Intraluminal duodenal diverticulum (IDD) is a rare congenital abnormality, consisting of a sac-like mucosal lesion in the duodenum. Cases of IDD can present with gastrointestinal bleeding, duodenal obstruction, or pancreatitis. Here, we report a rare case of a 25-year-old female presenting with IDD complicated by duodeno-duodenal intussusception and recurrent pancreatitis. The diagnosis was based on findings from radiologic examinations (CT and MRI), upper gastrointestinal series (barium swallow), and gastroduodenofiberscopy. Laparoscopic excision of the presumed duodenal duplication was performed. The subsequent histopathologic evaluation of the excised sac revealed normal mucosa on both sides, but the absence of a proper muscle layer confirmed the diagnosis of IDD. Radiologic detection of a saccular structure in the second portion of the duodenum can indicate IDD with duodeno-duodenal intussusception as the lead point

For many years it had been universally taught that administration of the commonly used analgesic agents retards the progress of labor. It was therefore advised that these agents should not be administered until the labor was active and progress was rapid. In recent years, more scientific analysis of the progress of labor and accurate recording of uterine contractility revealed that this classical teaching was inaccurate. Despite the increasing use of regional analgesia during labor, systemic medications are still widely used to relieve pain and anxiety. There is no ideal, generally applicable analgesic agent for use during childbirth. All systemic medications used for pain relief in labor cross the placenta and may have a depressant effect on the fetus and injudicious administration of an overdose can cause some depression of uterine activity. It is suggested that elimination of pain or anxiety will decrease adrenal medullary release of epinephrine. Since epinephrine is a known inhibitor of uterine activity, a decrease in its serum level should lead to increased uterine activity. Thus it was decided to make an objective estimation of the effects of morphine, meperidine, diazepam and ketamine upon uterine contractility of pregnant rat uteri, in vitro. The results are as follows: 1) Morphine caused a significant concentration dependent decrease in the contractility of pregnant rat uteri. 2) Meperidene did not cause any significant change in the contractility of pregnant rat uteri. 3) Diazempam caused a concentration dependent decrease in the contractility and the contraction disappeared at a concentration of 80 ug/100ml. 4) Ketamine caused a significant concentration dependent decrease in the contractility of pregnant rat uteri. 5) Addition of CaCl2 to the K-H solution did not cause any significant change in the result.
Analgesia ; Analgesics ; Animals ; Anxiety ; Depression ; Diazepam* ; Epinephrine ; Fetus ; Ketamine* ; Meperidine* ; Morphine* ; Parturition ; Placenta ; Rats* ; Uterus*

We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan’s syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety.
Adhesives ; Amenorrhea ; Cicatrix ; Constriction, Pathologic* ; Female ; Hematocolpos ; Hemorrhage ; Humans ; Hypopituitarism ; Postpartum Period ; Uterine Hemorrhage

Stem cells are undifferentiated cells capable of self-renewal and differentiation into various cell lineages. Stem cells are responsible for the development of organs and regeneration of damaged tissues. The highly regenerative nature of the human endometrium during reproductive age suggests that stem cells play a critical role in endometrial physiology. Bone marrow-derived cells migrate to the uterus and participate in the healing and restoration of functionally or structurally damaged endometrium. This review summarizes recent research into the potential therapeutic effects of bone marrow-derived stem cells in conditions involving endometrial impairment.
Bone Marrow ; Cell Lineage ; Endometrium* ; Female ; Humans ; Physiology ; Regeneration* ; Stem Cells* ; Therapeutic Uses ; Uterus

Endometriosis is defined by the presence of extrauterine endometrial tissue and presents with symptoms of dysmenorrhea, chronic pelvic pain, and impaired fertility. This condition often follows a chronic progressive course with favorable recurrence, even after surgical or medical treatment. The etiology or exact pathophysiology of endometriosis remains to be clarified, although it is thought to be a complex and multifactorial disease. Prior epidemiological or population-based studies have reported several risk factors related to endometriosis, such as environmental, menstrual, habitual, and lifestyle factors. Moreover, anthropometry has been found to be significantly associated with the diagnosis of endometriosis, as a lower body mass index is associated with an elevated risk of endometriosis. Here, we review studies that have examined the association between body size and the risk of endometriosis and discuss the clinical and biological significance of the relationship between adiposity and endometriosis.

Endometriosis is characterized by the implantation of endometrial cells outside the uterus. This hormone-dependent disease is highly prevalent among women of reproductive age. Clinical symptoms of endometriosis include dysmenorrhea, pelvic pain, and infertility, which can negatively impact the overall quality of life of those affected. The medical treatment of endometriosis serves as an important therapeutic option, aimed at alleviating pain associated with the condition and suppressing the growth of endometriotic lesions. As such, it is employed as an adjuvant therapy following surgery or an empirical treatment after the clinical diagnosis of endometriosis. Dienogest, a fourth-generation progestin, has received approval for the treatment of endometriosis in many countries. A growing body of evidence has demonstrated its efficacy in managing endometriosis-associated pain, preventing symptoms, and reducing lesion recurrence. In this review, we examine the clinical efficacy, safety, and tolerability of dienogest in treating endometriosis. We also provide updated findings, drawing from clinical studies that focus on the long-term use of this medication in patients with endometriosis.

BACKGROUND: A decrease in core body temperature caused by heat distribution depends on the anesthetic agent used. The purpose of this study is to investigate the effects of sevoflurane and propofol on core temperature during laparoscopic major abdominal surgery requiring pneumoperitoneum of more than 90 min. METHODS: Fifty adult patients undergoing laparoscopic major abdominal surgery were randomly assigned to either a sevoflurane group (n = 25) or a propofol group (n = 25). In the sevoflurane group, anesthesia was induced with propofol 2 mg/kg, remifentanil 1.0 microg/kg, and maintained with 0.8-2.0 vol% sevoflurane and 0.1-0.2 microg/kg/min remifentanil. In the propofol group, anesthesia was induced with the effect-site concentration of propofol of 5.0 microg/ml and remifentanil 4 ng/ml, and maintained with the effect-site concentration of propofol of 2-3.5 microg/ml and remifentanil 3-5 ng/ml. Core body temperature was measured with an esophageal stethoscope with a temperature sensor after the start of the pneumoperitoneum (baseline) and at 15-min intervals until completion of surgery. RESULTS: During the study period, core temperature was comparable between the two groups. When compared with baseline values, core temperatures in both groups were significantly decreased 45 min after pneumoperitoneum. CONCLUSIONS: This study demonstrated that in patients undergoing prolonged laparoscopic surgery, a decrease in core body temperature during sevoflurane-remifentanil anesthesia was not different than propofol-remifentanil anesthesia, and the incidence of hypothermia of the two groups did not differ.
Adult ; Anesthesia ; Body Temperature ; Hot Temperature ; Humans ; Hypothermia ; Incidence ; Laparoscopy ; Methyl Ethers ; Piperidines ; Pneumoperitoneum ; Propofol ; Stethoscopes

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.
Adult ; Arteries/*surgery ; *Catheterization ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hysterectomy/*methods ; Placenta/*blood supply/ultrasonography ; Placenta Accreta/*surgery/ultrasonography ; Placenta Previa/*surgery/ultrasonography ; Postpartum Hemorrhage/*prevention & control ; Pregnancy ; Treatment Outcome

Remote afterloading high dose rate brachytherapy(HDRB) is a new technology and needs new biological principle for time and dose schedule. Here, authors attempt to evaluate the technique and clinical outcome in 116 patients, 590 procedures performed at Asan Medical Center for 3 years. From Sep. 1985 to Aug 1992, 471 procedures of intracavitary radiation in 55 patients of cervical cancer and 26 of nasopharyngeal cancer, 79 intraluminal radiation in 12 of esophageal cancer, 11 of endobronchial cancer and 1 Klatskin tumor and 40 interstitial brachytherapy in 4 of breast cancer, 1 sarcoma and 1 urethral cancer were performed. Median follow-up was 7 months with range 1~31 months. All procedures except interstitial were performed under the local anesthesia and they were all well tolerated and completed the planned therapy except 6 patients. 53/58 patients with cervical cancer and 22/26 patients with nasopharynx cancer achieved CR. Among 15 patients with palliative therapy, 80% achieves palliation. We will describe the details of the technique and results in the text. To evaluate biologic effects of HDRB and optimal time/dose/fractionation schedule, we need longer follow-up. But authors feel that HDRB with proper fractionation schedule may yield superior results compared to the low dose rate brachytherapy considering the advantages of HDRB in safety factor for operator, better control of radiation dose and volume and patients comfort over the low dose brachytherapy.
Anesthesia, Local ; Appointments and Schedules ; Brachytherapy* ; Breast Neoplasms ; Chungcheongnam-do ; Esophageal Neoplasms ; Follow-Up Studies ; Humans ; Klatskin's Tumor ; Nasopharyngeal Neoplasms ; Palliative Care ; Sarcoma ; Urethral Neoplasms ; Uterine Cervical Neoplasms

Traumatic aniridia is usually accompanied by severe anterior segment disruption including corneal laceration, cataract, and vitreous prolapse into the anterior chamber. We experienced a case of complete traumatic aniridia following corneal laceration without capsular rupture of lens, which has not been reported in Korea. A 28-year-old man had a corneal laceration of his right eye from a screw driver at work, which resulted in complete aniridia with only a remnant of ciliary process and UCVA was 0.08. Primary closure of corneal laceration was performed. During surgery, lens capsule was intact. Visual acuity was reduced 10 days after surgery as cataract developed. Although UCVA was 0.3 at 1 month postoperatively, he was symtomatic with glare due to aniridia.
Adult ; Aniridia* ; Anterior Chamber ; Cataract ; Glare ; Humans ; Korea ; Lacerations* ; Prolapse ; Rupture ; Visual Acuity