OBJECTIVE:The aims of this study were to investigate the ability of positron emission tomography (PET) with the glucose analog [(18)F]-fluoro-2-deoxy-D-glucose (FDG) to detect pelvic lymph node metastasis of uterine corpus cancer and to perform a retrospective comparison with computed tomography (CT) and magnetic resonance imaging (MRI) findings. METHODS:Forty-six patients with uterine corpus cancer scheduled for surgery, including bilateral pelvic and/or para-aortic lymphadenectomy, were eligible for this study. CT and MRI of the pelvis and abdomen were performed in all patients within 2 weeks preceding whole-body FDG-PET. FDG-PET images were analyzed visually for objective assessment of regional tracer uptake. The sensitivity and specificity of each imaging modality for detecting pelvic lymph node metastasis were determined, respectively. RESULTS:Eleven (7 with myometrial invasion less than 1/2, 4 with myometrial invasion over 1/2) of the 46 patients (23.9%) were revealed to have pelvic lymph node metastasis. The sensitivity and specificity for detecting pelvic lymph node metastasis in patients with uterine corpus cancer by FDG-PET were 31.3% and 96.1% by lymph node region, respectively, and 36.4% and 91.4% by patient, respectively. No significant difference was noted among each imaging modality with sensitivity or specificity. Moreover, the sensitivity and specificity for detecting pelvic lymph node metastasis in 29 patients with endometrioid adenocarcinomas by FDG-PET were 28.6% and 96.1% by lymph node region, respectively, and 50% and 92% by patient, respectively. No significant difference was noted among each imaging modality in terms of sensitivity or specificity. Among 11 patients with pathologically positive pelvic lymph node metastasis, three out of four patients with myometrial invasion over 1/2 were diagnosed as pelvic lymph node metastasis positive by all diagnostic modalities, however, only one of seven patients with myometrial invasion less than 1/2 was diagnosed as pelvic lymph node metastasis positive by PDF-PET and CT. MRI could not detect pelvic lymph node metastasis in patients with myometrial invasion less than 1/2. CONCLUSIONS:We suggest that current imaging modalities including FDG-PET cannot change medical management of patients with uterine corpus cancer before surgery.

Objective: The aim of the present study was to investigate the diagnostic accuracy of three-dimensional power Doppler ultrasound (3DPD) in the differentiation between benign and malignant adnexal masses and evaluate 3DPD for assessing malignancy in comparison with two-dimensional transvaginal gray-scale sonography (2DTVS), magnetic resonance imaging (MRI) and positron emission tomography (PET).Subjects and Methods: Thirty-six patients with suspicious adnexal masses were included in this study. 2DTVS and 3DPD were performed preoperatively. MRI and PET examinations were also carried on within two weeks of initial sonography. All the results of diagnostic imaging techniques were evaluated separately. Final diagnosis was confirmed by the postoperative histopathology. The mature cystic teratomas and endometriomas with typical gray-scale sonographic appearance were excluded from the study.Results: Of the 36 patients, 25 had a malignancy, 5 had a borderline tumor, and 6 had a benign mass. Sensitivity of 2DTVS, 3DPD, MRI and PET were 96.7%, 76.7%, 96.7% and 83.3%, respectively. The sensitivity of 2DTVS was as high as that of MRI, and both of them were significantly higher than those of 3DPD and PET, respectively. There were no significant differences both in specificity and accuracy among these 4 techniques.Conclusion: 3DPD did not improve the diagnostic accuracy for the prediction of malignancy in adnexal masses. 2DTVS may still remain an important modality for the prediction of adnexal malignancy.

露天掘り鉱山において，安定的な残壁を形成しつつ採掘を進めることは，鉱山労働者に対する危害の防止や景観保護等の観点から重要な課題となっている．しかしながら，残壁崩壊事例が以前より現在に至るまで多数報告されており，四国管内においても平成16年4件，平成17年1件，平成18年2件の残壁崩壊事故が発生している．このため，中国四国産業保安監督部四国支部では平成17年度および18年度に中国四国地方鉱山保安協議会四国部会に専門委員会を設置し，今後の残壁崩壊を防止するための対策に資するために，管内の露天堀鉱山における残壁の状況について取りまとめを行うとともに，これまでに発生した残壁崩壊事例の調査を行い，崩壊要因，前兆，対策などについて整理・検討を行った．

Primary ovarian lymphoma as the initial manifestation is rare. A 27-year-old woman presented to our hospital with the symptoms of lower abdominal fullness and pollakisuria. CT scan and MRI revealed bilateral ovarian tumors, which showed heterogeneous masses. 18F-FDG PET revealed strong uptake by the abdominal masses, and the maximum standardized uptake value (SUVmax) was 12.5. Abnormal uptake was not shown by other regions. An exploratory laparotomy was performed. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IV according to the Ann Arbor system. International prognostic index (IPI) was 3 (high-intermediate risk). Chemotherapy was administered consisting of three courses of an R-CHOP regimen, and 18F-FDG PET and CT scan revealed no signs of involvement 3 months after initiation of the chemotherapy. 18F-FDG PET was a useful method for staging and assessment of the therapeutic response in primary ovarian lymphoma.

For vulvar reconstruction following radical vulvectomy in a 71-year-old woman with a large vulvar cancer, we applied the deep inferior epigastric perforator flap (DIEP flap), a typical perforator flap, which could be performed by utilizing an abdominal incision wound without producing another surgical scar and had less donor site morbidity because of a minimal sacrifice of muscles. The surgical procedures were less invasive and simple, and morphologically and functionally satisfactory results were obtained: no recurrence of cancer, a well-preserved vulvar morphology with less donor site scarring, and no functional disturbance such as dysuria and abdominal hernia. We consider that the DIEP flap is the first choice for vulvar reconstruction following radical vulvectomy. Even in radical vulvectomy without an abdominal incision wound, the DIEP flap with an anatomically reliable vascular pedicle can be an effective option.

Pelvic arteriovenous malformations (AVMs) are uncommon lesions of frequently unknown cause. Congenital AVMs are considered to be undifferentiated vascular structures resulting from arrest of embryonic development at various stages1,2. Acquired AVMs are usually caused by neoplasms, trophoblastic disease or trauma, and procedures such as curettage and uterine surgery have been implicated3–5. These malformations are characterized by their slow growth with a period of latency before becoming symptomatic. They may produce local or systemic effects, including vaginal bleeding, abdominal pain, urinary symptoms, and high-output congestive heart failure. Many methods have been used to diagnose pelvic AVMs. Angiography, which is the gold standard for diagnosis, has the advantage of demonstrating the feeding arteries and draining veins of the AVM6. However, angiography is an invasive procedure, and should be reserved for cases in which surgical intervention or therapeutic embolization of the lesion is planned such as those with persistent and severe uterine hemorrhage7–9. Recently, color and power Doppler sonography has provided a valuable, non-invasive method for the definitive diagnosis of AVM10,11. We present our initial experience with applying three-dimensional sonography in the diagnosis of uterine vascular malformation. A 27-year-old Japanese woman, gravida 3 para 2, was referred to our outpatient department because of persistent high serum β-human chorionic gonadotropin (β-hCG) levels. Gray-scale sonography (GE Voluson 730 Expert, Yokogawa, Tokyo, Japan) revealed an ill-defined mildly echogenic lesion with multiple small hypoechoic spaces on the right side of the uterus. Twodimensional color and power Doppler flow imaging showed a hypervascular lesion with turbulent flow, with a peak velocity of 80.3 cm/s and low pulsatility index of 0.445. The clinical diagnosis of invasive mole was made, and five courses of chemotherapy with Etoposide were administered. After 3 courses of chemotherapy, the serum β-hCG levels normalized. Six months after chemotherapy, three-dimensional power Doppler sonography clearly showed an aneurysm-like structure typical of uterine vascular malformation including its feeding vessels and drainage within the right mesosalpinx (Figure 1). The diagnosis of uterine vascular malformation was confirmed by magnetic resonance angiography. The patient had no manifestation of clinical symptoms. The aneurysm-like structure of the uterine vascular malformation was still evident 17 months after the initial examination. The typical color Doppler sonographic pattern of an AVM is ‘chaotic’ flow characterized by a turbulent flow velocity waveform. The ‘chaotic’ or turbulent flow results from the area being filled with numerous individual velocity vectors randomly occurring in all directions. The diagnosis of AVM might be made from these findings on color Doppler ultrasound but confirmation of the diagnosis is usually achieved by angiography12. There has been only one report on the three-dimensional power Doppler sonographic diagnosis of AVM of the mesosalpinx12. In our case, the aneurysm-like structure of the uterine vascular malformation with its feeding vessels and drainage within the right mesosalpinx was shown beautifully by means of three-dimensional power Doppler sonography. Moreover, it could be observed from any angle, which enables a much easier and quicker understanding of the spatial relationships of the vessels involved12. As surgical manipulation for uterine or pelvic AVM may sometimes result in hemorrhage or even death, conservative management by means of serial observations, may be preferable8,12. Timmerman et al.10 reported that conservative management is possible in more than two-thirds of patients presenting with uterine vascular malformation diagnosed by color Doppler sonography, and that peak systolic velocity values appear to be useful in distinguishing lowfrom highrisk patients. Peak systolic velocities of ≥ 83 cm/s were associated with higher probabilities of further treatment such as embolization whereas no vascular malformation with a peak systolic velocity value

BACKGROUND:Early amnion rupture sequence is rare, and its antenatal three-dimensional sonographic features have not been reported.CASE:A 24-year-old japanese woman, gravida 1, para 0, was referred to our sonography clinic during her 16th week of gestation because of multiple fetal anomalies. Three-dimensional sonography clearly showed scalp adhesion, skull defect, abdominal wall disruption, amputation of the right hand, kyphoscoliosis, and clubfeet. Delivery was induced at 17 weeks of gestation. Autopsy showed a 166 gram male fetus and confirmed the prenatal diagnosis of early amnion rupture sequence.CONCLUSION:Three-dimensional sonography provides further information for sonographers. This includes unique identification of the displayed anatomic plane, realistic and reliable depiction of multiple fetal anomalies, and visualization of complex fetal anomalies.

OBJECTIVE:To describe the three-dimensional (3D) sonographic features of nuchal edema in the early second trimester of pregnancy.METHODS:From 16 to 22 weeks of gestation 5 cases with nuchal edema were studied using transabdominal 3D sonography.RESULTS:Nuchal edema could be easily imaged with both two-dimensional and 3D sonography; however, visualization of the continuity and curvature of structures was more easily accomplished with 3D sonography. Before 20 weeks of gestation, the skin has a transparent structure, so the bony structures are clearly identified. 3D sonography allowed visualization of nuchal edema in all three dimensions at the same time, providing an improved overview and a more clearly defined demonstration of the adjusted anatomical planes.CONCLUSION:These results suggest that 3D sonography provides a novel means of visualizing nuchal edema in utero.

BACKGROUND The aim of this study was to elucidate the expression of p57kip2 in a series of benign, borderline and malignant ovarian tumors, to evaluate its relationship with other G1 regulators of the cell cycle and to determine whether p57kip2 expression is associated with progression and prognosis of epithelial ovarian tumors. MATERIALS AND METHODS Immunohistochemical analysis was performed in 103 cases of epithelial ovarian tumors. Twenty-six of the 103 cases were evaluated by Western blot analysis. RESULTS The study demonstrated that high p57kip2 expression was detected in 63.6% (21 out of 33) of benign tumors, 52.2% (12 out of 23) of borderline tumors and 40.4% (19 out of 47) of ovarian carcinomas. The positive ratio of p57kip2 expression was decreased from benign to borderline to malignant tumors, whilst statistical significance was observed between benign and malignant tumors. Low p57kip2 expression was significantly associated with high tumor grades, advanced clinical stages and cyclin E overexpression. Kaplan-Meier analysis demonstrated that the patients with low p57kip2 expression had a short overall survival. When the combined phenotype of p57kip2 and p27kip1 was analyzed, the patients with both p57kip2 and p27kip1 low expression had a lower overall survival rate. CONCLUSION These findings suggest that decreased p57kip2 expression may play a pivotal role in the progression of ovarian tumors and provide an important prognostic implication for epithelial ovarian carcinomas.

Objective: To investigate the relationship between nuchal translucency thickness and cardiac flow velocity in normal fetuses at 11-13 weeks of gestation. Subjects and Methods: Eighteen normal pregnancies were prospectively studied with transvaginal sonography and pulsed and color Doppler ultrasound. Flow velocities at the fetal atrioventricular valves (mitral and tricuspid valve) and outflow tract levels (ascending aorta and pulmonary artery), and at the descending aorta were recorded. Nuchal translucency thickness was also measured. Results: Mitral peak velocity during early diastolic filling correlated with gestational age. Mitral peak velocities during early diastolic filling and atrial contraction, tricuspid peak velocity during early diastolic filling, ascending aorta peak velocity, and pulmonary artery peak velocity correlated well with nuchal translucency thickness. There was an inverse correlation between umbilical artery pulsatility index and gestational age. Conclusions., These results suggest that the increase of nuchal translucency thickness in normal fetuses at 11-13 weeks of gestation may be the consequence of changes in fetal cardiac functions. Copyright (C) 2002 S. Karger AG, Basel.

Survivin is a new member of the inhibitors of apoptosis proteins (IAP) family, selectively overexpressed in common human cancers but not in normal adult tissues, and associated with aggressiveness of the disease and unfavorable outcomes. Recent study also found that survivin expression is associated with cell proliferation. In order to gain insight into the role of survivin in ovarian tumors, we investigated the expression of survivin in a group of epithelial ovarian tumors, and examined the relationship of its expression with cell proliferation and clinical outcome. Immunohistochemical analysis was performed in 103 cases of epithelial ovarian tumors. Twenty-six of the 103 cases were evaluated by Western blot analysis. The results showed that survivin overexpression was detected in 21.2% (7 of 33) of benign tumors, 47.8% (11 of 23) of borderline tumors, and 51.1% (24 of 47) of ovarian carcinomas. The positive ratio was significantly higher in malignant or borderline tumors than in benign tumors, and the overexpression of survivin was significantly correlated with the size of residual disease. A positive correlation between survivin expression and proliferative activity of tumor cell measured by PCNA index was found. Kaplan-Meier analysis demonstrated that the patients with survivin overexpression have a short overall survival. These findings suggest that survivin overexpression may play a pivotal role in the progression of ovarian tumors and may provide an important prognostic implication for epithelial ovarian carcinomas.

OBJECTIVETo evaluate the estrogenic effect of tamoxifen (TAM) therapy in postmenopausal women.STUDY DESIGNThe subjects were 26 postmenopausal women. The maturation index (MI), maturation value (MV) and karyopyknotic index (KPI) were evaluated based on hormonal cytology. Endometrial cytologic examinations and transvaginal ultrasonography were also performed.RESULTSOf the 26 patients, 16 had low estrogenic activity from the viewpoint of hormonal cytology before TAM administration. During administration, their mean MV rose significantly, from 25.8 +/- 17.7 to 68.8 +/- 13.2, (mean +/- SD) and their mean KPI rose from 9.0 +/- 8.3 to 47.1 +/- 23.1. In contrast, among the 10 patients with high estrogenic activity, mean MV and KPI decreased from 62.9 +/- 8.4 and 27.2 +/- 16.9 to 58.4 +/- 7.7 and 17.7 +/- 16.1, respectively, with TAM administration. Mean endometrial thickness increased more significantly with TAM administration in the low estrogenic activity group than in the high estrogenic activity group.CONCLUSIONTAM had a reciprocal effect; no additional estrogenic effect was seen in patients with high estrogenic activity. Conversely, an estrogenic effect was seen in those with low estrogenic activity. An individualized gynecologic evaluation based on hormonal cytology is useful in selecting patients who will be more susceptible to TAM-induced endometrial abnormality.

OBJECTIVE:The aim of this study was to further evaluate whether the expression of p27(kip1), cyclin E, and cdk2 is related to the malignancy of ovarian tumors and whether their expressions, alone or in combination, are associated with prognosis in epithelial ovarian carcinoma.METHODS:Immunohistochemical analysis using anti-p27(kip1), anti-cyclinE, and anti-cdk2 antibodies was carried out for 103 cases consisting of benign, borderline, and malignant ovarian tumors, and Western blot analysis and cdk2 activity assay were performed in 26 fresh ovarian tumor samples.RESULTS:p27(kip1) expression was reduced in ovarian carcinomas in contrast to benign and borderline tumors. The expression of cyclin E and cdk2 gradually increased from benign to borderline to malignant tumors. Kaplan-Meier survival analysis showed that patients with p27(kip1) expression had a high overall survival rate. Patients with cyclin E overexpression had a low overall survival rate. When the combination of these proteins was analyzed, patients with the p27(kip1) (-)/cyclin E (++)/cdk2 (++) phenotype were significantly associated with the poorest overall survival. In multivariate Cox regression analysis, the combined phenotype of p27(kip1) (-)/cyclin E (++)/cdk2 (++) was independently related to poor prognosis.CONCLUSIONS:Our results suggest that loss of p27(kip1) expression and overexpression of cyclin E or cdk2 were significantly associated with malignancy in ovarian tumors. p27(kip1) and cyclin E proteins may be valuable prognostic factors for epithelial ovarian carcinoma patients. Furthermore, the combined evaluation of p27(kip1)/cyclin E/cdk2 may provide the most important prognostic implication.