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변승원 ( Seung Won Byun ),이희중 ( Hee Joong Lee ),박태철 ( Tae Chul Park ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.2
We have experienced a case of intestinal obstruction due to endometriosis. It may involve intestinal wall and protrude into its lumen and patients with severe intestinal involvement usually require surgical resection. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. An emergency laparotomy was performed. The pathologic examination of the resected sample revealed endometriosis of sigmoid colon. Endometriosis can involve the intestinal tract extensively, causing a variety of clinical symptoms, and can result in a spectrum of mucosal alterations.
민재영,이민경,변승원,김진휘,김연희 ( Yeon-Hee Kim ),이희중,박태철,송재연 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-
목적: 자궁출혈을 보이는 여성에서 자궁내막 조직검사는 매우 유용하며 치료의 방향을 결정하는데 매우 중요한 자료가 된다. 하지만 20세 이하 청소년에서는 자궁내막조직검사를 하기 어려운 것이 현실이다. 이에 5년간 조직검사를 시행한 결과를 토대로 의심되는 질환군에 대한정립이 하고자 한다. 방법: 2010~2014년 5년간 시행한 20세 이하 여성 (11~20세)에서 자궁내막조직검사를 58명을 대상으로 후향적 chart review를 통한 문진, 혈액검사, 호르몬, 초음파 검사와 자궁내막조직검사 결과를 확인하였다. 결과: 58명 중 2명이 임신력이 있었으며, 생리주기가 불규칙적인 여성은 35명, 규칙적인 여성은 23명이였다. 10이상의 생리기간을 보이는 경우는 30명 (52%)였으며 생리양이 과도하게 많은 경우는 41%, 중등도 이상은 40%로 대부분에서 생리양의 과다를 보였다. 빈혈이 12g/dL이하인 경우는 23명 (40%)였으며 그 중 4명은 Hb 8g/dL를 보였고, ferritin 감소를 보이는 경우는 14명(24%)였다. FSH/E2는 대부분 정상 가임기 여성의 수치를 보였으며, 간수치와 혈액응고 수치의 이상을 보이는 여성은 없었다. 대부분 특별한 호르몬 이상은 보이지 않았다. 갑작스런 체중변화를 보였던 환자는 6명 (10%)였으며, 초음파 상 자궁근종 등의 자궁병변은 보이지 않았으며, 난소에서 다낭성 변화를 보인 경우는 25명(43%), 난포를 보이는 경우는 11명 (19%), 난소낭종 2명, 나팔관낭종을 보이는 1명이 있었다. 조직검사 결과 proliferative phase 31명(53%), secretory phase 5명(9%), menstrual phase 2명 (3%), basal endometrium 1명(2%), endometrial hyperplasia 12명(21%), endometritis 4명(7%), endometrial polyp 1명(2%), conception 2명(3%)의 결과를 보였다. 결론: 청소년기에 나타나는 비정상자궁출혈 환자는 원인은 대부분 무배란과 관련되어 나타난다. 절반 이상의 환자에서 자궁내막조직검사에서 증식기 소견을 보이는 결과와도 상통된다. 하지만 자궁내막증식증, 자궁내막염, 용종 등 자궁내막병변이 원인인 경우도 30%로 나타나 상당한 비중을 차지한다. 비록 성경험이 없는 청소년 여성인 경우에도 의심될 경우 적극적인 자궁내막조직검사가 필요한 이유가 되겠다.
기은영,최윤진,변승원,이근호,허수영,배석년,박종섭 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
The clinical relevance of human papillomavirus type 16 (HPV16) DNA methylation has not been well documented, although its role in modulation of viral transcription is recognized. Detection of hypermethylated genes in cervical scrapings has been suggested as a promising tool for identification of cervical intraepithelial neoplasia and cancer. The aim of this study was to evaluate the presence of hypermethylated genes according to the degree of cervical disease. Study subjects with HPV 16 DNA positive were 122 women attending Seoul St. Mary`s Hospital from January 2009 to July 2011. Cervical cytology positive for HPV 16 were normal, CIN1, CIN2, CIN3, and cancer. Using quantitative bisulfite-pyrosequencing, we measured the methlyation of PAX1, CADM1, ADCYAP1 and MAL genes of cervical scrapings. Cervical scrapings were used for detection of the methylation in normal (n=29), CIN 1 (n=29), CIN2 (n=4), CIN3 (n=42), and cervical cancer (n=18). We observed that 4 genes (PAX1, CADM1, ADCYAP1, MAL) were more frequently methylated in cervical cancer (83.3, 77.8, 88.9 and 72.2 %) than in normal cytology (0, 3.4, 3.4 and 6.9%). ROC curve demonstrated that methylation of the 4 genes discriminated between high grade cervical lesions (≥CIN 3) and low grade cervical lesions (< CIN3). The estimated specificities of these 4 genes for detecting high grade lesion were 100, 96.6, 96.6 and 93.1% (p=0.0001). And the estimated sensitivities of that were 83.3, 77.8, 88.9 and 93.1%(p=0.0001). Additional ADCYAP1/PAX1 methylation analysis on the HPV16-positive women increased the sensitivity to 88% with a specificity to 96.7%(p<0.001). Methylation of the PAX1, CADM1, ADCYAP1 and MAL is significantly associated with the development of ≥ CIN3. Hence, testing for methylation may provide a diagnostic marker for the triage of high risk HPV-positive women at risk of ≥ CIN3.
Primary ovarian malignant mixed mesodermal tumor - case report
기은영,최윤진,변승원,이근호,박종섭,배석년,허수영 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
Malignant mixed mesodermal tumor (MMMT)s are highly aggressive tumors, usually diagnosed in advanced stage. Cases of MMMT derived from either ovary and uterus. The ovarian MMMT is consisting only 1% of all ovarian tumors. Because of the rarity of this disease, optimal treatment modality is not established. The range of operation, the effect of the radiation therapy, and proper chemotherapeutic regimen are still controversial. But for advanced stage ovarian MMMTs, optimal cytoreduction and adjuvant chemotherapy including platinum as part of the regimen are important. We report 4 cases of ovarian MMMTs (1: heterologous, 3: homologous) period 1990-2011. The patients were underwent operation immediately, after histopathologically confirmation, patients were treated with platinum based combination chemotherapy.
Incidence and costs of cervical intraepithelial neoplasia in the Korean population
장하균,서상수,명준표,유예리,변승원 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.3
Objective: The purpose of this study was to assess the incidence rate of cervical intraepithelial neoplasia (CIN) and cervical cancer, and their costs according to age. Methods: We collected data on annual incidence and medical costs of CIN and cervical cancer from 2010 until the end of 2014 from the Health Insurance Review and Assessment (HIRA) service. The CIN was classified into CIN3 (high-grade) requiring conization and CIN1/2 (low-grade) requiring observation. Results: Incidence rates of CIN3 and cervical cancer are reducing over time, whereas CIN1/2 is increasing significantly (p for trend: <0.001). The peak ages of incidence were 25–29, 30–34, and 70–74 years old for CIN1/2, CIN3, and cervical cancer, respectively. The crude incidence of CIN1/2 increased by approximately 30% in 2014 compared to 5 years ago and demonstrated an increasing trend in all age groups. The CIN3 showed a significantly increasing trend in the age group of 30–39 years old, the cervical cancer was significantly reduced in all ages, except the 35–39 years old. The treatment for cervical cancer costs $3,342 per year, whereas the treatment for CIN3 and CIN1/2 cost $467 and $83, respectively. Conclusion: The crude incidence rate of cervical cancer is currently decreasing among Korean women, but the incidence rates and medical costs of CIN and cervical cancer are increasing in women in their 30s in Korea. These findings suggest that different strategies by age will be required for prevention of cervical cancer in Korea.