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OBJECTIVE To assess the relationship of a cervical cytologic diagnosis based on number, size and degeneration of malignant clusters and necrotic background to cervical involvement of endometrial carcinoma. STUDY DESIGN Cervical smears of 53 women with endometrial carcinoma were evaluated for cervical involvement. The cytologic diagnosis was compared with actual involvement, and accuracy was calculated. Retrospectively, cytologic features, including number, size and degeneration of malignant clusters and necrotic background, were analyzed in involved and noninvolved cases. RESULTS Cervical involvement was confirmed in 15 patients (28.3%). The number and size of malignant clusters in the involved cases were significantly larger than those in the noninvolved cases (P < .001 and < .01, respectively). The proportion of degenerated malignant cells and necrotic background in involved cases were significantly higher than those in noninvolved cases (P < .05). Cytologic diagnosis had a sensitivity and specificity of 62.5% and 86.8%, respectively. CONCLUSION Cervical smears of involved cases revealed a large number and large size of malignant clusters. These findings support cytologic diagnosis based on number, size and degeneration of malignant cells and necrotic background. Cervical cytology is useful to exclude cervical involvement because of its high specificity and can help detect cervical involvement because of its moderately high sensitivity.

To clarify the clinical significance of uterine cervical cytology during pregnancy, we analyzed the incidence of cervical cytology and its accuracy. Of the 1,593 pregnant women underwent cervical cytology, the patients with abnormal cytology were followed up and performed histological confirmation on colposcopic biopsy specimen. An incidence of abnormal cytology and cervical neoplasm during pregnancy were 1.63% (26 cases) and 0.82% (13 cases), respectively. The incidence of abnormal cytology in the pregnant women was significantly higher than that (0.9%) in mass-screened, non-pregnant 214,375 women under the age of 45 years (P < 0.001). There was no significant difference of the incidence of cervical neoplasm between in the pregnant women and in mass-screened, non-pregnant women (0.82% vs. 0.46%). The accuracy of cervical cytology during pregnancy was 45.0% and this was not significantly different from that (27.6%) in the mass-screened, non-pregnant women. Since, cervical screening cytology for uterine cervical cancer in the pregnant women as shown in this study, has an equal effectiveness to that in the mass-screened non-pregnant women, routine cervical cytology is highly recommended to performed during pregnancy. In addition, management of pregnant women with abnormal cytology was discussed in this article.

OBJECTIVE: To assess the value of procedures for pre-operative diagnosis of cervical involvement of uterine corpus carcinoma. MATERIALS AND METHODS: Four diagnostic procedures, including cervical cytology, endocervical curettage (ECC), magnetic resonance imaging (MRI), and hysteroscopy, were performed for diagnosis of cervical involvement in 60 patients with uterine corpus carcinoma. The preoperative diagnosis based on results obtained using by each procedure was retrospectively compared with the diagnosis based on histological examination of surgical specimens. Data were analyzed according to the standard definition of sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Cervical involvement was confirmed in 18 patients (30%). ECC showed high sensitivity (90.9%) and specificity (88.9%). Cervical cytology showed high specificity (88.6%). MRI showed very high specificity (99.2%) and high sensitivity (88.5%) in cases with cervical stromal invasion. CONCLUSION: Cervical cytology and MRI are useful for excluding cervical involvement. ECC is useful for positive diagnosis. MRI may be useful for cases with stromal invasion. The use of a combination of several procedures is essential for obtaining an accurate diagnosis of cervical involvement in cases of uterine corpus carcinoma.

A 70-year-old, menopausal Japanese woman with large uterine tumor underwent total hysterectomy. Microscopic examination revealed a myxoid leiomyosarcoma with 5 to 6 mitoses/10 high power field (HPF). Immunohistochemically, the tumor cells reacted with desmin, suggesting that they are derived from uterine smooth muscle cells. The patient was treated with the combination chemotherapy consisting of cisplatin, adriamycin and cyclophosphamide, and she has been free from disease for 70 months after the operation.

Although family studies and genome-wide association studies have shown that genetic factors play a role in glaucoma, it has been difficult to identify the specific genetic variants involved. We tested 669 single nucleotide polymorphisms (SNPs) from the region of chromosome 2 that includes the GLC1B glaucoma locus for association with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) in the Japanese population. We performed a two-stage case-control study. The first cohort consisted of 123 POAG cases, 121 NTG cases and 120 controls: the second cohort consisted of 187 POAG cases, 286 NTG cases, and 271 controls. Out of six SNPs showing significant association with POAG in the first round screening, seven SNPs were tested in the second round. Rs678350 in the HK2 gene coding sequence showed significant allelic (p = 0.0027 in Stage Two, 2.7XE-4 in meta-analysis) association with POAG, and significant allelic (p = 4.7XE-4 in Stage Two, 1.0XE-5 in meta-analysis) association with NTG. Although alleles in the TMEM182 gene did not show significant association with glaucoma in the second round, subjects with the A/A allele in TMEM182 rs869833 showed worse visual field mean deviation (p = 0.01). Even though rs2033008 in the NCK2 gene coding sequence did not show significant association in the first round, it had previously shown association with NTG so it was tested for association with NTG in round 2 (p = 0.0053 in Stage Two). Immunohistochemistry showed that both HK2 and NCK2 are expressed in the retinal ganglion cell layer. Once multi-testing was taken into account, only HK2 showed significant association with POAG and NTG in Stage Two. Our data also support previous reports of NCK2 association with NTG, and raise questions about what role TMEM182 might play in phenotypic variability. Our data suggest that HK2 may play an important role in NTG in the Japanese population.

We present the first report of the use of an isosorbide dinitrate tablet for the purpose of uterine relaxation for manual extraction of a retained placenta. The tablet administered sublingually proved to be a rapid and effective uterine muscle relaxant for manual removal of the placenta without overt adverse effects.

Purpose To determine whether polymorphisms in the Toll-like receptor 4 ( TLR4 ) gene are associated with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and exfoliation glaucoma (XFG) in Japanese individuals. Design Genetic association study. Methods Setting: Multicenter study. Study population: One hundred eighty-four unrelated Japanese patients with POAG, 365 unrelated patients with NTG, and 109 unrelated patients with XFG from 5 hospitals. Procedures: Genomic DNA was extracted from leukocytes of the peripheral blood, and 8 polymorphisms in the TLR4 genes were amplified by polymerase chain reaction (PCR) and directly sequenced. Allele and genotype frequencies and the inferred haplotypes were estimated. Main outcome measures: Differences in allele and genotype frequencies and haplotypes between subjects with POAG, NTG, and XFG. Results The allele frequency of rs2149356 of the TLR4 gene in the POAG, NTG, and XFG groups was the most significantly different from that of the control group (minor allele frequency 0.446, 0.395, 0.404, vs 0.308; P = .000058, P = .0030, and P = .015). The allele frequencies of the 5 TLR4 SNPs were higher in all of the glaucoma groups than that in the control group. The statistics of genotypes of TLR4 were approximately the same for all allele frequencies. The haplotypic frequencies with Tag SNPs studied earlier showed that only POAG was statistically significant. Other haplotypes, such as rs10759930, rs1927914, rs1927911, and rs2149356, had higher statistical significance (overall P = .00078 in POAG, overall P = .018 in NTG, and overall P = .014 in XFG). Conclusions This study demonstrated that TLR4 polymorphisms are associated with NTG in the Japanese, and they also play a role in the pathogenesis of POAG and XFG.

Tissue engineering and transplantation of autogenic grafts have been widely investigated for solving problems on current allograft treatments (i.g., donor shortage and rejection). However, it is difficult to obtain an autogenic corneal stromal replacement that is composed of transparent, tough, and thick collagen constructs by current cell culture-based tissue engineering. Aim of this study is to develop transparent dermis for an autogenic corneal stroma transplantation. This study examined dehydration at 4–8 °C and carbodiimide cross-linking on cloudy rabbit dermis (approx. 1.8%–3.8% light transmittance at 550 nm) for dermis optical clearing. Transparency of dehydrated rabbit dermis was founded to be approx. 37.9%–41.4% at 550 nm. Additional cross-linking treatment on dehydrated dermis prevented from swelling and clouding in saline, and improved its transparency to be 56.9% at 550 nm. Rabbit corneal epithelium was found to regenerate on optically cleared dermis in vitro . Furthermore, no abnormal biological response (i.e., inflammation, vascularization, and the barrier defect of epithelia) or no optical functional change on optically cleared dermis was observed during its 4-week autogenic transplantation into rabbit corneal stromal pocket.

We investigated seasonal allergic conjunctivitis in Hakodate.The clinical records of 293 patients with allergy-like symptoms who were seen at the Departments of Ophthalmology and Otolaryngology of Hakodate Municipal Hospital in 2001 and 2002 were examined for pollinosis, and evaluated. The general severity of conjunctivitis was graded as (+), (++), and (+++). The allergen was identified by AlaSTAT and nasal provocation test.In March, June, and September 2001, and in March, April, and June 2002, many patients were examined. In 2001, 134 patients (87.0%) had allergic conjunctivitis, and 126 patients (90.6%) had it in 2002. The severity of allergic conjunctivitis in May, June, and September was significantly (p0.05) more severe than in February, March, and April. The major antigen rates for Cryptomeria japonica, Gramineae, Artemisia, and Betula platyphyia var. japonica were 22, 21, 8, and 3%. The specific IgE positive rates for Cryptomeria japonica, Betula platyphyia var. japonica, Gramineae and Artemisia were higher in March and April, in May, in June, and in September.The allergens of conjunctivitis in Hakodate were not the same as in the Kansai. We should consider the dispersion of pollens area by area.

We have investigated the nasal and eye symptoms of pollinosis in Hakodate. There were elevated levels of dispersion of Cryptomeria japonica pollen in Hakodate in 1995 and 1998. In 1995 and 2001, there were also elevated levels of dispersion of Betula platyphylia var. japonica pollen. From March to June and September from July 1999 to May 2002, there was an increased incidence of pollinosis in Hakodate. In 641 patients with allergic rhinitis, the specific IgE positive rates for house dust and mite, Artemisia (Art), Gramineae (Gra), Betulaplatyphylia var. japonica (BJ), and Cryptomeria Japonica (CJ) were 73.5, 28.5, 25.7, 14.2 and 21.2%, respectively. The subjects with pollinosis in 2001 and 2002 (n=95) were divided into four groups as follows: Cryptomeria japonica (n=49), Betula platyphylia var. japonica (n=11), Gramineae (n=18) and Artemisia (n=17) pollinosis. The general severity of rhinitis and conjunctivitis were divided into four grades ( (-), (+), (++) and (+++) ), respectively. The combined (++) and (+++) rates observed for the general severity of rhinitis for all these subjects (n=95) was 86.4% and there was no significant difference in the general severity of rhinitis between any of the four groups. The combined (++) and (+++) rates for the general severity of conjunctivitis for all subjects (n=95) was 56.9% and the general severity of conjunctivitis for BJ and Gra pollinosis were significantly (P0.01) higher than those observed for CJ pollinosis. In conclusion, the present data shows that the general severity of rhinitis in subjects with pollinosis in Hakodate was more severe than that of conjunctivitis and also that the general severity of conjunctivitis was dependent on the specific pollen (s) responsible for the pollinosis.

In this study, we evaluated whether proliferative activity and metastatic potential are prognostic factors in adenocarcinoma of the cervix. Formalin-fixed, paraffin-embedded sections from 34 patients with cervical adenocarcinoma or adenosquamous carcinoma were immunostained with monoclonal antibody MIB1, expressed in proliferating cells, and anti-nm23 antibody, reacts with metastasis suppression gene products. MIB1 positivity ranged from 0.2 approximately 54.7% with a mean of 21.4%. The level did not differ significantly between various clinicopathological categories. Although patient survival of high or low MIB1 expressing tumor was not significantly different, the disease-free interval of high (or =25%) expressing tumor was significantly lower than that of low (25%) expressing tumor. Strong and medium expression for nm23 were detected in 7 (21%) and 3 (9%) of patients. Tumor with strong nm23 expression tended to have a higher relapse rate. Although the survival of strong and weakly nm23 expressing tumor was not significantly different, the disease-free survival of strong nm23 expressing tumor was lower than that of weakly nm23 expressing tumor. MIB1 and nm23 immunostaining might be some of prognostic indicators of recurrence in cervical adenocarcinoma. In cervical adenocarcinoma, the nm23 gene products may not function as metastatic suppression but reflect proliferative activity.

The purpose of this study was to determine whether proliferative activity is a prognostic factor in ovarian clear cell adenocarcinoma. The paraffin-embedded sections from eight cases of ovarian clear cell adenocarcinoma were immunostained with monoclonal antibody MIB1 using microwave oven heating for antigen retrieval. The difference in survival (Kaplan-Meier) between patients with high and low MIB1 expression was estimated with the generalized Wilcoxon test. MIB1 positivity ranged from 1.80 to 27.12% with a mean of 11.43%. A cutoff point of 10% dichotomized patients into two groups. The survival of high (> or = 10%) expressing tumors was worse than that of low (< 10%) expressing tumors (p < 0.05). MIB1 immunostaining may have useful prognostic value in ovarian clear cell adenocarcinoma.

A 55-year-old woman presented with vaginal bleeding. A tumor was found in the cervix; it was composed of 2 distinctive elements: a clear-cell adenocarcinoma and a choriocarcinoma. Histologic findings suggested that the choriocarcinomatous element was derived from a preexisting clear-cell adenocarcinoma through a metaplastic process.

We present a case of pleurodesis by intrapleural injection of OK-432 for the treatment of fetal chylothorax at an early gestational age. OK-432 injection achieved rapid and effective control of pleural effusion with no adverse effects.