Osteoporosis and Fracture among Patients with Type 1 and Type 2 Diabetes

홍서유,박은주 대한골다공증학회 2010 Osteoporosis and Sarcopenia Vol.8 No.1

Diabetes mellitus is a major risk factor for osteoporotic fractures. The occurrence of Osteoporosis among patients who have diabetes mellitus further increases both economically and physically their burden of disease. Nevertheless, osteoporotic screening or prophylactic treatment for all patients with type 1 and type 2 diabetes mellitus is not being recommended at present. The reason is that neither the relationship between diabetes and osteoporosis and nor differences between type 1 and type 2 diabetes mellitus are clear. At present, while low bone mineral density (BMD) is consistently observed in type 1 diabetes mellitus, the relationship is less clear for type 2 diabetes mellitus, with some studies reporting modestly increased or an unchanged BMD. Both type 1 and type 2 diabetes mellitus have been associated with a higher risk of fractures. The presence of micro- and macro-vascular diabetic complications as a result of long standing poor glycemic control, rather than long duration predict low BMD in patients with type 1 diabetes mellitus. In type 2 diabetes mellitus patients, obesity protects bone loss and increases BMD. Nevertheless, hypoglycemic episodes under insulin therapy with commonly established risk factors of falls such as advanced age, impaired balance, a history of coronary heart disease or arthritis and peripheral neuropathy may have contributed to the increased risk for falls and result in fractures. We suggest that osteoporosis screening and prophylactic treatment for all patients with type 1 and 2 diabetes mellitus needs to be recommended along with considerations of each individual’s risk profile for osteoporotic fractures.

자궁 양측부속기 , 대장 및 대망에 발생한 방선균증 1 례

홍서유,강윤철,송애진,이해양 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.1

저자들은 본 을지병원 산부인과에 입원한 환자에서 조직검사 소견으로 대장과 대망 자궁부속기에 발생한 방선균증 1례를 경험하였기에 증례보고와 아울러 문헌고찰을 하는바이다. Actinomycosis is chronic, progressive, bacterial or fungal disease, more suppurative than granulomatous with a marked tendency for forming abscesses and sinus tracts. Actinomycosis, depending on the site of primary infection, is generally classified as cervicofacial, abdominal and thoracic type. In most instance, pelvic infection is found closely related to IUD, direct extension from GI tract and hematogenous sprewad. The causative agent is a branching, gram-positive anaerobic or microaerobic organism, apparently parasitic but bacteria-like in most of its characteristics. Recently authors are experienced a case of actinomycosis, which occured at bilateral adnexae, colon and greater omentum. A brief review of literatures pertinent to this case was done.

신생아 황달에 대한 임상적 고찰

홍서유 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.7

난소종양의 조직병리학적 및 임상 고찰

홍서유,김병선,이치중,성영미 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.1

1983년 7월부터 1988년 6월까지 만 5년간 서울을지병원 산부인과에서 입원하여 난소종양으로 진단된 환자중 수술에 의해 제거된 조직의 병리조직학적검사로서 난소종양으로 확인된 148예에 대하여 임상 및 병리학적, 통계학적으로 비교, 관찰한 결과는 다음과 같다. 1. 전 난소종양중 비종양성 난소낭이 59예로 39.9%, 양성종양이 77예로 52.0%, 악성종양은 10예로 8.1%이었다. 2. 비종양성 난소낭의 경우는 황체낭포가 22예로 37.3%를 나타내 가장 많았으며 진성 난소종양에서는 낭성종양이 98.7%이었고 충실성 종양이 1.3%이었다. 양성종양에서는 낭성기형종이 44예로 57.2%, 장액성 낭선종이 20예로 26.0%, 점액성 낭선종이 12예로 15.5%의 빈도를 나타냈으며, 악성종양은 점액성 낭성선암이 6예 50.7%, 장액성 낭성선암이 2예 16.7%, 과립막 세포종이 3예로 25.9%의 빈도로 나타났다. 3. 조직병리학적으로 분류하면 난소상피세포에서 유래한 종양이 난소종양의 45%를 점하였으며, 그 중 점액성 낭선종이 20예로 가장 많았고 배세포에서 유래한 종양은 양성낭성기형종으로 49.5%이었으며 생식선 기질에서 유래한 종양은 과립막 세포종이 3예, 섬유종이 1예 관찰되었다. 4. 연령분포를 보면, 비종양성 난소낭은 30대가 42.4%, 40대가 30.5%의 분포로 평균연령이 36.5세였으며 양성종양에서는 30대가 37.7%, 20대가 27.3%로 평균연령이 34.7세이었다. 악성종양은 40대가 호발하여 58.3%로 평균연령이 44.5세이었다. 5. 난소종양의 크기는 비종양성 난소낭과 양성종양에서 직경 6~10 cm인 경우가 각각 55.9%, 62.9%로 평균직경이 7.2 cm, 9.4 cm이었으며 악성종양에서는 16~20 cm이 50%로 평균직경이 14.3 cm이었다. 6. 난소종양의 양측성은 비종양성 난소낭이 5.1%, 양성종양이 14.3%, 악성종양이 16.7%의 빈도를 나타내었다. 7. 주요 임상증상은 복부동통 및 불편감이 41.1%로 가장 많았고 복부종괴촉지, 이상질출혈의 순이었다. 8. 임신과 동반된 경우는 총 148예중 14예로 9.5%였으며 그 중에서 양성 낭성기형종이 5예, 35.7%로 가장 많았다. 9. 난소종양의 합병증은 총 18예에서 발생하였는데 파열이 10예로 6.8%, 염전이 6예로 4.1%, 염증성 변화가 2예로 1.4%에서 관찰되었다. The ovarian tumors are one of the many neoplasms seen in practice of Gynecology. A clinicopathological as well as statistical survey was on a series of 148 cases of the ovarian tumors which were operated and confirmed with postoperative histopathological study at the department of obstetrics and gynecology of Eul Ji hospital, Seoul during a period of 5 years from July, 1983 to June 1988. The results obtained are as follows; The incidence of true neoplastic tumor was 60.1% of all ovarian tumors which comprising 52.0% of benign and 8.1% of all malignant tumors. The corpus luteal cyst was the most frequent cyst among the non-neoplastic tumors. In benign neoplastic tumor, benign cystic teratoma was ranked first as 57.2%, followed by serous cystadenoma and mucinous cystadenoma comprising 26.6% and 15.5% respectively. In malignant tumors the incidence of mucinous cystadenocarcinoma and serous cystadenocarcinoma were 50.7% and 16.7%. On histopathological classification, the tumors originated from common epithelial cell were 45.0%, germ cell tumors were 49.5%, and sex cord stromal tumors were 4.5%. Mean age of non-neoplastic ovarian tumors were 36.5 years, that of benign tumors was 34.7 years and that of malignant tumors was 44.5 years. As to the subjective symptoms of all ovarian tumors. lower abdominal pain and discomfort was noted in 41.1%, palpable mass in the lower abdomen in 14.7% and vaginal bleeding in 14.7%. The ovarian tumors associated with pregnancy were 14 cases(9.5%), and the most common tumors were cystic teratoma as 35.7%

姙産婦 및 胎兒 臍帶血中의 Somatomedin-C와 成長 호르몬値에 關한 硏究

洪瑞裕,姜宰成,洪性鳳 고려대학교 의과대학 1989 고려대 의대 잡지 Vol.26 No.1

The mechanism responsible for intrauterine fetal growth is poorly understood despite the impressive progress made in understanding how hormone and growth factors regulate postnatal growth Recently the isolation of the insulin-like growth factor Ⅰ and Ⅱ shed some light on this important subjects and insulin-like growth factor Ⅰ is similar to the somatomedin-C in structuies. It has been shown that the growth hormone may augment the action of the insulin on the liver to form somatomedins which might augment fetal growth. This study was undertaken to determine the relationship between growth hormone and somatomedin-C in mothers and their infants, and to evaluate the correlation of these hormones to birth weights in newborn infants in 45 term pregnant women and their infants, and 10 non-pregnant healthy women. The results were as follows; 1. Maternal plama growth hormone levels were significantly higher in non-pregnant women than women who delivered average for gestational age, small for gestational age and large for gestational age infants and the birth weights were not affected by maternal plasma growth hormone. 2. Maternal plasma somatomedin-C levels were significantly higher in pregnant women who delivered average for gestational age, small for gestational age and large for gestational age infants than non-pregnant women and the birth weights were influenced by maternal plasma somatomedin-C. 3. Fetal cord plasma growth hormone levels were significantly higher in small for gestational age infants than average or large for gestational age infants. 4. Fetal cord plasma somatomedin-C levels were significantly lower in small for gstational age infants than average or large for gestational age infnats. The birth weights were correlated to fetal cord plasma somatomedin-C. The present study suggests that the birth weights of all infants studied had a significant overall effect on maternal and fetal somatomedin-C and somatomedin-C may be involved in fetal growth in utero.

원발성 난관융모상피암 1 예

홍서유,김은경,유달영,방영태,선윤수,박종호 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Gestational choriocarcinoma of the fallopian tube is very rare phenomenon which may originate in any form of pregnancy; about 100 cases have been collected from the world lit-erature to date. A patient, who had been diagnosed as primary choriocarcinoma of the fall-opian tube arising in a tubal ectopic pregnancy of 16weeks` gestation, was treated with the initial extirpated operation as total hysterectomy and bilateral salpingo-oophorectomy follo-wing chemotherapy. Primary tubal choriocarcinoma is considered worthwhile in view of the paucity of its cases. We recently experienced a case of primary tubal choriocarcinoma, and report with a brief review of literatures.

기능장애성 자궁출혈의 임상 및 병리학적 고찰

홍서유,유철모,박내형,이태원,정연실 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.3

1987년 9월부터 1988년 8월까지 본 병원 산부인과에서 기능장애성 자궁출혈 환자 113례의 임상 및 자궁내막생검에 대한 연구로 다음과 같은 결과를 얻었다. 1. 연령분포는 40대에서 50%, 30대에서 23%, 50대에서 17%였다. 2. 평균 임신횟수는 56회였고, 분만횟수는 23회였다. 3. 출혈양상은 과다월경과 월경간 출혈이 동반되는 경우가 35%, 월경간 출혈이 27%, 폐경후 출혈은 166%였다. 4. 자궁내막의 조직소견은 증식기 내막이 63.7%, 분비기 내막이 23.9%, 내막 증식증이 8.8% 순이었다. 5. 표준화한 월경주기 14일후 자궁내막생검을 시행한 66례중 배란성출혈을 의미하는 분비기 내막은 20례(33%)로서 주로 무배란성출혈이 많았다. Dysfunctional uterine bleeding is defined as bleeding from the uterine endometrium unrelated to anatomic lesions of the uterus. According to definition, the diagnosis of dysfunctional uterine bleeding seems to be a diagnosis of exclusion. Dysfunctional uterine bleeding is the most frequent problem of all gynecologic disease and occurs more frequently during puberty and in the perimenopausal period and is less common during the reproductive period. Pathologically, the endometrium of DUB patients represents the proliferative pattern most commonly. We performed the clinical and pathologic studies of DUB patients in order to evaluate the abnormal uterine bleeding and brief review of literature was made. 113 cases of dysfunctional uterine bleeding obtained by endometrial biopsy. The results were follows: 1. Age distribution of uterine bleeding was mainly 5th decade. 2. Dysfunctional uterine bleeding patients were mainly multigravidas and showed 5 ~ 6 times of pregnancy and 2 ~ 3 times of pregnancy. 3. Among variable bleeding patterns, menorrhagia with intermenstrual bleeding was the most common pattern. 4. The histologic findings of endometrium were proliferative phase, secretory phase, hyperplasia irregular shedding, atrophic endometrium in order of frequency. 5. According to endometrial biopsy, the incidence of anovulatory DUB was 67 % (46 cases out of 66 cases) and ovulatory DUB was 33 % (20 cases out of 66 cases).

자궁외임신에 관한 임상적 고찰

홍서유,정연실,박준영,성낙구 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.2

1984년 1월부터 1988년 12월까지 5년간 서울을지병원 산부인과에서 입원치료한 자궁외임신 환자 222예를 임상적 고찰하여 그 결과를 보고하면 다음과 같다. 1. 총 분만수에 대한 자궁외임신의 빈도는 1:43.2(222예/9586분만)이었다. 2. 호발연령은 26~30세로 43.2%이었다. 3. 분만과의 관계에서 미산부의 자궁외임신이 41%를 차지하였고, 한번도 임신한 경험이 없는 미임부가 16.2%를 차지하였다. 4. 인공유산과의 관계에서 인공유산의 경험이 있는 경우가 68.9%로써 자궁외임신 유발과의 유의성이 있음을 보여주었다. 5. 기왕력은 기왕개복술의 경험이 있는 경우가 21.6%, 복강경 난관불임시술을 받은 경우가 5.9%, 인공임신중절이 60.9%, 골반내염증이 8.8%, 그외 자궁내 피임장치가 0.8%였다. 6. 최종월경 제 1일로부터 증상 발현되어 내원하기까지의 기간은 6주이내가 29.7%, 6~8주가 37.8%로 대다수를 차지하였다. 7. 임상증상에서 하복부 동통이 73.9%, 무월경이 69%, 질출혈이 64.5%, 자궁경부압통이 48.6%, 골반부위 중압감이 43.6%등 주 증상으로 나타났다. 8. 자궁외임신의 진단에서 urine hCG(+)가 93.4% culdocentesis가 88.6%, 초음파검사가 79.8%, 복강경진단이 83.3%이었으며 자궁내막검사상 Arias-stella reaction이 20.3%, secretory endometrium이 45.6%, proliferative endometrium이 22.8%, decidua가 11.3%였다. 9. 자궁외임신의 위치는 나팔관이 93.3%, 자궁각이 2.7%, 난소가 1.4%, 자궁경관이 1.8%, 복강내가 0.4%, rudimentaly horn이 0.4%이었다. 10. 수술방법은 환측 난관절제술이 59.5%, 환측 난소난관절제술이 27%로 대다수를 차지하였다. 11. 입원당시 혈색소치는 10 gm%미만이 24.3%, 10 gm%이상이 75.7%이었고, 수술시 복강내 출혈량은 500 ml이하가 51.8%, 500~2000 ml가 45.9%이었다. 12. 수술합병증은 복강내 농양 형성이 0.4% 있었으며 수혈에 대한 합병증 및 사망한 예는 없었다. The ectopic pregnancy is the one of the gynecologic emergency. And now second leading cause of maternal death in the United States. The reasons or causes for increasing ectopic pregnancy include the following. 1. Tubal infection due to increased prevalence of sexual transmitted disease. 2. Use for contraception that prevents intrauterine pregnancy but not extrauterine pregnancy by intrauterine device or low-dose progestational agents. 3. Unsuccessful tubal sterilization. 4. Induced abortion followed by infection. 5. Fertility induced by ovulatory agents. 6. Previous pelvic surgery. 7. Exposure to stilbestrol in utero. 8. Better and earlier diagnostic procedures. The incidence of ectopic pregnancies has been expressed in various ways. Population-based data are presented that based on the 222 ectopic pregnancies reported in Seoul Eul-Ji General Hospital from Jan. 1st, 1984 to Dec. 31, 1988. A review of determinant factors of ectopic pregnancy is presented as follows; 1. The incidence of ectopic pregnancies was 1 per 43.2 deliveries(222/9586). 2. The most common incidence of age group was found in 26~30 years old and the rate was 42.3%(94/222). 3. The obstetrical histories of ectopic pregnant patients were nulligravida in 16.2%, abortion in 52.3%, delivery in 22% and previous ectopic gestation in 9.5%. 4. The past histories were previous operation in 21.6%, laparoscopic tubal sterilization in 5.9%, artificial abortion in 60.9%, pelvic inflammatory diseases in 8.8% and intrauterine device in 0.8%. 5. The duration from LMP to the time of onset of the symptoms was below 6 weeks in 29.7% and 6~8 weeks in 37.8%. 6. According to symptomatological analysis, these symptoms occurred as follows, lower abdominal pain in 73.9%, amenorrhea in 69%, vaginal spotting or bleeding in 64.5%, cervical moving pain in 48.6%, bearing down sensation in 43.6% and then one more symptoms were complicated. 7. The diagnostic procedures for early detection of 122 ectopic pregnant women were urine hCG, culdocentesis,ultrasonogram, endometrial biopsy, and diagnostic laparoscopy from Jan.lst,1986 to Dec.31th, 1988. The result with positive urine hCG was in 93.4%, with culdocentesis in 88.6%, with positive urine hCG was in 93.4%, with culdocentesis in 88.6%, with ultrasonogram in 79.8%, and with diagnostic laparoscopy in 83.3%. The findings of endometrial biopsy were decidua,only in 11.3%. 8. Ectopic pregnancies were implanted on fallopian tube in 93.3%, uterine conus in 2.7%, ovary in 1.4%, cervix in 1.8%, abdomen in 0.4% and rudimentary horn in 0.4%. 9. The operative procedures were ipsilateral salpingectomy in 59.5%, ipsilateral salpingo-oophorectomy in 27%, cornual resection in 2.7%, total abdominal hysterectomy in 2.3%and others in 8.5%. 10. The value of Hb was below 10gm% in 24.3% and above 10 gm% in 75.7%. The amount of intraabdominal hemorrhage was below 500ml in 51.8%, 500~2000ml in 45.9%.The rate of patients with transfusion was 44.1%. 7. The diagnostic procedures for early detection of 122 ectopic pregnant women were urine hCG, culdocentesis, ultrasonogram, endometrial

제왕절개술 시행한 산모에 합병된 폐전색과 심부정맥혈전증 2 예

홍서유,방영태,정환부,김대영,한경철,최재웅 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

저자 등은 본원에서 척추마취하에 제왕절개술을 시행하고 수술 2일째 갑작스런 호흡곤란과 일시적인 의식소실을 보인 산모에 대해 심초음파와 폐관류스캔을 시행하였고, 또한 동통 및 부종이 있는 산모에 대해 정맥조영술 및 폐관류 스캔을 시행하여 폐전색을 확진하고 헤파린 요법으로 치료하였다. 이에 폐전색의 위험요인이 없는 산모에 있어서도 폐전색의 발생 가능성을 생각하고 조기진단 및 적극적인 치료의 필요성을 인식할 필요가 있기에 간단한 문헌 고찰과 함께 보고하는 바이다. Pulmonary embolism is a critical complication of pelvic surgery. This diagnosis should be suspected if pulmonary symptoms occur abruptly. Pulmonary embolism is a complication of pelvic or lower extremity thrombophlebitis; Indeed, in some patients no evidence of thromboembolism can be found and occurs on about the several to tenth postoperative days, although it may occur at any time. Also, pulmonary thromboembolism, first identified as the leading cause of maternal death in 1970s, continues to account for an increasing proportion of maternal deaths. The main or major causes of maternal deaths were pulmonary thromboembolism, hemorrhage, ectopic pregnancy, pregnancy induced hypertension complication and infection. Recently, deaths by pulmonary thromboembolism may be becoming more important as a cause of maternal death. Pulmonary thromboembolism was originated almost commonly from the venous thrombus, especially deep vein thrombus in the leg, which migrated to and occluded the pulmonary vasculatures. Also, the deep vein thrombosis was most commonly located in the lower extremities. Of the deep vein thrombosis patients, 40% showed high probability pulmonary embolism on the lung perfusion scans. We reported 2 cases of pulmonary thromboembolism and deep vein thrombosis developed after cesarean section with the review of literature.

정상 한국여성의 골반계측

홍서유,조기환,정구열,홍성봉 대한산부인과학회 1982 대한산부인과학회 학술대회 Vol.49 No.-