유기용제 2-bromopropane이 가임기 여성들의 난소기능에 미치는 영향: 7년간의 경과보고

윤정섭 ( Jeong Sup Yun ),김기형 ( Ki Hyung Kim ),김돈균 ( Don Kyoun Kim ),조병만 ( Byung Mann Cho ),최욱환 ( Ook Hwan Choi ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

목적 : 화학물질에 의한 난소기능의 소실후 장기 추적관찰과 난소기능에 대한 평가는 큰 의의가 있다고 생각하여 이에 대한 연구를 시행하였다. 연구 방법 : 1995년 전자제품 제조공장에서 2-bromopropane에 폭로된 25명의 여성 근로자를 대상으로 난소기능 부전의 원인과 역학관계를 조사하였고, 이후 2002년 4월까지 여성호르몬 투여를 통하여 무월경의 회복 및 혈중 LH, FSH, E_2, BMD의 변화양상에 대하여 연구하였다. 결과 : 25명의 여성 근로자 중 16명에서 무월경이 발생하였고, 9명에서 무월경이 발생되지 않았다. 무월경이 발생한 군중 10명에서는 호르몬 대체요법중에 자연적인 월경회복을 보였고, 6명에서는 무월경이 회복되지 않았다. 무월경이 발현된 환자들에서는 난소조직검사상 성숙난포의 소실과 함께 원서난포만이 발견되었고, 여성호르몬을 장기간 투여하면서 혈중 호르몬치를 관찰한 결과 점차적인 FSH의 감소와 E_2의 증가가 확인되었다. 무월경군에서는 골밀도가 감소되어 있었고 여성 호르몬을 투여하면서 다소 증가하는 양상을 보였다. 결론 : 2-bromopane이 난소에 직접적인 독작용을 일으킨 것이 확실하고 그로 인한 난소기능 부전의 경우 그것은 가역적인 변화로, 장기간의 시간이 걸린 후에 획복됨을 확인할 수 있었다. 연구에서 난소의 기능 소실과 획복의 여부에 가장 큰 영향을 미치는 인자는 환자의 나이였다. 공업사회를 살면서 근로 환경에서 사용되는 여러 화학물질로 인한 신체적, 정신적 피해는 더욱 늘어날 것으로 생각되며 앞으로 더욱 광범위한 연구가 필요할 것이다. Objective : We conducted a study of the effect of an organic solvent on the failure of ovarian function after exposure to 2-bromopropane for 7 years. Methods : We conducted a study on 25 female workers in a manufactory who were exposed to 2-bromopropane in 1994. Some of them experienced premature ovarian failure. We have investigated their recoveries from ovarian function and checked LH, FSH, E_2, BMD, for 7 years of period. Results : 16 among 25 workers experienced amenorrhea, but the rest of them did not report amenorrhea. In 10 out of the 16 amenorrhea patients, recovery from amenorrhea patients that mature recover from amenorrhea. Though ovarian biopsy, it was observed in the amenorrhea patients that mature follicles were lost and only primordial follicles were present. Through HRT, gradual decrease in FSH and increase in E_2. in the amenorrhea patients were found. Also, their BMD were decreased, but gradually increased with female hormone replacement therapy. Conclusion : The study confirms that the exposure to 2-bromopropane leads to the serious ovarian toxicity and ovarian failure as well. In such case, the failure of ovarian function, which is reversible change, can be recovered after long-term perlods. A significant factor which affect ovarian failure and recovery from ovarian function is patient`s age. In industrial environment, physical and psychological damage due to the use of and exposure to chemical materials will likely increase. Hence, more studies of industrial materials used in working conditions are needed.

생식기능 장애 환자에서의 세포유전학적 이상

윤정섭 ( Jeong Sup Yun ),장성규 ( Sung Kyoo Jang ),최욱환 ( Ook Hwan Choi ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 본 연구는 염색체 이상과 남성과 여성의 생식능 장애와의 연관성을 알아보고 9번 염색체의 역위의 표현형과의 연관성을 확인하고자 시행하였다. 방법: 1995년 1월부터 2003년 12월까지 본원 세포유전 검사실에 의뢰되어 검사를 시행한 1713명의 염색체 분석 결과를 분석하였다. 연구 대상은 불임인 658명의 남성과 18명의 여성군, 반복 자연유산을 경험한 65명의 남성과 109명의 여성군, 일차성 무월경인 78명의 여성군, 61명의 이차성 무월경군으로 생식능 장애가 없는 남성 382명과 여성 342명을 대조군으로 정하였다. 대상군에서의 9번 염색체 역위의 빈도를 대조군과 통계학적으로 비교하였다. 결과: 염색체 이상은 남성 불임군에서 110예 (16.7%), 여성불임군에서 2예 (11.1%), 반복자연유산군의 남성과 여성에서 각각 3예 (4.6%), 15예 (13.8%), 일차성 무월경군에서 29예 (37.2%), 그리고 이차성 무월경군에서 10예 (16.4%)로 나타났다. 여성불임 환자와 이차성 무월경 환자에서는 생식능 장애와 염색체 이상 소견과의 관련성은 없었다. 반복자연유산을 하는 여성에서 6예 (5.5%)는 상염색체 전위, 그리고 7예 (6.4%)에서는 9번 염색체의 역위를 보였다. 일차성 무월경 환자에서는 다른 연구들에서와 같이 대부분의 염색체 이상은 터너 증후군을 포함한 성염색체의 이상이었다. 총 1713명의 염색체 분석에서 33예의 9번 염색체 전위가 발견되었다 (1.93%). 남성 불임의 경우, 10예 (1.52%)에서 9번 염색체의 전위가 발견되었고, 이는 남성 대조군과 큰 차이를 보이지 않았으나, 반복자연유산을 하는 여성군에서의 7예 (6.42%)의 9번 염색체 역위는 여성 대조군에 비해 유의하게 높았다 (p<0.05). 결론: 생식능 장애가 있는 많은 환자들은 다양한 세포유전학적 이상을 가지고 있기 때문에, 염색체 분석은 불임, 반복자연유산과 무월경을 평가하는 검사로 고려되어야 할 것으로 생각된다. 그리고 9번 염색체의 역위가 여성의 반복자연유산에서 많은 빈도를 보인다는 것을 알 수 있었다. Objective: The aim of this study was to investigate the relationship between chromosome abnormalities and male or female reproductive dysfunction and to be convinced of the role of pericentric inversion of chromosome 9 (inv (9)) on human phenotypes. Methods: Between Jan. 1995 and Dec. 2003, results of 1713 chromosomal analyses which were referred to our cytogenetic laboratory were analyzed. Study groups consisted of 658 cases of men and 18 cases of women with unexplained infertility, 65 cases of men and 109 cases of women with history of recurrent spontaneous abortion, 78 cases of women with primary amenorrhea, 61 cases of women with secondary amenorrhea and, 382 cases of men and 342 cases of women with no reproductive dysfunction (control group). The incidence of inv (9) among each group was compared with control group. Results: Chromosomal abnormalities were found in 110 cases (16.7%), 2 cases (11.1%), 3 cases (4.6%), 15 cases (13.8%), 29 cases (37.2%) and 10 cases (16.4%) in each group. The incidence of chromosomal abnormalities in male infertility was higher than previous reports, and 10 cases of inv (9) were detected in male infertility group. In cases of women with infertility and secondary amenorrhea, we couldn`t find the relevance between reproductive dysfunction and chromosomal abnormality. In cases of women with recurrent spontaneous abortion, 6 cases (5.5%) had autosomal translocation and 7 cases (6.42%) had inv (9). In cases with primary amenorrhea, most chromosomal abnormalities found were related to sex chromosome such as Turner`s syndrome, similar to other investigations. Thirty three cases of inv (9) was detected among the whole 1713 chromosomal analyses (1.93%). In cases of male infertility, 10 cases (1.52%) had inv (9), not significantly different with male control group. But 7 cases (6.42%) of inv (9) in women with recurrent spontaneous abortion were significantly higher than female control group (p<0.05). Conclusion: Because considerable proportion of patients with reproductive dysfunction had various cytogenetic abnormalities, the chromosomal analysis should be considered as a diagnostic tool in the evaluation of reproductive dysfunction such as infertility, recurrent spontaneous abortion, and amenorrhea. We also found that Inv (9) had a significantly increased incidence in female recurrent spontaneous abortion.

자궁내막증과 합병된 난소의 세포성섬유종 1 예

김기형 ( Ki Hyung Kim ),이동형 ( Dong Hyung Lee ),윤만수 ( Man Soo Yoon ),윤정섭 ( Jeong Sup Yun ),장성규 ( Sung Kyoo Jang ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

Ovarian cellular fibroma is an uncommon benign tumor and accounts for approximately 4% of all ovarian neoplasms. It mimics fibrosarcoma histologically because of its rich cellularity and high number of mitoses. Ovarian cellular fibroma with endometriosis was a rare case. We experienced a case of ovarian cellular fibroma in a 25-year-old woman underwent exploratory laparotomy for huge ovarian enlargement and report the case with brief review of literature.

원발성 상피성 난소암에서의 고용량 Cisplatin - Cyclophosphamide 의 치료성적에 관한 연구

윤정섭,김하정,장성규,김기형,윤만수 대한부인종양 콜포스코피학회 2001 Journal of Gynecologic Oncology Vol.12 No.1

Objective: The purpose of this study was to evaluate the therapeutic efficacy and toxicity of high dose cisplatin-cyclophosphamide combination chemotherapy on patients with primary epithelial ovarian cancer. Methods: A review of 63 patients previously diagnosed as primary epithelial ovarian cancer after initial operation and histology at Pusan National University Hospital from Jul, 1993 to Jun, 1997 was performed. Patients were received the combination chemotherapy including cisplatin 100mg/m2/day and cyclophosphamide 750mg/m2/day, repeated 6 cycles every 4 weeks. The mean age was 48 years old, and previous surgical procedures were total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy. The patients were classified into FIGO stage and pathologic results. Results: The clinical response rate was 100% in the FIGO stage Ic patients with PC combination chemotherapy, 100% in stage II, 53.5% in stage III, and 25% in stage IV. The overall response rate was 69.8%. The 3-year survival rate according to the treatment groups was 93.3% in stage Ic group, 60% in stage II, 50% in stage III and 0% in stage IV. The mean survival duration was 34.6 months. Hematologic toxicities in cisplatin-cyclophosphamide chemotherapy were neutropenia and anemia. Nausea and vomiting were the most common side effects and occurred in 96.8%. Most of the toxicities were grade 1 and 2. Conclusion: The combination chemotherapy with cisplatin-cyclophosphamide is relatively safe and effective method in the treatment of primary epithelial ovarian cancer.