Background: In Japan, neonates have typically been bathed in a bathtub immediately after birth because bathing is a custom for cleansing impurities. However, dry technique has been introduced into many institutions since 2000. There is little scientific evidence on the benefit or harmfulness of either method to neonatal skin, and consequently, opinion remains split on which method is superior. Objective: The purpose of the present study was to determine whether bathing or the dry technique of cleaning is better in maintaining skin health in the early neonatal period. Methods: Transepidermal water loss (TEWL) and skin pH, considered an index of skin barrier function, were measured in each group. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, which are inflammatory cytokines released by keratinocytes, were measured by skin blotting. Results: TEWL and skin pH of neonates were lower with the dry technique than with bathing. The expression level of IL-6 and TNF-α in chest skin of neonates was higher with bathing than with the dry technique. Conclusion These results suggest that the dry technique may maintain skin health better than bathing in the early neonatal period.

　　We report a case of subcutaneous port-site hematoma developed on day 6 after laparoscopic left-sided salpingooophorectomy. To start the procedure, three ports were placed in the umbilicus and in each lower quadrant using bladeless trocars. No bleeding was observed at the trocar sites after insertion or withdrawal. The patient was discharged on postoperative day (POD) 3, but returned to the emergency outpatient department with acute left lower abdominal pain on POD 6. Dynamic CT revealed a port-site hematoma with active bleeding from a subcutaneous artery. Hemostasis was achieved easily by opening the trocar wound. Dynamic CT was useful to locate the bleeding vessel and enabled use of a minimally invasive procedure to control bleeding.

　　We report a case of vaginal cuff dehiscence after total laparoscopic hysterectomy that was successfully managed by a newly developed vaginal double-layer circular incision-closure method through a transvaginal approach. The nulligravid postmenopausal patient with cervical cancer received a diagnosis of vaginal evisceration on postoperative day 24. The eviscerated small intestine was pushed back after vaginal douching with normal saline before the procedure. The vaginal mucosa was incised circularly in two layers at the levels of 10 mm and 15 mm from the vaginal stump, and the edges apposed with double-layer closures. She was discharged on postoperative day 3 and followed up for 5 years, with no recurrence of cancer or vaginal dehiscence. This operative method is especially useful for a nulligravida with a small vagina.

　　This retrospective study was carried out to clarify the preventive effect of neutral positioning of both arms on upper extremity neuropathy after gynecological laparoscopic surgery compared with right arm abduction positioning. In 93 cases of right arm abduction positioning >90°, with the left arm tucked in at the side, postoperative right hand numbness occurred in 6 cases (6.5%). In these 6 cases, symptoms disappeared in 4 cases after postoperative day (POD) 1, in 1 case after POD 21, and in the remaining case after POD 41. In 81 cases where both arms were in the neutral position tucked in at the sides with shoulder braces applied, upper extremity numbness was not experienced in any cases; however, shoulder pain developed in 4 cases (4.9%) and was thought to be related to using the shoulder braces. The pain disappeared in 2 cases after POD 1, in 1 case after POD 2, and in the remaining case after POD 3. In right arm abduction positioning without the use of shoulder braces, shoulder pain was not experienced in any cases. Neutral positioning of both arms in gynecological laparoscopic surgical patients was effective for the prevention of upper extremity neuropathy, but measures to alleviate the onset of shoulder pain after change in positioning need to be addressed in the future.

　　We have developed a new surgical procedure for uterine prolapse of round ligament suspension to the psoas minor tendon by the use of a laparoscope. Here, we describe the new technique and report the outcome of surgery in three cases.　　Operative procedure: The fundus of the uterus is lifted back up to its natural position by fixing the round ligament of the uterus to the psoas minor tendon after incising the peritoneum covering psoas. It is important to use the tendon as a stronger reattachment site in addition to the psoas major muscle. The round ligament is tacked to the tendon by a 2-0 nonabsorbable suture on bilateral sides. The second suture may be added if the uterus is not appropriately lifted up by the first suture. The retroperioneum is closed by a continuous 3-0 absorbable suture after fixation.　　Cases: Two patients with severe uterine prolapse and one patient with a mild condition went through the operation safely and have experienced no recurrence for 10 to 24 months. One severely ill patient complained about post -operative right inguinal pain early and another with the severe condition complained that something felt wrong with the right thigh.　　We propose the operation of laparoscopic round ligament psoas minor tendon-hitching as a safe and effective surgical treatment for uterine prolapse.

　　Placental abruption occurs suddenly and may cause maternal and fetal mortality. Forced delivery is the only way to improve perinatal outcome, but the aftereffects could be severe despite a high survival rate.　　Our hospital manages approximately 170 cases of maternal transport annually, including cases of severe placental abruption. Longer transport time can lead to undesirable maternal and fetal outcome. Hence this study, we compared the perinatal backgrounds and outcome of placental abruption retrospectively between the cases managed by maternal transport and by the local hospital (our hospital). The study included 54 cases of placental abruption during the period from January 2008 to December 2012, of which 27 cases were managed by our hospital, the other halves were managed by maternal transport. There were 6 intrauterine fetal deaths but not a single maternal death. There were no significant differences in the amount of blood lost and obstetric DIC (disseminated intravascular coagulopathy) score between two groups (p＝0.342, p＝0.649), and the number of cases that needed anti-DIC therapy and blood transfusion in each group was statistically similar (p＝0.807, p＝0.115). The time taken from the on-set of placental abruption to delivery was significantly shorter for the cases managed by our hospital (in-hospital management 143±133 minutes, maternal transport management 265±176 minutes, p‹0.05), while obstetric DIC score and Apgar score showed no significant differences (p＝0.336, p＝0.780) between the two groups. Thus, it could be said there were no correlations between the time taken from onset to delivery and perinatal outcome. It should be noted, however, maternal and fetal outcome of placental abruption could be fatal even with the rapid intervention, so quick diagnosis and management at the first contact are crucial. Thus, we concluded that forced delivery managed by the local hospitals is necessary for the potential better perinatal outcome, and an ideal system to manage maternal and/or neonate transport after the delivery should be established immediately.

  A 41-year-old woman, gravid 3, para 3, was admitted to the Department of Obstetrics and Gynecology at Tsuchiura Kyodo General Hospital, complaining of a tender, gradually enlarging mass in the right inguinal region during menses. Examination found the mass was about 2 cm in diameter, which protruded slightly (on lying position?). During menstrual periods, the mass enlarged and the pain intensified, but between menses, the mass decreased in size and the pain subsided. The case was diagnosed as inguinal endometriosis and then a preoperative GnRH analog therapy was given for six weeks to make a good operative local condition. Surgery was performed under general anesthesia and a mass about 4.0×3.0 cm in diameter near inguinal ligament was removed. The cut surface revealed small hemorrhagic areas or spaces. Microscopic examination of the dissected mass confirmed the diagnosis of inguinal endometriosis. It was found that the patient had a moderate inguinal swelling on the first visit to the hospital as an outpatient 7 days after operation, but the swelling disappeared shortly afterword. She has been receiving a post-operative GnRH analog therapy for 3 months to maintain a good local condition. The authors concluded thatthe appearance of a lump in the inguinal region and objective changes of the lesion in relation to the menstrual cycle should be considered as the symptoms of endometriosis.

  We report a case of new-onset depressive disorder in a patient with a history of rectal endometriosis treated with GnRH analog and no previous psychiatric history. This medical history allowed us to suspect the possibility of a link between GnRH analog and depression. It also highlighted the need to screen patients treated with GnRH analog for depression.
  The patient was 41-year-old woman who had been diagnosed with rectal endometriosis. She was referred to the Gynecology Department of Tsuchiura Kyodo General Hospital. The subjective symptoms included cyclic abdominal pains and rectal bleedings. The patient had undergone total abdominal hysterectomy and left salpingo-oophorectomy for endometriosis two years before. She was started by her first gynecologist on GnRH agonist (nafarelin acetate) and the symptoms disappeared soon. But several weeks after the initiation of the GnRH agonist treatment, she began to feel depressed and hopeless. She visited a psychiatric hospital and diagnosed as having depression. She was given anti-depressive drugs and inpatient treatment at the psychiatric hospital. Her clinical course was reviewed by her second gynecologist, and she was suspected to have developed depressive disorder by GnRH analog treatment. She stopped taking GnRH analog medication and started progestin (Dinagest) therapy. She became soon free of depressive disorder and then anti-depressive drugs with rectal endometriosis well controlled. This case also suggested Dinagest is a recommended drug for rectal endometriosis.

The guidelines for the prevention of heat disorders during sports activities were established 13 years ago in Japan. Since then, various studies on preventive measures against heat disorders have been done, yielding new knowledge about its prevention. It has been reported that the incidence of heat disorders is high in children and the elderly, and heat acclimatization and clothing are the factors involved in this disorder. We proposed to lower the WBGT (wet-bulb globe temperature) limit for warning (discontinuation of hard exercise) from “28°C or more” to “25°C or more” (corresponding to an ambient temperature of 28°C) for non-acclimatized persons, children, the elderly, and persons wearing clothes covering the entire body. We also indicated that heat disorders can occur due to unpredictable causes, because the mechanism is very complicated.

To clarify the effects of varying skin temperature due to several types of clothing on temperature responses and heat-stress during exercise, we analyzed thermoregulatory responses while wearing various types of sportswear including soccer (SC), baseball (BB), and fencing uniforms (FU), and while wearing water-perfused suits (WS) and vests (WV) during exercise in a hot environment. We also compared these results with those obtained under a semi-nude condition (NU). Eight male subjects performed three 20-min cycling sessions at light intensity (250W/m²) in a room maintained at 28°C (wet-bulb globe temperature, WBGT). The experiment was performed under ten conditions, with six sets of clothing, WS and WV at 14°C (WS14, WV14), 20°C (WS20, WV20) and 26°C (WS26, WV26), and FU, SC, BB or NU. While wearing sport-swear, increases in esophageal (ΔTes), mean skin (Tsk), mean body (Tb) temperature, heart rate (HR), thermal sensation (TS) at the end of exercise, and total sweat loss (m_{sw, tot}) during exercise were significantly (p<0.01) higher in BB and FU than in NU. In comparison to WS or WV conditions, ΔTes was significantly (p<0.01) higher under WV conditions than under NU, while there was no significant difference in ΔTes between WS and NU. Tsk, Tb, HR, TS and m_{sw, tot} tended to be lower in WS14 and 20, and higher in WV26 than in NU. Under all conditions at the end of exercise, the ΔTes markedly increased when Tsk exceeded 34°C ; and ΔTes was significantly correlated with Tsk (r=0.861, p<0.01) for all conditions except WS14 and 20. For Tsk less than 34°C, however, ΔTes remained constant. ΔTes, Tsk, and Tb significantly correlated with HR (r=0.932, p<0.001), TS (r=0.888, p<0.001), and m_{sw, tot} (r=0.961, p<0.001), respectively. These results show that during light exercise under hot conditions, 1) in several types of clothing, a critical level of skin temperature causing core temperature elevation may exist, 2) cooling the skin temperature can alleviate heat-stress due to body temperature elevation, and 3) the semi-nude condition is the simplest method of alleviating core temperature elevation without using body cooling materials such as WS or WV.