Short interpregnancy interval after B-Lynch uterine compression suture: a case report.

PURPOSE: The influence of the B-Lynch suture technique on subsequent fertility and pregnancy outcomes is not clear. In the present report, the authors describe the case of a very short interpregnancy interval following the successful placement of a B-lynch suture and discuss the associated problems. MATERIALS AND METHODS: A 33-year-old-woman underwent cesarean section after undergoing artificial induction of labor and subsequent atonic postpartum hemorrhage. Placement of a B-Lynch brace suture successfully stopped the bleeding and preserved the uterus. The patient became unexpectedly pregnant only four months later, making the present case the shortest reported interpregnancy interval after a surgery involving the B-Lynch suture. CONCLUSION: In the present case, fertility was not affected, and obstetric complications (abortion, fetal growth restriction, preterm delivery, and placenta previa) were not observed. Adhesions between the abdominal wall and the surface of the uterus along the previous B-Lynch suture line were observed and irregular, large blood vessels were observed on the surface of the uterus. Further reports are expected to determine the influence of the B-Lynch brace suture technique on the subsequent pregnancy.

Cesarean delivery via a transverse uterine fundal incision for the successful management of a low-lying placenta and aplastic anemia.

PURPOSE: To present a case report on the successful management of a low-lying placenta and aplastic anemia. Aplastic anemia is a rare but serious disorder that is often characterized by severe pancytopenia. Because of the rarity of aplastic anemia, a pregnancy complicated by it is rarely encountered by obstetricians. Moreover, placenta previa (low-lying placenta) complicated by aplastic anemia has not been previously reported. MATERIALS AND METHODS: The authors present the first reported case of placenta previa with aplastic anemia in a patient who had undergone a previous cesarean delivery. RESULTS: They successfully managed this case by making a transverse uterine fundal incision during an elective cesarean delivery. This incision minimized blood loss and enabled good visualization of the source of bleeding in the lower uterine segment. Bleeding was stemmed by suturing the source of bleeding. CONCLUSION: The authors propose that this procedure should be considered for patients with low platelet counts and abnormal placentation.

Oxidative stress-induced S100B protein from placenta and amnion affects soluble Endoglin release from endothelial cells.

Oxidative stress with elevated intracellular Ca(2+) concentration as well as endothelial dysfunction is a component of pre-eclampsia. Our aim was to investigate the oxidative stress-dependent expression of Endoglin and Ca(2+)-binding S100B protein from villous and amniotic tissue cultures, and to assess sEng expression from S100B protein-stimulated endothelial cells. We initially examined Endoglin and Hydroxy-nonenal-(HNE)-modified proteins in the placentas and amnion obtained from women with pre-eclampsia (n = 8), and healthy controls (n = 8) by immunohistochemistry. To examine oxidative stress and the S100B protein effect on sEng expression from endothelial cells, normal villous and amniotic tissue cultures were stimulated by 4-HNE, sodium fluoride and xanthine/xanthine oxidase, whereas human umbilical vein endothelial cell cultures were treated with S100B protein in a dose- and time-dependent manner at 37 degrees C in an environment of 95% air and 5% of CO(2). Culture supernatants were assessed using ELISA. Cell viability was determined using MTS assay. The concentrations of sEng and S100B protein were significantly increased in the villous and amniotic tissue culture supernatants under oxidative stress. S100B protein-stimulated endothelial cells released sEng into conditioned media with a significantly higher expression levels at a concentration of 200 pM-20 nM S100B by 2 h, whereas treated with 200 nM of S100B endothelial cells significantly expressed sEng by 12 h and stimulated the cell proliferation by the same period of time. Our findings show that oxidative stress affects sEng and S100B protein expression from villous and amniotic tissues, and picomolar and low nanomolar concentrations of S100B protein significantly up-regulate sEng release from endothelial cells leading to endothelial dysfunction.

Amniotic fluid 'sludge' detected in patients with subchorionic hematoma: a report of two cases.

Amniotic fluid 'sludge' is defined as the presence of dense aggregates of particulate matter in close proximity to the internal cervical os. It is of clinical significance in asymptomatic patients at high risk for spontaneous delivery, and in patients with preterm labor and intact membranes. Subchorionic hematoma is another ultrasound finding that is associated with a higher incidence of threatened miscarriage and preterm delivery. We report two cases of occurrence of amniotic fluid sludge in patients with previously detected large subchorionic hematoma. In the first case subchorionic hematoma and amniotic fluid sludge were detected by ultrasonography at 13 + 1 and 18 + 6 weeks' gestation, respectively, followed by preterm premature rupture of membranes, placental abruption and emergency Cesarean section. In the second case subchorionic hematoma and amniotic fluid sludge were detected by ultrasound at 11 + 3 and 15 + 5 weeks' gestation, respectively, followed by miscarriage with histological chorioamnionitis. The coincidence of subchorionic hematoma and amniotic fluid sludge in these cases points to a possible connection between these two significant ultrasound findings.

The human tumor-associated antigen RCAS1 in pregnancies complicated by pre-eclampsia.

The human tumor-associated antigen RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) is considered to play a role in the escape of tumor cells from immune surveillance and, at the same time, participates in the inhibition of the maternal immune response during pregnancy. The aim of our study was to investigate the expression of tumor-associated RCAS1 protein in the placenta and amniotic membranes and to assess and compare its concentration in amniotic fluid, maternal and cord blood sera in pregnancies complicated by pre-eclampsia. Samples were obtained from women with pre-eclampsia (N=9), pre-eclampsia with IUGR (N=4), normotensive IUGR (N=7) and healthy term controls (N=25) after delivery. Placentas were studied by immunohistochemistry, Western blot analysis and real-time (RT)-PCR. For assessment of RCAS1 protein concentrations in biological fluids, ELISA was performed. RCAS1 mRNA expression in the placentas of pre-eclamptic patients was significantly lower than in controls (p<0.01). The maternal blood serum RCAS1 protein concentration in the pre-eclampsia cases was also significantly lower than in controls (p=0.0207). The other study groups did not differ significantly. This study reveals the possible role of the RCAS1 protein in the development of pre-eclampsia through an immunological pathway.

Fluorescent quenching-based quantitative detection of specific DNA/RNA using a BODIPY((R)) FL-labeled probe or primer.

We have developed a simple method for the quantitative detection of specific DNA or RNA molecules based on the finding that BODIPY((R)) FL fluorescence was quenched by its interaction with a uniquely positioned guanine. This approach makes use of an oligonucleotide probe or primer containing a BODIPY((R)) FL-modified cytosine at its 5'-end. When such a probe was hybridized with a target DNA, its fluorescence was quenched by the guanine in the target, complementary to the modified cytosine, and the quench rate was proportional to the amount of target DNA. This widely applicable technique will be used directly with larger samples or in conjunction with the polymerase chain reaction to quantify small DNA samples.

Portal venous gas associated with splenic abscess secondary to colon cancer.

We report a successfully treated case accompanied by portal venous gas, which was associated with splenic abscess due to penetration of colon cancer. In June, 1998, a 67-year-old Japanese man was referred to our hospital because of a continuous fever over 40 degrees C and portal venous gas detected by computed tomography (CT). CT revealed low density areas in the spleen and wall thickening of the descending colon next to the spleen. Barium-enema examination demonstrated an extrinsic filling defect in the splenic flexure of the colon. Splenectomy, resection of the pancreatic tail and left hemicolectomy were performed Histopathological studies showed moderately differentiated adenocarcinoma, which made a fistula at the bottom of the ulceration to the spleen. The postoperative course was uneventful. The portal venous gas was likely to have resulted from a bacterial infection in the portal venous systems secondary to the splenic abscess.

Successful resection of rectal carcinoma in an Evans' syndrome patient followed by predonisolone and high-dose immunoglobulin: report of a case.

A 69-year-old woman was admitted to our hospital because of anal bleeding and fatigue. The patient was previously diagnosed as having Evans' syndrome on the basis of hematological examination and had been treated with predonisolone for 8 years. On admission, severe anemia and thrombocytopenia were noted. Colonoscopy and Barium enema studies demonstrated an irregular tumor with hemorrhagic ulceration in the rectum, which was histopathologically confirmed as an adenocarcinoma. After red blood cells and platelets were transfused, and the patient was treated with high-dose gammaglobulin, predonisolone, and camostat mesylate, the platelet count gradually increased and hemolysis was well controlled. The patient then underwent Hartmann's operation and splenectomy without any postoperative complications. Predonisolone and high-dose immunoglobulin therapy in a rectal cancer burdened patient with Evans' syndrome is considered useful in combination with surgical treatment. This is the first case report of rectal carcinoma resection in a patient with Evans' syndrome.

Detection of atrial-flutter and atrial-fibrillation waveforms by fetal magnetocardiogram.

Two cases of fetal tachycardia are reported: atrial flutter and fibrillation. The waveforms from each case were detected by fetal magnetocardiograms (FMCGs) using a 64-channel superconducting quantum interference device (SQUID) system. Because the magnitude of supraventricular arrhythmia signals is very weak, two subtraction methods were used to detect the fetal MCG waveforms: subtraction of the maternal MCG signal, and subtraction of the fetal ORS complex signal. It was found that atrial-flutter waveforms showed a cyclic pattern and that atrial-fibrillation waveforms showed f-waves with a random atrial rhythm. Fast Fourier transform analysis determined the main frequency of the atrial flutter to be about 7Hz, and the frequency distribution of atrial fibrillation consisted of small, broad peaks. To visualise the current pattern, current-arrow maps, which simplify the observation of pseudo-current patterns in fetal hearts, of the averaged atrial flutter and fibrillation waveforms were produced. The map of the atrial flutter had a circular pattern, indicating a re-entry circuit, and the map of the atrial fibrillation indicated one wavelet, which was produced by a micro-re-entry circuit. It is thus concluded that an FMCG can detect supraventricular arrhythmia, which can be characterised by re-entry circuits, in fetuses.

Fluorescence-quenching phenomenon by photoinduced electron transfer between a fluorescent dye and a nucleotide base.

Fluorescently labeled oligonucleotide probes have been widely used in biotechnology, and fluorescence quenching by the interaction between the dyes and a nucleobase has been pointed out. This quenching causes big problem in analytical methods, but is useful in some other cases. Therefore, it is necessary to estimate the fluorescence quenching intensity under various conditions. We focused on the redox properties of some commercially available fluorescent dyes, and investigated dye-nucleotide interactions between a free dye and a nucleotide in aqueous solution by electrochemical and spectroscopic techniques. Our results suggested that the quenching was accompanied by photoinduced electron transfer between a thermodynamically quenchable excited dye and a specific base. Several kinds of fluorescent dyes labeled to the 5'-end of oligonucleotide C10T6 were prepared, and their quenching ratios compared upon hybridization with the complementary oligonucleotide A6G10. The quenching was completely reversible and their efficiencies depended on the attached fluorophore types. The fluorescence of 5-FAM, BODIPY FL or TAMRA-modified probe was strongly quenched by hybridization.

Role of ICAM-1 and LFA-1 in endotoxin-induced uveitis in mice.

The effect of monoclonal antibodies against adhesion molecules on the development of endotoxin-induced uveitis (EIU) and interleukin-1 (IL-1)-enhanced EIU were studied. When endotoxin or IL-1 was injected into C3H/HeN mice, the expression of intercellular adhesion molecule-1 (ICAM-1) on the ciliary body was up-regulated as determined by immunohistochemical assay. However, these agents did not alter lymphocyte function-associated antigen-1 (LFA-1) expression on leukocytes when whole blood cells were analyzed with flow cytometry. Monoclonal anti-ICAM-1 antibody or anti-LFA-1 antibody was intraperitoneally administered to C3H/HeN mice simultaneously with endotoxin, and the effect on the development of EIU was studied. The cell number in aqueous humor and frequency of posterior synechiae were markedly decreased in EIU when either antibody was administered. However, protein concentration in the aqueous humor was not statistically reduced by the injection of these antibodies. In the model of IL-1 enhanced EIU, not only the cell number and frequency of posterior synechiae but also protein concentration were decreased. Moreover, there were no differences between these two antibodies in the effect on EIU, whereas anti-LFA-1 antibody was more effective than anti-ICAM-1 antibody in IL-1-enhanced EIU.

Ocular activity of topically administered anandamide in the rabbit.

Marijuana and its psychoactive constituents, cannabinoids, reduce intraocular pressure (IOP) in humans and animals. Because anandamide, a recently discovered endogenous ligand of cannabinoid receptors, reportedly shows cannabimimetic pharmacological activity, we examined its effect on the eye. Varying amounts of anandamide, in 50 microL of light mineral oil, were topically applied to a rabbit eye and changes in IOP and ocular symptoms were monitored. Anandamide (50 micrograms to 1 mg) induced a significant decrease in IOP within 1 hour after administration; maximum reduction occurred at 2 hours; and there was a return to baseline by 7 hours following administration. A noticeable hyperemia of conjunctival blood vessels was also noted 2 hours after administration. Neither mineral oil alone or with palmitylethanolamide (an analogue of anandamide) caused a significant decrease in IOP or conjunctival hyperemia. This study indicates that anandamide does produce cannabimimetic effect in rabbit eyes.

Biological treatment of ammonia gas at high loading.

The exhaust gas from compost processing plants contains a large amount of ammonia. To treat ammonia gas at high loads, bench-scale experiments were carried out. First, nitrifying bacteria were enriched from soil and immobilized on porous ceramics. The ceramics were packed in an acrylic cylinder (diameter, 100 mm; packed height, 190 mm) and ammonia gas was introduced to the top of the cylinder. The concentration and flow rate of ammonia gas were gradually increased and finally 85 ppm was introduced at a space velocity of 800 h(-1) (empty bed residence time (EBRT), 4.5 sec). The ammonia load was 1.0 kg N/m3 day(-1). The exhaust contained 1.5-2 ppm of ammonia. Then the packed ceramics were transferred to another acrylic cylinder (diameter, 50 mm; packed height, 800 mm). A high concentration of ammonia gas (1,000 ppm) was introduced at a space velocity of 96 h(-1) (ammonia loading, 1.44 kg N/m3 day(-1); EBRT, 37.5 sec). The exhaust contained 2 ppm of ammonia (removal rate, 99.8%). The packed bed was washed with water intermittently or continuously, and the wastewater from the cylinder contained a large amount of ammonium and nitrate ions of at a 1:1 ratio. Stoichiometric analysis showed that half of the introduced ammonia was oxidized to nitrate, and the rest was converted to ammonium ion. Thus, ammonia gas was effectively treated at a high load by biofiltration with nitrifying bacteria.

[A case report of Campylobacter fetus subspecies fetus oophoritis].

A 45-year-old female with oophoritis (pelvic inflammatory disease) caused by Campylobacter fetus (C. fetus) is reported. She was admitted to the hospital because of high fever and an acute abdomen. On admission, severe inflammation was observed by the laboratory findings, and abdominal X-ray and CT scan revealed ileus with marked swelling of the right ovary. Laparotomy was performed with adonexooophrectomy due to the tubo-ovarian abscesses. C. fetus was isolated from the right ovary, salpinx and ascites. Erythromycin was administered after a sensitive test of C. fetus as the bacteria was isolated at operation. She was discharged on the 17th day after her admission. Indirect immunofluorescent test with hyperimmune rabbit sera to isolated C. fetus revealed a fine to coarse granular immunoreaction in the cytoplasm of the macrophages infiltrated in the tissue. This result was interpreted as the existence and growth of bacteria in the right ovarian tissue. Oophoritis due to C. fetus subspecies fetus is very rare. To our knowledge, this case is the second case reported in Japan.

[Correlations between cell proliferating activity and apoptosis in the colorectal cancer and apoptosis in the mucosa adjacent to colorectal cancer].

To investigate the growth and progression of colorectal cancer, cell production versus cell loss in colorectal cancer was examined using the proliferating cell nuclear antigen (PCNA) positivity rate and apoptotic index (AI). Cell loss was then examined using AI in the mucosa adjacent to colorectal cancer. The higher the PCNA positivity rate, the higher the apoptotic index in colorectal cancer. These results suggested that changes in cell production and cell loss may be closely correlated and play a role in the growth and progression of colorectal cancer. In patients with advanced colorectal cancer, the mucous composition of the adjacent mucosa was classified as sialomucin-predominant. Apoptosis at the proliferating zone in the mucosa adjacent to colorectal cancer (one or two glandular ducts) was also examined using the TUNEL method. This suggests that the mucosa adjacent to cancer is involved in apoptosis.

Maternal arterial stiffness in normotensive pregnant women who subsequently deliver babies that are small for gestational age.

OBJECTIVE: To assess the association between maternal arterial stiffness and delivery of a baby that is small for gestational age (SGA) in normotensive pregnant women. STUDY DESIGN: Pulse wave analyses were performed to assess maternal arterial stiffness at 26-33 weeks of gestation in 40 normotensive women who subsequently delivered SGA babies (SGA group) and 111 normotensive women who delivered babies with normal growth (control group). RESULTS: Central systolic pressure (CSP), augmentation index (AIx) and AIx at a heart rate of 75 beats/min (AIx-75) were significantly higher in the SGA group compared with the control group, but this was not the case for brachial systolic pressure, brachial diastolic pressure or brachial pulse pressure. Birth weight was significantly correlated with CSP (r=-0.26, p<0.01), AIx (r=-0.33, p<0.01) and AIx-75 (r=-0.27, p<0.01), but not with brachial systolic pressure, brachial diastolic pressure or brachial pulse pressure. CONCLUSION: Increased arterial stiffness may be involved, in part, in the pathogenesis of SGA in normotensive women, suggesting an association between fetal growth and maternal endothelial function. Pulse wave analysis may be a clinically applicable method for assessment of maternal arterial stiffness, and may be more relevant to intrauterine fetal growth than conventional brachial blood pressure.

Imbalance of angiogenic factors and avascular edematous cystic villi in a trisomy 13 pregnancy: a case report.

The incidence of pre-eclampsia is significantly higher in trisomy 13 pregnancies than in normal pregnancies. Soluble fms-like tyrosine kinase-1 (sFlt-1), located on chromosome 13, is an anti-angiogenic molecule derived from the placenta and contributes to the pathogenesis of pre-eclampsia. Elevated sFlt-1 and reduced placental growth factor (PlGF) are associated with trisomy 13 pregnancies and may play a pathogenic role in the subsequent development of pre-eclampsia. Here we present a case of a trisomy 13 pregnancy without any signs of pre-eclampsia that showed alterations in circulating angiogenic factors and abnormal placental appearance. The placenta developed edematous changes and contained multiple small cysts. Histology of the placenta confirmed avascular edematous cystic villi and did not show the typical appearance of a partial mole or mesenchymal dysplasia. The sFlt-1/PlGF ratio in maternal serum (134) was much higher than that in gestational age-matched women who were normotensive (2.9-7.2; mean, 5.0). Immunostaining for Flt-1 and endoglin was more intense in our case compared with gestational age-matched controls, and at a similar level to a case of pre-eclampsia. Placental findings that showed avascular edematous cystic villi in our case may be associated with angiogenic imbalance involved in the pathogenesis of pre-eclampsia in trisomy 13 pregnancies.

Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome.

A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, on the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obstetric regional anesthesia is exceedingly small even in a patient with coagulopathy and, to our knowledge, this is only the second reported case following obstetric regional anesthesia. Anesthesia for HELLP syndrome in patients with an adequate platelet count but without disseminated intravascular coagulation is controversial. It is therefore important for clinicians to recognize the symptoms and signs of spinal subarachnoid hematoma to avoid delay in treatment that might result in severe neurological deficit.

S100B protein expression in the amnion and amniotic fluid in pregnancies complicated by pre-eclampsia.

Our aim was to investigate the expression of S100B protein in the amnion and to assess the amniotic fluid concentration in pregnancies complicated by pre-eclampsia. Samples were obtained from women who developed pre-eclampsia (n = 7), pre-eclampsia with intrauterine growth retardation (IUGR) (n = 4), normotensive IUGR (n = 7) and gestational hypertension (n = 4) during pregnancy and healthy controls who delivered at term (n = 35). To determine the difference in the expression of S100B in the amnion, we performed immunohistochemistry, western blot analysis and RT-PCR. Using enzyme-linked immunosorbent assay (ELISA), we assessed the S100B concentration in amniotic fluid. The S100B mRNA expression in the amnion of pre-eclamptic patients and patients with pre-eclampsia with IUGR was significantly higher than that in the control. The amniotic fluid S100B protein concentration of the pre-eclampsia and normotensive IUGR cases was significantly higher than that of the control. This study shows that amnion could be a source responsible for the increased concentration of S100B in amniotic fluid. In pre-eclampsia, reactive oxygen species (ROS) are generated by oxidative stress. Some pathological conditions that develop during pregnancy and are related to hypoxic stress can affect the elevation of S100B concentration in the amnion.