Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

The Level of Serum and Urinary Nephrin in Normal Pregnancy and Pregnancy with Subsequent Preeclampsia

PURPOSE: The aim of this study was to evaluate serum and urinary nephrin levels of normal pregnancy to establish a standard reference value and to compare them with patients who subsequently developed preeclampsia (PE). MATERIALS AND METHODS: In this prospective study, 117 healthy singleton pregnancies were enrolled between 6 to 20 weeks of gestation at 2 participating medical centers during October 2010 to March 2012. Urine and serum samples were collected at the time of enrollment, each trimester, and at 4 to 6 weeks postpartum. Enzyme-linked immunosorbent assay for nephrin was performed and samples from patients who subsequently developed PE were compared to the normal patients. RESULTS: Of 117 patients initially enrolled, 99 patients delivered at the study centers and of those patients, 12 (12.1%) developed PE at a median gestational age of 34⁺⁴ weeks (range 29⁺⁵–36⁺⁶). In the normal patients (n=68), serum nephrin level decreased and urinary nephrin level increased during the latter of pregnancy. In 12 patients who subsequently developed PE, a significant rise in the 3rd trimester serum and urinary nephrin levels, compared to the controls, was observed (p<0.001), and this increase occurred 9 days prior to the onset of clinical disease. CONCLUSION: As the onset of PE was preceded by the rise in the serum and urinary nephrin in comparison to normal pregnancy, serum and urinary nephrin may be a useful predictive marker of PE.

Palliation of postintubation tracheal stenosis using insulation-tipped diathermic knife 2: a case report

Objective: To report the first case of using the insulation-tipped diathermic knife 2 [IT knife-2] for the treatment of postintubation tracheal stenosis

Clinical Presentation and Intervention: A 71-year-old female patient with a history of endotracheal intubation 3 years earlier presented with throat discomfort, gross wheezing and dyspnea. Chest imaging and bronchoscopy demonstrated a strand-like tracheal stenosis in the upper trachea. The IT knife-2 was used to treat the patient and the lesion was palliated without complication

Conclusion: This case was successfully treated with the IT knife-2 and thus implies a potential usefulness of the IT knife-2 as a new modality for bronchoscopic intervention

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

Comparison of the performance of screening test for gestational diabetes in singleton versus twin pregnancies

OBJECTIVE: We compared the performance of the 50-g glucose challenge test (GCT) in singleton versus twin pregnancies and investigated the need for adjusting GCT cutoff values for gestational diabetes mellitus (GDM) in twin pregnancies among Korean women. METHODS: A retrospective chart review was performed in women who underwent GCT at 24 to 28 weeks' gestation and delivered in our department between January 2000 and April 2008. GCT performance was compared between singleton and twin pregnancies for an ideal cutoff value of the GCT for GDM screening. RESULTS: GCT results were available in 3,578 pregnancies (3,435 singleton and 143 twin pregnancies). The mean GCT value was higher in the twin group than in the singleton group. Women in the twin group had a higher mean GCT value (P=0.043) and a higher incidence of GCT > or =130, > or =135, and > or =140 mg/dL (P=0.014, 0.005, and 0.015, respectively). The false positive rate for GCT > or =140 mg/dL was significantly higher in the twin than in the singleton group (P=0.042). The optimal GCT screening cutoff value appears to be > or =145 mg/dL in twin pregnancies. CONCLUSION: Our study demonstrates that the GCT is associated with a higher false positive rate in twin rather than singleton pregnancies. This study suggests we should consider adjusting the GCT cutoff value for GDM in Korean twin pregnancies.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

Metastatic Pulmonary Mucoepidermoid Carcinoma with Fulminant Clinical Course / 이화의대지

Pulmonary mucoepidermoid carcinoma (MEC) is a rare form of lung cancer that originates from submucosal glands of tracheobronchial tree. Unlike low-grade tumor with benign nature, high-grade case is even rarer and has aggressive clinical features with no definite treatment option. Here, we report a case of high-grade pulmonary MEC with fulminant clinical course. A 74-year-old man presented with cough, sputum and mental change. Chest imaging showed massive mediastinal lymphadenopathy with obstructive pneumonia, and multiple metastases in lung and adrenal gland. Bronchoscopy showed polypoid masses obstructing right main bronchus and bronchus intermedius. Histopathology revealed a mixture of glandular structure lined with mucussecreting cells and nests of squamoid cells with nuclear atypia and pleomorphism, which is compatible with high-grade MEC. We intensively treated the patient with combination antibiotics and ventilator care. However, the patient did not respond to the treatment and rapidly deteriorated, and finally expired a month after diagnosis.

Pregnancy Outcomes in Women with Moyamoya Disease: Experiences at a Single Center in Korea

PURPOSE: Moyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD. MATERIALS AND METHODS: We conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded. RESULTS: We identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9+/-3.5 years old. The mean gestational age at delivery was 38.0+/-0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7+/-348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days. CONCLUSION: For pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.

Image Settings Affecting Nuchal Translucency Measurement Using Volume NT(TM) Software

PURPOSE: To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT(TM) software. MATERIALS AND METHODS: In 79 pregnant women, NT was measured using Volume NT(TM). Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10degrees intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. RESULTS: The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40degrees and -0.10 mm (p<0.01) between 2D and 41-50degrees. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. CONCLUSION: NT measurements made using Volume NT(TM) are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.

Current status of infrastructures of obstetrics and gynecology in South Korea

No abstract available.

A Case of Urosepsis Caused by Aerococcus viridans / 대한내과학회지

Aerococcus viridans is a rare pathogen in humans, with only six cases of A. viridans urinary tract infections reported worldwide. Nosocomial urinary tract infections with bacteremia caused by A. viridians are even rarer, with no prior reports of urosepsis caused by A. viridans occurring in the Republic of Korea. Here we report a case of urosepsis caused by A. viridans in a 79 year-old female nursing home resident. The patient was admitted to the hospital presenting a fever of 39degrees C, chills, and oliguria for two days prior to admission. Urine culture yielded a robust growth of 105 CFU/mL of A. viridians, with blood culture positive for the same organism. Following diagnosis, the patient was treated with ciprofloxacin intravenously for 2 weeks, resulting in clearance of the infection and a full recovery from urosepsis. Although A. viridans is rarely associated with human infections, this case shows that, under the right conditions, it can be responsible for severe infections like urosepsis.

A Case of Immunoglobulin G4-Related Disease Presenting as a Pleural Mass / 결핵및호흡기질환

Immunoglobulin G4 (IgG4)-related disease is a newly recognized condition characterized by fibroinflammatory lesions with dense lymphoplasmacytic infiltration, storiform-type fibrosis and obliterative phlebitis. The pathogenesis is not fully understood but multiple immune-mediated mechanisms are believed to contribute. This rare disease can involve various organs and pleural involvement is even rarer. We report a case of IgG4-related disease involving pleura. A 66-year-old man presented with cough and sputum production for a week. Chest radiography revealed consolidation and a pleural mass at right hemithorax. Treatment with antibiotics resolved the consolidation and respiratory symptoms disappeared, but the pleural mass was unchanged. Video-assisted thoracoscopic surgery was performed. Histopathology revealed dense lymphoplasmacytic infiltration and storiform fibrosis with numerous IgG4-bearing plasma cells. The serum IgG4 level was also elevated. Further examination ruled out the involvement of any other organ. The patient was discharged without further treatment and there is no evidence of recurrence to date.

A Huge Umbilical Vein Aneurysm: Case Report and a Brief Review of Literatures Describing Umbilical Vessel Aneurysm / 대한주산의학회잡지

An umbilical vein aneurysm is rare, but appears to be associated with fetal morbidity and mortality. There are no specific guidelines for pregnancy with umbilical vein aneurysm and the management is substantially up to the clinician. We report a case of intra-amniotic umbilical vein aneurysm diagnosed at 35 gestational weeks by ultrasound. Because the aneurysm was growing rapidly, prompt cesarean delivery was conducted. After delivery, a huge fusiform umbilical cord was noted, which was confirmed to be umbilical vein aneurysm by pathological examination. We also reviewed previous reported cases and summarized the management strategies of prenatally detected umbilical vein aneurysms. In addition, the umbilical vein in this case report had the largest size ever reported.

Pulmonary Tumor Thrombotic Microangiopathy Associated with Advanced Gastric Cancer Successfully Treated with Chemotherapy / 이화의대지

Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon and fatal malignancy-related pulmonary complication characterized by fibrocellular intimal proliferation of small pulmonary arteries and arterioles. It causes marked pulmonary hypertension, right-side heart failure, and sudden death. Diagnosis of PTTM is extremely difficult while the patient is alive. Here, we report a 44-year-old woman who presented with complaining of progressing dyspnea and pulmonary hypertension but with no history of cancer. She was diagnosed with PTTM caused by advanced gastric cancer ante mortem and was treated effectively with chemotherapy.

Evaluation of the Temporal Association between Kawasaki Disease and Viral Infections in South Korea

BACKGROUND AND OBJECTIVES: This study is aimed at elucidating potential temporal associations between the occurrence of Kawasaki disease (KD) and various viral infections. SUBJECTS AND METHODS: We obtained monthly patterns of KD from the seventh nationwide survey and viral detection data from the Korea Centers for Disease Control and Prevention from 2009 to 2011 and evaluated temporal correlations between them for each month. The respiratory viruses detected using a multiplex real-time-polymerase chain reaction kit were influenza virus (A/H1N1, A/H3N2, A/H5N1, and B), adenovirus, parainfluenza virus (type 1, 2, 3), respiratory syncytial virus (type A, B), human rhinovirus, human coronavirus (OC43/229E, NL63), human bocavirus, and enterovirus. RESULTS: We obtained data from a total of 13031 patients who were treated for acute KD from 87 hospitals with pediatric residence programs. During this survey, KD showed highest overall incidence in summer and winter seasons and lowest incidence in February and October. We received viral detection data for a total of 14267 patients. Viral detection was highest during winter and spring seasons. The most commonly detected virus was human rhinovirus (32.6%), followed by influenza virus (26.8%). The monthly incidence of KD showed significant correlation with the monthly overall viral detection (p=0.022, r=0.382). In particular, human bocavirus and enterovirus have significant correlations with monthly patterns of KD occurrence (p=0.032 and p=0.007, respectively) and influenza virus correlated with KD occurrence with borderline significance (p=0.063). CONCLUSION: The temporal association between monthly occurrence of KD and viral detection suggests the etiologic importance of precedent infection in the development of KD.

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

OBJECTIVE: To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. METHODS: Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. RESULTS: Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (> or =300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. CONCLUSION: Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.

Epidemiology of Kawasaki disease in infants 3 months of age and younger / 소아과

PURPOSE: This study investigated the epidemiology of Kawasaki disease (KD) in infants 3-month-old. RESULTS: The 609 KD patients 2- and 3-months-old. The ratio of males to females was 1.72:1. The incidence of coronary artery (CA) dilatation (19.9% vs. 18.7%) and CA aneurysms (3.4% vs. 2.6%) detected by echocardiography did not differ significantly between patients with KD younger and older than 3-month-old. CONCLUSION: Compared with the data for the KD patients >3-month-old, the data for the 609 patients < or =3-month-old did not show a significantly higher incidence of CA dilatation or CA aneurysms.

Effects of Night Sleep on Motor Learning Using Transcranial Magnetic Stimulation

OBJECTIVE: To investigate the effects of night sleep on motor cortical excitability with TMS (transcranial magnetic stimulation) and finger tapping performance. METHOD: Eight volunteers were enrolled to investigate the effects of day wake or night sleep on motor learning and finger performance. Each subject underwent a finger tapping task over a 12 hour period, which was employed to evaluate the motor cortical excitability affected by motor learning. Starting at 9:00 am for the day wake cycle and restarting at 9:00 pm for the night sleep cycle. The finger tapping task was the index finger of the non-dominant hand with the Hangul word personal computer (PC) training program. The data was assessed by comparing the changes observed with the cortical excitability and finger tapping performance tests between the day wake and night sleep after equivalent amounts of training. RESULTS: The results showed that in paired-pulse techniques, there was a significant decrease of intracortical inhibition (ICI) in the morning following the night sleep cycle (p<0.05), but no significant change was seen in the ICI in the evening for the day wake cycle. In addition a significant decrease of the ICI was observed in comparison to the morning following the night sleep cycle and the evening following the day wake cycle (p<0.05). The 140% recruitment curve (RC) and accuracy of the finger tapping performance demonstrated a significant improvement for both cycles (p<0.05). CONCLUSION: Through this study, we observed that the Hangul typing practice requires both explicit and implicit skill learning. And also the off-line learning during a night of sleep may be affected by an inhibitory neurotransmitter related synaptic plasticity and by the time dependent learning with recruitments of remote or less excitable motor neurons in the primary motor cortex.

Alien Hand Syndrome in Stroke: Case Report & Neurophysiologic Study

Alien Hand Syndrome is defined as unwilled, uncontrollable, but seemingly purposeful movements of an upper limb. Two major criteria for the diagnosis are complaint of a foreign limb and complex, autonomous, involuntary motor activity that is not part of an identifiable movement disorder. After a cerebrovascular accident in the corpus callosum, the parietal, or frontal regions, various abnormal involuntary motor behaviors may follow. Although different subtypes of Alien Hand Syndrome have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal motor behaviors of the upper extremity. And there are few known studies about the neurophysiology of this syndrome using transcranial magnetic stimulation (TMS). We recently experienced 2 rare cases of Alien Hand Syndrome which occurred after anterior cerebral artery (ACA) infarction. A 72 year-old male with right hemiplegia following a left ACA infarct had difficulty with voluntarily releasing an object from his grasp. A 47 year-old female with left hemiplegia following a right ACA infarct had a problem termed 'intermanual conflict' in which the two hands appear to be directed at opposing purposes. Both of them had neurophysiologic studies done, and showed reduced amplitude by single pulse MEP and a lack of intracortical inhibition (ICI) by paired pulse TMS. No abnormalities were found in SSEP.