Hyun S. Park

Single-Port Laparoscopic Salpingectomy for the Surgical Treatment of Ectopic Pregnancy

STUDY OBJECTIVEnTo evaluate the feasibility of a single-port laparoscopic salpingectomy in the surgical treatment of tubal pregnancy.nnnDESIGNnProspective cohort study (Canadian Task Force classification II-2).nnnSETTINGnUniversity teaching hospitalnnnPATIENTSnTwenty women with tubal pregnancy, as determined by ultrasonography.nnnINTERVENTIONnAll patients have undergone single-port laparoscopic salpingectomy. Entry through a single port was established with a wound retractor as fascial retractor and a surgical glove, which served as the working channels for the laparoscopic equipment. A 30-degree laparoscope and a rigid or flexible grasper were used during the procedure.nnnMEASUREMENTS AND MAIN RESULTSnSingle-port laparoscopic salpingectomy was successfully performed in all 20 patients with ectopic pregnancy. The median operative time was 55 minutes (range 25-85 minutes), and blood loss in all patients was minimal. The median difference between preoperative and postoperative hemoglobin was 1.8 g/dL (range 0-3.2 g/dL). The median postoperative hospital stay was 2 days (range 2-4 days). No complication was encountered, nor was there any need for conversion to conventional laparoscopy.nnnCONCLUSIONSnSingle-port laparoscopic salpingectomy is feasible and promising. However, for drawing the definite conclusion of the surgical efficacy, additional investigations to compare this approach with conventional laparoscopy are needed.

Effectiveness of high-dose progestin and long-term outcomes in young women with early-stage well-differentiated endometrioid adenocarcinoma of uterine endometrium.

PurposeWe assessed the effectiveness of high-dose progestins as a conservative treatment in young women with endometrial adenocarcinoma.MethodsWe retrospectively reviewed the hospital data of patients with endometrial cancer that were managed conservatively. Of those women with grade 1 endometrioid endometrial adenocarcinoma, we included those who were younger than 40xa0years and in whom the disease was clinically confined to the endometrium. A complete response was defined pathologically as the absence of tissue with adenocarcinoma or hyperplasia.ResultsFourteen patients were included. Their mean age was 30.0xa0±xa04.8xa0years and the mean follow-up period was 47.3xa0±xa029.7xa0months. Twelve patients received 30–500xa0mg/day medroxyprogesterone acetate and two received 160 or 240xa0mg/day megestrol acetate. The median duration of treatment was 6xa0months (range 3–15xa0months) and 13 (93%) patients showed a complete response. Endometrial pathology reappeared in four patients (4/13, 31%) including two relapses, three of whom developed after the patients gave birth. Six patients used a combined oral contraceptive or a progestin-releasing intrauterine device as a maintenance therapy and experienced no recurrence. Four women (4/7, 57%) conceived successfully seven times with assisted-reproductive technology. No adverse effects of the progestins or tumor-related death were noted.ConclusionsHigh-dose progestin therapy can be an effective conservative treatment in young patients with well-differentiated early-stage endometrial cancer. If patients wish to preserve their fertility even after they have completed childbearing, maintenance therapy with a cyclic oral contraceptive or a progestin-releasing intrauterine device may be an option to prevent recurrence.

miR-145, targeting high-mobility group A2, is a powerful predictor of patient outcome in ovarian carcinoma.

MicroRNA-145 (miR-145) expression is downregulated in several human cancers, but its clinical and functional relevance to ovarian carcinoma has not yet been elucidated. This study addressed the hypothesis that miR-145 serves as a prognostic biomarker and a tumor suppressor that regulates the expression of high-mobility group A2 (HMGA2) oncoprotein in ovarian cancer. Here, we found that low miR-145 expression and HMGA2 overexpression determined by qRT-PCR and immunohistochemistry significantly correlated with advanced stage, lymph node involvement, and distant metastasis in 74 ovarian carcinomas. Low miR-145 expression significantly correlated with tumor recurrence and worse overall survival (HR=8.62, Pu2009=u20090.039). Transfection of pre-miR-145 resulted in reduced cell growth and migration, and increased apoptosis of ovarian cancer cells by TUNEL, colony forming, and cell migration assays. MiR-145 was found to directly target HMGA2 by luciferase assay and Western blotting. Our findings suggest that miR-145 functions as a tumor suppressor in ovarian cancer and directly targets HMGA2 oncoprotein. Low miR-145 and high HMGA2 expressions are potential biomarkers of poor prognosis of ovarian carcinoma and miR-145 is the more powerful predictor of patient outcome.

Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes.

OBJECTIVEnTo compare the surgical outcomes of single-port laparoscopic salpingectomy (SPLS) and conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy.nnnSTUDY DESIGNnFrom January to June 2009, patients with tubal pregnancy were assigned to two surgical groups: SPLS and conventional laparoscopic salpingectomy. Surgical outcomes, including operative time, postoperative haemoglobin drop, hospital stay and complications, were compared prospectively. For SPLS, a novel multichannel port was made using a wound retractor and a surgical glove.nnnRESULTSnIn total, 60 patients were enrolled in the study (30 in the SPLS group and 30 in the conventional group). All operations were completed successfully. No significant difference was observed between the two groups in terms of mean operative time (52.6 ± 16.1 min vs 46.8 ± 16.2 min; p=0.174), mean difference between pre- and postoperative haemoglobin (1.7 ± 0.8 g/dl vs 1.8 ± 1.0 g/dl; p=0.636), or mean postoperative hospital stay (2.4 ± 0.5 days vs 2.4 ± 0.9 days; p=1.000). No complications were encountered in either group, and there was no conversion to conventional laparoscopy in the SPLS group.nnnCONCLUSIONnSPLS has comparable surgical outcomes to conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy in terms of operative time, hospital stay and complication rates. However, further studies are needed to evaluate the merits expected of single-port laparoscopic surgery, such as cosmetic advantage and decreased pain in patients.

Short-term results of magnetic resonance imaging-guided focused ultrasound surgery for patients with adenomyosis: symptomatic relief and pain reduction

The objective of this study was to evaluate the degree of symptomatic relief obtained after treatment with magnetic resonance-guided focused ultrasound surgery in patients with adenomyosis. Quality of life and pain assessment questionnaires from 35 women, collected on the day of treatment and up to 6 months after treatment, indicated that the treatment was safe and there was a significant reduction in symptoms.

Electrochemical deposition of conductive and adhesive polypyrrole-dopamine films

Electrode surfaces have been widely modified with electrically conductive polymers, including polypyrrole (PPY), to improve the performance of electrodes. To utilize conductive polymers for electrode modification, strong adhesion between the polymer films and electrode substrates should be ensured with high electrical/electrochemical activities. In this study, PPY films were electrochemically polymerized on electrodes (e.g., indium tin oxide (ITO)) with dopamine as a bio-inspired adhesive molecule. Efficient and fast PPY electrodeposition with dopamine (PDA/PPY) was found; the resultant PDA/PPY films exhibited greatly increased adhesion strengths of up to 3.7 ± 0.8u2009MPa and the modified electrodes had electrochemical impedances two to three orders of magnitude lower than that of an unmodified electrode. This electrochemical deposition of adhesive and conductive PDA/PPY offers a facile and versatile electrode modification for various applications, such as biosensors and batteries.

Experimental and computational studies of formic acid dehydrogenation over PdAu: influence of ensemble and ligand effects on catalysis

The critical role of the ligand effect and ensemble effect in enhancing formic acid (FA) dehydrogenation over PdAu catalysts was highlighted by both experimental and theoretical studies. FA dehydrogenation energy was calculated by DFT on PdAu model catalysts of different surface atomic arrangements. The Pd3Au1 surface exhibited the lowest reaction energy and kinetic barrier for FA dehydrogenation among four different PdAu surfaces. The Pd trimer played a critical role in stabilizing reaction intermediates. The experimental FA dehydrogenation activity of three different PdAu catalysts supported the theoretical results. In addition, the electronic interaction between the surface and subsurface layers also proved to contribute to the improved catalytic activity of PdAu catalysts via modification of Pd d states.

Magnetic Resonance Imaging-guided Focused Ultrasound Treatment of Pedunculated Subserosal Uterine Fibroids: A Preliminary Report

PURPOSEnTo evaluate magnetic resonance (MR) imaging-guided focused ultrasound (US) as a treatment for pedunculated subserosal fibroids.nnnMATERIALS AND METHODSnOver a 2-year period (March 2007 to March 2009), 135 women with symptomatic uterine fibroids were treated in the authors institution using MR imaging-guided focused US. Of these women, nine (mean age, 39 years; range, 25-47 y) had a single pedunculated subserosal fibroid. During treatment, these pedunculated fibroids were targeted, while sparing the stalk connection between the fibroid and the uterus. Contrast-enhanced T1-weighted MR images were obtained immediately after the treatment to measure the nonperfused volume (NPV) ratio and to check stalk viability. Changes in tumor volume, diameter of the stalk, patient symptoms and adverse events were evaluated 6 months after treatment.nnnRESULTSnThe volume of the treated fibroids (n=9) ranged from 79-380cm(3) (mean, 198cm(3)), and NPV ratio ranged from 45%-80% (mean, 67%). MR imaging follow-up at 6 months showed a 14%-48% (mean, 30%) reduction in the volume of the treated fibroids (P =.008). In all cases, the pedunculated subserosal fibroids remained connected to the uterus with a 13% average decrease in the mean diameter of the stalks (from 3.5 to 3.0cm; P=.008). Eight of nine patients (89%) reported improvement in bulk-related fibroid symptoms after treatment.nnnCONCLUSIONSnThe results of this preliminary study suggest that MR imaging-guided focused US may be a safe and effective treatment for pedunculated subserosal fibroids. Larger prospective studies with longer follow-up are needed to confirm the suitability of MR imaging-guided focused US to treat this type of fibroid.

Photodynamic therapy for premalignant lesions of the vulva and vagina: A long-term follow-up study.

We aimed to evaluate responses to photodynamic therapy (PDT) and its long‐term efficacy in preserving normal anatomy and function in women with premalignant lesions of the lower genital tract.

Germline Mutations of BRCA1 and BRCA2 in Korean Ovarian Cancer Patients: Finding Founder Mutations

Objectives To investigate and analyze the BRCA mutations in Korean ovarian cancer patients with or without family history and to find founder mutations in this group. Methods/Materials One hundred two patients who underwent a staging operation for pathologically proven epithelial cancer between January 2013 and December 2014 were enrolled. Thirty-two patients declined to analyze BRCA1/2 gene alterations after genetic counseling and pedigree analysis. Lymphocyte specimens from peripheral blood were assessed for BRCA1/2 by direct sequencing. Results BRCA genetic test results of 70 patients were available. Eighteen BRCA1/2 mutations and 17 unclassified variations (UVs) were found. Five of the BRCA1/2 mutations and 4 of the UVs were not reported in the Breast Cancer Information Core database. One BRCA2 UV (8665_8667delGGA) was strongly suspicious to be a deleterious mutation. BRCA1/2 mutations were identified in 11 (61.1%) of 18 patients with a family history and in 7 (13.5%) of 52 patients without a family history. Candidates for founder mutations in Korean ovarian cancer patients were assessed among 39 BRCA1/2 mutations from the present study and from literature reviews. The analysis showed that 1041_1043delAGCinsT (n = 4; 10.2%) and 3746insA (n = 4; 10.2%) were possible BRCA1 founder mutations. Only one of the BRCA2 mutations (5804_5807delTTAA) was repeated twice (n = 2; 5.1%). Conclusions The prevalence of BRCA1/2 mutations in Korean ovarian cancer patients irrespective of the family history was significantly higher than previously reported. Possible founder mutations in Korean ovarian cancer patients were identified.