Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression.

A multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%, respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.

Post-partum maternity 'blues' as a reflection of newborn nursing care in Japan.

OBJECTIVES: To investigate the prevalence of post-partum 'blues' in mothers whose babies are cared for in a newborn nursery, compared with mothers providing rooming-in care. METHODS: Japanese normal primiparous women were prospectively studied from 1998 to 1999. The newborns of these mothers were managed in the newborn nursery or by rooming-in care. To diagnose maternity 'blues' and 'depression', the Stein's Questionnaire and the Edinburgh Postnatal Depression Scale were used. RESULTS: Ninety-seven and 93 women were managed by newborn nursery care and by rooming-in care, respectively. Of these women, a total of 181 women were considered for analysis. 'Blues' was noted in 31 of 92 mothers (33.7%) receiving newborn nursery care and in 18 of 89 (20.2%) receiving rooming-in care with a significant difference (P<0.05), and in 49 of 181 (27.1%) as a whole. The daily Stein's scores changed significantly during the 10 days post-partum in each group (P<0.0001). Post-partum 'depression' was observed in three mothers (3.4%) in the newborn nursery care group and in four (4.8%) of the rooming-in care group, not a significant difference, and in seven (4.1%) as a whole. CONCLUSION: Maternity 'blues' is experienced by 25% or more of Japanese primiparous women delivering healthy babies via uncomplicated delivery. The system of newborn nursery infant care may be a potential causal factor for maternity 'blues', although it should be confirmed by a prospective randomized trial.

Clearance of antiphospholipid antibodies in pregnancies treated with heparin.

OBJECTIVE: To describe the natural history of serum antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) in pregnant women treated with heparin, and to identify a possible association between changes in antibody status and outcomes of subsequent pregnancies. METHODS: Thirty-six women with antiphospholipid antibodies who had three or more repeated miscarriages were enrolled. Intravenous heparin was used for each of the first pregnancies after referral. Changes in antibody status were investigated with relation to outcomes of the index and subsequent pregnancies. RESULTS: Eighteen of 23 pregnancies in 36 antibody-positive women treated with heparin resulted in term or preterm deliveries with live-born infants, and five ended in abortions. Antibodies cleared in ten of 12 term pregnancies, in five of six preterm pregnancies, and in one of five abortions. There was a statistically significant difference between the term pregnancy and abortion groups (P <.05). Eleven second and third pregnancies in nine women in whom antibodies cleared resulted in term or preterm deliveries of live-born infants, without heparin therapy. The second and third pregnancies in one woman whose antibodies persisted ended in miscarriages despite repeated heparin administration. CONCLUSION: Antiphospholipid antibodies cleared spontaneously in some pregnant women treated with heparin. Subsequent pregnancies among women in whom antibodies cleared were managed successfully without medication, whereas pregnancies in women with persistent antibodies required treatment.

Treatment of malignant ovarian germ cell tumors with preservation of fertility: reproductive performance after persistent remission.

To describe our experience with malignant ovarian germ cell tumors with special reference to reproductive performance after remission, medical records of 31 patients were reviewed. The mean age at diagnosis was 18.6 years. Tumor by stage was I in 16 cases, II in 5, III in 5, IV in 3, and recurrence in 2. Histology was dysgerminoma in 7 cases, yolk sac tumor in 10, immature teratoma in 7, choriocarcinoma in 1, and mixed-type tumor in 6. Conservative surgery for fertility preservation was performed in 21 cases. Postoperative chemotherapy was given to all cases except two with stage Ia dysgerminoma. Of 31 cases, 4 including one fertility-preserved case died of disease. The other 27 cases including 20 fertility-preserved cases were successfully treated. Twenty-five cases (92.6%) have been followed longer than 60 months and 13 cases (48.1%) longer than 120 months. By the last follow-up, 8 of the 20 fertility-preserved cases delivered a total of 9 normal babies. Of the remaining 12 nonpregnant cases, 3 married, 9 have had regular menses, and 3 have had menstrual problems. Two of the latter three cases have been in hypergonadotropic anovulatory cycles. One patient has been diagnosed with tubal infertility caused by peritubal adhesion. Thus, management of the disease with fertility preservation is safe and the majority of patients can attain or retain normal ovarian function and reproductive potential.

Tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) for uterine cervical cancer treated with irradiation.

PURPOSE: To evaluate the prognostic value of tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) in patients with uterine cervical cancer treated with radiation therapy. METHODS AND MATERIALS: Forty-four patients with intact uterine cervical squamous carcinoma treated with a combination of external irradiation and high-dose-rate intracavitary therapy were analyzed. Actuarial disease-free survival (DFS), pelvic control rate (PC), and distant metastasis-free rate (DMF) were analyzed by tumor diameter, volume, and pelvic node status assessed by pretreatment MRI. RESULTS: Anteroposterior (AP) and lateral (RL) tumor diameter significantly affected DFS. The 2-year DFS was 74% for patients with < 40 mm in AP diameter tumor, and 24% for > or = 40 mm tumor (p = 0.02). Whereas PC was not influenced, DMF was significantly affected by AP tumor diameter. Tumor volume did not significantly affect any endpoints. Patients with enlarged pelvic nodes had significantly poorer outcome compared to those with none on PC, DMF, and DFS. The 2-year DFS was 78% for node-negative, and 10% for node-positive patients (p = 0.0001). CONCLUSION: AP tumor diameter and pelvic lymph node status assessed by MRI were the significant prognostic factors in uterine cervical cancer treated with irradiation. Prognostic value of tumor volume should be reassessed prospectively with an appropriate imaging technique. AP tumor diameter predominantly affected the incidence of distant metastasis, and lymph node status affected both pelvic control and distant metastasis.

Therapeutic value of neoadjuvant intra-arterial chemotherapy (cisplatin) and irradiation for locally advanced uterine cervical cancer.

We analyzed long-term treatment results in 51 patients with locally advanced uterine cervical carcinoma (IIB, 4; IIIB, 43; IVA, 4) treated with neoadjuvant intra-arterial (I-A) chemotherapy (cisplatin) via the uterine artery and irradiation. Thirty patients (58.8%) developed recurrence. Twelve had pelvic recurrence alone, 8 had distant metastases alone, and 10 had both pelvic and distant failure. The 5-year cumulative pelvic control rate, absolute survival rate, and disease-free survival rate were 55.3, 47.1, and 39.4%, respectively. Eight of 51 patients (15.7%) suffered late complications. These results suggest that our neoadjuvant I-A chemotherapy prior to irradiation has limited additional value for long-term prognosis in patients with locally advanced uterine cervical carcinoma.

Intra-arterial chemotherapy with cisplatin followed by radical radiotherapy for locally advanced cervical cancer.

Locally advanced cervical cancer has a dismal prognosis, with a high local failure rate and a poor survival rate. To improve the cure rate for advanced carcinoma of the cervix, we initiated a study of intra-arterial (I-A) chemotherapy with cisplatin via the uterine artery prior to definitive radiotherapy. I-A chemotherapy via the internal iliac artery has been used to treat advanced cervical cancer; however, access by way of the uterine artery has not been tested for this purpose. Thirty-four patients with central tumor > or = 5 cm in anteroposterior diameter observed on CT scans were treated with I-A chemotherapy. I-A chemotherapy consisted of unilateral catheterization of the uterine artery using 120 mg/m2 cisplatin. After assessment of I-A chemotherapy, all but 3 patients were treated with a combination of whole-pelvis external irradiation and intracavitary irradiation. The 3 patients underwent external radiotherapy alone. Twenty-seven of 34 patients treated were evaluable for response to I-A chemotherapy. Eleven patients (41%) experienced a partial response. Seventy-six percent of the 34 patients treated with I-A chemotherapy followed by radiotherapy exhibited a complete response by the end of treatment. Toxicity was well tolerated and no death due to treatment occurred. The 2- and 5-year actuarial survival rates were 64 and 55%, respectively. The crude incidences of pelvic recurrence and distant metastasis observed at a median follow-up of 54 months were both 47%. This study for locally advanced cervical cancer suggests there is benefit to be derived from our I-A chemotherapy followed by radical radiotherapy.

Prognostic value of cervical size and pelvic lymph node status assessed by computed tomography for patients with uterine cervical cancer treated by radical radiation therapy.

PURPOSE: To determine the prognostic impact of cervical size and pelvic lymph node status assessed by computed tomography (CT) in uterine cervical carcinoma treated with irradiation alone. METHODS AND MATERIALS: Seventy patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB and IIIB uterine cervical squamous cell carcinoma treated with a combination of external and high dose-rate intracavitary irradiation were entered into analyses. Univariate and multivariate analyses using the Cox regression model were performed to determine statistical significance of some tumor-related factors. RESULTS: There were no significant differences in pelvic control rate (PC), distant metastases-free rate (DMF), cause-specific disease-free survival rate (CSDFS) among subgroups with cervix < 60 mm in diameter. However, PC (p = 0.023), DMF (p = 0.000025), and CSDFS (p = 0.0023) were significantly lower for patients with cervix > or = 60 mm than < 60 mm. The 5-year CSDFS was 77.5% for < 60 mm, and 28.6% for > or = 60 mm. Pelvic node status assessed by CT scans had significant prognostic impact on outcome. the 5-year CSDFS rate was 84.9% for patients with no enlarged nodes, and 58.9% for those with enlarged nodes greater than 1 cm in minimum diameter (p = 0.023). Whereas PC was not significantly affected, the DMF was strongly correlated with nodal status (p = 0.00027). Pelvic node status was taken as an independent predictor for DMF (p = 0.019) on multivariate analysis. CONCLUSION: Although cervical size assessed by CT had limited prognostic value, pelvic node status assessed by CT is the significant prognostic factor for patients with uterine cervical carcinoma treated with radical irradiation.

Radical radiation therapy for adenocarcinoma of the uterine cervix.

PURPOSE: Analysis of the therapeutic value of radical irradiation for patients with uterine cervical adenocarcinoma with special reference to pelvic disease control. PATIENTS AND METHODS: 20 patients with uterine cervical adenocarcinoma were treated with a combination of external beam and intracavitary irradiation (four patients stage IB, one stage IIA, three stage IIB and twelve patients stage IIIB). Seven patients were treated with high dose-rate (HDR) intracavitary irradiation, eleven with low dose-rate (LDR) intracavitary irradiation and two with HDR and LDR. RESULTS: Six out of the 20 patients experienced pelvic recurrence (all stage IIIB patients). Analysis of the relation between pelvic recurrence and dose rate of intracavitary irradiation revealed that LDR showed a higher pelvic disease control rate than HDR (6/7 vs. 0/4) in stage IIIB patients. Intracavitary irradiation doses of LDR were 1.2 to 1.5 times higher than those of HDR. Three out of the 20 patients developed rectal complication grade 2 (two patients treated with HDR, one with LDR). The five-year cumulative survival rate was 67.2% for all, 100% for stage I and II, and 43.3% for stage IIIB patients. CONCLUSION: These results suggest that locally advanced uterine cervical adenocarcinoma should be treated with a higher dose using LDR intracavitary irradiation. If adequate total doses can be delivered, pelvic disease control of uterine cervical adenocarcinoma is comparable with that achieved for squamous cell carcinoma.

[Role of postoperative irradiation for carcinoma of the uterine cervix: multivariate analysis of prognostic factors and patterns of failure].

We retrospectively analyzed the patterns of recurrence in 48 patients who underwent postoperative irradiation following surgery for carcinoma of the uterine cervix. The end points of pelvic control, distant metastases and disease-free survival were analyzed for parameters including FIGO stage, nodal status, degree of stromal invasion, histology and tumor size. Univariate and multivariate analyses showed that some prognostic parameters had little influence on pelvic control rate, but had a marked impact on the incidence of distant metastases and disease-free survival rate. These results suggest that postoperative irradiation improves pelvic control rate, but has little therapeutic benefit in preventing distant metastases or improving survival rate. In conclusion, we should give more consideration to adjuvant systemic therapy in addition to postoperative irradiation for high-risk patients.

[Intra-arterial infusion chemotherapy with cisplatin in the management of advanced uterine cervical cancer].

To improve the cure rate for locally advanced cervical cancer, intra-arterial infusion chemotherapy with cisplatin (I-A chemotherapy) was performed before starting radiation therapy. Twenty-five patients, having a large central tumor (over 5 cm in antero-posterior diameter by CT scan), were treated by I-A chemotherapy. The catheter was inserted selectively into the uterine artery. The dose of cisplatin was 120 mg/m2. After the chemotherapy, all the patients were treated by radiation therapy. Eighteen of 25 patients treated with I-A chemotherapy were evaluable. Seven patients (38.8%) experienced partial tumor regression (greater than 50% reduction in the measured diameter). The survival rate (Kaplan-Meier Method) for combined therapy with I-A chemotherapy and radiotherapy was significantly higher than that for 23 patients treated by conventional radiation therapy alone. The toxicity of I-A chemotherapy was similar to that of systemic administration. There were three catheter complications. Intra-arterial chemotherapy with cisplatin followed by radiation therapy is effective for advanced uterine cervical cancer.