Takeyoshi Kubota

A Study of Tubo-Ovarian and Ovarian Abscesses, with a Focus on Cases with Endometrioma

Objective: To determine the incidence and causes of endometrioma‐associated tubo‐ovarian abscesses (TOAs) and ovarian abscesses.

Evaluation of Insulin‐Like Growth Factor Binding Protein‐1 as a Diagnostic Tool for Rupture of the Membranes

Objective:To evaluate the diagnostic value of insulin‐like growth factor binding protein‐1 (IGFBP‐1) as an indicator of ruptured fetal membranes.

Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan.

Objective: To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who attended a sexually transmitted disease (STD) clinic in Tokyo. Methods: Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects for HBs antibody and antigen and HCV antibody. Results: HIV antibodywas not detected in either CSW or control subjects. The positive rates for HBs antigen and antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV antibody positive rate was 3.2% in the CSW group and 0.4% in the control group. Conclusion: A statistically significant difference between the two groups was observed only in HCV antibody positive rate. STD checkup for CSW alone is inadequate – STD health education and screening for the general public are also required.

Cytodiagnosis of placental site trophoblastic tumor. A report of two cases.

BACKGROUND Placental site trophoblastic tumor (PSTT) is a rare form of trophoblastic neoplasm. Approximately 100 cases of PSTT have been reported, but we found no report on its cytodiagnosis. CASES Case 1, a 39-year-old female, came to the hospital because of abnormal genital bleeding. Case 2, a 36-year-old female came because of amenorrhea for a year. In both cases, endometrial smear and intrauterine curettage suggested trophoblastic disease, and hysterectomy was performed. Laboratory data revealed a mild increase in human chorionic gonadotropin (hCG) and beta-hCG but normal human placental lactogen (hPL). In the cytologic examination, the background contained some hemorrhagic and fibrinous areas but no necrosis. Most tumor cells stained light green, were round or polygonal, and contained abundant cytoplasm. Some were palely stained and had vacuoles. Some cells showed hyperchromatism, an irregular nucleus, fine-to-coarse chromatin granules and markedly different sizes. Most of the cells were hPL positive, and a few were hCG positive. CONCLUSION Both cases were considered benign because of rare mitoses despite cellular pleomorphism. However, careful follow-up is required. The differential diagnosis of PSTT is difficult from cytologic and biopsy specimens alone but may be achieved with additional magnetic resonance imaging findings and positive staining of hPL and hCG.

Prevalence of Human Papillomavirus Infection and Its Correlation with Cervical Lesions in Commercial-Sex Workers in Japan

Objective: To investigate the prevalence of the human papillomavirus (HPV) infection and its correlation with cervical lesions in commercial‐sex workers (CSWs) who attended a sexually transmitted disease (STD) clinic in an entertainment area in Tokyo.

Cytodiagnosis of vaginal endodermal sinus tumor. A case report.

BACKGROUND Endodermal sinus tumor (EST) of vaginal origin is extremely rare, and few previously published reports have described the cytology of this tumor. CASE A high serum alpha-fetoprotein (AFP) level and magnetic resonance imaging findings in a 10-year-old female suggested EST of the lower genital tract. Laparotomy revealed EST occupying the pelvic cavity. The patient died on the 17th postoperative day due to complications from disseminated intravascular coagulation. Autopsy was performed immediately after death. The tumor originated in the posterior vaginal wall directly below the ectocervical area. Both ovaries were involved, and the tumor proliferated to occupy the cavity of the pelvis minor. A vaginal smear, obtained on two occasions, revealed severe necrosis with few cells, and a diagnosis could not be made. An imprint smear of the tumor obtained during surgery showed relatively characteristic cytologic findings of EST. Immunocytochemical and immunohistochemical studies revealed staining positive for AFP. CONCLUSION Vaginal EST usually occurs in patients under 3 years of age. This 10-year-old patient was the oldest among the reported cases. Vaginal EST is clinically similar to sarcoma botryoides and clear cell carcinoma, and a differential diagnosis is necessary. Immunocytostaining for AFP is essential for a definitive cytologic diagnosis of EST.

Organisms Detected in the Uterine Adnexa in Patients with Adnexal Infections at different Stages of the Inflammatory Process

This study investigated organisms causing uterine adnexal infections by examining specimens from the adnexa obtained by laparoscopy or laparotomy. Forty-nine organisms were detected from 45 patients with adnexal infections. Of these patients, a subgroup of 35 had no recent delivery or invasive procedure, and consisted of 16 with acute salpingitis (stage A), 9 with pyosalpinx or inflammatory complex (stage B), and 10 with tuboovarian abscess (stage C). The percentage of stage A, B and C patients withChlamydia trachomatis was 81.3%, 33.3% and 20%, respectively (A vs. B,P=0.031; A vs. C,P=0.004, Fisher exact test). Among the 13 chlamydia-positive stage A patients, only 1 was polymicrobial, and all were chlamydia-positive in the cervix. The percentage of patients in stages A, B and C withNeisseria gonorrhoeae, was 0%, 33.3% and 0%, respectively (A vs. B,P=0.036, Fisher exact test). TheN. gonorrhoeae-positive patients were all polymicrobial, andN. gonorrhoeae was found in the cervix in 33.3% of the patients. These results suggest thatC. trachomatis is the most prevalent primary infective organism which gains easy unaided access to the upper genital tract from the cervix. The ascent ofN. gonorrhoeae may be predisposed or facilitated byC. trachomatis or overgrowth of other bacteria in the vaginal flora. As empiric therapy for adnexal infections, antimicrobials should have broad spectrum activity against organisms includingC. trachomatis, N. gonorrhoeae, and aerobes and anaerobes.

Antibiotic Prophylaxis Using Cefpirome Sulfate in Gynecologic Surgery and Elimination Rate of Enterococcus faecalis from the Vagina

Seventy-five patients undergoing total abdominal hysterectomy were given 1 g of cefpirome sulfate (CPR) intravenously twice daily from immediately after surgery through the second postoperative day (CPR group). The results were compared with data from our previous study (1984–1985) in which 85 patients were given either piperacillin, cefazolin, or cefmetazole in the same dosage pattern after the same surgery (PIPC-CEZ-CMZ group). In the CPR group, the incidence of postoperative infection, febrile morbidity, and a persistent temperature of ≥37.5°C after the seventh postoperative day was 0%, 6.7%, and 6.7%, respectively. In the PIPC-CEZ-CMZ group, these values were 1.2%, 4.7% and 8.2%, respectively. There were no significant differences between the two groups (chi-square test), and no evidence could be found that CPR was more beneficial. Unlike other cephems, CPR is reported to show in-vitro activity againstEnterococcus faecalis, which is frequently found in the vagina after gynecologic surgery. In this study, the postoperative vaginal colonization rate ofE. faecalis was 24% (18/75) in the CPR group, which was lower than that in patients given other cephems in another study (1985–1990), including cefazolin (6/18), cefapirin (CEPR) (8/16), cefmetazole (12/25), and latamoxef (6/10). The vaginal elimination rate ofE. faecalis was 60% (6/10) in the CPR group, and this was significantly higher than that in patients who were given other cephems (0/14,P=0.0354, chi-square test). This elimination rate supported the in vitro data of CPRs high activity againstE. faecalis.