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Lichen planus (LP), common mucocutaneous disorder, involves not only oral mucosa and skin but genitalia membrane. LP is frequently seen in patients with HCV infection. This study evaluated patients with HCV-associated oral lichen planus (OLP) for vulvar and vaginal LP involvement, and the possible intraspousal transmission of HCV. We examined a total of 24 female Japanese patients with OLP for genitalia LP: 14 OLP-HCV positive and 10 OLP-HCV negative. All subjects were evaluated for genital LP by a gynecologist. All 24 subjects and 10 of the husbands were tested for anti-HCV and serum HCV RNA. Vulvar LP was observed in 10 (41.7%) of 24 patients with OLP. Vulvar LP in 14 (OLP-HCV positive) and 10 patients (OLP-HCV negative) were observed in 42.9 and 40%, respectively. There were no significant differences (age, sites of OLP, blood transfusion, HCV infection, and degree of liver diseases) between the vulvar LP and non-vulvar LP patients. Two spouses of 10 married couples were shown to be infected with HCV. In one couple with HCV infection, the wife and husband had also erosive OLP, the wife had erosive vulvar LP. In conclusion, the majority of OLP patients suffered from genitalia LP in Japan. Clinicians should follow the OLP patients with sufficient attention to the presence of extraoral manifestations. These data may suggest the occurrence of intraspousal transmission of HCV through erosive vulvar LP.

We outline chemotherapy mainly for malignant ovarian germ cell and sex-cord tumors, based on studies in the literature and our own clinical experiences. With both tumors, PEB treatment is standard adjuvant chemotherapy. With regard to the number of dosage courses, 4 courses are regarded as tolerable after incomplete reduction, and 3 courses as adjuvant treatment after complete extraction. This chemotherapy is effective for preservation of fertility in young patients with malignant ovarian germ cell tumor. In both tumors, some cases show chemotherapy resistance. An effective second-line treatment strategy using a new anticancer agent needs to be established for such cases in the future.

Sixty-five patients with unresectable advanced epithelial ovarian cancer who underwent exploratory laparotomy or unilateral oophorectomy were reviewed. Forty-five of 65 patients received 3.8 cycles of neoadjuvant chemotherapy (NAC) and were successfully debulked at interval cytoreductive surgery (IRS); 31 of 45 showed no evidence of disease. Patients with residuals <1 cm at IRS had a high possibility of achieving clinical remission. Patients who failed to receive IRS showed poor prognosis. Also, 63 patients who underwent conventional primary debulking surgery with residuals >1 cm were investigated as a contrast. No significant difference was observed in patient survival between the NAC group and the conventional treatment group. NAC and IRS offered patients with unresectable tumors survival similar to that of those with suboptimally resectable tumors at primary debulking. We conclude that this strategy has potential benefits for the patients with clinically aggressive ovarian cancer who are unable to receive standard treatment.

To evaluate the correlation between prolactin (PRL) secreting capacity and puerperal lactation, 66 women who had delivered normally without any complications during pregnancy were studied. They were divided into two groups depending on the lactating state a month after the delivery: The breast feeding group (group A, 40 cases), and the supplementary feeding group (group B, 26 cases), respectively. 10 mg of metoclopramide (MCP) loading was carried out in the 36th week of gestation and in the third day of the puerperium, and serum levels of PRL (at 0, 30, 60 min. after the MCP loading) were measured by RIA. Serum levels of insulin, glucose, triglyceride, free fatty acid, cholesterol and lipoproteins were also examined. There was no significant change in the serum levels of the various, substances during pregnancy and puerperium. Also, no significant change could be seen in the MCP loading test in the 36th week of gestation. However, on the third day of puerperium, serum PRL after 30 min. of the MCP loading showed a significant increase in group B compared with group A (587.1 +/- 202.9 vs. 431.2 +/- 196.6 ng/ml, p less than 0.02, mean +/- standard deviation). These results suggested that the MCP loading test during the early stage of puerperium might be an important index to use in determining whether the mother was ready to breast feed.

The circadian and pulsatile secretions of prolactin were studied in 15 pregnant and 5 puerperal women. Blood samples were taken every 15 minutes for 3 hours during daytime and at night. Diurnal levels of prolactin and estradiol were examined in 135 pregnant women. In addition, prolactin and estradiol of 8 parturient women were measured every 15 minutes until 24 hours after delivery. Prolactin and estradiol levels increased gradually in advance of pregnancy, and a positive correlation was revealed between prolactin(Y) and gestational weeks(X): Y = 7.125X-42.997, r = 0.9955. Furthermore, a positive correlation between prolactin(Y) and estradiol(X) levels was observed: Y = 4.439X + 44.115, r = 0.7590. The circadian secretion of prolactin was observed in 15 out of 20 cases studied. The pulsatile secretion of prolactin was revealed in all 20 cases. The daytime pulse-frequency significantly decreased in the 2nd trimester and that of the nighttime also decreased in the 3rd trimester. The pulse-amplitude increased in advance of pregnancy, but amplitude/baseline value ratio was stationary 28% during the daytime and 34% during the nighttime in every trimester of pregnancy. 63.0% of coincidence in prolactin pulse with increase of immunoreactive LH-hCG was observed. The pulsatile secretion of hCG has not been yet reported. However, the pulsatile increase of immunoreactive LH-hCG was observed in 10 pregnancies, while LH was not detected in any pregnancy by highly specific LH assay. This suggested that immunoreactive hCG changed in a pulsatile manner in the blood of pregnant subjects. A highly significant decline of prolactin levels was observed from 10 hours before until 4 hours after delivery, which did not correlate with changes of estradiol levels. These results indicated that the pulsatility and circadian secretion of prolactin were preserved during pregnancy and puerperium and also suggested that prolactin secretion during pregnancy, delivery and puerperium was regulated by at least 3 factors: estradiol, dopamine and LH-hCG.

The relationship between the body weight or weight gain during pregnancy and various obstetrical factors was investigated in 731 patients who delivered in San-ikukai Hospital for in the year 1986. The patients were classified into three groups according to their body weight in non-pregnant states: slender (n = 214), ordinary (n = 379) and obese (n = 138), according to the standard for "The decision diagram for the estimation of obesity and emaciation in Japanese" published in 1986 by the Ministry of Health and Welfare, Japan. Each of these groups was further divided into two groups according to the degree of weight gain during pregnancy (more or less than 15kg). Then, the duration of labor, the blood loss during delivery, the birth weight, the placental weight and the obstetrical abnormalities (prolonged labor, arrested labor, blood loss of more than 500 ml, fetal distress and toxemia of pregnancy) were investigated in these groups. The blood loss, the neonatal birth weight and the placental weight in the obese groups were much greater than those in the ordinary or the slender group (p less than 0.005). However, there was no significant difference in the duration of the labor among these groups. The incidence of obstetrical abnormalities in the obese group was significantly higher than in the ordinary or the slender group (chi 2 = 4.37, p less than 0.05, chi 2 = 5.27, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate a new treatment for so-called functional sterility, 17 out of 456 infertile patients were treated in the past three years (age: 32.7 +/- 3.6 years old, infertile period: 5.9 +/- 1.4 years, M +/- S.D.). These patients were treated with HMG-HCG. The injection of HMG (75-450iu) was started on the 5th day of the menstrual cycle, and the follicular development was observed by ultrasonography. Then, HCG (10,000-20,000iu) was injected when 3 or 4 matured follicles (with a diameter greater than 20mm) were observed. In some cases, the endometrial biopsy was done in the mid-luteal phase and the effect of the treatment was examined morphologically. Pregnancies were observed in 6 cases (35.3%) and all of them were singletons. One of them spontaneously aborted at 9 weeks of gestation, but remaining five cases delivered at full term without any complications. The total dose of HMG was 2,116.8 +/- 843.3iu, and OHSS was observed in 5 cycles out of 31 cycles (16.1%). There was no other severe complication during the treatment. The growth of the endometrium thickened in the treated cases, but no time lag in endometrial dating could be found in the morphological study. These results indicated that the intended superovulation method for the treatment of so-called functional sterility was effective through the mechanism of the improvement of the implantation ratio.

To clarify the diagnostic criteria of occulted or transient hyperprolactinemia, the resting prolactin level and the prolactin secreting capacity of normal women, which were tested with a 500 micrograms of TRH injection, were compared with those of patients with occulted hyperprolactinemia. Results revealed that: resting levels of prolactin in normal women were 13.4 +/- 4.4 ng/ml (mean +/- S.D.) in the follicular phase and 13.4 +/- 5.6 ng/ml in the luteal phase, which overlapped those of occulted hyperprolactinemia. the prolactin secreting capacity of occulted hyperprolactinemia was significantly greater than that of the normal women. These results indicated that it was impossible to distinguish the occulted hyperprolactinemia from the normal by the measuring the resting prolactin level, but possible by the evaluating the prolactin secreting capacity. If the serum prolactin was more than 150 ng/ml at 15 min. after TRH administration, occulted hyperprolactinemia was strongly suggested.