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Abstract: Objective: To evaluate the clinical outcomes of traditional surgical approaches to pelvic organ prolapse. Methods: From January 20, 2000, to March 24, 2009, 182 patients underwent traditional prolapse surgery at Osaka City University Graduate School of Medicine, Osaka, Japan, after prolapse assessment by the pelvic organ prolapse quantification system. Incontinence, defined as more than 2g of urine leaked in a 1-hour pad test; posterior urethrovesical angle, using chain cystography; and quality of life (QOL), using a face visual analog scale, were assessed 1, 3, 6, and 12months postoperatively, and then annually for 2 more years, in the 167 patients who completed follow-up. The presence of lower urinary tract symptoms was determined preoperatively and postoperatively. Results: The anatomic and subjective recurrence rates were 21.0% and 6.0%. There was a significant difference in time to recurrence between anatomic and subjective prolapse. The posterior urethrovesical angle was improved postoperatively. The prevalence of lower urinary tract symptoms was 67.1% preoperatively and decreased to 28.2%, 17.2%, 16.2%, 15.6%, and 15.6% at 1month, 6months, 1year, 2years, and 3years, respectively, and QOL was improved postoperatively regardless of anatomic recurrence. Conclusion: Anatomic support and QOL were satisfactory after traditional prolapse surgery. [Copyright &y& Elsevier]

ABSTRACT Objectives To investigate time intervals of ductus venosus (DV) flow velocity waveforms (FVW) in correlation to fetal heart rate and gestational age and to construct reference ranges for the second and third trimester. Furthermore, we investigate time intervals of FVW through the tricuspid valve. Methods Flow velocity waveforms of the DV and through the tricuspid valve were recorded in 135 normal singleton fetuses between 17 and 38 weeks' gestation. Time intervals for systolic (S) and early diastolic (D) peaks were analyzed regarding acceleration time (acc-S for S, acc-D for D) and deceleration time (dec-S for S, dec-D for D), respectively. Similarly, time intervals for both peaks of right ventricular inflow were analyzed regarding acceleration time (acc-E for E-wave, acc-A for A-wave) and deceleration time (dec-E for E-wave, dec-A for A-wave), respectively. Results In the DV, acc-D and dec-D increased significantly with gestational age. In tricuspid valve, acc-E and acc-A showed a significant increase with gestational age. All parameters except acc-S showed significant negative correlations with fetal heart rate. Conclusion With advancing gestational age, prolongation of the diastolic phase of DV-FVW and of the E-wave of tricuspid flow was observed, suggesting maturation of ventricular diastolic function. Time-related analysis of Doppler signals of DV-FVW may provide detailed insights into fetal cardiac function. © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Uterine leiomyosarcoma (LMS) is a highly metastatic smooth muscle neoplasm for which calponin h1 is suspected to have a biological role as a tumor-suppressor. We earlier reported that LMP2-null mice spontaneously develop uterine LMS through malignant transformation of the myometrium, thus implicating this protein as an anti-tumorigenic candidate as well. In the present study, we show that LMP2 may negatively regulate LMS independently of its role in the proteasome. Moreover, several lines of evidence indicate that although calponin h1 does not directly influence tumorigenesis, it clearly affects LMP2-induced cellular morphological changes. Modulation of LMP2 may lead to new therapeutic approaches in human uterine LMS. [Copyright &y& Elsevier]

Aim: To clarify the effects on uterine arterial flow velocity waveforms of uterine contractions following oxytocin infusion and during spontaneous labor. Methods: Uterine arterial flow velocity waveforms were obtained by pulsed Doppler methods from 22 women during an oxytocin challenge test (OCT), 26 women during oxytocin-induced labor, and 40 women during spontaneous labor. Mean resistance index (RI) for bilateral arteries was used for analyses. After the onset of labor, flow velocity waveforms were assessed according to cervical dilatation. During OCT, Doppler flow velocimetry was performed when three uterine contractions occurred per 10-min period. Results: RI values did not differ significantly between induced and spontaneous labor during relaxations at any level of cervical dilatation. However, during contractions, RI was significantly higher for induced labor than for spontaneous labor. Absence or reversal of flow was more frequent in the OCT group than in the induced labor group ( P < 0.0001). However, no significant differences were found between spontaneous and induced labor groups. Conclusion: Interactions between the contracting uterine body and the relaxing lower segment in oxytocin-induced labor might be associated with differences in uterine arterial flow during contraction between oxytocin-induced and spontaneous labor. However, changes in the intensity of uterine contractions during labor progression might differ between oxytocin-induced and spontaneous labor. [ABSTRACT FROM AUTHOR]

Aim: To explore parameters relating to shrinkage of submucosal myomas after microwave endometrial ablation. Methods: Fourteen patients underwent microwave endometrial ablation at 2.45 GHz using a curved microwave applicator to treat menorrhagia caused by a submucosal myoma. The size of myomas was measured on magnetic resonance images before, one month after, and six months after the operation. The average radius r was defined as half of the size of the myoma measured in three dimensions. The protrusion ratio α was defined as the ratio of the thickness of the protruding part of a myoma in the uterine cavity to the size of the myoma before the operation. The ratio of the directly necrotized volume by microwave irradiation to the total volume ( RODNeV) of preoperative myomas was calculated using the following formula: where d is the depth of myoma tissue directly necrotized by microwave irradiation. The relationships of preoperative α, r and RODNeV to postoperative shrinkage were then examined. Results: Two-dimensional plots showing shrinkage of submucosal myomas versus the RODNeV indicated that shrinkage at six months after microwave endometrial ablation depends on the RODNeV. Myomas with a RODNeV greater than 0.17 had shrunk more than 50% at six months after the operation. Conclusions: RODNeV is closely related to postoperative necrosis and shrinkage of the submucosal myoma after microwave endometrial ablation. Prediction of the shrinkage rate of submucous myomas appears to be possible by calculating the RODNeV preoperatively. [ABSTRACT FROM AUTHOR]

Aim: The effects of transcervical microwave myolysis at 2.45 GHz after microwave endometrial ablation for menorrhagia were examined in patients with myomas. Methods: A transcervical microwave irradiation system assisted by transvaginal ultrasonic guidance was developed. Ten patients waiting for microwave endometrial ablation for menorrhagia caused by myomas entered the study after complete informed consent was obtained. Their outcomes were examined at least 6 months after transcervical microwave myolysis using the system. After completion of microwave endometrial ablation, interstitial microwave irradiation was performed using a guiding needle set in a puncture adaptor attached to a transvaginal ultrasonic probe and a microwave applicator of 1.6 mm in diameter. Shrinkage of the myoma was measured at 3 months and ≥6 months after the operation. Results: In nine patients with typical myomas, the major part consisting of a submucous or an intramural node 4.0–7.5 cm in size was necrotized. The typical myomas had shrunk by 41–68% at 3 months and 37–69% at ≥6 months after the operation. In one patient with a 6.8-cm cellular leiomyoma, necrosis was limited to the neighborhood of the applicator tip. Shrinkage was 17% at both 3 and 6 months. This patient required a second microwave endometrial ablation at 6 months to treat recurrent menorrhagia. None of the patients underwent hysterectomy after the treatment. No remarkable complications were encountered. Conclusions: Typical myomas shrink after microwave myolysis following microwave endometrial ablation. Transcervical microwave myolysis seems to be applicable as a low-invasive treatment for a typical myoma. [ABSTRACT FROM AUTHOR]

Aim: To examine the feasibility of microwave endometrial ablation (MEA), using a curved microwave applicator, in patients with menorrhagia caused by a submucous myoma greater than 3 cm in diameter, which is among the contraindications for conventional endometrial ablation. Methods: Patients included were refractory to medication, more than 45 years of age, and due to undergo hysterectomy to treat menorrhagia as a result of submucous myomas, although they hoped to avoid hysterectomy. Three patients underwent MEA at 2.45 GHz using a curved microwave applicator and microwave tissue coagulator to treat menorrhagia. Patients 1, 2 and 3 had submucous myoma nodes 4.5, 5.0 and 13 cm in diameter respectively. The applicator was guided under transabdominal ultrasonography to microwave irradiation sites arranged to cover the entire uterine lining based on preoperative magnetic resonance images. MEA was performed under general anesthesia or spinal anesthesia. Microwaves were irradiated at 40 W for 50 s for single irradiation sites. Results: Patient 1 became amenorrheic after the second MEA, which was performed 2 months after the first operation. Patients 2 and 3 became amenorrheic after the first MEA. Postoperative abdominal pain was controllable by a suppository of non-steroidal anti-inflammatory drugs. The patients were discharged the day after the operation. No remarkable complications were encountered during or after surgery. Conclusion: Microwave endometrial ablation improves menorrhagia caused by large submucous myomas when the microwave applicator reaches all parts of the uterine cavity. [ABSTRACT FROM AUTHOR]

Aim: We investigated microwave power and duration of use, which does not affect extrauterine organs, in order to treat organic menorrhagia caused by myomas or adenomyosis. Methods: Electric fields around a microwave applicator at a frequency of 2.45 GHz were calculated using the finite element method with commercially available software for analysis of electromagnetic fields. Transient temperature distributions around the applicator were obtained by numerically solving the bioheat transfer equation during microwave irradiation for 120 s in the human uterus and swine liver. We compared areas enclosed by the 60°C isotherm obtained using numerical simulations and necrosis areas after microwave irradiation. Postoperative avascular areas in a Gd-enhanced MRI of a uterus enlarged by adenomyosis after clinical microwave endomyometrial ablation were compared with numerical simulations. Results: There was good agreement between the calculated results and the experiments. At 40 W of output power for 50 s of duration and 64.5 W for 100 s, the depth of the necrotized uterine wall did not increase beyond 7 mm and 11 mm, respectively, either in the calculations or the experiments. Generally, the 50°C isotherm was located approximately 2 mm external to the 60°C isotherm in temperature distributions. The Gd-enhanced MRI after the operation depicted avascular areas, which agreed with the results of numerical simulations. Conclusions: The myometrial portion of a uterine wall ≥13 mm throughout the uterus irradiated for ≤64.5 W for 100 s is sufficient to avoid thermal damage of the extrauterine organs during microwave endomyometrial ablation. [ABSTRACT FROM AUTHOR]

Human parvovirus B19 infection has been shown to be transmissible by blood and blood products and to result in transient aplastic crisis in patients with rapid red cell turnover. We report three cases of iatrogenic parvovirus B19 infection resulting from the use of the same batch of fibrin sealant under operation. Fibrin sealant, which is a typical haemostatic agent produced from blood, has been used during surgery. Human parvovirus is resistant to existing virus-inactivating techniques, suggesting that infection may occur from blood products contaminated with it. Use of recombinant products for these proteins may thus be necessary. [ABSTRACT FROM AUTHOR]