Nihon Sanka Fujinka Gakkai zasshi最新文献

To examine the impact of amenorrhea on bone mineral density in women of reproductive age, bone mineral density in the lumbar spine (L2-L4) was measured by Dual-energy X-ray absorptiometry in 43 amenorrheal women. There was a significant lower bone mineral density in this test group (0.917 +/- 0.121 g/cm2) than in a normally menstruating control group (1.032 +/- 0.095 g/cm2). In premature ovarian failure, we found lower bone mineral density (0.863 +/- 0.112 g/cm2) than in any other subclass. Seven women with premature ovarian failure received cyclic hormone replacement therapy for 12 months (day 1-28, 0.625 mg conjugated estrogen, and on days 14-28, 5 mg medroxyprogesterone, followed by a seven-day pause). After 12 months, bone mineral density had increased significantly (p < 0.05) compared to the initial bone mineral density. We conclude that amenorrhea is a cause of bone loss in young women and that estrogen therapy is effective in preventing bone loss.

Purpose: To discriminate patients with severe mental disorders from those complaining of menopausal symptoms, psychological tests were performed on patients who visited the menopausal clinic. The effectiveness of hormone replacement therapy (HRT) in patients with slight mental disorders was also evaluated.

Subjects and methods: Patients with menopausal symptoms (n = 150, 41-59 yr. old) were interviewed by a psychiatrist (according to DSM-III-R) and classified as the climacteric syndrome group (C) and the mental disorder group (P). The patients were also evaluated by the Menopausal index (MI), Maudsley Personality Inventory (MPI) and Self-rating depression Scale (SDS). The patients with severe mental disorders were eliminated and the remaining patients with menopausal symptoms were treated with conjugated equine estrogen (0.625 mg/day) and medroxyprogesterone acetate (2.5mg/day) for 24 weeks.

Results: 1) Thirty six patients were diagnosed as P (24%) and seven of them were diagnosed as having major depression (4.7% of the all patients). 2) MPI-N (neurosis scale) in C was 16.2 +/- 10, and in P was 30.5 +/- 9.0, and SDS in C and P were 39.0 +/- 8.0, and 51.4 +/- 8.9, respectively. In both psychological test, P shows a significantly higher value than C (p < 0.01). 3) Ninety point six % of the patients responded. HRT was not effective in 63.2% of P, but when psychotropic drugs were combined, significant improvement (p < 0.05) was observed.

Conclusion: One fourth of the patients were suspected of having mental disorders in the menopausal clinic, and 5% of the patients needed the care of the psychiatrist. And the application of MPI and SDS was useful in helping the gynecologist to differentiate and classify the mental disorders to some extent. The applicability and effectiveness of HRT for patients with mild mental disorders were suggested.

To clarify the roles of nitric oxide synthase (NOS) during pregnancy, histopathological changes in the placenta were observed after the administration of an NOS inhibitor [NG-nitro-L-arginine methyl ester (L-NAME)] to rats. L-NAME was infused subcutaneously from day 12 of gestation at stable concentrations of 3mg/day (group B) or 25mg/day (group C) until day 18 when the placentae were removed. The mean systolic blood pressures in groups B and C were higher than in the controls (group A). By both light and electron microscopy, morphological changes were observed and compared to those of human placenta in preeclampsia. In groups B and C, light microscopy showed that giant cells were vacuolated, degenerated and decreased in number. In the labyrinth, the stroma was extremely edematous, and the intervillous space and fetal vessels were narrowed. Electron microscopy showed that micro-fibrin clots were deposited on the maternal surface of trophoblasts. The endothelial cells of fetal vessels were irregular in shape. In group B the endothelial cells and intermediate filaments were increased. These findings suggest that decreased NO production may cause changes similar to those found in preeclampsia. Treatment with NOS inhibitor may be used in an animal model for preeclampsia.

We evaluated the incidence of synchronous or metachronous multiple primary cancer, hereditary or familial cancer, and the familial aggregation of cancer in 142 patients who were treated for endometrial cancer at Tsukuba University Hospital in the period 1977 to 1995. Synchronous multiple primary cancers were identified in 6 of the 142 patients (4.2%). Eleven patients (7.7%) had a history of extraendometrial cancer. Patients with endometrial cancer had a significantly high incidence of a history of breast cancer. Endometrial cancer was diagnosed in two patients who were screened before menopause. Four patients with endometrial cancer (2.8%) subsequently developed extraendometrial forms of cancer. One patient (0.7%) was considered to have a hereditary form of cancer, and 5 patients (3.5%) had familial forms of cancer. A total of 86 cases of cancer were found among 53 kindred (37.3%). More detailed studies are needed to elucidate the aggregation of cancers in the families of patients with endometrial cancer in Japan. Patients with a history of breast cancer should be screened for the presence of endometrial cancer.

One hundred and sixty patients with FIGO stage I and II endometrial cancer entered this study. Magnetic Resonance Imaging (MRI; 61 cases), fractional curettage (110 cases) and hysteroscopy (119 cases) were performed to evaluate the presence of cervical involvement, and the findings were histologically compared with specimens obtained in abdominal hysterectomy. MRI showed the highest sensitivity (90.9%), specificity (96.0%) and diagnostic accuracy (95.1%) for the presence of cervical involvement. In 11 cases with cervical lesions, MRI predicted all 9 cases with invasion deeper than 1.5 mm. From these results we concluded that MRI appeared to be an excellent technique for cervical involvement and it would be a great help in determining the surgical procedure for endometrial cancer.

In order to assess the effect of vitamin D receptor (VDR) gene polymorphisms on vitamin D3 therapy for postmenopausal bone loss. Thirty-four Japanese postmenopausal women, administered vitamin D3 (Alfarol 1.0 microgram/day) and Ca (2.0 g/day) for 18 months, were analyzed by RFLP. Bone mineral density (BMD) at the lumbar spine (L2-4) and Os-calcis were measured every 6 months by dual energy X-ray absorptiometry (DXA) and single energy X-ray absorptiometry (SXA). VDR gene allelic polymorphisms were assessed by Bsm 1 endonuclease restriction after specific PCR amplification. Genotypic polymorphism was defined as BB, bb and Bb. The genotypes were BB in 1 (3.1%), Bb in 13 (40.6%), and bb in 18 (56.3%). The women in these two major VDR genotype groups (Bb and bb) were similar in their backgrounds (in terms of age, body mass index, and BMD in premedication), but the VDR genotype was associated with the percent of change in BMD after treatment. In Group-Bb, the mean percent increases in L2-4 BMD were 3.2%, 4.9% and 4.1% at 6, 12 and 18 months. In contrast, in Group-bb they were 0.8%, 1.8% and 1.2% at the same points. Analysis of VDR alleles may prove useful in selecting the vitamin D therapy for osteopenia before treatment.