Norichika Ushioda

Hyperemesis Gravidarum in Eastern Asian Population

Objective: To investigate the clinical features of hyperemesis gravidarum in Eastern Asian women. Method: Retrospective cohort study was conducted based on delivery records. Hyperemesis gravidarum was defined as a pregnancy with severe nausea and vomiting necessitating hospitalization with a body weight loss of over 5% from pre-pregnancy weight with ketonuria. The onset is at 10 weeks of gestation or less. Maternal and neonatal variables were compared. Result: There were 3,350 singleton deliveries in the study period. All subjects were Eastern Asian women. Hyperemesis gravidarum was observed in 119 cases (3.6%). Hyperemesis gravidarum subjects had a smaller pre-pregnancy body weight (50.5 ± 0.64 kg vs. 51.8 ± 0.16 kg, p = 0.046) and a smaller pre-pregnancy body mass index compared to non-hyperemetic subjects (20.2 ± 0.21 kg/m2 vs. 20.8 ± 0.06 kg/m2, p = 0.02). Conclusion: The Eastern Asian population had a significantly higher incidence of hyperemesis gravidarum. Small pre-pregnancy body habitus increased the risk of hyperemesis gravidarum.

Parental aging synergistically decreases offspring sex ratio

Objective:  The aim of this study was to investigate the effect of parental age as a factor in the observed decline in the male to female birth ratio expressed as the offspring sex ratio (OSR).

Change of salivary stress marker concentrations during pregnancy: Maternal depressive status suppress changes of those levels

Aim:  The aim of the present study was to show changes in salivary cortisol and chromogranin A/protein concentrations as stress markers during pregnancy and to clarify the effect of chronic stress on stress markers.

Increased leukocyte distribution in the pre-clinical stage of pre-eclampsia

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Correlation of neuron-specific enolase and S100B with histological cerebral damage in fetal sheep after severe asphyxia

Experimental brain damage was induced in 16 fetal sheep by umbilical cord occlusion, and the correlation of neuron-specific enolase (NSE) or S100B with the damage grade was investigated in seven fetuses. Significant correlations of damage degree with NSE (p = 0.016) and S100B (p = 0.018) in serum 2 h after insult were shown by Spearmans test. These findings suggest that they represent potentially useful markers for detecting brain damage at early stage after ischemic insult.

Timing of cisplatin administration for chemoradiotherapy in transgenic mice bearing lens tumors.

Cisplatin-based concurrent chemoradiotherapy (CCRT) has become a standard treatment for cancer of the uterine cervix. However, there have been no investigations into the optimum timing for administration of anticancer drugs using animal models. The aim of the present study was to determine the appropriate timing for administration of the anticancer drug cisplatin in relation to delivery of radiation by assessing the antitumor activity and adverse effects of 3 different regimens in αT3 transgenic mice bearing lens epithelial tumors. CCRT showed the strongest antitumor activity. There was a significant difference between CCRT and administration of cisplatin before radiotherapy (neoadjuvant therapy) with regard to the apoptotic effect detected by TUNEL staining, but there was no significant difference between CCRT and administration of cisplatin after radiotherapy (adjuvant therapy). Assessment of adverse effects showed that there were no significant differences in the mortality rate, weight loss, anemia and leukopenia among the 3 regimens. In conclusion, these findings obtained in an animal model suggest that cisplatin should probably not be administered before irradiation, since the antitumor effect is significantly weaker than that of CCRT or administration after irradiation, while adverse effects are similar.

Maternal urinoma during pregnancy

Urinoma is peripelvic extravasation of urine seen as the squeal of urinary trauma or stones. Little is known about maternal urinoma during pregnancy. A 27‐year‐old primigravida presented with gradual worsening right flank pain at 215/7 weeks of gestation. She denied any past medicosurgical history. Initial work‐up revealed cost‐vertebral angle tenderness and mild hydronephrosis by ultrasonography. Her symptom worsened and follow‐up ultrasonography was performed 48 h later, which showed worsened hydronephrosis with large perinephric fluid collection. A Double‐J stent was placed under cystoscopy. After the placement, the patients symptoms improved quickly. The stent was removed three weeks later. The patient delivered vaginally at 39 weeks of gestation without complication. Maternal urinoma during pregnancy developed in the right side of the kidney in five of six reported cases (83.3%), and all were seen in the second half of pregnancy. All showed flank pain as the initial presentation. Ultrasonography for diagnosis was used in half of the patients. Fifty percent underwent Double‐J stent before delivery and 16.7% after delivery. All cases delivered at term and 33.3% underwent cesarean delivery. Maternal urinoma is an important differential diagnosis for flank pain during pregnancy. Double‐J stent placement was the main management. Close monitoring of the symptom with serial ultrasonography may be the key for diagnosis.

Maternal positioning and fetal positioning in utero.

Aim:  Approximately two‐thirds of term vertex fetuses are in the left occiput position in utero. However, little is understood about the physiology of maternal–fetal positioning during pregnancy. It was hypothesized that fetal left occiput positioning is affected by maternal positioning. The present study was designed to investigate the relationship between maternal positioning in late pregnancy and fetal positioning in utero.

Assessing the effect of guideline introduction on clinical practice and outcome in patients with endometrial cancer in Japan: a project of the Japan Society of Gynecologic Oncology (JSGO) guideline evaluation committee

Objective The Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system. Methods Data of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model. Results In total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003). Conclusion It was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome.

A case of serous endometrial intraepithelial carcinoma with p53 positivity for six years.

A 69‐year‐old postmenopausal woman was referred because she had been taking tamoxifen for four years. Tissues obtained by endometrial curettage were immunopositive for p53, but there was no definite malignancy. At age 73, cytology again showed abnormalities, so we repeated complete endometrial curettage. Again, there was no malignancy, but p53 immunostaining was widely positive. At age 75, hysterectomy was performed because cytological examination showed increasingly abnormal findings and the patient opted for surgery. In the resected uterus, endometrial glands were replaced by malignant cells resembling papillary serous carcinoma cells with high‐grade nuclei, but there was no stromal or myometrial invasion. The pathological diagnosis was intraepithelial serous endometrial carcinoma. This is a rare case because we could follow the patient for 6 years by endometrial cytology or endometrial curettage and we observed gradual transformation into endometrial intraepithelial carcinoma.