Hiroshi Ozasa

Study of Uterine Prolapse by Magnetic Resonance Imaging: Topographical Changes Involving the Levator ani Muscle and the Vagina

Alternations of the pelvic structure with an emphasis on those of the levator ani muscle, associated with uterine prolapse, were studied using sagittal magnetic resonance images obtained from 19 subjects without and 14 with uterine or vaginal prolapse of varied degree and 3 patients with Rokitansky syndrome who had undergone a McIndoe operation. Two additional patients with a grade III uterine prolapse were also studied before and 2-3 months after corrective surgery consisting of vaginal hysterectomy combined with anterior colporrhaphy and posterior colpoperineorrhaphy. Absence or presence of prolapse, irrespective of its grade, was found to be related to whether or not a reference line extrapolated from the levator plate crossed the pubis on sagittal images. This was the case as well in patients with Rokitansky syndrome with a neovagina and loss of such crossings was restored in patients with prolapse after surgery. Backward bending of the upper vagina noted in nonprolapse conditions was usually absent in patients with uterine prolapse. These results document that topographical changes involving the levator ani muscle and the vagina occur in association with uterine prolapse.

Progesterone increases serum CA-125 in endometriosis

Serum level of CA-125 was monitored up to 48 hours after injection of 125 mg P-in-oil into patients with or without endometriosis in the follicular phase of their menstrual cycle. Circulating CA-125 levels remained unchanged at around 5 U/ml during the observation period in patients without endometriosis; however, a significant elevation was observed at 30 hours after injection in those patients with endometriosis (from 19.6 U/ml before injection to 30.0 U/ml at 30 hours after injection, P less than 0.05).

CT and MR demonstration of nabothian cysts mimicking a cystic adnexal mass

The CT and magnetic resonance appearance of prominent nabothian cysts is presented. Although small nabothian cysts are common gynecologic findings, they at times reach 2-4 cm in diameter and may simulate a cystic adnexal mass.

Cystic pedunculated leiomyomas of the uterus with unusual CT manifestations.

Two cases of pedunculated, cystic uterine leiomyoma with unusual CT manifestations are described. The normal contours of the uterus were largely preserved. Ascites and pleural effusion were noted in one case.

Plasma dehydroepiandrosterone-to-cortisol ratios as an indicator of stress in gynecologic patients

To evaluate the usefulness of the plasma dehydroepiandrosterone (DHEA)-to-cortisol ratio (D/C) and the plasma aldosterone-to-plasma renin activity ratio (ALDO/PRA) as indicators of stress, we first monitored changes in these ratios associated with surgery in 13 patients who were healthy except for their localized gynecologic diseases. D/C and ALDO/PRA ratios were reduced by 37 and 42%, respectively, 4-5 days postsurgery compared to those 3-4 days before surgery (P less than 0.05 and P less than 0.01, respectively) and returned to preoperative levels 11-13 days after surgery. In contrast, individual hormone levels showed no significant changes associated with surgery. Having documented that these ratios may serve as indicators of stress, we then sequentially measured D/C ratios in patients with gynecologic malignancy subjected to cytotoxic chemotherapy or radiation therapy and in patients in the terminal stage. Although such therapies did not affect D/C ratios to a measurable extent, patients in the terminal stage gave consistently low D/C ratios in spite of normal vital signs (a D/C ratio below 6 was deemed low). Such low ratios occurred only sporadically in other patients and, again, individual values for DHEA and cortisol showed no consistent pattern. We believe that use of D/C ratios as an indicator of stress warrants further investigation.

A dynamic test of hormonal sensitivity of gynecologic malignancy by use of an antiestrogen, tamoxifen

To assess the hormonal sensitivity of tumors, progestin receptor levels in the tumor were monitored before and after tamoxifen, 40 mg/day for 7 days in patients with various gynecologic malignancies. Tamoxifen induced progestin receptors in two of eight-cases of endometrial cancer, four of eight cases of cervical epidermoid cancer, and two of seven cases of cervical adenocarcinoma. Induction of progestin receptors did not occur in one case of uterine mixed müllerian tumor and there were no measured progestin receptors after tamoxifen treatment in three cases of ovarian cancer and in one case of benign ovarian tumor. Because induction of progestin receptors is the best-documented response of estrogen target cells to estrogenic stimuli, this induction of progestin receptor with tamoxifen may be considered to indicate the estrogen sensitivity of a tumor. Further study is warranted to determine whether hormonal sensitivity assessed by the use of tamoxifen might serve to select tumors likely to respond to hormonal therapy.

Diagnostic capability of ultrasound versus CT for clinically suspected ovarian mass with emphasis on detection of adhesions

Diagnostic capability was compared prospectively between ultrasound and CT using 25 consecutive cases of clinically suspected ovarian mass, which were found postoperatively to be comprised of 12 cases of ovarian neoplasm (of which 7 were malignant). 5 cases of endometriotic cyst, and 8 cases of nonovarian tumors including 4 cases of abscess. Accuracy for the histologic diagnosis with ultrasound and CT was 56 and 84%, respectively (P less than 0.05). With respect to discrimination of cystadenoma from cystadenocarcinoma, detection of intraperitoneal seedings, of paraaortic lymph node metastasis, and of ascites, either of the two imaging modalities was comparable to the other in their proficiency. In contrast to ultrasound, which permitted evaluation of adhesions to the uterus only in selected cases and hence was of limited use in this respect, CT was proficient in predicting the presence or absence of adhesions around the mass involving the uterus as well as other adjoining structures. The fact that CT is competent in detecting adhesions adds further value to CT as a powerful tool for the preoperative investigation of pelvic mass.

Radioautographic demonstration of dihydrotestosterone receptor in cultured human fibroblasts

Radioautographically, we obtained direct evidence for the localization of3H-dihydrotestosterone binding sites in cultured human fibroblasts derived from vulvar skin.