[Diagnosis of endometriosis].
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Biomedical subjects
Publications and source records attributed to T Fukaya.
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PURPOSES: The purposes of this study are to examine two points; 1) What effects do regular visits to hospitals have on the existence of friend?. and 2) Do the elderly use hospitals as substitutes for other meeting places or independent of other places?. METHODS: Data concerning 2,447 older adults were obtained from a national survey for the elderly aged 60 and over, conducted in 1996. 1) To examine effects of regular visits to hospitals on friends, friendships as a dependent variable, regular visits to hospitals as a confounding variable, and some two way-interaction terms as independent variables were entered in logistic regression analysis. 2) To analyze relationships between hospitals and other meeting places, correspondence analyses and logistic regression were used. 3) Existence of friends whom the elderly contact at hospitals as a dependent variable, existence of friends whom they meet at other places as a confounding variable, and some two way-interaction terms as independent variables were entered in logistic regression analysis. 3) Relationships between clinics and other meeting places were also analyzed using correspondence analyses and logistic regression. RESULTS: 1. Although regular visits to hospitals did not have a significant direct impact on existence of friends, the respondents with low activities of daily living who regularly visits hospitals were more likely to have friends than ones did not visits hospitals. 2. The respondents who meet friends at hospitals were also more likely to have contacts with friends at community centers for the elderly or community organization. 3. The respondents who meet friends at clinics had similar characteristics to those who meet friends at hospitals. CONCLUSIONS: Regular visits to hospitals may contribute to maintain contacts with friends, especially in the elderly with low ADL. The elderly may use hospitals as meeting places with friends independent of other places. Hospitals may have similar functions to what clinics as meeting places with friends.
OBJECTIVE: To evaluate the expression of estrogen receptor (ER)-alpha and ER-beta messenger RNA (mRNA) in ovarian endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with endometriosis and patients with uterine leiomyoma or carcinoma in situ. INTERVENTION(S): A sample of ovarian endometriotic cyst tissue was obtained from each of the 32 patients during laparoscopic cystectomy. Samples of ovarian tissue and endometrium were obtained from 15 patients during or just after surgery. MAIN OUTCOME MEASURE(S): Expression of mRNA for ER-alpha and ER-beta with use of the reverse transcription-polymerase chain reaction (RT-PCR) and nonradioactive in situ hybridization (ISH) techniques. RESULT(S): Expression of mRNA for ER-alpha and ER-beta was observed in all of the control tissues from the normal endometrium and normal ovaries in the RT-PCR and ISH analyses, although the distribution of positive signals changed in the ISH analysis during different phases of the menstrual cycle. Messenger RNA for ER-alpha was detected in all of the ovarian endometriotic cysts analyzed (19 of 19), but mRNA for the ER-beta was limited (12 of 19) in the RT-PCR analysis. The ISH analysis confirmed the RT-PCR results and revealed that the two estrogen receptors were localized in both epithelial and stromal cells of endometriotic tissues. CONCLUSION(S): The results suggest that predominant expression of ER-alpha in both glandular epithelial and stromal cells may be essential to the development and growth of ovarian endometriosis.
OBJECTIVE: To investigate the susceptibility to oxidation of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) in women with preeclampsia. METHODS: Plasma levels of total cholesterol, total triglyceride, and concentrations of cholesterol, triglyceride, and protein in LDL and HDL were measured in 12 preeclamptic women and 12 normal pregnant women. Oxidation of LDL or HDL was assessed by incubation with copper ions and evaluated by monitoring the kinetics of conjugated diene formation. RESULTS: The plasma levels of total triglyceride and concentration of LDL protein were significantly higher in preeclamptic women than in normals. Levels of HDL lipid did not differ significantly. Analysis of kinetics of conjugated diene production showed a significantly shorter lag time for LDL (83.1 +/- 5.5 minutes versus 67.4 +/- 10.2 minutes, P <.001) and HDL (76.9 +/- 7.3 minutes versus 59.5 +/- 9.2 minutes, P <.001) and a significantly higher oxidation rate for LDL (3.6 +/- 0.4 nmol/minutes/mg LDL versus 4.4 +/- 1.0 nmol/minutes/mg LDL, P <.05) in preeclamptic women. CONCLUSION: Low-density lipoprotein and HDL particles were more susceptible to oxidative modification, and plasma concentration of LDL particles, but not of HDL particles, was increased in preeclampsia.
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We evaluated the antioxidant property of melatonin as related to the vasospastic effect of lysophosphatidylcholine (LPC), a component of oxidized lipoprotein, on the human umbilical artery. Helical sections of umbilical arteries with intact endothelium were obtained at elective cesarean delivery between 37 and 39 weeks of gestation. Changes in 5-hydroxytryptamine (5-HT)-induced vasoconstriction were measured. Arterial sections were treated with LPC alone (15 or 30 microM) or pretreated with an hydroxyl radical (.OH) scavenger (mannitol), a cyclooxygenase inhibitor (indomethacin, 20 microM), nitric oxide (NO) synthesis inhibitor (L-N(G)-monomethylarginine, LNMA, 2 x 10(-4) M), or melatonin (1 or 10 microM). LPC potentiated 5-HT-induced contraction in a concentration-dependent manner. Pretreatment with mannitol significantly suppressed the vasospastic effect of LPC. LNMA augmented the vasospastic effect of LPC, but indomethacin did not. Melatonin significantly suppressed the vasospastic effect of LPC in a concentration-dependent manner. Considering a previous finding that .OH and oxidized low-density lipoprotein decrease NO production in the human umbilical artery, the vasospastic effect of LPC appear to involve suppression of endothelial NO synthesis. Melatonin significantly suppresses the vasospastic effect of LPC, probably by scavenging .OH arising from LPC.
We evaluated the antioxidant property of melatonin in countering the vasospastic effect of oxidized low-density lipoprotein (ox-LDL), which has been reported to be the most important risk factor for atherosclerosis and also may be linked to preeclampsia. Helical sections of umbilical arteries were obtained from human placentas at elective cesarean deliveries between 37 and 39 weeks of gestation. Changes in maximal tension induced by potassium chloride were measured in arterial sections with intact endothelium. ox-LDL (200 or 300 microg protein/mL) increased vascular tension by 15.6 +/- 2.3 or 31.9 +/- 4.0%, respectively. In contrast, native LDL only slightly increased vascular tension (2.7 +/- 1.0% for 200 microg protein/mL and 6.0 +/- 1.7% for 300 microg protein/mL). Pretreatment with L-N(G)-monomethyl-arginine (2 x 10(-4) M) significantly reduced the vasospastic effect of ox-LDL, as did pretreatment with mannitol (30 mM). Melatonin (10 microM) significantly reduced the vasospastic effect of ox-LDL. These findings suggest that ox-LDL potentiates vascular tension in the human umbilical artery, possibly by suppressing endothelial synthesis of nitric oxide. Melatonin significantly suppressed the vasospastic effect of ox-LDL, probably because it scavenges hydroxyl radical arising from ox-LDL.
We evaluated the antioxidant property of melatonin as related to the vasospastic effect of lysophosphatidylcholine (LPC), a component of oxidized lipoprotein, on the human umbilical artery. Helical sections of umbilical arteries were obtained from healthy pregnant women who were delivered between 37 and 39 wk of gestation. Changes in maximal tension induced by KCl were measured in arterial sections having intact endothelium. Sections were treated with LPC alone (15 or 30 microM), or were pretreated either with a hydrogen peroxide (H2O2) scavenger (catalase, 1,200 U/mL), a hydroxyl radical scavenger (mannitol, 30 mM), a nitric oxide (NO) synthesis inhibitor (L-N(G)-monomethyl arginine, LNMA, 2 x 10(-4) M) or melatonin (1 or 10 microM). The effect of LPC (30 microM) on the vasorelaxation induced by 5-hydroxytryptamine (5-HT) was also determined, with or without melatonin pretreatment (10 microM). LPC potentiated vascular tension in a concentration-dependent manner. Pretreatment with LNMA significantly suppressed this vasospastic effect of LPC. Pretreatment with catalase or mannitol significantly reduced the vasospastic effect of LPC. Melatonin significantly lessened the vasospastic effect of LPC in a concentration-dependent manner. Pretreatment with LPC significantly inhibited the relaxation induced by 5-HT. Treatment with melatonin prior to LPC exposure significantly restored the relaxation induced by 5-HT. Results suggest that LPC potentiates vascular tension in human umbilical artery, perhaps by suppressing the endothelial synthesis of NO. Melatonin significantly suppressed the vasospastic effect of LPC. This agent probably scavenges the hydroxyl radicals arising from LPC.
The endolymphatic sac (ES) is thought to have close relations to pathogenesis of endolymphatic hydrops. Here is reported a retrospective study of 41 patients (42 ears) with Meniere's disease who underwent MRI prior to endolymphatic sac surgery. Based on proton-density weighted image (PDI) and T2-weighted image (T2), the ES including an endolymphatic duct (ED) were estimated whether it was detectable or not. Fourteen ESs were detected on both images (Group A), 14 ESs were detected only on PDI (Group B), and the remaining 14 ESs were not detected on either image (Group D). The actual shape of the sac, obtained from surgical findings, was classified into three (normoplastic, atrophic, invisible). Seventeen ears showed normoplastic ESs and 14 showed atrophic ESs. ES was not detected in 11 ears during surgery, and these findings were compared with image classification. From the study data, normoplastic ESs tend to be observed on both images whereas atrophic or invisible sacs were hardly observed on T2. This classification of ES on MRI was thought to correlate with surgical findings and this correlation was statistically significant (Spearman's rank correlation coefficient. r(s) = 0.58, p < 0.01).
OBJECTIVE: To investigate the expression of manganese (Mn) and copper-zinc (Cu,Zn) superoxide dismutase (SOD) in normal cycling human ovaries throughout the menstrual cycle. DESIGN: Descriptive, controlled study. SETTING: Tohoku University School of Medicine. PATIENT(S): Twenty-four normal cycling human ovaries were obtained from patients who underwent oophorectomy and hysterectomy for squamous cell carcinoma of the uterine cervix. INTERVENTION(S): Immunohistochemistry for Mn-SOD and Cu,Zn-SOD. MAIN OUTCOME MEASURE(S): Immunostaining. RESULT(S): In the follicular stage, Mn-SOD immunoreactivity was detected in granulosa and theca interna cells of steroid-producing follicles, that is, preantral, nondominant, dominant, and atretic follicles, whereas Cu,Zn-SOD was detected in theca interna cells of these follicles and in granulosa cells of dominant follicles. In the luteal stage, immunoreactivity for Mn-SOD and Cu,Zn-SOD was observed in both luteinized granulosa and theca cells of the functioning corpus luteum. In the early degenerating corpus luteum, both Mn-SOD and Cu,Zn-SOD were positive in steroid-producing luteinized theca cells. Mn-SOD immunoreactivity was also detected in nonsteroid-producing luteinized granulosa cells and macrophages. CONCLUSION(S): Our results suggest that the expression of Mn-SOD and Cu,Zn-SOD closely correlates with steroidogenesis in the human ovary. In addition, Mn-SOD may play an important role in the process of luteal regression.
We examined the localization of oestrogen receptor (ER) beta mRNA in the human endometrium throughout the menstrual cycle using non-radioactive in-situ hybridization with Brigati-tailed oligonucleotides. The findings were compared with those of ERalpha in order to examine the possible biological significance of ERbeta in the human endometrium. Both ERalpha and ERbeta mRNA expression were detected in all major human uterine cell types, including glandular epithelial cells, stromal cells and smooth muscle cells of the uterine wall, at every menstrual cycle stage. However, ERalpha mRNA expression was more prominent than that of ERbeta in all cell types throughout the menstrual cycle. In proliferative phase endometrium, ERalpha mRNA was expressed in both glandular epithelial and stromal cells, while ERbeta mRNA was expressed predominantly in glandular epithelial cells. Although the same pattern was observed in the secretory phase, both the ERalpha and ERbeta mRNA expression was relatively weaker. These results suggest that oestrogenic effects occur predominantly through ERalpha, but that ERbeta may also play a role in the modulation of oestrogenic action, especially on glandular epithelial cells in the human endometrium throughout the menstrual cycle.
PROBLEM: The present study examined the presence and cellular distribution of transforming growth factor-beta1, 2, and 3 isoforms and their type I and II receptors in endometriotic cysts of the ovary, relative to their presence in normal endometrial tissue. METHOD OF STUDY: Thirteen control samples of normal endometrium in the proliferative phase and 11 ovarian endometriotic cysts were examined by immunohistochemistry for transforming growth factor-beta1, 2, and 3 isoforms and their type I and II receptors. RESULTS: Immunoreactivity for all ligands and receptors was detected in both normal endometrium and endometriotic cysts. Isoform-specific differences in immunostaining were not detected. Expression of all ligands and receptors was significantly increased in epithelial cells of endometriotic cysts compared with those of normal endometrium. On the other hand, stromal cells in normal endometrium and endometriotic cysts were only faintly immunostained. Inflammatory cells infiltrating among endometriotic stromal cells contained the highest immunostaining intensity for all ligands and receptors. We identified nearly all inflammatory cells as macrophages using a specific antibody. CONCLUSIONS: These findings suggest that macrophages in endometriotic tissue are a major source of transforming growth factor-beta, which may be an important regulator of cell proliferation in endometriotic cysts through paracrine and autocrine actions.
Defects in the cell-mediated immune system may play a role in the pathogenesis or progression of pelvic endometriosis. Possible mediators include macrophages, interleukins-1 and -6, and tumor necrosis factor-alpha. More recent work points to the involvement of adhesion molecules and growth factors. To clarify the pathogenesis of endometriosis, we compared the characteristics of soluble intercellular adhesion molecule-1 (soluble ICAM-1) and hepatocyte growth factor (HGF) in women with and without endometriosis. We found that, in patients with endometriosis, the concentrations of soluble ICAM-1 in peritoneal fluid increased and interfered with the activity of natural killer cells. We also found that HGF secretion was significantly increased in cultured endometrial stromal cells, and that HGF stimulated the proliferation and migration of, and morphogenic changes in, endometrial epithelial cells. HGF and ICAM-1 play important roles in the initiation and regulation of endometriotic lesions on the microenvironment level. The increased secretion of HGF by eutopic endometrial stromal cells may contribute to the pathogenesis of endometriosis, whereas the increased levels of soluble ICAM-1 may impair natural killer cell activity and accelerate the progression of the disease.
We examined the expression of a recently characterized novel estrogen receptor (ER) beta in 25 cases of invasive ductal carcinoma of the breast, using messenger RNA (mRNA) in situ hybridization, and compared the findings with those of ERalpha, to study its localization and its possible biological significance in human breast cancer. ERalpha and ERbeta hybridization signals were both detected, predominantly in carcinoma cells and in some stromal cells, in 18 of 25 (72%) and 11 of 25 (44%) cases, respectively. The cases in which more than 25% of carcinoma cells demonstrated mRNA hybridization signals were 13 of 25 (52%) and 2 of 25 (8%) cases for ERalpha and ERbeta, respectively. Among the cases expressing ERbeta, 10 of 11 (91%) also expressed ERalpha mRNA; and in these 10 cases, coexpressing both ERalpha and beta, the number of carcinoma cells expressing ERalpha was greater than that expressing ERbeta in 9 cases. Eight cases demonstrated only ERalpha mRNA hybridization signals in carcinoma cells. These results indicate that ERbeta is coexpressed with ERalpha in most ERbeta-positive breast carcinoma cells, which suggests that the expression of ERbeta depends on the presence of ERalpha in the great majority of human breast cancer. In addition, the number of carcinoma cases and/or the ratio of carcinoma cells expressing ERalpha was much greater than those expressing ERbeta. The relative ratio of ERalpha and ERbeta expression in carcinoma cells may be related to various estrogen-dependent biological features of human breast cancer.
Functional endoscopic sinus surgery has become an increasingly popular treatment for chronic sinusitis. This approach is aimed at re-establishment of ventilation and mucociliary clearance of the sinuses. However, some otolaryngologists believe that the Caldwell-Luc procedure should be routinely used for unilateral chronic sinusitis, because it is often associated with the maxillary sinus carcinomas. To evaluate the state of endoscopic sinus surgery for the diagnosis and treatment of unilateral chronic sinusitis, we analyzed the cases of 39 patients with unilateral chronic sinusitis who underwent endoscopic sinus procedures. These patients were unresponsive to appropriate antibiotic management for more than 6 months. Generally, endoscopic ethmoidectomy and antrostomy were performed with preservation of the middle turbinate. After the ostium was enlarged, the maxillary sinus was cleaned and carefully inspected for the presence of associated neoplasms using 30 and 70 degree endoscopes. Preoperative computed tomography (CT), postoperatve pathologic diagnosis, fiberscopic findings of the maxillary sinus, and symptomatic improvement were evaluated. Three patients had CT evidence of bone destruction of the lateral nasal wall. Pathological diagnosis demonstrated that three patients had maxillary sinus mycoses caused by Aspergillus species, one patient had inverted papilloma, and the other 35 patients had chronic sinusits. No associated malignancy was found. Eighty-one percent of the patients had almost normal endoscopic findings of the maxillary sinus by postoperative fiberscopic examination 4 to 8 months following surgery. With an average follow-up of 26 months, 88% of the patients were judged as having significantly improved in their presenting complaints of mucopurulent rhinorrhea, nasal obstruction, and facial pain. The results of this series suggest that endoscopic sinus surgery is an effective procedure for the diagnosis and treatment of unilateral chronic sinusitis.
The purpose of this study was to examine the impact of social support on life satisfaction among Japanese elderly aged 60 and over (N = 1,285), using the longitudinal data of a national representative sample. An initial survey was carried out in 1987, and a follow-up was conducted in 1990. We measured life satisfaction by the Life Satisfaction Index A. Social support was measured from two aspects, providing support and receiving support. The impact of social support and changes in support during a period of three years on life satisfaction were assessed by sex after controlling for influences of socioeconomic status, physical functioning, and initial life satisfaction. Providing support predicted a high life satisfaction three years later only in females. Receiving support was not significantly associated with life satisfaction for either males or females. However changes in providing and receiving support had a significant impact on life satisfaction of the elderly. The findings of this study suggest that the effects of social support on life satisfaction differ by sex and the impacts of changes in support are strong determinant predicting life satisfaction of the elderly.
BACKGROUND: With recent advances in laparoscopic surgery, many reports have described laparoscopic cornual resection for interstitial pregnancy as a safe alternative to laparotomy. We report a laparoscopic cornuostomy for unruptured interstitial pregnancy with myometrium reconstruction. CASE: A 32-year-old woman presented with complaints of abdominal cramps and vaginal spotting after 6 weeks of amenorrhea. Ultrasonographic examination revealed a gestational sac 7 mm in diameter in the left uterine corner. There was clear separation between the endometrium and gestational sac. A 3-mm periumbilical trocar for the laparoscope and a 3-mm trocar in the lower abdomen were used, and the left interstitial pregnancy was confirmed. An additional, 5-mm trocar was used in the lower abdomen for the laparoscopic surgery. The patient underwent a laparoscopic cornuostomy. Myometrium reconstruction was performed by suturing and tying with a laparoscopic technique. CONCLUSION: In this case, minilaparoscopy was useful in the diagnosis and treatment of interstitial pregnancy.
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