Novel technique for total laparoscopic myomectomy: the "bottom-up suture".

INTRODUCTION: As more women with symptomatic uterine myomas undergo laparoscopic management without hysterectomy, we increasingly encounter many difficult situations, such as of the need to extract large intramural myomas. Even for a skilled surgeon, laparoscopic myomectomy in such a situation is difficult. We have established a new technique for laparoscopic myomectomy to solve these issues called the "bottom-up suture" method. MATERIALS AND SURGICAL TECHNIQUE: Before complete removal of the myoma, countertraction is applied by an assistant with a claw forceps, elevating the bed of the myoma to make suturing easy. The deep myometrium can be sutured while the myoma is still attached to the uterus. DISCUSSION: This technique, the "bottom-up suture," may improve the suturing of laparoscopic myomectomies. The advantages of this technique are that it is easy to control unexpected bleeding, and dead space formation can be prevented even when the myomas have grown deep into the uterine myometrium. This technique will become a reliable standard for laparoscopic myomectomy.

Unsuspected uterine leiomyosarcoma: magnetic resonance imaging findings before and after focused ultrasound surgery.

Uterine leiomyosarcoma, initially diagnosed as leiomyoma on magnetic resonance (MR) images, was disclosed after focused ultrasound surgery (FUS). The tumor did not display high signal intensity on either T1- or T2-weighted images on the patient's first visit. Four months thereafter, T2-weighted images revealed a high signal intensity area within the tumor, while T1-weighted images showed low signal intensity. Six months after FUS, the nonperfused volume calculated on meglumine gadoterate-enhanced T1-weighted images decreased markedly and an intermediate signal intensity in a circular area on T2-weighted images appeared to be atypically increasing in volume. After laparoscopic myomectomy, this tumor was diagnosed as uterine leiomyosarcoma coexistent with leiomyoma. The early stages of uterine leiomyosarcoma are clinically difficult to diagnose; therefore, both careful monitoring during FUS and close follow-up after the procedure are vital.

Familial risk among Japanese patients with endometriosis.

OBJECTIVES: This study was designed to examine the prevalence of endometriosis among female siblings of patients with endometriosis in Japan. METHODS: A total of 339 patients with endometriosis were questioned about endometriosis in their sisters. The control group consisted of 284 Japanese healthy fertile women with no history of endometriosis. Similarly, the controls were interviewed about their sisters. RESULTS: We detected sisters with endometriosis in 8.8% of cases and 1.5% of the control population. The relative risk of endometriosis in female siblings was 5.7. However, a significant difference was not seen in age at diagnosis and clinical stage between patients with or without a family history of endometriosis. CONCLUSIONS: These data demonstrate a familial tendency for endometriosis and suggest that endometriosis has a genetic factor in the pathogenesis.

A new approach for accessing retroperitoneal space using a 5-mm [corrected] visual access cannula.

Retroperitoneal lymph node evaluation is a very important step in planning cancer therapy. Traditional staging laparotomy is too invasive and causes considerable morbidity. However, laparoscopic access of the retroperitoneal space offers the onco-endoscopist a unique, noninvasive, and less dangerous method for assessing and managing women with gynecologic malignancies. The retroperitoneal approach is noninvasive and less dangerous way of accessing the paraaortic space. A new minimally invasive approach of accessing the retroperitoneal space using a 5-mm visual access cannula is introduced. A complete paraaortic and pelvic lymphadenectomy was possible for 60 patients with varied gynecologic malignancies using our retroperitoneal laparoscopic approach. Less blood loss and rapid recovery was observed, and no bowel complication was encountered. The use of the 5-mm visual access cannula offers a less invasive surgical procedure and provides cosmetic advantages.

The effects of zenarestat, an aldose reductase inhibitor, on peripheral neuropathy in Zucker diabetic fatty rats.

We studied the effects of zenarestat, an aldose reductase inhibitor (ARI), on peripheral neuropathy in Zucker diabetic fatty (ZDF) rats, an animal model of type 2 diabetes. ZDF rats and their lean rats counterparts were fed a sucrose-containing diet, and zenarestat was given orally once a day for 8 weeks. Motor nerve conduction velocity (MNCV), F-wave minimal latency (FML), and sorbitol concentrations in the sciatic nerve were measured. In ZDF control rats, a remarkable accumulation of sorbitol, a delay in FML, and a slowing of MNCV were observed compared with lean rats. At a dose of 3.2 mg/kg, zenarestat had no significant effect on the delay in FML and the slowing of MNCV, although the sorbitol accumulation in the sciatic nerve was partially inhibited in ZDF rats. On the other hand, 32 mg/kg zenarestat treatment improved these nerve dysfunctions in ZDF rats, along with a reduction of nerve sorbitol accumulation almost to the level of lean rats. These data showed that zenarestat improved diabetic peripheral neuropathy in ZDF rats, a type 2 diabetes model, providing evidence for the therapeutic potential of zenarestat for the treatment of diabetic neuropathy.

The role of orally administered dimethylarsinic acid, a main metabolite of inorganic arsenics, in the promotion and progression of UVB-induced skin tumorigenesis in hairless mice.

The effect of dimethylarsinic acid (DMA) on skin tumorigenesis by UVB irradiation was examined. Hairless mice (Hos: HR-1) irradiated with UVB at a dose of 2 kJ/m(2) twice weekly, were fed with drinking water containing 1000 ppm DMA, a main metabolite of inorganic arsenics, produced more skin tumors than DMA-untreated mice. Histopathological examination revealed that the mouse malignant tumors with severe atypism appeared only in the treatment group of UVB plus 1000 ppm DMA. These positive results point out the importance of dimethylated metabolites of inorganic arsenic in the process of skin carcinogenesis.

Laparoscopic surgery assisted by a transvaginal approach.

We used laparoscopic surgery assisted by a transvaginal approach for gastrointestinal diseases. In the first case, a huge submucosal tumor enucleated laparoscopically from the minor curvature of the stomach was extracted through the vagina. In the second case, partial resection of the rectum to treat rectal endometriosis was performed laparoscopically with the assistance of manual handling inserted transvaginally. Although it can be applied only to female patients, especially to multipara, the vagina as an access point to the abdominal cavity can be widely used for various purposes in laparoscopic surgery.

Chemical assay of iron in ovarian cysts: a new diagnostic method to evaluate endometriotic cysts.

CA-125 is abundantly secreted from ovarian endometriotic cysts, but is not specific to endometriosis. In order to develop a new, more specific diagnostic marker for endometriosis, the iron concentrations in various ovarian cysts were assayed. The ovarian cysts were punctured and the contents aspirated laparoscopically, laparotomically, or transvaginally. The iron concentration in the ovarian cystic fluid was assayed using a spectrophotometer after protein precipitations and chromogen treatment. The iron concentrations in ovarian cysts were 69.5+/-10.4 micromol/l in serous cystadenomas, 73.5+/-29.3 in mucinous cystadenomas, 65.4+/-12.4 in dermoid cysts, and 92.5+/-18.2 micromol/l in adenocarcinomas. On the other hand, high iron concentrations were demonstrated in endometriotic cysts (1,749.6+/-41.5 micromol/l), a lutein cyst (1,393.8), hemorrhagic corpus luteum (1,957.5) and endometrioid adenocarcinomas (1,860.9+/-157.9 micromol/l). Cytological smear tests of the contents as well as histological examination allowed differential diagnosis between endometriosis and endometrioid adenocarcinoma. In conclusion, assay of the ovarian cystic iron concentration is a useful diagnostic tool for the evaluation of ovarian endometriotic cysts.

Laparoscopic ovarian cystectomy using double balloon catheter: a new technical application.

In the present study, a modified application of the surgical instrument with double balloon is described in the ovarian cystectomy procedure. This technique has been proved effective and safe especially in removing chocolate-like cystoma. This new instrument, which we originally designed, has two balloons at the tip of the catheter. After a cyst is punctured, the inner and outer balloons are inflated to fix the cyst well. After fixing the cyst with two balloons, the internal needle of the instrument can be removed. This catheter, named the SAND balloon catheter, is advantageous in laparoscopic ovarian cystectomy.

Laparoscopic colpopoiesis using sigmoid colon.

A new technique for colpopoiesis using sigmoid colon autograft by a laparoscopic surgery is introduced for the first time. This technique requires advanced skills perform and may be the choice in respect to naturalness and permanency of the neovagina with minimum invasion.

Laparoscopic reconstruction of vagina using sigmoid autograft.

With the advent of advanced laparoscopic techniques in surgery, new applications have been found, which have expanded the role of laparoscopy in the gynecological field. The aim of this paper is to introduce our laparoscopic technique of taking a sigmoid colon autograft for colpopoiesis in a patient with congenital agenesis of the vagina. This technique is less invasive and is easy to perform, and it may be the best choice of operation in respect to the naturalness and the permanency of the vagina that results. The success of this laparoscopic technique of taking a sigmoid autograft for colpopoiesis suggests diverse possible applications in the future.

Laparoscopic ovarian cystectomy: extraperitoneal method.

A laparoscopic method for resecting benign ovarian cysts has been devised and involves excising the cyst wall extraperitoneally after aspirating the cystic fluid. In this report, the technique and clinical results are described and mini-laparotomy which is used in this technique is discussed. A total of 104patients were treated by this method. The diagnosis was simple cyst in 46,dermoid cyst in 33,and chocolate cyst in 25. The method was successful in 90 patients (87%).The remaining 14(14%)were converted to open surgery, 9 be- cause of severe adhesions. The remaining 5 patients had various complications: malignancy, bladder injury, dermoid content too solid to aspirate, and bleeding. We found endometrioid adenocarcinoma in 1 patient whose chocolate cyst could be removed completely.

Laparoscopic surgery for colpopoiesis with the pelvic peritoneum: first report in Japan.

Several methods have been developed for colpopoiesis in patients with vaginal agenesis. Nonetheless, various problems remain, including technical difficulty, invasiveness, operative stress, and poor cosmetic results, as well as the insufficient naturalness of the vagina itself. We have successfully completed colpopoiesis using the pelvic peritoneum in a laparoscopic surgery for Rokitansky-Küster-Hauser syndrome (RKH).

[Laparoscopic resection of ovarian cysts: precautions and improvements in the procedure and application of the mini-laparotomy].

We previously devised and reported a laparoscopic resection of benign ovarian cysts. In the present paper, we report precautions and improvements in the procedure and the application of the mini-laparotomy. 1. The subjects consisted of a total of 41 cases with preoperatively diagnosed cysts. These were 17 cases with simple cysts, 15 cases with dermoid cysts, and nine cases with chocolate cysts. The present surgical procedure was performed on 34 (83%) cases. 2. One case, preoperatively diagnosed as a chocolate cyst, was diagnosed as an endometrioid adenocarcinoma. 3. Laparotomy was required in 7 cases; in four as a result of hard adhesions, in one because it was impossible to withdraw fluid, in one due to a damaged urinary bladder and in one due to endometrioid adenocarcinoma. 4. It became essential to classify the ovarian cysts into three groups according to size. 5. Mini-laparotomy was performed for two giant ovarian cysts and five ovarian cysts in pregnant women. In this procedure the goal is minimal, simple, safe and reliable surgery with results equal to those of standard laparotomy.

[Inhibitory effect of bithionol on NADH-fumarate reductase in ascarides].

To elucidate the mechanism of anthelmintic action of bithionol, the inhibitory effect of the drug on NADH-fumarate reductase (NADH-FR) of Ascaris lumbricoides suum was examined. NADH-FR, an enzyme of anaerobic carbohydrate metabolic pathway was solubilized from the mitochondria of the worm's muscle with deoxycholate, and then partially purified with the monoethanolamine-Sepharose 4B column chromatography. Rhodoquinone (RQ), which is required for the electron transfer from NADH to fumarate, was separated from the enzyme protein and phospholipids. Although the enzyme protein fraction eluted from the above column did not show NADH-FR activity, this enzyme was reactivated by the addition of purified RQ and phosphatidylcholine. The IC50 value of bithionol for reconstituted NADH-FR was 18 +/- 2 microM. The inhibition type was competitive to RQ. Bithionol inhibited at most 30% NADH-ferricyanide reductase, which did not require RQ, even at high concentration of 150 microM. These results suggest that the pharmacological action of bithionol, a phenolic anthelmintic, depends on the inhibition of the electron transport system by the competition with RQ.

Improvement in Raw Meat Texture of Cultured Eel by Feeding of Tochu Leaf Powder.

The muscle of eels fed tochu (Eucommia ulmoides Oliver) leaf powder was 1.8 times harder than the control. The component analysis showed no difference in moisture, lipid, or protein content between the muscles of the control and the tochu-fed eels. Not only the extracted neutral fat but also the compound fat of the raw muscles of the tochu-fed eel and the control had the same TLC patterns and fatty acid composition by gas chromatographic analysis. There was a great difference between the tochu-fed eel and the control concerning the amount of muscle protein stroma fraction which mainly consisted of collagen. The microscopic observation showed that the perimysium and endmysium which were the main components of the stroma fraction of the muscle of the tochu-fed eel were firm and thick compared to those of the control. These findings suggested that the intake of tochu leaf powder hardened the muscle.

[Laparoscopy-guided extraperitoneal resection of ovarian cysts: surgical procedure, indications and limitations].

We designed a new surgical method for the treatment of benign ovarian cysts. We have previously reported that, with our laparoscopy-guided method, the cyst wall is pulled outside the abdominal cavity after evacuation of the cyst contents, and resection is performed by the same method as during laparotomy. The preoperative assessment and surgical findings were investigated in 16 subjects, 5 with simple cysts, 2 with para-ovarian cysts, 2 with chocolate cysts, 5 with dermoid cysts and 2 with mucinous cysts. This surgical method was applicable in 11 of the 14 patients. Laparotomy was required in the other 3, because 2 of the patients had strong adhesions and in 1 evacuation was impossible. The patients were classified into 3 grades of difficulty before surgery: Grade I; operable, Grade II; operable with special care, Grade III; laparotomy required. During surgery, the feasibility of continuing the procedure was also assessed. In this surgical procedure, through a small incision in the abdominal wall, the entire resection of an ovarian cyst is done extra-peritoneally. However, the eligibility of patients for this method needs to be very carefully examined preoperatively and reviewed throughout the procedure.