자궁동정맥기형의 임상경험

이병석(BS Lee),신숙진(SJ Shin),이장호(JH Lee),민혜원(HW Min),이윤호(YH Lee),이국(K Lee),김동익(DI Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9

We experienced 4 clinical cases which had been diagnosed of uterine arteriovenous malformation by Doppler ultrasonogram and pelvic angiogram. In all patients, trasarterial emolization was performed as first choice of treatment modality. Among them, two cases have failed. However, another two patients conceived after the successful transarterial embolization. Therefore, we concluded Doppler ultrasonogram si a useful diagnostic method in patients with arteriovenous malformation. And trasarterial embolization is effective as a first choice of treatment in patients who desire to preserve fertility.

조기폐경 환자의 난소조직에 대한 면역조직화학적 연구

이병석(BS Lee),임경호(KH Lim),박기현(KH Park),송찬호(CH Song) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.8

The ovaries from a patient with premature ovarian failure were evaluated by conventional H-E staining and immunohistological staining. Ovarian primordial follicles were found in 4 out of 15 patients. In the immunohistologic analysis using monoclonal antibody of the inflammatory cells, including common leukocytes, T cell, B cell and macrophage. Common leukocytes were positive in 9 patients, T cell, B cell and macrophage were 7, 4, and 5 out of total 15 patients, And, autonatibody was detected in 5 out of 15 patients. On the basis of our study, ovarian destruction may be caused by the pathogenetic mechanism of autoimmune oophoritis.

자궁근종과 자궁평활근에서 Transforming Growth Factor-β1의 표현 및 Collagen I, Ⅲ mRNA에 미치는 영향

이병석(BS Lee),박기현(KH Park),조동제(DJ Cho),이국(K Lee),김재욱(JU Kim),송찬호(CH Song),양우익(WI Yang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

Leiomyomas, which are the commonest pelvic tumors in women, are originated from myometrial cells. Although the exact initial pathophysiologic event of the leiomyoma is not known, recent evidences suggested that the effects of sex steroid hormones in the process of tumor growth are mediated by local production of growth factors including epidermal growth factor(EGF), in- sulin-like growth factor-I(IGF-I) and insulin-like growth factor-II(IGF-II). Recently, it was sugge- sted that transforming growth factor-β(TGF-β) may play a role for growing of leiomyomas. It was known that TGF-β increase the formation of extracellular matrix. And we examined TGF-β1 expression and tried to know the effect of TGF-β1 on the extracellular matrix, collagen I and III mRNA levels in cultured leiomyoma and myometrial cells. We found that immunoreactive TGF-β1 was expressed in myometriums and in leiomyomas. There was no difference at the intensity of immunostaining between two tissues. In northern blotting, there was no difference of TGF-β1 expression at the transcriptional level in both tissues. TGF-β1 increased the mRNA levels of collagen I in cultured myometrial and leiomyoma cells at the concentration of 1 ng/ml(p<0.05), 10 ng/ml(p<0.001). And TGF-β1 increased the mRNA levels of collagen III in cultured myo- metrial and leiomyoma cells at the concentration of 1 ng/ml (p<0.05), 10 ng/ml(p<0.05). Therefore, expressed TGF-β1 may stimulate the incorporation of collagen I and III into the extracellular matrix in myometriums and leiomyomas.

난소암 ( 1966∼1983 ; 연세의료원 ) -Ⅰ. 난소암의 임상 및 조직병리학적 분석 -

이병석(BS Lee),최동희(DH Choi),박찬규(CK Park) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.8

1966년 1월 1일부터 1983년 12월까지 18년간 본 연세의료원 산부인과에 입원 치료받은 142예의 악성 난소종양에 대한 임상 및 조직병리학적 고찰을 통하여 다음과 같은 결론을 얻었다. 1. FIGO classification에 의한 암파급정도는 암 제 1기 38.7%, 암 제2기 5.6%, 암 제3기 15.5%, 암 제4기 40.2%였다. 2. 난소암의 WHO에 의한 조직병리학적 분류는 상피성 악성 난소종양이 2.8%, 배세포 악성난소종양 이 20.4%, 전이성 악성 난소종양이 18.3%, sex cordstromal tumor가 8.5%였다. 3. 난소암 환자의 연령별 분포는 상피성악성 난소종양이 45∼55세, 배세포 악성난소종양이 20∼30세 에 가장 호발하였다. 4. 난소암 환자에게 실시한 다양한 치료방법은 외과적 처치만 받은 환자가 34예였고 생검을 포함한 외과적 처치후 추가 약물요법을 받은 환자가 72예, 의과적 처치후 추가 방다선 요법을 받은 환자가 25예였다. 5. 핵 분열수에 따라 분류한 grade와 조직학적 인자인 증식상, 유두상 증식, 세포의 이형도, 기질 침 윤에 있어서 grade가 증가할수록 이러한 조직학적 인자들이 더 심한 양성을 보였다. 6. Grade에 의한 상피성 악성 난소종양의 3년 누적 생존율은 grade Ⅰ에서 78%, grade Ⅱ에서 55%, grade Ⅲ에서 32%, grade Ⅳ에서 17%로 grade가 증가할수록 그 생존율이 감소하였다. 7. 암파급정도에 따른 3년 누적 생존율은 암 제1기에서 68%, 암 제2기에서 38%, 암 제3기에서 23%, 암 제4기에서 0%였다. 이상의 결과로 난소암의 정확한 파급정도 결정시 가능한 종괴제거에 따른 적출물의 병리조직학적 인 자인 세포형태, grade 등의 난소암의 예후인자와 더불어 biologic behavior를 고려한 추가항암 화학요 법 또는 방사선 요법 등의 다양한 치료방법이 난소암 치료시 매우 중요한 것이다. A clinico-histopathologic study was made on a series of 142 cases of malignant ovarian cancers, which were admitted to the department of obstetrics and Gycecology, Yonsei University Medical Center during the period Jan 1, 1966 to Dec 31, 1983 The results obtained were as follows: 1. According to FIGO classifcation, the patient were classifed as; stage Ⅰ 38.7% stage Ⅱ 5.6%, stage Ⅲ 15.55 and stage IV 40.25 2. According to WHO histopathological classifcation epithelial ovarian tumor was found in 52.85, germ cell tumor in 20.4% metastatic tumor in 18.3% sex cord-stromal tumor in 8.5% 3. Age distribution of ovarian cancer showed the highest frequency in 45-55 years of epithelial ovarian tumor, 20-30 years of germ cell tumor 4. As for the modalities of treatment surgeries only were performed in 34cases surgeries(including biopsies) with adjuvant chemotherapy in 72cases, and surgeries with adjuvant radiotherapy in 25cases 5. Corrdlation between hisological grading and histologic features such as stratif cation nuclear pleomorphism, papillary projection and stromal invasion showed that these histologic features tend to become more severe as the grade developed 6. A three year cumulative survival rate of epithelial ovarian cancer according to histologic grading was 78% in grade Ⅰ, 55% in grade Ⅱ, 32% in grade Ⅲ, 17% in grade Ⅳ, The survival rate of patients was directly related to histologic grading 7. A three year cumulative survival rate of epithelial ovarian cancer 68% in stage Ⅰ, 38% in stage Ⅱ, 23% in stage Ⅲ, 0% in stage IV. Therefore in the treatment of ovarian cancer it is very important to perform adjuvant radiotherapy of chemotherapy according to the prognostic factors and biologic of the cancer

흰쥐에서 난소제거가 Follocle Stimulating Hormone ( FSH ) 분비와 FSHβ Subunit mRNA에 미치는

이병석(BS Lee),윤미정(MJ Yoon),김창미(CM Kim),박기현(KH Park),조동제(DJ Cho),김재욱(JU Kim),송찬호(CH Song),유경자(KZ Ryu) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Follicle stmulating hormone ( FSH ) consist of α and β subunits, which are encoded by se-parate genes. Pituitary release of FSH appears to be regulated by the hypothalamic GnRH and the gonadal steroid hormones. In addition , inhibin and follistatin produced by the gonad have been known to inhibit FSH secretion selectively. However , little is known about their regulation of the biosynthesis of FSH subunits at transcriptional and posttranscriptional levels. In the pre-sent study , we studied the time course of changes in α and FSHβ subunit mRNA concentrati-ons after castration and the effects of ovarian steroids of changes in α and FSHβ subunit mRNA concentrations after castration and the effects of ovarian steroids on α and FSHβ subunit mRNA in ovariectomized rats in order to determine Whether FSH subunit synthesis is modulated at the pretranslational levels, and whether synthesis and secretion are differently regulated. Results are as follows: 1. The time course of the rise in the steady state α subunit and FSHβ subunit mRNA levels were observed after ovariectomy, which paralleled the increases in serum and pituitary FSH concentrations. The time course experiments revealed differences in the patterns of α and FSHβ subunit mRNA responses , the rise in FSHβ subunit mRNA levels being more pro- minent than the rise in α subunit mRNA. 2. FSHβ mRNA levels were negatively regulated by the single injection of progesterone but not by estradiol , suggesting that FSHβ subunit mRNA seemed to be more sensitive to ne-gative feedback by progesterone than estradiol. Similar results were obtained by the continuous treatment of ovarian steroids for 1∼4 days , but inhibition was more prominent with continuous treatment. It is , therefore , concluded that estradiol and progesterone inhibit the synthesis of FSH at the pretranslational level by modulating the steady state levels of α and FSHβ subunit mRNA , progesterone effect being more promiment than that of estradiol and α and FSHβ subunit are regulated in a different manner.

과배란유도 성숙난포액내의 Insulin-like Growth Factor-I ( IGF-I ) , Insulin-like Growth Factor Binding Protein-3 ( IGFBP-3 ) , Growth Hormone ( GH ) 및 Estradiol ( E2 ) 과의 상호관계

이용주(YJ Lee),배상욱(SW Bae),정창진(CJ Jeong),김동현(DH Kim),장경환(KH Jang),이병석(BS Lee),박기현(KH Park),조동제(DJ Cho),송찬호(CH Song) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Recently, the ovary is known to be a center of paracrine and autocrine rehulating factors. IGF-I is a local regulator of follicular function and a poten stimulator of ovarian cell proliferation and differentiation, in synergy will the gonadotrophins, whilst GH may exert its effect by changing intra-ovarian IGF-I concentration. Inbiological fluids, IGFs are bound to specific, high affinity binding proteins(IGFBP). The IGFBPs are considered paracrine modulators of the action of IGF-I in the ovary. The aim of the study is to elucidate relationships amongst IGF-I, IGFBP-3, GH and estadiol in mature follicular fluids or serum. Thirty-six infertility patients who underwent ovulation induction program by GnRH agonist short or long protocol for in vitro fertilization (IVF) were examined to investigate the correlations amongst the concentration of IGF-I, IGFBP-3, GH and estradiol in follicular fluid or serum. These hormones were quantitatively anayzed by radioimmunoassay(RIA) or Immunoradiometric assay(IRMA). There were statistically significant correlations between the concentration of IGF-I and GH, IGFBP-3 in follicular fluid. Therefore, GH tends to increase IGF-I levels in follicular fluid and IGF-I may functions as an important regulator of IGFBP-3 synthesis in follicular fluid, but IGFBP-3 is not likely to be under the direct control of GH in follicular fluid.

난관요인을 가진 불임환자에서 Chlamydia Trachomatis감염의 의의

이우식(WS Lee),황동훈(DH Hwang),이병석(BS Lee),박기현(KH Park),송찬호(CH Song) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.4

Chlamydial infection is one of the most common of the sexually transmitted pathogens, and produce tubal damage to cause infertility. Traditionally, at least 20% to 35% of infertile couples are considered to have tubal infertility, and chlamydia trachomatis is probably highly associated with tubal infertility. We undertook this study to determine whether chlamydial infection would be an etiologic factor of the infertile cases in which a tubal factor is responsible for infertility. Sixty-six women who came to the infertility clinic at the Yonsei University, College of Medicine, Severance Hospital were subject to serologic tests and cultures, and subsequent tubal evaluation was done with hysterosalpingogram, laparoscopy, and laparotomy. The number of patients with tubal factor was 35, and those with other factors was 31. The results obtained were as follows: 1. The mean age was 29.4 years in seropositive patients, and 28.1 years in seronegative patients. 2. The number of patients with primary infertility was 41 and those with secondary infertility was 25. 3. The average duration of infertility was 3.7 years in seropositive patients and 3.2 years in seronegative patients. 4. There were no elevated values of ESR or WBC count. 5. Only 10% of seropositive patients complained of symptoms. 6. Sixty-one percent of infertile women were seropositive, and among them 68% were associated with tubal factors. In seronegative patients, 38% were associated with tubal factors. 7. Infertility with tubal factors was due to tubal obstruction in 68%, adhesions in 26%, and hydrosalpinx in 8% of patients. 8. Tubal infertility showed significantly higher incidence in patients who had antibody titers greater than 1:128. 9. Sensitivity was 77%, specificity was 58%, NPV was 69%, and PPV was 685 for serologic tests.

Methotrexate로 치유된 경관임신

김세광(SK Kim),이병석(BS Lee),서경(K Seo),박용원(YW Park),김재욱(JU Kim),박찬규(CK Park),송찬호(CH Song),신동환(DH Shin) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.5

A successful use of methotrexate(MTX) in the treatment of a cervical pregnancy is presented. The patient was treated with four doses of methotrexate (50mg, intramuscularly) followed by four doses of leucovorin (50mg, intramuscularly) because of her desire to maintain subsequent fertility potential. The patient was followed up with serum beta hCG and sonography. Resolution was diagnosed 78 days after ocmpletion of 2nd course of methotrexate treatment.

자궁 동정맥기형에서 Transarterial Embolization 실패후 전자궁적출술을 시행한 1 례

신숙진(SJ Shin),이병석(BS Lee),정창진(CJ Jeong),조은정(EJ Cho),차동현(DH Cha),이국(K Lee) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.5

A 29 year old woman who had long history of recurrent uterine bleeding was diagnosed of arteriovenous malformation of uterus by ultrasonogram and angiogram. In our case report, we tried transarterial embolization 2 times for preservation of reproductive capability. But failure of embolization due to recanalization and new collateral arteriovenous malformation formation, the patient was taken total abdominal hysterectomy.

Hypogonadotropic Hypogonadism환자에 있어서 gonadotropin Releasing Hormone의 간헐적 정 맥 투여방법에 의한 배란유도

박기현(KH Park),이병석(BS Lee),황동훈(DH Hwang),박찬규(CK Park) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.9

이상의 결과로 첫째 Hypogonadotropic Hypogonadism환자에서 간혈적 GnRH투여에 의한 배 란유도는 타 배란유도제에 비해 안전하고 생리적인 방법이며, 둘째 Hypogonadotropic Hypogonadism환자에서 배란유도시 standard GnRH bolue test를 시행하지 않고 바로 간헐적 으로 GnRH를 투여하므로서 시상하부 뇌하수체 난소축의 기능검사와 배란유도를 동시에 평 가하는데 좋은 방법으로 사료된다. Recently, pulsatile intravenous administration of gonadotropin Releasing Hormone has brought much improvement in treating anovulation. It is especially effective in patients with hypothalamic amenorrhea, and there are several reports of cases in which GnRH administraion has been effective where other ovulation induction method have failed. The authors have attempted ovulation induction through pulsatile intravenous administration of 5-10 ug/90 min. GnRH using an autoinfusion pump to 25 Hypogonadotropic Hypogonadism patients among which 12 were experincing primary amenorrhea and 13 secondary amenorrhea who visited severance Hospital . Among them , we successfully induced ovulation in 25 cycle which pregnancy success rate of 47% , 9 out of 19 women -excluding 6 unmarried persons-became pregnancy. During this period mean E2 peak level was 390 pg/ml, mean follicullar size 1.97cm, mean luteal legnth 13 days, mean follicullar length 14.8days. complications observed were in one case thrombophlebitis there were no hyperstimulation syndromes or multiple pregnancy. in two cases, there was spontaneous abortion. From the above , intravenous pulsatile administration of GnRH in Hypogonadotropic Hypogonadism patients is a more safe, and phsiologic method of induction of ovulation