A rare case of microinvasive squamous cell carcinoma arising in mature cystic teratoma of the ovary

Malignant transformation of a mature cystic teratoma (MCT) of the ovary is rare, with squamous cell carcinoma (SCC) being the most common type. The authors report a novel case of microinvasive squamous cell carcinoma arising in a mature cystic teratoma of the ovary. A 56-year-old woman presented with a 12-cm mass, which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. Subsequently, laparoscopic surgery for the ovarian tumor was performed. The pathologic diagnosis was microinvasive squamous cell carcinoma arising in a mature cystic teratoma of the ovary. Appropriate staging surgery was then performed, with no evidence of malignant tissue except for the removed left ovary. Microinvasive SCC arising in MCT of the ovary is extremely rare, and, to the best of the authors' knowledge, this has not previously been reported in the literature.

Clinical usefulness of concentrated ascites reinfusion therapy (CART) for gynecological cancer patients with refractory massive ascites due to cancerous peritonitis

PURPOSE

Cell-free and concentrated ascites reinfusion therapy (CART) is intended to treat patients by ultrafiltration and reinfusion of their refractory ascites. In the CART system, bacteria and cancer cells in removed massive ascites are filtrated. Then, water is removed in the condenser, resulting in a higher protein concentration. The purpose of this study was to assess the clinical usefulness of CART in the treatment of refractory massive ascites in patients with cancerous peritonitis.

MATERIALS AND METHODS

CART was performed 13 times in four patients with ovarian and endometrial cancer.

RESULTS

Autologous protein with a higher concentration was intravenously administered. The amount of aspirated and condensed ascites was 3,190 +/- 1,086 ml (975 4,500 ml) and 538 +/- 249 ml (100 - 860 ml), respectively. Condensed albumin, albumin concentration, and concentration time were 43.2 +/- 25.8 g, 8.2 +/- 3.3 g/dl, and 73.3 +/- 24.8 min (28 - 122 min), respectively. CART was effective in maintaining serum albumin concentrations, and it is possible to repeat infusion. During CART, patients performance status was 1-2 and vital signs were stable except for mild elevations in body temperature. Daily life was maintained without serious side-effects.

CONCLUSIONS

The use of CART for gynecological cancer patients with refractory massive ascites due to cancerous peritonitis contributes to improvements in quality of life and relief of symptoms. With autologous infusion of condensed ascites, patients can avoid infection, allergic reactions, and administration of expensive blood products.

Human papillomavirus detected in female breast carcinomas in Japan

To investigate the aetiological role of human papillomavirus (HPV) in breast cancer, we examined the presence, genotype, viral load, and physical status of HPV in 124 Japanese female patients with breast carcinoma. Human papillomavirus presence was examined by PCR using SPF10 primers, and primer sets targeting the E6 region of HPV-16, -18, and -33. The INNO-LiPA HPV genotyping kit was used to determine genotype. Human papillomavirus DNA was detected in 26 (21%) breast carcinomas. The most frequently detected HPV genotype was HPV-16 (92%), followed by HPV-6 (46%), HPV-18 (12%), and HPV-33 (4%). In 11 normal epithelium specimens adjacent to 11 HPV-16-positive carcinomas, 7 were HPV-16-positive. However, none of the normal breast tissue specimens adjacent to HPV-negative breast carcinomas were HPV-positive. The real-time PCR analysis suggested the presence of integrated form of viral DNA in all HPV-16-positive samples, and estimated viral load was low with a geometric mean of 5.4 copies per 10(4) cells. In conclusion, although HPV DNA was detected in 26 (21%) breast carcinomas and, in all HPV-16-positive cases, the HPV genome was considered integrated into the host genome, their low viral loads suggest it is unlikely that integrated HPV is aetiologically involved in the development of Japanese breast carcinomas that we examined.

Menopausal status influences the relationship between serum ghrelin levels and fat mass in healthy women

OBJECTIVE

To examine the relationships of fasting serum ghrelin levels to bone mass index (BMI) and body fat mass, focusing on the effects of menopausal status and changes in fat distribution in women after menopause.

DESIGN

An observational study.

PATIENTS

Fifty-nine pre-menopausal and 31 post-menopausal healthy Japanese women volunteers were enrolled in the present study.

MEASUREMENTS

Total and regional body fat mass weight was measured by dual energy x-ray absorptiometry. Serum ghrelin was measured. Relationships of serum ghrelin levels to weight, BMI, total body and regional fat mass weight were separately examined in post-menopausal and pre-menopausal women.

RESULTS

Serum ghrelin levels were significantly inversely correlated with weight (r = -0.377, p < 0.05, Pearson's correlation test), right arm fat mass (r = -0.408, p < 0.05), left arm fat mass (r = -0.386, p < 0.05), trunk fat mass (r = -0.361, p < 0.05) and total body fat mass (r = -0.383, p < 0.05) in the post-menopausal women but not in pre-menopausal women.

CONCLUSIONS

Menopausal status may influence the relationship between serum ghrelin levels and fat mass in healthy women.

The leptin receptor in human osteoblasts and the direct effect of leptin on bone metabolism

It is important to elucidate whether the leptin receptor, especially the long signal-transducing form of the leptin receptor (OB-Rb) is expressed in human osteoblasts. We detected the expression of human OB-Rb in cultured commercially available human osteoblasts (NHOst cells) using real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR). After confirming the expression of OB-Rb, we investigated the effect of leptin on NHOst cells. Leptin enhanced cell proliferation of the cells shown by the MTT assay. Furthermore, leptin changed the copy numbers of Bax and Bcl-2 mRNAs in the cultured cells as shown by real-time quantitative RT-PCR, although the effect was not consistent. Leptin did not change the production of osteocalcin and osteopontin by the cells. Leptin did not change the expression of OB-Rb mRNA in the cells. In conclusion, OB-Rb mRNA is expressed in cultured commercially available human osteoblasts. Leptin may have some effects on bone metabolism by directly modulating cell proliferation and apoptosis of osteoblasts in humans.

Relationships among serum testosterone levels, body fat and muscle mass distribution in women with polycystic ovary syndrome

We investigated the relationships among serum testosterone levels, body fat and muscle mass distribution in women with polycystic ovary syndrome (PCOS). Subjects were 67 women with PCOS (mean age +/- standard deviation, 28.8 +/- 6.6 years). Baseline characteristics included age and height. Trunk-leg fat ratio and trunk-leg muscle ratio were assessed with dual-energy x-ray absorptiometry. Serum testosterone and dehydroepiandrosterone sulfate levels were measured with radioimmunoassays. Relationships among serum testosterone levels, body fat and muscle mass distribution were investigated using Pearson and partial correlation tests. Serum testosterone levels were positively correlated with trunk-leg fat ratio (r = 0.398, P < 0.01), but were inversely correlated with trunk-leg muscle ratio (r = -0.332, P < 0.05). Trunk-leg muscle ratio was inversely correlated with trunk-leg fat ratio (r = -0.360, P < 0.01). Serum testosterone levels were still correlated with trunk-leg fat ratio (r = 0.500, P < 0.001) and trunk-leg muscle ratio (r = -0.286, P < 0.05), after adjusting for age and height. Trunk-leg fat ratio was still correlated with trunk-leg muscle ratio, after adjusting for age, height, and serum testosterone levels. Based on these results, we concluded that higher serum testosterone levels may contribute to the upper body fat distribution and peripheral muscle mass distribution. In addition, peripheral muscle mass distribution may also contribute to the upper body fat distribution.

Relationship of androgens to muscle size and bone mineral density in women with polycystic ovary syndrome

OBJECTIVE

To investigate the relationship of androgens to regional muscle size and bone mineral density (BMD) in women with polycystic ovary syndrome (PCOS).

METHODS

Seventy-one amenorrheic and right-side dominant women with PCOS (mean age +/- standard deviation 28.1 +/- 6.7 years) were enrolled. Baseline characteristics included age, height, weight, and body mass index (BMI). Regional BMD and lean mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Serum levels of testosterone, dehydroepiandrosterone sulfate (DHEAS), and androstenedione were measured by radioimmunoassay. Correlations between regional BMD and variables were investigated using a Pearson correlation test and multiple regression analysis.

RESULTS

Serum testosterone levels correlated significantly with lean mass of the left arm, right arm, trunk, left leg, and right leg (r =.34, P <.05 to r =.50, P <.01). Regional lean mass correlated significantly with respective regional BMD (r =.30, P <.05 to r =.68, P <.001). These relationships remained significant after adjusting for age, height, and weight. Serum testosterone levels were not correlated with BMD of the bilateral arms and lumbar spine. Although serum testosterone levels correlated with leg BMD (r =.34, P <.05 to r =.45, P <.01), significance did not persist after adjusting for respective regional lean mass.

CONCLUSION

Testosterone influences regional BMD through increasing regional muscle mass in women with polycystic ovary syndrome.

Perioperative changes in circulating leptin levels in women undergoing total abdominal hysterectomy

To investigate the effects of total abdominal hysterectomy on circulating leptin levels, 16 pre- and 8 postmenopausal patients with uterine leiomyoma or carcinoma in situ of the uterine cervix were enrolled. Serum levels of leptin and fasting blood sugar (FBS) were determined before (day -7) and after surgery (day +1 and +7). Body mass index (BMI) was recorded at day -7 and +7. Anesthesia duration, surgical duration, hematology, and blood loss during surgery were recorded. Relations of these variables to serum leptin levels were investigated. Serum leptin levels rose from 7.3+/-4.7 ng/mL to 9.3+/-5.8 ng/mL at day +1 (P < 0.01), then decreased to 4.9+/-3.0 ng/mL at day +7 (P < 0.05 vs. values at day -7 and +1). FBS levels also rose from 89.4+/-7.5 mg/dL to 119.3+/-24.0 mg/dL (P < 0.01), then returned to normal at day +7 (96.2+/-9.0 mg/dL). However, there was no significant correlation observed between FBS and leptin levels at each time point (r < or = 0.22). BMI decreased from 22.7+/-3.0 kg/m2 to 21.7+/-2.9 kg/m2 at day +7 (P < 0.001). At day -7 and +7, leptin levels were positively correlatd with BMI (r = 0.79, P < 0.001 and r = 0.71, P < 0.001, respectively). Circulating leptin levels were increased on day one after total abdominal hysterectomy.

Chronic estrogen treatment replaces striatal dopaminergic function in ovariectomized rats

Eight-week-old female Sprague-Dawley rats were divided into three groups: ovariectomized rats (OVX); ovariectomized rats treated with estradiol valerate (E2), 20 microg subcutaneously (s.c.) twice weekly for 12 weeks (OVX+E2 group); and sham-operated control rats treated with vehicle alone (controls). Spontaneous locomotor activity was measured for 24 h, and then again after the administration of methamphetamine (1 mg/kg, i.p.). In addition, striatal contents of dopamine (DA) and its metabolites were measured. Using an in vivo microdialysis technique, changes in extracellular striatal dopamine concentration were studied in a separate set of similarly treated rats after the administration of methamphetamine (0.2 mg/kg, i.p.). Spontaneous locomotor activity decreased in the OVX group, and estradiol replacement reversed this decreased activity. No significant differences were observed in the contents of DA and its metabolites at the striatum among the three groups. The basal output of DA at the striatum was lower in the OVX group than in those of the other two groups. Extracellular DA concentration following methamphetamine administration was also lower in the rats of OVX group. These results indicate that ovariectomy decreases spontaneous locomotor activity, response to methamphetamine, and striatal DA release in the female rats. Chronic replacement of estrogen reversed spontaneous locomotor activity and DA release by the striatum. These results suggest that chronic administration of estrogen may be beneficial in the treatment of female menopausal patients with Parkinson's disease.

Body fat distribution and body composition during GnRH agonist therapy

OBJECTIVE

To identify the effects of GnRH agonist therapy on body composition (lean and fat mass components) and body fat distribution.

METHODS

Fifteen women with uterine leiomyomas were given a GnRH agonist (leuprorelin acetate, 3.75 mg) monthly for 4 months. Weight, height, and body mass index (BMI, weight/height) were recorded. Regional and total body composition, trunk-leg fat ratio, bone mineral density of the lumbar spine (L2-L4), and total body were assessed by whole-body scanning with dual-energy x-ray absorptiometry before and after treatment. Uterine volume was measured by transabdominal ultrasonography.

RESULTS

The mean (+/- standard deviation [SD]) lean mass of total body, trunk, and leg decreased significantly (36.3 +/- 4.9 to 35.4 +/- 4.4 kg, P <.01; 18.8 +/- 2.8 to 18.1 +/- 2.8 kg, P <.05; and 11.4 +/- 1.8 to 11.1 +/- 1.6 kg, P <.05; respectively), whereas body fat mass, percentage of body fat, and trunk fat mass increased significantly (20.8 +/- 4.8 to 21.8 +/- 4.6 kg, P <.01; 34.9 +/- 5.9 to 36.5 +/- 5.2%, P <.01; and 8.6 +/- 3.0 to 9.3 +/- 3.0 kg, P <.01; respectively). Trunk-leg fat ratio increased significantly (1.03 +/- 0.32 to 1.12 +/- 0.33, P <.05). Weight, BMI, arm tissue composition (lean and fat mass components), and leg fat mass did not change during 4 months of GnRH agonist therapy. Bone mineral density and uterine volume decreased significantly.

CONCLUSION

Hypogonadism by GnRH agonist therapy induces lean mass loss, increased adiposity overall, and upper body fat accumulation.

Waist to hip circumference ratio as a significant predictor of preeclampsia, irrespective of overall adiposity

OBJECTIVE

To investigate whether abnormal body fat distribution is a significant predictor of the development of preeclampsia, irrespective of overall adiposity.

METHODS

Twenty-six women with preeclampsia and 198 control women were enrolled. Waist to hip circumference ratio (WHR), body weight (BW), and body mass index (BMI, wt/ht2) were measured early in pregnancy (< 9 weeks of gestational age). Age, height, parity, tobacco usage, education period, gestational duration, and weight gain during pregnancy were also recorded for each subject.

RESULTS

WHR, BMI, and BW early in pregnancy were significantly higher in the preeclampsia group (p < 0.0001). WHR, BMI, and BW positively correlated with the development of preeclampsia on univariate regression analysis (Standardized regression coefficient = 0.410, 0.387, and 0.363, respectively, p < 0.0001). On stepwise multiple regression analysis, WHR still correlated with the development of preeclampsia irrespective of BMI and BW. When the WHR predictive of the development of preeclampsia was set at 0.9, the sensitivity was 46.2% (12/26), which was significantly better than that of 25 of BMI (19.2%, 5/26; p < 0.05).

CONCLUSION

Higher WHR is a significant predictor of the development of preeclampsia. This relation is irrespective of overall adiposity.

Relationships between serum leptin level and regional bone mineral density, bone metabolic markers in healthy women

BACKGROUND

Leptin might affect bone metabolism. This study was performed to investigate the relationship of leptin to bone metabolism in detail in premenopausal and postmenopausal healthy women.

METHODS

The relationships between serum leptin level and bone mineral density of several regional sites of the body as well as whole body, along with bone metabolic markers, were examined in 47 premenopausal and 29 postmenopausal healthy women.

RESULTS

Serum leptin level was weakly correlated with bone mineral density of pelvis (Pearson's correlation coefficient r=0.39, p<0.05) and left leg (r=0.41, p<0.01) in the premenopausal women, although the correlation decreased after adjustment for BMI. There was no significant relationship between serum leptin level and whole body bone mineral density both in the premenopausal and postmenopausal women. Serum leptin level was correlated with serum alkaline phosphatase (r=0.56, p<0.001) and urinary deoxypyridinoline/cr (r=-0.32, p<0.05) by Pearson's correlation test in the premenopausal women; the relationships were maintained even after adjustment for BMI (r=0.50 and -0.48, respectively).

CONCLUSIONS

Leptin is not a key regulator of bone metabolism, although it may have some effects on bone metabolic markers and BMD regionally in premenopausal women.

Body fat distribution as a risk factor of endometrial cancer

OBJECTIVE

To investigate the relative contributions of upper body fat distribution and overall adiposity to endometrial cancer risk.

METHODS

Subjects were 63 postmenopausal women with endometrial cancer aged less than 70 years and 201 age-matched controls. Age, age at menopause, years since menopause, height, weight, and body mass index were recorded at the time of admission. The trunk-leg fat ratio, body fat mass, trunk fat mass, and the percentage of body fat were measured by dual-energy X-ray absorptiometry.

RESULTS

Trunk-leg fat ratio was higher in endometrial cancer patients than in controls (1.40 +/- 0.59 vs 1.23 +/- 0.39, p < 0.05). Whereas, other variables including age at menopause, percentage of body fat, body fat mass, and body mass index did not differ between the 2 groups. On stepwise multiple regression analysis, the trunk-leg fat ratio was still correlated with the presence of endometrial cancer (p < 0.05).

CONCLUSIONS

Upper body fat distribution rather than overall adiposity is associated with endometrial cancer risk.

A novel mutation of desert hedgehog in a patient with 46,XY partial gonadal dysgenesis accompanied by minifascicular neuropathy

We describe a patient with 46,XY partial gonadal dysgenesis (PGD) who presented with polyneuropathy. Sural nerve pathology revealed peculiar findings characterized by extensive minifascicular formation within the endoneurium and with a decreased density of myelinated fibers. We found, in the patient, a homozygous missense mutation (ATG-->ACG) at the initiating codon in exon 1 of the desert hedgehog (DHH) gene, which predicts a failure of translation of the gene. The same heterozygous mutation was found in the patient's father. This is the first report of a human DHH gene mutation, and the findings demonstrate that mutation of the DHH gene may cause 46, XY PGD associated with minifascicular neuropathy.

Relation of estrogen receptor expression in endometrial cancer specimens to bone mineral density

BACKGROUND

To investigate the relation of estrogen and progesterone receptor (ER and PR) expression in endometrial cancer specimens to bone mineral density (BMD).

MATERIALS AND METHODS

Subjects were 48 postmenopausal women with endometrial cancer treated with hysterectomy. Baseline characteristics included age, years since menopause (YSM), height, weight, and body mass index (BMI). Lumbar spine BMD (L2-4), the ratio of trunk fat to leg fat mass (trunk-leg fat ratio), body fat mass, and the percentage of body fat were measured by dual-energy x-ray absorptiometry (DEXA). ER and PR expression in endometrial cancer specimens were determined immunohistochemically.

RESULTS

Of 48 women, 32 (66.7%) were ER/PR-positive, nine (18.8%) were ER/PR-negative, three (6.3%) were ER-positive/PR-negative, and four (8.3%) were ER-negative/PR-positive. Lumbar spine BMD and trunk-leg fat ratio were significantly higher in women with ER-positive than in those with ER-negative (p<0.05), but other variables did not differ between the two groups. BMD and baseline- and anthropometric characteristics did not differ between the two groups divided by the presence or absence of PR expression.

CONCLUSIONS

ER expression in endometrial cancer specimens is associated with higher lumbar spine BMD.

Differences in umbilical venous and arterial leptin levels by mode of delivery

OBJECTIVE

To investigate the differences in umbilical venous and arterial leptin levels by mode of delivery.

METHODS

Subjects were 30 mothers who had elective cesarean deliveries and 34 mothers who had vaginal deliveries. Umbilical venous and arterial leptin levels were measured immediately after delivery. Maternal age, neonatal gender, neonatal birth weight, placental weight, and gestational duration were recorded. Inter- and intragroup comparisons were made in umbilical venous and arterial leptin levels and obstetric variables. Significant determinants of differences in umbilical venous and arterial leptin levels were investigated.

RESULTS

Umbilical venous and arterial leptin levels were higher in the vaginal delivery group (n = 34) than in the cesarean group (n = 30) (P <.01). In the vaginal delivery group, umbilical venous leptin levels were significantly higher than arterial leptin levels (P <.001). These differences were still significant after adjustment for neonatal gender, neonatal birth weight, and placental weight. However, in the cesarean group, leptin levels did not differ between umbilical vein and artery.

CONCLUSION

Placental leptin release is augumented during advanced labor.

Effect of non-weight-bearing body fat on bone mineral density before and after menopause

OBJECTIVE

To investigate the difference in the effect of non-weight-bearing body fat mass on bone mineral density between premenopausal and postmenopausal women.

METHODS

We studied 252 regularly menstruating premenopausal women and 213 postmenopausal women with right side dominance. Age, years since menopause (in postmenopausal women), height, weight, and body mass index were recorded. Bone mineral density of non-weight-bearing sites (ie, arms), weight-bearing sites (ie, lumbar spine including L2-4 and legs), and body fat mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Body fat mass was also measured by dual energy x-ray absorptiometry.

RESULTS

Body fat mass did not differ between groups. In postmenopausal women, body fat mass correlated positively with bone mineral density of the left leg (r =. 41, P <.001), right leg (r =.36, P <.001), left arm (r =.31, P <. 001), and lumbar spine (r =.27, P <.001). The correlation between body fat mass and bone mineral density of the left arm remained significant after adjusting for age, years since menopause, and height. In premenopausal women, body fat mass correlated positively with bone mineral density of left leg (r =.37, P <.001) and right leg (r = 0.31, P <.001), but correlated weakly with bilateral arms (r < or =.19) and lumbar spine bone mineral density (r = 0.13, P <.05).

CONCLUSION

The effect of non-weight-bearing body fat on bone mineral density was greater in postmenopausal than premenopausal women.

Relationship between body fat distribution and bone mineral density in premenopausal Japanese women

OBJECTIVE

To investigate the relationship between body fat distribution and bone mineral density (BMD).

METHODS

Subjects were 282 premenopausal women (mean age +/- standard deviation [SD], 38.8 +/- 8.5 years; range, 20-51 years) with regular menstrual cycles. Baseline characteristics included age, age at menarche, height, weight, body mass index ([BMI], weight/height(2)), and parity. Anthropometric characteristics including the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio), percentage of body fat, and total body lean mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Lumbar spine BMD (L2-4) was also measured by dual-energy x-ray absorptiometry. Correlations of BMD to baseline and anthropometric characteristics were investigated using univariate and multivariate analysis.

RESULTS

Although height, trunk-leg fat ratio, and total body lean mass were positively correlated with lumbar spine BMD (r =.18, P <.01; r =.17, P <.01; and r =.25, P <.001; respectively), age at menarche was inversely correlated with BMD (r = -.19, P <.01). On multivariable analysis, trunk-leg fat ratio, height, age at menarche, and total body lean mass were still independently correlated with lumbar spine BMD (P <. 05). However, total fat mass was not correlated with BMD.

CONCLUSION

Upper body fat distribution rather than overall adiposity is associated with lumbar spine BMD in premenopausal women. Humoral factors associated with body fat mass appear to influence lumbar spine BMD.

The effects of physical exercise on body fat distribution and bone mineral density in postmenopausal women

OBJECTIVE

The present cross-sectional study investigated the effects of physical exercise on body fat distribution and bone mineral density (BMD).

METHODS

Subjects were 57 postmenopausal women (mean age, 60.5+/-6.4 years) who had exercised regularly for at least 2 years. Controls were 130 age-matched sedentary women. Age, years since menopause (YSM), height, weight, and body mass index (BMI, wt./ht.(2)) were recorded. Total fat mass, percentage of body fat, trunk fat mass, leg fat mass, the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio), total body lean mass, percentage of body lean, and lumbar spine BMD (L2-L4) were measured by dual-energy X-ray absorptiometry.

RESULTS

Baseline characteristics and leg fat mass did not differ between the two groups. Total fat mass, percentage of body fat, trunk fat mass, and trunk-leg fat ratio were lower (P<0.05, P<0.01, P<0.01 and P<0.001, respectively), while total body lean mass, percentage of body lean mass, and lumbar spine BMD were higher in exercising women (P<0.05, P<0.05 and P<0.01, respectively). Performing physical exercise was inversely correlated with trunk-leg fat ratio (standardized regression coefficient=-0.178, P<0.01), but positively correlated with BMD (0. 203, P<0.01) irrespective of age, height, YSM, and total fat mass.

CONCLUSION

Physical exercise has beneficial effects on body fat distribution and BMD in postmenopausal women. Reduction of upper body fat distribution with physical exercise may be more attributable to the decrease in trunk fat mass.

Difference in the effect of adiposity on bone density between pre- and postmenopausal women

OBJECTIVES

Elevated bone mineral density (BMD) in obese women is partially attributable to the higher circulating estrogen levels derived from extraglandular aromatization in adipose tissue. However, it remains unclear whether there is an effect of overall adiposity on BMD in both pre- and postmenopausal women. The difference in the effect of overall adiposity on BMD between pre- and postmenopausal women was investigated.

MATERIALS AND METHODS

Subjects were 296 premenopausal women with regular menstruation and 233 postmenopausal women. Age, age at menarche, years since menopause (YSM, in postmenopausal women), weight, height, and body mass index were recorded. Total fat mass amount, lean mass amount, and percentage of body fat were measured by whole body scanning with dual-energy X-ray absorptiometry (DEXA). Lumbar spine BMD (L2-L4) was measured by DEXA. In each group, significant determinants of BMD were investigated using univariate and stepwise multiple regression analysis.

RESULTS

In postmenopausal women, YSM, lean mass amount, total fat mass amount, and height were significant determinants of BMD (R(2)=0.273, P<0.001). In premenopausal women, only two variables including lean mass amount and age at menarche were significant determinants of lumbar spine BMD (R(2)=0.110, P<0.001), but total fat mass amount and percentage of body fat were not significant determinants of BMD.

CONCLUSION

The effect of overall adiposity on BMD is more prominent in postmenopausal women than in premenopausal women.

Association of upper arm circumference at muscle flexion with lumbar spine bone mineral density

We investigated the association of upper arm circumference at muscle flexion with lumbar spine (L2-L4) bone mineral density (BMD) in 252 postmenopausal Japanese women (mean age, 62.0 +/- 7.6 years; range, 43-78 years) with right-side dominance. Age, age at menopause, years since menopause (YSM), weight, and height were recorded. Dominant upper arm circumference (cm) was measured at muscle flexion. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry (DXA). Correlations between BMD and variables were determined using Pearson's correlation coefficient. Significant predictors of the lumbar spine BMD were determined using stepwise multiple regression analysis. Upper arm circumference, weight, and height were positively correlated with BMD (r = 0.397, 0.343, and 0.323, respectively), whereas YSM and age were inversely correlated with BMD (r = -0.415 and -0.392, respectively). On stepwise multiple regression analysis, YSM, upper arm circumference, and weight were significant predictors of BMD (R2 = 0.322, P < 0.0001). Predicted value of the lumbar spine BMD was calculated by the following formula: Predicted BMD = 0.249 - 0.0078 (YSM) + 0.016 (upper arm circumference) + 0.0046 (weight). Dominant upper arm circumference at muscle flexion in combination with YSM and weight is a useful predictor of lumbar spine BMD.

The contribution of menopause to changes in body-fat distribution

OBJECTIVE

To investigate whether menopause contributes to changes in body-fat distribution, irrespective of aging or obesity.

METHODS

The subjects were 545 premenopausal (aged 16-55 years; mean +/- standard deviation, 37.7 +/- 9.1 years) and 219 postmenopausal (aged 45-65 years, 58.0 +/- 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk-leg ratio) was estimated by dual-energy X-ray absorptiometry. The trunk-leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk-leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationship of the trunk-leg ratio to YSM or age after adjusting for BMI was investigated.

RESULTS

The trunk-leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk-leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk-leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk-leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk-leg ratio, independent of the BMI (p < 0.01).

CONCLUSIONS

Menopause contributes to a change in body-fat distribution, irrespective of aging or obesity.

Serum androgen levels and muscle mass in women with polycystic ovary syndrome

OBJECTIVE

To relate serum androgen levels and muscle size in women with polycystic ovary syndrome (PCOS).

METHODS

Forty-eight women with PCOS were studied. Baseline characteristics included age, height, weight, and hirsutism. Total-body lean mass was measured by wholebody scanning with dual-energy x-ray absorptiometry, and the lean mass index (total-body lean mass/height2, kg/m2) was calculated. Trunk-leg fat mass ratio (trunk-leg fat ratio) was assessed by dual-energy x-ray absorptiometry. Serum testosterone, dehydroepiandrosterone sulfate, and androstenedione levels were measured by radioimmunoassay. Subjects were arbitrarily divided into two groups according to lean mass index (lean mass index at least 14 kg/m2, n = 24; or less than 14 kg/m2, n = 24). Baseline characteristics and serum androgen levels were compared between the groups. In all subjects, lean mass index was correlated with age, height, trunk-leg fat ratio, and serum androgen levels.

RESULTS

Although trunk-leg fat ratio, serum testosterone and androstenedione levels, and the prevalence of hirsutism were significantly higher in women with a lean mass index at least 14 kg/m2, age and height did not differ significantly between the groups. Trunk-leg fat ratio and serum testosterone and androstenedione levels correlated significantly with lean mass index (r = .68, .75, and .54, respectively). Hirsutism also correlated with lean mass index (standardized regression coefficient = .49; P<.05).

CONCLUSION

Muscle size in women with PCOS correlated positively with serum androgen levels and upper body-fat distribution, independent of height.

Differences in umbilical cord serum lipid levels with mode of delivery

OBJECTIVE

To investigate whether umbilical cord serum lipid levels differ with mode of delivery.

DESIGN

Retrospective observation study.

POPULATION

Two hundred and ninety mothers aged 29.1 years (SD 4.7) who had vaginal delivery, and 44 mothers aged 30.4 years (SD 4.7) who had elective caesarean section were enrolled.

MAIN OUTCOME MEASURES

Maternal and umbilical cord blood were obtained immediately after delivery. Serum lipid levels including total cholesterol, high density lipoprotein cholesterol, saturated fatty acid, mono-unsaturated fatty acid and polyunsaturated fatty acid were measured. Obstetric variables and serum lipid levels were compared between the two groups. In each group the correlations of fetal serum lipid levels with maternal serum lipid levels were investigated.

RESULTS

There were no significant differences in maternal age, neonatal weight, gestational duration, placental weight and neonatal gender distribution between the two groups. Only the two fetal serum lipid levels (including total cholesterol and non-high density lipoprotein cholesterol) showed a correlation with maternal fetal lipid levels with correlation coefficients > 0.3 in the caesarean section group. However, saturated fatty acid, mono-unsaturated fatty acid and total fatty acid levels in the non-high density lipoprotein low density lipoprotein, very low density lipoprotein, intermediate density lipoprotein and free fatty acid fraction in the umbilical cord serum were significantly higher in the vaginal delivery cases (P < 0.01).

CONCLUSIONS

Umbilical cord serum levels of saturated and mono-unsaturated fatty acids increase during vaginal delivery.

Bone mineral density in postmenopausal women with endometrial cancer

OBJECTIVE

The aim of the study was to investigate the relationship between endometrial cancer and bone mineral density (BMD).

MATERIALS AND METHODS

A total of 55 postmenopausal Japanese women with well-differentiated adenocarcinoma and 284 age-matched healthy women were studied. Baseline characteristics including age, age at menopause, years since menopause (YSM), weight, height, body mass index (BMI), prior menstrual history, parity, and fertility were recorded for each subject. Lumbar spine BMD (L2-4), and body fat indices including body fat mass amount and percent body fat were measured by dual-energy X-ray absorptiometry. These variables were compared between the two groups. In all subjects (n = 339), correlations of BMD with the presence of endometrial cancer, baseline characteristics, and body fat indices were investigated, using univariate and multiple regression analyses.

RESULTS

BMD, weight, BMI, body fat mass amount, and percent body fat were significantly higher in women with endometrial cancer. Other baseline characteristics did not differ between the two groups. Age at menopause, height, weight, BMI, percent body fat, and body fat mass amount were positively correlated with BMD, while age and YSM were inversely correlated with BMD. After adjusting for age, YSM, and height, the presence of endometrial cancer was still correlated with BMD (P < 0.05). However, after adding body fat mass amount to these three adjusted variables, there was no correlation between the presence of endometrial cancer and BMD.

CONCLUSION

Women with endometrial cancer have a high BMD. This is attributable to high body fat mass amount in this disease.

A longitudinal study of the effect of vitamin K2 on bone mineral density in postmenopausal women a comparative study with vitamin D3 and estrogen-progestin therapy

OBJECTIVES

To investigate the effect of vitamin K2 treatment for a year on spinal bone mineral density (BMD) in postmenopausal women, comparing with vitamin D3 hormone replacement therapy and to determine the factors which affect the efficacy of vitamin K2 therapy.

SUBJECTS AND METHODS

Seventy-two postmenopausal women were randomized into four groups and treated with respective agents. Before the therapy, 6 and 12 months after the treatment, their lumbar spine BMD were measured by dual energy X-ray absorptiometry. The rates of change in BMD (delta BMD) were calculated. Correlations of BMD with age, year since menopause and the initial BMD were determined.

RESULTS

Vitamin K2 suppressed the decrease in spinal BMD as compared with no treatment group. BMD in women treated with vitamin K2 was inversely correlated with their age (r = -0.54; P < 0.05).

CONCLUSIONS

Vitamin K2 therapy may be a useful method for preventing postmenopausal spinal bone mineral loss. In addition, the therapy should be started early in postmenopausal period.

Relationship between body mass index and transvaginal ultrasonographic endometrial thickness in postmenopausal women

OBJECTIVE

To investigate the relationship between body mass index (BMI) and transvaginal ultrasonographic endometrial thickness.

MATERIALS AND METHODS

Two hundred and twelve postmenopausal Japanese women (mean age, 62.1+/-8.0 years; range 47-85) with histologically proven normal endometrium and with endometrial thickness more than 1.0 mm were studied. Baseline characteristics including age, years since menopause, and BMI were recorded for each subject. The relationship between sonographic endometrial thickness and baseline characteristics was assessed in each subject.

RESULTS

BMI was significantly correlated with endometrial thickness (r=0.40, p<0.001), but age and years since menopause were not correlated. On stepwise regression analysis only BMI was still associated with endometrial thickness (R2=0.16, p<0.001).

CONCLUSION

Sonographic endometrial thickness differs with BMI in postmenopausal women. Higher BMI is associated with greater endometrial thickness.

Menstrual disorders in patients undergoing chronic hemodialysis

OBJECTIVE

To investigate the etiology of menstrual disorders in patients undergoing chronic hemodialysis (CHD).

METHODS

The menstrual histories, along with hormonal, biochemical, and hematological data, were investigated in 25 reproductive-aged CHD patients.

RESULTS

All subjects had had regular menstrual cycles before entering CHD therapy. Of the 20 women who developed amenorrhea after beginning CHD therapy, 8 showed a return to their regular cycles and 6 improved to oligomenorrhea, 3 months to 66 months later, while 6 remained amenorrheic. The serum prolactin (PRL) levels were significantly higher in the patients (n = 9) with normogonadotropic amenorrhea or oligomenorrhea than in patients (n = 13) with regular cycles (53.6 +/- 36.2 vs 27.8 + 15.2 ng/ml, p < 0.05). The serum LH levels were high in both groups. In a cross-sectional study, the serum PRL levels gradually decreased with longer duration of dialysis.

CONCLUSIONS

Patients undergoing CHD are likely to develop menstrual disorders. Hyperprolactinemia in part contributes to these menstrual disorders. However, menstrual disorders in CHD patients tend to improve during long-term follow-up, because of the gradual decrease in serum PRL levels during long-term CHD therapy.

The effect of menopause on regional and total body lean mass

OBJECTIVES

To investigate the effect of menopause on regional and total body lean mass.

METHODS

Evaluation of 123 healthy premenopausal women (40.6 +/- 10.8 years) and 123 healthy postmenopausal women (61.8 +/- 7.5 years). All subjects were right side dominant. Regional (head, bilateral arms, trunk, and bilateral legs) and total body lean mass were measured using whole-body scanning by dual-energy X-ray absorptiometry. Baseline characteristics including age, height, weight, and menopausal state were recorded. These variables were compared between pre- and postmenopausal women. In all subjects, correlations between regional or total body lean mass and baseline characteristics were investigated using univariate and multiple regression analyses.

RESULTS

Height, and lean mass of the trunk, bilateral legs and total body were significantly lower in postmenopausal women than in premenopausal women, while lean mass of the bilateral arms did not differ between the two groups. On univariate regression analysis, bilateral arms lean mass was positively correlated with height (P < 0.001). Trunk, bilateral legs, and total body lean mass were inversely correlated with age and menopausal state (P < 0.001), but were positively correlated with height (P < 0.001). After adjusting for age and height, trunk lean mass was still correlated with menopausal state (P < 0.01).

CONCLUSIONS

Menopause induces lean mass loss, independent of aging and height. Trunk lean mass is more prone to decline with menopause than lean mass of other sites.

The relationship between maternity blues and thyroid dysfunction

OBJECTIVE

To investigate whether there is evidence of thyroid dysfunction in women with maternity blues.

METHODS

Twenty women with maternity blues and 20 age-matched normal controls were enrolled in our study. The serum levels of 6 kinds of thyroid hormones, cortisol, and prolactin (PRL) of the 2 groups were compared, and obstetric variables were recorded for each subject. In addition, significant variables correlating with the development of maternity blues were determined by stepwise regression analysis.

RESULTS

The serum-free triiodothyronine (FT3) level at 5 days puerperium was lower in the maternity blues group (p < 0.05) than in the control group. In the maternity blues group, the FT3 level at 5 days puerperium was lower than that at 37 weeks of pregnancy and at 1 month puerperium (p < 0.05). The reverse T3 levels and TSH levels at 5 days postpartum were higher in women with maternity blues than among the controls (p < 0.05). The proportion of primiparous women was higher in the maternity blues group (p < 0.01). Stepwise regression analysis revealed that the low FT3 level and primiparity were significantly correlated with the development of maternity blues (R2 = 0.281, p < 0.001).

CONCLUSION

Thyroid dysfunction might be associated with the development of maternity blues.

A woman with three ectopic pregnancies after in-vitro fertilization and embryo transfer

Although a higher incidence of ectopic pregnancy has been reported after in-vitro fertilization (IVF) and embryo transfer, three ectopic pregnancies in the same woman is very rare. A patient of 32 years underwent IVF-embryo transfer six times within 3 years. Three of four conceptions resulted in ectopic pregnancies. The first involved simultaneous intrauterine and left tubal pregnancy, the second was a right tubal pregnancy, and the third was a right interstitial pregnancy. In IVF-embryo transfer, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.

Predictors of bone mineral loss in patients with ovarian cancer treated with anticancer agents

OBJECTIVE

To identify factors predicting bone mineral loss during anticancer chemotherapy.

METHODS

Fifteen women (mean age 38.2 +/- 7.8 years; range 30-46 years) with ovarian cancer who had been treated with cisplatin-adriamycin-cyclophosphamide for six cycles every 4 weeks following surgical cytoreductin were studied. Bone mineral density (BMD) of the lumbar spine (L2-L4) was measured by dual-energy x-ray absorptiometry before and after chemotherapy. Fifteen age-matched women whose ovaries had been removed surgically for other reasons. served as controls. None of the patients had received hormonal treatment. The two groups were compared for percentage change of BMD (BMD%) over the same period. In the chemotherapy group, total fat mass, body fat ratio, total lean mass, percent lean, and ration of trunk fat to leg fat were measured by dual-energy x-ray absorptiometry. Lean loss during chemotherapy was also calculated. These variables were compared before and at the end of chemotherapy. Possible correlations of baseline variables with BMD% were determined in univariate and stepwise regression analysis.

RESULTS

Mean ( +/- standard deviation) BMD decreased to 87.4 +/- 2.1% after six cycles of chemotherapy and 97.6 +/- 0.4% after 6 months in controls, but the greatest decrease was observed in the chemotherapy group (P < .001). Although baseline lean mass, baseline BMD, body weight, and lean loss during chemotherapy were correlated with BMD% in univariate analysis, baseline lean mass was still significant in stepwise regression analysis.

CONCLUSION

Baseline lean mass predicts bone mineral lose with anticancer chemotherapy.

The effect of body composition on bone density in pre- and postmenopausal women

OBJECTIVES

To investigate the relative contribution of body composition (lean and fat) to bone mineral density (BMD), 196 premenopausal and 128 postmenopausal Japanese women were enrolled.

METHODS

Total fat mass, total lean mass, lumbar BMD (L2-L4), and total body BMD were measured by dual-energy X-ray absorptiometry (DEXA, Hologic QDR 2000, MA. USA). Physical characteristics were also recorded for each subject. Correlation between BMD and variables were calculated for each of the two groups in single and stepwise regression analyses.

RESULTS

Total lean mass was significantly higher in premenopausal women than postmenopausal women (P < 0.0001), while body weight, body mass index, and total fat mass were not different between the two groups. In stepwise regression analysis, total lean mass was the most powerful determinant of lumbar BMD and total body BMD in premenopausal women. In postmenopausal women, total fat mass was the most significant determinant of lumbar BMD, while total lean mass was the most significant determinant of total body BMD.

CONCLUSIONS

These findings suggest that there is a difference between pre- and postmenopausal women in the relative contribution of lean and fat mass. Total lean mass is the most significant determinant of BMD in premenopausal women. On the other hand, total fat mass may have some advantages in maintaining BMD in postmenopausal women.

Correlation of body fat distribution with grade of endometrial cancer

To elucidate whether body fat distribution correlates with the grade of endometrial cancer, we studied 74 postmenopausal women with endometrial cancer (mean age 62.4 +/- 6.6 years, range 49-78 years). The subjects were divided into three groups as follows: well-differentiated adenocarcinoma (G1 group; N = 53), moderately differentiated adenocarcinoma (G2 group; N = 11), and poorly differentiated adenocarcinoma (G3 group; N = 10). Four body fat indices [total fat weight (g), body fat ratio (%), trunk fat weight (g), and weight ratio of trunk fat to leg fat (trunk/leg ratio)] were measured by dual-energy X-ray absorptiometry. Baseline characteristics and body fat indices in the three groups were compared. In all subjects, the correlations of these variables with the grade of adenocarcinoma were investigated using single and stepwise regression analyses. Total fat weight, body fat ratio, and trunk fat weight showed slight increases with the grade of differentiation. The trunk/leg ratio in G1 group was significantly higher than in G2 and G3 groups. The trunk/leg ratio was significantly correlated with the grade in stepwise regression analysis. Body fat distribution in women with endometrial cancer may correlate with the grade of the adenocarcinoma.

Possible association of body-fat distribution with preeclampsia

OBJECTIVE

To investigate whether preeclampsia is associated with body-fat distribution.

METHODS

Twenty-two patients with preeclampsia (mean age: 31.9 +/- 6.0 years) and 126 controls without preeclampsia (mean age: 30.9 +/- 5.2 years) were enrolled in this study. We compared baseline characteristics and 4 body-fat indices measured by DEXA on Day 5 postpartum. The possible correlation between the variables and the development of preeclampsia was evaluated by multivariate analysis.

RESULTS

The body-fat ratio, the upper-half body-fat amount, upper-half-body body-fat amount ratio, and upper-/lower-half-body body-fat amounts ratio on Day 5 postpartum were significantly higher in the preeclampsia group. However, the upper-/lower-half-body body-fat amount ratio was best correlated with preeclampsia among variables in multivariate analysis.

CONCLUSION

Upper-body-fat distribution might be associated with the development of preeclampsia.

The relation between body-fat distribution and lipid metabolism in postmenopausal women

OBJECTIVE

To evaluate the relationship between body-fat distribution and lipid metabolism in postmenopausal women.

METHODS

Fifty-four women (mean: 61.8 +/- 7.8 years old) showing hyperlipidemia and 63 controls were enrolled in this study. Their baseline characteristics and body-fat indices, as measured by DEXA, were compared. The correlations between the serum-lipid levels and the variables were evaluated.

RESULTS

The amount of upper-half-body fat and the body-fat ratio were significantly higher in the hyperlipidemia group. In single-regression analysis, there were low levels of correlation between the serum TC levels and the amount of upper-half-body fat and the upper-body fat ratio. There was a low level of correlation between the serum TG level and the amount of upper-half-body fat, the upper-lower-half-body-fat ratios, and the upper-half-body-fat ratio. After adjusting for variables, the serum TC and TG levels best correlated with the amount of upper-half-body-fat (r = 0.458, r = 457, respectively).

CONCLUSION

In postmenopausal women, lipid metabolism is reflected in the amount of upper-half-body fat, irrespective of age and the body-mass index (BMI).

Effects of weight loss on bone mineral density in rats

OBJECTIVE

To evaluate the effects of weight loss on bone mineral density (BMD).

METHODS

Eight-week-old female rats were divided into 4 groups: Those in Group A received a restricted diet for 4 weeks; those in Group B received a restricted diet and were treated with estrogen; those in Group C were castrated; and those in Group D underwent sham operations. The rat's body weight (BW) and vaginal smears were checked, and their femoral BMD was measured.

RESULTS

The BW and BMD at 12 weeks were lower in Groups A and B than in Groups C and D; thereafter, however, these values increased for Groups A and B, but were still lower than those in Group D even at 20 weeks. In Group C, the BMD did not decrease, but it was significantly lower than that in Group D at 16 and 20 weeks. Group A showed continuous diestrus 2 weeks after dietary restriction began, but recovered to a 4-day cycle 2 weeks after the initiation of free food consumption.

CONCLUSION

Weight loss had a greater effect on BMD than hypoestrogenism.

Relationship between sonographic endometrial thickness and progestin-induced withdrawal bleeding

OBJECTIVE

To determine whether the response to the progestin challenge test can be predicted from the endometrial thickness measured sonographically.

METHODS

Progestin challenge tests were performed on 44 women with secondary amenorrhea, each of whom also had her endometrial thickness measured by transvaginal ultrasonography and her serum estradiol (E2) levels determined. The relationships between the response to the challenge test, endometrial thickness, and serum E2 levels were studied, as well as whether the presence or absence of withdrawal bleeding could be predicted from the endometrial thickness and serum E2 levels.

RESULTS

The endometrium was significantly thicker in 32 women who had withdrawal bleeding (10.3 +/-4.1 mm) than in the 12 who did not bleed (5.0 +/- 1.3 mm) (P < .001). The serum E2 level was also significantly higher in the positive group: 45.3 +/- 19.4 versus 18.6 +/- 8.0 pg/mL (P < .001). Endometrial thickness of 6.0 mm or more predicted the occurrence of withdrawal bleeding with an accuracy of 95.5%. Endometrial thickness was superior to the serum E2 level in predicting withdrawal bleeding.

CONCLUSION

Progestin-induced withdrawal bleeding can be predicted from the endometrial thickness measured sonographically.

Body fat distribution in women with polycystic ovary syndrome

OBJECTIVE

To investigate body fat distribution in women with polycystic ovary syndrome (PCOS).

METHODS

Body weight, body mass index (BMI), and six indices of body fat measured by dual-energy x-ray absorptiometry were compared in 40 women with PCOS and 97 age-matched controls. The possible correlations between the body fat characteristics and serum androgen levels were evaluated in the 40 PCOS women. Body fat distribution was classified into upper- (N = 24) and lower-half body type (N = 16), and androgen levels and the incidence of hirsutism were compared in the two types.

RESULTS

The BMI, body fat ratio, upper-half body fat ratio, and upper-half/lower-half body fat ratio were significantly higher in PCOS women than in controls. After adjustment for age, height, and body weight, the upper-half/lower-half body fat ratio was still significant (P < .001). The PCOS subjects exhibited a significant positive correlation between the upper-half/lower-half body fat ratio and dehydroepiandrosterone-sulfate (DHEA-S) levels (r = 0.607, P < .01) as well as testosterone levels (r = 0.585, P < .05). Dehydroepiandrosterone-sulfate and testosterone levels were significantly higher in those with the upper-half body type than in those with the lower-half body type (P < .001). After adjustment for confounding variables, only DHEA-S was still significantly higher in this body type (P < .05).

CONCLUSION

Serum DHEA-S levels seem to be associated with upper-half body fat distribution in women with PCOS, irrespective of body weight.