Masaki Kamio

Differences in umbilical venous and arterial leptin levels by mode of delivery

Objective To investigate the differences in umbilical venous and arterial leptin levels by mode of delivery. Methods Subjects were 30 mothers who had elective cesarean deliveries and 34 mothers who had vaginal deliveries. Umbilical venous and arterial leptin levels were measured immediately after delivery. Maternal age, neonatal gender, neonatal birth weight, placental weight, and gestational duration were recorded. Inter- and intragroup comparisons were made in umbilical venous and arterial leptin levels and obstetric variables. Significant determinants of differences in umbilical venous and arterial leptin levels were investigated. Results Umbilical venous and arterial leptin levels were higher in the vaginal delivery group (n = 34) than in the cesarean group (n = 30) (P < .01). In the vaginal delivery group, umbilical venous leptin levels were significantly higher than arterial leptin levels (P < .001). These differences were still significant after adjustment for neonatal gender, neonatal birth weight, and placental weight. However, in the cesarean group, leptin levels did not differ between umbilical vein and artery. Conclusion Placental leptin release is augumented during advanced labor.

Giant ovarian cancer weighing 100 kg with poor prognosis

We encountered a patient with giant ovarian cancer with a tumor weight of 100u2003kg. The patients girth measured 198u2003cm after approximately 4u2003years duration, and she complained of dyspnea and inability to walk. Adnectomy was performed with intensive intraoperative monitoring. The ovarian cancer was entirely adherent to the parietal peritoneum. However, 10u2003h after adnectomy, she died of massive abdominal bleeding from extremely redundant parietal peritoneum caused by disseminated intravascular coagulation.

Torsion of the normal ovary and oviduct in a pre-pubertal girl

We encountered a 10‐year‐old prepubertal girl with a normal ovary and oviduct torsion. Hemorrhagic infarction of the ovary and oviduct occurred, and these structures were laparoscopically removed. Torsion of the normal ovary and oviduct in a prepubertal girl is discussed.

A Very Rare Case of Endometriosis Presenting With Massive Hemoperitoneum

Endometriosis is a cause of acute abdomen because of the leakage or rupture of endometriotic cyst and tubo-ovarian abscess. However, massive hemoperitoneum as a cause of acute abdomen with endometriosis is very rare. We herein present a case of a 48-year-old woman who was urgently referred to our clinic with colic, abdominal distension, and hypovolemic shock during menstruation. Ultrasonography revealed massive hemorrhagic ascites. Exploratory laparoscopy was urgently performed to achieve hemostasis. The volume of hemoperitoneum evacuated from the pelvis was 1,890 mL. Although the uterus and bilateral ovaries were normal, fresh bleeding was observed from endometriosis on the left cul-de-sac peritoneum, and hemostasis was successfully performed. The potential occurrence of hemorrhagic shock associated with endometriosis, depending on the implantation site, needs to be recognized.

Identification of new risk factors for wound separation in gynecologic malignancy surgery

The purpose of this study was to compare prophylactic subcutaneous drainage plus subcuticular sutures versus staples for the risk of wound separation after skin closure following gynecologic malignancy surgery, and to investigate the risk factors of this procedure.

Clinical management of uterine cervical mullerian adenosarcoma: A clinicopathological study of six cases and review of the literature

OBJECTIVEnTo assess the clinicopathological characteristics and clinical management of patients diagnosed with mullerian adenosarcoma of the uterine cervix.nnnMATERIALS AND METHODSnRecords of six patients surgically treated for cervical mullerian adenosarcoma were reviewed.nnnRESULTSnThe median age of the patients was 50 years (range, 17-74). Four patients presented with vaginal bleeding and two of them had watery discharge as the primary symptoms. Three nulliparous patients who hoped to preserve their uterus were included in this study and only one of the three patients received fertility-preservation surgery. Five patients underwent hysterectomy (simple in 3, modified radical in 2) with bilateral salpingo-oophorectomy or bilateral salpingectomy. One patient underwent conization of the cervix to preserve her fertility as there was no sarcomatous overgrowth, heterologous elements, or deep cervical stromal invasion. A recurrence of cervical mullerian adenosarcoma with sarcomatous overgrowth was observed in one patient who underwent simple hysterectomy.nnnCONCLUSIONnThe presence of sarcomatous overgrowth and deep cervical stromal invasion are associated with poor prognosis. Along with adequate counseling, fertility-preservation surgery may be an acceptable option for exophytic cervical mullerian adenosarcoma in the cases that do not show sarcomatous overgrowth and deep cervical stromal invasion.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with septic shock: A case report

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare complex of structural abnormalities of the female urogenital tract. A nulliparous 37‐year‐old woman was referred to our department for an acute abdomen. Multiple uterine myomas and painful right vaginal bulge were found on gynecological examination. Transvaginal ultrasonography revealed a cystic mass and a right‐side cervix that was hidden behind the longitudinal vaginal septum. For these findings, pyocolpos arising from OHVIRA syndrome was suspected. Her general condition gradually worsened within an hour, and she developed septic shock and was hospitalized in the intensive care unit (ICU). Laboratory data revealed disseminated intravascular coagulation (DIC) and multiple organ failure. Her general condition gradually improved as a result of intensive care and transvaginal puncture drainage of the abscess. Hysterectomy, performed 2 months after the acute septic episode, confirmed the diagnosis of septate uterus with obstructed hemivagina. To date, there is no documented case of OHVIRA syndrome with an eventual septic shock.

Risk factors for lymphatic complications following lymphadenectomy in patients with cervical cancer

BackgroundnThe purpose of this study was to evaluate the occurrence of lymphatic complications following pelvic lymphadenectomy (PLA) in patients with cervical cancer.nnnMethodsnA retrospective study of 169 cervical cancer patients was conducted. Lower extremity lymphedema (LEL) was diagnosed using the International Society of Lymphology guidelines, and pelvic lymphocele (PL) was evaluated using trans-vaginal ultrasonography and computed tomography.nnnResultsnThe median patient age was 46 years (range: 22-74) and median body mass index was 21.7 kg/m2 (range: 15.7-37.1). The median number of lymph nodes (LNs) removed was 27 (range: 22-74); 94 (55.6%) patients underwent circumflex iliac node (CIN) dissection; 39 (23.1%) patients received adjuvant chemotherapy; and 81 (47.9%) patients received adjuvant postoperative radiotherapy. There were 28 (16.6%) and 32 (18.9%) occurrences of LEL and PL, respectively. In multivariate logistic regression analysis, the number of LNs removed (odds ratio [OR]: 3.37; 95% CI: 1.43-8.54; P = 0.0053) and CIN removal (OR: 3.92; 95% CI: 1.55-11.4; P = 0.0033) were independent risk factors for LEL; however, no risk factors were significantly associated with PL.nnnConclusionsnOur results demonstrated that CIN removal and the number of LNs removed were significant risk factors for LEL in patients with cervical cancer. However, we did not identify any significant risk factors for PL in this study. We instead speculate that LN dissection itself causes PL. We suggest that establishment of comprehensive PLA without CIN dissection, or use of the sentinel lymph node concept, will prevent the occurrence of lymphatic complications in cervical cancer patients.

Tumor bleeding requiring intervention and the correlation with anemia in uterine cervical cancer for definitive radiotherapy

BackgroundnThe prognostic impact of tumor bleeding requiring intervention and the correlation with anemia on the survival outcome of cervical cancer radiotherapy is unclear.nnnMethodsnOne hundred and ninety-six patients requiring hemostatic intervention between January 2006 and March 2014 were retrospectively investigated. The correlation between anemia and bleeding during radiotherapy, the prognostic impact of genital bleeding during radiotherapy and the influence of blood transfusion were estimated.nnnResultsnNone of the patients had incomplete or prolonged treatment exceeding 1 week due to bleeding. All tumor bleeding could be controlled by gauze packing, and no patients suffered from fatal genital bleeding. Bleeding significantly correlated with progression-free survival (P = 0.015) and overall survival (P = 0.048). Regarding the risk factors of anemia: age (P = 0.043), FIGO stage (P < 0.001), tumor diameter (P < 0.001), and bleeding (P = 0.002) were significant. Multivariate analysis revealed FIGO stage (Odds Ratio: 2.360; 95% CI = 1.202-4.633; P = 0.013), tumor diameter (Odds Ratio: 2.089; 95% CI = 1.048-4.162; P = 0.036) and Bleeding (Odds Ratio: 2.226; 95% CI = 1.052-4.709; P = 0.036) were independent to anemia. Anemia (Hazard Ratio = 1.894; 95% CI = 1.082-3.318; P = 0.025) was only independently correlated with progression free survival, while bleeding (Hazard Ratio = 1.156; 95% CI = 0.556-2.406; P = 0.698) had no independent correlation. Blood transfusion did not improve progression-free survival in patients with anemia or genital bleeding (P = 0.742).nnnConclusionnWe have proved that genital bleeding requiring intervention during cervical cancer radiotherapy is a negligible prognostic factor and is the independent factor for causing anemia. Easily bleeding tumors are potential prognostic markers, which are not effectively treated using existing radiotherapy.

Prospective study of sentinel lymph node mapping for endometrial cancer

To evaluate sentinel lymph node (SLN) mapping for endometrial cancer, using radioisotope and indocyanine green (ICG) injections.