Seiji Inoue

Okayama University, Okayama, Okayama, Japan

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Publications (11)15.25 Total impact

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    ABSTRACT: Background Transarterial embolisation (TAE) has been attracting attention as a treatment option for post-partum haemorrhage (PPH).AimsWe investigated cases in which TAE was performed for PPH to determine the efficacy of TAE for the treatment of PPH and its impact on subsequent pregnancies and childbirth in a multi-institutional case-series study.Materials and MethodsA total of 211 women who underwent emergency (n=161) or prophylactic (n=50) TAE for the management of PPH from 2002 to 2011 in the Chugoku and Shikoku regions of Japan were evaluated. Data on maternal background, treatment efficacy, adverse events in 113 cases followed up after TAE and subsequent pregnancies in 76 women were obtained.ResultsThe overall success rate of emergency and prophylactic TAE was 91.9 and 96.0%, respectively. The rate of complications such as infection, uterine necrosis and amenorrhoea was 13.3% among women followed up after TAE. Forty women became pregnant after TAE, and the pregnancy rate among those who desired fertility was 52.6%. Twenty-eight gave birth, including four preterm deliveries. Five (16.7%) were associated with a hysterectomy due to placenta accreta.Conclusions To reduce haemorrhage and avoid hysterectomy, TAE may be considered as a treatment option for PPH, however short and long terms complications are not uncommon.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 10/2014; 54(6). DOI:10.1111/ajo.12228 · 1.62 Impact Factor
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    ABSTRACT: Struma ovarii is a rare neoplasm that accounts for approximately 0.3% of ovarian tumors. Due to its ultrasound morphology, which is quite similar to that of malignant ovarian carcinoma, most struma ovarii cases are open operated with laparotomy rather than laparoscopy. We present 3 cases of struma ovarii, which were diagnosed preoperatively by imaging studies and removed by laparoscopic surgery. All patients were premenopausal women between ages 31‒50. The magnetic resonance imaging (MRI) findings were complex masses composed of multiple cysts and solid components with T2-hypointense regions as well as multiple T1-hyperintense cystic areas, findings that are typical for struma ovarii. A combination of plain computed tomography (CT), positron emission tomography (PET)-CT, and scintigraphy was useful for diagnosis. Laboratory examination revealed elevated serum thyroglobulin, which led to the diagnosis of struma ovarii. Laparoscopic surgeries were performed without rupturing the tumors. Although it has been difficult to differentiate between struma ovarii and malignant tumors by conventional methods, recently MRI techniques appear make it possible to diagnose struma ovarii preoperatively from the abovementioned imaging characteristic, together with laboratory data. As for treatment, we think laparoscopy could be successful for struma ovarii, but the surgeon must be careful not to rupture the tumor intra-abdominally in order to prevent dissemination, which could lead to malignancy.
    Acta medica Okayama 06/2013; 67(3):191-195. · 0.75 Impact Factor
  • Open Journal of Obstetrics and Gynecology 01/2013; 03(10):711-716. DOI:10.4236/ojog.2013.310131
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    ABSTRACT: Aim: To evaluate whether pregnant women with chronic kidney disease (CKD) adapt poorly to increases in renal blood flow. This can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE). Methods: We analyzed the outcomes of 90 pregnant women with preexisting CKD. The estimated glomerular filtration rate (eGFR) was measured along with the levels of angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor, which might act in the pathophysiology of PE. Results: In pregnancies with CKD, PE and preterm delivery were increased and the increased blood pressure worsened the perinatal outcomes much more than the increased proteinuria. All pregnancies with severe renal insufficiency were delivered preterm because of impaired renal function. The eGFR was correlated significantly with 24-hour creatinine clearance (r = 0.830). Significant differences in sFlt-1 and placental growth factor levels were found between severe PE without any complications and severe superimposed PE (p < 0.05), and between women with and without declining renal function in superimposed PE (p < 0.01). Conclusion: Pregnancies with CKD have a high risk of obstetrical complications. The eGFR might serve for evaluating renal function during pregnancy. Angiogenic factors might be potential markers for a differential diagnosis between PE and worsening renal function.
    Gynecologic and Obstetric Investigation 07/2012; 74(4). DOI:10.1159/000339935 · 1.25 Impact Factor
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    ABSTRACT: Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses a number of problems during pregnancy. Here, we report two cases of pregnancy and delivery with Fontan circulation. Case 1, who underwent Fontan procedure for congenital pulmonary atresia with intact vertical septum at age 7, delivered a male infant weighing 1073 g by cesarean section at 28(6/7)  weeks due to massive genital bleeding. Case 2 underwent Fontan procedure for double inlet left ventricle and delivered by vacuum extraction a male infant weighing 2142 g, while monitoring central venous pressure at 37(5/7)  weeks. The former had ascites and dose of diuretic had to be added at early pregnancy, and the latter had no adverse cardiac and obstetric events. These cases suggest that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae, but might be complicated with cardiac or obstetrical events. Intensive care should be required with specialists, including a neonatologist, anesthesiologist and cardiologist. We have added a literature review of pregnancy with Fontan circulation, referring to previous reports.
    Journal of Obstetrics and Gynaecology Research 06/2012; 39(1). DOI:10.1111/j.1447-0756.2012.01910.x · 0.93 Impact Factor
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    ABSTRACT: Adiponectin was reported recently to have roles in the pathophysiology of preeclampsia. Moreover, elevation of adiponectin and brain natriuretic peptide (BNP) has been observed in preeclampsia. We examined the possible links between adiponectin and BNP in the pathophysiology of preeclampsia. We performed a cross-sectional study in 56 preeclampsia patients and 56 controls matched for gestational age and body mass index. The BNP, leptin, and adiponectin levels were measured by ELISA, and their mRNA expressions were evaluated in omental adipose tissue by real-time PCR. The effects of BNP on adiponectin and leptin mRNA expression and secretion were investigated in primary cultures of adipocytes from obese and normal-weight women. The BNP, adiponectin, and leptin levels were significantly higher in preeclampsia patients compared with controls. The adiponectin level was increased significantly in normal-weight preeclampsia patients compared with overweight preeclampsia patients. Adiponectin mRNA expression was increased significantly in adipose tissues of preeclampsia patients compared with controls and was also increased significantly in normal-weight preeclampsia patients compared with overweight preeclampsia patients, whereas leptin was not. BNP and adiponectin showed significant positive correlations in both normal-weight and overweight preeclampsia patients. BNP had a significantly weaker effect on adiponectin in overweight compared with normal-weight preeclampsia patients. Moreover, BNP had a weaker effect on adiponectin production in adipocytes from overweight women compared with adipocytes from normal-weight women using primary culture of human adipocytes. These data suggested that BNP may play a role in hyperadiponectinemia of preeclampsia patients. The weaker effect of BNP on adiponectin production may participate in the pathophysiology of overweight preeclampsia patients.
    AJP Endocrinology and Metabolism 01/2012; 302(6):E687-93. DOI:10.1152/ajpendo.00548.2011 · 4.09 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the cellular effects of intermittent high glucose on the human BeWo placental choriocarcinoma cell line, used as a model of the effects of glucose fluctuation in diabetic pregnancies. BeWo cells were subjected to three different glucose conditions for 48 h: 7 mmol/L (control), 42 mmol/L (high glucose), or 7 and 42 mmol/L glucose (intermittent, alternated every 6 h). Cell viability was assessed using cell counts, a cell proliferation assay, and a cell viability assay. Apoptosis was also studied using a terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay and by immunocytochemistry of fractin, the N-terminal fragment of actin, which can distinguish apoptotic from necrotic cells. Furthermore, the expression of the well-known survival factors of trophoblast cells, heparin-binding epidermal growth factor-like growth factor and leptin, was evaluated by real-time polymerase chain reaction and Western blot analyses. Intermittent high-glucose conditions significantly decreased cell viability and enhanced apoptosis compared with control or continuous high-glucose conditions. Furthermore, the expression of heparin-binding epidermal growth factor-like growth factor, but not that of leptin, was significantly increased under intermittent high-glucose conditions compared to its expression under either control or continuous high-glucose conditions. These data indicate that intermittent high glucose is more deleterious to BeWo cells than continuous high-glucose conditions. Although further in vitro and in vivo study is necessary, excess fluctuation of glucose levels in the placental circulation might be involved in the impairment of placental development leading to the placental dysfunction.
    Journal of Obstetrics and Gynaecology Research 05/2011; 37(10):1365-75. DOI:10.1111/j.1447-0756.2011.01539.x · 0.93 Impact Factor
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    ABSTRACT: Preeclampsia is characterized by the onset of high blood pressure and proteinuria during pregnancy, which results in substantial maternal and neonatal morbidity and mortality. Insulin resistance has been observed before the onset of preeclampsia, and is implicated in its pathophysiology. Recently, retinol-binding protein 4 (RBP4), which carries retinol in circulation, has been shown to be a potential regulator of insulin resistance originating from adipose tissue. Here we measured insulin resistance and RBP-4 levels in patients with preeclampsia and in women with normal pregnancies matched for gestational age and body mass index at Okayama University Hospital. Our aim was to examine the potential role of RBP4 in the pathophysiology of this disorder. There were no significant differences in RBP4 levels between all patients with preeclampsia and controls. However, the RBP4 level and homeostasis model assessment as an index of insulin resistance (HOMA-IR) in overweight patients with late-onset preeclampsia were significantly higher than in overweight controls carrying normal pregnancies and in normal weight women with late-onset preeclampsia. In contrast, there were no significant differences between the overweight and normal weight groups among patients with early-onset preeclampsia and in healthy pregnant women. These data suggest that RBP4 might act in the pathophysiology of late-onset preeclampsia via increased insulin resistance in obese women.
    Endocrine Journal 01/2011; 58(1):47-53. DOI:10.1507/endocrj.K10E-288 · 2.02 Impact Factor
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    ABSTRACT: Ciliary neurotrophic factor (CNTF) has been shown to decrease food intake in mouse models of obesity and to improve insulin sensitivity. It is well known that tight regulation of glucose metabolism is essential for successful gestational outcomes (e.g. fetal growth), and that abnormal insulin resistance is associated with preeclampsia (PE). To investigate the possibility that CNTF might be involved in the regulation of insulin resistance during pregnancy, circulating levels of CNTF were assessed in non-pregnant, normal pregnant, postpartum, and pregnant women with PE. Sera from healthy non-pregnant women (n = 10), pregnant women (n = 30:1st trimester; n = 10, 2nd trimester n = 10; 3rd trimester; n = 10), postpartum women (n = 10), and patients with PE (n = 11) were studied with Western blotting. Circulating CNTF was detected by Western blotting, and the levels of CNTF in pregnant women were decreased as compared with those in non-pregnant women, and tended to decrease as pregnancy progressed. A significant decrease was found in PE as compared with normal pregnancy. Circulating CNTF might be associated with physiological and abnormal insulin resistance during pregnancy.
    Acta medica Okayama 04/2010; 64(2):129-36. · 0.75 Impact Factor
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    ABSTRACT: Recent progress in adiposcience has revealed several important adipose-tissue-originated factors, so-called adipokines. Retinol-binding protein 4 (RBP4), a protein expressed and secreted by adipocytes, has been identified as a novel regulator of insulin resistance. Physiological insulin resistance occurs during the pregnancy of mammals to accommodate fetal growth, and it has been suggested that insulin resistance and hyperinsulinemia might also be associated with pregnancy-induced hypertension (PIH). In order to shed light on the role of RBP4 during pregnancy, we attempted to assess RBP4 levels during pregnancy. Fetal growth could be affected by aberrant regulation of RBP4 levels in fetal circulation per se, so we examined the RBP4 levels in cord blood samples of growth restricted cases. Circulating RBP4 levels were examined in non-pregnant and pregnant healthy women using Western blotting. Also, RBP4 levels in normal pregnancy and PIH were quantitated using Dot-blot analysis. RBP4 levels in cord blood samples also were evaluated in selected cases. RBP4 levels tended to decrease after early gestation with no obvious difference between mid- to late-gestation. RBP4 levels were increased in pregnant women with PIH compared with normal pregnancies (P < 0.01). RBP4 levels were decreased in the cord blood of PIH pregnancies and light-for-dates infants without obvious causes for intrauterine growth restriction compared with normal pregnancies (P < 0.01). These results suggest that circulating RBP4 could be elevated in PIH, where maternal glucose metabolism is perturbed, and that RBP4 levels in cord blood might be closely associated with fetal growth.
    Journal of Obstetrics and Gynaecology Research 05/2009; 35(2):293-300. DOI:10.1111/j.1447-0756.2008.00950.x · 0.93 Impact Factor
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    ABSTRACT: Oncostatin M (OSM), hepatocyte growth factor (HGF) and soluble glycoprotein 130 (sgp130) have been demonstrated to be involved in fetal liver development. In this study, we examined the relation between neonatal jaundice and OSM, gp130 or HGF levels in umbilical cord blood. A cross-sectional study of 160 neonates born at Okayama University Hospital. Tertiary referral center serving a population of three million. The serum concentrations of OSM, HGF and sgp130 in umbilical venous cord blood were measured and compared with the clinical records of these neonates. The HGF level was correlated to both gestational week (p=0.007) and birthweight (p=0.015), as well as to total bilirubin on Day 1 (p=0.032). In preterm neonates, the HGF levels were lower in neonates who received phototherapy (photo group) than in those who did not receive phototherapy (non-photo group) (p=0.002). In contrast, in term neonates, OSM levels were lower in the photo group than in the non-photo group (p=0.0003). These findings suggest that the phototherapy requirement for neonatal jaundice may be associated with lower umbilical HGF concentration in preterm neonates and with lower umbilical OSM concentration in term neonates.
    Acta Obstetricia Et Gynecologica Scandinavica 11/2008; 87(12):1322-8. DOI:10.1080/00016340802468332 · 1.99 Impact Factor