bluuebunny/crossref_metadata_2025 huggingface dataset:
Pityriasis Lichenoides et Varioliformis Acuta in Pregnancy: A Case Report
Authors: Fukada Yukihito , Okuda Yasuhiko , Yasumizu Takehiko , Hoshi Kazuhiko
Published: May 2010

If pityriasis lichenoides et varioliformis acuta (PLAVA) exists in the vagina or cervical os of the uterus, it may cause premature labor and premature rupture of the membranes.
Menstrual Disorders in Patients Undergoing Chronic Hemodialysis
Authors: Kawashima Rieko , Douchi Tsutomu , Oki Toshimichi , Yoshinaga Mitsuhiro , Nagata Yukihiro
Published: May 2010

Objective:To investigate the etiology of menstrual disorders in patients undergoing chronic hemodialysis (CHD).

Methods:The menstrual histories, along with hormonal, biochemical, and hematological data, were investigated in 25 reproductive‐aged CHD patients.

Results:All subjects had had regular menstrual cycles before entering CHD therapy. Of the 20 women who developed amenorrhea after beginning CHD therapy, 8 showed a return to their regular cycles and 6 improved to oligomenorrhea, 3 months to 66 months later, while 6 remained amenorrheic. The serum prolactin (PRL) levels were significantly higher in the patients (n = 9) with normogonado‐tropic amenorrhea or oligomenorrhea than in patients (n= 13) with regular cycles (53.6 ± 36.2 vs 27.8 + 15.2 ng/ml, p < 0.05). The serum LH levels were high in both groups. In a cross‐sectional study, the serum PRL levels gradually decreased with longer duration of dialysis.

Conclusions: Patients undergoing CHD are likely to develop menstrual disorders. Hyperprolactinemia in part contributes to these menstrual disorders. However, menstrual disorders in CHD patients tend to improve during long‐term follow‐up, because of the gradual decrease in serum PRL levels during long‐term CHD therapy.
An Immunohistochemical Study of Cadherin 5 (VE‐cadherin) in Vascular Endothelial Cells in Placentas with Gestosis
Authors: Kawashima Masanari , Kitagawa Michihiro
Published: May 2010

Objective:To evaluate vascular endothelial‐cell functioning in placentas with gestosis, using the monoclonal antibody to cadherin 5.

Methods:The extra‐cellular moiety of cadherin 5 was transfected into L‐cells to enable us to examine their cell‐adhesion activity. The expression of cadherin 5 was evaluated in human umbilical‐vein endothelial cells and in placentas with gestosis by immunostaining using the anti‐cadherin 5 antibody. A microspectrophotometric study also was conducted of the placentas with gestosis.

Results:We determined the total base sequence for cadherin 5 and found that it is homologus with a known cadherin but is a new, unique clone. Cadherin 5 has cell‐adhesion activity and is expressed in endothelial cells at the cell‐adhesion surface. The expression of cadherin 5 in endothelial cells took place in the placentas with gestosis, but to a lesser extent than in normal placental endothelial cells.

Conclusions:The reduced expression of cadherin 5 in placentas with gestosis suggests that endothelial cell functioning is impaired in placentas with gestosis. Cadherin 5 in endothelial cells might influence placental functions and fetal development.
Current Status in Intrauterine Fetal Stem Cell Therapy
Authors: Pschera Helmut
Published: May 2010

In utero fetal stem cell transplantation, a today experimental treatment option, represents a new therapeutic strategy with broad implications for diseases related to the hematopoietic system. The object of the present paper is to give a review of the published literature on fetal stem cell therapy with special reference to immunologi‐cal and strategical considerations. Furthermore, ethical considerations on account of the use of fetal cells are pointed out and a prospective view concerning experimental and clinical future perspectives is presented.
Conservative Surgery for Microinvasive Carcinoma of the Cervix
Authors: Winter Raimund
Published: May 2010

Objective:To evaluate the prognosis of patients with stage IA1 and IA2 micro‐carcinoma of the cervix according to the 1994 FIGO classification.

Methods:The histologic specimens of 494 patients who underwent conization for microcarcinoma of the cervix between 1958 and 1992 were reviewed and classified according to the 1994 FIGO system.

Results:After a mean follow‐up of 14 years (range, 1–35) 2 patients with stage IA1 tumors and 2 patients with stage IA2 tumors died of disease. Patients with early stromal invasion only accounted for 70% of patients with stage IA1 lesions. If these patients are excluded from stage IAI, the mortality rates for stages IA1 and IA2 did not differ significantly. Surgical radicality declined markedly during the study period.

Conclusion:Neither the 1985 nor the 1994 FIGO classification of microcarcinoma can be used as a guide to therapy. Conization only suffices for patients with early stromal invasion or a depth of invasion of 1—3 mm without lymph vascular space involvement. Additional pelvic lymphadenectomy can be considered for patients with stage IAI lesions with lymph vascular space involvement. Removal of the tumor and pelvic lymphadenectomy is indicated for all patients with stage IA2 lesions, regardless of lymph vascular space involvement. Radical vaginal or radical abdominal hysterectomy represent overtreatment for patients with microcarcinomas because parametrial involvement in these patients has not been demonstrated.
Glucose Transporter 4 (GLUT4) mRNA Abundance in the Adipose Tissue and Skeletal‐Muscle Tissue of Ovariectomized Rats Treated with 17β‐Estradiol or Progesterone
Authors: Sugaya Ayumi , Sugiyama Takashi , Yanase Sachiko , Terada Yumiko , Toyoda Nagayasu
Published: May 2010

Objective: To investigate the effects of 17β‐estradiol and progesterone on the expression of glucose transporter 4 (GLUT4) in the adipose tissue and skeletal‐muscle tissue of ovariectomized rats.

Methods: Female Sprague‐Dawley rats (n = 63) received a daily subcutaneous injection of 10 μg, 50 μg, or 250 μg of 17β‐estradiol (Group E) or of 1 mg, 5 mg or 25 mg of progesterone (Group P) for 3 days, 7 days, or 10 days (n = 3, at each dose). The expression of GLUT4 mRNA was assessed by performing ribonuclease protection assays.

Results: The levels of GLUT4 mRNA in adipose tissue was significantly reduced by treatment with estradiol, 50 μg or 250 μg, relative to findings in control rats (p < 0.01). No such reductions were seen regarding the progesterone treatment. The level of GLUT4 mRNA in skeletal‐muscle tissue did not change, regardless of treatment.

Conclusion: In ovariectomized rats, higher than physiologic dosages of 17β‐estradiol can suppress the expression of GLUT4 mRNA in adipose tissue.
Interleukin‐6 (IL‐6) Does Not Change the Expression of Bcl‐2 Protein in the Prevention of Cisplatin‐Induced Apoptosis in Ovarian Cancer Cell Lines
Authors: Ishioka Shin‐ichi , van Haaften‐Day Caroline , Sagae Satoru , Kudo Ryuichi , Hacker Neville F.
Published: May 2010

Objective: To study whether interleukin‐6 (IL‐6) changes the expression of the anti‐apoptic Bcl‐2 protein in the prevention of cis‐diaminedichloroplatinum (II) (CDDP)‐induced apoptosis of human ovarian cancer cells.

Methods: Comparative studies were performed on 3 ovarian cancer cell lines after 48 hours of exposure to 0.5–50 ng/m/ IL‐6, 2 μg/m/ anti‐IL‐6 monoclonal antibody (anti‐IL‐6 mAb), 10 μm CDDP, 10 μm CDDP + 0.5–50 ng/m/ IL‐6, and 10 μm CDDP + 2 μg/m/ anti‐IL‐6 mAb. Apoptosis was measured morphologically and by a DNA fragmentation assay. Bcl‐2 protein levels were measured by an ELISA.

Results: An increase in apoptosis was observed for each cell line after 48 hours of exposure to 10 μm CDDP. Although high doses of IL‐6 decreased the percentage of apoptotic cells, this cytokine did not change the expression of the Bcl‐2 protein.

Conclusion: CDDP‐induced apoptosis was negatively controlled by IL‐6. However, the anti‐apoptic Bcl‐2 protein level was not changed by IL‐6 in the process of apoptosis in the ovarian cancer cell lines.
A Case Report: Rare Case of Primary Transitional Cell Carcinoma of the Fallopian Tube
Authors: Takeuchi Shigeto , Hirano Hiroshi , Ichio Takao , Taniguchi Haruki , Toyoda Nagayasu
Published: May 2010

Carcinomas other than adenocarcinomas are extremely rare in the fallopian tube. A 42‐year‐old woman with watery, intermittent vaginal discharge was found to have a left adnexal tumor. This case was diagnosed as primary carcinoma of the fallopian tube, FIGO Stage la. She underwent a total abdominal hysterectomy, a bilateral salpingo‐oophorectomy, a pelvic and periaortic lymphoadenectomy, and an omentectomy, followed by cisplatin‐based chemotherapy. Four years after the initial diagnosis of the disease, she remains in a disease‐free state. Histologically, the tumor revealed a primary transitional cell carcinoma of the left fallopian tube. The findings on an immunohistochemical test for an epithelial membrane antigen, the CA125 antigen, were positive, whereas findings on a test for CEA were negative. We report a case of a malignant neoplasm of the fallopian tube with histological features of transitional cell carcinoma that arose from the tubal epithelium.
Obstetrics and Gynaecology in the Asia and Oceania Region: Requirements for Postgraduate Training and Certification
Authors: Zaidi Shahida
Published: May 2010

This paper reviews the requirements of postgraduate training and certification in the countries of the Asia and Oceania regions. It explores the feasibility of establishing exchange training programmes, and presents recommendations which might facilitate national societies in standardising their programmes.
The Effect of Epidermal Growth Factor on the Preimplantation Development, Implantation and Its Receptor Expression in Mouse Embryos*
Authors: Kim Chung‐Hoon , Chae Hee‐Dong , Cheon Yong‐Pil , Kang Byung‐Moon , Chang Yoon‐Seok , Mok Jung‐Eun
Published: May 2010

Objective: To investigate the influence of epidermal growth factor (EGF) on preimplantation development, implantation, and expression of epidermal growth factor receptor (EGFR) itself in mouse embryos.

Materials and Method: Eight‐cell stage mouse embryos were cultured for 48 hours with EGF at concentrations of 0.1, 1.0, 10 and 100 ng/m/. Embryos not treated with EGF were served as control. The percentages of embryos which developed to the expanded, hatched blastocyst stage and in vitro implantation at 48 hours were determined. Reverse transcription‐polymerase chain reaction (RT‐PCR) has been used to examine the expression of EGFR in developed hatched blastocysts. Following reverse transcription, strategically designed nested primers, optimized for specificity, were used for amplification from the cDNA equivalent of a single embryo. The products were then verified by restriction enzyme digestion and sequence analysis. Results were analyzed with X2 test and Student's t‐test as apropriate, and statistical significance was defined as p < 0.05.

Results: The percentages of fully expanded blastocysts at 48 hours in all the EGF treated group were not significantly different from the control. The percentages of hatched blastocysts were significantly higher in the EGF treatment group at 0.1 ng/m/ (90.5 ± 9.8%) compared to the control (82.1 ± 7.2%), 1.0 ng/m/ (82.2 ± 12.7%), and 100 ng/m/ (81.9 ± 11.8%) (p < 0.05, p < 0.05, p < 0.05, respectively). The percentages of hatched blastocysts were significantly higher in the EGF treatment group at 10 ng/m/ (89.4 ± 7.5%) compared to the control, and 100 ng/m/ (p < 0.05, p < 0.05, respectively). The percentages of attached blastocysts in vitro were significantly higher following incubation with EGF at concentrations of 0.1 ng/m/ (37.0 ± 17.0%), 1.0 ng/m/ (32.0 ± 14.3%), 10 ng/m/ (21.3 ± 7.2%) compared to the control (9.5 ± 7.7%) (p < 0.05, p < 0.05, p < 0.05, respectively). The attachment rates in 0.1 ng/m/ and 1.0 ng/m/ EGF treatment groups were also significantly higher than those in other EGF treatment groups. Embryo development and attachment were not significantly inhibited or enhanced in cultures supplemented with 100 ng/m/ EGF compared to the control. The mRNA concentration of EGFR in embryos treated with 0.1 ng/m/ of EGF was significantly higher than those of the control and other EGF treatment groups.

Conclusion: EGF may have a stimulatory role in later stage embryonic development, implantation and expression of EGFR in hatched blastocyst itself at the specific concentration.
Assessment of Myometrial Invasion at the Invasion Site of an Endometrial Carcinoma by Ultrasonography Along with an Intrauterine Catheter
Authors: Perdomo Ilse A. , Miyagi Yasunari , Yamada Shinako , Kawanishi Kunihiro , Yamamoto Junko , Miyagi Yuji , Hongo Atsushi , Kodama Junichi , Yoshinouchi Mitsuo , Kobashi Yuji , Kudo Takafumi
Published: May 2010

Objectives: To evaluate by transvaginal ultrasonography (TVU) the thickness of the intact myometrium at the presumed tumor‐origin site and to establish criteria for a half myometrial invasion.

Methods: A total of 19 successive patients with endometrial cancer who were treated between January 1, 1997, and January 31, 1998, participated in this study. TVU mode B with and without the use of an intrauterine silicon catheter was performed.

Results: Using a catheter, the origin site was correctly detected in 15 cases (79%). The best criterion for half myometrial invasion was a 6‐mm thickness of the intact myometrium at the origin site. The sensitivity/specificity/accuracy of TVU with the use of a catheter in cases with the correct estimated origin site, were 1.00/0.67/0.86 for myometrial invasion < 1/2, and 0.67/1.00/0.86 for myometrial invasion < 1/2.

Conclusion: It is of value to use 6‐mm as the criterion for the thickness of the intact myometrium at the estimated tumor‐origin site in connection with TVU with the use of a catheter for preoperatively assessing half myometrial invasion.
A Randomized Controlled Trial Comparing Midwife‐Managed Care and Obstetrician‐Managed Care for Women Assessed to Be at Low Risk in the Initial Intrapartum Period
Authors: Law Yvonne Y. H. , Lam Kit‐Yee
Published: May 2010

Objectives: To compare the efficacy of midwife‐managed care and obstetrician‐managed care for women assessed to be at low risk in the initial intrapartum period.

Methods: 1,050 women assessed to be at low risk on admission to labour ward in the Prince of Wales Hospital participated in this study. By computer‐generated random allocation, 563 (54%) women were assigned to Group A (experimental) under midwifery care, and 487 (46%) women to Group B (control) under obstetrician care. The outcomes and complications between the 2 groups were compared. Data were analyzed by 2 times 2 contingency tables and Chi‐square.

Results: 150 (26.6%) women in the experimental group were taken over by the obstetricians. 46 (30.7%) women were transferred to obstetrician‐management for the preference of epidural analgesia. The other reasons for taken over the remaining 104 (69.3%) women were fetal distress, poor progress of labour, complications in first or second stage of labour. The experimental group had less oxytocic augmentation (Chi‐square = 7.49, p = 0.006) and the insertion of intravenous infusion (Chi‐square = 5.34, p = 0.02). Both groups had similar outcomes on normal delivery, operative vaginal delivery, caesarean section and complications.

Conclusions: Midwife‐managed care is as safe as obstetrician‐managed care for women who were assessed to be at low risk in the intrapartum period. Routine visit by obstetrician is not necessary and the midwives are able to detect complications in the course of labour and alert the obstetrician for taking the necessary action.
A Case of Simultaneous Presence of Primary Endometrial Carcinoma and Metastasis of a Breast Carcinoma to the Ovary after 5 Years of Tamoxifen Therapy
Authors: Ishioka Shin‐ichi , Sagae Satoru , Kobayashi Kanji , Sugimura Masaki , Nishioka Yoshihiro , Kudo Ryuichi
Published: May 2010

We report a case of a 43‐year‐old woman with the simultaneous presence of a primary uterine endometrial cancer and metastasis of breast cancer to the ovary after 5 years of tamoxifen therapy. Tamoxifen therapy lengthens recurrence‐free survival of the patient. However, the risk of endometrial cancer and the possibility of recurrence of breast cancer also must be considered.
Thermal Balloon Endometrial Ablator: A Preclinical Safety and Effectiveness Study
Authors: Banerjee Kaberi , Buckshee Kamal , Bhatla Neerja , Gupta Siddhartha Datta
Published: May 2010

Objective: To evaluate the preclinical safety and efficacy of the thermal balloon endometrial ablator (TBEA).

Methods: Informed consent was taken from all patients for TBEA and hysterectomy at same sitting. TBEA was performed in vivo just before hysterectomy on 6 patients' uteri to determine uterine rupture, perforation and thermal damage to surrounding viscera and peritoneum. Temperatures in the pouch of Douglas, uterovesical peritoneum and serosa of uterus were taken by a sterile laboratory thermometer to note for any rise in temperature before, during and after the procedure. The extirpated uteri were then examined grossly for the nature and extent of thermal damage which was visible as a zone of erythema in the endomyometrium. Five extirpated uteri, 3 from the above group and 2 on whom TBEA was performed 3 months ago were histopathologically examined to study the nature and extent of damage to endomyometrial cells. A 5 mm longitudinal strip of uterus along with both the cornual ends were sectioned in such a way that it was representative of the entire uterus.

Results: There was no evidence of uterine perforation, rupture or any damage to the surrounding viscera and peritoneum. There was no rise in temperature in most sites while TBEA was performed. The only area that felt warm was the surface of the uterus and there too the measured rise was only 1°C. On gross examination the zone of erythema measured 5.4 mm (mean) (range 3–9 mm). In those uteri subjected to histopathology immediately after TBEA early evidence of thermal damage was visible as hemorrhage, congestion, edema, eosinophilic infiltration and necrosis in 2 out of 3 cases. Late changes of thermal damage after TBEA were seen as basal endometrium and areas of hyalinization. The changes in general were patchy and not uniform.

Conclusions: TBEA is a safe device with no thermal damage to uterus and surrounding viscera. The mean zone of thermal damage in the endomyometrium is 5.4 mm. On histopathology, the early changes of thermal damage are hemorrhage, congestion, edema, eosinophilic infiltration and necrosis and the late changes are visible as areas of hyalinization and presence of basal endometrium.
Serum Vitamin A and E in Pregnant Women with Hemoglobinopathies
Authors: Phuapradit Winit , Panburana Panyu , Jaovisidha Adithep , Chanrachakul Boonsri , Bunyaratvej Ahnond , Puchaiwatananon Orawan
Published: May 2010

Objective: To evaluate the relationship between the status of serum vitamin A, E and hemoglobinopathies among Thai pregnant women.

Methods: This was a cross‐sectional study in which serum vitamin A and E were assessed in 323 pregnant women with normal hemoglobin and 73 with hemoglobinopathies (47 with hemoglobin E and 26 with thalassemia) during the first trimester.

Results: There were no significant differences in the mean serum vitamin A, E concentrations and vitamin E/cholesterol ratio between pregnant women with normal hemoglobin and hemoglobinopathies, while confounding variables that might affect serum vitamin levels i.e. maternal age, gravida, BMI, gestational age, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration and blood group were not different.

Conclusion: The results of this study suggest that antenatal care in terms of micronutrients‐vitamin A, E in Thai pregnant women with hemoglobinopathies should not be different from normal pregnant women.
Early Discharge: Its Impact on Low‐Income Mothers and Newborns in the State of Hawaii
Authors: Taniguchi Hatsumi
Published: May 2010

Objectives: The objectives of this survey were to investigate whether, in the state of Hawaii, early discharge had a negative effect on the health of new mothers and their infants, especially those at high sociodemographic risk, and whether early discharge was implemented in compliance with the early‐discharge guidelines of the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG).

Methods: This statewide survey was conducted from June 17 through July 12,1996. The data was collected and recorded by perinatal providers at 14 PSS (Perinatal Support Services) sites through interviews of mothers using questionnaires. This report is based on the 108 questionnaires that were returned from the PSS sites. A descriptive analysis was performed, using the statistical/epidemiologic program EPI INFO 6.

Results: The survey reveals that the practice of early discharge had been implemented extensively but not in compliance with AAP/ACOG early discharge guidelines. The neonatal readmission rate for this survey group was 6.5% among low‐income mothers and infants. This was found to be among the highest rates reported in the United States and Canada; in the United States, reported neonatal readmission rates vary from 1 to 4%.

Conclusions: Early discharge greatly contributes to negative outcomes among low‐income mothers and infants. This paper reports on the results of this survey in Hawaii and recommends a comprehensive approach for promoting the health and well‐being of low‐income mothers and infants.
A Clinicopathological Study of Postoperative Pulmonary Metastasis of Uterine Cervical Carcinomas
Authors: Shiromizu Kenji , Kasamatsu Takahiro , Takahashi Michiko , Kikuchi Akihiko , Yoshinari Tsutomu , Matsuzawa Masumi
Published: May 2010

Objective: To investigate the clinicopathological backgrounds and prognostic factors of uterine cervical carcinomas metastatic to the lung.

Methods: A total of 519 patients with invasive cervical carcinoma (Stage pTIb‐IIb) treated by abdominal radical hysterectomy at the Saitama Cancer Center from January 1, 1976 to December 31, 1989 were analyzed clinicopathologically.

Results: The frequencies of pulmonary metastasis were 6.4% (24/377) and 11.3% (16/142) in patients with negative and positive pelvic lymph nodes, respectively. Among 24 negative lymph node patients, 15 had pulmonary metastasis only. The overall 5‐year survival rate of these 15 patients was 36% after relapse. Of the 15, the prognosis of 12 patients with 1–3 pulmonary metastases only was better, that is, 46% after surgical resection (mean size of resectable tumor = 2.8 cm) and / or chemotherapy. But the other patients died within 3.3 years after relapse.

Conclusions: The occurrence of pulmonary metastasis only, its number (1–3) and size (mean size = 2.8 cm), and no lymph node metastasis are important prognostic factors. For these patients, active surgical resection of the pulmonary lesion(s) and further chemotherapy are recommended in order to improve their prognosis.
Comparison of the Anterior Colporrhaphy Procedure and the Marshall‐Marchetti‐Krantz Operation in the Treatment of Stress Urinary Incontinence among Women
Authors: Luna Maria Teresa C. , Hirakawa Toshio , Kamura Toshiharu , Yahata Hideaki , Ogawa Shinji , Sonoda Takanori , Nakano Hitoo
Published: May 2010

Objective: To compare retrospectively the efficacy of the anterior colporrhaphy procedure (AC) and the Marshall‐Marchetti‐Krantz operation (MMK) in the treatment of stress urinary incontinence (SUI).

Methods: A retrospective analysis through a review of the medical records of Japanese women with stress urinary incontinence who were surgically treated at Kyushu University Hospital from 1980 through 1996. A questionnaire regarding the current status of urinary incontinence was sent to all patients.

Results: A total of 103 patients could be evaluated, 77 of whom had undergone an AC, and 26 of whom had undergone an MMK. Postoperative complications were more common in the AC group (p < 0.05). There were no significant differences between the 2 groups in terms of the duration of hospital stay or postoperative catheterization. The long‐term subjective cure rates of the ACs and the MMKs were 55% and 58%, respectively.

Conclusions: The AC and the MMK were equally effective in treating stress urinary incontinence, and both showed decreased long‐term subjective cure rates. The recurrence rate did not differ between the AC and the MMK. The AC had more postoperative complications and shorter recurrence intervals.
Immunohistochemical Studies concerning Cathepsin D in Endometrial Carcinomas
Authors: Inoue Yoshiki , Abe Kunio , Obata Koshiro , Doh Kunihiko , Ohmura Gen , Hoshiai Hiroshi , Noda Kiichiro
Published: May 2010

Objectives: To study the prognostic value of immunohistochemical detection of cathepsin D and laminin in endometrial carcinomas.

Methods: Immunohistochemical staining of cathepsin D was performed on paraffin sections of 111 endometrial carcinomas, and laminin deposition was studied in 65 endometrial carcinomas.

Results: Of 111 tissue specimens, 55 showed a positive reaction for cathepsin D. The incidence of cathepsin D‐positive staining increased with the extension of the primary tumor (p < 0.01). Patients with vessel invasion and pelvic lymph‐node metastasis had a higher incidence of cathepsin D‐positive staining than patients without these findings (p < 0.05). A favorable prognosis was obtained in a negative case of cathepsin D in comparison with a positive case (p < 0.01). Of 9 patients in whom laminin was detected in the cytoplasm of cancer cells, 5 showed poor prognoses and died from a primary disease.

Conclusion: Cathepsin D and laminin status might represent possible prognostic factors.
Effects of Low Oxygen Condition on the Generation of Reactive Oxygen Species and the Development in Mouse Embryos Cultured in vitro*
Authors: Kwon Hyuck‐Chan , Yang Hyun‐Won , Hwang Kyung‐Joo , Yoo Jung‐Hyun , Kim Myung‐Sin , Lee Chi‐Hyeong , Ryu Hee Sug , Oh Kie Suk
Published: May 2010

Objective(s): To elucidate the relationship between intracellular H2O2 production and embryo development in different oxygen culture conditions.

Methods: Pronuclear stage embryos were obtained from C57BL/CBA F1 and ICR mice. Measurement of H2O2 level was performed with 2′,7′‐dichlorodihydroflourescein diacetate and the number of blastomeres was counted after staining with 4′,6′‐diamidino‐2‐phenylindole.

Results: Regardless of strains, H2O2 level reached a peak at the 2‐cell stage in 20% O2. But in embryos cultured in 5% O2 it was significantly lower at the 2‐cell and 4‐cell stages compared to those from 20% O2. The embryos cultured in 20% O2 showed developmental delay or block, but in 5% O2 these phenomena were overcome and the development was significantly increased with an infrequent fragmentation.

Conclusions: Our data suggest that the 5% O2 decreases the relative concentration of H2O2 and results in improved embryo development in terms of quantity and quality without regard to type of strains.
Significance of Multi‐Drug‐Resistant Proteins in Predicting Chemotherapy Response and Prognosis in Epithelial Ovarian Cancer*
Authors: Yokoyama Yoshihito , Sato Shigemi , Fukushi Yoshiyuki , Sakamoto Tomomi , Futagami Masayuki , Saito Yoshiharu
Published: May 2010

Objectives: To clarify the expression of multi‐drug‐resistant (MDR) markers, GST‐π, c‐Jun, P‐glycoprotein (Pgp), and MDR‐associated protein (MRP) in epithelial ovarian cancer, and to determine whether their expression is predicitve of chemotherapy response and patient prognosis.

Methods: Specimens of 58 epithelial ovarian cancer cases obtained at initial surgery were studied immunohistochemically using antibodies.

Results: Overall positive rates in the 58 specimens were 58.6% for GST‐π, 44.8% for c‐Jun, 27.6% for Pgp, and 22.4% for MRP. The 5‐year disease‐free survival rate was 26.0% for patients with MRP‐positive tumors and 75.2% for those with MRP‐negative tumors. The prognosis for those with MRP‐positive tumors was significantly poorer (p < 0.05). Patients with GST‐π‐positive tumors had a significantly worse prognosis than those with GST‐π‐negative tumors (51.9% vs 79.2%, p < 0.05). Multivariate analysis showed that residual tumors 2 cm or larger and MRP expression were independent prognostic factors for chemotherapy resistance. The relative risk of chemotherapy resistance in a patient with a residual tumor 2 cm or larger, positive MRP, and positive GST‐π was 10.6 times greater than the risk in a patient without these factors.

Conclusion: MRP and GST‐π expression might be potential predictors of the response to standard chemotherapy in epithelial ovarian cancer. Their expression also might contribute to individualizing clinical trials of postoperative chemotherapy.
The Rapid Biophysical Profile for Assessment of Fetal Well‐being
Authors: Tongsong Theera , Piyamongkol Wirawit , Anantachote Athittaya , Pulphutapong Karune
Published: May 2010

Objective: To determine the efficacy of the rapid biophysical profile (BPP), the combination of amniotic fluid index (AFI) and sound‐provoked fetal movement (SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high‐risk pregnancies, compared with the nonstress test (NST).

Study Design: The prospective study of diagnostic tests was conducted on a total of 1,069 high‐risk singleton pregnancies, undergoing antepartum assessment of both the standard NST and the new rapid BPP, including AFI and SPFM detected by ultrasound. Intrapartum continuous fetal heart rate (FHR) monitoring was performed in all of them. The diagnostic indices of the NST and the rapid BPP was calculated in term of predicting intrapartum fetal distress.

Results: The rapid BPP was a reliable predictor of intrapartum fetal distress with higher sensitivity and specificity. Its accuracy was better than that of the NST. The incidence of fetal compromise among positive, equivocal, and negative tests of the rapid BPP are 78.57, 15.82 and 0.9%, respectively, whereas the incidence among nonreactive and reactive NST are 31.63 and 2.52%, respectively.

Conclusions: The rapid BPP is an effective predictor of intrapartum fetal distress in high‐risk pregnancies. It may suffice as an inexpensive and less time‐consuming method of evaluating antepartum fetal well‐being.
An Earlier Menopause as Clinical Manifestation of Granulosa‐Cell Tumor: A Case Report
Authors: Hiroi Hisahiko , Momoeda Mikio , Yamauchi Naoko , Abe Yumiko , Yoshikawa Hiroyuki , Tsutsumi Osamu , Taketani Yuji
Published: May 2010

We present a case of a granulosa‐cell tumor, which can cause menopause at an earlier than normal age. The hormonal profiles were characterized by undetectable FSH levels associated with an estradiol level compatible with the level seen in perimenopausal women and by a significant increase in the inhibin level.
Clinical Usefulness of Basal FSH as a Prognostic Factor in Patients Undergoing Intracytoplasmic Sperm Injection*
Authors: Chae Hee‐Dong , Kim Chung‐Hoon , Kang Byung‐Moon , Chang Yoon Seok
Published: May 2010

Objective: To determine if basal serum follicle stimulating hormone (FSH) level could be a prognostic factor of the clinical outcome in intracytoplasmic sperm injection (ICSI) cycles in the couples with male factor infertility

Materials and Methods: From December 1995 to March 1998, total 118 patients underwent in vitro fertilization and embryo transfer (IVF‐ET) with ICSI due to male factor infertility were included in this study. Patients were allocated to the low basal FSH group (< 8.5 mIU/ml) and the high basal FSH group (< 8.5 mIU/ml). The basal levels of FSH were measured in the 3rd day of menstrual cycle preceding ovarian stimulation cycle in total IVF cycles by immunoradiometric assay (IRMA). Statistical analysis was performed using Student's t‐test, Fisher's exact test, and X2 test as appropriate. Statistical significance was defined as p < 0.05.

Results: The total dose of exogeneous gonadotropin required in the high basal FSH group was significantly higher than that in the low basal FSH group. The numbers of retrieved oocytes and oocytes with grade I, II were significantly higher in the low basal FSH group. The clinical pregnancy rate per cycle in the low basal FSH group (16.2%) was significantly higher than that in the high basal FSH group (4.0%).

Conclusion: These results suggested that the basal serum FSH levels could be predictive of pregnancy outcome and the results of controlled ovarian hyperstimulation (COH) in ICSI cycles.
Transvaginal Hysterosalpingo‐Contrast Sonography (HyCoSy) Compared with Chromolaparoscopy
Authors: Tanawattanacharoen Somchai , Suwajanakorn Somchai , Uerpairojkit Boonchai , Boonkasemsanti Wisut , Virutamasen Pramuan
Published: May 2010

Objective: To compare the efficacy and safety of HyCoSy with chromolaparoscopy for the diagnosis of tubal occlusion and uterine abnormalities.

Methods: Sixty infertile women in whom the cause of infertility was thought to be tubal occlusion or uterine abnormalities and who satisfied the inclusion and exclusion criteria as specified in the study protocol were included. HyCoSy was performed during the first half of the menstrual cycle at least 24 hours prior to chromolaparoscopy. The results from both HyCoSy and chromolaparoscopy were compared in assessing tubal occlusion and uterine pathology.

Results: For the evaluation of fallopian tubes, we found corresponding results between HyCoSy and chromolaparoscopy in 80.0%. The agreement between both procedures in assessing the uterine pathology was 80.4%. Twenty‐two women experienced adverse events. The most common complaint was pelvic pain. Other events encountered were: nausea (3 women) and vaginal bleeding (2 women). All events were thought to be not related to the study drug.

Conclusion: HyCoSy showed good diagnostic performance in the evaluation of the fallopian tubes and uterus in infertile women. The adverse events reported in this study are minor and procedure‐related (catheter insertion) rather than the trial substance.
Changes in the Serum Levels of Human Chorionic Gonadotropin and the Pulsatility Index of Uterine Arteries during Conservative Management of Retained Adherent Placenta
Authors: Matsumura Noriomi , Inoue Takuya , Fukuoka Masatsune , Sagawa Norimasa , Fujii Shingo
Published: May 2010

Objective: Our purpose was to assess the natural course of retained adherent placenta at term.

Methods: Five cases of retained adherent placenta, clinically diagnosed as placenta accreta, were managed conservatively without methotrexate. To assess the biochemical and circulatory changes in the placentas, the serum levels of human chorionic gonadotropin (hCG) and the pulsatility index (PI) of the uterine arteries were examined.

Results: Serum hCG levels decreased spontaneously; the half‐life of serum hCG was calculated to be 5.2 ± 0.26 days (mean ± SEM). The PI of the uterine arteries remained at the level of pregnant women at term, but became elevated within a few days after the removal of the placentas. All the placentas were successfully removed transvaginally within 6 weeks postpartum.

Conclusions: The changes in serum hCG observed in this study indicated the spontaneous degeneration of the placenta. Such changes might be similar to those reported to occur during treatment with methotrexate. In contrast, the PI of the uterine arteries did not reflect degeneration of the placenta.
A Retrospective Survey of Clinical, Pathologic, and Prognostic Features of Adnexal Masses Operated on during Pregnancy
Authors: Usui Rie , Minakami Hisanori , Kosuge Shuichi , Iwasaki Ryuhiko , Ohwada Michitaka , Sato Ikuo
Published: May 2010

Objectives: To evaluate retrospective data concerning patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome.

Methods: Data were reviewed concerning pregnant women who required surgery at our hospital between 1980 and 1997 for an adnexal mass.

Results: In the past 19 years at our hospital a total of 69 Japanese women aged 28.5 ± 3.4 years (including 2 women with twin pregnancies) were diagnosed with adnexal masses that required surgery. The masses (10.2 ± 4.5 cm in the largest diameter) were removed at 13.9 ± 3.7 weeks of gestation. The pathologic features of the 69 lesions were as follows: 33 mature cystic teratomas, 13 functional cysts, 8 mucinous cystadenomas, 6 endometriotic cysts, 4 paraovarian cysts, 3 serous cystadenomas, and 2 malignant neoplasms. Of the 60 patients for whom the outcome of pregnancy was available, 7 (12%) gave birth before 37 weeks of gestation, while 2 (3.3%) experienced spontaneous abortions. There were 3 perinatal deaths among the 60 infants. Two of these 3 infants died due to major anomalies.

Conclusions: Although larger studies are required for confirmation, our results suggest that an adnexal mass might be associated with an adverse fetal outcome. Surgical intervention at < 24 weeks of gestation per se might not have been related to the adverse outcomes. We emphasize that surgical intervention during pregnancy can be avoided in patients who have ultrasonographically pathognomonic features of benign cystic teratomas, which are the most common neoplasms operated on during pregnancy.
Anemia as a Risk Factor of Hemorrhagic Tendency during Surgery
Authors: Sagesaka Toshiaki , Juen Hiroyasu , Kaibara Makoto
Published: May 2010

Objectives: Although it is well‐known that a hemorrhagic tendency in patients with massive bleeding during surgery, or with anemia before surgery, is difficult to control, its mechanism is still obscure.

Study Design: Using a damped oscillation rheometer, we measured the initiation time (Ti) of whole blood with several concentrations of red blood cells (RBCs) and the Ti of platelet‐free plasma (PFP) with various concentrations of RBCs.

Results: The Ti of the whole blood became prolonged according to the dilution of the RBC concentration. RBCs could coagulate the PFP, and the Ti of PFP also was prolonged according to the dilution of the RBC concentration.

Conclusion: These results suggest that RBCs might have an important role as a phospholipid supplier in the intrinsic pathway of the blood‐coagulation mechanism. Anemia could thus represent a risk factor for hemorrhagic tendency during surgery due to lower RBC concentrations.
Comparison of Sex Chromosome Aneuploidy in Spermatozoa of Fertile Men and Those Requiring ICSI Treatment Detected by Fluorescence In Situ Hybridization*
Authors: Damri Louise E. , Vutyavanich Teraporn , Fishel Simon
Published: May 2010

Objective: To compare the frequencies of aneuploidy for chromosomes X, Y and 18 in spermatozoa of infertile and fertile males, using 3‐color fluorescence in situ hybridization.

Methods: Twelve infertile patients who underwent intracytoplasmic sperm injection treatment at Queen's Medical Centre, Nottingham were studied. Three fertile men served as controls. Aneuploidy frequencies in both groups were compared using 2‐sample t‐tests.

Results: A total of 26,615 ad 93,649 cells were scored in the control and infertile groups respectively. The frequencies of diploidy, sex chromosome disomy and chromosome 18 disomy in the fertile (0.11, 0.28 and 0.11%) compared to the infertile males (0.05, 0.18 and 0.06%) were not statistically significantly different.

Conclusion: Our preliminary data do not indicate an increased risk from paternal origin sex chromosome aneuploidies in ICSI. However, we recommend further investigations of the cytogenetic constitution of spermatozoa from severe male factor patients.
Post Partum Splenic Artery Aneurysm Rupture
Authors: Asokan S. , Chew E. K. , Ng K. Y. , Thanaletchimy N. , Asmiati A. , Kong N. M.
Published: May 2010

Ruptured splenic artery aneurysm during pregnancy is a rare event with high maternal and fetal mortality rate. A case of ruptured splenic artery aneurysm in the post partum period is presented. The literature is reviewed on pathophysiology, clinical presentation and management of this rare and potentially fatal entity.
A Clinicopathological Study of Postoperatively Upgraded Early Squamous‐Cell Carcinoma of the Uterine Cervix
Authors: Yoshida Manabu , Jimbo Haruko , Shirai Takako , Takahashi Michiko , Shiromizu Kenji , Kuwabara Yoshinori
Published: May 2010

Objective:To investigate the clinicopathological backgrounds and diagnostic problems of postoperatively upgraded early squamous‐cell carcinomas of the uterine cervix

Patients and Methods:A total of 23 patients with postoperatively upgraded early squamous‐cell carcinomas who were treated at the Saitama Cancer Center during the period of January 1, 1976, through December 31, 1991, were analyzed clinicopathologically. We reexamined the Pap smears (ectocervix, endocervix), colposcopic findings, punch biopsies, and histological findings of the operative specimens. All patients were divided into one of 3 groups based on each patient's main location of the carcinoma of the cervix:

Type A: ectocervical type;

Type B: endocervical type; or

Type C: combined (ectocervical and endocervical) type.

Clinical staging of the uterine cervical carcinomas was done in accordance with the 1994 FIGO rules.

Results:The numbers of patients were: Type A, 2; Type B, 10; Type C, 11. Of the 23 patients, 21 (91.3%) had lesions in the endocervical portion at least. Fifteen patients (65.2%) complained of atypical vaginal bleeding. Colposcopic findings suggesting an invasive carcinoma appeared for only 6 patients (26.1%). A cytological reevaluation revealed that the endocervical findings were much stronger than the ectocervical ones in 10 (66.7%) of 15 patients whose smears of both sites could be rechecked.

Conclusions:Even if the preoperative diagnosis was early cervical carcinoma, CIS or Stage Ia1, the signs of atypical vaginal bleeding suggested that the final clinical stage would be upgraded after an operation. Furthermore, when the endocervical cytological findings were much more exaggerated than the ectocervical ones, the possibility of deeply invaded endocervical lesions should be considered.
Effectiveness of Second‐ and Third‐Generation Immunoassays for the Detection of Hepatitis C Virus Infection in Pregnant Women
Authors: Lin Ho‐Hsiung , Kao Jia‐Horng
Published: May 2010

Objective: To compare the sensitivity and specificity of a third‐generation anti‐hepatitis C virus (anti‐HCV) assay (HCV 3.0) with second‐generation one (HCV 2.0), and correlate with HCV‐RNA positivity by reverse‐transcription polymerase chain reaction (RT‐PCR).

Methods: We enrolled 197 pregnant women without screening for alanine aminotransferase (ALT) (Group A) and 324 pregnant women with elevated ALT activity (> 45 IU/l) (Group B). Each serum sample was tested by second‐ and third‐generation tests, and anti‐HCV titer was determined by serial dilutions. Anti‐HCV‐positive samples were subjected to HCV‐RNA assays.

Results: Three (1.5%) and 4 (2.0%) of the 197 group A subjects were anti‐HCV‐positive by the second‐ and third‐generation methods, respectively, while 17 (5.3%) and 21 (6.5%) of group B were positive, respectively. Three (1.5%) in group A and 8 (2.5%) in group B were HCV 2.0‐negative, but positive for HCV 3.0. The sensitivity, specificity, positive and negative predictive values of HCV 2.0 and HVC 3.0 for positive HCV‐RNA in both groups were 67 vs 100%, 30 vs 75%, 67 vs 92%, and 30 vs 100%, respectively. The anti‐HCV‐positive samples with optical density (O.D.) < 1.0 either by second‐ or third‐generation test were negative for HCV‐RNA, whereas samples with O.D. < 1.0 were all HCV‐RNA‐positive.

Conclusions: The performance of HCV 3.0 is better than that of HCV 2.0, and anti‐HCV‐positive samples with O.D. < 1.0 are negative for HCV‐RNA.
Uterine Leiomyoma Causing Massive Ascites and Left Pleural Effusion with Elevated CA 125: A Case Report
Authors: Migishima Fujio , Jobo Toshiko , Hata Hiroki , Sato Rinya , Ikeda Yasuhiro , Arai Masahide , Kuramoto Hiroyuki
Published: May 2010

A 51‐year‐old patient presented with an abdominal mass and ascites as well as a left pleural effusion. Her serum CA125 was 820 U/ml. Surgical exploration revealed a benign leiomyoma of the uterus without malignant cytology in the ascites. Postoperatively, the pleural effusion was resolved dramatically and the CA125 decreased to the normal range after 4 months postoperatively. This is an extremely rare case of pseudo‐Meigs' syndrome caused by uterine leiomyoma.
Perinatal Risk Factors Related to Neurologic Outcomes of Term Newborns with Asphyxia at Birth: A Prospective Study*
Authors: Asakura Hirobumi , Ichikawa Hisashi , Nakabayashi Masao , Ando Kazuto , Kaneko Kazuhiko , Kawabata Masakiyo , Tani Akihiro , Satoh Masashi , Takahashi Katsuyuki , Sakamoto Shouichi
Published: May 2010

Objectives: The incidence of poor neurologic outcomes was studied in term newborns who had suffered severe asphyxia at birth.

Methods: Subjects were 152 newborns admitted to the NICU with a low Apgar score at 1 or 5 minutes. A 1‐year prospective follow‐up of neurological outcomes was carried out by a questionnaire survey concluded between April 1, 1996 and March 31, 1998.

Results: 1) The incidence of a poor neurologic outcome, including 15 neurologic sequelae and 6 deaths, was 13.8% among the subjects. 2) The risk of a poor outcome was increased by 13‐fold in neonates with adverse neurological signs and 31‐fold in those with hypoxic ischemic encephalopathy.

Conclusion: The incidence of poor neurologic outcome was very high among term infants with low Apgar scores. These infants were 10 times to 20 times more likely to die, or to survive with permanent disabilities, than were infants without low Apgar scores.
Primary Mucinous Adenocarcinoma of the Appendix: A Rare Entity in the Differential Diagnosis of Ovarian Cancer
Authors: Sehouli J. , Kopetsch O. J. , Ricke J. , Buchmann E. , Stengel D. , Riess H. , Weidemann H. , Schäper F. , Freiesleben W. , Lichtenegger W.
Published: May 2010

We report a 58‐year‐old female patient with the suspected diagnosis of ovarian cancer. Upon surgical exploration, examination of the appendix revealed the histological diagnosis of primary mucinous adenocarcinoma. This is an unusual consideration in the differential diagnosis of the ovarian cancer. We discuss the diagnosis, classification and treatment of the cancer of the appendix in relation to ovarian cancer.
Secondary Mitochondrial Dysfunction after Transient Intrauterine Ischemia in the Fetal Rat Brain*
Authors: Nakai Akihito , Taniuchi Yoshinari , Asakura Hirobumi , Yokota Akishige , Koshino Tatsuo , Araki Tsutomu
Published: May 2010

Objective: Recirculation following transient intrauterine ischemia has previously been found to cause partial recovery and secondary deterioration of cellular bioenergetic states in the fetal rat brain. Our objective was to assess whether secondary bioenergetic failure is due to mitochondrial dysfunction.

Study Design: Cerebral cortical tissues were obtained from 20‐day‐old fetal rats at the end of 30 minutes of intrauterine ischemia (n = 6) and after 1 hour (n = 6), 2 hours (n = 6), and 4 hours (n = 6) of recirculation. Mitochondrial respiratory activities were measured polarographically using homogenates.

Results: Mitochondrial activities decreased to 45% of sham‐operated controls at the end of ischemia. Recirculation (1 hour) brought about partial recovery, but continued reflow (2 hours and 4 hours) was associated with a secondary deterioration of mitochondrial activities.

Conclusion: The results indicate that although during the early time period after ischemia mitochondrial respiratory capacity is restored, secondary mitochondrial dysfunction develops in the immature rat brain.