Yoshiaki Yagami

Preconceptional natural-killer-cell activity as a predictor of miscarriage

There is no immunological test for the prospective identification of alloimmune causes of miscarriage. We investigated whether activity of natural killer cells was predictive of subsequent abortion in women who had had unexplained recurrent abortions and had received no treatment. 24 women with high preconceptional NK activity, defined as mean plus 1 SD of NK activity of 47 controls, had a significantly higher abortion rate in the next pregnancy than 44 women with normal levels of NK activity (71 vs 20%; relative risk 3.5; 95% CI 1.8-6.5). The preconceptional evaluation of NK activity in women with recurrent miscarriages may thus be predictive of the risk of pregnancy loss at the next conception.

β2-Glycoprotein I-dependent anticardiolipin antibodies as a predictor of adverse pregnancy outcomes in healthy pregnant women

Our aim was to elucidate prospectively whether beta 2-glycoprotein I-dependent anticardiolipin antibodies (beta 2GPI-dependent aCL; autoimmune type) can predict an adverse pregnancy outcome in healthy pregnant women and whether beta 2GPI-dependent aCL should be applied for routine screening of the pregnant population. A prospective cohort study was performed on 1600 healthy pregnant women from whom blood samples were obtained at about week 10 of gestation. We used a modified enzyme-linked immunosorbent assay with which to divide the subjects into three study groups: beta 2GPI-independent aCL positive, beta 2GPI-dependent aCL positive and aCL negative. Their subsequent pregnancy outcomes were ascertained and the three study groups were compared statistically for the following poor pregnancy outcomes: intrauterine fetal death (IUFD) after 12 gestational weeks, intrauterine growth retardation (IUGR) and pre-eclampsia. The total number of patients eligible for this study was 1125. The prevalence of beta 2GPI-dependent aCL positive was eight (0.7%), beta 2GPI-independent aCL positive was 17 (1.5%) and aCL negative was 1100 (97.8%). Beta 2-GPI-dependent aCL positivity was significantly associated with poor pregnancy outcome: 25.0% of beta 2GPI-dependent aCL-positive and 0.5% of aCL-negative patients experienced IUFD [relative risk 52.4; 95% confidence interval (CI), 12.7-216.3; P = 0.0009]; 37.5% of beta 2GPI-dependent aCL-positive and 2.9% of aCL-negative patients experienced IUGR (relative risk 18.4; 95% CI, 4.6-74.0; P = 0.001); and 50.0% of beta 2GPI-dependent aCL-positive and 4.0% aCL-negative patients experienced pre-eclampsia (relative risk 22.1; 95% CI, 5.7-85.7; P = 0.0002). In contrast, beta 2GPI-independent aCL did not show any significant association with such adverse pregnancy outcomes. beta 2GPI-dependent aCL are significantly highly associated with adverse pregnancy outcomes in healthy pregnant women and can be used for prediction purposes, whereas beta 2GPI-independent aCL cannot. Our results suggest that routine screening for beta 2GPI-dependent aCL should be introduced for the general pregnant population.

Specific antiphospholipid antibodies as a predictive variable in patients with recurrent pregnancy loss

PROBLEM: Antiphospholipid antibodies (APLs) consist of very heterogenous autoantibodies. It has not been fully explored what kind of specificities are most relevant to recurrent pregnancy loss. Thus, we investigated the effects of specific APLs on recurrent aborters.

Diagnosis of fetal rubella infection with reverse transcription and nested polymerase chain reaction : a study of 34 cases diagnosed in fetuses

OBJECTIVE Our purpose was to develop a reliable method for prenatal diagnosis of fetal rubella infection through the detection of viral ribonucleic acid extracted from the chorionic villi, amniotic fluid, or fetal blood in pregnant women. STUDY DESIGN Double amplification of rubella viral ribonucleic acid by nested polymerase chain reaction after reverse transcription was applied to samples from 34 women suspected of having rubella. The results were compared with those of serum antibody and levels of rubella virus-specific immunoglobulin M antibodies in fetal blood. RESULTS Viral ribonucleic acid was revealed in 8 of 34 cases (23.5%). In the remaining 26 cases, healthy babies were born in 24, 1 was electively aborted, and 1 died in the thirty-sixth week of pregnancy of unknown causes. CONCLUSIONS This method allowed very early detection of fetal rubella infection by sampling of chorionic villi and amniotic fluid compared with evaluation of the maternal symptoms and serum antibody levels. Fetal blood was also more useful for making a diagnosis up to the twentieth week of pregnancy than was measuring rubella virus-specific immunoglobulin M antibodies.

Clear cell carcinoma of the ovary with colony-stimulating-factor production. Occurrence of marked granulocytosis in a patient and nude mice.

A case of clear cell carcinoma of the ovary with colony‐stimulating‐factor (CSF) production is presented. Granulocytosis (54,200/mm3) of unknown cause was observed in a patient at the terminal stage of the clinical course. This tumor was successfully heterotransplanted into athymic nude mice, and transplantable tumor line was designated as OCL‐1. OCL‐1 tumor reproduced granulocytosis up to 640,000/mm3 in nude mice, and CSF production was demonstrated by colony‐forming assay using tumor extract and mouse bone marrow cells in vitro. This is the first report that describes the case of CSF‐producing clear cell carcinoma of the ovary and its heterotransplantation in nude mice.

Anticardiolipin Antibodies in Patients With Pregnancy Loss Induce Factor Xa Production in the Presence of (β2‐Glycoprotein I

PROBLEM: Anticardiolipin antibodies (aCL) are commonly associated with recurrent pregnancy loss, though the mechanism is uncertain. Some investigators have indicated that aCL may be directed at a complex made up of cardiolipin and a blood anticoagulant, β2‐glycoprotein I (β2GPI). We therefore investigated the effects of β2GPI‐dependent aCL IgG enriched fractions, isolated from sera of patients with pregnancy losses, on blood coagulation.

Laparoscopic-assisted creation of a vagina

The applicability of laparoscopy for colpopiesis using pelvic peritoneum was examined in two women with the Mayer-Rokitansky-Kuster-Hauser syndrome. Using a modification of laparoscopic guidance proved advantageous for safe dissection of the vesicorectal space and accurate suturing of the pelvic peritoneum without laparotomy. A sufficient vaginal cavity was achieved in both patients. This modification of the original procedure, featuring introduction of a laparoscope, thus provides effective and safe conditions for creation of a new vagina.

Human Pregnancy Serum Suppresses the Proliferative Response of Lymphocytes to Autologous PHA-Activated T Lymphoblasts

PROBLEM: We have previously demonstrated that human serum can suppress the proliferative response in autologous mixed lymphocyte reaction (AMLR) in which phytohemagglutinin (PHA)‐activated T lymphoblasts act as stimulators (T‐TPHA AMLR). The aim of the present work was to determine whether pregnancy serum (PS) possesses an inhibitory capacity similar or different in magnitude.

A fetus with partial trisomy 3 (p21-pter) detected by prenatal diagnosis

SummaryA fetus with trisomy 3 (p21-pter) was detected prenatally in the pregnancy of a mother with t(3;11) (p21;q25). The aborted fetus had various kinds of congenital anomalies compatible with partial trisomy 3.

HLA-DR, DRw52.53, and DQ homozygosity in patients with neural tube defects

SummaryStudies of the possible relationship between malformations of the neuraxis and the human major histocompatibility complex have been contributive to the search for a human equivalent of the murine T/t complex. We conducted a population and family study in 34 Japanese couples together with their children with neural tube defects. HLA-DR homozygosity among the affected children was significantly increased as compared with that in controls. HLA-DR and DQ maternal-paternal sharing was also significantly higher than the controls. Significantly higher frequencies of A11 (father), B35 (mother) and A11 (affected children) were observed. These data support the hypothesis that a T/t-like complex in or near the HLA complex might be etiologically related to neural tube defects.