The relationship between low back discomfort ratings and the NIOSH lifting index

An epidemiological study was performed to evaluate the relation between low-back discomfort ratings and use of the revised NIOSH lifting guide to assess the risk of manual material handling (MMH) tasks. We surveyed 97 MMH workers on site in 15 factories and designed a questionnaire to systematically collect job-related information. Approximately 90% of the workers had suffered various degrees of lower back discomfort, and 80% had sought medical treatment. The survey showed that 42 of the 97 jobs analyzed had a recommended weight limit of 0, which was attributed to either a horizontal distance or a lifting frequency that exceeded the bounds of the NIOSH lifting index. Apparently, the limits for horizontal distance and maximum allowable frequency are too stringent to accommodate many existing MMH jobs. For the remaining 55 jobs, the significant positive correlation obtained between the lifting index and the severity of low-back discomfort suggests that the lifting index is reliable in assessing the potential risk of low-back injury in MMH. These findings provide useful information on the application of the NIOSH lifting guide to the assessment of low-back pain.

Extraperitoneoscopic colposuspension using CO2 distension method

PURPOSE

To validate our experience in extraperitoneoscopic colposuspension for genuine stress incontinence.

MATERIALS AND METHODS

Between March 1995 and July 1996, 48 women who had genuine stress incontinence underwent extraperitoneoscopic colposuspension in our institute. After standard laparascopic surgery preparation, a 10 mm puncture site was made midline just in the cm above the pubic hair line, and the extraperitoneal space was developed with the higher pressure of insufflating CO2. A pair of sutures was inserted at the level of the midurethral and unrethrovesical junction with Cooper's ligament.

RESULTS

All of these patients underwent the same procedures. The average blood loss was less than 50 ml, with a range from 10 to 200 ml. The operative time was from 20 to 90 min, with a mean time of 32 min. There was one bladder injury, 2 cases of voiding difficulties and 2 of detrussor instability in our series and the overall complication rate was 10.4%. So far, 45 of the 48 patients are satisfied with the surgery.

CONCLUSIONS

Laparoscopic Burch colposuspension is a practicable surgical procedure for managing stress incontinence. Extraperitoneal space was created easily with the higher pressure of insufflating CO2. An extraperitoneoscopic approach can reduce the necessity of laparscopic suturing. Moreover, it avoids violating the peritonel cavity and reduces the potential risk of postoperative adhesion formation and the discomfort resulting from pneumoperitonium. Thus, extraperitoneal colposuspension affords an alternative to laparoscopic or abdominal retropubic colposuspension in well-selected patients.

Minimal access surgery in children: the use of laparoscopy for management of pediatric ovarian teratoma: a case report

This article presents a case of left ovarian teratoma in a young child. Prompt diagnosis was made using real-time ultrasound, computed tomography (CT) and laparoscopy. The latter was used for performing tumor enucleation. We recommend that laparoscopy precede laparotomy and be done more routinely in the young patient.

Management of major complications in laparoscopically assisted vaginal hysterectomy

We reviewed 722 laparoscopically assisted vaginal hysterectomies performed between March 1991 and March 1996 at our institute, looking at the management of major complications. The indications for hysterectomy included adenomyosis, myoma uteri, intractable menorrhagia, endometriosis, and severe pelvic adhesion. During 1 to 6 years' follow-up, there were 12 (1.7%) major complications, comprising six bladder injuries, one iliac artery perforation, two bowel injuries, two cases of partial intestinal obstruction, and one pelvic abscess. Four complications were repaired successfully by laparotomy, six were repaired laparoscopically or vaginally, and two were treated conservatively. All the cases with visceral injuries were detected intraoperatively, therefore, adequate repair operations could be performed uneventfully. Early detection and treatment allow complications to be resolved more easily.

Dye incorporation to enhance the laser ablation of standard and reduced-modulus bone cements

Laser ablation of acrylic bone cement is an alternative method of cement removal that can be used during revision arthroplasty of cemented implants. This study investigated the feasibility of using a continuous-wave Argon ion laser (wavelength = 514 nm) with the addition of methylene blue or red dye no. 13 to enhance the ablation of two types of bone cements: polymethylmethacrylate and polybutylmethylmethacrylate. Six cement/dye combinations were studied while power (0.5, 0.75, and 1.0 W) and exposure times (30, 45, 60, and 90 seconds) were varied. The Argon laser was unable to ablate undyed polymethylmethacrylate or polybutylmethylmethacrylate. However, ablation was shown for both cements with either dye. The red dye had a stronger absorption peak at 514 nm than did the blue dye. Statistically larger ablation areas were seen for red polymethylmethacrylate than for blue polymethylmethacrylate (p < 0.013) at all levels tested. Ablation areas were larger in red than in blue polybutylmethylmethacrylate cement. Blue polybutylmethylmethacrylate cement produced larger ablation areas than did blue polymethylmethacrylate cements at all energy levels tested, with smaller surrounding damage areas. Red polybutylmethylmethacrylate cement also produced larger ablation areas than did red polymethylmethacrylate cement (at 0.75 and 1.0 W), again with smaller damage areas. Damage zones were smallest in red polybutylmethylmethacrylate cements at all test levels. These results suggest that, by using dyes to selectively alter the absorption characteristics of bone cement, laser ablation can be an effective method for cement removal. Changes in the chemical structure of the cement can also influence the response to laser treatment. Furthermore, the absorption spectra of the bone cement can be altered to maximize energy absorption at a wavelength that is not absorbed by bone tissue; this potentially minimizes damage to bone during revision surgery.

Local circuit abnormalities in chronically epileptic rats after intrahippocampal tetanus toxin injection in infancy

In vitro slice experiments were undertaken in adult rats to investigate the physiological origins of a chronic epileptic condition that was initiated in infancy. A unilateral injection of a minute quantity of tetanus toxin into hippocampus on postnatal day 10 produced a severe convulsive syndrome characterized by brief but repeated seizures that lasted for 5-7 days. Hippocampal slices were then taken from these rats in adulthood because at this time previous studies have shown the occurrence of electrographic and behavioral seizures. Dramatic alterations in local circuit functioning were observed. In normal artificial cerebrospinal fluid (ACSF), spontaneous epileptiform network bursts were recorded in a majority (73%) of experimental rats. Network bursts occurred in area CA3 of both the injected and contralateral hippocampus. These consisted of intracellular depolarization shifts that were coincident with extracellularly recorded network bursts. Often they occurred at frequencies of 0.05-0.1 Hz and although variable in amplitude and duration, had all-or-none-like qualities. These events appeared to arise largely from local circuits in the CA3C subfield. Network bursts were rarely recorded in area CA1 and were never observed in the dentate gyrus. However in 31% of rats, a novel, higher frequency (2-8 Hz) field potential was recorded in area CA1. This was coincident with rhythmic, intracellularly recorded, inhibitory postsynaptic potentials (IPSPs). These summated IPSPs blocked action potential firing and reversed polarity near -75 mV. To understand the origins of network bursting in area CA3C, comparisons were made of the fundamental neurophysiological properties of pyramidal cells in epileptic and control rats. Of the passive and active membrane properties examined, all appeared normal. Unusually prolonged bursts of action potentials were observed in a small subset of pyramidal cells. However on average the duration of intrinsic bursts were unaltered in the CA3 neurons analyzed from experimental rats. To explore the role that alterations in CA3 recurrent excitatory network excitability may play in epileptiform discharges, picrotoxin was bath applied. On blockade of gamma-aminobutyric acid (GABAA) receptors, slices from experimental rats underwent prolonged electrographic seizures that were up to 10 s in duration. In contrast, slices from control rats produced only brief 100-ms network bursts. These results suggest that a change in excitability within CA3C recurrent excitatory networks likely contributes to seizures in chronically epileptic rats. However, at the same time, this hyperexcitability is controlled to an important degree by functional GABAA-mediated synaptic inhibition.

Localized sampling of cytoplasm from Xenopus oocytes for capillary electrophoresis

Continued progress in cellular physiology requires new measurement strategies which can be applied to solitary cells. Since many cellular signaling pathways act on time scales of a few seconds, there is a critical need for single-cell techniques with subsecond time resolution. Capillary electrophoresis shows great promise as a tool for the analysis of individual cells. In the present work, we describe a technique to load a capillary with picoliter to nanoliter volumes of cytoplasm and initiate electrophoresis in less than 500 ms. When cytoplasm was sampled from a Xenopus laevis oocyte previously loaded with fluorescein, calcium green, or a mixture of the two fluorophores, their fluorescent peaks were readily identifiable on the electropherogram. Since the volume of cytoplasm (< or = 30 nL) loaded into the capillary was much smaller than the 1 microL oocyte volume, spatially localized biochemical measurements were also possible. To demonstrate the utility of this new technique, the activity of the enzyme beta-galactosidase was measured in small regions of the Xenopus oocyte. Subcellular, subsecond sampling of oocyte cytoplasm will enable biochemical measurements with the resolution required to understand many cellular signal transduction pathways.

Twenty-four-hour ambulatory esophageal pH monitoring in patients with symptoms of gastroesophageal reflux

We investigated the relationship between gastric acid reflux patterns and esophageal mucosal damage in 142 patients with symptoms suggestive of gastroesophageal reflux and esophagitis. Each patient underwent endoscopy of the esophagus and 24-hour ambulatory esophageal pH monitoring. Endoscopy revealed varying degrees of esophagitis in 37 patients and a normal esophagus 105 patients. No significant difference in symptoms was found between patients with and without esophagitis. Sixteen of the 37 patients with esophagitis had a normal composite score on pH monitoring, whereas 24 of the 105 patients without esophagitis had an abnormal composite score (p < 0.001). Comparison of individual pH parameters during the study showed more reflux episodes (pH < 4), a higher percentage of reflux time, and more reflux episodes longer than 5 minutes in the group with esophagitis than in the without (p < 0.05). Both the percentage of reflux time and the number of reflux episodes longer than 5 minutes/hour were significantly higher (p < 0.05) in the group with endoscopically proven esophagitis in the supine period, but not in the upright period. There was a positive correlation between the severity of endoscopic esophagitis and the percentage of reflux time in the supine period (r = 0.64; p < 0.001), and the number of reflux episodes longer than 5 minutes/hour in the supine period (r = 0.56; p < 0.001). In conclusion, our patients with peptic esophagitis had significant gastric acid reflux and impaired acid clearance by the esophagus in the supine position. We advocate that 24-hour ambulatory esophageal pH monitoring should be considered in Chinese patients with normal endoscopy findings but with symptoms suggestive of gastroesophageal reflux disease.

New approaches in laparoscopically assisted radical vaginal hysterectomy

BACKGROUND

To illuminate our new approaches in laparoscopically assisted radical vaginal hysterectomy.

METHODS

Twenty-four women underwent laparoscopically assisted radical vaginal hysterectomies during the period from March 1994 to May 1995 in our institute. Indications for this surgery, including cervical carcinoma stage 1A to 2A, were the same as for abdominal radical hysterectomy. The procedure was performed under general endotracheal anesthesia through means of the technique of videolaparoscopy. Two new approaches were recruited in these procedures including using middle upper abdomen as the primary trocar site and using ureteral stent or illuminator as a ureter marker.

RESULTS

All of these patients completed the procedures without exception. The mean hospital stay was 8.2 +/- 3.2 days. The average blood loss was 540 +/- 210 ml with a range from 100 to 1800 ml. Operating time was from 220 to 420 minutes with a mean time of 325 minutes. In all cases pelvic lymphadenectomy was performed without exception, yielding an average of 13.2 macroscopic nodes. Two of them metastatic lymph nodes were noted. No ureteral injury occurred after using the ureteral stent as a marker.

CONCLUSIONS

In this preliminary result, using middle upper abdomen as the primary trocar site could provide the surgeon with a wider and familiar visual angle, thus making the pelvic or para-aortic lymphadenectomy much easier. Moreover, using the ureteral illuminator as a marker during unroofing the ureter laparoscopically is helpful to prevent the ureteral injury and facilitating the procedures in laparoscopically radical hysterectomy.

Establishment and characterization of a renal cell carcinoma line from a patient with von Hippel-Lindau syndrome

It is not known how the von Hippel-Lindau (VHL) gene and the, as yet unidentified, renal cell carcinoma (RCC) gene(s) interact to result in RCC; nor is it known if mutations in both, or all genes are necessary for this progression. The availability of a RCC cell line from a VHL patient would be useful in studies comparing sporadic RCC with RCC resulting from VHL syndrome; and for determining the relationship or interaction of the RCC gene with the VHL gene to produce a common tumor type. This paper describes the isolation and characterization of a renal cell carcinoma cell line derived from a patient with von Hippel-Lindau disease. The line is epithelial in origin and the genome contains a familial mutation in the VHL gene. Tissue culture studies indicate that this cell line, although immortalized, is not fully transformed. Chromosomal analysis performed on cells derived from disseminated primary tumor cells revealed no detectable chromosomal abnormalities. However, analysis performed on cells at passages 9, 19, 41, and 79 showed both numerical and structural chromosomal changes. The cytogenetic profile of this cell line demonstrated a number of abnormalities known to be associated with RCC from patients with and without VHL syndrome.

Food-borne disease outbreaks due to bacteria in Taiwan, 1986 to 1995

Between 1986 and 1995, 852 outbreaks of food-borne disease involving 26,173 cases and 20 deaths were reported in Taiwan. About 80% of the outbreaks occurred in the warmer months, i.e., between April and October. Of the 852 reported outbreaks, 555 (65%) were caused by bacterial pathogens. The three most common bacteria involved were Vibrio parahaemolyticus (35%, 197 of 555 outbreaks), Staphylococcus aureus (30%, 169 of 555 outbreaks), and Bacillus cereus (18%, 104 of 555 outbreaks).

The outcome of in vitro fertilization and embryo transfer therapy in women with endometriosis failing to conceive after laparoscopic conservative surgery

STUDY OBJECTIVE

To compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) after laparoscopic surgery in women with endometriosis with that of patients with tubal factor infertility.

DESIGN

Retrospective survey of hospital and office charts using a computerized worksheet.

SETTING

Lin-Kou medical center of Chang Gung Memorial Hospital.

PATIENTS

Sixty-seven women with minimal to mild or moderate to severe endometriosis. Women with tubal factor infertility without other associated disorders (60 cycles) made up the control group.

INTERVENTIONS

Seventy-five consecutive cycles of IVF-ET were performed in these patients who failed to conceive after laparoscopic conservative surgery.

MEASUREMENTS AND MAIN RESULTS

The concentration of serum estradiol on the day of human chorionic gonadotropin (hCG) injection, the day of hCG injection, clinical pregnancy rates per transfer, number of follicles larger than 14 mm, number of embryos transferred, and implantation rate were not significantly different between women with endometriosis and those with tubal factor infertility. The number of oocytes retrieved and number fertilized were decreased, and the basal level of follicle-stimulating hormone on cycle day 3 was higher in women with both degrees of endometriosis. Women in both endometriosis groups received more follicle-stimulating hormone and human menopausal gonadotropin than those with tubal factor infertility.

CONCLUSIONS

The outcome of IVF-ET in patients with endometriosis after laparoscopic surgery did not differ from that in the group with tubal factor infertility, but the former required more ampules of gonadotropin to achieve the same response. The advantages of laparoscopic surgery in women with endometriosis should be probably correlated with success of IVF-ET.

An efficient in vitro method for mass propagation of a woody ornamentalIxora coccinea L

Various factors that affect culture establishment, shoot growth, proliferation and rooting ofIxora coccinea L., a woody shrub, were studied. Stem cuttings (decapitated shoot, three nodes) were the most suitable explants for multiple-shoot proliferation, and when cultured on a woody plant medium (WPM) containing 2.5 μM BA produced axillary shoots which branched repeatedly, yielding an average of 27 shoots per explant after 6 weeks in culture. Kinetin, 2-iP, zeatin and thidiazuron all induced multiple-shoot formation, but were less effective than BA. While the presence of IAA in the multiplication medium was detrimental to shoot proliferation, shoot growth was not affected by IAA. The production of large amounts of basal callus and vitrification of shoots were the major problems to be avoided in proliferating shoot cultures. Addition of TIBA to the multiplication medium markedly reduced basal callusing, while sealing the culture vessels with a fluorocarbon polymer (tetrafluoroethyleneperfluoroalkyl vinyl ether) film (Neoflon PFA film) almost completely eliminated vitrification. A reduction in the number of vitrified shoots was also achieved with AVG treatment. Following this protocol of using BA-supplemented WPM and Neoflon film, it would be possible to produce more than 100,000 plants from a single stem cutting in 1 year.

Hepatitis B vaccination and hepatocellular carcinoma in Taiwan

OBJECTIVE

In 1984, Taiwan started a large-scale hepatitis B vaccination program, enabling us to test the hypothesis that prevention of hepatitis B virus infection eventually decreases the incidence of hepatocellular carcinoma.

METHODS

Groups aged 0 to 9 years and 10 to 100 years in each calendar year were defined as the study group and the reference group, respectively. The percentage of children vaccinated in the study group increased during recent years. The study group and the reference group were divided into 5-year age strata (0 to 4, 5 to 9, ..., 80 to 84, and 85 and over). Poisson regression was used to estimate age- and gender-adjusted liver carcinoma mortality rate ratios for 1974 through 1993, relative to 1974.

RESULTS

The adjusted mortality rate ratios of liver carcinoma in the study group decreased significantly for 1992 and 1993, whereas in the reference group it did not show the same result. A significantly declining trend of liver carcinoma mortality rate ratios was observed in the study group after 1984, whereas the same trend was not found in the reference group.

CONCLUSIONS

Our results support the hypothesis that hepatitis B vaccination can decrease the incidence of hepatocellular carcinoma.

[Pathogenic strains of Escherichia coli in Taiwan]

From July 1994 through June 1996, 28 strains of Escherichia coli were isolated from 1,260 patients with acute diarrhea. These strains were further differentiated with serotypes and virulence factors. Enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC) were accounted for 53.6 (15 of 28 strains), 28.6 (8 of 28), 10.7 (3 of 28) and 7.1% (2 of 28), respectively. Therefore, ETEC and EPEC are playing an important role in food-borne illness in Taiwan. Escherichia coli O157:H7, a new emerging pathogen of food-borne disease, has not been isolated in this study.

Life table analysis of pregnancy rates in women with moderate or severe endometriosis comparing danazol therapy after carbon dioxide laser laparoscopy plus electrocoagulation or laparotomy plus electrocoagulation versus danazol therapy only

STUDY OBJECTIVE

To assess the effectiveness, in terms of pregnancy rates, of isotopic 13CO2 laser laparoscopy versus traditional laparoscopy or laparotomy in the treatment of infertile women with moderate or severe endometriosis.

DESIGN

Prospective 5-year study.

SETTING

Medical school-affiliated hospital.

PATIENTS

Three hundred nine infertile women with moderate to severe endometriosis.

INTERVENTIONS

The patients were treated with one of four options: operative laparoscopy with the 13carbon dioxide (13CO2) laser vaporization and/or resection, operative laparoscopy with simple electrocoagulation and sharp dissection, laparotomy with electrocoagulation and sharp dissection, and medical treatment with danazol. Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among treatments. A subgroup of 192 women considered to have endometriosis as the only infertility factor was also evaluated.

MEASUREMENTS AND MAIN RESULTS

Pregnancy rates in the laparoscopy group were equal to or higher than those of the laparotomy group, for both the entire population and the endometriosis-only subset. When the CO2 laser was used as an adjuvant option, the rates were better, especially in patients with advanced disease and with endometriosis as the only infertility factor.

CONCLUSION

In women with endometriosis as the only infertility factor, laparoscopic surgery with the 13CO2 laser was more effective than nonlaser treatment.

Efficacy of isotopic 13CO2 laser laparoscopic evaporation in the treatment of infertile patients with minimal and mild endometriosis: a life table cumulative pregnancy rates study

STUDY OBJECTIVE

To assess the efficacy of 13CO2 laser laparoscopy in treating infertile women with minimal to mild endometriosis according the American Fertility Society classification in terms of pregnancy rates.

DESIGN

Prospective study.

SETTING

Medical school-affiliated hospital.

PATIENTS

One hundred seventy-six women whose infertility was associated with minimal or mild endometriosis diagnosed by laparoscopy.

INTERVENTIONS

The patients were treated with one of four methods: 49 underwent operative laparoscopy with newly developed 13CO2 laser vaporization and/or resection; 45 were treated by operative laparoscopy with simple monopolar electrocoagulation; 43 who had undergone only diagnostic laparoscopy did not receive any treatment; and 39 received danazol 800 mg/day for 3 months after diagnostic laparoscopy.

MEASUREMENTS AND MAIN RESULTS

Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among the treatments. A subgroup of 111 patients considered to have endometriosis as the only major infertility factor were also evaluated and compared among treatment options. Pregnancy rates in the CO2 laser laparoscopy group were significantly higher than in the other three groups and in endometriosis-only subset.

CONCLUSIONS

Advanced laparoscopic surgery with the CO2 laser can be more efficient than other modalities in treating infertile women with minimal to mild endometriosis in terms of pregnancy rates. It appears that in experienced hands, laser laparoscopy has more favorable results than the other treatments.

The effects of Vero cell co-culture on human zygotes resulting from in vitro fertilization and oocytes following subzonal insemination

A variety of co-culture systems have been devised to enhance the human embryo development in vitro. Vero cells were selected because they can be highly controlled and are easy to handle. To evaluate the embryotrophic effects of Vero cell monolayers, when they were co-cultured with human in vitro fertilized zygotes or subzonal inseminated oocytes. Total 1695 two-pronuclear embryos resulting from in vitro fertilization were cultured with Vero cells or medium alone for 24 hours. Similarly, sixty-six two-pronuclear embryos resulted from subzonal insertion of sperm (SUZI) with co-culture starting immediately following SUZI were compared with fifty-two two-pronuclear embryos resulted from SUZI, without co-culture. The numbers of blastomere and morphology of embryos were compared between the co-culture group and control group using student's t-test. Cell numbers in each embryo were greater in the IVF/co-culture group than in the control group (4.01 +/- 1.32 vs. 3.86 +/- 1.45, p < 0.05). The rates of poor quality embryo with major fragmentation were lower in the co-culture group than in the control group(11.5% vs. 19.9%, p < 0.001, for IVF embryos; 9% vs. 27%, p < 0.005, for SUZI oocytes). Co-culture SUZI oocytes on Vero cells prior to fertilization did not positively influence embryo cleavage, but improved embryo quality. We conclude that Vero cells can enhance human embryo development; however, the period for one-day or two-day co-culture is too short to provide a maximal support. Short term co-culture did not increase implantation rates. Immediate co-culture following SUZI might somewhat rescue the microinseminated oocytes. However, a longer duration of co-culture is necessary to exert the maximal effects on embryo development and implantation.

Comparison of hysterosalpingography and hysteroscopy in female infertility

STUDY OBJECTIVE

To determine the diagnostic value of hysterosalpingography (HSG) and diagnostic hysteroscopy in infertility evaluations.

DESIGN

Comparative 2-year study.

SETTING

Outpatient infertility clinic of a tertiary medical center.

PATIENTS

Two hundred sixteen women being investigated for infertility.

INTERVENTIONS

An HSG was followed by a diagnostic hysteroscopy.

MEASUREMENTS AND MAIN RESULTS

The HSGs were interpreted as normal in 79 (36.9%) women and as showing some abnormalities of the uterine cavity in 135 (63.1%). In the former group, 51 patients had a normal uterine cavity, but 28 had abnormal findings on hysteroscopy, a false negative rate of 35.4%. Of 135 women with an abnormal HSG, hysteroscopy found a normal uterine cavity in 21, a false positive rate of 15.6%. The sensitivity of HSG was 80.3% in revealing intrauterine abnormality and its specificity was 70.1%. Although some abnormalities were identified by both methods in 114 women, findings of both procedures were similar in only 88 (77.2%). In 75 (35.0%), the findings of HSG differed from those of hysteroscopy. In only 139 (65%) patients were the findings (normal and abnormal) similar for both methods.

CONCLUSIONS

We advocate hysteroscopy in the investigation of female infertility for its accuracy, safety, simplicity, and convenience.

Laparoscopic Removal of a Large Leiomyoma Using Airlift Gasless Laparoscopy

Some discrepancies still exist with regard to the efficacy of laparoscopic removal of large symptomatic leiomyomas. In our experience, when performing myomectomy, airlift gasless laparoscopy has several advantages. First, a small incision can be made, through which conventional surgical instruments (endoscopic equipment is not required) are inserted and the myomectomy is efficiently performed. Second, the large excised leiomyoma can be cut into strips easily with a conventional long knife and removed through a small abdominal incision. Third, sutures can be placed easily, and the surgeon can place fingers through a small surgical wound to palpate the organ and tie the knot directly. Fourth, high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum. Finally, the potential risks of metabolic and hemodynamic instability due to carbon dioxide insufflation to establish pneumoperitoneum are avoided.

Legionella pneumophila infection in Taiwan: a preliminary report

Legionella pneumophila infection has been recognized as an important cause of pneumonia. However, epidemiologic baseline data about the occurrence of legionella-related pneumonia and the distribution of legionellae in aquatic environments are still not available in Taiwan. A survey conducted by the National Institute of Preventive Medicine found that 8.6% of 487 pneumonia patients studied were positive for the L. pneumophila serologic test (indirect fluorescent test, IFA) and 32.0% of the 25 water samples were positive for isolation of legionellae. In conclusion, this survey supported the existence of Legionnaires' disease in Taiwan, indicated a preliminary prevalence of L. pneumophila antibodies among pneumonia patients and identified the prevalence of legionellae in water environments.

Laparoscopic myomectomy of large symptomatic leiomyoma using airlift gasless laparoscopy: a preliminary report

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 min (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 leiomyomata 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 performed suture techniques; (iv) high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum; and (v) the potential 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 pneumoperitoneum. For patients who are thin, and even those with moderate obesity, the exposure obtained with airlift mechanical suspension is adequate; however, morbidly obese patients with previous abdominal surgery with suspected pelvic adhesions can incur some problems during the operation because of a poor operative field.

Subspecies typing of Vibrio parahaemolyticus by pulsed-field gel electrophoresis

Vibrio parahaemolyticus is one of the most important food-borne pathogens in Taiwan, Japan, and other costal regions. We report on the development of a pulsed-field gel electrophoresis (PFGE) method for the molecular typing of this pathogen. Genomic DNA was digested with SfiI, and the fragments were resolved on 1% agarose with a contour-clamped homogeneous electric field apparatus set at 190 V and a pulse time of 3 to 80 s. A total of 130 selected isolates obtained from outbreaks during 1993 and 1994 on Taiwan were also characterized by this PFGE method. These isolates were grouped into 14 PFGE types which consisted on one to six patterns, and a total of 39 patterns were identified. Most of these domestic clinical isolates could be clustered into several major types (types A, B, C, and G). These major types showed relatively low degrees of similarity to several foreign strains and other domestic but environmental strains. Strain CCRC12863, which originated from Japan, was close to the group consisting of F, G, and H PFGE types, suggesting a clonal relationship between this Japanese strain and other domestic isolates.

Insulin-like growth factor-binding proteins produced by Vero cells, human oviductal cells and human endometrial cells, and the role of insulin-like growth factor-binding protein-3 in mouse embryo co-culture systems

Co-culturing embryos on helper cells can mimic the in-vivo environment, thereby enhancing embryo development in vitro. Insulin-like growth factors (IGF) and their binding proteins (IGFBP) also enhance embryo development. To investigate the kinds of IGFBP produced by various cell monolayers and the effects of IGFBP-3 on mouse embryo co-culture systems, 2-cell ICR mouse embryos were cultured in either human tubal fluid medium alone or in the presence of Vero cells, human oviductal cells or endometrial cells. The helper cells were analysed immunohistochemically to investigate the types of IGFBP produced by various cell monolayers. The concentrations of IGF-I and IGFBP-3 in media obtained from the culture of embryos alone, cells alone or cells plus embryos were determined by radioimmunoassays. On day 7, more blastocysts hatched in the co-culture groups (73% in the Vero cell group, 76% in the endometrial cell group and 74% in the oviductal cell group) than in the control group (43%) (P < 0.0001). The results of immunohistochemistry revealed that (i) all three cell groups produced a lot of IGFBP-1, -2 and -3, but only a little of IGFBP-4 and -5; and (ii) IGFBP-1, -2, and -3 were present in blastocysts in either the presence or absence of helper cells. The IGF-I secreted by cell monolayers or embryos was undetectable (detection limit 0.83 microg/l). The IGFBP-3 concentrations in media obtained from co-cultured embryos and cells were significantly higher than in media without embryos (median values in oviductal cell culture medium, 165 versus 127 microg/l, P = 0.04; median values in endometrial cell culture medium, 277.5 versus 183.5 microg/1, P = 0. 0002; median values in Vero cell culture medium, 219 versus 120 microg/l, P = 0.011). Although IGFBP-3 concentration in the medium that contained embryos alone was undetectable by radioimmunoassay (detection limit 1.1 microg/l), immunohistochemistry demonstrated the presence of IGFBP-3 in the embryos. Co-culture in systems in which there was an increased production of IGFBP-3 led to an improved development of mouse embryos. IGFBP can improve the binding of IGF to cell surface receptors of target tissue, and thus enhance the effect of limited IGF concentrations in promoting embryo development in a co-culture system. We conclude that Vero cells, human endometrial cells and oviductal cells produce IGFBP-1, -2, -3, -4 and -5. IGFBP-3 may play a role in embryotrophic potential by either regulating the action of IGF or directly enhancing embryo development.

Food-borne disease outbreaks in Taiwan, 1994

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.

Hysteroscopic extraction of a vaginal foreign body in a child

A 3.5-year-old girl had a persistent, foul-smelling, blood-tinged vaginal discharge. She was initially treated for recurrent and persistent vulvovaginitis, which resulted in no improvement. Vaginoscopy revealed an intravaginal foreign body, which was removed successfully by hysteroscopy. We believe hysteroscopy is safe, convenient, effective, and easy to perform, even in a child.

Coculture of human spermatozoa with reproductive tract cell monolayers can enhance sperm functions better than coculture with Vero cell monolayers

PURPOSE

In order to develop a better system for support of human sperm function in vitro, we conducted studies to evaluate whether reproductive tract cells are better than non-reproductive tract cells as an adjunt in that regard.

METHODS

Human spermatozoa were cocultured with Vero cells, with human oviduct cells and endometrial cells, and without cells (control) for either 1, 4, or 24 hr. Sperm motility was then analyzed with a computer-aided sperm analyzer (CASA-Hamiliton Thron, HTM IVOS Motility Analyzer). Aliquots of spermatozoa incubated for 24 hr were also stained with Hoechst 33258 and FITC-PNA to evaluate the status of acrosome in live cells.

RESULTS

Significant differences (P < 0.05) between the oviduct cell and the control groups after 24 hr were evident in the curvilinear velocity (VCL) (81.4 +/- 13.4 vs 60.0 +/- 14.1 microns/sec) and amplitude of lateral head displacement (ALH) (5.2 +/- 0.6 vs 4.1 +/- 0.5 microns). The incidence of acrosome reaction of live sperm was significantly higher in the endometrial cell group than in the controls (25.4 +/- 9.9 vs 6.6 +/- 2.4%; P < 0.001).

CONCLUSIONS

Coculture with human reproductive tract cells seems to improve some functional parameters of human spermatozoa. Coincubation with such cell lines, especially oviduct cells, might be a feasible approach to optimization of human spermatozoa for assisted fertilization using subfertile or frozen-thawed samples. We think coincubating human spermatozoa with a human reproductive tract cell line, especially oviduct cells, might be a feasible approach in preparing human spermatozoa for assisted fertilizatioin in subfertile and frozen-thawed semen samples.

Glutathione S-transferase and glutathione peroxidase are essential in the early stage of adriamycin resistance before P-glycoprotein overexpression in HOB1 lymphoma cells

We have previously established Adriamycin-resistant HOB1 cell lines showing the multidrug resistance (MDR) phenotype. For further study, we analyzed the free-radical scavengers glutathione S-transferase (GST) and glutathione peroxidase (GPX) by enzyme assays and Northern blots. Three cell lines, HOB1/ADR0.1, HOB1/ADR1.0, and HOB1/ADR5.0, represented HOB1 cells resistant to 0.1, 1.0, and 5.0 microM Adriamycin, respectively. The mdr1 transcript was overexpressed in HOB1/ADR0.1 cells, and the amount of its expression reached a maximum between HOB1/ADR1.0 and HOB1/ADR5.0 cell lines. The increases in GST activity and GST-pi expression were observed only in high-level-resistant cell line (HOB1/ADR1.0 and HOB1/ADR5.0), which also showed increased GPX activity and expression. For investigation of the cytotoxic effect of Adriamycin on HOB1 cells prior to the mdr1 overexpression, an appropriate number of parental HOB1 cells were treated with 0.1 microM Adriamycin for 7 days, and the viable cells (HOB1/ADR) were isolated and subjected to analyses for mdr1, GST-pi, and GPX expression and for GST and GPX activity. In comparison with HOB1/ADR0.1 cells, HOB1/ADR cells did not show mdr1 overexpression but had significant increases in the activity and expression of GST and GPX. The current study suggests that in the early phase of Adriamycin treatment, GST and GPX are more important than P-glycoprotein for the development in HOB1 cells of resistance against Adriamycin.

Improved sperm recovery rate with Percoll gradient method in intrauterine insemination

The purpose of this study was to compare the different sperm manipulation methods on the recovery rate of motile sperm that was collected to use in the intrauterine insemination. Three hundred and thirty-five IUI (intrauterine insemination) cycle from a total of 963 treatment cycles was performed for non-peritoneal factor infertility couples. The sperm separation methods were swim-up, swim-down and Percoll gradient (since Mar. 1992). We compared the different sperm preparation methods in normal and abnormal semen analysis group. Our results show that in the abnormal semen samples (oligospermic approximately, asthenospermic approximately), the Percoll gradient method is superior to the swim-up and swim-down methods on the recovery of a higher number of total, motile and active motile spermatozoa (p < 0.05), even though the sperm quality before preparation was rather poorer than the samples prepared by the other two methods. The pregnancy rate in both groups are not statistically significant. We conclude that the Percoll gradient is an improved method for semen manipulation as it allows greater recovery of sperm with higher motility in intrauterine insemination.

Mushroom poisoning in children: report of an accident

There were very few cases of mushroom poisoning every year in Taiwan and yet no fatal incident have been reported. A species named Amanita phalloides had high lethality rate (22-33%). Physicians should be aware of it's toxic property and be able to treat the patient in case of mushroom poisoning. However, mycologist sometimes might not distinguish edible from toxic mushroom so that educating people not to ingest wild mushroom is very important. We present 4 children with gastrointestinal syndrome after ingesting wild mushroom. We also introduce some basic approaches in treating mushroom poisoning in this paper.

Management of urinary bladder injuries in laparoscopic assisted vaginal hysterectomy

BACKGROUND

To illustrate our experience and evolution in management of urinary bladder injury in laparoscopically assisted vaginal hysterectomy.

METHODS

Four hundred and twenty-two women underwent laparoscopically assisted vaginal hysterectomy with or without adnexectomy during the period March 1991-September 1994. The indicators for hysterectomy included adenomyosis, myoma uteri, intractable menorrhagia, endometriosis and severe pelvic adhesion. There are six cases of urinary bladder injuries resulting from our 422 cases of laparoscopically assisted vaginal hysterectomy.

RESULTS

The first two cases of urinary bladder injuries were repaired through exploratory laparotomy. The third case was repaired through laparoscopic intracorporeal suture. The technique of the automatic linear stapler through laparoscopy was used in case 4. The last two cases were repaired vaginally. All these patients recovered well after primary repair with an indwelling catheter for five to seven days regardless of the method of repair. The operation time for repairing the injuries is shortest in vaginal approach.

CONCLUSIONS

The urinary bladder injury is one of the most common complications associated with laparoscopically assisted vaginal hysterectomy. Early detection and treatment enable complications to be overcome easily. As the laparoscopist acquires further experience in dealing with these complications, the urinary bladder injury may be managed laparoscopically. However, vaginal approach may be an easier way in dealing with this complication. Thus, most laparotomy or high technique laparoscopically repair could be avoided.

The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa

PURPOSE

The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population.

PATIENTS

When 939 couples underwent 1375 cycles of IUI with varying etiologies of infertility which included male factor, endometriosis, tubal factor, ovulatory dysfunction, uterine factor, cervical factor, and unexplained infertility, the results were 207 pregnancies.

RESULTS

The overall pregnancy rate per cycle was 15.1% (207/1375). The total motile sperm count were significantly increased in the pregnant group than the nonpregnant group (38.7 x 10(6) versus 28.6 x 10(6); P < 0.001). There was a trend toward an increased success rate with increased total motile sperm count. Significance was reached when the total motile sperm count exceeded 5 x 10(6). Life table analysis was performed and the curve representing a cumulative chance of pregnancy calculated from our data reached 72%.

CONCLUSIONS

Our findings suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy and allow couples to be informed of the chances of success.

Results of modified laparoscopically assisted neovaginoplasty in 18 patients with congenital absence of vagina

Construction of a neovagina using pelvic peritoneum via a laparoscopically assisted approach was used in 18 patients with congenital absence of the vagina. A better operative procedure is reported, which was modified from our preliminary technique, and the results of treatment are evaluated. Pelvic peritoneum was used for construction of a vagina, replacing a laparotomy by a minimally invasive laparoscopic approach. During follow-up, the advantages of our procedures are: (i) minimal likelihood of 'poor take' or later contraction because an autograft peritoneal epithelial line is used; (ii) minimal short and long term care is required; (iii) the technique is simple in experienced hands and has all the well-recognized benefits of minimal invasive surgery; (iv) the average length of neovagina is adequate and patency and depth can be maintained with minimal dilatation; (v) the neovagina, with epithelial lining resembling that of a normal vagina, facilitates comfortable sexual intercourse; (vi) the procedure is unaccompanied by dyspareunia or scarring, which are frequently associated with other techniques; (vii) less emotional stress and better cosmetic and economic benefits are noted.

The trend of sudden infant death syndrome in Taiwan from 1984 to 1993

We collected 1984 to 1993's health statistics to calculate the incidence and trend of SIDS in Taiwan. Deaths of SIDS were listed in the International Classification of Diseases (ICD) code 798.0. All infants under 1 year of age died of SIDS were included in our study. We found Taiwan was a low incidence area of SIDS. The incidences of SIDS from 1984 to 1993 were increased from 0.25 to 0.56 per 1000 live births. We also found the SIDS had inclining trend from 1984 to 1993. Whether the reason of inclining trend of SIDS in Taiwan is due to westernization of living style needs further exploration.

Laparoscopic repair of bowel herniation through previous cannula insertion sites

Operative laparoscopy frequently requires large cannulas below or above the umbilicus, which may result in unusual complications such as small bowel herniation through these insertion sites. Three women experienced small bowel herniation through cannula incision sites, either extraumbilically or paraumbilically, after major laparoscopic surgery. Two patients who had undergone laparoscopic myomectomy developed small bowel herniation through the 12-mm extraumbilical cannula site on postoperative days 7 and 8, respectively. In the first woman, the nontender, palpable, and reducible herniation healed spontaneously, with no episode of herniation during follow-up. The second patient required laparoscopic reduction of the herniated loop and repair of the fascial defect. The last woman had undergone laparoscopic-assisted vaginal hysterectomy and developed small bowel herniation through an unrecognized fascial defect paraumbilically 3 days postoperatively. Intended repair by laparoscopy was changed to laparotomy due to extensive and incarcerated bowel herniation.

Ureteral injury during laparoscopically assisted radical vaginal hysterectomy

We report on a case of ureteral injury during laparoscopically radical hysterectomy to treat a patient with a stage IA2 carcinoma of the uterine cervix. The advantage of laparoscopically radical hysterectomy is the prevention of the identification and dissecting of the ureter from a vaginal approach, the main problem in the Schauta technique. However, ureteral injury may still occur while resecting the cardinal ligament without good visualization of the ureter during a vaginal procedure. Because the ureter was well identified and freed laparoscopically, a vaginal approach after uterine removal may be an option for treatment. Moreover, using the ureteral stent as a marker during a modified Schauta technique is helpful in the prevention of ureteral injury during laparoscopically assisted radical vaginal hysterectomy.

Laparoscopic rescue after tubal anastomosis failure

Laparoscopic rescue after tubal anastomosis failure is reported for the first time. The patient was a 33 year old woman sterilized by Pomeroy's method. Reconstruction of fertility was achieved by mini-laparotomy with isthmo-isthmic end-to-end anastomosis of bilateral tubes. Unfortunately, the patient did not become pregnant and tubal occlusion was diagnosed 6 months later by hysterosalpingography. Laparoscopic rescue with repeat isthmic-ampullary anastomosis and adhesiolysis was performed. Post-operatively, the patient had one menstruation and then achieved an intrauterine pregnancy. Instead of in-vitro fertilization/embryo transfer, laparoscopic rescue may be an alternative option for the patient with failed anastomosis.

Role of laparoscopic assisted vaginal hysterectomy in gynecology

One hundred and thirty laparoscopic assisted vaginal hysterectomies (LAVH) were performed at Chang Gung Memorial Hospital. All hysterectomies were for indications of the uterus, endometriosis, and extensive adhesions. Some of the patients also underwent concomitant procedures including unilateral or bilateral salping-oophorectomy, vaporization and/or excision of endometriosis, lysis and/or excision of adhesions. Kleppinger bipolar forceps were used for large vessel hemostasis and excision of adhesions in all the patients. CO2 laser was used for vaporization and excision of endometriosis. The complication rate was 10.0%. This included febric morbidity, intraoperative bladder injury, partial small bowel obstructions and thermal injury of the sigmoid colon. Four patients required laparotomy either to complete the procedure or to manage the complications. The mean blood loss was 160 ml and the mean hospital stay was 2.2 days. The mean operating time was 148 minutes and the mean age of the patients was 42.3 years. Two weeks after surgery, the majority of the patients were permitted to drive and resume normal nonstrenuous physical activity. The majority of the surgeries were videotaped. The study demonstrates that a hysterectomy can be safely performed laparoscopically by the well trained laparoscopic surgeon, resulted in reduced surgical morbidity, blood loss, postoperative discomfort and pain, shortened hospital stay and recovery.

Parameters of semen analysis affecting the pregnancy rate of artificial insemination with husband's spermatozoa

The efficacy of intrauterine insemination with husband's semen (AIH) is well established for some types of infertility. Results that had been reported previously were Dwing difficult to assess owing to the low number of patients or treatment cycles as well as an inadequate definition of the indications in most cases. In this study, we report our experience with intrauterine insemination (IUI) using post-treated sperm suspension from husband's semen in the treatment of infertility. A total of 328 treatment cycles were completed from January to December in 1991. The indications for AIH/IUI were male infertility (130 cycles), unexplained infertility (87 cycles), sex selection (72 cycles) and anovulatory disorder (39 cycles). Sixty-eight pregnancies were achieved. The clinical usefulness of AIH/IUI with or without concomitant hMG regimens were established according to diagnostic subgroups. In our results, the cycle fecundity of pregnancy was higher in patients with ovulatory disturbance. The importance of sperm motility confirmed by our results that have compared by the serial sperm parameters. The motile sperm count may appear to be a highly consistent parameter that serves as a sensitive indicator of sperm function and correlation of successful pregnancy in our results. In conclusion, this study indicates that AIH with controlled ovarian hyperstimulation can result in higher viable pregnancy rate, and it is also a non-invasive and relatively easy procedure. We believe that this is a transient useful method for the treatment of non-organic infertility, prior to any attempt of aggressive assisted reproductive procedures.

Extraumbilical insertion of the operative laparoscope in patients with extensive intraabdominal adhesions

In 12 patients who had known or suspected intraabdominal adhesions, we evaluated the benefit of using Palmer's point for inserting the Veress needle and primary cannula during laparoscopic adhesiolysis to prevent direct intestinal injury. After inserting the laparoscope through this point, four women were found to have extreme intestinal adhesions around the umbilical area, and intestinal or severe omental injury might occur if the cannulas were inserted directly through the umbilical fossa. The other eight patients had omentum, partial to severe, adherent to the anterior abdominal wall. No complication occurred during insertion of the Veress needle and primary cannula through Palmer's point. Nine patients had successful laparoscopic adhesiolysis and were discharged within 2 days. In the other three women the procedure was converted to laparotomy because of extensive intestinal adhesions (2 patients) and small bowel injury during laparoscopic adhesiolysis (1). Palmer's point can be considered a safe and good alternative site for inserting the Veress needle and primary cannula to lyse dense intestinal and extensive omental adhesions. This technique should provide the surgeon with wider visual angel and surgical field, thus making adhesiolysis much easier to perform.

Bowel injury by the suction-irrigator during operative laparoscopy

Bowel injury is common during operative laparoscopy, yet injury by the suction-irrigator has never been reported to our knowledge. Any injury to the sigmoid colon by suction-irrigator occurred during intestinal retraction. Primary repair was performed through minilaparotomy incision. In addition to the potentially damaging effect of the instrument, a firm, distended, and unprepared bowel was a leading factor in this injury. We recommend that all patients have bowel preparation before operative laparoscopy, and that great care be taken for all surgical manipulations, even when employing traditionally atraumatic instruments.

Latex agglutination test for detection of tetanus antitoxins

A rapid and easy method of slide agglutination test for the detection of human tetanus antitoxins was developed in this study. Testing reagents were prepared from carboxylated polystyrene latex particles with tetanus toxin by soluble carbodiimide. The test was performed on a glass slide with a drop of test sample and a drop of testing reagent. The agglutination reaction was usually completed within five minutes. Sensitivity of this test for tetanus antitoxins can be reached at 0.125 IU/ml. Therefore, the latex agglutination test can be used to determine the immune status of a patient in an emergency.

Tetanus toxin-induced seizures in infant rats and their effects on hippocampal excitability in adulthood

A new experimental model of developmental epilepsy is reported. Behavioral and EEG features of seizures produced by unilateral intrahippocampal injection of tetanus toxin in postnatal day 9-11 rats, are described. Within 24-72 h of tetanus toxin injection, rat pups developed frequent and often prolonged seizures which included combinations of repetitive wet dog shakes, and wild running-jumping seizures. Intrahippocampal and cortical surface EEG recordings showed that coincident with these behaviors, electrographic seizures occurred not only in the injected hippocampus, but also in the contralateral hippocampus and bilaterally in the neocortex. Analysis of the interictal EEG revealed multiple independent spike foci. One week following tetanus toxin injection, the number of seizures markedly decreased; however, interictal spiking persisted. After injection rats were allowed to mature some were observed to have unprovoked behavioral seizures and/or epileptiform EEG activity. Mature animals were also studied using in vitro slice techniques. Recordings from hippocampal slices demonstrated spontaneous epileptiform burst discharges in the majority of rats which had tetanus toxin induced seizures as infants. These events occurred in area CA3 and consisted of interictal spikes and intracellularly recorded paroxysmal depolarization shifts (PDSs). On rarer occasions, electrographic seizures were recorded. The use of the tetanus toxin model in developing rats may facilitate a better understanding of the unique features of epileptogenesis in the developing brain and the consequences early-life seizures have on brain maturation and the genesis of epileptic conditions in later life.

Laparoscopic hysterectomy: is dissecting the ureter necessary?

Laparoscopic hysterectomy has been first reported by Reich et al. in 1989, which confirmed the possibility of laparoscopic hysterectomy being employed as a replacement of the vast majority of traditional abdominal hysterectomies. There are three critical points in laparoscopic hysterectomy. The most important critical point is to identify uterine arteries from the ureter in the paracervical area. Several ureteral injuries at operative laparoscopy have been reported. We performed two hundred and thirty laparoscopic hysterectomies during the period from March 1991 to October 1993. Sixty patients were later included in this study. Thirty of these applied the technique of dissecting the ureter at the initiation of laparoscopic hysterectomy. Most of the patients were discharged on the second postoperative day. Although dissecting the ureter at the beginning of the operation did not produce a significant discrepancy in operation time, blood loss, hospitalization day and ureter injury when compared with the control group, the uterine arteries, however, may be confidently desiccated once the path of the ureter near the uterosacral ligament is identified.

Major complications during laparoscopy-assisted vaginal hysterectomy--report of four cases and review of the literature

This paper presents four recent cases of complications resulting from of a total 130 cases of laparoscopy-assisted vaginal hysterectomies performed at Chang Gung Memorial Hospital from March 1991 till January 1993. These included two cases of bladder injury, one case of vessel laceration and one case of colon injury. In addition, the literature about complications occurring at laparoscopy are reviewed and classified. This paper will: 1. present precautionary measures for avoiding intraoperative complications; 2. describe management of complications.

Combined laparoscopic hysterectomy and cholecystectomy--a case report

We present the first recorded case which received a combined laparoscopic hysterectomy, right salpingo-oophorectomy and cholecystectomy during one anesthetic period in Taiwan. This procedure was done to treat the coexisting benign lesions of the uterus, ovary, and the gall bladder. Postoperative pathological diagnoses was myoma, an ovarian hemorrhagic corpus leutum cyst, cholelithiasis, and cholecystitis. Estimated blood loss was less than 150 ml for the combined procedure. With the total operation time being 135 minutes. The patient recovered soon and could take a regular diet and walk without assistance 20 hours after operation. She discharged 4 days later and returned to work 5 days after discharge. We think for well trained laparoscopists, a cross-specialty cooperation between a gynecologist and a general surgeon to treat coexisting lesions of the uterus and the gall bladder is a safe, feasible, and beneficial procedure.

Laparoscopic ovariopexy before irradiation for medulloblastoma

Ovarian preservation before abdominal irradiation may be recommended for young patients with various types of invasive cancer. The most common site for ovarian transposition is just below the iliac crest or posterolateral to the uterus. Here, we demonstrate laparoscopic ovariopexy with an automatic stapling device to transpose the ovaries to an uncommon site, i.e. lower anterolateral abdomen, in a patient with medulloblastoma prior to her receiving irradiation of the craniospinal axis. The anterolateral transposition of the ovary not only kept it away from the irradiated field but allowed it also to be shielded by the uterus. Thus, ovarian function could be well preserved.