Comparison of Surgical Outcomes according to Suturing Methods in Single Port Access Laparoscopic Myomectomy

OBJECTIVES: This study was performed to consider the clinical experience of surgical outcome of single port access (SPA) laparoscopic myomectomy according to suturing methods. METHODS: The authors operated with 2 suturing method in SPA laparoscopic myomectomy for 246 patients and compared the surgical outcomes. RESULTS: The some significant difference of surgical outcome according to two suturing methods was demonstrated. Operating time was 100.50 minutes (+/- 42.09 minutes) in interrupted suture method group than 121.04 minutes (+/- 61.56 minutes) in continuous interlocking suture method group (P = 0.021). Estimated blood loss was less 222.59 mL (+/- 144.94 mL) in interrupted suture group than 340.11 mL (+/- 380.62 mL) in continuous interlocking suture method group (P = 0.042). CONCLUSION: This experience suggests that interrupted suture method was effective for operating time and estimated blood loss than continuous interlocking method in SPA laparoscopic myomectomy.

Clinical Efficacy of Recombinant Activated Factor VII in Management of Postpartum Hemorrhage / 대한주산의학회잡지

PURPOSE: This study was aimed to investigate the clinical efficacy of recombinant activated factor VII (rFVIIa) for patients with intractable postpartum hemorrhage. METHODS: This was a retrospective study of ten patients who were treated with rFVIIa from July 2010 to February 2012 in one tertiary center. To evaluate each case, we used a standardized case record form. The primary outcome measures were response of rFVIIa, reduction of blood product requirement, changes of coagulation parameter. The response of rFVIIa was categorized to three groups: "complete responder", "partial responder", "poor responder". RESULTS: After the administration of rFVIIa, effect for bleeding was completely responded in 4 patients, partially responded in 6 patients, and poorly responded in none. A certain amount of reduction in blood product requirements was noted following rFVIIa administration, although no significant differences were observed statistically between before and after rFVIIa administration except RBC (P<0.01). Fibrinogen and INR were significantly reduced in all case types, but other coagulation parameters were not (P<0.01). CONCLUSION: The present results suggest that rFVIIa is a beneficial therapeutic option that could reduce blood loss and contribute to reduction of maternal morbidities and mortalities in patients with massive postpartum hemorrhage.

Surgery for Recurrent Lumbar Disc Herniation During Pregnancy: A Case Report

A few cases of lumbar disc herniation (LDH) that have been treated by surgery during pregnancy have been reported in the literature. However, symptomatic recurrent LDH during pregnancy has been rarely reported. A 32-year-old parous woman presented with lumbago and severe right leg pain at 20 weeks' gestation. Eleven years prior to admission, she had undergone an open discectomy for right-sided LDH at the L4-5 level. Magnetic resonance imaging (MRI) showed a recurrent disc herniation that affected the nerve root at the right L4-5 level. The radiating pain did not respond to conservative treat-ment. Revision surgery was performed under general anesthesia and in the left lateral position to avoid fetal stress and aortocaval compression, and the ruptured disc particle was completely removed. Postoperatively, the radiating pain was completely relieved. She delivered a full-term healthy girl (birth weight, 3.39 kg) at 40 weeks' gestation by normal vaginal delivery. We report the rare case of a 32-year-old parous woman with recurrent LDH that was successfully treated by revision surgery. In recurrent LDH patients with incapacitating pain who do not respond to opioid injections, surgical treat-ment could lead to a satisfactory outcome maintaining pregnancy.

Effects of simvastatin on the proliferation and apoptosis of human endometrial stromal cells from women with endometriosis / 대한산부인과학회지

OBJECTIVE: To evaluate the effects of simvastatin on the proliferation and apoptosis of human endometrial cells from women with endometriosis. METHODS: Endometrial tissues were obtained from four women with endometriosis. The endometrial stromal cells isolated from tissue were cultured with 0, 2 and 10 micrometer simvastatin treatments for 48 hours. The proliferation of endometrial stromal cells was inhibited with 2 and 10 micrometer simvastatin treatments compared to control. The effect of simvastatin on the sub-G1 phase of cell cycle was determined by flow cytometry. The expression of apoptosis related molecule (Bcl-2, Bax and caspase-3) was examined in control and simvastatin treatments using western blot. RESULTS: The sub-G1 phase was higher in 10 micrometer simvastatin than in control and 2 micrometer simvastatin (P<0.05). This result showed that simvastatin could induce apoptosis of stromal cells. The expression of Bcl-2 was increased in simvastatin treatments slightly (P<0.05) and the expression of Bax was not different between control and experimental groups. The activation of caspase-3 was significantly higher in 10 micrometer simvastatin treated group than control and 2 micrometer simvastatin treated groups (P<0.05). CONCLUSION: Simvastatin induces apoptosis of endometrial stromal cells and inhibits their proliferation. It was considered that simvastatin could potentially be a therapeutic agent for the treatment of endometriosis.

Rupture of Renal Artery Aneurysm Misdiagnosed as Postpartum Retroperitoneal Hematoma / 대한주산의학회잡지

Aneurysms in the renal artery are relatively rare and predominately asymptomatic. Histological data estimate that renal artery aneurysms (RAAs) are found in 0.1% of the general population. The most catastrophic complication of RAA is rupture, which occurs in less than 3% of patients. Nearly 30 cases of rupture of RAA (RRAA) during pregnancy have been reported in the international literature, but no RRAA diagnosed after labor has been reported. We report on the first case of acute RRAA after labor, which was initially misdiagnosed as postpartum retroperitoneal hematoma, and provide a brief review of the literature.

A Case of Advanced Gastric Cancer Diagnosed by Endoscopy Performed in the Second Trimester due to Persistent Nausea and Vomiting / 대한주산의학회잡지

Gastric cancer is rarely associated with pregnancy and its incidence is reported to be 0.1%. The dilemma in the treatment of this rare occasion is that it is usually diagnosed at an advanced stage. The most common reason for delayed diagnosis is that early symptoms of gastric cancer, such as nausea, vomiting and epigastric discomfort, are nonspecific and usually misinterpreted as those related to pregnancy. Clinicians' reluctance to request diagnostic studies is another reason for delayed diagnosis. So these make the prognosis much worse. We must consider the rare possibility of gastric cancer in case of persistent nausea and vomiting. We report a case of advanced gastric cancer diagnosed by gastroscopic examination performed in the second trimester because of persistent nausea and vomiting.

Rb pathway alteration and E2F-1 expression in epithelial ovarian cancer / 부인종양

OBJECTIVE: To evaluate the clinicopathological implications of Rb pathway alteration and E2F-1 expression in Epithelial ovarian cancer using immunohistochemical staining. METHODS: Tissue samples (n=72) were collected after staging operation between 1998 and 2004. RESULTS: In 72 cases, the overall expression of pRb, and E2F-1 were 59.7% (43/72), and 58.3% (42/72), respectively. pRb expression was inversely correlated with stage, histologic grade and mitotic index. E2F-1 expression was correlated with advanced stages, high grade, mitotic index, Ki-67 labeling index (LI). CONCLUSION: We suggest that Rb pathway alteration and E2F-1 expression could play roles as a new prognostic factors in Epithelial ovarian cancer.

Preliminary Clinical Experience of Anterior Cervical Interbody Fusion with the AMSLU(TM) Cage

OBJECTIVE: The authors investigate the effectiveness and the demerits of the AMSLU(TM) cervical cage used in cervical spinal fusion for correction of cervical degenerative disc disease. METHODS: A total of 19 patients with cervical degenerative disc disease underwent anterior microdiscectomy and the AMSLU(TM) cage fusion. We made a retrospective comparative analysis between cases using the AMSLU(TM) cage and the classical autogenous iliac crest graft(AICG) with plate fixation about operative time, blood loss and hospital stay. The patient's neurological and functional outcomes were assessed on the basis of the modified Odom's criteria. RESULTS: The use of the AMSLU(TM) cage was found to save operative time(mean, 153+/-52min: P=0.004) and blood loss(mean, 236+/-171cc: P=0.032) as compared with the use of AICG. There was no donor-site complications and all patients were tolerable to ambulation at 1 day postoperatively. The patient's clinical success rate was 89% on discharge and 84% at 6 months postoperatively. CONCLUSION: The use of the AMSLU(TM) cage provides several advantages: no donor-site complications, brief instrument procedures, short operative time, small amount of blood loss and satisfactory clinical success rate. But it also has many limitations: short follow up period, kyphotic change and subsidence. Further investigations and clinical applications are necessary to use AMSLU(TM) cage in cases of spondylolisthesis and traumatic cervical disease.

Emergency Trephination Site of Acute Subdural Hematoma

No abstract available.

Effects of MK-801, CNQX, Cycloheximide and BAPTA-AM on Anoxic Injury of Hippocampal Organotypic Slice Culture

No abstract available.

Hemangioblastoma of the Conus Medullaris : Case Report

No abstract available.

Hemangioblastoma of the Conus Medullaris : Case Report

No abstract available.

Difference of Neuronal Recovery by Incubation Condition after Transient Hypoxia

No abstract available.

The Protective Effect of Preconditioning Ischemia on Subsequent Cerebral Ischemic Insults

A brief period of cerebral ischemia produces neuronal damage in the vulnerable regions of the brain, such as the CA1 area of the hippocampus. However, mild ischemic episodes may limit damage from subsequent ischemic insults, the phenomenon known as ischemic tolerance or preconditioning. We used hippocampal slices as an experimental model to investigate the possible utilization of ischemic tolerance, and to determine the effects of various drugs acting on glutamate and adenosine receptors following a conditioned ischemic insult. Preconditioning ischemic insult was induced in hippocampal slices of 450nm thickness for 60-70 seconds. Glutamate and adenosine receptors were pretreated 1 hour later with D,L-2-amino-5-phosphonovaleric acid(AP-5, 50nM), propentofylline(PPF, 200nM), 6-cyano-7-nitroquinoxaline-2,3-dione(CNQX, 10nM), 8-cyclopentyl-3,7-dihydro-1,3-dipropyl-1H-purine-2,6-dione(DPCPX, 1, 10nM) and 2-chloro-N6-cyclopentyl-adenosine (CCPA, 1, 10, 50nM). The slices were reoxygenated for 3 hours, after then a second ischemic insult was induced by substituting 95% O2, 5% CO2 and glucose for 95% N2, 5% CO2 and sucrose for 10 minutes. Population spikes(PS) were estimated from extracellular electrophysiological recordings of the hippocampal CA3-CA1 synaptic conduction 1 hour following the second ischemic insult. The PS(mV) was 2.69+/-0.06 in the normal hippocampal slice, while it was reduced to 1.21+/-0.05 in the hippocampal slice induced with 10 minutes of ischemia. The effects of the A1 selective agonist CPPA revealed a reduction of PS to 0.98+/-0.06 with low concentration(1nM), similar PS as the control group with a concentration of 10nM, and an increase in ischemic tolerance of 1.78+/-0.05 at a higher concentration(50nM). The selective A1 antagonist DPCPX(1nM) showed minimal reduction in PS of 1.10+/-0.04, while the NMDA antagonist AP-5(5nM) had a more profound weakening effect(1.05+/-0.04). The adenosine uptake inhibitor profentophylline(200nM) augmented the PS to 1.56+/-0.06; this effect was not influenced by 1nM DPCPX(1.60+/-0.07), but was abolished by a higher concentration of 10nM(1.36+/-0.05). These results confirmed ischemic tolerance in the hippocampal experimental model. We conclude that adenosine plays an important role in ischemic tolerance as activation of adenosine receptors or adenosine uptake inhibition enhances ischemic tolerance.

Intracranial Aneurysm Associated with Moyamoya Disease

It is well known that moyamoya disease is often accompanied by an intracranial aneurysm. We present 3 patients, among total 40 patients with moyamoya disease over a recent 4-year period, in whom moyamoya disease and an intracranial saccular aneurysm were discovered simultaneously. In 2 of the 3 patients, the aneurysms were occluded endovascularly by Guglielmi detachable coils(GDC). Here, with review of pertinent literature, we discuss the clinical characteristics of an intracranial aneurysm associated with moyamoya disease and the benefits and drawbacks between two therapeutic options- direct surgery and endovascular treatment.

Extramedullary Plsasmacytoma Developed in the Thoracic Epidural Space: Case Report

Spinal cord compression associated with plasma cell neoplasm is observed always in the patients suffering from the multiple myeloma or solitary plasmacytoma that occur in the marrow of the spine. Authors report a rare case of extramedullary plasmacytoma forming a mass in the epidural space of the thoracic spine. In 70 year old woman with paraplegia, MRI of the thoracic spine indicated a presence of epidural mass at the 2nd to 8th thoracic vertebrae. There was no abnormal bony changes in the spine on plain X-ray and MRI. Total removal of the epidural mass was performed by posterior approach. Histopathologic examination including immunohistochemical stain showed the plasma cell neoplasm producing IgM and kappa light chain. Cancer workup after operation including bone marrow study and whole body simple radiologic studies supported the diagnosis of extramedullary plasmacytoma.

Influence of Hypoglycemia and Hypothermia on Direct Current Potential During Cortical Spreading Depression in Rats

The object of this study was to investigate the influences of hypoglycemia and hypothermia on the direct current(DC) pontetial changes during cortical spreading depression(CSD) in rats. The induction of CSD was achieved by the application of KCI solution on the cortex of the frontal lobe. Hypoglycemia and hypothermia were induced respectively by insulin injection and the application of an ice pack. The DC potential changes during progressive hypoglycemia and hypothermia were measured with microelectrodes from the cortex of the parietal lobe of rats. Under contril condition, the rate of CSD was one per 5-10 min and the negative shift of DC potential was about 30 mV. The recovery time from negative shift to base line of DC potential was about 40 sec. In rats treated with insulin, the amplitude of DC potential shift was unaffected by hypoglycemia. The recovery time of DC shift was 40+/-2.26 sec at normoglycemia and it was delayed progressively as the blood glucose level lowered. The mean of it was 63+/-8.02 sec at 30 mg/dl and 77.1+/-22.0 sec with the blood glucose falling below 20 mg/dl. The same delay in the recovery time as seen in the hypogylcemia group was observed in rats treated with hypothermia. The recovery time of DC shift was 39.4+/-3.02 sec in normothermia(36.5degrees C), but it was delayed to 61.15+/-4.15 sec at 30degrees C and 96.67+/-14.92 sec at 26degrees C body temperature. This study suggested that each condition of profound hypoglycemia below 30 mg/dl and hypothermia below 30degrees C was to be harmful to the ion homeostasis and the integrity of the cell membrane and it may lead neurons to death.