골반외 자궁내막증

장기홍,연혜정,박경수,이윤호,황동훈,Chang, Ki-Hong,Yeon, Hye-Jeong,Park, Kyoung-Soo,Lee, Yoon-Ho,Hwang, Dong-Hun 대한생식의학회 1993 Clinical and Experimental Reproductive Medicine Vol.20 No.2

Endometriosis involving sites outside the pelvic cavity is a relatively uncommon occurrence and its frequency is cited as being less than one percent of all occurences of endometriosis. Sites previously reported in literature have described involvement of the extraperitoneal portion of the round ligament, the rectosigmoid, the appendix, and the ileum. Other more distal sites reported to have been found to have endometriosis lesions include the inguinal ligaments, the umbilicus, abdominal incisional wounds, thoracic lesions involving the pleura or diaphragm which may result in catamenial pneumothorax, the kidneys, and vulvar episiotomy wounds. Endometriosis have even been reported to occur in males. In this presentation, three cases of endometriosis, two involving the vulvar area and one involving a Pfannenstiel incision wound, is presented with a review of the pertinent literature in order to discuss its etiology, pathology, diagnosis and treatment.

난소기능평가를 위한 Gonadotropin Releasing Hormone Agonist Stimulation Test (GAST)의 효용성에 관한 연구

김미란,송인옥,연혜정,최범채,백은찬,궁미경,손일표,이진우,강인수,Kim, Mee-Ran,Song, In-Ok,Yeon, Hye-Jeong,Choi, Bum-Chae,Paik, Eun-Chan,Koong, Mi-Kyoung,Song, Il-Pyo,Lee, Jin-Woo,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2

Objectives: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. Design: Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. Materials and Methods: After blood sampling for basal FSH and estradiol $(E_2)$ on cycle day two, 0.5ml (0.525mg) GnRH agonist ($Suprefact^{(r)}$, Hoechst) was injected subcutaneously. Serum $E_2$ was measured 24 hours later. Initial $E_2$ difference $({\Delta}E_2)$ was defined as the change in $E_2$ on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by ${\Delta}E_2$; group A (n=30):${\Delta}E_2$<40 pg/ml, group B (n=52): 40 pg/ml${\leq}{\Delta}E_2$<100 pg/ml, group C (n=20): ${\Delta}E_2{\leq}100$ pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-ET was followed. Ratio of $E_2$ on day of hCG injection over the number of ampules of gonadotropins used ($E_2hCGday$/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as $E_2$ hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. Results: Mean age $({\pm}SEM)$ in group A, B and C were $33.7{\pm}0.8^*,\;31.5{\pm}0.6\;and\;30.6{\pm}0.5^*$, respectively ($^*$: p<0.05). Mean basal FSH level of group $A(11.1{\pm}1.1mlU/ml)$ was significantly higher than those of $B(7.4{\pm}0.2mIU/ml)$ and C $(6.8{\pm}0.4mIU/ml)$ (p<0.001). Mean $E_2hCGday$ of group A was significantly lower than those of group B or C, i.e., $1402.1{\pm}187.7pg/ml,\;3153.2{\pm}240.0pg/ml,\;4078.8{\pm}306.4pg/ml$ respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: $38.6{\pm}2.3,\;24.2{\pm}1.1\;and\;18.5{\pm}1.0$ (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: $6.4{\pm}1.1,\;15.5{\pm}1.1\;and\;18.6{\pm}1.6$, respectively (p<0.0001). By stepwise multiple regression, only ${\Delta}E_2$ showed a significant correlation (r=0.68, p<0.0001) with $E_2HCGday$/Amp, while age or basal FSH level were not significant. Likewise, only ${\Delta}E_2$ correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). Conclusions: These data suggest that initial $E_2$ difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial $E_2$ difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.

선행 제왕절개 임산부에서의 분만방법 결정에 관한 연구

김태윤 ( Kim Tae Yun ),권혜경 ( Kwon Hye Gyeong ),김인규 ( Kim In Gyu ),연혜정 ( Yeon Hye Jeong ),한상원 ( Han Sang Won ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.5

목적 : 선행 제왕절개 임산부가 선택하는 분만방법의 형태를 알아보고, 질식분만시도를 결정하는데 영향을 미치는 요인을 분석고자 한다. 연구 대상 및 방법 : 본 연구는 국민건강보험공단 일산병원 산부인과에서 2000년 10월부터 12개월간 산전 진찰을 받기 시작한 임산부로서 임신이 종결된 1회의 선행 제왕절개 임산부를 대상으로 전향적으로 실시하였다. 산전 진찰을 위하여 내원한 임산부 중 만삭까지 임신이 유지된 산모로서 질식분만시도의 적응이 가능한 환자를 대상으로 하였다. 이들에 대하여 분만 방법에 대하여 설명하고 환자의 결정에 따라 질식분만시도를 결정하였다. 임산부가 가지고 있는 사회적, 산과적 특성을 문진에 의하여 조사하고, 의무기록의 분석을 통하여 그 결과를 조사하였다. 결과 : 산전진찰 대상 임산부 185명 중 질식분만시도가 가능하다고 판단된 경우는 106명이었다. 이중 반복 제왕절개분만을 선택한 임산부는 72명, 질식분만을 시도하기로 결정한 경우는 34명이었다. 질식분만시도를 실시한 34명 중 24명 (71%)은 질식분만에 성공하였다. 질식분만시도에 실패하여 응급제왕절개 분만을 한 10명의 제왕절개술의 적응증은 아두골반불균형 7예, 태아곤란증이 1예였다. 2예의 임산부는 특별한 적응증 없이 응급제왕절개 분만하였다. 반복제왕절개 분만을 결정한 군 (72예)과 질식분만시도를 결정한 군 (34예)에서 최종학력이 대졸 이상인 임산부의 비율은 질식분만시도군에서 높았으며 (50% 대 60%, p=0.04), 선행제왕절개술의 적응증이 비정상태위, 태아곤란증, 또는 비정상 태반의 경우가 차지하는 비율은 질식분만시도 군에서 의의있게 높았다 (23% 대 48%, p=0.007). 결론 : 분 연구의 결과는 국내 종합병원 규모의 의료기관에서의 선행제왕절개 임산부에서의 질식분만 시도에 관한 연구로서 분만방법의 결정 과정에서 임상적인 상담자료로 사용될 수 잇을 것으로 보이며, 향후 다른 규모의 의료기관을 포함한 광범위한 연구가 진행되어야 할 것으로 생각된다. Objective : To estimate the rates at which women with a previous cesarean delivery were offered and consented to trial of labor (TOL) and to investigate the factors affecting the decision making about mode of delivery. Methods : For 12 months duration, pregnant women with one previous cesarean were enrolled prospectively in this study. Eligibility to TOL was defined as pregnancy after 36 weeks of gestation without medical or obstetric indication of cesarean section. Patients were received counseling and consented to the process of TOL. The social and obstetric factors were collected through interview and the medical records were analyzed. Results : Among the initial 185 patients with one previous cesarean, 106 were considered eligible to TOL. Seventy-two patients out of the 106 delivered with elective repeat cesarean while 34 patients tried TOL ; 24 were delivered with vaginal birth after cesarean (VBAC), while 10 were received emergency cesarean section. The indications of cesarean section were cephalopelvic disproportion (CPD, 7 cases) and fetal distress (FD, 1 case). Two received emergency cesarean without definite obstetric indication. The rate of high education, college greaduate or more was higher n the group of TOL than in those of elective cesarean (50% vs 68%, p=0.04). The rates of patients with indication of previous cesarean, CPD, FD, or abnormal placentation were more frequent among the patient with TOL (23% vs 48%, p=0.007). Conclusion : These result provides clinical information about the decision making about mode of delivery among the patients eligible to TOL with one previous cesarean. More clinical studies about TOL and VBAC are required in the different setting of hospital or institute.

Sertoli - Leydig Cell Tumor 1 예

한상원 ( Sang Won Han ),김태윤 ( Tae Yoon Kim ),권혜경 ( Hye Kyung Kwon ),강경숙 ( Gyoung Sook Kang ),연혜정 ( Hye Jeong Yeon ),기정혜 ( Jung Hye Kie ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary, accounting for less than 0.5% of all primary ovarian neoplasm. This tumor is the most common type of all virilizing ovarian tumors. However, only one-third of patients develop virilization. Recently, we experienced a case of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.