[Menopausal syndrome].
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Autonomic Nervous System Diseases↗
Biomedical subjects
Hiroaki Ohta
Publications and source records attributed to Hiroaki Ohta.
Peripheral arterial thrombosis induced by chemotherapy in ovarian carcinoma coexisted with endometrial carcinoma.
INTRODUCTION: Most patients with peripheral arterial occlusion have underlying atherosclerosis. Peripheral arterial thrombosis induced by chemotherapy in gynecological malignancies is rare. CASE REPORT: A 60-year-old woman was diagnosed with ovarian carcinoma coexisting with endometrial carcinoma after surgical histopathological examination. Chemotherapy was started on postoperative day 11. On day 2 of chemotherapy, she developed bilateral lower extremity cyanosis. Thrombocytopenia due to chemotherapy was diagnosed and treated with repeated platelet transfusions. Anticoagulant therapy was also continued. However, the patient worsened steadily and died of liver dysfunction due to multiple liver metastases. CONCLUSION: Although arterial thrombosis induced by chemotherapy is rare, it is important for physicians to consider this possibility in the course of treatment with cytotoxic agents because this complication has serious health implications.
Adenocarcinoma↗
Efficacy and tolerability of once-weekly administration of 17.5 mg risedronate in Japanese patients with involutional osteoporosis: a comparison with 2.5-mg once-daily dosage regimen.
In this multicenter, randomized, double-blind controlled trial, the efficacy and safety of once-weekly dosing with 17.5 mg risedronate was compared with once-daily dosing with 2.5 mg risedronate in Japanese patients with involutional osteoporosis. A total of 496 patients were randomized to receive either once-weekly (n = 249) or once-daily (n = 247) treatment. All patients were supplemented with 200 mg/day calcium. Following 48 weeks of treatment, the mean (+/-SD) percent changes, from baseline, in the bone mineral density of the lumbar spine (L2-L4 BMD) in the once-weekly and once-daily treatment groups were 5.36 +/- 4.27% and 5.87 +/- 4.47%, respectively. The difference between the groups was -0.5% (95% confidence interval: -1.35% to 0.35%), demonstrating that the effect on BMD of once-weekly treatment was not inferior to that of once-daily treatment. The time-course reductions in biochemical markers of bone resorption (urinary N- and C-telopeptide of type I collagen) and bone formation (bone-specific alkaline phosphatase) were similar for the two dosing regimens. There were no differences in the incidence of new vertebral fractures or the worsening of existing fractures between the once-weekly (2.2%) and once-daily (2.7%) dosing regimens. No significant differences were observed between the two dosing regimens in the incidence or the type of adverse events. However, 10.1% of the patients in the once-daily group withdrew due to adverse events as compared to 5.2% in the once-weekly group. Moreover, drug-related adverse events, including upper gastrointestinal disorders and abnormal changes in laboratory parameters, tended to be less in the once-weekly dosing regimen than in the once-daily dosing regimen. In conclusion, once-weekly oral dosing with 17.5 mg risedronate was well tolerated in Japanese osteoporotic patients, and showed equivalent efficacy to once-daily oral dosing with 2.5 mg risedronate. This once-weekly regimen is expected to provide a more convenient therapeutic option as an alternative to daily dosing and to enhance patient compliance in long-term therapy for osteoporosis.
Aged↗
[Effect of raloxifene as a SERM on bone metabolism].
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Bone Density↗
[Bone and bone related biochemical examinations. Bone and collagen related metabolites. Bone-specific alkaline phosphatase].
Research has long been conducted to elucidate the association between bone and alkaline phosphatase (ALP). ALP-labeled monoclonal antibodies developed in recent years represent a significant advance in the evaluation of bone quality by making bone-specific ALP (BAP) available for standard quantitative measurement. While BAP yields variable results depending on the assay used, the enzyme immunoassay (EIA) or immunoradiometric assay (IRMA), it has enabled the risk of fracture, as well as the efficacy of pharmacological intervention, to be predicted to a certain degree, through evaluation of a parameter other than bone mass. In this regard, BAP is assumed not only to reflect bone strength, but also to serve as an index for bone quality, quite apart from bone mass. Thus, quantitative measurement of BAP currently represents the most effective means available for clinical evaluation of bone quality.
Adult↗
[Evaluation of therapeutic intervention on bone mass and turnover through monitoring of biochemical markers of bone turnover].
Monitoring of biochemical markers of bone turnover has brought about a number of breakthroughs in the area of osteoporosis management. Of these, the following three are of particular interest: 1) monitoring of these biochemical markers represents the only clinical means available for assessment of bone quality: 2) it helps grasp the patient's condition, as well as predicts the patient's risk for developing fractures: and 3) it allows the effect of therapeutic intervention to be evaluated at an earlier stage than bone mineral density. Thus, monitoring of these biochemical markers not only helps strengthen motivation among healthcare professionals for osteoporosis treatment, but also helps enhance patient compliance to treatment.
Alkaline Phosphatase↗
Risk factors of preterm delivery at less than 35 weeks in patients with renal transplant.
BACKGROUND: To identify prenatal events associated with preterm delivery at less than 35 weeks of gestation in women with renal transplant. METHODS: A case-control study of 53 pregnancies in 42 renal transplant recipients, at a single center from 1984 to 2003 was analyzed. Preterm delivery cases (n=23) at less than 35 weeks of gestation were compared with the controls (n=30). RESULTS: Preterm delivery at less than 35 weeks of gestation occurred in 23 cases (43.4%). Hypertension (> or =140/90 mmHg) prior to pregnancy (odds ratio (OR) 6.3, 95% confidence interval (CI) 1.0-38.6), proteinuria (> or =0.3g/day) prior to delivery (OR 11.7, CI 2.7-51.8) and serum creatinine (> or =1.5mg/dl) prior to delivery (OR 4.4, CI 1.0-19.5) were significantly associated with increased risk of preterm delivery. Perinatal or neonatal deaths were not found. Fetal anomaly was seen in one case (polydactyly), and periventricular leukomalacia was found in two cases. CONCLUSION: In this case-control study, hypertension prior to pregnancy, proteinuria and serum creatinine (> or =1.5mg/dl) prior to delivery were related to the occurrence of preterm delivery at less than 35 weeks in renal transplant pregnancies.
Adult↗
Serum ionized magnesium during magnesium sulfate administration for preterm labor and preeclampsia.
OBJECTIVE: The purpose of this study is to estimate the relations between ionized and total Mg levels during MgSO4 administration in patients with preterm labor and preeclampsia. METHODS: Forty-three pregnant patients who were candidates for MgSO4 were studied (preterm labor, 27; preeclampsia, 16). The administration method was intravenous injection of MgSO4 4 g over 30 min followed by 1-2 g/h. Ionized Mg was measured by the selective ion electrode method at bedside, and compared it with total Mg levels. RESULTS: Significant correlation was existed between levels of ionized and total Mg throughout therapy for both preterm labor (ionized Mg=0.19 x total Mg+0.19; r=0.61, p<0.001) and preeclampsia (ionized Mg=0.20 x total Mg+0.14; r=0.60, p<0.001). CONCLUSION: There are correlations between ionized and total Mg levels during administration of MgSO4 for both preterm labor and preeclampsia.
Female↗
Sister Joseph umbilical nodule coexisting with endometriosis from endometrial carcinoma.
A 58-year-old woman was diagnosed with endometrial carcinoma. Total hysterectomy, bilateral salpingo-oophorectomy and paraaortic and a pelvic lymph node dissection were performed. The cytology of peritoneal fluid was negative. There was no peritoneal dissemination except umbilical nodule. A peritoneal 2.0x1.5 cm umbilical nodule was also resected. The nodule was identified as a metastasis from endometrial cancer with endometriosis. The pelvic lymph nodes also showed metastatic lesion with endometriosis. Our case showed that endometriosis coexisted with umbilical and pelvic lymph nodal metastatic lesions from endometrial cancer. This fact suggests that the mode of metastasis to the umbilicus via lymph flow from endometrial cancer is the same as that for endometriosis.
Adenocarcinoma↗
Prognosis in cervical insufficiency at less than 32 weeks of gestation.
OBJECTIVE: To identify prenatal events associated with adverse outcome in babies at less than 32 weeks of gestation in cases of cervical insufficiency and preterm labor (PTL)/premature rupture of the membranes (PROM). STUDY DESIGN: A case-control study was performed using a logistic regression model at 17 tertiary hospitals in Japan. Adverse outcome was defined as neonatal death or abnormal cerebral ultrasound scans (intraventricular hemorrhage [IVH] and periventricular leukomalacia [PVL]) prior to discharge from hospital. RESULTS: Data were analyzed for 307 cases (74 for cervical insufficiency and 233 for PTL/PROM). Neonatal death and IVH/PVL were noted in 25 and 29 cases, respectively. A significant association of cervical insufficiency (odds ratio (OR) 1.32, 95% confidence interval (CI) 1.02-1.68), gestational age at delivery (<26 weeks) (OR 4.64, 95% CI 1.73-12.44), and Apgar score <7 at 5 min (OR 3.3, 95% CI 1.42-7.64) with combined neonatal death or IVH and PVL was found in a logistic regression model that controlled for in utero transportation, gestational age on admission, clinical chorioamnionitis, and histopathologic chorioamnionitis. CONCLUSION: Cervical insufficiency is a significant factor related to the occurrence of adverse outcome.
Case-Control Studies↗
Guidelines for the use of biochemical markers of bone turnover in osteoporosis (2004).
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Biomarkers↗
Long-term effects on bone mineral density and bone metabolism of 6 months' treatment with gonadotropin-releasing hormone analogues in Japanese women: comparison of buserelin acetate with leuprolide acetate.
Our objective was to assess the effects of 6 months' treatment with two types of gonadotropin-releasing hormone (GnRH) analogues on lumbar bone mineral density (BMD) and bone metabolism. We studied 27 women who had been given a diagnosis of endometriosis or uterine myoma. The subjects received drug therapy for 6 months and were subsequently followed up for 1 year. The BMD of the lumbar spine (L2, L3, L4) was measured by dual energy X-ray absorptiometry four times: at baseline, after 6 months, after 12 months, and after 18 months. The serum concentrations of sex steroids and bone metabolic markers were measured at the same times as BMD. Compared with the baseline value, the mean decrease in the buserelin group L2-4 BMD was 3.7% at 6 months, 1.7% at 12 months, and 0.4% at 18 months. In the leuprolide group, L2-4 BMD decreased respectively by 5.1%, 6.2%, and 4.3%. Serum concentrations of calcium increased significantly after 6 months of treatment (P < 0.05) and returned to the baseline level at 12 months in both groups. In the leuprolide group, the intact osteocalcin concentration after 6 months was significantly higher than the baseline value, and after 12 months, it decreased to the baseline level. Our results indicate that the effect on BMD of 6 months' treatment with GnRH analogues virtually resolves by 1 year after treatment, provided that drugs affecting bone metabolism are not given during this period.
Absorptiometry, Photon↗
Placenta previa totalis complicated with pulmonary embolism during cesarean section: a case report.
Venous thromboembolism is believed to be rare in Japan, whereas increases in occurrence of pulmonary embolism have been drawing attention because it has become the most common cause of maternal death in recent years. A 36-year-old woman at 33 weeks of pregnancy was transferred to our hospital because of placenta previa totalis and treated with emergency cesarean section on the same day. Soon after the delivery of the fetus, the patient developed pulmonary embolism. The condition of pulmonary embolism was suspected when abnormal values were noted in respiratory and circulatory parameters and then confirmed by intraoperative transesophageal echocardiography, which revealed a thrombus in the right atrium. Anticoagulant treatment with unfractionated heparin started during the operation caused a tendency to bleed during and after the operation, and subsequently required a second laparotomy to control bleeding. After insertion of an inferior vena cava filter, a third laparotomy was performed to remove a giant hematoma. Heparin discontinuation intended to decrease the tendency to bleed was followed by two recurrences of pulmonary embolism, resulting in a dangerous condition. Despite these difficult complications, our interventions successfully saved the patient's life and restored her health. We report changes observed in her conditions along with treatment and management we provided, and describe the specificity of pulmonary embolism occurring during the operation.
Adult↗
Stillborn baby with partial monosomy of the short arm of chromosome 5 and partial trisomy of the short arm of chromosome 20.
A stillborn baby with multiple malformations, including cardiac defects and cerebellar hypoplasia, is described. The abnormal features were ascribed to an unbalanced chromosome translocation, resulting in a partial deletion of the short arm of chromosome 5 and a partial trisomy of the short arm of chromosome 20. A parental balanced translocation t(5; 20)(p13.3; p11.23) was identified. The present case is the first case in Japan of monosomy of the short arm of chromosome 5 and trisomy of the short arm of chromosome 20.
Abnormalities, Multiple↗
[SERMs: an update for clinicians].
With the successful manipulation by molecular pharmacological technology of the estrogenic properties of selective estrogen receptor modulators (SERMs) that are highly organ- and tissue-specific, SERMs have now become available for the management of osteoporosis, as they did for breast cancer earlier. This presentation focuses on raloxifene (RLX), a second-generation SERM and an agent of interest to clinicians engaged in the management of osteoporosis on a day-to-day basis. RLX is a unique agent, in that it exhibits similar but distinct effects on bone metabolism from those of estrogen. RLX also appears to exert milder inhibitory effects on bone resorption than bisphosphonates (BPs), another class of antiresorptive agents, while ample evidence suggests that RLX compares favorably with BPs in preventing a variety of non-traumatic fractures.
Animals↗
[Raloxifene and bone quality issues].
With advances in clinical research in osteoporosis management, there has occurred a shift in therapeutic endpoints in osteoporosis from enhancement of BMD (bone mineral density) to prevention of bone fractures. Of note in this connection is the observation that fluoride therapy was associated with significant increases in BMD but was not preventive of bone fractures;on the other hand, raloxifene, while not as effective as bisphosphonate in increasing BMD, was preventive of bone fractures to a degree comparable to bisphosphonate therapy. This finding suggested that there should be more factors implicated in preventing bone fractures than increasing BMD, pointing to the importance of bone quality, as had been speculated in earlier studies. Thus, raloxifene has contributed in no small way towards advancing osteoporosis management. But in the same breath, the issue of bone quality still remains to be further explored, and further advances in both basic and clinical research are required to elucidate what it is that constitutes bone quality, as well as to establish a methodology for the assessment of bone quality.
Bone Density↗
Suppression by 17beta-estradiol of monocyte adhesion to vascular endothelial cells is mediated by estrogen receptors.
Several observational studies have shown that estrogen replacement therapy decreases cardiovascular mortality and morbidity in postmenopausal women. However, The Women's Health Initiative (WHI) study has found that women receiving estrogen plus progestin had a significantly higher risk of breast cancer, coronary heart disease, stroke, and pulmonary embolus. In the present study, we examined whether estrogen prevents mechanisms that relate to plaque formation by inhibiting monocyte adhesion to endothelial cells. ECV304 cells, an endothelial cell line that normally expresses minimal estrogen receptor (ER)alpha, were transfected with an ERalpha expression plasmid. Treatment with tumor necrosis factor (TNF)-alpha increased expression of vascular cell adhesion molecule (VCAM)-1 mRNA, activation of nuclear factor-kappaB (NF-kappaB), and U937 cell adhesion in ECV304 cells. These effects of TNF-alpha were not significantly inhibited by pretreatment of native ECV304 cells with 17beta-estradiol (E(2)). In ECV304 cells overexpressing ERalpha, E(2) significantly inhibited the effects of TNF-alpha on NF-kappaB activation, VCAM-1 expression, and U937 cell adhesion. These findings suggest E(2) suppresses inflammatory cell adhesion to vascular endothelial cells that possess functional estrogen receptors. The mechanism of suppression may involve inhibition of NF-kappaB-mediated up-regulation of VCAM-1 expression induced by atherogenic stimuli. E(2) may prevent plaque formation, as first stage of atheroscrelosis through inhibiting adhesion monocytes to endothelial cell. Actions of estrogen replacement therapy can be assessed in terms of densities of functional ERalpha.
Cell Adhesion↗
Detection of specific antibodies against deflagellated Salmonella Enteritidis and S. Enteritidis FliC-specific 9kDa polypeptide.
Specific antibody levels of laying hens and young chickens experimentally infected with Salmonella Enteritidis and vaccinated farm flocks were evaluated by enzyme-linked immunosorbent assays (ELISAs) with two different antigens, deflagellated S. Enteritidis whole cell (DEWC) and S. Enteritidis FliC-specific 9kDa polypeptide (SEP9). Infected laying hens excreted S. Enteritidis throughout the experimental period, and the specific antibody titers in DEWC-ELISA, were significantly higher than the uninfected group. It suggests that this DEWC-specific antibody will serve as an effective indicator of S. Enteritidis infection, especially for non-vaccinated laying flocks. SEP9-specific antibodies were detected in spray-inoculated young chickens but not in oral-inoculated young chickens. Compared with greatly high SEP9-specific antibody levels of vaccinated farm flocks, no response was observed in orally infected hens. These results indicate that S. Enteritidis discontinues expressing SEP9 once it has crossed the intestinal barrier, and that SEP9-ELISA will serve as a valuable monitoring tool for the status of S. Enteritidis vaccination on a flockwide basis, independent of stable S. Enteritidis infections.
Animals↗