Since its introduction, laparoscopic surgery has been often preferred over open surgery in obstetrics and gynecology due to its advantages, such as less bleeding, lower incidence of adhesions, reduced postoperative pain, short hospital stay, and quick return to daily life. However, in the case of complex surgeries, laparoscopy presented some limitations. Nonetheless, since the 1980s, medical robots have been introduced to overcome the technical limitations of laparoscopy and start a new age for minimally invasive surgery. In this review, we explore the indications and advantages and disadvantages of robotic surgery in the field of gynecology, and try to assess the recent trend of robotic surgery.

Human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) are used in tissue repair and regeneration; however, the mechanisms involved are not well understood. We investigated the hair growth-promoting effects of hUCB-MSCs treatment to determine whether hUCB-MSCs enhance the promotion of hair growth. Furthermore, we attempted to identify the factors responsible for hair growth. The effects of hUCB-MSCs on hair growth were investigated in vivo, and hUCB-MSCs advanced anagen onset and hair follicle neogeneration. We found that hUCB-MSCs co-culture increased the viability and up-regulated hair induction-related proteins of human dermal papilla cells (hDPCs) in vitro. A growth factor antibody array revealed that secretory factors from hUCB-MSCs are related to hair growth. Insulin-like growth factor binding protein-1 (IGFBP-1) and vascular endothelial growth factor (VEGF) were increased in co-culture medium. Finally, we found that IGFBP-1, through the co-localization of an IGF-1 and IGFBP-1, had positive effects on cell viability; VEGF secretion; expression of alkaline phosphatase (ALP), CD133, and β-catenin; and formation of hDPCs 3D spheroids. Taken together, these data suggest that hUCB-MSCs promote hair growth via a paracrine mechanism.
Alkaline Phosphatase ; Alopecia ; Cell Survival ; Coculture Techniques ; Fetal Blood* ; Hair Follicle ; Hair* ; Humans* ; In Vitro Techniques ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Mesenchymal Stromal Cells ; Regeneration ; Stem Cells* ; Umbilical Cord* ; Vascular Endothelial Growth Factor A

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.
Biological Therapy ; Colitis ; Crohn Disease* ; Dysbiosis ; Fecal Microbiota Transplantation* ; Gastrointestinal Microbiome ; Humans ; Immune System ; Inflammation ; Inflammatory Bowel Diseases ; Lymphoma

Primary central nervous system (CNS) sarcomas are exceedingly rare, and, to the best of our knowledge, there has not yet been a report of intramedullary sarcoma. Here, we report a primary intradural intramedullary sarcoma of the spinal cord in a four-year-old boy who presented with low back pain and a radiculopathy involving both lower extremities. The tumor showed significant enhancement on magnetic resonance (MR) images due to its extreme vascularity. Gross total tumor removal was performed with microelectrical pulse recording, and the patient also received adjuvant radiotherapy and chemotherapy. After the operation, the patient's sensory deficits were improved. Because CNS dissemination is common, entire neuraxis evaluation is essential, although there was no evidence of dissemination in this case. The prognosis of primary CNS sarcoma is poor due to infiltrative nature and early CNS dissemination is common, and the treatment of choice is radical surgical resection. Adjuvant therapy is also beneficial with radiotherapy and chemotherapy.
Central Nervous System ; Humans ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Prognosis ; Radiculopathy ; Radiotherapy, Adjuvant ; Sarcoma ; Spinal Cord

PURPOSE: This study was to develop and prove the effects of aself management compliance promotion program for primary hypertension patients who reside in rural communities. METHOD: The content of the self management compliance promotion program developed by this study was as follows: A leader trains patients as a group or individually, in walking, education and green tea therapy from the first to twelfth week. From the thirteenth to twenty fourth week, the patients should perform walking and green tea therapy by themselves. One hundred twenty subjects volunteered to participate in the study, who were among those registered as hypertension patients in the 14 community health clinics located in Chungcheongbuk-do. RESULT: Systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglyceride, step width, and degree of obesity decreased significantly. High-density lipoprotein cholesterol, step length, knowledge of hypertension, and self management compliance significantly increased. CONCLUSION: A self management compliance promotion program for primary hypertensive patients enhances biophysical index and knowledge on hypertension, thus ultimately suggesting a nursing intervention for promoting self management compliance.
Adult ; Aged ; Aged, 80 and over ; Female ; Health Promotion ; Humans ; Hypertension/psychology/*therapy ; Life Style ; Male ; Middle Aged ; Patient Compliance ; *Patient Education as Topic ; Rural Population ; *Self Care

PURPOSE: Firstly, to analyze factors in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma. Secondly, to explore an effective salvage treatment for these relapses. MATERIALS AND METHODS: Two patients who had high-risk disease (T3bM1, T3bM3) were treated with combined chemoradiotherapy. CT-simulation based radiation-treatment planning (RTP) was performed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. RESULTS: Review of radiotherapy portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume. When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. CONCLUSION: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
Brain ; Chemoradiotherapy ; Craniospinal Irradiation ; Humans ; Medulloblastoma* ; Optic Nerve ; Radiotherapy ; Recurrence*

PURPOSE: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received 63~70 Gy (Median 66 Gy, fraction size 1.8~2 Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. RESULTS: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were 15+/-1.65 and 11+/-0.95 months, respectively. There was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were 21+/-5.03 and 12+/-1.59 months, respectively, while for Arm 2 patients they were 14+/-0.94 and 10+/-1.63 months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; 44.7% versus 19.2%. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. CONCLUSION: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.
Arm ; Diagnosis ; Disease-Free Survival ; Edema ; Follow-Up Studies ; Glioblastoma* ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neurologic Examination ; Prospective Studies ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden

The authors report a case of fusiform aneurysm in the proximal anterior cerebral artery(ACA). A 44-year-old woman presented with severe headache after subarachnoid hemorrhage. The right carotid angiography demonstrated a fusiform aneurysm in the A1 segment of right ACA with vasospasm. Clipping of a fusiform right A1 aneurysm was performed via the right pterional approach. The postoperative cerebral angiography demonstrated complete occlusion of the fusiform aneurysm and moderate degree of vasospasm with preservation of A1 segment. The postoperative course was uneventful. We report a case of fusiform aneurysm of A1 segment that was successfully clipped with the fenestrated aneurysmal clip.
Adult ; Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Cerebral Angiography ; Female ; Headache ; Humans ; Subarachnoid Hemorrhage

OBJECTIVE: The authors report the various factors which correlated with the intraoperative rupture during aneurysm surgery. METHODS: Retrospective study was done in patients who had been perfomed aneurysmal neck clipping by same surgeon from January 1998 to May 2000. A total of 121 patients were operated by using the microsurgical technique of aneurysmal neck clipping and intraoperative ruptures occurred during dissection in 19 cases and aneurysmal neck clipping in 12 cases. In this study, the incidence of intraoperative rupture was 25.6%. We analyzed the followings: preoperative neurologic status(Hunt-Hess grade), preoperative hemorrhage volume on computed tomography(Fisher grade), timing of operation, aneurysm location, aneurysm size, aneurysm direction, shape of the aneurysmal neck, prescence of atherosclerotic plaque around aneurysmal neck and parent vessel and Glasgow outcome scale score. RESULTS: Hunt-Hess grade, Fisher grade, timing of operation, aneurysm location, aneurysm size and direction of the aneurysm had not associated with intraoperative rupture. However, the incidence of intraoperative aneurysmal rupture during surgery was higher in patients whose anterior communicating artery aneurysm was directed inferiorly and aneurysmal neck was broad. The GOS score and the prescence of atherosclerotic plaque around the aneurysmal neck and parent vessel also correlated with the intraopertive rupture but more closely influenced by neck clipping than dissection. CONCLUSION: Surgeons should keep in mind the use of careful microsurgical sharp dissection especially in cases of inferiorly directed anterior communicating artery, broad-neck aneurysm and presence of atherosclerotic plaque around aneurysmal neck and parent vessels.
Aneurysm* ; Arteries ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Neck ; Parents ; Plaque, Atherosclerotic ; Retrospective Studies ; Rupture* ; Subarachnoid Hemorrhage*

Actinomycosis is difficult to diagnose preoperatively because of non-specific clinical feature. We usually have excessively invasive treatment for actinomycosis. So, we must rule out actinomycosis in the case of patients with a complaint of lower abdominal pain with a long time IUD inserted state and laboratory findings suggestive of inflammation. We experienced two cases of pelvic actinomycosis associated with IUD and report these cases with a brief review of literatures.
Abdominal Pain ; Actinomycosis* ; Humans ; Inflammation ; Intrauterine Devices*