폐경여성에서 프로제스테론 용량에 따른 지질 및 지단백대사에 미치는 영향

유한기,손영수,김향미,장병우 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12

Menopause constitutes a sizable population of the adult womans life, and it is resonable to consider that most women will benefit from hormone replacement therapy. also, it it important to realized that cardiovascular disease is a major cause of morbidity and death in the menopausal patient. To study the effects of different dose of progesterone on lipoprotein metabolism, we treated two groups of postmenopausal woment with for 25 days with conjugated equine estrogen 0.625mg per day and different sequential estroge-progesterone regimens as followes : Group I received medroxyprogesterone acetate, 2.5mg per day, from day 14 to day 25 of the cycle; Group II, medroxyprogesterone acetate, 5mg per day. The data demonstrated a beneficial effect in lipoprotein profiles, that total cholesterol decreased in two groups by 8.6 to 11.7 percent from the base line values. Low density lipoprotein cholesterol decrease in two groups by 18.5(group I) and 32.7 (group II) percent in post HRT 12 months. High density lipoprotein cholesterol increase during treatment by smaller in 5.3 percent and higher in 27 percent in both groups. Trigly- ceride increase during initial 6 months period (6.5~28.3 percent) and decrease during post 12 months period in both groups. Our result sugget that medroxyprogesterone acetate, especially 5mg per day have the beneficial effect of postmenopausal estrogen treatment on HDL-cholesterol and so, the favorable lipoprotein profile offer protection to the cardiovascular system.

트롬빈 저해제인 LB30057의 평활근 세포 및 경동맥 신내막 증식 억제효과

유병수,윤정한,윤경희,이상구,이승환,고지연,최현민,박학천,황성오,최경훈 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.9

복부대동류 및 회장부 출혈성 궤양이 동반된 Behcet씨병 1예

최현민,김우재,고지연,유병수,김효열,오중환,김익용,김태헌,박광화,윤정한 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.10

말기 악성 Brenner 종양의 치험 1예

신호문(HM Shin),유중배(JB Yoo),신영우(YW Shin),한영호(YH Han),김문신(MS Kim),김두상(DS Kim),이태형(TH Lee) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.1

조직학적으로 확진된 4기 악성 Brenner 종양 1예에 수술 및 화학치료를 가하고 이와 병행하여 second-look Laparotomy로서 debulking하고 third-look laparotomy로서 완치를 확인하였기 보고한다. Malignant Brenner tumor is a relatively rare tumor of the obary. We had experienced a rare case of malignant Brenner tumor, Stage Ⅳ. A Brief review of the litertures and a discussion concerning malignant Brenner tumor are presented in this paper.

임신과 합병된 자궁경암에 관한 임상적 고찰

유능화(NH Yoo),문영기(YK Moon),곽현모(HM Kwak) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.9

1) 임신과 합병된 자궁경암환자 26예에 대하여 임상적 고찰을 하였으며 26예중 비침윤성암이 6예, 침윤성암이 20예였다. 2) 자궁경암의 임신에 대한 발생빈도는 1:1110(0.09%)이었으며, 자궁경암환자에 있어서의 임신합병빈도는 1:69(1.43%)였다. 3) 연령의 범위는 31~45세까지였으며 36~40세군이 10예(38.4%)로 가장 많았으며 평균연령은 37.7세였다. 4) 분만회수의 경우, 5회 이상의 경산부가 26예중 11예(42.4%)로 가장 많았고 다음이 4회 경산부로 7예(26.9%)로서 다산부에서 자궁경암이 호발함을 알 수 있었다. 5) 임상증상으로는 접촉출혈이 17예로(비침윤성암-2예, 침윤성암-15예) 가장 많았으며, 임신중 자궁출혈의 경우 접촉출혈의 유무가 자궁경암을 감별진단하는데 큰 도움을 주었다. 6) 세포학적 진단을 26예중 24예에서 시행한 결과, Class Ⅲ 이상이 22예나 되어 진단적 정확성은 91.4%였다. 7) 진단의 동기는, 타병원에서 자궁경암이 의심스럽거나 확진되어 전원된 경우가 12예, 임상증상 및 진찰소견상 자궁경암이 의심되어 진단을 하게 된 경우가 12예였고 2예는 다른 질환으로 수술후 병리조직검사를 통하여 확인된 경우였다. 8) 진단시기를 임신기간으로 분류하여 보면, 임신초기가 11예로 가장 많았으며, 임신중기가 9예, 임신말기 및 산욕기가 각각 2예였다. 9) 자궁경암의 진행도를 보면 stage Ⅱ가 9예로 가장 많았으며, 다음이 stage Ⅰ으로 7예였고 stage 0가 6예, stage Ⅲ 및 Ⅳ가 각각 2예였다. 10) 침윤성암 20예의 조직학적 분류를 보면, poorly differentiated type이 13예(65.0%)로 가장 많았으며, moderately well differentiated type이 6예(30.0%), well differentiated type이 1예(5.0%)였다. 11) 치료성적을 보면, 비침윤성암의 경우, 임신중기 전에 진단된 전예(6예)에서 전자궁적출술을 시행하였고, 침윤성암시는 방사선치료만을 시행한 경우가 15예(75.0%)로 가장 많았으며, Radical abdominal hysterectomy는 4예(20.0%)에서 시행하였으며, 4예중 1예는 재발로 인하여 External Irradiation도 시행하였다. 12) 침윤성암의 경우, 분만방법으로는 Classical cesarean section을 원칙으로 하였으며, Classical cesarean section에 의해 분만된 태아는 전예(4예)에서 생존하였다. 13) 침윤성암환자 20예에 대한 예후관찰은 15예만이 가능하였고, 최장 예후관찰기간은 4년 6개월이었고, 최단 예후관찰기간은 3개월이었다. 재발은 2예에서 확인되었다. Carcinoma of the cervix is the most common malignant tumor in women in Korea, but it is infrequently associated with pregnancy. Carcinoma of the cervix during pregnancy has been the subject of considerable discussion and contradiction as to behavior, incidence, treatment and the diagnosis. Certainly early diagnosis followed by immediate and adequate therapy is most important. For this object, routine cervical smear should be examined in all pregnant women. There are few reports in cervical cancre during pregnancy in Korea. We observed cervical cancer during pregnancy 12 years ago(1959.2~1964.8) for further evaluation of cervical cancer during pregnancy, we studied 26 cases of cervical cancer associated with pregnancy in the Depratment of Obstetrics and Gynecology, Severance Hospital and Wonju Christian Hospital during the period from Sep., 1, 1967 to Jul., 31, 1977. The results obtained were as follows; 1) The incidence of cervical cancer among pregnant women was 1:1110(0.09%) and the incidence of pregnancy among cerical cancer patients was 1:69(1.43%). 2) Age distribution of cervical cancer during pregnancy was from 31 to 45 years and the average age was 37.7 years. 3) Average parity was 4.28. 4) Contact bleeding was encountered in 17 cases and 2 cases were entirely asymptomatic cases. 5) Cytologic smear as a screening procedure was performed in 24 cases, and 22 cases(91.4%) were more than Class Ⅲ. 6) Acoording to motivation of diagnosis, were eferred to our department from other clinic 12 cases. 7) At the time of diagnosis, 1st trimester-11 cases, 2nd trimester-9 cases, 3rd trimester-2 cases and postpartum-4 cases were found. 8) According to the clinical stage, the results showed stage 0-6 cases, stage Ⅰ-7 cases, stage Ⅱ-9 cases, stage Ⅲ-2 cases and stage Ⅳ-2 cases. 9) External irradiation and intracavitary irradiation were done in 15 caes(75.0%) and radical abdominal hysterectomy with pelvic lymphadenectomy was done in 4 cases of invasive carcinoma of the cervix. 10) The result of follow up was poor bec

한국 임신부의 풍진감염시 중합효소 연쇄반응 (Polymerase chain reaction) 을 이용한 선천성 풍진감염의 산전진단

이승호,유한기,김은성,문인걸,한호원,김문영,류현미,조동희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Objectives; Rubella viral infection in pregnant women is frequently transmitted to the fetus, resulting in the fetal damage. Fetal rubella infection have been diagnosed by detection of rubella specific IgM in fetal blood. However this has been limited because the fetal IgM is not developed before 22 weeks of gestation. The purpose of this study was to determine accuracy of PCR for rubella virus to diagnose congenital rubella infection. Methods; In this study, 85 amnionic fluid and 30 fetal blood samples were obtained from 85 pregnant women, whose serum rubella IgM were positive. Viral RNA from clinical specimens was reverse transcribed and the produced cDNA was amplified by nested polymerase chain reaction(nested PCR)using a set of primers, the outer primer pair defining a 591 bp sequence and the inner primer pair defining a 321 bp sequence within the former one. Results; A reverse transcription nested PCR by detection of RNA extracted from 10-1 50% tissure culture infective dose of live attenuated rubella vaccine was sensitive method. The identity of PCR product were verified by direct sequencing using fluorescent dideoxy-termination to confirm the target sequence. RT-PCR detected rubella virus RNA in bloods from 4 children who were confirmed rubella infection serologically. Rubella virus was detected from 2 of 15 products of conceptus which was obtained from pregnant women with rubella specific IgM. Among 85 pregnant women, there were typical skin rashes in 15 cases(18%). In only one case of 55 amnionic fluid obtained in 13∼19 weeks of gestation from pregnant women with rubella specific IgM, rubella PCR was positive. Rubella virus was detected by RT-PCR in only 1 case among 30 fetal blood obtained by cordocentesis from another pregnant women with rubella specific IgM. But, in one case, the results were not concordent, that is, PCR was negative and rubella specific IgM was positive in fetal blood obtained in 22 weeks of gestation. There was no statistical significance between maternal clinical symptoms, such as rashes, and incidence of fetal infection. Among delivered 56 neonates whose prenatal rubella PCR and IgM results were negative, 3 neonates showed positive for postnatal rubella specific IgM, but showed no congenital rubella up to 8∼9 months follow up. Among total 85 cases, presently 19 were ongoing pregnancy, 56 went to term and resulted in healthy babies except 2 anomaly with unrelated congenital rubella infection, while 19 pregnancies are progressing normally and 4 were failed to follow up and one was preterm birth and 5 were electively terminated. Incidence of congenital rubella infection which was diagnosed prenatally or postnatally was relatively low, 7%(6/85). Coclusion; PCR for rubella virus was earlier, faster and more accurate method for detection of fetal rubella infection in amnionic fluid and/or fetal blood than rubella specific IgM in fetal blood, when rubella specific IgM was positive in early pregnant women. Appropriate detection for fetal rubella infection should be carried out by direct etiologic diagnosis such as PCR. This method will become an valuable approach to provide prenatal counselling following rubella virus infection for prevention of unnecessary termination of pregnancy.

Pentoxifylline이 생쥐 정상정자의 체외수정 및 초기배아의 성장발달에 미치는 영향에 관한 연구

우복희,유한기,안정자,손영수,김향미 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1

Object: This study was carried out to investigate the effect of pentoxifylline on in vitro fertillization and developmen of preimplantation stage of mouse embryos. Matrial and Methods:F1 hybrid mice was superovulated with PMSG/hCG and mouse oocytes were recruited. After the normal sperms were incubated with PTX before in vitro fertilization, it was observed whether the fertilization and embryo development was affected or not by the sperm preparation(washing, dilution and no washing or no dilution). And after 1-cell and 2-cell stage of mouse embryos were incubated with PTX, the development to hatching blastocyst was also observed. Results: When in vitro fertilization was revealed by using the washed normal sperms after 0, 3.6 and 7.2 mM PTX incubation, the fertilization rates were 92.5%, 48.8%, 36.8%, respectively. So 3.6 and 7.2 mM groups presented significantly low fertilizatin rate, but the development rates were 93.9%, 85.0%, 95.2%, respectively. Therefore, there were no significant difference between each group. When in vitro fertilization was revealed by using the diluted normal sperms after 0, 3.6, and 7.2 mM PTX incubation, the fertilization rates were 58.6%, 5.4%, 9.4%, respectively. So 3.6 and 7.2 mM groups presented significantly low fertilization rate. The developmental rates were 88.2%, 100%, 100%. And there were no significant difference between each group. When in vitro fertilization was revealed by using the not washed and not diluted normal sperms after 0, 3.6 and 7.2 mM PTX incubation, the fertilizatin rates were 61.2%, 5.7%, 3.8%, respectively. 3.6 and 7.2 mM group presented significantly low fertilization rate. The development rates were 73.3%, 0%, 0%, respectively. So 3.6, 7.2 mM group presented significantly low developmental rate. After 1-cell stage of mouse embryos were incubated in 0, 5, 10, 50 μM of PTX, the development rates were not significantly different among them. After 2-cell stage of mouse embryos were incubated in 0, 5, 10, 50 μM of PTX, the development rates were not significantly different among them. Conclusion: In conclusion, when PTX is used in in vitro fertilization program with normal sperms, it may affect the fertilization and embryo development in high concentration. And if PTX concentration is very low, the developmental rate would not be affected. So PTX must not be used to normal sperms and where use of PTX is indicated, it is recommended that remainder PTX must be removed as completely as possible.

질식초음파검사시 난황낭 측정이 초기임신 예후에 미치는 영향에 관한 연구

우복희,유한기,손영수,김향미,양선이,강혜승,윤수정,원현주 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.7

1993년 6월 1일부터 1994년 5월 31일까지 1년간 이화대학병원에 내원한 산부인과 외래 환자 중 임신 6주에서 10주에 해당하는 206명을 대상으로 질식초음파를 이용하여 난황낭 크기를 측정하여 다음과 같은 결과를 얻었다. 1. 임신일수와 난황낭 크기사이에는 출혈이 없었던 군에서는 비례적인 관계로 임신일수가 증가할수록 난황낭 크기가 증가하였으며(r=0.8892, $lt;p0.05) 출혈이 있었던 군에서는 서로 유의한 관계가 없었다(r=0.267649, p$gt;0.05). 2. 두둔부 길이와 난황낭 크기사이에는 비례적인 관계로 두둔부 길이가 증가할수록 난황낭 크기가 증가하였으며(r=0.6198, p$gt;0.05), 평균 임신낭 크기와 난황낭 크기사이에는 가장 비례적인 관계로 평균 임신일수가 증가할수록 난황낭 크기가 증가하였다(r=0.92285, p$lt;0.05). 3. 평균 임신낭 크기에 따른 난황낭 크기의 비례관계에서 벗어난 경우 70%에서 비정상적인 임신으로 나타났다. 4. 난황낭 크기가 평균보다 2 표준편차 높은 경우에 비정상 임신을 예측하는 민감도는 154%이고 특이도는 96.4%이며 양성 예측도가 50%였으며, 평균보다 2 표준편차 낮은 경우에 비정상 임신을 예측하는 민감도는 62.8%이고 특이도는 96.4%이며 양성 예측도가 77.8%였다. 5. 난황낭 크기가 평균보다 2 표준편차 높거나 낮은 경우에 비정상 임신을 예측하는 민감도는 69.2%이고 특이도는 92.8%이며 양성 예측도는 69.2%였다. 이상의 결과로 임신 10주이전에 초음파를 실시하여 난황낭크기, 모양의 관찰을 통해 난황낭의 이상이 관찰되는 경우 유산 등의 비정상적인 임신예후를 예측할 수 있다. We performed two hundred six consecutive women who underwent endovaginal sonography when their fetuses were less than 10 weeks menstrual age were evaluated. The results obtained were as follows; 1. The relationship between yolk sac diameter and menstrual age was significant for patients without bleeding (r=0.8892, p$lt;0.05). 2. The relationship between yolk sac diameter and menstrual age was not significant for patients with vleeding(r=0.267649, p$gt;0.05). 3. The relationship was significant in the relationship between yolk sac diameter and crown rump length(r=0.6198, p$lt;0.05) and between yolk sac diameter and mean sac diameter(r=0.92285, p$lt;0.05). 4. The value above and below the 95% confidence limits for the abnormal group are superimposed on the curve for normal yolk sac diameter versus mean sac diameter. 5. For a yolk sac diameter more than two SDs above the mean and below the mean, the sensitivity of predicting an abnormal outcome was 15.4% and 53.4%, the specificity was 96.4% and 96.4%, and the positive predictive value was 50% and 77.8% respectively. 6. When these two groups were combind, the sensitivity of predicting an abnormal outcome was 69.2%, the specificity was 92.8%, and positive predicting value was 69.2%.

생쥐배아의 체외성장에서 Albumin 첨가에 의한 수질극복효과에 대한 연구

우복희,유한기,손영수,이미자,김향미 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

체외수정시술 프로그램의 정도관리의 방법으로써 생쥐 제 1대 잡종(C57BL*CBA)의 1-세포기 배아와 2-세포기 배아를 이용하여 배양액에 사용되는 수질에 따른 배아의 성장 및 발생 및 소혈청 알부민의 첨가에 의한 배아의 성장발육의 효과를 생물학적 검증을 시행후 비교분석하여 다음과 같은 결과를 얻었다. 1. 1-세포기 생쥐 배아는 단순 배양액과 복합 배양액에서 수질에 관계없이 체외 성장발육을 하였으며, 소혈청 알부민의 첨가로 체외 성장발육이 유의하게 촉진되었다. 2. 2-세포기 생쥐배아는 단순 배양액에서는 정제되지 않은 물에 민감하며, 고순도의 물에 비해 유의하게 저조한 체외 성장발육을 보였으나 이는 소혈청 알부민의 첨가로 극복되는 것으로 나타났다. 복합 배양액에서는 체외 성장 발육에 있어 수질에 따른 차이를 보이지 않았으나 소혈청 알부민의 첨가로 체외 성장 발육이 유의하게 촉진되었다. 이상의 결과로 미루어 보아 소혈청 알부민의 첨가로 인한 초기 생쥐배아의 체외 성장발육은 배아의 세포기나 배양액의 종류에 관계없이 촉진되며, 수질에 대한 영향은 2-세포기 배아에서 민감하게 나타내며, 또한 이는 단순 배양액에서 현저하게 나타나지만 이는 소혈청 알부민의 첨가로 극복되는 것으로 사료된다. This study was carried out to investigate the sensitivity of preimplantation mouse embryo to the influence of water quality and whether the influence of poor water quality is overcome by the addition of SBA. F1 hybrid mice was superovulated with PMSG/hCG and timely mated. 1-cell stage and 2-cell stage mouse embryos were recruited. The embryos were cultivated in m=KRB and Ham`s F-10 media; both media were produced by using highly purified water adn tap water and each media was divided into two groups: 0.4% BSA was added to one group and nothing was added to other group. 1-cell stage mouse embryo grew and developed in vitro in simple media and complex media regarless of water quality. And its in vitro growth and development was significantly stimulated by the addition of BSA. In simple media, in vitro growth and development of 2-cell mouse embryo was low in poor water quality but the retarded growth and development was overcome by the addition of BSA. In complex media, its in vitro growth and development was not changed by water quality but it was significantly stimulated by the addition of BSA. Conclusively, in vitro growth and development of preimplantation mouse embryo is stimulated by the addition of BSA regardless of embryonic cell stage or media type. 2-cell stage mouse embryo appears to be sensitive to the influence of poor quality, especially in simple media, but it would be overcome by the addition of BSA.

Estrogen이 혈관에 미치는 직접적인 효과의 증거로서 제대혈관 내피세포내 Estrogen 수용체에 대한 연구

허민,박형무,유재형,박용욱,강응택 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

본 논문은 1993년도 중앙문화연구원 학술연구비에 의하여 연구되었음. 본 논문의 요지는 1993년 대한폐경학회 제2차 학술대회에서 발표되었음. It has been reported that estrogens have a protective role on the cardiovascular system, that is, the reduction of the risk of cardiovascular disease which is the most common cause of death in women over 50 years of age in the industrialized countries. Postmenopausal estrogen replacement therapy reduces the risk of coronary heart disease by 30-70% and risk of stroke by 40%. The exact role of estrogens in the pathogenesis of atherosclerosis and myocardial in farction remains to be defined. This beneficial effect of hormone replacement therapy on the cardiovascular disease is mainly mediated by changes in lipid and lipoprotein metabolism such as decreased total and LDL-cholesterol and increased HDL-cholesterol, which reduce the atherogenesis.But other non-lipid mechanisms also appear to be involved. The current data prove that the vascular endothelium plays a prominent role in the regulation of vascular tone and reactivity by producing several potent locally acting vasoactive peptides. Estrogens have been reported to induce vasodilation in variety of animals. if estrogens are clearly associated with release o certain vasoactive peptides such as prostacyclin or endothelium-derived relaxing factor (EDFR), endothelium may have an another causative mechanism in addition to muscularis of the blood vessel wall for the expression of estrogen actions on the cardiovascular system. To prove this hypothesis, we carried out preliminary study about the status of the estrogen receptors in the vascular endothelium immunohistochemically by using the umbilical vein and endothelial cell culture. Weekly positive reaction of estrogen receptor is noted in the endothelial cells of umbilical veins and arteries in fresh umbilical specimen. intracytoplasmic and intranuclear positive reaction of estrogen receptor in clutured endothelial cells of umbilical vein were clearly identified. These findings suggest that vascular endothelium may be target tisues for estrogen and the effect of estrogens on vascular tissuse may be partially mediated through the actions on endothelium.