IntroductionIsolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls.Case presentationsIn case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course.ConclusionWe have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.

IntroductionSpontaneous rupture of an ovarian artery aneurysm is extremely rare. Although a majority of these cases have been associated with pregnancy, there have been recent reports and reviews of rare cases that were not directly associated with pregnancy. Transcatheter arterial embolization is considered to be an alternative therapy to surgery.Case presentationA 44-year-old Japanese woman, gravida 3 para 3, presented to our emergency room complaining of intermittent right flank pain. She had undergone a cesarean section 2 years previously, and had no history of abdominal trauma. On admission, her blood pressure was 115/78 mmHg, pulse 70 beats per minute, and hemoglobin concentration 9.8 g/dL. Abdominal ultrasonography and contrast-enhanced dynamic computed tomography revealed a large retroperitoneal hematoma. Findings on three-dimensional computed tomography angiography suggested ruptured aneurysm of her right ovarian artery. A selective right ovarian artery angiogram revealed a tortuous aneurysm. Transcatheter arterial embolization using N-butyl-2-cyanoacrylate was performed. The aneurysm was successfully embolized, and her course after embolization was uneventful. She has remained symptom-free during 3 months of follow-up.ConclusionsThis was a very rare case of a patient who had a retroperitoneal hemorrhage originating from an ovarian artery aneurysm. A review of published case reports found that contrast-enhanced computed tomography with reconstruction images is an excellent imaging tool. Diagnostic angiography and subsequent transcatheter arterial embolization are thought to be very effective for this condition.

To estimate the effectiveness of screening for invasive cervical cancer, a case-control study was performed in Miyagi, Japan. A total of 198 cases (129 mass screen-detected and 69 outpatient-detected) of invasive cervical cancer were identified between 1984 and 1990. The results of the Papanicolaou smear of these cases were compared to those of 396 age-(±5 years) and area-matched controls. Compared with women who had no prior screening (cases 51.6%, controls 16.2%), women who were screened had an odds ratio (OR) for invasive cervical cancer of 0.14 (95% confidence interval [CI] 0.088-0.230). The OR for the 175 cases of squamous cell carcinoma was 0.13 (95% CI 0.077-0.215), while the OR for the 23 cases of screened women with adenocarcinoma was 0.40 (95% CI 0.091-1.753). The time intervals following the last negative smear were assessed and we found an OR for a one-year interval and a two-year interval of 0.09 (95% CI 0.055-0.163) and 0.17 (95% CI 0.083-0.335), respectively. In conclusion, screening for invasive cervical cancer is not only effective but also the degree of protection is high for one to two years. cervical cancer; case-control study; cervical cancer screening Miyagi is one of the first areas in Japan to be involved in mass screening for cervical cancer. From 1984From -1990, in Miyagi, a total of one million Papanicolaou (Pap) smears were taken among women over the age of 30. The cytodiagnoses of the Pap smears for these women were performed primarily at the Center for Clinical Cytology (Miyagi Cancer Society). The results of the screening program and the relationship between histological features and history of prior cervical screening have previously been reported by our group (Yajima et al. 1979;. However, the effectiveness of this form of screening for cervical cancer in Miyagi using epidemiological methods has not been described before except for a prelimi-

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