Objectives: The objective of this study was to identify the correlation between preoperative magnetic resonance imaging (MRI) findings of myoma and the incidence of bleeding during laparoscopic myomectomy (LM).
Methods: We investigated the preoperative MRI findings of 25 patients who underwent LM from January 2012 to December 2014, including patients who had undergone myoma resection. We evaluated the correlations between perioperative blood loss and the size of the myoma as well as between perioperative blood loss and the maximal minor axis of flow void (MMAFV) of the myoma margins.
Results: The mean diameters of the myomas were as follows: longest axis, 60.4 ± 20.6 mm; occipitofrontal diameter, 55.0 ± 15.7 mm; upper and lower diameters (ULDs), 53.7 ± 19.3 mm; and transverse diameter, 56.5 ± 21.7 mm. The mean MMAFV was 2.1± 0.9 mm. The estimated mean blood loss was 104.9 g (range, 5–450 g). All myoma diameters showed a significant linear positive correlation with the estimated perioperative blood loss. The correlation of the ULDs was the highest among all myoma diameters (r = 0.59, P = 0.0021). The MMAFV showed a significant linear positive correlation with the estimated perioperative blood loss (r = 0.62, P = 0.0010).
Conclusions: Our results suggest that the ULDs and MMAFV of the myoma margins are risk factors for bleeding during LM, as determined using preoperative MRI.
Objectives: Trochanteric fractures with a detached greater trochanter are often encountered during routine medical examinations. We analyzed cases of stable reconstruction following surgery for these fractures.
Methods: Forty-two patients who sustained a trochanteric fracture with a detached greater trochanter from 2015 to 2016 were clinically and radiographically reviewed. Fracture fixation was performed with 135° free-sliding plates. On postoperative day 14, the patients were classified into two groups based on their computed tomography findings: those in whom a lag screw could be inserted in the anterolateral part that continues to the diaphysis and those in whom the screw could not be inserted in this position. Outcome measures included the quality of reduction (postoperative neck–shaft angle on the lateral view, postoperative ratio of subtype A or subtype N according to Ikuta's classification), postoperative placement of the tip of the lag screw in the femoral head on the lateral view, and sliding distance of the lag screw on postoperative day 14.
Results: The mean neck–shaft angle on the lateral view and the mean sliding distance of the lag screw were significantly shorter in the group in which the lag screw could be inserted in the anterolateral part that continues to the diaphysis.
Conclusions: For trochanteric fractures with a detached greater trochanter, insertion of the lag screw in the anterolateral part that continues to the diaphysis is important and can achieve stable reconstruction. Moreover, caution should be employed with respect to the neck–shaft angle on the lateral view.
Objectives: Estimates of the numbers of patients with intractable diseases in Japan use data from nationwide epidemiological surveys under the assumption that the mean number of patients among hospitals that respond to the survey is equal to that among hospitals that do not respond ( "the assumption of no response bias" ). We examine the validity of this assumption.
Methods: Data from nationwide epidemiological surveys of eosinophilic granulomatosis with polyangiitis (EGPA) and familial Mediterranean fever (FMF) were used. Information from initial questionnaires and from second surveys, of hospitals that did not respond to the initial surveys, were combined in a statistical model to estimate rates of response.
Results: The proportion of hospitals that had patients with EGPA and FMF was higher among hospitals that responded to the initial survey than among those that responded to the second survey. The ratio of the response rate for hospitals without affected patients to that for those with affected patients was estimated to be 0.86 for EGPA and 0.90 for FMF. The ratio of the number of patients estimated under the assumption of no response bias to that based on the estimated ratio of response rate between in hospitals with and without affected patients was 1.11 for EGPA and 1.09 for FMF.
Conclusions: The number of patients with EGPA and FMF estimated under the assumption of no response bias was only about 10% greater than the true number, suggesting that the assumption was almost completely valid.
The genetic etiology of female infertility is almost completely unknown. Recently, the egg membrane protein JUNO was identified as a receptor of the sperm-specific protein IZUMO1 and their interaction functions in sperm-egg fusion in fertilization. In the present study, we examined 103 women with infertility of unknown etiology. We analyzed the JUNO gene in these cases by PCR and Sanger sequencing. We identified seven variants in total: four common, two synonymous, and a previously unidentified intronic mutation. However, it is not clear from these variants that JUNO has a major role, if any, in infertility. Many factors affect sterility and a larger cohort of patients will need to be screened in the future because the cause of female infertility is highly heterogeneous.