Techniques of transvaginal mesh prolapse surgery in Japan, and the comparison of complication rates by surgeons' specialty and experience.

OBJECTIVES: To investigate techniques of transvaginal mesh prolapse surgery in Japan, and compare complication rates by surgeons' specialty and experience with transvaginal mesh prolapse surgery. METHODS: We carried out an anonymous questionnaire survey for surgeons attending a national transvaginal mesh prolapse surgery meeting in 2010. The surgeons were asked to state their specialty, practice patterns, transvaginal mesh prolapse surgery techniques and the number of transvaginal mesh prolapse procedures carried out as an operator including the complications that occurred. RESULTS: A total of 118 surgeons (59% of the attendees) responded to the questionnaire. The mean age was 44.0 ± 9.1 years, 54 (46%) were gynecologists and 64 (54%) were urologists. All urologists and 78% of gynecologists carried out anti-incontinence surgery (midurethral sling), whereas more gynecologists (93%) carried out native tissue repair than urologists (73%). Most of both specialties (each 98%) avoided prophylactic anti-incontinence surgery during prolapse surgery. Concomitant hysterectomy during transvaginal mesh prolapse surgery was generally avoided. Surgeons reached a consensus regarding the critical transvaginal mesh prolapse surgery techniques: hydrodissection (98%) and the full-thickness dissection (the "Lychee layer"; 69%). A total of 11 935 Prolift-type transvaginal mesh prolapse procedures were carried out and the following complications were reported: bladder injury (1.6%), rectal injury (0.3%), ureteral injury (0.1%), blood transfusion (0.2%), vaginal exposure (2.8%) and recurrence requiring reoperation (1.1%). Although complications did not differ between specialty, bladder injury, transfusion and vaginal exposure were less prevalent with experienced surgeons (≥50 transvaginal mesh prolapse surgery cases). CONCLUSIONS: Over 10 000 transvaginal mesh prolapse surgery had been carried out in Japan with a relatively low complication rate until 2010. This survey shows that surgeons' experience could lead to a decrease in the amount of transvaginal mesh prolapse surgery complications.

[Folic acid reduces the risk of neural tube defects: awareness and folate intake among pregnant women in 2006].

Folic acid plays an important role in proliferating cells and tissues of the fetus. A randomized control trial demonstrated in 1991 that 4 mg of folic acid supplements successfully prevented 72% of recurrence of neural tube defects (NTDs) in women who had had afflicted pregnancy. In 2000, the Japanese Government recommended women of childbearing age to take 400 microgram of folate supplements per day from 4 weeks prior to and 12 weeks after conception. A questionnaire study was performed in pregnant women by post on their awareness of the role folic acid plays, their life style, and folate intake by dietary consumption. Thirty-five percent of 1,251 pregnant women were aware of the important role of folic acid in the critical stage of fetal development and 31% actually took the supplement. Information on folic acid was obtained through mass media in 47% of the women, through the internet in 17%, through healthcare providers in 13% and so forth. The food record analysis revealed that the dietary intake of folic acid averaged 341 microg/day that was 60 microg less than what was recommended by the Government and that 33 of 86 women took the supplement. Overall, a half of pregnant women are required to take 400 microg folate supplement per day. It is to be stressed that primary prevention of NTDs by periconceptional intake of folic acid is a major public health opportunity and that prevention is more important than cure in the management of NTDs.

[A case of ovarian cancer in which a remarkable effect was seen with low-dose CDDP intratumoral injection of CPT-11].

We treated an ovarian cancer patient in whom low-dose CDDP intratumoral injection with CPT-11 therapy was very effective. The patient was a 63-year-old woman. She showed symptoms of peritonitis. Carcinomatous peritonitis was suspected on abdominal CT scan and tumor markers were at high levels (CA125 10,827 U/ml, SLX 82 U/ml). At laparotomy, massive ascites (3,000 ml), omental cakes and disseminated peritoneal tumors were revealed. Her uterus and adnexa were not enlarged. The omental tumor and ovaries were biopsied and revealed serous adenocarcinoma. The patient was treated with combined chemotherapy of CDDP and CPT-11. CDDP (20 mg/day) was administered by intraperitoneally for 3 days, and CDDP (10 mg/day) was administered by intratumoral injection (percutaneous for omental tumor) for 5 days. CPT-11 (40 mg/day) was administered twice a week. As a result, marked shrinkage of the tumors was confirmed. This low-dose CDDP intratumoral injection with CPT-11 may be effective for such omental tumors with carcinomatous peritonitis.