특집 임신성 고혈압의 병태생리

조수용(SY hough) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.3

호르몬 대체요법시 Dydrogesterone이 지질대사 및 골대사에 미치는 영향

조수용(SY hough),이재관(JK Lee),허준용(JY Hur),서호석(HS Suh),박용균(YK Park),주갑순(KS Ju),임인수(IS Lim),이갑노(KN Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

The addition of a monthly course of progesterone decrease the incidence of endometrial hyperplasia and endometrial carcinoma. The progesterones used in hormonal replacement therapy(HRT) differ markedly in their progesteronic, androgenic and even estrogenic activities. These characteristics may influence both symptomatic and metabolic side effects. The purpose of this study was to examine effect of bone and lipid metabolism in postmenopausal women treated with conjugated equine estrogens plus dydrogesterone. A total 131 postmenopausal women(surgical menopause=95, natural menopause=36) and not-treated postmenopausal women(control=22) were invited to participate in this study. Patients were divided into groups which had received conjugated equine estrogen(CEE) 0.625 mg/day 21-day-cycle each month(n=20), CEE 0.625 mg/day plus Dydrogesterone 10 mg/day 10-day-cycle each month(n=111), and no treatment control group(n=20). Serum lipid & lipoprotein(Triglyceride, Total cholesterol, High density lipoprotein, Low density lipoprotein) and serum osteocalcin, urinary Deoxypyridinoline were examined in all patients. There were no significant differences in bone & lipid metabolism between CEE and CEE plus Dydrogesterone groups. In conclusion, Dydrogesterone may be used safely in postmenopausal women without Metabolic side effect.

HPL-HAIR Test Kits 에 의한 HPL측정

조수용(SY hough),이진호(JH Lee),이재억(JA Lee) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.2

hPL-HAIR test kits를 이용하여 정상 및 이상 임신의 각 시기의 임산부 47예와 19예의 태 아제대혈청을 반정량법으로 hPL량을 측정하였다. hPL-HAIR test kits의 감도는 0.1㎍/ml이고 정상 남자의 혈청이나 HCG와는 반응이 없었고 영향을 받지 않았다. 임신 28주 이전까지는 대체로 2㎍/ml이었으며 28주 이후에는 정상임신에서 6∼8㎍/ml로 점 차 증가하는 양상을 보였다. 이는 다른 hPL-Kobe radioimmunoassay 성적과 비교하여 조금 높은 듯 하나 거의 일치하는 성적이었다. 자궁 내 태아사망이나 조산의 경우에는 임신 32주 이후에서 hPL치가 4㎍/ml 또는 그 이하 치를 나타냈는데 Spellacy(1970) 등도 4㎍/ml 이하일 때는 태반기능의 부전증을 의심한다고 발표하였다. 저자 등이 이 kits를 이용하여 측정한 결과도 비슷하다. 많은 예의 실험으로 임 신말기에 정상 하한점을 정확히 판정할 수 있도록 하면 한 번의 hPL 측정치로서도 태반기 능의 부전을 지적할 수 있다고 사료된다. 임신중독증과 자궁근종, 난소종양 및 심장질환이 합병된 임신의 경우 36주 이후에는 hPL치 가 6∼8㎍/ml로서 정상의 범위였다. 태아제대혈청의 hPL치는 대부분 O이고 임산부혈청의 hPL농도와 태아체중과의 관계는 본 실험에서 찾아볼 수 없었다. Plasma levels of human placental lactogen have been measured by hPL-HAIR test kits in 47 pregnant women, in normal and abnormal state, and in 19 cord bloods. 1) Sensitivity of hPL-HAIR test kits was to 0.1㎍/ml of hPL plasma level, had no cross reaction to the HCG or to the male serum, and was not affected by the HCG or by the male serum. 2) hPL value was around 2㎍/ml in first 28 week of pregnancy and was 6∼8㎍/ml after 32 week of pregnancy in normal group. 3) hPL value in intrauterine fetal death or premature labor after 34 week of pregnancy was less than 4㎍/ml. 4) Pregnancy complicated by myoma of the uterus, ovarian tumor, and heary disease showed normal range of hPL at term. 5) hPL value in cord blood was negligible.

임신중 선천성 단심실 심장기형아의 초음파적 진단 2 례

최승필(SP Choi),조수용(SY hough),주갑순(KS Ju),이갑노(KN Lee) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.8

선천성 심장기형의 발생빈도가 출생아의 1%에 해당하며, 그 중 단심실 심장기형인 경우와 같이 출생후 수술이 불가능한 경우나, 출생후 수술이 가능한 질환인 경우라도 산전에 noninvasive, nonteratogenic, nontoxic procedure의 초음파적 조기발견으로 출생직후 적절한 치료 및 대책을 세울 수 있을 것이다. 저자들은 초음파를 이용한 산전 선천성 단심실 심장기형을 진단한 2례를 문헌 고찰과 함께 보고하는 바이다. Diagnostic ultrasound has been used for a number of years for assessment of the human fetus. because of the improved technology and ability to handle the mordern realtime cross-sectional ultrasound scanners, it has become possible to study cardiac anatomy during intrauterine life. Recently, two cases of single ventricular heart of fetus were detected by the long axis four-chamber plane. Accordingly we present these cases with a brief review of the literature.

임신부에서 실시한 Anti-HEV 측정에 대한 연구

주갑순(KS Ju),박용균(YK Park),조수용(SY hough),서호석(HS Suh),허준용(JY Hur),이갑노(KN Lee),신재철(JC Shin),문준(J Moon) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.3

Hepatitis E was formerly called enterically-transmitted, enteric, epimemic, waterborne, or fecal-oral non-A, non-B hepatitis. Another non-A, non-B hepatitis, namely hepatitis C poses serious problems of livers to cirrhosis ans gepatocellular carcinoma in the industrialized countries. On the other hand, hepatitis E may not be endemic in these countries but is prevalent in developing countries. Hepatitis E has its highest attack rate in young to middle aged adults, with highest case-fatality rates in pregnant women. But it is not clear whether the pregnncy itself caused more severe disease, whether pregnant women were more symptomatic because of other manifestations of pregnancy, or whether pregnant women(in developing countries) were nutritionally and medically disadvantaged, thus allowing more severe impact of the infection. This study was undertaken with the objective of searching the prevalence of hepatitis E in Korea and evaluate the effect of hepatitis E on pregnancy. A total of 313 pregnant women who visited the antenatal clinic were selected during the period from May, 1994 to July, 1994 at the department of Obstetrics and Gynecology, Guro hospital, Korea University and taken the test for IgG and IgM anti-HEV with the use of ELISA kit. The positive rate of anti-HEV was 9.9%(IgG ; 5.9%, IgM ; 3.0%, IgG and IgM ; 1.0%). The discrepancy among age or parity groups was not shown, and almost all of infected women have no clinical manefestations. So we concluded that hepatitis E exists in Korea but most infected cases are probaby subclinical infections. But it is considered the patient must take the test for anti-HEV in case hepatitis A, B and C are excluded, and further study in the effect of HEV on pregnancy should be performed.

상피성난소암 환자에 대한 Early "Second-Look" laparotomy와 "Third-Look" laparotomy

김두상(DS Kim),문형(H Moon),조수용(SY hough),황윤영(YY Hwang),강길전(KC kang),김문신(MS Kim),정성노(SR Chung) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.10

1978년 10월부터 1982년 4월까지 3년 6개월동안 한양대학병원 산부인과에서 치료했던 상피성난소암 21예중 5예에 대하여 1차수술후 약 6개월동안 PAC또는 Hexa-CAF regimen으로 적극적 화학요법을 한 후 early "second-look" laparotomy가 시행되었다. "second-look" laparotomy로서 3예의 complete remission을 확인하였는데 그중 2예(stage Ic와 IIb )는 6개월,stage IIc 1예는 3개월 화학요법후 시행되었다. 그러나 나머지 2예는 residual cancer로 그중 stage III 1예는 4개월, stage IV 1예는 6개월 화학요법후 확인되었다. Complete remission된 3예에 대하여는 premature remission을 모면하기 위하여 추가화학요법으로 6개월간 melphalan이 투여되었다.당뇨병과 갑상선항진증이 합병된 stage III예의 경우는 첫 CAF화학요법후 "second-look" laparotomy에서 stable disease로 판단되었고 poor resectability로 partial debulkation만이 가능했으며 다음화학치료도 PAC으로 대치되었다. 그러나 그후 계속 악화되어 사망하였다. stage IV "second-look" laparotomy에서 잔재종양이 만족할 만큼 제거되었고 그후 적극적인 화학요법이 6개월동안 투여되었으며 "third-look" laparotomy에서 complete remission이 확인되어 melphalan화학요법이 계속 추가되었다. Median follow-up은 27개월 (range: 24~28개월)이었고 complete remission된 4예의 mean present survival은 18.8개월이다. 약 6개월간의 복합화학치료후의 early "second-look" laparotomy는 항암제로 인한 독성을 최소로 감소하기 위하여 그리고 특히 화학요법효과를 강화시키기 위한 debulking의 목적에서 타당하다고 믿어진다. "second-look" laparotomy에서 residual cancer가 발견되고 다음 화학요법이 계속되었을 때 근처의 확인을 위하여 "third-look" laparotomy는 불가피한 수단이라 생각되며 또 이와같이 early "second-look" laparotomy를 실시함에 따라 "third-look" laparotomy도 증가될 것으로 기대된다. Early "second-look" laparotomies were carried out for 5 cases among 21 of ovarian epithelial carcinima which were managed at the Department of Obsterics and Gynecology of Han Yang University Hospital during 3 years and 6 months from Oct. 1978 through April 1982 following intensive chemotherapy with PAC or Hexa-CAF for around 6 months after primary surgeries were applied. At the second-look laparotomies complete remissions were identified in 3 cases, 2 cases (Stage Ic and Stage IIb) after 6 months` chemotherapy and 1 case of stage IIc after 3 months, and residual cancers in 2 cases, 1 case of stage III after 4 months and 1 case of stage IV after 6 months. For 3 cases of complete remission additional chemotherapy with melphalan for 6 months were given to avoid possible premature remission. In the case of stage III the second-look laparotomy following initial chemotherapy with CAF disclosed stable disease for which only partial debulkation was possible due to poor resectability, and following chemotherapy was changed to PAC while she was under the control of diabetes mellitus and hyperthyroidism. However, the patient expired due to progressive disease. In the case of stage IV residual cancer mass was found at the second-look laparotomy where rather satisfactory debulkation was carried out, and following intensive chemotherapy for another 6 months was given, and at the 3rd look laparotomy complete remission was identified, and additional melphalan was contimued on the safety basis. Median follow-up has been 27 months(range, 24 to 28 months) and mean present survival in 4 cases after complete remissions were assessed at the second-look laparotomy has been 18.8 months. Early second-look laparotomy aruond after 6 months` combination chemotherapy is believed to be appropriate for the management of ovarian epithelial cancer to minimize.possible toxicities of anticancer agents, especially when it is necessary to reduce the residual cancer mass so as to enhance the effectiveness of following chemotherapy. When the residual cancer is found at the second-look laparotomy and following chemotherapy is administered, it is thounght to be appropriate to have the 3rd-look laparotomy, and possibly another follow-up laparatomies. By utilizing early second-look laparotomy it is expected that the incidence of 3rd-look laparotomy will be increase.

자궁내 태아 발육지연의 임상적 고찰

강준구(JK Kang),이광호(KH Lee),정경우(GW Jeong),조수용(SY hough),박용균(YK Park),서호석(HS Suh),허준용(JY Hur),주갑순(KS Ju) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9

This study was taken at the Department of Obstetrics and Gynecology, college of Medicine, Korea University, to investigate the association between some of the risk factor and the incidence of fetal growth retardation. The retrospective survey of obstetric records of 4887 delivery, who were admitted between 1992 and 1994, was carried out in Korea University Medical Center. The results were as follows: 1. IUGR was 215 births(4.56%) in 4,709 births for 3 years. 2. 53% of IUGR was unknown cause, 46.9% of IUGR was known. Among 46.9%, maternal factor was 78.2%, Placenta factor was 19.8%, fetal anomaly was 4%. 3. Among maternal factor, PIH was the most common cause(64.5%).

자궁내 발육지연아를 동반한 임신중독증 산모 태반조직의 단백질 및 핵산함량의 동태에 관한 연구

박문일(MI Park),정성노(SR Chung),강길전(KC kang),조수용(SY hough),김두상(DS Kim) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.3

본 연구는 임신중독증에 있어서 자궁내 발육지연아의 원인을 규명하고자 태아의 각 장기의 발육을 대신하여 태반의 발육의 정도를 조사하였다. 즉 정상산모 8예를 대조군으로, 발육지연아를 동반하지 않는 임신중독증 10예 및 발육지연아를 동반한 임신중독증 7예를 실험군으로 하여 태반조직의 단백질함량, DNA함량 및 RNA함량을 조사한 바 다음과 같은 결론을 얻었다. 1. 태반조직의 단백질함량 및 RNA 함량은 발육지연아를 동반하지 않는 임신중독증에서는 대조군보다 의의있는 감소를 보였고, 발육지연아를 동반한 임신중독증은 발육지연아를 동반하지 않은 임신중독증보다도 더욱 감소되어 있었다. 2. 태반조직의 DNA함량은 발육지연아를 동반하지 않는 임신중독증이나 발육지연아를 동반한 임신중독증이나 공히 대조군과 비슷하였다. 3. 임신중독증의 자궁내 발육지연아에 있어서 세포학적 수준에서 그 발육장애의 양상이 자궁-태반기능 부전증의 경우와 꼭 같으므로 결국 임신중독증에서 발육지연아의 원인은 자궁-태반 혈류량의 감소가 원인인 것으로 사료된다. In order to elucidate a causative factor of intrauterine growth retardation (IUGR) in toxemic mother, contents of protein, DNA, RNA were determined in placental tissue from toxemic patients without IUGR and toxemic patients with IUGR and were compared with those from normal pregnant women. The results obtained were as follows; 1) Protein and RNA contents of placental tissues were significantly decreased in toxemic patients without IUGR and toxemic patients with IUGR as compared with that in normal pregnant women. Also observed was a decrease in placental protein and RNA contents in toxemic patients with IUGR than in toxemic patients without IUGR. 2) No significant changes were observed in DNA contents of placental tissue in all groups of patients studied. 3) Chemical changes do occur in the placental tissues of toxemic mother with IUGR with respect to protein and RNA. But cell number of the placental tissue was not changed. This suggested that reduction of cell size may attributed to the decreased uteroplacental blood flow.

임신중 혈장 Renin 활성도의 변화

오긍식(KS Oh),전송원(SW Chun),정성노(SR Chung),조수용(SY hough) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.7

정상임신 51례와 중독증임신 24례, 초기임신 8례를 대상으로 R.I.A.방법을 사용 P.R.A를 측정하여 정상가임부, 정상임부 및 중독증임부의 분만전과 후, 비임 및 임신초기와 말기의 P.R.A의 변화 그리고 연령별, 초산경산에 따른 동태 및 pitocin과의 관계를 고찰하여 다음과 같은 결론을 얻었다. 1. 비임시에 비해 정상임신초기 및 임신말기의 분만 전과 분만 후 2일에 P.R.A는 비임신시에 비해 임신초기에 유의한 증가를 보였으며 임신말기에는 임신초기에 비해 유의한 감소를 보였고 비임신시에 비해서는 유의한 증가를 유지하였다. 2. 연령별, 초산 및 경산에 따른 분만 전과 후의 P.R.A의 관계는 유의한 상호관계가 없었다. 3. Pitocin투여군과 비투여군에 있어서 P.R.A의 변화는 정상임부 및 중독성임부에 있어서 공히 유의성이 없었다. 4. 정상임부의 분만 전과 후의 P.R.A는 분만 전에 비해 분만 후에 있어서 유의한 감소를 보였다. 5. 정상임부 및 중독증임부의 분만 전 P.R.A는 정상임부에 비해 중독증임부에서 유의한 감소를 보였다. Of the subjects who visited for antenatal care and delivery between December 1. 1978 and March 1. 1979. 51 cases of normal pregnant women, 24 cases of toxemic women and 8 cases of first trimester of normal pregnancy were made the subject of study. Plasma renin activity(P.R.A.) was estimated with the usage of radioimmunoassay method. It showed the following results: Compared to non-pregnancy, P.R.A. showed significant increase during the first trimester of normal pregnancy. However, there was a significant decrease in P.R.A. during the third primester compared to the first trimester but the third trimester maintained significant increase in P.R.A. compared to non-pregnancy. A comparison of P.R.A. in case before and after delivery of normal pregnancy showed that compared to before delivery it decreased significantly after delivery. Lastly, a comparison of before delivery state of normal pregnant women and toxemic women showed a significant decrease in P.R.A. of toxemic women than normal pregnant women.

임신중기 양수천자 1,046 례에 대한 분석

오민정(MJ Oh),허준용(JY Hur),서호석(HS Suh),박용균(YK Park),조수용(SY hough),박선화(SH Park),주갑순(KS Ju) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

Prenatal diagnosis of genetic disorders is now an established part of routine antenatal care. This is a study of our experience with 1,046 cases that have been undergone amniocentesis at the Guro Hospital of the Korea University Medical School from October 1983 to June 1996. Advanced maternal age was by far the most common indication of amniocentesis. Chromosomal aberrations were diagnosed in 15 cases(1.4%) of which numerical aberration was 9 cases(60/0%) and structural aberration was 6 cases(40.0%). Autosomal aberration was observed in fourteen cases(93.3%) and sex chromosomal aberration was observed in one case(6.7%). Among the 14 autosomal aberrations, trisomy 21 was most common, being 5 cases, and one case of trisomy 13 and another case of trisomy 18 was found respectively. The others were 4 cases of translocation, one case of inversion and another case of isochromosome. Sex chomosomal aberration case was only one and it was a Klinefelter syndrome.