태아성장제한 임신에서 영양모세포의 세포고사와 BRCA1 발현에 관한 연구

문종수 ( Chong Soo Moon ),정지윤 ( Ji Youn Chung ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.3

질출혈을 동반한 자궁내 초기임신에서 혈중 CA125의 임신예후 예측 효용성

정지윤 ( Ji Youn Chung ),문종수 ( Chong Soo Moon ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.6

목적: 질출혈이 동반된 초기임신에서 임신의 예후를 알아보기 위하여 혈중 CA125를 측정하여 그 농도가 급격하게 증가하거나 고농도를 유지하는 경우에 유산의 발생을 예측할 수 있는 지를 알아보고, 만약 그 가치가 존재한다면 기준값을 알아보기 위하여 본 연구를 시행하였다. 연구 방법: 임신 초기에 질출혈이 동반된 임신부 40명을 대상으로 하였다. 첫 방문 시에 혈중 CA125를 측정하였으며 이후 1주 간격으로 임신 1삼분기까지 추적검사하였으며, 이 때 유산으로 확인된 경우에는 소파수술 후 추적을 중단하였다. 모든 방문 시에는 β-hCG와 초음파 검사를 동시에 시행하였다. 결과: 결국 14명에서 유산이 발생하였고 26명은 임신이 지속되었다. 유산은 대부분 혈중 CA125 농도가 유의하게 증가한 경우에 발생하였으며, ROC 곡선에서 150 U/mL가 유산예측의 기준 농도로 가장 의미가 있었다. CA125 농도가 150 U/mL 이상이었던 17명 중에서 12명이 유산되었고, 150 U/mL 미만이었던 23명 중에서는 2명이 유산되어 유산발생에 대한 양성예측도와 음성예측도는 각각 70.6%와 91.3%였다(P<0.01). 결론: 임신 초기의 모체 혈중 CA125 농도는 임신의 예후를 판정하는 제 3의 중요한 예측인자가 될 수 있다. 특히 임신 초기에 질출혈이 동반된 경우에 CA125의 농도가 갑자기 증가한다면 유산의 발생을 강력히 예견할 수 있으며, 기존의 혈중 β-hCG와 초음파와 같이 적용한다면 임신 예후 예측에 더욱 가치가 있을 것으로 사료된다. Objective: To investigate whether sudden rise or already increased level of maternal serum CA125 predicts spontaneous abortion in early pregnancy with vaginal bleeding. And if so, to decide the CA125 cut-off level for poor pregnancy outcomes. Methods: The prospective study was performed in forty women presenting with any vaginal bleeding at early pregnancy. Maternal serum CA125 levels were evaluated on the first visit and followed up during the first trimester, or until the time to diagnose abortion. Serial maternal serum β-hCG and ultrasonographic evaluation were also performed at the same time. Results: There were eventually fourteen abortions and twenty-six ongoing pregnancies. Using receiver-operating characteristic curve, 150 U/mL of serum CA125 was the most useful value for predicting spontaneous abortion. In most of abortion women, the serum CA125 level was increased over than 150 U/mL immediately before the abortion. The twelve of 17 women who were 150 U/mL or more resulted in abortion, while there were just two cases of abortion among 23 women who were less than 150 U/mL. Its positive predictive value was 70.6% and negative predictive value was 91.3% respectively (P<0.01). Conclusion: There was a strong correlation between high level of serum CA125 and subsequent spontaneous abortion in early pregnancy. It should be valuable to check maternal serum CA125 added to β-hCG and ultrasound for predicting pregnancy outcome at the early pregnancy, especially in the cases with vaginal bleeding.

고위험 산모 신생아 통합치료센터 - 진행현황과 문제점: 산과적 측면

김호연 ( Ho Yeon Kim ),문종수 ( Chong Soo Moon ) 대한주산의학회 2014 Perinatology Vol.25 No.3

The medical environment of obstetric field has been deteriorated seriously, which is caused by sharply declined birth rates and several other causes in Korea. Inversely the prevalence of high risk pregnancy is continuously going to explode, human resources and facilities in delivery unit is still in shortage. It is greatly needed to reinforcement, but rather diminished substantively. Finally, maternal death rate of Korea has been extremely increased. It is time that the policies for treatment of high risk maternity in national level, no more leave the situation. The integrated care system which treats high risk maternity and neonate sequentially is very important in their disease characteristics. It is sure that the integrated management for high risk pregnancy and neonate can make an important role in improvement of perinatal and maternal death rate and maternal-neonatal health care. Therefore, Ministry of Health and Welfare made a policy that enforcement of ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonate. It suppose to start 4 centers for demonstration project in 2014, and finally establish 17 centers in 11 broad territory divided all of the country in 2017. It will be fulfilled by together and all their steps for treatment of maternity and neonate in Integrated Care Center. It also accomplishes a task of emergency center, and carry out treatment and emergency operation at all times. In addition, it takes an emergency transfer system, data collection and analysis, preventive management service through public education and relations. In the future, Integrated Care Center should be important role for improving maternal health care as well as Obstetric infrastructure. It is considered that establishment of Integrated Care Center in Korea.

복벽종괴로 발견된 속자궁목증

나연식 ( Yeon Sik Na ),정지윤 ( Ji Youn Chung ),문종수 ( Chong Soo Moon ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.12

Endocervicosis refers to the presence of benign mucinous glands of endocervical type in ectopic site. It is rare and usually detected incidentally by histologic examination. The urinary bladder is the most common site, but peritoneum, small bowel, abdominal scar, outer wall of the cervix, vagina, and lymph nodes have been documented. Because this is the first documented report of endocervicosis arising in the rectus muscle in korea, we report this with a brief review of the concerned literatures.

난포호르몬이 임신 자궁동맥 평활근세포에서 extracellular signal-regulated kinases 활성화에 미치는 영향

이용우 ( Yong Woo Lee ),김호연 ( Ho Yeon Kim ),박상민 ( Sang Min Park ),최수란 ( Soo Ran Choi ),정지윤 ( Ji Youn Chung ),문종수 ( Chong Soo Moon ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.9

목적: 내피세포를 제거한 자궁동맥 평활근세포에 난포호르몬을 투여하여 자궁동맥 평활근세포가 난포호르몬의 직접적인 표적조직인지와 난포 호르몬이 자궁동맥 평활근세포에서 직접적으로 extracellular signal-regulated kinases (ERK2/1) 활성화하는지 여부를 파악하여 난포호르몬의 자궁동맥 혈관확장 중에서 내피세포-비의존성 기전을 알아보기 위하여 본 연구를 시행하였다. 연구방법: 만삭임신의 양에서 절제된 자궁동맥을 대상으로 콜라겐 분해효소로 내피세포를 제거하였다. 내피세포가 제거된 자궁동맥 평활근 분절은 소화효소처리 후에 평활근세포를 수집하여 성장배지에서 계대배양하였다. 혈관 내피세포와 평활근 상태의 평가는 항평활근 알파-액틴 단 일클론 항체, 항내피세포 산화질소 합성효소 단일클론 항체, 항caveolin-1 다클론 항체를 처리하여 중복 면역형광 염색과 흐름세포측정으로 판정하였다. 자궁동맥 평활근세포에 난포호르몬을 농도를 달리하여(10-14 M에서 10-6 M까지) 투여하여 전체 세포 추출물에 대하여 항인산 특이 mitogen activated protein kinases (MAPKs) 다클론 항체로 ERK2/1 인산화의 western blot 분석을 하였다. 난포호르몬 수용체 길항제인 ICI 182,780으로 전처치한 후에 다시 난포호르몬을 낮은 농도(10-10 M)와 높은 농도(10-7 M)로 투여하여 인산화 ERK2/1의 western blot 분석을 하여 전처치하지 않은 경우와 비교하였다. 결과: 평활근세포의 전형적인 hill and valley 양상과 세포 내에 평활근 알파-액틴과 caveolin-1이 뚜렷하게 염색되었다. 흐름세포측정 분석에서 평활근 알파-액틴과 caveolin-1은 각각 99.96%와 99.98%가 발현되었지만 내피세포 산화질소 합성효소 단백질은 26.12%에서만 발현되었다. 난포호르몬의 농도의 증가에 따라 인산화 ERK2/1의 발현은 이상성 증가반응을 보였다. 난포호르몬이 저농도(10-14-10-10 M)에서는 ERK2/1의 인산화는 용량-의존적으로 증가하였지만, 고농도(10-9-10-8 M)에서는 ERK2/1의 인산화는 오히려 감소하였으며, 약물농도인 초고농도(10-7-10-5 M)에서는 ERK2/1의 인산화가 급격하게 증가하였다. 난포호르몬 수용체 길항제인 ICI 182,780으로 전처치하면 난포호르몬을 저농도(10-10 M) 혹은 고농도(10-7 M)로 투여하더라도 ERK2/1 인산화는 소멸되었다. Reverse transcription-polymerase chain reaction 분석에서 난포호르몬 알파-수용체와 베타-수용체는 자궁동맥 평활근과 자궁동맥 평활근세포에서 모두 발현되었다. 결론: 자궁동맥 평활근은 난포호르몬 수용체를 지니고 있는 난포호르몬의 표적조직이며, 난포호르몬의 혈관확장 작용에는 자궁동맥 평활근세포에서 직접적인 ERK2/1 활성화를 통한 혈관내피 비의존성 기전도 존재한다는 것을 확인할 수 있다. Objective: To explore the endothelium-independent mechanisms of estrogen induced uterine vasodilatation, this study was performed to determine whether uterine artery smooth muscle (UASM) cells are direct targets of estrogen, and estradiol (E2) stimulates extracellular signal-regulated kinases (ERK2/1) in endothelium denuded UASMs. Methods: The uterine arteries were obtained from late gestation pregnant sheep and the endothelium was denuded with collagenase digestion. The uterine artery smooth muscle segments were digested, collected and cultured. Endothelial integrity and smooth muscle status were assessed by Double immunofluorescence staining and flow cytometry. The UASM cells were treated with increasing concentrations of E2 (10-14 to 10-6 M), and pretreated with ICI 182,780 followed by different concentrations (10-10 and 10-7 M) of E2. Western blot analysis of ERK2/1 phosphorylation with a phospho-mitogen activated protein kinases (MAPKs) antibody were carried out to total cell extracts. Results: The loss of endothelial function and adequacy of smooth muscle integrity were confirmed. When challenged with increasing concentrations of E2, a bi-phase ERK2/1 phosphorylation was observed. Treatment with low doses (10-14 to 10-10 M) of E2, ERK2/1 phosphorylation was dose-dependently increased, whereas high doses (10-9 to 10-8 M) did not phosphorylate ERK2/1. However, treatment with pharmacological doses (10-7 to 10-6 M) drastically phosphorylated ERK2/1. In the presence of ICI 182,780, E2 induced ERK2/1 phosphorylation were abolished in both. Conclusion: It suggests that UASM is the target tissue of estrogen during uterine vasodilatation, and estrogen stimulation of ERK2/1 activation is mediated by an estrogen receptor-dependent mechanism. It also is presumed that endothelium independent mechanism exists in estrogen induced vasodilatation.

성경험이 없는 여성의 자궁 내막에 존재한 방선균

지은정 ( Eun Jung Ji ),손혜연 ( Hyae Yeon Son ),김시내 ( Shi Nae Kim ),이용우 ( Yong Woo Lee ),장재혁 ( Jae Hyuk Chang ),정지윤 ( Ji Youn Chung ),문종수 ( Chong Soo Moon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11

Actinomyces species are anaerobic or microaerophilic non-spore-forming gram-positive rods that may reach, occasionally, the normal female genital tract. Actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). IUD and pessaries facilitate the access of the microorganisms to the pelvis. Almost 85% of cases occur in women who have had an IUD in place for 3 or more years. In fact, the detection rate of Actinomyces in patients with pelvic actinomycosis is as low as 2%. The diseases caused by Actinomyces spp. is often of difficult diagonsis. The diagnosis of actinomycosis can be confirmed by culture. However, it is often difficult to culture Actinomyces. Therefore a diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by the finding of Actinomyces-like organisms on Papanicolaou smears. The endometrial involvement is extremely rare. The authors report an unusual case of endometrial infection by Actinomyces in a 21 year-old female without intercourse, admitted into the institute with menorrhagia. She had received oral pills. Abdominal ultrasonography showed a endometrial thickening. The pre-diagnosis was endometrial hyperplasia. The endometrial biopsy was done. The sample from the endometrium developed actinomycosis. After procedure and treatment, the menorrhagia was disappeared.