ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
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Volume 64, Issue 1
Displaying 1-17 of 17 articles from this issue
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ARTICLES
Original
  • Laparoscopic surgery in elderly patients with benign ovarian tumor : a retrospective evaluation of laparoscopic and open adnexectomy
    Kyoka AMEMIYA, Azusa MIYAMOTO, Naoko SASAMOTO, Masami HAYASHI, Yoshimi ...
    2012 Volume 64 Issue 1 Pages 1-8
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.1
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    In recent years, laparoscopic surgery in elderly patients has spread rapidly in gynecology field. But it is unclear whether the approach result has a better outcome than open surgery. We studied a retrospective analysis of these two surgical procedures in elderly patients (70 years old and over) with ovarian tumor which was diagnosed benign preoperatively. The median age of the patients with laparoscopic adnexectomy (LA) was 75.2 years old and 78.6 years old in open adnexectomy (OA). The median diameter of tumors with LA was shorter than that with OA (7.7 cm vs. 12.1 cm, p=0.027). The median operation time in LA was longer (135 minutes vs. 86 minutes, p=0.008), and bleeding loss was less (13.7 ml vs. 56.6 ml, p=0.016) than those in OA. The postoperative C-reactive protein (CRP) value was significantly elevated in patients with OA compared with those undergoing LA (p=0.047). The pain scales of postoperative day 0,1,3 were also significantly higher in patients with OA. In this study, there was no pneumoperitoneum related complications. The comparison of bleeding loss, the degree of alterations of postoperative CRP value and pain scales in two groups revealed that laparoscopic procedure is less invasive and associated with a reduction in postoperative pain. These results indicate that laparoscopy is as safe as laparotomy for elderly patients with benign ovarian tumor. Therefore, elderly patients may benefit from laparoscopic surgery. Chromological age alone should not be considered as a contraindication in selecting patients for laparoscopic surgery. [Adv Obstet Gynecol, 64(1):1-8, 2012 (H24.2)]
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  • Perinatal outcome in women with diabetes mellitus and gestational diabetes mellitus
    Ayako SONOYAMA, Kenji TANIMURA, Mayumi MORIZANE, Nobue KOJIMA, Hideto ...
    2012 Volume 64 Issue 1 Pages 9-16
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.9
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    Changes in maternal lifestyle are likely to influence the morbidity in pregnancies complicated with gestational diabetes mellitus (GDM) and diabetes mellitus (DM). We retrospectively assessed pregnancy outcomes among women with type-1 and type-2 DM (n=65) and GDM (n=65) who gave births during the period between January 2005 and September 2010. The GDM group comprised 25 GDM women who satisfied the new GDM diagnostic criteria and 40 GDM women who satisfied the old GDM diagnostic criteria. Pregnant women who satisfied the new GDM diagnostic criteria but not the old GDM diagnostic criteria were designated as new GDM women in this study. Results showed that type-1 DM women had higher levels of glycated hemoglobin (HbA1c) and glycoalbumin (GA) than the other women. Moreover, type-1 DM women had significantly higher frequencies of delivering infants who were heavy for date (HFD) or had shoulder dystocia than the other women. Type 2 DM women had significantly higher frequencies of obesity and hypertension than the other women. Three new GDM women showed high insulin resistance (homeostasis model assessment ratio [HOMA-R] ≥ 2.5), and received diet therapy and insulin injections. Type-1 DM women had high risks of adverse pregnancy outcomes because of hyperglycemia that could not be well controlled in these women. [Adv Obstet Gynecol, 64 (1) : 9-16, 2012 (H24.2)]
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  • A study of maternal progress during pregnancy complicated by chronic hypertension resulting in poor perinatal outcomes
    Shinya TAIRAKU, Mineo YAMASAKI, Natsuko MAKIHARA, Kenji TANIMURA, Ryoi ...
    2012 Volume 64 Issue 1 Pages 17-22
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.17
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    Chronic hypertension is a major medical complication during pregnancy that may result in poor perinatal outcome. Most cases with jeopardized offspring are considered to have preeclampsia superimposed on a preexisting hypertensive state. In Japan, during gestation, worsening of hypertension without proteinuria is not categorized as superimposed preeclampsia. However, pregnancies complicated by worsened hypertension may have poor perinatal outcomes like those with superimposed preeclampsia. This study aimed to clarify the differences between these 2 conditions with regard to perinatal outcomes. The study subjects included 42 pregnant women with chronic hypertension. Retrospective analyses were perfomed using medical records and the subjects were classified into the following 3 groups. The mild hypertension group (n=22), in which patients remained mildly hypertensive throughout pregnancy; the severe hypertension group (n=9), in which patients become severely hypertensive after 20 weeks of gestation; and the superimposed preeclampsia group (n=11). Clinical parameters of the patients were compared among the groups. In this study, poor perinatal outcomes were defined as intrauterine fetal death, neonatal death, birth weight less than 1500 g, growth restriction less than -2.0 SD, or severe neonatal asphyxia with an Apgar score of 3 or less. No statistical differences were observed for maternal age, pregestational BMI (body mass index) and BMI just before delivery among the groups. However, in cases with poor perinatal outcomes, the rate at which antihypertensive medication was used during the early half of gestation was higher than in cases without poor perinatal outcomes (88% vs. 32%, p=0.015), although this rate was not associated with the final state of the mothers. In the severe hypertension group, gestational age at delivery was significantly earlier than that in the mild hypertension group. The rates of both cesarean section and poor perinatal outcomes were significantly higher in the former than that in the latter groups. However, no statistical differences were observed in these parameters between the severe hypertension and the superimposed preeclampsia groups. This study suggests that antihypertensive therapy during the first half of gestation may be a predictive factor of poor perinatal outcomes. Furthermore, we suggest that the worsening of hypertension without development of proteinuria during pregnancy and superimposed preeclampsia may be a warning state of poor perinatal outcomes. [Adv Obstet Gynecol, 64(1) : 17-22, 2012 (H24.2)]
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Case Report
  • Primary malignant lymphoma of the uterus treated by radiation therapy : a case report with review of Japanese literature
    Misako YAGI, Yuri YASUI, Chiaki EBARA, Mari TOMIIE, Masahiro ASADA, Mu ...
    2012 Volume 64 Issue 1 Pages 23-31
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.23
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    The following is a rare case report of primary malignant lymphoma of the uterus, in which the patient, an 88-year old woman, was admitted in 2009 to our hospital for facial palsy and lower abdominal distention. After being treated for facial palsy at the department of otorhinolarygology, she was then transferred to our department, as abdominal-pelvic computed tomography showed a huge intra-pelvic mass involving the uterus and the left piriformis muscle with hydronephrosis of the left kidney. Internal examination found her uterus to be irregularly enlarged to fist size and hard with restriction of movement. Her vagina and portio vaginalis appeared to be clean. Cervical cytology was negative but endometrial cytology showed a few atypical cells. Inguinal lymph node biopsy showed invasion of diffuse large B cells positive for CD20 and negative for CD3. Along with this clinical data, MRI demonstrated the clinical staging as IV (Ann Arbor staging). Taking her age and performance status into consideration, radiation therapy (RT) was selected. She received 50Gy whole pelvic external RT. After 3 weeks, the tumor had dramatically shrunk, renal function had improved and the nephrostomy had decatherized. After 6 weeks, metastatic skin lesions which had appeared on the left side of the abdomen and the Inguinal region were also treated with 40Gy of RT. She was rehospitalized 4 months later for general fatigue, fever and loss of appetite due to aggravation of the lymphoma. She died 7 days after admission. 25 cases of uterine malignant lymphoma have been reported in domestic literature to date. The origin, average age, chief complaint, laboratory data and method of therapy are also discussed. [Adv Obstet Gynecol, 64(1) : 23-31, 2012(H24.2)]
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  • Lymphoepithelioma-like carcinoma of the uterine cervix : a case report
    Seiki MATSUO, Taisuke MORI, Morio SAWADA, Haruo KUROBOSHI, Hiroshi TAT ...
    2012 Volume 64 Issue 1 Pages 32-35
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.32
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    Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare variant of squamous cell carcinoma. LELC is characterized by a nest of poorly differentiated epithelial cells surrounded by a prominent lymphocytic infiltration. Despite the poorly differentiated pathological findings, it appears to have a better outcome than the usual squamous cell carcinoma of the uterine cervix. Therefore, it is important to differentiate this tumor from poorly differentiated squamous cell carcinoma and lymphoproliferative disorders of the cervix before the treatment. LELC arising from the nasopharynx has been suggested to be associated with Epstein-Barr virus (EBV) infection, whereas the involvement of EBV in LELC of the uterine cervix is still controversial. In addition, the role played by high-risk human papilloma virus (HPV) in this type of tumor remains unknown. We report a case of LELC of the cervix with diagnosis on the basis of histopathology in a 52-year-old Japanese woman who presented with a history of postmenopausal continuous bleeding. We also examined the association of EBV and HPV in this case, but they are negative. [Adv Obstet Gynecol, 64(1) :32-35, 2012(H24.2)]
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  • Delayed diagnosis of amnionicity in three cases of monoamniotic twin pregnancy
    Kenji HISHIKAWA, Masaya HIROSE, Takumi UEDA, Ayaka YAMAGUCHI, Shingo U ...
    2012 Volume 64 Issue 1 Pages 36-40
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.36
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    Amnionicity diagnosis in monochorionic twin pregnancy is important in obstetric practice, because of increased perinatal morbidity and mortality, mainly from cord entanglement and fetal malformation. We experienced 3 monoamniotic twin pregnancy cases between 2004 and 2010. Although examinations were done from the first trimester in each case, clear diagnosis was not obtained until 20-26 weeks of gestation. When amnionicity diagnosis is unclear or a dividing membrane is difficult to detect after diagnosis of monochorionic diamniotic twins, monoamniotic twins should be considered. For accurate amnionicity diagnosis, detection of cord entanglement is useful along with that of a dividing membrane. [Adv Obstet Gynecol, 64(1) : 36-40, 2012(H24.2)]
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  • Successful long-term dienogest therapy for recurring pelvic pain due to endometriosis after laparoscopic surgery : a case report
    Koji KUMAGAI, Kiyoji OKUDA, Yoshito TERAI, Masayuki YASUDA, Yoshiki YA ...
    2012 Volume 64 Issue 1 Pages 41-48
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.41
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    We report the case of successful long-term dienogest therapy for recurring pelvic pain due to endometriosis after laparoscopic surgery. A 38-year-old woman (46 years old at present; 2 gravida, 1 para) presented to our hospital with severe pelvic pain that persisted both during and around her menstrual period. Herbal medicines or oral contraceptives that were administered for 1 year partially reduced the pain. The patient underwent laparoscopic surgery for complete relief from the pain. Laparoscopic observation confirmed stage IV endometriosis, which was evaluated according to the revised American Society for Reproductive Medicine (r-ASRM) classification system. We dissected both the severe adnexal adhesions, excised both ovarian chocolate cysts, and dissected extensive adhesion in the cul-de-sac. After the surgery, the patient was prescribed oral contraceptives for 2 years as maintenance therapy. However, the pain recurred; hence, she was treated with oral dienogest (2 mg/day) for 56 weeks. 22 weeks after drug cessation, she was again treated with the same dose for the next 81 weeks, until presently. Almost complete relief from the pain was achieved using this long-term dienogest therapy. No obvious side effects adverse events were observed, except for dizziness and scant uterine bleeding. The present case indicates that long-term dienogest therapy (lasting even over 80 weeks) after laparoscopic surgery is effective and safe. Dienogest therapy may be a novel alternative post-laparoscopic treatment for pelvic pain due to endometriosis. [Adv Obstet Gynecol, 64(1) : 41-48, 2012 (H24.2)]
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  • A case of pregnancy and delivery complicated with salt-wasting congenital adrenal hyperplasia
    Noriko SATO, Mitsunori SHIOJI, Satoshi KUBOTA, Michiko YAMASHITA, Ryok ...
    2012 Volume 64 Issue 1 Pages 49-53
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.11437/sanpunosinpo.64.49
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    Congenital adrenal hyperplasia (CAH) is an inherited defect of cortisol biosynthesis. More than 90% of CAH cases are caused by 21-hydroxylase deficiency (21-OHD). Complete 21-OHD leads to the classical salt-wasting form, characterized by decreased cortisol and aldosterone production and androgen excess, leading to prenatal virilization of external genitalia in female fetuses and salt-wasting in both sexes. Fertility prognosis in women with classical 21-OHD is low, especially in the salt-wasting form. We report a case of pregnancy and delivery complicated with salt-wasting CAH. The patient was a 26-year-old female with CAH and salt-wasting due to 21-OHD. She had been diagnosed with salt-wasting CAH in the first month of life when she presented with dehydration, vomiting, hyperkalemia, and ambiguous external genitalia. She was treated with glucocorticoid and mineral corticoid. Surgical repair of the external genitalia was performed at 6 years, followed by vaginoplasty at 11 years. She was married at 25 years and became pregnant spontaneously at 26 years. The pregnancy was uneventful. The dose of medication remained unchanged throughout the pregnancy. Because of extensive prior vaginal reconstruction, she underwent elective caesarian section at 38 weeks gestation and delivered a healthy 2694g male infant. Before the caesarian section, 100mg hydrocortisone was administrated intravenously. She and her baby were discharged from the hospital 7 days after delivery uneventfully. [Adv Obstet Gynecol, 64 (1) : 49-53, 2012 (H24.2)]
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124th Meeting of the OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN
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