Hiroaki Negishi

Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy

Background.  The aim of this study was to identify the independent histopathologic prognostic factors for patients with cervical carcinoma treated with radical hysterectomy including paraaortic lymphadenectomy.

Preoperative serum SCC, CA125, and CA19-9 levels and lymph node status in squamous cell carcinoma of the uterine cervix

Background.  We wanted to investigate the clinical usefulness of determining the pretreatment levels of multiple serum tumor markers in predicting lymph node status and the prognosis for patients with cervical carcinoma.

Correlation between cytokine levels of amniotic fluid and histological chorioamnionitis in preterm delivery.

The aim of this study was to investigate the correlation between the cytokine levels in the amniotic fluid (AF) and the histological stage of chorioamnionitis (CAM) in premature labor. AF of 6 cases (7 samples of AF were obtained as one was a twin pregnancy) in whom CAM was diagnosed histologically, and 12 cases without CAM were included in this study. Amniotic fluid was obtained within 24 hours prior to delivery. Cytokine levels (IL-2, -4, -6, TNF-alpha, IFN-gamma) in AF were measured by an ELISA method. Levels of IL-2 and -6 in the CAM-positive group (mean +/-S.E., 52.9 +/- 83.9 pg/ml, and 20,537.9 +/- 8853.7 pg/ml, respectively) were higher than those in the CAM-negative group (i.e. undetectable, and 65.6 +/- 27.5, respectively) with a statistical significance of p < 0.05, p < 0.001, respectively. There was a positive linear relationship between IL-6 levels of AF and the placental histological inflammatory stages of Blanc in the CAM-positive group. From these results it would appear that the IL-6 level in AF is the most sensitive test in the detection of extraamniotic infection or intraamniotic infection in preterm labor with intact membranes and also indicates the severity infection.

Outcome of non-immune hydrops fetalis and a fetus with hydrothorax and/or ascites: with some trials of intrauterine treatment.

The subject of this study was 38 cases of non-immune hydrops fetalis and 11 cases of fetal hydrothorax and/ or ascites (FH/A), a syndrome characterized by the accumulation of pleural effusion and/or ascitic fluid, without generalized skin edema, due to various etiologies, admitted to the obstetrics ward of Hokkaido University Hospital during the period between 1987 and 1994. Fetal treatment consisted of (1) intravascular transfusion or intra-abdominal transfusion for anemia, (2) frequent centesis or shunt insertion for pleural effusion and ascites, (3) reduction of cystic hygroma by puncturing and OK432 injection, and (4) intravascular or maternal injection with an anti-arrhythmic drugs to treat tachycardia. The outcome of NIHF and FH/A was assessed to be able to make a prognosis in NIHF and to compare the efficacy of fetal therapy in cases with (15 cases: 9 NIHF, 6 FH/A) and without (34 cases: 29 NIHF, 5 HF/A) intrauterine treatment. The average survival rates were 23.1% in NIHF and 54.5% in FH/A. None of fetuses with a chromosomal abnormality or cystic hygroma survived. The average GW at the time of detection of NIHF by ultrasonography was week 24.9 +/- 1.1 (mean +/- S.E., n = 38). The average GW at the time of detection of FH/A by ultrasonography was week 26.6 +/- 1.8 (n = 11). NIHF was detected significantly earlier in the IUFD and early neonatal death group (GW 22.4 +/- 1.4) than in the survivor group (GW 27.6 +/- 1.2) (p < 0.05). FH/A was also detected earlier in the IUFD/early neonatal death group than in the survivor group (GW 21.8 +/- 2.4 vs. 31.1 +/- 1.1, n = 11, p < 0.05). The survival rate in the intrauterine treatment group was higher than in the nontreatment group (treatment group: 10/15; non-treatment group: 5/34, p < 0.001). After the trial of intrauterine treatment in the 15 cases mentioned above, some efficacy was observed in 7 cases (reduction of cysts, effusion or edema, disappearance of arrhythmia).

Diagnosis of premature rupture of the membranes in preterm patients, using an improved AFP kit: comparison with ROM-check and/or nitrazine test

OBJECTIVE We developed a new kit for detecting AFP in leaked amniotic fluid. Later, we developed an improved AFP kit utilizing the same anti alpha-fetoprotein (AFP) monoclonal antibody. In this study, we evaluate the clinical usefulness of this improved kit in the diagnosis of preterm premature rupture of membranes (PROM). METHODS We compared this improved AFP test with the ROM-check and/or the nitrazine tests in 46 preterm patients. RESULTS The ROM-check and nitrazine tests showed a diagnostic accuracy of 89.1 and 87.0%, respectively, compared with 95.7% with the improved AFP test. The sensitivity of the improved AFP test on cervical samples was significantly higher than that of the nitrazine test on vaginal samples (P < 0.05). The reaction time with the improved AFP kit test is 90 s. CONCLUSION This study has confirmed a great clinical utility of the improved AFP test kit as a method of PROM diagnosis.

Prenatal diagnosis of congenital unilateral hydrocephalus

Abstract A case is presented in which fetal unilateral hydrocephalus that had not been definitively diagnosed by ultrasonography was confirmed by means of magnetic resonance imaging. Computed tomography performed in the neonatal period after intraventricular injection of contrast medium showed stenosis of the foramen of Monro.

Diagnosis of preterm premature rupture of the membranes using a newly developed AFP monoclonal antibody test kit

OBJECTIVE We have developed a new anti-AFP monoclonal antibody kit which is easier to use than other examination methods for detecting AFP in the leaked amniotic fluid. In this study, we investigate the clinical value of this test in the diagnosis of preterm premature rupture of the membranes (PROM). METHODS We employed 103 patients of less than 37 weeks of gestational age for this preliminary study. We compared the clinical usefulness of this new AFP test with that of the nitrazine test and measured the concentration of AFP in vaginal fluid or cervical secretion by EIA. RESULTS The nitrazine test showed a correct diagnostic rate of 62.1%, in contrast the AFP test kit had a 98.0% rate (P < 0.001). The reaction time using the kit is 3 min. CONCLUSION The AFP test is a simple and non-invasive test which can be easily carried out repeatedly as a bedside examination. This study has confirmed the high clinical efficacy of the newly developed AFP test kit as a method of PROM diagnosis.

Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma.

Abstract.Background: The survival effects of combined organ resection in cytoreductive surgery for advanced ovarian carcinoma with regard to the site and the number of organs involved have not yet been clarified. Methods: Data obtained from 143 patients with stage III/IV ovarian carcinoma were used for analysis. Combined organ resection (COR) was employed in 21 patients in whom optimal cytoreduction (defined as a residuum ≦2 cm in diameter) was expected to be achieved by the procedure. Results: The tumors were optimally cytoreduced in 98 (68.5%) of 143 patients, either in primary surgery (n = 53) or in interval cytoreductive surgery (n = 45). The overall survival of patients with optimal cytoreduction was significantly higher than that of patients with nonoptimal cytoreduction (P < 0.01). There was no significant difference between the survival of patients in the optimal primary cytoreduction group and that of patients in the optimal interval cytoreduction group. The survival of stage III patients who underwent optimal surgery with COR was comparable to that of stage III patients who underwent optimal surgery without COR and was better than that of stage III patients who underwent nonoptimal surgery (P < 0.01). However, no effect of COR on the survival of stage IV patients was found. In the group of stage III patients who underwent optimal surgery with COR, the survival time tended to be shorter in patients who had upper abdominal organ resections (P = 0.059), and it was significantly shorter in patients who underwent resections of two or more organs (P = 0.0299). There was no operative mortality in any of the patients who underwent COR. Conclusion: Although COR has therapeutic significance for stage III ovarian carcinoma, the survival periods of patients with stage III ovarian carcinoma who have undergone additional upper abdominal organ resections, or two or more organ resections, may be shorter than the survival periods of patients with stage III ovarian carcinoma who have undergone resection of a single non-upper-abdominal organ.

Comparison of an Improved AFP Kit with the Intra-Amniotic PSP Dye-Injection Method in Equivocal Cases of Preterm Premature Rupture of the Fetal Membranes

Objective: We developed an improved AFP kit for detecting AFP in leaked amniotic fluid. We studied the relationship between the results of the improved AFP kit and! those of the intra‐amniotic PSP dye‐injection test (PSP test), and compared the results of two tests with the prognosis for subsequent pregnancy outcome, in order to know the diagnostic value of the two tests for preterm PROM, especially in equivocal cases.

Silent Premature Rupture of Membranes, Detected and Monitored Serially by an AFP Kit

A 24‐year‐old woman underwent conization and cervical cerclage during pregnancy. After she later complained of fluid leakage, a premature rupture of the membranes (PROM) was suspected, because of positive results on a test for nitrazine, the intra‐amniotic dye injection method (PSP test), and an AFP‐kit test at 22 weeks of gestation. The nitrazine and PSP tests later turned negative. However, during the period from the 22nd through 26th weeks of gestation, the results of AFP‐kit tests fluctuated, with repeated positive indications for bacterial cultures and elevated granulocyte elastase activity in the cervical mucus. The pregnancy was well maintained with administration of antibiotics and ritodrine hydrochloride until 34 weeks of gestation. The presence of chorioamnionitis, local inflammation of the fetal membranes, was found by pathological examination after the delivery. We propose a new clinical entity‐to be referred to as silent PROM‐the premature chemical rupture of the membranes.