Preservation of tubal function following methotrexate treatment for ectopic pregnancy

To evaluate methotrexate (MTX) administration as a conservative treatment for ectopic pregnancy, we reviewed the medical records of 248 cases (210 patients) of MTX treatment for tubal pregnancies at our department between December 1985 and December 2003, and compared its pregnancy prognosis with that of laparoscopic salpigotomy (59 patients). With the MTX treatment, 185 patients were successfully treated, and the subsequent pregnancy rate and ectopic pregnancy rate were 48.4 % and 18.4 %, respectively, while those rates were 49.2 % and 18.6 %, respectively, after the salpigotomy. These results suggest that MTX treatment is comparable to the more conservative operation. To clarify the (dys/) function of the ectopic implantation tubes and MTX-treated tube (s), we excluded patients who had a contra-lateral healthy tube, and extracted 40 patients as "the affected tube group", where the pregnancy-related parameters were not adversely affected. The findings suggest that MTX is not necessary to preserve tubal function.     

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects.Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.     

Beneficial aspect of oral estriol as hormone replacement therapy: consideration on bone and lipid metabolism

To improve the quality of life of elderly people in Japanese society where women have the longest life expectancy in the world, osteoporosis, and hyperlipidemia are among the major targets of medical treatment. To differentiate two types of regimens for hormone replacement therapy (HRT), we tried to evaluate the efficacy on lipid and bone metabolism. With informed consent, 34 postmenopausal women of more than 2 years were assigned to receive 1 of 2 types of HRT (the HRT group) for 12 months observation: one with a combination of conjugated equine estrogen (CEE) 0.625 mg/day and medroxyprogesterone acetate (MPA) 2.5 mg/day (the CEE group), and the other with oral estriol (E3) 2 mg/day (the E3 group). Parameters of serum lipid were measured, as well as those of bone metabolism with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DEXA) using QDR-2000. In HRT groups, lipid and bone metabolism were confirmed to be improved. Whereas, an increase of triglycerides (TG) observed in the CEE group was not observed in the E3 group. Thus, in the clinical management of postmenopausal women, oral E3 preparation as an alternative regimen for HRT for CEE might be efficacious.     

The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases

The successful long-term outcome of microvascular decompression for trigeminal neuralgia is largely dependent on the maintenance of the isolation between the trigeminal nerve and the offending vessel, avoiding also the development of scar tissue around the nerve. We propose an alternative technique to achieve this target by "hanging" the offending vessel from the overlying tentorium using a strip of autologous tissue without interposing any foreign material.     

Solitary plasmacytoma of the upper cervical spine: therapeutic considerations

Solitary plasmacytomas are localized plasma cell malignancies involving bone marrow (solitary bone plasmacytoma, SBP) or extramedullary tissues (solitary extramedullary plasmacytoma, SEP). The upper cervical spine involvement by SBP is a rare and more challenging condition. The authors describe a patient with solitary plasmacytoma involving all the elements of C2 vertebra. Severe neck pain was the only manifestation of disease. The patient underwent an occipito-cervical stabilization with a partial decompression through a single posterior approach. The authors stress the importance of early diagnosis followed by appropriate multidisciplinary treatment strategies, including surgery and discuss the management dilemmas concerning the timing and management consequence, in scope to prevent a major neurological damage and allow the patient to be ambulatory.