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Sporadic cases of fallopian tube prolapse and various methods of management have been reported since the initial case described in 1902. Two cases were managed recently by a combined vaginal and laparoscopic approach. Total salpingectomy was accomplished with minimal difficulty and limited invasiveness. A brief summary of each case and detailed description of the operative technique are presented.

TERUMO guide wire was used for treatment of urinary tract diseases in 30 cases of percutaneous nephrolithotomy, 35 cases of transurethral retrieval for ureteral stones and one case each of stricture of uretero-ileal junction with a ureteral stone, urethral stricture after mechanical instrumentation, and cystic dilatation of terminal seminal duct with hematospermia. The advantages of the use of TERUMO guide wire in the urinary tract are described. The rigid stem wire with a floppy terminal portion is superior to other types of guide wires concerning flexibility, elasticity, degree of sliding and maneuverability.

A combination of gonadotropin-releasing hormone agonist and human menopausal gonadotropins was used for ovulation induction in a patient with premature ovarian failure. A paradoxical suppression of any ovarian response was noted despite increasing doses of human menopausal gonadotropins.

In 1980, extracorporeal shock wave lithotripsy (ESWL) was incorporated as a nonsurgical method of stone removal in the cases of nephrolithiasis and rapidly found worldwide acceptance. Several devices commonly designated "second generation" lithotripters vs "first generation" Dornier HM3 are now under experimental or clinical trial. We report our clinical experience of ESWL using a Siemens Lithostar and compared it with that obtained using a Dornier HM3. One hundred patients were treated during the period of April through October, 1986 using an HM3, and 100 other patients were treated using a Lithostar from April to August, 1988. More cases were treated with a Lithostar than with a HM3. Nearly 10% of all patients treated by ESWL required additional therapeutic approaches (excepted ureteral stent) either with HM3 or Lithostar. However, in the cases of ureteral stone, with the Lithostar more cases required adjuvant procedures (TUL) than HM3. Significantly more shock waves were needed with Lithostar than HM3 for complete fragmentation of the same size of renal and ureteral stones. The stone-free rate during a one month period after ESWL was nearly the same for HM3 and Lithostar (HM3: 84.3%, Lithostar: 83.5%). Lithostar is a multifunctional lithotriptor which has most of the advantages required by the lithotripter.

During the past 10 years, we have experienced 110 bladder tumor cases. Among them, 70 patients were diagnosed superficial bladder tumor. Of these 70 cases, 30 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 13 with ADR only and one case with PEP and remaining 26 with TUR and hydrostatic pressure technique. We studied the efficacy of combination intravesical chemotherapy with ADR and PEP and other treatments in the prevention of recurrence in the superficial bladder tumor cases. The recurrence rate during 3 years of each group, was 25% in the group treated with ADR and PEP, 35% with ADR and 55% in remaining group. 3 years recurrence rate in the group treated with ADR and PEP was significantly low than that in the group tread with TUR and hydrostatic pressure technique alone (Wilcoxon test). Side effects was pollakisuria, pain after micturition and others. Anaphylactic shock appeared in one case. From these results we concluded that intravesical chemotherapy with combined agents is more effective than that with a single one or no treatment after TUR.

Clinical experience based on gynecologic practice in Hawaii indicated a high incidence of endometriosis among Oriental women. To investigate this impression, a statistical analysis of gynecologic admissions and of diagnoses of endometriosis was performed on the basis of race at three hospitals, two in Hawaii and one in Japan. The result supports the impression that the Japanese female population has a high incidence of endometriosis. Approximately 10% of their gynecologic admissions were for endometriosis. The order of incidence in other racial groups was non-Japanese Oriental, white, and black.

The medical records and histopathology of 250 patients who underwent cervical conization between January 1979 and December 1982 were reviewed. Two hundred thirty (92%) had endometrial curettage at the time of cervical conization. Abnormal findings were present in 7 (3%) of the 230 curettings. Limiting the performance of endometrial curettage at the time of conization to patients meeting specific criteria would have reduced the number of combined procedures by 75% without jeopardizing our ability to detect significant pathology. Endocervical curettage was performed on 221 (88%) of the 250 patients undergoing conization. The endocervical curettings were not a good predictor of the involvement of the cone margins with neoplasia. Only 7 (20%) of 35 patients with involved endocervical margins had a positive endocervical curettage. While the cone margins predicted residual carcinoma in the hysterectomy specimen with a sensitivity of 1.0, the sensitivity of the endocervical curettings for predicting residual carcinoma was 0.5. Although endocervical curettings can detect an invasive cancer not detected in the cone specimen, a negative endocervical curettage does not rule out invasive cancer above the excision line.

C-reactive protein (CRP) is one of the most characteristic acute phase proteins which appear in the serum during certain inflammatory diseases. We report here that human CRP acquired the ability to augment platelet reactivity when treated with an Fe2+ (Cu2+)-ascorbate system. CRP modified by such treatment showed no appreciable activation of platelets in the absence of platelet activators such as platelet-activating factor, thrombin, or ADP. However, in the presence of the modified-CRP, irreversible activation of platelets occurred with sub-optimal doses of platelet-activating factor and other stimulatory agents for platelets. CRP without any treatment did not show any modulating activity. Each component of the Fe2+-ascorbate system was required for modification of CRP, suggesting that CRP was modified through an oxidative process. The modification of the CRP structure was confirmed by the change in the fluorescence spectrum of 8-anilino-1-naphthalene sulfonate complexed with CRP, the increased susceptibility of CRP to proteolytic enzymes and the altered reactivity to anti-CRP mAb. We also found an inactivating system for the modified CRP in plasma. The modified human CRP did not show any modulating activity toward rabbit platelets, suggesting that the activity is species specific.

A frequency stabilized IMPATT source for application to radio astronomy and plasma diagnostics has been developed. A harmonic mode of IMPATT operation is phase-locked through injection locking of the fundamental mode. An automatic frequency control system is used to stabilize the injection source of a Gunn device operating at the frequency desired.

Between 1980 and 1984, 406 patients were referred to Tripler Army Medical Center's cervical clinic for the evaluation of atypical squamous cells in a Papanicolaou smear. Their evaluation included repeating the smear, colposcopy in all cases, colposcopically directed biopsies, and/or endocervical curettage in 70%. The results of the repeat Papanicolaou smear in 400 patients were 274 (68.5%) negative, 77 (19%) atypical squamous cells, 40 (10%) cervical intraepithelial neoplasia (CIN) 1, seven (2%) CIN 2, and two (0.5%) CIN 3. No invasive cancer was detected. Dysplasia was documented histopathologically in 18.7%, but a repeat smear was reported as negative in 10.9% of patients with biopsy-proven dysplasia. A Papanicolaou smear report of atypical squamous cells should not be considered normal, and further evaluation of the patient is required. If colposcopy is impractical, serial follow-up smears are recommended.

From July 1, 1978 to June 30, 1984, 45 radical abdominal hysterectomies were performed by the authors at Tripler Army Medical Center. Management was uniform except for the use of prophylactic antibiotics. Three patterns of practice were identified: Group I, no antibiotics were used; Group II, intravenous (i.v.) antibiotics were given in the induction room and for less than 48 h post-surgery; Group III, prophylactic i.v. antibiotics were given and the surgical site was also irrigated with a cefamandole and saline solution. The three groups were found to be similar with regard to age, parity, weight-height index, pre- and postoperative hematocrit, pre-operative white blood cell count, operative and anesthesia times, estimated blood loss, and amount of blood transfused. Groups I and II had a higher surgical site infection rate (87.5% and 63.6%, respectively) than Group III (3.8%). The mean 10-day fever index in degree hours was 109 for Group I, 71 for Group II, and 30 for Group III (P less than 0.001). Irrigation of the surgical site with a cefamandole and saline solution in addition to i.v. antibiotics decreases the infectious morbidity of radical hysterectomy.

Antibacterial activity of cefmenoxime (CMX) against clinically isolated organisms was examined in comparison with that of 4 other antibiotics and concluded as follows: Antibacterial activity of CMX was markedly stronger than those of cefazolin (CEZ), cefmetazole, latamoxef and ampicillin against E. coli, K. pneumoniae, S. marcescens, H. influenzae, P. mirabilis and indole positive Proteus. But the MIC level of CMX against S. aureus was higher than that of CEZ.

To evaluate different methods of radiation therapy for advanced vulvar malignancy, a retrospective study was done on 33 patients treated with radiation between 1950 and 1979. Group I consisted of 18 patients treated with surgery and radiation and group II of 15 patients treated with radiation alone. The patients received several kinds of radiation therapy. Group I received radiotherapy because of local recurrence or positive lymph nodes found in the groin and/or pelvis; the overall survival in that group ranged from 3 months to 11 years. Group II received radiation only because of locally advanced disease and/or associated medical problems; the overall survival in that group ranged from 2 to 40 months. We concluded that megavoltage radiation minimized the local reaction and that better local control was obtained with a combination of photons and electrons and an interstitial implant. Postoperative radiation for positive lymph nodes prevented local recurrence but did not seem to improve survival.

A highly stable and low noise IMPATT oscillator at 75 GHz is realized by using the parametric injection locking technique along with an AFC circuit in which a crystal oscillator is used as a reference. Noise level of this oscillator is lower by 25 dB as compared with that of the free-running IMPATT oscillator and the frequency stability is as good as 10/sup -8/ / /spl deg/C.