Current status of HTLV-1 carrier in Japanese pregnant women.

We examined the current status of human T-cell leukemia virus type 1 (HTLV-1) carrier in Japanese pregnant women, according to the results of HTLV-1 screening and confirmation tests of women who gave birth in Japan in 2011. We requested 2642 obstetrical facilities to provide information of HTLV-1 tests and 71.3% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of HTLV-1 carrier in Japanese pregnant women was estimated to be 1620 (0.16%) per year.

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.

Prolonged fetal bradycardia as the presenting clinical sign in congenital syphilis complicated by necrotizing funisitis: a case report.

Syphilis remains a serious cause of neonatal morbidity and mortality worldwide. In this paper, we describe a case of congenital syphilis that was fully supported by abnormal fetal heart rate patterns and placental histopathological evidence. A 24-year-old para 4 woman, who did not attend antenatal care, was admitted to our hospital with a complaint of abdominal discomfort at an estimated 31-week gestation. Fetal heart rate monitoring showed prolonged bradycardia. A neonate weighting 1,423 g with severe birth asphyxia was immediately delivered by cesarean section. Following delivery, the mother and the neonate were diagnosed with syphilis. Histopathological examination confirmed severe chorioamnionitis and necrotizing funisitis with numerous Treponema pallidum. Conclusions. Challenges in establishing the diagnosis of necrotizing funisitis are essential for optimal management of a fetus with a systemic inflammatory response in utero.

Postpartum maternal pneumococcal meningitis complicated by endocarditis.

Bacterial meningitis is associated with high morbidity and mortality. Few cases of pneumococcal meningitis during pregnancy and the postpartum period have been reported. We describe a case of postpartum pneumococcal meningitis complicated by endocarditis. A 26-year-old para-2 woman who had had a normal vaginal delivery at 38 weeks at a maternity home was transported to our hospital with a 39.5°C fever 11 days postpartum. Eight hours after her arrival, her state of consciousness deteriorated rapidly. Lumbar puncture revealed Gram-positive cocci consistent with Streptococcus pneumoniae. She was immediately treated with antibiotics and subsequently diagnosed with endocarditis. Final culture results from the blood and cerebrospinal fluid confirmed the presence of S. pneumoniae. She recovered completely with no evidence of neurological damage. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential to reducing the morbidity and mortality associated with bacterial meningitis.

A patient with diabetes and breast cancer in whom virilization was caused by a testosterone-producing mature cystic teratoma containing a Brenner tumor.

A 74-year-old woman with impaired glucose tolerance exhibited virilization. An examination of various hormone levels showed normal pituitary hormone and adrenal hormone levels. However, the patient's blood testosterone level was remarkably high and was suspected of having caused the virilization. An abdominal computed tomography revealed a multilocular cystoma in the left ovary with the features of a mature cystic teratoma. In addition, a chest computed tomography revealed the presence of a mass in the left breast that was subsequently diagnosed as breast cancer based on the results of a biopsy. After the simultaneous surgical resection of the ovarian and breast tumors, her blood testosterone level decreased. The mature cystic teratoma containing a Brenner tumor was considered to be responsible for the high testosterone level because of the presence of androgenic enzymes. This case is extremely rare, but the case was accurately diagnosed through a comprehensive analysis.

Antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease: a case report.

PURPOSE: Moyamoya (meaning a "hazy puff of smoke" in Japanese) disease is a rare cerebrovascular occlusive disease. Moyamoya disease may become symptomatic for the first time during pregnancy. We report a case of antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease, which was subsequently diagnosed as HELLP syndrome during the postpartum period. STUDY DESIGN: A case report of a 29-year-old Japanese primigravida who was transported to our hospital at 39 weeks of gestation because of sudden loss of consciousness and left hemiplegia. On arrival, her blood pressure was 143/94 mmHg with 1+ proteinuria by dipstick. Brain computed tomography revealed a right putaminal hemorrhage with intraventricular hemorrhage. The patient delivered a neonate by emergency cesarean section, and an intracranial hematoma was subsequently evacuated. Approximately 3 h postoperatively, she was diagnosed with HELLP syndrome and the following were initiated: IV magnesium sulfate, antihypertensive agents, and transfusion of 10 units of platelets. Angiographic findings were consistent with unilateral moyamoya disease. CONCLUSIONS: Moyamoya disease is a rare entity that must be considered in the differential diagnosis of hemorrhagic stroke during pregnancy. It is important to perform careful monitoring and adequate management with cooperation between obstetricians and other specialists when serious complications arise.

Hyalinizing spindle cell tumor with giant rosettes of the omentum.

We report the first case of a hyalinizing spindle cell tumor with giant rosettes of the omentum. The mesenchymal tumor arises from a multiplication of fibroblastic cells containing large rosette-like structures composed of a central collagen core surrounded by plump oval to spindle tumor cells. A 38-year-old woman exhibited the symptom of abdominal pain in the right side, with a correlated sensation of a mass in the same area. A tumor consisting of both solid and cystic cytologic features was subsequently diagnosed, on the right side of the uterus. Her serum level of CA-125 was only slightly elevated. Surgical intervention indicated that the tumor originated from lower pole of the omentum and the histological diagnosis was hyalinizing spindle cell tumor with giant rosettes. The metastatic potential of this type of tumor is considered similar to that of the metastatic low-grade fibromyxoid sarcoma, which indicated the need for careful clinical follow up of this case.