Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: Surgical treatment is considered as a secondary treatment option for obstructive sleep apnea (OSA). This study was performed to determine whether surgical treatment can be considered in patients with moderate-severe OSA as a treatment modality. MATERIALS AND METHODS: A total of 127 patients with moderate-severe OSA were retrospectively enrolled. The anatomic narrowing sites were mainly evaluated using cephalometry and drug induced sleep endoscopy (DISE), and then multi-level surgeries were performed. RESULTS: Both uvula and soft palate were the most frequent narrowing sites and a total of 110 patients showed upper airway narrowing more than two anatomic structures. A total of 79 patients (62.1%) were categorized as responders and 48 patients (39.1%) were non-responders. After multi-level sleep surgeries, patients' subjective symptoms and sleep parameters were significantly improved. However, AHI was not considerably decreased. Non-responders to sleep surgeries showed relatively higher rates of severe OSA and body mass index. Tongue base narrowing, incomplete corrections of nasal pathologies and soft palate were significant factors for lower success rates. CONCLUSION: We estimate that sleep surgery might be a therapeutic option for moderate to severe patients with OSA. A delicate pre-operative evaluation for upper airway narrowing is necessary to adapt sleep surgery to these patients.

Should the High Septal Deviation be Corrected to Improve Nasal Obstruction During Septal Surgery?

BACKGROUND AND OBJECTIVES: High dorsal deflection of the nasal septum around cartilage or the perpendicular plate is technically difficult to correct. The objective of this study was to assess whether correction of high septal deviation during septoplasty is necessary to improve nasal airflow. PATIENTS AND SURGICAL METHOD: Twenty-one patients with high septal deviation around the septal cartilage or the perpendicular plate were included in this study. In order to improve nasal obstruction, septoturbinoplasty was performed, but high septal deviation was not corrected. Subjective and objective improvements were evaluated using the visual analogue scale and acoustic rhinometry 1 month before and 3 months after surgery. RESULTS: After correction of nasal septum deviation except high septal deviation and reduction of turbinate mucosal volume, postoperative nasal volume and minimum cross-sectional area were significantly increased. Subjective symptom scales for nasal obstruction, rhinorrhea, sneezing, and posterior nasal drip were considerably improved after limited septoturbinoplasty in patients who still had high dorsal deflection of the nasal septum. CONCLUSION: Our findings suggest that limited septoturbinoplasty without excessive resection of high dorsal deflection of the nasal septum can improve nasal airflow and reduce subjective symptoms, including nasal obstruction.

A Case of Subdural Hematoma due to Brandt-Daroff Habituation Excercise / 대한이비인후과학회지

Subdural hematoma is a common disease of intracranial hemorrhage that accounts for 11-21% of all head trauma patients. It is defined as a hematoma that develops between dura mater and subarachnoid space. In elder patients, mild trauma may not always be accurately recognized and symptoms may not develop slowly due to the large area of subdural space. Headache is the most common symptom of subdural hematoma and may be associated with hemiplegia, dysarthria, sensation disorder, conscious disorder, and etc. We present, with a literature review, a case of a patient who developed subacute subdural hematoma after performing Brandt-Daroff habituation exercise to treat benign paroxysmal positional vertigo.

Nasal Obstruction due to Fibrous Dysplasia Invading Inferior and Middle Turbinates: A Case Report and Literature Review / 대한이비인후과학회지

Fibrous dysplasia (FD) is a rare type of fibro-osseous lesion characterized by progressive replacement of normal bone with immature tissue. The involvement of craniofacial bones is reported in 10% of FD cases, while the involvement of sinonasal cavity is extremely rare. We report a unique case of FD in which the primary complaint was nasal obstruction. As FD cases involving the turbinate bones are very rare, we also reviewed all reported cases of FD involving the inferior or middle turbinates. Based on our experience and a review of the relevant literature, we conclude that inferior and/or middle turbinectomy via endoscopic approach and septoplasty can improve nasal symptoms.

A Case of Angioleiomyoma of Nasal Septum / 대한이비인후과학회지

Angioleiomyoma is a benign myogenic tumor that may develop wherever smooth muscle is present. It occurs commonly in the uterus, skin, and gastrointestinal tract and is rare within the nasal cavity, but only three of 24 reported cases of sinonasal leiomyoma may have originated from the nasal septum. Treatment of choice for these neoplasms is surgical excision. We present one case of nasal septal angioleiomyoma arising from the nasal septum with symptoms of nasal obstruction and epistaxis, which were successfully removed by endoscopic surgery.

Comparison of Cytokine Expression in Mesenchymal Stem Cells from Human Placenta, Cord Blood, and Bone Marrow

Mesenchymal stem cells (MSCs) are capable of self-renewal and differentiation into lineages of mesenchymal tissues that are currently under investigation for a variety of therapeutic applications. The purpose of this study was to compare cytokine gene expression in MSCs from human placenta, cord blood (CB) and bone marrow (BM). The cytokine expression profiles of MSCs from BM, CB and placenta (amnion, decidua) were compared by proteome profiler array analysis. The cytokines that were expressed differently, in each type of MSC, were analyzed by real-time PCR. We evaluated 36 cytokines. Most types of MSCs had a common expression pattern including MIF (GIF, DER6), IL-8 (CXCL8), Serpin E1 (PAI-1), GROalpha(CXCL1), and IL-6. MCP-1, however, was expressed in both the MSCs from the BM and the amnion. sICAM-1 was expressed in both the amnion and decidua MSCs. SDF-1 was expressed only in the BM MSCs. Real-time PCR demonstrated the expression of the cytokines in each of the MSCs. The MSCs from bone marrow, placenta (amnion and decidua) and cord blood expressed the cytokines differently. These results suggest that cytokine induction and signal transduction are different in MSCs from different tissues.

Perinatal Outcomes in Pregnant Women with Impaired Glucose Tolerance (IGT) Proven through 100 g Oral Glucose Tolerance Test (OGTT) / 대한주산의학회잡지

OBJECTIVE: To compare the perinatal outcomes of pregnant women with 100 g oral glucose tolerance test (OGTT) proven impaired glucose tolerance (IGT), with normal control and gestational diabetes mellitus (GDM) groups. METHODS: 159 pregnant women who had visited our medical center between March 2002 and March 2004, positive (> or = 140 g) for 50 g OGTT were included in this study. IGT was defined by the presence of one abnormal 100 g OGTT glucose value, and they were compared with the control group, and the GDM group(with at least 2 abnormal glucose values). The maternal and neonatal outcomes were assessed among three groups. RESULTS: Even though familial history of DM was significantly higher in the IGT and GDM group (p4 kg) and hypoglycemia was significantly increased in GDM group than other groups. The difference in the frequency of i) large for gestational age birthweight (>90 percentile) ii) preterm delivery, iii) APGAR score (1-min and 5-min), iv) shoulder dystocia, and v) congenital anomalies among the three groups was not notable-however, the incidence of neonatal hyperbilirubinemia was significantly higher and duration of NICU admission is significantly longer in the IGT group, compared to the control group (p95%) ii) infections (genitourinary and surgical wounds) in the three groups, the prevalence of preeclampsia was significantly higher in the IGT (p=0.018) and GDM group (p=0.023), compared with the control group. CONCLUSION: Neonatal hyperbilirubinemia, as well as maternal preeclampsia were significantly elevated in the IGT group. The results obtained thus far demonstrate the possibility of the need for active perinatal care with therapeutic intervention in pregnant women with IGT.

Clinicopathologic Characteristics and Prognostic Factors of Stage I and II Endometrial cancer of the uterus: A Study of 59 Cases / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the clinicopathologic findings, treatment, and prognostic factors of uterine endometrial cancer. METHODS: We retrospectively reviewed 59 patients with histologically proven stage I and II endometrial cancer between January 1994 and December 2004, for clinical profiles and survival. The survival of patients was determined by description of last follow up date in medical records or phone calls. RESULTS: The median age at the time of diagnosis was 51 years (range: 30-71 years) and the most common presenting symptom was vaginal bleeding (83.0%). Endometrioid adenocarcinoma was the most common (96.6%) histologic type of all cases. Forty-nine patients (83.0%) were FIGO stage I and 10 patients were stage II (17.0%), and the histological grades of the tumors were 23 (39.0%) grade 1, 17 (28.8%) grade 2, 7 (11.9%) grade 3, and 12 (20.3%) unknown, respectively. All patients were treated by surgery as primary treatment and given postoperative adjuvant therapy including radiation therapy (32.2%), concurrent chemotherapy and radiation therapy (6.8%), and chemotherapy (3.4%). The 5-year disease free survival rate (DFSR) of stage I and stage II were 92.7% and 66.7%, respectively. The age (> or =60) and menopausal status were significant prognostic factors by univariate anlaysis (p=0.0077; p=0.0149, respectively). However, parity, FIGO surgical stage, histological grade, myometrial invasion, and lymph-vascular space invasion were not significant prognostic factors (p>0.05). CONCLUSION: The age (> or =60) and menopause state were significant prognostic factors of stage I and II uterine endometrial cancer affecting survival of the patients.

Clinical application of serum CA 125 and CA 19-9 in Endometriosis / 대한산부인과학회지

OBJECTIVE: The aim of the present study was to investigate the clinical usefulness of serum CA 125 and CA 19-9 levels for diagnosing and determining the severity of endometriosis. METHODS: A total of 112 women who underwent gynecologic surgery between January 1998 and August 2004 were selected in this study. 81 patients had histologically confirmed endometriosis and the remaining 31 had benign ovarian tumor but no obvious evidence of endometriosis. Blood samples were collected in all patients before the operation and the mean values and standard deviations of both serum CA 125 and CA 19-9 levels were measured in various stages of disease. Both tumor markers were also measured in the control group. The results were compared to determine the usefulness of CA 125 and CA 19-9 in diagnosing and predicting the severity of endometriosis. As a results, new cutoff values of serum CA 125 and CA 19-9 in endometriosis were obtained. RESULTS: The mean levels of serum CA 125 and CA 19-9 in patients at stage III and IV of endometriosis were significantly higher than in patients without endometriosis, and increased in accordance with the advancement of the clinical stage. Statistically appropriate cutoff values of CA 125 and CA 19-9 were calculated to be 20 IU/mL and 10 IU/mL, respectively. The sensitivity and specificity of CA 125 at this cutoff value for endometriosis were 72% and 71%, respectively. The sensitivity and specificity were 59% and 55% respectively in the case of CA 19-9. CONCLUSION: CA 125 is a useful marker for diagnosing and determining the severity of endometriosis. CA 19-9 shows limitation in diagnosing endometriosis, but is indeed a potential marker in predicting the severity of disease.

Correlation of Serum Vascular Endothelial Growth Factor and Matrix Metalloproteinase-2 in Patients Complicated with Preeclampsia and Normotensive Pregnant Women / 대한산부인과학회지

OBJECTIVE: The aim of this study is to evaluate whether serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) are different between normotensive pregnant women and preeclampsia patients and also to investigate the relationship of VEGF and MMP-2. METHODS: We analyzed the serum levels of VEGF and MMP-2 in patients with preeclampsia (n=20) and normotensive pregnant women (n=20). RESULTS: Of the normotensive pregnant and preeclampsia women, the serum VEGF levels are 0.28 +/- 0.14 ng/mL 2.39 +/- 0.75 ng/mL, the serum MMP-2 levels are 11.81 +/- 1.75 ng/mL, 31.99 +/- 6.5 ng/mL respectively. These serum levels are higher in preeclampsia patients than normotensive pregnant women (P<0.001) The serum VEGF levels positively relate with plasma MMP-2 levels in preeclampsia (P<0.05, r=0.78). CONCLUSION: The serum VEGF levels highly correlate with the increased MMP-2 levels in preeclampsia, which may contribute the pathophysiology of preeclampsia.

Agenesis of corpus callosum prenatally diagnosed with fetal MRI: case report / 대한산부인과학회지

Agenesis of corpus callosum is the cerebral malformations whose prognosis is uncertain. But the complete agenesis shows more poor prognosis than partial agenesis. So, the type of agenesis can affect significantly the antepartum management. Recently, there has been a development in diagnostic tools like MRI to overcome these limitations of antenatal ultrasonography. We report a case of agenesis of corpus callosum which was diagnosed by prenatal MRI. This case was confused with Dandy-Walker complex in prenatal ultrasonography and supported in diagnosis by prental MRI.

Endometrial stromal sarcoma of the uterus: A study of 8 cases / 부인종양

OBJECTIVE: The purpose of this study was to investigate the clinicopathologic findings, treatment, and outcome of patients with endometrial stromal sarcoma (ESS) of the uterus. METHODS: This study retrospectively reviewed 8 patients with histologically proven stage I low-grade ESS of the uterus, at the Department of Obstetrics and Gynecology of Korea University Kuro Hospital, between May 1994 and July 2005, for clinical profiles and survival. The median follow-up was 79 months and ranged from 7 months to 131 months. RESULTS: The median age at the time of diagnosis was 43 years (range: 29-49 years). The common presenting symptoms were vaginal bleeding, lower abdominal pain and vaginal discharge. Four patients were treated with surgery followed by postoperative adjuvant chemotherapy, and four patients were treated with surgery alone. Recurrence was in one patient, and the site was the lung. The overall five-year survival rate of stage I low-grade ESS was 100%. Bilateral salpingo-oophorectomy and adjuvant chemotherapy did not significantly affect the survival of patients (p>0.05). CONCLUSION: The patients with stage I low-grade ESS have a very excellent prognosis. The role of bilateral salpingo-oophorectomy and adjuvant chemotherapy have not get been clearly defined and further studies, including prospective studies with larger numbers of patients, are needed.

A Case of Congenital Cytomegalovirus Infection with Severe Hydrocephalus in Prenatal Ultrasonography / 대한산부인과학회잡지

Cytomegalovirus (CMV) infection is one of the most common viral infections in human and it is known to cause primary and recurrent infections. CMV is spread to the fetus in 40% of pregnancies in primary infection, while 0.5-1% of pregnancies in recurrent infection are known to cause congenital infections. Only 10% of such infections are presented with severe symptoms, with the other 90% being asymptomatic. However, there are no definite methods to predict the manifestation of fetal infections or specific treatments in such cases. Intraventricular calcification, ventriculomegaly, intraventricular adhesion, abnormal patterns of brain fissures, brain atrophy, abnormal findings of cerebellum and cisterna magna, and hyperechoic bowels can be presented by ultrasonography in CMV infection. We introduce a case of CMV infection presented as ventriculomegaly and hyperechoic bowels by ultrasonography and pathologically confirmed by autopsy.

Angiotensinogen, Thermolabile Methylenetetrahydrofolate Reductase and Factor V Gene Variants among Korean Women with Preeclampsia, as Risk Factors / 대한산부인과학회잡지

OBJECTIVE: To know the genotypic distributions of Angiotensinogen, Thermolabile Methylenetetrahydrofolate Reductase (MTHFR) and Factor V Gene Variants, suggested as risk factors of preeclampsia, among Korean Women. METHODS: 113 preeclampsia patients and 70 normotensive pregnancy controls were evaluated. DNA was extracted from peripheral leukocytes, then PCR and restriction by appropriate enzymes were done to identify the single nucleotide polymorphism. The genotypic distributions of preeclampsia and the control group were compared. RESULTS: Nineteen of 113 women with preeclampsia (17%) and 14 of 72 with nulliparous preeclampsia (19%) were heterozygous for the angiotensinogen T704C mutation, and 94 of 113 women with preeclampsia (83%) and 58 of 72 women with nulliparous preeclampsia (81%) were homozygous. While 7/70 (10%) were heterozygous, and 59/70 (84%) were homozygous for the T704C mutation among the control subjects. The frequency of the MTHFR T677 allele was 36% in the preeclamptic group and 38% in the control group, and TT homozygosity was found in 26 preeclamptic women (23%) and in 13 controls (19%). No women were homozygous or heterozygous for the factor V Leiden mutation. CONCLUSION: Angiotensinogen T704C mutation is associated with preeclampsia in the Korean population. There was no association between the thermolabile variant of MTHFR and risk of preeclampsia in our study population. We observed no factor V Leiden mutation. We also suggested that a person with angiotensinogen T704C mutation plus MTHFR C677T variant does not have more of an increased risk for preeclampsia than with angiotensinogen T704C mutation only.

Uterine Artery Embolization for Leiomyoma / 대한산부인과학회잡지

OBJECTIVE: To evaluate the role of uterine artery embolization as treatment for symptomatic uterine leiomyoma. METHODS: From January 2000 to March 2002, 40 consecutive patients (mean age, 42.5 years; range, 27-53 years) underwent uterine artery embolization for the treatment of uterine leiomyomas. After a nonselective pelvic arteriogram was obtained, bilateral embolization was performed in each case. After discharge from the hospital, the patients were followed up at regular intervals (at 1st, 2nd, 3rd months, at 6th months, at 12 months and annually thereafter). The mean duration of follow-up was 11.5 months (range; 2-30 months). During the follow-up period, consecutive myoma volume, serum hemoglobin, menstrual index (MI) were checked. All patients were contacted by telephone to confirm any change in their symptoms after the embolization and were questioned regarding their satisfaction with the procedure. RESULTS: A total of 40 patients were treated successfully. Initially, the presenting symptoms of the participants were menorrhagia (34/40, 85%), dysmenorrhea (14/40, 35%) and bulk symptoms (4/40, 10%). Most patients had improvement in symptoms by 3 months after the procedure and patient satisfaction paralleled the symptom change. Of 34 patients who initially presented menorrhagia, 28 patients checked their own serum hemoglobin levels and recorded MI regularly. The patterns of change of serum hemoglobin levels and MI during follow-up period were statistically correlated with their symptom changes. And the mean dominant myoma volume was reduced by 40% after 1 month, by 56% after 3 months, by 71% after 6 months and by 72% after 12 months (ANOVA, SAS 8.0, p<.0007). CONCLUSION: We conclude that uterine artery embolization for leiomyoma is minimally invasive and effective method of treatment. Most patients report improved symptoms and satisfaction with the outcome from treatment.

Positive Margins after Cervical Conization and the Predictive Factors of Residual Disease / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the predictive factors of residual disease for positive conization margins. METHODS: Retrospective study was performed in 735 patients treated with bovie electroknife conization at the University Hospital of Kuro between January, 1988 and December, 2003. Of the 735 patients, 81 patients (11.0%) had positive margins after conization. 58 of these 81 patients underwent either immediate reoperation or monitoring with a Pap smear, HPV test, endocervical curettage and colposcopy. Fisher exact test, Trend test were used for statistical analysis. RESULTS: The mean age of the patients was 44.5 years. 27 of 58 patients (46.6%) undergoing conization followed by reoperation had residual lesion in the specimen obtained by reoperation. Severity of lesion was associated with the predictive factors of residual disease (p<0.05). Age of patients, site of resection margins were not associated with the predictive factors of residual disease. But more sufficient number of cases of Pap smear, HPV test, endocervical curettage and colposcopy directed biopsy are thought to be needed for stastistical analysis. CONCLUSION: Severity of lesion is useful in predicting residual disease for positive conization margins.

Isolated Oligohydramnios in Low-risk Pregnancy as a Predictor of Adverse Perinatal Outcome / 대한산부인과학회잡지

OBJECTIVE: The aim of our study was to assess whether isolated oligohydramnios is associated with adverse perinatal outcomes in low-risk term pregnancy. METHODS: Women delivered between March 2001 and July 2003, who underwent ultrasonography from 37 to 41(+6) weeks gestation were analyzed. Women undergoing labor induction for oligohydramnios were matched by gestational age and parity to women with normal amniotic fluid index measurements. Oligohydramnios was defined as an amniotic fluid index (AFI) 5.0 cm with respect to maternal age, parity, nulliparity, gestational age at delivery. The study (N=21) and control groups (N=100) had similar the primary outcome (rate of total cesarean delivery and rate of cesarean delivery for fetal distress) as well as the secondary outcome variables such as birthweight, Apgar score8 day. There were no differences between pregnancies with 5th percentile of AFI with respect to maternal age, parity, nulliparity, and the secondary outcome variables such as birthweight, Apgar score8 day. However, pregnancies with 5th percentile of AFI. Rate of cesarean delivery for fetal distress was not significantly different in the two groups. CONCLUSION: We demonstrated that oligohydramnios in low-risk term pregnancy does not affect the increased perinatal morbidity and mortality. Therefore, isolated oligohydramnios may not be a marker for fetal compromise in low-risk term pregnancy, and induction of labor may not be warranted in most cases.

Maternal Circulating Vascular Endothelial Growth Factor in Normal Pregnancies and their Relationship to Platelet Counts / 대한산부인과학회잡지

OBJECTIVE: The aim of the present study was to evaluate changes of vascular endothelial growth factor levels in maternal circulating blood during normal pregnancies and examine their relationship with maternal platelet counts. METHODS: The 33 subjects were selected from healthy normotensive women from the antenatal clinic at Korea University Medical Center, Guro Hospital. Blood samples for VEGF were taken at 7 to 8 weeks' gestation, 16 to 18 weeks' gestation, 24 to 26 weeks' gestation, 30 to 32 weeks' gestation, 37 to 41 weeks' gestation. Serum and plasma were extracted from all samples, and VEGF concentrations were measured in duplicates by competitive enzyme immunoassay. The 23 of them, the platelet counts were performed with an automated blood Coulter counter. RESULTS: Serum VEGF levels during normal pregnancies were mean 6.73 ng/mL at 7-8 weeks' gestation, 7.88 ng/mL at 16-18 weeks' gestation, 7.18 ng/mL at 24-26 weeks' gestation, 8.42 ng/mL at 30-32 weeks' gestation, 14.03 ng/mL at 37-41 weeks' gestation. Plasma VEGF levels were mean 5.50 ng/ mL at 7-8 weeks' gestation, 7.23 ng/mL at 16-18 weeks' gestation, 7.98 ng/mL at 24-26 weeks' gestation, 7.35 ng/mL at 30-32 weeks' gestation, 14.05 ng/mL at 37-41 weeks' gestation. The trends in the mean VEGF levels were similar between serum and plasma, with stable levels until 30 to 32 weeks' gestation, and then the levels were increased. There was no significant difference between serum VEGF levels and plasma VEGF levels (p=0.236) and no correlation between circulating VEGF levels and platelet counts. CONCLUSION: Our data suggests that platelets may not be the origin of elevated VEGF levels in normal pregnancies because there was no correlation between VEGF levels and platelet counts.

A Case of Vasa Previa / 대한산부인과학회잡지

Vasa previa is one of the most unusual and tragic accidents to fetus in obstetrics. This condition is not diagnosed easily because it is rare and unexpected. To improve the perinatal outcome, early detection by ultrasonography is very important during pregnancy. We present a case of vasa previa with velamentous insertion of cord with a brief review of the literatures concerned.

A Case of Intrauterine Pregnancy after Laparoscopic Bilateral Uterine Artery Ligation for Treatment Uterine Myoma / 대한산부인과학회잡지

Uterine artery ligation or embolization is a minimally invasive alternative for treatment of symptomatic leiomyoma. However, the experience with pregnancy management and outcome after ablating uterine blood flow is still unknown. We have recently experienced a case of a woman who had two successful spontaneous intrauterine pregnancies after laparoscopic uterine artery ligation to treat uterine myoma for dysmenorrhea and menometrorrhagia.