Satoko Fujita

Analysis of Renal Artery Hemodynamics in Normal Fetuses Using the Color Doppler Method

Objective: From analysis of fetal renal artery hemodynamics, we attempted to reveal renal glomerular and tubular function in normal fetuses during pregnancy. Design: The study included 36 cases of normal fetuses from the 20th to the 40th week of gestation; Vmax (the systolic peak velocity of main renal artery), Vmean (time averages of trace of peak velocity) blood flow were initially measured between 20 and 24 weeks of gestation and every 4 weeks thereafter. The measurement was performed a total of five times in a longitudinal study. In addition, the blood flow waveform was concurrently examined. Results: The Vmax was 22.02 ± 0.50 cm/s at 20–24 weeks of gestation. This standard value (100%) was found to increase for each group as follows: 125.2, 149.1, 156.1, and 181.5%. Furthermore, using 20–24weeks of gestation as the standard, the Vmean increased after the 37th week of gestation: 186.7%, respectively. At 20–24 weeks of gestation, the blood flow wave forms consisted of 43.2% type I (only systolic waveforms), and 56.8% type II (both systolic and diastolic waveforms). Type III waveforms (waveforms that extended beyond the diastolic to the next systolic component) were not recognized. In the 33- to 36-week group, 82.6% of the waveforms were type II, and in the 37- to 40-week group, 76.2% of the waveforms were type III. Conclusions: The Vmax and Vmean of the renal artery in normal fetuses exhibit a similar rate increase when 20–24 weeks of gestation is compared to 37–40 weeks of gestation. The blood flow waveforms changed as pregnancy progresses; thus, it was inferred that this finding was related to the development of the renal glomerular and renal tubular function.

Prenatal Diagnosis of the Hemodynamics of Fetal Renal Disease by Color Doppler Ultrasound

Objective: Hemodynamic analysis of the fetal renal artery elucidated the function of the renal glomerulus and renal tubule in normal growth fetus and was weighed against fetal renal disease. Design: The subjects were fetuses from pregnant women who gave informed consent. There were 6 cases of polycystic kidney, 4 cases of hydronephrosis and 33 cases of fetuses presenting with normal growth. A longitudinal study was performed for normal growth fetuses. Using maximum systolic velocity (Vmax), pulsatility index (PI) and resistance index (RI), the blood flow was measured initially at 20–24 weeks of pregnancy and every 4 weeks thereafter. The measurement was performed 5 times in total. Also, for fetal renal disease, the measurement was performed using the same indexes. Results: In 2 cases of polycystic kidney, which led to death due to postpartum afunctional kidney, Vmax indicated the lower level of less than mean –1.5 SD. In 1 case of single hydronephrosis, the single afunctional kidney was observed postpartum due to blood flow disruption. In 7 cases of normal renal function after birth, it indicated the lower level in some gestational ages but was generally in the normal range. Conclusions: Using indexes to evaluate the glomerulus and renal tubule of fetal renal disease, mean –1.5 SD of Vmax can be considered to be the lower limit in the normal range and expected to be an important factor for the final outcome.

Comparison of the digene hybrid capture 2 and Roche cobas 4800 HPV tests for detection of CIN2+ in a referral population in Japan

To examine validity of the hybrid capture‐2 and cobas 4800 HPV tests, 396 women including 188 women visiting for cancer screening, and 208 referral cases were examined with both HPV tests and the liquid‐based cervical Pap test. Concordant results between the HPV assays were observed in 333 cases (coincident rates; 84.1%, kappa value; 0.682). The sensitivity for CIN2+ was 98.6% (69/70) and 82.9% (58/70) for HC2 and cobas 4800 (McNemars test; P = 0.0026). The sensitivity for CIN3+ was 97.2% (35/36) and 83.3% (30/36) (Not significant, P = 0.0736). The specificities for CIN2+ or CIN3+ did not differ between the tests. The HPV16, 52, 18, 31, and 58 were the most common types in CIN2+ cases. Reasonable sensitivity for HPV52, and cross‐hybridization with some probable high‐risk HPV type such as HPV82 explain the higher sensitivity of HC2 than cobas 4800 in detection of CIN2+ in a referral population in Japan.

Single type infection of human papillomavirus as a cause for high-grade cervical intraepithelial lesion and invasive cancer in Japan

To elucidate oncogenic human papilloma virus (HPV) types in Japan, HPV genotyping was performed in 1526 cervical intraepithelial neoplasia (CIN) and 371 invasive cervical cancer (ICC) patients with the novel Genosearch-31+5 HPV test. The HPV-positive rates were 89.3% and 90.8% in CIN and ICC. Regarding single-type infections, 13 internationally recognized high-risk (13HR) types excluding HPV 35, and probably HR HPV 53, 67, 69, and 70 were identified in ICC, suggesting that all these types may be oncogenic. HPV16 and 18 were identified in both SCC and adenocarcinoma (ADC). HPV HPV52, 31 and 58 (alpha-9) were predominantly detected in SCC, whereas HPV 18, 45, 39 and 59 (alpha-7) were in ADC. The prevalence of HPV 18 in SCC significantly decreased with increasing age of patients, whereas the opposite trend was observed in the other HR types. HPV18 is likely to induce SCC rapidly. All ICC cases aged 20–29 were positive for HPV 16 or 18, suggesting that present HPV 16, 18 vaccines may be quite effective to prevent ICC in young women.

Utility of 18F-fluorodeoxyglucose-positron emission tomography in the differential diagnosis of benign and malignant gynaecological tumours

Positron emission tomography/computed tomography (PET/CT) involving 18F‐fluorodeoxyglucose (FDG) is widely used for systemic cancer and recurrence diagnosis. However, the differential diagnosis of benign and malignant gynaecological tumours according to FDG accumulation is unclear. This study aimed to investigate the intensity of FDG uptake/metabolic activity for the differential diagnosis of benign and malignant gynaecological tumours.

Malignant Transformation of an Ovarian Endometrioma during Endometriosis Treatment: A Case Report

Dienogest (DNG) is considered to be effective against ovarian endometrioma (OMA). We report a rare case of OMA transformation to ovarian cancer during long-term endometriosis treatment with a periodic administration of a gonadotropin-releasing hormone agonist (Gn-RH agonist) and DNG. The patient was a 41-year-old Japanese woman. OMA and adenomyosis of the uterus were revealed via computed tomography. Consequently, she underwent conservative treatment without undergoing surgery because her overall status was poor. She received cyclic therapy (Gn-RH agonist and DNG) for approximately eight years. However, she reported lumbago and underwent close medical examination at our hospital after about eight years of treatment. Under the suspicion of malignant transformation, she underwent surgery. The pathological diagnosis was clear cell carcinoma of the right ovary (stage 2B). After surgery, she received six courses of chemotherapy (conventional TC). No evidence of disease was observed after chemotherapy. Our findings suggest that malignant transformation of OMA can occur during DNG treatment. Since the delayed detection of ovarian cancer greatly affects the prognosis, women older than 40 with OMA are encouraged to undergo regular check-ups every few months.

Myeloperoxidase in blood neutrophils during normal and abnormal menstrual cycles in women of reproductive age

We previously reported that granulocyte colony‐stimulating factor (G‐CSF) plays a critical role in ovulation, suggesting that neutrophils may maintain ovulation. We assessed myeloperoxidase (MPO), a major and specific enzyme of neutrophils, in women with abnormal and normal menstrual cycles to clarify the relationship between MPO and ovulation.

P30.08: The usefulness of MRI in the diagnosis of fetal lung maturity

Results: TFLV correlated best with FBV, according to the following cubic fit: TFLV = 2E − 09 × FBV3 − 1E − 05 × FBV2 + 0.0508 × FBV − 1.7934 (r2 = 0.85, P < 0.001). The normal median O/E TFLV based on gestational age in eutrophic fetuses (n = 174) was 99.1% (range, 31.2–158.0%) being higher than that in fetuses ≤ 5th percentile (n = 11; 46.2%; range, 15.7–87.3%, P < 0.01) and lower than in fetuses ≥ 95th percentile (n = 15; 146.8%; range, 87.2–204.2%, P < 0.01). However, the normal median O/E TFLV based on FBV was independent of biometric indices irrespective of the percentile of fetal weight. Conclusion: FBV correlated best with TFLV, irrespective of its biometry. In fetuses suspected of pulmonary hypoplasia, the benefit of FBV in prediction of postnatal survival remains to be determined.

P02.58: Prenatal diagnosis of the hemodynamics of fetal renal disease by color Doppler ultrasound

OBJECTIVE Hemodynamic analysis of the fetal renal artery elucidated the function of the renal glomerulus and renal tubule in normal growth fetus and was weighed against fetal renal disease. DESIGN The subjects were fetuses from pregnant women who gave informed consent. There were 6 cases of polycystic kidney, 4 cases of hydronephrosis and 33 cases of fetuses presenting with normal growth. A longitudinal study was performed for normal growth fetuses. Using maximum systolic velocity (V(max)), pulsatility index (PI) and resistance index (RI), the blood flow was measured initially at 20-24 weeks of pregnancy and every 4 weeks thereafter. The measurement was performed 5 times in total. Also, for fetal renal disease, the measurement was performed using the same indexes. RESULTS In 2 cases of polycystic kidney, which led to death due to postpartum afunctional kidney, V(max) indicated the lower level of less than mean -1.5 SD. In 1 case of single hydronephrosis, the single afunctional kidney was observed postpartum due to blood flow disruption. In 7 cases of normal renal function after birth, it indicated the lower level in some gestational ages but was generally in the normal range. CONCLUSIONS Using indexes to evaluate the glomerulus and renal tubule of fetal renal disease, mean -1.5 SD of V(max) can be considered to be the lower limit in the normal range and expected to be an important factor for the final outcome.

P04.36: Analysis of the hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound—longitudinal comparison to normal fetuses

Objective: To determine the accuracy of ultrasound (US) estimation of fetal weight (EFW) in gastroschisis. Methods: The reliability of US EFW in gastroschisis has been questioned, mainly due to the presumed decrease in abdominal circumference resulting from bowel evisceration. In order to answer this question, we performed a retrospective review of all infants delivered at Thomas Jefferson University Hospital between 1991–2003 with gastroschisis. EFW was determined from the most recent US prior to delivery combined with a correction for normal anticipated interval growth (Williams RL, Obstet Gynecol 1982). Adjusted EFW was then compared with actual birth weight (BW). The primary outcome was the difference between adjusted EFW and BW. Mann-Whitney test was used for comparison of nonevenly distributed continuous variables. Type 1 error was set at 0.05 (two-sided). Results: Overall, US accurately predicted weight in 26 cases of gastroschisis with a mean difference of 2% ± 15% SD. However, there was a trend for US < 36 w GA to overestimate BW, compared to US ≥ 36 w GA: 45% vs. 0%, p 0.09. Similarly, when anticipated normal growth was factored in, US performed ≥ 2 w from delivery was more likely to overestimate BW than US < 2 w from delivery: 90% vs. 0%, p < 0.001. Infants born < 36 w (N = 10) had a mean BW at the 52% for GA compared to 37% for infants born ≥ 36 w (N = 16), p 0.14. No infants born < 36 w were < 10% for GA, compared to 12.5% born ≥ 36 w, p 0.51. Conclusions: Overall, US is an accurate predictor of fetal weight in gastroschisis. When compared to the expected growth rate of normal fetuses, the rate of fetal growth appears to be slower in fetuses with gastroschisis, particularly after 36 w GA.