Toshitake Moriyama

Noncompaction of the left ventricular myocardium diagnosed in pregnant woman and neonate

Abstract Noncompaction of the left ventricular myocardium (NCLV) is an uncommon congenital cardiomyopathy with poor prognosis. We describe a case of NCLV that developed in a pregnant woman and her neonate. A nulliparous woman was referred at 24 weeks’ gestation due to dyspnea and fetal hydrops. Maternal echocardiography demonstrated NCLV with characteristic findings of prominent and excessive ventricular trabeculations and deep intertrabecular recesses in the left ventricle. An M-mode echocardiography suggested depressed left ventricular systolic function. A fetal echocardiography at 24 weeks’ gestation demonstrated cardiomegaly, but morphologic findings were not definitive for NCLV. An emergency cesarean section was performed due to maternal heart failure. A neonatal echocardiography diagnosed NCLV with depressed left ventricular systolic function. The neonate died of cardiac failure on the second day of life. Autopsy confirmed the echocardiographic findings. Since patients with NCLV may develop heart failure, multidisciplinary management is mandatory. In addition, awareness of familial occurrence of NCLV should be kept in mind for early diagnosis in the fetus and neonate.

Plasma adiponectin concentrations and placental adiponectin expression in pre-eclamptic women

This study was conducted to compare maternal plasma adiponectin concentrations and adiponectin expression in term placentas between normotensive pregnant women and pre-eclamptic women. Plasma adiponectin concentrations were assessed by a sandwich enzyme-linked immunosorbent assay in 81 normotensive pregnant women, 27 pre-eclamptic women and 15 non-pregnant healthy women. The expression of adiponectin in the placentas was assessed by immunohistochemistry. Plasma adiponectin concentrations in normotensive pregnant women did not show a significant change during pregnancy and postpartum compared with non-pregnant women. However, plasma adiponectin concentrations in pre-eclamptic women were significantly (p < 0.05) lower than in non-pregnant and normotensive pregnant women. No immunoreactive adiponectin was detected in the term placentas of normotensive pregnant women, whereas a positive immunostaining for adiponectin was observed in endothelial cells of chorionic vessels in pre-eclamptic women. Our data suggest that decreased plasma adiponectin concentrations may contribute to the pathophysiology of pre-eclampsia and that adiponectin localized in chorionic vessels may play a role in the restoring of endothelial damage in the feto-maternal units of pre-eclampsia.

Prenatal Imaging of Congenital Cerebral Primitive Neuroectodermal Tumor

A case of fetal brain tumor, which appeared after 32 weeks’ gestation, is presented. Prenatal ultrasonography and magnetic resonance imaging demonstrated a large heterogeneous mass in the right supratentorial region and left enlarged ventricle. A male fetus weighing 2,616 g was delivered at 34 weeks’ gestation by cesarean section and died on the 37th day of life due to rapid growth of the tumor. Following autopsy, the pathohistological examination revealed primitive neuroectodermal tumor. Magnetic resonance imaging in the prenatal management of the congenital brain tumor is efficient in evaluating the expansion and margin of the tumor and intratumoral bleeding, which are not demonstrated by ultrasonography.

Caffeine induces apoptosis of human umbilical vein endothelial cells through the caspase-9 pathway

Caffeine is known to modulate placental and fetal umbilical circulation. It is demonstrated that apoptosis of human umbilical vein endothelial cells (HUVECs) is associated with placental umbilical vascular diseases. The present study was conducted to investigate the effects of caffeine on apoptosis of HUVECs. Isolated HUVECs were cultured under serum-free conditions for 24 h, and then treated with graded concentrations of caffeine (30, 100 and 300 μM) for additional 24 h and 48 h. The number of viable HUVECs was determined by cell counting. Apoptotic HUVECs were assessed by Hoechst33342 dye staining. The expression of caspase-9, caspase-8, caspase-3 and poly(ADP-ribose) polymerase (PARP) was assessed by Western blot analysis. Caffeine induced a dose- and time-dependent decrease in the number of viable HUVECs. Caffeine at concentrations higher than 100 μM significantly increased the percentage of apoptotic HUVECs. Caffeine at concentrations higher than 100 μM significantly increased cleaved caspase-9, caspase-3 and PARP expression in HUVECs at 24-h treatment compared with untreated cultures, whereas 30 μM caffeine significantly increased only caspase-3 expression at 24 h. Caffeine did not affect cleaved caspase-8 expression at 48 h. These results suggest that high concentrations of caffeine inhibit cell growth of HUVECs and induce apoptosis through the caspase-9 pathway.

A late complication of thrombosis in internal jugular vein and subclavian vein in a pregnant woman with ovarian hyperstimulation syndrome

A case of thrombosis in the left internal jugular vein and subclavian vein occurring in a pregnant woman as a late complication of ovarian hyperstimulation syndrome is reported. A 28-year-old woman underwent a long protocol for in vitro fertilization and intracytoplasmic sperm injection. After seven days of embryo transfer, she developed ovarian hyperstimulation syndrome and was treated with intravenous fluids, albumin infusion, and abdominal paracenteses. At 12 weeks of twin pregnancy, she complained of pain and swelling in the left neck. She was diagnosed as having thrombosis of the left internal jugular vein and subclavian vein with pleural effusion on an enhanced computed tomography. There were no findings of pulmonary emboli or deep vein thrombosis in the lower extremity. Laboratory investigations showed hypoalbuminemia with no signs of hemoconcentration. Coagulation profiles demonstrated increased fibrinogen levels and decreased antithrombin III levels, normal protein C levels and activity, normal total and free protein S levels, and normal anti-cardiolipin IgG. She received continuous intravenous heparin and her symptoms steadily subsided. Pregnancy was terminated at 13 weeks of gestation on the patient’s request. She was maintained on oral warfarin daily. In conclusion, although rare, careful monitoring of pregnant women with ovarian hyperstimulation syndrome is warranted because a life-threatening thromboembolic disorder may develop as a late complication. Thromboembolism associated with ovarian hyperstimulation syndrome (OHSS) remains a life-threatening complication. The pathogenesis of this disorder remains unknown. We describe a case of thrombosis in the left internal jugular vein and subclavian vein occurring in a pregnant woman as a late complication of OHSS.

Management of Acute Chylothorax with Hydrops fetalis Diagnosed in the Third Trimester of Pregnancy

A fetus with large pleural effusion and hydrops fetalis diagnosed in the third trimester was successfully treated with prompt vaginal delivery followed by drainage of the pleural cavity, after confirmation of congenital chylothorax and re-expansion of the lung with prenatal thoracentesis.

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