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Purpose: To evaluate the OCT images of eyes with fovea-involved complete retinal pigment epithelial and outer retinal atrophy (cRORA) as well as best-corrected visual acuity (BCVA) to explore the pathogenesis of visual impairment and atrophy., Design: Retrospective observational study., Subjects: Data of eyes with cRORA associated with age-related macular degeneration with foveal center involvement were collected from 10 hospitals in Japan., Methods: Ophthalmic examination data, BCVA, and extents of retinal pigment epithelial and outer retinal atrophy (RORA), represented by choroidal hyper-transmission, and outer plexiform layer (OPL) deterioration, central retinal thickness (CRT), and central choroidal thickness (CCT) measured using built-in software on the sectional OCT images were evaluated., Main Outcome Measures: Relationship between BCVA and extents of RORA and OPL deterioration., Results: Of the 64 eyes of 64 patients (mean age: 76.8 ± 9.5 years old), 38 eyes (59.4%) belonged to men. Mean BCVA was 0.602 ± 0.475 (median: 0.523; range, -0.079 to 1.523) in logarithm of the minimum angle of resolution (logMAR). Mean extent of RORA was 2921 ± 1291 (median: 3172; range: 479-5985) μm. BCVA in logMAR positively correlated with extents of RORA ( P  = 0.004) and OPL deterioration ( P  = 0.004) and negatively correlated with CRT ( P  = 0.022). Best-corrected visual acuity ≥0.5 was associated with extents of RORA ≥3000 μm (odds ratio [OR], 4.227; 95% confidence interval [CI], 1.440-12.408; P  = 0.009) and OPL deterioration ≥1700 μm (OR, 2.984; 95% CI, 1.034-8.609; P  = 0.043), and presence of complete central outer plexiform layer defect (cCOD) (OR, 12.700; 95% CI, 2.439-66.132; P  = 0.003), after adjusting for age and sex. The extent of RORA ≥3000 μm was associated with BCVA ≥0.5 (OR, 4.213; 95% CI, 1.437-12.356; P  = 0.009), extent of OPL deterioration ≥1700 μm (OR, 58.682; 95% CI, 6.865-501.592; P  < 0.001), and presence of cCOD (OR, 4.107; 95% CI, 1.339-12.604; P  = 0.014), after adjusting for age and sex. The extent of RORA positively correlated with that of OPL deterioration ( P  < 0.001), CRT ( P  = 0.001), and CCT ( P  = 0.041)., Conclusions: A longer extent of cRORA in the OCT images with foveal center involvement was associated with a longer extent of OPL deterioration and the presence of cCOD and worse BCVA. Further studies focusing on OPL changes are warranted for understanding the pathogenesis of RORA and vision loss., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (© 2024 by the American Academy of Ophthalmologyé.)

Macular edema is a known side effect of taxane-based anticancer drugs. We retrospectively investigated data from 11 centers between January 2016 and December 2021. Among 14,260 patients, 30 (0.21%) developed macular edema; from these, the number of cases associated with nab-paclitaxel was 16 (0.43%), significantly higher than the number of cases associated with paclitaxel or docetaxel (P < 0.01). Visual acuity (VA) and retinal choroidal change were examined in 27 patients, with a follow-up of at least 3 months. The patients' mean age was 67.2 years; 14 (51.3%) were male and four (14.8%) had unilateral onset. The mean interval between anticancer drug initiation and the first ophthalmology visit was 290.1 days. Among the 20 patients who discontinued anticancer drugs, VA and edema significantly improved 2 months after discontinuation (LogMAR VA: 0.50 vs. 0.28, central retinal thickness: 472.7 µm vs. 282.5 µm, both P < 0.01). No significant changes were observed in the central choroidal thickness. A correlation was found between duration of taxane treatment and VA immediately before discontinuation of anticancer drugs (β = 0.00050; 95% confidence interval: 0.00036-0.00097; P < 0.05). Although taxane-induced macular edema is reversible, slower anticancer drug discontinuation worsened VA, highlighting the need for regular ophthalmologic evaluation during treatments., (© 2024. The Author(s).)

Aims/introduction: To conduct a multicenter survey of visually impaired patients with diabetes mellitus (DM) and to identify the physical and ocular characteristics that lead to blindness in Japan., Materials and Methods: Visually impaired patients with diabetes mellitus in Japan were divided into blind and low-vision groups according to the World Health Organization classification. Data on parameters related to diabetes mellitus and ocular complications in the right and left eyes were collected from 19 highly advanced medical facilities and compared between the two groups., Results: Among 408 visually impaired persons (blind group: 257, low-vision group: 151), 72.1% were under 70 years of age. The rates of neovascular glaucoma (NVG) (right eye, P = 0.041; left eye, P = 0.0031) or proliferative diabetic retinopathy (PDR) (right eye: P = 0.014, left eye: P = 0.0047) and the rate of proliferative membrane beyond half of the retinal area (right eye: P = 0.0263, left eye: P = 0.037) were significantly higher in the blind group. The direct cause of visual impairment was retinal atrophy, common in both groups. Neovascular glaucoma and diabetic macular edema were equally prevalent in the blind and low-vision groups, respectively., Conclusions: In Japan, blind patients with diabetes mellitus are characterized by severe conditions such as neovascular glaucoma and progressive proliferative diabetic retinopathy upon their initial visit to an advanced care facility. These results highlight the importance of monitoring retinopathy through regular ophthalmological examinations, internal medicine, and appropriate therapeutic intervention., (© 2024 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Introduction: Osteopetrosis is a rare heritable disorder characterized by increased bone density resulting from osteoclast dysfunction. Major complications include bone fracture, osteomyelitis, anemia, and cranial nerve compression. Optic atrophy can occur due to compression of the optic nerve. Although osteomyelitis of the jaw is a common complication, it rarely occurs in the maxilla. Here, we report a case of a 74-year-old female with osteopetrosis who developed maxillary osteomyelitis, leading to orbital inflammation., Case Presentation: She was referred to our clinic for 2 months of ptosis and swelling of the left eyelid and temporal region. Previous imaging revealed a left intraorbital occupying lesion, but a biopsy of the temporal subcutaneous tissue did not provide a definitive diagnosis. After 7 months, she presented with severe temporal swelling and purulent discharge. Upon examination, maxillary osteomyelitis resulting from caries of the upper jaw was observed. Treatment with oral antibiotics, drainage of the temporal skin fistula, and regular cleaning of the maxillary drainage improved her symptoms., Conclusion: This is a rare case of maxillary osteomyelitis associated with osteopetrosis, causing orbital inflammation., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Aims/introduction: Inhibition of peroxisome proliferator-activated receptor gamma (PPARγ) phosphorylation mediated by cyclin-dependent kinase 5 (Cdk5) is one of the main mechanisms of action of antidiabetic drugs. In this study, we analyzed the ocular expression and activation of Cdk5 in patients with proliferative diabetic retinopathy (PDR)., Materials and Methods: The concentrations of PPARγ, Cdk5 and its activating subunit (p35) were determined in the vitreous body of 24 PDR and 63 control eyes by enzyme-linked immunosorbent assay. In addition, the messenger ribonucleic acid and protein expression levels of PPARγ, Cdk5 and p35 were measured in proliferative neovascular membranes from seven PDR eyes and non-neovascular epiretinal membranes from five control eyes by quantitative real-time polymerase chain reaction and immunohistochemical analysis., Results: PPARγ, Cdk5 and p35 concentrations in the vitreous body were significantly higher in the PDR group compared with the control group. There was also a positive significant correlation of Cdk5 with PPARγ and p35 in the PDR group. Furthermore, the messenger ribonucleic acid expression levels of PPARγ, Cdk5 and p35 in proliferative neovascular membranes were significantly higher in the PDR group compared with the control group. Immunostaining showed increased protein expression levels of PPARγ, Cdk5 and p35 in proliferative neovascular membranes in the PDR group compared with the control group., Conclusions: Cdk5 activation is involved in PDR pathogenesis through PPARγ expression, and inhibition of Cdk5-mediated PPARγ phosphorylation might be a new therapeutic target for treatment of PDR., (© 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)

Background: A patient with undiagnosed tracheomalacia undergoing surgery experienced accidental expiratory central airway collapse after tracheal intubation. Here, we aimed to diagnose tracheomalacia from the preoperative data., Case Presentation: A 73-year-old man, scheduled for abdominal surgery, had a clinical history of chronic obstructive pulmonary disease. Preoperative chest computed tomography revealed a lateral narrowing of the tracheal shape. After tracheal intubation, we could not manually ventilate the inflated lung. Emergent bronchoscopy findings, including severe expiratory tracheal collapse, indicated a diagnosis of tracheomalacia. We could fully ventilate the patient by moving the endotracheal tube near the tracheal carina and finally changing it to a double-lumen tube. Airway collapse did not occur under spontaneous breathing., Conclusion: Accidental expiratory central airway collapse could occur in patients with undiagnosed tracheomalacia during surgery. A diagnosis of tracheomalacia should be presumed from a deformed trachea on preoperative imaging and history of chronic obstructive pulmonary disease., Competing Interests: Approval of the research protocol: N/A. Informed consent: Verbal and written informed consent was obtained from the patient. Registry and registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None., (© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Aims: To examine the choroidal change accompanying retinal vein occlusion (RVO) in detail, we measured changes in choroidal structure after intravitreal aflibercept (IVA) injections for RVO using binarisation of enhanced depth imaging optical coherence tomographic (EDI-OCT) images and assessed associations with clinical outcome., Methods: Retrospective, observational case series. Forty treatment-naïve patients (10 central, 18 major branch and 12 macular branch RVO) were examined by EDI-OCT before and 1, 3 and 6 months after IVA injections. EDI-OCT images were binarised using ImageJ. Subfoveal cross-sectional areas of the luminal, stromal and total choroid over a 1500 µm span were measured and the stromal area to total choroidal area (S/C) ratio was calculated., Results: Compared to normal contralateral eyes, afflicted eyes at baseline exhibited significantly greater stromal area (p<0.001), total choroidal area (p=0.001) and S/C ratio (p<0.001), but no difference in luminal area (p=0.083). The stromal area, S/C ratio and total choroidal area were significantly reduced in afflicted eyes at 1, 3 and 6 months after IVA (all p<0.006). Baseline S/C ratio was significantly correlated with baseline visual acuity (VA), baseline central retinal thickness (CRT) and VA and CRT improvement at 1, 3 and 6 months post-treatment even after adjusting for the axial length, age and sex (all p<0.012)., Conclusion: RVO induces substantial oedema of the choroidal stromal area that is detectable by binarisation of EDI-OCT images. This stromal oedema likely stems from high intraocular vascular endothelial growth factor levels. Changes in choroidal structure may be used to assess severity and prognosis of RVO., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The effects of coffee intake on the ratio of stromal and luminal components in the choroid and the underlying mechanism remain unclear. This prospective cross-sectional study aimed to explore how coffee intake affects the choroidal component ratio and circulation., Methods: Forty-nine right eyes of healthy adult volunteers were evaluated as the coffee intake group. Thirty-two right eyes of healthy volunteers served as the control group. The participants consumed 185 mL of coffee or water, respectively, and the systemic hemodynamics, enhanced-depth imaging optical coherence tomographic (EDI-OCT) images, and foveal mean blur rate (MBR), an indicator of blood flow velocity, were recorded at baseline and after coffee or water intake. The EDI-OCT images were binarized using ImageJ software, and subfoveal choroidal thickness (SCT) and whole, luminal, and stromal choroidal areas were calculated., Results: In the coffee intake group, significant decreases in SCT and luminal area peaked at 60 minutes after intake (both P < 0.001), whereas a significant increase in MBR peaked at 30 minutes (P < 0.001). No significant stromal area fluctuations were observed. SCT and luminal area fluctuations exhibited a significant positive correlation (r = 0.978, P < 0.001). Significant negative correlations of luminal area fluctuations with MBR fluctuations were observed by stepwise regression analysis (r = -0.220, P < 0.001). The control group exhibited no significant fluctuations., Conclusions: Coffee-induced choroidal thinning may result mainly from a reduction in the choroidal vessel lumen, and this vessel lumen reduction correlated with an increased choroidal blood flow velocity after coffee intake. These coffee-induced changes in choroidal component ratio and circulation should be considered when evaluating choroids.

This study examined whether age and brachial-ankle pulse-wave velocity (baPWV) can be predicted with ultra-wide-field pseudo-color (UWPC) images using deep learning (DL). We examined 170 UWPC images of both eyes of 85 participants (40 men and 45 women, mean age: 57.5 ± 20.9 years). Three types of images were included (total, central, and peripheral) and analyzed by k-fold cross-validation (k = 5) using Visual Geometry Group-16. After bias was eliminated using the generalized linear mixed model, the standard regression coefficients (SRCs) between actual age and baPWV and predicted age and baPWV from the UWPC images by the neural network were calculated, and the prediction accuracies of the DL model for age and baPWV were examined. The SRC between actual age and predicted age by the neural network was 0.833 for all images, 0.818 for central images, and 0.649 for peripheral images (all P < 0.001) and between the actual baPWV and the predicted baPWV was 0.390 for total images, 0.419 for central images, and 0.312 for peripheral images (all P < 0.001). These results show the potential prediction capability of DL for age and vascular aging and could be useful for disease prevention and early treatment.

Retinal vascular occlusion after ocular surgery is a rare but serious complication. A history of cardiovascular diseases, retrobulbar anesthesia injection, high intraocular pressure during the perioperative period, and drug toxicity have been reported as possible causative factors. We report here two cases of multiple retinal vascular occlusions after the subconjunctival injection of gentamicin at the end of uncomplicated 25-gauge vitrectomy. Case 1 was a 61-year-old man who developed a macular hole in the right eye. Phacovitrectomy with gas tamponade was performed. On postoperative day (POD) 1, dot hemorrhage was observed on the temporal side of the optic disk. On POD10, macular whitening, retinal hemorrhage, and multiple occlusion of retinal arteries and veins were observed. Case 2 was a 51-year-old woman who was diagnosed with rhegmatogenous retinal detachment in the right eye and underwent phacovitrectomy with gas tamponade. On POD3, macular whitening with cotton wool spots and retinal hemorrhage were observed with macular ischemia owing to occlusion of retinal arteries and veins. In both cases, subconjunctival injection of gentamicin given at the end of surgery was the most suspected cause of retinal vascular occlusion., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)

This study was to investigate the choroidal vessels in eyes with central serous chorioretinopathy (CSC) quantitatively. We studied 41 CSC eyes and their fellow eyes, and 41 normal eyes of 41 age-adjusted individuals. En-face optical coherence tomography image of the top 25% slab of Haller's layer was analyze. The mean vessel area, vessel length, and vessel diameter were calculated. The running pattern of the vessels was quantified and used to determine the degree of symmetry, the "symmetry index". The vessel area of CSC eyes was not significantly different from that of fellow eyes but significantly larger than that of normal eyes. The vessel length of CSC eyes was not significantly different from fellow eyes but significantly shorter than that of normal eyes. The mean vessel diameter was larger in CSC eyes than in the fellow eyes and the normal eye. The symmetry index was not significantly different in CSC eyes from that of their fellow eyes but was smaller than that of normal eyes. The quantitative analysis showed that eyes with CSC had larger choroidal vessels and asymmetrical vessels running in Haller's layer.

Knowledgeof the choroidal structures in eyes with diabetes and diabetic retinopathy (DR) should provide information on the pathogenesis of DR. A prospective study was performed to determine the systemic and ocular factors that affect the choroidal structures in eyes with diabetes. Two-hundred consecutive diabetic subjects consisted of 160 treatment-naïve patients with different stages of DR and 40 patients with proliferative DR with prior panretinal photocoagulation (PRP). All underwent blood and urine tests and enhanced depth imaging optical coherence tomography (EDI-OCT). The cross-sectional EDI-OCT images of the subfoveal choroid were binarized to measure the total choroidal area (TCA), luminal area, and stromal area. Multivariate regression analyses were performed to determine the systemic and ocular factors that were significantly correlated with the choroidal structures. The subfoveal choroidal thickness, TCA, luminal area, and stromal area were larger at more advanced stage of DR, and smaller in eyes with PRP than those without (P < 0.001). The TCA and stromal area were significantly and positively correlated with the degree of albuminuria (P = 0.034, P = 0.025, respectively). The choroidal lumen and stroma may increase as the stages of DR progress and decrease after PRP. Albuminuria may be associated with the choroidal stromal edema.

Purpose: To evaluate the long-term outcome and safety of vitrectomy for the treatment of an idiopathic macular hole using indocyanine green (ICG) to peel the internal limiting membrane(ILM)., Subjects and Methods: By means of a retrospective study, we evaluated the outcomes of 56 eyes in 56 patients with an idiopathic macular hole who all underwent a primary vitrectomy with successful closure of macular hole. We compared the outcomes of 35 eyes in 35 patients who underwent a vitrectomy with ICG-assisted ILM peeling to those of 21 eyes in 21 patients who underwent the same procedure without ILM peeling. The main outcomes were compared between preoperative and postoperative visual acuities., Results: The periods to achieve the postoperative best visual acuity were 11.1 months in the ILM peeling group and 8.9 months in the non-ILM peeling group. However, there were no significant differences between the two groups regarding the postoperative best visual acuity and the final visual acuity. Complications related to ILM peeling with ICG were not found., Conclusion: These results support the safety of ILM peeling with ICG.

The three-dimensional (3-D) structure of human immunodeficiency virus type 2 (HIV-2) Vpr/Vpx was predicted by homology modeling based on the NMR structure of human immunodeficiency virus type 1 (HIV-1) Vpr. The three proteins similarly have three major amphipathic alpha-helices. In contrast to HIV-1 Vpr, Vpr/Vpx of HIV-2 have a long N-terminal loop and clustered prolines in the second half of the C-terminal loop. HIV-2 Vpx uniquely contains a long region between the second and third major helices, and bears several glycines in the first half of the C-terminal loop. Instead of the glycines, there is a group of hydrophilic amino acids and arginines in the corresponding regions of the two Vprs. To compare the cytopathogenic potentials of HIV-1 Vpr and HIV-2 Vpr/Vpx, we examined the production of luciferase as a marker of cell damage. We further analyzed the characteristics of cells transduced with vpr/vpx genes driven by an inducible promoter. The results obtained clearly show that structurally similar, but distinct, HIV Vpr/Vpx proteins are detrimental to target cells.

A total of 290 measurements of the size of the fetal liver in utero were made from 19 through 42 weeks of gestation. The right hepatic lobe circumference and area, considered to be the liver size, increased linearly with the advance of gestation. A statistical analysis of these results showed a highly significant correlation between liver size and gestational age (0.87, 0.77: p less than 0.001). The liver size also closely correlated with such growth parameters as biparietal diameter, femur length, and abdominal circumference (0.86, 0.76; 0.85, 0.76; 0.85, 0.73; p less than 0.001). When the liver size of normally grown fetuses was compared with that of growth-retarded fetuses, the liver of the growth-retarded fetuses was found to be significantly smaller (p less than 0.01). We conclude from this study that the measurement of fetal liver size aids in assessing the intrauterine growth of the fetus.

An accurate preoperative diagnosis of uterine adenomyosis is often difficult. We reviewed our experience with ultrasound evaluation of this pathological entity. Patients with histologically proven adenomyosis were studied to determine the usefulness of ultrasound for the preoperative diagnosis of this entity. In patients with adenomyosis, variable ultrasound patterns are seen, namely, enlargement of the uterus, irregular vesicular spaces within the myometrium, and an acoustically enhanced posterior wall of the uterus. However, leiomyoma had a similar echopattern. Based on five cases of histologically extensive adenomyoasis, an accurate diagnosis of adenomyosis proved feasible when ultrasonography showed all three ultrasonic patterns mentioned above, associated with a retroverted uterus or possible adhesions between the uterus and structures in close proximity, nodule or outgrowth in the region of the uterosacral ligaments or in combination, as frequently found in conjunction with external endometriosis. The ultrasonographical demonstration of endometrial cyst of the ovary may contribute to an accurate diagnosis of adenomyosis.

Fetal echocardiographic, electrocardiographic, and pulsed Doppler ultrasonic examinations were performed to detect congenital heart anomalies and fetal arrhythmias antenatally, from April 1980 to March 1985. In nineteen subjects, these techniques revealed premature atrial contractions (PAC) in five fetuses, PAC and blocked PAC in two, PAC and premature ventricular contraction (PVC) in one, PAC, blocked PAC and PVC in one, sinus bradycardia in one, congenital complete atrio-ventricular block in one, atrial septal defect with PAC and PVC in one, fetal unilateral hydronephrosis with PAC and PVC in one, complicated heart anomalies with dilated colon in one, single atrium and ventricle with esophageal and anal atresiae in one, complicated heart anomalies with encephalocele and single umbilical artery in one, and asymmetrical septal hypertrophy in one, antenatally. In nine out of fifteen cases with fetal arrhythmias, the arrhythmia resolved within the first month of life. Sustained arrhythmias occurred in three cases. In three cases with fetal arrhythmias, in utero therapies with Coenzyme Q10(CoQ10) were performed, and anti-arrhythmic effects of CoQ10 recognized. Deaths occurred in three cases with complicated heart anomalies.

Seventy-two continuous-wave Doppler ultrasonographic examinations were performed on nine nonpregnant and 56 normal pregnant women. The range of gestation was 6 to 40 weeks, and the objective was to record the renal arterial blood flow velocity waveform. Acceleration time and systolic per diastolic ratio of renal arterial blood flow velocity waveforms were assessed. Of 72 examinations, 68 recordings were made of the left renal artery (94.4%) and 28 of the right renal artery (38.9%), respectively. There was no correlation between acceleration time and systolic per diastolic ratio and gestational age, respectively, and no correlation between acceleration time and systolic per diastolic ratio, and caliceal diameter of the renal pelvis, respectively. Acceleration times of the left and right renal arteries were 47 +/- 11 and 40 +/- 8 msec in nonpregnant women and 62 +/- 23 and 62 +/- 23 msec in pregnant women, respectively. The left and right systolic per diastolic ratios were 3.1 +/- 0.7 and 2.9 +/- 0.5 in nonpregnant women and 2.8 +/- 0.6 and 2.6 +/- 0.5 in pregnant women, respectively. Therefore these data provide a foundation for the study of hydronephrosis, which may occur in pregnant women.

To differentiate pre-operatively between leiomyomata uteri and adenomyosis, we measured serum levels of an antigen (CA 125) common to most nonmucinous epithelial ovarian carcinoma in patients with benign uterine tumor (11 of leiomyomata uteri, 7 of adenomyosis and 1 of adenomyosis with leiomyomata uteri). CA 125 in serum samples pre and postoperatively were measured using an RIA Kit. The normal range of CA 125 levels was below 35U/ml. The mean CA 125 level (+/- S.D.) was 18.3 +/- 6.1U/ml in patients with leiomyomata uteri and 93.3 +/- 49.4U/ml in those with adenomyosis. Student's t-test showed a significant correlation (0.001 less than p less than 0.01). The mean CA 125 level in patients with adenomyosis was statistically higher than that in disease-free women. Among 7 patients with surgically demonstrable adenomyosis, the CA 125 values were over 35U/ml (87.5%). In all 11 patients with surgically demonstrable leiomyomata uteri, the CA 125 level was below 35U/ml. The CA 125 level in patients with adenomyosis gradually decreased postoperatively and in all was below 35U/ml up to one month postoperatively. Using this approach, leiomyomata uteri and adenomyosis can be differentiated, pre-operatively.

Ultrasound is an established method of confirming the presence of a hydatidiform mole in utero. However, in agreement with other investigations, we have often noted that the appearance of this entity is less specific than originally reported. To elucidate this, the ultrasonic patterns of 26 patients with trophoblastic disease and 27 with other entities were reviewed. Since there is a paucity of literature with regard to the response of choriocarcinoma to chemotherapy, determined by ultrasound, we simultaneously studied the relationship between findings of the ultrasonograms and the levels of hCG-beta-subunit in sera. We noted variable ultrasonic features in trophoblastic disease, and the sonograms of the choriocarcinoma have occasionally been confused with those of hydatidiform mole. If special attention is directed to the thickness of the placenta-like echoes as well as the sonolucent areas within it, the diagnosis of partial hydatidiform mole may be feasible. We also noted a rough correlation between ultrasonic appearances and the hCG-beta-subunit value, determined during chemotherapy for choriocarcinoma.

To determine whether or not the serum corticosteroid binding capacity (CBC) level is related to the outcome of pregnancy or fetal well-being, a total of 124 determinations of CBC were performed in 96 pregnant individuals, using hydrophobic resin adsorption methods. The serum CBC values were elevated with progression of gestation. On the other hand, high-risk pregnancies or those with an abnormal outcome were among the low CBC group, below the mean value (p less than 0.001), whereas normal pregnancies were more often in the high CBC group, over the mean value, in comparison with the low CBC group below the mean value (p less than 0.001), after 28 weeks of gestation. In addition, the ratios of birth weight/placental weight and maternal weight/placental weight were slightly but not statistically high in the low CBC group, in comparison with the high CBC group. Thus, various events related to placental growth might be important factors regulating the serum CBC level. While there are many determinants of corticosteroid binding globulin production and excretion, assessment of CBC levels seems to be a reliable indicator of the outcome of pregnancy, including high-risk pregnancy, in the 3rd trimester.