진행된 부인과적 악성종양에 대한 cis-Platinum과 Adriamycin 병합요법의 반응과 독성에 관한 임상적 고찰

김원규(WK Kim),정기묵(KM Chung),정재훈(JH Chung) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.3

1982년 1월부터 1984년 6월말 사이에 고신의대 산부인과에 입원핸 재발성 또는 지속성 자궁경부암 환자 18예, stage Ⅱ 이상의 난소상피암 환자 7예, 그리고 원발성불명 전이성 선암 환자 3예등 총 28예를 대상으로 cis-Platinum 50mg/m2과 Adriamycin 50mg/m2을 2~4주 간격으로 1회 1시간내 혈관내 주입법으로 투약하여 다음과 같은 결론을 얻었다. 1. 약제에 대한 반응을 관찰할 수 있었던 환자는 3회 이상 투약한 경우로 총 14예 였으며 이들은 각각 자궁경부암 7예, 난소상피암 5예, 원발성불명 전이성 선암 2예였다. 2. 전체적 반응도는 총 14예 중 7예로 50%였다. 3. 자궁경부암은 7예 중 3예에서 부분적관해(42.6%)를 보였으며 2예는 약간의 호전만 있었고 나머지 2예는 변화를 보이지 않았으나 투약기간 동안 더 이상 진행되지는 않았다. 4. 난소상피암 환자는 5예 중 2예에서 완전관해, 1예는 부분적관해를 보여 60%의 반응도를 보였고 나머지 2예는 약간의 호전과 무변화로 각각 1예씩이었다. 5. 원발성불명 전이성 선암 환자 2예는 부분적관해와 무변화 각각 1예로 50%의 반응도를 보였다. 6. 자궁경부암, 난소상피암 및 원발성불명 전이성 선암의 모든 예에서 cis-Platinum과 Adriamycin을 투약중에는 더 진행된 예는 없었다. 7. 약제의 독성으로는 골수에 대한 독성은 28예 중 8예로 29%, 신장독성은 28예중 8예로 29%, 심장독성은 28예중 7예로 21%, 위장관독성은 28예중 28예로 100%에서 나타났다. 위의 모든 독성은 환자가 견딜 수 있을 정도였으며 투약후 2주내에 모두 정상으로 회복되었다. Twenty-eight patients with advanced gynecologic malignant neoplasms who had prior surgery and/or radiation and no longer amenable with surgery and/or radiation were treated with combination chemotherapy of cis-Platinum 50mg/m2 and Adriamycin 50mg/m2 from January, 1982 to June, 1983 at the Department of Obstetrics & Gynecology, Kosin Medical College. 1) We evaluated all the 28 patients for toxicity. To evaluate response, we selected 14 patients who were treated at least three courses of chemotherapy, included 7 patients of cervical cancer, 5 patients of ovarian epithelial cancer, 2 patients of metastatic adenocarcinoma of ovary. 2) The over-all response rate 50 percent(7/14). 3) The responses in cervical cancers were 3 partial responses, 2 improvements and 2 stable diseases in 7 patients. The response rate were 42.6 percent(3/7). 4) The responses in ovarian epithelial cancers were 2 complete responses, 1 partial response and 2 improvements in 5 patients. The response rate were 60 percent(3/5). 5) The responses in metastatic adenocarcinoma of ovary were 1 partial response and 1 stable disease in 2 patients. The response rate were 50 percent(1/2). 6) There were no progressive disease in all patients during combination chemotherapy of cis-Platinum-Adriamycin. 7) Toxicity included myelosuppression(29%), nephrotoxicity(29%), ototoxicity(21%), gastrointestinal toxicity(100%), cardiac toxicity(29%) and alopecia(100%). These toxicities were generally mild to moderate and appeared tolerable.

유산과 동시에 시행한 복강경 불임술의 안전도에 관한 임상적 비교연구

김원규(WK Kim),전종영(JY Jun),박찬규(CK Park),곽현모(HM Kwak) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.7

1977년 1월부터 12월까지 만 1년간 연세대학교 의과대학 산부인과 수태조절실에서 유산과 동시에 복강경 불임술을 시행한 158예(제1군), 유산만 시행한 666예(제2군), 복강경불임술만을 시행한 1361예(제3군)에 대해 임상통계학적으로 비교분석하여 다음과 같은 결과를 얻었다. 1. 수술당시 및 직후의 제1,2,3군의 합병증의 발생율을 보면 각각 0.63%, 0.00%, 0.15%였다. 2. 조기 수술후의 제1,2,3군의 합병증의 발생율은 각각 0.00%, 0.30%, 0.007%였다. 4. 제3군에서 1예의 임신이 있었다. 유산과 동시에 복강경불임술을 받은 제1군은 158예로서 비교적 적은 예의 경험이지만 통계학적 분석결과에 의하면 유산 혹은 복강경불임술을 단독으로 시행한 다른 두군에 비하여 의의있는 합병증 및 실패율의 차이는 없다고 사료되므로 이는 그 안전도에 있어서 별 차이가 없다는 것을 추정할 수 있었다. 고로 임신 10주 이내의 유산과 복강불임술을 동시에 시행할 경우 본 연구에서는 단독으로 시행한 군보다 합병증 및 실패율의 차이는 없으므로 불임수술의 수락도가 가장 높은 시기인 유산직후에 권장함이 좋다고 사료된다. To evaluate the safety of laparoscopic sterilization performed at the time of vaccum aspiration, records of 158 patients undergoing combined vaccum aspiration and laparoscopic sterilization(group 1) were reviewed and compared with those of 666 patients who had abortion only(group 2) and with those of 1361 patients who underwent laparoscopic sterilization only(group 3) with the same outpatient procedure. Mean operating time for the combined procedure was 8 minutes 52 seconds. Immediate complication rates for group 1, group 2, and group 3 were 0.63%, 0.00%, and 0.15%, respectively(P>0.05). Early postoperative complication rates for group 1, group 2, and group 3 were 0.00%, 0.3% and 0.07%, respectively(P>0.05). Late postoperative complication rates for group 1 and group 3 were 5% and 16% respectively(P>0.05). Our findings indicate that patients who underwent outpatient laparoscopic sterilization with abortion did not encounter higher rates of complications that the other two groups.

자궁내막암의 임상병리학적 고찰

김원규(WK Kim),김현(H Kim),박은동(ED Park) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.11

During the 10 years period from January 1984 to December 1993, 70 cases of endometrial carcinoma were encountered at Kosin Medical College & Medical Center. Out of 70 cases, 60 cases were treated primarily at our hospital. From these patients, 46 cases underwent surgicla treatment (12 cases, Radical hysterectomy with lymph node dissection or biopsy and 34 cases, Total abdominal hysterectomy with bilateral salpingoophorectomy ) and 12 cases received radiotherapy only and remaining 2 cases, one case received radiotherapy with adjuveant chemotherapy and one case was treated with ovulation induction. There were 52 cases with adenocarcinoma, 4 with adenoacanthoma, 4 with adenosquamous cell carcinoma, 4 with papillary serous adenocarcinoma and 1 with clear cell carcinoma. Among 70 cases, 36 cases wyre followed up at least 2 years and 2-year survival rate varied according of the following; stage of disaese-stage I 100%, stage II 60.0%, stage III 50%, stage IV 33.3%; tumor grade-grade I 93.7%, grade II 50.0%, grade III 62.5%; age-under 40 100%, between 41 and 60 91.3%, over 61 30.0%; the mean 2-year survival rate was 75.0%.

40 세이하 연령층의 자궁내막암 10 례의 임상병리학적 고찰

김원규(WK Kim),박은동(ED Park) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9

The authors have reported that endometrial cancer has a favorable prognosis in the young women than in the older patient because it diagnosed at early stage with lower grade, so we have done a clinicopathologic review of 10 cases of endometrial cancers in young women under the age 40 retrospectively.

만성무배란증후군과 자궁내막암이 동반된 젊은 여성 3 례

김원규(WK Kim),박은동(ED Park) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.1

We experienced three cases of endometrial carcinoma associated with chronic anovulation syndrome in young aged infertile women (28-30-31 years old). It is now apparent that polycystic ovarian disease and progesterone deficiency states belong ot a heterogenous group of disorders categorized as chronic anovulation syndrome, a spontaneous biologic experiment of unopposed secretion of estrogen by ovaries and it is believed to be the continuous estrogen stimulation of the endometrium, unmodified by the cyclic effect of progesterone, that leads to endometrial hyperplasia and, in susceptibla patient, to cancer, it is this concept of unopposed estrogen proposed by Gusberg, so we report three cases of endometrial cancer associated with chronic anovulation syndrome in young women with a brief review of literature.

자궁내 피임장치와 동반된 여성 생식기 방선균증 3 예

이영미(YM Lee),김원규(WK Kim),박은동(ED Park) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

It has been known that actinomycosis rare in human, especially in the female genital tract without any predisposing factors. some cases of actinomycotic pelvic inflamatory disease in IUD users were reported and its correlation has been studied by sereral investigators. Someone reported that actinomycotic pelvic infection occured more in IUD users especially, plastic device and with long duration. In contrast, Others suggested that actinomycoces was commmensal in the female genital tract and it developed opportunistic infection irrespective of IUD presence. it was supposed that actinomycosis was screened by Papanicolaou stain and confirmed by culture with immunofluorescent staining. We have experienced 3 cases of actinomycosis-two cases detected on routine Pap. smear and one case of pelvic abscess confirmed by pathologic specimen-in IUD users and reported them with a review of literature.

자궁경부 상피내암의 처치에 관한 연구

임희규(HK Lim),김원규(WK Kim),박찬규(CK Park),곽현모(HM Kwak) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.6

1968년 1월부터 1977년 12월까지 만 10년간 연세대 학교 의과대학 부속 세브란스병원 산부인과에서 자궁경부 상피내암으로 진단되어 치료를 받은 158예의 환자의 임상기록부를 대상으로, 진단 및 치료에 관하여는 여러 인자를 임상통계학적으로 분석하여 아래와 같은 결과를 얻었다. 1. 조절편 생검을 시행한 87예중 원추형 생검과의 조직학적 차이를 보인 경우는 10예(11.5%)이었다. 2. 치료방법은 152예(96.2%)에서 전자궁적출술을 시행하였고 그중 수술 전 상피내암으로 진단되어 치료 목적으로 시행한 경우가 137예(90.0%)이었다. 3. 원추형 생검술 후 전자궁적출술을 시행한 139예중 열이환률을 보인 경우는 56예(40.3%)이었으며 시간 간격과의 관계를 보면 72시간 이내 특히 24시간 이내와 42일 이후에서 이환율의 빈도가 낮았다. 4. 원추형 생검을 시행한 139예중 병소가 잔유한 경우는 47예(33.8%)이었다. 5. 치료후 추후관찰이 가능했던 경우는 59예(37.3%)이었으며 이중 1예(0.6%)는 2년 후 질구개에 침윤성 편평상피암이 발견되었다. 이상의 결과로서 소절편 생검만으로는 병소의 누락이 있을 수 있으므로 원추형 생검에 의한 진단이 필요하다고 사료되며 원추형 생검술 후 전자궁적출술은 늦어도 72시간 이내거나 42일 이후에 시행하는 것이 수술 후의 이환율을 저하시킬 수 있는 것으로 사료된다. 원추형 생검술 후 병소의 잔유빈도로 보아 상피내암의 표준적 치료는 전자궁적출술로 사료되며 전자궁적출술 후에도 재발된 경우를 감안할 때 환자의 적절한 치료뿐만 아니라 추후관찰은 매우 중요하다고 사료된다. One hundred and fifty eight patients with carcinoma in situ were reviewed. A discrepancy of histopathologic findings between punch biopsies and subsequent cone specimens was found in 11.5% of cases. Extended hysterectomy was carried out in 96.2% of cases. The cone-hysterectomy febrile morbidity was found to be 40.3%. The morbidity was increased when the time interval between operations is greater than 72 hours and less than 6 weeks. The 33.8% of patients who had undergone previous cone biopsy had residual carcinoma in the subsequent hysterectomy specimens. Among the 59 patients(37.3%) who were followed postoperatively, one developed an invasive carcinoma of the vagina.

진행된 난소암의 복강내 Cisplatin 항암화학요법

박지욱(JW Park),문찬화(CH Moon),김원규(WK Kim),박은동(ED Park) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.10

Treatment of patients with advanced ovarian cancer who have had failure of systemic chemotherapy is rarely effective. Preliminary pharmacokinetic studies established the feasibility of delivering relatively high concentrations of cisplatin intraperitoneally via a semipermanent catheter, 9 patients with advanced ovarian cancer, 3patients of whom had failure os systemic chemotherapy, were treated with high-dose intraperitoneal cisplatin(100 mg/m2). Of the 9 patients evaluable for response, 5(56%)disappearance of malignant ascitew, 4(44%) showed a clinical partial response. Side effect consisted of nausea and vomiting(9 cases), hepatotoxicity(1 case), nephrotoxicity (1 case) and bone marrow depression(1 case). One Patient had treatment cased after one coruse of intraperitoneal chemotherapy due to hepatotoxicity nephrotocicity and bone marrow depression. It is felt that prospective studies to compare the efficacy of intraperitoneal chemotherapy with other forms of salvage therapy, as well as its use as initial chemotherapy for advanced ovarian cancer, need to be done.

초기 자궁경부암에서 DNA 배수성 분석이 예후에 미치는 영향

박은동(ED Park),이영미(YM Lee),김원규(WK Kim),김홍열(HY Kim),장희경(HK Jang),허만하(MH Huh),김인선(HS Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

Prognostic value of flow cytometric DNA analysis was assessed for early cervical cancer patients (FIGO stage I & IIa) treated with radical abdominal hysterectomy and lymph node dissection. Flow cytometry was performed on archival paraffin-embedded tumor tissues of 38 subjects. 8 patients recieved radiotherapy post-operatively because ofthe presence of lymphnode metastasis at the time of initial surgery. 38 subjects were analized: 18 patients(47%) were categorized as DNA-aneuploidy and 20 (53%) patients were categorized as DNA. diploidy. 26 (68%) patients were in FIGO stage IB, 12(32%) in IIA. 8(21%) patients were found to have lymphnode metastasis at the time of initial surgery. 8(21%) patients recurred. There is no significant correlation between DNA-ploidy patterns and stage, differentiation, cell type or mitosis. Although the results are not significant statistically, aneuploidy tended to be more frequently observed in association with lymph node metastasis and recurrence. Overall 5 year disease-free survival for diloid and aneuploid were 79.72% and 67.57%, respectively.

인유두종 바이러스 16/18형 감염이 있는 자궁경부암에서 c-erb B2와 p53 단백의 과발현에 관한 연구:자궁경부암의 원인 및 임상병리학적 연구

이상민(SM Lee),이천준(CJ Lee),김원규(WK Kim),박은동(ED Park),허만하(MH Huh),허방(B Hur),조무연(MY Cho),정인철(IC Jung) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The 43 cases of the primary uterine cervical carcinoma were analyzed for HPV type 16/18 infection and also analyzed for overexpression of p53 and c-erb B2 oncoprotein to evaluate theirs oncogenic and clinicopathologic relationships. HPV type 16/18 infection was examined by polymerase chain reaction(PCR) and the overexpression of p53 and c-erb B2 protein by usi-ng immunohistochemical method. The results were as follow: 1. The HPV infection rate in primary uterine cervical carcinomas was 83.7% respectively.The standard clinicopathologic characteristics(age, histologic type, koilocytosis, mitosis, clinical stage, tumor size, cervical invasion depth, lymph node metastasis, parametrial invasion) were nat significantly correlated with HPV type 16/18 infectivity. 2. The overexpression rate of p53 protein was 72.1% and there was no Significant correlation between expression of p53 protein and the Clinicopathologic characteristics. 3. The overexpression of c-erb B2 oncoprotein was 44.2% and there was no significant correlation between the overexpression of c-erb B2 oncoprotein and the clinicopathologic char-acteristics. 4. There was no significant correlation between HPV type 16/18 infection and overexpression of p53 and c-erb B2 oncoprotein.