Conservative treatment of a cervical pregnancy with local methotrexate injection.
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Adult↗
Biomedical subjects
H Masuzaki
Publications and source records attributed to H Masuzaki.
[The evaluation of ovarian tumor associated with pregnancy by the ultrasonographical method and serum CA125 levels].
We examined and evaluated ovarian tumor during pregnancy using ultrasonography. The CA 125 level was measured in 21 cases in the first and second trimesters. For a total of 65 cases of ovarian tumor considered to be tumor-like lesions (corpus luteum cyst, etc) the longitudinal and transverse diameters were measured, and the shape was assumed to be ellipsoid. Disappearance of the tumor was confirmed in 40 of the 65 cases. The disappearance occurred by the 16th week of gestation (mean time = 13 weeks and 2 days) in 32/39 (82%) cases, and the maximum diameter (size) did not exceed 10cm (50cm2) at any gestational week. Also the diameter (size) did not exceed 7cm (30cm2) after 15 weeks of gestation in the tumor-like lesions. Surgery performed during pregnancy (9-24 weeks) in 22 cases revealed 19 tumors (16 benign, one borderline malignant and two malignant tumors). The remaining 3 were chocolate cysts and did not require surgery because the diagnosis had been confirmed before pregnancy. There was no difference in the CA 125 level in benign and malignant tumors (15 were benign, 3 were chocolate cysts, one was borderline malignant and two were malignant tumors). Cases in which the maximum diameter (size) of an ovarian tumor increases or remains unchanged during the gestational period may need surgery for benign or occasionally malignant ovarian tumors.
Adult↗
[A case report of aplasia cutis congenita].
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Adult↗
Relationship between the prognosis of conception and the location of pelvic involvement in endometriosis: significance of the TOP (tube, ovary, peritoneum) classification.
To determine the main factors that affect the prognosis for conception in endometriosis-associated infertility, 99 infertile patients with laparoscopically confirmed endometriosis were classified according to the new TOP classification, which we have developed to evaluate the severity of endometriosis by site, i.e., fallopian tubes (T), ovaries (O) and the peritoneum (P). According to the TOP classification, a negative correlation between the pregnancy rate after treatment and the severity of lesions was noted in case of tubal and peritoneal involvement, but not when the ovaries were involved. If there was no tubal involvement or only unilateral tubal involvement, high pregnancy rates were achieved for patients with ovarian endometrioma (87%) and for those with partial or complete posterior cul-de-sac obliteration (83%). The results suggest that for endometriosis-associated infertility, the treatment modality should be selected according to the severity of tubal involvement, which is considered to contribute to infertility more than ovarian or peritoneal lesions.
Adult↗
[A case of pregnancy with antiphospholipid antibodies: serial measurement of flow velocity waveforms of uterine arteries].
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Adult↗
[A case of Cushing syndrome caused by ACTH producing atypical lung carcinoid tumor].
A forty-one-year-old male who was found to have lung carcinoid tumor showed clinical features of Cushing syndrome. At the age of 38 years during a regular check-up, a chest roentgenogram showed multiple nodular shadows in the bilateral lung, and he was admitted to hospital. By open lung biopsy, he was diagnosed as having malignant carcinoid or small cell carcinoma of the lung. The abnormal lung shadows did not respond to chemotherapy (CDDP + VDS). The clinical course after discharge was uneventful until the age of 41 years, when he was readmitted to our hospital because of brain metastasis. Physical examination revealed moon face and central obesity. Plasma ACTH level was high and dexamethasone suppression test showed no cortisol suppression on 8 mg dexamethasone administration. Therefore, it was thought that the patient had ACTH producing ectopic tumor which led to Cushing syndrome. We measured the molecular weight of ACTH by column chromatography and found he had a big ACTH (molecular weight about 22,000). Reexamining him clinically and histologically, we concluded that the patient had atypical carcinoid tumor in the lung which might produce ACTH causing Cushing syndrome with metastasis to the brain.
Adrenocorticotropic Hormone↗
Association between chlamydial infections and pelvic lesions.
Chlamydia trachomatis usually causes asymptomatic cervicitis, but it sometimes ascends into the uterine cavity, fallopian tubes, or peritoneal cavity, causing pelvic inflammatory disease and infertility. In this study, we examined endocervical chlamydial antigens and serum chlamydial antibodies in infertile women and laparoscopically evaluated pelvic lesions according to our pelvic scoring system. In patients testing positive for a chlamydial infection, the total pelvic score was significantly higher than in patients testing negative. When each area examined was assessed separately, however, only the tubal score was significantly higher in the chlamydia infected patients. These findings may indicate that tubal lesions are the major cause of infertility in women with chlamydial infections.
Adult↗
Peritoneal endometriosis: endometrial tissue implantation as its primary etiologic mechanism.
The mechanisms involved in primary implantation of pelvic endometriosis were investigated in women undergoing laparoscopy as part of an infertility evaluation. Among the women with a diagnosis of endometriosis, those with no observed lesions in the ovaries and no adhesions in the pelvic cavity were classified as being in stage I. These women were further subdivided into two groups: the stage Ia group in which implants were found in one area (25 women) and the stage Ib group in which implants were found in two or more areas (29 women). In both groups the most frequent site was the uterosacral ligaments followed by the posterior uterine serosa, the posterior cul-de-sac, and the posterior broad ligaments in that order. Regardless of the position of the uterus, endometriosis was found significantly more frequently in the posterior compartment. The finding that the most frequent implants on the uterosacral ligaments were near the tubal ostium and, in the stage Ia group, the absence of implants on the anterior uterine serosa but a 33% frequency on the posterior uterine serosa, which is more frequently exposed to menstrual blood, suggest that implantation of endometriosis is the result of retrograde menstruation. However, the possibility that metaplasia of the serosal epithelium is stimulated by menstrual blood cannot be ruled out, inasmuch as the process of implantation in the peritoneum has not yet been proved.
Animals↗
[A rare case of allergic granulomatous angitis (Churg Strauss syndrome) with positive anti-glomerular basement membrane (GBM) antibody in serum].
A 33-year-old man with a 6-month history of rhinitis and bronchial asthma was referred to our hospital with polyarthralgia, severe anemia, hypoxemia, mononeuropathy multiplex, and renal insufficiency with hematuria. Marked eosinophilia was observed in his sputum, peripheral blood, and bronchoalveolar lavage fluid (BALF). In addition, his sputum contained many hemosiderin-laden macrophages, indicative of pulmonary hemorrhage. His chest roentgenogram on admission showed diffuse ground grass appearance. High resolution computed tomography (HRCT) demonstrated diffuse high density areas throughout the lung fields and characteristic irregularity and enlargement of the peripheral pulmonary arteries. His general condition rapidly deteriorated, but dramatically improved with oral steroid administration, and his major symptoms disappeared within a few days. Examination of the biopsied lung tissue revealed unequivocal evidence of pulmonary angitis with marked eosinophilic infiltration and perivascular granulomas. Bone marrow biopsy showed hyperplasia of eosinophilic leukocytes in contrast to the low cellularity. Suppression of erythroid hemopoiesis was thought to be the primary cause for his rapidly progressive anemia. Serum anti-GBM antibody titer returned to within the normal range soon after the initiation of steroid therapy.
Adult↗
Activity of peritoneal macrophages in endometriosis.
The mechanism of infertility in women with endometriosis is still largely unclear. It is thought that peritoneal macrophages increase in number in women with endometriosis and that the macrophages phagocytize sperm or the fertilized ovum, leading to infertility. We examined the levels of phagocytosis by peritoneal macrophages in patients with and without endometriosis using a flow cytometric assay. The level of phagocytosis in the control group was significantly lower than in the group with endometriosis. Quantitative results on the level of phagocytosis by peritoneal macrophages suggest that peritoneal macrophages are one of the factors contributing to infertility associated with endometriosis.
Endometriosis↗
[A study on the diagnosis and treatment of the infertile patient with endometriosis externa by scoring].
Though the conservative treatment of infertility associated with endometriosis has undergone a significant evolution, clinical diagnostic problems still remain. In order to evaluate the efficacy and diagnostic value of the non-surgical scoring method, personal histories, symptoms, signs, hysterosalpingographic findings and routine infertility test results for 63 patients with endometriosis diagnosed laparoscopically were compared with those of 63 controls. 8 findings specific to endometriosis and the scores were as follows: Dysmenorrhea (1), dyspareunia (3), retroverted uterus (3), cul-de-sac nodularities (3), atonic (1) and marginal irregularity (1) of uterus, and perifimbrial adhesion (2) in hysterosalpingography, and unexplained infertility (2). The results obtained retrospectively revealed that the probability of endometriosis was seen in the cases in which the total scores ranged 0-4, 5-8, and 9-16; the incidence being approximately 10%, 60%, and 90% respectively. These results were confirmed by a prospective study. After completing a course of treatment, the pregnancy rate was 55% in patients with endometriosis. This fertility rate was higher than that of controls (23%). Thus, infertile women whose total scores ranged 0-4, 5-8, and 9-16 will be required to undergo re-examination of other sterility factors other than endometriosis, diagnostic laparoscopy and treatment for endometriosis, respectively.
Antigens, Neoplasm↗
[Monitoring of follicles by ultrasonography during induction with HMG-HCG treatment--especially on the prevention of side effects].
Estrogen levels are a useful indicator to use in predicting of ovarian hyperstimulation syndrome (OHSS) which is one of the side effects of HMG-HCG therapy. However, the quantitative assay of estrogens entails cumbersome time-consuming procedures. The present study represents our attempt to establish criteria for predicting the occurrence of OHSS by the use of ultrasonography (USG), a diagnostic procedure that can be performed quickly and conveniently. The subjects were 40 anovulatory women (79 cycles) receiving HMG-HCG therapy. Each patient had USG performed at the time of switching to HCG in a regimen of sequentially administered gonadotropins and was measured for maximum follicular diameter (FD) and total of vertical follicular area (FA) to correlate measurements of these parameters with simultaneously determined serum estradiol (E2) levels. A study was also made of relationships of FD and FA with ovulation and OHSS. The results are summarized as follows: No distinct correlation was observed between FD and E2 (r = 0.3794). It should be noted, however, that the therapy was successful in inducing ovulation in those cases in which the patient was switched to HCG from HMG when FD was 18mm or above. There was a significant correlation between FA and E2 (r = 0.8113, p less than 0.001). FA was thus proven to well reflect E2 levels and hence to be a parameter of the predictive value for OHSS. All but one (with moderate OHSS) of 26 cases showing evidence of OHSS had FA values of more than 6.0cm2, while those developing severe OHSS invariably.(ABSTRACT TRUNCATED AT 250 WORDS)
Amenorrhea↗
[Clinical studies on ceftriaxone in the field of obstetrics and gynecology].
Clinical studies were made on ceftriaxone (CTRX, Ro 13-9904), a new long-acting cephalosporin antibiotic, with the following results. Following a single intravenous injection of 1 g, the transfer of CTRX to the internal genital organs was found to be good. The transfer of CTRX to exudate of the dead space of pelvis was also good. Elbow vein and uterine artery blood serum levels revealed marked increase immediately after administration, then followed by gradual reduction at very slow rate. CTRX was given to 3 patients of female genital infections. Efficacy was excellent in 1 case and good in 2 cases. As to side effect, 2 cases of diarrhea and 1 case of leukopenia were observed.
Adult↗