[Show abstract][Hide abstract] ABSTRACT: Estrogen replacement therapy (ERT) is necessary for uterine development and bone mass acquisition in women with Turner syndrome (TS) suffering from ovarian insufficiency. However, adequate ERT regimens have not yet been established. The aim of this study was to evaluate the efficacy of ERT for both uterine development and bone mass acquisition. One hundred TS patients from Yokohama City University Hospital (88 with primary amenorrhea (PA) and 12 patients with spontaneous menstrual cycles (MC)) were enrolled after obtaining consent. Clinical profiles, uterine length (UL) measured by ultrasonic examination, and bone mineral density (BMD) of the lumbar vertebrae (L2-4) assessed by DEXA were evaluated. At the time of the first visit, the ULs of patients in the PA group were significantly shorter than those in the MC group. After receiving ERT, there were no significant differences in UL between patients with PA and MC. Forty-seven patients for whom the ERT initiation age was known were investigated to clarify the influence on BMD. The results showed that the BMD in the late initiation (18 years or older) group at the latest visit (0.770 ± 0.107 g/cm(2): n = 16) was significantly lower than that in the early initiation (under 18 years) group (0.858 ± 0.119 g/cm(2): n = 21) or the MC group (0.941 ± 0.118 g/cm(2): n = 10). No significant differences were seen between the early initiation and MC group. ERT was effective in increasing UL and BMD. However, early initiation of ERT is necessary to increase BMD.
Full-text · Article · Aug 2015 · Endocrine Journal
[Show abstract][Hide abstract] ABSTRACT: We report a case of heterotopic pregnancy resulting in intrauterine fetal death (IUFD) after laparoscopic resection of an ectopic pregnancy. A 30-year-old woman, who conceived after ovulation induction with clomiphene, was referred to our hospital because of abdominal pain at 6 weeks of gestation. Ultrasound examination showed an intrauterine fetus with a heartbeat, a 3-cm right adnexal mass, and intra-abdominal hemorrhage. We diagnosed a heterotopic pregnancy with miscarriage in a right tubal pregnancy. With careful observation, the intra-abdominal hemorrhage resolved. However, we discovered an abscess in the right adnexa at 11 weeks and 1 day of gestation. Concurrently, chorioamnionitis was suspected because the patient developed purulent discharge and high fever. Antibiotics were administered, but appeared to be ineffective. Therefore, laparoscopic salpingectomy was performed at 11 weeks and 6 days of gestation. Macroscopic and microscopic examination revealed villi and abscess in the excised Fallopian tube. Subsequent to surgery, the amniotic fluid volume kept decreasing, probably because of chorioamnionitis. The fetal heartbeat disappeared at 16 weeks of gestation, and the fetus was delivered at 17 weeks. In this case, the infection of gestational products in the Fallopian tube might have been the cause of chorioamnionitis. Therefore, earlier surgery might have prevented IUFD. In the treatment of heterotopic pregnancy with a live intrauterine fetus, we tend to elect observation because of concern for the fetus. From our experience, surgery should be elected for heterotopic pregnancy in accordance with the treatment criteria for ectopic pregnancy.
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of a malignant lymphoma that was diagnosed by pelvic lymph node biopsy during a total laparoscopic hysterectomy for cervical carcinoma in situ (CIS). The patient was a 65-year-old woman with an unremarkable past history. She was referred to our hospital because a cervical cancer screening revealed a high-grade squamous intraepithelial lesion (HSIL). A cervical biopsy revealed squamous cell carcinoma in situ, which was confirmed by cervical conization. Moreover, she complained of an enlarged lymph node in her left neck. For this reason, she was referred to the department of otorhinolaryngology six days after the conization. Although fine-needle aspiration cytology of the cervical lymph node was performed twice, the results were negative. Because she refused a lymph node biopsy, antibiotics were given under the presumptive diagnosis of cat scratch disease. We recommended a total laparoscopic hysterectomy for the cervical CIS after providing informed consent. During the procedure, we biopsied a right obturator lymph node, which was noted to be enlarged with a pelvic MRI. Histologic examination revealed no residual tumor in the cervix; however, the lymph node was diagnosed as a grade 2 follicular lymphoma. She was subsequently diagnosed as a stage III malignant lymphoma (Ann Arbor classification) and is currently receiving R-CHOP chemotherapy in department of hematology. In our experience, laparoscopic lymphadenectomy is useful not only for the diagnosis of gynecological malignancies but also for the diagnosis of non-gynecological malignancies. Laparoscopic surgery can determine the cause of lymph node enlargement within the scope of less invasive surgery.
[Show abstract][Hide abstract] 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.
No preview · Article · Jul 2013 · Reproductive Medicine and Biology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to identify factors that can predict the resistance to parenteral therapy in patients with tubo-ovarian abscesses (TOA).
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.
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/mm3), 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).
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.
No preview · Article · Mar 2013 · Journal of Obstetrics and Gynaecology Research
[Show abstract][Hide abstract] ABSTRACT: It has been reported that high quality embryos can be selected using the Graduated Embryo Score (GES) on day2 or day3. However it is still unknown whether GES is useful for the selection of day5–6 blastocyst stage embryos. Blastocyst stage embryos were evaluated with the conventional Gardner's classified system on day5 following evaluation with the modified GES system on day2–3, and were then transferred. The pregnancy rate (47.4%) was significantly higher for transferred blastocysts with high GES points (GES ≥ 70) than the pregnancy rate (16.7%) of transferred blastocysts with low GES points (GES < 70) which had been evaluated as high potential quality blastocysts by Gardner's classification. These results suggest that the GES system is useful for the selection of high potential blastocysts in blastocyst transfer cycles. Moreover, the GES may help to promote elective single blastocyst transfer.
No preview · Article · Apr 2011 · Journal of Mammalian Ova Research
[Show abstract][Hide abstract] 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.
Full-text · Article · Mar 2011 · Journal of Obstetrics and Gynaecology Research
[Show abstract][Hide abstract] 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
No preview · Article · Dec 2010 · Reproductive Medicine and Biology
[Show abstract][Hide abstract] 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.
No preview · Article · Sep 2009 · Reproductive Medicine and Biology
[Show abstract][Hide abstract] 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.
No preview · Article · Aug 2008 · American journal of obstetrics and gynecology
[Show abstract][Hide abstract] 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.
Full-text · Article · Aug 2006 · Endocrine Journal
[Show abstract][Hide abstract] 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.
No preview · Article · Jul 2006 · Journal of Obstetrics and Gynaecology Research
[Show abstract][Hide abstract] ABSTRACT: We report a case of fetal congenital heart block treated with maternal administration of beta-sympathomimetics. The case was diagnosed as fetal complete heart block associated with maternal anti-Ro/SS-A antibody at 22 weeks of gestation. By fetal sonography, the ventricular rate was revealed to be 60 beats/min and mild cardiomegaly was shown. We initiated maternal administration of a sympathomimetic, specifically terbutaline, to prevent fetal heart failure. An increase in the fetal ventricular rate and an improvement in cardiac function were both achieved during the treatment. A viable infant was delivered by an elective cesarean section without complications at term. Maternal administration of the beta-adrenergic agent terbutaline is suggested to be effective for improving fetal congenital heart block in order to prevent heart failure in utero.
No preview · Article · Feb 2001 · Gynecologic and Obstetric Investigation