자궁경부와 좌측신장에 동시에 발생한 원발성 악성종양 1 예

남계현(KH Nam),김민의(ME Kim),진소영(SY Jin),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.11

Synchronous tumors, definded as neoplasms diagnosed simultaneously of within a 6 months interval, are less common. Significant synchronous tumor pair of cervical carcinoma is ovary and primary multiple tumors of cervix and kidney is rare. We experienced 52 years old female patient who had squamous cervical carcinoma and adenocarcinoma of left kidney simultaneously. So, we present the case with a review of literature.

치골자궁저 높이 측정시 검사자간의 변동평가에 따른 3 가지 통게학적 방법의 비교

남계현 ( KH Nam ),이권해 ( KH Lee ),조태호 ( TH Cho ),이해혁 ( HH Lee ),선우재근 ( JG Sunwoo ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.11

The measurement of symphysis-fundal height has been considered a simple and attractive screening method to detect the intrauterine growth retardation. Yet examination of published reports of fundal height measurement show wide variation in its performance. One possible reason for this wide variation is inter-observer variation. So, we assessed the variation by three statistical methods-the coefficient of variation, the correlation coefficient, and the limits of agreement. 1. The coefficient of variation between observer A & observer B was 4.9%. 2. The correlation coefficient between observer A & observer B was 0.968. 3. Above methods were highly significant statistically but, the limits of agreement were very wide and true limits of agreement were-4.3 to 2.6cm. 4. When the method of measurement was imperfect was tested, and when one of the observers was not good was tested, the results were similar to above results. Applying these limits to centile charts of symphysis-fundal height shows that the fundal height cannot be measured by different observers with sufficient agreement to seperate small fundal heights of those which are not small, and this severely limits the usefulness of measurement of the symphysis-fundal height as a screening test for intrauterine growth retardation. We conclude that inter-observer variation should be assessed by the method of limits of agreement, and not by calculating the coefficient of variation or the correlation coefficient.

산부인과 환자에서 악성 난소종양 발견을 위한 타액 및 혈액 CA 125 검출비교

남계현(KH Nam),전호용(HY Jeon),차상헌(SH Cha),이순곤(SG Lee),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.2

Since Bast discovered the monoclonal antibody CA 125 for ovarian cancer, use of this antibody to estimate serum CA 125 has been established as a good tumor marker for detecting ovarian malignancy & follow-up after primary surgery. CA 125 is a glycoprotein complex that might also be found in saliva. So, we assaied the CA 125 levels from saliva and serum of 28 normal women, 38 benign pelvic mass patients and 34 gynecologic malignant patients and determined the correlation between saliva and serum CA 125 levels. The following results were obtained. 1. The CA 125 level of saliva was significantly higher by normal saline dilution than by free serum dilution. 2. The CA 125 level of saliva in normal control women (mean ±ISD: 1542±1468 U/ml) was significantly lower than those of benign pelvic mass patients(2823±2314U/ml) and gynecologic malignant patients(3142±2845U/ml). 3. The diagnostic efficiency of saliva CA 125 for detecting ovarian malignant tumors was equal to that of serum CA 125. 4. No correlation between saliva CA 125 and serum CA 125 was observed. 5. There were many cervical cancer patients who had normal serum CA 125 levels but had high saliva CA 125 levels over normal range.

CA125를 생산하는 자궁내막선암 세포주의 수립과 동정 및 Dibutyl Cyclic Adenosine Monophosphate 에 의한 CA125 생산의 변화에 대한 연구

남계현 ( KH Nam ),이권해 ( KH Lee ),조태호 ( TH Cho ),김순덕 ( SD Kim ),이순곤 ( SG Lee ) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

A new human endometrial carcinoma cell line, designated SCHE-1, was established from the endometrial adenocarcinoma of a 68-year-old woman. This cell line has grown well for 16 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, showing a pavement-lide arrangement and a piling up tendency without contact inhibition. The chromosomal number shows aneuploidy and the modal chromosomal number is in the diploid range. 1*10^5 SCHE-1 cells produced CA 125 (184-682U) during 19 days in cluture media. CA 125 was demonstrated immunohistocytochemically in the original tumor, and SCHE-1 cells. The cells contain no estrogen or progesterone receptors. We studied the effects of dibutyl cyclic adenosine monophosphate on celluiar growth and production of Ca125 in vitro. It is possible that the serum in the in vitro culture medium contains CA 125 and influences the activity of dibutyl cyclic adenosine monophosphate. Dibutyl cyclic adenosine monophosphate (which is said to have an influence upon gene expression) suppressed their proliferation and increased CA 125 levels. A dose-response relationship exists between the concentration of dbc AMP and CA 125 levels in the conditioned media, while the normal cells could not produce even after being administered dibutyl cyclic adenosine monophosphate. The above fact suggests that CA 125 gene expression was induced by dibutyl cyclic adenosine monophosphate.

자궁외임신의 비수술적 치료방법 : 국소 Methotrexate 주사

남계현(KH Nam),이정재(JJ Lee),진소영(SY Jin),이임순(IS Lee),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.5

A methorexate (MTX), a cytotoxic drug that is largely used in cases of gestational trophoblastic disease, had previously shown promise in resolving unruptured ectopic pregnancy when given systemically, there by eliminating the need for surgery. However, its systemic use exposes the patients to serious side effects and toxicity. To minimize the risk of side effects and maximise benifits from high tissue concentration of MTX in the fallopian tube, the drug was locally applied by one injection to the pregnancy site. We performed local MTX injection to ectopic pregnancies by laparoscopy (8 cases) or transvaginal route (3 cases) and obtained following results. The mean hCG level on admission was 8,867 mIu/ml (range; 179~32,057) and the mean days of resolution of hCG below 5mIu/ml were 34 days. The mean days of hospitalization were 4 days. No serious or treatable toxicity by MTX injection was occured during procedure and follow-up. There were 3 ectopic patients (27%) who were ruptured during follow-up and required salpingectomy. The ectopic case who had positive fetal heart beat or initial high hCG was high failure rate & probably was required repeated injection or systemic adjuvant injection. The transvaginal injection under transvaginal sonography guided was more convenient than laparoscopic injection on the definite ectopic sac. Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy. And, there is a need to establish criteria for patients selection before local MTX injection becomes a routine treatment for unruptured tubal pregnancy.

복식 자궁적출술후 발생한 심한 질외번증 환자에서 미야 훜을 이용한 천골가시인대 고정술 2 예

남계현(KH Nam),최경준(KJ Choi),이정재(JJ Lee),이해혁(HH Lee),이권해(KH Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always surgical, and all defects. The managements is always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments. Massive eversion of the vagina can be treated by a variety of transvaginal and transamdo minal surgical technique. In most instances a transvaginal approach is useful. If strong cadi nal and uteroscral support in not available fiocation of the vginal vault to the sacrospinous lig ment is useful. In 1987, Miyazaki introduced his Miya Hook ligature carrier. With this instrume nt, introduction of the needle became safer and easier than with the Deschamp aneurysm needle. We had experienced two cases of massive eversion of vagina after the total abdominl hyst erectomy who were treated succesfully with sacrospinous ligement fixation by using Miya Hook. We report above two cases and review briefly.

자궁부속기 염전의 임상병리학적 고찰

남계현(KH Nam),이권해(KH Lee),조태호(TH Cho) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.4

Acute pelvic pain is a symptom encountered by the gynecologist. Torsion of the uterine adnexa should always be considered in the differential diagnosis since such torsion can result in serious complication, including necrosis of the ovary and tube, peritonitis, shock and rarely death. This study was undertaken for clinicopathological review and statistical analysis on the 50 cases of torsion of the uterine adnexa who were operated at dept. of obstetrics & gynecology Soonchunhyang university from July. 6, 1974 to Dec. 31, 1988. The obtained results were as follows; 1. The overall incidence of torsion was 6.1% of all ovarian tumors. The incidence of torsion in pregnancy was 18.6% which is significantly higher when compared with incidence of 5.1% in nonpregnant state. 2. Almost the patient(90%) presented with lower abdominal pain and had other symptoms and signs, such as abdominal mass, nausea and vomiting and so on. 3. The most prevalent size was 10~14 cm(40%) and next was 5~9 cm(36%). 4. The correlation between turns of torsion and tumor size was not significant statistically. 5. The percent of the right site torsion(52%) was not different from left site(48%) and the direction of the torsion was not different statistically, irrespective of site. 6. The body temperature was high as number of the torsion increased but leucocytosis was not different compared to number of the torsion. 7. The preoperative diagnosability was 78% and other diagnosis were pelvic mass, surgical observation and so on. 8. The 5 cases among 11 cases in pregnancy were occured before gestational age of 12 weeks and 3 full deliveries were procedured. 9. The most common operation of the torsion was ipsilateral salpingoophorectomy and most common histologic diagnoses were cystic teratoma, irrespective of pregnancy.

초음파로 산전진단된 Body Stalk Anomaly 1 례

이권해(KH Lee),전호용(HY Jeon),남계현(KH Nam),진소영(SY Jin),조태호(TH Cho) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.1

Body stalk anomaly represents and extreme maldevelopment of embryonic body folding and is characterized by absence of umbilicus and umbilical cord. The failure of complete extraembryonic coelom obliteration is responsible for the absence of the umbilical cord formation and the wide-based insertion of the amnio-peritoneal membrane on to the placental chorionic plate. Recently, we experienced a case of body stalk anomaly in a fetus of intrauterine pregnancy at 34 weeks who was terminated because of ultrasonographic demonstration of a large abdominal wall defect, short umbilical cord and maldevelopment of lower extremities. No case has been reported up to present in our national literature. Thus, we report a case of body stalk anomaly with brief review of the literatures.

자궁경부상피의 암화 과정에 있어서 Integrin β4의 발현에 관한 연구

이철호(KH Lee),남계현(KH Nam),조태호(TH Cho) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Integrin β4 is expressed in normal squamous epithelium and in squamous cell carcin-omas. We evaluated by immunohisto- chemistry the topography of the β4 subunit in 40 biopsy samples representative of the sequence from normal exocervical epithelium to invas-ive squamous cell carcinoma. In normal and metaplastic squamous cervical epithelium, and in condylomas, β4 was detected in basal and parabasal cells. In moderate and severe dys-plasia there were enhanced β4 expression and upward shift of β4 topography to the whole epithelial thickness. The β4 chain was diffusely expressed in most invasive squamous cell carcinomas. These observations suggest that profound alterations in the expression of the α6β4 adhesion glycoprotein occur in the intraepithelial phase of cervical carcinogenesis.

질확대경하 조직생검 ( Punch biopsy ) 과 LEEP의 조직학적 결과 비교에 의한 LEEP의 효용성

최경준(KJ Choi),남계현(KH Nam),심재호(JH Shim),이임순(IS Lee),이권해(KH Lee),김동원(DW Kim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

Colposcopically directed punch biopsy is the standard method to assess the severity of lesions detected at colposcopic assessment in women with abnormal cytologic screening. The ability of the colposcopist to identify the area of the most severe lesions from which to take a punch biopsy has been questioned recently. We perfomed a retrospective compari-son between the findings from colposcopy guided punch biopsies and those from loop elect-rosurgical excison procedure. The histologic diagnoses from LEEP and concurent colposcopy guided punch biopsies were compared in 46 women. Disaggrement between punch bipsy and LEEP was recorded in 16 cases(35 %). The undercall and overcall rates for punch biopsy were 9 and 26 %, retrospectively. And then, the histologic diagnoses from LEEP and subs-equent hystrectomy specimen were compared in 29 women. Residual disease was identified in 10 of 29 patients(34%). With these results, it can be concluded that LEEP allows further and more accurate histologic examination of the transformation zone. However, in the therapeutic efficacy of LEEP, it may be resected incompletely. Therefore, we must examine the colposcopic and cytologic follow up to identify the number of women with residual CIN after therapy.