척추후만곡증에 동반된 임신의 임상적 고찰

김승룡(SR Kim),이경구(KK Lee),유중배(JB Yoo),김경태(KT Kim),문형(H Moon),김두상(DS Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

한양대학교 의과대학 산부인과학교실에서는 1977년 1월부터 1988년 12월사이 본원에 입원하 여 분만한 척추만곡증을 동반한 임신 10예를 분석하여 다음과 같은 결론은 얻었다. 1. 동기간중 분만건수는 21790예로 척추만곡증과 동반된 임신의 빈도는 1/2179이었다. 2. 산모의 평균연령운 28.5세, 평균신장은 140.5cm, 체중은 42.3kg이엇으며 초산부 9예, 경산 부 1예였다 3. 척추후만곡증의 부위는 흉추 7예, 흉요추부 2예, 요추 1예였고 원인은 외상 4예, 소아마비 1예, 나머지 5예는 병력상 원인을 알수 없었다. 4. 분만전에 심폐부전을 보인예는 2예로 모두 임신 35주경부터 소견이 있었고, 다른 2예에서 는 임신성고혈압을 동반하였다. 5. 분만시의 임신주수는 평균 39.3주였으며 1예에서는 심부전증으로 인하여 37주에 조산을 하였다. 6. 10예모두 제왕절개술로 분만하였으며 이중 2예에서 고전적제왕절개술을 시행하였다. 7. 출생아의 평균체중은 2730gm이었고 자궁내 태아발육지연은 5예에서 있었다. 8. 분만후 심폐부전이 새로이 발생한 예는 없엇으나 1예는 분만전 발생한 심부전이 회복되 지 않아 8개월후에 사망하였고, 다른 1예는 분만후 2일까지 빈호흡의 증상을 보였으나 호흡 하였다. From January 1977 to December, 1988, 10 cases of pregnancy associated with kyphoscoliosis were experinced at Hanyang Univircity Hospital and their clinical characteristics were analysed. During this period , the frequency of pregnancy associated with kyphoscoliosis was 1 to 2179 delivery. Mean height and weight of mother were 140.5cm and 42.3kg respectively. Affectived sites of spine were thoracic in 8 thoracolumbar in 2 and lumbar in 1, the causes of kyphoscoliosis wer trauma in 4, poliomyelitis in 1, and unknown in 5. The mean duration of disease was 24.4year . Cardiopulmonary decompensation symptoms developed in two patients at neat term and were managed conservatively to delivery. All the patients were delivery by cesarean section between 38 and 41 weeks . The mean birth weight was 2730 gm. Five of 10 babies showed intrauterine growth retardation . Nine patients showed uneventful postoperative course, but one patients who had shown antepartal decompensatory symptom died of cardiac failure 8 months later

보조생식술에서 점수제에 의한 배아의 분류와 이의 임상적 유용성에 관한 연구

김승룡(SR Kim),(Carl Wood) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1

Aims: To study the validity of a scoring system in evaluating embryo quality and predicting pregnancy potential. The scoring system was formulated using morphologic parameters and cleavage rates. Embryos were scored between 0 and 10 according to morphologic criteria and cleavage rate. Materials and Methods: The pregnancy results of 2,371 fresh embryos scored by this criteria and transferred between January 1991 and September 1992 in the Monash IVF Program, Melbourne, Australia were analysed for this study. Results: Analysis of 2,371 fresh embryos scores from 926 consecutive transfers showed that intrauterine and multiple pregnancy rate increased significantly along with increased total score per transfer(p<0.05). Pregnancy rate also increased from 10.7% to 21.6% as the number of embryos with a score of 7 or more(good embryo) increased from 0 to 3(p<0.05). The well-known relationship between the number of embryos transferred and pregnancy rate was also found but this correlation could not seen when all of added embryos were scored less than 7. When all the embryos in a given transfer were scored less than 4(poor embryo), the pregnancy rate was near zero regardless of the number of embryos transferred. Conclusion: This study indicated that an embryo scoring system based on morphologic and cleavage rate criteria could be useful in selecting good quality embryos and predicting the pregnancy rate in an IVF/ET program.

비정상 임신 중기 혈청 태아 당단백치를 보이는 산모에서 태아 염색체 이상의 빈도 및 주산기 예후에 관한 연구

김종호(JH Kim),정성노(SR Chung),김승룡(SR Kim),황정혜(JH Hwang),황윤영(YY Hwang),이춘근(CK Lee),조율희(YH Cho) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

Purpose: The purpose of this study was to investigate the incidence of fetal chromosomal abnormality and perinatal outcome in pregnancy with unexplained midtrimester abnormal maternal serum alpha-fetoprotein (MSAFP) level. Methods: Eighty eight patients with high (> 2.5 MoM) (n=42) or low (< 0.5 MoM) AFP (n=46) but without any abnormal fetal sonographic findings underwent amniocentesis at 14∼20 weeks of pregnancy at the department of Obstetrics and Gynecology, Hanyang university hospital between January 1992 and June 1997. Their chromosomal analyses and perinatal outcomes were reviewed retrospectively. Results: The incidence of abnormal karyotyping was 3.4% (3/88). In high MSAFP group, it was 2.4% (1/42) and in low MSAFP group, it was 4.3% (2/46). Three abnormal karyotypes were 47 XXY, 46 XX inv (9), and 46 XY inv (9). Abnormal perinatal outcomes were found in 20.5% (18/88). In high MSAFP group, one congenital anomaly (2.4%), 2 intrauterine fetal deaths (4.8%), 4 IUGRs (9.5%), 2 PIHs (4.8%), 3 preterm deliveries (7.1%) were found. In low MSAFP group, 1 intrauterine fetal death (2.2%), 2 IUGRs (4.4%), 1 PIH (2.2%), 1 LGA (2.2%) were found. Conclusion: The risk of chromosomal abnomality were increased 4∼7 times in patients with unexplained abnormal AFP level. So, amniocentesis and fetal karyotyping are recommended for these patients. Furthermore, close observation were needed for pregnancy with abnormal MSAFP because perinatal outcomes were poorin this group.

Sertoli-Leydig 세포종양 1 예

김진조(JJ Kim),황정혜(JH Hwang),김승룡(SR Kim),유중배(JB Yoo),김경태(KT Kim),이재억(JA Lee) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.12

Sertoli-Leydig cell tumors belog to sex-cord storomal tumor and account for less than 0.5% of all ovarian tomors but are very interesting from pathologic and clinical point of view. Recently we experienced a stage Ia Sertoli-leydig cell tumor with intermediate differentiation. We present this case with review of related literatures.

정상임신 , 자궁외임신 및 계류유산에서의 Transforming Growth Factor β1 , β2의 발현

황정혜(JH Hwang),김승룡(SR Kim),문영진(YJ Moon),박문일(MI Park),정성노(SR Chung),문형(H Moon),이재억(JA Lee),황윤영(YY Hwang),장세진(SJ Jang),박용욱(YW Park) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

Objectives: This study have demonstrated that transforming growth factor TGF-βs(TGF-β 1 and TGF β2) may play an important role in implantation and also to determine the defferences of in the decidua and placenta between normal pregnancy, ectopic pregnancy, and missed abortion. Methods: We have studied the expression of TGF-β1 and TGF-β2 by immunohistochemical staining method in the decidua trophoblasts of normal early pregnancy, ectopic pregnancy, and missed abortion. Results: In the epithelial cells and decidua, TFG-β1 was moderately expressed in the normal pregnancy and weakly expressed in the ectopic pregnancy. But TGF-β1 was not expressed in missed abortion. In contrast, the epithelial expression of TGF-β2 was moderately in all groups and there are no differences among the groups. And in the decidua, TFG-β2 was moderately expressed in the normal pregnancy and missed abortion and was weakly expressed in the ectopic pregnancy. In the trophoblasts, TFG-β1 was weakly expressed in all groups and TGF-β2 was moderately expressed in all groups that are no differences among the groups. Conclusions: These findings suggest that TGF-β2 may have an important role in decidua during pregnancy, especially normal pregnancy. These could indicate that the presence of troplablast and/or hormonal milieu of normal pregnancy resulted in the expression of TGF-βs, particularly TGF-β1.

클로미펜 저항성 무배란 환자에서의 클로미펜 연장요법의 성공 1 예

고승희(SH Goh),황정혜(JH Hwang),김승룡(SR Kim),문영진(YJ Moon),유중배(JB Yoo),이재억(JA Lee),문형(H Moon),황윤영(YY Hwang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7

Clomiphene citrate is the simplest and least expensive from of ovulation induction therapy. In most cases, women who fail to ovulate in response to maximal doses of clomiphene became candidates for treatment with gonadotropins or pulsatile GnRH. Recently, as an alternative to the use of gonadotropins and ovarian surgery, there are some studies of the effectiveness of extended duration clomiphene among the anovulatory women who were resistant to a standard 5-day course of treatment with clomiphene. We have experienced a case of successive ovulation induction and pregnancy with an extended 10-day course of clomiphene in women with clomiphene-resistant anovulatory disorders and reproted with brief reviews of related literatures.

17-B Estradiol , Medroxyprogesterone Acetate 및 부갑상선 호르몬이 골아세포의 분화에 미치는 영향

조수현(SH Cho),김광진(KJ Kim),김승룡(SR Kim),이재억(JA Lee),문형(H Moon),황윤영(YY Hwang) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

Since the effects of estrogen on osteoblast differentiation were not well known, the effects of estradiol on alkaline phosphatase activity were evaluated in rat osteosarcoma derived osteoblast-like cells(ROS-17/2.8-5) and human osteosarcoma derived osteoblast-like cells(OST). Both osteoblast cells were cultured in DMEM in the presence(+Dex) and absence(-Dex) of 10nM dexamethasone for 6 days. The medium was then replaced with serum free medium containing 0.1% BSA with or without Dex, and incubation continued for a futher 48 hours. it showed that the +Dex cells had higher alkaline phosphatase(ALP) activity than the -Dex cells. 17B-estradiol had significant stimulatory effects on alkaline phosphatase activity in ROS-Dex cells, but inhibitory effects on ROS+Dex cells, OST+Dex cells. Parathyroid hormone(PTH) significantly inhibit the ALP activity in all cells except ROS+Dex cells. 17 B-estradiol and MPA synergistically stimulate the ALP activity in OST+Dex cells. Synergism between 17B-estradiol and PTH have been observed in OST+Dex cells. 17B-estradiol blacked the effects of Dex and PTH while MPA did block the effects of PTH action on ALP activity. Although the effects of hormonal response of osteoblatic cells in cluture depended on species and stage of differentiation of the cells, it could be suggested that 17B-estradiol had direct effects on osteoblast differentiation.

자궁경부암 환자에 있어 telomerase 활성도의 임상측명

조삼현(SH Cho),유중배(JB Yoo),김승룡(SR Kim),김기성(KS Kim),라명재(MJ Ra),김경태(KT Kim),문형(H Moon),황윤영(YY Hwang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

A current hypothesis gaining prominence proposes that activation of the telomerase is necessarey for cells to become immortal, or be capable of proliferating indefinitely. The theory suggersts that that almost all cancer cells must attain immortality for progression to malingnant state and, hence, require activation of telomerase. To assess the role of telomerase in the development of mailignant transformation of the uterine cervical carcinoma, telomerase activeiy was measured by using a recently developed sensitive RPR-based telomerase assay(telomeric repeat amplification protocol; TRAP)in benign uterine condition and invasive uterine cervical carcinoma tissues revealed to be telomerase positive (14/16, 88%) which represents a characteristic 6 bp ladder pattern, while none of the 4 cervical tissues with the nonspecific pathologic findings or just chronic cervictis which were obtained by simple bysterenctomy under the diagnoses of benign myoma or uterine prolapse showed any telomerase actiovity. These findings suggest that this enzyme activity may play a key role in the establishment and progression of the uterine cervical carcinoma. This activity of telomerase may influence from the initial stage of tumorigenesis of uterine cervical carcinoma because poitive findings were noticed from the early stage (stage (i 1a1) to the advanced stage. The results of neoadjuvant chemotherpy which were revealed in final histopathologic specimens following radical hysterectomuy, pelvic and raraaortic lymph nodes dissection (suggestion by Rosen et al,) were one grade IV wiht telomerase poistive, 2 grade III with all positivie, 5grade II with 3 positive 2 negative. The two cases of pelvic lymph node metastasis belong to the group of grade II and their activeities of telomerase were 1 positive and 1negative. The situation of apoptosis induced by antineoplastic chemotherapy has not been related to that of telomerase activeity. Furthemore, the late recurrences has been noticed over 5years follow-up following neoadjuvant chemotherapy and radical surgery for the management of the high risk group of patients (not shown in this study) This measn that the nowday`s regimen for induction tumoricidals may have been operating as dual effects (partial restoring and redamaging) to the cell cycle chekpoint. Therefore if telomerase inhibitor will be applied combined whit the induction chemotherapy, unexpected benefits mignt be obtained for the patient with the advanced uterine cervical carcinoma.

임신성 당뇨병 산전검사에서 50 gm-경구 당부하검사의 의의

박문일(MI Park),김진조(JJ Kim),이정한(JH Lee),김승룡(SR Kim),안유헌(YH Ahn) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

One of the most common metabolic disorders that is complicated by pregnancy is gestational diabetes mellitus (GDM). GDM may be affiliated with various adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Women with GDM are at higher risk for non-insulin dependent diabetes mellitus later in life and are predisposed to dyslipidemia and cardiovascular disease. GDM may also have long-term affects on the offspring. The offspring of mothers with pregestational and gestational diabetes have been found with a higher frequency of obesity in childhood, impaired glucose tolerance or non-insulin dependent diabetes in adolescence or thereafter. The prevalence of GDM in Korean women is 2∼3%, which is similar to that in Caucasian and African-American women in North America. The frequencies of obstetrical complications and adverse perinatal outcomes observed in Korean women with GDM are also similar to those in other reports. Thus, screening of GDM is very important in Korean women. This study was performed to assess the significance of 50 gm-oral glucose tolerance test (GTT) as a screening test of GDM from November, 1994 to September, 1996. The tests were performed during the 24∼28th gestational weeks period. Three hundred twelve patients (235 high risk and 77 control) were entered to this study. The results were as follows. 1. The mean maternal age, gravity and parity in the high risk group were 30.93 6.82, 4.50 2.25, and 0.97 1.11, respectively. The mean maternal age, gravity and parity in the control group were 26.26 4.86, 1.95 1.31 and 0.35 0.72 respectively. No differences were presented between the two-groups. 2. The mean body mass index in the high risk group and control group was 21.23 2.64 and 20.10 2.68 kg/m2, respectively. No significant differences were noted between the two groups. The incidence of obesity in each group was 8.5% and 6.8%, respectively. 3. The mean birth weight of neonates in the high risk group and control group was 3075.0 582.7 gm and 3206.4 428.6 gm respectively. No differences were observed between the two groups. 4. The incidence (43%, 104/235) of positive screening tests (1hr oral GTT>130 gm/dl) in the high risk group was significantly higher than that (26%, 20/77) of the control group. 5. All positive results of 100gm-oral GTT (100%, 19/19) were seen from the patients with positive screening tests (50 gm-oral GTT). 6. All positive results of 100 gm-oral GTT were seen in patients whose levels above 140 mg/dL. No positive results were seen in patients whose levels between 130∼139 mg/dL. In view of the above results, the authors believe that the screening test of GDM, 50 gm-oral GTT, would be preferable for `high risk groups of GDM` only, rather than for `all pregnant women`, at least in Korea.

임신중 합병된 감염성 심내막염 1 예

고은선(ES Koh),이원준(WJ Lee),김승룡(SR Kim),문영진(YJ Moon),황정혜(JH Hwang),이재웅(JW Lee),유중배(JB Yoo),조삼현(SH Cho),황윤영(YY Hwang) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

Infective endocarditis is uncommon complication in pregnant women but it is virtually always fatal if untreated. Therefore, early diagnosis, prompt medical or surgical intervention are essential for favorable maternal and fetal outcome. Recently, we experienced a case of infective endocarditis in a 28 year-old women in 35 weeks gestation who presented prolonged fever, malaise, pain and motor weakness of lower extremites, and petechia. We present this case with brief literature review.