한국형 자궁경부 촬영진 ( New Cervicography ) , 세포검사 그리고 HPV-DNA 검사를 이용한 새로운 자궁경부암 검진 모델 ( Model ) 개발

김승조(SJ Kim),박찬규(CK Park),이효표(HP Lee),남궁성은(SE Namkoong),강순범(SB Kang),서호석(HS Saw),이재관(JK Lee),김수녕(SN Kim),김재원(JW Kim),배석년(SN Bae),김찬주(CJ Kim),이근호(KH Lee),이선영(SY Lee),김인호(IH Kim),이찬(C Lee),이정노(JN Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

Objective : The false negative rate of conventional cytology is reported to range from 18 to 45%. It is necessary to develop more effective screening strategies that would ideally be more accurate than conventional cytology. This study is designed to investigate the potential of conventional cytology, cervicography, HPV-DNA testing and their combinations as primary screening techniques for cervical neoplasia. The purpose of this project is to develop the models and guidelines for screening tools of cervical cancer of the uterus by evaluating sensitivity, specificity and cost-effectiveness of all the screening methods. Study design : We conducted a screening of random sample of women who visited the department of OB-Gyn. of five different major university hospitals such as Catholic University Hospital, Korea University Hospital, Seoul National University Hospital, Yeonsei University Hospital and Pochon CHA University Bundang CHA Hospital, from May 1, 1996 to April 30, 1999. In a cohort women with an age range of 20 to 70 who underwent routine cytologic screening at Catholic University, Hospital Bundang CHA General Hospital and local clinics from April 1, 1996 to Decomber 31, 2000. cervicography (n=417,125) and testing for HPV-DNA (n=1,347) by the hybrid capture assay were studied for the ability of the cervical cancer screeuing. A new cervicography system with Kim's classification which was developed by Prof. Kim Seung Jo as an adjunctive method for the cervical cancer screening was applied in this cohort study. And then, accuracy, effectivencess, cost-effectiveness of the single or combined screening method were analysed. Result : Sensitivity and specificity of Pap smear were ranged from 55.6% to 83.1% and 72.8% to 88.3% respectively. The combination of Pap smear and cervicography had sensitivity from 89.7% to 98.6%, specificity from 68.2% to 93.2%. With combination of Pap smear, HPV DNA test and cervicography, sensitivity became also highest accuracy among all screening methods from 92.8% to 98.8%. Considering medical charges for diagnosis and social cost occurred by false positive and false negative results, the most cost-effective diagnostic modality was thought to be the combination of Pap smear and cervicography(91,433 won). In patients who were diagnosed as LSIL, colposcopic examination confirmed progression to high grade intraepithelial lesion(HSIL) in 10.7% patients, persistence of LSIL in 55% patients during the 3 year follow-up period. Accuracy of the screening for cervical cancer and CIN can significantly be improved by cytology with new cervicography rather than cytology alone. We concluded that cervicography can be important adjunctive tests for cervical cytology, improving the effectiveness of cervical screening by allowing a more sensitive detection of cervical neoplasia.

난관복원술의 성공율을 높이는 제반여건의 고찰

차경연(KY Cha),양재이(JI Yang),류철희(CH Rhyu),두재균(JK Doo),김종덕(JD Kim) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.6

For evaluation of factors that influence the success rate of tubal reversal, 116 cases of microsurgical reversal were investigated, which were performed at the infertility clinic in the Department of Obstetrics and Gynecology, Chonbuk National University Hospital from March 1982 to February 1990. 106 cases were able to follow up more than 6 months among these 116 cases of tubal reversal patients. The results were as follows; 1. The pregnancy rate was 84.9%(90 patients) in 106 cases of tubal reversal. 2. The most common incentive was the loss of their children(75.5%), but since 1987 remarriage(24.6%) and change of marital attitude(20.0%) were increasing steadily. 3. After tubal reversal, the mean age of pregnant patients was 28.5 years and that of non-pregnant patients was 30.3 years(p<0.05). 4. The time interval between the sterilization and the tubal reversal was 35.5 months in pregnancy groups, 42.4 months in non-pregnancy groups(p<0.05). 5. The mean length of reconstructed tube was 8.3 cm in pregnancy patients, 6.8 cm in non-pregnant patients(p<0.05). 6. Referring to the sterilization types, the pregnancy rate was higher and the length of reconstructed tube was longer in those who underwent tubal ligation with Falope ring. 7. Referring to the site of anastomosis, the pregnancy rate was higher in ampulloampullar, cornu-ampullary, isthmo-isthmic anastomosis than other group(p<0.05). 8. The pregnancy rate within the first year after tubal reversal was 95.5%, but no case after 2 years was noted. 9. Postoperative tubal pregnancy developed in one case(0.9%) after tubal reversal. 10. Kim`s clamp and Doo`s microirrigator were considered to be valuable instruments in tubal surgery.

인간 상피성 자궁경부암 세포주 ( CUMC-6 ) 의 확립 및 특징화

김진우(JW Kim),남궁성은(SE Namkoong),박태철(TC Park),김태웅(TW Kim),김흥기(HK Kim),김재훈(JH Kim),김사진(SJ Kim),정재근(JK Jung),김승조(SJ Kim),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

A new cell line, CUMC-6, has been derived from an invasive non-keratinizing squamous cell carcinoma of the uterine cervix in a 31-year-old patient. It has been maintained in long term culture for 61 months, and passaged over 300 times. The results were as follows; 1. Monolayer-cultured cells were polygonal in shape, showing a pavement-like arrangement and a tendency to pile up without contact inhibition. 2. The epithelial nature of the cultured CUMC-6 cells was confirmed by transmission electron microscopy which demonstrated the presence of desmosomes and tonofilaments. 3. The sbucutaneous injection of cultured cells into nude mice gave rise to fast growing tumor. The transplanted tumor showed similar histological features, but poor differentiation than the original tumor. 4. Repeated chromosome analysis revealed that most metaphases of this cell line contained diploid number of chromosomes. The consistently observed structural abnormality in this cell line was elongation of short arm of chromosome 1. The G-banded pattern of this chromosome was inv dup (1)(1pter->1p34:: 1p21->34:: 1p34->1qter). 5. The results of isozyme analyses were distinct from the HeLa cell line. 6. Cultured CUMC-6 cells produced human chorionic gonadotropin B-subunit(B-HCG),and a-fetoprotein(AFP). 7. Cytosol estrogen and progesterone receptors were not measured in this cell line. 8. Human leukocyte antigen(HLA) typing of CUMC-6 cells indicated the presence of DR12 and DQw3. 9. Analysis of the DNA extracted from the CUMC-6 cells showed the presence of human papillomavirus(HPV) type 16 and 18 DNAs. 10. Southern blotting technique revealed ampification and rearrangement of oncogene c-myc and no amplification of L-myc. 11. Using the polymerase chain reaction-single strand conformation polymorphism(PCR-SSCP) technique, we have screened CUMC-6 cells for p53 mutation in exons 4 to 9. No mobility shift was observed in this cell cline. This cell line will be a valuable tool in studying the in vitro and in vivo properties of human cervical carcinoma.

Anti-Diabetic Effects of DY-101267, A Potent PPARs Agonist

Lee CH,Kim MK,Shin CY,Chae YN,Son MH,Kim JK,Min JP,Moon HS,Kim HJ,Bae MH,Kim SH,Lee JG,Lim JI 대한약학회 2004 大韓藥學會 總會 및 學術大會 Vol.2004 No.2

Krukenberg 종양 1 예

고재근(JK Ko),김현호(HH Kim),신재경(JK Shin),김경호(KH Kim),김영래(YR Kim) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

위의 원발암종이 난소에 전이된 것으로 보이는 Krukenberg 종양 1예를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Krukenberg tumor is comparatively rare in metastatic ovarian tumors . We have experienced one case of Krukenberg tumor which are presented with a brief review of literatures

자궁내막증환자에서 체액성 면역인자의 양상

김정구(JK Kim),김동호(DH Kim),최두석(DS Choi),김대원(DW Kim),문신용(SY Moon),강순범(SB Kang),이진용(JY Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

Objectives: To investigate specific profiles of humoral immune factors in endometriosis and to evaluate the changes in these profiles after surgical treatment of endometriosis. Methods: Blood samples from thirty-four patients with endometriosis and 20 patients with normal control patients were tested for antiendometrial, antithyroglobulin and antinuclear antibodies, rheumatoid factor[RF], lupus anticoagulant[LAC]. Also, antiendometrial antibodies, immunoglobulin[Ig]G, IgA, IgM, complement C3, C4 and CA-125 were measured in endometriosis patients before and after operation and normal controls. Fisher`s exact test and student`s t-test were used in statistical analysis. Results: Seventeen[50.0%], 14.7%, 2.9% and 2.9% of endometriosis patients had antiendometrial and antinuclear antibodies, RF and LAC respectively while 10.0% and 5% of normal controls had antiendometrial antibodies and RF repectively. Other nonspecific antibodies were not detected in both group. Nonspecific antibodies were detectable ony in patients with antiendometrial antibodies. Compared with normal controls, endometriosis patients had higher IgG and CA-125 levels but no differences in levels of IgA, IgM and complements were found. After surgical treatment of endometriosis CA-125 levels decreased while humoral factors did not changed. Conclusions: Fifty % of endometriosis patients had autoantibodies and no specific changes in humoral factors are not found after surgical treatment of endometriosis.

복부초음파 유도하에 복수천자를 시행하여 산전진단된 태변성 복막염 1 례

김준권(JK Kim),이동훈(DH Lee),최석태(ST Choi),황종대(JD Hwang),전종관(JK Jun),윤보현(BH Yoon),신희철(HC Shin),김승욱(SW Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.10

We report a case of meconium peritonitis diagnosed antenatally by ultrasound-guided paracentesis of fetal ascites. Cytologic or meconium-stained fluid examination is a useful tool for the antenatal diagnosis of meconium peritonitis in presenting fetal ascites only.

자궁내막증 발생에 있어서 유전적 요인: 자궁내막증의 발생과 HLA 항원과의 관계

김동호(DH Kim),김태철(TC Kim),허민(M Hur),이미경(MG Lee),박애자(AJ Park),김정구(JK Kim),김대원(DW Kim),최두석(DS Choi) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

Objective: Many of previous reports have demonstrated a hereditary tendency to development of endometriosis and the incidence of the disease varies in different ethnic groups. However, the genetic background to these differences has not been clearly explained. Our investigation was performed to seek a possible association between certain HLA antigens and the development of the endometriosis. Methods: From May 1997 to the end of October 1998, 70 patients, 39 patients who have endometriosis [34 nonfamilial and 5 familial subjects] and 31 control subjects, were typed for HLA-A, B, C, and DR. To evaluate differences in HLA antigen frequencies between endometriosis and control subjects, X2 tests were performed. Analysis was performed on the entire sample of 39 as well as separatively for familial[n=5] and nonfamilial subjects[n=34]. A two-tailed P value was calculated for each X2 value. Fisher`s exact P value was calculated for small numbers. Results: Increased frequency of HLA-A24, B61, and DR15 antigen were found as compared the entire sample of 39 endometriosis to 31 control subjects [p〈0.05]. In turn, there was a reduced frequency of DR2 antigen in endometriosis. Also, increased frequency of HLA-B61 and DR3 antigen were found as compared 5 familial subjects to 31 control subjects[p〈0.05]. Conclusion: We suggest that the development of endometriosis may be associated with HLA antigens, specially A24, B61, DR15 and negatively associated with DR2, and that HLA-B61 and DR3 antigens may be associated with the development of the familial endometriosis. We think that HLA typing may be valuable in detecting those women with a tendency to develop endometriosis, and further study is needed.

인간 정자의 수정 능력 평가에 있어서 SPA 검사의 유용성에 관한 연구

김석현(SH Kim),김명희(MH Kim),지병철(BC Jee),정병준(BJ Jung),김희선(HS Kim),류범용(BY Ryu),방명걸(MG Pang),오선경(SK Oh),서창석(CS Suh),최영민(YM Choi),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

The objective of this study was to test the validity of zona-free hamster ova sperm penetration assay (SPA) prospectively as a prognostic indicator of male infertility. Fifty infertile patients undergoing in vitro fertilization and embryo transfer (IVF-ET) were selected and classified as fertile and subfertile groups. The fertile group consisted of 25 men in whom fertility was already identified with pregnancy within 1 year before this study, and the subfertile group consisted of 25 men who had the previous history of fertilization failure or less than 30% fertilization rate without oocyte defects in IVF-ET cycles. The effectiveness of SPA as a prognostic indicator for fertilization capacity of human spermatozoa was evaluated after establishing the normal value in SPA. The results of SPA were significantly different in penetration index (PI) and penetration rate (PR) between two groups. Mean PR was 97.4±7.4% in fertile group, and 64.9±36.2% in subfertile group (p=0.003), and mean PI was 5.4±2.9 in fertile group, and 1.5±1.5 in subfertile group (p=0.0001). In evaluating the effectiveness of SPA, ROC curve was used. Among the various thresholds for the prediction of fertilizing ability, PI 3.0 corresponded to the value with higher sensitivity and lower false positve rates, and was determined as a cut-off value. Using this cut-off point, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SPA for the prediction of fertilization capacity was 87.0%, 94.7%, 95.2%, and 85.7%, respectively. To evaluate the clinical validity of SPA, this cut-off point was applied to 299 patients undergoing IVF-ET. The sensitivity, specificity, PPV, and NPV of SPA for the prediction of fertilization capacity in IVF-ET was 93.7%, 93.4%, 98.2%, and 79.2%, respectively. In conclusion, our results clearly show that SPA can be a valuable tool as a prognostic indicator of fertilization capacity of human spermatozoa, and can be also useful in performing IVF-ET in male factor infertile patients.

Gonadotropin Releasing Hormone ( GnRH ) 유사체 투여에 의한 상피성 난소종양의 GnRH 막 수용체의 변화

김진우(JW Kim),노덕용(DY Ro),김태응(TE Kim),나덕진(DJ Rah),김사진(SJ Kim),한구택(GT Han),정재근(JK Jung),남궁성은(SE Namkoong),김승조(SJ Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

Gonadropin releasing hormone (GnRH) analog, ([D-Trp^6]-luteinizing hormone-releasing hormone, [D-Trp^6]-LH-RH), can cause regression of hormone-dependent human tumors. These effects are thought to be mediated through inhibition of the gonadotropic and steroid hormone. But, it has been reported recently that this analog has a direct inhibitory effect on the tumor. To evaluate the direct inhibitory effect of GnRH analog on ovarian tumors, the characteristics of membrane receptors for GnRH analog were investigated in tissues of normal human ovaries, human ovarian cancers obtained from surgery, and heteroctransplanted nude mice tumors. The results were as follows; 1. In the heterotransplanted nude mice tumors, the inhibitory effect of GnRH analog on tumor growth was compared with untreated animals and in vivo treated animals with [D-Trp^6]-LH-RH. In the treated group showed significant growth inhibition(P<0.001). 2. Specific binding of [^125I, D-Trp^6]-LH-RH were demonstrated in plasma membranes extracted from 7 human epithelial ovarian carcinomas and heterotransplanted nude mice tumors, but not in normal human ovaries. 3. In the plasma membrane preparations from ovarian cancer, statistical analysis of the binding data showed that the interaction of [D-Trp^6]-LH-RH with the binding sites was consistent with a single class of low affinity (Kd=2.1*10^9M)and high capacity binding sites (Bmax=15.8 M/mg membrane protein). 4. Therapy with [D-Trp^6]-LH-RH significantly decreased the binding capacity of receptors for [D-Trp^6]-LH-RH in heterotransplanted nude mice tumors (P<0.001). 5. We observed possible correlation between GnRH binding site density and the clinical corse of the patients, and found out that GnRH responded group showed a higher GnRH binding sites than that of non responded group(P<0.05). These findings are compatible with the view that [D-Trp^6]-LH-RH might exert some direct inhibitory effects on the growth of human ovarian and heterotransplanted nude mice ovarian tumors. Although the functional role of this specific binding site for [D-Trp^6]-LH-RH in ovarian carcinoma is still obscure, it might be part of an autocrine regulatory system and provide that this malignancy might be responsive to hormonal manipulations.