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Purpose: To analyze the usefulness of intravaginal insemination (IVI) for the infertility treatment in couples with sexual dysfunction before applying assisted reproductive technology (ART)., Methods: Among 208 couples who presented sexual dysfunction, 144 couples underwent IVI procedures. The profiles of pregnant and non-pregnant patients were compared., Results: Of 144 patients, 58 women conceived successfully (40.3% pregnancy rate). Between the pregnant and non-pregnant cases, the husband's age and infertility period were significantly higher ( P  = .0104) and longer ( P  = .0027) in the unsuccessful cases than the successful ones. The husbands who could not impregnate had a significantly higher ratio of sperm abnormalities ( P  = .0048). Among the 57 successful cases who underwent IVI treatment, 38 (66.7%) patients became pregnant within 3 times of the procedure, while 48 (84.2%) patients conceived within 6 times., Conclusion: The authors can propose the following inclusion IVI criteria for couples with sexual dysfunction: (a) younger husband (36 years old or less) which may be most important, (b) infertility duration of 3 years or less, (c) normal sperm condition, and (d) IVI trial for 3 times (maximum of 6 times). Since IVI appears to be a simple, noninvasive, and inexpensive way for couples with sexual dysfunction, it can be attempted before ART application., Competing Interests: The authors report no declarations of interest., (© 2021 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.)

Objective: To report a case of cystic cervical endometriosis that caused a massive hemorrhage due to rupture of a cyst and successful management with a loop electrosurgical excision procedure (LEEP)., Design: Case report., Setting: University Hospital., Patient: A 37-year-old nulliparous woman., Intervention(s): Medical management including surgical treatment., Main Outcome Measure(s): Clinical follow-up and pathologic diagnosis., Result(s): A hemorrhagic cystic cervical mass was excised with emergent LEEP. The mass was found to be cervical endometriosis. There was no evidence of recurrence until 1 year after excision., Conclusion(s): Cystic formation of cervical endometriosis--like ovarian endometrioma, which causes a massive hemorrhage due to rupture--is extremely rare, although cervical endometriosis is generally asymptomatic. Hysterectomy is considered in such cases but can be avoided via LEEP that incorporates partial excision of the uterine cervix.

A sandwich-type enzyme immunoassay system specific for human chorionic gonadotrophin (hCG) was prepared with the antibody Fab'-beta-D-galactosidase complex and the antibody F(ab')2-immobilized silicone rubber solid phase by using a purified antibody to beta subunit of hCG (hCG beta). The assay system cross-reacted less than 4% with human luteinizing hormone (hLH) and human follicular stimulating hormone (hFSH), and proved to be highly sensitive with hCG measurable at levels as low as 0.3 mIU per assay tube. Using 50 microliter of serum sample, 6-600 mIU/ml of hCG in serum could be determined specifically with the same degree of precision as in radioimmunoassay but without sample interference with the assay. The coefficients of variation within-run and between-run were 8.6-8.9%, and 4.9-10.7%, respectively. Values obtained with the enzyme immunoassay correlated well with those of radioimmunoassay (r = 0.98, slope = 0.94, y-intercept = 10.2 mIU/ml for 75 serum samples). Results of the immunoassay of hCG levels in serial samples of serum from healthy women and patients with choriocarcinoma show that this method is useful in the clinical diagnosis of trophoblastic disease.

From 1961 to 1977, thoracotomy was performed on 19 patients with pulmonary metastasis of choriocarcinoma in Nagoya University with regard to the role of thoracotomy in management of pulmonary metastasis of choriocarcinoma. Our surgical indications for the disease are: 1) the patients must be a good risk for surgical intervention. 2) The primary malignancy be controlled. 3) Evidence of pulmonary metastasis be limited to the lung. 4) The urinary human chorionic gonadotropin (hCG) titers should be controlled at low levels below 1000 mIU/ml by preoperative chemotherapy. At levels below 200 mIU/ml, the indication for surgery will be assessed by the cellular response to chemotherapeutic agents. As an operative procedure, in view of a low incidence of lymph nodes metastases, extended pulmonary surgery appears to be unnecessary providing that the gross pulmonary lesion is removed by partial resection of the lung or lobectomy. Postoperative adjuvant chemotherapy is required to induce a complete remission of the choriocarcinoma.

In patients with trophoblastic tumors, changes in immuno-capacity through their clinical courses were examined, by 1) 3H-thymidine uptake by PHA-stimulated peripheral lymphocytes using whole blood microculture assay (common cellular immunity), and 2) the effects of patients' sera to 3H-thymidine uptake by PHA-stimulated peripheral blood lymphocytes (humoral factor). Hydatidiform mole: After molar delivery, cellular immunity accelerated, and humoral suppressive factor significantly increased. Invasive mole: No significant change was observed in the cellular immunity, but humoral suppressive factors increased gradually as the therapies proceeded. And the suppressive apex came at about the 60th day of admission, but these factors decreased afterwards. Choriocarcinoma: At initial time, cellular immunity accelerated significantly, and from the 60th day to the 90th day of admission, this cellular immunity declined significantly compared with that in the pretreated state. But cellular immunity was not entirely eliminated by the courses of treatment. The humoral suppressive apex came at about the 120th day of admission. Nevertheless, where death unfortunately occurred, humoral suppressive factors were not so numerous. As a whole, from the viewpoint of immunotherapy in patients with choriocarcinoma, common immunity which was observed in this study did not decline, so that specific immunotherapy must be regarded as likely kept in mind.

1. The findings of 30 cases of cerebral metastasis of choriocarcinoma on autopsy were analysed in relation to their localization, depth, and number, and it was proven that the cerebral metastasis was neurosurgically resectable in most cases. 2. Thirty-five cases of choriocarcinoma with cerebral metastasis were treated at Nagoya University Hospital. Twenty-four out of 26 cases treated by chemotherapy alone died within 2 months after the manifestation of cerebral metastasis. Whereas 6 out of 9 patients treated by chemotherapy and surgery survived for over 2 months. Four cases among them survived over 6 months. The lifesaving effects of surgery were marked in this group. 3. Surgery was thought to be especially effective on those patients satisfying the following 3 conditions: I) Degree of brain damage is not severe. II) The lesion is localized at removable site, and the post-operative sequela is anticipated to be insignificant. III) The chemotherapy was not proven to be ineffective. 4. Cerebral metastasis of choriocarcinoma should be treated as follows. If symptoms of increased intracranial pressure are present, removal of tumor or, at least, decompression should be immediately performed. Multi-drug chemotherapy and whole-brain irradiation should be started within several days after surgery. If symptoms are not present, chemotherapy combined with irradiation is the first treatment of choice.

One hundred and sixty-five patients of choriocarcinoma were treated during the period from 1957 to 1979. Pulmonary metastases were found in 111 of the 165 patients. The authors found that surgical intervention for pulmonary metastasis was an extremely effective means for the patients who were not cured by chemotherapy and satisfied the criteria that we newly established for surgery. All patients satisfied the criteria achieved primary complete remission and their three years survival rate was 80%. The timing for surgery was also discussed and it was concluded that pulmonary surgery should be adopted when patient's urinary hCG values persisted at the level below 1000 iu/l for 70-80 days period.

One hundred and eighty-two cases of choriocarcinoma were treated in our clinic during the 26 years period from 1957 to 1982. Forty-one patients among them (2.3%) had cerebral metastases. Analysis on the autopsy findings of patients with cerebral metastases of choriocarcinoma proved neurosurgical resectability in most cases. Craniotomy and removal of cerebral metastatic lesion has been adopted since 1972, and a significant difference was noted in the surviving time between surgically treated group and the group without surgery. The risk factors for developing brain metastases were analyzed. Patients whose uterine lesion showed immature type of histopathology (p less than 0.01), patients without uterine lesion (p less than 0.05) and patients with pulmonary metastasis (p less than 0.01) had higher risk of developing cerebral metastasis.

A sandwich-type enzyme immunoassay for human chorionic gonadotropin (hCG) was developed with anti hCG-beta antibody-enzyme complex and the immobilized solid-phase antibody which was prepared from the antiserum to the synthetic peptide corresponding to the carboxyl-terminal region of the beta-subunit of hCG (hCG-beta). This assay system showed a high sensitivity equal to the radioimmunoassay and did not cross-react with human luteinizing hormone (hLH), human follicle stimulating hormone (hFSH) or alpha-subunit of hCG (hCG-alpha). The coefficients of variation in within-run and between-run were less than 10% and there was a good correlation between the enzyme immunoassay and the radioimmunoassay of serum sample with a regression equation of y = 1.038 x -0.647 and a correlation coefficient of r = 0.953.

A total of 39 patients was admitted to the obstetric and gynecological wards of Nagoya University Hospital and the University's 5 related hospitals during the period from July 1981 to March 1982. The efficacy of cefoxitin sodium was evaluated in the 39 patients with a wide variety of obstetric and gynecological infections. The findings are the follows: Of the 39 patients, the responses in 7 were judged "excellent", 28 "good" and 4 "poor" with the clinical efficacy rate of 89.7%. The causative pathogens in 23 of the cases were isolated from clinical materials submitted to the Institute of Anaerobic Bacteriology, School of Medicine, Gifu University. In these 23 cases, it was found that 8 were due to aerobic bacteria only (34.8%), 8 mixed aerobic-anaerobic bacteria (34.8%) and the remaining 6 anaerobic bacteria only (26.1%), i.e. a substantial percentage (60.9%) was due to anaerobic bacteria or mixed aerobic-anaerobic bacteria. Cefoxitin was active against most strains of Bacteroides spp. and was not affected by the inoculum size. On the other hand, most strains of Bacteroides spp. were resistant to cefazolin when the inoculum size was increased from 10(6)/ml to 10(8)/ml. Lincomycin was also found to be active against many fo the strains of Bacteroides spp. Cefoxitin and cefazolin were fairly active against anaerobic bacteria other than Bacteroides spp., while these same bacteria were resistant to sulbenicillin and many of them showed resistance to lincomycin. Cefoxitin was well tolerated and no untoward side effects were observed. The clinical and bacteriological results indicate that cefoxitin is a very effective antibiotic in the treatment of a wide variety of obstetric and gynecological infections and is a suitable choice as initial antibiotic therapy in these conditions.

To clarify the clinical significance of ultrasonography (USG) in the therapeutic course of invasive mole and choriocarcinoma, a detailed study of USG images from 31 patients, taken upon admission, in which an abnormal condition was clearly indicated, was undertaken. In addition, the clinical value of the pulse doppler and color doppler images used to determine the blood flow was also studied. The results revealed the following points. 1) Before the 1st therapy, USG conditions could be classified into three categories, type I (massive echogenic), type II (one or more echo free space (EFS) surrounded with a massive echogenic area) and type III (EFS). 2) A large number of patients with invasive mole exhibited type II, with a few exhibiting type III. A large number of patients with choriocarcinoma exhibited type I, and a few exhibited type II. 3) A comparison with PAG conditions showed a high correlation between the pooling image in PAG and the EFS in USG. 4) There was a positive correlation between the estimated volume of the tumor at the start of therapy and the hCG value in urine. In the chemotherapy patients, the reduction of hCG was accompanied by shrinkage of the tumor, and in 9 out of 22 patients (40.9%), the tumor disappeared on the USG at the point where the hCG became negative. 5) 14 of 22 chemotherapy patients (63.6%) matched the "Standard Progress" course, which was decided and based on the changes observed in the USG image over the course of chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The remarkable improvement has been recently made in the treatment of choriocarcinoma, about 80% of survival rate has been achieved. This improvement was acquired according to appearance and betterment on administration method of MTX and ACTG, surgical treatment for pulmonary and cerebral metastases and irradiation for cerebral metastases. Recent died cases were analysed and divided into two groups; one group consisted of recurrent cases and the other consisted of those who, at first showed good response to therapy resulted in drop of hCG value and reduction of tumor, however, then showed gradual reincrease of hCG and expired at latt. Therefore for achieving the 0% of mortality rate, it is a important subject to exterminate the death from recurrence and clarify more aggressive treatment method at the time when reduction of the tumor is obtained.