Earticle

Purpose. This study was conducted to investigate the effectiveness of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal delivery. Methods. The subjects of this study were 49 (experimental group: 25, control group: 24) postpartum women who passed 6 weeks after normal delivery without complication of pregnancy, delivery and postpartum. The experimental group was applied to the pelvic muscle enforcement program by biofeedback and electrical stimulation for 30 minutes per session, twice a week for 6 weeks, after then self-exercise of pelvic floor muscle was done 50-60 repetition per session, 3 times a day for 6 weeks. Maximum pressure of pelvic floor muscle contraction (MPPFMC), average pressure of pelvic floor muscle contraction (APPFMC), duration time of pelvic floor muscle contraction (DTPFMC) and the subjective lower urinary symptoms were measured by digital perineometer and Bristol Female Urinary Symptom Questionnaire and compared between two groups prior to trial, at the end of treatment and 6 weeks after treatment. Results. The results of this study indicated that MPPFMC, APPFMC, DTPFMC were significantly increased and subjective lower urinary symptoms were significantly decreased after treatment in the experimental group than in the control group. Conclusions. This study suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for reinforcing pelvic floor muscle after normal delivery.

This study helps Primipara and Multipara an attempt to sound about his experiences. Study to gangwon province, four living in cities by 20 June 2015 and November survey of women in their 20s and 30s by Primipara and Multipara simulation to determine the contents a normal birth descriptive survey research. Content analysis of data meeting the normal delivery in accordance with the procedure of the act a normal birth, felt Primipara and Multipara advantages, disadvantages of a normal birth, on the necessary education to become a normal birth. Meaningful statement the doors and drawn with the categories in accordance with analysing. Accordingly, Primipara and Multiparasimulated a normal birth experience, prenatal education early pregnancy through education active and confirm the time of low birth rates due to family, women's employment and to support delivery of her husband loudly to have children to force them to actively can be achieved.

This study was performed to identify the normal anatomic orientation of pulmonary arteries and to obtain the normal baseline parameters and the optimal contrast material delivery methods of computed tomographic pulmonary angiography (CTPA) on normal beagle dogs. Based on the contrast injection flow rate, the contrast volume, and the administration methods, the experimental groups were divided into 4 groups such as group 1 : 2 ml/s, 3 ml/kg, and monophasic administration; group 2 : 5 ml/s, 3 ml/kg, and monophasic administration; group 3 : 5 ml/s, 4 ml/kg, and monophasic administration; group 4 : 5 ml/s and 2 ml/kg in first phase, 0.3 ml/s and 2 ml/kg in second phase, as biphasic administration. Normal anatomic orientation of pulmonary arteries in CTPA was evaluated through reformatted and 3D images after retro-reconstruction. Normal parameters for great arteries and peripheral pulmonary arteries were obtained on the factor of basement hounsfield unit (HU) values, contrast enhanced HU values, delay time, and peak time. And the optimal contrast delivery methods were evaluated on the factor of contrast enhanced HU values, image quality, and artifact. The monophasic administration with 5 ml/s contrast injection flow rate and 3 ml/kg contrast volume was optimal in canine CTPA.

목적 : 건강한 산모의 정상분만 후 발생한 valsalva retinopathy를 경험하였기에 보고하고자 한다. 대상과 방법 : 내원 1일 전부터 시작된 우안의 갑작스런 시력저하를 주소로 내원한 32세 여자환자로 외상의 병력은 없었으며 과거력상 특이 질환은 없었다. 초진시 교정시력은 0.02였고, 전안부 검사와 안저검사, 형광안저 촬영을 시행하였다. 환자는 전안부 소견상 특이한 소견은 보이지 않았고, 안저검사상 황반부 망막전 출혈이 관찰되었다. 망막전 출혈은 경계가 뚜렷하고 진한 빨간색의 내경계막하 출혈이었으며, 형광안저 촬영상 황반부에 2 유두직경의 형광차단소견이 관찰되었다. 결과 : 경과관찰 2주 후 망막전출혈의 크기가 감소하였고, 3주 후에는 노란색의 변성부위가 관찰되면서 크기가 감소하였으나 시력은 0.04로 큰 호전은 없었다. 6주 후 망막전 출혈은 완전히 흡수되었고 시력도 1.0으로 회복되었다. 결론 : 태아 정상분만시 과도한 valsalva maneuver에 의해 valsalva retinopathy가 발생하였고, 이로 인해 생긴 망막전출혈은 특별한 치료 없이 6주에 걸쳐 서서히 흡수되었으며 시력도 정상으로 회복된 것을 경험하였다.

Purpose: We report a case of Valsalva retinopathy following normal delivery. Methods: A 32-year-old woman presented with visual blurring in her right eye which had developed on the previous day. At the first visit, visual acuity was 0.02 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up for two years. Results: Two weeks after the first visit, the size of the preretinal hemorrhage decreased. Three weeks after the first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity did not improve. Six weeks after the first visit, the preretinal hemorrhage was resolved completely and visual acuity returned to normal with no specific treatment.

=자궁 소낭 (uterine sacculation)은 자궁벽의 일부가 풍선 (balloon)처럼 불어나 형성되는 주머니 혹은 낭성 구조물로 임신 중에만 일시적으로 발생하는 임신의 아주 드문 합병증이다. 자궁 소낭은 자궁 내강과 연결된 구조를 보이며, 출산 후 소낭이 사라지면서 자궁벽은 정상화된다. 자궁 소낭의 원인은 아직 밝혀지지 않았으나, 자궁 근층의 손상을 일으키는 원인들과 관련이 있을 것으로 보고되고 있다. 자궁 소낭은 임상 증상이 다양하므로 진단하기가 어렵다. 자궁 소낭 내의 구조물은 대개 태반의 일부분 혹은 전부로 잔류태반이 동반되는 경우가 많다. 자궁 소낭 내 착상된 태반은 자궁 내강과 소낭의 연결부분이 좁아져 있으므로 태아 분만 후 잔류태반을 용수 박리하기가 매우 어려우며, 자궁 소낭 안에 태반 전부가 갇혀 있는 경우 초음파 유도하 흡입소파술도 효과가 없는 경우가 대부분이므로 개복하여 자궁절개술을 시행하여 태반을 제거하며, 심한 경우 자궁적출술을 시행한다.

목 적: 자연분만 후 발생한 비골신경마비 환자에 대한 Muscle Energy Technique (MET)병행 치료가 족하수 증상감소 및 기능 회복에 미치는 영향을 알아보고자 한다. 방 법: 환자들은 침, 뜸, 부항치료와 병행하여 하루 한번, 일주일에 5회 MET 치료를 받았다. MET는 piriform muscle, gluteus medius muscle, anterior tibial muscle, adductor muscles을 중심으로 시행하였으며 총 20회의 MET치료를 받았다. 효과측정에는 Ankle dorsiflexion ROM, Manual Muscle Test, Numerical Rating Scale, Ankle Hindfoot Scale이 사용되었다. 결 과: Case 1의 경우 MET병행치료 후 ROM은 −5에서 20으로 MMT는 0에서 4, NRS는 5에서 1, AHS는 54에서 94로 변화하였다. Case 2의 경우 MET병행치료 후 ROM은 0에서 20으로 MMT는 1에서 5, NRS는 4에서 1, AHS는 64에서 97로 변화하였다. 결 론: 본 연구에서 MET를 분만직후 발생한 비골신경마비로 인한 족하수 환자에게 침 뜸 부항 등 여러 치료와 병행하여 시행하여 증상 및 기능회복에 효과가 있었다. 기존의 연구와 비교하여 MET치료를 적용한 환자들의 치료 결과가 비슷하거나 치료기간을 단축시킨 것으로 미루어, MET는 분만 직후 발생한 비골신경마비 환자들에게 사용가능한 치료법이라 사료된다.

Objectives: The purpose of this study is to evaluate the clinical effects of Muscle Energy Technique (MET) for peroneal nerve palsy after normal delivery. Methods: Two patients with peroneal nerve palsy were treated with acupuncture, moxibustion, cupping and MET. MET was performed in piriform, gluteus medius, anterior tibial and adductor muscles. To evaluate the effect of MET, we analyzed Ankle dorsiflexion range of motion (ROM), Manual Muscle Test (MMT), Numerical Rating Scale (NRS) and Ankle Hindfoot Scale (AHS). Results: In Case 1, ROM score was changed from −5 to 20, and MMT score was changed from 0 to 4. NRS score was changed from 5 to 1, and her AHS score was changed from 54 to 94 after treatment. In Case 2, ROM score was changed from 0 to 20, and her MMT score was changed from 1 to 5. NRS score was changed from 4 to 1, and her AHS score was changed from 64 to 97 after treatment. Conclusions: MET may be a useful treatment for patients who, shortly after childbirth or while breastfeeding, strongly refuse to treat the irritation.

This study was designed to evaluate the effect of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal vaginal delivery. The data were collected from November 1999 to April 2000 at a university hospital located in Seoul, Korea. Out of 49 women with normal vaginal delivery, 25 of experimental group(with exercise) and 24 of control group(without exercise) were questioned about lower urinary symptoms, discomfort during sexual intercourse and daily life. The maximum pressure of pelvic floor muscle contraction(MPPFMC) and duration of pelvic floor muscle contraction(DPFMC) were measured at pre-treatment, the end of treatment and 8 weeks after a treatment program. The pelvic floor muscle exercise program(using biofeedback and electrical stimulation) was applied to the experimental group twice a week for 4 weeks at the incontinence clinic and the pelvic floor muscle exercise at home for that time and more 8 weeks. Data were analyzed by t-test, $x^2$-test, Fisher's exact test and the repeated measures ANOVA. The results were as follows; 1) MPPFMC(p=0.000) and DPFMC(p=0.021) were significantly increased in the experimental group. 2) In the lower urinary symptoms, daily frequency(p=0.001), nocturia(p=0.002), incontinence episode(p=0.016), stress incontinence(p=0.012), quantity of incontinence(p=0.026), straining(p=0.041), and strength of stream(p=0.009) were significantly decreased in the experimental group. 3) Discomfort during sexual intercourse had not a significant difference between the two groups, which was not significantly decreased as time passed. 4) In the discomfort during daily life, activity restriction(p=0.042), exercise restriction (p=0.008), interpersonal relationship restriction(p=0.046), and discomfort of general life(p=0.027) showed a significant difference between the two groups, which were not significantly decreased as time passed. In conclusion, it is suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for the improvement of postpartum pelvic muscle contraction.

Background: Though it is clear that many types of viruses can infect the oral mucosa, its condition for infection is unclear. The purpose of this study was to analyze the conditions for viral infection of normal oral mucosa and explore the possibility of topical gene therapy to oral mucosa using a viral vector. Methods: Freshly taken fragments of the palate and the tongue of mice were used for organ culture. The specimens were exposed to green fluorescent protein (GFP)-adenoviral vector for 1 hour except for the control. Initial viral titer was $6.3{\times}10^{11}\;pfu/ml$ and the virus was diluted to working concentrations. The dilution ratio was 1:1,000 ($6.3{\times}10^8\;pfu/ml$), 1:10,000 ($6.3{\times}10^7\;pfu/ml$), and 1:100,000 ($6.3{\times}10^6\;pfu/ml$). They were then cultured on a stainless steel wire mesh in an organ culture dish. The specimens were stereoscopically examined every 24 hours for 6 days, after which they were fixed and analyzed through immunohistochemical methods Results: There was no visible expression in the control, $6.3{\times}10^6\;pfu/ml$, and $6.3{\times}10^7\;pfu/ml$ groups. Initial expression was observed at 24 hours after infection in both the palate and the tongue in $6.3{\times}10^8\;pfu/ml$ and the expression significantly increased until 3 days in the palate and 2 days in the tongue after infection (P<0.05). In both groups, the expression was mostly observed at the resection margin. Immunohistochemical studies showed that the epithelial cells were positive to GFP. Conclusion: The present study showed that topically applied adenovirus containing specific genetic information of GFP could successfully transduce GFP in normal oral epithelial cells at the resection margin in organ culture in terms of dose and exposure time.

=프로락틴을 분비하는 선종은 뇌하수체 종양 중 가장 높은 발생빈도를 보이며 이로 인한 고 프로락틴혈증은 무월경, 유즙분비등과 함께 여성 불임의 중요한 원인중의 하나이다. 이러한 뇌하수체 선종 환자에서 브로모크립틴 치료와 배란유도 등을 통해, 혹은 특별한 치료없이 자연적으로 임신된 경우는 보고된 바가 있으나, 임신 중에 두통, 복시, 시야장애 등의 신경학적 증상이 나타나서 우연히 뇌하수체 종양이 발견된 경우는 아주 드문 예이다. 저자들은 최근 뇌자기공명영상촬영과 혈중 프로락틴치의 측정을 통해 뇌하수체의 프로락틴분비 거대선종을 진단받은 복시와 시야장애를 보이는 27세 초임부에서, 브로모크립틴의 경구투여 만으로 증상의 호전 및 정상적인 임신유지 후 건강한 여아를 정상 분만한 예를 경험하였기에 이를 간단한 문헌고찰과 함께 보고하는 바이다.

본 연구는 르봐이예분만군과 일반질식분만군의 분만경험지각, 분만통증, 신생아통증반응 및모성애착행위정도를 비교하기 위하여 D시에 위치한 여성전문병원중에서월 분만 100건 이상의30병상 이상의병원중A, B, C 3곳을 임의 선정하여 르봐이예분만군 41명, 일반질식분만군 33명, 총 74명을 대상으로 자료수집하였다. A병원에서는 르봐이예분만법을적용하였으며, 나머지 B와 C병원에서는 르봐이예분만법외의 일반질식분만을 적용하였다. 2010년2월 28일부터 2010년4월15일까지약3개월간자료수집하였으며, 그결과는 아래와 같다. 분만경험지각은 르봐이예분만군이 평균 91.02점으로일반질식분만군의69.64점보다유의하게높았다(t= 7.47, p<.001). 분만전통증에서는르봐이예분만군이평균8.95점, 일반질식분만군 9.06점으로 유의한 차이가 없었으나(t=-0.32, p=.743), 분만후 통증에서는 르봐이예군과 일반질식분만군이 각각 평균 3.391점과 5.15점으로 참여군이 통계적으로 유의하게 통증이 낮았다(t= -2.51, p=.014). 신생아 통증반응은 르봐이예분만군(M=3.07)이 일반질식분만군(M=4.27)에비해 통계적으로 유의하게낮았다(t=-5.15, p<.001). 모성애착행위는 르봐이예분만군이 평균 16.95점, 일반질식분만군이 8.70점으로 르봐이예군이유의하게높았으며(t=10.39, p<.001), 구체적으로 살펴보면, 동일시는르봐이예분만군이평균7.32점으로일반질식분만군의3.85점보다 유의하게높았으며(t=8.00, p< .001), 상호작용도 르봐이예분만군이 평균 9.63점으로일반질식분만군의4.85점보다유의하게높았다(t= 10.46, p<.001). 결론적으로 르봐이예분만군은 일반질식분만군에 비해산모의분만경험지각이긍정적이었으며, 모성애착행위정도가높았고, 산부의산후분만통증과신생아통증정도가 낮았다. 따라서 앞으로 르봐이예분만법을 배우자에게 교육하여 그 효과를 확인하는 연구를 제언하며 또한 르봐이예분만법의 효과연구를 위해 연구조건을 잘 통제한 실험연구디자인에의한반복연구를제언한다. 본연구는일개지역을 대상으로 작은 수의 표본을 대상으로 시행하였으므로 우리나라 전체의 산모로 일반화 하는 데는 한계가 있다. 지역을 확대하고 많은 수의 산모를 대상자로 하여 효과를 검증하는 반복연구를 제언한다.

Objectives: The Leboyer childbirth method is known as less stressful and humane delivery method for both mothers and newborns. The objectives of this study was to compare the Leboyer childbirth method with normal vaginal delivery in terms of mothers’ perception of the childbirth experience,labor pain, newborn's pain response and maternal attachment behaviors. Materials and Methods: Sample of this study included forty one mothers in the Leboyer group and thirty three normal delivery mothers from two women's hospitals during the period of 28th February to 15th April 2010. All mothers completed questionnaires including the Marut and Mercer's perception of childbirth experience, 0~10 numeric scale of labor pain, Lawrence's newborn pain response, and Cropley, Lester, Pennington's maternal attachment behaviors. Results: The findings indicated significantly higher scores for mothers’ with the Leboyer method of childbirth on the Perception of Childbirth Experience (t=7.47, p<.001) and on maternal attachment behaviors (t=10.39, p<.001) and lower scores on maternal post-labor pain (t=-2.51, p=.014) as well as on the newborn's pain (t=-5.15, p<.001). There were no significant differences between the two groups for pre-labor pain. Conclusion: Mothers with Leboyer childbirth method reported more positive maternal childbirth experiences, maternal attachment behavior, and less newborn's pain response and less post-labor pain than mothers in the comparison group with the exception of pre-labor pain.

Globozoospermia is a rare type of teratozoospermia. It occurs in 0.1% of all andrological patient's and used to be considered sterile. Globozoospermic patient has 100% round headed spermatozoa, but the spermiogram is normal. The spermatozoa show oval-shape head, the lack of a nuclear envelope, acrosome, and post acrosomal sheath. Objective: To report that a couple with infertility secondary to globozoospermia received ICSI treatment. Material and Method: Case report Results: In the first trial, fertilization was failed. In the second trial, 40% of oocytes were fertilized and all of these embryos were cleaved, but pregnancy did not achieved. In the third trial, sperm injected oocytes were exposed to 10 ${\mu}M$ calcium ionophore for 15 min. All of the injected oocytes were fertilized and proceeded to develop. Triplet pregnancy was achieved after the transfer of six embryos in their third cycle. One embryo vanished and the remaining twins (female) were delivered at 33 weeks of gestation by Caesarean section. Conclusion: This result shows that assisted activation following ICSI may overcome infertility associated with globozoospermia.

Combined pregnancy occasionally occurs when intrauterine pregnancy is complicated with ectopic pregnancy. The incidence of combined pregnancy is normally rare, but the incidence increases when assisted reproductive technology was conducted for infertility treatment. We had a case of intrauterine pregnancy complicated with tubal pregnancy after IVF-ET cycle was conducted. The tubal pregnancy was removed via pelviscopy, which led to the delivery of healthy offspring at the $39^{th}$ week of pregnancy without additional complication.

병합임신이란 두 개의 수정란이 자궁강 내와 자궁강 외의 장소에 동시에 착상되어 임신 되는 것을 말하며 임상적으로 매우 드물게 발견되나, 최근 불임률의 증가에 따라 체외수정술 등의 보조 생식술의 기회가 증가되고 자궁내막증, 골반내 염증, 난관수술의 유병률이 증가되면서 점차 그 발생 빈도가 높아지고 있다. 대부분의 병합임신은 난관과 자궁강에 발생되거나 난소나 자궁경부, 자궁각 또는 복강에서도 발생될 수 있으나 자궁벽 내에 병합임신이 발생하는 경우는 매우 드물며, 그런 경우 자궁벽 내 임신의 제거 후 자궁강 내의 정상 임신은 자궁파열의 위험성을 가지므로 만삭까지 유지시키기 매우 어렵다. 본 저자들은 시험관 아기 시술에 의해 자궁벽과 자궁강 내에 병합임신이 된 임신부에서 자궁벽 내 임신을 수술적으로 제거 한 후, 만삭까지 유지하여 성공적인 분만을 한 1예를 경험하여 간단한 문헌고찰과 함께 보고하는 바이다.

고주파 자궁근종용해술은 일종의 열치료로, 자궁근종세포를 가열하여 세포사를 유도하는 치료방법으로, 자궁을 보존할 수 있 으며 전신마취와 입원치료가 필요하지 않다는 장점을 가지고 있다. 그러나 근종적출술과 같은 열치료 방법이 임신과 분만에 어떠한 영향을 주는가에 대해서는 잘 알려져 있지 않다. 저자들은 장막하 근종을 가지고 있는 여성의 고주파 자궁근종용해 술 이후 자연임신에 성공하여 만삭 분만한 1예를 경험하였으며, 이를 문헌고찰과 함께 보고하고자 한다.

Radiofrequency (RF) myolysis is a minimally invasive treatment by create thermal energy in targeted uterine fibroid and cause the aseptic necrosis of leiomyoma cells. Unlike hysterectomy which is considered to be the most common treatment of uterine leiomyoma, RF myolysis can preserve the uterus, and unlike myomectomy which can preserve the uterus but requires the hospitalization and general anesthesia, it can be performed as outpatient procedure using only sedation for pain relief without additional need for medication. There are many published studies reporting the pregnancy complications and outcomes after myomectomy, but few studies regarding pregnancy and myolysis are available. We have experienced a full term vaginal delivery after RF myolysis of subserosal myoma and hereby we report our case with a brief review.