Novel Ablation Therapy Using Endoscopic Irreversible Electroporation in the Bile Duct: A Pilot Animal Study

Background/Aims@#Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model. @*Methods@#A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. @*Results@#Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode. @*Conclusions@#Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

Novel Ablation Therapy Using Endoscopic Irreversible Electroporation in the Bile Duct: A Pilot Animal Study

Background/Aims@#Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model. @*Methods@#A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. @*Results@#Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode. @*Conclusions@#Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

Minimally Invasive Gastric Electrical Stimulation Using a Newly Developed Wireless Gastrostimulator: A Pilot Animal Study

Background/Aims@#Gastric electrical stimulation (GES) is a feasible modality for the treatment of gastroparesis; however, the presently available device requires invasive surgical implantation for long-term stimulation and repeated surgical procedure after a period of time. This study is aimed at developing a wireless miniature GES device and testing its endoscopic insertion in animal models. @*Methods@#Endoscopic gastric implantation of the GES device was performed on 5 healthy weaner pigs under general anesthesia. We created an endoscopic submucosal pocket and inserted the gastro-electrical stimulator. In vivo gastric slow waves were recorded and measured during electrical stimulation. A multi-channel recorder, called an electrogastrogram, was used to record the gastric myoelectrical activity in the study. @*Results@#The gastric slow waves on the electrogastrogram were more consistent with GES on the gastric tissues compared to no stimulation. The frequency-to-amplitude ratio was also significantly altered after the electrical stimulation. @*Conclusions@#GES is feasible with our minimally invasive wireless device. This technique has the potential to increase utilization of GES as a treatment alternative.

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.

Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies

BACKGROUND/AIMS: Some observational epidemiologic studies have reported conflicting results on the relationship between hypnotics use and the risk of developing and/or dying from heart disease. We investigated these associations using a meta-analysis of available literatures. METHODS: We searched the databases PubMed and EMBASE, along with the bibliographies of relevant articles to find additional publications in February 2016. RESULTS: Of 495 articles satisfying our initial criteria, two case-control studies and six cohort studies met our inclusion criteria and were included in the final analyses. Compared with never having used any kind of hypnotics, the odds ratio for overall use was 0.84 for risk of or mortality from heart disease (95% confidence interval, 0.79 to 0.89) in a random-effects meta-analysis of all eight studies. With respect to the geographical region, use of hypnotics was associated with a decreased risk or mortality of heart disease in Asia but not in Western countries. Among various types of sleep medications, zolpidem showed a decreased risk (–29%) of developing or dying from heart disease, but benzodiazepines were related with an increased risk (80%) of or mortality from heart disease. CONCLUSIONS: The current meta-analysis of observational epidemiological studies suggested an evidence of association between hypnotics use and a decreased risk of heart disease.

Use of Hypnotics and Risk of Cancer: A Meta-Analysis of Observational Studies / 가정의학회지

BACKGROUND: Previous observational epidemiological studies have shown inconsistent results on the relationship between hypnotics use and risk of cancer. To determine the association between hypnotics use and risk of cancer, we conducted a meta-analysis of available literature. METHODS: We searched databases PubMed, EMBASE, and the bibliographies of relevant articles to locate additional publications in February 2016. Three evaluators independently reviewed and selected eligible studies based on pre-determined selection criteria. RESULTS: A total of six observational epidemiological studies including three case-control studies and three cohort studies, which involved 1,830,434 participants (202,629 hypnotics users and 1,627,805 non-users), were included in the final analyses. In a random-effects meta-analysis, compared with non-use of hypnotics, the odds ratio for overall hypnotics use was 1.29 for various cancers (95% confidence interval, 1.08–1.53). Subgroup meta-analyses by various factors such as study design, type of case-control study, study region, and methodological quality of study revealed consistent findings. CONCLUSION: Our findings from a meta-analysis of low-biased epidemiological studies suggested evidence linking the use of hypnotics to an increased risk of cancers. The results should be cautiously interpreted because of considerable heterogeneity with a Higgins I2 value.

Generalized Joint Laxity is Associated with Primary Occurrence and Treatment Outcome of Lumbar Disc Herniation / 가정의학회지

BACKGROUND: We investigated relationships between generalized joint laxity and primary lumbar disc herniation occurrence and compared clinical outcomes after conservative treatment in lumbar disc herniation patients with and without generalized joint laxity. METHODS: The study group included 128 men, and the control group included 276 men matched for age and body mass index with the study group. The primary outcome measure was the presence or absence of generalized joint laxity using the Beighton scale. Clinical outcomes measured by the visual analog scale and the Oswestry disability index 2 years after conservative treatment were the secondary outcome measure. RESULTS: Generalized joint laxity prevalence was 13.2% in the study group and 5.1% in the control group, a significant difference (P=0.01). Spearman correlation analysis revealed that weight (r=0.162, P=0.03), body mass index (r=0.131, P=0.03), and generalized joint laxity (r=0.372, P<0.01) significantly correlated with lumbar disc herniation occurrence. In multivariate regression analysis, generalized joint laxity was the only significant lumbar disc herniation predictor (P=0.002; 95% confidence interval, 1.08 to 5.26). Generalized joint laxity in lumbar disc herniation patients was associated with worse clinical outcomes after conservative treatment measured by visual analog scale scores for lower extremity pain (P=0.02), lower back pain (P=0.03), and Oswestry disability index scores (P=0.03). CONCLUSION: Generalized joint laxity might be associated with lumbar disc herniation occurrence and might also be a negative predictor of worse clinical outcomes after conservative treatment.

Comparison of HE4, CA125, and Risk of Ovarian Malignancy Algorithm in the Prediction of Ovarian Cancer in Korean Women

This study is a multi-center clinical study, which aimed to compare CA125, HE4, and risk of ovarian malignancy algorithm (ROMA) in predicting epithelial ovarian cancer of Korean women with a pelvic mass. Prospectively, serum from 90 Korean women with ovarian mass was obtained prior to surgery. For control group, serum from 79 normal populations without ovarian mass was also obtained. The HE4 and CA125 data were registered and evaluated separately and ROMA was calculated for each sample. Total 67 benign tumors and 23 ovarian cancers were evaluated. Median serum levels of HE4 and CA125, and ROMA score were significantly higher in patients with ovarian cancer than those with benign ovarian tumor and normal population (P < 0.001). In ROC curve analysis for women with a pelvic mass, area under the curve (AUC) for HE4 and ROMA was higher than CA125. Statistical differences in each study compared to CA125 were marginal (P compared to CA125; 0.082 for HE4 and 0.069 for ROMA). Sub-analysis revealed that AUC for HE4 and ROMA was higher than AUC for CA125 in post-menopausal women with a pelvic mass, but there were no statistically significant differences (P compared to CA125; 0.160 for HE4 and 0.127 for ROMA). Our data suggested that both HE4 and ROMA score showed better performance than CA125 for the detection of ovarian cancer in women with a pelvic mass. HE4 and ROMA can be a useful independent diagnostic marker for epithelial ovarian cancer in Korean women.

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.

Effects of Korean Red Ginseng on Cardiovascular Risks in Subjects with Metabolic Syndrome: a Double-blind Randomized Controlled Study / 가정의학회지

BACKGROUND: This study investigated the effects of Korean red ginseng (KRG) supplementation on metabolic parameters, inflammatory markers, and arterial stiffness in subjects with metabolic syndrome. METHODS: We performed a randomized, double-blind, placebo-controlled, single-center study in 60 subjects who were not taking drugs that could affect metabolic and vascular functions. Subjects were randomized into either a KRG (4.5 g/d) group or a placebo group for a 12-week study. We collected anthropometric measurements, blood for laboratory testing, and brachial-ankle pulse wave velocity (baPWV) at the initial (week 0) and final (week 12) visits. RESULTS: A total of 48 subjects successfully completed the study protocol. Oral administration of KRG did not significantly affect blood pressure, oxidative or inflammatory markers, or baPWV. CONCLUSION: We found no evidence that KRG had an effect on blood pressure, lipid profile, oxidized low density lipoprotein, fasting blood glucose, or arterial stiffness in subjects with metabolic syndrome. These findings warrant subsequent longer-term prospective clinical investigations with a larger population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00976274

A comparison of robot assisted and abdominal radical hysterectomy (RH) for early stage cervical and endometrial cancer / 대한산부인과내시경학회지

OBJECTIVE: To compare perioperative outcome of robot-assisted radical hysterectomy with abdominal radical hysterectomy for early-stage cervical cancer and endometrial cancer and to evaluate the feasibility of robotic-assisted radical hysterectomy. METHODS: We reviewed medical record of 37 patients who had radical hysterectomy at Hallym university for cervical cancer stage Ia1 to IIa and endometrial cancer stage Ia to Ib. Abdominal radical hysterectomy was carried out in 27 (Abdominal group) patients and robot-assisted radical hysterectomy carried out in 10 patients (Robotic group). We compared patient's characteristics between two groups. Perioperative characteristics compared included cancer stage, operative time, number of nodes, estimated blood loss, length of hospital stay and complications. RESULTS: There were no differences in age, parity, history of medical disease, body mass index between two groups (p>0.05). Robotic operative times were significantly longer than for abdominal (480.0+/-117.8 vs. 286.9+/-65.6 min, p<0.0001). Blood loss (660.0+/-245.9 vs. 1,137.0+/-608.4 mL. p<0.0001) and length of hospital stay (7.2 versus 17.1 days, p<0.0001) were significantly lower for the robotic group. Lymph node yield in the robotic group was equivalent to that for the abdominal group (30.1+/-8.7 vs. 35.4+/-16.9, p=0.356). No major operative complications occurred with both groups. CONCLUSION: Robot-assisted radical hysterectomy appears safe and feasible in early-stage cervical and endometrial cancer.

Comparison of morbidity by uterine weight in total laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVE: To evaluate the effect of uterine weight on short-term outcome of total laparoscopic hysterectomy (TLH) for benign gynecological conditions. METHODS: A retrospective medical records review of 265 cases of patients with TLH was performed. Patients included in this study underwent TLH as benign uterine disorders at Kangnam Sacred Heart Hostpital, Hallym University from January 2008 through June 2009. These patients were stratified into three groups; Group 1 patients with uterus weighing less than 180 g (n=60), Group2 patients with uterus weighing 180 g to 350 g (n=141), Group 3 patients with uterus weighing more than 350 g (n=64). The groups were compared as regard postoperative stay, operative time, estimated blood loss, hemoglobin change, conversion to open surgery, and postoperative complications. RESULTS: There was no significant difference in age, gravidity, body mass index, previous pelvic surgery and past medical history. The overall complication rates were not significantly different. But operative time prolonged as uterine weight increased. CONCLUSION: The TLH can be performed successfully in case of enlarged uterus. Therefore the enlarged uterus is not an absolute contraindication for TLH.

Idiopathic Thrombocytopenic Purpura in a Patient with Carcinoma of the Uterine Cervix

We describe here the case a patient with advanced cervix carcinoma and who developed idiopathic thrombocytopenic purpura (ITP). A 63-year-old woman with stage IV squamous cell carcinoma of the uterine cervix and that was complicated by hydronephrosis was treated palliatively with 45Gy of external beam radiation to the pelvis. About 3 years later, she developed hematochezia and severe thrombocytopenia. The laboratory examinations showed no evidence of thrombotic thrombocytopenic purpura or disseminated intravascular coagulopathy, and she was positive for serum anti-platelet antibodies. On the bone marrow examination, there was a normal number and morphology of megakaryocytes with no evidence of malignant cell infiltration. We made the clinical diagnosis of ITP, and the intravenous immunoglobulin and steroid therapy was successful. This case suggests the possibility that ITP can occur in association with advanced cervix carcinoma.

Current opinion on intrauterine device (IUD) / 대한산부인과학회지

Intrauterine device (IUD) is a safe and efficient method of contraception in comparison with the efficacy of tubal sterilization, yet remains underutilized due to biased or outdated information about IUD. It is currently believed that the mechanism of action for IUDs is the production of an intrauterine environment that is spermicidal. IUD does not increase a woman's risk for pelvic infection, ectopic pregnancy, or subsequent infertility. IUD insertion in nulliparous or unmarried women is not contra-indicated. IUD is also a useful contraceptive method for those women without increasing the risk of ascending pelvic infection. The other benefit of IUD beyond contraception includes lowering the risk of endometrial cancer. The levonorgestrel-releasing intrauterine system reduces massive menstrual bleeding and dysmenorrhea. The copper IUD is the most effective method for emergency contraception. The careful patient selection and pre-insertion counseling are crucial to the success of IUD.

The influence of body mass index on the prevalence of complications after hysterectomy: A comparison of prognosis of hysterectomy related to body mass index / 대한산부인과학회지

OBJECTIVE: To investigate the association between obesity and peri- or postoperative outcome after abdominal or vaginal hysterectomies for benign gynecologic disorder. METHODS: We retrospectively reviewed the charts of all women who underwent abdominal or vaginal hysterectomy for benign gynecologic disorders in Kangnam Sacred Heart Hospital between Jan and Dec, 2006. We analyzed the rate of operative and postoperative complications, length of hospital stay, operative time, and perioperative hemoglobin change for abdominal or vaginal hysterectomy. RESULTS: The study group consisted of 915 women, of who 643 underwent vaginal, and 272 abdominal hysterectomy. Obesity was related to longer operation time for vaginal hysterectomy only. No association was found between BMI and serious complications such as postoperative bleeding, transfusion, urinary tract injury, febrile morbidity, bowel injury, wound complication, ileus, infection. CONCLUSION: Obesity is not a contraindication of vaginal or abdominal hysterectomy. Obese patients did not experience an increased risk of serious morbidity compared to normal weight women. Hysterectomy can be successfully performed, with acceptable morbidity, in obese women.

Change of Smoking Attitude in High School Students of Korea after Increase in Cigarette Tax

BACKGROUND: Increasing cigarette tax is known to be effective in stopping smoking and preventing initiation of smoking in adolescents. This study was designed to investigate the change of smoking attitudes in high school students after increase in cigarette tax in 2004. METHODS: A self-questionnaire study was performed in high school students in Seoul and Chungnam province in June, 2004. The number of respondents was 1,424 consisting of 883 males and 541 females. The factors related to smoking cessation or reduction of smoking amount after increase in cigarette tax were analysed. RESULTS: Among the total 1,424 subjects, 199 (14.0%) students smoked before the increase in cigarette tax. The smoking rate of males and females were 19.5% and 5.0%, respectively. Thirty nine percent of smokers quit smoking or reduced the smoking amount after increase in tax, among them 28.6% of the smokers (27.9% and 33.0% for males and females, respectively) reported quitting smoking. Female smokers and smokers in preparation stage of Prochaska model reported quitting smoking or reducing the smoking amount than male smokers and smokers in pre-consideration stage (OR 6.85:95% CI=1.78~26.33, OR 6.62:95% CI= 2.20~19.95, respectively). CONCLUSION: Increase of cigarette tax was effective in quitting the smoking and reducing the smoking amount in adolescents in Korea.

Change of Smoking Attitude in High School Students of Korea after Increase in Cigarette Tax

BACKGROUND: Increasing cigarette tax is known to be effective in stopping smoking and preventing initiation of smoking in adolescents. This study was designed to investigate the change of smoking attitudes in high school students after increase in cigarette tax in 2004. METHODS: A self-questionnaire study was performed in high school students in Seoul and Chungnam province in June, 2004. The number of respondents was 1,424 consisting of 883 males and 541 females. The factors related to smoking cessation or reduction of smoking amount after increase in cigarette tax were analysed. RESULTS: Among the total 1,424 subjects, 199 (14.0%) students smoked before the increase in cigarette tax. The smoking rate of males and females were 19.5% and 5.0%, respectively. Thirty nine percent of smokers quit smoking or reduced the smoking amount after increase in tax, among them 28.6% of the smokers (27.9% and 33.0% for males and females, respectively) reported quitting smoking. Female smokers and smokers in preparation stage of Prochaska model reported quitting smoking or reducing the smoking amount than male smokers and smokers in pre-consideration stage (OR 6.85:95% CI=1.78~26.33, OR 6.62:95% CI= 2.20~19.95, respectively). CONCLUSION: Increase of cigarette tax was effective in quitting the smoking and reducing the smoking amount in adolescents in Korea.

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.