Medroxy Progesterone Acetate ( MPA ) 가 생쥐의 교미 및 배란에 미치는 영향

이영호(HY Lee),정순오(SO Chung),곽현모(HM Kwak) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.8

Medroxy-pogesterone acetate(MPA)가 생쥐에서 성적행동, 배란 및 자궁상태에 미치는 영향에 대하여 실험한 바 다음과 같은 결론을 얻었다. 1. 교미전에 MPA(2㎎/㎖)를 주사하면 발정일을 제외한 발정주기 기간중 어떠한 날에 도 교미를 억제한다. 2. MPA(2㎎/㎖)는 Pregnant Mare’s Serum(PMS) 2 iu과 Human Chorionic Gonadotrophin(HCG) 2 iu으로 유도된 인공배란에는 영향을 미치지 안었다. 3. MPS는 자궁상태에 심한 이상을 나타내었다. 4. 이와 같은 MPA의 작용과 PMS나 HCG의 중량에는 상호 상관관계를 가할 수 없었 다. 이상의 실험결과로 미루어 보아 생쥐에서 MPA는 배란에 대한 영향은 없었으나 교미 와 자궁상태에는 강한 영향을 나타내었으며 이러한 효과는 MPA가 주로 시상하부와 뇌 하수체를 연결하는 tract에 작용하고 또 한 난소에도 작용하여 나타나는 것으로 사료된다. Females of most mammals, except for higher primates, show specific sexual behavior and permit copulation only during estrus when ovulation occurs, During this period females reveal peculiar sexual behavior while males, seizing opportunities for copulation from such behavior, usually carry out copulation (Nalbandov,1958). Among the mammals, rats and mice, for instance reveal the fohowing three signs of sexual begavior during estrus; first, permission of copulation; second, lordosis and male like mounting; and third, running activity (Young, 1961). Ho-wever these signs of sexual behavior come always during estrus, and females allow copulation with males only during that period. In the early stage of reproductive physiology, it was confirmed through research that sexual behavior during estrus directly linked with ovaries are removed( Ball, 1936; Robson, 1938; Young and Orbisin, 1944). Later research by many investigators led to discovery of the fact that an appropriate combination of estrogen and progesterone os required to induce sezual behavior in the rat ( Boling and Blandau, 1939; Beach,1942), mouse(ring, 1944), hamster (Frank and Fraps, 1945` Kent and Lieberman,1947) and cow (Melampyet al., 1957). Zeilmaker (1966) observed that progesterone had the effect of advance or delay in the release of gonadotrophic hormones under the influence of time of injection and estrous cycle of the rat. Progesterone had also been described to have a biphasic effect on estrous behavior and pituitary stimulation are mediated by means of altered thresholds of neural activity (Kawakami and Sawyer,1959). The synthesis of steroid hormones has become possible, while medroxy-progesterone acteate (MPA), which has a far stronger biological effect than progesterone, has emerged as a contraceptive drug (Zanartu, 1968, Soichet, 1967). MPA is believed to have contraceptive effects by inhibition of ovulation (Mishell, 1967; Zanartu etal., 1970) and by influencing the uterine cervical mucus and endonetrium (Mishellet al., 1968; Zanartu et al., 19970). In rats, MPA is known to inhibit ovulationuterine water retention and vaginal epithelial cornification(Banik and Herr, 1969). MPA is also believed to delay or suppress implantation in rats (Barnes and Meyer,1964; Yoshinaga and Greep, 1971), but not in mice (Chung, 1977). It was therefore the aim of this study to research the effect of MPA on the sexual behavior of mice and to ascertain the relation between ovulation and sexual behavior after ovulation has been induced with gonadotrophin injection. Mammals used for the experiment were mice weighing about 25 to 30 grams, while the mammal subjects were adapted to an environment where illumination was controlled in order to keep the estrous cycle constant. Bright and datk conditions were maintained to last 14 and 10 hours, respectively, while the indoor thmperature was kept at 17 to 25 degrees C. The progesterone used for this experiment was MPA (2mg/ml) manufactured by Upjihn pharmaceutical Co. In order to ensure synchronization with the estrous cycle, 2 international unit (ju0 of pregnant mare`s serum (PMS) was injected into the intraperitoneal cavity, and after the elapse of 48 hours, 2ju of human chorionic gonadotrophin (HCG) was also injected into the intraperitoneal cavity, and then the female mouse was put into a cage along with mature male, The next morning copulation was confirmed by using vaginal plugs. In addition, in order to observe ovulation, the number of ovulated eggs and the state of uterine condition, the mice were slaughtered through cervical dislocation, and the fallopian tube was removed by opening the abdominal cavity. Then the number of eggs collected by washing the fallopian tube from the upper part down with 0.85% physiological salt water was counted under a dissection microscope.

자궁내막선암의 임상병리학적 고찰

이영호(HY Lee),나창수(CS Nah),이봉구(BK Lee) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

1970년 1월부터 1985년 12월까지 만 16년간 자궁내막선암 환자에 대한 임상경험을 조사한 결과 아래와 같은 결과를 얻었다. 1. 자궁내막선암의 발생 빈도는 전 부인암 중 1.5%를 차지하였고, 자궁경부암에 대한 비율 은 1:55이엇다. 2. 환자의 평균 연령은 55세이었고, 연령분포는 50-59세 군이 41.4%로 가장 많은 빈도를 보 였다. 3. 월경력과의 관계는 폐경기 이후가 72.4%로 가장 많았고, 폐경기가 17.3%폐경기전이 10.3%순이었다. 4. 해산 경력과의 관계는 5회 이상 경산부가 27.6%로 가장 많았고, 미경산율은 17.2%이었다. 5. 내과적 또는 산부인과적 합병증으로는 고혈압과 불임증이 21.5%, 비만이 17.2% 자궁근종 과 당뇨가 8.6%순 이었다. 6. 자각 증상은 불규칙한 자궁출혈이 93.1%이었으며, 이중 폐경기 이후 출혈이 75.9%로서 가장 많았고, 대하가 20.7% 하복통 호소가 17.2%순이었다. 7. FIGO의 임상 분류법에 의하면 1기가 58.8%, 제 2기 17.2%, 제 3기 20.6%, 제 4기 3.4%이 었으며 연령과 임상적 stage와의 특별한 연관성은 없었다. 8. 조직학적 진단으로서는 자궁내막선암이 96%, 선극 세포암이 4%이었다. A Clinico-pathological study was made on a series of 28 endometrial cancers experienced at the Department of Obsterics and Gyunecology, Presbyterian Medical Center during the period from January 1, 1970 to December 31, 1985. The results obtained were as follows; 1. The incindence of endometrial cancer of all gynecological malignancies was 1.5% and the ratio of the endometrial cancer to cervical cancer was 1:55. 2. Age distribution of endometrial cancer was concentrated on the age group of 50-59 and average age was 55years. 3. the menstrual status at the time of development of endometrial cancer showed that 21 cases (72.4%) were post menopausal, 5 cases (17.3) were menopausal and 3 cases (10.3%) were premenopausal. 4. The frequency of nulliparity was 17.2% 5. Associated medical and gynecological conditions were as follows ; hypertension and infertility was noticed in 21.5% obesity in 17.2% myoma and diabetes mellitus in 8.6% respectively. 6. As to the presenting symptoms, abnormal bleeding was encountered in 93.1%, commonly postmenopausal in 75.9% nd vaginal discharge and lower abdominal pain were in 20.7% respectively. 7. According to the clinical stage adopted by FIGO classification stage I was found in 58.8% stage 2 in 17.2%, stage 3 in 20.6% stage 4 in 3.4% and clinical stage and age were seemed to be no related. 8. Accordiong to WHO histopathological classfication the percentage of the adenocarcinoma was 96% and adenoacanthoma was 4%.

융모종양에 관한 임상적 고찰

이영호(HY Lee),이동식(DS Lee),이국(K Lee) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.6

This study was undertaken for the clinical analysis and evaluation of the women with trophoblastic tumors who were admitted and treated at the Yonsei University Medical Center from Jan. 1,1961 to June 30, 1972. A total of 187 cases were seen with the following distribution: Hydatidiform mole 94, chorioadenoma destruens 17, and choriocarcinoma 76. The following features were the results of this study: 1. Hydatidiform mole occurred approximately once in every 186 pregnancies and 161 deliveries, chorioadenoma destruens once in every 1028 pregnancies and 889 deliveries, choriocarcinoma once in every 230 pregnancies and 199 deliveries, respectively. 2. While the rate of normal intrauterine pregnancy declines markedly after the age of 40, the occurrence of the trophoblastic tumor after this age become remarkably increased. It was noteworthy that the incidence of choriocarcinoma increased in proportion to the gravidity. 3. Among the patients with choriocarcinoma, 71 per cent of patient had lung metastasis, 21 per cent vagina, 8 per cent brain, and 4 per cent G-I tract. 4. In cases of choriocarcinoma, 33 per cent of cases occur after hydatidiform mole, 30 per cent after term pregnancies, 30 per cent after abortion. 5. Forty seven per cent of the patient with hydatidiform mole were managed by D & E, hysterectomy was done in 41 per cent of the patient with chorioadenoma destruens, and 53 per cent of the patient with choriocarcinoma were managed by chemotherapy with Methotrexate alone or Methotrexate and Actinomycin-D. 6. In the patient with chorioadenoma destruens, remission rate was 76 per cent. In patients with choriocarcinoma, remission rate was 51 per cent, mortality rate was 26 per cent and recurrence rate was 12 per cent respectively. In the cases of choriocarcinoma the earlier the treatment, the better the result. Among the patient with remission after chemotherapy, most of them had at least 3 kurs of therpapy, and the patient with multiple metastasis showed very poor remission rate compared with those without metastasis.

난관불임술에 관한 임상적고찰

이국(K Lee),이영호(HY Lee),박찬규(CK Park),오기석(KS Oh) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.3

1) 난관불임수술을 실시한 총 931 예중 복식난관불임수술 823예, 질식난관불임수술 108예였 으며 복식난관불임수술예 중 산욕기 난관결찰수술은 356예에서 시행하였다. 2) 난관불임수술환자 중 다산부는 473예(50.8%), 다산부이면서 산과 및 부인과적 수술시 난 관불임수술을 겸행한 환자는 각각 152예(16.3%) 및 292예(31.4%), 내과적 적응증 환자는 14 예(1.5%)였다. 3) 연도별 난관불인수술 환자의 수와 분만례에 대한 난관불임수술빈도는 매년 증가하는 경 향을 보였고 년령은 낮아지고 생존아수도 감소하는 경향을 보인 반면 연도별 생존아의 평균 남녀 성비는 12:100으로 남아가 우세하였다. 4) 난관불임수술환자의 평균년령은 33.1세, 평균임신회수 5.3, 평균분만회수 3.5, 평균 생존아 수 3.2, 평균 인공유산회수 1.6회였다. 5) 산욕기 난관결찰수술은 가장 편리한 수술이며 대부분의 예에서 산욕기 1일 이내에 시행 하였다. 6) 난관불임수술 중 산욕기 난관결찰수술은 타수술군에 비해 최단 평균입원일(3.3일)과 최소 이환률(3.7%)을 보여주었다. 7) 마취는 대부분의 예에서 전신마취를 하였다. 8) 난관불임수술환자 931예 중 1예에서 실패하여 0.1%의 실패률이었다. A clinical analysis has been made on 931 cases of tubal sterilization which were seen at the Department of Obstetrics and Gynecology, Yonsei Uneversity Medical Center from Jan. 1, 1965 to Dec. 31, 1972. The results are as follws ; 1) 931 cases of tubal sterilization were performed. Among them, 88.4% were abdominal procedures and the remaining 11.6% were vaginal procedures. 2) The main indications(motivations) for tubal sterilization were as follows ; Multiparity only …………………………………………………… 50.8% Gynecological indication accompanying multiparity ………… 31.4% Obstetrical indication accompanying multiparity …………… 16.3% Medical indication ………………………………………………… 1.5% 3) For recent 8 years, annual number of tubal sterilized patients has been increasing as well as the incidende of puerperal sterilization, but average age of tubal sterilized patients tended to be lowered with the decreased number of their living children. According to the sex ratio of their living children (male : female=129:100), the number of male had a slightly higher preponderance for having tubal sterilization. 4) Average age of tubal sterilized patients was 33.1 years. Average number of gravidity, living children and induced abortion were respectively 5.3, 3.5, 3.2, and 1.6. 5) Considering the shortest average postoperative hospital day(3.3 days) and the lowest morbidity rate (3.7%) as compared with those of the other abdominal and vaginal sterilizations, the postpartum tubal sterilization was the most convenient method, and it was performed usually on postpartum 1st day. 6) General anesthesia was performed in the majority of cases. 7) Among 931 tubal sterilizations, there was 1 failure in vaginal tubal sterilization. Failure rate was 0.1%.

단안증 1 예

박충학(CH Park),최원도(WD Choi),장윤석(YS Chang),김강희(KH Kim),이영호(HY Lee) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.8

서울대학교 의과대학 산부인과학교실 박충학·최원도*·장윤석·김강회·이영호 =Abstract= A Case of Cyclopia Park CH, Choi WD, Chang YS,* Kim KH, Lee YH Dept of Obstetrics and Gynecology College of Medicine Seoul National University Cyclopia is a fetal ocular anomaly in which the eyes are fused together such a serious degree of maldevelopment is incompastible with survival Its name is derived from Cyclops the one eyed giant of Greek legned It is the severest from of holotelencephaly which is failure of cleavage of the prosencephalon with a deficit in midline facial development In cyclopia combined with an extrachromosome in the 13-15 group there are characteristically multipld congenital anomalies and it is called also Patau`s syndrome A case of cyclopia associated with hydramnios in a 25 years old para 1-0-0-1 woman is presented with brief review of literatures concerned.

한국불임여성에 있어서 자궁난관조영술의 임상적 고찰

곽현모(HM Kwak),김성도(SD Kim),이영호(HY Lee),오기석(KS Oh) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.6

1967년 1월부터 1969년 12월까지 만 3년간 불임을 주소로 연세대학교 의과대학 산부인과 외 래에 내원하여 자궁난관조영술을 시행한 예 중 임상 및 X선 기록이 충실한 200예를 대상으 로 분석 고찰하여 다음과 같은 결론을 얻었다. 1) 자궁난관조영술을 시행한 200예 중 원발성불임은 121예, 속발성불임은 79예였다. 2) 연령분포를 보면 원발성불임군에는 25∼29세군이 58예(47.9%), 속발성불임군에서는 30∼ 34세군이 31예(39.3%)로 가장 많았다. 3) 불임기간은 월발성 및 속발성 불임 전체에서 불임 기간 7∼9년이 60예(30.0%)로 가장 많 았고, 속발성불임군에서 원발성불임군에 비해 불임기간이 다소 긴 경향을 볼 수 있었다. 4) 기왕력에 있어서 골반염증성 질환이 22예(11.0%)로 가장 많았으며 원발성불임군에서는 진단목적으로 소파수술을 받은 예가 11에, 충수절제술이 7예였고 속발성불임군에서는 최종 임신을 임신중절술로 마친 예가 25예(12.5%)로 가장 많았다. 5) 자궁상은 정상이 125예(62.5%)이고 비정상 70예 중 내강벽 불규칙상이 30예(15.0%)로 가 장 많았다. 6) 난관상에서는 팽대부 및 체부의 난관수종상이 76예(38.0%)로 가장 높은 빈도를 나타냈 다. 7) 양측난관폐쇄는 52.0%(104예)이였으며 편측폐쇄가 16.0%(32예)로 좌우측난관에서 의의있 는 차이는 없었다. 8) 난관의 폐쇄부위는 각부 30예, 협부 32예 그리고 팽대부가 71예(35.5%)로 가장 많았으며 좌우측 난관에서 차이는 없었다. 9) 복강상은 96예(48.0%)에서 출현하였다. 10) 골반내맥관상의 출현빈도는 13.5%로 타 보고자보다 높은치를 보였으며 원발성 및 속발 성에서 의의있는 차이는 없다. 11) 자궁, 난관, 복강상에 있어서 이들 전부가 정상인 것은 42예(21.0%), 하나 이상에서 비정 상인 것은 116예(58.0%)이였다. Hysterosalpingography has been universally accepted and approved method as a valuable aid in the diagnosis and treatment of infertility and tubal pathology, especially for tubal patency. A clinical analysis has been made on 200 cases of known infertile patients by the view of hysterosalpingogrm. The results were as follows : 1) In 200 cases of infertility, 121 cases were primary and remaining 79 cases were secondary infertility. 2) Age distribution showed the peak at 25-29 year old group in primary infertility and at 30-34 year old group in secondary infertility, cases of which were 58(47.9%) and 31(39.3%) respectively. 3) 60 cases of this study shows 7-9 years of duration infertility and it was longer in secondary than primary infertility. 4) In past history, pelvic inflammatory diseases were found in 22 cases (11.0%), diagnostic D & C in 25 cases (12.5%) of secondary infertility. 5) Uterine shadow revealed 125 cases of normal finding and 30 cases of irregular uterine cavity shadow, which was 15.0% and predominant abnormal finding. 6) Tubal pathology was predominent lesion in hysterosalpingogrm and bilateral occlusion was noted in 104 cases(52.0%) and unilateraltubal occlusion was 32 cases(16.0%).Tthere was no significant difference between right and left side. 7) In shape of tubes, hysterosalpinx of ampuaalr and fimbrial portion was predominant to the exclusion of patent tubes and cornual obstruction. 8) Sites of tubal occlusion were cornual in 30 cases, isthmic in 32 cases and ampullar and fimbrial portion in 71 cases. 9) Intravasation, one of complications of HSG was noted in pelvic cavity of 27 cases among 200 cases, which was 13.5%. 10) Abdominal despersion of radiopaque material appeared in 96 cases(48.0%) of this study and most common appearance was homogeneous hazzy cloudy shape. 11) Normal hysterosalpingogrm was noted in 42 cases(21.0%) and 116 cases(58.0%) was abnormal in one or more among uterine, tubal, and intraabdominal shadow.

양성 갑상선결절에서 부피의 변화

임창훈(Chang Hoon Yim),최현아(Hyun Ah Choi),정호연(Ho Yeon Chung),한기옥(Ki Ok Han),장학철(Hak Chul Jang),윤현구(Hyun Ky Yoon),한인권(In Kwon Han),김희숙(Hy Sook Kim),이영호(Young Ho Lee) 대한여성건강학회 2001 여성건강 Vol.2 No.2

미숙분만에 관한 역학적 고찰

이영호,이봉구,이영혜,장부용,이형열,오병전,정두수 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.2

1986년 1월부터 1988년 6월까지 2년 6개월간 본원 산부인과에서 분만한 총 6275예의 분만중 미숙분만 519예에 대한 통계학적분석을 실시, 여러 위험인자에 대한 빈도를 조사하여 다음과 같은 결론을 얻었다. 1. 미숙분만율은 1986년 7.7%, 1987년 7.2%에서 1988년 10.0%로 최근 증가추세를 보이고 있다. 2. 최근 5년간 borderline preterm delivery는 54.5%를 차지하였으며, moderately preterm delivery는 32.2%, extremely preterm delivery는 13.3%를 차지하였다. 3. 미숙분만 산모의 연령분포는 35세이하 7.8%에 비해 35세이상에서 20.5%로 현저히 높았다. 4. 미숙분만 산모의 분만횟수는 분만횟수 4회이상 산모에서 28.9%로 초산부나 1회 경산부의 7.6%에 비해 현저하게 높았다. 5. 미숙분만 산모의 유산횟수는 유산경험이 없는 경우 6.6%에 비해 3회이상의 경우 17.1%로 현저히 증가되었다. 6. 산모의 교육정도와 미숙분만과 관련성은 교육기간이 길수록 적게 나타났다. 7. 미숙분만율과 최초 산전진찰시기와는 연관 관계가 없었다. 8. 분만과거력에 있어서는 과거 미숙분만 및 만기 유산력이 있는 경우 전체분만에 비해 8.2배의 높은 율을 보였으며, 과거 사산 및 주산기 영아 신생아 사망 예에서 1.9배로 높았으나, 제왕절개 수술력은 관련이 없었다. 9. 조산의 발생과 직접적 연관이 있는 원인으로는 다태임신, 선천성 태아기형, 전치태반, 태반조기박리, 자궁내 태아사망, 이상태위, 자궁경관내구무력증, 자궁기형, 양수조기파수 등이 있으며, 임신자간증 및 중증 자간전증의 경우는 의인성으로 조산을 시킨 경우도 있었으나 상당수 연관이 있었다. 10. 산모의 전신질환에는 결핵, 만성고혈압 등이 연관이 있고 심장질환, 신장질환 등에서는 별로 연관니 없었다. 11. 저 Apgar score(6) 신생아 발생율은 extremely preterm newborn에서 1분 71.2%, 5분 65.4%를 보였다. Although neonatal intensive care of the preterm newborn has improved the chances of healthy survival of infants, prematurity is still the major cause of neonatal mortality and morbidity. In order to investigate the various risk factors of preterm birth and contribute to prevention of preterm birth hereafter, we performed statistical analysis on 519 cases of preterm birth delivered at Department of Obstetrics and Gynecology, Presbyterian Medical Center from January 1986 to June 1988 per 6275 total delivery cases. The results of the study were as follows: 1. The incidence rate of preterm births was 7.7 % on 1986 and 7.2 % on 1987, and 10.0 % on 1988, increasing trends recently. 2. The rate of borderline preterm birth was 54.5 % and moderately preterm birth was 32.2 %, and extremely preterm birth was 13.3 % during 5 years, recently. 3. The rate of preterm birth to total birth by maternal age was 7.8 % in maternal age of under 35 years and 20.5 % in maternal age of over 35 years. 4. Number of preterm birth was increased as number of parity, and preterm birth rate to total birth by parity was 7.6 % in para 0.1, and 28.9 % in para above 4. 5. Number of preterm birth was increased as number of abortion, and preterm birth rate to total birth by abortion number was 6.6 % in no abortion group and 17.1 % in experienced abortion over 3 times. 6. Number of preterm birth was lesser in more 13 years education periods group than under 9 years education periods group. 7. There was no significant relationship of the preterm birth incidence rate and first antenatal care time. 8. As compared with previous obstetric history, preterm birth was 8.2 times more in cases with previous preterm birth and late abortion and 1.9 times more in cases with past still birth and postnatal death, but not related to past cesarean section. 9. Obstetric risk factors related to preterm birth was multiple pregnancy, congenital malformation, placenta previa, abruptio placenta, IUFD, abnormal presentation and IIOC, uterine anomaly, PROM and preeclampsia severe form and eclampsia. 10. High risk maternal disease was tuberculosis and chronic hypertension, but heart disease and renal discase was not related. 11. Incidence of low Apgar score($lt;6)rate was 71.2% at 1 minute and 65.4% at 5 minute on extremely preterm newborn.

자궁경암 1411 예에 대한 임상적 고찰 : 12 년간 임상 경험의 재조사 A Review of 12 Years Clinical Experience

이영호,이영혜,장부용,나창수,이형렬,오병전 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.3

1975년 1월부터 1986년 12월까지 만 12년간 자궁경암 환자에 대한 임상경험을 재 조사한 결과 아래와 같은 결론을 얻었다. 1. 발생빈도는 여성 성기에서 발생하는 악성 종양중 단연 1위였으며(28.5%), 년 평균 환자수는 117.6명이었다. 2. 자궁경암의 평균연령은 침윤성의 경우 48.5세였고 비침윤성의 경우 42.1세였다. 3. 직업별 분포는 농업, 임업, 축산업이 많았고, 지역별 분포는 전북, 충남 거주 순이었으며, 농촌 거주 환자가 도시 거주 환자보다 많았다. 4. 결혼연령 분포는 20세이하가 63.1%였으며, 기왈 출산 평균횟수는 5회였고, 한번도 유산 경험이 없었던 환자에게서의 발생빈도가 40.2%로 가장 높았다. 폐경기 이후에 환자의 47.3%가 발생하였으며 평균 폐경기연령은 47.4세였다. 5. 병리조직학적 분포를 살펴보면, 편평상피암이 대다수(93.6%)였고 선암이 6.1%를 차지하였다. 임상증상은 접촉 출혈, 자궁 점적출혈 및 자궁출혈이 가장 많았고, 자궁경의 소견은 외번이 가장 많았으며 임상기별 분포는 제II기가 가장 많았다. 6. 치료는 개별화하여 시행하였으며 자궁경 상피내암의 5년생존율은 100%였다. 침윤성 자궁경암의 경우 방사선 치료를 했을 때 5년 생존율이 제 I 기 88.0%, 제 II 기 64.1%, 제 III 기 24.1% 및 제 IV 기 33.3%였으며 광범위 수술 및 수술전후에 방사선요법으로 보조를 받았던 경우 5년 생존율은 제 I기 86.4%, 제 II기 40%였다. 광범위 수술을 시행한 경우 유병율은 12.3%였고 루공형성빈도는 1.2%였다. 7. 자궁기저암의 발생은 7예에서 볼 수 있었으며, 자궁 부분절제술 이후부터 암이 발생하기까지의 소요기간은 평균 8년이었다. 8. 임신중의 자궁경암 발생빈도는 0.06%였고, 자궁경암 환자중의 0.85%였다. 대다수 제 II기였으며(66.6%), 암이 발견된 시기는 임신 중기까지가 66.6%로 가장 많았고, 치료후 5년 생존율은 50%였다. 9. 재발은 방사선 치료시 15.0%였고, 수술을 받은 경우는 7.8&였다. 병리조직학적으로는 선암에서 더욱 높은 빈도를 보였고, 대다수 18개월내에 재발되었다. 재발의 경우 개별치료후 5년 생존율은 31.3%였다. 10. 자궁경암의 전이 장소는 폐장이 34.0%로 가장 많았다. The results of a review of 1141 cases of cervical carcinoma at Presbyterian Medical Center from January, 1975 to December, 1986 were as follows: 1. The evidence of cervical carcinoma was 11.8 % in the total number of cancer patients and 28.5 % in the female cancer patients. 2. The means number of patients per year was 117.6 cases. The mean age was 48.5 years old in invasive cervical carcinoma, and 42.1 years in intraepithelial carcinoma. 3. The lower the socioeconomic condition, the higher was the risk of cancer, and patients from rural areas showed higher risks of cancer than those from urban areas. 4. The earlier the age of marriage, the higher was the risk of cancer, but the number of deliveries and abortions was not clear. In Postmenopausal women cervical carcinoma was found in 47.3 % of the cases. 5. In the distribution by histologic type, squamous cell carcinoma was 93.6 % and adenocarcinoma was 6.7 %. The most frequent clinical symptom was postcoital or vaginal spotting and vaginal bleeding (68.0 %). In the majority of cases, the gross findings of the uterine cervix was exophytic mass (42.8 %). The distribution by clinical stages was stage I, 15.8 %; stage II, 49.7 %; stage III, 15.3; stage IV, 3.9 %. 6. The determinate five-year survival rate was as follows; a) In radiation therapy-stage I, 84.0 %; stage II, 60.8 %; stage III, 16.7 %; stage IV, 33.3 % b) In radical surgery-stage I, 86.4 %; stage II, 40.0 % 7. The incidence of carcinoma of the cervical stump was 0.49 %; the mean duration was 8 years. 8. The incidence of cervical carcinoma in pregnant woman was 0.06 % per live births and 0.85 % per cervical carcinoma. The determinate five-year survival rate was 50 %. 9. The recurrence rate in radiation therapy was 15.0 %, in radical surgery was 7.8 %. The most frequent symptom in recurrent cervical carcinoma was vaginal bleeding or spotting; an the majority of cases, the recurrence developed within 24 months (77.0 %). The determinate five-year survival rate was 31.3 %. 10. The most frequent metastatic site was the lung(34.0%).

체외수정 및 배아이식에 있어서 Color Doppler Ultrasonography의 임상적 연구

이영호,박종민,이승재,차영범,김홍기 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.5

저자들은 난관이상으로 진단받고 과배란유도를 하여 체외수정 및 배아이식을 시행한 43명의 환자를 대상으로 color Doppler초음파검사를 시행하여 다음과 같은 결론을 얻었다. 1. color Doppler초음파를 이용하므로써 일반 흑백 Doppler초음파검사로는 찾아내기 힘들었던 자궁 및 난소동맥을 쉽게 인지하여, 용이하고 신속하게 혈류측정이 가능하다. 2. 자궁 및 난소의 혈류량은 배란유도 기간 중 난포채취 전까지 증가하는 양상을 보였다. 3. 혈중 estradiol치가 자궁 및 난소로의 혈류량에 영향을 미침을 알 수 있었다. 4. 성숙된 난포의 수가 많을 수록 자궁 및 난소로의 혈류량이 증가하는 경향을 보였으나 통계학적인 유의성은 없었다. 5. 배란 유도주기에서 자궁내막의 두께와 혈류량과의 상관관계는 관찰할 수 없었다. 6. 임신성공 유무에 따라 혈류량에 차이는 있었으나 유의성은 없었다. 결론적으로 color Doppler초음파검사를 이용하면 자궁 및 난소동맥을 신속하고, 정확하게 관찰하여, 자궁 및 난소의 기능적인 면, 즉 혈류학적 정보를 쉽게 얻을 수 있어 좀 더 연구하면 아직까지 우리가 몰랐던 불임의 원인규명에 도움을 줄 수 있을 것으로 사료된다. The condition of the endometrium is a crucial factor for successful implantation, but published research into the reasons for failure of implantation of embryos has been confined to histochemical and histological studies of the endometrium. This paper presents the functional aspects of the endometrium and ovaries in view of the blood flow patterns with the use of the color Doppler ultrasonography. In 43 women from an in vitro fertilization(IVF) program, the uterine and ovarian blood flows were investigated by color Doppler ultrasonography. The Resistance Index(RI) was used to evaluate the blood flow pattern. Blood flows to the uterus and ovaries were increased during the stimulated cycles and were well correlated with the serum estradiol level. When comparing the patients who became pregnant after embryo transfer(n=7) with those who did not conceive(n=36), the RI of pregnant group was lower than non-pregnant group on the day of embryo transfer, but it is not significant. In conclusion, the color Doppler ultrasonography of the uterine and ovarian arteries was useful in the hemodynamic evaluation of the uterus and ovaries and the data available so far suggest that hemodynamic parameters detected by color Doppler ultrasonography may provide additional aid to decision making with regard to IVF-ET.