조기진통을 예측하는 인자로서의 Oncofetal Fibronectin 측정, 자궁경부 길이 측정 그리고 PCR을 이용한 질내 균도말검사의 유용성

선우태원 ( Tae Won Sunwoo ),서호석 ( Ho Suk Saw ),박용균 ( Yong Kyun Park ),조수용 ( Soo Yong Chough ),주갑순 ( Kap Soon Ju ),허준용 ( Jun Young Hur ) 대한주산의학회 1998 大韓周産醫學會雜誌 Vol.9 No.3

자궁 경부 상피내 종양과 미세 침윤암에서 환상 투열 요법의 효용성과 인유두종 바이러스 검색의 임상적 유용성

신용원(Yong Won Shin),선우태원(Tae Won Sunwoo),이찬(Chan Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 환상 투열 요법과 질 확대경 조준하 생검의 조직학적 결과를 비교하고 이를 통해 질 확대경 조준하 생검의 정확성과 환상 투열 요법이 지니는 임상적 의미 등을 알아보고자 하였으며, hybrid capture system을 이용하여 인유두종 바이러스의 DNA를 검색하고 조직학적 등급별 HPV 감염율을 조사하여 자궁 경부 병변과의 상관 관계 및 임상적 유용성를 분석하기 위함이다. 연구 방법: 본원에서 1995년 4월부터 1998년 5월까지 환상 투열 요법을 시행 받은 150명의 자궁 경부 상피내 종양 환자와 7명의 미세 침윤암 환자를 대상으로 연령별 분포, 질 세포진 검사 및 질 확대경 조준하 생검의 조직학적 결과의 비교, 경계 부위 침범 여부와 조직학적 등급의 분포 등을 분석하였으며, 이중 114명을 대상으로 hybrid capture system을 이용한 인유두종 바이러스 DNA검색을 시행하였다. 결과: 대상 환자의 연령 분포는 30대가 69명 (44%)으로 가장 많았으며, 질 확대경 조준하 생검과 환상 투열 요법의 조직학적 진단에서는 통계학적으로 유의한 차이는 없었으나 (p>0.05,χ2 test), LLETZ에서의 진단이 한 단계 높게 나온 경우가 23예 (고등급 병변-16예, 저등급 병변-7예), 두 단계 이상 나온 경우가 5예 있었으며, 질 확대경 검사상 예상하지 못했던 미세 침윤암이 9예 있었다. 환상 투열 요법을 시행 받은 환자군의 31.2%에서 경계 부위의 침범이 관찰 되었으며CINⅢ 이상의 고등급 병변에서 흔히(93.8%) 관찰 되었다. 인유두종 바이러스의 감염율은 고위험군이 72.8% (83/114), 저위험군은 3.5% (4/114)였고, 각 조직학적 등급에 따른 검색율은 저등급 병변 (CINⅠ)에서 65.9% (29/44), 고등급 병변 (CINⅡ,Ⅲ)에서 82% (50/61)이었으며, 미세 침윤암에서는 88.9%(8/9)의 검색율을 보여 조직학적 등급이 높을수록 인유두종 바이러스 DNA의 검색율이 증가하는 결과를 나타냈다. 결론: 환상 투열 요법은 질 확대경하 조준하 생검에서 간과될 수 있는 병변을 더욱 정확히 진단할 수 있으나, CINⅢ 이상의 고등급 병변에 있어서는 완전한 제거가 이루어지지 않을 수도 있으므로 국소 치료시 자궁 경부 이행대를 완전히 절제함을 원칙으로 하고 이행대의 경계로부터 가능한 넓은 범위를 절제하여야 하며, 반드시 잔여 병변에 대한 추적 조사가 필요하리라 사료된다. 인유두종 바이러스 검색은 자궁 경부 세포진 검사와 병행시 자궁 경부 상피내 종양과 미세 침윤암 환자의 진단에 유용하며, 비정상 세포진 결과를 가지는 환자에서 전암 병변이 침윤암으로 진행할 수 있는 고위험 환자를 예측하여 자궁 경부암으로 진행되는 경우를 예방, 치료하는 지표로 임상에서 유용하게 이용될 수 있을 것으로 사료된다. Objectives: This study was performed to assess the efficacy of LLETZ and clinical significance of HPV detection in the cervical intraepithelial neoplasias and microinvasive cervical cancer. Methods: One hundred fifty patients with cervical intraepithelial neoplasias and seven patients with microinvasive cervical cancer were diagnosed by LEETZ from April, 1995 to May, 1998. In all patients, age distribution, histological comparisons of colposcopically-directed punch biopsy and LLETZ specimens and margin positivities were analyzed. HPV detections with hybrid capture system were performed in one hundred fourteen of the 157 patients Results: The mean age was 39.5 years (range 21-80 years). The disparity of pathologic diagnosis between colposcopically-directed punch biopsy and LLETZ was not statistically significant (p>0.05,χ2 test). There were 28 cases (19.1%) of cervical intraepithelial neoplasias and 9 cases (81.8%) of microinvasive cervical cancers that were misinterpreted by colposcopically-directed punch biopsy. The rates of margin positivity in the patients underwent LLETZ was 31.2% (49/157). Most of the patients with positive margin were diagnosed higher than CINⅡ (93.8%). The detecion rates of high-risk HPV and low-risk HPV were 72.8%(83/114), 3.5%(4/114) respectively. According to the histologic grade, the detection rates of HPV were 65.9% in CIN Ⅰ, 82% in CINⅡ·Ⅲ, 88.9% in microinvasive cancer. Conclusion: LLETZ seems to diagnose intraepithelial lesions more exactly that were missed by colposcopically-directed punch biopsy. However, in the therapeutic efficacy of LLETZ, it may be resected incompletely. Therefore, we must examine the colposcopic and cytologic follow up to identify the number of women with residual CIN after therapy. Detection of HPV infection plays a role in the diagnosis and follow-up of cervical intraepithelial neoplasia and microinvasive cervical cancer in conjuction with other tests.

한국 청소년기 여성의 성경험 실태에 관한 연구

이찬(Chan Lee),선우태원(Tae Won Sunwoo),구병삼(Byung Sam Ku) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: The objective of this survey is to introduce the recent adolescent sexuality, such as the level of sexual knowledge of adolescent, their actual state for the attitudes and behaviors toward sex, and in Korea in comparison with the past and to seek the answers to the improvement of the teproductive health statos of the adolescents. Method: The total number of 11,433 girls was drawn fiom middle and high schools girls in Seoul, Pusan, Incheon, Kwangju, Taegu, Taejeon and Ansan. Among them, the number of 82 girls was drawn fiom factory workers in Ansan. For the data collection, the survey was conducted during the period fiom Feb 15, 1994 to May 23, 1995 by using prepared questionaire. Result: Of those who respond to this study, 37.6% had sexual problems, which was that of acquaintance of the opposite sex(44.7%), menstruation(33.1%), and sexual maturity(13.1%). Among them, only 5.5% had a feeling of satisfaction about sex education. In regard to the attitude toward the friendly relationsbip with the oppasite sex, the approval rate respondents was 80.4%. Many respondents felt chastity and a virtue, but only 60.1% answered that pemarital chastity should be kept. For the each age group, age at sexual intercourse is revealed that among the respondents about 31.5% are experienced sexual intercourse for under 14 yearss old group, 25.3% for 15 years old, 26.3% for 16 years old, 12.6% for 17 years old, 3.3% for 18 years old, 1.0% for 19 years old. The major information source of knowledge source was school(38.4%), mass-media such as TV/radio(22.6%), book and magazine(19.9%), friends(16.2%), and parents (1.5%). Conclusion: In order to cope with the problems of adolescent sexuality, a drastic and strong policy measures should be taken by the government. At the same time, the public should be aware of the urgency of adolescent sexual problems. The most effective countermeasures appear to be education. Sexual education is necessary for the youth that they should bave an adequate sexual knowledge, attitudes and behaviors in their adolescent period.

포상기태와 동반된 자궁의 동정맥기형

최용성(Yong Sung Choi),우지원(Ji Won Woo),이은혜(Eun Hye Lee),안창수(Chang Soo Ahn),민유선(You Sun Min),선우태원(Tae Won Sunwoo),이찬(Chan Lee),조진호(Jin Ho Cho) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.4

Uterine arteriovenous malformation(AVM) is a rare cause of massive uterine bleeding. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Curettage may precipitate life-threatening hemorrhage and is therefore contraindicated when uterine AVM is suspected. These lesinons may be congenital or acquired. Acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynecologic malignancies. Until rescently, this condition was difficult to diagnose and management almost always required hysterectomy. Doppler flow ultrasound and pelvic angiography are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in woman who wish to retain their fertility. We have experienced one case of uterine AVM complicated by partial hydatidiform mole, which is presented with a brief review of the literature.

제왕절개술 후 발생한 폐동맥 색전증 1례

전규정 ( Kyu Chung Chun ),김현철 ( Hyun Chul Kim ),선우태원 ( Tae Won Sunwoo ) 대한주산의학회 2000 Perinatology Vol.11 No.1

조기난소부전에서의 염색체이상에 대한 분석

남윤성(Yoon Sung Nam),김남근(Nam Keun Kim),이은정(Eun Jung Lee),선우태원(Tae Won Sunwoo) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.1

N/A Objectives: To analyze chromosomal abnormalities in patients with premature ovarian failure, Materials and Methods: Karyotyping was performed in 53 cases of premature ovarian failure. Results: The incidence of chromosomal abnormalities was 17%. The age ranged from 25 to 36 years and follicle stimulating hormone rose to the level between 42.1 93,7 mIU/mL, Two cases experienced the pregnancy and thyroid antibody was found as associated abnormalities, Chromosomal abnormalities which was found were mosaicism, isochromosome, reciprocal translocation, inversion, deletion, and gain. Conclusions: A karyotype should be performed as part of basic laboratory evaluation for all patients with premature ovariam failure and prodromal premature ovarian failure. Although it has been suggested that the karyotype be omitted in patients who are either parous or older than 35 years, neither age nor parity rules out a chromasomal abnormality.

골반 장기 탈출 환자에서 실리콘 환 페사리 이용에 대한 임상적 고찰

김현철,선우태원,이위현 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

목적: 본 연구는 골반 장기 탈출증 환자의 치료에 있어서 수술이 부적당한 경우 대안으로 실리콘 환 페사리 사용에 대한 효용성 및 안전성, 그리고 순응도에 대하여 알아보고자 시행되었다. 연구방법 : 1997년 1월부터 1998년 12월까지 골반 장기 탈출증으로 본원에 내원한 환자중 수술에 부적합하거나 수술을 거부한 환자 58명을 대상으로 순응도, 합병증, 자궁유무와의 관계등에 대하여 조사하였고 페사리삽입 및 착용유지실패군에 대해서는 따로 분석하였다. 결과 : 58명의 대상환자중 8명이 중도에 포기하여 13.7%의 탈락율을 보였고 29명(50%)에서 합병증을 보였다. 페사리실패의 주된 원인은 질점막궤양(4예)과 페사리의 탈출(3예)으로 나타났다. 페사리의 합병증 및 문제점은 다양하게 나타났는데 페사리의 탈출(10예), 질점막미란 및 궤양(9예), 질내감염(6예)등이었다. 자궁적출술을 시행한군과 자궁이 있는군사이에서는 페사리실패율 및 합병증발현율에서 별다른 차이가 나타나지 않았다. 결론 : 골반내 장기 탈출 환자중 수술에 부적합한 환자에 있어서 페사리는 간편하고 안전하며 효과적인 대안이 될 수 있을것이라 생각되며 추후 이에 대한 더 많은 연구가 필요할 것으로 생각된다. Objective : To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. Methods : This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. Results : Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. Conclusion: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.

Primary serous papillary peritoneal carcinoma 1예

이찬,선우태원 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.3

Primary papillary serous carcinomas (PPC) of the peritoneum are very rare and classically present with widespread intraperitoneal dissemination, superficial invasion, and minimal ovarian stromal involvement. Because of clinically and histologically similar to advanced stage epithelial ovarian carcinoma the treatment has been a similar fashion-cytoreductive surgery followed by systemic chemotherapy. Histologic differentiation between papillary mesotheliomas, primary ovarian tumors, borderline tumors of the ovary with peritoneal deposits and primary peritoneal carcinoma may be difficult. The prognosis is very poor and the median lifespan 4 months. We experienced a case of primary peritoneal carcinoma and reported with the brief review of the literature.

자궁 혈관 색전술 후 자궁근종의 질외 배출 1 예

이은혜,선우태원,손정륜,안창수 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.11

Uterine fibroids are the most common benign tumor of the female genital organ. Menorrhagia is the most common symptom associated with uterine fibroid. Since the first suggestion that embolization of uterine arteries might have a role in the management of fibroids by Ravina et al (France) in 1995,3 uterine artery embolization for management of fibroids has been performed actively in United states, United Kindom and Japan, and excellent therapeutic results have been reported. We have performed uterine artery embolization on patients with symptomatic fibroids or adenomyosis since August 1998. There have been few case reports of expelled fibroids out of vagina after uerine artery embolization, so we present a case in which successful embolization in woman with submucosal myoma resulted in a subsequent vaginal expulsion.

원발성 난관암 2예

이재관,김세규,박재헌,선우태원,서호석,이경주 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

Primary carcinoma of the fallopian tube is very rare, accounting for fewer than 1% of all malignant gynecologic tumors. Abnormal vaginal bleeding is the leading presenting complaint. The histology and behavior of primary tubal carcinoma are similar to ovarian cancer, thus the evaluation and treatment are also essentially the same. The correct preoperative diagnosis of tubal carcinoma is very difficult and its incidence is less than 1%. The prognosis of patients with primary tubal carcinoma has generally been regarded poor, with an overall survival rate parallels that of epithelial ovarian cancer. Recently we experienced two cases of primary tubal carcinoma, therefore we present these rare malignant neoplasm of the female genital tract with a brief review of the literature.