Myasthenia gravis is a autoimmune neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The underlying defect is a decrease in the number of available acetylcholine receptors at neuromuscular junction due to an antibody-mediated autoimmune attacks. The course of myasthenia gravis during pregnancy is not predictable. We experienced a patient of myasthenia gravis associated with pregnancy who underwent cesarean section and transient neonatal myasthenia gravis of the newborn. We present this case with brief review of the concerned literatures.
Cesarean Section ; Female ; Humans ; Infant, Newborn ; Muscle, Skeletal ; Myasthenia Gravis* ; Myasthenia Gravis, Neonatal ; Neuromuscular Junction ; Pregnancy* ; Receptors, Cholinergic

The chest radiographs and angiograms were retrospectively evaluated in 47 patients with pulmonary atresia (PA) and ventricular septal defect (VSD) to determine the characteristic findings of major aortopulmonary collateral arteries (MAPCSs) on the chest radiographs. Of 47 patients, 23 had MAPCAs and 24 had only PDA for blood supply of whole right and left lung. Chest radiographs enabled identification of 16 of 23 patients with MAPCAs. The most common finding of MAPCAs was inappropriately large peripheral pulmonary vasculature (n=16, 69.6%). The other findings were tortuosity of pulmonary vasculature (n=12, 52.2%), focal unevendistribution of pulmonary vasculature (n=12, 52.2%), and two descending pulmonary arteries (n=4, 17.4%). When chest radiographs showed two or more findings of MAPCAs, MAPCAs could be differentiated from PDA with statistical significance (p<0.005). It is concluded that chest radiographs may help to identify MAPCAs before angiography if two-dimensional echo ardiography suggests PA with VSD.
Angiography ; Arteries* ; Heart Septal Defects, Ventricular* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Radiography, Thoracic ; Retrospective Studies ; Thorax*

OBJECTIVE: The aim was to assess the value of resistance index(RI) and pulsatility index(PI) to differentiate between benign and malignant ovarian tumors by color and pulsed Doppler ultrasound. METHODS: 129 ovarian tumors identified with ultrasound were referred for color and pulsed Doppler ultrasound evaluation to calculate the lowest RI and PI, and the corresponding histopathologic diagnosis was recorded. RESULTS: The intratumor artery waveforms were obtained in 37.1%(36 of 97) of benign tumors and in 91.0%(29 of 32) of the malignant group. RI and PI were lower in malignant tumors than in benign tumors(p<0.01). Also, there was a significant incremental decrease in both indices value from the benign tumor toward borderline malignancy(p<0.05) and to invasive ovarian cancer(p<0.01). But, there was no significant difference in both indices value according to the FIGO stage of ovarian malignancy. For RI cut-off value of 0.6, sensitivity and specificity were 89.7% and 91.7%; for PI cut-off value of 1.1, 86.2% and 91.7%. Therefore, the most accurate cut-off values of RI and PI were 0.6 and 1.1, respectively. CONCLUSION: RI and PI calculated by color and pulsed Doppler ultrasound can help in the diagnosis and selection of treatment plan of ovarian tumors, especially when the morphological finding of ovarian tumor is equivocal. And during the follow up of benign tumors, both indicies can give us the clue of malignant potential of benign tumors.
Arteries ; Diagnosis* ; Follow-Up Studies ; Ovarian Neoplasms* ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Asthma is an inflammatory disease of the airways that is induced by Th2 cytokines and inhibited by Th1 cytokines. Oligodeoxynucleotides containing a CpG motif(CpG ODN), as potent inducers of Th1 immunity, are considered promising candidates for immune modulation in asthma. In this study we wanted to investigate the effect of CpG ODN on eosinophilia and cytokines of BALF in a mouse model established airway inflammation and the optimal route(systemic vs mucosal) of CpG ODN. We examined the difference of immunologic responses between CpG ODN and corticosteroids. METHODS: Female BALB/c mice, induced pulmonary allergic inflammation, were treated intranasally or intraperitoneally with CpG ODN and Dexamethasone. Allergen-specific antibody responses, cytokines(IL-4, IL-5, IL-12), and eosinophilic inflammation of the airways were investigated on BALF and splenocyte. RESULTS: CpG ODN effectively induced IL-12 and inhibited IL-4 and IL-5 as well as eosinophilic inflammation when CpG ODN was administered intranasally or intraperitoneally with allergen challenge. Therapy with corticosteroides, while effective inhibiting IL-5 generation, did not induced IL-12 in BALF. CONCLUSION: Systemic or mucosal administration of CpG ODN effectively stimulated the production of Th1 cytokines and suppressed eosinophilic airway inflammation in contrast of corticosteroids and control ODN. Thus, CpG ODN vaccination is a potentially useful approach for immunomodulation of established airway inflammation in a mouse model of asthma.
Administration, Mucosal ; Adrenal Cortex Hormones ; Animals ; Antibody Formation ; Asthma ; Cytokines* ; Dexamethasone ; Eosinophilia* ; Eosinophils ; Female ; Humans ; Immunomodulation ; Inflammation* ; Interleukin-12 ; Interleukin-4 ; Interleukin-5 ; Mice* ; Oligodeoxyribonucleotides ; Vaccination

Sustained downgaze mostly occurs in association with lesions affecting the dorsal midbrain. We report sustained downgaze in a patient with hepatic encephalopathy. The sustained downgaze existed for seven more days after she regained her consciousness. The persistent downgaze even after regaining full consciousness indicates localized pretectal dysfunction rather than diffuse encephalopathy as the mechanism of sustained downgaze in our patient. The ocular motor dysfunction in hepatic encephalopathy may be due to localized dysfunction of the brainstem

Objectives: This study used data from the seventh National Health and Nutrition Survey, a dataset which signifies that dental services in the country exhibit relatively low health insurance coverage and high copay rates compared to other medical healthcare services. We surveyed the utilization rate of dental care and the prevalence of untreated conditions among Korean elders aged over 65.Furthermore, we aimed to present policy implications to improve dental care accessibility and expand health insurance coverage for elders, especially vulnerable individuals who are bedridden or living alone. Methods: We used raw data from the seventh National Health and Nutrition Survey to investigate Korean elders’ dental service utilization and untreated conditions. We opted for elders aged over 65 and finalized 1,712 subjects for the analysis. Statistical analysis was performed using IBM SPSS 25.0 (IBM Corp., Chicago, IL, USA). Groups were detailed in terms of strata of variation estimation and elders aged over 65, cluster of district enumeration, and weighted oral survey. We generated a scheme file and employed complex sampling analysis with a statistical significance level of P<0.05. Results: This study intended to survey the rate of dental care use and untreated care of Korean elders over 65 using the seventh National Health and Nutrition Survey data which represents our country. 1. Dental care use rate based on general traits showed statistically significant relevance (P<0.01) with lower age, higher income, higher education level, residence of ‘Dong’, and ‘with’ private insurance. 2. In untreated rate of dental care by general traits showed the significant total of 26.1% with female, lower income, lower education level, ‘recipient’ of basic living, and subjectively poor status of oral health. 3. The multiple answers of the patients who went to the dentists over the past year showed dental care details of dental checkups 54.3%, prosthetic dentistry 32.1%, preventive treatment 30.9%, cavity of root canal treatment 25.7%, gum treatment 17.1%, and tooth extraction 14.7%. 4. The reasons for untreated dental care of those untreated subjects showed the highest 34.0% of economic reason, mild condition 32.3%, lack of time 8.2%, and scared of treatment 8.0% in order. Based on this analysis, we intended to suggest policy implications for the necessity of dental checkup expansion and the activation of prevention treatment. Conclusions To improve dental care accessibility for elders aged 65 and above, especially the vulnerable individuals who are bedridden or living alone, it is imperative to expand outpatient insurance coverage and tailor the dental services as per their specific needs. Shifting the focus from treatment-oriented health insurance to preventive measures and examination service expansion and invigoration is essential to improve dental health and overall quality of life. It is deduced that expansion of dental care health insurance coverage and checkup services is critical for vulnerable elders, such as those who are bedridden or living alone.

Primary ovarian pregnancy is comparatively rare in ectopic pregnancy. Ovarian pregnancy occurs in corpus luteum cyst and is usually accompanied with the rupture of ovary and a massive hemoperitoneum. It presents as a hemorrhagic ovary and frequently misdiagnosed as a ruptured corpus luteum. Spiegelberg's criteria should be fulfilled for the diagnosis of ovarian pregnancy. Two cases of ovarian pregnancy were presented with a brief review of the literatures.
Corpus Luteum ; Diagnosis ; Female ; Hemoperitoneum ; Ovarian Cysts ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

PURPOSE: To observe the hemodynamic change in brain tumors and peritumoral edemas after steroid treat-ment, and then nvestigate the clinical usefulness of perfusion MRI. MATERIALS AND METHODS: We acquired conventional and perfusion MR images in 15 patients with various in-tracranial tumors (4 glioblastoma multiformes, 4 meningiomas, 3 metastatic tumors, 1 anaplastic ependymo-ma, 1 anaplastic astrocytoma, 1 hemangioblastoma, and 1 pilocytic astrocytoma). For perfusion MR imaging, a 1.5T unit employing the gradient-echo EPI technique was used, and further perfusion MR images were ob-tained 2-10 days after intravenous steroid therapy. After processing of the raw data, regional cerebral blood volume (rCBV) maps were reconstructed. The maps were visually evaluated by comparing relative perfusion in brain tumors and peritumoral edemas with that in contralateral white matter. Objective evaluations were performed by comparing the perfusion ratios of brain tumors and peritumoral edemas. RESULTS: Visual evaluations of rCBV maps, showed that in most brain tumors (67%, 10/15), perfusion was high before steroid treatment and showed in (80%, 12/15) decreased afferwards. Objective evaluation, showed that in all brain tumors, perfusion decreased. Visual evaluation of perfusion change in peritumoral edemas revealed change in only one case, but objective evaluation indicated that perfusion decreased signifi-cantly in all seven cases. CONCLUSIONS: rCBV maps acquired by perfusion MR imaging can provide hemodynamic information about brain tumors and peritumoral edemas. Such maps could prove helpful in the preoperative planning of brain tumor surgery and the monitoring of steroid effects during conservative treatment.
Astrocytoma ; Blood Volume* ; Brain Neoplasms* ; Brain* ; Edema* ; Glioblastoma ; Hemangioblastoma ; Hemodynamics ; Humans ; Magnetic Resonance Imaging* ; Meningioma ; Perfusion* ; Steroids

PURPOSE: To observe the hemodynamic change in brain tumors and peritumoral edemas after steroid treat-ment, and then nvestigate the clinical usefulness of perfusion MRI. MATERIALS AND METHODS: We acquired conventional and perfusion MR images in 15 patients with various in-tracranial tumors (4 glioblastoma multiformes, 4 meningiomas, 3 metastatic tumors, 1 anaplastic ependymo-ma, 1 anaplastic astrocytoma, 1 hemangioblastoma, and 1 pilocytic astrocytoma). For perfusion MR imaging, a 1.5T unit employing the gradient-echo EPI technique was used, and further perfusion MR images were ob-tained 2-10 days after intravenous steroid therapy. After processing of the raw data, regional cerebral blood volume (rCBV) maps were reconstructed. The maps were visually evaluated by comparing relative perfusion in brain tumors and peritumoral edemas with that in contralateral white matter. Objective evaluations were performed by comparing the perfusion ratios of brain tumors and peritumoral edemas. RESULTS: Visual evaluations of rCBV maps, showed that in most brain tumors (67%, 10/15), perfusion was high before steroid treatment and showed in (80%, 12/15) decreased afferwards. Objective evaluation, showed that in all brain tumors, perfusion decreased. Visual evaluation of perfusion change in peritumoral edemas revealed change in only one case, but objective evaluation indicated that perfusion decreased signifi-cantly in all seven cases. CONCLUSIONS: rCBV maps acquired by perfusion MR imaging can provide hemodynamic information about brain tumors and peritumoral edemas. Such maps could prove helpful in the preoperative planning of brain tumor surgery and the monitoring of steroid effects during conservative treatment.
Astrocytoma ; Blood Volume* ; Brain Neoplasms* ; Brain* ; Edema* ; Glioblastoma ; Hemangioblastoma ; Hemodynamics ; Humans ; Magnetic Resonance Imaging* ; Meningioma ; Perfusion* ; Steroids

OBJECTIVES: The aims of this study were to find and compare the effect of directional (DIR) processing of two different hearing aids via both subjective and objective methods, to determine the association between the results of the subjective and objective evaluations, and to find out individual predictive factors influencing the DIR benefit. METHODS: Twenty-six hearing aid users fitted unilaterally with each two different experimental hearing aid performed modified Korean Hearing in Noise Test (K-HINT) in three DIR conditions; omnidirectional (OMNI) mode, OMNI plus noise reduction feature, fixed DIR mode. In order to determine benefits from DIR benefit within a hearing aid and compare performance of the DIR processing between hearing aids, a subjective questionnaire was administrated on speech quality (SQ) and discomfort in noise (DN) domain. Correlation analysis of factors influencing DIR benefit was accomplished. RESULTS: Benefits from switching OMNI mode to DIR mode within both hearing aids in K-HINT were about 2.8 (standard deviation, 3.5) and 2.1 dB SNR (signal to ratio; SD, 2.5), but significant difference in K-HINT results between OMNI and OMNI plus noise reduction algorithm was not shown. The subjective evaluation resulted in the better SQ and DN scores in DIR mode than those in OMNI mode. However, the difference of scores on both SQ and DN between the two hearing aids with DIR mode was not statistically significant. Any individual factors did not significantly affect subjective and objective DIR benefits. CONCLUSION: DIR benefit was found not only in the objective measurement performed in the laboratory but also in the subjective questionnaires, but the subjective results was failed to have significant correlation with the DIR benefit obtained in the K-HINT. Factors influencing individual variation in perceptual DIR benefit were still hard to explain.
Hearing Aids* ; Hearing Loss ; Hearing* ; Noise ; Signal-To-Noise Ratio ; Speech Intelligibility