YouTube as a Source of Information and Education on Hysterectomy

Background@#Globally, YouTube is one of the most popular websites, and the content is not restricted to entertainment. The purpose of this study was to assess the quality of information in YouTube videos pertaining to hysterectomy. @*Methods@#We explored YouTube using the search terms “hysterectomy” and “remove uterus.” The videos that appeared were sorted using the filter “sort by view count.” Of the initial 100 videos, the top 50 videos for each search term were included for review, as determined by the “relevance” filter based on YouTube's algorithm. After excluding 34 videos for various reasons, 66 were included in the final analysis. Each video rated as “useful” was further analyzed for reliability and completeness of information; a set of pre-determined criteria were modified from a previous study and used to grade the quality of videos. @*Results@#The top 66 videos on hysterectomy had a total of 4,679,118 views. Based on authorship, the videos were categorized as follows: videos uploaded by patients, 37%; academic videos, 35%; videos uploaded by physicians, 13%; commercial videos, 4%; and videos uploaded by non-physicians, 2%. The type of content was also categorized: 50% of the videos recorded personal experiences, 23% recorded surgical techniques, 21% involved explanations of the surgery, and 4% were commercial videos. The majority of the videos made by patients were negatively biased toward hysterectomy surgery (71.72%), while the majority of those made by academics or physicians were surgical educational videos for doctors, not patients. @*Conclusion@#YouTube is currently not an appropriate source for patients to gain information on hysterectomy. Physicians should be aware of the limitations and provide up-to-date and peer-reviewed content on the website.

The Anti-Inflammatory Effect of Sulforaphane in Mice with Experimental Autoimmune Encephalomyelitis

BACKGROUND: Multiple sclerosis (MS) is an immune-associated inflammatory disorder of the central nervous system and results in serious disability. Although many disease-modifying therapy drugs have been developed, these drugs have shown limited clinical efficacy and some adverse effects in previous studies, therefore, there has been reasonable need for less harmful and cost-effective therapeutics. Herein, we tested the anti-inflammatory effect of sulforaphane (SFN) in a mouse model of experimental autoimmune encephalomyelitis (EAE). METHODS: The EAE mice were randomly assigned into two experimental groups: the phosphate-buffered saline (PBS)-treated EAE group and SFN-treated EAE group. After EAE mice induction by auto-immunization against the myelin oligodendrocyte glycoprotein peptide, we evaluated EAE symptom scores and biochemical analyses such as infiltration of inflammatory cells and demyelination of the spinal cord. Furthermore, western blotting was performed using the spinal cords of EAE mice. RESULTS: In the behavioral study, the SFN-treated EAE mice showed favorable clinical scores compared with PBS-treated EAE mice at the 13th day (1.30 ± 0.15 vs. 1.90 ± 0.18; P = 0.043) and 14th day (1.80 ± 0.13 vs. 2.75 ± 0.17; P = 0.003). Additionally, the biochemical studies revealed that SFN treatment inhibited the inflammatory infiltration, demyelinating injury of the spinal cords, and the up-regulation of inducible nitric oxide synthase in the EAE mice. CONCLUSION: The SFN treatment showed anti-inflammatory and anti-oxidative effects in the EAE mice. Conclusively, this study suggests that SFN has neuroprotective effects via anti-inflammatory processing, so it could be a new therapeutic or nutritional supplement for MS.

Patient-reported satisfaction after robot-assisted hysterectomy among Korean patients with benign uterine disease

OBJECTIVE: This study aimed to evaluate patient-reported satisfaction following robot-assisted hysterectomy due to benign uterine disease, and to identify the factors associated. METHODS: We used a questionnaire to evaluate patients' satisfaction with robot-assisted hysterectomy. The questions concerned overall patient-reported satisfaction and specific factors affecting satisfaction, including postoperative pain, return to daily life, the hospital experience, wounds, cost, the doctor-patient relationship, whether expectations were met, and whether detailed information was provided. We also collected data from patient records, such as uterine weight, rate of pelvic adhesion, operation time, rate of transfusion, delayed discharge, and readmission. One hundred patients who underwent robot-assisted hysterectomy participated in the study. Seventy-three fully completed questionnaires were returned. RESULTS: The majority of patients (95.9%) were satisfied with robot-assisted hysterectomy. The doctor-patient relationship, whether expectations were met, the hospital experience, wounds, and whether detailed information was provided were statistically significant factors influencing patients' overall satisfaction. Payment of fees and clinical and surgical outcomes did not significantly influence patients' overall satisfaction. CONCLUSION: Our findings show that most patients reported high levels of satisfaction following robot-assisted hysterectomy, regardless of cost or clinical and surgical outcomes. Therefore, if gynecologists consider robot-assisted hysterectomy suitable for patients they need not hesitate based on potential costs; they should feel confident in recommending the procedure to patients.

A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review

Ectopic pregnancy is an extrauterine pregnancy, and 98% of which occur in the fallopian tube. The incidence of twin tubal pregnancy is rare but is increasing due to assisted reproductive technology. Spontaneous unilateral twin tubal pregnancy is extremely rare, and only a small number of case reports have been made. We herein report a rare case of spontaneous unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Right salpingectomy was performed in this case. Pathologic and histologic assessment confirmed the 2 distinct pregnancies in the same tube. The twins were dichorionic and diamniotic.

Attitudes Regarding HPV Vaccinations of Children among Mothers with Adolescent Daughters in Korea

The aim of this study, carried out before the beginning of human papillomavirus (HPV) vaccinations as a National Immunization Program (NIP) in Korea in 2016, is to assess the ranges of perceptions and personal experience and their influences on attitudes regarding HPV vaccinations of children, among mothers of adolescent (9–14 years of age) daughters in Korea. From November 2015 to February 2016, we distributed a written questionnaire to mothers who had daughters aged 9–14 years. The questionnaire consisted of several questions, related to knowledge of HPV, personal experiences of HPV vaccination, and attitudes toward HPV vaccinations of their adolescent daughters. Of the 260 questionnaires distributed, 140 participants returned answered ones. And although only 51% of participants were aware that cervical cancer is highly related with HPV infection, 70% said they were willing to vaccinate their daughters, showing that awareness does not coincide with intention to vaccinate. Among the participants showing negative attitudes, 50% were concerned about the vaccination side effects. The more the participants’ pre-knowledge about HPV infection, and about the relationship of HPV to cervical cancer, the more positive their attitudes (P = 0.002, P < 0.001). Our study showed that, as the level of education rose, the proportion of mothers with negative attitudes toward vaccinating their adolescent daughters rose as well. Thus, the provision of correct education by health care providers and accurate information through active advertising may play an important role in increasing the vaccination rate among adolescent girls in Korea.

Carvenous lymphangioma of the vulva

Lymphangioma is a rare proliferation of the lymphatic system which is classified as either lymphangioma circumscription or carvenous lymphangioma. The involvement of the vulva is very rare and only a small number of case reports have been made on carvenous lymphangioma of the vulva. We herein report a case of 20-year-old unmarried girl presented with gradually expanding and painless tumor of the left labium majus. The mass was removed surgically and pathology confirmed as carvenous lymphangioma, with no recurrences to date.

Uterine arteriovenous malformation caused by intrauterine instrumentation for laparoscopic surgery due to left tubal pregnancy

Uterine arteriovenous malformation (AVM) is a rare entity in gynecology with fewer than 100 cases reported in the literature. Due to abnormal connection between arteries and veins without an intervening capillary system, recurrent and profuse vaginal bleeding is the most common symptom which can be potentially life-threatening. Uterine AVM can be either congenital or acquired. Acquired AVM is reported as a consequence of previous uterine trauma such as curettage procedures, caesarean section or pelvic surgery. It is also associated with infection, retained product of conception, gestational trophoblastic disease, malignancy and exposure to diethlystilboestrol. We herein report a case of acquired uterine AVM located on the right lateral wall after intrauterine instrumentation for laparoscopic left salpingectomy due to left tubal pregnancy. The patient was successfully treated with embolization.

A case of trapped placenta in uterine sacculation after normal delivery / 대한산부인과학회지

Uterine sacculation is a very rare functional malformation associated with pregnancy in which a part of the uterine wall balloons. It is a transitory pouch or sacculation and resolves once the uterine contents are delivered. The uterine sacculation frequently contains the placenta. If the aperture of the sacculation is small, manual delivery of the placenta is impossible. It explains why many patients with uterine sacculation ends up with having a laparotomy with or without a hysterectomy. We report a case of a trapped placenta in uterine sacculation after normal delivery which is removed by laparotomy.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Validity of Indications and Clinical Outcome of Transabdominal Cervicoisthmic Cerclage for Cervical Incompetence / 대한주산의학회잡지

OBJECTIVES: The purpose of this study was to review the indications of transabdominal cervicoisthmic cerclage and clinical outcome to determine whether it is a valid alternative to transvaginal cerclage. METHODS: A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to Dec. 2004. Analysis of the indications for the transabdominal rather than the vaginal approach and evaluation of fetal outcomes was performed. RESULTS: 48 patients underwent transabdominal cerclage. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 23 patients, the secondary indication was short cervix for transvaginal cerclage in 19 patients and cervical laceration in 6 patients. In 48 pregnancies, 8 twins were included. Therefore, total number of fetus was 56. One fetus of twin died in uterus at 27 weeks of gestation with unknown cause. 48 patients successfully delivered 55 live babies by Cesarean section. However, three babies died due to Tetralogy of Fallot, gastroschisis and preterm delivery. Complication including blood loss requiring transfusion did not occur. All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Live birth rate was 92% (52/56), compared with 28% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. CONCLUSIONS: Our results and review of literature confirm that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.