大口 昭英

We counted nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in the umbilical cord blood from 98 twins born to 49 women with uncomplicated twin pregnancies at greater than or equal to 34 weeks of gestation to better characterize NRBC in twins. Twelve women with monochorionic (MC) placentas and 37 with dichorionic (DC) placentas gave birth at 36.7 +/- 1.9 and 36.5 +/- 2 weeks of gestation, respectively. All twins were born with an Apgar score of greater than or equal to7 at 1 min. Log(10) (NRBC/100 BC) in 98 twins exhibited a nearly normal distribution, and was significantly associated with gestational age for both MC (r = -0.457, p = 0.025) and DC twins (r = -0.275, p = 0.018), and with birth weight for both MC (r = -0.682, p < 0.001) and DC twins (r = -0.336, p = 0.003). Log(10) (NRBC/100 WBC) tended to be larger in smaller twins than in larger twins in the MC group, and significantly larger in smaller twins than in larger twins in the DC group (p < 0.05). Intertwin difference in Log(10) (NRBC/100 WBC) was defined as the value of Log(10) (NRBC/100 WBC) of the smaller twin minus Log(10) (NRBC/100 WBC) of the larger twin, and became greater with increasing intertwin difference in birth weight (r = 0.411, p = 0.003). These findings suggest that neonatal NRBC reflected gestational age and birth weight in twins. This preliminary observation using a small number of twins suggests that the smaller twin may have experienced a relative lack of oxygen compared with the larger twin in utero.

Background. Chorioamnionitis (CAM) may accelerate lung maturation in fetuses. It is possible that CAM prevents infant death after live birth., Methods. A retrospective study of live-born singletons at <32 weeks of gestation between 1993 and 1997, Perinatal risk factors for adverse outcomes were analyzed using a logistic regression model, with special reference to the presence of histologically confirmed CAM. Adverse outcomes included infant death before 1 year of age, and survival with cerebral palsy and/or mental retardation. Results. A total of 81 infants, weighing 1181+/-426 g, were born at 28.1+/-2.3 weeks of gestation. Of those, 15 (19%) died before 1 year of age, while 16 (20%) infants developed major handicaps by 1.5 years of age (six with cerebral palsy, eight with mental retardation, and two with both cerebral palsy and mental retardation). CAM, present in 44 women, was significantly associated with a reduced risk of death after live birth, with an odds ratio of 0.11 (p=0.01). Only the presence of such intracranial lesions as periventricular leukomalacia and intraventricular hemorrhage were significantly associated with an increased risk of major handicaps (odds ratio of 11.0, p=0.04). Adverse outcomes occurred in a similar proportion of infants in groups without CAM (14/37) and with CAM (17/44). However, among infants with adverse outcomes, the number of deaths was significantly higher in the group without CAM (10/14),a. with CAM (5/12) (p<0.05). Conclusions. The presence of CAM may somehow prevent infant death after live birth. Larger studies are required to confirm this phenomenon.

Background. The number and percentage of viable vaginal polymorphonuclear leukocytes (vPMNs) are known to be increased in women who experience preterm labor. Whether those parameters may be associated with the presence of histologic chorioamnionitis (CAM) is not known. Methods. We investigated prospectively 39 women at 26.3 +/- 6.2 weeks of gestation. The following were determined in vaginal washings. total number of vPMNs and the percent that were viable, the pH, and the concentrations of granulocyte elastase and interleukin-8 (IL-8). In addition, the while blood cell count and the serum level of C-reactive protein were determined in peripheral blood. The placenta and the umbilical cord were examined histologically with special reference to the presence of CAM. The optimal cutoff value for prediction of histologic CAM was obtained for each variable using receiver operating characteristic curves. A multivariate logistic-regression model was used to determine the independent risk factors for this disorder. Results. Histologic CAM was present in ten women (37.1+/-3.8 weeks) and absent in 29 women (38.2+/-1.5 weeks). The total number of vPMNs, the percent of viable vPMNs, and the IL-8 level were all significantly increased in the women with CAM, in contrast to those without CAM. When the optimal cutoff value for each of seven covariates was entered into the model, only the percent of viable vPMNs, greater than or equal to 11%, demonstrated a significant relationship with histologic CAM (odds ratio 26.9; 95% confidence interval 1.3 to 545; p<0.05). Conclusions. Women with a % viability of vPMNs of greater than or equal to 11% were at a significantly higher risk for histologic CAM. Data suggest that an influx of PMNs into the vagina occurs continuously in patients with histologic CAM.

Objective: To devise preventive measures for stillbirths, which account for more than 70% of perinatal deaths in Japan. Methods: We retrospectively reviewed the medical records of 77 women with singleton pregnancies who gave birth to stillborn infants at ≥ 30 weeks between 1979 and 1996 at our hospital. Results: Major malformations were present in 21 (27%) of 77 infants, including 11 infants with anencephaly. Two infants (2.6%) were severely hydropic. Preeclampsia preceded the stillbirth and might have been an indirect cause of stillbirth in 21 (39%) of 54 women whose infants had normal formations. The cause of stillbirth in 33 non-preeelamptic women was unclear in 15 (28%), abruptio placentae in 9, fetal growth retardation in 3, the HELLP syndrome in 3, chorioamnionitis in 2, and cord accident in 1. Abruptio placentae also occurred in 9 of 21 preeclamptic patients. Thus, abruptio placentae was responsible for 18 (33%) of 54 stillborn infants with a grossly normal appearance. An autopsy was performed on only 13 (24%) of 54 infants with grossly normal appearance and did not provide new information relating to deaths. Conclusions: The causes of stillbirth were many and varied, with a large proportion having no obvious cause, although autopsies were underused. Increased monitoring for women with preeclampsia and early diagnosis and prompt delivery for women with abruptio placentae might be helpful in reducing the number of stillbirths.

Thirty-one patients with clear cell ovarian carcinoma who underwent primary surgery and postoperative therapy were retrospectively evaluated. Eighteen patients (58%) had International Federation of Gynecology and Obstetrics (FIGO) stage I disease, 3 patients (9.7%) stage II disease, and 10 patients (32.3%) stage HI and IV disease. Patients with stage ffi and IV disease demonstrated a significantly poor prognosis compared with patients who had stage I or II disease (p&lt 0.01). No patients with stage HI and IV disease survived 5 years. p53 protein expression and proliferative activity (PA) were studied by immunohistochemical methods using p53 molecule and antibodies to PCNA (proliferative cell nuclear antigen) . Intranuclear accumulations of p53 product were observed in 15 of 31 (48. 4 %). On the other hand, 15 of 31 (48.4%) patients stained positively for PCNA (≥60% of cancer cells stained positively). Positive p53 staining and highly PA were associated with poor survival. Two patients with stage I a relapsed were positive p53 and highly PA. Accordingly, consolidation chemotherapy is necessary for patients with stage Ia who are positive p53 and highly PA. Platinum-based chemotherapy for patients who had minimal residual tumor was effective, but 5 patients who had ≥2 cm tumor burden were not effective at all. The response rate for platinum-based chemotherapy was 20 % (1/5) among p53 positive, in contrast to 66.7% (4/6) among p53 negative patients. So it seems that p53 positive patients are chemoresistant.