Expulsion of Fibroids to the Endometrial Cavity after Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound Surgery (MRgFUS) Treatment of Intramural Uterine Fibroids

OBJECTIVES: This report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy. METHODS: Of the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system. RESULTS: The volume of fibroids ranged from 26.0 cm³ to 199.5 cm³, averaging 95.6 cm³. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy. CONCLUSIONS: In some cases, after an intramural uterine fibroid is treated with MRgFUS, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution.

Clinical Consideration of Treatment to Ablate Uterine Fibroids with Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound (MRgFUS): Sonalleve

OBJECTIVES: Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS. METHODS: This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio. RESULTS: When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly. CONCLUSIONS: In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.

Clinical experience with single-port access laparoscopic cystectomy and myomectomy / 대한생식의학회지

OBJECTIVE: This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. METHODS: The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. RESULTS: The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33~0.78 g/dL and 4.14%~2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34~1.13 g/dL and 4.17%~3.24% in SPA laparoscopic myomectomy, respectively. CONCLUSION: This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy.

Protective effect of halophyte Salsola komarovi Iljin against gastric ulcer Induced by alcohol treatment in rats / 동물의과학연구지

Salsola komarovi Iljin is a halophyte and herbaceous annual native to the sand dunes and beaches of Japan, northern China, Sakhalin, and Korea. The plants have been known as an ecologically important species for enhancing formation of sand dunes in Korea. The purpose of this study was to examine the anti-gastric ulcer effect of Salsola komarovi Iljin halophyte in an HCl-ethanol-induced gastritis model. SD rats (7-weeks-old) were divided into normal (I, n=10), control (II, 60% HCl-ethanol + water, n=10), 60% HCl-ethanol + Ranitidine 300 mg/kg (III, n=10), 60% HCl-ethanol + Salicornia herbacea L. 500 mg/kg (IV, n=10), 60% HCl-ethanol + 50% alcohol extract of Salsola komarovi Iljin 500 mg/kg (V, n=10), and 60% HCl-ethanol + water extract of Salsola komarovi Iljin 500 mg/kg (VI, n=10) groups. Salsola komarovi Iljin significantly suppressed gastric lesions and ulcers in the 60% HClethanol-induced gastric model. Especially, 500 mg/kg of 50% alcohol extract of Salsola komarovi Iljin showed significant inhibitory effects against gastritis. Especially, 50% alcohol extract of Salsola komarovi Iljin 500 mg/kg showed a significantly inhibitory effect, which was more potent than that of 300 mg/kg of Ranitidine. In histopathological analysis of the animal model, Salsola komarovi Iljin attenuated gastric ulcer formation. Our results suggest that Salsola komarovi Iljin has inhibitory effects against gastritis and gastric ulcers and could be developed as a new anti-gastric ulcer agent.

Sildenafil Inhibits Advanced Glycation End Products-induced sFlt-1 Release Through Upregulation of Heme Oxygenase-1

OBJECTIVES: We examined the effect of sildenafil citrate on advanced glycation end products (AGEs)-induced soluble fms-like tyrosine kinase 1 (sFlt-1) release in JEG-3 choriocarcinoma cells. METHODS: Cells were incubated with control bovine serum albumin (BSA) or AGEs-BSA, and expression of sFlt-1 mRNA and protein release was determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. AGEs-BSA increased sFlt-1 mRNA expression and protein release in a dose-dependent manner. RESULTS: Sildenafil citrate suppressed sFlt-1 mRNA expression and protein release in cells treated with AGEs-BSA in a dose-dependent manner. Likewise, it inhibited the increase of reactive oxygen species (ROS) production and NF-kappaB activity in these cells. Cobalt protoporphyrin (CoPP) and bilirubin also inhibited sFlt-1 release and ROS production in cells treated with AGEs-BSA, whereas zinc protoporphyrin IX (ZnPP IX) antagonized the effect of sildenafil citrate. In cells transfected with the heme oxygenase-1 (HO-1) siRNA, sildenafil citrate failed to inhibit the sFlt-1 release and ROS production. CONCLUSION: These results strongly suggest that sildenafil citrate inhibits sFlt-1 release and ROS production in cells treated with AGEs-BSA through upregulation of the HO-1 expression in JEG-3 cells.

Rhabdomyolysis due to hyponatremia in a patient taking benzodiazepines / 대한내과학회지

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.

Etiology and clinical course of secondary membranous nephropathy / 대한내과학회지

BACKGROUND: Membranous nephropathy (MN) is the most common cause of adult nephrotic syndrome worldwide. Although MN is commonly idiopathic, there are some secondary causes. In this article we describe the clinical courses of the patients with MN presumedly due to secondary causes. METHODS: Fifty-one patients with MN were retrospectively evaluated for possible etiologic factors as well as evaluated for their clinical courses after renal biopsy between March 1990 and December 2003 in the Dong-a University College of Medicine. RESULTS: There were 19 men and 32 women (M:F=1:1.6). The majority of the causes of secondary MN were SLE (31 cases, 60.8%) and hepatitis B (12 cases, 23.5%). The others included malignancy, hepatitis C, syphilis and MCTD. Twenty-nine of 31 cases with SLE which were treated with prednisolone and cyclophosphamide and 25 cases (86.4%) showed complete remission (CR) or partial remission (PR). Three of 12 cases associated with hepatitis B (HB) were treated with prednisolone over 6 months and showed CR or PR. Three of other 12 cases associated with HB which showed positivity to HBsAg and HBeAg were treated with interferon-alpha and represented complete seroconversion of HBeAg, but rapidly progressed to chronic renal failure. CONCLUSION: In our study, the most common causes of secondary MN are SLE, HB. HBeAg may be the important predictor in the prognosis of HBV-associated MN. The effect of interferon-alpha therapy in treating secondary MN is as yet inconclusive. HBV-associated MN progresses rapidly to CRF, therefore more extended study is required in Korea, an endemic area of HB.

A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen / 결핵및호흡기질환

BACKGROUND: The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. PATIENTS AND METHODS: From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. RESULTS: The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>5). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce?phalosporin had been infused. CONCLUSION: Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.