Akikazu Fujii

The impact of endometriosis on the reproductive outcome of infertile patients

OBJECTIVE We examined whether the presence and severity of endometriosis affect the reproductive outcome of infertile patients. STUDY DESIGN The conception rates of 2080 infertile women, 1263 who had endometriosis and 817 who did not have endometriosis, were analyzed retrospectively by means of the chi 2 test. Depending on the stage of the disease patients who had endometriosis-associated infertility underwent expectant management, danazol therapy, or minor or major conservative surgery. The patients who failed to conceive after these conventional treatments were enrolled in the in vitro fertilization-embryo transfer program. RESULTS The conception rates were virtually identical regardless of the presence or absence of endometriosis (30.7% vs 30.0%). The outcome of in vitro fertilization-embryo transfer was not affected either by the presence or the severity of the disease. CONCLUSION Endometriosis had no impact on the reproductive outcome of infertile patients in this series unless the anatomy of the pelvic organs was heavily distorted, which can occur in the advanced stages of the disease.

Cloning and sequencing of the human homeobox gene HOX4A

The HOX4A gene, one of the homeobox-containing genes on human chromosome 2, has been isolated by screening a genomic cosmid library with a HOX4B cDNA probe. The HOX4A gene consists of at least two exons separated by a long intron of 1860 bp. According to conceptual translation, the HOX4A protein is predicted to be composed of 416 amino acid residues. Interestingly, the HOX4A protein has a sequence, Pro-Ala-Ser-Gln-Ser-Pro-Glu-Arg-Ser, eight amino acids downstream from the homeodomain, which is similar to that containing a phosphorylation site in pp60c-src, Pro-Ala-Ser-Gln-Thr-Pro-Asn-Lys-Thr. However, the HOX2G protein, which exhibits a paralogous relationship with the HOX4A protein, does not possess the sequence which is similar to that in pp60c-src. A comparison of the predicted HOX4A protein with the HOX2G protein revealed four regions of amino acid sequence similarities: an N-terminal tetrapeptide, a pentapeptide (pre-box) upstream of the homeodomain, the homeodomain and a C-terminal octapeptide.

Management of Pregnancy Complicated with Idiopathic Thrombocytopenic Purpura: A Review of 16 Cases

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder related to the destruction, mostly in the spleen, of platelets coated with antibody which belongs, usually, to the IgG class. Normalization of platelet value after both acute and chronic ITP may occur spontaneously, but recovery by surgical or pharmaceutical treatment is preferred for several reasons. Primary goals are to decrease the production of antibodies or to modify the production of phago-cytosing macrophages quantitatively or qualitatively. The etiology of primary ITP is unknown, but it follows secondarily to various other diseases, especially viral infections. Since ITP is common in young women in their reproductive years, it does occasionally complicate pregnancy. On one hand, fertility is not affected by the disease [10], but on the other, the percentage of spontaneous abortions is reported to be relatively high, between 7% and 30% [1,5,10]. The course of ITP does not seem to be influenced by pregnancy [2,9,10], while perinatal mortality can be up to 20% [1,2,6–8]. According to several reports [1,2,6–8], obstetrical management of ITP during pregnancy should be attempted in order to increase maternal platelet count throughout the pregnancy thus bringing it to term and preventing complications during labor. Karpatkin et al. [6] demonstrated that steroids are effective in increasing maternal and fetal platelet value. Recently, Imbach et al. [3,4] introduced treatment with high-dose intravenous immunoglobulin.