Satoshi Asai

Pseudoaneurysm of the uterine artery after laparoscopic myomectomy

OBJECTIVE To describe a case of uterine pseudoaneurysm after laparoscopic myomectomy in a 36-year-old woman. DESIGN Case report. SETTING University hospital. PATIENT(S) A 36-year-old woman, 3 months after laparoscopic myomectomy, presenting with an intrauterine hypoechoic lesion measuring 5 cm in diameter. INTERVENTION(S) Uterine pseudoaneurysm was diagnosed by color Doppler ultrasound. MAIN OUTCOME MEASURE(S) Complete resolution of the pseudoaneurysm. RESULT(S) Spontaneous thrombosis was observed in the pseudoaneurysm. At 6-month follow-up, the uterus appeared normal. CONCLUSION(S) Our case presents the possibility of delayed occurrence of uterine pseudoaneurysm after laparoscopic myomectomy.

Expression of Ovary-Specific Acidic Protein in Steroidogenic Tissues: A Possible Role in Steroidogenesis

Ovary-specific acidic protein (OSAP) is a novel molecule discovered from a genomic project designed to identify ovary-selective genes in mice. Whereas public databases suggest extraovarian expression of OSAP, its tissue distribution has not yet been well documented. Thus, the expression profile of mouse and human OSAP was determined by quantitative real-time RT-PCR using RNAs isolated from various tissues. The results demonstrate that the human and mouse OSAP expression profiles are similar; OSAP is prominently expressed in steroidogenic tissues with the highest level of expression observed in the adrenal gland. Placenta served as an exception and possessed minimal level of OSAP mRNA. Immunohistochemical studies show that mouse OSAP localizes almost exclusively to the steroid-producing cells of the ovary, adrenal gland, and testis. Consistent with predictions made by several subcellular localization algorithms, dual labeling studies in Y-1 mouse adrenocortical cells indicate OSAP resides in the mitochondria. Because of its abundant expression in steroidogenic cells and mitochondrial localization, a role for OSAP in steroidogenesis was determined. OSAP silencing by specific small interfering RNAs significantly inhibits 8-bromoadenosine-cAMP-induced progesterone production in Y-1 cells. Reduction in OSAP levels results in mitochondrial fragmentation and a decrease in the cellular content of mitochondrial DNA, indicative of decreased mitochondrial abundance. Lastly, 8-bromoadenosine-cAMP does not regulate OSAP protein expression in Y-1 cells as is the case for other steroidogenic components known to be induced by cAMP. Collectively these results suggest that OSAP is involved in steroidogenesis, potentially through its ability to maintain mitochondrial abundance and morphology.

Laparoscopic Cystectomy of Ovarian Teratoma in Anti-NMDAR Encephalitis: 2 Case Reports

We present 2 case reports of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis that was successfully treated via laparoscopic ovarian cystectomy. In both cases, resection of an ovarian teratoma resulted in eventual full recovery. Although adnexectomy has been reported for tumor resection in anti-NMDAR encephalitis, we chose ovarian cystectomy to preserve ovarian function. The efficacy of cystectomy is equivalent to that of adnexectomy. This suggests that ovarian adnexectomy may not be necessary in anti-NMDAR encephalitis with ovarian teratoma.

Pancreatic β-cell function and fetal growth in gestational impaired glucose tolerance

Objective. To investigate the metabolic phenotype and pregnancy outcomes of gestational impaired glucose tolerance (IGT) defined by isolated hyperglycemia during an oral glucose tolerance test (OGTT). Design. Retrospective cohort study. Setting. University referral hospital. Population. A total of 4,789 women were screened for gestational diabetes mellitus (GDM) between 1996 and 2008 with a glucose challenge test (GCT), followed by a 2‐hour 75‐g OGTT if the GCT result was abnormal; in addition, measurement of plasma insulin concentration during the OGTT was implemented from 2004. Methods. The insulin sensitivity (ISOGTT) and β‐cell function (insulinogenic index/homeostasis model assessment for insulin resistance) were calculated for 283 women who underwent a diagnostic OGTT between 2004 and 2008. Perinatal complications were examined in 4,789 women who were screened for GDM between 1996 and 2008. Main outcome measures. Comparison of outcomes among women stratified by glucose tolerance status using the GCT and OGTT profiles. Results. Insulin sensitivity and β‐cell function significantly decreased from normal OGTT to 2‐hour IGT (single hyperglycemia at 2 hours) to 1‐hour IGT (single hyperglycemia at 1 hour) to GDM, with significant differences between normal OGTT and 1‐hour IGT or GDM. The occurrence of large‐for‐gestational age (LGA) neonates was significantly increased in women with GDM or 1‐hour IGT (adjusted odds ratio: 2.15, 2.22; 95% confidence interval 1.23–3.75 and 1.04–4.35, respectively) compared to those with normal GCT or normal diagnostic OGTT results. Conclusions. Like GDM, isolated 1‐hour hyperglycemia on the OGTT is associated with β‐cell dysfunction and an increased risk for LGA neonates.

The Periphery of the Human Fetal Adrenal Gland Is a Site of Angiogenesis: Zonal Differential Expression and Regulation of Angiogenic Factors

CONTEXT Although the inner fetal zone (FZ) of the mid-gestation human fetal adrenal (HFA) produces dehydroepiandrosterone sulfate, the function of the outer definitive zone (DZ) remains less clear. We have proposed that the DZ phenotype is that of a pool of progenitor cells, many of which are mitotically active. Recently, we studied HFA expression of a family of vascular endothelial cell-specific angiogenic factors, the angiopoietins (Angs), and demonstrated that Ang2 was localized predominantly in the periphery of the gland. Ang1 stabilizes, whereas Ang2 destabilizes, vessels, increasing responsiveness to angiogenic stimuli such as vascular endothelial growth factor (VEGF)-A and fibroblast growth factor (FGF)-2. OBJECTIVE Our objective was to test the hypothesis that the periphery of the HFA is a site of angiogenesis. DESIGN Studies were conducted involving RNA, frozen sections, and primary cell cultures from midgestation HFAs. MAIN OUTCOME MEASURES Immunofluorescence, laser capture microdissection, and real-time quantitative RT-PCR were used. RESULTS Double immunostaining demonstrated that proliferating endothelial cells were limited to the DZ and DZ/FZ border. Ang2 mRNA was primarily expressed in the DZ, whereas Ang1 mRNA was primarily in the FZ. VEGF-A and FGF-2 mRNA levels were higher in the DZ. FGF-2 (10 ng/ml) induced Ang2 mRNA by 4-fold in both zones of cells (P < 0.01, at 24 h), but not Ang1 or VEGF-A mRNA. CONCLUSION Data suggest that angiogenesis occurs at the periphery of the HFA. The DZ-predominant expression of Ang2 may be explained, in part, by the parallel pattern of FGF-2 expression.

Prenatal diagnosis of retroperitoneal teratoma: a case report and review of the literature.

We report a case of retroperitoneal teratoma diagnosed prenatally by serial sonographic examinations in the third trimester. A 29-year-old woman was referred for sonographic evaluation at 33 weeks’ gestation because of a fetal intra-abdominal mass. Our initial sonographic image suggested a neuroblastoma. Repeat ultrasound images demonstrated an increase in size of the tumor, while the content of the tumor became predominantly solid with areas of calcification. Teratoma should be considered on detection of any cystic or mixed semisolid mass, especially when calcification is present. The fetus was prenatally diagnosed with retroperitoneal teratoma. After birth at 39 weeks, the tumor was removed and histological analysis revealed an immature retroperitoneal teratoma. Intensive monitoring of the changes in ultrasound images of the tumor should provide ground for a precise antenatal diagnosis.