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Peroxide와 자간전증 환자의 혈청 관류에 따른 제대정맥의 prostaglandin 생성의 변화
목정은,김암,이필량,한지수,이인식 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1
Objective This study was performed to evaluate the prostaglandin secretion rates in human umbilical vein with preeclamptic sera and peroxide perfusion. Study design Isolated human umbilical cords(n=10) were perfused for 30-minute intervals with cord buffer, 15% normal pregnant sera and preeclamptic patient sera, 100 mol/L t-butyl hydroperoxide alone, and after perfusion with low-dose aspirin(5×10( )mol/L). Cord buffer gassed with 95% oxygen and 5% carbon dioxide and warmed to 37℃ was used for the perfusion buffer. Effluent flow rates were measured during each experimental treatment. Effluent samples were measured for 6-keto prostaglandin Flα and thromboxane B( ) by enzyme immunoassays. Results The concentrations of 6-keto prostaglandin F( )α in preeclamptic sera were significantly higher than those in normal pregnant sera.(989.3849 ± 1602.927 vs. 1.3116 ± 1.22085 ng/ml, mean ± SD, p<0.01). However, the concentrations of thromboxane B( ) were not different between normal pregnant sera and preeclamptic sera. The secretion rate of 6-keto-prostaglandin F( )α in human umbilical endothelial cells was not significantly different(p=0.77) between two groups. Comparing to normal pregnant sera, the secretion rate of thromboxane B( ) was significantly increased(p<0.01) after preeclamptic sera perfusion. The secretion rate of 6-keto-prostaglandin F( ) was significantly increased(p<0.01) following peroxide perfusion and that was significantly decreased by aspirin. The secretion rate of thromboxane B( ) was not significantly different between preeclamptic sera and peroxide alone or subsequent perfusion with aspirin. Conclusions (1) Preeclamptic sera stimulate thromboxane production rather than prostacyclin production by endothelial cells of human umbilical vein in vitro. (2) Peroxide stimulates the secretion of both prostacyclin and thromboxane, and low dose aspirin mitigates hydroperoxide-induced prostacyclin secretion. We confirmed that thromboxane secretion is stimulated by preeclamptic sera and the role of peroxide in prostaglandin secretion. We established the perfusion system using human umbilical vein through this study. This perfusion system may be useful to understand the pathophysiology of preeclampsia.
부신피질호르몬의 산전 투여가 조산의 예후에 미치는 영향
남주현,이필량,김암,원혜성,이인식,신명신,강지안 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5
목적 : 조산은 전체 임신의 7-10%를 차지하며 신생아의 질병 이환과 사망의 가장 주요한 원인이다. 미숙아는 호흡곤란 증후군, 폐기관지 이형성증, 동맥관개존증, 괴사성장염, 미숙아 망막질환 등의 합병증에 이환될 수 있다. 이에 본 연구에서는 조산이 임박한 임신부에서 부7신피질호르몬을 투여한 경우와 투여하지 않은 경우에 임신부 및 신생아의 예후를 비교하여 조산에서 부신피질호르몬 투여의 유용성을 규명하고자 하였다. 대상 및 방법: 1994년 1월부터 1999년 1월까지 울산대학교 의과대학 서울 중앙병원에서 조기진통이나 조기파수등으로 조산이 임박했던 임신부와 태아 모체 질환으로 인해 계획된 조산이 필요했던 재태연령 24주-34주의 임신부를 대상으로 dexamethasone을 5mg, 12시간격으로, 4회 근주하였고, dexamethasone을 사용하지 않고 조산이 이루어진 임신부를 대조군으로 설정하여 호흡곤란증후군, 괴사성 장염, 신생아 사망 등의 주산기 예후인자를 의무기록을 통하여 비교분석 하였다. 결과 : Dexamethasone을 산전에 투여하지 않은 군에 비해 dexamethasone을 산전에 투여한 군에서 호흡곤란 증후군 (28.6% vs 15.7%, p=0.019), IVH/PVL(26.2% vs 4.9%, p=0.03), 괴사성장염(16.2% vs 6.9%, p=0.035), 신생아 사망(11.9% vs 3.9%, p=0.038) 등의 합병증 발생빈도가 유의하게 낮았다. Dexamethasone 산전 투여로 호흡곤란증이 53%(OR 0.47, 95% CI; 0.25-0.86) 뇌실내 출혈이 68%(OR 0.32, 95% CI;0.12-0.86), 괴사성 장염이 51%(OR 0.49, 95%CI; 0.25-0.98), 신생아 사망이 70%(OR: 0.30, 95% CI: 0.10-0.89) 감소되는 효과가 관찰되었다. 조기파수임신부에 대한 산전 부신피질호르몬의 투여는 신생아의 이환율 및 사망의 감소에 별다른 도움이 되지 않았다. 결론 : 조산이 불가피한 경우 산전 부신피질호르몬의 투여는 임신부에게 별다른 합병증을 유발하지 않고 신생아의 유병율 및 신생아 사망을 현저히 감소시켜 주산기 예후를 향상시킬 수 있는 효과적인 치료법이다. Objectives : To determine the effectiveness and clinical utility of antenatal corticosteroids in the reduction of neonatal morbidity and mortality on preterm birth Material and method: Neonatal outcomes of 312 preterm babies were evaluated retrospectively. One hundred and two preterm babies(study group) were given dexamethasone more than 1 dose antenatally and 210 preterm babies(control group) were not given dexamethasone antenatally. Antenatal steroids were administered in the form of four 5mg intramuscular doses of dexamethasone 12 hours apart. Maternal and neonatal outcomes of study group were compared with those of control group. Student t- test, χ2 test, Fisher's exact test, and logistic regression analysis were used where appropriate. p-value$lt; 0.05 was considered significant. Results : Antentenatal corticosteroid significantly decreased the incidence of RDS(OR:0.47, 95% CI:0.25-0.86), IVH/PVL(OR : 0.32, 95% CI : 0.12-0.86), necrotizing enterocolitis(OR : 0.49, 95% CI : 0.25-0.98), and neonatal death(OR: 0.30, 95% CI: 0.10 - 0.89) in preterm delivery. In the presence of PROM, antenatal corticosteoid seemed to have no protective effect on the neonatal complications such as RDS, IVH/PVL, NEC, PDA, and neonatal death. Conclusion : Antenatal administration of corticosteroids was effective to decrease the incidence of neonatal morbidity and neonatal mortality in the preterm neonates with no apparent maternal complications.
Clinical Analysis on Ectopic Pregnancy
Ahn, Chi Seok,Ahn, Kwang Hwa,Lee, Pyl Ryang,Kim, Hak Soon 충북대학교 의과대학 충북대학교 의학연구소 1994 忠北醫大學術誌 Vol.4 No.1
자궁외 임신은 임상에서 비교적 익숙하게 접하는 질환으로 그 중요성에도 불구하고 본원의 사정상 경험이 극히 제한된 실정이다. 자궁외 임신의 진단 및 치료에 대한 최근의 괄목할 만한 발전으로 각 병원의 다양한 임상 경험 및 충분한 자료의 축적이 요구되고 있다. 비록 제한된 관찰이긴 하나 자궁외임신의 일반적인 임상 양상을 이해하고 향후에 보다 광범위한 분석을 계획하고자 그 기본 자료로써 본원 개원 이후 본 교실에서 경험하고 성공적인 치료가 되었던 35예의 자궁외 임신을 환자의 임상, 수술 소견에 따라 분석하였다. Despite of numerous reports on ectopic pregnancy in other hospitals, we have still extremely limited experiences. The recent advances in diagnosis and treatment of ectopic pregnancy urge us to found on our own basic database. For the purpose of this, we analyzed the clinical characteristics of thirty-five ectopic pregnancies treated at our hospital. Although it is very limited observations, yet we hope to understand the nature of ectopic pregnancy and construct the extended findings in future.
Doppler초음파를 이용한 발육지연태아의 흉부하강대동맥 혈류속도파형의 양상
윤보현 ( Bo Hyun Yoon ),이필량 ( Pyl Ryang Lee ),김승협 ( Seung Hyup Kim ),신희철 ( Hee Chul Shin ),김승욱 ( Syng Wook Kim ) 대한주산의학회 1990 大韓周産醫學會雜誌 Vol.1 No.1
A real time sector scanner with a pulsed Doppler transducer was used to study and compare the blood flow velocity wavefroms of fetal descending thoracic aorta in 97 normal pregnancies and 50 cases of fetal growth retardation with 170 and 67 examinations, respectively. All pregnancies were in the third trimester. In both groups, A / B ratio, resistance index, and pulsatility index remained unchanged with increasing gestational age. In growth reatarded pregnancies, there were singnificant increases in A / B ratio, pulsatility index, and resistance index, and significant decrease in end diastolic velocity compared to those in normal pregnancies(p<0.05), reflecting increased peripheral vascular resistance. In the 8 distressed fetuses, Doppler findings were more pathological than those in the fetuses without distress. This method may be of value in the evaluation of fetal well-being in risk pregnancies by giving an early sign of hemodynamic changes in developing hypoxia.