Prevalence of Low Bone Mineral Density and Associated Risk Factors in Korean Puerperal Women.

Although pregnancy is a medical condition that contributes to bone loss, little information is available regarding bone mineral density (BMD) in puerperal women. This cross sectional study aimed to evaluate the prevalence of low BMD in puerperal women and to identify associated risk factors. We surveyed all puerperal women who had BMD measurements taken 4-6 weeks after delivery in a tertiary university hospital, and did not have any bone loss-related comorbidities. Among the 1,561 Korean puerperal women, 566 (36.3%) had low BMD at the lumbar spine, total hip, femoral neck, and/or trochanter. Multivariate analysis revealed that underweight women had a significantly higher risk of low BMD compared with obese women at pre-pregnancy (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.83-5.63). Also, women with inadequate gestational weight gain (GWG) were 1.4 times more likely to have low BMD than women with excessive GWG (aOR, 1.42; 95% CI, 1.04-1.94). One-way ANOVA showed that BMDs at the lumbar spine and total hip were significantly different between the 4 BMI groups (both P < 0.001) and also between the 3 GWG groups (both P < 0.001). In conclusion, this study identifies a high prevalence of low BMD in puerperal women and thus suggests the need for further evaluation about the change of BMD in pregnancy and postpartum period.

Rare case of complete colon structure in a mature cystic teratoma of the ovary in menopausal woman: a case report.

BACKGROUND: Mature cystic teratoma (MCT) of the ovary is benign germ cell tumor and shows the highest incidence in women of reproductive age. Histologically, it includes components derived from endoderm, mesoderm, and ectoderm. Although there have been many reports of MCT having small part of the intestinal component, ovarian MCT containing complete colon structure was very rare. CASE PRESENTATION: A 54-year-old woman underwent laparoscopic left salpingo-oophorectomy due to an incidentally found ovarian mass. The pathologic diagnosis of the ovary was MCT containing complete colonic structure. The colonic wall exhibited complete structure of the large intestine composed of mucosa, submucosa, proper muscle, subserosa and serosa. It also contained sebaceous gland, sweat glands, fat tissue, and bone. The patient recovered without any complications. CONCLUSION: Immunohistochemical staining can be used for differential diagnosis between MCT with colonic wall and mucinous tumor. We report a very rare case of MCT that had complete colon structure with a brief literature review.

Antiplatelet and antithrombotic effect of Phyllostachys pubescens leaves and Mume Fructus combination.

BACKGROUND: Agents currently used for the treatment and prevention of thrombosis have a number of side effects. We conducted this study to develop antithrombotic agents from herbs that are used in food. METHODS: The 80% (v/v) ethanol extracts of Phyllostachys pubescens leaf (PL) and Mume Fructus (MF) and their combinations-2:1 (PM21), 1:1 (PM11), and 1:2 (PM12)-were evaluated on rat platelet aggregation induced by adenosine diphosphate (ADP) in vitro and on arteriovenous shunt thrombosis after 3 days of oral treatment in rats in vivo. RESULTS: At 100 µg/mL, PM21 and PM11 inhibited in vitro ADP-induced aggregation by 44.0 ± 4.3% and 30.0 ± 3.2%, respectively, whereas PL, MF, and PM12 weakly or scarcely inhibited ADP-induced aggregation by 3.9 ± 3.2%, 13.0 ± 2.7%, and 5.2 ± 1.3%, respectively. The IC50 values of PM21 on ADP-, collagen-, and thrombin-induced platelet aggregations were 135.6 ± 7.4 µg/mL, 142.7 ± 5.8 µg/mL, and 186.5 ± 9.7 µg/mL, respectively. In an in vivo rat arteriovenous-shunt thrombosis model, thrombus weight was significantly decreased after the oral administration of 400 mg/kg PL (27.8 ± 3.0%, p < 0.01) or MF (35.2 ± 2.1%, p < 0.01), and with a good accord to the in vitro results, the combination of PL and MF in the ratio of 2:1, PM21 (60.9 ± 1.2%, p < 0.001), showed a superior antithrombotic effect to those of individual extracts. At dosages of 200 mg/kg, 100 mg/kg, and 50 mg/kg, PM21 dose-dependently decreased thrombosis weight (ED50, 314 mg/kg). CONCLUSION: These results suggest that combination preparations of PL and MF, especially their 2:1 combination, can increase antiplatelet and antithromboticeffects more than PL and MF alone, offering evidence for a potential novel combination antithrombotic therapy.

Clinical efficacy of cervical length and volume for prediction of labor onset in VBAC candidates.

BACKGROUND: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates. METHODS: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records. RESULTS: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm(3) vs. 34.07±13.41 cm(3), p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729. CONCLUSION: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.

Comparison of laparoscopic and laparotomic surgery for the treatment of peritoneal inclusion cyst.

OBJECTIVES: Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC. METHODS: Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups. RESULTS: There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (P=0.037, P=0.047 and P=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209). CONCLUSION: Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.

Antenatal sonographic features of ileal atresia.

AIM: The purpose of this study was to determine the antenatal sonographic features of ileal atresia. MATERIAL AND METHODS: We identified neonates with surgically-confirmed ileal atresia who had antenatal sonography performed in our institution between 1 January 1999 and 30 June 2009. The antenatal sonography images and reports were reviewed. RESULTS: Sixteen neonates had surgically-confirmed ileal atresia in our institution in 11 years. Seven fetuses (43.7%) did not have any intestinal abnormalities detected antenatally on ultrasonography. Nine fetuses (56.3%) had various sonographic features of ileal atresia, including multiple dilated bowel loops, ascites, cysts, and polyhydramnios with or without associated anomalies. Six of nine fetuses had multiple dilated bowel loops and two fetuses had ascites. One fetus had a large, cystic, mixed, echogenic dilatation of bowel. Polyhydramnios was present in three fetuses. Heart anomalies, kidney anomalies, or hydrops were present in four fetuses. Eight of 16 fetuses (50%) had other intestinal problems, including intussusceptions in one fetus, small bowel malrotation, meconium pseudocyst volvulus, meconium peritonitis, and a congenital band. CONCLUSION: The prenatal sonographic features of ileal atresia are not simple. Various sonographic findings are shown and ileal atresia was detected in about 60% of cases.

Comparison of cervical parameters by three-dimensional ultrasound according to parity and previous delivery mode.

BACKGROUND: We would like to find out that whether the patient's parity, previous delivery mode and previous labor could influence cervical parameters. Cervical length, volume and width were measured using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound on normal pregnant women. METHOD: This study was conducted between January 2009 and December 2010 in singleton pregnant women who were admitted for routine antenatal care at hospitals in affiliation with the Catholic University, Seoul, Korea. The study group was classified by parity (nullipara and multipara) and previous delivery mode (cesarean section group and vaginal delivery group). The previous cesarean section group was divided by elective group who did not undergo labor and labor group who underwent labor. Cervical parameters such as cervical length, volume and width were measured using 2D and 3D ultrasound examinations in the first and second trimesters and the results were analyzed between those groups mentioned above. RESULTS: One hundred and twenty-one pregnant women in their 1st trimester and 233 pregnant women in their 2nd trimester (a total of 354) were enrolled in this study. Cervical parameters were not statistically significant from parity, nor previous delivery mode and previous labor in 1st trimester. Cervical volumes were not statistically significant from nullipara and elective cesarean section groups (35.96±9.81 vs. 34.73±9.75 cm3), but the nullipara groups were significantly lowered in the vaginal group (35.96±9.81 vs. 43.10±11.87 cm3) in 2nd trimester. For the nullipara group, cervical widths were not statistically significant in the elective cesarean section group but these were significantly lower than labor and previous vaginal group in the 2nd trimester. CONCLUSION: The cervical volume and width have an influence on parity, previous delivery mode and labor in the 2nd trimester.

Risk factors of neonatal anemia in placenta previa.

OBJECTIVES: Placenta previa is a major cause of neonatal anemia. The purpose of this study was to elucidate the risk factors of neonatal anemia in placenta previa. METHODS: The study was conducted on 158 placenta previa patients at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 through December 2009. The subjects were divided in to 2 groups: 47 placenta previa patients with neonatal anemia, and 113 placenta previa patients without neonatal anemia. The subjects' characteristics were compared. Logistic regression was used to control for confounding factors. RESULTS: Anterior placental location (OR 2.48; 95% CI: 1.20-5.11) was an independent risk factor of neonatal anemia after controlling for potential confounders. CONCLUSION: To manage neonatal anemia in placenta previa patients, obstetricians should do their best to detect placental location. Pediatricians should consider the high possibility of neonatal anemia in cases involving anterior placental location.

Monoamniotic twins with one fetal anencephaly and cord entanglement diagnosed with three dimensional ultrasound at 14 weeks of gestation.

A 29-year-old pregnant woman with parity 0-0-0-0 was diagnosed with monoamniotic twin pregnancy discordant for anencephaly at 14 weeks gestation. Umbilical cord entanglement, which is an important cause of fetal death in monoamniotic twins, was confirmed by three-dimensional ultrasound. Cesarean section was performed at 34 weeks of gestation, and the normal newborn infant was discharged without any complications. We report a case of monoamniotic twin pregnancy discordant for anencephaly and diagnosed with cord entanglement by three-dimensional ultrasound at 14 weeks of gestation, and now report it along with a literature review.

Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE.

This study was undertaken to investigate the pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and the appropriate timing of pregnancy. We performed a retrospective evaluation of 183 pregnancies with SLE at Catholic University Medical Center during the 13-year period from 1998 to 2010. Pregnancy outcomes were compared according to SLE characteristics. The predictive value of the different cut-off points of the stable period before conception on adverse pregnancy outcomes was calculated by ROC (Receiver operating characteristics) curve analysis. In multivariate analysis, the presence of antiphospholipid antibodies (aPLs) increased the risk of pregnancy loss (p<0.0001) and premature birth (p=0.0040). Active disease at conception increased the risk of premature birth (p< 0.0001) and complications (IUGR, PIH, or both) (p= 0.0078). The other predictor of complications was found to be lupus flare (p=0.0252). At a cut-off level of stable period of 4 months before conception, sensitivity and specificity were 70.8% and 53.2%, 71.4% and 61.5%, and 63.6 % and 59.8 %, respectively on reducing pregnancy loss, premature birth, and complications. Pregnancies with aPLs, active disease at conception and SLE flares are at a higher risk of adverse outcomes. It is essential that disease activity remains stable at least 4 months before conception, for favorable pregnancy outcomes.

Placenta percreta-induced uterine rupture diagnosed by laparoscopy in the first trimester.

Spontaneous uterine rupture is lethal in pregnant women. Placenta percreta-induced spontaneous uterine rupture in the first trimester is extremely rare and difficult to diagnose. A 35-year-old pregnant woman, with a history of 2 vaginal deliveries and 2 spontaneous abortions treated by dilatation and curettage, was admitted to the emergency department because of sudden severe abdominal pain; the gestational age as calculated by sonography was 14 weeks. Diagnostic laparoscopy was considered for surgical abdomen and fluid collection that was noted in sonography. During laparoscopy, uterine rupture with massive bleeding was detected; therefore, total abdominal hysterectomy was performed. The patient was discharged without any complications. Pathological analysis of the uterine specimen revealed placenta percreta to be the cause of the rupture. Uterine rupture should be considered in the differential diagnosis in all pregnant women who present with acute abdomen, show fluid collection in the peritoneal cavity. In addition, we recommend laparoscopy for the investigation of acute abdomen with unclear diagnosis in the first trimester of pregnancy.

Maternal outcomes according to placental position in placental previa.

PURPOSE: The purpose of this retrospective cohort study was to elucidate whether the location of placenta below uterine incision in cesarean section is important in the development of maternal complications in placenta previa patients. METHODS: The study was conducted on 409 patients 414 parturition at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 to December 2009. The subjects were divided to two groups: the group whose placenta was located in the anterior portion of the uterus (anterior group) and the group whose placenta was located in the posterior portion of the uterus (posterior group). And then they are compared to each other. Logistic regression was used to control for confounding factors. RESULTS: In the anterior group, regardless of confounding factors, the incidence of excessive blood loss (OR 2.97; 95% CI: 1.64-5.37), massive transfusion (OR 3.31; 95% CI: 1.33-8.26), placental accreta (OR 2.60, 95% CI: 1.40-4.83), and hysterectomy (OR 3.47, 95% CI: 1.39-8.68) was higher. CONCLUSION: Sonographic determination of the placental position where its location beneath the uterine incision is very important to predict maternal outcomes in placenta previa patients, and such cases, close attention should be paid for massive hemorrhage.

Prenatal diagnosis of autosomal recessive polycystic kidney disease by molecular genetic analysis.

A 27-year-old primigravida was referred for evaluation of severe oligohydramnios at 22 weeks of gestation. For a more accurate diagnosis and detection of other fetal anomalies, complementary fetal magnetic resonance imaging (MRI) was performed. Findings of fetal MRI evaluation were consistent with autosomal recessive polycystic kidney disease (ARPKD). Parental mutation analysis in the PKHD1 gene was performed. By PKHD1 mutation analysis, we were able to identify a heterozygous missense mutation in exon 20 (K626R) in the father. Molecular genetic analysis can be helpful for an early and reliable prenatal diagnosis of ARPKD. Herein, we present a case of ARPKD that was diagnosed at 22 weeks of gestation by ultrasonographic examination and MRI and verified by PKHD1 mutation analysis and array-based genetic deletion analysis.

Current status of transurethral prostatectomy: a korean multicenter study.

PURPOSE: We aimed to verify the current status of transurethral resection of the prostate (TURP) in Korea. MATERIALS AND METHODS: The medical records of 1,341 men who underwent TURP in 9 Korean medical centers between 2004 and 2008 were reviewed. The patients were divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008 (group 2). To verify differences in the two patient groups, age, prostate volume, indications for TURP, preoperative International Prostate Symptom Score (IPSS), and resected tissue weight were evaluated. RESULTS: The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The patients' characteristics were not significantly different between the two groups. The annual cases of TURP increased over the study period. The proportion of lower urinary tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2 compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who presented with acute urinary retention decreased from 35.5% to 30.3% with marginal statistical significance (p=0.051). Other indications such as hematuria, bladder stone, recurrent urinary tract infection, and hydronephrosis were not significantly different between the groups. The mean resected weights of the prostate were similar (17.5 g in group 1 and 18.3 g in group 2, respectively; p>0.05). CONCLUSIONS: TURP has been steadily performed in patients with benign prostatic hyperplasia and it is expected to remain constant. LUTS was the most common indication for TURP in recent years.

Effect of pre-pregnancy body mass index and weight gain during pregnancy on the risk of emergency cesarean section in nullipara.

PURPOSE: We attempted to examine the effects of delivery via emergency cesarean section in nullipara, presenting with increase in body weight during pregnancy and pre-pregnant body mass index. METHODS: A total of 1,024 nullipara with singleton pregnancy who experienced labor pain after 37 gestational weeks at St.Vincent's Hospital of Catholic University of Korea during 1 January 2004 to 31 March 2010 were enrolled in this study. Study patients were divided into four groups based on pre-gestational BMI, two groups based on weight gain more than 18 kg during pregnancy and three groups based on weight gain according to the guidelines of IOM (Institute of Medicine). Univariate and multivariate analysis were performed. RESULTS: On univariate analysis, the frequency of emergency cesarean section was increased both in pre-pregnant overweight women and women with excess weight gain during pregnancy. On multivariate analysis, however, increase in body weight during pregnancy according to IOM guidelines did not independently affect the frequency of emergency cesarean section. If the degree of increase in body weight during pregnancy was divided based on a definite numeric value of 18 kg, the frequency of cesarean section was significantly increased. CONCLUSIONS: For successful spontaneous delivery, the nullipara should become pregnant when the pre-gestational BMI is maintained at an appropriate level. We also propose that women should not gain more than 18 kg until delivery in all pre-BMI groups.

Optimal gestational age of delivery to decrease neonatal morbidity in preterm pregnancies in Korea.

AIMS: Preterm birth is the most common cause of neonatal morbidity and mortality. Neonatal morbidity and mortality are known to decrease significantly after 34 weeks in preterm births following preterm labor, and after 32 weeks in preterm births following preterm rupture of the membranes. However, these outcomes may not apply to Korean preterm neonates. This study analyzed the morbidity of preterm neonates based on gestational age to determine the optimal gestational age of delivery following preterm labor. MATERIALS AND METHODS: We retrospectively analyzed the medical records of preterm neonates and their mothers who delivered at Seoul St. Mary's Hospital between January 1995 and December 2007. RESULTS: Among 1234 preterm neonates, 1008 were singletons and 226 were multiple births. In both singleton and multifetal pregnancies, the maternal characteristics did not differ based on gestational age. The 1- and 5-min Apgar scores were significantly lower than at 35 weeks in singleton births, and at 33 weeks in multiple births. Major complications, such as intraventricular hemorrhage and the use of a respirator, decreased significantly after 35 weeks in singleton births, and after 33 weeks in multiple births. CONCLUSIONS: The optimal gestational age for decreasing the morbidity of major complications in preterm neonates was 1 week later than the American College of Obstetricians and Gynecologists recommendations. For Korean mothers with preterm labor, delivery needs to be delayed until 35 weeks in singletons, 33 weeks in twins, and 32 weeks in singletons with preterm rupture of the membranes.

Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery.

PURPOSE: The aim of this study was to evaluate the effect of absent or reversed end-diastolic umbilical artery Doppler flow on neonatal outcome independent of oligohydramnios, gestational age, and maternal factors. METHODS: From January 2004 to March 2010 we reviewed 76 cases at our hospital, which were diagnosed with intrauterine growth restriction (IUGR). Among those cases, the existence of absent or reversed end-diastolic velocity of umbilical artery (AEDV) was considered abnormal. We set the group that had no abnormal signs as the control group (57 cases), and compared it with the AEDV group (19 cases). Logistic regression was used to control for oligohydramnios and gestational age. RESULTS: The gestational age was lower in the AEDV group compared to that of the control group. Neonatal weight, platelet count were also lower in the AEDV group and serum SGOT level, the frequency of non-reassuring fetal heart beat pattern were higher in AEDV group compared to that of the control group independent of gestational age. Perinatal outcomes such as Apgar score at 1 min below 4, use of a ventilator, admission to the neonatal intensive care unit (NICU), respiratory disease, neurologic disease, neonatal sepsis, anemia, thrombocytopenia, and neonatal mortality were statistically less favorable in the AEDV group compared to those in the control group independent of gestational age and presence of oligohydramnios. There were more intrauterine fetal death histories and preeclampsia in the AEDV group compared the control group. CONCLUSION: The waveform of umbilical artery Doppler velocity is an informative parameter of perinatal outcomes independent of gestational age or the presence of oligohydramnios in IUGR patients. It is especially important to check the waveform of umbilical artery Doppler velocity in IUGR patients with preeclampsia and IUGR patients with FDIU history.

Simple excision and periosteal reattachment for the treatment of calcified cephalhematoma. Technical note.

Until now, calcified cephalhematoma has been treated by excision of the lesion and the use of an onlay autograft. The authors report their use of a less complicated alternative, simple excision and periosteal reattachment, in a 3-month-old male infant. They excised the calcified cap of cephalhematoma and reattached the periosteum to the exposed bone surface instead of using an onlay autograft technique. A follow-up CT scan demonstrated a smooth skull contour and good cosmetic appearance. The authors note that this is the first report of the successful use of simple excision and periosteal reattachment for the treatment of a case of calcified cephalhematoma in which there was a depressed area after the calcified cap was removed. They conclude that in cases of calcified cephalhematoma it may be unnecessary to perform a complicated cranioplasty with bone harvested from the top of the calcification.