Rationale for the early diagnosis & treatment of asthma

(MW Watt) 대한 소아알레르기 호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.1

복강경난관불임술 후 발생한 자궁외임신 4예

김문욱(MW Kim),이선경(SK Lee),김광희(KH Kim),임병흡(BH Lim),강재성(JS Kang) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.2

본 저자들은 복강경난관불임수술후 발생한 자궁외임신중 황체기 임신으로 인한 경우가 아니, 전기응고 또는 소작절단이 불충분하여 생긴 자구외임신 4례를 체험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. Recently laparoscopic tubal sterilization has been widely used for female sterilization. The causes of failure are due to the luteal phase pregnancy, the inadequate coagultion and the coagultion of other organs. The ectopic pregnancy, one of the complications, is uncommon, but it is a life threatening disease and suggests a new medicolegal problems. Four cases of laparoscopic tubal sterilization followed by the ectopic pregnancy are reported with brief literatures.

사지단지증아의 일례보고

오명환(MW Oh),박학만(HM Park),황치학(CH Hwang),조재현(SH Jo) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.5

사지단지증아의 일례보고 Authors report a case of chondrodystrophia fetalis, of who was delivered by a 30 year old para 2 at out hospital. The fetus was edematous and assumed a bizarre shape and expired in few minutes after delivery. A review of literatures on chondrodystrophia fetalis was made briefly.

분만예정일 초과

신면우(MW Shin) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.6

분만예정일 초과를 보인 환자군과 대조군간에서 분만방법을 비교한 바 산과수술인 흡인분만 및 제왕절개수술등이 분만예정일 초과를 보인 환자군에서는 대조군에 비해 월등히 고율이었다. A total of 3,559 births which occurred after 30weeks of gestation at The Seoul National University Hospital during the period from January 1, 1967 to December 31, 1970 were reviewed. The duration of prtegnancy was calculated by Nagele`s rule with correction for cycles greater or less than 28 days. A pregnancy lasting 42 weeks or more from the first day of the last menstrual period was considered postdate, this arbitrary period being the one most commonly described in the literature. Patients whose menstrual cycles were grossly irregular were not included in this study. The purpose of this study were;(1) to asses the importance of certain conditions suggested as being significant in the etiology of prolonged pregnancy;(2) to determine the effect of prolonged gestation upon th fetus; and (3) to delineate a plan for the management of patients in whom pregnancy is prolonged past the expected date of confinement. Of these 3,559 births, 563 were postdate pregnancy. The following factors were analyzed: distribution of over-all births in relation to length of gestation, age, parity, birth weight, fetal distress, perinatal death, duration of labor, and method of delivery. The findings in paints in whom pregnancy prolonged were compared with over-all clinic experience for the same period. the results obtained in this study were as following. 1. A series of 563 postdate pregnancies is presented. The incidence of prolonged pregnancy was 15.6 percent, with the highest incidence occurring in the 25 to 29 year age group. 2. Of these 563 births, 51.2 percent were to multiparas and 48.8 percent were to primiparas. 3. The incidence of heavier babies in postdate deliveries was apparent and had been noted also by other investigators. 4. Fetal distress ocurred more commonly in the postdate group (9.6 percent) than in the control group (5.7 percent), especially in primiparous patients (11.4%). A trend toward a greater incidence of fetal distress as the postdate period lengthens was noted. 5. Perinatal mortality rate in the postdate group was 55.1 per thousand as compared to a 64.9 per thousand perinatal mortality in over-all deliveries. A trend toward a greater rate of fetal mortality as the baby weight increases and the postdate period lengthens was noted, especially in primiparous patient. 6. A trend toward a prolonged labor was noted in primiparous paients with postdate pregnancy. 7. A significantly increased incidence of operative delivery was noted. In particular, the primiparous patient with postdate pregnancy frequently came to operative delivery. The cesarean section rate was increased in the postdate group compared to the control group.

임신 빈혈에 관한 연구

신면우(MW Shin),이현식(HS Lee) 대한산부인과학회 1972 Obstetrics & Gynecology Science Vol.15 No.12

임신 빈혈에 관한 연구를 통해 빈혈환자의 대부분은 철분결핍빈혈환자이었다. This study is to investigate the status of pregnancy anemia in 127 Korean pregnant women who have had antenatal care at the Dept. Of Obst. and Gyne. Seould National University Hospital and admitted for delivery. The changes in homoglobin, hematocrit, mean corpuscular hemoglobin concentration, protein total, serum albumin, serum iron and total iron binding capacity during pregnancy have been observed. The followings are the summary result of this study. 1. The average hemoglobin levels were 11.8±1.22gm/100ml in first trimester, 11.6±1.42gm /100ml in second trimester, 11.2±1.44gm/100ml in third trimester and 11.1±1.36gm/100ml in puerperiu. The incidence of severe anemia with hemoglobin level below 10.0gm/100ml was 1.26 per cent of the total and onother 48 per cent were classified as mild anemia with hemoglobin level between 10.0gm/100ml and 12.0gm/100ml. 2. The majority of anemia cases were associated with serum iron and albumin deficiency. The incidence of serum iron deficiency was 79 per cent among the cases with severe anemia.

자궁태아사망을 초래한 제대진결절의 1례

신면우(MW Shin),이효표(HP Lee),신경자(KJ Shin),나태경(TK Rha) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.10

The occurrence of true knot of the umbilical cord is rare and occasionally they may be pulled so tight as to become compressed and lead to fetal distress and death. A case of true knot of umbilical cord resulting in fetal death in utero is presented with the brief review of the literatures.

모성사망 25 년간 ( 1961∼85 ) 연구

이명화(MW Lee),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.12

1. 과거 25년간(1961∼`85), 서울지역 이대병원 모성사망율의 추세는 1960년대 생존출생아 10만당 187예에서 최근 1980년대 전반(1981∼`85) 127로 현저하게(30%가) 감소하였으나, 아직 높은 추세에 있다. 도착모성사망율도 1960년대 사망률 153에서 최근 1980년대 전반의 50으로 더욱 현저하게(66%가) 감소하는 추세를 보였다. 2. 최근 1980년대 전반에 있어서의 병원사의 주요 원인은, 역시 자간전증 및 자간증(10만당 34), 감염(34), 출혈(25) 및 융모암(25)등이었다. 과거 25년간 자간전증 및 자간증의 사망률은 현저하게 감소하는 추세에 있었으나(1960년대에 136→1980년대 전반에 34), 출혈사는 고착상태에 있었으며(1960년대에 20→1980년대 전반에 25), 감염사는 오히려 증가추세에 있었다(1960년대에 10→1980년대 전반에 34). 도착사도 과거 25년간, 자간전증 및 자간증은 더욱 현저하게 감소되었고(1960년대에 39→1980년대 전반 8), 출혈사도 감소되었으며(1960년대 69→1980년대 전반에 33), 감염사는 산발적으로 있었을 뿐이었다. 3. 자간전증사 및 자간사는 지난 25년간, 그들 고혈압환자인구 중 사망률 에 있어서 조금도 개선되지 않는 추세에 있었다. 4. 과거 25년가 병원감염사에 있어서 임신중절로 인한 사망은 7예로써 증가하는 추세에 있었으며, 제왕절개술로 인한 사망은 5예로서 산발적으로 나타났다. 도착사에서의 감염사는 모두 임신중절에 의한 사망이었으며 역시 가끔 볼 수 있었다. 5. 융모암에 의한 모성사망은 25년간 9예로서 그 중 75%(6예)는 서울지역(비전문급)에서 전입되어온 예이었으며(내용물 불완전 불완전 제거), 그들은 모두(100%) 폐나 뇌로 이미 전이되어 있어서 예방불가능한 상태이었음은 주목되었다. 6. 연령별 모성사망율의 분포는, 과거 20년전에는 26∼30세에 많았으나, 최근 1980년대 전반에는 25세이하의 더 젊은 연령층에 많았다. 7. 과거 25년간 병원사와 도착사는 모든 임신 후 1/3기에 많이 일어났으며, 최근 1980년대 전반에는 임신 중 1/3기에서 사망률 이 증가하는 추세에 있었다. 8. 자가분만과 관련된 병원모성사망(태반잔류 등)은 1960년대 21%였으나, 최근 1980년대 전반에는 7%로 현저하게 감소하였다. 9. 분만 및 임신중절과 관련된 병원사 및 도착사는 93예 중 45예(48.4%)가 임신종료후 24시간 이내 사망하였다. Maternal mortality is always an important problem, irrespective of developing or developed countries in all over the worlds. For the past 25 years period(1961-85), there have encountered quite large number of 140 maternal deaths including 82 cases of hospital deaths and 58 cases of deaths on arrival among 48,538 live births in Ewha Womans University Hospital, Seoul, capital city district. All the deaths were regularly records and analyzed by the hospital maternal mortality conference. 1. The hospital maternal mortality rate over the recent early 1980s period(1881-85) were 15 deaths or 127 per 100,000 live births, and it was reduced about 30% compared with 185 of the early 1960s(19 deaths in 1961-66). 2. The leading causes of hospital maternal deaths over the recent early 1980s were preeclampsia/eclampsia(34 per 100,000 live births), infection(34), hemorrhage(25) and trophoblastic disease(25). 3. In reviewing the trend of maternal mortality rates over the past 25 years, preeclampsia and eclamptic deaths were dramatically declined(136 per 100,000 to 100, 62, 12 or 34). However hemorrhagic deaths(rate of 20, 10, 12, 36 or 25) and infection deaths(rate of 10, 20, 37, 48 or 34) were basically unimproved or even more steadily increasing. Mortality rate of trophoblastic desease(all metastatic choriocarcinomas) also unforly showed decrease in the tendency. Deaths related to the pregnancy termination which was mainly due to sepsis also revealed increased rate in the trend(rate of 10, 12, 36 or 17) over the 20 years. Death from cesarean section accounted for 21 cases or 20% of maternal deaths, and the major cause was operative complications(10 cases, 48% of cesarean deaths) including 5 anesthetic deaths and 4 septic deaths overwhelmingly. 4. In recent early 1980s the overall probable preventable hospital death estimated 11 cases of 73% of deaths including 3 deaths from delayed admission(20%) and 8 from managemental complications(53%), and overall reduction of the avoidable deaths was frotunately 23% compared with early 1960`s of 95% or 18deaths.

복강경난관불임수술 후에 속발된 원발성 난소임신의 1예

신면우(MW Shin),남주현(CH Nam),이건용(KY Lee),이필한(PH Lee) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

Ectopic pregnancy following laparoscopic tubal sterillzation is rare , but is a serious problem. The possiblity of ectopic pregnancy should not be excluded simply because of a patients`s past history with previous tubal sterilization precedure. It has been known that incidence of ovarian pregnancy among ectopic pregnancy is extremely rare. Authors have recently experinced a case of ovarian pregnancy which satisfied all of the four criteria proposed by Spiegelberg, and which was occured 7 months after laparoscopic tubal sterilization procedure. A case of ovarian pregnancy is presented with a brief review of literature concerning ectopic pregnancy after failed tubal sterilization and ovarian pregnancy.

단백성 호르몬의 면역학적 연구

신면우(MW Shin),류장희(CH Yu),강소자(Kang SJ) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.12

단백성 호르몬의 면역학적 연구를 시행하여 보고하는 바이다. For the immunologic determination of H.C.G. in both urine and serum in the patients of hyperemesis gravidarum and the comparison of the concentration of H.C.G. in both serum and amniotic fluid of term pregnant women, basic experiments and semi-quantitative assay has been performed by means of hemagglutination inhibition technique. The obtained results are as following. 1. H.C.G. of relatively high purity(5,427 IU/mg.) was used as antigen and high titer of antiserum was obtained even with relatively small amount of antigen through booster injection of antigen and complete Freund`s adjuvant. 2. The specificity of the obtained antiserum has been confirmed by the neutralization test of biologic activity of H.C.G. on the weight of immature rat ovary. The analysis of the purity of H.C.G. with Onchterlony test revealed that used H.C.G. contained negligible amount of other proteins. 3. In the patinet of hyperemesis gravidarum, the titer of H.C.G. in both serum and urine were significently higher than that of normal pregnancy at the same period. 4. The severity of emetic symptoms seems relatively correlate with the titer of H.C.G. in both urine and serum. 5. The titer of H.C.G. in both serum and amniotic fluid of 40 term pregnant women was 28.0IU/ml. 5.3IU/ml. respeefively. The ratio of H.C.G. concentration of amniotic fluid to serum was 17.3%.

미국의 의료보험과 수가의 현황

송문원(MW Song) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.2

날로 발전하는 현대의학과 더부러 의료혜택의 범위도 날로 팽창하며, 그에 따르는 의료 비용 역시 상당한 증가를 보이고 있으며 그 의료비용을 감당키 위하여, Health Insurance는, 일상생활에 있어서 필수불가결의 조건으로 되어 있는 것이 오늘의 미국입니다. 의료보험이 오늘에 이르기까지의 경로와 실행되고 있는 보험의 종류를 조사 관찰하였고, 현재 의료인들의 수가 규정이 어떤 단계를 거쳐서 오늘에 이르렀으며 또 그 수가 규정을 실예를 들어서 관찰하고저 합니다. 이 수가 규정의 문제점, 아울러 나아가서 의료보험 자체의 문제점과 그 전망을 기술하겠습니다. Under private practice physician is free to charge his customary fee. The physician normally bills the patient for each service he has performed (such as office call, home visit, injection, or operation). In most cases elaborate lists of services, with a designated fee for each service, have been negotiated with the profession by the insurance system. Usually the negotiated fee represents the total that the physician can claim for the sevice, whether he makes his claim dircct to the insurer or whether he claims from the patient, who in turn is reimbursed in whole or part by the insurer. Under the fee-for-service system, the patient is free to choose and change his physician. This method has the advantage of paying practitioners according to services actually performed, but this system also provides practitioners with financial incentive to perform unnecessary or excessive services. the United States provides governmental health insurance program under the Social Security Act amendments of 1965, such as medicare(compulsory health insurance for the aged) and Medicaid(the program for the medically indigent). but most health insurance in the U.S. still consists of private health insurance programs. Much private health insurance in the U.S. is operated on a group basis, generally through groups of employees whose insurance payments may be subsidized by their employer. In 1956, Califonnia Medical Society completed a statewide survey of Fee Schedule through, 4,700 California pyhsicians after 3 years survey, forming "Relative Value Study"(Rvs). This Rvs has been used as a useful guide for physician, health insurances, government, throughout the country, for the last two decades. However, recently goverment agency, FTC(Federal Trade Commission) charged that Relative Value Study is "a price-fixing tool" and a violation against Anti-Trust Law, and therefore it is inflationary. Health care constitues the fastest growing major expenses of American consumers. The total annual cost of health care is estimated to be $115 billion, or 8% of the Gross National Product. Carter administration is preparing a wide comprehensiv NHI(National Health insurance) to put skyrising health care cost under control. The price of an average hospital expense has gone up form $350 in 1965 to $1,300 today. Average expense of normal delivery is about $1,000 and that of hysterectomy is over $2,500 to $3,000. High malpractice insurance premium causes fee increase and nationaly more than 50%, insurance cost was under $8,000 ; 35% paid $8,000-$15,000 and 13% had insurance costing over $15,000 and the highest rate is in California.