研究者データベース

蝦名 康彦(エビナ ヤスヒコ)
保健科学研究院 保健科学部門 創成看護学分野
教授

基本情報

所属

  • 保健科学研究院 保健科学部門 創成看護学分野

職名

  • 教授

学位

  • 医学博士

ホームページURL

J-Global ID

研究キーワード

  • 産婦人科学   婦人科腫瘍学   周産期医学   臨床遺伝学   生殖免疫学   細胞診断学   thrombophilia   母子感染   性分化疾患   サイトメガロウイルス   テロメア   

研究分野

  • ライフサイエンス / 産婦人科学
  • ライフサイエンス / 人体病理学

職歴

  • 2020年05月 - 現在 北海道大学大学院保健科学研究院 創成看護学分野 教授
  • 2019年07月 - 2020年04月 市立札幌病院 産婦人科 医長
  • 2012年04月 - 2019年06月 神戸大学大学院医学研究科 外科系講座 産科婦人科学分野 准教授
  • 2010年08月 - 2012年03月 神戸大学大学院医学研究科 外科系講座 産科婦人科学分野 講師
  • 2009年07月 - 2010年07月 JA北海道厚生連 旭川厚生病院主任部長(産婦人科)
  • 2007年04月 - 2009年06月 北海道大学病院助教(産婦人科)
  • 2007年05月 Memorial Sloan-Kettering Cancer Center, Department of Surgery, Gynecology Service
  • 2003年02月 - 2007年03月 北海道大学医学部付属病院助手(産婦人科)
  • 2000年11月 - 2003年01月 北海道対がん協会細胞診センター所長
  • 2000年01月 - 2000年10月 北海道大学医学部付属病院助手(産婦人科)

学歴

  •         - 1997年   北海道大学   医学研究科   外科系専攻
  •         - 1990年   北海道大学   医学部

所属学協会

  • 日本エンドメトリオーシス学会   日本女性医学学会   日本周産期・新生児医学会   日本臨床ウイルス学会   日本生殖免疫学会   International Gynecologic Cancer Society   American Society of Clinical Oncology   International Academy of Cytology   日本人類遺伝学会   婦人科悪性腫瘍化学療法研究機構   日本婦人科がん検診学会   日本産科婦人科内視鏡学会   日本産婦人科手術学会   日本癌治療学会   日本婦人科腫瘍学会   日本臨床細胞学会   日本産科婦人科学会   

研究活動情報

論文

  • Matsuo K, Machida H, Yamagami W, Ebina Y, Kobayashi Y, Tabata T, Kaneuchi M, Nagase S, Enomoto T, Mikami M
    Obstetrics and gynecology 134 5 1017 - 1026 2019年11月 [査読有り][通常論文]
  • 今福 仁美, 蝦名 康彦
    日本臨床細胞学会雑誌 58 4 162 - 166 (公社)日本臨床細胞学会 2019年07月 [査読有り][通常論文]
     
    目的:子宮頸部細胞診atypical squamous cells、cannot excluded high-grade squamous intraepithelial lesion(ASC-H)判定例の臨床的取り扱いにおける留意点を明らかにする。方法:2010年1月から2016年12月までの期間に、ASC-Hと判定して子宮頸部組織診を施行した80人を対象とした。初回組織診検査結果、経過観察例における臨床的転帰について検討した。成績:初回の組織診結果は、cervical intraepithelial neoplasia(CIN)3が30人(37.5%)と最も多く、次いでCIN1 10人(12.5%)、CIN2 9人(11.3%)、子宮頸癌IA1期4人(5.0%)、子宮体部癌肉腫1人(1.2%)であった。CIN2以上の診断となったものは、44人(55.0%)であった。初回の組織診結果が良性で経過観察を行った22例のうち、6例(27.3%)が中央値16ヵ月(範囲10〜32ヵ月)で、CIN2〜3の組織診断となった。結論:ASC-H判定例においては、CIN2以上の組織診断となる頻度が高く、すみやかなコルポスコピー下生検が必須である。また、初回の組織診結果が良性であっても、経過観察中にhigh-grade CINと診断される頻度が高く、厳重なフォローアップが必要である。(著者抄録)
  • Hideto Yamada, Kenji Tanimura, Masashi Deguchi, Shinya Tairaku, Mayumi Morizane, Akiko Uchida, Yasuhiko Ebina, Akira Nishikawa
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 6 427 - 430 2019年06月 [査読有り][通常論文]
     
    Primary infection with Toxoplasma gondii (T. gondii) during pregnancy may cause congenital infection of the infant. This study evaluated whether screening using IgG avidity and multiplex-nested polymerase chain reaction (PCR) methods was effective for detecting a high-risk pregnancy for congenital T. gondii infection. In a prospective cohort study serum T. gondii IgG avidity was measured in 469 pregnant women who had a positive test for T. gondii antibody plus a positive or equivocal test for IgM. Multiplex-nested PCR for T. gondii DNA on amniotic fluid, maternal blood, and neonatal blood was performed with informed consent. Low (<30%), borderline (30-35%), and high (>35%) IgG avidity indices were found in 104 (22.2%), 30 (6.4%), and 305 (71.4%), respectively. A total of 12 cases had a positive PCR test for amniotic fluids of the prenatal amniocentesis or at birth, or neonatal blood. Seven of the 12 cases were diagnosed as having congenital T. gondii infection, and they had low IgG avidity indices. Congenital T. gondii infection screening using of IgG avidity and multiplex-nested PCR methods for pregnant women with a positive test for T. gondii antibody plus a positive or equivocal test for T. gondii IgM was useful for detecting a high-risk pregnancy and diagnosing congenital T. gondii infection.
  • Machida H, Matsuo K, Yamagami W, Ebina Y, Kobayashi Y, Tabata T, Kanauchi M, Nagase S, Enomoto T, Mikami M
    Gynecologic oncology 153 3 589 - 596 2019年06月 [査読有り][通常論文]
  • Maho Miyaji, Masashi Deguchi, Kenji Tanimura, Yuki Sasagawa, Mayumi Morizane, Yasuhiko Ebina, Hideto Yamada
    Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 1 - 6 2019年04月23日 [査読有り][通常論文]
     
    The aim of this prospective cohort study was to evaluate clinical factors associated with pregnancy outcomes in women with recurrent pregnancy loss (RPL). Women with a history of two or more pregnancy losses underwent workups for clinical factors of RPL and their pregnancies were followed-up with informed consent. Two hundred eleven (81.5%) of 259 women with RPL became pregnant. The multivariable analyses demonstrated that age (p < .01, OR 0.9, 95%CI 0.97-0.83), uterine abnormality (p < .05, OR 0.3, 95%CI 0.11-0.8), and protein C (PC) deficiency (p < .01, OR 0.14, 95%CI 0.03-0.6) were independent factors for becoming pregnancy in women with RPL. The number of previous pregnancy loss (p < .01, OR 0.57, 95%CI 0.43-0.75) and natural killer (NK) cell activity ≥33% (p < .01, OR 0.31, 95%CI 0.13-0.73) were independent factors for live birth in the subsequent pregnancy. Advanced age, the presence of uterine abnormality, and PC deficiency were risk factors for reduced pregnancy rate in women with RPL. Increased number of previous pregnancy loss and high NK cell activity were risk factors for miscarriage in the subsequent pregnancy. These results involve important information and are helpful for clinical practitioners.
  • Uenaka M, Morizane M, Tanimura K, Deguchi M, Ebina Y, Hashimoto M, Morioka I, Yamada H
    The Kobe journal of medical sciences 64 6 E197 - E199 2019年03月 [査読有り][通常論文]
  • Yasuhiko Ebina, Mikio Mikami, Satoru Nagase, Tsutomu Tabata, Masanori Kaneuchi, Hironori Tashiro, Masaki Mandai, Takayuki Enomoto, Yoichi Kobayashi, Hidetaka Katabuchi, Nobuo Yaegashi, Yasuhiro Udagawa, Daisuke Aoki
    International journal of clinical oncology 24 1 1 - 19 2019年01月 [査読有り][通常論文]
     
    The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2017 for the Treatment of Uterine Cervical Cancer are for the purpose of providing standard treatment strategies for cervical cancer, indicating treatment methods currently considered appropriate for cervical cancer, minimizing variances in treatment methods among institutions, improving the safety of treatment and prognosis of diseases, reducing the economic and psychosomatic burden of patients by promoting performance of appropriate treatment, and enhancing mutual understanding between patients and healthcare professionals. The guidelines were prepared through consensus of the JSGO Guideline Committee, based on careful review of evidence gathered through the literature searches and in view of the medical health insurance system and actual clinical practice situations in Japan. The guidelines comprise eight chapters and five algorithms. The main features of the 2017 revision are as follows: (1) evidence was collected using a search formula and with cooperation of the Japan Library Association. The bibliographical search formula was placed at the end of the book; (2) regarding clinical questions (CQs) where evidence or clinical inspection in Japan was lacking, opinions of the Guidelines Committee were described as "proposals for future directions"; (3) cervical intraepithelial neoplasia (CIN) 3 and adenocarcinoma in situ (AIS) were treated as a cervical precancerous lesion; (4) the CQs of endoscopic surgery, radical trachelectomy, and sentinel node biopsy were newly added in Chapter 3, "primary treatment for stage IB-II cervical cancer"; and (5) the CQ about hormone replacement therapy after cancer treatment was newly established. Each recommendation is accompanied by a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSGO Guidelines 2017 for the Treatment of Uterine Cervical Cancer.
  • Hideto Yamada, Kenji Tanimura, Shinya Tairaku, Ichiro Morioka, Masashi Deguchi, Mayumi Morizane, Satoshi Nagamata, Kana Ozaki, Yasuhiko Ebina, Toshio Minematsu
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 24 9 702 - 706 2018年09月 [査読有り][通常論文]
     
    The aim of this nested case-control study was to evaluate clinical factors associated with the occurrence of congenital cytomegalovirus (CMV) infection in pregnant women with non-primary CMV infection. In a cohort study of CMV screening for 2193 pregnant women and their newborns, seven newborns with congenital CMV infection were identified among 1287 pregnant women with non-primary CMV infection that was defined as negative IgM and positive IgG with IgG avidity index >45%. In the 1287 women with non-primary CMV infection, clinical findings and complications were compared between pregnancies with and without congenital CMV infection. Clinical factors associated with the occurrence of congenital CMV infection were evaluated. The birth weight of newborns with congenital CMV infection was less than that of newborns without congenital infection (p < 0.05). Univariate logistic regression analyses demonstrated that threatened premature delivery (OR 10.6, 95%CI 2.0-55.0; p < 0.01) and multiple pregnancy (OR 7.1, 95%CI 1.4-37.4; p < 0.05) were associated with congenital infection. Multivariable logistic regression analyses demonstrated that threatened premature delivery (OR 8.4, 95%CI 1.5-48.1; p < 0.05) was a single risk factor for congenital CMV infection in pregnant women with non-primary CMV infection. This study revealed for the first time that threatened premature delivery was associated with the occurrence of congenital CMV infection in pregnant women with non-primary CMV infection, the pathophysiology of which may be closely associated with CMV reactivation during pregnancy.
  • Ebina Y, Uchiyama M, Imafuku H, Suzuki K, Miyahara Y, Yamada H
    Medicine 97 23 e11009  2018年06月 [査読有り][通常論文]
  • Hitomi Imafuku, Yoshiya Miyahara, Yasuhiko Ebina, Hideto Yamada
    The Kobe journal of medical sciences 64 1 E1-E5 - E5 2018年05月28日 [査読有り][通常論文]
     
    BACKGROUND: Both twin pregnancies with complete hydatidiform mole and coexisting normal fetus (CHMCF) and partial hydatidiform mole can be found in association with a live fetus and a placenta displaying a molar degeneration. Two cases of CHMCF using magnetic resonance imaging (MRI) for a diagnosis are reported. CASE: In the first, CHMCF was suspected at 12 weeks of gestation. At 18 weeks of gestation, the existence of molar placenta and a sac separating from fetus and normal placenta was clearly depicted on MRI. At 19 weeks of gestations, she had termination of pregnancy because of a development of gestational trophoblastic neoplasia (GTN) and started chemotherapy. In the second case, CHMCF was suspected at 14 weeks of gestation. MRI demonstrated the existence of molar placenta and a sac separating from fetus and normal placenta. She chose induced abortion and there was no evidence of GTN during the 1 year-follow up period. Pathological examination in both cases was consistent with a complete hydration mole and a coexisting normal female fetus. CONCLUSION: MRI was useful for an accurate diagnosis for CHMCF.
  • Ryo Nishikawa, Kenji Yoshida, Yasuhiko Ebina, Mayumi Omoteda, Daisuke Miyawaki, Takeaki Ishihara, Yasuo Ejima, Hiroaki Akasaka, Hitoaki Satoh, Katsusuke Kyotani, Satoru Takahashi, Ryohei Sasaki
    Journal of radiation research 59 3 316 - 326 2018年05月01日 [査読有り][通常論文]
     
    This study aimed to compare dosimetric parameters between non-optimized and optimized treatment planning (NOP and OP, respectively) of magnetic resonance imaging (MRI) -based intracavitary (IC) image-guided adaptive brachytherapy (IGABT) using the central shielding (CS) technique for cervical cancer. Fifty-three patients treated with external beam radiotherapy using CS and MRI-based IGABT with the IC approach alone were evaluated. The total high-risk clinical target volume (HR-CTV) D90 was aimed at >70 Gy equivalent dose in 2 Gy fractions (EQD2). In the small HR-CTV group (≤30 cm3), the mean D90s for NOP/OP were 98.6/80.7 Gy. In the large (30.1-40 cm3) and extensive (>40 cm3) HR-CTV groups, the mean D90s were 81.9/77.5 and 71.1/73.6 Gy, respectively. The mean D2cc values for organs at risks (OARs) in OP were acceptable in all groups, despite the high bladder D2cc in the NOP. The correlation between HR-CTV at first brachytherapy (BT) and NOP D90 was stronger than that between HR-CTV at first BT and OP D90. The targeted HR-CTV D90 and dose constraints of D2cc for OARs were both achieved in 16 NOP/47 OP patients for the bladder, 39/50 for the rectum, and 47/50 for the sigmoid colon (P < 0.001, P = 0.007, and P = 0.34, respectively). For small tumors, the role of optimization was to reduce the D2cc for OARs while maintaining the targeted D90. However, optimization was of limited value for extensive tumors. Methods of optimization in IGABT with CS for cervical cancer should be standardized while considering its effectiveness and limitations.
  • Kenji Tanimura, Mayumi Morizane, Masashi Deguchi, Yasuhiko Ebina, Utaru Tanaka, Yoshiko Ueno, Kazuhiro Kitajima, Tetsuo Maeda, Kazuro Sugimura, Hideto Yamada
    Placenta 64 27 - 33 2018年04月 [査読有り][通常論文]
     
    INTRODUCTION: Placenta previa (PP) is one of the most significant risk factors for adherent placenta (AP). The aim of this study was to evaluate the diagnostic efficacy of a novel scoring system for predicting AP in pregnant women with PP. METHODS: This prospective cohort study enrolled 175 women with PP. The placenta previa with adherent placenta score (PPAP score) is composed of 2 categories: (1) past history of cesarean section (CS), surgical abortion, and/or uterine surgery; and (2) ultrasonography and magnetic resonance imaging findings. Each category is graded as 0, 1, 2, or 4 points, yielding a total score between 0 and 24. When women with PP had PPAP score ≥8, they were considered to be at a high risk for AP and received placement of preoperative internal iliac artery occlusion balloon catheters. If they were found to have AP during CS, they underwent hysterectomy or placenta removal using advanced bipolar with balloon catheter occlusion. The predictive accuracy of PPAP score was evaluated. RESULTS: In total, 23 of the 175 women with PP were diagnosed as having AP, histopathologically or clinically. Twenty-one of 24 women with PPAP score ≥8 had AP, whereas two of 151 women with PPAP score <8 had AP. The scoring system yielded 91.3% sensitivity, 98.0% specificity, 87.5% positive predictive value, and 98.7% negative predictive value for predicting AP in women with PP. DISCUSSION: This prospective study demonstrated that PPAP scoring system may be useful for predicting AP in women with PP.
  • Yoko Maesawa, Masashi Deguchi, Kenji Tanimura, Mayumi Morizane, Yasuhiko Ebina, Hideto Yamada
    Reproductive medicine and biology 17 2 149 - 154 2018年04月 [査読有り][通常論文]
     
    Purpose: This study aimed to assess the efficacy of high-dose i.v. immunoglobulin (HIVIg) therapy in pregnant women with antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus with a history of pregnancy failure, despite receiving low-dose aspirin plus unfractionated heparin therapy, of which condition being designated as "aspirin-heparin-resistant APS" (AHRAPS). Methods: The HIVIg therapy (20 g/d, 5 days) was performed for the pregnancies of five women with AHRAPS. Results: Five of the eight pregnancies ended in live births. The gestational ages of delivery in four of the five pregnancies were extended, compared with previous pregnancies. The HIVIg therapy was considered to be successful for these four pregnancies. Excluding one pregnancy that ended in miscarriage with an abnormal chromosome karyotype of the villi, the HIVIg therapy was considered to be successful in four (57.1%) of the seven pregnancies of the women with AHRAPS. Although all the live newborns were prematurely delivered, no adverse effect of the HIVIg therapy was observed. Conclusions: The HIVIg therapy might be beneficial as an immune modifier for pregnant women with AHRAPS. However, the precise indication of which women with AHRAPS who should receive HIVIg therapy remains unknown.
  • Shigeki Shimada, Yasuhiko Ebina, Norifumi Iijima, Masashi Deguchi, Hideto Yamada
    American journal of reproductive immunology (New York, N.Y. : 1989) 79 2 2018年02月 [査読有り][通常論文]
     
    PROBLEM: Is an abnormal increase or decrease of M1/M2 macrophages observed in the deciduae of miscarriages with normal fetal chromosome (MN)? METHODS OF STUDY: Deciduae of 18 MN and 26 miscarriages with abnormal fetal chromosome (MA) were obtained. Additionally, deciduae from 15 women whose pregnancies ended in induced abortions (IA) and endometriums at the mid-luteal phase from 19 non-pregnant women endomeriums of mid-luteal phases (EM) were obtained. Macrophages were analyzed by flow cytometry using monoclonal antibodies for CD68, HLA-DR, and CD163. RESULTS: M1 macrophages, defined as CD68+ HLA-DR+ CD163- cells, increased in MN compared with MA or IA. M2 macrophages, defined as CD68+ HLA-DR- CD163+ cells, increased in the deciduae of MA and IA compared with EM. However, this increase was not observed in the deciduae of MN. CONCLUSION: Our findings of phenotypic characters of decidual macrophages in MN provide additional evidence that M2 polarization is favorable for the maintenance of early stages of pregnancy.
  • Masashi Deguchi, Yoko Maesawa, Shino Kubota, Mayumi Morizane, Kenji Tanimura, Yasuhiko Ebina, Hideto Yamada
    Journal of reproductive immunology 125 39 - 44 2018年02月 [査読有り][通常論文]
     
    The aim of this prospective study was to determine clinical factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus (SLE). Fifty-six pregnancies from 46 women with SLE were enrolled. Risk factors for pregnancy loss, premature delivery, hypertensive disorders of pregnancy (HDP), and light-for-date neonate (LFD), were evaluated. Univariate and multivariate logistic regression analyses revealed a history of two or more pregnancy losses before 10 gestational weeks (GW) (OR 11.5, 95%CI 1.72-76.8) as a risk factor for pregnancy loss; low levels of blood complements (OR 7.55, 95%CI 1.10-51.9) and antiphospholipid syndrome (OR 26.5, 95%CI 3.17-219) as risk factors for premature delivery before 37 GW; SLEDAI score at conception (OR 1.68, 95%CI 1.05-2.68) and positive tests for two or more antiphospholipid antibodies (OR 6.89, 95%CI 1.13-41.9) as risk factors for premature delivery before 34 GW; prednisolone therapy >14mg/day (OR 7.55, 95%CI 1.10-51.9) as a risk factor for HDP; and low dose aspirin therapy (OR 0.21, 95%CI 0.05-0.97) decreased the risk for LFD neonate. These results have important implications for clinicians managing SLE complicated pregnancy.
  • Kenji Tanimura, Shinya Tairaku, Ichiro Morioka, Kana Ozaki, Satoshi Nagamata, Mayumi Morizane, Masashi Deguchi, Yasuhiko Ebina, Toshio Minematsu, Hideto Yamada
    CLINICAL INFECTIOUS DISEASES 65 10 1652 - 1658 2017年11月 [査読有り][通常論文]
     
    Background. The aim of this prospective cohort study was to evaluate the efficacy of maternal screening for congenital cytomegalovirus infection (CCI) using cytomegalovirus (CMV) immunoglobulin G (IgG) and the IgG avidity index (AI). Methods. Pregnant women underwent screening of CMV IgG and AI measurements. IgG-negative women underwent remeasurement of IgG after educational intervention. Women with an AI <= 45% received further examinations, including measurement of CMV IgM. All newborns received polymerase chain reaction analyses of the urine, and CCI was diagnosed by the detection of CMV-DNA in the urine. Primary infection was defined as an AI <35% and/or positive IgM (>1.20 index). Serum samples from women with an AI >45% were stored, and the IgM levels were measured after delivery. The efficacy of AI and IgM for CCI screening was compared. Results. A total of 1562 (71.2%) women tested positive for IgG. In this study, 10 newborns with CCI were detected. The presence of infection in 3 newborns from mothers with primary infection was predicted by screening of IgG and AI <35%. However, infection in 7 newborns from women with nonprimary infection could not be predicted by screening of CMV IgG, AI <35%, or IgM. The application of an AI <35% for CCI screening yielded 22.2% sensitivity, 95.0% specificity, 2.5% positive predictive value, and 99.5% negative predictive value and was similar to that of IgM (11.1% sensitivity, 93.2% specificity, 0.9% positive predictive value, and 92.7% negative predictive value). Conclusions. Maternal screening using CMV IgG and AI can identify pregnancies with CCI from primary infection, but overlooks a number of those from nonprimary infection.
  • Yasuhiko Ebina, Yukari Nishino, Masashi Deguchi, Yoko Maesawa, Yuki Nakashima, Hideto Yamada
    JOURNAL OF REPRODUCTIVE IMMUNOLOGY 120 42 - 47 2017年04月 [査読有り][通常論文]
     
    This study aimed to evaluate whether natural killer (NK) cell activity was associated with the etiology of recurrent miscarriage (RM), and to evaluate the predictive value of NK cell activity for outcomes of following pregnancies in women with RM. Peripheral NK cell activity was measured in 160 non-pregnant women with a history of two or more miscarriages. This activity was compared according to the etiology of RM and to pregnancy outcomes in women who became pregnant. NK cell activity in women with unexplained RM was significantly higher than that in those with known etiologies of RM. NK cell activity in women whose next pregnancies ended in miscarriage of fetuses with a normal chromosome karyotype (MN) was higher than that in those with live births (p < 0.05). Women with NK cell activity >= 33% had a higher risk for MN (relative risk 3.4, 95% confidence interval 1.3-8.7). An increase in peripheral NK cell activity was associated with MN. This increase might be involved in the pathophysiology underlying RM.
  • Kana Ozaki, Kenji Tanimura, Yasuhiko Ebina, Kiyonori Kanemitsu, Hideto Yamada
    Journal of Medical Case Reports 11 1 66  2017年03月11日 [査読有り][通常論文]
     
    Background: Surgical meshes are widely used in incisional hernia repair. However, there are no reports of pregnancies complicated by infection of surgical meshes used for hernia repair. This is the first case report of a pregnant woman who experienced surgical site infection associated with surgical mesh used for repair of an abdominal wall incisional hernia. Case presentation: We report a case of a 41-year-old pregnant Japanese woman with surgical site infection after mesh repair of an abdominal wall incisional hernia. She was diagnosed with an abdominal wall incisional hernia at 3 months after her third cesarean section, and she underwent an operation of hernia repair with use of monofilament polypropylene mesh 7 months after the third cesarean section. However, a surgical site infection associated with surgical mesh occurred. During antibiotic treatment, she was found to be pregnant. She was referred to our hospital at 13 weeks and 2 days of gestation. The surgeons removed the infected mesh at 16 weeks and 3 days of gestation. Neither the hernia nor infection at the surgical site recurred throughout pregnancy. We planned a cesarean section using a transverse uterine fundal incision method with an upper abdominal incision. The patient delivered a 2478-g healthy female infant. Conclusions: The present report shows that removal of mesh can safely control surgical site infection during pregnancy.
  • H. Morita, Y. Miyahara, Y. Ueno, K. Otani, F. Kawakami, Y. Ebina, H. Yamada
    EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 38 5 815 - 817 2017年 [査読有り][通常論文]
     
    Lymphangioleiomyomatosis (LAM) is a rare disease that afflicts mostly young women. It is characterized pathologically by the appearance of interstitial collections of atypical smooth muscle cells and cyst formation in the lungs, lymph node, kidney, and so on. A case was presented that underwent radical operation with the diagnosis of endometrial cancer, in which were found LAM cells in dissected lymph node and myometrium. Case: A 40-year-old woman underwent radical operation with the diagnosis of endometrial cancer. Although the dissected pelvic and para-aortic lymph nodes did not show the metastases of cancer, immunohistochemical study revealed the LAM cells among the dissected lymph nodes. Further histological study showed the LAM cells were in the uterine myometrium as well. Physical examination excluded the diagnosis of tuberous sclerosis. Since pulmonary LAM were observed as well, the physician followed the patient. Discussion: Sporadic LAM, without a complication of tuberous sclerosis, rarely shows LAM cells systemically as in this case. Conclusions: When LAM is observed coincidentally in operated dissected lymph node, it is important to examine for tuberous sclerosis and also to follow up the fmdings in the lung.
  • Kenji Tanimura, Yasuhiko Ebina, Hideto Yamada
    EXPERT REVIEW OF MOLECULAR DIAGNOSTICS 17 6 535 - 537 2017年 [査読有り][招待有り]
  • Kenji Tanimura, Shinya Tairaku, Yasuhiko Ebina, Ichiro Morioka, Satoshi Nagamata, Kana Deguchi, Mayumi Morizane, Masashi Deguchi, Toshio Minematsu, Hideto Yamada
    CLINICAL INFECTIOUS DISEASES 64 2 159 - 165 2017年01月 [査読有り][通常論文]
     
    Background. This prospective study aimed to determine maternal clinical, laboratory, and ultrasound findings that effectively predict the occurrence of congenital cytomegalovirus (CMV) infection (CCI) in high-risk pregnant women. Methods. Three hundred CMV immunoglobulin (Ig) M-positive pregnant women were enrolled. The maternal clinical and laboratory findings, including serum CMV IgM and IgG; IgG avidity index (AI); antigenemia assay (C7-HRP); polymerase chain reaction (PCR) for the detection of CMV-DNA in the maternal serum, urine, and uterine cervical secretion; and prenatal ultrasound findings, were evaluated. To determine predictive factors for the occurrence of CCI, logistic regression analyses were performed. Results. In 22 of the 300 women, CCI was confirmed using PCR for CMV-DNA in newborn urine. Univariate analyses demonstrated that the presence of maternal flu-like symptoms, presence of ultrasound fetal abnormalities, serum titers of CMV IgM, positive results for C7-HRP, CMV IgG AI <40%, and positive PCR results in the uterine cervical secretion were statistically associated with the occurrence of CCI. Multivariable analysis revealed that the presence of ultrasound fetal abnormalities (odds ratio [OR], 31.9; 95% confidence interval [CI], 8.5-120.3; P<.001) and positive PCR results in the uterine cervical secretion (OR, 16.4; 95% CI, 5.0-54.1; P<.001) were independent predictive factors of CCI in CMV IgM-positive women. Conclusions. This is the first prospective cohort study to suggest that the presence of CMV-DNA in the maternal uterine cervical secretion and ultrasound fetal abnormalities are predictive of the occurrence of congenital CMV infection in high-risk pregnant women.
  • 【産婦人科感染症の最前線】 母子に影響を与える感染症 トキソプラズマ感染症
    山田秀人, 出口雅士, 森岡一朗, 谷村憲司, 蝦名康彦
    産婦人科の実際 65 13号 1719 - 1724 2016年12月 [査読無し][招待有り]
  • Yasuhiko Ebina, Shigeki Shimada, Masashi Deguchi, Yoko Maesawa, Norifumi Iijima, Hideto Yamada
    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY 76 3 199 - 204 2016年09月 [査読有り][通常論文]
     
    ProblemThe aim of this prospective study was to evaluate phenotypic differences of helper T (Th), cytotoxic T (Tc), and regulatory T (Treg) cells in the deciduae of missed miscarriage with a normal chromosome karyotype of a fetus (MN) and missed miscarriage with an abnormal chromosome karyotype of a fetus (MA). Methods of studyThe decidua of 19 MN and 28 MA was obtained. Additionally, the decidua of 15 induced abortion (IA) and the endometrium of 19 non-pregnant women (EM) were obtained. IFN-(+), IL-17(+), CD25(high)Foxp3(+) cells in CD4(+) (Th) cells, and IFN-(+) cells in CD8(+) (Tc) cells were evaluated by flow cytometry. ResultsThe percentages of IFN-(+) Tc and CD4(+)CD25(high)Foxp3(+) (Treg) cells in MN were significantly increased as compared with MA and IA. The percentage of IFN-(+) Th in MN was increased as compared with IA. ConclusionActivation of IFN-(+) Tc and Treg cells in the decidua might be associated with the pathophysiology underlying MN.
  • Yasuhiko Ebina, Hidetaka Katabuchi, Mikio Mikami, Satoru Nagase, Nobuo Yaegashi, Yasuhiro Udagawa, Hidenori Kato, Kaneyuki Kubushiro, Kiyoshi Takamatsu, Kazuhiko Ino, Hiroyuki Yoshikawa
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 21 3 419 - 434 2016年06月 [査読有り][通常論文]
     
    The third version of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine body neoplasms was published in 2013. The guidelines comprise nine chapters and nine algorithms. Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. This revision was intended to collect up-to-date international evidence. The highlights of this revision are to (1) newly specify costs and conflicts of interest; (2) describe the clinical significance of pelvic lymph node dissection and para-aortic lymphadenectomy, including variant histologic types; (3) describe more clearly the indications for laparoscopic surgery as the standard treatment; (4) provide guidelines for post-treatment hormone replacement therapy; (5) clearly differentiate treatment of advanced or recurrent cancer between the initial treatment and the treatment carried out after the primary operation; (6) collectively describe fertility-sparing therapy for both atypical endometrial hyperplasia and endometrioid adenocarcinoma (corresponding to G1) and newly describe relapse therapy after fertility-preserving treatment; and (7) newly describe the treatment of trophoblastic disease. Overall, the objective of these guidelines is to clearly delineate the standard of care for uterine body neoplasms in Japan with the goal of ensuring a high standard of care for all Japanese women diagnosed with uterine body neoplasms.
  • Satoshi Nagamata, Yasuhiko Ebina, Yumika Yamano, Takeo Miyamoto, Mitsuhiro Nishijima, Hideto Yamada
    Kobe Journal of Medical Sciences 62 2 E45 - E48 2016年 [査読有り][通常論文]
     
    Uterine leiomyosarcoma (ULMS) is an aggressive tumor associated with high rates of progression, recurrence, and mortality. Pazopanib is the only approved molecular targeted drug for advanced soft tissue sarcoma, and it has been proven to prolong progression-free survival relative to placebo. We herein report a case of ULMS with multiple lung metastases treated with pazopanib, which led to sustained disease control for 44 weeks. A 53-year-old woman was referred to our hospital due to massive uterine bleeding from a uterine corpus tumor mass. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed as emergency surgery. The final histopathological diagnosis was uterine leiomyosarcoma, and computed tomography revealed multiple lung metastases. After chemotherapy with 17 cycles of gemcitabine and docetaxel and two cycles of doxorubicin, the lung metastases had increased in size and new lesions had appeared. Pazopanib administration at 800 mg/day was started as third-line therapy. Ten weeks later, the dose of pazopanib was reduced to 600 mg/day because of hepatic impairment and hypertension. However, lung metastases of ULMS were stabilized by pazopanib administration for about 44 weeks without a decline in the patient’s quality of life. After 44 weeks of therapy, pazopanib administration was discontinued because of progressive disease and worsening of the patient’s respiratory status. Pazopanib is an oral multityrosine kinase inhibitor of vascular endothelial growth factor receptor-1,-2, and-3 platelet-derived growth factor-α and-β and c-Kit receptor. The role of pazopanib may be clinically significant in the treatment of advanced ULMS.
  • Nanae Shinozaki, Yasuhiko Ebina, Masashi Deguchi, Kenji Tanimura, Mayumi Morizane, Hideto Yamada
    GYNECOLOGICAL ENDOCRINOLOGY 32 8 672 - 674 2016年 [査読有り][通常論文]
     
    This prospective study aimed to evaluate pregnancy outcome and complications in women with recurrent pregnancy loss (RPL) and protein S (PS) deficiency, who received low dose aspirin (LDA) or LDA plus heparin (LDA/H) therapies. Clinical characteristics, pregnancy outcome and complications of 38 women with two or more RPL and <60% of plasma free PS antigen were compared among three groups: antiphospholipid antibody (aPL)-negative women who received LDA (group A), aPL-negative women who received LDA/H (group B) and aPL-positive women who received LDA/H (group C). Gestational weeks (GW) at delivery in group C (median 32 GW) were earlier than 40 GW in group A and 38.5 GW in group B (p < 0.05). The birth weight in group C (median 1794 g) was less than 2855 g in group B (p < 0.05). The incidences of fetal growth restriction (37.5%), pregnancy-induced hypertension (37.5%), and preterm delivery (62.5%) in group C were higher than those (4.5%, 0%, and 4.5%, respectively) in group B (p<0.05). Women with RPL, PS deficiency, and positive aPL had high risks for adverse pregnancy outcome and complications, even when they received LDA/H therapy. Among women with RPL, PS, and negative aPL, there was no difference in these risks between LDA alone and LDA/H therapies.
  • Kenji Tanimura, Akira Nishikawa, Shinya Tairaku, Nanae Shinozaki, Masashi Deguchi, Mayumi Morizane, Yasuhiko Ebina, Ichiro Morioka, Hideto Yamada
    JOURNAL OF INFECTION AND CHEMOTHERAPY 21 9 668 - 671 2015年09月 [査読有り][通常論文]
     
    Primary Toxoplasma gondii (T. gondii) infection during pregnancy may lead to congenital toxoplasmosis. Maternal screening using T. gondii IgG avidity measurement and multiplex nested PCR was performed. The aim of this prospective cohort study was to determine a cut-off value of IgG avidity index (AI) for the prediction of the presence of T. gondii DNA in the amniotic fluid. One hundred thirty-nine women with positive or equivocal tests for IgM underwent both serum IgG avidity measurement and PCR analysis for the amniotic fluid. Nine had positive PCR results, and three of them were diagnosed as having congenital infection. A cut-off value of IgG AI was determined using receiver operating characteristic analysis. IgG AI (mean 13%) in women with positive PCR results was significantly lower than that (39%) in women with negative results. A cut-off value of <25% IgG AI yields the best results with 77.8% sensitivity and 81.5% specificity for the presence of T. gondii DNA in the amniotic fluid. None of women with IgG AI of >= 30% had a positive PCR result or congenital infection. This study firstly demonstrated that a cut-off value of 25 -30% IgG AI might be useful for the prediction of the presence of T. gondii DNA in the amniotic fluid and congenital infection. (C) 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
  • Yasuhiko Ebina, Masahiro Ieko, Sumiyoshi Naito, Gen Kobashi, Masashi Deguchi, Hisanori Minakami, Tatsuya Atsumi, Hideto Yamada
    THROMBOSIS AND HAEMOSTASIS 114 1 65 - 69 2015年07月 [査読有り][通常論文]
     
    It was the study objective to evaluate whether low levels of plasma protein S (PS) activity, free PS, protein C (PC) activity and coagulation factor XII (FXII) during early pregnancy are related to adverse pregnancy outcomes. Peripheral blood samples were obtained at 8-14 gestational weeks (GW) from a consecutive series of 1,220 women. The levels of plasma PS activity, free PS, PC activity, and FXII were measured. Cut-off values were defined as <1st, <5th, and <10th percentiles of values obtained from 933 women whose pregnancies ended in normal deliveries without complications. PS activity of <10th percentile yielded risks of pregnancy-induced hypertension (PIN) and severe PIH, while free PS level of <5th percentile yielded a risk of pre-eclampsia. FXII level of <1st percentile yielded a risk of premature delivery (PD) at <34 GW. None was associated with PD at <37 GW, fetal growth restriction or fetal loss. A multivariate analysis demonstrated that PS activity of <10th percentile (odds ratio 5.9, 95% confidence interval 1.7-18.1) and body mass index (BMI) >= 25 kg/m(2) (4.3, 1 1.1-13.3) were independent risk factors for severe PIN. Similarly, free PS level of <5th percentile (4.4, 1.0-14.3) and BMI >= 25 kg/m(2) (4.0, 1.3-10.9) were independent risk factors for pre-eclampsia. In conclusion, women with low levels of plasma PS activity and free PS during early pregnancy might have increased risks of PIN, severe PIN or pre-eclampsia. Women with low FXII level might have an increased risk of PD at <34 GW.
  • Kazuhiro Kitajima, Yuko Suenaga, Yoshiko Ueno, Tetsuo Maeda, Yasuhiko Ebina, Hideto Yamada, Takashi Okunaga, Kazuhiro Kubo, Keitarou Sofue, Tomonori Kanda, Yukihisa Tamaki, Kazuro Sugimura
    EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 42 8 1268 - 1275 2015年07月 [査読有り][通常論文]
     
    Purpose To evaluate the usefulness of metabolic parameters obtained by F-18-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas. Methods Preoperative F-18-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed. Results MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0 % sensitivity and 74.2 % specificity for risk stratification. Conclusion MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax.
  • Hideto Yamada, Masashi Deguchi, Yoko Maesawa, Yuki Nakajima, Yukari Nishino, Kenji Tanimura, Yasuhiko Ebina
    JOURNAL OF REPRODUCTIVE IMMUNOLOGY 109 48 - 51 2015年06月 [査読有り][通常論文]
     
    This study aimed to evaluate changes in natural killer (NK) cell activity and the percentage of monocytes in women with recurrent miscarriage who received medium-dose intravenous immunoglobulin (IVIg) therapy. Fourteen women with a history of six or more recurrent miscarriages of unexplained etiology received 60-g IVIg therapy (20 g daily, for three days) during early gestation. NI( cell activity in the peripheral blood decreased to 12% one week after therapy compared with before therapy (median, 22%, P<0.001) and the percentage of monocytes increased from 5.2% to 7.5% (P < 0.005). Four pregnancies ended in live births of healthy neonates, whereas the other ten pregnancies ended in miscarriages. Excluding one miscarriage with a chromosomal abnormality, the live birth rate was 30.8% (4/13). The rate of reduction of NI( cell activity in the success group (-58.8%) tended to be greater than that in the failure group (-14.8%, P = 0.057). (C) 2015 Elsevier Ireland Ltd. All rights reserved.
  • Yasuhiko Ebina, Toshio Minematsu, Ichiro Morioka, Masashi Deguchi, Shinya Tairaku, Kenji Tanimura, Ayako Sonoyama, Satoshi Nagamata, Mayumi Morizane, Hideto Yamada
    JOURNAL OF CLINICAL VIROLOGY 66 44 - 47 2015年05月 [査読有り][通常論文]
     
    Background: Human Cytomegalovirus (CMV) is the virus most frequently responsible for severe diseases of the fetus and newborn. The reported intrauterine transmission rate of CMV following primary maternal infection is approximately 40%. Invasive techniques are needed for the prenatal diagnosis of congenital CMV infection. Objectives: The aim of this study was to evaluate whether the rapidity of change in the CMV IgG avidity index (AI) is associated with the presence of congenital CMV infection among mothers with suspected primary CMV infection. Study design: The serum CMV IgG AI was repeatedly measured in 17 pregnant women with positive or borderline test results for CMV IgM together with an initial IgG AI value of <40%. Their neonates underwent polymerase chain reaction analyses for the presence of CMV DNA in the urine. The rapidity of change in the IgG AI per 4 weeks was defined as the Delta AI (%). The Delta AI of women with congenital CMV infection was compared with that of women with no infection. Results: The Delta AI of nine mothers with congenital CMV infection (median, 15.7%; range, 7.8-42.8%) was significantly higher than that of eight mothers with no infection (median, 6.5%, range, 2.0-8.8%; p < 0.001). The incidences of congenital CMV infection were 100.0%, 16.7%, and 0.0% among mothers with a Delta AI of >10, 5-10, and <5%, respectively. Conclusions: Measurement of the Delta AI in pregnant women might be useful for estimating the risk of mother-to-neonate CMV transmission. (C) 2015 Elsevier B.V. All rights reserved.
  • Yasuhiko Ebina, Nobuo Yaegashi, Hidetaka Katabuchi, Satoru Nagase, Yasuhiro Udagawa, Toru Hachisuga, Tsuyoshi Saito, Mikio Mikami, Yoichi Aoki, Hiroyuki Yoshikawa
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 20 2 240 - 248 2015年04月 [査読有り][通常論文]
     
    The second edition of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine cervical cancer was published in 2011. The guidelines comprise eight chapters and five algorithms. They were prepared by consensus among the members of the Japan Society of Gynecologic Oncology Guidelines Formulation Committee and Evaluation Committee and are based on a careful review of the evidence obtained from the literature, health insurance system, and actual clinical settings in Japan. The highlights of the 2011 revision are (1) the recommended grades have been changed to five stages-A, B, C1, C2, and D; (2) the revisions are consistent with the new International Federation of Gynecology and Obstetrics staging system; (3) the roles are shared between the 'Japanese classification of cervical cancer' and the new guidelines; (4) clinical questions related to adenocarcinoma have been revised; and (5) a clinical question regarding cervical cancer in pregnant patients has been added. Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. Each recommendation is accompanied by a classification of recommendation categories. The objective of these guidelines is to update the standard treatment strategies for cervical cancer, thus eliminating unnecessary and insufficient treatment.
  • Kenji Tanimura, Yui Yamasaki, Yasuhiko Ebina, Masashi Deguchi, Yoshiko Ueno, Kazuhiro Kitajima, Hideto Yamada
    EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY 187 41 - 44 2015年04月 [査読有り][通常論文]
     
    Objective: Adherent placenta is a life-threatening condition in pregnancy, and is often complicated by placenta previa. The aim of this prospective study was to determine prenatal imaging findings that predict the presence of adherent placenta in pregnancies with placenta previa. Study design: The study included 58 consecutive pregnant women with placenta previa who underwent both ultrasonography and magnetic resonance imaging prenatally. Ultrasonographic findings of anterior placental location, grade 2 or higher placental lacunae (PL >= G2), loss of retroplacental hypoechoic clear zone (LCZ) and the presence of turbulent blood flow in the arteries were evaluated, in addition to MRI findings. Forty-three women underwent cesarean section alone; 15 women with adherent placenta underwent cesarean section followed by hysterectomy with pathological examination. To determine imaging findings that predict adherent placenta, univariate and multivariate logistic regression analyses were performed. Results: Univariate logistic regression analyses demonstrated that anterior placental location, PL >= G2, LCZ, and MRI were associated with the presence of adherent placenta. Multivariate analyses revealed that LCZ (p < 0.01, odds ratio 15.6, 95%Cl 2.1-114.6) was a single significant predictor of adherent placenta in women with placenta previa. Conclusion: This prospective study demonstrated for the first time that US findings, especially LCZ, might be useful for identifying patients at high risk for adherent placenta among pregnant women with placenta previa. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
  • Tanimura K, Jin H, Suenaga T, Morikami S, Arase N, Kishida K, Hirayasu K, Kohyama M, Ebina Y, Yasuda S, Horita T, Takasugi K, Ohmura K, Yamamoto K, Katayama I, Sasazuki T, Lanier LL, Atsumi T, Yamada H, Arase H
    Blood 125 18 2835 - 2844 2015年04月 [査読有り][通常論文]
     
    Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis and/or pregnancy complications. beta 2-glycoprotein I (beta 2GPI) complexed with phospholipid is recognized as a major target for autoantibodies in APS; however, less than half the patients with clinical manifestations of APS possess autoantibodies against the complexes. Therefore, the range of autoantigens involved in APS remains unclear. Recently, we found that human leukocyte antigen (HLA) class II molecules transport misfolded cellular proteins to the cell surface via association with their peptide-binding grooves. Furthermore, immunoglobulin G heavy chain/HLA class II complexes were specific targets for autoantibodies in rheumatoid arthritis. Here, we demonstrate that intact beta 2GPI, not peptide, forms a complex with HLA class II molecules. Strikingly, 100 (83.3%) of the 120 APS patients analyzed, including those whose antiphospholipid antibody titers were within normal range, possessed autoantibodies that recognize beta 2GPI/HLA class II complexes in the absence of phospholipids. In situ association between beta 2GPI and HLA class II was observed in placental tissues of APS patients but not in healthy controls. Furthermore, autoantibodies against beta 2GPI/HLA class II complexes mediated complement-dependent cytotoxicity against cells expressing the complexes. These data suggest that beta 2GPI/HLA class II complexes are a target in APS that might be involved in the pathogenesis.
  • Yoko Maesawa, Hideto Yamada, Masashi Deguchi, Yasuhiko Ebina
    GYNECOLOGICAL ENDOCRINOLOGY 31 4 306 - 308 2015年04月 [査読有り][通常論文]
     
    The aim of this study was to evaluate whether the presence of history of biochemical pregnancy (BP) was associated with clinical characteristics and the subsequent pregnancy outcome among women with recurrent spontaneous abortion (RSA). One-hundred and seventy-five RSA women with two or more clinical pregnancy losses were enrolled. The clinical characteristics were compared between 164 women with history of 0-1 BP (Group A) and 11 women with two or more BP (Group B). The frequency of previous pregnancy loss and history of in vitro fertilization and embryo transfer in Group B was higher than that in Group A; while frequency of secondary RSA in Group B was lower than Group A. The subsequent pregnancy outcome was assessed prospectively; and live-birth rate in Group A (72.9%) was higher (p<0.05) than that in Group B (41.7%). The incidence of reproductive failure (58.3%, p<0.05) and spontaneous abortion with normal chromosome (25.0%, p=0.050) in Group B was higher than those (27.1 and 5.9%, respectively) in Group A. RSA women with two or more BP had higher risk of reproductive failure and spontaneous abortion with normal chromosome together with lower chance of live-birth. The results of the present study involve important information and are helpful for clinical practitioners.
  • Astuti Y, Nakabayashi K, Deguchi M, Ebina Y, Yamada H
    The Kobe journal of medical sciences 61 1 E1-8 - 8 1 2015年03月24日 [査読有り][通常論文]
     
    Relaxin is essential for trophoblast development during pregnancy. Evidence shows that relaxin increases trophoblast cell migration capacity. Here, we show the effect of relaxin on protein kinase B (AKT) activation and glycogen synthase kinase 3-beta (GSK3β) inactivation as well as on the proliferation of HTR-8/SVneo cells, a model of human extravillous trophoblast (EVT). HTR-8/SVneo cells were treated with different doses of human recombinant (rH2) relaxin in serum-deprived conditions and treated for increasing time with 1 ng/mL of rH2 relaxin. Western blot analysis was performed to detect pAKT, AKT, pGSK3β, GSK3β, and actin expression. Proliferation of HTR-8/SVneo cells was analyzed by MTS assay. rH2 relaxin treatment increased the ratio of pAKT/AKT, pGSK3β/GSK3β, and proliferation in HTR-8/SVneo cells. Furthermore, AKT and GSK3β activation by rH2 relaxin was inhibited by a phosphoinositide 3-kinase (PI3K) inhibitor. This study suggests that rH2 relaxin induces AKT and GSK3β phosphorylation as well as proliferation in HTR-8/SVneo cells.
  • Yoko Kobayashi, Ichiro Morioka, Tsubasa Koda, Yuji Nakamachi, Yoko Okazaki, Yoriko Noguchi, Miki Ogi, Masatsugu Chikahira, Kenji Tanimura, Yasuhiko Ebina, Toru Funakoshi, Masanobu Ohashi, Kazumoto Iijima, Naoki Inoue, Seiji Kawano, Hideto Yamada
    JOURNAL OF PERINATAL MEDICINE 43 2 239 - 243 2015年03月 [査読有り][通常論文]
     
    Aims: Neurological outcomes differ considerably between symptomatic and asymptomatic infants with congenital cytomegalovirus (CMV) infection. Our objective was to characterize laboratory markers in symptomatic newborns in comparison with asymptomatic newborns with congenital CMV infection. Methods: Ten newborns with symptomatic and 13 newborns with asymptomatic congenital CMV infection were included in this 3-year prospective cohort study. Total immunoglobulin M (IgM), CMV-IgM, CMV antigenemia, and CMV-DNA in blood and urine were measured and their positive rates and quantitative values compared between the symptomatic and asymptomatic groups. Results: Fifty percent of newborns in the symptomatic group were positive based on total IgM; this was significantly lower than in the asymptomatic group (100%). Quantitative total IgM values were significantly lower, and there were significantly more copies of CMV-DNA in the blood of symptomatic newborns than in -asymptomatic newborns (median values for total IgM: 14 vs. 43 mg/dL and blood CMV-DNA: 3.2 x 10(2) vs. 3.5 x 10(1) copies/10(6) white blood cells). CMV-IgM, CMV antigenemia, and urine CMV-DNA did not differ significantly between groups. Conclusion: Low total IgM values and high blood CMV loads were associated with the presence of symptoms in newborns with congenital CMV infection.
  • Hideto Yamada, Shinya Tairaku, Ichiro Morioka, Ayako Sonoyama, Kenji Tanimura, Masashi Deguchi, Satoshi Nagamata, Yasuhiko Ebina
    JOURNAL OF INFECTION AND CHEMOTHERAPY 21 3-4 161 - 164 2015年03月 [査読有り][通常論文]
     
    Objectives: The aim of this survey study was to evaluate a state of mother-to-child infections in Japan. Methods: A nationwide survey on 2714 obstetric facilities where regular maternity checkups were carried out was conducted. A primary questionnaire assessed numbers of pregnancies including induced abortion, spontaneous abortion, still-birth as well as live-birth, which were affected by congenital infections of 6 pathogens during a year of 2011. The secondary questionnaire assessed clinical information, diagnostic modality, and the outcome for each case. The clinical features and diagnostic problems were evaluated. Results: The high reply rates for the primary (73.7%) and the secondary questionnaire (100%) were achieved. The presence of congenital infections for 34 cases with cytomegalovirus (CMV), 1 with Toxoplasma gondii, 4 with rubella virus, 5 with Treponema pallidum, 8 with herpes simplex virus, and 69 with parvovirus B19 was confirmed after questionnaire assessment. The incidence of fetal demise among pregnancies with congenital parvovirus B19 infection was up to 71.0%. Eleven mothers with hydrops fetalis received prenatal fetal therapies involving fetal blood transfusion and immunoglobulin administration, whereas only three pregnancies (27.3%) ended in live-births. Conclusions: This survey study for the first time revealed the annual frequency of pregnancies with mother-to-child infections of 6 pathogens in Japan. The results involve important information and are helpful for clinical practitioners. The majority of neonates with congenital infection of CMV or T. gondii might be undiagnosed in obstetric facilities. (C) 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
  • パルボウイルスB19母子感染-全国参加施設を対象とした実態調査
    蝦名康彦
    小児科 56 2 191 - 198 2015年02月 [査読有り][招待有り]
  • Kazuhiro Kitajima, Utaru Tanaka, Yoshiko Ueno, Tetsuo Maeda, Yuko Suenaga, Satoru Takahashi, Masashi Deguchi, Yoshiya Miyahara, Yasuhiko Ebina, Hideto Yamada, Masakatsu Tsurusaki, Yukihisa Tamaki, Kazuro Sugimura
    PLOS ONE 10 1 e0117411  2015年01月 [査読有り][通常論文]
     
    Background and Purpose To investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies. Materials and Methods Sixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis. Results Locally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3,79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C. Conclusion MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.
  • Fumi Kawakami, Shuho Semba, Hiroe Itami, Noriko Oka, Tamotsu Sudo, Yasuhiko Ebina, Chiho Ohbayashi, Yoshiki Mikami, Hiroshi Yokozaki, Tomoo Itoh
    The Kobe journal of medical sciences 60 3 E66-73 - 73 2014年11月06日 [査読有り][通常論文]
     
    To determine the etiology of combined high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS) of the uterine cervix, we examined human papillomavirus (HPV) subtypes, methylation status of the HPV-16 L1 gene, and immunohistochemical staining pattern of Krt7 in 8 cases of combined HSIL and AIS. Overall, 6 (75%) of 8 patients with combined HSIL and AIS were infected by the same subtype of HPV in both HSIL and AIS (cases 1-5, HPV-16; and case 6, HPV-18), whereas 2 (25%) patients showed infection with different subtypes of HPV (case 7, HPV-31 and -18; and case 8, HPV-52 and -16, in HSIL and AIS, respectively). The degrees of methylation at CpG islands within the HPV-16 L1 gene were almost equivalent between HSIL and AIS in cases 1-4, whereas a great difference in CpG methylation patterns between two was seen in only 1 case (case 5). In addition, both patients infected with different subtypes of HPV between HSIL and AIS were positive for Krt7 only within the AIS component. Based on these results, we propose two distinct developmental pathways of combined HSIL and AIS of the uterine cervix, the common pathway and the individual pathway.
  • Fumi Kawakami, Shuho Semba, Hiroe Itami, Noriko Oka, Tamotsu Sudo, Yasuhiko Ebina, Chiho Ohbayashi, Yoshiki Mikami, Hiroshi Yokozaki, Tomoo Itoh
    The Kobe journal of medical sciences 60 3 E66-73 - 73 2014年11月06日 [査読有り][通常論文]
     
    To determine the etiology of combined high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS) of the uterine cervix, we examined human papillomavirus (HPV) subtypes, methylation status of the HPV-16 L1 gene, and immunohistochemical staining pattern of Krt7 in 8 cases of combined HSIL and AIS. Overall, 6 (75%) of 8 patients with combined HSIL and AIS were infected by the same subtype of HPV in both HSIL and AIS (cases 1-5, HPV-16; and case 6, HPV-18), whereas 2 (25%) patients showed infection with different subtypes of HPV (case 7, HPV-31 and -18; and case 8, HPV-52 and -16, in HSIL and AIS, respectively). The degrees of methylation at CpG islands within the HPV-16 L1 gene were almost equivalent between HSIL and AIS in cases 1-4, whereas a great difference in CpG methylation patterns between two was seen in only 1 case (case 5). In addition, both patients infected with different subtypes of HPV between HSIL and AIS were positive for Krt7 only within the AIS component. Based on these results, we propose two distinct developmental pathways of combined HSIL and AIS of the uterine cervix, the common pathway and the individual pathway.
  • Yasuhiko Ebina, Toshio Minematsu, Ayako Sonoyama, Ichiro Morioka, Naoki Inoue, Shinya Tairaku, Satoshi Nagamata, Kenji Tanimura, Mayumi Morizane, Masashi Deguchi, Hideto Yamada
    JOURNAL OF PERINATAL MEDICINE 42 6 755 - 759 2014年11月 [査読有り][通常論文]
     
    Background: Cytomegalovirus (CMV) causes congenital infection with high mortality and morbidity rates in affected neonates. Objectives: To evaluate the maternal IgG avidity value for the prediction of congenital CMV infection. Study design: The serum IgG avidity in all mothers was measured, and the urine of their neonates was assessed for CMV DNA in a prospective cohort study. Results: Of 759 women with a positive test for CMV IgG, 14 had congenital CMV infection. CMV IgG avidity indices in the congenital infection group (median 35.1%) were significantly lower than those in the non-congenital infection group (70.4%). A cutoff value of <40% IgG avidity index with 96.1% specificity and 64.3% sensitivity for congenital infection was determined by receiver operating characteristic curve analyses. The highest sensitivity (88.9%), 96.2% specificity, 27.6% positive predictive value, 99.8% negative predictive value, and 96.1% accuracy were found when IgG avidity was measured in < 28 weeks of gestation. Conclusion: The IgG avidity measurement with a cutoff value of < 40% IgG avidity index might be helpful in predicting congenital CMV infection, especially in < 28 weeks of gestation.
  • 牧原 夏子, 蝦名 康彦, 山崎 友維, 生橋 義之, 松岡 正造, 前田 哲雄, 川上 史, 山田 秀人
    日本産科婦人科内視鏡学会雑誌 30 1 112 - 116 (一社)日本産科婦人科内視鏡学会 2014年11月 [査読有り][通常論文]
     
    病理診断にて卵巣成熟嚢胞性奇形腫(MCT)と診断した73例(良好群)と卵巣奇形腫の悪性転化と診断した4例(悪性群)の術前所見を後方視的に比較し、悪性転化のリスク診断に有用な因子を検討した。手術時年齢、最大腫瘍径、血清SCC抗原値、血清CEA値、骨盤MRIにおける腫瘍結節部分の造影効果の有無について解析した結果、卵巣奇形腫の悪性転化の術前診断に有用な因子として、60歳以上、腫瘍径10cm以上、血清SCC抗原2.5ng/ml以上、血清CEA 5.0ng/ml以上、骨盤MRIにて造影効果を示す充実部分を有するといった因子が選択された。術前の検査情報から得られる悪性転化のリスク、具体的な手術手技によるメリットとデメリットを十分に説明し、理解と納得を得た上で術式を選択してもらうことが重要であると考えられた。
  • Kenji Tanimura, Shinya Tairaku, Masashi Deguchi, Ayako Sonoyama, Mayumi Morizane, Yasuhiko Ebina, Ichiro Morioka, Hideto Yamada
    The Kobe journal of medical sciences 60 2 E25-9 - 9 2014年07月11日 [査読有り][通常論文]
     
    The aim of this trial study was to assess the preventive efficacy of immunoglobulin with a high titer of anti-CMV antibody for mother-to-fetus cytomegalovirus (CMV) transmission among pregnant women with primary/acute CMV infection. The primary CMV infection in mothers was diagnosed by a positive test for CMV IgM and/or low IgG avidity. Intact type immunoglobulin with a high titer of anti-CMV antibody was injected intravenously at a dosage of 2.5-5.0 g/day for consecutive 3 days to mothers with primary CMV infection. Four pregnant women were enrolled. One pregnancy ended in no congenital infection, while two pregnancies ended in congenital CMV infection. The other one pregnancy was terminated. The mother-to-fetus CMV transmission rate was found to be high as 66.7% (2/3). This preliminary result suggests that intravenous immunoglobulin injections are not effective for the prevention of mother-to-fetus CMV transmission in the present protocol.
  • Kazuhiro Kitajima, Yuko Suenaga, Yoshiko Ueno, Tomonori Kanda, Tetsuo Maeda, Masashi Deguchi, Yasuhiko Ebina, Hideto Yamada, Satoru Takahashi, Kazuro Sugimura
    CLINICAL IMAGING 38 4 464 - 469 2014年07月 [査読有り][通常論文]
     
    Purpose: To investigate the fusion of pelvic magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET) for assessment of locoregional extension and nodal staging of cervical cancer. Methods: PET/computed tomography (CT), MRI, and non-fused and fusion of PET and MRI for assessing the extent of the primary tumor and metastasis to nodes were evaluated. Results: Accuracy for T-status was 83.3% for fused and non-fused PET/MRI and MRI proved significantly more accurate than PET/CT (53.3%) (P=.0077). Sensitivity, specificity, and accuracy for nodal metastasis were 92.3%, 88.2%, and 90.0% for fused PET/MRI and PET/contrast-enhanced CT; 84.6%, 94.1%, and 90.0% for nonfused PET/MRI; and 69.2%, 100%, and 86.7% for MRI. Conclusion: Fused PET/MRI combines the individual advantages of MRI and PET. (C) 2014 Elsevier Inc. All rights reserved.
  • Yoshiya Miyahara, Natsuko Makihara, Yui Yamasaki, Yasuhiko Ebina, Masashi Deguchi, Hideto Yamada
    GYNECOLOGICAL ENDOCRINOLOGY 30 7 502 - 504 2014年07月 [査読有り][通常論文]
     
    Objective: The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp. Materials and methods: Twelve women (group A) developed hemorrhagic shock (shock index<1.5) and received uterine artery embolization (UAE). The other 25 women (group B) had shock index<1.5 and did not receive UAE. All women underwent transcervical resection (TCR). The risk factors for the development of hemorrhagic shock, including the age, conception mode, numbers of previous abortion, gestational weeks at termination of pregnancy (TOP), blood loss weights at TOP and at TCR, were analyzed. Results: When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p<0.01), number of previous abortion (median 1.58 versus 0.68, p<0.05), gestational weeks at TOP (median 36.5 versus 17.0 weeks, p<0.05), and blood loss weight at TOP (median 2151 versus 40 g, p<0.05). A logistic regression analysis reveled that IVF-ET (OR 41, 95% CI 1.3-1264) and blood loss weight at TOP (1.0025, 1.0006-1.0044) were independent risk factors for hemorrhagic shock. Conclusions: For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.
  • Kazuhiro Kitajima, Yasuhiko Ebina, Kazuro Sugimura
    JAPANESE JOURNAL OF RADIOLOGY 32 6 313 - 323 2014年06月 [査読有り][通常論文]
     
    Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG) is a useful technique for acquiring both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened up a new field of clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, treatment optimization, re-staging, therapy monitoring, and prognostication of uterine and ovarian cancers as well as various malignant tumors. The present review discusses the current role of FDG-PET/CT in the management of gynecologic malignancies, focusing on its usefulness and limitations for imaging such patients.
  • Mizuki Uenaka, Kenji Tanimura, Shinya Tairaku, Ichiro Morioka, Yasuhiko Ebina, Hideto Yamada
    EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY 177 89 - 93 2014年06月 [査読有り][通常論文]
     
    Objective: To determine the factors related to adverse pregnancy outcomes and neonatal thyroid dysfunction in pregnancies complicated by Graves' disease. Study design: Thirty-five pregnancies complicated by Graves' disease were divided into two groups: adverse pregnancy outcome (n = 15) and no adverse pregnancy outcome (n = 20). Adverse pregnancy outcomes included spontaneous abortion, stillbirth, premature delivery, fetal growth restriction, and pregnancy-induced hypertension. The 31 pregnancies resulting in live births were also divided into two groups: neonatal thyroid dysfunction (n = 9) and normal neonatal thyroid function (n = 22). Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), TSH-receptor antibody (TRAb), the duration of hyperthyroidism in pregnancy, doses of antithyroid medication, and the duration of maternal antithyroid medication throughout pregnancy were compared. Results: There were no significant differences in these factors between pregnancies with an adverse pregnancy outcome and those with no adverse pregnancy outcome. However, serum levels of FT4, TRAb, the duration of hyperthyroidism in pregnancy, the maximum daily dose of antithyroid medication, and the total dose of antithyroid medication were significantly different between pregnancies with neonatal thyroid dysfunction and those with normal neonatal thyroid function. Multivariate logistic regression analysis showed that the FT4 level in mothers was a significant factor related to the development of neonatal thyroid dysfunction (odds ratio 28.84, 95% confidence interval 1.65-503.62, p < 0.05). Conclusion: Graves' disease activity in women of childbearing age should be well controlled prior to conception. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • 子宮体癌根治術における廓清リンパ節および子宮筋層にリンパ脈管筋腫症細胞を認めた一例
    森田 宏紀, 山崎 友維, 白川 友香, 平久 進也, 鈴木 嘉穂, 今福 仁美, 生橋 義之, 出口 雅士, 宮原 義也, 新谷 潔, 蝦名 康彦, 川上 史, 山田 秀人
    日本婦人科腫瘍学会雑誌 32 3 590 - 590 (公社)日本婦人科腫瘍学会 2014年06月 [査読有り][通常論文]
  • Yui Yamasaki, Hiroki Morita, Yoshiya Miyahara, Yasuhiko Ebina, Takuya Okada, Masato Yamaguchi, Hideto Yamada
    JOURNAL OF PERINATAL MEDICINE 42 3 359 - 362 2014年05月 [査読有り][通常論文]
     
    Objective: The transcatheter pelvic arterial embolization (TAE) is effective for postpartum hemorrhage (PPH). There has been a little information about the factors for ineffectiveness of TAE. The aim of this study was to determine factors associated with TAE failure for PPH. Study design: Fifty-five women who underwent TAE for intractable PPH were included. Clinical factors involving age, history of pregnancy, gestational weeks of delivery, mode of delivery, causes of PPH, complete blood count, blood loss volume, transfusion amount, shock index and disseminated intravascular coagulation (DIC) score were compared between TAE success group (n=48) and TAE failure group (n=7). Results: The uni- and multi-variate analyses revealed that advanced maternal age (OR 1.46, 95% CI 1.12-2.18) and retained placenta as a cause of PPH (15.48, 2.04-198.12) were found to be significant factors for TAE failure. Conclusion: The advanced age and retained placenta were independent factors associated with TAE failure for intractable PPH.
  • Hideto Yamada, Shinya Tairaku, Ichiro Morioka, Yasuhiko Ebina, Ayako Sonoyama, Kenji Tanimura, Masashi Deguchi, Satoshi Nagamata
    CONGENITAL ANOMALIES 54 2 100 - 103 2014年05月 [査読有り][通常論文]
     
    Mother-to-child infections cause congenital infection with disease and sequelae. To evaluate a state of maternal blood screening for mother-to-child infections in Japan, we for the first time conducted a nationwide survey on obstetric facilities where regular maternity checkups were carried out. A questionnaire assessment involved an annual number of deliveries, scale of facilities and a state of maternal blood screening for eight pathogens. A high rate (73.7%) of reply to the questionnaire was achieved from 1990 facilities, covering 75.1% of annual number of delivery in 2011. The performance rates of blood screening were more than 99% for rubella virus, Treponema pallidum, human immunodeficiency virus (HIV), human T cell leukemia virus type 1 (HTLV-1), hepatitis B virus, and hepatitis C virus, while the rate was found to be only 4.5% for cytomegalovirus (CMV), and 48.5% for Toxoplasma gondii with large differences in regions. Most of the facilities performed blood tests for rubella virus, Treponema pallidum, HIV, hepatitis B virus and hepatitis C virus once in early pregnancy, while approximately 28% of the facilities performed blood tests for HTLV-1 once during the 2nd or 3rd trimester. Most of the facilities used HA tests for Toxoplasma gondii, whereas there was a wide variation in antibody measurement methods for CMV. Generally, the obstetric facilities in Japan have performed maternal blood screening properly according to the current recommendations. The results of this survey involve important information and are helpful for clinical practitioners.
  • Management of Thromboembolism in Pregnant Women with Inherited Antithrombin
    Ebina Y, Nakamachi Y, Tanimura K, Morizane M, Morikami D, Deguchi M, Kawano S, Yamada H
    Exprimental & Clinical Cardiology 20 6 145 - 159 2014年04月 [査読有り][通常論文]
  • Yasuhiko Ebina, Hidemichi Watari, Masanori Kaneuchi, Mahito Takeda, Masayoshi Hosaka, Masataka Kudo, Hideto Yamada, Noriaki Sakuragi
    EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 41 3 446 - 451 2014年03月 [査読有り][通常論文]
     
    Purpose To investigate the impact of PET and PET/CT scanning on decision-making in management planning and to identify the optimal setting for selecting candidates for surgery in suspicious recurrent ovarian cancer. Methods A retrospective chart review was performed in patients with possible recurrent ovarian cancer after primary optimal cytoreduction and taxane/carboplatin chemotherapy who had undergone FDG PET or FDG PET/CT scans from July 2002 to August 2008 to help make treatment decisions. The analysis included 44 patients who had undergone a total of 89 PET scans. The positive PET scans were classified as follows. (1) localized (one or two localized sites of FDG uptake), (2) multiple (three or more sites of FDG uptake), (3) diffuse (extensive low-grade activity outlining serosal and peritoneal surfaces). Results Of the 89 PET scans, 52 (58.4 %) led to a change in management plan. The total number of patients in whom cytoreductive surgery was selected as the treatment of choice increased from 12 to 35. Miliary disseminated disease, which was not detected by PET scan, was found in 22.2 % of those receiving surgery. Miliary disseminated disease was detected in 6 of the 12 patients with recurrent disease whose treatment-free interval (TFI) was <12 months, whereas none of those with a TFI of >= 12 months had such disease (P = 0.0031). Conclusion PET or PET/CT is useful for selecting candidates for cytoreductive surgery among patients with recurrent ovarian cancer. To avoid surgical attempts in those with miliary dissemination, patients with a TFI of >= 12 months are the best candidates for cytoreductive surgery.
  • Ichiro Morioka, Ayako Sonoyama, Shinya Tairaku, Yasuhiko Ebina, Satoshi Nagamata, Mayumi Morizane, Kenji Tanimura, Kazumoto Iijima, Hideto Yamada
    CONGENITAL ANOMALIES 54 1 35 - 40 2014年02月 [査読有り][通常論文]
     
    To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother-to-child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother-to-child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother-to-child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women.
  • N. Makihara, T. Maeda, Y. Ebina, K. Kitajima, F. Kawakami, S. Hara, H. Yamada
    EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 35 2 174 - 177 2014年 [査読有り][通常論文]
     
    Primary leiomyosarcoma of the broad ligament is a very rare and highly malignant gynecological tumor. The authors report a 61-year-old postmenopausal woman with signs and symptoms of malignant ovarian tumor. Preoperative magnetic resonance imaging (MRI) was interpreted as being suspicious for malignant tumors, such as an ovarian cancer or a leiomyosarcoma of the broad ligament, so laparotomy was performed. Macroscopically, the tumor was revealed with a 18x13.7x9.5 cm degenerated, multiple cystic part and solid whitish part arising from broad ligament which on histopathology proved to be leiomyosarcoma. To the best of the authors' knowledge, primary leiomyosarcoma of the broad ligament has been documented in 21 reports or so, and no imaging findings are available. Here the authors present the Mill findings of primary leiomyosarcoma of the broad ligament.
  • Kazuhiro Kitajima, Yuko Suenaga, Yoshiko Ueno, Tomonori Kanda, Tetsuo Maeda, Natsuko Makihara, Yasuhiko Ebina, Hideto Yamada, Satoru Takahashi, Kazuro Sugimura
    ANNALS OF NUCLEAR MEDICINE 28 1 25 - 32 2014年01月 [査読有り][通常論文]
     
    To evaluate the diagnostic value of retrospective image fusion from pelvic magnetic resonance imaging (MRI) and F-18-fluorodeoxyglucose positron emission tomography (PET) in detecting intra-pelvic recurrence of gynecological tumor. Thirty patients with a suspicion of recurrence of gynecological malignancy underwent inline contrast-enhanced PET/computed tomography (CT) and pelvic contrast-enhanced MRI for restaging. Diagnostic performance about the local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion of PET/low-dose non-enhanced CT (PET/ldCT), PET/full-dose contrast-enhanced CT (PET/ceCT), contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) were evaluated by two experienced readers. Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. McNemar test was employed for statistical analysis. Documented positive locally recurrent disease, pelvic lymph node and bone metastases, and peritoneal dissemination were present in 53.3, 26.7, 10.0, and 16.7 %, respectively. Patient-based sensitivity for detecting local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion were 87.5, 87.5, 100 and 80.0 %, respectively, for fused PET/MRI, 87.5, 62.5, 66.7 and 60.0 %, respectively, for contrast-enhanced MRI, 62.5, 87.5, 66.7 and 80.0 %, respectively, for PET/ceCT, and 50.0, 87.5, 66.7 and 60.0 %, respectively, for PET/ldCT. The sensitivity of diagnosing local recurrence by fused PET/MRI was significantly better than that of PET/ldCT (p = 0.041). The patient-based sensitivity, specificity and accuracy for the detection of intra-pelvic recurrence/metastasis were 91.3, 100 and 93.3 % for fused PET/MRI, 82.6, 100 and 86.7 % for contrast-enhanced MRI, 82.6, 100 and 86.7 % for PET/ceCT and 78.3, 85.7 and 80.0 % for PET/ldCT. Fused PET/MRI combines the individual advantages of MRI and PET, and is a valuable technique for assessment of intra-pelvic recurrence of gynecological cancers.
  • Romana S. Z. Lodhi, Koji Nakabayashi, Kaho Suzuki, Ai Y. Yamada, Rhoichi Hazama, Yasuhiko Ebina, Hideto Yamada
    GYNECOLOGICAL ENDOCRINOLOGY 29 12 1051 - 1054 2013年12月 [査読有り][通常論文]
     
    The study was conducted to evaluate the effects of human relaxin on apoptosis in the human trophoblast derived HTR-8/SV neo cell line, which is a possible model of human extravillous trophoblasts (EVTs). HTR-8/SV neo cells, cultured in phenol red free RPMI1640 medium, were treated with different doses of human recombinant (rH2) relaxin in serum-deprived conditions. RT-PCR was used for evaluating relaxin receptor: RXFP1 and RXFP2 expression in HTR-8/SV neo cells. The cell death was examined by TUNEL assay. Furthermore, we investigated caspase-3, cleaved PARP and Bcl-2 expressions by Western blot analysis to recognize the translational effects of anti-apoptotic and pro-apoptotic proteins. RXFP1 and RXFP2 mRNA expression was observed in HTR-8/SV neo cells. Compared with untreated control cultures, treatment with rH2 relaxin, decreased TUNEL-positive rate in HTR-8/SV neo cells was observed. Western blot analysis revealed that treatment with rH2 relaxin decreased the expression of caspase-3 and cleaved PARP, but in contrast increased Bcl-2 expression in those cells. These results suggest that rH2 relaxin has anti-apoptotic effects on HTR8/SV neo cells by decreasing pro-apoptotic caspase-3 and cleaved PARP expression and up-regulating anti-apoptotic Bcl-2 expression.
  • Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Takahashi S, Ebina Y, Miyahara Y, Yamada H, Sugimura K
    European journal of radiology 82 10 1672 - 1676 10 2013年10月 [査読有り][通常論文]
     
    Purpose: To investigate the diagnostic value of retrospective fusion of pelvic MRI and F-18-fluorodeoxyglucose (F-18-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer. Materials and methods: Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. Results: Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p = 0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p = 1). Conclusion: Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer. Crown Copyright (C) 2013 Published by Elsevier Ireland Ltd. All rights reserved.
  • 転移性子宮腫瘍の診断に腹水セルブロック法が有用であった2症例
    蝦名 康彦, 山崎 友維, 森上 聡子, 白川 得朗, 篠崎 奈々絵, 塚本 龍子, 川上 史, 酒井 康裕, 伊藤 智雄, 山田 秀人
    日本臨床細胞学会雑誌 52 Suppl.2 697 - 697 (公社)日本臨床細胞学会 2013年10月 [査読有り][通常論文]
  • 卵巣奇形腫における悪性転化の術前予測についての検討
    牧原 夏子, 蝦名 康彦, 松岡 正造, 中林 幸士, 宮原 義也, 新谷 潔, 森田 宏紀, 川上 史, 前田 哲雄, 山田 秀人
    日本婦人科腫瘍学会雑誌 31 3 470 - 470 (公社)日本婦人科腫瘍学会 2013年06月 [査読有り][通常論文]
  • 白川 得朗, 蝦名 康彦, 川上 史, 牧原 夏子, 生橋 義之, 新谷 潔, 宮原 義也, 中林 幸士, 伊藤 智雄, 山田 秀人
    産婦人科の進歩 65 2 227 - 227 「産婦人科の進歩」編集室 2013年05月 [査読有り][通常論文]
  • 卵巣癌・腹膜癌における胸腹水セルブロック法の有用性の検討
    山崎 友維, 蝦名 康彦, 森上 聡子, 白川 得朗, 篠崎 奈々絵, 塚本 龍子, 川上 史, 酒井 康裕, 伊藤 智雄, 山田 秀人
    日本臨床細胞学会雑誌 52 Suppl.1 190 - 190 (公社)日本臨床細胞学会 2013年05月 [査読有り][通常論文]
  • Ayako Sonoyama, Yasuhiko Ebina, Ichiro Morioka, Kenji Tanimura, Mayumi Morizane, Shinya Tairaku, Toshio Minematsu, Naoki Inoue, Hideto Yamada
    JOURNAL OF MEDICAL VIROLOGY 84 12 1928 - 1933 2012年12月 [査読有り][通常論文]
     
    Cytomegalovirus (CMV) causes congenital infection with high mortality and morbidity rates in affected neonates. The aim of this study was to assess whether prenatal clinical or laboratory findings in pregnant women who had high risks for primary CMV infection predicted the presence of congenital infection. Fifty pregnant women who had serum CMV IgG and positive or borderline tests for serum CMV IgM were included in this prospective study. Serum IgG avidity was measured, and PCR was conducted for CMV DNA in maternal serum, urine, and uterine cervical secretion. All neonates underwent PCR testing for CMV DNA in the urine for the presence of congenital infection. Risk factors were compared between congenital infection group and group without congenital infection. As a result, nine neonates (18%) were diagnosed as having congenital infection. The frequencies of ultrasound fetal abnormality and positive test for CMV DNA in cervical secretion, CMV IgM titer and IgM/IgG ratio in the congenital infection group were significantly higher than those in the group without congenital infection. Conversely, IgG avidity index in the congenital infection group was significantly lower than that in the group without congenital infection. By multivariate logistic regression analyses, IgG avidity index (Odds ratio 0.91, 95% CI: 0.830.99) and ultrasound fetal abnormality (291.22, 2.7231125.05), were selected independently as significant signs predictive of congenital CMV infection. Among pregnant women with positive or borderline tests for CMV IgM, when they have findings of low serum CMV IgG avidity or ultrasound fetal abnormality, the probability of congenital CMV infection may increase. J. Med. Virol. 84:19281933, 2012. (c) 2012 Wiley Periodicals, Inc.
  • Kazuhiro Kitajima, Yoshiko Ueno, Kayo Suzuki, Masato Kita, Yasuhiko Ebina, Hideto Yamada, Michio Senda, Tetsuo Maeda, Kazuro Sugimura
    EUROPEAN JOURNAL OF RADIOLOGY 81 11 3557 - 3562 2012年11月 [査読有り][通常論文]
     
    Objective: To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated F-18-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer. Materials and methods: One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months. Results: Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods (McNemar test, p < 0.0005, p = 0.023, and p < 0.0001, respectively). The scales of detecting 104 recurrent lesion sites were N: 14, E: 6, P: 84 for PET/ceCT, and N: 15, E: 17, P: 72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT. Conclusion: PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT. Crown Copyright (C) 2012 Published by Elsevier Ireland Ltd. All rights reserved.
  • 検診で発見されたatypical lobular endocervical glandular hyperplasia(LEGH)の1例
    森上 聡子, 蝦名 康彦, 山崎 友維, 白川 得朗, 篠崎 奈々絵, 塚本 龍子, 川上 史, 酒井 康裕, 伊藤 智雄, 山田 秀人
    日本臨床細胞学会雑誌 51 Suppl.2 760 - 760 (公社)日本臨床細胞学会 2012年09月 [査読有り][通常論文]
  • Hideto Yamada, Mayumi Morizane, Kenji Tanimura, Ichiro Morioka, Yasuhiko Ebina, Hideo Matsuda, Masashi Yoshida, Hajime Wakamatsu, Kenichi Furuya, Jun Murotsuki, Shigeru Saito, Ichiro Kawabata, Yuichiro Takahashi, Toshiko Ueda, Yukiyasu Sato, Masato Kamitomo, Yuko Maruyama, Hideto Hirano, Takashi Yamada, Hisanori Minakami, Nobuo Yaegashi, Toshio Minematsu, Ryu Matsuoka, Michio Banzai, Tsuyomu Ikenoue
    JOURNAL OF REPRODUCTIVE IMMUNOLOGY 95 1-2 73 - 79 2012年09月 [査読有り][通常論文]
     
    No medical intervention guideline for prenatally diagnosed symptomatic congenital cytomegalovirus infection (CCMVI) is currently available. The aim of the study was to assess the efficacy of immunoglobulin fetal therapy for symptomatic CCMVI. With informed consent, hyper-immunoglobulin was injected into the peritoneal cavity of affected fetuses or into the maternal blood in 12 women who had symptomatic CCMVI. After immunoglobulin therapy, ultrasound examinations demonstrated the following changes: Ascites disappearance 57.1% (4/7) and a decrease in ascites volume 14.3% (1/7); improvement in intrauterine growth restriction 54.5% (6/11); disappearance of mild ventriculomegaly 40% (2/5); and in one case hepatomegaly and hydronephrosis disappeared. The survival rate of affected infants was found to be 83.3% (10/12). Concerning morbidity, 25.0% (3/12) of the infants developed normally. An additional two cases had only unilateral hearing difficulty without other sequelae. Therefore, 41.7% (5/12) of symptomatic CCMVI infants whose mothers received prenatal immunoglobulin therapies had no or only minimal sequelae (unilateral hearing difficulty). No direct adverse effects were observed. Immunoglobulin therapy may be effective for symptomatic CCMVI, reducing the incidence and severity of sequelae. To confirm the efficacy, a randomized study should be further performed. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
  • 子宮体部より発生した大細胞神経内分泌癌の2症例
    牧原 夏子, 蝦名 康彦, 中林 幸士, 宮原 義也, 新谷 潔, 前田 哲雄, 川上 史, 伊藤 智雄, 山田 秀人
    日本婦人科腫瘍学会雑誌 30 3 419 - 419 (公社)日本婦人科腫瘍学会 2012年06月 [査読有り][通常論文]
  • Kenji Tanimura, Yashuhiko Ebina, Ayako Sonoyama, Hiroki Morita, Shigeki Miyata, Hideto Yamada
    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 38 4 749 - 752 2012年04月 [査読有り][通常論文]
     
    A 33-year-old woman developed deep venous thrombosis at 7 gestational weeks (GW). Heparin-induced thrombocytopenia was evident at 9 GW during unfractionated heparin infusion. Immediately, anticoagulation therapies together with antithrombin (AT) infusion were commenced with the use of argatroban from 9 GW, and fondaparinux was substituted for argatroban after 24 GW. The patient had hereditary AT deficiency type I determined by laboratory findings and results of genomic DNA analysis. The pregnancy ended in full-term vaginal delivery of a healthy male without adverse effects of the anticoagulation therapies. This was the first report of a pregnant woman who developed heparin-induced thrombocytopenia caused by heparin therapy for deep venous thrombosis due to AT deficiency.
  • Kaho Suzuki, Koji Nakabayashi, Ai Y. Yamada, Romana S. Z. Lodhi, Rhoichi Hazama, Yasuhiko Ebina, Hideto Yamada
    FERTILITY AND STERILITY 97 3 734 - 741 2012年03月 [査読有り][通常論文]
     
    Objective: To evaluate the effects of human relaxin on proliferation and apoptosis in cultured human uterine leiomyoma cells and normal myometrial cells. Design: In vitro experiment. Setting: Research laboratory at Kobe University Graduate School of Medicine. Patient(s): Nine patients undergoing hysterectomy for uterine leiomyoma. Intervention(s): Cultured leiomyoma cells and normal myometrial cells were treated with human recombinant (rH2) relaxin. Main Outcome Measure(s): Human relaxin receptor LGR7 expressions in cultured leiomyoma cells and myometrial cells were evaluated by immunocytochemical staining. Cell proliferation, proliferating cell nuclear antigen-positive rate, and TUNEL-positive rate were assessed by MTS assay, immunocytochemistry, and TUNEL assay, respectively. Caspase-3 expression was evaluated by Western blot analysis. Result(s): LGR7 expression was observed both in cultured human leiomyoma cells and myometrial cells. Compared with untreated control cultures, treatment with rH2 relaxin increased the number of viable cultured leiomyoma cells and the proliferating cell nuclear antigen-positive rate in those cells but not in myometrial cells. Moreover, treatment with rH2 relaxin decreased the TUNEL-positive rate in cultured leiomyoma cells but not in myometrial cells. Similarly, Western blot analysis revealed that treatment with rH2 relaxin decreased the expression of caspase-3 in cultured leiomyoma cells but not in myometrial cells. Conclusion(s): These results suggest that rH2 relaxin selectively inhibits apoptosis by down-regulating caspse-3 expression and induces proliferation in cultured human leiomyoma cells without affecting apoptosis or proliferation in normal myometrial cells. (Fertil Steril (R) 2012; 97: 734-41. (C) 2012 by American Society for Reproductive Medicine.)
  • CIN3の経過観察中に発見された妊娠性絨毛癌の1症例
    山崎 友維, 蝦名 康彦, 森上 聡子, 白川 得朗, 陌間 亮一, 達摩 知子, 塚本 龍子, 川上 史, 伊藤 智雄, 山田 秀人
    日本臨床細胞学会雑誌 51 Suppl.1 282 - 282 (公社)日本臨床細胞学会 2012年03月 [査読有り][通常論文]
  • Yamada H, Takeda M, Maezawa Y, Ebina Y, Hazama R, Tanimura K, Wakui Y, Shimada S
    ISRN obstetrics and gynecology 2012 512732  2012年 [査読有り][通常論文]
  • Yoshiya Miyahara, Shigeki Yoshida, Tokuro Shirakawa, Natsuko Makihara, Kiyoshi Niiya, Yasuhiko Ebina, Hideto Yamada
    Kobe Journal of Medical Sciences 58 5 E138 - E144 2012年 [査読有り][通常論文]
     
    OBJECTIVE: The purpose of this study was to validate the therapeutic efficacy of the innovative surgical approach using laparoscopy, atelocollagen sponge, and hand-made mould on the achievement of a satisfactory neovagina in patients with vaginal agenesis. STUDY DESIGN: The current study involved four patients diagnosed as having Mayer-Rokitansky-Küster-Hauser syndrome. After creating a vaginal tunnel, the mould wrapped with atelocollagen sponge was placed within the neovagina. The hand-made mould made of expanded polystyrene was started to insert into the neovagina at 7 days after operation. Since this mould is lighter and easier to adjust compared with the previous commercialized ones, it was less stressful for the patients to master the procedure than previous methods. RESULTS: Average operation time was 124 minutes with average blood loss being 45 ml. Average hospital stay was 23 days. The mean length of the neovagina one week postoperation was 8 cm with two fingers in width in all patients. No remarkable postoperative complications were noted. At two months after surgery, the neovagina was confirmed to be completely epithelialized in all patients, assessed by Schiller's test. CONCLUSIONS: This innovative surgical procedure using a mould wrapped with atelocollagen sponge may be a more useful approach for the treatment of vaginal agenesis.
  • Ebina Y, Hazama R, Nishimoto M, Tanimura K, Miyahara Y, Morizane M, Nakabayashi K, Fukumoto T, Ku Y, Yamada H
    Journal of prenatal medicine 5 93 - 96 4 2011年10月 [査読有り][通常論文]
  • Tomoko Mitsuhashi, Katsuhiko Warita, Teruo Sugawara, Yoshiaki Tabuchi, Ichiro Takasaki, Takashi Kondo, Fumio Hayashi, Zhi-Yu Wang, Yoshiki Matsumoto, Takanori Miki, Yoshiki Takeuchi, Yasuhiko Ebina, Hideto Yamada, Noriaki Sakuragi, Toshifumi Yokoyama, Takashi Nanmori, Hiroshi Kitagawa, Jeffrey A. Kant, Nobuhiko Hoshi
    CONGENITAL ANOMALIES 50 2 85 - 94 2010年06月 [査読有り][通常論文]
     
    In normal ontogenetic development, the expression of the sex-determining region of the Y chromosome (SRY) gene, involved in the first step of male sex differentiation, is spatiotemporally regulated in an elaborate fashion. SRY is expressed in germ cells and Sertoli cells in adult testes. However, only few reports have focused on the expressions of SRY and the other sex-determining genes in both the classical organ developing through these genes (gonad) and the peripheral tissue (skin) of adult XY females. In this study, we examined the gonadal tissue and fibroblasts of a 17-year-old woman suspected of having disorders of sexual differentiation by cytogenetic, histological, and molecular analyses. The patient was found to have the 46,X,inv(Y)(p11.2q11.2) karyotype and streak gonads with abnormally prolonged SRY expression. The sex-determining gene expressions in the patient-derived fibroblasts were significantly changed relative to those from a normal male. Further, the acetylated histone H3 levels in the SRY region were significantly high relative to those of the normal male. As SRY is epistatic in the sex-determination pathway, the prolonged SRY expression possibly induced a destabilizing effect on the expressions of the downstream sex-determining genes. Collectively, alterations in the sex-determining gene expressions persisted in association with disorders of sexual differentiation not only in the streak gonads but also in the skin of the patient. The findings suggest that correct regulation of SRY expression is crucial for normal male sex differentiation, even if SRY is translated normally.
  • Tomoko Mitsuhashi, Katsuhiko Warita, Yoshiaki Tabuchi, Ichiro Takasaki, Takashi Kondo, Teruo Sugawara, Fumio Hayashi, Zhi-Yu Wang, Yoshiki Matsumoto, Takanori Miki, Yoshiki Takeuchi, Yasuhiko Ebina, Hideto Yamada, Noriaki Sakuragi, Toshifumi Yokoyama, Takashi Nanmori, Hiroshi Kitagawa, Jeffrey A. Kant, Nobuhiko Hoshi
    CONGENITAL ANOMALIES 50 1 40 - 51 2010年03月 [査読有り][通常論文]
     
    XY females are rare individuals who carry a Y chromosome but are phenotypically female. In approximately 80-90% of these cases, there are no mutations in the SRY gene, a testis-determining gene on the short arm of the Y chromosome, and the pathophysiology of XY females without SRY mutation remains unclear. In the present study, we used a molecular data mining technique to analyze the pathophysiology of an XY female with functional SRY and pericentric inversion of the Y chromosome, and compared the results with those of a normal male. Interestingly, upregulations of numerous genes included in the development category of the Biological Process ontology, including genes associated with sex determination and organ morphogenesis, were seen in the patient. Additionally, the transforming growth factor-beta (TGF-beta) signaling pathway and Wnt signaling pathway, in which most cell-cell interactions during embryonic development are involved, were altered. Alterations in the expression of numerous genes at the developmental stage, including alterations at both the gene and pathway levels, may persist as a vestige of anomalies of sex differentiation that presumably began in the fetal period. The present study indicates that a data mining technique using bioinformatics contributes to identification of not only genes responsible for birth defects, but also disorders of sex development (DSD)-specific pathways, and that this kind of analysis is an important tool for clarifying the pathophysiology of human idiopathic XY gonadal dysgenesis. Our findings could serve as one of the basic datasets which will be used for future follow-up investigations.
  • Hee Chul Park, Shinichi Shimizu, Akio Yonesaka, Kazuhiko Tsuchiya, Yasuhiko Ebina, Hiroshi Taguchi, Norio Katoh, Rumiko Kinoshita, Masayori Ishikawa, Noriaki Sakuragi, Hiroki Shirato
    YONSEI MEDICAL JOURNAL 51 1 93 - 99 2010年01月 [査読有り][通常論文]
     
    Purpose: The purpose of this study is to evaluate the clinical results of treatment with a high dose of 3-dimensional conformal boost (3DCB) using a real-time tracking radiation therapy (RTRT) system in cervical cancer patients. Materials and Methods: Between January 2001 and December 2004, 10 patients with cervical cancer were treated with a high dose 3DCB using RTRT system. Nine patients received whole pelvis radiation therapy (RT) with a median dose of 50 Gy (range, 40-50 Gy) before the 3DCB. The median dose of the 3DCB was 30 Gy (range, 25-30 Gy). Eight patients received the 3DCB twice a week with a daily fraction of 5 Gy. The determined endpoints were tumor response, overall survival, local failure free survival, and distant metastasis free survival. The duration of survival was calculated from the time of the start of radiotherapy. Results: All patients were alive at the time of analysis and the median follow-up was 17.6 months (range, 4.9-27.3 months). Complete response was achieved in nine patients and one patient had a partial response. The 1- and 2-year local failure free survival was 78.8% and 54%, respectively. The 1- and 2-year distant metastasis free survival was 90% and 72%, respectively. Late toxicity of a grade 2 rectal hemorrhage was seen in one patient. A subcutaneous abscess was encountered in one patient. Conclusion: the use of the high dose 3DCB in the treatment of cervical cancer is safe and feasible where intracavitary brachytherapy (ICBT) is unable to be performed. The escalation of the 3DCB dose is currently under evaluation.
  • Hidemichi Watari, Takashi Mitamura, Masashi Moriwaki, Masayoshi Hosaka, Yoko Ohba, Satoko Sudo, Yukiharu Todo, Mahito Takeda, Yasuhiko Ebina, Noriaki Sakuragi
    INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 19 9 1585 - 1590 2009年12月 [査読有り][通常論文]
     
    We investigated the survival and the failure pattern of 288 patients with endometrial cancer treated with extensive surgery including systematic pelvic and para-aortic lymphadenectomy followed by cisplatin-based chemotherapy from 1982 to 2002. We correlated the failure pattern with various clinicopathologic factors to find the predictors of recurrence sites. The 5-year overall survival rates were 97.5% for stage I, 87.5% for stage II, 85.2% for stage III, and 12.5% for stage IV Notably, the 5-year survival rate was 76.5% for patients with stage IIIC disease. Among patients with a low risk (n = 92) for recurrence who received no adjuvant chemotherapy, 2 (2.2%) showed recurrent disease. Among those with intermediate (n 98) and high (n = 98) risks for recurrence who received adjuvant chemotherapy, 9 (9.2%) and 20 (20.4%) showed recurrent disease, respectively. The recurrence sites were described as follows: distant (n = 12), vaginal (n = 8), peritoneal (n = 7), pelvic (n = 2), and lymphatic (n = 2). Lymphatic failure was found beyond the area of lymphadenectomy. Architectural and nuclear grades; myometrial, lymph-vascular space, and cervical invasions; and lymph node metastasis were predictors of distant failure. Cervical invasion and lymph node metastasis were predictors of vaginal failure. For patients with stage I/II cancer, the architectural and nuclear grades were related to distant failure. Seven (63.6%) of 11 patients with a low or intermediate risk survived after relapse, whereas only 1 (4.8%) of 21 patients with a high risk survived after a recurrence. We conclude that we need to further test the efficacy of systemic adjuvant therapy using new chemotherapeutic regimens to prevent distant failure and to improve the survival of patients with endometrial cancer.
  • 金内 優典, 三田村 卓, 首藤 聡子, 中谷 真紀子, 加藤 達矢, 保坂 昌芳, 武田 真人, 蝦名 康彦, 渡利 英道, 工藤 正尊, 櫻木 範明, 加藤 秀則, 半田 康, 木川 聖美, 野村 英司, 光部 兼六郎
    産婦人科手術 20 161 - 161 (株)メジカルビュー社 2009年06月 [査読有り][通常論文]
  • 乳癌の子宮頸部転移の一例
    加藤 達矢, 武田 真人, 保坂 昌芳, 三田村 卓, 蝦名 康彦, 渡利 英道, 櫻木 範明, 松野 吉宏, 久保田 佳奈子, 山田 洋介
    日本臨床細胞学会雑誌 47 Suppl.2 629 - 629 (公社)日本臨床細胞学会 2008年09月 [査読有り][通常論文]
  • 子宮頸部悪性黒色腫の一例
    佐々木 尚子, 武田 真人, 三田村 卓, 保坂 昌芳, 蝦名 康彦, 渡利 英道, 櫻木 範明, 松野 吉宏, 久保田 佳奈子, 山田 洋介
    日本臨床細胞学会雑誌 47 Suppl.2 630 - 630 (公社)日本臨床細胞学会 2008年09月 [査読有り][通常論文]
  • Masayoshi Hosaka, Hidemichi Watari, Mahito Takeda, Masashi Moriwaki, Yoko Hara, Yukiharu Todo, Yasuhiko Ebina, Noriaki Sakuragi
    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 34 4 552 - 556 2008年08月 [査読有り][通常論文]
     
    Aim: To compare the clinical efficacy focused on post-treatment morbidity between adjuvant chemotherapy (CT) and pelvic radiotherapy (RT) after radical hysterectomy for patients with cervical cancer. Methods: A total of 125 patients with cervical squamous cell carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy at Hokkaido University Hospital between 1991 and 2002 were enrolled in the study for retrospective analysis. Seventy patients with recurrent risk factors, including deep stromal invasion, lymph vascular space invasion, parametrial invasion, lymph node metastasis (LNM), and bulky tumor (>= 4 cm), received adjuvant therapy; 42 were treated with RT, and 28 were treated with CT. Almost all patients with multiple LNM received RT. Analyses were also performed on a subgroup of 50 patients without multiple LNM (23 RT, 27 CT). Clinical efficacy of post-treatment morbidity and survival was evaluated. Results: Because there were more patients with multiple LNM in the RT group, we analyzed disease-free survival in 50 patients without multiple LNM. The 3-year disease-free survival rate was 82.6% with RT and 96.3% with CT (P = 0.16). Postoperative bowel obstruction was significantly more frequent in the RT group versus the CT (P = 0.007) and no-therapy (P = 0.0026) groups. Urinary disturbance was also more frequent in the RT group than in the CT (P = 0.0016) and no-therapy (P = 0.089) groups. Conclusion: CT has the equivalent therapeutic effect as RT with fewer postoperative complications for patients with intermediate risks. A prospective randomized trial is needed to compare CT combined with radical hysterectomy and pelvic lymphadenectomy to RT or chemoradiotherapy.
  • Takahiro Yamada, Takao Matsuda, Masataka Kudo, Takashi Yamada, Masashi Moriwaki, Shinya Nishi, Yasuhiko Ebina, Hideto Yamada, Hidenori Kato, Tomoo Ito, Norio Wake, Noriaki Sakuragi, Hisanori Minakami
    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 34 1 121 - 124 2008年02月 [査読有り][通常論文]
     
    We present the first report of complete hydatidiform mole (HM) with coexisting dichorionic diamniotic twins. This pregnancy was achieved after testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermia in the woman's husband. Standard in vitro fertilization may cause multisperm fertilization and increase triploid partial HM and complete HM, which arise from dispermic fertilization. In contrast, ICSI can avoid multisperm fertilization. In our case, paternal isodisomy in the molar tissue was confirmed by microsatellite analysis suggesting that it resulted from duplication of a haploid paternal genome following monospermic fertilization of an inactivated oocyte or from monospermic fertilization of an inactivated oocyte with a diploid sperm. Although the patient was eager to continue the pregnancy, the size of the HM component increased rapidly and termination of the pregnancy was required for pre-eclampsia-like symptoms at 15 weeks of gestation. After the operation, chemotherapy was initiated for persistent trophoblastic disease.
  • H. Watari, M. Hosaka, T. Mitamura, M. Moriwaki, Y. Ohba, Y. Todo, M. Takeda, Y. Ebina, N. Sakuragi
    EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 29 6 573 - 577 2008年 [査読有り][通常論文]
     
    Purpose: Since the prognosis of recurrent ovarian cancer patients is still poor, we need to establish a useful treatment strategy to achieve their long-term survival. We treated recurrent ovarian cancer patients with weekly paclitaxel (PTX)/5-fluorouracil (5-FU) followed by platinum retreatment to investigate its clinical efficacy in a preliminary manner. Methods: Sixteen patients with recurrent ovarian cancer. pretreated with taxane and platinum, were treated with weekly paclitaxel (PTX)/5-fluorouracil (FU). PTX (80 mg/m(2)) on day 1, 8, and 15 was combined with a bolus injection of 5-FU (500 mg/m(2)) on day 2, 9, and 16. Chemotherapy was given every four weeks. Patients with stable disease or progressive disease Were subsequently retreated with a platinum-containing regimen, Response was evaluated by RECIST criteria or CA 1225 criteria. Toxicities were evaluated according to the National Cancer Institute-common toxicity Criteria (NCI-CTC) version 3. Results: Among live patients with sensitive disease, one Of four patients with measurable turner and one without measurable tumor responded to weekly PTX/5-FU. Among 11 patients with resistant disease. none of five patients with measurable tumor and three of six patients without measurable tumor responded to weekly PTX/5-FU, Overall objective response rate by weekly PTX/5-FU was 31.3% (5/16). Among 16 patients, 13 patients who showed no response or progressive disease (three with sensitive disease, ten with resistant disease) received platinum retreatment after weekly PTX/5FU. All three patients with sensitive disease and three of ten patients with resistant disease revealed response to platinum retreatment. Overall objective response rate by platinum retreatment after weekly PTX/5-FU was 46.2% (6/13). Conclusions: Weekly PTX/5FU followed by platinum retreatment Could be a useful treatment strategy for recurrent ovarian cancer patients. We need to establish the standard treatment strategy for recurrent ovarian cancer patients with a poor prognosis.
  • Yukiharu Todo, Kazuhira Okamoto, Masaru Hayashi, Shinichiro Minobe, Eiji Nomura, Hitoshi Hareyama, Mahito Takeda, Yasuhiko Ebina, Hidemichi Watari, Noriaki Sakuragi
    GYNECOLOGIC ONCOLOGY 104 3 623 - 628 2007年03月 [査読有り][通常論文]
     
    Objetive. The aim of this study was to verify whether a preoperative scoring system to estimate the risk of lymph node metastasis (LNM) in endometrial carcinoma is clinically useful for tailoring the indication of lymphadenectomy. Study design. LNM score was set up using volume index, serum CA125 level, and tumor grade/histology, which were found to be independent risk factors for LNM in a pilot study. Based on the LNM score before a validation study was started, the estimated rates of LNM (para-aortic LNM) were 3.4% (0.0%) in a low risk group, 7.7% (5.8%) in an intermediate group, 44.4% (30.6%) in a high risk group and 70.0% (50.0%) in an extremely high risk group. The validation study was carried out using data for 211 patients with endometrial carcinoma for whom three risk factors were preoperatively confirmed. Logistic regression analysis was used to determine whether these factors remain valid. The actual rate of LNM was investigated according to the LNM score. Results. Volume index, serum CA125 level, and tumor grade/histology were found to be independent risk factors for LNM in the cohort of this study. The actual rates of LNM (para-aortic LNM) were 3.2% (1.0%) in the low risk group, 15.3% (11.9%) in the intermediate group, 30.2% (23.8%) in the high risk group and 78.6% (57.1%) in the extremely high risk group. Conclusion. The actual rate of LNM for each score was fairly consistent with the estimated rate of LNM. Para-aortic lymphadenectomy may not be necessary in cases of a low risk group. A large prospective multicenter clinical trial needs to be conducted to establish the clinical usefulness of our preoperative scoring system. (c) 2006 Elsevier Inc. All rights reserved.
  • Y Todo, M Kuwabara, H Watari, Y Ebina, M Takeda, M Kudo, R Yamamoto, N Sakuragi
    INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 16 1 369 - 375 2006年01月 [査読有り][通常論文]
     
    The objective of this study was to assess the postsurgical bladder function by urodynamic study in patients with cervical cancer treated with nerve-sparing radical hysterectomy. A total of 27 consecutive patients were included in the study. Of the 27 patients, autonomic nerves had been completely preserved at least on one side in 22 patients (group A), and autonomic nerves could not be successfully preserved in five patients (group B). In group A, there was no significant difference in compliance at the moment of strong desire to void, maximum flow rate, and residual urine volume between before the operation and at 12 months after the operation. However, abdominal pressure at maximum flow had significantly increased in patients of group B than of group A. Detrusor contraction pressure at maximum flow had significantly decreased in patients of group B than of group A. Bladder sensation was diminished in three cases (60%) of group B but preserved in all the patients of group A. Although it is still preliminary, our surgical technique described in this report is thought to be effective for preservation of bladder function. For further evaluation of the efficacy of nerve-sparing radical hysterectomy in terms of quality of life and survival of patients, a prospective randomized trial needs to be performed.
  • R Yamamoto, T Ohkouchi, K Tabata, Y Ebina, H Watari, M Kudo, K Shimizu, S Satomura, H Minakami, N Sakuragi
    ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA 84 12 1145 - 1149 2005年12月 [査読有り][通常論文]
     
    Background. The mechanisms of the increase in the percentage of alpha-fetoproteins (AFPs) that strongly binds to Lens culinaris agglutinin (AFP-L3) in pregnancies with a trisomy 21 fetus have not been analyzed. To investigate the oligosaccharide variants of AFP produced by normal fetuses and fetuses with trisomy 21, the lectin reactivity of AFP was analyzed. Methods. Fetal liver tissue, amniotic fluid, and maternal serum were obtained from five normal pregnancies and five pregnancies with a trisomy 21 fetus. The percentages of AFP reactive to lectins were determined by lectin-affinity electrophoresis coupled with antibody-affinity blotting. Results. The percentages of AFP-L3 in the fetal liver and the maternal serum were 23.9 and 27.0%, respectively, in normal pregnancies, and 28.7 and 38.5%, respectively, in pregnancies with a trisomy 21 fetus. There was no statistically significant difference between the percentage in the fetal liver and the percentage in the maternal serum in normal pregnancies; however, a significant difference (P < 0.01) was found in pregnancies with a trisomy 21 fetus. In regard to the percentage of AFP-L3 in the fetal liver, there was no significant difference; however, a significant difference (P < 0.05) was found in the maternal serum between normal pregnancies and pregnancies with a trisomy 21 fetus. Conclusions. The transference of the AFP-L3 fraction might be relatively high in the placentas of women carrying a trisomy 21 fetus, and this could be the one of the reasons for the increase in the percentage of AFP-L3 in the maternal serum in pregnancies with a trisomy 21 fetus.
  • N Sakuragi, H Watari, Y Ebina, R Yamamoto, E Steiner, H Koelbl, M Yano, M Tada, T Moriuchi
    INTERNATIONAL JOURNAL OF CANCER 116 4 514 - 519 2005年09月 [査読有り][通常論文]
     
    In addition to the loss of function, mutant p53 can possess a dominant-negative effect on wild-type p53 and may also exert gain-of-function activity. It is not clear whether the functional status of p53 mutation contributes to differences in outcome in endometrial cancer. We collected a total of 92 RNA samples of high quality from endometrial cancer tissues, and the samples were subjected to yeast functional assay and sequencing for p53 mutations. The detected mutant p53 genes were further investigated for their dominant-negative activity using a yeast-based transdominance assay. p53 mutation was found in 24 out of 92 (26.1%) tumors, of which 10 exhibited no dominant-negative activity (recessive mutation) and 14 showed dominant-negative activity. Dominant-negative p53 mutation was related to advanced stages (p = 0.01), non-endometrioid type tumors (p = 0.01) and grade 3 tumors (p = 0.04). The patients with dominant-negative mutation had significantly shorter survival than patients with no mutation (p < 0.0001) and those with a recessive mutation (p = 0.01) in the p53 gene. No difference in survival was found between the patients with tumors harboring a recessive p53 mutation and those with tumors harboring a wild-type p53. Multivariate analysis revealed that dominant-negative p53 mutation (p = 0.019), FIGO stage (p = 0.0037) and histologic subtype (p = 0.014) were independently related to patient survival. Dominant-negative p53 mutation was the most important prognostic factor for stage III/IV endometrial cancer (P = 0.0023). In conclusion, dominant-negative p53 mutation is often found in advanced stages and aggressive histologic subtypes of endometrial cancer and it is a strong predictor of survival of patients with advanced endometrial cancer. To elucidate further the role of p53 mutation in endometrial cancer, it is necessary to investigate gain-of-function activity involving dominant-negative p53 mutant proteins. (c) 2005 Wiley-Liss, Inc.
  • H Watari, Y Todo, M Takeda, Y Ebina, R Yamamoto, N Sakuragi
    GYNECOLOGIC ONCOLOGY 96 3 651 - 657 2005年03月 [査読有り][通常論文]
     
    Objective. The aim of this Study was to determine pathologic variables associated with disease-specific survival of node-positive patients with endometrial carcinoma treated with combination of surgery including pelvic and para-aortic lymphadenectomy and adjuvant chemotherapy. Methods. Survival of 55 node-positive endometrial carcinoma patients prospectively treated with Surgery and adjuvant chemotherapy between 1982 and 2002 at Hokkaido University Hospital was compared to various histopathologic variables. All patients underwent primary surgical treatment including pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy consisting of intravenous cisplatin, doxorubicin, and cyclophosphamide. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis using a forward stepwise selection. Results. Among 303 consecutive endometrial cancer patients treated during the period of this study, 55 patients (18.2%), including 44 without peritoneal rnetastasis (FIGO stage IIIc) and II with peritoneal metastasis (FIGO stage IV), were found to have retroperitoneal lymph node metastasis. Multivariate Cox regression analysis revealed that peritoneal metastasis and lymph-vascular space invasion (LVSI) were independently related to poor Survival in node-positive endometrial carcinoma. The estimated 5-year survival rate of stage IIIc patients with or without moderate/prominent LVSI was 50.9% and 93.3%, respectively with statistically significant difference (P = 0.0024). The estimated 5-year survival rate of stage IV patients was 20.0%. Prognosis of stage IIIc patients could be stratified into three groups by the number of positive para-aortic node (PAN) with an estimated 5-year survival rate of 86.4% for no positive PAN (n = 23), 60.4% for one positive PAN (n = 13), and 20.0% for >= 2 positive PAN (n = 8). The difference of survival rate between no or one positive PAN and >= 2 positive PAN was statistically significant (P = 0.0007 for no positive PAN vs. >= 2 positive PAN, P = 0.0319 for one positive PAN vs. >= 2 positive PAN). Multivariate analysis including number of positive PAN groups showed that LVSI, number of positive PAN groups were independent prognostic factors for survival. Survival of patients with stage IIIc disease could be stratified into three groups by combination of LVSI and number of positive PAN groups with an estimated 5-year Survival rate of 93.3% for no or one positive PAN group with nil or minimal LVSI, 62.6% for no or one positive PAN group with intermediate or prominent LVSI, and 20.0% for 2 positive PAN groups irrespective of LVSI (P = 0.0002 for no or one positive PAN group with nil or minimal LVSI vs. 2 positive PAN groups, P = 0.0223 for no or one positive PAN group with nil or minimal LVSI vs. no or one positive PAN group with intermediate or prominent LVSI, P = 0.0388 for no or one positive PAN group with intermediate or prominent LVSI vs. >= 2 positive PAN groups). Conclusions. LVSI and number of positive PAN groups were independent prognostic factors for stage IIIc endometrial cancer patients. Postoperative therapy and follow-up modality need to be individualized according to LVSI and the number of positive PAN for stage life patients. New molecular markers to predict the Prognosis of endometrial cancer patients preoperatively should be found for individualization of treatment. New chemotherapy regimen including taxane needs to be considered as an adjuvant therapy for patients with node-positive endometrial cancer. (c) 2004 Elsevier Inc. All rights reserved.
  • H Negishi, M Takeda, T Fujimoto, Y Todo, Y Ebina, H Watari, R Yamamoto, H Minakami, N Sakuragi
    GYNECOLOGIC ONCOLOGY 94 1 161 - 166 2004年07月 [査読有り][通常論文]
     
    Objective. We evaluated the primary sites of lymph node (LN) metastasis in patients during the early stage of ovarian cancer. Methods. Study 1: patients with clinical stage I and II common epithelial ovarian carcinoma (n=150) underwent systematic retroperitoneal LN dissection of the pelvic and paraaortic areas. The relationship between the incidence and location of LN metastasis and clinical and histological characteristics was examined. Study 2: we studied I I women with endometrial or fallopian tube tumors. At laparotomy, activated charcoal solution was injected into the unilateral cortex of the ovary. Ten minutes later, the retroperitoneal spaces were opened and charcoal uptake within the pelvic lymph node (PLN) and paraaortic node (PAN) as far as the level of renal vein was examined. Results. Study 1: The incidence of LN metastasis by stage was 6.5% (8/123) in stage I and 40.7% (11/27) in stage II. Among 19 patients with LN metastasis, 14 had only PAN, 2 had only pelvic LN, and 3 had both PAN and PLN metastases. Metastasis was limited to the ipsilateral side in 12 (63%) patients, but was bilateral in 5 (26%) and contralateral to the neoplastic ovary in 2 (11%). Positive peritoneal cytology was significantly (P<0.05) correlated with lymph node metastasis. Study 2: Lymphatic channels along the ovarian vessels were identified in all injected ovaries. Charcoal was deposited in the LN of all patients. The locations of these nodes included PAN in all patients, common iliac node in three, and external iliac node in one. Conclusion. PAN is the primary site of LN metastasis in ovarian cancer. Bilateral PAN dissections are necessary to determine the extent of tumors even in stage I ovarian carcinoma. (C) 2004 Elsevier Inc. All rights reserved.
  • Yamamoto R, Minobe S, Ebina Y, Watari H, Kudo M, Henmi F, Satomura S, Fujimoto S, Minakami H, Sakuragi N
    Congenital anomalies 44 87 - 92 2 2004年06月 [査読有り][通常論文]
  • M Kaneuchi, M Sasaki, Y Tanaka, H Shiina, M Verma, Y Ebina, E Nomura, R Yamamoto, N Sakuragi, R Dahiya
    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS 316 4 1156 - 1162 2004年04月 [査読有り][通常論文]
     
    We hypothesize that 14-3-3 sigma gene expression and its regulation by methylation can characterize histological types of primary human epithelial ovarian cancer. To test this hypothesis, ovarian cancer cell lines and 54 ovarian cancer tissue samples were analyzed for expression and methylation of 14-3-3 sigma gene using methylation specific PCR. The results of our experiments demonstrate that 14-3-3 sigma gene was methylated and inactivated in ES-2 ovarian cell line, which was derived from clear cell adenocarcinoma. Treatment of this cell line with demethylating agent 5-aza-2'-deoxycytidine restored the expression of 14-3-3 sigma gene. In human ovarian cancer tissues, the expression of 14-3-3 sigma protein was inactivated in most of the ovarian clear cell carcinoma tissues. Interestingly, 14-3-3 sigma protein expression was positive in significantly higher percentages of serous (89.5%), endometrioid (90%), and mucinous (81.8%) ovarian adenocarcinoma tissues. The ovarian clear cell carcinoma samples with inactivated 14-3-3 sigma protein were highly methylated, suggesting that inactivation of 14-3-3 sigma gene is through DNA methylation. Using direct DNA sequencing, 14-3-3 sigma gene methylation on all the 17 CpG sites was significantly higher in ovarian clear cell carcinoma as compared to other histological types of ovarian cancer (serous, endometrioid, and mucinous). This is the first report suggesting that 14-3-3 sigma gene expression and methylation status can characterize histological features of different types of ovarian cancer. (C) 2004 Elsevier Inc. All rights reserved.
  • Y Ebina, D Akashi, M Takeda, H Watari, R Yamamoto, H Minakami, N Sakuragi
    PET AND MOLECULAR IMAGING: STATE OF THE ART AND FUTURE PERSPECTIVES 1264 222 - 226 2004年 [査読有り][通常論文]
     
    We evaluated the clinical significance of FDG-PET to detect recurrent tumors in ovarian cancer patients. Retrospective chart review of four patients with recurrent ovarian cancer was performed. All patients underwent initial cytoreductive surgery and chemotherapy. Recurrence was suspected at 3-14 years after initial treatment. Three patients had a suspected recurrence based on elevated serum CA 125 level. All patients had increased FDG uptakes in abdominal wall, ascending colon, paraaortic node, and pararectal lesion. They underwent laparotomy to resect the tumors and histology confirmed recurrence. After completion of the operation, CA 125 level was normalized. Accurate identification of recurrent tumor nodules may have a significant impact on clinical management and the selection of patients for tumor resection. (C) 2004 Elsevier B.V. All rights reserved.
  • H Yamada, EH Kato, M Morikawa, S Shimada, Y Ebina, N Sakuragi, S Suzuki, H Minakami
    SEMINARS IN THROMBOSIS AND HEMOSTASIS 29 6 639 - 643 2003年12月 [査読有り][通常論文]
     
    We present the clinical characteristics of pregnancy histories and subsequent pregnancy outcomes of 13 women who tested positive for anticardiolipin beta(2)-glycoprotein I antibody (aCLbeta2GPI). Six of the 13 women had a history of recurrent spontaneous abortion (RSA). The prevalence of aCLbeta2GPI syndrome among women with RSA was very low (2.1%). Other women with aCLbeta2GPI were identified by the presence of a biological falsepositive serological test for syphilis, intrauterine growth restriction (IUGR), and a history of thrombosis. However, serum aCLbeta2GPI titers in the 13 women varied, with a wide range from 3.6 to 1468 U/mL. Their pregnancy histories, subsequent pregnancy outcomes, and complications were compared according to the classification of serum aCLbeta2GPI titers as low, moderate, or high. The history of second trimester fetal death was found only in women with high serum aCLbeta2GPI titers. All women with high serum aCLbeta2GPI titers experienced severe maternal-fetal complications such as IUGR, fetal distress, systemic thromboembolism, and neonatal sequelae in subsequent pregnancies.
  • Y Todo, S Minobe, K Okamoto, M Takeda, Y Ebina, H Watari, M Terashima, M Kaneuchi, R Yamamoto, N Sakuragi
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 33 12 636 - 641 2003年12月 [査読有り][通常論文]
     
    Objective: Serous adenocarcinoma (SAC) of the endometrium has a poor prognosis compared with that of typical endometrioid adenocarcinoma (EAC). The objective of this study was to determine whether SAC can be distinguished from EAC preoperatively by cervical or endometrial cytology. Study design: Cervical smears and endometrial smears obtained from 128 patients with endometrial carcinoma were reviewed. Histological types included 117 cases of EAC and 11 cases of SAC. The positive rates of cervical smears and those of endometrial smears in SAC and EAC cases were compared. Papillary clusters and bare nuclei of malignant cells in positive cervical smears were also investigated for their diagnostic significance in discriminating between EAC and SAC. Results: The positive rate of cervical smears in SAC was significantly higher than that in EAC (72.7 vs 27.4%, P < 0.05). Among cases with positive cervical smears, there were significantly more cases with papillary clusters and/or bare nuclei in cases of SAC than in cases of EAC. Conclusion: When endometrial carcinoma is clinically suspected and a cervical smear is positive, the predominance of either papillary clusters or features of bare nuclei of malignant cells in the smear may indicate the presence of SAC.
  • Y Todo, N Sakuragi, R Nishida, T Yamada, Y Ebina, R Yamamoto, S Fujimoto
    AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 188 5 1265 - 1272 2003年05月 [査読有り][通常論文]
     
    OBJECTIVE: The aim of this study was to predict retroperitoneal lymph node metastasis during the preoperative examination of patients with endometrial carcinoma and to determine whether lymphadenectomy must be performed. STUDY DESIGN: This study was carried out on 214 patients with endometrial carcinoma. Preoperative evaluators were volume index, depth of myometrial invasion (as assessed by magnetic resonance imaging), serum CA 125 level, histologic type, and histologic grade. With the use of receiver operating characteristic curves, cutoff values of volume index and serum CA 125 levels were determined. The relationships of these evaluators with pelvic lymph node metastasis were investigated by multivariate analysis with a logistic regression model. The relationships of these evaluators with para-aortic lymph node metastasis were investigated in the same way. RESULTS: Histologic type, volume index, histologic grade, and serum CA 125 level were found to be independent risk factors for pelvic lymph node metastasis; serum CA 125 level and volume index were found to be independent risk factors for para-aortic lymph node metastasis. Among 110 cases with no risk factors for pelvic lymph node metastasis, pelvic lymph node metastasis was observed in 4 cases (3.6%). On the other hand, only 1 case of 128 cases (0.7%) with no risk factors for para-aortic lymph node metastasis actually had metastasis. CONCLUSION: Careful consideration of the possibility of the elimination of the requirement of retroperitoneal lymphadenectomy is needed in cases with no risk factors for lymph node metastasis. However, our results suggest that para-aortic lymphadenectomy may not be necessary in cases with no risk factors for para-aortic lymph node metastasis.
  • T Kishida, H Yamada, Furuta, I, N Kobayashi, EK Hirayama, Y Ebina, N Sakuragi, S Fujimoto
    FETAL DIAGNOSIS AND THERAPY 18 2 98 - 104 2003年03月 [査読有り][通常論文]
     
    Objective: The objective of this study was to investigate the predictive factors of premature rupture of the membranes (preterm PROM). Methods:The study was undertaken with cervical secretions collected from 72 consenting singleton pregnant women between 20 and 33 weeks of gestation. The levels of interleukin (IL) 1alpha, IL-1beta, IL-6, IL-8, matrix metalloproteinase (MMP) 1, MMP-2, MMP-9, tissue inhibitors of matrix metalloproteinase (TIMP) 1, TIMP-2, granulocyte elastase, and fetal fibronectin in cervical diluted specimens were measured by immunoassay, and the uterine cervix was assessed by transvaginal ultrasonography. Demographic, obstetric, clinical, neonatal, and laboratory data were analyzed by univariate analysis, multiple logistic regression, and receiver operator characteristic curve analysis. Results: Preterm PROM occurred in 6 women, and 63 women delivered at term. Multiple logistic regression analysis indicated a significant independent association with preterm PROM for the cervical IL-6 levels and cervical length. The receiver operator characteristic curve analysis revealed that an IL-6 level of greater than or equal to240 pg/ml in cervical secretions and a cervical length of less than or equal to28 mm had higher diagnostic performance in predicting preterm PROM. Conclusion: It is suggested that preterm PROM is associated with increased cervical IL-6 levels and a short cervix. Copyright (C) 2003 S. Karger AG, Basel.
  • Y Ebina, H Yamada, EH Kato, R Yamamoto, N Sakuragi, S Fujimoto
    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 28 5 251 - 257 2002年10月 [査読有り][通常論文]
     
    We treated three thrombophilia-complicated pregnant women (two antiphospholipid antibody syndrome, one protein C deficiency) with low molecular weight heparin (dalteparin). All three pregnancies including one twin pregnancy ended in live births without a decrease in bone mineral density This treatment modality was effective and safe preventing thrombosis during their pregnancies.
  • Y Ebina, N Sakuragi, H Hareyama, Y Todd, E Nomura, M Takeda, K Okamoto, H Yamada, R Yamamoto, S Fujimoto
    ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA 81 5 458 - 465 2002年05月 [査読有り][通常論文]
     
    Background. To investigate the relationship between preoperative serum CA 125 levels and para-aortic lymph node (PAN) metastasis as determined by systematic pelvic and para-aortic lymph node dissection in endometrial carcinoma. Methods. This study included 180 patients (n = 55, premenopausal; n = 125, postmenopausal) with endometrial carcinoma treated by complete surgical staging. Cut-off values of preoperative serum CA 125 levels for PAN metastasis were determined by receiver characteristic curve (ROC) analysis. Logistic regression analysis was used to determine independent predictors for PAN metastasis. Results. The median serum CA 125 levels of patients with PAN metastasis were significantly higher than the levels of those with no metastasis in both premenopausal and postmenopausal groups. Based on ROC analysis, we could determine four cut-off values (70 and 210 U/mL for premenopausal patients, 20 and 60 U/mL for postmenopausal patients) and categorize the serum CA 125 levels into low, moderate and high groups. By logistic regression analysis, the CA 125 level and nuclear grade were found to be significant predictors of PAN metastasis, respectively. Using this model, the patients were stratified into three risk groups. The probabilities of PAN metastasis for patients in the low-risk, intermediate-risk and high-risk groups were less than 2%, 2-25% and more than 50%, respectively. Conclusions. Serum CA 125 levels and nuclear grade are important risk factors for PAN metastasis in endometrial carcinoma.
  • A Yamaguchi, N Hashimoto, W Tsutae, K Seino, Y Ebina, T Tokino, N Sato, K Kikuchi
    CLINICA CHIMICA ACTA 318 1-2 41 - 49 2002年04月 [査読有り][通常論文]
     
    Background: Cervical cancer screening is conducted by a cytological Papanicolaou (Pap) test. For screening, it is becoming increasingly important to introduce a more objective result, based on human papillomavirus (HPV) DNA test. We describe here a practical method allowing the mass detection of HPV-DNA by PCR followed by fluorogenic DNA intercalation. Methods: Samples used were cervical scrapes or biopsy specimens obtained from women who had undergone cytological testing for cervical cancer, Crude DNAs were extracted by a simplified proteinase K-boil method. Common and type-specific primers were newly designed for major types of high-risk HPVs. A fluorogenic DNA intercalator, SYBR(R) Green I was directly added to the specific PCR products. The resultant fluorescence was measured by a conventional fluorometric microplate reader. Results: The proposed PCR/microfluorometry (MFL) allowed a simple, rapid and economical detection of HPV-DNA without any use of labeling primers or probes. HPV-DNAs were found in 48.2% (123/255) of the cervical scrapes. The detection rate of HPV in cervical cancer biopsy specimen was 92.4% (61/66). Conclusions: PCR/MFL detection of HPV-DNA, followed by combined type-specific PCR, is expected to be an extremely useful tool in cervical cancer screening. (C) 2002 Elsevier Science B.V. All rights reserved.
  • S Kataoka, Furuta, I, H Yamada, EH Kato, Y Ebina, T Kishida, N Kobayashi, S Fujimoto
    PLACENTA 23 2-3 224 - 231 2002年02月 [査読有り][通常論文]
     
    Apoptosis is thought to participate pathophysiologically in the rupture of human fetal membranes (ROM). The aim of this study was to assess apoptosis of the amnion and the chorion in relation to ROM and chorioamnionitis (CAM). The amnion and chorian at the position of the cervical os and fundus of the uterus were obtained from 44 patients. Apoptotic DNA fragmentation was densitometrically determined, and the relative ratio was used for the quantitative evaluation. Among patients without CAM, the relative ratios of apoptosis in the amnion from patients with ROM were higher than those in patients without ROM (P<0.05). Among patients without ROM, the apoptotic levels in the amnion from patients with CAM were higher than those in patients without CAM (P<0.05). These were the cases with die amnion at the position of cervical os and fundus, but not with the chorion, The highest ratio of apoptosis was seen in the amnion from patients with CAM and ROM. Among patients with ROM and no CAM, the apoptotic levels at the cervical os in the amnion (P=0.059) and chorion (P<0.05) was higher than those at the fundus. The increased apoptosis of human fetal membranes was related to ROM and CAM. Apoptosis plays a role in the pathophysiology of ROM. (C) 2002 Esevier Science Ltd.
  • G Kobashi, H Yamada, K Ohta, EH Kato, Y Ebina, S Fujimoto
    AMERICAN JOURNAL OF MEDICAL GENETICS 103 3 241 - 244 2001年10月 [査読有り][通常論文]
     
    Hypertension in pregnancy (HP), including preeclampsia, is known to be a multifactorial disease. Recently, a Glu298Asp variant of the endothelial nitric oxide synthase gene (NOS3) was identified as being associated with coronary spasm and myocardial infarction, whereas it has been reported that endothelial nitric oxide synthase plays a role in HP. We therefore performed an association study of the Glu298Asp variant with HP among 152 H-P patients and 335 normal pregnant control individuals, in the context of other risk factors before pregnancy. The frequency of the variant GA+AA NOS3 genotypes was significantly higher in the patients (0.23) than in the controls (0.12) (P <0.01). Multivariate analysis revealed that family history of hypertension, TT genotype of the angiotensinogen gene (AGT), GA+AA NOS3 genotype, and prepregnancy body mass index greater than or equal to 24 were independent potent risk factors, after adjustment for maternal age and parity. The odds ratios of the factors were 2.7, 2.3, 2.2, and 2.1, respectively. Our results suggested that the Asp298 of NOS3 is a potent, independent risk factor for HP. (C) 2001 Wiley-Liss, Inc.
  • T Kishida, H Yamada, Furuta, I, N Kobayashi, EK Hirayama, Y Ebina, K Cho, K Okuyama, S Fujimoto
    FETAL DIAGNOSIS AND THERAPY 16 5 259 - 264 2001年09月 [査読有り][通常論文]
     
    Objectives: The objectives of this study were to cl in ica I ly characterize and seek risk factors for the patients with persistently detected alfa-fetoprotein (AFP) in the vagina without showing overt preterm premature rupture of the membranes (PROM). Study Design: The cohort study was undertaken using vaginal-cervical specimens collected consecutively between 21 and 40 weeks of gestation from 25 consenting women. Demographic, obstetric, neonatal, and laboratory data from patients with persistent positive results of AFP kit tests without showing overt leakage of amniotic fluid were compared to those from controls. Cervical levels of interleukin-1 alpha, interleukin-1 beta, interieukin-6, interleukin-8, and granulocyte elastase were measured by immunoassay, and the uterine cervix was assessed by transvaginal ultrasonography. Statistical analysis involved Fisher's exact test and Mann-Whitney U test. Results: The incidence of overt preterm PROM was significantly higher in the patients with persistently detected AFP in preterm (3 in 4 cases) than in controls (3 in 21 controls). At sampling before determination of persistently detected AFP, patients with persistently detected AFP had significantly higher cervical levels of interleukin-6 and significantly shorter cervical length than controls. Conclusions: Patients with persistently detected AFP in the vagina without showing overt preterm PROM have the risk of overt preterm PROM. Increased levels of interleukin-6 in cervical specimens and short cervical length may be risk factors for the occurrence of persistent detection of AFP in the preterm. Copyright (C) 2001 S. Karger AG, Basel.
  • Yamada H, Kato EH, Kobashi G, Ebina Y, Shimada S, Morikawa M, Sakuragi N, Fujimoto S
    American journal of reproductive immunology (New York, N.Y. : 1989) 46 132 - 136 2 2001年08月 [査読有り][通常論文]
  • H Yamada, EH Kato, G Kobashi, Y Ebina, S Shimada, M Morikawa, N Sakuragi, S Fujimoto
    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY 46 2 132 - 136 2001年08月 [査読有り][通常論文]
     
    PROBLEM: The aim of this study was to assess the role of natural killer (NK) cells in pregnant women with a history of recurrent spontaneous abortion (RSA). METHOD OF STUDY: Consecutive 66 pregnant women with a history of RSA were prospectively assessed for peripheral NK cell activity, percentage of the NK cell subsets, and subsequent pregnancy outcome. RESULTS: NK cell activity in women with subsequent live birth (group I) at 4-5 gestational weeks (GW) (mean +/- SD, 32.5 +/- 12.3%) significantly decreased at 6-7 GW (28.1 +/- 12.1%) and at 8-9 GW (28.0 +/- 11.8%). NK cell activity in women with subsequent abortion with normal chromosomes (group II) at 6-7 GW (41.2 +/- 19.0%) was significantly higher than that in group I women, while NK cell activity at 6-7 GW in women with subsequent abortion with abnormal chromosomes (group III) was the same as the level in group I women. CONCLUSIONS: High NK cell activity at 6-7 GW correlates with subsequent abortion with normal chromosomes.
  • Yamada H, Noro N, Kato EH, Ebina Y, Cho K, Fujimoto S
    European journal of obstetrics, gynecology, and reproductive biology 97 1 101 - 104 1 2001年07月 [査読有り][通常論文]
     
    A pregnant woman developed acute demyelinating poly-neuropathy (Guillain-Barre syndrome (GBS)) in the 28th week of gestation (GW) after flu-like infection. Hypertension, liver dysfunction, and a decrease in consciousness level developed at 29 GW. Blood chemical analysis revealed increased levels of liver enzymes GOT 247 IU/I and GPT 624 IU/I. Viral serological study showed a positive test for Epstein-Barr virus IgM. Weakness of bilateral facial muscles and limbs, a loss of tendon reflexes, and generalized paresthesia were detected by neurologic examinations. Over the course of 5 days, a massive dose (100 g) of intravenous immunoglobulin (MIVIg) was infused in 30 GW. An average manual muscle testing score by the Medical Research Council method and peak flow value began to be significantly restored during and after MIVIg infusions. Values of the liver enzymes gradually decreased, and improvement of the muscle weakness and dysbasia was observed. Her pregnancy normally ended in spontaneous vaginal delivery of a healthy infant in 37 GW. This is the first report confirming the efficacy of MIVIg, without plasmapheresis, in GBS-complicated pregnancy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
  • ML Luo, N Sakuragi, M Shimizu, K Seino, K Okamoto, M Kaneuchi, Y Ebina, K Okuyama, T Fujino, T Sagawa, S Fujimoto
    CANCER CYTOPATHOLOGY 93 2 115 - 123 2001年04月 [査読有り][通常論文]
     
    BACKGROUND. Noncancerous cells simulating adenocarcinoma cells may interfere with the analysis of peritoneal cytology (PC) in patients with endometrial carcinoma. Immunocytochemistry (ICC) may improve the diagnosis of PC. METHODS, PC slides from 115 patients with endometrial carcinoma were reviewed. Suspicious or positive cell clusters were recovered with a cell transfer method and were subjected to ICC for MOC-31, cytokeratin 5/6, and p53. Conventional Papanicolaou staining and ICC results were compared directly on the same cells. RESULTS. By combined conventional and immunocytochemical PC (CONV-ICC-PC), cytodiagnosis was positive in 18 of 115 patients (15.7%) and suspicious in 3 of 115 patients (2.6%). According to a multivariate Cox regression analysis of patients with tumors confined to the uterus that included grade, myometrial invasion, cervical involvement, and CONV-ICC-PC, only CONV-ICC-PC was an independent prognostic factor (P < 0.05). A multivariate analysis for all of the patients studied that compared CONV-ICC-PC with staging variables revealed that only peritoneal metastasis (P < 0.0001) and lymph node metastasis (P < 0.01) were independent prognostic factors. When peritoneal metastases were excluded, CONV-ICC-PC (P < 0.01) and lymph node metastasis (P < 0.0025) were the independent prognostic factors. By cell transfer and p53 immunostaining in samples from 14 patients with malignant cells in their peritoneal washings, no deaths occurred among 5 patients with negative p53, whereas 5 of 9 patients with positive p53 died of disease at the time of data analysis. CONCLUSIONS, MOC-31 immunostaining improves the diagnosis of PC in endometrial carcinoma. Positive PC is an important prognostic factor for patients with endometrial carcinoma confined to the uterus. The p53 positive cells in PC have possible prognostic significance. Cancer (Cancer Cytopathol) 2001;93:115-123, (C) 2001 American Cancer Society.
  • Y Ebina, H Yamada, EH Kato, F Tanuma, S Shimada, K Cho, S Fujimoto
    PRENATAL DIAGNOSIS 21 1 68 - 71 2001年01月 [査読有り][通常論文]
     
    We report a case of agnathia-holoprosencephaly which was prenatally diagnosed based on helical computed tomography (CT) images obtained at 23 weeks of gestation. Ultrasound examination first showed the presence of alobar holoprosencephaly, but the facial structures were not clearly detailed. However, three-dimensional imaging by helical CT precisely demonstrated the most striking feature of agnathia: absence of the mandible. This technique provided us valuable information that contributed to the in utero diagnosis. In utero helical CT is a useful examination tool for the diagnosis of osteogenic abnormalities. Copyright (C) 2001 John Wiley & Sons, Ltd.
  • H Yamada, EH Kato, R Tsuruga, Y Ebina, G Kobashi, T Sagawa, Z Makita, T Koike, S Fujimoto
    GYNECOLOGIC AND OBSTETRIC INVESTIGATION 51 2 103 - 109 2001年 [査読有り][通常論文]
     
    The aim of this study was to evaluate the insulin dynamics of patients with gestational diabetes mellitus (GDM) and to compare perinatal outcomes according to the insulin response patterns. Twenty-two out of 925 consecutive women examined were diagnosed as having GDM. One hundred and ten women who experienced a normal pregnancy were used as controls. Plasma glucose levels and insulin responses were evaluated by a 2-hour 75-gram oral glucose tolerance test (OGTT). Immunoreactive insulin (IRI), the area under the curve (AUC) of glucose (AUCg) and insulin (AUCi), and the insulinogenic index (II = Delta IRI 30 min/Delta BS 30 min) were measured. The GDM patients were divided into three subgroups, consisting of hyper-, normo- and hypoinsulinemic groups, according to the mean +/- 2 SD of the AUCi obtained from the controls. Clinical and laboratory findings were compared among the GDM subgroups and controls. The GDM patients showed impaired insulin secretion to glucose stimuli, with low plasma insulin levels (at 30 min) and reduced insulin/glucose ratios (at 30 and 60 min) early in the 75-gram OGTT. The II and AUCi/AUCg values of GDM patients were reduced as compared with those of controls. These reduced insulin responses were remarkable in hypo- and normoinsulinemic GDM patients, but were not detected in hyperinsulinemic GDM patients. The number of babies large for their gestational age in normo- and hypoinsulinemic GDM patients was significantly higher than that in hyperinsulinemic GDM patients or controls. Hyperinsulinemic GDM patients had a high frequency of pregnancy-induced hypertension (40%). The body mass index prior to pregnancy of hyperinsulinemic GDM patients was significantly higher than that of normoinsulinemic GDM patients or controls. It was demonstrated that not only insulin secretion, but also perinatal clinical characteristics, differed among the GDM subgroups. The heterogeneity of the disease was thus confirmed. Copyright (C) 2001 S. Karger AG. Basel.
  • H Yamada, EH Kato, G Kobashi, Y Ebina, S Shimada, M Morikawa, T Yamada, N Sakuragi, S Fujimoto
    SEMINARS IN THROMBOSIS AND HEMOSTASIS 27 2 121 - 129 2001年 [査読有り][通常論文]
     
    Congenital and acquired thrombophilia are associated with an increased risk of pregnancy-associated venous thrombosis and fetal loss. Two hundred eighty-nine patients with a history of recurrent spontaneous abortion were subjected to screening examinations for the etiology of these abortions. Endocrine abnormality (28.0%), uterine abnormality (10.4%), autoimmune diseases (1.4%), antiphospholipid antibody syndrome (4.5%), and balanced type chromosome translocation (4.2%) were found as underlying causes of recurrent abortions, and the remaining 55.0% of the 289 patients were classified as having an unexplained etiology. Congenital thrombophilia such as protein C (PC) deficiency, protein S (PS) deficiency, antithrombin deficiency, and factor V Leiden mutation was not frequently detected; only one patient had PS deficiency. A reduced factor XII activity was found at a frequency of 4.2%. The frequency of methylene tetrahydrofolate reductase gene C677T mutation in recurrent aborters (0.38) was the same as that found in a fertile control group. Although the prevalence of anti-beta2-glycoprotein I antibody (a beta2-GPI) syndrome was very low (1.7%), patients with a high titer of immunoglobulin G (IgG) class a beta2-GPI, despite anticoagulation therapy, experienced severe fetomaternal complications in subsequent pregnancies. The rate (13.8%) of positive tests for serum IgA class a beta2-GPI in patients with unexplained etiology was higher than that in the controls (0%) (P < .05). We conclude that congenital thrombophilia is rare in Japanese patients who had experienced consecutive spontaneous abortions.
  • M Morikawa, H Yamada, EH Kato, S Shimada, Y Ebina, T Yamada, T Sagawa, G Kobashi, S Fujimoto
    GYNECOLOGIC AND OBSTETRIC INVESTIGATION 52 3 163 - 167 2001年 [査読有り][通常論文]
     
    Objective: The aim of this study was to assess the role of NK cells in nonpregnant women with a history of spontaneous abortion. Study Design: 113 nonpregnant women with a history of spontaneous abortion were assessed for peripheral NK cell activity and percentage of NK cell subsets, in relation to the cause of abortions, the number of spontaneous abortions, and subsequent pregnancy outcome (n = 56). Results: Neither NK cell activity nor subsets showed a significant difference in relation to the cause or number of spontaneous abortions. NK cell activity in nonpregnant women who later experienced subsequent abortion with normal chromosomes (n = 10) (mean SD: 42.8 +/- 15.8%) was relatively higher than that in women with subsequent live birth (control, n = 39) (32.1 +/- 13.7%) (p = 0.099). NK cell activity in women who later experienced subsequent abortion with abnormal chromosomes (n = 7) (28.7 +/- 21.4%) was the same as the level in the control. Conclusion: Peripheral NK cell activity or subsets during nonpregnant status were not related to the cause or number of previous spontaneous abortions. A relation between preconceptional NK cell activity and later experiencing abortion with normal chromosomes should be further studied. Copyright (C) 2001 S. Karger AG, Basel.
  • ML Luo, N Sakuragi, M Shimizu, K Seino, K Okamoto, M Kaneuchi, Y Ebina, K Okuyama, T Fujino, T Sagawa, S Fujimoto
    FRONTIERS IN OBSTETRICS AND GYNECOLOGY, PROCEEDINGS 49 - 53 2001年 [査読有り][通常論文]
     
    We examined peritoneal cytology (PC) for 115 cases of endometrial carcinoma using immunocytochemistry (ICC) for MOC-31, which reacts with glandular epithelial cells. PC was positive in 18 of 115 (15.7%) cases and suspicious in 3 of 115 (2.6%) cases. By a multivariate Cox regression analysis including grade, myometrial invasion, cervical involvement, and PC, only PC was found to be the independent prognostic factor for tumors confined to the uterus (p <0.05). A multivariate analysis for all the patients studied, which compared PC with staging variables, revealed that only peritoneal metastasis (p <0.0001) and lymph node metastasis (p <0.01) were independent prognostic factors. These results suggest that positive PC is an important prognostic factor for patients with endometrial carcinoma confined to the uterus.
  • M Sakaihara, H Yamada, EH Kato, Y Ebina, S Shimada, G Kobashi, M Fukushi, S Fujimoto
    CLINICAL ENDOCRINOLOGY 53 4 487 - 492 2000年10月 [査読有り][通常論文]
     
    OBJECTIVE The aim of this study was to establish the risk of postpartum thyroid dysfunction (PPTD) in women who had normal thyroid function during pregnancy and no history of thyroid disease. DESIGN Four thousand and twenty-two consecutive pregnant women were screened for thyroid function and antithyroid antibody. Among women with normal thyroid function during pregnancy and no history of thyroid disease, thyroid function were assessed in 131 of 388 antithyroid antibody positive (Group I) and 1030 of 3503 antibody negative (Group II) women at 1 and 3 months postpartum. In Group I women who experienced PPTD, the frequency of later manifestation of Hashimoto's disease was compared according to titres of antithyroid antibodies. MEASUREMENTS Blood samples in early pregnancy, and at 1 month and 3 months postpartum were obtained using the dried blood spot method. Levels of fT4 were measured by RIA, TSH by fluoroimmunoassay or ELISA, antimicrosome antibody (AMC) and antithyroglobulin antibody (ATG) by indirect agglutination reactions. RESULTS The prevalence of PPTD at 1 month and 3 months postpartum were found to be 6.9% and 21.3% in Group I, and 5.3% and 4.7% in Group II, respectively. The prevalence of PPTD was significantly higher at 3 months postpartum in Group I (P < 0.05). 27.3% of women with PPTD in Group I were later found to have Hashimoto's disease and 9.1% manifested hypothyroidism without goitre. A high AMC titre (greater than or equal to 25 600) at 3 months postpartum in women with PPTD was related to the manifestation of Hashimoto's disease. AMC titres of PPTD women and women who developed Hashimoto's disease were significantly higher than those of control women who did not experience PPTD. CONCLUSION A high prevalence of PPTD was found in women with antithyroid antibodies who were euthyroid during pregnancy. Prolonged follow-up of the subsequent thyroid function may be needed in women who experience PPTD and/or show a high titre of antithyroid antibody.
  • R Yamamoto, T Saitoh, T Kusaka, Y Todo, M Takeda, K Okamoto, E Nomura, Y Ebina, M Kaneuchi, N Sakuragi, S Fujimoto
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 30 9 397 - 400 2000年09月 [査読有り][通常論文]
     
    Background: The occurrence of pelvic lymphocysts is an important complication following systematic lymphadenectomy for gynecological malignancies. We employed a procedure to prevent vaginal shortening following radical hysterectomy and we examined whether this procedure could be effective in preventing pelvic lymphocyst formation. Methods: We studied the incidence of lymphocysts in 190 patients with 84 cervical cancers, 74 endometrial cancers and 32 ovarian cancers, using computed tomographic examination at 3 and 6 months subsequent to the surgery. The surgery included radical hysterectomy and a procedure to prevent vaginal shortening (101), modified radical hysterectomy (79) and simple hysterectomy (7), with systematic lymphadenectomy. Results: There was a significant difference in the incidence of pelvic lymphocysts between cervical cancer (4.8%) and ovarian cancer (18.8%). The postoperative incidence of lymphocyst formation in patients undergoing radical hysterectomy with the procedure to prevent vaginal shortening (5.9%) was significantly lower than in those who underwent modified radical hysterectomy (15.2%). Conclusion: Our procedure to prevent vaginal shortening could be effective in preventing not only the shortening of the vagina but also the occurrence of pelvic lymphocysts in patients undergoing radical hysterectomy with systematic lymphadenectomy for gynecological malignancies.
  • R Yamamoto, K Okamoto, Y Ebina, H Shirato, N Sakuragi, S Fujimoto
    BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 107 7 841 - 845 2000年07月 [査読有り][通常論文]
     
    We describe a surgical procedure and post-operative management for the prevention of vaginal shortening following radical hysterectomy. A total of 452 patients who underwent hysterectomies were examined prospectively depending on the operation method. This study showed that our procedure was effective in the prevention of vaginal shortening following radical hysterectomy. Preservation of the ovaries appeared to be important in preventing vaginal shortening, and post-operative hormone replacement therapy was not as effective as the preservation of the ovaries. The effect of external irradiation on vaginal shortening was not conspicuous in the case that the ovaries were preserved.
  • H Yamada, N Hoshi, EH Kato, Y Ebina, T Kishida, T Sagawa, K Matsuno, S Fujimoto
    AMERICAN JOURNAL OF MEDICAL GENETICS 91 5 348 - 350 2000年04月 [査読有り][通常論文]
     
    A 35-year-old Japanese woman with a low level (42-54%) of blood antithrombin (AT) III, experienced two induced abortions due to deep venous thrombosis at 8 weeks of gestation (GW) and cerebral thrombosis at 10 GW, The present pregnancy was successfully managed with intravenous administration of AT III (6,000-8,000 U/wk), Analysis of polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) for exons 3A and 4 of the AT III gene (AT3) using her DNA revealed extra expansion bands with altered migration. The DNA sequencing demonstrated novel mutations in exon 3A of AT3: a G to T substitution at nucleotide position 5333 in codon GAG for Glu 113, causing a stop codon (E113X), and an A to T substitution at position 5338 in codon AAA for Lys 114, forming Asn (K114N). These novel mutations, especially E113X, in AT3 may be related to recurrent thrombosis in the pregnancy. (C) 2000 Wiley-Liss, Inc.
  • H Yamada, EH Kato, Y Ebina, T Kishida, N Hoshi, G Kobashi, N Sakuragi, S Fujimoto
    GYNECOLOGIC AND OBSTETRIC INVESTIGATION 49 2 80 - 83 2000年 [査読有り][通常論文]
     
    Congenital thrombophilia is known to cause significant maternal complications, and possibly has an adverse effect on normal feta I development, The aim of this study was to assess the prevalence of factor XII (FXII) deficiency in women with a history of recurrent miscarriage. Two hundred and forty-one consecutive Japanese women with a history of two or more recurrent miscarriages were prospectively assessed for their etiology by conventional screening methods. Seven women were found to have reduced FXII activity (19.2-46.1%) and prolonged activated partial thromboplastin time (33.3-51.3 s). Of these 7 women, 6 had experienced early pregnancy losses, while 1 woman had experienced repeated midtrimester fetal losses with coincidental gestational thrombocytopenia, In 241 women with a history of recurrent miscarriage, the prevalence of FXII deficiency was 2.9%. Copyright (C) 2000 S. Karger AG, Basel.
  • Ritsu Yamamoto, Kazuhira Okamoto, Yasuhiko Ebina, Hiroki Shirato, Noriaki Sakuragi, Seiichiro Fujimoto
    BJOG: An International Journal of Obstetrics and Gynaecology 107 7 841 - 845 2000年 [査読有り][通常論文]
     
    We describe a surgical procedure and post-operative management for the prevention of vaginal shortening following radical hysterectomy. A total of 452 patients who underwent hysterectomies were examined prospectively depending on the operation method. This study showed that our procedure was effective in the prevention of vaginal shortening following radical hysterectomy. Preservation of the ovaries appeared to be important in preventing vaginal shortening, and post-operative hormone replacement therapy was not as effective as the preservation of the ovaries. The effect of external irradiation on vaginal shortening was not conspicuous in the case that the ovaries were preserved. © 2017 Wiley. All rights reserved.
  • Y Ebina, H Yamada, T Fujino, Furuta, I, N Sakuragi, R Yamamoto, M Katoh, M Oshimura, S Fujimoto
    INTERNATIONAL JOURNAL OF CANCER 84 5 529 - 532 1999年10月 [査読有り][通常論文]
     
    Telomerase activity has been implicated in the progression of various human tumors. Our aim was to evaluate telomerase activity and to compare it with histo-pathological factors in uterine endometrial carcinoma, to look for possible correlations. Telomerase activity was measured by dilution analysis using a PCR-based telomeric repeat amplification method and detected in 31 of 35 primary endometrial carcinoma tumor specimens. High telomerase activity, detected after 100-fold dilution of extracts, was identified in 15 specimens. There was no significant correlation between the positive telomerase activity and tumor surgical stage or histopathological factors. However, high telomerase activity was significantly correlated with advanced surgical stage and with pelvic lymph node metastasis. Our findings suggest that an increase in telomerase activity may be associated with tumor progression and that its level may have a prognostic value in endometrial carcinoma. Int. J. Cancer (Pred. Oncol.) 84:529-532, 1999. (C) 1999 Wiley-Liss, Inc.
  • H Yamada, EH Kato, Y Ebina, M Moriwaki, R Yamamoto, Furuta, I, S Fujimoto
    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY 42 4 226 - 232 1999年10月 [査読有り][通常論文]
     
    PROBLEM: Maternal anti-SSA(B) antibody crosses the placenta and causes fetal myocarditis, congenital heart block (CHB), hydrops fetalis, and intrauterine fetal death. The aim of this study was to evaluate corticosteroids' efficacy as a treatment for CHB. METHOD OF STUDY: One fetus with complete CHB and one fetus with incomplete CHB due to anti-SSA(B) antibody received maternal prednisolone (PSL) and dexamethasone (DEXA) treatments. Heart rate, cardiothoracic ratio (CTR), left ventricular fractional shortening (FS), and preload index (PLI) were longitudinally measured by serial fetal echocardiograms. RESULTS: In the former case, after maternal PSL/DEXA administration,improvement of cardiohemodynamics, i.e., the reduction of PLI from 1.7 to 0.4, CTR from 70 to 52%, and FS from 63 to 54% were observed. In the latter case, second degree 2:1 block was converted to 3:2 block/sinus rhythm, resulting in the increase of the fetal heart rate from 65 to 116 beats per minute (bpm). CONCLUSIONS: We disclosed for the first time the beneficial effects of corticosteroids in the fetal cardiohemodynamics and conduction system of affected fetuses with the presence of maternal anti-SSA(B) antibodies.
  • Ritsu Yamamoto, Yukio Wakui, Kazuhisa Taketa, Hiroshi Ishikura, Noriaki Sakuragi, Rifumi Hattori, Hirofumi Sato, Yasuhiko Ebina, Shinzo Nishi, Seiichiro Fujimoto
    Tumor Biology 20 4 212 - 217 1999年07月 [査読有り][通常論文]
     
    The carbohydrate structure of glycoproteins is considered to be tissue- specific or cell type-specific, but there have been no reports on the differences of the carbohydrate structure of alpha-fetoproteins (AFPs) produced by histologically identical tumors in different tissues. The lectin affinity electrophoresis of hepatoid adenocarcinomas and yolk sac tumors from different organs suggested that either the tumor heterogeneity or the tissue specificity is possibly involved, the lectin reactivity of the AFP sugar chain structure produced by the tumors in different tissues.
  • R Yamamoto, M Fujita, M Kuwabara, M Sogame, Y Ebina, N Sakuragi, H Kato, S Fujimoto
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 29 6 308 - 313 1999年06月 [査読有り][通常論文]
     
    We investigated the tumor marker for malignant Brenner tumors, which had not been established because of the rarity and variable histological criteria. Representative areas of two cases of malignant Brenner tumor were investigated by means of the peroxidase-antiperoxidase method using monoclonal antibody to CA125 and CA72-4 antigen and the streptavidin-biotin immunoperoxidase complex method using monoclonal antibody to SCC antigen. Based on clinical course and immunohistochemical studies, serum CA125 and CA72-4 for Case 1 and SCC and CA72-4 for Case 2 were appropriate tumor markers for the establishment of the extent of tumor burden before treatment and to monitor the response to therapy. The discrepancy of the tumor markers of the two present cases is considered to be a reflection of the difference in the malignant component of these cases. However, serum CA72-4 was an appropriate tumor marker for both malignant Brenner tumors.
  • Noriko Kobayashi, Hideto Yamada, Tatsuro Kishida, Emi-Hirayama Kato, Yasuhiko Ebina, Noriaki Sakuragi, Gen Kobashi, Akito Tsutsumi, Seiichiro Fujimoto
    American Journal of Reproductive Immunology 42 3 153 - 159 1999年 [査読有り][通常論文]
     
    PROBLEM: The aim of this study was to elucidate fetomaternal risks in systemic lupus erythematosus (SLE)-complicated pregnancy. METHOD OF STUDY: Pregnancy course, complications, and fetal outcome in 82 pregnancies of 55 patients with SLE were investigated. RESULTS: These 82 pregnancies resulted in 14 fetal losses and 66 live births. Without clinical manifestation of SLE-flare, 4 of 8 patients who had low serum complement activity during the pregnancies delivered small-for-date neonates. The rate of the intrauterine growth retardation was significantly higher than that observed in pregnancies with normal complement activity. The frequency of premature deliveries (60%) in patients who received more than 15 mg/day of prednisolone was significantly high when compared with pregnancies maintained by 0-15 mg/day (13.1%) CONCLUSIONS: These data demonstrate the preconceptional and perinatal management necessary in SLE and suggest that the pregnancy with hypocomplementemia, the disease activity, and/or a relatively high maintenance dose of corticosteroid should be carefully managed and monitored.
  • Hideto Yamada, Emi H. Kato, Yasuhiko Ebina, Masashi Moriwaki, Ritsu Yamamoto, Itsuko Furuta, Seiichiro Fujimoto
    American Journal of Reproductive Immunology 42 4 226 - 232 1999年 [査読有り][通常論文]
     
    PROBLEM: Maternal anti-SSA(B) antibody crosses the placenta and causes fetal myocarditis, congenital heart block (CHB), hydrops fetalis, and intrauterine fetal death. The aim of this study was to evaluate corticosteroids' efficacy as a treatment for CHB. METHOD OF STUDY: One fetus with complete CHB and one fetus with incomplete CHB due to anti-SSA(B) antibody received maternal prednisolone (PSL) and dexamethasone (DEXA) treatments. Heart rate, cardiothoracic ratio (CTR), left ventricular fractional shortening (FS), and preload index (PLI) were longitudinally measured by serial fetal echocardiograms. RESULTS: In the former case, after maternal PSL/DEXA administration, improvement of cardiohemodynamics, i.e., the reduction of PLI from 1.7 to 0.4, CTR from 70 to 52%, and FS from 63 to 54% were observed. In the latter case, second degree 2:1 block was converted to 3:2 block/sinus rhythm, resulting in the increase of the fetal heart rate from 65 to 116 beats per minute (bpm). CONCLUSIONS: We disclosed for the first time the beneficial effects of corticosteroids in the fetal cardiohemodynamics and conduction system of affected fetuses with the presence of maternal anti-SSA(B) antibodies.
  • H Yamada, EH Kato, G Kobashi, T Kishida, Y Ebina, M Kaneuchi, S Suzuki, S Fujimoto
    SEMINARS IN THROMBOSIS AND HEMOSTASIS 25 5 491 - 496 1999年 [査読有り][通常論文]
     
    The aim of this study was to evaluate risk factors for occurrence of neonatal passive immune thrombocytopenia (PIT) in pregnancy complicated by idiopathic thrombocytopenic purpura (ITP). We studied 63 pregnant women with ITP and the 66 neonates retrospectively. Neonatal platelet counts were compared with maternal platelet counts, platelet-associated gamma G immunoglobulin (PAIgG) values, and the presence of antiplatelet antibody in the maternal circulation, history of previous PIT, maternal treatments for ITP, and other maternal or neonatal factors. PIT (platelet counts <100 x 10(3)/mu L) was observed in 9 (14.3 %) of 63 pregnancies. Presence of circulating antiplatelet antibody in maternal blood, splenectomy prior to pregnancy, and history of previous PIT were observed more frequently with statistical significance in patients giving birth to neonates who developed PIT. No effect on occurrence of PIT was found by the administration of corticosteroids or immunoglobulin. Splenectomy prior to pregnancy was found by logistic regression analysis to be a single significant variable (p = 0.021, odds ratio 7.20, confidence intervals: 1.35 to 38.3) among the risk factors for PIT.
  • Prenatal diagnosis and fetal therapy for congenital cytomegalovirus infection: a trial of intraperitoneal hyperimmunoglobulin injection.
    Yamada H, Negishi H, Ebina Y, Kato EH, Kobashi G, Sagawa T, Sakuragi N, Fujimoto S
    Virus Infection Seminar 1 27 - 34 1999年 [査読有り][通常論文]
  • M Nishiya, N Sakuragi, H Hareyama, Y Ebina, M Furuya, M Oikawa, R Yamamoto, T Fujino, S Fujimoto
    INTERNATIONAL JOURNAL OF CANCER 79 5 521 - 525 1998年10月 [査読有り][通常論文]
     
    The International Federation of Gynecology and Obstetrics (FIGO) adopted surgical staging criteria in 1988. Many studies have shown that histologic grade, nuclear grade, lymphvascular space invasion and cell type are also important predictors of survival. It has not been clarified, however, how to integrate these histopathologic variables into the process of estimating individual prognosis. We performed Cox multivariate regression analysis to create models that incorporate various histopathologic factors for estimating the prognoses of patients with endometrioid adenocarcinoma of the uterine corpus. Our study was based on data from 206 patients who underwent complete surgical staging, including systematic pelvic and para-aortic lymph node dissection. Two models resulted: one included depth of myometrial invasion, paraaortic node metastasis and the number of sites involved by the tumor among the cervix, ovary and pelvic lymph nodes (which we designated as extracorporeal spread score, ECS) and the other incorporated nuclear grade and lymph-vascular space invasion as variables. These 2 models enabled the prognosis for patients with endometrioid adenocarcinoma to be stratified into several levels according to hazard ratio. Comprehensive integration of the histopathologic prognostic factors, categorized into those relating to tumor extent and those relating to tumor virulence, should facilitate the estimation of individual prognosis more accurately than FIGO staging alone. Int. J. Cancer (Pred. Oncol.) 79:521-525, 1998. (C) 1998 Wiley-Liss, Inc.
  • R Yamamoto, K Taketa, Y Ebina, Y Cho, H Hareyama, N Sakuragi, S Makinoda, K Kobayashi, S Nishi, S Fujimoto
    JOURNAL OF CLINICAL PATHOLOGY 50 10 856 - 858 1997年10月 [査読有り][通常論文]
     
    Aims-To investigate a potential diagnostic use of alpha fetoprotein (alpha FP) isoform analysis by lectin affinity electrophoresis to distinguish between endodermal sinus tumours arising in the vagina in infants from those at other sites. Methods-alpha FP in the serum of a patient with a vaginal endodermal sinus tumour was analysed for its isoforms by lectin affinity electrophoresis. The isoforms were compared with that of cord serum, sera of hepatoid adenocarcinoma of the uterus, and endodermal sinus tumour of the ovary. Results-The isoforms of alpha FP obtained by lectin affinity electrophoresis in the serum of the patient with vaginal endodermal sinus tumour differed from the isoforms of alpha FP in the cord serum of normal neonates, and sera of patients with hepatoid adenocarcinoma of the uterus or endodermal sinus tumour of the ovary. Conclusions-Endodermal sinus tumour arising in the vagina could be distinguished from that in the ovary by the lectin affinity electrophoresis, and a potential diagnostic use of alpha FP isoform analysis by the lectin affinity electrophoresis for the detection of the endodermal sinus tumour in infants was demonstrated.
  • Y Ebina, H Hareyama, N Sakuragh, R Yamamoto, M Furuya, M Sogame, T Fujino, S Makinoda, S Fujimoto
    INTERNATIONAL SURGERY 82 3 244 - 248 1997年07月 [査読有り][通常論文]
     
    Background. There has been a controversy about the prognostic significance of positive peritoneal cytology in endometrial carcinoma. Materials and methods. Peritoneal cytology was obtained at the time of surgery, including systematic retroperitoneal lymph node dissection, in 114 patients. Results. The incidence of positive peritoneal cytology was 35.1%, The 5-year survival rates of the stage IIIA and IIIC (FIGO, 1988) cases were 82.8% and 58.3%, respectively, In pathological stage I (the disease was histologically confined to the uterine corpus), there was no significant difference in 5-year survival rates between patients with and without positive peritoneal cytology, Though the patients in stage IIIA who had only positive peritoneal cytology were given no postoperative therapy unless they had extrauterine disease, no patients developed recurrence, In stages IIIC and IV, the prognosis was significantly poorer for patients with positive peritoneal cytology than for those with negative cytology. Conclusion. Positive peritoneal cytology is not an adverse prognostic factor of endometrial carcinoma if disease is limited to the uterus.

書籍

  • 読める生かせる説明できる産科の臨床検査ディクショナリー
    蝦名 康彦 (担当:共著範囲:自己抗体検査、サイトメガロウイルス抗体、ヒトパルボウイルスB19)
    メディカ出版 2018年11月
  • 実践 臨床生殖免疫学
    蝦名 康彦 (担当:共著範囲:妊娠と感染症 パルボウイルスB19)
    中外医学社 2018年05月
  • 不妊・不育診療指針
    蝦名 康彦 (担当:共著範囲:不妊治療と妊娠 NIPT)
    中外医学社 2016年11月
  • 患者さんとご家族のための子宮頸がん・子宮体がん・卵巣がん治療ガイドライン 第2版
    蝦名 康彦 (担当:分担執筆範囲:卵巣がん~プラチナ抵抗性再発~)
    金原出版 2016年02月
  • 婦人科癌診療Q&A~一つ上を行く診療の実践~
    蝦名 康彦 (担当:分担執筆範囲:子宮頸癌の罹患率、死亡率の推移について教えてください。)
    中外医学社 2014年04月
  • 腫瘍減量手術に適する再発卵巣癌患者の選択におけるFDG-PETの意義
    蝦名 康彦 (担当:単著)
    メディカルレビュー社 2014年03月
  • 産科の臨床検査ディクショナリー
    蝦名 康彦 (担当:分担執筆範囲:サイトメガロウイルス抗体,ヒトパルボウイルスB19)
    メディカ出版 2014年01月
  • 内科 増大号 検査値を読む
    蝦名 康彦 (担当:分担執筆範囲:ヒト絨毛性ゴナドトロピン)
    2013年
  • EBM 婦人科疾患の治療
    蝦名 康彦 (担当:分担執筆範囲:子宮体癌:再発癌に対して推奨される化学療法とは?)
    中外医学社 2013年
  • プロメテウス婦人科がん最新医療
    蝦名 康彦 (担当:分担執筆範囲:子宮体がんにおける妊孕性温存と妊娠への影響)
    金原出版 2013年
  • The management of antiphospholipid antibodies affected pregnancy
    谷村憲司 (担当:分担執筆範囲:Antiphospholipid Syndrome)
    InTech-Open Access Publisher 2012年
  • A Smarter Path; Dhiscovery PET/CT
    蝦名 康彦 (担当:分担執筆範囲:腫瘍領域における患者のためのPET/CT活用法)
    メテオエイト(東京 2012年
  • 腹式単純子宮全摘術.「子宮筋腫の臨床」平松祐司編集
    メジカルビュー社 2008年
  • 進行・再発癌に対する化学療法.「婦人科がん標準化学療法の実際」宇田川康博,八重樫伸生編集
    金原出版 2008年
  • PET/CT 画像診断のポイント 婦人科癌
    メディカルレビュー社 2007年
  • 婦人科腫瘍におけるPET 検査.「産婦人科・専門医に聞く最新の医療」鈴木光明,吉村泰典編集
    中外医学社 2007年
  • 卵巣癌の妊孕能温存手術,「よくわかる卵巣癌のすべて」安田 允編集
    永井書店 2007年
  • 第二次腫瘍縮小手術の意義.「先端医療シリーズ39産科婦人科の最新医療」武谷雄二編集主幹
    先端医療技術研究社 2006年
  • 18F-fluoro-deoxyglucose positron emission tomography for the detection of recurrent ovarian cancer. 「PET and Molecular Imaging, State of the art and future perspectives. International Congress Series 1264」
    ELSEVIER 2004年
  • 卵巣癌と境界悪性腫瘍の最新の治療「卵巣腫瘍病理アトラス」,石倉浩編集
    文光堂 2004年
  • 超音波断層法(婦人科)「Newエッセンシャル産科学・婦人科学第3版」,池ノ上克共編
    医師薬出版株式会社 2004年
  • The presence of high-risk HPV in cervical dysplastic cells is associated with clinical course: long-term follow-up. 「9th biennial meeting of the international gynecologic cancer society」, ed by Mok JE, Quinn MA, Namkoog SE, Kim YT
    Monduzzi Editore 2002年
  • 母子感染 サイトメガロウイルス 「図説産婦人科VIEW 38,母子感染」
    メジカルビュー社 2000年
  • 常染色体転座保因者・染色体異常モザイク「周産期遺伝相談」
    医学書院 2000年
  • 産婦人科とジェネテイクス 「Modern Reproductivity Medicine 3, 生殖ジェネテイクス〜ART向上のための遺伝子学〜」
    メジカルビュー社 1999年

講演・口頭発表等

  • 産婦人科と血栓性素因  [招待講演]
    第10回神戸シンポジア 2019年03月
  • 産婦人科と血栓性素因  [招待講演]
    蝦名 康彦
    第8回神戸産婦人科臨床フォーラム 2018年01月 口頭発表(招待・特別)
  • 性分化疾患のケアと治療~ライフステージに寄り添いながら~  [招待講演]
    蝦名 康彦
    第58回 日本母性衛生学会総会 2017年10月 口頭発表(招待・特別)
  • 産婦人科と血栓性素因  [招待講演]
    蝦名 康彦
    第7回北海道産婦人科周術期合併症研究会 2017年08月 口頭発表(招待・特別)
  • 病態の理解を深めよう~婦人科がん~  [招待講演]
    蝦名 康彦
    兵庫県臨床検査技師会 新春セミナー 2017年01月 口頭発表(招待・特別)
  • シンポジウム「母子感染対策の最前線2016年」本邦におけるパルボウイルスB19母子感染の実態  [招待講演]
    蝦名 康彦
    第52回日本周産期・新生児医学会総会・学術集会 2016年07月 シンポジウム・ワークショップパネル(指名)
  • ワークショップ「母子感染予防に関する最近の話題」本邦におけるパルボウイルスB19母子感染の実態  [招待講演]
    蝦名 康彦
    第26回日本産婦人科・新生児血液学会学術集会 2016年06月 シンポジウム・ワークショップパネル(指名)
  • 婦人科再発癌手術を考える  [招待講演]
    蝦名 康彦
    第4回高知産婦人科周術期セミナー 2016年02月 口頭発表(招待・特別)
  • 再発卵巣癌化学療法のエビデンスと現状  [招待講演]
    蝦名 康彦
    中外婦人科腫瘍セミナー 2016年02月 口頭発表(招待・特別)
  • 子宮頸部無形成・双角子宮症例に対する形成術~頸部瘢痕組織を利用する工夫~  [通常講演]
    蝦名康彦, 村田友香, 田中恵里加, 森田宏紀, 山田秀人
    第38回日本産婦人科手術学会 2015年11月 シンポジウム・ワークショップパネル(公募)
  • 【教育講演】 今さら聞けない、子宮頸部の病理と臨床  [招待講演]
    蝦名 康彦
    第133回近畿産科婦人科学会 2015年10月 口頭発表(招待・特別)
  • Low levels of plasma protein S, protein C and coagulation factor XII during early pregnancy and adverse pregnancy outcome  [通常講演]
    Yasuhiko Ebina, Masahiro Ieko, Sumiyoshi Naito, Gen Kobashi, Masashi Deguchi, Hisanori Minakami, Tatsuya Atsumi, Hideto Yamada
    International Society for the Hypertension in Pregnancy (ISSHP) European Congress 2015年09月 口頭発表(一般)
  • 【Invited Lecture】 Toward optimized therapy plans using FDG PET/CT for the patients with gynecologic cancers  [招待講演]
    蝦名 康彦
    Joint Symposium of University of Liege and Kobe University 2015年05月 口頭発表(招待・特別)
  • 【特別講演】アバスチンの求められるもの ~当科の卵巣癌治療例を通して~  [招待講演]
    蝦名 康彦
    第7回神戸シンポジア 2015年02月 口頭発表(招待・特別)
  • Phenotypic differences of T cells and macrophages in the decidua obtained from spontaneous abortion  [通常講演]
    蝦名 康彦
    The 9th Conference of the Pacific Rim Society for Fertility and Sterility 2013年11月 ポスター発表
  • A trial of immunoglobulin fetal therapy for symptomatic congenital cytomegalovirus infection  [通常講演]
    蝦名 康彦
    17th International Conference on Prenatal Diagnosis and Therapy 2013年07月 ポスター発表
  • Diagnostic value of IgG avidity for prediction of congenital cytomegalovirus infection  [通常講演]
    蝦名 康彦
    17th International Conference on Prenatal Diagnosis and Therapy 2013年07月 ポスター発表
  • 【ランチョンセミナー】 FDG-PET/CTで子宮がん・卵巣がん診療はどう変わったか?  [招待講演]
    蝦名 康彦
    第65回日本産科婦人科学会学術講演会 2013年05月 公開講演,セミナー,チュートリアル,講習,講義等
  • 【ワークショップ】 自然流産における脱落膜T細胞、マクロファージの解析  [通常講演]
    蝦名 康彦
    第65回日本産科婦人科学会学術講演会 2013年05月 シンポジウム・ワークショップパネル(公募)
  • 【教育講演】先天性アンチトロンビン欠乏症合併妊娠の診断と治療  [招待講演]
    蝦名 康彦
    第2回周産期血液・免疫セミナー神戸 2012年12月 公開講演,セミナー,チュートリアル,講習,講義等
  • Low IgG Avidity and Ultrasound Fetal Abnormality Predict Congenital Cytomegalovirus Infection  [通常講演]
    蝦名 康彦
    Combined Meetings: 4th Congenital Cytomegalovirus Conference and 14th International CMV/BataHerpesvirus Workshop 2012年10月 ポスター発表
  • ssessment of treatment in patients with recurrent ovarian cancer using PET-CT:Potential change of disease free interval and chemotherapeutic regimen  [通常講演]
    蝦名 康彦
    14th Biennial Meeting of the International Gynecologic Cancer Society 2012年10月 ポスター発表
  • 【シンポジウム】腫瘍シンポジウム「PETを用いた悪性腫瘍の治療戦略~個別化医療を視野に入れて~」 卵巣癌診療におけるPET-CTによる治療個別化の現状とその問題点について  [通常講演]
    蝦名 康彦
    第52回日本核医学会学術総会 2012年10月 シンポジウム・ワークショップパネル(指名)
  • 【ワークショップ】「早期卵巣癌を対象とした新規臨床試験」 卵巣癌の臨床試験におけるPET-CTの導入とその問題点  [通常講演]
    蝦名 康彦
    第123回 日本産科婦人科学会関東連合学術集会 2012年06月 シンポジウム・ワークショップパネル(指名)
  • 「FDG-PET/CTで子宮がん・卵巣がん診療はどう変わったか?」  [招待講演]
    蝦名 康彦
    PETサマーセミナー2012 in 松本 2012年 公開講演,セミナー,チュートリアル,講習,講義等
  • 特別講演「子宮がん・卵巣がん診療におけるPET-CTのインパクト ~婦人科医は、何を知りたいのか?~」  [招待講演]
    蝦名 康彦
    第53回兵庫県核医学研究会 2011年 口頭発表(招待・特別)
  • 特別講演「子宮がん・卵巣がん診療におけるPET-CTのインパクト ~婦人科医は、何を知りたいのか?~」  [招待講演]
    蝦名 康彦
    第二回東北FDG-PET研究会 2011年 公開講演,セミナー,チュートリアル,講習,講義等
  • 特別講演「再発卵巣癌治療 ~どのように選択する?~」  [招待講演]
    蝦名 康彦
    徳島卵巣がん化学療法講演会 2011年 公開講演,セミナー,チュートリアル,講習,講義等
  • ランチョンセミナー「子宮がん・卵巣がん診療におけるPET-CTのインパクト ~婦人科医は、何を知りたいのか?~」  [招待講演]
    蝦名 康彦
    第70回日本医学放射線学会総会 2011年 口頭発表(招待・特別)
  • ランチョンセミナー「日常臨床でのPET/CTの活用について」婦人科癌診療におけるFDG-PETの有用性について  [招待講演]
    第10回日本核医学会春季大会(東京) 2010年 公開講演,セミナー,チュートリアル,講習,講義等
  • Impact of FDG-PET on the decision making for ovarian cancer recurrence  [通常講演]
    40th Annual Meeting of SGO(米国,サンアントニオ) 2009年 ポスター発表
  • 高得点演題「卵巣癌再発に対して,FDG-PETを用いた症例選択により行うsecondary debulking surgeryは,生存期間延長に寄与する」  [通常講演]
    第61回日本産科婦人科学会学術集会(京都) 2009年
  • シンポジウム“子宮体癌腹腔洗浄細胞診の今日的話題”「子宮体癌の腹腔細胞診にお ける,液状処理と免疫組織化学導入による診断精度向上の試み」  [通常講演]
    第50回日本臨床細胞学会総会(東京) 2009年
  • 細胞検査士要望教育シンポジウム“細胞診の将来と可能性~癌治療の選択および予後 推定における細胞診の役割~”「卵巣癌における組織型と治療戦略;細胞診が果たし 得る役割について」  [通常講演]
    第50回日本臨床細胞学会総会(東京) 2009年
  • シンポジウム“卵巣癌治療の新たな展開~10年後を見据えて~”「FDG-PETを用いた 症例選択により行う再発卵巣癌腫瘍減量手術は,生存期間延長に寄与する」  [通常講演]
    第47回日本癌治療学会総会・学術集会(横浜) 2009年
  • シンポジウム“悪性腫瘍の診療に不可欠なPET検査”「PETの臨床応用;婦人科癌 への応用」  [通常講演]
    第99回北海道癌談話会(札幌) 2009年
  • 特別講演「PET:婦人科癌診療に与えたインパクト」  [招待講演]
    蝦名 康彦
    第2回愛知PET臨床利用研究会 2008年 口頭発表(招待・特別)
  • ランチョンセミナー「PET:婦人科癌診療に与えたインパクト」  [通常講演]
    第115回日本産科婦人科学会 関東連合地方部会学術集会(東京) 2008年
  • 教育講演「最新治療の理解と看護が行う生活障害支援のベストプラクティス;婦人科がん診療アップデート」  [通常講演]
    日総研看護セミナー(札幌) 2008年
  • 教育講演「婦人科疾患の臨床と経腹超音波検査の有用性」  [通常講演]
    JSS北海道第9会地方会(帯広) 2008年
  • ンポジウム“PETのがん診療への利用”「卵巣がん診療におけるFDG-PETの有用性」  [通常講演]
    第5回北海道PET研究会(札幌) 2007年
  • ランチョンセミナー「婦人科臨床におけるPET活用のノウハウ〜PET診断のコツとピットフォール〜」  [通常講演]
    第59回日本産科婦人科学会(京都) 2007年
  • ランチョンセミナー「婦人科がん診療におけるFDG-PETの有用性と今後の展開」  [通常講演]
    第41回日本婦人科腫瘍学会(大阪) 2006年
  • ワークショップ“婦人科悪性腫瘍の臨床におけるPETの有効性とその限界”「婦人科癌再発診断におけるFDG-PETの有用性と限界に関する検討」  [通常講演]
    第38回婦人科腫瘍学会(和歌山) 2005年
  • 高得点演題「卵巣癌再発診断におけるFDG-PETの有用性に関する検討」  [通常講演]
    第56回日本産科婦人科学会学術集会(東京) 2004年
  • シンポジウム“卵巣がんにおける細胞診の現状と問題点”「初期卵巣癌(T1/T2)症例に おける腹腔細胞診とリンパ節転移との関連」  [通常講演]
    第45回日本臨床細胞学会総会(福岡) 2004年
  • シンポジウム”腫瘍マーカーを用いた婦人科疾患の管理”「子宮体癌の診断・管理における腫瘍マーカー活用へのアプローチ」  [通常講演]
    第5回日本産婦人科腫瘍マーカー・遺伝子診断学会学術集会(東京) 2001年
  • シンポジウム”子宮頸癌検診は体癌発見を早めるか?”「北海道における集検での 子宮体癌検診〜第二次老健法後14年間の取り組み〜」  [通常講演]
    第10回日本婦人科がん検診学会学術集会(東京) 2001年

その他活動・業績

受賞

  • 2015年06月 平成27年度 兵庫県産科婦人科学会賞
     The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study 
    受賞者: 蝦名 康彦

共同研究・競争的資金等の研究課題

  • 母児接点におけるNK細胞、制御性B細胞、樹状細胞の発現と流産との関連の解明
    科学研究費:基盤研究(C):
    研究期間 : 2017年04月 -2019年03月 
    代表者 : 出口 雅士
  • HLA class II複合体抗体による不育症、妊娠合併症の新診断・治療法の確立
    科学研究費:基盤研究(C):
    研究期間 : 2017年04月 -2019年03月 
    代表者 : 山田 秀人
  • 子宮内膜の性周期および発癌過程におけるPITX1発現とテロメレース制御の解析
    科学研究費:基盤研究(C):
    研究期間 : 2013年04月 -2016年03月 
    代表者 : 蝦名 康彦
  • ヒト子宮頸部扁平上皮癌の進展における3次元的血管ネットワークの変化とVRGF,MMPの関連に関する研究
    21世紀COE「トポロジー理工学の創成」:プロジェクト研究
    研究期間 : 2004年04月 -2005年03月 
    代表者 : 北大大学院工学研究科教授, 丹田 聡

大学運営

委員歴

  • 2015年04月 - 現在   Annals of Nuclear Medicine誌   査読委員
  • 2014年12月 - 現在   日本生殖免疫学会   評議員
  • 2014年04月 - 現在   日本婦人科腫瘍学会   査読委員
  • 2012年11月 - 現在   International Cancer Conference Journal   Editorial Board
  • 2010年03月 - 現在   日本婦人科腫瘍学会 評議員
  • 2003年01月 - 現在   日本臨床細胞学会   評議員   日本臨床細胞学会

社会貢献活動

  • 「最新情報でがんにそなえる」子宮がん 最新の診断と治療
    期間 : 2017年05月06日
    役割 : 出演
    主催者・発行元 : 第15回日本癌治療学会市民公開講座(神戸市)

メディア報道

  • 「早めの対処で子宮頸癌は予防できる!」
    報道 : 2018年04月01日
    発行元・放送局 : 阪神電車
    番組・新聞雑誌 : ホッと! HANSHIN
     会誌・広報誌
  • 「アステラス製薬 健やかライフ ~子宮筋腫~」
    報道 : 2015年04月13日
    発行元・放送局 : ABCラジオ
    番組・新聞雑誌 : ドッキリハッキリ三代澤康司です
     テレビ・ラジオ番組

学術貢献活動

  • 兵庫17事例協働調査委員会委員長
    期間 : 2012年05月 - 2014年12月
    役割 : 企画立案・運営等
    種別 : 学術調査
    主催者・責任者 : 日本医療安全調査機構モデル事業

その他

  • 2019年10月 - 9999年  J-MELS ベーシックコース・インストラクター 
    日本母体救命システム普及協議会(J-CIMELS)
  • 2017年04月 - 9999年  日本臨床細胞学会 教育研修指導医
  • 2016年03月 - 9999年  日本専門医機構 産婦人科専門医
  • 2015年11月 - 9999年  日本婦人科腫瘍学会 婦人科腫瘍指導医
  • 2015年08月 - 9999年  日本産科婦人科学会 産婦人科指導医
  • 2014年07月 - 9999年  生殖医療に関する遺伝カウンセリング受入れ可能な臨床遺伝専門医
  • 2012年11月 - 9999年  臨床遺伝専門医
  • 2008年04月 - 9999年  日本がん治療認定医機構 認定医
  • 2007年02月 - 9999年  日本婦人科腫瘍学会 婦人科腫瘍専門医
  • 2003年09月 - 9999年  国際細胞学会 サイトパソロジスト (FIAC)
  • 1996年12月 - 9999年  日本臨床細胞学会 細胞診専門医
  • 1995年10月 - 9999年  日本産科婦人科学会 産婦人科専門医


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