Search

Background The use of total laparoscopic hysterectomy is increasing. However, as with conventional abdominal hysterectomy, vaginal bacteria-related postoperative complications need to be managed in total laparoscopic hysterectomy. Therefore, we started to combine metronidazole vaginal tablets with intravenous administration of cephem antibiotics immediately before starting surgery to reduce complications. To evaluate the effect of this combination, and to determine the risk factors for these complications, we retrospectively collected medical records from our hospital and performed a multivariate analysis. Methods We reviewed the medical records of 520 patients who underwent total laparoscopic hysterectomy from 1 January 2015 to 31 December 2021. Among these cases, we identified 16 cases as having vaginal bacteria-related postoperative complications, defined as needing more than one additional day for treatment of postoperative complications, namely postoperative infection (10 cases) and vaginal dehiscence (6 cases). First, we evaluate the effect of metronidazole vaginal tablets by dividing the patients into two groups according to whether metronidazole vaginal tablets were used, and comparing the vaginal bacteria-related postoperative complication rates and other indices. Second, we performed a multivariate logistic regression analysis to assess the influence of each of 17 representative factors, including patient characteristics and symptoms, uterus and leiomyoma sizes, concomitant procedures such as laparoscopic cystectomy and pelvic lymphadenectomy, and others. Results In the multivariate analysis of the 520 cases, we confirmed that the use of metronidazole vaginal tablets could reduce the vaginal bacteria-related postoperative complications rate by more than half (odds ratio, 0.36). In addition to metronidazole vaginal tablets use, concomitant laparoscopic cystectomy and blood transfusion were associated with significant increases in the vaginal bacteria-related postoperative complication rate. Conclusions The effect of the addition of metronidazole vaginal tablets to pre- and postsurgical treatment on the reduction of vaginal bacteria-related postoperative complications was confirmed. This easy, safe, and low-cost method may improve the management of total laparoscopic hysterectomy.

Background Acute puerperal uterine inversion is rare but may cause massive postpartum blood loss due to uterine atony. Therefore, these patients must be diagnosed, and uterine replacement must be performed as soon as possible. However, in some cases, active bleeding due to uterine atony becomes uncontrollable, even though the uterine inversion itself is treated. In these cases, additional treatments, including surgical procedures, are needed. Case presentation A 41-year-old Japanese woman, gravida 1, para 0, was hospitalized for labor induction at 40 weeks and 3 days of gestational age. She had a vacuum-assisted delivery after 3 days of oxytocin administration, but acute uterine inversion occurred. Although replacement of the inverted uterus was successful by manual repositioning and Bakri balloon tamponade insertion, massive postpartum hemorrhage caused by uterine atony became uncontrollable. In this situation, since disseminated intravascular coagulation had developed, we used uterine artery embolization to stop the bleeding. After detecting the pseudo-aneurysmal sac and tortuous vessels of the right uterine artery, transcatheter right-sided uterine artery embolization was performed. Thirteen days after uterine artery embolization, she was discharged with no complications. Conclusions In cases of disseminated intravascular coagulation caused by massive postpartum bleeding, uterine artery embolization may often be selected. In our case, since we performed angiography to detect the main bleeding site, the hemorrhage could be stopped with unilateral uterine artery embolization alone, without hysterectomy.

Background: Laparoscopic salpingostomy to treat tubal ectopic pregnancy (TEP) is increasing due to patient preference for subsequent spontaneous pregnancy. However, the incidence of persistent trophoblasts (PT) ranges from 5–29%, though PT rarely occurs after laparoscopic salpingectomy. For this reason, the selection of laparoscopic salpingostomy should be performed carefully. Here, we aimed to identify the risk factors for PT, focusing on serum hCG levels.Methods: We reviewed the medical records of 128 patients who underwent laparoscopic surgeries for TEP from 2015/1/1 to 2021/12/31, including 62 with laparoscopic salpingostomy and 66 with laparoscopic salpingectomy. Among these cases, we identified 13 with PT detected during the postoperative follow-up period. We performed a multivariate logistic regression analysis to assess the influence of each representative factor, especially serum hCG levels, on the occurrence of PT. We first performed this analysis for 62 cases with laparoscopic salpingostomy and then for all 128 cases. Additionally, we focused on the reduction rates of serum hCG levels after surgery. Based on the scatter plot of the association between the reduction rates and elapsed time after surgery, we tried to create linear regression lines for estimating the appropriate postoperative follow-up period.Results: In the multivariate analyses of the 62 cases with laparoscopic salpingostomy, “high hCG”, including serum hCG levels of over 2000 and 4000 mIU/mL, showed significance. These results were also detected in the analysis of all 128 cases. Next, we obtained the regression lines based on the scatter plots of the association between reduction rates of serum hCG levels and elapsed time after surgery. By referring to the slopes of the regression lines, we could predict 37 and 30 days as necessary for serum hCG levels to be reduced to one-thousandth in the cases with laparoscopic salpingostomy and salpingectomy.Conclusions: Our evaluation of the association between serum hCG level and PT allows us to provide the selection criteria, namely, serum hCG level over 2000 and 4000 mIU/mL, for laparoscopic salpingostomy. Additionally, our analysis of the association between the reduction rates of serum hCG levels and the elapsed time after surgery allows us to predict the appropriate length for the postoperative follow-up period.

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.

Background: We compared the revised American Society for Reproductive Medicine (ASRM) scores determined during laparoscopic surgery to evaluate the effect of the location of the endometrioma (right vs. left ovary) on the severity of endometriosis. Methods: The medical records of 151 patients, including 58 right-sided and 93 left-sided cases, who underwent an initial laparoscopic surgery for unilateral ovarian endometrioma were reviewed retrospectively. We extracted the ASRM scores determined during surgery and some representative factors related to endometriosis that are separate from the tumour characteristics, such as the coexistence of uterine fibroids, adenomyoma, or other ovarian tumours, a history of use of assisted reproductive technology (ART), and tumour marker values. A statistical analysis was performed to assess the impact of each factor. We classified the ASRM scores into 4 categories to compare the tendency towards endometrial lesion spread with a focus on the “sidedness” of the endometrioma. We defined contralateral endometrial lesion (CEL), Douglas pouch endometrial lesion (DEL), same endometrial lesion (SEL) and peritoneal endometrial lesion (PEL). Results: The ASRM scores of patients with a right-sided endometrioma were significantly higher than patients with a left-sided endometrioma (41.5 ± 22.1 points vs. 32.9 ± 15.8 points, p

AIM The aim of this study was to identify predictive factors for emergent surgical interventions in patients with ovarian endometriomas hospitalized for pelvic inflammatory disease (PID). METHODS We retrospectively identified 22 patients with ovarian endometriomas who were hospitalized to manage PID. Patients were divided into two groups: those who required emergent surgery after failed antibiotic therapy (emergent surgery group, n = 6) and those who were discharged with successful antibiotic therapy (conservative group, n = 16). Logistic regression analysis was performed to analyze the factors associated with emergent surgery. RESULTS Patients in the emergent surgery group were significantly more likely to have intrauterine or intrapelvic procedures before the onset of PID compared to those in the conservative group (83% vs 38%, odds ratio 8.33, 95% confidence interval 1.02-181.3; P = 0.048). The mean interval between the onset of PID symptoms and the commencement of parenteral antibiotic therapy was significantly longer in the emergent surgery compared to the conservative group (6.5 vs 1 day, odds ratio 1.28, 95% confidence interval 1.01-1.75; P = 0.041). CONCLUSION A history of an intrauterine or intrapelvic procedure before the onset of PID was more likely to result in emergent surgery. A longer interval between the onset of PID symptoms and the commencement of parenteral antibiotics was also associated with emergent surgery. These findings could help to identify patients with ovarian endometriomas hospitalized with PID at higher risk of emergent surgical intervention.

Background To determine the prevalence of and risk factors for malignant transformation of ovarian endometrioma during dienogest therapy, which is very rare, we examined multiple cases of malignant transformation of ovarian endometrioma during dienogest therapy and performed a multivariate analysis of the records in our hospital. Methods The medical records of 174 patients who underwent DNGT for the treatment of OMA from June 1, 2011, to May 31, 2018, were reviewed retrospectively with the approval of the Human Ethical Committee of the University of Teikyo Hospital. And we provided one representative case of MT with obtaining written informed consent. To assess the effects of six representative factors, including advanced age, parity, surgical history, and endometrial cyst characteristics (including 3 factors), on the possibility of malignant transformation, we performed a multivariate logistic regression analysis. Results Of the 174 cases, 4 were diagnosed with malignant transformation, and these cases are reported. In the multivariate analysis, advanced age (P = 0.0064), nullipara (P = 0.0322), and enlargement (P = 0.0079) showed significant differences for malignant transformation occurrence. All 4 malignant transformation cases were among the 19 patients who had all of these 3 factors. Conclusions For a more accurate determination of the treatment approach, a larger sample size will be needed to determine the risk factors for malignant transformation during dienogest therapy.

The aim of this study was to identify predictive factors for emergent surgical interventions in patients with ovarian endometriomas hospitalized for pelvic inflammatory disease (PID).We retrospectively identified 22 patients with ovarian endometriomas who were hospitalized to manage PID. Patients were divided into two groups: those who required emergent surgery after failed antibiotic therapy (emergent surgery group, n = 6) and those who were discharged with successful antibiotic therapy (conservative group, n = 16). Logistic regression analysis was performed to analyze the factors associated with emergent surgery.Patients in the emergent surgery group were significantly more likely to have intrauterine or intrapelvic procedures before the onset of PID compared to those in the conservative group (83% vs 38%, odds ratio 8.33, 95% confidence interval 1.02-181.3; P = 0.048). The mean interval between the onset of PID symptoms and the commencement of parenteral antibiotic therapy was significantly longer in the emergent surgery compared to the conservative group (6.5 vs 1 day, odds ratio 1.28, 95% confidence interval 1.01-1.75; P = 0.041).A history of an intrauterine or intrapelvic procedure before the onset of PID was more likely to result in emergent surgery. A longer interval between the onset of PID symptoms and the commencement of parenteral antibiotics was also associated with emergent surgery. These findings could help to identify patients with ovarian endometriomas hospitalized with PID at higher risk of emergent surgical intervention.

Estrogen receptor (ER) is a hormone-inducible transcription factor as a member of the nuclear receptor gene superfamily. Unliganded ER is transcriptionally silent and capable of DNA binding; however, it is unable to suppress the basal activity of the target gene promoters, unlike non-steroid hormone receptors that associate with corepressors in the absence of their cognate ligands. To study the molecular basis of how unliganded human ERalpha is maintained silent in gene regulation upon the target gene promoters, we biochemically searched interactants for hERalpha, and identified heat shock protein 70 (Hsc70). Hsc70 appeared to associate with the N-terminal hormone binding E domain, that also turned out a transcriptionally repressive domain. Competitive association of Hsc70 with a best known coactivator p300 was observed. Thus, these findings suggest that Hsc70 associates with unliganded hERalpha, and thereby deters hERalpha from recruiting transcriptional coregulators, presumably as a component of chaperone complexes.

透析開始時の穿刺順番についてのトラブルは多くの維持透析施設で経験されさまざまな対処がなされてきたが, 未だに十分な対処法は確立されていない.当院では開院当初よりこの問題に取り組み, 穿刺時間固定制 (以下: 時間固定制) 導入後20年が経過し, 現在, 主に時間固定制を実施し, 夜間のみ来院順制を実施している. 今回われわれは長期の経験をもとに, 時間固定制の実際をまとめ, その他の穿刺順番制との比較ならびに穿刺に関する患者アンケート調査を行ったので報告する.時間固定制の基本ルールは (1) 時間枠として5分間を1枠, (2) 穿刺はスタッフ2人組とし, その人数で穿刺可能な患者数を時間枠にいれる, (3) 穿刺順位は透析歴・透析時間・通院距離・穿刺困難度・介護度等を考慮, (4) 患者・スタッフ両者が見やすい場所に開始時間を掲示する, ことなどである.次に他の穿刺順番制との比較では, 来院順制は患者同士が順番を競い合い朝早く来院するため, 待ち時間が長くなる傾向にある. また, ベッド配置順制ではスタッフにとって動線が短く効率的であるが, 穿刺順番に対し患者側から不満がでることが多い. 一方, 時間固定制は患者の無駄な早朝通院の防止や, 穿刺までの時間の短縮, 総じて透析にかかわる時間の短縮・効率化が生じる. スタッフは穿刺業務に集中できるうえ, 全患者への穿刺機会が増えるので穿刺技術の向上につながる. さらに返血業務も効率よく行える.患者アンケート調査の結果, 時間固定制では入室後穿刺までの待ち時間は5分以内が38%で, 20分以内で80%を占めた. 満足度調査では, 満足群 (満足・やや満足の合計) が97%を占めた. しかし穿刺時間枠については, やや不満が10%認められ, 全て透析歴10年未満であった. すなわち時間固定制の問題点は, 新規患者には時間枠の選択が限られてしまうため, 穿刺順番の優先項目を考慮しながら, 患者の状況変化に合わせて随時時間枠の変更を検討する必要があった. 一方, 夜間に実施している来院順制の穿刺待ち時間は5分以内が72%と高く, さらに20分以内に全穿刺が開始されていた. 満足群は94%と高く, 夕方仕事後のため順番を競うことなく効率よく行われていることが明らかとなった. 以上より穿刺順番制の導入は, その利点を生かした適正な使い分けが重要である.

Unlike previously reported cases with total protein 4.2 deficiency due to mutations in the EPB42 gene, we describe a total deficiency in protein 4.2 with normal EPB42 alleles. Hereditary spherocytosis (HS) was observed in a Japanese woman (unsplenectomized) and her daughter (splenectomized). The mother showed a partial deficiency in band 3 and a proportional reduction in protein 4.2. She was heterozygous for a novel allele of the EPB3 gene, allele Okinawa, which contains the two mutations that define the Memphis II polymorphism (K56E, AAG-->GAG, and P854L, CCG-->CTG) and, additionally, the mutation: G714R, GGG-->AGG, located in a highly conserved position of transmembrane segment 9. The latter change was responsible for HS. In trans to allele Okinawa, the daughter displayed allele Fukuoka: G130R, GGA-->AGA, an allele known to alter the binding of protein 4.2 to band 3. The daughter presented with a more pronounced decrease of band 3, and lacked protein 4.2, resulting in aggravated haemolytic features. Although the father was not available for study, heterozygosity for allele Fukuoka has been documented in another individual who showed no clinical or haematological signs, and a normal content of band 3. We suggest that band 3 Okinawa binds virtually all the protein 4.2 in red cell precursors, band 3 Fukuoka being unable to do so, and that the impossibility of band 3 Okinawa incorporation into the membrane leads to degradation of the band 3 Okinawa protein 4.2 complex. In contrast, band 3 Fukuoka, free of bound protein 4.2, could then incorporate normally into the bilayer. Thus, protein 4.2 would not appear in the daughter's red cell membrane.

血液透析治療中に低血糖発作を合併した非糖尿病, 慢性腎不全の3症例を経験した. そのうち1例は臨床経過から抗菌剤エノキサシンによる低血糖の初報告例と考えられた.症例1は58歳, 男性で7年の透析歴を有する. 平成1年5月, 朝食を摂取せずに無糖重炭酸透析液による血液透析を開始し, 2時間後より発汗, 口渇, 全身倦怠感を訴えた. 意識障害も出現したため透析中止し, 血糖を測定したところ, 65mg/dlであった. グルコース静注により各症状の改善を見た. 症例2は69歳, 女性で, 夫が糖尿病, 高血圧で内服薬治療中である. 透析歴は5年で, 平成1年12月, 朝から起床せず昏睡状態にて緊急入院となった. 血糖は40mg/dlと低下しており, ブドウ糖静注により意識は回復した. しかし数時間後に低血糖発作が再発し, 24時間にわたりブドウ糖の静脈投与を必要とした. 発症前日に夫への処方薬グリクラジド40mgを降圧薬と信じて自己服用したことを, 低血糖回復から数日後に申告した. 症例3は78歳, 女性で, 透析歴は4年. 平成1年12月より38℃の発熱が出現し, 精査目的で入院となった. 尿路感染症と診断しエノキサシン600mgを投与した. 投与後3日目から発汗, 動悸が出現したが食後に回復した. 4日目の夜, 意識低下が出現し, 血糖が20mg/dlと低値であったため投薬を中止し, ブドウ糖静注をしたところ症状は消失した. しかし1時間後には低血糖発作が再発し, 翌日昼過ぎまで頻回の糖補給を必要とした. エノキサシン以外の投薬は継続したが以後低血糖の再発をみていない. 3症例とも低血糖発作回復後の各種画像診断, 内分泌学的検査等により, 低血糖をきたす器質的疾患の存在は否定的だった.血液透析中の慢性腎不全患者では非糖尿病患者でも種々の原因で低血糖発作をおこすことがあり注意を要する. またエノキサシンの大量投与時には低血糖の発現に注意する必要がある.

The action of estrogen in the female reproductive organs is well known in terms of the expression pattern and gene regulation of the estrogen receptor (ER). The significance of ERs in female reproduction is undisputed. The role of the androgen receptor (AR) is less clear. Clinical hyperandrogenism, a typical feature of polycystic ovary syndrome (PCOS), highlights pathological androgen production by the ovary. By contrast, the physiological impact of androgen action in female reproductive organs remains elusive. Androgens affect folliculogenesis in a variety of experimental approaches and ARs are expressed in developing follicles. Recent observations have discovered that inactivation of ARs in female mice results in premature ovarian failure (POF), indicating that normal folliculogenesis requires AR-mediated androgen action. Moreover, these results imply that POF might be caused by impairment of AR-mediated androgen action.

Estrogen receptor (ER) is a hormone-inducible transcription factor as a member of the nuclear receptor gene superfamily. Unliganded ER is transcriptionally silent and capable of DNA binding; however, it is unable to suppress the basal activity of the target gene promoters, unlike non-steroid hormone receptors that associate with corepressors in the absence of their cognate ligands. To study the molecular basis of how unliganded human ERalpha is maintained silent in gene regulation upon the target gene promoters, we biochemically searched interactants for hERalpha, and identified heat shock protein 70 (Hsc70). Hsc70 appeared to associate with the N-terminal hormone binding E domain, that also turned out a transcriptionally repressive domain. Competitive association of Hsc70 with a best known coactivator p300 was observed. Thus, these findings suggest that Hsc70 associates with unliganded hERalpha, and thereby deters hERalpha from recruiting transcriptional coregulators, presumably as a component of chaperone complexes.

Estrogen receptor (ER) is a hormone-inducible transcription factor as a member of the nuclear receptor gene superfamily. Unliganded ER is transcriptionally silent and capable of DNA binding; however, it is unable to suppress the basal activity of the target gene promoters, unlike non-steroid hormone receptors that associate with corepressors in the absence of their cognate ligands. To study the molecular basis of how unliganded human ERα is maintained silent in gene regulation upon the target gene promoters, we biochemically searched interactants for hERα, and identified heat shock protein 70 (Hsc70). Hsc70 appeared to associate with the N-terminal hormone binding E domain, that also turned out a transcriptionally repressive domain. Competitive association of Hsc70 with a best known coactivator p300 was observed. Thus, these findings suggest that Hsc70 associates with unliganded hERα, and thereby deters hERα from recruiting transcriptional coregulators, presumably as a component of chaperone complexes.