Two receptors for TNF-alpha (TNF-R1 and TNF-R2) and their soluble forms (sTNF-R1 and sTNF-R2) have been identified. TNF-R1 is involved in cell apoptosis and endothelial damage, while TNF-R2 is related to cell differentiation and insulin resistance. The aim of this study is to clarify the changes of plasma levels of the receptors in preeclamptic pregnancy, and their localization in placenta or fat tissue.
Plasma samples were collected from healthy non-pregnant women (n=40), normal pregnant women (10~40 gestational weeks, n=53) and women with preeclampsia (28~40 gestational weeks, n=16), whose BMI in non pregnant state were less than 25. Placental and subcutaneous fat tissue samples were also obtained from 2 normal pregnancy cases and 3 preeclampsia cases at delivery. Plasma levels of sTNF-R1 and sTNF-R2 were determined by ELISA. The protein expressions of TNF-R1 and TNF-R2 in placenta were studied by Western blotting and immunohistochemistry. mRNA expression in placenta and fat tissue were determined with RT-PCR.
Plasma levels of sTNF-R1 and sTNF-R2 in the normal pregnant group were significantly higher than those in the non-pregnant group (p<0.0001 and p<0.0001, respectively). sTNF-R1 in the 3rd trimester of pregnancy was higher than that in the 1st trimester (p<0.05). R2/R1 ratio in the normal pregnant women was also significantly higher than in the non-pregnant group (p<0.0001), while it was significantly lower in the 3rd trimester than in the 2nd trimester (p<0.05). Plasma levels of sTNF-R1 in patients of preeclampsia were higher than those in normal pregnant subjects at corresponding gestational stage (p<0.01 and p<0.01, for less than 32 weeks and for 32 weeks or more, respectively). sTNF-R2 in preeclampsia also showed an elevation compared to that in normal gestation, although the difference was not statistically significant. R2/R1 ratio was lower than in the normal pregnant group (p<0.05 and p<0.01, for less than 32 weeks and for 32 weeks or more, respectively). TNF-R1 and TNF-R2 expressions in placenta and subcutaneous fat tissue were detected both in normal pregnancy and preeclampsia, and the receptor molecules were also localized on the trophoblast membrane of both normal and preeclamptic placenta.
In preeclampsia, intensified expression of TNF-R1 compared to TNF-R2 may play a significant role for pathophysiology of the disease. The changes in the soluble receptors in the circulation of patients with preeclampsia are suggested to reflect the altered action of TNF-alpha at the placenta or vascular endothelium. Further knowledge on the mechanism underlying the production and release of the receptors might contribute to predict the onset and to evaluate the prognosis of preeclampsia. [Adv Obstet Gynecol, 56 (4) : 423-434, 2004 (H16. 11)]

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With the advent of assisted reproductive technologies, such as transplantation of eggs fertilized in in vitro fertilization-embryo transfer, infertile patients who could not conceive naturally in the past are now able to have children. At the same time, various new issues have emerged, such as surrogate motherhood. We conducted an attitude survey among infertile patients in 28 hospitals in Kinki district. 715 patients (644 females and 71 males) responded, indicating that artificial insemination was widely accepted but in vitro fertilization and intracytoplasmic sperm injection were less well in the treatment of infertility. Regarding the surrogate or foster motherhood and in vitro fertilization using sperm or eggs provided by third-party donors, opinions were divided showing moderately questionable acceptance. A good number of respondents felt that doctors' explanations were inadequate and waiting time too long, and held uneasiness about the infertility treatment. The respondents expressed strong desire for the availability of counselors for their infertility problems. Our study highlighted several areas to achieve improvement of care and treatment for infertile patients. [Adv Obstet Gynecol, 56(4) : 435-441, 2004(H16.11)]

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CD39 (vascular ecto-ATPDase) and placental ecto-ATPDase play a crucial role in the inhibition of platelet aggregation in the utero-placental circulation. In this study we aimed to clarify the changes in expression and activity of ecto-ATPDase in the placenta of women with preeclampsia. Twelve normal term placentas (NP) and 10 preeclamptic placentas (PP) were obtained just after delivery. The localization (immunohistochemistry), protein expression (Western blotting, arbitrary units) and mRNA expression (real time PCR, fg/pg b-actin) of ecto-ATPDase were investigated (M±SD). The enzyme was purified by immunoadsorbent chromatography, and the ATP/ADP hydrolyzing activity of the enzyme was measured (unit/mg protein/min). Ecto-ATPDase was localized to the chorioepithelial membrane in both NP and PP. The protein level of ecto-ATPDase in PP (1.58±0.39) was significantly higher than that of NP (1.00±0.34, p<0.05). The mRNA level of placental ecto-ATPDase in PP (1.15±0.89) was significantly higher than that of NP (0.36±0.30, p<0.05). CD39 mRNA levels in NP and PP were 0.36±0.30 and 0.73±0.29 respectively. The activity of ecto-ATPDase purified from PP (8.7±6.5) was significantly lower than for NP (19.4±1.9, p<0.05).
Although the expression of ecto-ATPDase on the placental membrane was increased, the enzyme activity was significantly affected in preeclampsia. We speculate that decreased enzyme activity causes deterioration of anti-thrombotic function in the placental membrane, resulting in placental infarction. [Adv Obstet Gynecol, 56(4) 442-451, 2004 (H16. 11)]

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Primary vaginal cancer is rare in gynecological cancer. The pathohistological findings of vaginal cancer are mostly squamous cell carcinoma, and there are few reports of vaginal clear cell adenocarcinoma in Japan. We present here a case of vaginal cancer ; the final pathohistological diagnosis is clear cell adenocarcinoma with uterine anomaly.
A 29-year-old woman, gravida 0, para 0, complaining of abnormal vaginal bleeding, was found to have an uterine anomaly, vaginal tumor and atypical cells in a vaginal smear. We diagnosed uterine cervical cancer stage Ib with bicornuate uterus from image analysis, internal examination and histology. She underwent an abdominal radical hysterectomy with wide resection of the vagina. Pathohistologically, the vaginal tumor was adenocarcinoma, and had many capillary formation and short papillary formation in the lumen. Few cells had a clear cell matrix, but we found many hobnail cells in the tumor. Invasion to the uterine cervix and parametrium was absent. We therefore diagnosed vaginal clear cell adenocarcinoma stage I. After surgery, the patient underwent 5 courses of chemotherapy (CDDP-CPT-11), and she has remained cancer free for 8 months since treatment. [Adv Obstet Gynecol, 56 (4) : 452-457, 2004 (H16.11)]

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