한국불임부 1520명에 대한 원인적 고찰

이은숙(ES Lee) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.1

1. 불임환자의 빈도는 1957년 1월 1일부터 1958년 8월31일까지 2년 8개월간 외래환자 9080명중 16.63%(1520명) 그중 원발성불임은 8.7%(799명), 속발성불임은 7.9%(721명)이었다. 2. 불임환자의 연령분포는 원발성불임예에서는 25~29세 속발성불임예에서는 30~34세가 정점으로 되어 있으며 속발성불임부에서는 연령의 증가에 따르는 감소율이 원발성불임부보다 저율이다. 3. 불임기간은 원발성불임예에서는 3~5년이 245명(30.66%), 속발성불임예에서는 6~10년간이 306명(42.44%)로서 3~5년 불임예의 2배를 차지하여 임신에 대한 욕구가 최후까지 존속됨을 알 수 있었다. 4. 자궁난관조영술에 의한 난관소통성은 실시예 269예 중 양측난관폐쇄예는 84예(31.2%)이었다. 5. 배란유무의 판정은 기초체온표(B.B.T.)와 자궁내막검사를 평행하였으며 양자의 검사법을 병용한 136명에 있어 14명(10.29%)의 무배란성주기를 발견하였다. 배란유무의 판정에 대하여는 양자의 병용법 특히 기초체온측정이 가장 신뢰도가 높은 것을 강조하였다. 6. 내막검사결과로 295명에 대한 결핵성내막염의 빈도는 22명(7.5%)이었다. 7. Huhner`s test에서 이상이 있는 경우에는 직접법의 추가가 절대필요함을 예증하였다. 8. 4대불임인자에 대한 검사완료예는 92명으로 불임환자총수의 약 6%에 불과했으며 그중 이상예 51명중 1종의 불임인자를 가진 예는 46명(90.19%), 2종의 불임인자를 가진 예는 5명(9.8%)이었다. 9. 4대불임이자에 대한 검사완료이상예에서 양측난관폐쇄예가 45.09%(23명)이었다. 10. 4대불임인자에 이상이 없는 41명중 22명에 대한 갑상선기능검사로서 B.M.R.과 cholesterol의 성적이 일치하지 않는 경우가 상당히 많다는 것을 지적하였다. B.M.R.이 -15이하 또는 15이상의 level에서도 배란현상이 정상적으로 존속됨을 볼 수 있었다. 소위 "normel" infertile couple 에 대한 불임원인추궁은 현대의학의 중요한 숙제의 하나로서 앞으로의 연구에 많은 자극을 주었다.

Noradrenaline 및 Adrenaline의 상승작용의 비교관찰

이은숙(ES Lee) 대한산부인과학회 1959 Obstetrics & Gynecology Science Vol.2 No.1

1) 정상군에서는 혈압의 상승도에는 현저한 차이가 없으나, 지속효과는 noradrenaline이 보다 약 1.5배 강력하다. 2) 실혈군에서는 가토에 있어 adrenaline의 승압지속효과는 크다고 하겠으나 가토에서의 승압도, 개에서의 승압도 및 지속시간은 noradrenaline이 더욱 현저하였다. 3) adrenaline을 투여한 가토에 있어서는 정상군이나 실혈군을 막론하고 혈압은 종극에가서 약물투여전치이하로 계속하강됨을 보았다. 4) 개의 실혈군에서 상승된 혈압이 약물투여전치로 하강된 다음 양자를 교대사용해 보았으나, 상기와 동일한 효과를 보았을 뿐이다. Introduction Recently I had the opportunity of receiving Noradrenaline with the trade name of Levophed. Thus it was possible for me to make observations and to compare it with adrenalin regarding its pressor action on the rabbit and dog. Method : Experimental animals were divided into two groups, a bleeding group and a control group. Bleeding was done by severing the carotid-vein. Pre-calculated amounts of Noradrenaline and Adrenaline were given groups of animals checking their B.P. before and after medication. During these procedure, changes of B.P. were observed. Total blood volume was estimated as 1/13 of body weight in the rabbit and 1/10 in the dog. In the bleeding group, it was planned to hane them bled to the equivalent of 1/3 of the total blood volume in the rabbit and to 1/4 in the dog. However, in some animals the B.P. dropped to 40 mm Hg. before the amount of blood loss reached the planned amount. In these groups. blood let`ing had to be stopped when B.P. was 40 mm Hg. Result : 1) In the con`rol group of rabbits, the duration of pressor effect of noradrenaline was longer then adrenaline (1.5 times) with of no apparent difference in the degree of initial elevation of blood pressure. 2) In the bleeding group of rabbits, the pressor effect of adrenalin was remarkably prolonged. However, the degree of B.P. elevation in the group of rabbits and both degree and the duration of pressor effect in the group of dogs were more signifcant with noradrenaline than adrenaline. 3) In the bleeding group of dogs, the same result of pressure elevation and prolongation were obtained by the alternate use of these two drugs just after the elevated B.P. dropped to the previous level.

대음순에 기생한 스파르가눔증 1 예 보고

이은숙,허민,박형무,김성호,이재우 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.5

34세 여자 좌측 대음순에 기생한 스파르가눔증 1례를 수술적 체험하였기에 문헌고찰과 함 께 보고하는 바이다. Sparganosis is a rare parasitic infestation caused by plerocercoid larva of sparometra erinacei. The majority of infestation involves the subcutaneous tissue, but the vulvar area of female is rarely involved. We experienced a case of vulvar sparganosis that showed as painful palpable left vulvar mass for 2 months initially. Simple excision was preformed with granulation tissues contained a live sparganum measured about 16 cm in length from the left labium major. So we reported this case with a brief review of the literatures.

체외수정 시술시 성공적인 과배란유도의 지표로서 clomiphene citrate challenge test 의 효용 성에 관한 연구

이은숙,배도환,이상훈,정병준 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.8

중앙대학교 의과대학 산부인과학교실에서는 1993년 1월부터 1994년 4월까지 불임을 주소로 내원한 환자중 자궁내막증, 고령에 의한 불임, 복강내 인자로 인한 불임환자, 과거 난소절제 술을 시행했던 환자, 원인불명의 환자 115명을 대상으로 기초불임 검사의 일환으로 CC challege test를 실시한 후 과배란유도 및 체외수정을 실시하였는데, CC 투여후 혈중 FSH 상승을 보인 비정상군에서는 그후에 시행된 과배란 유도와 체외수정시술에서 높은 시술 취 소율, 낮은 난자 채취율, 이식된 배아의 감소, 질이 낮은 난포 및 낮은 임신율을 볼 수 있었 으며 또한 비정상군 일수록 나이가 증가하는 경향을 보여, 난소의 과배란유도 및 체외수정 시술 전에 실시한 CC challenge test는 난소기능을 예견할수 있는 좋은 지표가 되며 CC challenge test에 비정상적인 반응을 보인 부적절한 환자군에서는 결과가 좋지 않음을 예측 할 수 있는 지표라고 사료된다. Despite a well conducted controlled ovarian hyperstimulation(COH) some patients will produce a very small number of follicles. This makes it neccessary either to cancel the COH or, if follicle is present, to attempt an IVF procedure, which has a very limited chance of success. The detection of these patients before starting an expensive, time-consuming and rather stressful procedure like IVF is certainly of great interest. A poor response of COH cannot be anticipated on the basis of clinical parameters such as the patients age or the characteristics of their spontaneous menstrual cycles. Because ovarian age does not always correspond to chronological age and many of them have a normal ovulatory cycle. By contrast the endocrine evaluation of these `poor responders` has revealed that at least some of them present an abnormally elevatd basal serum follicle stimulating hormone(FSH), which suggests that they suffer from incipient ovarian failure. But variations in FSH from cycle to cycle discourage clinicians from prognosticating stimulation outcome based on one FSH value alone. We studied to assess ovarian reserve in poor responders by means of serum FSH levels after Clomiphene citrate(CC) administration before COH for IVF from Jan, 1993 to April 1994. The group studied comprised 94 patients 115 cycles for IVF and who applied to patients 35 years or older, patients with extensive pelvic adhesion, ovarian endometriosis, or patients with only ovary patients elevated basal FSH level. The abnormal CC challenge test resulted in 28.6%, 28.6% and 42.9% of the patients in the age groups younger than 30,31-34,35 and older, respectively(p$lt;0.01). In the abnormal response group, the FSH levesl were significantly higher before CC administration compared with normal response group(p$lt;0.001). The E2 level was no difference before CC in the two groups, the E2 level after CC was significantly higner with a normal response group(p$lt;0.001). The cancellation rate per cycle were 15.4% in abnormal response group, 3.2% in normal response group, the cancellation rate was higher in the abnormal response group(p$lt;0.05). The number of oocyte retricved and embryos obtained in the normal response group were significantly higher than abnormal response group(p$lt;0.05). Eignteen clinical pregnancies were obtained in the normal response group, however, no pregnancies in the abnormal reponse group. The percentage of oocytes of high quality(Grade I, II) was 73.7% in normal response group, 18.5% in abnormal response group. The oocytes quality in the normal response group was better than in the abnormal response group. We concluded that the FSH response to CC administratin combined with basal level of FSH was good prognostic value of subsequent COH for IVF. We may suggest that CC challenge test in used to evaluate ovarian reserve before IVF esppecially in patients of 35 years or more and in all patients who have ovarian surgery or have ovarian endometriosis.

폐경여성에서 Biochemical Bone Markers 에 관한 연구

이은숙,허민,박형무,서정호,강병희 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7

The non-invasive assessment of bone turnover has received increasing attention over the past few years, because of the need of sensitive markers in clinical investigation of osteoporosis. The purpose of this study was to assess the availibility of the bone resorption marker and bone formation marker in menopause and to assess the correlation of bone markers and osteoporosis. This study was undergone from January 1995 to October 1995 retrospectively for total 88 postmenopause women who were not treated by hormone replacemetn therapy. The subjects comprised 28 healthy perimenioausal women; 55 healthy natural postmenopausal women; 5 women with surgical menopause. We measured serum osteocalcin as a bone formation marker and urinary deoxypyridinoline as a bone resorption marker. Bone mineral densities were also measured by Dual Energy X-ray Absortiometry(DEXA). The mean serum osteocalcin level in perimenopausal women was 6.40+-3.12ng/ml, and mean levels in potmenopausal women with duration of menopause for 12 to 48 months, 49 to 84 months, 85 to 120 months, over 121 months were 9.26+-5.89ng/ml, 9.01+-2.75ng/ml, 8.36+-4.99ng/ml, 9.88+-3.82ng/ml, respectively. The level in surgical menopausal women was 8.76+-5.24ng/ml. The mean serum osteocalcin levels were significantly higher in post- menopausal women with duration of menopause for 12 to 48 months(p$lt;0.05), for 49 to 84 months(p$lt;0.05), and over 121 months(p$lt;0.01). The urinary deoxypyridinoline level in perimenopausal women was 5.67+-1.26 nMDpD/ mMCr, and the levels in postmenopausal women with duration of menopause for 12 to 48 months, 40 to 84 months, 85 to 120 months, over 121 months were 7.13+-1.35 nMDpD/mMCr, 5.14+-0.83 nMDpD/mMCr, 5.04+-1.11 nMDpD/mMCr, 6.09+-1.86 nMDpD/mMCr, respectively. The level in surgical menopausal women was 6.26+-1.35 nMDpD/mMCr. The urinary deox- pyridinoline level was significantly higher in postmenopausal women with duration of menopause for 12 to 48 months(p$lt;0.01). There was a tendency that osteocalcin levels were increasing according to decrease in bone mineral density but osteocalcin levels were not statistically significant among 3 groups such as normal, osteopenic, and osteoporotic groups and there was also no significance in deoxypyridinoline levels among 3 groups. As a conclusion, there were no significant correlation between bone formation and resorption markers, indicated that there was imbalance in bone formation and resorption in menopause period. Also bone loss of menopause was peak in 2 to 4 years after menopause.

반복유산환자에서 발견된 단순균형전좌 t (7; 10) (q22; q26) 1 예

이은숙,김광철,문진수,한영,서태광,손시환,류은경,전병균 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Chromosomal abnormality is one of the main causes for the repeated spontaneous abortion. A 31-year-old patient, otherwise normal woman who had experienced three consecutive miscarriage were karyotyped using peripheral blood cells. The patient has been found to have a novel, balanced translocation, with a formal karyotype of 46,XX,der(7)t(7;10)(q22;q26). The present result suggests that chromosomal analysis may be necessary for diagnosing the couples experiencing repeated spontaneous abortion.

골반경수술중 주입된 복강내 CO2가스의 소실에 관한 연구

이재찬,김성호,강용기,이은숙,김동호,배도환 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

1994년 3월부터 1994년 8월까지 중앙의대부속 필동병원 산부인과에 내원하여 골반경수술을 시행한 환자 100명을 대상으로 골반경 수술중 주입된 복강내 CO2 가스의 소실에 대하여 흉부단순 방사선 검사로 연구분석한 결과 다음과 같은 결론을 얻었다. 인체와 동배(1:1)의 흉부방사선 사진상 횡격막하 free air는 수술후 1일, 3일, 5일에 각각 63%, 31%, 5%에서 검측되었고 free air의 정도는 평균 5.22+-7.42 mm, 1.99+-4.64 mm, 0.41+-2.23 mm로 나타났으며 수술후 1주일 후에는 free air가 검측되지않는 양상을 나타냈다. 수술후 1일과 3일 사이에는 CO2 가스의 의미있는 소실이 있었고(p$lt;0.01) 수술후 3일과 5일사이에는 CO2 가스의 소실이 1일과 3일에 비해 적었다(p$gt;0.05). 그러나 심한 자궁내막증으로 인한 장유착으로 장천공과 복막염이 합병된 1명의 환자에서는 수술후 5일째 횡경막하 free air의 정도가 10 mm이상으로 오히려 증가되는 양상을 보였다. 골반경 수술후 정상적으로 CO2 가스로 인해 복강내 양성 기복이 형성될 수 있다는 점을 인식하고 장손상이 의심되는 경우의 복강내 가스의 증가되는 양상을 파악함으로써 임상적으로 중요한 지표가 될 수 있으리라 생각한다. 골반경 수술후 CO2 가스 사용으로 형성된 복강내 양성기복의 정상적인 소실양상을 파악함으로써 향후 장손상의 가능성이 의심되는 경우 복강내 기복소실정도를 정상적인 소실양상을 파악함으로써 향후 장손상의 가능성이 의심되는 경우 복강내 기복소실정도를 정상적인 소실양상과 비교함으로써 임상적으로 중요한 지표가 될 수 있을 것으로 생각된다. From March 1994 to August 1994, 100 patients were checked plain chest X-ray who had underwent pelviscopic surgery including radical hysterectomy, total hysterectomy, CISH, myomectomy, adnexectomy etc. The operative indications were invasive cervical cancer, CIN, myoma uteri, intractable vaginal bleeding, ectopic pregnancy, benign ovarian mass, acute or chronic pelvic pain. Surgical techniques indluded usage of videolaparoscopy, bipolar forceps for hemostasis, endolops and endoloops and endonahts. Endo-GIAs, lasers and monopolar electrosurgical devices were not used. During the operation, pneumoperitoneum was formed by using the CO2 insufflator maintaining intra-abdominal pressure about 12 mmHg. On the postoperative(POD) 1 day, 3 day, 5 day, simple chest X-ray were checked serially. The results were as follows. The mean age of patients was 38.1 years old. Operative time ranged from 35 min. to 420 min. and mean was 122+-65 minutes. Used CO2 gas ranged 35 L to 125 L and mean was 317+-224 L. Mean hemoglobin change from preperation to postoperative first day was 1.6mg/dl. On the real size chest X-ray firm, the subphrenic vertical free air length was 5.22+-7.42 mm on POD first day, 1.99+-4.63 mm on POD third day and 0.41+-2.23 mm on POD fifth day. In a case of intestinal perforation, over 10 mm subphrenic free air was detected on the chest film on POD fifth day. We conclude that checking serial simple chest X-ray may be helpful for differential diagnosis of possible intestinal injury, when it is suspected.