Michio Nakayama

Acute glomerulonephritis during the third trimester of pregnancy

We report a very rare case of acute poststreptococcal glomerulonephritis (PSGN) occurring in the eighth gestational month. The pregnancy succeeded despite initially severe nephrotic syndrome, and after delivery there was a complete recovery to normal renal function. Fetal prognosis was also good. The diagnosis of PSGN was made based on serological examinations and postpartum renal biopsy. Light and electron microscopic findings showed that the glomerular lesions were different from those of typical pre‐eclampsia.

Serial serum determination on α-fetoprotein as a marker of the effect of postoperative chemotherapy in ovarian endodermal sinus tumor

Serial serum determinations of alpha-fetoprotein (alpha FP) as a tumor marker were carried out in the management of six patients with endodermal sinus tumor (EST). Histological examinations in all six patients revealed a typical EST pattern, and in one of them another germ cell tumor, a malignant teratoma, was also found. All patients were treated postoperatively with combination chemotherapy. The serum alpha FP concentrations before treatment, using radioimmunoassay, were abnormally high and ranged from 2500 to 100,000 ng/ml. One patient having Stage Ia neoplasm is living at 50 months after diagnosis with a normal alpha FP concentration and without clinical evidence of recurrence. The other five patients with Stage III disease died from 4 to 9 months after surgery, respectively, although the serum alpha FP in all these cases during chemotherapy decreased markedly but temporarily to a normal level (less than 20 ng/ml) or to 3000 ng/ml and was paralleled by a certain improvement in the conditions of the disease. These results suggest that serial serum determination of alpha FP may be useful as a marker and prognostic indicator of endodermal sinus tumor.

Maternal and fetal plasma steroid hormone levels in vaginal delivery with and without ACTH infusion.

Radioimmunoassay tests were performed on the plasma of healthy women before, during and after labor and on plasma from the umbilical cord of their newborns at delivery to determine the levels of cortisol, progesterone and unconjugated estradiol‐17β (estradiol) and estriol. The levels of plasma cortisol found in six women just before delivery were statistically higher than the levels found in the same women before the onset of labor. The fetal plasma cortisol level found just after delivery was considerably lower than the maternal level, and the difference was statistically significant. The levels of plasma estradiol and estriol did not change in seven women during labor. In the newborn infants, these levels were significantly higher than the maternal levels. When adrenocorticotrophic hormone (ACTH) was infused into four women during labor, the levels of plasma cortisol increased slightly, but not significantly. The maternal plasma levels of both estradiol and estriol did not differ from the control values, while in the newborn infants these levels were significantly lower than those normally found. During labor, there was no difference between the plasma progesterone levels found in women who had been treated with ACTH infusion and in those who were not treated with ACTH. The results of this study suggest that an infusion of ACTH during labor causes the maternal adrenal cortex to increase the synthesis of corticosteroids. The corticosteroids then cross the placental barrier from the maternal to the fetal side and suppress the production of the estrogen precursor in the fetal adrenal gland, which results in lowered fetal plasma estrogen levels.

Rapid assays of urinary estriol in pregnant women.

Two devices designed for rapid assay of urinary estriol, the E3 KIT and the E3 HAIR KIT, were evaluated using urine samples taken from pregnant women. Additionally, the clinical application of these devices in pregnancy management was examined. Correlations were high between an established method and the E3 KIT method (r=0.819, p<0.001) and between the E3 HAIR KIT method and the E3 KIT method (r=0.936, p<0.01). E3 HAIR KIT assays showing E3 values of less than 20 μg/ml (positive at 100‐fold dilution of the urine) after the 36th week of pregnancy suggested fetoplacental dysfunction and indicated that more detailed tests were required. The E3 KIT, which provided rapid quantitative assay of urinary estriol, was capable of measuring 10 samples in approximately 3 hours. The E3 HAIR KIT provided semiquantitative assays of 10 samples in 2 hours. The speed, simplicity, and accuracy of the E3 HAIR KIT indicates its high clinical value as a prospective large‐scale screening method for fetoplacental function.