Despite the expanding role of laparoscopic surgery in many gynaecological fields, some discrepancies still exist regarding the efficacy of laparoscopic myomectomy in treating patients with large ...symptomatic leiomyoma.. in this report,, a better operative procedure and the results of treatment are evaluated. Patients (n = 14) presenting with infertility, menorrhagia, pressure symptoms or pelvic mass associated with a large leiomyoma were managed with laparoscopic myomectomy using airlift gasless laparoscopy. Uterine size ranged from 14 to 24 weeks gestational age and the weight of the myoma ranged from 246 to 669 g (mean 454); operatIve time ranged from 78 to 165 mm (mean 104) and blood loss from 90 to 580 ml (mean 201). No major complication occurred during the operation or follow-up. All except one patient were discharged within 72 h of the operation and resumed normal activity within 1 week.. When myomectomy is Indicated, the airlift gasless laparoscopic approach appears to offer a better alternative to abdominal or pneumoperitoneum laparoscopic surgery in selected cases. Airlift gasless laparoscopy has several advantages: (i) small abdominal incisions and minimal endoscopic equipment are required; (ii) the excised leiomy omata mass can be easily cut into strips and removed through the small abdominal incision; (iii) the uterine defect can be more efficiently repaired using easily per formed suture techniques; (iv) high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitonewn; and (v) the poten tial risk of metabolic and haemodynamic derangements during pneumoperitoneum laparoscopy are obviated. Gasless laparoscopy also has some disadvantages. The exposure obtained with gasless laparoscopy is not as good, under some circumstances, as that achieved by pneumoperi toneum. For patients who are thin, and even those with moderate obesity, the exposure obtained with airlift mechanical suspension is adequate however, morbidly obese patients and patients with previous abdominal sur gery with suspected pelvic adhesions can incur some prob lems during the operation because of a poor operative field.
Endometrial cancer is predominately a postmenopausal disease. Endometrial cancer in women of childbearing age is relatively unusual. Endometrial cancer is typically treated with hysterectomy. After ...the development of endometrial cancer, successful pregnancy is rare. We present a case of recurrent stage I endometrial adenocarcinoma in a 35-year-old woman. Magnetic resonance imaging (MRI) revealed endometrial lesions without myometrium invasion and no pelvic lymph node enlargement. The patient refused surgical intervention with abdominal hysterectomy and bilateral salpingo-oophorectomy because of her essential desire for children. Fertility-preserving medical therapy with megestrol acetate for 1 year and subsequent assisted reproductive treatment (ART) were performed. Successful pregnancy occurred after in vitro fertilization-embryo transfer (IVF-ET). On the basis of these observations and the low malignant potential of well-differentiated endometrial carcinoma, fertility-preserving treatment using Megace therapy was suggested. In this case, recurrence occurred after the completion of Megace therapy and three failed attempts at artificial insemination by the husband (AIH). Recurrent endometrial adenocarcinoma was documented using hysteroscopy and direct endometrial biopsy. Another course of Megace therapy was administered due to her desire for children. A successful pregnancy occurred after long-term medical treatment and IVF-ET.
In 1994, 102 outbreaks of food-borne disease involving 4,726 cases were reported to the Taiwan Department of Health. This is the highest number of outbreaks and cases in recent years in Taiwan. Of ...these outbreaks, 72.5% (74/102) were caused by bacterial pathogens, with Vibrio parahaemolyticus responsible for 56.7% (42/74), Staphylococcus aureus 20.3% (15/74), Bacillus cereus 14.9% (11/74) and Salmonella spp other than S. typhi and S. paratyphi 8.1% (6/74). V. parahaemolyticus has been a leading cause of problems in Taiwan for many years. Contamination of seafood with this organism has been reported frequently, particularly in the warmer months. In 1994, small outbreaks (fewer than 5 cases) and large outbreaks (more than 50 cases) represented 31.4% (32/102) and 12.7% (13/102), respectively, of the total. The median outbreak size was 10 cases. A high proportion (54%, 7/13) of the large outbreaks was associated with commercial lunch-boxes supplied to elementary and junior high schools. Health education to improve food sanitation and supervision of food sanitation practices need to be strengthened.
5,6-Dehydrokawain (DK) and dihydro-5,6-dehydrokawain (DDK) inhibited the aggregation and ATP release of rabbit platelets induced by arachidonic acid and collagen, without affecting those induced by ...ADP, PAF and thrombin. This inhibition was reversible and in a concentration-dependent manner. The IC50 of DK and DDK on arachidonate-induced platelet aggregation were calculated to be about 10 and 60 micrograms/ml, respectively. Thromboxane B2 formation caused by arachidonic acid was also suppressed by both antiplatelet agents. DK inhibited the intracellular calcium concentration rised by arachidonic acid, but not that by collagen or thrombin. DK also inhibited the secondary, but not the primary aggregation of human platelet-rich plasma induced by ADP and epinephrine. It is concluded that the antiplatelet effect of both DK and DDK is due to the inhibition of thromboxane A2 formation.
For infertile women aged over 37 years, failure of the zona pellucida to rupture is believed to be associated with a decreased implantation rate in in vitro fertilization (IVF) or intracytoplasmic ...sperm injection (ICSI). It has been suggested that assisted hatching of embryos will increase the pregnancy rate with IVF by means of mechanically facilitating the hatching process.
One hundred twenty cycles of IVF/ICSI in females aged over 37 years were analyzed. Women included in this study were allocated into 2 groups. In group I, embryos were cultured and transferred without laser-assisted hatching (LAH), whereas embryos of group II were examined and treated with LAH just before being transferred. Laser manipulations were performed using a 1.48-microm (infrared) diode laser (Fertilase). The laser was aimed at the zona to create openings of about 20 microm in diameter.
The mean ages of women in groups I and II were 38.8 +/- 1.8 and 39.5 +/- 1.6 years, respectively (p = 0.17). The number of retrieved oocytes, endometrial thickness, and number and quality of transferred embryos did not significantly differ between the 2 groups. Rates of implantation (7.3% and 6.7%, respectively, p = 0.89), pregnancy (16.3% and 17.5%, respectively, p = 0.86), and early pregnancy loss did not differ between the 2 groups.
Our data failed to demonstrate any benefit of LAH in improving implantation or pregnancy rates in women of advanced age, suggesting that factors other than laser drilling of the zona should be considered.
A 65 nm node strained SOI technology with high performance is demonstrated, providing drive currents of 1015 and 500 /spl mu/A//spl mu/m for N-FET and P-FET, respectively, at an off-state leakage of ...40 nA//spl mu/m using 1 V operation. The technology employs an aggressively scaled slim spacer of 30 nm width to amplify stress benefits for performance improvement, and to reduce by 10-20 % the layout area for SRAM-cell-like circuits, while maintaining excellent hot carrier immunity and well-controlled short-channel effects. For the first time, we demonstrate that FinFET devices, implicitly implemented in this technology, offer a 8-15 % higher inverter speed compared to planar SOI devices at the same drive current.
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