산전 초음파로 진단된 치명적인 태아 기형의 임상적 고찰

김사진(SJ Kim),김수평(SP Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.5

We have observed 32 cases of lethal anomalies by antenatal ultrasonogram, based on the 108 cases of major congenital anomalies among 6757 newborns delivered from Jan. 1, 1993 to Dec. 31, 1995 at department of Obstetrics and Gynecology, Holy Family Hospital of Catholic University. The analysed results were as follows: 1. The incidence of the lethal anomalies were 32 cases among 108 congenital anomalies (29.62%), 6757 newborns (0.47%). 2. The incidence of the lethal anomalies over 35 and under 20 years old was absent. 3. The incidence of the lethal anomalies according to parity was not significant in the multipara groups and nullipara groups. 4. The frequency of the lethal anomalies in female baby (0.56%) was higher than that of male baby (0.39%). 5. Each incidence of the termination of the lethal anomalies less than 28 weeks gestation and 1000 gm was 93.72%, 84.7% respectively. 6. The incidence of the lethal anomalies were 46.87% in central nervous system, 21.87% in genitourinary system, 9.37% in musculoskeletal & skin, and 6.25% in cardiopulmonary system. The most single anomaly among the lethal anomalies was anencephaly (34.37%). 7. The incidence of selective autopsy among the lethal anomalies was 17cases (53.12%).

토끼 태아에서 표피성장인자 투여가 코티졸 , 티록신 , 프로락틴의 생성에 미치는 영향

김수평(Soo Pyung Kim),신종철(Jong Chul Shin),이종건(Jong Kun Lee),김용욱(Yong Wook Kim),변태섭(Tae Sup Byun),신재인(Jae In Shin),이종승(Chong Seong Yi),나종구(Jong Gu Rha) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12

Respiratory distress syndrome (RDS) is a major cause of death in premature neonates, and it is caused by the failure of morphological and biochemical lung maturation (synthesis and secretion of lung surfactant). It is known that cortisol, thyroxine, prolactin, epidermal growth factor (EGF), and estrogen accelerate the lung maturation. Cortisol and thyroxine are currently used in the antenatal treatment for the prevention of RDS in premature neonates. In order to evaluate the effect of EGF on the levels of cortsol, thyroxine, and prolactin, this study was undertaken. Phosphate buffered saline (PBS) with and without EGF was directly injected into the 25 days gestational fetus in uterus. Blood was collected for the measurement of cortisol, thyroxine, and prolactin one day or two days after the injection. Body weights and lung weights were also measured. The results were as follows: 1. There was no significant difference in body weights and lung weights between PBS-treated group(control group) and EGF-treated poup(experimental group), 24 hours and 48 hours after the injection. 2. 24 hours after the injection, the levels of cortisol were significantly inaeased in the EGF-treated group compared with those in the PBS-treated group. However 48 hours after the injection, there was no significant difference in the levels of cortisol between the two groups. The levels of thyroxine and prolactin in the EGF-treated group did not significantly differ from those in the PBS-treated group 24 hours and 48 hours after the injection. In conclusion, in vivo, the synthesis of cortisol may be affected by EGF treatment, which suggests that the action of EGF for lung maturation may be partially mediated by the increased endogenous levels of cortisol.

복막의 악성혼합 뮬러리안종양 1 예

김수평(Soo Pyung Kim),김정자(Jeong Ja Kim),최은(Eun Choi),노승혜(Seung Hae Ro),김장흡(Jang Heub Kim),이안희(An Hee Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

Malignant mixed miillerian tumor (MMMT) was one of the rare uterine sarcoma. This tumor is composed of sarcoma and carcinoma. Primary MMMT in the peritoneum is among the rarest sites for MMMT. MMMT is highly malignant and the prognosis is grave due to frequent recurrence and metastasis. In the world literature, only 22 cases with primary MMMT of the peritoneum have been reported and most of these were single report. We report one case of primary MMMT in the peritoneum with a brief review.

임신오조증으로 발생한 Wernicke`s Encephalopathy 1 예

김수평(Soo Pyung Kim),유영옥(Young Oak Lew),김대훈(Dae Hoon Kim),양용재(Yong Jae Yang),이형근(Hyung Gun Lee),임채춘(Chae Chun Rhim),나순숙(Soon Sook Nah),박동춘(Dong Chun Park),정대영(Dae Young Jeong),김재훈(Jae Hoon Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

Hyperemesis gravidarum is a complication defined as nausea and vomiting during early pregnancy. Wernickes encephalopathy is an illness of acute onset characterized by mental disturbance, paralysis of eye movements, and ataxia of gait cause by thiamine deficiency. We recently experienced a case of Wernickes encephalopalhy due to hyperemesis gravidarum, which is treated by administration of thiamine even though outcome of serious healthy problem to both mother and fetus, and reported it with a brief review of the literature.

전치 태반의 임상적 고찰

김수평(Soo Pyung Kim),이초희(Cho Hi Lee),김사진(Sa Jin Kim),허수영(Soo Young Hur),이귀세라(Gui Se Ra Lee),이지현(Jee Hyun Lee),권인(In Kweon),송승규(Seung Kyu Song) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

Objective: A Clinical Study of Placenta P#revia done by cesarean section and the study of preterm delivery that is major cause of premature motality even thought expected managment of placente previa. Methods: This study was evaluated for the clinical analysis on the 641 patients with placenta previa among total deliveries of 56,120 cases at the St. Mary and Holy Family hospital of Catholic University from Jan. 1,1989 to Dec.31,1997. Results: The following results were obtained: 1. The total incidence of placenta previa was 1.14%. 2. The incidence of placenta previa increases with age. 3. Placenta previa has occurred more often in multipara(60.2%) than primipara(39.8%), and placenta previa has occurred more often in women who had experienced abortion(71.8%) than women who hadnt(28.2%). 4. The types of placenta previa distributed 326 cases of totalis(50.9%), 110 cases of partialis(17.2%), 99 cases of marginal(15.4%) and 106 cases of low lying placenta(16.4%). 5. The fetal presentation distributed 557 cases of vertex(86.9%), 49 cases of breech(7.6%), 28 cases of transverse lie(4.4%). 6. The types of uterine incision included 543 cases of low sepnent transverse incision(84.7%), 46 cases of classical incision(7.2%), 9 cases of inverted T incision and 43 cases of cesarean hysterectomy(6.7%). 7. Premature delivery of placenta previa prior to completion of 37 weeks was 186 cases(29.0%) and low birth infant less than 2,500gm was 128 cases(20.0%).and perinatal mortality rate was 28.0 per 1,000. 8. During delivery, 278 cases of placenta previa(43.4%) were transfused with mean 3.6 pints. Incidence of vaginal bleeding was 49.3% of placenta previa,mean admission day until delivery was about 5 day. Conclusion: there is a strong association between advancing age and incidence of placenta previa, and then. the risk increases with parity & the number of abortion. Considering the mean volume of blood loss more than 3 pints of blood should be prepared befor delivery.

양 태아 출혈에 대한 적혈구 조혈인자의 반응

김사진(Sa Jin Kim),(Robert A Brace),이귀세라(Gui Se Ra Lee),노승혜(Seung Hye Rho),백은정(Jong Chul Shin),정대영(Dae Young Jung),이영(Young Yi),신종철(Jong Chul Shin),김진우(Jin Woo Kim),김수평(Soo Pyoung Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.3

Objective: The ovine fetus responds to hemorrhage with a 10-20 fold increase in plasma erythropoietin (EPO) concentration at 24 hr and a return toward normal at 48 hr after the hemorrhage. The objective of the present study was more accurately to compare the magnitude and time course of the plasma EPO response after fetal hemorrhage. Methods: Chronically catheterized, 12 of late gestation ovine fetus were gradually hemorrhaged 40% of their blood volume over 2 hr (1ml/min). Plasma was sampled for EPO concentration at 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 30, 36 hr after initiating the hemorrhage were collected at these times. Radioimmunoassay was used to measure plasma EPO concentrations. Analysis of variance was used for statistical analysis. Result: After a slow hemorrhage in the ovine fetus (1ml/min over 2hr), plasma EPO concentration increased significantly at 4hr (2.3 times basal values), reached a maximum at 16 hr (33.3 times basal values), and declined thereafter. Conclusion: We studied change in time course of the fetal plasma EPO after slow hemorrhage and recent studies have shown that the fetal kidney, liver and placenta express EPO mRNA. These observation suggest that plasma EPO increase may be mediated by a tissue specific up-regulation of EPO transcription in the fetal kidney, liver and placenta. We have studied change in Epo mRNA expression in various fetal tissue after slow haemorrhage.

트리코모나스 질염치료에 있어서 [ 티베랄 ] ( Ro7 - 0207 ) 1일 요법의 효과

김수평(SP Kim),조윤원(YW Cho),장문기(MK Chang),김승조(SJ Kim) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.3

저자들은 1975년 10월부터 1976년 9월까지 만 1년동안 가톨릭 의과대학 부속 성모병원 산부인과를 방문한 환자들중「트리코모나스」 질염으로 확진된 환자에서 티베랄 1일 요법후 2 개월간 추적 검사가 가능하였던 95명을 약제의 투여량에 따라 세군으로 나누어 치료 성적, 부작용 및 1일 대량 투여에 따른 약물의 독성 여부를 관찰하였던 바 다음과 같은 결과를 얻 었다. 1. 임상 증상은 A군 93.5%, B군 97.5%, C군 92.2%에서 소실 되었다. 2. 질 트리코모나스의 음전화율은 A군 91.4%, B군 89.3%, C군 90.6%로서 세 투여군이 비슷한 성적을 보였다. 3. 부작용은 환자의 경우 A군 14.3%, B군 21.4%, C군 9.4%에서 나타났으며 배우자의 경우 A.B군의 배우자에서 9.6%, C군의 배우자에서 6.9%를 보였다. 4. 전환자에서 치료전, 치료후에 실시한 혈액검사, 간 및 신장기능 검사상 투약으로 인한 이상은 발견되지 않았다, 따라서 트리코모나스 질염의 치료는 티베랄 1.5gm의 경구 투여와 함께 국소 치료로 1일 요법을 도모함으로써 높은 치료효과와 적은 부작용을 얻을 수 있으리라 생각한다. One day therapy of Tiberal with three different dosage of 2.0gm p.o., 2.0gm p.o., and 500 gm vaginal route, and 1.5gm p.o. to group A,B and C was tried on three divided groups of 95 patients suffering from Trichomonas vaginitis during a period of one-year from Oct. 1975 to Sept. 1976 at out-patient clinic in Dept. of Obstet. and Gynecol., St, Mary`s Hosp. of Catholic medical College. The results were summarized as follows: 1. Clinical symptoms of Trichomonas vaginitis were subsided in 93.5%, 97,5% and 92.2% of group A,B and C respectively. 2.Parasitologic cure rates were showed in 91.4%, 89.3% and 90.6% of group A,B and C respectively. 3. Side effects, but transitory were appeared in 14.3%, 21.4% and 9.4% of group A,B and C about the patient group and 9.6%, and 6.9% of group A-B`s partner`s group and group C`s partners respectively. 4. No significant changes of laboratory data on including CBC, liver and kidney function tests were noticed by the administration of the drug. Therefore, it is valuable for the treatment of Trichomonas vaginitis with 1.5gm single oral therapy and local treatment of Tiberal, and the side effects were minimzed from, this treatment.

자궁경부암 세포에서 retinoid / interferon 에 의한 성장 억제 조절의 새로운 분자생물학적 기전

김수평(Soo Pyung Kim),남궁성은(Sung Eun Namkoong),김승조(Seung Jo Kim),김은주(Eun Joo Kim),엄수종(Soo Jong Um),박종섭(Jong Sup Park),이근호(Keun Ho Lee),김찬주(Chan Joo Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

Objective: Retinoic acids (RAs) and interferons (IFNs) have been implicated in the growth regulation of cervical cancer cells, which was suggested by clinical trials and in vitro experiments. However, the molecular mechanisms of growth regulation are not fully defined, The purpose of this study is to assess the effect of RA and/or IFN on human cervical carcinoma cells in vitro and to analyze their action mechanisms in HPV-positive cervical carcinoma cells by molecular biologic studies. Methods: HPV-positive (CaSki, HeLa), HPV-negative (C33A, HT-3), and non-cervical cancer Cos-1 cell lines were treated with RA and/ar IFN. Their effects on cell growth were evaluated by the cell pmliferation assay and the following BrdU DNA incorporation assay. The molecular mechanism was further investigated by a series of immunoblottings and transient cotransfection assays, which were conducted in HeLa cells and C33A cells using the CAT reporter gene assay. To observe the down regulation of HPV E6/E7 gene expression by RA/IFN, reverse transcription-polymerase chain reaction (RT-PCR) was perforned. Results: The powth of RA-treated cells was less suppressed than that of IFN-treated cells. Combined treatment of RA and IFN leads to additive effect on the growth suppression of HeLa and CaSki cells. The proliferation activity was most severely reduced in Hela cells by treatment of both all-trans-RA (AtRA) and IFN-r. Combined treatment of AtRA/IFN-r causes a great increase in the level of interferon regulatory factor-1 (IRF-1) protein in HeLa cells, whereas no induction of IRF-1 was observed in C33A cells. The CAT gene expression for IRF-1 was greatly induced by IFN-r in HeLa cells. Immunoblotting assays shows the concurrent induction of p21 CDK inhibitor and dephosphorylation of Rb protein in HeLa cells. In RT-PCR, an individual treatment of either RA or IFN reduced HPV E6/E7 mRNA levels and significantly cooperative when both RA and IFN were treated. By deaeasing E6 levels, the p53 level was increased in HeLs cells treated with RA and/or IFN. Transient cotransfection of IRF-1 and p53 as the transcription factors leads to the cooperative activation of a common p21 promoter to regulate the cell cycle. Conclusion: RA/IFN suppressed the growth of HPV-positive cervical cancer cells. When they were both #treated, additive suppressive effects were observed in cellular proliferation as well as DNA synthesis. The growth suppressive effect is likely to be related to the increased expression of IRF-1 and p21 (antitumoral effect; p53-independent). The down regulation of HPV E6 gene suppression may account for the resultant increase of p53 levels (antiviral effect; p53-dependent). Both induced IRF-1 and p53 cooperatively augument tbe suppession of p21 CDK inhibitor, which results in dephosphorylation of pRb. Although clinical effects are likely complex and may include interactions of in vitro growth inhibitory effects with immunomodulatory and antiangiogeaetic effect, tbese results suggest the optimal clinical role for the combination of RA/IFN in the treatment of cervical canccers.

수자궁질증의 산전 태아 초음파 소견 1 예

김사진(Sa Jin Kim),김수평(Soo Pyung Kim),김민정(Min Joung Kim),이상호(Sang Ho Lee),이희중(Hee Joong Lee),문희봉(Hee Bong Moon),이지현(Jee Hyun Lee),박철훈(Chul Hun Park),이귀세라(Gui Se Ra Lee),신종철(Joung Chul Shin) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3

Cloacal anomalies are very rare congenital malformations with the incidence of 1/50,000-250,000 births. Hydrocolpos involves the dilatation of the vagina due to obstruction of the genital tract, leading to accumulation of secretions. Because of wide spectrum of abnormal anatomy involving urogenital and gastrointestinal systems, prenatal diagnosis is difficult. As ultrasound becomes more and more reliable, prenatal diagnosis is possible as early as in the second trimester. The presence of prenatally detected hydro (metro) colpos warrants a systematic evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes. We present a case of urogenital sinus maldevelopment which was initially presented as a fetal ascites.

태아질식에 대한 임상적, 생물리학적 그리고 생화학적 지표

김수평 ( S. P. Kim ) 대한주산의학회 1994 Perinatology Vol.5 No.4