임신과 동반한 Krukenberg종양 1 예

나용연(YY Nah),이영기(YK Lee),김성림(SR Kim),이태형(TH Lee),이승호(SH Lee) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.2

임신과 동반한 Krukenberg 종양 1례를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. An ovarian malignancy associated with pregnancy has been reported to be very infrequent. we report a caes of Krukenberg tumor, dianogsed at 29 weeks of pregnancy, with a brief review of literatures.

대인돌봄 재활 원예치료프로그램이 요양시설 뇌졸중노인의 정신기능에 미치는 효과

이숙(Lee S),손영신(Son YS),최이용(Choi YY),이미선(Lee MS) 인간식물환경학회 2016 인간식물환경학회 학술대회 Vol.2016 No.추계

자궁경부 원추생검후 임신

조삼현,황윤영,이재억,조수현,이윤영 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.5

Four cases of pregnancy following conization of the cervix due to cervical intraepithelial neoplasia was reported here. Two patients underwent prophylactic transabdominal cerclage at 17, 18 weeks` gestational age and two patients underwent no surgery. All patients delivered at term except one who underwent no operation delivered at 37 weeks gestation. Our cases and the literature suggest that there is not high danger of premature birth after conization and therefore performance of the operation does not seem to necessiate preventive cerclage.

전기자극 및 바이오피드백치료가 여성 복압성요실금 환자의 성생활과 삶의 질에 미치는 영향

이용찬,윤하나,박영요 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.10

자궁경부무력증 환자에 있어서 복식 및 질식 자궁경부 원주봉합술의 비교분석

황윤영,이재억,박문일,서호상 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

1991년부터 1993년까지 한양대학병원 산부인과의 습관성유산클리닉에 등록된 자궁경부무력증 환자 102명중, 과거력에 질식자궁경부원주봉합술을 시행받은 환자 50예를 분류하여 연구대상으로 선정하고, 질식과 복식자궁경협부 원주 봉합술을 각각 시행한 후, 이에 따른 예후를 비교분석하였던 바, 그 결과는 다음과 같다. 1. 전 예들(N=102)에 있어서 수술방법에 따라 수술시기를 비교하여 보면, Shirodkar법은 평균 15.7주, McDonald법은 평균 20.3주, TCIC는 평균 15주이었다. 수술방법에 다른 분만주수는 각각 평균 35.3주, 33.9주 및 38.3주이었다. 2. 전 예들(N=102)에서 수술방법에 따른 임신연장기간은, Shirodkar 법은 평균 19.7주, McDonald 법은 평균 12.8주 및 TCIC는 평균 24.3주로 TCIC방법과 다른 방법들 사이에 통계적 차이가 있었다. 3. 연구집단(n=50)에서 임신의 연장기간은, 과거 TVC가 성공한 후 다시 TVC를 시행한 경우(Group I) 평균 22.93주, 과거 TVC 실패후 TVC를 제시행한 경우(Group II) 16.25주, 그리고 과거 TVC를 실패한 후 TCIC를 시행한 경우(Group III)23.00주로서 Group II와 Group III사이에 통계적 차이가 있었다. 4. 연구집단에서 태아구제율은 Group I에서 83.79%, Group II에서 64.7% 그리고 Group III에서는 100%로서 Group II와 Group III사이에 통계적 차이가 있었다. 5. 전 예들(N=102)에서 시행된 30예의 TCIC의 경우, 태아구제율은 96.7%이고, 적응증은 30에중에서 과거에 TVC의 경험이 있는 경우가 23예로 가장 많았고, 그중 6예는 자궁경부의 깊은 상혼이 동반되어 있었다. 6. TCIC수술 후의 합병증은 6예에서 조기진통이 발생하였으나 모두 치료되었고, 2예의 자궁내 태아발육부전이 있었으나, 이는 정상 산모들의 발생율과 근사하였다. 이상의 결과로서, 과거에 질식자궁경부원주봉합술을 실패하였을 경우에는 특히 자궁경부의 상혼이 동반되는 경우, 같은 방법의 재적용보다는 우선 복식 자궁경부원주봉합술을 시도하는 것이 임신기간의 연장 및 양호한 태아구제율을 얻는데에 도움이 될 수 있다는 것을 알 수 있었다. The incompetent internal os of cervix is one of the most prevalent causes of midtrimester abortion and has become an important disease entity in obstetrics due to the increasing incidence that followed the coincidental increase of spontaneous abortions and curettages. Most cerclage operations for IIOC are performed transvaginally. The transabdominal route is beneficial in trating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. It is reasonable to guess that if a previously performed transvaginal cerclage has failed, applying the same operaion would result in a poor obstetric outcome. We therefore believe that it is better to apply TCIC than TVC in patients who had had a history of a previously failed transvaginal cerclage. But, because of the technical difficulty, high risk brought on to the fetus and the fat that a Cesarean section is necessary for delivery, TCIC has not been a procedure easily adopted. One hundred-two patients who had a history of transvaginal cerclage were selected to analyze the effectiveness of the following cerclages according to the route of procedures in 3-year period from 1991 to 1993. This resulted in as follows: 1. The average time of operation according to the surgical procedure in all of the cases was 15.7 weeks for Shirodkar, 20.3 weeks for mcDonald and 15 weeks for TCIC. The gestational age of delivery averaged 35.3 weeks, 33.9 weeks and 38.3 weeks, respectively. 2. The prolongation of pregnancy according to the surgical procedure averaged 19.7 weeks for Shirodkar, 12.8 weeks for McDonald and 24.3 weeks for TCIC, showing a statistical difference between TCIC and the other methods. 3. The prolongation of pregnancy in patients who underwent TVC following a previously successful TVC (Group I) averaged 22.93 weeks and 16.25 weeks( Group II) for patients who underwent the zrocedure following a previouslly failed TVC. An average of 23.00 weeks was prolonged in patients who underwent TCIC following a previously unsuccessful TVC (Group III), resulting in a statistical difference between Groups II and III. 4. The fetal salvage rate in Group I was 83.79 and 64.7% in Group II and 100% for group III, resulting in a statistical difference between Group II and Group III. 5. A previously performed TVC was the most common indication for TCIC comprising 23 out of 30 cases Of the 23 cases, sixteen cases had deep scars of the cervix, also. 6. The complications following TCIC included 6 cases of preterm labor of which all were successfully treated and 2 cases of intrauterine growth retardation which showed a rate that was similar to that of normal pregnancy. We therefore conclude that the failure of a previous failed transvaginal cerclage should be the sole indication for a transabdominal procedure.

Factor Ⅷ 유전자인자의 Intron 13 및 Intron 22의 Microsatellite 다형현상

황윤영,이재억,문형,정성노,조율희,조상희,심성한,서한규 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The factor Ⅷ gene comprises 26 exons spanning 185kb of DNA located at the distal end of the long arm of the X-chromosome, Defects in this gene cause hemophilia A, a bleeding disorder affecting 1/10,000 males. Linkage analysis is known as an efective method for the prenatal diagnosis and for the identification of carrier status. Several polymorphic markers had been studied to establish the diagnostic procedure for hemophilia A in Korea, and heterozygosity of 96% could be expected with 4 markers such as St14.1/TaqⅠ, intron 18/BclⅠ, intron 22/XbaⅠ and DX13/BalⅡ. But in some families, above markers were not informative, and it was required another polymorphic markers should be applied for the diagnosis. Two recently identified microsatelite polymorphisms in intron 13 and 22 of FV III gene were investigated to increase the heterozygosity and to diagnose previously uninformative families. Intron 13(CA)n repeats polymorphism showed 7 alleles with expected heterozygosity of 0.5336. Intron 22(CA)n(TC)n repeats polymorphism showed 4 alleles with expected heterozygosity of 0.5146. With the two microsatellite polymorphisms we could expect the heterozygosity of 0.6756. And we could successfully perform prenatal diagnosis previously uninfirmative family with intron 13 microsatelite polymorphism. With 4 polymorphisms detected by polymerase chain rection(intron 13 and intron 22 microsatellite polymorphisms, intron 18/BclⅠ and St14.1 VNTR/TaqⅠ), about 97% of hemophilia A family in Korea would be diagnosed by linkage analysis.

원인불명 습관성유산 환자에서 자용량 아스피린 투여후 혈중 Lipid-Peroxides의 변화

황윤영,이재억,유중배,나도수,박문일,정성노 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.5

습관성유산의 임신중의 병태생리는 자궁내 발육부전 및 임신성고혈압과 유사한 점들이 많으나 아직 그 병태생리는 확실히 밝혀지지 않고있다. 최근 특히 임신성고혈압의 병태생리에서 혈청 및 태반에서의 prostacyclin(PC), thromboxane(TX)및 lipidperoxides(LPO)의 역할이 주로 지적되고 있는데, 특히 저용량 아스피린을 투여하면 TX및 LPO가 선택적으로 억제되어, PC와 TX의 균형이 이루어지고 결과적으로 임신예후가 좋아진다는 보고들이 발표되어 왔다. 물론 이러한 사실만이 저용량 아스피린의 작용기전의 전부는 아니지만, 본 연구에서 저자들은 원인불명의 습관성유산 환자에서 저용량 아스피린만을 사용후 LPO의 변화를 관찰하고자 하였다. 본 연구는 향후 습관성유산의 병태생리를 이해하는 초보적 연구로서 향후 혈관내 응고에 영향을 미치는 다양한 요인들에 대한 연구의 기본자료로서 활용할 목적으로 시도되었다. 서울소재 한양대학교 병원 산부인과의 `습관성유산크리닉`을 방문한 환자들을 대상으로 동종면역이상으로 판정된 환자 및 최종 면역적인 검사에서도 원인이 밝혀지지 않은, 즉 원인불명으로 진단된 환자들을 연구대상으로 하였다. 연구기간중 임신이 된 경우 저용량 아스피린(100 mg/day)을 임신진단시부터 임신 34주까지 투여하였다. 이중 절박유산으로 입원한 환자를 대상으로 임신 12주까지의 혈청을 1주 간격으로 주기적으로 채취하여 TBA reactive products 방법을 응용하여 LPO를 측정하여 다음과 같은 결과를 얻었다. 전체적으로 혈액체취는 14예의 38건에서 이루어졌다. 1. 저용량 아스피린 투여후의 임신주수별 평균 LPO치의 비교에서는 임신 5주(N=1)에서 2.6+-0.0, 6주(N=2)는 2.8+-0.21, 7주(N=3)는 2.7+-0.35, 8주(N=10)는 2.7+-0.5, 11주(N=4)는 2.7+-0.27, 12주(N=1)는 2.7+-0 nmol/ml로서 임신주수별 변화가 관찰되지 않았다. 2. 저용량 아스피린 투여중 7예에서 1주간격으로 측정된 혈중 LPO의 임신주수별 변화에서는 1예를 제이한 나머지 6예에서 모두 저용량 아스피린 투여중에 임신이 진행될수록 점차 감소경향을 보였다. 3. 저용량 아스피린 투여중의 48시간 간격으로 측정될 혈중 LPO의 임신주수별 변화의 관찰은 모두 8예의 10경우에서 이루어졌는데, 10경우중 4예만이 LPO가 감소하였다. 상기결과와 같이 임신주수별 측정에서는 큰 차이를 보이지 않았는데, 이는 임신이 진행될수록 LPO가 차츰 증가한다는 보고를 감안하면 일단 아스피린 투여의 긍정적인 효과를 추정할 수 있다. 또한 한 환자에서 연속 측정한 결과에서는 LPO가 감소되는 경향을 보인것은 확실한 저용량 아스피린의 효과라고 생각할 수 있었으며 LPO의 감소에는 적어도 1주일 이상의 저용량 아스피린의 투여가 기여하리가고 생각되었다. 요약하면, LPO는 PC의 생성을 억제하므로 비정상적으로 증가된 LPO는 결국 `낮은 PC/높은 TX화`의 불균형을 초래하게 되는 것이다. 본 논문에서 저자들은 습관성 유산 환자의 임신초기에서 우선 저용량 아스피린 투여후 LPO치의 감소를 관찰하였다. 향후의 과제는 이러한 조사를 전 임신기간으로 확대하는 것이며 동시에 TX또는 PC의 측정을 실시하는 것이다. 이러한 과정을 통하여 과연 지금까지 밝혀진 임신성고혈압의 발생기전이 원인불명 습관성 유산의 발생기전과 유사한지를 규명해야 하는 것이 차후과제이다. Lipid peroxides(LPO) are toxic compounds that damage cells and inhibit prostacyclin synthase. It is responsible for endothelial cell damage and decreased prostacyclin(PC) levels. Preeclampsia is associated with an imbalance of increased thromboxane(TX) and decreased prostacyclin. Low-dose aspirin therapy reduces the incidence of preeclampsia, presumbly by selective inhibition of TX and LPO, however, there were limited studies in the field of recurrent abortion. This study was done to invesgate the effect of low-dose aspirin on serum LPO levels in patients of unknown recurrent abortion. The followings are summarized results. 1. Of 14 patients of recurrent abortion who were receiving low-dose aspirin(100 mg/day) therapy between 5-12th gestational weeks, 38 tests of LPO were done with TBA method. 2. There were no significant differences of mean serum LPO levels as increasing gestational seeks (21 serial tests in 7 patients). 3. As increasing gestational weeks in each patient, six patients among 7 patients(85.7%) revealed decreasing trends of serum LPO levels during low-dose aspirin therapy. the serum LPO levels were decreased after 48 hours of low-dose aspirin therapy in 4 cases among 10 paired-tests. From these results, we could confirm the low-dose aspirin therapy inhibit serum LPO levels during the first trimester in patients of recurrent abortion. And it is supposed that at least 1 week interval in needed for reducing the level of serum LPO during low-dose aspirin therapy.

소아 외음부질염 원인균의 특성 : 1980 년대와 1990 년대의 비교

황윤영,이재억,문형,조수현,김진조,한동익 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

This study was designed to evaluated a difference of the etiologic organisms of vulvovaginitis in pediatric age group in the 1980s and the 1990s. We compared the results of the culture for vaginal discharge and the antibiotics sensitivity test from 266 patients under the age of 18 who visitied the Hanyang University Hospital from March 1981 through March 1991(Group 1) with those from 56 patients under the age of 18 who visited the hospital from April 1991 through April 1996(Group 2). The prevalent age was from 2 to 10 in both group. The most commonly isolated etiologic organism in both groups was gram-positive coagulase negative staphylococcus(25.2% and 26.7%, respectively), and the second most commonly isolated etiologic organism was E.coli(20.1% and 16.9%, respectively).Candida albicans was isolated in 2.8% of patients in Group 2, whereas it was not detected in Group 1. In Group 2 the incidence of E.coli was significantly reduced (30.4% vs 8.7%, p=0.01), and the incidence of lactobacillus was increased(0.0% vs 8.7%, p=0.01) and Candida albicans(0.05% vs 18.2%, p=0.01) were increased in Group 2 in age group of 11 to 18. amikacin was the most sensitive antibiotics for Gram-negative and Gram-positive organisms in both groups, gentamicin for Gram-negative organism in Group 1, and chloramphenicol for Gram-negative in Group 2. These results indicate that E.coli infection in pediatric age group of 2 to 5 was reduced in 1990s whereas Enterococci infection in pediatric age group of 11 to 18 was increased in 1990s. Therefore it is suggested that the improvement of the hygiene and sanitation of genital organ in pubertal girls is needed through education.

원인불명 습관성 유산 환자에서 정맥내 인혈청 면역글로부린 투여 효과

황윤영,이재억,문형,박문일,정성노,황정혜,신중식 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

한양대학병원 산부인과 `습관성 유산 클리닉`에 등록된 동종면역성 요인 및 원인불명 습관성 유산환자로 분류 21명(23예)을 대상으로 최초 임신 진단시 면역글로부린 0.5/kg을 초 투여한 후 매 3주마다 1∼3회 투여 후 다음과 같은 결과를 얻었다. 1. 23예의 면역글로부린 투여환자 중 17명이 분만에 성공하였고, 4명은 유산하였지만 이 중 2명은 다음 임신 에서 재투여 후 만삭아를 분만하였다. 2명은 추적 관찰 도중 주소 변경으로 계속적인 추적이 불가능하였다. 2. 17명의 환자 중 7명은 질식분만, 10명은 제왕절개 술로 생존아를 분만하였다. 이 중 2명은 각각 36주와 37 주에 조기분만 하였지만 나머지는 만삭분만을 하였다. 3. 차단항체 지수(BEI)의 변화는 최초 면역글로부린을 투여하였던 23예에서 임신 전의 BEI 평균치(BEI-1) - 3.23±31.42%(분포: -53.6∼75%)에서 면역글로부린 1차 투여 후 20명의 환자에서 측정된 BEI 평균치(BEI-2)는 21.81±30.31%(분포: -42.2∼75%), 2차 투여 후 5명의 환자에서 측정된 BEI 평균치(BEI-3)는 14.34±14.24%(분 포: -10∼26.5%)로 각각 증가하였다. 이 연구는 면역글로부린의 기전이 아직 확실하지는 않지만 투여 후 혈청내 차단항체의 증가가 동종면역성 요인 및 원인불명 유산환자를 치료할 수 있다는 가정 하 에, 부작용이 적고 임신중 투여가 가능한 점에서 실시되 었다. 결론적으로는 생존아 분만에 높은 성공률을 나타 냈지만 대조군의 설정과 위약의 사용을 이용한 전향적 인 이중 맹검법이 불충분한 점, 그리고 Table 3의 BEI-3 에서와 같이 적은 개체 수(5예)로 인하여 객관성 결여 등 이 문제점으로 제시되었다. 또한 고비용의 치료제제 및 투여를 위해 환자가 입원을 해야 하고, 환자 및 보호자의 동의가 있어야 하는 등의 여러 제한요소가 뒤따른다. 하 지만 면역글로부린 투여 후 대부분의 환자에서 BEI 수치 가 증가되었고, 또한 결과적으로 본 교실 연구뿐만 아니 라 다른 보고에서도 높은 성공률을 나타내고 있다. 따라 서 다른 약제 투여와의 지속적인 연구가 비교 및 검토될 때 향후 원인불명 환자에서 치료 방법의 하나로 채택될 수 있을 것으로 사료된다. Intravenous human immunoglobulin (IVIG) has been proposed in patients with unexplained recurrent spontaneous abortion (RSA). Twenty-one women with a history of recurrent spontaneous abortion were treated with IVIG. Among them, 2 patients miscarried and were treated with immunoglobulin again during their next pregnancy (N=23). At the time of diagnosis of pregnancy, patients were treated with 0.5 g/Kg dose of IVIG. Therapy was repeated every 3 weeks at a dose of 0.5 g/Kg until 13 week`s gestation. Of these patients, Blocking Effect Index (BEI) was peformed before and after treatment, respectively. The results were as follows ; 1. Of 23 pregnancies participating in the study, treated with IVIG. Pregnancy outcomes included 17 deliveries and 4 abortions. Two patients were not followed up. The success rate was 81.0% (17/21). But among 4 patients who miscarried, 2 patients were resulted as abnormal pregnancies (chromosomal abnormality & partial hydatdiform mole, respectively), and treated with immunoglobulin during their next pregnancy and gave birth successfully. Therefore, the overall success rate was 89.5% (17/19). 2. Seven out of 17 babies were born vaginally (41.2%), while ten (58.8%) were delivered by cesarean section. Fifteen were born at term, while 2 (11.8%) were preterm (36th and 37th gestatonal weeks, respectively). 3. Twenty-three cases received IVIG once, 21 cases twice and 11 cases three times. The rate of BEI in patients who were not treated with IVIG was -3.23±31.42% (N=23)(range: -53.6∼75%). The rate of seroconversion of BEI in patients who were treated with IVIG was 21.81±30.31% (N=20)(range: -42.2∼75%). The converted BEI rate after second infusion of IVIG was 14.34±14.24 (N=5)(range: -10∼26.5%) in 5 out of in 20 patients who showed poor results and needed a recheck. There was no adverse effect of IVIG. Immunotherapy with human IVIG is effective in unexplained recurrent spontaneous abortion and the rate of seroconversion of BEI was increased. However, the immunomodulating effect of IVIG`s related to its possible mechanism to prevent abortion remains unestablished.

혈우병 A의 효율적 진단을 위한 한국인의 St14 VNTR 다형현상에 대한 Southern 및 PCR-RELPs 분석

황윤영,문형,박문일,정성노,이춘근,박봉림,조율희 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9

One of the extragenic polymorphic markers of coagulation factor VIII gene, a VNTR locus St14(DXS52) was investigated to determine the degree of the polymorphism in Koreans and evaluate the usefulness in prenatal diagnosis of Hemophilia A through Southern and PCR-RELPs analysis. In Southern analysis of 151 X chromosomes(49 males and 51 females), the hybrid probe called F814 detects in BclI digests both the St14(DXS52) multiallelic polymorphism and FVIII RFLP. Although the exact allelic frequency of multiallelic polymorphism could not be determined due to incomplete separation of multiple alleles, but most of alleles were clearly discernible this polymorhpic system. The female heterozygote rate of this probe was 84%. It is noticeable that the distribution pattern of multialleles was well corresponded to the PCR results of this locus. A total of 15 alleles were detected in PCR amplification of VNTR locus St14. The allele distribution patterns were different from those previously reported in Caucasian males. The polymorphism information content(PIC) of this locus was 78%. Digestion of the PCR products of this locus with TaqI revealed the presence of a polymorphic TaqI restriction site within the product 200 bp from the end. This restriction site present on 92.2%and absent on 7.8% of all alleles, but the absence is confined soley to the alleles 1690 bp(6.5%) and 2470bp(1.3%). Determination of this polymorphism within St14 VNTR region increase the expected heterozy-gosity about 16% and 50% in homozygotes of alleles 1690 bp and 2470 bp, respectively. The above results indicate that analysis of St14 VNTR locus give more accurate informations than Southern analysis, but the probe F814 increase the informativity by sinultaneous detection of FVIII intragenic polymorphism. It is concluded that about 80% of Hemophilia A families in Korean population can be successfully and efficiently diagnosed when using Southern or PCR-RFLPs analysis of St14 VNTR locus for the carrier detection and prenatal diagnosis of hemophilia A.