Won Moo Lee

The Role of Steroid Sulfatase as a Prognostic Factor in Patients with Endometrial Cancer

Purpose The aim of the study was to determine steroid sulfatase (STS) expression in endometrial cancer patients and its correlation with disease prognosis. Materials and Methods We conducted a retrospective study in 59 patients who underwent surgery with histologically confirmed endometrial cancer from January 2000 to December 2011 at Hanyang University Hospital. Immuno-histochemical staining of STS was performed using rabbit polyclonal anti-STS antibody. Results Sixteen of the 59 patients (27.1%) were positive for STS expression. Disease free survival (DFS) was 129.83±8.67 [95% confidence interval (CI): 112.84–146.82] months in the STS positive group (group A) and 111.06±7.17 (95% CI: 97.01–125.10) months in the STS negative group (group B) (p=0.92). Overall survival (OS) was 129.01±9.38 (95% CI: 110.63–147.38) months and 111.16±7.10 (95% CI: 97.24–125.07) months for the groups A and B, respectively (p=0.45). Univariate analysis revealed that FIGO stage and adjuvant therapy are significantly associated with DFS and OS. However, in multivariate analysis, FIGO stage and adjuvant therapy did not show any statistical significance with DFS and OS. STS was also not significantly associated with DFS and OS in univariate and multivariate analysis. Conclusion STS expression was not significantly associated with DFS and OS, despite positive STS expression in 27% of endometrial cancer patients. Therefore, the role of STS as a prognostic factor in patients with endometrial cancer remains unclear and requires further research.

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.

Feasibility and efficacy of laparoscopic restaging surgery for women with unexpected ovarian malignancy.

OBJECTIVE To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. STUDY DESIGN We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. RESULTS The median age and median body mass index women were 49 years (range, 22-63) and 24.2m/kg(2) (range, 18.9-25.3), respectively. The median operating time was 230min (range, 155-370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6-41) and 18 (range, 2-40), respectively. The median return of bowel activity was 28h (range, 21-79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. CONCLUSION Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.

Regulatory T cells increase after treatment with poly (ADP-ribose) polymerase-1 inhibitor in ischemic stroke patients

Background: Regulatory T cells (Tregs) are thought to play a modulatory role in immune responses and to improve outcomes after ischemic stroke. Thus, various strategies for increasing Tregs in animal models of ischemic stroke have yielded successful results. The aim of this study was to examine the potential effect of poly (ADP‐ribose) polymerase‐1 (PARP‐1) inhibitor on Treg proportion in stroke patients. Methods: Peripheral blood samples were collected from 12 ischemic stroke patients (within 72h of stroke onset) and 5 healthy control subjects. Flow cytometry analyses and quantitative reverse transcription polymerase chain reactions (qRT‐PCR) were performed on peripheral blood mononuclear cells (PBMCs) before and after treating them with PARP‐1 inhibitor (3‐AB; JPI‐289 1&mgr;m, JPI‐289 10&mgr;m) for 24h. Results: Treg proportions were significantly higher in healthy controls (median 2.8%, IQR 2.6–5.0%) than ischemic stroke patients (median 1.6%, IQR 1.25–2.2%) (p<0.001). In the latter, Treg proportions were positively correlated with age (r=0.595, p=0.041), but not with infarct volume (r=0.367, p=0.241). After PARP‐1 inhibitor treatment, Treg proportions among PBMCs increased in response to high dose (10&mgr;m) JPI‐289 (median 2.3%, IQR 2.0–2.9%) as did Treg‐associated transcription factors such as FoxP3 and CTLA‐4 mRNA. PARP‐1 inhibitor treatment also decreased pro‐inflammatory cytokines (IFN‐&ggr;, TNF‐&agr;, and IL‐17) and increased anti‐inflammatory cytokines (IL‐4, IL‐10, and TGF‐&bgr;1). Conclusion: Treg proportions are reduced in ischemic stroke patients and increased by treatment with high‐dose PARP‐1 inhibitor JPI‐289. The PARP‐1 inhibitor also had a possible anti‐inflammatory effect on cytokine levels, and may ameliorate the outcome of ischemic stroke by up‐regulating Tregs. HIGHLIGHTSProportions of regulatory T cells (Tregs) are reduced in the PBMCs of ischemic stroke patientsPoly (ADP‐ribose) polymerase‐1 (PARP‐1) inhibitors increased Treg proportions in the PBMCs of ischemic stroke patientsPARP‐1 inhibitors may have anti‐inflammatory effects by affecting T cell numbers and cytokine levels

Coexisting ovarian and tubal pregnancies on opposite sides after intrauterine insemination: a case report

BackgroundOvarian pregnancy is very rare, and contralateral tubal pregnancy coexisting with ovarian pregnancy must be even rarer.Case presentationA 33-year-old Korean nulliparous woman was referred to our hospital because she suffered lower abdominal pain and had missed her periods after controlled ovarian hyperstimulation and intrauterine insemination. We could not identify any normal gestational sac in the endometrium, or specific ectopic pregnancies, on an initial ultrasound scan. However, there was a large hematoma in the cul-de-sac and free fluid in the right paracolic gutter. We decided to perform emergent laparoscopic surgery. We found contralateral tubal and ovarian ectopic pregnancies.ConclusionTo the best of our knowledge, this is the first report of a case in which a patient underwent laparoscopic right salpingectomy and left ovarian ectopic mass excision due to contralateral tubal and ovarian ectopic pregnancies after assisted reproductive technology.

Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy

Objective To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). Methods This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. Results There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. Conclusion For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.

Laparoscopic treatment of Castleman's disease in a patient with a history of malignant Brenner tumor.

Castlemans disease (CD) is a rare, atypical, lymphoproliferative disease of unknown etiology. The most common location for CD is the mediastinum (63%) [1]. A retroperitoneal location has been reported in 7% of patients, with only 2% of cases involving the pararenal region [2]. For this reason, CD located in the retroperitoneum is difficult to differentiate from other benign or malignant lesions. Here, we report a patient with CD located in the anterior lower pole of the right kidney who had been diagnosed with a malignant Brenner tumor after hysterectomy. A 56-year-oldwoman visited our hospital with a chief complaint of a growing abnormal retroperitoneal mass. She had undergone a total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) due to a malignant Brenner tumor at another university hospital 3 months previously. Baseline serum levels of CA-125 and CA 19-9 were normal (5.59 U/mL and 8.11 U/ mL, respectively). An abdominal computed tomography (ACT) scan revealed a 3.0-cm nodule in the anterior lower pole of the right kidney that had been visualized by ACT prior to the TAH and BSO. The mass had increased in size over the course of 3 months (Figure 1). No distant metastases or other abnormal findings were noted on ACT. We suspected that the mass was a metastatic lymph node and performed laparoscopic retroperitoneal removal. The patient was placed in the dorsolithotomy position, and four ports were used for the procedure (Figure 2). The first assistant gradually rotated the telescope 180 clockwise from the pelvic

Current status of infertility counseling in Korea

목적 본 연구에서는 불임부부 지원사업을 받아 보조생식술을 시행 받은 불임환자들을 대상으로 불임상담 실태에 대하여 알아보고자 하였다. 연구방법 2006년과 2008년 각각 1년 동안 불임부부 지원사업의 시술비를 지원받은 불임환자 2006년 19,131예 중 7,931예와 2008년 13,240예(총 21,171예)를 대상으로 우편설문조사를 실시하였다. 결과 불임시술 이전에 상담 받은 횟수는 2내지 3회 상담을 시행 받은 경우가 각각 409명(33.4%, 2006년), 534명(42.4%, 2008년)으로 가장 많았으며, 불임부부에게 불임상담을 해준 상담자로 불임전문의에게 상담을 받았다고 한 경우가 2006년은 1,009명(85.5%), 2008년은 879명(67.7%)으로 가장 많았다. 불임상담의 형태로는 진료실에서 불임환자나 부부 단독으로 구두상담 받은 경우가 가장 많았으며, 불임상담시 심리검사를 하지 않았다는 경우가 대부분이었다. 불임시술 중 가장 스트레스를 받은 경우는 ``임신결과 발표 시``로 나타났으며, 불임치료 시에는 가장 도움을 많이 준 사람으로 배우자가 가장 많았다. 결론 불임시술 전 과정이 불임환자에게 스트레스를 주는 것으로 나타났다. 특히 임신 결과 발표 시에 가장 많은 스트레스를 받는다고 하였으며, 시술이전에 2-3회의 상담을 받았고, 상담 시 심리검사 등은 시행하지 않았다. 우리나라의 불임상담은 외국과는 달리 정신과 전문의나 정신건강전문가에게 받지 않고 대부분 불임전문의에게 상담받았다고 하였는데, 국내에서도 불임부부의 상담에 정신심리 전문가가 포함된 팀으로서의 접근이 필요할 것으로 생각된다. 향후 불임상담과 임신율과의 상관 관계에 대한 추가 연구가 필요할 것으로 생각된다.