Tamotsu Hando

Recent aspects of gestational trophoblastic disease in Japan

The regional registration in 11 prefectures and one area covering 34% of total Japanese population started in 1974, increasing gradually to 21 prefectures and one area in 1993 covering 48.5% of total Japanese populations, by the Japan Trophoblastic Disease Committee under the auspices of Japan Society of Obstetrics and Gynecology. The results showed marked decreasing trend in incidence of molar pregnancy and choriocarcinoma in Japan. The most frequent antecedent pregnancies of choriocarcinoma has shifted from molar pregnancy in 1974 to term pregnancy in 1993.

Reciprocal Effects of Tamoxifen on Hormonal Cytology in Postmenopausal Women

OBJECTIVE To evaluate the estrogenic effect of tamoxifen (TAM) therapy in postmenopausal women. STUDY DESIGN The subjects were 26 postmenopausal women. The maturation index (MI), maturation value (MV) and karyopyknotic index (KPI) were evaluated based on hormonal cytology. Endometrial cytologic examinations and transvaginal ultrasonography were also performed. RESULTS Of the 26 patients, 16 had low estrogenic activity from the viewpoint of hormonal cytology before TAM administration. During administration, their mean MV rose significantly, from 25.8 +/- 17.7 to 68.8 +/- 13.2, (mean +/- SD) and their mean KPI rose from 9.0 +/- 8.3 to 47.1 +/- 23.1. In contrast, among the 10 patients with high estrogenic activity, mean MV and KPI decreased from 62.9 +/- 8.4 and 27.2 +/- 16.9 to 58.4 +/- 7.7 and 17.7 +/- 16.1, respectively, with TAM administration. Mean endometrial thickness increased more significantly with TAM administration in the low estrogenic activity group than in the high estrogenic activity group. CONCLUSION TAM had a reciprocal effect; no additional estrogenic effect was seen in patients with high estrogenic activity. Conversely, an estrogenic effect was seen in those with low estrogenic activity. An individualized gynecologic evaluation based on hormonal cytology is useful in selecting patients who will be more susceptible to TAM-induced endometrial abnormality.

Alleviation of Cisplatin Nephrotoxicity: Efficacy of Local Intra-Arterial Injection Concomitant with Hemodialysis

Although cis-diamminedichloroplatinum (cisplatin) is widely used in the treatment of malignant tumors, the dose administered is limited because of side effects such as nephrotoxicity. The plasma levels of non-protein-bound platinum, which can be removed by dialysis, play an important role in the antitumor effects and the appearance of side effects. Selective intra-arterial injection of cisplatin during concomitant hemodialysis (HD) was performed in patients with gynecological malignancies. At a dose of 100 mg, about three times the non-protein-bound platinum excreted in the urine during the same period was removed by HD. The area under the time-concentration curve of plasma total platinum up to 5 h after intra-arterial injection was reduced by 46%. When doses of 200 or 250 mg were administered concomitantly with HD, the maximum plasma levels were suppressed to about the same degree as when 100 mg were injected without concomitant HD. A definite reduction in the incidence of side effects was seen, and a reduction in the severity of nephrotoxicity was also observed when 100 mg were given with HD. No severe side effects were found even when 200 or 250 mg were administered with concomitant HD. The antitumor effects were not reduced or possibly potentiated, but follow-up is still of short duration. These results indicate that chemotherapy with local intra-arterial injections of cisplatin using concomitant HD not only reduces systemic side effects, in particular nephrotoxicity, but also allows for increased doses at the tumor site and can be applied in patients with renal dysfunction.

Frequency of positive peritoneal cytology during laparotomy, especially in clinical stage I adenocarcinoma of the endometrium.

1984～1993年の10年間に香川医科大学附属病院で治療された子宮体癌68例中, 術中腹膜細胞診施行例は47例であり, うち5例 (10.6%) が陽性であった. これを臨床進行期1期のみについてみると, 腹膜細胞診陽性例は41例中4例 (9.8%) であった. ただし, この中には手術進行期分類IIIの1例が含まれていた. 腹膜細胞診陽性例は, 腺扁平上皮癌, 未分化腺癌や推計学的有意差はなかったものの子宮筋層浸潤の深いものとの関連が示唆された. 腹膜細胞診陽性5例中1例は, 細胞形態学的に悪性細胞と判別できたものの子宮体癌由来と診断することは難しい細胞像を呈していた.術前に子宮鏡診を施行した46例中, わずか4例のみが腹膜細胞診陽性であった.