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Objective: To investigate the possibility of prediction of the histological type of ovarian tumors by preoperative imaging in patients had undergone surgery for pregnancy-associated ovarian tumors. Methods: Maternal ovarian tumor was detected by ultrasonography (USG) examination and magnetic resonance image (MRI) and operation was performed in 18 pregnant women. In 18 cases, collected medical records, USG/MRI and pathologic findings were analyzed retrospectively. Results: Histopathological diagnoses were parovarian cyst, simple cyst, mucinous cystadenoma, a combination of mucinous cystadenoma and mature cystic teratoma, mature cystic teratoma, hemorrhagic lutein cyst, immature teratoma (Grade1), a combination of mucinous cystadenocarcinoma and mature cystic teratoma. The rate of agreement between the tissue pattern predicted by USG and the histopathological diagnosis was 25%. Matching rate for dermoid cysts was 37.3%. Immature teratoma (G1) could not be predicted preoperatively, but a combination of mucinous cystadenocarcinoma (G1) and mature cystic teratoma was diagnosed as ovarian cancer and a low malignant potential case by some gynecologists. MRI was useful for the diagnosis of dermoid cyst. On the other hand, it was quite difficult to diagnose the tumors as malignant by MRI. Conclusions: USG can make images at a given cross-section in real-time, and follow the time course of their changes. On the other hand, MRI may display excellent tissue contrast to target tissues and delineate more accurate morphological changes. The combined use of USG and MRI may further improve the diagnosis of ovarian tumors., Acta medica Nagasakiensia, 58(2), pp.33-40; 2013

Endometriosis is an estrogen-dependent chronic inflammatory condition associated with variable degrees of pelvic pain and infertility. Studies have showed that the growth and progression of endometriosis continue even in ovariectomized animals. This indicates that besides ovarian steroid hormones, the growth of endometriosis can be regulated by the innate immune system in the pelvic environment. As a component of innate immune system, increased infiltration of macrophages has been described in the intact tissue and peritoneal fluid of women with endometriosis. Different immune cells and dendritic cells express Toll-like receptors (TLR) and exhibit functional activity in response to microbial products. In this review article, we discuss the role of the TLR system in endometrium and endometriosis and outline the involvement of cytokines/endotoxin in causing adverse reproductive outcome. In the first part of this review article, the fundamentals of innate immune system, functional characteristics of TLR and signaling pathways of TLR4 are discussed for easy understanding by the readers., The Journal of Obstetrics and Gynaecology Research, 39(8), pp.1281-1292; 2013

We present a case of ovarian plasmacytoma results in the patient's death by very quick progression after the operation, radiation and chemo therapy. As reported cases of primary ovarian plasmacytoma are very rare, its prognosis remains unknown. To date, we found seven reports of solitary ovarian plasmacytoma. Except for our case, most cases showed relatively slow progression or need only strict observation without recurrence. Although post-surgical therapy of ovarian plasmacytoma is not clearly established, our case was needed to use radiation and chemo therapy against the very rapid recurrent tumor. In this case, ovarian plasmacytoma relapsed very quickly, suggesting that some cases of ovarian plasmacytoma may require an aggressive adjuvant therapy., Acta medica Nagasakiensia, 58(1), pp.9-12; 2013

Using ultrasonography, we measured the largest vertical dimension for pockets of amniotic fluid (largest vertical pocket) directly before elective cesarean delivery in 42 pregnant women and compared the results to actual amniotic fluid volume (AFV). In another 3 pregnant women of vaginal delivery suspected polyhydramnios, we performed amniocentesis and successively recorded the largest vertical pocket and actual AFV, and finally made a fitting curve and correlative equation. A high degree of correlation was found between the largest vertical pocket measured by ultrasound and the actual AFV. The equation is: Y=63.03-8.46X+0.71X2-0.01X3+0.00006X4. Using the equation obtained which relates largest vertical pocket to actual AFV; a 30mm largest vertical pocket corresponds to an actual volume of 200ml, an 80mm largest vertical pocket to 800ml, and a 120mm largest vertical pocket to 3,000ml. In conclusion, the largest vertical pocket is well reflected in the actual AFV., Acta medica Nagasakiensia, 57(2), pp.41-44; 2012

Objective: This study aimed to determine whether fetal arm movements change when music is presented to the mother or directly to the fetus through the mother's lower abdomen, and whether maternal mood influences changes in fetal arm movements. Methods: Using a diagnostic ultrasound apparatus, fetal arm movements were measured in 47 pregnant women in the 35-36th week of pregnancy. Subjects were divided into two groups: a maternal presentation group, in which the mothers listened to music through headphones; and a fetal presentation group, in which music was presented directly to the fetus through headphones placed on the mother's abdomen. Fetal arm movements were observed and recorded by ultrasound for a total of 10 min (5 min without music followed by 5 min with music). The music used was Mozart's Sonata for Two Pianos in D Major, K. 448. The Profile of Mood States-Brief Form (POMS) was used to investigate the influence of maternal mood on fetal arm movements. Results: In the maternal presentation group, changes in fetal arm movement did not differ between mothers with different moods. In the fetal presentation group, fetal arm movements increased when the mother was energetic and decreased when the mother lacked energy. Fetal arm movement also decreased when the mother had a high level of fatigue and increased when the mother had a low level of fatigue. Conclusion: Presenting music directly to the fetus while the mother is relaxed has the potential to increase fetal response to the music and may possibly promote fetal well-being., Acta Medica Nagasakiensia, 55(1), pp.7-13; 2010

Open infrarenal aortic clamping has been performed for traumatic pelvic hemorrhage or aortic rupture, and there are few reports of its use in the field of obstetrics and gynecology1). We report a patient with placenta previa accreta who was successfully treated by open infrarenal aortic clamping., Acta medica Nagasakiensia, 58(3), pp.93-95; 2013

A 41-year-old Japanese woman who presented with right lower abdominal pain underwent partial omental resection with tumor excision, leaving no residual tumor. The tumor was diagnosed as a myxoid leiomyosarcoma that apparently originated in the greater omentum. A recurrent omental tumor was excised at 4.5 months after the first operation, and then at 5.5 months after this, CT revealed metastatic sarcoma at the surface of the liver (S7) and the left upper abdomen. She died 20 months after the last operation despite treatment of the metastases with MAID therapy (mesna, adriamycin, ifosfamide, dacarbazine). A literature review revealed that this tumor mainly occurs in the uterus, soft tissue, and cardiovascular system, with a preponderance among middle-aged to elderly women. The present report is the first description of primary omental myxoid leiomyosarcoma., Acta medica Nagasakiensia, 54(1), pp.21-24 ; 2009

The purpose of the present study was to evaluate the prognostic significance and relationship between tumor volume and microvessel density in squamous cell carcinoma of the uterine cervix. The estimated tumor volume (TV) in 57 patients (22 stage Ib, 18 stage IIa, and 17 stage IIb) had radical hysterectomy was calculated on the assumption that the tumor mass was spheroid. The micro-vessel density (MVD) was evaluated as the ratio of endothelial area immunoreactive to factor-VIII related antigen (von Willebrand factor) to whole image area measured by computer-aided image analysis system. Tumor volume ranged from 0.1 to 41.0 cm3 (median 3.6 cm3) and MVD from 0.33 to 2.95 % (median 0.85 %). A significantly larger median TV was noted in women with positive pelvic node metastasis (6.3 vs 2.6 cm3, P=0.0228), parametrial invasion (8.9 vs 0.8 cm3, P< 0.0001), and postoperative irradiation (5.4 vs 0.6 cm3, P=0.0007). In contrast, these clinical parameters had no effect on MVD. There was no correlation between TV and MVD. The overall survival rate at 5 years was 93.1% and 60.7% (P=0.0037) between women with a TV of ?4 cm3 and >4 cm3, respectively; and 96.2% and 61.3% (P=0.0022) between tissue specimens with a MVD of ?0.8% and >0.8%, respectively. A combined TV of >4 cm3 and MVD >0.8% further deteriorated 5 year survival rate (42.1% vs 94.7%, P, Acta medica Nagasakiensia, 53(4), pp.77-84 ; 2009

OBJJECTIVE: To determine the genotypes of four candidate genes in Japanese women with a history of preeclampsia, and in a control group of parous woman. STUDY DESIGN: Fifty-two pregnant women with a history of preeclampsia in their first pregnancy and 113 normotensive gravid women were studied. All subjects were Japanese women with singleton gestations. Genomic DNA was extracted, and genotypes of angiotensinogen (AGT), methyleneteterahydofolate reductase (MTHFR), factor V Leiden, and prothrombin genes were analyzed. RESULTS: The frequencies of homozygous AGT gene mutation and homozygous MTHFR gene mutation in preeclampsia were significantly higher than that in control. The calculated risk associated with the presence of both mutations did not exceed the risk with polymorphism of each gene. None of the examined cases showed polymorphism of factor V Leiden and prothrombin G20210A genes. CONCLUSION: In Japanese patients with preeclampsia, the angiotensinogen gene and particularly MTHFR gene may play a role in the pathogenesis of preeclampsia., Acta medica Nagasakiensia, 53(2), pp.37-41 ; 2007

The fetus could not be considered a patient until ultrasonography stripped the fetus of his/her aura of mystery; until the origin and development of the fetus from embryo to neonate could be explained scientifically. Ultrasonographies enabled accurate delineation of normal and abnormal fetal anatomy with considerable detail and later on live moving pictures. Ultrasonographic imaging appears to have no harmful effect on the mother or on the fetus. The ability of prenatal ultrasonography to diagnose fetal abnormalities, both as a screening tool and for targeted examinations, has also been confirmed. The ability to perform invasive prenatal diagnostic procedures, such as amniocentesis, chorionic villus sampling, and cordocentesis as well as fetoscopy for fetal therapy has been significantly improved by real-time ultrasonography. Three-dimensional ultrasonography and MRI are now also available for fetal imaging. Recently, cell free fetal DNA released into maternal plasma is known as useful tool for non-invasive prenatal diagnosis of genetic diseases. The fetus may become our new patient in the near future., Acta medica Nagasakiensia. 2007, 52(1), p.1-6

Chorioangioma is the most common benign placental tumor arising from the chorionic stroma and capillaries, and histologically accounts for about 1% of placental tumors1). It rarely exceeds 5 cm in diameter, and is clinically diagnosed in 1 out of every 8,000-50,000 patients1). We report a patient with a relatively large chorioangioma (10 cm in diameter) accompanied by polyhydramnios., Acta medica Nagasakiensia, 58(1), pp.29-31; 2013

The aim of this study was to test the effects of vitamin E on fetal lung growth in rats with congenital diaphragmatic hernia (CDH). Experimental congenital diaphragmatic hernia (CDH) was induced in rat fetuses by maternal administration of 100 mg nitrofen by gastric gavage on day 9.5 of gestation. Vitamin E was provided at days 16-20 of gestation, at 30 IU/day. Cesarean section was performed at day 21 of gestation. Immunohistochemistry was performed using anti-surfactant protein A (SP-A) and anti-SP-B polyclonal antibodies. RT-PCR evaluated SP-A and SP-B mRNA expressions. The lung weight/body weight ratio in rats with CDH was lower than the control (p, Acta medica Nagasakiensia. 2002, 47(3-4), p.117-121

To investigate cellular growth and differentiation of the airway epithelium of the human fetal lung using immunohistochemistry, with a particular focus on cases of pulmonary hypoplasia. A total of 25 autopsy cases of stillbirth and early neonatal death were examined at Nagasaki University Hospital from 1986 to 1997. Using immunohistochemistry, we determined the expression of a variety of growth factors (EGFR, HGFR, GRP and SAPA) in lung tissues with or without pulmonary hypoplasia. A significant decrease in radial alveolar count was detected in hypoplastic lungs compared with normal lungs. The expressions of EGFR, HGFR and GRP in tissues from hypoplastic lungs were significantly lower than in tissues from normal lungs, but the expression of SAPA was not different between the two groups. Our results indicated that significant abnormalities of cellular growth and differentiation are present in pulmonary hypoplasia. However, lung maturation in pulmonary hypoplasia was not significantly different to that in normal lungs., Acta medica Nagasakiensia. 2000, 45(1-2), p.61-66

As the fibrinogen level decreases early in atonic bleeding, early administration of FFP may be important as an initial approach to treat atonic bleeding. Amniotic fluid embolism is classified into 2 types, conventional type and uterus-type., The Journal of Obstetrics and Gynaecology Research, 40(2), pp.336-337; 2014