제왕절개술후 반흔과 충수돌기에 발생한 자궁내막증 2 예

최규홍(KH Choi),김희진(HJ Kim),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.7

저자들은 1982년 2월 본 병원에서 한국인의 희귀한 제왕절개술 반흔에 발생한 자궁내막증과 1983년 4월 충수돌기에 발생한 자궁내막증을 각각 경험하였기에 문헌고찰과 함께 보고하는 바이다. We have experienced two cases of endometriosis of which one was found in abdominal wall scar formed after cesarean section and the other in the appendix during explorative laparotomy This paper presents those cases and a brief review of the literatures.

복강경 불임시술 후에 속발된 자궁외임신에 관한 임상적 고찰

한규완(KW Han),박상철(SC Park),김희진(HJ Kim),홍진기(JK Hong),최규홍(KH Choi) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

1985년 1월1일부터 1986년 12월31일까지 본 청구성심병원 산부인과에서 치료받은 55명의 자 궁외임신 환자중에서 복강경 난관불임시술 후에 자궁외임신이 발생된 14례를 대상으로 임상 적인 관찰을하여 다음과 같은 결론을 얻었다. 1. 자궁외임신의 발생빈도는 총분만 1572례중 55례로서 3.5%였고, 관찰한 총 55례의 자궁외 임신 중에서 전에 난관 불임시술을 받은후 자궁외임신이 발생한 예는14 례로서 자궁외임신 중 25.5%를 차지함으로써 자궁외임신의 발병 원인중 가장 중요한 요소가 전의 난관 불임시 술이었음을 볼 수있엇다. 2. 호발연령층은 26세에서 35세사이가 전체의 71.4%였다. 3. 임신력은 평균 5.3회 분만력은 2회 분만이 가장 많았고, 3회 분만이 그 다음을 차지하였 다. 4. 임상 증상은 하복통과 질출혈이 가장 흔한 증상(57.1%)이었고, 무월경, 질출혈, 하복통, 쇼 크 등의 임상 증상을 보였다. 5. 증상이 발현된 사기는 최종 월경일로부터 계산하여 8주에 가장 많았고, 평균 7주에 나타 남을 볼수 있었다. 6. 복강경 불임시술을 받은 후 자궁외임신이 발병하기까지는 43개월에서 48개월이 소요되는 경우가 가장 많았다. 7. 거의 모든 예에서 다그라스와 천자 소견이 양성이었다. 8. 57%에서 뇨임신 반응검사가 양성을 보였다. The incindence of ectopic pregnancy was reported to be increased recently throughout the country presumbly chiefly due to the previously performed laparoscopic tubal sterilization several authors have reported that the single major etiologic factors for tubal pregnancy was previous laparoscopic tubal sterilization. This study was taken to evaluat the clinical and statical nature of ectopic pregnancy which were diagnosed and treated at the Department of Obsterics and Gyunecology, Chung Goo Sung Sim Hospital during 2 years from January 1, 1985 to December. 31 1986. The results were as follows; 1. 25.5% of ectopic pregnancy was develped in patients who had previous laparoscopic tubal sterilization . this indicates that the laparoscopic tubal sterilization is a single major etiologic factors for the development of ectopic gestation. 2. Age distributions was respectively five cases between 26 to 30 yrs and 31 to 35 yrs old, three between 36 to 40 yrs old and one over 40 yrs old age. 3. The parity of the most of women who had treated under the diagnosis of ectopic pregnancy was two. 4. Major clinical symptoms and sings were abdominal pain and vaginal bleeding, amenorrhea, and signs of hypovolemia. 5. Most of the symptoms were developed between eight weeks from LMP. 6. The interval between the development of ectopic pregnancy and laparoscopic tubal sterilization was average 45.7 months. 7. Almost all cases had revealed positive culdocentesis findings . 8. 57% of cases had revealed posivie urine hCG test.

흉부대동맥에서 발생된 Takayasu 동맥염의 풍선혈관확장 1예

김희진,고영엽,강성인,최규복,윤견일,정호인,정은철 梨花女子大學校 醫科大學 醫科學硏究所 1992 EMJ (Ewha medical journal) Vol.15 No.1

Takayasu's arteritis is a nonspecific inflammatory process of unknown etiology affecting segmentally the aorta and its main branches. The predominant clinical features were reducion of amplitude of peripheral arterial pulses, vascular bruits, and raised blood pressure. Usually it can be managed with medical treatment and surgical treatment. Recently percutaneous transluminal balloon angioplasty is performed, but the report of balloon angioplasty of the thoracicaorta is rare. Authors experienced a case of percutaneous transluminal balloon angioplasty of Takayasu's arteritis involving thoracic arota. The peak systolic gradient across the constriction decreased from 90mmHg to 20mmHg immediately after dilatation and the pulses of the femoral and the dorsalis pedis arteries were palpated after angioplastic dilatation.

임신중의 급성 신우신염에 대한 고찰

최규홍,김희진,이기동,박상철,최영주 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.6

1985년 1월 1일부터 1989년 12월 31일까지 청구성심병원 산부인과에 입원하였던 임산모 4,851명에 대하여 임산중과 분만후 6주이내에 급성 신우신염으로 판명된 53예를 대상으로 다음과 같은 임상적 연구결과를 얻었다. 1. 동 기간중 산부인과를 방문한 4,851명의 산모중에서 53예가 급성 신우신염으로 입원하여 그 빈도가 1.09%를 보였다. 2. 임신기간별로 볼 때 그 빈도가 임신중에는 임신중기가 35.8%로 가장 많았고, 분만후에는 26.4%를 보여 분만후보다 분만전이 발병율이 높았다. 3. 가장 발생이 많은 연령층은 주로 임신적령기 (25∼29세)때로, 45.3%를 보였으며 평균발생연령은 28세였다. 출산경력상으로는 초산부에서 53명중 33예(62.3%)로 가장 많았다. 4. 급성 신우신염을 유발시키는 기왕력을 보면, 원인불명이 22예(41.5%)이고 과거 요로감염이 있었던 환자가 총 15예(28.3%)와 도뇨가 9예(17.0%)순이였다. 5. 임상증상중 가장 흔한 것은 고열 오한이 50예(41.0%)였으며, 그 다음으로 혈복부동통과 요통이 46예(37.7%)였으며, 특히 우측이 좌측에 비하여 3배정도 높았다. 35예에서 (66.0%) 38℃이상의 고열을 동반하였으며, 대부분이 입원후 48시간만에 고열의 소실(23예, 43.4%)를 보였다. 6. 증상이 시작되어 입원하기까지 기간으로는 1주이내가 23예(43.4%)로 가장 많았으며, 2주이내가 19예(35.8%)로 나타났고, 2주이상 지속된 예(11예, 20.8%)도 있었다. 7. 요검사소견에서 백혈구수가 5/HPF이상 보인자가 53명중 41예(71.5%)로 나타났으며, 이 중에서 백혈구수가 31/HPF이상 보인 경우가 25예(47.2%)로 가장 많았고, 정상을 보인 경우도 12예(22.6%)였다. 혈액소견상에서도 백혈구수가 8,000/㎣이상 보인 경우는 42예(79.2%)로 나타났다. 8. 요세군 배양검사상 그람음성균이 양성균에 비하여 26예(63.4%)로 가장 많았는데, 이 중에서 대장균이 22예(53.7%)로 높았고, 그 다음이 포도상구균이 4예(9.8%)였다. 혈액배양에서도 역시 대장균이 3예(42.9%)였다. 9. 약제에 대한 감수성소견에서는 대장균이 amikacin(78.3%)에 감수성이 높았으며 포도상구균은 ampicillin에 (77.6%), pseudomonas은 gentamycin에 (76.9%) 연쇄상구균은 erythromycin에(75.5%) 감수성이 있었다. 10. 태아에 미치는 영향으로는 신우신염으로 입원한 산모와 조산관계는 큰 차이를 발견할 수가 없었다(8.5% : 9.5%). Acute pyelonephritis is the most frequent complication involving the urinary tract, as well as the most frequent medical cause of hospitalization, during the course of pregnancy. And associated with risk to the mother and fetus. We have retrospectively evaluated 53 cases among 4,851 pregnant women following an acute episode of pyelonephritis during pregnancy admitted at the Chung Goo Sung Shim Hospital during the 5 years period from Jan. 1, 1985 to Dec. 31, 1989. The incidence was 53 cases out of 4,851 gestational women cases during the same period and the rate was 1.09%. Acute pyelonephritis occurred usually during the second trimester and third trimester. It was most common in second trimester (35.8%) and postpartum (26.4%). The most prevalent age distribution was seen in the age grup of 25 to 29 years. The average age was 28 years old. And is commoner in primiparas than in multiparas, that is does occur in about 62.3% of primiparas, rising to about 37.5% in multiparas. History of previous factors were unknown in 22 cases (41.5%) of all cases, followed previous urinary tract infection in 15 cases (28.3%) and were due to previous catheterization in 9 cases (17.0%). As to the initial chief complaints, high fever and chils was found in 50 cases (41.0%) and flank pain or lumbago was 46 cases (37.7%). The right flank tenderness was affected 3 times (32 cases) more than left (9 cases), and 12 cases were bilateral. The febrile condition was 38℃ or more in 41 cases (71.5%) of the patients, 23 cases were completely afebrile within 48 hours after the onset of therapy. On duration of symptoms and signs until admission, 23 cases (43.4%) of all cases were less than 1 week but 11 cases (20.8%) were more than 2 weeks. In the microscopic urinalysis, white blood cell count per the high power field ( 5/HpF) was measured in 41 cases or 71.5%. Of these 41 cases, 25 patients (47.2%) were identified the leukocytosis with more than 31/HpF of ㅉ but normal urine was seen in 12 cases (22.6%).And the serum leukocytosis(8,000/mm3)was found in 42 cases (79.2%). The most frequently associated Gram negative organisms(63.4%)more than positive organisms(17.1%)in the urine at colony counts of $gt; 105 per milliliter.The most predominant microorganisms isolated was coliform and of these Wscherichia coli was the most common organisms(53.7%)and the rest was staphylococci organisms.And the Escherichia organisms was cultured from the blood of 3 cases(42.9%)of the patients. In sensitivities for this microorganisms, Escherichia coli was highly sensitive to Amikecin(78.3%),Ampicillin(74.9%).And the staphylococci was highly sensitive to Ampicillin(77.6%), Clindamycin(75.8%). In correlation between the pregnant women with pyelonephritis and the pregnant women without phelonephritis for prematurity there was no relationship between the two(8.:9.5%).And there was no spontaneous abortion and neonatal anomaly in this study.