History-indicated cerclage: the association between previous preterm history and cerclage outcome

OBJECTIVE: Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome. METHODS: We conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses. RESULTS: The incidence of preterm delivery (< 32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at < 32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively. CONCLUSION: Comparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.

Evaluation of factors influencing the success rate of orthodontic microimplants using panoramic radiographs / 대한치과교정학회지

OBJECTIVE@#The purpose of this study was to investigate factors influencing the success rate of orthodontic microimplants (OMIs) using panoramic radiographs (PRs).@*METHODS@#We examined 160 OMIs inserted bilaterally in the maxillary buccal alveolar bone between the second premolars and first molars of 80 patients (51 women, 29 men; mean age, 18.0 ± 6.1 years) undergoing treatment for malocclusion. The angulation and position of OMIs, as well as other parameters, were measured on PRs. The correlation between each measurement and the OMI success rate was then evaluated.@*RESULTS@#The overall success rate was 85.0% (136/160). Age was found to be a significant predictor of implant success (p 0.05). The highest success rate was observed for OMIs with tips positioned on the interradicular midline (IRML; central position). Univariate analyses revealed that the OMI success rate significantly increased with an increase in the OMI length and placement height of OMI (p = 0.001). However, in simultaneous analyses, only length remained significant (p = 0.027). Root proximity, distance between the OMI tip and IRML, interradicular distance, alveolar crest width, distance between the OMI head and IRML, and placement angle were not factors for success. Correlations between the placement angle and all other measurements except root proximity were statistically significant (p < 0.05).@*CONCLUSIONS@#Our findings suggest that OMIs positioned more apically with a lesser angulation, as observed on PRs, exhibit high success rates.

Recording natural head position using an accelerometer and reconstruction from computed tomographic images

OBJECTIVES: The concept of natural head position (NHP) was first introduced by Broca in 1862, and was described as a person's stable physiologic position “when a man is standing and his visual axis is horizontal.” NHP has been used routinely for clinical examination; however, a patient's head position is random during cone-beam computed tomography (CBCT) acquisition. To solve this problem, we developed an accelerometer to record patients' NHP and reproduce them for CBCT images. In this study, we also tested the accuracy and reproducibility of our accelerometer. MATERIALS AND METHODS: A total of 15 subjects participated in this study. We invented an accelerometer that measured acceleration on three axes and that could record roll and pitch calculations. Recorded roll and pitch data for each NHP were applied to a reoriented virtual image using three-dimensional (3D) imaging software. The data between the 3D models and the clinical photos were statistically analyzed side by side. Paired t-tests were used to statistically analyze the measurements. RESULTS: The average difference in the angles between the clinical photograph and the 3D model was 0.04° for roll and 0.29° for pitch. The paired ttests for the roll data (P=0.781) and the pitch data (P=0.169) showed no significant difference between the clinical photographs and the 3D model (P>0.05). CONCLUSION: By overcoming the limitations of previous NHP-recording techniques, our new method can accurately record patient NHP in a time-efficient manner. Our method can also accurately transfer the NHP to a 3D virtual model.

Relationship between maturation indices and morphology of the midpalatal suture obtained using cone-beam computed tomography images / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to determine whether predicting maturation of the midpalatal suture is possible by classifying its morphology on cone-beam computed tomography (CBCT) images and to investigate relationships with other developmental age indices. METHODS: The morphology of the midpalatal suture was assessed by using CBCT images of 99 patients. Axial plane images of the midpalatal suture were classified into five stages according to the classification scheme. To make the assessment more accurate, the morphology and fusion of the midpalatal suture were additionally investigated on coronal cross-sectional planar images and volume-rendered images. Bone age was evaluated using the hand and wrist method (HWM) and cervical vertebrae method (CVM); dental age (Hellman's index), sex, and chronological age were also assessed. To evaluate relationships among variables, Spearman's rho rank test was performed along with crosstabs using contingency coefficients. RESULTS: The HWM and CVM showed strong correlations with the maturation stage of the midpalatal suture, while other indices showed relatively weak correlations (p < 0.01). Through crosstabs, the HWM and CVM showed high association values with CBCT stage; the HWM demonstrated slightly higher values (p < 0.0001). Based on the HWM, the midpalatal suture was not fused until stage 6 in both sexes. CONCLUSIONS: Among developmental age indices, the HWM and CVM showed strong correlations and high associations, suggesting that they can be useful in assessing maturation of the midpalatal suture.

Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage

OBJECTIVE: To assess the role of preoperative and postoperative serum C-reactive protein (CRP) level on the prediction of pregnancy outcomes following ultrasound-indicated cerclage (UIC). METHODS: We retrospectively reviewed the medical records 44 women who underwent UIC between January 2011 and December 2011. UIC was performed between 14 and 24 weeks of gestation in women with short cervix. We divided UIC patients into two groups according to the gestational age at delivery (34 weeks) and compared the two groups. Group A was defined as patients who delivered ≥34 weeks of gestation, and group B as patients delivered <34 weeks. Correlation and receiver-operating characteristic curves were also analyzed for the prediction of preterm birth after UIC. RESULTS: Thirty women delivered ≥34 weeks (group A) and 14 women delivered <34 weeks (group B). Pre- and post-cerclage CRP were significantly lower in group A (pre-cerclage CRP, 1.1±1.0 vs. 11.4±6.2 mg/dL, P<0.001; post-cerclage CRP, 0.6±0.5 vs. 7.4±7.2 mg/dL, P<0.001). The mean gestational age at delivery in group A was 37.7±1.8 weeks and that in group B was 26.9±4.3 weeks (P<0.001). There were significant negative correlations between pre- and post-cerclage CRP and latency from UIC to delivery (r=-0.82, P<0.001; r=-0.70, P<0.001, respectively). CONCLUSION: Both pre- and post-cerclage CRP were useful in predicting the preterm birth following UIC.

Accuracy of three-dimensional printing for manufacturing replica teeth / 대한치과교정학회지

OBJECTIVE: Three-dimensional (3D) printing is a recent technological development that may play a significant role in orthodontic diagnosis and treatment. It can be used to fabricate skull models or study models, as well as to make replica teeth in autotransplantation or tooth impaction cases. The aim of this study was to evaluate the accuracy of fabrication of replica teeth made by two types of 3D printing technologies. METHODS: Fifty extracted molar teeth were selected as samples. They were scanned to generate high-resolution 3D surface model stereolithography files. These files were converted into physical models using two types of 3D printing technologies: Fused deposition modeling (FDM) and PolyJet technology. All replica teeth were scanned and 3D images generated. Computer software compared the replica teeth to the original teeth with linear measurements, volumetric measurements, and mean deviation measurements with best-fit alignment. Paired t-tests were used to statistically analyze the measurements. RESULTS: Most measurements of teeth formed using FDM tended to be slightly smaller, while those of the PolyJet replicas tended to be slightly larger, than those of the extracted teeth. Mean deviation measurements with best-fit alignment of FDM and PolyJet group were 0.047 mm and 0.038 mm, respectively. Although there were statistically significant differences, they were regarded as clinically insignificant. CONCLUSIONS: This study confirms that FDM and PolyJet technologies are accurate enough to be usable in orthodontic diagnosis and treatment.

The safety of cesarean myomectomy in women with large myomas

OBJECTIVE: To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm. METHODS: One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups. RESULTS: There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance. CONCLUSION: Cesarean myomectomy in patients with large myomas is a safe and effective procedure.

Developed diplopia and ptosis due to a nonfunctioning pituitary macroadenoma during pregnancy

Physiologic pituitary enlargement is common during normal pregnancy. However, symptoms such as diplopia, blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy. A 39-year-old woman complained of sudden diplopia and left eye ptosis at 33th weeks of gestation. An magnetic resonance imaging (MRI) demonstrated the pituitary enlargement compressing the optic chiasm. Notwithstanding the medication of bromocriptine, her symptoms did not regress during pregnancy. At 5 months after delivery, her symptoms dramatically resolved without any surgery, and her visual acuity was normalized. Her MRI scan also revealed more decreased size of pituitary gland compared to antenatal MRI. We report a case of visual loss due to the physiologic pituitary enlargement of nonfunctioning adenoma during pregnancy, which regressed spontaneously after delivery without any surgery.

CD30 Activation Induced Eosinophil Apoptosis is Mediated by Caspase-9 / 소아알레르기및호흡기학회지

PURPOSE: Although CD30 is known to be expressed more on eosinophils undergoing apoptosis, it is still not known how CD30 activation leads to eosinophil apoptosis. In this study, we evaluated whether ligation of CD30 incites apoptosis and investigated whether the mechanisms of CD30 induced eosinophil apoptosis are dependent on caspase activation. METHODS: We drew 90 mL of peripheral blood from healthy donors and then purified eosinophils using a MACS system. Expression of CD30 on eosinophils was measured, and eosinophils were cultured in wells pretreated with anti-CD30 mAb, isotype control immunoglobulin G1, interleukin (IL)-5, and dexamethasone in Roswell Park Memorial Institute 1640 media supplemented with 10% fetal bovine serum. Their rates of apoptosis were then compared using flow cytometry. To evaluate whether caspase-9 is involved in CD30-induced eosinophil apoptosis, the apoptotic rate was evaluated after the addition of caspase-9 inhibitor. The expression of procaspase-9 was also measured using Western blot. RESULTS: Expression of CD30 molecules on eosinophils increased steadily as the culture time lapse. The apoptotic rates of eosinophils cultured in the presence of anti-CD30 mAb were significantly increased to 29.1+/-6.1% and 47.3+/-4.7% compared to 17.1+/-6.7% and 29.4+/-9.2% of the control at 4 and 24 hours, respectively (both P<0.05). The apoptotic rates of eosinophils treated with anti-CD30 mAb were even faster than those of eosinophils treated with dexamethasone, and the mAb also suppressed the IL-5-induced enhancing effect of eosinophil survival. Caspase-9 inhibitor suppressed mAb induced eosinophil apoptosis from 54.8+/-6.9% and 71.5+/-11.6% to 24.5+/-6.0% and 47.8+/-11.4% at 18 and 36 hours, respectively (both P<0.001). We also demonstrated that the expression of procaspase-9 with mAb was diminished compared to that of the control and of IL-5. CONCLUSION: This study showed CD30 activation enhances eosinophil apoptosis, and the effect is mediated by caspase-9 activation.

Need for an Intensive Care Unit for High Risk Pregnancy and a Neonatal Center / 대한주산의학회잡지

Today Korea faces a low birth rate and an aging society, newly rising issues not easily solved. Of these problems, the low birth rate is the most urgent but a rather neglected issue by today's society, which causes increases in high risk pregnancies and high risk infants and thus necessitates intensive medical care and attention. According to the National Health Insurance Cooperation, the number of high risk pregnancies has been increasing dramatically every year. In 2009, the number of immature infants among total births reached 25,000 (5.7%). However this statistical information is derived from national registration without verification by the Obstetrics and Gynecology Academic Association, which should be involved in the collection of this data in the near future. High risk pregnancies have greater fetus morbidity and mortality rates compared to normal pregnancies, resulting in increased medical costs and low quality of life. Formation of an intensive care unit for high risk pregnancy may resolve these problems and also increase the infant survival rate. The following chapter deals with issues related to high risk pregnancy and infants, the recent increase in elderly pregnancy, the hospital medical cost problems of treating high risk pregnancy, and most importantly discusses the need for and proposes an intensive care unit for high risk pregnancy and a neonatal center.

A Case of Maxillary Actinomycosis

Actinomycosis is a very rare infectious disease caused by Actinomyces, which are gram-positive, predominantly anaerobic, non acid-fast bacillus. Actinomyces are normal flora in the upper and lower aerodigestive tracks but can become pathogenic after mucosal injuries such as tooth extraction and trauma to the mouth or jaw. Actinomycosis of the maxillary sinus is very difficult to diagnose due to its low incidence and lack of characteristic clinical findings. We recently experienced a case of maxillary actinomycosis in a 78-year-old immunocompetent male who underwent endoscopic sinus surgery 10 months previously and a molar tooth extraction 3 months previously. CT scans showed soft tissue density with a focal calcification and flexible fiberscopy indicated a brown-colored mass at the maxillary sinus floor. The maxillary sinus lesion was removed by sinus irrigation through the ostium and histopathology confirmed sulfur granules compatible with actinomycosis. The patient was treated with a 6-month course of oral augmentin-clavulanate. A diagnosis of actinomycosis should always be considered in a patient with unilateral intractable maxillary sinusitis, focal calcification in CT scans, and a history of molar tooth extraction.

A case of acute pancreatitis induced by hypertriglyceridemia in gestational diabetes / 대한산부인과학회지

Hypertriglyceridemia is a rare cause of pancreatitis in pregnancy. Pregnancy is related with hypertriglyceridemia especially in the 3rd trimester due to increase of estrogen. Diabetes is known as a common cause of secondary lipid metabolism disorder and is often associated with hypertriglyceridemia. Shock and sepsis related to pancreatitis in pregnancy result in a relatively high morbidity and mortality rate for both the mother and the fetus. Hypertriglyceridemic pancreatitis complicated in gestational diabetes has not previously been reported. We report a case of 26(+4) weeks gestational aged primigravida with acute pancreatitis induced by hypertriglyceridemia in gestational diabetes. We reviewed the clinical courses and treatments of acute pancreatitis in pregnancy with the literatures.

Evaluation of the Measurement of Nucleated Red Blood Cells in Neonatal Blood with ADVIA 2120 / 임상검사와정도관리

BACKGROUND: Nucleated red blood cells (NRBCs) are immature erythrocytes. The current line of thought is that increased NRBC production in the immediate neonatal state primarily reflects hypoxic injury and a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis. So, the accurate, reproducible, and timely reporting of NRBC is an important function of the clinical laboratory. The aim of this study is to evaluate the performances of the ADVIA 2120 Hematology System (Siemens, USA) in the NRBCs measurement and compare them with the conventional microscopic method. METHODS: The study was performed in Kangnam Sacred Heart Hospital from March to September, 2009. One hundred twenty neonatal samples were submitted to measure NRBC count. For comparison, 225 blood samples except neonates were also included. The specimens were analyzed for the NRBC counts both with ADVIA 2120 analyzer and by microscopic method. RESULTS: Correlations of NRBC counts form the ADVIA 2120 compared with microscopic results were excellent in neonatal and in all specimens, r=0.8630 and r=0.9012, respectively. Sensitivity and specificity for the presence of NRBC was 98.2% and 94.2%, respectively. Concordance rate was 95.5%. There were some discordant results in cases of chronic lymphocytic leukemia and iron deficient anemia. CONCLUSIONS: The ADVIA 2120 NRBC method correlated well with the manual microscopic method. The automatic correction of the WBC count and differential, the shorter turnaround time compared to microscopic counting are additional advantages of automatic method. The automatic NRBC counting is considered to be a useful method in neonatal hematology.

Etiologies and Clinical Characteristics of Cervical Lymphadenopathy in Children / 소아알레르기및호흡기학회지

PURPOSE:This study was performed to investigate clinical characteristics and the etiology of cervical lymphadenopathy in children. METHODS:A clinical review of 240 cases of children under the age of 18 who were admitted with cervical lymphadenopathy from January 2002 to December 2007. RESULTS:Cervical lymphadenopathy was diagnosed as follows:clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4 %), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%). Abscess was presented as an acute lesion (94.1%) with less than 2 weeks of fever (69.4 %) and tuberculous lymphadenitis was presented as a chronic lesion (62.5%) without fever (90 %). Malignant disease (100%) and necrotizing lymphadenitis (62.5%) were found in chronic lesion of older children with systemic symptoms (40% and 37.5%, respectively). Leukopenia (57.9%) with various duration of fever occured in case of necrotizing lymphadenitis. CONCLUSION:Clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4%), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%) were found in cervical lymphadenopathy. Although cervical lymphadenopathy was commonly caused by a benign infectious process, a more serious disease was not rare, which may have different clinical characteristics including age, duration of fever and disease, previous or accompanying symptoms, or white cell counts. Meticulous combination of clinical characteristics, history, physical examination and workup as well as follow-up may be the most important for the proper approach on cervical lymphadenopathy in children.

A case of uterine rupture in IUP 15+1weeks following previous myolysis / 대한산부인과학회지

The development of myolysis has allowed number of gynecologic surgeons to treat myoma instead of hysterectomy or myomectomy. However not long time has passed since this operation started, little studies were conducted on this complication and side effect. Especially, there are not enough studies about complication and prognosis related pregnancy after myolysis. One of these complications, uterine rupture during pregnancy is not frequent, but fatal condition to both mother and fetus. We report a case of uterine rupture that occurred in early second-trimester who had been myolysis 22 months before pregnancy.

A case of Meigs' syndrome with elevated serum CA 125 level / 대한산부인과학회지

Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated CA 125 in Meigs'syndrome is unusual clinical condition reported in few cases. We report here, a 49-year-old postmenopausal woman with right ovarian fibrothecoma with ascites, right pleural effusion and high serum levels of CA 125. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA 125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.

Effectiveness of preemptive Gabapentin on postoperative pain after vaginal hysterectomy / 대한산부인과학회지

OBJECTIVE: Gabapentin is a new generation anticonvulsant drug. Preemptive gabapentin may produce analgesic effect in postoperative patient and have antiemetic effect. The aim of the present study was to investigate the opioid-sparing and analgesic effect of preemptive gabapentin on postoperative pain in patient undergoing vaginal hysterectomy. METHODS: In a randomized, double-blind, controlled study, 40 patients scheduled for an elective vaginal total hysterectomy were investigated/-. The patients were randomized to receive either oral gabapentin 1200mg (GABA group 2, n=17) or 900mg (GABA group 1, n=13) with premedication the night before and again 2hours before surgery. The other group (control group, n=10) had only routine premedication without gabapentin. All patients received patient-controlled analgesia (PCA). Postoperatively, pain was assessed using a visual analogue scale (VAS, 0-10) at time 1, 2, 4, 8, and 20 hours. Cumulative PCA consumption and opioid-related adverse events (nausea, vomiting, dizziness) was recorded. RESULTS: There was significant decrease of fentanly consumption in gabapentin group (GABA 2 group : 57.51+/-8.95 mg, GABA 1 group : 52.21+/-5.78 mg) compared to control group (50.63+/-2.55 mg)(p<0.05). There was no significant difference in side-effect (nausea, vomiting, dizziness) were observed between case and control group. CONCLUSIONS: Preemptive gabapentin has a good analgesic effect and reduce postoperative fentanyl consumption on postoperative pain after vaginal hysterectomy. Gabapentin effectively rescue analgesic requirement in post-operative patients with vaginal total hysterectomy.

Diagnostic and Surgical Approaches of the Parapharyngeal Space Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumors originating in the parapharyngeal space are rare, accounting for about 0.5% of all head and neck tumors. The anatomic characteristics of the parapharyngeal space makes clinical examination of this area difficult and unreliable method for assessment of these tumor. This study was performed to evaluate the proper diagnostic and surgical approaches for the parapharyngeal space tumors with our experiences. SUBJECTS AND METHOD: During the period from January 1998 to December 2006, 34 patients underwent surgery for parapharyngeal space tumors. We reviewed medical records and imaging study retrospectively. RESULTS: 82.4% (28/34) of the parapharyngeal space tumors were benign; 17.6% (6/34) were malignant. 41.2% (14/34) were of salivary glandular origin, 35.3% (12/34) were of neurogenic origin, and 23.5% (8/34) were of miscellaneous origin. 76.5% (26/34) of cases had been performed fine needle aspiration cytology (FNAC) before surgery. 14 of 19 patients (73.7%) who had a diagnostic sample had a correct or highly suggestive diagnostic finding. Most of the parapharyngeal space tumors were treated with transcervical (44.1%;15/34) or transparotid (44.1%; 15/34) approach, and transparotidcervical approach was performed in 4 patients (11.8%). All patients with salivary gland tumor were located in the prestyloid space, and most (92.9%) of them were treated with transparotid approach. Most patients (91.7%) with neurogenic tumor were located in the poststyloid space and treated with transcervical approach. CONCLUSION: In our study, the origin and location of the parapharyngeal space tumors were correlated with surgical approaches (p<0.05). Preoperative FNAC showed high accuracy to diagnose the tumor in the parapharyngeal space.

The Clinical Manifestations and Immunological Characteristics of Selective IgA Deficiency in Children / 소아알레르기및호흡기학회지

PURPOSE: Selective immunoglobulin A deficiency (IgAD) is the most common primary immunodeficiency disease. The aim of the present study is to analyze clinical manifestations and immunological characteristics of selective IgAD in children. METHODS: Twenty-one children aged 1-14 years with the serum IgA level of 2 standard deviation (2 SD) below normal for age who had recurrent infection were enrolled in this study at Uijeongbu St. Mary's Hospital of the Catholic University of Korea, between January 2006 and August 2007. Recurrent infection was defined as the presence of at least 6 febrile infection episodes per year before this study. Among IgA deficient patients, we excluded panhypogammaglobulinemic patients. RESULTS: The average frequency of admission was 2.2+/-2.0 per year. The most common causative disease at admission was lower respiratory infection (53.6%). Immunoglobulin G (IgG) subclass deficiency was corcurrent in 9 patients (42.9%): deficiency of IgG2 in 1, IgG3 in 5, IgG4 in 1 and IgG3+IgG4 in 2. Five patients (23.8%) had a decrease in CD3+ cells and 8 patients (38%) had a decrease in CD4+ cells. One patient progressed to common variable immunodeficiency (CVID). Serum IgA levels of 76.5% of the patients increased to 2 SD above normal for age after 15.9+/-4.5 months. CONCLUSION: The patients with IgAD in this study showed frequent respiratory and gastrointestinal infections and combined with other immunodeficiencies including IgG subclass deficiency. Our data suggest that it is necessary to examine the immunological status including IgA level in patients with frequent infections and that those with IgAD should be observed for the potential progression to CVID.

A case of acute pulmonary edema with peripartum cardiomyopathy in severe preeclampsia / 대한산부인과학회지

Women with severe preeclampsia or eclampsia who develop pulmonary edema most often do so postpartum and some of these women have cardiac failure. Peripartum cardiomyopathy is defined as a cardiac failure occurring in the latter part of pregnancy or in the peripartum, without obvious cause and prior evidence of heart disease. It is very rare but the mortality rate is as high as 10~50%. Here, we describe a case of a woman who has undergone emergency Cesarean section due to complicated severe preeclampsia with acute pulmonary edema and peripartum cardiomyopathy at 33+1 weeks of gestation.