It has been widely accepted that chorioamnionitis is one of major causes of preterm delivery. Inflammatory process in the uterine cervix and/or fetal membranes would stimulate the local tissue to produce lots of bioactive substances which are potent to bring uterine contractions and/or cervical ripening, resulting in parturition. Non-specific clinical markers of inflammation and parameters reflecting the local inflammatory changes in utero have been utilized to determine severity of the pathological state. However, there are still some cases of premature labor in which prognoses are falsely estimated. The purpose of this study was to evaluate the significance of vaginal microbial environment, concentration of oncofetal fibronectin (fFN) in vaginal pool and concentrations of IL-8 in uterine cervical mucus for predicting outcomes of gravidas with premature labor.
  Retrospective analysis was done for 124 patients with premature labor between 22 and 33 weeks of pregnancy. All the subjects carried singletons. They received in-patient management with appropriate drug therapy after determination of the followings: bacterial and fungal culture of vaginal secretions, concentration of oncofetal fibronectin (fFN) in vaginal pool, and that of IL-8 in cervical mucus. Correlations between each of them and outcomes of pregnancy were investigated.
 Numbers of cases resulting in premature delivery before 34 weeks of gestation (delivery before 34) and delivery within 7 days after admission (refractory illness) were 28 (22.6%) and 18(14.5%), respectively. Fifty cases (40.3%) were positive for vaginal bacteria other than lactobacillus and/or fungi, and showed slightly higher incidence of delivery before 34 and significantly higher rate of refractory illness compared with those of negative results. There were no differences in cervical mucus IL-8 levels between the groups. Subjects with positive for vaginal pool fFN (47/124=37.9%) showed significantly higher incidence of delivery before 34 or refractory illness than did those with negative fFN, while the former had significantly lower concentration of cervical mucus IL-8 compared with the latter. For patients with negative vaginal pool fFN, those who had any vaginal microbes other than lactobacillus or fungi had higher risk of refractory illness than did those who had lactobacillus and/or fungi. This trend was also same for pregnant women with positive vaginal pool fFN. Concentrations of IL-8 (ng/ml) ranged between 1 and 1873. Median was 87.5. More than half (51.6%) of the subjects showed the levels between 1 and 100. Cases with low concentration, determined with less than 300, were 83 (66.9%) and high cases were 41 (33.1%). There were no differences in the incidences of delivery before 34 or refractory illness between the groups.
  These data suggest that simultaneous assessment of vaginal microbial environment and vaginal pool fFN is important in evaluation of prognosis of pregnant women presenting premature labor, while usefulness of cervical mucus IL-8 concentration in the same purpose seems doubtful. [Adv Obstet Gynecol, 57 (1) : 1-12, 2005 (H17. 2)]

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In postmenopausal women, the usefulness of the thickness and the organic changes of the endometrium obtained in MRI were investigated in the diagnosis of uterine cancer.
  A total of 129 study subjects were selected from the postmenopausal women, consisting of 72 cases of control group (C-group) having no endometrial hyperplasia or uterine cancer, 12 cases of endometrial hyperplasia group (EH-group) and 45 cases of uterine body cancer group (Ca-group), which were confirmed by histological diagnosis during the period from 1996 to 2001. Women with submucous myomata or endometrial polyp were excluded form the subjects. With the T2-weighted MRI, the thickness and heterogeneity of the endometrium (evaluated by comparisons with heterogeneity in the signal of bladder content), and the intensity of endometrial signal (classified by rating "high", "intermediate" or "low" in comparison with intracystic signal intensity) were comparatively examined. To determine cut-off values for differentiation of disease-free from EH, and for that of EH from cancer, analyses with receiver-operating characteristic (ROT) curve were performed.
  The endometrial thickness (mm, M ± SD) in the Ca-group (24.6 ± 17.2) was significantly greater than that in the C-group (3.0 ± 1.2) or EH-group (6.9 ± 5.3). ROC curve analyses revealed cut-off value for differentiating EH from disease-free was 4mm, and that for EH from cancer was 10mm. The endometrial thickness in the EH-group tended to increase compared to that in the C-group, while there were no significant differences in endometrial heterogeneity and signal intensity between these groups. In the Ca-group, there were significantly more cases (77.8%) showing endometrial heterogeneity compared to those in the C-group (0%) or EH-group (9.3%). The percentage of the cases showing a "low" endometrial signal intensity was found to be significantly higher in the Ca-group (48.9%) compared to those in the C-group (0%) or EH-group (0%), and the same was observed in any clinical stage in the Ca-group. The endometrial thickness in the Ca-group was examined at different clinical stages, showing an increasing trend with the progress of clinical stage, while significant differences in the endometrial heterogeneity and signal intensity between the Ca-group and C- or EH-group were observed from an early period of clinical stage.
  The present study revealed that there are qualitative and quantitative differences in MRI findings of endometrium and/or myometrium between in patients with uterine cancer and in those with endometrial hyperplasia or with uterine pathologies other than endometrial cancer. This suggests the usefulness of MRI for the differential diagnosis of endometrial disorders. Endometrium thickness over 10mm, heterogeneity in endometrial signal intensity, and "low" signal intensity of endometrial tissue in T2 weighted MRI would be useful criteria for screening diagnosis of endometrial cancer in postmenopausal women.[Adv Obstet Gynecol, 57 (1) : 13-23, 2005 (H17. 2)]

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To elucidate the control mechnism of serum leptin levels, production of leptin in the adipose tissue and placenta was measured during normal and preeclamptic pregnancy.
  Participants were 158 non-pregnant women, 197 early, 204 mid and 243 late normal pregnant women, 19 mild and 23 severe preeclamptic pregnant women. Serum leptin levels (RIA) and correlation between serum leptin levels and body mass index (BMI) were compared between the groups. Abdominal subcutaneous adipose tissue and placental villi were obtained from non-pregnant and pregnant women. Samples were homogenized in 1ml of Tris buffer, and then centrifuged. Levels of leptin and the levels of ob mRNA in the supernatant were compared between the groups.
  Serum leptin levels in the early pregnant, mid pregnant and late normal pregnant group were significantly higher than those in the non-pregnant group (p<0.0001, respectively). There were significant positive correlations between serum leptin levels and BMI in the non-pregnant, early pregnant and mid pregnant groups (p<0.0001, respectively). The correlation coefficient in the early pregnant group (r=0.729) was higher than that of the non-pregnant (r=0.564), and the correlation coefficient in the late normal pregnant group (r=0.355) was lower than that of the non-pregnant group. Serum leptin levels in the severe preeclampsia group were significantly higher than those in the mild preeclampsia and late normal pregnant groups (p<0.0001, respectively). There was no significant correlation between serum leptin levels and BMI in the mild and severe preeclampsia groups. Leptin levels in the tissue homogenate and ob mRNA levels in adipose tissue in the late pregnant group were similar to those in the non-pregnant group and severe preeclampsia group. Leptin levels in the tissue homogenate and ob mRNA levels in placental villi in the early pregnant and severe preeclampsia groups were significantly higher than those in the late normal pregnant group (p<0.005, and p<0.05).
  The control mechanism of serum leptin levels alters during pregnancy. In early pregnancy, a strong positive correlation between serum leptin levels and BMI suggests that leptin production in adipose tissue is increased in this stage of pregnancy. Leptin production in placental villi is also involved in the rapid elevation of serum leptin levels.
  In late pregnancy, a weak correlation between serum leptin levels and BMI suggests that adipose tissue is not the main regulator of serum leptin levels in this stage. The volume and leptin expression in placental villi, which alters by gestational age, are mainly involved in the regulation of serum leptin levels. Increased leptin level in severe preeclampsia is brought about by the increased leptin production in placental villi. [Adv Obstet Gynecol, 57 (1) : 24-31, 2005 (H17. 2)]

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Intravenous leiomyomatosis of the uterus is a rare neoplastic disease characterized by a benign intravenous smooth muscle tumor. A 47 years old woman was found to have intravenous leiomyomatosis of the uterus with extension into the inferior vena cava and the right atrium. Laparotomy revealed the uterus to be 14 x 13 x 11 cm in size consisting of 12 x 7 x 7 cm mass with retroperitoneal part projecting from its right wall. The retroperitoneal mass was connected to the right ovarian vein, extended into the inferior vena cava and reached the right atrium. The patient underwent sternotomy simultaneously with laparotomy. Excision of the total tumors was successfully achieved with the use of normothermic cardiopulmonary by-pass system under extracorporeal circulation. Pathological findings indicated that these tumors originated from leiomyoma. No additional therapy was required after surgery, and the patient has shown no evidence of recurrence of the disease for 9 years to date. [Adv Obstet Gynecol, 57(1) : 32-36, 2005(H17.2)]

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