무심 쌍태아 1례

정성윤 ( Seong Yun Jeong ),이해혁 ( Hae Hyeog Lee ),이석민 ( Seok Min Lee ),조환성 ( Hwan Sung Joe ),남계현 ( Kye Hyun Nam ),이임순 ( Im Soon Lee ),이권해 ( Kwon Hae Lee ),김동원 ( Dong Won Kim ) 대한주산의학회 2000 Perinatology Vol.11 No.2

자궁 동맥색전술 후 자궁벽내근종의 경질구축

박승준 ( Seung Jun Park ),김지영 ( Gi Young Kim ),한상확 ( Sang Hwak Han ),최정범 ( Jeong Bum Choi ),김신혜 ( Sin Hye Kim ),유지훈 ( Ji Hoon Yoo ),조환성 ( Hwan Sung Joe ),한효상 ( Hyo Sang Han ),황인철 ( In Cheul Hwang ),양승부 ( 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.11

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We`ve made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.

양측 자궁동맥 색전술을 이용한 자궁근종의 치료

최정범 ( Jeong Bum Choi ),유지훈 ( Ji Hoon Yoo ),김신혜 ( Shin Hye Kim ),박승준 ( Seung Jun Park ),조환성 ( Hwan Sung Joe ),한효상 ( Hyo Sang Han ),황인철 ( In Cheol Hwang ),최규연 ( Kyu Yeon Choi ),양승부 ( Seung Boo Yang ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.11

목적: 자궁근종 환자들을 대상으로 하여 수술을 피하고 싶은 환자, 가임 여성으로 자궁을 보존하고 싶은 환자들을 대상으로 양측 자궁동맥 색전술을 시행하여 양측 자궁동맥 색전술이 자궁근종 증상 및 근종의 크기를 얼마나 감소시킬 수 있는지를 평가하고자 하였다. 연구 방법: 2003년 1월부터 2005년 6월까지 2년 6개월 동안 본원 산부인과 외래에서 초음파로 자궁근종으로 진단 받은 환자들을 대상으로 하여 수술을 원치 않거나, 가임기 여성으로 임신을 위해 자궁을 보존하고 싶어하는 증상이 있는 환자들을 대상으로 하였다. 시술 전에 질식초음파와 MRI를 이용하여 자궁근종의 크기를 다시 정확히 측정하였으며, 시술 후 2, 6, 12주 후에 질식 초음파를 통하여 근종 크기의 감소 여부를 측정하였고, 증상의 호전 여부에 대하여 많이 호전, 약간 호전, 호전 없음, 약간 악화, 많이 악화로 구분하여 조사, 평가하였다. 결과: 환자군의 평균연령은 24세 에서 50세로 평균 36.3±7.9세였고, 근종의 평균 직경은 4.8±2.5 cm이었고, 평균 부피는 55.4 (46.3-67.4) cm3이었다. 근종의 형태는 간질 또는 근층내 근종이 9예, 점막하근종이 6예였고, 장막하 또는 복막하 근종 및 유경성 근종, 광간막 근종은 없었다. 평균자궁근종 용적감소는 시술 후 2주 후, 6주 후, 12주 후에 58.6±9.7%, 77.5±12.3%, 86.8±23.5%으로 자궁근종의 크기가 의미 있게 감소한 것을 확인할 수 있었다. 질출혈이나 하복부 통증의 증상은 시술 12주 후 많이 호전된 경우가 60%, 약간 호전된 경우가 40%였으며, 호전이 없거나 악화된 경우는 없었다. 대부분의 연구 대상자에 있어서 증상의 호전을 보였다. 자궁동맥 색전술 시행 후 전자궁 절제술이나, 자궁근종 절제술 등의 수술을 시행 받은 경우는 없었으며, 자궁근종 크기의 증가나, 증상의 악화를 보인 경우도 없었다. 시술 후 합병증으로는 시술 후 복부통증이 모든 환자에게서 발생하였으나, 감염, 자궁괴사, 난소기능저하, 재출혈, 혈종 등의 합병증은 없었다. 결론: 따라서, 자궁동맥 색전술을 이용한 자궁근종의 치료는 수술로 인한 출혈이나 감염, 요관손상 등의 부작용을 최대한 줄일 수 있으며, 덜 침습적인 치료방법으로, 무엇보다도 자궁내막 손상이 거의 없어 가임 여성에서 생식능력을 보존할 수 있다는 장점을 가진 유용하고 안전한 치료방법이 될 것이다. Objective: The purpose of this study is to evaluate the effectiveness and safety of uterine artery embolization for the treatment of symptomatic leiomyomas in the patients who want to preserve uterus, want fertility or feel fear for operation. Methods: From January 2003 to June 2005, among the patients with symptomatic uterine leiomyoma, fifteen women who wanted to preserve uterus or wanted fertility or had fear for operation were included in this retrospective study. Bilateral Uterine artery embolization (UAE) was performed. At the preprocedure and at 2, 6, and 12 weeks of postprocedure, transvaginal ultrasonography was performed for all patients. Clinical symptoms and follow-up information for each patient were evaluated. Results: 15 leimyomas were treated with UAE. The initial mean volume of leiomyomas was 55.4 (46.3-67.4) cm3. The mean volume decrease was 58.6±9.7%, 77.5±12.3%, 86.8±23.5% at 2, 6, 12 weeks. The outcome of clinical symptoms were as followed; `much improved` 20% (3/15), `somewhat improved` 60% (6/15), `no improvement` 20% (3/15), `somewhat worsen`s 0% (0/15), and `much worsen` was 0% (0/15). There was no case of hysterectomy or myomectomy after UAE. And also no case of increasement of volume nor worsening of clinical symptoms were found. Lower abdominal pain was the most common symptoms after UAE, but complications were not detected. Conclusion: In this study, UAE to treat patients with uterine leiomyoma is proved to be effective not only in volume reduction, but also in symptom improvement. And it is a relatively less-invasive procedure which decreases the risk of side effects of operation. Above all things, it preserves fecundity in young women. Therefore, UAE is very effective and safe procedure in the treatment of symptomatic uterine leiomyoma.

한국인 임신부에서 Parvovirus B19의 IgG와 IgM 항체 보유율에 관한 연구

유지훈 ( Ji Hoon Yoo ),이정재 ( Jeong Jae Lee ),최정범 ( Jeong Bum Choi ),김신혜 ( Shin Hye Kim ),최규연 ( Kyu Yeon Choi ),김미경 ( Mi Kyung Kim ),박은희 ( Eun Hee Park ),김종수 ( Jong Su Kim ),조환성 ( Hwan Sung Joe ),김태희 ( Ta 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.12

목적: Parvovirus B19의 항체 보유을은 아직 우리나라의 통계가 없는 실정이다. 따라서, 임신 제 1삼분기 및 제 2삼분기 산전검사시 Parvovirus B19 IgG와 IgM을 검사하여 우리나라 임신부의 Parvovirus B19의 항체양성율 및 지역, 직업, 연령에 따른 차이를 알아보고자 하였다. 연구 방법: 서울, 부천, 천안, 구미의 4개 지역에서 각각 59, 63, 28, 71명씩 총 221명의 임신 1삼분기 및 2삼분기 임신부를 대상으로 동의하에 혈액검사를 시행하였다. Parvovirus B19 IgM-3rd generation EIA, Parvovirus B19 IgG-3rd generation EIA를 이용한 ELISA로 Parvovirus B19 IgG, IgM을 검사하였다. 상관관계의 유의성을 보기 위해서 SPSS program을 이용하여 χ2 test를 사용하였다. 결과: Parvovirus B19의 IgG 양성이 118명 (53.3%), Parvovirus B19의 IgM 양성이 1명 (0.5%) 이었다. 초검 및 재검시의 IgM Positive였던 산모들에게서 비면역성 태아수종, 자연 유산과 사산 등의 결과는 없었다. 연령, 지역, 출산력 및 제태연령에 따른 항체 보유율의 차이는 통계적으로 유의성을 보이지 않았다. 결론: 이번 연구의 결과는 Parvovirus B19의 항체 보유율이 53.3%로 우리나라 가임기 여성의 Parvovirus B19의 항체보유율이 다른 아시아 국가들에 비해 높았다는 것과, 지역 및 연령별 항체 보유율을 알 수 있었다. 비록 우리나라 여성들의 Parvovirus B19 급성 감염은 1명으로 적었지만, 임신 초기 Parvovirus B19의 선별검사로 태아에의 부정적 영향을 예측하는데 도움이 될 수 있을 것이며, 예방접종에 대한 고려를 해볼 필요가 있을 것이다. Objective: The prevalence of Parvovirus B19 antibody in Korea has not been known. The aim of this study is to analyze variation of prevalence according to area, job and maternal age. Methods: A prospective study of the pregnant women was performed at first & second trimester. This study was an analysis of 221 pregnant women who lived in Seoul, Bucheon, Cheonan, and Gumi in South Korea. All serum samples were drawn during first and second trimester. Presence of parvovirus B19 IgG antibodies and IgM antibodies was determined by ELISA using Parvovirus B19 IgM-3rd Generation EIA, Parvovirus B19 IgG-3rd Generation EIA, Parvovirus B19 Quantitative IgG Calibrators Kit (Biotrin International, Ireland). Data and level of significance were analysed by χ2 test using the SPSS program. Results: In total, 118 (53.3%) of the 221 pregnant women were IgG antibody positive for parvovirus B19 during first and second trimester. Only 1 (0.5%) of 221 pregnant women was IgM antibody positive. There were no nonimmune fetal hydrops, spontaneous abortion and stillbirth in acutely infected woman. There were no statistically significant differences in Parvovirus IgG positive rate according to maternal age, area, parity and gestational age. Conclusion: This study has confirmed seroprevalence rate of human parvovirus B19 in South Korea comparable to the rate found in Asian countries. But positive rate of Parvovirus IgG was higher than other Asian countries. This study also showed that a proportion of adults of childbearing age was still susceptible to the virus and serological data also showed evidence of infection occurring in this age group. It will be of interest for the obstetricians in this country to note the role of Parvovirus B19 in relation to the extent of stillbirths and hydrops fetalis and to if there is any need for a vaccine to reduce fetal wastage.

유방암 환자에서 타목시펜 사용 후 자궁내막에 발생한 암육종 1 예

이임순(Im Soon Lee),이윤희(Yun Hee Lee),정집광(Jib Kwang Chung),이석민(Seok Min Lee),안준모(Jun Mo Ahn),김신아(Shin Ah Kim),김대원(Dae Won Kim),김성욱(Seong Uk Kim),조환성(Hwan Sung Joe),김동원(Dong Won Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

Tamoxifen, which is often used in breast cancer therapy, has also been used in the treatment of patients with advanced and recurrent endometrial carcinoma. Tamoxifen has been shown to have significant benificial effects in the treatment of breast cancer patients as hormonal therapy. However, there is evidence that tamoxifen may affect other hormone sensitive organs, including the uterus and ovaries. An increased risk of endometrial polyps, endometrial hyperplasia and endometrial cancer has been reported in tamoxifen treated women. We are able to make this report because we have experienced uterine endometrial carcinosarcoma which is developed in a patient treated with tamoxifen for five years following a modified radical mastectomy due to breast cancer in our hospital.

자궁선근증의 고찰

조환성,이해혁,정성윤,김성욱,이순곤,남계현,이임순,이권해 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Objective: This study was designed to estimate the frequency and risk factor for edenomyosis Methods: The clinical records of 623 women undergoing hysterectomy were retrieved in the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital, during 5 years, from Jan. 1995 to Dec. 1999. Results: The following result were obtained. 1. Adenomyosis was found in 247 of 623 patients(39.6%) 2. The highest incidence was 40-49 years of age group, an incidence of 46.6% and mean age was 44.7 years. 3. Adenomyosis was more frequently observed in parous women than non-parous women, such as 93.1% and 6.9%, respectively. 4. Dysmenorrhea, metrorrhagia, pelvic pain and vaginal bleeding were common symptom of adenomyosis, an incidence of 28.7%, 19.0%, 18.2% and 16.2%, respectively. 5. Myoma was the most combined disease in adenomyosis, showing the incidence of 54.7%. 6. Grossly, the size of uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 61.9%. 7. Preoperative diagnostic accuracy of adenomyosis was 6.9%. Conclusion: The results show that deeply understanding of the common symptoms and epidemiology of adenomyosis improve the preoperative diagnostic accuracy.