Kyoko Shirota

A normal uterus communicating with a double cervix and the vagina: a müllerian anomaly without any present classification

OBJECTIVE To report a rare uterine anomaly consisting of a normal uterus, a double cervix, and a double vagina. DESIGN Case report. SETTING University hospital. PATIENT(S) A 28-year-old nulligravida patient referred for evaluation of primary infertility and a suspected müllerian anomaly. INTERVENTION(S) Clinical and surgical evaluation of the anomaly. MAIN OUTCOME MEASURE(S) Description and treatment for a rare uterine anomaly and a subsequent literature search. RESULT(S) Successful resection of vaginal septum and subsequent pregnancy. CONCLUSION(S) This extremely rare anomaly is not explained by classic embryologic teachings, and it does not fit into the classification system currently used to describe müllerian anomalies.

Metronomic doxifluridine chemotherapy combined with the anti-angiogenic agent TNP-470 inhibits the growth of human uterine carcinosarcoma xenografts

Uterine carcinosarcoma is a highly aggressive gynecological neoplasm that responds poorly to conventional chemotherapy and radiotherapy. Metronomic chemotherapy is accepted as a new approach for cancer treatment, and its underlying mechanism seems to involve the suppression of angiogenesis. However, the efficacy of metronomic and anti‐angiogenic therapies against uterine carcinosarcoma is unknown. The anti‐angiogenic effect of doxifluridine was assessed in vitro using human umbilical vein endothelial cells (HUVEC) co‐cultured with FU‐MMT‐1 human uterine carcinosarcoma cells. The antitumor and anti‐angiogenic effects of metronomic doxifluridine (delivered via oral gavage) in combination with TNP‐470 were evaluated in vivo. Tumor vascularity was assessed by contrast‐enhanced color Doppler ultrasound, laser Doppler and microvessel density staining. Doxifluridine suppressed tube formation of HUVEC and vascular endothelial growth factor production by FU‐MMT‐1 cells. Metronomic doxifluridine alone significantly suppressed tumor growth compared with the untreated (control) group, while metronomic doxifluridine in combination with TNP‐470 significantly inhibited tumor growth compared with each treatment alone. A significant reduction of intratumoral vascularity was observed in FU‐MMT‐1 xenografts following treatment with metronomic doxifluridine in combination with TNP‐470, as compared with each treatment alone. Intestinal bleeding was only observed when the maximum tolerated dose of doxifluridine was administered in combination with TNP‐470. Metronomic doxifluridine chemotherapy in combination with TNP‐470 might be effective for uterine carcinosarcoma without marked toxicity, possibly acting via its potent anti‐angiogenic effects. Clinical studies are needed to evaluate the safety and efficacy of this treatment in humans. (Cancer Sci 2011; 102: 1545–1552)

Amphiregulin is much more abundantly expressed than transforming growth factor-alpha and epidermal growth factor in human follicular fluid obtained from patients undergoing in vitro fertilization–embryo transfer

OBJECTIVE To identify the most important epidermal growth factor (EGF) receptor ligand in the LH or hCG signal pathway in human ovary. DESIGN A retrospective clinical study. SETTING Tertiary university hospital. PATIENT(S) Ninety-eight infertile patients who underwent IVF-embryo transfer. INTERVENTION(S) Sera and follicular fluid were collected at the time of oocyte retrieval. The levels of EGF, transforming growth factor-alpha (TGFalpha), and amphiregulin (AR) were measured in follicular fluid and sera by using ELISA. MAIN OUTCOME MEASURE(S) The relationships between the level of AR and level of hCG, fertilization rate, and embryo quality. RESULT(S) Amphiregulin was abundantly expressed in follicular fluid after hCG stimulation. Although large differences were found between AR and both EGF and TGFalpha in follicular fluid, no significant difference was detected in the levels of the three EGF receptor ligands in sera. The level of AR was inversely correlated with the fertilization rate and hCG level, whereas little significant association was observed between the level of AR and embryo quality. CONCLUSION(S) Amphiregulin was expressed most dominantly among EGF receptor ligands tested and may mediate the hCG signal in human oocyte maturation. Elaborate interaction between AR and hCG may be required for an optimal oocyte maturation.

Clinical usefulness of color doppler ultrasound in patients with endometrial hyperplasia and carcinoma

The objective of this study was to examine the usefulness of transvaginal color Doppler ultrasound (TV‐CDU) in differentiating between endometrial hyperplasia (EH) and endometrial carcinoma (EC) and in predicting tumor spread in patients with EC.

The efficacy of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas.

Aim:  The aim of this study was to investigate the influence of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas. We identified differences in follicle loss and surgical difficulties with or without preoperative hormonal therapy.

Separation efficiency of a microfluidic sperm sorter to minimize sperm DNA damage

OBJECTIVE To evaluate whether microfluidic sperm sorters (MFSSs) allow effective recovery of sorted motile sperm without DNA damage compared with the centrifugation and swim-up procedure. DESIGN Experimental laboratory study. All participants completed questionnaires regarding previous and/or current diseases, surgery, reproductive experiences, lifestyle factors, and date of the preceding ejaculation. SETTING University research laboratory. PATIENT(S) Male volunteers were recruited without setting conditions. Semen samples from healthy volunteers (n = 37) were collected in sterile containers by masturbation. INTERVENTION(S) Flow cytometric measurement and sperm chromatin structure assay analysis of DNA damage after sperm preparation using MFSS and the centrifugation and swim-up procedure. MAIN OUTCOME MEASURE(S) Efficacy and efficiency of sperm preparation, correlation between sperm DNA fragmentation index (DFI) and semen parameters, and relationship between basic characteristics and DFI after the centrifugation and swim-up procedure. RESULT(S) Final sperm concentration and motility were significantly different between the centrifugation and swim-up procedure and MFSS sperm preparations. A significantly lower sperm DNA fragmentation rate was detected with MFSS compared with the centrifugation and swim-up procedure use. No correlation was observed between DFI and smoking or drinking, but significant correlations were observed between DFI and medication use and sexual abstinence duration. CONCLUSION(S) MFSSs can be used to efficiently and reliably prepare sperm compared with the centrifugation and swim-up procedure. Further research on the clinical use of MFSSs is required to evaluate the safety and usefulness of this device.

Relaxin-induced angiogenesis in ovary contributes to follicle development.

Abstract: CD31‐positive blood vessels increased in human ovarian cortical tissues cultured with relaxin than in tissues cultured without relaxin. The number of vWF‐positive vessels counted in rat ovaries after relaxin injection (40.5 ± 4.3) significantly increased compared to that in saline‐injected rats (24.3 ± 3.0). The proportion of primordial follicles was significantly decreased, that of primary follicles was significantly increased at 16 h, and that of early antral follicles was significantly increased at 24 h in rats after relaxin injection. These results suggest that relaxin may contribute to follicle development through the mechanism of angiogenesis in the ovary.

Involvement of anticentromere antibody in interference with oocyte meiosis and embryo cleavage.

The aim of this study was to investigate the clinical significance of anticentromere antibody (ACA) among types of antinuclear antibody (ANA) in the properties of oocytes retrieved from infertile women. The rate of metaphase II oocytes or embryo cleavage was significantly decreased in patients with positive ACA compared with patients with negative ACA, suggesting that ACA is an essential marker for flawed oocytes in infertile women with any type of ANA.

A Case of Congenital Familial Short Femur Diagnosed Prenatally

A fetus at 24 weeks of gestation had been suspected of congenital familial bilateral short femur. The Japanese mother, 41 years old and 139 cm in height presented with bilateral short femur herself. The mother had two affected aunts and one affected daughter in her family history. Ultrasound examination was given to the mother for the first time at 24 weeks of gestation and it revealed bilateral short femur of 30 mm in length on the right and 31 mm on the left femur of the fetus. Other examinations were entirely normal and the pregnancy resulted in a full-term spontaneous vaginal delivery to a male baby. Birth weight was 2,790 g and the 1 and 5 min Apgar scores were at 8 and 10. Diagnosis was confirmed by skeletal radiographs.

Uterine inversion due to a leiomyoma on postpartum day 41: A case report

Uterine leiomyomas are common tumors in women of reproductive age and are frequently detected during pregnancy. The major complications during pregnancy include abortion, preterm delivery, abruptio placentae, intrauterine growth retardation, dystocia, and postpartum hemorrhage. Little attention is given to uterine leiomyomas postpartum compared to leiomyomas prior to childbirth. In the present case, a 27‐year‐old woman, gravida 1 para 1, presented with massive vaginal bleeding, urinary retention and lower abdominal pain on postpartum day 41. She was diagnosed with uterine inversion due to leiomyoma. After a vaginal myomectomy, the uterus was re‐placed with a combined vaginal and abdominal approach. Because of timely medical intervention, the patient managed to overcome the crisis and her reproductive organs were successfully preserved.