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A patient with schizoaffective disorder and receiving long-term treatment with lithium developed prolonged delirium. She had recently been diagnosed with stage IIIC1 endometrial cancer and presented a deteriorating general condition. Toxic levels of lithium were measured in serum. After hemodialysis, lithium levels gradually decreased and the symptoms disappeared completely.

There is currently controversy regarding the criteria for low and intermediate risk of cervical cancer (CC) after surgery. In the present study, the Gynecology Oncology Group (GOG) score was used to detect intermediate risk. Adjuvant radiotherapy was applied in the case of a GOG score120. The present study aimed to evaluate the validity of the recurrence risk classification using the GOG score for stage IB-IIA node-negative CC. All cases of stage IB-IIA node-negative CC who underwent radical surgery between February 2007 and December 2015 were retrospectively reviewed. The GOG scores were determined from clinical and pathological findings and accordingly, subjects were divided into 4 groups: A, ≤40; B,40 and ≤70; C,70 and ≤120; and D,120. Overall survival (OS) and recurrence-free survival (RFS) curves were generated using the Kaplan-Meier method. The log-rank test produced an estimated P-value by comparing the OS and RFS of group A (low-score group) with those of others. The present study included 61 patients (mean age, 47.82 years; age range, 22-76 years) and the median follow-up was 79 (39-149) months. Of these, 60 patients were observed for at least 60 months. During the follow-up period, the OS and RFS rates of group C were 94.7 and 84.2%, respectively, while those of group D were 100 and 91.7%, respectively; the OS and RFS of groups A and B were 100%. Log-rank tests for all OS and RFS indicated no significant differences compared to group A. It was indicated that a GOG score ≤70 does not require adjuvant therapy; however, a GOG score70 requires consideration of adjuvant therapy based on the risk factors which constitute the score.

Endometrioid carcinoma is the most common histological type of concurrent synchronous cancers of the uterus and ovary. Here we report a case of synchronous seromucinous carcinoma of the ovary and mucinous carcinoma of the endometrium with a literature review. A 51-year-old multiparous female complained of irregular bleeding and shortness of breath. Computed tomography revealed a large pelvic mass that consisted of cystic and solid components, a tumor of the endometrium, and a large amount of pleural effusion. An endometrial biopsy indicated adenocarcinoma, and adenocarcinoma cells were found in the pleural fluid. The patient with advanced ovarian cancer or endometrial cancer with massive pleural effusion received three courses of neoadjuvant chemotherapy (NAC) with paclitaxel and carboplatin followed by interval debulking surgery (IDS). The NAC was effective, and IDS was performed with no gross residual lesions. The post-operative diagnosis was seromucinous carcinoma of the ovary in FIGO (2014) stage IVA (ypT3cNxM1a) and mucinous carcinoma of the endometrium in FIGO (2008) stage IA (ypT1aNXM0). Three courses of postoperative TC therapy were performed, and maintenance therapy with Bevacizumab is ongoing. The patient is well without evidence of recurrence, sixteen months after surgery.

AIM Vascular or intestinal injuries at the time of the first trocar insertion can cause serious complications during laparoscopic surgeries. In this study, we evaluate the usefulness of ultrasound scans of the umbilical region as well as intraumbilical conditions to help prevent serious complications. METHODS The subjects included 430 cases who underwent laparoscopic gynecologic surgeries. The umbilical ultrasound scan was performed after tracheal intubation to observe the intestinal movements associated with respiration. Structures of the umbilical region as well as peristalsis and the movement of the intestinal tract were observed. Then, the thickness of the subcutaneous fat (between the umbilical skin surface and the rectus fascia) and the preperitoneal fat (between the rectus fascia and the peritoneum) were measured. The relationship between body mass index (BMI), insertion time of the first trocar and ultrasound measurements were analyzed. RESULTS The anatomical structures of the umbilical region (the subcutaneous tissue and the preperitoneal fat) were clearly observed in all cases. The BMI score had a significant relationship with subcutaneous fat thickness (r = 0.547), but remarkably not with preperitoneal fat thickness (r = 0.174). There was no significant relationship between BMI and insertion time. However, insertion time of the first trocar had a significant relationship with preperitoneal fat thickness (r = 0.534). CONCLUSIONS Preoperative ultrasonography of the umbilical region is asimple process, and it is helpful inpreventing serious complications caused by the first trocar insertion. We have found that preperitoneal fat thickness seems to be an important factor in predicting the potential difficulty of the first trocar insertion.

A combination chemotherapy of paclitaxel plus carboplatin (TC) is the most frequently used regimen for gynecological malignancies. As long as it is effective, a carboplatin-containing combination chemotherapy is used for every relapse. This implies that the number of platinum administrations and the frequency of hypersensitivity reaction (HSR) increase as the prognosis improves. When a patient develops HSR to carboplatin, we have three options: 1) desensitizing and continuing to use carboplatin, 2) switching to other platinum drugs, or 3) changing to a non-platinum drug. Here we report an experience of an HSR to carboplatin in a patient with recurrent uterine carcinosarcoma. The patient was treated by surgery and TC therapy initially, resulting in no residual disease. The patient relapsed 18 months after the completion of the first-line chemotherapy and was treated with TC therapy again as second-line. An HSR to carboplatin occurred at the 10th cycle of TC in total. We replaced the carboplatin with cisplatin. A chemotherapy including cisplatin and adriamycin was repeated without further HSR. We reviewed the literature regarding HSR to carboplatin and in this paper we summarize the management for dealing with it.

We investigated the effect of poultry manure (PM) on the occurrence and early growth of Monochoria vaginalis in relation to soil solution electrical conductivity (SSEC). PM was applied at rates corresponding to 0 g of nitrogen (N) m−2 (PM-0), 1 g N m−2 (PM-1), 3 g N m−2 (PM-3), and 5 g N m−2 (PM-5). At 7 d post-seeding, the soil solution was sampled to measure EC, and also the emergence and growth of M. vaginalis were evaluated. The emergence rate of M. vaginalis decreased with increasing application rate of PM and SSEC. SSEC was significantly negatively correlated with the emergence rate of M. vaginalis seedlings. The average leaf number and length of M. vaginalis did not differ between PM-0, PM-1, and PM-3, but were significantly lower in PM-5. In summary, PM would allow to better control the emergence and early growth of M. vaginalis.

AIM To evaluate the perioperative complications and the anatomical outcomes of our laparoscopic uterosacral ligament (USL) colpopexy, which is a novel laparoscopic technique for the management of uterine prolapse. The objective was to report on outcome after 2 years of a technique using laparoscopic USL colpopexy. METHODS A total of 152 uterine prolapse patients underwent laparoscopic USL colpopexy from May 2013 to April 2015. We described the surgical technique and performed a retrospective analysis of this laparoscopic technique. Patients underwent standardized assessment and examination using pelvic organ prolapse quantification (POP-Q) score. The dependent values of Ba point (bladder), C point (vaginal cuff) and Bp point (rectum) were recorded preoperatively, and at 1, 3, 6, 12 and 24 months of postoperative examination. Pre/postoperative data were compared using the Kaplan-Meier method. RESULTS Mean age, operative time and amount of hemorrhage were 68.2 ± 7.5 years, 118.3 ± 36.4 min and 60.5 ± 73.3 mL, respectively. Overall recurrent prolapse, which was defined as POP-Q stage II or higher, was noted in 29 patients (19%). However, only 2 patients presented recurrent rectocele among 51 patients with preoperative POP-Q stage II of uterine prolapse alone (recurrence rate; 3.9%). The pre/postoperative average POP-Q scores were -0.2/-2.7 cm (P

Objective Laparoscopic sacrocolpopexy (LSC) has been reported to achieve lower recurrence rates, shorter recovery time, and less dyspareunia. However, as a pelvic organ prolapse (POP) surgery, LSC is problematic because it requires specific techniques and it takes a comparatively longer operative time. In this study, we present our surgical techniques of LSC and their effectiveness for shortening operative times and raising safety. Methods Thirty-four women with stage 2 or greater POP who underwent LSC in our hospital between September 2014 and October 2015 were enrolled in this study. The notable points of our operative procedures are as follows: (1) fixing the sigmoid colon to the left lateral abdominal wall for a clearer visualization of the sacral promontory, (2) making a retroperitoneal tunnel (not opening the peritoneum) from the sacral promontory to the Douglas pouch, (3) dissection of the vaginal wall after transvaginal hydrodissection, (4) fixation of mesh to the vaginal wall by using absorbable tacks, and (5) limiting usage of posterior mesh for the patients with posterior vaginal wall descent. Results The median operative time was 140 (range, 90–255) minutes, and blood loss was 50 (range, 10–1600) mL. The operative time decreased as the surgical techniques improved through experience. No major intra- or postoperative complications occurred. The mean follow-up period was 4 (range, 1–14) months, and only one patient presented a recurrent grade 2 cystocele. Conclusion Our unique procedures will help shorten operative times and reduce complications of LSC.

Seven flavonoid profiles, some of which were reported to show antiallergic activity in vitro, were surveyed in 28 kinds of tea. Flavonoids were extracted with hot water, hydrolyzed to aglycons, and determined by HPLC. The hydrolysis time needed to obtain the maximum for each aglycon was examined. Flavonols quercetin and kaempferol were found in 17 kinds of tea infusions, as well as Japanese green tea infusions. Myricetin was found in jasmine and pu-erh tea infusions. A flavon, luteolin, was found in 5 kinds of tea infusions including great plantain tea. Apigenin was found in 4 kinds of tea infusions including perilla leaf tea, and scutellarein was found in 3 kinds of tea infusions. Scutellarein, which is a potent antiallergic and low cytotoxic flavonoid, is found in great plantain tea and was detected in perilla leaf and safflower tea infusions at concentrations of approximately 2 mg/g and 0.3 mg/g in dried whole tea leaves, respectively. The presence of scutellarein in both samples was confirmed by LC/MS...

Whether nutritional control can retard senescence of immune function and decrease mortality from infectious diseases has not yet been established; the difficulty of establishing a model has made this a challenging topic to investigate. Caenorhabditis elegans has been extensively used as an experimental system for biological studies. Particularly for aging studies, the worm has the advantage of a short and reproducible life span. The organism has also been recognized as an alternative to mammalian models of infection with bacterial pathogens in this decade. Hence we have studied whether the worms could be a model host in the fields of immunosenescence and immunonutrition. Feeding nematodes lactic acid bacteria (LAB) resulted in increases in average life span of the nematodes compared to those fed Escherichia coli strain OP50, a standard food bacteria. The 7-day-old nematodes fed LAN from age 3 days were clearly endurable to subsequent salmonella infection compared with nematodes fed OP50 before the salmonella infection. The worm could be a unique model to study effects of food factors on longevity and host defense, so-called immunonutrition. Then we attempted to establish an immunosenescence model using C. elegans. We focused on the effects of worm age on the Legionella infection and the prevention by immunonutrition. No significant differences in survival were seen between 3-day-old worms fed OP50 and 3-day-old worms infected with virulent Legionella strains. However, when the worms were infected from 7.5 days after hatching, the virulent Legionella strains were obviously nematocidal for the worms' immunosenescence. In contrast, nematodes fed with bifidobacteria prior to Legionella infection were resistant to Legionella. C. elegans could act as a unique alternative host for immunosenescence and resultant opportunistic infection, and immunonutrition researches.

Whether nutritional control can retard senescence of immune function and decrease mortality from infectious diseases has not yet been established; the difficulty of establishing a model has made this a challenging topic to investigate. Caenorhabditis elegans has been extensively used as an experimental system for biological studies. Particularly for aging studies, the worm has the advantage of a short and reproducible life span. The organism has also been recognized as an alternative to mammalian models of infection with bacterial pathogens in this decade. Hence we have studied whether the worms could be a model host in the fields of immunosenescence and immunonutrition. Feeding nematodes lactic acid bacteria (LAB) resulted in increases in average life span of the nematodes compared to those fed Escherichia coli strain OP50, a standard food bacteria. The 7-day-old nematodes fed LAN from age 3 days were clearly endurable to subsequent salmonella infection compared with nematodes fed OP50 before the salmonella infection. The worm could be a unique model to study effects of food factors on longevity and host defense, so-called immunonutrition. Then we attempted to establish an immunosenescence model using C. elegans. We focused on the effects of worm age on the Legionella infection and the prevention by immunonutrition. No significant differences in survival were seen between 3-day-old worms fed OP50 and 3-day-old worms infected with virulent Legionella strains. However, when the worms were infected from 7.5 days after hatching, the virulent Legionella strains were obviously nematocidal for the worms’ immunosenescence. In contrast, nematodes fed with bifidobacteria prior to Legionella infection were resistant to Legionella. C. elegans could act as a unique alternative host for immunosenescence and resultant opportunistic infection, and immunonutrition researches.

Histamine release inhibitors in watercress (Nasturtium officinale) were isolated using a monitoring system with antigen-stimulated RBL-2H3 cells. Of the 15 compounds isolated, flavonols and megastigmanes significantly inhibited histamine release. Two flavonols, 3-O-sophorosides of rhamnetin and rhamnazin, were new compounds. To investigate the inhibitory mechanism, the effects of rhamnetin, rhamnetin 3-O-sophoroside and an isolated megastigmane glucoside on the increase in the intracellular free calcium concentration were examined at a concentration providing 60% inhibition of histamine release. The results suggest that these compounds did not affect the calcium influx at that concentration. The structure-activity relationships of the megastigmanes on histamine release were also investigated.

Carrot juice was administered orally to BALB/c mice immunized intraperitoneally with dinitrophenylated (DNP)-OVA for about 1 month. The titers of DNP-specific IgE, DNP-specific IgG, and the levels of total IgE in mouse sera were determined. The DNP-specific IgE production by mice fed carrot juice was significantly inhibited. On the other hand, the DNP-specific IgG production and the level of total IgE in mice fed carrot juice were not significantly different from those in control mice. We also examined the effect of feeding carrots on immediate-type hypersensitivity. One hour after antigen stimulation, the ears of mice fed carrots swelled less than those of control mice. Furthermore, the rise in serum histamine in the mice fed carrots under active systemic anaphylaxis was lower than in controls. We then examined the pattern of cytokine production by spleen cells from mice followed by restimulation with DNP-OVA in vitro. The spleen cells from the mice fed carrots produced more interferon-gamma than those from the control group. In contrast, the spleen cells from the mice fed carrots produced less interleukin-4 than those from the control group. Furthermore, the interleukin-12 production of the spleen cells from mice fed carrots was also higher than that of the control group. These findings suggest that feeding carrots improves the helper T cell (Th)1/Th2 balance, inhibiting specific IgE production and antigen-induced anaphylactic response.

In vitro antiallergic activity of the 70% ethanol fraction (Scheme 1) from ten kinds of vegetables was investigated using three types of assay systems, which are based on inhibition of histamine release from rat peritoneal mast cells and rat basophilic leukemia cells (RBL-2H3), and inhibition of hyaluronidase activity. The fraction from cabbage showed a strong antiallergic effect in all of the in vitro assays, while the fractions from tomato, red cabbage and watercress showed strong antiallergic effects in two of the in vitro assays. These results suggested that the fractions from four vegetables exhibit antiallergic activity by acting on multiple points in a series of immediate-type allergic reactions.