Kuniaki Niwa

Background: The occurrence of clear-cell adenocarcinoma (CCAC) in the uterine cervix is very rare. We report a case of CCAC diagnosed by preoperatively cervical smears.<BR>Case: The patient was a 74-year-old woman whose endometrial smears were diagnosed as positive at another hospital. When she was referred to our hospital, she had some atypical genital bleeding. Her cervical smears showed CCAC. Simple total hysterectomy and adnexectomy were conducted based on her general condition. Cervical smears demonstrated varied tumor cells with remarkable cytoplasm, large nuclei, and bare nuclei-often large bare nuclei having lost cytoplasm and hobnail cells. Histologically, tumor cells showed a papillary structure with hobnail cells, solid nests, and composite areas.<BR>Conclusion: CCAC of the uterine cervix difficult to diagnose in the absence of hobnail cells in smears. It becomes ever more difficult when other tumor cells appear independently in smears. Since CCAC prognosis is generally dismal, it is important that preoperative differential diagnosis be done carefully to derermine the most appropriate surgical procedure.

Background: The occurrence of clear-cell adenocarcinoma (CCAC) in the uterine cervix is very rare. We report a case of CCAC diagnosed by preoperatively cervical smears.<BR>Case: The patient was a 74-year-old woman whose endometrial smears were diagnosed as positive at another hospital. When she was referred to our hospital, she had some atypical genital bleeding. Her cervical smears showed CCAC. Simple total hysterectomy and adnexectomy were conducted based on her general condition. Cervical smears demonstrated varied tumor cells with remarkable cytoplasm, large nuclei, and bare nuclei-often large bare nuclei having lost cytoplasm and hobnail cells. Histologically, tumor cells showed a papillary structure with hobnail cells, solid nests, and composite areas.<BR>Conclusion: CCAC of the uterine cervix difficult to diagnose in the absence of hobnail cells in smears. It becomes ever more difficult when other tumor cells appear independently in smears. Since CCAC prognosis is generally dismal, it is important that preoperative differential diagnosis be done carefully to derermine the most appropriate surgical procedure.

Up until the present, the primary treatment for threatened premature labor has been bed rest, with drug therapy as a supplement. However, with drug therapy the problems of side effects and dosage limitations have made it difticult to achieve therapeutic effectiveness. In this paper, the authors report the favorable results obtained in such cases when moxibustion and a microwave emitter were used for stimulation therapy based on Oriental medical theory. Moxibustion was carried out on Shiin, Yusen and Saninko (acupuncture points) in cases of threatened premature labor beyond the 24th week. Despite the short duration of treatment, uterine tension was relieved, fetal movement increased, and resistance in the umbilical artery and uterine artery reduced. Similar results were achieved with multiple microwave stimulation treatments; the effects lasted for long periods and were not accompanied by side effects. Thus, the results showed that through the use of moxibustion therapy in conjunction with drug therapy, the dosage could be reduced, and the frequency of side-effect appearance lowered. These results suggest that moxibustion therapy has potential as an effective and safe new treatment for threatened premature labor.

Up until the present, the primary treatment for threatened premature labor has been bed rest, with drug therapy as a supplement. However, with drug therapy the problems of side effects and dosage limitations have made it difticult to achieve therapeutic effectiveness. In this paper, the authors report the favorable results obtained in such cases when moxibustion and a microwave emitter were used for stimulation therapy based on Oriental medical theory. Moxibustion was carried out on Shiin, Yusen and Saninko (acupuncture points) in cases of threatened premature labor beyond the 24th week. Despite the short duration of treatment, uterine tension was relieved, fetal movement increased, and resistance in the umbilical artery and uterine artery reduced. Similar results were achieved with multiple microwave stimulation treatments; the effects lasted for long periods and were not accompanied by side effects. Thus, the results showed that through the use of moxibustion therapy in conjunction with drug therapy, the dosage could be reduced, and the frequency of side-effect appearance lowered. These results suggest that moxibustion therapy has potential as an effective and safe new treatment for threatened premature labor.

This study was undertaken to elucidate the effects of epidural analgesia on vibro-acoustic stimulation test (VAST) during normal labor and auditory brainstem response (ABR) in fifty full term parturients without any complication. The safety of VAST in relation to the ABR of neonates was also studied. The results were as follows, 1) There were some changes in CTG monitoring in five cases (10%) in the 10 minutes after epidural analgesia. However, these changes were not ominous signs but all reIated to the coiling of the cord, as previously reported. 2) The ABR latency-intensity curve (audiofunction of the newborn infants) revealed no hazardous change in VAST-loaded infants or in the controls. The response threshold was 10dB in this study. The application of VAST to the parturients under epidural analgesia was therefore not only harmless to the fetuses but also a useful way to evaluate fetal well-being.

Correction of fetal malpresentation such as knee-chest positioning and external cephalic version, has long been performed in cases of breech presentation. The reliability and safety of such treat-ment, however, remains unclear. We performed moxibustion on three acupoints, namely, Saninko, Shiin, and Yusen to correct the condition. We studied a total of 28 women, 22 of whom were observed until delivery, and six who had not reached full term by the end of the study. Cephalic presentation was achieved in 25 (89.3%). All but one of the fetuses that were corrected to cephalic presentation had full term vaginal delivery. The remaining one underwent premature delivery due to premature rupture of the mem-brane at 35 weeks 6 days. None of the babies showed any abnormalities. Correction could not be achieved in three women by the time of delivery. One of these three had dicornate uterus and underwent caesarian section due to premature rupture of the membrane. The other two had full term vaginal delivery of live babies. These results indicate that the correction of breech presentation by moxibustion is a safe method which cause no adverse effects on the mother or baby.