한국 신생아 갑상선 홀몬분비 양상에 관한 연구

차광열(KY Cha),유경자(KZ Ryu),한혁동(HD Han),송찬호(CH Song),곽현모(HM Kwak) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.9

생후 3일에서 7일 사이의 신생아 79명을 대상으로 하여 혈청내 T4및 TSH치를 측정하여 다음과 같은 결과를 얻었다. 1.신생아 T4의 평균치는 9.44+-0.29ug/100ml를 나타내었으며 전체의 94.9% (75명)이 성인의 T4 정상치인 5~13ug/100ml에 속하는 것을 알 수 있다. 2.신생아 TSH의 평균치는 4.23+-1.56uIU/ml를 나타내었으며 전체의 96.3%(76명)가 성인의 TSH 정상치인 10uIU/ml이하를 보임을 알 수 있다. 3.신생아의 성별 T4, TSH의 평균치를 비교하여 볼 때 통계학적으로 유의한 차이는 없었다. 4.신생아의 체중별 T4, TSH의 평균치를 비교하여 볼 때 통계학적으로 유의한 차이를 볼 수 없었다. The incidence of congenital hypothyroidism is about 1 in 7,000 (Hobel, 1980) and it is believed to be an cause of the mental ratardarton. Early diagnosis and treatment of congenital hypothyroidism is critical to the prevention of severe mental retardation. Thus, there is a need for further study and improvement in screening tests of hypothyroidism. This study was conducted to evaluate values of serum T4 and TSH in Korean neonates at the age of 3~7 days. Seventy-nine neonates were recruited from Department of Obstetrics and Gynecology, Yonsei University College of Medicine and Jeil Hospital. Serum T4 and TSH values were measured by specific and sensitive radioimmunoassay. Results obtained are as follows: 1.The average T4 value was 9.44+-0.29ug/100ml. T4 values obtained from 43 neonates (54.4% of the total sample population) were in 9.0~10.9ug/100ml, which was highest distribution of neonates. 2.THe average TSH value was 4.23+-1.56uIU/100ml. TSH values obtained from 24 neonates (30.3% of total sample population) were in 2.0~2.9uIU/ml, which was highest distribution of neonates. 3.There was no sex difference in serum T4 and TSH values in male and female neonates. 4.No significant correlation was observed between birthweight and serum T4 and TSH values in Korean neonates. It might be, therefore, concluded that serum levels of T4 and TSH in 3~7 days Korean neonates were not significantly different from normal values of Korean adult and there were no sex and weight differences in serum T4 and TSH of Korean neonates.

단속적 원형봉합 (Interrupted Circular Suture) 전치 유착태반 제왕절개 수술시 지혈방법

차경섭,계정웅,조주연,차광열,김수연 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.12

전치태반으로 제왕절개 수술시 때때로 태반박리부위부터 짧은 시간에 많이 나오는 출혈은 수술시야를 흐리게 하고 급격히 환자의 혈압을 떨어뜨리게 된다. 전치태반으로 제왕절개 수술을 받은 120예의 환자중에서 출혈부위의 단순봉합으로 지혈이 되지 않거나 태반박리 부위로부터 짧은 시간에 많이 나오는 출혈을 보이는 환자 20예에서 단속적 원형봉합수술을 시행하였으며 결과는 다음과 같다. 1. 유착 전치태반이 있는 산모 20예의 제왕절개 수술에서 19예는 단속적 원형 봉합수술로 지혈에 성공하여 자궁적출 수술을 피할 수 있었으며 1예는 자궁적출 수술을 하였다. 2. 이 새로운 수술방법은 전치태반으로 제왕절개 수술시 자궁적출을 피하면서 지혈을 시도할 때 출혈량이나 수술시간을 감소시킬 수 있을 것이다. 3. 전치태반으로 인한 제왕절개 수술시 자궁적출을 해결책으로 사용하는 빈도를 크게 감소시킬 수 있을 것으로 사료된다. Rapid accumulation of blood from the placental separation site during cesarean delivery for placenta previa sometimes obscures the surgical field and quickly leads to deterioration of the patient`s vital signs. We used the following technique in 20 cases of intractalbe bleeding among 120 cesareans for placenta previa. Following failure to control the bleeding by suture at the placental separation site via the lower segment cesarean incision, the vessels were ligated using interrupted 2-3 cm sutures at 1cm intervals in a circle around the bleeding area on the serosal surface of the uterus. The sutures were placed as deeply as possible in order to reach the endometrium. This led to marked decrease in bleeding and allowed the small vessels to be easily identified and ligated. The results were as follows. 1. The amount of blood transfused and the operation time were gradually reduced as we became adapt in the use of this ptocedure. 2. Our experience suggests that this technique could reduce the use of hysterectomy in cesarean section for placenta previa.

창문수술 (Window Operation) 바토린낭종과 농양치료

차경섭,조주연,차광열 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.1

본 저자들은 바토린선의 낭종과 농양을 간단하면서도 더욱 효과적으로 치료할 수 있는 창문수술(window operation)을 개발하였다. 1986년 10월부터 1994년 2월까지 7년 5개월동안 79예의 모든 바토린선 낭종과 55예의 모든 바토린선 농양에 대하여 창문수술을 한 결과 다음과 같은 결과를 얻었다. 1. 연구 기간동안에 수술 부작용이나 재발은 1예도 없었다. 2. 창문수술은 바토린선의 낭종이나 농양에서 선택할 수 있는 간단하고 효과적인 치료방법으로 선택될 수 있을 것으로 사료된다. The $quot;window Operation$quot; as a more effective way to treat Bartholin gland cysts and abscesses was developed. The window operation was attempted to treat all 79 cases of Bartholin cysts and all 55 cases of Bartholin abscesses during 7 years and 5 months from October 1986 to February 1994. Under local anesthesia, a small piece of skin including the cyst wall was excised in an oval shape, and suture was performed along the excised margin. Postoperative antibiotics were given in cases of acute inflammation before the window operation. A new mucocutaneous junction was observed in 4-week follow up period. No complications or recurrences have been observed during the study period. The window operation can be an effective alternative method in the treatment of Bartholin gland cysts or abscesses.

복강경하 미세 난관복원수술에 대한 임상적 고찰

윤태기,차광열,차선희,성혜리,이정노 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

저자들은 1993년 12월부터 1994년 12월까지 차병원 불임센터에서 33예의 복강경하 미세 난 관복원수술을 시행하여 다음과 같은 결과를 얻었다. 1. 복강경하 미세 난관복원수술의 임신성공율은 73.3%(22/30) 이었고 이중 4명은 이미 분만 되었고 3명은 임신초에 자연유산되었고, 15명은 현재 임신이 지속중이다. 2. 불임시술의 종류에 따른 수술예는 ring이 19예, cautery는 9예, pomeroy는 5예였으며, 임신 성공예는 각각 11예, 7예, 4예였다. 3. 난관의 복원부위에 따른 수술에는 cornual-isthmic 3예, isthmic-istmic 3 예, cornual-isthmic 3예, isthmic-ampulla 24예, cornual-ampulla 2 예, ampulla-ampulla 1예였으며 임신예는 3예, 2 예, 14예, 2예, 1예였다. 4. 복원수술 후 난관의 길이에 따른 수술예는 4cm 이하에서 6예, 5cm는 3예, 6cm 이상에서 는 24예였으며 임신예는 각각 4예, 1예, 7예였다. 5. 복원수술후 임신까지의 평균기간은 2.1+-0.3개월이었고 본 추적 기간중 자궁외 임신은 한 예도 없었다. 이상의 결과로 보아 복강경한 미세 난관복원수술은 비교적 짧은 추적기간임에도 불구하고 높은 임신율을 나타내었고, 복강경한 수술이 개복술에 비하여 여러 장점이 많이 있음을 감 안할 때 향후 수술기법의 발달과 미세수술기구가 더욱 개발된다면 이 방법이 매우 유용하게 시행될 수 있을 것이라 사료된다. We evaluated 33 cases of laparoscopic microsurgical tubal anastomosis performed between December 1993 and December 1994 and the results are as follows; 1. The previous tubal sterilization method was bipolar cauterization in 9 cases tubal ring in 19 cases , and 5 cases of pomeroy method. 2. The anastomosis site in the favorable tube was isthmic-istmic in 3 cases , cornual isthmic in 3cases , cornual-isthmic in 3 cases isthmic-ampulla in 24 cases , cornual-ampulla in 2 cases , and ampulla-ampulla in 1 case. 3. The overall pregnancy rate was 73.3%(22/30) in a 4 month follow up period. 3 cases were excluded from pregnancy rate because 2 were in premartital status and one was lost during follow up. 4. The mean interval to conceiver from the operation was 2.1+-0.3 months 5. There was no ectopic pregnancy during our follow up period. 6. There were no intraoperative or postoperative complications . Considering the high pregnancy rate inspite of the short follow up period in our experience, this procedure could certainly replace the conventional open microsurgery.

착상전 유전질환진단의 임신성공 1 례 ; 염색체 전좌보인자 배아의 착상전진단을 거친 임신성공

이숙환,차광열,이혜경,김언경,박성은,엄기붕,고정재 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

착상전 진단에서 FISH는 주로 반성 유전성 질환에서 성감별이나 염색체 숫적이상의 진단에 이용이 되었으나, 본 연구에서는 t(2;6)(p13;21)의 균형전좌(balanced translocation)의 배아에서 2개의 whole chromosome paining probes을 써서 정상적인 각각 2개의 signals을 보이는 배아만 골라서 이식, 임신에 ㅓㅇ공하여 문헌고찰과 함께 보고하는 바이다. 염색체 전좌의 착상전 진단의 경우 보다 적절한 분석의 판정기준이 필요하며 보다 정확한 진단을 위하여 정상 중기(metaphase) 염색체위의 DNA와 dual FISH에 의한 comparative genomic hybridization기법의 이용이 멀지않은 시기에 이루어지리라 기대된다. 그 밖에 confocal microscope을 이용한 진단방법도 앞으로 많은 도움이 되리라 생각된다. Fluorescent detection of insitu hypridization(FISH) with whole chromosome painting probe(chromosome 2 and 6) has used to assess the use of this method for preimplatation diagnosis of the carrier of a balanced traslocation t(2;6)(p13;p21) which has repeatedly led to spontaneous abortions. Interphase nuclei have been analyzed and four embryos with 2 green/red signals each for the chromosome 2 and 6 were transferred and a pregnancy resulted.

현미경을 이용한 난관복원술의 임상적 고찰

윤태기,차광열,차선희,박종영,이우석 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2

1989년 1월부터 1990년 12월까지 2년간 차병원 산부인과에서 시행한 미세수술에 의한 난관 복원술 265예중 1년이상 추적이 가능했던 180예를 대상으로 다음과 같은 결론을 얻었다. 1. 대상환자의 연령은 평균 32.2세 (25-42세)이며 불임수술후 복원수술까지의 기간은 평균 5 년 (2-10년)이었다. 2. 과거에 시술받았던 불임수술의 종류중 복강경시술이 91.7%로 대부분을 차지하였고, 그중에서도 전기소작을 한 경우가 현저히 많았다. 3. 시행된 난관문합술의 부위별 분포는 협부-팽대부 문합이 65.5%로 가장 많았으며, 그 다음으로는 협부-협부, 자궁각-협부의 순이었다. 4. 복원수술후 난관의 길이는 5.1-6cm가 27.8%로 가장 많았으며, 난관의 길이가 4.1cm이상인 경우는 전체의 77.2%를 차지하였다. 5. 추적조사가가 가능했던 180예중 150예에서 임신이 확인되어 83.3%의 임신성공률을 보였으며 그 결과를 보면 만삭분만 83.6 %, 조기분만 0.7%, 자궁내 태아사망 1.3%, 자연유산 9.2%, 난관임신 3.9%였다. 6. 복원수술후 임신이 성립될 때까지의 경과기간은 평균 4.5개월 (1-25개월)이었다. 7. 불임시술 종류에 따라 임신성공률은 복강경에 의한 ring삽입의 경우 80.0%, 전기소작술의 경우 84.9%로 두 방법간의 유의한 차이는 없었다. 8. 난관문합부위에 따른 임신성공률은 자궁각-협부 83.3%, 자궁각-팽대부 90.4%였으나 각 부위에 따른 임신율에는 차이가 없었다. 9. 수술후 난관길이에 따른 임신율은 7cm이상시 83.3%였으나 각 난관의 길이에 따른 임신 율에는 유의한 차이가 없었다. 10. 복원된 난관길이와 수술후 임신까지의 평균 경과기간은 4cm이하의 경우 4.3개월 4.1cm 이상의 경우 4.6개월로 난관의 길이가 임신경과기간에 유의한 영향을 주지 못하는 것으로 나타났다. During 2 year period from Jun. 1989 to Dec. 1990, 265 cases of microsurgical tubal reversal were performed and 180 cases of them were followed up for more than 1 year postoperatively in the Department of Obstetrics and Gynecology, Cha General Hospital. The results were as follows : 1. The reasons for requesting reversal of sterilization were a loss of children (25.6%), remarriage (28.9%), change of attitude (45.5%). 2. The mean age was 32.2 years and 91.7% of them had been sterilized by laparoscopic cauterization . 3. The most common site of the anastomosis was isthmic-ampullar portion (65.5%). 4. The postoperative tubal length was 4.1cm or more in 77.2%. 5. No statistical differences were found in pregnancy rate according to the method of previous sterilization, the site of tubal anastomosis and postoperative tubal length. 6. The tubal length did not influence the mean interval form operation to pregnancy. 7. The overall pregnancy rate after tubal reveral was 83.3% and the outcome of the pregnancy was as follows ; term pregnancy 83.6%, premature delivery 0.7%, IUFD 1.3%, spontaneous abortin 9.2%, ectopic pregnancy 3.9%.

Hashimoto씨 갑상선염과 동반된 희발월경 1 례

최동희,윤태기,차광열,한세열,남윤성 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

저자들은 희발월경을 가진 불임환자에서 매우 높은 항갑상선 항체 역가를 보인 Hashimoto씨 갑상선염 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Thyroid hormone deficiency is among the most common diseases affecting women. Two percent of women suffer overt hypothyroidism and five percent develop subclinical hypothyroidism during their lives. An additional six percent of women have transient postpartum hypothyroidism. Furthermore, complaints consistent with thyroid hormone deficiency[e.g.,fatigue and weight gain] are common in euthyroid individuals and must be distinguished from actual thyroid dysfunction. Finally, clinical manifestations of hypothyroidism may include significant disturbances of reproductive physiology: both precocious and delayed puberty, menstrual dysfunction, and ovulatory disorders that can contribute to infertility. We have experienced a case of Hashimoto`s thyroiditis which was found in infertile patient with oligomenorrhea. So we report this case with a brief review of literatures.

시험관아기 시술시 정자직접주입법을 이용한 2146 예의 임상 결과

최동희,윤태기,차광열,한세열,정형민,엄기붕,고정재,오종훈,손지온 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Since Palermo and coworkers(1992) reported the first ICSI-baby, ICSI has been widely accepted as a treatment of male factor infertility. ICSI techniques have also been used to treat abnormal semen parameters in order to overcome fertilization failures and to increase clinical outcomes. From January 1994 to December 1996, 2146 ICSI cycles were performed at the Infertility Center of Cha General Hospital and we achieved a 75.1% of fertilization rate with 713 subsequent pregnancies(34.8%). The ICSI fertilization rate using 1-day old oocytes which failed to fertilize using conventional IVF method was lower than the ICSI fertilization rate using fresh oocytes(75.7% vs 65.9%). However, we achieved 13 pregnancies out of 125 embryo transfers from the total fertilization failure group. There was no statistical difference in the fertilization rates using normal semen or semen with single defect, but statistical differences were observed between normal semen and semen with two or more defects. No statistical difference was found in pregnancy rates between normal and defective semen groups. In our MESA, PESA and TESE programs, we achieved high fertilization rates(69.2∼82.5%) and a 45.8%(mean) pregnancy rate. Categorizing the female patients by age, ie., ≤29, 30∼34, 35∼39, ≥40, fertilization rates were consistently in the range of 74.5∼ 75.7%, but pregnancy rates significantly decreased in patients older than 35 yrs(31.3%) or 40 yrs(14.2%). Of the 713 pregnancies, we were able to obtain follow-up information of the babies in 527 cycles, of which we found 8abnormalities.

ICSI를 실시한 2146예 중 수정란이식에 실패한 경우에 대한 원인 분석

이재호,윤태기,차광열,김현주,엄기붕,손지온 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.3

Since the introduction of intracytoplasmic sperm injection [ICSI] by Palermo et al.[1992], ICSI has been widely accepted in many IVF programs, including our own. Since our first successful pregnancy in 1993 using ICSI, we have continued to utilize the method in our IVF program to treat male factor patients. From January 1994 to December 1996, 2146 ICSI cycles were performed, most of the cases involving patients with severe male-factor infertility. The overall fertilization rate from the 2146 cycles was 76.0%. Embryo transfers failed in only 93 cycles[4.3%]. Details of the 93 failed ET`s were analysed. The fertilization rate of the ET failure group was 15.4% and the rates of 1PN and 3PN formation were 1.3% and 5.9%, respectively. A significant difference was found in the 3PN formation rate of the successful ET cycles [1.1%] compared with the 3PN rate of the failed embryo transfer group. The fertilization rate of small number[≤3] of oocyte group was slightly lower than the groups of oocyte number 4∼7 and more than 8. Forty eight cycles out of 93[51.6%] were categorized as having a poor quality oocyte with severe granulation, degenerative signs or abnormal morphology. In 24 cycles where non-motile sperm were used, fertilization did not occur. The women`s ages were not correlated with the fertilization rates. In conclusion, ET failures following ICSI for the treatment of severe male factor infertility was mainly caused by poor quality oocytes and/or poor viability of the spermatozoa used for injection into oocytes.

항갑상선 항체를 동반한 습관성 유산 1 예

최동희,윤태기,차광열,한세열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

An autoimmune etiology has been proposed as the cause of recurrent abortions in couples with no other obvious explanation for their reproductive failure. It has been known for quite sometime that women with systemic lupus erythematosus(SLE) have an increased risk of pregnancy loss. Pregnancy loss in these women has been associated with the presence of non-organ-specific antibodies not only in the presence of active SLE but also in subclinical autoimmune disease. The most common autoantibodies associated with pregnancy loss are antiphospholipid antibodies(in particular anticardiolipin and the lupus anticoagulant)and antinuclear antibodies. These autoantibodies along with other non-organ-specific antibodies are implicated not only in pregnancy loss but other aspect of infertility. Among organ-specific autoantibodies, antithyroid antibodies specifically have been linked to repeated pregnancy loss. We have experienced a case of recurrent pregnancy loss associated with antithyroid antibodies. So we report this case with a brief review of literatures.