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Transdermal nitric oxide donor may be a relatively safe treatment strategy for fetal growth restriction and oligohydramnios due to placental insufficiency.

In the present report, the patient was a 55-year-old woman who had undergone an oophorectomy in October 2016 as surgical intervention for ovarian cancer, followed by 6 courses of TC therapy as postoperative adjuvant therapy. She was diagnosed with recurrent ovarian cancer in August 2017, and we planned anticancer drug treatment considering that the tumor exhibited platinum resistance. However, the platelet count decreased significantly to 2.4×104/μL. Accordingly, she was referred to the hematology department and was diagnosed with idiopathic thrombocytopenic purpura. She was started on oral eltrombopag, and her platelet level recovered to 5.8×104/μL on day 68. Next, gemcitabine plus bevacizumab therapy was initiated. However, as the platelet level again decreased to 1.6×104/μL on day 8, the eltrombopag dose was increased only for 5 days before and after the anticancer drug administration on day 1. Accordingly, after increasing the eltrombopag dose, the anticancer drug treatment was performed without interruptions. Moreover, the gemcitabine dose could be increased. Herein, we report that in patients with platinum-resistant recurrent ovarian cancer complicated with idiopathic thrombocytopenic purpura, increasing the oral hematopoietic stimulant dose for 5 days before and after day 1 had beneficial results in continuing anticancer drug treatment.

Background The prenatal diagnosis of microhydranencephaly is important and needs to be distinguished from anencephaly, because unlike anencephaly, fetuses with microhydranencephaly can survive after birth. Herein, we report a case of microhydranencephaly that was diagnosed and distinguished from anencephaly prenatally. Case presentation The patient was an 18-year-old woman, 2 gravida nullipara, who presented at 15 weeks of gestation. Ultrasonography showed a normal biparietal diameter (BPD) and no major anomalies. At 23 weeks of gestation, an ultrasound examination revealed a BPD of 40 mm (-5.3 standard deviation, SD). At 29 weeks, anencephaly was suspected despite difficulty in visually examining the fetal head above the orbit. At 34 weeks, insertion of a metreurynter made it possible to observe the skull. Three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the fetal skull, a prominent occipital bone, sloping forehead, marked microcephaly, cerebral loss, and excess cerebrospinal fluid. This allowed differentiation between microhydranencephaly and anencephaly. She delivered vaginally at 37 weeks, and the child had a birth weight of 2342 g and a head circumference of 24 cm (-5.4 SD). The baby’s head was flat above the forehead, with a suspected partial head defect. The baby received desmopressin acetate due to central diabetes insipidus 6 months after birth. Conclusions The use of multiple imaging modalities and physical manipulation of the fetal head are required to accurately differentiate between microhydranencephaly and anencephaly.

Key Clinical Message When to deliver the monochorionic diamniotic (MCDA) twins with specific cord patterns? Although there is no clear evidence supporting an earlier delivery (before 36 weeks of gestation) in MCDA twins, an earlier delivery might prevent intrauterine death or neuromorbidity in MCDA twins with specific cord patterns.

To prepare for a future clinical trial for improving the long-term prognosis of patients with uterine leiomyosarcoma (ULMS), we conducted a multi-institutional survey in the Tohoku region of Japan. We conducted a retrospective cohort study between 2011 and 2014 in member institutions of the Tohoku Translational Research Center Development Network. A total of 53 patients with ULMS were registered in 31 institutions for the present survey. The median patient age was 56 years, 67.9% of the patients were postmenopausal, 88.7% had a performance status of 0 or 1, and only 6 patients (11.3%) showed preoperative evidence of malignancy. Although retroperitoneal lymphadenectomy was performed in only 26.4% of patients, 64.2% patients were identified as having FIGO stage 1 disease; 73.6% were eligible to undergo complete surgery. Among 36 patients who were treated with postoperative chemotherapy, 28 (77.8%) received docetaxel and gemcitabine combination therapy. The most frequent recurrence site was the lungs, and the median progression-free survival of all enrolled patients was 11.7 months. However, the median progression-free survival and the median overall survival in patients with stages III and IV disease were 3.4 and 11.4 months, respectively. Although ULMS was associated with a high rate of complete or optimal surgery, the long-term prognosis was poor. Effective postoperative therapy should be developed to improve the long-term prognosis of patients with ULMS.

Several studies have shown that brain hypothermia therapy (BHT) after neonatal hypoxic-ischemic encephalopathy (HIE) can improve neurodevelopmental outcomes. However, there have been no reports of the neurodevelopmental outcomes for the infant with a serum creatine kinase (CK) level above 20,000 IU/L in association with neonatal HIE. We report a female infant with a very high serum CK level (26,428 IU/L) associated with neonatal asphyxia. We diagnosed this infant with moderate HIE, and BHT was achieved by head cooling within 6 hours after birth to an esophageal temperature of 34.5°C. There were no significant adverse events during BHT, and the CK level spontaneously decreased. Although we report only the short-term outcomes for this case, she presents neurodevelopmental delays at the age of 18 months. It may be correlated between high serum CK level and long-term neurodevelopmental delays. Abbreviations: CK, creatine kinase; HIE, hypoxic-ischemic encephalopathy; BHT, brain hypothermia therapy; NRFS, non-reassuring fetal status; CK-MB, creatine kinase-myocardial band; MRI, magnetic resonance imaging; CK-BB, creatine kinase-brain band.

The purpose of this study was to observe some fetal endocrinologic and biophysical responses to prolonged (24-hour) nonacidemic hypoxemia in fetal goats.Endocrinologic and biophysical changes during continuous infusion of nitrogen into the maternal trachea were examined in six chronically instrumented goat fetuses at 123 to 131 days' gestation. We measured arginine vasopressin, adrenocorticotropic hormone, cortisol, epinephrine, and norepinephrine as endocrinologic parameters and fetal heart rate, fetal blood pressure, and fetal breathing movements as biophysical parameters.Fetal arterial PO2 declined from 25.1 +/- 2.1 mm Hg at baseline to 16.8 +/- 0.9 mm Hg at 1 hour of hypoxemia and remained at this level (p0.05). Arginine vasopressin, adrenocorticotropic hormone, and epinephrine initially rose in response to hypoxic stress, gradually declined, and by 24 hours were not significantly different from control values. Cortisol and norepinephrine remained significantly elevated through the experiments. Fetal breathing movements as a percentage of total time were 34.9% +/- 1.2% at baseline, 12.9% +/- 3.7% at 1 hour, and 70% to 80% of control values from 4 hours. Fetal heart rate was significantly reduced for the first 10 minutes, then progressively became tachycardiac thereafter. Systolic fetal blood pressure was significantly elevated for only 30 minutes.Arginine vasopressin, adrenocorticotropic hormone, and epinephrine of the endocrinologic parameters and fetal heart rate, fetal blood pressure, and fetal breathing movements are normalized during prolonged nonacidemic hypoxemia in fetal goats.