The Risk of Spontaneous Preterm Birth according to Maternal Pre-pregnancy Body Mass Index in Twin Gestations

BACKGROUND: Maternal obesity is a well-known risk factor for both total preterm birth (PTB) and spontaneous PTB in singleton gestation, whereas this association is not well determined in multiple pregnancy. The objective of this study was to determine the risk of spontaneous PTB according to the pre-pregnancy body mass index (BMI) in twin gestations. METHODS: The association between the risk of PTB and pre-pregnancy BMI was determined in women pregnant with twins between 2004 and 2014. Pre-pregnancy BMI values were divided into three groups (underweight/normal/overweight and obese). PTB was classified as spontaneous PTB (following preterm premature rupture of membranes, preterm labor, or cervical insufficiency) or medically indicated PTB (cesarean section or induction of labor because of maternal/fetal indications). RESULTS: A total of 1,959 women were included in the analysis, and the percentages of total PTB and spontaneous PTB were 13.1% and 9.3%. The percentages of total PTB and spontaneous PTB in three groups were 14.1%, 11.9%, 16.3%, respectively, and 11.0%, 8.0%, 12.5% (P < 0.05 between normal and overweight/obese women). The risks of total and spontaneous PTB in overweight/obese women were higher than those in women with normal weight, even after adjustment for prior history of PTB, age, maternal height, parity, in vitro fertilization-embryo transfer (IVF-ET) (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.01–2.03; OR, 1.58; 95% CI, 1.05–2.36). CONCLUSION: The risks of both total and spontaneous PTB were significantly greater in the overweight/obese group than in the normal BMI group.

Tumor resection from retromolar trigone, posterolateral maxilla, and anterior mandibular ramus using lower cheek flap approach: a case report and review of literature

A surgical approach involving the retromolar trigone, posterolateral maxilla, and pterygoid region is the most challenging in the field of maxillofacial surgery. The upper cheek flap (Weber-Ferguson incision) with subciliary extension and the maxillary swing approach have been considered as alternatives; however, neither approach provides sufficient exposure of the pterygoid region and the anterior portion of the mandibular ramus. In this report, we describe two cases in which a lower cheek flap approach was used for complete tumor resection in the retromolar trigone and the anterior mandibular ramus. This approach allows full exposure of the posterolateral maxilla and the pterygoid region as well as the retromolar trigone without causing major sensory disturbances to the lower lip. A mental nerve anastomosis after tumor resection was performed in one patient and resulted in approximately 90% sensory recovery in the lower lip. The lower cheek flap approach provides adequate exposure of the posterolateral maxilla, including the pterygoid, retromolar trigone, and mandibular ramus areas. If the mental nerve can be anastomosed during flap approximation, postoperative sensory disturbances to the lower lip can be minimized.

Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium?

OBJECTIVE: To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period. METHODS: The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured. RESULTS: One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73). CONCLUSION: The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

Sterilization effect of atmospheric pressure non-thermal air plasma on dental instruments

PURPOSE: Autoclaves and UV sterilizers have been commonly used to prevent cross-infections between dental patients and dental instruments or materials contaminated by saliva and blood. To develop a dental sterilizer which can sterilize most materials, such as metals, rubbers, and plastics, the sterilization effect of an atmospheric pressure non-thermal air plasma device was evaluated. MATERIALS AND METHODS: After inoculating E. coli and B. subtilis the diamond burs and polyvinyl siloxane materials were sterilized by exposing them to the plasma for different lengths of time (30, 60, 90, 120, 180 and, 240 seconds). The diamond burs and polyvinyl siloxane materials were immersed in PBS solutions, cultured on agar plates and quantified by counting the colony forming units. The data were analyzed using one-way ANOVA and significance was assessed by the LSD post hoc test (alpha=0.05). RESULTS: The device was effective in killing E. coli contained in the plasma device compared with the UV sterilizer. The atmospheric pressure non-thermal air plasma device contributed greatly to the sterilization of diamond burs and polyvinyl siloxane materials inoculated with E. coli and B. subtilis. Diamond burs and polyvinyl siloxane materials inoculated with E. coli was effective after 60 and 90 seconds. The diamond burs and polyvinyl siloxane materials inoculated with B. subtilis was effective after 120 and 180 seconds. CONCLUSION: The atmospheric pressure non-thermal air plasma device was effective in killing both E. coli and B. subtilis, and was more effective in killing E. coli than the UV sterilizer.

Effect of location of glass fiber pre-impregnated with light-curing resin on the fracture strength and fracture modes of a maxillary complete denture / 대한치과보철학회지

PURPOSE: This study evaluated the effect of glass fiber pre-impregnated with light-curing resin on the fracture strength and fracture modes of a maxillary complete denture. MATERIALS AND METHODS: Maxillary acrylic resin complete dentures reinforced with glass fiber pre-impregnated with light-curing resin (SES MESH, INNO Dental Co., Yeoncheon-gun, Korea) and without reinforcement were tested. The reinforcing material was embedded in the denture base resin and placed different regions (Control, without reinforcement; Group A, center of anterior ridge; Group B, rugae area; Group C, center of palate; Group D, full coverage of denture base). The fracture strength and fracture modes of a maxillary complete denture were tested using Instron test machine (Instron Co., Canton, MA, USA) at a 5.0 mm/min crosshead speed. The flexure load was applied to center of denture with a 20 mm diameter ball attachment. When fracture occurred, the fracture mode was classified based on fracture lines. The data were analyzed with one-way ANOVA at the significance level of 0.05. RESULTS: There were non-significant differences (P>.05) in the fracture strength among test groups. Group A showed anteroposterior fracture and posterior fracture mainly, group B, C and control group showed partial fracture on center area mostly. Most specimen of group D showed posterior fracture. CONCLUSION: The location and presence of the fiber reinforcement did not affect the fracture strength of maxillary complete denture. However, reinforcing acrylic resin denture with glass fiber has a tendency to suppress the crack.

Utility of Abdominal Computerized Tomography in Diagnosis of Acute Appendicitis / 소아과

PURPOSE: To evaluate the accuracy of ultrasonography(USG) and abdominal computerized tomography(CT) and the possibility of reducing unnecessary appendectomy rate with improvement of diagnostic accuracy using optional CT with USG. METHODS: From January 1999 to May 2003, 496 patients younger than 14 years received surgical intervention with preoperative impression of acute appendicitis. They were devided into three groups no preoperative imaging study; preoperative abdominal USG only; and USG with optional abdominal CT. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated in each group, and percentage of unnecessary appendectomy was also obtained. RESULTS: Sensitivity and unnecessary appendectomy rate of group was 78.4% and 21% respectively. Sensitivity, specificity, positive predictive value, negative predictive value and unnecessary appendectomy rates of group were 96.5%, 42.8%, 85.4%, 78% and 12.2%. Sensitivity and positive predictive value of group was 100% and 98%, and no unnecessary appendectomy was performed in this group. CONCLUSION: With consideration of radiation exposure, cost, and in-hospital delay time, using optional CT with USG under optimal indication can decrease the frequency of complications and unnecessary appendectomy rates.

Interpretation of Traumatic Lumbar Puncture in Aseptic Meningitis / 소아과

PURPOSE: This study was undertaken to find out a useful method that can predict the true leukocytosis in blood-contaminated cerebrospinal fluid(CSF) due to traumatic lumbar puncture(LP), using white and red cell counts of sanguineous CSF and peripheral blood. METHODS: From May 2001 to December 2002, among 1,247 patients presenting symptoms of meningitis who had received LP at Chonnam Hospital, 126 patients were included in this study who had undergone a second LP due to a traumatic first one. According to the final results of second LP, they were devided into two groups, aseptic meningitis group; and normal CSF group. Medical records were reviewed retrospectively, the proportions of white blood cells to red blood cells were obtained in the peripheral blood(WBC:RBCBlood) and CSF(WBC:RBCCSF), based on the results of the traumatic first LP and simultaneously performed peripheral blood count. The WBC:RBCCSF/WBC:RBCBlood ratio was calculated in each patient. RESULTS: The WBC:RBCCSF/WBC:RBCBlood of the normal CSF group was 13.5+/-7.3(standard deviation), significantly lower than 47.3+/-39.5 of the aseptic meningitis group. CONCLUSION: The WBC:RBCCSF/WBC:RBCBlood is a useful value to predict frank leukocytosis in the blood-contaminated CSF due to traumatic LP, but all clinical and laboratory informations must be considered before deciding on a treatment strategy to minimize the risk of misdiagnosis.