Measurement of zinc concentration in blood and breast milk of a Wilson's disease patient taking zinc acetate.

Case: A 27-year-old, gravida 2, para 0, Japanese female who was maintained on zinc acetate (75 mg/day) during pregnancy expressed her desire to breastfeed after birth. We investigated the possibility of breastfeeding while on treatment. Breast milk zinc concentrations were determined using an atomic absorption photometer. Breast milk zinc concentrations on the 4th (colostrum) and 32nd (post-colostrum) days post partum were 10.80 µg/mL and 3.28 µg/mL, respectively. These values are less than the reported range of breast milk zinc concentrations in Japanese women who are not under any medication. Conclusion: We measured blood and breast milk zinc concentrations of a patient with Wilson's disease who was taking zinc acetate (75 mg/day). Zinc values were within the range of breast milk concentrations of mothers who are not on zinc acetate.

Heparanase expression in endometrial cancer: analysis of immunohistochemistry.

The human enzyme heparanase has been shown to function in tumour progression, metastatic spread and tumour angiogenesis. The aim of the present study was to assess heparanase expression assessed by immunohistochemical staining (IHC) in endometrial cancer in correlation with clinicopathological factors. A total of 52 endometrial cancers were obtained from previously untreated patients (median age, 56 years, range, 35-80 years). The expression of heparanase was evaluated by using IHC with anti-heparanase polyclonal antibody. This antibody was raised by immunising a rabbit with a peptide containing the amino acid residues from 238 to 250 of the heparanase. The IHC data were used to determine the relationship between heparanase expression, and clinicopathological parameters. IHC showed that the heparanase was expressed in 23 of 52 (44.2%) endometrial cancers. Heparanase was abundantly and equally expressed in both the cytoplasm and the cell membrane of the cells in endometrial cancer. Strong heparanase-positive staining was also seen at the invasive front of the tumour into myometrium. The expression was significantly related to lymph-vascular space involvement (p = 0.0028), depth of myometrial invasion (p = 0.0026), and histological tumour grade (p = 0.0135). In six tumours with positive lymph nodes, the heparanase expression was observed as being higher compared with tumours with negative lymph nodes, which was not significant (p = 0.2349). In terms of peritoneal cytology, ovarian metastasis, and cervical invasion, we observed no significant difference in the heparanase expression assessed by IHC. These results suggest that the expression of heparanase may promote tumour invasion into myometrium and lymph vascular space in endometrial cancer.

Post-partum maternity 'blues' as a reflection of newborn nursing care in Japan.

OBJECTIVES: To investigate the prevalence of post-partum 'blues' in mothers whose babies are cared for in a newborn nursery, compared with mothers providing rooming-in care. METHODS: Japanese normal primiparous women were prospectively studied from 1998 to 1999. The newborns of these mothers were managed in the newborn nursery or by rooming-in care. To diagnose maternity 'blues' and 'depression', the Stein's Questionnaire and the Edinburgh Postnatal Depression Scale were used. RESULTS: Ninety-seven and 93 women were managed by newborn nursery care and by rooming-in care, respectively. Of these women, a total of 181 women were considered for analysis. 'Blues' was noted in 31 of 92 mothers (33.7%) receiving newborn nursery care and in 18 of 89 (20.2%) receiving rooming-in care with a significant difference (P<0.05), and in 49 of 181 (27.1%) as a whole. The daily Stein's scores changed significantly during the 10 days post-partum in each group (P<0.0001). Post-partum 'depression' was observed in three mothers (3.4%) in the newborn nursery care group and in four (4.8%) of the rooming-in care group, not a significant difference, and in seven (4.1%) as a whole. CONCLUSION: Maternity 'blues' is experienced by 25% or more of Japanese primiparous women delivering healthy babies via uncomplicated delivery. The system of newborn nursery infant care may be a potential causal factor for maternity 'blues', although it should be confirmed by a prospective randomized trial.

Clearance of antiphospholipid antibodies in pregnancies treated with heparin.

OBJECTIVE: To describe the natural history of serum antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) in pregnant women treated with heparin, and to identify a possible association between changes in antibody status and outcomes of subsequent pregnancies. METHODS: Thirty-six women with antiphospholipid antibodies who had three or more repeated miscarriages were enrolled. Intravenous heparin was used for each of the first pregnancies after referral. Changes in antibody status were investigated with relation to outcomes of the index and subsequent pregnancies. RESULTS: Eighteen of 23 pregnancies in 36 antibody-positive women treated with heparin resulted in term or preterm deliveries with live-born infants, and five ended in abortions. Antibodies cleared in ten of 12 term pregnancies, in five of six preterm pregnancies, and in one of five abortions. There was a statistically significant difference between the term pregnancy and abortion groups (P <.05). Eleven second and third pregnancies in nine women in whom antibodies cleared resulted in term or preterm deliveries of live-born infants, without heparin therapy. The second and third pregnancies in one woman whose antibodies persisted ended in miscarriages despite repeated heparin administration. CONCLUSION: Antiphospholipid antibodies cleared spontaneously in some pregnant women treated with heparin. Subsequent pregnancies among women in whom antibodies cleared were managed successfully without medication, whereas pregnancies in women with persistent antibodies required treatment.

Hysteroscopic appearance of the mid-secretory endometrium: relationship to early phase pregnancy outcome after implantation.

A total of 172 patients who underwent hysteroscopic assessment of the endometrium and then became pregnant, was analysed retrospectively to explore the relationship between endoscopic findings and early phase pregnancy outcome after implantation. Histological examination of the endometrium and assay of serum progesterone and oestrogen were carried out simultaneously with hysteroscopy. Of 172 patients, 12 were excluded. Of the remaining 160 patients, 62 (38.8%) were classified endoscopically as having 'good' mid-secretory endometrium and 98 (61.3%) as 'poor', between one and four cycles prior to the conception cycle. There were no clinical differences between these two groups, except that the frequency of patients with a history of early abortion was significantly higher in the 'poor' group (25.5%) than in the 'good' group (8.1%) (P < 0.05). Of 160 pregnancies, 118 persisted successfully to live birth, but 42 ended in early pregnancy loss. The incidence of early abortion was significantly higher in the 'poor' group (33.7%) than in the 'good' group (14.5%) (P < 0.05). Significant differences were observed between the two groups for histological dating of the endometrium (P < 0.05) but not for serum progesterone and oestradiol concentrations or progesterone:oestradiol ratio. In conclusion, our data suggest that the hysteroscopic appearance of the mid-secretory endometrium at this stage of the menstrual cycle is a better prognostic factor for pregnancy outcome than hormonal data.

Ultrasonographic evaluation of lower uterine segment to predict the integrity and quality of cesarean scar during pregnancy: a prospective study.

A prospective randomized study was conducted to measure the serial thickness of the lower uterine segment (LUS) by transvaginal ultrasonography in a control group of 80 women having no history of uterine surgery and in a study group of 43 women having a history of previous cesarean section (C/S). In the study group, more than 2 mm of thickness of the LUS was considered as good healing and less than 2 mm of thickness as poor healing. After serial sonographic examination, the women with good healing were given trial for labor unless an obstetrical indication for C/S existed. The appearance of the LUS during surgery was compared with antenatal ultrasonographic assessment by direct inspection. Twenty two (79%) of 28 women with a well healed scar had trial labor with the result that 46% had a successful vaginal birth without any uterine rupture of dehiscence. Eight women with poor healing all had elective C/S. Seven women with a 2 mm LUS thickness were individually categorized for delivery mode. Two of those women delivered vaginally. The LUS was found to be thin to translucent in these later two groups. Two mm or less as a criterion for poor healing had the sensitivity and specificity of 86.7% and 100% respectively. The positive predictive value was 100% and the negative predictive value was 86.7%. Ultrasonographic evaluation is effective in predicting the quality of a uterine scar and in differentiating the risk group of probable uterine rupture from the non risk group.