Ketone Bodies in the Fetus and Newborn During Gestational Diabetes and Normal Delivery

Background: Authors successfully treated gestational diabetes by a very low carbohydrate diet without insulin and other drugs. Increased ketone bodies seemed to play an essential role in energy metabolism, and the fetus and newborn also showed hyperketosis. It is necessary to clarify how much ketone bodies were present in the placenta and umbilical cord in the fetus and newborn and the pregnant mother with or without gestational diabetes. Subjects and Methods: All cases were patients of Muneta OB/GYN Clinic in Chiba, where about 700 deliveries were done every year, 90% normal and 10% gestational diabetic. Blood of 313 mothers and babies at health check-up postpartum, 192 samples of placenta and cord blood at the delivery, and 122 cases were obtained at the time of miscarriage. Abbott's kit measured βHB, and 101 samples obtained at the post partem health check-up were biochemically analyzed for both βHB and glucose. The IBM-SPSS did the statistical analysis. Results: βHB in Mothers' and newborns' blood at four days postpartum was 0.062 and 0.244 mmole/L (median), respectively, and glucose was 4.55±0.81 mmole/L. βHB was high throughout the pregnancy; In the placenta, βHB in the first-, second-and-third trimester was 1.95±0.9 mmole/L, 2.82±0.49 mmole/L, 1.87±0,65 mM/L, respectively. In the cord blood, it was 2.3±1.13 mmole/L, 1.36±0.76 mmole/L, and 0.69±0.6 mmole/L, respectively. Placental βHB at the delivery was 1.99±0.78 mmole/L, and that of the umbilical cord was 0.75±0.36 mmole/L. In the first trimester miscarriage, βHB in spontaneous abortion was 1.84±0.85 mmole/L, while it was 2.09±0.94 mmole/L in artificial abortion. Aborted cases in the second trimester showed 1.96±0.38 mmole/L βHB and 3.74±0.75 mmole/L glucose in the cerebrospinal fluid. Discussion: Our data showed βHB and glucose concentration in the human fetus and newborn under the normal physiological condition. βHB was present in the placenta and umbilical cord blood throughout fetal life and after birth. Different concentrations between the placenta and umbilical cord blood suggested the fetus's uptake for energy and intrauterine growth. High βHB in the cerebrospinal fluid suggested the effects on neuronal development

Ketone Bodies Elevation in Placenta, Umbilical Cord, Newborn and Mother

Background: Low carbohydrate diets (LCD) have been recently prevalent in the medical and health field, especially in diabetes mellitus. We have applied LCD on thousands of patients with metabolic diseases and reported the clinical effect of LCD so far. Through our experience and research concerning LCD, the physiological role of glucose and ketone bodies during the pre- and post-partum period was investigated in this study. Subjects and methods: Subjects were 60 normal pregnant woman who had a normal delivery in full-term, without an abnormal glucose intolerance. Methods included the measurement of the value of ketone bodies in the umbilical cord blood, placental tissue fluid and maternal blood, associated with the value of blood glucose. As ketone bodies, the value of 3-hydroxybutyric acid (3-OHBA, beta-hydroxybutyric acid) was measured. 3-OHBA and glucose values were measured by the electrode method using Precision Exceed Kit (Abbott) and the conventional enzymatic cycling method, with comparison investigation of the data from two kits. Results: The average 3-OHBA levels were as follows: 2,235.0 μmol/L in the placenta, 779.2 μmol/L in the umbilical cord blood, in which the former is significantly higher than the latter (p < 0.001), 240.4μmol/L in the newborn after four days, and 366.7μmol/L after 30 days. The standard 3-OHBA level in a healthy man is less than 85 μmol/L. Glucose levels in the umbilical cord and placenta were 78.6 mg/dL vs 74.9 mg/dL, with no significant difference, and was the same as that of the pregnant woman. Accuracy management of the two kits revealed a significant correlation (r = 0.94, p < 0.001). 3-OHBA values of the maternal blood and umbilical cord blood were extremely elevated from the standard level, with a mutual significant correlation (r = 0.724, p < 0.001, n = 416). Conclusion: This clinical study concerning ketone bodies during pre- and post-partum period was investigated, and revealed that 1) a clinically rapid useful kit for ketone bodies had high reliability and validity compared with conventional kit, 2) elevated values of 3-OHBA were shown in the placental tissue fluid, umbilical cord, newborn and maternal blood, 3) 3-OHBA would be a physiologically indispensable element in nutrition metabolism for fetus and newborn at least until 30 days, with further development of investigation for ketone bodies

A case of early gastric cancer with difficulty in achieving hemostasis after endoscopic submucosal dissection

　症例は80歳代，男性．貧血の精査目的で当科受診し，上部消化管内視鏡検査で前庭部小弯に早期胃癌を認めた．内視鏡的粘膜下層剥離術（ESD）を施行し，治癒切除であった．その後，ESD 後潰瘍からの出血を繰り返し，内視鏡的止血術を計９回，経カテーテル的動脈塞栓術を計３回行った．潰瘍からの再出血予防のためポリグリコール酸シート（以下 PGA シート）とフィブリン糊を貼付した．その後は出血なく潰瘍の上皮化を確認した．PGA シートとフィブリン糊を用いた内視鏡的粘膜欠損被覆法は，ESD の後出血予防における有用性に関していくつかの報告がされており，出血リスクが高いと思われる症例に関しては PGA シートによる被覆法を検討する必要がある．　The patient was a man in his 80s. He was referred to our department for anemia. He was diagnosed with early gastric cancer in the lesser curvature of the antrum confirmed by upper gastrointestinal endoscopy and underwent endoscopic submucosal dissection (ESD). Histopathological examination was curative resection. Afterward, recurrent bleeding from an ulcer led to endoscopic hemostasis nine times and transcatheter arterial embolization three times. We covered the base of the ulcer with a polyglycolic acid sheet and fibrin tissue adhesive to prevent bleeding. Subsequently, he passed without rebleeding, and the ulcer became epithelial. There have been some reports on the effectiveness of covering an ulcer with a polyglycolic acid sheet and fibrin tissue adhesive. We may consider using polyglycolic acid sheets for patients with hemorrhage high risk for post-ESD bleeding