Submucosal Myoma Treatment for Women Who Wish to have Children in the Future Nodule Dissection Centripetal Cutting Method of TCR (Transcervical Resection).

Due to the recent trend to marry later, patients with uterine myoma, and who wish to preserve their uterus have increased, are leading to greater demand for minimally invasive myomectomies. For intramural myomas and submucosal myomas, which are located near the uterine cavity, which are high risk for sterility or infertility, incision of the myometrium, and suture to the uterine cavity during laparoscopic myomectomy is required, and Caesarean section is frequently selected as the child delivery method. Hysteroscopic myomectomy is advantageous for persons wishing for pregnancy. The abdominal wall is not damaged, and there is less pain and a shorter hospital stay. Hysteroscopic myomectomy does not cause postoperative intraperitoneal adhesion, contraceptive period is shorter, and vaginal delivery is also possible. Since expensive disposal surgical instrument, surgery assistants are not needed, it also contributes to medical economy, and its widespread is desired. On the other hand, learning the technique is difficult, since unique complications may occur and only an endoscope in the specific field of vision, the uterine cavity is used for this procedure. If only cases with small submucosal myoma are indicated for hysteroscopic myomectomy, technical improvement and wider adoption will not occur. However, if the indication can be correctly recognized and a safe and accurate technique be acquired, adoption of hysteroscopic myomectomy could actually be widened. It is an excellent technique which can become mainstream for fibroid treatment.

Multiple neurenteric cysts in the posterior fossa and cervical spinal canal--case report.

A 46-year-old woman presented with multiple neurenteric cysts in the posterior fossa and spinal canal. Neuroimaging demonstrated neurenteric cysts in the interspace between the left cerebellar hemisphere and vermis, the lateral side of the right cerebellar hemisphere, and the ventral side of the spinal cord at the C-2 and C-4 levels. Total resection of the paravermian cyst and partial removal of the spinal cyst at the C-4 level were performed. Histological examination showed the cyst wall consisted of single or multiple layers of columnar epithelial cells with secretory granules, with mucin secretion verified by periodic acid-Schiff staining. Immunohistochemical staining showed the walls were positive for the cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen, and negative for glial fibrillary acidic protein and S-100 protein. These findings confirmed the endodermal origin. The diagnosis was neurenteric cyst. The paravermian cyst disappeared, but the spinal cyst at the C-4 level recurred 8 months later. Reoperation became necessary 16 months later. The other two cysts also showed enlargement at 6 or 15 months. Total removal of neurenteric cyst is recommended if possible.

Aromatase cytochrome P450 and estrogen and progesterone receptors in uterine sarcomas: correlation with clinical parameters.

We examined the immunohistochemical expression of aromatase cytochrome P450 (P450arom), estrogen receptor (ER), progesterone receptor (PR), and Ki-67 in postoperative uterine sarcomas (n = 31) and the corresponding eutopic endometria (n = 20) to evaluate the relationships between the endocrine character of uterine sarcomas and the clinical features. In sarcoma tissues, P450arom was detected in 55% of cases, ER in 42%, PR in 42%, and Ki-67 in 90%. In eutopic endometria, P450arom was detected in 60% of cases, ER in 60%, and PR in 35%. There were correlations in the steroid-related proteins between the tumors and endometria (P = 0.001-0.026). The positivity of endometrial P450arom (P = 0.04) and ER (P = 0.006) was higher in surviving patients than dead patients regardless of the menstrual state. The results demonstrate correlation between the expression of P450arom, ER, and PR in tumors and eutopic endometria. Intense expression of the steroid-related proteins was associated with better survival.

[A case of ovarian cancer in which a remarkable effect was seen with low-dose CDDP intratumoral injection of CPT-11].

We treated an ovarian cancer patient in whom low-dose CDDP intratumoral injection with CPT-11 therapy was very effective. The patient was a 63-year-old woman. She showed symptoms of peritonitis. Carcinomatous peritonitis was suspected on abdominal CT scan and tumor markers were at high levels (CA125 10,827 U/ml, SLX 82 U/ml). At laparotomy, massive ascites (3,000 ml), omental cakes and disseminated peritoneal tumors were revealed. Her uterus and adnexa were not enlarged. The omental tumor and ovaries were biopsied and revealed serous adenocarcinoma. The patient was treated with combined chemotherapy of CDDP and CPT-11. CDDP (20 mg/day) was administered by intraperitoneally for 3 days, and CDDP (10 mg/day) was administered by intratumoral injection (percutaneous for omental tumor) for 5 days. CPT-11 (40 mg/day) was administered twice a week. As a result, marked shrinkage of the tumors was confirmed. This low-dose CDDP intratumoral injection with CPT-11 may be effective for such omental tumors with carcinomatous peritonitis.

Management of vaginal birth after cesarean.

OBJECTIVE: To raise the success rate of vaginal birth after cesarean (VBAC) without increasing maternal or perinatal morbidity and mortality rates. METHODS: Of 468 women with a prior scar, 365 gave valid informed consent for our management of VBAC at Akashi Municipal Hospital during 1986-1999. Trials of labor (TOL) were attempted in 322 cases principally by waiting for spontaneous labor onset and teaching the patients a breathing method to avoid straining until expulsion by vacuum extraction become possible, controlling the intrauterine pressure. Our selection criteria for TOL changed during the trial; from 1991-1999 patients with a prior scar extending into fundus were excluded. RESULTS: Of the 322 TOL, 88.2% were successful, and VBAC was successful in 77.8% (284 of the 365 patients). Uterine rupture was observed in 2 cases (0.62%). Fetal death occurred in 1 case. Three women gave birth to neonates with a 1-minute Apgar score < or = 6. CONCLUSION: The rate of VBAC was 77.8% in all women with a prior scar. During our management of VBAC, maternal or perinatal morbidity and mortality rates did not increase significantly.

Local injection of botulinum toxin type A for hemifacial spasm.

The preliminary experience of botulinum toxin treatment for hemifacial spasm is reported in this study. Five patients were treated with 10 injections of botulinum toxin in total. Botulinum toxin had a good to excellent effect in all cases. Improvement was observed 2 weeks to 1 month after the injection. The duration of improvement was 0-9 months (mean 4.2 months). The peak rank tended to decrease and the duration of improvement increased after several treatments. Hemifacial spasm caused by the anterior inferior cerebellar artery tended to subside easily. In contrast, compression by the vertebral artery was more refractory. Continuous facial spasm caused by operative trauma subsided after the injection, but paroxysmal spasm still occurred when eating or laughing. Spasm caused by trauma disappeared 4.5 months after the injection. The complications, which were facial nerve paresis in two cases (3 injections, 30%) and diplopia in one case (1 injection, 10%), were transient and subsided in 2 weeks.