결절성 경화증이 동반된 태아 심장 횡문근종

길기철 ( Ki Cheol Kil ),남선영 ( Sun Young Nam ),김수미 ( Su Mi Kim ),하재은 ( Jae Eun Ha ),류기성 ( Ki Sung Ryu ),이영 ( Young Lee ) 대한주산의학회 2009 Perinatology Vol.20 No.4

Fetal cardiac tumors are a rare condition and are histologically benign. Cardiac rabdomyoma is the most common cardiac tumor and may be associated with tuberous sclerosis. Clinical follow-up including monitoring of fetal well-being is warranted as long as the fetus remains asymptomatic and there is no evidence for hydrops fetalis. If obstruction to blood flow and/or early fetal compromise is noted, then the decision of whether to deliver early must be made. We report a case of fetal cardiac tumor diagnosed by antenatal ultrasonography and diagnosed as tuberous sclerosis with brain MRI scanning after birth.

제왕절개술 후 합병된 폐색전증

길기철(Ki Cheol Kil),강대호(Dae Ho Kang),이종건(Jong Kun Lee),백은정(Eun Jeong Baik),이영(Young Lee),나종구(Jong Gu Rha),김수평(Soo Pyung Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1

Pulmonary Embolism, one of the causes of maternal death, is a life threatening disease that needs early and accurate diagnosis. We have exprerienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on the postoperative 1 day after cesarean delivery and was managed with heparin therapy. We present this case with a brief review of literatures.

임상 ; 40세 이상 고령 임신이 주산기 결과에 미치는 영향

길기철 ( Ki Cheol Kil ),이귀세라 ( Gui Se Ra Lee ),권지영 ( Ji Young Kwon ),박인양 ( In Yang Park ),김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ),김수평 ( Soo Pyung Kim ) 대한주산의학회 2007 Perinatology Vol.18 No.2

변형된 Garcia 방법을 이용한 질횡격막 성형

길기철 ( Ki Cheol Kil ),정재은 ( Jae Eun Chung ),유시현 ( Sie Hyun You ),박미선 ( Mi Sun Park ),권동진 ( Dong Jin Kwon ),유영옥 ( Young Ok Yoo ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.

임신 16주에 부분포상기태와 양측난포황체낭종이 함께 동반된 중증전자간증

길기철 ( Ki Cheol Kil ),이귀세라 ( Gui Se Ra Lee ),강영화 ( Young Wha Kang ),박동춘 ( Dong Choon Park ),최현주 ( Hyun Joo Choi ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.12

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks` gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks` gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.

임신 3삼분기에 동반된 난소 염전 2예

길기철 ( Ki Cheol Kil ),윤주희 ( Joo Hee Yun ),박동춘 ( Dong Chun Park ),권동진 ( Dong Jin Kwon ),유영옥 ( Yong Ok Yoo ),김대훈 ( Dae Hoon Kim ),이귀세라 ( Gui Se Ra Lee ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.5

전치 태반에서 응급 제왕 자궁절제술의 위험 요인

길기철 ( Ki Cheol Kil ),임시연 ( Si Yeon Lim ),고현선 ( Hyun Sun Ko ),김사진 ( Sa Jin Kim ),권동진 ( Dong Jin Kwon ),신종철 ( Jong Chul Shin ),김수평 ( Soo Pyung Kim ),이귀세라 ( Gui Se Ra Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.3

목적: 이 연구의 목적은 전치 태반 산모에서 응급 제왕 자궁절제술의 임상적 위험요소와 전치 태반의 제 3삼분기 경질 초음파로 응급 제왕 자궁절제술을 예측할 수 있는 지를 알기 위해 조사하였다. 조사 대상 및 방법: 1995년 1월부터 2005년 3월까지 전치 태반으로 제왕 절개술을 시행한 산모의 의무 기록을 후향적으로 비교 분석하여 자궁 절제술을 받은 군과 받지 않은 군으로 나누어 조사하였다. 결과: 연구 기간 중 31명의 전치 태반 산모가 있었으며 3명이 응급 제왕 자궁 절제술을 시행 받았다 (10.83%). 산모의 연령 (31.53±4.41 vs 34.06±4.12, p<0.05), 분만력 (0.81±0.70 vs 1.29±0.63, p<0.05), 기 제왕절개 횟수 (0.36±0.56 vs 0.91±0.75, p<0.05), 전치 태반의 과거력과 유착 태반인 경우에 두 군간의 유의한 차이가 있었으나 재태 연령, 산전 질 출혈, 유산 횟수, 응급 제왕절개술 등은 유의한 차이를 보이지 않았다. 제 3삼분기 경질 초음파 기록에서 자궁 경부로부터의 거리 (1.18±3.66 vs 2.67±2.94, p<0.05)와 하부 태반 변연부 두께 (1.91±1.55 vs 2.96±1.33, p<0.05)는 유의한 차이를 보였으나, 라쿠나 (lacuna)는 유의한 차이를 보이지 않았다. 결론: 전치태반의 경우 응급 제왕 자궁절제술을 시행하게 되는 위험요인은 산모의 유착태반과 태반 부착 부위가 자궁 경부로부터의 양의 방향으로 먼 거리, 태반 변연부의 두꺼운 두께 등이 관련된다. 다른 임상적 위험 요인은 산모 연령, 분만력, 제왕절개 횟수, 전치 태반의 과거력 등이 관련된다. Objectives: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. Materials and Methods: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. Results: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53±4.41 vs 34.06±4.12, p<0.05), parity (0.81±0.70 vs 1.29±0.63, p<0.05), the number of cesarean section (0.36±0.56 vs 0.91±0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18±3.66 vs 2.67±2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. Conclusions: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.

자궁경부 종양 환자에서 세포진 검사, 질확대경조준하생검, 원추절제술의 진단적 정확도와 원추절제술 후 잔류 종양의 예측인자

길기철(Ki Cheol Kil),허수영(Soo Young Hur),이귀세라(Gui Se Ra Lee),양용재(Yong Jae Yang),이지현(Jee Hyun Lee),이희중(Hee Joong Lee),김사진(Sa Jin Kim),김은중(Eun Jung Kim),송승규(Seung Kyu Song),남궁성은(Sung Eun NamKoong),김수평(Soo P 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

목적: 세포진 검사, 질확대경 검사, 질확대경 조준하생검, 원추절제술 및 자궁적출술을 연속적으로 시행한 자궁경부 종양 환자에서 각각의 검사 결과를 조직병리학적으로 비교하여 상호간의 정확도를 분석하고 원추 절제술 후 잔류 종양의 예측 인자를 조사하여 자궁경부 초기암 환자의 진단과 치료 관리에 도움을 주고자 본 연구를 시작하였다. 연구방법: 1993년 1월부터 1998년 8월까지 가톨릭대학교 의과대학 부속 성가병원 산부인과를 방문하여 자궁경부 세포진 검사 및 질확대경 검사에서 이상 소견을 보이는 환자 중에서 질확대경 조준하생검 후, 적응증에 따라 연속적으로 원추 절제술과 자궁적출술을 시행한 167명을 대상으로 하였다. 결과: 세포진 검사의 진단적 정확도(완전 일치율)는 59.3%(99/167), 질확대경 조준하생검의 진단적 정확도(완전 일치율)는 71.3%(119/167), 원추 절제술과 자궁적출술 후 조직 소견을 비교한 결과 자궁적출술 조직 소견 중 51예(30.1%)에서 잔류 종양이 확인되었는데, 동일한 병변이 잔류한 것이 46예(90.2%), 원추절제술보다 낮은 병변이 잔류한 경우가 4예(7.8%)이었고 더 진행된 병리 소견을 보이는 경우는 1예(2.0%)이었다. 원추절제술 후 조직의 절제면에서 종양 세포의 침범 유무와 추후 실시한 자궁적출술 후 조직병리검사에서 잔류 종양 유무와의 상관관계를 관찰한 바 침범이 있었던 군에서 잔류 종양이 더 많음을 확인할 수 있었다(P<0.001). HPV 16 혹은 18 DNA 검출과 잔류 종양의 존재와는 관계가 없었다. 결론: 세포진 검사와 질확대경 조준하생검이 자궁경부 종양 환자의 진단에 유용하지만 자궁경부 상피내종양 III 또는 미세침윤암이 의심되는 경우에는 원추절제술을 시행하여 병변을 정확히 판단하여야 하며 원추절제술 후 절제면에서 종양 침범이 발견된 경우 잔류 종양의 가능성이 높으므로 보다 적극적인 치료가 필요 할 것으로 생각된다. Objective: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. Methods: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. Results: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. Conclusion: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.

증례 : 임신 제 2삼분기에 합병된 급성 간질성 폐렴 2예

길기철 ( Ki Cheol Kil ),이귀세라 ( Lee Gui Se Ra ),이세연 ( Se Yeon Lee ),최정수 ( Jung Soo Choi ),유희정 ( Hee Jung Yu ),권동진 ( Dong Jin Kwon ),신종철 ( Jong Chul Shin ) 대한주산의학회 2006 大韓周産醫學會雜誌 Vol.17 No.4

임신 제 2삼분기에 발생한 급성 간질성 폐렴을 기계호흡과 고용량 corticosteroid로 치료한 경험을 보고하고자 한다. 임상 양상, 검사 및 영상 진단 기술. 증례 1) 29세 G1P1 임신 24+3주의 산모가 3주간 지속된 기침, 객담, 호흡 곤란과 흉통을 주소로 내원하였다. 양쪽 폐에서 수포음을 동반한 거친 호흡음이 들렸으며 흉부 방사선 검사에서 폐렴을 의심하여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴을 의심하는 소견을 보여 기계 호흡 치료 및 기관 절개를 시행하였고 항생제와 고용량 corticosteroid 치료를 시행하였으며 제왕 절개로 사산아를 출산 후 증상이 좋아져 corticosteroid 용량을 줄인 후 퇴원하였다. 증례 2) 33세 G1P1 임신 24+4주의 산모가 3개월간의 지속적인 기침과 객담, 호흡 곤란 주소로 내원하였다. 양쪽 폐에서 거친 호흡음이 청취되었고 흉부 방사선 검사에서 간질설 폐렴을 의심하는 소견을 보여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴 혹은 좁쌀 결핵의 소견을 보여 즉각적으로 항생제 및 고용량 corticosteroid를 정주하였지만 호전이 없고 호흡 곤란 심해져 기관 삽관 후 기계호흡 치료를 시행하였으며 임신 26+1주에 분만을 하였고 분만 후 DIC가 발생하여 사망하였다. 급성 간질성 폐렴은 매우 드물며 치명적인 질환으로 59~100%의 사망률을 보인다. 임상 양상, 검사실 소견, 치료 방법이 아직 확립이 되지 않은 상태이다. 흉부 방사선 검사와 HRCT가 진단에 도움이 되며 고용량 steroid와 면역억제 요법이 사용되지만 그 효과는 장담할 수 없다. We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24+3 weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24+4 weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.

Impact of obesity in pregnant women performed cesarean delivery on perinatal outcome

길기철 ( Ki Cheol Kil ),( Mi Na Choi ),( Gui Se Ra Lee ),( Sa Jin Kim ),( Jong Chul Shin ) 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-