Gen-ichi Nakamura

Efficacy of a low-dose leuprolide acetate depot in the treatment of uterine leiomyomata in Japanese women*

OBJECTIVE To compare the efficacy of two different doses, 1.88 mg and 3.75 mg, of a monthly depot injection of a gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of uterine leiomyomata. DESIGN A prospective randomized study. SETTING Hospital department of gynecology and obstetrics. PATIENTS Forty-one premenopausal Japanese women, 25 to 53 years of age, with uterine leiomyomata. INTERVENTIONS Depot type of GnRH-a, leuprolide acetate (LA) 1.88 mg or 3.75 mg was administered subcutaneously every 4 weeks for 24 weeks. MAIN OUTCOME MEASURES Efficacy of treatment was assessed in terms of uterine volume, serum levels of estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and adverse symptoms during treatment. RESULTS In both groups, a significant reduction in uterine volume, 52% in 1.88 mg group and 47% in 3.75 mg group, was obtained at week 24, with near maximal reduction (41%, 45%) apparent by 12 weeks. No significant difference was observed between the groups in percent uterine volume reduction at each treatment week. Both groups showed significant and equal suppression of serum levels of E2, LH, and FSH. In addition, the incidence of adverse symptoms was not significantly different between the two groups. CONCLUSIONS Monthly injection of 1.88 mg or 3.75 mg LA depot has equivalent treatment efficacy in reducing uterine volume. Twelve weeks of treatment is enough to obtain near maximal reduction.

High prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in female commercial sex workers in Japan

Our objectives were to explore the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium in Japanese female commercial sex workers (CSWs), in comparison with pregnant women as controls. A high-risk group of 174 female CSWs and 90 asymptomatic pregnant women were enrolled in this study. Detection of C. trachomatis, N. gonorrhoeae, and M. genitalium on the endocervix of the women was performed mainly by using polymerase chain reaction (PCR)-based assays. The prevalence rates of C. trachomatis, N. gonorrhoeae, and M. genitalium were 19.0%, 32.8%, and 12.6%, respectively, in the CSWs, compared with 5.6%, 0%, and 1.1% respectively, in the pregnant women. These results suggest a high prevalence of C. trachomatis , N. gonorrhoeae, and M. genitalium in Japanese CSWs. We conclude that continued close monitoring of the prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infection in CSWs is important for preventing the dissemination of these microorganisms, and that further investigation of M. genitalium as a sexually transmitted pathogen in women is needed.

Cytotoxic Cells Directed Against Placental Cells Detected In Human Habitual Abortions by an In Vitro Terminal Labeling Assay

PROBLEM: From the clinical point of view, it has been proposed that an immunological imbalance between the mother and the fetus might exist in one of the mechanisms for human habitual abortion. However, in the definition of habitual abortion, we have no distinct immunological criteria for this clinical entity at the moment.

Dating sonographic endometrial images in the normal ovulatory cycle

Pelvic sonograms were obtained from 5 fertile volunteers and 150 infertile patients with normal ovulatory cycles, using real‐time ultrasound. The existence of a linear cavity echo (C), thick hypoechoic layer (H) and increased echogenicity (E) were chosen as the parameters of sonographic endometrial images to be studied for dating the ovulatory cycle. In 109 serial sonograms from the fertile volunteers, H was observed from 3 days before ovulation (day −3) to ovulation day (day 0). E was observed from day +1 to day +8, and C, from day −10 to day +3. Studies on 189 sonograms from the infertile patients revealed a similar pattern for these parameters. We tested the accuracy of sonographic images of the endometrium, using sonograms from five patients who underwent hysterectomy. The measurements of endometrial thickness, in vivo, and in vitro, showed little difference. Sonographic endometrial images are considered indicative of histological changes, under the influence of estradiol and progesterone. Therefore, observation of the combined quantitative changes in C, H and E facilitates dating of the sonographic endometrial images in a normal ovulatory cycle.

Changes in phospholipase A2 activity of the rabbit ampullary epithelium by ovarian steroids.

Phospholipase A2 (EC 3.1.1.4) activity of the ampullary epithelium from rabbit oviducts was compared in the presence of various ovarian steroids to assess how they could modulate prostaglandins (PG) biosynthesis in the oviduct. The phospholipase A2 (PLA2) activity of the cells from ovariectomized rabbits (control) was 190.8 +/- 9.8 pmol/min/mg. The PLA2 activity of the cells from progesterone-treated rabbits was 156.0 +/- 41.8 pmol/min/mg and was not significantly different from the control activity. However, the PLA2 activity of the cells from the estrogen-treated rabbits was 233.5 +/- 29.0 pmol/min/mg, which was significantly higher than the control activity (p < 0.05). On the other hand, the PLA2 activity of the cells from progesterone-treated rabbits after being primed with estrogen was 116.3 +/- 25.9 pmol/min/mg, which was significantly lower than the control activity (p < 0.01). These results suggest that the effects on PLA2 activity of ovarian steroids could regulate the local production of PG which plays a role in both smooth muscle contractility and ciliary activity.

Sonographic study of the endometrial responses to ovarian hormones in patients receiving ovarian stimulation

A total of 486 endometrial sonograms from 60 cases were reviewed to study the endometrial responses. There was a significant change in the proportion of each sonographic criterion between the pre‐ and post‐ovulatory phases. After ovulation endometrial image showed distinct changes, and its thickness increased. These results suggest that classification of endometrial sonograms according to criteria and thickness measurements provides useful information.

Cervical cancers in uterus didelphys

Two cases of cervical cancer in uterus didelphys are presented. One was extensive adenocarcinoma and one was squamous cell carcinoma in situ. In both cases the cancers appeared to have originated separately in each cervix.

Effects of two different doses of leuprolide acetate depot on uterine cavity area in patients with uterine leiomyomata.

OBJECTIVE To compare the effects of two different doses of a monthly depot injection of a GnRH agonist (GnRH-a) on uterine cavity area in patients with uterine leiomyomata. DESIGN Prospective, randomized study. SETTING Hospital department of obstetrics and gynecology. PATIENTS Thirty-six premenopausal women, 25 to 52 years of age, with uterine leiomyomata. INTERVENTION Leuprolide acetate (LA) depot, 1.88 or 3.75 mg, was administered SC every 4 weeks for 24 weeks. MAIN OUTCOME MEASURE Uterine cavity area before and after treatment was assessed by hysterosalpingography. RESULTS The 1.88- and 3.75-mg LA depots significantly reduced uterine cavity area by 40.8% and 40.2%, respectively. No significant difference was observed between the two groups. CONCLUSION Monthly injection of 1.88 or 3.75 mg LA depots appears to reduce uterine cavity area to a similar extent in patients with uterine leiomyomata.

Corpus Luteum Insufficiency as a Cause of Nidatory Failure

Abstract. To assess the clinical significance of corpus lute‐um insufficiency (CLI), 612 women with infertility but otherwise without ovulatory defects, organic disturbances, or other untoward factors were evaluated. The procedures included endometrial biopsy (E. Bx.), and monitoring of serum progesterone (Pr) and estradiol‐17β (E2) levels in association with the patterns (I to IV) of basal body temperature (BBT) chart.

Regional differences of phospholipase A2 activity in the rabbit oviductal epithelium

To evaluate the biosynthesis of prostaglandins in the oviducts, phospholipase A2 (EC 3.1.1.4) activities were first measured in the epithelial cells obtained from rabbit oviducts. At least four kinds of phospholipase A2 (PLA2) activities with respect to calcium dependency and pH requirement were observed. There were two calcium-dependent, pH optima of 7.5 and 8.5 activities, and two calcium-independent, pH optima of 4.0 and 8.0 activities. One of those activities, a calcium-dependent and alkaline active PLA2 activity of the epithelial cells was then compared between the ampullary portion and the isthmic portion of the oviducts. The activity was significantly higher in the ampullary epithelium than in the isthmic epithelium (223.2 +/- 57.2 or 103.8 +/- 32.3 pmol/min/mg, p < 0.05). These results support the idea that the production of prostaglandins, which is dependent upon the activity of the arachidonate cascades, was higher in the ampullary portion of oviduct than that in the isthmic portion. The PLA2 activity of the ampullary epithelium may thus play an important role in the regulation of smooth muscle contractility and ciliary movement.