Hiroshi Yoshida

Yokohama City University, Yokohama, Kanagawa, Japan

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Publications (8)8.03 Total impact

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    ABSTRACT: AIM: The aim of this study was to identify factors that can predict the resistance to parenteral therapy in patients with tubo-ovarian abscesses (TOA). MATERIAL AND METHODS: We conducted a case-control study involving 55 admitted patients with TOA. The subjects eligible for this study included 28 patients who failed antibiotic therapy and required surgery (surgical cases) and 27 patients who were conservatively cured (control cases). The clinical characteristics of the patients on admission were reviewed. Logistic regression analysis was performed after univariate analysis to identify potentially important variables and to calculate odds ratios with 95% confidence intervals. RESULTS: As per the univariate analysis, compared to the control cases, the surgical cases were older (40.4 vs 31.5 years), had higher white blood cell counts (14000 vs 11828 cells/mm(3) ), higher C-reactive protein levels (16.1 vs 7.6 mg/dL), and a larger abscess diameter (6.6 vs 3.9 cm). There were no significant differences in gravidity, parity, body temperature, rate of endometrial cyst formation, and Chlamydia trachomatis infection rates between the groups. Multiple logistic regression analysis indicated that the only statistically significant risk factor predicting parenteral antibiotic therapy failure was the abscess diameter >5 cm (odds ratio = 69.6; 95% confidence interval = 9.3-527, P < 0.0001). CONCLUSION: An abscess diameter >5 cm is an important factor for predicting the failure of antibiotic therapy in patients with TOA. Moreover, it is useful for determining whether patients with TOA should be surgically treated.
    Journal of Obstetrics and Gynaecology Research 03/2013; · 0.84 Impact Factor
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    ABSTRACT: Since women with Turner Syndrome (TS) have various complications, they require comprehensive medical evaluation and multidisciplinary treatment. Although TS patients receive adequate care in childhood, many adults with TS do not. Since most TS adults attend gynecologists for hormone replacement therapy, we suggest gynecologists take primary responsibility for their management. In an attempt to provide TS patients with a comprehensive treatment regimen, we started multidisciplinary medical management in the Reproductive Health Clinic at Yokohama City University Hospital. To evaluate the efficacy of this medical care system, a retrospective analysis was conducted. The clinical profiles of 57 TS patients were examined. The past histories, complications and clinical data of these patients were extracted from their medical records and examined clinically. Bone mineral density measurements of lumbar vertebrae (L(2-4)), anti-thyroid antibody titer measurements, hearing tests and cardiovascular MRI were also performed. Mean follow-up duration was 5.1 years (range, 1-8 years). At the time of transition, patients with complications developed in childhood, such as amenorrhea, osteopenia/osteoporosis, otitis media, thyroid dysfunction and cardiovascular disease were identified. All these complaints were successfully followed up in our adult care system. Several complications common to TS adults, such as glucose intolerance, liver dysfunction, hyperlypidemia and hypertension could be identified by our screening system. Patients were referred to specialists when necessary. Multidisciplinary health management in our Reproductive Health Clinic improved the status of medical care for TS adults.
    Journal of Obstetrics and Gynaecology Research 03/2011; 37(7):836-42. · 0.84 Impact Factor
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    ABSTRACT: We report a rare case in which a cystic lesion in the cervix, caused by endometriosis, resulted in a massive vaginal hemorrhage. Cervical endometriosis is relatively common and is usually considered a mild condition. However, we report a case in which a severe vaginal bleed originated from an endometrial cyst of the cervix and in which diagnosis was confused by the presence of atypical cells.
    American journal of obstetrics and gynecology 08/2008; 199(1):e12-3. · 3.28 Impact Factor
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    ABSTRACT: Adiponectin is an adipocyte-derived hormone involved in glucose, lipid and energy metabolism. A low plasma adiponectin concentration is associated with insulin resistance, obesity and atherosclerosis. In women, energy homeostasis is remarkably changed during gestation and lactation in order to supply sufficient nutrition for a fetus or newborn. In this study we aimed to elucidate the physiological impact of gestation and lactation on the plasma adiponectin levels and the influence of reproduction-related hormones on adiponectin secretion. We studied the longitudinal changes in plasma adiponectin concentration during pregnancy (1st, 2nd and 3rd trimester) and lactation (3 days and 1 month after the delivery) in lean healthy women (n = 22). The plasma adiponectin level declined slightly as the pregnancy advanced and reached its lowest level during lactation (12.25 +/- 0.182 microg/ml at early pregnancy vs. 6.88 +/- 0.375 microg/ml at 3 days postpartum, p < 0.001). In order to investigate the role of the lactogenic hormone prolactin in the decrease of plasma adiponectin levels during lactation, we further performed in vitro experiments using human primary cultured adipocytes. Western blotting of the adipocyte lysate and ELISA of the culture medium revealed that exogenous prolactin inhibited both production and secretion of adiponectin in a dose-dependent manner. Our results thus suggests that prolactin affects the regulation of maternal metabolism through suppression of adiponectin.
    Endocrine Journal 08/2006; 53(4):555-62. · 2.23 Impact Factor
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    ABSTRACT: We present three cases of post-traumatic stress disorder (PTSD) that occurred in patients with gynecologic cancers. Case 1 and 2 had ovarian cancer and case 3 had endometrial cancer. The patients developed anxiety, difficulty in sleeping, and complaints of various discomforts after their diagnosis. On consulting with psychiatrists, PTSD was diagnosed based upon the DSM-IV classification. In cases 1 and 2, the symptoms worsened during the patients' primary treatment and interfered with their ability to continue the treatment. Psychiatric interventions were provided making it possible to complete their treatment. In case 3, the patient needed psychiatric intervention because of her psychological distress during her treatment. She was finally diagnosed as having PTSD. There are few reports regarding PTSD occurring in gynecologic cancer patients. However, attention should be given to the symptoms of these disorders so that patients may complete their standard therapies.
    Journal of Obstetrics and Gynaecology Research 07/2006; 32(3):349-53. · 0.84 Impact Factor
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    ABSTRACT: PurposeTo identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy. MethodsForty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment. ResultsThe rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000mIU/ml and the levels of hCG 48h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000mIU/ml and above or when the levels of hCG level 48h later was 80% of initial levels and above. ConclusionsExpectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed.
    Reproductive Medicine and Biology 8(3):119-123.
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    ABSTRACT: Empty follicle syndrome (EFS) has been defined as a condition where no oocytes can be retrieved for in vitro fertilization (IVF) even though ultrasound findings and estradiol (E2) levels suggest the presence of potential follicles. The EFS is a rare condition with an incidence of 0.5–7 % of women undergoing IVF treatments. Although there are many hypotheses as to the cause of EFS, including advanced ovarian age, drug-related problems, and dysfunctional folliculogenesis, its cause remains unknown. A 37-year-old woman with endometriosis and a 5-year history of primary infertility underwent IVF treatment for 4 cycles. No oocytes were retrieved in 2 cycles and no fertilized eggs were obtained in the other 2 cycles. We assumed that endometriosis adversely affected folliculogenesis and fertilization. Aspiration of an endometrial cyst in the right ovary and subsequent administration of oral contraceptives resulted in successful folliculogenesis and fertilization. Thereafter, she conceived and delivered a 2,662 g female infant at 38 weeks of gestation. Here, we report a case of EFS who conceived in the 5th IVF cycle after aspiration of an endometrial cyst. We assumed that endometriosis might have been involved in the dysfunction of folliculogenesis and EFS.
    Reproductive Medicine and Biology 12(3).
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    ABSTRACT: PurposesIt is sometimes difficult to restore a regular ovulatory cycle in women with polycystic ovary syndrome (PCOS) using classic agents such as clomiphene citrate or gonadotropins. Saireito, a herbal medicine, is believed to have an effect similar to corticosteroids. We examined the effect of Saireito on ovulatory induction and endocrine status in women with PCOS. MethodsTwenty-four women with PCOS were treated with Saireito for 3months. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), testosterone (T), estradiol (E2), adrenocorticotropic hormone (ACTH), and cortisol were measured before and after treatment, and ovulation was assessed. We compared serum LH levels between ovulation (n=21) and anovulation (n=3) groups, and compared ovulation rate and serum LH levels between obese (n=6) and nonobese (n=18) groups. ResultsOvulation was restored in 21 (87.5%) of the 24 PCOS patients following administration of Saireito for 3months. LH levels were significantly decreased 1month after medication in ovulatory group (P<0.001), but only slightly decreased in anovulatory group. Ovulation rate in the nonobese group (94.4%) was higher than in the obese group (66.7%). Serum LH levels were significantly reduced in the nonobese group, but only slightly reduced in the obese group. ConclusionsSaireito reduced serum LH levels and increased ovulatory rate, particularly in nonobese women. KeywordsHerbal medicine-Luteinizing hormone-Ovulatory induction-Polycystic ovary syndrome-Saireito
    Reproductive Medicine and Biology 9(4):191-195.