Progestogen이 인간 혈관평활근의 긴장도에 미치는 영향

문종수(Zong Soo Moon),박형무(Hyoung Moo Park),허민(Min Hur),이무열(Moo Yeol Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.4

Objective : This study was performed to investigate whether 1) progestogens induce changes of vascular tone in endothelium-denuded smooth muscles of human uterine artery, 2) endothelium-independent vascular reactivity is mediated by intracelluar calcium ion modulation through 2 types of calcium channel, both voltage- and receptor-dependent and 3) 3 kinds of progestogen such as a progesterone, C19 nortestosterone(norethindrone acetate ; NETA) and C21 progestogen(medroxyprogesterone acetate ; MPA), have a different vasoreactivity. Methods : The uterine arteries were obtained at the time of hysterectomy from 24 women who had no cardiovascular disease risk factors and the endothelium was denuded. Vascular reactivity was monitored by using isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by adding 10μM acetylcholine(endothelium-dependent vasorelaxant) to the specimens, which were pretreated with 1μM norepinephrine(α-adrenergic stimulant). The integrity of smooth muscle was assessed by adding 10μM sodium nitroprusside(endotelium -independent vasorelaxant) and 10μM tamsulosin(α-adrenergic blocker) to the specimens, pretreated with 1μM norepinephrine. The uterine smooth muscles were pretreated with 35mM and 70mM potassium chloride and 10-7M and 10-6M norepinephrine. Three kinds of progestogen - progesterone, NETA and MPA - each at 5 different concentrations(10-9g/ml, 10-8g/ml, 10-7g/ml, 10-6g/ml and 10-5g/ml) were used. Results : The loss of endothelial function and adequacy of smooth muscle function were confirmed. Three kinds of progestogen had concentration-dependent inhibitory effects on vascular smooth muscle contraction induced by high potassium solution and norepinephrine, respcetively. There were no siginificant differences noted among the inhibitory effects of three progestogens in 35mM concentration of potassium solution and 10-6M norepinephrine induced muscular contraction. In 70mM potassium solution, there were significant differences among the three progestogens-induced inhibitory effects. Progesterone showed the most potent inhibitory effect, NETA was intermediate, and MPA had the mildest effect. In 10-7M norepinephrine, progesterone had more potent inhibitory effect than NETA or MPA. The difference between progesterone and NETA/MPA was statistically siginificant, with no significance between NETA and MPA. Conclusion : The results of this study revealed that progestogens have a concentration-dependent vaso-relaxant effect on endothelium-denuded vasular smooth muscles via a calcium antagonistic mechanism of direct inhibitory effects on receptor- and voltage-dependent calcium ion channels. This vaso-relaxant effect of progestogens differed among a variety of progestogens. In conclusion, the progestogens combined with estrogens have not antagonistic effect on vaso-relaxation at least and maybe have synergistic effect with estrogens, in vivo.

임신중기 양수천자의 임상적 고찰

이상호(Sang Ho Lee),박영순(Young Soon Park),장재혁(Jae Hyuk Chang),문종수(Zong Soo Moon),서수형(Soo Hyung Seo),박양서(Yang Suh Park),윤숙경(Sook Kyung Yun) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

Objective : We performed this study to analyze the indications, distributions of maternal age and cytogenetic results of midtrimester amniocentesis and to determine the complications and risks of it. Methods : This study was retrospectively reviewed 674 cases of midtrimester genetic amniocentesis from January 1997 to October 2001 in Kangdong Sacred Hospital, Hallym University. We analyzed the indications, distributions of maternal and gestational age, chromosomal results, and of which accorded to indications of cytogenetic studies. Results : The indications of amniocentesis were abnormal maternal serum screening (46.2%), advanced maternal age (≥35: 44.8%), abnormal ultrasonographic findings (5.9%), familial history of fetal anomaly (2.8%) and previous history of fetal chromosomal abnormalities (0.3%), in order. The overall incidence of chromosomal aberration was 3.6% (24/674), which were composed of 18 cases of numerical aberrations and 6 cases of structural aberrations. In autosomal aberrations, there were 7 cases of Down`s syndrome, 6 cases of Edward syndrome, 1 case of Patau syndrome and 3 cases of Mosaicism. In sex chromosomal aberration, there was a case of Turner syndrome. In chromosomal aberrations according to indications, there was 7.5% (3/40) of chromosomal abnormalities in abnormal ultrasonographic findings group, 3.2% (10/311) in abnormal maternal serum screening group and 3.0% (9/302) in advanced maternal age group. There was statistical significance only in abnormal ultrasonographic findings group. There was no significant complication after amniocentesis except 0.3% (2 cases) of fetal loss. Conclusion : Maternal serum screening, advanced maternal age and antenatal ultrasonograms should be important screening methods for amniocentesis which is considered to the most effective diagnostic procedure for prenatal cytogenetic studies. The karyotyping analysis of midtrimester amniocentesis is efficacious method for evaluation of chromosomal aberrations and genetic counselling for parents.

임신중 심부전 및 조기분만진통과 합병된 근긴장성 이영양증 1 예

양순하(Soon Ha Yang),노정래(Cheong Rae Roh),정재현(Jae Hyun Chung),문종수(Zong Soo Moon),문종택(Jong Taek Moon),김병준(B . Joon Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.

SEMM 식 자궁적출술에 대한 임상적 고찰

우소영(So Young woo),박영순(Young Soon Park),이상호(Sang Ho Lee),문종수(Zong Soo Moon),서수형(Soo Hyung Seo),박양서(Yang Suh Park) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

Objectives : We performed this study to review the clinical availability of the classical intrafascial SEMM hysterectomy (CISH), and report our experience for 2 years restrospectively. Methods : From March 1999 to February 2001, 100 cases of CISH were performed at the Department of Obstetrics and Gynecology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym university. We performed this procedure by 3 steps. The dissection of uterus was done by classical suture methods (including extracorporeal and intracorporeal suture techniques) to uterine isthmic portion. And then transvaginal cylindrical coring out of the cervical tissue was done using a cervix corer, the Calibrated Uterine Resection Tools (CURT) for resection of cervical tissue especially transformation zone. Finally, the dissected uterus was extracted by using a Serrated Edged Macro-Morcellator (SEMM) without colpotomy. We reviewed the patient's data retrospectively and made phone calls to each patients. Results : The indications for CISH, based on the pre-and intraoperative diagnosis, were leiomyoma, adenomyosis, endometrial hyperplasia and chronic pelvic inflammatory disease or pelvic pain, in order of frequency. The mean operative time was 126 minutes and the mean hemoglobin change was 1.27 gm/dL. The mean hospital days were 5.7 days and the mean age of the patients was 44.6 years old. There were no definite intra- and postoperative complications except for 3 cases of CO2 retentions and 2 cases of delayed bleeding on cervical stump. The mean days to first sexual contact after surgery were 34.5 days. In view of sexual feeling, 86% of the patients didn't feel any difference and only 13% felt worse than before. During postoperative follow-up, the cervical cytologic study were found no endocervical cells at all of 44 checked patients. Conclusion : The CISH procedures can be safely performed by well-trained laparoscopists, and this technique minimally alters the anatomy and integrity of the pelvic floor and vagina. Therefore the reductions of surgical morbidity, blood loss, hospitalization and postoperatve discomfort were obtained. Through the preservation of the anatomical relations of the pelvic floor and the function of female sexuality, this technique is the new proposal in gynecologic surgery.

자연생리주기에서 발생한 병합임신 1례

송성욱 ( Sung Wook Song ),정영환 ( Young Whan Jung ),문종수 ( Zong Soo Moon ),서수형 ( Soo Hyung Seo ),박양서 ( Yang Suk Park ) 대한주산의학회 2001 Perinatology Vol.12 No.2

DNA분석에 기포한 표피박리성 수장족저 각피증 ( Epidermolytic palmoplantar keratoderma ) 의 산전 진단

양순하(Soon Ha Yang),노정래(Cheong Rae Roh),이제호(Je Ho Lee),정재현(Jae Hyun Chung),문종수(Zong Soo Moon),양준모(Jun Mo Yang),김승욱(Syng Wook Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

Objective: The purpose of this investigation was to establish the prenatal diagnosis for identifying the risk for epidermolytic palmoplantar keratoderma(EPPK) of a fetus by sequence analysis of fetal genomic DNA from chorionic villi. Methods: Chorionic villus sampling under transvaginal sonography at 12 weeks of gestation from a woman at risk for a child in a EPPK-affected family was perfomed. Polymerase chain reaction amplification of specific allele (PASA) assay was carried out for the detection of mutation(R162W in keratin 9 [K9] gene) previously identified in this family. Direct DNA sequencing analysis of K9 gene was accomplished to confirm the mutation. Results: We had found the point mutation, R162W of K9 gene, in affected family members and confirmed by PASA assay. Affected family members were shown to have PCR products reactive with both the mutant and wildtype specific primers. Because we could not find any expected products after PASA assay with the primers la(+)/KSmt(-) of the fetal DNA, we predicted that the fetus did not inherited the mutant allele and that the fetus could be unaffected. After PASA assay, we analyzed DNA sequences of two family members to confirm the mutation. A C-to-T substitution at bp 545 was detected in the father, instead the fetus did not have any mutant band at that base pair. Conclusion: The PASA assay and direct DNA sequencing analysis of K9 gene through chorionic villi sampling and extraction of genomic DNA had validity to early prenatal diagnosis whether fetus was affected in EPPK or not.

원발성 난소 이행세포암

박영순 ( Young Soon Park ),이상호 ( Sang Ho Lee ),정영환 ( Young Hwan Chung ),고준성 ( Sung Ko ),문종수 ( Zong Soo Moon ),서수형 ( Soo Hyung Seo ),박양서 ( Yang Suh Park ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

Primary ovarian transitional cell carcinoma (TCC) is extremly rare tumor and has been recently classified into the one of the histologic subtypes of ovarian epithelial cell carcinomas. Primary ovarian TCC has been proven to differ from malignant Brenner tumor (MBT) and TCC of th bladder for it`s histologic characteristics as well as therapeutic and prognostic implications. TCC of the ovary has been also recognized to have excellent response to chemotherapy and favorable prognosis although it`s aggressive properties. We experienced a case of primary ovarian TCC (stage; Ⅱc) in 57 year old woman who presented with low abdominal pain and report this case with a brief review of the concerned literatures.

임신 중 발생한 결핵성 복막염

이존익(John Ik Lee),권민연(Min Yeon Kwon),송성욱(Sung Wook Song),박주진(Choo Jin Park),문종수(Zong Soo Moon),서수형(Soo Hyung Seo),박양서(Yang Suh Park) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1

The tuberculous peritonitis, especially in pregnancy, is very rare and difficult to diagnose since there is no diagnostic clue and limitation of diagnostic means. The clinical features may vary such as fever, chill, tachycardia, abdominal tenderness or rebound tenderness which are not controlled easily with antibiotics. It is possible to diagnose by AFB culture and biopsy through exploro-laparotomy which is done due to uncontrolled symptoms even to unstable vital signs. It's clinical symptoms and signs are dramatically improved with antituberculotic therapy. Recently we have experienced a case of tubeculous peritonitis at 29 weeks gestation which was diagnosed through exploro-laparotomy including cesarean section. So we report this case with a brief review of literature

초기임신 자연유산의 태아 핵형분석에 관한 고찰

권민연 ( Min Yeon Kwon ),우소영 ( So Young Woo ),윤숙경 ( Sook Kyung Yun ),이지영 ( Ji Young Lee ),문종수 ( Zong Soo Moon ),서수형 ( Soo Hyung Seo ),박양서 ( Yang Suh Park ) 대한주산의학회 2000 大韓周産醫學會雜誌 Vol.11 No.3

복막에 발생한 원발성 유두양 장액성 악성종양

권민연(Min Yeon Kwon),이존익(John Ik Lee),우소영(So Young Woo),최규하(Kyu Ha Choi),박주진(Choo Jin Park),김덕환(Duck Hwan Kim),문종수(Zong Soo Moon),서수형(Soo Hyung Seo),박양서(Yang Suh Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

Primary papillary serous carcinoma of the peritoneum(PPSCP) is vere rare. It has been suggested that PPSCP derives from embryonal coelomic epithelium with m llerian ducts potential. PPSCP can develop from a single or multicentric focus. The clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but PPSCP involves the ovarian surface only minimally(microscopic disease) or spares the ovaries entirely. We have experienced a case of primary papillary serous carcinoma of the peritoneum and report this case with brief review of the concerned literature.