자궁경관무력증의 수술요법에 대한 임상적 관찰

박인서(IS Park),김현찬(HC Kim),김선동(SD Kim),박찬무(CM Park) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.2

1964년 10월 초부터 1973년 6월말까지 만 8년 9개월간 국립의료원 산부인과에서 자궁경관무 력증으로 진단을 맏은 33예에 대하여 44회의 수술을 시행하여 그 임상적 관찰을 시행한 바 바듬과 같은 결과를 얻었다. 1) 자궁경관무력증의 임신 및 분만에 대한 비율은 1:352와 1:336이었다. 2) 환자의 평균연령은 31.6세였다. 3) 수술 전 평균 임신회수는 5.5회였으며 fetal salvage rate는 16.5%였다. 4) 원인적 소인 중 외상성 소인을 가졌었다고 생각되는 환자는 79%에 해당하였다. 5) 진단은 산과적 기왕력, 자궁경관의 소견, 외상성 소인 등을 종합 참작하였으며 33예 중 30예를 임신중에 진단하였다. 6) 수술방법 및 회수는 Shirodkar 술식 19회, Mc-Donald 술식 20회, Lash & Lash 술식 5 회였다. 7) 수술 후 평균입원기간은 Shirodkar 술식에서 12일, Mc-Donald 술식에서 21일, Lash & Lash 술식에서 5.4일이었다. 8) 수술 후 보조적 치료제로는 opium tincture, 황체홀몬, librium 등을 투여하였다. 9) 생아를 얻었던 경우에 분만방식은 약 2/3에서 질식분만이었고 약 1/3에서 제왕절개수술 에 의한 분만이었다. 10) 수술에 직접 관련된 합병증의 빈도는 17.3%이었으며 합병증으로는 자궁내감염 및 태아 사망, 파막, 분만의 유발, 자궁경관질루 및 염증성괴사로 인한 자궁경관탈락, 이차성불임증 등이었으나 모체사망은 없었다. 11) 수술의 성적 즉 수술회수와 임신회수에 대한 전체적인 fetal salvage rate는 70%와 68.1%이었으며 Lash & Lash 술식 (100∼80%), Mc-Donald 술식(77.7%), Shirodkar 술식 (55.5∼57.1%)의 순위였다. From October 1964 through June 1973, during the period of 8 years and 9 months, 44 times of operations were carried out in 33 patients of incompetence of the cervix which was diagnosed on the bases of previous obstetric histories, findings on the cervix in pregnant or nonpregnant state and its combinations with consideration of predisposing traumatic factors. A number of operations, such as Shirodkar(19 times), Mc-Donald(20times) and Lash & Lash(5 times) had been done and a variety of suture materials used. Before operation those 33 patients had 182 conceptions with successful outcome of pregnancy in 23. If the artificial abortions were deleted, fetal salvage had occurred in 16.5%. Fourty operations had been followed up to deliveries with 28 successful pregnancies and a overall operative successful fetal salvage rate was 70%. Fourty four pregnancies had been follwed up to deliveries and 30 pregnancies resulted in success with a overall fetal salvage rate of 68.1% whicg was success rate regarding to the numbers of pregnancies after operations. An attempt to analyze the incidence, predisposing etiological factors, post-operative complications, comparative results of each operation and other concerned problems was made with a brief review of literateres.

Ritodrine Hydrochloride ( Yutopar ) 가 조기진통에 미치는 효과

박인서(IS Park),김용철(YC Kim),박형무(HM Park),차인식(IS Cha) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.8

Although modern intensive care of the premature newborn has improved the infant`s chances of healthy survival, prematurity is still the major cause of neonatal morbidity and mortality. Recognition of these problems has led to effort aimed at either prevention of pret erm labor or inhibition of the process once it has begun. Adrenergic betamimetic compounds are known to be potent inhibitors suppressing the intensity of uterine contractions. However, because these compounds also affect the cardiovascular system, causing marked hypotension and tachycardia,their clinical usefulness has been limited. A double-blind placebo-controlled study with Ritodrine had been performed in 38 patients in premature labor. All patients were treated according to the fixed dosage scheme consisting of an intravenous infusion followed by oral tablets for total seven days. The results of this study were as follows: 1.There were no statistically singificant differences in clinical characteristics such as- maternal age,parity,gestational weeks,cervical dilatation,initial maternal heart rate and blood pressure. 2.Labor was successfully postponed for more than 24 hours in 17 cases(89.5%) and one week or more in 14 cases (73.7%) of 19 cases with intact membranes,who were treated with Ritodrine, while in the placebo group these were seen in 6 cases(50.0%) and 4 cases(33.3%) of 12 cases, respectively. The difference between the two groups is statistically significant. 3.The mean gain days were 29.2 in treated group with intact membrans and 10.3 in placebo with intact membranes. The difference between the two groups is statistically significant. 4.The maximal maternal heart rate was significantly elevated during Ritodrine infusion. But the maximal systolic and minimal diastolic blood pressure, and maximal fetal heart rate did not change significantly. 5.There was no statistically signicant difference between the two groups in the 1 and 5 minute Apgar scores of the newborn.

분만 예에 있어서 모성건강기록의 임상통계학적 분석 ( II )

박인서(IS Park),이규완(KW Lee),조명준(MJ Cho),박찬용(CY Park),박창서(CS Park),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

1980년 2월1일부터 1980년 7월31일까지 만 6개월간 국립의료원 산과에 입원, 분만한 총 551 예를 대상으로 분석 조사한 결과 다음과 같은 결과를 얻었다. 1. 총 분만 551예중 초산부가 287예(50.63%) , 경산부가 271(49.37%)이었다. 2. 산전 산모의 상태는 합병증이 없는 경우가 397예(71.24%)로 가장 많고 합병증이 있는 경 우는 임신성 고혈압 54예(10.15%) 생식기 및 골반의 이상이 20예(3.76%), 감염이 13예(2.44%) 및 산전 질출혈이 12예(2.26%)순이었다. 3. 분만 방법은 정상 질식분만이 333예(60.84%)로 가장 많고 기계분만 113예(20.58%) 및 제 왕절개술 93예(16.94%)의 순이었다. 4. 분만 중 합병증은 분만지연이 24예(초산 19예, 경산 5예)로 가장 많았고 태반계류가 15예 (4:11), hypotonic uteruie contraction 이 8예(5:3) 전치태반 7예(3:4)의 순이었다. 5. 총 분만 549예중 일반 전공의 (인턴)가 분만을 시술한 경우는 45예(8.20%)로 초산모 8예, 경산모 37예이며 나머지 502예(91.44%)는 산부인과 전공의 (레지던트)이상이 시술하엿다. 6. 제왕절개술의 적응증은 제왕술의 기왕력이 36예(38.70%)로 가장 많고 이상태위 13예 (13.98%), 전치태반 8예(8.60%)의 순이었다. 7. 신생아의 평균 1분 Apgar score는 7.65±1.07이었으며 5분 Apgar score는 7.68±1.54이었 다. 8. 평균 신생아 체중은 3125.22±598.78gm이었으며 초산은 3054.07±587.21gm이었고 경산은 3194.62±603.73gm이었다. 9. 산후 합병증은 치료를 요하였던 산욕열이 18예로 제일 많았고 치료를 요하였던 산후출혈 6예, 요로감염증 6예, 봉합술파열 1예의 순이었다. 10. 총 분만 551예 중 모성 사망은 한 예도 없었으며 신생아 사망률 은 1000명당 42.11이었다. This is a review of 551 cases of delivered women in National Medical Center from Feb. 1 to July 31, 1980. Maternity record which was designed by Korean Institute for Family Planning was checked for all delivered cases The results of these material were as follows; 1. The times of mean antenatal visit was 3.05±2.84, gestational weeks; 39.11±3.94, Hb. level ; 10.53±1.87gm%, mean age ; 28.05±3.95 year and mean educational duration 10.82±1.76 years. 2. The incidence of primary antenatal complications was 28.76% in 532 cases, of which hypertensive disorder was most one (10.15%). 3. The methods of deliveries were as follows; spontaneous viaginal delivery ; 334 (60.84%) operative one 113(20.58%) and C-section 93 (16.94%). 4. Of 82 cases of intrapartum complications, prolonged labor was major one (24 case) others were as retained placenta hypotonic uterine contration and placenata previa. etc. 5. Majority of attendant at delivery was resident or staff (91.44%). 6. Indications for cesarean section revealed as previous history of cesarean section (38.70%), malpresentation (13.98%), placenta previa (8.60%) and so. 7. The mean Apgar score at one minute was 7.65±1.07 and at 5 minutes after birth 7.68±1.54. 8. The mean body weight of newborn was 3125.22±598.78gm 9. of analized 542 cases, 42 cases had postpartum complications as purepheral fever, postpartum hemorrhage and urinary tract infection. 10. perinatal mortality rate was 42.11 per 1000 infants delivered, but maternal one was zero.

난소 종양의 임상 병리학적 고찰

박인서(IS Park) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.3

1. 전난소종양중 양성종양이 84.6%, 악성종양이 15.4%이었다. 2. 연령분포는 전난소종양 및 양성종양예에서는 36~40세, 악성종양예에서는 56~60세에서 가장 많이 볼 수 있었다. 양성종양예의 평균 연령은 38.5세, 악성종양예에서는 42.5세이었다. 3. 전난소종양예중 월경이 규칙적이었던 예가 68.3% 불규칙적이었던 예가 16.2%이었다. 양성종양예 및 악성종양예에 있어서 월경이 규칙적이었던 예는 각각 71.1% 및 52.6%, 월경이 불규칙적이었던 예는 각각 16.3% 및 15.8%이었다. 4. 자각증상으로 복부종양촉지가 전난소종양의 69.1%, 하복통은 52.0%, 요통은 22.7%이었다. 5. 타각증상으로 복수를 수반하였던 예가 전난소종양예중 5예(4.8%), cachexia가 4예(3.1%)이었다. 악성종양예에서는 복수 및 Cachexia의 빈도가 26.3%, 10.5%이었으며 양성종양예에서는 복수를 볼 수 없었고 1.6%의 cachexia를 볼 수 있을 뿐이었다. 6. 양성종양에 있어서 pseudomucinous cystadenoma 가 전양성종양의 32.6%, dermoid cyst가 30.7%, serous cystadenoma가 27.8%의 순위로 되어 있다. 악성종양에 있어서는 serous papillary cystadenocarcinoma가 전악성종양의 26.3%, pseudomucinous cystadenocarcinoma가 15.8%이었다. 7. Neoplastic ovarian cyst에 있어서 앙측성으로 온 dermoid cyst는 전 dermoid cyst의 18.7%, serous cystadenoma 는 3.5%, pseudomcinous cystadenoma는 2.9%이다. 8. 악성종양예에 있어서 serous cystadenocarcinoma가 pseudomucinous cystadenocarcinoma보다 2배 정도 많았다. 9. Neoplastic ovarian cyst의 악성빈도는 serous type이 14.7%, pseudomucinous type가 8.1%, dermoid tumor가 3%이었다. 10. Cystic carcinoma는 9예중 3예가, 양측성이었고 primary solid carcinoma 5예에서는 전부 단측성이었다. 11. Cystic carcinoma 중 양측성 발생빈도는 pseudomucinous cystadenocarcinoma 3예중 1예, serous papillary cystadenocarcinoma 5예중 1예이었다. 12. 악성빈도에 관하여는 전난소종양에서 15.4%, serous neoplasm 에서 14.7%, pseudomucinous neoplasm에서 8.1%였고 dermoid tumor에 있어서는 3.0%이었다. A clinico=pathological survey was made on a series of 123 ovarian tumors operated upon at National Medical Center, Seoul, Korea. The results obtained are as follows: 1) The incidence of benign tumors was 84.6% of all ovarian tumors while that of malignant ones 15.4%. 2) Age distribution of all ovarian tumors as well as benign tumors was concentrated on the ages between 36-40(average 38.5 years). malignant one on the ages between 56-60(average 42.5 years). 3) 68.3% of all ovarian tumors had regular menstrual cycles and 16.2% of them had irregularity to some extent; benign tumors showed 71.1% of regular cycles and 16.3% of irregular ones, while in malignat ones they were 52.6% and 15.8%, respectively. 4) As to the subjective symptoms of all ovarian tumors, palpable mass in the lower abdomen was noticed in 69.1%, lower abdominal pain in 52.0% and backache in 22.7%, respectively. 5) Ascites were observed in 5 cases(4.8%), cachexia in 4 cases(3.1%). In malignat cases ascites and cacheexia were noted in 26.3% and 10.5%, while in benign cases none had ascites and cachectic only 1.6%. 6) Among the benign tumors the incidence of pseudomucinous cystadenomas was 32.6%, that of dermoid cysts 30.7% and that of serous cystadenomas 27.8%. Of malignat tumors serous papillary cystadenocarcinomas were 26.3%, pseudomucinous cystadenocarcinomas 15.8%. 7) Bilaterality of dermoid cysts was noted in 18.7%, that of serous cystadenomas 3.5% and that of peudomicinous cystadenomas 2.9%. 8) Serous cystadenocarcinomas were obseved twice as frequently as pseudomicinous ones. 9) Malignancy of serous type was observed in 14.7%, while that of pseudomucinous type 8.1% and that of dermoid 3%. 10) Three out of 9 cases of cystic carcinoma were bilateral while all 5 cases of primary solid carcinoma were unilateral. 11) In cytic carcinma, bilateral occrrence was observed in one of 3 cases of pseudomucinous cystadenocarcinoma, and also in one of 5 cases of serous papillary cystadenocarcinoma. 12) The malignancy in serous neoplasma, pseudomucinous ones and dermoid tumors occurred in 14.7%, 8.1%, and 3.0%, respectively.

Methotrexate를 사용한 융모상피종의 치험례

박인서(IS Park),박연숙(YS Park) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.4

28세 경산부, 3회경산, 4회임신, 최종분만 1961년 4월, 산 후 계속되는 자궁출혈로 2회 소파수술 시행하였으나 지 혈되지 않아 1961년 9월 중순 모병원에서 개복수술을 시 행하여 자궁을 절개하고 소편의 태반조직을 절제하였다 함. 그후 계속되는 자궁출혈(중등도)로 타의사를 방문하 여 거기서 frog test for gonadotrphic hormone을 행하였 던바, Positive로 보고되었고 수구후 다시 Fricdmann test를 하였던바 역시 positive였다고 한다. 1961년 10월13일 국립의료원에 입원하여 재차 frog test 를 시행하였던 바 역시 Positive로 나타났고 자궁내막 시 험 소파에서는 특별한 소견이 없었으나 계속되는 양성 뇨소견으로 1961년 10월23일 개복수술을 시행하였다. 수술소견에 있어서 융모상피종을 의심할만한 것이 없고 단지 전수술시의 자궁벽을 절제하였던 부위에 약간의 necrosis와 adhesion이 있었을 따름이다. 적출표본 병리검사 결과는 chronic metritis라고 보고되 었다. 수술후 뇨반응도 음성화하고 수술경과도 양호하여 동년 11월 9일 퇴원하였다. 수술전 흉부 X-ray소견은 이상이 없었으나 술후 3주의 뇨반응이 다시 음성화하였 으므로 즉시 흉부X-ray 를 촬영하였던 바 융모상피종 전이를 발견하였으므로 즉시 재 입원하여 methotrexate 를 5일간 75mg를 투여하고 부작용으로 일시 중단하였다 가 다시 5일간에 125mg를 투여하였다. 그후 임신반응도 음성으로 변하고 흉부X-ray소견도 점차 호전되어 극히 소부분만이 잠재하고 있으며 계속 관찰중에 있다.

난소갑상선종의 1예

박인사(IS Park),탁혜정(HJ Tack),신현우(HY Shin),박호영(HY Park) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.10

좌측난소갑상선종 1예를 보고하고 그 문헌적 고찰을 하였다. A case of struma ovarii was reported with brief review of literatures. The tissue fragments of tumor were composed of thyroid tissue exclusively and no other dermoid element could be seen. Pre-and post-op I uptake were within normal limit.

기능성 난소종양 ( 특히 여성난소종양 ) 의 임상적 관찰

박인서(IS Park),강옥희(OK Kang),조성진(SJ Cho),박춘식(CS Park) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.5

1. 여성화난소종양의 발생빈도는 전 난소종양의 1.7%, 전 악성난소종양의 15.7%이었다. 2. 여성화난소종양중 과립막세포종이 62.5%, 세포막세포종 25.0%, 과립막 세포막 세포종 12.5%이 었다. 3. 여성화난소종양 환자의 최소연령은 23세, 최고연령은 72세이었고 평균연령은 42.6세 이었다. 4. 여성화난소종양 16예 중 7예(43.8%)는 5회 이상의 경산부이었고 6예(37.5%)는 미산부이었다. 5. 생식 연령층이 10례(62.5%)로 가장 많았고, 폐경기후가 5예(31.3%), 생식기전 연령충이 1예(6.3%)이었다. 6. 임상증세로 하복부 종양촉지가 13예(81.3%), 복수 9예(56.3%), 월경과다 6예(37.5%) 의 순위이었다. 7. 자궁내막선암이 공존하였던 경우가 8예(50.5%), 자궁내막중식증이 있었던 경우가 6 예(37.5%)이었다. 8. 치료는 외과적 절제술을 원칙으로 하였으며 방사선 치료를 선택적으로 시행하였다. 9. 수술 후 경과 및 예후는 16예 중 10예(62.5%)에서 재발없이 생존하고 있었다. Clinical observation was made on sixteen cases of granulosa-theca cell tumors collected at the Department of Obstetrics and Gynecology from January 1,1960 to December 31,1975. The results were as follows: 1. The incidence of feminizing ovarian tumors for all ovarian neoplasm and for all ovarian malignancy were 1.7% and 15.7%, respectively. 2. Granulosa cell tumor occupied 62.5%, theca cell tumor 25.0% and granulosa-theca cell tumor 12.5% of all feminizing ovarian tumors. 3. The youngest age and oldest age for feminizing ovarian tumors were 23 and 72 year old, respectively. The mean age was 42.6 year old. 4. Out of 16 feminizing ovarian tumors, 7 cases (43.8%) belonged to more than 5 parity group and 6 cases (37.5%) to nulliparous group. 5. Out of 16 feminizing ovarian tumors, 10 cases (62.5%) occured in menstruating period, 5 cases (31.3%) in postmenopausal period and 1 case(6.3%) in premenstrating period. 6. Clinical manifestations revealed palpable mass in 13 cases(81.3%), ascites in 9 cases (56.3%) and hypermenorrhea in 6 cases(37.5%) 7. Endometrial adenocarcinoma concomitantly existed in 8 cases (50.0%) and endometrial hyperplasis in 6 cases (37.5%) 8. Treatment primarily resorted to surgical intervention and followed by irradiation therapy in the selective cases. 9. Ten cases out of 16 (62.5%) were survival without sign of recurrence so far.

경막외마취가 분만에 미치는 영향

박인서(IS Park),김용철(YC Kim),박형무(HM Park),김순관(SK Kim),강대웅(DW Kang),송시종(SJ Song) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.2

1. 1981년 4-5월동안 총 분만예는 219였으며 경막외마취를 시행하였던 18예의 평균 경관개대는 4.0cm이었다. 경막외마취제는 1% lidocaine을 사용하였고 주입 부위는 대부분 제 4-제 5요추이었다. 2. 마취군의 평균 연령은 25.1세, 대조군은 27세였다. 3. 분만 제 1기의 마취군의 평균시간은 11.1 시간에 비해 대조군은 9.8시간으로 특이한 차이를 보이지 않았다. 4. 경막외마취 18예의 분만 제 2기의 평균시간은 69.2분으로 대조군(39.0분)에 비하여 현저한 지연을 보였다. 5. 분만진통 억제효과는 약 2/3에서 양호한 결과를 보였다. 6. 진통억제의 평균시간의 78.3분이었다. 7. 경막외마취에 사용된 평균 약제양은 14.5 ml이었다. 8. 18예의 마취군 중 14예에서 마취후 태아심음에 변화를 초래하지 않았으며 나머지 3예도 직접적인 결과를 보이지는 않았다. 9. 6예에서 합병증을 보였으며 전신전율, 오심 및 구토, 운동신경 장애, 현기증 등의 순이었다. 10. 분만방법은 대조군에 비해 2배의 흡입분만의 빈도(8:4)를 보이며 제왕절개술은 한예도 없었다. Recently many obstetricians believed that the epidural effect for pain relief was satisfactory. The effect of epidural block on labor of 18 cases was studied from April to May in 1981 at National Medical Center. Epidural block was achieved by help of anesthesiologist with 1% lidocaine. All epidural group, 18 primigravida, had no complication during antepartum and intrapartum. Fetal monitoring was provided before and after block for the purpose of observation on fetal heart rate. The results of these studies were as followings. 1. Eighteen epidural block with 1% lidocaine was carried out among 219 deliveries. The mean cervical dilatation was 4.0 cm. 2. The mean age of block-group was 25.1 year and control group 27. 3. The effect of epidural block on the 1st stage of labor revealed non-specific difference in both group(11.1: 9.8 hrs). 4. The prolongation of 2nd stage of labor in block-group was noted (69.2 min), but control group was 39.0 min. 5. The efficacy of pain control by epidural block was good to excellent. 6. The mean duration of analgesic effect was 78.3 minutes. 7. Six cases got consecutively given agent among 18 block cases, and mean total dose was 14.5 ml. 8. The effect on fetal heart rate was not significant. 9. Six of 18 block-group had two or more adverse effects including shivering, nausea & vomiting, motor disturbance and others. 10. The incidence of operative vaginal delivery was increased due to prolongation of 2nd stage and decreased expulsive effort (vacuum delivery was 2 times more than control group).

산부인과영역에서 Cefoperazone ( Cefobid ) 의 임상적 효과

박인서(IS Park),박형무(HM Park),송시종(SJ Song),김영제(YJ Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결과 Celfozone 2gm 1일 2회 정주 투여 방법에 의한 산부인과 영역의 임상실험의 안전성과 임상효과를 평가하여 본 결과 전체적으로 만족스러운 임상효과를 보았던 경우가 87%에 해당되었다. Cefoperazone, a new broad-spectrum semisynthetic cephaiosporin, is one of the new third-generation cephalosporin which has been shown to inhibit most of the important Gram-positive and Gram-negative pathogens. This is a report based on 31 cases of clinical trials of these drugs on serious obstetric and gynecologic patients in this hospital during 1 year period from April 1981 to March 1982. Six cases were primarily treated with Cefoperazone and 25 cases were treated with Cefoperazone mostiy due to be refractory to the previous antibiotic therapy. Cefoperazone was mainly administrated by 2gm/day intravenously. We had an excellent results in eradication rate of organisms by Cefopcrazone as follows. E. coli, Enterococcus, Klebsiella. Serratia, Proteus and Neisstria showed 100% eradition, and Staphylococcus 80% eradication, respectively. Pseudomonas was eradicated in one case of two, and EnterococcuS or Acinetob-acter was not eradicated in each single case. respectively. The overall eradication rate corresponded to 87%. Side effects were almost negligible in all cases. Two out of 31 patients experienced mild degree of nausea with vomiting and dizziness with flushing, but became under control with smiple symptomatic treat-ments.

지상아를 동반한 쌍태임신의 1례

박인재(IS Park),조무호(MH Cho),구제춘(JC Koo) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.1

본원 산부인과에서 임신 제36주의 쌍태임산부에서 제2아가 지장아였던 1예를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Fetus Papyraceus in multiple pregnancy is a rare complication. If one fetus of multiple pregnancy will be died in uterus usually before the second trimester and retained until the end of the pregnancy, compressed between the uterine wall and the membrane of the living child, become a fetus papyraceus. Recently, authers have a case of fetus papyraceus in fraternal twin pregnancy at our dept. of Obstet. & Gynec. A case of fetus papyraceus is presented with brief literatures.