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Article type: Cover
2009 Volume 18 Issue 5 Pages
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Article type: Cover
2009 Volume 18 Issue 5 Pages
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Article type: Index
2009 Volume 18 Issue 5 Pages
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
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[in Japanese], [in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
335-
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Sunao Kaneko
Article type: Article
2009 Volume 18 Issue 5 Pages
336-341
Published: May 20, 2009
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Women with epilepsy have many legitimate concerns regarding the effect of antiepileptic drugs (AEDs) on their unborn children. These concerns fall into three areas: increased seizure frequency during pregnancy, risk of birth defects, and risks associated with breast-feeding. The incidence of congenital malformations in infants born to mothers taking AEDs is higher than that in healthy women or in women with epilepsy who do not take AEDs during pregnancy. It becomes higher when women with epilepsy taking high dosages of AEDs and many kinds of AEDs. Studies have shown that many of these risks can be minimized with appropriate management and counseling. This article describes some of the data regarding these risks and how best to alter AED therapy to minimize them.
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Naomi Hizuka, Kazue Takano
Article type: Article
2009 Volume 18 Issue 5 Pages
342-346
Published: May 20, 2009
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While female patients with functioning pituitary adenoma are often infertile, it is essential to consider the management of those patients who do become pregnant, including before and during pregnancy, and post partum. The anterior pituitary gland enlarges during pregnancy, and the hormonal environments are altered. Therefore, it is important to understand the endocrine alteration of the pituitary gland during pregnancy in managing for patients with functioning pituitary adenomas who become pregnant. In this paper, we describe the management of women with prolactin (PRL), growth hormone (GH), or ACTH producing pituitary adenomas who wish to become pregnant.
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Kazunori Arita, Hirofumi Hirano, Shunji Unoue, Shingo Fujio, Mika Habu ...
Article type: Article
2009 Volume 18 Issue 5 Pages
347-355
Published: May 20, 2009
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The disturbance of pituitary function, usually not obviously recognized by other groups of patients, evidently appear as menstrual disorders and/or infertility in premenopausal women. Therefore, the preservation of pituitary function should be a primary concern during surgical treatment. At the same time, the surgical cure is also of great importance considering the patient's relatively young age. Pituitary surgeons, thus, should perform pituitary function orientated adenomectomy on this particular group of patients. We reviewed our own experiences of treatment of premenopausal women with pituitary tumors. The normalization of prolactin level was achieved in more than 90% of cases with prolactinoma presenting with menstrual disturbances and the rate of regular menstruation is around 80% at 2 years after the surgery. In our 95 cases with pituitary adenomas other than prolactinoma, the rate of preoperative menstrual disorders including amenorrhea was 60% to 80% but dramatically decreased to 20% to 40% postoperatively. The postoperative resolution of the menstrual disorders was accompanied with decreasing prolactin level, improving gonadotropin secretory functions, and normalization of preoperative hypersecretion of growth hormone or adrenocorticotropic hormone.
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Keisuke Ueki
Article type: Article
2009 Volume 18 Issue 5 Pages
356-360
Published: May 20, 2009
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Oligodendrogliomas affect a relatively younger population and hence are more likely to be seen in female patients wanting to bear children in the near future. In such cases, treatment choice should be considered based on various factors including the effect of chemotherapy on the reproductive system, priority of patients and their families, and the cumulative evidence on the various treatment options. Several clinical studies on oligodendrogliomas showed 1) radiation and chemotherapy both prolong progression free survival, 2) the timing of these adjuvant treatments does not affect overall survival, and 3) 1p/19q deletion cases show better response to these treatments and enjoy longer overall survival. For patients considering pregnancy as the utmost priority, radiation therapy would be the choice of treatment given that it would provide longer PFS without any significant effect on pregnancy. When chemotherapy is offered, various methods to preserve ovarian function can be considered as options especially in relatively older patients, although many of these techniques are not yet widely accessible in Japan.
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Nao Suzuki, Bunpei Ishizuka
Article type: Article
2009 Volume 18 Issue 5 Pages
361-366
Published: May 20, 2009
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Ovarian dysfunction induced by anticancer agents is termed chemotherapy-induced amenorrhea. The symptoms include oligomenorrhea, amenorrhea, and anovulation, and the incidence is considered to depend on the age of the patient and the types and dosages of the anticancer agents administered. Restoration of ovarian function is essential for young female cancer patients following chemotherapy not only from the viewpoint of preservation of fertility but also for maintaining a good quality of life (QOL). Many clinical studies have shown the efficacy of chemotherapy based on alkylating agents for highly malignant oligodendroglioma. Among the various anticancer agents administered, including CCNU, BCNU, ACNU, procarbazine hydrochloride, vincristine, cisplatin, etoposide, melphalan, and 5-FU, the alkylating agents are considered to be associated with the highest risk of chemotherapy-induced amenorrhea. Measures such as cryopreservation of fertilized or unfertilized eggs have led to the improvement of QOL or restoration of fertility in adult female cancer patients. However, such measures cannot be employed for female cancer patients before menarche or after menopause, and the only available measures are administration of a GnRH analog for protection against the ovarian toxicity of anticancer agents or cryopreservation of ovarian tissues before starting chemotherapy. An increasing number of young female cancer patients are selecting treatment that allows restoration of fertility with progress in the diagnosis and treatment of cancer. However, emphasis on the restoration of fertility should not take precedence over survival of the patient, and the suitability of using measures to restore fertility in young female cancer patients should be carefully determined after thorough discussion.
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Jun C. Takahashi, Tomoaki Ikeda, Koji Iihara, Susumu Miyamoto
Article type: Article
2009 Volume 18 Issue 5 Pages
367-375
Published: May 20, 2009
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The authors conducted a nationwide survey of women with moyamoya disease on their pregnancy and delivery experiences. In pregnant women who were known to have moyamoya disease, the incidence of perinatal cerebrovascular attacks was low. Although caesarian section was mainly adopted in these cases, there was no evidence that vaginal delivery should be avoided. On the other hand, serious cerebral hemorrhage or infarction was reported in those patients who had not been diagnosed with moyamoya disease before their pregnancy. To make pregnancy and delivery of the female patients safer, cooperation between obstetrician and neurosurgeons is important, and guidelines on pregnancy management for female patients with moyamoya disease should be established.
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Tomoaki Ikeda, Reiko Neki, Sachie Suga, Jun Takahashi, Koji Iihara, Su ...
Article type: Article
2009 Volume 18 Issue 5 Pages
376-382
Published: May 20, 2009
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There remains some controversy regarding the delivery rout, via cesarean section or vaginal, for pregnant patients with Moyamoya disease. We have set vaginal delivery under epidural analgesia as the first choine of delivery rout in our department of perinatology, at the National Cardiovascular Center. Since 1982, we have experienced 23 deliveries in patients with Moyamoya disease for 26 years. Three cases were transferred after brain hemorrhagic stroke, of whom one pregnant women finally died. Of the remaining 20 cases, 16 (80%) received epidural analgesia and resulted in successful deliveries without complications for mothers and infants. In the other 4 cesarean cases, all of the indication for cesarean were obstetrical, including 2 cases of preeclampsia complaining at headache. Although our clinical experience seems permissive, it should be noticed that our epidural vaginal policy can only be applied to the limited number of institutes where the obstetrical and neruosurgical departments are well connected.
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Takaaki Kirino
Article type: Article
2009 Volume 18 Issue 5 Pages
383-385
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Yoshie Hara, Haruo Yamashita, Masao Tomioka
Article type: Article
2009 Volume 18 Issue 5 Pages
386-390
Published: May 20, 2009
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Two patients with vertebral artery injury associated with cervical spine trauma underwent successful endovascular intervention. One patient with unilateral vertebral artery dissection underwent coil embolization of the affected artery. The other with bilateral vertebral artery dissection suffered cerebellar infarction and underwent decompressive craniectomy. He had an endovascular stent implanted into one vertebral artery. Traumatic vertebral artery dissection and occlusion can cause serious neurologic deficits. Because clinical diagnosis of vertebral artery injury is often difficult in patients with severe trauma, radiological screening is important. We extended the field of view of routine screening contrast-enhanced chest and abdomen CT scan to include the cervical arteries for patients with severe trauma. This method contributes to the diagnosis of vertebral artery injury in the acute stage. Catheter angiography should be considered when vertebral artery injury is detected on CT scan. To prevent the devastating effect of cerebellar and brainstem infarction that may result from vertebral artery injury, endovascular revascularization or occlusion of the affected artery is a safe and useful option.
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[in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
391-
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[in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
391-392
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
393-
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Tukasa Kawase, [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
394-398
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[in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
399-400
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
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[in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
402-
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[in Japanese]
Article type: Article
2009 Volume 18 Issue 5 Pages
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
405-
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
406-407
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
408-412
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
413-
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Article type: Appendix
2009 Volume 18 Issue 5 Pages
413-
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Article type: Cover
2009 Volume 18 Issue 5 Pages
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Published: May 20, 2009
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