ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
Volume 63, Issue 4
Displaying 1-10 of 10 articles from this issue
ARTICLES
Original
  • Kensuke HORI, Ryosuke ANDO, Naoya SHIGETA, Yasunari MIYAGI, Keiko ONIS ...
    2011 Volume 63 Issue 4 Pages 477-482
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    We retrospectively reviewed 32 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIc ovarian cancer, who were primarily treated in our hospital between 2002 and 2008. We used the patients' charts and analyzed the details of their treatment. 5-year overall and disease-free survival rates were 51.2% and 47.3%, respectively. These rates were higher than those of the FIGO report in 2006. The recurrence rate of 7 cases who underwent optimal debulking surgery either primarily or secondarily was significantly lower than that of the 23 cases who did not (p=0.0042). In the primary suboptimal surgery group, the recurrence rate of 18 cases who underwent optimal debulking surgery was significantly lower than that of the 5 cases who did not undergo surgery because they achieved a clinical complete response (CR) with chemotherapy (p=0.0361). In the recurrence group, the overall survival rate of 10 cases treated with more than 5 cycles of salvage chemotherapy was significantly higher than that of the 3 cases who underwent less than 6 cycles of the same (p=0.0024). These results show that the combination of optimal debulking surgery, performed either primarily or secondarily, and continuing chemotherapy are important for prolonged survival of patients with recurrent stage IIIc ovarian cancer. [Adv Obstet Gynecol, 63(4) : 477-482, 2011(H23.11)]
    Download PDF (516K)
Clinical Report
  • Kana IWAI, Hidekazu OI, Taihei TSUNEMI, Katsuhiko NARUSE, Taketoshi NO ...
    2011 Volume 63 Issue 4 Pages 483-487
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    Serological diagnosis of patients with amniotic fluid embolism (AFE), based on the detection of Sialyl-Tn (STN) and Zinc coproporphyrin1 (Zn-CP1), is a unique and original method used in Japan. Maternal serum (MS) levels of STN and Zn-CP1 have been measured at the Hamamatsu University School of Medicine in the Department of Obstetrics and Gynecology as part of a project of the Japan Association of Obstetricians and Gynecologists for diagnosing AFE. Serum data from 201 individuals enrolled from 1992 to 2006 were used in this study. Seventy-four of the 201 cases did not fit the definition for differential diagnoses for patients presenting with possible AFE (controls). The purpose of this study was to evaluate the usefulness of STN and Zn-CP1 as serum markers for diagnosing AFE. The number of samples with concentrations greater than the upper reference limit for MS STN (>47U/ml) and MS Zn-CP1 (>1.6 pmol/ml) was found to be significantly higher in AFE patients than in controls by the Chi-square test (STN: p=0.00003; Zn-CP1: p=0.00953). Serum STN levels in AFE patients were higher compared with those in controls (p=0.0011), unlike Zn-CP1 levels (p=0.0994). The sensitivity and specificity of MS STN and MS Zn-CP1 levels were 25.8% and 97.3% and 45.9% and 73.0%, respectively. This study demonstrated that STN and Zn-CP1 levels are potential markers for the diagnosis of AFE. The diagnosis of AFE should be that of exclusion and strongly suspected by clinical manifestations; it should not be solely based on serological STN and Zn-CP1 values. [Adv Obstet Gynecol, 63(4) : 483-487, 2011 (H23.11)]
    Download PDF (548K)
Case Report
  • Fuminori ITO, Sachiyo MARUYAMA, Yoshikatsu FUJIMOTO, Ken YAMASHITA
    2011 Volume 63 Issue 4 Pages 488-492
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    In general, it is thought that the risk of developing peptic ulcer disease (PUD) is lower during pregnancy compared to non-pregnant period. Reported case of perforated ulcer during pregnancy is also uncommon, although there are reports of such cases during third trimester, no case during early pregnancy has been reported. In this report, we share our experience with such a case in which the patient developed perforated duodenal ulcer during early pregnancy, but was able to maintain her pregnancy with some treatments. The patient was a 39-year old unipara who had already been under the hospital's care due to hyperemesis. Because she developed acute epigastric pain and an X-ray showed free gas in the abdominal cavity, upper gastrointestinal endoscopy was performed. She was diagnosed with perforated duodenal ulcer, but was able to maintain her pregnancy through conservative treatments such as drug administration. We report our diagnosis, management, and treatment of the digestive tract perforation during pregnancy, along with some bibliographic considerations. [Adv Obstet Gynecol, 63(4) : 488-492, 2011 (H23.11)]
    Download PDF (2317K)
  • Yuki IKEDA, Hiroshi TSUBAMOTO, Kayo INOUE, Toru KATO, Riichiro KANAZAW ...
    2011 Volume 63 Issue 4 Pages 493-498
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    Adenocarcinoma (including adenosquamous carcinoma) of the uterine cervix is resistant to radiation therapy and patients in advanced stages have a worse prognosis than those with squamous cell carcinoma. Cervical carcinoma FIGO stage IVa without lateral invasion can be completely resected with exenteration. From 1998 through 2006, a clinical trial of neoadjuvant chemotherapy (NAC) was conducted at our institution. The regimen consisted of paclitaxel (intravenous, 60 mg/m2, days 1, 8, and 15) and cisplatin (trans-uterine arterial infusion of 70 mg/m2, followed by transcatheter embolization with gelatin sponge particles on day 2) repeated every 3 weeks for 2-3 cycles. Two patients with FIGO stage IVa disease were enrolled, and achieved long-term survival after anterior or posterior exenteration following NAC. [Case 1] A 66-year-old multipara with Parkinson's disease was admitted to our hospital for vaginal bleeding. A cervical adenocarcinoma 8 cm in diameter, FIGO stage IVa, was diagnosed by cervical biopsy, MRI, and barium enema results. After 2 cycles of NAC, feces appeared through the vagina and a recto-vaginal fistula was diagnosed, while MRI showed disappearance of the tumor (complete response). A radical hysterectomy with low anterior resection and anastomosis of the rectum was performed, and the obtained specimen showed no malignant cells. She was alive 84 months after surgery without evidence of recurrence or bowel complications. [Case 2] A 59-year-old multipara consulted a urology clinic for macroscopic hematuria. Bladder invasion by a cervical adenocarcinoma was diagnosed and she was referred to our institution. After 3 cycles of NAC, cystoscopy revealed no abnormal findings and MRI showed partial response. Anterior exenteration (radical hysterectomy and cystectomy) was performed and she was alive at 72 months without evidence of recurrence. [Adv Obstet Gynecol, 63(4) : 493-498, 2011 (H23.11)]
    Download PDF (1131K)
  • Izumi SUGANUMA, Izumi KUSUNOKI, Hiroshi TATSUMI, Tomoharu OKUBO, Jo KI ...
    2011 Volume 63 Issue 4 Pages 499-504
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    The spontaneous development of heterotopic pregnancy is rare (1/30,000 pregnancies). However, with the widespread application of ART, the incidence has increased in patients undergoing in ART (1/670 pregnancies). With this tendency, the incidence of interstitial heterotopic pregnancy has also increased. In the treatment of interstitial heterotopic pregnancy, cornuostomy and cornual resection by laparotomy have commonly been performed. However, it is important to minimize the influence on intrauterine pregnancy. If possible, laparoscopic surgery should be selected. In this case, we performed laparoscope-assisted cornuostomy to treat interstitial heterotopic pregnancy after embryo transplantation, leading to a successful outcome. A 39-year-old primigravida underwent frozen embryo transplantation with 2 blastocysts for idiopathic infertility in another hospital. As heterotopic pregnancy was suspected on gestational age of 6 weeks and 1 day, the patient was referred to our hospital. A fetus with heartbeat was observed in the uterus and a gestational sac alone in the right interstitial region. Therefore, the patient was admitted to wait for the growth of the intrauterine pregnancy and abortion of the interstitial pregnancy. However, a fetus with heartbeat appeared in right interstitial region, and right lower abdominal pain was also noted. On gestational age of 7 weeks and 0 day, emergency laparoscopic surgery was performed. There was no intraperitoneal hemorrhage. In the pelvic cavity, marked endometriosis-related adhesion was observed. Cornuostomy was conducted employing the external method. The postoperative course was favorable. On gestational age of 9 weeks and 0 day, the patient was transiently discharged. As there was a case report on uterine rupture after surgery for interstitial pregnancy, supervisory admission was started at gestational age of 29 weeks. On gestational age of 35 weeks and 6 days, cesarean section was performed because it was difficult to inhibit contraction and right-flank pain was increased. A girl weighing 1994 g, with an Apgar score of 9 (5 minutes), was born. The neonatal course was favorable. Growth and development were normal. Advances in transvaginal ultrasonic equipment and precautions regarding heterotopic pregnancy following ART have increased the number of patients diagnosed with heterotopic pregnancy in the early stage. For treatment, surgery is primarily performed. However, some studies reported conservative and topical drug therapies in which the influence of surgical invasiveness on the maternal condition and intrauterine pregnancy is reduced. When performing surgery, laparoscopic surgery should be recommended to reduce the influence on intrauterine pregnancy in patients with a favorable general condition in the absence of rupture. [Adv Obstet Gynecol, 63(4) : 499-504, 2011(H23.11)]
    Download PDF (765K)
  • Anna UMEDA, Ikuko SAWADA, Hirofumi YAMAGUCHI, Saha YU, Kumiko KAZUMI, ...
    2011 Volume 63 Issue 4 Pages 505-509
    Published: 2011
    Released on J-STAGE: December 26, 2011
    JOURNAL RESTRICTED ACCESS
    Thyroid function is known to be enhanced in patients with trophoblastic disease because of an increase in the serum levels of human chorionic gonadotropin (hCG). However, few patients show clinical hyperthyroidism. We report a rare case of hydatidiform mole complicated with thyrotoxicosis. A 52-year-old multiparous woman complained of genital bleeding for 4 months after her last menstrual period. She visited a local clinic for loss of appetite, leg edema, and abdominal distention and was referred to our hospital. She was diagnosed with thyrotoxicosis because of elevated levels of free T4 (FT4) (3.52 mg/dl) and low levels of thyroid stimulating hormone (TSH) (less than 0.01 μU/ml). A huge abdominal mass was also detected. Imaging studies showed an enlarged uterus. Endometrial cytology showed trophoblast cells and a marked elevation of serum hCG levels (681676 mIU/ml). These findings were suggestive of trophoblastic disease and thus hysterectomy was planned. Two days before the operation, intrauterine contents were spontaneously exhausted. Total abdominal hysterectomy was performed according to plan. Histological examination revealed an invasive mole. After the operation, serum hCG level decreased gradually and has not increased for 1 year. Thyroid hormone level has also been normal. Thus, consideration of hyperthyroidism is important in the treatment of trophoblastic disease. [Adv Obstet Gynecol, 63(4) : 505-509, 2011 (H23.11)]
    Download PDF (919K)
OPINIONS
Clinical view
Current topic
feedback
Top