Retrorectal epidermoid cyst with unusually elevated serum SCC level, initially diagnosed as an ovarian tumor

Retrorectal epidermoid cyst is one of the developmental cysts which arise from remnants of embryonic tissues. We report a rare case of retrorectal epidermoid cyst, initially diagnosed as an ovarian tumor. Serum SCC value as tumor marker was elevated to the high level. Laparoscopy revealed ovaries, uterus and other pelvic organs were all normal. This tumor existed in the retroperitoneal cavity and compressed the rectum. Later, complete tumor resection was performed by laparotomy. Histological study revealed the epithelium of this tumor consisted of only squamous cells without atypia, and the diagnosis of this tumor was retrorectal epidermoid cyst. Retrorectal epidermoid cyst is very rare, and difficult to diagnose before surgery. However, if we have-knowledge of developmental cysts, and by careful digital examination and image diagnosis, a differential diagnosis can be made

A NEW APPROACH TO THE PREVENTION OF VERTICAL TRANSMISSION OF HEPATITIS B VIRUS (HBV)-BASED ON THE NATURAL HISTORY OF HBV VERTICAL TRANSMISSION, NEONATAL IMMUNE RESPONSE AND COST-EFFECTIVENESS

B型肝炎ウイルス(HBV)母児感染による児キャリア化予防法としてhepatitis B immunoglobulin (HBIG), HB vaccine (Vaccine)併用療法が広く行われており,殆ど全ての施設で厚生省方式(HBIG 2回投与:生後1週以内,生後2カ月/Vaccine:生後2カ月開始,生後3, 5カ月追加接種)が採られている。1985年以来何ら改善が図られなかったのが実情であるが,児キャリア化予防を経済的且つ省力的に行うには少量の薬剤でより早期に児に能動免疫を獲得させるのが肝要である。本研究では1) HBV母児感染natural history (216例)における児自然能動免疫獲得時期,2) HBeAg陽性母の出生児(56例)における投与HBIGの有効期間,3) HBeAg陰性母の新生児(12例)におけるyeast vaccine接種効果,4) HBeAg陽性母の出生児(111例)における厚生省方式と千葉大方式(HBIG 1回投与および生後24時間内vaccine接種)の臨床比較について検討を行い,以下の成績を得た。HBIGは200IU/ml (107GS;ミドリ十字中央研究所,大阪)を筋注し,yeast vaccineは10μg/0.5ml (YHB;化学および血清療法研究所,熊本)を皮下注した。成績]1)キャリア母の児216名中25名(11.6%)が自然能動免疫にてHBsAbを獲得,そのうち4%が生後1カ月以内,20%が生後3カ月以内,76%が生後6カ月以内に既にHBsAb陽性であった。2) HBeAg陽性母の出生児に生後24時間以内にHBIGを投与し,その後3カ月(41例)および4カ月(15例)毎に追加投与を行い,18カ月間追跡調査をした。4カ月間隔群では26.7%がキャリア化したが,3カ月間隔群で僅か4.9%に抑えられた。3)生後24時間以内にYHB接種を受けたHBeAg陰性母の出生児12例において,33.3%が生後1カ月以内に,83.3%が生後3カ月以内にすでに能動免疫を獲得していた。以上の基礎的検討により新生児期にはすでに十分な免疫応答能があり,投与HBIGは少なくとも3カ月間

10ダイ シュッサン ジョセイ ノ ゲンジョウ ト カダイ : 10ダイ シュッサン ジョセイ ノ アンケート チョウサ カラノ ケントウ

10 代妊娠を「防ぐべきである」という視点ではなく,出産を目指す10 代妊婦に共感し,母性意識の発達を促し,セルフケアできるよう援助していくための方法を探索することを目的として,1998 年から10 年間に当センターで出産した10 代妊婦138 名を対象に承諾を得た85 名に対し,アンケート調査を実施した (回収率45.9%).妊娠時の心境としては妊娠を肯定的に受け止めていた者が76.9%であったが,出産時には92.3%と増加していた.現在の相談相手は母親,夫,友人であり,育児,金銭面の相談が主であったが,相談相手すらいない状況下,一人で育児を行っている者もいた.10 代での妊娠出産をよかったと71.8%が判断していたが,10 代出産のデメリットは経済的不安,知識の少なさが挙げられた.思春期には性行動,妊娠,出産そして育児など長いスタンスの知識提供と現況を把握理解した上での支援体制が必要と考える.In order to search for a method to assist development ofmotherhood consciousness instead of the standpoint to"prevent" the teenage pregnancy, we investigated thequestionnaires as to the present situation of the 85 deliveredwomen in our center between 1998 and 2007. This trialobtained 39 teenage mothers (45.9 %). The 30 women(76.9 %) accepted their pregnancy affirmatively when theyfound their pregnancy. In thirty-six cases (92.3 %) deliveredwith delight. The present main advisor about childrearingand economical worries was mother, husband andfriends. However some women take care of their childrenalone. The rate of breastfeeding was 81.6 % and the averageof breastfeeding duration was 4.4 months. Sixty-onepercents of adolescent mothers experienced a next pregnancy:80 % of these delivered a second child in spite ofthe anxiety for the future life in economic respects. Thirtythreepercents of women were planning to have anotherbaby in the future, 3 of them wished it within a year. Butonly 63.8 % of women have being using long-acting contraceptions.In 28 women( 71.8%) satisfied with the childbearingin the teens, but they listed economical worries and thelack of knowledge of pregnancy and childbearing as theteenage delivery. In conclusions, we need to spread theknowledge as to sexual behavior, gravidity, childbirth, nursingand long term childcare in puberty. It is necessary tosupport teenager by filling up the window with administration.Healthcare providers need more consideration thathow to support and understand the adolescent mothers

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

Murine CD4+ T Cell Responses Are Inhibited by Cytotoxic T Cell-Mediated Killing of Dendritic Cells and Are Restored by Antigen Transfer

Cytotoxic T lymphocytes (CTL) provide protection against pathogens and tumors. In addition, experiments in mouse models have shown that CTL can also kill antigen-presenting dendritic cells (DC), reducing their ability to activate primary and secondary CD8+ T cell responses. In contrast, the effects of CTL-mediated killing on CD4+ T cell responses have not been fully investigated. Here we use adoptive transfer of TCR transgenic T cells and DC immunization to show that specific CTL significantly inhibited CD4+ T cell proliferation induced by DC loaded with peptide or low concentrations of protein antigen. In contrast, CTL had little effect on CD4+ T cell proliferation induced by DC loaded with high protein concentrations or expressing antigen endogenously, even if these DC were efficiently killed and failed to accumulate in the lymph node (LN). Residual CD4+ T cell proliferation was due to the transfer of antigen from carrier DC to host APC, and predominantly involved skin DC populations. Importantly, the proliferating CD4+ T cells also developed into IFN-γ producing memory cells, a property normally requiring direct presentation by activated DC. Thus, CTL-mediated DC killing can inhibit CD4+ T cell proliferation, with the extent of inhibition being determined by the form and amount of antigen used to load DC. In the presence of high antigen concentrations, antigen transfer to host DC enables the generation of CD4+ T cell responses regardless of DC killing, and suggests mechanisms whereby CD4+ T cell responses can be amplified

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

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

TISSUE POLYPEPTIDE SPECIFIC ANTIGEN (TPS) AS A TUMOR MARKER FOR GYNECOLOGIC MALIGNANCIES : A COMPARATIVE STUDY WITH TISSUE POLYPEPTIDE ANTIGEN (TPA), CANCER ANTIGEN 125 (CA125) AND SQUAMOUS CELL CARCINOMA-ASSOCIATED ANTIGEN (SCC)

1957年共同研究者により各種腫瘍組織混合抽出液より精製されたtissue polypeptide antigen (TPA)はその後cytokeratins 8, 18, 19との交差反応が見られ,一種の細胞構築蛋白であることが判明している。最近Bjurk・lundはTPAをマウスに免疫しcytokeratinと交差しない単クローン抗体M3を得た。同抗体を使用して組み立てられたimmunoradiometrical assay (IRMA)を用いてspecific TPA (TPS)を各種婦人科癌患者血清にて測定し,従来のTPA, cancer antigen 125 (CA 125)およびsquamous cell carcinoma-associated antigen (SCC)と比較し,その臨床的有用性と限界を検討した。A new immunoradiometrical assay (IRMA) for a tissue polypeptide specific antigen (TPS) has recently been established using a monoclonal antibody (M 3) against purified tissue polypeptide antigen (TPA). With the use of this IRMA, we measured serum TPS levels in 68 patients with benign gynecologic diseases and in 71 patients with gynecologic malignancies before treatment. Eleven gynecological cancer patients who showed the positivity for TPS before the treatment were followed up by monitoring the serum TPS levels. Tissue polypeptide antigen (TPA), cancer antigen 125 (CA 125) or squamous cell carcinoma-associated antigen (SCC) were also measured in these patients. The present study first described the clinical usefulness and weakness of TPS as a tumor marker for gynecologic malignancies by making a comparison with TPA, CA 125 or SCC