Ken-ichi Shukunami

Concentrations of pentosidine, an advanced glycation end-product, in umbilical cord blood.

Advanced glycation end-products (AGEs) are formed over several weeks to months by non-enzymatic glycation and oxidation (“glycoxidation”) reactions between carbohydrate-derived carbonyl groups and protein amino groups, known as the Maillard reaction. Pentosidine is one of the best-characterized AGEs and is accepted as a satisfactory marker for glycoxidation in vivo. The present study was intended to measure pentosidine concentrations in umbilical cord blood from newborns with various gestational ages using our recently established high-performance liquid chromatography method [Tsukahara, H. et al. (2003) Pediatr. Res. 54, 419–424]. Our study demonstrates, for the first time, that pentosidine is detected in most of the umbilical blood samples. This study also shows that the umbilical blood concentrations of pentosidine are considerably lower than normal adult values, but that they increase with gestation progression and fetal growth. Umbilical pentosidine concentrations were significantly elevated in newborns of mothers with preeclampsia compared to those of mothers without preeclampsia. We conclude that accumulation of AGEs and oxidative stress occurs in fetal tissues and organs in utero at the early stage of human life and that their accumulation is augmented in the maternal preeclampsic condition.

Hypersensitivity reaction to carboplatin during treatment for ovarian cancer: successful resolution by replacement with cisplatin.

Development of hypersensitivity reactions to carboplatin (CP) during cancer treatment makes optimal chemotherapy difficult to achieve. Many approaches have previously been used following the development of reactions to CP. We report on a patient with ovarian cancer who developed a hypersensitivity reaction to CP. The patient was successfully treated following replacement of carboplatin with cisplatin.

Transverse fundal uterine incision in a patient with placenta increta

In cases with placenta accreta occurring on the previous cesarean scar, a longitudinal incision is generally appropriate. However, the placenta may prevent both a longitudinal and lower transverse incision. We report a case of placenta increta on the previous cesarean scar, and discuss the role of transverse fundal uterine incision.

Well-differentiated papillary mesothelioma involving the peritoneal and pleural cavities: successful treatment by local and systemic administration of carboplatin.

Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare form of epithelial mesothelioma. It usually shows an indolent course and no standard treatment is available. Only a few cases of WDPM in the pleural cavity have been reported. We report on a 56-year-old post-menopausal woman who presented with ascites and right pleural effusion. Laparotomy followed by biopsy established the presence of WDPM in the peritoneum and pleural cavity. The patient was successfully treated with local and systemic administration of carboplatin.

An operative technique for conservative management of placenta accreta

BACKGROUND: Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments. CASES: Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the uterine wall after intramyometrial administration of oxytocin. CONCLUSION: A vertical incision in the anterior uterine wall and subsequent eversion of the uterus may aid in avoiding hysterectomy with placenta accreta.

Unicornuate uterus with a noncommunicating cavitary, laterally dislocated rudimentary horn presenting with adenomyosis, associated with ipsilateral renal agenesis.

Abstract Unicornuate uterus with a rudimentary horn is a rare müllerian anomaly. We report a case of a unicornuate uterus with adenomyosis in a laterally dislocated rudimentary horn, which showed a functioning endometrial islands, with associated ipsilateral agenesis of the kidney.

Adjunctive treatment with low-dosage aripiprazole for blonanserin-induced hyperprolactinemia in a female patient with schizophrenia.

Hyperprolactinemia, which is induced by antipsychotic treatment through the dopaminergic blockade, causes amenorrhea, infertility, and galactorrhea (Johnsen et al., 2008). Recently, aripiprazole has been widely reported as effective for the treatment of antipsychoticinduced hyperprolactinemia because of its partial agonistic actions to dopamine D2 receptor with high affinity (Byerly et al., 2009; Chen et al., 2008, 2009; Rainka et al., 2009; Saitis et al., 2008; Kane et al., 2009). However, in all cases, therapeutic gain of adjunctive aripiprazole in the treatment of hyperprolactinemia was evaluated only during one week with high dosage greater than 10 mg/day. We report the case of a 32-year-old female patient with schizophrenia who showed blonanserin-induced hyperprolactinemia through the potent (high affinity) dopamine D(2) antagonist properties. Her serum prolactin level declined rapidly during 12 h and normalized within five days by adjunctive low-dosage aripiprazole treatment. A 32-year-old woman with a 7-year history of schizophrenia was admitted to our inpatient ward because of acute psychotic exacerbation following discontinuation of blonanserin treatment. Having been treated unsuccessfully with adequate trials of risperidone and olanzapine, she had been treated with blonanserin 24 mg/day during the prior year, thereby showingmarked improvement in both positive and negative symptoms. However, she stopped blonanserin treatment because she had been suffering from bilateral breast swelling, galactorrhea, and infertility. She was re-treated with the same dosage of blonanserin (24 mg/day). Two weeks after admission, she showed complete remission in psychotic symptoms with elevated serum prolactin at 128 μg/ml (normal range 6.1–30.5 μg/ml). Other causative mechanisms for hyperprolactinemia such as pituitary microadenoma or hypothyroidism were excluded using either blood analysis or brain magnetic resonance imaging (MRI) examinations. A low-dosage aripiprazole (6 mg/day) treatment was added to her drug regimen to improve blonanserin-induced hyperprolactinemia. Blood samples were obtained in the morning on days 1, 2, 3, 4, 5, 7, and 10 to assess serum prolactin levels. Serum prolactin levels decreased progressively to72.7 μg/ml, 65.2 μg/ml, 42.0 μg/ml, 37.2 μg/ml, 24.2 μg/ml, 22.2 μg/ml, and 21.1 μg/ml at days 1, 2, 3, 4, 5, 7, and 10. Oral administration of blonanserin (24 mg/day) and aripiprazole (6 mg/day) was continued. Her breast pain and galactorrhea had improved during 10 days after the initiation of aripiprazole without worsening psychotic symptoms. She was discharged four weeks after admission. This is the first report describing assessment of the time course of daily changes of antipsychotic-induced hyperprolactinemia, which improved following adjunctive low-dosage aripiprazole treatment. In the previous reports, the dosage of aripiprazole used for treating antipsychotic-induced hyperprolactinemia was greater than

Massive Subchorionic Hematoma: Peculiar Prenatal Images and Review of the Literature

Massive subchorionic hematoma is a localized collection of blood or hematoma in the placenta, and can result in serious obstetrical complications. The condition can be diagnosed antenatally by ultrasound. However, no reports have previously described the same condition featuring an intraplacental fluid–fluid level on imaging studies. We report a case of massive subchorionic hematoma diagnosed prenatally, and propose an additional peculiar finding detectable on both the ultrasound and magnetic resonance images: the intraplacental fluid–fluid level. We also review previously reported cases that were detected by ultrasonography.

Placenta previa of a succenturiate lobe: a report of two cases.

Previa of a succenturiate placenta is a rare condition. We report two cases of such lesions, which could not be detected by transabdominal ultrasound. When no cause of uterine bleeding is detected, previa of a posterior succenturiate lobe should be considered, and transvaginal ultrasound should be performed.

Management for Neonatal Aspiration Syndrome Caused by Vernix caseosa

Objective: To clarify resuscitation methods against the lethal vernix caseosa aspiration syndrome. Method: A single case report with a literature review. Results: Our case report was associated with aspiration syndrome caused by an airway obstruction of vernix caseosa: a proteolipid biofilm synthesized by the fetus. A 23-year-old woman normally delivered a mature infant at term. The infantile oral cavity was filled with numerous aggregates of vernix caseosa. Two hours after his birth, the infant died from respiratory insufficiency. We discuss the difference between management of our case and the previously reported case.Conclusion: Pregnant women with a diffuse pattern of high-level echoes in prenatal ultrasonography, suggesting the presence of massive vernix caseosa, should be transferred to a well-equipped institution that can administer inhaled nitric oxide and extracorporeal membrane oxygenation.