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송치훈(Chi Hun Song),홍서유(Seo Yoo Hong),정수미(Soo Mi Chung),한경철(Kyung Chul Han),박철범(Chul Bum Park),신봉규(Bong Gyu Shin) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3
Ovarian cysts in the newborn are uncormnon. Fetal ovarian cysts are being diagnosed with inaeasing fiequency with development of obstetrical sonography. Most of these cysts are found within the first few months of life and have no clinical significance. But, a large ovarian cyst would be founded antenatally with sonography. A large ovarian cyst can cause life-theatening complications during parturition and in the neonatal period. We have experienced a case of fetal ovarian cyst in a 32-year-old primiparous woman with antenatal sonography and report our experience with a brief review of literatures.
김송이 ( Song E Kim ),홍서유 ( Seo Yoo Hong ),김주오 ( Joo Oh Kim ),신정환 ( Jung Whan Shin ),김대운 ( Dae Woon Kim ),신영진 ( Young Jin Shin ) 대한주산의학회 2002 Perinatology Vol.13 No.1
목적:을지 의과대학 산부인과 교실에서 시행된 산후 응급 자궁적출술의 증례들을 관찰 분석하고자 한다. 연구방법:1996년 5월부터 2000년 12월까지 산후 자궁적출술을 시행받은 37례를 대상으로 빈도, 연령별 및 분만횟수별 분포, 적응증, 위험인자, 수술방법, 수혈량, 합병증 그리고 태아의 예후를 후향적 연구로 분석하였다. 결과:산후 자궁적출술의 총 빈도는 1,000분만당 2.3례였고 분만방법에 따른 빈도는 질식분만후 0.03%, 제왕절개술 분만후 0.52%로 제왕절개 분만후 산후 자궁적출술의 빈도가 더 높았다. 또한 연령이 증가할수록 그리고 분만횟수가 많을수록 산후 자궁적출술의 빈도는 높았다. 수술의 적응증은 전치태반과 유착태반을 포함한 태반요인(54.1%), 자궁무력증(37.8%), 자궁근종(5.4%), 자궁파열(2.7%)의 순서로 나타났다. 위험인자에 대한 산후 자궁적출술의 비교 위험도는 태반요인에 대해 97.6(95% 신뢰구간 52.17~184.06), 제왕절개술에 대해 16.3(95% 신뢰구간 4.94~52.31), 그리고 기왕제왕절개술에 대해 2.4(95% 신뢰구간 1.21~4.76)로 태반 요인이 높은 비교위험도를 나타내었으며 95% 신뢰구간에서 볼 때 의의가 있었다. 수술방법은 대부분 전자궁적출술(92%)로 이루어졌고 평균 수혈량은 17.1pints 였다. 합병증은 전체의 43.2%로 나타났는데 주로 폐부종, 무기폐, 기흉등의 호흡기계 합병증, 범발성 혈관내 응고장애, 감염 및 비뇨기계 합병증이었으며 산모사망의 예는 없었다. 태아사망은 2례(5.3%)에서 있었고 신생아 이환율은 26.3%로 10례에서 발견되었다. 결론:산후 자궁적출술의 주된 원인은 전치태반 또는 유착태반 등의 태반요인이다. 산후 자궁적출술은 산모의 생명이 위협을 받는 상황 아래서 시행될 수 있는 최선의 방법이나 산모의 이환율이 높으므로 산전관 리부터 위험요인에 대한 세심한 관리와 처치가 필요하다. Objective:To analyze incidence, indications, risk factors, complications, and neonatal outcomes of emergency postpartum hysterectomies performed at EulJi University Medical Center. Methods:A retrospective study of all cases of postpartum hysterectomies between May. 1996 and Dec. 2000. was carried out. Results:37 cases of postpartum hysterectomies during this period were performed, for overall incidence of 2.3 per 1000 deliveries. Incidence after vaginal delivery and cesarean section was 0.03% and 0.52% respectively. The rate of postpartum hysterectomy increased with increasing age and parity. The main indications were placental disorders(54.1%) including placenta previa and adherent placenta, uterine atony(37.8%), uterine myoma(5.4%) and uterine rupture(2.7%) in order. The relative risk of postpartum hysterectomy according to the risk factors was 97.6(95% confidence interval 52.17-184.06) for placental disorders, 16.3(95% confidence interval 4.94-52.31) for cesarean section and 2.4(95% confidence interval 1.21-4.76) for previous cesarean section. The mean amount of transfusion was 17.1 pints. Although no maternal mortality had occurred, 16 patients(43.2%) had complicaions including respiratory complication(13.5%), hemorrhagic complication(10.8%), infection(8.1%) and urologic injury(8.1%). Regarding fetal outcome, 2 of 38 infants(1 case, twin) were stillborn (5.3%) and 10 infants(26.3%) were suffered from various illness including prematurity, sepsis, meningitis, and brain hemorrhage. Conclusion:The data identifies placental disorders are the leading cause of postpartum hysterectomy. Although postpartum hysterectomy is a necessary life-saving operation, maternal morbidity remained high.
임신 중 당뇨의 조절은 어느 과에서 시행하는 것이 적절한가?: 내과와 산부인과에서의 비교
서용수 ( Yong Soo Seo ),신정환 ( Jung Hwan Shin ),이헌열 ( Hun Yul Lee ),박원일 ( Won Il Park ),김재령 ( Jae Ryung Kim ),김혜민 ( Hae Min Kim ),최은주 ( Eun Joo Choi ),김대운 ( Dae Woon Kim ),홍서유 ( Seo Yoo Hong ),박은주 ( Eun J 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.7
Objective: To compared obstetric outcomes of pregnancies complicated by diabetes according to the managing department and to consider role of obstetrician and endocrinologist Methods: A retrospective analysis of 72 pregnant women managed for diabetes during March 2004 to December 2006 was performed. Eighteen women had been managed by obstetricians (Group I) while 54 women had been managed by endocrinologists of internal medicine (Group II) during their pregnancies at Eulji Hospital. None of these patients had multiple pregnancies, abnormal karyotype, or other medical disorders other than diabetes. Pregnancy outcomes were compared between two groups. Results: No difference was found with regard to the age, parity, BMI (body mass index), weight gain during the pregnancy, and the gestational weeks of delivery. There was also no difference in the blood glucose levels after 100 gm OGTT (oral glucose tolerance test) and HbA1C levels in two groups. The neonatal birth weight of group I (2.89±0.21 kg) was significantly lower than that of group II (3.38±0.08 kg, P=0.040). The 1 min APGAR score, which was corrected by weight through ANCOVA test, was also significantly lower in group I (7.11±0.51 vs 8.11±0.19, P=0.028). But There was no difference in 5 min APGAR score. The incidence of birth weight over 3.8kg was significantly higher in group II [37/54 (68.5%) vs 1/17 (5.6%), P=0.030]. Neonatal hypoglycemia was also higher in group II (37.0% vs 11.1%, P=0.043). Other neonatal and maternal complications associated with diabetes were not significantly different between two groups. Conclusions: In medical point of view, obstetrician can effectively manage diabetes during pregnancy as good as internist. Besides, the management by obstetricians may be more economic, less annoying, and can induce more compliance and motivation of the patients.
무배란 환자에서 Anastrozole과 Clomiphene citrate의 임상 성적 비교
양재석 ( Jae Seok Yang ),유이화 ( Yoo E Hwa ),이진용 ( Jin Yong Lee ),홍서유 ( Seo Yoo Hong ),신정환 ( Jung Hwan Shin ),박철홍 ( Cheol Hong Park ),박은주 ( Eun Joo Park ),서용수 ( Yong Soo Seo ),박원일 ( Won Il Park ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8
Objective: To compare the clinical effectiveness of Anastrozole in ovulation induction with that of clomiphene citrate. Methods: Sixty anovulatory women were randomly divided into 4 groups (1 ㎎, 2 ㎎ and 4 ㎎ of Anastrozole groups and Clomiphene citrate group). The ovulation induction was tried with 3 dosages of Anastrozole or 100 ㎎ of Clomiphene citrate for 5 days. The serum level of estradiol, testosterone, FSH and LH were serially monitored (on 3rd, 5th and 8th days of treatment). Serum estradiol level at the time of hCG injection was also measured. Ovulation rate, number of dominant follicles, endometrial thickness, and pregnancy rate were measured and compared across the study groups. Results: There was no statistically significant difference in estradiol, testosterone, or LH level between women treated with Anastrozole and Clomiphene citrate. In patients treated with 4 mg of Anastrozole, serum FSH level was higher than that of the women treated with Clomiphene citrate (P<0.05). Endometrial thickness was greater in patients treated with Anastrozole than women treated with Clomiphene citrate (P<0.05). Number of dominant follicles in patients treated with Clomiphene (1.56) was slightly greater than in women treated with Anastrozole (1.0-1.1), but there was no statistically significant difference. Conclusion: Anastrozole had similar clinical effectiveness in ovulation induction when compared to Clomiphene citrate. At 1 ㎎ or 2 ㎎ of Anastrozole, ovulatory rate remained below the effectiveness of Clomiphene citrate, therefore considering the expensive cost of Anastrozole, it should not be considered as first-line medication for ovulation induction but reserved for those who have certain conditions such as thin endometrium and polycystic ovarian syndrome.
김수경 ( Su Kyoung Kim ),신정환 ( Jung Hwan Shin ),서용수 ( Yong Soo Seo ),양재석 ( Jae Suck Yang ),박철홍 ( Cheol Hong Park ),홍서유 ( Seo Yoo Hong ),박은주 ( Eun Joo Park ),신종승 ( Sung Seung Shin ),박원일 ( Won Il Park ),이진 대한주산의학회 2005 Perinatology Vol.16 No.3
임신과 동반된 속립성 결핵은 매우 드문 질환이다. 이는 종종 산모의 약물 중독, 종양, 알콜 중독, 그리고 인 면역결핍 바이러스 감염과 관련되어 있고, 임신과 동반되어 결핵의 진단이 어려울 수 있다. 임신이 결핵의 경과에 해로운 영향을 미친다는 결정적인 증거는 없고, 따라서 결핵이 동반된 임신일 경우 일반적으로 치료적 유산은 필요하지 않다. 결핵이 조기에 진단되고 적절한 항결핵제를 사용한다면, 결핵에 동반된 임신의 예후는 양호하다. 저자들은 최근 임신 20주에 결핵 감염에 대한 다른 위험인자가 없는 상태에서 속립성 결핵으로 진단된 경우를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Although miliary tuberculosis is uncommon during pregnancy. it is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection, and it is difficult to diagnose when associated with pregnancy. There is no solid evidence that pregnancy has an adverse effect on tuberculosis, thus routine therapeutic abortion is not indicated. If the early diagnosis and promptly adequate chemotherapy was done, the outcome of pregnancy in a women with miliary tuberculosis is likely to be good. Recently we have experienced a case of miliary tuberculosis at 20 weeks gestation without any risk factors of tuberculosis. So we report this case with a brief review of literature.
정상 난소 위치에 고환이 존재한 안드로젠 수용체 아미노산 607번의 돌연변이에 의한 안드로젠 저항성 증후군
김효정 ( Hyo Jung Kim ),고덕성 ( Duck Sung Ko ),이진용 ( Jin Yong Lee ),홍서유 ( Seo Yoo Hong ),신정환 ( Jung Hwan Shin ),박철홍 ( Cheol Hong Park ),박은주 ( Eun Joo Park ),서용수 ( Yong Soo Seo ),박원일 ( Won Il Park ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8
Androgen insensitivity syndrome (AIS) is a disorder of male sexual differentiation caused by mutations within the androgen receptor gene, represents a variety of phenotypes from females with 46,XY karyotype over individuals with ambiguous genitalia to infertile males. Single base mutations resulting in amino acid substitution represent the most common mutations of the androgen receptor (AR) gene and are associated with complete AIS. The location of the gonads can be variable including, the intra-abdominal cavity, the labioscrotal folds, and the inguinal regions. Testicular descent is a two-stage process comprising transabdominal and transinguinal phases. The first phase is not controlled by androgen and may be regulated by mullerian inhibiting substance, by contrast the second phase is androgen dependent. Recently we have identified a point mutation CGA to TGA at position 607 of exon 3 in complete AIS patient, so we report it with brief review of literatures.
자궁내막이 얇은 환자에서 체외수정시술 및 배아이식술의 시행 시에 Estradiol 과 Sildenafil 병합용법의 효용성
신소영(So Young Shin),김대운(Dae Wun Kim),신정환(Jung Hwan Shin),홍서유(Seo Yoo Hong),박원일(Won Il Park),조병구(Byung Gu Cho),박준영(Joon Young Park),황경진(Kyung Jin Hwang),권혁찬(Hyuck Chan Kwon) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.4
Objective : The purpose of this study was to evaluate the effect of estradiol (E2) only/and sildenafil supplement on controlled ovarian hyperstimulation and pregnancy outcome in patients undergoing IVF-ET cycles. Methods : Total 104 cycles of IVF-ET patients were included in this study, which had been undergone controlled ovarian hyperstimulation (COH) with long protocol in Eulji infertility center and Ilsan Grace hospital between January 1999 and December 2000. Group 1 (COH only) consisted of 34 cycles, group 2 (COH+estradiol supplement) consisted of 35 cycles, and group 3 (COH+estradiol/sildenafil supplement) consisted of 35 cycles. Results : With E2 and/only Sildenafil supplement, improvement of the endometrial thickness (P<0.05) and clinical pregnancy rate (P<0.05) were obtained. There was no significant increase in pregnancy rate with sildenafil supplement compared to E2 supplement only (20.0% versus 25.7%). However, rather short duration of controlled ovarian hyperstimulation (13.3±1.7 days versus 11.7±1.7 days) was found in the group that received E2 and sildenafil supplementation. (P<0.1) Conclusion : In patients with thin endometrium, the sildenafil supplement might lead to increase endometrial receptivity, and in consequence improvement of pregnancy rate. Sildenafil may augment the vasodilatory effect of nitric oxide by inhibition of cGMP hydrolysis, by improving ovarian perfusion, stimulates follicular development thus might shorten the duration of controlled ovarian hyperstimulation in IVT-ET cycles as we observed in our study.