A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain.

BACKGROUND: This study aimed to compare single-port transumbilical total laparoscopic hysterectomy (SPLS-TLH) and four-port total laparoscopic hysterectomy (TLH) in terms of postoperative pain. METHODS: The study enrolled 68 patients who underwent TLH from October 2009 to March 2010 and randomly assigned them to one of two groups. Patient demographics, operative outcomes, and postoperative pain were prospectively examined. RESULTS: Four cases in the SPLS-TLH group were converted to other laparoscopic approaches. The two study groups did not differ in terms of patient demographics and surgical outcomes. Postoperative pain scores, measured using a visual analog scale, did not differ between the two groups. However, significantly higher total requests for analgesics were observed in the SPLS-TLH group (11.3 ± 4.1 vs. 7.7 ± 2.7; p < 0.001). CONCLUSION: Compared with four-port TLH, SPLS-TLH is a feasible approach with comparable operative outcomes. However, reduction of postoperative pain is not evident with SPLS-TLH.

Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes.

OBJECTIVE: The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH). STUDY DESIGN: We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar. RESULTS: The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance. CONCLUSION: SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.

CD133+/C-kit+Lin- endothelial progenitor cells in fetal circulation demonstrate impaired differentiation potency in severe preeclampsia.

OBJECTIVES: Individuals delivered from preeclamptic pregnancies exhibit a long-term increased risk of developing cardiovascular and metabolic diseases, likely caused by aberrant fetal cell reprogramming incurred in utero. The present study investigated the functional impairment and epigenetic changes exhibited by endothelial progenitor cells derived from offspring born to preeclamptic pregnancies. STUDY DESIGN: The capacity of CD133+/C-kit+/Lin- (CKL-) human umbilical cord blood endothelial progenitor cells (EPCs) derived from gestationally matched normal and preeclamptic (n = 10 each) pregnancies to differentiate to form outgrowth endothelial cells (OECs) was assessed by observing both their morphology, and the number and size of generated OECs colonies. Likewise, OECs angiogenic function was evaluated via migration, adhesion, and tube-formation assays. EPCs from preeclampsia were cultured in normal-, and preeclampsia-derived serum-conditioned media to assess the effects of environmental factors on EPC differentiation potency and OEC angiogenic function, and finally, EPCs H3K4, H3K9, and H3K27 trimethylation levels were assayed. RESULTS: The preeclampsia-derived CKL- EPCs exhibited decreased H3K4 and H3K9 trimethylation levels, significantly delayed differentiation times, and a significant reduction in both their number of generated OECs colonies, and exhibited reduced OECs migration, adhesion, and tube formation activities compared to those achieved by the normal-derived EPCs. Interestingly, the reduced differentiation potency of the preeclampsia-derived EPCs was not rescued via exposure to normal serum. CONCLUSIONS: Exposure to preeclampsia significantly and irreversibly reduced CKL- EPC differentiation potency and OEC angiogenic function, likely reflecting incurred irreversible epigenetic changes.

Episiotomy and the risk of severe perineal injuries among Korean women.

PURPOSE: We examined the frequency of severe perineal injuries according to the use of episiotomy in vaginal deliveries of Korean women. MATERIALS AND METHODS: This is a retrospective cohort study in which 358 consecutive parturients were included. Women were divided into episiotomy (n = 115) and no episiotomy (n = 243) groups. The main outcome was the occurrence of severe (third or fourth degree) perineal injuries. Delivery records and medical documents were reviewed to collect the data. Parametric and nonparametric tests were used as appropriate. RESULTS: There were no significant differences in the frequency of severe perineal injuries between two groups (6.1% (7/115) in episiotomy versus 3.7% (9/243) in no episiotomy group, p = 0.308). Anterior perineal laceration was more frequent (40.3% (98/243) vs. 18.3% (21/115), p < 0.001), but intact perineum was found in 15.6% (38/243) of women in no episiotomy group. Logistic regression analysis was performed to evaluate independent risk factors in the occurrence of severe perineal injuries including maternal age, parity, performance of episiotomy, head position at delivery, length of second stage of labor, birth weight, head circumference, and the use of vacuum during delivery. Only birthweight was a significant factor in predicting severe perineal injuries, and performance of episiotomy did not increase nor decrease the risk of severe perineal injury. CONCLUSIONS: There was no difference in the occurrence of severe perineal injuries according to the use of episiotomy.

Estrogen-induced acute pancreatitis: A case report and literature review.

Estrogens are commonly used in gynecologic area, such as oral contraception, hormone replacement therapy, and in vitro fertilization-embryo transfer. Although estrogen is a common cause of acute drug-induced pancreatitis, there has been paucity of report in Korea. Clinical course of estrogen-induced acute pancreatitis is usually mild to moderate, but fetal case can occur. In addition, there can be a latency from the first administration to the symptom. Therefore, physicians should consider the possibility of the disease when a woman taking estrogen or previous history of taking estrogen presents with acute abdominal pain. Here, we report a case of estrogen-induced acute pancreatitis that occurred during the preparation for embryo transfer.

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines.

OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.