bluuebunny/crossref_metadata_2025 huggingface dataset:
The Contribution of Menopause to Changes in Body‐Fat Distribution
Authors: Ijuin Hirofumi , Douchi Tsutomu , Oki Toshimichi , Maruta Kuninori , Nagata Yukihiro
Published: May 2010

Objective: To investigate whether menopause contributes to changes in body‐fat distribution, irrespective of aging or obesity.

Methods: The subjects were 545 premenopausal (aged 16–55 years; mean + standard deviation, 37.7 + 9.1 years) and 219 postmenopausal (aged 45–65 years, 58.0 + 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk‐leg ratio) was estimated by dual‐energy X‐ray absorptiometry. The trunk‐leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk‐leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationsip of the trunk‐leg ratio to YSM or age after adjusting for BMI was investigated.

Results: The trunk‐leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk‐leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk‐leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk‐leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk‐leg ratio, independent of the BMI (p < 0.01).

Conclusions: Menopause contributes to a change in body‐fat distribution, irrespective of aging or obesity.
Risk of Recurrence of Fetal Chromosomal Aberrations: Analysis of Trisomy 21, Trisomy 18, Trisomy 13, and 45,X in 1,076 Japanese Mothers
Authors: Uehara Shigeki , Yaegashi Nobuo , Maeda Tohru , Hoshi Nobuhiko , Fujimoto Seiichiro , Fujimori Keiya , Yanagida Kaoru , Yamanaka Michiko , Hirahara Fumiki , Yajima Akira
Published: May 2010

Objective: To evaluate the risk of recurrence of fetal chromosomal aberrations in women who had offspring with numeric chromosomal abnormalities.

Subjects and Methods: This collaborative study consisted of 1,076 Japanese women with a history of offspring with trisomy‐21, ‐18, ‐13, or 45,X. Second‐trimester amniocenteses were performed, resulting in 1,248 fetal karyotypes that were analyzed with reference to prior offspring karyotypes and maternal age.

Results: Of the 842 women with trisomy‐21 offspring, 10 conceived another such fetus. In 2 women with 3 or more such offspring, parental mosaicism of trisomy‐21 was suspected. The incidence of recurrence of trisomy‐21 increased with age, and significantly exceeded the incidence of trisomy‐21 fetuses in the general population. None of the 170 women with trisomy‐18 offspring, and none of the 46 women with trisomy‐13 offspring, had another such fetus. Of the 18 women with 45, X offspring, 1 with mos 45, X/46, XX had another such fetus.

Conclusions: The risk of recurrence of trisomy‐21 is affected by maternal age and parental germline mosaicism. The risk of recurrence of trisomy‐18 or ‐13 appears to be much lower than that of trisomy‐21. Women who give birth to more than 1 offspring with 45, X should be examined for mos 45, X/46, XX.
Androgen‐Producing Ovarian Tumors: A Clinicopathological Study of 3 Cases
Authors: Arai Masahide , Jobo Toshiko , Iwaya Hiroaki , Sato Rinya , Watanabe Jun , Ohno Eiji , Kuramoto Hiroyuki
Published: May 2010

The clinical course and pathological findings of 3 rare cases of androgen‐producing ovarian tumors are presented. The ages of the 3 patients (Cases 1, 2, and 3, respectively) were 43, 34, and 57 years, respectively. Their preoperative serum testosterone levels were 506, 491, and 231 ng/dl, respectively. The pathological diagnoses of Cases 1, 2, and 3 were a Sertoli‐stromal cell tumor of intermediate differentiation, a stromal tumor containing Leydig cells, and a stromal tumor with minor sex cord elements, respectively. Patient 1 experienced a recurrence, of a lesion at the vaginal stump 1 year and 2 months after the initial surgery. The clinical courses of Cases 2 and 3 have been non‐contributory.
Emergency Obstetric Hysterectomies for Postpartum Haemorrhage
Authors: Wong Wai‐Chung , Kun Ka‐Yan , Tai Chark‐Man
Published: May 2010

Objective: To review emergency obstetric hysterectomy in our unit, including the indications for and morbidity associated with the procedure

Design: A retrospective cases analysis.

Subjects and methods: Records of obstetric patients who had undergone emergency hysterectomies in between 15 October 1993 and 31 December 1997 were reviewed retrospectively.

Results: There were 15,474 deliveries and 7 emergency obstetric hysterectomies. All cases had total abdominal hysterectomy. The indications for hysterectomy were uterine atony and placental disorders. There were one case of urinary bladder injury and 2 cases of disseminated intravascular coagulopathy. There was no maternal mortality.

Conclusion: Emergency obstetric hysterectomy remains a potentially life‐saving procedure in unavoidable catastrophe. The 7 patients with life threatening postpartum haemorrhage underwent hysterectomy after failure of conservative measures. The morbidity is low and there was no mortality in this series.
New Method to Prevent Bladder Dysfunction after Radical Hysterectomy for Uterine Cervical Cancer
Authors: Kuwabara Yoshinori , Suzuki Masaaki , Hashimoto Masanori , Furugen Yoshiaki , Yoshida Koyo , Mitsuhashi Naoki
Published: May 2010

Objective: The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy.

Methods: Twelve patients with stage Ib cervical cancer underwent intraoperative electrical stimulation to identify the vesical branches of the pelvic nerves. Autonomic nerve localization in the vesicouterine ligament was examined in 10 patients immunohistochemically. According to the results of the above studies a new method to preserve the vesical branches was developed. Grades of postoperative bladder dysfunction were compared between new (n = 19) and conventional methods (n = 18).

Results: Electrical stimulation on the outer surface of the posterior sheath of the vesicouterine ligament caused the increase of intravesical pressure. S‐100 protein localized also on this area. Postoperative compliance of the detrusor in cases with the new method demonstrated less decrement from preoperative values than in cases with the conventional method. The new method required significantly fewer days to achieve residual urine volumes less than 50 ml after surgery.

Conclusions: The new method significantly reduces bladder dysfunction after radical hysterectomy.
Contraception in Diabetic Women: Comparative Metabolic Study of Norplant, Depot Medroxyprogesterone Acetate, Low Dose Oral Contraceptive Pill and CuT380A
Authors: Diab Khaled M. , Zaki Mona M.
Published: May 2010

Objective: To evaluate the long‐term intake of Norplant, depot medroxyprogesterone acetate (DMPA) and low dose oral contraceptive pill (OCs) on glycemic control, lipoprotein metabolism and coagulation profile in diabetic women.

Methods: Prospective comparative study including 80 uncomplicated controlled diabetic women. Twenty women allocated to each group. Clinical, metabolic and coagulation status were followed up at 3, 6 and 9 months' visits.

Results: Fasting blood sugar increased in OCs and DMPA users. Total cholesterol (TC) and LDL‐cholesterol (LDL‐C) decreased in all groups except DMPA where it increased. Triglyceride (TG) only increased in OCs group. HDL‐cholesterol (HDL‐C) increased with OCs and decreased with Norplant and DMPA. Compared to IUD users, significantly higher percentage TG and HDL‐C and lower LDL‐C were observed in OCs users, while DMPA users had significantly higher TC and LDL‐C and lower HDL‐C. Partial thromboplastin time was prolonged in Norplant users.

Conclusion: In diabetics, Norplant results in minimal metabolic alterations followed by OCs while DMPA has unfavorable outcome.
Maternal and Perinatal Outcome of Pregnancies after the Age of 45
Authors: Abu‐Heija Adel T. , Jallad Mohammad F. , Abukteish Faisal
Published: May 2010

Objective: To describe the maternal and perinatal outcome of pregnancies in women aged 45 years or more at the time of delivery and to compare them with pregnancies in women aged between 20 and 29 years.

Methods: A retrospective review of hospital deliveries after 28 weeks gestation was performed at the Princess Badeea Teaching Hospital in North Jordan for patients delivered between 1st April 1994 and 31st December 1997. We compared the maternal and perinatal outcome of pregnancies in women aged of 45 years or more (study group, n = 114) with women aged between 20–29 years (control group, n = 121) delivered at the same hospital during the same period.

Results: The incidence of pregnant women aged 45 years or more was 3.3 per 1,000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45 to 46 years old. Gravidity and parity was significantly higher in the study group (p < 0.0001), also antenatal and medical complications as pre‐eclampsia and diabetes mellitus were higher in the study group. Caesarean section rate, incidences of placental abruption and placenta previa were more common in older patients compared with young patients (32.4 vs 10.7%, 6.1 vs 0.8% and 4.4 vs 1.6%, respectively). There were no differences in the incidences of neonatal deaths, lethal malformations and fetal weight between the 2 groups.

Conclusion: Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery.
A Case of a Screlosing Stromal Ovarian Tumor That Expresses VEGF
Authors: Ishioka Shin‐ichi , Sagae Satoru , Saito Tsuyoshi , Kiya Tamotsu , Akutagawa Noriyuki , Sugimura Masaki , Kudo Ryuichi
Published: May 2010

A case of a sclerosing stromal tumor (SST) of the ovary is presented. One of the tumor's characteristics was its high vascularity. On immunohistochemical staining, the vascular endothelial growth factor (VEGF) was positive for both cellular and edematous areas in the tumor. VEGF was thought to be a factor that affected the clinicopathological features of this tumor.
Influence of Female Age on Pregnancy Outcome in in vitro Fertilization and Embryo Transfer Patients Undergoing Intracytoplasmic Sperm Injection***
Authors: Moon Shin Yong , Kim Seok Hyun , Jung Byeong Jun , Jee Byung Chul , Suh Chang Suk , Lee Jin Yong
Published: May 2010

Purpose: To determine the influence of female age on the outcomes of ICSI in IVF‐ET patients.

Methods: One hundred and seventy‐five couples underwent 352 cycles of ICSI. The quality of oocytes and embryos, fertilization rate, and pregnancy outcomes were retrospectively evaluated according to female age; < 30 years in Group A (49 cycles), 30–34 in Group B (177 cycles), 35–39 in Group C (97 cycles), and ≥ 40 in Group D (29 cycles).

Results: The fertilization rates were not significantly different among the age groups. Significant negative linear correlations were observed between female age and the numbers of oocytes retrieved and embryos transferred, and cumulative embryo score. Clinical pregnancy rates were significantly decreased and spontaneous abortion rate increased with advancing age.

Conclusions: Female age may be a prognostic indicator in ICSI program.
The Association of Transforming Growth Factor‐β1 with Myometrial Invasion of Endometrial Carcinomas through Effects on Matrix Metalloproteinase
Authors: Yabushita Hiromitsu , Narumiya Hisao , Hiratake Kanji , Yamada Hidefumi , Shimazu Mitsuma , Sawaguchi Keizo , Noguchi Masayoshi , Nakanishi Masami
Published: May 2010

Objective: The association of transforming growth factor‐β1 (TGF‐β1) with a matrix metalloproteinase (MMP) and a tissue inhibitor of metalloproteinase (TIMP), as well as myometrial invasion of endometrial cancer was studied.

Methods: The effects of TGF‐β1 on cellular invasiveness, gelatinase activity, and expression of TIMP‐1 were examined in 2 endometrial adenocarcinoma cell lines, KLE and Ishikawa. Plasma was obtained from 8 endometrial cancer patients with Stage‐Ia disease, from 6 with Stage‐Ib disease, and from 4 with Stage‐Ic disease, and the levels of TGF‐β1 were measured by enzyme immunoassays. The immunohistochemical expression of MMP‐9, TIMP‐1, TGF‐β1, and TGF‐β receptor Type I in tumor tissue from the same patients also was detected.

Results: Invasiveness, gelatinase activity, and the expression of TIMP‐1 were higher in KLE cells than in Ishikawa cells, and they were increased by treatment with rTGF‐β1. The expression of TGF‐β receptor Type I was higher in KLE cells than in Ishikawa cells, which were unresponsive to exogenous TGF‐β1. The plasma levels of TGF‐β1 were greater in Stage‐Ib and Stage‐Ic patients than in Stage‐Ia patients. MMP‐9 and TGF‐β receptor Type I were expressed mainly in tumor cells, while TIMP‐1 and TGF‐β1 were localized in both tumor epithelial cells and stromal cells. MMP‐9 and TIMP‐1 were expressed only in Stage‐Ib and Stage‐Ic patients, although TGF‐β1 and TGF‐β receptor Type I were ubiquitous.

Conclusions: Myometrial invasion of endometrial cancers involves an increase in gelatinase activity, regulated to some extent by TGF‐β1 in an autocrine or paracrine fashion.
Ten Years' Experience of Antenatal Mean Corpuscular Volume Screening and Prenatal Diagnosis for Thalassaemias in Hong Kong
Authors: Sin S. Y. , Ghosh A. , Tang L. C. H. , Chan V.
Published: May 2010

Objective: To determine the prevalence of thalassaemia carriers in Hong Kong.

Subjects and Methods: From 1988 to 1997, 25834 (53.7%) of 48089 mothers were screened for thalassaemias by mean corpuscular volume (MCV) at the first antenatal visit.

Results: In the screened population of 25834, 2229 (8.6%) had MCV ≤ 75 fl. Of these, 1121 (4.3%) were α‐thal, 715 (2.8%) were β‐thal, 23 (0.1%) were αβ‐thal, 57 (0.2%) were other haemoglobin variants, and 281 (1.1%) had either iron deficiency or uncertain causes. Out of 200 pregnancies at risk for homozygous α‐thal‐1 and 32 at risk for β‐thal major, 27 homozygous α‐thal‐1 and 7 β‐thal major were identified, compared favourably with the expected figures of 23 and 9.

Conclusion: Antenatal screening for thalassaemias by MCV is simple, effective and reliable. Universal screening has a different impact as bone marrow or cord blood stem cell transplant provides cure for β‐thal major. At risk couples have, as an alternative to termination of pregnancy, the option of early detection and treatment for their affected newborns or fetuses.
Immature Brain Injury via Peroxynitrite Production Induced by Inducible Nitric Oxide Synthase after Hypoxia‐Ischemia in Rats
Authors: Ikeno Shinji , Nagata Naoki , Yoshida Souichi , Takahashi Hiroyuki , Kigawa Junzo , Terakawa Naoki
Published: May 2010

Objective: To determine whether, and if so how, iNOS expresses and affects brain injury induced by hypoxia‐ischemia in an immature brain.

Material and Methods: Seven‐day‐old Wistar rat pups were exposed to right common carotid artery ligation followed by 1.5 hours of hypoxia. The time course of iNOS mRNA expression, enzymatic activity, and protein production in the cerebral cortex were determined. The extent of the infarct area in the cerebral cortex and the production of 3‐nitrotyrosine (a biomarker of peroxynitrite) were compared between the control pups and pups treated with S‐methyl‐isothiourea (a selective iNOS inhibitor).

Results: In the cortex ipsilateral to carotid ligation, iNOS mRNA appeared from 6 hours to 24 hours after hypoxia‐ischemia and disappeared at 48 hours. The iNOS protein and its activity also increased at 12 hours and reached a maximum level at 48 hours after the insult. The percentage of damage in the cerebral cortex was significantly higher in the control pups than in treated pups (31.9 vs 10.6%). Tri‐nitrotyrosine following iNOS expression‐positive cells were located predominantly at the infarct and peri‐infarct regions.

Conclusions: iNOS expression might be an important determinant of ischemic immature brain injury.
Sonohysterography in the Diagnosis of Abnormal Uterine Bleeding
Authors: Chittacharoen Apichart , Theppisai Urusa , Linasmita Vasant , Manonai Jittima
Published: May 2010

Objective: The purpose of this study was to evaluate the value of sonohysterography in diagnosis of patients with abnormal uterine bleeding.

Method: Fifty‐five patients with abnormal uterine bleeding and transvaginal sonography suggested an abnormal endometrial echo were enrolled in the study. Sonohysterography was performed on all patients, using saline instilled through an endocervically placed catheter. The histologic or pathologic finding was evaluated after surgical procedures and compared with sonohysterography results.

Results: Sonohysterography was successfully completed in 52 cases (94.54%). Three cases had cervical stenosis and failed to pass the catheter into the uterine cavity. Mean age was 41.56 + 7.82 years (range 29–58 years). Forty‐six of 52 sonohysterography demonstrated intrauterine abnormalities (29 endometrial polyps, 15 submucous myomas, 2 endometrial hyperplasia). The pathologic finding demonstrated 46 intrauterine pathologic cases (28 endometrial polyps, 15 submucous myomas, 3 endometrial hyperplasia). Sonohysterography had 97.82% sensitivity, 83.33% specificity, 97.82% positive predictive value, 83.33% negative predictive value, and 96.15% accuracy.

Conclusion: Sonohysterography is a highly sensitive, specific, and accurate screening procedure for the evaluation of uterine cavity in abnormal uterine bleeding and is a simple, minimally invasive, and effective tool to use in the evaluation of patients.
Isolated Pericardial Effusion and Transient Abnormal Myelopoiesis in a Fetus with Down's Syndrome
Authors: Hirashima Chikako , Eguchi Yukari , Kohmura Yasuhiro , Minakami Hisanori , Sato Ikuo
Published: May 2010

Isolated pericardial effusion was detected in a fetus at 34 weeks of gestation. A male infant weighing 2,044 g was born by cesarean section because of a non‐assuring fetal heart rate pattern at 35 weeks of gestation. Transient leukocytosis (36,100/μl) with 49% blast cells was seen in this neonate. The infant's karyotype was 47, XY + 21. The pericardial effusion disappeared after treatment with prednisolone at a dose of 2 mg/kg/day. Hypothyroidism was subsequently found. Thus, the subject patient with Down's syndrome developed isolated pericardial effusion, transient abnormal myelopoiesis (TAM), and hypothyroidism. Because more than 20% of the infants with TAM and Down's syndrome develop acute nonlymphocytic leukemia in early childhood, he is being closely observed.
Sonographic Diagnosis of Exencephaly: Omphalocele at 11 Weeks of Gestation
Authors: Chanprapaph Pharuhas , Tongsong Theera , Wongtra‐ngan Supreeya
Published: May 2010

This report presents a sonographic diagnosis of exencephaly combined with omphalocele at 11 weeks of gestation. The transvaginal ultrasound showed frog‐eye appearance face with no skull, abnormal shape of disorganized brain with covering membrane separated from brain mass by anechoic fluid in some area, and omphalocele of 8 mm diameter. Therapeutic abortion was successfully done with misoprostol. Postabortal macroscopic findings confirmed the prenatal diagnosis. The combination of exencephaly and omphalocele is rare, and this is one of the earliest diagnosis of not only exencephaly but also omphalocele. To our best knowledge, this represents the earliest diagnosis of the combination. In conclusion, transvaginal ultrasound proved highly informative for both exencephaly and omphalocele as early as in first trimester.
Severe Hypoproteinemia in a Fetus after Pleuro‐Amniotic Shunts with Double‐Basket Catheters for Treatment of Chylothorax
Authors: Koike Toshimitsu , Minakami Hisanori , Kosuge Shuichi , Izumi Akio , Shiraishi Hirohiko , Sato Ikuo
Published: May 2010

The prognosis of a fetus with hydrothorax at mid‐trimester is extremely poor. We encountered a fetus who developed bilateral chylothoraxes at 23 weeks of gestation. Bilateral pleuro‐amniotic shunts with double‐basket catheters were successfully installed at 25 weeks of gestation. Hydrothorax did not recur in this fetus. After the shunting, however, polyhydroamnios, fetal hypoproteinemia, and placental edema developed, and the hydrops worsened. The drainage of the fetal pleural effusion into the amniotic cavity was believed to have contributed to these complications. The infant, born at 29 weeks of gestation, died of cardiac failure and pulmonary hypoplasia. Thus, the shunts did not ameliorate the adverse conditions in this patient.
Triple Marker Screening for Trisomy 21, Trisomy 18 and Open Neural Tube Defects in Singleton Pregnancies of Native Japanese Pregnant Women
Authors: Onda Takekazu , Tanaka Tadao , Yoshida Koyo , Nakamura Yasushi , Kudo Ryuichi , Yamamoto Hiroyuki , Sato Akira , Yanagida Kaoru , Takai Yasushi , Uemura Hiraku , Hoshi Kazuhiko , Fukada Yukihito , Miyake Yoshiaki , Ohnishi Miyako , Kaneoka Tsuyoshi , Makino Yasuo , Murata Yuji , Kanzaki Toru , Kanzaki Hideharu , Osaki Takashi , Aono Toshihiro , Maeda Kazuhisa , Ogita Sachio , Yamamasu Seiichi , Aso Takeshi , Shimizu Yasufumi , Izutsu Toshihiko , Kudo Tomohiko , Okai Takashi , Sakai Masato , Hashimoto Toshirou , Matsuzaki Noboru , Kitagawa Michihiro , Sago Haruhiko , Grier Robert E. , Myrick Faye
Published: May 2010

Objective: To report the results of prenatal triple marker screening on a population of Japanese pregnant women.

Methods: From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker‐screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut‐off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1:295, 1:290, and 1:100, respectively. Follow‐up information was collected postpartum and statistically analyzed.

Results: Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%.

Conclusions: The first cumulative data of an intervention program and prospective follow‐up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age‐dependent screening for detecting T21, T18 and ONTD pregnancies.
The Presence and Role of the Dopamine DA‐2 Receptor in the Human Decidua
Authors: Arai Fujimi , Kishimoto Yasuo , Tada Katsuhiko , Kondo Yuji , Kudo Takafumi
Published: May 2010

Objectives: Our objectives were to identify the presence of the dopamine DA‐2 receptor in human decidua and to study its function in human parturition.

Methods: Human term decidual tissues were obtained during vaginal delivery and then homogenized. The P3 fraction was prepared for a radiolabeled receptor assay with [3H] spiperone as the ligand. Human decidual tissues obtained at cesarean section before the onset of labor were incubated in Krebs‐Ringer buffer at 37°C for 30 minutes in the presence of dopamine with or without (–)‐sulpiride. The level of prostaglandin (PG) F in the medium was measured with a RIA kit. Differences were assessed with the Wilcoxon non‐parametric test.

Results: Scatchard analysis showed a single class of binding sites having an equilibrium dissociation constant (Kd) of 2.25 + 0.59 nm (mean + SD) and a maximum binding capacity (Bmax) value of 166.5 + 77.7 fmol/mg protein (n = 3). Dopamine significantly increased the production of PGF. This stimulatory effect of dopamine was suppressed by (–)‐sulpiride (p < 0.05; n = 7).

Conclusion: The DA‐2 receptor was demonstrated in the human decidua. Dopamine can stimulate PGF production via this receptor.
Effect of Human Hydrosalpinx Fluid on in vitro Mouse Embryogenesis
Authors: Saito Shinichi , Yao Yoichiro , Shiraishi Toshiko , Ueyama Mamoru , Hirakawa Shun
Published: May 2010

Objective: Women with hydrosalpinx have an unfavorable pregnancy rate. As one approach to elucidate the effect of hydrosalpinx on uterine tubal functioning, we examined the effect of hydrosalpinx fluid on early embryo development in mice.

Methods: Hyperovulation was induced in ICR mice, and late 2‐cell‐stage embryos were harvested 42 hours after administration of human chorionic gonadotropin (hCG). Hydrosalpinx fluid was obtained from patients during surgery after informed consent was obtained. The embryos were cultured in 3 culture fluids: (1) mBWW medium containing 0.3% bovine serum albumin (positive‐control medium) (BSA), (2) Ca2+, Mg2+‐free phosphate buffered saline (negative‐control medium) (PBS), and (3) 100% human hydrosalpinx fluid. The developmental status of the embryos 120 hours after hCG administration was examined.

Results: Embryogenesis from a 2‐cell‐stage embryo to a blastocyst was observed in 98.3% (118/120) of the embryos cultured in the mBWW medium, in 0% (0/120) of the embryos cultured in PBS, and in 98.3% (118/120) of the embryos cultured in 100% human hydrosalpinx fluid.

Conclusion: In the micro‐environment of human hydrosalpinx fluid, late 2‐cell embryos of ICR mice developed normally to blastocysts. The present results also suggest that non‐species‐specific embryogenetic factors might be present in human hydrosalpinx fluid.
Fertility and Gynaecologic Malignancies
Authors: Sivanesaratnam V.
Published: May 2010

Fertility and gynaecological malignancies have an important relationship. A clear inverse relationship exists between family size and the incidence of ovarian and endometrial cancer.

Current methods of fertility control have an influence on subsequent development of various gynaecological malignancies. A slightly increased risk of breast cancer has been reported in current users and those who had used hormonal contraceptives (OCs) within 10 years; this risk declined with time and disappeared after 10 years. Women who started OC before age 20 had a higher relative risk; the disease did not spread beyond the breast in the majority. Most studies found OC to reduce the risk of ovarian and endometrial cancer. The relative risks of squamous cell carcinoma and adenomatous carcinoma of the cervix have been reported to be 1.3 and 1.5, respectively in ever‐users of OCs; however, the aetiology of cervical cancer is multifactoral. Several reports suggest the beneficial effect of tubal ligation and breast feeding in reducing the risk of ovarian cancer.

Therapy of gynaecological malignancies may have an influence on subsequent fertility. Amenorrhoea developing after treatment of hydatidiform mole may be due to choriocarcinoma, recurrent mole or a normal pregnancy. Choriocarcinoma can also develop after a partial mole. The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or immediately following the treatment cycles. Fertility is not impaired following chemotherapy. Successful pregnancies have occurred in women who have had widespread GTD including cerebral metastases.

In the young patient with gynaecological malignancy preservation of fertility is possible. Fertility‐sparing surgery may be safe in early ovarian epithelial cancers and even in advanced germ cell tumours. Recently, the fertility‐sparing surgery of radical trachelectomy and pelvic lymphadenectomy has been carried out for early invasive cervical cancer in young women.

Gynaecological cancer occurring in pregnancy is uncommon; it presents the clinician with a difficult situation to manage. In most instances the cancer is treated as though the patient is not pregnant; the timing and mode of delivery needs individualization. The overall prognosis for breast cancer complicating pregnancy is poor. Survival in cervical cancers diagnosed antepartum is similar to the non‐pregnant patient. Ovarian cancer in pregnancy has a good prognosis because of the early stage at diagnosis.
Waist to Hip Circumference Ratio as a Significant Predictor of Preeclampsia, Irrespective of Overall Adiposity
Authors: Yamamoto Shinako , Douchi Tsutomu , Yoshimitsu Nobuyuki , Nakae Mitsuhiro , Nagata Yukihiro
Published: May 2010

Objective: To investigate whether abnormal body fat distribution is a significant predictor of the development of preeclampsia, irrespective of overall adiposity.

Methods:Twenty‐six women with preeclampsia and 198 control women were enrolled. Waist to hip circumference ratio (WHR), body weight (BW), and body mass index (BMI, wt/ ht2) were measured early in pregnancy (< 9 weeks of gestational age). Age, height, parity, tobacco usage, education period, gestational duration, and weight gain during pregnancy were also recorded for each subject.

Results:WHR, BMI, and BW early in pregnancy were significantly higher in the preeclampsia group (p < 0.0001). WHR, BMI, and BW positively correlated with the development of preeclampsia on univariate regression analysis (Standardized regression coefficient = 0.410, 0.387, and 0.363, respectively, p < 0.0001). On stepwise multiple regression analysis, WHR still correlated with the development of preeclampsia irrespective of BMI and BW. When the WHR predictive of the development of preeclampsia was set at 0.9, the sensitivity was 46.2% (12/26), which was significantly better than that of 25 of BMI (19.2%, 5/26; p < 0.05).

Conclusion:Higher WHR is a significant predictor of the development of preeclampsia. This relation is irrespective of overall adiposity.
Phenobarbital Following Phototherapy for Crigler‐Najjar Syndrome Type II with Good Fetal Outcome: A Case Report
Authors: Ito Takashi , Katagir Chieko , Ikeno Shinji , Takahashi Hiroyuki , Nagata Naoki , Terakawa Naoki
Published: May 2010

In the presence of severe hyperbilirubinemia in Crigler‐Najjar syndrome Type II, a fetus is at risk for kernicterus. A 34‐year‐old woman, gravida 4, para 1, with Crigler‐Najjar syndrome Type II was treated with phenobarbital administration following phototherapy during each of 2 pregnancies. Both infants were healthy and developed normally.
Splenectomy Combined with Cesarean Section in a Patient with Severe Immunological Thrombocytopenic Purpura Refractory to Medical Therapy
Authors: Sendag Fatih , Kazandi Mert , Terek Mustafa Cosan
Published: May 2010

Splenectomy as a treatment for severe immunological thrombocytopenic purpura is rarely performed in the third trimester of pregnancy. We report a 28‐year‐old patient who presented at the 34th gestational week with severe immunological thrombocytopenic purpura resistant to both corticosteroid and intravenous immunoglobulin therapies. Splenectomy combined with delivery by cesarean section provided remission of the disease.
Legal and Ethical Considerations of Assisted Reproductive Technology and Surrogate Motherhood in AOFOG Countries
Authors: Chen Kok‐Choo , Ng Heung‐Tat
Published: May 2010

With increasing use of assisted reproductive technologies (ART) and its related issues, the Ethics Committee of the Asia‐Oceania Federation of Obstetrics and Gynecology (AOFOG), after discussion at its council meeting, took up the mission to understand the current legal and ethical aspects of this special subject in Asia‐Oceania area before making proper recommendations.

This Committee drafted a questionnaire to all 22 country member societies in 1995, and again conducted the same survey in 2000 to track changes in each country/region's laws and regulations.

The results show that the current attitude and status of country member societies vary in a wide range and do not have formal legal codes in majority regulating the ethical aspects of ART. The use of ART and surrogacy is obviously affected by local traditions, popularity in the use of such techniques and cultural/religious concerns. The changes in 5 years are not major. Three countries do not as yet practice such techniques. However, liberalization of surrogate motherhood has become a trend. Five countries, compared with two only in 1995, are now available for surrogate motherhood, though regulated by strict criteria.

Based on the data collected and issues discussed, a detailed guideline may not be generally applicable as each region has its own rules, reflecting differences in the management of ART, especially in the surrogate motherhood. This Committee therefore recommends that ART must be performed by a board certified gynecologist in a certification laboratory and surrogate motherhood must be used only for medical reasons and not be commercialized. The patients of this special group must be treated individually, based on this recommendation and the regulations of their own country/region.
Distribution of Oxygenated Blood Flow at Three Different Routes of Extracorporeal Membrane Oxygenation in Exteriorized Fetal Lambs
Authors: Fujimori Keiya , Murata Yuji , Quilligan Edward J. , Nagata Naoki , Hirano Takahiro , Sato Akira
Published: May 2010

Objective: The purpose of this study was to determine which extracorporeal membrane oxygenation (ECMO) route best approximates the normal physiologic pattern of oxygenated blood distribution in fetal lambs submerged in warm saline solution.

Study Design: Six fetal lambs ranging from 113 to 129 days of gestation were delivered by cesarean section and oxygenated with ECMO in a warm saline solution bath. We compared the distribution of oxygenated blood flow during intact placental circulation with 3 routes of ECMO, from the right atrium to the carotid artery (V‐A), from the right atrium to umbilical vein (V‐UV), and from the right atrium with umbilical artery to umbilical vein [(V + UA)‐UV], in exteriorized fetal lambs. Distribution of oxygenated blood flow was determined by nonradioactive colored microspheres.

Results: The ECMO blood flow rate through the catheters during V‐A, V‐UV or (V + UA)‐UV ECMO ranged at 150 to 300 ml/min. Among the 3 different routes of ECMO, the oxygenated blood distribution in (V + UA)‐UV showed the best correlation with placental‐fetal blood flow, particularly in the brain and heart.

Conclusion: This study indicated that (V + UA)‐UV ECMO most closely approximates normal intact placental‐fetal blood flow distribution in fetal lambs.
Isolated Langerhans Cell Histiocytosis of the Vulva: A Case Report
Authors: Pather Selvan , Moodley Jack M. , Bramdev Ashwin
Published: May 2010

We present a case of isolated vulval Langerhans cell histiocytosis (LCH) that was initially treated with an excision biopsy but recurred 2 months later. Local vulval radiotherapy resulted in complete resolution of the lesion and there was no evidence of recurrence after 24 months of follow‐up.
Effects of Counseling on Climacteric Symptoms in Japanese Postmenopausal Women
Authors: Takamatsu Kiyoshi , Ohta Hiroaki , Makita Kazuya , Horiguchi Fumi , Nozawa Shiro
Published: May 2010

Objectives: We objectively assessed the effects of counseling on climacteric symptoms in Japanese postmenopausal women.

Methods: Symptoms in 44 women (age, 51.4 + 3.4 years; period after menopause, 3.6 + 3.4 years) treated with counseling were evaluated according to the Keio modified menopause index. The response to counseling was compared with that to hormone replacement therapy (HRT).

Results: Forty cases (90.9%) showed an improvement in index score. There were no significant relationships between improvement and age, the period after menopause, or the severity or type of symptoms before counseling. The most improved symptom was headache, followed by palpitation and insomnia. Physical symptoms accounted for most of the common symptoms. The pattern of improvement with counseling was markedly different from that with HRT.

Conclusions: We suggest that counseling is effective for treating climacteric symptoms, since it improves not only psychological symptoms, but also physical ones. Counseling may deserve evaluation as a complementary treatment to HRT.
Indication for Histological Examination of Endometrium in Breast Carcinoma Patients Receiving Tamoxifen Therapy
Authors: Ito Takashi , Katagiri Chieko , Murata Yoko , Hamazoe Ryuichi , Morita Kiyomi
Published: May 2010

Objective: To investigate the effects of tamoxifen on the uterine endometrium and define the indications for histological examination of endometrium on the thickness of uterine endometrium and on the duration of tamoxifen therapy.

Methods: The endometrial thickness was measured on the transvaginal ultrasonogram in 40 postmenopausal breast carcinoma patients receiving tamoxifen (tamoxifen group), and control group. Endometrial histological examination was carried out.

Receiver operating characteristic (ROC) curve analysis was carried out.

Results: Endometrial thickness in the tamoxifen group was 11.2 + 5.1 mm, and that of the control group was 3.8 + 2.1 mm. The incidence of endometrial abnormalities in the tamoxifen group was greater than that in control group.

The cut off values derived from the ROC curve analysis were 9 mm for endometrial thickness, and 24 months for duration of tamoxifen therapy.

Conclusion: The histological examination of endometrium should be carried out if the endometrial thickness is more than 9 mm, or the duration of tamoxifen therapy is more than 24 months even if the patients do not have any symptoms.
The Relationship between the Level of Expression of Intercellular Adhesion Molecule‐1 in Placenta and Onset of Preeclampsia
Authors: Oyama Rie
Published: May 2010

Objective: To investigate the differences in the expression of intercellular adhesion molecule‐1 (ICAM‐1) in the placenta and the concentration of soluble ICAM‐1 between early‐onset and late‐onset preeclampsia.

Methods: Preeclampsia was divided into early‐onset type (EO: 20 to 31 weeks gestation) and late‐onset type (LO: ≧ 32 weeks gestation). Post delivery, placentas were obtained from 19 control pregnant women and from 9 EO and 8 LO preeclamptic women. The expression of ICAM‐1 in placenta was determined by immunohistochemical staining. Blood samples were taken from 21 non‐pregnant women, 16 control pregnant women, 13 EO and 8 LO preeclamptic women, and umbilical cord blood samples from 38 control pregnancies and from 16 EO and 14 LO preeclampsia. The concentration of ICAM‐1 was measured by enzyme‐linked immunosorbent assays.

Results: The expression of ICAM‐1 in placenta was higher in LO than in EO preeclampsia (48.2 + 8.2% vs 17.9 + 5.0%) (p < 0.05). ICAM‐1 concentration in umbilical cord blood was higher in EO than in LO preeclampsia (umbilical artery, 150.6 + 34.0 ng/ml vs 90.3 + 9.4 ng/ml) (umbilical vein, 128.3 + 31.2 ng/ml vs 91.3 + 10.2 ng/ml) (p < 0.05).

Conclusions: Significant differences were noted in the expression of ICAM‐1 between patients with EO and LO preeclampsia, which suggest that the possibility that EO and LO preeclampsia may have different onset mechanisms.
The Application of Magnetic Cell Sorter (MACS) to Detect Fetal Cells in Maternal Peripheral Blood
Authors: Fukushima Akimune , Utsugisawa Yukari , Wada Yuko , Mizusawa Noriko , Horiuchi Saburo , Kagabu Teruo
Published: May 2010

Objectives: The aim of the present study was to investigate the effectiveness of sorting fetal nucleated red blood cells (FNRBC) from maternal peripheral blood, particularly during early gestation periods, by a combination of specific gravity centrifugation and magnetic cell sorter (MACS).

Methods: Without prior knowledge of the gender of the fetus, we determined gender by analyzing a Y‐chromosome specific sequence by nested‐PCR, using 10 ml of the peripheral blood of healthy primigravida women at different stages of gestation (first trimester: n = 17, second trimester: n = 13, and third trimester: n = 19). The results of this prenatal sex determination were compared to the sex of newborns.

Results: The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of the present method during the first trimester were 100, 81.8, 100, and 75%, respectively; during the second trimester, 80, 50, 80, and 50%, respectively; and during the third trimester, 25, 63.6, 53.8, and 33.3%, respectively.

Conclusion: The results show that this prenatal sex determination method has a highly accurate diagnostic rate during the first trimester, suggesting that it could be developed as a practical, non‐invasive prenatal diagnostic technique for use during early gestation periods.
Bacterial Vaginosis in Early Pregnancy and Adverse Pregnancy Outcome
Authors: Purwar Manorama , Ughade Suresh , Bhagat Bharti , Agarwal Vandana , Kulkarni Hemant
Published: May 2010

Objective: to assess the prevalence of bacterial vaginosis (BV) in asymptomatic pregnant women and its association with preterm birth (PTB) and premature rupture of membranes (PROM).

Methods: In a cohort study 1,006 pregnant women between 16–28 weeks' gestation were screened for BV (Nugent's criteria) and for lower genital tract infection. Women were followed to confirm pregnancy outcome. Data were analyzed using STATA software. Univeriate and multivariate methods were used to investigate the association between bacterial vaginosis and adverse pregnancy outcome.

Results: Prevalence of BV was 11.53%. Baseline characteristics were similar for both groups, 6.8% women were lost to follow‐up. Incidence of PTB was higher in BV positive women compared to BV negative women (p = 0.001). On multiple logistic regression (MLR), BV was associated with an increasd risk of PTB (p = 0.001) and PROM (p = 0.001), other correlates being previous PTB (p = 0.003) and the presence of enteropharynangeal organisms in vagina (p = 0.03). BV accounted for 82.53% of the attributable risk for PTB.

Conclusion: Presence of BV in early pregnancy is associated with an increased risk of PTB and PROM. Multicentric interventional study is recommended.
Using Village Theatre to Increase Knowledge about Eclampsia in Bangladesh
Authors: Islam Khandoker Saiful , Sachchu Shahidul Alam , Sandani Rehana , Bullough Colin , Siraj Nahid , Dimmock Paul , Johanson Richard Brian
Published: May 2010

Objective: To assess the impact of a theatre based educational initiative on the knowledge and attitudes to eclampsia and its treatment in a rural Bangladeshi village.

Methods: An established theatre company, Theatre Centre for Social Development, performed scenarios regarding eclamptic pregnant women to a diverse audience of village observers. Before the performance 15 men and 15 women were randomly selected from the audience and asked a series of questions regarding eclampsia. After the performance the series of questions were repeated to the same people.

Results: The plays were enthusiastically received by the villagers. The level of knowledge of the villagers interviewed increased significantly after seeing the two plays.

Conclusion: The intervention successfully raised both the awareness of eclampsia and the level of knowledge of effective treatments for eclampsia. Village theatre has shown the potential to be a very effective tool in Bangladeshi rural society.
Sonographic Determination of Fetal Size from 20 Weeks of Gestation Onward Correlates with Birth Weight
Authors: Yoshida Sho‐hei , Unno Nobuya , Kagawa Hideyuki , Shinozuka Norio , Kozuma Shiro , Taketani Yuji
Published: May 2010

Objective: To evaluate the clinical efficacy of ultrasonographic measurement of fetal weight, estimated fetal weight (EFW) was analyzed in relation to birth weight.

Method: Data were collected retrospectively from the medical records of 548 term pregnancies unassociated with fetal malformations. The subjects underwent sonographic examinations from 20–23 weeks onward at 4 weeks intervals for the estimation of EFW. Subjects were divided into 6 subgroups based on birth weight deviation (BWD) (A: – 3.0 ≤ BWD < – 2.0; B: – 2.0 ≤ BWD < – 1.5; C: – 1.5 ≤ BWD < – 1.0; D: – 1.0 ≤ BWD < – 0.5; E: – 0.5 ≤ BWD < + 0.5 and F: + 0.5 ≤ BWD). Distribution and changes in EFW deviation (EFWD) with gestational age were analyzed related to BWD.

Result: A difference in fetal growth based on EFWD was noted in small for gestational age (SGA) cases compared to non‐SGA cases, and the difference was observed as early as 20–23 weeks. EFWD was significantly correlated with BWD from 20–23 weeks to term.

Conclusion: Sonographic determination of fetal growth from 20 weeks of gestation onward correlated with birth weight deviation, and this emphasized the clinical value of evaluating fetal growth during the latter half of pregnancy.
Unilateral Ectopic Twin Pregnancy Following an IVF Cycle
Authors: Göker Ege N. Tavmergen , Tavmergen Erol , Özçakir H. Tayfun , Levi Rafael , Adakan Şaban
Published: May 2010

We report here a 37‐year‐old woman who underwent ovulation induction and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment because of infertility who developed vaginal bleeding at the 6th week of gestation. Abdominal ultrasonography was insufficient to distinguish the intrauterine gestational sac. Subsequently, vaginal doppler ultrasonography detected two separate unilateral twin ectopic pregnancies with cardiac activity in both fetuses, which were operated on pelviscopically.
Umbilical Artery Blood Acid‐Base Analysis and Fetal Heart Rate Baseline in the Second Stage of Labor
Authors: Honjo Shigeichiro , Yamaguchi Masaaki
Published: May 2010

Objective: To evaluate the correlation between umbilical arterial acidemia and second‐stage baseline fetal heart rate (FHR) abnormalities in Japanese newborn infants.

Methods: Subjects were 365 newborns, born at term. Specimens were obtained from the umbilical artery as soon as possible after delivery and blood gas determinations were performed within 5 minutes of delivery. FHR monitoring was performed in the second stage.

Results: Umbilical arterial acidemia occurred in 54.1% of the newborns with moderate to severe bradycardia, in 27.3% with mild bradycardia, and in 19.3% with tachycardia, compared with only 1.3% of those with a normal FHR (p < 0.001). The mean umbilical arterial base excess was significantly greater in newborns with metabolic acidemia (‐ 13.9 + 2.9 mmol/l) than in those with either mixed (‐ 11.5 + 2.8 mmol/l) (p < 0.02) or respiratory (‐ 9.1 + 3.2 mmol/l) (p < 0.01) acidemia.

Conclusion: The second‐stage baseline FHR abnormalities were highly correlated with an increased risk of umbilical arterial acidemia at delivery.
Use of Gonadotrophin Releasing Hormone (GnRH) Antagonist (Cetrotide) during Ovarian Stimulation for in‐vitro Fertilization Treatment: Multiple Doses and Single Dose*
Authors: Ng Ernest Hung Yu , Ho Pak Chung
Published: May 2010

Objectives: To report preliminary experience in using the GnRH antagonist (Cetrotide) and to compare the multiple dose and single dose protocols.

Methods: Fifteen patients received multiple doses and another 10 patients received the single dose protocol of GnRH antagonist during ovarian stimulation for IVF treatment. Outcome measures included the duration/dosage of gonadotrophin and number of oocytes aspirated.

Results: All patients had successful oocyte retrieval after the hCG injection. The single dose group had a significantly shorter duration of gonadotrophin but fewer frozen embryos than the multiple dose group.

Conclusions: Both protocols were effective in preventing premature LH surges. The stimulation regimen was simplified by reducing the total treatment period, the dosage and duration of gonadotrophin. There may be differences in ovarian responses between the two protocols.
Pregnancy Complicated with Bartter's Syndrome: A Case Report
Authors: Nohira Tomoyoshi , Nakada Toshihide , Akutagawa Osamu , Fujito Atsuya , Okabe Kazuhiro , Ioya Noriko , Yoshida Masaharu
Published: May 2010

Bartter's syndrome is a rare renal disorder, and since there are few case reports of Bartter's syndrome complicating pregnancy are few, the changes of electrolytes and hormonal metabolism during pregnancy are unknown. We describe and discuss the course of pregnancy complicated with Bartter's syndrome.