Laparoendoscopic Single Site Surgery for the Treatment of Huge Ovarian Cysts Using an Angiocatheter Needle

PURPOSE: The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm). MATERIALS AND METHODS: Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5–2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection. RESULTS: The median maximal diameter of ovarian cysts was 18 cm (range, 15–30 cm), the median operation time was 150 minutes (range, 80–520 minutes), and the median volume of blood loss was 100 mL (range, 20–800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port. CONCLUSION: LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.

Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction

Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe.

Enhanced Anti-Cancer Effect of Snake Venom Activated NK Cells on Lung Cancer Cells by Inactivation of NF-kappaB

In the present study, we investigated anti-cancer effect of snake venom activated NK cells (NK-92MI) in lung cancer cell lines. We used snake venom (4 microg/ml) treated NK-92MI cells to co-culture with lung cancer cells. There was a further decrease in cancer cell growth up to 65% and 70% in A549 and NCI-H460 cell lines respectively, whereas 30-40% was decreased in cancer cell growth by snake venom or NK-92MI alone treatment. We further found that the expression of various apoptotic proteins such as that Bax, and cleaved caspase-3 as well as the expression of various death receptor proteins like DR3, DR4 and Fas was also further increased. Moreover, consistent with cancer cell growth inhibition, the DNA binding activity of NF-kappaB was also further inhibited after treatment of snake venom activated NK-92MI cells. Thus, the present data showed that activated NK cells could further inhibit lung cancer cell growth.

Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary / 부인종양

OBJECTIVE: We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. METHODS: All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. RESULTS: Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0+/-11.4 vs. 13.7+/-7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients < 35 years of age had fertility-preserving surgery. CONCLUSION: Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.

A case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma / 대한산부인과학회지

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.

Association of Fas gene polymorphisms with bone mineral density in postmenopausal Korean women / 대한산부인과학회지

OBJECTIVE: To examine the relationship between Fas gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Fas A670G, G1377A gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. RESULTS: The distribution of A670G and G1377C polymorphisms in all postmenopausal women was as follows: AA 18.3%, AG 46.3%, GG 35.4%; GG 38.0%, GA 39.7%, AA 22.3%, respectively. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A670G polymorphism was significantly associated with BMD at the lumbar spine, the femur neck and trochanter in osteopenic and osteoporotic patients, and G1377A polymorphism was significantly associated with BMD at lumbar spine and the femur neck in osteopenic patients. CONCLUSION: These findings suggest that Fas gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.

Establishment of a novel malignant Brenner tumer cell line / 대한산부인과학회지

OBJECTIVE: Ovarian cancer is the most lethal disease among gynecologic malignancies. Although many efforts have been made to explore the mechanisms involved in its development, the genetic events in the pathogenesis of ovarian cancer are still unclear. We characterized a cell line (designated OHK) established from a malignant Brenner tumor cell. METHODS: The cells were obtained during the operation of a 43-year-old Korean woman with ovarian cancer. The OHK cells continuously propagated in vitro over a period of about 36 months and, to date, have undergone over 200 passages, without being infected by either Mycoplasma or any bacteria. We measured the doubling time of OHK cells. To investigate the tumorigenecity of OHK, cells were inoculated subcutaneously into the back of nude mice. Several tumor markers were analyzed using culture media and lysates of cytosol. Morphology and ultrastructure were analyzed by phase-contrast microscopy and electron microscopy. OHK was also analyzed for gene mutation, the typing of human leukocyte antigen and Flow cytometric cell cycle analysis and DNA index. RESULTS: They proliferated in a monolayered sheet showing a pavement-like arrangement without suppression by intercellular contacts. They also formed epithelial cell lining in shapes of polymorphism and polygons. Doubling time was 38.4 hour which was relatively slow compared to other cancer cells. Microscopic view revealed intranuclear infoldings which are typical in malignant Brenner tumors. The OHK cells secreted significantly high level of CA 125 into the culture medium. A 215th codon at exon 4 of p53 was mutated to C/C in OHK. BRCA 1 was a wild type and polymorphisms were detected in exons 2, 10, 11, 14 and 17 of BRCA 2. The cells showed aneuploidy with DNA index of 1.589 measured by flow cytometry. When transplanted into nude mice, OHK cells successfully induced tumor which was histopathologically resembled malignant Brenner tumor. CONCLUSION: These results strongly suggest that OHK is a typical cell line of malignant Brenner tumor. This may provide a useful cellular resource for studying the pathogenesis of malignant Brenner tumor.

The effect of colpoperineoplasty on female sexual function / 대한산부인과학회지

OBJECTIVE: To evaluate female sexual function after colpoperineoplasty. METHODS: Women who visited regional clinic for colpoperineoplasty from June. 2004-Aug. 2004. filled in FSFI (The Female Sexual Function Index) questionnarie before and 4 months after surgery. Six weeks after surgery, they start pelvic muscle training with HMT 2000 (Korea, electric stimulator). RESULTS: Frequency of coitus, sexual desire, arousal, lubrication and orgasm was increased after colpoperineoplasty. Percentage of patients who had coitus more than once a week increased from 18% to 63%. In sexual desire, about 18% felt sexual arousal more than or about half the time before surgery, but increased to 45% after surgery. In sexual arousal, percentage of who felt sexually aroused during more than half of sexual activity increased from 34% before surgery to 69% after surgery. In Lubrication, percentage of who became lubricated during more than half of sexual activity increased from 44% before surgery to 82% after surgery. Who reached orgasm more than half of sexual activity increased from 29% before surgery to 70%. CONCLUSION: Colpoperineoplasty increased female sexual activity.

An Unusual Relapse of Acute Lymphoblastic Leukemia in the Uterine Corpus / 대한산부인과학회잡지

The relapse of leukemia is usually classified as hematologic relapse and extramedullary relapse. The most common sites of clinical extramedullary relapse are the central nervous systems (CNS) and gonads. However, the relapse in the uterus is very rare. We experienced a very unusual case of uterine relapse of acute lymphoblastic leukemia (ALL) after about a 6-year remission period. This female patient returned to our hospital with a two-month history of amenorrhea. Pelvic radiology confirmed an about 7 cm sized ill-defined ovoid mass in the uterus. There was no evidence of ALL relapse in the peripheral blood or CNS. The uterine biopsy showed diffused homogenous infiltration of numerous small round cells in uterine corpus, suggesting ALL relapse. The bone marrow study revealed 100% cellularity, most of which were lymphoblasts. Our patient received the bone marrow transplantation (BMT) and achieved the second complete remission (CR). Therefore, we here report our case with a brief review of literature.

A Case of Unilateral Blindness Following Subcutaneous Injection of the silicone Oil on the Glabellar Area

We recently observed an unusual case of visual loss after periocular injection of silicone oil. A 31-year-old woman immediately experienced total loss of vision in the left eye with ipsilateral headache and ocular pain, dyspnea, abdominal pain, general weakness, and transient coma after subcutaneous injection of silicone oil on the glabellar area to reduce the facial wrinkles. We believe that the cause of blindness was multiple embolization in the central retinal artery and posterior ciliary branches of the ophthalmic artery.

A Clinical Study of 3M Multifocal Intraocular Lens Implant

Recently, it has been widely recognized that the newly developed multi focal intraocular lens provides good near and far vision. Therefore, among 70 eyes who underwent 3M multifocal intraocular lens insertion procedure at our hospital from July 1989 to may 1990, 50 eyes that could be closely followed up for at least 3 months postoperatively were chosen as our study subjects. After careful analytical review of data such as postoperative near and far vision, refractory power, spherical equivalent of diopter of spectacles needed for correction of vision, change of vision according to size of pupil as well as relationship between central location of intraocular lens(IOL) and vision, and multifocusing ability of IOL, we have attained the following results. 1. 36(72.0%) males and 14 females(28.0%) have received multifocal IOL. According to age, 16 eyes(32.0%) were in their 40's, comprising the greatest number, followed by those in the 50's(24.0%) and 60's(24.0%). 2. Postoperatively, 23 eyes(46.0%) have attained emmetropia. 12 eyes(24.0%) were hyperopic, and 15 eyes(30.0%) were myopic. Spherical equivalent of corrected spectacles was -0.35D. The number of eyes attaining corrected vision over 1.0 was 36(72.0%),44 eyes over 0.5(88.0%), and 6 eyes less than 0.4(12.0%). 3. The number of near vision J1 with corrected vision over 1.0 were 33 eyes(66.0%), greater than J2 were 36(72.0%), and in the case of vision of 0.9-0.8 J1 and J2 were 2 eyes(4.0%) and 3 eyes(6.0%), respectively; vision of 0.7-0.5 J2 was 1 eye(2.0%), J3 were 2 eyes(4.0%). In vision less than 0.4, J3 and less than J3 were 3 eyes(6.0%) in each cases. 4. Corrected near vision attained by additional diopter in 15 eyes that have a near vision of less than J2 are as follow: 7 eyes of J1(14.0%), 4 eyes of J2(8.0%) 2 eyes of J3(4.0%) and 2 eyes of less than J3(4.0%). Average additional diopter required to obtain J1 was +0.64D. 5. In the group that has corrected vision over 1.0, the number of eyes that had matched center of IOL and center of pupil was 17(34.0%), number of eyes that has a deviation of 0.5 mm was 6(12.0%), 8 eyes with a deviation of 1.0 mm(16.0%), 5 eyes with a deviation of 1.5 mm(10.0%); but, none have affected vision. 6. Change of vision according to the size of pupil was measured. In the case of corrected vision over 1.0, pupil size of 2.0-4.0 mm and dilated pupil size over 5.0 mm occurred in 36 eyes in each case, and a constricted pupil size less than 2.0 mm occurred 35 eyes with no vision change observed. 7. In the case of corrected vision over 1.0, additional use of lens from +1.0D to -3.0D has not affected vision when maintained at a level of over 0.8 but use of any lens out of this range has dramatically decreased vision. 8. After inserting vultifocal IOL, complaints of diplopia, glare, dizziness and seeing rings were observed in 10 eyes(20.0%); but, 5 months later symptoms had disappeared in all cases.

A Clinical Study of 3M Multifocal Intraocular Lens Implant

Recently, it has been widely recognized that the newly developed multi focal intraocular lens provides good near and far vision. Therefore, among 70 eyes who underwent 3M multifocal intraocular lens insertion procedure at our hospital from July 1989 to may 1990, 50 eyes that could be closely followed up for at least 3 months postoperatively were chosen as our study subjects. After careful analytical review of data such as postoperative near and far vision, refractory power, spherical equivalent of diopter of spectacles needed for correction of vision, change of vision according to size of pupil as well as relationship between central location of intraocular lens(IOL) and vision, and multifocusing ability of IOL, we have attained the following results. 1. 36(72.0%) males and 14 females(28.0%) have received multifocal IOL. According to age, 16 eyes(32.0%) were in their 40's, comprising the greatest number, followed by those in the 50's(24.0%) and 60's(24.0%). 2. Postoperatively, 23 eyes(46.0%) have attained emmetropia. 12 eyes(24.0%) were hyperopic, and 15 eyes(30.0%) were myopic. Spherical equivalent of corrected spectacles was -0.35D. The number of eyes attaining corrected vision over 1.0 was 36(72.0%),44 eyes over 0.5(88.0%), and 6 eyes less than 0.4(12.0%). 3. The number of near vision J1 with corrected vision over 1.0 were 33 eyes(66.0%), greater than J2 were 36(72.0%), and in the case of vision of 0.9-0.8 J1 and J2 were 2 eyes(4.0%) and 3 eyes(6.0%), respectively; vision of 0.7-0.5 J2 was 1 eye(2.0%), J3 were 2 eyes(4.0%). In vision less than 0.4, J3 and less than J3 were 3 eyes(6.0%) in each cases. 4. Corrected near vision attained by additional diopter in 15 eyes that have a near vision of less than J2 are as follow: 7 eyes of J1(14.0%), 4 eyes of J2(8.0%) 2 eyes of J3(4.0%) and 2 eyes of less than J3(4.0%). Average additional diopter required to obtain J1 was +0.64D. 5. In the group that has corrected vision over 1.0, the number of eyes that had matched center of IOL and center of pupil was 17(34.0%), number of eyes that has a deviation of 0.5 mm was 6(12.0%), 8 eyes with a deviation of 1.0 mm(16.0%), 5 eyes with a deviation of 1.5 mm(10.0%); but, none have affected vision. 6. Change of vision according to the size of pupil was measured. In the case of corrected vision over 1.0, pupil size of 2.0-4.0 mm and dilated pupil size over 5.0 mm occurred in 36 eyes in each case, and a constricted pupil size less than 2.0 mm occurred 35 eyes with no vision change observed. 7. In the case of corrected vision over 1.0, additional use of lens from +1.0D to -3.0D has not affected vision when maintained at a level of over 0.8 but use of any lens out of this range has dramatically decreased vision. 8. After inserting vultifocal IOL, complaints of diplopia, glare, dizziness and seeing rings were observed in 10 eyes(20.0%); but, 5 months later symptoms had disappeared in all cases.

A Case of Metastatic Squamous Cell Carcinoma of the Choroid

In adults, it is known that the choroid is the most eyeball common site of metastasis. However, only a few cases have been reported. The authors have experienced a case of pulmonary squamous cell carcinoma metastasis in the Lt. choroid in a 57 year old Korean male patient. We report this case and a review of the literature.