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| 1.
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Oishi, Sugiko ; Mekaru, Keiko ; Tanaka, E. Suguru ; Arai, Wataru ; Ashikawa, Kyota ; Sakuraba, Yoshiyuki ; Nishioka, Mikiko ; Nakamura, Rie ; Miyagi, Maho ; Akamine, Kozue ; Aoki, Yoichi
概要:
Purpose: To investigate the relationship between the microbiome of the female genital tract and endometriosis. Methods: This prospective cohort study included 36 women who underwent laparoscopic surgery for ovarian tumor from July 2019 to
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April 2020. Of them, 18 had endometriosis, and 18 did not have endometriosis. Vaginal secretions, endometrial fluid, peritoneal fluid, and ovarian cystic fluid were collected during surgery. Next-generation sequencing of bacterial 16S rRNA was performed to characterize the microbiome. Results: Specific microbiomes were not detected in either peritoneal fluid or ovarian cystic fluid regardless of the presence or absence of endometriosis and the type of cyst. When the cutoff value of infectious bacterial abundance in the vagina was set as 64.3%, there were many cases more than a cutoff value in the endometriosis group significantly (p = 0.01). When the cutoff value of infectious bacterial abundance in the endometrium was set as 18.6%, there were many cases more than a cutoff level in the endometriosis cases significantly (p = 0.02). Conclusion: Peritoneal fluid and ovarian cystic fluid are almost sterile, although dysbiosis may occur in the vaginal and endometrial microbiome in women with endometriosis.
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| 2.
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Akamine, Kozue ; Mekaru, Keiko ; Gibo, Keiya ; Nagata, Chinatsu ; Nakamura, Rie ; Oishi, Sugiko ; Miyagi, Maho ; Heshiki, Chiaki ; Aoki, Yoichi
概要:
Purpose: To investigate impact of the one‐carbon metabolism (OCM) on oocyte maturity and embryo development.\nMethods: T
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his prospective study analyzed 18 women who agreed to participate. We measured the OCM biomarkers’ concentrations including Vitamin B12 (VB12), folic acid (FA), and homocysteine (Hcy) in serum and follicular fluid (FF), and assessed their correlation. We also evaluated the influence of such OCM biomarker concentrations in mono‐FF on oocyte maturation, fertilization, embryo quality, and consequent pregnancy after embryo transfers.\nResults: All biomarkers showed a high concentration variability in different follicles of each woman, but their mean levels correlated with the serum levels. Among the 106 collected oocytes, 92 were mature, 59 were fertilized, and 16 yielded good‐quality embryos. We performed 26 single embryo transfers, and 7 patients achieved clinical pregnancies. VB12 concentration (FF) was significantly lower in fertilized than unfertilized oocytes by univariate analysis. In multivariate logistic analysis, a significant correlation was found between FA concentration (FF) <14.25 ng/mL and good‐quality embryos and between Hcy concentration (FF) <4.9 nmol/mL and clinical pregnancy.\nConclusion: OCM in FF may affect fertilization, embryo quality, and clinical pregnancy.
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| 3.
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Kinjo, Tadatsugu ; Mekaru, Keiko ; Nakada, Miyuki ; Nitta, Hayase ; Masamoto, Hitoshi ; Aoki, Yoichi
概要:
We report a case of Cornelia de Lange syndrome (CdLS) where prenatal diagnosis was not made even with major anomaly. A 3
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3-year-old Japanese woman was referred to our institution at 23 weeks of gestation because of fetal forearm defect. Ultrasound examination revealed short forearms and short humeri and femurs (–2.1 SD). The fetal estimated body weight was 450 g (–1.3 SD). Fetal MRI at 26 weeks of gestation revealed short forearms and hypoplasty of hand fingers. Fetal growth restriction became evident thereafter, leading to intrauterine fetal death occurring at 29 weeks of gestation. A stillbirth baby was of 798 g in body weight and 33.0 cm in length. External examination showed a low hairline, synophrys, low-set ear, hypertrichosis, and smooth long philtrum with thin lips. The neck appeared short and broad. Finally, CdLS was diagnosed. The prenatal diagnosis might be possible as the arm findings were totally characteristic in a small fetus, regardless of whether an overhanging upper lip was identified. Because CdLS is a rare condition, it is important to consider its possibility as a part of differential diagnosis.
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| 4.
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Miyuki, Miyagi ; Kinjo, Tadatsugu ; Mekaru, Keiko ; Nitta, Hayase ; Masamoto, Hitoshi ; Aoki, Yoichi
概要:
Massive subchorionic thrombohematoma (MST), termed Breus’ mole, is a rare condition in which a large maternal blood clot
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separates the chorionic plate from the villous chorion. Common complications of MST include fetal growth restriction, preeclampsia, and intrauterine fetal death. Here, we present a case of a 17-year-old Japanese woman referred to our institution at 21 weeks of gestation. Ultrasound examination revealed a large placental mass with mixed high and low echogenicity measuring approximately 7.6 cm in thickness. Doppler examination showed absence of end-diastolic velocity of the umbilical artery. At 22 weeks of gestation, the patient had a stillbirth weighing 138g. The placenta weighed 502 g and was 8 cm thick, and the total blood loss was 270 g. Macroscopic examination revealed that a subchorionic blood clot measuring 12 cm × 5 cm covered a large portion of the placenta with well-defined margins on the fetal surface. Microscopic examination revealed an intervillous hematoma and fibrinous deposits directly beneath the chorionic plate with adjacent compressive effects. Based on these findings, MST was diagnosed. Because MST is rare, it must be considered in the differential diagnosis of parental conditions. Magnetic resonance imaging can be optimal for diagnosing MST when ultrasound diagnosis is difficult.
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| 5.
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Yagi, Hisao ; Kinjo, Yoshino ; Chinen, Yukiko ; Nitta, Hayase ; Kinjo, Tadatsugu ; Mekaru, Keiko ; Masamoto, Hitoshi ; Goya, Hideki ; Yoshida, Tomohide ; Sanabe, Naoya ; Aoki, Yoichi
概要:
A 37-year-old (G4P3) woman was referred to our hospital at 32 weeks of gestation for the evaluation of a fetus with an i
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ntrathoracic cystic lesion. Ultrasonography and magnetic resonance imaging revealed that a fetal cystic lesion without a mucosal layer was located in the posterior mediastinum. These findings were consistent with a bronchogenic cyst. At 38 3/7 weeks of gestation, an elective cesarean section was performed because of her previous cesarean section. A female neonate without any external anomalies, weighing 2,442 g, with Apgar scores of 8 and 9, and requiring no resuscitation was born. Four weeks after delivery, the neonate was admitted because of respiratory distress due to mass effect. At right lateral thoracotomy, a 105 × 65 mm of solitary smooth-walled cyst containing serosanguineous fluid was found in the posterior mediastinum, which was excised completely. Histologic examination revealed the diagnosis of the mediastinal gastric duplication cyst. The neonate made an uneventful recovery. Accurate diagnosis is not necessary, but detection and continuous observation are logical. Although gastric duplication, particularly intrathoracic, is a rare pathology, it should be considered in the differential diagnosis of any intrathoracic cyst.
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| 6.
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Kozaki, Mitsuru ; Iraha, Yuko ; Masamoto, Hitoshi ; Nitta, Hayase ; Chinen, Yukiko ; Kinjo, Tadatsugu ; Mekaru, Keiko ; Aoki, Yoichi
概要:
Two types of congenital bronchial atresia (proximal and peripheral) have been classified. We report two cases of periphe
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ral bronchial atresia diagnosed by prenatal ultrasonography (US) and magnetic resonance imaging (MRI). Evaluating an enlarged lung mass that is homogeneously hyperechoic on US and hyperintense on T2-weighted MRI can help in determining whether bronchial atresia is present. Proximal type is suggested when a dilated main bronchus is observed as a tubule structure of an involved lung hilum. In our cases, T2-weighted MRI revealed homogeneously hyperintense lung lesion with decreased signal intensity of adjacent lobe, flattening diaphragm, and mediastinal shift. Dilatation of the main bronchus was not observed and the opposite lung was normal in appearance. These findings were explained by secondary compression due to enlargement of the involved lung. The preservation of vascular structure and the retained normal shape, though enlarged, in the affected lobe were observed, which demonstrated undisrupted pulmonary architecture of the lobe. Thus, congenital cystic adenomatoid malformation was excluded because pulmonary architecture was relatively preserved. Finally, presumed diagnoses of the peripheral bronchial atresia were made and confirmed by postnatal chest computed tomography.
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| 7.
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Akamine, Kozue ; Mekaru, Keiko ; Heshiki, Chiaki ; Chinen, Yukiko ; Kinjyo, Tadatugu ; Masamoto, Hitoshi ; Aoki, Yoichi
概要:
Background: The impact of vanishing twin (VT) syndrome on obstetric outcome is currently unknown. The aim of this study
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was to compare obstetric and neonatal outcomes of VT with singleton and twin deliveries after assisted reproduction and to evaluate the impact of VT on pregnancy outcome. Methods: We analyzed 130 births at our hospital between January 2000 and February 2012 that resulted from assisted reproduction. Among these, 96 were singleton, 10 were VT, and 24 were twin deliveries. Vanishing twin was defined as a first-trimester (≤ 12 gestational weeks) embryonic loss of one of the twins. We compared the obstetric and neonatal outcomes of VT with singletons and twins, respectively. Results: The obstetric and neonatal outcomes were similar between VT and singleton deliveries, although there was a trend towards an increased rate of preterm delivery (9.4% vs. 20%, p=0.28), extremely preterm delivery (5.2% vs. 20%, p=0.13), and low birth weight <2500 g (30% vs. 73.3, p=0.023) in the VT group. Outcomes were significantly better in the VT group than in the twin group. The rate of preterm delivery was significantly higher in the twin group than in the VT group (20% vs. 70.8%). Furthermore, birth weight was significantly lower in the twin group than in the VT group (2798 ± 187 vs. 2046 ± 97), and the rate of low birth weight was higher in the twin group than in the VT group (30% vs. 73.3%). Conclusion: Obstetric and neonatal outcome after assisted reproduction may deteriorate according to pregnancy status in the following order: singleton, VT and twin pregnancy.
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| 8.
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Mekaru, Keiko ; Yagi, Chiaki ; Asato, Kozue ; Masamoto, Hitoshi ; Sakumoto, Kaoru ; Aoki, Yoichi ; 銘苅, 桂子 ; 安里, こずえ ; 正本, 仁 ; 青木, 陽一
概要:
Purpose: The aim of this retrospective study was to determine whether laparoscopy is necessary in patients with infertil
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ity showing bilateral tubal patency on hysterosalpingography (HSG). Methods: One hundred and eight women <40 years of age underwent 4-6 cycles of timed intercourse or intrauterine insemination (IUI) following confirmation of bilateral tubal patency on HSG. Thereafter, 84 women underwent laparoscopy and further cycles of timed intercourse or IUI (laparoscopy group). The remaining 24 women underwent in vitro fertilization-embryo transfer (IVF-ET) without laparoscopy (IVF group). Results: Multivariate analysis showed that infertility of >5 years duration was the only independent factor contributing to the reduced pregnancy rate in the laparoscopy group (HR, 0.64; 95% confidence interval (CI), 0.40- 0.96). The cumulative live birth rates were 75.9% for the IVF group and 62.2% for the laparoscopy group (P=0.03). Conclusions: In women with bilateral tubal patency observed on HSG, laparoscopy may be omitted if IVF-ET is the subsequent treatment of choice, particularly in women with infertility of >5 years duration
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| 9.
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大石, 杉子 ; 銘苅, 桂子 ; 仲村, 理恵 ; 宮城, 真帆 ; 赤嶺, こずえ ; 青木, 陽一 ; Oishi, Sugiko ; Mekaru, Keiko ; Nakamura, Rie ; Miyagi, Maho ; Akamine, Kozue ; Aoki, Yoichi
概要:
Laparoscopic ovarian cystectomy usually does not require ovarian suturing. However，in patients receiving anticoagulant t
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herapy after a surgical procedure，there is a risk of increased bleeding when perioperative bridging of anticoagulation therapy with heparin is performed. This case report discusses the risk of bleeding with anticoagulation therapy. A 38-year-old，nulliparous female underwent laparoscopic ovarian cystectomy for mature cystic teratoma in the left ovary. Because she was administered warfarin for paroxysmal atrial fibrillation before，anticoagulation bridging with heparin was prescribed after hospitalization and 1 week before the surgery. We performed laparoscopic cystectomy with bipolar coagulation. Absence of bleeding from the surgical site was confirmed，and the patient had stable vital signs; therefore，we restarted anticoagulation bridging with heparin 6 hours after the surgery and warfarin approximately 27 hours after the surgery. Severe abdominal pain and hypotension were suddenly observed 4 days after the procedure; computed tomography revealed arterial bleeding from the left ovary，and laparoscopic hemostasis was performed immediately. Arterial bleeding was observed around the left proper ovarian ligament，and the internal abdominal hemorrhage volume was 2,060 ml. We obtained hemostasis by suturing the ovary. After the second surgery，warfarin was discontinued，and the patient was discharged 6 days later. Because 4 days after surgery is too late for bleeding to occur due to surgery，it was considered that the bleeding occurred due to compounded effect of warfarin and heparin . However，it is important to perform elaborate hemostasis by not only inducing coagulation but also including suturing the ovary. Moreover，careful follow-up is required in patients who undergo laparoscopic ovarian cystectomy and receive anticoagulant therapy.
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| 10.
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Tong, Lin ; Mekaru, Keiko ; Yagi, Chiaki ; Asato, Kozue ; Kinjyo, Tadatsugu ; Masamoto, Hitoshi ; Xiulan, Zhang ; Aoki, Yoichi
概要:
Purpose: We retrospectively analyzed the clinical outcome of patients over 40 years who received in vitro fertilization-
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embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) at a single center, and compared four different ovarian stimulation protocols to determine the most suitable method for use in these women. The aim of the study is to provide valuable information for use in the counseling of prospective IVF patients. Patients and Methods: The clinical records of 272 patients (aged ≥ 41 years) who received IVF-ET/ICSI at our institution between January 2008 and September 2011 were retrospectively analyzed. Four ovarian stimulation protocols were used: Group A received GnRH agonist long protocol with short-acting drugs, Group B received GnRH agonist long protocol with long-acting drugs, Group C received GnRH antagonist protocol, and Group D received microdose GnRH agonist protocol. Results: The mean age was 42.5 years (range, 41-49 years), and the median duration of infertility was 8.2 years (range, 0.5-22 years). The overall pregnancy rate, and live-birth rate per transfer were 20.3%, and 9.1%, respectively, and the abortion rate was 46.8%. The live-birth rate per transfer was decreased as follows: 15.6% at 41 years, 6.4% at 42 years, 6.3% at 43 years, and 4.5% over 44years. A significantly lower live-birth rate per transfer (p = 0.0165) was observed in age group ≥42 years than in 41 years of age. The age ≥42 years and the number of oocyte retrieval (≤4) were found to be an independent unfavorable factor for both pregnancy and live birth by a multivariate analysis. Groups A and B received the highest dosage of HMG injection and the longest HMG treatment, and had the highest oocyte retrieval, whereas group D received the lowest HMG dosage over the shortest period, but had the highest cycle cancelation rate and the fewest oocytes (p < 0.01). Group C had a lower HMG dosage and fewer HMG medication days than Groups A and B (p < 0.01). However, no significant differences were observed in the pregnancy rates among patients among the four groups. Conclusions: Age, in particular ≥42 years, and the less oocyte retrieval are found to be a predictive factor for the treatment failure. For the decreased medication costs and patient discomfort, use of GnRH antagonist or microdose GnRH agonist for ovarian stimulation seem to be better in patients over 40 years.
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