日本女性医学学会は更年期障害から老年期の医学的諸問題まで思春期も含め女性の一生を通じ研究する医療従事者の団体です。

ORIGINAL The protective effect of fibrate against endothelial dysfunction induced by platinum-based chemotherapy in gynecological cancer patients.

Ayako Watanabe , Akiko Tanabe, Kana Nakai, Youko Nagayasu, Risa Maruoka, Masaaki Takai , Kiyoko Nakamura,Tatuharu Sekijima , Masahide Ohmichi

Department of Obstetrics and Gynecology, Osaka Medical College

Summary:
Introduction: Patients with gynecologic cancer generally undergo surgery followed by the administration of platinum-based chemotherapy (PtChem). Although previous reports suggested that PtChem is associated with vascular toxicity, the mechanisms are still unclear. Therefore, our aim was to evaluate the influence of PtChem on arteriosclerosis and whether fibrate prevents vascular dysfunction in cancer survivors.
Materials and Methods: This study included 43 women (Period A: 2006.4-2010.3, n=28, Period B: 2010.4-2012.5, n=15) who underwent surgical treatment with paclitaxel and carboplatin Chemotherapy (TC-Chem) according to established protocols. Triglyceride (TG) was monitored before and immediately following TC chem and patients in Period B whose TG did not raise to more than 150 mg/dl in serum were excluded. We finally investigated 38 patients who were administrated with (Fibrate group; n=10) or without (Control group; n=28) Bezafibrate® (400 mg/day) which started two weeks before chemotherapy and continued during chemotherapy. Lipid profiles were measured and the endothelial dysfunction was evaluated by the flow-mediated dilatation (FMD) of the brachial artery performed before and immediately following TC chem.
Results: In the fibrate group, the plasma levels of TG were reduced and the fold decrease of %FMD was improved. Furthermore, the plasma levels of TG during TC-chem were negatively correlated with %FMD. Conclusions: This research suggests that TC-Chem induces hyper triglicemia and vascular endothelial dysfunction. In addition, fibrate may improve TC-chem induced vascular dysfunction.

 
ORIGINAL The prevalence of overactive bladder symptoms in prolapse patients, and the changes after treatment for pelvic organ prolapse

Chika Hiroga, M.D., Ph.D., Akiko Tanabe*, M.D., Ph.D., Masaaki Takai, M.D., Kiyoko Nakamura, M.D., Yoshito Terai, M.D., Ph.D., and Masahide Ohmichi, M.D., Ph.D.

Department of Obstetrics and Gynecology, Osaka Medical College

Summary Objectives: The aim of this study was to assess the relationship between pelvic organ prolapse (POP) and overactive bladder (OAB), and to evaluate the changes in the symptoms of OAB in the POP patients after treatment.
Methods: This study was a retrospective study. Eighty patients who were diagnosed to have POP of stage 3 or higher according to the Pelvic Organ Prolapse-Quantitative (POP-Q) system were enrolled. Forty-four patients were treated with flexible Wallace ring pessaries, and thirty-six patients were treated with tension-free vaginal mesh procedures. All patients completed the OAB questionnaires and Overactive Bladder Symptoms Scores (OABSS) were calculated before the treatment and at the three month follow-up.
Results: The prevalence of OAB symptoms among the POP patients was 68.8%. In the pessary treatment group, the number of OAB patients significantly decreased after treatment. The majority (70.5%) of the patients had improvements in their OAB symptoms, while de novo OAB symptoms appeared in 6.8% of the patients. In the surgical treatment group, 72.2% of the patients had improved OAB symptoms, and no de novo OAB symptoms appeared.
Conclusions: It seems that POP is a predictive risk factor for OAB. This study suggests that a clinical examination for POP is needed for the patients who have refractory OAB symptoms.
 
ORIGINAL Present status of hormone replacement for primary Ovarian Insufficiency in Japan

Suguru IGARASHI, Kiyoshi TAKAMATSU, Hisashi NARAHARA, Shunichiro IZUMI, Masahiro NOZAKI, Hiroko KOMURA, Yodo SUGISHITA, Thuyosi HIGUCHI,
Bunpei ISHIZUKA, Hideki MIZUNUMA

Summery
Number of patients with Primary Ovarian Insufficiency (POI) and the types of hormone treatments for them were investigated by postal questionnaires to 732 registered, teaching hospitals for early residency of Obstetrics and Gynecology designated by Japan Society of Obstetrics and Gynecology. Two-hundred and fifty three hospitals (35.0%) responded.
There were 7200 patients being seen at these institutes.
The diagnosis was most prevalently made by FSH levels over 40mIU/ml and estradiol levels below 10 pg/ml. The hormone products used for estrogen replacement were (1) conjugated estrogen, (2) transdermal estrogen and (3) middle dose oral contraceptives (order of prevalence).
As a progestines, (1) medroxyprogesterone, (2) dydrogesterone were used. The dosage and the method of administration were different from institute to institute. Hormone replacement was most commonly terminated at the age of either 45 years or 50 years of age.
Adverse effects reported to have occured during hormone replacement were fractures (n=7), venous thrombosis (n=4), breast cancer (n=3), myocardial infarction (n=2) and apoplexy (n=2).
This investigation revealed the present situation of hormone replacement for POI in Japan. Guide line of the hormone replacement for POI should be made in the near future.