임신부에서 실시한 Anti-HEV 측정에 대한 연구

주갑순(KS Ju),박용균(YK Park),조수용(SY hough),서호석(HS Suh),허준용(JY Hur),이갑노(KN Lee),신재철(JC Shin),문준(J Moon) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.3

임신부를 대상으로 실시한 본 연구에서 E형간염에 대한 항체양성율이 9.9%로 나타난 것은 우리나라에도 E형 간염이 상당히 존재하는 것을 보여주고 있으나, 임신부들의 연령별, 임신횟수 및 분만횟수별 분포에서는 각군간 유의한 차이를 볼 수 없었고, 또한 대부분에서 임상증상이 발현하지 않는 즉 무증상 감염(subclinical infection)으로 지나가는 것으로 나타났다. 그러나 간염환자에서 A형, B형 및 C형 간염이 배제된다면 반드시 E형 간염에 대한 검사는 실시해야 할 것이며, 또한 임신중 E형 간염이 발생한 경우에 그 치사율이 매우 높은 것으로 알려져 있으므로 향후 임신과 E형 간염의 관게에 대한 지속적인 연구가 필요할 것으로 사료된다. Hepatitis E was formerly called enterically-transmitted, enteric, epimemic, waterborne, or fecal-oral non-A, non-B hepatitis. Another non-A, non-B hepatitis, namely hepatitis C poses serious problems of livers to cirrhosis ans gepatocellular carcinoma in the industrialized countries. On the other hand, hepatitis E may not be endemic in these countries but is prevalent in developing countries. Hepatitis E has its highest attack rate in young to middle aged adults, with highest case-fatality rates in pregnant women. But it is not clear whether the pregnncy itself caused more severe disease, whether pregnant women were more symptomatic because of other manifestations of pregnancy, or whether pregnant women(in developing countries) were nutritionally and medically disadvantaged, thus allowing more severe impact of the infection. This study was undertaken with the objective of searching the prevalence of hepatitis E in Korea and evaluate the effect of hepatitis E on pregnancy. A total of 313 pregnant women who visited the antenatal clinic were selected during the period from May, 1994 to July, 1994 at the department of Obstetrics and Gynecology, Guro hospital, Korea University and taken the test for IgG and IgM anti-HEV with the use of ELISA kit. The positive rate of anti-HEV was 9.9%(IgG ; 5.9%, IgM ; 3.0%, IgG and IgM ; 1.0%). The discrepancy among age or parity groups was not shown, and almost all of infected women have no clinical manefestations. So we concluded that hepatitis E exists in Korea but most infected cases are probaby subclinical infections. But it is considered the patient must take the test for anti-HEV in case hepatitis A, B and C are excluded, and further study in the effect of HEV on pregnancy should be performed.

( 21q 21q ) 전위형 다운즈증후군아를 가진 임신에서 21번 3배성 다운즈증후군 태아 산전진단 1예

주갑순(KS Ju) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.12

There were many reports about the recurrence of Downs syndrome and the prenatal diagnosis of Downs syndrome. A prenatal diagnosis of the 21 trisomy Downs syndrome fetus from the mother having a (21q 21q) translocation Downs syndrome child is presented with a brief review of references.

Y - 염색체 변화의 1 예

주갑순(KS Ju),배기원(KW Bae),한갑수(KS Han) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.6

최근 휴식기의 세포에서 Y- 염색립을 식별 검사함으로써 보더 정확하게 간편한 남녀의 성별감별에 이용되고 있다. 임상적으로 Y- 염색립의 관찰은 Y- 염색체의 수적이상, 반음양인 및 악성생식선 종양을 진단하는데 도움을 줄 뿐만아니라 산전 태아의 성별감별에 의한 성염색체 열성유전병을 산전진단하는데 많이 이용하고 있다 그러나 Y- 염색체는 그 모양이 다양하고 또한 형광성에도 차이가 있어 형광성을나타내지 않는 Y -염색체도 있어서 Y-염색립의 관찰에 의한 핵성남녀성별감별에 각별한 주의를 요하게 된다 저자들은 지능이 높은 건강한 남자의 임파구 배양에서 일종의 Y-염색체 변형인 무형광성인 작은 Y-염색체를 경험하였기에 이에 보고하는 바이다. Shortely after the introduction of a specific fluresecent banding pattern in chromosomes of Vicia fava stained by quinarine mustard (QM) standarization of human chromosome identification was presented in Paris Conference in 1971 Usually the Y chromosome is esaily identified by its brilliant fluorecent segment on the distal parts of the long arms varing in length Herein is presented a case of Y choromosme variants of the lymphocytes cultured from a high intelligent and healthy man.

산아 손실에 관한 임상적 고찰

주갑순(KS Ju),김영기(YK Kim) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.5

An analysis of stillbirths and neonatal deaths chiefly based upon autopsy findings during the period from Jan 1, 1959, through August 31, 1962(for 3 years and 8 months) was undertaken on the obstetric ward of the NMC. There were 3,059 deliveries with 49 cases of twin births. Therefore, total number of bieths were 3,108 and of these 3,019 were livebirths. The total number of perinatal mortality was 138. But as the charts of 6 cases were missing, only 132 cases were available to study. There were 89 stillbirths and 42 neonatal deaths. The perinatal mortality mortality index was 44.4 per 1,000 deliveries, purpose of presenting this study are: 1) to investigate perinatal mortalily in NMC. 2) to determine the causes of perinatal death and point out preventable factors. 3) to improve prenatal, obstetrical and early postnatal care, in order to reduce further the number of stillbirths and neonatal deaths. The major causes of death were reviewed and tubulated. The majority of perinatal death is directly related to maternal complications. Almost half of the cases (48.5%) were associated with anoxia from abruptio were encountered most ferquently. Prematurity was a factor in 61% of perinatal deaths, and prematurity with its associated conditions accounted for two thirds of the deaths. Forty-seven cases(35.6%) of perinatal death were judged to have been preventable. Had they been prevented, the perinatal mortalty rate would have been reduced from 44.4 to 28.6. Even if it is most likely that not all of these babies could have been salvaged, it was felt that in many of these cases the outcom would have been much better if the patients could be given competent medical care from the very moment the complication started. in many cases the patients(unregistered) condition had previously been neglected, so they had to be brought to the hospital as an emergency case when serious complication developed. Unregistered cases ; 87(65.9%) Registered cases ; 45(34.1%) In oder to reduce the perinatal mortality I would like to stress the importance of conscientious prenatal care. Further still much research is needed in the many field of medicine which are related to the perinatal mortality problem. If the interest for these problems could be stimulated among the medical persons handling pregnant women, much improvement might be expected.

산부인과 영역에서 진정제 사용

주갑순(KS Ju) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.10

진정제는 대뇌피질의 중추신경계(지각령, 운동령, 종합중추)에 억제적으로 작용함으로서 불안경감 및 최면촉진을 야기시킨다. 진정제의 약리학적 작용은 전신 마취와 거의 동일하며 주로 액체 혹은 고형의 물질로 이룰 투여시 Table 1과 같이 약의 투여량 및 투여기간에 따라 그 약리작용이 다르게 나타난다. 소량 즉 적량에서는 불안경감 및 진정의 효과가 있으나 다량일 경우에는 수면을 초래하며 극량을 초과시는 호흡중추의 마비로 사망하게 된다. 따라서 자살의 목적으로 사용되는 수가 있다. 또한 계속 장기 투여시는 금기증상이 야기된다. -------------------------------------------------------------------------- Table 1. Action of sedatives With increasing doses: Relief of anxiety Secation Ataxia Excitement, Drunkenness, disinhibition Anesthesia Respiratory and vasomoter depression and death With continued administration : With continued administration : Anticonvulsant action Physical dependence(withdrawal state) Habituation Voluntary muscle relation -------------------------------------------------------------------------- 산부인과 영역에서는 일반적인 진정, 최면제로 사용될 뿐 아니라 마취전처치, 단시간 산과마취, 임신중의 고혈압환자 및 전간화자, 임신중동증, 자간, 임신오조등 널리 사용되고 있다. 따라서 산 부인과 환자 특히 임산부에 투여시는 태아에 미치는 영향을 고려하여 각별한 주의가 요한다.

The Culturability of the Fetal Skin induced by instilation of Urea or Prostaglandin Intramniotically

주갑순(KS Ju) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.9

제16주내지 제 20주 중기인공임신 중절을 시행하여 유산된 47예의 태아에서 얻어진 피부조 직을 배양하여 임신중절 방법에 따른 배양성공여부를 관찰하였다. 중기임신중절은 양수내 뇨소삽입법과 양수내 prostaglandin F2a 삽입법으로 시행되었다. 25 예의 뇨소삽입군에서는 23예에서 피부조직배양이 성공하지 못하였으며 prostaglandin F2a 삽 입군에서는 22예중 16예(72%)에서 피부배양이 성공하였다. The fetal skin has been used extensively to confirm the prenatal gegetic diagnosis done by amniocentesis or the determination of certain enzymatic activities of the metabolic disorders. Furthermore as a result of advancing cellular science, human cells are now being tried as a replacement for the animal cells in studing the human cellular biology. Park et al, had successful cultures in 21 of 31 (68 percent) fetal skins induced by prostaglandin intravenously but not in saline group. In this paper we will present the results of fetal skin cultures obtained after intra-amniotic instillation of urea in 25 cases and prostagladin F2a in 22 cases

임파구의 세포유전학적 염색체분석

주갑순(KS Ju),박현석(HS Park),김승보(SB Kim),이재현(JH Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.2

결론 1976년 1월부터 1981년 7월까지 5년 7개월간 경희대학교 의과대학 유전학연구실에 유전적 질환이 의심되어 각과에서 의뢰된 316예에 대하여 염색체 검사를 실시한 결과 43예의 정상변형을 포함한 정상핵형이 200예이었으며 염색체이상이 116예 이었다. 염색체이상을 나타낸 경우 중 autosome anomaly가 75%, sex chromosome anomaly가 25%를 차지하였으며 그 결과는 다음과 같다. 1. Autosome anomalies 1) Down`s syndrome ................. 76 cases 2) Ph`(+) leukemia ................. 4 cases 3) 18 trisomy ...................... 2 cases 4) Marker chromosome ............... 2 cases 5) 18p- syndrome ................... 1 cases 6) 14/21 translocation carrer....... 1 cases 7) Complex translocation ........... 1 cases 2. Sex chromosome anomalies 1) Turner`s syndrome ............... 6 cases 2) XYY syndrome .................... 2 cases 3) XXY syndrome .................... 1 cases 4) 45,XO/46,XX with transverse vaginal septum................... 1 cases 5) 45,XXq- with primary amenorrhea.. 1 cases 6) 15/Y translocation carrier....... 17 cases 이와 같이 유전적 질환이 의심되었던 환자중 32.6%에서 염색체이상이 관찰되어 상당히 높은 비율을 차지하므로, 선천적인 유전질환 뿐만 아니라 후천적인 염색체 이상을 발견하기 위해 염색체 연구가 보다 더 광범위하게 시행되어야 하며 적절한 genetic counselling과 향후 치료 및 악성질환 예방을 기할 수 있으며 또한 산전 진단 필요 유무를 counselling 할 수 있다. The numerical and structural aberrations of lymphocyte chromosomes were analyzed from 316 cases who had been referred to cytogenetic laboratory in Kyung Hee University Hospital because of suspected chromosomal abnormalities from Jan. 1, 1976 to July, 31 1981. Out of 316 cases, 103 cases (32.6%) had the abnormal karyotypes, and the otheres had others had the normal karyotypes including 43 case of normal variants. Among the 103 chromosomal anomalies, there were the autosomal anomalies in 75%, and the sex chromosomal anomalies in 25% of the anlomalies.

여성성기 결핵의 임상 조직학적 관찰

주갑순(KS Ju),박찬무(CM Park) 대한산부인과학회 1961 Obstetrics & Gynecology Science Vol.4 No.3

과거 3년간 국립의료원에서 진료한 여성성기결핵환자 48예를 관찰하여 다음과 같은 결론을 얻었다. 1. 48예중 36예가 조직학적으로 확진된 예였고 그 중 16예가 수술후 조직학적 검사로 확진된 예였으며 20예는 진사소파 및 생검에 의하여 발견된 예들이다. 2. 371예의 진단소파에 대한 결핵성자궁내막의 발견율은 4.9%이었다. 31예의 불임증환자에서의 진단소파에 의한 발견율은 19%이었다. 3. 수술후 얻은 적출표본검사에 있어서는 23예의 난관중 22예에서 결핵성병변을 볼 수 있었고, 22예의 난소중 8예에서, 9예의 자궁에서 2예의 결핵성병변을 볼 수 있었다. 4. 연령별발생빈도에 있어서는 대부분이 성년기인 21~35세에서 발견할 수 있었으며 평균연령은 26세이었다. 5. 38예에 있어서 흉부 X-ray 촬영결과 20예에서 폐결핵치유상을 보였고 5예에 있어서는 활동성폐결핵상을 보였으며 15예에 있어서는 늑막염의 근적을 볼 수가 있었다. 문진에 의하여 48예중 10예에서 복막염의 기왕력을 가지고 있었다. 6. 기오아임신력에 있어서는 3예가 미혼이었고 45예가 기혼이었으며 그중 31예가 원발성불임예였고 14예의 경산부중 초산부가 6예, 다산부가 8예였다. 7. 임상증상에 있어서는 불임증이 82%, 복통이 63%, 부정출혈이 23%, 무월경 및 대하가 각각 15% 및 12%이었다. 8. 초진시 내진소견으로는 부속기종창이 42%, 자궁유착이 42%, 부속기낭성종창이 29%, 부속기압통이 27%이었고 무소견이 15%이었다. 9. 치료는 Streptomycin, P.A.S., I.N.H. 삼자 또는 삼자중 후2자 병용요법으로 수술전 3개월~6개월간 가료하였고 수술후 6개월~12개월간 가료하여 양호한 예후를 보였다. A study has been made of 48 cases of genital tuberculosis in women who have been treated during last 3 years at Dept of Ob. and Gyn. in N.M.C. Among 48 cases, 36 cases were proved histologically with biopsies and surgical specimens.(16 cases were proved with surgical specimens alone histologically and 7 cases were proved with biopsies and surgical specimens both togather and 13 cases were proved with biopsies alone. 371 curettings were examined and tuberculosis of the endometrium was found in 4.9%. The incidence of tuberculosis of the endometium in infertility was 19% in 31 cases. The most frequent site of tuberculous lesion in the surgical specimens was in tubes. Of the 23 tubes, tuberculous involvement was in 22, of the 22 ovaries in 8, and of the 9 uteri in 2. A history of previous lung tuberculosis was obtained in 2 cases and pleurisy in 5 cases among 48 cases. However, 25 cases showed radiological evidence of tuberculous lung conditions and 15 cases evidence of pleural affection in the past. A history of previous peritonitis was obtained in 10 cases. With reference to the age incidence, the average age was 26 years old at the first attendance. Of 45 married cases, only 14 gave a history of previous pregnancy. The major complaints were infertility in 82%, abdominal pain in 63%, irregular bleeding in 23%, amenorrhea in 15% and vaginal discharge in 12%. As to the pelvic findings, adnexal swelling or thickning could be found most frequently as many as in 42%. All patient were treated with a combination of streptomycin, P.A.S and I.N.H. For a first few months, they were treated with all above 3 drugs and later with the last 2 drugs. Preoperatively combined therapy was given for 3 to 6 months and postoperatively for 6 to 12 months with good effect.

임신 중기 양수천자법의 임상적 관찰 ( 보고 II )

박기수(KS Park),주갑순(KS Ju) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

A total of 400 amniocentesis was carried out into 4 groups during mid-pregnancy. Ist group of 100 amniocenetsis under the guidance of ultrasound examination and II nd group of 100 cases without ultrasound examination were attempted by a same senior resident. IIIrd and Ivth group of ammiocentenis, (100 in each) were attempted with ultrasonagraph by a different junior resident. The four groups were compared each other in terms of number of needle insertion per tap visit, color of amniotic fluid abtained, complications of amniocentesis and success rate of getting fluid as well as personal techniques to obtain the fluid. The analysed results are as followes 1. There were no differences of clinical analyzed amniocentesis with or without ultrasound examination if done by a senior resident. 2. There were less bloody tapping, and less needle insertion per each visit of amniocentesis attempted by a senior resident than a junior resident. 3. It was observed personal technical differences between junior residents. 4. No significant complication was observed after amniocentesis. 5. To minimize complications and failure rate of amniocentesis, it seems to be carried out amniocentesis preferably after 16 week of gestation by skillful obstetritians.

산부인과 영역에서 마이코프라스마 호미니스 감염에 관한 연구

안희성(HS Ahn),주갑순(KS Ju),이금자(KJ Lee),김상재(SJ Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.11

1987년 6월부터 9월까지 3개월간에 걸쳐서 고려대학교 구로병원 외래에 내원한 환자중 187명을 대상으로 M. hominis 배양 및 발육저지검사를 시행하여 다음과 같은 결론은 얻었다. 1. 대조군은 63예중 9예에서 M. hominis 양성을 보여 14.3%(9/63)의 감염율을 보였고, 불임군 골반염군 및 자궁경부염군에서 각각 22.7%(15/66), 21.4%(3/14) 및 17.9%(7/39)의 M.hominis 감염을 보였다. 2. 불임군 66예중 정상불임군, 배란이상군, 난관패색군, 자궁내막유착군, 골반염군 및 자궁경부염군으로 분류관찰한 바 각각 16.7%(3/18), 15.0%(3/20), 18.8%(3/16), 22.2%(2/9) 20.0%(1/5) and 40.0%(4/10)에서 M. hominis 의 감염을 보였나 대조군과 비교시 자궁경부염군에서만 유 의한 차이를 보였다. 3. 연령별 대조군에서는 연령이 증가됨에 따라 감염율이 증가되는 반면, 골반염군 및 자궁경관염군에서는 연령이 증가됨에 따라 감소되는 추세를 보였다. 4. 자연유산의 병력이 있는 예에서는 대조군보다 유의하게 M. hominis 의 감염율이 높았다. 5. 여성불임환자와 Artificial insemination of husband and in vitro fertilization을 시행함에 있어 반드시 M. hominis 검사를 시행하여야 한다고 사료된다. 1. Among 63 case of the control group , 9 cases were positive for M. hominis showing a 14.3%( 9/63) of the case. The positive rates for M. hominis in the infetility , PID and cervicities group were 22.7% (15/66), 21.49%(3/14) and 17.9%(7/39) respectively. 2. It was showing that the higher age, the higher infectivity in the control group except the cervicitis group which showed in the opposite way. 3. The 66 cases of infertiity group was subdivided into normal infertile couple, ovulatory failure tubal obstruction uterine synechia PID and cervicitis group and the positive rate for each group was consequently 16.7%(3/18), 15.0%(3/20), 18.8%(3/16), 22.2%(2/9) 20.0%(1/5) and 40.0%(4/10). The cervicitis group showed the highest infection of the M. hominis 4. The spontaneous abortion group showed a significantly higher infectivity rate for M. hominis 5. It is considered that tests for M. hominis were essential in infertility patients and case for artificial insemination of donor, Artificial insemination of husband and in vitro fertilization