수자궁질증의 산전 태아 초음파 소견 1 예

김사진(Sa Jin Kim),김수평(Soo Pyung Kim),김민정(Min Joung Kim),이상호(Sang Ho Lee),이희중(Hee Joong Lee),문희봉(Hee Bong Moon),이지현(Jee Hyun Lee),박철훈(Chul Hun Park),이귀세라(Gui Se Ra Lee),신종철(Joung Chul Shin) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3

Cloacal anomalies are very rare congenital malformations with the incidence of 1/50,000-250,000 births. Hydrocolpos involves the dilatation of the vagina due to obstruction of the genital tract, leading to accumulation of secretions. Because of wide spectrum of abnormal anatomy involving urogenital and gastrointestinal systems, prenatal diagnosis is difficult. As ultrasound becomes more and more reliable, prenatal diagnosis is possible as early as in the second trimester. The presence of prenatally detected hydro (metro) colpos warrants a systematic evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes. We present a case of urogenital sinus maldevelopment which was initially presented as a fetal ascites.

태아 긴박증에서 태아 심장박동의 비선형 동력학 및 카오스 분석

김사진(Sa Jin Kim),신종철(Jong Chul Shin),정대영(Dae Young Chung),심영보(Young Bo Sim),이상훈(Sang Hoon Yi),김창이(Chang Yi Kim),김수평(Soo Pyung Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

목적 : 태아의 건강을 평가하기 위한 새로운 분석 방법을 개발하기 위함이다. 방법 : 전자식 태아 감시장치를 이용하여, 긴박증 태아에서 발생되는 심박동 신호를 컴퓨터로 받아들여 데이터 전처리 (low pass filtering; LPF)후에 비선형 분석으로 지연시간 (delay time), 매립차원 (embedding dimension), 상관차원 (correlation dimension), Isoangular return map을 통한 mean crossing, information entropy를 구하였고, 태아 긴박증 소견을 보인 신생아 22명의 출생후 제대 혈액 가스값을 산혈증군 5명과 비산혈증군 17명으로 나누어 비선형 카오스 분석 결과와 비교하였다. 결과 : 1. 데이터 전처리를 거친 지연 시간은 15.73±2.47 이었다. 2. FNN 법으로 계산한 매립 차원은 5.00±0.82 이었다. 3. 산혈증군의 상관차원은 1.41±0.20으로 비산혈증군의 상관차원 1.10±0.38 보다 높았으나 통계적 유의성은 없었다. 4. Isoangular return map 의한 mean crossing값은 산혈증군이 28.80±11.34이었고 비산혈증군은 16.65±7.00으로 통계적으로 유의성이 있었다 (P=0.008). 5. Information entropy에 의한 1-D ED 비교에서 산혈증군은 6.32±0.38, 비산혈증군은 6.20±0.28로 통계적인 의의가 없었다. 또한 2-D ED 값의 비교에서는 산혈증군은 10.20±0.34로 비산혈증군의 9.51±0.44보다 통계적으로 의의있게 높았다(P=0.004). 그러나 2-D EP 값 비교에서는 산혈증군은 8.70±0.90, 비산혈증군 9.22±0.74로 통계적으로 유의성이 없었다 (P=0.281). 또한 2-D ED(DI) 값도 산혈증군은 10.64±0.14, 비산혈증군은 10.51±0.18로 통계적으로 유의성이 없었다 (P=0.141). 결론 : 태아 심박동 자료로 컴퓨터를 이용한 비선형 및 카오스 동력학 분석이 실시간으로 태아의 건강상태를 평가할 수 있는 새로운 진단 방법으로 역할을 할 수 있다는 것을 알 수 있었으나, 임상에 적용하기까지는 향후 더 많은 연구를 통하여 이의 진단 기준 확립과 컴퓨터 프로그래밍화하여 실시간 진단 방법이 임상에 적용되어야 할 것으로 생각된다. Objectives: For estimating the antenatal fetal wellbeing to develop new analysis method of fetal heart rate(FHR) with electronic Fetal Heart Rate Monitoring(eFHRM) and computer.Methods: Heart rate signal is received from distressed fetus using eFHRM. It is necessary to carry out low pass filtering as a preprocess for the nonlinear method. Nonlinear parameters are calculated and classified to investigate the relations between these parameters and values of umbilical cord blood gas.Results: By dividing values of the umbilical cord blood gas into 5 fetuses of acidemic group and 17 fetuses of non-acidemic group after 22 neonates who presented fetal distress were born, the following results as compared with nonlinear chaotic analysis result were obtained. 1. Delay time through AMI for acidemic group was 16.80±3.11, and was higher than 15.41±2.27 for non-acidemic group, and is not significant in statistics.2. Embedding Dimension calculated with FNN method was 5.60±2.07 for acidemic group, and 4.71±1.26 for non-acidemic group, and it was not significant statistically.3. Correlation dimension for acidemic group was 1.41±0.20, and was higher than 1.10±0.38 for non-acidemic group, and is not significant in statistics.4. Mean crossing value by isoangular return map was 28.80±11.34 for acidemic group, and 16.65±7.00 for non-acidemic group, and it was significant statistically(P=0.008).5. In comparison of information entropy in 1-D ED, acidemic group was 6.32±0.38 and non-acidemic group was 6.20±0.28 and it was not significant statistically. Also, in comparison of value in 2-D ED, acidemic group was 10.20±0.34. It was higher than non-acidemic group of 9.51±0.43 significantly in statistics(P=0.004). But, in comparison of value in 2-D EP, acidemic group was 8.78±0.86 and non-acidemic group is of 9.22±0.74 and it wasn't significant statistically. And, 2-D ED(DI) value was 10.64±0.14 for acidemic group and 10.51±0.18 for non-acidemic group, and it wasn't significant statistically.Conclusions: By the above result, nonlinear dynamics and chaotic analysis of heart rate data with computer can serve as a new diagnosis method which may estimate the fetal wellbeing with real time. Through further studies for establishment of diagnosis standard and computer programming, real time diagnosis method shall be applied to clinical practice.

전산화단층촬영을 이용하여 측정한 한국인 여성에서 뼈골반 구조의 차이에 따른 분만방법 비교

김사진 ( Sa Jin Kim ),김장흡 ( Jang Heub Kim ),이대우 ( Dae Woo Lee ),강소연 ( So Yeon Kang ),이해남 ( Hae Nam Lee ),김민정 ( Min Jeong Kim ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.4

목적: 전산화단층촬영을 시행한 한국인 여성에서 골반뼈구조의 차이에 따른 분만방법의 차이에 대해 연구하고자 하였다. 연구방법: 본 연구는 2006년 3월부터 2008년 5월까지 전산화단층촬영을 시행한 175명의 환자를 대상으로 하였다. 객관적 측정을 위해, 한명의 산부인과 전문의가 시상면에서 출산앞뒤지름, 참앞뒤지름과 빗앞뒤지름을, 관상면에서 가로지름, 궁둥뼈결절사이거리와 궁둥뼈가시사이지름을 측정하였다. 전자궁절제술 또는 자궁에 질환이 있는 환자들은 연구에서 제외하였다. 결과: 총 175명의 한국인 여성을 측정하였으며, 나이 범위는 20-50세, 평균 연령은 37.6±7.4세이었다. 전산화단층촬영을 통해 측정한 궁둥뼈가시사이지름은 질식분만군(n=84)에서는 94.6±7.8 mm, 제왕절개군(n=20)에서는 90.9±6.6 mm이었으며 두 군 간에 통계학적인 차이가 있었다. 결론: 본 연구는 전산화단층촬영을 이용하여 골반구조의 차이를 연구하였으며, 궁둥뼈가시사이지름이 질식분만에 영향을 줄 수 있는 중요한 요소임을 확인하였다. 즉, 골반계측법에서 궁둥뼈가시사이지름은 질식분만과 관계가 있는것으로 보인다. 여러 다양한 요소들이 분만방법에 영향을 줄 수 있으므로 분만에 영향을 줄수 있는 해부학적 구조에 대한 다각적인 연구가 더 진행되어야 할 것이다. Objective: We investigated the structural differences in the pelvic bone architecture of Korean women and their association with the mode of delivery by performing computed tomography (CT) pelvimetry. Methods: This study was conducted on 175 women who underwent CT between March of 2006 and May of 2008. For making an objective assessment, one specialist in obsterics and gynecology measured the obstetrical conjugate, the true conjugate and the diagonal conjugate on the sagittal plane and the transverse diameter, the intertuberous diameter and the interspinous diameter on the coronal plane. The patients who underwent total hysterectomy or those who had a disease of the uterus were excluded from the current analysis. Results: A total of 175 Korean women were examined, and their ages ranged from 20 to 50 years. The mean age was 37.6±7.4 years. The interspinous diameter that was measured on CT scans was 94.6±7.8 mm in the vaginal delivery group (n=84) and this was 90.9±6.6 mm in the cesarean section group (n=20). This difference reached statistical significance. Conclusion: Our study examined the difference in the pelvic architecture with using CT and we found that the interspinous diameter can be the important determinant that affects normal vaginal delivery. Of these pelvimetric parameters, a wider interspinous diameter was significantly associated with vaginal delivery. Multi-displinary approaches are warranted to examine this relation with regard to the various factors that are involved in delivery.

최신임상강좌 : HELLP증후군 처치의 최신지견

김사진 ( Sa Jin Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.5

중증 전자간증의 증세인 고혈압과 단백뇨를 보이는 것과는 다르게 용혈성 빈혈, 간기능장애, 혈소판 감소증을 동반하는 HELLP증후군은 산모 및 태아에게 심각한 부작용의 위험도를 증가시키므로 조기진단에 따른 치료가 필수적이다. 지금까지 후향적인 방법이나 무작위 임상실험을 통하여 명확한 진단적 기준이나 위험인자의 선별, 치료방법에 대하여 많은 논문이 발표되었지만, 이러한 수많은 노력에도 불구하고 아직까지 HELLP증후군의 정확한 진단 및 치료기준은 이루어지지 않은 실정이다. 이에 본 고찰은 최근까지 발표된 논문들을 중심으로 HELLP증후군의 다양한 진단기준 및 유사질환의 감별진단을 다루어보고, 치료에 있어 논쟁의 여지가 있는 기대요법, 스테로이드 투여 등의 다양한 치료 방법에 대하여 알아보고자 한다. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is considered to be a severe form of preeclampsia. Preeclampsia is a multi system disease of pregnancy associated with a significant impact on health for both mother and fetus. Despite the voluminous literature, the diagnosis and management of this syndrome remain controversial and it is ultimately treated by delivery. Treatment of HELLP syndrome usually is supportive management, including seizure prophylaxis and blood pressure control and treatment of complications. However, several clinical trials have suggested that corticosteroids can stabilize the disease in the antepartum period and accelerate recovery after delivery. Rarely, some patients require transfusion of blood products and plasmapheresis. This articles focuses on the diagnosis, management of HELLP syndrome based on results of recent studies.

3D - ultrasound diagnosis of angular pregnanacy

김사진 ( Sa Jin Kim ),( Min Jeong Kim ),( In Yang Park ),( Soo Young Hur ),( Joung Chul Shin ) 대한산부인과학회 2006 대한산부인과학회 학술대회 Vol.92 No.-

조기파수와 Cytochrome P450 1A1 및 1A2 유전자 다형성과의 연관성

김사진 ( Sa Jin Kim ),박철훈 ( Cheol Hoon Park ),신종철 ( Jong Cheol Shin ),양동은 ( Dong Eun Yang ),박인양 ( In Yang Park ),고현선 ( Hyun Sun Ko ),김연희 ( Yeun Hee Kim ),안현영 ( Hyun Young Ahn ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

목적 : 조기분만은 신생아 사망 및 이환의 가장 중요한 원인이지만 아직 원인이나 병태생리가 잘 밝혀져 있지 않다. 최근에 조기분만의 원인 및 발생기전을 유전학적 관점에서 접근하는 경향이 있다. 한국 여성에서 CYP1A1 및 CYP1A2 유전자 다형성이 조기파수에 의해 조기분만한 임신부와의 연관성을 알아보고자 이 연구를 시행하였다. 연구 방법 : 2002년 8월부터 2003년 10월까지 가톨릭의대 부속 병원들에서 37주 이후에 분만한 264명의 산모들과 Objective : Preterm delivery (PTD) is the leading cause of perinatal mortality and morbidity. However, its etiology and pathogenesis remain unknown in most cases. Recently, some research put forth the hypothesis that PTD results, at least in part, from a

유도 분만시 미소프로스톨 투여용법의 임상적 고찰

김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ),윤철구 ( Chul Gu Yoon ),양용재 ( Yong Jae Yang ),이근호 ( Keun Hoo Lee ),박태철 ( Tae Chul Park ),나종구 ( Jong Gu Rha ),김수평 ( Soo Pyung Kim ),이희중 ( Hee Joong Lee ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

목적 : 임신 말기에 필요에 따라 프로스타그란딘 E1 유도체인 미소프로스토롤을 질 경내에 투여해서 자궁경관을 숙화시킨 후 정상 질식 분만한 산모 중에서 두 군으로 나누어 이의 결과를 비교하였다. 연구 방법 : 유도 분만을 위한 자궁 숙화가 필요한 37주 이상의 정상 만삭 임신산모에서 무작위로 35명에서는 미소프로스톨 50㎍, 32명에게는 미소프로스톨 100㎍을 질 경내에 4시간마다 최고 6회까지 투여하였고 규칙적인 진통이 없거나 진통이 있더라도 자궁경관 Objective : The purpose of this study was to compare the efficacy and the safety of two different dose regimens of intravaginal misoprostol for labor induction. Methods : Sixty-seven consenting women with maternal or fetal indication for labor and no prio

Preeclampsia : Management of HELLP syndrome

김사진 ( Sa Jin Kim ) 대한산부인과학회 2006 서울심포지움 Vol.11 No.-

Ruptured tubal pregnancy caused by inactive chorionic villi presenting with negative serum β-hCG

김사진 ( Sa Jin Kim ),( Min Jeoung Kim ),( Jeoung Su Choi ),( Se Hyun Park ),( In Yang Park ),( Soo Young Hur ),( Hee Jeong ) 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

진행된 간경변을 가진 여성에서의 성공적인 분만 3 예

김진휘(Jin Hwi Kim),문희봉(Hee Bong Moon),안현영(Hyun Young Ahn),이지현(Jee Hyun Lee),김사진(Sa Jin Kim),신종철(Jong Chul Shin),김수평(Soo Pyung Kim),이현정(Hyun Jeong Lee) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.8

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.