Nihon Sanka Fujinka Gakkai zasshi最新文献

The implantation site in 25 pregnant uteri was studied morphologically and immunohistochemically to clarify the developmental process of extravillous trophoblasts (EVTs). 1. Dense trophoblastic invasion of the decidua was observed. Multinuclear trophoblasts appeared in the deciduo-muscular junction from the 10th week. Trophoblasts infiltrated decidual vessel walls, where extensive perivascular degeneration existed. EVTs may be indispensable for construction of the placenta. 2. In villous trophoblasts (VTs) the location of hCG and hPL was limited to multinuclear cells, whereas in EVTs hCG was present in a few mononuclear cells and hPL was observed in most mononuclear and multinuclear cells. The immunoreactivity of trophoblast-related monoclonal antibodies also differed: neither anti-Tropl (reactive with cytotrophoblasts (CTs)) nor NDOG1 (reactive with syncytiotrophoblasts (STs)) was reactive with EVTs. 3. The absence of hCG and hPL in mononuclear trophoblasts of the cell column indicates that EVTs differentiate after invading the decidua. Kurman et al. proposed the term intermediate trophoblast, indicating cells in transition from CTs to STs and EVTs, and this is based on the concept that the developmental processes of EVTs and VTs are identical. But the results of this study suggested an independent developmental process for EVTs and therefore it seemed that the term intermediate trophoblast should not be employed for EVTs.

The purpose of this study was to estimate the risk of heart diseases in pregnancy. A total of 594 patients with heart diseases treated at the National Cardiovascular Center between 1982 and 1993 were evaluated. The heart diseases were classified into eight categories: congenital heart disease with or without pulmonary hypertension (8 cases (1%) and 219 cases (37%), respectively), mitral valve prolapse (38 cases (6%)), valvular heart disease with or without valve replacement (9 cases (2%) and 54 cases (9%), respectively), arrhythmia (222 cases (37%)), cardiomyotitis (15 cases (3%)) and miscellaneous (29 cases (5%)). Maternal risk was estimated from the incidence of maternal mortality and artificial preterm delivery. Maternal death within two years after delivery was observed in 7 cases (1.2%): 4 cases with cardiomyotitis (3 DCM and 1 HCH), 2 cases with heart disease with pulmonary hypertension (1 PPH and 1 PDA), and a single case with valvular heart disease with aortic valve replacement. Artificial preterm delivery was carried out in 32 cases (5.4%), most frequently in cases with congenital heart disease with pulmonary hypertension (6/8, 75%) which follows cardiomyotitis (4/15, 27%) and cases with valvular heart disease with valve replacement (2/9, 22%). Fetal risk was measured by the incidence of fetal death, fetal growth retardation and congential heart disease of the fetus. IUFD because of maternal heart disease was observed in 4 cases: two cases with valvular heart disease with valve replacement, a single case with Marfan's syndrome and a single case with DCM. Fetal growth retardation was observed in 59 cases, most frequently in cases with congenital heart disease with pulmonary hypertension and cases with valvular heart disease with valve replacement (3/8 (38%) and 3/9 (33%), respectively). Neonatal congenital heart disease was found in 8 of 228 neonates (3.5%) whose mothers also had congenital heart disease. It is therefore suggested that intensive medical care be recommended in pregnancies complicated with congenital heart disease with pulmonary hypertension or with valvular heart disease with valve replacement, which increase both maternal and fetal risk, and in pregnancies complicated with cardiomyotitis which significantly increases the maternal risk.

By means of pulsed Doppler ultrasound, external iliac vein (EIV) velocimetries were carried out on non-pregnant, pregnant and postpartum women. 1. According to the results of a phantom simulation study, the difference between measured values and theoretical values increased when the angle of incidence was over 50 degrees. 2. The coefficient variation of the measured value for ten pregnant women was 4.4 to 9.8%. 3. EIV velocity was 21.4 +/- 7.7cm/sec for non-pregnant women, 20.8 +/- 9.5cm/sec in the 1st trimester, showing no significant difference between the two groups. In the 2nd trimester, it was 8.8 +/- 5.6cm/sec decreasing slightly (p < .001), and 6.1 +/- 3.3cm/sec in the 3rd trimester showing a further decrease (p < 0.01). At 24 hours postpartum, it was 12.7 +/- 4.3cm/sec, an increase over the 3rd trimester (p < 0.001), but it was lower than in non-pregnant women (p < 0.001). At 4 weeks postpartum, it was 19.3 +/- 5.3cm/sec, showing no significant difference from non-pregnant women. The results suggested the following. 1. EIV velocimetry by pulsed Doppler ultrasound is reliable for clinical studies. 2. EIV velocity decreased significantly in the 2nd and 3rd trimesters and recovered to the same level as non-pregnant women by 4 weeks postpartum.

I have investigated 84 endometrial specimens (from 15 cases of normal endometrium, 20 cass of hyperplasia and 49 cases of endometrial carcinoma) to determine the relationship between three proteins (proliferating cell nuclear antigen (PCNA), p53 gene product and c-erB-2 gene product) and endometrial carcinoma by immuno-histochemical staining. In 49 cases of endometrial carcinoma, the positive rates for PCNA, p53 protein (mutant type) and c-erbB-2 protein were 65.3%, 59.2% and 22.4%. I could not find the expression of p53 protein besides endometrial carcinoma. And I could find the expression of c-erbB-2 protein in 11 cases of endometrial carcinoma and 1 case of atypical hyperplasia, but not in normal endometrium. p53 protein was more common in such a case, as with lymphnode metastasis, deep myometral invasion and undifferentiated adenocarcinoma. c-erbB-2 was also more common in a case with deep myometrial invasion. In conclusion, PCNA, p53 protein and c-erbB-2 protein are related to the proliferation of endometrial carcinoma. So they can be useful factors in making the prognosis.