• Clinical and Experimental Reproductive Medicine
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• v.26 no.3
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• pp.483-490
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• 1999

Objectives: Polycystic ovary syndrome (PCOS) has the feature of excessive LH, hyperandrogenism and disturbance of folliculogenesis. Also, insulin, IGF-I and IGFBP-l are involved in the pathogenesis of PCOS. Various surgical and medical therapies have been used and the action mechanisms are related to the endocrine effect. Laparoscopic ovarian electrocautery or laser vaporization is effective in the restoration of ovulation and normal menstrual cycle with minimal invasive procedure especially in the patients resistant to medical therapy. Clomiphen citrate (CC) is used for the ovulation induction in pcas and the resistance is known to be related to insulin, IGF-I, IGFBP-l levels. This study was performed to evaluate the effect of the laparoscopic laser vaporization on the levels of LH, FSH, testosterone, IGF-I and IGFBP-l and on the ovarian response to clomiphen citrate in patients with CC-resistant PCOS. Materials and Methods: The fasting basal serum LH, FSH, testosterone, IGF-I and IGFBP-l level were measured in 10 PCOS patients with CC-resistance and 7 normal controls with regular menstrual cycle. In PCOS, after laparoscopic $CO_2$ laser vaporization, endocrine levels were measured in 1 week interval for 4 weeks and then compared with preoperative levels. Results: In PCOS group, mean serum LH/FSH ratio, testosterone, IGF-I levels were higher and IGFBP-l level was lower than control. LH/FSH ratio decreased from $2.51{\pm}0.67$ to $1.7{\pm}0.6$ (p<0.05) in 2 weeks, to $0.56{\pm}0.2$ (p<0.01) in 3 weeks and to $1.41{\pm}0.3$ (p<0.01) in 4 weeks after operation. Testosterone level decreased from $1.51{\pm}0.82ng/ml$ to $0.65{\pm}0.34ng/ml$ (p<0.05) in 2 weeks, to $0.56{\pm}0.67ng/ml $(p<0.01) in 3 weeks after operation. IGF-I level also decreased from $436{\pm}47.5{\mu}g/l$ to $187{\pm}38{\mu}g/l$ (p<0.0l) in 1 week, to $167{\pm}42{\mu}g/l$ (p<0.01) in 2 weeks, $179{\pm}55{\mu}g/l$ (p<0.01) in 3 weeks and to $120{\pm}43{\mu}g/l$ (p<0.01) in 4 weeks after operation. IGFBP-l level showed no significant change. In 8 of 10 PCOS patients, ovulation was induced with low dose clomiphen citrate. Conclusion: Laparoscopic $CO_2$ laser vaporization restores normal menstrual cycle and ovulation through endocrine effect of decreasing LH/FSH ratio, testosterone and IGF-I level and increases the response to CC. Therefore it is useful for restoration of normal menstruation and induction of ovulation in CC resistant PCOS patients.

• Journal of Veterinary Clinics
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• v.26 no.4
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• pp.353-358
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• 2009

Unilateral ureteronephrectomy was performed in a dog presented with unilateral hydroureter and hydronephrosis. On laparotomy, severe adhesion of the dorsomedial border of the affected kidney to the abdominal aorta longitudinally and caudal pole of the kidney firmly to the ipsilateral ovary were observed. Since it was not possible to ligate the renal artery and vein separately due to severe adhesion tissue, two mass ligations were applied in the medial border of kidney, and the adhesion tissue was transected distal to each ligature. Then, blunt and sharp dissections were performed to isolate dorsomedial border of the kidney from the abdominal aorta, but they brought out unexpected hemorrhage caused by incision of renal artery and it has been suspected that two mass ligations could not include renal artery, which was adhered to dorsomedial border of the kidney. The hemorrhage was controlled by double ligations and electrocautery. In this case report, we recommend that if isolation of renal vessels is impossible due to strict adhesion of kidney to adjacent tissue, the mass ligation could be chosen to isolate and exteriorize the kidney and placed carefully not only at medial border of the kidney, where the renal vessels come into the kidney anatomically but also additional border of the kidney where adhesion tissues are formed.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.25-34
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• 1995

Background: Endobronchial tuberculosis is classified into 7 subtypes as fibrostenotic type, edematous-hyperemic type, actively caseating type, tumorous type, ulcerative type, granular type and nonspecific bronchitic type by bronchoscopic features, and we make a prospective study to follow up how bronchoscopic findings change during treatment-course in each subtype of active endobronchial tuberculosis. Methods: We planned to do follow-up bronchoscopic examination every month until there was no significant change in endobronchial lesion, then every 3 months and at the end of the treatment in each patient with biopsy proven endobronchial tuberculosis from May, 1990 to August, 1993. Results: 1) This study included 66 cases, but bronchoscopic follow-up was completed as scheduled in 47 cases. 2) In actively caseating and edematous-hyperemic type, bronchostenosis occurred within 2 or 3 months of treatment in about 2/3 of total cases. 3) In fibrostenotic type, bronchostenosis did not improve in spite of the treatment. 4) In tumorous type, the changes in bronchoscopic findings were unpredictable because new lesions occured on other sites even 4 or 6 months after treatment in 2 cases and the size of initial mass increased 6 months after treatment in 1 case (among 7 cases). 5) Granular and nonspecific bronchitic type improved without significant sequelae within 2 or 3 months of treatment. Conclusion: It may be necessary to follow up the patient with bronchoscopy repeatedly 2 or 3 months after starting treatment in active endobronchial tuberculosis, and it is better to perform bronchoscopic examination at 6 months of treatment, especially in patients with tumorous type because there is possibility that new endobronchial lesion occurs. Aggressive therapeutic modalities such as stent-insertion, laser therapy or electrocautery should be considered to prevent bronchostenosis in cases with granulation tissue, fibrostenotic and tumorous types of endobronchial tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.272-277
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• 2008

Background: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. Methods: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately $-89^{\circ}C$, and the icing time was 5~20 seconds. Results: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications- one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. Conclusion: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.742-755
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• 1997

Background : Endobronchial tuberculosis(ET) is still relatively common disease in Korea. We intended to evaluate the length of endobronchial lesion, peribronchial thickness, luminal irregularity and associated mediastinal lymph node enlargement with Chest CT to get information for such aggressive treatment as electrocautery, laser therapy and so on of bronchial stricture in ET, and also to compare the change of Chest CT finding with that of bronchoscopic finding after one month of anti-tuberculosis treatment. Method : We performed CT in 26 patients who were diagnosed as ET by bronchoscopy at Boramae Hospital from November 1991 to March 1996. After classifying ET into seven subtypes according to bronchoscopic finding, we analyzed the CT finding of each subtype. And we followed up the bronchoscopy, CT, and PIT after one month of anti-tuberculosis treatment, and compared the change of CT findings with those of bronchoscopic findings in nine patients. Results : Age of the patients was from 17 to 73 years old, and the ratio of male to female was 1 : 25 with absolute female predominance. The site(s) of bronchial involvement by tuberculosis is one in 14 cases, two in nine cases and three in one case, respectively, and the left main bronchus was the most frequently involved site (13 cases for multiple involvements and 7 cases for single involvement among 26 cases). The length of bronchial involvement by tuberculosis which was measured by CT was from 10 to 55 mm, and there was a tendency that the length of involved lesion in fibrostenotic type was shorter than that of actively caseating type. Bronchial stricture on CT was noticed in 25 (96%) cases and the range of severity was from total occlusion to near-normal and also showed wide variation even though the subtype of ET was same. The increase of peribronchial thickness which was measured by CT, was noticed in 21 cases (91%) among 23 cases (in which the measurement was possible), and there was no improvement of peribronchial thickness in those cases which showed little improvement in bronchial stricture despite anti-tuberculosis treatment. There was no difference in the luminal irregularity of involved bronchi on CT in relation to bronchoscopic subtypes. The mediastinal lymph node enlargement, defined as the diameter of lymph node was larger than 1cm on CT, was detected in 20 cases (77%), and right side was more frequently involved (L : R = 1 : 5.2). The CT finding usually showed extrinsic bronchial compression but showed direct invasion in two cases which were bronchoscopically classified as tumorous type. When follow-up bronchoscopy and CT was performed after one month of anti-tuberculosis treatment in nine patients, CT showed significant improvement in peribronchial thickness and mediastinal lymph node enlargement. Bronchial stricture was also improved in 6 cases but aggravated in 3 cases despite anti-tuberculosis therapy. In two cases which were classified as fibrostenotic type by bronchoscopy, CT showed significant improvement in bronchial stricture, interestingly. Conclusion : We concluded that the role of Chest CT was complimentary to bronchoscopy in ET, since CT was useful in evaluating the length of bronchial involvement, peribronchial thickness, and mediastinal lymph node enlargement.