Vaginal pessary sharpens uterocervical angle in uterine prolapse during pregnancy. A case report.

A 37-year-old multiparous woman complained of uterine prolapse at 14 weeks of gestation. A silicone ring-shaped middle-size vaginal pessary (# 62 mm) was placed into the vagina to reduce prolapsed uterus. Because the cervical length became shortened at 25 weeks of gestation, we decided to start intramuscular administration of progesterone (250 mg) weekly. At 33 weeks of gestation, she complained of the vaginal pessary spontaneous falling out, so we inserted a vaginal pessary of the same size again. The uterocervical angle became acute, going from 100° to 60° after placing the vaginal pessary into the vagina. We took the vaginal pessary out at 37 weeks of gestation. The patient gave birth at 39 weeks by spontaneous vaginal delivery to a healthy baby. A vaginal pessary may help continue a pregnancy via the same mechanism as a cervical pessary, which sharpens the uterocervical angle.

Effects of synthetic sex steroid hormone exposures on gonadal sex differentiation and dynamics of a male-related gene, Gonadal soma-derived factor (Gsdf) and an estrogen up-regulated gene, Choriogenine-H (ChgH) gene expression in the euryhaline Javafish medaka, Oryzias javanicus, based on genetic sexes.

To clarify the basal aspects of sexual development in Javafish medaka, Oryzias javanicus (ZZ/ZW), a model marine species for ecotoxicity testing, we examined the details of gonadal sex differentiation and exogenous sex hormone-dependent sex reversals using genetic sex-linked DNA markers. Sex differences in germ cell numbers were observed at 5 days post hatching (dph), in which there was a significant increase in the germ cells of ZW. In ZW, diplotene oocytes and the ovarian cavity appeared at approximately 10, and 30 dph, respectively. In ZZ, spermatogonial proliferation was observed at approximately 20 dph. A ZZ-dominant expression of Gonadal soma-derived factor (Gsdf) mRNA was detected before hatching. The exposure of embryos to 17α-ethinylestradiol (EE2; 0.1, 1, 10 ng/mL) did not cause sex reversals in most cases. However, EE2 exposures led to significant Choriogenin-H (ChgH) mRNA expression, an estrogen up-regulated gene, in all fry; these exposures did not suppress Gsdf expression in ZZ fry. The exposure of embryos to 17α-methyltestosterone (MT; 0.1, 1, 10 ng/mL) caused sex reversals but only at low frequencies in ZW and ZZ fish. Although the 10 ng/mL MT exposure was accompanied by induction of significant Gsdf expression in ZW fry, induction of ChgH expression was also observed in several fry. Together, the present study indicates for the first time that male-dominant sexual dimorphic expression of Gsdf precedes the first morphological sex difference, i.e., the sex difference in germ cell number, and results strongly suggest that exogenous sex hormone-dependent sex reversal is not induced easily in O. javanicus.

Antibodies against superantigenic exotoxins produced by Staphylococcus aureus in sera from mothers and their infants' cord blood.

A novel neonatal disease and puerperal toxic shock syndrome (TSS) induced by a superantigen, TSS toxin-1 (TSST-1), has spread throughout Japan. It is important to investigate serum titers against exotoxins in new mothers and in their infants' cord blood. We investigated antitoxin antibodies against TSST-1, staphylococcal enterotoxin (SE) A (SEA), SEB, and SEC, including immunoglobulin G (IgG) subclass specificity by enzyme-linked immunosorbent assay, in sera from 221 mothers and 97 cord blood samples. The rate of mothers with negative anti-TSST-1 antibody titer was high (more than 40%). Although antitoxin antibody titers in the sera of cord blood were well correlated with those in the sera of the mothers for every toxin, the tendencies of antibody transmission differed between toxins. Anti-TSST-1 antibody consisted mainly of IgG1 and IgG4 subclasses. Anti-TSST-1 IgG1- and IgG4-specific antibody titers in cord blood were well correlated with those in the sera of the mothers. The low frequency of pregnant women with positive anti-TSST-1 antibody titers could be one reason for the spread of TSS in Japan. Neonates whose mothers have positive IgG titers against TSST-1 should be protected because the antibody is composed of the subclasses transferred well through the placenta.

Sister Joseph umbilical nodule coexisting with endometriosis from endometrial carcinoma.

A 58-year-old woman was diagnosed with endometrial carcinoma. Total hysterectomy, bilateral salpingo-oophorectomy and paraaortic and a pelvic lymph node dissection were performed. The cytology of peritoneal fluid was negative. There was no peritoneal dissemination except umbilical nodule. A peritoneal 2.0x1.5 cm umbilical nodule was also resected. The nodule was identified as a metastasis from endometrial cancer with endometriosis. The pelvic lymph nodes also showed metastatic lesion with endometriosis. Our case showed that endometriosis coexisted with umbilical and pelvic lymph nodal metastatic lesions from endometrial cancer. This fact suggests that the mode of metastasis to the umbilicus via lymph flow from endometrial cancer is the same as that for endometriosis.