산부인과 영역수술후 감염증 예방에 있어서의 ornidazole 의 투여효과

이승훈(SH Lee),한상균(SK Han),김장흡(JH Kim),나종구(JG Na),김수평(SP Kim),이헌영(HY Lee) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.3

1987년 5월1일부터 1987년 8월31일까지 4개월간 가톨릭의과대학 부속성모병원에 수술을 받 기 위하여 입원한 환자중 무작위로 추출한 50명을 대상으로 수술후 감염방법을 위하여 ornidazole 단회 투여법으로 얻은 임상결과에서 다음과 같은 결론을 얻었다. 1. 수술후 부작용은 창상감염 및 농양 2예, 자궁내막염 2예, 발열 2예, 요로감염 1예, 기관지 감염 1예등 8예에서 발생하여 16%의 발생율을 보였다. 2. 창상감염 1예와 자궁내막염 1예는 혐기성 및 호기성균 복합감염이었으며 나머지 6예는 모두 호기성균 감염이었다. 3. 수술후 협기성균 감염에 ornidazole 은 96%의 예방효과를 보였고, 혐기성 균주로는 2예에 서 모두 peptostreptococci가 배양되었다. 4. 호기셩균 감염은 ornidazole 단독 투여군에서 3예, ornidazole 과 cephradine동시 투여군에 서 5예가 발생했다. 5. ornidazole 투여에 다른 부작용은 전혀 없었다. The aim of this study was to investigate the effect of ornidazole (a(chloromethryl)-2-methy-5-nitroimidazole-1-ethanol;Tiberal), administered prophylactically against postoperative infections connection with Obsterics and Gynecology surgery. 50 patients aged between 23 and 62 years who had to undergo abdominal surgery at the Department of Obsterics and Gynecology, Catholic University Medical College from May 1987 to August 1987 were admitted to the study. 25 patients in group A were given at the time of premedication 1 hour before the start of the operation, 1000 mg ornidazole in 500 ml 5% dextrose in water by intravenous infusion. 25 patients in group B were given 1000 mg ornidazole in 500ml 5% dextrose in water by hour before the start of the operation. The two medications were administered seperatively in group B cases The results obtained were as follows; 1. Postoperative complications occured in 8 cases (16%); 2 with wound abscess, 2 with endometritis, 2 with fever , 1 with urinary tract infection and 1 with pneumonia. 2. 1 case with wound abscess and 1 case with endometriosis were combined anaerobic and aerobic infections and the other 6 cases were all aerobic infections. 3. There was 95% prophylactic value of ornidazole in preventing anaerobic infections postoperatively, 2 strains of peptostreptococi were isolated from the infectious foci. 4. 3 aerobic infections were observed in group A compared to 5 in group B. 5. No side effects attributable to the ornidazole administered were observed . The study demonstrates that ornidazole is effective in preventing anaerobic infections postoperatively, But does not prevent complications with aerobic pathogens. So the neccessity of giving adjuvant prophylaxis against aerobic infections must also be emphasized.

Tranexamic Acid가 부인암 세포주 및 생쥐 신피막하에 이식된 암조직 성장에 미치는 영향

박태철(TC Park),박대순(DS Park),윤희종(HC Yoon),한상균(SK Han),박종섭(JS Park),김도강(DK Kim),남궁성은(SE Namkoong) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

저자들은 자궁경부암, 난소암, 융모상피암 세포주들의 배양액에 각기 다른 농도의 tranexamic acid를 첨가하여 배양액내에서 종양의 성장억제효과로 세포수의 감소와 형태학적 변화를 관찰하였고, 생체실험으로서 장액성 난소암조직을 tranexamic acid 가 첨가된 배양액 에 처리한 후 마우스의 신피막하에 이종이식된 종양조직절편에서 감수성의 결정을 조직학적 판정점수로 측정하여 보조적인 항암치료제로 tranexamic acid 의 효용성을 밝히고자 실험했 떤 바 다음과 같은 결론은 얻었다. 1. 난소암 세포주는 tranexamic acid 농도의 증가에 비례하여 세포수의 감소와 종양세포의 파괴가 증가되면서 세포성장의 억제가 관찰되었다. 자궁경부암 및 융모상피암 세포주는 배양액내에 tranexamic acid를 첨가하엿으나 세포증식의 억제효과는 없었다. 2. 생체내 신피막하 이식 4일후 장액성난소암조직의 변화는 사전처리된 tranexamic acid 농 도의 증가에 비례하여, 조직학적 판정기준에 의한 점수가 감소됨이 관찰되었다. 이상의 결과로 tranexamic acid 는 장액성 난소암조직에 대한 성장억제효과가 있었으며 따라 서 악성난소암의 보조적인 치료제로서 임상적가치가 있을것으로 사료된다. After treating the carcinoma of uterine cervix ovarian carcinoma and choriocarcinoma cell lines with tranexamic acid in different concentration we obaserved effects of tranexamic acid on the growth inhibition of gynecologic cancer cell lines in vitro And we tried to find out the antitumor effects of tranexamic acid by evaluating morphologic changes of the ovarian carcinoma tissue which was xenografted in the subrenal capsule of immunocompetent mice. The results are as follows; 1. We observed the inhibition of the tumr cell proliferation in serous cystadeno carcinoma cell line of ovary , by the proportion to the tranexamic acid concentration . But squamous carcinoma cell line of uterine cervix and choriocarcinoma cell line were added by tranexamic acid in a culture fluid, but there was no any phenomena of restraint against the tumor cell proliferation. 2. The morphologic changes of the serous cystadenocarcinoma tissue of ovary four days after the subrenal capsular xenograft in immunocompetent mice showed decreased of the histologic score by the proportion to the tranexamic acid concentration was well observed. These results suggest that, the tranexamic acid is associated with the inhibition of the tumor cell proliferation in serous cystadenocarcinoma of ovary , it is of clinical value as an adjuvant antitumor chemotherapeutic agent.

35 세이하 여성에서의 침윤성 자궁경부암

김승조,한상균,남궁성은,이준모,김현홍,이필호,고영미 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9

1980년 1월부터 1993년 12월까지 가톨릭의과대학 부속 강남성모병원 산부인과 종양부에서 일관된 추적관찰을 받은 35세이하 자궁경부암환자 65예와 35세이상 자궁경부암환자 579예를 대상으로 자궁경부암의 예후인자들과 그 예후인자들에 따른 무병생존기간을 연구하였고, 광범위 자궁적출술 및 골반임파절 절제술을 시행한 35세이하 자궁경부암환자 42예와 36세이상 자궁경부암환자 248예에서는 임파선 전이율, 종양침윤율과 임파혈관강 침윤율을 산출하여 다음과 같은 결론을 얻었다. 1. 35세이하에서의 자궁경부암 발생빈도는 각각 2년주기로 볼대 1989년까지는 증가하였으나, 1990년이후부터는 감소하는 경향을 보이고 있다. 2. 자궁경부암 환자의 연령이 낮을수록 임상병기 I기는 증가하였고, II기, III기, IV기는 감소하는 추세였다(p$lt;0.05). 3. 자궁경부암 환자의 연령에 따른 조직학적 형태별 분포는 유의한 차이가 없었다. 4. 조직학적 분화도의 발생빈도는 환자의 연령에 관계없이 grade II가 grade I 및 III보다 유의하게 높았다(p$lt;0.05). 5. 환자의 연령에 다른 종양의 크기가 4.0cm 이상인 환자의 발생빈도는 유의한 차이가 없었다. 6. 종양의 침윤이 1.0cm 이상인 환자의 발생빈도는 36세이상이 35세이하보다 유의하게 높았다(p$lt;0.05). 7. 연령에 따른 임파혈관강 침윤율은 유의한 차이가 없지만 임파절 전이율은 46-55세에서 유의하게 높았다(p$lt;0.05). 8. 임상병기에 관계없이 35세 이하인 환자와 36세이상인 환자의 156개월 무병생존율의 차이는 유의하지 않았다. 9. 임상병기 I기에서 35세이하인 환자와 36세이상인 환자의 150개월 무병생존율의 차이는 유의하지 않았다. 10. 임상병기 II기에서 35세이하인 환자가 36세이상인 환자보다 90개월 무병생존율이 유의하게 낮았다. 11. 35세이하이고 임파절 전이가 양성인 환자와 음성인 환자의 70개월 무병생존율의 차이는 유의하지 않았다(p$gt;0.05). 12. 35세이하이고 종양크기가 4.0 cm이상인 환자와 4.0 cm미만인 환자의 144개월 무병생존율의 차이는 유의하지 않았다(p$gt;0.05). 13. 35세이하이고 종양 침윤정도가 1.0 cm이상인 환자와 1.0 cm이하인 환자의 97개월 무병생존율의 차이는 유의하지 않았다(p$gt;0.05). The incidence of cervical cancer in young women appears to be increasing. However, the influence of young age on prognosis remains unknown. There is almost no information on the prognosis of young women, age 35 years or less, with invasive cervical carcinoma. From Jan.1980 to Dec. 1993, the clinical courses of 65 patients with 35 years orless were reviewed and compared with that of 579 patients with 36 years or more. We obtained the following results: 1. There was an increasing tendency of patients with 35 years or less during 2 year time interval between Jan. 1980 to Dec. 1989, but a decreasing tendency was showed after jan. 1990. 2. The lower the patients age, the higher the incidence of clinical stage I. and the higher the patients age, the higher the incidence of clinical stage II, III, IV(P0.05). 3. The 156-months disease free survival rate for patients with 35 years or less was 83.2% versus 60.6% for matched patients with 36 years or more in all stages. This difference was not statistically significant(p$gt;0.05). 4. The 150-months disease free survival rate for patients with 35 years or less was 86.1% versus 80.0% for matched patients with 36 years or more in stage I. This difference was not statistically significant(P$gt;0.05). 5. The 90-months disease free survival rate for patients with 35 years or less was 60.0% versus 70.0% for matched patients with 36 years or more in stage II. This difference was statistically significant(P$lt;0.05). 6. The 70-months disease free survival rate for patients with lymph node metastasis was 83.3% versus 84.2% for matched patients without lymph node metastasis in patients with 35 years or less. This difference was not statistically significant(p$gt;0.05). 7. The 144-months disease free survival rate four patients with tumor size above 4.0 cm was 82.3% versus 90.9% for matched patients with tumor size below 4.0cm. This difference was not statistically significant(P$gt;0.05). In most stages of disease their clinical characteristics was similar to that of older patients, and in stage II their prognosis was considerably worse. But it is not possible to evaluate the question statistically from this group of cases, and it must remain an individual problem for each patient under consideration. The time honored percepts of early diagnosis, adequate treatment, and careful post-treatment follow-up are nowhere more mecessary than in the younger age group.

트리코모나스질염 및 비 특이성 세균질염에서 Solco Trichovac의 치료효과

김승조,한상균,남궁성은,이준모,이근우,고영미,장석일 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.11

본 연구는 트리코모나스 질염 환자 22명과 비특이성 질염환자 9명을 대상으로 면역치료 요법의 일종인 Solco Trichovac의 치료 및 예방 유효성을 알아보고져 환자 혈청의 항체역가, 질내의 세포진 검사 및 pH를 동시에 측정하여 다음과 같은 성적을 얻었다. 1. 트리코모나스 질염 환자에서 백신 주사전 그리고 처음주사 1개월, 2개월, 3개월후의 환자혈청에서 응집가를 관찰한 결과 백신주사전 응집가는 평균 1:35, 주사후 1개월에는 1:161, 2개월에는 1:255, 3개월에는 1:269로서 3개월까지는 증가하는 추세를 보였다. 2. 비특이성 질염 환자에서는 백신주사전과 주사후 1개월, 2개월, 3개월 후으 환자혈청 응집가는 평균 1:48, 1:112, 1:167, 1:151의 응집가를 보였다. 3. 비 특이성 질염은 트리코모나스 질염 평균항체응집가와 비교하여 비교적 낮은 응집가를 관찰하였다. 4. 트리코노나스 질염 환자에서 치유율은 wet sm-ear상 면역 주사후 1개월에 36.4%, 2개월에 18.2%, 3개월에 13.6%에서 트리코모나스 원충의 활동성이 관찰되어 3개월후 86.4%의 치유율을 보였다. 5. 비 특이성 질염 환자에서 치유율은 wet smerar성 면역 주사후 1개월에 33.4%, 2개월에 22.2%, 1개월에 11.1%의 clue cell이 관찰되므로서 최종 3개월후에 88.9%의 치유율을 보였다. 6. 비 특이성 질염의 항체 응집가는 트리코모나스 항체 응집가보다 비교적 낮은 수준을 나타내었으나 치유율의 차이는 없었다. 7. 백신 투여후 비 특이성 환자의 질내 pH값은 투여전 평균 5.62에서 투여후 1개월에 4.96, 2개월에 4.81, 3개월에 4.61로서 최종 3개월에는 정상 질내상태에 이르게 되었다. 이상의 성적을 미루어 보아 Solco Trichovaccine은 트리코모나스 질염과 비 특이성 질염의 치료에 성과를 보여줌과 동시 최소한 3개월까지 혈청내 항체역가가 상승되므로서 에방적 차원으로 임상에서 사용될 수 있는 약제로 사료된다. Solco Trichovac is a vaccine of Lactobacillus acidophilus developed for treating trichomoniasis. The efficacy of the vaccine is reportedly clue to cross reacting antibody being produced in people immunized with the lactobacellus bacteria. We present a analysis of 22 patients with trichomoniasis and 9 patients with non-specific vaginitis who visitied out department between Jul.1992 and Oct. 1993 after vaccination with Solco Trichovac. Immunological and cytological examinaations were used to evaluate the efficacy of treatment in trichomoniasis and non-specific vaginitis and following results were obtained: 1. The specific serum agglutination titers in trichomoniasis increased from a basal mean level 1:35 to 1:161 after 1 month, 1:255 after 2 months and 1:269 after 3 months. 2. The specific serum agglutination titers in non-specific vaginitis increased from a basal mean level of 1:48 to 1:112 after 1month, 1:167 after 2 months and 1:151 after 3months. 3. The specific serum agglutination titers in non-specific vaginitis was relatively lower than in trichomoniasis. 4. The identification rate of trichomonas vaginalis decreased from 36.4%(8/22) after 1 months, to 18.2%(4/22) after 2 months and 13.6%(3/22) after 3 months. 5. The prevalence of demonstrated Clue cell in non-specific vaginitis decreased from 33.4%(3/9) after 1month, to 22.2%(2/9) after 2 months and 11.1%(1/9) after 3 months. 6. The initial mean pH value of 5.62 before the vaccination in non-specific vaginitis also dropped to 4.96 after 1month 4.81 after 2 months, and 4.61 after 3 months. The seresults now appear to be attributable to treat the trichomonas vaginalis infection and non-specific vaginitis, but further studies are necessary to fully evaluate the occurrence of reinfection or relapse over a longer period of time.

자궁경부암 Screening Test에 있어서 Giftec의 효용성

김승조,정재근,한상균,남궁성은,김흥기,안웅식 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.4

가톨릭의대부속 강남성모병원의 산부인과에 내원한 부인과질환 환자 93예와 정상인 17예를 대상으로 국내에서 개발된 새로운 암표자로 알려진 para-hydroxyphenyl 유도체로 추정되는 물질을 뇨중에서 간편 신속하게 측정할 수 있는 Giftec시약을 가지고, 자궁경부암 종양표지물질 TA4와 기존의 질세포진 검사를 비교하여 다음과 같은 결론을 얻었다. 1. 뇨중 para-hydroxyphenyl 유도체의 측정에서, 총 110예중 자궁경부이형증을 포함한 자궁경부암 환자 72예에서 45예(62.5%)가 양성소견이며, 양성종양 및 임산부 21예중 15예(71.4%)가 음성소견이었고, 정상인 17예에서 모두 음성이었다. 2. 혈중 TA4측정에서, 총 110예중 자궁경부이형증을 포함한 자궁경부암 환자 72예에서 36예(50%)가 양성소견이며, 양성종양 및 임산부 21예중 6예(28.6%)가 음성소견이었고, 정상인 17예에서 5예(29.4%)가 양성이었다. 3. 질세포진 검사에서 총 110예중 자궁경부이형증을 포함한 자궁경부암 환자 72예에서 class Ⅰ 및 Ⅱ가 34예(47.2%), class Ⅲ이상이 38예(52.8%)를 보였다. 한편 양성종양 및 임산부 21예중 class Ⅰ 및 Ⅱ가 17예(80.9%), class Ⅲ이상이 4예(19.1%)를 보였다. 정상인 17예에서 5예(29.4%)가 class Ⅲ이상이었다. 4. 자궁경부암중 0기 및 1기 즉, 초기단계인 경우 총 48예중 민감도는 para-hydroxyphenyl 유도체측정에서 75.0%, TA4측정에서 50.0%로 각각 나타났다. 5. Para-hydroxyphenyl 유도체 측정, TA4측정 및 질세포진검사의 민감도는 각각 62.5%, 50%, 52.8%였으며, 특이도는 84.2%, 47.3%, 76.3%였다. 각 군단의 민감도의 차이는 para-hydroxyphenyl 유도체 측정이 TA4측정에 비하여 의의 있었으며(p$lt;0.05), 특이도의 차이는 para-hydroxyphenyl 유도체 측정이 TA4측정에 비하여 의의있게 높았다(p$lt;0.01). 이상의 결과로 보아 새로 소개된 뇨중 para-hydroxyphenyl 유도체를 검출하는 방법이 기존의 방사성 동위원소를 이용한 혈중 TA4를 검출하는 방법보다 자궁경부암 환자를 조기검진 및 집단검진에서 그 유용성과 경제성 및 간편성면에서 우수하다는 임상적 의의를 관찰할 수 있다. To evaluate the validity of Giftec for large scale screening test, a series of tests was performed for comparative studies on 110 women who visited the Department of Obstetrics and Gynecology, Catholic University Medical College, Seoul, Korea. Giftec is a new agent developed in Korea detecting para-hydroxyphenyl derivative in urine. The results of the tests were: 1. Detection of para-hydroxyphenyl derivative in urine; 45 of a total of 72 cervical cancer cases including CIN(cervical intraepithelial neoplasia) were positive, 15 of 21 benign including pregnant cases were negative and all 17 normal control were negative. 2. Detection of TA4(tumor antigen); 36 of a total of 72 cervical cancer cases including CIN were positive, 6 of 21 benign including pregnant cases were negative and 5 of 17 normal control were positive. 3. Pap smear; 34 of a total of 72 cervical cancer cases including CIN came under class Ⅰ and Ⅱ, and 38 came under class Ⅲ or higher. 17 of 21 benign including pregnant cases came under class Ⅰ and Ⅱ, and 4 came under class Ⅲ or higher, 5 of 17 normal control came under class Ⅲ or higher. 4. When two agents were tested for comparative sensitivity on a total of 48 cases of CIS(carcinoma in situ=stage 0) and cervical cancer stage Ⅰ, the sensitivity was 75% for detection of para-hydroxyphenyl derivative, and 50% for detection of TA4. 5. The sensitivity of detection of para-hydroxyphenyl derivative, detection of TA4 and pap smear was 62.5%, 50%, and 52.8% respectively, and the specificity of the three was 84.2%, 47.3%, and 76.3% respectively. As for the comparative sensitivity with the test groups, detection of parahydroxyphenyl derivative was more available in both sensitivity(P$lt;0.05) and specificity(P$lt;0.01) than detection of TA4. Thus the clinical significance of the new method using Giftec was observed in early detection and group screeing for cervical cancer, and it is superior to the detection of blood TA4 method in usefulness, and cost as well as simpleness.

신생기 생쥐에서 합성 에스트로겐 제재로 유발되는 자궁경관 및 질선증에 대한 레티놀 아세테이트의 효과

김승조,안웅식,한상균,낭궁성은,송승규,이헌영 대한부인종양 콜포스코피학회 1990 Journal of Gynecologic Oncology Vol.1 No.1

Preventi.on by retinol acetate of the occurrenrce of diethylstilbestrol(DES) induced persistent vaginal and uterine changes was studied in neonatal ICR strain mice. The mice were devided into six groups. DES injected group received five daily injectiona of 20ug DES alone from the day of birth. In the DES plus retinol acetate-injected groups, daily injections of 20ug DES together with 100 I,U. or 200 I.U. retinol acetate were given tu mice for 5 days from the day of birth respectively. Another group of mice was first given daily injections of 20ug DES for 5 days from the day of birth and then given five daily injections af 200 I.U. retinnl acetate from 15th postnatal day. In addition, daily inj'ectiuns of 200 l.t.J. retinol aeetate only and of 0.02ml sesame oil only were given to mice for 5 days from the day of birth respectively. The mice were sacrifieecl at 5 (lays, 30 days, and 120 days separately. Histological observation was made on vaginae ancI uteri. Cells at metapha.e per 500 basal cells were calculated in two sectinns of each of the cranial and candal portions of the vaginal epithelium and in section of uterine epithelium. Number of cell layers of the vaginal and uterine epithelium was counted. The occorrence cif the atypical epithelial change such as adenosis, adensis-like lesion and keratinizatioa was also examined. The results were as follows: 1) In the 120-day-old mice receiving neonatal DES injection, the occurrence of adenosis significantly increased(P$lt;0.001) compared with neonatally DES-injected, 5-day-old or 30-day-old mice. 2) In the DES plus retinol acetate-injected groups, the occurrence of adenosis significantly decreased(P$lt;0.01), and 1000I.U./day) retinol acetate-injected group had more blocking trend on the occurrence of adenosis compared with 500I.U.(100I.U./day) retinol acetate-injected group. 3) Inthe 30-day-old mice of DES plus retinol acetate-injected groups, the mitotic rate significantly increased(P$lt;0.05). compared with 30-day-old mice of DES-injected group, whereas in DES plus retinol acetate-injected mice aged 120 days, the mitotic rate significantly decreased(P$lt;0.05) compared with DES-injected mice aged 120 days. The mitotic rate was more signitificantly decreased in the injection of DES together with 1000I.U.(200I.U/day) retinol acetate(P$lt;0.001) than that of DES together with 500I.U.(100I.U./day) retinol acetate among mice aged 120 days. 4) There was no difference of the number of cell layers in both cranial and caudal portions of vaginal epithelium between DES plus retinol acetate injected mice aged 30 days and DES-injected mice aged 30 days. In the 120-days-old mice, DES retinol acetate-injected group showed a significant decrease of the number of cell layers in both carnial and caudal portions of vaginal epithelium(P$lt;0.001) compared with DES-injected group 5) Two groups which had received injections either of 1000I.U(200I.U./day) retinol acetate from the day of birth of 1000I.U.(200I.U./day) retinol acetate from the 15th postnatal day showed no significant difference in the blocking effect of the occurrence of DES induced vaginal adenosis. However, of the two groups in mitotic rate and the number of cell layers in vaginal epithlium are more significantly decreased in the former than the latter(P$lt;0.01) The present study, therefore, suggests that retinol acetate has a blocking effect on the occurrence of DES-induced atypical epithelial changes in vaginae and uteri, and the blocking effect depends upon dose of retinol acetate and date

자궁경부암의 임상병리학적 예후인자를 이용한 새로운 임상적 분류

김승조,정재근,김진우,한상균,남궁성은,이관훈,백은정 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.12

1985년 1월부터 1990년 12월까지 가톨릭 의과대학 산부인과 부인암클리닉에 등록된 자궁경부암 환자들중 광범위 자궁적출술 및 골반임파절 절제술을 시행한 후 일관된 추적관찰을 받은 259예를 대상으로 현재 사용되고 있는 수술전 임상병리학적 예후인자와 2.5년을 기점으로 한 무병생존기간을 비교분석하고, 다변수 분석법을 이용하여 유의성이 있는 임상병리학적 예후인자를 토대로 새로운 자궁경부암 위험군 예측점수제를 창안하여 다음과 같은 결과를 얻었다. 1. 자궁경부암 환자의 연령분포는 35세부터 50세까지가 43%로 가장 많았으며 60세이상, 35세이상, 50대의 순이었다. 2. 기왕 분만횟수별 분포는 4회이상이 32.8%로 다수를 차지하였다. 3. 암파급기별 분포는 Ia기가 3.5%, Ib기가 72.2%, IIa기가 24.3%였다. 4. CEA치는 5 ng/ml미만이 76.4%로 가장 많았으며 5-20 ng/ml가 17.0%, 20 ng/ml이상이 6.6%였다. 5. TA-4치는 5 ng/ml미만이 89.2%로 가장 많았으며 5-20 ng/ml가 7.3%, 20 ng/ml이상이 3.5%였다. 6. 조직세포형태별 분포를 보면 편평상피암 92.3%, 선암피암 2.3%, 선암 5.4%였다. 7. 조직분화도별 분포를 보면 중등도분화도가 61.4%로 가장 많았으며 미분화도 25.9%, 고분화도 12.7%였다. 8. 종괴의 크기에 다른 분포는 2.0 cm미만이 61.4%, 2.0-2.9 cm가 24.7%, 3.0 cm이상이 13.9%였다. 9. 환자의 평균연령은 무병생존기간이 2.5년미만인군이 2.5년이상인 군보다 유의하게 높았고, 평균분만횟수는 두 군사이에 유의한 차이가 없었다. 10. 평균 종괴의 크기는 무병생존기간이 2.5년미만인군이 2.5년이상인 군보다 유의하게 컸다. 11. CEA의 평균치는 무병생존기간이 2.5년미만인 군이 2.5년이상인 군보다 유의하게 증가했지만, TA-4의 평균치에서는 두 군사이에 유의한 차이가 없었다. 12. 암 파급정도가 진행될수록 무병생존기간이 2.5년이상인 경우는 감소하였으나, 편평상피암일 수록 무병생존기간이 2.5년이상인 경우는 증가하였다. 13. 조직분화도에 따른 2.5년 이상과 미만의 무병생존의 차이는 없었다. 14. 수술전 임상병리학적 예후인자들의 2.5년 무병생존기간에 대한 다변수분석을 시도한 결과 종괴의 크기, 세포형태, 암파급정도, CEA 측정치, 환자의 연령 5개 예후인자가 통계학적으로 의의있는 예후인자로 산출되었다. 15. 위의 5가지 예후인자를 묶어서 자궁경부암 위험군 예측점수제를 만들어 0-6점은 저위험군, 7점 이상은 고위험군으로 분류하였다. 16. 총 대상환자 159명에 대하여 자궁경부암 위험군 예측점수제를 적용한 결과 고위험군 및 저위험군의 예측치가 각각 82.9%(39/47), 35.8%(76/212)로 나타났으며, 특히 고위험군의 예측치가 높아 이의 조기진단에 도움이 되는 것으로 사료되었다. We studied to find out the possibility that scoring system obtained by clinicopathological risk factors including age, parity, clinical stage, CEA level, TA-4 level, cell type, histologic grade and tumor size in patients with cervical cancer can be used as prediction scording system for the high risk group of patients with cervical cancer. We studied 9 patients with clinical stage Ia, 187 patients with clinical stage Ib and 63 patients with stage IIa who visited the Clinic of Cervical Neoplasia at Department of Obstetrics and Gynecology, Catholic University Medical College from Jan. 1985 to Dec. 1990, for whom radical hysterectomy were performed. Total 259 cases were divided into two groups. The group I was 64 cases which disease free interval was below 2.5 years, the group II was 195 cases shich disease free interval was above 2.5 years. Using the computerized $quot;Stepwise Discriminant Analysis$quot;, all factors were investigated for measuring degree of discriminating two group. The result were as follows. 1. In comparison of clinical factors, patient age, tumor size and cea LEVEL were significantly higher in group I than group II(P$lt;0.01), but parity and TA-4 level were not significantly different between the two groups(p$gt;0.01). 2. Comparing the two groups according to the clinical stage, there was a significant positive correlation between incidence of and the degree of clinical stage(p$lt;0.01), but there was a significant negative correlation between incidence of group II and the degree of clinical stage (p$lt;0.01). 3. The incidence of squamous cell types was significantly higher than adenomatous type in group II(p$lt;0.01), but the incidence of squamous cell type was significantly lower than adenomatous type in group I(p$lt;0.01). 4. There was not a significant correlation between histologic grade and incidence of two groups (p$gt;0.01). 5. We composed new prediction scoring system for the risk of cervical cancer used with clinicohistological factors such as tumor size, cell type, clinical stage, CEA level, age, that were selected by $quot;Stepwise Discriminant Analysis$quot;and then total investigated patients were divided into two groups. (low risk group with scores ranging from 0 to 6, high risk group above 7). 6. Predictive value of high risk and low risk in patients with cervical cancer employing new prediction scoring system were 82.9%(39/47), 35.8%(76/212) respectively. From these results, it might be concluded that pretreatment evaluation of high risk patients with cervical cancer by means of new prediction scoring system up is not only useful in proper treatment and follow up of patients with cervical cancer but also contbibutory to the reduction of mortality from cervical cancer by predicting the high risk patients with cervical cancer.

자궁경부암에서 cis-Platin을 포함한 복합항암요법에 의한 오심 및 구토의 조절에 있어 Ondansetron-Dexamethasone의 효과에 대한 비교분석

김승조,송승규,권용일,김미란,이유미,한상균,남궁성은 대한부인종양 콜포스코피학회 1993 Journal of Gynecologic Oncology Vol.4 No.2

Chemotherapy induced nausea and vomitting remain important concerns for patients. In recent years, many antiemetics based on diphenhydramine, dexamethasone, metoclopramide or lorazepam have eiinically demonstrable antiemetie effects. Cis-Platin, which is one of the most effective chemotherapeutic agents, produces severe emesis after its administration and delayed emesis also. Metoclopramide, which is a potent dopamine receptor antagonist, have been shown to be safe and effective single agent for the control of nausea and vomitting. But the antiemetic effects of metoclopramide was thought to be mediated by dopamine receptor blockade and so produced adverse events like as extrapyramidal reactions. Recently, Ondansetron is a highly selective 5-HT, (5-Hydroxytryptamine,) receptor antagonist that dose not have any activity at dopamine receptors. It has been shown to be an effective antiemetic activity especially when combined with dexamethasoe and also be safe and less side effects. All patients suffering from a diaease with cervical cancer were receiving cis-Platin (80 to 120 mg/ m) containing combination chemotherapy. OD( Ondan,setron (Hmg)-Dexamethasone (20mg) $gt;was given to 30 patiente. Their mean ages were 43 and 47 years old, respectively. In the OD group, Ondansetron 8mg and Dexamethasone 20mg were given by intravein 30 minutes prior to chemotherapy and administered intravenously by 8 hour intervals after chemotherapy on day 1 on days 2~3, the patients reveived Ondansetron at a dose of 8mg tid Fro the 3 days following, Ondansetron was administered as an oral dosage of 8 mg every 8 hours. In the MD group, Metoclopradmide 30 mg in normal saline 100ml and Dexamethasone 20mg were of given by intravein 30 minutes prior to cis-Platin administration for 30 minutes and administered intravenously by 8 hour intervals on days 1~3. For the 3 days following, the drugs were administered as an oral dosage of 30mg every 8 hours. In the MDL group, Metoclopramide 2mg/kg in normal saline 100ml, Dexamethasone 20mg and Lorazepam 1mg were fiven by intravein 30 minutes prior to chemotherapy and administered intravenously by 8 hour intervals on day 1. On days 2~3, the patients received Metoclopramide and Dexamethasone at a dosage of 2mg/kg and 20mg tid. For the 3 day following, Metoclopramide was administered by oral dosage of 100mg every 8 hours. In the OD group, MD group and MDL gorup, mausea was controlled in 100% of the patients(none:48.4%, mild $quot; 51.6%), 55% (5%, 50%(, 46%(13%, 33%) and vomitting was controlled in 100% of patients (complete: 87.1%, major: 12.9%), 60%(25%, 35%), 83%(43%, 40%) on day 1. On days 2 to 3, nausea was controlled in 71% of the patients(none: 12.9%, mild: 58.1%), 57.5(2.5%, 55%), 66.6%(13.3%, 53.3%) and vomitting was controlled in 80.7%(complete: 48.4%, major:32.3%), 67.5%(7.5%, 60%), 80%(23.3%, 56.7%). On days 4 to 6, mausea was controlled in 77.5% (none: 45.2%, mild: 32.3%), 77.5%(2.5%, 75%), 93.3%(33.3%, 60%), and vomitting was controlled in 87.1%(complete: 67.7%, major: 19.4%), 77.5%(20%, 57.5%), 96.7%(56.7%, 40%). The side effects of the OD group were mild with dystonic reaction(4 patients), headache(5 patients), constipation(5 patients), xerostomia(7 patients), nonspecific abdominal pain(6 patients) and cutaneous flushing(4 patients). In the MD group, expyramidal, side reaactions were seen with exrostomia(25 patinets), cutaneous flushing(26 patients), headache(10 patients), acute dystonic reaction(9 patients), restlessness(8 patients) and abdominal pain(8 patients), In the MDL group, the side effects were mild with sedation(6 patients), restlessness(1 patient) and no expyramidal reaction was seen, There is no patients who had treatment failure in 101 patients. the results showed that OD group was more effective than MD or MDL groups in a controlled envrionment of acute emesis induced by cis-Platin based combination chemotherapy. But in delayed emesis, the MDL group was the most effective regimen among the three groups. Lorazepam was an effective regimen in controlling the expyramidal side reactions

자궁경부암에서 c-myc DNA증폭과 DNA배수체 분석

김승조,이헌영,김진우,한상균,남궁성은,박종섭,한구택,박수경 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.1

저자들은 자궁경부암에서 c-myc DNA 증폭 유무 및 유식 세포분석기에 의한 DNA 부석결과를 생물학적 예후인자로서 사용 가능성을 검토하고 관찰하기 위하여 본 실험을 실시하였다. 1991년 1월부터 동년 12월까지 가톨릭 의과대학 산부인과 부인암클리닉에 내원한 자궁경부암 환자들 중 광범위 자궁적출술을 시행한 임상 제 I, II기의 31예를 대상으로하여 DNA 교잡법에 의하여 c-myc DNA 증폭 유무와 HPV 아형의 검색 및 유식 세포분석기에 의한 DNA 분석결과와 질환의 병기, 연령, 조직학적 진단 결과와의 관계를 분석하여 다음과 같은 결과를 얻었다. 1. c-myc DNA 증폭의 발생빈도는 암 조직내의 임파관 및 혈관에 암세포 침윤이 있는 군이 암세포 침윤이 없는 군보다 유의하게 높았으나, 환자의 연령, 임상병기, 세포형태, 조직의 분화도, 병소의 크기, 침윤의 정도, 골반내 임파절 전이 여부에 따른 c-myc DNA 증폭율의 차이는 유의하지 않았다. 2. DNA 지수는 비각질화군이 각질화군보다 유의하게 높았고, 세포주기 중 합성기율은 유의한 차이가 없었다. 그외의 병리학적 특징들에서 DNA 지수값의 차이는 유의하지 않았다. 3. c-myc DNA 증폭이 양성과 음성인 경우에서 각각 DNA지수는 유의한 차이가 없었다. 4. 2배수체성에 비교한 비배수체성 종양의 발생빈도는 임상적, 병리학적 특성에 의하여 분류된 예후 인자들에서 각각 유의한 차이는 없었다. 5. c-myc DNA 증폭이 음성이면서 2배수체성 종양군 6예(19.4%)가 다른 세가지 군을 합한 25예(80.65)보다 유의하게 낮았으며, c-myc 유전자 증폭유무와 DNA배수체성 상태와는 유의한 상관관계를 보이지 않았다. 6. 인유두종 바이러스 16형이 양성인 5예에서 c-myc 유전자 증폭이 모두 양성이었고 이중 3예에서 비배수체성, 2예에서 2배수체성을 보였다. 이와 같은 결과들로 자궁경부암 세포의 c-myc 유전자 증폭유무 및 DNA배수체성 상태는 자궁경부암의 임상병리학적 특징을 반영하는 지표로 이용될 수 있으며 예후인자로서 중요성은 장기간에 걸쳐 보다 많은 수에서의 검사와 추적관찰을 통해 인식될 수 있을 것으로 사료된다. We conducted this experiments to find out the possibility that DNA patterns obtained by flow cytometry in patients with cervical cancer can be used as a biological prognostic factors. We studied 31 cervical cancer patients with clinical stage I or II who visited the Clinic of Cervical Neoplasia at Department of Obstetrics and Gynecology, Catholic University Medical College from Jan. 1991 to Dec. 1991, for whom radical hysterectomy were performed. We obtained following results from those patients by analyzing the results and factors such as patterns of c-myc DNA amplification, detection of Human papillomavirus (HPV) subtype, DNA analysis obtained from flow cytometry, clinical stage, age, histologic findings. 1. The incidence of c-myc DNA amplification was significantly higher in group with lymphovascular involvement than those group without lymphovascular involvement, but the amplification rate of c-myc DNA was not affected by age, clinical stage, cell type, histologic differentiation, tumor size, depth of invasion, and pelvic lymph node metastasis. 2. DNA index was significantly higher in non-keratinizing group than that of keratinizing group, but the mean S-phase rate was not significantly different between two groups. The value of DNA index was not significantly affected by other pathologic characteristics. 3. There was no significant difference in DNA index between the group with c-myc DNA amplification and group without c-myc DNA amplification. 4. The incidence rate of aneuploid and diploid tumors was irrespective of above prognostic factors classified by clinicopathologic characteristics. 5. The group which consisted of 6 cases (19.4%) negative c-myc DNA amplification and diploidy was significantly lower than other three groups which consisted of 25 cases (80.6%), but the ploidy patterns was irrelevant of either presence of absence of c-myc DNA amplification. 6. All 5 cases with detection of HPV subtype 16 showed c-myc DNA amplification patterns, of which 3 cases showed aneuploid and 2 cases showed diploid patterns. From these results, we concluded that amplification pattern of c-myc DNA and ploidy patterns of cervical cancer can be used as a index which reflex the clinicopathologic characteristics of cervical cancer, but further follow up observation and study over a long period will be needed to use them as a prognostic factors of cervical cancer.

포상기태에 있어서 유식 세포분석기에 의한 DNA 분석과 임상적 예후

김승조,이헌영,정재근,한상균,안웅식,홍승덕 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.6

1982년부터 1988년까지 가톨릭의과대학부설 한국융모상피질환연구소에 등록된 환자 중에 병리학적으로 확진된 포상기태환자 114예(완전포상기태 96예, 부분포상기태 18예), 정상 태반조직 10예(초기임신 5예, 말기임신 5예) 및 융모상피암 6예를 대상으로 유식 세포분석기를 이용하여 DNA양의 측정과 세포주기를 분석하고 이들의 생화학적 및 임상위험인자들과 비교하여 다음과 같은 결과를 얻었다. 1. 세포주기의 분포양상중 합성기는 정상태반, 완전포상기태 및 부분포상기태에서 각각 11.0±4.5%, 33.2±15.2%, 및 35.5±13.4%로서 완전포상기태 및 부분포상기태에서 모두 정상태반보다 현저히 높았으나(P$lt;0.01), 완전포상기태와 부분포상기태간에는 차이가 없었다. 2. 조직소견에 따른 수체상태는 정상태반과 융모상피암은 모두 2배체였으나, 완전포상기태는 55.2%가 2배체, 44.8%는 비배체를 보였으며, 부분포상기태는 66.7%가 2배체, 33.3%가 비배체를 보여 완전포상기태와 부분포상기태의 수체상태에 따른 차이는 유의하지 않았다. 3. 포상기태의 위험군에 따른 세포주기의 분포양상증 합성기는 저위험군, 중등도위험군 및 고위험군에서 각각 34.2±11.6%, 36.7± 12.0% 및 24.5±7.0%로서 위험군에 따른 세포주기 분포양상의 차이는 유의하지 않았다. 그러나 위험군에 따른 세포 증식율은 각각 1.19±0.41%, 15.6±0.31 및 2.37±0.45로서 저위험군과 중등도위험군의 차이는 없었으나, 저위험군과 고위험군간의 차이는 유의하였다(P$lt;0.05). 4. 포상기태의 위험군에 따른 2배체의 발생빈도는 저위험군, 중등도위험군 및 고위험군에서 각각 49.4%, 68.2% 및 84.6%로서 고위험군으로 갈 수록 2배체의 발생빈도는 증가하였다. 5. 질환의 예후에 따른 세포주기의 합성기는 자연경쾌군에서 32.3±11.3%이며, 존속성 융모상피질환으로의 이행한 군에서 35.6±10.6%로 세포주기 분포양상은 유의한 차이가 없었다. 그러나 세포증식율은 자연경쾌군에서 1.13±0.38이고 존속성 융모상피질환으로 이행한 군에서 1.92±0.69로 증가하였다(P$lt;0.05). 6. 존속성 융모상피질환으로 이행된 포상기태중 2배체의 발생빈도는 저위험군, 중등도위험군 및 고위험군에서 각각 88.2%, 89.9% 및 91.9%로 2배체성 포상기태에서의 이환율이 비배체성 포상기태에서의 이환율보다 유의하게 높았다(p$lt;0.05). 7. 2배체성 포상기태의 세포증식율이 1.5이상인 경우는 36예중 26예(72.2%)가 존속성융모상피질환으로 이행하였으며, 1.5이하인 경계로하여 질횐의 예후에 유의한 차이를 나타내었다 (p$lt;0.01). 이상의 결과로 보아 융모상피질환에서 염색체의 수체상태 및 세포증식율은 이 질환의 중요한 예후인자가 됨을 알 수 있으며, 포상기태에서 임상 및 생화학적 위험요소들과 함께 유식 세포분석기에 의한 DNA양의 측정은 포상기태임신의 진단과 예후를 측정하는데 도움을 주리라고 생각된다. In order to diagnose molar pregnancy and risk assessment, nuclear DNA content was measured by flow cytometry in 10 placentas, 114 hydatidiform moles and 6 choriocarcinomas. Flow cytometric DNA patterns were compared with biochemical and clinical risk factors. The results were as follows; 1. The S-phase DNA content fraction was higher in complete hydatidiform moles(33.2±15.2%) and in partial hydatidiform moles(35.5±13.4%) than in the placentas(110±4.5%). 2. Of the 96 complete moles, 53(55.2%) were diplod and 43(44.8%) were aneuploid(4 hypodiploid, 10 peridiploid, 4 triploid, 10 peritetraploid, 13 tetraploid, 2 polyploid). Of the 18 partial moles, 12(66.7%) were diploid and 6(33.3%) were aneuploid(1 peridiploid, 4 triploid, 1 peritetraploid), All the placentas and choriocarcinomas were diploid. 3. The S-phase fraction in low(34.2±11.6%), medium(36.7±12.0%) and high risk group(24.5±7.0%) was not increased, but the proliferation index was increased accordingly as low(1.19±0.41), medium(1.56±0.31) and high risk group(2.37±0.45). 4. The incidence of diploid moles of the low, medium and high risk group was increased proportionally as 49.4%, 68.2%, and 84.6%. 5. There was no change in the S-phase fraction in the spontaneous remission cases and molar pregnancies progressed to persistent trophoblastide disease, but the proliferation index of molar pregnancies progressed to persistent trophoblastic disease(1.92±0.69) was higher than that of the spontaneous remission cases(1.13±0.38). 6. The incidence of diploid tumor in molar pregnancies progressed to persistent trophoblastic disease(89.5%) was higher than that of spontaneous remission cases(40.8%). 7. The proliferation index greater than 1.5 separated molar pregnancies progressed to persistent trophoblastic disease from the spontaneous remission cases in diploid moles(P$lt;0.01). These findings suggest that ploid levels and cell cycle analysis by flow cytometric DNA content measurement could be used as important aid in the diagnosis of molar pregnancy and risk assessment. the high degree of cell proliferation found in this study appears to implicate the premalignant potential of hdatidiform moles.