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We developed a method of endocervical staining with toluidine blue solution during cervicoscopy that clearly discriminates between the endocervical region and the endometrium and allows easy detection of superficial cervical invasion by endometrial carcinoma. Toluidine blue staining cervicoscopy was used for preoperative histological diagnosis in 10 cases of endometrial carcinoma. The staining permitted a correct diagnosis in 3 cases in which conventional diagnostic methods were practically useless. Endocervical staining with toluidine blue is highly useful for diagnosis of superficial cervical invasion by endometrial carcinoma.

Objective: This study was conducted to assess the usefulness of dimeric inhibin A as a fourth marker for Down's syndrome screening in addition to AFP, hCG and uE3 markers for native Japanese women. Methods: Serum specimens from 367 native Japanese women in the second trimester were assayed for dimeric inhibin A levels. Day specific dimeric inhibin A medians were established for gestational ages 15.0–21.9. Weekly median values for the native Japanese were compared with those of a U.S. population. Selected Japanese specimens from 15 diagnosed Down's syndrome and 3 trisomy 18 cases were also assayed for dimeric inhibin A. Results: Dimeric inhibin A levels did not vary greatly over the gestational age range as expected. Median value comparison showed that native Japanese dimeric inhibin A medians are higher than the U.S. population medians by an average of 7.95%. Native Japanese dimeric inhibin A median values in this study are 1.77 times higher in Down's syndrome cases than in unaffected pregnancies. Trisomy 18 dimeric inhibin A levels show no significant difference from the unaffected pregnancies. Conclusions: This report shows for the first time that dimeric inhibin A can be informative as a fourth marker for Down's syndrome screening in native Japanese women. We expect the addition of dimeric inhibin A to a triple marker protocol will increase the accuracy of predicted risk for all pregnancies screened and increase the detection rate of Down's syndrome affected pregnancies.

We have already reported satisfactory therapeutic results of cisplatin-based cyclic balloon-occluded arterial infusion chemotherapy (BOAI) enabling treatment by simple total hysterectomy (STH) in patients with advanced cervical cancer of the uterus (cervical cancer), with 2- and 5-year survival rates of 88.9% and 66. 7%, respectively. Considering the fact that 3 to 4 months are needed to complete BOAI, the present study was a retrospective assessment of 18 cervical cancer patients to prepare criteria for the early determination of the efficacy of BOAI in patients who can be treated by STH. The results showed that STH could be performed after the first BOAI in patients with SCC value decreased to 34.3+/-8.2% of the pretreatment value (p=0.0001) and whose tumor size had decreased by 45.1+/-7.5% (p=0.0002).

Tumor tissue from 57 cases of keratinizing-type squamous cell carcinoma of the uterine cervix that had been stored in the archives of Osaka City University Hospital between May 1986 and October 1994 were stained with periodic acid-Schiff (PAS) reagent following amylase and alcian blue to identify the presence of intracellular mucin and to assess the value and significance of demonstrating the presence of mucin. Nineteen specimens (33.3%) stained positive for mucin with alcian blue or PAS following diastase. The results of mucin staining were not significant in terms of survival by Kaplan-Meier's analysis.

Objectives: Our purpose was to investigate whether urinary incontinence (UI) severity could be graded by UI scores. Methods: The study included 168 UI patients diagnosed by conventional procedures as stress incontinence (SI, n=108) or urge incontinence (URI, n=60). A questionnaire containing 15 items scored for stress-score (s-s) and urge-score (u-s) was administered to patients to assess the correlation between pad test values (PTVs) and s-s in SI and u-s in URI. Results: Significant correlations were found between log[PTVs] and both s-s and u-s: log[PTVSI]=0.051s-s−0.207 (r=0.830, P

Cells from benign and borderline malignant mucinous cystadenomas surgically resected from three postmenopausal women with elevated serum estradiol levels were found to have different abilities to synthesize estrogen from [14C]-cholesterol. Addition of gonadotropins to cultured cells with low levels of estrogen synthesis did not result in any significant increase in estrogen synthesis. Immunohistochemical studies of these mucinous cystadenomas showed that LDL receptors were distributed in the benign cystadenoma cells and in the stromal cells of borderline tumors, but not in the cystadenoma cells of borderline tumors. Sterol regulatory element binding protein was immunohistochemically shown to be distributed in the mucinous cystadenoma cells of borderline tumors, but not in the benign cystadenoma cells.

We previously reported on the efficacy of transcervical needle biopsy of a uterine muscle tumor. In this study, to examine diagnostic accuracy of our needle biopsy with small specimen size, previous slide preparations were used from 8 cases diagnosed with leiomyosarcoma and from 24 post-operative leiomyoma cases. Each tissue specimen was examined through needle biopsy-sized slit that had been randomly positioned over the slide. Three predictors: mitotic index, cytologic atypism, and tumor cell necrosis were evaluated on a 3-point scale (0, 1, or 2 points). When the diagnostic cut-off value was set to two, the sensitivity was 92.5% and the specificity was 100%.

Twenty-five patients with ovarian clear cell carcinoma (CC-Ca) were enrolled in this study, and tumor cell expression of vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) was investigated, and correlated with the microvessel count (MVC) and the impact of complication endometriosis. Expression of VEGF was strongly positive in 16 cases, weakly positive in 6 cases, and negative in 3 cases. Expression of PD-ECGF was strongly positive in 11 cases, weakly positive in 6 cases, and negative in 8 cases. VEGF expression and the MVC were significantly correlated (p

We investigated the possibility of preoperative diagnosis and clinical features of mature ovarian teratoma containing malignant elements (MOTME). Between 1982 and 1998 in our hospital, MOTME accounted for 2.0% (5 cases) of the total of 251 patients with mature ovarian teratoma (ages, 37-72; mean age, 60.6). Serum CA19-9, CA125, SCC and CEA levels were high. All cases were strongly suspected malignancies, preoperatively diagnosed using serum tumor markers with diagnostic imaging. Two cases of stage I squamous cell carcinoma and one case of borderline malignancy survived, while the other two advanced cases died within 8 months.

A retrospective study to explore the prognostic factor was conducted in 39 patients with advanced epithelial ovarian cancer, FIGO stage III-IV, who underwent single-agent adjuvant chemotherapy with cisplatin following primary debulking surgery. The survival rate following the adjuvant chemotherapy was 50.9% after 3 years and 44. 7% after 5 years, with a median survival time of 40.4 months. The actual dose intensity of the cisplatin ranged from 14.38 to 46.30 mg/m2/week, and the total dose/m2 was 143.79 to 645.83 mg/m2. Under these therapeutic conditions, the actual dose intensity was found to correlate with survival time (p

We first performed 3 or 4 courses of balloon-occluded arterial infusion (BOAI) chemotherapy in 19 patients with advanced cancer of uterine cervix classified as stage III-IV according to the International Federation of Gynecology and Obstetrics. In the patients in whom the first BOAI resulted in insufficient drug accumulation in tumor tissue, the ovarian arteries and veins were ligated to improve the therapeutic effect. Ultimately simple total hysterectomy and radiotherapy were performed in 9 patients in whom the uterus was resectable (the combination group), and radiotherapy alone was conducted in the other 10 patients in whom hysterectomy was not practicable (the incomplete group). The survival rates were significantly higher in the combination group (2-year survival 88. 9%; 5-year survival 66.7%) than in the incomplete group (p=0.0013).

We report a case of transient rapid growth of uterine leiomyoma in a postmenopausal woman. A 58-year old woman presented with a rapidly enlarging pelvic tumor, from a 14-week to a 20-week gestational size in the one month. Transcervical needle biopsy revealed a smooth muscle tumor with 5 mitotic figures per 10 high power fields. However, surgical specimen obtained 1 month later revealed less than 1 mitotic figure per 100 high power fields. This variation may influence the final histopathological diagnosis because mitotic index is believed to be one of the most reliable histopathological parameters for differentiating between uterine leiomyoma and leiomyosarcoma.

The reported success rate of uterine artery embolization (UAE) for obstetrical hemorrhage is more than 90%. We experienced a case of failed UAE for postpartum hemorrhage, although an embolic particle was found pathologically in the uterine vessels without coagulation. A 42-year-old woman (gravida 7, para 2) with placenta previa had genital bleeding at 35 weeks of gestation, and cesarean section was performed. We immediately added UAE aiming to reduce massive bleeding after the cesarean section, successful embolization of the bilateral uterine arteries and internal iliac arteries were confirmed by angiography regardless the vital sign was recovered with an appropriate amount of transfusion; the massive bleeding recurred after 1 hour of UAE. Hysterectomy was performed and pathological findings of the uterus showed that there was no coagulation in the vessels, which was supposed to be observed by the effect of gelatin sponge. In addition, despite the fact that no coagulation was found, only one gelatin sponge was found in 16 slices of the uterine wall specimens. We speculate that thrombotic materials were caught in vasoconstricted vessels triggered by hypovolemic shock due to acute blood loss, and then the gelatin sponge could be washed out after recovering to normalized circulation status leading to recurrent massive hemorrhage.

Background Malignant melanoma is an extremely malignant tumor with an unpredictable profile of spread and variable periods of remission. The late recurrence of malignant melanoma after diagnosis and treatment is a rare but characteristic metastatic behavior of malignant melanoma. When the late recurrence of malignant melanoma occurs, the most common sites of metastasis are the skin, subcutaneous tissue and lymph nodes. Case A 41-year-old woman presented with recurrent malignant melanoma which had clinical features of an acute state mimicking peritoneal cancer. Seven years after the excision of the primary tumor, the patient noticed diffuse abdominal distention. The patient underwent computed tomography and magnetic resonance imaging examination, which demonstrated extensive nodularity of the peritoneal surfaces, soft tissue thickening of the omentum and large amount of ascites. Therefore, primary peritoneal cancer was initially considered the most likely diagnosis. The patient underwent an exploratory laparotomy. Macroscopically, a numerous number of white-yellow rubbery nodules of tumor were present diffusely in the ovaries and omentum and on the uterine serosal surface. The pathological examination showed poorly differentiated adenocarcinoma of peritoneum. The tumor cells showed strong positivity by immunohistochemistry for S-100, melan A and vimentin. The diagnosis was established post-operatively by immunohistochemistry. Our case was an unusual recurrent case of malignant melanoma occurring 7 years after diagnosis and treatment of malignant melanoma. Conclusion The incidence of malignant melanoma has been increasing. The late recurrence of malignant melanoma may be seen frequently in the future. A variety of imaging and pathological methods including an exploratory laparotomy may be necessary in cases of patients suspecting peritoneal cancer with a previous history of melanoma.

Background: Relations between response systems for estrogen receptors and p53 with codon 72 olymorphism in cancer cell lines are suggested through experiments for adenovirus-mediated p53 gene

We report that we found differences in changes in vascular endothelial growth factor (VEGF) levels in pleural effusion and ascites after removal of ovarian tumor complicated by Meigs' syndrome. Postoperative VEGF levels decreased in the patient's pleural fluid but not in the peritoneal fluid. The mechanism of the development of the pleural effusion and ascites in Meigs' syndrome may differ.

the inferior vena cava was 87.1o (range 52–130o). Both angles were constant during pregnancy. The size of the angle between the rt. hepatic and ductus is 45% of that between the angle of rt, hepatic and IVC. Two groups were defined according to gestational age: 13–19 weeks gestation (99 women) and 20–30 weeks of gestation (84 women). The angles between the rt. hepatic to the ductus venosus and IVC were 37.6o and 85.7o, respectively, in the first group; 40.9o and 87.8o at second trimester. There were no significant differences in the angles between the 2 groups Conclusions: The geometrical arrangement of the abdominal venous return to the atrium is constant throughout pregnancy. We believe that knowledge of this arrangement can assist in evaluation of abnormal venous return to the rt. atrium.

We report the case of a patient with uterine myoma who developed uncontrollable massive hemorrhage from the uterus during anticoagulant therapy after cardiac valve replacement and required hysterectomy. There was a discrepancy between the laboratory findings regarding the blood coagulation system and the clinical manifestations, suggesting a combination of multiple factors, such as a hormonal imbalance. This was a case that demanded strict attention to the management of the uterine lesions during the conduct of anticoagulant treatment.

Human parvovirus B19 infection has been shown to be transmissible by blood and blood products and to result in transient aplastic crisis in patients with rapid red cell turnover. We report three cases of iatrogenic parvovirus B19 infection resulting from the use of the same batch of fibrin sealant under operation. Fibrin sealant, which is a typical haemostatic agent produced from blood, has been used during surgery. Human parvovirus is resistant to existing virus-inactivating techniques, suggesting that infection may occur from blood products contaminated with it. Use of recombinant products for these proteins may thus be necessary.

Anemia-inducing substance (AIS) appears in plasma as cancer progresses. In this study, a non-coated charcoal column was used to remove AIS from the cachectic plasma obtained from patients with advanced cancer. AIS could be completely removed by 6 cycles of adsorption using this column. Similar data were obtained in an experiment using VX-2-transplanted rabbits. These observations raised the possibility that plasmapheresis with a non-coated charcoal column may be available as a new means of immunotherapy for advanced cancer.

5172 Background: There is no standard chemotherapy regimen for R-OC and ER-OC. CPT-11 (a DNA topoisomerase I inhibitor) is active against OC. A combination of CPT-11 and DXR (a topoisomerase II inh...

We developed a simple and accurate method of diagnosing urinary incontinence by means of a 15-item questionnaire that helps physicians evaluate a patient's incontinence status more easily than conventional diagnostic procedures. The results of using the questionnaire showed a total improvement rate of more than 80% among urinary incontinence patients treated in our clinic. Surgical treatment for stress urinary incontinence has improved in terms of both effectiveness and patient quality of life after introduction of a tension-free vaginal tape procedure. Our research on the prevalence of urinary incontinence among a large number of Japanese women showed that, overall, 26.8% complained of some symptoms of incontinence and, the percentage increased with age, reaching more than 40% among women over 40 years of age. However, very few of the women (4%) wished to consult a physician, with shame in the young population and resignation in the old population being the major reasons for not seeking treatment. Women need to be provided with correct information about urinary incontinence in order to improve their quality of life.

Dynamic osmotic fragility of erythrocytes in cord blood and its changes during the neonatal period were studied by means of a coil planet centrifuge system. The starting-point for hemolysis in the newborn become similar to that of adult blood after approximately a week, while the shift of the end-point to the adult range required one month or more. The percentage of fragile cord blood cells with a hemolysis starting-point above 110 m osmol and the maximum bilirubin level during neonatal period were examined. A high percentage of fragile cells was associated with high bilirubin levels, and when fragile cells comprised more than 7.0% of the total cord blood erythrocytes, the bilirubin level tended to rise above 15 mg/dl.

Composition of the amylase isozymes in the amniotic fluid and their transition with fetal age were studied by means of thin-layer acrylamide gel electrophoresis. The results indicate that amylase isozymes in the amniotic fluid were composed of a pancreatic type faint major isozyme and several salivary type isozymes consisting of an intense major and a few less intense minor bands. Characteristic changes in the pattern of these isozymes with fetal age consisted of a marked increase of the salivary type isozymes rather than of the pancreatic type isozyme. A densitometric analysis of the isozyme patterns proved that the ratio of the pancreatic type isozyme to the salivary type major isozyme was highly correlated with fetal age regardless of levels of amylase activity.

The aim of this study was to determine whether the expression of cyclooxygenase-2 (COX-2) in uterine sarcoma cells and carcinosarcoma cells is associated with cell type. Nineteen sections of tissues from uterine sarcomas, carcinosarcomas, and an adenosarcoma, and endometrial stromal sarcomas, were immunohistochemically analyzed for the cellular expression of COX-2. Positive immunostaining for COX-2 was observed in 88.9% (8/9) uterine carcinosarcomas, uterine adenosarcomas but was not observed in uterine sarcomas and the endometrial stromal sarcoma (0/10). But positive immunostaining for COX-2 was observed in some sarcomatoid cells in carcinosarcoma tissue. These findings suggest that some of the sarcoma cells in uterine carcinosarcomas resemble epithelial malignant cells in regard to the increase in COX-2 expression, and support the hypothesis that some uterine carcinosarcomas are combination tumors. This may serve as a basis for new chemoprevention and treatment strategies for uterine carcinosarcomas through the inhibition of COX-2 activity.