Successful pregnancy following transmyometrial embryo transfer after robot-assisted radical trachelectomy / 대한생식의학회지

Radical trachelectomy is a fertility-preserving alternative to radical hysterectomy in carefully selected young women with early-stage cervical cancer. However, in cases with subsequent severe cervical stenosis, assisted reproductive techniques can be difficult. This is a case report of a 34-year-old patient who underwent robot-assisted radical trachelectomy and cerclage for early-stage (IB2) adenosquamous carcinoma. Three months after surgery, the patient underwent ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol. As it was impossible to perform transcervical embryo transfer due to the almost complete absence of the cervical opening, transmyometrial embryo transfer under ultrasound guidance was performed. This resulted in a successful singleton pregnancy. This is the first case of successful pregnancy conceived by in vitro fertilization with transmyometrial embryo transfer in a patient who had previously undergone robot-assisted radical trachelectomy.

Successful pregnancy following transmyometrial embryo transfer after robot-assisted radical trachelectomy / 대한생식의학회지

Radical trachelectomy is a fertility-preserving alternative to radical hysterectomy in carefully selected young women with early-stage cervical cancer. However, in cases with subsequent severe cervical stenosis, assisted reproductive techniques can be difficult. This is a case report of a 34-year-old patient who underwent robot-assisted radical trachelectomy and cerclage for early-stage (IB2) adenosquamous carcinoma. Three months after surgery, the patient underwent ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol. As it was impossible to perform transcervical embryo transfer due to the almost complete absence of the cervical opening, transmyometrial embryo transfer under ultrasound guidance was performed. This resulted in a successful singleton pregnancy. This is the first case of successful pregnancy conceived by in vitro fertilization with transmyometrial embryo transfer in a patient who had previously undergone robot-assisted radical trachelectomy.

Can the cervical length in mid-trimester predict the use of vacuum in vaginal delivery?

Subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis in women with spontaneous preterm delivery

OBJECTIVE: To compare subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis (HCA) in women with spontaneous preterm delivery (SPTD).METHODS: Among 1,706 women who gave birth twice or more at our institution, 138 women delivered spontaneously at preterm (<37.0 weeks). Subsequent deliveries occurred at our institution and placental biopsy results were available. The study population was categorized into 2 groups based on the presence of acute HCA at the time of SPTD: HCA group (n=52) and non-HCA group (n=86). The primary outcome measures were gestational age at delivery, birthweight, and frequency of preterm delivery in subsequent pregnancies.RESULTS: The median gestational age at the time of SPTD was 34.0 weeks (interquartile range [IQR], 28.9–35.3 weeks), and the frequency of acute HCA was 52/138 (38%). There were no differences in gestational age at delivery, birthweight, and frequency of preterm delivery between the HCA group and non-HCA group (median gestational age at delivery, 38.0 weeks (IQR, 36.7–38.8 weeks) in the HCA group vs. 37.9 weeks (IQR, 35.7–39.0 weeks) in the non-HCA group; frequency of preterm delivery, 14/52 (27%) in the HCA group vs. 33/86 (38%) in the non-HCA group; and median birthweight, 3.14 kg (IQR, 2.64–3.45 kg) in the HCA group vs. 2.95 kg (IQR, 2.44–3.36 kg) in the non-HCA group; P>0.1 for all.CONCLUSION: The presence of acute HCA in women at prior SPTD did not significantly affect their subsequent pregnancy outcomes.

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Objective@#To investigate the effect of gestational weight gain (GWG) on maternal and neonatal outcomes based on the Institute of Medicine (IOM) guidelines for twin pregnancies. @*Methods@#This study included women with twin pregnancies who delivered at Seoul National University Bundang Hospital. Based on the weight gain per gestational week according to the 2009 IOM guidelines, the subjects were divided into the following 3 groups: inadequate, adequate, and excessive GWG. We compared the maternal and neonatal outcomes of each group. @*Results@#A total of 1,738 twin pregnancies were included in our study. Of these cases, 881, 694, and 163 (50.7%, 39.9%, and 9.4%, respectively) twin pregnancies were categorized into the inadequate, adequate, and excessive GWG groups, respectively. In the inadequate GWG group, the risks of preterm birth <34 weeks (aOR, 2.33, 95% confidence interval [CI], 1.63–3.34) and delivering neonates who were small for gestational age (aOR, 1.92, 95% CI, 1.42–2.60) were increased, and the risk of preeclampsia (aOR, 0.49, 95% CI, 0.32–0.76) was decreased. The excessive GWG group had an increased risk of the neonates being large for gestational age (aOR, 1.79, 95% CI, 1.15–2.81). @*Conclusion@#The 2009 IOM recommendations for GWG can be applied to Korean women with twin pregnancies to help achieve optimal maternal and neonatal outcomes. However, more than half of the women were categorized as having inadequate weight gain according to the guidelines. Further studies should be performed to obtain Korean national references for GWG in twin pregnancies.

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Objective@#To investigate the effect of gestational weight gain (GWG) on maternal and neonatal outcomes based on the Institute of Medicine (IOM) guidelines for twin pregnancies. @*Methods@#This study included women with twin pregnancies who delivered at Seoul National University Bundang Hospital. Based on the weight gain per gestational week according to the 2009 IOM guidelines, the subjects were divided into the following 3 groups: inadequate, adequate, and excessive GWG. We compared the maternal and neonatal outcomes of each group. @*Results@#A total of 1,738 twin pregnancies were included in our study. Of these cases, 881, 694, and 163 (50.7%, 39.9%, and 9.4%, respectively) twin pregnancies were categorized into the inadequate, adequate, and excessive GWG groups, respectively. In the inadequate GWG group, the risks of preterm birth <34 weeks (aOR, 2.33, 95% confidence interval [CI], 1.63–3.34) and delivering neonates who were small for gestational age (aOR, 1.92, 95% CI, 1.42–2.60) were increased, and the risk of preeclampsia (aOR, 0.49, 95% CI, 0.32–0.76) was decreased. The excessive GWG group had an increased risk of the neonates being large for gestational age (aOR, 1.79, 95% CI, 1.15–2.81). @*Conclusion@#The 2009 IOM recommendations for GWG can be applied to Korean women with twin pregnancies to help achieve optimal maternal and neonatal outcomes. However, more than half of the women were categorized as having inadequate weight gain according to the guidelines. Further studies should be performed to obtain Korean national references for GWG in twin pregnancies.

Successful vaginal birth after prior cesarean section in a patient with pyoderma gangrenosum

Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery.

Simple mathematical formulae for estimation of median values of fetal biometry at each gestational age

OBJECTIVE: The aim of this study was to propose simple mathematical formulae to estimate median values of fetal biometry including biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) at each gestational age (GA) easily without looking up the previously established reference values. METHODS: Simple mathematical formulae to estimate median values of fetal biometric values at each gestational week were inferred. To validate these formulae, three different linear equations were derived from previously reported reference values of median BPD, AC and FL using regression analysis at each gestational week. Finally, calculated data through the inferred formula were compared to retrospectively collected data (observed data). RESULTS: The equation revealing the relationship between BPD and GA was: median BPD (cm)=GA (wk)/4. Using this simple mathematical formula, the absolute percentage error between observed data and calculated data ranged from 0.12% to 7.50%. The equation between AC and GA was: median AC (cm)=GA (wk)-5. Through this formula, the absolute percentage error was analyzed same as above and it ranged from 0.30% to 4.76%. Lastly the derived formula between FL and GA was: median FL (cm)=GA (wk)/5 and the absolute percentage error ranged from 4.52% to 16.75%. CONCLUSION: The three simple formulae suggested in our study showed a significantly easy way to estimate the median values of fetal biometry at each gestational week with good reliability.

Intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis: Two case reports

Embolization of the uterine arteries is a valuable method for controlling postpartum hemorrhage. There have been recent attempts to apply this tool as a means of controlling bleeding during Cesarean section, especially in patients with placenta previa. However, the benefits are controversial due to lack of randomized controlled studies, no evidence of significant improved outcomes, and potential harm including radiation exposure. This paper includes two case reports of intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis.

Febrile Seizures after 5 Years of Age : Clinical and Electroencephalographic Characteristics / 대한간질학회지

PURPOSE: We aimed to investigate the electroclinical characteristics of patients having persistent seizures with fever after 5 years of age, which has not been elucidated well. METHODS: We identified 101 patients over 5 years (M : F=64 : 37, range: 5.0-11.0), visited our hospital for febrile seizure. Their medical records for clinical features and EEG findings at last seizure were retrospectively reviewed. RESULTS: The mean onset age of seizure of total patients was 3.0 years (range: 0.3-8.3). The complex features were noted in 15.8%. Family history were in 53.3%. Neurologic abnormalities were in 10.9%. Abnormal EEGs were in 36.7% (generalized spike or polyspike-waves: 10, focal epileptic discharges: 16, others: 3). When we compare the patients of 5.0-5.9 years (Group A, n=48) to the patients after 6 years (Group B, n=53), complex features (20.8% vs 37.8%, p=0.063) and AED treatments (6.3% vs 18.9%, p=0.059) were more common in Group B. Among group B, patients after 8 years were more apt to be treated by AED than youngers (6.1% vs 40.0%, p=0.002). When we compare the patients starting their first seizure before 5.0 years (Group C, n=78) to the patients after 5.0 years (Group D, n=23), Group C had more frequent seizures (6.6 vs 2.3, p= < 0.0001) and family history (58.3% vs 25.0%, p=0.039). Group D had more common abnormal neurologic findings (7.7% vs 21.7%, p=0.057). CONCLUSION: Febrile seizures in older age group are more associ-ated with complex features, EEG abnormalities and AED treatments. The patients with seizure onset before 5.0 years had more seizure frequency and family histories.

Clinical and EEG Characteristics of Epilepsy in Rett Syndrome / 대한간질학회지

PURPOSE: Rett syndrome (RS) is an X-linked dominant neurodevelopmental disease. The patients with RS have normal early development, however, experience gradual regression of speech and motor development. About 2/3 of the patients develop seizures and usually show characteristic EEG findings. This study was performed to investigate whether there is correlation between clinical staging and EEG features in RS. METHODS: Thirty-five patients diagnosed as having RS from 2003 to 2007 at Seoul National University Children's Hospital were retrospectively evaluated. Diagnosis of RS was made according to consensus diagnostic criteria in 2001. RESULTS: Epileptic seizures were present in 30 patients (85.7%). The seizure onset according to the clinical staging was as follows: 3 patients (10%) in stage I, 9 (30%) in stage II, 18 (60%) in stage III. Twenty-two patients had two or more seizure types. EEG patterns get worse deterioration of background activity and decrease epileptiform discharges by clinical stage evolution. Sixteen patients (53%) achieved seizure freedom with antiepileptic drugs at clinical stage III and IV. CONCLUSIONS: EEG features were neither diagnostic nor pathognomonic in epilepsy due to RS. However, EEG patterns and response to treatment changed according to the clinical staging. Therefore, AED therapy should be decided considering the clinical courses of RS.

Clinical Characteristics of Childhood Pompe Disease / 대한소아신경학회지

PURPOSE: Pompe disease is one of the glycogen storage diseases caused by a deficiency of acid alpha-glycosidase. This enzyme defect results in lysosomal glycogen accumulation in many tissues and shows a various spectrum of clinical features from early infantile hypotonia to mild weakness. For the investigation of the clinical characteristics of Pompe disease, we reviewed 6 cases of childhood Pompe disease diagnosed by muscle biopsy and acid alpha-glycosidase assay. METHODS: We reviewed the medical records of 6 childhood Pompe disease patients in Seoul National University Children's Hospital, retrospectively from January 2001 to October 2006. RESULTS: The age of the symptom onset was 1 month to 11 years(mean 2.2 years) and the diagnosis was made at the age of 8 months to 14 years(mean 5.3 years). The patients showed delayed motor development, motor weakness, hypotonia, cardiomegaly, hypertrophic cardiomyopathy, hepatomegaly, recurrent pulmonary infections but the severity was very diverse. Liver transaminase and CK levels were elevated in all of the patients. Their muscle biopsy showed the characteristic accumulation of purple colored glycogen granules and the degeneration of myofibers. CONCLUSION: Childhood Pompe disease had various clinical features and severities depending on the age of onset, organ involvement and the rate of progression. Enzyme replacement therapy may modify the disease courses, so we need to diagnose earlier for the treatment at an optimal time.

Cord blood IL-10, IL-12 in preterm newborns as predictors of respiratory distress syndrome and bronchopulmonary dysplasia / 소아과

PURPOSE: Inflammation plays a major role in the pathogenesis of RDS and BPD in the immature lung. We investigated the possible role of IL-10 and IL-12 in the cord blood of preterm newborns with RDS or BPD. METHODS: Forty preterm newborns whose mothers received antenatal care at Ewha Womans University Mokdong Hospital between January 2003 to June 2005, and agreed to testing their cord blood samples were enrolled. The gestational ages were below 34 weeks. Cord blood level of IL-10 and IL-12 were determined by ELISA. We separated the patients into 2 groups (RDS group and non- RDS group, BPD group and non-BPD group) and compared the cytokine levels and clinical records of the groups. RESULTS: Cord blood IL-10 level showed a significant inverse correlation with gestational age and birth weight (P=0.001, P=0.005). Preterm infants with RDS showed higher IL-10 level (1.0 vs 0.1 pg/mL; P=0.001) in the cord blood than those without RDS. The differences remained statistically significant after correction for the effect of gestational age between both preterm groups. Despite similar cord blood IL-10 levels, preterm infants with BPD showed no significant difference with those without BPD. CONCLUSION: Cord blood IL-10 levels are increased in preterm infants which may be due to the immuno-suppression occurring during pregnancy and to fetal immaturity because these levels are inversely correlated with the gestational age. So, Cord blood IL-10 level can be used as the predictor of RDS.

Homocysteine, insulin, vitamin B(12) and folic acid levels in obese children / 소아과

PURPOSE: As the prevalence of childhood obesity is increasing, hypertension, hyperlipidemia, insulin resistance and diabetes mellitus have become problems. High homocysteine levels and low vitamin B(12) supplementation are acknowledged to have a role in coronary artery disease, but there are few studies on homocysteine, insulin and vitamin B(12) levels in obese children. We aimed to study whether homocysteine, insulin, vitamin B(12), folic acid levels could have any difference and relation in obese children. METHODS: The disease group consisted of 27 children from 8 to 11 years old, whose obesity index was over 130. The control group consisted of 30 healthy children of the same age group. Obesity index and body mass index were calculated by height and body weight of the children, and their systolic and diastolic blood pressures at resting state were checked. Total cholesterol, triglyceride, homocysteine, insulin, vitamin B(12), folic acid levels were studied after 10 hours of fasting. Intracellular fluid, extracellular fluid, protein, mineral, muscle mass, lean body fat, fat mass and fat percentages were checked by bioelectrical impedance. RESULTS: Homocysteine levels were higher in obese children(8.1+/-2.1 micromol/mL vs. 4.9+/-1.0 micromol/mL). Insulin levels were also higher in obese children(26.8+/-11.2 microIU/mL vs. 12.5+/-5.24 microIUl/mL). Vitamin B(12) was lower in obese children(798.6+/-174.3 pg/mL vs. 967.8+/-405.0 pg/mL). But there was not a difference in the folic acid levels between the two groups. In obese children, systolic blood pressure (r=0.535), triglyceride(r=0.517), total cholesterol(r=0.408), folic acid(r=0.408), vitamin B12(r=0.338) and abdomoanl fat %(r=0.306) had a positive correlation. CONCLUSION: We found definite differences of insulin, homocysteine, and vitamin B(12) plasma levels in obese children, but we need more study to use those parameters as risk factors of metabolic syndrome in pediatric obese patients.

Clinical Characteristics of Temporal Lobe Epilepsy in Childhood / 대한소아신경학회지

PURPOSE:Temporal lobe epilepsy(TLE) is now recognized as a distinct syndrome in adults. The seizure evolution in adult patients is well characterized, manifesting initially with an aura, behavioral arrest, automatism, and secondary generalized tonic-clonic seizures. In contrast, relatively few studies are available for the pediatric age group. In the present study, we investigated children undergoing temporal lobectomy for refractory seizures and correlated the pathologic findings with clinical presentations. METHODS:The records of the pediatric patients admitted at the Seoul National Children's Hospital for epilepsy surgery between January 1995 and December 2005 were reviewed. Then, eighteen patients were included in this study. The clinical records were reviewed in terms of the patient profiles imaging findings, surgical techniques, and pathologic findings. The seizure outcomes were described according to the Engel's classification. RESULTS:The postsurgical outcomes were favorable. Lateral temporal epilepsy was more common in childhood than in adulthood. Dual pathology was commonly found. Arm dystonia or tonic arm elevation have a lateralizing value. Head turning may have a lateralizing value based upon a time sequence. The brain MRI was less predictable for pathologic findings. The ictal EEG cannot always have a localizing value. Delta beginning in the ictal rhythm may suggest lateral lobe epilepsy. Anterior temporal beginning of the ictal location may suggest mesial temporal lobe epilepsy. Ganglioglioma tends to cause rhythmic beta activities at the beginning of the ictal event. CONCLUSION:TLE in childhood shows more complex and atypical clinical manifestations and have more variable etiologies. No single presurgical investigation can be a good predictable value to localization or lateralization.

Aseptic Meningitis Secondary to High-Dose Intravenous Immunoglobulin Therapy in Kawasaki Disease / 소아과

PURPOSE: Kawasaki disease is a multisystemic inflammatory vasculitis and associated with neurologic features such as aseptic meningitis. High-dose intravenous immunoglobulin(IVIG) is used to treat Kawasaki disease and generally considered to be safe, but rare cases of aseptic meningitis with unknown etiology have been reported. The aseptic meningitis associated with Kawasaki disease was compared with meningitis as the adverse reaction of high-dose IVIG. METHODS: Sixteen Kawasaki disease patients with typical meningeal irritation symptoms were reviewed from January 1997 to July 2002. Group I(n=11) had meningitis associated with Kawasaki disease and Group II(n=5) had meningitis as the adverse reaction of high-dose IVIG therapy. The clinical features and hematologic and cerebrospinal fluid(CSF) findings were compared between the two groups. RESULTS: The duration of fever was significantly longer in group I than group II. Meningeal irritation symptoms were milder in group II than group I. Hemoglobin levels were lower in group II than group I. Monocyte counts were higher in group I than group II. In the CSF analysis, neutrophil counts were significantly higher in group II than group I. Otherwise, there were no significant differences in CSF protein and sugar levels between the two groups. CONCLUSION: Aseptic meningitis occurred in patients with Kawasaki disease after administration of high-dose IVIG. High-dose IVIG was considered to be safe in general. However, clinicians should be aware of the potential for neurologic complications such as acute aseptic meningitis in patients receiving high-dose IVIG for Kawasaki disease.

A Study for Adiponectin in Obese Adolescents with Hypertension / 소아과

PURPOSE: The adipocyte has traditionally been known as a reservoir for energy, but currently there is growing evidence that the adipocyte plays an important role in the pathogenesis of energy metabolism and homeostasis. Adipocytokine released from the adipocyte has been known to play a role in diabetes mellitus, coronary artery disease and other diseases related with obesity. The purpose of this study was to investigate the relationship between adipocytokines and hypertension and to find out whether it is useful to evaluate adipocytokines as a risk factor for the development of hypertension in obese adolescents. METHODS: Forty five obese adolescents(16-17-years-old, obesity index >130) with hypertension and 27 normal controls with normotensive blood pressure were included in this sudy. Obesity index and body mass index were calculated and blood pressure was measured at the resting state. Lipid profile, insulin, adiponectin, leptin, TNF-alpha and IL-6 levels were tested after 10 hours of fasting. RESULTS: Adiponectin was significantly lower in the obese group, compared to the control group (3,241.3+/-2,055.9 mug/mL vs 5,088.4+/-1,347.1 mug/mL). Leptin(10.6+/-5.4 ng/mL), TNF-alpha(7.2+/-0.8 pg/mL) and IL-6(7.2+/-0.8 pg/mL) were significantly higher in the obese group. Insulin was significantly higher in the obese group than the control group(14.7+/-7.5 IU/mL vs 7.9+/-2.9 IU/mL). Adiponectin had negative correlations with TNF-alpha, body mass index, LDL cholesterol, obesity index, diastolic, and systolic blood pressure. CONCLUSION: Adiponectin might be a predictor of hypertension and a guideline for clinical intervention. Further clinical research will be necessary to ascertain the relation of adiponectin in hypertensive patients without obesity.

Differentiation and Apoptosis of the Erythroid, Myeloid and Megakaryocytic Lineage Cells in vitro Culture of Cord Blood CD34+ Cells Using Various Cytokines / 대한혈액학회지

BACKGROUND: In vitro generated cells from cord blood (CB) CD34+ cells increase cell dose and may reduce the severity and the duration of pancytopenia after transplantation. But safe engraftment for adolescents and adults is still not predictable and standardized. We attempted to establish a clinically application of in vitro generated cells by investigating the use of cytokines for the culture of CB CD34+ cells. METHODS: CD34+ cells, purified from four separate human CB units by magnetic bead selection, were cultured in IMDM with several cytokines. Differentiation of the in vitro generated cells has been confirmed by flowcytometry with specific erythroid, myeloid and megakaryocytic lineage surface markers. And apoptosis of these cells also was analysed with annexin V staining and morphologic analysis under the electron microscopic examination was done, simultaneously. RESULTS: Purified CB CD34+ cells were expanded with differentiation from CD38- to CD38+ expression with time. CB CD34+ cells could be terminally differentiated into erythroid (GPA+) and myeloid (CD33+/CD15+) lineage cells without apoptosis (annexin-V - ) in the presence of EPO and G-CSF, respectively. Megakaryocytic differentiation was partially arrested in early stage due to apoptosis in the presence of TPO. Morphological examination using electron microscope revealed all stages of erythroid and myeloid lineage cells without apoptosis, and apoptotic megakaryocytic lineage cells of early stage. But we could observe the small number of fully maturated platelets. CONCLUSION: CB CD34+ cells were terminally differentiated to erythroid, myeloid, and megakaryocytic lineage cells with or without apoptosis by several cytokines.