bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasu‐Hakola disease: The first case reported by Nasu and review
Authors: Kaneko Minoru , Sano Kenji , Nakayama Jun , Amano Naoji
Published: May 2010

Nasu‐Hakola disease (NHD) was first reported separately by Nasu and Hakola around the same time in the 1970s. It is an autosomal recessive inherited disorder characterized by progressive dementia and repeated pathological fractures during adolescence. It has recently been demonstrated that NHD is caused by a mutation in the TREM2 or DAP12 gene. The present paper demonstrates the first patient reported by Nasu and reviews NHD. The patient was a man who died at the age 38 years. His family history was unremarkable. There was no abnormal developmental history. At the age of 26, the patient suffered a pathological fracture of the right tibia, and X‐ray confirmed bone resorption in the right tibia. As for mental status, the patient tended to be euphoric. After that, bone resorption was also seen in other long bones. At the age of 33, the patient could not walk after suffering a right femoral neck fracture. He was apathetic and exhibited behavioral abnormalities. At the age of 38, he could not move or speak and subsequently died. General pathological examination showed yellow opaque gelatinous substances in the medullary cavities, matching translucent cystic lesions in the femur, tibia, and fibula on X‐rays. Light microscopy showed numerous membranocystic changes in the substances. The brain weighed 1050 g. Symmetric systemic cerebral atrophy, in particular atrophy of the cerebral white matter in the occipital and temporal lobes, was confirmed. Histological examination showed white matter degeneration and diffuse sclerosis accompanied by astroglial proliferation. Severe demyelination was confirmed. Axonal degeneration and destruction were marked. In demyelinated areas, fat granule cells appeared, and lipid granule‐positive cells aggregated around vessels. Cerebral cortical neurons were relatively maintained. In the brain, no membranocystic lesions could be recognized. In the DAP12 gene, the patient had a conversion of nucleotide at position 116 resulting in serine 38 to asparagine substitution.
Estimating the hydration status in nephrotic patients by leg electrical resistivity measuring method
Authors: JIANG FENG , BO YUHONG , CUI TAIGEN , ZHOU YILUN , LI ZHONGXIN , MA LIJIE , BI ZENGQI
Published: May 2010

Aim:  For years, bioelectrical impedance analysis has been widely used to evaluate the hydration status in dialysis patients. However, its value in assessment and controlling the hydration status in non‐dialysis patients with kidney disease, such as nephrotic syndrome, is little mentioned. Because a simple and accurate method to evaluate the hydration status of nephrotic patients is not available, the aim of the present study was to assess the value of leg electrical resistivity measurement in controlling the hydration status of nephrotic patients.

Methods:  The study investigated 46 nephrotic patients with a mean age of 41.65 ± 17.15 years, 47.8% of whom were female. The patients were divided into remission and relapse groups according to their serum albumin concentration and oedema. Four hundred and twenty‐seven healthy persons were studied as normal control. Their hydration status estimated by leg electrical resistivity was studied.

Results:  There was significant negative correlation between leg electrical resistivity and percentage of extracellular fluid (ECF) measured by the bromide dilution method. The percentage of ECF estimated by the leg electrical resistivity in the relapse group was significantly larger than that of the remission group, but it was approximately the same in the remission group as in the normal control. For nephrotic patients in the relapse group, after they ahcieved remission, their percentage of ECF estimated by the leg electrical resistivity was significantly less than that before treatment, and was close to that of the normal control.

Conclusion:  Leg electrical resistivity measurement is a simple, non‐invasive and valuable method for controlling the hydration status in patients with nephrotic syndrome.
Changes in Purine Metabolism and Production of Oxygen Free Radicals by Intermittent Partial Umbilical Cord Occlusion in Chronically Instrumented Fetal Lambs
Authors: Masaoka Naoki , Hayakawa Yasuhito , Ohgame Sachiko , Sakata Hisaei , Satoh Kazuo , Takahashi Hideo
Published: May 2010

Objective: Undetected umbilical‐cord compression has been suggested to be implicated in unexplained fetal brain damage. We tested the hypothesis that the generation of oxygen‐free radicals (OFRs) during intermittent partial umbilical cord occlusion might play a causal role in antenatal CNS injury.

Methods: Using 7 established chronically instrumented fetal lambs, intermittent partial occlusion of the umbilical circulation was produced according to the method of Clapp et al. for 1 of every 3 minutes for 2 hours. A microdialysis probe was implanted in the fetal brain white matter. Normal saline was infused, and the perfusate obtained at 2 μl/min. Hypoxanthine (HX), xanthine (XA), and inosine‐5‐monophosphate (IMP) concentrations in the perfusate and blood samples obtained from fetal jugular veins were assayed by HPLC. Concurrently, the perfusate, which contained superoxide produced in the brain, when mixed with cypridina luciferin analogue extracorporally, caused chemiluminescence that in 4 cases was measured by a highly sensitive electronic fluorescence detector.

Results:

HX, XA, and IMP concentrations in the blood and perfusate were higher than in the control during the intermittent partial occlusion of the umbilical circulation period and returned to control levels during the recovery period.

The residual chemiluminescence of perfusate revealed that the intermittent partial occlusion of the umbilical circulation level was about 100% higher than the control level, and during the recovery period the level returned to the control level.

The chemiluminescence during the intermittent partial occlusion of the umbilical circulation period was inhibited by infusion through the fetal jugular vein of 1 μM polyethylene glycol conjugated superoxide dismutase.

Conclusions: During the intermittent partial occlusion of the umbilical circulation period the fetal brain tissue releases a large amount of OFRs, and a portion of these might be synthesized by the increased conversion of HX to XA. This phenomenon might play an important role in the etiology of fetal brain injury.
Immunohistochemical Evidence of the Mesothelial Histogenesis of a Uterine Adenomatoid Tumor
Authors: Satoh Yuzuru , Hiraguchi Masaki , Matuura Tadao , Takasu Koushou
Published: May 2010

We present rare case of a uterine adenomatoid tumor. In order to characterize the diversity of immunoreactive antigens associated with mesothelial differentiation, we immunohistochemically examined the tumor's epithelioid and myofibromatoid components, as well as the biphasic pattern of its adenomatoid changes. Immunostaining of tumor cells was positive for high‐and low‐molecular‐weight cytokeratins and vimentin. Specific immunoreactions with antibodies against desmin, α‐actin, and the S‐100 protein also were observed. The present adenomatoid tumor can be explained in terms of various transformations and typical alterations in mesothelioma cells: (1) the mesothelial cells had differentiated to epithelial and stromal components, concomitant with the presence of predominant reactive foci; (2) intermediate cells expressed different types of cytoskeletal intermediate filament proteins (IMPs); and (3) the patterns of fibromatoid and leiomyoid differentiation resembled those of a benign mesothelioma of the ovarian or oviductal peritoneum. Our immunohistochemical investigations indicated that the present tumor exhibited the histogenesis of a true mesothelioma, an adenomatoid mesotheliorna.
Book Review
Authors: Tank D.K.
Published: May 2010

Books Reviewed in this article

Menopause (Obstetrics and Gynecology Perspective Series) Edited by Usha R. Krishna and Duru Shah
Intrahepatic Vein Fetal Blood Sampling: Current Role in Prenatal Diagnosis
Authors: Chinnaiya Anandakumar , Venkat Annapoorna , Dawn Chia , Chee Wong Yee , Choo Koh Bee , Gole Leena Abhijit , Meng Chua Tsei
Published: May 2010

Objective: To identify the site of fetal blood sampling (FBS) with lesser complications; and also analyses the reasons for targetting the intrahepatic vein (IHV) for FBS.

Methods: Fetal blood sampling (FBS) performed on 382 women over a period of 7 years at the National University Hospital, Singapore was analysed. FBS was performed from 13 weeks of gestational age onwards. In 76.4% (292 of 382) the intrahepatic part of the umbilical vein (IHV) was targetted; in 18.3% (70 of 382) percutaneous umbilical cord sampling (PUBS) was performed; in 5.2% (20 of 382) cardiocentesis was performed to obtain fetal blood.

Results: Multivariate analysis showed an increase in odds of fetal loss for umbilical cord and cardiocentesis groups compared with the IHV FBS group. It was statistically significant (p < 0.01) only in the cardiocentesis group for fetal loss at < 2 weeks of performing the procedure.
Ligation of Internal Iliac Arteries in Pelvic Haemorrhage
Authors: Das Birendra N. , Biswas Asok K.
Published: May 2010

Objective: To study the value of bilateral ligation of internal iliac arteries in the management of intractable postpartum haemorrhage and to curtail blood transfusion during operations for gynaecological cancers.

Methods: Internal iliac arteries were ligated in 15 cases of PPH, 4 cases of secondary haemorrhage after hysterectomy and in 27 cases of gynaecological cancers during surgery, over a period of 5 years in a general hospital at Calcutta.

Results: The method controlled PPH in all cases except one who required hysterectomy. Secondary haemorrhage was arrested in all. No blood transfusion was necessary during operations for gynaecological cancers except one.

Conclusion: The method was effective in 75% of atonic PPH and in majority of PPH due to other causes including caesarean section. It almost entirely avoid blood transfusion during operation for gynaecological cancers. The procedure was simple and did not involve any hazard.
An Ovarian Leiomyoma: A Case Report
Authors: Sato Yasumi , Tanaka Tosinobu
Published: May 2010

We present a rare case of a 61‐year‐old Japanese woman with an ovarian leiomyoma. That was detected during a mass screening. To our knowledge, this is the first report of an ovarian leiomyoma found during a mass screening. We performed a total abdominal hysterectomy and a bilateral salpingo‐oophorectomy. The tumor originated in the right ovary, and it did not connect with the uterus. The smooth muscle origin of the tumor was detected by immunohistochemical staining with antibodies to vimentin, desmin, and smooth‐muscle actin (SMA).
Evaluation of Insulin‐Like Growth Factor Binding Protein‐1 as a Diagnostic Tool for Rupture of the Membranes
Authors: Kubota Takeyoshi , Takeuchi Hisaya
Published: May 2010

Objective:To evaluate the diagnostic value of insulin‐like growth factor binding protein‐1 (IGFBP‐1) as an indicator of ruptured fetal membranes.

Methods:IGFBP‐ 1 concentrations were measured on 42 paired cervicovaginal samples before and after membrane rupture, using an immunoenzymatic assay. A PROM test [dipstick detecting IGFBP‐1 with a cutoff value of 25 μg/l (A)], a BTB test (B), a ROM‐Check (C), and a fern test (D) were compared in diagnosing ruptures of the membranes in 48 patients.

Results:The optimal cutoff concentration was between 20.1 μg/l and 148.4 μg/l by receiver operating characteristic curve analysis. The PROM test had the highest sensitivity (94.7%) and highest specificity (93.3%) (sensitivity of A‐D, B‐D, C‐D and specificity of A‐B: p < 0.05 by χ2‐test). Unlike the other tests, the PROM test is unaffected by contamination, cervical dilatation, or uterine contraction.

Conclusions:The measurement of IGFBP‐1 in vaginal fluids is useful for the diagnosis of ruptured fetal membranes.
Borderline Tumors of the Ovary: A Clinico‐Pathologic and Immunohistochemical Study of 54 Cases
Authors: Kuhn Walther , Marx Dagmar , Meidel Andre , Fattahi‐Meibodi Arjang , Korabiowska Monika , Ruschenburg Ilka , Droese Manfred , Schauer Alfred , Meden Harald
Published: May 2010

Objective:To study EGF‐R, HER‐2/neu (p185), p53, Mib‐1 (Ki‐67), Bax, Bcl‐2, ras expression and ploidy in borderline tumors of the ovary by assessing their frequency, and relationship to histologic type, tumor recurrence and survival.

Methods:Fifty‐four patients with borderline tumors were followed 3–140 months (median: 38 months). Paraffin‐embedded sections were stained using monoclonal antibodies against EGF‐R, HER‐2/neu (p185), p53, Mib‐1 (Ki‐67), Bax, Bcl‐2, and ras. The immunohistochemical findings were correlated to histologic subtype, tumor recurrence, and survival.

Results:Positivity for EGF‐R was found in 24% (13/54), in 22% (12/54) p185 was positive, 9% (5/54) of tumors were p53‐positive, Mib‐1 (Ki‐67)‐positivity was demonstrable in 46% (25/54). Expression of Bax, Bcl‐2, and ras was found in 37% (20/54), 28% (15/54) and in 7% (4/54) of the cases, respectively.

Conclusion:The data demonstrate expression of EGF‐R, p185/HER‐2/neu, p53, Mib‐1 (Ki‐67), Bax, Bcl‐2, and ras in a subgroup of patients with ovarian borderline tumors. Further studies to evaluate their prognostic value are warranted.
Operative Results after Primary and Secondary Debulking‐Operations in Advanced Ovarian Cancer (AOC)
Authors: Lichtenegger Werner , Sehouli Jalid , Buchmann Erhardt , Karajanev Constanza , Weidemann Henning
Published: May 2010

Objective:To assess the role of primary and secondary radical surgery in advanced ovarian cancer (AOC).

Design: Retrospective study.

Methods:One handred and fifty‐one patients with AOC (FIGO III/IV) underwent altogether 191 extended multivisceral operations between 1/1992 and 2/1998. The statistic analysis compared the primary with the secondary operations.

Results:One hundred and seventeen patients had a primary, 63 patients had a secondary and 18 patients a tertiary operation because of relapse of ovarian cancer. Surgical procedures entailed respectively: small‐bowel‐resection (21%/48%), colon resection (39%/58%), colostomy (9%/ll%), ileostomy (2%/4%), ileum‐pouch (0%/6), splenectomy (3%/3%), pelvic floor‐covering (4%/6%), peritoneal removal (24%/21%), infrared contact coagulation (4%/6%). Seventy‐five percent of the patients had no complications: relaparotomy (3%/3%), fistula (3%/6%), short‐bowel‐syndrome (5%/ 11%), postoperatively mortality (2%/6%). Postoperative tumor‐free were 26%/22%, 57% and 65% had residual disease ≤ 2 cm, 16%/13% > 2 cm.

Conclusions:Radical multivisceral surgery is feasible, safe and efficient in primary as well in secondary situation of advanced ovarian cancer.
Elective Induction of Labor at 39 Weeks of Gestation: A Prospective Randomized Trial
Authors: Amano Kan , Saito Katsu , Shoda Takashi , Tani Akihiro , Yoshihara Hajime , Nishijima Masahiro
Published: May 2010

Objective: To clarify the safety of elective induction of labor at 39 weeks of gestation.

Study design: Prospective randomized study.

Subjects and methods: Uncomplicated nulliparas (N = 194) were randomly assigned at 36 weeks of gestation. Labor was electively induced in 63 women at 39 weeks of gestation in the active management group (I group, N = 98). Spontaneous labor onset was expected with semi‐weekly nonstress test (NST) and amniotic fluid index (AFI) by 42 weeks of gestation in the expectant group (E group, N = 96). Perinatal events were compared between the 2 groups.

Results: A significantly higher incidence of meconium‐stained amnios (19.4% vs 3.2%) and fetal resuscitation (16.7% vs 4.8%) was found in the E group than in the 1 group. Also, although a significantly higher incidence of epidural analgesia was noted in the 1 group (89%) than in the E group (54%) (labor onset ≥ 39 weeks, N = 72), the duration of the 1st stage was shorter in 1 group and the duration of the 2nd stage was not significantly different. No other significant difference was noted between the 2 groups in terms of the rate of C‐section, blood loss, incidence of pathological FHR, birth weight, Apgar score, umbilical arterial pH, or admission to NICU.

Conclusion: Active management of labor at 39 weeks could be made as safely as expectant management with modified biophysical profile monitoring.
Obstetrical Management Following Incontinence Surgery
Authors: Casper Fritz W. , Linn Jürgen F. , Black Peter
Published: May 2010

Objective: To analyze in a retrospective fashion our experiences with obstetrical management following previous incontinence surgery.

Methods: Between 1990 and 1997 4 women presented to our institution in the third trimester of pregnancy with a history of colposuspension performed 3 months to 4 years before onset of pregnancy for second degree stress incontinence. Three of 4 patients experienced recurrent incontinence during the third trimester.

Results: A cesarean section was performed before the onset of labor in all 4 patients. Postpartal pelvic floor exercises were prescribed and a follow‐up ensued after 6 and 11 months in the form of a questionnaire. While incontinence persisted in 2 patients for 6 months, all 4 patients demonstrated complete continence after one year.

Conclusions: We consider an elective cesarean section to be the optimal mode of delivery in women with a history of incontinence surgery.
A Prospective Randomized Study Comparing Hysteroscopy and Curettage (H & C) under Local Anaesthesia (LA) and General Anaesthesia (GA) in Chinese Population
Authors: Kun Ka‐Yan , Lo Leslie , Ho Mei‐Wa , Tai Chark‐Man
Published: May 2010

Objective: To compare the difference in patient's acceptance of local anaesthesia (LA) and general anaesthesia (GA) hysteroscopy and curettage in Chinese population.

Design: A prospective randomized study.

Subjects and methods: In the period September 1994 to August 1995, all Chinese women with abnormal uterine bleeding or suspected uterine anomaly who warranted hysteroscopy and uterine curettage were invited to participate in this study with informed consent. They were randomly allocated to the control (ie. GA) and study (ie. LA) group.

Results: Overall 90% of the controls and 91% of the study group were satisfied with the procedure. The hysteroscopic diagnostic accuracy was 83%. Significantly higher percentage of patients in the study group opted for the same form of admission arrangement if given the choice.

Conclusion: Hysteroscopy and curettage under LA and GA are equally acceptable in the Chinese population in Hong Kong. The patient satisfaction rate is high in both groups. Hysteroscopic diagnosis is highly accurate in malignant condition (100% sensitivity and 83% specificity).
Maternal Mortality in the Developing World: Many Unanswered Questions
Authors: Rizvi Javaid H. , Khan Khalid S. , Nwosu Chika R. , Isiavwe Odenefe J.
Published: May 2010

Maternal mortality remains a scourge of motherhood even as we approach the end of the 20th century. The magnitude of maternal mortality in developing countries and its disparity with similar statistics from the developed world1) has touched a responsive cord in some policy makers and health services officials. With this background in mind, this commentary presents some of the problems encountered in attempting to reduce maternal mortality, and by asking some pertinent questions — offer some solutions.
Rates of Endometriosis Recurrence and Pregnancy 1 Year after Treatment with Intranasal Buserelin Acetate (Suprecur®) (A Prospective Study)
Authors: Mori Hiroyuki , Taketani Yuji , Uemura Tsuguo , Miyake Akira , Tango Toshiro
Published: May 2010

Objectives: This multicenter prospective study of buserelin acetate (Suprecurr̀) therapy for endometriosis was performed in order to examine pregnancy rates and the recurrence of endometriosis 1 year after the end of intranasal administration.

Methods: This study was conducted at 349 institutions, including university hospitals and major hospitals in Japan, and 1,284 patients were recruited as participants.

Recurrence of symptoms was followed for 1 year after the end of administration of buserelin acetate in patients whose condition as a whole was evaluated as “improved” or better at the end of administration. Furthermore, the pregnancy rate was similarly followed in patients who complained of sterility at the commencement of the administration.

Recurrence was defined as either a case in which all of the main symptoms observed before administration returned to the pretreatment state, or a case in which at least one symptom deteriorated compared to the pretreatment state.

Kaplan‐Meier's method was used for statistical analysis.

Results: Among 459 patients who could be evaluated for recurrence of symptoms, the cumulative recurrence rate was 17.8% 1 year after the end of administration. Among 156 patients who could be evaluated for pregnancy, the pregnancy rate was 23.3% 1 year after the end of administration.

Conclusion: Intranasal buserelin acetate therapy exhibited not only transient clinical effects during administration or immediately after the end of administration, but also exhibited specific continuing effects after the end of administration.
Survey of Physical Abuse during Pregnancy GMCH, Nagpur, India
Authors: Purwar Manorama B. , Jeyaseelan L. , Varhadpande Urmila , Motghare Vijay , Pimplakute Sonali
Published: May 2010

Introduction: Domestic violence is a major health concern for women globally. Violence may commence or escalate during pregnancy and may be more frequent than obstetric complications e.g. preeclampsia or gestational diabetes for which they are routinely screened. No literature is available on abuse during pregnancy from India.

Objective: To assess the frequency and severity of physical abuse during pregnancy and its association with entry to antenatal care and to identify lifetime risk factors.

Study Design: Cross sectional study.

Study Setting: Secondary and tertiary care public hospital.

Participants: Six hundred randomly selected pregnant women in third trimester of pregnancy (28–40 weeks of gestation) attending routine antenatal clinic were assessed for physical abuse using Abuse Assessment Screen (AAS) developed by McFarlane.

Main Outcome Measures: Abuse status, gestational age at first antenatal visit and life‐time risk factors.

Analysis: Descriptive, Univariate and MLR.

Results: Of the 600 pregnant women interviewed, 152 (25.33%) women reported abuse during non pregnant state, 132 (22%) women reported physical abuse during index pregnancy and 10 (8.33%) women reported increase in abuse during pregnancy. In majority the abuse site was head and neck and 20% reported being hit in the abdomen. Abuse was recurrent in 92% of women. Six (4.54%) women were hospitalized, 5 (3.78%) needed medical assistance and 19.7% women were afraid of partner (husband). Abused women were twice as likely to begin antenatal care after 32 weeks of gestation as compared to non abused women (OR = 2.5; 95% CI 1.1–5.6, p = 0.02). Abused women were more likely to be Buddhist (p = 0.005), of greater parity with unwanted pregnancy, dwelling in slums (p = 0.005), from extended family (p = 0.005), with low level of education to husband (p = 0.009) and with stress to husband (p = 0.03).

Conclusions: There is significant physical abuse during pregnancy in central India. Routine screen by AAS and a cohort study looking at adverse outcome of pregnancy is recommended.
Optimal Dose of Nalbuphine for Treatment of Intrathecal‐Morphine Induced Pruritus after Caesarean Section
Authors: Somrat Charuluxananan , Oranuch Kyokong , Ketchada Uerpairokit , Siriprapa Singhapreecha , Thipawan Ruangrit
Published: May 2010

Objectives: To search for the optimal dosage of nalbuphine relief of intrathecal‐morphine induced pruritus after caesarean section.

Methods: Ninety parturients who developed moderate to severe pruritus caused by intrathecal morphine after caesarean section were randomly allocated into 3 groups receiving 2, 3 and 4 mg of intravenous nalbuphine respectively. The improvement of pruritus and adverse effects of nalbuphine such as increasing pain scores, nausea, vomiting, sedation and respiratory depression were evaluated at 15 minutes after nalbuphine administration.

Results: Percentage of successful treatment of pruritus with 2, 3 and 4 mg, nalbuphine were 86.7,96.7 and 100, respectively (p = 0.12). There was no statistically significant difference in adverse effects. No evidence of respiratory depression was detected. However, there was significant increase in pain scores in group of 4 mg nalbuphine (p = 0.004).

Conclusions: Nalbuphine of 2 to 3 mg was considered to be adequate in treatment of intrathecal morphine induced pruritus after caesarean section without increasing pain scores or causing other side effects.
Sexual Transmission and Reinfection of Group B Streptococci between Spouses
Authors: Yamamoto Tsutomu , Nagasawa Isamu , Nojima Michio , Yoshida Koyo , Kuwabara Yoshinori
Published: May 2010

Objectives: To study how GBS infection takes place between pregnant GBS‐carriers and their husbands.

Methods: Pregnant women in whom GBS infections could be detected during 26 to 30 weeks of pregnancy and their husbands were studied during the two periods of August 1994 through May 1995 (Period A, 243 couples) and June through September 1997 (Period B, 141 couples). A urine sample was collected from a husband in the same morning when the vagina of his wife was tested for GBS. GBS were also classified according to their serotypes in 34 couples during Period A and B.

Results: In the two periods, GBS was detected in 18.1 and 19.3% of the wive's vaginal cultures, and in 19.1 and 17.0% of husbands' urinary cultures, respectively. There were no significant differrences of the rate of GBS detection between the spouses, and also between the two trials. A high possibility of GBS infection was found in a couple when either of the spouses was possible to GBS. The serotypes of 31 of the 34 couples (91.2%) were identical.

Conclusion: It is suggested that GBS can be sexually transmitted, and cause reinfection between spouses in spite of antepartum medication.
Morphological Aspects of Ectopia Cordis: Four Case Reports and a Review of the Literature
Authors: Yamada Takahiro , Hoshi Nobuhiko , Okuyama Kazuhiko , Negishi Hiroaki , Sudo Satoko , Kishida Tatsuro , Yamada Hideto , Sagawa Tadashi , Fujii Hiroaki , Ishizu Akihiro , Ishikura Hiroshi , Fujimoto Seiichiro
Published: May 2010

Ectopia cordis is a rare congenital anomaly. We present 4 cases of ectopia cordis, 1 of which is the first report of an affected fetus in a triplet pregnancy. The morphological relationship between the types of ectopia cordis and their outcomes were investigated in all 4 cases. In addition, the literature on ectopia cordis in Japan was reviewed and discussed.
The Effect of Medroxyprogesterone Acetate and Heparin in the Prevention of Postsurgical Adhesion Formation in the Rat Uterine Model
Authors: Saǧol Sermet , Özşener Serdar , Dinçer Ömer , Yilmaz Hüseyin , Karadadas Nedim
Published: May 2010

Objective: To evaluate the effects of depot medroxyprogesterone acetate and heparin in preventing postsurgical adhesion formation in the rat model.

Methods: A hundred and five female Wistar rats were divided into 7 groups. Groups 1 and 2 were injected with intramuscular 15 mg medroxyprogesterone acetate 3 weeks before surgery and at the end of laparotomy. Groups 3 and 4 were given 15 mg medroxyprogesterone acetate by intramuscular injection, 3 weeks before surgery. An equal volume of intramuscular sterile saline was injected to control groups, 3 weeks before and at the end of surgery. Before abdominal closure, 2 ml of Ringer's lactate was instilled into the peritoneal cavity of all rats, except group 7. Groups 1, 4, and 5 were given 2 ml of intraperitoneal Ringer's lactate containing 500 U heparin/ml. A standardized surgical injury was performed in all rats. Two weeks after surgery, the adhesions were scored on a scale of 0 to 3 according to their thickness‐tenacity and vascularity. Kruskall‐Wallis and Mann‐Whitney U statistical test were used.

Results: The preoperative and postoperative administration of medroxyprogesterone acetate resulted in the least number of and the least severe adhesions, when compared with single dose medroxyprogesterone acetate treated rats and controls (p < 0.05). However, the combination of medroxyprogesterone acetate and intraperitoneal heparin did not enhance the adhesion reducing capacity of medroxyprogesterone acetate.

Conclusions: Concurrent preoperative and postoperative administration of medroxy‐progesterone acetate results in the most significant reduction of postsurgical adhesions. The combination treatment of medroxyprogesterone acetate and heparin does not show any additional effect in the reduction of adhesion formation, when compared with medroxyprogesterone acetate treatment alone.
A Case of Primary Transitional Cell Carcinoma of the Fallopian Tube
Authors: Kim Jae Wook , Cho Eun Me , Kim Young Tae , Han Jae Ho
Published: May 2010

The primary carcinoma of the fallopian tube is the rarest of all gynecologic malignancies and histologically most of them are adenocarcinomas. Primary transitional cell carcinomas are extremely rare in the fallopian tube. A 63‐year‐old postmenopausal woman presenting with lower abdominal pain was found to have a left adnexal mass. Exploratory laparotomy revealed a mass arising from the fallopian tube with the histologic features of transitional cell carcinoma. Light and electron microscopic studies supported the notion of transitional cell carcinoma. The tumor was extended to the muscle layer and confined to the left fallopian tube without metastasis. The patient received 3 courses of systemic cisplatin‐based chemotherapy and has been well with no evidence of recurrence until August, 1998.
Effect of Methamphetamine on Male Mice Fertility
Authors: Yamamoto Yoshiko , Yamamoto Keiichi , Hayase Tamaki
Published: May 2010

The effect of methamphetamine (MAMP) on the ability of males to mate with females and to impregnate them was examined in 8‐week‐old ICR mice. Male mice that had been administered an intraperitoneal injection of MAMP (15 mg/kg, 7.5 mg/kg, or 3.75 mg/kg) or saline were housed with females 24 or 48 hours later. The vaginal plugs were checked, and the number of births was counted. The effect of MAMP on sperm motility and the serum testosterone (TS) concentration was also examined.

Methamphetamine was observed to have harmful effects only at the highest dose level. In the mice housed 24 hours after the injection of 15 mg/kg MAMP, the increase in the cumulative number of vaginal plugs lagged, and the total number of vaginal plugs decreased significantly. A significant decrease was also observed in the total number of births.

Methamphetamine, at a dose of 15 mg/kg, decreased sperm motility. The TS concentration decreased initially, then increased.
Recent Trends in Histological Pattern of Cervical Carcinoma among Three Ethnic Groups in Malaysia*
Authors: Cheah Phaik‐Leng , Looi Lai‐Meng , Sivanesaratnam Vallipuram
Published: May 2010

Objective: To study the trend of different histological types of cervical carcinoma among the 3 major ethnic groups in Malaysia.

Methods: All invasive cervical carcinoma histologically diagnosed for the first time in 1991–1992 and 1996–1997 at the University Hospital, Kuala Lumpur (UHKL) were reviewed for the following parameters; age, ethnic group, histological category.

Results: One hundred and twenty‐one and 145 cases were diagnosed in 1991–1992 and 1996–1997, respectively. During both periods, squamous was followed by adeno and adenosquamous carcinoma in frequency. Patients' mean ages ranged within the 4th decade for all 3 major histological types. Ethnically, an overall predilection for the Chinese was observed. While squamous carcinomas had declined among the Chinese and Malays, adenocarcinomas were noted to increase. The converse was observed among the Indians.

Conclusions: Ethnically, cervical carcinoma showed a predilection for Malaysians of Chinese descent. A decreasing incidence of squamous with a worrying increasing trend of adenocarcinoma was observed, like in other populations studied.
Brain Natriuretic Peptide (BNP) and Cyclic Guanosine Monophosphate (cGMP) Levels in Normal Pregnancy and Preeclampsia
Authors: Okuno Suzuka , Hamada Hiromi , Yasuoka Mana , Watanabe Hideki , Fujiki Yutaka , Yamada Naoki , Sohda Satoshi , Kubo Takeshi
Published: May 2010

Objective: Our purpose was to evaluate plasma levels of brain natriuretic peptide (pBNP) and cyclic guanosine monophosphate (pcGMP) in preeclamptic patients and controls.

Study Design: Blood samples were obtained from 35 patients with preeclampsia and from the same women during the subsequent puerperal period. The control group consisted of normotensive pregnant women, matched with the patients for age, gestational age, and parity. The concentrations of pBNP and pcGMP were determined by the RIA method. Statistical analysis was performed using the Mann‐Whitney's U test.

Results: The pBNP level in the preeclampsia group was significantly increased, to 7‐fold that of the control group. The pcGMP level was 50% higher in the preeclampsia group than in the control group, but this was not significant. Both the pBNP level and the pcGMP level in the puerperal period did not significantly differ between the patients and the controls.

Conclusion: The pBNP concentrations increased in the preeclamptic women, and then these compensations were normalized in the puerperal period.
Causes of Stillbirth: An Analysis of 77 Cases
Authors: Yamauchi Ariko , Minakami Hisanori , Ohkuchi Akihide , Usui Rie , Idei Sadayoshi , Sato Ikuo
Published: May 2010

Objective: To devise preventive measures for stillbirths, which account for more than 70% of perinatal deaths in Japan.

Methods: We retrospectively reviewed the medical records of 77 women with singleton pregnancies who gave birth to stillborn infants at ≥ 30 weeks between 1979 and 1996 at our hospital.

Results: Major malformations were present in 21 (27%) of 77 infants, including 11 infants with anencephaly. Two infants (2.6%) were severely hydropic. Preeclampsia preceded the stillbirth and might have been an indirect cause of stillbirth in 21 (39%) of 54 women whose infants had normal formations. The cause of stillbirth in 33 non‐preeclamptic women was unclear in 15 (28%), abruptio placentae in 9, fetal growth retardation in 3, the HELLP syndrome in 3, chorioamnionitis in 2, and cord accident in 1. Abruptio placentae also occurred in 9 of 21 preeclamptic patients. Thus, abruptio placentae was responsible for 18 (33%) of 54 stillborn infants with a grossly normal appearance. An autopsy was performed on only 13 (24%) of 54 infants with grossly normal appearance and did not provide new information relating to deaths.

Conclusions: The causes of stillbirth were many and varied, with a large proportion having no obvious cause, although autopsies were underused. Increased monitoring for women with preeclampsia and early diagnosis and prompt delivery for women with abruptio placentae might be helpful in reducing the number of stillbirths.
Intrapartum Common Peroneal Nerve Compression Resulted in Foot Drop: A Case Report
Authors: Qublan Hussein S. T. , Al‐Sayegh Hisham
Published: May 2010

This case report is to illustrate a case of a 24‐year‐old Jordanian woman, gravida 1, para 0 who developed intrapartum foot drop due to compression injury of the common peroneal nerve behind the head of fibula. Diagnosis was based on history, clinical examination and electrophysiological studies. Treatment included daily sessions of physiotherapy. Complete recovery of the condition took place within 2 months.
Asymptomatic Uterine Incarceration at Term Gestation: A Case Report
Authors: Li Yiu‐Tai , Tsui Man‐Shing , Yin Chang‐Sheng , Lin Hsien‐Ming , Chan Chying‐Chyuan
Published: May 2010

Uterine incarceration is a rare event complicating pregnancy. Herein, we present a unique case of an asymptomatic term pregnancy with uterine incarceration; this patient had had an anterior myomectomy 3 years earlier. She had an asymptomatic antenatal course and incidental identification of uterine incarceration during cesarean section. We also address the importance of early recognition and appropriate management regarding this circumstance.
Spinal Cord Compression: A Rareness in Pregnant Thalassemic Woman
Authors: Phupong Vorapong , Uerpairojkij Boonchai , Limpongsanurak Sompop
Published: May 2010

Thalassemia is a common hematological disease in Southeast Asia. Extramedullary hematopoiesis is common sequelae in thalassemic patients but extramedullary hematopoiesis in the spinal epidural space that leads to paraparesis in pregnancy is very rare. We managed a thalassemic patient with extramedullary hematopoiesis and spinal cord compression during pregnancy. The diagnosis was made on clinical features and magnetic resonance imaging (MRI) showing a paravertebral mass infiltrating the epidural space. She was treated successfully with repeated blood transfusions until delivery. Fetal growth restriction was found but otherwise the fetus was clinically normal. She had an uneventful recovery when she was seen 6 weeks after delivery.
Vaginal Misoprostol in Termination of Second Trimester Pregnancy
Authors: Herabutya Yongyoth , Chanrachakul Boonsri , Punyavachira Piyaporn
Published: May 2010

Objective: To study the effectiveness and complications of 600 μg of intravaginal misoprostol for terminating second trimester pregnancies.

Study Design: One hundred and seventy‐two patients undergoing termination of pregnancy between March 1997 and April 1999 were studied. Each patient received 600 μg of intravaginal misoprostol every 12 hours until abortion occurred.

Results: The mean induction to abortion time was 24.1 ± 21.6 hours. The percentage of women aborting within 24 and 48 hours was 68.6 and 89.5 respectively. There was no significant difference in the mean induction to abortion time and the percentage of women aborted within 48 hours between nulliparous and multiparous women. The mean amount of misoprostol used was 1405.5 ± 1084.6 μg. Incomplete abortion occurred in 23.3% of women. The most common complication was temperature of more than 38° occurred in 41% followed by diarrhoea (20%), nausea and vomiting (15%).

Conclusion: Six hundred μg of vaginal misoprostol is effective, but whether the 48 hours abortion rate can be improved with a large dose or shortened the time interval between doses, requires further study.
Peritoneal and Peripheral B‐1‐Cell Populations in Patients with Endometriosis
Authors: Chishima Fumihisa , Hayakawa Satoshi , Hirata Yoshiyasu , Nagai Nobuhisa , Kanaeda Takashi , Tsubata Katsuo , Satoh Kazuo
Published: May 2010

Objective: The purpose of this study was to investigate the frequency of B‐1 cells in the peritoneal cavity and peripheral blood of patients with endometriosis.

Materials and Methods: We examined 31 patients with endometriosis and 14 normal nonpregnant women. Peripheral blood cells and peritoneal exudate cells (PECs) were stained with FITC or PE‐labeled anti‐CD5/CD19 monoclonal antibodies. Immunofluorescence analysis was performed using a flow cytometer. The significance of differences between the patient and control groups was determined by the non‐parametric Mann‐Whitney test.

Results: There was no significant difference in the percentages of B‐1 cells in the peripheral blood of women with and without endometriosis (median, 22.7%; range, 4.7–92.3% vs median, 20.05%; range, 11.1–12.6%, respectively). Endometriosis patients with antinuclear antibodies (ANAs) demonstrated significantly elevated B‐1 cells compared to both endometriosis patients without ANAs and normal controls (p < 0.005 and p < 0.05, respectively). Endometriosis patients demonstrated significantly higher B‐1 cell populations (B‐1 cells/total B‐cell ratio) in PECs than did non‐endometriosis patients (p < 0.05).

Conclusions: The peripheral B‐1‐cell population in patients with endometriosis is related to ANA production. B‐1 cells might play important roles in the development of endometriosis through autoantibody production.
A Case Report: Verrucous Carcinoma of the Endometrium — The Difficulty of Diagnosis, and a Review of the Literature
Authors: Shidara Yoshihiro , Karube Akihiro , Watanabe Masato , Satou Eiju , Uesaka Yoshinori , Matsuura Tooru , Tanaka Toshinobu
Published: May 2010

A verrucous carcinoma is a subtype of well‐differentiated squamous‐cell carcinomas, arising in the vagina, vulva, and uterine cervix. But a verrucous carcinoma very rarely arises in the uterine endometrium. The present paper presents a case of a verrucous carcinoma of the endometrium that is described in association with the tumor marker SCC; this paper also includes a review of the relevant literature.
Prevalence of Human Papillomavirus Infection and Its Correlation with Cervical Lesions in Commercial‐Sex Workers in Japan
Authors: Ishi Kazuhisa , Suzuki Fujihiko , Saito Akira , Kubota Takeyoshi
Published: May 2010

Objective: To investigate the prevalence of the human papillomavirus (HPV) infection and its correlation with cervical lesions in commercial‐sex workers (CSWs) who attended a sexually transmitted disease (STD) clinic in an entertainment area in Tokyo.

Methods: Surveys were conducted on 546 prostitutes and 233 control subjects. In all subjects, HPV detection was performed by the hybrid capture method. A cervical cytological examination was performed on 247 prostitutes and 233 control subjects.

Results: The HPV‐positive rates in the two periods of study were higher (p < 0.01) in CSWs than in the control subjects. When the cytological grades were examined according to HPV‐positive rates, the proportion of cytologic Class IIIa to Class IV was significantly higher (p < 0.01) in the HPV‐positive CSWs than in the HPV‐negative CSWs or in the normal subjects.

Conclusion: The high frequencies of HPV infection and cervical dysplasia in the CSWs in the present series might predict a higher risk of cervical cancer in this group of subjects.
Epidural Analgesia in Primigravidae in Spontaneous Labour at Term: A Prospective Study
Authors: Leong Eugene W. K. , Sivanesaratnam V. , Oh Lilian L. L. , Chan Y. K.
Published: May 2010

Objectives: To prospectively study the intervention rate, duration of labour, malpositions, fetal outcome, maternal satisfaction, voiding complications and adverse events in healthy primigravidae in spontaneous labour at term following epidural analgesia.

Methods: A prospective randomized study involving 55 patients in the epidural group and 68 in the control pethidine — inhalational entonox group.

Results: There were significantly more obstetric interventions (instrumental deliveries) in the epidural group (p < 0.01). The total duration of labour and the duration of the second stage was prolonged in the epidural group (p < 0.01). There were more malpositions at the second stage of labour in the epidural group (p < 0.02). There were no differences in fetal outcome (Apgar scores and Special Care Nursery admissions). Patients in the epidural group were consistently happier with their method of pain relief (p < 0.01). Two patients required blood patches while another 2 patients had persistent backache post epidural analgesia.

Conclusion: Epidural analgesia in primigravidae in spontaneous labour at term led to an increased instrumental delivery rate, prolonged duration of labour, greater rate of malpositions in the second stage, increased oxytocin requirements but with no difference in fetal outcomes but with happier mothers as compared to the control group.
A Prospective Randomized Study Comparing Endocrinological and Clinical Effects of Two Types of GnRH Agonists in Cases of Uterine Leiomyomas or Endometriosis
Authors: Takeuchi Hiroyuki , Kobori Hiroyuki , Kikuchi Iwao , Sato Yuichi , Mitsuhashi Naoki
Published: May 2010

Objective:In order to assess the endocrinological changes associated with 2 types of low‐dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis.

Methods:A prospective randomized study involving 67 patients with uterine leiomyomas or endometriosis was carried out. These patients were randomly administered either buserelin MP 1.8 mg (Group B,n= 34) or leuprolide 1.88 mg (Group L,n= 33). In each group we evaluated the symptoms of genital bleeding and hot flashes during GnRHa treatment, as well as the levels of serum LH, FSH, and estradiol 8 weeks after the start of treatment. In addition, the endometrial thickness was measured by transvaginal ultrasonography, and changes in the volume of the uterine leiomyoma or endometrial cyst at the end of treatment. The GnRHa depot was administered from 3 to 8 times, 28 days apart, in both groups.

Results:The incidence of menstruation‐like genital bleeding 8 weeks after treatment was significantly (p < 0.01) higher in Group B. However this difference disappeared by 12 weeks after treatment. The climacteric symptom of hot flashes was found to be significantly (p < 0.01) more severe in Group L, and this tendency continued until 20 weeks after treatment. The 2 groups did not differ significantly with regard to the levels of the serum LH, FSH, and estradiol at 8 weeks after treatment or in the endometrial thickness at the end of the GnRHa treatment. In both groups, the volumes of the uterine leiomyomas were significantly (p < 0.01) lower after the treatment. In contrast, the volumes of the endometrial cysts did not decrease after administration of GnRHa in both groups.

Conclusion:Leuprolide 1.88 induced pituitary down regulation more rapidly than buserelin MP. However the hypoestrogenic symptoms such as hot flashes were more severe in cases treated with leuprolide 1.88 than in those treated with buserelin MP. Our data confirm that the therapeutic efficacy of buserelin MP and leuprolide 1.88 are similar, with both being sufficient to treat uterine leiomyomas and endometriosis.
Maternal Mortality Associated with Eclampsia and Severe Preeclampsia of Pregnancy
Authors: Sawhney H. , Aggarwal N. , Biswas R. , Vasishta K. , Gopalan S.
Published: May 2010

Objective: To analyse factors associated with maternal mortality in eclampsia and preeclampsia.

Method: Retrospective analysis of 69 maternal deaths due to (eclampsia‐61; severe preeclampsia‐8) was carried out during a period of 17 years (1982–1998). Maternal condition on admission, associated complications and principal cause of death was analysed in each case.

Results: Mean time interval between hospitalization and maternal death was 49.56 + 62.01 hrs (1–240 hrs). Twenty (28.9%) women died undelivered. Twenty‐three (37.7%) women were in grade IV coma and 52.4% of eclampsia patients had recurrent convulsions (> 10) prior to admission. Associated complications in form of hemorrhage, cerebrovascular accidents, acute renal failure, jaundice, aspiration pneumonia and pulmonary oedema were 30.4, 31.8, 34.8, 18.8, 17.8, and 5.8%, respectively. Maternal mortality in eclampsia was significantly low in time period B (4.1%) when magnesium sulphate was used as an anticonvulsant.

Conclusions: Maternal condition on admission and associated complications are the major determinant of maternal outcome. Use of magnesium sulphate is associated with significant reduction of maternal mortality.