正常 및 異常姙娠 血淸中 Cystine Aminopeptidase의 活性度에 關한 硏究

金顯燦 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.1

악성 위험지수 (RMI;risk of malignancy index) 에 의한 난소종양의 평가

김현찬,김기태,김우경,이재준,최영태,한지원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

The purpose of this clinical study was to evaluate the efficacy of RMI(risk of malignancy index) as a preoperative predictive screening method in ovarian tumors. The RMI was calcula- ted by the following formula;─ RMI=The ultrasonographic score(0, 1, or 3) x serum CA-125 level x menopausal status score(1 or 3). The preoperative RMI was obtained from 69 cases of ovarian tumors operated from July 1993 to March 1996 at the Dept. of Obstetrics and Gynecology , Pusan Paik Hosp. Reviewing the histopathological diagnosis of surgical specimen, using RMI cut-off value of 200, the sensitivity, specificity, positive and negative predictive value of RMI was obtained and compared with CA-125 value and sonographic scores, respectively. The results obtained were as follows; 1. The sensitivity of RMI was 67.7%, it was lower than that of serum CA-125 value(74.0%) and ultrasonographic score(80.6%)(P=0.535). 2. The specificity of RMI was 100%, it was higher than that of serum CA-125 value(81.6 %) and ultrasonographic score(84.2%)(P=0.006). 3. The positive predictive value of RMI was 100%, it was higher than that of serum CA-125 value(76.7%) and ultrasonographic score(80.6%)(P=0.047). 4. The negative predictive value of RMI was 79.2%, it was lower than that of CA- 125 value(79.5%) and ultraconographic score(84.2%)(P=0.83). In conclusion, the RMI could be a useful screening method to discriminate a benign from malignant ovarian tumors prior to operation.

惡性卵巢腫瘍의 臨床病理學的 考察

金顯燦 大韓産婦人科學會 1968 大韓産婦人科學會雜誌 Vol.11 No.12

Obstetric Hemorrhage

김현찬 中央醫學社 1985 中央醫學 Vol.48 No.6

산부인과 영역의 Shock의 진단과 처치

김현찬 釜山醫師會 1979 釜山醫師會誌 Vol.15 No.11

저 체중아의 산과적 요인에 관한 임상적 고찰

김현찬 부산의대 1978 부산의대잡지 - 부산대학교 의과대학 Vol.18 No.2

고위험군 융모성질환에서 EMA-CO요법의 치료 결과

김현찬,김기태,최상림,김용학 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.1

인제대학교 부속 부산백병원 산부인과에서 1986년 초부터 1989년 말까지 WHO기준에 의한 고위험군 융모성질환 18례를 EMA-CO 요법으로 치료하여 아래와 같은 결과를 얻었다. 1. 환자의 평균 연령은 40.6±8.6세이었고 평균 위험점수는 10.6±2.4이었다. 2. 총 18례 중 16례가 경쾌되어 경쾌율은 88.9%이었다. 3. 혈청 β-HCG가 경쾌수준(5mlU/ml)에 도달할 때까지의 기간은 평균 13주이었고 화학요법투여 주기는 평균 6주기이었고 경쾌수준에 도달한 후 평균 1.9주기 더 투여하였다. 4. 전이 병소에 따른 경쾌율은 폐 91.7%, 골반 100%, 뇌 66.7%, 간과 질이 100%, 신장에 전이된 경우는 치료에 실패하였다. 5. 약물에 대한 부작용으로는 탈모증과 오심이 100%, 조혈기관 독성 94.4%, 구토 77.8%, 경도의 간독성 50%, 구내염 33.3%이었고 약진, 심부정맥혈전증과 화학적 뇌막염을 각각 2, 1, 1례 경험하였다. 6. 본원에 입원전 선행 단일화학요법에 저항을 보인 1례와 뇌, 신장 및 폐장에 다발성 전이를 보인 1례에 각기 EMA-CO 요법을 적용하였으나 효과가 만족스럽지 못하여 BEP 요법으로 대치하였으나 모두 실패하였다. Eighteen patients of high-risk(mean risk score of 10.6±2.5) gestational trophoblastic dsisease had been treated (Jan. 1986∼Dec. 1989) with EMA-CO regimen. The results could be summarized as follows : The sustained remission rate (mean duration of follow up, 20.0±10.4 months) was 88.9% with mean applied course of 6±2, and additional 1.9 courses of chemotherapy. The toxicity of EMA-CO regimen was relatively frequent, in order of frequency, alopecia and nausea(100%), bone marrow depression(94.4%), vomiting(77.8%), stomatitis(33.3%) etc. However it could be manageable and tolerable for scheduled course of chemotherapy. EMA-CO regimen was not satisfactory on one case of previous failed chemotherapy(risk scor of 13) and the other case of multiple metastasis of brain, kidney and lung(risk score of 15). BEP regimen was appleid on those cases but could not achieve remission. As a conclusion, we could believe that EMA-CO regimen was quite effective one with tolerable toxicity and we also could suggest combination chemotherapy, consisted of etoposide and cisplatin, from the outset on ultra high-risk group (risk score over 13 or/and multiple site of metastasis, brain etc.).

복식 전자궁적출술시 예방적 Fasigyn의 효과

김현찬,제구화,김기태,박호,조종희,최상림 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.6

인제대학교 의과대학부속 부산백병원에서 복식 전 자궁적출술시 Fasigyn을 예방적으로 투여하여 대조군과 비교하여 그 효과를 분석한바 다음과 같은 결과를 요약하고 결론을 내릴 수 있었다. 1. 열성이환의 빈도와 추가적인 다른 항생제투여가 필요한 경우가 투약군에서 대조군에 비하여 반감하였다. 2. 복벽창상감염은 경미한 경우이었고 빈도가 높지 않았으며, 대조군과 투약군에서 빈도는 별 차이가 없었다. 3. 골반감염(골반 봉과직염 및 질구개 봉과직염)의 빈도는 투약군과 대조군에서 큰 차이가 없었으며, 양군에서 골반농양의 경우는 1례도 없었다. 이는 아마도 질구개를 개방한 술식과 더불어 열성이환을 보인 예에 추가적으로 다른 복합항생제를 사용한 것에 기인한 것으로 사료된다. 4. 뇨로감염의 빈도는 비교적 높은 편이었고, 투약군에서 대조군보다 그 빈도가 낮았다. 저자들이 시행한 수술 전처치 및 수술방식에는 대조군과 투약군에서 비교적 열성이환의 빈도가 다른 보고자에 비하여 낮고 중한 골반감염과 이로인한 문제가 될만한 후유증으로 입원이 연장된 예는 없었다. 저자들이 시행한 술식과 더불어 비용이 적게들고 간편한 예방적 단회경구 Fasigyn의 투여는 다소 열성이환과 비뇨기감염의 빈도를 저하 시킨고로 그 효과를 인정할 수 있다고 생각되며, 환자를 선별하여 예방적으로 투여하는 것이 좋을 것으로 생각된다. 그러나 비뇨기감염의 빈도가 비교적 높은 것으로 보아 향후 이에 대한 개선된 대책이 요구된다. In 100 patients undergoing elective abdominal hysterectomy, a double blind study was undertaken to evaluate the efficacy of Fasigyn treatment in diminishing the postoperative infection rate. The study group (n= 50) received a single dose of 2.0 gm Fasigyn p.o. before 12 hours preoperatively while the control group (n= 50) did not. The two groups of patients, 50 in each, were comparable with regard to age, anemia, pathologic condition, length of operation, blood loss and indication of htsterectomy, etc. The febrile morbidity was noticed in 6 % and 12 % of the study and control groups, respectively. Significant pelvic infectious complications (pelvic and vaginal cuff cellulitis) were observed in 6 % of the control group and 4 % of the study group but no case of pelvic abscess was encountered. Abdominal wound infection, moderate degree, was found in 2 % of the control group and 4 % in the study group. Urinary tract infection, the most frequent complication in this study, was found in 26 % of the control and in 16 % of the study group. The result of this study indicated that oral preoperative single dose Fasigyn prophylaxis reduced modestly the over all rate of febrile morbidity and urinary tract infection, but no significant difference of pelvic and abdominal wound infection rate was found between two groups. No difference of hospital stay was found between two groups but more case of infectious complication in the group were treated by additional other antibiotics. Because the incidence of febrile morbidity is relatively low and serious consequences of pelvic and abdominal infection are rare in this study, the routine Fasigyn prophylaxis in all low risk patients undergoing elective abdominal hysterectomy, although somewhat effective, is probably not always necessary, but it seems to be prudent to give additional measures to reduce postoperative urinary tract infection.

자궁경부 편평상피성 종양에서 CD44 변이형 발현, 미세혈관밀도, VEGF 발현과 HPV 16/18 감염과의 연관성

김현찬,윤혜경,이정형 대한부인종양 콜포스코피학회 2000 Journal of Gynecologic Oncology Vol.11 No.3

Objective: In the development of squamous neoplasia of the uterine cervix, high risk HPV infection has been followed by CD44 variant expression and angiogenesis. The aim of this study is to evaluate the sequential changes and relatianship of CD44 variant expression, microvessel density (MVD), and VEGF expression in CIN III, microinvasive (MI) and invasive (CA) squamous cell carcinoma. Methods: The materials were 17 cases of CIN III, 14 cases of MI and 15 cases of CA. In situ PCR for HPV 16/18 and immunohistochemical studies for CD44std, v6, v7/8, CD 31 for MVD, and VEGF were performed. Results: CD44std expression was decreased in squarnous neoplasia compared to normal, and CD44v6 and v7/8 expressions were increased, however, there was no statistical significance. Accentuated staining of CD44v6 and v7/8 along the infiltrating borders was noted in 76.9% and 69.2% of MI and in 71.4% and 42.9% of CA, respectively. High MVD and VEGF 2+ expression were higher in the squamous neoplasia compared to normal, however, there was no significant difference between the squamous neoplasia and no significant relationship between MVD and VEGF expression. The expression rates of CD44std and CD44v6 were higher in HPV 16/18 negative squamous neoplasia and that of CD44v7/8 was higher in HPV 16/18 pasitive squamous neoplasia, however, their differences were not significant. The incidences of high MVD and VEGF 2+ expression were higher in HPV 16/18 positive suqmaous neoplasia with no statistical significance. Conclusions: These results suggest that CD44 variants expression and angiogenesis are involved in the development of squamous neoplasia of the uterine cervix, however, HPV 16/18 might not be related to CD44 variant expression and angiogenesis.

진행된 국소 자궁경부암에서 선행 항암요법의 효과

김현찬,김기태,김용학,유병규 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.9

1988년 1월부터 1991년 4월까지 40개월간 인제대학교 의과대학부속 부산백병원 산부인과에 입원한 자궁경부암 병기 Ib∼IIb, 병변의 크기가 3cm이상인 환자 57례를 대상으로 하여 cisplatin과 5-FU의 선행 복합항암요법을 3회 시행하여 다음과 같은 결과를 얻었다. 1. 항암요법을 시행하여 임상적으로 완전관해 22례(38.6%), 부분관해 30례(52.6%)로 91.8%에서 치료효과를 보였다. 2. 임상기가 낮은 경우, 병변의 크기가 적은 경우 반응이 좋았다. 3. 수술후 병리조직검색에서 종양조직을 발견할 수 없었던 경우가 13례(27.1%)있었다. 4. 임파절 전이빈도는 29.1%이었으며 병기가 진행된 경우 또는 선행항암요법에 반응이 없는 경우에 빈도가 보다 높았다. . 선행항암요법후 완전관해된 후 수술요법을 한 군이 방사선요법을 한 군에 비하여 월등히 평균 무병생존율이 높았다. 6. 약물의 독성으로는 오심 및 구토, 탈모증, 조혈기관의 독성, 간 및 신장 독성을 경험하였으나 치료를 중단할 정도는 아니었으며 심한 조혈기관 독성으로 인한 패혈증으로 1례 사망하였다. 결론적으로 치료실패율이 높을 것으로 생각되는 진행된 국소 자궁경부암에서 선행항암요법은 시도해 볼만한 가치가 있다고 생각되며 cisplatin과 5-FU의 복합항암요법은 아주 효과적인 방법으로 생각된다. 선행항암요법이 전이 임파절의 빈도를 얼마만큼 감소시키는가의 여부는 확실치 않은 것 같다. 치료횟수는 3회후 반응을 보는 것이 좋을 듯하나, 환자의 상태에 따라 3회이상 치료하는 것도 무방하겠다. 항암요법후 방사선치료보다는 수술하는 것이 재발과 무병생존율을 증가시키는 듯한 인상이나 증례수가 적고 추적기간이 짧아 결론을 내릴려면 향후보다 잘 계획된 장기간의 전향적 연구가 필요할 것으로 사료된다. To evaluate the therapeutic potential of cytotoxic therapy in patients with cervical cancer, 57 previously untreated patients with bulky mass (more than 3 cm) in stage Ib, IIa, and IIb locally advanced cervical cancer were treated with three courses of induction chemotherapy of Cisplatin and 5-FU combined regimen and placed on subsequent radical surgery or radiation therapy during Jan. 1, 1988 to April 31, 1990. The results were obtained as follows. 1. As to the response rates, complete response was seen in 22 cases (38.6%), and partial response in 30 cases (52.6%), so the total response rate was 91.8%. 2. The rewponse rates seemed to increase in the lower clinical stage than the higher and the smaller size of the lesion than the bigger. 3. Thirteen cases of the 48 surgical specimens (27.1%) were found to be histologically free of disease. 4. The overall incidence of surgically documented nodal metastasis was found to be 29.1% and higher incidence was found in advanced clinical stage and poor responders. 5. Patients achieving complete response (CR) to induction chemotherapy with subsequent radical surgery had much more improved mean 2 year disease free survival rate compared with those who had radiation therapy after CR. 6. Toxicities encountered during chemotherapy were nausea and vomiting, alopecia, bone marrow depression, hepatotoxicity, nephrotoxicity, etc. and well tolerated in most of cases except one case of death due to severe bone marrow depression and septicemia. Conclusively, this preliminary study suggests that Cisplstin and 5-FU combination, followed by radical surgery is one of the most effective and beneficial treatment methods in the management of some patients who are at high risk for failure with conventional treatment. It is still necessary to take well designed prospective long term study with longer follow-up to define which modality of treatment could positively influence prolonged disease free survival.