The natural history and biological behavior of adenocarcinoma and related lesions of the uterine cervix remain controversial issues. However, dynamic alternation in glycosylation (Tn, STN, and T antigens) in cancer cells is well known.
Over the past eight years, we encountered 13 cases of invasive adenocarcinoma (AD), 11 of early adenocarcinoma (early AD) including 6 adenocarcinoma in situ and 5 microinvasive adenocarcinoma, 20 of endocervical glandular dysplasia (EGD), and 10 of normal endocervix (control) among 2165 postoperative cases. We used immunohistochemical technique to examine the expression of the above antigens in adenocarcinoma and related lesions in the uterine cervix in these cases.
STN and T antigens were very weak in the surface epithelium of controls. Tn antigen was localized predominantly in the perinuclear portion of the cytoplasm in AD and early AD cases. Localization of the Tn antigen might play an important role in distigushing adenocarcinoma from other lesions.
Localizations of the T antigen was very weak in early AD cases compared with other lesions. Localization of the T antigen may be a useful marker in differentiating early AD from other lesions.
Localization of Tn, STN, and T antigens was often detected in AD cases ; the T antigen was the most strongly localized antigen in AD cases. We believe that the activity of galactosyltransferase is more predominant than that of sialyltransferase in cancer cells of AD patients. [Adv Obster Gynecol 46(2) : 165-172, 1994 (H6.3)]

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The purpose of this study was to clarify the role of the platelet activating factor (PAF) in the pathophysiology of preeclampsia.
1) Plasma levels of PAF and PAF-acetylhydrolase activity (PAF-AH), which is an enzyme metabolizing PAF into an inactive form, were determined in normal and hypertensive pregnancy. Plasma concentrations of PAF in normal male and non-pregnant women in the follicular phase and luteal phase were 653.7, 488. 8 and 620.2 pg/ml, respectively. Those in normal pregnant women in the 1st, 2nd and 3rd trimester and puerperal subjects were 291.7, 242.9, 246.4 and 256.2 pg/ml, respectively. Plasma PAF in normal pregnant women was significantly lower than that in nonpregnant subjects. Plasma concentrations of PAF-AH in normal male and non-pregnant women in follicular phase and luteal phase were 31.1, 21.1 and 22.2 nmol/ min/ml, respectively. Those in normal pregnant women in 1st, 2nd and 3rd trimester and puerperal subjects were 18.1, 18.0, 18.8 and 19.3 nmol/min/ml, respectively. Plasma PAF-AH in normal pregnant women tended to be lower than that in nonpregnant subjects, while the difference between them was not statistically significant. Plasma levels of PAF in mild and severe preeclamptic patients were 295.2 and 426.0 pg/ ml, respectively. Either level was significantly higher than that in normal pregnant women in the 3rd trimester. Plasma levels of PAF-AH in mild and severe preeclamptic subjects were 17.3 and 13.8 nmol/min/ ml, respectively. PAF-AH in patients with severe preeclampsia was significantly lower compared with that in women with normal pregnancy in the 3rd trimester. In preeclamptic patients a negative correlationship between plasma concentrations of PAF and PAF-AH was noted, but not in normal pregnant women.
2) Relationships between plasma levels of PAF and either of several parameters in physiology were investigated. There was a negative correlationship between plasma PAF concentrations and diastolic blood pressure in mild and severe preeclamptic patients, while no such correlation was noted in normal pregnant women. The platelet count in peripheral blood of preeclamptic women was significantly correlated to plasma PAF levels, but not in normal pregnant subjects. There was a weak correlationship between hematocrit and plasma PAF levels in normal pregnant women, however, but not in preeclamptic women.
3) According to in vitro experiments using cultured human umbilical endothelial cells, sera obtained from preeclamptic subjects displayed more potential toward an increase in intracellular PAF production than did the samples from normal pregnant women. However, PAF release into media of the cultured cell was not affected by the preeclamptic sera. Estradiol and progesterone had a small inhibitory effect in intracellular PAF production. The former also inhibited the PAF release into media, while the latter stimulated it. However, these changes which caused the steroids in either the PAF production or release were not enough to explain the alteration in PAF concentration in preeclamptic women compared to normal pregnant women. Prolactin and parathyroid hormone (PTH) increased the intracellular PAF production, while human placental lactogen (hPL) had the smallest effect on that. Prolactin and hPL did not cause any changes in PAF release into media, although PTH increased the compound release.
These results suggest the following :
1) In preeclamptic patients PAF may have a role in antagonizing hypertension, which is considered to be one of the homeostatic functions against the pathophysiology.
2) Sera from preeclamptic women may contain factors which stimulate PAF production. PTH seems to be one of humoral factors which are responsible for such stimulatory effects.
3) PAF is regarded as not a causative, but a modulating factor in preeclampsia. [Adv Obster Gynecol 46(2) : 163-186, 1994 (H6.3)]

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The purpose of this study was to clarify the role of endothelin-1 (ET-1) in the pathophysiology of pregnancy induced-hypertension (PIH).
1) Plasma levels of ET-1, which is a potent vasoconstrictor produced by vascular endothelial cells, were determined in normal and hypertensive pregnancy. Plasma concentration of ET-1 in normal pregnant women in the 3rd trimester was 0.81±0.39pg/ml. The value in patients with mild and severe PIH was 1.01±0.34 and 1.67±0.48pg/ml, respectivery ; the latter were significantly higher than those in normal pregnant women, while the former were also higher but not significantly so. There was a signficant correlationship between serum ET-1 levels and systolic and diastolic blood pressure (r=0.489, p<0.001 and r =0.333, p <0.02, respectively).
2) The serum progesterone level in normal pregnant women (126.1±18.2ng/ml) was higher than that in hypertensive subjects (197.5±92.2ng/ml); however the difference was not statistically significant. The serum concentrations of estradiol in normal and hypertensive pregnant women were 19.5±3.0 and 7.32± 1.55ng/ml, respectively. The value in hypertensive subjects was significantly lower than that in normal pregnant women.
3) (i) Treatment of the cultured endothelial cells with 17β-estradiol (10, 100ng/ml) decreased the ET-1 level in culture media, while it increased the intracellular of the peptide. Changes in the intracellular and extracellular concentration of big ET-1, which is a precursor of ET-1, after the same treatment showed similar results as those of ET-1. (ii) Treatment of the cells with progesterone (10, 500ng/ml) resulted in an increase in the extracellular level of ET-1 and a decrease in intracellular concentration. Changes in the intracellular and extracellular concentration of big ET-1 caused by progesterone treatment were also similar to those of ET-1.The concentration of ET-1 in the cultured media was increased by simultaneous application of 17β-estradiol 10ng/ml and progesterone 300ng/ml. However, the intracellular levels of the peptide were not influenced by combined treatment of the two sex steroids. Changes in level of big ET-1 in the cultured media were similar to those of ET-1. These results suggest that, (i) ET-1 may have a pathophysiological role in PIH, (ii) hypertensive pregnant women may have an altered function in secretory mechanisms of ET-1, (iii) hormonal milieu, in women with PIH, higher progesterone and lower estrogens, may partly contribute to the higher serum concentration of ET-1, and (iv) these sex steroids do not affect the mechanism in conversion of big ET-1 into ET-1. [Adv Obster Gynecol 46(2) : 187-195, 1994 (H6.3)]

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Now that ultrasonographic examination is available, it is possible and necessary for an obstetrician to detect fetal abnormalities.
This paper presents one case of fetal ovarian cyst that could be found prenatally (34 w. g.) by the ultrasonographic examination. The baby was vaginally delivered smoothly. The right ovarian cyst was removed on the 27th day after delivery. [Adv Obster Gynecol 46(2) : 196-199, 1994 (H6.3)]

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This is the first case report of fat embolism syndrome during pregnancy.
A 31-year-old female, 30 weeks' gestation, para 1, was admitted with left femoral shaft fracture due to a traffic accident. Her left femur was fixed with direct traction, and ritodrine 100μg/min was administered for uterine tocolysis. Two days later respiratory distress and delirium appeared, and her chest roentgenograms showed bilateral diffuse infiltrations. She underwent cesarian section because of severe hypoxemia (PaO₂/FiO₂ ; 85mmHg) and a critical condition.
Her respiration was controlled with synchronized intermittent mandatory ventilation (SIMV) with positive endo-expiratory pressure (PEEP) for 4 days after the cesarean section. Respiratory control and the prevention of DIC are important in treating fat embolism syndrome.
The mother's life was saved but the baby (1790 g, Apg.4/7) died shortly after cesarian section despite almost normal FHB monitoring just before the operation. There is a strong suspicion of fat emboli in the placenta and new born lung. Termination of pregnancy should be considered when there is life threatening hypoxemia, which is one of the major signs of fat embolism syndrome. [Adv Obster Gynecol 46(2) : 200-207, 1994 (H6.3)]

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Fetomaternal hemorrhage (FMH) is associated with an appreciable fetal morbidity and mortality. The following are two reports of FMH with mild and severe clinical courses. The early diagnosis and treatment in prenatal period were thought to be difficult, but important factor for its outcome. [Adv Obster Gynecol 46(2) : 208-211, 1994 (H6.3)]

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Two cases of placental chorioangioma with hydramnios are presented.
Case 1 : A 27-year-old primigravida was referred at 28 weeks' gestation because of placental tumor and hydramnios. There were no findings of fetal anomaly or fetal distress. Chromosomal analysis of amniotic cells revealed a karyotype of 47, XXX. At 37 weeks of gestaion, a mature female baby weighing 3144g was born uneventfully.
Case 2 : A 28-year-old multigravida was diagnosed with placental tumor at 23 weeks' gestation. Amniotic fluid volume was normal. There were no findings of fetal anomaly or fetal distress.
At 36 weeks' gestation the tumor enlarged and hydramnios developed. At 37 weeks' gestation, labor was induced because of dyspnea of the mother, and a mature male baby weighing 2930g was born. He had multiple small hemangiomas on the skin. In both cases, placental tumors were choriohemangiomas histologically.
When a placental tumor is diagnosed and chorioangioma is suspected, fetal chromosomal analysis and examination for fetal anomaly are required. Careful management should take into account the possibility of fetal distress, hydramnios, preterm labor and neonatal hemangioma. [Adv Obster Gynecol 46(2) : 212-218, 1994 (H6.3)]

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Common sites of distant metastasis from breast carcinomas are bone, liver and brain, and the involvement of gynecological organs is relatively rare. In our Department between 1971 and 1992, 5 ovarian and 1 cervical carcinomas metastasized from breast cancer were encountered. All 6 patients had undergone radical mastectomy one to 3 years before the metastases were detected.
Of the 5 patient with metastatic ovarian lesions, 4 had multiple bone metastases and were referred to us for surgery. None of the 4 patients were associated with gynecological symptoms or ovarian enlargement. Metastases were diagnosed by histological examination of the resected ovaries. In the remaining patient who complained of lower abdominal distention, ultrasonography and MRI showed left ovarian enlargement, which was due to mucinous cystadenoma coexistent with small foci of metastatic tumors. Therefore, early detection of ovarian lesions metastatic from breast cancer may be difficult even by ultrasonography or MRI.
A patient with secondary cervical carcinoma metastatic from breast cancer had noticed abnormal genital bleeding. Pelvic examination revealed an enlarged cervix with positive vaginal cytology. Complete response of the tumor was achieved by intraarterial infusion chemotherapy followed by radiotherapy. A review of 26 cases in the literature also suggests that survival of these patients may be improved by radiation with or without chemotherapy.

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