Atsuo Hidaka

Differences between Occidental and Oriental postmenopausal women in cutoff level of endometrial thickness for endometrial cancer screening by vaginal scan

Abstract The findings of this study suggest that the mean endometrial thickness and the cutoff thickness for detection of endometrial cancer in Occidental and Oriental postmenopausal women may differ.

Comparison between Transabdominal and Transvaginal Ultrasonography for Identifying Endometrial Malignancies

Transvaginal ultrasound (TVS) is generally considered superior to transabdominal ultrasound (TAS) in the estimation of endometrial abnormalities. A disadvantage of TVS is the limited field of view. The purpose of this study is a comparison between TAS and TVS for endometrial cancer screening. Ninety-one postmenopausal women were included. They were evaluated by TAS, TVS, and endometrial tissue sampling. The mean endometrial thickness estimated by TVS was larger than that obtained by TAS (p < 0.0001). Sensitivity and specificity of TAS were 83.3 and 58.8% and of TVS 100 and 54.1%, respectively. We conclude that TVS might be superior to TAS, especially in patients with a retroflexed uterus.

Continuous Local Injection of Carboplatin into the Uterine Cervix for Cervical and Endometrial Cancer: Preliminary Study

Platinum compounds are thought to be concentration- and time-dependent, but intravenous (i.v.) administration does not afford prolonged high platinum concentration in tumor tissue. In order to examine the influence of long-term local continuous (LC) injection of carboplatin, a pharmacokinetic study was performed. Twenty-six patients with uterine cancer were included. I.v. administration (11 patients): carboplatin (210 mg) was given i.v. and samples of target tissue were obtained at operation about 2 or 24 h after administration. LC administration (15 patients): the 21-gauge needle was implanted at the uterine cervix, and carboplatin was injected continuously (30 mg/day) for 3, 7 or 14 days using an external pump. The tissue platinum concentration was measured in the pelvic organs. The mean platinum levels at the cervix and vaginal wall in the LC (7 days) group were higher than those in the i.v. (2 h) group (p < 0.01). With LC injection, sustained platinum levels were maintained in the pelvic organs for a long time, with very few side effects. LC injection may be advantageous on the basis of pharmacokinetics.

Sevoflurane anesthesia for elective cesarean section

Sevoflurane anesthesia was given to sixteen women who had been scheduled for elective cesarean section. The maternal systolic blood pressure significantly decreased during the anesthesia induction. Both the anesthesia induction and emergence were smooth and rapid. These findings were supported partially by the pharmacokinetic analysis of sevoflurane concentration in the maternal artery and expired gas mixture. Spontaneous uterine contractions were good in 12 patients, fair in two and poor in two. The measured blood loss was 752±257 ml including amniotic fluid. No blood transfusion was given to any patient. The median value of the Apgar score at one minute was seven (range three to nine). No neonate was intubated for resuscitation. No abnormal maternal laboratory data were found, including liver and kidney function tests and blood cell counts one week after the operation. No adverse effect of sevoflurane on the neonate was found one week after the delivery and three months after the discharge.

EFFECTS OF MATERNAL POSTURAL CHANGE FROM SUPINE TO LEFT-LATERAL ON TOCOLYSIS, MATERNAL CARDIAC FUNCTION AND PULSATILITY INDEX OF UTERINE ARTERY

In order to prove the usefulness of the left-lateral position (l-lat.) in preventing the cardiovascular complications associated with ritodrine, twenty-nine patients having preterm labor were employed as the subjects of this study. Before and during the administration of ritodrine, the cardiac function was recorded by impedance cardiography. (1) When ritodrine was administered in the supine position, SV and CO first increased but eventually tended to decrease. When the position was changed to the l-lat. after SV and CO had almost returned to the preadministration level, HR decreased and SV and CO increased in 70% (10/14) of the patients. However, in patients showing no change in HR in the supine position, the cardiac function did not change either. (2) The magnitude of the changes in cardiac function accompanying the postural change during ritodrine administration was compared with that observed before administration. The decrease in HR and the increase in SV due to the postural change to the l-lat. were larger during ritodrine administration than before administration. The l-lat. position is recommended as a means for preventing the side effects accompanying ritodrine administration. This study also indicated the possibility that the inferior vena cava may be more strongly compressed in the supine position by the relaxed gravid uterus.