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Akihiro Takeda

Department of Ob/Gyn, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, 507-8522, Japan
gyendoscopy@gmail.com

Journal articles

2011
Akihiro Takeda, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2011)  Isobaric laparoendoscopic single-site surgery with wound retractor for adnexal tumors: a single center experience with the initial 100 cases.   Eur J Obstet Gynecol Reprod Biol 157: 2. 190-196 Aug  
Abstract: To report our experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery in 100 patients with adnexal tumors at a single center.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2011)  Early experience with isobaric laparoendoscopic single-site surgery using a wound retractor for the management of ectopic pregnancy.   Eur J Obstet Gynecol Reprod Biol 154: 2. 209-214 Feb  
Abstract: To report our initial experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery using a wound retractor for the management of ectopic pregnancy.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Hiromi Nakamura (2011)  Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report.   J Med Case Reports 5: 1. Aug  
Abstract: ABSTRACT: INTRODUCTION: Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known. CASE PRESENTATION: A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted. CONCLUSIONS: A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2011)  Temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy for cervical myoma.   Eur J Obstet Gynecol Reprod Biol Jun  
Abstract: OBJECTIVE: To report our initial experience with temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy (LAVH) for cervical myoma. STUDY DESIGN: Thirteen patients with cervical myoma were treated by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries from September 2008 to October 2010. Preoperative evaluation of cervical myoma was made by ultrasonography, magnetic resonance imaging and three-dimensional computerized tomographic angiography, and curative management was made by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. RESULTS: Nine patients with extracervical myoma and 4 patients with intracervical myoma were successfully managed by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. For extracervical myomas, the median extirpated uterine weight was 591g (range 360-1010g). Median duration required for placement of balloon occlusion catheter was 60min (range 47-69min). Median surgical duration was 98.5min (range 77-149min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 66min (range 42-98min). The median estimated blood loss was 355mL (range 50-1950mL). For intracervical myomas, the median extirpated uterine weight was 513g (range 302-710g). Median duration required for placement of balloon occlusion catheter was 63min (range 42-76min). Median surgical duration was 96.5min (range 92-100min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 49min (range 44-60min). The median estimated blood loss was 210mL (range 150-650mL). Transfusion of preoperatively donated autologous blood negated the need for bank blood. There were no major interventional radiological and surgical complications in the present case series. CONCLUSIONS: Temporary endovascular balloon occlusion of the bilateral internal iliac arteries is a feasible minimally invasive alternative to control hemorrhage during LAVH for cervical myoma.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Junko Yamada, Hiromi Nakamura (2011)  Isobaric two-port laparoscopic-assisted myomectomy by combined approach through umbilical and suprapubic mini-incisions with hidden scar: a technique and initial experience.   Eur J Obstet Gynecol Reprod Biol Oct  
Abstract: OBJECTIVE: To report our initial experience with isobaric (gasless) two-port laparoscopic-assisted myomectomy (LAM) in 40 patients with symptomatic myoma at a single center. STUDY DESIGN: In each case, wound retractors were used as working ports through umbilical and suprapubic mini-incisions. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic and laparotomic instruments under vision with a rigid 30-degree, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed. RESULTS: Between November 2010 and May 2011, forty patients with symptomatic myomas were treated with isobaric two-port LAM. Cases consisted of 24 intramural, 13 subserosal and 3 submucosal myomas in various locations. The median surgical duration was 86 (range, 38-160)min with median blood loss of 50 (range, 10-670)mL. Median number and weight of excised myoma nodes were 2.5 (range, 1-30) and 130.5 (range, 4-712)g, respectively. Neither additional incisions nor laparotomic conversion were required in any cases. Although major surgical complications were not experienced in the present case series, extended hospitalization was required in 4 cases (10%) due to elevated inflammatory parameters. Delayed dehiscence of the suprapubic incision was noted in 1 case and was conservatively managed. After the umbilical incision was concealed within the umbilical fold and the suprapubic incision was hidden in the pubic hair, all patients were satisfied with their cosmetic results. CONCLUSIONS: Isobaric two-port LAM performed by a combined approach through umbilical and suprapubic mini-incisions with hidden scar is a useful minimally invasive measure for management of symptomatic uterine myomas under various conditions.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Junko Yamada, Hiromi Nakamura (2011)  Uterus-like mass of ovarian ligament: Image diagnosis and management by laparoendoscopic single-site surgery.   J Obstet Gynaecol Res 37: 12. 1895-1899 Dec  
Abstract: Uterus-like mass composed of a cavity lined by mucosa resembling endometrium and surrounding smooth muscle layer simulating myometrium is an extremely rare disease entity of which the histogenesis is presently unknown. A 39-year-old, gravida 2, para 2, woman presented with sudden onset of lower abdominal pain and was found to have left adnexal mass with unusual image diagnostic appearance. The adnexal mass arising from the left ovarian ligament was excised by laparoendoscopic single-site surgery. Histopathological diagnosis was uterus-like mass of ovarian ligament.
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2010
Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2010)  Conservative management of placenta increta after first trimester abortion by transcatheter arterial chemoembolization: a case report and review of the literature.   Arch Gynecol Obstet 281: 3. 381-386 Mar  
Abstract: INTRODUCTION: Placenta increta is a potentially life-threatening condition that may complicate a first trimester abortion in rare occasion. However, the therapeutic value of transcatheter arterial chemoembolization for the conservative management of this disorder is not described. CASE REPORT: A 27-year-old woman (gravida 3, para 1) with significant obstetric history for one previous lower segment cesarean section and one dilatation and curettage for missed abortion had uncomplicated dilatation and curettage for missed abortion. Eight weeks after curettage, the patient presented with increased amounts of vaginal bleeding. Image diagnostic modalities localized the heterogeneous mass within the myometrium in the fundal portion of the uterine corpus. Initially, arteriovenous fistula formation after abortion was suspected. However, an elevated serum hCG value indicated the presence of retained placental tissue and gave the diagnosis of persistent placenta increta after a first trimester abortion. Transcatheter arterial chemoembolization with dactinomycin was initiated to achieve immediate hemostasis and cytocidal effects on the placental tissue. The post-interventional course was uneventful. Twenty days after chemoembolization, the serum hCG value decreased to a normal level and the mass lesion disappeared on ultrasonography without secondary hemorrhagic complications. CONCLUSIONS: After precise diagnostic imaging, transcatheter arterial chemoembolization is a useful minimally invasive procedure to achieve uterine preservation in women with placenta increta masquerading as arteriovenous fistula after a first trimester abortion.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2010)  Computed tomographic angiography in diagnosis and management of placental polyp with neovascularization.   Arch Gynecol Obstet 281: 5. 823-828 May  
Abstract: OBJECTIVE: To evaluate the neovascularization in placental polyp tissue by computed tomographic angiography and to determine the need for uterine artery embolization before hysteroscopic resection. STUDY DESIGN: Seventeen consecutive women with suspected placental polyp were enrolled in this retrospective study. Neovascularization in placental polyp tissue was assessed by computed tomographic angiography. Cases with neovascularization were treated by hysteroscopic resection with preoperative uterine artery embolization, while cases without neovascularization were treated by hysteroscopic resection alone. RESULTS: Of 17 patients with suspected placental polyp after abortion or parturition, nine patients were diagnosed to have placental polyp with prominent neovascularization by computed tomographic angiography, and were treated by uterine artery embolization followed by hysteroscopic resection. Two patients subsequently conceived after conservative management. CONCLUSIONS: After precise evaluation of neovascularization by computed tomographic angiography, hysteroscopic resection with preoperative uterine artery embolization is an effective minimally invasive procedure to conservatively treat placental polyp with prominent neovascularization.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2010)  Placental polyp with prominent neovascularization.   Fertil Steril 93: 4. 1324-1326 Mar  
Abstract: Placental polyp is a potentially life-threatening disorder that develops after abortion or parturition. Evaluation of neovascularization by multimodal imaging is potentially useful in management of placental polyp in a woman who wishes to preserve fertility.
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Sanae Imoto, Akihiro Takeda, Kazuyuki Koyama, Seiko Taguchi, Kentaro Horibe, Hiromi Nakamura (2010)  Late occurrence of severe hyponatremia followed by extrapontine osmotic demyelination syndrome after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.   J Matern Fetal Neonatal Med 23: 7. 742-746 Jul  
Abstract: Development of severe hyponatremia followed by extrapontine osmotic demyelination syndrome was reported as a significant late complication after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2010)  Paraneoplastic consumptive coagulopathy related to intramyometrial low-grade endometrial stromal sarcoma coexistent with adenomyosis diagnosed 7¬†years after laparoscopic-assisted myomectomy.   Arch Gynecol Obstet 282: 6. 665-670 Dec  
Abstract: INTRODUCTION: Paraneoplastic coagulation disorders associated with benign and malignant gynecological tumors have been reported. However, reports on cutaneous purpural manifestation of paraneoplastic coagulopathy in cases of gynecological tumors are extremely limited. CASE REPORT: A 40-year-old woman was referred due to generalized ecchymosis 7 years after laparoscopic-assisted myomectomy. Coagulogram was markedly deranged with severe thrombocytopenia. After hematological disorders were excluded, image diagnostic modalities showed multiple intramyometrial heterogeneous mass lesions with extensive intratumoral hemorrhage. Laparoscopic-assisted vaginal hysterectomy was performed with supplementation of coagulation factors and platelets. Histological examination showed intramyometrial low-grade endometrial stromal sarcoma (ESS) coexistent with adenomyosis. Coagulation disorder immediately disappeared after hysterectomy and the postoperative course was uneventful. Recurrence of either ESS or coagulopathy has not been noted 15 months postoperatively, to date. CONCLUSIONS: This case illustrates a rare but potentially life-threatening consumptive coagulopathy caused by intramyometrial low-grade ESS that was assumed to secondarily arise from stromal cells of adenomyosis developed in postmyomectomy scar.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2010)  Diagnostic multimodal imaging and therapeutic transcatheter arterial chemoembolization for conservative management of hemorrhagic cesarean scar pregnancy.   Eur J Obstet Gynecol Reprod Biol 152: 2. 152-156 Oct  
Abstract: OBJECTIVE: To evaluate the value of emergency transcatheter arterial chemoembolization (TACE) for initial conservative management of hemorrhagic cesarean scar pregnancy after multimodal image diagnosis. STUDY DESIGN: Five consecutive cases of hemorrhagic cesarean scar pregnancy were diagnosed for precise localization of ectopic placentation site, depth of placental invasion and uteroplacental neovascularization by imaging studies including color Doppler ultrasonography, magnetic resonance imaging (MRI) and three-dimensional computerized tomographic angiography. Emergency TACE with dactinomycin was initially performed to achieve immediate hemostasis and cytotoxic effects on chorionic villous tissue. Then, the need for either expectant management or subsequent hysteroscopic resection was individually determined. Systemic methotrexate (MTX) administration was added when delayed decline of serum hCG value was noted. RESULTS: On MRI, total placental invasion to the serosa of the anterior uterine wall was diagnosed in three cases, while the two remaining cases showed subtotal invasion to the anterior uterine wall. All cases were managed by emergency TACE as an initial conservative measure. Subsequently, spontaneous expulsion of gestational products occurred in one case of subtotal placental invasion. Additional MTX administration was required to achieve complete resorption of cesarean scar pregnancy in two cases of total placental invasion. In one case of subtotal placental invasion, successful hysteroscopic resection was performed under laparoscopic guidance, whereas, in one case of total placental invasion, hysteroscopic removal of gestational products was incomplete due to the risk of uterine perforation and additional systemic MTX administration was required for complete resolution. Uterine preservation was achieved in all cases without unfavorable effects of TACE or secondary hemorrhagic complications. CONCLUSIONS: This small case series emphasizes that TACE is potentially useful as an initial emergency intervention for conservative management of hemorrhagic cesarean scar pregnancy to achieve immediate hemostasis and direct cytotoxic effects on chorionic villous tissue with minimal systemic side effects of chemotherapeutic agent.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2010)  Wound Retraction System for Isobaric Laparoendoscopic Single-Site Surgery to Treat Adnexal Tumors: Pilot Study.   J Minim Invasive Gynecol 17: 5. 626-630 Sep  
Abstract: Transumbilical laparoendoscopic single-site (LESS) surgery is a recent advancement in minimally invasive surgery. However, this procedure usually requires a specialized multichannel port for introducing the laparoscope and instruments under pneumoperitoneum. In an isobaric procedure, a wound retractor alone can conveniently be used for transumbilical single-site access. Fourteen isobaric LESS adnexal surgeries including 1 emergency procedure with adnexal torsion were performed using multiple instruments inserted through the wound retractor. No extraumbilical incisions or conversion to standard multiple-port laparoscopic surgery were required. Port-related complications were not noted, and the cosmetic results were excellent. A wound retractor offers safe and reliable access for isobaric LESS adnexal surgery as an alternative to the current specialized port systems.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Tomoko Nakano, Hiromi Nakamura (2010)  Isobaric laparoendoscopic single-site assisted extracorporeal cystectomy in treatment of selected adnexal tumors: initial experience and technique.   J Minim Invasive Gynecol 17: 6. 766-770 Nov/Dec  
Abstract: Laparoscopic-assisted ovarian cystectomy with exteriorization is a minimally invasive procedure. However, applicability of this procedure for transumbilical laparoendoscopic single-site (LESS) surgery is not well established. Herein, we describe our initial experience with isobaric (gasless) LESS-assisted extracorporeal cystectomy in management of selected adnexal tumors. Of 17 consecutive adnexal tumors, 15 (88.2%) (dermoid cyst, 10; serous cystadenoma, 2; mucinous cystadenoma, 1; and paraovarian cyst, 2) were successfully managed with isobaric LESS-assisted extracorporeal cystectomy. Two dermoid cysts required intracorporeal LESS cystectomy because of poor mobility of the adnexal tissue. No conversion to either conventional laparoscopic surgery or laparotomy was necessary in this series.
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2009
Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2009)  Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization.   Arch Gynecol Obstet 280: 2. 305-308 Aug  
Abstract: INTRODUCTION: Interstitial pregnancy is a rare but dangerous form of ectopic pregnancy. Although various forms of minimally invasive management for this disorder have been previously reported, optimal treatment regimen has not been yet unknown due to its rarity. CASE REPORT: A 29-year-old married woman with no previous disease history was referred under suspicion of ectopic pregnancy. Serum hCG value was 95,365 mIU/mL. On ultrasonographic examination, gestational sac with a viable embryo was identified in the left cornual region. Three-dimensional computed tomographic angiography showed prominent vascular mass in the left cornual region. Preoperative transcatheter uterine artery embolization followed by laparoscopic-assisted cornual resection with local methotrexate injection was successfully performed. CONCLUSIONS: Laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization for interstitial pregnancy with prominent vascular flow is a safe and reliable minimally invasive procedure for woman wishing fertility preservation.
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Akihiro Takeda, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2009)  Laparoscopic management of mature cystic teratoma of the ovary with multiple intracystic floating spherules.   Arch Gynecol Obstet 279: 5. 775-776 May  
Abstract: INTRODUCTION: A feature of multiple spherical structures floating free in a cystic mass is one of the very rare patterns of mature cystic teratoma. CASE REPORT: A 32-year-old unmarried nulligravida was referred. Image diagnosis showed a large cystic tumor with unusual intracystic multiple floating spherules. Serum tumor marker test showed elevated squamous cell carcinoma antigen. Laparoscopic-assisted left salpingo-oophorectomy was performed. The histopathological diagnosis was mature cystic teratoma of the ovary with marked desquamative keratin formations. CONCLUSIONS: After obtaining pathognomonic findings on diagnostic imaging, laparoscopic management of a rare form of mature cystic teratoma of the ovary with numerous intracystic floating spherules was successfully performed.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2009)  Progressive formation of uterine arteriovenous fistula after laparoscopic-assisted myomectomy.   Arch Gynecol Obstet 280: 4. 663-667 Oct  
Abstract: INTRODUCTION: Laparoscopic-assisted myomectomy (LAM) is a minimally invasive procedure with many advantages. However, progressive formation of uterine arteriovenous fistula (AVF) after LAM is not described as a significant complication. CASE REPORT: A 39-year-old nulligravida underwent LAM for multiple myomas. On ultrasonography obtained 13 days after LAM, a prominent vascular mass was identified in the post-myomectomy scar. Computed tomographic angiography showed AVF originating from the left uterine artery. Uterine AVF was endovascularly embolized by metallic coils to avoid future hemorrhage. CONCLUSIONS: Development of uterine AVF after LAM is a potentially life-threatening complication. Early diagnosis and endovascular management can provide a significant benefit for a woman wishing uterine preservation.
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Akihiro Takeda, Masahiko Mori, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2009)  Laparoscopic management of ovarian dysgerminoma presenting with acute abdomen caused by adnexal torsion in a 17-year-old girl.   J Pediatr Adolesc Gynecol 22: 1. e9-13 Feb  
Abstract: BACKGROUND: Ovarian dysgerminoma cases very rarely present with acute abdomen due to adnexal torsion and the successful laparoscopic management of such a case has not been reported previously. CASE: A 17-year-old sexually inactive high school girl presenting with acute abdomen was referred to our emergency department. Transabdominal ultrasonography showed the presence of homogeneous tumor in the lower abdomen. Emergency laparoscopic surgery was performed and left ovarian tumor with adnexal torsion was identified. Left salpingo-oophorectomy was performed carefully to avoid damaging the tumor capsule and the excised tissue was removed after retrieval in an endobag. The histopathological diagnosis was pure ovarian dysgerminoma. The postoperative course was uneventful. CONCLUSION: Laparoscopic management with careful postoperative follow-up to monitor recurrence could be a treatment option in a young girl with dysgerminoma, if the disease condition is detected in the early stage.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2009)  Temporary endovascular balloon occlusion of the bilateral internal iliac arteries for control of hemorrhage during laparoscopic-assisted myomectomy in a nulligravida with a large cervical myoma.   Fertil Steril 91: 3. 935.e5-935.e9 Mar  
Abstract: OBJECTIVE: To describe the preoperative evaluation and minimally invasive management of a large cervical myoma in a nulligravida who wished to preserve fertility. DESIGN: Case report. SETTING: Departments of obstetrics and gynecology and radiology at a general hospital. PATIENT(S): A 33-year-old nulligravida with a large cervical myoma. INTERVENTION(S): A large cervical myoma was preoperatively diagnosed by ultrasonography, magnetic resonance imaging, and computed tomographic angiography and was successfully treated with minimal blood loss by laparoscopic-assisted myomectomy combined with prophylactic temporary endovascular balloon occlusion of the bilateral internal iliac arteries. MAIN OUTCOME MEASURE(S): Uterine conservation. RESULT(S): Fertility preservation was achieved with minimal blood loss in a nulligravida with a large cervical myoma. CONCLUSION(S): Laparoscopic-assisted myomectomy combined with prophylactic endovascular balloon occlusion of the bilateral internal iliac artery was an effective minimally invasive procedure to preserve fertility in a nulligravida with a large cervical myoma.
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Akihiro Takeda, Kazuyuki Koyama, Sanae Imoto, Masahiko Mori, Kotaro Sakai, Hiromi Nakamura (2009)  Early diagnosis and endovascular management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy.   Fertil Steril 92: 4. 1487-1491 Oct  
Abstract: OBJECTIVE: To describe the diagnosis and management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy. DESIGN: Case reports. SETTING: Departments of Obstetrics and Gynecology and Radiology at General Hospital. PATIENT(S): A 32-year-old woman and a 41-year-old woman each developed uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy. INTERVENTION(S): Uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy was diagnosed on ultrasonography, computerized tomographic angiography, and digital subtraction angiography, and treated by transcatheter arterial embolization. MAIN OUTCOME MEASURE(S): Uterine conservation. RESULT(S): Fertility preservation was achieved in both of these women who developed uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy. CONCLUSION(S): Early diagnosis and endovascular management of uterine artery pseudoaneurysm after myomectomy are important to prevent life-threatening hemorrhage caused by pseudoaneurysmal rupture.
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2008
Akihiro Takeda, Kayoko Kato, Masahiko Mori, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2008)  Late massive uterine hemorrhage caused by ruptured uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy.   J Minim Invasive Gynecol 15: 2. 212-216 Mar/Apr  
Abstract: Diagnosis and management of ruptured uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy is described.
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Akihiro Takeda, Kazuyuki Koyama, Masahiko Mori, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2008)  Diagnostic computed tomographic angiography and therapeutic emergency transcatheter arterial embolization for management of postoperative hemorrhage after gynecologic laparoscopic surgery.   J Minim Invasive Gynecol 15: 3. 332-341 May/Jun  
Abstract: STUDY OBJECTIVE: To evaluate the diagnostic value of 3-dimensional computed tomographic (CT) angiography and treatment efficacy of emergency transcatheter arterial embolization (TAE) for early postoperative hemorrhage after gynecologic laparoscopic surgery. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Department of gynecology at a general hospital. PATIENTS: Nine patients with early postoperative hemorrhage after gynecologic laparoscopic surgery were treated by TAE between January 2004 and October 2007. Diagnostic 3-dimensional CT angiography was performed for identification of the bleeding artery before TAE in 5 of those patients. INTERVENTIONS: Diagnostic 3-dimensional CT angiography and therapeutic emergency TAE. MEASUREMENTS AND MAIN RESULTS: In all, 2952 patients (1165 laparoscopic-assisted vaginal hysterectomy [LAVH], 1086 adnexal surgery, 417 laparoscopic-assisted myomectomy [LAM], 222 ectopic pregnancy surgery, and 62 other) were treated by laparoscopic surgery between January 1994 and October 2007. Fourteen patients developed postoperative hemorrhagic shock (5 LAVH [0.43%], 1 adnexal surgery [0.09%], 7 LAM [1.68%], 1 ectopic pregnancy surgery [0.45%]). Since 2004, instead of second laparotomy or laparoscopy, TAE was primarily chosen to manage the postoperative hemorrhage for 3 cases after LAVH and 6 cases after LAM. In 5 cases experienced in the last 2 years, diagnostic 3-dimensional CT angiography was performed to identify the bleeding artery before TAE. Transfusion of preoperatively donated autologous blood and intraoperatively salvaged autologous blood was sufficient to maintain vital functions of the patients except in 1 case of LAM that required homologous blood transfusion before TAE as a result of significant delay in establishing the diagnosis. Postembolization course was uneventful except in 1 case of LAVH that developed vaginal stump abscess and required transvaginal drainage twice after readmission. CONCLUSION: Emergency TAE is a safe and effective minimally invasive procedure for patients developing postoperative hemorrhage after gynecologic laparoscopic surgery. Diagnostic CT angiography could play a significant role in shortening the process of TAE by identifying the site of extravasation before TAE.
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2007
Akihiro Takeda, Masahiko Mori, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2007)  Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: Report of a case and review of the literature.   J Minim Invasive Gynecol 14: 6. 770-775 Nov/Dec  
Abstract: A 33-year-old woman, gravid 2 para 2, underwent laparoscopic myomectomy with electric tissue morcellation for intraligamental myoma. Six years later, asymptomatic pelvic tumor was found during a routine checkup. Under laparoscopic observation, multiple soft tumors were detected in the peritoneal cavity and these tumors were successfully excised by a laparoscopic-assisted procedure. Pathological examination demonstrated that these tumors were progesterone receptor-positive leiomyomas that were almost identical histologically to the myoma tissue excised 6 years earlier.
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Akihiro Takeda, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2007)  Management of large cystic adnexal tumor by gasless laparoscopic-assisted surgery with wound retractor.   J Minim Invasive Gynecol 14: 5. 644-650 Sep/Oct  
Abstract: We used a retrospective analysis to evaluate the efficacy of a wound retractor used in gasless laparoscopic-assisted surgery by the subcutaneous abdominal wall-lift method for the management of large cystic adnexal tumors. In the department of gynecology at a general hospital, 39 patients with large cystic adnexal tumors with an excised tissue weight including cystic contents exceeding 1000 g were treated by gasless laparoscopic-assisted surgery with a wound retractor from January 2001 through December 2006. Intervention was with a gasless laparoscopic-assisted adnexal surgery with a wound retractor. The median age of the patients was 51.5 years (range 16-79 years). The median weight of the excised tissue including cystic contents was 1857 g (range 1044-9454 g). The median blood loss was 30 mL (range 10-570 mL). The median surgical duration was 62 minutes (range 26-107 minutes). There were no major surgical complications. Histopathologic diagnosis of the excised tumor was mucinous cystadenoma, 18 cases; serous cystadenoma, 8 cases; mucinous cystadenocarcinoma of low-grade malignancy, 5 cases; dermoid cyst, 4 cases; paraovarian cyst, 2 cases; endometriotic cyst, 1 case; and clear cell adenocarcinoma, 1 case. Bilateral adnexal tumors were noted in 3 cases. We determined that gasless laparoscopic-assisted adnexal surgery with a wound retractor is an effective, minimally invasive procedure to treat large cystic adnexal tumors.
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Akihiro Takeda, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2007)  Wound retraction system for gasless laparoscopic-assisted myomectomy with a subcutaneous abdominal wall-lift method.   J Minim Invasive Gynecol 14: 2. 240-246 Mar/Apr  
Abstract: Over the course of 4 years we evaluated 209 women using gasless laparoscopic-assisted myomectomy and a wound retractor. Three were no significant differences in blood loss or surgical duration despite myoma size or location. Gasless laparoscopic-assisted myomectomy utilizing a wound retractor is an effective procedure for women desiring uterine preservation without significantly longer surgery duration.
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Akihiro Takeda, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2007)  Management of ruptured corpus luteum cyst of pregnancy occurring in a 15-year-old girl by laparoscopic surgery with intraoperative autologous blood transfusion.   J Pediatr Adolesc Gynecol 20: 2. 97-100 Apr  
Abstract: BACKGROUND: Laparoscopic surgery is a minimally invasive procedure with many advantages. However, laparoscopic treatment of ruptured corpus luteum cyst of pregnancy with massive hemoperitoneum occurring in a young girl has not previously been reported. CASE: A 15-yr-old girl presenting with acute abdomen and hemoperitoneum was referred to our department. A urinary pregnancy test was positive and an ultrasound revealed a gestational sac in the uterine cavity, the preoperative differential diagnosis was narrowed to either intrauterine pregnancy with ruptured corpus luteum cyst or heterotopic pregnancy. Emergency laparoscopic surgery was performed to investigate the cause of hemoperitoneum and a diagnosis of ruptured corpus luteum cyst of pregnancy was established. After retrieving pooled blood in the abdominal cavity for intraoperative autologous blood transfusion, the rupture site with active bleeding was laparoscopically sutured and hemostasis was achieved. At the same time, intrauterine pregnancy was electively terminated at the request of the patient and her family. The postoperative course was uneventful. CONCLUSION: Ruptured corpus luteum cyst of pregnancy manifesting massive hemoperitoneum is a rare but life-threatening disorder that can occur even in a young girl. Ovarian conservative treatment can laparoscopically be performed with intraoperative autologous blood transfusion.
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Akihiro Takeda, Kotaro Sakai, Takashi Mitsui, Hiromi Nakamura (2007)  Laparoscopic management of juvenile cystic adenomyoma of the uterus: report of two cases and review of the literature.   J Minim Invasive Gynecol 14: 3. 370-374 May/Jun  
Abstract: Two cases of juvenile cystic adenomyoma of the uterus treated by laparoscopic surgery are reported. Preoperative diagnostic imaging procedures located a cystic structure within the uterine nodule of each of these young women with severe dysmenorrhea. Under a diagnosis of cystic adenomyoma, laparoscopic excision was performed. Histopathologic examination of the resected tissues showed the presence of an endometrial structure composed of epithelium and stroma within myometrial nodule. In both of these patients, dysmenorrhea disappeared postoperatively.
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2006
Akihiro Takeda, Shuichi Manabe, Takashi Mitsui, Hiromi Nakamura (2006)  Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: report of two cases.   J Obstet Gynaecol Res 32: 2. 190-194 Apr  
Abstract: Two cases of spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after previous ipsilateral adnexectomy are presented. Laparoscopic observation and postoperative histopathological examination suggested intrauterine transmigration of the fertilized egg as the etiology. Laparoscopic excision of the remnant tube was performed and the postoperative course was uneventful in both cases. Attention should be paid to this unusual type of ectopic pregnancy while examining patients with previous history of adnexal surgery.
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Akihiro Takeda, Shuichi Manabe, Takashi Mitsui, Hiromi Nakamura (2006)  Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion.   J Minim Invasive Gynecol 13: 1. 43-48 Jan/Feb  
Abstract: STUDY OBJECTIVE: To evaluate the feasibility and safety of surgical laparoscopy with intraoperative autologous blood transfusion for ectopic pregnancy with massive hemoperitoneum. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Department of gynecology at a general hospital. PATIENTS: Seventeen consecutive patients with ectopic pregnancy with massive hemoperitoneum. INTERVENTION: Laparoscopic surgery with salvage device-based intraoperative autologous blood transfusion. MEASUREMENTS AND MAIN RESULTS: From January 2000 through June 2005, one hundred and twelve women with ectopic pregnancy (interstitial/cornual: 4; isthmic: 18; ampullary: 86; and ovarian: 4) were treated by laparoscopic surgery. Seventeen patients who demonstrated more than 501 g of intraabdominal bleeding were classified as having massive hemoperitoneum and retrospectively analyzed. Site of pregnancy in these 17 patients was interstitial/cornual: 3; isthmic: 5; ampullary: 7; and ovarian: 2. Except for two women with tubal abortion of ampullary pregnancy, all other patients had rupture at the pregnancy site. During laparoscopic surgery, blood pooled in the abdominal cavity was collected by an irrigation and aspiration procedure, and sent to an autologous blood-salvage device to make concentrated red blood cell solution. Processed blood was immediately transfused back to the patient through a leukocyte reduction filter. The mean amount of estimated intraabdominal bleeding, which was calculated by the difference between the volumes of aspirated and irrigated fluids, was 1362.1 +/- 491.4 g, and the mean volume of reinfused processed blood was 680.6 +/- 209.5 g. No patient received banked blood at any time. The degree of hemoperitoneum was well correlated with the shock index calculated by dividing the heart rate by systolic blood pressure at triage (r = 0.72; 95% CI 0.37-0.89; p = .001). In all cases of massive hemoperitoneum, there was no need for laparotomic conversion, and homologous blood transfusion was avoided. CONCLUSIONS: Even in women with ectopic pregnancy with massive hemoperitoneum, laparoscopic surgery can be safely conducted by experienced laparoscopists with intraoperative autologous blood transfusion if hemodynamic stability is achieved by perioperative management.
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Akihiro Takeda, Shuichi Manabe, Takashi Mitsui, Hiromi Nakamura (2006)  Laparoscopic management of mature cystic teratoma of bilateral ovaries with adnexal torsion occurring in a 9-year-old premenarchal girl.   J Pediatr Adolesc Gynecol 19: 6. 403-406 Dec  
Abstract: BACKGROUND: Laparoscopic surgery is a minimal-access procedure with many advantages. However, reports of young girls with adnexal disease treated by laparoscopic surgery are limited in the literature. CASE: A 9-yr-old premenarchal girl presenting with acute abdomen was treated by emergency laparoscopic surgery. Bilateral adnexal torsion was noted. After detorsion, bilateral cystectomy was successfully performed and ovarian tissues were preserved. Pathological diagnosis was mature cystic teratoma of bilateral ovaries. CONCLUSION: Although adnexal torsion occurring in a premenarchal girl is an extremely rare disorder and bilateral adnexal torsion is even more rare, gynecologists should possess sufficient knowledge about the manifestations of such disorder for immediate diagnosis and treatment to preserve future fertility and, if available, laparoscopic approach should be chosen for a young girl.
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2005
Akihiro Takeda, Shuichi Manabe, Satoyo Hosono, Hiromi Nakamura (2005)  Laparoscopic surgery in 12 cases of adnexal disease occurring in girls aged 15 years or younger.   J Minim Invasive Gynecol 12: 3. 234-240 May/Jun  
Abstract: STUDY OBJECTIVE: To evaluate the treatment by laparoscopic surgery of adnexal disease occurring in young girls. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Department of gynecology at a general hospital. PATIENTS: Twelve consecutive girls aged 15 years or younger. INTERVENTIONS: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Seven patients had dermoid cysts, and three of these were associated with adnexal torsion. Two patients had ruptured lutein cysts with ovarian bleeding, and one of them was pregnant. Torsion of the tube with paraovarian cyst, torsion of normal ovary, and serous cystadenoma were noted in one patient each. Although the underlying diseases varied, the chief symptom in each of these patients was lower abdominal pain. Because the symptom is nonspecific, the clinical features were confusing, especially in emergency cases; in two patients with adnexal torsion with dermoid cysts and one patient with adnexal torsion of a normal ovary, there was substantial delay in diagnosis, and salpingo-oophorectomy was required as a result. CONCLUSION: Even in young girls, laparoscopic surgery can be performed in an acceptable manner using regular instruments designed for adults.
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Akihiro Takeda, Shuichi Manabe, Satoyo Hosono, Hiromi Nakamura (2005)  A case of a mature cystic teratoma of the uterosacral ligament successfully treated by laparoscopic surgery.   J Minim Invasive Gynecol 12: 1. 34-36 Jan/Feb  
Abstract: An asymptomatic tumor was found in the pelvic cavity of a 49-year-old woman during a routine examination. With a diagnosis of mature cystic teratoma of the right ovary, laparoscopic surgery was performed. The intraoperative finding showed the presence of a cystic tumor firmly attached to the uterosacral ligament in a position distant from the bilateral ovaries. Laparoscopic excision was performed, and the diagnosis of mature cystic teratoma of the uterosacral ligament was made histopathologically. This is the first report in the literature of successful laparoscopic treatment for a mature cystic teratoma of the uterosacral ligament.
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2004
Akihiro Takeda, Shuichi Manabe, Satoyo Hosono, Hiromi Nakamura (2004)  Preoperative evaluation of submucosal myoma by virtual hysteroscopy.   J Am Assoc Gynecol Laparosc 11: 3. 404-409 Aug  
Abstract: STUDY OBJECTIVE: To assess the utility of a new technique called virtual hysteroscopy in the evaluation of the size and location of submucosal myomas before hysteroscopic myomectomy. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Department of gynecology at a general hospital. PATIENTS: Thirteen consecutive women. INTERVENTION: Sixteen-slice computed tomography (CT) scanner. MEASUREMENTS AND MAIN RESULTS: Thirteen women with submucosal myomas were examined by virtual hysteroscopy. The lesions were filmed by multislice CT scanner, immediately after CO2 injection into the uterine cavity with an intravenous dosage of iodide contrast media. The filmed image was subsequently reconstituted and analyzed by endoscopy mode and volume mode using three-dimensional computer graphics software. The size and depth of invasion of the submucosal myoma were clearly identified by the procedure. CONCLUSION: Accurate preoperative evaluation of the size and location of submucosal myomas before hysteroscopic myomectomy is important for a safe surgical procedure. Virtual hysteroscopy can provide such information with good reproducibility and is superior to previously described diagnostic procedures.
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1988
A Takeda, S Shimizu (1988)  Molecular effects of antiestrogens (tamoxifen and LY117018) on estrogen-dependent glycoprotein (USP-1) synthesized and secreted by rat uterine epithelial cells.   Endocrinology 123: 1. 258-263 Jul  
Abstract: We have previously identified and characterized a 97K secretory glycoprotein (uterine secretory protein-1:USP-1) synthesized and secreted by rat uterine epithelial cells under estrogen stimulation. We now have analyzed the qualitative and quantitative effects of antiestrogens (tamoxifen and LY117018) on the induction of USP-1 biosynthesis when administered alone or combined with 17 beta-estradiol (E2). By radioimmune precipitation assay of [35S]methionine-labeled uterine luminal fluid proteins, it was shown that tamoxifen and LY117018 could weakly induce USP-1 compared with E2. Concomitant administration of either tamoxifen or LY117018 with E2 significantly diminished the effects of E2 on USP-1 induction. Hence, both tamoxifen and LY117018 possess agonistic as well as antagonistic properties affecting the induction of USP-1. These agonistic effects of antiestrogens were also evident from the presence of USP-1 in rat uterine epithelial cells treated with antiestrogens, as revealed by immunohistochemical staining. Sodium dodecylsulfate-polyacrylamide gel analysis of immunoprecipitable [35S]methionine-labeled protein revealed that USP-1 induced by tamoxifen is larger (110K) than that induced by estrogen or LY117018 (97K). Peptide-N-glycosidase treatment of USP-1 induced by E2 or tamoxifen removed asparagine-linked carbohydrate chains and resulted in the appearance of polypeptides with apparent mol wt of 91K and 105K, respectively. Thus, the higher mol wt of tamoxifen-induced USP-1 is not due to changes in asparagine-linked carbohydrates. Since LY117018 could not induce any qualitative change in the USP-1 molecule, tamoxifen may act on uterine epithelial cells through a different molecular mechanism than LY117018.
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A Takeda, N Takahashi, S Shimizu (1988)  Identification and characterization of an estrogen-inducible glycoprotein (uterine secretory protein-1) synthesized and secreted by rat uterine epithelial cells.   Endocrinology 122: 1. 105-113 Jan  
Abstract: An estrogen-inducible 97-kilodalton (kDa) secretory glycoprotein, designated as uterine secretory protein (USP)-1, synthesized by rat uterine epithelial cells was identified and characterized. Uterine luminal fluid (ULF) proteins were labeled by direct administration of [35S]methionine into uterine lumen of rats. Incorporation of [35S]methionine into ULF proteins was negligible in ovariectomized rats. However, when 17 beta-estradiol (E2) was administered in the ovariectomized rat as sc paraffin pellets, a marked increase of [35S]methionine incorporation was noted after 2 days of treatment, showing that the de novo synthesis and secretion of ULF proteins were induced by E2. Six estrogen-inducible polypeptides (130, 110, 97, 65, 42, and 39 kDa) were identified in the analysis of the labeled ULF proteins by sodium dodecylsulfate-polyacrylamide gel electrophoresis and fluorography. Four of these polypeptides (110, 65, 42, and 39 kDa) were adsorbed by the immobilized antibody against rat serum proteins, indicating that these polypeptides are antigenically similar to serum proteins. Two polypeptides (130 and 97 kDa) not adsorbed by the antibody column were suggested to be uterine-specific secretory proteins. The 97-kDa protein (USP-1) was further purified by preparative sodium dodecylsulfate-polyacrylamide gel electrophoresis and electroelution. Reactivity of purified USP-1 to various lectins and carbohydrate composition analysis suggested that USP-1 possesses biantennary N-linked complex-type carbohydrate chain with fucose. Rabbit polyclonal antibody which can specifically immunoprecipitate [35S]methionine-labeled USP-1 was developed. Dot blot enzyme immunoassay showed that 4-day E2-treated ULF contains 78.3 +/- 24.1 (+/- SE) micrograms USP-1/mg protein. Immunohistochemical staining of rat uterine tissue showed that this protein localized only in the epithelial cells treated with estrogen (E2 and diethylstilbestrol). Testosterone, progesterone, and dexamethasone failed to induce synthesis and secretion of USP-1 as assessed by dot blot enzyme immunoassay, immunoprecipitation of [35S]methionine-labeled ULF proteins, and immunohistochemical staining of uterine tissue. The present result, for the first time, revealed that estrogen can induce synthesis and secretion of specific secretory protein which could be the useful marker to analyze the molecular mechanism of estrogen action in rat uterine epithelial cells.
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A Takeda (1988)  Progesterone and antiprogesterone (RU 38486) modulation of estrogen-inducible glycoprotein (USP-1) synthesis and secretion in rat uterine epithelial cells.   Endocrinology 122: 4. 1559-1564 Apr  
Abstract: Previous study in this laboratory revealed that estrogen stimulates synthesis and secretion of 97K glycoprotein [uterine secretory protein-1 (USP-1)] in rat uterine epithelial cells. In the present communication, the effects of progesterone and antiprogesterone (RU 38486) on estrogen-stimulated USP-1 biosynthesis were investigated. Ovariectomized rats were treated with estrogen for 4 days to induce USP-1 synthesis and secretion. Then, progesterone and RU 38486 were injected sc. After 6 and 12 h of treatment, uterine luminal fluid proteins were labeled for 6 h by direct administration of [35S]methionine into uterine lumen. By radioimmune precipitation assay using specific antibody against USP-1, it was shown that progesterone can reduce the USP-1 synthesis and secretion, which were prestimulated by estrogen. This antagonistic effect of progesterone on estrogen-induced USP-1 biosynthesis was also evident by the decreased staining intensity of USP-1 in uterine epithelial cells, as revealed by the immunohistochemical method. Although RU 38486 itself did not manifest any effect on estrogen-stimulated USP-1 biosynthesis, it completely inhibited the progesterone-induced decrease in synthesis and secretion. This system is believed to provide a useful model to analyze the progesterone and antiprogesterone actions on rat uterine epithelial cells.
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1987
A Masuda, A Takeda, H Fukami, C Yamada, M Matsuyama (1987)  Characteristics of cell lines established from a mixed mesodermal tumor of the human ovary. Carcinomatous cells are changeable to sarcomatous cells.   Cancer 60: 11. 2696-2703 Dec  
Abstract: Four clonal cell lines of two types were established from a heterotransplantable mixed mesodermal tumor of the human ovary. Biologic properties of these cell lines (designated CS-C1, CS-S1, CS-S2, and CS-S3) were examined. Cells of one line (CS-C1) had an epithelioid shape and grew in monolayers (C-type). The cells showed alkaline phosphatase activity, stained positively with antikeratin antiserum, and had an ultrastructure with carcinomatous characteristics. Cells of the other three cell lines (CS-S1, CS-S2, and CS-S3) had an irregular shape and grew in multilayers (S-type). Most of the cells did not show alkaline phosphatase activity. They stained, not with antikeratin antiserum, but in fibrillar array with antifibronectin antiserum. Their ultrastructure had sarcomatous characteristics. By low cell density cultures, S-type sublines arose from CS-C1 cell line, but no C-type sublines arose from CS-S1 cell line. These findings may support the theory of the combination tumor as the cytogenesis of mixed mesodermal tumor of the ovary; they also suggest the conversion of carcinomatous cells to sarcomatous cells.
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W W Leavitt, A D Cobb, A Takeda (1987)  Progesterone-modulation of estrogen action: rapid down regulation of nuclear acceptor sites for the estrogen receptor.   Adv Exp Med Biol 230: 49-78  
Abstract: Our previous studies demonstrated that progesterone down regulates the occupied form of nuclear estrogen receptor (Re). Using the density shift method, we discovered that progestins stimulate the turnover of nuclear Re within 3 h of treatment, and Re synthesis is suppressed subsequently. Thus, the primary site of progestin action in down-regulating Re is the stimulation of nuclear Re turnover followed by the inhibition of Re replenishment. A major breakthrough in our understanding of how progestin controls Re turnover was made by studying nuclear acceptor sites for Re that were found to decrease markedly within 2 h of progestin treatment. These and other results indicate that progestin induces a factor called the Re regulatory factor (ReRF) which acts to block nuclear Re acceptor sites, and this in turn decreases nuclear Re retention on chromatin acceptor sites, leading to an enhanced turnover (or processing) of nuclear Re.
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1986
W W Leavitt, A Takeda (1986)  Hormonal regulation of estrogen and progestin receptors in decidual cells.   Biol Reprod 35: 2. 475-484 Sep  
Abstract: Total estrogen receptor (Re) and total progestin receptor (Rp) were measured in the cytosol and nuclear fractions from hamster deciduomal tissue and decidual cell cultures. Correlation of serum steroid (estradiol and progesterone) and deciduomal receptor profiles revealed a significant loss of Re during the first four days of decidualization that was not attributable to changes in serum steroid levels. A decidual cell-tissue culture system was used to study the receptor's recovery response to progesterone withdrawal. Decidual cells were plated and grown in Ham's F12/Dulbecco's modified Eagle's medium with 5% horse serum supplemented with insulin, transferrin, selenium and progesterone (10 ng/ml). Within 48 h of culture large, multinucleate decidual cells were observed by phase microscopy. At 72 h of culture in medium containing progesterone, only Rp was detectable in decidual cells. Re was not detectable (less than 200 fmol/mg DNA) in either cytosol or nuclei from cells maintained in the presence of progesterone. However, when progesterone was deleted from the medium, cytosol Re recovered progressively from 8 h to 16 h of culture. Progesterone withdrawal also caused parallel increases in cytosol and nuclear Rp, and estradiol treatment (2 ng/ml) in combination with progesterone withdrawal further enhanced Rp levels in decidual cell cultures. These results with cultured decidual cells demonstrate that progesterone down-regulates Re and Rp, Re recovers rapidly upon progesterone withdrawal, and the Re system is competent to respond to estrogen action in terms of Rp induction. We used the density-shift method to determine that progestin increases the turnover of nuclear Re in hamster decidual cells within 3 h. Hamster decidual cells were isolated from the endometrium and cultured in progesterone-free medium containing normal amino acids (1H, 12C, 14N) for 2 days. Confluent monolayers of cells were exposed to 1 nM estradiol (E2) for 1 h to maximize the amount of occupied Re in the nuclear fraction. Then, at time 0, cells were transferred to medium supplemented with dense (2H, 13C, 15N) amino acids and either 1 nM E2 or E2 plus 100 nM progesterone. After Re was labeled with dense amino acids for 1, 3, 6 and 9 h, nuclear Re was extracted with 10 mM pyridoxal -5' phosphate and labeled with 125I-iodoestradiol (5 nM). Two radioactive peaks representing preexisting and newly synthesized Re were separated by sucrose density-gradient centrifugation. The halflife of nuclear Re in decidual cells was 3.7 h when cells were treated with E2 alone.(ABSTRACT TRUNCATED AT 400 WORDS)
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A Takeda, W W Leavitt (1986)  Progestin-induced down regulation of nuclear estrogen receptor in uterine decidual cells: analysis of receptor synthesis and turnover by the density-shift method.   Biochem Biophys Res Commun 135: 1. 98-104 Feb  
Abstract: The density-shift method was used to study the effect of the synthetic progestin, R5020, (17,21-dimethyl-19-nor-4,9-pregnadiene-3,20-dione) on the turnover and synthesis of nuclear estrogen receptor in hamster decidual cells. Newly-synthesized receptor was labeled with dense [2H, 13C, 15N] amino acids and separated from pre-existing receptor by density-gradient centrifugation. Progestin increased receptor turnover within 3 h of treatment and blocked estradiol-induced receptor synthesis at 6 h and 9 h. Thus, progestin down regulates estrogen receptor by increasing receptor turnover and inhibiting estrogen-induced receptor replenishment.
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A Takeda, W W Leavitt (1986)  Temporal effects of progesterone domination on estrogen and oxytocin receptors in hamster uterus.   J Steroid Biochem 25: 2. 219-224 Aug  
Abstract: The purpose of this study was to determine whether progesterone (P)-induced down regulation of estrogen receptors (Re) and oxytocin receptors (ROT) changes with the time of P exposure. Ovariectomized hamsters were given s.c. Silastic implants of estradiol (E2) and P for 4, 8 and 16 days. Cytosol and nuclear Re were measured at low temperature with the pyridoxal phosphate exchange assay, and ROT was assayed in the membrane fraction by [3H] oxytocin binding. Nuclear Re and ROT were down regulated throughout the 16-day P exposure period, but cytosol Re (and total Re) increased progressively from 4 to 16 days indicating that the down regulation of cytosol Re escapes P control with time. This conclusion was supported by P withdrawal studies in which P implants were removed for 6 or 12 h. P withdrawal resulted in equivalent recovery responses of nuclear Re and ROT after 4, 8 and 16 days of P exposure. Although cytosol Re recovery to P withdrawal occurred at 4 and 8 days, no response was obtained after 16 days of P exposure. Uterine weight increased during steroid treatment, and morphometric analysis of the P-dominated uterus revealed significant increases in the cross sectional area of the endometrium and myometrium with time of P exposure. Cytological examination of the uterus showed prominent secretory changes in the epithelial compartment on day 16 with accumulation of secretion in the uterine lumen. These results demonstrate that P can chronically down regulate nuclear Re and ROT. However, the control of cytosol Re varies with the time of P exposure, and cytosol Re levels become refractory to P domination by 16 days. The present observations indicate that the escape of cytosol Re from P control may be associated with the proliferation of one of more uterine cell populations such as glandular and luminal epithelial cells.
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1984
A Takeda, K Suzumori, Y Sugimoto, Y Yagami, T Miyazawa, C Yamada, M Matsuyama (1984)  Clear cell carcinoma of the ovary with colony-stimulating-factor production. Occurrence of marked granulocytosis in a patient and nude mice.   Cancer 54: 6. 1019-1023 Sep  
Abstract: A case of clear cell carcinoma of the ovary with colony-stimulating-factor (CSF) production is presented. Granulocytosis (54,200/mm3) of unknown cause was observed in a patient at the terminal stage of the clinical course. This tumor was successfully heterotransplanted into athymic nude mice, and transplantable tumor line was designated as OCL-1. OCL-1 tumor reproduced granulocytosis up to 640,000/mm3 in nude mice, and CSF production was demonstrated by colony-forming assay using tumor extract and mouse bone marrow cells in vitro. This is the first report that describes the case of CSF-producing clear cell carcinoma of the ovary and its heterotransplantation in nude mice.
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A Takeda, K Suzumori, Y Sugimoto, Y Yagami, K Kato, M Okuyama, M Matsuyama (1984)  Tumor hypoglycemia induced in nude mice by a heterotransplantable human ovarian carcinoma line (OCL-1).   Cancer Res 44: 2. 761-767 Feb  
Abstract: Tumor hypoglycemia induced by a heterotransplantable human ovarian carcinoma line (OCL-1) was described. Plasma glucose decreased to 36 +/- 9 mg/dl (S.D.) at 8 to 12 weeks after the transplantation. Significant amounts of immunoreactive insulin and insulin-like active substance could not be detected in tumor tissues. Plasma immunoreactive insulin levels were low, and glucagon levels were high in OCL-1-bearing nude mice, compared with the control. Light- and electron-microscopically, tumor cells possessed large amounts of glycogen, and this finding was also biochemically confirmed. OCL-1 tumor showed high glycogen synthetase activity compared with other control tumors, while glycogen phosphorylase activity was the same level as other tumors. The high glycogen synthetase activity was considered to be the cause of glycogen accumulation in tumor cells. Hypoglycemia in OCL-1-bearing nude mice was considered to be caused by abnormal redistribution of glycogen, i.e., marked accumulation of glycogen in tumor tissues and depletion of glycogen in the host liver. This OCL-1 tumor-nude mice system was thought to be a good model for research on the mechanisms of tumor hypoglycemia occurring in cancer patients with nonpancreatic islet cell tumors.
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A Takeda, M Matsuyama, K Kuzuya, T Chihara, S Tsubouchi, S Takeuchi (1984)  Mixed mesodermal tumor of the ovary with carcinoembryonic antigen and alkaline phosphatase production. Histochemical, autoradiographic, and electron microscopic studies of heterotransplanted tumors in athymic nude mice.   Cancer 53: 1. 103-112 Jan  
Abstract: A mixed mesodermal tumor of the ovary with carcinoembryonic antigen (CEA) and alkaline phosphatase (ALP) production was serially heterotransplanted into nude mice. The original tumor was diagnosed as homologous tumor, with sarcomatous component consisting of nonspecific spindle-shaped cells. These features were basically retained in the transplanted tumors, including CEA and ALP production. But, heterologous, chondrocytic-differentiated foci were found in the tumors at the third and sixth passages. Transitional-type cells from sarcomatous to carcinomatous cells were sometimes found in the transplanted tumors by light and electron microscopy. Ciliated sarcomatous cells, which may also represent the epithelial differentiation of sarcomatous cells, were found in the tumors at first passage. The current results support the combination tumor theory, which means that both the carcinomatous and sarcomatous components are of common stem cell origin.
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1983
A Takeda, M Matsuyama, Y Sugimoto, K Suzumori, T Ishiwata, S Ishida, Y Nakanishi (1983)  Oncocytic adenocarcinoma of the ovary.   Virchows Arch A Pathol Anat Histopathol 399: 3. 345-353  
Abstract: A case of ovarian adenocarcinoma mainly composed of oncocytes was studied by light and electron microscopy. Oncocytes, characterized by granular and eosinophilic cytoplasm by light microscopy possessed numerous mitochondria at the ultrastructural level. These oncocytes were classified into two types: typical and condensed oncocytes. Typical oncocytes seemed to be active, whereas condensed oncocytes were thought to be involved in a degenerative process. The two types of cells showed a close similarity to oncocytes in other organs (e.g., thyroid, parathyroid and salivary glands). This appears to be the first report of an ovarian oncocytic tumor.
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A Takeda, M Matsuyama, K Kuzuya, T Chihara, Y Ariyoshi, T Suchi, K Kato (1983)  Secretory component and IgA in endometrial adenocarcinomas. An immunohistochemical study.   Acta Pathol Jpn 33: 4. 725-732 Jul  
Abstract: The localization of secretory component (SC) and IgA was immunohistochemically studied in 6 normal endometrium and 55 endometrial adenocarcinomas including 34 well, 11 moderately and 10 poorly differentiated ones. In normal endometrium, SC localization was found in the cytoplasm of epithelial cells and luminal contents of the gland. IgA showed similar localization of SC. Secretory phase endometrium contained proportionally larger numbers of positive cells for SC and IgA than proliferative phase endometrium. SC localization was found in all cases of well and moderately differentiated carcinomas, while it was found only in 4 cases out of 10 poorly differentiated carcinomas. IgA localization was similar to that of SC and this condition was thought to reveal the binding of IgA to SC existing in the tumor cells. The present immunohistochemical study revealed that the staining intensity of SC well correlated with the histological grade of differentiation of the tumors.
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1982
A Takeda, T Ishizuka, T Goto, S Goto, M Ohta, Y Tomoda, M Hoshino (1982)  Polyembryoma of ovary producing alpha-fetoprotein and HCG: immunoperoxidase and electron microscopic study.   Cancer 49: 9. 1878-1889 May  
Abstract: Polyembryoma of ovary producing alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) was studied by indirect immunoperoxidase method for AFP and HCG, and electron microscopy. Clinically, this patient showed pseudoprecocious puberty caused by elevated HCG which is synthesized by trophoblastic cells in polyembryoma. She is put under VAC (vincristine, actinomycin-D, cyclophosphamide) chemotherapy after operation and shows no signs of recurrence including reelevation of serum AFP at five months after operation. Embryoid bodies which we studied correspond to normal embryo at 15- or 16-day stage. Immunoperoxidase study showed that AFP is synthesized by yolk sac cells of the embryoid bodies and HCG is synthesized by syncytiotrophoblastic cells. The finding about AFP synthesis suggests that normal embryo at 15- or 16-day stage may begin AFP synthesis. Electron microscopic study showed that each part of the embryoid bodies had some characteristic structures. Most striking features found in the cytodifferentiation of the embryoid bodies were noticed in some special differentiation of plasma membrane and existence of surface coat. Desmosomes were found in endodermal cells and yolk sac cells. Ectodermal cells were attached to each other by zonulae occludentes and adherentes. Microvilli were found in ectodermal cells and yolk sac cells. Two different kinds of surface coat were found in mesodermal cells and lining cells of yolk sac cavity: thin-layered deposit of electron-dense material covering the plasma membrane facing intercellular space of mesodermal cells and endodermal cells, and thick-layered deposit of electron-dense material which covered the plasma membrane facing yolk sac cavity of endodermal cells and yolk sac cells. Presence of similar characteristic material in RER of yolk sac cells led us to speculate that thick deposit was synthesized by yolk sac cells and secreted into yolk sac cavity. Combined with immunoperoxidase study by light microscopy, we assume that this thick-layered deposit has some close relation to AFP.
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