The vasopressin injection technique for laparoscopic excision of ovarian endometrioma: a technique to reduce the use of coagulation.

STUDY OBJECTIVE: To estimate the efficacy of the vasopressin injection technique for laparoscopic cystectomy of ovarian endometriomas with regard to operative time and coagulation events. DESIGN: Prospective study (Canadian Task Force Classification II-1) SETTING: Osaka Central Hospital in Osaka, Japan PATIENTS: Fifteen women with single lobular similarly-sized ovarian endometrioma. INTERVENTIONS: Women who planned to undergo laparoscopic cystectomy of endometrioma were allocated randomly to 3 groups: (1) ordinary laparoscopic cystectomy without injection, (2) laparoscopic cystectomy with the injection of saline solution, and (3) laparoscopic cystectomy with the vasopressin injection technique. MEASUREMENTS AND MAIN RESULTS: Reviewing the video, we counted the number of pinpoint bipolar coagulations on the normal ovarian cortex that were required from the beginning of stripping until hemostasis had been achieved, as well as the times required to achieve hemostasis. The group with the vasopressin injection technique required significantly fewer coagulation events (p=.041) to achieve hemostasis, as compared with the group receiving an ordinary cystectomy. CONCLUSION: The vasopressin injection technique reduces the use of coagulation, in such a way as to suggest the possibility to protect ovarian reserves.

Re-evaluation of the true rate of hepatitis C virus mother-to-child transmission and its novel risk factors based on our two prospective studies.

OBJECTIVE: To re-evaluate the true hepatitis C virus (HCV) mother-to-child transmission (MTCT) rate and its novel risk factors. STUDY DESIGN: A comparative study based on our own two prospective studies done during the two periods, 'early' (1989-1994) and 'recent' (1995-2004). RESULTS: All carrier infants became HCV RNA-positive within 3 months after birth. The MTCT and de-carrier rates were, respectively, higher (14.2%) and lower (16.7%) in the recent period, although liver dysfunction of carrier infants was found very frequently (66.7%) in both groups. MTCT occurred significantly when the maternal viral load, serum alanine aminotransferase (sALT) levels and blood loss at delivery were, respectively, more than 10(5) copies/mL, 110 IU/L, and 500 g. No MTCT was found when elective cesarean section was done. CONCLUSIONS: The true HCV MTCT and de-carrier rates were found to be much higher and lower than those reported previously. The maternal liver dysfunction (sALT >or=110 IU/mL) and blood loss (>or=500 g) at delivery are the next risk factors to maternal viral load (>or=10(5) copies/mL) for MTCT.

P16-immunostaining pattern as a predictive marker of lymph node metastasis and recurrence in early uterine cervical cancer.

OBJECTIVES: We investigated the relationship between P16-immunostaining patterns and clinicopathological factors in early uterine cervix cancers and assessed whether P16-immunostaining patterns predict the prognosis of the patients with early uterine cervix cancers. METHODS: Twenty-nine early squamous cell carcinoma (SCC) specimens of the uterus were examined using immunohistochemistry for P16 expression. The P16-immunostaining pattern was classified into two groups: the homogeneous type and the heterogeneous type. P16-immunostaining patterns were evaluated in different parts of the carcinoma in situ (CIS): the center of the tumor and the front interface of the infiltrating tumor. RESULTS: All specimens were of the homogeneous type in CIS. The P16-immunostaining pattern was significantly of the heterogeneous type in the front interface of the infiltrating tumor with lymphatic invasion, vascular invasion, lymph node metastasis, and recurrence. Regarding the P16-immunostaining patterns in the front interface of the infiltrating tumor, the patients with the heterogeneous type showed a significantly worse prognosis than the patients with the homogeneous type. CONCLUSIONS: The prognosis of patients with early uterine cervical SCC may be predicted by evaluating the P16-immunostaining pattern in the front interface of the infiltrating tumor.

A study of abnormal cervical cytology in pregnant women.

During the 4-year routing study of smears in 2,919 pregnant women, 33 cases of abnormalities of the uterine cervix were detected (1.13%). The patients were followed with uterine cervical cytology and colposcopy, and in case of need, sometimes punch biopsies were performed. As a result of the cytologies, 33 cases with abnormalities were detected. There were 26 cases classified as class IIIa and 7 cases were class IIIb. All cases underwent colposcopy. For the 17 cases that showed lesions by colposcopy, punch biopsies were performed. The results of histologic examination were wide: 5 chronic cervicitis, 1 condyloma, 1 mild dysplasia, 3 moderate dysplasia, 3 severe dysplasia, 3 carcinoma in situ, and 1 microinvasive carcinoma. Only two cases were treated during pregnancy, condyloma underwent Laser vaporization and microinvasive carcinoma underwent Loop electrosurgical excision procedure (LEEP) conization. Other cases were conservative treatment during pregnancy. Excluding one case for persistence smear class IIIa of histology condyloma, all the other cases with regression of dysplasia and carcinoma in situ with treatment after delivery. We conclude that lesions up to carcinoma in situ do not require intervention during pregnancy but microinvasive carcinoma is suspected, diagnostic LEEP conization is necessary, even during pregnancy.

A study of abnormal cervical cytology in pregnant women.

During the 4 year routine study of smears in 2,919 pregnant women, 33 cases of abnormals of the uterine cervix were detected (1.13%). The patients were followed with uterine cervical cytology and colposcopy and in case of need, sometimes punch biopsies were performed. The results of the cytologies, 33 cases with abnormalities were detected. There were 26 cases classified as class IIIa, 7 cases were class IIIb. All the cases underwent colposcopy. For the 17 cases that showed lesions by colposcopy, and punch biopsies were performed. The results of histologic examination were wide variety, five chronic cervicitis, one condyloma, one mild dysplasia, three moderate dysplasia, three severe dysplasia, three carcinoma in situ, and one microinvasive carcinoma. Only two cases were treated during pregnancy; one with condyloma underwent Laser vaporization and another with microinvasive carcinoma underwent LEEP conization. Other cases were given conservative treatment during pregnancy. Excluding one case for persistence smear class IIIa of histology condyloma, all the cases showed regression of dysplasia and carcinoma in situ with treatment after delivery. We conclude that lesions up to carcinoma in situ do not require intervention during pregnancy but microinvasive carcinoma is suspected, diagnostic LEEP conization is necessary, even during pregnancy.

Inhibitory effects of herbal drugs on the growth of human ovarian cancer cell lines through the induction of apoptosis.

OBJECTIVE: In order to develop and search for more effective and safe treatments for early and advanced stages of ovarian cancer, we examined the direct effects of four extracts of Chinese herbal drugs on ovarian cancer cells in vitro. METHODS: The growth inhibition of four herbal drugs on a total of six cell lines of human ovarian cancer cells was determined by a Cell Counting Kit-8 by counting viable cells. Apoptotic cells induced by herbal drugs were detected by using MEBCYTO Apoptosis Kit. All experiments were performed in triplicate. The significance of the difference was analyzed with a two-sided Student's t test. A P value less than 0.05 was accepted as statistically significant. RESULTS: The MN, A2780, and KF cell lines exhibited significant growth inhibition in the presence of Sho-saiko-to concentrations of 150 microg/ml, 300 microg/ml, and 500 microg/ml, respectively, and at the concentration of 1000 microg/ml, Sho-saiko-to demonstrated a significant apoptotic induction effect on all six kinds of ovarian cancer cell lines. This concentration is the same as the blood concentration attained when 7.5 g of Sho-saiko-to per day is orally administered and all absorbed. CONCLUSIONS: Sho-saiko-to exhibited significant growth inhibition of ovarian cancer cell lines, and the mechanisms of the inhibitory effects can be attributed, in part, to apoptosis induced by Sho-saiko-to.

Endometrial adenosquamous carcinoma with osteoclast-like giant cells: immunohistochemistry and histogenesis.

Primary extraskeletal epithelial neoplasms containing osteoclast-like giant cells (OGCs) are rare. We herein describe a case of adenosquamous carcinoma that developed in the endometrium together with non-neoplastic OGCs. The patient was a 72-year-old woman who underwent radical hysterectomy with salpingo-oophorectomy and lymph node dissection after being diagnosed with uterine cancer. Histologically, the tumor was found to be an adenosquamous carcinoma containing a large number of OGCs and mononuclear cells (MNCs) that had infiltrated into the stroma. Immunohistochemically, the OGCs and MNCs stained strongly positive for KP-1 and alpha-1-antichymotrypsin, and negative for the epithelial markers epithelial membrane antigen (EMA) and cytokeratins. These findings suggest that the OGCs and MNCs in this patient's tumor originated from monocytes/histiocytes, and most likely developed as part of the stromal reaction to the neoplasm.

Incarceration of the retroverted gravid uterus: the key to successful treatment.

INTRODUCTION: Incarceration of the retroverted gravid uterus is rare, and it is difficult to make a diagnosis, and, therefore, difficult to treat. We present two cases of incarceration of the retroverted gravid uterus. CASE REPORT: Two pregnant women presented with urinary retention at 14 weeks' gestation. We tried to push the gravid uterus upward, but in the end the two women underwent cesarean section. In one of the women it was possible to relieve incarceration of the retroverted gravid uterus. CONCLUSION: There was no sign of endometriosis in these pregnancies, which is important to evaluate when pregnant women have a complication.

PTEN and p53 abnormalities are indicative and predictive factors for endometrial carcinoma.

PTEN (phosphatase and tensin homologue deleted on chromosome 10) and p53 alterations were expected to be diversely involved in endometrial carcinogenesis. Patients (n=92) with endometrial carcinoma (EC) were analyzed, and PTEN and p53 were immunostained in the tissue sections. Tumor histology, grade of differentiation, presence of endometrial hyperplasia, staining status of PTEN and p53 and clinical information were examined. There were 37 cases (40%) negative for PTEN staining, which suggests lost or reduced PTEN function. Loss of PTEN staining was significantly related to the advanced staging in the grade 1 (G1) and grade 2 (G2) endometrioid adenocarcinoma group (p=0.026). Also, 18 cases (20%) showed positive staining for p53. p53 staining was largely found in grade 3 (G3) endometrioid adenocarcinoma and other phenotypes of EC. In the G1 and G2 group, all 29 cases with reduced PTEN staining showed p53-negative staining (p=0.025). In the G3 and others group, 6 of 8 cases with reduced PTEN staining showed p53-positive staining. p53-positive staining was associated with a high probability of tumor recurrence in the G1 and G2 group (p=0.0234). In contrast, in the G3 and others group, p53-positive cases had a low probability of tumor recurrence (p=0.0473). Both PTEN and p53 staining may be good indicators of clinical stage and probability of tumor recurrence in EC. Reciprocal abnormality of p53 or PTEN occurred at an early phase of carcinogenesis, however simultaneous abnormality of p53 and PTEN often occurred at the a late phase of carcinogenesis. Thus, immunohistochemistry for PTEN and p53 in biopsy specimens of EC can provide supportive information for determining a treatment plan.