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Ichigo S.,Matsunami General Hospital | Takagi H.,Matsunami General Hospital | Matsunami K.,Matsunami General Hospital | Suzuki N.,Gifu University | Imai A.,Institute of Endocrine Related Cancer
Archives of Gynecology and Obstetrics

Purpose: Uterine leiomyomas are the most common benign tumors of reproductive age women, but there is no effective medical therapy to data. Aim of this study was to examine and compare the efficacy of gonadotropinreleasing hormone agonist (GnRHa) versus dienogest in premenopausal women with uterine myoma. Methods: We retrospectively analyzed the medical records of 55 premenopausal patients with endometriosis, who received dienogest (2 mg daily) for 6 months regarding coexistence of uterine myoma between January 2008 and June 2010. To compare these data in a case-control study, we analyzed a matched control group of 12 patients treated with leuprolide acetate (1.88 mg monthly) for 6 months having uterine myoma. Results: Of the 55 patients treated with dienogest, six were associated with coexistent myoma node. Total myoma volume significantly decreased to 59.7 ± 7.0% of initial in dienogest group and 51.9 ± 5.5% in GnRHa group. Reduction rate in myoma volume was similar in both groups. Conclusion: Uterine myoma volume was successfully reduced by use of dienogest. Consideration of GnRHa disadvantages may lead to short-or long-term management of women with myoma who are to be managed transiently, and who wish to avoid surgical intervention, especially perimenopausal women. © Springer-Verlag 2010. Source

Suzuki N.,Gifu University | Imai A.,Institute of Endocrine Related Cancer
Gynecological Endocrinology

Androgen receptor (AR) is one of the large superfamily of nuclear hormone receptors. AR consists of distinct domains including an N-terminal DNA-binding domain and a C-terminal ligand-binding domain (LBD). Regulation of AR nuclear import and subsequent transactivation activity represent essential steps in androgen action. Mutations in the AR gene are known to cause different degrees of androgen insensitivity syndrome (AIS). This study aimed to identify the possible contribution of LBD of AR to cellular distribution, ligand binding, and transactivation activities using mutant AR clone lacking the entire LBD that we previously observed in an AIS patient. Subcellular distribution was assessed by green fluorescence protein-tagged vector and transcriptional activity was analyzed by luciferase assay. Wild-type AR had ligand-dependent transcriptional activation and nuclear import activities. On the other hand, mutant AR had no transcriptional activity regardless of the presence of ligand, 5-α-dihydroxytestosterone (DHT). These mutants were presented predominantly in the nucleus even without DHT. The observation of no transactivation in the mutant receptor must be due to the loss of complex formation between androgen and AR protein. The C-terminal domain has the critical role in the cellular localization and transactivation as well as on the ligand binding. © 2011 Informa UK, Ltd. Source

Takagi H.,Matsunami General Hospital | Ichigo S.,Matsunami General Hospital | Murase T.,Matsunami General Hospital | Ikeda T.,Matsunami General Hospital | Imai A.,Institute of Endocrine Related Cancer
Journal of Gynecologic Oncology

The most common form of malignant transformation developing from a mature cystic teratoma is squamous cell carcinoma, representing 80% of malignant transformations, while adenocarcinoma accounts for approximately 5%. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by magnetic resonance imaging, in particular with fat suppression techniques. Here, we report magnetic resonance imaging findings and clinical features of a 79-year-old woman with mucinous adenocarcinoma arising from a mature cystic teratoma (measuring 5×6 cm), classified as surgical stage IA. Because of the poor prognosis of malignant transformation, when mature cystic teratomas are detected (even smaller than 5 cm tumor size) in postmenopausal women, serum tumor marker carcinoembryonic antigen levels and fat-suppressed magnetic resonance imaging may be potential indicators of malignant transformation. © 2012. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology. Source

Imai A.,Institute of Endocrine Related Cancer | Suzuki N.,Gifu University
European Journal of Obstetrics Gynecology and Reproductive Biology

Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that may cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. An increasing number of adhesion reduction agents, in the form of site-specific and broad-coverage barriers and solutions, are becoming available to surgical teams. The most widely studied strategies include placing synthetic barrier agents between the pelvic structures. Most of the adhesions in the barrier-treated patients develop in uncovered areas in the abdomen. This fact suggests that the application of liquid or gel anti-adhesive agents to cover all potential peritoneal lesions, together with the use of barrier agents, may reduce the formation of postoperative adhesions. This article introduces the topical choices available for adhesion prevention mentioned in preliminary clinical applications and animal models. To date there is no substantial evidence that their use reduces the incidence of postoperative adhesions. In combination with good surgical techniques, these non-barrier agents may play an important role in adhesion reduction. © 2009 Elsevier Ireland Ltd. All rights reserved. Source

Imai A.,Institute of Endocrine Related Cancer | Takagi H.,Matsunami General Hospital | Matsunami K.,Matsunami General Hospital | Suzuki N.,Gifu University
Archives of Gynecology and Obstetrics

Purpose: The purpose of this document is to review the non-barrier methods to prevent postoperative adhesion formation in humans. Methods: A MEDLINE computer search was performed to identify relevant articles using the keywords "postoperative adhesion prevention" "abdominal" and "humans". Subsequent searches were performed using the keyword "non-barrier" to further supplement the information obtained. After careful review of the abstracts, 15 articles were selected for inclusion in the manuscript. Results: Many methods, drugs and materials have been demonstrated e V ective for reducing postoperative adhesion in animal models. Among them, four types of drugs have been clinically used in attempts to reduce postoperative adhesions: gonadotropin-releasing hormone agonists, anti-inflammatory drugs, humidified CO2 and hydroflotation. Many clinical and meta-analyses revealed that hydroflotation materials do not increase adhesion-free outcome. GnRHa pretreatment using a standard clinical dose (3.75 mg monthly) before myomectomy do not decrease adhesion formation. The role of CO2 on the reduction and/or prevention of postoperative adhesions have been reported only in cardiac surgery. None of them have been adopted for clinical standard therapy, despite positive reports in animals or preclinical applications. Conclusion: In contrast to the results from animal studies, there is no substantial evidence that the use of non-barrier materials reduces postoperative abdominal adhesions in humans. © Springer-Verlag 2010. Source

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