bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracorporeal Spread and Its Prognostic Impact in Stages I and II (FIGO) Endometrial Carcinoma
Authors: Sakuragi Noriaki , Tanaka Toshinobu , Satoh Chikara , Nishiya Masashi , Ohkouchi Toshihiro , Tsumura Norihiko , Takeda Naoki , Hirahatake Koji , Sagawa Tadashi , Ohkubo Hitoshi , Fujimoto Seiichiro
Published: August 2010

Prognostic risk factors were statistically analyzed from the histopathologic data obtained from 90 Japanese women with stages I and II endometrial carcinoma treated surgically, including systemic retroperitoneal lymph node dissection, between June 1979 and June 1989.

In stage Ia endometrial carcinoma, pelvic and paraaortic nodes metastasis were seen in 13.8(4/29)% and 0.0(0/19)% of patients, respectively. In stage Ib, the incidence of pelvic and paraaortic node metastasis was 25.6(11/43)% and 9.7(3/31)%, respectively. In stage II, the incidence was 38.9(7/18)% and 13.3(2/15)%, respectively.

Prognosis of patients even with deep myometrial invasion (>=2/3) or G3 tumor was fairly good (5‐year survival rate: 87.5% and 85.7%, respectively) if the disease was histologically confined to the uterine corpus. Once the tumor spread outside the corpus uteri, the survival rate of patients was strongly affected by the grade of the tumor, moderate to marked lymph‐vascular space invasion of tumor cells, or tumor invading middle or outer third of myometrium (P<0.05 for each factor). In summary, endometrial cancer frequently metastasize to pelvic and paraaortic lymph nodes even in the early stages, and lymph node metastasis and other extracorporeal spread of disease have a serious impact on patient survival. Prognosis of patients with extra‐corporeal spread of disease seems to be determined by the high grade of tumor and lymph‐vascular space invasion. These results suggest that surgical exploration including paraaortic lymph node dissection to accurately evaluate the extent of the disease is essential to estimate the patient's prognostic risk and to individualize the treatment schedule.
Epidural Anesthesia Shortens Duration of Labor in Singleton Vertex Presentation Spontaneous Delivery
Authors: Lurie Samuel , Matzkel Avi
Published: August 2010

Influence of epidural anesthesia on the duration of labor was studied in 1,206 parturients having spontaneous singleton vaginal delivery. In primiparous women, the mean first stage was 3.52 hr in the epidural group, and 7.68 hr in the control group (p<0.001), the mean second stage was 25.78 min in the epidural group, and 43.58 min in the control group (p<0.001). In the multiparous women, the mean first stage was 2.06 hr in the epidural group, and 3.85 hr in the control group (p<0.001), the mean second stage was 17.06 min in the epidural group, and 25.42 min in the control group (p<0.0001). The conclusion is that epidural anesthesia shortens the duration of first and second stages of labor in singleton vaginal delivery.
Asymptomatic Axial Torsion of the Pregnant Uterus: A Cause of the Failure of Induction of Mid‐Trimester Abortion
Authors: Gupta Indu , Handa Pusnap R. , Khera Kamla R. , Mahajan Urmil
Published: August 2010

Torsion of gravid uterus is a rare obstetric condition in which diagnosis is usually made only on laparotomy. A case of asymptomatic axial torsion of uterus during mid‐trimester, because of an ovarian cyst is reported. This presented as a failure of induction of abortion by extra‐amniotic isotonic saline instillation and oxytocin infusion.
Treatment Effects of GnRH Agonist on the Binding of Estrogen and Progesterone, and the Histological Findings of Uterine Leiomyomas
Authors: Uemura Tsuguo , Mori Jun , Yoshimura Yasuhiro , Minaguchi Hiroshi
Published: August 2010

The changes in the histology and steroid hormone binding capacity of the uterine leiomyomas treated with; GnRH agonists (GnRHa buserelin acetate in, 900 μg/day for 16 weeks) were investigated.

The occurrence of hyaline degeneration in the myometrium was significantly higher in the GnRHa‐treated group than in the control group, and the grade of hyaline degeneration was more advanced in the GnRHa group. After the GnRHa treatment, the Bmax of the estrogen receptor increased significantly in the leiomyomas and myometrium. The Bmax of progesterone receptors in the myometrium decreased significantly and the reduction rates of leiomyomas (% of the initial volumes) measured by MRI correlated (r=0.775) with the Bmax of progesterone receptors.

In summary, GnRHa caused hyaline degeneration of the uterine leiomyomas which were responsible for the shrinkage. The shrunk leiomyomas have the potential for regrowth in response to estrogen as they still have high concentrations of the estrogen receptors.
Changes in Bone Mineral Density and Fracture Prevalence in Japanese Women after Oophorectomy
Authors: Seimiya Yumiko , Chen Jui‐Tung , Hirai Yasuo , Hasumi Katsuhiko , Masubuchi Kazumasa , Shiraki Masataka , Matsuura Masanori , Aoki Choju
Published: August 2010

The bone changes after gynecological surgery during the early phase of recovery were examined. The subjects were randomly selected from women who had undergone bilateral oopho‐hysterectomies (OOX, n=98, 46.0±5.0 year‐old) or hysterectomies (HX, n=75, 43.6±4.6 year‐old) within 4 years prior to entering the study. The ovarian functions in the HX group were presumed to be intact following the hysterectomies, judging from the cytological evaluation of the vaginal pap smears.

The bone morphological changes in both groups were examined to measure the cortical thickness of the metacarpal bone (MCI) on hands X‐ray film using microden‐sitometry, and the posterior/anterior height ratios (P/A ratio) of the entire vertebral bodies, on vertebral X‐ray films using a digitizer. The changes in bone mineral densities in both groups were measured by dual energy X‐ray absorptiometry at lumbar vertebrae (L2–4 BMD) and by microdensitometry at the metacarpal cortical bone; the bone densities of metacarpal bone were referenced by the density of aluminum step wedge on the same X‐ray films. The prevalence of vertebral body fractures (P/A ratio>1.4) in the OOX group (5.1%) was 3.9 times higher than that in the HX group (1.3%). There was a significant decrease in MCI in the OOX group compared with the HX group (p<0.01). L2–4 BMD in the OOX and HX group were 1.07±0.15 and 1.16±0.13 g/cm2, respectively (p<0.001). The bone densities of the metacarpal cortical bone in the OOX and HX group were 2.57±0.38 and 2.81±0.38 with an aluminum density equivalent, respectively (p<0.001).

When the bone mineral density of the operated women exhibited below ‐1SD of age‐matched Japanese reference value, their bone mineral densities were defined as low. The relative risk (Odd's ratios) of low bone mineral density at the lumber vertebrae and metacarpal cortical bone against the HX group was 4.6 and 6.9 (p<0.05), respectively. The Odd's ratio of lower MCI between OOX and HX group was 4.0 (p<0.05).

The bone changes in either density or morphology were apparent shortly after oophorectomy. Oophorectomy is thus considered a significant risk for the development of osteoporosis.
Experience with Screening for Abnormal Glucose Tolerance in Pregnancy: Maternal and Perinatal Outcome
Authors: Rizvi Javaid H. , Saadia Rasul , Shamim Malik , Amin Rehamatuallh , Ata Khan M.
Published: August 2010

In order to determine the prevalence of glucose intolerance in pregnancy, 2,230 consecutive women attending the antenatal clinic at the Aga Khan University Medical Centre in Karachi, Pakistan were subjected on the first antenatal visit, irrespective of gestational age, to a 75 g glucose challenge followed 2 hr later by plasma glucose determination. The test, was repeated at 28–32 weeks of gestation for those patients who had an abnormal initial screen at <28 weeks gestation followed by a normal glucose tolerance test and for those who had a risk factor for gestational diabetes even though the initial screen at <28 weeks gestation was normal. The initial glucose challenge test was abnormal (2 hr plasma glucose >140 mg%) in 8.6% of the screened population. An oral glucose tolerance test on these patients revealed a prevalence for the entire population of 3.5% of gestational diabetes and 1.9% of impaired glucose tolerance test based on the modified O'Sullivan criteria. Patients with abnormal glucose tolerance test were older, had higher parity, a past history of macrosomia and a family history of diabetes compared to the controls. These patients also had a higher incidence of preterm labour and caesarean section. In the neonates hypoglycemia and hy‐perbilirubinemia were similarly higher. The fetal abnormality rate was 5.6% and the perinatal mortality was 28/1,000 which were higher than the controls.
Sheehan's Syndrome Following Eclampsia: A Case Report
Authors: Uhiara Joseph E. , Narayan Raghwa , Kumar S.
Published: August 2010

A case of Sheehan's syndrome following eclampsia is presented. The clinical features were not recognised early probably because the condition was not suspected, being a rare sequel of eclampsia. Non availability of specialist care may have been partly responsible and is highlighted. Increased awareness of all possible aetiological factors in this condition is necessary for clinicians.
BOOK REVIEW
Authors: Kuwabara Y.
Published: August 2010

Contributions to Obstetrics and Gynaecology—Vol. 1 & 2 Edited by S. S. Ratnam, Ng Soon Chye, D. K. Sen, and S. Arulkumaran
Ultrasonography and Doppler Studies in Twin‐to‐Twin Transfusion Syndrome
Authors: Ishimatsu Junji , Yoshimura Osamu , Manabe Akihiko , Matsuzaki Touru , Tanabe Ryouhei , Hamada Teiji
Published: August 2010

In 40 twin pregnancies, the evaluation of hemodynamics by ultrasound was performed during the period January 1986 through September 1991. The blood flow velocities' waveforms in the umbilical artery, umbilical vein and tricuspid valve, and the total cardiac dimension, were obtained by ultrasonography in conjunction with 3.5 MHz pulsed Doppler ultrasound. Six patients with twin pregnancies were identified as having twin‐to‐twin transfusion syndrome (TTS), on the basis of like‐sex twins with monochorionic diamniotic placentation, vascular anastomosis in the placenta, and umbilical cord venous blood hemoglobin difference exceeding 5 g/dl at delivery. No distinctive findings for TTS were revealed by the measurement of umbilical artery blood flow velocity waveforms. However, cardiomegaly in 5 recipient fetuses and tricuspid regurgitation and biphasic umbilical vein waveforms in 3 recipient fetuses constituted characteristic features of TTS. Ultrasonography and a Doppler study might be beneficial in diagnosing TTS and evaluating the hemodynamics in a recipient fetus.
Predictive Value of 1 Hour 50g Oral Glucose Load Screening Test for Gestational Diabetes Mellitus Compared to 3 Hour Oral Glucose Tolerance Test in High Risk Pregnant Women
Authors: Jirapinyo Mayuree , Puavilai Gobchai , Chanprasertyotin Suwannee , Tangtrakul Somsak
Published: August 2010

A prospective study for detecting gestational diabetes mellitus was undertaken to evaluate the use of one hour plasma glucose level after 50 g glucose loading test (1‐hr GLT) as compared to the traditional 3‐hours 100 g oral glucose tolerance test (3‐hr OGTT) in 396 high risk cases. Each patient, had 1‐hr GLT and 3‐hr OGTT performed in a separate week. Forty‐two cases (10.6%) who had abnormal 3‐hr OGTT were classified as gestational diabetes (GDM). One hundred and sixty cases (40.4%) had an abnormal 1‐hr GLT (plasma glucose level ≥140 mg/dl). Thirty‐six of these 160 cases (22.5%) had an abnormal 3‐hr OGTT. In 236 women (59.6%) that had normal 1‐hr GLT (plasma glucose level <140 mg/dl) only 6 cases (2.5%) had an abnormal 3‐hr OGTT. If 1‐hr plasma glucose level ≥150 mg/dl was used as the cutoff point, 110 cases (27.8%) were found to have abnormal 1‐hr GLT, and 35 of these 110 cases (31.8%) had an abnormal 3‐hr OGTT. Seven of 286 women (2.4%) that had normal 1‐hr GLT (plasma glucose level <150 mg/dl) had an abnormal 3‐hr OGTT. The sensitivity and specificity of the 1‐hr GLT when abnormal 3‐hr OGTT was used as gold standard for detecting GDM were 85.7% and 65% respectively (BS ≥140 mg/dl). Whereas the sensitivity and specificity were 83.3% and 78.8% respectively when plasma glucose level >150 mg/dl was used as the cut point. From this study in oriental pregnant women it can be concluded that 1‐hr GLT is a valuable screening test for GDM.
Clinical Observation of Personality Characteristics of Perimenopausal Women with Undefined Complaints
Authors: Ushiroyama Takahisa , Sugimoto Osamu
Published: August 2010

Personality tests, including the Self‐Rating Questionnaire for Depression (SRQ‐D), the Minnesota Multiphasic Personality Inventory Alexithymia Scale (MMPI‐AS), and the Egogram Check List (ECL) were completed by 202 perimenopausal women with undefined complaints. Patients diagnosed as having mental disorders showed SRQ‐D scores of over 16 points. Patients diagnosed as having mental disorders showed MMPI‐AS scores of over 13 points, which can be estimated as alexithymia. Patients experiencing climacteric disorders and the ovarian deficiency syndrome showed slightly higher MMPI‐AS scores than healthy middle‐aged women. The average ECL scores of patients diagnosed as having mental disorders tended to show an N‐shape pattern. The findings suggest that personality tests would be helpful for screening perimenopausal women with mental disorders who are seen at outpatient gynecology clinics.
Is Postoperative Radiotherapy Beneficial in the Management of Stage I‐II Squamous‐Cell Carcinoma of the Uterine Cervix with Negative Metastatic Nodes and Positive Parametrial Involvement?: A Retrospective Review of 70 Patients
Authors: Takamura Akio , Mizoe Jun‐etsu , Arimoto Takuro , Kamada Tadashi , Shirato Hiroki , Matsuoka Yoshisuke , Tomita Masayoshi , Irie Goro
Published: August 2010

Seventy patients having squamous‐cell carcinoma of the uterine cervix FIGO Stage I‐II with negative lymph nodes and positive parametrial involvement received postoperative radiotherapy following radical hysterectomy and pelvic lymphadenectomy. In 48 patients with microscopic parametrial invasion, the 5‐year survival rate was 92%. The other 22 patients with macroscopic parametrial involvement had a 5‐year survival rate of 75%. The overall recurrence rate was 13% (9 of 70). The sites of failure were 3 pelvic alone, 5 distant metastases alone, and 1 combined pelvis and para‐aortic lymph node. All of those with recurrence were Stage‐II cases. The absolute pelvic‐control rate was 94.3% (66/70). Fifty‐six percent of the patients experienced mild‐to‐moderate lymphedema. Severe complications requiring surgical intervention were observed in 6 patients (5 bowel obstructions and 1 femoral head fracture). A review of the literature suggests that early carcinoma can be successfully treated by surgery alone. Taking into consideration the risk and benefits involved, postoperative radiotherapy is not recommended for most cases with cervical carcinoma with negative lymph nodes and positive parametrial involvement in the present form, despite excellent local control. However, no definite conclusion can be drawn from this retrospective analysis.
Immunoradiometrical Measurement of Tissue Polypeptide Specific Antigen (TPS) in Normal, Healthy, Nonpregnant and Pregnant Japanese Women
Authors: Inaba Noriyuki , Fukasawa Ichio , Okajima Yuko , Ota Yoriko , Tanaka Kiyoshi , Matsui Hideo , Iwasaki Hideaki , Sato Naomi , Sudo Hatsumi , Björklund Bertil , Takamizawa Hiroyoshi
Published: August 2010

Using a monoclonal immunoradiometrical assay, we measured the concentrations of the specific epitope M3 of tissue polypeptide antigen (TPA), namely, tissue polypeptide specific antigen (TPS), in serum and amniotic fluid obtained from normal, healthy, nonpregnant and pregnant Japanese women (NHNJW and NHPJW).

The cut‐off value of the serum TPS level was set at 130 Ul, based on the mean+2 standard deviations in the NHNJW. The serial measurement of serum TPS levels demonstrated the significant emporal elevation of TPS level near the time of ovula‐tion (±3 days) in the ovulatory women. In the NHPJW, the mean serum TPS level and the positivity rate (>130 U/l) increased with the advance of gestation, reaching 183.7 U/l and 66.7%, respectively, in the third trimester. Maternal serum levels were much elevated just before (mean: 982.3 U/l) and after (mean: 824.6 U/l) delivery, and were reduced to about one‐fourth by 3 days. In addition, markedly high TPS concentrations were found in the retroplacental blood (one case: 9,076 U/l) and the amniotic fluid (mean: 11,650 U/l). The serum TPS level correlated well (r=0.871) with the serum TPA level in the TPS range of 2‐2,000 U/l, while a poor correlation (r=0.273) was found in the TPS range of 2–500 U/l.

The present study thus obtained fundamental data on TPS in Japanese women. The fluctuation and change of serum TPS levels during the menstrual cycle and in pregnancy should be taken into consideration when we apply TPS as a tumor marker for women.
Experimental Studies of Cis‐Diamminedichloroplatinum (II) and Cis‐Diammine‐1, 1‐Cyclobutandicarboxylate Platinum (II) Combination Therapy for Malignant Gynecologic Tumors
Authors: Kato Noriko
Published: August 2010

A comparative exploration of the optimum regimens for CDDP and CBDCA therapy of malignant gynecologic tumors was conducted using both in vitro and in vivo approaches. In vitro, CBDCA exerted less cytotoxicity with short‐time exposure, but over a longer time was as effective as CDDP. Pharmacokinetic studies demonstrated rapid binding of all administered CDDP to protein, while free‐Pt was seen for many hours after CBDCA treatment. These results suggest that the gradual action of CBDCA leads to the appearance of cytotoxicity, and that in clinical use CBDCA affects the tumor cells for a long time. To increase the active dose of platinum, treatment with high doses of CDDP, or CBDCA, or the two platinum compounds with different pharmacokinetic behavior in combination, was designed for optimal therapeutic protocols. In the CDDP‐alone treatment animals, renal toxicity was apparent with the increase in dose level. However, in the combination CDDP‐and‐CBDCA treatment animals, the total dose level could be elevated without causing toxicity. In the drug‐sensitivity test, the combination therapy also exerted strong activity. The fact that the combined CDDP‐and‐CBDCA therapy appears to exert greater anti‐tumor effects without any increment in adverse toxicity of these drugs is clinically promising.
Birth Weight Distribution in The United Arab Emirates
Authors: Hughes Phillip F. , Morrison John
Published: August 2010

Abstract

Birth weight is a point measure of size, not a measure of growth and past presentation of birth weight data has confounded its use by maintaining an emphasis on size at birth rather than health at birth. This paper presents current data for a United Arab Emirates (UAE) national population for both international comparison and contrast with other Gulf populations. Unique local conditions include a high rate of diabetes in pregnancy, extreme grandmultiparity and significant numbers of mature gravida (age >35 yrs), and emphasizes a need for a re‐appraisal and redevelopment of this form of analysis as a part of the overall obstetric care of the pregnant population.
Immunological Characterization of Human Decidual Mononuclear Cells: Natural Killer Activity, Response to Interleukin‐2 and Distribution of Interleukin‐2 Receptor Subunits
Authors: Kurahayashi Yumiyo , Uehara Shigeki , Okamura Kunihiro , Yajima Akira , Sugamura Kazuo
Published: August 2010

Abstract

We investigated the immunological character of mononuclear cells obtained from the decidua in the first trimester of normal pregnancy. These cells showed in vitro cytotoxicity against NK cell targets, although with lower activity than that of the peripheral blood mononuclear cells. Response to IL‐2 was dose‐dependent. Since decidual CD56‐positive cells express two IL‐2 receptor subunits, p55 and p75, it is concluded that these cells have high‐affinity receptors to IL‐2. Peripheral blood CD56‐positive cells, which express p75 alone, might have intermediate‐affinity IL‐2 receptors. These results indicate that the decidual mononuclear cells have a function resembling that of the peripheral blood NK cells in vitro, moreover, that even low levels of IL‐2 can affect the character of the decidual mononuclear cells through the high‐affinity IL‐2 receptor. It is considered that the NK activity of decidual mononuclear cells is suppressed in conditions of low IL‐2 levels to permit the maintenance of pregnancy, but can be rapidly elicited by intrauterine infections or abortion, both of which elicit the secretion of IL‐2.
Prostaglandin Biosynthesis in the Umbilical Artery and Its Relation to Fetal Growth
Authors: Mitsuhashi Naoki , Kuwabara Yoshinori
Published: August 2010

Abstract

Arachidonic acid metabolites were investigated in umbilical arteries of 16 normal pregnancies. Several prostaglandins (PGs) and hydroxyacids were synthesized by the umbilical artery. Prostaglandin I2, PGF2a, PGE2 and PGD2 were found in the products, and PGI2 was the most abundant metabolite in the umbilical artery. The conversion rate of PGI2 from arachidonic acid is strongly correlated with the body weight of the baby (correlation coefficient: 0.621) and with the weight of the placenta (correlation coefficient: 0.668). PGI2 is known to be a strong vasodilator and anticoagulant, and is known to increase blood circulation. We therefore conclude that the PGI2‐syn‐thetic activity of the umbilical artery is strongly related to feto‐placental blood flow and hence to fetal growth.
Autologous Blood Transfusion for the Patient with Placenta Previa Complicated by Placenta Increta: A Case Report
Authors: Kuromaki Kenichi , Takeda Satoru , Seki Hiroyuki , Kinoshita Katsuyuki , Maeda Hiroo , Hitomi Yuko
Published: August 2010

The patient, who was 34 years of age, had previously had a transverse incision of the lower uterine segment cesarean section because of placenta previa. She was admitted to the hospital due to placenta previa again at 27 weeks of gestation in the current pregnancy. Ultrasound examination revealed placenta increta as well as placenta previa. In an attempt to avoid homologous blood transfusion at the time of profuse hemorrhage anticipated to occur during cesarean section, an autologous blood transfusion was planned. Fifteen hundred ml of autologous blood was collected by a leap‐frog method during the 8 weeks prior to cesarean section. A cesarean hysterectomy was performed at 37 weeks of gestation because of placenta increta. Blood loss was estimated at 1,830 ml, and 1,500 ml of autologous blood was transfused.

A leap‐frog method of autologous blood collection for this pregnant woman with risk of massive hemorrhage was simple and beneficial, resulting in the preservation of more than 1,500 ml of autologous blood for transfusion.
Two Cases of Gas Gangrene Complicating Uterine Rupture and Fetal Death at Term
Authors: Habeebullah S. , Bupathy A. , Rajaram P.
Published: August 2010

Two patients with obstructed labor and uterine rupture complicated by clostridial septicemia are reported. The diagnosis was apparent clinically. The importance of early diagnosis and prompt treatment are emphasized. The place of hysterectomy, which should be individualized is discussed. All efforts should be directed towards prophylaxis in high risk cases.
Effects of Human Serum Supplementation on Fertilization and Development of Mouse Embryos
Authors: Tanikawa Masahiro
Published: August 2010

Serum is generally used as a protein supplement in culture media for human in vitro fertilization (IVF). To determine the effects of serum supplementation on the development of preimplantation embryos, one‐cell and two‐cell mouse embryos fertilized in vitro and in vivo were cultured in BWW medium supplemented with preovulatory patient serum (PS), human fetal cord serum (HCS), or bovine serum albumin (BSA). The rates of fertilization and development of embryos fertilized in vitro and in vivo were suppressed when the embryos were cultured with PS or HCS as compared with BSA. In the medium supplemented with HCS, growth of in vitro fertilized embrycs was retarded at an earlier embryonic stage than was the case with embryos fertilized in vivo. These results suggest that the in vitro fertilized embryo culture model is more sensitive to culture conditions than is the in vivo fertilized embryo culture model. Incorporations of [3H]uridine and [3H] leucine were measured using embryos that developed to the blastocyst stage in a medium supplemented with HCS or BSA. Blastocysts cultured with HCS showed significantly higher incorporations of [3H]uridine and [3H]leucine than those cultured with BSA. While serum supplementation in culture media has adverse effects on embryo cleavage, it augments synthesis of RNA and protein.
Prediction of Pregnancy‐Induced Hypertension by Isometric Exercise
Authors: Tomoda Shoji , Kitanaka Takashi , Ogita Sachio , Hidaka Atsuo
Published: August 2010

The purpose of this study is to evaluate an isometric exercise (Hand‐Grip test) as a method to predict pregnancy‐induced hypertension (PIH). One hundred and twenty‐five pregnant women were given the Hand‐Grip (HG) test before the 15th gestational week. The Hand‐Grip test was rated positive when the systolic blood pressure increased 15 mmHg or more during isometric exercise or decreased 14 mmHg or more immediately after isometric exercise. As a result, the Hand‐Grip test had the highest sensitivity (81.8%) and specificity (68.4%) for predicting PIH, compared to other risk factors. The positive predictive value was 20% (second highest among risk factors, the actual incidence of hypertension was 8.8%), and the negative predictive value was 97.5% (highest). In conclusion, by use of a very simple Hand‐Grip test early in gestation, we are able to predict PIH with the highest sensitivity.
Spontaneous Perforation of Pyometra: A Case Report
Authors: Kaneko Yoshiharu , Doi Misa , Kaibara Manabu
Published: August 2010

Spontaneous perforation is a rare complication of pyometra and is usually associated with uterine cervical occlusion. We report a very rare case of spontaneously perforated pyometra without cervical occlusion.

A 56‐year‐old woman with severe abdominal pain was admitted to our hospital. Exploratory laparotomy was performed because of suspicion of gastro‐intestinal perforation with generalized peritonitis. There was no perforation of the stomach, gallbladder, or bowels, but examination of the uterus revealed a perforation of the uterine fundus. A total abdominal hysterectomy with bilateral salpingo‐oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, the condition must be born in mind with regard to elderly women with acute abdominal pain.
Sudden Death Due to Pulmonary Tumor Embolism in a Patient with Endodermal Sinus Tumor of the Ovary
Authors: Anai Takanobu , Hirota Yoshiko , Hayata Takashi , Miyakawa Isao
Published: August 2010

Only 2 cases of fatal pulmonary tumor embolism have been described in patients having malignant tumors of the ovary. Both were diffuse microtumor emboli in the pulmonary arteries of elderly individuals. We present a teen‐aged patient who died suddenly due to a massive tumor embolism of the right main pulmonary artery after a two‐year remission of an endodermal sinus tumor of the ovary. Upon her first admission, she was treated with radical operation and insufficient chemotherapy. Two years later, she was readmitted to our hospital because of the sudden onset of dyspnea and shock; and she died 5 hours after readmission. A case of endodermal sinus tumor of the ovary with fatal pulmonary tumor embolism is described.
Maternal Mortality: Evolving Trends
Authors: Loh F.H. , Arulkumaran S. , Montan Sven , Ratnam S.S.
Published: August 2010

Despite improvement in socioeconomic standards, good and accessible health care facilities the maternal mortality rate in Singapore is not declining. The maternal mortality rate in National University Hospital, Singapore, over a 7 year period 1986–1992 was 22.9 per 100,000 when direct and indirect causes were considered (34.4 per 100,000 when incidental deaths were included). However closer scrutiny reveals that most deaths were not due to the traditional direct causes of haemorrhage, sepsis, embolism or hypertensive disease. Most were due to medical disorders which in their own right carries a high risk to life even without a pregnancy.
The Present Status of Assisted Reproductive Technology in Asia‐Oceania
Authors: Chang Yoon‐Seok , Jun Jong‐Kwan , Choi Young‐Min , Moon Shin‐Yong
Published: August 2010

This is a survey on the present status of assisted reproductive technology in the Asia‐Oceanic region. The survey formats were sent to the 19‐member societies of AOFOG. By the end of August 1991, 11 countries responded: Australia, Egypt, Hong Kong, Israel, Japan, Malaysia, New Zealand, Philippines, Republic of China, Singapore and Thailand. This report is a summary of data from 12 countries including Korea. It comprised of 14 headings: IVF, GIFT, AIH, AID, donor sperm in ART, donor eggs in ART, preembryos from IVF for donation, cryopreservation of eggs, cryopreservation of fertilized eggs and preembryos, research of preembryos, surrogate mothers, additional procedures, quality assurance in reproductive technology and formation of policy for emerging reproductive technology. Each heading is composed of status of regulations, cost and coverage and the results and management of program.
Fetal Bladder Outlet Obstruction Diagnosed at 13‐Weeks' Gestation
Authors: Oga Masayuki , Anai Takanobu , Yoshimatsu Jun , Inoue Ikuo , Kawano Yasushi , Miyakawa Isao
Published: August 2010

An ultrasonographic examination revealed increased fetal bladder size as well as fetal bilateral hydronephrosis at 13‐weeks' gestation. Diagnosis of the fetal urethral obstruction was made. Repeated ultrasonography was undertaken from the 13th to throuh 16th weeks of gestation. Percutaneous puncture with aspiration and laboratory analysis of fetal urine was performed at 15‐weeks' gestation. The fetal renal function seemed not to be damaged by use of these antenatal procedures. Following induced abortion at 16‐weeks' gestation, an autopsy showed that the fetal urethral obstruction was caused by a posterior valve, with no histological evidence of fetal renal dysplasia.
The Value of a Single Sensitive Urine Pregnancy Test in Prediction of Pregnancy Outcome
Authors: Chan Yuen‐fai , So William W. K. , Yeung William S. B. , Lau Estella Y. L. , Ho Pak‐chung
Published: August 2010

A simple and reliable indicator for pregnancy outcome will be valuable clinically for patient management and for counselling women whose pregnancies are results of subfertility treatment. This study aimed at evaluating the ICON II test, a simple semiquantitative sensitive urine pregnancy test, in predicting pregnancy outcome in women who conceived after various forms of subfertility treatment. The ICON II test was performed on day 20 after the ovulating dose of hCG administration or spontaneous LH surge. One hundred and forty‐five consecutive pregnancies were studied, 99 being viable and 46 nonviable which included subclinical abortion, clinical abortion and ectopic pregnancies. There was a significant difference in the luteal serum progesterone and hCG levels between viable and nonviable pregnancies. There was also a significant difference in the ICON II test result, i.e. either weakly positive (hCG of 25–50 IU/l) and positive (hCG > 50 IU/l) and the pregnancy outcome (p < 0.0001). The specificity of a weakly positive ICON II test in predicting poor pregnancy outcome was 98.8% whereas the sensitivity was 28.6%. In conclusion, a weakly positive ICON II test is useful in predicting poor pregnancy outcome.
Trial of Vaginal Birth Following Cesarean Section for Arrest Disorders of Labor: Analysis of Patients with Well‐Documented Medical Records
Authors: Yasumizu Takehiko , Nozawa Akira , Kinoshita Toshihiko , Kato Junzo
Published: August 2010

We elucidated several controversial problems surrounding the vaginal trial in patients with prior abdominal delivery under the diagnosis of failure to progress or cephalopelvic disproportion, by conducting a prospective 6‐year survey on the basis of patients who underwent prior operation for arrest disorders of labor (ADL). Of 45 full‐term women who were denned as patients of prior ADL following a review of their past medical records, 28 patients underwent trial of labor and 75% (21/28) were successfully delivered of their infants vaginally. The seemingly critical determinants as to whether or not a vaginal birth is successful are the difference in neonatal weights between prior and current pregnancies as well as the difference between maternal obstetric conjugate and fetal biparietal diameter. These data suggest that patients who underwent prior cesarean section for indications of ADL have a high chance of safely succeeding if given a trial of labor under certain exclusionary criteria.
Activities of Phospholipase A2, Cyclooxygenase, and PGI2 Synthase of Umbilical Venous Endothelial Cells in Preeclamptic Women
Authors: Seki Hiroyuki , Takeda Satoru , Kinoshita Katsuyuki , Satoh Kazuo
Published: August 2010

To elucidate the cause of low prostacyclin (PGI2) production in severe preeclampsia (PE), we studied the activities of phospholipase A2, cyclooxygenase, and PGI2 synthase in umbilical venous endothelial cells obtained from healthy pregnant women and from patients with mild or severe PE. Umbilical venous endothelial cells homogenized in a buffer solution were analysed by calculating the apparent Vmax (mean ± SEM: p mol/min mg protein) and Km (mean ± SEM:;μm) values for phospholipase A2 activity by the release of arachidonic acid from phosphatidylcholine, for the activity of a complex of cyclooxygenase and PGI2 synthase by the conversion of arachidonic acid to PGI2, and the activity of PGI2 synthase by conversion of PGH2 to PGI2. The phospholipase A2 activity of normal‐pregnancy cells (Vmax; 17.0 ± 2.7 Km: 0.26 ± 0.04) (n = 10) significantly exceeded that of cells from women with either mild PE (5.8 ±0.5, 0.12 ± 0.02) (n = 4) or severe PE (6.3 ±2.0, 0.08 ± 0.03) (n = 5). The apparent combined activity of cyclooxygenase and PGI2 synthase in mild PE (552 ± 142, 0.29 ± 0.07) (n = 8) significantly exceeded that of a normal pregnancy (176 ± 42, 0.76 ± 0.25) (n = 7), whereas that in severe PE (326 ± 36, 3.26 ±0.78) (n = 3) was significantly lower than that of a normal pregnancy. PGI2 synthase activity in mild PE (305 ± 50, 0.12 ± 0.07) (n = 4) exceeded that of a normal pregnancy (220 ±45, 0.13 ±0.06) (n =5), whereas that in severe PE (55 ±12, 0.16 ± 0.04) (n = 3) was lower than that of a normal pregnancy. The phospholipase A2 activity in cells of normal pregnant women exceeded that of cells of women with mild or severe PE. The combined activity of cyclooxygenase and PGI2 synthase in a normal pregnancy was lower than in mild PE, but higher than in severe PE. Similar results were found for PGI2 synthase activity; in normal pregnancy the activity was less than in mild PE, but higher than in severe PE. Low production of PGI2 in severe PE seems to result from a decreased activity of enzymes that produce PGI2, especially cyclooxygenase.
Endocrinological and Histological Changes after Treatment of Uterine Leiomyomas with Danazol or Buserelin
Authors: Ueki Minoru , Okamoto Yoshiaki , Tsurunaga Takemichi , Seiki Yasuo , Ueda Masatsugu , Sugimoto Osamu
Published: August 2010

The following results were obtained from our investigations performed to compare the effects of danazol (400 mg/day orally for 4 to 6 months, n = 164) with those of buserelin (900 μg/day intranasally for 4 to 6 months, n = 83) on patients with uterine myomas.

The effectiveness of buserelin (76.1%) in shrinking uterine myomas was better than that of danazol (56.7%). The serum‐estradiol and progesterone levels were lower in the buserelin group than in the danazol group. The estrogen and progesterone receptors in a hysterectomied uterus were positively stained even at the end of those therapies. The degree and frequency of hyaline degeneration were higher in the buserelin group than in the danazol group. Thus, the shrinking of uterine myomas and the degree of hyaline degeneration might be caused by the lowering of uterine‐tissue hormones, particularly of estradiol levels.
Vaginal Birth after One Previous Caesarean Section: A Jordanian Experience
Authors: Abu‐Heija Adel T.
Published: August 2010

In this prospective study, 119 women out of 135 (88%) of cases delivered previously by one lower segment caesarean section at Princess Basma Teaching Hospital in North Jordan, had a trial of labour, 103 out of 119 women (86.6%) delivered vaginally. A high incidence of vaginal delivery occurred in women originally delivered by caesarean section for cephalopelvic disproportion (CPD) (69%). Repeat caesarean section was necessary only in 13.4% of women mainly because of CPD and foetal distress. Labour was induced for obstetric reason only. The incidence of scar rupture was very low 1 of 119 cases (0.8%), with no maternal deaths. The duration of labour doesn't differ significantly for those who had from those who never had vaginal delivery before. So it is relatively safe to have a trial of labour in patients delivered previously by one caesarean section.
How Safe Is Caesarean Section
Authors: Mukherji Joydev , Samaddar Jitesh Chandra
Published: August 2010

Over an almost 5 year period, 8,017 caesarean sections were done, and there were 51 maternal deaths following caesarean section (of which 5 were done outside). Caesarean section deaths accounted for 1 in 8 overall maternal deaths in the hospital, and institutional mortality for caesarean section was 5.7/1,000 operations. The causes of death included haemorragic shock in 19 (37.3%), general anaesthesia 6 (11.6%), hypertensive disorders 5 (9.8%), general anaesthesia in hypertensive pregnancies 4 (7.8%), septicaemia 7 (13.7%), hepatic failure 3 (5.9%), pulmonary edema 2 (3.9%) and unknown including pulmonary embolism 6 (11.6%). Five deaths followed elective operations. Caesarean section done in cases of antepartum haemorrage, hypertensive disorders, post caesarean pregnancies with adherent placentae and obstructed labour caused the majority of caesarean mortalities.
The Effect of Follicular Fluid on Intracellular Free Calcium Levels in Human Spermatozoa
Authors: Fukui Keisuke , Takeda Yasunari , Yano Juri , Kaura Rumiko , Kitagawa Hiroyuki , Suginami Hirosi , Matsuura Shumpei , Oka Keizo
Published: August 2010

In this study, we demonstrate the effect of follicular fluid (FF) on free cytosolic calcium ion ([Ca2+]i) in human spermatozoa, using a fluorescent indicator “fura 2,” and we evaluate the factors that increase [Ca2+]i in FF. A significant and immediate [Ca2+]i increase (656.3 ± 148.6 nM) was elicited by intact FF. The increase in [Ca2+]i elicited by lipid‐stripped FF was only 50% (322 ± 68.7 nM) of that elicited by intact FF. However, 82% of the [Ca2+]i increase elicited by intact FF was observed when lipid‐stripped FF was supplemented with progesterone, but not when it was supplemented with estradiol. Also, progesterone at the concentrations of 1 ng/ml to 1 μg/ml caused a significant increase in [Ca2+]i by itself, but estradiol produced a small effect, ranging from 3% to 9% of the effect produced by progesterone. These results indicate that progesterone plays a major role in the lipid fraction in FF to elicit the entry of calcium into human spermatozoa.
Detection and Identification of Amines in Bacterial Vaginosis
Authors: Kubota Takeyoshi , Sakae Utsuno , Takeuchi Hisaya , Usui Mitsugu
Published: August 2010

For the purpose of determining an objective indicator of bacterial vaginosis (BV), we tried to detect and to identify amines in the vaginal fluid of patients by using the dansyl method (to detect amine in a solution of water). Bacteria isolated from these patients were also analyzed.

In BV (n: 32) 7 kinds of amines were detected; and the positive rate of detection of the dansyl method was 90.6%. No specific bacteria was found in BV.

The positive rate was 80.0% for the patients with trichomonas vaginitis (n: 5).

The positive rate of detection was 20.0% in the candida group (n: 5), and 28.6% in the control group (n: 14). Those amines detected in other than BV‐related vaginitis are presumed not to vaporize. For purposes of diagnosis, it would be better to detect vaporized amines instead of detecting amines dissolved in vaginal fluid.
Bone Mineral Density in Premenopausal Anovulatory Women
Authors: Park Ki H. , Song Chan H.
Published: August 2010

To examine the impact of amenorrhea on bone mineral density in women of reproductive age, we performed a cross sectional study in 190 amenorrheic women, comprising 113 premature ovarian failure, 27 primary hypothalamic amenorrhea, 38 hyperprolactinemia and 12 Sheehan's syndrome.

Measurement of bone mineral density was carried out using dual photon absorptiometry at four sites: femur neck, ward's triangle, trochanter and spine (L2–4) and we compared the result with that of 163 normal‐cycle control women with age matched.

Bone mineral densities was significantly low in patients with primary hypothalamic amenorrhea and premature ovarian failure at all four sites. In those with hyperprolactinemia a decrease in bone mineral density was noted at femur neck and spine while those with Sheehan's syndrome is associated with decreased bone density at femur neck, ward's triangle and trochanter. The degree of bone loss and the affected sites seems differ depending on the type of amenorrhea. In patients with primary hypothalamic amenorrhea, significant bone loss was already noted at all four sites by age 20. The decrement in bone density continued rapidly during the early twenties up to age 25 and then slowed after age 25. In those with premature ovarian failure with secondary amenorrhea there were no decrease in bone mineral density within the first year after onset of amenorrhea, however, in the subsequent 2 years, the reduction in BMD was rapid and thereafter the reduction slowed remarkably. The BMD in this study positively correlated with the body mass index and negatively with the phosphorus intake.
Practical Management of Postmenopausal Women with Low Bone Mineral Density
Authors: Taga Michiyoshi
Published: August 2010

For the management of postmenopausal women with low bone mineral density (BMD), the gynecologist, as a primary care physician, should play a central role in preventing osteoporotic fracture by educating them for elimination of risk factors and for healthy life‐style and by providing an appropriate drug therapy. Because the risk of fracture usually increases after BMD decreases as much as 20–30% of peak bone mass, it is practically reasonable to set this level of BMD as a criteria for the initiation of management. As for a drug treatment, it is better to combine estrogen, the first choice drug, with progestogens to counteract any neoplastic effect of unopposed estrogen on the endometrium. Bisphosphonates and calcitonin, which are inhibitors of bone resorption, provide an alternative in prevention and treatment of postmenopausal bone loss in case of contraindication for estrogen or in those women who are unwilling to take estrogen.
Detection of Lymph Node Metastasis in Ovarian Carcinoma and Uterine Corpus Carcinoma by Preoperative Computerized Tomography or Magnetic Resonance Imaging
Authors: Sugiyama Toru , Nishida Takashi , Ushijima Kimio , Sato Norio , Kataoka Akio , Imaishi Kiyohisa , Fujiyoshi Keizo , Yakushiji Michiaki
Published: August 2010

Objective: Preoperative CT or MRI findings were compared with the results of staging laparotomy to evaluate the accuracy of CT or MRI for detecting pelvic and para‐aortic lymph‐node metastases.

Methods: In evaluating CTs in 95 ovarian carcinomas, we examined plain and contrast images made in 1‐ to 1.5‐cm‐thick slices from the pubis to the xiphoid process. Lymph nodes 1.5 cm or larger were considered to be positive. MRIs of 60 uterine corpus carcinomas utilized T1‐weighted contrast, T2‐weighted, and short‐ inversion time inversion‐recovery (STIR) images.

Results: CT had a sensitivity of 60.9% and a specificity of 93.1%. The positive and negative predictive values were 73.7% and 88.2%, respectively. The diagnostic accuracy of CT for detecting para‐aortic lymph‐node metastases exceeded that for pelvic node metastases. The results of MRI indicated that the T1‐weighted image and STIR image were the most accurate in identifying metastatic nodes.

Conclusions: These results indicate that the most practical approach might be to search for enlarged lymph nodes by CT, and to follow‐up with MRI when CT scans are questionable.
Filtration of Human Seminal Specimens Using LeukoSorb Leukocyte‐Retention Medium
Authors: Fujii Shunsaku , Sagara Morio , Ikeda Shiro , Kagiya Akifumi , Sato Shigemi , Saito Yoshiharu
Published: August 2010

Objective: To compare LeukoSorb filtration with Percoll centrifugation in preparing sperm.

Methods: Each of 26 human seminal specimens were analyzed before and after two preparation methods.

Results: In normospermic specimens (n = 11), LeukoSorb produced higher results than Percoll did with regard to mean percentage of motility (72.7% vs 59.2%), total swollen sperm in a hypo‐osmotic swelling test (84.8% vs 59.0%), (g)‐type swollen sperm (37.8% vs 23.4%) and tail abnormality (20.4% vs 10.1%). In asthenospermic specimens (n = 15), LeukoSorb produced higher results than Percoll did with regard to mean percentage of motile sperm recovery (22.2% vs 10.1%), motility (46.9% vs 23.2%), viability (75.6% vs 54.7%), total swollen sperm (84.8% vs 59.0%) and tail abnormality (42.2% vs 24.3%), although the mean percentage of head abnormality was lower with LeukoSorb than with Percoll (30.6% vs 40.2%). In pyospermic specimens (n = 10), the mean concentration of round cells after LeukoSorb decreased significantly more than with Percoll (p = 0.029). The filtration time correlated with the total sperm concentration.

Conclusion: LeukoSorb filtration is useful for preparing asthenospermic and pyospermic seminal specimens.
Primary Thrombocythaemia Presenting as Postpartum Haemorrhage: A Case Report
Authors: Rashid Zainul , Hamidah N.H. , Othman Ainoon , Cheong S.K. , Fairuz A.K.A. , Adeeb Nafisah
Published: August 2010

A young primigravida presented with postpartum haemorrhage with no apparent cause following a low forceps delivery. She was extremely pale with gross hepato‐splenomegaly. Hysterectomy was performed following three episodes of disseminated intravascular coagulation. Investigations revealed an extremely high platelet count with poor aggregatory function. A diagnosis of primary thrombocythaemia was made.
Adenomyosis in a Rudimentary Uterine Horn with Intrauterine Fetal Death: A Case Report
Authors: Numa Fumitaka , Ogata Hidenobu , Murakami Akihiro , Sase Masakatsu , Nakamura Yasuhiko , Takasugi Nobuyoshi , Kato Hiroshi
Published: August 2010

A case of pregnancy in a rudimentary uterine horn complicated with adenomyosis resulting in intrauterine fetal death without rupture is reported. Although ultrasonographic and hysteroscopic examinations are useful, laparoscopy or laparotomy should be initiated promptly in a case where a pregnancy with a rudimentary horn is suspected.
Maternal Mortality Rate in the Obstetric Unit of University Kebangsaan Malaysia: 1981–1990
Authors: Abdullah Ashar , Mahmood Jemilah H. , Adeeb Nafisah
Published: August 2010

This paper analyses maternal mortality as seen in the Obstetric Unit of the University Kebangsaan Malaysia. During the 10 year study period, the maternal mortality rate was 74 / 100,000 total births. Women who were non‐booked, aged above 40 years, gradmultiparous and of India ethnicity were at the highest risk of maternal death. The commonest causes of death were hemorrhage, hypertension, embolism and sepsis. Post‐mortem examinations were performed in only 8.2% of women who died.