폐경기 여성에서 1년간 호르몬 대치 요법이 혈청 지질에 미치는 영향

이해혁,남계현,김승형,이임순,이권해,최승도 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Cardiovascular disease is one of the most common cause of death in postmenopausal women. After the onset of menopause, the risk of cardiovascular disease is increased. Several risk factors of cardiovascular disease are well known to us. Among the risk factors, the changes of lipid profiles are roles for cardiovascular disease. Estrogen appears to protect the development of cardiovascular disease, by several mechanism. Especially the protective effect is believed to be mediated by the changes of lipid profiles. Decreased high-density lipoprotein (HDL)-cholesterol and increased low density lipoprotein (LDL)-cholesterol are important factors for development of cardiovascular disease. The purpose of this study was to evaluate the effect of hormone replacement therapy on the lipid profiles to include total cholesterol (TC), high density lipoprotein(HDL)-cholesterol, low density lipoprotein(LDL)-cholesterol, and triglycerides. We measured lipid profiles in 31 postmenopausal women and gave each conjugated equine estrogen (CEE, 0.625mg, day 1-30) plus medroxyprogesterone acetate (MPA, 5mg, day 1-12) for 12months. The levels of serum TC, LDL-cholesterol, and triglycerides were decreased significantly (p<0.05) and HDL-cholesterol was increased significantly (p<0.05) after 12months of hormone replacement therapy. These data suggest that hormone replacement therapy appears to protect agianst the development of cardiovascular disease by the changes of lipid profiles.

갱년기 여성의 호르몬 대치 요법에 대한 수용율

이임순,장진영,이정재,이순곤,이권해,이해혁,김승형 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Purpose: We have evaluated the compliance of hormone replacement therapy. Method: There are 185 climacteric women who are divided into three groups (Group I, Group II, Group III). Group I is given conjugated equine estrogen(CEE, 0.625mg, day 1-30) plus medroxyprogesterone acetate(MPA, 5mg, day 1-12). Group II is given conjugated equine estrogen (CEE, 0.625mg, day 1-30) plus medroxyprogesterone acetate (MPA, 2.5mg, day 1-30), Group III is given only conjugated equine estrogen(CEE, 0.625mg, day 1-30). Results: 1) The compliance rate of hormone replacement therapy during three months is 77.9% including each Group I : 77.7%, Group Ⅱ : 76.1%, Group Ⅲ :80.4%. 2) The compliance rate of hormone replacement therapy during six months is 60.7% including each Group Ⅰ:52.9%, Group Ⅱ: 56.4%, Group Ⅲ: 79.5%. 3) The compliance rate of hormone replacement therapy during nine months is 49.7% including each Group Ⅰ: 45.5%, Group Ⅱ:41.7%, Group Ⅲ: 64.3%. 4) The compliance rate of hormone replacement therapy during a year is 44.4% including each Group Ⅰ: 40.2%, Group Ⅱ:35.3%, Group Ⅲ: 59.5%. Conclusion : It is vital that we maximize compliance if patients are to receive the full benefits from hormone replacement therapy. We think that physicians who prescribe hormone replacement therapy for climacteric women should enough explain the purpose, risks, and side effect of treatment for maximizing compliance of hormone replacement therapy.

다산부에서 자간전증의 임상적 고찰

이주롱,이석민,한효상,이해혁,이임순,이권해 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

목적 : 전자간증 산모에서 초임신부와 다산부 각각의 임상적 특징을 조사하여 비교 분석하고자 하였다. 연구방법 : 1998년 1월부터 1999년 12월까지 2년간 순천향대학 서울병원에서 입원 분만한 임신성 고혈압성 질환 환자중 초임신부 106명과 다산부 50명, 총 150명을 대상으로 임상통계학적으로 조사 분석하였다. 결과 : 분만까지 임신기간의 비교시 초임신부에서는 33-36주에서 17.9%였고 다산부에서는 34.0%로, 다산부에서 조기분만의 예가 의의있게 많았다. 신생아 체중이 2500g 미만인 군이 초임신부군에서는 36.8%였고 다산부군에서는 62.0%로 다산부군에서 더 많았다. 임신성 고혈압성 질환의 중등도를 보면 중증자간전증의 초임신부에서 35.8%와 다산부에서는 44.0%로, 초임신부에 비해 다산부군의 중증 자간전증의 비율이 많았다. 결론 : 중증 임신성 고혈압성 질환이 다산부군에서 더 많았으며 적은 주수에서 제왕절개술을 시행해 출생아의 체중이 초임신부군에 비해 더 작았고 Apgar 점수도 더 낮았다. Objective : To study the clinical differences of primiparous and multiparous preeclamptic patients. Methods : We statistically analyzed 106 primiparous and 50 multiparous preeclamptic patients who were admitted to the Soonchunhyang University Hospital from January 1998 to December 1999. Results : It was statistically found that multiparae were more likely to give premature birth than primiparae: Thirty four percents of multiparae gave birth in the period between the 33rd and the 36th gestational weeks while 17.9% of primiparae did in the same period. Sixty two percents of the newborn babies of multiparae weighed less than 2500g. Among primiparae, the ratio was 36.8%. In addition, more multiparae(44.0% vs. 35.8%) suffered from severe preeclampsia. Conclusion : severe preeclampsia was found more frequently among multiparae. Since they gave birth earlier by cesarian section than primiparae, their babies weighed less and had lower apgar scores.

자궁내 태아사망의 임상적 고찰

이권해,이정재,조현철,이석민,이임순,이해혁,김권대,이순곤,남계현 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Objective: This study was designed to evaluate diagnosis and complication, prognosis during clinical study of cases of intrauterine fetal death. Methods and materials: This is a clinical study of 56 cases of the intrauterine fetal death among 8064 deliveries at Seoul Sunchunhyang university hospital during 5 years from January, 1994 to December, 1998. Results: The incidence was 0.7%. The age distribution of mothers was 18 - 44 years and was highest in the 25 - 29 years range(46.4%). The parity was the most highest in the nulliparous group(51.8%). The most common gestational weeks was 20 - 28 weeks gestational period(46.4%), and most common presentation was cephalic(73.5%). The most common weights of the intrauterine fetal death was from 5,00gm to 1,000g(48.2%). The mode of the most common delivery was the induction of delivery(57.2%). The etiologic factors were: unknown(42.9%), preeclampsia(17.9%), chorioamnionitis(14.3%), congenital anomaly(12.5%), abruptio placenta(7.1%), cord complication(3.6%), placenta previa, death of one for twin. There were 2 cases of maternal complication(DIC, Uterine atony). Conclusion : Intrauterine fetal death should be diagnosised early and treated properly to reduce risk of the maternal complication.

폐경기 여성에서 호르몬 대치 요법시 병행 투여된 프로제스토젠 투여 방법에 따른 혈청 지질 및 지단백에 미치는 영향

이임순,전섭,이순곤,이해혁,이권해,정집광,이석민 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Objective : The purpose of our study is to evaluate the effect of different administration method of progestogen on lipid profiles including total cholesterol, LDL(low density lipoprotein)-cholesterol, HDL(high density lipoprotein)-cholesterol, triglycerides during hormone replacement therapy in postmenopausal women. Methods and Materials : Seventy-one postmenopausal women who were assigned to following groups (Group I : conjugated equine estrogen(CEE), 0.625 mg/day plus continuous medroxyprogesterone acetate (MPA), 2.5mg/day, Group II : CEE, 0.625 mg/day plus cyclic MPA, 5mg/day for 12days/month. And we measured serum total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglycerides before hormone replacement therapy(HRT) and 12 months later after hormone replacement therapy. Results: 1. Total cholesterol decreased in group I,III. 2. HDL-cholesterol increased in group I,II,III. 3. LDL-cholesterol decrease in group I,II. 4. Triglycerides increased in group I,II,III. There was significance in serum total cholesterol and LDL-cholestrerol among three groups. Conclusions : Estrogen alone or in combination with progestogen both in cyclic and continuous use improves lipid profiles, so medroxyprogesterone acetate(MPA) does not seem to blunt estrogenic effect on lipid profiles.

자궁선근증의 고찰

조환성,이해혁,정성윤,김성욱,이순곤,남계현,이임순,이권해 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Objective: This study was designed to estimate the frequency and risk factor for edenomyosis Methods: The clinical records of 623 women undergoing hysterectomy were retrieved in the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital, during 5 years, from Jan. 1995 to Dec. 1999. Results: The following result were obtained. 1. Adenomyosis was found in 247 of 623 patients(39.6%) 2. The highest incidence was 40-49 years of age group, an incidence of 46.6% and mean age was 44.7 years. 3. Adenomyosis was more frequently observed in parous women than non-parous women, such as 93.1% and 6.9%, respectively. 4. Dysmenorrhea, metrorrhagia, pelvic pain and vaginal bleeding were common symptom of adenomyosis, an incidence of 28.7%, 19.0%, 18.2% and 16.2%, respectively. 5. Myoma was the most combined disease in adenomyosis, showing the incidence of 54.7%. 6. Grossly, the size of uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 61.9%. 7. Preoperative diagnostic accuracy of adenomyosis was 6.9%. Conclusion: The results show that deeply understanding of the common symptoms and epidemiology of adenomyosis improve the preoperative diagnostic accuracy.

2차원 및 3차원 초음파를 이용한 태아표면의 해부학적 선별 검사에 관한 연구

윤석범,이해혁,이정재,최경훈,이순곤,이임순,이권해 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Objective : Our purpose of this study was to determine the clarity and consuming time of fetal surface screening in thirty-eight fetuses from 24 to 32 weeks of gestation by use of two and three-dimensional ultrasonography. Methods : From May 1998 to July 1998, we performed the fetal surface screening of the fetal face, extremities, and spine. Thirty-eight fetuses of 24-32 weeks of gestation (thirty-seven normal fetuses and one abnormal fetus) were studied by use two-dimensional (AI 5200S, 3.5-5.0MHz; Acoustic Imaging Technologic Cooperation, U.S.A.) and three-dimensional ultrasonography (Volusion 530D, 3.5-5.0 MHz ; Kretz-Medicine, Korea). On the fetal face, we evaluated both orbits, nose, lips and brow. Both hands and feet, five digits and toes should be seen in this study. We evaluated cervical spine and lumbosacral junction of the spine. Results : The maternal average age of 38 patients was 29.9 years and the average gestational age was 29.7 weeks. The results of fetal surface screening were as follows : face (both orbits 89.5%, lips 92.1%, nose 92.1%, and brow 89.5%), extremities (both hands 68.4% and feet 73.7%), and spine (cervical spine 94.7% and lumbosacral junction 97.4%) by use of two-dimensional ultrasonography. By use of three-dimensional ultrasonography, results were as follows : face (both orbits 76.3%, lips 81.6%, nose 81.6%, and brow 78.9%), extremities (both hands 76.3% and feet 78.9%), and spine (cervical spine 71.1% and lumbosacral junction 73.7%). Consuming time for two-dimensional ultrasonography were 4.7 minutes for face, 11.6 minutes for extremities, and 5.7 minutes for spine. Using three-dimensional ultrasonography results were 12.8 minutes for face, 17.9 minutes for extremities, and 11.7 minutes for spine. Average consuming time of all fetal anatomic screening was 22.0 and 42.4 minutes by use of two and three dimensional ultrasonography. In one abnormal fetus had cleft lip and polydactyly of right foot which were detected all by three-dimensional ultrasonography, but we couldn't detect the polydactyly by two-dimensional ultrasonography. Conclusion : Three-dimensional ultrasonography was more time-consuming method, but we suggested that three-dimensional ultrasonography was superior than two-dimensional ultrasonography in fetal surface screening.

난소 임신 10예의 분석

김용진,이충일,이해혁,남계현,이임순,이권해 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Ovarian pregnancy is an uncommon form of the ectopic pregnancies. The ovarian vascularity results in maternal hemorrhage early in the first trimester, which disrupts the pregnancy and usually ruptures the ovary with sufficient hemoperitoneum to require emergency operation. This report presents 10 cases of ovarian pregnancy by retrospective review between January 1986 and December 1995 at the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital. There was 19,849 deliveries and 637 ectopic pregnancies during same period. It showed that the incidence of ovarian pregnancy was 3.21 % of all ectopic pregnancies. The clinical features of ovarian pregnancy revealed that abdominal pain was the major symptom, and history of amenorrhea was obscure. Because of life-threatening course, the early diagnosis and treatment of ovarian pregnancy is important. The clinical diagnosis of ovarian pregnancy was more difficult than that of tubal pregnancy.

임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예

김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.

골반 초음파 감시 하에 16 Gauge Angioneedle™을 사용하여 치료적 더글라스와 천자를 시행하여 치유된 복강 내 출혈 1예

김미영,이해혁,유애리,박정희,이임순,정수호,레앙소팔,배동한,김태희,이권해 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1

Culdocentesis is a procedure that checks for abnormal Quid in the space just behind the vagina (cul-de-sac). First, a pelvic examination is done. Then, after exposing the postehor vaginal fonix with a bivalve vaginal speculum the posterior lip of the cervix is grasped with a tenaculum. The cul-de-sac is then entered through the postehor vaginal wall with an 18-20 gauge needle with a syringe inserted. As the cul-de-sac is entered, suction is applied, and the intraperitoneal contents are aspirated. In the recent past, culdocentesis was commonly used in the evaluation of a vahety of common intraperitoneal conditions, principally, the hemorrhage associated with ectopic gestations and ruptured ovarian cysts the presence and/or drainage of purulent associated with pelvic inGammatory disease, and as a screening procedure to facilitate early diagnosis of ovarian neoplasms. Usually 16-18 gauge needle with a syhnge attached was used for culdocentesis. But we have experienced a case of therapeutic culdocentesis with 16 gauge angioneedle in patient of hemoperitoneum. So, report it with a bhef review of literature.