제왕절개술후 반흔과 충수돌기에 발생한 자궁내막증 2 예

최규홍(KH Choi),김희진(HJ Kim),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.7

저자들은 1982년 2월 본 병원에서 한국인의 희귀한 제왕절개술 반흔에 발생한 자궁내막증과 1983년 4월 충수돌기에 발생한 자궁내막증을 각각 경험하였기에 문헌고찰과 함께 보고하는 바이다. We have experienced two cases of endometriosis of which one was found in abdominal wall scar formed after cesarean section and the other in the appendix during explorative laparotomy This paper presents those cases and a brief review of the literatures.

선천성 다발성 관절만곡증 1례

고응구(EK Koh),장석균(SK Chang),최규홍(KH Choi),이영주(YJ Lee) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.11

Arthrogryposis multiplex congenita denote congenital contraction of joints in flexion and usually occurs alone but may be associated with other malformations. A case of arthrogryposis multiplex congenita was presented with brief review of literatures.

복강경 불임시술 후에 속발된 자궁외임신에 관한 임상적 고찰

한규완(KW Han),박상철(SC Park),김희진(HJ Kim),홍진기(JK Hong),최규홍(KH Choi) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.6

1985년 1월1일부터 1986년 12월31일까지 본 청구성심병원 산부인과에서 치료받은 55명의 자 궁외임신 환자중에서 복강경 난관불임시술 후에 자궁외임신이 발생된 14례를 대상으로 임상 적인 관찰을하여 다음과 같은 결론을 얻었다. 1. 자궁외임신의 발생빈도는 총분만 1572례중 55례로서 3.5%였고, 관찰한 총 55례의 자궁외 임신 중에서 전에 난관 불임시술을 받은후 자궁외임신이 발생한 예는14 례로서 자궁외임신 중 25.5%를 차지함으로써 자궁외임신의 발병 원인중 가장 중요한 요소가 전의 난관 불임시 술이었음을 볼 수있엇다. 2. 호발연령층은 26세에서 35세사이가 전체의 71.4%였다. 3. 임신력은 평균 5.3회 분만력은 2회 분만이 가장 많았고, 3회 분만이 그 다음을 차지하였 다. 4. 임상 증상은 하복통과 질출혈이 가장 흔한 증상(57.1%)이었고, 무월경, 질출혈, 하복통, 쇼 크 등의 임상 증상을 보였다. 5. 증상이 발현된 사기는 최종 월경일로부터 계산하여 8주에 가장 많았고, 평균 7주에 나타 남을 볼수 있었다. 6. 복강경 불임시술을 받은 후 자궁외임신이 발병하기까지는 43개월에서 48개월이 소요되는 경우가 가장 많았다. 7. 거의 모든 예에서 다그라스와 천자 소견이 양성이었다. 8. 57%에서 뇨임신 반응검사가 양성을 보였다. The incindence of ectopic pregnancy was reported to be increased recently throughout the country presumbly chiefly due to the previously performed laparoscopic tubal sterilization several authors have reported that the single major etiologic factors for tubal pregnancy was previous laparoscopic tubal sterilization. This study was taken to evaluat the clinical and statical nature of ectopic pregnancy which were diagnosed and treated at the Department of Obsterics and Gyunecology, Chung Goo Sung Sim Hospital during 2 years from January 1, 1985 to December. 31 1986. The results were as follows; 1. 25.5% of ectopic pregnancy was develped in patients who had previous laparoscopic tubal sterilization . this indicates that the laparoscopic tubal sterilization is a single major etiologic factors for the development of ectopic gestation. 2. Age distributions was respectively five cases between 26 to 30 yrs and 31 to 35 yrs old, three between 36 to 40 yrs old and one over 40 yrs old age. 3. The parity of the most of women who had treated under the diagnosis of ectopic pregnancy was two. 4. Major clinical symptoms and sings were abdominal pain and vaginal bleeding, amenorrhea, and signs of hypovolemia. 5. Most of the symptoms were developed between eight weeks from LMP. 6. The interval between the development of ectopic pregnancy and laparoscopic tubal sterilization was average 45.7 months. 7. Almost all cases had revealed positive culdocentesis findings . 8. 57% of cases had revealed posivie urine hCG test.

제왕절개분만의 기왕력과 완전 전치태반과의 연관성

안현경(HK Ahn),김은성(ES Kim),한정열(JY Han),김문영(MY Kim),류현미(HM Ryu),최규홍(KH Choi),양재혁(JH Yang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : To determine the relationship between previous cesarean section and subsequent development of placenta previa totalis and placenta previa totalis with accreta. Materials and Methods : A retrospective review of the case records of all women delivered with the diagnosis of placenta previa totalis during the 5-year period from August 1, 1994, to July 31, 1999, at the Samsung Cheil Hospital. Results : There were 38,215 deliveries in the study period. 237(0.62%) had placenta previa totalis and 56(23.6%) of whom had a history of previous cesarean section. The incidence of placenta previa totalis was significantly increased in those with a previous cesarean section(1.19%) compared with those with an unscarred uterus(0.54%). In the group without antecedent of cesarean section, accretism risk was 11.6%, with one section or more 32.1%. The need for cesarean hysterectomy occurred more commonly in patients who had a prior cesarean delivery, 14 of 56(25%), as compared with patients with no prior cesarean delivery, 6 of 181(3.3%). Conclusion : There is a strong association between previous cesarean section and risk of subsequent development of placenta previa totalis. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk of developing placenta accreta. Patients with previous cesarean section have a significantly higher incidence of postpartum hemorrhage and are more likely to undergo emergency hysterectomy.

완전 고환성 여성화증후군 1 례

최규홍,김경호,신성식,이미리,신훈범,유미정 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

Complete testicular feminization syndrome is characterized by female phenotype, in spite of the normal male karyotype 46,XY. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Therefore, androgen induction of Wolffian duct developmetn does not occur. However, antimullerian hormone activity is present, and the individual does not have mullerian development.

임신중의 급성 신우신염에 대한 고찰

최규홍,김희진,이기동,박상철,최영주 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.6

1985년 1월 1일부터 1989년 12월 31일까지 청구성심병원 산부인과에 입원하였던 임산모 4,851명에 대하여 임산중과 분만후 6주이내에 급성 신우신염으로 판명된 53예를 대상으로 다음과 같은 임상적 연구결과를 얻었다. 1. 동 기간중 산부인과를 방문한 4,851명의 산모중에서 53예가 급성 신우신염으로 입원하여 그 빈도가 1.09%를 보였다. 2. 임신기간별로 볼 때 그 빈도가 임신중에는 임신중기가 35.8%로 가장 많았고, 분만후에는 26.4%를 보여 분만후보다 분만전이 발병율이 높았다. 3. 가장 발생이 많은 연령층은 주로 임신적령기 (25∼29세)때로, 45.3%를 보였으며 평균발생연령은 28세였다. 출산경력상으로는 초산부에서 53명중 33예(62.3%)로 가장 많았다. 4. 급성 신우신염을 유발시키는 기왕력을 보면, 원인불명이 22예(41.5%)이고 과거 요로감염이 있었던 환자가 총 15예(28.3%)와 도뇨가 9예(17.0%)순이였다. 5. 임상증상중 가장 흔한 것은 고열 오한이 50예(41.0%)였으며, 그 다음으로 혈복부동통과 요통이 46예(37.7%)였으며, 특히 우측이 좌측에 비하여 3배정도 높았다. 35예에서 (66.0%) 38℃이상의 고열을 동반하였으며, 대부분이 입원후 48시간만에 고열의 소실(23예, 43.4%)를 보였다. 6. 증상이 시작되어 입원하기까지 기간으로는 1주이내가 23예(43.4%)로 가장 많았으며, 2주이내가 19예(35.8%)로 나타났고, 2주이상 지속된 예(11예, 20.8%)도 있었다. 7. 요검사소견에서 백혈구수가 5/HPF이상 보인자가 53명중 41예(71.5%)로 나타났으며, 이 중에서 백혈구수가 31/HPF이상 보인 경우가 25예(47.2%)로 가장 많았고, 정상을 보인 경우도 12예(22.6%)였다. 혈액소견상에서도 백혈구수가 8,000/㎣이상 보인 경우는 42예(79.2%)로 나타났다. 8. 요세군 배양검사상 그람음성균이 양성균에 비하여 26예(63.4%)로 가장 많았는데, 이 중에서 대장균이 22예(53.7%)로 높았고, 그 다음이 포도상구균이 4예(9.8%)였다. 혈액배양에서도 역시 대장균이 3예(42.9%)였다. 9. 약제에 대한 감수성소견에서는 대장균이 amikacin(78.3%)에 감수성이 높았으며 포도상구균은 ampicillin에 (77.6%), pseudomonas은 gentamycin에 (76.9%) 연쇄상구균은 erythromycin에(75.5%) 감수성이 있었다. 10. 태아에 미치는 영향으로는 신우신염으로 입원한 산모와 조산관계는 큰 차이를 발견할 수가 없었다(8.5% : 9.5%). Acute pyelonephritis is the most frequent complication involving the urinary tract, as well as the most frequent medical cause of hospitalization, during the course of pregnancy. And associated with risk to the mother and fetus. We have retrospectively evaluated 53 cases among 4,851 pregnant women following an acute episode of pyelonephritis during pregnancy admitted at the Chung Goo Sung Shim Hospital during the 5 years period from Jan. 1, 1985 to Dec. 31, 1989. The incidence was 53 cases out of 4,851 gestational women cases during the same period and the rate was 1.09%. Acute pyelonephritis occurred usually during the second trimester and third trimester. It was most common in second trimester (35.8%) and postpartum (26.4%). The most prevalent age distribution was seen in the age grup of 25 to 29 years. The average age was 28 years old. And is commoner in primiparas than in multiparas, that is does occur in about 62.3% of primiparas, rising to about 37.5% in multiparas. History of previous factors were unknown in 22 cases (41.5%) of all cases, followed previous urinary tract infection in 15 cases (28.3%) and were due to previous catheterization in 9 cases (17.0%). As to the initial chief complaints, high fever and chils was found in 50 cases (41.0%) and flank pain or lumbago was 46 cases (37.7%). The right flank tenderness was affected 3 times (32 cases) more than left (9 cases), and 12 cases were bilateral. The febrile condition was 38℃ or more in 41 cases (71.5%) of the patients, 23 cases were completely afebrile within 48 hours after the onset of therapy. On duration of symptoms and signs until admission, 23 cases (43.4%) of all cases were less than 1 week but 11 cases (20.8%) were more than 2 weeks. In the microscopic urinalysis, white blood cell count per the high power field ( 5/HpF) was measured in 41 cases or 71.5%. Of these 41 cases, 25 patients (47.2%) were identified the leukocytosis with more than 31/HpF of ㅉ but normal urine was seen in 12 cases (22.6%).And the serum leukocytosis(8,000/mm3)was found in 42 cases (79.2%). The most frequently associated Gram negative organisms(63.4%)more than positive organisms(17.1%)in the urine at colony counts of $gt; 105 per milliliter.The most predominant microorganisms isolated was coliform and of these Wscherichia coli was the most common organisms(53.7%)and the rest was staphylococci organisms.And the Escherichia organisms was cultured from the blood of 3 cases(42.9%)of the patients. In sensitivities for this microorganisms, Escherichia coli was highly sensitive to Amikecin(78.3%),Ampicillin(74.9%).And the staphylococci was highly sensitive to Ampicillin(77.6%), Clindamycin(75.8%). In correlation between the pregnant women with pyelonephritis and the pregnant women without phelonephritis for prematurity there was no relationship between the two(8.:9.5%).And there was no spontaneous abortion and neonatal anomaly in this study.

임신중기 복부초음파로 진단된 흉부유착중복아의 1 예

최규홍,박상철,최영주,이용미,정규호 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.8

본 저자 등은 임신 제 25주에 초음파검사와 X- 선촬영으로 흉부유착쌍태아를 진단하여 자궁절개술을 시행하였기에 간단한 문헌고찰과 함께 보고하였다. Thoracopagus is very rare congenital anomalies. We have diagnosed a case of it by ultrasonography and X-ray at intrauterine pregnancy for 25th weeks. We present it with brief review of literatures.

정상분만후 회음절개 부위에 발생한 자궁내막증 2 례

최규홍,유미정,하승호,정윤진 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

Endometriosis in the episiotomy scar following vaginal delivery is one of the very rare condition among the extrapelvic endometriosis. We have experienced two cases of endometriosis in the episiotomy scar following vaginal delivery. We report two cases with a brief review of the concerned literatures.

자궁외임신의 임상과 자궁내막의 조직학적 고찰

최규홍,한은경,유영건,서주홍,허경선 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

1991년 6월 1일부터 1993년 5월 31일까지 2년간 청구성심병원에서 치료한 자궁외임신 101례를 대상으로 임상 및 자궁내막의 조직학적 고찰을 하였던 바 다음과 같은 결론을 얻었다. 1. 자궁외임신의 분만수에 대한 발생빈도는 1:41.1였다. 2. 호발연령군은 30-34세로써 32.7%로 가장 많았으며 25-34세까지가 59.4%였다. 3. 분만횟수는 2회가 38.6%로 가장 많았고, 미산부에서도 24.8% 발생하였으며, 인공유산의 경험이 있는 경우가 전체의 75.2%였다. 4. 기왕력은 인공유산의 경험이 75.2%, 골반내염증 26.7%, 복강경불임술이 17.8%였다. 5. 임상증상 발현시기는 최종 월경일로부터 4-8주가 74.3%를 차지하였다. 6. 주요증상으로는 무월경 97%, 하복부 동통 95.0%, 질출혈 77.2% 등의 순이었다. 7. 내원 당시의 수축기혈압은 55.4%에서 100 mmHg를 보였고, 70 mmHg미만은 9.0%였다. 8. 내원 당시의 혈색소치는 7 mg/dl미만이 5.0%, 12 mg/dl이상이 28.6%였고, 10 mg/dl이상이 전체의 67.2%를 차지하였다. 9. 진단방법으로 소변 임신반응검사 양성율은 96.0%였고, 다글라스와천자 양성율은 92.6%였다. 10. 발생부위로는 난관이 91.1%, 자궁각이 5.9%, 난소가 3.0%였다. 11. 복강내 출혈량은 1,000 cc이하가 전체의 44.5%였다. 12. 수술방법은 환측 난관절제술이 57.4%로 가장 많이 시행되었고, 양측 난관절제술이 23.8%였다. 13. 34례의 자궁외임신에서 소파술을 시행하여 탈락막 반응이 64.7%에서 관찰되어졌다. 14. Arias-Stella 현상은 34례중 28례(82.4%)에서 나타났다. 15. 자궁외임신에서는 혈관들의 두께(76.5%) 와 직경(82.4%)에서 경등도의 증가를 보였다. 16. 자궁외임신시의 소파술에서는 중간형 영양배 염세포는 전혀 나타나지 않았다. 17. 입원후 경과는 101레중 사망한 예는 없었으며, 전례에서 특별한 합병증없이 퇴원하였다. This study is a clinical analysis of 101 ectopic pregnant patients who were admitted and treated at Department of Obstetrics and Gycecology, Chung Goo sung Shim Hospital from June 1, 1991 to May 31, 1993. The results obtained were as follows; 1. The incidence of ectopic pregnancy was 1 in 41.1 deliveries (101/4151). 2. The most frequent age group was in 30-34 years of age, comparing 32.7%, 25-34 years of 59.4%. 3. Nullipara was 24.8% and the cases who experienced artificial abortion was 75.2%. 4. According to past history of illness, artificial abortion was in 75.2%, PID was in 26.7%, Laparoscopic tubal sterilization was 17.8% of total. 5. The most frequent interval between L.M.P. and the onset of symptoms was 8 weeks in 74.3%. 6. On the symptomatological anaysis, low abdominal pain was encountered in 95.0%, amenorrhea in 97.0%, vaginal spotting or bleeding in 77.2%. 7. In initial systolic blood pressure at hospital, under 70 mmHg was 9.0%, and over 100 mmHg was 55.4%. 8. The laboratory studies in most cases were not significant. Hemoglobin value over 10.0 mg% was 67.2% and below 7.0 mg% was 5.0%. 9. Urine hCG test was positive in 96.0% and culdocentesis was positive in 92.6%. 10. Ectopic pregnancy was implanted on faillopian tube in 91.1%, on the uterine cornus in 5.9%, on the ovary in 3.0%. 11. Intraabdominal hemorrhage below 1000cc in amount was 44.5%. 12. Most commonly used surgical procedure was salpingectomy(57.4%). 13. Desidua without chorionic villi was present in 64.7% of the cases studies. 14. The Arias-Stella phenomena was present in 28 (82.4%) of the 34 ectopic cases. 15. The ectopic pregnancies are demonstrated a slight increase in both vessel wall thichness (76.5%) and lumen size(82.4%). 16. None of the curettings associated with ectopic pregnancies displayed the intermediate trophoblastic cell. 17. There was no fatal case in 101 ectopic pregnancy.

제왕절개술후 복벽반흔에 발생한 자궁내막증 2 례

최규홍,서주홍,허경선,신성식,박성욱 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.5

본원에서 비교적 보기드문 수술 반흔 부위에 발생한 자궁내막증 2예를 경험하였기에 문헌고 찰과 함께 보고하는 바이다. Endometriosis in the abdominal scar following cesarean section is one of the very rare condition among the extrapelvic endometriosis. Two cases of scar endometeriosis following cesarean section were experienced and treated completely after surgical excision and postoperative Danazol therapy. This case was reported with a brief review of the concerned literatures.