임신 및 분만시의 체자세에 따른 혈액상의 변동

이희동(IS Lee) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.6

Conventional obstetric table is designed to take the parturients in supine lithotomy position. This posture is convenient for the management of delivery to whom take care of, but it is not well understood whether this is an optimum posture on the ground of maternal and fetal physiology. An attempt was made to observe maternal and fetal physiological changes due to maternal postures in late pregnancy and delivery, by pH, oxygen saturateon, pO2, pCO2, bicarbonate, and base excess in the maternal arterial and fetal cord bloods. Study cases were consisted of (1) 48 parturients, vaginally delivered, (2) 48 parturients, cesarean-sectioned, (3) 60 infants vaginally delivered, (4) 51 infants, cesarean-sectioned, (5) 114 pregnant women not in labor, and (6) 10 non-pregnant control women, making the total of 361 cases, Any complicated case which might have influenced on the fetus was excluded in the study. Effects on blood pressure caused by postures were observed in the pregnant not in labor group. Gestation periods were between 36 and 42 weeks. Vaginally delivered cases were subdivided from the viewpoints of anesthesia(caudal and non-anesthesia) and posture(supine and sitting). Cesarean-sectioned cases were subdivided from the viewpoints of anesthesia(spinal and general) and posture (supine and 15 degrees left tilt). The results were as follows: (1) Supine hypotensive syndrome was found in 12.1% of late pregnant women when the drop of 30 mmHg or more of blood pressure (arm) was included. (2) The differences of blood pressure, when turned from lateral to supine, were ranging from -50mmHg to +39mmHg (median -12.9mmHg). Extent and direction of changes were variable by individuals. (3) Maternal arterial pO2 was significantly higher in sitting posture (100.0mmHg) than in recumbent posture (94.1mmHg) (p<0.001), whereas the difference in non-pregnant women was not significnat. (4) In vaginal delivery with sitting posture, significantly higher values than with supine were noted for the followings: bicarbonate (22.0 vs. 19.9mEq/L) and base excess (-3.6 vs. -1.5Eq/S) in maternal arterial blood; oxygen saturation (68.8 vs. 60.3%) and pO2 (30.7 vs. 27.1mmHg) in umvilical vein blood. (5) With caudal anesthesia in vaginal delivery, higher values were noted in sitting posture than in supine for all of the followings: pO2 (106.0 vs. 93.5mmHg) in maternal arterial blood; pH(7.24 vs. 7.20), oxygen saturation (32.9 vs. 22.5%), pO2 (18.8 vs. 16.0mmHg)and base excess (-5.8 vs. -7.6mEq/L) in umbilical artery blood; pH(7.35 vs. 7.28), oxygen saturation (72.6 vs. 55.5%) and pO2 (31.6 vs. 25.7mmHg) in umbilical vein blood. In contrast, no significant difference was noted in non-anesthesia groups. (6) With spinal anesthesia in cesarean section, higher values were noted in tilting than in supine posture for all of the followings: pO2 (104.2 vs. 95.6mmHg) in maternal artery blood; oxygen saturation (28.5 vs. 23.2%) in umbilical artery blood; oxygen saturation (66.7 vs. 54.0%) and pO2 (30.4 vs. 24.0mmHg) in umbilical vein blood. In contrast no significant difference was noted in general anesthesia group. All the differences caused by maternal postures were not so great to influence maternal or fetal well-beings in uncomplicated cases, but might be an additional risk in complicated cases.

산부와 태아의 혈청 Ferritin에 관한 연구

이희동(IS Lee),이윤이(YE Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.3

결과 1982년 5월부터 동년 11월까지 6개월간 충남대학교 의과대학 부속병원에서 분만한 만삭산부 및 신생아에서 혈청 ferritin, 혈청액 및 hemoglobin을 측정하여 본 바 다음과 같은 결과를 얻었다. 1. 말기임부에 있어서 혈청 ferritin치는 평균 27.4±17.7gm/ml, 혈청액은 96.2±23.2㎍/dl, hemoglobin은 11.6±1.4gm/dl이었다. 2. 태아의 제대정맥혈청 ferritin치는 126.4±56.4gm/ml, 혈청액은 183.2±59.4㎍/dl, hemoglobin은 17.2±2.1gm/dl이었다. 3. 대상임신중 혈청 ferritin치가 12gm/dl 이하인 경우는 19명(19%)이었으며 임신의 혈청 ferritin치에 비례하여 태아의 제대혈청 ferritin치도 변동하는 경향이 있었으나 통계학적 의의는 보여주지 않았다. 4. 임부는 태아에서 모두 혈청 ferritin치는 혈청액이나 hemoglobin과 의의 있는 상관관계가 없었다. 5. 임부의 경산회수가 증가함에 따라 혈청 ferritin치가 하강하였다. Serum ferritin was measured in 100 paired maternal and cord samples for the women who had normal deliveries and normal fetuses daring the period from May to November 1982. These values were analyzed by the parameters of maternal age, maternal weight, gestational weeks, parity, fetal weight, placental weight and fetal sex, and compared with serun iron and hemoglobin which measured concomitantly. Following results were obtained. 1. Average values for maternal serum ferritin was 27.4±17.7ng/ml and those for serum iron and hemoglobin were 96.2±23.2㎍/dl and 11.6±1.4gm/dl respectively. 2. Average values for cord ferritin was 126.4±56.8ng/ml and those for iron and hemoglobin were 183.2±59.4㎍/dl and 17.2±2.1gm/dl respectⅳely. 3. Maternal serum ferritin values measuring below 12ng/ml were found in 19cases(19%). And these values were generally parallel with cord ferritin values although no statistical significance. 4. There found no correlation between serum ferritin and serum iron or hemog-lobin in both maternal and cord samples. 5. Serum ferritin values were decreasing as the number of parity increased.

고도의 양수과다증을 동반한 소하수증 및 하재성이개의 1 예

이희동(IS Lee),김동창(DC Kim),송기명(KM Song),오세량(SR Oh) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.2

고도의 양수과다증을 동반한 소하수증 및 하재성이개의 1 예를 보고하는 바이다. A case of huge hydramnios with multiple fetal anomalies is presented with the review of literature available. The patient was 26 year old secundigravida of 38 week gestation by menstrual age, complaining of overdistention of the abdomen and dyspnea. Labor was induced by rupture of membrane. A small (2100gm) male baby was born in breech. The amniotic fluid collected was measured 9600ml. excluding the loss during delivery. The baby died in 5 minutes, no apparent cause being found. Anomalies found in the baby and the fetal appendage are: micorgnathia, low-set ears, talipes equinovarus (both sides), and short umbilical cord(29cm). Autopsy findings revealed complete atresia of duodenum at the descending portion including papilla. Parents their first baby were healthy and normal.

인공유산 및 자연유산에 관한 임상 통게적 고찰

이희동(IS Lee) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.9

A considerable number of pregnancy are interrupted before or even after the viablilty of fetus. It may be spontaneous or artificially induced. In recent years artificial interruption of pregnancy has markedly increased and it may be due to poor knowledge or technique in contraceptive methods. Consequentiy, spontaneous abortion seems to increase in frequency. The observasion of 2643 women who visited Seoul Red Cross Hospital gave the following results. 1) About half (43.0%) of the married women had the history of abortion;half of the latter was artificial and the other half spontanece. The abortion rates to pregnancies were 14.0% in artificial and 9.8% in spontaneous. The incidence of artificial abortion increased for the last 10 years and spontaneous abortion also showed increasing tendency in recent years. 2) Artificial adortion was much more frequently experienced in well-educated and economically rich women than in poorly educated and economically poor ones, whereas the incidence of sponsaneous adortion showed no significant difference in family occupation. 3) Abortions, spontaneous or artifcial, occurred most frequently within the third months of pregnancy. Artificial interruption was more common in multigravida and multipara, while the gravidity and parity showed little influence in spontaneous abortion. 4) As the cause of artificial adortion, most women indicated family planning: too many children, too short interval between pregnancies, economical problem and health. 5) Complications including mild ones were found in 28.1% of all artificial abortions and in 32.8% of all spontaneous abortions.

화학물질주입이 가토난관불임효과에 미치는 실험적 연구 ( 제1보 )

이지재(GJ Lee),이종현(JH Lee),이희동(IS Lee) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.3

저자들은 영구불임목적으로 가토난관에 1%, 3% 및 10% sodium hydroxided와 5%와 10% salicylic acid를 용액상태로 각각 1회씩 주입하고 1내지 5주후 관찰한바 전례에서 정도의 차 이는 잇으나 난관조직의 섬유화와 폐쇄 및 심한 협착을 초래하였으며 이와 같은 가토난관 조직 및 형태변화는 불임을 가져올수도 있다는 결론을 얻었다. 동시에 화학물질에 의한 불 임술의 가능성과 임상적 응용을 실시할 수 있는 계기를 가져왓다고 사료되는 바이다. The authors have evaluated experimentally tabal sterilization in the rabbit fallopian tube, applicating 1%, 3% and 10% sodium hydroxide and 5% and 10% salicylic acid in solution. After laparotomy under thiopenthal intravenously. or ether open dropping anesthesia, the using chemical was administered in the uterine cornus with a fine-gauge needle and the syring was maintained in position for approximately the seconds. Laparotomy after application of chemical into tube was made 1 to 5 weeks interval, then rabbits were not killed while hysterctomy was taken. In histological examination of the tubes, there were extensive tissue adhesive, fibrosis, destruction or regeneration of epithelial cells of the tubal mucosa and narrowing or complete obliteration of the tubal lumen. For one rabbit, one side of the tubes was treated with 1% sodium hydroxide and the other was not treated. Two weeks after the procedure, the rabbit was mated and we found five embryos in the not treated uterine horn and no embryos in the treated side. It appears that chemical tubal sterilization was simple, low cost and not required faciliated setting so it seems to be promised satisfactory effectiveness in the rabbit or evev in human.

Meconium Peritonits의 1부검예

배병주(BJ Bai),이희동(IS Lee),이인성(HT Lee) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.8

A 32 year old woman (gravida 5, para 2) admitted as an emergency patient under the diagnosis of full term pregnancy. The Cesarenan section was necessiated by the mento posterior face presentation of the boby. The baby was cyanotic and expired 40 minutes after birth. Postmortem examination shows an enormously protruded abdomen with extensive amount of ascites, which contain a lot of meconium like material, and dark greenish in color. Evacuating these, atrophic adhesed intestinal loops, which are a little difficult to seperate out, and widely acattered plaques of calcified material in the abdominal wall and visceral surface, are noted. Finally, an obvious conglomeration of organized, serofibrinous clot with bile tinging is noted at one edge of the duodenum, upper part of which, the lumen of duodenum, stomach and esophagus, is empty, despite below this portion is filled with some dull greenish clay colored contents. These findings are regarded as the sealed-off prenatal rupture of duodenum, which had resulted the peritonitis. Left lung shows complete atelectasis, right lung partial atelectasis, and subcutaneous hemonnhage in vault, subarachinoidal congestion in parieto-occiptal region, are noted. The severe degree of meconium peritonum peritonitis finally brought about peripheral circulatory failure and this, with breathing difficulty, has caused the caused the cessation of life.

복강경 불임수술 후 발생한 자궁외임신 18례

김일선(IS Kim),조상원(SW Cho),이희동(IS Lee) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.10

본 대학 산부인과학교실에서는 1978년 3월부터 1982년 9월까지 54개월간 발생한 자궁외 임신 220예 중에서 난관 불임수술을 받은 후 발생한 자궁외임신 18예를 분석한 바 다음과 같은 결과를 관찰할 수 있었다. 1. 난관 불임 수술후 발생한 자궁외 임신은 전 자궁외 임신 220명 중에서 18명으로 8.2%이었다. 2. 연령은 31세에서 35세까지에서 6명으로 가장 많았다. 3. 생존 자녀수는 평균 2.3명이었고, 인공 유산을 경험한 사람은 14명이었다. 4. 난관 불임 수술전 피임 방법은 경구 피임이 5명, condom 3명, 자궁내장치 2명, 주기법 2명이었으며, 피임을 하지 않은 경우도 4명이었다. 5. 난관 불임 수술을 받은 의료기관은 산부인과의원 12명, 가족계획협회 4명이었으며, 모두 산부인과 전문의에 의한 시술이었다. 6. 복강경 불임수술후 자궁외 임신이 발생할 때까지의 기간은 제일 짧은 경우가 3개월이었으며, 가장 길은 경우는 5년이었다. 7. 난관 불임 수술 방법중 전기 소작법이 14명, Siliastic band가 4명이었다. 8. 자궁외 임신이 발생한 난관에서 육안적 소견은 난관이 서로 분리되어 있는 경우가 6명, 반흔이나 협착에 의해 연결되어 있는 경우가 12명이었다. 9. 자궁외 임신이 발생된 부위는 하협부 6명, 팽대부 6명, 난관채 4명, 간질부 2명, 상협부 1명이었다. 10. 개복시 수술은 반대측 난관을 포함시킨 경우가 6명, 반대측 난관 및 난소를 포함시킨 경우가 2명, 전자궁적출술을 시행한 경우가 3명이었다. An analysis of 18 cases of ectopic pregnancy which occured after laparoscopic sterilization during the period from March 1978 to September 1982 in Chung nam National University was done, and obtained following results. 1. Among the 220 cases of ectopic pregnancy during the period, 18 cases were disclosed to occur after laparoscopic sterilization. 2. The most prevalent age group was 31 to 35 years. 3. Average number of children was 2.3. 4. As the usual contraceptive method beofre tubal sterilization, oral pill was the most frequent one(5 cases), and in 4 cases thy used nothing. 5. The duration from tubal sterilization to ecopic pregnancy was 3 months to 5 years. 6. The methods of sterilization was mostly electrical cauterization(14 cases) and the rest was silastic band application(4 cases). 7. The affected tubes were separated completely at the sterilized site in 6 cases and scarring and norrowing in 12 cases. 8. Ectopic sites were distal isthmus(6 cases), ampulla(6 cases), fimbriam(3 cases), cornu(2 cases) and proximal isthmus(1 case). 9. At the surgery contralatera tube was removed in 6 cases, salpingo-oophorectomy in 2 cases and total hysterectomy in 3 cases.

Lipiodol 조영술에 의한 난관이물육아종의 1예

송기명(KM Song),이희동(IS Lee),오세량(SR Oh),허만하(MH Huh) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.4

This is the first case, reported in Korea, of foreign-body granulomatous lesions confirmed clinically and pathologically, following the use of Lipiodol for the (hysterosalpingography), Literature review realted to foreign-body granulomas of the fallopian tubes, following the use of Lipiodol, are carried out.

난소 중신종 1예

이재윤(JY Lee),이희동(IS Lee) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.5

난소중신종은 Schiller의 발표 이후 많은 례가 보고 되고 있으나 발생, 조직소견 및 명명에 관하여는 아직 확정된 견해가 없다. 저자는 최근에 간, 위에 전이를 일으킨 난소중신종 1례를 경험하였기에 문헌적 고찰과 더불어 보고하는 바이다.

거대 난소미분화배세포종의 1예

박병우(BW Park),송성선(SS Song),이희동(IS Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 18세의 미혼여성에 발생한 거대양측난소미분화배세포종의 1예를 경험하였기에 문헌적 고찰과 더불어 보고하였다. A 19 years old girl with the chief complaints of growing abdominal mass and abd-ominal distension was undertaken laparatomy . On operation there noted a large ovarian tumor at each side, measuring 27.2*11. 5X12.4(cm),3130gm(left)and 18X10.4X8.8(cm), 800m (right). Capsules were intact and there was no evidence of ascites, adehesion and any metatsis. Microscopic examination disclosed these huge bilateralt dysgerminomas with typical pathologic picture.