Introduction and utility of resuscitative endovascular balloon occlusion of the aorta for cases with a potential high risk of postpartum hemorrhage: A single tertiary care center experience of two cases

Postpartum hemorrhage is an important obstetric complication and the leading cause of maternal mortality worldwide. Occasionally, we encounter unexpected massive postpartum hemorrhage diagnosed for the first time after delivery. Therefore, it is essential to pay attention to patients with a high risk of postpartum hemorrhage. The authors report two cases of patients at high risk of postpartum hemorrhage that were successfully managed by resuscitative endovascular balloon occlusion of the aorta before cesarean section. Case 1: A 32-year-old woman with a history of cesarean section and who conceived using assisted reproductive technology was diagnosed with partial placenta previa at 25 weeks of gestation. Because of tocolysis failure, emergent cesarean section with resuscitative endovascular balloon occlusion of the aorta was performed at 36 weeks of gestation. Natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage. Case 2: A 41-year-old woman with suspected placenta accreta spectrum due to a cesarean scar pregnancy was referred to our hospital at 33 weeks of gestation. A planned cesarean section with resuscitative endovascular balloon occlusion of the aorta was conducted at 37 weeks of gestation. There was no visual evidence of abnormal placental invasion of the myometrium, and natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage

胆嚢癌および胆嚢前癌性病変における血液型物質の免疫組織学的検討

胆嚢癌および胆嚢前癌性病変における血液型物質の消長を知る目的で,胆嚢粘膜癌11例,進行癌23例,腺腫9例,異型上皮5例および胆石症13例を用い,免疫組織学的に血液型物質の組織内局在を検討した.その結果,胆石症では血液型物質は胆嚢固有上皮および新生粘液腺にみられ,化生性杯細胞では陽性から陰性まで種々であった.腺腫および異型上皮の大部分は血液型物質陽性であった.また粘膜癌(すべて高分化腺癌)や高分化型進行癌では血液型物質が比較的よく残存していたが,低分化型進行癌では完全に消失したものが多く,組織型との関連性がつよくみられた.なお化生性変化が癌巣内にみられた粘膜癌では,全例血液型物質が残存していた.また血液型物質と粘液組成との関連を知る目的でhigh iron diamine-Alcian blue染色を重染色すると,血液型物質が消失した部にはnon-sulfated acid mucinが多く出現していた.血液型物質の検索は,良悪境界病変の鑑別や胆嚢癌の組織発生の解明に有用と思われ,その意義につき若干の考察を加えた.A.B.O. type blood group antigens in human gallbladders were studied immunohistologically in 11 cases with mucosal carcinoma, 23 cases with advanced carcinoma, 9 cases with adenoma, 5 cases with dysplasia and 13 cases with cholecystolithiasis. Blood group antigens were always detected in proper epithelia and mucous glands in cases with cholecystolithiasis, but were sometimes also detected in metaplastic goblet cells. Most adenoma and dysplasia were positive for these antigens. Mucosal carcinomas and well differentiated advanced carcinomas were occasionally positive for blood group antigens, but poorly differentiated advanced carcinomas were almost always negative. All mucosal carcinomas with metaplastic changes were positive for these antigens. Double staining with blood group antigens and high iron diamine-Alcian blue revealed non-sulfated acid mucin in areas where blood group antigens were lost. Immunohistological investigation of blood group antigens may be useful in differentiating border line lesions and in study of cancer histogenesis

胆嚢前癌性病変および胆嚢癌組織における腸上皮化生の検討

胆嚢粘膜の腸上皮化生が胆嚢癌の組織発生にどのように関与しているかを探る目的で,胆嚢前癌性病変および胆嚢癌組織内にみられた化生性変化の種類と頻度を組織学的に検討した.対象として腺腫8例,異型上皮7例,過形成性ポリープ20例,粘膜癌11例および進行癌37例の計83例を用いた.その結果,異型上皮では杯細胞,粘液腺および内分泌細胞が60～80%の頻度でみられ,また過形成性ポリープでも粘液腺,杯細胞,内分泌細胞およびパネート細胞がおのおの10～100%の頻度で認められた.しかし腺腫では杯細胞のみが25%にみられたにすぎなかった.また粘膜癌では杯細胞と内分泌細胞が22～36%で,進行癌では同様の細胞が8～16%で認められた.以上より,胆嚢粘膜の腸上皮化生は,種々の化生性変化を高率に伴う異型上皮や過形成性ポリープから癌化する場合に重要な役割を演じ,化生性変化を伴うことが少ない腺腫からの癌化にはあまり関与しないものと推定した.In order to study the relationship between mucosal metaplastic changes and cancer histogenesis in the gallbladder, precancerous lesions and carcinomas were investigated histologically for frequency and the variety of intestinal metaplasia in them. The materials included 8 cases of adenoma, 7 cases of dysplasia, 20 cases of hyperplastic polyp, 11 cases of mucosal carcinoma and 37 cases of advanced carcinoma. Goblet cells, mucous glands and endocrine cells were detected in 60-80% of cases with dysplasia and 10-100% of cases with hyperplastic polyp. However, adenoma only displayed goblet cells in 25% of cases. In cases with carcinoma, goblet cells and endocrine cells were present in 22-36% of mucosal carcinomas and 8-16% of advanced carcinomas, all of which were well differentiated adenocarcinomas. These results seem to indicate that intestinal metaplasia play an important role in malignant changes from dysplasia and hyperplastic polyp rather than adenoma

BIOCHEMICAL STUDIES ON THE INCREASE AND FORMATION OF ANTIBODIES WITH CHYMOPAPAIN IN VITRO : IV. STUDIES ON THE FORMATION OF DIPHTHERIAL ANTITOXIN FROM PRELIMINARILY PEPSIN-OR TRYPSIN-DIGESTED NORMAL EQUINE SERUM GLOBULINS

The previous papers have reported studies on the increase of diphtherial antitoxic titers in vitro from the preliminarily pepsin- or trypsin-digested, acid- or alkali-heated, or with urea or with sodium salicylate pre-denaturated diphtherial antitoxic equine serum globulins, these globulins were obtained from immunized horses during the course of progressive diphtherial immunization, incubating with diphtherial toxin (antigen) and oxidized chymopapain (catalyzer) at pH 7.3,Eh 450〜500 mV and 40℃. The process and mechanism of antibody formation have invited numerous studies ever since effective techniques for immunization have been found. Although the studies of the investigators to produce antibodies in vitro have brought remarkable advance in this field, lack of enzymechemical studies in the problem led the present authors to undertake some enzymic works on the formation and production of antibodies in vitro. The present paper deals with negative results of studies on the formation of diphtherial antitoxin incubating preliminarily pepsin- or trypsin-digested normal equine serum globulins with toxic solutions and oxidized chymopapain

BIOCHEMICAL STUDIES ON THE INCREASE AND FORMATION OF ANTIBODIES WITH CHYMOPAPAIN IN VITRO : III. STUDIES ON THE INCREASE OF DIPHTHERIAL ANTITOXIC TITERS FROM PRELIMINARILY DENATURATED ANTITOXIC GLOBULINS

The present data indicate that the pre-denaturated diphtherial antitoxins produced by acid-heating, by alkali-heating, by urea or by sodium salicylate addition, from the large incomplete antitoxic molecules, those produced in a horse at the initial stages of diphtherial immunization, are not converted newly into small and complete antitoxic molecules in the incubating procedures with oxidized chymopapain and diphtherial toxin, in which those produced with pepsin-predigestion were converted into. In these studies, the fact was found that to increase the diphtherial antitoxic titers of immune equine serum globulins, which obtained from horse at the initial stages of immunization, with oxidized chymopapain and diphtherial toxin under suitable definite conditions of the incubation in vitro, the pre-digestion of large incomplete antitoxic globulins with pepsin is particularily necessary

BIOCHEMICAL STUDIES ON THE INCREASE AND FORMATION OF ANTIBODIES WITH CHYMOPAPAIN IN VITRO : II. STUDIES ON THE INCREASE OF DIPHTHERIAL ANTITOXIC TITERS FROM THE TRYPSIN-DIGESTED ANTITOXIC GLOBULINS

The present data indicate that the fragmental diphtherial antitoxins produced with trypsin digestion from the large incomplete antitoxic molecules, those produced in horses at the initial stages of the diphtherial immunization, are not converted newly into small and complete antitoxic molecules in the incubation with oxidized chymopapain and toxin, by which those produced with pepsin digestion were converted into. It is considered that the fragments, produced with trypsin digestion, are not convenient to be converted into complete antitoxins by the incubating procedures with oxidized chymopapain and toxin. The fact suggests that the characteristic differentiation of the pepsin-digested globulins and trypsin-digested ones is due to the difference of the molecular fine structure of the two