한국부인 자궁경암환자의 치료후 추적조사에 관한 연구

장윤석(YS Chang),신모우(MW shin),진건(K Jin),임진호(JH Lim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.3

Duting the period from Jan. 1, 1959 through Dec. 31, 1981, 1731 cases of cancer of the uterine cervix were evaluated at Seoul National University Hospital. In this study we have analyzed the epidemiologic analysis and five year survival rate vased on home visit. The resul were summarized as follows: 1. The total number of the rteated patients from 1959 to 1981 was 1734 cases. 2. The average annual incidenc was 76.2 cases with gradual increment yearly. 3. More than sixty percent of the total cases had residency in Seoul city. 4. The majority of patients, 778 cases (44.9%), were found in the group of age between 41 and 50. 5. The parity distribution was concentrate on the parity of 3∼4. 6. Distrion of the patients by the clinical stages was as follows: stage o; 200 cases(11.5%), stage I; 722 cases (41.6%), stage Ⅱ; 617 cases(35.6%), satge Ⅲ; 145 cases (8.4%) and stage Ⅳ; 50cases(2.9%) 7. The result of gistopathologic subtype were distrbuted as follws: Squamous cell carcinoma was 95.3%, asenocarcinoma was 14.2% in stage I and 33.3% in satge Ⅱ. 9. Out of 1734 cases treated, 748 cases were followed up by home visit. The follow up rate by home visit showed 20.1% in Seoul city and 46.6% in the other areas. 10. The result of the five year survival rate by home visit showed as follows: 100% in satge 0, 85.3%in stage I, 56.1% in stage Ⅱ, 23.1% in stage Ⅲ, 0% in stage Ⅳ respectively. 11. The five year survival rate related th the age group showed the highest (85.1%) in the group of age 41 to 50, 80% in both age group of 31 to 40 and 61 to 70, 75% in the age group of 21 to 30 and 74.3% in the age group of 51 to 60. But there was no statistical significant differences among them.

장막하 낭포성 자궁근종의 1 례

김종화(JH Kim),장상호(SH Chang),진건(K Jin),장윤석(YS Chang) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

Cystic degeneration is a rather common secondary change of myoma. In extreme cases, all of the original tumor is involved, being converted into a large cystic cavity, simulating ovarian cysts. We presented the case with a brief review of the literature.

난소에 발생한 양성 섬유성 조직구종 1 예

진건,정을영,민창수 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Benign fibrous histiocytoma is a tumor composed of a mixture of fibroblastic and histiocytic cells that are often arranged in a cartwheel or storiform pattern and accompanied by varying number of inflammatory cells, foam cells, and siderophages. Benign fibrous histiocytoma represents one of the common soft tissue tumors with most cases presenting in the skin. The common sites of incidence are the limbs, trunk, head, neck, and posterior peritoneal cavity:less commonly, these lesions arise in female reproductive organs. This report documents a case of benign fibrous histiocytoma arising in the ovary of 48 year-old female whose chief complaint was abdominal pain.

임산부 체형특성과 만삭아 출생체중과의 관계

진건,박충학,고경심,박혜영,하진완,신광철 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

목적: 본 연구의 목적은 합병증이 없는 만삭아를 분만한 임산부들의 신체적 특성과 만삭아의 출생체중 및 경량아 및 적정체중아 분만의 관련성을 파악하여 적절한 산전관리의 지침을 마련하고자 하였다. 연구방법: 1995 년 11 월부터 1996 년 12 월까지 단국대학교병원 산부인과에서 분만한 산모 중 합병증이 없는 만삭분만아를 출산한 임산부 307 예를 대상으로 하였다. 이 중 만삭 경량아는 15 예가 있었으며 적정체중아는 241 예가 있었다. 만삭 경량아 출산과 관련된 요인들을 파악하고자, 산모 연령, 출산력, 교육연한과 산모의 신장을 보정하기 위하여 다변량 로지스틱회귀분석을 시행하여 보정 상대위험도와 95% 신뢰구간을 산출하였다. 결과: 산모의 체형이 저체중군인 경우 정상체중군보다 임신전 산모 체중, 분만시 산모 체중 및 총 체중증가가 통계적으로 유의하게 낮았으며, 경량아 출산이 더 많았다. 산모의 체질량지수가 19.8 kg/㎡ 미만일 때 경량아 출산의 상대위험도는 6.2 배였으며, 임신전 산모체중이 50 kg 미만일 때, 상대위험도는 9.9 배였다. 출산시 산모체중이 60 kg 미만일 경우 경량아 출산의 상대위험도는 25.0 배였으며, 임신 중 체중증가가 12.5 kg 미만일 경우 상대위험도는 5.5 배로 증가하였다. 산모의 신장이 155 cm 미만일 때, 교육기간이 12 년 미만일 때, 경산부일 때, 직업이 있을 때, 신생아 성별과는 통계적으로 유의하게 상대위험도가 증가하지 않았다. 결론: 전체중의 임산부와 임신 중 불충분한 체중증가를 보이는 경우 태아체중의 적절한 증가에 제한이 있음을 시사한다. 따라서 산전진찰시 적절한 태아의 체중 증가를 도모하기 위하여 산모의 체형을 고려해서 교육하는 것이 필요하다. Objective: Our aim is to examine the association of maternal body characteristics and fullterm infant birthweight without complications. Methods: We used data collected from 307 pregnant women who delivered fullterm singleton infants without complications in Dankook University Hospital from November 1995 to December 1996. Fifteen cases of SGA infants were identified and other infants were analysed as controls. Multiple logistic regression analyses were performed for controlling maternal age, parity, years of education and maternal height. Adjusted odds ratios[AOR] and 95% confidence intervals[CI] were calculated. Results: In the underweight mothers, the pre-pregnancy body weight, body weight at delivery, total body weight gain and delivery of SGA infants were greater than that in the normal weight mothers. The adjusted odds ratios for delivery of SGA infants were 6.2 in the women of BMI less than 19.8 kg/㎡, 9.9 of pre-pregnancy body weight less than 50 kg, 25.0 of body weight at delivery less than 60 kg, and 5.5 of gestational weight gain less than 12.5 kg. The risk of delivering SGA infants was not increased in the women of height over than 155 cm, of education less than 12 years, of multiparity and with occupation. Conclusion: Women of underweight and inadequate weight gain during pregnancy may be associated with fetal growth restriction. We should focus to check maternal body characteristics to ensure the adequate infant birthweight for prenatal care.

부인암 환자에서 방사선치료 후 발생한 합병증에 관한 연구

진건,박충학,고경심,윤형근,서흥식,박혜영,오현양 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

1994년 5월부터 1997년 7월까지 단국대학교병원에서 부인암으로 방사선치료를 받은 72명의 환자를 대상으로 방사선치료 후 발생한 합병증을 비교 분석하였다. 급성 합병증은 총 72명 중 20명(27.7%)(Upper GI toxi city; 1, Lower GI toxicity; 13, GU toxicity; 6)에서 발생했 는데 합병증 발생 빈도를 비교 분석한 결과는 다음과 같았다. 1. 방사선 총조사량이 45 Gy 미만인 경우(14.3%) 보다 방사선 총조사량이 45 Gy 이상인 경우(29.2%)에서 합병 증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다. 2. 외부 방사선치료만 받은 경우(25.0%) 보다 외부 방 사선치료와 강내 근거리요법을 병행해서 치료 받은 경 우(28.8%)에서 합병증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다. 3. 60세 미만인 경우(25.6%) 보다 60세 이상인 경우 (31.0%) 합병증 발생 빈도가 더 높았으나 통계적으로 유 의한 차이를 보이지는 않았다. 4. 내과적 병력이 없는 경우(27.4%) 보다 내과적 병력이 있는 경우(30.0%)에서 합병증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다(Table 8). 만성 합병증은 총 66명 중 18명(27.2%)(Lower GI toxi city; 11, GU toxicity; 7)에서 발생했는데 합병증 발생 빈 도를 비교분석한 결과는 다음과 같았다. 1. 방사선 총 조사량이 45 Gy 미만인 경우(14.2%) 보 다 방사선 총 조사량이 45 Gy 이상인 경우(28.8%)에서 합병증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다. 2. 외부 방사선치료만을 받은 경우(22.2%) 보다 외부 방사선치료와 강내 근거리요법을 병행해서 받은 경우 (29.2%)에서 합병증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다. 3. 60세 미만인 경우(30.8%) 보다 60세 이상인 경우 (22.2%)에서 합병증 발생 빈도가 더 낮았으나 통계적으 로 유의한 차이를 보이지는 않았다. 4. 내과적 병력이 없는 경우(25.4%) 보다 내과적 병력 이 있는 경우(42.9%)에서 합병증 발생 빈도가 더 높았으나 통계적으로 유의한 차이를 보이지는 않았다(Table 9). 이상의 결과로 부인암 환자에서 방사선치료 후 급성 합병증과 만성 합병증이 흔하다는 것을 알 수 있었으며, 특히 방사선 총조사량이 많은 환자군, 외부 방사선치료와 강내 근거리요법을 병행해서 치료받은 환자군, 내과 적 병력이 있는 환자군에서 더 많았으나 통계적으로 유 의한 차이를 보이지는 않았다. 그러나 대부분의 합병증 이 grade 2 이하의 경증 합병증이었고 grade 3 이상의 중 증 합병증은 2명(2.8%)(Acute GI toxicity; 2)에서 발생 했다. 정확한 만성 합병증의 발생 빈도를 연구하기 위해서는 추적 관찰 기간이 길어야 하므로 향후 지속적인 연구 가 있어야 할 것이다. 급성과 만성 합병증 모두에서 하부 위장관계 합병증이 가장 많았으므로 향후 하부 위장관계 합병증을 줄이는데 노력해야 하겠다. Objective; The purpose of this study was to determine the frequency and severity of complications following pelvic irradiation in patients with gynecologic malignancies. Study Design; A retrospective analysis was done in 72 patients treated with pelvic radiation therapy for cervical (N=66) and endometrial (N=6) cancer at Dankook University Hospital from May 1994 to July 1997. Results; The complications of pelvic irradiation were as follows; 1. Acute gastrointestinal complications occured in 14 of 72 patients (19.4%) (mild diarrhea; 5, hematochezia; 4, mild nausea and vomiting; 1, moderate diarrhea; 2, severe diarrhea; 2). 2. Acute genitourinary complications occured in 6 of 72 patients (6.3%) (cystitis; 6). 3. Chronic gastrointestinal complications occured in 11 of 66 patients (16.7%) (mild diarrhea; 5, hematochezia; 4, mild small bowel obstruction; 1, moderate diarrhea; 1). 4. Chronic genitourinary complications occured in 7 of 66 patients (10.6%) (cystitis; 6, gross hematuria; 1). 5. The incidences of acute and chronic complications after pelvic irradiation in gynecologic malignancies were higher in the following groups; 1) The group with total dose of external radiation over 45Gy. 2) The group with external beam radiation and brachytherapy modality. 3) The group of patients with medical problems. But there were no statistical significant differences in these groups. Conclusion; We concluded that complications are common after pelvic radiation therapy. Pelvic radiation therapy should be used judiciously for the purpose of reducing complications, particularly in the patients with higher dose radiation therapy and pre-existing medical problems.

CO2 레이저와 인터페론 알파-2b로 병합치료한 질에 발생한 다발성 첨형 콘딜로마 1 예

진건,박충학,고경심,서흥식,박혜영,오현양,박향준 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6

저자 등은 1997년 6월 단국대학교병원 산부인과에 내원한 55세의 경산부에서 자궁경부와 질에 발생한 다발성 첨형 콘딜로마를 CO2 레이저와 인터페론 알파-2b로 병합치료하여 완치시켰기에 문헌고찰과 함께 보고하였다. Condyloma acuminatum is a contagious viral infection caused by types 6 and 11 human papillomavirus[HPV], but may also be caused by types 16, 18, 30s group, 40s group, 50s group, and 60s group. The warts tend to occur most directly by coitus. Treatment of vulvar condyloma ranges from topical podophyllin, trichloroacetic acid, and 5-fluorouracil application to local excision, cryotherapy, electrosurgery, and carbon dioxide laser vaporization. The goal of treatment is removal of the warts;it is not possible to eradicate the viral infection. We have experienced one case of multiple condyloma acuminata in the vagina treated with carbon dioxide laser vaporization combined with intralesionally injected interferon alfa-2b, which is presented with a brief review of the literatures.

폐경기여성에서 에스트로젠 보충요법시 병행투여된 프로게스테론제제가 골밀도에 미치는 영향

김동진,진건,신용덕,김수련,박교만,정을영,민창수 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Estrogen replacement therapy is known to reduce the incidence of cardiovascular disease and osteoporosis in postmenopausal women. Estrogen has beneficial effect on bone density and adding progesterone to estrogen is known to have synergistic effect. However, the effect of progesterone on bone mineral density had not been precisely evaluated in Korean postmenopausal women. To evaluate the impacts of progesterone on bone mineral density during estrogen replacement therapy, we conducted the randomized 2-year trials of conjugated equine estrogen (Premarin 0.625 mg/day) with or without cyclic progesterone(medroxyprogesterone acetate : MPA 10 mg/day for 12 days) in 105 postmenopausal women. Bone mineral density was measured in the lumbar vertebrae(L2-L4) using dual energy X-ray absorptiometry(DEXA) at the beginning of the treatment, 6 onths, 12 months and 24 months later, respectively. In Premarin only group, bone mineral density at 6 months and 12 months after treatment did not show significant difference from baseline value. But bone mineral density on 24 months after treatment showed significantly increased value(p value$lt;0.05) than that of initial. In Premarin plus MPA group, bone mineral density at 12 months and 24 months after treatment showed significantly increased than baseline(p value$lt;0.05). And compared with Premarin only group, Premarin plus MPA group showed significant increase in spinal bone density after 2 years treatment(p value$lt;0.05). These results suggest that the addition of MPA in estrogen replacement therapy appears to increase in bone mineral density more than unopposed estrogen. Thus combination of estrogen and progesterone appeared to be effective long-term prophylactic treatment regimen upon postmenopausal bone loss.

자궁탈에 관한 임상적 관찰

김동진,진건,이석환,김태웅,차용재,김준길,김준태,윤미림 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.10

1981년 1월부터 1992년 12월까지 12년동안 지방공사 강남병원 산부인과에서 경험한 자궁탈 환자 168례(이중 수술환자 155례)에 대하여 임상적 고찰로 다음 결론을 얻었다. 1. 총 산부인과 환자에 대한 자궁탈의 발생빈도는 0.09%였다. 2. 연령분포는 25세부터 84세였고, 평균연령은 54.5세, 50세-59세군이 36.3세로 가장 높은 빈도를 나타냈다. 3. 자궁탈의 정도는 3도의 탈이 1도 15.55, 2도 35.7%에 비해 높은 48.8%빈도를 나타냈다. 4. 분만횟수는 0회에서 13회까지이고 평균횟수는 4.7회 4회이상이 70.3%로 가장 높은 빈도를 나타냈다. 5. 분만장소는 가정분만(89.85),병원분만(10.2%) 지역별분포는 시골지역(10.7%), 도시지역(89.3%)의 빈도를 나타냈다. 6. 자궁탈의 발생연령은 16세부터 78세까지이며 평균 발생연령은 46.5세였다. 7. 자궁탈의 지속기간은 3일에서부터 49년까지이며 평균 15.3년였고, 10년이상인 경우가 57.2%였다. 8. 임상증상은 자궁탈 호소가 95.2%로 가장 많았고 배뇨곤란과 빈뇨가 20.2%였다. 9. 총 168례중 과거치료 경험은 7례(4.1%)였으며 그중 질식자궁절제술이 제일 많았다. 10. 수술을 받은 155례중 145례(93.2%)에서 질식 자궁절제술과 전후질벽성형술 또는 후질벽성형술을 시행하였고 부속기병변 때문에 복식자궁절제술과 전후질벽성형술 또는 부속기제거술을 시행한 례가 5례(3.2%)였고, 4례에서는 질폐쇄술, 1례에서 Manchester op.를 시행하였다. 11. 재발된 경우는 4례(2.5%)로서 2례에서 전후절벽성형술 1례에서 Le Fort op. 1례에서 복식자궁 절제술을 실시하였다. 12. 수술후 합병증은 발열 6.4%, 요로감염 5.1%, 요저류 3.8%순이었다. 13. 자궁 및 부속기가 제거된 86례의 병리학적 소견은 만성경관염 65.8% 경관선의 편평세포화생 63.8%였으며 기타 자궁근종 3.2%, 난소낭종 4.4%였다. This clinical and statistical study was attempted to analyze 168 cases of uterine prolapse(13 cases-not operated, 155 cases-operated) at the Department of Obstertrics and Gynecology, KangNamGeneral Hospital during the perilod from Jan 1981 to Dec. 1992. The results are as follows: 1. The incidence of the uterine prolapse found at the Department of Obstetrics and Gynecology during the past 12 years was 0.09%. 2. The highest group of age distribution at the time of admission was 50 to 59 years(36.3%)and the mean age was 54.5 years old. 3. The highest group of the degree of uterine prolapse was the 3 rd degree(48.8%). 4. The parity showed that 118 cases(70.3%) was over 4 and I case(0.6%)was nullipara. 5. The delivery place was home in 151 cases(89.8%) and the urban area(89.3%)had a higher incidence than rural area(10.7%) 6. The age distribution at the time of development of uterine prolapse showed that 48 cases (28.5%) were 50 to 59years 33cases(19.6%) were 30 to 39years and mean age was 46.5years. 7. 96 cases(47.2%)was those cases who had suffered from the uterine prolapse for more than 10years and mean duration was 15.3years. 8. The feeling of a prolapsed mass was the most common symptom (95.25)and dysuria and urinary frequency were the next common symptoms(20.2%). 9. In 7 cases out of 168 cases(4.1%), previous treatment such as vaginal hysterectomy abdominal hysterectomy chemical cauterization was done. 10. Out of 155 cases of uterine prolapse, 106 cases(68.4%)were treated by the vaginal hysterectomy with either anterior and posterior repair and/or posterior repair. 11. Recurrence was 4 cases(2.5%) . 12. The fever was the most common postoperative complication(6.4%)and urinary tract infection was the next common symptom(5.1%). 13. Pathologic findings were as follows: Chronic cervicitis 102 cases(65.8%) squamous metaplasisa of cervical gland 99 cases(63.8%), associated ovarian cyst 7 cases (4.4.%) Leiomyoma 5 cases (3.2%)etc.

악성난소종양에서의 CEA의 면역조직학적 반응과 혈중치에 관한 연구

이효표,진건,김승철 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.12

저자는 서울대학교병원 산부인과에서 악성난소종양으로 진단되어 수술로 확진한 33명의 증례에서 CEA혈중농도의 방사면역법측정과 난소종양조직을 대상으로 면역조직화학적 방법을 이용한 반응도와의 관련성을 관찰하여 다음의 결과를 얻었다. 1. 혈중 CEA치가 2.5ng/ml이상인 양성율은 각각 제 1기 14.3%, 제 2기 25%, 제 3기 30%, 제 4기 50%이었으며, 세포형태학적별로는 점액성종양 41.7%, 장액성종양 17.6%, 자궁내막모양 50%이었다. 2. 평균 �중 CEA치(평균±표준편차)(ng/ml)는 제 1기에서 1.57±0.741, 제 2기에서 2.11±1.107, 제 3기에서 2.40±1.264, 제 4기에서 10.78±20.17이었다. 3. 혈중 CEA치 양성군(≥2.5ng/ml)의 경우 70%, 혈중CEA치 음성군의 경우 17.4%에서 각각 조직 CEA 염색 양성율을 보였다. 4. 조직 CEA염색 양성율은 임상기별로 제 1기 28.6%, 제 2기 37.5%, 제 3기 20%, 제 4기 50%였으며, 조직 CEA염색 양성군의 경우 전임상기에서 평균 혈중 CEA치는 2.5ng/ml이상이었다. 5. 조직 CEA염색 양성율은 점액성종양 66.7%, 장액성종양 11.8%, 자궁내막모양종양 25%로서 점액성종양에서 유의한 조직 CEA양성을 보였다. Immunohistochemical staining with Biotin-strept Avidin complex immunoperoxidase technique and measuring plasma level by RIA method of Carcinoembryonic Antigen(CEA) was performed in 33 patients with malignant ovarian tumors. The results were as follows; 1. The incidence of positive level of CEA(above 2.5ng/ml) were 30.3%(10/33). 2. The percentage of patients with positive level of CEA(above 2.5ng/ml) were 42.7%(5/12) in mucinous cystadenocarcinoma, 17.6%(3/17) in serous cystadenocarcinoma and 50%(2/4) in endometrioid carcinoma. 3. The mean plasma CEA level(Mean ±S.D.)(ng/ml) of each clinical stage were 1.57±0.741 in stage I, 2.11±1.167 in stage II, 2.40±1.264 in stage III, 10.90±20.171 in stage IV respectively. 4. Positive tissue staining of CEA was present in 33.3%(11/33) of total cases. In 10 cases with high level of plasma CEA 70%(1/10) present positive CEA staining, whereas in 23 case with normal level of plasma CEA only 17.4%(4/23) of case present positive CEA staining. 5. The mean plasma CEA level of positive CEA staining groups were observed to be elevated above 2.5ng/ml in all stages, whereas those of negatige CEA staining groups were within the normal range. The significance of CEA in cancer is unresolved. However these results suggest that a careful study of tumor CEA may be of value in the evaluation of tumor evolution, progression, response of therapy and survival rate.

난소에 재발한 급성백혈병 1 예

김동진,진건,김수련,박교만,정을영,민창수 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

Currently attention is focused on the testicle as a site of leukemic relapse. However, leukemic involvement of the ovary has been described in several autopy series with an incidnce of 11 to 50 percents in patients with bone marrow relapse, but has rarely been reported during the clinical course of leukemia. But leukemic involvement of the ovaries has received little attention, and the significance of ovary associated relapse in relation to the eventual outcome of the patient has not been investigated. We experienced one case of acute lymphocytic leukemia(ALL) presenting as ovarian tumor. Involvement was also presented in abdominal and pelvic lymph node, mesentery, omentum, and serosal surface. Here we present the case with brief review of literature.