Kiguna Sei

Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery

Based on our experience with seven deliveries (five cesarean and two vaginal deliveries) in five women with Moyamoya disease, we discussed the appropriate method of delivery and anesthesia for patients with Moyamoya disease. In certain conditions, women with Moyamoya disease can successfully undergo vaginal delivery.

Comparison of low-dose dienogest with low-dose danazol for long-term treatment of adenomyosis.

INTRODUCTION: The objective of this study was to compare low-dose dienogest with low-dose danazol for the long-term treatment of adenomyosis because evidence regarding the effects of its long-term use is scarce. METHODS: We compared 20 patients receiving low-dose dienogest treatment with 22 patients receiving low-dose danazol treatment for endometriosis including adenomyosis. We evaluated the effects and complications of low-dose dienogest treatment in comparison with those of low-dose danazol treatment. In addition, the values of serum hormones, tumor markers, and lipid metabolism were compared between both groups. This study was approved by the institutional review board. RESULT: The daily dose of dienogest could be decreased from 2.0 to 1.5 or 1.0 mg. Although irregular genital bleeding was recorded as an adverse effect, it was controllable; however, the monthly cost incurred by the low-dose dienogest treatment group was higher than that by the low-dose danazol treatment group. The daily dose of danazol could be decreased from 200 to 50 or 33 mg in patients with adenomyosis, but it was difficult to determine the adequate dose for individual patients. Some patients in the low-dose danazol treatment group developed polycythemia as an adverse effect, and the administration of the drug was therefore discontinued. There was no significant difference in the values of serum hormones, tumor markers, or lipid metabolism between both groups. CONCLUSION: We suggest that both low-dose dienogest and low-dose danazol are effective and safe for long-term management of endometriosis. However, the selection of either treatment for adenomyosis depends on each patients baseline condition.

Size of uterine leiomyoma is a predictor for massive haemorrhage during caesarean delivery

BACKGROUND Uterine leiomyoma is a common benign tumour, and a risk factor for various complications during pregnancy and peripartum period. Peripartum haemorrhage is the most critical complication that can cause maternal death. Although the relationship of leiomyoma and peripartum haemorrhage has been indicated, little is known about the characteristics of leiomyoma as predictors for massive haemorrhage in caesarean delivery. OBJECTIVE We examined whether characteristics of leiomyoma and pregnant patients could predict massive haemorrhage in women undergoing caesarean delivery. STUDY DESIGN This is a single-institution, retrospective cohort study. We reviewed singleton caesarean deliveries between January 2005 and December 2011. We excluded women with the following risk factors for massive haemorrhage: abnormality of placental position, abruptio placentae, haemorrhagic diseases, hydramnios, and labour arrest after induction. Myomectomy was not performed during delivery. Multivariate logistic regression analysis was performed to identify predictors of massive intraoperative haemorrhage (≥1000 ml). The following predictors were evaluated: maternal age, body mass index, parity, gestational week, birth weight, number of leiomyomas, and volume of the largest leiomyoma. Detailed characteristics of leiomyomas were evaluated using sonography or magnetic resonance imaging. RESULTS Seven hundred and fifty-nine women were included; 55 women (7.25%) had leiomyoma. Thirty-eight women with leiomyoma underwent magnetic resonance imaging scan. The median intraoperative haemorrhage was 939 ml (395-5296 ml) in women with leiomyoma and 689 ml (129-3060 ml) in women without. Multivariate analysis revealed that a largest leiomyoma ≥175 cm3 (odds ratio 6.4 [95% confidence interval: 1.5-27], P = 0.007), birth weight of ≥2500 g (2.3 [1.53.6], P < 0.001), and primipara (1.5 [1.1-2.1], P = 0.025) were significant predictors of massive intraoperative haemorrhage. CONCLUSIONS The presence of a leiomyoma of ≥175 cm3, birth weight of ≥2500 g, and primipara were found to be predictors for massive intraoperative haemorrhage during caesarean delivery. A leiomyoma ≥175 cm3 which is equivalent volume to a 7 cm diameter sphere can be diagnosed in the first trimester using sonography. In cases of cesarean delivery with these predictors, preparation for massive haemorrhage, including storage of autologous blood, may be considered.

In vivo photoacoustic imaging of uterine cervical lesion and its image processing based on light propagation in biological medium

For diagnosis of cervical cancer, screening by colposcope and successive biopsy are usually carried out. Colposcope, which is a mesoscope, is used to examine surface of the cervix and to find precancerous lesion grossly. However, the accuracy of colposcopy depends on the skills of the examiner and is inconsistent as a result. Additionally, colposcope lacks depth information. It is known that microvessel density and blood flow in cervical lesion increases associated with angiogenesis. Therefore, photoacoustic imaging (PAI) to detect angiogenesis in cervical lesion has been studied. PAI can diagnose cervical lesion sensitively and provide depth information. The authors have been investigating the efficacy of PAI in the diagnoses of the cervical lesion and cancer by use of the PAI and ultrasonography system with transvaginal probe developed by Fujifilm Corporation. For quantitative diagnosis by use of PAI, it is required to take the light propagation in biological medium into account. The image reconstruction of the absorption coefficient from the PA image of cervix by use of the simulation of light propagation based on finite element method has been tried in this study. Numerical simulation, phantom experiment and in vivo imaging were carried out.

Immunohistochemical Expression of Bronchial Dysplasia Associate Proteins in Uterine Cervical Lesions [6P]

INTRODUCTION: Bronchial dysplasia associate proteins are involved in the proliferation, cell differentiation and adhesion, tumorigenesis, invasion and metastasis of cancer. We examined the immunohistochemical expression of bronchial dysplasia associate proteins in uterine cervical lesions. METHODS: Specimens from 32 patients with uterine cervical intraepithelial neoplasia (CIN) or uterine cervical invasive carcinoma were immunohistochemically evaluated for the expression of the 6 proteins associated with bronchial dysplasia: serpin peptidase inhibitor B2 (SERPINB2), carboxypeptidase A4 (CPA4), keratin 6A and 13, interleukin 1 receptor antagonist (IL-1Ra), small proline-rich protein 3 (SPRR3) and desmoglein 3 (Dsg3). Immunohistochemistry staining intensity was quantitatively scored from 0 to 2+. This study was approved by the Institutional Review Board. RESULTS: The positive expression rates of SERPINB2, CPA4, Dsg3 and SPRR3 were 84%, 62.5%, 27%, and 18.9% in the uterine cervical cells, 87.5%, 75%, 70.3%, and 0% in the biopsy tissue specimens, respectively. The expression of keratin6A/13 was not specific, and the expression of IL-1Ra only in the cervical dysplastic cells revealed positive, but negative in normal cells and cervical invasive carcinoma cells, and in all biopsy tissues. The expression of SERPINB2 seemed to have positive correlation with the progression of lesions, but the expression of CPA4 in only the dysplastic cells revealed positive. CONCLUSION: SERPINB2 might be useful as a marker for uterine cervical lesions because it was expressed according to the grade of the CIN and cervical invasive carcinoma specimens. CPA4, Dsg3, and IL-1Ra could be potential immunohistochemical markers for uterine cervical lesions because of positive expression in the dysplastic cells.

Immunohistochemical Expression of Serpin Peptidase Inhibitor B2 and Carboxypeptidase A4 in Uterine Cervical Lesions [200]

OBJECTIVE: Serpin peptidase inhibitor B2 is involved in the invasion and metastasis of cancer. Carboxypeptidase A4 may have a correlation with the grade of prostate cancer. We examined the immunohistochemical expression of serpin peptidase inhibitor B2 and carboxypeptidase A4 in uterine cervical lesions. MATERIALS AND METHODS: Specimens from 25 patients with uterine cervical intraepithelial neoplasia (CIN) or uterine cervical invasive carcinoma were immunohistochemically evaluated for the expression of the two markers, serpin peptidase inhibitor B2 and carboxypeptidase A4. Of the patients from whom uterine cervical cells and biopsy tissue specimens were obtained, eight had normal tissues (32%), two had CIN1 lesions (40%), eight had CIN2 lesions (32%), five had CIN3 lesions (20%), and two had cervical invasive carcinoma (8%). Immunohistochemistry staining intensity was quantitatively scored from 0 to 2+. This study was approved by the institutional review board. RESULT: The positive expression rates of serpin peptidase inhibitor B2 and carboxypeptidase A4 were 75% and 20% in the uterine cervical cells and 63% and 0% in the biopsy tissue specimens, respectively. The expression of serpin peptidase inhibitor B2 seemed to have a positive correlation with the progression of lesions, but the expression of carboxypeptidase A4 in the only dysplastic cells revealed positive. The expression of serpin peptidase inhibitor B2 was positive, but that of carboxypeptidase A4 was negative in cases of cervical invasive carcinoma. CONCLUSION: Serpin peptidase inhibitor B2 might be useful as a marker for uterine cervical lesions because it was expressed according to the grade of the CIN and cervical invasive carcinoma specimens. Carboxypeptidase A4 could be potential immunohistochemical markers for uterine cervical lesions because of positive expression in the dysplastic cells.

Can measurement of maternal anti-cytomegalovirus immunoglobulin-M antibody levels be used to screen for cytomegalovirus infection in embryos and fetuses?

Aims:  Our study aims to estimate whether measurement of maternal anti‐cytomegalovirus immunoglobulin‐M antibody (CMV‐IgM) levels are useful as a screening method for achieving early detection of congenital CMV infection.