Diagnosis of Advanced Gastric Cancer Occasioned by Persistent Postpartum Fever: A Case Report.

Pregnancy-associated gastric cancer is extremely rare. In many cases, the cancer is already advanced at the time of diagnosis, and the prognosis is often poor. A 39-year-old primigravida, with dichorionic diamniotic twins, was admitted to our hospital for threatened preterm labor at 31 weeks of gestation. At 32 weeks of gestation, she developed a fever and tested positive for influenza A. She recovered from influenza A on the following day but had an emergency cesarean section for premature rupture of the membranes at 32 weeks of gestation. She was discharged on postpartum day six. Thereafter, she was again infected with influenza A. On day 18, she underwent an abdominal ultrasound revealing multiple mass lesions in the liver, because she had an uncomfortable upper gastric with persistent fever. She was referred to the internal medicine team, who made a diagnosis of stage IV gastric cancer. Importantly, non-specific symptoms and physical signs that are not explicable by the normal course of pregnancy may be recognized through conscientious history-taking and physical observations. If gastrointestinal symptoms are prolonged, or if symptoms such as severe weight loss, melena, a tender abdominal mass, or persistent and unexplained fever develop, an endoscopic assessment should be conducted to suspect other diseases. In addition, proactive ultrasound scanning, including the upper abdomen, may detect pregnancy-associated gastric cancer and lead to further in-depth investigations.

Re-evaluation of the Edinburgh Postnatal Depression Scale as screening for post-partum depression in Iwate Prefecture, Japan.

AIM: Although the Edinburgh Postnatal Depression Scale (EPDS) is widely used for screening for post-partum depression (PPD), screening time point and cut-off value in the current medical environment are not sufficiently examined. In this study, we examined appropriate timing and cut-off value of EPDS for the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. METHODS: This study was a prospective cohort study of women who delivered at the Iwate Medical University Hospital from August 2016 to February 2019. The EPDS self-assessment was conducted at 4 days and at 1 month after delivery (4D-EPDS and 1M-EPDS), and the Center for Epidemiologic Studies-Depression scale (CES-D) self-assessment was conducted at 1 month after delivery (1M-CES-D) in eligible patients and the scores were tabulated. Participants were interviewed by a psychiatric specialist to identify PPD within 2 months after delivery. For each screening, a receiver operating characteristic analysis was performed to calculate the cut-off value for PPD. Sensitivity, specificity, positive predictive value, negative predictive value and correct diagnostic rate were evaluated. RESULTS: Of the 80 post-partum women, PPD was found in nine cases (11.3%). The cut-off values for PPD were ≥10 for 4D-EPDS, ≥13 for 1M-EPDS and ≥21 for 1M-CES-D. No significant difference was found in the sensitivity, positive predictive value or negative predictive value among the three screening methods. However, a significant difference was found in the specificity, and the correct diagnosis rate and these values were relatively higher in 1M-EPDS. CONCLUSION: Based on the result of this Japanese cohort, 1M-EPDS with a cut-off value of ≥13 might be appropriate for PPD screening although that of ≥9 is currently employed.

Vesico-amniotic shunting for lower urinary tract obstruction in a fetus with VACTERL association.

Newborn cases of VACTERL association with lower urinary tract obstruction (LUTO) are rare and there have been no reports on those patients undergoing fetal therapy in English literature. We successfully performed vesico-amniotic shunting in a fetus having LUTO caused by abnormality of the external genitalia at 16 weeks' gestation. Although fetal karyotype was normal 46XY, follow-up fetal ultrasound examinations revealed ventriculomegaly in the brain, a small stomach and a right multicystic dysplastic kidney. MRI at 31 weeks' gestation suggested lobar type holoprosencephaly. Diagnosis of VACTERL association was confirmed postnatally. We consider that vesico-amniotic shunting is indicated for a fetus of VACTERL association with LUTO if the parents wish the procedure after genetic counseling and explanations about the fetal conditions.

Altered magnetic resonance images of brain and social behaviors of hatchling, and expression of thyroid hormone receptor ßmRNA in cerebellum of embryos after Methimazole administration.

RATIONALE AND OBJECTIVES: The effects of low thyroid hormone level during embryogenesis on MRI of the brain and social behaviors of hatchlings were examined using "fertilized hen's egg-embryo-chick" system. METHODS AND RESULTS: Control and hatchlings treated with methimazole (20 µmol/egg), which hatched 3 days later than controls were examined. The results are as follows: 1. The MRI examination of the midsagittal section of the brain on hatch day showed that the sizes, by T1- and ADC values by diffusion-weighted images, of the optic lobe and cerebellum of the MMI-hatchlings were significantly bigger than those of the controls. 2. The social behaviors on post-hatch day 3 were based on the following tests: (a) Aggregation test: The speed of four chicks, individually isolated by cardboard barriers in a box, to make a group upon the removal of barriers. (b) Belongingness tests: The speed of a chick isolated at a corner to join the group of three chicks placed at the opposite corner. (c) Vocalization test: The number of decibel produced by a chick isolated at a corner using a sound meter. These tests demonstrated that MMI-hatchlings took longer times and had weaker vocalization than the controls, significantly. 3. Upregulation of THRß mRNA after MMI treatment suggested that THR was necessary for cerebellum development. CONCLUSIONS: The MMI exposure during the last week of embryogenesis possibly delayed the myelination of certain brain regions and impaired the social behaviors of hatchlings. The chick embryos can be easily induced with hypothyroidism without maternal influences, and the hatchling's behaviors were analyzed using a video camera. The present method will be useful for assessing the effects of unfavorable influences during embryogenesis on social behaviors in later life.

Effect of antithyroid drug on chick embryos during the last week of development: delayed hatching and decreased cerebellar acetylcholinesterase activity.

AIM: Hypothyroid state during embryogenesis disturbs normal growth and brain development, influencing later life. To evaluate the harmful consequences of the state during embryogenesis using an animal model, we inhibited thyroid hormone biosynthesis in chick embryos by using methimazole (MMI). MATERIAL AND METHODS: Typically, embryos were treated with MMI (20 µmol/egg) on day 14, and examined on specific days. RESULTS: Of the control embryos, 94% hatched on day 21, whereas 0% and 60% of MMI-treated embryos hatched on days 21 and 24, respectively. MMI retarded the rates of bodyweight gain as well as liver and heart development, and delayed hatching. However, the external differences in appearance and differences in the weights of the newly hatched control chicks on day 21 and the MMI-treated chicks on day 24 were less obvious. Embryos treated with MMI exhibited increased mass in their brain parts on day 24. Most notably, the treatment resulted in a 1.35-fold increase in cerebellum weight compared to that of the untreated animals. Acetylcholinesterase activity in the cerebellum on the day of hatching decreased significantly to 0.85-fold that of the untreated controls. Thyroid hormone receptor ß mRNA was detected from day 12 and dramatically expressed from day 19 to the day of hatching. CONCLUSION: The 'fertilized hen's egg-chick embryo-chick system' is an appropriate animal model for investigating the hypothyroid state during embryogenesis. Decreased cerebellar acetylcholinesterase activity after MMI treatment was assumed to relate to a mechanism of motor and cognitive deficits in congenital hypothyroidism.

Survey of early preterm singleton live births in Iwate Prefecture as a provincial model of the medical situation in Japan.

AIM: The aim of this study was to survey early preterm (prior to 32 weeks' gestation) singleton live births in Iwate Prefecture as a provincial model of the medical situation in Japan. MATERIALS AND METHODS: Data from 177 early preterm singleton live births, and 31,445 total live births (January 2005-December 2007) in Iwate Prefecture Japan were used to analyze the incidence of early preterm singleton live birth in each medical service area. RESULTS: The incidence of spontaneous early preterm singleton live birth did not differ between the coastal and inland medical service areas (3.35 vs 3.57 per 1000 live births). In the Morioka medical service area (radius about 40 km), the incidence of spontaneous early preterm singleton live birth in municipalities without obstetric care facilities was significantly higher than that in municipalities with obstetric care facilities (6.62 vs 2.65 per 1000 live births, P < 0.005). The incidence of early preterm singleton live birth due to pregnancy-induced hypertension in the coastal medical service areas was higher than that in the inland areas (1.67 vs 0.71 per 1000 live births, P < 0.05). CONCLUSIONS: In Iwate Prefecture, Japan, the incidence of singleton preterm live birth before 32 weeks of pregnancy varies among its constituent medical service areas according to geographic factors as well as the availability of obstetric care facilities.