산전초음파진단에 의한 골형성부전증 1 예

박용원(YW Park),정인배(IB Chung),김재욱(JU Kim),양영호(YH Yang),한은경(EK Han),박찬일(CI Park) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.10

최근저자들은 제태기간 36주에 초음파진단에 의해 선천성 골형성부전증을 경험하였기에 문 헌적 고찰과 함께 보고하는 바이며, 이를 경험으로 많은 저자들이 보고한 바와 같이 임신 14주이후부터 숙련된 초음파 술자에 의한 의례적인 시행이 산전관리의 필수적 검사임을 강 조하지 않을 수 없다. osteogenesis imperfecta is a clinical , genetically biochemically radiologically heterogenous group of inherited connective tissue disorder characterized by bone fragility and other evidence of connective tissue involvement. One of these , the perinatal form on OI tyep II is rare disorder characterized by poorly ossified calvaria, beaded rib and short, bowed limbs. we recentrly exeprinced a case of OI type II diagnosed in utero by ultrasonography and confirmed by postnatal radiograph and autopsy. We present the case with the review of the literatures

자궁경부암 환자에서 국소 임파절형태에 따른 예후 평가

최동희 ( DH Choi ),박찬규 ( CK Park ),박찬일 ( CI Park ),이병석 ( BS Lee ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.11

치료전 개복에 따른 자궁경암근치술 및 양측 골반임파절 절제술을 시행받은 침윤성 자궁경부암 환자 91예를 대상으로 적출된 국소임파절을 형태학적으로 분류하고, 각 임파절형태와 다른 예후인자와의 상관관계 및 각 임파절형태에 따른 누적생존율을 분석하여 다음과 같은 결과를 얻었다. 1. 91예에서 국소임파절을 Cottier criteria(1972)에 의해 형태학적으로 분류해 볼때, LP군이 58예(63.7%)로 가장 많았고, GCP군이 22예(24.2%), US군이 11예(12.1%)였으며, LD군은 없었다. 2. 국소임파절 형태별 평균연령을 보면, US군이 46세로 GCP군의 41세에 비해 많았다(P<0.05). 3. IB기(수술적 병기)의 빈도는 LP군에서 94.8%로써 GCP군, US군의 68.1%, 72.7%에 비해 의의있게 높았다(P<0.05). 4. 치료전 병소의 크기, 조직학적 세포형태, 자궁경부 실질의 암침윤 깊이 및 lymphoplasmacytic cell 침윤형태는 국소임파절의 형태와 의의있는 상관관계가 없었다. 5. 골반임파절의 암 전이 빈도는 LP군에서 3%로써 GCP군의 27.3%, US군의 27.3%에 비해 의의있게 낮았다(P<0.01). 6. 국소임파절 형태별 3년 누적생존율을 보면, LP군이 92.8%로서 가장 높았고 GCP군이 87.5%, US군이 76.7%였다. 이상에서 볼때, 침윤성 자궁경부암 환자에서 국소임파절의 형태는 예후적 가치가 있고 특히 lymphocyte predominance 형태는 다른 형태에 비해 양호한 예후를 갖는다고 사료된다. Histologic materials from 91 cases of primary invasive cervical cancer in patients who underwent pretreatment laparotomy followed by radical abdominal hysterectomy and bilateral pelvic lymph node dissection were studied, with particular emphasis on the morphology of regional lymph nodes. Lymph nodes were classified morphologically according to the criteria proposed by Cottier (1972). The relationship between regional lymph node morphology and other clinicopathologic prognostic factors, and the cumulative survival rate in various types of regional lymph node morphology were evaluated. Among the 91 cases, lymphocyte predominance pattern(LP) was most common, occurring in 58 cases (63.7%), germinal center predominance pattern(GCP) in 22 cases (24.2%), and unstimulated node (U) in 11 cases in order of frequency. Lymphocyte depletion pattern (LP) was not present in this study. The mean age of the patients with US was 46 years, significantly older than those patients with GCP whose mean age was 41 years (P<0.05). The frequency of surgical stage IB in patients with LP was 94.8%, significantly higher than 68.1%, 72.7% of those with GCP, and US each. There was no direct relationship between lymph node morphology and cervical lesion size, cell type, depth of tumor invasion of cervix, or major type of lymphoplasmacytic cell infiltration into cervical lesion. LP was associated with a statistically significant decrease (3%) in lymph node metastases (P<0.01). In contrast, patients with lymph nodes showing US or GCP had a high incidence of metastatic lymph node (27.3% each). The Three-year cumulative survival rate according to lymph node morphology was the highest in LP (92.8%), followed by GCP (87.5%) and US (76.7%). These findings suggest that regional lymph node morphology may be of prognostic significance and lymphocyte predominance pattern seemed to be connected with favorable prognosis in patients with invasive carcinoma of the uterine cervix

자궁경관에 발생한 이소성 혼합육종의 1례

이국(K Lee),이윤호(YH Lee),김대현(TH Kim),박찬일(CI Park),이광길(KK Lee),노재윤(JY Ro) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.1

결론 1. 자궁경관에 발생한 이소성 혼합육종의 1예를 보고하였다. 2. 근치자궁적출술 및 양축 골반 임파선적출술, 방사선치료, 불완전하나마 혼합약물요법같은 병합요법으로 치료한 예에서 1년간 재발없이 생존하였다. Mixed heterologous sarcoma of the uterine cervix is a rare and highly malignant tumor. A case of this type was recently experienced in a 20-year0old unmarried woman and served as the vasis of this report. The patient has been bollowed for 1 year without evidence of recurrence. Such tumors develop from the mesodermal tissue associated with mullerian duct and consist of heterologous and gifhly malignant tissues. A brief rebiew of literature is presented, especially concerning the current tend- ency of treatment : combined modality with surgery, radiotherapy and combinatation chemotherapy.

단순화된 체외수정 및 배아이식술의 경험

오기석,박찬일,김행수,박지영,윤인자,김동민,권혁찬,황경주,양현원,유정현,홍순정 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

During the past few years much effort has been put into simplifying the clinical man-agement of in-vitro fertilization/embryo transfer cycles. One important step was the intro-duction of transvaginal ultrasound-guided oocyte collection, as previously described. This study describes further simplifications in the clinical management of ovarian stimulation and luteal support, and in-vitro fertilization procedure. During the period from October 1994 to September 1995, two major simplification steps were introduced. All cycles were administe-red with a gonadotrophin-releasing hormone agonist according to a long or short protocol preventing premature LH surge. During period Ⅰ(Group Ⅰ, n=62 cycles), closer monitoring by several pelvic ultrasound scans and serum oestradiol was used for monitoring the ovarian stimulation;HTF media with fetal cord serum was used for insemination, growth and tran-sfer media in IVF-ET procedure;progesterine in oil was daily used by intramuscular injec-tion for luteal support. During period Ⅱ(Group Ⅱ-Ⅰ, n=71 cycles), only several ultrasound scans were used for monitoring the ovarian cycle;Medi-cult IVF media containing synthetic serum replacement was used for insemination, growth and transfer media; Progesterine in oil was used daily by intramuscular injection for luteal support. During period Ⅲ(Group Ⅱ-Ⅱ, n=16 cycles), further simplification of the clinical management was introduced by using a intravaginal micronized progesterone(Utrogestan) for luteal support. Retrospective analysis between Group Ⅰ and Group Ⅱ showed no differences in the number of oocyte(13.2±0.8/14.6±1.0), fertilization rate(71.5 %/60.7 %), cleavage rate(63.6 %/57.9 %), number of embryos transfered(5.0±0.5/4.5±0.5). Ongoing pregnancy rates obta ined from the three groups(Group Ⅰ, Group Ⅱ-1, Group Ⅱ-Ⅱ) were 25.8 %, 25 % and 40 %, respectively(p=ns). But introduction of minimal monitoring gave a significant reduction in the average number of US measurements in the simplified groups(Group Ⅱ) compared with the group using the conventional monitoring protocol(Group Ⅰ)(3.8±1.0/8.7±2.8, p<0.05). In the above groups, five patients developed severe OHSS but there was no differenc e in the distribution. Conclusively, simplified protocols including minimal follicle monitoring only by US, IVF-ET with Medi-cult IVF media containing synthetic serum replacement and the luteal support with intravaginal micronized progesterone gave a increased efficacy of the clinical phase of IVF treatment without a reduction in the success rate.

난소의 악성 배세포종양

최동희,김수녕,박찬규,김재욱,박찬일,이성기 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

난소의 악성 배세포종양은 사춘기를 전후한 ��은 여성에게 흔히 발생하는 드문 종양으로 치료방법 및 예후인자가 타 난소종양과 다르다. 지금까지 전세계적으로도 이 종양에 대한 연구보고는 그 수가 많지 않으며 특히 국내에서는 몇몇의 증례보고만이 있을 뿐이다. 이에 저자는 1967년 1월부터 1988년 12월까지 연세대학교 의과대학부속 세브란스병원에서 난소의 악성 배세포종양으로 치료받은 71예의 환자를 대상으로 의무기록을 토대로 한 후향적 연구를 실시하여 임상 조직학적 특성을 종합하고 생존율에 영향을 미치는 예후인자예를 분석하였던 바 다음과 같은 결론을 얻었다. 환자의 연령은 1세에서부터 65세까지 분포하였고 20대가 가장 많았으며 평균연령은 23세이었다. 임상적 병기의 분포는 I기와 III기가 각각 45%와 37%로 대부분을 차지하였고 II기와 Ⅳ기가 각각 4%와 6%였다. 조직학적 분류에 따른 종양의분포는 미분화 배세포종(dysgerminoma)이 55%로 가장 많았고 내배엽동 종양(endodermal sinus tumor)과 미분화기형종(immature teratoma)이 각각 13%, 배아암종(embryonal carcinoma)이 10%, 혼합 배세포종(mixed germ cell tumor)이 8%, 융모상피암종(choriocarcinoma)이 1%순이었다. 71예 전체의 5년 누적생존율은 60%였고 미분화 배세포종이 68%의 생존율을 보였으며 혼합 배세포종은 20개월만에 모두 사망하였다. 난소의 악성 배세포종양의 예후인자로는 임상적 병기와 잔류종양의 크기가 가장 중요한 인자였고 복수도 의의있는 예후인자였다. 종양의 크기는 예후에 영향을 미칠 수 있는 인자라고 생각되나 미분화 배 세포종에 있어서는 의의가 없었다. 미분화배세포종에서는 복수와 환자의 연령이 예후와 관계있는 인자일 것으로 사료되었다. 미분화배세포종 이외의 악성 배세포종양에서는 증례의 수가 적어 예후 인자의 분석을 실시하지 못하였다. Seventy-one patients with malignant germ cell tumors of the ovary treated at Yonsei University College of Medicine from January 1967 throught Decembdr 1988 were retrospectively reviewed. Mean age of the patients was 23 years. Distribution of patients by histlolgic type revealed that dysgerminoma was most frequent (55%), followed by endodermal sinus tumor(13%), immature teratoma (13%), embryonal carcinoma(10%), mixed germ cell tumor(8%), and choriocarcinoma (1%). The overall 5-year cumulative suvival rate was 60%. Stage, residual tumor size, and ascites were found to be significant prognostic factors. Tumor size was a prognostic factor of marginal importance.

자궁경부암 환자의 임상적 양상 및 치료후 5 년생존율

최영민,강순범,이효표,신면우,장윤석,박찬일,박진완,서대식,하성환 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.6

서울대학병원 산부인과학교실에서는 1959년부터 1987년까지 서울대학병원 산부인과와 치료 방서선과에서 자궁경부암으로 진단 및 치료받은 2555에의 임상양상과 1977년 1월부터 1982 년 12월까지 치료를 받은 침윤성 자궁경부암환자들의 임상기별 5년생존율을 생명표법(life table analysis)으로 구하여 다음과 같은 결과를 얻었다. 1. 자궁경부암의 임상양상(1959년~1987년) 1) 연평균 환자수는 88.1명이었다. 2) 연령별 분포는 41~50세군이 전체 환자의 41.9%를 차지하여 가장 높은 발생빈도를 보였다. 3) 임상병기별 분포는 II기가 41.4%로 가장 높은 빈도를 보였으며, I기(38.0%), 0기와 III기 (8.8%), IV기(3.0%)순이었다. 4) 조직병리학적 분포는 편평상피세포암이 95%, 선암이 4.3%, 선편평상피세포암이 0.7%였다. 5) 임파선전이는 I기에서는 15.2%, II기에서는 33.8%였다. 2. 생명표법(life table analysis)에 의한 침윤성 자궁경부암 환자의 5년생존율(1977년~1982년) 1) 대상환자는Ia기 37예, Ib기 199예, IIa기 127예, IIb기 171예, III기 64예, IV기 29예였다. 2) 5년생존율은 Ia기 100%, Ib기 80.8%, IIa기 74.5%, IIb기 66.8%, III기 51.9%, IV기 27.4%였다. From January 1959 to December 1987, 2555 cases of uterine cervical cancer were evaluated at Seoul National University Hospital, Seoul, Korea. The purpose of this study was to analyze the clinical profile and 5-year survival rate of cervical cancer. The mean number of patients per year was 88.1 cases. The majority of patients, 1070 cases (41.9%), was found in the group of age between 41 and 50. The distributions of patients by the clinical stages were as follows: Stage 0, 224 cases(8.8%); Stage I, 971 cases (38.0%); Stage II, 1059 cases (41.4%); Stage III, 225 cases (8.8%); and Stage IV, 76 cases (3.0%). The result of histopathologic subtype were distributed as follows: squamous cell carcinoma was 95.0%, adenocarcinoma was 4.3% and adenosquamous cell carcinoma was 0.7%. The frequency of lymph node metastasis was 15.2% in Stage I and 33.8% in Stage II. We have also evaluated the 5-year survival rate of the patients treated from January 1977 to December 1982, according to life table analysis. The results were as follows: Stage Ia, 100%: Stage Ib, 80.8% ; Stage IIa, 74.5%; Stage IIb, 66.8%; Stage III, 51.9%; Stage IV, 27.8%.