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양수양 측정에 있어서 Two-Diameter Pocket의 임상적 의의
김수평,이종건,신종철,차정일,백은정,김휘준,송경근,조태준 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9
1993년 5월부터 1994년 5월까지 가톨릭대학교 의과대학 부속 강남성모병원 및 성빈센트병원 산부인과에 내원한 임신부중 임신주수가 정확하고 7일 이내에 분만한 단태아 임신부 463예를 대상으로 two-diameter pocket을 측정하여 다음과 같은 결과를 얻었다. 1. 연구대상에 포함된 임신부 463예중 정상임신은 259예(55.6%), 기제왕절개술 53예(11.4%), 조기분만 42예(9.1%), 내과적 합병증 20예(4.3%), 임신성 고혈압 18예(3.9%)등의 순이었다. 2. 전체 임신부의 평균연령은 29.8+-3.8세, 평균 임신주수는 38.7+-2.3주, 평균 분만력은 0.7+-0.8회, 신생아의 평균체중은 3.22+-0.67 kg이었으며, 세 군사이에 유의한 차이는 없었다. 3. 임신기간에 따른 분포는 세 군사이에 유의한 차이가 없었다. 4. 제 1군은 제 2군에 비해 태변착색, 비정상적 태아심박동, 태아곤란증으로 인한 제왕절개술, 7미만의 1분 및 5분 Apgar score, 자궁내 태아발육지연, 신생아 집중관리실 입원 및 주산기 사망 등의 빈도가 유의하게 높았다. 5. 제 3군은 제 2군에 비해 태변착색, 7미만의 1분 및 5분 Apgar score, 선천성기형, 자궁내 태아발육지연, 신생아 집중관리실 입원 및 주산기 사망등의 빈도가 유의하게 높았다. 이상의 결과로 보아 two-diameter pocket에 의한 양수양의 측정은 주산기예후를 예측하는데 유용할 것으로 사료된다. Ultrasonographic estimation of amniotic fluid volume is an important adjunct to assessment of fetal well-being. Many sonographers have used subjective, largest vertical pocker or amniotic fluid index in evaluation of amniotic fluid volume. However, no method has emerged as most predictive. Amniotic fluid volume assessment using two-diameter pocket (defined as vertical*horizontal of the largest vertical pocket) was eveluated in 463 singleton pregnancies. This technique is simple and reproducible, and gives a semiquantitative estimate of amniotic fluid volume. The perinatal outcome was evaluated in each group-group 1(1-10), group 2(10.1-50), group 3($gt;50.1). Group 1 showed a significant increase in meconium stained amniotic fluid, abnormal fetal heart rate, Apgar score less than 7 at 1 and 5 minutes, IUGR, admission to NICU, pernatal death, and was more likely to require delivery by cesarean section for fetal distress. On the other hand, Group 3 showed a significant increase in Apgar score less than 7 at 5 minutes, congenital anomaly, admission to NICU and perinatal death. This study suggests that two-diameter pocket represents an simple and effective test to be able to be used in pregnancy evaluation.
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Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea
Cho, JH,Chang, SH,Shin, NH,Choi, BY,Oh, HJ,Yoon, MJ,Lee, EY,Lee, EB,Lee, TJ,Song, YW SAGE Publications 2014 Lupus Vol.23 No.9
<P><B>Objective</B></P><P>To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea.</P><P><B>Method</B></P><P>Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression.</P><P><B>Results</B></P><P>The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (<I>p</I> = 0.050) and 49.1% (<I>p</I> = 0.024), respectively, and an average increment in annual direct costs of 26.4% (<I>p</I> = 0.050) and 43.3% (<I>p</I> = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, <I>p</I> = 0.006; 33.3%, <I>p</I> = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09–4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, <I>p</I> = 0.203)</P><P><B>Conclusion</B></P><P>Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.</P>
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김창이,김수평,이종건,나종구,홍승덕,신종철,김찬주,송경근,조태준 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.8
가톨릭의과대학 부속 성모병원에서 1990년 1월 1일부터 1992년 12월 31일 사이에 조기분만한 362명의 신생아(쌍태아 17명)와 345명의 산모의 의무기록을 조사하여 각 임신주수와 혈압, 임신중독증 여부, 24시간 이상된 조기 양막파수, 분만전 출혈여부, 분만전 진통유무, 분만방법, 신생아의 성별, 자궁내 태아의 발육지연 등의 유무에 따른 신생아 호흡곤란 증후군의 발생정도를 Multiple logistic technique을 이용하여 분석 비교한 후에 다음과 같은 결과를 얻었다. 1. 24시간이상 조기양막파수, 그리고 24시간 이상된 질출혈을 조정하였을 때 확장기 혈압이 110이상인 임신성 고혈압군은 정상 혈압군보다 유의하게 높은 신생아 호흡곤란 증후군의 위험도를 나타내었다. 2. 혈압, 24시간이상 조기 양막파수, 24시간 이상 질출혈, 산전분만통의 유무, 신생아의 성별, 자궁내 태아발육지연 등을 조정하였을 때, 임신주수와 분만방법이 신생아 호흡곤란증후군에 영향을 주는 유의한 위험인자로 입증되었다. Hypertension during pregnancy continues to be a major cause of preterm delivery and neonatal morbidity due to RDS. The effect of hypertension in pregnancy on the incidence of neonatal RDS remains controversial. It is due to the fact that the incidence of neonatal RDS was associated with confounding variable such as membrane rupture$gt;24 hours, vaginal bleeding, undergoing labor, having a cesarean section, growth retardation and neonatal sex. In order to investigate the assocation between maternal hypertension and the incidence of neonatal RDS, we used the multiple logistic regression to control for the above mentioned variabled and the 362 preterm birth were retrospectively analyzed. The results were as follows: 1. After adjustment for membrane rupture$gt;24 hours and vaginal bleeding, the risk of developing respiratory distress syndrome was significantly greater(adjusted odds ratio; 2,990, P value=0.002) in babies of hypertensive mothers(diastolic B.P.$gt;110 mmHg). 2. After adjustment for blood pressure, membrane rupture$gt;24 hours, vaginal bleeding, labor, neonatal sex and growth retardation, the risk of developing respiratory distress syndrome was significantly greater (adjusted odds ratio; 1.833, P value=0.04) in babies delivered by cesarean section without labor. These results suggests that the incidence of RDS in babies of hypertensive mothers might be more escalated due to the absence of labor before delivery because of the greater likehood of cesarean section.
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