記述言語：日本語   出版者・発行元：日本エンドメトリオーシス学会  

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

【目的】子宮筋腫の内分泌療法においてはGnRHアゴニストが用いられてきたが,フレアアップに伴う出血のリスクから粘膜下子宮筋腫に対しては慎重投与となっている.一方GnRHアンタゴニストはフレアアップを回避できるため,粘膜下子宮筋腫に対して比較的安全に使用可能である.そこで今回,粘膜下子宮筋腫に対する術前内分泌療法として,当院でGnRHアンタゴニストを使用した症例を後方視的に解析し,その安全性および有用性を検討した.【方法】症例は2019年4月から2022年5月まで当院にて術前にGnRHアンタゴニストを2ヵ月から6ヵ月投与した粘膜下子宮筋腫36症例であり,MRIまたは超音波断層画像によって筋腫サイズを評価し,外来にて定期的に貧血や副作用の有無を確認した.粘膜下子宮筋腫に対する手術方法は,子宮温存希望の有無,子宮筋腫の大きさや個数,既往手術の有無,患者Body Mass Indexなどを総合的に判断して決定した.【成績】対象群の平均年齢は40.8歳,平均経産回数は0.9回であった.全症例のうち1例で出血の増加による術前治療の中断を認めたが,その他の症例では大きな有害事象を認めず予定手術まで管理することができた.手術術式は,腹式単純子宮全摘術が5例,腹腔鏡下子宮全摘術が13例,腹腔鏡下筋腫核出術が7例,子宮鏡下筋腫核出術が11例(うち4例で粘膜下子宮筋腫以外の子宮筋腫を腹腔鏡下で核出)であった.【結論】今回の検討では,粘膜下子宮筋腫に対してGnRHアンタゴニストを使用し,危機的出血を認めることなく手術まで管理することが可能であり,さらに貧血の改善および腫瘍の縮小を認めた.粘膜下子宮筋腫に対する術前GnRHアンタゴニスト投与は比較的安全で有用であると考えられた.(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

腸管子宮内膜症の診断は大腸内視鏡,注腸造影,MRIゼリー法などの侵襲的検査を要する.今回,内診と経腟超音波検査のみで行う子宮内膜症評価法であるNMS-E(Numerical Multi-scoring System of Endometriosis)を用いて非侵襲的に腸管子宮内膜症を診断した1例を報告する.症例は35歳,0妊0産.月経困難症,性交痛,排便痛があり,月経時の血便が出現したため,腸管子宮内膜症が疑われ紹介となった.NMS-Eに基づいた経腟超音波検査により,子宮後面に癒着したstone ring様の像を腸管子宮内膜症性病変として特定した.腹腔鏡下卵巣嚢腫摘出術,深部病変切除術,腸管切除術を行った結果,癒着および深部病変は術前評価と同様であり病理学的にも子宮内膜症性病変として矛盾はなかった.NMS-Eが腸管子宮内膜症の診断手段になりうると示唆された.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.

DOI： 10.3390/diagnostics13101774

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Accurate diagnosis of retroflexed uterus in daily practice is essential because this condition is related to pelvic pain and deep endometriosis. Uterine flexion can be measured by transvaginal ultrasonography (TVUS), a cost-effective primary test, but the accuracy required for diagnosing retroflexed uterus is unclear. This study assessed the accuracy of TVUS for diagnosis of retroflexed uterus in patients with endometriosis and compared it with that of magnetic resonance imaging (MRI) -the gold standard for measuring the uterine axis. METHODS: The study included 123 patients who underwent endometriosis surgery in our department between 2012 and 2017. Uterine flexion angles were measured by retrospectively examining TVUS and MRI images, and the correlation was analyzed. Analysis of anteverted and retroverted uterine subgroups identified aspects of diagnosing uterine flexion with TVUS. RESULTS: Uterine flexion angles on TVUS were strongly positively correlated (r = 0.86) with MRI results. Additionally, TVUS yielded no false-positive diagnoses and 28 false-negative diagnoses of retroflexion. All false-negative diagnoses occurred in patients with anteverted retroflexed uteruses. CONCLUSIONS: TVUS was generally accurate for measuring uterine flexion angle, as indicated by its strong correlation with MRI. Misdiagnosis of anteverted retroflexed uterus was a limitation of using TVUS for retroflexion diagnosis.

DOI： 10.1272/jnms.JNMS.2023_90-106

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. MATERIALS AND METHODS: We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. RESULTS: Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. CONCLUSION: We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.

DOI： 10.4103/gmit.gmit_36_22

PubMed

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

腟から腹腔内に貫通して発育し、腹腔鏡下に病変を完全摘出し得たpolypoid endometriosisの1例を経験したため報告する。症例は37歳、0妊0産。29歳時に不正性器出血と月経痛などの疼痛症状を主訴に当院受診。子宮内膜症と診断し、ノルエチステロン・エチニルエストラジオールの内服を開始。30歳時に後腟円蓋から発生する腟内のポリープを認め、切除術を施行したが、再発・増大を繰り返した。36歳時に腟内のポリープの増大と8cm大の腹腔内腫瘤を認めた。精査の上、悪性は否定的とし、腹腔鏡手術を施行。手術所見では、直腸腟中隔にポリープを認め、腟壁を貫通し後腟円蓋のポリープと連続していたため、一塊として病変を摘出し得た。病理診断はpolypoid endometriosisであった。文献的考察を加えると、polypoid endometriosisの好発部位は子宮内膜症の好発部位と一致する可能性が推察された。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

著者等は腹腔鏡下卵巣嚢腫摘出術の際に嚢腫の内容物漏出を防ぐため、細径腹腔鏡システムにバスタブ法を併用している。バスタブ法は、ダグラス窩のポートからENDOPOUCHを挿入し、ENDOPOUCH内に嚢腫を留置して内容物が漏出しない状態で嚢腫摘出を行い、ダグラス窩から嚢腫を回収する。本法は、手術操作スペースと小骨盤腔の腹膜をENDOPOUCHで遮断できるため、嚢腫内容物が漏出してもENDOPOUCHが受け止め、骨盤腔への拡散を防ぐことができる。今回、本術式により皮様嚢腫摘出を行い、併存していたparasitic myomaも同時に同様の方法で摘出しえた症例(32歳)を報告した。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02563&link_issn=&doc_id=20230206480020&doc_link_id=10.5180%2Fjsgoe.38.2_113&url=https%3A%2F%2Fdoi.org%2F10.5180%2Fjsgoe.38.2_113&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

掲載種別：研究論文（学術雑誌）   出版者・発行元：Medknow  

DOI： 10.4103/gmit.gmit_12_20

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

子宮内膜症は、子宮内膜腺・間質組織が子宮内膜以外の部位で増殖する疾患である。なかでも腸管子宮内膜症は、消化器外科との連携がより重要となる疾患である。今回われわれは2011年1月1日から2019年8月31日までの間に当院にて消化器外科と連携し、8例の腸管子宮内膜症の手術症例を経験したので報告する。5例(62.5%)に血便やイレウスなどの消化器症状を認めたが、3例(37.5%)は認めなかった。疼痛症状は全症例に認めた。子宮内膜症の症例において、慢性骨盤痛や排便痛、性交痛など強い疼痛を認める場合には、消化器症状が随伴せずとも腸管子宮内膜症も念頭におく必要がある。精査においては消化器科と相談し内視鏡検査や注腸造影検査も検討する。さらに手術提示の際には腸管切除の可能性も含めた拡大的なインフォームドコンセントが重要となり、他科との十分な連携が不可欠であると改めて認識した。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

14歳9ヵ月。月経困難症状の増悪を主訴とした。7歳時に右腎臓無形成を指摘された。経直腸超音波断層法、骨盤部MRI各所見および月経モリミナ症状を有することより、完全閉塞型OHVIRA症候群の疑い、右卵巣子宮内膜症嚢胞と診断した。手術待機期間中、疼痛症状緩和および逆流血減少目的に低用量エストロゲン・プロゲスチン(LEP)配合薬を投与していたが腹膜炎を発症した。緊急腹腔鏡下で右卵巣嚢胞摘出術、右側子宮亜全摘術を行った。病理所見より、卵巣嚢胞は子宮内膜症性嚢胞と診断した。術後、炎症反応は改善、術後1ヵ月に月経が発来し月経困難症状は認めない。本症例はOHVIRA症候群のAcien分類Type5の亜型で、右側子宮の流出路障害により右側子宮留膿腫および右側卵管留膿腫が出現し、腹膜炎をきたしたと考えられた。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02563&link_issn=&doc_id=20210204570010&doc_link_id=%2Fcj7sanai%2F2020%2F003602%2F010%2F0153-0157%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcj7sanai%2F2020%2F003602%2F010%2F0153-0157%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語  

We report a rare case of an ovarian steroid cell tumor with a diagnosis prompted by heart failure symptoms. A 28-year-old Japanese nulligravida/nullipara with a chief complaint of respiratory discomfort during physical exertion and exhibiting heart failure symptoms was referred to our hospital. She also had signs of virilization, including secondary menorrhea since the age of 20, hirsutism and balding. Cushing's syndrome was suspected, and further examinations showed hypertestosteronemia and right ovarian tumor. Symptomatic treatment for heart failure with diuretics and antihypertensives was followed by abdominal right adnexectomy performed due to the androgen-producing ovarian tumor. The tumor was solid and larger than a fist, and confirmed as a steroid cell tumor through postoperative histopathology. Serum total testosterone levels normalized at day 3 postoperatively, and menstruation resumed 2 months later. Our case was diagnosed due to heart failure symptoms, and its treatment resulted in improvement in virilization signs.

DOI： 10.1111/jog.14339

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. METHODS: In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. RESULTS: Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). CONCLUSION: Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

DOI： 10.1111/jog.14191

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：日本エンドメトリオーシス学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

腹腔鏡下子宮筋腫核出術(Laparoscopic myomectomy;LM)は開腹手術に比べ術後疼痛の軽減や入院日数の減少などが期待できる低侵襲な手術であるが,時として多量の出血や手術時間の延長を経験することがある.今回,LMの出血量や手術時間を術前に予測するため,それらに影響を与える因子を解析し,よりリスクが低いLMを施行するための条件を検討した.2015年1月から2017年7月までの間に当科で行なったLM 102例のうち,最大筋腫が漿膜下筋腫の症例では有意に単位時間当たりの出血量が減少するため,漿膜下筋腫の症例を除外した計84例のLMを対象とした.解析の結果,出血量の増加に影響を与える因子は手術時間,最大筋腫直径であった.一方,手術時間に影響を与える因子は筋腫個数であった.したがって,LMにおいて出血量に影響を与える因子は最大筋腫直径,手術時間に影響を与える因子は筋腫個数であることが分かった.出血量400mlを基準としてROC曲線を引くと最大筋腫直径が62mm,また時間を介して筋腫個数3.5個がカットオフポイントになることが判明した.これらは術前に分かる指標となり,この条件に合う症例がより安全なLMを行うための,とりわけ認定医を持たない医師が執刀する良い適応となると考えられた.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated. There was no evidence of recurrence or reoperation in either group for the apical vaginal compartment. Regarding recurrence within the anterior vaginal compartment, there were no significant between-group differences in either of the two randomized controlled trials targeting vaginal vault prolapse. In contrast, in the randomized controlled trial targeting POP including cases with uteruses, there were more recurrent POP with grade II or more in the LSC group than in the ASC group (11/60 [18.3%] vs 1/60 [1.6%], P = 0.004). Reoperation for the posterior vaginal compartment was performed in three cases (2.5%) in the LSC group and in one case (0.8%) in the ASC group. The combined repeat surgery and mesh removal surgery rate was higher in the LSC group (8/119 [6.7%]) than in the ASC group (2/121 [1.7%], P = 0.049). LSC has an excellent therapeutic effect and is comparable to ASC for the treatment of apical prolapse. However, cystocele recurrence, repeat surgery of the posterior compartment, and mesh-related complications were more frequent in patients who had undergone LSC.

DOI： 10.1111/ases.12478

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gmit.2017.02.001

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The major effector cells for cellular adaptive immunity are CD8(+) cytotoxic T lymphocytes (CTLs), which can recognize and kill virus-infected cells and tumor cells. Although CTLs exhibit strong cytolytic activity against target cells in vitro, a number of studies have demonstrated that their function is often impaired within tumors. Nevertheless, CTLs can regain their cytotoxic ability after escaping from the tumor environment, suggesting that the milieu created by tumors may affect the function of CTLs. As for the tumor environment, the patho-physiological situation present in vivo has been shown to differ from in vitro experimental conditions. In particular, low pH and hypoxia are the most important microenvironmental factors within growing tumors. In the present study, to determine the effect of these factors on CTL function in vivo, we examined the cytolytic activity of CTLs against their targets using murine CTL lines and the induction of these cells from memory cells under low pH or hypoxic conditions using antigen-primed spleen cells. The results indicated that both cytotoxic activity and the induction of functional CTLs were markedly inhibited under low pH. In contrast, in hypoxic conditions, although cytotoxic activity was almost unchanged, the induction of CTLs in vitro showed a slight enhancement, which was completely abrogated in low pH conditions. Therefore, antigen-specific CTL functions may be more vulnerable to low pH than to the oxygen concentration in vivo. The findings shown here provide new therapeutic approaches for controlling tumor growth by retaining CTL cytotoxicity through the maintenance of higher pH conditions.

DOI： 10.1016/j.imlet.2015.07.003

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

AimThe aim of this study was to assess the cut-off age of the risk factors for postoperative recurrence of ovarian endometriomas and to evaluate the end-points of follow-up after laparoscopic excision of ovarian endometriomas.
Material and MethodsWe retrospectively reviewed 167 patients who underwent laparoscopic excision of ovarian endometriomas at our hospital between 2000 and 2009, and followed up the patients until 2010. Following surgery, patients chose to receive gonadotrophin-releasing hormone agonist, oral contraceptive pills (OCP), dienogest, or no medication and underwent regular ultrasonographic examinations. Potential risk factors for recurrence, including age at surgery, were assessed in the patients receiving no medication. Postoperative recurrence, defined as re-appearance of an ovarian endometrioma&gt;2cm in size, was assessed for each treatment group.
ResultsAge at surgery was the only significant risk factor for recurrence, at a cut-off of 32 years, obtained through receiver-operator curve analysis. In patients not receiving medication, the recurrence rate gradually increased up to 50% over 5 years; there was no recurrence 5 years after surgery. Although no recurrence was seen in patients during continuous treatment with OCP or dienogest, the disease recurred in 55.5% of patients after discontinuing OCP.
ConclusionsAlthough adjuvant therapy for all patients may represent overtreatment, the findings of the present study suggest that, in the interest of fertility preservation, continuous postoperative hormonal treatment should be administered, at least to patients younger than 32 years. In patients who decline hormonal treatment, we recommend that they undergo follow-up for recurrence until 5 years after surgery.

DOI： 10.1111/jog.12164

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.

DOI： 10.1111/ases.12041

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect.

DOI： 10.1111/j.1447-0756.2012.01987.x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Minimally invasive surgery is widely used in gynecology. Women who seek a cosmetic advantage (i.e., concealed scars) choose minimally invasive surgery. Although laparoendoscopic single-site surgery could be an ideal solution, some of our patients have had cosmetic problems, such as pigmentation and cicatrix of the umbilicus. In addition, umbilical eversion and umbilical herniation occasionally develop. Therefore, mini-laparoscopic surgery using 3-mm trocars can be recommended for patients who do not want the natural appearance of the navel to be altered. We have developed an approach to achieve a superior cosmetic outcome by direct placement of 3-mm trocars in the lateral wall of the abdomen and at the lower border of the pubic hair. We refer to this method as mimic mini-laparoscopic surgery and report cases in which this procedure was used.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mesh surgeries, such as sacrocolpopexy and transvaginal mesh surgery, are commonly used to treat pelvic organ prolapse. Although mesh surgeries have a high success rate, they are unsuitable for some patients. For a patient with pelvic organ prolapse and highly calcified multiple fibroids, we performed hybrid sacrocolpopexy combined with transvaginal mesh surgery with a method modified for the patient's condition. Three months after surgery, the results were highly satisfactory. This approach is simple, secure, and versatile for patients who are not good candidates for conventional mesh surgeries. This novel hybrid mesh surgery is an option for treating various types of pelvic organ prolapse.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTS: Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system. METHODS: This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures. RESULTS: Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min). CONCLUSION: Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To examine the efficacy of local methotrexate (MTX) administration following linear salpingostomy for tubal pregnancy in the prevention of persistent ectopic pregnancy (PEP). METHODS: Patients who underwent a laparoscopic linear salpingostomy between January 1996 and December 2006 were enrolled in the study. Patients who were assigned to the prophylaxis group were administered MTX (50 mg) into the tubal wall in the vicinity of the lesion immediately following linear salpingostomy (n=41). Patients who were treated without MTX were assigned to the control group (n=40). Serum human chorionic gonadotrophin levels were followed in both groups postoperatively once every 3 days until they became undetectable. The incidence of PEP was compared between the two groups. RESULTS: Persistent ectopic pregnancy occurred in seven patients (17.5%) in the control group compared with zero patients in the prophylaxis group (P<0.05). There were no side-effects attributable to MTX in the prophylaxis group. CONCLUSION: A single prophylactic intratubal injection of MTX following laparoscopic linear salpingostomy is a safe and effective regimen for the prevention of PEP.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The majority of human and rodent cancers display various antigens which could elicit cellular and humoral immune responses. Such immunity, however, often fails to prevent progressive growth of cancers. It has long been speculated that tumor antigens may not be presented in appropriate fashion, which subsequently fails to elicit a strong immune response. Recent studies, however, indicate that immunization by formulated tumor antigens or even transfer of pre-activated T lymphocytes also have limited impact on cancer growth despite the fact that these methods could often enhance immune responses in cancer patients. These findings imply that even afferent arm of immunity are strengthen, it is not necessarily being translated to tumor regression. It is possible that the development of evasion mechanisms in tumor microenvironment play a critical role in the resistance of therapeutic immune responses. Recent studies provide compelling evidence that human and rodent cancers develop evasion mechanisms by aberrantly expressing normal proteins, which are required for normal tissue homeostasis, to either build a microenvironment locally or reach other organs systemically. In this review, we will focus our discussion on two recently described molecules, B7-H1 and B7-H4, in the context of their roles in the evasion of tumor immunity and possible approaches for therapeutic manipulation.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Contemporary approaches for vaccination and immunotherapy are often capable of eliciting strong T-cell responses against tumor antigens. However, such responses are not parallel to clinical tumor regression. The development of evasion mechanisms within tumor microenvironment may be responsible for poor therapeutic responses. We report here that constitutive or inducible expression of B7-H1, a B7 family molecule widely expressed by cancers, confers resistance to therapeutic anti-CD137 antibody in mice with established tumors. The resistance is accompanied with failure of antigen-specific CD8+ CTLs to destroy tumor cells without impairment of CTL function. Blockade of B7-H1 or PD-1 by specific monoclonal antibodies could reverse this resistance and profoundly enhance therapeutic efficacy. Our findings support that B7-H1/PD-1 forms a molecular shield to prevent destruction by CTLs and implicate new approaches for immunotherapy of human cancers.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recent findings suggest that macrophage-tropic human immunodeficiency virus type 1 (HIV-1) produced in colostrum/early breast milk may hold a clue to determine the mechanisms of transmission of HIV-1 via breast-feeding. Here, we show that the majority of CD4(+) cells in the colostrum are CD14(+) macrophages expressing both chemokine receptors and DC-SIGN, a dendritic cell-specific receptor for HIV-1. The R5-type macrophage-tropic HIV-1 isolate NL(AD8) infected such breast-milk macrophages and caused them to secrete virus particles efficiently; however, the secreted virions showed only a weak transmissibility to their susceptible target, MAGIC-5 cells. When stimulated with interleukin-4, the breast-milk macrophages demonstrated a striking enhancement of expression of DC-SIGN and showed a strong capacity to transmit NL(AD8) virions to MAGIC-5 cells, which was specifically blocked by anti-DC-SIGN-specific antibody. These results suggest that HIV-1 virions captured by DC-SIGN, but not secreted cell-free virions, may be more efficiently transmitted to other compartments, such as the gastrointestinal tract, through acidic gastric juice.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Peripheral blood monocytes extravasate and differentiate into tissue macrophages to mediate effective local defence, but how tissue-specific stimuli and environments may influence their functions remains unknown. Here, we found that peripheral blood monocytes gained the ability to produce granulocyte-macrophage colony-stimulating factor (GM-CSF) upon exposure to breast milk and differentiated into CD1+ dendritic cells (DCs) in the presence of exogenous interleukin-4 (IL-4) alone. This in vitro observation appeared physiologically relevant since macrophages that were freshly isolated from breast milk were also found to produce GM-CSF spontaneously. Furthermore, in contrast to peripheral blood monocytes that differentiated into DCs only in the presence of both exogenous GM-CSF and IL-4, differentiation of breast milk macrophages into DCs was induced by incubation with exogenous IL-4 alone. These IL-4-stimulated breast milk macrophages were efficient in stimulating T cells, suggesting their potential role in mediating T-cell-dependent immune responses in situ. On the other hand, unexpected expression of DC-SIGN, a DC-specific receptor for human immunodeficiency virus (HIV), even in unstimulated breast milk macrophages, may favour HIV infection, resulting in an increased risk of mother-to-infant vertical transmission of the virus via breast milk. Thus, tissue-specific development of macrophages is often linked to effective local immunity, but may potentially provide an opportunity for a pathogen to spread and transmit.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本女性骨盤底医学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本エンドメトリオーシス学会  

2010年から半年以上フォローできた子宮腺筋症患者32人を対象に、子宮腺筋症に対するレボノルゲストレル徐放型子宮内避妊システム(LNG-IUS)療法におけるGnRHアゴニスト(GnRHa)の有効性について検討した。対象の平均年齢は43.9(32〜51歳)、平均経産回数は0.83回、挿入前の筋層の厚さは平均42.3(20〜80)mmであった。LNG-IUS挿入により、月経痛のVASは半年間で平均8.0から1.9に有意に減少した。GnRHa併用投与例が6例で、いずれも筋層の厚さが40mmを超えていた。GnRHaの併用パターンは先行投与、追加投与、脱出例の3パターンであった。LNG-IUSは子宮腺筋症による疼痛症状を改善し、安価で患者コンプライアンスもよく、治療法の1として非常に有効であった。筋層が厚い症例に対しても。GnRHa併用により治療効果があった。

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記述言語：日本語   出版者・発行元：(NPO)小切開・鏡視外科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：日本エンドメトリオーシス学会  

AMH(抗ミュラー管ホルモン)は卵巣予備能の一指標として有用とされ、卵巣子宮内膜症性嚢胞の術後に低下することが知られているが、一定期間後にその値が回復するという報告がある一方で、回復しないという報告もある。そこで今回、AMHの術後回復に寄与する因子について検討した。方法は、当院で2011〜2015年に腹腔鏡下手術を行った卵巣子宮内膜症性嚢胞患者のうち、術前と術後1ヵ月・6ヵ月・1年時にAMH値を測定していた35例のデータを分析した。術後6ヵ月以降のAMH値が術後1ヵ月時よりも20%以上上昇していた20例を&quot;上昇群&quot;、他の15例を&quot;非上昇群&quot;とし、両群間で「年齢」「術前AMH値」「腫瘍径」「CA19-9」「CA125」「AMH変化率」「r-ASRMスコア」などを比較したところ、非上昇群は「年齢」と「r-ASRMスコア」が有意に高かった。

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

ポリープ状異型腺筋腫は主として子宮下部に発生する稀なポリープ様病変である。組織学的には良性腫瘍に分類される。しかし、一部に子宮体癌との共存例が報告されている。当科にてポリープ状異型腺筋腫の発生茎部付近の子宮内膜に癌の合併を確認できた症例を経験した。症例は1回経産、近医にて子宮内膜細胞診クラスIIIを指摘され、紹介となった。子宮内膜全面掻爬にてポリープ状異型腺筋腫と診断し、経過観察となった。9ヵ月後、子宮内にポリープ状腫瘤が再度出現した。低悪性度ポリープ状異型腺筋腫と子宮体癌0期の混在との病理診断であった。このようにポリープ状異型腺筋腫は子宮体癌との共存例があることに留意する必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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