악성 난소종양의 처치와 예후

황동훈(DH Hwang) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.1

Stage에 따른 생존율 예후와 생존율을 결정하는 가장 중요한 조건은 해부학적 stage, 조직학적종류 및 종양의 grade아더(Table 10) 1. 방사선치료에 따른 생존율 Stage II에서 잔여골반질환이 있을시 방사선요법으로 뚜렷한 향상을 보인다 Extended Abdominal fields는 복강내재발을 감소시 키며 종양이 불현성이나 현미경적질환일 경우 최대로 치료되며 5년 생존율이 57%이다. paraaortic nodal irradiation으로 StageIII군의 일부에서 5년 생존율이 53%를 보인다. 또 StageIIB군에서 수술적 처치로 불완전하게 종양을 제거했을 때 pelvic irradiation으로 50%치료율을 보인다. 2. 화학요법에 따른 생존율 ① MD Anderson Study Cytoxan(CIT)과 Adriamycin(Adria)을 같이 치료한 군과 각각의 melphalan(L-PAM), Hexamethylmelamine(HEXA), Adriamycin(Adia) 로 치료한 군을 비교하면 CIT와 Adria의 군의 반응율은 36%(8/22)이고 완전회복은 16%(3/19)인 반면에 각각의 L-PAM, HEXA, Adria군에서는 반응율이 30∼32%이며 완전회복은 15%(3/20)였다. ② N.C.I. (National Cancer Institute)Study; HEXA-CAF(Four drug combination of hexamethylmelamin, Cyclophosphamide, methotrexate and 5-Fluorouracil)와 L-PAM(melphalan)을 비교하였더니 HEXA-CAF에서의 반응율은 79%이었고 완전 회복은 33%이 며 평균생존 기간은 24.4개월이었다. 반면에 L-PAM에서는 반응율이 61%, 완전회복은 19%, 평균생존기간은 17개월이었다. ③ New England Medical Center Study; adjuvant single agent(Thiotepa)나 four drug therapy(Act-D. 5-FU, vincristine, cyclophosphamide)를 수술후 사용한 군과 pelvic abdominal irradiation군과는 생존율에 차이가 없다. 즉 3년 생존율은 38%이 다. (Table11)

경구피임제의 장기 투여에 의한 가토 자궁 내막의 형태 및 조직화학적 변화

황동훈(DH Hwang) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.5

The ovulation inhibiting of progestins has been suspected even longer for Beard in 1897, inferred that the corpus luteum suppressed ovulation during pregnancy. Progesterone was first isolated in 1934 by Allen and in the next years it became know that progesterone, testosterone, and estrogen could each inhibit ovulation. However, until 1954, these steroids were not of practical value as antifertility agents in human beings, either because of undesirable side effects, or because of lack of therapeutic effectiveness on continued therapy. In addition to the 19-nor steroids as orally effefctive progestogens, there has emerged a new groups, 17-acetoxyprogesterone and its various derivatives. Several of these compounds in the from of sequential or combined with estrogen have also proved to be successful oral contraceptives. An enormous amount of study has gone into the experiemtnal animal trial and oral contra- ceptives prevent pregnancy by action on other sites in the uterine body; the endometrium, cervix, or fallopian tubes. Here, it appeared prudent to study one of the target organs of these agents, the uterus or more specifically the endometrium. Thus, this study concerns itself with endometrial morphological changes and histochemical changes and carcinogenic effects of rabbit`s endometial changes after cessation of oral contraceptive. The methods of study was as follows. Out of 20 non-pregnant normal rabbits weighing from 1.6kg to 2.2kg, four rabbits were enrolled in the control group and eight rabbits in the study of combined theraphy group and eight in the sequential theraphy. In the study group, oral adult daily does of the Eugynon(Ethiny Estradio 0.1mg-Norgestrel 0.5mg) and Serial (Ethinly Estradiol 0.1mg-Megestrol acetate 1.0mg) were given to each rabbit for 6 menstrual cycles and 9 menstrual cycles and sacrified on each designated menstrual day of proliferative phase and secretory phase. The obstained material of endometrial tissuses were fixed immediately in neutral buffered formalin and stained with haematoxylin and eosin for general endometrial morphology, with Gomori`s method for alkaline phosphatase and P.A.S. and diastase-P.A.S. for mucosubstances in the endometrium without buffering. The results of the study was as follows: 1. Out of the 20 non-pregnant noemal rabbits. the endometrial morphological changes and histochemical changes of endometrial changes after cessation of oral contraceptive for 1 or 2 months. 2. In endometrium under the influence of combined therapy with Eugynon for 9 months, there was a marked stromal edema and moderate degree of stromal fibrosis, showing atrophic, inactive secretory endometrium compared to Serial groups. 3 The endometrial changes after cessation of long term use of oral contraceptive were returned to normal functioning endometrium progressively in both combined and sequential groups. 4. The alkaline phospatase activity in the glands was increased during the proliferative phase, reached a peak during the early secretory phase and there was no remarkable difference between the control and sequential groups except the slight decreasing activity in combined groups. 5. The combined or sequential therapy produced little changes in the stained mucosubstances during the various phases of the induced menstrual cycles as compared to the control groups. 6. There was no evidence of anaplastic endometrial changes following long term use of oral contraceptives.

X선골반계측에 관한 산과학적 고찰

황동훈(DH Hwang),이용배(YB Lee),김용우(YW Kim),송상환(SW Song) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.5

This is a clinical analysis of 244 obstetrical patients who received X-ray pelvimetry among a total of 3655 patients admitted to the Dept. of Ob & Gyn from january 1, 1965 to August 31,1968. The Colcher-Sussman technique was used to measure the various diameters of the pelvis while the biperietal diameters and weights were obtained post[artum. Since labor and delivery are a dynamic process this study is mainly concerned with relationships between pelvic diameters and fetal weight-size factors. 1. 190 X-ray were taken in patients thought to have dystocia with a vertex presenting. In this 54.2% had a vaginal delivery12.2% had a mid-forceps delivery and the remaining 33.3% received a Cesarean section. 2. In this same group when the AP of the inlet was less than 10.0cm.61.9% had a Cesarean section, when between 10.0 and 10.4cm. the rate was 30.2% and above 10.5 the rate was 22.5%. 3. Even better correlation is found in terms of type of delivery when the A.P of the inlet is related to the biparietal diameter of the infant. When the difference was between 1.0 and 1.4cm. the C-section rate was 51.1%; when the difference was between 1.5 and 1.9 weight above 3500gm. and the difference under 1.4cm. the C-section rate was around 73%. 4. The mid-pelvic transverse diameter was much less accurate in predicting the method of delivery, especially C-section. 5. When used with nulliparous breech presentation the section rate was 12.5%. 6. When the X-ray was used un patients requiring an induction the subsequent section rate was 7.9%.

한국인 만삭 산모의 바이러스 간염 항원 ( HBAg ) 의 수직간염

구정진(JJ Koo),황동훈(DH Hwang),김원중(WJ Kim),김영민(YM Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.2

1982년 7월부터 동년 12월까지 분만을 위하여 내원한 임신 제38주부터 43주에 이르는 30예에 paracervical block을 시행 block 전후의 태아심박의 변동 및 자궁수축상의 변화를 연구한 바 그 성적을 아래와 같이 요약한다. Paracervical block후 태아심박변동 및 자궁수축 변화는 실험 총 30예중 7예와 8예로 각각 23.3%와 26.7%를 점하였다. 심박변동에서 가장 흔히 볼 수 있었던 것은 late deceleration 으로 7예중 6예로 85.7% 이었다. bradycardia는 30예중 4예로 13.3%를 점하였다. 자궁수축 변동중 가장 심한 예는 block의 강도차가 70mmHg를 보였고, 빈도가 가장 많은 것은 12회이었고 기간이 가장 긴 것은 100분이었다. Paracervical block후의 태아심박 변화군과 불변화군에 있어 년령, 임신일수, block부터 분만까 지의 시간, Apgar score 1분 및 5분치, 태아체중, 태반중량 등의 평균치를 각항별로 비교한 바 전 항에 있어 유의차를 인정할 수 없었다. 이러한 성적은 자궁수축 변화군과 불변화군 사이 에서도 인정되어 전항의 성적비교에서 유의차가 없었다. Paracervical block후의 신생아 사망은 1예로 3.3%를 점하였으나 그 원인을 정확히 밝힐 수는 없었다. Department of Obstetrics, and Gynecology, Yonsei University, College of Medicine. Lee W-Y, M.D. Department of Microbiology, Yonsei University College of Medicine (Directed by Professor Hyun Mo Kwak, M.E.) More than 350 cases of mother and their newborn babies were studied. The blood samples of mothers were taken by collecting peripheral blood before the delivery. Placental cord sera were collected by taking blood from one of the umblical veins at the time of delivery. Microtitration methods employing reverse hemagglutination test were used throughout the test by using antigen and antibody coated chicken erythrocytes. The findings are summarized as follows: 1) Percent of HBs antigen positive mother was 7.1%. 2) Percent of HBs antigen positive babies from the HBs antigen positive mother was 29.5%. (1/353 for HBs Ag(+) baby/negative mother, 2/353 for HBs Ab(+)/negative mother) 3) Once the mother was identified as antigen positive, the incidence of vertical transmission was not correlated with the extent of titer. 4) Five out of eight antigen positive babies were found topersistance antigen carrier for the study period. (6 months) 5) Anong these, 4cases were found to have increased titer than that found at the time of birth. 6) All of the babies born with HBs Ag did not show any clinical sign of hepatitis for the study period. (7 months)

형광항체법을 이용한 질강내 Candida albicans의 검색에 관한 연구

문영기(YK Moon),황동훈(DH Hwang) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.8

candida albicans의 빠르고 정확한 고정을 목적으로 형광항체법을 이용하여 다음과 같은 결 론을 얻었다. 1. 배양방법에 의한 candida albicans의 고정예는 총 218예중 48예(22.0%)이었으며 형광항체 법에 의한 방법과의 일치율은 97.9%이었다. 2. 임산부 147예를 대상으로 형광항체법으로 candida albicans라고 고정된 예는 28예로서 9.0%이었다. 3. 유흥업소 종업원 71례를 대상으로 한 실험에서 양성인 예는 21예로서 29.5%이었다. 4. 형광항체법은 사용이 가능한 방법 중의 하나이다. One hundred forty seven vaginal swab specimens from out-patients who had come to severance Hospital for antenatal care and 71 from general entertainer in the pulbic resorts at Kangwha-d area, were colletec for the diagnosis of candida albicans infection by employing direct fluorescent antibody technique. The results are summarized as follows; 1. Forty eight cases our of 218 sample (22.0%) cultivated on Sabouraud`s glucose slant media were identified as candida albicans and agreement rate between positive cases detected by cultivation method and DFAT was 97.9%. 2. Out of 147 specimens obtained from the out-patients 28 cases (19.0%) were revealed as positive reaction by DFAT. 3. 21 positive cases out of 71 general entertainers (29.5%) were detected by DFAT. 4. As in above results it is considered that DFAT is an available tool for the diagnosis of candida albicans infection especially in mass survey.

기왕 제왕절개술 후에 생긴 자궁과 복벽간의 루공

박영동(YD Park),황동훈(DH Hwang) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.1

기왕 제왕절개수술후 약 8년만에 발견된 임신중반기에 양막조기파수와 합병한 자궁과 복벽간에 생긴 루공 1예를 보고하고 문헌고찰을 하였다. The following is a case of a utero­abdominal fistula which developed after a classical cesarean section and was followed with spontaneous rupture of membranes during intrauterine pregnancy of 5½ months. In this presentation, we are concerned only with those due to postoperative enclosures of membranous tissue in the abdominal scar and compared with the formation of menstrual fistula which was due to direct communication with the uterine or tubal mucosa.

Colcher-Sussman방법에 의한 X선골반계측에 관한 산과학적 연구

조동제(DJ Cho),황동훈(DH Hwang),송찬호(CH Song),곽현모(HM Kwak) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.8

The study was carried out retrospectively based on the clinical chart of 1746 obstetrical patients who received X-ray pelvimetry among a total of 14,000 patients admitted to the Dept. Of Ob. & Gy. from Sept. 1, 1968 to dec. 31, 1975 except 1969. The Colcher-Sussman technique was used to measure the various diameters of the pelvis while the biparietal diameter and weights of fetus were obtained postpartum. Even though pelvimetry has been widely used over the years and has been generally accepted as a clinical tool, this study was mainly concerned with relationships between pelvic diameters and fetal weight-size factors. 1. 1436 X-ray pelvimetry were taken in patients thought to have dystocia with a vertex presenting. In these patients, 53.6% had vaginal delivery, 4.2% had a mid forceps delivery and the remaining 42.1% received a cesarean section. 2. In the same group, when the A-P of the inlet was less than 10.0cm, the Cesarean section rate was 70.2% when between 10.0cm and 10.4cm the rate was 47.0% and above 10.5cm the rate was 30.5%. 3. Even better correlation is found in terms of type of delivery when the A-P of the inlet is related to the biparietal diameter of the infant. When the difference was between 1.0cm and 1.4cm the Cesarean section rate was 52.8% when the difference was between 1.5cm and 1.9cm the Cesarean section rate was 24.4% and above 2.0cm the rate was 14%. with the birth weight above 3500gm and the difference under 1.4cm the Cesarean section rate was around 58%. 4. When the transverse diameter of midpelvis was between 8.5-8.9cm the Cesarean section rate was 77.1% The mid-pelvic transverse diameter was much less accurate in predicting the method of delivery especially Cesarean section and mid-forceps delivery. 5. When used with nulliparous breech presentation the section rate was 46%. 6. In 1746 case who taken X-ray pelvimetey, 413 cases were spontaneous premature rupture of membrane, and the subsequent section rate was 40.4%.

동제 자궁내 피임장치인 Gravigard 일반형과 소형의 삽입에 관한 임상연구

이위현(WH Lee),강희원(HW Kang),황동훈(DH Hwang),정순오(SO Chung),곽현모(HM Kwak) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.6

자궁내 피임장치 삽입 대상자가 적어서 통제적인 의 의를 언급하기는 어렵지만 이상과 같이 동제 자궁내 피임장치 Gravigard의 일반형과 소형을 삽입하여 다음 과 같은 결과를 얻었다. 1. 총 사용 개월수는 일반형군이 208개월, 소형군이 135개월, 합계 343개월이었다. 2. 자궁내 피임장치 삽입자의 대부분이 25∼29세군 (71.7%)의 연령분포였고, 평균연령은 23.9세였다. 3. 자궁크기는 대부분(91.7%)이 자궁내강 깊이 6.0 ∼7.0cm이었고, 일반형군은 6.6cm, 소형군이 6.1cm 의 평균치를 나타냈다. 4. 부작용은 일반형군에서 53.3%, 소형군에서 56.7 %, 평균 55%였다. 5. 자궁내 피임장치의 배출율은 일반형군에서 26.7 %, 소형군에서 16.7%, 평균 21.7%였다. 6. 자궁내 피임장치의 사용중단율은 일반형군에서 46.7%, 소형군에서 63.3%, 평균 55%였다. 7. 임신은 총 60예중 1예에서 있었으며, 6.0cm의 자궁내강을 가진 소형군에서 발생하였다. 8. 자궁내강 깊이의 대소에 따른 부작용, 자연배 출, 사용중단율은 일반형과 소형군에서 별 차이가 없 었다. 본 저자의 연구 결과와 Rees(1979)의 보고를 통하 여 소형의 Gravigard를 임신경험이 없거나, 작은 크기 의 자궁을 가진 여성에게 사용하는 것이 좋고, 아울러 정상크기의 자궁을 가진 여성에게도 일반적으로 사용 하여도 좋을 것이라는 가정을 세울 수 있겠으나, 앞으 로 좀 더 많은 대상자를 취급하여 연구 관찰하여야 할 것으로 사료된다. We conducted comparative clinical study to evaluate the acceptability and effici-ency of the small frame intrauterine deⅵce by using the intrauterine copper contr- aceptive, regular and small Graⅵgard. Regular and small Graⅵgards were inserted into 30 acceptors in each at Yonsei University Family Planning Clinic from January to June 1978. We followed up abo- ut the side effects expulsion, termination rates of the lUD after insertion for 18 months. And the results were as follows. 1. The total months of use were 208 in regular Graⅵgard group, 135 in small Graⅵgard group, total 343. 2. ln most of acceptors (71.7%) were in age group of 25~29 years, and the average of age was 23.9 years. 3. The uterine depth was 6.0~7.0cm in 91.7% of cases. 4. The side effects were seen in 53.3% of regular Graⅵgard group, 56.7% of SMall Graⅵgard group, average 55%. 5. The expulsion rates were 26.7% in regular Graⅵgard group, 16.7% in small Graⅵgard group, average 21.7%. 6. The termination rates were 46.7% in regular Graⅵgard group, 63.3% in small Gravigard group, average 55%. ,7. Only one pregnancy was developed in small Graⅵgard group. 8.There were no eⅵdence of significant differences of the side effects, expulsion termination rates of small Graⅵgard from regular Gravigard to uterine depth.

한국인 선천성 이상질환이 의심되는 환자에 대한 세포유전학적 연구

김진경(JK Kim),양영호(YH Yang),황동훈(DH Hwang),노성일(SI Rho),조주연(JY Cho) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

1974년 1월부터 1980년 5월까지 연세대학교 의과대학 부속병원 산부인과 유전학 연구실에서 선천성 이상이 의심되는 환자 428명에 대하여 세포유전학적 연구를 시행하여 다음과 같은 결과를 얻었다. 1. 다운증후군이 76예였으며 21번 염색체의 3배성이 69예, 모자이시즘이 7예였다. 2. 터너증후군이 13예였으며, 45,X가 7예, 모자이시즘이 6예였다. 3. 클라인펠터증훈군이 17예였으며, 47,XXY가 14예, 46,XY/47,XXY가 2예, 48,XXYY가 1예였다. 4. 원발성무월경이 62예였으며, 60세에서 46,XX,2예에서는 46,XY를 나타내었다. 5. 간성이 75세였으며 정상 염색체양상을 나타내었다. 6. 뇌성마비아동이 98예였으며, 정상 염색체 양상을 나타내었다. 7. 생식기관이외에 선천성 기형이 있었던 경우가 81예였으며 모두 정상 염색체 양상을 나타내었다. 8. 에드워드증후군이 1예 있었으며, 46,XY,+18염색체 양상을 나타내었다. 9. Cri du Chat증후군이 1예 있었으며, 46,XX,5P-의 염색체 양상을 나타내었다. 10. 기타 종질중격과 중복자궁이 각각 2에씩 있었으며, 정상 염색체양상을 나타내었다. As the cytogenetics developed, cytogenetic study in Korea has also developed progressively. However, cytogenetic studies in Korea were merely studies on normal chromosome pattern or simple studies of several genetic disorders or cases reports. This study is a systematical cytogenetic analysis of 428 cases where congenital disorders were suspected and referred to our cytogenetic laboratory in the Department of Obstetrics and Gynecology, Yonsei University Medical Center, from Jan. 1974 to May 1980. The results were as follows; 1) Downs syndrome was found in 76 cases, consisting of 69 cases(90.79%) of primary 21 trisomy and 7 cases of mosaicism. 2) Turners syndrome was found in 13 cases, consisting of 7 cases(53.85%) of 45,X and 6 cases of mosaicism. 3) Klinefelters syndrome was found in 17 cases, consisting of 14 cases(82.35%) of 47,XXY, 2 cases of 46,XY/47, XXY and 1 case of 48,XXYY. 4) Primary amenorrhea was found in 62 cases, consisting of 60 cases(96.78%) of 46,XX and 2 cases of 46,XY. 5) Intersex was found in 75 cases, consisting of 45 cases(60%) of 46,XY and 30 cases of 46,XX. 6) Cerebral palsy was found in 98 cases and all cases were normal karyotype. 7) Congenital anomalies excluding the reproductive organ was found in 81 cases were normal karyotype. 8) Edward syndrome was found in 1 case, karyotype was 46,XY, +18. 9) Cri-du Chat syndrome was found in 1 case, karyotype was 46,XX, 6P-. 10) Longitudinal vaginal septum and double uterus were found in 2 cases each and all cases were 46,XX.

자궁영기경부암의 임상 및 병리조직학적 고찰

이준환(JH Lee),박도순(DS Park),황동훈(DH Hwang),조태호(TH Cho) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.10

The terms "Carcinoma in situ", "intraepithelial carcinoma", "non-in-vasive carcinoma", and "stage O cancer" have been used to denote the same pathological process in the epithelium of the cervix uteri. Since 1910 when Rubin described his first two cases of"incipient carcinoma", this condition has been accepted by increasing numbers of cliicians and pathologist as the morphological sequence of events through which the squamous epithelium of the cervix progress before it becomes of the cervix, the methods used for early detection, diagnosis, treatment, and follow-up of care- inoma in situ have heen studied by many authors. There are many reports and clinical reviews on carcinoma in situ of the cervix in other coun- tries but none yet in Korea in spite of great interest in the subject. It is the purpose of this paper to study clinical pictures and pathological findings and compare them with those of other athors. The author selected a total of 67cases of carcinoma in situ of the cervix which were admitted to the Medical Center of Yonsei University over the last five and a half years, from Jan. 1, 1961 to June 30, 196. The results were obtained as follows; 1.Most of cases were detected by Pap. smear or punch biopsy at the first visit. 2.87.2% of 47 cases showed suspicious and positive Pap. Smear and the false negative diag- nosis was 12.8%. 3. The average age incidence was 45 years and was 3 years less than that of invasive cancer. 4. There was minimal to moderate erosion of the cervix in about 50% of cases and 11.9% were normal in gross appearance. 5. 38.8% of all cases had no specific gynecological complaints and in about 70% the chief symptom was abnormal vaginal bleeding. 6. The pathological findings of post-cone bysterectomy specimens showed no residual cancer in 61.8%, residual cancer in 32.7%, atypical hyperplasia in 3.6%, and microscopic invasion in 1.9% respectively. 7. The post-operative morbidity revealed no relationship with the time interval between conization and hysterectomy. there was no significant difference in morbidity compared with the control group. Also although no effect on morbidity was achieved from prophylactic antib- iotics, it has been suggested that further study by made with more cases. 8. 36 patietns among 60 cases which received adequate treatment were followed for 1.7 years on the average, and have lived without recurrence to the present, but further close observation will be needed.