제왕절개술의 임상적 고찰

김종덕(JD Kim),강훈(H Kang),박종덕(JD Park),변지수(JS Pyun) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.5

1975년 2월 1일부터 1978년 7월 31일까지 3년 6개월동안 전북의대 부속병원 산부인과에 입원하여 1,000g 이상의 태아를 분만한 1,179예중 의무기록이 만족스러웠던 193예를 임상 통계학적으로 고찰하여 다음과 같은 결론을 얻었다. 1. 제절의 빈도는 16.4%였다. 2. 제절의 적응증은 아두골반불균형이 34.7%로 수위였으며 태위이상 14.5%, 전치태반 13.5%, 반복제절 9.8%, 태반조기박리 9.8%, 자간증 및 자간전증 8.3% 순위였으며 골반위의 제절율은 18.0%였다. 3. 연령분포는 26∼30세군이 43.0%, 21∼25세군 26.4%, 31∼35세군 16.6%의 순위이고 35세 이하가 87.1%이다. 4. 제절술식은 자궁협부의 횡절개술이 88.1%, 자궁체부종절개술이 10.3%, 제절자궁전적출술이 1.6%이었다. 5. 전예에서 전신마취를 시행하였다. 6. 선택적제절이 19.2%, 응급제절이 80.8%였고 수혈은 44.9%에서 시행하였으며 응급제절 43.6%, 선택제절 45.9%에서 수혈을 시행하였다. 7. 모성이병율은 13.0%이었고 산욕열 복부창상감염이 주 내용이었다. 8. 모성사망은 1예(0.52%)였다. 9. 미숙아 14.2%, 성숙아 85.8%, 3,000∼3,500g군이 37.6%였다. 10. 주산기 사망률은 19.2%였으며 사산 20예, 신생아사망 12예였고 그중 미숙아군이 18예로 과반수 이상을 차지하였다. Of 1,179 deliveries performed at Jeonbug National University Hospital From Feb. 1. 1975 to July 31. 1978, 193 cases of C-section was reviewed clinically. The results were as follows. 1. The rate of C-section was 16.4% for the period. 2. The age group of 26 to 30 years was 43.0% and 86.6% of all were below the age of 35 years. 3. In indications, C.P.D. was the most prevalent with 34.7% and malpresentation 14.5%, placenta previa 13.5%, repeated C-section 9.8%. There was some difference between the order of indication of primigravida and multipara. 4. In the type of operation, lower cervical transverse C-section was 88.1%, classical 10.3% and C-hysterectomy 17.6%. 5. Each of C-section were performed under the general anesthesia. 6. Of 193 cases of C-section, emergency C-section was 80.8%, elective 19.2%. Whole blood transfusion was carried out in the cases of 44.9% with emergency 43.6%, elective 45.9% respectively. 7. Apger score 6-10 was 74.1% and the mature newborn was 85.8%. 8. Perinatal mortality rate was 19.2%, stillbirth of which was 20 cases, the premature 18 cases. 9. The postoperative complications were noted in 13.0%, most of which were puerperal fever, wound infection of abdomen. 10. Maternal death occured in one case.

사람 태반의 r-Gultamyl Transpeptidase

조중동(JD Cho) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.4

정상만기분만에서 얻은 태반에 Υ-glutamyl tramspeptidase(Υ-GTP)활성이 왕성함을 보고 이 효소의 성상을 구명하였다. 태반 Υ-GTP활성은 사람 혈청의 Υ-GTP활성보다 약 40배나 더 높았으며 태반의 모체면조직이 태아면조직에 비하여 약 15% 정도 활성이 더 높았다. 태반의Υ-GTP는 pH 8.3에서 glycylglycine이 Υ-glutamy1기의 acceptor일 때 최고 활성을 나타냈고, bromosulfophthalein과 또 borate존재하에 L-serine에 의하여 현저 히 억제되어 기왕에 보고된 흰쥐 신장이나 사람혈청 Υ-GTP의 성상과 대동소이하였다. 그러나 transpeptation반응에서 Υ-glutamyl기의 acceptor로 작용하는 여러 L-amino산 은 오히려 태반의 Υ-GTP활성을 억제하고 dipeptide인 glycylglycine만이 acceptor로 작용하여 본 산소활성을 현저히 촉진시켰다. 태반 Υ-GTP는 L-amino산의 조직내 흡수보다 오히려 peptide의 흡수에 더 중요한 역할을 맡고 있을 것이 시사되었다. Human placenta obtained from normal, full-term delivery is a rich source of Υ-glutamyl transpeptidase(GTP), its activity being appriximately 40-times higher than in normal human serum. The maternal site of the placenta was found to contain slightly higher(15%) activity compared with the fetal site. The enzyme activity was highest at pH8.3 in the presence of glycylglycine as a γ glutamyl acceptor. Bromosulfophthalein, and L-serine in the presence of borate markedly inhibited the placental enzyme as report for rat kidney and human serum enzymes, However, various L-amino acids which act as γ-glutamyl acceptors in transpeptidation by rat kidney γ-glutamyl acceptor was found to inhibit the placental enzyme. These enzyme properties suggest that hyman placental γ-GTP may play a role in cellular transport of some pepties rather than of L-amino acids.

외음부 한관종 1 예

정재돈(JD Jung),손종우(JW Shon),이선경(SK Lee),김낙인(NI Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

Syringoma of the vulva is a rare organoid tumor with differentiation toward eccrine sweat ducts. The lesions are firm to soft, skin colored, and slightly raised and measured 1-3 mm in size. No other literature reported the case of vulvar syringoma in Korea. We report a case of syringoma confined to the vulva which was pathologically proven and successfully treated with contact type Nd: YAG laser.

미세수술을 이용한 가토난관 복원술시 사용된 봉합사 및 복강내 첨가물이 난관조직에 미치는 영향

김종덕(JD Kim),두재균(JK Doo) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.4

미세수술을 이용한 난관 문합술시 봉합사, 복강내첨가물, 수술 후 경과기간별로 난관조직의 유착정도, 봉합사의 흡수유무, 복수존재유무, 난관유통검사, 조직학적 소견을 관찰하여 다음과 같은 결과를 얻었다 1 난관정도의 유착정도는 vicryl군과 nylon군이 dexon군에 비하여 약간 적었으나 유의한 차이는 없었고(P=0 1504), macrodex군이 생리적 식염수군과 대조군보다 비교적 적었으나 유의한 차이는 없었다(P=0 8325) 2, 봉합사별 흡수유무는 수술 후 60일에서 vicryl군은 완전흡수, dexon군은 1마리(16 7%)에서 부분흡수, nylon군은 전혀 흡수되지 않았다(P=0 0002) 3 난관유통성 검사결과는 vicryl군과 nylon군이 dexon군에 비해서 약간 우수하였으나 유의한 차이는 없었고(P=0 6218) macrodex군이 생리적 식염수군과 대조군에 비하여 우수하였다(P=0 048) 4 복수는 수술 후 60일에 macrodex군의 50%(3/6)에서 존재하였으나 생리적 식염수군과 대조군에서는 없었다 수술 후 60일과 90일의 경과기간에 따른 차이는 없었다(P=0 2059) 5 조직구와 다핵거대세포의 침윤에 의한 조직 반응과 섬유화는 vicryl군과 macrodex군이 각각의 비교군보다 적었다 이상과 같은 결과로 봉합사로는 vicryl과 nylon을 사용하고 복강내 첨가물로는 6% dexon을 주입하였을 때 조직의 유착이 적고 난관의 유통성이 우수하며 조직반응 및 섬유화가 가장 적어 난관의 미세복원수술에 이들의 사용이 좋을 것으로 사료되었다 Tubal sterilization has been increased progressively in young reproductive women and it has made tubal reversal using microsurgery increase consistently Pregnancy success rate by tubal reanastomosis using microsurgery has been reported approximately two times higher than the previous operation methods Microsurgical tubal reanastomoses were performed on bilateral fallopian tubes of 18 female rabbits using different suture materials and adjuvants Adhesions, absorption of suture materials, tubal patency, and presence of ascites were compared and tissue responsiveness was evaluated by histologic examinations of the restored tubes, and the results were as follows: 1 There was no difference in the degree of adhesion of the restored tubal tissue when the groups were compared according to the suture materials(P=0 1504) and the adjuvants(P=0 8325) 2 Absorption of suture material was marked in the vicryl and the dexon groups compared to the nylon(P=0 0002) 3 There was no difference in tubal patency between the vicryl, dexon, and nylon groups(P=0 6218), but more cases with free flow were found in the macrodex group compared to the normal saline and the control(P=0 048) 4 Ascites were observed in 50%(3/6) in the macrodex group on the 60th day after reanastomosis, whereas none was found in the normal saline and the control(P=0 0735) No difference was noted in the frequency of ascites between the 60 days and 90 days groups(P=0 2059) 5 Tissue responsiveness assessed by infiltrations of histiocytes and multinucleated giant cells, and fibrosis in histologic examination was less marked in the vicryl and the macrodex groups compared to corresponding group

낭성변화를 동반한 거대한 자궁경부근종의 11예

강정대(JD Kang),임태웅(TW Lim),유광사(KS Yoo) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.9

This report deals with a case of giant leiomyoma arising in the right mid portion of the cervix uteri in 27 year old unmarried female. The leiomyoma has grown into the right broad ligament, and it has cystic degeneration and hematoma leading to fistula formation into the cervical canal. The pertinent literature has been reviewed. The case is found to be rare in occurrence.

난소임신의 1예

김종덕(JD Kim),이종수(JS Lee),박찬영(CY Park) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.11

A case of ovarian pregnancy associated with lithopedion and fulfilled Spiegelburg`s criteria in a 38 year old woman is presented.

치골상부소절개에 의한 난관불임술

김종덕(JD Kim) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.11

1. 80% of cases were under 34 years of age and youngest 23 years oldest 42 years. 2. Number of living children was 2-4 persons in 86.4% 3. Ratio of male to female of offspring was 2 to 1 in most cases. 4. Cases never experienced artificial abertion were 57.6%, 37 cases (62.6%) had been performed artificial abortion with tubal sterilization together. But no difference was noted in time of operation and complication compared with non pregnant cases. 5. Tubal sterilization was performed from 1 years to 3 years after last delivery in 61%. 6. Motive of tubal sterilization was her will and doctor`s advice after counsel in 67.7%. 7. Cases wanted only tubal sterilization had been performed under local anesthesia except extreme anxiety. 8. The operation was finished within 20 Min. in 73% After using of Bai`s 17 elevator the time of operation was shorted for facilitated elevation and rotation of uterus. 9. Cases discharged within 12 hours were 64.3% and most of them after 6-8 hours. 10. camplication were encountered in 2 cases, ie hemorrhage due to laceration of mesosalpinx during manipulation and mild inflammation around stitches. 11. No failure was noted.

선천성 태아 성상세포종 1 예

이재동(JD Lee),채진호(JH Chae),김훈(H Kim),최윤석(YS Choi),서준영(JY Seo),김태상(TS Kim),김익수(IS Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

Congenital intracranial tumors are very rare. We report a case of the astrocytoma confirmed by autopsy after stillbirth at 37+5 weeks gestation. Prenatal ultrasound revealed relatively well defined, large, lobulated, heterogeneous hyperechoic lesion, which involve the left cerebral hemisphere and displace the falx cerebri opposite side. Hydramnios was not seen. The methods of delivery are cesarean section or vaginal delivery according to intrapartum destructive procedures. We have reviewed with attention to sonographic characteristics, associated findings of the congenital astrocytoma and management and progress of congenital astrocytoma with brief review of literatures.

자궁내 태아발육지연의 1예

이준덕(JD Lee) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.7

저자는 최근 자궁내 발육속연을 제왕절개술에 의하여 분만하여 매우 희귀한 삼배성 염색체를 가진 형성부전증등을 종반한 기형아임을 발견하였기에 간단한 문헌고찰과 함께 이를 보고하는 바이다.

상피성 난소종양에서 p53단백의 발현과 예후와의 관계

정재돈(JD Jung),이주희(JH Lee),홍진기(JK Hong),이선경(SK Lee),김승보(SB Kim),이재현(JH Lee) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.10

It has been recongnized that abnormalities of tumor suppressor gene play a significant role in development of human cancer. One of the most common genetic alterations seen in human malignancies is inactivation of p53 tumor suppressor gene. In recent studies many authors has reported that intranuclear accumulation of p53 suppressor gene is common finding of various types of human cancer and is closely correlated with poor prognosis. We adapted p53 and PCNA immunohistochemical staining to evaluate the prognostic significance of p53 expression in epithelial ovarian cancer and to compare the relationship between p53 expression and cellular proliferation. We used paraffine embeded block of epithelial ovarian cancer from 38 patients treated at Kyunghee University between 1982-1992. p53 expression was seen in 39.5%(15/38) of epithelial ovarian cancer , 8.3 %(1/12) in borderline malignancy but not in normal ovary. Although p53 expression was lower in early stage ovarian cancer(stage I, II)than advanced stage and lower in mucinous cancer(26.7%) than other types of epithelial ovarian cancer, the relationship were not statistically significant. There were no relationship between p53 expression and size of tumor or disease free survival but significantly higher recurrence rate was seen in p53 expression group . The present study suggested that p53 expression could be utilized as a predictor of recurrence and showed that p53 expression was associated with inappropriate cellular growth but not with adverse outcome of epithelial ovarian cancer.