치골자궁저 높이 측정시 검사자간의 변동평가에 따른 3 가지 통게학적 방법의 비교

남계현 ( KH Nam ),이권해 ( KH Lee ),조태호 ( TH Cho ),이해혁 ( HH Lee ),선우재근 ( JG Sunwoo ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.11

1990년 3월 1일부터 3월 31일까지 순천향대학교 의과대학 산부인과 외래를 방문한 임신 20주부터 40주 사이에 무작위로 선택한 41명의 산모를 대상으로 검사자 3인이 치골자궁저 높이를 측정하여 다음과 같은 결과를 얻었다. 1. 검사자 A와 B간의 변동계수는 4.9%였다. 2. 검사자 A와 B간의 상관계수는 0.968였다. 3. 상기방법은 통계적으로 유의한 결과를 나타내지만, 동의한계란 방법으로 조사시 실제 동의한계는-4.3cm에서 2.6cm로 상당한 변동을 나타냈다. 4. 검사방법간의 차이와 제삼의 검사자를 이용하여 조사했을 때도 동의한게는 비슷한 결과를 나타냈다. 치골자궁저 높이의 백분율표를 이용하여 동의한계를 적용할 때 치골자궁저 높이의 측정은 실제 정상태아와 자궁내 태아발육지연아를 충분히 감별할 수 없다는 결론이 나왔으며, 자궁내 태아 발육지연아를 발견하는 선별검사로서, 치골자궁저 높이의 측정은 한계를 갖는다. 우리는 검사자간의 변동을 조사시, 상관계수나 변동계수를 이용하는 것보다 동의한계를 이용해 검사하는 것이 타당하다고 결론지었다. The measurement of symphysis-fundal height has been considered a simple and attractive screening method to detect the intrauterine growth retardation. Yet examination of published reports of fundal height measurement show wide variation in its performance. One possible reason for this wide variation is inter-observer variation. So, we assessed the variation by three statistical methods-the coefficient of variation, the correlation coefficient, and the limits of agreement. 1. The coefficient of variation between observer A & observer B was 4.9%. 2. The correlation coefficient between observer A & observer B was 0.968. 3. Above methods were highly significant statistically but, the limits of agreement were very wide and true limits of agreement were-4.3 to 2.6cm. 4. When the method of measurement was imperfect was tested, and when one of the observers was not good was tested, the results were similar to above results. Applying these limits to centile charts of symphysis-fundal height shows that the fundal height cannot be measured by different observers with sufficient agreement to seperate small fundal heights of those which are not small, and this severely limits the usefulness of measurement of the symphysis-fundal height as a screening test for intrauterine growth retardation. We conclude that inter-observer variation should be assessed by the method of limits of agreement, and not by calculating the coefficient of variation or the correlation coefficient.

Novel dentin phosphoprotein frameshift mutations in dentinogenesis imperfecta type II

Lee, K‐,E,Kang, H‐,Y,Lee, S‐,K,Yoo, S‐,H,Lee, J‐,C,Hwang, Y‐,H,Nam, KH,Kim, J‐,S,Park, J‐,C,Kim, J‐,W Blackwell Publishing Ltd 2011 Clinical genetics Vol.79 No.4

<P>Lee K‐E, Kang H‐Y, Lee S‐K, Yoo S‐H, Lee J‐C, Hwang Y‐H, Nam KH, Kim J‐S, Park J‐C, Kim J‐W. Novel dentin phosphoprotein frameshift mutations in dentinogenesis imperfecta type II.</P><P>The dentin sialophosphoprotein (<I>DSPP</I>) gene encodes the most abundant non‐collagenous protein in tooth dentin and DSPP protein is cleaved into several segments including the highly phosphorylated dentin phosphoprotein (DPP). Mutations in the <I>DSPP</I> gene have been solely related to non‐syndromic form of hereditary dentin defects. We recruited three Korean families with dentinogenesis imperfecta (DGI) type II and sequenced the exons and exon–intron boundaries of the <I>DSPP</I> gene based on the candidate gene approach. Direct sequencing of PCR products and allele‐specific cloning of the highly repetitive exon 5 revealed novel single base pair (bp) deletional mutations (c.2688delT and c.3560delG) introducing hydrophobic amino acids in the hydrophilic repeat domain of the DPP coding region. All affected members of the three families showed exceptionally rapid pulp chambers obliteration, even before tooth eruption. Individuals with the c.3560delG mutation showed only mild, yellowish tooth discoloration, in contrast to the affected individuals from two families with c.2688delT mutation. We believe that these results will help us to understand the molecular pathogenesis of DGI type II as well as the normal process of dentin biomineralization.</P>

자궁외임신의 비수술적 치료방법 : 국소 Methotrexate 주사

남계현,이권해,조태호,진소영,이임순,이정재 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.5

1990년 2월부터 1991년 1월까지 순천향대학병원 산부인과에서 비파열형 자궁외임신으로 진 단받은 11예를 대상으로 복강경(8예)과 질식초음파(3예)를 통한 국소MTX투여를 실시하여 다음과 같은 결과를 얻었다. 1. 자궁외임신 진단시 초기 hCG 농도는 179mIU/ml 에서 32,057mIU/ml로 평균 8,867mIU/ml이었다. 2. 국소 MTX투영로 치료에 성공한 예는 7예로 70%(7/10)였으며, MTX 국소투여후 개복수술을 요하였던 경우는 3예였다. 3. 치료에 성공한 7예의 hCG정상환원기간은 14~55일로 평균 34일이었다. 4. 치료후의 평균 입원기간은 4일이었다. 5. 국소 MTX투여시 치료를 요하는 부작용은 없었다. 6. 치료실패 3예는 모두 심박동이 확인되었고, 진단시 hCG가 10,000mIU/ml이상이었던 경우 로써 이들에게는 추가적인 MTX 투여가 사료되었다. Methorexate (MTX), a cytotoxic drug that is largely used in cases of gestational trophoblastic disease, had previously shown promise in resolving unruptured ectopic pregnancy when given systemically, there by eliminating the need for surgery. However, its systemic use exposes the patients to serious side effects and toxicity. To minimize the risk of side effects and maximise benifits from high tissue concentration of MTX in the fallopian tube, the drug was locally applied by one injection to the pregnancy site. We performed local MTX injection to ectopic pregnancies by laparoscopy (8 cases) or transvaginal route (3 cases) and obtained following results. The mean hCG level on admission was 8,867 mIu/ml (range; 179~32,057) and the mean days of resolution of hCG below 5mIu/ml were 34 days. The mean days of hospitalization were 4 days. No serious or treatable toxicity by MTX injection was occured during procedure and follow-up. There were 3 ectopic patients (27%) who were ruptured during follow-up and required salpingectomy. The ectopic case who had positive fetal heart beat or initial high hCG was high failure rate & probably was required repeated injection or systemic adjuvant injection. The transvaginal injection under transvaginal sonography guided was more convenient than laparoscopic injection on the definite ectopic sac. Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy. And, there is a need to establish criteria for patients selection before local MTX injection becomes a routine treatment for unruptured tubal pregnancy.

자궁내막에서 발생한 유두양 장액성 악성종양 1 례

남계현,이권해,김동원,박상수,최규연,이순미 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9

Uterine papillary serous carcinoma(UPSC) is a rare and highly malignant form of adenocarcinoma of the endometrium. Recently, a highly malignant variant of endometrial carcinoma, called uterine papillary serous carcinoma, has been described by Hendrickson et al. It is similar both cytologically and histologically to ovarian epithelial neoplasms and has a poor prognosis even in early stage disease. Deep myometrial invasion and vascular and lymphatic space involvement are frequently identified in hysterectomy specimens. In view of the poor prognosis of this disease entity, a means of estimating the likelihood for extrauterine metastases preoperatively and of monitoring the disease status of patients during and after therapy would be advantageous. Newer approaches will be needed to treat this biologically aggressive uterine cancer which has usually spreaded beyond the uterus at the time of diagnosis. Our experience, particularly with the uterine papillary serous carcinoma associated with metastasis to both ovaries, and salpinges, is given and the literatures were reviewed briefly.

제대주위 피부종양으로 재발된 난소암 1 예

남계현,조태호,진소영,이민철,권소연,허영문,박혜경 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

저자들은 본원에서, 제대주위 피부종양으로 재발된 난소암 1예를 경험하였기에 간단한 문헌고찰과 함께 이에 보고하는 바이다. We present a case of recurrent cutaneous metastasis which origniated from an internal organ. The patient had been a 63 years old female who had had ovarian carcinoma stage III and total abdominal hysterectomy with bilateral salpingooophorectomy, partial omentectomy, pelvic lymphadenectomy and chemotherapy had been done. She presented a nodule measuring 1×1cm on her umbilical area. Histopathologic findings were consistent with metastatic papillary serous cystadeno-carcinoma and clinically it was associated with carcinoma of the ovary.

Flowcytometry를 이용하여 배양세포주에 있어서 인간단주항체 HMST-1이 인식하는 Type Ⅰ Sugar-Chain의 발현에 관한 연구

남계현,조태호,이순곤 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.2

지금까지 자궁내막의 암화에 따라서 H형 sugar chain, Leb, Ley형 sugar chain이 증가된다는 사실이 보고되어 왔다. 본 연구에서는 혈액형 전구물질인 type Ⅰ sugar chain의 분석을 위한 예비실험으로 배양세포에 있어서 type Ⅰ sugar chain의 발현상태를 flowcytometry에 의해 검토해 본 결과 다음과 같은 결론을 얻었다. 1. Sialidase 처리하지 않은 상태에서는 자궁내막암세포주 SNG-Ⅱ에는 많은 세포에 type Ⅰ sugar chain항원이 존재하지만 자궁경부암 세포주 SKG-Ⅲa에는 존재하지 않는 사실이 재현성 있는 실험의 결과로써 확인되었다. 2. Sialidase 처리에 의하여 SKG-Ⅲa세포 표면에 type Ⅰ sugar chain항원활성이 출현할 가능성이 있음을 알 수 있었다. Changes in the expression of blood group antigens A, B and H(the antigen that defines blood group type) are known to occur in cancer tissues. The most common change is a loss or diminution of antigens A and B. This phenomenon is probably due to the incomplete biosynthesis of these antigens, which is associated with accumulation of precursor antigens. An increased rate of expression of Lewis type antigens, particularly Lewisb antigen in endometrial carcinoma, was observed in comparison to that in normal endometrium. In this study, flowcytometric analysis of the expression of type Ⅰ sugar-chain in cultured cell lines (uterine endometrial adenocarcinoma cell line. SNG-Ⅱ, uterine cervical epidermoid carcinoma cell line. SKG-Ⅲa) was carried out by using monoclonal antibody. 1. The type Ⅰ sugar-chain appeared frequently in SNG-Ⅱ cell membranes and rarely appeared in SKG-Ⅲa cell membranes. 2. But after sialidase treatment, amplified expression of type Ⅰ sugar-chain was observed especially in SKG-Ⅲa cells.

CA125를 생산하는 자궁내막선암 세포주의 수립과 동정 및 Dibutyl Cyclic Adenosine Monophosphate 에 의한 CA125 생산의 변화에 대한 연구

남계현,이권해,조태호,김순덕,이순곤 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

1992년 4월 15일 수술을 시행한 68세의 자궁내막선암 환자의 적출 표본으로 부터 새로운 자궁내막선암 세포주 $quot;SCHE-1$quot;을 수립하였다. 첫째, 세포는 16개월이상 접촉저지를 일으키는 일없이 잘 쌓이는 경향을 유지하면서 안정된 증식을 하고 있다. 둘째, 염색체는 이수성으로 분포하고 있으며, 이배체의 것이 가장 높은 빈도를 보였으며, 핵형분석에서도 이상을 보였다. 셋째, 형태학적으로 각각의 세포는 큰핵, 염색질과다(hyperchromatism), 다핵성, 뚜렷한 핵소체 등의 세포학적인 악성기준을 가지고 있었다. 넷째, 전자 현미경소견에서 핵에는 뚜렷한 함요와 여러개의 핵소체가 있으며, 세포사이에는 세포간교가 나타나 세포가 상피성 유래라고 생각되어졌다. 또 다수의 미소융모가 관찰되었다. 또한 SCHE-1세포는 종양 표지물질로 CA125를 생산하고 있었는데 이는 자궁내막암의 기초적인 연구에 유용할 것으로 여겨진다. 또 dbc AMP가 CA125생산에 미치는 영향을 살펴본 결과 자궁내막선암 세포주 SCHE-1는 dbc AMP에 의하여 세포의 증식이 억제되었고, CA125의 생산이 증가되었으며 dbc AMP의 농도가 증가될수록 CA125의 양도 증가되었으나 정상세포는 dbc AMP를 첨가한 후에도 CA125가 생산되지 않았다. A new human endometrial carcinoma cell line, designated SCHE-1, was established from the endometrial adenocarcinoma of a 68-year-old woman. This cell line has grown well for 16 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, showing a pavement-lide arrangement and a piling up tendency without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the diploid range. 1*10^5 SCHE-1 cells produced CA 125 (184-682U) during 19 days in cluture media. CA 125 was demonstrated immunohistocytochemically in the original tumor, and SCHE-1 cells. The cells contain no estrogen or progesterone receptors. We studied the effects of dibutyl cyclic adenosine monophosphate on celluiar growth and production of Ca125 in vitro. It is possible that the serum in the in vitro culture medium contains CA 125 and influences the activity of dibutyl cyclic adenosine monophosphate. Dibutyl cyclic adenosine monophosphate (which is said to have an influence upon gene expression) suppressed their proliferation and increased CA 125 levels. A dose-response relationship exists between the concentration of dbc AMP and CA 125 levels in the conditioned media, while the normal cells could not produce even after being administered dibutyl cyclic adenosine monophosphate. The above fact suggests that CA 125 gene expression was induced by dibutyl cyclic adenosine monophosphate.

자궁경부와 좌측신장에 동시에 발생한 원발성 악성종양 1 예

남계현,이권해,조태호,진소영,김민의 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.11

필자들은 특발성 혈소판감소성 자반증 증세와 함께 자궁경부암 진단을 받고, 입원하여 기본검사 도중에 우연히 발견된 좌측 신세포암 환자를 치료한 경험이 있기에 다발성 악성종양에 대한 문헌고찰과 함께 보고하는 바이다. Synchronous tumors, definded as neoplasms diagnosed simultaneously of within a 6 months interval, are less common. Significant synchronous tumor pair of cervical carcinoma is ovary and primary multiple tumors of cervix and kidney is rare. We experienced 52 years old female patient who had squamous cervical carcinoma and adenocarcinoma of left kidney simultaneously. So, we present the case with a review of literature.

융모성성선자극호르몬 측정시 단주항체를 이용한 효소면역측정과 방사면역측정의 비교

남계현,조태호,차상헌,이민철 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.12

1988년 1월부터 1988년 8월까지 서울 순천향대학병원에 내원한 환자 중 융모성성선자극호르몬측정이 필요한 82개의 혈액가검물에서 융모막성선자극호르몬 다주항체를 이용한 hCG의 효소면역측정값을 구하였고, 또한 방사면역측정을 동시에 실시하여 다음과 같은 결론을 얻었다. 1. RIA에 의한 -hCG값이 5-5,000mIU/ml일 때 ELISA검사치와 조사시 Y=1.74X-111(r=0.969)였다(이하 모두 Y=ELISA의 hCG, X=RIA의 -hCG값). 2. RIA에 의한 -hCG값이 5-200,000mIU/ml일 때는 Y=1.09X-787(r=0.961)였다. 3. 자궁외임신시는 Y=0.804X+927(r=0.989)였다. 4. 임신성융모질환시는 Y=1.12X-1117(r=0.964)였다. 5. 정상임신시는 Y=0.9X+739(r=0.988)였다. hCG의 단주항체를 이용한 효소면역측정법으로 융모성성선자극호르몬을 측정하였고, 동시에 융모성성선자극호르몬을 방사면역측정법으로 측정한 후 유의한 직선의 상관관계가 있음을 확인하고, 융모성 성선자극호르몬 측정시 방사면역측정법 대신에 효소면역측정법을 이용할 수 있다는 가능성을 시사한다. Human chorionic gonadotropin(hCG) is synthesized by trophoblastic tissue and has been established as a reliable index of trophoblastic activity. Since 1927 when Ascheim and Zondek discorved the earliest pregnancy test by bioassay from female rats, diverse methods for assay of the hCG have developed. Among the methods, radioimmunoassay is excellent and accurate but has the disadvantages like as the expences of regents and potential health risks from isotope. We examined the hCG by the RIA and ELISA from several cases of 82 patient simultaneously. The purpose of this study was to evaluate the correlation between RIA and ELISA of hCG and to consider the ELISA as the substitute of RIA of hCG assay. The results were as follows: 1. When the data of RIA were 5-5,000mIU/ml, the regression equation was Y=1.74X-111(Y=data from ELISA, X=data from RIA). The coefficient of corrlation(r) was 0.969. 2. When the data were 5-200,000mIU/ml, the regression equation was Y=1.09X-787. The coefficient of correlation(r) was 0.961. 3. In cases of ectopic pregnancies, the regression equation was Y=1.12X+927. The coefficient of correlation(r) was 0.987. 4. In cases of trophoblastic diseases, the regression equation was Y=1.12X-1117. The coefficient of correlation(r) was 0.964. 5. In cases of normal pregnancies, the regression equation was Y=0.90X+739. The coefficient of correlation(r) was 0.988. We concluded that there were significant positive relationships between RIA and ELISA of hCG assay. So, we considered the possibility of the ELISA as the substitute of RIA of hCG assay in the future.

경질 초음파검사를 이용한 임신초기 주수 산정지표 및 태아 구조물 발달과정 연구

남계현,이권해,조태호,차상헌,최용귀,박혜경 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.3

최근 보편화되어 있는 고해상력 경질 초음파검사를 임신초기에 실시하므로써 가장 빨리 자궁 내 임신을 확진할 수 있고 임신의 보다 정확한 주수 산정이 가능하며 각각의 임신주수에 따 른 임신구조물의 연속적인 탐사에 의해 일찌기 임신상태를 평가 할 수 있는 장점이 있다. 1. 임신낭은 자궁내 임신을 확진할 수 있는 최초 임신구조물로써 임신 4주초에 탐사가 가능 하다. 2. 난황낭은 임신 5주에 탐지할 수 있으며, 임신 11주가 되면 태반내에 부분적으로 합해져 묻히게 되다. 3. 태아 심음 및 태아 심박수는 임신5주말부터 M-mode sweep이나 육안으로 탐지할 수 있으 며, 배아 생존의 확진 소견이다. 4. 단뇌실은 임신 7주부터 탐지되며 임신 9주말이후에는 대뇌겸에 의해 분리되고, 임신 10 주부터는 좌우 측뇌실내에 맥락총을 탐지할 수 있다. 5. 척추돌기는 임신 8주부터 배아의 배측부 시상단면탐사로 시경관을 나타내는 평행한 두개 의 고반향성 선이 탐지되며, 임신 9주이후에는 척추구조를 탐사할 수 있다. 6. 안와는 임신 7주말부터 탐지되며, 상악골 및 하악골은 임신 10주에, 입과 코는 임신 11주에 탐지할 수 있다. 7. 생리적 중장 탈장은 임신 8주부터 탐지되며, 정상적으로 임신 11주부터 소실되기 시작하 여 임신 12주에는 모두 소실된다. 8. 상하지 돌출부는 임신 8주에 탐지되며, 상하지운동은 임신 9주에 탐지되고, 손가락 및 발 가락은 임신 11주에 모두 탐지된다. 경질 초음파검사는 첫째, 자궁내 임신을 월경예정일이 지나고 2~3일후부터 확진하고 조기에 임신구조물들을 평가하며 둘째, 정확한 임신주수를 산정하여 임신말기에 태아 발육지연의 진 단이나 임신 예정일의 오산으로 인한 조기 유도분만 방지에 유용하게 쓰일 수 있고 셋째, 선천성기형 발견의 선구적 역할을 할 것이다. 앞으로 임신 초기 경질 초음파검사는 더욱 보편화 될 것이며 산과적으로는 정상임신의 평가 뿐만아니라 자궁외임신이나 유산 혹은 병적인 임신의 조기 진단에 많은 도움이 될 것으로 사료된다. Ttansvaginal ultrasonography is recently diagnostic procedure using for evaluation of early pregnancy, early detection of ectopic pregnancy and pathologic pregnancy or abortion, and workup of congenital anomalies, etc.. Also, transvaginal sonography is no difficulty with empty urinary bladder, can avoid the gas-contained bowel, is convenient to obese patients, and allows earlier & more definitive diagnoses than the conventional transabdominal ultrasonography. Especially, because the first trimester pregnancy is a dynamic period with more rapid developmental & functional changes, transvaginal ultrasonography is very important screening method for assessment of early pregnancy. For the evaluation of early pregnancies, early normal singleton intrauterine pregnancies of 112 healthy women were scanned by a 5 MHz transvaginal probe for 10months(mar. 1st, 1990 to Dec. 31th, 1990). Specific embryonic structures were detected & weekly changed. These pregnances are evaluated by the serial screening of the following embryonic structures: 1. IUP at 4 weeks; gestational sac. 2. IUP at 5 weeks; yolk sac. 3. IUP at 6 weeks; fetal heart beat. 4. IUP at 7 weeks; single ventricle in brain. 5. IUP at 8 weeks; physiologic midgut herniation, upper & lower limb buds, spine(vertebral column). and orbits. 6. IUP at 9~10 weeks; falx cerebri, choroid plexi, and limb movements. 7. IUP at 10 weeks; mandible & maxilla. 8. IUP at 11 weeks; fingers & toes, and mouth & nose. 9. IUP at 12 weeks; disappearance of physiologic midgut herniation. This weekly serial evaluation of the 1st trimester pregnancies suggest that transvaginal sonography is exact, effective diagnostic fool of early pregnancies.