[Objective] The estimation of maternal weight change during gestation is thought to be very important for adequate fetal growth and the prevention of preeclampsia and its related disorders. However the changes of the body composition of body fat (Fat Mass : FM) and body water (Total Body Water : TBW) during pregnancy have not yet been clarified because there is no applicable method to analyze them. In this study the FM and TBW changes were investigated in pregnant women with normal, preeclampsia and gestational edema with a new system developed to nalyze maternal body composition.
[Subjects and Methods] Three hundred and fifty-eight pregnant women who gave birth after 36 weeks of pregnancy were the study subjects. They were divided into 3 groups as follows ; 1) Sixty-six subjects from the 6th to the 16th week of pregnancy, 2) Forty-four subjects in late pregnancy, 4 days and 1 month at postpartum, 3) Two hundred and ninety subjects composing normal, preeclampsia and gestational edema. The subjects were classified into 3 groups according to their pre-pregnancy body mass index (BMI) : underweight (BMI<18), normal-weight (18-24) and overweight (24<) groups and further divided according to the maternal body weight gain during pregnancy. The maternal FM and TBW in the subjects were measured with the bioelectrical impedance method (BIA) with compensation for the fetal component weight as previously reported. The term of preeclampsia was applied only to the case accompanied by hypertension, not concerned with the existence of proteinuria or edema. The distinction between severe and mild preeclampsia and gestational edema was based on the classification of the Japan Society of Obstetrics and Gynecology (JSOG).
[Results] The maternal FM and TBW changes from 6 to 16 weeks of pregnancy were proportional to the increases in body weight, and the weight ratios of FM and TBW to body weight were 57% (FM) and 29% (TBW) respectively, which were indistinguishable from the ratio values calculated from the past reference by Hytten (1971). The maternal body weight and TBW increased in an almost linear manner through the gestational age in all groups of normal pregnant women. On the other hand, maternal FM mainly increased during the first half of pregnancy but the rate of increase lessened variously during the second half. The changes in maternal body weight had a more significant correlation with FM than TBW during pregnancy but were correlated postpartum with only TBW in normal pregnancies. In the cases of severe preeclampsia, maternal FM decreased below the levels of the non-pregnant state throughout the whole gestational period. On the other hand, maternal FM and TBW greatly increased in early to mid-pregnancy in the cases of mild preeclampsia and general gestational edema. The correlation between maternal weight gain and FM gain was also observed in preeclampsia and gestational edema but the correlation with TBW, while not significant in preeclampsia (r=0.174~0.362, NS), was significant in gestational edema (r=0.760~0.851, p<0.001). Under the classification of all pregnant women by the maternal FM and TBW values in late pregnancy, the cases of severe preeclampsia were mainly contained in the group of gunder-FM/over or normal-TBW grouph. However, the cases of mild preeclampsia were located in the over-FM/over- or normal-TBW groups and severe gestational edema mainly in the over- or normal-FM/over-TBW group. On the other hand, the cases of mild gestational edema were widely distributed among almost all groups. According to the analyses with the two-dimensional coordinate system, the cases of mild gestational edema and mild preeclampsia were overlapped and distributed over the area of normal groups in the 1st quadrant but the cases of severe preeclampsia inclined towards the upper left in the 4th quadrant.

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Synopsis Primary ovarian carcinoid tumor is a rare germ cell tumor. This case report concerns a patient with primary ovarian strumal carcinoid who was not suffering from carcinoid syndrome, but rather from severe constipation. The patient, a 47-year-old woman, complained of having suffered from constipation for several years. Physical examination revealed a pelvic mass, and laparotomy revealed the right ovarian tumor which measured 15 cm in diameter and weighed 1500g. Bilateral salpingo-oophorectomy with hysterectomy was performed, and the symptom rapidly abated postoperatively. The carcinoid tumor cell was stained using the Grimelius technique. Immunohistochemically, peptide YY, which has a strong inhibitory action on intestinal motility, was localized in the cytoplasm of carcinoid tumor cell. We have recognized the relationship between constipation and functions of peptide YY on ovarian carcinoid tumor. [Adv Obstet Gyneool, 56 (3) : 287-292, 2004 (H16. 8)]

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Synopsis The patient is a 19-year-old unmarried woman of zero gravidity and zero parity. An approximately 12 cm long stick-like foreign body made of plastic was inserted into the vagina of the patient at the age of 14. Background information relating to the insertion was not revealed through history taking. The patient has a partner at the age of 19 and had visited the obstetrics and gynecology department of another medical institution hoping for the intravaginal foreign body to be removed. The patient was referred to our hospital because MRI had revealed a suspicion of rectal perforation caused by an intravaginal foreign body. Rectal endoscopy was performed at our department and confirmed penetration from the posterior fornix of the vagina to the superior rectum. Intravenous hyperalimentation was started after admission to the hospital, and the foreign body was removed transvaginally under general anesthesia after a week of pre-operative fasting. The foreign body turned out to be a plastic ice cream stick approximately 12cm long the major axis. The tip of the stick had penetrated the rectum, and the umbrella shaped area of the middle of the stick was stuck in the posterior fornix of the vagina and had become embedded in granulation tissue. After 31-days of post-operative fasting, no leakage of contrast media with a barium enema was confirmed and oral ingestion was resumed. The patient afterward recovered to be capable of sexual intercourse, became pregnant and delivered a baby.
As far as we researched, 10 cases including our case reported that fistula was formed by an intravaginal foreign body having been inserted except for the purpose of medical treatment. The following is a breakdown of the 10 cases: six cases of vesicovaginal fistula, three cases of rectovaginal fistula, and one of urethral vaginal fistula. 6 of the 10 cases were under 20 years old. Intravaginal foreign bodies are known to be often inserted as an aid to masturbation or as sexual abuse in adults, but the background is not very clear in many juvenile cases. This case had been neglected for five years, and each of the other cases with rectovaginal fistula formation had been neglected four years.
In this case, we experienced treating a intravaginal foreign body that had been neglected for five years and had formed rectovaginal fistula. We are reporting a rare case where the patient recovered to be capable of sexual intercourse, became pregnant, and delivered a baby after treatment. [Adv Obstet Gynecol, 56 (3) : 293-297, 2004 (H16. 8)]

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[in Japanese]

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The role of para-medical staff contributing reproductive medicine in Japan
Modern reproductive medicine involving assisted reproductive technology is based on teamworking. In order to establish the complicated course of program for infertility treatment, the role of staff surrounding physician is important. The surrounding staff contains specialized nurse for infertility, coordinator, embryologist and psychologist. It is the feature that the quality of staff as an individual affects the quality of whole program. In the present advanced stage of reproductive medicine, the quality management of treatment program is requirce and the education of those staff is essential.

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