Surgical Removal of Intraneural Perineurioma Arising in the Brachial Plexus Using an Interfascicular Dissection Technique

No abstract available.

Comparison of Mechanical Stability between Fibular Free Flap Reconstruction versus Locking Mandibular Reconstruction Plate Fixation

BACKGROUND: The fibular free flap has been used as the standard methods of segmental mandibular reconstruction. The objective of mandibular reconstruction not only includes restored continuity of the mandible but also the recovery of optimal function. This paper emphasizes the advantage of the fibular free flap reconstruction over that of locking mandibular reconstruction plate fixation. METHODS: The hospital charts of all patients (n=20) who had a mandibular reconstruction between 1994 and 2013 were retrospectively reviewed. Eight patients had plate-only fixation of the mandible, and the remaining 12 had vascularized fibular free flap reconstruction. Complications and outcomes were reviewed and compared between the 2 groups via statistical analysis. RESULTS: Overall complication rates were significantly lower in the fibular flap group (8.3%) than in the plate fixation group (87.5%; p =0.001). Most (7/8) patients in the plate fixation group had experienced plate-related late complications, including plate fracture or exposure. In the fibular flap group, no complications were observed, except for a single case of donor-site wound dehiscence (1/12). CONCLUSION: The fibular free flap provides a more stable support and additional soft tissue support for the plate, thereby minimizing the risk of plate-related complications. Fibular free flap is the most reliable option for mandibular reconstruction, and we believe that the flap should be performed primarily whenever possible.

Comparison of Mechanical Stability between Fibular Free Flap Reconstruction versus Locking Mandibular Reconstruction Plate Fixation

BACKGROUND: The fibular free flap has been used as the standard methods of segmental mandibular reconstruction. The objective of mandibular reconstruction not only includes restored continuity of the mandible but also the recovery of optimal function. This paper emphasizes the advantage of the fibular free flap reconstruction over that of locking mandibular reconstruction plate fixation. METHODS: The hospital charts of all patients (n=20) who had a mandibular reconstruction between 1994 and 2013 were retrospectively reviewed. Eight patients had plate-only fixation of the mandible, and the remaining 12 had vascularized fibular free flap reconstruction. Complications and outcomes were reviewed and compared between the 2 groups via statistical analysis. RESULTS: Overall complication rates were significantly lower in the fibular flap group (8.3%) than in the plate fixation group (87.5%; p =0.001). Most (7/8) patients in the plate fixation group had experienced plate-related late complications, including plate fracture or exposure. In the fibular flap group, no complications were observed, except for a single case of donor-site wound dehiscence (1/12). CONCLUSION: The fibular free flap provides a more stable support and additional soft tissue support for the plate, thereby minimizing the risk of plate-related complications. Fibular free flap is the most reliable option for mandibular reconstruction, and we believe that the flap should be performed primarily whenever possible.

Change of Deformity due to Position and Anesthesia in Adolescent Idiopathic Scoliosis / 대한정형외과학회잡지

PURPOSE: To determine changes in the end vertebra and neutral vertebra as well as in the magnitudes of coronal and rotational deformities according to position and anesthesia in patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS: Sixty-two structural curves in 31 patients were evaluated using standing, supine, side bending, post-anesthesia, and postoperative anteroposterior plain radiographs. Cobb angles and rotation angles by perdriolle torsionmeter were measured, and the end vertebra and neutral vertebra were identified in each radiograph. RESULTS: Coronal cobb angles decreased significantly with correction rates of 25.0%, 31.7%, 59.5%, and 74.0%, and rotational deformities decreased with correction ratesof 6.1%, 24.5%, 6.2%, and 25.7% by supine position, anesthesia, side bending and surgery, respectively.The end vertebrae changed in 18 patients (58.1%) in both supine and post-anesthesia radiographs, and the neutral vertebrae changed in 10 patients (32.3%) in supine radiographs and in 20 patients (64.5%) in post-anesthesia radiographs. CONCLUSION: Coronal deformities are significantly corrected by supine position and anesthesia. Anesthesia significantly corrects axial rotation, but more correction cannot be achieved by rod derotation. The end vertebra and neutral vertebra have a tendency to vary by position and anesthesia, which gives rise to confusion in the determination of fusion level.

DNA-based Prenatal Diagnosis of Epidermolytic Palmoplantar Keratoderma in Two Pregnancies at Risk in One large Pedigree

BACKGROUND: Epidermolytic palmoplantar keratoderma (EPPK) is an autosomal dominant disease of cornification which presents as severe thickening of the palms and soles with prominent epidermolytic hyperkeratosis pathologically. Recent studies have shown that EPPK is caused by mutations in the keratin 9 (K9) gene which is expressed essentially only in the palms and soles. Previously, We have reported that patients in one large pedigree of EPPK have an R162W substitution in the K9 protein. In this pedigree, two women whose husbands are both EPPK patients had become pregnant. OBJECTIVE: Since both women were concerned about this genetic disorder, we have performed prenatal diagnosis by biopsy analysis of chorionic villi tissue. METHODS: Chorionic villi biopsies were performed at 12 weeks gestation. Since the skin lesions are strictly confined to the palms and soles of the babies, the prenatal diagnosis of EPPK by ultrastructural analysis of fetal skin biopsy or amniotic fluid cells is highly problematic. Polymerase chain reaction amplification of specific allele (PASA) assay and direct DNA sequencing analyses were performed whether the fetuses carried mutant allele of K9 gene. RESULTS: PASA assay and direct DNA sequencing analyses showed that one fetus was normal, but the other fetus carried the abnormal allele. Subsequently, the mother of the unaffected fetus delivered a normal child, but the mother of the affected fetus terminated the pregnancy. CONCLUSION: We describe the analysis of the K9 mutation in the two fetuses at risk for EPPK. We believe that this is the first report of prenatal diagnosis for EPPK. But, we have to think about the ethical problems before we decide to perform the prenatal diagnosis of any kind of skin diseases.

Myotonic Dystrophy in Pregnancy complicated with Preterm Labor and Congestive Heart Failure / 대한산부인과학회잡지

Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.

DNA - based Prenatal Diagnosis of Epidermolytic Palmoplantar Keratoderma / 대한산부인과학회잡지

OBJECTIVE: The purpose of this investigation was to establish the prenatal diagnosis for identifying the risk for epidermolytic palmoplantar keratoderma(EPPK) of a fetus by sequence analysis of fetal genomic DNA from chorionic villi. METHODS: Chorionic villus sampling under transvaginal sonography at 12 weeks of gestation from a woman at risk for a child in a EPPK-affected family was perfomed. Polymerase chain reaction amplification of specific allele (PASA) assay was carried out for the detection of mutation(R162W in keratin 9 [K9] gene) previously identified in this family. Direct DNA sequencing analysis of K9 gene was accomplished to confirm the mutation. RESULTS: We had found the point mutation, R162W of K9 gene, in affected family members and confirmed by PASA assay. Affected family members were shown to have PCR products reactive with both the mutant and wildtype specific primers. Because we could not find any expected products after PASA assay with the primers la(+)/KSmt(-) of the fetal DNA, we predicted that the fetus did not inherited the mutant allele and that the fetus could be unaffected. After PASA assay, we analyzed DNA sequences of two family members to confirm the mutation. A C-to-T substitution at bp 545 was detected in the father, instead the fetus did not have any mutant band at that base pair. CONCLUSION: The PASA assay and direct DNA sequencing analysis of K9 gene through chorionic villi sampling and extraction of genomic DNA had validity to early prenatal diagnosis whether fetus was affected in EPPK or not.

Transvaginal Ultrasonographic Evaluation of the Uterine Cervix in the Prediction of a Successful Induction of Labor in Term Gestation / 대한산부인과학회잡지

OBJECTIVES: The purposes of this study were to determine the usefulness of transvaginal ultrasonographic assessment of the uterine cervix and to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in predicting a successful induction of labor. STUDY DESIGN: One hundred-one singleton term pregnancies without ruptured membranes admitted for the labor induction were included in this study. Digital examination and transvaginal ultrasonography of the uterine cervix were performed at the time of admission. Cervical parameters evaluated included cervical length, presence of funneling, funnel length, and funnel width. Labor induction was underwent by prostaglandin E2 (PGE2) vaginal suppository and/or pitocin intravenous infusion. Outcome variable was a successful labor induction within 48 hours after beginning of the induction. RESULTS: The prevalence of induction failure was 10.9% (11/101). Receiver-operator characteristic (ROC) curve and multiple logistic regression analysis indicated a significant relationship between the successful induction of labor and cervical length <3.1 cm. The diagnositic indices of endocervical length was superior to those of Bishop's cervical score in predicting a successful induction of labor. In patients with cervical length <3.1 cm, the labor was induced successfully with fewer tablets of PGE2, less use of pitocin infusion, and shorter induction-delivery interval. CONCLUSION: Transvaginal ultrasonographical examination of the uterine cervix is more accurate than digital examination of the cervix in the prediction of a successful induction of labor in term gestation.

The Effect of Platelet Activating Factor and Tumor Necrosis Factor on the Synthesis of Prostaglandin E2 from Human Amnion Cells / 대한산부인과학회잡지

To investigate the properties and mechanism of PAF and TNF on the synthesis of prostaglandin E2 in human amnion, primary monolayer culture method was used for human amnion cell incubation. Amnion cells were incubated with various concentrations of PAF or TNF in Ca++ containing medium for various duration. Then PG E2 concentrations were measured by RIA and analyzed for the effect of PAF and TNF on PG E2 production according to their doses and incubation time. To test the role of Ca++ in E2 production, Ca++ free medium, Ca++ -channel antagonist and cyclo-oxygenase inhibitor were substituted or added in incubation medium. Following results were obtained. The synthesis of PG E2 was significantly enhanced by PAF of 10(-6) mol/L. The TNF also stimulated PG E2 synthesis at concentration of 10(-6)g/ml. The maximal level in PAF(10-6mol/L)-stimulated release of PG E2 was observed after 16 hours in incubation. The TNF(10(-6)g/ml)-induced PG E2 release was maximal after 24 hours of incubation. Combined application of PAF and TNF produced positive effect in PG E2 production. PAF or TNF stimulated-PG E2 production in Ca++ -free media was much lower than that of Ca++ -containing media. The PAF-stimulated PG E2 release was significantly inhibited by Ca++ -channel antagonist but TNF-stimulated PG E2 release was not effected by Ca++ -channel antagonist or cyclo-oxygenase inhibitor. It is strongly suggested us that both PAF and TNF enhance PG E2 release by amnion cell, although Ca++ -channel opening is essential only for PAF stimulation.

A Common Genetic Variant of the Angiotensin Converting Enzyme(ACE) Gene and Pregnancy InducedHypertensive Disorders / 대한산부인과학회잡지

BACKGROUND: The angiotensin coverting enzyme(ACE) gene(encoding kininase II, EC3.4.15.1) contains a polymorphism based on the presence(insertion [I]) or absence(deletion[D]) within an intron of a 287bp nonsense DNA domain, resulting in three genotypes(D/I) and I/I homozygotes, and I/D heterozygotes). Alu insertion is associated with lowerACE level than deletion allele(D) and it was observed that D/D individuals have twice theACE activity of I/I patients. Pregnancy induced hypertension(PIH) probably results fromdominating pressor systems owing to loss of antagonizing vasodilator autacoids. AngiotensinII is an extremely potent arteriolar vasoconstrictor. Overactivity or failure to supressresponsiveness to the increased activity of angiotensin II, which is generated by ACE,would seem to be a reasonable basis for the vasoconstriction of PIH. The aim of this studyis to evaluate the relationship between ACE genotype and PIH. METHODS: Blood sampling was taken from 39 patients with PIH. The hypertensivedisorders, confirmed at postpartum follow up, were classified as gestational hypertensionwithout proteinuria, preeclampsia(mild and severe) and eclampsia. The diagnosis ofpreeclampsia was made according to the American College of Obstetrics and Gynecology criteriaof hypertension and proteinuria(>300 mg/24 hr urine). Genomic DNA was extractedfrom blood sample. After PCR amplification of the respective fragments from intron 16 ofthe ACE gene, size fractionation and visualization by electrophoresis were performed. RESULTS: PIH group(including gestational hypertension, mild and severe preeclampsia: frequency of I allele 0.756 and D allele 0.244) had more I allele and less D allele whencompared with normal population(frequency of I allele 0.609 and D allele 0.391)(p < 0.05).And PIH group had more I/I homozygote individuals showing significant distortion fromHardy-Weinberg equilibrium of ACE genotype(p < 0.05). Moreover, severe preeclampsiagroup alon(frequency of I allele 0.759 and D allele 0.241) had more I allele and less Dallele when compared with normal population and had significantly more I/I homozygoteindividuals. CONCLUSION: As pregnancies with PIH had more ACE I allele and I/I homozygoteindividuals. PIH could be associated with I allele of the ACE gene. Considering the observedcodominant association between the D-I polymorphism and plasma ACE activity, our resultis in favor of the thesis that PIH primarily arises from defective synthsis of vasodilatingautacoids and renin-angiotensin system exerts secondary vasoconstrictive action. However,the relationship between ACE genotype and defective vasodilating mechanism during pregnancyis unknown at present.

Adverse Pregnancy Outcomes after a False-PositiveScreen for Down Syndrome using Triple Serum Markers / 대한산부인과학회잡지

OBJECT: To assess the relative risk of an adverse pregnancy outcome in women with a false-positive riskfor Down syndrome by prenatal screeen using triple markers(maternal serum alpha-fetoprotein[AFP], unconjugated estrio[uE3], and human chorionic gpna dotropin[hGC] levels) and age. METHODE: Case-Control study including sixity four women with false-positive screens for Down sydromeand a matched control group of 128 women whose screen indicated a risk for Down syndrome of less than1 :270. The risk for adverse pregnancy outcome was compared for the two groups,and the roles of maternal serum AFP, uE3, and hCG as predictors of adverse pregnancy outcome weredetermined. RESULT: Women with false-positive screen for Down syndrome were not significantly different from theirmatched controls in the incidence of preterm delivery (5% versus 2%), pretermpremature rupture of membrane(3% versus 0%), placental abruption(0% versus 1%),preeclampsia(3% versus 1%), small for gestational age newborns(5% versus 6%), and fetal demise after20 week's gestation(2% versus 0%). The occurrence of an adverse outcome in 7 of 64(11%) pregnancieswith a flase positive screen for Down syndrome was not different from that in 12 of 128(9%) matchedcontrol pregnancies.Only maternal age (odds ratio 1.19,95% cofidence interval 1.05~1.34, p < 0.005) was siginificantly associatedwith adverse outcome after controlling for the effects of maternal serum AFP, hCG and uF3. CONCLUSION: Althought the sample on this study, women with a false-positive screen for Down syndromedo not seem to be at increased risk for a adverse pregnancy outcome when compared to those with a negativescreen result. Among maternal age, maternal serum AFP, hCG, and uE3level, only maternal age seemed tobe a predictorof an adverse pregnancy outcome.

Adverse Pregnancy Outcomes after a False-PositiveScreen for Down Syndrome using Triple Serum Markers / 대한산부인과학회잡지

OBJECT: To assess the relative risk of an adverse pregnancy outcome in women with a false-positive riskfor Down syndrome by prenatal screeen using triple markers(maternal serum alpha-fetoprotein[AFP], unconjugated estrio[uE3], and human chorionic gpna dotropin[hGC] levels) and age. METHODE: Case-Control study including sixity four women with false-positive screens for Down sydromeand a matched control group of 128 women whose screen indicated a risk for Down syndrome of less than1 :270. The risk for adverse pregnancy outcome was compared for the two groups,and the roles of maternal serum AFP, uE3, and hCG as predictors of adverse pregnancy outcome weredetermined. RESULT: Women with false-positive screen for Down syndrome were not significantly different from theirmatched controls in the incidence of preterm delivery (5% versus 2%), pretermpremature rupture of membrane(3% versus 0%), placental abruption(0% versus 1%),preeclampsia(3% versus 1%), small for gestational age newborns(5% versus 6%), and fetal demise after20 week's gestation(2% versus 0%). The occurrence of an adverse outcome in 7 of 64(11%) pregnancieswith a flase positive screen for Down syndrome was not different from that in 12 of 128(9%) matchedcontrol pregnancies.Only maternal age (odds ratio 1.19,95% cofidence interval 1.05~1.34, p < 0.005) was siginificantly associatedwith adverse outcome after controlling for the effects of maternal serum AFP, hCG and uF3. CONCLUSION: Althought the sample on this study, women with a false-positive screen for Down syndromedo not seem to be at increased risk for a adverse pregnancy outcome when compared to those with a negativescreen result. Among maternal age, maternal serum AFP, hCG, and uE3level, only maternal age seemed tobe a predictorof an adverse pregnancy outcome.

The Association of Abnormal Maternal Serum Alpha-fetoprotein with Adverse Pregnancy Outcome / 대한주산의학회잡지

OBJECTIVE:To determine whether elevated or low levels of maternal serum alpha- fetoprotein(AFP) measured at 15-20 weeks of gestation predict increased risk of adverse pregnancy outcome, including preterm birth(before 36 weeks of gestation), fetal growth retardation(FGR), preeclampsia, placental abruption, FDIU, placenta previa and fetal anomaly. METHOD: Data of pregnancy outcomes in singleton pregnancies with elevated or low maternal serum AFP levels measured at 15-20 weeks of gestation were gathered retrospectively. As a part I study, case-control study including 106 women with maternal serum AFP) 2.0 MOM(Multiples of median) and matched control group of 212 women with 0.5 MOM

Analysis of Fetal Nucleated Erythrocytes in Maternal Blood by Fluorescence In Situ Hybridization(FISH) / 대한산부인과학회잡지

The isolation of fetal cells from maternal circulation has the potential to allow relativelyself prenatal diagosis for all pregnant women. The present technology, however, has notreached the accuracy required for clinical diagnosis because of maternal cell contaminationSo we published a new method for enrichment of nRBC in a fetal cell isolation(1996).In this study, attempted to FISH analysis of nRBC which was isolated by our ownmethods. We evaluated the efficiency of FISH.As the results, we have successfully used FISH on enriched nRBC.We were able to identified 2 abnormal fetus which were confirmed by conventionalcytogenentic study as Down syndrome(Fig.1) and Klinefeltre syndrome(Fig.2). And thesensitivity and specificity for FISH was 86%(49/57) and 92.3%(36/39), respectively.According to our results, fetal cell analysis by FISH can be reliable used for prenatalaneuploidy diagnosis. However, the problems of enrichment of the fetal cell and FISH probeor condition should be over come before analyze.

The Clinical Applicability of PCR and FISH in the Detection of Y-chromosome from Fetal Nucleated Red Blood Cells in Maternal Blood / 대한산부인과학회잡지

No abstract available.

Transplacental Fetal Therapy for a Case of Fetal Supraventricular Tachycardia which Caused Fetal Hydrops / 대한산부인과학회잡지

A case of fetal supraventricular tachycardia which caused fetal hydrops was diagnosed at 29 weeks of gestation by fetal echocardiography. Transplacental fetal therapy with ma-ternal intravenous digoxin administration resulted in restoration of normal fetal sinus rhythm and disappearance of fetal hydrops on 7th day after initiation of treatment when the mat-ernal serum digoxin level was 2.11 ng/mL. The fetus showed normal sinus rhythm when evaluated by fetal echocardiography during the remainder of pregnancy with maternal oral digoxin maintenence. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.

A case of leiomyosarcoma of the uterine cervix / 대한산부인과학회잡지

No abstract available.

The efficacy of computed tomography in pretreatment evaluation of invasive cervical carcinoma / 대한산부인과학회잡지

No abstract available.

Analysis of doppler blood flow velocity waveforms of the fetal umbilical artery in normal pregnancies / 대한산부인과학회잡지

No abstract available.