Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy

PURPOSE: A variety of instruments, including circular staplers, ultrasonic scalpels, lasers, and bipolar electrothermal devices, are currently used when performing a hemorrhoidectomy. This study compared outcomes between hemorrhoidectomies performed with an ultrasonic scalpel and conventional methods. METHODS: The study was a randomized prospective review of data available between May 2013 and December 2013, involving 50 patients who had undergone a hemorrhoidectomy for grade III or IV internal hemorrhoids. The hemorrhoidal pedicle was coagulated with an ultrasonic device in the ultrasonic scalpel group (n = 25) and sutured with 3-0 vicryl material after excision in the conventional method group (n = 25). RESULTS: The patients' demographics, clinical characteristics, and lengths of hospital stay were similar in both groups. The mean ages of the conventional and the ultrasonic scalpel groups were, respectively, 20.8 ± 1.6 and 22.4 ± 5.0 years (P = 0.240). In comparison with the conventional method group, the ultrasonic scalpel group had a shorter operation time (P < 0.005), less postoperative pain on the visual analogue scale score (for example, P = 0.211 on postoperative day 1), and less postoperative bleeding (P = 0.034). No significant differences in postoperative complications were observed between the 2 groups. CONCLUSION: A hemorrhoidectomy using an ultrasonic scalpel is an effective and safe procedure. The ultrasonic scalpel reduces the operation time, the postoperative blood loss, and the postoperative pain. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with an ultrasonic scalpel.

Cardiovascular Safety Pharmacology of Sibutramine

Sibutramine is an anorectic that has been banned since 2010 due to cardiovascular safety issues. However, counterfeit drugs or slimming products that include sibutramine are still available in the market. It has been reported that illegal sibutramine-contained pharmaceutical products induce cardiovascular crisis. However, the mechanism underlying sibutramine-induced cardiovascular adverse effect has not been fully evaluated yet. In this study, we performed cardiovascular safety pharmacology studies of sibutramine systemically using by hERG channel inhibition, action potential duration, and telemetry assays. Sibutramine inhibited hERG channel current of HEK293 cells with an IC50 of 3.92 muM in patch clamp assay and increased the heart rate and blood pressure (76 Deltabpm in heart rate and 51 DeltammHg in blood pressure) in beagle dogs at a dose of 30 mg/kg (per oral), while it shortened action potential duration (at 10 muM and 30 muM, resulted in 15% and 29% decreases in APD50, and 9% and 17% decreases in APD90, respectively) in the Purkinje fibers of rabbits and had no effects on the QTc interval in beagle dogs. These results suggest that sibutramine has a considerable adverse effect on the cardiovascular system and may contribute to accurate drug safety regulation.

Laparoscopic Totally Extraperitoneal Hernia Repair in Patients with Previous Lower Abdominal Surgery-Early Experience / 대한내시경복강경외과학회지

PURPOSE: Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has established itself as a safe and effective treatment for inguinal hernia. Nevertheless, there are difficulties in learning the technique. In particular, patients with a medical history of having undergone lower abdominal surgery are generally excluded from laparoscopic hernia repair due to the technical difficulty of the procedure. This study evaluated the early surgical outcome and examined the feasibility of techniques for laparoscopic TEP inguinal hernia repair in patients who had previously undergone lower abdominal surgery. METHODS: Ten cases of laparoscopic TEP inguinal hernia repair in patients with a prior history of lower abdominal surgery between November 2006 and January 2010 were reviewed. All cases were treated by a single highly experienced laparoscopic surgeon. RESULTS: Previous operations included 5 cases of radical prostatectomies for prostate cancer, 2 cases of open suprapubic prostatectomies for benign prostate hypertrophy, 2 cases of radical cystectomies for bladder cancer and 1 case of laparoscopic low anterior resection for rectal cancer. In all 10 cases, the patients were male with 9 cases involving an indirect hernia and 1 case involving a direct hernia. The mean operation time was 136.5+/-33.7 minutes, and in 1 case, the surgical method was converted to the transabdominal preperitoneal approach. Postoperatively, there were 3 cases of urinary retention, and the administration of analgesics were required 1.0+/-0.6 times on average. The mean length of hospitalization was 1.2+/-0.8 days. During the mean 18 month (1~36 months) follow-up period, there was no recurrence and chronic pain but 1 case of mesh infection was encountered 6 months after TEP repair. CONCLUSION: Although the laparoscopic TEP inguinal hernia repair can be carried out safely on patients with previous lower abdominal surgery, it needs to be carried out by fully trained surgeons with sufficient experience in the TEP technique. Nevertheless, more extensive experience and a longer follow-up period will be needed to evaluate the feasibility and efficiency of the TEP approach.

A Case of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회지

Primary Peritoneal Serous Papillary Carcinoma has a diffuse involvement of peritoneum in the absence of an obvious primary site and is very rare. It is histologically identical to ovarian serous papillay carcinoma but involves the ovarian surface mimimally, or spare the ovaries. Clinically it is impossible to differentiate with other tumor originated from peritoneum and ovarian carcinoma because of the similarity of clinical presentation and course. Primary Peritoneal Serous Papillary Carcinoma was first described by Swerdlow in 1959 and then has been very rarely reported in literatures. A few cases were reported in Korea. We have experienced a case of Primary Peritoneal Serous Papillary Carcinoma and report this case with a brief review of concerned literatures.

Investigation of the Bovine Leukemia Virus Proviral DNA in Human Leukemias and Lung cancers in Korea

The bovine leukemia virus (BLV) is the causative agent of enzootic bovine leucosis. This study investigated the presence of the BLV in leukemia (179 acute lymphoblastic leukemia, 292 acute myeloid leukemia and 46 chronic myelogenous leukemia cases) and 162 lung cancer patients (139 adenocarcinoma, 23 squamous cell carcinoma) to determine if the BLV is a causative organism of leukemia and lung cancer in Koreans. A BLV infection was confirmed in human cells by PCR using a BLV-8 primer combination. All 517 cases of human leukemia and 162 lung cancer were negative for a PCR of the BLV proviral DNA. In conclusion, although meat has been imported from BLV endemic areas, the BLV infection does not appear to be the cause of human leukemia or lung cancer in Koreans. These results can be used as a control for further studies on the BLV in Koreans.

Difference of Short Term Survival in Patients with ARDS According to Responsiveness to Alveolar Recruitment / 결핵

BACKGROUND: Lung protective strategies, using low tidal volume in ARDS, improve survival rate in ARDS. However, low tidal volume ventilation may promote alveolar de-recruitment. Therefore, alveolar recruitment is necessary to maintain arterial oxygenation and to prevent repetitive opening and closure of collapsed alveoli in lung protective strategies. There has been a recent report describing improvement in arterial oxygenation with use of recruitment maneuver. However, impact of recruitment on outcome of ARDS is unknown. We evaluated whether short-term survival difference existed in patients with ARDS, who were performed alveolar recruitment maneuver(ARM) and prone position, according to response of alveolar recruitment or not. METHODS: All patients who were diagnosed with ADRS and received mechanical ventilation were included. ARM were sustained inflation(35-45 cmH2O CPAP for 30-40 sec.) or increasing level of PEEP. If these methods were ineffective, alveolar recruitment with prone position was done for at least 10 hours. PaO2/FiO2(P/F) ratio was determined before and at 0.5 and 2 hours after ARM. We defined a responder if the P/F ratio was increased over 50% of baseline value. We compared 10-days and 30-days survival rate between responders and non-responders. RESULTS: 20 patients(M:F=12:8, 63 +/- 14 age) were included. Among them, 12 patients were responders and 8 patients were non-responders. In responders, P/F ratio was increased from 92 +/- 25 mmHg to 244 +/- 85 mmHg. In non-responders, P/F ratio increased from 138 +/- 37 mmHg to 163 +/- 60 mmHg. Among non-responders, P/F ratio was improved over 50% in 2 patients after prone position. Overall, 14 patients were responders after ARM and prone position. The 10-days and 30-days survival rate in responders was significantly higher than in non-responders(86%, 57% in responders and 33%, 0% in non-responders)(p<0.05). There was no significant difference between responders and non-responders in age(71 +/- 11, 60 +/- 14), lung injury score(2.8 +/- 0.2, 2.9 +/- 0.45), simplified acute physiology score(SAPS) II (35 +/- 4.6, 34 +/- 5.7), positive end-positive pressure level(15.6 +/- 1.9 cmH2O, 14.5 +/- 2.1 cmH2O). CONCLUSION: ARM may improve arterial oxygenation in some patients with ARDS. These responders in patients with ARDS showed significant higher 10-days and 30-days survival rate than non-responders patients with alveolar recruitment.

Biodistribution of Adenovirus p53 Following Intraperitoneal Administration in Mice

Reproductive toxicology is relatively new to the field of gene therapy, and is a very important issue for the safety. An important safety concern of gene therapy products is the distribution of vector beyond target organs. This is particularly important if vector distributes to gonads, raising the possibility of inadvertent germ-line transmission. In addition, for indications such as prostate cancer and ovarian cancer, the proximity of the point of viral administration to organs of the reproductive system raises concerns regarding inadvertent germ-line transmission of genes carried by the virus. To evaluate the reproductive toxicity of in vivo E1-deleted replication-incompetent adenoviral vector encoding p53 or lacZ, we studied the biodistribution and potential germ-line transmission of the vector. Both male and female Balb/c mice were injected with 1x10(8) pfu of Ad-CMV-LacZ or Ad-CMV-p53. DNA and RNA extracted from major organs including gonadal tissues were analyzed for vector sequences and expression. The PCR analysis showed that there were detectable vector sequences in liver, kidney, spleen, seminal vesicle, epididymis, prostate, ovary, and uterus. The RT-PCR analysis showed that Ad-CMV-LacZ or Ad-CMV-p53 viral RNA were present in spleen, prostate and ovary. Vectoradministered female and male mice were mated and their offspring were evaluated for germ-line transmission of the adenoviral vector. The PCR analysis showed no evidence of germ-line transmission, although vector sequences were detected in DNA extracted from gonadal tissues. Together, we conclude that the risk of the inadvertent germ-line transmission of vector sequences following intraperitoneal injection of adenovirus is extremely low, although vector distributed to gonadal tissues.

Carpal Tunnel Configuration Measured by Ultrasonography as a Risk Factor of Carpal Tunnel Syndrome in Motor Part Manufacturing Workers / 대한산업의학회지

OBJECTIVES: This study was conducted to evaluate individual susceptibility to carpal tunnel syndrome (CTS) by ultrasonographic measurement of the carpal tunnel configuration in workers doing repetitive work. METHODS: The study subjects consisted of 24 male and 11 female workers in a soundproof material manufacturing company in Gyeongju. We conducted a self-reported questionnaire survey, a physical examination and an electrodiagnostic study (EDS) in April 2000. After the examination, jobs were rearranged for workers with CTS. A follow up physical examination, EDS, and measurement of the carpal tunnel by ultrasonography was done six months later. RESULTS: Of those studied, prevalence of CTS was 63.6/100 persons among women and 29.2/100 persons among men. Mean depth and width of wrist was shorter in those with CTS compareal to the controls (p<0.05). The risk of CTS was higher in workers whose carpal tunnel ratio (displacement/width) was 0.17 or higher (OR 7.13, 95 % confidence interval 1.18-43.1), and in workers whose carpal tunnel area was less than 300 mm2 (OR 8.00, 95 % confidence interval 1.18-68.5). Carpal tunnel depth and depth/width ratio had a positive correlation with motor latency of the median nerve and median-ulnar sensory latency difference (p<0.05), whereas the carpal tunnel width, displacement/depth ratio, and area (width X displacement) had a negative correlation with median nerve latencies after adjusting for gender. Workers who showed an improvement in the clinical stage of CTS after job rearrangement had a significantly lower carpal tunnel displacement/width ratio and displacement/depth ratio. They also had smaller upper carpal tunnel area ( width X displacement) and larger upper carpal tunnel area [(depth-displacement) X width] than the controls (p< 0.05 ). CONCLUSIONS: Ultrasonographic measurement of the carpal tunnel is a good predictor of susceptibility and prognosis of CTS in workers doing repetivive work.

Carpal Tunnel Configuration Measured by Ultrasonography as a Risk Factor of Carpal Tunnel Syndrome in Motor Part Manufacturing Workers / 대한산업의학회지

OBJECTIVES: This study was conducted to evaluate individual susceptibility to carpal tunnel syndrome (CTS) by ultrasonographic measurement of the carpal tunnel configuration in workers doing repetitive work. METHODS: The study subjects consisted of 24 male and 11 female workers in a soundproof material manufacturing company in Gyeongju. We conducted a self-reported questionnaire survey, a physical examination and an electrodiagnostic study (EDS) in April 2000. After the examination, jobs were rearranged for workers with CTS. A follow up physical examination, EDS, and measurement of the carpal tunnel by ultrasonography was done six months later. RESULTS: Of those studied, prevalence of CTS was 63.6/100 persons among women and 29.2/100 persons among men. Mean depth and width of wrist was shorter in those with CTS compareal to the controls (p<0.05). The risk of CTS was higher in workers whose carpal tunnel ratio (displacement/width) was 0.17 or higher (OR 7.13, 95 % confidence interval 1.18-43.1), and in workers whose carpal tunnel area was less than 300 mm2 (OR 8.00, 95 % confidence interval 1.18-68.5). Carpal tunnel depth and depth/width ratio had a positive correlation with motor latency of the median nerve and median-ulnar sensory latency difference (p<0.05), whereas the carpal tunnel width, displacement/depth ratio, and area (width X displacement) had a negative correlation with median nerve latencies after adjusting for gender. Workers who showed an improvement in the clinical stage of CTS after job rearrangement had a significantly lower carpal tunnel displacement/width ratio and displacement/depth ratio. They also had smaller upper carpal tunnel area ( width X displacement) and larger upper carpal tunnel area [(depth-displacement) X width] than the controls (p< 0.05 ). CONCLUSIONS: Ultrasonographic measurement of the carpal tunnel is a good predictor of susceptibility and prognosis of CTS in workers doing repetivive work.

A case of simultaneous bilateral tubal pregnancies following the ovulation induction and intrauterine insemination / 대한산부인과학회잡지

Bilateral tubal pregnancy is the least common type of all extrauterine pregnancies, 1:725-1:1580 of pregnancies are bilateral. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, assisted reproductive techniques. The high incidence of ectopic pregnancy assisted with ovulation induction continues to be a problem. Bilateral tubal pregnancy associated with the ovulation induction has been reported few cases of 3.0% to 6.0% in frequency. This paper describes a case of simultaneous bilateral tubal pregnancy after ovulation induction and intrauterine insemination in a 27 year old patient. The diagnosis was confirmed by laparoscopy performed 30 days after intrauterine insemination, which revealed bilateral tubal pregnancy and mild hyperstimulated ovaries. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspect and incidence and treatment options are discussed.

Flow cytometric evaluation on the age-dependent changes of testicular DNA contents in rats

An age-dependent cellular change of DNA contents in the testis of Sprague-Dawley rats was investigated by flow-cytometric method. Testicular cell suspensions at the age of 4, 5, 6, 7, 8, 10, 12, 16 and 26 weeks were prepared and stained with propidium iodide. The relative proportions in the number of mature and immature haploid (1n), diploid (2n), S-phase and tetraploid (4n) cells were calculated. The proportion in the number of mature haploid cells was sharply increased to the age of 10 weeks (about 38%), thereafter increased slightly to the level of 42% at the age of 26 weeks. The proportion of immature haploid cells was dramatically increased to the age of 6 weeks, then maintained at the level of 20 to 30% thereafter. The proportion of diploid cells was 64% at the age of 4 weeks, then decreased gradually through the age of 26 weeks. The proportion of S-phase cells was increased to the age of 4 weeks, then maintained at a plateau level to the age of 26 weeks. The proportion of tetraploid cells were about 26% at the age of 4 weeks, then decreased gradually to the age of 26 weeks. These results suggest that the proportions of testicular cells may depend on the age of the rat and that the flow cytometric method may be useful in the evaluation of the spermatogenic status with regard to accuracy and sensitivity.

A Case of Complete Remission by Combination Chemotherapy with BEP Regimen after Operation in Endodermal Sinus Tumor of Ovary / 대한산부인과학회잡지

Endodermal sinus tumor (EST) has also been referred to as yolk sac carcinoma because they are derived from the primitive yolk sac. These lesions are the third most frequent malignant germ cell tumor of the ovary. Patient with EST have a median age of 18 years, but approximately one third of the patients are premenarchal at the time of initial presentation. Abdominal and/or pelvic pain is the most frequent presenting symptom, most EST secrete AFP. Radical surgery has not been helpful, but recent advances in treating the EST of the ovary with the combination chemotherapy after unilateral salpingo-oophorectomy result in improvement of the prognosis. We had experienced a case of endodermal sinus tumor of 36 years old woman. So, we report this case with brief review of the literature.

Age Related Serosurvey of Immunity to Tetanus in Korean Populations / 감염

BACKGROUND: The incidence of tetanus in adults and neonatal tetanus have been markedly reduced by world-wide use of DTP vaccines. But, tetanus is still one kind of major health problems in many developing countries, and several serosurvey stduies in developed countries revealed that substantial proportions of adult population may lack immunity against tetanus and immunity level against tetanus is continuously decreasing by age. In Korea, tetanus outbreaks have been disappeared since the 1980s by high acceptant DTaP vaccination rates. Annually, few tetanus patient has been reported since 1990s. But, there have been no seroepidemiological studies to tetanus, no trials to assess tetanus immunizations. And we do not use Td vaccine in adults for maintaning tetanus immunity. In this aspect, we conducted age related survey of immunity to tetanus and indirectly assessed the immunogenecity of tetanus vaccines, used in Korea. METHODS: For the evaluation of age related serosurvey of tetanus immunity in Korean population, study subjects were classified into 16 groups (A~J group; below 10 years with one year interval, K~O group; 11~60 yrs with 10 years interval, P group; over 60 yrs). The numbers of each group were 100, and sex distributions of each group were almostly equal. And for the indirect assessment of tetanus immunization in Korean children, children under 15 years old age were classified into 6 groups (I~VI) according to the status of DTaP vaccination. The numbers of this each group were 50, and sex ratio was almostly equal. Specific IgG antibody to tetanus toxin were detected by ELISA. And the ANOVA repeated t-test was used to compare antibody levels in study groups. RESULTS: In age related groups, the antibody levels to tetanus toxin were well maintained until 20 years old age group (L group), but thereafter the titers abruptly decreased below 0.1 IU/mL and over 75% populations among the groups over 30 years old age needed maintenance of protective immunity to tetanus. The antibody level of male was statistically higher than that of female in P group. In the groups related DTaP vaccination status, the antibody titer was very low in prevaccination group (I), but the titers after primary vaccinations were sharply increased and highly maintained until 15 years. CONCLUSOIN: The results of our study revealed that the immunity to tetanus was dramatically decreased in age groups over 30 years old. This result indicates that Td vaccination program in adults should be considered for maintenance of immunity to tetanus. And our study indicate that DTaP vaccination programs and vaccines, used in Korea, are effective for acquisition and maintenance of tetanus immunity in Korean children.

Bacteriologic status of uterine endocervix and amniotic fluid and clinical outcome in pregnant women with preterm labor / 대한산부인과학회잡지

No abstract available.

A case of meigs' syndrome occured in pregnancy / 영남의대학술지

Meigs' syndrome consists of an ovarian fibroma, or fibroma-like benign tumor, associated with fluid in both abdomen and chest. Characteristically, the ascites and hydrothorax disappeared and do not recurred following removal of the ovarian tumor. The authors presented a case of Meigs' syndrome that was cured by surgical removal of ovarian tumor and resulted in normal pregnancy outcome in 27-year-old pregnant woman with a brief review of literatures.

The relationship between maternal serum and leukocyte zinc concentration and birth weight / 대한산부인과학회잡지

No abstract available.

A case of coincidental occurence of Bochdalek hernia in mother & her newborn infant / 대한산부인과학회잡지

No abstract available.

Study of pH and gas analysis of umbilical arterial blood and apgar score as indicators of newborn health / 영남의대학술지

Apgar score is most widely used evaluating indicator of newborn health, but it is very subjective. Umbilical cord blood gas analysis is more objective and effective than Apgar score in evaluation of newborn status. Cord blood gas was changed slightly by processing of time after fetal birth. This study was undertaken to observe objectiveness and effectiveness of umbilical arterial blood gas analysis and effects of time interval of cord clamping to newborn health with 122 pregnant women and their babies. We observed following results: 1. There were poor correlation between Apgar score and umbilical cord arterial blood analysis in evaluating of newborn health (P>0.05). 2. There was no clinical significance of Apgar score or umbilical arterial blood gas analysis as single indicator in evaluating of newborn health (P>0.05). 3. Gas analysis and pH of umbilical arterial blood was more helpful in evaluating of newborn health than Apgar score. 4. There were no significant effects of time interval of umbilical cord clamping to newborn health. 5. If there were no indications of early umbilical cord clamping, cord blood sampling at immediately after birth without cord clamping was more effective to evaluate newborn status.

A barium study of hypopharyngeal outpouching

When the hypopharynx is examined in the frontal view during modified Valsalva maneuver after barium swallow anoutpouching of the lateral wall of the hypopharynx resembling a deverticulum is commonly observed. Review of theliterature however fails to disclose provious documentation of systematic prospecative observation of this phenomenon. The present study has been undertaken to detemine the incidence and degree of outpouching according tothe age and sex and to assess the clinical implication of the outpouching. The clinical materials consist of 100 consecutive cases of routine upper GI series with a particular effort directed to induce hypopharyngeal out pouching by a modified Valsalva maneuver at the Department of Radiology, St. Mary's Hospital, Catholic Medical College during 6 months period from Jan. 1982. Technically, outpouching was best demonstrated in the erectposition with a slight extension of the neck during the pharyngeal phase of barium swallowing while the subjectwas instructed to blow through the closed lips. Observation were made ofhhte incidence and intensity of theoutpouching by an arbitrary line drawning to measure the depth of outpouchings. Our study revealed thathypopharyngeal outpouchings occure bilaterally in every case studied. There was definite dominancy on the rightside(p<0.01) and the outpouching was greater in intensity in male (p<0.05) and the depth varied from a few to 15mm. And there was no statistically significant difference according to the age. Outpouchings collapsed and disappeared completely after release of Valsalva maneuver and did not appear to produce any clinical symptoms. The reason of right-side dominancy should further be investigated.