Naoki Mitsuhashi

Reduction of Adhesions with Fibrin Glue after Laparoscopic Excision of Large Ovarian Endometriomas

STUDY OBJECTIVE To evaluate the effect of fibrin glue on the formation of adhesions after laparoscopic excision of endometriomas. DESIGN Prospective case series. SETTING Department of Obstetrics and Gynecology at a university-affiliated hospital. PATIENTS Thirty women with ovarian cysts. INTERVENTIONS In 10 women (16 cysts) we performed laparoscopic resection of endometriomas leaving the ovarian capsule open. Twenty patients (25 cysts) underwent laparoscopic removal of endometriomas and fibrin glue approximation of the ovarian capsule, as well as coating of serosal defects with the glue. At second-look laparoscopy 4 to 6 months after the initial surgery, postoperative adhesion formation was assessed according to the revised American Fertility Society classification. MEASUREMENTS AND MAIN RESULTS The mean (+/- SEM) adnexal adhesion score in patients without fibrin glue was 8.6 +/- 2.2 at initial surgery and increased slightly to 12.6 +/- 2.6 at second-look laparoscopy. In patients treated with fibrin glue, the score decreased significantly from 10.9 +/- 1.4 to 7.8 +/- 1.3 (p <0.02). The decrease was most marked in women with endometriomas 5 cm or more in diameter and for those with a preoperative adhesion score of 8 or higher. CONCLUSION Fibrin glue reduced postoperative adhesions after laparoscopic resection of endometriomas.

New Method to Prevent Bladder Dysfunction after Radical Hysterectomy for Uterine Cervical Cancer

Objective: The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy.

A Prospective Randomized Study Comparing Endocrinological and Clinical Effects of Two Types of GnRH Agonists in Cases of Uterine Leiomyomas or Endometriosis

Objective: In order to assess the endocrinological changes associated with 2 types of low‐dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis.

Immunoadsorption plasmapheresis as a treatment for pregnancy complicated by systemic lupus erythematosus with positive antiphospholipid antibodies.

PROBLEM: Our purpose was to study the effect of maternal immunoadsorption plasmapheresis (IA) on the outcome of pregnancies complicated by systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies, which were known to have a strong correlation with abortion or stillbirth.

Effects of Fibrin Glue on Postsurgical Adhesions after Uterine or Ovarian Surgery in Rabbits

Objective: To evaluate the prophylaxis with fibrin glue on postoperative adhesions following uterine or ovarian surgery in rabbits.

Direct identification of Streptococcus agalactiae and capsular type by real-time PCR in vaginal swabs from pregnant women

Most group B streptococcus (GBS) infections in newborns are with capsular type Ia, Ib, or III. To prevent these infections more effectively, we developed a real-time PCR method to simultaneously detect GBS species and identify these 3 capsular types in vaginal swab samples from women at 36-39 weeks of gestation. DNA to be detected included those of the dltS gene (encoding a histidine kinase specific to GBS) and cps genes encoding capsular types. PCR sensitivity was 10 CFU/well for a 33-35 threshold cycle. Results were obtained within 2 h. Direct PCR results were compared with results obtained from cultures. Samples numbering 1226 underwent PCR between September 2008 and August 2012. GBS positivity rates by direct PCR and after routine culture were 15.7% (n = 192) and 12.6% (n = 154), respectively. Sensitivity and specificity of direct PCR relative to culture were 96.1% and 95.9%. Of GBS positive samples identified by PCR, capsular types determined directly by real-time PCR were Ia (n = 24), Ib (n = 32), and III (n = 26). Real-time PCR using our designed cycling probe is a practical, highly sensitive method for identification of GBS in pregnant carriers, allowing use of prophylactic intrapartum antibiotics in time to cover the possibility of unexpected premature birth.

Spontaneous uterine rupture at 32 weeks of gestation after previous uterine artery embolization

Uterine artery embolization (UAE) is a common treatment for post‐partum hemorrhage and uterine fibroids. However, the effects of UAE on subsequent pregnancies have not been established. Here, we present a case of spontaneous uterine rupture after previous UAE. A 31‐year‐old woman underwent UAE for a cervical ectopic pregnancy. Contrast‐enhanced magnetic resonance imaging (MRI) at days 5 and 25 post‐UAE suggested a regionally decreased blood supply in the mid‐posterior wall of the uterine fundus. During a subsequent pregnancy at age 35 years, she underwent an emergency cesarean delivery due to spontaneous uterine rupture at the mid‐posterior wall of the uterus at 32 weeks of gestation. Obstetricians should be attentive to the possibility of spontaneous uterine rupture in pregnant women who have previously undergone UAE. Detection of ischemic uterine muscle on MRI may predict potential for uterine rupture in a subsequent pregnancy.

Cardiovascular Responses of Goat Fetuses to Hypercapnia during Extrauterine Incubation Using Extracorporeal Membrane Oxygenation

The purpose of this study was to assess the effects of changes in fetal PaCO2 on circulatory functions without maternal influences. In 5 goat fetuses that were incubated using an extrauterine incubation system with arteriovenous extracorporeal membrane oxygenation, fetal carotid arterial blood flow, heart rate, mean blood pressure, and serum catecholamine levels were determined under the conditions of several grades of hypercapnia without hypoxemia. The hypercapnia was induced gradually by decreasing the flow of gas to the membrane oxygenator located on the extracorporeal circulation system. Fetal arterial CO2 tension increased significantly, from 36.2 +/- 1.1 mm Hg (means +/- SE) to 82.9 +/- 6.5 mm Hg, and the pH decreased significantly, from 7.410 +/- 0.012 to 7.121 +/- 0.028, due to the hypercapnia. In all cases, the fetal carotid arterial blood flow increased significantly (from 42.2 +/- 6.2 to 52.4 +/- 6.2 ml/min). Although a slight increase was observed in the heart rate at the mild hypercapnia stage, severe hypercapnia induced bradycardia in all cases. The mean arterial pressure and rate of extracorporeal circulation were unchanged during hypercapnia. We found that cerebral blood flow increased due to hypercapnias direct effect on the vascular system, but the response of the peripheral chemoreceptor to hypercapnia seemed to be attenuated in chronic stimulation because bradycardia was induced in chronic hypercapnia.

Prenatal management of fetal cardiac tumors : Two case reports

Although primary cardiac tumors are extremely rare, their prenatal and neonatal management is very important because fetal arrhythmia is a frequent complication and such tumors may be the only manifestation of tuberous sclerosis. We present 2 cases of fetal cardiac tumor in which cardiac function was assessed by color Doppler ultrasonography. In both cases, there was no evidence of tuberous sclerosis or cardiac failure and tumor regression was noted 8 months after birth. Ultrasonographic examination of fetal cardiac function was useful in the management of these tumors.