Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients

OBJECTIVE: To evaluate the usefulness of transvaginal ultrasound measurements of cervical length before and after elective prophylactic cervical cerclage in predicting preterm delivery before 32 weeks of gestation. METHODS: Women who underwent an elective cerclage operation at 14 to 19 weeks of gestation and who delivered between January 2004 and December 2009 were enrolled in this study (n=52). Ultrasonography was performed to measure cervical length before and after cerclage. The primary outcome was defined as preterm delivery before 32 weeks of gestation. A receiver operating characteristic curve was used to determine the most discriminating cut-off values of ultrasonographic cervical parameters predictive of preterm delivery before 32 weeks of gestation. RESULTS: Among the 52 patients studied, ten delivered before 32 weeks of gestation. Among the ultrasonographic cervical parameters compared, only the cervical length after cerclage was significantly different (shorter) in patients who delivered before 32 weeks of gestation (P=0.037) compared to that of those who delivered after 32 weeks of gestation in univariate and multivariate analyses (odds ratio, 0.402; 95% confidence interval, 0.174 to 0.925; P=0.021). The receiver operating characteristic curve showed that a cervical length of 25 mm or less after cerclage was predictive of preterm delivery before 32 weeks of gestation (area under curve, 0.71; 95% confidence interval, 0.56 to 0.87; P=0.029) with a sensitivity of 91.0% and a specificity of 30.0%. CONCLUSION: Patients with a cervical length less than 25 mm after elective cerclage may be at higher risk of preterm delivery before 32 weeks of gestation.

Efficacy of Nei-Guan acupressure on Nausea and Vomiting in Patients undergoing laparoscopic prostatectomy with Intravenous Patient Controlled Analgesia / 기본간호학회지

PURPOSE: This study was done to evaluate the efficacy of Nei-Guan acupressure on nausea and vomiting in patients undergoing laparoscopic prostatectomy with intravenous patient controlled analgesia (IV-PCA). METHODS: Data were collected between August 13, 2012 and January 31, 2013 at a hospital in Busan. The participants were 45 men, who underwent the surgery laparoscopic prostatectomy, with IV-PCA. Data were analyzed using descriptive statistics, chi2-test, repeated measures ANCOVA and Games-Howell test with PASW 18.0. RESULTS: Nei-Guan acupressure had an interaction effect on nausea between group and time (F=5.01, p<.001), group (F=10.80, p<.001), time (F=26.51, p<.001) in laparoscopic prostatectomy with IV-PCA and also an interaction effect on vomiting between group and time (F=2.77, p=.032), group (F=8.89, p=.001), time (F=4.01, p=.022). CONCLUSION: Results indicate that nei-guan acupressure is a potentially effective therapy for the prevention of nausea and vomiting which occur with IV-PCA. Therefore, if patients complain of nausea and vomiting when receiving IV-PCA, nurses can provide patients with information about nei-guan acupressure and help them with nausea and vomiting.

Application of Sperm Selection Using Hyaluronic Acid Binding in Intracytoplasmic Sperm Injection Cycles: A Sibling Oocyte Study

The purpose of this study was to investigate whether sperm selection by hyaluronic acid (HA) binding could improve fertilization rate and embryo quality in intracytoplasmic sperm injection (ICSI) cycles. Two hundred nineteen oocytes obtained from eighteen women were injected with either HA-bound (n = 107) or conventionally selected spermatozoa (n = 112) in a randomized way. All of the participants were infertile couples who had normal sperm parameters but low fertilization rate in previous in vitro fertilization (IVF) cycle (n = 5) or experienced multiple IVF failures (n = 13). Lower fertilization (75.7% vs 83.0%) and cleavage rate on day 2 (72.9% vs 83.0%) was observed in oocytes injected with HA-bound spermatozoa than the conventional group, but the difference was not significant. Significantly lower cleavage rate was observed on day 3 in HA group (56.0% vs 69.6%, P = 0.038). Blastocyst formation rate and the number of transferred embryos were similar in both groups. In multiple IVF failure patients, significantly reduced fertilization rate (71.8% vs 85.3%, P = 0.046) and cleavage rate on day 2 (70.4% vs 85.3%, P = 0.029) and day 3 (53.5% vs 77.3%, P = 0.002) were noticed in HA group. Five women achieved pregnancy continuing more than 12 weeks after transfer (27.8%). Success of ICSI was not related with the number of embryos fertilized by HA-bound spermatozoa. Application of ICSI by sperm selection using HA binding is not helpful in couples with repeated poor fertilization or implantation despite normal sperm parameters.

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization / 부인종양

OBJECTIVE: To evaluate pregnancy outcomes after electrosurgical conization. METHODS: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. RESULTS: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p<0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; <28 week, 6.5% vs. 8.0%, p=1.000; <34 week, 19.4% vs. 20.0%, p=1.000; <37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. CONCLUSION: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.

Effects of Drospirenone 2 mg with 17-beta-Estradiol 1 mg on blood pressure and body weight in postmenopausal Korean women / 대한산부인과학회지

OBJECTIVE: To evaluate effects of Drospirenone 2 mg (DRSP) with 17-beta-Estradiol 1 mg (E2) on blood pressure (BP) and body weight in postmenopausal Korean women. METHODS: BP and body weight were measured at baseline and 3 months of the treatment. We compared the change in BP and body weight between normotensive (group 1, control) and high-normotensive (group 2) group during treatment. And we compared the change in BP and body weight between hypertensive group receiving anti-hypertensive with (group 3) and without (group 4, control) DRSP/E2 during treatment. RESULTS: The mean systolic BP/diastolic BP of group 1 was not significantly decreased from baseline (116.9/75.0 mmHg) after treatment with DRSP/E2 for 3 months (116.1/73.2 mmHg) (P<0.152/P=0.088), however that of group 2 was significantly decreased from baseline (128.8/81.8 mmHg) after treatment with DRSP/E2 for 3 months (126.2/79.3 mmHg) (P<0.001/P=0.002). The mean systolic BP/diastolic BP of group 3 was significantly decreased from baseline (133.5/82.5 mmHg) after treatment with DRSP/E2 for 3 months (129.3/77.9 mmHg) (P<0.001/P<0.001), and that of group 4 was also significantly decreased from baseline (133.2/80.7 mmHg) after treatment with DRSP/E2 for 3 months (131.0/78.3 mmHg) (P=0.002/P<0.001). However change in the mean systolic BP/diastolic BP of group 3 was greater than that of group 4 (P=0.041/P=0.024). There was no weight change in all four groups. CONCLUSION: The use of DRSP/E2 showed a tendency to decrease the BP of high-normotensive or above in postmenopausal Korean women, and hypertensive patients receiving anti-hypertensive showed greater decline in BP. However there was no statistical significance in body weight change.

A case of Sertoli-Leydig cell tumor with mature cystic teratoma in a postmenopausal woman / 대한산부인과학회지

Sertoli-Leydig cell tumor is a gonadal tumor of the sex cord-stromal type. It is a rare tumor comprising 0.5% of all ovarian tumors and is best known for their frequent virilizing effects among the young women. They also have very rarely been reported in association with other ovarian neoplasms. We report such a tumor accompanied with a mature cystic teratoma at the same ovary in a 61-year-old postmenopausal woman without any virilization sign. We present it with brief review of literatures.

The Morphologic Changes of Parvalbumin- Immunoreactive Interneurons of the Dentate Gyrus in Kainate-Treated Mouse Hippocampal Slice Culture Epilepsy Model

PURPOSE: Loss of hippocampal interneurons in dentate gyrus has been reported in patients with severe temporal lobe epilepsy and in animals treated with kainic acid(KA). Interneurons contain Ca2+- binding protein parvalbumin(PV). The effects of kainic acid on parvalbumin-immunoreactive (PV-IR) interneurons in dentate gyrus were investigated in organotypic hippocampal slice cultures. METHODS: Cultured hippocampal slices from postnatal day nine C57/BL6 mice were exposed to 10 muM KA, and were observed at 0, 8, 24, 48, 72 hours after a one hour KA exposure. Neuronal injury was determined by morphologic changes of PV-IR interneuron in dentate gyrus. RESULTS: Transient(1 hour) exposure of hippocampal explant cultures to KA produced marked varicosities in dendrites of PV-IR interneuron in dentate gyrus and the shaft of interbeaded dendrite is often much thinner than those in control. The presence of varicosities in dendrites was reversible with KA washout. The dendrites of KA treated explants were no longer beaded at 8, 24, 48 and 72 hours after KA exposure. The number of cells in PV-IR interneurons in dentate gyrus was decreased at 0, 8 hours after exposure. But there was no significant difference in 24, 48 and 72 hours recovery group compared with control group. CONCLUSIONS: The results suggested that loss of PV-IR interneurons in dentate gyrus is transient, and is not accompanied by PV-IR interneuronal cell death.

Culturing Successfully Adult Schwann Cells from Peripheral Nerve of Rats / 대한소아신경학회지

PURPOSE: Schwann cells are difficult to isolate from adult mammalian peripheral nerves because of the abundant connective tissue and the highly differentiated state of the cells, particularly those involved in the formation of myelin. It has been shown that in vivo, both neurons and Schwann cells are conditioned by a nerve lesion, speeding up the Schwann cell proliferation and the neuronal regeneration. In this study with adult rat peripheral nerves, we report that a conditioning lesion increases Schwann cells and of cells which successfully attach to a tissue culture striatum. METHODS: The study was done with Sprague-Dawley male rats(250-300 g). Their left sciatic nerves were exposed, severed at the sciatic notch and deflected. After 14 days, with 20 mm segments the nerves were excised from the distal stump of the conditioned sciatic nerves. Schwann cells were cultured in RPMI-1640 media. The identity of the cells was verified with antibody staining using S-100. RESULTS: The lesion evoked a progressive and significant increase in the number of cells obtained as early as 48 hr of the plating, until day 12. Decreasing the duration of enzyme digestion to 3 and 4 hrs markely increased the number of attached Schwann cells. The peak numbers of attached Schwann cells was observed between day 12 and day 14 of the plating. Most attached Schwann cells had typical oval-shaped cell bodies, with prominent nuclei and bipolar cell extensions, resulting in overall spindle shapes. CONCLUSION: Our findings indicate that a conditioning lesion enables us to isolate and culture adult Schwann cells successfully from the peripheral nerves of rats.

Mutations of SCN1B in Generalized Epilepsy with Febrile Seizures Plus(GEFS+) / 대한소아신경학회지

PURPOSE: Febrile seizures affect 2-5% of all children younger than 6 years old. A small proportion of children with febrile seizures later develop epilepsy. Generalized epilepsy with febrile seizures plus(GEFS+) is an important childhood genetic epilepsy syndrome with heterogeneous phenotypes, including febrile seizures(FS) and generalized epilepsies of variable severity. It was reported that the gene locus for GEFS+ exists in the chromosome 19q13.1, and has relationship with a 387 C->G mutation in the voltage- gated sodium channel beta1 subunit(SCN1B) gene. This study is to determine whether there are mutations in children with GEFS+ and FS. METHODS: Eighteen GEFS+ and thirteen FS patients were screened for mutations in the sodium channel beta-subunits SCN1B. The primer pairs used to amplify the exons of SCN1B are given in the supplementary data on the Neurology web site. All exons were amplified by PCR and PCR products were subsequently sequenced. Single-stranded conformation polymorphism(SSCP) was carried out using 8% polyacrylamide gel. RESULTS: Twenty four patients(77%) were younger than 10 years old, three(10%) were between 10 and 14 years old, and four(13%) older than 14 years old. The ratio of female to male was 0.55:1.0. In phenotypes of GEFS+, fourteen patients(88%) had generalized tonic-clonic seizures, one patient(6%) myoclonic seizures and one patient(6%) atonic seizures. In EEG findings of GEFS+, eleven(78%) patients had normal findings, five(28%) patients generalized spike waves and two patients(11%) diffuse slowings. In sequencing and SSCP of PCR products, we could observe added C mutations between 224G and 225C of exon 3 in two unrelated patients with GEFS+. CONCLUSION: We proved the existence of a new mutation of SCN1B in two unrelated patients with GEFS+.

Train of Four Responses as Indicies of Onset and Recovery during Pancuronium Induced Neuromuscular Blockade / 대한마취과학회지

The train of four (TOF) stimulation is commonly used in animal research and clinical practice to determine the degree of neuromuscular blockade. It has been suggested that relationship existed between the degree of single, or initial twitch depression and the amount of TOF fade responses within train. Although block produced by all non-depolarising muscle relaxants is associated with fade in response to tetanic or TOF stimulation, recent studies have shown quantitative difference in degree of these fade between various agent. However, more recently, the variability of this relationship with the same neuromuscular blocker during onset and spontaneous recovery of neuromuscular blockade has been demonstrated. And so, the degree of fade may be affect the reliability in assessment of degree of block and recovery of block in comparison to single twitch stimulation. In present study, we has assessed the effect of pancuronium 0.04 mg/kg on the pattern of TOF (T(4) ratio) and first twitch response in the train compared with control twitch (T(1) ratio) and, thereafter, the twitch responses of vecuronium 0.02 mg/kg on recovery period from pancuronium induced neuromuscular blockade in 14 rabbits. The changes in neuromuscular transmission were measured by recording the isometric contraction of the left gastrocnemius muscle evoked by supramaximal stimulation of the tibial nerve. The results were as follows: 1) The effect of pancuronium 0.04 mg/kg was variable, ranging from incomplete (64.3%) to complete (35.7%) neuromuscular block. 2) During the onset of action, there was greater reduction associated with T(1) than T(4), ratio in all cases. The changes of T(1) ratio decreased steadily in all cases, but the changes of T(4) ratio in cases of incomplete neuromuscular blockade was biphasic, showing initial decrease to 77.2+/-8.1% followed by increase to 100% of T(4) rato when T(1) ratio was 4.6+/-3.2%. 3) During the recovery period, T(4) ratio was increased linearly with T(1) ratio which reached 25% when T(4) ratio was approximately 22.5+/-18.8% in cases of complete neuromuscular blockade. In cases of incomplete neuromuscular blockade, T(1) ratio was increased linearly depending on time course, but the change of T(4) ratio was biphasic, showing initial decrease to 28.2+/-16.6% when T(1) ratio was 25%, followed by increased linearly with T(1) ratio. 4) The twitch response during the onset of the action and recovery after vecuronium 0.02 mg/kg on 75% recovery period of pancuronium induced neuromscular blokade was similar to that of pancuronium. The results of this study suggest that the TOF ratio and the depression of the single twitch bear no fixed relationship. The clinical use of TOF using the T(4) ratio only, as a monitor of the degree of block and recovery from non-depolarising block has been useful, but we would recommended that T, ratio of TOF should be considered to evaluated the incomplete neuromuscular block of pancuronium and vecuronium in rabbit.