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대한산부인과학회> Obstetrics & Gynecology Science> 다낭성 난소 증후군 환자에서 체중과 임신이 내분비 양상 및 당 대사에 미치는 영향

KCI등재SCOUPUS

다낭성 난소 증후군 환자에서 체중과 임신이 내분비 양상 및 당 대사에 미치는 영향

The Effect of Overweight and Pregnancy on Endocrinologic Features and Glucose Metabolism in Patients with Polycystic Ovarian Syndrome

황경주(Kyung Joo Hwang) , 오기석(Kie Suk Oh) , 김세광(Sei Kwang Kim) , 권혁찬(Hyuck Chan Kwon) , 박영한(Young Han Park) , 양정인(Jung In Yang) , 유희석(Hee Suk Rhyu)
  • : 대한산부인과학회
  • : Obstetrics & Gynecology Science 42권3호
  • : 연속간행물
  • : 1999년 03월
  • : 606-613(8pages)
Obstetrics & Gynecology Science

DOI


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Objective: The purpose of this study attempts to determine the endocrinologic characteristics and changes in glucose metabolism before/during pregnancy according to different body weights in women with Polycystic ovarian syndrome (PCOS). Methods: 94 women dia with PCOS were evaluated through measuring serum hormone levels and oral glucose tolerance tests preconceptionally and gestationally. Results: In patients who were of normal weight showed significantly increased serum LH levels compared to those who were overweight (12.8+-0.9 Vs. 7.1+-0.8 mIU/ml, p= 0.000), and the serum levels of insulin was increased significantly in the overweight group (7.1+-0.7 Vs. 15.2+-2.8 ulU/ml, p= 0.000). the IGFBP-I (32.8+-10.6 Vs. 8.3+-2.5 ng/ml, p=0.034) and SHBG (55.8+-4.2 Vs. 37.1+-3.1 nmol/ml, p= 0.001) were significantly lower in the ovnweight group. The oral glucose tolerance test before/after pregnancy showed increased frequency of abnormal glucose metabolism, in both of the non-obese group (38.8%, 26,9%) and the obese group (64.2%, 53.9%) compared with normal population. Conclusion: It is thought that in the normal weight group with polycystic ovarian syndrome androgen production is stimulated in the theca cells by abnormally high LH secretion, while in the overweight group the hyperinsulinemia state which decreases the SHBG and IGFBP-I, lead to increase biologically active hee androgens and IGF-I and increase insulin binding to its receptor. And during/before pregnancy, women with PCOS showed that incidence of abnormal glucose metabolism was significantly increased in both of non-obese and obese groups.

UCI(KEPA)

I410-ECN-0102-2009-510-005330013

간행물정보

  • : 의약학분야  > 산부인과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2287-8572
  • : 2287-8580
  • : 학술지
  • : 연속간행물
  • : 1958-2022
  • : 11141


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1Prenatal maternal alcohol exposure: diagnosis and prevention of fetal alcohol syndrome

저자 : Young Min Hur , Jiwon Choi , Sunwha Park , Sarah Soyeon Oh , Young Ju Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 385-394 (10 pages)

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Fetal alcohol syndrome (FAS) is a developmental and congenital disorder characterized by neurocognitive impairment, structural defects, and growth restriction due to prenatal alcohol exposure. The estimated global prevalence of alcohol use during pregnancy is 9.8%, and the estimated prevalence of FAS in the general population is 14.6 per 10,000 people. In Korea, the estimated prevalence of alcohol use during pregnancy is 16%, and the prevalence of FAS is 18-51 per 10,000 women, which is higher than the global prevalence. Women's alcohol consumption rates have increased, especially in women of childbearing age. This could increase the incidence of FAS, leading to higher medical expenses and burden on society. Alcohol is the single most important teratogen that causes FAS, and there is no safe trimester to drink alcohol and no known safe amount of alcohol consumption during pregnancy. Thus, physicians should assess women's drinking patterns in detail and provide education on FAS to women by understanding its pathophysiology. Moreover, the prevention of FAS requires long-term care with a multidisciplinary approach.

KCI등재 SCOPUS

2Sentinel lymph node biopsy in high-risk endometrial cancer: performance, outcomes, and future avenues

저자 : Yoo-na Kim , Young Tae Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 395-405 (11 pages)

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Endometrial cancer is the second most common gynecological malignancy worldwide, with an overall favorable prognosis. However, a subgroup of patients has a high risk of recurrence and poor prognosis. This review summarizes recently published articles that examined sentinel lymph node (SLN) biopsy in patients with high-risk endometrial cancer. We focused on the performance and outcomes of SLN biopsy, and examined potential methods for improving the management of this high-risk subset. Few studies have examined the long-term outcomes of SLN in patients with high-risk endometrial cancer. Thus, we reviewed recently published retrospective studies that have adopted statistical techniques, such as inverse probability weighting or propensity score matching, to examine the outcome of SLN biopsy compared to conventional lymphadenectomy. Potential avenues for future research to fine-tune decision making for this patient subgroup were also discussed.

KCI등재 SCOPUS

3Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials

저자 : Ahmed Abu-zaid , Saeed Baradwan , Ehab Badghish , Rayan Alsghan , Ahmed Ghazi , Bayan Albouq , Khalid Khadawardi , Nora F Alnaim , Latifa F Alnaim , Meshael Fodaneel , Fatimah Shakir Abualsaud , Mohammed Ziad J

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 406-419 (14 pages)

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To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy and safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy for benign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed for risk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervals in a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two and three studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirement for postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantly reduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobin level was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequency of self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhea rate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolic events, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivity analyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions, prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative blood loss and related morbidities.

KCI등재 SCOPUS

4Ritodrine in external cephalic version: is it effective and safe?

저자 : Sin Ae Kim , Eun-hwan Cha , Kyoung-chul Chun , Young Ah Kim , Jae-whoan Koh , Jung Yeol Han , Jong Hee Hwang

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 420-429 (10 pages)

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Objective
The external cephalic version (ECV) has been shown to lower the likelihood of cesarean section requirements among pregnant women with breech presentations. In the current study, we investigated the effectiveness and safety of ritodrine as a tocolytic for ECV.
Methods
A total of 407 pregnant women with breech presentations, who had no contraindications for ECV, were enrolled in this study. Multivariable logistic regression analyses were used to assess the impact of ritodrine use on the safety and efficacy of ECV.
Results
The overall success rate was 67.6%, and ritodrine use was associated with significantly higher odds of successful ECV after adjusting for confounders. Moreover, using ritodrine did not increase the risk of adverse effects, including temporary changes in fetal heart rate, need for elective or emergency cesarean section due to fetal distress during ECV, low Apgar scores, and perinatal mortality.
Conclusion
Our results suggest that using ritodrine as a tocolytic during ECV may increase the likelihood of ECV success and may not increase adverse perinatal outcomes.

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Objective
To determine the value of endometrial thickness (ET) and Doppler indices of uterine artery (UtA) as sonographic markers in predicting endometrial cancer (EC) among postmenopausal bleeding (PMB) women in low-resource settings as Vietnam.
Methods
This cross-sectional study was conducted at the Hue University Hospital and Hue Central Hospital between June 2016 and June 2019. The study enrolled all women who complained of PMB and were followed by transvaginal Doppler ultrasound. Their definitive histopathological examination was the gold standard for comparison.
Results
The UtA Doppler indices, including resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV), were significantly lower in the malignant group than in the benign group. The threshold values of the UtA, RI ≤0.73 and PI ≤1.42, were found with an area under receiver operating characteristic curve (AUC) of 0.85-0.88, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Unlike PSV, the diagnostic value was the lowest, with an AUC of 0.72. ET was a good predictor for the diagnosis of EC, with an AUC of 0.89. In women with PMB, when using the cutoff value of EC more than 12.5 mm, the sensitivity and specificity were 93.8% and 77.8%, respectively. In addition, the higher the stage of EC, the lower the RI and PI and the greater the EC.
Conclusion
ET, and RI, PI, and PSV of the UtA could help in differentiating malignant from benign endometrial changes. Pulsed ultrasonic Doppler velocimetry seems to play a role in predicting the higher stages of EC. Further studies are needed to confirm these findings.

KCI등재 SCOPUS

6The effect of a support program on the burden of spouses caring for their partners with breast cancer: a randomized controlled trial

저자 : Seyedeh-zeynab Hosseinnejad , Forouzan Elyasi , Seyed-nouraddin Mousavinasab , Zohreh Shahhosseini

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 441-450 (10 pages)

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Objective
This study aimed to determine the effect of a support program on burden of spouses caring for their partners with breast cancer.
Methods
This randomized controlled trial was conducted among spouses of women with breast cancer undergoing chemotherapy at a referral chemotherapy center in Iran. They were assigned to intervention (n=40) and control (n=40) groups using permuted block randomization. Three small group sessions lasted 45-60 minutes, followed by three telephone-based sessions, lasting 15-20 minutes (twice a week). The intervention sessions included defining stress management strategies in different situations: strengthening creativity, optimism, and management in planning, and defining the role of the caregiver. Primary outcome was care burden, and secondary outcomes were spouses' stress, satisfaction with intervention, and partners' quality of life (QOL). The caregiver burden inventory, depression anxiety stress questionnaire, World Health Organization QOL brief version, and client satisfaction questionnaire were completed before and after the intervention and at a 6-week follow-up.
Results
Thirty-eight participants in each group with a mean age of 44.24±9.01 years completed the study. Repeated measures analysis of variance showed a significant difference in the care burden (P<0.05; effect size, 0.70), stress (P<0.05; effect size, 0.64), and women's QOL (P<0.05; effect size, 0.67) before and after the intervention.
Conclusion
The results of this study can be used to develop interventions, targeting the care burden and stress of spouses of women with breast cancer undergoing chemotherapy.

KCI등재 SCOPUS

7Predictive value of 'Smartscopy' for the detection of preinvasive cervical lesions during the COVID-19 pandemic: a diagnostic study

저자 : Thamawoot Phoblap , Amornrat Temtanakitpaisan , Apiwat Aue-angkul , Pilaiwan Kleebkaow , Bandit Chumworathayi , Sanguanchoke Luanratanakorn , Yuwadee Itarat

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 451-458 (8 pages)

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Objective
To evaluate the performance of “Smartscopy” in diagnosing preinvasive cervical lesions among patients with abnormal cervical cancer screening results obtained during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
This diagnostic study enrolled non-pregnant women with abnormal cervical cancer screening results obtained at the colposcopy clinic at Srinagarind Hospital (Khon Kaen, Thailand) between September 2020 and March 2021. Two colposcopists independently evaluated the uterine cervix using a smartphone and colposcopy. Cervical biopsies and endocervical curettage were performed in accordance with standard procedures. The diagnostic performance of a smartphone in detecting low-grade squamous intraepithelial lesions or worse plus (LSIL+) and high-grade squamous intraepithelial lesions plus (HSIL+) was assessed.
Results
In total, 247 patients were included. There was high agreement between the two colposcopists (κ=0.88; 95% confidence interval [CI], 0.82-0.93). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the smartphone to detect LSIL+ were 96.6% (95% CI, 91.6-99.1), 12.9% (95% CI, 8.06-19.2), 46.2% (95% CI, 39.7-52.4), 83.3% (95% CI, 62.6-95.3), and 0.49% (95% CI, 0.43-0.55), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of smartscopy in diagnosing HSIL+ were 67.6% (95% CI, 55.2- 78.5), 85.4% (95% CI, 79.9-90.0), 60.5% (95% CI, 48.6-71.6), 88.9% (95% CI, 83.7-92.9), and 81.0% (95% CI, 0.75-0.85), respectively.
Conclusion
Smartscopy demonstrated a remarkable correlation with colposcopy and a high diagnostic performance value for the detection of preinvasive cervical lesions. Therefore, smartscopy may be an alternative tool for detecting abnormal cervical lesions in low to medium medical resource settings. Smartscopy may be applied in telemedicine during the COVID-19 pandemic.

KCI등재 SCOPUS

8Clinical outcomes of immunohistochemistry of the p53 staining pattern in high-grade serous ovarian carcinoma

저자 : Panarat Orachum , Amornrat Temtanakitpaisan , Pilaiwan Kleebkaow , Bandit Chumworathayi , Sanguanchoke Luanratanakorn , Apiwat Aue-angkul , Yuwadee Itarat

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 459-467 (9 pages)

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Objective
To investigate the prevalence of p53 mutations and associated factors between immunohistochemistry (IHC) and p53 staining patterns among patients with high-grade serous ovarian carcinoma (HGSOC).
Methods
This study is a retrospective review. A total of 62 patients with HGSOC underwent surgery at Srinagarind Hospital between January 2016 and December 2020. Histological examination was performed based on a combination of morphology and IHC staining with p53. The p53 immunostaining pattern was interpreted as a missense mutation, nonsense mutation, or a wild-type pattern. Missense (p53 overexpression pattern) and nonsense (null expression p53 pattern) mutations were considered p53 mutations. A wild-type pattern was defined as a p53 non-mutation.
Results
p53 mutations were identified in 93.6% of the patients. Subgroup analysis of the p53 mutation group between the p53 overexpression pattern and the p53 null expression pattern in terms of clinicopathological characteristics and initial treatment was performed. Patients with the p53 overexpression pattern had significantly more omental metastases than those with the p53 null expression pattern (87.8% vs. 64.7%, P=0.042). There were no statistically significant differences in median progression-free survival (PFS) (9 vs. 10 months, P=0.813) or median overall survival (OS) (12 vs. 17 months, P=0.526) between the two groups.
Conclusion
The prevalence of p53 mutations in HGSOC patients in this study was 93.6%. Omental metastasis is a significant pathological factor in predicting overexpression p53 pattern in HGSC. However, IHC analysis of the p53 staining pattern did not affect OS or PFS among patients with HGSOC.

KCI등재 SCOPUS

9Body fat distribution and insulin resistance among Korean middle-aged women: a Korean National Health and Nutrition Examination Survey

저자 : Sae Mi Lee , Ki-jin Ryu , Serhim Son , Yeon Ju Lee , Hyuntae Park , Tak Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 468-476 (9 pages)

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Objective
To evaluate menopause-related changes in body fat distribution and their relationship with insulin resistance in middleaged Korean women.
Methods
We analyzed women aged 40-60 years using data from the National Health and Nutrition Examination Survey conducted from 2008 to 2011. Body fat was measured using dual-energy X-ray absorptiometry. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).
Results
Among 3,468 participants, menopausal women (n=1,489) had a higher body mass index (BMI) and higher trunk, arm, and head fat percentages than premenopausal women (n=1,979). However, no significant difference was found in the leg fat percentage according to menopausal status. Multivariable regression analysis for HOMA-IR showed that trunk fat percentage, BMI, and waist circumference positively correlated with insulin resistance and leg fat percentage negatively correlated after adjusting for several confounding factors, whereas menopausal status was not associated with HOMA-IR.
Conclusion
Middle-aged women not only have different body weights and BMI but also have different body fat distributions according to menopausal status. Each fat percentage change in the trunk and leg is differently associated with metabolic health, particularly insulin resistance. To evaluate the metabolic health of middle-aged women, BMI is generally noted; however, body fat distribution, which can be easily assessed using dual-energy X-ray absorptiometry, should also be considered.

KCI등재 SCOPUS

10Vaginal vault drainage as an effective and feasible alternative in laparoscopic hysterectomy

저자 : Soohyun Oh , Seung Joo Chon , Seung Ho Lee , Jin Woo Shin

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 477-482 (6 pages)

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Objective
Infected pelvic hematoma is a serious complication of hysterectomies. Pelvic drainage can help reduce complications. In this study, we evaluated the efficacy and safety of vaginal vault drainage in patients who underwent laparoscopic hysterectomy for benign gynecological diseases.
Methods
Patients who underwent laparoscopic hysterectomy and pelvic drain insertion for benign gynecological diseases between January 2008 and December 2015 were enrolled retrospectively in the study. They were grouped according to drain insertion sites, that is, through the abdomen (group 1) and vaginal vault (group 2). The postoperative outcomes were compared between the two groups.
Results
A total of 504 women were included. No significant differences were observed in the prevalence of postoperative fever, readmission, and reoperation between the two groups.
Conclusion
Given the discomfort associated with holding and removing the abdominal drain, inserting a closed pelvic gravity drain through the vaginal vault appears to be a feasible alternative to an abdominal drain.

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KCI등재SCOUPUS

1폐쇄성 무정자증 환자에서 정자 채취 후 난자 세포질내 정자 주입술의 결과 : 결핵성 부고환염의 영향

저자 : 문신용(Shin Yong Moon) , 최영민(Young Min Choi) , 김석현(Seok Hyun Kim) , 오선경(Sun Kyung Oh) , 서창석(Chang Suk Suh) , 이진용(Jin Yong Lee) , 정병준(Byeong Jun Jung) , 김희선(Hee Sun Kim) , 류범용(Buom Yong Ryu) , 김정구(Jung Gu Kim) , 지병철(Byung Chul Jee) , 임경실(Kyung Sil Lim)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 451-456 (6 pages)

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Objective: To investigate the intluence of previous tuberculous epididymitis in infertile males with obstructive azoospermia on the outcome of sperm retrieval and intracytoplasmic sperm injection(ICSI) in IVF-ET propam. Methods: Retrospective analysis was paformed in 26 patients with obstructive azoospermia undergoing sperm retrieval and ICSI at Seoul National University Hospital from January, 1996 to August, 1997; 12 cycles in 5 patients with tuberculous obstructive azoospermia(Group A), and 40 cycles in 21 patients with non-tuberculous obstructive azoospermia(Group B). Results: There was no significant difference in the clinical pregnancy rate(PR) per fresh transfer between Groups A and B(20.0%[2/10] vs. 26.8%(11/41)). The rates of embryo implantation and clinical miscarriage were also comparable in both groups(6.3% vs. 11.1%, 50.0% vs. 9.1%). This tendencies were also similar after including five cryopreserved-thawed transfer cycles. Conclusion: Embryo quality and pregnancy outcome in sperm retrieval and ICSI were comparable in both the tuberculous and non-tuberculous obstructive azoospermia patients. Our results suggest that previous history of tuberculous epididymitis in patients with obstructive azoospermia does not affect the outcome of sperm retrieval and ICSI.

KCI등재SCOUPUS

2고식적 체외수정시술시 3 일째 배아이식술의 효용성에 관한 연구

저자 : 문신용(Shin Yong Moon) , 최영민(Young Min Choi) , 김석현(Seok Hyun Kim) , 오선경(Sun Kyung Oh) , 서창석(Chang Suk Suh) , 이진용(Jin Yong Lee) , 정병준(Byeong Jun Jung) , 김희선(Hee Sun Kim) , 류범용(Buom Yong Ryu) , 김정구(Jung Gu Kim) , 지병철(Byung Chul Jee) , 오수영(Soo Young Oh)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 457-463 (7 pages)

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Objective: To investigate the positive or negative effect of delaying embryo transfer(ET) one day in IVF-ET. Methods: From May to July, 1997, a total of 64 patients was emolled in this prospective randomized case-controlled study. When the timing of oocyte retrieval was decided, random allocation of patients was made to one of the two groups: day 2 transfer or day 3 transfer. In day 3 transfer group, embryos were cultured in M3 media(Medi-Cult) for further 24 hours. Results: There were no significant differences in age of patients, infertility factor, basal serum FSH level, and serum E2 level on hCG day between two poups, but number of previous IVF-ET cycles was significantly higher in day 3 transfer group(p 0.042). Number of oocytes retrieved, fertilization rate, cleavage rate, and number of embryos transferred had no significant difference, but cumulative embryo score(CES) was significantly higher in day 3 transfer group(p 0.0001). Clinical pregnancy and implantation rates were bigher in day 3 transfer group, but without significance(34.4% vs. 21.9%; 8.7% vs, 5.4%). There were also no significant differences in spontaneous miscarriage and multiple pregnancy rates. Especially in patients over 35 years of age, clinical pregnancy and implantation rates were more higher in day 3 transfer group, but without significance(41.7% vs, 8.3%; 8.5% vs. 1.6%). Conclusion: Considering the higher number of previous cycles in day 3 transfer group, it is at least likely that delaying ET one day may be clinically beneficial in IVF-ET, especially in patients with old age or repeated failure of previous cycles.

KCI등재SCOUPUS

3임신 중기 임신중절에서의 Misoprostol의 질내 투여시 사산아와 생존아에서 효능성의 비교

저자 : 김종인(Jong In Kim) , 이정호(Jung Ho Lee)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 464-467 (4 pages)

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Objective: To compare the efficiency, success rate and abortion time between the live and the dead fetus in second trimester pregnancy termination with intravag-inal misoprostol. Subjects and methods: A total of 45 pregnant women between 18-29 weeks of gestation with medical, obstetric, or genetic reasons for termination were recruited to receive 50 ug misoprostol inserted intravaginally (posterior fornix) every 4 hours. Results: The success rate of complete termination(abortion) within 12 and 24 hours in dead fetuses were 78.2% and 95.6%, respectively, while in live fetuses were 36.3% and 90.9%, respectively. The mean abortion time of the dead fetus group (10.31+-3.43 hours) was significantly less than that of the live fetus group (14.20+-3.31 hours). No serious complications occurred in terms of hemorrhage, diarrhea, nausea and vomiting. Conelusion: Intracervicovaginal misoprostol is a safe and effective method for second trimester pregnancy termination. The abortion time is less in dead fetus pregnancy than that in the live fetus pregnancy.We used 50 ug tablets of misoprastol every four hours. But, we suspect that the regimen of 100ug misoprostol inserted intracervicovaginally every eight hours will beis the proper and optimal method for pregnancy termination.

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4원발성 난관암의 임상병리학적 연구

저자 : 목정은(Jung Eun Mok) , 조준식(Jun Sik Jo) , 나준희(Jun Hee Na) , 김종혁(Jong Hyeok Kim) , 김봉희(Bong Hee Kim) , 허주령(Joor Rung Huh) , 김용만(Yong Man Kim) , 김영탁(Young Tak Kim) , 남주현(Joo Hyun Nam)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 468-474 (7 pages)

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Objective The aim of this study was to evaluate the clinicopathologic findings of eight patients with primary cancer of fallopian tube diagnosed and treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center for nine years. Methods Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and survival of patients were reviewed retrospectively. Results The patients with primary cancer of fallopian tube constituted 0.4% of all gynecologic malignancies encountered during this period. The age of patients ranged 42 to 70 years(mean+- S.D.; 53.9+-9.9) and half of patients were postmenopausal and two patients were nulliparous. Patients were treated by simple or radical hysterectomy and bilateral salpingoophorectomy with or without omentectomy and five patients received postoperative chemotherapy. The FIGO surgical stages of the patients were I(4 cases), II(2 cases), III(1 case) and IV(1 case). There were 3 cases of adenocarcinoma, 3 cases of malignant mixed Mullerian tumor, 1 case of undifferentiated carcinoma and 1 case of serous cystic tumor of low malignancy potential. Serum CA 125 values were followed during treatment and decreased during clinical remission and increased at the time of tumor progression. The mean follow-up duration was 24.3(+28.3) months and 7 patients were alive free of disease and one patients with stage Ic died of the disease. Conclusion Primary fallopian tube cancer is an extremely rare malignancy of the female genitalia and preoperative diagnosis of this disease is difficult. Cytoreductive surgery and postoperative combination chemotherapy seem to be effective treatment and CA 125 value could reflect the disease status during the treatment and follow-up of patients.

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5자궁내막증환자에서 Western blot 과 효소면역법에 의한 순환 항자궁내막항체 측정

저자 : 문신용(Shin Yong Moon) , 최영민(Young Min Choi) , 김석현(Seok Hyun Kim) , 이진용(Jin Yong Lee) , 김정구(Jung Gu Kim) , 강순범(Soon Beom Kang) , 서창석(Chang Seok Suh)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 475-480 (6 pages)

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Objectives: To investigate whether endometrial proteins with molecular weight(MW) of 92 kilodalton(kDa) may be a specific antigen involved in autoimmunity in endometriosis and to evaluate the efficacy of enzyme-linked immunosorbent assay(ELISA) in determining antiendometrial antibodies, compared with Western blot. Methods: Sera of forty-eight patients with endometriosis, 21 patients with normal control patients, 7 patients with Mayer-Rokitansky-Kustner-Hauser(MRKH) syndrome and cord sera of 22 male neonates(experimental controls) were tested for the presence of antibodies against endometrial proteins by Western blot and ELISA. All statistics were performed by Fishers exact teast and Student's t-test. Results: Fourteen(29.1%), 18.8%, and 33.3% of sera from patients with endometriosis had immunoglobulin (IgG) antibodies that were reactive against endometrial proteins of MW of 71, 92, 103 kDa while any sera from experimental controls did not show any reactivity against these antigens. Overall, threr were specific IgG antiendometrial antibodies detectable by Western blot in 56.3% of patients with endometriosis and in a normal eontrol patient. The binding activities of serum IgG to endometrial proteins were higher in patients with endometriosis than other groups. Circulating IgG antiendometrial antibodies were detected by ELISA in 54.3% of 35 patients with endometriosis and in 2 normal control patients. The concordance rate between ELISA and Western blot in determining the presence of antiendometrial antibodies was 78.3%. Conclusions: Ninety-two kDa endometrial protein is a specific antigen eliciting IgG responses in endometriosis. ELISA may be an useful method in screening autoimmune endometriosis.

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6전치 태반의 임상적 고찰

저자 : 김수평(Soo Pyung Kim) , 이초희(Cho Hi Lee) , 김사진(Sa Jin Kim) , 허수영(Soo Young Hur) , 이귀세라(Gui Se Ra Lee) , 이지현(Jee Hyun Lee) , 권인(In Kweon) , 송승규(Seung Kyu Song)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 481-486 (6 pages)

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Objective: A Clinical Study of Placenta P#revia done by cesarean section and the study of preterm delivery that is major cause of premature motality even thought expected managment of placente previa. Methods: This study was evaluated for the clinical analysis on the 641 patients with placenta previa among total deliveries of 56,120 cases at the St. Mary and Holy Family hospital of Catholic University from Jan. 1,1989 to Dec.31,1997. Results: The following results were obtained: 1. The total incidence of placenta previa was 1.14%. 2. The incidence of placenta previa increases with age. 3. Placenta previa has occurred more often in multipara(60.2%) than primipara(39.8%), and placenta previa has occurred more often in women who had experienced abortion(71.8%) than women who hadnt(28.2%). 4. The types of placenta previa distributed 326 cases of totalis(50.9%), 110 cases of partialis(17.2%), 99 cases of marginal(15.4%) and 106 cases of low lying placenta(16.4%). 5. The fetal presentation distributed 557 cases of vertex(86.9%), 49 cases of breech(7.6%), 28 cases of transverse lie(4.4%). 6. The types of uterine incision included 543 cases of low sepnent transverse incision(84.7%), 46 cases of classical incision(7.2%), 9 cases of inverted T incision and 43 cases of cesarean hysterectomy(6.7%). 7. Premature delivery of placenta previa prior to completion of 37 weeks was 186 cases(29.0%) and low birth infant less than 2,500gm was 128 cases(20.0%).and perinatal mortality rate was 28.0 per 1,000. 8. During delivery, 278 cases of placenta previa(43.4%) were transfused with mean 3.6 pints. Incidence of vaginal bleeding was 49.3% of placenta previa,mean admission day until delivery was about 5 day. Conclusion: there is a strong association between advancing age and incidence of placenta previa, and then. the risk increases with parity & the number of abortion. Considering the mean volume of blood loss more than 3 pints of blood should be prepared befor delivery.

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7복강경하 난관복원수술 후 임신율에 관한 임상연구

저자 : 이위현(Wee Hyun Lee) , 차선희(Sun Hee Cha) , 이미화(Mee Hwa Lee)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 487-490 (4 pages)

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Objective: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. Method; During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+-4.3 years(mean+-SD; range 26 to 47 years). Result: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+-35.5 minutes) than for laparotomy(159.7+-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+-2.3 days for laparoscopy, 6.1+-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. Conclusion: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.

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8TDx - FLM 에 의한 태아 폐성숙도 측정에 혈액 및 태변이 미치는 영향

저자 : 김수평(Soo Pyung Kim) , 신종철(Jong Chul Shin) , 이영(Young Lee) , 이종건(Jong Kun Lee) , 백은정(Eun Jeong Baik) , 김기홍(Ki Hong Kim) , 정대영(Dae Young Jung) , 김창이(Chang I Kim)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 491-495 (5 pages)

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Objective: We studied to determine the effect of blood or meconium contamination on the TDx-FLM assay for the assessment of fetal lung maturity. We also studied to evaluate the degree of diluted contaminants that affect the results. Methods: Nineteen samples of amnotic fluid-14 cases < GA 37weeks and 5 cases > GA 37weeks-were collected and assayed for assessment of fetal lung maturity using tbe TDx-FLM assay. Among the above 19 samples, we used 12 samples-7 cases < GA 37weeks and 5 cases > GA37 weeks-to contaminate with blood or meconium. Maternal blood was added to the amniotic fluid at increasing concentrations fro 1:10 to 1:1280. Diluted meconium (0.5g meconium/10ml amniotic fluid) was added at increasing concentration fiom 1:1 to 1:128. Each samples were assessed by TDx assay. Results: TDx values in the cases of gestational age 37 weeks or more were matured level or borderline level(TDx value > 50mg/g), but below 37 weeks, TDx values wae immature level(TDx value < 50mg/g) except one case. In preterm cases, blood or meconium contamination did not affect the TDx values significantly, although the thick meamium contamination (diluted meconium: amniotic fluid 1:1 - 1:4) increased the TDx values. In term cases, they did not affect the TDx values. Conclusion: TDx test was suitable for the evaluation of fetal lung maturity regardless of blood or meconium contamination.

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9다낭성난소증후군 환자들에게서 배란유도시 성장억제호르몬 유사체가 난소반응에 미치는 영향

저자 : 추형식(Hyung Sik Chu) , 채희동(Hee Dong Chae) , 김정훈(Chung Hoon Kim) , 강병문(Byung Moon Kang) , 장윤석(Yoon Seok Chang) , 강은희(Eun Hee Kang)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 496-503 (8 pages)

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Objective: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). Methods: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n 21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. Results: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +- 695.5 pg/ml compared with 2217.5 +- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). Conclusion: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.

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10자궁경부암 세포에서 retinoid / interferon 에 의한 성장 억제 조절의 새로운 분자생물학적 기전

저자 : 김수평(Soo Pyung Kim) , 남궁성은(Sung Eun Namkoong) , 김승조(Seung Jo Kim) , 김은주(Eun Joo Kim) , 엄수종(Soo Jong Um) , 박종섭(Jong Sup Park) , 이근호(Keun Ho Lee) , 김찬주(Chan Joo Kim)

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 42권 3호 발행 연도 : 1999 페이지 : pp. 504-516 (13 pages)

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Objective: Retinoic acids (RAs) and interferons (IFNs) have been implicated in the growth regulation of cervical cancer cells, which was suggested by clinical trials and in vitro experiments. However, the molecular mechanisms of growth regulation are not fully defined, The purpose of this study is to assess the effect of RA and/or IFN on human cervical carcinoma cells in vitro and to analyze their action mechanisms in HPV-positive cervical carcinoma cells by molecular biologic studies. Methods: HPV-positive (CaSki, HeLa), HPV-negative (C33A, HT-3), and non-cervical cancer Cos-1 cell lines were treated with RA and/ar IFN. Their effects on cell growth were evaluated by the cell pmliferation assay and the following BrdU DNA incorporation assay. The molecular mechanism was further investigated by a series of immunoblottings and transient cotransfection assays, which were conducted in HeLa cells and C33A cells using the CAT reporter gene assay. To observe the down regulation of HPV E6/E7 gene expression by RA/IFN, reverse transcription-polymerase chain reaction (RT-PCR) was perforned. Results: The powth of RA-treated cells was less suppressed than that of IFN-treated cells. Combined treatment of RA and IFN leads to additive effect on the growth suppression of HeLa and CaSki cells. The proliferation activity was most severely reduced in Hela cells by treatment of both all-trans-RA (AtRA) and IFN-r. Combined treatment of AtRA/IFN-r causes a great increase in the level of interferon regulatory factor-1 (IRF-1) protein in HeLa cells, whereas no induction of IRF-1 was observed in C33A cells. The CAT gene expression for IRF-1 was greatly induced by IFN-r in HeLa cells. Immunoblotting assays shows the concurrent induction of p21 CDK inhibitor and dephosphorylation of Rb protein in HeLa cells. In RT-PCR, an individual treatment of either RA or IFN reduced HPV E6/E7 mRNA levels and significantly cooperative when both RA and IFN were treated. By deaeasing E6 levels, the p53 level was increased in HeLs cells treated with RA and/or IFN. Transient cotransfection of IRF-1 and p53 as the transcription factors leads to the cooperative activation of a common p21 promoter to regulate the cell cycle. Conclusion: RA/IFN suppressed the growth of HPV-positive cervical cancer cells. When they were both #treated, additive suppressive effects were observed in cellular proliferation as well as DNA synthesis. The growth suppressive effect is likely to be related to the increased expression of IRF-1 and p21 (antitumoral effect; p53-independent). The down regulation of HPV E6 gene suppression may account for the resultant increase of p53 levels (antiviral effect; p53-dependent). Both induced IRF-1 and p53 cooperatively augument tbe suppession of p21 CDK inhibitor, which results in dephosphorylation of pRb. Although clinical effects are likely complex and may include interactions of in vitro growth inhibitory effects with immunomodulatory and antiangiogeaetic effect, tbese results suggest the optimal clinical role for the combination of RA/IFN in the treatment of cervical canccers.

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