Prostaglandin F2α 의 양막외주입에 의한 중기임신중절

김종덕(JD Kim),노효섭(HS Ro),배남규(NK Bae) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.9

The consciously unwanted pregnancy is a complex medical-psycological-social condition. Various methods of termination at midtrimester pregnancy were individually used up to the date. It is well known that prostaglandin E and F are effective in uterine contraction in both pregnant and non-pregnant uterus. The instillation of prostaglandin F2α through Foleys catheter into extraovular uterine cavity has been shown to be effective for terminating pregnancy at midtrimester. The terminations at midtrimester were carried out by extrovular infusion of prostaglandin F2αin 22 patients between 16 and 30 gestational weeks and this method has been proved to be a safe and effective mean of terminating pregnancies at midtrimester. The results were as follows: 1. The psychological-social problems were indicated in most cases. 2. Nullipara were 12 below 25 years of age and multiparar had 2 more children, 6 cases 4 or more children. 3. The mean abortion time from initial infusion to the abortion of fetus was 25.26 hours and the mean dosage of infused prostaglandin F2α was 7.284ug. The mean abortion time and mean dosage of the prostaglandin decreased disproportionately to the increase of gestational week from 16 up to 26. 4. The initial uterine contraction was noted around 10.28 minutes and Foleys catheter was expelled between 15 and 16 hours in most cases after first infusion of prostaglandin. 5. The mean time of oxytocin augmentation after expulsion of Foleys catheter as supporting aid was 5.08 hours. 6. The most common side effects consisted of face flush, nausea, and vomiting, which disappeared spontaneously after the expulsion of Foleys catheter without specific treatment. 7. The success rate of termination in 22 patients was 95% and 3 patients were complicated by incomplete abortion.

난소임신의 1예

김종덕(JD Kim),이종수(JS Lee),박찬영(CY Park) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.11

A case of ovarian pregnancy associated with lithopedion and fulfilled Spiegelburg`s criteria in a 38 year old woman is presented.

치골상부소절개에 의한 난관불임술

김종덕(JD Kim) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.11

1. 80% of cases were under 34 years of age and youngest 23 years oldest 42 years. 2. Number of living children was 2-4 persons in 86.4% 3. Ratio of male to female of offspring was 2 to 1 in most cases. 4. Cases never experienced artificial abertion were 57.6%, 37 cases (62.6%) had been performed artificial abortion with tubal sterilization together. But no difference was noted in time of operation and complication compared with non pregnant cases. 5. Tubal sterilization was performed from 1 years to 3 years after last delivery in 61%. 6. Motive of tubal sterilization was her will and doctor`s advice after counsel in 67.7%. 7. Cases wanted only tubal sterilization had been performed under local anesthesia except extreme anxiety. 8. The operation was finished within 20 Min. in 73% After using of Bai`s 17 elevator the time of operation was shorted for facilitated elevation and rotation of uterus. 9. Cases discharged within 12 hours were 64.3% and most of them after 6-8 hours. 10. camplication were encountered in 2 cases, ie hemorrhage due to laceration of mesosalpinx during manipulation and mild inflammation around stitches. 11. No failure was noted.

미세수술을 이용한 가토난관 복원술시 사용된 봉합사 및 복강내 첨가물이 난관조직에 미치는 영향

김종덕(JD Kim),두재균(JK Doo) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.4

미세수술을 이용한 난관 문합술시 봉합사, 복강내첨가물, 수술 후 경과기간별로 난관조직의 유착정도, 봉합사의 흡수유무, 복수존재유무, 난관유통검사, 조직학적 소견을 관찰하여 다음과 같은 결과를 얻었다 1 난관정도의 유착정도는 vicryl군과 nylon군이 dexon군에 비하여 약간 적었으나 유의한 차이는 없었고(P=0 1504), macrodex군이 생리적 식염수군과 대조군보다 비교적 적었으나 유의한 차이는 없었다(P=0 8325) 2, 봉합사별 흡수유무는 수술 후 60일에서 vicryl군은 완전흡수, dexon군은 1마리(16 7%)에서 부분흡수, nylon군은 전혀 흡수되지 않았다(P=0 0002) 3 난관유통성 검사결과는 vicryl군과 nylon군이 dexon군에 비해서 약간 우수하였으나 유의한 차이는 없었고(P=0 6218) macrodex군이 생리적 식염수군과 대조군에 비하여 우수하였다(P=0 048) 4 복수는 수술 후 60일에 macrodex군의 50%(3/6)에서 존재하였으나 생리적 식염수군과 대조군에서는 없었다 수술 후 60일과 90일의 경과기간에 따른 차이는 없었다(P=0 2059) 5 조직구와 다핵거대세포의 침윤에 의한 조직 반응과 섬유화는 vicryl군과 macrodex군이 각각의 비교군보다 적었다 이상과 같은 결과로 봉합사로는 vicryl과 nylon을 사용하고 복강내 첨가물로는 6% dexon을 주입하였을 때 조직의 유착이 적고 난관의 유통성이 우수하며 조직반응 및 섬유화가 가장 적어 난관의 미세복원수술에 이들의 사용이 좋을 것으로 사료되었다 Tubal sterilization has been increased progressively in young reproductive women and it has made tubal reversal using microsurgery increase consistently Pregnancy success rate by tubal reanastomosis using microsurgery has been reported approximately two times higher than the previous operation methods Microsurgical tubal reanastomoses were performed on bilateral fallopian tubes of 18 female rabbits using different suture materials and adjuvants Adhesions, absorption of suture materials, tubal patency, and presence of ascites were compared and tissue responsiveness was evaluated by histologic examinations of the restored tubes, and the results were as follows: 1 There was no difference in the degree of adhesion of the restored tubal tissue when the groups were compared according to the suture materials(P=0 1504) and the adjuvants(P=0 8325) 2 Absorption of suture material was marked in the vicryl and the dexon groups compared to the nylon(P=0 0002) 3 There was no difference in tubal patency between the vicryl, dexon, and nylon groups(P=0 6218), but more cases with free flow were found in the macrodex group compared to the normal saline and the control(P=0 048) 4 Ascites were observed in 50%(3/6) in the macrodex group on the 60th day after reanastomosis, whereas none was found in the normal saline and the control(P=0 0735) No difference was noted in the frequency of ascites between the 60 days and 90 days groups(P=0 2059) 5 Tissue responsiveness assessed by infiltrations of histiocytes and multinucleated giant cells, and fibrosis in histologic examination was less marked in the vicryl and the macrodex groups compared to corresponding group

난소에서 발생한 양성 낭성 기형종의 1예

김종덕(JD Kim),노효섭(HS Ro),최영원(YW CHOI),진소자(SJ Jin) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.1

It was not infrequent that we have found primary malignant tumor developed in fallopian tube. But we have rarely experienced teratoma and benign cystic moreover. We have experienced one of the benign dermoid cyst primarily developed in fallopian tube and we are to report it with literary review.

만삭산모에서 음향자극검사를 이용한 태아심음반응과 태아안녕의 평가

김종덕 ( JD Kim ),장은실 ( ES Chang ),조성남 ( SN Cho ),강경석 ( GS Kang ),정유석 ( YS Jeong ),엄철 ( C Um ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.12

1991년 9월 1잉부터 1990년 12월 31일까지 만 4개월 동안 전북대학교 병원 산부인과에 정상 양수양과 두부 태위의 단태아를 가진 만삭산모 70명을 음향자극 검사를 시행하여 다음과 같은 결론을 얻었다. 1. 반은성이 대조기간에는 72.9%를 보인 반면 음향자극검사 후에는 90.0%를 나타내었다. 2. 음향자극후 평균 기초 태아 심박동수, 분당 15박동이상의 증가와 평균빈도, 15박동 증가의 기간과 백분율 그리고 태동의 평균빈도는 현저히 증가(P<0.01)하였으나 분당 15박동 증가의 진폭은 유사하였다. 3. 음향자극검사후 반응성 대 무반응성의 주산기 결과는 양수내 태변착색, 태아적응증에 의한 제왕절개, 1분과 5분 Apgar점수가 7 미만인 경우(P<0.01)와 신생아 집중치료실의 입원빈도(P<0.001)가 무반응성군에서 현저한 증가를 보였다. 4. 산전감시에서 음향자극검사의 예측치는 낮은 유병율, 높은 특이도와 음성 예측도를 보였다. 그러므로 음향자극검사는 비수축검사보다 산전 태아안녕의 평가에 대한 우수한 예비검사로 사료된다. Objective clinical evaluation of fetal health is primary goal of obstetrics care. Fetal acoustic stimulation test(AST) has recently received much attention in the literature. To improve the predictive value and to decrease the length of nonstress testing, there has been a wide spread introduction of different acoustic stimulation tests combined with nonstress testing in the assessment of fetal health. This study was undertaken to assess the clinical efficacy of AST on 70 nonmal term pregnant women who are anatomically singleton fetus with vertex presentation and normal amnionic fluid volume from Sep. 1, 1990 to Dec 31, 1990 at the Department of Obstetrics and Gynecology, Chonbuk National University, Medical School. The results were as follows: 1. Fifty one (72.9%) fetuses had reactive fetal heart rate patterns during the control feriod but sixty three(90.0%) fetuses demonstrated reactive fetal heart patterns after vibratory acoustic stimulation. 2. Mean baseline fetal heart rate, mean frequency of accelerations > 15-beats/min, duration of 15-beat accelerations, precentage of acceleration time and mean frequency of fetal movement were significantly increased after vibratory acoustic stimulation(P<0.01). 3. Comparison of Perinatal outcome for reactive versus nonreactive acoustic stimulation showed significanly increases in the incidence of meconium staining of the amnionic flud, cesarean section for fetal indication, Apgar score<7 at 1, 5 minutes, umbilical artery pH<7.20(p<0.01) and newborn intense care unit admission(P<0.001) in the nonreactive group. 4. Predictive value of acoustic stimulation test in antepartum surveillance showed low prevalence rate (below 10%), high sensitivity and negative predictive value(above 90%) respectively. So acoustic stimulation test were considered as an excellent test than nonstress test for the evaluation of fetal well-being.

제왕절개술의 임상적 고찰

김종덕(JD Kim),강훈(H Kang),박종덕(JD Park),변지수(JS Pyun) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.5

1975년 2월 1일부터 1978년 7월 31일까지 3년 6개월동안 전북의대 부속병원 산부인과에 입원하여 1,000g 이상의 태아를 분만한 1,179예중 의무기록이 만족스러웠던 193예를 임상 통계학적으로 고찰하여 다음과 같은 결론을 얻었다. 1. 제절의 빈도는 16.4%였다. 2. 제절의 적응증은 아두골반불균형이 34.7%로 수위였으며 태위이상 14.5%, 전치태반 13.5%, 반복제절 9.8%, 태반조기박리 9.8%, 자간증 및 자간전증 8.3% 순위였으며 골반위의 제절율은 18.0%였다. 3. 연령분포는 26∼30세군이 43.0%, 21∼25세군 26.4%, 31∼35세군 16.6%의 순위이고 35세 이하가 87.1%이다. 4. 제절술식은 자궁협부의 횡절개술이 88.1%, 자궁체부종절개술이 10.3%, 제절자궁전적출술이 1.6%이었다. 5. 전예에서 전신마취를 시행하였다. 6. 선택적제절이 19.2%, 응급제절이 80.8%였고 수혈은 44.9%에서 시행하였으며 응급제절 43.6%, 선택제절 45.9%에서 수혈을 시행하였다. 7. 모성이병율은 13.0%이었고 산욕열 복부창상감염이 주 내용이었다. 8. 모성사망은 1예(0.52%)였다. 9. 미숙아 14.2%, 성숙아 85.8%, 3,000∼3,500g군이 37.6%였다. 10. 주산기 사망률은 19.2%였으며 사산 20예, 신생아사망 12예였고 그중 미숙아군이 18예로 과반수 이상을 차지하였다. Of 1,179 deliveries performed at Jeonbug National University Hospital From Feb. 1. 1975 to July 31. 1978, 193 cases of C-section was reviewed clinically. The results were as follows. 1. The rate of C-section was 16.4% for the period. 2. The age group of 26 to 30 years was 43.0% and 86.6% of all were below the age of 35 years. 3. In indications, C.P.D. was the most prevalent with 34.7% and malpresentation 14.5%, placenta previa 13.5%, repeated C-section 9.8%. There was some difference between the order of indication of primigravida and multipara. 4. In the type of operation, lower cervical transverse C-section was 88.1%, classical 10.3% and C-hysterectomy 17.6%. 5. Each of C-section were performed under the general anesthesia. 6. Of 193 cases of C-section, emergency C-section was 80.8%, elective 19.2%. Whole blood transfusion was carried out in the cases of 44.9% with emergency 43.6%, elective 45.9% respectively. 7. Apger score 6-10 was 74.1% and the mature newborn was 85.8%. 8. Perinatal mortality rate was 19.2%, stillbirth of which was 20 cases, the premature 18 cases. 9. The postoperative complications were noted in 13.0%, most of which were puerperal fever, wound infection of abdomen. 10. Maternal death occured in one case.

습관성 유산 환자에 있어서의 Toxoplasma 항체가

김생기(SK Kim),정채득(CD Jeong),오병찬(BC Oh),김종덕(JD Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.6

A prospective study of 110 obstetric cases was done to find out the role of toxo- plasmosis in abortion. The subjects comprised 15 habitual abortion, 35 sporadic abortions and 60 normal pregnancy cases were investigated for toxoplasmosis by dye test and by mouse inoculation with gestational materials. In no case, could Toxoplasma gondii be isolated from the pregnant endometrium by inoculation. The dye test was positive in 80 per cent of habitual abortion and 62.7 per cent of spo- radic abortion respectively. In normal pregnancy as the control postives result were pregnancy and abortion were significnat particularly in habitual abortion. These findings suggest that toxoplasma may prove an important etiological factor for spontaneous abortion.

양수과다병을 동반한 태반 혈관종의 1예

조재윤(JY Cho),김종덕(JD Kim),박찬영(CY Park) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.11

양수과다병을 동반한 태반 혈관종의 1예를 보고하는 바이다. In this paper a case of hemangioma of placenta with hydramnios was reproted and a brief review of literature on etiology, pathology and complication was made.

가토자궁의 조직손상시 유착에 영향을 미치는 제반 약물에 관한 연구

두재균(JK Doo),김종덕(JD Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.7

가토를 이용한 실험에서 복강내 장기수술후 첨가물질이 유착에 미치는 영향을 보기 위하여 첨가물질별 복강내 장기유착 정도, 복수존재 유무, 조직학적 소견 등을 관찰하여 다음과 같 은 결론은 얻었다. 1. 복강내 첨가물질별 조직의 유착정도는 대조군에 비해서 SCMC과 hyskon군이 적었으며, 이중에서 SCMC군의 유착방지 효과가 우수한 것으로 나타났다. 2. Talcum powder군은 모든 실험군중에서 가장 심한 복강내 유착을 일으켯다. 3. 복수형성은 talcum powder군에 가장 심하였다. 4. 자궁에 대한 인위적 손상중 전기소작에 의한 소상이 나일론 봉합과 절상 등에 비해서 조 직유착이 더 심한 것으로 나타났다. 5. 조직구와 대핵 거대세포의 침윤과 섬유화 등의 조직반응은 talcum powder군에서 가장 심 했으며, SCMC군과 hyskon 군은 대조군보다 적었다. 이상과 같은 결과로 복강내 첨가물질에 의한 수술후 유착방지 효과는 SCMC군과 hyskon군 이 우수하였고 조직학적 반응과 섬유화가 가장 적어서 부인과 영역에 있어서의 불임환자의 난과성형술 및 수술후 유착방지를 위한 목적으로 사용하는 것이 바람직하다고 사료되었어므 수술용 장갑에 묻어있는 talcum powder는 수술후 심한 유착을 일으키므로 수술에 임하기 전 완전히 세척하는 것이 필요한 것으로 사료된다. To study the effects of adjuvants agent on the formation of postoperative adhesions 20 rabbits were randomly divided into five group ; a control group (n=4) a normal saline group (n=4), a hyskon group (n=4), a sodium carboxymethylcellulose group (n=4), nad a talcum powder group (n=4). All of the animals were received standardized injuries, and adhesions , presence or abscence of ascites, and histologic response were compared, and the results were as follow; 1. Adhesions were significantly less in the sodium carboxymethylecellulose and hyskon groups than the control group . When the groups were compared according to the adjuvants, the least adhesion was noted in the sodium carboxymethylecellulose group 2. There was the most pronounced adesions in the talcum powder group . 3. Ascites were founded considerably in the talcum powder group . 4. Adhesions were marked at the cautery site compared to the nylon stitch and incisional wound among artificial injuries. 5. Tissue responsiveness assessed by infiltration of histocyte and multinucleated giant cells, and fibrosis in histologic examination was the most pronounced in the talcum power group , while being less in the sodium carboxymethylecellulose and hyskon group than the control group.