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선천성 부신증식증에 의한 음핵비대증 환아에 대하여 음핵신경과 혈관총을 보존한 음핵성형술을 실시한 증례보고
김은중(EJ Kim),이선영(SY Lee),이귀세라(GSR Lee),유진희(JH Yoo),김사진(SJ Kim),송승규(SK Song),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5
Congenital adrenal hyperplasia, which is caused by the disorder of the enzyme for synthesizing adrenal hormones, results in hypertropy of the clitoris due to overporduction of adrenal androgen. Diagnosis of the congenital adrenal hyperplasia can be obtained by the study of steroid levels in blood and urine. The blood levels of ACTH, testosterone and 17-hydroxyprogesterone were increased and the concentration of 17-ketosteroid were decreased after the dexamethasone suppression test. The internal genital organ was normal appearance on the pelvic CT scan. Clitoromegaly due to congenital adrenal byperplasia was corrected previously by the various operational procedures in which the clitoris was removed entirely for only physial appearance. However the sensitive function of the clitoris after the operative correction through puberty is to be preserved by the method clitoroplasty for preserving neurovascular supply to the clitoris. The writer experienced a case of a 5-year-old girl with congenital adrenal hyperplasia and tried this clitoroplasty for surgical treatment of clitoromegly for preservation of postoperative sensitivity of the clitoris.
원발성 자궁경부암에서 인유두종 바이러스감염과 p53 종양 억제유전자의 변이와의 관계
김진우(JW Kim),조율희(YH Cho),김봉윤(BY Kim),김재훈(JH Kim),김은중(EJ Kim),한구택(GT Han),남궁성은(SE Namkoong) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.4
Tumor specimens obtained from 136 patients with primary carcinoma of the uterine cervix were analysed for presence of human papillomavirus(HPV) sequences and for mutation of p53 tumor suppressor gene. HPV detection was done using polymerase chain reaction(PCR) amplication with HPV E6 region type specific primers as well as L1 consensus primers. Mutations of the p53 gene were examined by single-strand conformation polymorphism(SSCP) analysis of PCR products. The results were as follows: 1. PCR showed that 130 of 136(96%) tumors contained oncogenic HPV 16 or 18 sequendce. Three(2%) had an unidentified type of HPV and 3(2%) lacked HPV DNA. Of the 127 tumor specimens cell carcinomas analyzed, only 14(11%) showed HPV 18, in contrast to 122 of 127 (96%) having HPV 16(including 13 tumors coinfected with HPV 16 and 18). Of the 9 cases of adenocarcinomas, HPV 16 and HPV 18 were identified in five cases(56%) each (including 3 tumors coinfected with HPV 16 and 18). These results suggest that HPV 16 is predominant type in cervical squamous cell carcinomas(P
A Case of Secondary Amenorrhea in a Triple X Female
김진홍(CH Kim),박동춘(DC Park),김은중(EJ Kim),고영미(YM Ko),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8
Jacobs and associates in 1959 were the first to report a case of triple X syndrome and to associate this chromosome abnormality with ovarian failure. The incidence of trisomy X in newborn population is estimated to be 1 in 1,000 live born females. Most of them have normal physical appearance and puberty. Therefore, the reported number of triple X females in the literature is low. They presented with episodes of amenorrhea, elevated levels of circulating folliclestimulating hormone, luteining hormone, and decreased estrogen concentration. Primary or secondary amenorrhea and premature menopause are common accompaniments, but there is no difficulty in puberty or secondary sex development. It is uncertain whether the menstrual difficulties are associated with the karyotype or the psychogenic factors. Such patients can produce, and generally there is no chromosomal abnormality in their children, if they produce. The writer experienced a case of secondary amenorrhea in a triple X female and so we reported in firstly in Korea with brief review of literature.
난소과립막세포 스테로이드호르몬 생성 및 증식에 대한 Mullerian Inhibiting substance의 효과
김장흡(JH Kim),제동성(DS Jae),김태응(TE Kim),신재인(JI Shin),김은중(EJ Kim),이진우(JW Lee),나종구(JG Na),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12
Ovarian follicular growth is a consequence of granulosa cell proliferation, and steroid production by these cells appears to be a major determinant of the endocrine microenvironment of ovum maturation. The gonadotropins, FSH ad LH, regulate directly the growth and differentiation of the granulosa cells in the ovary, but there is evidence to suggest that the gonadotropins act partly through locally produced growth factors and that this interaction is complex. A number of growth factors, such as epidermal growth factor(EGF), insulin-like growth factor-I(IGF-I), and transforming growth factor-β(TGF-β) are produced in the ovarian follicle and might act in an autocrine and/or paracrine manner to directly control granulosa cell proliferation and differentiation. While it has been demonstrated that steroid hormones, gonadotropins and growth factors regulate proliferation and differentiation of ovarian follicles, little is known concerning the fators involved in the inhibition of ovarian function. Recently, Mullerian inhibiting substance(MIS), a non-steroidal testicular Sertoli cell product responsible for the regression of Mullerian duct in male embryo, has been shown to be produced by ovarian granulosa cells in adolescnet and ault females. Although the function of MIS in the ovary has not been fullydelineated, MIS appears to be a regulator of oocyte maturation and follicular development in the rat. In this study, in order to investigate the influence of MIS on steroidogenesis and proliferation of human granulosa cells, we performed culture of human granulosa cells. The cells were cultured for 2 to 12 days under two conditions, with and without MIS(20 ng/ml). Each condition was additionally defined by the presence and absence of EGF(20 ng/ml), FSH(10 ng/ml), or LH (10 ng/ml). Estradiol, progesterone, and testosterone were mearsured form the spent media by radioimmunoassay and the cell number was determined by trypsinizing the cells and counting them with a Coulter counter. The result were as follows: 1. There was about 6-fold increase in the final granulosa cell number when the culture were maintained for 12 days in Ham`s F-10 supplemented with 10% MIS-free female fetal calf serum(control). FSH and EGF caused a significant increase in granulosa cell number compared with the control but LH significantly suppressed cell number after 8 days in culture. 2. MIS caused a significant decrease in granulosa cell number compared with the control after 8 days in culture in the 20 ng/ml dose, and on day 12 in the 2 ng/ml dose(p
정자의 수정능력평가에 있어 일반 정액매개변수 , 정자운동성 지수 , 정자 침투거리측정법의 비교
김진홍(CH Kim),김은중(EJ Kim),손우석(WS Shon),권동진(DJ Kwon),임용택(YT Lim),이진우(JW Lee),김창이(CY Kim),김수평(SP Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7
Results were as follows; 1. The seminal parameters, SMI value and sperm penetration distance in both fertile & infertile groups showed significant statistical differences(p
미세수술을 이용한 가토 난관문합수술에 고정대 및 복합첨가물이 미치는 영향
김진흥(JH Kim),정기욱(KW Chung),유영옥(YO Yoo),김장흡(JH Kim),나덕진(DJ Rah),김은중(EJ Kim),이진우(JW Lee),송승규(SK Song),이헌영(HY Lee) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2
The maintenancy of tubal patency and the prevention of pelvic adhesion are the major keys for the successful fallopian tube surgery for infertility. Various kinds of tubal splints hva been used to maintain tubal patency in clinical and experiemntal tuboplasties, but there are still undetermined factors such as the optimum duration of splint indwelling and its effects on tubal healing and patency. Therefore, authors performed experimental tuboplasty in rabbits and attempted to known the effects of the nylon splint on tubal patency according to the duration of indwelling and also the effects of the intraperitoneal adjuvants on pelvic adhesion. All results were analyzed clinically and pathologically by using the light and electron microscopes. The total number of experimental rabbits were 72. Both normal oviducts were obtained from three rabbits as a control group. In sixty nine rabbits experimental reananstomoses were performed at the ampullae of both oviducts and a nylon splint was inserted into only one oviduct of each rabbit. Twenty (Group I) of sixty nine rabbits were sacrificed on the 1st week (seven), 2nd week (six) and 4th week (seven rabbits). In the remained forty nine rabbits (Group II), only the splint was removed on the 1st week (sixteen), 2nd week (seven-teen) and 4th week (sixteen rabbits). And finally, all of these Group II rabbits were sacrificed on the 8th week to obtain oviducts. To evaluate the preventive effect of intraperioneal adjuvant against adhesion, twenty milliliters of saline, 10% dextran (Reomacrodex), or combined regimen (saline, solumedrol, ampicillin and heparin) was applied into the pelvic cavity of Group II animals. The results were as follows: 1. The restoration of tubal peristalsis in Group II was significanly high (75%) in one week splinted group as compared with other splinted groups (P
김진범(JB Kim),이귀세라(GSR Lee),김사진(SJ Kim),곽은경(EK Kwak),최영석(YS Choi),김은중(EJ Kim),송승규(SK Song),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3
Primary trbal choriocarcinoma is extremely rare. We have experienced a case of primary tubal choriocarcinoma and report with a brief review of its related literatures.
Nd-YAG Laser를 이용한 가토의 미세 난관 문합술에서 문합부의 조직학적 소견
김진홍(CH Kim),고영미(YM Ko),김은중(EJ Kim),정기욱(KW Chung),권동진(DJ Kwon),김장흡(JH Kim),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10
To study tubal adhesion, tubal patency and histologic difference under light, electronic microcopy in a site of anastomosis, authors performed three anastomosis surgery in rabbit fallopian tube;1-layer and 2-layer anastomosis in splint-not-used group(group 1) and in splint-used group(group 2) and laser anastomosis in splint-used group(group 3). 10 rabbits were used in each group, therefore the total number of experimental rabbits in 3 groups were 30. The results were as follows; 1. The degree of gross adhesion in group Ⅱ was significantly high as compared with other groups but there was no difference between left and right tube in the degree of adh- esion in each group(Table 1). 2. The incidence of tubal patency in group Ⅱ was significantly high(89%) as compared with group Ⅰ(44%). Especially, the incidence of tubal patency in group Ⅲ was significantly high(100%) but there was no difference between left and right tube in incidence of tubal patency in each group. 3. Inflammatory cell infiltration appeared in each group on optical microscopic examin- ation. Especially, fibrosis and inflammatory cell infiltration appeared more in group Ⅱ but there was no statistically significant difference. And there was no significant difference between left and right tube in each group. 4. Transmission electron microscopic examination of group I, as compared with normal control group, showed increase of microvilli and secretory granules and decrease in size of epithelial cell. Epithelial cell was morphologically transformed but maintained the original structure comparatively. TEM examination of group Ⅱ, as compared with normal control group, showed decrease of microvilli and secretory granules and flattening of epithelial cell. It showed that epithelial cell vanished in it`s original structure. TEM examination of group Ⅲ, as compared with normal control group, showed decrease of microvilli and increase of secretory granules and morphological transformation of epithelial cell. Group Ⅲ showed the resemblence to normal control group. From the above results, in reversal tuboplasty and tubal factor infertility, it is consi- dered that simple splint-used anastomosis or splint-used anastomosis with Nd-YAG laser will improve the successful rate of tubal anastomosis.
토끼난관 미세문합수술에서 문합부의 성장인자 ( TGF ) 발현의 비교
김진홍(CH Kim),노승혜(SH Rho),김은중(EJ Kim),정기욱(KW Chung),권동진(DJ Kwon),김장흡(JH Kim),이진우(JW Lee),김수평(SP Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11
Twenty seven rabbits were divided into 3 groups of 1, 2-1 and 2-2(n=9 in each group). Arbitarilly cut ends of mid-ampullar portion of each tubes were microscopically reanastomosed using vicryl as suture material without intraluminal splint in group 1, using vicryl as suture material with intraluminal splint in group 2-1 and coagulation by Nd-YAG Laser beam as ref-usion method with intraluminal splint in group 2-2. A week after operation, the tubal tissue segments of reanastomosis were embedded into paraffin to examine the expression rate and intensity of TGF-β1, 2 and 3 by immunohistochemical staining. The results were as follows. 1. The expression rate of TGF-β1, 2 and 3 revealed no stastically significant difference between group 1 and 2. 2. Among comparisons group 2-1 and 2-2, the TGF-β1 expression rate in group 2-2 showed lower value than that in group 2-1 with stastical significance(P<0.05). The above fact that tuboplasty with Nd-YAG Laser using intraluminal splint resulted in lower expression rate of TGF β1 may suggest raising the succe ss rate of pregnancy.
자궁경부암 환자에서 광범위 자궁적출술 전후의 방광과 요도의 해부학적 형태에 대한 연구 - 금속성 염주상 연쇄 요도방광 조영술을 이용한 분석-
김진범(JB Kim),이귀세라(GSR Lee),김사진(SJ Kim),안상복(SB Ahn),이형근(HG Lee),공기환(KH Kong),허수영(SY Hur),박태철(TC Park),김은중(EJ Kim),송승규(SK Song),김수평(SP Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1
This present study was undertaken to evaluate the chacteristic anatomic configuration of bladder and urethra in parients with cervical cancer before and after radical hysterectomy. From July 1994 to December 1996, metallic beaded chain urethrocystography was conducted in 33 patients with cervical cancer before and after radical hysterectomy at Holy Family hospital. The results were as follows 1. After radical hysterectomy, posterior urethrovesical angles at rest and strain were significantly increased(P = 0.0004 at rest, P = 0.0016 at strain) and posterior urethrovesical junction at rest and strai were significantly descended(P = 0.004 at rest, P = 0.0024 at strain). 2. Postoperative urethral inclination angle at rest was greater than before radical hysterectomy(P = 0.002), but postoperative urethral inclination angle at strain was not increased statistically(P > 0.05). From these results, we concluded that stress urinary incontinence after radical hysterectomy is the results of anatomically defective supports of urethrovesical junction and urethra. We must consider a proper surgical method to prevent stress urinary incontinnce and anatomical defect of urethrovesical junction.