Osamu Naka

The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer

Aim:  The objective of this study was to verify the impact of systematic retroperitoneal lymphadenectomy on survival in patients with ovarian cancer.

Myocardial infarction as a complication of pheochromocytoma in a pregnant woman

Pheochromocytoma is an unusual cause of hypertension during pregnancy. We present a 40-year-old woman who had a myocardial infarction during pregnancy in whom pheochromocytoma was subsequently diagnosed. This disorder carries a high risk of maternal and perinatal mortality, if undiagnosed prior to delivery. Therefore, the diagnosis of pheochromocytoma should be considered in pregnant patients who exhibit a marked fluctuation in hypertension. Urinary concentrations of catecholamines and their metabolites should be measured in such cases.

Plasma Exchange in a Patient with Postpartum HELLP Syndrome

The case of a patient with HELLP syndrome, who was unresponsive to supportive management but successfully treated with plasma exchange, is presented. The significance of plasma exchange in the treatment of HELLP syndrome is discussed.

Ultrasonography and magnetic resonance imaging findings in a patient with an unruptured interstitial pregnancy

We report a case of an unruptured interstitial pregnancy, which showed characteristic ultrasonographic and magnetic resonance imaging (MRI) findings. Color and pulsed Doppler sonography may facilitate early diagnosis of interstitial pregnancy. MRI may play some role in the diagnosis of this entity when ultrasound studies are insufficient or equivocal.

Immunosuppressive 30-kDa protein in urine of pregnant women and patients with trophoblastic diseases

Urine samples obtained from normal pregnant women and patients with trophoblastic diseases contain 30-kDa protein that suppresses phytohemagglutinin-induced T cell proliferation. The immunosuppressive protein was measured by a newly developed radioimmunoassay. The 30-kDa protein was demonstrated in almost all urine samples examined, fluid from hydatid vesicles and chorionic extracts, but not in any serum samples except at low levels in some sera from patients with choriocarcinoma. During pregnancy, the level of urinary 30-kDa protein was higher in the first (1625.5 +/- 1212.0 ng/ml, mean +/- S.D.) and second (1457.4 +/- 1332.4 ng/ml) trimesters than in the third trimester (460.6 +/- 419.0 ng/ml). The urinary 30-kDa protein/hCG ratios in patients with choriocarcinoma (8.3 +/- 10.9) were significantly higher than those in patients with hydatidiform mole (0.67 +/- 1.00, P < 0.01) and in all trimesters than those of normal pregnant women (0.54 +/- 0.44 in first trimester, P < 0.05; 0.63 +/- 0.46 in the second trimester, P < 0.05; 0.24 +/- 0.17 in the third trimester, P < 0.01). There is no significant difference between the ratios in hydatidiform mole and normal pregnancy. These findings and the fast disappearance of the 30-kDa protein from the circulation suggest that the 30-kDa protein plays a part in proliferation of trophoblastic cells in, or their invasion into the host by locally suppressing the immune reaction of the host and that the increase in the urinary 30-kDa protein level, in cases of choriocarcinoma, may be due to the malignant transformation of trophoblastic cells resulting in their rapid invasion.

Difference of the Hormonal Profile at the Periovulatory Phase in Pregnant and Nonpregnant Cycles of Infertile Women with Unexplained Etiology

Ten women with unexplained infertility, who conceived by intrauterine insemination (IUI) or timed intercourse under controlled ovarian hyperstimulation, were analyzed to investigate the difference of hormonal environment at the periovulatory phase. Forty-two cycles were divided into three groups: the pregnant cycle group, the high luteinizing hormone (LH) group (LH > or = 60 mIU/ml on day -1: the day of human chorionic gonadotropin administration) of nonpregnant cycles and the low LH group (LH < 60 mIU/ml on day -1) of nonpregnant cycles. Progesterone (P4)/estradiol (E2) ratios of the high LH group on day -1 and day 0 were significantly higher than those of each corresponding day in the pregnant cycle. On the other hand, P4/E2 ratio of the low LH group on day +1 was significantly lower. P4/E2 ratio but absolute level of each hormone showed a high indicative value for the estimation of abnormal hormonal environment. It is concluded that the P4/E2 ratio at the periovulatory phase is a good parameter to estimate the efficacy of the method for ovulation induction.

Detection of anti-zona pellucida activities in human sera by the passive hemagglutination reaction**Supported in part by a grant-in-aid (56570569) for scientific research from the Ministry of Education of Japan and from the Ministry of Health and Welfare of Japan for research on handicapped children.

A simple method of detecting anti-zona activities in human sera has been developed by passive hemagglutination reaction ( PHAR ) using bovine erythrocytes as indicator cells coated with purified porcine zona substance. By this test, 8 of 88 serum samples (9.1%) from infertile women gave positive reactions, whereas only 1 of 90 control sera (1.1%). A positive immunofluorescence (IF) assay confirmed the results of the PHAR in seven of the eight positive samples. Positive PHAR and IF on porcine zonae were abolished after adsorption with porcine erythrocytes, but IF on human zonae was retained by four of eight serum samples, indicating the presence of anti-zona autoantibodies in these infertile sera that were directed to an antigen(s) proper to human zonae.