藤原 寛行

Background: In Japan, the cervical cancer screening rate is extremely low. Towards improving the cervical cancer screening rate, encouraging eligible people to make an informed choice, which is a decision-making process that relies on beliefs informed by adequate information about the possible benefits and risks of screening, has attracted increased attention in the public health domain. However, there is concern that providing information on possible risks of screening might prevent deter from participating.Methods: In total, 1,912 women aged 20-39 years who had not participated in screening in the fiscal year were selected from a Japanese urban community setting. Participants were randomly divided into 3 groups. Group A received a printed reminder with information about the possible benefits of screening, group B received a printed reminder with information about possible benefits and risks, and group C received a printed reminder with simple information only (control group).Results: Out of 1,912 participants, 169 (8.8%) participated in cervical cancer screening. In the intervention groups, 137 (10.9%) participated in cervical cancer screening, compared to only 32 (4.9%) of the control group (p &lt 0.001). In addition, logistic regression analysis revealed that there was no significant difference in screening rate between group A and group B (p = 0.372).Conclusions: Providing information on the possible risks of screening may not prevent people from taking part in cervical cancer screening among a Japanese non-adherent population.

Human epididymis protein 4 (HE4) levels and the Risk of Ovarian Malignancy Algorithm (ROMA) have recently been shown to improve the sensitivity and specificity of epithelial ovarian cancer (EOC) diagnosis. We evaluated HE4 levels and ROMA as diagnostic tools of type I and type II EOC in Japanese women. Women who had a pelvic mass on imaging and were scheduled to undergo surgery were enrolled as ovarian mass patients. Serum levels of carbohydrate antigen 125 (CA125) and HE4 were tested in 319 women (131 benign, 19 borderline, 75 malignant, and 94 healthy controls). CA125, HE4, and ROMA were evaluated for sensitivity and by receiver operating characteristics (ROC) in type I and type II EOC. The results showed that, at 75 % specificity, the sensitivity of CA125 and HE4 for type II was 92.1 % for both markers and for type I was 51.5 % and 78.8 %, respectively. The sensitivities of ROMA (type I, 84.8 % and type II, 97.4 %) were better than those of CA125 and HE4. CA125, HE4, and ROMA were all highly accurate markers for type II. For type I, HE4 and ROMA showed better sensitivity than CA125. ROMA displayed the best diagnostic power for type I and type II including for the early stage of type I. In conclusion, HE4, CA125, and ROMA are valuable markers for type II EOC diagnosis. HE4 and ROMA analyses may improve differentiation between type I EOC and a benign mass. Measurement of combined HE4 and CA125 levels provides a more accurate method for EOC diagnosis.

Background: Endometrial cytology by direct intrauterine sampling is the most common test for an initial evaluation of the endometrium in Japan. However, its diagnostic value for endometrial cancer remains unknown. Here, we assess the correlation between cytopathology and histopathology to evaluate the diagnostic value of cytology for endometrial cancer. Methods: Patients with histologically confirmed endometrial cancer and controls with a normal endometrium confirmed by hysterectomy had all undergone preoperative endometrial cytology between 2001 and 2010 at our eight institutions and were retrospectively analyzed. The cytological results were compared by clinical stage, histological type, differentiation, and sampling instrument. Results: We analyzed 1,441 endometrial cancer and 1,361 control cases. Endometrial cytology detected cancer in 1,279 (916 positive and 363 suspicious) cases with a sensitivity (positive plus suspicious cases) of 88.8% and a specificity of 98.5%. The positive rate was high in advanced-stage, nonendometrioid, and undifferentiated cases, but there was no significant difference in sensitivity between these clinical conditions. Conclusion: Endometrial cytology shows a relatively high sensitivity and specificity for endometrial cancer, and neither statistical measure is significantly affected by clinical stage, histological type, differentiation, sample numbers, or sampling instrument. These findings form a superior dataset for evaluating the efficacy of endometrial cytology. (C) 2014 S. Karger AG, Basel

The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1st dose, 96.2% for the 2nd dose, and 91.2% for the 3rd dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%-95.0% for the 1st dose, 41.1%-93.7% for the 2nd dose and 3.1%-90.1% for the 3rd dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1st dose, 93.7% for the 2nd dose, and 90.1% for the 3rd dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%-1.4% for the 1st dose, 0.0%-0.8% for the 2nd dose, and 0.1%-0.1% for the 3rd dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs.

The purpose of this study was to present the results of fertility-sparing treatment using medroxyprogesterone acetate (MPA) for endometrial carcinoma (EC), and to clarify patient characteristics by investigating patient background factors. A total of 59 patients with EC, who received MPA as fertility-sparing therapy at two institutions over a 21-year period between 1987 and 2008, were studied retrospectively. Patients were administered oral MPA at 400-600 mg/day for 16-24 weeks as long as they responded. Endometrial tissue was assessed twice, at 8-12 weeks (during treatment) and shortly after treatment. The overall complete response (CR) rate was 71%. A total of 22 (52%) of 42 responders later developed relapse. A total of 19 cases became pregnant, and 25 infants were born. Eighty percent of recurrences occurred within 2 years. For stages la and Ib-IIa (FIGO, 1988), initial CR rates were 80.0 and 42.9%, respectively (p<0.01), demonstrating a significant difference. Total hysterectomy was performed for 26 patients (44%) due to recurrence or failure to respond to the initial treatment. Among these 26 patients, postoperative stages were more advanced in 10 patients (38%). The grade advanced (became more poorly differentiated) postoperatively in 2 patients (8%). Premenopausal females with EC can be treated successfully with MPA, however patients should be informed of the risks and limitations of this conservative treatment.

Objective: To investigate the effectiveness of montelukast, a leukotriene receptor antagonist, in alleviating the symptoms of dysmenorrhea. Study design: This prospective, double-blind, randomized, placebo-controlled study was comprised of 62 patients with dysmenorrhea who were randomly divided into 2 groups (montelukast and placebo). Data obtained from 50 patients were analyzed (montelukast: 24; placebo: 26). Using visual analog scale (VAS) scores and nonsteroidal anti-inflammatory drug (NSAID) usage per menstrual cycle, values before treatment were compared to average scores over two menstrual cycles with treatment. Results: Both the VAS scores and NSAID usage decreased significantly in both groups. The decreases were greater in the montelukast group compared to the placebo group, but the differences were not statistically significant. Nevertheless, in "highly effective cases," which were defined as having a post-treatment value less than half of the pre-treatment value, the decreases were significantly greater in the montelukast group than in the placebo group (VAS: montelukast, 4 vs. placebo, 0 (P = 0.029); NSAID: montelukast, 9 vs. placebo, 3 (P = 0.031)). Conclusions: The present study found that montelukast may be effective in alleviating pain associated with dysmenorrhea in some women. Montelukast is safe and does not influence hormonal levels. Therefore, montelukast is a clinically reasonable management option to consider before prescribing a hormonal agent. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

In the present study, we measured urinary hCG after assisted reproductive technology to accurately calculate normal doubling time (DT) of hCG, and we compared DT values with prognosis of pregnancy. We clarified the correlation between normal DT values, calculated from urinary hCG levels, and viable and nonviable pregnancies.

Problem: Although the presence of mast cells in endometriosis lesions has been reported, there have been no reports of their pathological localization in ovarian endometrial cysts. Methods of study: The localization of mast cells in ovarian endometrial cysts were investigated using hematoxyline and eosin and toluidine blue staining with light microscopy, immunohistochemical c-kits, and electron microscopy. Results: Mast cells were identified in endometrial cyst tissues. Few mast cells were localized in the endometrial stroma, which is characteristic of endometrial gland-like regions. Many mast cells were noted around blood vessels and the interstitium with fibrosis, that is, the fibrotic interstitium of endometrial cysts. Conclusions: Mast cells may be involved in the development and progression of endometriosis. Localization of mast cells suggests a particularly close relationship with fibrosis and adhesion. © Blackwell Munksgaard, 2004.

Objective: To evaluate the usefulness and prognostic value of transvaginal hydrolaparoscopy (THL) in infertile women. Design: Retrospective study. Setting: Jichi Medical School Hospital, Tochigi, Japan. Patient(s): Thirty-six patients who were followed up for 6 months or longer after THL was performed. Intervention(s): Transvaginal hydrolaparoscopy findings in comparison with hysterosalpingography (HSG). Main Outcome Measure(s): Transvaginal hydrolaparoscopy findings, HSG findings, treatment strategy, and prognosis. Result(s): Twenty of 36 patients (55.5%) became pregnant, including 7 by coitus, 7 by artificial insemination with the husband's semen, and 6 by assisted reproductive technology (ART). In 11 of these pregnant patients, information obtained during THL differed from findings on HSG. Conclusion(s): Transvaginal hydrolaparoscopy is useful in selecting a future treatment strategy.