선천성 기형에 대한 임상적고찰

김해중(HJ Kim),김창곤(CG Kim),주갑순(KS Ju) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.2

1983년 9월 1일부터 1986년 4월 30일까지 만 2년 7개월에 걸쳐 고려대학교 부속 구로병원 분만실에서 분만한 2495예중 54예의 선천성 기형아를 관찰하여 다음과 같은결론을 얻엇다. 1. 총 출산아중 선천성 기형아의 발생 빈도는 2.16%였다. 2. 남녀간의 발생빈도는 여아에서 약간 높은 발생율을 보였으나 통계적 의의는 없었다. 3. 산모의 나이와 분만횟수에 따른 기형의 발생율은 서로 상관관계가 없었다. 4. 기형아에서는 자궁내 성장지연 및 미숙아로 인하여 2500gm미만의 저체중아가 7.32%로 2500gm이상의 성숙이 1.42%의 5배 정도 높은 비율로 보였다. 5.기형아에서는 둔위가 12.96% 에 비해 높은 비율을 보이나 기형아에서 저체중아가 많은 것 을 감암하여 보면, 둘사이의 차이는 통계적 의의는 없었다. 6. 사산아에서 기형아의 발생은 20.27%로 출생아 1.61%에 비해 현저히 높은 비율을 보였다. 7. 기형의 기관별 분포를 보면 근 골격계, 소화기계, 중추 신경계 순으로 기형이 호발하였다. 8. 총 기형아 54예중 11예(20%)에서 산전 진단이 가능하였다. Clinical analysis was carried out on 54 newborns with congenital anomlies among 2495 newborns delivered at Guro hospital korea university from sep 1. 1983 to April 30. 1986. The results are as follows 1. Among 2495 newborns the incindence of birth with congenital anomaly was 2.16% 2. The incindence of congenital anomaly in female (2.25%) was higher than that of male (1.87%) 3. It seems that the incindence of congenital anomaly was not related to maternal age and parity. 4. The incindence of congenital anomaly in low birth weight less than 2500 gm due to premature and growth retardation was 7.32% which was 5 times higher than that in mature biabies. 5. The incindence of breech presentation in congenital anomaly was higher than that in normal newborns . But it couldn`t be compared the two groups because of higher incindence of low birth weight in the group of congenital anomaly. 6. The incindence of congental anomaly in still birth was high such as 20.27% as compared with 1.61% in live birth 7. 51.87% of the cases were anomalies in musculoskeletal system 24.07% of the cases anomalies in digestive system and 22.22% of the cases anomalies in central nervous system. 8. Among 54 congenital anomalies 11 cases were diagnosed prenatally.

임신중 난소종양의 임상적 고찰

이규완,김해중,이낙우,김용민,장기훈 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.7

1. 발생빈도는 같은 기간의 총 분만수 9537예에 대해 1:289로 0.35%였고 악성종양의 빈도 는 9537분만 예 중 1예로 0.01%였다. 2. 연령분포는 20-35세로 평균연령은 27.9세였고 분만횟수별 분포는 초산모가 가장 많아 23 예로 69.7%였다. 3. 난소종양으로 인한 임상증상으로 무증상이 20예(60.6%)로 가장 많았으며 하복부 동통이 9 예로 27.3% 질출혈이 3예로 9.1%의 순이었으며 하복부 종괴촉지도 1예 있었다. 4. 발생부위는 일측성이 32예(97.0%)로 대부분이었다. 5. 임신주수에 따른 진단율은 임신초기가 48.5%로 가장 높았으며 임신중기가 9.1% 임신말기 가 42.4%등이었고 진단방법은 16예(48.5%)가 초음파와 내진으로 확진되었고 제왕절개 수술 중 우연히 발견된 경우도 13예(39.4%)나 되었다. 6. 종양의 크기는 5-6cm인 경우가 15예(45.5%) 7-10cm인 경우가 13예(39.4%)로 대부분을 차지하였다. 7. 병리학적 소견으로는 양성 낭성기형종이 7예(23.3%) 단순낭종이 5예(16.7%) 점액성 낭선종이 4예(13.4%) 황체낭종이 3예(13.4%) 등의 순이었으며 기타 자궁내막장종, 장액점액성 낭성종, 난포막 황체낭종, 미확인 혈종 등이었고 악성종양으로는 악성 미분화세포종이 1예(3.3%) 이었다. 8. 합병증은 염전이 2예(6.0%) 파열이 1예(3.0%)였고 모두 임신초기에 일어났다. 9. 수술방법은 보존적 낭종절제술이 13예(44.8%) 일측성 난소 난관절제술이 13예(44.8%) 일 측성 난소 절제술이 3예(6.9%) 쐐기형 절제술이 1예(3.5%) 등의 순이었고 수술을 시행하지 않은 예는 4예(11.8%)이었다. The thirty three cases of ovarian tumors in pregnancy among 9537 women were reviewed clinically at the Department of Obstetrics and Gynecology, College of Medicine, Korea University . The result obtained were as follows; 1. The incidence of ovarian tumors in pregnancy was 1 in 289 deliveries. 2. Mean age was 27.9 years old and the range was 20-35 years old. 3. Mean parity was 0.4. 4. According to clinical manifestation, a free of symptoms and sings in 20 cases (60.6%), low abdominal pain in 9 cases(27.3%) vaginal bleeding in 3 cases (9.1%) and palpable mass in 1 case(3.0%) were formed. 5. As to the size of tumor 15 cases(45.5%), were 5-6cm in diameter, 13 cases(39.4%) were 7-10cm, 2 cases (6.0%) were 11-15cm and 3 cases(9.1%) were over 16cm 6. Among the reviewed cases 32 cases(97.0%) were unilateral and 1 case(3.0%) was bilateral. 7. As the timing of diagnosis, 48.5% was diagnosed in the 1st trimester, 9.1% in the 2nd trimester, 42.4% in the 3rd trimester. 8. According to the method of diagnosis, known ovarian tumors were 4 cases(12.1%) 16 cases(48.5%), were found by physical examination and ultrasonography and 13 cases(39.4%) were incidental finding during cesarean section. 9. According to histopathologic type, benign cystic teratoma was 7 cases (23.3%) simple cyst was 5 cases (16.7%) mucinous cystandenoma was 4 cases (13.4%) corpus leteum cyst was 4 cases (13.4%) endometrial cyst was 3 cases(10.0%) serous cystadenoma was 2 cases(6.7%) parovarian cyst, serousmucinous cystadenoma, theca lutein cyst, Blood filled undetermined cyst was 1 case (3.3%) repectively. One case of malignant ovarian tumor was dysgerminoma. 10. As a complicated cases, the torsion of tumor was formed in 2 cases (6.0%) and the rupture of tumor was formed 1 case(3.0%). 11. Conservative ovarian cystectomy was performed in 13 cases(44.8%) unilateral salpingoophrectory in 13 cases (44.8%) , unilateral oophrectomy in 3 cases(6.9%) and ovarian wedge resection in 1 case(3.5%). 12. Outcome of pregnancy and mode of delivery : Fourteen cases(70%) were followed up. Among them, term delivery in 8 cases (40.0%) among them vaginal delivery in 2 case(25.0%) cesarean section in 6 cases(75%) and artificial abortin in 6 cases(30.0%) were occurred. Lost follow up cases were 6 cases(30.0%).

자궁근 cGMP 형성에 대한 융모막의 역할과 산모 및 태아혈청의 그 억제효과

김해중,Carl P. Weiner 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

The mechanism of uterine quiescence during pregnancy and initiation of labor is unknown. In previous report, we demonstrated myometrial cGMP rises dramatically during pregnancy and then declines just prior to the onset of labor. Further, pregnancy decrease myometrial soluble guanylate cyclase activity while enhancing particulate activity. Theses findings suggest a natriureitc peptide(NP) is responsible for the increase in cGMP. This study was undertaken to evaluate the source of that NP. We incubated myometrium from term guinea pigs in oxygenated buffer in the absence/presence of either amnionic membranes(AM, 400mg), chorionic membrane(CM, 400mg), fetal guinea pig plasma(FP, 1ml), maternal guinea pig plasama(MP, 1ml), or a combination. After incubation, cGMP(mol/mg portein) was measured by radioimmuno assay. Both AM and CM(CM$gt;AM, significantly) increased myometrial cGMP. The stimulation of myometrial cGMP by the CM has a significant linear relationship between fetal weight and the greatest cGMP increase occurred between 51~60 days after which it showed a trend to decrease. Both FP and MP decrease myometrial cGMP and inhibition of cGMP by MP increase significantly with advancing gestational age. Our date indicate that myometrial cGMP is stimulated by a compound produced by the CM and the action of this compound is inhibited by a substance produced by the mother and fetus at the end of a normal pregnancy.

지연임신의 산전진찰

김해중 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

각 검사결과를 종합하여 볼 때 다른 합병증이 없는 단순 지연임신의 경우 산전태아 평가검사는 제태기간 41주부터 실시하는 것이 좋으며 매주 자궁경부의 상태를 살펴보아 분만시도가 적절한 시기를 알아 보아야 하며 매주 초음파검사로 양수의 양 및 태반의 상태를 살펴보고 주 1회의 CST 혹은 주 2회의 NST를 실시하여 태아의 상태에 따른 적적한 조치를 취하면 태아손실을 최소한으로 줄일 수 있다.

거대 난소낭종 1 례

이규완,김해중,이광호,임옥룡,강준구 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.9

본례는 20세 미혼녀의 좌측난소에서 발생하여 빠른 발육을 보인 거대낭종으로서 조직학적으 로는 다방성 점액성 난소 낭종이며, 그 무게는 15kg에 달하였으며 수술적 적출치료를 받고 양호한 상태로 퇴원하였던 증례로 저자들은 간단한 문헌적 고찰과 함께 보고하는 바이다. We report a huge ovarian cyst, which observed in a nulligravida 20-years old woman. This tumor measured 34.5 X 32 X 14.5cm in size, and it weighed 15kg and the volume of cystic content was 11L. Pathologic diagnosis was mucinous cystadenoma, left ovary. And we presented with a brief review of literatures.

피부로 전이된 자궁경부 편평상피암 4 례

이규완,김해중,이상희,민유선,이용호 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

Cutaneous metastasis from carcinoma of the uterine cervix is extremely rare, particularly in comparison with the incidence of metastasis to noncutaneous sites. Although carcinoma of the cervix is one of the most common gynecological malignancy, less than 30 cases of skin involvement have been clearly documented in the literature. We describe four cases of skin metastasis from carcinoma of uterine cervix to illustrate the importance of the diagnosis regarding the prognosis of the patients. These patients were all histologically diagnosed as squamous cell carcinoma. The clinical stages of these patients were stage II except one patient with stage IV. All the patients underwent a homogenous therapy consisting of total hysterectomy, bilateral salpingo-oophorectomy, radiation treatment, and/or chemotherapy. The interval between the diagnosis of primary cancer and skin metastasis ranged from 4 to 20 months. The prognosis of these patients were very grave, the longest survival among the patients was only 11 months.

21-Hydroxylase결핍의 선천성 부신증식증에 의한 여성반음양 치험 1 예

주갑순,김해중,박상진 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.4

위와 같이 CAH중 Heterozygous 21-hydroxylase의 결핍으로 인한 것으로 사료되는 여성 반 음향 1례를 치험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Female hermaphroditism is a condition in which individuals with a 46, XX chromosomal constitution differentiate partially as phenotypic males, usually manifesting masculinization of the external genitalia. Most female hermaphrodites have one of the types of congenital virilizing adrenal hyperplasia. Congenital adrenal hyperplasia is an inborn error transmitted by an autosomal recessive gene and may be due to a defect in any of the enzymic steps in the biosynthesis of cortisol. Most affected individuals have a failure of 21-hydroxylation which prevents the conversion of 17-hydroxyprotesterone to 11-deoxycortisol. A defect in 21-hydroxylase leads not only to inefficient formation of cortisol but also to excessive production of adrenal androgens causing virilization. A case of female hermaphroditism due to congenital adrenal hyperplasia is presented with a brief review of the literature.

자궁의 악성혼합 뮬러리안종양 4 예

이규완,김해중,박종찬,오민정,안정희 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.8

저자 등은 본원 산부인과에서 악성혼합 뮬러리안 종양 4예를 경험하였기에 문헌과 함께 보고하는 바이다.

반복 기왕 제왕절개술에 의한 태아 두부변형 (fetal cranial deformation) 1 례

강재성,김해중,장기훈 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.8

본원 산부인과에 내원한 29세 다산부의 네 번째 제왕절개술을 시행한 결과 태아 두부의 변 형이 관찰되었고, 이것이 다발성 반복 제왕절개술로 인한 자궁변형의 결과로 여겨지며 이러 한 경우보다 적극적인 산전진찰이 요구될 것으로 사료되기에 간단한 문헌고찰과 함께 보고 하는 바이다. The field of dysmorphology has expanded dramatically over the last 20 year, Fetal deformation is an alteration in shape and structure of a part which has differentiated normally. The majority of deformation involove the musculoskeletal system and are probably caused by the increase of intrauterine pressure. Michaels et al.(1988) have published a classification of the uterine defectcs at ultrasonic examination and Brown et al (1986) have presented their experience with vaginal ultrasonic examination for evaluation the lower uterine segment. We expearineced one case of fetal cranial deformation that may be associated with uterine deformity caused by previous repeated cesarean sections in 29 year old woman, So we report the case and review of literatures briefly.

상피성 난소암에 있어서 DNA Flow Cytometry의 임상적 의의

이규완,김인선,구병삼,김해중,문준,이상희 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.6

저자들은 1992년 4월부터 1994년 3월까지 복부종괴를 주소로 본원 산부인과를 내원하여 시 험개복술을 시행한 환자중 병리조직검사에서 상피성 난소암을 진단된 27예를 대상으로 flow cytometry로 DNA를 분석하여 임상적 양상과 비교하여 다음과 같은 결과를 얻었다. 1. 상피성 악성종양에서 aneuploidy 발현율은 45.0%, SFP 비율은 11.9+-5.7% 로 경계성 난 소종양의 14.3%, 6.6+-6.0%보다 높았으나, SFP비율에서만 통계적인 유의성이 있었다(p$lt;0.05). 2. 병기 3, 4기의 난소 진행암에서의 aneuploidy 발현율운 44.4%로 1, 2기의 22.2%보다 높았으나 통계적인 유의성은 없었고 SPF 비율은 진행암의 경우에서 12.2+-5.1%로 1, 2기의 6.6+-3.1%보다 유의한 차이가 있었다(p$lt;0.05). 3. 난소암의 분화도가 grade III 인 미분화암에서 aneuploidy 발현율이 61.5%, SPF 비율이 14.5+-6.3%로 경계성 난소암의 12.5%나 5.6+-4.0%보다 유의하게 높아 통계적인 유의성이 있었다(p$lt;0.05). 4. 난소의 악성종양에서 조직학적 분류에 따른 DNA flow cytometry 양상은 서로 통계학적 유의성은 없었다(p$gt;0.05). 5. 상피성 난소암의 flow cytometry 분석에서 aneuploidy 양상과 18% 이상의 높은 SPF 비율을 보인 전예에서 진행된 암의 소견과 grade III 의 미분화 양상을 보여 임상적 예후가 불량한 예들이었다. 이상과 같은 결과로 미루어 상피성 난소암에서 DNA flow cytometry 측정은 그 임상적 양상이나 예후를 판정하는 주요 진단수단으로 의의가 있을 것으로 사료되나 앞으로 더욱 많은 예들의 분석과 이들에서의 5년생존율에 대한 연구를 병행하여야 되리라고 본다. We investigated the clinical significance of DNA content and proliferative activity or tumor cell populations as flow cytometry analysis from twenty epithelial malignant turmor of the ovary and seven boderline malignant tumors of the ovary. The DNA aneuploidy was found in nine cases of twenty malignant epithelial tumors(45.0%) of the ovary and one case of seven boderline tumors of the ovary(14.3%). The S-phase fraction(SPF) of malignant ovarian tumor(11.9+-5.7%) was significantly higher than that of boderline ovarian tumor (6.5+-6.0%). The DNA aneuploidy and S-phase fraction were significantly correlated with FIGO stge and tumor grade. The DNA aneuploidy rate and S-phase fraction were higher in the advanced and poorly differentiated epithelial malignant ovarian tumors. Analyzing the result of flow cytometry, the malignant epithelial ovarain tumors were separated into the three groups, aneuploidy group with a SPF greater than 18% aneuploidy group with a SPF less than 18% and diploidy group. All cases of the aneuploidy group with a SPF greater than 18% showed advanced stage(stage III-IV) and poorly differentiated grade(grade III). From our results we suggested that the flow cytometric DNA pattern correlate with the aggresive potential of a malignant epithelial ovarian tumor and provide additional information about tumor prognosis.