중기 임신중단에 있어서 산과적 원인에 대한 연구

김석영 ( Suk Young Kim ),김인규 ( In Kyu Kim ),이국 ( Kook Lee ),박용원 ( Yong Won Park ),조재성 ( Jae Sung Cho ),김재욱 ( Jae Wook Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Objectives; To analyze the clinical causative factors of fetal wastage in the second trimester at Inchon Severance Hospital and to identify the changing pattern of them last 14 years. Methods; During the 14 years(l983-1996) there were 6080 total births with 101 fetal losses comprising 72 stillbirths, 27 termination of pregnancy and 2 neonatal death. The classification of this research was based on a modified Aberdeen classification(Baird & Thomson, 1969) and additional small modification revised by Whitefield(l986). The results of the survey were divided into two periods: namely first 9 years(l983~1991) and later 5 years(l992-1996) to compare the changing patterns of causes. Results; The most common causes of fetal losses in later 5 years were fetal abnormalities(23 losses: 37.1 %). On the other hands, unexplained intrauterine fetal death(17 losses: 43.6 %) in first 9 years. The next most frequent cause was spontaneous preterm labor(22 losses: 23.2 %), followed by maternal disease(10 losses: 10.5 %), hypertension(6 losses: 6.3 %), antepartum hemorrhage(5 losses: 3.1 %), trauma(2 losses: 2.1 %) and intrauterine growth retardation(2 losses: 2.1 %). Losses associated with unexplained intrauterine fetal death tend to decrease in the later 5 years. The most common predisposing factors of spontaneous preterm was the cervical incompetence. Conclusions; With the recent advanced methods for early prenatal diagnosis such as ultrasound, the fetal abnormalities seemed to be one of the commonest causes of fetal wastage. The cervical incompetence causing predisposing factor of spontaneous preterm were increasing and seemed to be the effects of the voluntary abortion for family planning. Although unexplained intrauterine fetal death decline in later 5 years, it has to be investigated these losses through postmortem examination or screening marker at risk of women.

임신 주수에 따른 쌍태아의 태아발육곡선

김석영(Suk Young Kim),김광준(Gwang Joon Kim),김용욱(Yong Wook Kim),이지성(Jee Sung Lee),황병철(Byung Chul Hwang),최유덕(Yoo Duk Choi) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.11

Objective : In order to investigate more accurate patterns of intrauterine growth in twin fetuses, we constructed the twin-specific growth curve based on gestational age in live-born non-anomalous infants. Methods : 563 twin pairs, 1,126 infants delivered between January 1994 and October 1999 were comprised our study population. The newborns were grouped according to gestational age and the median, 10th, 50th, and 90th percentile birth weight for each gestational week were calculated. Curves were plotted for the general population and for each gender and parity and compared with previously reported singleton's growth curve. Results : After 32 weeks gestation, birth weight of twins falls below that of singleton, so that by 38 weeks the 50th percentile for twins falls below the singleton 10th percentile. This difference was also present among all subgroups of twins, such as gender and parity. And the mean birth weight in male twin infant was heavier than in female twin infant throughout all gestational week. Conclusion : The pattern of growth in twin infants differed from those of singleton. We recommend twin-specific growth curve for clinical use in the management of twin gestations.

제왕절개 자궁적출술의 임상적 고찰

김용욱(Yong Yook Kim),김석영(Suk Young Kim),황병철(Byung Chul Whang),이종민(Jong Min Lee),최유덕(Yu Duk Choi),한양석(Yang Seok Han),이지성(Ji Sung Lee),노성혁(Seong Hyeok Noh),김장수(Jang Su Kim),최태행(Tae Haeng Choi),최용민(Yong Mi 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.7

Objective : To study the prevalence, indications, and outcome of cesarean hysterectomy in women delivered at the Gil Medical Center, Gacheon Medical School. Method : This is a retrospective study of all cases of cesarean hysterectomy performed between January 1995 and December 1999. Results : The incidence of cesarean hysterectomy was 0.4% (122/31,481). Cesarean hysterectomy was performed in 100 of 17,829 cesarean sections (0.6%) and in 22 of 13,652 vaginal deliveries(0.2%). The higher the age and the parity of patients, the higher the incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(50 cases, 41.9%), followed by 25 cases of placenta previa with adhesive placenta(20.5%), 14 cases of adhesive placenta(11.5%), 11 cases of uterine myoma with pregnancy(9.0%), 9 cases of uncontrolled bleeding with placenta previa(7.4%), 7 cases of uterine rupture(5.7%) and 6 cases of extension of uterine incision(4.9%). All patients who had cesarean hysterectomy received transfusion from 0 pint to 78 pints. Live births were 115 cases(94.3%) and 3 infants were still birth(2.5%). Four infants were dead during early neonatal period(3.3%), so perinatal mortality rate was 5.7%. The postoperative complications were bladder injury, ureteral injury, febrile morbidity, disseminated intravascular coagulopathy, hematoma, wound disruption, postpartum cardiomyopathy, and vaginal stump bleeding. There was two maternal deaths due to acute, severe hemorrhage and DIC. Conclusion : Cesarean hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. The procedure itself is usually associated with considerable perioperative morbidity. Obstetricians should identify patients at risk and anticipate the procedure and complications.

신 이식후 발생한 악성종양에 관한 임상적 고찰

김용수(Yong Soo Kim),방병기(Byung Kee Bang),김석영(Suk Young Kim),장윤식(Yoon Sik Chang),양철우(Chul Woo Yang),박주현(Joo Hyun Park),김병수(Byung Soo Kim),복현정(Hyun Jung Bok) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Objective: The aim of this retrospective analysis was to study the incidence, clinical course, treatment, prognosis of malignancy in immunosuppressed renal transplant recipients. Methods: The object were 38 cases of cancer that occured in 1,130 transplant recipients between 1969 and 1997 at Kangnam CUMC. Mean follow-up periods was 61.6±41.8 months. The incidence of can- cers was compared to the number expected in age-matched general population. This allows the calculation of a risk ratio. We used international cancer registry for comparison. Results : The incidence of de novo malignancy in 1,130 renal transplant recipients was 3.3% for 5years of mean follow-up period and there was no difference between sex. The most common cancer was stomach cancer in case of male and cervix cancer for female. This distribution was same as general population. The incidence of malignant lymphoma and Kaposi's sarcoma was higher in renal transplanted patients than the general population. Cancers with the most striking increased risk(IR) were lymphoma(IR 167), and Kaposis sarcoma. It took 55 months for the malignant lymphoma to be occurred and it developed faster than other cancer. CsA caused faster breakout of cancer than Aza did. Conclusion: The features of malignancy in renal transplant recipients are different from those of general population.

신 이식 환자에서 B 형과 C 형 간염 바이러스 감염 환자의 15 년간 추적 조사

김용수(Yong Soo Kim),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang),김형욱(Hyung Wook Kim),양철우(Chul Woo Yang),최의진(Euy Jin Choi),최범순(Bum Soon Choi),김석영(Suk Young Kim),김성권(Sung Kwon Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3

목 적 : 신 이식 후 B형과 C형 간염 바이러스 감염에 의한 간질환은 신 이식 환자의 이환율, 사망률 및 생존율 등에 나쁜 영향을 미치는 것으로 보고되고 있으나 저자에 따라서 신 이식의 예후에 미치는 영향은 다르게 보고되고 있다. 저자들은 B형과 C형 간염 바이러스에 감염된 신이식 환자와 간염 바이러스 비감염 환자를 15년 동안 추적 관찰하여 신 이식의 예후에 미치는 영향에 관하여 비교 검토하고자 한다. 방 법 : 1984년 3월부터 1998년 12월 31일까지 가톨릭대학교 의과대학 강남성모병원에서 신 이식을 받은 1,042예 중 HBs Ag 양성군(HBV(+)군) 107예, anti-HCV Ab 양성군(HCV(+) 군) 81예, HBs Ag 및 anti-HCV Ab 모두 음성인(NBNC군) 714예를 대상으로 간질환의 유병율, 임상 경과, 사망률 및 생존율에 미치는 영향을 비교 검토하였다. 대상 환자 중 anti-HCV Ab 가 측정되지 않은 140예는 비교 연구에서는 제외하였다. 결 과 : 추적 기간 동안 환자의 사망률은 HBV(+)군 32.7%, HCV(+)군 9.9%, NBNC군 8.4%로서 HBV(+)군에서 훨씬 높았다. 특히 사망 환자 중 간질환에 의한 사망률은 HBV(+)군 57.1%, HCV(+)군 0%, NBNC군 1.7%로서 HBV(+)군에서 유의하게 높았다(p=<0.001). 5년과 10년 이식신 생존율은 HBV(+)군에서 52.2%와 39.2%, HCV(+)군에서 68.4%와 47.2%, NBNC군에서 86.6%와 65.8%로서 NBNC군에서 타군에 비하여 유의하게 높았다. 5년과 10년 환자 생존율은 HBV(+)군에서 72.0%와 63.9%, HCV군에서 91.8%와 87.3%, NBNC군에서 94.4%와 88.2%로서 HBV(+)군에서 타군에 비하여 훨씬 감소하였으며 HCV(+)군과 NBNC군 간에는 큰 차이는 없었다. 결 론 : HBV(+)군은 다른군에 비하여 신 이식 후 이식신 및 환자 생존률이 현저히 낮았다. 생존율이 낮은 원인은 특히 간질환에 의한 사망률이 타군에 비하여 높기 때문이었다. HCV(+) 군은 HCV(-)군에 비하여 이식신 생존율은 낮았으나 환자 생존율에 큰 차이가 없었다. HCV (+)군의 간질환은 면역억제제의 투여량을 조절하여 간질환의 진행을 예방할 수 있었으며 간질환의 의한 사망을 감소 시킬 수 있었다. Background : The impact of hepatitis B or hepatitis C virus infection on renal transplantation outcome is controversial. The aim of this study is to assess the impact of hepatitis B and hepatitis C infection on kidney transplant over the long-term, 15 years and to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival. Methods : We analyzed 1,042 patients who underwent renal transplantation in period from March 1984 to Dec. 1998 including 107 with positive HBsAg (HBV(+) group), 81 with positive anti-HCV antibody (HCV(+) group) and 714 noninfected recipients (NBNC group). One hundred-forty patients who had not taken ani-HCV antibody screening test were excluded. The prevalence of chronic liver disease, the patient mortality, the patient survival rate and the graft survival rate were evaluated. Results : The patient mortality during the period of follow-up was significantly higher in HBV(+) group(32.7%) than in HCV(+) group(9.9%) and NBNC group(8.4%). The cause of death related to liver desease was significantly higher in HBV(+) group(57.1%) than HCV(+) group(0%) and NBNC group(1.7%). Five year and 10 year graft survival rate were significantly lower in HBV(+) group(52.2 %, 39.2%) than in HCV(+) group(68.4%, 47.2%) and NBNC group(86.6%, 65.8%). Five year and 10 year patient survival rate of HBV(+) group(72.0%, 68.9%) was significantly lower than HCV(+) group(91.6%, 87.3%) and NBNC group(94.4%, 88.2%), but there was no significant difference in the patient survival rate between HCV(+) and NBNC group. Conclusion : Hepatitis B virus infection has a significant deleterious effect on the patient and graft survival of renal transplantation recipients. The poor survival rate was a result of the mortality from liver disorder. Hepatitis C virus infection also has a poor graft survival rate compared to NBNC group, but the patient survial rate is similar to NBNC group.

임산부에서 Hepatitis C Virus 감염에 관한 연구

김용욱 ( Yong Wook Kim ),이종민 ( Jong Min Lee ),김광준 ( Gwang Jun Kim ),이향미 ( Hayng Mi Lee ),김향미 ( Hayng Mi Kim ),김석영 ( Suk Young Kim ),이지성 ( Jee Sung Lee ),이선 ( Sun Lee ),김영진 ( Young Jin Kim ),손영수 ( Young S 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.4

Objective : Our purpose was to estimate the prevalence of hepatitis C virus seropositivity and define the risk factors for HCV infection in a group of pregnant women and the effect of HCV infection to mother and baby at the time of delivery. Methods : From March 1997 to February 1998, 5655 women who delivered over 20 gestational weeks at our hospital were screened for HCV-Antibody(RIA), and the samples of most of HCV-Ab positive cases were analyzed for HCV-RNA by polymerase chain reaction(PCR). We also studied the risk factors for HCV infection, the effect of HCV infection to mothers and neonates at delivery. Results : Of 5655 mothers 25 (0.44%) were HCV-Ab positive, and 20 of HCV-Ab positive mothers were analyzed for HCV-RNA by PCR. Of 20 HCV-Ab positive mothers 12 cases (60%) were HCV-RNA positive. Risk factors significantly more prevalent among HCV-seropositive patients were : a history of habitual intraveneous drug use, a history of smoking, alcohol drinking during pregnancy, having liver cirrhorsis. The proportions who had received a blood transfusion, had a history or ongoing syphilis or were positive for hepatitis B virus surface antigen were not significantly different between seropositive and seronegative women. Liver function test at delivery was abnormal in 4 cases(16%) of HCV-Ab positive group. And the number of abnomal liver function test cases in HCV-Ab negative group were 47(0.83%). This had statistical difference. In neonates at delivery, all 20 neonates of 20 ones having HCV-Ab positive mother were HCV-Ab positive. But only 2 cases of 20 babies were HCV-RNA positive. Conclusion : Mothers who have risk factors such as injecting drug use, smoking, alchohol drinking and liver cirrhorsis, should undergo HCV-Ab testing and quantitative HCV-RNA testing by PCR. More advanced studies about vertical transmission of HCV infection are needed.

혈액 투석 환자에서 투석중 정맥압과 요소재순환율 측정에 의한 동정맥루 협착의 조기진단

김영옥(Young Ok Kim),전희경(Hui Kyung Jeon),박용근(Yong Kun Park),윤선애(Sun Ae Yoon),송하헌(Ha Hun Song),김남일(Nam Il Kim),김용수(Yong Soo Kim),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang 대한내과학회 1998 대한내과학회지 Vol.54 No.6

Objectives: The most cammon cause of vascular access loss is thrombosis, usually caused by venous stasis associated with venous stenotic lesions. Therefore early detection of venous stenosis is very important. We studied the correlation of venous dialysis pressure and urea recirculation ratio to venous stenosis in chronic hemodialysis patients. Methods: Venous dialysis pressure and urea recirculation ratio were measured at extracoporeal blood flow of 200 ml/min thruugh 16 gauge needles within initial 30 minutes in 80 chronic hemodialysis patients. Venography was performed in patients with elevated venous dialysis pressure (>100 mmHg) or urea recirculation ratio (>15%), and if significant stenosis was found, venous dialysis pressure and urea recirculation ratio were reevaluated after percutaneous transluminal angioplasty (PTA). Results: Of the total 80 patients, 30 patients had elevated venous dialysis pressure or urea recirculation ratio. In patients with elevated urea recirculation ratio, venous dialysis pressure was high (102±21 mmHg vs 71±20 mmHg, P<0.001) and the past history of subclavian catheterization ipsilateral to fistula site was also high (39.1% vs 15.8%, P=0.02). There were no differences between two groups in terms of age, sex, diabetes mellitus, duration of hemodialysis, fistula site, and interneedle length. Of the total 27 patients undergone venography, 14 patients (51.9%) had venous stenosis. PTA was performed in 11 significant stenotic lesions in 5 patients and initial success rate of 91% was obtained, After PTA, urea recirculation ratios significantly decreased (16.7±5.9% vs 5.0±3.6%, P=0.01) and venous dialysis pressures slightly decreased without statistical significance (117.4±23.0 vs 99.0±8.9 mmHg, P=0.058). Conclusion: Venous dialysis and urea recirculation ratio seem to be active indicator of venous stenosis and outcome of subsequent percutaneous transluminal angioplasty in hamodialysis patients.

건조기용 열펌프 설계 및 제작

김종률(Jong-Ryul Kim),김용민(Yong-Min Kim),김석영(Suk-Young Kim),이공훈(Kong-Hoon Lee),김욱중(Ook-Joong Kim) 대한설비공학회 2010 대한설비공학회 학술발표대회논문집 Vol.2010 No.11

융단형 위 용종의 내시경적 레이저 치료

김부성(Boo Sung Kim),박석영(Suk Young Park),임계순(Kae Soon Im),김영우(Young Woo Kim),백남종(Nam Jong Baeg),박준철(Jun Chul Park),신호균(Ho Kyun shin),김석영(Suk Yong Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

Adenomatous polyps of the stomach have a well-defined risk for malignancy. As lesions become increasingly seesile and of increasing size, the risk of cancer increases. Recently most peduncleated or small sessile polyps can be removed with an electrocautery snare during gastroscopy. But endos- copic removal of larger sessile polyps or those with abroad pedicle may cause severe bleeding, so such lesions should be removed surgically. We experienced a flat carpet type adenomatous polyp of the stomach. A'e did endoscopic Nd-YAG laser therapy without complications.

임신 중기 양수검사후 태아손실과 관련된 인자

김광준(Gwang Jun Kim),김용욱(Yong Yook Kim),김석영(Suk Young Kim),박찬용(Chan Yong Park),이향미(Hyang Mi Lee),황병철(Byung Chul Whang),이선(Sun Lee),김영진(Young Jin Kim),최승헌(Seung Hun Choi),이순표(Soon Pyo Lee),이종민(Jong Min L 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

Objective: To evaluate factors associated with fetal losses following mid-trimester diagnostic amniocentesis.Methods: 412 pregnancy outcomes following amniocentesis were analyzed for each variables(maternal age, gestational age, indication for the amniocentesis, placental penetration by aspiration needle, needle touch by the fetus, color of amniotic fluid) with statistical methods(student t-test, chi-square test and multiple logistic regression test).Results: Mean maternal age was 31.8±4.9 years, fetal loss rate was increased slightly with the age of the mother. If the indications were abnormally high maternal serum alpha-fetoprotein level, the pregnancy courses after the procedure were worse than other indication groups. In cases of discolored amniotic fluid, the dark brown discoloration made the pregnancy outcome poor. Gestational age at the time of the procedure, penetration of the placenta by the aspirating needle, needle touch during the procedure by the fetus, did not influence the outcomes after the procedure. Conclusion: Maternal age, indication as neural tube defect in triple test and dark brown discoloration of amniotic fluid are associated with fetal losses following mid-trimester diagnostic amniocentesis.