자궁경부상피내 종양처치에 있어서 질확대경 조준하 원추형생검의 효용성

유희석(HS Ryu),박찬규(CK Park) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.3

1977년 1월 1일부터 1985년 6월 30일까지 9년 6개월간 연세대학교 의과대학 부속 세브란스병원 산부인과에서 자궁경부 상피내 종양으로 진단되어 치료를 받은 165예의 임상기록부를 대상으로 진단 및 치료에 관여하는 여러인자를 임상 통계학적으로 분석하여 다음과 같은 결과를 얻었다. 1. 조절편 생검을 시행한 102예중 원추형 생겸과 조직학적 차이를 보인 경우는 11예(10.8%)이었고, 이중 질확대경조준하 원추형 생검을 시행한 28예에서는 1예(3.5%), 그리고 육안에 의한 원추형 생검을 시행한 74예에서는 10예(13.5%)가 조직학적 진단의 차이를 보였고, 2. 치료방법은 146예에서 전자궁 적출술 이상의 수술을 하였는데 이중 원추형 생검으로 수술전 자궁경부상피내 종양으로 진단되어 치료목적으로 시행한 경우가 135예이었다. 3. 원추형 생검후 전자궁 적출술을 시행한 135예중 열이환율을 보인 경우는 29예(21%)이었으며, 시간간격과의 관계를 보면 48시간이내와 42일 이후에서 이환율의 빈도가 낮았다. 4. 원추형 생검을 시행한 109예의 상피내 암중 병소가 잔류한 경우는 30예(27.6%)이었으며 이중 질확대경 조준하 원추형 생검을 시행하였던 30예중에서는 5예(16.7%), 육안적 원추형 생검을 하였던 79예중에서는 25예(31.6%)에서 상피내암이 잔류하였다. 5. 치료후 추후관찰이 가능했던 경우는 72예(53.3%)이었으며 이중 원추형 생검 2년후에 질세포진 검사상 재발을 보인 경우가 1예 있었다. 이상의 결과로서 자궁경부 상피내 종양의 정확한 진단을 위하여 원추형 생검을 실시할 때 질확대경 조준하에 가능한 전병소를 제거하면 병소의 잔류빈도를 낮출 수 있있으며, 이때 추후관찰이 가능하면 질확대경 조준하 원추형 생검만으로 처치를 할 수도 있다고 사료된다. 한편 추가치료로서 전자궁 적출술을 시행한 경우엔 48시간이내거나 42일이후에 실시하면 수술합병증을 낮출 수 있다고 생각되며, 치료후 추후관찰이 가장 중요하다고 사료된다. Upon reviewing the medical records of 165 patients with cervical intraepithelial neoplasia, a number of factors that might have had contributed in establishing their diagnosis and treatment plans were analyzed statistically and the followint observations were made. Conization, performed under the guidance of either colposcopy-directed-conization or direct visualization(naked-eye-conization) in 135 patients, who had their punch biopsies taken previously, revealed histopathological discrepancies in 11 patients. These 11 patients were constituted by 1 patient(3.5%) from the colposcopy-directed-conization group(28 patients), and 10 patients(13.5%) from the naked-eye-conization group(74 patients). As for their therapeutic measures, 146 patients received operation more extensive than total abdominal hysterectomy. 29(21.5%) of 135 patients who underwent total abdominal hysterectomy after conization showed febrile morbidity and the incidence of overall morbidity after conization was lower within 48 hours, or after 42 days. Among 109 patients with cervical intraepithelial neoplasia, in which their colposcopy-directed-conization or naked-eye-conization was performed, 30 patients(27.6%) were found to have residual lesions. These patients were distributed in such a way that the colposcopy-directed-conization performed on 30 patients resulted in 5 cases(16.7%) of residual lesions, whereas the naked-eye-conization performed on 79 patients resulted in 25 cases(31.6%) of residual lesions. Postconization cytological recurrence was seen after 2 years, 1 of 72 patients in whom the follow-up was possible.

적출 자궁운동에 대한 Neuropeptide Y의 영향

유희석(HS Ryu),이경은(KE Lee),안영수(YS Ahn) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.4

Among the nonadrenergic, noncholinergic transmitters, neuropeptide Y(NPY), vasoactive intestinal polypeptide and substance P are found in the female genital organs and they are known to regulate the uterine motility. NPY is consisted of 36-amino acid residues which is originally isolated from porcine brain and co-exist with the classical autonomic neurotransmitters in some sympathetic neurons. In particular, it was found in nerves around the vascular and nonvascular smooth muscle in the uterus, which suggests that NPY may have an important role in uterus. So far, however, few supporting studies are reported. In the present study, it was aimed to examine the effect of NPY on the motility of the isolated rabbit uterine strip and to investigate its mechanism of action. Rabbits weighing about 2 kg were spayed and treated either with estrogen(17- -estradiol:500 g/kg/day,s.c.) or progesterone(4-pregnene-3,20-dione:12.5 mg/kg/day,s.c.) for 1 week. After sacrifice, uterus was isolated and the uterine strip(1 mm 10 mm) was suspended in a chamber containing 1 ml Tyrode solution. The motility was recorded on a Polygraph(Model 7,Grass) through force displacement transducer. The results obtained are as follows: 1. Norepinephrine, acetylcholine and histamine increased the spontaneous motility of uterine strip of estrogen- or progesterone-treated rabbit dose-dependently. But 5-HT inhibited the contraction of estrogen-treated uterus and had little effect on progesterone-treated uterus. 2. NPY increased the motility of estrogen-treated uterus, but had little effect on progesterone-treated uterus. 3. NPY-induced uterine contraction was not blocked by phentolamine, atropine, chlorpheniramine or indomethacin. 4. Cromakalim completely blocked the uterine contraction induced by NPY. 5. The effect of NPY was abolished by diltiazem, and further, NPY had no effect on the uterine tension in Ca++-free high potassium depolarizing solution. These results indicate that NPY has a stimulatory effect via specific receptor on the uterine motility of rabbit, which is estrogen dependent and might be associated with extracellular calcium mobilization.

비정형적 증식성 점액성 낭선종을 동반한 거대난소기형종 1 예

이희춘(HC Lee),유희석(HS Ryu),장기홍(KH Jang),주희재(HJ Joo),이은주(EJ Lee),오기석(KS Oh),송찬호(CH Song) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.5

Because of their high incidence of occurrence, benign cystic teratomas often occur coincidentally with other abnormalities of the ovary r uterus, and a common association has been noted with mucinous cystadenoma. However, the combination of cystic teratoma and serous cystadenoma is less common. The associated mucinous cystadenoma is most likely secondary to an overgrowth of gastrointestinal type epithelium, and some 4.5% of mucinous cystadenomas are associated with dermoid. We present here, with a brief review of the literature, a case of a huge mature cystic teratoma combined with ovarian mucinous cystadenoma, borderline malignancy.

자궁경부암 환자에서 MRI로 측정한 3 차원적 종양종괴 크기와 종양표지물질 SCC Ag치와의 상관관계

정태영(TY Jung),유희석(HS Ryu),이은주(EJ Lee),장기홍(KH Jang),김미란(MR Kim),오기석(KS Oh),송찬호(CH Song) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.6

To evaluate the correlation between the serum SCC Ag(Squamous Cell Carcinoma antigen) level and tumor volume measured by MRI(Magnetic Resonance Imaging), we studied 32 patients with invasive cervical carcinoma, 15 patients with cervical intraepithelial neoplasia, and 10 healthy women who were admitted to Aju University Hospital, Department of Obstetrics and Gynecology from December 1, 1994 to Aug 31, 1995. Serum SCC Ag levels were measured by Microparticle Enzyme Immunoassay technique va IMx SCC assay and tumor volume was measured with 1.5 T Signa System(GE, Milwaukee, WI., USA) by obtaining sagittal and axial views with Fast Spin Echo T2 weighted series and consequently reconstructed to 3 dimension, calculating the mean value. The results obtained as follows: 1. The mean value and positive rate of SCC antigen were higher in invasive cancer(6.0 ng/ml and 50%, respectively) compared with control(0.5ng/ml and 0%, respectively) and cervical intraepithelial neoplasia(1.6ng/ml and 26%, respectively). 2. The mean value of serum SCC antigen level was more elevated in patients with squamous cell carcinoma(5.7ng/ml) than in patients with endocerival adenocarcinoma(1.7ng/ml) and adenosquamous cell carcinoma(1.6ng/ml). This difference was not statistically significant. 3. Serum SCC antigen level was increased according to the increase of tumor volume. This difference was statistically significant. 4. The relationship between serum SCC antigen level and clinical lesion size was not significant statistically. In conclusion, it would be suggested that measurement of pretreatment serum SCC antigen levels and tumor volume by MRI are helpful in pretreatment prognostic factor after treatment.

난소갑상선종의 임상적 다양성

장기홍(KH Jang),김영태(YT Kim),유희석(HS Ryu),권혁찬(HC Kwon),이은주(EJ Lee),이희춘(HC Lee),김재욱(JU Kim),오기석(KS Oh) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Struma ovarii is a rare tumor of the ovary pathologically resembling teratomas with thyroid components. The presenting clinical, radiological, and pathological features of patie-nts with consequent struma ovarii is diverse and does not give substantial information with regard to the nature of the ovarian tumor. Ten cases collected over a period of eight years from two institutes are presented which showed a wide diversity of clinical features, and in which the diagnosis was only made later by strict pathological criteria. The treatment for struma ovarii, and in even rarer cases, malignant struma ovarii, remains highly controvers-ial, but it is suggested that conservative treatment by tumor excision only may be sufficie-nt. Surgical treatment also greatly ameliorates any accompanying hydrothorax and ascites.

생쥐 초기 배아배양에 있어서 산소유리기 보집제인 Superoxide Dismutase ( SOD ) 가 미치는 영향

김미란(MR Kim),권혁찬(HC Kwon),유희석(HS Ryu),황경주(KJ Hwang),박지영(JY Park),홍순정(SJ Hong),이영돈(YD Lee),계명찬(MC Gye),최규환(KH Choi),오기석(KS Oh) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7

It is well known that developmental delay or arrest occurs before implantation in mamals, which have undergone in vitro culture. Recently, these phenomena are being attributed to oxygen free radicals, and successful cell culture are being obtained by lowering the oxygen environment of in vitro culture. This is due to the fact that the oxygen concentration in the fallopian tube is around 5%, which is lower than the room air 20% concentraition for in vitro culture. Superoxide dismutase(SOD), which are free radical scavenger, were added to early embryo mice culture and compared the free radical level at each stage of development with that of culture in which free radical scavenging agent was not added. The highest free radical level in control group observed in the late 2-cell stage and was markedly decreased if SOD added to culture media. Blastulation rate, hatching rate, and blastomere count as the parameters of embryo development was significantly increased in the experimental group. This study suggests the possibility of improvement in in-vitro embryo culture with media including free radical scavengers.

산소유리기 보집제인 Rutin이 생쥐 초기배아의 포배발달과 포배내 할구수에 미치는 영향

황경주(KJ Hwang),권혁찬(HC Kwon),유희석(HS Ryu),김행수(HS Kim),양현원(HW Yang),오기석(KS Oh) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

It is well known that developmental delay or arrest occurs before implantation in mammals, which have undergone in vitro culture. Recently, these phenomenon are being attributed to oxygen free radicals, and successful cell culture are being obtained by lowering the oxygen environment of in vitro culture. This is due to the fact that the oxygen concentration in the fallopian tube is around 5%, which is lower than the room air 20% concentration for in vitro culture. Rutin, which is a free radical scavenger, was added to early embryo mice culture and compared the free radical level at blastocyst stage with that of different culture conditions, and found that free radical level was markedly decreased. Also, there was increased embryo development with decreasing free radical levels in the experimental group, and there was significant increase in the blastulation rate and blastomere count. This study therefore suggests the possibility of improved in in-vitro embryo culture.

부정기적 자궁출혈 환자에서의 경질 초음파 자궁조영술 ( Sonohysterography ) 의 진단적효용성

이희춘(HC Lee),권혁찬(HC Kwon),유희석(HS Ryu),정태영(TY Jung),유정현(JH Yoo),장기홍(KH Jang),양정인(JI Yang),오기석(KS Oh),이은주(EJ Lee),주희재(HJ Joo) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

The comparison between Sonohysterography assesment and transvaginal sonohysterography was made in 33 women with abnormal vaginal bleeding and spotting. Surgical intervention(endometrial biopsy, hysteroscopy, total abdominal hysterectomy) was performed after Sonohysterography according to each patients condition between July 1994 and February 1995. The main results were as follows; 1. The distribution of pathology were ;normal(6), endometrial polyp(19), submousal mayoma(3), endometrial hyperplasia(2), mixed pattern(2), endometrial synechia(1). 2. In the comparison of transvaginal sonography with Sonohysterography, hypertrophy(9/10), hyperechoic(10/10), nodular(4/4) mixed (2/2) patterns were correlated with Sonohysterography findings. 3. The diagnostic sensitivity of transvaginal sonography and Sonohysterography in endometrial pathology was 66% and 85% (p

분만 후 자궁경부혈관에서 증명된 양수색전증의 1 예

김지영(JY Kim),양정인(JI Yang),유희석(HS Ryu),오기석(KS Oh),주희재(HJ Joo) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7

Ammiotic fluid embolism(AFE) is an often-devastating condition of pregnancy with high mortality. The diagnosis of amniotic fluid embolism is generally made postmortem and rests upon the morphological demonstration of amniotic fluid debris including fetal epithelial squames and hair in the pulmonary vasculature. We have made the diagnosis of amniotic fluid embolism by detection of amniotic fluid debris in cervical blood vessels ension with profuse postpartum hemorrhage and evidence of disseminated intravascular coagulation, cervical laceration after uneventful delivery. Amniotic fluid debris were only demonstrated in the blood vessels of cervical laceration site. We present a case of amniotic fluid embolism which was diagnosed at postpartum hysterectomy specimen via thorough histological examination.

태아 폐성숙평가에 있어서 Lamellar Body Count의 임상적 효용성

김지영(JY Kim),양정인(JI Yang),김행수(HS Kim),장기홍(KH Jang),권혁찬(HC Kwon),유희석(HS Ryu),오기석(KS Oh) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

From July 1994 through August 1995, 31 patients who delivered before 37 weeks gestation at the Ajou University Hospital were tested for lamellar body count in the amniotic fluid. The obtained results are summarized as follows; 1. Lamellar body count was associated with 1 minute Apgar score(p=0.02). 2. There was no sexual, gestational and birth weight differences in the incidence of respi- ratory distress syndrome. 3. Lamellar body count showed that the positive predictive value for respiratory distress syndrome was 90.0 %, the negative predictive value was 95.2 %, and the sensitivity was 90.0 %, and the specificity was 95.2 %, therefore it may be regarded as more accurate than other previously employed methods. This study suggests that the lamellar body count reflects fetal lung maturity sufficiently to assure that the neonate will not develop respiratory distress syndrome, and can be used as a quick screening test or one in series of tests for thorough assessment of fetal lung maturity.