만성 신부전 산모의 만삭 제왕절개 분만 1 예

이종학,김종화,백원영,이성재,이순애,정영택,신정규 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

저자 등은 만성 신부전증으로 정기적인 혈액투석을 시행하고 임신기간중 양수과다증으로 인해 반복적 양수천자를 시행하였던 37세 산모에서 임신 37주 만에 2640 gm의 건강한 남아를 반복제왕절개술로 성공적인 분만을 한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Pregnancy is an unusual event in patient with chronic renal failure under going hemodialysis. When it occurs, spontaneous abortion, still birth, and neonatal death end 75% to 80% of the pregnancies. The mother is at risk for hypertension and abruptio placenta. The fetus is at risk for prematurity and growth retardation. Successful term pregnancy and cesarean delivery of a patient with chronic renal failure is presented.

흰쥐 뇌의 Brain Natriuretic Peptide 함유신경세포의 분포에 관한 연구

이종학,김종화,백원영,이순애 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12

Brain natriuretic peptide(BNP) is a recently discovered neuropeptide from porcine brain and is highly homologous to atrial natriuretic peptide. This study was carried out to localize the BNP containing neurons morphologically and investigate the distribution in rat brain. Colchicine injections were made into the lateral ventricle of brain, and rats were perfused with 4% paraformaldehyde-lysine periodate and brains were resected after 48 hours. By Immunohistochemical staining with Avidine-Biotin-Complex method, BNP containing neuronal cells showed strong immunoreactivity in situ. Mostly, BNP containing neurons were multipolar in shape and were localized at the areas of paraventricular nucleus, parabrachial nucleus, locus ceruleus, substantia nigra, nucleus of facial nerve, dorsal vagal nucleus, hypoglossal nucleus, raphe nucleus and nucleus ambiguus.

난소갑상선종의 1 례

이종학,김종화,백원영,이순애,한성천,강태길,권성택 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

Struma ovarii, an ovarian teratoma of which all or a large part is composed of thyroid tissue, is an uncommon tumor accounting for 2.7% of all ovarian teratomas. We reported a case of struma ovarii and review the literature concerning this tumor briefly.

임신시 합병된 복직근의 테스모이드 종양 1 예

이진호,김종우,이신애,이지연,이종은,이춘배,장윤주 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

복벽의 데스모이드 종양은 근건막 구조물에서 기원하면서 매우 드물게 발생하는 신생물이다. 비록 모든 연령대의 남성과 여성에서 발생가능하나 거의 80%가 여성에서, 특히 20대에서 40대 사이의 가임연령에서 일어난다. 전형적으로 복벽의 데스모이드 종양은 복직근에서 가장 많이 발견되고 경산부에서 임신 동안 또는 출산 후 첫 1년 동안에 흔히 발생한다고 한다. 결코 전이는 일어나지 않으나 광범위 절제술을 시행한 경우에도 재발률이 24%에 달한다. 저자들은 30세 경산부에서 임신말기에 합병된 복직근의 데스모이드 종양 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Abdominal desmoid tumor is a very rart neoplasm and arises from musculoaponeurotic structures. Approximately 80% of cases occur in woman, usually between the ages of 20 and 40 years, but they have been described in both men and women of all ages. Typically, abdominal desmoid tumor occurs most commonly in the rectus abdominis muscle and in young, gravid, or parous women during gestation or, more frequently, during the first year following childbirth. The rates of recurrence following local excision of desmoid tumors have been reported to be about 24%, but metastases do not occur. We experienced one case of desmoid tumor of the rectus abdominis muscle in a 30-year old woman with pregnancy and so present it with brief review of literatures.

임신과 합병된 난소종양

이종학,김종화,백원영,신순철,이순애,양화석 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.9

경상대학교병원 산부인과에서는 1983년 1월부터 1990년 2월까지 만 7년간 경험한 임신중 합병된 난소종양 28례(양성종양 27례, 악성종양 1례)를 분석 고찰하여 아래와 같은 결과를 얻었다. 1. 발생빈도는 같은 기간의 총분만수 8,371례에 대하여 1:299이었고 악성종양의 빈도는 3.6%이었다. 2. 평균연령은 27.2세이었고 초산모가 2/3를 차지하였다. 3. 난소종양으로 인한 환자의 증상 및 증후로는 하복부 동통 및 불쾌감이 50.0%, 무증상이 32.1%, 하복부 종괴촉지 10.7% 순으로 나타났고 그외 요통 및 질출혈이 있었다. 4. 진단시기는 임신초기가 50.0%, 임신중기가 28.6%, 임신말기가 14.3%, 산욕기가 7.1%이었고 진단방법은 초음파와 내진으로 이루어진 경우가 대부분이었으며 제왕절개수술중 우연히 발견된 경우(17.9%)도 있었다. 5. 종양의 병리조직학적 소견으로는 양성 낭성기형종이 32.1%, 부난소낭종 17.9%, 장액성 낭선종 14.3%, 점액성 낭선종 10.7%, 그 외 난포막 황체낭종, 황체낭포, 단순낭종, 자궁내막증 등이 있었으며, 악성종양으로는 장액성 낭선암이 1례(3.6%)이었다. 6. 난소종양의 크기는 6∼10cm정도가 가장 많았으며(53.6%), 대부분 일측성이었다. 7. 난소종양이 동반된 합병증으로 염전이 7례(25%), 파열이 1례(3.6%)이었고 염전이 일어난 7례중 4례는 양성 낭성기형종이었다. 8. 수술방법은 보존적 난소난관절제술의 42.9%, 일측성 난소난관절제술 35.7%, 일측성 난소절제술 21.4%이었다. 9. 수술후 자연유산의 빈도는 13.6%이었다. Ovarian tumors complicating pregnancy present challenging diagnostic and therapeutic problems, and there are great variations in the clinical and pathologic characteristics of these tumors and treatment carried out. A series of 28 patients with ovarian tumors operated upon in pregnancy of during puerperium is presented. The incidence of ovarian tumor associated with pregnancy was 1 in 299. The incidence of malignancy was 3.6%. The most common tumors were the benign cystic teratoma (32.1%) and the only malignant tumor was serous cystadenocarcinoma. Lower abdominal pain was the most presenting symptom in 50% and no symptoms or signs in 32% of patients. The diagnosis was made by physical examination and ultrasound in 50% and made in the first trimester in 50% of the patients. Ovarian tumors which measured less than 6 cm in diameter were 4 cases (14.3%), between 6~10 cm in 15 cases (53.6%), and more than 10cm in 9 cases(32.1%). Complication resulting from ovarian tumors occurred in 8 cases(36.4%), being 7 cases of torsion and 1 cases of rupture. Conservative ovarian cystectomy was performed in 12 cases(42.9%), unilateral salpingoophorectomy in 10 cases(35.7%), and unilateral oophorectomy in 6 cases(21.4%). The incidence of spontaneous abortion after surgery was 13.6%.

Nitric Oxide가 사람 자궁평활근의 수축-이완에 미치는 영향 및 그 작용기전에 관한 연구

이종학,김종화,백원영,박신근,이순애,정원석,장기철 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

The purpose of this study was to establish whether endogenous L-arginine/nitric oxide(L-ARG/NO) pathway system exists in human uterine smooth muscle and this muscle is responsive to exogenous nitric oxide(NO). The differences of the effect of NO on myometrial contractility between pregnant and non-pregnant uterus were also observed. Isometric tension of human myometrial strips from pregnant(n=10) and non-pregnant(n=20) women were measured in vitro in response to L-arginine(L-ARG), N-nitro-L-arginine methyl ester(L-NAME), or Nw-nitro-L-arginene(L-NNA) that modulate endogenous L-ARG/NO action as well as to exogenous NO that is generated by photolysis of NO-carrying compound such as streptozotocin(STZ). Changes of amplitude and cycle length of phasic contraction by photolysis of STZ with various concentration were measured and compared between pregnant and non-pregnant uterus. Cyclic guanosine monophosphate(cGMP) levels were measured by radioimmunoassay in various testing conditions of myometrial tissues. Spontaneously contracting non-pregnant myometrial strips were relaxed by application of L-ARG(10-3mol/L). This L-ARG-induced relaxation was obliterated by application of L-NAME(10-3mol/L). These L-ARG- or -L-NAME-induced effects were exagerated in the lipopolysaccharide(10 micro g/ml)-pretreated or pregnant myometrium. The non-pregnant myometrial contractile activity was decteased by exogenous NO dose-dependently, that is, by photolysis of the STZ with the concentration of 10-6, 10-5, 10-4, and 10-3 mol/L, the mean percent decrease of amplitude were 8.3±3.2%, 15.8±6.1%, 26.4±9.3%, and 45.7±18.6%, respectively and the mean percent delay of cycle length were 14.3±6.4%, 24.5±9.5%, 48.8±15.5%, and 120.6±51.5%, respectively. These mean percent changes of amplitude and cycle length under the same dose of STZ(10-4 mol/L) were greater in pregnant myometriums compared with non-pregnant ones(26.4±9.3% vs 50.5±14.1%, 48.8±15.5% vs 73.3±30.3%, mean ±SD, p$lt;0.01,respectively) suggesting that the pregnant uterus is more sensitive to NO than nonpregnant one. Cycle GMP levels in the myometrial tissue were increased by exogenous NO dese-dependently, that is, by photolysis of STZ with the concentration of 104 mol/L, the cGMP levels were 4.85±1.52,5.96±1.67, and 8.97±1.91 fmol/mg tissue according to the UN light exposure time of 1,2 and 4 minutes, respectively. But in methylene blue pretreated myometrium, the cGMP level was lower than that of control even at 4 minutes of exposure time. There findings suggest that endogenouse L-ARG/NO pathway system exists in human uterne smooth muscle and NO is regarded as, at least in part, regulator of human myometrial relaxation or quiescience during pregnancy by modulating c GMP levels.

사람 태반에서 GnRH 와 GnRH mRNA의 동정

이종학,김종화,백원영,신반철,백상호,이순애,김명옥,이봉희,최완성 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.12

사람 태반에서 GnRH가 존재하는가 또한 자체합성되는가를 형태학적으로 확인하고 나아가서 GnRH 또는 GnRH mRNA가 태반내의 어느 부위에 주로 위치하며 이들의 분포가 임신시기에 따라 어떠한 변화가 있는지를 조사하기 위하여 임신중의 각 시기별 태반조직을 실험대상으로 GnRH에 대한 면역조직화학과 GnRH mRNA에 대한 in situ hybridization을 시행한 결과 다음과 같은 소견을 얻었다. 1. 사람 태반 조직내의 cytotrophoblast, syncytiotrophoblast, villous stroma 세포에서 GnRH peptide와 GnRH mRNA가 동정되었다. 2. GnRH peptide와 GnRH mRNA의 양성반응은 임신 전기간에 걸쳐 cytotrophoblast와 syncytiotro phoblast에서 거의 비슷하게 나타났으며 villous stroma에서는 임신이 진행함에 따라 점차적으로 강하게 나타났다. 이상의 소견으로 볼때 사람의 태반내에 국소적으로 GnRH 또는 GnRH 유사물질이 생성되어 존재하며 이들은 임신의 유지에 필요한 호르몬의 합성 및 분비에 조절인자로 작용할 가능성이 있으며 부분비(paracrine) 또는 자가분비(autocrine)역할을 할 것으로 사료된다. Localization of the GnRH and its mRNA was performed in the human placentas by immunohistochemistry and in situ hybridization techniques. Human placentas in first, second, and third trimester of normal pregnancy were obtained. These placentas were fixed with 4% paraformaldehyde and embedded in OCT compund, and sectioned by cryostat. For immunohistochemical study, avidin-biotin peroxidase complex(ABC) method and immunofluorescence method were employed and for in situ hybridization histochemistry, digoxigenin-dCTP labeled cDNA and ^35S labeled RNA probes were used and followed by autoradiography. GnRH and its mRNA were localized in the cytotrophoblast, syncytiotrophoblast, and villous stromal cells of the human placental villi. The distribution and intensity in GnRH immunohistochemistry were showed to be similar to those in GnRH mRNA in situ hybridization histochemistry. GnRH immunoreactivity and its mRNA signals were identified nearly constantly in both the cytotrophoblast and syncytiotrophoblast cells throughout gestation. However, those in the villous stromal cells were shown to be gradually increased with placental development, although not in the cells of early placenta. These results suggest that the local GnRH or GnRH-like substance may be synthesized in the human placental villi and may, thus, represent a local paracrine or autocrine role in endocrine control mechanism within the placenta.

난소 섬유육종 1 례

이종학,김종화,김규현,신반철,이순애,고경혁,최원준,강태길 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

난소에서 발생하는 섬유육종은 주로 폐경기 이후에 발생하는 것으로 알려진 매우 드물고 치 명적인 종양이다. 본 저자들은 본원 산부인과에서 난소에서 일차적으로 기인한 거대 난소 섬유육종 1례를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Fibromatous tumors of the ovary are considered to originate from specialized ovarian stromal cells and account for approximately 4% of all ovarian neoplasms. There are divided into two subtypes : one is cellular fibromas with one to three mitotic figures per ten high power field(HPF), which were mostly benign and frequent, the other is fibrosarcoma with higher mitotic counts, which were always malignant and very rare. We have met a case of large ovarian fibrosarcoma which have six mitotic figures per ten high power field. So we report this case with the brief review of literatures.

임신 34 주에 초음파로 진단된 미골 림프관종 1 예

이종학,김종화,백원영,이순애,정영택,신정규,구현진 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

저자들은 산전 진단 중에 초음파 단층촬영으로 임신 34주에 특이하게 미골주위에 발생한 림프관종을 진단하여 임신 36주에 제왕절개술로 분만 후 OK-432로 경화치료후 호전을 보인 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Fetal lymphangioma is a congenital malformation of the fetal lymphatic system resulting from the jugular-lymphatic obstruction sequence, which appears as a single or multiloculated fluid-filled cavity mainly in the nuchal region and is easily diagnosed by ultrasonography in antenatal period. We report a case of coccygeal lymphangioma which was diagnosed by ultrasonography at 34 weeks, gestation and was delivered by cesarian section at 36 weeks, gestation with a brief review of literatures.

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유중현(Peter JH Ryu),최승환(Shawn SH Choi),지민우(Jimmy MW Ji),김종원(John JW Kim),김성애(Lowell SA Kim),김덕수(Douglas DS Kim) 한국항공우주학회 2023 한국항공우주학회 학술발표회 논문집 Vol.2023 No.6