Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

OBJECTIVE: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. METHODS: We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. RESULTS: The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. CONCLUSION: LAVH is effective and safe for women with anterior wall adherence after cesarean section.

Laparoscopic management of pelvic splenosis

Splenosis is defined as heterotopic autotransplantation of spleen tissue following traumatic rupture of the spleen, or surgery. It is a benign disease that is generally without any symptoms and is discovered incidentally. Surgical intervention is recommended if symptoms are present. We report the successful laparoscopic management of a 49-year-old Korean woman with splenosis-associated symptoms who had undergone splenectomy.

Retroperitoneal vascular anomalies in paraaortic region: Impact on laparoscopic paraaortic lymphadenectomy in patients with gynecologic malignancies / 대한산부인과내시경학회지

OBJECTIVE: To document our experience of the vascular anomalies or variants in paraaortic region and intend to increase vigilance among the gynecological surgeons for presence of variable vascular anomalies or variants. METHODS: We conducted a retrospective chart review of 280 patients with various gynecologic malignancies who had undergone systemic laparotomic or laparoscopic paraaortic lymphadenectomy between November 2003 and July 2011. RESULTS: We discovered total nine patients of vascular anomalies during the surgery. Seven patients had an accessory polar renal artery. One patient had a duplicated inferior vena cava and the other had a right paravertebral vein. There were no vascular complications such as tearing, ligation or transection. CONCLUSION: It is not uncommon to encounter vascular anomalies in paraaortic region during the lymphadenectomy. Hence, the gynecological surgeons must be cognizant of various vascular anomalies occurring within this area to reduce the vascular accidents.

Investigating the Relationship between Serum Interleukin-17 Levels and Systemic Immune-Mediated Disease in Patients with Dry Eye Syndrome

PURPOSE: To investigate the association between dry eye syndrome (DE) and serum levels of interleukin (IL)-17 in patients with systemic immune-mediated diseases. METHODS: IL-17 and IL-23 levels were measured in the sera of patients whose tear production was <5 mm on the Schirmer test. Subjects included patients with chronic graft-versus-host disease (GVHD), rheumatoid arthritis (RA), Sjogren's syndrome (SS), systemic lupus erythematosus (SLE), and no systemic disease. Corneal/conjunctival fluorescein staining was scored and the correlation between the score and the IL-17 level was evaluated. RESULTS: A strong correlation existed between IL-17 level and the type of systemic disease. IL-17 was significantly elevated in patients with chronic GVHD compared to those with RA and SS. IL-17 was not detectable in patients with SLE or in those without systemic disease. IL-23 was not detected in any of the subjects. IL-17 was significantly increased in patients with high fluorescein staining scores. CONCLUSIONS: Our data suggest that IL-17 is involved in the pathogenesis of DE in patients with systemic immune-mediated diseases.

A case of successful delivery after ultrasound guided hysteroscopic removal of intrauterine device with missing tail during early pregnancy / 대한산부인과내시경학회지

In case of intrauterine pregnancy with an intrauterine device (IUD), it is recommended to remove the device because of the increased risk of abortions, septic complications and premature delivery. But removal of intrauterine devices in early pregnancy remains a troublesome problem for both doctors and patients, especially when IUD threads are not visible at the external os. If the thread of the IUD is not visible, extraction with hysteroscopy and ultrasonic guidance is advised. But due to postoperative complications such as uterine rupture or bleeding and electrolyte imbalance, many doctors prefer not to perform the procedure. IUD removal is scarcely performed that there are only 2 successful cases which were reported in Korea until today. Recently we experienced a case of an early pregnant woman with IUD in whom thread was invisible at the cervical os and IUD removal was attempted and successfully performed by ultrasound guided hysteroscopy. Pregnancy was maintained without complications until 39th week and delivered healthy baby. So we report this case with the review of articles related.

Preterm delivery in a primigravida with uterine adenomyosis / 대한산부인과학회지

Adenomyosis has been well known to be associated with infertility, spontaneous rupture of the uterus during labor in a primiparous woman, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and delayed postpartum hemorrhage. We recently experienced a case of preterm delivery at 29 gestational weeks in a primigravid woman with uterine adenomyosis. We report the case of preterm delivery accompanied by various complications such as uncontrolled pain, preterm labor, and oligohydramnios in a woman with uterine adenomyosis.

DNA Microarray-Based Gene Expression Profiling in Porcine Keratocytes and Corneal Endothelial Cells and Comparative Analysis Associated with Xeno-related Rejection

Porcine to rat corneal xenotransplantation resulted in severe inflammation and rejection of the corneal stroma, whereas an allograft showed mainly endothelial cell-associated rejection. We, therefore, investigated and compared the gene expression between porcine keratocytes and corneal endothelial cells. RNA was isolated from primary cultured porcine or human keratocytes and porcine corneal endothelial cells. Gene expression was comparatively analyzed after normalization with microarray method using Platinum pig 13 K oligo chip (GenoCheck Co., Ltd., Ansan, Korea). Real-time polymerase chain reaction (PCR) was performed for C1R, CCL2, CXCL6, and HLA-A in porcine keratocytes and corneal endothelial cells. As a result, upregulated expression more than 2 folds was observed in 1,162 genes of porcine keratocytes versus porcine endothelial cells. Among the immune-regulatory genes, SEMA3C, CCL2, CXCL6, F3, HLA-A, CD97, IFI30, C1R, and G1P3 were highly expressed in porcine keratocytes, compared to porcine corneal endothelial cells or human keratocytes. When measured by real-time PCR, the expression of C1R, CCL2, and HLA-A was higher in porcine keratocytes compared to that in porcine corneal endothelial cells. In conclusion, the increased expression of C1R, CCL2, and HLA-A genes in porcine keratocytes might be responsible for the stromal rejection observed in a porcine to rat corneal xenotransplantation.

The Role of Cyclosporine and Mycophenolate in an Orthotopic Porcine-to-Rat Corneal Xenotransplantation

We performed this study to investigate the feature of rejection in porcine-to-rat corneal orthotopic transplantation and to evaluate the effect of cyclosporine and mycophenolate on the xeno-rejection. Orthotopic corneal transplantation was done at 91 Sprague-Dawley rats, and they were divided into 10 groups based on the combination of immunosuppressants including dexamethasone, cyclosporine, and mycophenolate mofetil. Graft survival was analyzed and grafted eyes were examined with Hematoxylin & Eosin and CD4 or CD8 staining. Enzyme-linked immunosorbent assays were done for interleukin-2 (IL-2), IL-4, IL-5, IL-10, and interferon (IFN)-gamma in cornea, lacrimal gland, and cervical lymph nodes. The longest median survival of the immune suppressant group was 11.00+/-1.96 days, which showed no statistical differences compared with that of control (8.00+/-1.52 days). The neutrophils were prominent in the early phase but soon gave way to the monocytes. The number of CD8+ cells was higher than that of CD4+ cells. IL-2 and IFN-gamma markedly increased at 10 to13 days in cornea, lacrimal glands, and cervical lymph nodes, which showed a decrease with immunosuppressants except in the cornea. In conclusion, cyclosporine and mycophenolate could not prevent the rejection in porcine to rat orthotopic corneal xenograft associated with infiltraton of CD8+ and innate immune cells.

Short-term Efficacy of Topical Immunosuppressive Agents on the Survival of Cultivated Allo-Conjunctival Equivalents

PURPOSE: To investigate the short-term efficacy of topical immunosuppressive agents on the survival of cultivated allo-conjunctival equivalents. METHODS: Twenty-five eyes of New Zealand white rabbits were included. Temporal conjunctivae were trephined to a diameter of 7.5 mm, and then cultured allo-conjunctival epithelial cells on amniotic membrane were transplanted onto them. Various immunosuppressants including steroid, cyclosporine, and rapamycin were applied topically four times a day for a week. Epithelial defects and graft edema were graded daily. Numbers of inflammatory cells were measured in H&E. PKH26 and cytokeratin 4 and 7 were immunostained. RESULTS: Earlier epithelialization was observed in 1% steroid-treated eyes and defects persisted significantly in 0.5% CsA applied eyes. In histology, PKH26 positive cells considered as donor cells were only found in 1% steroid or 0.01% rapamycin applied eyes. 1% steroid- or 0.01% rapamycin-applied eyes both showed positive staining for keratin-4 and -7. Inflammatory cells were less found in 1% steroid or 0.01% rapamycin treated eyes. CONCLUSIONS: Topical steroid or rapamycin can help to suppress acute inflammation and enhance the acute survival of transplanted conjunctival cells.

The Feasibility of Short-term Dry Eye Animal Model Using Concanavalin A

PURPOSE: To evaluate the possibility of short-term dry eye model in rabbits by injection of concanavalin A (conA) to the lacrimal and haderian gland of rabbits. METHODS: We injected conA (10 mg/ml, 0.05 ml) to the lacrimal and haderian gland of rabbits twice to induce inflammation of lacrimal gland and compared with saline-injected control by lacrimal gland biopsy with H&E staining for identification of inflammation. The ratio of lacrimal secretion was evaluated by Schirmer test (preinjection vs. postinjection of conA) for 10 days and the number of goblet cells was counted in 10 consecutive high power field using impression cytology with PAS staining. The corneal & conjunctival apoptotic cell deaths were investigated with TUNEL staining 10 days after injection. RESULTS: Infiltration of inflammatory cells and destructed normal architecture of lacrimal gland was found only in conA injected group till 10 days. The Schirmer test showed marked reduction (0.56+/-0.26) by 5days after injection compared with control group (1.07+/-0.35) (p=0.02) and its significant difference was maintained till 10days. The number of goblet cell was 9.70+/-5.03/x200HPF, which was statistically significant decreased compared to control (47.50+/-17.13/x200HPF) at 10 days (p=0.00). Apoptotic cells were increased in injected eye (26.20+/-4.27) compared with those in control (16.60+/-2.70). CONCLUSIONS: Injection of conA to lacrimal glands in rabbit shows decrease of lacrimal secretion and similar cytological changes of the cornea and conjunctiva in human dry eye patients. It suggests its possible feasibility of short-term dry eye animal model for the 10 days.

The Efficacy of an Acrylic Intraocular Lens Surface Modified with Polyethylene Glycol in Posterior Capsular Opacification

To investigate if the surface modification of intraocular lens (IOL) is efficient in the prevention of posterior capsular opacification (PCO), the acrylic surface of intraocular lens (Acrysof(R)) was polymerized with polyethylene glycol (PEG-IOL). The human lens epithelial cells (1x10(4) cells/mL) were inoculated on PEG grafted or unmodified acrylic lenses for the control. The adherent cells on each IOL surface were trypsinized and counted. The every PEG-IOL was implanted in 20 New Zealand rabbits after removal of crystalline lens. The formations of PCO were checked serially through retroilluminated digital photography, and the severity scores were calculated using POCOman(R). The cell adherence patterns on each IOL were examined by scanning electron microscopy. As a result, the mean number of adherent cells of PEG-IOL (3.2+/-1.1x10(3)) tended to be smaller than that of the acrylic controls (3.6+/-1.9x10(3)) without a statistical significance (p=0.73). However, the mean severity of PCO formation in PEG-IOL was significantly lower than that in the control during the third to sixth weeks after surgery. Scanning electron microscopy revealed that the more patch-like cells were found firmly attached to the IOL surface in control than in the PEG-IOL. Conclusively, PEG polymerization to the acrylic IOL would possibly lessen the formation of PCO after cataract removal.

The Characteristics of Porcine Cornea as a Xenograft

PURPOSE: To investigate the feasibility, in terms of both physical and immunological aspects, of using porcine cornea as a xenograft in humans. METHODS: Corneal diameter, thickness and axial length were compared in 30 porcine and human control eyes. The histological characteristics and the distribution of the xenonatural antibody were also evaluated. In addition, changes in antigenecity were investigated by cultivating individual corneal cells. RESULTS: The mean values of the porcine corneal diameter (14.2+/-0.3 mm) and the thickness (867.2+/-23.8 mm) were larger than those of human, but, on the contrary, the axial length (20.2+/-0.74 mm) and the refractive power (40.4+/-0.9D) were not. The lymphocytes existed in the normal porcine limbus, and the distribution of alpha-gal was confined. However, in the cell culture, the expression of alpha-gal was prominent in both stromal (39.0+/-28.4%) and endothelial cells (87.1+/-4.4%) at the second passage. The expression of class II major histocompatibility antigen was comparable to that of human. CONCLUSIONS: Physical, optical, histological, and immunological characteristics suggest the possibility of using porcine cornea as a xenograft in humans.

Effect of Polyethylene Glycol Polymerization onto a Foldable Intraocular Lens in Pathogenesis of Posterior Capsular Opacity

PURPOSE: To investigate the effect of polyethylene glycol (PEG)-grafted acryl intraocular lenses on the prevention of posterior capsular opacification (PCO). METHODS: The acrylic surface of an intraocular lens (Acrysof SA 60AT, Alcon) was polymerized with PEG (PEG-IOL). To investigate the degree of cell adhesion to the modified lens surface, human lens epithelial cells (1x10(4) cells/ml) were inoculated on each PEG-grafted and acrylic control lens, and all were cultured in a carbon dioxide incubator for 24 hours. The adhered cells were trypsinized and counted. The PEG-IOL was implanted in 20 New Zealand rabbits after removal of the crystalline lens. The formations of PCO were checked serially through retroilluminated digital photography and severity scores were calculated using POCOman. The cell adherence pattern on the PEG-grafted IOL was examined by scanning electron microscopy. RESULTS: The mean number of adherent cells in PEG-IOL was 3.2+/-1.1x10(3), which tended to be smaller than that of the unmodified acrylic control (3.6+/-1.9x10(3)), but without statistical significance. The mean severity of posterior capsular opacification in PEG-IOL was much lower than in the control, especially at week 3. Scanning electron microscopy revealed more patch-like cells firmly attached to the lens surface in the control. CONCLUSIONS: PEG polymerization of the acrylic IOL may lessen the formation of posterior capsular opacification.