조기자궁경암의 진단에서 질확대경의 이용가치

서우갑(UG Suh),박순옥(SO Park),송승규(SK Song),이헌영(HY Lee),김승조(SJ Kim) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.11

저자들은 1974년 10월부터 1976년 8월까지 가톨릭 의과대학 부속 성모병원 자궁암 크리닉에서 질 확대경 검진을 받은 789예 중 세포진과 조준생검(colposcopic selective biopsy), 원추생검(cone biopsy) 또는 분활생검(fractional biopsy)을 병행한 380예를 분석한 결과 다음과 같은 결론을 얻었다. 1) 질 확대경 검진은 자궁경부 질환의 진단에 중요한 보조적 방법이며, 특히 염증성질환 과 침윤암의 진단율은 각각 97.2%, 94.5%로서 매우 효과적이었다. 2) 세포진과 조준생검을 병행하면 각각 사용했을 때 보다 진단의 정확도가 높았으며 위 음성율(false negative rate)을 줄일 수 있었다. 3) 생검부위를 선정함으로써 무작위생검(randombiopsy)이나 원추생검에서 오는 불필요 한 조직 손상을 감소시킬 수 있었다. 4) 위양성율(false positive rate)을 감소시키는 데 있어서는 질 확대경 소견의 정확한 평가를 할 수 있는 숙달된 colposcopist가 필요하다고 생각되었다. 5) 이상 질 확대경 소견들은 단독으로 관찰될 때 보다 공존할 경우에 악성율 (malignancy rate)이 높았다. 6) 질 확대경은 생체조직의 변화 과정을 추적 검사 할 수 있을 뿐만 아니라, 병소의 범 위를 정하는데도 도움이 컸다. It was our purpose for thin study to evaluate the accuracy of colposcopic examination in the diagnosis of cervical disease, especially in the detection of early cervical cencer. From October 1974 through August 1976, colposcopic examinations were taken in a series of 789 patients registered at Uterine cancer Clinic, Catholic Medical college. Among them, we selected 380 cases, who was taken cytology and biopsy tor the evaluation of the accuracy of colposcopic examination. At the time of colposcopic examination, findings were documented by color colpophotography. patients were distributed into three major groups ; 1. Patients with negative colposcpy; This group incluede patients in the cases of the squamocolumnar junction was fully visible, but no focal colposcopic lesion was either positive or revealed repeatedly suspicious. Conization was performed in these cases, regadless of negative colposcopy, to evaluate the false negative rate of colposcopy. 2. patients with a focal colposcopic lesion; In these patients, a selective biopsy was performed under colposcopic vision, using a Kevirkian-Yunge biopsy forceps. Before the biopsy, the colposcopic impression of the anticipated cervical pathology was recorede. This impression was based on Kolstad`s five diagnostic criteria of the focal lesion; 1) vascular pattern, 2) intercapillary distance, 3) surface contour tone, and 4) clarity of demarcation of the lesion. 3. patients with unsatisfacuory colposcopy; In patients in whom the squamocolumnar junction was not fully visible, cloposcopy was classified as unsatisfactory because a more severe lesion higher in the endocervical canal could not be excluede. ig the referring cytology was positive or repeatedly suspicious, diagnostic conization or fractional biopsy was recommended. According to the above protocol, we examined 380 cases. A focal colposcopic lesion was found in 228 patients (60.0%); colposcopy was negative in 141 (37.1%) and unsatisfactory in 11 patients (2.8%) The results were as follows; 1. colposcopic examination was a valuable adjunct in diagnosis of lesions of the cervix, espedially in invlammatory or malignant lesions. 2. the combination of cytology and colposcopic selective biopsy diminished the falws negative rate under that of each method separately. 3. Selective biopsy under colposcopy could reduce an unnecessary tissue damage resulted from random or cone biopsies. 4. For the low falwe-positive rate, a correct estimation of each colposcopic finding was needed by skilled and experienced colposcopist. 5. Malignancy rate was higher when the lesion revealed several abnormal colposcopic findings mixed than single finding. 6. Colposcopic examination was available and/ or helpful in the following-up and in make range of the focal lesions.

난소선암을 동반한 자궁경부선암 1예

서우갑(UG Suh),김윤호(YH Kim),최명학(MH Choi) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.4

저자들은 난소선암을 동반한 자궁경부선암 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Adenocarcinoma of the cervix combined with ovarian Adenocarcinoma is a rare case. Adenocarcinoma of the cervix arises from the columnar epithelium of the endocervix and constitues 4-5% of all cervical cancers. It usually arises in the endocervical canal and may be found localized to the isthmic region in an occasional hysterectomy specimen. The lesion may have a higher incidence of radioresistance and thus indicate surgery as primary treatment more often. Adenocarcinoma of the cervix is characterized by its gland architecture which may present various degrees of differentiation. If both ovary and endometrium are involved, it is impossible to know which is the primary tumor or if there is a multicentric malignant trend of uterine and ectopic endometrium. A case of cervical Adenocarcinoma combined with an ovarian Adenocarcinoma is presented with a brief review of literature available.

지상아를 동반한 쌍태임신의 1예

서우갑(UG Suh),김윤호(YH Kim),최명학(MH Choi),김승조(SJ Kim) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.2

본대학 산부인과에서 임신 제 37주의 지상아를 동반한 1난성쌍생아 분만을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Fetus papyraceus is a rare complication of multiple pregnancy. Recently we had a chance to study a case of fetus papyraceus in monochorial twin pregnancy at the obst. and gynec. Dept of Catholic medical college. A case of fetus papyraceus is presented with brief review of literature.

광범위 자궁경암근치수술후의 방광기능장애와 방광기능측정

정병래(BL Chung),서우갑(UG Suh),송승규(SK Song),김승조(SJ Kim) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.3

1. Average duration of catheter drainage which was returned to clinically normal bladder function was 20.4 days. The longest duration of catheter drainage was 169 days , the shortest was 12 days. 2. Pre-operative bladder capacity was average 556+-85ml, and preoperative bladder pressure was average 23 cm H2O and postoperative was 33 cm H2O, both bladder capacity and pressure values indicate that a hypertonic dysfunction occurs following radical pelvic surgery for the cervial cancer. 3. The 3 cases of hypotonic bladder dysfunction resulted from an accidental episode of urinary retension and overdistention. 4. It was not possible to predict duration of bladder dysfunction by evaluating the initial cytometric findings but there was a tendency for those patients demonstrating the greatest initial alteration to necessitate catheter drainage for the longest period of time. 5. The catheter will not be removed until cystometric examination of the bladder capacity demonstrates greater than 250 ml and/or bladder pressure less than 28cm H2O and the patients can void spontaneously, resulting in a residual urine volume less than 70 ml.

남성화를 동반한 여성반음양 1예

공원보(WB Kong),서우갑(UG Suh),최희원(HW Choi),이정기(JG Rhee) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.8

최근 남성화를 동반한 여성반음양 1예를 경험하였기에 보고하는 바이다. A case of female hermaphroditism with virilization is presented with a brief review of the concerned literatures. The patient had an enlarged clitoris and was noted the absence of breast development. On exploratory laparotomy, the uterus was small with polycystic enlargenent of the both ovaries to the double thumb sized and its surface was noticed to be smooth, thickened, and gray-white in color. Wedge resection of both ovaries and reconstruction of external genitalia were made.

병합임신 1예

이주석(JS Lee),홍창수(CS Hong),서우갑(UG Suh),진성대(SD Jin) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.6

저자들은 우측 난관 임신을 중절후 병합임신으로 진단되어 자궁내 임신이 9개월 후까지 지속한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A case of combined pregnancy which was relatively rare condition, was presented with brief review of literatures. A 29 years old woman, para 3, whose last menstrual period had occurred 9 weeks ago, was admitted complaining of the low abdominal pain, nausea and vomitting. The right salpingectomy was performed under the diagnosis of ectopic pregnancy. The accumulated blood in the abdominal cavity was about 1,000cc, and the uterus was enlarged, early three months gestation size. The Gravindex showed no agglutination on postoperative 7th day. The histologic findings revealed right tubal pregnancy. The uterus enlarged progressively, so it was slight smaller than man`s fist size on postoperative 2 weeks. The height of fundus was 17cm, and fetal heart sound was detected on right low abdomen with cephalic presentation on 11 weeks after operation. Aboue five hundred cases of combined pregnancy were reported until 1961. It has been estimated that combined pregnancy occurs in every 30,000 gestations. It must coexist in a live state at the same time, resulting from one fertilization or two separate fertilizations within a relatively short period of time. It must be therefore assumed that all combined pregnancy are the result of the fertilization of two ova.