Indocyanine Green-Loaded PLGA Nanoparticles Conjugated with Hyaluronic Acid Improve Target Specificity in Cervical Cancer Tumors

Purpose@#Indocyanine green (ICG) is a promising agent for intraoperative visualization of tumor tissues and sentinel lymph nodes in early-stage gynecological cancer. However, it has some limitations, including a short half-life and poor solubility in aqueous solutions. This study aimed to enhance the efficacy of near-infrared (NIR) fluorescence imaging by overcoming the shortcomings of ICG using a nano-drug delivery system and improve target specificity in cervical cancer. @*Materials and Methods@#ICG and poly(lactic-co-glycolic acid) (PLGA) conjugated with polyethylenimine (PEI) were assembled to enhance stability. Hyaluronic acid (HA) was coated on PEI-PLGA-ICG nanoparticles to target CD44-positive cancer cells. The manufactured HA-ICG-PLGA nanoparticles (HINPs) were evaluated in vitro and in vivo on cervical cancer cells (SiHa; CD44+) and human dermal cells (ccd986sk; CD44-), respectively, using NIR imaging to compare intracellular uptake and to quantify the fluorescence intensities of cells and tumors. @*Results@#HINPs were confirmed to have a mean size of 200 nm and a zeta-potential of 33 mV using dynamic light scattering. The stability of the HINPs was confirmed at pH 5.0–8.0. Cytotoxicity assays, intracellular uptake assays, and cervical cancer xenograft models revealed that, compared to free ICG, the HINPs had significantly higher internalization by cervical cancer cells than normal cells (p<0.001) and significantly higher accumulation in tumors (p<0.001) via CD44 receptor-mediated endocytosis. @*Conclusion@#This study demonstrated the successful application of HINPs as nanocarriers for delivering ICG to CD44-positive cervical cancer, with improved efficacy in NIR fluorescence imaging.

Indocyanine Green-Loaded PLGA Nanoparticles Conjugated with Hyaluronic Acid Improve Target Specificity in Cervical Cancer Tumors

Purpose@#Indocyanine green (ICG) is a promising agent for intraoperative visualization of tumor tissues and sentinel lymph nodes in early-stage gynecological cancer. However, it has some limitations, including a short half-life and poor solubility in aqueous solutions. This study aimed to enhance the efficacy of near-infrared (NIR) fluorescence imaging by overcoming the shortcomings of ICG using a nano-drug delivery system and improve target specificity in cervical cancer. @*Materials and Methods@#ICG and poly(lactic-co-glycolic acid) (PLGA) conjugated with polyethylenimine (PEI) were assembled to enhance stability. Hyaluronic acid (HA) was coated on PEI-PLGA-ICG nanoparticles to target CD44-positive cancer cells. The manufactured HA-ICG-PLGA nanoparticles (HINPs) were evaluated in vitro and in vivo on cervical cancer cells (SiHa; CD44+) and human dermal cells (ccd986sk; CD44-), respectively, using NIR imaging to compare intracellular uptake and to quantify the fluorescence intensities of cells and tumors. @*Results@#HINPs were confirmed to have a mean size of 200 nm and a zeta-potential of 33 mV using dynamic light scattering. The stability of the HINPs was confirmed at pH 5.0–8.0. Cytotoxicity assays, intracellular uptake assays, and cervical cancer xenograft models revealed that, compared to free ICG, the HINPs had significantly higher internalization by cervical cancer cells than normal cells (p<0.001) and significantly higher accumulation in tumors (p<0.001) via CD44 receptor-mediated endocytosis. @*Conclusion@#This study demonstrated the successful application of HINPs as nanocarriers for delivering ICG to CD44-positive cervical cancer, with improved efficacy in NIR fluorescence imaging.

Scheduled injection of ramosetron for prevention of nausea and vomiting following single-port access total laparoscopic hysterectomy: a prospective randomized study

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of scheduled ramosetron injections for controlling postoperative nausea and vomiting (PONV) after single-port access total laparoscopic hysterectomy (SPA-TLH). METHODS: Ninety patients who underwent SPA-TLH at the Korean National Health Insurance Service Ilsan Hospital between June 2013 and July 2014 were enrolled in this prospective, randomized, double-blinded, placebo-controlled study. The patients were divided into 2 groups as follows: the ramosetron group (0.3 mg intravenously [IV]; n=45) and the placebo group (normal saline IV; n=45). Both groups received their respective injections 12 and 24 hours post surgery. The incidence and severity of PONV (numerical rating scale, 0–10), and the use of rescue antiemetics post surgery were evaluated. RESULTS: Demographic and perioperative statistically significant differences were not observed between the 2 groups. The incidence of PONV in the ramosetron and placebo groups was 46.7% and 51.1%, respectively (P=0.51). We found significant differences in the severity of PONV between the 24- to 48-hour postoperative periods in both groups (ramosetron group, P=0.04 and placebo group, P=0.03). The use of rescue antiemetics was significantly lower in the ramosetron group than in the placebo group (P=0.02). CONCLUSION: After general anesthesia, scheduled injections of ramosetron 12 and 24 hours after SPA-TLH reduced the severity of PONV and the use of rescue antiemetics. Administration of ramosetron can be considered not only immediately after SPA-TLH but also during the first 24-hour recovery period. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT 02011659

The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Bone Mineral Density in Korean Postmenopausal Women / 전남의대학술지

The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are known to be markers of the systemic inflammatory response. However, the few studies that have been done on the relationship between the NLR and PLR and osteoporosis have yielded inconsistent results. Therefore, we assessed the relationship between the NLR and PLR and bone mineral density (BMD). This study was conducted with postmenopausal patients admitted to an orthopaedic hospital. Data including BMD, NLR, PLR and covariates were obtained from the subjects' medical records. In total, 407 postmenopausal patients were enrolled in this study. Analysis of covariance was performed to identify significant differences in BMD according to NLR and PLR. After adjusting for other covariates, a quartile of NLR was negatively associated with the mean value of lumbar BMD (p=0.040, p for trend=0.005) but not with the mean value of femur neck BMD. However, there were no significant associations among the PLR, the BMD of the lumbar and the femur neck. In conclusion, the quartile of NLR was negatively associated with the mean value of lumbar BMD in Korean postmenopausal patients.

Comparison of the clinical outcome of frozen-thawed embryo transfer with and without pretreatment with a gonadotropin-releasing hormone agonist

OBJECTIVE: To describe the clinical outcomes of frozen-thawed embryo transfer (FET) with artificial preparation of the endometrium, using a combination of estrogen (E2) and progesterone (P4) with or without a gonadotropin-releasing hormone agonist (GnRHa), and the modified natural cycle (MNC) with human chorionic gonadotropin (hCG) trigger. METHODS: In this retrospective study, we evaluated 187 patients during 3 years (February 2012–April 2015). The patients were allocated to the following treatment groups: group A, comprising 113 patients (181 cycles) who received GnRHa+E2+P4; group B, comprising 49 patients (88 cycles) who received E2+P4; and group C, comprising 25 patients (42 cycles) who received hCG+P4. The inclusion criteria were regular menstrual cycles (length 24–35 days) and age 21–45 years. RESULTS: The primary outcome of the study — implantation rate (IR) per embryo transferred — was not statistically different among the 3 groups. Similar results were found for the IRs with fetal heartbeat per embryo transferred (68/181 [37.6%] in group A vs. 22/88 [25.0%] in group B vs. 14/42 [33.3%] in group C) and for the live birth rates (LBRs) per embryo transferred (56/181 [30.9%] in group A vs. 18/88 [20.5%] in group B vs. 11/42 [26.2%] in group C). CONCLUSION: Although the pregnancy outcomes were better in the hormone therapy with GnRHa group, hormone therapy FET with GnRHa for pituitary suppression did not result in significantly improved IRs and LBRs when compared with hormone therapy FET without GnRHa or MNC FET.

Securing patient access to new medical technology under the diagnosis-related group system in South Korea: a review of foreign policies and selective reimbursement coverage programs for 4 major conditions

The Korean government operates a fee-for-service system, as well as a diagnosis-related group (DRG) payment system that only applies to 7 different specific disease groups. To control rapidly increasing health expenditures, the Korean government adopted a compulsory DRG payment system for 7 disease groups in 2013. However, the current Korean DRG (K-DRG) system does not address the cost of new medical technologies and accompanying services, whereas the United States and European countries have implemented incentive systems within the DRG payment system to promote technological innovations. The Korean government is expanding the accessibility of new medical technologies to strengthen the coverage of 4 major conditions with a selective reimbursement system, but the K-DRG system is inconsistent with the selective reimbursement system in terms of adopting new medical technology. Such inconsistency is clearly shown in the case of advanced energy devices that are essential for surgical procedures. Despite their clinical usefulness and the high demand for such instruments, there is little space for compensation for advanced energy devices in DRG groups. Neither healthcare providers nor patients can choose selectively reimbursed medical devices under the current DRG system, leading to unequal healthcare benefits among patient groups. This paper proposes additional payments for new medical technology that is costly but clinically effective to ensure patient access to new medical technology under the K-DRG system, and suggests that a fair and consistent policy would be to apply the selective reimbursement of medical services in K-DRG.

Securing patient access to new medical technology under the diagnosis-related group system in South Korea: a review of foreign policies and selective reimbursement coverage programs for 4 major conditions

The Korean government operates a fee-for-service system, as well as a diagnosis-related group (DRG) payment system that only applies to 7 different specific disease groups. To control rapidly increasing health expenditures, the Korean government adopted a compulsory DRG payment system for 7 disease groups in 2013. However, the current Korean DRG (K-DRG) system does not address the cost of new medical technologies and accompanying services, whereas the United States and European countries have implemented incentive systems within the DRG payment system to promote technological innovations. The Korean government is expanding the accessibility of new medical technologies to strengthen the coverage of 4 major conditions with a selective reimbursement system, but the K-DRG system is inconsistent with the selective reimbursement system in terms of adopting new medical technology. Such inconsistency is clearly shown in the case of advanced energy devices that are essential for surgical procedures. Despite their clinical usefulness and the high demand for such instruments, there is little space for compensation for advanced energy devices in DRG groups. Neither healthcare providers nor patients can choose selectively reimbursed medical devices under the current DRG system, leading to unequal healthcare benefits among patient groups. This paper proposes additional payments for new medical technology that is costly but clinically effective to ensure patient access to new medical technology under the K-DRG system, and suggests that a fair and consistent policy would be to apply the selective reimbursement of medical services in K-DRG.

Post Traumatic Stress and Related Factors in Some Hand Replantation Patients

BACKGROUND: The risk for a hand injury was increased according to industrial structure and lifestyle change. This study investigated the post traumatic stress (PTS) and related factors in some hand replantation patients. METHODS: Total 150 hand replantation patients in one hospital were selected using convenience sampling methods. General characteristics of patients, characteristics of injured hand, self-esteem and PTS were collected using self-reported questionnaires. And clinical characteristics of injured hand were obtained from a review of medical records. Descriptive analysis, t-test, ANOVA and multiple regression analysis were performed to determine the associated factors with the score of PTS. RESULTS: Among 150 patients, 80% were male and 94% had a job. The mean score of PTS was 22.2±16.9. In simple analysis, PTS score were associated with smoking status, injury day of the week, pain score and self-esteem. Finally, the subjects who injured in weekdays had significantly higher PTS score compared to subjects who injured in weekend (β=0.185, P=0.021) and pain score was positively associated with PTS score (β=0.181, P=0.027) in multiple regression analysis. CONCLUSIONS: Injury day of the week and pain score were associated with PTS score in some hand replantation patients. Considering these results will help to management and improve quality of life of hand replantation patients.

Knowledge of HPV and Surgery among Women Who Underwent Cervical Conization: A Korean Multi-Center Study

PURPOSE: Human papillomavirus (HPV) infection is a well-known cause of cervical cancer, which, along with its precursors, can be diagnosed and treated with cervical conization (CC). This study aimed to assess HPV- and procedure-related knowledge among women who had undergone CC. MATERIALS AND METHODS: Between February and May 2014, consecutive women who had undergone CC at five different educational hospitals were recruited. All patients had undergone a loop electrosurgical excision procedure as the method of CC. A survey was conducted with a self-developed, 29-item questionnaire, measuring knowledge related to HPV and CC. We analyzed the responses of 160 patients who completed the questionnaire. RESULTS: Mean total knowledge scores (±standard deviation) for HPV and CC were 5.2±3.0 of a possible 13.0 and 8.3±4.2 of a possible 16.0, respectively. While 73% of the patients knew that HPV is the main cause of cervical cancer, only 44% knew that HPV is sexually transmitted. The purpose of CC was correctly identified by 71% of the patients. However, 35% failed to indicate the anatomical area resected at the time of CC in the schematic diagram. Women who were younger (p<0.001), had higher education level (p<0.001), and higher family income (p=0.008) had higher knowledge scores. In contrast, neither interval from CC to survey nor disease severity were associated with total knowledge score. CONCLUSION: The level of knowledge related to HPV and CC was unexpectedly low in women who had undergone CC. Intuitive educational resources may improve this knowledge, and further cohort studies are warranted.

Current Status and Availability of Specialized Maternity Non-Standard Room for Delivering Mothers / 대한주산의학회잡지

PURPOSE: Demand of specialized maternity ward is increasing as national income level rises. However, the National Health Insurance limits the number of hospital's non-standard room to less than 50% of total hospital beds. Therefore, this research was performed to investigate the utilization rate of non-standard room among the Korean women who recently delivered baby in medical facilities in order to examine the factors affecting their selection. METHODS: One hundred sixty six medical facilities which deliver a minimum of ten cases in 2011 were selected and categorized by type, region, and size. A cross-sectional survey was done in November 2012 by a professional research survey company. Eight hundred and two pregnant women answered the questionnaire through a face-to-face interview. RESULTS: Of the 802 expecting mothers, 690 (86%) occupied non-standard room and 684 (85.2%) preferred non-standard room to the standard room. Satisfaction levels were significantly higher in mothers occupying non-standard room [5.9+/-1.0 vs. 5.4+/-1.2 (0-7 scale), P<0.01] and high-income families used non-standard room more often. Reasons for using non-standard room included adequate convalescence (78%), separate place for breastfeeding (6.1%), and convenience on receiving visitors (5.4%). Preference for non-standard room on next visit was higher in case of delivery compared to other cause of hospitalization (81.8% vs. 44.9%, P<0.001). CONCLUSIONS: Preference and actual use of non-standard room after delivery were significant. In spite of concrete preference, there was certain barrier in use of non-standard room according to the income and types of hospitals. Therefore, changes of policy such as insurance support for room charge may be needed in case of delivery.

Comparison of Obstetric and Neonatal Outcomes According to Oral Glucose Challenge Test in Korean Pregnant Women / 대한주산의학회잡지

PURPOSE: The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution. METHODS: One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM ; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups. RESULTS: Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P<0.01, and 1.9% vs.5.5% vs. 13.5%, P<0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P<0.01, and 12.3% vs. 24.2% vs. 38.5%, P<0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia. CONCLUSION: GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.

Robotic single-port transumbilical total hysterectomy: a pilot study / 부인종양

OBJECTIVE: To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system. METHODS: We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and two 8 mm trocars. RESULTS: Seven patients were treated with robotic single-port transumbilical total hysterectomy. Procedures included total hysterectomy due to benign gynecological disease (n=5), extra-fascial hysterectomy due to carcinoma in situ of the cervix (n=1), and radical hysterectomy due to cervical cancer IB1 (n=1). The median total operative time was 109 minutes (range, 105 to 311 minutes), the median blood loss was 100 mL (range, 10 to 750 mL), and the median weight of the resected uteri was 200 g (range, 40 to 310 g). One benign case was converted to 3-port robotic surgery due to severe pelvic adhesions, and no post-operative complications occurred. CONCLUSION: Robotic single-port transumbilical total hysterectomy is technically feasible in selected patients with gynecological disease. Robotics may enhance surgical skills during single-port transumbilical hysterectomy, especially in patients with gynecologic cancers.

Pap smear screening for small cell carcinoma of the uterine cervix: a case series and review of the literature / 부인종양

OBJECTIVE: Small cell carcinoma of the uterine cervix (SMCC) is extremely rare, and an aggressive disease that proliferates rapidly. It was often reported that the diagnostic accuracy of cytologic smears in diagnosing SMCC was low. This is a report of the Severance Hospital experience with the patients suffering from SMCC. METHODS: Twenty-seven patients with small cell carcinoma of the uterine cervix were diagnosed and treated at the Severance Hospital from November 1991 to January 2010. The data were analyzed retrospectively, based on the available charts and pathology reports. Various fields, such as chief complaints and symptoms present at first clinic visit, age, International Federation of Obstetrics and Gynecology (FIGO) clinical stage, treatment modality, the 5-year overall survival rate, and recurrence rate were investigated. RESULTS: Among the 27 patients diagnosed with small cell carcinoma of the uterine cervix, 18 of them (66.7%) presented with symptoms, including vaginal bleeding, at the first clinic visit, and the remaining 9 patients (33.3%) showed abnormal Pap smear screening in the process of their routine health check-up. The median age of the patients was 54 years (range, 24 to 77 years). FIGO stage IIB was the most common stage (11 of 27 patients). The 5-year overall survival rate of 21 patients, who could be followed up, was 57.2%. Six patients showed recurrence after remission, and the mean disease free interval of them was 9.2 months (range, 6 to 11 months). Abnormal Pap smear screening results of 9 patients was investigated, and the diagnostic accuracy of the cytologic findings was 22.2%. CONCLUSION: Our study was consistent with the concept that Pap smear screening might not be helpful in early diagnosis of SMCC considering its low diagnostic accuracy. Further large-scale multicenter prospective studies are definitely needed in order to produce abundant information about optimal therapy and diagnosis.

Acute toxicity of cyclooxygenase-2 inhibitor rofecoxib as a radiosensitizer for concurrent chemoradiation in the treatment of uterine cervical cancer / 부인종양

OBJECTIVE: To evaluate the acute toxicity of rofecoxib during concurrent use with cisplatin-based chemoradiotherapy (CCRT) in patients with cervical cancer. METHODS: We evaluated 67 FIGO stage IB2-IVA cervical cancer patients treated with CCRT between June 2002 and July 2004. The study group included patients who received rofecoxib (N=30) and the control group included patients who received CCRT only (N=37). The patients' medical records were retrospectively reviewed for patient characteristics, toxicity related to CCRT and treatment results. RESULTS: There were no significant differences in toxicity between the two groups. The most common acute grade 3/4 toxicity was neutropenia (13.3% in the study group and 21.6% in the control group). Grade 3/4 late toxicity was observed in 2 (6.6%) patients in the study group and 3 (8.1%) in the control group. There was no treatment-related deaths in either group. Six (20.0%) patients in the study group had treatment failure. In the control group, 6 (16.2%) patients experienced treatment failure. Progression-free and overall survival was 55.8+/-4.2 and 59.0+/-2.8 months, respectively, in the study group, and 69.7+/-4.3 and 71.6+/-3.6 months, respectively, in the control group. There were no differences in progression-free and overall survival between the 2 groups. CONCLUSION: Our data indicate that rofecoxib, at a dose of 25 mg twice daily, has acceptable acute toxicity as a radiosensitizer during CCRT. Although rofecoxib was not efficacious as a radiosensitizer in the present study, the benefit of rofecoxib as a radiosensitizer should be further evaluated in a prospective study.

Transumbilical single port total laparoscopic hysterectomy / 대한산부인과학회지

Laparoscopic hysterectomy is currently considered the standard procedure in many patients who need hysterectomy. To reduce incisional morbidity and improve cosmetic outcomes we performed transumbilical single-port total laparoscopic hysterectomy using a special "single three-channel port" and standard laparoscopic tools with virtually no scar. We used an Alexis wound retractor (Applied Medical, CA, USA) and a surgical glove as the "single three-channel port". In this paper, we report four cases of total laparoscopic hysterectomy performed exclusively through an umbilical incision using a single three-channel port.

Comparison of modified Cherney incision and vertical midline incision for management of early stage cervical cancer / 부인종양

OBJECTIVE: The aim of this study was to compare operative feasibility and surgical outcome of the modified Cherney incision and vertical midline incision in patients undergoing radical hysterectomy and pelvic lymphadenectomy. METHODS: Between March 2005 and December 2007, retrospective data of 78 patients (n=17; modified Cherney incision, n=61; vertical midline incision) with early stage cervical cancer who received radical hysterectomy and pelvic lymphadenectomy were reviewed. RESULTS: Baseline characteristics of patients who underwent modified Cherney incision and vertical midline incision were similar except for age (mean+/-SD: 32.3+/-3.4 yr vs. 52.5+/-8.4 yr, p<0.001). Patients who received modified Cherney incision had earlier initiation of soft diet (mean+/-SD: 46.5+/-19.5 hr vs. 56.4+/-25.4 hr, p<0.016) and shorter hospital stay compared to those who received vertical midline incision (mean+/-SD: 18.0+/-4.8 days vs. 21.7+/-3.7 days, p<0.042). There was no difference in the number of dissected pelvic lymph nodes, hemoglobin change, postoperative pain, postoperative ileus, Foley indwelling duration, and perioperative complications. CONCLUSION: Excluding the selection bias for age, there was no significant difference of the clinical outcome between the modified Cherney incision group and the vertical midline incision group. Modified Cherney incision can be cosmetically performed in young age women obtaining equal number of lymph nodes without increased operative morbidity compared to vertical midline incision.

Comparison of modified Cherney incision and vertical midline incision for management of early stage cervical cancer / 부인종양

OBJECTIVE: The aim of this study was to compare operative feasibility and surgical outcome of the modified Cherney incision and vertical midline incision in patients undergoing radical hysterectomy and pelvic lymphadenectomy. METHODS: Between March 2005 and December 2007, retrospective data of 78 patients (n=17; modified Cherney incision, n=61; vertical midline incision) with early stage cervical cancer who received radical hysterectomy and pelvic lymphadenectomy were reviewed. RESULTS: Baseline characteristics of patients who underwent modified Cherney incision and vertical midline incision were similar except for age (mean+/-SD: 32.3+/-3.4 yr vs. 52.5+/-8.4 yr, p<0.001). Patients who received modified Cherney incision had earlier initiation of soft diet (mean+/-SD: 46.5+/-19.5 hr vs. 56.4+/-25.4 hr, p<0.016) and shorter hospital stay compared to those who received vertical midline incision (mean+/-SD: 18.0+/-4.8 days vs. 21.7+/-3.7 days, p<0.042). There was no difference in the number of dissected pelvic lymph nodes, hemoglobin change, postoperative pain, postoperative ileus, Foley indwelling duration, and perioperative complications. CONCLUSION: Excluding the selection bias for age, there was no significant difference of the clinical outcome between the modified Cherney incision group and the vertical midline incision group. Modified Cherney incision can be cosmetically performed in young age women obtaining equal number of lymph nodes without increased operative morbidity compared to vertical midline incision.

A case of ultrasound-guided cyst aspiration and sclerotherapy for the management of intractable pelvic pseudocyst / 대한산부인과학회지

Patients who underwent laparotomy often experience recurrent pelvic pseudocysts and they may need to undergo another laparotomy. Nowadays, many less invasive techniques such as the use of ultrasound-guided aspiration of pelvic pseudocysts and sclerotherapy were developed and were replacing laparotomy. We report a case of intractable pelvic pseudocyst treated successfully with ultrasound-guided cyst aspiration and sclerotherapy using acetic acid with a brief review of literature.