Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study.

OBJECTIVE: This study aimed to investigate the relationships between sleep apnea parameters and various symptoms in postmenopausal women who had treatment-resistant sleep disorders. METHODS: The respiratory disturbance index (RDI), the number of times apnea-hypopnea occurred in an hour, and transcutaneous oxygen saturation (SpO2) were monitored during one night of sleep using a portable monitoring device in 51 postmenopausal women who did not have an improved subjective sleep quality with the use of hypnotics. Physical and psychological health statuses and subjective sleep disturbance were evaluated using validated questionnaires, including the Epworth Sleepiness Scale, the Cornell Medical Index, and the Questionnaire for Assessment of Climacteric Syndrome in Japanese Women. The associations between RDI, nadir SpO2 and various symptoms, as well as cardiovascular parameters, such as blood pressure, serum lipid profile, and glucose tolerance, were analyzed separately. RESULTS: Among the 51 study participants, seven (13.7%) were diagnosed with obstructive sleep apnea. After adjustment for age, body mass index, and the background factors related to RDI and nadir SpO2, the association remained significant between a higher RDI and joint pain (Questionnaire for Assessment of Climacteric Syndrome in Japanese Women) (standardized partial regression coefficient [ß] = 0.423, P  = 0.016), and between lower nadir SpO2 and fatigability (Cornell Medical Index) (ß = -0.472, P  = 0.007). CONCLUSIONS: Detailed examination of sleep-disordered breathing is warranted in women with severe joint pain and fatigability.

Extraregional lymph node recurrence of stage IA1 squamous cell carcinoma of the uterine cervix after initial surgery: two case studies.

Objective: Lymph node recurrence is extremely rare in cases of stage IA1 squamous cell carcinoma (SCC) of the uterine cervix without lymphovascular space invasion (LVSI). We present two cases of extraregional lymph node recurrence after initial surgery for stage IA1 SCC of the uterine cervix without LVSI. Patients: Both patients initially underwent hysterectomy and developed recurrent extraregional lymph nodes within a few years postoperatively. Case 1: The patient showed no symptoms of recurrence, and follow-up computed tomography (CT) for evaluation of gallstones revealed a para-aortic lymph node (9 mm). The patient subsequently underwent serum SCC antigen testing and CT and was diagnosed with recurrence. Case 2: The patient noticed a right inguinal node swelling, which was evaluated using CT. Both patients survived without relapse for 8 and 4 years, respectively. Conclusion: Although stage IA1 SCC of the uterine cervix without LVSI is associated with a low risk of lymph node recurrence, oncologists should consider the possibility of recurrence in such cases. Evaluation for recurrence is difficult in asymptomatic patients. Serum SCC antigen testing may be a useful biochemical marker before imaging for early detection of recurrence, even in asymptomatic patients.

Effects of hormone replacement therapy and hepatic lipase polymorphism on serum lipid profiles in postmenopausal Japanese women.

The purpose of this study was to evaluate the relationships among hepatic lipase (HL) polymorphism, serum lipids, lipoproteins, and remnant-like particle cholesterol (RLP-C) and to determine the effects of hormone replacement therapy (HRT). We assessed the HL polymorphism in 209 postmenopausal Japanese women. Levels of serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein (Apo) AI, Apo B, Apo E, Apo CII, Apo CIII, and RLP-C were measured before and after 3 months of HRT. The frequency of each genotype was 32% for -514 C/C, 41% for C/T, and 27% for T/T. Subjects with the C/T and T/T genotypes had higher levels of HDL cholesterol and Apo AI than those with the C/C genotype. Those with the T/T genotype had higher levels of RLP-C than those with the C/C or C/T genotype. Serum total cholesterol, LDL cholesterol, Apo B, Apo E, and Apo CII were decreased, and HDL cholesterol and Apo AI were increased significantly in all genotypes after 3 months of HRT. There were no differences in these changes with genotype. The HL polymorphism was associated with higher levels of HDL cholesterol, Apo AI, and RLP-C, and the HL gene variation may contribute to HL activity and affect serum lipoprotein metabolism. Effects of HRT on serum lipids, lipoproteins, and remnant lipoprotein metabolism were unaffected by the HL polymorphism.

[Neoadjuvant intraarterial chemotherapy with nedaplatin, peplomycin and mitomycin C for advanced cervical cancer].

The aim of the present study was to examine the usefulness of neoadjuvant intraarterial chemotherapy (NAC) using nedaplatin as key drug to improve the prognosis in case of advanced cervical cancer. Twenty-five cases of advanced cervical cancer (15 cases of stage II with high risks, 10 of stage III, referred to as the 254-S group) treated by NAC using nedaplatin, mitomycin C and peplomycin were compared with 30 cases (22 cases of stage II with high risks, 8 of stage III, referred to as the CDDP group) treated using cisplatin and mitomycin C which is the conventional regimen, in terms of measurable response, pathological response, rate of lymph node metastasis, cumulative survival rate, side effects and relapse style. According to the evaluation by measurable responses, the response rate was 90% (CR 52%) in the 254-S group and 75% (CR 15%) in the CDDP group. For pathological response of the specimen, the CR rate was 16% in the 254-S group and 23% in the CDDP group. The rate of lymph node metastasis extracted surgically was 33% and 41%, respectively. The cumulative survival rate in the 254-S group was about 10% better than in the CDDP group, but no significant difference was found. Leucopenia of both groups was of the same grade. In the 254-S group, although thrombocytopenia was more critical than in the CDDP group, there was a slight tendency to kidney toxicity. The locoregional recurrence rate was 12% in the 254-S group and 30% in the CDDP group. The distant metastasis rate was 16% and 27%, respectively. Although neoadjuvant intraarterial chemotherapy using nedaplatin as a key drug was useful to improve the prognosis of advanced cervical cancer, measures against recurrence outside the pelvis and individualization of medical treatment were considered to lead to a further improvement of the prognosis.