An alternative system for transvaginal removal of dermoid cyst and a comparative study with laparoscopy

The objective was to introduce a new system for transvaginal removal of ovarian cyst and to evaluate its feasibility. With a new transvaginal system, ultrasound-assisted culdotomy, and laparoscopy supported cystectomy if vaginal procedure failed. The authors conducted a retrospective review in which 35 cases using new vaginal ovarian cystectomy were compared with 40 cases of laparoscopic cystectomy for the treatment of dermoid cyst. All cystectomies were completed without conversion to laparotomy and complications. In a case from vaginal group, laparoscopy was required. No differences existed in operating time, hemoglobin decrease, and C-reactive protein value between groups. Laparoscopically supported vaginal ovarian cystectomy with ultrasound-guided culdotomy was equivalent to laparoscopic cystectomy as to invasiveness and preserved the option of a completely vaginal approach. When a presumed benign dermoid cyst is located in cul-de-sac, this operation may represent a preferable alternative to an exclusively laparoscopic or exclusively vaginal ovarian cystectomy. © The Author(s) 2012

Evaluation of transvaginal peritoneal surgery in young female patients

Background: The transvaginal approach is being used for natural orifice transluminal endoscopic surgery (NOTES), and reports of the clinical use of transvaginal NOTES have increased rapidly. However, hasty use of a transvaginal route may cause unexpected complications. Infertility or dyspareunia after transvaginal NOTES in young women is one of the most important issues to be resolved. The purpose of this study was to assess long-term complications, including infertility and dyspareunia, after transvaginal peritoneal surgery. Methods: An anonymous questionnaire was sent to 73 young patients who had undergone ovarian cystectomy using a transvaginal approach from 2003 to 2011. The questionnaire contained 15 questions; 6 dealt with fertility, and 8 dealt with discomfort after surgery. A 5-point scale was used to evaluate patients\u27 overall satisfaction with surgery. Results: Forty-four (60 %) questionnaires were returned. The patients\u27 mean age was 33.0 years, and the mean postoperative follow-up period was 16.5 months. Of responders younger than age 40 years, 24 did not use contraception, and 9 (38 %) conceived. The pregnancy rate among women younger than age 30 years was 60 %. Two (5 %) women reported temporary dyspareunia 1 month after surgery, but none developed permanent dyspareunia. The average patient satisfaction score was 4.12. Conclusions: There was no evidence to suggest that transvaginal peritoneal surgery causes infertility or dyspareunia. The majority of patients gave a high evaluation to vaginal ovarian cystectomy, suggesting the usability of a transvaginal approach for intraperitoneal surgery in young premenopausal women. © 2013 Springer Science+Business Media New York

The culdotomy two U procedure for vaginal ovarian cystectomy

When transvaginal removal of ovarian cysts is performed successfully, the procedure compares favorably with laparoscopy in terms of invasiveness. However, the approach into peritoneal cavity has been laborious. The objective was to evaluate feasibility of an ultrasound-guided culdotomy using a newly developed umbrella needle. New culdotomy was performed on 36 patients with ovarian cysts. Each cyst was directly punctured by the needle from vagina under ultrasound guidance. The vaginal walls on both sides of the needle were incised with an electric scalpel. Through the wound, cyst was exteriorized and enucleated. Preoperative characteristics of patients, outcome, operating time, blood loss, complications, and cyst histology were analyzed. Culdotomy was performed successfully in all cases. Operating time was less than 10 minutes and blood loss was less than 10 mL. There were no culdotomy-associated complications. Culdotomy assisted by ultrasound imaging and an umbrella needle is a simple, safe, and reliable method for vaginal ovarian cystectomy. © 2011 The Author(s)

Tamoxifen-induced ovarian hyperstimulation during premenopausal hormonal therapy for breast cancer in Japanese women

Purpose: Tamoxifen is an anti-estrogenic drug that is widely used for endocrine-dependent breast cancer as adjuvant hormonal therapy, and its use has been reported to be frequently associated with high levels of serum estradiol. Since the population of premenopausal women receiving tamoxifen therapy is growing in Japan, we retrospectively analyzed the incidence of ovarian hyperstimulation by tamoxifen therapy in Japanese women. Methods: Eleven patients who received surgical therapy for endocrine-dependent breast cancer and showed high values of serum estradiol during post-operative tamoxifen therapy were recruited in this study and evaluated by examining the serum concentration of follicular stimulating hormone (FSH) and follicular development. Results: The mean age, serum concentrations of estradiol and FSH, and follicular diameter were 41.3 years old, 1015.8 pg/mL, 11.8 mIU/mL, and 3.47 cm, respectively. In 6 cases, multiple follicular development was observed, while the other cases showed single follicular development with a mean serum estradiol level of 848.6 pg/mL and follicular diameter of 4.46 cm. There was no significant difference in age or FSH concentration between the two groups. The mean periods from the start of the single administration of tamoxifen to the initial detection of a high estradiol concentration was 716.5 days. Conclusions: These findings indicate that tamoxifen could stimulate the ovarian function even after 2-year treatment. Since single and multiple follicular developments with large sizes were observed, dual mechanisms through the inhibition of both negative and positive feedback to the hypothalamic-pituitary-axis can be proposed to explain the adverse effects of tamoxifen on ovarian function. © 2015, Yamazaki et al

血小板の上皮化促進作用に対する子宮体癌の不応性獲得機序の解明とその責任分子の同定

子宮内膜癌の浸潤能、転移能における血小板由来因子の作用について、実験的手法によって検討した。正常子宮内膜細胞に対しHPV-E6/E7/hTERTを導入した不死化モデル、さらにK-rasを導入した癌化モデルを用いて、血小板由来のmicroparticleもしくはchemokineを様々な条件で抽出・作用させ、表現型の変化を観察した。血小板とモデル細胞の共培養によって接着関連因子であるE-cadherinおよびリン酸化FAKの発現上昇が観察された。その他の、表現型の変化は、実験系の樹立に成功せず、評価できなかった。観察された接着関連因子の発現変化における責任因子の同定には至らなかった。The effects of platelet-derived factor on the invasive and metastatic potential of endometrial cancer were investigated by experimental in vitro models. We used HPV-E6/E7/hTERT- and additional Kras-transfected endometrial epithelial cells as immortalized and cancer models, respectively. Platelet-derived microparticles or chemokines were extracted and treated the cells under various conditions, and phenotypic changes were investigated.Co-culture of platelets with model cells resulted in increased expression of the adhesion-related factors E-cadherin and phosphorylated FAK. Other phenotypic changes could not be evaluated due to unsuccessful establishment of the experimental system. We were not able to identify the responsible factors for the observed changes in the expression of adhesion-related factors.研究課題/領域番号:18K09252, 研究期間(年度):2018-04-01 - 2021-03-31出典：「血小板の上皮化促進作用に対する子宮体癌の不応性獲得機序の解明とその責任分子の同定」研究成果報告書　課題番号18K09252（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/report/KAKENHI-PROJECT-18K09252/18K09252seika/）を加工して作