, reducing peritoneal adhesion, decreasing the post-operative discomfort, pain, and morbidity, making early ambulation possible, and shortening the period of hospitalization and rehabilitation, etc. Many portion of gynecologic surgery requiring laparotomy will be replaced by pelviscopic surgery in the future. The results were summarized as follows : 1. The mean age of the patients was 30.7 years(25-42 years). The majority of th patients were multipara. 2. The most frequent presenting symptom was a lower abdominal pain in 6 patients(85.7%), followed by amenorrhea in 4 patients(57.1%). 3. Clinical indications for pelviscopic surgery were ectopic pregnancy 4 cases(57.1%), ovarian cyst 2 cases(28.6%), and chronic pelvic pain 1 case(14.3). 4. The types of operation in pelviscopic surgery were salpingectomy 2 case(28.6%), ovarian cystectomy 1 case(14.3%), puncture and aspiration with reduction of torsion 1 case(14.3%), pelvic adhesiolysis 2 cases(28.6%), and diagnostic surgery 2 cases(28.6%). 5. Complications of pelviscopic surgery were 2 cases(28.6%) : acute pelvic inflammatory disease 1 case and right epigastric artery bleeding 1 case. 6. The mean operation time was 90 minutes(60∼120 minutes) and the mean day of hospitalization was 5 days(3∼10 days). In conclusion, this study indicates that pelviscopic surgery is useful treatment modality and has many advantages in benign gynecologic diseases, if properly applied.

天安 및 忠淸地域의 産婦人科 應急患者에 관한 臨床的 硏究

李元起,朴忠學,朴鎭完,許義宗,李昌益 단국대학교 1995 論文集 Vol.29 No.-

The objective of this study is to analyze clinical evaluation of 313 patients in Obstetrics and Gynecology who visited Emergency Room in Dankook University Hospital from June, 1994 to December, 1994 for the purpose of successful and perfect emergency care of the patients in Obtetrics and Gynecology in Cheonan-Chungcheong District in the futrure. Today, the goal of modern obstetrics is the well-being of both mother and fetus. And there are many gynecologic diseases which lead the female patient to emergency room with the chief complaint of severe abdominal pain or vaginal bleeding, etc. We have of emergency patients, clinical characteristics of the patients, the time of patient's entrance in emergency room, the monthly distribution of visit, the crowding day of visit, the distribution of the patients according to living area, the admission rate, and the management of the patients, etc. Followings are the results summarized : 1. The mean age was 29.8 years(range form 10 to 85). The mean number of gravidity and parity were 2.0 and 1.1 respectively. The mean number of abortion and living child were 1.0 and 1.0 respectively. 2. The most predominant monthly distribution of visit were August and December. 3. The admission rate was 48.2% and the discharge rate was 49.5%. 4. Distribution of department was Internal Medicine, Pediatrics, Orthopedics, and Obstetrics & Gynecology, in order. 5. The most crowding day of visit was Sunday(22.0%). The peak time of patint's entrance in emergency room was between 20:00 PM and 24:00 PM(24.3%), and the second peak time was between 16:00 PM and 20:00 PM(21.4). 6. Of 313 patients, 53% were known to live in Cheonan city and Cheonan county. 82.7% were known to live in Chungcheong District. 7. In 151 patients who admitted the ward, 53% were obstetric patients and 47% were gynecologic patients. 8. In 80 obstetric patients of admission, the most common chief complaint was labor pain(76.3%). In 71 gynecologic patients of admission, the incidence of disease was abortion(32.3%), ectopic pregnancy(25.4%), and pelvic inflammatory disease(11.3%), in order. 9. Major operations were performed in 40 patients of 151 admitted patients(26.5%). Minor operations including Dilatation and Curettage were performed in 12 patients(7.6%). 10 In 155 patients of discharge, the incidence of disese was abortion(36 patients), pelvic inflammatory disease(20 patients), false labor(15 patients), and uterine bleeding(11 patients), in order.

상악동 후비공 용종에서 줄기의 경로에 따른 상악동구 전산화단층촬영 소견

이승훈,박동우,이승로,함창곡,이학수,김용수,박충기 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Purpose: We evaluate the pathway of the stalk of antrochoanal polyp on the coronal and axial computed tomography scans (CT), comparing with operative findings. Materials and Methods: Fourteen patients (7∼40 years old, median= 12.5 years old, ratio of male to female: 8/6) with antrochoanal polyp were examined, who took the orbitomeatal unit (OMU) CT including both coronal and axial scans as well as the operation. The CT findings and clinical findings were analyzed for the pathway of the stalk of antrochoanal polyp, comparing with the operative findings. Results: The antrochoanal polyps were mostly located on the left side (12/14, 85.7%) and equally passed through the natural and accessory ostia (7/14, 7/14) in our cases. Those that were passing through the accessory ostium were located more inferiorly and posteriorly, with preserving the natural ostium on CT scans, comparing to those via the natural ostium. However, those passing through the natural ostium had a larger stalk that eroded the uncinate process widely. So each ostium was hardly discriminated on CT scans. Conclusions: The pathway of the stalk of the antrochoanal polyp could be more specifically evaluated on both coronal and axial OMU CT scans. So, it could be more hilpful in the presurgical planning.

Krukenberg종양 3예

진건,박충학 단국대학교 2000 論文集 Vol.35 No.-

Krukenberg tumor is comparatively rate in metastatic ovarian tumor and is almost metastasized from gastrointestinal tract. We have experienced three cases of Krukenberg tumor of the ovary and report this cases with a brief review of literatures.

골반경수술에 대한 임상적 고찰

진건,고경심,박충학 단국대학교 1998 論文集 Vol.33 No.-

In endoscopic gynecology, laparoscopy was developed first as a diagnostic tool and later as an efficacious surgical technique. Operative laparoscopy(pelviscopy) makes minimal incision, minimal postoperative adhesion, low morbidity rate, and early recovering brings short hospitalization with acceptable complication rate. A retrospective study was undertaken to review the spectrum of pelviscopic surgery. The purpose of this study was to assess the scope of pelviscopic surgery on gynecologic disease, and to analyze clinical evaluation and to identify advantages or disadvantages associated with the procedure. 78 cases of pelviscopic operation were performed at Department of Obstetrics and Gynecology in Dankook University Hospital from September 1994 to Jun 1998. The results of this study were summarized as follows : 1. The mean age of patient was 31.2 years, age ranged from 16 to 62 year and the great incidence occurred in 21 to 25 years groups. 2. The mean number of parity was 1.3 and majority of patients were multipara. 3. The most common clinical indication was tubal pregnancy 33 cases(42.3%), followed by ovarian tumor 31 cases(39.7%), myoma uteri 4 cases(5.1%), pelvic adhesions 4 case(5.1%), ovarian bleeding 3 cases(3.8%), CIS of the cervix 2 cases(2.6%), and ectopic IUD 1 case(1.3%). 4. The types of operation in pelviscopic surgery were salpingectomy 29 cases(37.2%), oophorectomy 19 cases(24.4%), adnexectomy 11 cases(14.1%), L.A.V.H. 6 CASES(7.7%), ovarian coagulation 3 cases(3.8%) adhesiolysis 4 cases(5.1%), ectopic IUD removal 1 case(1.3%). 5. Complications of pelviscopic surgery were 5 cases(6.4%) : infection at the puncture site 3 cases, hematoma t puncture site 1 case, arm paresis 1 case. 6. The mean duration of hospitalization was 4.59 days.

Cross Hole Type 비 연삭 밀링 인서트의 가공특성에 관한 연구

김택수,이상민,박휘근,채승수,이충석,손일복,김학규,이종찬 한국공작기계학회 2008 한국공작기계학회 추계학술대회논문집 Vol.2008 No.-

This paper reports some experimental results on the machining performance of non-ground cross hole type milling inserts. Six kinds of milling inserts were manufactured without using grinding process. Machining experiments were carried out to compare the machining performance of non-ground inserts with that of ground ones. The experimental results indicate that the cutting forces and surface roughnesses of machined surface of both ground and non-ground inserts are comparable.

난소의 원발성 유두상 이행세포암 1예

김현준,고재향,박충학 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.1

난소의 원발성 이행세포암은 최근까지 조직학적으로 난소 상피 종양의 독자적인 한 종류로 인식되지 못하고 악성 Brenner 종양으로 분류되어 왔으나 악성 Brenner 종양과는 달리 항암 치료에 좋은 반응을 보이고 환자 생존율이 높은 것으로 알려지면서 하나의 중요한 조직학적 아류(subtype)로 인식하게 되었다. 이행세포암은 요로 상피의잠재력을 갖는 난소의 세포에서 직접 종양이 발생한다고 추정된다. 이행세포암은 조직학적, 생물학적으로 악성도가 매우 높은 종양으로 예후가 극히 불량하여 병기가 낮더라도 낮은 생존율을 보이는 것으로 알려져 왔으며 표준화된 치료법이 없었으나 최근에는 수술 요법과 항암화학요법을 병행 시 예후가 상당히 좋고 높은 생존율을 보이고 있다. 저자 등은 최근 38세 여성에서 그 발생 빈도가 매우 희귀한 좌측 난소의 원발성 이행세포암 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Primary transitional cell carcinoma of the ovary has been only recently recognized, as one of the main types of ovarian carcinoma because of the favorable response to chemotherapy and improved survival of the patient. Histologically, it is distinguished from malignant Brenner tumor only in the absence of benign or proliferative Brenner tumor component. Recent histopathologic reports show that transitional cell carcinoma of the bladder and of the ovary are immunophenotypically different. Primary transitional cell carcinomas are more aggressive than malignant Brenner tumor. However, primary transitional cell carcinomas have a better response to chemotherapy than other types of ovarian carcinomas. We have experienced a very rare case of primary papillary transitional cell carcinoma of the left ovary in a 38-year-old woman and report it with review of literatures.

자궁경부암 선별검진을 위한 PapSure 검사에서 Spiral Brush의 유용성에 관한 연구

송언호,김어진,명나혜,박충학 대한부인종양 콜포스코피학회 2002 Journal of Gynecologic Oncology Vol.13 No.4

2001년 12월 1일부터 2002년 6월 30일까지 만 7개월 간 단국대학교의료원 산부인과 부인종양 Clinic에서 자궁경부암 선별검진을 위한 PapSure 검사를 시행한 환자 중 SpiraBrush Cx_® 검사를 실시한 33예를 대상으로 하여, 기존의 Papanicolaou 세포진 검사의 진단과 SPiraBrush Cx_®)에 의한 Papanicolaou 세포진 검사의 진단 및 최종적인 병리조직학적 진단을 비교, 분석하여 SpiraBrush Cx_®에 의한 세포진 검사가 생검에 의한 조직검사를 대체할만한 유용성이 있는지 그 여부를 조사하기 위하여 본 연구를 시행하여 다음과 같은 결과를 얻었다. 1. 환자의 연령별 분포는 21세에서 70세까지였으며 40-49세 군이 42%로 가장 많은 분포를 보였고, 평균 연령은 45.7세였다. 2. 환자의 평균 임신횟수는 3.6회였으며, 평균 출산횟수는 2.0회였다. 3. 기존의 자궁경부 세포진 검사(Conventional Papanicolaou cytology)상 진단이 음성으로 나온 경우가 19예(57.6%)였고, ASC를 포함하여 양성으로 나온 경우가 14예(42.4%)였다. 자궁경부 형광경진 검사(Speculoscopy)에서는 음성이 13예(39.4%)였고, Suspicious 진단을 포함하여 양성으로 나온 경우가 20예(60.6%)였다. SpiraBrush Cx®에 의한 세포진 검사(SpiraBrush Cx_® Papanicolaou cytology)에서는 진단이 음성인 경우가 8예(24.2%)였고, ASC를 포함하여 양성으로 나온 경우가 25예(75.8%)였다. 4. 병리조직학적 검사의 진단은 음성 12예(52.2%), 저등급 편평상피내병변(Low-grade Squamous Intraepithelial Lesion: 이하 LSIL이라 함) 2예(8.7%), 고등급 편평상피내병변(High-grade Squamous Intraepithelial lesoin: 이하 HSIL이라 함) 3예(13.0%), 편평세포암(Squamous Cell Carcinoma: 이하 SCC라 함) 6예(26.1%)였다. 5. 검사 결과의 양성판정 기준을 세포진 검사의 경우는 ASC 이상으로 하고 조직학적 검사의 경우는 LSIL이상으로 정할 경우, 기존의 Papanicolaou 세포진 검사의 민감도는 63.6%이고 특이도는 66.7%였으며, SpiraBrush Cx_®세포진 검사의 민감도는 90.9%이고 특이도는 33.3%였다. 이상의 결과로 미루어 볼 때 연구 대상의 숫자가 적어서 통계학적인 유의성은 찾을 수 없으나 SpiraBrush Cx_®가 자궁경부암 선별검진에서 생검에 의한 자궁경부의 조직학적 진단을 대체하지는 않는다고 판단된다. 그러나 기존의 Papanicolaou 세포진 검사의 민감도가 63.6%인데 반하여 SpiraBrush Cx_® 세포진 검사의 민감도는 90.9%로 훨씬 더 높았으며 이로 인해 SpiraBrush Cx_® 세포진 검사의 특이도는 33.3%로 훨씬 낮았는데 이는 매우 흥미있는 사실로서 향후 많은 Data로 더욱 연구하여 진위를 구분함이 필요하리라 사료된다. 또한 본 연구에서는 SpiraBrush Cx_® 기구의 강모들이 단단하고 날카로워서 기저막층까지의 조직과 상피층 세포들을 탈락시키면서 많은 출혈을 초래하여 슬라이드 판독에 어려움을 주었고 이는 연구 결과에 지대한 영향을 미쳤으리라고 생각되는 바, 이러한 출혈로 인한 요인을 최대한 배제하기 위하며 향후 SpiraBrush Cx_® 세포를 채취한 후 최신의 자궁경부 세포진 검사법인 ThinPrep Pap Test를 이용하거나 조직표본을 만들기 위한 Cellblock 기법을 사용하여야 한다고 판단된다. Objective : The purpose of this study was to investigate the clinical efficacy of a new stiff bristled spiral shaped brush (SpiraBrush Cx_(??))∼in) PapSure Test for cervical cancer screening, by comparing SpiraBrush Cx_(??) cytologic diagnoses with conventional Papanicolaou cytologic diagnoses and final histologic diagnoses. Methods : This study was performed in Gynecologic Oncology Clinic of Department of Obstetrics and Gynecology at Dankook University Medical Center from December I, 2001 to June 30, 2002. Thirty three cases who underwent PapSure Test (Pap cytology t Speculoscopy) were analyzed. SpiraBrush Cx_(??) Papanicolaou cytologic diagnoses were compared with conventional Papanicolaou cytologic diagnoses and histologic diagnoses as a reference standard. Results : Followings are the results summarized. 1. Age distribution was between 21 and 70. The mean age was 45.7 years. 2. The mean gravidity was 3.6 and the mean parity was 2.0. 3. There were 19 (57.6%) conventional Papanicolaou cytologic diagnoses of Negative, and 14 (42.4%) of Positive including ASC. There were 13 (39.4%) Speculoscopy diagnoses of Negative, and 20 (60.6%) of Positive including Suspicious. There were 8 (24.2%) SpiraBrush Cx_(??) cytologic diagnoses of Negative and 25 (75.8%) of Positive including ASC. 4. There were 12 (52.2%) histologic diagnoses of Negative, 2 (8.7%) of LSIL, 3 (13.0%) of HSIL, and 6 (26.1%) of SCC, according to the criteria of TBS, 2001. 5. For detecting LSIL or worse lesions, conventional Papanicolaou cytologic test yielded sensitivity of 63.6% and specificity of 66.7%. On the other hand, SpiraBrush Cx_(??) cytologic test yielded sensitivity of 90.9% and specificity of 33.3%. Conclusion : SpiraBrush Cx_(??) cytologic diagnosis does not seem to have clinical efficacy replacing the histologic diagnosis by punch biopsy in cervical cancer screening in this study. But further studies using ThinPrep Pap Test or Cellblock techniques with large data will be required and anticipated.