증상체온법에 의한 배란점수와 혈중 Luteinizing Hormone 값에 관한 관찰

장봉림(BR Jang),이용선(YS Lee),최성기(SK Choi),김승조(SJ Kim) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.3

저자들은 본 산부인과학교실에서 자연피임법의 새로운 방법으로 개발한 배란점수법의 신뢰도를 조사하기 위하여 1975년 9월부터 1977년 8월까지 성모병원 산부인과 외래 및 가족계획 크리닉에 등록된 기혼여성중 본 연구에 협조적인 93명에서 배란기 혈중 LH값을 측정하여 50mIU/ml 이상의 LH surge가 확인된 75명중 72명은 1주기씩, 3명은 2주기씩 합계 78주기를 대상으로 배란기 혈중 LH값의 변화와 이들에게서 회수한 증상체온표 78주기를 검토하여 배란점수를 준 결과를 비교 관찰하여 다음과 같은 결과를 얻었다. 1. 정상 월경주기의 혈중 luteinizing hormone의 값은 난포기, 배란기, 황체기에 각각 26.12, 61.03, 28.24mIU/ml로서 배란기에 급상승함을 관찰하였다. 2. 기초체온표상의 기초체온 상승은 LH peak일 후 0.8일에 나타났다. 3. 경관점액의 변화는 LH peak일보라 5.7일 전에 나타나기 시작했으며 최고 증상일은 LH peak일보다 0.42일 앞서 나타났다. 4. 배란기 하복통의 최고증상은 LH peak일보다 0.4일 후에 나타났다. 5. 배란기 성기 점상출혈의 최고증상일은 LH peak일보다 1.3일 후에 나타났다. 6. 유방팽만의 첫 증상일은 LH peak일 후 5.3일이었다. 7. 배란점수법에 의한 5점 이상의(possible fertile score) 가임기 첫날부터 LH peak일까지는 6.8일의 기간이 있었고, LH peak일부터 가임기 마지막날까지는 5.6일의 기간이 있었다. 8. 각 월경주기에서 평균 금욕기는 12.3일, 배란전 안전기는 7.9일, 배란후 안전기는 9.4일이었으며 배란점수는 LH peak일을 중심으로 4일간이 가장 높은 점수를 보였다. 이상으로 배란점수법에서 이용한 배란증상들이 혈중 LH측정으로 산출한 배란기와 밀접한 관계를 가짐을 관찰하여 배란점수법이 유용한 자연피임법이란 결론을 얻었다. In a previous paper(Kim et al., 1977), ovulation score method was studied as a new natural contraceptive measure that is arranged of ovulation symptoms and menstrual period. It is based on the known characteristics change of fertile(cervical) mucus, intermenstrual abdominal pain(Mittelschmerz), intermenstrual genital bleeding(Kleine-Regel) and breast engorgement or fullness during the menstrual cycles. This paper attempts to determine whether the ovulation symptoms in ovulation score method are clossely related to the hormonal estimated ovulation time, and asses the usefulness of the ovulation score method as a natural contraceptive measure. In this study, 75 healthy fertile women were studied during 78 menstrual cycles. The ovulation score method, assessed by the patient and used in conjunction with basal body temperature, was correlated with serum levels of luteinizing hormone(LH) during periovulatory period. As a preliminary experiment, serum LH levels of the 3 women with normal menstrual cycle were also measured with double antibody technic radioimmunoassay. The results were as follows: 1. Mean serum LH levels of the 3 women with normal menstrual cycle were 26.1mIU/ml in the follicular phase, 61.0mIU/ml in the ovulatory phase and 28.2mIU/ml in the luteal phase. 2. The LH peak was noted on average 0.8 days before the estimeted ovulation date in basal body temperature chart. 3. The appearance of fertile mucus occured on average 5.7 days before the LH peak, and the fertile mucus peak day was noted on average 0.42 days before the LH peak. 4. The peak symptom day of Mittelschmerz was noted on average 0.4 days after the LH peak. 5. The peak symptom day of Kleine-Regel was noted on average 1.3 days after the LH peak. 6. The first day of breast engorgement was noted on average 5.3 days after the LH peak. 7. The mean interval from the first recorded ovulation score 5(possible fertile score) to the LH peak was 6.8 days and from the LH peak to the last recorded ovulation score 5 was 5.6 days. 8. Calculat

X - 선 유방촬영술 ( Mammography ) 을 이용한 생리적 유방변화외 기타 유방병변에 관한 관찰

배석천(SC Bae),장봉림(BR Jang),김도강(DK Kim),송승규(SK Song) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.1

저자들은 1976년 1월부터 만 1년간 카톨릭의과대학 부속 성모병원 산부인과학교실에서 환자 51명에 대한 53예의 X-선 유방촬영술을 실시하여 다음과 같은 결과를 얻었다. 1) 주상구조는 월경후 시일이 경과할수록 점차 얇아져서 월경후 12일경에 가장 얇아지고 선명하게 보이며 그후 월경의 시기에 가까이 갈수록 주상구조는 점차 두꺼워지며 소실되고 선상구조의 유식을 보인다. 2) 임신부터 산후 3일에 가까울수록 선상구조의 증식은 더 심하여지고 산후 3개월로 갈수록 약간 감소하는 경향을 보인다. 특히 임신과 수유시에는 선상 구조의 증식 때문에 병적 소견을 발견하기 어렵다. 3) 폐경의 기간이 길수록 주상구조는 더욱 얇아지고 현저해지며 선상구조는 점차 소실되고 지방으로 대체된다. 4) 병적소견이 있었던 9예중 5예에서 DY형의 유방을 보였고 N1형은 없었다. 그러므로 DY형의 유방을 가진 사람은 더욱 더 주의깊은 검사가 필요하리라고 본다. Having reached a statement over the past several decades in the therapy of breast carcinoma, many have turned their attention to methods of earlier diagnosis. Toward this end the utility of survey mammography as a cancer detection method has been widely tested. Female breast have great individual variation in shape, structure, and size. And moreover there are gross and histological changes following menstruation, pregnancy, lactation and menopause. So these physiologic changes are the base in the diagnosis of breast diseases. 53 mammography were performed on 51 patients during the period of January, 1976 to December, 1976 in Ob & Gyn Dept. of Catholic Medical College. The results were as follows: 1) Trabeculation of the fibrous tissue support is prominent on the twelveth day of the cycle. Later, proressive swelling and denseness of firous tissue occurs with loss of trabeculation. Tissue density reaches its height at the beginning of the menses and then regreses. 2) The proliferation of ductal pattern progress during the pregenancy till the postpartum third day and then regressed. During pregnancy & lactation, the detection of pathologic lesion is difficult due to proliferation of ductal pattern. 3) The more advancing age after-menopause is, the more prominent trabeculation becomes, the more ductal pattern regressed and changed to fat. 4) In 9 cases of pathologic findings, 5 cases showed DY type and there was no N1 type. So the DY type breast must be taken more careful examination.

고위험 임신부에서 양수내 Estriol , Human Placental Lactogen 및 Cortisol값과 Contraction Stress Test 성적과의 상관관계

이진우(JW Lee),김기원(KW Kim),장봉림(BR Jang),노영숙(YS Roh),전은의(EE Chun) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.10

임신 제 34-41주의 정상임신 87명의 양수내 estriol, human placental lactogen 및 cortisol을 측정하여 임신말기의 각 호르몬의 정상값을 구하였고, 임신 제 36-42주이상의 고위험 임신 부 158명에서 양수를 채취하여 estriol, human placental lactogen 및 cortisol을 측정하였으며 contraction stress test를 시행하여 contraction stress test 양성군과 음성군의 양수내 호르몬 측정치를 비교하고 진통중 태아감시 결과와 비교한 각 호르몬과 CST의 일치도를 점상관계 수로 구하여 다음과 같은 결론을 얻었다. 1. 정상임신의 임신 제 34, 36, 38 및 40 주에 따른 estriol값은 각각 340.7±132.04, 425.3±136348, 636.5±196.95, 906.1±295.72 ng/ml로 임신이 진행됨에 따라 점차 상승하였고 human placental lactogen값은 각각 0.60±0.203, 0.74±0.320, 0.63±0.262 0.53±0.171 ug/ml로 임신 제 36주까지 상승하다 그후 점차 감소하였으며 cortisol의 값은 각각 10.1+-3.08, 10.4±3.57, 17.6±4.38, 26.5±7.00 ng/ml로 임신 38주후에 급격히 상승하였다. 2. 고위험 임신에 있어서 저 estriol측정치에서 contraction stress test 양성율이 유의하게 높았 으나 human placental lactogen cortisol은 호르몬 값에 따른 contraction stress test 양성율과 유의한 차이가 없었으며 contraction stress test 와 양수내 estriol의 진통중 태아감시 결과와 의 일치도는 양수내 human placental lactogen cortisol에 비하여 유의하게 높았다. 3. 고위험 임신에 있어서 contraction stress test 와 양수내 estriol 측정의 진통중 태아 감시 결과와의 일치도는 각각 0.55와 0.71이었으나 2가지를 동시에 관찰하였을때는 0.85로 높아졌 다. 이상의 결과로 보아 양수내 제 estriol 이 CST결과에 만발성 태아심음수 감소상을 보임을 관 찰하였고 고위험 임신의 생리적 검사인 contraction stress test 결과의 관리지침을 얻기위해 서 생화학적 검사인 양수내 estriol측정을 함께 시행함이 바람직하다고 결론을 얻었다. Contraction stress test (CST) and measurement of three kinds of hormones in amniotic fluid were performed on 158 cases of term high-risk pregnancy during the period of antepartum care, and in 151 cases of them, the pattern of fetal heart rate curves of intrapartum fetal monitoring were analysed. the results were as follows; 1. The concentration of estriol in amniotic fluid between the 34th and 41st week of gestation increased to a mean value between 340.7-906.1 ng/ml, hPL decreased to a mean value 0.74-0.53 ug/ml and cortisol rapidly increased to a mean value between 10.1-26.5 ng/ml 2. There was significantly difference in CST positive rate between normal and low levels of estriol in amniotic fluid from high-risk pregnancy. In contrast there were no significant difference in CST positive rate between normal and abnormal levels of hPL and cortisol in amniotic fluid, the coefficients of estriol and CST analysed with the results of intrapartum fetal monitring were sighnificantly higher than that of hPL and cortisol. 3. the coefficients of estriol and CST were 0.71 and 0.55. When the results of both estriol and CST were analysed with those of intrapartum fetal monitoring simultaneously the coefficient increase to be 0.85. It can be concluded that among the concentration of hormones in amniotic fluid, the level of estriol is mostly well correlated with the results of CST, and the level of estriol is a parameter to analyse the interpretation of the less dependable CST during the period of antenatal care.

골반경수술 70 예에 대한 고찰

김두순(DS Kim),김유곤(YK Kim),조용수(YS Cho),남성원(SW Nam),장봉림(BR Jang),이우영(WY Lee),박양서(YS Park) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.11

Seventy cases of pelviscopic operation were performed at Hallym University Hospital from July 1991 to June 1992. The results of this study were summarized as follows. 1.Age ranged from 21 to 53years and the great incidence occured in 26 to 35years group. 2. The mean number of parity was 0.9 and two times and below was 94.4%. 3. The most common clinical indication was tubal pregnancy 28 cases(40.0%)and other indications were ovarian tumor 10 cases(14.3%), pelvic adhesions 9 cases(12.9%) among 70 cases. 4. Types of surgery were salpingectomy 23 cases(32.9%); adhesiolysis 9 cases (12.9%); adexectomy 7 cases(10.0%);fimbrioplasty 6 cases(8.6%) in decreasing order. 5. The mean duration of hospitalization was 3.0 days. 14 cases discharged from hospital at the operation day, 25cases(35.7%),in a day , 10cases (14.3%)in two days and 49 cases(70.0%)in three days.

정상임신 및 비정상임신에 있어서 경질초음파와 경복부초음파의 비교관찰

박양서,장봉림,신교식,고길수,정찬영,이성룡 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.3

1988년 1월부터 1988년 12월까지 만 1년간 한림대학교부속 강동성심병원 산부인과를 내원 한 정상임신군 40예, 비정상임신군 30예를 대상으로 경질 및 경복부초음파를 이용하여 다음과 같은 결과를 얻었다. 1. 정상 및 비정상임신군에서 평균연령, 평균분만 횟수, 평균 임신주수는 통계학적으로 유의 한 차이가 없었다(p$gt;0.1). 2. 경질초음파 사용시 경복부초음파 보다 임신낭은 평균 4.2일, 난황낭은 평균 6.1일, 태아심 음은 평균 5.3일 조기 감지할 수 있었으며 통계학적으로도 유의한 차이가 있었다(p$lt;0.01) 3. 경질 및 경복부초음파를 사용하여 임신낭의 크기, 돌연형태, 영양배엽반응을 관찰한 결과 정상 및 비정상임신군 사이에 통계학적으로 유의한 차이가 있었고(p$lt;0.01) 반면에 경질 및 경 복부초음파 사이에서는 유의한 차이는 없었고(p$gt;0.1), 경질초음파에서 biologic variation ±9일 을 ±3일로 줄일 수 있었다. 4. 혈청 β-hCG의 관찰결과, 경질초음파 사용시 discriminate zone의 level을 종래의 640mIU/ml 에서 760mIU/ml로 낮출수 있었으며 통계학적으로도 유의한 차이가 있었다(p$lt;0.01). 5. 난황낭의 관찰결과 정상임신군의 평균치는 경질초음파 6mm, 경복부초음파 5mm였고, 비정 상임신군인 early embryonic demise에서는 각각 3.5mm, 3.0mm로 통계학적으로는 유의한 차이가 없었으나 blighted ovum을 확진할 수 있는 시기는 각각 7주, 8주로 경질초음파에서 약1주일 조기 감지할 수 있었고, 임신 7~10주사이에서 3.5mm이하의 난황낭을 보인 전예에서 비정상 임신을 보였다. 6. 경질 및 경복부초음파를 사용하여 재태기간과 태아의 관두부길이 사이의 상관관계를 관찰한 결과 두 초음파사이에 통계학적 유의는 없었으나(p$gt;0.1), r=0.95, r`=0.93으로 경질초음파 에서 다소 strong correlation을 보였다(Fig. 4). In a recent study, methods used to assess fetal well-being in early pregnancy included ultrasonography. However, before a live embryo visualized in the intrauterine gestational sac and yolk sca, it can be difficult to differentiate between normal and abnormal pregnancy. As a result, repeat examinations after an interval were performed as an usual method. We wished to assess the usefulness of high resolution transvaginal sonography to determine whether there were any features that would enable us to tell distinction at the time of first examination. We studied normal early pregnancy 40 cases and abnormal early pregnancy 30 cases between pregnancy 4 weeks and 12 weeks. The results were summarized as follows: 1. There was no statistically significant difference between normal and abnormal pregnancy group about mean age, mean delivery number, mean gastational weeks(P$gt;0.1). 2. The transvaginal sonography (TVS) detected, on the average, the same embryonal structures about 5 days earlier (gestational sac; 4.2 days, yolk sac; 6.1 days, fetal heart beat; 5.3 days) than the generally used transabdominal sonography (TAS), and there was significant difference in two sonography (P$lt;0.01). 3. With regard to the pathologic gestational sac, there was no significant difference in size, shape and trophoblastic reaction using by TVS and TAS but biologic variation was much more decreased from ±9 days to ±3 days in TVS because of no bladder-filling. 4. With regard to the discriminatory zone using by TVS, this level has been adjusted to a much lower level, from 2640 mIU/ml to 760 mIU/ml, than that of TAS, and there was a significant difference in two sonography (P$lt;0.01). 5. The yolk sac diameters demonstrated wide biologic variation across the gestational age between normal and abnormal pregnancy using TVS and TAS, and there was no significant difference in two sonography (P$gt;0.1), but basic yolk sac structure was detected one week earlier, on the average, by TVS and TAS. All of the cases that the yolk sac size was smaller than 3.5 mm were proved to be abnormal pregnancy. 6. With regard to the growth curve of fetal crown-rump length, there was no significant difference in two sonography (P$gt;0.1) but more or less strong correlation with gestational age in TVS.

수술적 자궁경술 치험 71 예

김유곤,박양서,장봉림,이우영,임정원 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

The purpose of this study was to evaluate the usefulness, lower cose, convenience for patients of hysteroscopic surgery. To evaluate the efficacy and safety of hysteroscopic surgery, we reviewed 71 cases treated hysteroscopically from June 1991 to May 1994. The results were as follows. 1. Major indications were myoma(25%), polyp(22%), and uterine synechiae(21%). 2. The mean duration of operation is 78.6 minutes for myomectomy, 65.3 minutes for laminaria removal, 57.8 minutes for synechotomy and 15.2 minutes for intrauterine device(IUD) removal. 3. The mean amount of used media is 3800 cc for myomectomy, 1100 cc for polpectomy, 2500 cc for synechotomy, 3500 cc for laminaria removal and 460 cc for IUD removal and corresponds to the operation time. 4. The mean duration of hospitalization is 1.6 days. 5. There are 3 cases of postoperative complications. We concluded that operative hysteroscopy is safe and cost effective method for selective surgical indication.

안드로겐 과잉증 , 인슐린 저항성과 흑색극세포증 (HAIR-AN) 증후군 1 례

김유곤,박양서,장봉림,김기태,김현규,박주진,김두만 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The HAIR-AN syndrome affects between 2% and 5% of hirsute women and is charactedrized by elevated insulin levels due to insulin resistance, acanthosis nigricans, and hyperandrogenemia. The insulin resistance and compensatory hyperinsulinemia is typically due to a decreased number of insulin receptors, decreased functional activity of the receptor or circulating antiinsulin receptor antibodies. Multiple, independent lines of evidence support that chronic hyperinsulinemia causes ovarian hyperandrogenism. Acanthosis nigricans is considered a marker for insulin resistance in hirsute women. Although the association between hyperinsulinemia and hyperandrogenism remains to be fully explained at the molecular level, chronic hyperinsulinemia appears to be an important cause of hyperandrogenism.

임신성 당뇨병의 위험 인자와 그 유의성에 대한 고찰

이근영,박양서,장봉림,박주진,윤태숙,이존익,송성욱 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

목적: 임신성 당뇨병의 각 위험 인자의 유의성에 대하여 조사하기 위한 연구이다. 연구방법: 임신 24-28주 시기에, 산전 관리를 위해 내원한 716명의 임신부에게 50그램 경구 당부하 검사를 시행하고, 위험 인자 여부를 조사하였다. 50그램 경구 당부하 검사상 혈장 당 수치가 140mg/dl이상인 경우 100그램 경구 당부하 검사를 시행하였다. 결과: 임신성 당뇨병의 발생 빈도는 2.5%였다. 위험 인자를 가진 임신부[4.7%]에서는 위험 인자가 없는 임신부[0.8%]보다 임신성 당뇨병의 유병률이 높았다. 위험 인자 중에서는 가장 유의성이 높은 것은 비만[p$lt;0.001]이었고, 35세 이상의 연령[p=0.034], 요당의 검출[p=0.036]의 순이었다. 당뇨병의 가족력[p=0.877], 고혈압[p=0.654], 과거 거대아 출산력[p=0.062]은 통계적 유의성은 없었다. 결론: 임신 24-28주에 임신부를 대상으로 임신성 당뇨병의 선별 검사로 50그램 경구 당부하 검사를 시행하여야 하며, 특히 비만, 35세 이상 연령, 요당 검출 시에는 적극적인 임신성 당뇨병의 진단과 치료가 필요하다. Objectives: To evaluate significances of risk factors of gestational diabetes mellitus [GDM]. Methods: We performed 50gram oral glucose tolerance test for GDM screening to 716 pregnant women at 24-28 weeks of gestation and her risk factors were evaluated. In women with plasma glucose level over 140mg/dl, 100gram oral glucose tolerance tests were taken. Results: The prevalence of GDM was 2.5%. The GDM prevalence in women with risk factors[4.7%] was higher than in women without risk factors[0.8%]. The significant risk factors were obesity[p$lt;0.001], age over 35[p=0.034] and glycosuria[p=0.036]. Conclusion: 50g oral glucose tolerance test for GDM must be taken in pregnant women with obesity, age over 35 or glycosuria.

수술적 인공유산이 실패한 임신초기 환자에서 Misoprostol 을 사용한 1 예

김유곤,박양서,장봉림,김용필,노의선,박주진,정민영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Suction curettage is a relatively safe procedure to induce abortion of first trimester pregnancy with a very low complication rate. But, in order to do that, cervix should be dilated enough to pass operating devices. We experienced a case of first trimester pregnancy terminated successfully using transvaginal misoprostol when suction curettage was failed due to severely cervical stenosis after LEEP conization.

난소낭종흡인으로 치유한 중증 난소과배란증후군 8 예

김유곤,박양서,장봉림,이우영,김기태,김인수,박찬우,김경택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

The 8 cases of severe ovarian hyperstimulation syndrome among 78 cases of ovulation induction by gonadotropins at the Department of Obstetrics and Gynecology, Hallym university from January 1, 1993 to August 31, 1995 were treated by ovarian cyste aspiration and reviewed. The results were summarized as follows: 1. The origin of ovarian hyperstimulation syndrome is in the ovaries. 2. Aspiration of the ovarian cysts in the severe ovarian hyperstimulation syndrome was safe and not only relieved the symptoms but also shortened the disease process, and allowed outpatient treatment.