Young Lae Cho

Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy

Many reports regarding nerve‐sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve‐sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve‐sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. Clin. Anat. 23:186–191, 2010.

Prediction of high-grade squamous intraepithelial lesions using the modified Reid index

BackgroundColposcopic grading provides an objective and meaningful guide to histologic severity and neoplastic progression of squamous intraepithelial lesions of the cervix. The objective of this study was to develop a more efficient and convenient method to overcome procedural complexities involved with the traditional Reid index in prediction of high-grade squamous intraepithelial lesion (HSIL).MethodsThe Reid index uses four colposcopic signs (margin, color, vessel, and iodine staining). The proposed modified Reid index system specifically incorporates the location of the lesion within the transformation zone in place of iodine staining. Three hundred women with suspected or abnormal cytologies or abnormal cervicographic findings were evaluated by colposcopy, directed biopsy, and HPV testing by the Hybrid Capture II method, which detects high-risk HPV DNA types.ResultsThe sensitivity of high-risk HPV testing for detecting HSIL was 94.4%, the specificity was 65.0%, the positive predictive value was 75.5%, and the negative predictive value was 91.0%. The results of the colposcopic impression using the modified Reid index were superior to HPV testing. The sensitivity, specificity, positive predictive value, and negative predictive value of the colposcopic impression for detecting HSIL were 91.3, 92.9, 93.6, and 90.3% respectively.ConclusionThese results strongly indicate that the modified Reid index can accurately predict the histologic grade of squamous intraepithelial lesions of the cervix and can be applied easily and objectively in clinical practice without affecting the diagnostic accuracy of the traditional Reid index.

Vaginal evisceration after total laparoscopic radical hysterectomy in cervical cancer

A 50-year-old woman came to the emergency department with vaginal evisceration that occurred 7 months after a total laparoscopic radical hysterectomy. Vaginal evisceration was repaired by a laparoscopic-vaginal approach without a laparotomy. This is the first report of vaginal evisceration after a total laparoscopic radical hysterectomy.

A case of uterine pseudoaneurysm combined with gestational trophoblastic disease in a 30-year-old woman

Abstract Uterine artery pseudoaneurysm is a rare disease and it can be diagnosed using conventional doppler ultrasongraphy. Damaged uterine arteries from cesarean section, myomectomy, dilatation & curettage, etc. are known as causes of the disease. Massive bleeding in the rupture can cause fatal result. We observed an increase in β-hCG and uterine artery pseudoaneurysm a year after the performance of dilatation & curettage for hydatidiform mole and treated it with arterial embolization and chemotherapy. We report the case and give a brief review of the literature.

Abstract 496: Enhance efficacy of photodynamic therapy in combination with selenium in TC-1 animal model

Proceedings: AACR 101st Annual Meeting 2010‐‐ Apr 17‐21, 2010; Washington, DCnnPhotodynamic therapy (PDT) is a promising cancer treatment modality that involves the interaction of the photosensitizer, molecular oxygen and light of specific wavelength to destroy tumor cells. To improve efficacy of PDT, the efforts are underway to develop combination protocols. Selenium is an essential trace element and has anticarcinogenic properties on a various human cancer model. The aim of this study was to investigate the synergetic anti-tumor effects of PDT plus selenium in vitro and in vivo.nnTo compare the anti-proliferative effects by PDT, Selenium, or PDT plus selenium, MTT assay, microscopic observation and FACS analysis were performed. Apoptosis signaling pathways were analyzed using mouse signal transduction pathwayRT profiler PCR array (Superarray). For the vivo study, when tumor size was approximately 8 to 10 mm, Radachlorin (10mg/kg b.w.) was injected in to the tail vein at 3 hrs before irradiation with 100 J/cm2 of light and then selenium (1ug/kg b.w) was administrated daily during 20 days.nnOur results demonstrate that combination of selenium with PDT strongly inhibits growth of TC-1 cell and tumor in TC-1 cell implanted mice when compared to the other groups. Moreover, PDT and selenium treatment in TC-1 cells had apoptosis features in microscope and FACS analysis. Increased apoptosis was associated with tumor inhibition in the combination therapy group. In signal transduction pathway Superarray, genes closely relate to NFkB, p53, and phopholipase C pathway such as vcam1, mdm2, and fos were very significantly down-regulated at least 10 fold in TC-1 cell following co-treatment of PDT and selenium. Furthermore, anti-apoptosis related genes and tumor-promoting genes, birc2, birc3, hk2, ccl2, ptgs2, wisp1, mmp10 and wisp1 were also significantly down-regulated. Up-regulated genes by co-treatment of PDT and selenium had relatively low ranges of fold change than fold range of down-regulated genes and were related with cell survival and proliferation mechanism.nnThese data indicate that combination therapy of selenium and PDT could more effectively induce tumor suppression response compared to PDT or Selenium alone. We suggest that combination therapy using PDT and selenium can be a useful to for inducing synergistic anticancer effect.nnNote: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.nnCitation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 496.