正常 및 異常姙娠 血淸中 Cystine Aminopeptidase의 活性度에 關한 硏究

金顯燦 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.1

악성 위험지수 (RMI;risk of malignancy index) 에 의한 난소종양의 평가

김현찬,김기태,김우경,이재준,최영태,한지원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The purpose of this clinical study was to evaluate the efficacy of RMI(risk of malignancy index) as a preoperative predictive screening method in ovarian tumors. The RMI was calcula- ted by the following formula;─ RMI=The ultrasonographic score(0, 1, or 3) x serum CA-125 level x menopausal status score(1 or 3). The preoperative RMI was obtained from 69 cases of ovarian tumors operated from July 1993 to March 1996 at the Dept. of Obstetrics and Gynecology , Pusan Paik Hosp. Reviewing the histopathological diagnosis of surgical specimen, using RMI cut-off value of 200, the sensitivity, specificity, positive and negative predictive value of RMI was obtained and compared with CA-125 value and sonographic scores, respectively. The results obtained were as follows; 1. The sensitivity of RMI was 67.7%, it was lower than that of serum CA-125 value(74.0%) and ultrasonographic score(80.6%)(P=0.535). 2. The specificity of RMI was 100%, it was higher than that of serum CA-125 value(81.6 %) and ultrasonographic score(84.2%)(P=0.006). 3. The positive predictive value of RMI was 100%, it was higher than that of serum CA-125 value(76.7%) and ultrasonographic score(80.6%)(P=0.047). 4. The negative predictive value of RMI was 79.2%, it was lower than that of CA- 125 value(79.5%) and ultraconographic score(84.2%)(P=0.83). In conclusion, the RMI could be a useful screening method to discriminate a benign from malignant ovarian tumors prior to operation.

고위험군 융모성질환에서 EMA-CO요법의 치료 결과

김현찬,김기태,최상림,김용학 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.1

인제대학교 부속 부산백병원 산부인과에서 1986년 초부터 1989년 말까지 WHO기준에 의한 고위험군 융모성질환 18례를 EMA-CO 요법으로 치료하여 아래와 같은 결과를 얻었다. 1. 환자의 평균 연령은 40.6±8.6세이었고 평균 위험점수는 10.6±2.4이었다. 2. 총 18례 중 16례가 경쾌되어 경쾌율은 88.9%이었다. 3. 혈청 β-HCG가 경쾌수준(5mlU/ml)에 도달할 때까지의 기간은 평균 13주이었고 화학요법투여 주기는 평균 6주기이었고 경쾌수준에 도달한 후 평균 1.9주기 더 투여하였다. 4. 전이 병소에 따른 경쾌율은 폐 91.7%, 골반 100%, 뇌 66.7%, 간과 질이 100%, 신장에 전이된 경우는 치료에 실패하였다. 5. 약물에 대한 부작용으로는 탈모증과 오심이 100%, 조혈기관 독성 94.4%, 구토 77.8%, 경도의 간독성 50%, 구내염 33.3%이었고 약진, 심부정맥혈전증과 화학적 뇌막염을 각각 2, 1, 1례 경험하였다. 6. 본원에 입원전 선행 단일화학요법에 저항을 보인 1례와 뇌, 신장 및 폐장에 다발성 전이를 보인 1례에 각기 EMA-CO 요법을 적용하였으나 효과가 만족스럽지 못하여 BEP 요법으로 대치하였으나 모두 실패하였다. Eighteen patients of high-risk(mean risk score of 10.6±2.5) gestational trophoblastic dsisease had been treated (Jan. 1986∼Dec. 1989) with EMA-CO regimen. The results could be summarized as follows : The sustained remission rate (mean duration of follow up, 20.0±10.4 months) was 88.9% with mean applied course of 6±2, and additional 1.9 courses of chemotherapy. The toxicity of EMA-CO regimen was relatively frequent, in order of frequency, alopecia and nausea(100%), bone marrow depression(94.4%), vomiting(77.8%), stomatitis(33.3%) etc. However it could be manageable and tolerable for scheduled course of chemotherapy. EMA-CO regimen was not satisfactory on one case of previous failed chemotherapy(risk scor of 13) and the other case of multiple metastasis of brain, kidney and lung(risk score of 15). BEP regimen was appleid on those cases but could not achieve remission. As a conclusion, we could believe that EMA-CO regimen was quite effective one with tolerable toxicity and we also could suggest combination chemotherapy, consisted of etoposide and cisplatin, from the outset on ultra high-risk group (risk score over 13 or/and multiple site of metastasis, brain etc.).

복식 전자궁적출술시 예방적 Fasigyn의 효과

김현찬,제구화,김기태,박호,조종희,최상림 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.6

인제대학교 의과대학부속 부산백병원에서 복식 전 자궁적출술시 Fasigyn을 예방적으로 투여하여 대조군과 비교하여 그 효과를 분석한바 다음과 같은 결과를 요약하고 결론을 내릴 수 있었다. 1. 열성이환의 빈도와 추가적인 다른 항생제투여가 필요한 경우가 투약군에서 대조군에 비하여 반감하였다. 2. 복벽창상감염은 경미한 경우이었고 빈도가 높지 않았으며, 대조군과 투약군에서 빈도는 별 차이가 없었다. 3. 골반감염(골반 봉과직염 및 질구개 봉과직염)의 빈도는 투약군과 대조군에서 큰 차이가 없었으며, 양군에서 골반농양의 경우는 1례도 없었다. 이는 아마도 질구개를 개방한 술식과 더불어 열성이환을 보인 예에 추가적으로 다른 복합항생제를 사용한 것에 기인한 것으로 사료된다. 4. 뇨로감염의 빈도는 비교적 높은 편이었고, 투약군에서 대조군보다 그 빈도가 낮았다. 저자들이 시행한 수술 전처치 및 수술방식에는 대조군과 투약군에서 비교적 열성이환의 빈도가 다른 보고자에 비하여 낮고 중한 골반감염과 이로인한 문제가 될만한 후유증으로 입원이 연장된 예는 없었다. 저자들이 시행한 술식과 더불어 비용이 적게들고 간편한 예방적 단회경구 Fasigyn의 투여는 다소 열성이환과 비뇨기감염의 빈도를 저하 시킨고로 그 효과를 인정할 수 있다고 생각되며, 환자를 선별하여 예방적으로 투여하는 것이 좋을 것으로 생각된다. 그러나 비뇨기감염의 빈도가 비교적 높은 것으로 보아 향후 이에 대한 개선된 대책이 요구된다. In 100 patients undergoing elective abdominal hysterectomy, a double blind study was undertaken to evaluate the efficacy of Fasigyn treatment in diminishing the postoperative infection rate. The study group (n= 50) received a single dose of 2.0 gm Fasigyn p.o. before 12 hours preoperatively while the control group (n= 50) did not. The two groups of patients, 50 in each, were comparable with regard to age, anemia, pathologic condition, length of operation, blood loss and indication of htsterectomy, etc. The febrile morbidity was noticed in 6 % and 12 % of the study and control groups, respectively. Significant pelvic infectious complications (pelvic and vaginal cuff cellulitis) were observed in 6 % of the control group and 4 % of the study group but no case of pelvic abscess was encountered. Abdominal wound infection, moderate degree, was found in 2 % of the control group and 4 % in the study group. Urinary tract infection, the most frequent complication in this study, was found in 26 % of the control and in 16 % of the study group. The result of this study indicated that oral preoperative single dose Fasigyn prophylaxis reduced modestly the over all rate of febrile morbidity and urinary tract infection, but no significant difference of pelvic and abdominal wound infection rate was found between two groups. No difference of hospital stay was found between two groups but more case of infectious complication in the group were treated by additional other antibiotics. Because the incidence of febrile morbidity is relatively low and serious consequences of pelvic and abdominal infection are rare in this study, the routine Fasigyn prophylaxis in all low risk patients undergoing elective abdominal hysterectomy, although somewhat effective, is probably not always necessary, but it seems to be prudent to give additional measures to reduce postoperative urinary tract infection.

육종성 간질의 과증식을 동반한 뮐러씨 선육종 1 예

김현찬,김기태,이경복,김우경,박성혜,한지원,정철회,정대훈 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

Mullerian adenosarcoma has been described as a destinctive biphasic uterine tumor with benign neoplastic glands within sarcomatous stroma. It is a rare variants of mixed mesodermal tumors and considered to be a tumor of low grade malignancy with relatively good prognosis. The other histopathological variant of adenosarcoma is adenosarcoma with overgrowth by high-grade sarcoma. Sarcomatous overgrowth is seen in approximately 10% of adenosarcoma. The definition of sarcomatous overgrowth is the presence of a pure sarcoma, usually but not necessary of a higher grade and mitotic rate, that overgrows a typical adenosarcoma and accounts for at least 25% of the total tumor volume. In contrast to typical m llerian adenosarcoma of the uterus, ademosarcoma with sarcomatous overgrowth is extremely aggressive tumor frequently associated with metastasis, postoperative recurrence, rapid progression and death. For adequate management of patient, it is important to evaluate the presence or absence of the sarcomatous overgrowth when the m llerian adenosarcoma is diagnosed. Recently, we experienced a case of m llerian adenosarcoma with sarcomatous overgrowth in a 36-year-old married, nulliparous woman and report this case with a brief review of the literature.

경계성 난소상피종양에 대한 임상적 고찰

김현찬,김기태,김우경,오희연,최영태,한지원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

A clinical and pathological study was made on a series of 34 cases of borderline epithelial ovarian tumors, which were managed at Pusan Paik Hospital of InJe university, from January 1985 to December 1996. The results obtained as follows: 1. The incidence was 19.9%(34/171 cases) among all epithelial ovarian malignancies. 2. Age distribution was between 14 and 78 years old, mean age was 37 years old. 3. As for the parity, nulliparity was most common(38.2%). 4. Abdominal discomfort(58.8%), palpable mass(41.2%) and abdominal distension(41.2 %) were the main symptoms. 5. As for the FIGO stage, 29(85%) cases were at Ia, 2(5.9%) cases at Ic, 1(2.9%) case at IIc, at IIIb, at IIIc, respectively. 6. The most common histological type was mucinous, 28(82.4%) cases, the next was serous, 5(14.7%) cases. 7. Among the surgical staging procedures, the positive rate of peritoneal cytology was 29 %(5/22) and that of omentectomy was 12.5%(2/16). 8. Twenty one(61.8%) cases were managed by conservative operation and 13(38.2%) by extirpative operation, and postoperative chemotherapy was given in 2 cases. 9. Follow-up was possible in 27(79.4%) cases. The duration of follow-up ranged from 7 to 115 months. Mean duration was 32.9 months. The presumed 5 year survival rate was over 85%.

복식 전자궁적출술시 질구개 처치술식에 따른 이환 및 합병증

김현찬,김우경 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Post-operative morbidity and complication, focused on open versus closed vaginal cuff, were compared. The patients were divided into two groups according to the method of cuff management(open cuff : n=53, closed cuff : n=52). From Jan, 1990 to Dec. 1994 one hundred five cases of total abdominal hysterectomy on the benign uterine disease were carried out by the same operator at the Dept. of Ob/Gyn. Pusan Paik Hospital. The vaginal cuff was opened during the first half periods(1990. 1-1993.3), and it was closed during the later peroids(1993.4 - 1994.12). As to the postoperative morbidity and complication(closed : open), urinary tract infection(9.4% : 5.8%), vaginal cuff infection(7.5% : 3.8%), febrile morbidity(3.8% : 3.8%), wound infection(1.9% : 3.8%), pelvic hematoma(0: 1.9%) developed but there were no statistical differences between the two groups. Granulation tissue formation on the vaginal cuff was found in 26 cases(49.1%) of the open cuff and in 18 cases(34.6%) of the closed cuff(p=0.134, %^2 test ) within 6 months after operation. Post operative increased vaginal discharge developed in 7 cases(13.2%) of the open cuff and in 10 cases (19.2%) of the closed cuff group(p=0.516, Fisher`s Exact test).

흔적자궁각임신의 파열로 인한 이차성 복강내임신 1 례

김현찬,성문수,김우경,최정미,이재준,오희연 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

The unicornuate uterus with rudimentary horn is one of the rarest congenital uterine anomalies consists of a relatively normal-appearing uterus on one side with a rudimentary horn on the other side. Pregnancies with implantations in rudimentary uterine horns, rupture usually occurrs, mostly in the second trimester. On occasion a pregnancy may advance into the third tremester with a viable fetus in an intact horn, or rarely in the peritoneal cavity as a secondary abdominal pregnancy following rupture of the pregnant rudimentary uterine horn. We experienced a case of abdomino-uterine pregnancy secondary to rupture of pregnant rudimentary horn with survival of mother and infant and report the case with brief review of literatures.

질에 발생한 원발성 평활근육종 1 례

김현찬,김기태,이경복,윤혜경,이수,이재준,오희연 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

The primary malignant neoplasm of the vagina is rare and represents about 1% of all hynecologic malignancies. The majority are carcinomas. Primary sarcomas of vagina constitute only 2% of all malignant neoplasms of vagina. But sarcomas are the most common malignant mesenchymal tumor in the vagina. Among sarcomas, sarcoma botryoides predominates in childhood, whereas leiomyosarcoma is the most common neoplasm in adults. Because of the rareness of the leiomyosarcomas, the standard criteria of diagnosis and histopathologic classification have not been established, therefore the recommendation of the treatment modality also has not been established. We have recently experienced a case of primary leiomyosarcoma arising from vagina in 45 years-old woman and report our case with a brief review of the literature.

흰쥐 자궁조직에서의 bel-2 유전자 발현에 대한 Steroid 호르몬의 영향

김현찬,강성구,김주란,강한승,이병주 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

흰쥐 자궁조직에서의 bcl-2 유전자 발현과 스테로이드 호르몬의 영향을 알아보기 위하여 발정주기 각 단계의 자궁조직과 호르몬 처리한 자궁조직에서 bcl-2 유전자의 정도를 측정하였다. 이 연구에 사용된 동물을 두 번의 발정주기를 나타낸 흰쥐와 난소를 적출한 뒤, oil, progesterone(P₄), estrogen(E₂)을 처리한 흰쥐이다. 흰쥐에서 자궁내막조직과 자궁근막조직을 절제한 후 RNA를 추출하고 역전사-중합효소 증폭반응(RT-PCR)을 이용하여 각 조직에서의 bcl-2 mRNA의 변화를 측정하였다. 발정주기에 따른 bcl-2 mRNA의 변화를 측정하였다. 발정주기에 따른 bcl-2 유전자의 발현은 자궁내막조직에서는 발정기에 최고치를 나타낸 뒤 점차 감소하였으며 자궁근막조직에서는 발정후기에 가장 높았다. 난소를 적출한 흰쥐에서 자궁내막조직과 자궁근막조직의 bcl-2 유전자의 발현은 에스트로겐에 의해 유도되었다. 따라서 발정주기 동안 자궁조직은 proto-oncogene의 발현에 주기적인 변화를 일으키며, 이는 난소에서 분비되는 스테로이드 호르몬에 의한 영향으로 생각된다. The present study aims to determine whether the levels of bel-2 mRNA are changed in endometrium and myometrium of uterus during estrus cycle and ovariectomized rat. For this purpose, we used adult female rats exhibiting at least two consecutive 4-day estrus cycles and ovariectomized rats treated with oil, progesterone(P4) and estrogen(E2). Endometrium and myometrium tissues were dissected at each stage of estrus cycle and ovriectomized rats treated with steroids and then the total RNAs were used to determine the levels of mRNA using oligo-dT primer. The levels to bel-2 mRNA in endometrium tissue reached a maximum level at estrus stage and the gradually decreased. But in myometrium tissue the levels of bcl-2 mRNA showed a miximum level at metestrus stage. Estrogen induced the synthesis of bel-2 mRNA in endometrium and myometrium tissue of ovariectomized rat. These results suggest that there are cyclic fluctuations in proto-oncogene expression in uterine tissue during estrus cycle and this may be caused by cyclic ovarian steroid secretions.