Conservative management of cervical pregnancy with H2O2 irrigation of cervical canal / 대한산부인과학회지

Prevent vaginal bleeding before and after conservative management of cervical pregnancy is the important part of the treatment. We can choose two methode for the conservative management of cervical pregnancy. One is curettage and bleeding control, and the other is using fetocidal agent. Most frequently used fetocidal agent is methotrexate. But additional treatment would be needed after single dose of MTX, and for multiple dosage of MTX, one should be hospitalized about 7 to 10 days. We have used H2O2 intracervical irrigation through enema syringe for conservative management of cervical pregnancy, which is very useful and has no risk of consequent bleeding. So we report it with brief review of literatures.

Fat Myringoplasty Trimmed with CO2 Laser / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fat myringoplasty is a simple and safe method for repairing tympanic membrane perforation. The purpose of this study was to investigate the effect of fat myringoplasty accompanied by CO2 laser treatment for the trimming of perforation. MATERIALS AND METHOD: Twenty-one patients diagnosed with the following tympanic membrane perforations were used: 1) Traumatic perforation, 2) Chronic otitis media without active inflammation, 3) Re-perforation after middle ear surgery. The procedure was performed at OPD under local anesthesia while operating a microscope that was adapted to the CO2 laser. RESULTS: The overall success rate was 81 percent (17/21). CONCLUSION: Fat myringoplasty can be recommended for repairing tympanic membrane perforation in traumatic, chronic otitis media and re-perforation after middle ear surgery. Fat myringoplasty was simple and effective on only small perforations (

Suppressive Effects of Antioxidant DA-9601 on Hepatic Fibrosis in Rats / 대한간학회지

BACKGROUND/AIMS: Oxidative stress is one of the important underlying mechanisms of hepatic fibrosis. DA-9601, the ethanol extracts of Artemisia asiatica, has been reported to possess strong antioxidative and cytoprotective actions. We tried to evaluate whether antioxidant can ameliorate dimethylnitrosamine (DMN)-induced hepatic fibrosis. METHODS: Rat hepatic fibrosis was induced by intraperitoneal administrations of 10 mg DMN six times. Additionally, rats of one group were started daily with DA-9601 30 mg/kg containing diets and another group was fed a pellet diet containing DA-9601 100 mg/kg. The immunohistochemical studies for collagen, alpha-smooth muscle actin (alpha-SMA), and fibronectin, the measurements of hepatic malondialdehyde (MDA) and collagens, and the changes of liver function profiles were performed. Hepatic stellate cells (HSC) were isolated and in vitro effects of DA-9601 on HSC activations were measured. RESULTS: DA-9601 significantly attenuated the loss of body weights (p<0.05), the reduction of liver wet weights (p<0.05), and the elevation of liver enzymes provoked by DMN administrations. DMN injections caused the severe fibrosis of portal tract, hepatic inflammation, and significant oxidative damages, but DA-9601 treatment significantly reduced the mean scores of hepatic fibrosis, the amounts of hepatic collagens, and hepatic MDA levels. The prominent decreases in the expressions of collagens type I and III, alpha-SMA, and fibronectin or hepatic inflammations were observed in DA-9601-treated groups dose-dependently and similar efficacy was also proven in in vitro HSC experiment. CONCLUSIONS: DA-9601 effectively protected rat liver tissues against the DMN-induced hepatic fibrosis. Antioxidant could be considered as a supplementary therapeutic for alleviating the hepatic fibrosis.

Assessment of Pelvic Floor Muscle Exercise using Vaginal Cone in Stress Urinary Incontinence of Korea Women / 대한산부인과학회잡지

Defective or inadequate pelvic floor function is important etiologic factor for urinary stress incontinence and uterine prolapse. Pelvic floor muscle exercise is the mainstream of the nonoperative treatment for female stress urinary incontinence. Especially Vaginal cones have been known as a simple and practical means of improving both pelvic floor muscle strength and genuine stress incontinence using biofeedback mechanism. Forty adult women suffering from mild and moderate stress incontincnce were instructed to exercise their pelvic muscles using vaginal cones. They retained cones of increasing weight in the vagina by contracting pelvic floor muscles for 15 minutes twice a day for 4 weeks. The comparison of pelvic floor muscle function before and after the exercise were assessed by the frequency of incontinence, vaginal digital palpation, vaginal pressure measurement and speculm lift test. The results were as follows; 1. The frequency of incontinence was significantly reduced after the exercise using vaginal cone (P<0.001). 2. Vaginal digital palpation score (strength of vaginal levator muscle) was significantly increased after the exercise using vaginal cone (P<0.001). 3. The vaginal pressure by perineometer was significantly increased after the exercise using vaginal cones (P<0.001). 4. The vaginal lumen during contraction was significantly narrower after the exercise using vaginal cones (P<0.001). 5. The maximal cone weight which patients could hold over 1 minute was significantly increased after the exercise using vaginal cones (P<0.001).

Temporary Indwelling of Self-expandable Metal Stent may Obviate the Need of Staged Operation for Malignant Colonic Obstruction

PURPOSE: Staged operation employing temporary enterostomy is still the standard treatment of malignant colonic obstruction (MCO). Expandable metal stent has been used for the palliation of unresectable gastrointestinal obstruction. We applied this metal stent technique to the MCO to achieve temporary alleviation of the obstruction so that the bowel preparation and one-stage operation were enabled. In this study we examined the efficacy of temporary indwelling of metal stent to obviate the need of staged operation in the treatment of MCO. METHODS: From December 1998 to January 2001, 35 MCO patients were treated. Patients had typical symptoms of colonic obstruction such as abdominal pain and distension. When they were admitted, an self-expandable metal stent was introduced under the guide of flexible colonoscopy. For three days, formal bowel preparation (both chemical and mechanical) were followed. With regard to achievement of bowel preparation, postoperative complications and hospital stay, these 35 patients were compared with control group (N=20) of patients who underwent two staged operations for MCO. RESULTS: The tumor locations were upper rectum (N=10), sigmoid colon (N=22) and left colon (N=3). Metal stent slipped off in one patient. Double contrast barium enema was possible in 34 patients. One stage operation was performed in all patients. Anastomotic complications were not observed in both groups. Intraabdominal abscess requiring reoperation was noted in one patient in each group. Wound infection was noted in 3 (8.6%) stent patients whereas 16 (80%) patients had wound complication in the control group (P<0.05). Mean hospital stay was 12.2 days in stent group and 29.4 days in control group (P<0.05). CONCLUSIONS: Even though our series is limited in patient number, these data suggested that temporary indwelling of self-expandable metal stent may obviate the need of staged operation in the treatment of MCO.

A Case of Behcet's Disease with Multiple Ileocecal Ulcerations / 대한소화기내시경학회지

Behcet's disease is a chronic inflammatory symptom complex consisting of recurrent aphthous sttomatitis, nonspectific ulcerative lesions of the genital area, and uveitis. Skin, cardiovascular, arthritic, central nerve system and gastrointestinal involvement have been reported in association with the major triad. Intestinal involvement in Behcets disease most commonly affects the ileocecal region as ulceration. Intestinal ulcers give rise to abdominal pain, perforation, melena, and tumor in order of frequency. A 36-year-old female patient was addmitted to this hospital because of right upper quadrent abdominal pain and mass. There was a history of recurrent aphthous stomatitis and vaginal ulcers. Barium enema showed that the terminal ileum was irregularly indented with multiple nodular filling defects and the proximal ascending colon around ileocecal valve had several round shaped filling defects. Colonoscopy showed that the terminal ileum was irregularly marginated geographic ulcer, surrounded with hyperemic edematous mucosa, extended to ileoeecal valve. And the proximal ascending colon around ileocecal valve revealed several discreted whitish patched ulcers with apparently normal intervening mucosa. She was operated with right hemicolectomy and end to end ileotransverse colostomy under the impression of inttinal-Behcets disease. About 1 year after operation, right upper quardrent abdominal pain was reappeared. Colonoscopy was performed and revealed a recurred ulcer at anastomotic site. We report a case of Behcet's disease with multiple ileocecal ulcers, recurred after operation.