Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute / 영남의대학술지

Background@#Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital. @*Methods@#We retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. @*Results@#A total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). @*Conclusion@#Minimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Clinical and histopathologic analysis of gynecological cancer: a single institute experience over 7 years / 영남의대학술지

Background@#Approximately 100,000 women are diagnosed with cancer each year in Korea. According to a survey by the Korean central cancer registry in 2016, uterine cervical cancer, uterine corpus cancer, and ovarian cancer were the 5th, 7th, and 8th most prevalent cancers respectively among Korean women. The present study aims to review the clinico-pathologic characteristics of patients who were treated for major gynecological malignancies at Yeungnam University Medical Center. @*Methods@#Patients with invasive gynecological cancers from January 2012 to February 2019 were retrospectively identified. We analyzed the clinical features, demographic profiles, pathologic data, treatment modality used, adjuvant treatment used, complications, recurrence, and survival outcomes. @*Results@#A total of 287 patients (cervical cancer 115; corporal cancer 86; and ovarian, tubal, or primary peritoneal cancer 90) were included. Most cervical (82.7%) and corporal cancers (89.5%) were diagnosed in the early stages (stage I or II), while more than half (58.9%) the cases of ovarian, tubal or peritoneal cancers were diagnosed in the advanced stages (stage III or IV). Surgical complications were observed in 12.2% of cervical cancers, 16.3% of uterine corpus cancers, and 11.1% of ovarian, tubal, and peritoneal cancers, respectively. The 5-year overall survival rate was 94.1%, 91.0%, and 77.1% for cervical, corporal, and ovarian, tubal, or peritoneal cancers, respectively. @*Conclusion@#Surgical treatment was satisfactory in terms of the incidence of complications, and survival outcomes were generally good. Clinicians should be aware of the clinical and histopathological characteristics of patients with gynecological cancers to be able to provide optimal strategies and counseling.

Vascular Complications Related to Posterior Lumbar Disc Surgery

PURPOSE: To evaluate patients who underwent surgical or endovascular treatment after vascular injury related to posterior lumbar disc surgery. MATERIALS AND METHODS: We retrospectively reviewed seven cases of vascular injuries (four lacerations, one arteriovenous fistula [AVF], and two pseudoaneurysms) related to lumbar disc surgery by a posterior approach from January 1997 to December 2016 at Chonnam National University Hospital. Information of patient characteristics, diagnosis, treatment strategies, and outcomes were analyzed. RESULTS: Five out of seven cases were inhospital cases. In three laceration cases, each patient instantly became hypotensive and a life-threatening arterial injury was suspected. Therefore, the patient was immediately turned to the supine position and surgical repair was performed. The patients with pseudoaneurysm and AVF were treated by endovascular intervention. Remaining two were referred cases under the impression of vascular injuries. One laceration case of them was in preshock condition, and the left common iliac artery was surgically repaired. The other referred patient showed pseudoaneurysm which was treated with stent graft insertion. There was no surgery or endovascular intervention related death and none of the patients suffered any sequela related to vascular injury. CONCLUSION: Vascular injury associated with posterior lumbar disc surgery is not common, but can be fatal. Early recognition, diagnosis, and prompt treatment are essential to prevent fatal outcomes. Recently, endovascular intervention is increasingly and preferably used because of its low morbidity and mortality. However surgery is still the best option for the patients with unstable vital sign and endovascular approach can be applied to stable patients.

Bedside Teaching of Relaxation Technique for Terminal Cancer Patients Treated with Radiation Therapy / 한국호스피스완화의료학회지

Radiation therapy is an effective modality to alleviate cancer-related symptoms. To deliver radiation accurately, it is essential to secure stability of the treatment position in patients during each treatment time. However, some patients could be less cooperative due to their psychoemotional issues. We present two cases of terminal-stage cancer patients who were initially unable to lie still on the treatment table before simulation. A relaxation technique was taught to them on the bed, and they could relax and undergo radiation therapy with effective symptom relief.

Redox Factor-1 Inhibits Cyclooxygenase-2 Expression via Inhibiting of p38 MAPK in the A549 Cells

In this study, we evaluated the role of apurinic/apyrimidinic endonuclease1/redox factor-1 (Ref-1) on the tumor necrosis factor-alpha (TNF-alpha) induced cyclooxygenase-2 (COX-2) expression using A549 lung adenocarcinoma cells. TNF-alpha induced the expression of COX-2 in A549 cells, but did not induce BEAS-2B expression. The expression of COX-2 in A549 cells was TNF-alpha dose-dependent (5~100 ng/ml). TNF-alpha-stimulated A549 cells evidenced increased Ref-1 expression in a dose-dependent manner. The adenoviral transfection of cells with AdRef-1 inhibited TNF-alpha-induced COX-2 expression relative to that seen in the control cells (Ad beta gal). Pretreatment with 10 micrometer of SB203580 suppressed TNF-alpha-induced COX-2 expression, thereby suggesting that p38 MAPK might be involved in COX-2 expression in A549 cells. The phosphorylation of p38 MAPK was increased significantly after 5 minutes of treatment with TNF-alpha, reaching a maximum level at 10 min which persisted for up to 60 min. However, p38MAPK phosphorylation was markedly suppressed in the Ref-1-overexpressed A549 cells. Taken together, our results appear to indicate that Ref-1 negatively regulates COX-2 expression in response to cytokine stimulation via the inhibition of p38 MAPK phosphorylation. In the lung cancer cell lines, Ref-1 may be involved as an important negative regulator of inflammatory gene expression.

Overexpression of Ref-1 Inhibits Lead-induced Endothelial Cell Death via the Upregulation of Catalase

The role of apurinic/apyrimidinic endonuclease1/redox factor-1 (Ref-1) on the lead (Pb)-induced cellular response was investigated in the cultured endothelial cells. Pb caused progressive cellular death in endothelial cells, which occurred in a concentration- and time-dependent manner. However, Ref-1 overexpression with AdRef-1 significantly inhibited Pb-induced cell death in the endothelial cells. Also the overexpression of Ref-1 significantly suppressed Pb-induced superoxide and hydrogen peroxide elevation in the endothelial cells. Pb exposure induced the downregulation of catalase, it was inhibited by the Ref-1 overexpression in the endothelial cells. Taken together, our data suggests that the overexpression of Ref-1 inhibited Pb-induced cell death via the upregulation of catalase in the cultured endothelial cells.

Alternative Isoforms of TonEBP with Variable N-termini are Expressed in Mammalian Cells

Hypertonicity imposes a great deal of stress to cells since it causes rise in cellular ionic strength, which can be reduced by the accumulation of compatible osmolytes. TonEBP plays a central role in the cellular accumulation of compatible osmolytes via transcriptional stimulation of membrane transporters and aldose reductase. Alternatively spliced forms of TonEBP mRNA have previously been reported and two of them showed different transcriptional activity. In the present study, isoform-specific antibodies were produced to confirm the translation of the spliced mRNA to protein. TonEBP was immunoprecipitated by using anti-TonEBP antibody and then immunoblotted using anti-TonEBP or isoform specific antibodies to find out the expression profile of TonEBP isoforms in basal or stimulated condition. From these results, we conclude that all TonEBP isoforms are expressed in mammalian cells and their expression patterns are not same in every cells.

Effects of Behavior Modification on Body Image, Depression and Body Fat in Obese Korean Elementary School Children

This study was performed to investigate the effects of behavior modification on body image, depression and body fat in obese elementary school children. Sixty-two elementary students of the 4th to 6th grade were selected from two different Seoul schools. Thirty-four children in one school were designated as the experimental group, and 28 children from the other school as the control group. The experimental group received 60 - 70 minutes of behavior modification, once a week, for 8 weeks. The control group received neither management nor treatment. The results indicated a significant improvement of body image and a reduction in the increase rate of body fat for the experimental group. This finding strongly supports the theory that behavior modification can be used as an effective strategy in the treatment of obese children.

Correlation between Mother's Characteristics and Biophysical Index in Obese Children / 여성건강간호학회지

PURPOSE: This study was performed to investigate the correlation between mother's characteristics and obesity index, percentage of body fat, total cholesterol, and serum leptin levels in obese children. METHOD: Sixty two students in 4th, 5th, and 6th grades were selected from two elementary schools located in the suburbs of Seoul. Mother's characteristics were collected by questionnaires. Biophysical indexes were as follows; obesity indexes were calculated by height and weight, percentages of body fat were measured by a bioelectrical impedence fatness analyzer, total cholesterol levels were measured by a Hitachi automatic analyzer, and serum leptin levels were measured by the immunoradiometric assay method. RESULT: The degree of mother's concern for their children's obesity showed a statistically significant positive correlation with biophysical indexes such as obesity index and serum leptin level in obese children. However, there were no significant correlations between mother's economic state, education level, occupation and biophysical indexes. Also, there were no significant correlations between mother's concern for their children's obesity and percentage of body fat, and serum cholesterol levels. CONCLUSION: These results indicate that mother's concern for their children's obesity is one of the most important factors in child obesity.

Effects of Behavior Modification on Obesity Index, Skinfold Thickness, Body Fat, Serum Lipids, Serum Leptin in Obese Elementary School Children / 간호학회지

PURPOSE: This study was performed to investigate effects of behavior modification on obesity index, skinfold thickness, body fat, serum lipids, serum leptin in obese elementary school children. METHOD: Forty seven students were selected from two elementary schools. Twenty four children in one school were assigned to experimental group and twenty three children in another school were assigned to control group. Experimental group was received 60-70 minutes of behavior modification once a week for 8 weeks. RESULT: Obesity index of the experimental group was significantly decreased after behavior modification. But there was no significant difference between two groups. The increase of skinfold thickness was significantly low in the experimental group compared to the control group. Percentage of body fat and fat mass were significantly decreased in the experimental group. Fat free mass was significantly increased in the experimental group. HDL-C, triglyceride and serum leptin between the experimental group and control group showed no significant difference. CONCLUSION: These results indicate that behavior modification is effective in decreasing percentage of body fat and fat mass, in less increasing skinfold thickness and in increasing fat free mass. In conclusion, behavior modification can be used as effective strategy for managing obesity in elementary school children.

SM709, Ingredient of Antimelanogenic Bamboo Extract, Blocks Endothelin-1-induced Ca2+i Increase in Human Melanocytes

Endothelins secreted from keratinocytes are intrinsic mitogens and melanogens of human melanocytes in UVB-induced hyperpigmentation. To elucidate the cellular mechanism of antimelanogenic activity of bamboo extract, the effects of three ingredients of bamboo extract on endothelin 1 (ET-1) -induced Ca2+ mobilization were investigated in cultured human melanocytes. ET-1 receptors in human melanocytes were characterized by using specific antagonist, and ET-1 was found to increase intracellular Ca2+ concentration ([Ca2+]i) by activating ET-B receptor. SM709 (1, 2-O-diferulyl-glycerol), an ingredient of bamboo extract, inhibited ET-1-induced [Ca2+]i increase in a concentration- and time-dependent manner, although another ingredients SM707 and SM708 had no effect on ET-1-induced [Ca2+]i increase in human melanocytes. SM709 (100 microM), however, did not affect [Ca2+]i increase induced by thapsigargin and caffeine, suggesting that SM709 has no effect on the Ca2+ store in melanocytes. Furthermore, SM709 did not affect [Ca2+]i increase induced by LPA or ATP, known as G protein-mediated PLC activators like ET-1. Taken together, it is suggested that SM709 antagonizes ET-1-induced transmembrane signaling through ET-B receptor, which maybe a possible underlying mechanism of antimelanogenic activity of bamboo extract in human melanocytes.

Influence of Environmental Living Standards on Helicobacter pylori Infection in Korean Elementary School Children / 대한소아소화기영양학회지

PURPOSE: We measured anti-H. pylori IgG in Korean elementary school children living in Shinchon area of Seoul, Korea to evaluate the influence of environmental living standards on H. pylori infection. METHODS: IgG antibodies to H. pylori were measured in plasma using a commercial ELISA kit (GAP IgG Helicobacter pylori, Bio-Rad Laboratories Inc., Hercules, CA, USA). Information on environmental status such as place of birth, parental income, type of housing, number of persons in the household, parents' occupation, family history of peptic ulcer disease and gastric cancer was obtained. Statistical analysis was done by Chi-square and logistic regression test using SPSS 7.0(TM) for Windows. RESULTS: Study subjects consisted of 571 children, and the age distribution ranged from 6.0 to 13.6 years with a mean of 9.6+/-1.8 years. Male-to-female ratio was 1.1:1. The seropositive rates of H. pylori infection ranged from 10.4% in children aged 6 years to 30.9% in 12 year-old group, overall 16.8%. The prevalence of H. pylori infection progressively increased with age, but there was no significant difference in seropositive rates among children in different age groups (p=0.06). Seropositive rates of anti-H. pylori IgG on the basis of gender, place of birth, parental income, type of housing, parents' occupation, family history of peptic ulcer disease and gastric cancer showed no statistically significant difference. Interestingly, however, seropositive rate of anti-H. pylori IgG showed statistical significance in relation to number of persons in the household (p=0.003; Odds ratio 1.50 by logistic regression test). CONCLUSION: These results suggest that number of persons in the household is the most important factor among environmental living standards, and that risk of H. pylori infection increases by increment of 1.5 times as the number of persons in the household increases by one.

Effects of Behavior Modification on Physical Variables, Habit and Self-esteem in Obese Elementary School Children / 아동간호학회지

Behavior modification is an approach to decrease degree of obesity through changing maladaptive eating habit and life style. It produces small amount of weight loss but it has few side effects and low dropout rate. It also has great effectiveness on maintenance of decreased weight. This study was performed to investigate effects of behavior modification on physical variables, fat and thin habit, and self-esteem in obese elementary school children. Sixty two students of 4th, 5th, and 6th grade were selected from two elementary schools located in the suburbs of Seoul. Thirty four children in one school were assigned to experimental group and twenty eight children in another school were assigned to control group. All subjects were healthy and were not on any type of obesity control. Behavior modification, in this study, was consisted of introduction, self-monitoring and stimuli control, education about diet and physical activities, individual counseling and reinforcement, requesting personal assistance, cognitive restructuring, and closing and long-term planning. Experimental group was received 60 ~ 70 minutes of behavior modification once a week for 8 weeks from October 16 to December 22, 2000. Control group was not received any intervention. Data were collected before and after intervention by measuring physical variables, fat and thin habit, and self-esteem. Physical variables consisted of obesity index, skinfold thickness, body fat(percentage of body fat, fat mass, fat free mass), serum lipids(total cholesterol, HDL-C, LDL-C, triglyceride) and serum leptin. The results were as follows ; 1. physical variables 1)Obesity index of the experimental group was significantly decreased after behavior modification. But there was no significant difference between two groups. 2)The increase of skinfold thickness was significantly low in the experimental group compared to the control group. 3) Percentage of body fat and fat mass were significantly decreased in the experimental group. Fat free mass was significantly increased in the experimental group. 4) Total cholesterol, HDL-C, triglyceride and serum leptin between the experimental group and control group showed no significant difference. LDL-C was significantly decreased in the control group. 2. Thin habit score was significantly increased in the experimental group. In subcategories of habit, thin scores of life style, attitude, social relationship, nutrition were significantly increased in the experimental group. 3. Self-esteem score was significantly increased in the experimental group. These results indicate that behavior modification is effective in decreasing percentage of body fat and fat mass, in less increasing skinfold thickness and in increasing fat free mass, thin habit, and self-esteem. In conclusion, behavior modification can be used as safe and effective strategy for managing obesity in elementary school children.

A Case of Segmental Nectotizing Jejunitis / 대한소아소화기영양학회지

Segmental necrotizing jejunitis is characterized by severe abdominal pain of acute onset, bilious vomitings and foul smelling loose stools containing blood. Pathologic features include circumferential intestinal wall inflammation ranging from edema with minimal congestion to severe congestion, hemorrhage with necrosis, ulceration, and gangrene with perforation. Early diagnosis and suitable supportive measures prevent unnecessary laparatomy and complications. There was no report of this disease entity in children in Korea. We experienced a case of segmental necrotizing jejunitis with fever, abdominal pain and bloody stools, which was diagnosed by exploration and was treated successfully by antibiotics and supportive measures.

Change in the Synthesis of Brain-Derived Neurotrophic Factor in the Dorsal Root Ganglion Following Peripheral Inflammation / 대한해부학회지

It is well known that nerve growth factor (NGF) may serve as a link between inflammation and hyperalgesia. However, there is little information whether brain-derived neurotrophic factor (BDNF), another family of neurotrophin, may related with nociception. In the present study, in situ hybridization was used to evaluate i) the change in the level of BDNF mRNA, ii) colocalization of the trkA mRNA and BDNFmRNA and iii) colocalization of the preprotachykinin (PTT)mRNA and BDNFmRNA following peripheral inflammation produced by an intraplantar injection of Freund's adjuvant into the rat paws. The results obtained were as follows: 1. Peripheral tissue inflammation significantly increased BDNFmRNA levels in the DRG. 2. Many neurons expressing trkAmRNA showed increased expression of BDNFmRNA following peripheral inflammation. 3. Many neurons expressing PTT mRNA showed increased expression of BDNFmRNA following peripheral inflammation. 4. Intraplantar injection of antibody to NGF together with Freund's adjuvant prevent the increase in BDNFmRNA. The present results indicate that the peripheral inflammation induces an increased synthesis of BDNF which is mediated by NGF and BDNF coexist with substance P in the DRG and that BDNF may play an important role related with nociception.