Esophageal Squamous Cell Carcinoma with Marked Eosinophil Infiltration

We report a case of esophageal squamous cell carcinoma (SCC) with marked eosinophil infiltration which was identified postoperatively in the esophageal wall in areas not surrounding the SCC. The eosinophil infiltration was seen in the submucosa, muscle and adventitia, but not in the mucosa. Eosinophilic esophagitis (EoE) is a pathological condition defined as eosinophil infiltration within the esophageal mucosa. Eosinophil infiltration at the invasion front of esophageal SCC is termed tumor-associated tissue eosinophilia (TATE). However, the eosinophil infiltration in this case may be pathologically different from both EoE and TATE. To our knowledge, this is the first report of esophageal SCC with eosinophil infiltration

Conventional IVF デノ long protocol ニオケル hCG トウヨビ ノ ケッチュウ progesterone チ ト ニンシン セイセキ ニ ツイテ

Long protocol(L)下でのconventional IVF(cIVF)において,hCG 切り替え日の血中progesterone(P)値とcIVF における種々の因子及び妊娠成績との関係について検討した.不妊外来を受診した患者で,L 下でcIVF を施行された486 例,706 周期を対象とした.hCG 切り替え日の血中P 値と血中estradiol(E2)値,総hMG 投与量,採卵数,正常受精(2PN)発生数,2PN 発生率,良好胚(G1)胚数,G1 胚発生率,子宮内膜厚(EM),leaf pattern の有無,妊娠率等との関係について検討した.P 値とE2 値,採卵数,2PN 発生数,G1胚数との間には,有意な正の相関関係が認められた(P<0.01).2PN 発生率との間には有意な負の相関関係が認められた(P<0.01).子宮内膜におけるleaf patternの有無を見ると,leaf( +)の群ではleaf( &#8722;)の群に比べ有意にP 値が低かった(P<0.01).また,P 値レベル別での妊娠率,多胎率,流産率の比較では,P 値2.1&#8722;2.5 ng/ml で妊娠率が有意に高かった(P<0.05).P 値レベルは,E2 値,採卵数,2PN 発生数およびG1 胚発生数と相関している.これらのことから,P 値レベルは卵胞成熟および卵のquality を示す一つのシグナルとなり得ることが明らかになった.一方,P 値レベルが子宮内膜の肥厚や妊娠率に影響していないことも判明した.Objectives:The aim of this study was to evaluate thecorrelation between serum progesterone (P) levels on theday of hCG administration and various factors includingpregnancy outcome in a conventional IVF( cIVF) long protocolstimulation.Material and methods:Seven hundred six IVF cyclesusing a long protocol with GnRH agonist and hMG involving486 patients were studied. This study retrospectivelyevaluated the correlation of serum P levels on the day ofhCG administration with serum estradiol (E2) levels, totaldose of hMG, number of oocytes retrieved, number of normalfertilized oocytes, normal fertilized oocytes rate, numbersof high quality oocytes (G1), G1 rate, endometrialthickness, presence of endometrial leaf pattern and pregnancyoutcome in cIVF.Results:A significant positive correlation was observedbetween serum P levels on the day of hCG administrationand serum E2 levels, number of oocytes retrieved, numberof normal fertilized oocytes and numbers of G1,( p<0.01).A significant negative association was observed betweenserum P levels on the day of hCG administration and normalfertilized oocytes rate( p<0.01).Serum P levels on the day of hCG administration of theleaf( +) group( presence of endometrial leaf pattern) wassignificantly low in comparison with that of the leaf (&#8722;)group( p<0.01).Among the six groups, the pregnancy ratein P levels from 2.1 to 2.5 ng/ml was significantly high incomparison with others.Conclusion:A significant positive correlation was observedbetween serum P levels on the day of hCG administrationand E2 levels, number of oocytes retrieved, numberof normal fertilized oocytes and numbers of G1. Among thesix groups, the pregnancy rate in P levels from 2.1 to 2.5ng/ml was significantly high in comparison with others. Accordingto two above-mentioned results, we conclude thatan appropriate P levels is important for oocyte maturation

Clinical Evaluation of Breech Deliveries Over a Fifteen-Year Period at a Hospital in Ota, Japan

Objective : To examine the characteristics and perinatal outcome of pregnancies with breech presentation. Methods : Breech deliveries were divided into four groups : primipara vaginal delivery group (PV-multipara vaginal delivery group (MV-G), planned cesarean section group (PC-G), and emergency cesarean section group (EC-G). The maternal age, gestational week, neonatal birth weight, and Apgar score were compared.Results : There were no significant differences in maternal age, gestational week as well as neonatal birth weight among the four groups. An Apgar score at 1 minute of less than 6 points was seen in 0%, 11.1%, 15.3%, and 20% of the PC, MV, PV and EC-Gs, respectively. (PV-G and PC-G were compared to obtain p < 0.05) Although, no neonate in this study had an Apgar score at 5 minutes of less than 6 points.Conclusion : There was no significant difference of perinatal outcome between vaginal delivery and cesarean section for breech presentation at term

HPV カンセン ジョウキョウ ト シキュウ ケイガン ケンシン ニオケル サイボウ シン ト HPV ケンサ ヘイヨウ ノ イギ

Human papillomavirus (HPV) 中高リスク型の感染が,子宮頸部の前癌病変や子宮頸癌の発症に関与していることが明らかにされた.HPV 感染の一部は持続感染し,子宮頸癌のリスクとなる.そこでHPV 感染状況と子宮頸癌検診における細胞診とHPV 検査併用の意義について検討した.対象は3 年以上経過観察可能であった細胞診正常81 例と細胞診異常で組織診を施行した80 例である.HPV 検出にはHybrid Capture AssayII&reg;( HC-II&reg;) 法を用いた.細胞診正常11 例,細胞診異常61 例でHPV が検出され,細胞診異常の程度が進むほどHPV 検出率は上昇した.組織診でも病変が進行するほどHPV 検出率は高くなった.細胞診正常ではHPV陽性持続で病変の進行を認めた.組織診別では,慢性子宮頸管炎(Chronic Cervicitis:CC) ではHPV 陽性持続1 例と陽性化1 例に,子宮頸部上皮内病変(Cervical Intraepithelial Neoplasia:CIN) IではHPV 陽性持続2 例に,CIN IIでは陽性持続3 例と陽性化した1 例に,CIN IIIでは陽性持続2 例に病変の進行が認められた.HPV 感染が認められなかった例では病変の進行を認めない結果から,細胞診とHPV 検査を併用することにより,細胞診正常でHPV 検査陰性であれば検診間隔を3 年に延ばすことが可能であると示唆された.またHPV持続感染が病変進行の原因となると考えられ,HPV 検査の導入は子宮頸癌の早期発見,早期治療に有用である.Persistent infection with intermediate or high risk subtypesof human papillomavirus (HPV) is associated withuterine cervical neoplasia and cervical cancer. Over a3-year period, we followed up 161 patients with normal( 81cases) and abnormal (80 cases) results of cytologicalscreening tests to determine the status of persistent HPVinfection and the significance of combined uterine cervicalcancer cytological screenings and HPV tests. The hybridcapture assay II&reg; method was used to test for intermediateor high risk of HPV infection. HPV infection was detectedin 11 patients with normal results and 61 patients with abnormalresults of cytological screening tests. The positiverate of HPV infection was associated with the status of cytologicaland pathological lesion progression. Lesions of 2patients with persistent HPV infection who had normal resultsin cytological screening tests had been diagnosed withprogressive lesions. Lesions of patients in whom HPV infectionwas negative or negative conversion were determinedto be non-progressive. Disease progression was seen in theform of chronic cervicitis in 1 patient with persistent HPVinfection and 1 patient with HPV positive conversion;inthe form of cervical intraepithelial neoplasia (CIN) I in 2patients with persistent HPV infection;in the form of CINII in 3 patients with persistent HPV infection and 1 patientwith HPV positive conversion;and in the form of CIN IIIin 2 patients with persistent HPV infection. In conclusion,combined cytological screening and HPV tests will increasethe precision of uterine cervical cancer screening and willbe valuable for the early detection and a rapid treatment ofuterine cervical cancer. Moreover, the interval between 2consecutive uterine cervical cancer screenings can be extendedto at least 3 years in patients who have normal resultsof cytology and no HPV infection

TT ウイルス ボシ カンセン ノ コウホウシテキ, ゼンホウシテキ ケンキュウ : トクニ ボシ カンセン ヨウシキ ト シュウサンキ ニオケル リンショウテキ イギ ニツイテ

近年同定され,輸血後肝炎との関連が示唆されているTTV について,その母子感染の自然史と周産期における臨床的意義について後方視的,前方視的に検討した.HBV 及びHCV が検出されない妊婦(前方視的研究;NBCPW 群)におけるTTV DNA 陽性率は19.0%(37/195)であり,このうちsAST/sALT 値が110 U/L を超える例は皆無であった.HBV あるいはHCV キャリア妊婦(後方視的研究;BCCPW 群)ではTTV DNA 陽性率は25.0%(21/84)である.このうちsAST/sALT 値が110U/L を超える例は23.8%(5/21)に達し,この5 例はTTV 単独キャリアではなく,HBV 又はHCV との重複キャリアであった.NBCPW 群の出生児(14 名)におけるTTV DNA 陽転率は57.1%であり,このうちsAST/sALT 値が110 U/L を超えた例は無かった.BCCPW 群の出生児(21 名)におけるTTV DNA 陽転率は42.9%であり,このうちsAST/sALT 値が110 U/L を超えた児は2 名(22.2%)で,この2 名はHCV キャリアでもあった.TTV DNA 陽転化した総数17 名の出生児は全員生後18 ヶ月時点までTTV DNA 陽性が持続しており,脱キャリア化は認められていない.また,キャリア化児におけるTTV DNA 出現時期および哺育方法より経胎盤感染,経産道感染および経唾液感染は否定的であり,経母乳感染の可能性が強く示唆される結果であった.また,キャリア妊婦及びキャリア化児における肝機能異常は母子共々TTV 単独キャリアでは認められず,TTV 感染の周産期における臨床的インパクトは低いと思われる.The natural history of mother-to-child transmission(MTCT) of the TT virus (TTV) was investigated retroandprospectively.Serum TTV DNA was detected in 37 out of the 195( 19.0%) pregnant women without both HBV and HCV in theirsera (NBCPW) and 21 out of the 84 (25.0 %) pregnantwomen with HBV and/or HCV (BCCPW). In the lattergroup, 5 out of the 21( 23.8%) TTV carrier pregnant womenshowed repeatedly sAST and/or sALT levels over110U/L, but none of the former group did.With informed consent (IC), 14 (NBCPW) and 21 (BCCPW)infants were followed from birth up to 18 months ofage by receiving tests for serum TTV DNA and levels ofsAST and sALT. Eight out of the 14 infants (57.1 %, NBCPW)and 9 out of the 21 infants( 42.9%, BCCPW) developedTTV carrier-state, and all of these 17 carrier infantsmaintained serum TTV DNA-positive through the followupperiods. No infants (NBCPW) showed elevated serumlevels (>110 U/L) of AST or ALT during the follow-upperiods, but 2 out of the 9 infants( 22.2%, BCCPW) showedsAST or sALT levels higher than 110 U/L, and these 2 infantswere found to be in HCV carrier-state.None of the infants developed a TTV-positive resultwithin 1 month after birth, and thereafter 11.8 % (2/17)developed carrier-state in 3 months, 47.1 % in 6 months,82.4 % in 12 months. These findings may exclude the intrauterineor trans-vaginal infection as a mode of TTVMTCT. On the other hand, all carrier infants with one exceptionwere raised by breast feeding, which was rich inTTV. Both carrier pregnant women and children, who wereneither HBV nor HCV carriers, showed no abnormal liverfunction through the follow-up periods.Thus, we conclude that TTV MTCT occurs highly, but itis not so significant practically

シュウサンキ リョウイキ ニオケル Gガタ カンエン ウイルス ノ リンショウテキ イギ : オナジ フラビ ウイルス カ ニ ゾクスル Cガタ カンエン ウイルス ト ヒカク シテ

HBV, HCV 同様血清肝炎を惹起する可能性を示唆されているHGV の(1)妊婦における検出率,(2)母子感染の自然史,そのリスクファクター及びキャリア化児の予後,(3)キャリア妊婦及びキャリア化児における肝機能を前方視的に調査し,同ウイルスの周産期における臨床的意義を同じフラビウイルス科に属するHCV と比較検討した.対象は1996&#12316;2004 年に当科を受診した妊婦3,738 名(HGV),4,023 名(HCV)とキャリア妊婦の出生児14 名(HGV),24 名(HCV)である.HGV RNA は RT-PCR 法(定性)k,real-time PCR(定量)及びcycle-sequence 法(genome sequence)により,HGV-E2 抗体はELISA 法を用いて,またHCV RNA はnested RT-PCR(定性),real- time PCR(定量)により,またHCV-Ab は2nd 及び3rd generation EIA を用いて測定した.対象児の血清サンプルは臍帯血から最長119 ヶ月まで定期的に検査に供された.妊婦におけるHGV RNA, HCV RNA の検出率は各々0.64%(24/3,738),0.60%(24/4,023)であり両者に有意差を認めなかった(p=0.7984).HGV-E2 抗体の検出率は4.4%(82/1,858)であり,HGV RNA とHGV-E2 抗体は相互排他的であった.HGV RNA 単独陽性妊婦で肝機能異常は見られなかった.出生児におけるHGV RNA,HCV RNA 陽性はそれぞれ64.3%(10/16),12.5%(3/24)に認められ,両ウイルス陽性児とも経膣分娩症例であり,キャリア妊婦のviral loads はそれぞれ107 及び105 copies/ml 以上の症例であった.HGV 母子感染と推測された4 組の母子ペア血清を用いたHGV RNA シークエンス相同性の検討では各母子間で100%の一致率が得られ,HGV 母子感染の直接的証拠が得られた.キャリア化した9 名の児のうち1名が肝機能異常(sALT 値>110 U/L)を呈したが,これはHCV との重複感染例であった.フォローアップ中にHCV では約16.7%がキャリア化後3 年以内に脱キャリア化したが,HGV キャリア児ではRNA 陰性化は少なくとも最長約10 年間のフォローアップ期間中には皆無であった.妊婦のHGV 及びHCV 保有率(キャリア率)はほぼ同等であり,一方母子感染率は前者が後者の約5.1 倍に達し,母子感染がHGV キャリアの主たる供給源であることが示唆された.HGV およびHCV 母子感染では,キャリア妊婦の血中viral loads 及び経膣分娩がリスクファクターであることが示された.さらに,同じフラビウイルス科に属しながら,HGV はHCV とは異なり,肝傷害性が殆ど無いことが判明した.The epidemiology and natural history of mother-to-childtransmission( MTCT) of hepatitis G virus( HGV) were investigatedto evaluate potential clinical significance of HGVin perinatal periods. The data was discussed by comparisonwith those of a well-known flavivirus, hepatitis C virus(HCV).During the periods from 1996 to 2006, 3,738 pregnantwomen received screening tests for HGV RNA and 4,023pregnant women received screening tests for HCV Antibodies(Ab). HGV RNA-positive pregnant women weretested for HGV-E2 Ab and HCV Ab-positive pregnantwomen were tested for HCV RNA. HGV- and HCV RNApositivewomen underwent the measurement of viral loadswith use of real-time PCR. With informed consent, 14 infantsborn to HGV carrier mothers and 24 infants born toHCV carrier mothers were followed from birth to 19months of age by receiving the measurement of serumHGV- or HCV RNA and sAST/sALT levels.HGV RNA was detected in 0.64 % (24/3,738) of thewomen tested and HCV RNA was detected in 0.60 %(24/4,023) of the women tested. HGV-E2 Ab was detectedin 4.4 % and mutually exclusive with HGV RNA. Nine ofthe 14 infants born to HGV carrier mothers( 64.3%) and 3of 24 infants born to HCV carrier mothers (12.5 %) developedHGV and HCV carrier-states respectively. The homologyof HGV RNA sequences was perfectly identical betweenthe 4 paired sera of mother-child.Both of vaginal delivery mode and maternal viral loads atdelivery (HGV>107, HCV>105 copies/ml) were suggestedas one of risk factors for MTCT. The elevation of sAST/sALT levels (>110 U/L) in the HGV and HCV carrier infantswere 7.1%( 1/9) and 66.7%(2/3) respectively. However,one HGV carrier infant with elevated sAST/sALTlevels was found to be a HCV carrier.We conclude that HGV MTCT occurs very frequently,but HGV is not so significant in perinatal periods comparedwith another flavivirus, HCV