임신 및 분만결과에 따른 경구당부하검사의 분석

김정혜(JH Kim),송혜섭(HS Song),오말례(ML Oh),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 1. 서구인과 비교해 본 저자들의 경구당부하검사는 많은 차이점들 나타내었다. 즉 저자들이 시행한 검사치를 미국인의 것과 비교했을 때 평균치에 있어서 약30~4omg%,2S.D.에서 25~40mg%가 각각 높았다. 그러므로 식생활이 다른 한국인의 임신성 당뇨병 진단에 미국인의 기준치를 적용하는 것은 많은 오류를 범할 수 있다고 생각되므로 좀 더 많은 수의 검사로 한국인의 표준을 정하는 것이 필요하다고 본다. 2. 비정상 임신시 정상 임신에 취하여 비정상 당부하검사를 나타내는 예가 월등히 많았다. 과체중아 분만시에 고혈당치 뿐 아니라 저혈당치의 빈도도 높이 나타났으며 처체중아 분만시에도 고혈당치를 나타내는 빈도가 높았다. 또한 산과력이 나빴던 예에서도 저혈당치를 나타낸 예와 현성당뇨병을 나타낸 예가 많았으며 임신중독증 시에도 고혈당치 뿐 아니라 저혈당치도 높은 빈도를 나타내었다. 3. screening test로써의 single test는 3시간이 의의가 있는 것으로 생각되나 일부의 비정상적인 사람들을 포함하지 못할 수도 있다. 모든 임신부에게 3시간의 single test를 행하는 것이 바람직하나 비정상적인 임신이 기대될 때는 표준당부하검사를 시행하는 것이 좋을 것이다. lt has been wedely recognized that many complications in obstetrics & gynecology are asscoiated with abnormal carbohydrate metabolism. Oral glucose toIerance test is the one of the better tests in diagnsing diabetes mellitus but its value changes depending upon the basic diet, especially amount of carbonhydrate intake. Therefore we thought there may be a difference in glucose tolerance between Western and Korean peoples. Oral glucose tolerance tests were done in 159 control group people, nonpregnant 34, pregnant 59, and postpartum (baby, A.G.A.I.)66, and a group of 389 with abnormali- ties of pregnancy, L.G.A.I.215, S.G.A.I.76, stillbirth unknown cause 22, bad ㅇbstetric history 20, hypertensⅳe disorders in pregnancy 53, and fetal abnormality 3. The results are as follows; 1. There was a marked difference between Korean and American mean oral glucose tolerance test results. This study showed 30~40mg% higher value than American pre- gnancy standard, and 25~40mg% higher in comparing 2 S.D. This study would mean that it would be dangerous if the American standards are used in diagnosis and treat- ment of Gestational Diabetes in Kotea. 2. Abnormal pregnancy showed a more frequent association with abnormai G.T.T. compared to normal pregnancy. Hyperglycemia was associated with L.G.A.I. in 7.9% cases but also hypoglycemia was associated with hyperglycemia. Patients with a bad obstetric history showed 20% hypoglycemia and 15% overt diabetes, but none in the hyperglycemia, not diabetic level. Dypertensⅳe disorders in pregnancy were associated with hyperglycemia as well as hypoglycemia. 3. For singIe Ioading test a 3hr test is probably the best but it would still miss some of the patients with abnormal curves. As a screening test of all pregnant patients the 3hr single loading test could be used but when there is an abnormality of pregnancy it would be adⅵsable to do a full G.T.T.

자궁내 융모상피암의 보존적 수술요법 3 례

이남희(NH Lee),송진희(JH Song),전미경(MG Jeon),문정주(JJ Moon),민보은(BE Min),김정혜(JH Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

In treating young women for gestational trophoblastic tumor ( G.T.T. ) , all efforts are made to preserve fertility and hysterectomy is avoided unless absolutely essential. However , in some cases the operation may be lifesaving. During the last 20 years among the 310 cases of G.T.T. treated at Il Sin Christian Hospital , there were 3 cases in which hysterectomy was avoided by the excision of a localized uterine lesion thus preserving fertility.

Rh 음성 산모의 문제점

송혜섭(HS Song),장애숙(AS Chang),김정혜(JH Kim),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

1976년 1월 1일부터 1980년 7월 31일까지 일신부인병원 산부인과에서 분만한 Rh 음성 산모 43명과 53회의 임신으로 출생된 55명의 신생아를 대상으로 Rh 음성이 산모와 태아에 미치는 영향을 비교 관찰한 결과 다음과 같은 결과를 얻었다. 1.28,249명의 산모중 Rh 음성은 43명이었고 53회의 임신으로 그 빈도는 0.19%였다. 2.Rh 면역된 임신 5예에서 그 원인이 수혈에 의한 것으로 생각되는 것이 3예로 가장 많았고 이전의 인공유산에 의한 것으로 생각되는 것이 2예였다. 3.산후 Rhogam을 투여했던 9예에서는 모두 Rh면역이 일어나지 않았다. 4.Rh 음성 산모의 산전관리에서 Rh 항체역가치에만 의존하지 말고 양수천자에 의한 빌리루빈치의 측정이 필요한 것으로 생각되었다. 5.Rh 음성이 산모에 미치는 영향으로써 산후출혈 후 혈액공급이 어려운 것이었고, 분만전에 가족의 광범위한 혈액형 검사로 Rh 음성 혈액의 준비가 필요한 것으로 사료되었다. 6.Rh 면역된 신생아에서 주산기 사망은 없었으나 빠른 빌리루빈치의 증가가 나타남으로 제대혈액으로 혈액형, 혈색소치, 빌리루빈치, 직접쿰수치의 측정이 필요하고 출생 후 면밀한 관찰과 적극적인 처치가 요구된다. 53 pregnancies in 45 Rh neg. women who were delivered between Jan. 1st 1976 and July 30th 1980 in Il Sin Women`s Hospital were reviewed and following results were obtained. 1.The incidence of Rh neg. women among a total 28,249 patients was 0.19%. 2.5 patients were immunized. In 3 patients the immunization was probably due to previous transfusion of Rh positive blood and in 2 cases the immunization followed previously induced abortions. 3.The use of Rhogam after delivery, abortion, ectopic or possible placental trauma in the non-immunized patient prevents immunization and reduces the neonatal problem.In this series 9 patients who had been given Rhogam after previous delivery Rh immunization was not present. 4.In the management of pregnancy in a Rh negative women not only the Rh antibody titer but also amniocentesis with bilirubin absorption curve is required. 5.Danger to the mother was difficulty in obtaining Rh negative blood for transfusion after severe P.P.H. It is important to check blood grouping of many of the relatives as possible in order to have rapid collection of Rh negative blood when necessary. 6.There were no stillbirths or neonatal deaths, but 4 babies required exchange transfusion due to rapid increase of serum bilirubin. To lower the perinatal morbidity the cord blood needs to be examined in detail followed by close observation with active treatment if jaundice develops to a certain level.

복식 전자궁적출술에 관한 임상 통계학적 고찰

신규미(GM Shin),김현옥(HO Kim),최현경(HG Choi),김정혜(JH Kim) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.8

This study was attempted to analysis 378 women who undeerwent total abdominal hysterectomy at the department of Obstet & Gynecol, Ilsin Christian Hospital from Jan. 1985 to Dec. 1989. The results were summerized as follows; 1. The peak incidence of age distribution was in 40 to 49 years old age group and 53.4% of patients was belonged to that age range. 2. The most common gravity was gravida 4 to 5 group and the most common parity was para 2. 3. Lower abdominal pain was the most common symptom and followed by hypermenorrhea. 4. Uterine myoma was the most common indication of hysterectomy and followed by cervical intraepithelial neoplasia. 5. The most common postoperative pathologic finding was uterine myoma and followed by adenomyosis and cervical intraepithelial neoplasia. 6. Overall 64.8% of the preoperative clinical diagnosis was confirmed by pathologic examination. But diagnostic accuracy rate of adenomyosis was only 9.5%. 7. 115 patients (30.42%) were performed prehysterectomy curettage and 2 cases of endometrial adenocarcinoma were diagnosed. 8. Intravenous pyelograms were performed on 344 patients (91%) and 5 patients had congenital urinary tract abnormalities.

임신성 융모성 종양에서 Methotrexate 단일 항암화학요법시 약제 내성의 발생에 대한 분석

안현숙(HS Ahn),김경서(KS Kim),박치희(CH Park),김정혜(JH Kim),민보은(BE Min) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

MTX with Leucovorin rescue as a single drug treatment for G.T.T. causes complications, is usually adequate but drug resistance occasionally occurs. This is a report of a study done in 80 consecutive patients (pts) treated with MTX between 1983 and 1991 at Il Sin Christian Hospital, Pusan to see if predictive factors for the development of the drug resistance could be identified. According to the 1983 WHO prognostic score 72 pts were low risk, 7 medium and high risk. Durg resistance developed in 22/72 pts (30.6%) low risk pts and in all of the medium and high risk pts. Factors analysed as possible predictive factors for developing drug resistance were total prognostic score, the seperate factors of the prognostic score, factors related to the preceeding mole, size of uterus at start of chemotherapy and factors relatd to previous fertility. The most significant factors associated with a higher risk of resistance were WHO prognostic score 5 and over, 8/8 pts(100%), HCG titer>10^4 mIU/ml, 12/15 pts(85.7%), tumor size 3 cm and over, 8/8 pts(100%), and less commonly a preceeding non molar pregnancy 2/3 pts. Among the 8 medium & high risk pts the preceeding preg. was non molar in 2 pts and of the remaining 6 pts all had at least 1 of the 2 predictive risk factors and 5/6 had both of these factors. These results emphasise the reliability of the WHO prognostic score in selecting pts who need multiple therapy and also that MTX alone is usually inadequate in these pts. Among the low risk pts if either or both of these factors were present, 80% of pts (8/10) developed drug resistance compared to 22.6% (14/62) if neither factor was present.

임신성 융모성종양에서 병기분류와 예후점수제의 신뢰도의 비교

박승희(SH Park),하현미(HM Ha),김양희(YH Kim),김정혜(JH Kim),민보은(BE Min) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.6

A restrospective study of 129 patients with GTT admitted to Il sin Christian hospital between January 1983 and December. 1992 was done to assess and compare the reliability of both the 1983 WHO prognostic score (Prog. score) and 1992 FIGO staging in determining the severity of the disease and therefore the outcome and method of treatment needed. The overall remission rate was 93.8%. The addition of 2 risk factors, HCG titer 10^5 and above and interval of 6 months or more to separate each stage into a, b, c subgroups(none, one or both risk factors) greatly improved the correlation with the prognostic score(r=0.595) compared to the previously purely anatomically staging (r=0.460). 60/66(91%) of stage Ia and 17/21(81%) of stage IIIa pts were low risk but 11/21(52%) of stage Ib and 5/6 (83%) of stage IIIb were high risk, all 4 pts in c subgroup were high risk. When cases were considered form the prognostic score aspect, 60/82(73%) of low risk were stage Ia but 17/82(21%) were stage IIIa, 11/29 pts of high risk pts were stage III or IV and 12 pts were stage I. Treatment was determined according to the prognostic score and apart form a few pts, low risk pts were given single therapy and med/high risk, 42 % of med, risk pts and 24% of Ia and 43% of IIIa pts had to be changed to multiple therapy. The outcome of the treatment given was then evaluated, as if the guide lines of single therpy for low risk, and multiple therpy for med/high risk cases had been strictly followed for the initial treatment on comparing the two modified score, there would had been moderate increase 81.9% appropriate treatment compared 76.4%. In conclusion risk factors seem to be more important than the antomical stage in determining severity of disease. In addition an HCG titer of 10^4 or more may be a better indicator to separate the stage than the titer of 10^5.

반복 자연유산아의 융모막융모세포를 이용한 염색체 분석

황혜란(HR Hwang),서성숙(SS Seo),이신영(SY Lee),김정혜(JH Kim),박숙자(SJ Park) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.12

Chromosomal analysis was done on abortus chorionic villi samples obtained 30 women with a history of two or more spontaneous abortions who were treated at Il Sin Christian Hospital between March 1992 and January 1993. 1. The overall incidence of chromosmal abnormalities was 36.7%(11 out of 30 cases). 2. Numerical abnormalities were detected in 9 women; 3 cases of monosomy(27.3%), 3 or trisomy(27.3%) and 3 of triploidy(27.3%). Structural abnormalities were present 2 women, one case of inversion (9.1%) and one case of deletion (9.1%). 3. No abnormalities were detected in the remaining 19 women and there was no difference between those with normal and abnormal results in regard to age, number of abortions and abortus gestational age.

미혼여성에서 GnRH Agonist 치료후 자궁근종절제술을 시행한 3 예

오경열(KY Oh),신규미(GM Shin),홍옥련(OL Hong),김정혜(JH Kim) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.4

Three unmarried young women with large uterine leiomyoma were treated with a long acting agonist of lutenizing hormone-releasing hormone (LH-RH), decapeptyl (D-trp6 -LHRH), 4gm administered intramuscularly every month. After reduction in uterine volume myomectomy was performed for the difinitive surgery. This experience is reported with brief reviews of the literature.

자궁의 동정맥 기형 3 예

안현일(HI Ahn),백미경(MK Baek),정미은(ME Jung),김정혜(JH Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

Uterine arteriovenous malformation is a rare gynecologic condition, which is sometimes accompanied torrential vaginal bleeding and it can be aggravated with diagnostic dilatation and curettage. For proper management of vaginal bleeding, accurate diagnosis should be achieved before the intervention. In the past, the diagnosis was made retrospectively after hysterectomy, however recently it may be made by noninvasive method such as Doppler ultrasonogram before management. We have experienced 3 cases of uterine arteriovenous malformation, of which 2 cases were diagnosed with Doppler ultrasonogram.

자궁경부 상피내종양의 처치에 있어서 환상투열절제술의 효용성

박민혜(MH Park),이지연(JY Lee),박은선(ES Park),김정혜(JH Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

Objective: This study was performed to demonstrate efficacy of LLETZ in the treatment of CIN. Method: One hundred patients with dysplasia diagonsed by colposcopically -directed punch biopsy underwent the LLETZ from April, 1993 to December, 1997 at Gynecologic department of Il Sin Christian Hospital. Results: The comparison between the diagnosis of punch biopsy and that of LLETZ showed fair agreement with 48%[48/100.table3] of cases. The abnormal lesion was underestimated by punch biopsy in 11% of cases. Of them, severe dysplasia was 2 cases and CIS was 4 cases. As the dysplasia lesion was getting severe, margin involvent rate was increased, but there was no relation to recurrence. The 2 case of 90 fallowed up from 3 months to 12 months were reccured after LLETZ. Complication was few. Conclusion: LLETZ allowed more acurate histologic examination of the CIN lesion than punch biopsy and showed good result of treatment without complication.