계류유산에 관한 임상적 연구

심재철(JC Sim),김수용(SY Kim),김종현(JH Kim),조성진(SJ Cho),김경태(KT Kim),박인서(IS Park) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.13

Missed abortion has been one of the major problems being confronted with the physician in the midtrimester of pregnancy. This is a clinical study of 31 cases of missed abortions recruited at National Medical Center during 5 years from January 1, 1978 to December 31, 1982. The resutls were as follows: 1. The age distribution was from 22 to 45 years of age and about 50% of cases in 20 to 29 years of age. 2. According to parity, 63.3% of cases were in para 4 or more. 3. Frequent chief complaints were absence or cessation of fetal movement(50%), vaginal bleeding(36.6%), and cessation of uterine growth or decrease in uterine size(13.3%). 4. Gestational ages at the time of fetal death were from 7 to 25 weeks. 5. Seventeen cases(56.1%) retained dead fetus for 1 or 2 months and 9 cases(30%) for 3 or 4 months. 6. None of the cases had abnormal value of blood coagulation tests and fibrinogen before treatment. 7. According to the method of treatment, 13 cases were evacuated by dilatation and curettage, 9 cases by extraovular prostaglandin induction, 6 cases by metreurynter method and 2 cases by highly concentrated intravenous pitocin induction.

Fetal Hydantoin 증후군을 암시하는 치육 증식증 1례

김동명(DM Kim),심재철(JC SIM),김용철(YC Kim),박인서(IS Park) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.7

저자들은 24세 된 간질 임부의 신생아에서 발생한, Fetal Hydantoin 증후군의 한 소견으로 생각되는, 하치육 증식증 1례를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Fetal hydantoin syndrome is a birth defect and can be shown about 10% of the neonates who were exposed to diphenyl hydantoin during gestational period. This syndrome was discribed for the first time by Hanson in 1975, who reported craniofacial abnormalities, limb defects, and deficiencies in growth, developmental performance and intelligence as the most common findings. Recently we have experienced one case of gingival hyperplasia which was suggested of one of the typical findings of fetal hydantoin syndrome. We report a case of probable fetal hydantoin syndrom with the brief review of literatures.

경주지역 임산부에서 실시한 E형간염바이러스 항체 ( Ig G ) 보유율에 대한 조사

이민석(MS Lee),심재철(JC Sim) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Hepatitis E was formerly caused enterically-transmitted, waterborne, or fecal-oral non -A, non-B hepatitis. Hepatitis E has its highest care-fatality rates in pregnant women. The study was undertaken with the objection of searching the Anti-HEV(IgG) positive rate in Kyeong Ju, Korea. A total of 500 pregnant women who visited the antenatal clinic were selected during the period from November, 1993 to June, 1994 at the department of Obstetrics and Gyneco- logy, Kyeong Ju hospital, Dongguk university and taken the test for IgG anti-HEV with ELISA kit. The positive rate of IgG anti-HEV was 2.8%. So we recommanded that anti-HEV is included in addition to HBsAg and ALT in prenatal screening tests for pregnant women, who have had clinical history of hepatitis.

자궁선근증의 질식초음파와 Color doppler 초음파검사의 유용성

양회생(HS Yang),심재철(JC Sim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

This study was designed to evaluate the diagnostic capability of transvaginal sonography and color doppler findings in detecting adenomyosis. We compared the preoperative transvaginal and color doppler findings with the pathological findings of the surgical specimen in a series of women who underwent hysterectomy. From January 1996 to through December 1997, we studied 142 women (mean age of 48.7) with enlarged uterus and recurrent menorrhagia. The sensitivity of transvaginal ultrasonogram was 79%, the specificity 72%, the predictive value of a normal test 80%, and that of an abnormal test 72%. However, color doppler findings had no usefulness for diagnosis of adenomyosis. The mean resistance index of the flow detected within the myometrium of adenomyosis was covering the value of 0.77, while the RI of the uterine arteries was 0.57. In contrast, the mean resistant index of the myometrium was 0.75 and RI of the uterine arteries was 0.74. In conclusion, we can suggest that the transvaginal sonogram might be useful to detect the adenomyosis. But the color doppler findings were not useful to differentiate the adenomyosis and leiomyoma.

임신시 급성 지방간 1 례

임문환(MH Im),이민석(MS Lee),심재철(JC Sim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

Acute fatty liver of pregnancy is a rare but potentially fatal complication of the third trimester of pregnancy. The exact cause of acute faty liver of pregnancy is still debatable, but it is characterized by jaundice, coagulopathy, central nervous system disturbance, and microvesicular fatty infilteration of the liver on liver biopsy specimens. Acute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclampsia in the presence of hypoglycemia, low fibrinogen, and prolonged proghrombin time, particulary in the absence of severe abruptio placenta. Computed tomography of the liver has a high false-negative rate in patients with acute fatty liver of pregnancy. As recently as 1980 fetal and maternal mortality rate as high as 85% were reported. With increased awareness especially in less severe cases, the use of ultrasonography and computed tomography(CT) of the liver for the diagnosis of this condition, and more aggressive management, the mortality from acute fatty liver of pregnancy has been significantly reduced in the past decase. Careful monitoring of input and output is necessary because of the associated renal failure. And high caloric intake of carbohydrate, vitamins, and fluid replacement is essential. Subsequent pregnancies in an appreciable number of women who previously had severe acute fatty liver of pregnancy have proved to be totally binign. We have experienced a case of the acute fatty liver of pregnancy and it is reported with a brief review.

McCune-Albright 증후군 1 례

장연희(YH Jang),임문환(MH Im),심재철(JC Sim),박성기(SK Park),김태우(TW Kim),이창연(CY Lee),오연희(YH Oh),이원재(WJ Lee),박석건(SG Park),유문집(MJ Yu) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.1

The McCune-Albrights syndrome is extremely rare if one considers the complete form which fullfils the triad of cafe au lait spots, fibrous dysplasia, and endocrine disturbances. A current concept about endocrine disturbances in this syndrome is that it is the result of autonomous hyperfunction of peripheral target glands, and that other endocrine disorders (hyperthyroidism, Cushing syndrome, gigantism, and acromegaly)are occasionary accompanied, and that treatment with the aromatase inhibitor testolactone which blocks the synthesis of estogens seems to be successful. The authors report a case of a 22/12-year-old girl with sexual precocity and cafe au lait spots with literature review.

여성 요실금 및 대변실금의 유병률

황진석(JS Hwang),박태형(TH Park),김도균(DK Kim),강민아(MA Kang),김승만(SM Kim),배철성(CS Bae),심재철(JC Sim),윤혜원(HW Yoon) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

We have studied the prevalence of female urinary and fecal incontinence in general practices. Based from 350 case, a retrospective analysis of the prevalence of female urinary and fecal incontinence between February 1997 and January 1998, which included patients and nurses without abnormal voiding disturbance due to pregnancy, genitourinary infection, puerperal woman and anorectal disease or previous anorectal operation was done. All subjects were subjected a questionnaire about the experience of urinary and fecal incontinence through adult life. It was reported that 49.4% of the subjects had experienced of urinary and 19.4% the subjects had experienced fecal incontinence. The mean age and the mean number of delivery of symptomatic group of stress urinary incontinence, urge incontinence and fecal incontinence were significantly higher than those of asymptomatic group (p<0.01). The frequency of stress urinary incontinence and fecal incontinence increased with age and the number of delivery and parous group (p<0.01). The delivery mode of symptomatic group of stress and fecal incontinence was higher with vaginal delivery than with cesarean delivery (p<0.001). The mean age and mean number of delivery of the symptomatic group of urinary incontinence with fecal incontinence were higher than those of urinary incontinence (p<0.01). The frequency of stress, urge, fecal incontinence was significantly higher in postmenopause group than that of premenopause group (p<0.01). As a result, the prevalence of female urinary and fecal incontinence was significantly correlated with age, parity, delivery method and states of menopause.

Mayer-Rokitansky-Kster-Hauser증후군에서의 질성형술 2 례

도은형(EH Doh),강민아(MA Kang),최석철(SC Choi),양회생(HS Yang),배철성(CS Bae),윤혜원(HW Yoon),심재철(JC Sim),이종문(JM Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

Mayer-Rokitansky-Kster-Hauser Syndrome is characterized by the absence of the vagina and uterus, the presence of apparently normal tubes and ovaries, feminine appeara-nce, normal female secondary sexual characteristics, a normal 46,XX karyotype, and a fem-inine psychosexual orientation. Various methods of surgical treatment have been introduced, but the ideal method is still not found. The two cases reviewed in this paper were all treated with McIndoe operation using full thickness skin graft. Both women were satisfied with vaginal depth and excellent result was achieved. We report two vaginoplasties in patients of Mayer-Rokitansky-Kster-Hauser Syndr- ome including a brief review of literature.

자궁경부의 상피내암과 침윤성암에서 세포증식능 표지자로서의 Heat Shock Protein-70과 Ki-67의 발현에 관한 연구

도은형(EH Doh),최석철(SC Choi),양회생(HS Yang),배철성(CS Bae),윤혜원(HW Yoon),심재철(JC Sim),이종임(JI Lee),김정란(JR Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.5

Heat shock protein (HSP) expressions is upregulated in some tumor cells. Furthermore, the 70-kda HSP (HSP70) is implicated in the degree of tumor differentiation, the rate of tumor proliferation and the magnitude of the antitumor immune reponse. Accordingly, the distribution and intensity of HSP 70 expression were assessed in normal squamous epithelium, squamous metaplasia and 32 cervical intraepithelial neoplasm (CIN, 14 CIN Ⅰ, Ⅱ and 18 CIN Ⅲ) and 18 squamous cell carcinoma (SCC) of uterine cervix with Ki-67 cell proliferation associated antigen by avidin biotin complex immunohistochemisrty. Staining intesity was recorded in scoring index. Specific staining with anti-HSP 70 antibody was exclusively confined to the cytoplasm. HSP 70 was expressed in normal squamous epithelium (66.7%). Metaplastic squamous cells were completely negative. Rate of positive cases of HSP 70 expression were 35.9% in CIN Ⅰ/Ⅱ, 50% in CIN Ⅲ, 89% in carcinomas (100% in keratinizing, 85% in nonkeratinizing) and scoring index of HSP 70 were 0.57 in CIN Ⅰ/Ⅱ, 0.61 in CIN Ⅲ, 1.50 in carcinomas (2.00 in keratinizing, 1.31 in nonkeratinizing). The distribution and intensity of HSP 70 expression in keratinizing SCC was greater than that in nonkeratinizing SCC, although this result just failed to reach stastistical significance. Results of staining HSP 70 were correlated with distribution and rate of Ki-67 antigen expression but there was no significant regression coefficience between these groups. The expression and intensity of HSP 70 had no overlap between CIN and SCC, which can be proposed as a useful marker for the detection likely to be at risk of progression of CIN to SCC.

풍진 유행지역의 임산부에서 풍진면역항체 양성률에 관한 조사

김승만(SM Kim),김도균(DK Kim),강민아(MA Kang),황진석(JS Hwang),배철성(CS Bae),윤혜원(HW Yoon),심재철(JC Sim),하경임(KI Ha) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

This study was focused on figuring out the positive rate of rubella antibody on pregnant women in epidemic area. This research was carried out from Mar., 1996 to Oct., 1996 on 303 pregnant women in Kyongju and Pohang, the epidemic area of rubella. The presence of rubella antibody was checked by ELISA method with sera collected from the first prenatal check. Also, the demographic characteristics, the history of natural infection of rubella and vaccination, and the results of pregnancy were reviewed with charts. The results obtained were summarized as followings; 1. The overall positive rates of rubella specific IgG antibody and IgM antibody were 68.6% and 1.3%, respectively. 2. The positive rate of rubella specific IgG antibody was 77.2% in Pohang and 63.5% in Kyongju which was statistically significant. 3. There were no stastically significant differences of the positive rates of rubella specific IgG antibody according to education level, occupation of gravidas, parity, at the time of examination, and gestational age. 4. There were two cases of congenital malformations associated with rubella. One case was intrauterine fetal death, who had retinal detachment and inflammatory granulation tissue and carditis. The other case was consistent with congenital rubella syndrome such as focal myocarditis and ophthalmitis in arbotus at 12weeks gestational age. We observed a low positive rate of rubella specific IgG antibody in the epidemic area as compared with non-epidemic area which means rubella occurs epidemically in a low immunity population. In order to prevent epidemic rubella infection and congenital rubella syndrome, the rubella vaccination should be given to all early reproductive women especially female high school students.