Effect of cryoprecipitate transfusion therapy in patients with postpartum hemorrhage: a retrospective cohort study.

To evaluate the effect of cryoprecipitate (CRYO) transfusion in women referred for postpartum hemorrhage (PPH). This retrospective cohort study included patients with primary PPH referred to Gifu University Hospital between April 2013 and March 2020. We analyzed the effect of CRYO transfusion on fluid balance 24 h after the initial examination using a multivariable linear regression model adjusted for several confounding variables. To evaluate whether outcomes were modified by active bleeding, an interaction term of CRYO*active bleeding was incorporated into the multivariable model. We identified 157 women: 38 in the CRYO group (cases) and 119 in the control group. Fluid balance in the aforementioned period tended to decrease in the CRYO group compared with that in the control group (coefficient - 398.91; 95% CI - 1298.08 to + 500.26; p = 0.382). Active bleeding on contrast-enhanced computed tomography affected the relationship between CRYO transfusion and fluid balance (p = 0.016). Other outcomes, except for the overall transfusion requirement, were not significantly different; however, the interaction effect of active bleeding was significant (p = 0.016). CRYO transfusion may decrease the fluid balance in the first 24 h in PPH patients, especially in those without active bleeding.

The validity of the subsequent pregnancy index score for fertility-sparing trachelectomy in early-stage cervical cancer.

OBJECTIVE: To evaluate timing and a prediction model for pregnancy in early-stage cervical cancer patients who underwent fertility-sparing trachelectomy. DESIGN: Retrospective cohort. SETTING: Academic multicenter. PATIENT(S): Women ages <45 years with clinical stage I-II cervical cancer were enrolled between 2009 and 2013 (n = 393). INTERVENTION(S): Planned fertility-sparing trachelectomy. MAIN OUTCOME MEASURE(S): Cumulative incidences and clinicopathological characteristics of those who developed subsequent pregnancy were examined. RESULT(S): There were 77 (21.6%) women who had subsequent pregnancies after fertility-sparing trachelectomy with 1-, 2-, and 5-year cumulative pregnancy rates of 2.8%, 6.2%, and 17.4%, respectively. The median time to develop subsequent pregnancy was 3.2 years. In a competing risk analysis, women had a higher risk of recurrent cancer than conception during the first 11 months postsurgery. On multivariable analysis, younger age, being married, and postoperative reproductive treatment were independently associated with an increased chance of developing a subsequent pregnancy. The subsequent pregnancy index (SPI) score to predict the likelihood of having pregnancy was proposed, and it was calculated based on age, marital status, and reproductive treatment (2, 2, and 4 points, respectively). Women with a higher SPI score had significantly higher subsequent pregnancy rates (5-year pregnancy rate; the score was 3 in 4.7% of cases; 4 to 5 in 11.3%; 6 to 7 in 27.4%; and 8 in 50.8%), but they had similar recurrence rates (5.0%). CONCLUSION(S): The SPI score proposed in our study is useful in predicting subsequent pregnancy in women with early-stage cervical cancer undergoing fertility-sparing trachelectomy.

Creating a Global Community of Practice for Oncofertility.

Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.

Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate.

OBJECTIVE: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. METHODS: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. RESULTS: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99-7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68-17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). CONCLUSION: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

Study protocol for an open-label, single-arm, multicentre phase II trial to evaluate the efficacy and safety of combined triplet therapy and olanzapine for prevention of carboplatin-induced nausea and vomiting in gynaecological cancer patients.

INTRODUCTION: Carboplatin (CBDCA) administered at a dosage of 4 mg/mL/min or more area under the blood concentration-time curve (AUC) is considered to be ranked as the highest chemotherapy-induced nausea and vomiting (CINV) risk of the moderately emetogenic chemotherapy agents. The complete response (CR) rate for preventing overall CINV, defined as no emetic episodes and no use of rescue medication, for standard triplet antiemetic therapy (5-HT3RA, 5-hydroxytryptamine-3 receptor antagonist; NK1RA, neurokinin-1 receptor antagonist; DEX, dexamethasone) was approximately 60% in gynaecological cancer patients receiving CBDCA-based therapy. Further improvement in antiemetic treatment is needed to optimise care. This trial is to evaluate the efficacy and safety of using 5 mg olanzapine (OLZ) plus standard triplet antiemetic therapy for CINV after AUC ≥4 mg/mL/min CBDCA combination therapy in gynaecological cancer patients. METHODS AND ANALYSIS: This trial is an open-label, single-arm, multicentre phase II trial. Patients who receive CBDCA (AUC ≥4)-based therapy and have never been administered moderate to high emetogenic chemotherapy will be enrolled. All patients will receive OLZ (5 mg oral administration on days 1-4, after supper) in combination with 5-HT3RA, NK1RA and DEX. The primary endpoint is the CR rate during the overall period (0-120 hours). Testing the hypothesis that this regimen can improve CR rate from 60% (null hypothesis) to 75% (alternative hypothesis) with a one-sided type I error of 0.1 and power of 0.8 will require 53 patients. Considering the dropout rate, the target sample size is set at 60. ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board at each of the participating centres. Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000031646.

Fertility preservation in adolescent and young adult cancer patients: From a part of a national survey on oncofertility in Japan.

PURPOSE: This study evaluated the current status of reproductive disorders and provision of information on oncofertility to female adolescent and young adult (AYA) cancer patients in Japan. METHODS: A national survey of AYA cancer survivors was conducted. Children were <15 years old, and AYAs were 15-39 years old. Results from the survivors of other than gynecological disease who underwent chemotherapy were analyzed. RESULTS: Among the survivors, 41.4% were concerned about their reproductive function and infertility, and 36.2% were aware of menstrual cycle abnormalities. Among them, 15.5% (n = 20) of all and 21.2% (n = 17) of the AYA-onset survivors suffered infertility due to chemo- or radiotherapy and gave up childbearing. These rates were significantly higher than those of healthy AYAs. Although 80.8% of AYA-onset survivors answered that they had received information on reproductive function and infertility, only 55.8% had received information on fertility preservation methods. Furthermore, only 22.4% of all and 42.3% of AYA-onset survivors had received pretreatment information on fertility preservation methods. CONCLUSIONS: Not a few AYA cancer survivors reported reproductive dysfunction. These findings indicate that information provided on therapy-related problems before cancer treatment in Japan was insufficient and highlight the need to improve patient decision-making and support systems for fertility preservation.

Problems of reproductive function in survivors of childhood- and adolescent and young adult-onset cancer revealed in a part of a national survey of Japan.

PURPOSE: This study aimed to evaluate the current status of reproductive disorders as long-term complications in adolescent and young adult (AYA) cancer patients by comparing survivors of childhood-onset with those of AYA-onset cancer in Japan. METHODS: We conducted a national survey of AYA cancer survivors and healthy AYAs and analyzed the results from survivors who underwent chemotherapy and reported fertility problems as their current concern. RESULTS: Among all of the childhood-onset survivors, 27 (35.5%; nine males [28.1%] and 18 females [40.9%]) listed reproduction fertility problems as their current concern. Among all AYA-onset survivors, 25 (69.5%; 1/4 males [25.0%] and 24/32 females [75.0%]) listed these problems as a current concern. In contrast, 96.3% (26/27) of all childhood-onset cancer survivors and 68.0% (17/25) of all AYA-onset cancer survivors who received chemotherapy listed these problems as a current concern. CONCLUSIONS: A considerable number of both childhood-onset and AYA-onset cancer survivors, and especially those who had undergone chemotherapy, reported reproductive dysfunction as a delayed complication. It is vitally important to establish a supportive care system both for the patients whose fertility was abolished after the completion of cancer treatment and prophylactically for patients before they begin treatment.

[Current Status of Oncofertility in Adolescent and Young Adult (AYA) Generation Cancer Patients in Japan - National Survey of Oncologists].

A national survey conducted in 2016 aimed to evaluate the current status and needs of the field of oncofertility and to consider optimized medical delivery systems. A total of 739 oncologists, excluding gynecological and urological specialists, were surveyed. Of these, 99.2% thought that providing information on fertility preservation was important. Of the surveyed oncologists, 48% were affiliated with facilities providing assisted reproductive technology, and 79.3% practiced in university hospitals. Of 238 (32.2%) specialists who provided information on the risk of reproductive damage resulting from treatment in their facility, 163 (44.9%) and 75 (19.9%) practiced in university hospitals (n=363) and non-university hospitals (n= 376), respectively. In contrast, 14.3% and 32.7% of oncologists who practiced in university hospitals and non-university hospitals, respectively, collaborated with local obstetricians and gynecologists. Among oncologists who use a gradually expanding regional oncofertility network, 0.6% practice in university hospitals and 2.7% practice in non-university hospitals. Patients were advised that the risk of infertility was 92.3% and the likelihood of fertility preservation was 66.9%. Furthermore, as an ideal way of providing information on preservation of fertility, 22.9% of oncologists collaborate with local gynecologists, and 26.3% do so at a public cancer and reproductive medical counseling center. In addition, 34.7% and 55.1% of oncologists at university and non-university hospitals, respectively, thought that implementation of a fertility preservation program at a public facility would be desirable. Although most oncologists recognize the importance of providing information on reproductive medicine, the support system for reproductive function and fertility in adolescent and young adult (AYA) generation cancer patients is limited because of the lack of agreement on patient referral. The limited number of referrals in turn limits data collection in the field of oncofertility. Grant: A Health and Labour Sciences Research Grant: H27-Cancer Control-Ippan.

Examining Japanese women's preferences for a new style of postnatal care facility and its attributes.

Perinatal care in rural Japan is currently facing a crisis because of the lack of medical staff, especially obstetricians. In this study, a new style of postnatal care facility that combines both medical and nonmedical support is considered. Contrary to most postnatal care facilities in Japan, this new postnatal care facility accepts a puerperant from the cooperating maternity facility soon after birth (≤2 days). We conducted a hypothetical choice experiment to investigate whether this new postnatal care facility could be accepted by women in Gero City, Hida, Gifu Prefecture and how these women evaluate different kinds of postnatal care services. The results show that after a 2-day hospital stay, women from Gero City preferred to move to the new postnatal care facility over the other alternatives (continued hospitalization or discharge home). In addition, the estimated choice probabilities for selecting the postnatal care facility under different scenarios show a high level of acceptance for this new postnatal care facility.

Management of ovarian hyperstimulation syndrome with abdominal compartment syndrome, based on intravesical pressure measurement.

There are few reports on abdominal compartment syndrome that are caused by ovarian hyperstimulation syndrome (OHSS). Here, a case of a 29 year old woman is reported in which intravesical pressure measurement was useful in the management of severe OHSS that had been complicated by abdominal compartment syndrome. The patient's urinary output and general condition did not improve after the initial treatment. The woman's intra-abdominal pressure was evaluated indirectly, based on her intravesical pressure, and was found to be significantly elevated. The patient's urinary volume increased after a 14 mm Hg decrease in the intravesical pressure was achieved by the drainage of ascitic fluid. Intravesical pressure measurement was useful in the management of the general condition of this patient with OHSS.

Iron regulatory protein 2 in ovarian endometrial cysts.

Ovarian endometrial cysts cause some kinds of ovarian cancer, and iron is considered as one factor of carcinogenesis. In contrast, hypoxia is associated with progression, angiogenesis, metastasis, and resistance to therapy in cancer. We investigated hypoxia-induced perturbation of iron homeostasis in terms of labile iron, iron deposition, and iron regulatory protein (IRP) in ovarian endometrial cysts. Iron deposition, expression of IRPs, and a protein marker of hypoxia in human ovarian endometrial cysts were analyzed histologically. The concentration of free iron and the pO2 level of the cyst fluid of human ovarian cysts (n = 9) were measured. The expression of IRP2 under hypoxia was investigated in vitro by using Ishikawa cells as a model of endometrial cells. Iron deposition and the expression of IRP2 and Carbonic anhydrase 9 (CA9) were strong in endometrial stromal cells in the human ovarian endometrial cysts. The average concentration of free iron in the cyst fluid was 8.1 ± 2.9 mg/L, and the pO2 was 22.4 ± 5.2 mmHg. A cell-based study using Ishikawa cells revealed that IRP2 expression was decreased by an overload of Fe(II) under normoxia but remained unchanged under hypoxia even in the presence of excess Fe(II). An increase in the expression of IRP2 caused upregulation of intracellular iron as a result of the response to iron deficiency, whereas the protein was degraded under iron-rich conditions. We found that iron-rich regions existed in ovarian endometrial cysts concomitantly with the high level of IRP2 expression, which should generally be decomposed upon an overload of iron. We revealed that an insufficient level of oxygen in the cysts is the main factor for the unusual stabilization of IRP2 against iron-mediated degradation, which provides aberrant uptake of iron in ovarian endometrial stromal cells and can potentially lead to carcinogenesis.

Cohort study of the incidence of spontaneous preterm birth and septic abortion referred by pathological examination in Gifu prefecture in Japan.

AIMS: To clarify the incidence of spontaneous preterm birth (PB) and septic abortion (sab) in Gifu prefecture in Japan. STUDY DESIGN: This prospective, population-based cohort study was approved by our hospital's Institutional Review Board. All 36 hospitals (100%) in Gifu prefecture offering obstetrical services participated in the study. Patient enrollment criteria were: sab and PB from 22 to <37weeks gestation (WG), excluding for maternal and fetal indications. Pathological examinations before 36 WG and associated factors for both PB and chorioamnionitis (CAM) stage 3 were analyzed by multiple logistic regression analysis judging from minimum daily clinical information in Gifu prefecture. RESULTS: The sab rate per all deliveries was 29/16871 (0.17%) at 16.9±2.9 WG. The total spontaneous PB rate was 615/16871 (3.65%) at 34.5±2.7 WG, with birth weight (BW) 2267±557g. There were 26 (0.15%) PBs from 22+0 to 27+6 WG (weeks+days) at 25.2±1.5 WG, with BW 745±199g. Among 214 pathological examinations, CAM was detected in 80% (sab) and 63% (PB<36 WG), respectively. Funisitis were 14% and 17% respectively. Episodes of serial genital bleeding and/or hematoma at <12 WG were more frequent in sab and earlier PB (<28 WG) associated with CAM stage 3 (odds 1.9, P<0.0001). Combined factors such as bleeding and past history of CAM correlated with earlier delivery at 23.4±5.9 WG (P=0.0032). CONCLUSION: In Gifu prefecture, the incidence of sab was 0.17% (per all deliveries) and 3.65% of spontaneous PB. The combined risk of past CAM history and bleeding was associated with earlier delivery among total preterm birth.

Creating a Global Community of Practice for Oncofertility.

Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.

Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of ovarian cancer including primary peritoneal cancer and fallopian tube cancer.

The fourth edition of the Japan Society of Gynecologic Oncology guidelines for the treatment of ovarian cancer including primary peritoneal cancer and fallopian tube cancer was published in 2015. The guidelines contain seven chapters and six flow charts. The major changes in this new edition are as follows-(1) the format has been changed from reviews to clinical questions (CQ), and the guidelines for optimal clinical practice in Japan are now shown as 41 CQs and answers; (2) the 'flow charts' have been improved and placed near the beginning of the guidelines; (3) the 'basic points', including tumor staging, histological classification, surgical procedures, chemotherapy, and palliative care, are described before the chapter; (4) the FIGO surgical staging of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer was revised in 2014 and the guideline has been revised accordingly to take the updated version of this classification into account; (5) the procedures for examination and management of hereditary breast and ovarian cancer are described; (6) information on molecular targeting therapy has been added; (7) guidelines for the treatment of recurrent cancer based on tumor markers alone are described, as well as guidelines for providing hormone replacement therapy after treatment.

Treatment and prognosis of bone metastasis from cervical cancer (KCOG-G1202s).

AIM: The early and precise diagnosis and proper palliative treatment of bone metastasis is important for improving the quality of life of cervical cancer patients. The aim of this study was to clarify the clinical features, treatment modalities and prognosis of bone metastasis in cervical cancer patients in Japan. METHODS: The medical records of 75 cervical cancer patients with bone metastasis who were treated between January 2000 and December 2010 were retrospectively analyzed in a multi-institutional study. RESULTS: Fifty-four patients (72.0%) had a single bone metastasis. Bone metastases were found in the spine (46.7%) and pelvis (42.7%). Forty-three patients (57.3%) also had extra-osseous metastases. Most of the patients received radiotherapy, chemotherapy or both, but 25 patients (33.3%) received palliative care only. Bisphosphonates were given as palliative therapy to 25 patients (33.3%). The median overall survival after the diagnosis of bone metastasis was significantly shorter in patients with extra-osseous metastases than in those without extra-osseous metastases (14 vs 5 months; P < 0.05). The survival of patients who received chemotherapy following radiotherapy or concurrent chemoradiotherapy was significantly longer than that of the patients who received palliative care. On multivariate analysis, the presence of extra-osseous metastasis was an independent predictor of survival in patients with bone metastasis from cervical cancer. CONCLUSIONS: Multidisciplinary treatment might improve the prognosis of patients with bone metastasis who do not have extra-osseous lesions.

An evaluation of the Gifu Model in a trial for a new regional oncofertility network in Japan, focusing on its necessity and effects.

Purpose: We evaluated our 2-year experience of the regional oncofertility network in Gifu Prefecture (GPOFS) in order to establish a more sophisticated regional oncofertility networking model in Japan. Methods: Questionnaires were distributed twice in January 2013 to 57 departments in 35 hospitals that provide cancer treatment in Gifu Prefecture, before the establishment of the regional oncofertility network. The number and type of disease of the referred adolescent and young adult (AYA) cancer patients who visited the oncofertility clinic in Gifu University Hospital via the GPOFS were analyzed. Results: The majority of regional oncologists are aware of the need to provide information about oncofertility to their patients, but they cannot provide sufficient information due to their lack of knowledge about reproductive medicine. Eighty-one AYA patients were referred to our clinic for oncofertility counseling in the first 2 years after the establishment of the GPOFS. Conclusions: The GPOFS as the first regional oncofertility network in Japan has just started and may be working to help both AYA cancer patients and their oncologists. The nationwide establishment of the regional oncofertility network model could help both AYA cancer patients and oncologists.

Exploratory study of pre-surgical medications with dienogest or leuprorelin in laparoscopic cystectomy of endometrial cysts.

AIM: The aim of this study was to compare the effects of pre-surgical medication with dienogest or leuprorelin on post-surgical ovarian function. MATERIAL AND METHODS: We conducted an exploratory study in two centers in Japan that comprised 30 patients with ovarian endometrial cysts for whom surgical excision was planned. Patients were enrolled and divided into pre-surgical medication groups with dienogest or leuprorelin for 12 weeks. Thereafter, patients were treated by laparoscopic cystectomy. The primary outcome was ovarian function post-surgery, as assessed by serum anti-Müllerian hormone (AMH) level, antral follicle count (AFC) and resumption of menses. Secondary outcome was the effect of pre-surgical medication, as assessed by the size of endometrial cysts and visual analog scale (VAS) score. Serum AMH, AFC, size of endometrial cysts, and VAS scores were measured at baseline (before medication), after medication (1 day before surgery), and at 4 and 12 weeks post-surgery. RESULTS: Serum AMH levels did not change after pre-surgical medication with either dienogest or leuprorelin. Although AMH decreased after surgery, it recovered by 12 weeks post-surgery in both groups with no statistically significant difference. Mean AFC did not change after surgery in either group. Menses returned by 12 weeks post-surgery in all patients except for those who were pregnant. The rate of reduction of endometrial cyst volume did not differ between the groups. Both dienogest and leuprorelin were associated with substantial reductions in VAS scores. CONCLUSION: There were no statistically significant differences between pre-surgical medication with dienogest and leuprorelin in post-surgical ovarian function. Both medications were effective in reducing endometrial cyst volume and VAS score.

Impact of specialization in gynecology and obstetrics departments on pregnant women's choice of maternity institutions.

In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women's choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women's choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area.

Ovarian mucinous cystadenoma coexisting with benign Brenner tumor: MR imaging findings.

PURPOSE: The purpose of this study was to describe the MR imaging findings of ovarian mucinous cystadenomas coexisting with benign Brenner tumors. MATERIALS AND METHODS: MR images with a 1.5-T unit obtained in five consecutive patients (age range, 51-72 years; mean age, 61 years) with surgically confirmed ovarian mucinous cystadenomas coexisting with benign Brenner tumors were retrospectively reviewed for the presence, configuration, and signal intensity of cystic and solid components of the lesions. RESULTS: Tumors ranged in size from 7.5 to 22.1 cm (mean, 13.5 cm). In four patients (80%), the size of mucinous cystadenoma (range 6.4-22.1 cm; mean, 12.5 cm) was larger than that of Brenner tumor (range 0.2-9.1 cm; mean, 2.8 cm). All patients (100%) had cystic, and three (60%) had solid components. Four patients (80%) showed multilocular cystic, and one (20%) showed unilocular cystic appearance. MR imaging findings were classified into three patterns: (1) a bulky solid mass adjacent to the cystic component, (2) a mural nodule at the periphery of the cystic component, and (3) a cystic component without a detectable solid component. All four multilocular cystic areas exhibited "stained glass" appearances on both T1- and T2-weighted images, and all three solid areas showed homogeneous hypointensity on T2-weighted images. CONCLUSION: Mucinous cystadenomas were often larger than the coexisting benign Brenner tumors. Mucinous cystadenomas coexisting with benign Brenner tumors should be considered when multilocular or unilocular cystic components are accompanied by homogeneously hypointense solid components on T2-weighted images.

A cost-benefit analysis on the specialization in departments of obstetrics and gynecology in Japan.

In April 2008, the specialization in departments of obstetrics and gynecology was conducted in Sennan area of Osaka prefecture in Japan, which aims at solving the problems of regional provision of obstetrical service. Under this specialization, the departments of obstetrics and gynecology in two city hospitals were combined as one medical center, whilst one hospital is in charge of the department of gynecology and the other one operates the department of obstetrics. In this paper, we implement a cost-benefit analysis to evaluate the validity of this specialization. The benefit-cost ratio is estimated at 1.367 under a basic scenario, indicating that the specialization can generate a net benefit. In addition, with a consideration of different kinds of uncertainty in the future, a number of sensitivity analyses are conducted. The results of these sensitivity analyses suggest that the specialization is valid in the sense that all the estimated benefit-cost ratios are above 1.0 in any case.