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김석중(SJ Kim),김문종(MJ Kim),김재욱(JU Kim),김철수(CS Kim),곽현모(HM Kwak) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.1
1965년부터 1985년까지 5년간격으로(1965, 1970, 1975, 1980, 1985) 연세대학교 의과대학 세브란스병원에서 분만한 체중 501gm이상의 총 출산아 9,303예를 분석하여 다음과 같은 결론을 얻었다. 1. 혼혈아를 제외한 한국인의 평균 제왕분만율은 18.8%로 1965년 6.9%에서 1985년 25.8%로 증가하였으며, perinatal period II rate는 평균 47.8로 연도간 변화는 파동적으로 약간 감소하는 듯 하였으나 그 통계학적 의의는 없었다. 2. 1965년부터 1985년까지 만 21년동안 체중 1,001gm이상의 39,181예의 분만을 대상으로 조사한 연도별 제왕분만율과 perinatal period I rate의 상관계수는 -0.25로 역상관관계를 보였고 특히 신생아사망율은 -0.36으로 통계학적 의의가 있는 역상관관계를 보였다. 3. 모체연령의 분포는 고위험 임신군인 19세 이하와 48세 이상에서 현저한 감소를 보였으나 perinatal period II rate에는 5.6%의 감소효과밖에 보여주지 않았다. 4. 임신회수와 반만회수의 분포는 각각 4회이상, 3회이상에서 현저한 감소를 보였으나 perinatal oeriod II rate에는 각각 9.9%, 10.0%의 감소효과밖에 보여주지 않았다. 5. 제태연령의 분포는 42주 이상의 의의있는 감소에도 불구하고 20∼24주에서 현저한 증가를 보여서 perinatal period II rate에 35.6%의 악화요인이 되었다. 6. 출산체중의 분포는 비교적 안정되어 있었으나 501∼1,000gm에서만 의의있는 증가를 보여서 perinatal period II rate에 30.4%의 악화요인이 되었다. 7. 태위의 분포는 둔위만 의의있게 증가하였으나 둔위시 제왕분만율이 도리어 높아서 1.9%의 perinatal period II rate 감소효과를 보엿다. 8. 제왕분만 적응증의 연도별 변화는 둔위의 경우만 의의있게 증가하였다. 9. 혼혈아는 한국인에 비하여 모체연령이 젊고, 임신회수가 많은 반면 분만회수는 적으며, 저체중아가 적고 제왕분만율은 다소 높아 평균 perinatal period II rate는 현저히 낮았다. During the past few decades, the incidence of cesarean section had steadily increased with the developments of advanced surgical techniques. Increased rates of cesarean birth partly due to broadened fetal indications coincided with the improvement in perinatal survival. Perinatal mortality is influenced by numerous factors such as socioeconomic class, cultural and geographic characteristics as well as accessibility of sophisticated materno-fetal medicine, and obstetrical and neonatal care. Therefore, whether or not the increase in cesarean section has contributed significantly to reducing perinatal mortality in recent years remains controversial. Based on these, a total of 9,303 cases of birth with birth weights more than 500 grams which were delivered from 1965 to 1985 in 5-year interval at Yonsei University College of Medicine, Severance Hospital and obtained the following results. 1. From 9,302 cases of total births, we excluded the babies of mixed race and selected 8,719 cases. Total cesarean births were 1,635 and the overall cesarean birth rate was 18.8%; the rate rose gradually from 6.9% in 1965 to 22.5% in 1985, and the highest was achieved in 1980 with 28.6%. 2. Perinatal mortality was resulted in 417 cases and the overall perinatal mortality rate was 47.8%, including 190 cases of fetal death and 227 cases of neonatal death. There were no significant differences in the quinquennial perinatal mortality rate. By another analysis based on perinatal period I rate, there were marked decreases in perinatal mortality from 50.7 in 1965 and 34.1 in 1975 to 25.5 in 1985. The correlation of cesarean birth rate with perinatal mortality rate and with neonatal mortality rate showed inverse relationship. Pearson correlation coefficients were -0.24 and -0.36 repectively; the former was statistically not significant(p=0.15), but the latter was significant(p=0.60).
자궁경부암 환자에 있어 telomerase 활성도의 임상측명
김승룡,김경태,조삼현,황윤영,문형,유중배,김기성,라명재 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4
A current hypothesis gaining prominence proposes that activation of the telomerase is necessarey for cells to become immortal, or be capable of proliferating indefinitely. The theory suggersts that that almost all cancer cells must attain immortality for progression to malingnant state and, hence, require activation of telomerase. To assess the role of telomerase in the development of mailignant transformation of the uterine cervical carcinoma, telomerase activeiy was measured by using a recently developed sensitive RPR-based telomerase assay(telomeric repeat amplification protocol; TRAP)in benign uterine condition and invasive uterine cervical carcinoma tissues revealed to be telomerase positive (14/16, 88%) which represents a characteristic 6 bp ladder pattern, while none of the 4 cervical tissues with the nonspecific pathologic findings or just chronic cervictis which were obtained by simple bysterenctomy under the diagnoses of benign myoma or uterine prolapse showed any telomerase actiovity. These findings suggest that this enzyme activity may play a key role in the establishment and progression of the uterine cervical carcinoma. This activity of telomerase may influence from the initial stage of tumorigenesis of uterine cervical carcinoma because poitive findings were noticed from the early stage (stage (i 1a1) to the advanced stage. The results of neoadjuvant chemotherpy which were revealed in final histopathologic specimens following radical hysterectomuy, pelvic and raraaortic lymph nodes dissection (suggestion by Rosen et al,) were one grade IV wiht telomerase poistive, 2 grade III with all positivie, 5grade II with 3 positive 2 negative. The two cases of pelvic lymph node metastasis belong to the group of grade II and their activeities of telomerase were 1 positive and 1negative. The situation of apoptosis induced by antineoplastic chemotherapy has not been related to that of telomerase activeity. Furthemore, the late recurrences has been noticed over 5years follow-up following neoadjuvant chemotherapy and radical surgery for the management of the high risk group of patients (not shown in this study) This measn that the nowday`s regimen for induction tumoricidals may have been operating as dual effects (partial restoring and redamaging) to the cell cycle chekpoint. Therefore if telomerase inhibitor will be applied combined whit the induction chemotherapy, unexpected benefits mignt be obtained for the patient with the advanced uterine cervical carcinoma.
김장흡,김태응,김용욱,김경미,박명재,임희경 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10
About 1.5 to 2.5% of all ovarian neoplasms are brenner tumors. Malignant and borderline variants occur, but they are very unusual. We experienced a case of malignant Brenner tumor. This case is malignant Brenner tumor with borderline and benign component. We report the case with brief review of literature.