BACKGROUND: Laparoscopy with peritoneal carbon dioxide insufflation is a standard procedure in many gynecological departments. And more prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. Despite laparoscopic operations have many advantages, peritoneal insufflation of CO2 to create the pneumoperitoneum necessary for laparoscopy induces intraoperative hemodynamic changes that complicate anesthetic management of laparoscopy.The purpose of this study is to evaluate the effect of general anesthesia on hemodynamics during loparoscopic hysterectomy. METHODS: Twenty six women undergoing laparoscopic hysterectomy were randomly allocated to either a propofol (Group 1, n=13) intravenous anesthesia or a enflurane (Group 2, n=13) anesthesia with fentanyl-N2O/O2-vecuronium. Hemodynamic parameters were measured before induction (T1), 5 min after induction (T2), 5 min after head-down (T3), 5, 10, 15, 20 min after pneumoperitoneum (T4, T5, T6, T7), 5, 10 min after deflation (T8, T9). The MAP, HR, CI, SVRI, SI were measured by transthoracic electrical bioimpedence method and automated blood pressure device. RESULTS: The mean arterial pressure were increased during pneumoperitonem in both groups and heart rate were increased in Group 2. The cardic index were decreased in both groups after induction by 27.4 % in Group 1 and 25.7% in Group 2. The systemic vascular resistanace index were increased in both groups from head-down to after deflation by 68.3% in Group 1, 73.1% in Group 2 maximally. No significant changes of stroke index were observed during surgery in Group 1. CONCLUSIONS: Laproscopy with CO2 insufflation induces significant hemodynamic changes includig increases of MAP, SVR and a reduction of CI. And usual intraoperative hemodynamic monitoring; the blood pressure and heart rate give no information on the reduction in cardic output.
Anesthesia ; Anesthesia, General* ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Enflurane ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Hysterectomy* ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Propofol ; Stroke

No abstract available.

OBJECTIVE: In our domestic market, Belotecan (Camptobel(R), chongkeundang, Korea) is newly introduced recently. Belotecan has many advantages of improved water solubility and fewer side effects like severe diarrhea or GI bleeding compare to other camptothecin derivatives. In this study, primary focus is aiming to evaluate the effectiveness of belotecan by providing the cytotoxicity and apoptotic pathway on cervical cancer cells. METHODS: Cervical cancer cell line, HeLa and Caski were used. Belotecan applied on both cell lines and checked whether it has anti tumor effect on cancer cell by using MTT assay. DNA fragmentation and western blot was performed to confirm cellular apoptosis pathway. Also cDNA microarray and RT-PCR were serially carried out in order to identify responsible genes for apoptosis. RESULT: Dose- and time- dependent inhibition of cell proliferation is noted on the Belotecan applied HeLa and CaSki cervical carcinoma cell line by MTT assay. DNA fragmentation assay showed the DNA ladder indicating apopoptosis. Also apoptotic pathway and genes that are related with Belotecan activities are identified. Apoptosis, cell cycle, and drug metabolism related gene, and DNA repair gene were found to be differently regulated by treatment of Belotecan in HeLa cells. Among the DNA repair gene, RT-PCR reconfirmed the increased expression of CIB1(Calcium and intergrin binding 1), APEX1 (APEX nuclease 1) and the decresed expression of EXO1 (Exonuclease 1), WDR33 (WD repeat domain 33), and GADD45A (Growth arrest and DNA-damage-inducible, alpha). CONCLUSION: The first domestically introduced 1st line anti- tumor agent, Belotecan shows its excellent inhibiting action on cervical cancer cell proliferation by apoptotic pathway in this study. Also genetic alterations in cDNA microarray leads to the new fact that Belotecan, as a topoisomerase I inhibitor, is not only involved with apoptotic, cell cycle-related pathway but also involved in DNA repair.
Apoptosis ; Blotting, Western ; Camptothecin ; Cell Cycle ; Cell Line* ; Cell Proliferation ; Diarrhea ; DNA ; DNA Fragmentation ; DNA Repair ; DNA Topoisomerases, Type I ; HeLa Cells ; Hemorrhage ; Humans ; Metabolism ; Oligonucleotide Array Sequence Analysis ; Solubility ; Uterine Cervical Neoplasms*

OBJECTIVE: To evaluate the usefulness of serum CA 125, CA 19-9, and eosinophil as biological markers for the diagnosis and recurrence of endometriosis. METHODS: One hundred seventeen patients who underwent operations for endometriosis between January 2000 and December 2006 at our department were included. A total of 50 reproductive aged women who visited our health care center were the control group. Data on serum level of CA 125, CA 19-9, and eosinophil was collected. Patients symptoms, sonographic findings, stage, treatment, recurrence were also collected. Venous blood sampling was performed 1 month before operation and 1 to 6 months after operation. We analyzed the serum level of CA 125, CA 19-9, and eosinophil according to the endometriosis stage and symptoms. We also analyzed the differences between preoperative and postoperative serum marker levels. RESULTS: The serum level of CA 125 and CA 19-9 was available in 88 patients and 45 patients, respectively. The mean eosinophil count was significantly lower in endometriosis group than in control group. In comparison between preoperative values and postoperative values, the CA 125 and CA 19-9 level showed significant reduction (P<0.05), however the eosinophil level showed no difference. The positive rate of serum CA 125 and CA 19-9 were 68.9% and 60.0% as a single test, whereas the combined positive rate of CA 125 and CA 19-9 was 82.2%. CONCLUSION: For the diagnosis and follow-up of endometriosis, serum CA 125 and CA 19-9 combination test will be valuable. Serum eosinophil count seems to be unsuitable for the screening and follow up test of endometriosis.
Aged ; Biomarkers ; Delivery of Health Care ; Endometriosis ; Eosinophils ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Recurrence

OBJECTIVES: To evaluate preoperative anti-Mullerian hormone (AMH) levels in women with endometrioma or other benign ovarian cysts and differences of AMH changes according to various characteristics. METHODS: Ninety-seven patients aged 20 to 39 years who underwent surgery for benign ovarian cyst were enrolled retrospectively. Of these, 65 patients were diagnosed as endometriomas, and 32 had other benign cysts. Serum AMH, mean, maximum, and total diameter of ovarian cysts were measured. The AMH levels were compared according to pathology (endometrioma vs. other benign cyst), size of ovarian cyst, age-matched AMH quartile percentile and characteristics of endometrioma. RESULTS: Preoperative serum AMH level was significantly lower in endometrioma group than other benign cyst group (4.12 +/- 2.42 ng/mL vs. 6.02 +/- 2.29 ng/mL, P < 0.001). Serum AMH level was significantly lower in endometrioma group, especially in patients aged 30 to 39 years. Dividing to age-matched AMH quartile percentile, there were significantly fewer patients with AMH level > or = 75 percentile in endometrioma group (24.6% vs. 50.0%, P = 0.035). Among 4 subgroups of endometrioma, patients with AMH level > or = 75 percentile were significantly decreased in multiple bilateral endometrioma group. Mean and total diameter of cysts were negatively correlated with preoperative serum AMH level in other benign cyst group. CONCLUSION: We suggest that preoperative AMH level measurement might be considered in women with endometrioma, especially in 30 to 39 years old, multiple bilateral type, or big-sized other benign ovarian cyst to assess the diminished ovarian reserve.
Anti-Mullerian Hormone* ; Endometriosis* ; Female ; Humans ; Ovarian Cysts* ; Pathology ; Retrospective Studies

No abstract available.
Apoptosis* ; Placenta Previa* ; Placenta*

Purpose: To identify changes in medical expenditures and health care utilization before and after visual impairment onset, then analyze differences according to visual impairment severity. Methods: Patients aged ≥ 18 years who were registered as visually disabled from 2005 to 2013 were selected using the database from the registry of the disabled and the National Health Insurance Service. The observation period of 3 years before and after the registration was divided into 6-month units (12 points of interest). At each point of interest, medical cost, number of outpatient visits, and length of hospital stay (LOS) were analyzed. The control group was obtained through 1:10 stratification randomization to match sex and age; individuals in the control group were then selected via 1:1 propensity score matching for the premium quantile and residential area. Results: In total, 131,434 patients with visual disability and the same number of non-visually impaired controls were included. Compared with non-disabled individuals, the mean medical cost and number of outpatient visits were higher for patients with visual disability (1.9- and 1.4-fold, respectively, p < 0.001); the LOS was also 3.5 days longer (p < 0.001). The mean medical cost and number of outpatient visits were greater in severely visually disabled patients than in mildly disabled patients (1.6- and 0.5-fold, respectively, p < 0.001); the LOS was also 12 days longer in severely disabled patients (p < 0.001). From 18 months before disability registration, medical costs and LOS increased according to the presence and severity of visual disability; the number of outpatient visits increased uniformly, regardless of disability and severity. Conclusions More severe cases of visual impairment are associated with greater health care utilization and expenditures. Policy intervention is necessary to ensure that patients receive appropriate treatment and steady health care by reducing the burden of medical expenditures.

OBJECTIVE: To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment). METHODS: Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need. RESULTS: The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ. CONCLUSION: The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.
Child ; Child Development ; Diagnosis ; Electroencephalography ; Humans ; Intelligence ; Language ; Language Development ; Language Development Disorders ; Linguistics ; Risk Factors ; Walking ; Weights and Measures

OBJECTIVE: To perform an in depth evaluation of children, and thus provide a systematic method of managing children, who after infantile health screening, were categorized as suspected developmental delay. METHOD: 78 children referred to the Developmental Delay Clinic of Ilsan Hospital after suspected development delay on infantile health examinations were enrolled. A team comprised of a physiatrist, pediatrician and pediatric psychiatrist examined the patients. Neurological examination, speech and cognitive evaluation were done. Hearing tests and chromosome studies were performed when needed clinically. All referred children completed K-ASQ questionnaires. Final diagnoses were categorized into specific language impairment (SLI), global developmental delay (GDD), intellectual disability (ID), cerebral palsy (CP), motor developmental delay (MD) or autism spectrum disorder (ASD). RESULTS: 72 of the 78 patients were abnormal in the final diagnosis, with a positive predictive value of 92.3%. Thirty (38.4%) of the 78 subjects were diagnosed as GDD, 28 (35.8%) as SLI, 5 (6.4%) as ASD, 9 (12.5%) as MD, and 6 (7.6%) as normal. Forty five of the 78 patients had risk factors related to development, and 18 had a positive family history for developmental delay and/or autistic disorders. The mean number of abnormal domains on the K-ASQ questionnaires were 3.6 for ASD, 2.7 for GDD, 1.8 for SLI and 0.6 for MD. Differences between these numbers were statistically significant (p<0.05). CONCLUSION: Because of the high predictive value of the K-ASQ, a detailed evaluation is necessary for children suspected of developmental delay in an infantile health promotion system.
Cerebral Palsy ; Child ; Autism Spectrum Disorder ; Health Promotion ; Hearing Tests ; Humans ; Intellectual Disability ; Mass Screening ; Neurologic Examination ; Psychiatry ; Risk Factors ; Surveys and Questionnaires

OBJECTIVE: This study was performed to evaluate the effect of body mass index (BMI) on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS). METHODS: Ninety-six patients with PCOS who completed their first cycle of IVF-ET were included in this retrospective study. All patients were stimulated by GnRH antagonist multi-dose protocol. The patients were divided into one of two groups on the basis of BMI > or =23 kg/m2 vs. BMI <23 kg/m2, and their outcome of IVF-ET was compared. Additionally the patients with BMI > or =23kg/m2 were divided into patient group with 23 < or =BMI <25 kg/m2 and patient group with BMI > or =25 kg/m2, and these three groups were also compared in regard to the outcome of IVF-ET. RESULTS: The total amount and duration of rhFSH administration were significantly higher in PCOS women with BMI > or =23 kg/m2 than in those with BMI <23 kg/m2 (P<0.001 in both). The implantation rate was significantly lower in women with BMI > or =23 kg/m2 (17.4% vs 7.8%, P=0.024). When compared three group divided on the basis of BMI <23 kg/m2 vs BMI 23~25 kg/m2 vs BMI > or =25 kg/m2, similar results were showed in women with BMI > or =25 kg/m2, although implantation rate in women with BMI > or =25 kg/m2 was lower with borderline significance (P=0.069). CONCLUSION: Obesity (BMI > or =23 kg/m2) has a detrimental effect on implantation rate and is associated with the increased total amount and duration of rhFSH administration for ovarian stimulation in IVF-ET cycle. Consequently BMI may be a predictor for IVF outcomes in patients with PCOS.
Body Mass Index ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; Humans ; Obesity ; Ovulation Induction ; Polycystic Ovary Syndrome ; Retrospective Studies