여러가지 형태의 난관결찰 부인에서 고정대를 이용한 미세난관문합수술

김진홍(CH Kim),김은중(EJ Kim),정기욱(KW Chung),권동진(DJ Kwon),고영미(YM Ko),임용택(YT Lim),김장흡(JH Kim),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.6

Many methods have been tried to raise the rate of success of tuboplasty. The purpose of tuboplasty is to maintain tubal patency, to prevent postoperative adhesion, and to prevent abortion and tubal pregnancy for term delivery. Various kinds of tubal splints have been used to maintain the tubal patency after tubal anastomosis of experimental animals and human. Therefore, this investigation was performed to examine the clinical effectiveness of the Nylon splint for women who had underwent various types of tubal ligation and wanted tubal reversal. For target of study, 110 splinted women among 285 women who had underwent the tubal reversal using splint at Department of Obstetrics and Gynecology in St.Mary`s Hospital affiliated to Catholic University Medical College from Mar. 1989 to Feb. 1995 were selected and could be traced more than one year. The were assorted by tubal ligation method, tubal length after anastomosis, splint duration, menstrual phase at the time of operation, age and postoperative hysteroalpingopragphy. The results were as follows; 1. The mean age was 30.4 years and 88.2% of them had been sterilized by laparoscopic ring or cauterization. 2. The most common site of anastomosis was isthmic-ampular portion(49.1%). 3. The overall pregnant rate was 80.0% and the outcome of the pregnancy were as follows; term pregnancy(40.9%), on going pregnancy(32.8%), spontaneous abortion(4.5%), ectopic pregnancy(1.8%). 4. The mean pregnancy rate and postoperative tubal length of women who received the tubal ligation by laparoscopic ring were(93.3%, 7.3cm), statistically significantly higher and longer than that of the women by laparoscopic cauterization(69.2cm, 5.1cm). 5. The postoperative tubal patency patency and pregnancy rate of isthmic-isthmic anastomosis were the higher rate(100%, 90%). 6. The mean postoperative tubal length of pregnant group(6.6cm) was statistically significantly longer than that of non-pregnant group(4.4cm). 7. No statistical differences were found in pregnancy rates according to the time of splint removal(3 days or 7 days after operation) and menstrual phase at that time of operation.

정자의 수정능력평가에 있어 일반 정액매개변수 , 정자운동성 지수 , 정자 침투거리측정법의 비교

김진홍(CH Kim),김은중(EJ Kim),손우석(WS Shon),권동진(DJ Kwon),임용택(YT Lim),이진우(JW Lee),김창이(CY Kim),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

Results were as follows; 1. The seminal parameters, SMI value and sperm penetration distance in both fertile & infertile groups showed significant statistical differences(p

Nd-YAG Laser를 이용한 가토의 미세 난관 문합술에서 문합부의 조직학적 소견

김진홍(CH Kim),고영미(YM Ko),김은중(EJ Kim),정기욱(KW Chung),권동진(DJ Kwon),김장흡(JH Kim),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

To study tubal adhesion, tubal patency and histologic difference under light, electronic microcopy in a site of anastomosis, authors performed three anastomosis surgery in rabbit fallopian tube;1-layer and 2-layer anastomosis in splint-not-used group(group 1) and in splint-used group(group 2) and laser anastomosis in splint-used group(group 3). 10 rabbits were used in each group, therefore the total number of experimental rabbits in 3 groups were 30. The results were as follows; 1. The degree of gross adhesion in group Ⅱ was significantly high as compared with other groups but there was no difference between left and right tube in the degree of adh- esion in each group(Table 1). 2. The incidence of tubal patency in group Ⅱ was significantly high(89%) as compared with group Ⅰ(44%). Especially, the incidence of tubal patency in group Ⅲ was significantly high(100%) but there was no difference between left and right tube in incidence of tubal patency in each group. 3. Inflammatory cell infiltration appeared in each group on optical microscopic examin- ation. Especially, fibrosis and inflammatory cell infiltration appeared more in group Ⅱ but there was no statistically significant difference. And there was no significant difference between left and right tube in each group. 4. Transmission electron microscopic examination of group I, as compared with normal control group, showed increase of microvilli and secretory granules and decrease in size of epithelial cell. Epithelial cell was morphologically transformed but maintained the original structure comparatively. TEM examination of group Ⅱ, as compared with normal control group, showed decrease of microvilli and secretory granules and flattening of epithelial cell. It showed that epithelial cell vanished in it`s original structure. TEM examination of group Ⅲ, as compared with normal control group, showed decrease of microvilli and increase of secretory granules and morphological transformation of epithelial cell. Group Ⅲ showed the resemblence to normal control group. From the above results, in reversal tuboplasty and tubal factor infertility, it is consi- dered that simple splint-used anastomosis or splint-used anastomosis with Nd-YAG laser will improve the successful rate of tubal anastomosis.

토끼난관 미세문합수술에서 문합부의 성장인자 ( TGF ) 발현의 비교

김진홍(CH Kim),노승혜(SH Rho),김은중(EJ Kim),정기욱(KW Chung),권동진(DJ Kwon),김장흡(JH Kim),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Twenty seven rabbits were divided into 3 groups of 1, 2-1 and 2-2(n=9 in each group). Arbitarilly cut ends of mid-ampullar portion of each tubes were microscopically reanastomosed using vicryl as suture material without intraluminal splint in group 1, using vicryl as suture material with intraluminal splint in group 2-1 and coagulation by Nd-YAG Laser beam as ref-usion method with intraluminal splint in group 2-2. A week after operation, the tubal tissue segments of reanastomosis were embedded into paraffin to examine the expression rate and intensity of TGF-β1, 2 and 3 by immunohistochemical staining. The results were as follows. 1. The expression rate of TGF-β1, 2 and 3 revealed no stastically significant difference between group 1 and 2. 2. Among comparisons group 2-1 and 2-2, the TGF-β1 expression rate in group 2-2 showed lower value than that in group 2-1 with stastical significance(P<0.05). The above fact that tuboplasty with Nd-YAG Laser using intraluminal splint resulted in lower expression rate of TGF β1 may suggest raising the succe ss rate of pregnancy.

원인불명 불임 여성혈청의 항정자항체검출에 있어 응집 , 부동화반응검사 및 Immunobead 검사의 비교

김진홍(CH Kim),유영옥(YO Yoo),정기욱(KW Chung),권동진(DJ Kwon),임용택(YT Lim),김장흡(JH Kim),김창이(CY Kim),이헌영(HY Lee) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.1

There are weveral methods of detecting antisperm antibodies in serum including method of sperm agglutination (Franklin-Duke test; F-D test), sperm immobilization (SIT), antiglobulin uptake, and immunofluorescences. Recently, much attention has been directed to the immunobead binding test (IBT). It allows us to determine the degree of binding and even to locate antibody binding site on the sperm itself. This test detect sperm-bound antibodies by using polyacrylamide bead which is coated with rabbit anti-human IgG, IgA, IgM respectively. This study was designed to compare the new IBT methodology with the classical tests, SIT and F-D test. Sera from 89 unexplained infertile women were assayed for antisperm antibodies using the IBT, SIT and F-D test simultaneously. Also, we tried to determine the immunoglobulin isotype of antisperm antibodies and its binding site on sperm. The results were as follows; 1. Among 89 infertile women, IBT-positive was found in 18 cases (20.2%) and IBT-negative was 71 cases(79.8%), and 15 cases (16.9%) were positive for SIT, compared to 20 cases (22.5%) for F-D test. Of the 18 IBT positive, 13 cases (72.2%) were positive for SIT and 7 cases(38.9%) were F-D positive. In the 71 IBT negative group, however, it is found that the SIT positive was 2.9% (2 out of 71), and F-D positive was 18.3% (13 out of 71) respectively. The correlations between IBT and SIT was statistically significant (p0.05) (Table 1,2). 2. The immunoglobulin of 18 IBT-positive sera was found to be IgG in 14 cases (77.7 %), IgA in 11 cases (61.1%), and IgM in 4 cases (22.2%). The 13 cases was positive for both IBT and SIT. Among them, IgG was detected in 10 cases (76.9%), IgA in 8 case (61.5%), and IgM in 3 case(23%). Likewise, 7 cases showed positive in both IBT and F-D test. In this group 5, cases (71.4%) have IgG, 4 cases (57.1%) have IgA, 2 cases (28.6%) have IgM respectively (Table 3,4). 3. In IBT positive infertile women, the binding site of antisperm antibodies was directed to the head in 63.0% of IgG, tail in 62.5 of IgA, and tail tip in 90% of IgM respectively (Table 3,4). The significant correlation we noted between the SIT and IBT finally made it possible to conclude that the SIT can replace IBT as a antisperm antibody detection method in a clinical setting. Most of antisperm antibodies in sera of unexplained infertile women, another our major concern, consists of IgG and IgA which located in the sperm head and at the tail respectively.

A Case of Secondary Amenorrhea in a Triple X Female

김진홍(CH Kim),박동춘(DC Park),김은중(EJ Kim),고영미(YM Ko),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

Jacobs and associates in 1959 were the first to report a case of triple X syndrome and to associate this chromosome abnormality with ovarian failure. The incidence of trisomy X in newborn population is estimated to be 1 in 1,000 live born females. Most of them have normal physical appearance and puberty. Therefore, the reported number of triple X females in the literature is low. They presented with episodes of amenorrhea, elevated levels of circulating folliclestimulating hormone, luteining hormone, and decreased estrogen concentration. Primary or secondary amenorrhea and premature menopause are common accompaniments, but there is no difficulty in puberty or secondary sex development. It is uncertain whether the menstrual difficulties are associated with the karyotype or the psychogenic factors. Such patients can produce, and generally there is no chromosomal abnormality in their children, if they produce. The writer experienced a case of secondary amenorrhea in a triple X female and so we reported in firstly in Korea with brief review of literature.

긴장성 요실금의 비수술적 치료

김진홍(CH Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

N/A

17 a-Hydroxylase 결핍으로 인한 남성가성반음양 1 예

김재훈(JH Kim),최소영(SY Choi),김장흡(JH Kim),김진홍(CH Kim),나종구(JG Na),강창석(CS Kang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

A 21-year-old phenotypic female with 46,XY genotype presented with primary amenorrhea, headache, absence of secondary sex characteristics, and hypertension. Further evaluation confirmed male pseudohermaphroditism having no nterus and adnexase. After basic hormonal study and ACTH stimulation test, we concluded 17 a-hydroxylase deficiency. Owing to the high risk of gonadal neoplasia in XY gonadal streaks, prophylactic removal of the steaks is recommended. Traditionally this procedure has been performed by laparotomy, but in this case laparoscopic gonadctomy was performed. Following treatment with hydrocrtisone, potassium, progesterone, 11-deoxycorticosterone, corticosterone and urinay pregnanediol levels were normalized. normal blood pressure measurements were achieved during treatment with hydrocortisone and estrogen with the patient. We report this case with a breif review of the literatures.

난소에서 Mullerian Inhibiting Substance의 발현

김장흡(JH Kim),김미란(MR Kim),권동진(DJ Kwon),김진홍(CH Kim),나종구(JG Na),김수평(SP Kim),김경미(KM Kim),강창석(CS Kang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Mullerian inhibiting substance(MIS) has been known as a non-steroidal testicular Sertolicell product responsible for the regression of Mullerian duct in male embryos. More recently MIS was also found to be present in an bioactive form in the bovine and rat ovaries but the function of MIS in the ovary has not been fully delineated. In this study, in order to understand its function in the ovary the ontogeny of the production profile of MIS and the pattern of its localization in ovaries from adult normal cycling women were studied by immunohistochemical staining using the rabbit polyclonal antibody against human recombinant MIS that almost completely blocks its biological activity. MIS was detected specifically and exclusively in the cytoplasm of granulosa cells. The flattened granulosa cells in primordial follicles failed to stain for MIS, but the cuboidal cells of growing follicles stained intensely. The granulosa cells of both single and multiple layered growing follicles showed strong specific staining for MIS. Within the multiple layers of granulosa cells, closer to the oocyte, stained more intensely than those near the basement membrane. Similarly, in antral follicles, cumulus cells and periantral granulosa cells stained more intensely than those in the periphery. MIS staining waned in the mature follicles just before ovulation and could not be found in atretic follicles, corpus albicans. In conclusion, this specific localization suggest that MIS may act as an intraovarian regulator of follicular development and oocyte maturation during the adult reproductive cycle.

체외수정 및 배아이식 후 발생한 난소임신 1 예

김미란(MR Kim),정기욱(KW Chung),권동진(DJ Kwon),임용택(YT Lim),김장흡(JH Kim),김진홍(CH Kim),정재근(JK Jung),강석진(SJ Kang),이원돈(WD Lee),임진호(JH Lim),이진우(JW Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

Primary ovarian pregnancy is a rare form of ectopic pregnancy. Its occurrence remains rare despite the increased risk of different forms of ectopic pregnancy following assisted conception. We report a case of ovarian ectopic pregnancy which followed in-vitro fertilization and embryo transfer[IVF-ET]. Conservative surgery was performed and subsequently a successful intrauterine pregnancy followed.