Shigeki Minoura

Ovarian leiomyosarcoma: an autopsy case report.

Primary non‐specific sarcoma of the ovary is extremely rare, and only 22 reported cases of pure leiomyosarcoma (LMS) are known to the authors. We present an autopsy case of a primary ovarian leiomyosarcoma in a 73‐year‐old woman. She had noticed an abdominal mass after difficulty in defecating for several months. The excision of tumor with bilateral salpingo‐oophorectomy and hysterectomy was carried out. A diagnosis of pure leiomyosarcoma of the left ovary was made on pathological examination with immunohistochemistry. Adjuvant radio–chemotherapy was not given. At 18 months’ follow up, abdomino‐pelvic sonography revealed an abdominal tumor and hepatic metastasis. The patient died 3.5 years after the initial surgery. The post‐mortem examination revealed a peritoneal recurrent tumor and extensive distant metastases of the liver, lungs, pancreas, gastric mucosa, muscle and skin. The prognosis of the ovarian LMS is poor from the pertinent literature. Several prognostic indicators on histology including mitotic activity, proliferative activity and p53 status of the tumor are discussed.

Establishment of a prediction method for premature rupture of membranes in term pregnancy using active ceruloplasmin in cervicovaginal secretion as a clinical marker

Aim: Term pregnancy complicated by premature rupture of membranes (PROM) is thought to be associated in part with subclinical infection, and places mothers and neonates at an increased risk for several complications. Therefore, perinatal care would be greatly helped if a reliable clinical measure were available for predicting the incidence of PROM.

Hyalinizing spindle cell tumor with giant rosettes of the omentum

We report the first case of a hyalinizing spindle cell tumor with giant rosettes of the omentum. The mesenchymal tumor arises from a multiplication of fibroblastic cells containing large rosette‐like structures composed of a central collagen core surrounded by plump oval to spindle tumor cells. A 38‐year‐old woman exhibited the symptom of abdominal pain in the right side, with a correlated sensation of a mass in the same area. A tumor consisting of both solid and cystic cytologic features was subsequently diagnosed, on the right side of the uterus. Her serum level of CA‐125 was only slightly elevated. Surgical intervention indicated that the tumor originated from lower pole of the omentum and the histological diagnosis was hyalinizing spindle cell tumor with giant rosettes. The metastatic potential of this type of tumor is considered similar to that of the metastatic low‐grade fibromyxoid sarcoma, which indicated the need for careful clinical follow up of this case.

Rapid Detection of Chromosome Aneuploidies by Prenatal Interphase FISH (Fluorescence in situ Hybridization) and Its Clinical Utility in Japan

Objective: The purpose of this study was to assess the accuracy, informative rate, detection rate, and clinical utility of prenatal interphase fluorescence in situ hybridization (FISH) analysis of amniotic fluid samples from Japanese women.

A case of a primary ovarian leiomyosarcoma.

A primary ovarian leiomyosarcoma is extremely rare. Moreover, there is no established treatment modality other than surgery, and the prognosis is extremely poor. We report a case of a primary ovarian leiomyosarcoma.

Habitual use of warm-water cleaning toilets is related to the aggravation of vaginal microflora

Aim:  Warm‐water cleaning toilets, or ‘bidet toilets’, are one of the most popular household goods in Japan. However, a recent large‐scale survey raised questions about the relationship between bidet toilet use and bacterial vaginitis as reflecting bacterial vaginosis with inflammation. Recently, gynecologists have expressed concerns about the increase in aggravated vaginal microflora in habitual bidet users. Therefore, the present study was designed to clarify the possible relevancy of bidet usage to changes in vaginal microflora.

Prolonged Fetal Bradycardia as the Presenting Clinical Sign in Congenital Syphilis Complicated by Necrotizing Funisitis: A Case Report

Syphilis remains a serious cause of neonatal morbidity and mortality worldwide. In this paper, we describe a case of congenital syphilis that was fully supported by abnormal fetal heart rate patterns and placental histopathological evidence. A 24-year-old para 4 woman, who did not attend antenatal care, was admitted to our hospital with a complaint of abdominal discomfort at an estimated 31-week gestation. Fetal heart rate monitoring showed prolonged bradycardia. A neonate weighting 1,423 g with severe birth asphyxia was immediately delivered by cesarean section. Following delivery, the mother and the neonate were diagnosed with syphilis. Histopathological examination confirmed severe chorioamnionitis and necrotizing funisitis with numerous Treponema pallidum. Conclusions. Challenges in establishing the diagnosis of necrotizing funisitis are essential for optimal management of a fetus with a systemic inflammatory response in utero.

Chronic hepatitis B infection in pregnancy illustrated by a case of successful treatment with entecavir.

Chronic hepatitis B virus (HBV) infection affects more than 350 million people worldwide [1]. The pregnancy courses of women with chronic HBV infection are generally favorable. However, severe complications of chronic HBV infection can occur during pregnancy. Optimal antiviral treatment of HBV infection during pregnancy is unclear. Keeffe et al. [2] have recommended individualization of therapy for pregnant HBV patients. chronic hepatitis B (CHB) with acute exacerbation has a high fatality rate up to 20–30% [3]. There are few reports on the management of CHB with acute exacerbation during pregnancy [4–7]. We present a successful pregnancy outcome of a woman treated with entecavir for CHB with acute exacerbation during pregnancy. A 36-year-old para-2 woman with CHB attended antenatal care visits our hospital from 6 weeks of gestation. She was diagnosed with CHB for the first time as a result of antenatal HBV screening on her first pregnancy. Since diagnosis, she has been followed by a gastroenterologist at our hospital and has been asymptomatic with the HBV DNA levels of approximately 7 log10 copies/mL and a normal alanine aminotransferase (ALT) level prior to the pregnancy described herein. Her previous pregnancies were uneventful and all resulted in full-term spontaneous deliveries. At 13-week gestation, she complained of fatigue and jaundice. Laboratory findings revealed a total bilirubin level of 3.6 mg/dL, a serum ALT level of 1,309 IU/L, a serum aspartate aminotransferase level of 2,386 IU/L and a lactate dehydrogenase level of 1,252 U/l. She was positive for hepatitis B surface antigen (HbsAg), hepatitis B e antigen (HbeAg) and HBV DNA in her serum. The HBV DNA level was greater than 7.6 log10 copies/mL. Hepatitis B e antibody (HbeAb) was not detected in her serum. Treatment with oral entecavir (0.5 mg/day) was initiated immediately for CHB with acute exacerbation. After initiation of treatment, she showed rapid clinical improvement; her ALT level decreased to 46 IU/L, and her HBV DNA level decreased to 4.6 log10 copies/mL at 2 weeks after initiation of treatment. Entecavir therapy was withdrawn after 32 days of therapy. She underwent hepatitis B e seroconversion during the course of treatment. After cessation of treatment, the patient showed no signs of a hepatitis flare-up. The HBV DNA level reached a plateau of approximately 3 log10 copies/mL with ALT normalization at 6 weeks after initiation of treatment. The spontaneous delivery of a male baby weighing 2,950 g occurred at 39 weeks gestation. The baby had Apgar scores of 8 and 9 at 1 and 5 min. The patient did not experience any adverse effects as the result of the treatment throughout the whole course of the pregnancy. The neonatal physical check-up revealed no congenital anomalies. The patient and the baby did not experience any complications during the postpartum period. Decisions about initiating treatment for HBV infection during pregnancy must include consideration of the risks and benefits for the mother and the fetus. Data on the safety of antiviral treatment of HBV during pregnancy remain limited. The US Food and Drug Administration lists telbivudine and tenofovir as pregnancy category B drugs and lamivudine, entecavir and adefovir as pregnancy category C drugs. Lamivudine is considered safe for use during J. Kakogawa (&) A. Sakurabashi M. Sadatsuki H. Gomibuchi S. Minoura Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Tokyo, Toyama 162-8655, Japan e-mail: jkakogaw@hosp.ncgm.go.jp

Postpartum maternal pneumococcal meningitis complicated by endocarditis

Bacterial meningitis is associated with high morbidity and mortality. Few cases of pneumococcal meningitis during pregnancy and the postpartum period have been reported. We describe a case of postpartum pneumococcal meningitis complicated by endocarditis. A 26‐year‐old para‐2 woman who had had a normal vaginal delivery at 38 weeks at a maternity home was transported to our hospital with a 39.5°C fever 11 days postpartum. Eight hours after her arrival, her state of consciousness deteriorated rapidly. Lumbar puncture revealed Gram‐positive cocci consistent with Streptococcus pneumoniae. She was immediately treated with antibiotics and subsequently diagnosed with endocarditis. Final culture results from the blood and cerebrospinal fluid confirmed the presence of S. pneumoniae. She recovered completely with no evidence of neurological damage. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential to reducing the morbidity and mortality associated with bacterial meningitis.

Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area

Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of nonattenders. Results. A total of 83 attenders and 45 nonattenders were enrolled. The mean gestational age at the first PNC visit was 31.1 weeks in the attenders. Attenders were found to have a lower incidence of preterm delivery, pregnancy-induced hypertension, emergency cesarean section, low birth weight, and the NICU admission than nonattenders (P < 0.05). Conclusions. The utilization of social service PNC greatly improved perinatal outcomes among women with socioeconomic problems problems in the Tokyo metropolitan area.