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Total laparoscopic hysterectomy (TLH) is becoming a standard minimally invasive procedure for benign pelvic diseases. However, TLH is not usually indicated in cases of large myomas or with severe adhesions in the cul-de-sac, etc., because TLH has been reported to have a higher incidence of injury to adjacent organs such as the ureters than abdominal hysterectomy. Therefore, we have adapted the retrograde hysterectomy, which has been used in abdominal hysterectomy, to TLH. We performed this procedure for 31 patients with indications in our institution from May 2008 to November 2009 with no complications. As a result, we propose that TLH using a retrograde approach can be safely performed in more severe cases.

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.

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.

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.

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.

Dynamic-range enhancement of a fiber optic sensor, which consists of an in-fiber Fabry-Perot interferometer (FPI) with chirped fiber Bragg gratings as mirrors, is demonstrated using multiple FPI resonant peaks in the pulse-position modulation scheme.

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.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.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.

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).

A new manufacturing process for extrusion molded magnets, composed of isotropic Nd-Fe-B powder and NyIon-12, has been developed. This newly developed extrusion molding process has several interesting features. First, the extruded product contains 72% by volume magnetic powder and yields a (BH) max of 8.0 MGOe. Second, through the addition of an anti-oxidant, the viscosity of the magnetic powder-nylon compound remains almost constant during molding. Third, by means of a specially cooled outlet, which is separated from the heated die by a thermal insulator, an optimized temperature profile is obtained which yields uniformly smooth extrusion molded magnets. Both long thin-walled magnets and small arc-shaped ("kawala") magnets are easily molded by this new process.

Study Objective To estimate the efficacy of the vasopressin injection technique for laparoscopic cystectomy of ovarian endometriomas with regard to operative time and coagulation events. Design Prospective study (Canadian Task Force Classification II-1) Setting Osaka Central Hospital in Osaka, Japan Patients Fifteen women with single lobular similarly-sized ovarian endometrioma. Interventions Women who planned to undergo laparoscopic cystectomy of endometrioma were allocated randomly to 3 groups: (1) ordinary laparoscopic cystectomy without injection, (2) laparoscopic cystectomy with the injection of saline solution, and (3) laparoscopic cystectomy with the vasopressin injection technique. Measurements and Main Results Reviewing the video, we counted the number of pinpoint bipolar coagulations on the normal ovarian cortex that were required from the beginning of stripping until hemostasis had been achieved, as well as the times required to achieve hemostasis. The group with the vasopressin injection technique required significantly fewer coagulation events (p=.041) to achieve hemostasis, as compared with the group receiving an ordinary cystectomy. Conclusion The vasopressin injection technique reduces the use of coagulation, in such a way as to suggest the possibility to protect ovarian reserves.

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.

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.

The X-ray crystal structure analysis of tertbutoxycarbonyl-L-phenylalanyl-D-leucine methyl ester showed two crystallographically independent molecules, each of them taking a similar open conformation in which the tert-butoxycarbonyl group and D-leucine isobutyl side chain are located facing parallel to each other. In the crystal, these molecules are piled up alternately along the b axis and form an infinite sheet structure through four independent NH...O-C hydrogen bonds

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.

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.

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.

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.

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.

An investigation on the conformations of highly receptor-selective opioid peptides was carried out to gain further understanding of the structure-activity relationship of endogenous enkephalins. The preferred conformations of a highly mu-selective [Val4]morphiceptin and a highly delta-selective delta-kephalin have been probed by 1H n.m.r. solvent-, concentration- and temperature-dependences of amide protons to take the folded conformations stabilized by an intramolecular hydrogen bond and the anti-parallely extended dimeric structures respectively. Their possible stereo-conformations were proposed, based on the analyses of the vicinal coupling constants (JHNC alpha H). The conformational difference between the mu- and delta-selective opioid peptides was further ascertained by the c.d. measurements. The c.d. spectra of the mu-selective peptides show negative bands in the range of 210-230 nm, while those of the delta-selective ones show the opposite positive bands. A correlation between c.d. spectra and receptor-selectivity was possible.

For quantitative estimation of sperm immobilizing antibody, a new assay method was developed and applied to a follow-up study of antibody titers in the sera of sterile women. The 50% sperm immobilization units (SI50) estimated by the quantitative method ranged from 1.2 to 97.3 in the sera from 16 sterile women who showed relatively high antibody activities in the previous semiquantitative sperm immobilization test. When the quantitative antibody titers, SI50, were followed over 3 years in sterile women with the sperm immobilizing antibody, the antibody titers were found to be unstable, and undulated over a period of several months. Therapy consisting of use of a condom seemed to be ineffective in decreasing the antibody titers.

The effect of sperm passage through cervical mucus (CM) on the fertilizing capacity of human spermatozoa was examined in the in vitro fertilization system of zona-free hamster eggs. Each drop of ejaculated semen and BWW culture medium was connected by a small capillary tube filled with preovulatory CM, egg white or BWW medium under liquid paraffin oil in a plastic petri dish. After 2 hours, zona-free hamster eggs were added to the drop of BWW culture medium containing spermatozoa which had passed through the capillary tube and the mixture was incubated for various lengths of time at 37 degrees C under 5% CO2 in air. Human spermatozoa, which were washed and preincubated for 2 hours in BWW medium, were capable of fertilizing zona-free hamster eggs but needed a longer incubation time than spermatozoa which had passed through CM. Fertilization rates of spermatozoa which had passed through CM and egg white were very similar, but no fertilization occurred in the drop containing spermatozoa which had passed through BWW medium, presumably because of the contamination with seminal plasma. These results indicate that the most important role of CM may be to separate motile spermatozoa from seminal plasma components hostile to fertilization.

The sperm penetration test (SPT) in cervical mucus (CM) is an important test in screening for sperm-CM incompatibility. For a routine SPT, a sufficient amount of preovulatory CM is necessary, but the amount of human CM is often inadequate. We examined estrous bovine CM as a substitute for human CM in the SPT. Preovulatory human CM and estrous bovine CM were collected and stored frozen at -20 degrees C until use. After being thawed at room temperature, the two CM samples were compared as to their pH, spinnbarkeit and ferning patterns, and it was found that they are quite similar. In Kremer's method of SPT, sperm penetration distance, density and motility were similar in human and bovine CM for 12 hours, but thereafter sperm motility became much lower in bovine CM than in human CM. The results of SPT with spermatozoa from patients with oligozoospermia were quite similar in both CMs. When spermatozoa pretreated with antisperm antibody were used for SPT, sperm penetration was completely blocked in human CM, but no inhibition was seen in bovine CM. From these results, we conclude that bovine CM can be substituted for human CM for some, but not all, purposes.

Rat spleen cells immunized to human azoospermic semen were fused with mouse myeloma cells (P3 X 63Ag8Ul) to obtain hybridomas which produce monoclonal sperm immobilizing antibodies. Of 114 hybrid clones obtained, 10 were found to produce antibodies with sperm immobilizing activity with complement. One clone (1C4) producing the highest antibody titer was chosen for further characterization. Chromosome analysis showed that 1C4 hybridoma cells contained two types of chromosomes which were derived from rat and mouse. Rat Ig was detected in both the cytoplasma and the culture medium of the cells by direct immunofluorescent test and immunodiffusion test, respectively. Gammaglobulin fractions from the culture medium had a strong sperm immobilizing activity and showed a common single precipitin line against human seminal plasma and human milk proteins. It was proved that the monoclonal antibody was produced to No. 7 antigen and not to No. 3 antigen (lactoferrin) in human seminal plasma, both of which have a common antigenicity to human milk proteins and compose the sperm coating antigens.

Thirteen infertile patients (18 cycles) with sperm immobilizing antibodies were subjected to in vitro fertilization and embryo replacement (IVF-ER) therapy during 12 months from January to December 1985. Four patients became pregnant, two of them delivered healthy babies at term and 2 had abortions at 5 weeks and 12 weeks of gestation, respectively. In the same duration, 24 patients (28 cycles) with tubal factor and 4 patients (5 cycles) with male factor for infertility were subjected to IVF-ER, and two patients with tubal factor became pregnant and delivered healthy babies at term. In the patients with immunological factor, fertilization and cleavage rates per mature oocyte were 85.9% (55 fertilized/64 oocytes) and 81.3% (52 cleaved/64 oocytes) respectively, while the fertilization rates in patients with tubal factor and male factor were 70.5% (62 fertilized/88 oocytes) and 50.0% (6 fertilized/12 oocytes) respectively and all fertilized eggs in these patients developed to the cleavage stage. Thus fertilization and cleavage rates for mature oocytes from the patients with the immunological factor were slightly better than those with the tubal factor and much better than those with the male factor. The antisperm antibody titers (SI50) in sera determined by the quantitative sperm immobilization test ranged from 20 to 243 units while those in follicular fluids ranged from 21 to 160 units in the patients with the immunological factor. The follicular sperm immobilizing antibodies could be detected in any patient who had the antibodies in the serum. Immunoglobulin (IgG, IgA, IgM) concentrations in follicular fluids were not significantly different from each other in the patients with immunological, tubal and male factor for infertility.

For detecting the sperm immobilizing antibody in the sera of infertile women with unknown cause, Isojima's sperm immobilization test was widely used, but there was great difference on the percentage of positive results among several laboratories. For analysis of factors influencing the sensitivity of the test, source and amount of complement were studied, and the following results were obtained. 1. Guinea pig serum which contained more than 200 CH50 as hemolytic titer was best for this test. 2. Rat and rabbit sera which contained much lower CH50 than guinea pig indicated relatively good sensitivity for the test. 3. Human serum which contained 34.9 CH50/ml and mouse serum which contained less than 5 CH50/ml, both could not work on sperm immobilization test. The human serum (AB) which was concentrated to the level of guinea pigs serum as CH50 did not work well on sperm immobilization test as guinea pig serum. 4. When the complement from same source was used, the positive correlation between CH50 (hemolytic titer) and 50% sperm immobilization titer (SI50) was present, but if the complement source was different, there was no correlation between CH50 and SI50. 5. It was proved that more than 10 CH50 of guinea pig serum was necessary for sperm immobilization test to obtain the most sensitive results.

In Isojima's sperm immobilization test, the complement is one of the most important factors which influence on sensitivity of the test. Previously we reported that more than 10 CH50 of guinea pig serum complement was necessary in the reaction to obtain the best result for measuring the sperm immobilizing antibody in the serum. This time, the influences of various test specimens on complement activities for the sperm immobilization test were studied and the necessary amounts of complement to detect the sperm immobilizing antibody in serum, cervical mucus and seminal plasma were compared. In the sperm immobilization test, the following results were obtained: 1. The amount of complement (guinea pig serum) added was 11.9 CH50, and after 60 minutes incubation at 32 degrees C in veronal buffer (VB2+), 2.0 +/- 0.3 (M +/- SD) of CH50 was consumed. 2. When human serum, cervical mucus and seminal plasma were added to the reaction as specimens, the complement consumptions (M +/- SD) were more 0.2 +/- 0.3 CH50, 0.2 +/- 0.2 CH50 and 3.3 +/- 0.8 CH50 than that of VB2+ buffer respectively. 3. When the washed human spermatozoa were added, the consumed amounts of complement (M +/- SD) were dose dependent; 3.5 +/- 0.7 CH50 for 100 X 10(4) spermatozoa, 7.3 +/- 0.3 CH50 for 200 X 10(4) spermatozoa and 15.7 +/- 2.2 CH50 for 400 X 10(4) spermatozoa. 4. In our sperm immobilization test, the net consumptions of complement (M +/- SD) were 5.0 +/- 0.7 CH50 for specimen of serum, 4.9 +/- 0.8 CH50 for specimen of cervical mucus and 11.1 +/- 1.2 CH50 for specimen of seminal plasma. 5. Complement doses necessary to obtain the most sensitive sperm immobilization tests were 10 CH50 for both serum and cervical mucus specimens, and 15 CH50 for seminal plasma specimen.

In order to apply the early pregnancy factor (EPF) to early diagnosis of fertilization, the establishment of optimal conditions for assay of EPF was attempted, and then EPF in the sera of contracepted and conceived women 4 to 6 days after ovulation were measured. For assay of EPF, 0.25 ml of 1:2 step diluted anti-human lymphocyte serum (ALS), 0.05ml of guinea pig serum as complement and 0.1ml of lymphocytes suspension (1 X 10(7)/ml) pretreated with test serum were mixed and then incubated at 37 degrees C for 90 min. To this mixture 0.1ml of sheep red blood cell suspension (2 X 10(9)/ml) was added and the rosette formation was counted after centrifugation. The rosette inhibition titer (RIT) was expressed as reciprocal of ALS dilutions which resulted in less than 75% of rosette formation as compared with the control. RITs of the conceived women who were assayed on the 5 th day after ovulation were in the range from 16 to 32 X 10(3), while that of the control contraceptive women who were assayed on the same day was in the range from 2 to 4 X 10(3). The sterile women who received AIH but failed to conceive all showed less than 4 X 10(3) as RIT. These results suggest that the assay of EPF is valuable in detecting the early stage of fertilization and possibly may help to differentiate the impairment of embryo implantation from non-fertilization of the ovum as a cause of sterility.