MCA 약물을 사용한 비수술적 여성 영구 불임술

나중열(JW Rha),구병삼(BS Koo),홍성봉(SB Hong),이수종(SJ Lee) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.3

Non-surgical permanent female tubal sterilization using Methylcyanoacrylate (MCA) was studied in 25 volunteers. The results are; 1. In the first MCA applications, bilateral tubal closure were 18 patients (72%), unilateral tubal closure were 4 patients(16%), and 3 patients were noted as bilateral tubal patentcy. 2. In the second MCA application with 3 unilateral tubal closure patients were all successful. 3. The total success rate after first and second MCA application were 100% (total 21 cases). 4. There were no specific subjective symptoms at the time of application, and there were no significant changes in menstrual, urinary and bowel functions. 5. It is concluded that the use of MCA in non-surgical permanent female sterilization is highly effective, safe and simple. so this methods of female sterilization would greatly contribute the national Family Planning Programs.

주산기Virus감염

나중열(JW Rha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.10

지금까지 언급한 것은 주산기에 발생할 수 있는 모체 및 태아(신생아)의 Virus감염중에서 소위 “만성주산기감염증”이라고 부를 수 있는 rubella, CMV,HSV,HBV등의 감염이 모체와 태아(신생아)에서 어떤 양상으로 발생, 전염,경과하며 이에 대한 치료나 대책은 어떠한지 알아보았다. 이들 질환은 아직도 감수성이 있는 가임기연령의 여성이 많으며 진단과 치료의 난점이 있고 또 이들 질환이 태아에 일으킬 수 있는 기형 또는 지속적인 감염상태를 감안할때, 모든 분야에서 아직도 정확한 자료에 의한 연구가 밝혀지지 못한 상태이기는 하나, 현재까지 규명된 가능한 예방법, 치료법 등을 통하여 사회적인 문제로 대두될 수 있는 선천기형이나 지능 지연등에 대한 적절한 대처를 할 수 있도록, 산과의들에게 이 문제들에 대한 세심한 주의를 기울이도록 요구하고 있으며, 특히 현재 점차 사용이 증가되는 특수항체검사에 의한 진단법,접종을 통한 예방법등에 대하여 앞으로 많은 관심을 기울여야될 과제라고 생각된다. 또 선천감염의 대책으로서 초기임신의 중절이나 또는 분만을 개조하는 경우의 무균조작,제왕절개에 의한 분만, 의심되는 증상에 대해서는 소아과의에게 충분한 정보를 제공함으로서 신생아의 격리면역,추적조사,적절한 치료등을 유도하여, 만성보균상태,감염의 근원등을 감소시키도록하고, 접종에 의한 전체 인구의 면역증가를 통해서 감염의 가능성을 줄이도록 노력하는것 등 이문제에 대한 산과의사의 기여가 한층 더 필요하게 되리라고 생각된다. 이것은 특히 과거에 희유하다고 여겨지던 주산기 virus감염의 빈도가 최근 보고되는 자료에 의하면 상당히 높음을 고려할때 더욱 그러하다.

거대 자궁근종의 1예

김종원(JW Kim),조기환(KH Cho),여재명(JM Yae),나중열(JW Rha) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.3

결론 32세의 미산부에서 발생된 거대한 1예의 자궁근종을 본 대학에서 경험하였기에 문헌고찰과 아울러 보고하는 바이다. A case of giant myoma in 32-year-old nulliparous woman is presented, and its literatures are reviewed briefly.

CO2 laser를 이용한 바토린선종양의 치료효과

이규완(KW Lee),나중열(JW Rha),구병삼(BS Koo),홍성봉(SB Hong) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.6

CO2 laser를 이용하여 21예의 바토린선 종양을 치료하여 다음과 같은 결과를 얻었다 1 바토린선종양의 종류는 21예중 14예가 단순종양이었고, 7예가 화농성종양이었으며, 종양의 크기는 3cm부터 8cm까지 다양하였으으나 평균크기는 4 8cm이었다 2 치료를 받은 군의 연령분포는 14세부터 53세사이였으며, 평균연령은 31 9세였고, 20∼29세군이 8예(38 1%)로 가장 많았다 출산력은 2회경산부가 5예(23 8%)로 가장 많았으며 평균출산횟수는 2 0회이었다 3 CO2 laser에 의한 수술시간은 21예 모두 10분 이내였으며, 마취는 18예에서 국소마취로 충분하였으나, 3예는 시술 중 동통을 호소하여 pethidine 50mg을 정주한 후 실시하였다 4 수술 후의 합병증으로는 7예에서 중등도 이하의 동통을 호소하였으며, 수술부위의 부종도 6예에서 호소하였으나, 7일이내에 모두 소실하였다 재발률은 21예중 1예로 4 8%였으며, 불충분한 기화때문이라고 생각된다 5 평균치유기간은 2 6주였고, 수술부위의 반흔은 4주 후에는 2∼3mm로 거의 발견할 수 없었다 Cystic enlargement of the duct of the bartholin gland is a common gynecologic disease caused by the obstruction of the duct dut to infection and scarring Many methods such as incision and drainage, excision of cyst, marsupialization of the cyst have been used to remedy this problem Each method has it`s benefits and limitations, but the CO2 laser may offer several advantages over more conventional methods in treating this common condition becasue it minimizes blood loss and abolishes the cyst capsule rather than leaving it exposed And laser surgery has been shown to be associated with rapid healing and a minimal amount of fibrosis Athors treated 21 cases of bartholin duct cyst such as 14 cases of simple cyst and 7 cases of bartholin`s duct abscess The follow up period were 6 to 18 months The results were abtained as follows: 1 Age distribution was between 14 and 53 years with 31 9 year of mean age, and the group of 20 to 29 year revealed highest incidence Mean parity was 2 0 1 An operation time was 10 minutes or less in all treated cases and no specific anesthetics and analgesics were necessary in the majority of cases 3 Postoperative complications were moderate pain and edema on the site of operation, but these symptom completely disappeared 7 days after operation 4 Complete healing took an average of 2 2 weeks and by the forth postoperative week, the site of operation was usually less than 2-3mm in it`s greatest dimention 5 In the follow up period of 6 to 18 months, these has been one recurrence According to our experience, the CO2 laser can be employed easily and successfully in the management of bartholin duct cyst The patient heals rapidly with no scar formation, no specific postoperative complications, no impairment of sexual function and low indicence of recurrence

임신부 양상의 변화 ( 1972~1982년 )

김숙희(SH Kim),나중열(JW Rha),홍성봉(SB Hong) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.5

From January 1971 to December 1982, 11,070 women were delivered at the Korea University Hospital. During the 12 years, maternity records were analysed retrospectively and following results were obtained: 1. In the age distribution for 11,070 cases, there were 56.0%(6,201 cases) in 25~ 29 year age group, 4.3%(470 cases ) in over 35 year age group, 0.4%(47 cases) in under 19 year age group. Over the years, maternal age was younger in late 1970s than in early 1970s. There were progressively decreased tendency in the proportion of old age mother. 2. In the parity of cases, 52.0%(5,760 cases) were primipara which was the highest incidence in the groups. There were no proportional differences between para 1 and para 2 groups in the early 1970s but the proportions of para 2 group decreased progressively in late 1970s. There were also decreased proportions in multipara cases by the years. 3. In the gravity of cases, 36.9%(4,080) cases were primigravidas that was the highest proportions in the groups over the years. The proportions of over gravida 5 cases were 13.9% in 1971, that was progressively decreased to 7.1% by 1982. 4. The methods of delivery were as follows; 64.2%(7,108 cases) by spontaneous vaginal delivery, 13.2%(1,456 cases) by vacuum extraction, 17%(1,885 cases) by Cesarean section. The percentage of C-section was increased by the years from 8.7% in 1971 to 27% in 1982, but sponaneous vaginal delivery and vacuum extraction were decreased over the years. 5. Indications of C-section revealed that 32.9%(624 cases) caused by cephalopelvic disproportion, 23.3%(442 cases) caused by previous C-section. Over the 12 years, the proportions of C-section caused by breech presentation and previous C-section increased. 6. In the types of C-section, most of physicians preferred low cervical trasverse incision(95.1%), whereas classical C-section decreased progressively. The percentage of cesarean hysterectomy have decreased since late 1970s. 7. There were no proportional difference in the body weight of new borns by the years. But the stillbirth rates decreased from 44.14 in 1972 to 21.82 in 1982.

기능장애성 자궁출혈의 임상 및 병리학적 연구

김숙희(SH Kim),조기환(KH Cho),나중열(JW Rha) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.6

Dysfunctional uterine bleeding is abnormal bleeding unassociated with tumor, inflammation or pregnancy. Pathologic studies have shown that although wuch uterine bleeding can be associated with any type of endometrial pathology, the most common finding is a nonsecretory pattern(novak, 1975). The division of patients into those with nonsecretory pattern is important as it distinguishes anovulatory from ovulatory types of bleeding. DUB may occur at any age and is one of the most common gynecological complaints, so the clinical and pathological studies in DUB and its relation of ovulation were studied and a brief review of literature was made. 117 cases of DUB were obtained by endometrial curettage and biopsy. The results were as follows; 1) Age distribution of DUB (117 cases) was mainly in 4th decade and 5th decade of life. 2) DUB patients were mainly multigravida and showed 4-5 times of pregnancy and 2-3 times of delivery. 3) The bleeding patterns revealed that menorrhagia with intermenstrual bleeding(45%), were most frequent and intermenstrual bleeding(31%). 4) Histologic findings of endometrium were proliferative phase, 76 cases (65%), hyperplasia, 21 cases(17.9%), and secretomy phase, 17 cases(14.5%) in order of frequency. 5) In 95 cases analysis, considering 64 patients subjected to curettage in the second half of the menstrual cycle, only 12 cases(18.8%) showed secretomy endometrium. Special emphasis was made on the relatively high frequency of anovulation.

Bochdalek공을 통한 선천성 횡경막 탈장증 1 예

김탁(T Kim),김진홍(CH Kim),나중열(JW Rha),홍성봉(SB Hong) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

저자등은 21세의 건강한 임신부에서 36주에 부분 전치태반으로 제왕절개만출술을 시행하여 태어난 2900g의 남아에서 선천성 횡경막 탈장을 발견하여 수술을 권유하던 중 사망한 1례 를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Congenital disphragmatic hernia occures about one in every 2200 new born infant and is a condition in which the abdominal contents protured into the thoracic cavity through a congenital defects in the diaphragm. congenital diaphragmatic hernia is divided into two types; one is herniation through the foramen of morgagni and the other is gerniation through the foramen of Bochdalek. Herniation trough the foramen of Bochdalek is the most common type of congenital diaphragmatic hernia nd requires emergency operation in the affected new born infants. Congenital disphragmatic hernia is frequency associated with congenital heart disease Down`s syndrome, hydrocephalus, undersceded testis, ureteral reflux meckel`s diverticulum, malformation of mid gut. We experienced one case of herniation through foramen of Bochdalek and presented this case

자궁통이 척수반사에 미치는 영향

나중열,노태성,윤영옥,홍승길 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.6

출산시나 자궁에 병변이 있을때 허리에 통증을 호소하는 수가 있는데, 허리근육의 수축이 이 에 관련되는지를 밝혀보고자, α-chloralose로 마취한 고양이에서 통각 유발물질인 bradykinin 을 고양이 자궁동맥을 통해 주입한 후 32개의 단일 척수운동신경섬유에서 임펄스 발사빈도의 변화 즉, 척수반사를 관찰해 보았다. 그 결과 척수전근에서 α-운동신경 세포로 생각되는 신경세포와 γ-운동신경 세포로 생각되 는 신경세포 모두에서 임펄스 발사빈도가 증가되는 경우들을 많이 발견할 수 있었다. 척수 level에 따른 반응의 정도를 비교해 본 결과 구심성 하복신경이 가장 많이 입력되는 L4에서 가장 반응이 컸고, L3, L2로 갈수록 작아지는 경향을 나타내었다. Bradykinin을 정맥을 통해 주입하였을 때, α-운동신경세포는 반응하지 않았 고, γ-운동신경세포는 임펄스 발사빈도가 증가되었으나, 자궁동맥을 통해 주입한 경우보다는 그 반응이 적었다. 이상의 결과로 볼 때 자궁에 동통이 유발되면 구심성 하복신경을 통해 척수로 들어간 통각신 호가 반사기전으로 척수 운동신경의 활성을 증가시켜 허리 근육을 수축시킨다고 생각되며, 이것이 허리에 통증을 호소하게 되는 기전의 하나일 가능성을 시사해 주고 있다. Many parturients and patients who have uterine disease develop the low back pain. Whether the spasmic contraction of the back muscles can be the cause of the low back pain is the subject of this study. The changes of impulse discharge rate were recorded from the 32 single spinal motoneurons in the ventral roots of alpha-chloralose anesthetized cats. We could find many spinal motoneurons both those supposed to be α-motoneurons and those supposed to be Υ-motoneurones which increase the impulse discharge rate as the response to the algesic substance, bradykinin injected into the uterine artery. The response was largest at the L4 ventral root, and decreased gradually as the level was changed to L3 and L2. When the bradykinin was injected intravenously, the spinal motoneurons supposed to be γ-motoneurons increased impulse discharge rate. But the response was smaller than to intra-arterially injected bradykinin. These results suggest that the signal of uterine pain which is transmitted to the spinal cord by way of the hypogastric nerve activate the spinal motoneurons which elicits the contraction of the low back muscles. This mechanism may be one of the explanations of the causes of the low back pain as the symptom of the patients at the clinics of obstetrics and gynecology.

자궁내 감각 수용체의 화학수용적 특성에 대한 연구

나중열,정용훈,홍승길,한희철 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.1

통각유발물질로 알려진 bradykinin, capsaicin 그리고 potassium chloride 등의 화학물질을 자궁내 수용체에 자궁동맥을 통하여 투여하고 이들의 반응을 관찰하므로써 자궁수용체의 화학수용적 특성을 규명하기 위하여 alpha-chloralose로 마취한 고양이의 하복신경에서 29개의 단일 자궁구심성 신경섬유를 분리하여 흥분발사를 기록한 결과 다음과 같은 결과와 결론을 얻었다. 1. 본 실험에서 얻어진 자궁을 지배하는 29개의 구심성 신경섬유는 9개의 A-d군 신경섬유와 20개의 C군 신경섬유로 나타났다. 2. Von Frey hair자극에 대한 반응은 27개의 신경섬유에서 얻어졌으며 이들의 반응은 자극의 세기에 비례하여 증가하는 단계반응(graded response)을 보였다. 3. 자궁동맥을 통하여 bradykinin 2-10 micro g을 투여한 결과 시험한 27개의 자궁구심성 신경섬유중 74.1%인 20개에서 흥분반응을 관찰하였으며 이러한 반응은 강한 자궁수축을 동반하였다. 자궁구심성 신경섬유의 bradykinin에 대한 반응은 주입한 bradykinin의 양에 비레하는 용량의존성 관계를 보였다. 또한 자궁의 수축은 시간적으로 자궁구심성 신경섬유의 흥분반응에 선행하여 나타났다. 4. Capsaicin 1-2 micro g에 대하여는 20개의 자궁구심성 신경섬유중 50%인 10개에서 흥분반응을 보였으며 동시에 자궁의 수축도 동반되었다. Capsaicin에 의한 자궁구심성 신경섬유의 흥분반응과 자궁의 수축반응은 bradykinin에 대한 반응과 매우 유사하게 나타났다. 연속적인 capsaicin주입에 대하여 자궁구심성 신경섬유의 반응은 유의한 변화가 없었으나 자궁의 수축은 점차 감소하는 경향을 보였다. 5. 15개의 자궁구심성 신경섬유에 potassium chloride 0.1ml*0.15M과 0.1ml*0.3M를 투여한 결과 87.7%인 13개에서 흥분반응을 관찰할 수 있었다. 이러한 반응은 bradykinin과 capsaicin에 대한 반응에 비하여 반응기간은 짧게 나타났으나 최대 임펄스 발사빈도는 오히려 크게 나타났다. 2개의 자궁구심성 신경섬유는 오직 potassium chloride에 대하여만 흥분반응을 보였다. 6. 평활근 수축억제제인 loperamide는 낮은 농도에서는 자궁근의 수축을 감소시켰으며 보다 높은 농도인 20 micro g에서는 완전히 자궁수축을 억제하였다. 그러나 이와같이 자궁수축이 완전히 억제된 상태에서도 bradykinin에 대한 자궁구심성 신경섬유의 흥분반응은 계속 유지되었다. 이상의 결과를 종합하여 볼때 자궁내에 존재하는 자궁수용체는 자궁동맥을 통하여 주입된 여러종류의 통증유발물질에 의하여 활성화 될 수 있으며 이들에 대한 흥분반응은 자궁근의 수축이 완전히 억제된 상태에서도 유지되었다. 이러한 사실은 자궁수용체가 화학수용적 특성을 지니고 있다는 것을 강력히 시사하고 있다. This present study was performed to investigate the response of the uterine receptors to chemical substance, i.e potassium chloride, bradykinin and capsaicin which are known as algesic substance and to examine the chemoreceptive properties of uterine receptors for them. The recordings were done from 29 single uterine afferents in the hypogastric nerve of alpha-chloralose anesthetized cat. The results are as follows. 1. The twenty nine uterine afferents that obtained tin this study were composed of 9 A-delta fibers and 20^ fibers. 2. The response to von Frey hair were showed in 27 uterine afferents. The higher the stimuli was applied, the larger the magnitude of response was revealed, and so they showed graded response. 3. Bradykinin(2-10 micro g) were applied to the receptive field of 27 units through the uterine artery. Among them 20 units(72.1%) showed response of increased inpulse discharge to the injected bradykinin and it was followed by intense uterine contraction. And the response had dose dependent relationship to the injected bradykinin. But the initiation of uterine contraction preceded the response of uterine afferents to bradykinin in time relation. 4. 10 of 20 uterine afferents (50%) were stimulated when capsaicin (1-2 micro g) was injected as a bolus into the uterine artery. The response of uterine afferents and uterine contraction had similar pattern with the bradykinin in dose dependent relation and chronological sequence. In the nerve activity, there is nosignificant desensitizing effect but the uterine contraction curve had tendency to diminish with the serial injection of capsaicin. 5. 13 of 15 units (86.7%) revealed increased response when tested with potassium chloride of dose from 0.1 ml of 0.15M to 0.1 ml of 0.3 M concentration. Comparing with the response to bradykinin and capsaicin, the duration of response was smaller but the peak discharge was larger. The two units did not show any response to bradykinin and capsaicin but excited only by potassium chloride. 6. Loperamide, smooth muscle relaxant, diminished the magnitude to uterine contraction at lower dose (2-10 micro g) and completely abolished the contraction at higher dose (20 micro g). But the response of uterine afferents to bradykinin persisted yet inspite of complete abolition of contraction. To summarize the above results, uterine receptors were activated by the various algesic chemicals injected through uterine artery and they showed persistent response during elimination of uterine contraction. It could suggest that there might be uterine receptors that have chemoreceptive properties.

자궁 - 골격근 반사에 관한 신경회로 연구

나중열,윤영옥,홍승길,남궁미경,남숙현 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

분만시 및 자궁에 병변이 있을 때 허리에 통증을 동반하는 경우가 있는데 자궁의 통증이 허리근육의 수축을 유발시키는지를 알아보고자 a-chloralose로 마취한 고양이에서 통각유발물질인 bradykinin과 potassium chloride를 자궁동맥을 통해 주입한 후 요수 4번째 수준에서 나와 최장근을 지배하는 34개의 단일 운동신경섬유에서 임펄스 발사빈도의 변화를 관찰하였다. 최장근을 지배하는 a-운동신경섬유와 y-운동신경섬유 모두에서 자궁근내로 주입한 bradykinin과 potassium chloride에 대해 임펄스 발사빈도가 증가하였으며 bradykinin 이 potassium chloride에 비해 좀 더 반응기간이 길게 지속되었다. 이상의 결과로 볼때 자궁에 동통이 유발되면 구심성 하복신경을 통해 척수로 들어간 통각신호가 반사기전으로 근육운동신경의 활성을 증가시켜 허리근육을 수축시킨다고 생각되며 이것이 허리에 통증을 호소하게 되는 기전의 하나일 가능성을 시사해 주고 있다. Many parturients and patients who have uterine diseases suffer form low back pain coin-cidently Whether the contraction of the longissimus muscle can be evoked by uterine pain is the purpose of this study. Recordings have been made from 34single efferent nerve fibers of longissimus muscle at L level of the a-chloralose anesthetized cat. The obtained results are summerized as follows; 1. Impulse discharges of 34 muscular efferents were recorded. Among them 21 fibers were a-motor fibers and 13 fibers were y-motor fibers. 2. 21 a-motor fibers revealed the increased impules dischasrges to the injected brady-kinin adn potassium chloride into rterus. 3. 13 y-motor fibers had increased responses to intra-arterially injected bradykinin adn potassium chloride into uterus. 4. The excitation response of bradykinin had logner duration and less small peak discharge in comparison with that of potassium chlorde. These results suggest that the signal of the uterine pain which was transmitted to the spinal cord gy way of the hypogastric nerve activated the back muscle efferents which elicited the contraction of the back muscle. This reflexive responses may explain the back pain by which uterine pain is accompanied.