Factors Related to Sleep Time Underestimation in Obstructive Sleep Apnea: Retrospective Study Based on Polysomnographic Data

BACKGROUND: The perception of sleep time in obstructive sleep apnea (OSA) is not well understood, some studies have reported that subjects with OSA have abnormal sleep perception. We hypothesized that the severity of OSA would affect the sleep perception of patients with OSA and investigated the associated factors that affect the sleep perception in OSA. METHODS: Four hundred and sixty eight subjects with OSA were included in present study. Subjects with OSA were divided, depending upon their sleep perception. The first group included individuals who underestimated their time spent sleeping, the second group included those who did not underestimate their sleep time. The underestimation of sleep time is defined as the perceived total sleep time being less than 80% of that measured in polysomnography (PSG). All participants were analyzed their demographics, PSG parameter and questionnaires such as Beck Depression Inventory, Epworth Sleepiness Scale. RESULTS: Of 468 participants, 179 (38.2%) subjects were included in the group that underestimating sleep. Gender (female, odds ratio [OR]=2.01, 95% confidence interval [CI]=1.25–3.22), depression (OR=1.75, 95% CI=1.03–2.97) and proportion of slow wave sleep (OR=0.98, 95% CI=0.96–0.99) were related to the underestimation of sleep. CONCLUSIONS: The underestimation of sleep in OSA is not directly related to OSA severity. Gender, psychiatric disorder, and sleep architecture are associated with the underestimating sleep in OSA.

Erratum to: HIFU: Effects and Clinical Effectiveness of Non-surgical Therapy for Uterine Fibroids

Author's list and affiliation correction.

HIFU: Effects and Clinical Effectiveness of Non-surgical Therapy for Uterine Fibroids

No abstract available.

Herpes Simplex Virus 2 Infection Rate and Necessity of Screening during Pregnancy: A Clinical and Seroepidemiologic Study

PURPOSE: This study determined the seroprevalence of herpes virus 2 in gravidas and the differences between herpes virus 2-infected and healthy gravidas. The need to screen gravidas for herpes virus 2 was also evaluated. MATERIALS AND METHODS: A retrospective analysis involving 500 gravidas who underwent herpes virus 2 serologic testing and delivery in our hospital between January 2009 and August 2010 was performed. All patients in the study group were classified as herpes simplex virus 2 (HSV2) positive, and all cases were analyzed with respect to the clinical course of the pregnancy, pregnancy outcome, obstetric complications, and neonatal outcomes. SPSS software (version 14.0) was used for statistical analysis. A chi-square test and Student's t-test were used for statistical analysis. RESULTS: In the current study, the herpes virus 2 seroprevalence rate in gravidas was 17%. There was no significant difference in the rates of preterm delivery, premature rupture of membranes, preterm labor, and intrauterine growth restriction between the herpes virus 2-infected gravidas and the healthy control group. The rates of spontaneous abortion and sexually transmitted disease were higher in the herpes virus 2 infection group than the healthy control group. CONCLUSION: After educating gravidas on genital herpes and, if gravidas thereafter consent to herpes virus 2 screening, the risk of neonatal herpes virus 2 infections can be reduced. In addition, examination of gravidas for sexually transmitted diseases would increase as would appropriate treatment.

Isolated Inferior Rectus Palsy from Midbrain Infarction / 대한뇌졸중학회지

We describe a patient with isolated inferior rectus palsy due to midbrain infarction. A 68-year-old-man developed vertical diplopia of sudden onset which was maximal with a right lower side gaze. Neurological examination revealed weakness of the right inferior rectus muscle. Magnetic resonance imaging of the brain showed a focal infarction in the dorsomedial portion of the right midbrain tegmentum. The sole involvement of fascicular fibers of the inferior rectus muscle in the midbrain was accountable as the cause of this isolated inferior rectus palsy. We think that this is a case supporting the three-dimensional model of somatotopic fascicular arrangement of oculomotor nerve in the midbrain.

An unusual foreign body in the bladder 5 years after a laparoscopic burch colposuspension / 대한산부인과학회지

Stress urinary incontinence is the predominant symptom in young and middle-aged women. Stress urinary incontinence is not a life-threatening disease but can lead to discomfort, which can also limit the social and sexual activities of women. Lately TOT operation is performed in most cases of stress urinary incontinence. But Burch colposuspension had been one of successful operations for genuine stress incontinence until TOT procedure was performed. Burch colposuspension has significant morbidity such as bleeding, infection and wound hematoma, and subsequent complications including voiding difficulty, de novo detrusor instability, recurrent urinary tract infection and uterovaginal prolapse. In this case, Delayed migration of the suture and bolster after an endoscopic Burch colposuspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We report an unusual complication 5 years after Burch operation. It was an intravesical foreign body granuloma caused by suture material.

Group B Streptococcal Colonization Rate in Korean Pregnant Women / 대한산부인과학회지

OBJECTIVE: To evaluate the colonization rate of the group B streptococcus (GBS) in Korean pregnant women and their neonates, and the antimicrobial susceptibility of isolated GBS. METHODS: From March 2005 to May 2005, pregnant women who visited 3 obstetric clinics in Goyang-si and Paju-si for antenatal care after 35 weeks of gestation were enrolled. According to Centers for Disease Control and Prevention (CDC) guideline for collecting and processing clinical specimens for group B streptococcal culture, specimens were obtained from the lower third of the vagina and perianal areas, and then inoculated on Todd-Hewitt broth. The test for antimicrobial susceptibility was performed by a disc diffusion method. RESULTS: Of the 273 pregnant women, 13 (4.8%) had a positive culture from at least 1 site (vaginal culture 6, perianal culture 3, both 4). No GBS colonization was found in their neonates. The antibiotic resistance rate was 53.9% (7/13) for erythromycin and 61.5% (8/13) for clindamycin. CONCLUSION: In this study, the colonization rate of group B streptococci in Korean pregnant women was found to be lower than those reported in USA, Western Europe, and other Asian countries. The antibiotic resistance rate for erythromycin and clindamycin was higher than those reported in other countries. Further evaluation was needed to establish the screening and chemoprophylaxis guideline for Korean pregnant women.

The Effectiveness of a Preoperative Use of Misoprostol in Laparoscopically Assisted Vaginal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To investigate the effectiveness of a single preoperative dose of rectal misoprostol in laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: Between October 2003 and July 2004, 63 patients underwent LAVH with a single preoperative dose of rectal misoprostol 400 microgram at Grace women's hospital. To compare efficacy of a single preoperative dose of rectal misoprostol, 63 patients underwent LAVH without misoprostol were sampled during same period at Grace women's hospital. Clinicopathological variables were collected from the review of medical record and compared between two groups. Included variables were age, parity, BMI, uterus weight, largest myoma diameter, operation time, 24 hr Hb change, blood loss during operation, postoperative morbidity and postoperative complication. Associations between variable were studied using paired t-test. RESULTS: There were no significant differences in age, parity, BMI, uterus weight, largest myoma diameter between each groups. Comparing each groups in operative outcomes, estimated blood loss (155.0 +/- 97.8 mL vs 220.1 +/- 82.5 mL) and 24 hr Hb change (1.10 +/- 0.53 g/dL vs 1.57 +/- 0.46 g/dL) were significantly reduced in misoprostol group. CONCLUSION: A single preoperative dose of rectal misoprostol is a simple, reliable method for reducing intraoperative blood loss in LAVH.

Effects of Metformin in Patients with Polycystic Ovary Syndrome (PCOS) undergoing In Vitro Fertilization and Embryo Transfer / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the effects of metformin in PCOS patients undergoing IVF-ET. METHODS: From January 2002 to December 2004, 87 cycles in 32 PCOS patients undergoing IVF-ET at the Infertility clinic of Grace Women's Hospital were randomly divided into two groups and enrolled in this study. The diagnosis of PCOS was made by the criteria from 2003 Rotterdam Consensus. Metformin group (19 patients, 45 cycles) received metformin (Daewoong Pharma Co., Korea; 500 mg three times or two times a day from one or two months before and during IVF cycle) and control group (13 patients, 42 cycles) did not receive metformin. All patients received controlled ovarian hyperstimulation (COH) using gonadotropins (Fostimon, IBSA, Switzerland) with GnRH antagonist (Cetrotide, Serono, Germany). When leading follilces reached 18 mm in diameter, recombinant hCG 250 ?g (OVIDREL, Serono, Italy) was injected. Oocytes were retrieved transvaginally 35 hours later. The luteal phase was supported everyday by progesterone 50 mg IM (Progest, Samil, Korea) with micronized progesterone 200 mg vaginal insertion (Utrogestan, Besins, France). RESULTS: There was no statistical difference in the patients age (34.1+/-3.0 vs 33.5+/-2.9 years), the duration of infertility (4.3+/-1.3 vs 4.5.+/-1.3 years) and BMI (23.5+/-2.4 vs 24.01+/-2.7 kg/m2) among two groups (p> or =0.05 for each). There was also no statistical difference in the indications of IVF among two groups; ovulation factor (27 cycles vs 23 cycles), tubal factor (7 vs 8), male factor (8 vs 7) and other factor (3 vs 4) (p> or =0.05). The duration of ovulation induction in metformin group was significantly shorter when compared with control group (10.1+/-2.3 vs 13.8+/-2.2 days, p<0.05). Total doses of FSH-HP in metformin group were significantly less than that in control group (30.3+/-11.5 vs 39.9+/-11.7 ampules, p<0.05). There was no difference in the number of aspirated oocytes (10.5+/-4.7 vs 9.6+/-3.6), the fertilization rate (65.9+/-17.4% vs 63.2+/-25.9%), implantation rate (30.3+/-11.5% vs 38.1+/-17.3%) and the number of good quality embryo (5.0+/-1.8 vs 4.7+/-2.5, p< or =0.05). Clinical pregnancy rate was higher in metfomin group (33.3% vs. 23.8%), although statistically not significant. CONCLUSION: Although more randomized study is needed, metformin therapy in PCOS patients undergoing IVF has possibility of reducing the duration of COH and the gonadotropin doses.

A Case of Edward Syndrome with Choroid Plexus Cyst / 대한산부인과학회잡지

Trisomy 18 is the second most common chromosomal anomaly which reach to live birth next to Down syndrome. Several methods were proposed to screen patients on the risk of Edward syndrome like maternal serum levels of total human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and unconjugated estriol or free beta hCG with AFP, but the serum screening has only 67% detection rate with a 7.2% of false positive rate. Therefore, in order to overcome the limitations which the serum markers have, detailed ultrasound examination is also necessary and sensitivity of 80% was reported. We report a case of Trisomy 18 fetus in which choroid plexus cyst was the only abnormal sonographic finding.

Effectiveness of Estradiol and Sildenafil supplement therapy in IVF-ET patients with thin endometrium / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the effect of estradiol (E2) only/and sildenafil supplement on controlled ovarian hyperstimulation and pregnancy outcome in patients undergoing IVF-ET cycles. METHODS: Total 104 cycles of IVF-ET patients were included in this study, which had been undergone controlled ovarian hyperstimulation (COH) with long protocol in Eulji infertility center and Ilsan Grace hospital between January 1999 and December 2000. Group 1 (COH only) consisted of 34 cycles, group 2 (COH+estradiol supplement) consisted of 35 cycles, and group 3 (COH+estradiol/sildenafil supplement) consisted of 35 cycles. RESULTS: With E2 and/only Sildenafil supplement, improvement of the endometrial thickness (P<0.05) and clinical pregnancy rate (P<0.05) were obtained. There was no significant increase in pregnancy rate with sildenafil supplement compared to E2 supplement only (20.0% versus 25.7%). However, rather short duration of controlled ovarian hyperstimulation (13.3+/-1.7 days versus 11.7+/-1.7 days) was found in the group that received E2 and sildenafil supplementation. (P<0.1) CONCLUSION: In patients with thin endometrium, the sildenafil supplement might lead to increase endometrial receptivity, and in consequence improvement of pregnancy rate. Sildenafil may augment the vasodilatory effect of nitric oxide by inhibition of cGMP hydrolysis, by improving ovarian perfusion, stimulates follicular development thus might shorten the duration of controlled ovarian hyperstimulation in IVT-ET cycles as we observed in our study.