발기부전 환자에서 Apomorphine Hydrochloride (Uprima?) 설하정투여의 초기경험

박현철,박현준,박남철 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.10

자궁내구기능불전증에 대한 임상적 고찰

박형철(HC Park),허혁(H Huh),임성렬(SY Lim),김창학(CH Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.12

We Studied 56 cases with incompetent internal os of the cervix, 35 patients of them were underwent cervical cerclage at lnje Medical College during the period from Jan. 1. 1977 to Dec. 31. 198l. The obtained result was as follows; l) The rate of encounted IIOC was approximately once in every 130 deliveries. 2) The most frequent age incidence was from 26 to 29 age group, and its most frequent, contributing factor was induced abortion and the next was cervical 1aceration. 3) The operation was performed in 35 patients of 56 cases. Operation was carried out by McDonald technique. 4) After operation. all patients were admitted to the hospital for about 6 days and placed in the position with foot side of the bed elevated. They were all medicated with valium, gestanon, proluton depot, or prophylactic antibiotics under close obser vation of vaginal bleeding and lower abdominal pain. 5) 35 patients undertaken surgery had been followed up to deliveries with 31 successful pregnancies, and a over-all fetal salvage rate after operation was 88.6%. 6} The delivery methods after operation were via vaginal route in 28 cases (73. 12%) and abdominal route in 7 cases (20%) 7) The most common causes of abdominal delivery were due to cephalopeIvic dis proportion (4 cases) and one cesarean section was carried out due to partial placenta1 previa 8) The most common causes of failed operation (10 cases) were premature 1abor (5 cases) and vaginal bleeding (3 cases) 9) The optimal time for operation was between the 17 th and 20th week of gestation and the success rate of the surgery was 92.3%. 10) The success rate of surgery was inversely proportional to the degree of the dilatation or effacement of the cervix. It was highest in the group of one cm or less in diameter of cervical dilatation.

한 도의 Salmonella sp.에 의한 집단발병보고

박형철(HC Park),전두영(DY Jeon),김개환(GH Kim),김순천(SC Kim) 한국농촌의학 지역보건학회 1992 농촌의학·지역보건 Vol.17 No.2

복강경불임술의 임상적 관찰 ( 제1호 )

박인재(IS Park),김현준(HC Kim),박성구(SK Park),송인철(IC Song) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.3

저자는 1974년 5월 1일 부터 11월 30일까지 국립의료원 산부인과를 방문한 불임수술희망자중 복강경불임술을 시행한 147명에 대하여 조사분석하여 다음과 같은 결과를 얻었다. 1) 연령분포는 31-35세군이 79례(53.7%)로 수위이었고 26-30세군이 37례(25.2%)로 차위이었다. 11) 합병증으로 난간막출혈 9례, 그리고 피하기종이 3례있었다. One hundred forty seven cases of Laparoscopic tubal sterilization wre performed by means of fulguration and resection under mostly general anesthesia or local anethesia in a small number of caes during 19 months period from May 1 1973 to Nov, 30 1974. One incision and three burn technique were applied in this study. Age distribution showed the highest incidence in the age group of 31 to 35 years and average age was 32.6 years with the youngest age 19 years and the oldest 42. The number of children at Laparoscopic sterilization reported 3 kid in 40.4% of all cases and 2 kids in 23.8% respectively. The interval between the last delivery and Laparoscopic sterilization ranged 1 to 3 years in 45.6% of all cases. General anesthesia was used for 126 caese (82.7%) local anesthesia for 18 cases (12.3%) and combined local and general anesthesia for 3 cases (2.0%) Three to five liters of CO2 gas consumed for pneumoperationeum in more than half of all cases. It took less than 30 minutes to complete Laparoscopic tubal sterilization in 79.0% of all cases. Hospital stay required less than 24 hours in 80.2% of all case mostly in case of general anesthesia. Twelve cases (8.2%) of previous appendectomy were submitted to Laparoscopic tubal sterilization without considerable technical difficulty. Other episodes of previous Laparotomy were excluded for the indication of Laparoscopic tubal sterilization Laparoscopic tubal sterilization coincidence with artificiall abortion were carried out in 63 cases As the complications 9 cases of mesosalphingeal hemorrhage 7 cases of tubal hemorrhage and 3 cases of subcutaneous emphysema were encountered, but no intensive medical care was required in any cases.

자궁경관무력증의 수술요법에 대한 임상적 관찰

박인서(IS Park),김현찬(HC Kim),김선동(SD Kim),박찬무(CM Park) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.2

1964년 10월 초부터 1973년 6월말까지 만 8년 9개월간 국립의료원 산부인과에서 자궁경관무 력증으로 진단을 맏은 33예에 대하여 44회의 수술을 시행하여 그 임상적 관찰을 시행한 바 바듬과 같은 결과를 얻었다. 1) 자궁경관무력증의 임신 및 분만에 대한 비율은 1:352와 1:336이었다. 2) 환자의 평균연령은 31.6세였다. 3) 수술 전 평균 임신회수는 5.5회였으며 fetal salvage rate는 16.5%였다. 4) 원인적 소인 중 외상성 소인을 가졌었다고 생각되는 환자는 79%에 해당하였다. 5) 진단은 산과적 기왕력, 자궁경관의 소견, 외상성 소인 등을 종합 참작하였으며 33예 중 30예를 임신중에 진단하였다. 6) 수술방법 및 회수는 Shirodkar 술식 19회, Mc-Donald 술식 20회, Lash & Lash 술식 5 회였다. 7) 수술 후 평균입원기간은 Shirodkar 술식에서 12일, Mc-Donald 술식에서 21일, Lash & Lash 술식에서 5.4일이었다. 8) 수술 후 보조적 치료제로는 opium tincture, 황체홀몬, librium 등을 투여하였다. 9) 생아를 얻었던 경우에 분만방식은 약 2/3에서 질식분만이었고 약 1/3에서 제왕절개수술 에 의한 분만이었다. 10) 수술에 직접 관련된 합병증의 빈도는 17.3%이었으며 합병증으로는 자궁내감염 및 태아 사망, 파막, 분만의 유발, 자궁경관질루 및 염증성괴사로 인한 자궁경관탈락, 이차성불임증 등이었으나 모체사망은 없었다. 11) 수술의 성적 즉 수술회수와 임신회수에 대한 전체적인 fetal salvage rate는 70%와 68.1%이었으며 Lash & Lash 술식 (100∼80%), Mc-Donald 술식(77.7%), Shirodkar 술식 (55.5∼57.1%)의 순위였다. From October 1964 through June 1973, during the period of 8 years and 9 months, 44 times of operations were carried out in 33 patients of incompetence of the cervix which was diagnosed on the bases of previous obstetric histories, findings on the cervix in pregnant or nonpregnant state and its combinations with consideration of predisposing traumatic factors. A number of operations, such as Shirodkar(19 times), Mc-Donald(20times) and Lash & Lash(5 times) had been done and a variety of suture materials used. Before operation those 33 patients had 182 conceptions with successful outcome of pregnancy in 23. If the artificial abortions were deleted, fetal salvage had occurred in 16.5%. Fourty operations had been followed up to deliveries with 28 successful pregnancies and a overall operative successful fetal salvage rate was 70%. Fourty four pregnancies had been follwed up to deliveries and 30 pregnancies resulted in success with a overall fetal salvage rate of 68.1% whicg was success rate regarding to the numbers of pregnancies after operations. An attempt to analyze the incidence, predisposing etiological factors, post-operative complications, comparative results of each operation and other concerned problems was made with a brief review of literateres.

한국여성의 융모종양의 임상적 고찰

박성구(SK Park),김현찬(HC Kim),주영철(YC Joo),장명익(MI Chang),김태홍(TH Kim),박인서(IS Park) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.7

1. 빈도 : 분만수에 대한 융모종의 발생빈도는 1:71분만(1.41%), 융모암은 1:279분만(0.36%)이었다. 2. 새로운 분류방법에 의한 융모종양의 분포는 양성융모종양 39예(52.7%), 악성융모종양 47.3%의 분포이었고 비전이성 32.4%, 전이성 12.9%이었다. 3. 연령 : 융모종의 연령분포는 생식능력이 강한 20∼34세가 대부분이라 추정된다. 4. 병리조직학적 분류는 융모종 67예중 포상기태 38예(56.7%), 융모암 12예(17.9%), 파괴성기태 2예(3.0%), 조직불분명 15예(22.4%)이었다. 5. 양성융모종양의 임상적 증상의 기간은 2개월내가 71.8%로 대부분이었고, 증상별로 는 부정성기출혈이 35.4%, 태아심음청취불능은 11.8%, 태동을 느끼지 못하는 예 9.5% 의 순위이었다. 6. 포상기태 환자들 중 예방적 화학요법을 실시한 예는 완전소퇴율이 88.9%, 실시하지 않은 예가 66.7%로 예방적 화학요법을 실시하지 않은 예에서 악성 융모종양으로 되는 율이 많 았다. 7. 악성 융모종양환자의 임상증상중 비전이성 악성융모종환자는 출혈 19예, 자궁팽대 4예인 반면 전이성 악성융모종환자는 출혈 16예, 출혈 6예, 무월경 6예의 순위이었다. 8. 악성융모종양의 화학요법에 의한 총괄적 치료효과는 비전이성 악성융모종양은 81.8%의 소퇴율을 보이고 전이성 악성융모종양은 54.1%를 나타내어 비전이성 융모종양의 완전소퇴율이 높았다. 9. 악성융모종양의 병리조직학적 검사소견과 화학요법의 치료효과는 파괴성기태 (100.0%), 융모암(83.3%), 포상기태(66.6%)의 순위이었으나 유의한 차이는 없었다. 10. 전이성융모종의 화학요법에서 관찰한 증상은 소퇴 13예의 환자들중 소퇴기간은 1~2년 사이가 6예로 제일 많았으며 이들은 적어도 5년이상의 추적을 요한다. 11. 전이성 융모종양의 완전 소퇴를 위하여 소요된 투약횟수는 3회기가 5예, 2회기가 3 예의 순위이었으며 5회기도 2예나 되었다. 12. 악성융모종양의 화학요법에 있어서 발병과 투약 개시사이의 기간이 치료성적에 미 치는 영향은 4개월이내에 치료를 개시한 환자가 79.2%의 소퇴율, 4개월이상이 27.3%로 소퇴율의 큰 차이를 보였다. 13. 전이성 융모종양의 전이부위와 화학요법과의 관계는 골반내, 폐, 질의 순서이었으며 두개골 전이는 예후가 불량하였다. 14. 화학요법의 중독증상은 구강염 46예, 소화기 장애 41예, 골수기능저하 및 고열 22예의 순위이었다. 15. 화학요법 중독증상으로부터 회복되는데 소요되는 필요한 월수는 각 회기를 통하여 대부분이 3주이내에 회복되었다. 16. 비전이성 융모종양환자 및 전이성 융모종양환자들 중 화학요법 및 수술요법을 병행한 환자의 소퇴율은 단일요법보다는 좋은 것으로 추정되었다. 17. Goldstein의 분류법에 의한 소퇴율은 class 3(100%), class 2(75%), class 4(63.2%), class 5(20%)로 class가 올라갈수록 소퇴율은 감소하는 경향을 보였다. This article is the report of trophoblastic tumor treated in the gynecological ward of the National Medical Center from January 1, 1972 to December 31, 1975. Trophoblastic tumors occured once in about 71 deliveries (1.4%) and choriocarcinoma once in about 279 deliveries (0.36%). A total of 67 cases was seen with the following distributions; hydatidiform mole 39, chorioadenoma destruens 2, choriocarcinoma 17, and unknown 9. The distributions of histological classification of total 67 cases were as followings; hydatidiform mole 38 (56.7%), chorioadenoma destruens 2 (3.0%), choriocarcinoma 12 (17.9%) and unknown 15 (22.4%). The distribution of new classification of total 67 cases were as followings; benign trophoblastic tumors 39 cases (52.7%), malignant trophoblastic tumors 38 cases (47.3%) (non-metastatic T.D. 32.4% and metastatic T.D. 12.9%). The distributions of Goldstein classification of total 67 cases were as followings; class 1.39 cases, class 2, 8, class 3, 3, class 4, 19, class 5, 5 cases. Complete remission rate tends to be poor according to the increase of Goldstein classification number. Patient could be seen most frequently in 20-34 age group. In 35 cases with malignant trophoblastic tumors 9 cases in 11 (81.8%), metastatic malignant trophoblastic tumors 13 cases in 24 (54.1%). Analysis of 17 metastatic trophoblastic cases treated with chemotherapy, according to histopathological findings showed that 100% of 2 invasive mole, 83.3% of 13 choriocarcinoma and 66.6% of 3 hydatidiform mole cases obtained complete remission. The number of courses of chemotherapy required to induce complete remissin indicated from 1 to 5 courses, with a high frequency of complete remission being induced by 2 to 3 courses. Perhaps the most critical factor in the response to chemotherpy appeared to be the duration of the disease process prior to the onest of treatment and this study showed that patient treated within 4 months of the onset of the disease revealed markedly favorable prognosis (complete remission 79.2%) and in patient treated over 4 months revealed poor outcome (complete remission 27.3%) The effect of metastatic site on response to the chemotherapy showed that the patients with pelvic metastases fared most favorable, pulmonary metastases were most poor. Manifestations of toxicity with chemotherapy showed that the patients with stomatitis (46 cases), gastrointestinal trouble (41 cases) and bone marrow depression (22 cases) in the order. The time interval required for recovery from toxicity of chemotherapy after each course showed no big difference and the great majority of patients recovered from toxicity within 3 weeks.

Tranexamic Acid가 부인암 세포주 및 생쥐 신피막하에 이식된 암조직 성장에 미치는 영향

박태철(TC Park),박대순(DS Park),윤희종(HC Yoon),한상균(SK Han),박종섭(JS Park),김도강(DK Kim),남궁성은(SE Namkoong) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

저자들은 자궁경부암, 난소암, 융모상피암 세포주들의 배양액에 각기 다른 농도의 tranexamic acid를 첨가하여 배양액내에서 종양의 성장억제효과로 세포수의 감소와 형태학적 변화를 관찰하였고, 생체실험으로서 장액성 난소암조직을 tranexamic acid 가 첨가된 배양액 에 처리한 후 마우스의 신피막하에 이종이식된 종양조직절편에서 감수성의 결정을 조직학적 판정점수로 측정하여 보조적인 항암치료제로 tranexamic acid 의 효용성을 밝히고자 실험했 떤 바 다음과 같은 결론은 얻었다. 1. 난소암 세포주는 tranexamic acid 농도의 증가에 비례하여 세포수의 감소와 종양세포의 파괴가 증가되면서 세포성장의 억제가 관찰되었다. 자궁경부암 및 융모상피암 세포주는 배양액내에 tranexamic acid를 첨가하엿으나 세포증식의 억제효과는 없었다. 2. 생체내 신피막하 이식 4일후 장액성난소암조직의 변화는 사전처리된 tranexamic acid 농 도의 증가에 비례하여, 조직학적 판정기준에 의한 점수가 감소됨이 관찰되었다. 이상의 결과로 tranexamic acid 는 장액성 난소암조직에 대한 성장억제효과가 있었으며 따라 서 악성난소암의 보조적인 치료제로서 임상적가치가 있을것으로 사료된다. After treating the carcinoma of uterine cervix ovarian carcinoma and choriocarcinoma cell lines with tranexamic acid in different concentration we obaserved effects of tranexamic acid on the growth inhibition of gynecologic cancer cell lines in vitro And we tried to find out the antitumor effects of tranexamic acid by evaluating morphologic changes of the ovarian carcinoma tissue which was xenografted in the subrenal capsule of immunocompetent mice. The results are as follows; 1. We observed the inhibition of the tumr cell proliferation in serous cystadeno carcinoma cell line of ovary , by the proportion to the tranexamic acid concentration . But squamous carcinoma cell line of uterine cervix and choriocarcinoma cell line were added by tranexamic acid in a culture fluid, but there was no any phenomena of restraint against the tumor cell proliferation. 2. The morphologic changes of the serous cystadenocarcinoma tissue of ovary four days after the subrenal capsular xenograft in immunocompetent mice showed decreased of the histologic score by the proportion to the tranexamic acid concentration was well observed. These results suggest that, the tranexamic acid is associated with the inhibition of the tumor cell proliferation in serous cystadenocarcinoma of ovary , it is of clinical value as an adjuvant antitumor chemotherapeutic agent.

쌍태임신에 관한 임상적 고찰

김성심(SS Kim),김현찬(HC Kim),배평원(PW Bae),김순애(SA Kim),박영주(YJ Park),박인재(IS Park),박찬무(CM Park) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.5

A clinical review of 239 twin deliveries at National Medical Center for 15 years from 1959 to 1973 was presented . 1. The frequency of twin birth was one in 71 births. 2. The youngest was twenty-one year old woman and the oldest was forty eight year old one in twin delivery, Average age was twenty-nine years. And in primipara 31.8 percent of twin delivery occured. 3. Delivery after 37th week of gestation occured in 76.5% and the babies weighting over 2500 gm. revealed 47.7% . And Apgar socre 7-10 was shown in 88% of the first twin and in 87.0% of the second. 4. In presentation cephalic presentation of the first twin revealed 75.8% and in approximately 70 % of vertex-breech combinations ,the first twin presented by the vertex. 5. Diagnosis of twin pregnancy before labor was made in 71.6% of 239 twin delivery 6. Sponaneous delivery of both babies occurred in 55.6% and operative delivery was performed in 44.4%. 7. Twenty four cases of cesarean section 10.0 % was encounted its main indication being such as repeat cesarean sections, fetal distress secondary inertia and eclampsia. 8. In 15.5% of the cases manual removal of the plaenta was perfomred. 9. About 1% of congenital anomaly was seen 10. Two cases of maternal deaths were encountered.

퇴행성 경추질환에서 자기공명영상과 컴퓨터 단층촬영간의 진단적 일치

안태준,현동근,박현선,김은영,박종운,하영수,박형천 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.1

정맥 혈관종이 동반된 뇌 해면상 혈관종

정지현,김명현,박향권,박형천,김성학,신규만,박동빈 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.3

With the advent of high resolution imaging modalities, revealing many previously angiographically occult vascular malformations are now possible, enabling correct diagnosis and treatment. We treated 7 cases of cerebral cavernous hemangiomas associated with venous angiomas of patients who were admitted to Ewha Womans University Hospital from 1992 to 1994. Their mean age was 29 years(range 11 to 50 years). Five patients(70%) had histories of seizures, four(57%) had focal neurologic deficit. three(43%) had headache and five(70%) had clinically significant intracerebral hemorrhage. Four patients underwent surgical procedures, resulting in improvement of seizure and neurologic deficit conditions.