형장 Ferritin 측정에 의한 만삭임부와 신생아의 철저장에 관한 연구

박형무(HM Park),박인서(IS Park),김승욱(SW Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.15

The present study was undertaken to evaluate the iron status of term pregnant women and to assess the relationship between maternal iron stores and iron status of their newborn infants. Iron status was evaluated in 113 mothers and their newborn infants by measuring the iron parameters, such as plasma ferritin, hemoglobin, hematocrit, mean corpuscular hemoglobin concentration, plasma iron, total iron binding capacity and transferrin saturation. The result were as follows. 1. Iron deficiency, if defined as plasma ferritin less than 12ng/ml, was observed in 81 mothers or 71.7 percent of the total. Overall prevalence rate of anemia at term was 25.4 percent and iron deficiency was observed in 86.2 percent of all anemic mothers. 2. Mean newborn cord plasma ferritin concentration of 87.9 ng/ml was 8.6 times of mean maternal concentration of 10.2 mg/ml. The levels of other biochemical iron parameters of newborn cord plasma were also higher than those of maternal plasma except the level of total iron binding capacity. 3. There was no correlation between maternal plasma and newborn cord plasma ferritin concentrations either in ono-iron deficient mothers (r=0.1633 p:0.186) or in iron deficient mothers (r=0.1233 p: 0.136), sugesting that newborn iron stores were independent of maternal iron stores. 4. There was no correlation between maternal plasma ferritin concentrations and levels of newborn iron parameters. Newborn plasma ferritin concentrations were not correlated with levels of maternal iron parameter. 5. No difference was observed in newborn cord plasma ferritin concentrations and levels of other biochemical iron parameters between newborns of non-iron deficient moehters and thoses of iron deficient mothers, whether the extent of deficiency was severe or mild.

자궁내장치와 병발된 원발성 난소임신 1예

박형무(HM Park),강대웅(DW Kang),박인서(IS Park) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

자궁내장치와 병발된 원발성 난소임신 1예를 경험하였기에 문헌고찰과 함께 국내 최초로 보고하는 바이다. An ovarian pregnancy with IUD in situ, which is an extremely rare type of ectopic pregnancy, is reported with the brief reviews of literatures for the first time in Korea.

고위험도 임신군에서 Non-Stress Test의 임상적 의의

박인서(IS Park),김용철(YC Kim),박형무(HM Park),박창서(CS Park),차인식(IS Cha) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

1. 1980년 9월 1일부터 1981년 8월 말까지 만 1년간 총 분만은 1,307예이었으며 NST의 시행빈도는 82예(6.27%)로 매우 낮은 비율을 보였으며, NST 시행군의 평균 연령은 26.7세, 평균 분만력은 1.4였다. 2. NST 시행군 82예의 적응증은 중증 임신중독증 27예, 과숙아 25예, 경증 임신중독증 11예의 순이었다. 3. 82예의 초회 NST 시행시의 평균재태 기간은 37.9주였다. 4. NST의 판독 결과 78회에서 반응성을 보였으며 무반응성은 6예(6.52)였다. 5. NST에 따른 신생아 Apgar 수치는 반응성인 경우 3미만이 없었으나 무반응성 4예 중 1예에서 심한 태아절박상태(3미만)을 보여 주고 있다. 6. 분만 방법은 질식분만이 68예, 제왕절개군은 14예(17.07%)였다. 7. 무반응성 NST 4예 중 NST 시행 결과 2예에서 양성을 보였으며 모두 태아사망을 보였다. 8. 신생아 사망은 NST시행군(92회)중 양성의 NST군(78예)에서는 전무하였으나 4예의 음성 NST군에서는 4명 중 2명 이었다. For the assessment of fetal well-being, a lot of methods such as biochemical, hormonal assay and fetal monitoring were available. Non-stress test is provided particulary important role in cases of high risk pregnancy. Especially it is simple, economic and not harmful to fetomaternal health, and results in wide utilization in the most obstetric services. We studied and reported 92 non-stress test in high risk pregnancy from Sep. 1980 to Aug. 1981 at National Medical Center. The results of these studies were as follows. 1. Total number of deliveries were 1,307 and incidence of NST was 82 (6.27%). 2. Non-stress test was provided for high risk pregnancy includeing hypertensive disorder in pregnancy 38(40.86%), post-date 25(26.88%), premature uterine contraction 9 (6.45%) and others. 3. The mean gestational weeks in NST group was 37.9. 4. Reactive pattern of NST was noted in 78 cases among 92 NST, whereas 6 cases(6.52%) in non-reactive result. 5. Apgar score had a correlation to non-reactive group (1/4 cases-under 3). 6. The cesarean section rate of NST group was 17.07%. 7. Consecutive CST 4 cases of non-reactive group showed positive in half and 2 cases of non-reactive NST was reactive CST. 8. Perinatal death was noted in 2 cases among 4 non-reactive NST group, but zero in reactive NST 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.

자궁외임신에 대한 임상 통계학적 고찰

박성구(SK Park),이명근(MK Lee),조성진(SJ Cho),박형무(HM Park) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.2

국립의료원 개원이후 즉 1960년초부터 1976년 말까지 만 17년간 본원 산부인과에 입원 가료후 병리조직학적 검사를 시행한 자궁외임신 환자 778예에 대하여 임상통계적 고찰을 하였으며 그 결과는 다음과 같다. 1. 자궁외임신의 분만수에 대한 빈도는 1:26.0(3.9%)였다. 년도별 발생빈도를 관찰할 때 현저한 증감의 추세는 볼 수 없었다. 2. 빈발연령은 25-34세로 64.1%를 점유했으며 평균 연령은 30.8세였다. 3. 불임자는 8.2%, 미산부는 14.4%이며, 1-4회 임신이 68.2%를 점유하였고 경산회수는 3회 이후에서 외임 발생빈도와 반비례 하였다. 4. 불임기간은 평균 4년 7개월이었다. 5. 기왕력은 인공유산이 56.3%로 가장 많았고 개복수술이 14.8%이며 이중 반복 외임이 11.2%, 충수절제수술이 2.2%, 골반내 결핵 2.0%이었다. 또 자궁내 장치를 삽입한 상태에서 외임이 된 2예가 있었다. 6. 주요증상은 동통이 99.9% 성기출혈이 91.3% 무월경이 62.1%였으며 오심구토가 37.3%, 현훈이 16.1%, 임신자각증상이 2.1%였다. 복부 진찰에서 압통이 87.7%, 팽창 67.7%, 종류촉지 68.0%였으며, 골반내진시 하복부 및 부속기 압통이 85.2%, 부속기 종류촉지 78.3%, 자궁경부 압통이 43.9%, 자궁증대, 더글라스와 팽만이 35.0%였다. 7. 쇽크의 증상을 보였던 예는 54.9%였고 혈색소 10gm% 이하의 빈혈을 보였던 예가 80.5%였다. 8. 임신 반응검사는 54.8%에서 양성이었다. 9. 증상발현후 입원까지의 기간은 6일 이상이 67.2%였다. 10. 진단의 정확도는 95.4%였으며 더굴러스와 천자의 적중율은 97.4%였다. 11. 이환은 우측이 다소 많았고 착상부위는 난관이 98.2%, 난소가 0.5%, 자궁경부가 0.4%, 난관절제후 자궁각임신이 0.1%였다. 난관임신에서는 팽대부 91.8%, 협부 4.1%, 체부 2.7%, 간질부 1.3%였다. 12. 복강내로 실혈된 혈액양은 60.5%에서 1,000-2,000cc로 측정되었다. 13. 중절양식은 파열이 87.5%, 유산의 11.8%, 무상이 1.4%였다. 14. 수술방법은 환측난관절제가 67.3%, 환측부속기절제가 33.4%였으며, 동시에 병행한 수술은 대측난관결찰이 9.3%, 충수절제수술이 1.8%, 대측난관성형술이 0.9%였다. 15. 외임에 동반된 타질환은 난관수종 2.1%, 골반내염증 1.4%, 난소낭종 0.9%, 자궁근종 0.4%, 골반결핵 0.3%였다. 16. 전 외임 예중 사망은 1예이었다. A clinico-statistical survey was made on a series of 778 ectopic pregnancies operated and confirmed with histopathological study at the Department of Obstetrics and Gynecology, National Medical Center during the period from January 1, 1960 to the end of December 1976. The results obtained were as follows. 1) During the same period, there were 20,209 deliveries, thus giving a rate of 1 ectopic per 26.0 deriveries, a rate of 3.9%. There has been no appreciable increase or decrease in the incidence of ectopic pregnancy. 2) The highest frequency of ectopic pregnancies was in 25-34 years of age, comprising of 64.1% and the mean age was 30.8 years. 3) The frequency of nulligravida was 8.2%, and nullipara, 14.4%, 68.2% of ectopic pregnancies was between gravida 1 to 4. 4) The mean duration of infertile period was 4 years and 7 months. 5) A history of previous curettage was noted in 56.3% of total. 14.8% of total cases had previous laparotomy. Among them, repeat ectopic pregnancies were 11.2% and appendectomy, 2.2%. A history of venereal diseases was detected in 4.0%, pelvic inflammatory disease, 2.2% and pelvic tuberculosis, 2.0% respectively. The intrauterine device in utero was noted in 2 cases of ectopic pregnancies. 6) The 3 most common symptoms in order of frequency were pain (99.9%), vaginal bleeding (91.3%) and amenorrhea (62.1%). Nausea and vomiting was found in 57.3%, dizziness and vertigo in 16.1% and subjective symptoms of pregnancy in 2.1%. Of the abdominal findings, tenderness was noted in 87.7%, distension in 67.7% and palpable mass in 68.0%. On pelvic examination, lower abdominal or adnexal tenderness was detected in 85.2%, adnexal mass in 78.3%, tenderness on the motion of cervix in 43.9%, the enlarged uterus in 36.0% and fullness in Cul-de-sac in 35.0%. 7) 54.9% of ectopic pregnancies was in shock state and hemoglobin level less than 10 gm% was found in 80.5% of cases. 8) The pregnancy test was positive in 54.8% of the total. 9) The period to admission after initial symptoms was more than 6 days in 67

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.

제왕절개 자궁적출술의임상적 고찰

박찬무(CM Park),박형무(HM Park),엄승호(SH Ohm),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.5

1. 제왕절개자궁적출술을 받은 환자 32예중 66%의 예에서 산과적 출혈에 의한 응급을 요한 수술이었다. 이의 적응증으로는 자궁파열이 6예로 18.75%를 차지하였고, 이완성 자궁출혈이 5예 (15.63%), 유착태반이 4예(12.5%) 전치태반에 의한 지혈곤란, 자궁근종, 자궁경부암 및 불임 목적으로 각각 3예씩 (9.38%)을 차지하였고 기타의 경우가 15.6%를 차지하였다. 2. 심한 출혈로 인한 쇼크 상태의 환자 즉 쿠베레어 자궁이나 지혈곤란의 경우에선 부분적 자궁적출술을 시행하였고 다발성 자궁근종의 경우는 출혈은 심하지 않았으나 수술상의 난점 으로 역시 부분적 자궁적출술을 실시하였다. 3. 수술후 21예(65.6%)에서 아무런 합병증이 없었으며, 합병증이 나타난 예에서는 창상감염 및 파열이 4예(12.5%)로 가장 많았고 요로감염 및 방광손상에 의한 방광무력증이 각각 2예 로 6.25%를 차지하였고, 그외 골반농양, 마비성 장폐쇄, 복막후강출혈등이 1예씩 있었다. 4. 산모사망은 2예(6.25%)로 비교적 높은 비율을 차지하였는데, 그중 1예는 수술중 지혈곤란 으로 사망하였고, 다른 1예는 패혈성 쇼크환자로서 수술후 골반농양, 장누공 및 패혈증으로 사망하였다. This study was undertaken to determine the present status of cesarean hysterectomy. Cesarean hysterectomy was originally devides to combat postcesarean infection and hemorrhage, and it indication have gradually been widended to include many conditions in which removal of the uterus is necessary or desirable. In this study the outcome of 32 cases of cesarean hysterectomy performed at National Medical Center during 18 years from Jan. 1962 to Dec. 1979 was discussed and evaluated. There were 21042 deliveries during this period. Cesarean hysterectomy was performed in 32 of 1360 cesarean section, an incidence of 2.35%. The incidence of cesarean section was 6.46%. The age of patients varied needed immediate emergency operations. In about 2/3 of total patients (65.6%) there were no postoperative complications There were 2 cases of maternal mortality in this series . They underwent cesarean hysterectomy for placenta previa and postpartum intrauterine infection, however, ond died of sepsis and the other of uncontrollable bleeding. To prevent these catastrophies periodic and meticulous antenatal care must be provided.

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).

양성난소 기형종에서 발생한 편평상피세포암 1 예

최병찬(BC Choi),박형무(HM Park),김우균(WK Kim),박용욱(YW Park),배도환(DH Pai) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.4

저자들은 중앙대학교 의과대학 부속병원 산부인과에서 양성난소기형종에서 발생된 편평상피 세포암 1예를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. The dermoid cyst is the most common ovarian germ cell neoplasm comprising 10% of all ovarian tumors . There are many complications in dermoid cyst such as rupture torsion, infection and suppuration etc. Among these, relatively uncommon but most serious complications is malignant degeneration. Many types of malignancy can develop from dermoid cyst. The most common type is the squamous cell carcinoma. We experienced a case of squamous cell carcinoma arising in dermoid cyst of the ovary in 68 years old postmenopausal woman and present this case with a brief review of concerned literatures.

분만중 자궁경관차단 마취의 효과 및 위험성에 관한 임상적 고찰

김용철(YC Kim),박형무(HM Park),이강보(KB Lee),차인식(IS Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.5

1. 산과적 합병증이 없는 분만 제 1기 산모 32예에서 PCB를 시행하였으며 평균연령 23.6세, 초산부 20예이며 경산부는 12예였다. 2. 32예의 PCB를 시행시 자궁개대정도는 평균 4.2cm(3-6cm)였으며 4cm이상이 약 89%였다. 3. 32예의 PCB군의 분만제 1기 중 자궁개대가 3cm에서 10cm까지의 평균시간은 대조군과 비교하면 초산모 215.8/255.0분, 경산부가 135.0/157.5분이었다. 4. PCB진통효과의 작용시간은 평균 53.2분(30-89분)이었으며 45-59분의 군이 11예(34.4%)로 제일 높았다. 5. PCB의 진통효과의 결과는 good이상의 예가 25예로서 약 78%의 높은 비율을 보였다. 6. PCB의 진통효과가 자궁수축에 미치는 영향은 PCB전과 변화가 없었던 예가 17예(53.1%), 저하 8예(25.0%)그리고 증가가 7예(21.9%)의 분포를 나타냈다. 7. 32예의 PCB군의 분만방법은 정상질식분만이 23예로 71.9%였고, 나머지 기계분만이 9예 였다. 8 PCB후 태아심음의 변동은 서맥이 2예(6.3%), 빈맥이 1예(3.1%)였으며 25예(78.1%)에서는 변화가 없었다. 9. 32예의 PCB군에서 산후 태아의 Apgar score는 1분에서 6미만이 1예였다. 10. 신생아체중은 PCB군에서 평균 3,250gm으로 대조군(3140gm)과 큰 차이를 발전 할 수 없 었으며 3000-3499gm군에서 15예(45.6%)로 제일 높은 분포를 보였다. Paracervical blocks administered during normal labor were undertaken 32 patients with the use of lidocaine one percent. Fetal heart rate and uterine contractions were monitored and electronically recorded. The mean duration and efficacy of PCB anesthesia were 53.2 minutes with satisfaction (good or excellent ; 78%). The effect of PCB on the uterine contraction was variable. Bradycardia after PCB was the most common hazard in literature, of which incidence was 6.3%. Apgar score of 32 PCB group was high.