Akishige Yokota

Developmental changes in mitochondrial activity and energy metabolism in fetal and neonatal rat brain

Experiments were undertaken to investigate mitochondrial activity and energy metabolism in the developing rat brain from the late fetal stage to the neonatal stage. Samples of cerebral cortical tissue were obtained from fetuses at 14, 16, 18, and 20 days of gestation, and from pups at 1 h, 1 day and 7 days after birth. Mitochondrial respiration was measured polarographically using homogenates. Fetal and neonatal brains were frozen in situ and fluorometric enzymatic techniques were used for the analysis of ATP, ADP, AMP, and lactate. In the fetal brain, there was a gradual increase in stimulated (+ADP) and uncoupled respiratory rates using glutamate and malate as substrates, from 14 days to 20 days of gestation, together with a moderate increase in ATP concentration and in the sum total of adenine nucleotides, and a significant decrease in lactate. Since non-stimulated (-ADP) respiratory rates did not change with increasing gestational age, the respiratory control ratio appeared to increase over the same period. An increase in mitochondrial activity was more pronounced immediately after birth, together with a marked increase in ATP concentration and in the sum total of adenine nucleotides. The highest rate of mitochondrial respiration was observed in 1-hour-old pups. These results indicate that, in the rat brain, there is maturation of oxidative metabolism in mitochondria that is initiated in late gestation. Acceleration in mitochondrial respiration occurs immediately after birth in order to maintain high-energy phosphate levels, and this may be crucial for the successful outcome of the newborn.

Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients

Objective: The aim of this study was to assess the frequency of severe perineal lacerations defined as either third- or fourth-degree lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors in Japanese patients. Materials and methods: An electronic audit of the perinatal database at the Tama-Nagayama Hospital of Nippon Medical School and Yamaguchi Hospital from 1997 through 2004 was completed. Singleton vaginal vertex deliveries were analyzed for potential risk factors using univariate and multivariate logistic regression analysis. Results: From the database, 7,946 deliveries were identified, with 135 deliveries resulting in severe lacerations (1.7%). In the multivariate logistic regression analysis, severe lacerations were associated significantly with primiparous (odds ratio, 4.36; 95% CI, 2.17–9.57), oxytocin use (odds ratio, 2.19; 95% CI, 1.27–3.73), midline episiotomy (odds ratio, 4.68; 95% CI, 2.09–11.55), forceps-assisted delivery (odds ratio, 7.11; 95% CI, 1.95–20.59), vacuum-assisted delivery (odds ratio, 5.93; 95% CI, 3.38–10.36), and shorter attendant experience (odds ratio, 2.88; 95% CI, 1.12–9.81). Conclusions: The present study demonstrated that operator factors, such as midline episiotomy, oxytocin use, assisted delivery and attendant experience, are independent risk for severe perineal lacerations after vaginal delivery in Japanese patients. The results suggest that midline episiotomy and assisted vaginal delivery, especially forceps-assisted delivery should be avoided in patients who are being delivered of a first child whenever possible.

Increased Level of Granulocyte Elastase in Cervical Secretion Is an Independent Predictive Factor for Preterm Delivery

Objective: The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor. Methods: One hundred and sixty-one women with preterm labor at 22–28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography. Results: Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3–6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8–4.6) and 1.5 (95% CI 0.6–5.0), respectively. Conclusion: The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.

Changes in uterine and ovarian arterial impedance during the periovulatory period in conception and nonconception cycles.

Objective: To evaluate whether the Doppler velocimetry of uterine and ovarian arteries during the periovulatory period in conception cycles differs from that in nonconception cycles.

Continuous Observation of Nitric Oxide Production in the Fetal Rat Brain during Uteroplacental Ischemia

Objectives: To demonstrate real-time changes in nitric oxide (NO) production within fetal rat brain during uteroplacental ischemia and subsequent reperfusion. Methods: Using a selective microsensor for NO, changes in NO electrocurrent in the brains of 10 fetal rats at gestational day 20 were observed during and after 30 min occlusion of uterine vessels in anesthetized pregnant rats. Results: The NO electrocurrent reached 397 ± 71.0% of the control level 30 min after occlusion and increased throughout the observation (p < 0.05) until placental administration of 1 M of L-NAME. In contrast, no significant changes in NO electrocurrent were found in 7 sham operated rats. Conclusion: An NO-specific microelectric sensor detected excessive NO production by fetal rat brains in response to uteroplacental ischemia.

Deciduoid mesothelioma in the pelvic cavity

A very rare case of deciduoid mesothelioma in the pelvic cavity is presented. A 24‐year‐old woman (gestational stage: 28 weeks and 6 days) was admitted because of a tumor mass in the abdominal cavity. A well‐circumscribed and fibrously encapsulated tumor mass was revealed in the Douglas cavity. Histologically, tumor cells were arranged in a solid sheet with deciduoid appearance and showed partial glandular and papillary structures. The tumor cells contained  PAS positive and diastase‐digested granules in the cytoplasm as well as alcian‐blue positive and hyaluronidase‐digested substances in the stroma. The cellularity of the tumor cells was moderate and mitoses were rare. There was partial tumor necrosis and tumor cells had infiltrated through the fibrous capsule. Immunohistochemically, the tumor cells were reactive for pancytokeratin, cytokeratin5/6, vimentin, HBME‐1, calretinin and thrombomodulin. Ultrastructurally, numerous, long microvilli, tonofilaments and desmosome junctions could be seen. Consequently, this case was diagnosed as deciduoid mesothelioma and 2 years and 4 months after operation, the patients clinical course has been good. This case is considered to be the first reported in Japan.

Secondary Mitochondrial Dysfunction after Transient Intrauterine Ischemia in the Fetal Rat Brain

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

Umbilical Cord Ulceration after Prenatal Diagnosis of Duodenal Atresia with Interstitial Deletion of Chromosome 13q: A Case Report

Umbilical cord ulceration complicated by massive local hemorrhage may be a lethal event in the fetus, and this ulceration has been reported to be associated with upper intestinal atresia. The diagnosis of umbilical cord bleeding is difficult. We present a case of umbilical cord ulceration, hemorrhage, and duodenal atresia which had, in addition, an interstitial deletion of chromosome 13q. A female infant weighing 1,691 g was delivered by cesarean section at 34 weeks of gestation and had resuscitation and laparotomy. Just before the cesarean section, ultrasonography showed a ‘double bubble’ sign and a linear shadow, suggesting fibrin in the amniotic cavity. This finding may help in the diagnosis of bleeding from the cord.

Contents Vol. 14, 1999

313 14th International Congress ‘The Fetus as a Patient’ New York City, N.Y., USA, April 22–24, 1999 285 Erratum 321 Drs. Haackert Prize 1999 Awarded to Prof. Juri Wladimiroff, The Netherlands Brezinka, Ch. (Innsbruck) 323 Prenatal Orogastric Gene Delivery Results in Transduction of the Small Bowel in the Fetal Rabbit Wu, Y.; Liu, J.; Woo, S.; Finegold, M.J.; Brandt, M.L. (Houston, Tex.) 328 Hemangioma of the Umbilical Cord: Stenotic Change of the Umbilical Vessels Kamitomo, M.; Sueyoshi, K.; Matsukita, S.; Matsuda, Y.; Hatae, M. (Kagoshima); Ikenoue, T. (Miyazaki) 332 Course of Maternal Serum Magnesium Levels in Low-Risk Gestations and in Preterm Labor and Delivery Arikan, G.M.; Panzitt, T.; Gücer, F.; Scholz, H.S.; Reinisch, S.; Haas, J.; Weiss, P.A.M. (Graz) 337 Failure of Amniotic Septostomy in the Management of 3 Subsequent Cases of Severe Previable Twin-Twin Transfusion Syndrome Pistorius, L.R. (Johannesburg/Pretoria); Howarth, G.R. (Pretoria) 341 Serum Enzyme Activities in Premature Infants with Bronchopulmonary Dysplasia Zanardo, V. (Padua); Rizzo, L. (Livorno); Trevisanuto, D.; Simbi, K.A.; Golin, R.; Magarotto, M.; Marzari, F. (Padua) 345 Significance of Echogenic Foci in the Left Ventricle of the Fetal Heart in a Low-Risk Population Jaffe, R. (New York, N.Y.); Cherot, E.; Allen, T.; Glantz, J.Ch. (Rochester, N.Y.) 348 Are Bilateral Fetal Lung Masses Double Trouble? Lipshutz, G.S.; Lopoo, J.B.; Jennings, R.W.; Farrell, J.; Harrison, M.R.; Albanese, C.T. (San Francisco, Calif.) 351 Amniotic Band Syndrome in Triplet Pregnancy Suzuki, S.; Yoneyama, Y.; Sawa, R.; Sinagawa, T.; Hayashi, T.; Araki, T. (Tokyo) 354 Continuous Observation of Nitric Oxide Production in the Fetal Rat Brain during Uteroplacental Ischemia Asakura, H.; Nakai, A.; Yokota, A.; Sekiguchi, A.; Koshino, T.; Araki, T. (Tokyo) 360 Multifetal Pregnancy Reduction and Selective Termination: The Canadian Experience von Dadelszen, P.; Johnson, J.-A.M. (Toronto); Farquharson, D.F.; Wilson, R.D. (Vancouver); Seaward, P.G.R. (Toronto) 365 Cerebellar Hypoplasia: Could It Be a Sonographic Finding of Abnormal Fetal Karyotype in Early Pregnancy? Rosati, P.; Guariglia, L. (Rome) 368 Initiating Extradural Analgesia during Labour: Comparison of Three Different Bupivacaine Concentrations Used as the Loading Dose Harms, C.; Siegemund, M.; Marsch, S.C.U.; Surbek, D.V.; Hösli, I.; Schneider, M.C. (Basel) 375 Abstracts 7th Journées Parisiennes Obstétrico-Pédiatriques, February 5, 1999 378 Erratum 379 Author Index Vol. 14, 1999 381 Subject Index Vol. 14, 1999 No. 5 No. 6