Two-port access versus four-port access laparoscopic ovarian cystectomy

OBJECTIVE: This study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy. METHODS: Four hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more. RESULTS: There were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy. CONCLUSION: Two-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.

Cell-Specific Growth Inhibition of Human Cervical Cancer Cell by Recombinant Adenovirus p53 in vitro and in vivo / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Despite the significance of the p53 adenoviral vector in cancer gene therapy, an advanced strategy for the development of preferential tumor cell-specific delivery and the long-term persistent gene expression control of p53 are required. In this study, the time-course expression patterns of p53 and E6, on cervical cancer cells, were investigated to obtain a molecular level understanding of the cell-dependent tumor growth suppression effects of a recombinant adenovirus expressing p53, both in vitro and in vivo. MATERIALS AND METHODS: The expressions of p53 and E6 in CaSki, SiHa, HeLa, HeLaS3, C33A and HT3 cervical cancer cell lines were examined. After infection with AdCMVp53, the cell growth inhibition was studied via cell count, MTT and Neutral red assays. After transfecting the AdCMVp53 and AdCMVLacZ into the cancer cells-xenografted nude mice, the anti-tumor effects were investigated for one month. RESULTS: The p53 protein levels were more notably expressed in the CaSki and HeLa than in the SiHa and HeLaS3 On day 6, the p53 was only detected in the HeLaS3. In contrast, the p53 expression was highly maintained in the C33A and HT3. The E6 mRNA levels gradually decreased in only the CaSki and HeLa. The growth suppression effects also showed cell-dependent patterns, which were consistent with the reciprocal expression patterns of p53 and E6. After transfection of the AdCMVp53, into the CaSki- and SiHa-xenografted nude mice, the tumor size was remarkably decreased in the SiHa cells as compared to that in the AdCMVLacZ transfected mice, indicating cell-specific growth inhibition patterns. CONCLUSION: The adenovirus-mediated p53 gene transfection was very effective both in vitro and in vivo. Also, the anti-tumor effects were accomplished via the differential role of p53-specific apoptotic cell death, which was dependent on the cervical cancer cell line.

Surgical Management of Ovarian tumors in Pregnancy: Laparoscopy versus Laparotomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the benefits of laparoscopic surgery compare with laparotomy in the surgical management of adnexal tumors during pregnancy. METHODS: Operating time, hospital stays, complications and pregnancy outcome were analyzed in 18 patients who underwent laparoscopic surgery and 30 patients who underwent laparotomy due to adnexal tumors discovered during pregnancy at Chungnam National University Hospital from January 1993 to June 2000. RESULTS: Mean age of the patients was 27.1 years and mean gestational age was not significantly different between the two groups. Tumor size was larger in laparotomy group (8.4 vs 6.4 cm in diameter). Unilateral salpingo-oophorectomy was most common operative procedures and cystic teratoma was most common histologic findings in both groups. Operating time was not significantly different between the two groups. Blood loss (43.2 vs 18.3 mL) and hospital stay (7.1 vs 5.7 days) was significantly less in laparscopy group. CONCLUSIONS: Laparoscopic surgery may be an effective treatment of adnexal tumors during pregnancy.

Total Laparoscopic Hysterectomy using Modified Bae's Uterine Elevator / 대한산부인과학회잡지

OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study was to introduce a new uterine elevator for total laparoscopic hysterectomy. METHODS: Bae's uterine elevator was modified for laparoscopic hysterectomy. Modified Bae's uterine elevator was 5 cm longer than original one and handle was modified to vertical position and stopper, silicon tube and silicon adapter for colpotomizer was installed on the shaft. Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed from Jan 1999 to Jun 2000. RESULTS: Mean age of the patients was 41.8, operation time was 48.3 minutes and uterine weight was 245.5 gm. Leiomyoma was the most common cause of hysterectomies (70.9%), and followed by adenomyosis (16.2%), endometriosis (7.6%). There were no major operative complications such as vascular, bladder, ureter or intestinal injuries. CONCLUSIONS: Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed successfully without any major complications. Modified Bae's uterine elevator was very convenient for uterine manipulation during total laparoscopic hysterectomy.

Growth inhibition and induction of apoptosis in cervical cancer cell lines by green tea polyphenols / 대한산부인과학회잡지

OBJECTIVE: The purpose of this article is to estimate the anti-cancer effects of the major components of the green tea (polyphenols, catechin and EGCG) and the mechanism of EGCG on different cervical cancer cell lines. METHODS: Six cervical cancer cell lines (HeLa, HeLaS3, Caski, SiHa, HT3 and C33A) were treated with 20 microgram/ml green tea polyphenols (GTPs), 50 micrometer catechin and various concentrations of (-)-epigallo- catechin-3-gallate (EGCG). The viabilities were determined by trypan blue exclusion assay, neutral red assay and 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. DNA fragmentation and nuclear condensation were used to see whether EGCG-induced anti-proliferation effect was due to apoptosis. RESULTS: Both GTPs, catechin and EGCG had growth inhibition effects on cervical cancer cell lines, but EGCG appeared to be the most effective. What's more, the sensitivity of each cell lines to EGCG was different. HT3 cells (HPV negative, mutant type p53) were most sensitive to EGCG (estimate IC50: 10 micrometer). Caski (HPV-16 positive, wild type p53) and HeLaS3 cells (HPV-18 positive, wild type p53) were less sensitive (estimate IC50: 35 and 70 micrometer respectively). EGCG-induced apoptosis can be seen in all the cell lines and it happened as early as 8 hours after EGCG treatment. CONCLUSION: Green tea or EGCG alone will be beneficial to the cervical cancer patients.

The treatment of cervical pregnancy in Korean / 대한산부인과학회잡지

OBJECTIVE: The study was designed to find out current state of conservative treatment modalities for cervical pregnancies in korean. METHOD: 64 cases of cervical pregnancies reported by the joining of The Korean Society of Obstetrics & Gynecology from 1960 to 2000 and the 10 cases at Chungnam National University Hospital were analyzed retrospectively. RESULTS: The average age of the 74 cases was 31.7+/-6.6 years, and the average gestational age at the time of diagnosis was 8.3+/-3.4 weeks. The average duration of hospitalization was 8.2+/-4.8 days. Most (67/74) of the patients had previously experienced delivery or abortion. Out of the 74 cases, 36 had total hysterectomy; 4 cases had curettage; 12 were used only methotrexate; 11 had combined curettage and methotrexate; 10 cases had Foley catheter ballooning after curettage. From the 1960's to the end of 1980's, 33 (84.6%) cases out of 39 were performed hysterectomy. Whereas mainly conservative methods, in particular methotrexate treatment, were performed in the 1990's. Among the conservative modalities, Foley catheter ballooning after curettage had the shortest length of hospitalization with 4.3 days. CONCLUSION: After comparing the conservative methods for treating cervical pregnancies, it was found that methotrexate treatment was performed the most; however, Foley catheter ballooning after curettage seems to be an excellent treatment option.

A Comparative Study of Laparoscopy and Laparotomy for the Management of Ovarian Dermoid Cyst / 대한산부인과학회잡지

OBJECTIVE: The objective of this study was to compare laparoscopic surgery with laparotomy for surgical management of ovarian dermoid cysts. METHODS: One hundred and fifteen patients were managed with laparoscopy and eighty two patients were managed with laparotomy. Two groups were compaired for age, marrital status, parity, tumor size, operation type, previous surgery, operating time, blood loss, pre-, and postoperative hemoglobin change, hospital stay, complications and recurrences. RESULTS: Unilateral slapingo-oophorectomy was the most common type of operation in either group. Between twenty one and thirty was the most common age in either group and para 0 in laparoscopy and para 2 in laparotomy group was the most common. Unilateral ovarian cystectomy was significantly more common for para 0 in laparoscopy group (p=0.035). Number of singles were significantly higher in laparoscopy group (p=0.046). Tumor size was significantly larger in laparotomy group (6.1 vs 7.8 cm). Operating time was shorter for unilateral ovarian cystectomy in laparoscopy group. Blood loss, pre-, and postoperative hemoglobin change, hospital stay was significantly less in laparoscopy group. Febrile morbidity was higher in laparotomy group (p<0.001). However no major complications were noted in either group. CONCLUSION: We conclude that operative laparoscopy has many advantages in the management of ovarian dermoid cysts. However tumor size was a relative limitations for laparoscopy compaired with laparotomy.

Clinical Study on Pediatric and Adolescent Gynecologic Patients / 대한산부인과학회잡지

OBJECTIVES: The purpose of this investigation was to review the distribution and treatment of gynecologic disease in pediatric and adolescent patients. METHODS: Two hundred forty-four pediatric and adolescent patients were evaluated clinically, who were admitted to Department of Obstetrics and Gynecology, Chungnam National University Hospital from Jan. 1989 to Sep. 1999. RESULTS: The most common disorder was ovarian tumors(43.0%) including 78.1% of neoplastic diseases and 21.9% of nonneoplastic diseases, and followed by pregnancy-associated disorders(20.5%), infectious disorders(11.5%), congenital abnormalities(9.8%), traumas(7.4%) and miscellaneous(7.8%). Pregnancy asso ciated disorders include abortion(42%), gestational trophoblastic disease(30.0%), and ectopic pregnancy(28%). Infectious disorders include acute pelvic inflammatory disease(53.6%), hydrosalpinx(21.4%), condyloma accuminata(10.7%) and tuberculous salpingitis(3.5%). Congenital abnormalities include congenital uterine anomalies(41.7%), imperforate hymen(20.8%), male hermaphroditism(12.5%), female hermaphroditism(8.3%), pure gonadal dysgenesis(8.3%) and mixed gonadal dysgenesis(8.3%). Traumas include vulvar laceration (33.3%), vulvar hematoma(33.3%), and vaginal wall laceration(33.3%). CONCLUSION: We analyzed two hundred forty-four pediatric and adolescent patients who were admitted to Department of Obstetrics and Gynecology, Chungnam National University Hospital from Jan. 1989 to Sep. 1999. The most common disorder was ovarian tumors(43.0%) and followed by pregnancy-associated disorders (20.5%), infectious disorders(11.5%), congenital abnormalities(9.8%), traumas(7.4%) and miscellaneous(7.8%).

Presence of E - cadherin in Placenta and Fetal Membrane / 대한주산의학회잡지

No abstract available.

Difference of Telomerase Activity Between Uterine Cervical Intraepithelial Neoplasia, Early and Advanced Cervical Cancers / 대한산부인과학회잡지

OBJECTIVES: Objective: Cellular immortality is believed to be a critical step in tumorigenesis. As an important component of the telomere maintenance mechanism, the activation of the enzyme telomerase is tightly associated with cellular immortality and cancer. However, little is known about the status of telomerase during human cervical cancer development. To assess the role of telomerase in the development of malignant transformation of the uterine cervix, this investigation was performed. PATIENTS AND METHODS: Telomerase activity was measured by telomeric repeat amplification protocol(TRAP) assay in 8 cervical intraepithelial neoplasia(CIN) and 24 cervical cancers. The tissue adjacent to the lesions from the same patients was also examined for the presence of telomerase activity. RESULTS: Thirty one of the 32(96.9%) lesions were positive for telomerase activity. In the CIN patients, four of the 8(50.0%) lesions showed moderately to strongly positive activities. In the cervical cancer Ia lesions, five of the 9(55.6%), and beyond the stage Ib lesions, fourteen of the 15(93.3%) showed moderately to strongly positive activities. There was a positive correlation between the grade of the lesion and the telomerase activity(P=0.023). Patient's gravida and telomerase activity also had a positive correlation(P=0.022). CONCLUSION: Relatively weak telomerase activity was detected in the low grade cervical lesion and strong activity was detected in the high grade lesion. There was a progressive increase of telomerase activity in association with an increased degree of cervical lesion. Patient's gravida also had an association with telomerase activity. These results suggest that the expression of telomerase activity may play a crucial role in cervical carcinogenesis.

A Case of Cellular Schwannoma of the Retroperitoneum / 대한부인종양콜포스코피학회잡지

Cellular schwannoma is a variant of schwannoma, and is diagnosed as malignant tumor in over one fourth of cases because of its cellularity, mitotic activity and the occasional presence of bone destruction. This tumor is a tumor with low malignant potential and usually occurs in peripheral nervous system, mainly in the posterior mediastinum and retroperitoneal space. But pelvic retroperitoneal cellular schwannoma is very rare. Recently, we experienced a case of pelvic retroperitoneal cellular schwannoma in a 42-year-old woman; in reporting the case a brief review of the literature is included.

New Cervicography in the Diagnosis of Cervical Cancer / 대한부인종양콜포스코피학회잡지

New Cervicography, a Pap smear adjunct test, is an innovative cervical cancer surveillance system. It is a relatively new technique in which a photograph of the cervix is obtained without the aid of colposcope after application of 5% acetic acid. The purpose of this study was to investigate the role of New Cervicography in diagnosis of cervical cancer. Pap smear and cervicogram data were obtained from 143 patients who visited the Department of Obstetrics and Gynecology, Chungnam National University Hospital from September 1996 to May 1997. Histologic specimens were obtained from patients in whom abnormalities were detected by either Pap smear or cervicogram. Specimens were taken either by colposcopically directed biopsy or large loop excision af the transformation zone. (continue)

Electron Microscopic Study of Cervical Carcinoma Tumor Cells after Chemotherapy / 대한부인종양콜포스코피학회잡지

Our aim was to identify histologic changes in cervical carcinoma tumor cells due to chemotherapy,by electron microscopic examination. Cisplatin and 5-fluorouracil were used between March 1, 1994 and February 28, 1995 on a total of 16 patients. The treatment schedule consisted of 75 mg/m2 cisplatin via iv with hyperhydration on Day 1, in combination with 1000 mg/m2 5-fluorouracil via continuous iv on Day 1 to 5. The treatment was repeated every 4 weeks with a maxinum of 3 courses. Ultrastructurally, chemotherapy induced apoptosis,indicated by condensation of nucleus and cytoplasm,fragmentation of nuclei, and apoptotic bodies. Due to repeat chemotherapy, increased levels of desmosomes were noted and parts of tumor nests were replaced by mature squamous cells. Tumor nests were reduced in size, mitochondria exhibited swelling, the endoplasmic reticulum was dilated, and infiltration of inflammatory cells increased after chemotherapy. These results suggest that chemotherapy induces apoptosis and injury to the cytoplasm and nuclei of tumor cells. However, the exact selection mechanism of the biochemical pathway of cell death is not fuUy understood. Further study of the molecular biologic actions of cell death after chemotherapy is warranted.

A case of successful pregnancy and birth in chronic renal failure patient receiving hemodialysis / 대한신장학회잡지

No abstract available.

Value of Squamous Cell Carcinoma Associated Antigen (TA-4) in Patients with Invasive Carcinoma of the Uterine Cervix / 대한치료방사선과학회지

We investigated the usefulness of tumor-associated antigen (TA-4) by a radioimmunoasay method in estimating the extent of disease and tracking the clinical course of disease in 58 patients with cervical cancer. According to our results and those of other authors, the normal range of serum TA-4 was arbitrarily taken to be less than 2 ng/ml. The proportion of the pretreatment positive serum TA-4 level of 48 squamous cell carcinoma patients was 60%. And 40% in 5 adenocarcinoma patients. Advanced disease group showed higher incidence of positive serum TA-4 level; 40%, 72%, 63%, and 100% in stage I to IV, respectively. And the absolute values of TA-4 were higher in advanced disease. In patients treated with radiation, elevated serum TA-4 level usually declined after 3000 cGy and further dropped to normal range in 44c13 after 5000 cGy. The Positive rate in Primary cervical cancer was 59% (32/54) and 100% (4/4) in recurrent cervical cancer. And 15 patients with recurrent or persistent disease during follow-up revealed 80% positive serum TA-4 level. In conclusion, it would be suggested that serial serum TA-4 measurements may be helpful in tracking the clinical course during and after treatment.