한국인 자궁경암에 대한 방사선요법 ( 예보 )

노경병(KB No),이승호(SH Lee),안승봉(SB Ahn) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.2

1. 한국인 자궁경암의 임상적 특징과 특히 방사선요법에 의한 치료성적을 확립키 위한 연구의 일부로서 자궁경암 50예에 Metastatic Series(Pretherapeutic baseline studies)를 마친 후 Intracavitary radium application과 External irradiation을 시행하였다. 2. 50예중 stage Ⅰ이 12예(24%), stage Ⅱ가 26예(52%), stage Ⅲ가 10예(20%) 그리고 stage Ⅳ가 2예(4%)였다. 3. Carcinoma 의 histological grade 는 intermediate group이 80%였다. 4. 환자의 연령은 44~55세가 가장 많았으며 최저 26세로부터 최고 68세까지 있었다. 5. 고등교육을 받은 환자들도 자궁암에 관한 지식이 박약하였다. 6. 경암진단지연의 책임중 16%는 의사에게 있다. 7. 방사선요법을 받은 후 방광질루가 8.3% 발생하였다. 8. 완전한 방사선요법을 받은 군에서 stage Ⅰ과 stage Ⅱ 의 Primary healing rate 은 각각 100%와 93%였다. In Korea as in other countries, carcinoma of the cervix is one of the most frequent gynecological problems. Until a few years ago it was treated mostly by surgical measures and partly by radiation therapy which was not too satisfactory due to lack of facilities. There are few reports on the clinical characteristics and the cure rate of carcinoma of the cervix in Korean medical literature. In our institution, since 1958 facilities for satisfactory radiation therapy have been available. Consequently we have directed our interest toward radiation therapy in addition to surgical measures in an effort to treat the disease successfully. The purpose of this preliminary report is to present 50 cases of carcinima of the cervix in Korean women treated with radiation therapy in an attempt to establish our own survival rate and clinical characteristics of this tumor. Among the various findings through this study the following are thought to be significant. 1) Fifty cases of carcinoma of the cervix treated by radiation therapy are classified as follows according to the international clinical classification. Stage Ⅰ24%, stage Ⅱ52%, stage Ⅲ20% and stage Ⅳ4%. 2) About 54% of cases are seen at the age between 45 and 55. The youngest case was 26 years and the oldest was 68 years. 3) Doctors are considered to be responsible for about 16% of diagnostic delay in this condition. 4) The indicence of vesicovaginal and rectovaginal fistulas up to the present are 5.5% and 8.3% respectively. 5) Primary healing was obtained in 100% in stage Ⅰ carcinoma of the cervix and in 93% in stage Ⅱ. The period at which primary healing was considered to have occurred was arbitrarily set at 3 to 6 months after the completion of therapy.

한국인 임부의 정상 정규 검사 결과에 대한 연구 ( 예보1 )

이승호(SH Lee),노경병(KB No) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.1

1. 한국인임부 320예에 산전규검사(Antenatal routine laboratory test)를 시행하고 각종검사결과를 고찰하였다. 2. 한국인임부의 혈색소 평균치는 11.02gm% Hematocrit 평균치는 34.59%이었다. 3. 한국인임부의 창내기생충검사에서 Ascaris Lumbricoides 77.7%, Anchylostoma duodenale 24.7%, Trichocephalus trichiurus 85.7%, Trichostrongylus Orientalis 29.1% 그리고 Clonorchis Sinensis 2.8%가 양성이었다. 4. 임부에 있어서의 뇨단백검사는 임신중독증 경중의 척도가 되며 그의 조기진단 및 치료방침 결정에 큰 도움이 되었다. 5. 임부 뇨당의 양성율은 약 8%였다. 6. 임부매독혈청반응양성율은 약 1.4%였다. 7. 임부의 활동성 폐결핵은 약 2.75%에서 양성이었다. 8. 임신중 소정의 진찰 및 검사를 받은 임부군은 안받은 임부군보다 산과적합병증의 발생 빈도가 현저히 낮았으며 특히 자궁내태아사망율은 전군에서는 1예도 없었음에 비하여 후군에는 12예나 되어 좋은 대조가 되었다..

자궁내구 기능부전증

문영기(YK Moon),노경병(KB No),황태식(TS Hwang) 대한산부인과학회 1962 Obstetrics & Gynecology Science Vol.5 No.1

Because of the rarity of reports on the subject of the "Internal os of the cervix" in Korea and the controversy about it`s management, six patients with incompetent internal os have been reported. These were seen at Yonsei University Hospital between February, 1956 and September, 1961. A modified Shirodkar operation was performed on 2 cases during the second trimester of pregnancy and resulted in a viable term fetus for both. A Lash operation was carried out on 1 case during the non pregnant siate. In the remaining cases, the patients delivered before it was possible to perform surgical correction. After reviewing the literrature on this subject, and in accord with the cases reported, the tentative policy for the management of this condition in our department has been presented. This plan is basically that those cases which are found during the non pregnancy are to be corrected by a Shirodkar operation and those who are diagnosed during the non pregnant state are to be corrected by either a Lash operation or a Shirodkar operation during next pregnancy depending upon desirability of children, age, and possibility of cooperation of the patients. A significant history of previous criminal adortion was found in those patients and probably represents on etiological factor.

융모종양에 관하여 ( 예보 )

황태식(TS Hwang),노경병(KB No),김두호(DH Kim) 대한산부인과학회 1962 Obstetrics & Gynecology Science Vol.5 No.2

This article is a preliminary report of the Yonsei University College of Medicine, from June 1, 1959 to July 30. 1961. A total of 20 cases were seen with the following distribution; Hydatiform mole 12, chorioadenoma destruent 1, choriocarcinoma 7. The following features were noted among the patients with hydatiform mole. One case was under age 25 and one case over 40 with all rest between the ages of 25-30. In the majority of patients tehre was a lapse of three months from the L>M>P> till the mole was passed but the shortest was 25 days and the longest was 155 days. 75% of the patients had a fever and at least 50% had a chilly sensation. Half the cases when first seen had uterine enlargement greater than expected by dates while 33% were consistent with their dates and the rest weresmaller than their dates. Toxemia was seen in 33% of the patients. One third of the patients who were less than 4 months pregnant or whose uterus was below the umbilicus had toxemia. Of the tow cases who were more than 4 months pregnant or whose uterus was enlarged above the umbilicus, one of them developed texemia. 25% of the patients devloped theca leutein cysts. The patients were managed by either pitocin induction or stimulation followed by a D&C. In one patient over 40 a hysterectomy was carried out after passage of the mole. the remaining paticnts were followed according to the chart seen in fig. 9 of the main article. The patients with choriocarcinoma ranged in age from 23 to 52 with three patients over 48 years old. The vast majority were multiparas. Four of the patients had a previous history of passing a mole and in the others there had been a normal delivery. None of the patients had had an abortion. Among the patients who passed a mole the diagnosis of carcinoma was made in one patient within 25 days and in the remainder before 10 months. Among the three patients who had had a normal pregnancy there was a time interval of 3 years in one case and 9 years in two cases. Theca lutein cysts were found in 3 cases. The Friedman test was positive in 100%. Metastatic lesions were found in the inngs in 57%, the vagina in 57% and in the broad ligament in 14%. A total abdominal hysterectomy and bilateral salpingoophorectomy was done in 4 patients. A combination of external rediotherapy and chemotherapy was tried in one case and no therapy was given in 2 cases. At present 2 patients have died, 3 are alive and well, and 2 have been lost to follow up.

자궁경부 열상으로 인한 습관성 유산 및 조산

정형오(SO Chung),홍준식(JS Hong),노경병(KB No) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.1

1. 습관성 유조산 환자중에서 심한 경부열상이 발견되었던 환자 11예에 대하여 임상적 관찰을 하였다. 2. 경부열상에 대하여 봉합술을 시행하여야 할 시기는 유조산 직후가 비임부시보다 유리함을 알았다. 3. 경부열상은 경부측방에서 흔히 발생하였으며 좌측에서 우측보다 더 많았음을 보았다. 4. 경부열상으로 인한 습관성 유조산을 예방하기 위해 힘든 겸자분만 인공유산 둔위만출술 자연 또는 인공적 급속분만후 기타 경부열상 발생을 의심케 하는 증후가 있을 때는 항시 자궁경부 열상의 유무를 조사하여 일차봉합술을 시행할 것을 주창하는 바이다.

자궁경부암의 임상 및 병리조직학적 연구

박종택(JT Park),노재윤(JY Ro),노경병(KB No),이유복(YB Lee),김동식(DS Kim) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.7

1971년 1월부터 1975년 12월말까지 만 5년간 연세대학교 의과대학 병리학교실에서 검색한 자궁경부 악성종양 총 1,243예에 대하여 임상 및 병리조직학 검사를 하여 다음과 같은 결론을 얻었다. 1) 자궁경부암은 같은 기간동안 발생된 전 여성 악성종양의 42.8%를 점하였다. 2) 검색한 총 1,243예의 자궁경부 악성종양중 편평상피암이 1,187예인 95.5%를 차지하였다. 3) 편평상피암중 상피내암, 침윤이 의심되던가 혹은 현미경적 침윤암 및 침윤암의 평균연령은 각각 42.9세, 45.0세 및 47.9세였으며 선암의 평균연령은 49.2세였다. 4) 편평상피암의 임상증상으로는 부정 성기출혈(56.5%), 악취대하(35.1%), 접촉성출혈(24.8%)등이었고 병력기간은 6개월이내가 66.1%였으며 평균 병력기간은 5.8개월이었다. 5) 초경이 16세에 있었던 환자가 73예로 가장 많았고 초혼연령은 16~21세 사이가 가장 많았으며 환자의 반수 이상인 53.3%에서는 폐경기 이후였다. 임신 및 분만횟수는 5~8회가 45.0% 및 47.0%로 가장 많았다. 6) 임상 각 기별 분포는 침윤암 350예중 48.6%가 제 2기였고 다음이 제 3기, 1기, 4기의 순위였다. 7) 상피내암과 침윤이 의심되던가 혹은 현미경적 침윤암의 상피내암의 핵유형으로는 small rounded type이 43.7%로 가장 많았다. 8) 침윤암의 분화 및 조직학적 세포유형에 따른 분류로는 Modified Broders Grade Ⅰ, Ⅱ, Ⅲ가 각각 2.5, 37.4 및 59.1%였고 large cell non-keratinizing, keratinizing, small cell형이 각각 83.3, 11.6 및 4.1%였다. 9) 분화정도에 따른 Brodersgrade와 조직학적 세포유형에 따른 분류가 각 기별 분포에 미치는 영향을 보면 분화정도와 각 기별 분포사이에는 별 연관이 없었으나 세포유형에 따른 분류와는 의의있는 관련이 있었다. 이상의 결론을 종합하여 보면 한국인에서 자궁경부암의 발생빈도는 상당히 높았고, 서구에 비하여 다소 젊은층에 호발되었으며 침윤암의 경우 조직학적 세포유형에 따른 분류가 예후와 연관이 많을 것으로 사료되었다. Clinical and histopathological studies were made on 1243 cases of malignancies of uterine cervix, that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 5 years from 1971 to 1975. The results were asummarized as follows; 1. Malignancies of the uterine cervix were 26.3% of total cancer of both sexes, and 42.8% of total female malignancies. 2. Among 1243 cases, 1187 cases(95.5%) were squamous cell carcinoma, in which 194 cases (15.6%) of in situ carcinoma, 72 cases(5.8%) of suspected or microinvasive carcinoma and 921 cases(74.1%) of invasive carcinoma were included. The adenocarcinoma was found in 48 cases(3.9%). 3. The average age of the patients with squamous cell carcinoma was 46.9 year-old; in cases of in situ carcinoma, it was 42.9, suspected or microinvasive, 45.0 and invasive, 47.9 year-old. The mean age of patients with adenocarcinoma was 49.2 year-old. 4. Clinical symptoms of the patients with squamous cell carcinoma in order of frequency were as follows; irregular vaginal bleeding(56.5%), vaginal discharge(31.1%) and postcoital bleeding(24.8%). Duration of the chief complaints was most commonly less than 6 months(66.1%) and the average duration was 5.8 months. 5. Among 260 patients with squamous cell carcinoma in which the age of the patients were noticed, menarche was most commonly 16 year-old(28.1%), and among 132 patients in which clinical histories were available, the most common age of marriage was between 19 to 21 year-old(37.9%). More than half of the patients(53.3%) were in post-menopausal period. Gravidity and parity 5-8 times in 45.0% and 47.0% with the average number of 6.7 and 4.8 times, respectively. 6. Subdivision of 350 cases of invasive carcinoma was made according to the clinical stage; stage Ⅰ, 170 cases(48.6%), stage Ⅱ, 108 cases(30.8%) and stage Ⅳ, 29 cases(8.3%). 7. The predominant nuclear configurations of the carcinoma in situ and suspected or microinvasive carcinoma were small rounded in 119 cases(43.7%), small elongate

특별한 혈소판 감소성 자반증에 합병된 만삭임신 1 예

한원희(WH Han),노성일(SI Rho),유국영(KY Yoo),노경병(KB No),이훈(H Lee),김은주(EJ Kim) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.1

ITP에 합병된 만삭임신에서 감마글로부린을 정맥주사하여 혈소판 수를 증가시킨 후, 제왕절개술을 성공적으로 시행한 1예를 체험하였기에 이를 문헌 고찰과 함께 보고하는 바이다 Idiopathic thrombocytopenic purpura may cause hemorrhagic complications in pregnant women, and transplacental transfer of IgG platelet autoantibodies often leads to neonatal thrombocytopenia Early splenectomy, corticoids and plasma exchange have all been used to provoke remission, and elective cesarean section is often recommended Infusion of high dose intravenous immunoglobulin is a new measure in treating ITP for reversal of platelet count with little side effect We report our experience with this agent in a pregnant woman with ITP and performed cesarean section safely