Platelet aggregation response and adenosine triphosphate secretion after abdominal total hysterectomy.

This study was designed to clarify the quantitative relationship between platelet aggregation and the secretion of adenosine triphosphate (ATP) after surgery. Peripheral blood was collected from 41 patients who underwent abdominal total hysterectomy. Platelet count, volume, aggregation and the amount of secreted ATP were determined using live platelets before, one day after and two weeks after surgery. Platelet aggregation and ATP secretion were investigated using a lumi-aggregometer. The aggregating reagents used were 5 microM of adenosine diphosphate (ADP) (final concentration) and 5 microg/ml of collagen. Structural alterations of platelets at these time points were also investigated by electron microscopy. Platelet aggregation induced by collagen was significantly lower (p<0.05) one day after surgery. ADP-induced aggregation two weeks after surgery was more intense than before (p<0.05) and one day after (p<0.05) surgery. The amount of secreted ATP induced by each of ADP and collagen was significantly lower (p<0.05-0.01) one day after surgery and correlation coefficients between platelet aggregation and secretion of ATP showed lower values in both ADP- and collagen-induced aggregation. One day after surgery electron microscopy showed that granule concentrations were markedly reduced in platelets. In conclusion, after consumption of circulating platelets at the site of operation, in addition to being lost by bleeding, the remaining platelets in circulation consist of platelet subpopulations different from those present before surgery, exhibiting low values of correlation coefficients between platelet aggregation and secretion of ATP and low concentrations of granules.

Mature adrenomedullin concentrations in plasma during pregnancy.

OBJECTIVE: Adrenomedullin is a novel peptide that exerts a potent, dose-dependent and long-lasting hypotensive effect. In human plasma, adrenomedullin consists of two molecular forms: mature and immature. Immature adrenomedullin is much less bioactive than mature adrenomedullin. Although a gradual increase in plasma adrenomedullin has been reportedly observed as pregnancy progressed, mature adrenomedullin has not been examined. The aim of this study was to elucidate the plasma level of mature adrenomedullin in pregnant women. METHODS: We measured the concentrations of mature adrenomedullin in ten pregnant women in the first trimester, ten pregnant women in the third trimester, and ten non-pregnant controls with the immunoradiometric assay. RESULTS: The mean concentration of mature adrenomedullin was significantly increased in pregnant women in the first trimester compared to age-matched non-pregnant subjects (p < 0.05). The mean concentration of mature adrenomedullin was significantly increased in pregnant women in the third trimester compared with pregnant women in the first trimester (p < 0.005). CONCLUSION: Our study demonstrated that concentrations of mature adrenomedullin were elevated in pregnant women compared with non-pregnant women and its concentration in the third trimester was significantly higher than that in the first trimester.

Successful pregnancy following gonadotropin therapy in a patient with hypogonadotropic hypogonadism resulting from craniopharyngioma.

The authors report a rare case of a patient with panhypopituitarism who became pregnant by gonadotropin therapy and gave birth to a healthy baby. A brain tumour and/or the surgical resection of a brain tumour occasionally results in pituitary dysfunction. An 18-year-old Japanese patient developed hypogonadotropic secondary amenorrhoea because of a craniopharyngioma, which was surgically removed. The patient came to us, and peripheral blood was collected every 15 minutes for four hours. The levels of luteinising hormone (LH) and follicle-stimulating hormone (FSH) were measured. Results showed that LH and FSH levels were very low and did not fluctuate. Several years later, the patient complained of infertility, and treatment with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) was started. The therapy was repeated for several cycles, but she did not conceive, so hMG-hCG therapy combined with conjugated oestrogen administration was started. The patient became pregnant at the seventh cycle of this combined therapy. She was not treated with supplementary growth hormone.

CD26 and CD30 expression on the surface of lymphocyte during normal pregnancy.

It is increasingly apparent that the Th1/Th2 cell ratio is decreased during pregnancy. In a previous study, we revealed that combined analysis of soluble CD26 and CD30 might be a potent surrogate tool for evaluating the Th1/Th2 balance during pregnancy. Therefore, in the present study, we elucidated whether the CD26 and CD30 expression on the surface of lymphocyte is useful marker for Th1 and Th2 lymphocytes, respectively, during pregnancy with flow cytometric technique. The peripheral blood samples were obtained from 6 non-pregnant healthy women, 8 healthy pregnant women in the first trimester and 12 pregnant women in the third trimester. The mean percentages of CD26 expression did not differ significantly among these groups (p = 0.45). Also, the mean percentages of CD30 expression did not differ significantly among these groups (p = 0.32). From the present study, the expression of CD26 and CD30 did not appear to be a useful marker for Th1 and Th2 lymphocytes during pregnancy.

Increased excretion of N-acetyl-beta-D-glucosaminidase and beta2-microglobulin in gestational week 30.

BACKGROUND: Little is known about when the urinary excretion of a combination of N-acetyl-beta-D-glucosaminidase (NAG) and beta2-microglobulin (beta2MG) concentration [relative to creatinine (Cr)] reaches maximal values during uncomplicated normotensive pregnancy. This study was thus designed to analyze when urinary excretion of biochemical parameters was increased during normotensive pregnancy. METHODS: NAG, beta2MG, total protein, albumin, and Cr were simultaneously measured in random (untimed) midstream urine samples from 22 healthy nonpregnant women and from 82 normotensive pregnant women (22 in gestational week 20, 25 in week 30, and 35 in week 37). RESULTS: NAG/Cr and beta2MG/Cr ratios were significantly higher (P < 0.01-0.05) in the normotensive pregnant women in gestational week 30 than in the nonpregnant control subjects and normotensive pregnant women in gestational week 20. The NAG/Cr and beta2MG/Cr ratios showed maximal values in gestational week 30. The total protein/Cr ratio was significantly higher in gestational weeks 20, 30, and 37 than in the control subjects. The albumin/Cr ratio was significantly higher in women in gestational week 30 and 37 than in women in gestational week 20 and in the control subjects. CONCLUSIONS: The excretion of both NAG and beta2MG relative to Cr was increased and showed the maximal values in gestational week 30 during normotensive pregnancy. The increase in a tubular enzyme (NAG) might be caused by renal tubular damage, and that in a low molecular weight protein (beta2MG) might result from decreased renal tubular reabsorption. These findings suggest that renal tubular damage and reabsorption dysfunction were increased in gestational week 30.

Plasma levels of soluble Fas during normal pregnancy.

The Fas/Fas ligand system could reportedly help to identify a mechanism for maternal immunotolerance of the fetus in human pregnancy. However, there are few reports on soluble Fas (sFas) which is an inhibitor of apoptosis during normal pregnancy. Therefore, ascertaining plasma sFas levels during pregnancy would be of interest. The subjects studied were 10 nonpregnant healthy women and 20 healthy pregnant women in the first and third trimester with singleton gestations. The plasma sFas was measured by sandwich enzyme-linked immunosorbent assay. The mean concentration of sFas was significantly decreased in normal pregnant women in the first trimester compared to age-matched control subjects, and it did not differ significantly between normal pregnant women in the third trimester and age-matched control subjects. From these results, we presume that the decreased plasma sFas plays an important role in maternal immunotolerance in the first trimester of pregnancy.

Changes in plasma soluble CD26 and CD30 during pregnancy: markers of Th1/Th2 balance?

The theory that the Th1 and Th2 cell ratio shifts towards Th2 dominance during pregnancy may improve fetal survival has gained support from recent studies. Also, the variation in the Th1/Th2 cell ratio is reportedly associated with intrauterine growth retardation and preeclampsia. On the basis of these findings, the analysis of the Th1/Th2 balance may be useful in predicting severe complications during pregnancy. However, simple methods for the analysis of Th1/Th2 balance are presently not available. Recently, it has been reported that regulation of CD26 cell surface expression correlates with the production of Th1-like cytokines. On the other hand, previous studies proposed that the sCD30 molecule is an activation marker useful for evaluation of a Th2 immune response. It is, therefore, possible that the analysis of the Th1/Th2 balance during pregnancy by measuring plasma sCD26 and sCD30 simultaneously is a simple and useful method. We herein demonstrate that combined analysis of sCD26 and sCD30 is a potent surrogate tool to evaluate the Th1/Th2 balance during pregnancy.

Osteochondroma of the pubic symphysis associated with sexual disturbance.

Osteochondroma of the pubic symphysis is a rare benign skeletal tumor. We report here a case of an osteochondroma of the pubic symphysis associated with a sexual disturbance, where a computed tomography scan clearly showed a tumor lesion of the pubic symphysis. The case is reported not only because of its rarity but also because it is important that gynecologists should bear this disease in mind, since a patient with this tumor may not visit an orthopedist but a gynecologist.

Primary small cell neuroendocrine carcinoma of the vagina. Marked effect of combination chemotherapy: a case report.

Primary small cell neuroendocrine carcinoma of the vagina is extremely rare and very aggressive. Nineteen patients with this cancer have been reported in the English-language literature to date. We report a 51-year-old woman with this cancer. Punch biopsy specimens of the vaginal tumor were studied. Electron microscopy demonstrated neuroendocrine granules in the cytoplasm. Tumor cells were strongly stained for cytokeratin, neuron-specific enolase, chromogranin A and serotonin. These findings were consistent with small cell neuroendocrine carcinoma. The patient was treated with combination chemotherapy. The cancer mass completely disappeared after five cycles of the therapy. The patient is still alive without metastasis 41 months after diagnosis. This is the first report of such a remarkable effect of combination chemotherapy on small cell neuroendocrine carcinoma of the vagina.

Regulation of dosage of conjugated equine estrogen is useful for add-back therapy.

In the hormonal treatment of uterine myomas, which are estrogen dependent, GnRH agonist (GnRHa) therapy has become widespread. However, the severe hypo-estrogenic state induced by the GnRHa gives rise to annoying side effects. Although the risk of these side effects may be reportedly modified when GnRHa is combined with estrogen (add-back therapy), it is difficult to target serum estradiol (E2) concentration to stay within the therapeutic window (20 approximately 50 pg/mL) by administering 0.625 mg conjugated equine estrogen (CEE)/day. Also, there is great individual variation in the circulating E2 concentration by administering the same dosage of CEE. Therefore, the use of smaller quantities of CEE in different dosages may approximate more closely to the clinical situation. This article focuses on the methods of administration of CEE combined with GnRHa for women with symptomatic uterine myomas.