多田 伸

We present three extremely rare cases of spontaneous spinal epidural hematoma occurring in pregnancy. The patients developed progressive paralysis of the upper and lower limbs and the diagnoses were confirmed by magnetic resonance imaging. Urgent decompression is required to prevent neurological sequelae. The pregnancy may either be continued or delivered depending on the gestational age and severity of the disorder. Pregnancy-induced structural changes of the vascular walls and hemodynamic changes may play a role in the pathogenesis of spontaneous spinal epidural hematoma.

Indoleamine 2,3-dioxygenase (IDO) is the rate limiting enzyme of the kynurenine pathway that degrades L-tryptophan, but a wider range of functions have now been proposed for this enzyme, including antioxidant activity. Our previous study revealed that reduced IDO expression in the placenta induces defective feto-maternal immuno-tolerance leading to the onset of pre-eclampsia. In our present study, we assessed the effects of low placental IDO activity as an antioxidant. The placental levels of 8-hydroxy-2'-deoxy-guanosine (8-OHdG), a maker for oxidative damage to DNA, were significantly higher in pre-eclamptic than normotensive pregnancies (P < 0.05). Immunohistochemical signals of 8-OHdG were detected mainly in syncytiotrophoblasts and vascular endothelial cells, and co-localized with those for IDO. Furthermore, a significant inverse correlation was found between the IDO activity and 8-OhdG levels. These results show that oxidative stress is associated with decreased 100 activity in the pre-eclamptic placenta and suggest an impact of low IDO activity other than immune modulation in promoting the onset of this disorder.

Aims: Cilostazol, a type. phosphodiesterase inhibitor, is utilized for the treatment of intermittent claudication and is considered to have the beneficial effects against the atherogenic process. In the present study, we examined the effects of cilostazol on BH4 biosynthesis in HUVEC treated with a mixture of the pro-inflammatory cytokines IFN-gamma and TNF-alpha. Methods: Isolated HUVECs were grown to confluence and treated with IFN-gamma (300 units/mL) and TNF-alpha (300 units/mL) for 16 h in order to stimulate BH4 biosynthesis. The BH4 levels were measured by HPLC. The mRNA expression of GTP cyclohydrolase I (GTPCH), the rate-limiting enzyme of BH4 biosynthesis, and GTPCH feedback regulatory protein (GFRP) were quantified by real-time PCR. The GTPCH protein expression was assessed by western blot analysis. Results: Cilostazol significantly reduced the BH4 levels in cytokine-stimulated HUVEC. Cilostazol produced a concomitant increase in the cAMP levels in HUVEC. Cilostazol decreased the GTPCH activity as well as the expression of GTPCH mRNA and protein. 8-bromo-cAMP (8Br-cAMP), a cell-permeable cAMP analogue, did not reproduce the effects of cilostazol. Cilostazol did not affect the cytokine-induced inhibition of GFRP mRNA expression. Conclusions: We conclude that cilostazol inhibited cytokine-stimulated BH4 biosynthesis via a cAMP-independent mechanism in HUVEC. Our data indicate that cilostazol reduced GTPCH activity and did so by suppressing the GTPCH protein levels.

A 25-year-old infertile woman underwent laparoscopy because of a dermoid cyst of the left ovary and was found to have an ectopic ovary, to which an abnormal right fimbria was connected, with an isolated right ovary in the normal position and the bilateral segmental absence of the middle portion of the fallopian tubes. The complex of these anomalies is rare. A fundamental error might have existed in the mesenchyme of the gonadal ridges of the early embryo, rather than the epithelial origin of the mullerian and wolffian ducts. Journal of Minimally Invasive Gynecology (2010) 17,534-537 (c) 2010 AAGL. All rights reserved.

In recent years, improvements in diagnostic technology have enabled the early detection of ectopic pregnancy, and the opportunities for preserving the oviduct have increased, particularly as laparoscopic surgery has become the first-line choice for treatment of ectopic pregnancy in an increasing number of institutions. At our institution we use laparoscopic techniques to attempt oviduct preservation in patients with ectopic pregnancy who wish to become pregnant again. In this report, we examined the rates of persistent ectopic pregnancy and repeat ectopic pregnancy over a ten year period in patients who were treated laparoscopically with oviduct preservation. When compared with other treatments, we found a lower rate of persistent and recurrent ectopic pregnancy in women who were treated with oviduct-persevering laparoscopy. We conclude that laparoscopic surgery with oviduct preservation should be the therapy of choice for ectopic pregnancy when the patient still desires to get pregnant. However, a thoroughly informed consent detailing the risks of persistent and recurrent ectopic pregnancies must be a priority because of the high emotional toll of these complications.

妊娠高血圧症候群(PIH)管理ガイドラインに則って診断した妊娠22週0日〜39週0日の妊娠高血圧腎症(PE群)12例、正常妊娠(NP群)19例を対象に、母体血流としての腎動脈と頸動脈について検討した。また、PIH管理ガイドラインに則って診断した妊娠24週0日〜34週0日のPIH群10例、子宮内胎児発育不全(FGR群)5例、NP群13例を対象に、胎児胎盤血流としての胎盤内血流を検討した。PE群、NP群の検討ではNP群に比べPE群の平均年齢とBMIが高かった。PE群の検査所見では尿蛋白定量所見が平均3.5g/日であったが他の血液検査では明らかな腎機能障害を示唆する所見はなかった。胎児中大脳動脈のRI、PI値はNP群に比べPE群で低かった。またPIH群、FGR群、NP群の検討では胎盤内血流のvolume histogramの結果、PIH群ではNP群に比べVI、FI、VFIが有意に低く、FGR群ではNP群に比べ平均値は低いものの有意差はなかった。PIHでは母体、胎児、胎児付属物の血管に機能的・器質的変化が出現し、これらが各臓器内血流の超音波ドプラ所見に影響を与えている可能性があった。