Proposal for individual treatment by tubal occlusion factor based on the results of salpingoscopic salpingoplasty.

AIM: As a treatment for tubal infertility, falloposcopic tuboplasty (FT) is one of the options for patients who wish to conceive naturally. Based on the results of FT, we propose an appropriate time of transitioning to assisted reproductive technology (ART) for tubal infertility. OBJECTS AND METHODS: We examined the outcomes of cases of tubal infertility during the period from June 1999 through March 2021 who were performed tuboplasty at our hospital using the FT catheter system under laparoscopy. RESULTS: The number of treated cases was 828. There were 243 cases of endometriosis and 119 cases of genital chlamydial infection. By FT, 712 cases (86.0%) were successfully recanalized. Of the 712 cases, 189 conceived naturally (26.5%) and miscarriages were 23 cases (12.2%), ectopic pregnancies were 8 cases (4.2%). The mean duration from FT to pregnancy was 6.5 months in natural pregnancy group, 90% of them were pregnant within 14 months. In endometriosis cases, the pregnancy rate after FT did not change significantly among clinical stage. CONCLUSIONS: Even when the fallopian tube was recanalized by FT, if the couple is unable to conceive naturally, they had better to consider switching to ART at about 14 months. When the couples with endometriosis consider switching to ART, we suggest deciding without considering the rASRM stage.

[Concurrent chemoradiation therapy for advanced cervical cancer].

In 2003, we began a clinical application of concurrent chemoradiation therapy (CCR) in patients with cervical cancer in our hospital. We analyzed 14 cases of advanced cervical cancer in stages IIa through IIIb by FIGO classification. Tumor size of the uterine cervix ranged from 1.5 cm to 8.0 cm in diameter. Patients received radiation therapy (50 Gy of external beam radiotherapy for pelvis and 20 Gy of high-dose rate intracavitary brachytherapy) combined with chemotherapy. Cisplatin was administered intravenously every 3 weeks at a dose of 70 mg/m(2) during the radiation therapy. In two cases, CCR was stopped because of the side effects. One case developed acute renal failure and another suffered intolerable exhaustion. As for the antitumor effects of CCR, the response rate was 75% (CR 58.3%,PR 16.7%). At the end of the CCR, 10 of 12 patients (83.3%) were negative for viable cells by cytology or biopsy of the uterine cervix. The grade 3 adverse effects were leukopenia, diarrhea and anemia. There was no statistical difference in the overall survival between CCR and radiation therapy alone. The CCR response rate in patients with paraaortic lymph node swelling (suspected metastasis) was low, and they had a poor prognosis. Further examinations for the long-term survival benefit of CCR are necessary.