Magnetic resonance imaging findings of a myxoid leiomyosarcoma of the uterus: A case report and literature review.

Uterine myxoid leiomyosarcomas (MLMSs) are extremely rare. Here, we report a rare case of uterine MLMS with unique and bizarre magnetic resonance imaging (MRI) findings on diffusion-weighted images (DWIs) and dynamic contrast-enhanced (DCE) MRI scans. A 67-year-old woman presented with a uterine MLMS that had a multilocular cystic mass with a septum and solid components. The tumour demonstrated marked hyperintensity on T2-weighted images in a myxoid stroma with gradual partial contrast enhancement and diffusion restriction, which could be a characteristic feature suggestive of a myxoid malignant smooth muscle tumour of the uterus rather than a uterine leiomyoma with myxoid degeneration.

Ratio of fetal anteroposterior to transverse cerebellar diameter for detection of the cerebellar hypoplasia in the second trimester and comparison with trisomy 18.

AIM: Cerebellar hypoplasia, particularly, trisomy 18, represents a chromosomal abnormality. However, morphological assessment of the fetal cerebellum is yet to be established. The purpose of this study was to produce reference values for the fetal transverse cerebellar diameter (TCD), anteroposterior cerebellar diameter (APCD) and the ratio of APCD to TCD (APCD/TCD ratio) in normal fetuses, compared with cases of trisomy 18. METHODS: This retrospective study included 266 normal singleton pregnancies resulting in term delivery at our institution from 2012-2013. Patients had received ultrasound examinations in the second trimester. TCD and APCD measurements were performed and then APCD/TCD ratio was calculated. Consequently, three cases of trisomy 18 were compared with reference values. RESULTS: Gestational age correlated with TCD (rs = 0.766, P < 0.0001) and APCD (rs = 0.61, P < 0.0001), but not with APCD/TCD ratio (rs = 0.070, P = 0.252). The median APCD/TCD ratio was 0.52 and the standard deviation was 0.05. In cases of trisomy 18, all TCD measurements were located within normal ranges. In contrast, both the APCD and APCD/ TCD ratio displayed lower values than that of normal fetuses. CONCLUSIONS: This study showed that not only TCD but also APCD correlated with gestational age, and APCD/TCD ratio indicated a fixed value (almost 0.5) in normal fetuses. Furthermore, APCD and APCD/TCD ratio were deemed useful indicators for cerebellar hypoplasia. In particular, the APCD/TCD ratio proved more convenient, without requiring individual evaluation of TCD and APCD.

Experience of fetoscopic laser photocoagulation and cord transection for twin-reversed arterial perfusion sequence.

AIM: The purpose of this study was to evaluate the usefulness of fetoscopic laser photocoagulation of placental communicating vessels or umbilical cord for twin-reversed arterial perfusion (TRAP) sequence. MATERIAL AND METHODS: We report a retrospective case series of all cases of TRAP sequence identified from 2006 to 2014 at out institutions. Fetoscopic laser photocoagulation of placental arterioarterial and venovenous anastomoses was performed in diamniotic twins, and in cases of monoamniotic twins we performed laser photocoagulation and transection of the umbilical cord of the acardiac twin to prevent cord entanglement. Pregnancy and perinatal outcomes were estimated. RESULTS: Ten cases were included in the study. The median gestational age at procedure was 21.3 weeks (range, 16.7-27.3 weeks). All cases completed the procedure. Two cases were treated with laser photocoagulation and transection of the umbilical cord of the acardiac twin. No major immediate complications were noted. Preterm rupture of membranes occurred in four cases (40%). One case resulted in miscarriage. The other fetuses were delivered alive. Median gestational age at delivery was 35.4 weeks (range, 25.6-42.0 weeks). Median interval of treatment to delivery was 85 days (range, 43-153 days). Five out four infants were delivered preterm. The overall neonatal survival was 9/10. CONCLUSION: This case series demonstrated favorable outcome, and fetoscopic laser photocoagulation seems to be a useful treatment for TRAP sequence. In particular, transection of the umbilical cord is effective to prevent cord entanglement of monoamniotic twins.

Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai Gynecology Study Group.

BACKGROUND: The therapeutic value of systematic lymphadenectomy for early-stage epithelial ovarian cancer (EOC) is controversial. This study evaluates the survival impact and adverse events of systematic pelvic and para-aortic lymphadenectomy in patients with pT1 and pT2 EOC. METHODS: A retrospective investigation was performed using data from patients with pT1 and pT2 EOC at multi-institutions belonging to the Sankai Gynecologic Study Group (SGSG). We selected patients who had undergone systematic pelvic and para-aortic lymphadenectomy (Group LA) (n = 284) and patients who had not undergone lymph node resection (Group no-LA) (n = 138). Outcomes for patients and peri-operative adverse events were compared between the two groups. RESULTS: The median operation time was significantly longer in Group LA (288 min) than in Group no-LA (128 min) (P < 0.0001). Total blood loss was significantly higher in Group LA, 43.7 % of patients receiving blood transfusions. There were no significant differences between the treatment groups for progression-free survival (PFS) or overall survival (OS). However, for patients with pT2, PFS was significantly longer in Group LA than in Group no-LA (P = 0.0150). Lymph node metastases were detected in 23 cases (8.1 %) and these patients had significantly shorter PFS than those without metastasis (P = 0.0409). The outcome for patients who underwent chemotherapy after surgery was significantly improved in the Group no-LA, but no improvement was observed in Group LA. CONCLUSIONS: Systematic lymphadenectomy may improve outcomes only in pT2 EOC patients with acceptable peri-operative events. Furthermore, accurate surgical staging may avoid unnecessary adjuvant chemotherapy in selected early-stage cases.

Guidelines for office gynecology in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists 2011 edition.

Gynecology in the office setting is developing worldwide. Clinical guidelines for office gynecology were first published by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists in 2011. These guidelines include a total of 72 clinical questions covering four areas (Infectious disease, Malignancies and benign tumors, Endocrinology and infertility, and Healthcare for women). These clinical questions were followed by several answers, backgrounds, explanations and references covering common problems and questions encountered in office gynecology. Each answer with a recommendation level of A, B or C has been prepared based principally on evidence or consensus among Japanese gynecologists.These guidelines would promote a better understanding of the current standard care practices for gynecologic outpatients in Japan.

[Clinical study of levofloxacin 500 mg qd in the treatment of cervicitis and intrauterine infections caused by Chlamydia trachomatis].

The clinical efficacy and safety of levofloxacin (LVFX) 500mg qd were evaluated in female patients with cervicitis with Chlamydia trachomatis and intrauterine infections. LVFX was administered orally at 500 mg qd for 7 days. Bacteriological efficacy was 94.4% (17/18) and clinical efficacy was 100% (16/16) at 14 to 21 days after the end of treatment in cervicitis. On the other hand, bacteriological efficacy and clinical efficacy at the end of treatment in intrauterine infections were 68.8% (11/16) and 94.7% (18/19), respectively. For safety, adverse drug reactions occurred in 9 of 43 patients (20.9%), i.e., increased y-GTP in 2 patients, glucose urine present in 2, and each of all other adverse reactions occurred in 1. All adverse drug reactions observed were either mild or moderate. Results suggested that LVFX 500 mg qd was effective and safe in the treatment of cervicitis with Chlamydia trachomatis and intrauterine infections.

Epidemiology of Chlamydophila caviae-like Chlamydia isolated from urethra and uterine cervix.

In 2000, chlamydial strains OK133 and OK135 were isolated from 2 female patients with cervicitis. These strains were unresponsive to commercially available PCR and LCR test kits for the diagnosis of Chlamydia trachomatis infection, and their phenotypic characteristics were very similar. The OK135 nucleotide sequence in MOMP-VD2 gene closely resembled that of Chlamydophila caviae GPIC. A similar strain was isolated in 2003 from a male patient OKM2 with urethritis, from which the strain SC10-6 was cloned by the plaque purification method. The nucleotide sequence of the entire MOMP gene of SC10-6 was exactly the same as that of OK135. Thus, the strains OK135 and SC10-6, together with OK133, have been called C. caviae-like Chlamydia. We designed primers for nested PCR assay, the product of which showed a single-band 311-bp fragment, to detect C. caviae-like Chlamydia. Of swab specimens obtained from 202 patients from 2003 to 2006 (119 male and 83 female patients), 18 specimens (8.9%) from 14 male and 4 female patients were positive, suggesting that C. caviae-like Chlamydia infection is rather common. Thus far, it has not been determined whether C. caviae-like Chlamydia is pathogenic for humans.

[Efficacy of tosufloxacin in genital chlamydial infections].

According to the 2006 and 2008 "Guidelines for diagnosis and treatment of sexually transmitted diseases" by the Japanese Society for Sexually Transmitted Diseases, quinolones, macrolides and tetracyclines are recommended to treat chlamydial infections. The administration method based on pharmacokinetic/pharmacodynamic theory, as well as the selection of antimicrobial drugs, is important in antimicrobial therapy. It is currently assumed that the efficacy of administering high-dose quinolones once a day is greater than dividing the dose over multiple administrations. To verify the treatment effects of the recommended tosufloxacin dose of 150 mg b.i.d. (300 mg/day) for 7 days, we performed a comparative multicenter open label study of 150 mg b.i.d. and 300 mg q.d. (300 mg/day). The results indicated complete efficacy with 100% (150 mg b.i.d.: 49/49, 300 mg q.d.: 57/57) eradication of Chlamydia trachomatis at both dosages. The clinical efficacy was "markedly effective" in 57.1% (28/49) of cases, "effective" in 42.9% (21/49), and "not effective" in 0% (0/49) in the 150 mg b.i.d. group, while these values were 59.6% (34/57), 40.4% (23/57) and 0% (0/57), respectively, in the 300 mg q.d. group. Quinolone therapy for genital chlamydial infections with tosufloxacin doses of 150 mg b.i.d. was confirmed to be effective as recommended in the guidelines. Moreover, tosufloxacin at 300 mg q.d. was shown to be an effective therapy.

[Evaluation of the new nucleic acid amplification system for direct detection of Chlamydia trachomatis and Neisseria gonorrhoeae in women].

The performance of a real-time DNA amplification assay, BD ProbeTec ET System (BDPT, BD Diagnostic Systems), to detect Chlamydia trachomatis and Neisseria gonorrhoeae on endocervical and oropharyngeal samples was evaluated. After obtaining informed consent, 364 endocervical, 363 urine and 247 oropharyngeal specimens were collected from 307 cases. The overall agreement rate of the BDPT and Amplicor (AMP, Roche) assays for the detection of C. trachomatis and N. gonorrhoeae in endocervical samples was 99.2% (361/364) for C. trachomatis and 99.5% (362/364) for N. gonorrhoeae. Assay of oropharyngeal swabs by the BDPT yielded 21 C. trachomatis positives, and 19 of them were C. trachomatis negative by the DNA probe assay (Gen-Probe PACE). The AMP assay showed that 16/19 (84.2%) of the BDPT +/DNA probe - samples were positive. The BDPT also yielded 21 N. gonorrhoeae positives, 15 of which were negative with the DNA probe. Additional testing showed that all 15 BDPT +/DNA probe - samples were positive by the established nested PCR method. Our data suggest that the performance of the BDPT is comparable to that of AMP for detection of C. trachomatis and N. gonorrhoeae in endocervical swab samples and that it may be a useful method for detecting of C. trachomatis and N. gonorrhoeae in oropharyngeal samples clinically.

A feasibility study on biweekly administration of docetaxel for patients with recurrent ovarian cancer.

OBJECTIVE: A recent study demonstrated that docetaxel (DTX) was an effective agent for second line chemotherapy against ovarian cancer. Weekly administration of taxane compounds had been more effective compared with a 3 week interval administration in ovarian cancer. The role of biweekly administration of DTX has been unknown. We conducted a dose determination and feasibility study of biweekly DTX administration in patients with ovarian cancer. METHODS: Patients with histologically confirmed epithelial ovarian cancer who received one or more regimens of prior chemotherapy with more than 4 weeks of treatment-free interval were eligible. DTX was administered as 1-h intravenous infusion every two weeks for at least four courses. The starting dose was 40 mg/m(2) (level 1) and the dose was escalated to 50 mg/m(2) (level 2) and 60 mg/m(2) (level 3) in consequent patient cohorts. RESULTS: Nine patients were examined in this study. The treatments were completely performed in all cohorts. Mean treatment delay ranged from 0 to 2.0 days. Dose level did not affect treatment delay. At the first dose level, no patients experienced grade 3/4 neutropenia. Two patients in level 2 experienced grade 3/4 neutropenia. In level 3, all patients had grade 4 neutropenia. Nonhematologic toxicities were tolerable. Of eight patients with measurable disease, all patients in level 1 showed progressive disease, and all patients in level 2 were no-change. There were two responders showing complete response and partial response and one case was no-change in level 3. CONCLUSION: The present study showed that biweekly administration of 60 mg/m(2) DTX was feasible for recurrent ovarian cancer.