중증근무력증이 합병된 만삭임신 1 례

김관수(KS Kim),김강회(KH Kim),이진용(JY Lee) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.1

The adult form of myasthenia gravis (MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor immunoglobulin G antibodies(anti- AChRIgG) which blocks the formation of acetylcholine at the motor end plate and causes anatomic deterioration of this structure. The end results is defective neuromuscular transmission manifested by progressive skeletal muscle weakness. The unpredictable course of MG in pregnancy, the task of management of MG in pregnancy, especially during labor, and of management of not infrequent "transient neonatal myasthenia" raise a problem, often a challenge, to an obstetrician. Authors have experienced a full term pregnancy complicated with the myasthenia gravis. Labor was induced with intravenous oxytocin, followed by spontaneous labor, and a vacuum extracted delivery of a surviving infant with transient neonatal myasthenia was carried out. The case is presented here with a brief review of literature concerned.

노령산모 임신과 출산에 관한 연구

신희철(HC Shin),김관수(KS Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.9

The majority of papers written on the subject of the pregnancy in women over forty have stressed the decline in physiological activity and efficiency in this group of patients, coupled with an increased incidence of medical complications giving rising to a high fetal mortality. Relationship between maternal age and the frequency of dysfunctional labor paterns was assessed retrospectively in a population of 5604 gravid women. Five hundred women among 5108 gravidas aged below 35 were used as a control group. The results obtained are as followings: 1. The pregnant women aged over 40 were 54 cases among total 5604 gravid women. The incidence of distribution ranged between 40 and 49 yrs among pregnant women aged over 40. 3. Concerning antepartal complications the incidence of PROM was 16.7% in pregnant women aged over 40 comparing with 9.4% in the control group. The incidence of hypertensive disorder was 11.2 comparing with 5.6% in the control group. 4. There were increased incidence of both low and high birth weight infants. 5. Neonal mortality rate was 148 comparing with 56 in the control group.

악성난소종양환자 혈청중 lactic Dehydrogenase 농도의 변도에 관한 연구

노태성(TS Roh),김관수(KS Kim),고민환(MH Koh),신면우(MW Shin) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.2

저자는 난소암에서 종양표지물질로서의 LDH의 임상적의의를 평가하기 위하여 1985년 1월부 터 1987년 9월까지 서울대하교 산부인과에 입원하여 수술 및 항암치료를 받거나 35명의 난 소암 환자와 50명의 양성 난소종양환자 및 정상대조군 43명을 대상으로 혈중 LDH.ALP, CEA, AFP 및 CA-125을 측정하여 다음과 같은 결과를얻었다. 1. 정상대조군 43명의 혈청 LDH치는 평균 162.4+-29.5mU/ml이었으며 1명에서만 정상치 이상 으로 상승되어 2.3%(1/43)의양성율을 보이었다. 2. 양성난소종양 환자 50명에서의 혈청 LDH의 치료전 평균치는 162.4+-29.5mU/ml이었고, 양 성율은 2.0% (1/50)로 평균 혈청 LDH치와 양성율은 정상대조군과 차이가 없었다. 3. 난소암 환자 35명의 치료전 혈청 LDH치는 평균 267.2+-100.0mU/ml로 정상대조군 및 양성 난소종양환자군에서 보다 통계적으로 유의한 상승치를 보였으며 LDH의 양성율은 57.1%(20/35)로 정상대조군 및 양성난소종양 환자군보다 현저하게 높았다. 4. 난소암 환자에서의 혈청 LDH의 양성율은 조직학적 소견에 따라 차이를 보여 전이성 (이 차성) 난소 선암의 경우 혈청LDH의 양성율은 11.1%로 정상대조군보다는 높았으나 기타의 난소암에 비해서는 현저히 낮았다. 또한 난소암의 임상기 및 침윤정도에 따른 평균 혈청 LDH치는 유의한 차이가 없었으며 양성율도 유의한 차이를 보이지 않았다. 5. 치료경과에 따른 혈청 LDH치는 치료후 추적이 가능하였고, 재발의 증거가 없었던 환자 23명에서 183.1+-30.8mU/ml로 치료전 혈청 LDH치 평균 267.2+-100.0mU/ml보다 유의한 정도 로 감소하였다. 6. 난소암에서 혈청 LDH의 양성율을 종양표지물질로 현재 가장 널리 사용되고 있는 CEA, ALP, AFP, CA-125 등과 비교한바 CEA와 CA-125와는 거의 유사한 값을 보이었으며 ALP, AFP보다는 월등히 우수하였다. 결론적으로 LDH는 난소암환자에 있어서 유용한 종양표지물질로 생각되며 기타의 종양지표 물질인 CEA CA-125와 같이 임상에 이용한다면 악성 난소종양의 진단 및 추적관찰에 큰 도 움을 주리라 사료된다. In order to evalute the clinical utility of serum Lactic Dehydrogenase (LDH) in ovarian cancer patients, we measured LDH carcinoembryonic antigen(CEA) alkaline phosphatse,AFP, CA-125 in 35 patients with ovarian cancer who were treated in Obsterics and Gynecology Seoul National Unviersity Hospital from Jan. 1985 to Sept . 1987 In this study 43 cases of normal control group and 50 cases of benign ovarian tumor were involved to compare the serum LDH levels of ovarian cancer patients with those of the latter. The results were as follows; 1. Our of 43 normal control group , elevated levels of serum LDH (>225 mU/ml) were found in only one(2.3%) and the mean value of serum LDH was 158.8+-32.6 mU/ml 2. The average concentration of serum LDH in 50 patients with benign ovarian tumor, 162.4+-29.5 mU/ml was similar to that of normal control. Also the positive rate of serum LDH in behign ovarian tumor patients 2.0% (1/50) was same as that of normal subjects 3. The percentage of patients with positive levels of serum LDH ovarian carinoma 57.1% (20/35) was significantly higher than those of normal control and the mean value of serum LDH in ovarian malignancy 267.2+-100.0 mU/ml was greater than normal control 4. In cases of ovarian carinoma there was no significant difference in the incindence of positive LDH results according to the clinical stage but the positive rate in secondary ovarian carinoma was significantly lower than primary ovarian carinoma 5. Among the patients who had positive LDH levels before treatment , the values returned to normal in 100% of patients within 2 months after treatment who showed no evidence of recurrence during followup 6. The positive rate of serum LDH as a tumor marker was nearly same as that of CEA and CA-125 currently used in patients with ovarian carinoma, In cases of recurrent ovarian carinoma, it was significantly high. conclusively, above result may suggest that serum LDH can be used as a useful tumor marker in the diagnosis of ovarian cancer before treatment and the evaluation of the disease state espcially during follow up If LDH were to be used together with CEA and CA-125, the positive rate of the serum tumor markers would be increased.

다발성기형을 동반한 뇌루의 1 례

차상헌(SH Cha),최원도(WD Choi),김관수(KS Kim),강순범(SB Kang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.6

다발성기형을 동반한 뇌루 Encephalocele is rare, occurring between 1 in 3,000 and 1 in 10,000 live births and results from defective closure of rostral neuropore(anterior neural tube) during the fourth week of gestation. It is possible to establish prenatal diagnosis with ultrasound scan and others. One case of congenital encephalocele is presented with the brief review of literature concerned.

질에 발생한 투명세포암 1 예

김관수,이형렬,이금노,김영희,정동규 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.7

DES나 다른 약물의 모성 복용 과거력은 없었으나 질중력에 발생한 투명세포암 1예을 경험하였기에 약간의 문헌적 고찰과 함께 보고하는 바이다. Vaginal Clear cell adenocarcinoma is very rare malignant disease and it has been known to be associated with in utero exposure to DES. We experienced a case of Clear-cell adenocarcinoma of the vagina in 28years old woman and it`s DES-related maternal history is unknown. We presented the case with a brief review of related literatures.

태아 폐성숙의 지표로서 Stable Microbubble Rating Test (SMR)

김관수,이형렬,이금노,김영희 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.8

1992년 7월부터 1993년 2월까지 전주예수병원 산부인과에서 분만한 만삭아 44예와 조산아 46예를 대상으로 안정 미세기포검사를 시행하여 다음과 같은 결론을 얻었다. 1. 신생아 호흡곤란증후군은 만삭아의 2.3%에서, 조산아의 34.8%에서 발생하였다. 2. 안정 미세기포검사에 따른 신생아 호흡곤란증후군의 발생율을 보면 strong SMR인 경우 5.9%, medium SMR인 경우 20%, weak SMR인 경우 80%, very weak 그리고 zero SMR인 경우 100 % 로, strong과 medium에서는 신생아 호흡곤란증후군의 발생이 낮았으며, weak, very weak 그리고 zero에서는 높았다. 3. 신생아 호흡곤란증후군의 발생에 있어서 남·녀의 차이는 없었다. 4. 안정 미세기포검사에서는 민감도는 85.7%, 특이도는 87.5%, 양성예측도 75%, 음성예측도 90.3 %로 태아 폐 발육도 평가에 있어서 매우 높은 정확도를 나타내었다. 5. SMR 검사는 태아 폐성숙의 지표로써 다른 검사에 비하여 그 경비가 저렴하고, 간단하면서 정확한 방법이다. The fetal lung maturation can be assessed by observation of stable microbubble (less than 15 ㎛ in diameter). As a prediction of idiopathic respiratory distress syndrome (RDS) in preterm delivary, the stable microbubble rating test was performed between 25 weeks and 37 weeks of 46 patients, and compared to the term deliveries of 44 patients. A strong stable microbubble rating (more than 20 micro-bubbles within 1mm2) indicate that the RDS of new-born will not occur. the absence of stable microbubble suggest high-risk of RDS. The result were as follows: 1. The incidence rate of RDS was 34.8% in preterm deliveries, and 2.3% in term deliveries. 2. The incidence rate of RDS in preterm deliveries was 5.9% in strong SMR, 20% in medium, 80% in weak, 100% in very weak and zero. And there was lower incidence rate in strong and medium, and higher incidence rate in weak, very weak, and zero. 3. There was no sexual difference in incidence of RDS. 4. There was no sexual difference in incidence of RDS. 4. SMR showed that the positive predictability was 75%, the negative predictability was 90.3%, and the sensitivity rate was 85.7%, the specificity was 87.5%, and so it was thought to be a surer method than other test. 5. SMR test is shorter-time comsuming, cheaper, and simpler method.

폐로 전이된 자궁 내임파간질성근증의 1 예

이영호,김관수,이금노,김영희,이광민 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

본원 산부인과에서는 매우 드문 자궁 내임파간질성근증을 가진 환자에서 폐로 전이된 경우를 치험하였기에 간단한 문헌적 고찰과 함께 보고하는 바이다. Endolymphatic stromal myosis is a low-grade infiltrating asrcoma that occurs predominantly in premenopausal women, It arises from the endometrial stroma from adenomyosis or rarely from endometriosis It refers to lesions with infiltrative borders, especially involving lymphatics, but with fewer than 10 mitoses per 10 HPF Long-term survival is the rule, even with recurrent disease. A rare case of endolymphatic stromal myosis with metastasis to lung in a 48-year old woman is presented with a brief review of the literatures.