갱년기

노영철(YC Roh) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.11

다른동물들은 노화하여 자연사하는 날까지 생식을 하는데 반하여 인간만은 어느 일정한 년령에 도달하면 생식능력을 상실하게 된다. 로마시대에는 전체여성의 평균수명이 23세였다고 하므로 폐경을 경험하는 여성이 극히 드물었고, 17세기까지도 전인구의 28%만이 폐경에 도달할 수 있었다. 현재에는 95%의 여성이 폐경을 경험하게 되며 전 여서의 50%가 75세까지 살 수 있으므로 전수명의 1/3 이상을 생식능력이 엇이 지내게 되는 것이다.

초음파 단층상을 이용한 골반종양의 진단적 가치

노영철(YC Roh),임정애(JA Im),나종구(Rha CG),김승조(SJ Kim) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.1

골반내 종양이 임상적으로 의심되는 부인과환자 175예에서 1회 이상 초음파진단장치를 실시하여 임상적소견과 단층상의 소견을 비교 분석하고 추적검사나 수술후 소견으로 다음과 같은 결론을 얻었다. 1) 총 175예에서 임상적으로 자궁근종이 의심되던 39예, 자궁부속기종양이 의심되던 78예, 종괴를 겸한 골반복막염 4예,포도상기태 30예중 초음파단층상만으로 특징적인 소견을 나타 내어 단독 확진이 32예(18.2%)에서 가능하였다. 2) 175예중 자궁근종 32예와 자궁부속기종양 68예 및 포도상기태 19예등 119예(69.5%)에 서는 내진소견이나 현병력을 참조한 초음파단층상의 진단이 가능하였고 단층상에 의하여 이 차성변화, 악성도판정 또는 종괴의 정확한 크기 및 그 성질을 정확히 간파할 수 이었다. 3) 175예중 24예(12.3%)는 추적검사, 수술결과 및 병리조직검사상 초음파진단과 상이함을 확인하였다. Although the clinical use of diagnostic ultrasound is well established, it`s value in gynecology is yet controversal. Authors experienced the 175 consecutive gynecologic patients, under the diagnosis of pelvic tumors including 45 cases of myoma uteri, 87 cases of adnexal masses, 30 cases of hydatidiform mole, 9 cases of malignant pelvic masses and 4 cases of pelvic inflammatory diseases with masses, clinically. They were assessed to the value of the ultrasonogram as the diagnostic procedure; they are divided from 3 group that diagnostic pictures with only ultrasound, adjunctive pictures in coincidence with clinical impression and the group with missed sonographic diagnosis. Final diagnosis was confirmed by operative findings and/or repeated sonographic picture and pathologic results in the clinical courses. Ultrasonogram was of great diagnostic value in myoma uteri and benign ovarian cysts among the pelvic tumors. The full bladder technic is used as an index of the differential diagnosis of solid and cystic masses. 1) As the energy volume is amplified (regulating by total gain, near gain and STC set in our apparatus), fluid filled structure remain relatively echo­free while solid structure is filled up with multiple echoes. 2) Especially, soild mass such as myoma uteri is poorly penetrated with ultrasound and with only increased STC(-3), the posterior wall of uterus is clearly defined. Otherwise, cystic mass such as ovarian cyst is well demarcated with linear echoes in lower grade of energy volume. 3) In myoma uteri with pregnancy, the power of penetration in ultrasound is more attenuated than solid mass. 4) The malignant pelvic masses are not characteristic in the sonographic pictures recently. The results are as follows: 1. Diagnostic ultrasonogrphic pictures are drawed in 32cases of the 175(18.2%). That is, 7cases of 39 in myoma uteri and 10 of the 78 cases in ovarian cysts, 11 of the 30 cases in hydatidiform mole, 4 cases of pelvic inflammatory diseases with mass are confirmed by only ultrasonogram. 2. Adjunctive information including accurate size of mass, secondary change of tumor are obtained in the 32 of myoma uteri, 68 of ovarian cysts and 19 cases of hydatidiform mole. (69.5%) 3. In 24cases among the 175, the ultrasonographic diagnosis are inaccurate. (12.3%). Most of malignant pelvic tumor are not diagnostic at present. Generally, the interpretation of sonographic picture is based upon the above characteristic findings.

산부인과영역에 있어서의 초음파진단의 이용

노영철(YC Roh),나종구(Rha CG),하상호(SH Ha),이헌영(HY Lee) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.8

1974년 7월1일부터 동년 9월10일까지 가톨릭의과 대학 부속 성모병원 산부인과에 입원한 환 자 및 외래환자 302명을 대상으로 A-mode B-mode 가 겸한 초음파 진단장치를 이용하여 다음과 같은 결론을 얻었다. 1. 초기임신의 진단을 위한 20예중 임신 6주이전에는 태낭상의 발견이 어려웠으며 임신 7주 부터는 환사의 태낭상을 용이하게 발견할 수 있었고 임신 14주부터는 아두상을 볼 수 있었 다. 2. 10예의 절박유산증중 임신의 지속이 어려울것으로 예측했던 4예중 2예에서는 자연유산으 로 중절되었다. 3. 5예의 불완전유산과 3예의 계류유산은 임상증상과 일치하였다. 4. 4예의 포상상기태중 부분기태 2예를 제외한 3예는 전형적인 초음파 단층상을 나타냈었다. 5. 태반위치를 확인하기 위한 8예중 2예의 전치태반과 2예의 태반초기박리를 확인할 수 있 었으나 나머지 4예에서는 태반위치의 확인이 어려ㅇ다. 6. 3예의 다태임신, 1예의 뇌수종 기형아, 30예의 이상태위의 진단에는 단순 복부 X-선 촬영 없이 신속하고 정확하게 진단할 수 있었다. 7. 산후 자궁수축부전증에서 태반 잔유물이나 혈괴를 산모 퇴원전에 발견하여 제거해 주므 로써 만기 자궁출혈을 예방할 수 있었다. 8. 13예의 난소종양, 2예의 자궁근종을 수술전에 크기, 위치 및 성상을 알수 있었다. 9. 6예의 자궁외 임신에서는 골반강내의 혈괴를 확인할 수 있었으며 자궁강내에서는 태낭상 을 발견할 수 없었다. 10. 3예의 자궁강내 피임장치를 쉽게 확인할 수 있었다. 1. The gestational ring before 6 weeks of pregnancy could hardly be recognized, however, after 7 weeks of pregnancy it was easily detectable. The fetal head was detectable after the 14 th weeks of pregnancy 2. Two of 4 cases which was suggested to interrup the pregnancy among 10 cases of threatened abortion clinically was noticed spontaneous abortion. 3. 5 cases of incomplete abortion and 3 cases of missed abortion were consistent with the clinical symptoms. 4. 3 cases of hydatidiform mole except 1 case of partial mole was shown the typical ultrasonic mole pattern. 5. placental location could not be easily identified for vaginal bleedings of 3rd trimester pregnancy. 2 cases of partial placenta previa and 2 cases of abruptio placenta were diagnosed, but 4 cases could`t be detected. 6. 3 cases of multiple pregnancy, 1 cases of hydrocephalus and 30 cases of abnormal pregentation were easily diagnosed without X-ray examination. 7. In many cases of insufficient postpartum uterine contraction were detected the placental remnants or blood clot before discharge, so we could prevent the late uterine bleeding. 8. 13 cases of ovarian tumor and 2 cases of myoma uteri were recongnized before operation. 9. In 6 cases of ectopic gestation was found the accumulated peritoneal blood, and not saw the intrauterine gestational sacs. 10. In 3 cases of intrauterine contraceptive devices localization was very helpful, because sonogram was relatively simple, accurate and safe.

난관 성형술의 최신 경향

노영철(YC Roh) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.6

Since the first corrective tubal surgery was performed by Schroder in 1884, many authors have reported new techniques and results concerning the surgical treatment of infertile tube. In recent reports by many authors, although operating techniques are similar, the term pregnancy rates vary in reported series from 10% to 75%, because it is very different by the operative kind and the site of tube. Laparascopy has become a prerequisite to toboplasty. During the last decade some progress has been made for the establishment and maintenance of tubal patency, the avoidance of postoperative adhesion, and the prevention of abortion and tubal pregnancy. Microsurgical techniques have doubled the term pregnancy rate(from 30 to 70%), while the incidence of ectopic gestation has been reduced in cases of previous sterilization. Maintenance of the patent tube after operation is a problem, and several procedures have been suggested. The trend has been to avoid intratubal devices, splints, or stents. Hoods are still utilized and their benifits are said to outweigh the disadvantage of the second laparatomy needed to remove them. Postoperative hydrotubation seems to be effective and various combinations of medication(using steroid and antihistamine) have been advocated.

Desamino-Oxytocin ( Oral Pitocin, Sandopart ) 의 유도분만경험

박원상(WS Park),노영철(YC Roh),최성기(SK Choi),김윤호(YH Kim) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.6

1973년 11월부터 1974년 2월까지 본 가톨릭의대 부속 성모병원 산부인과에 입원 분만한 산모 중 19예를 대상으로 oral pitocin을 사용하여 유도 분만을 시도한 결과 아래와 같은 결과를 얻었다. 1) 유도 분만은 총 19예 중 16예가 이 방법으로 성공하여 평균 85%의 성공률을 보였으며 2) 분만전의 연령층은 21세에서 40세까지로 초산부 9명 경산부 10명이며 4명은 임신 33주 -39주, 11명이 40주-42주 사이였고 4명은 임신 43주였다. 3) Pelvic score는 3-11 사이였으며 평균 Pelvic score는 5.8로서 분만의 성공율은 Pelvic score의 점수와 관련이 있는 것 같았다. 4) 진통 유발 시간은 약제 투여 후 15분에서 4시간 사이였으며 평균 30분에서 2시간 사이였 다. 5) 진통 유발에 필요한 약용량은 평균 465 I.U.로서 초산부 429 I.U., 경산부 422 I.U.로서 양 자간에는 별 차이가 없었다. 6) 초산부에 있어서 평균 분만시간은 8시간 51분, 경산부는 5시간 9분으로서 Pelvic score가 높을수록 분만시간은 단축되었다. 7) 약제 투여 후의 Friedman의 곡선과 정상 Friedman 곡선을 비교할 때 본 방법으로 행한 예에서는 정상 Friedman 곡선보다 좌측 이동의 양상을 보였다. 8) 평균 Apgarrscore는 분만 후 1분에서 91.0이었으며 9) 산후 출혈 1예와 과다 진통 1예를 제외하고서는 특별한 부작용은 없었고 또한 모성 및 태아 이환율은 없었다. 10) Oral Pitocin을 사용한 유도 분만은 다른 투여 방법으로 행한 방법보다 더욱 안전하고 간편하며 환자나 의사에게 더욱 받아들여 질 수 있는 방법이라고 생각된다. From November 1973 to February 1974, transbuccal administation of Pitocin, (Desamino-Oxytocin.) to 19 patients for induction of labor was studied and compared with intraveneous administation of unusal Pitocinin. The results were as follows : 1) Labor of 85% of gravida were induced successfully by transbuccal method. 2) Theie ages ranged from 21-40 years prior to delevery, 9 were para 0, 10 were multupara, 4 were 33-39 wek gravid, 11 between 40-42 weeks, and 4 were consideres to be pregnant 43 week. 3) The success rate seemed to be related to high pelvic score. 4) The latent period approximately 1/2-2 hour. 5) The average total dose necessary induce labor was 465 I.U. 6) The average duration of labor for primipara was 8:15 hour and for multipara 5:9 hour. 7) Friedman curve arter using of Sandoprat(R) showed shift to left in comparable with normal Friedman curve. 8) The average infant Apgar score at 1 minutes after delivery was 9.0. 9) Remarkable side effects were not observed in infant but a case of postartum bleeding was seen. 10) An oral method of inducing labor using transbuccal pitocin is safer, simpler, and more acceptable to the patient and physician than previously used routes of administration.

산후에 일어난 난소동맥류 자연파열의 1예

김승조(SJ Kim),노영철(YC Roh),오경근(KK Oh) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.7

1. 산후 14일에 발생한 우측난소동맥류자연파열의 1예를 치험하였던 바 수술후 경과가 양호하여 술후 4주에는 완쾌되었다. 2. 임신에 합병된 동맥류에 대한 문헌적 고찰을 하였다. Spontaneous rupture of an ovarian artery aneurysm has not been reported in Korean literatures, which only 3 cases have been reported in world literatures. Since the disease accompanies a high maternal mortality, unless treated adequately, obstetrician must always be aware of the existence of this phenomena, and be ready to present a clear cut method of manage-ment for progressive retroperitoneal hemorrhage. Recently we operated on an ovarian arterial aneurysm with proximal and distal ligation of the ovarian artery. The post-operative course was uneventful.

인삼이 정상산욕기 부인의 Human Prolactin분비에 미치는 영향

정구윤(KY Chung),나종구(Rha CG),노영철(YC Roh),김승조(SJ Kim) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.8

저자들은 1975년 7월부터 동년 12월까지 가톨릭의대 부속 성모병원 산원을 방문한 34명의 산모와 정상 월경주기를 갖는 3명의 여성을 대상으로 방사면역 측정법을 이용하여 월경주기 에 따른 혈정 hPRL 및 hLH값의 변동을 측정하고 인삼 추출물과 스테로이드제제 투여가 혈 중 hPRL값에 미치는 영향과 유즙분비 억제효과를 관찰한 바 다음과 같은 결론을 얻었다. 1. 정상 월경주기의 혈중 hPRL값은 난포기, 배란기 및 황체기에서 각각 20.85, 22.24, 27.43ng/ml로서 난포기, 배란기에 비해 황체기에서 유의하게 높음을 관찰하였다. 2. 정상월경주기의 혈중 hLH값은 난포기, 배란기 및 황체기에서 각각 26.12, 61.03, 28.24mIU/ml로서 배란기에 급상승함을 관찰한데 반해 월경주기에 따른 혈중 hPRL값은 분만 직전부터 산육 제 7일까지 각각 230.66, 179.0, 144.08, 122.0, 89.16, 81.91, 71.08, 55.91ng/ml 로 점차 하강됨을 볼수 있었다. 4. 인삼추출물 투여에 따른 산욕기 혈중 hPRL값은 산욕 제 3일에는 제 2군과 제 3군에서 대조군에 비해 유의한 차로 감소되나 제 1군과 제 4군에서는 유의성을 발견할 수 없었다. 5. 스테로이드제제 투여에 따른 산욕기 혈중 hPRL값은 산욕 제 3일에서 대조군에 비해 유 의한 차로 감소됨을 알 수 있었다. 6. 인삼 추출물을 투여한 군과 스테로이드제제 투여군의 유즙 분비 억제효과를 비교 관찰한 바 스테로이드 제제 투여군에서 인삼추출물 투여군에 비해아 더 현저한 억제 효과를 보였 다. 이상으로 저자들은 인삼이 산욕기 혈중 hPRL값의 감소를 초래함으로서 유즙 억제효과를 갖 고 있음을 관찰할 수 잇었으나 억제기전등에 관한 연구는 계속 해야할 과제라고 생각된다. 1. Mean serum hPRL levels of the 3 women with normal menstrual cycle were 20.8ng/ml in the follicular phase 22.2ng/ml in the ovulatory phase, and 27.4ng/ml in the luteal phase. considerable flucuation was evident in the luteal phase, where the mean serum hPRL was observed to be statistically higher than the mean follicular and ovulatory phse levels. 2. Mean serum LH levels of the same 3 women were 26.1 mIU/ml in the follicular phase, 61.0mIU/ml in the ovulatory and 28.2 mIU/ml in the luteal phase. It was also observed that mean serum hPRL levels were not necessarily related with serum hLH levels in each phase except ovulatory phase with reciprocal relationship. 3. Mean serum hPRL levels of 6 normal pregnant women in the first stage of labor 23.6 ng/ml from wihch gradwally decresased to 179.0, 144.0, 122.0, 89.1, 81.9, 71.0, 55.9 ng/ml for the first 7 postpartum days respectively. 4. Mean serum hPRL levels of group II and III after Korean gineseng administration on the 3rd postpartum day were sighnificantly lower than that of the control group. Mean serum hPRL levels of group I and IV did not show any sighnificant deviation from those of the control group. 5. Mean serum hPRL levels on the after steroid adminstration 3rd postpartum day were sighnificantly lower than those of the control group 6. Breast engorgement was much more suppressed considerable after steriod administration than after ginseng administration.

거대분만의 1예

조희중(HC Cho),김성규(SK Chun),노영철(YC Roh) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.4

There are two cases of giant baby who have 5,450gm. and 5,300gm of weight. They are delivered of living babies by vaginal vacuum extraction safely, And the literatures on giant baby are rieviewed briefly.

자궁내 태아발육지연에 대한 산과적 특징

최광영(KY Choi),정병래(BL Chung),장문기(MK Chang),노영철(YC Roh) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.4

Antenatal diagnosis for IUGR is very important to obstetrcians and pediatricians because it usually influences to high perinatal mortality and long-term morbidity after birth. For the diagnosis and prevention, it is valuable to know the obstetrical characteristics of IUGR. 1. the incidence of IUGR was 9.3% of total deliveries. 2. 46% of the obstetric patients in the IUGR group demonstrated no evidence of obstetric, gestational and maternal-medical complications but 54% of the patients had one or more complications. 15% of the IUGR mother with complications(54%) had obstetric complications such as toxemia and antepartum hemorrhage, 19% had gestational complications such as twin pregnancy, congenital anomaly and post date pregnancy 14% had gestational complications in the previous pregnancy, and the remainder 6% had medical complications such as chronic hypertension and chronic renal disease. 3. An increased risk of IUGR was probably evident in the patients of severe preeclampsia chronic hypertension, chronic renal disease and twin pregnancy. And to a less degree it was also evident in patient with a history of low birth weight infant in previous pregnancy, congenital anomaly antepartum hemorrhage, mild toxemia nad post date pregnancy.

고위험율 임신에서의 Foam test의 의의

민승기(SK Min),허필효(PH Hur),전지일(CI Chun),노영철(YC Roh) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.2

A rapid simple economical test has been devised to determine whether pulmonary surfactant is present in amniotic fluid. Analysis of 50 samples of the amniotic fluid by the foam test which showed that three zone infants of 6 of 6 patients with clearly negative tests had severe respiratory distress syndrome or transitional respiratory distress whereas those of 29 of 29 patients with clearly positive tests were free of respiratory distress. In 15 cases with intermediate tests 8 of the infants showed mild to severe respiratory difficulty. The test has high predictive value for RDS when applied to uncontaminated amniotic fluid.