자궁경관에 발생한 이소성 혼합육종의 1례

이국(K Lee),이윤호(YH Lee),김대현(TH Kim),박찬일(CI Park),이광길(KK Lee),노재윤(JY Ro) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.1

결론 1. 자궁경관에 발생한 이소성 혼합육종의 1예를 보고하였다. 2. 근치자궁적출술 및 양축 골반 임파선적출술, 방사선치료, 불완전하나마 혼합약물요법같은 병합요법으로 치료한 예에서 1년간 재발없이 생존하였다. Mixed heterologous sarcoma of the uterine cervix is a rare and highly malignant tumor. A case of this type was recently experienced in a 20-year0old unmarried woman and served as the vasis of this report. The patient has been bollowed for 1 year without evidence of recurrence. Such tumors develop from the mesodermal tissue associated with mullerian duct and consist of heterologous and gifhly malignant tissues. A brief rebiew of literature is presented, especially concerning the current tend- ency of treatment : combined modality with surgery, radiotherapy and combinatation chemotherapy.

초기 정상임신중 임신부 혈청 alpha-fetoprotein치에 관한 연구 (I)

이국(K Lee),이윤호(YH Lee),황동훈(DH Hwang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.9

1 1984년 2월 1일부터 연세의대 영동세브란스병원 산부인과에 임신 14-22주에 내원한 217예의 임신부 혈청 AFP치를 효소면역법으로 측정하여 각 주수에 따른 정상밤위를 설정하였다 2 정상범위에 포함된 대상은 임신주수가 확실하고 출생시 (1985년 7월 31일 까지) 단태아이며 태아의 이상이 없었던 임신부 혈청이었고 첫 재혈시 결과만 포함되었다 3 임신부 혈청 AFP치의 정상범위의 상한치로 각 주수에 따라 정상 중앙값의 2배, 2 5배, 97백분위수를 사용하였다 4 임신부 혈청 AFP치의 정상범위는 더 많은 자료 수집을 통해서 이루어져야 한다 A normal range of maternal serum alpha-fetoprotein (AFP) levels was estimated in 217 normal pregnant women between 14 and 22 weeks gestation by enzyme-immunoassay Only the first serum samples were included from singleton pregnant women whose infants were normal at birth The upper limits of normal range of maternal serum AFP were calculated for each gestational week using multiples of normal median (2 0M, 2 5M) and 97th centile A normal range of maternal serum AFP levels should be established from a much larger population of pregnant women

자궁내 장치 ( Lippes Loop ) 를 동반한 난소 임신 1 례

유국영(KY Yoo),이윤호(YH Lee),이국(K Lee),황동훈(DH Hwang) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.6

Lippes Loop 장치 15개월후 Spiegelberg`s criteria를 충족시킨 난소임신 1례를 경험하였기에 간단한 문헌고찰과 함께 보고하였다 Ovarian pregnancy associated with I U D is very rare ectopic disease, which was reported first time by Grafenberg at 1929 It is expected that I U D does reduce the incidence of uterin and tubal pregnancy, but not ovarian pregnancy A case of ovarian pregnancy associated with I U D is presented here with a brief review of the literature

자궁동정맥기형의 임상경험

이국,이윤호,이병석,신숙진,민혜원,이장호,김동익 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9

자궁동정맥기형의 진단에 있어 Doppler초음판 1차적 진단방법으로 매우 유용하며 치료방법으로 자궁을 보존하고자 하는 경우에는 1차적 치료방법으로 TAE를 시행하는 것이 유용하다고 사료된다. We experienced 4 clinical cases which had been diagnosed of uterine arteriovenous malformation by Doppler ultrasonogram and pelvic angiogram. In all patients, trasarterial emolization was performed as first choice of treatment modality. Among them, two cases have failed. However, another two patients conceived after the successful transarterial embolization. Therefore, we concluded Doppler ultrasonogram si a useful diagnostic method in patients with arteriovenous malformation. And trasarterial embolization is effective as a first choice of treatment in patients who desire to preserve fertility.

난성 (Zygosity) 에 따른 쌍태아의 주산기사망

이국,이윤호,서경,김석영,유용균,주태림 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.5

쌍태임신에서는 단태 임신보다 조산에 따르는 주산기 관리가 더욱 요구되는데, 이는 난성에 관계없이 가장 많은 주산기 사망의 원인이 되기 때문이다. 특히 일란성인 경우, 보다 세심한 산전관리가 필요한데, 왜냐하면 일란성 쌍태아의 대부분을 점하는 단일 융모막 쌍태아에서 생길수 있는 쌍태아간 수혈증후군, 무심체, 결합쌍태 등의 기형과 한쪽 태아 사망시 다른쪽 태아에게 발생할 수 있는 뇌 및 장기의 손상 같은 합병증이 이란성 쌍태아보다 높은 주산기 사망의 원인이기 때문이다. 이를 발견하기 위해서는 태아에 대한 세심하고도 지속적인 추적 관찰이 요구되기 때문에 임신초기에 초음파를 이용한 난성의 결정이 중요한다고 생각된다. The perinatal mortality among twin pregnancies by zygosity ws assessed. Of the 11,451 births, 130 twins were born at Yong Dong Severance Hospital between Apr. 1983 and Dec. 1993 including 44 cases of dizygotic twins, 42 cases of monozygotic twins (40 cases of diamniotic monochorionic twins +2 cases of monoamniotic monochorionic twins) and 44 cases of unknown zygotic twins. We may allow determination of zygosity in twins by prenatal ultrasonic evaluation of dividing membrance, sex-discordance and postpartum placental examination. The incedence of twins remained 1.13% of all pregnancies and monozygotic twins occured higher preinatal death than that of dizygotic twins because of their communicating placental circulation and its associated lethal anomalies. Eary prenatal ultrasonic evaluation of zygosity should be emphasized as well as recognition of twin pregnancy.

초음파에 의해 진단된 결합쌍태아 2 예

이국,이윤호,문태일,조용선,오연수,박정식 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

결합쌍태임신은 일란성 쌍태임신의 희귀한 합병증의 하나로서 초음파진단술의 발달이 이루어지기 전에는 대부분의 경우에 있어서 임신 말기에 시행한 재래식 방사선 골반계측을 시행하는 도중에 우연히 발견되어지거나 분만이 임박하여 발견되곤 하였다. 비교적 최근에 들어서야 초음파진단기기의 발달로 말미암아 상당히 정확히 결합쌍태임신을 산전 진단할 수 있게되었다. 이에 따라 결합쌍태아를 임신 초기에 진단하고 이와 더불어 결합의 정도를 파악하는 것이 산과적 처치를 수행하는 데 있어 중요한 요소가 되었다. 이런 배경 하에 저자 등은 최근에 경험한 결합쌍태임신 2예를 간단한 문헌 고찰과 더불어 보고하고자 한다. Conjoined twin is one of rare complications of monozygotic multiple pregnancy. Before the age of ultrasonography, this rare complication could hardly be recognized until the process of labor progressed. Recently, with the developement of ultrasonogrphy, we can diagnose conjoined twins in any stage of pregnancy with considerable accuracy. Early prenatal diagnosis and assessment of the degree of conjoining is essential for obstetrical counseling and management. Recently we have experienced two cases of conjoined twins diagnosed by ultrasonography during the second trimester, and report that with brief review of related literatures.

모성 심장질환과 임신에 관한 임상적 고찰

이국,조동제,이윤호,전종식,양정인 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

1983년부터 1990년까지 연세대학교 의과대학 영동세브란스병원에서 심장질환이 동반되었던 임산부를 대상으로 임상적 연구를 시행하여 다음과 같은 결론을 얻었다. 1. 심장질환을 동반한 임산부는 총 33예로 이중 26예에서 33회의 분만을 하여 0.45%의 빈도를 보였다. 2. 총 40 임신예중 류마티성 심질환군이 32.5%, 선천성 심질환군이 37.5%로 비슷한 빈도를 보였으며 기타 심질환구은 30%였다. 3. 모성 및 임신의 결과를 보면 모성사망은 없었으며 신생아사망이 3예로 주산기사망율이 91로 높아쓴데 조산과 임신주수에 비해 저체중아가 주 원인이었다. 4. 울혈성 심부진은 주요한 모성심혈관계 합병증으로 승모판협착에서 가장 많이 발생하였다. 5. 심장질환을 가진 산모가 임신을 원할 경우 임신전에 심장질환에 대한 평가 및 치료가 필요하며 임신시에는 태아의 선천성 심장기형의 평가를 위해 심에코도가 필요하며 심장질환의 진단 및 합병증의 치료를 위해 산과의와 심장내과의의 협조가 필요하다. Thirty-three cases of heart disease in pregnancy, seen at the Yongdong Severance hospital from 1983 to 1990, were clinically observed and reviewed. The results obtained are as follows; 1. Among 33 pregnant women with heart disease, 26 women underwent 33 deliveries representing the incidence of 0.45% (33/7539 deliveries). 5 other deliveries were cases transferred to our hospital after delivery and 2 cases underwent therapeutic abortion. 2. Of the total 40 pregnancies, the rheumatic heart disease group constituted 13 cases (32.5%) of which mitral stenosis was the most common. The congenital heart disease group constituted 15 cases (37.5%) of which atrial septal defect and ventricular septal defect were the most common defects. Other heart disease group constitute 12 cases (30.0%) which included arrhythmia -8cases, peripartum cardiomyopathy -2cases, ischemic heart disease -2cases. 3. The pregnancy outcomes showed no maternal death, 11 cases of small for gestational age, 3 cases of preterm births, 3 cases of neonatal deaths, which showed a high 91 perinatal death rate which was due to mainly preterm birth and small for gestatinal age. The rapeutic abortion was performed in 2 cases. 4. Maternal cardiac complication occurred most frequently in mitral stenosis patients and congestive heart failure was the most common complication. In conclusion, as the frequency of congenital heart disease shows an increasing rate of appearance in pregnant women, pre-pregnancy evaluation and treatment is necessary for women with heart disease who desire to become pregnant. During pregnancy, congenital fetal heart disease should be evaluated by echocardiography and after careful consideration of the hemodynamic changes in pregnancy and the effect on the fetus, close cooperation between the obstetrician and cardiologist is required for the proper evaluation and treatment of the heart disease.

조기 진통 임신부의 양수내 일부 Cytokine 의 측정치 자궁내 감염과의 관련성에 관한 연구

이국,김세광,이윤호,박용원,서경,조재성,김석영 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.12

조기진통과 자궁내감염과의 관련성을 조사하기 위하여 조기 임신 비진통군, 조기임신 진통군, 만기임신 비진통 군, 만기임신 진통군의 4군의 임신부를 대상으로 양수내 IL-1 b, IL-6의 증가 및 기타 자궁내감염소견 발생율 을 서로 비교하였다. 양수내 IL-1은 3예를 제외하고는 100pg/ml 이하의 낮은 수준을 보여 조기진통의 발생과 관련성이 적었다. 양수내 IL-6는 조기진통 및 만기진토에 구별없이 진통이 있는 임신부에서 공히 증가하였으 며 특히 자궁경관의 개대가 진행할수록 IL-6의 증가가 더욱 현져하였다. 따라서 양수내 IL-6의 증가는 조기진 통원인의 일부인 자궁내 감염에 의해서 증가된 것으로 해석하기보다는 진통 및 자궁개대에 수반되어 결과적으 로 나타나는 현상으로 해석하는 것이 타당할 것으로 사료되었다. Subclincal instrauterine infection was suggested as a cause of idiopathic preterm labor. Four groups of 66 pregnant women were studied. Women in the midtrimester of pregnancy undergoing genetic amniocentesis were studied as a preterm without labor group. Women with preterm labor were also studied. Term pregnant women undergoing repeat cesarean section were included as a term without labor group Women with term labor group were also included in the study. Amniotic fluid was obtained through amniocentesis. The fluid was culturd for aerobic and anaerobic bacterias. After centrifugation an aliquot of amniotic fluid was frozen(-70 C) for futher analsis. Interleukin-1(IL-1) and interleukin-6(IL-6) levels were measured by hexokinase method. Placentas were examined for histologic choriamninitis after delivery. Only two women with term labor showed opsitive amniotic fluid culture. Glucose levels were lower in the amniotic fluid of erm pregnant women than perterm pregnant women. IL-1 level in the amniotic fluid were increased over 290 pg/ml in 2 case of term labor group. IL-6 were found in all samples of amniotic fluid. The levels were increased in the women having either preterm or term labor IL-6 levles in the amniotic fluid were proportionally increased according to the degree of the cervical dilatation. The results suggested that the increased level IL-6 was a resullt of labor and/or cervical dilatation rather than a cause of intrauterine infection evoking preterm labor. Histologic choriamnionits were increased in the placenta of both preterm labor. Histologic choriamnionits were increased in the placenta of both preterm labor group and term labor group. The incidence rates of histologic choreioamnionitis were not statistically different among groups.

조기분만과 만삭분만에서 태반조직상에 관찰된 융모양막염의 비교

이국,이윤호,서경,정우희,김석영,조은정,차동현,임영구,김귀례 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.9

자궁내 감염과 조기 분만과의 상관관계를 규명하기 위하여 조기분만된 산모 태반의 병리조 직학점 염증 소견을 만삭 분만된 산모의 것과 비교하였다. 1992년 1월부터 1993년 12월까지 영동 세브란스 병원산부인과에 입원한 116명의 조기 분만산모를 대상으로 그리고 만삭분만 산모 134명을 대조군으로하여 다음의 결과를 얻었다. 1. 조기파막이 없는 86예의 조기 분만과 121예의 만삭분만한 산모 태반의 분석에서 조직학적 융모양막염과 조기분만과의 연관성이 관찰되었다. (조기분만 15.12%, 만삭분만 5.82% p=0.02). 2. 조직학적 융모양막염은 조기분만의 경우에도 임신 주수가 빠를수록 더욱 심하였다. 3. 탈락막염은 양군에서 비특이적이다 (조기분만 25.6%, 만삭분만 32.2% p$gt;0.1). 4. 분만 방법과 진통을 고려하였을 경우에도 조직학적 융모양막염과 조기 분만과의 관련성의 경향을 보여 주었다. (보기분만 26.72%, 만삭분만 11.53%,p=0.05). Objectives : To compare the placental infalammation between preterm and term deliveries. Methods : Placentas were obtained in 116 preterm and 134 term single live births at the Yonsei University Medical Center between January 1992 and December 1993. Pathlogic examination of placenta was done by two pathologists. Examnied placental sites were fetal membrane , placental disc, decidua, and umbilical cord. Student`s test and Fisher`s exacte test were used for statical comparisons. Results : 1) The prevalence of histologic chorioamnionitis in premature ruptrue of membrane (PROM) group tends to be higher in preterem(46.7%) deliveries(term 15.4% p=0.05). In intact membrane group, the result was satistically significant between preterm(15.12%) and term(5.82%) deliveries(p=0.02) 2) In 207 patients with intact membrane , associations between placental inflammation and preterm deliveries were statistically significant in chorioamnionitis and cord inflammation(preterm 5.8%, term 0%, p0.1) 3) In 43 patients with PROM no significant association was noted between placental inflammation and preterm deliveries. 4) Histologic choriamnionitis was more severe in preterm deliveries. 5) in 97 patients delived vaginally with intact membrane , the prevalence of histologic choriamnionitis tends to be higher in preterm (26.7%) deliveries(term 11.5% p=0.05). Conclusion : There was significant association between histologic choriamnionitis and preterm deliveries, and the degree of choriamnionitis was severe in ealier gestation. After controlling mode of delivery and labor, borderline association presisted between histologic choriamnionitis and preterm deliveries. Futher study will be needed.

복수를 가진 태아 10 예의 원인 , 처치 및 결과

이국,이윤호,서경,황홍규,김석영,최은아 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

The perinatal outcomes of fetus who were antenatally diagnosed with isolated ascites were evaluated by causes. Retrospective review of our patients from July 1991 to June 1995, revealed 10 patients with fetal ascites diagnosed sonographically. Fetuses who had associated hydrops were excluded. Four of the 10 fetuses with ascites had gastrointestinal anomalies, two fetuses had genitourinary anomalies, one had intrauterine infection, and three were labelled as idiopathic. Most fetuses underwent work-ups including karyotyping, serologic titer for infectious etiologies as well as follow-up ultrasound. Three fetuses were taken an ascitic fluid analysis including one cases of peritoneo-amniotic shunt. Five fetuses survived and others were terminated of pregnancy. We emphasize that fetuses who have isolated ascites many represent a separate condition that significantly differs from the general category of nonimmune hydrops in both perinatal course and outcome. Some cases of the ascites disappeared prior to delivery spontaneouslly and relatively good neonatal outcomes were observed.