9 0 0 0 IR 性同一性障害

著者
木下 勝之 Katsuyuki KINOSHITA 埼玉医科大学総合医療センター産婦人科 Department of Obstetrics and Gynecology Saitama Medical Center Saitama Medical School
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.52, no.8, pp.1208-1214, 2000-08-01
参考文献数
12

Individuals pursuing sex reassignment have not been taken seriously in Japan, differing from in modern Western societies, where gender identity disorder (GID) has been officially adopted in ICD-10 or DSM-IV. Under these circumstances, we established multidisciplinary gender team in Saitama Medical Center, in which transsexuals are diagnosed and treated. The term GID han been used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, or a sense of inappropriateness in the gender role of that sex. The number of the GID in our gender clinic was 317 during 6 years from 1993 to 1999, among which 178 cases (56%) was female to male transsexuals (FTMTS), whereas 139 (44%) was male to female transsexuals (MTFTS). The cases desiring sex reassignment surgery in FTMTS was 102 (57%). Most of the transsexuals visiting our gender clinic became manifest during infant days or before puberty. The sex partners of 48% of FTMTS were female, and one fourth of the patients had the episode of failure to suicide. The origins of transsexualism are still largey unclear. A first indication of anatomic brain differences between transsexuals and no transsexuals have been found. There are two phases for the diagnosis of GID. In the first phase, a diagnosis in made based on formal psychiatric classification criteria, a "strong and persistent cross-gender identification". In the second phase, one's capability to live in the desired role and the strength of the wish for SRS, in the face of disappointments while living in the opposite gender role, is tested. Then the psychological intervention starts, followed by hormone therapy. Sex reassignment surgery for FTMTS is composed of mastoidectomy, a urethra lengthening, closure of vaginal wall and oophorotomy with hysterectomy. The point of operation technique is to make the anterior vaginal flap to lengthening the urethra to reach the tip of clitoris released upward, at hysterectomy. SRS for MTFTS is to dissect penis to make new clitoris and followed by vaginoplasty. SRS was first undertaken in Japan in 1998, and the attitude toward GID has become positive. It seems likely that GID would be accepted in medical, legal social field soon in Japan.
著者
塚越 俊夫 Toshio TSUKAGOSHI 群馬大学医学部産科婦人科学教室 Department of Obstetrics and Gynecology Gunma University School of Medicine
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.42, no.12, pp.1655-1662, 1990-12-01

ある矯正施設に収容された女子集団 (15~20歳:平均17.4歳) 141例における性行動とC. trachomatis (以下CT) 感染の関係を疫学的に分析し以下の成績を得た. 1. 初経年齢は, 原発性無月経の1例を除き9~15歳に分布し, 平均12.1歳であった. 2. 全員に性交経歴があり, 初交年齢は11~18歳, 平均13.9歳と低年齢であった. 3. 16例 (11.3%) の子宮頚管材料からCTが分離培養され, Micro Trak法により9例 (6.4%) からCT抗原が検出された. いずれかの方法によるCT抗原陽性者は19例 (13.5%) であった. 4. CT抗原は子宮頚管炎と診断された55例中14例 (25.5%) に陽性であり, 炎症の認められなかった86例からの陽性率5.8%に比べ有意に高率であった (p < 0.001). 5. CT抗原検出と腔トリコモナス症の間に相関が認められた (p < 0.05). 6. CT抗原は低年齢層 (15~17歳) で21.1%と高率に認められ, 年長グループ (18~20歳) での陽性率はわずか4.6%であった (p < 0.01). 7. 57名に妊娠歴 (1~3回) があったが, CT抗原陽性率は妊娠経験のないグループのほうが高率であった(p < 0.05). 8. 血中の抗CTlgG抗体は65例 (46.1%) に証明された.抗CT抗体陽性グループにCT抗原が高率に見出され, かつ抗原と抗体の血清型(immunotype)が一致する例が多かった. このことから血中抗CT抗体は現症のCT感染の結果生じたものであるが, 頚管部へのCT感染に対し, 強い阻止効果を表さないことが示唆された. 9. CTに起因する子宮頚管炎を治療せずに放置した場合, 若年女子では平均56日で自然消失するグループと100日以上に亘って持続感染するグループに分かれることが窺われた.
著者
北村 邦夫 Kunio KITAMURA 群馬県衛生環境部保健予防課母子保健係 Department of Environment and Health Gunma Prefecture
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.36, no.7, pp.1001-1007, 1984-07-01

群馬県において昭和54年に出生した2,500g以下の低出生体重児の母と,その低出生体重児と地域や出生時期を極力マッチさせ出生体重が3,000~4,000gの正常児の母との間で症例一対照研究を行ない以下の結果を得た.1)低出生体重児には女児が多く,新生児期の死亡率は8.1%で,体重別にみた予後は1,500g未満の場合に悪い,2)低出生体重児に関与すると思われる妊娠前の危険因子としては年齢,体格,月経歴,既往歴等がある.3)社会医学的要因には職業,学歴,喫煙,睡眠時間,母子健康手帳の交付時期,健診回数等があげられる.4)妊娠中の危険因子としては,流早産徴候としての出血,腹痛や貧血,妊娠中毒症等が関与している.5)低出生体重児には多胎,骨盤位,前置胎盤,早期剥離などに伴うことが多い.A case-control study was made in Gunma Prefecture of 1,390 mothers of babies born weighing 2,500 grams or less and an equal number of mothers of 3,000-up to-4,000 gram babies matched by place and month of birth. A correlation was found between low birth weight babies and maternal age, stature, menstrual history and past history. The mother's occupation, educational career, smoking habits, amount of sleep each day, date of issue of the Mother's Handbook and the number of the periodical health examinations received can be listed as socio-medical factors. Bleeding and lower abdominal pain during pregnancy, anemia and toxemia of pregnancy are found as prenatal factors. Low-birth-weight babies are found to be correlated with multiple pregnancy, breech presentation, placenta previa and premature separation of the placenta, also.
著者
沖 明典 Akinori OKI 筑波大学大学院人間総合科学研究科婦人周産期医学 Department of Obstetrics and Gynecology Graduate School of Comprehensive Human Sciences University of Tsukuba
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.58, no.11, pp.1739-1744, 2006-11-01
被引用文献数
3

[Purpose] Our aim is to clarify how HPV type and other prognostic factors are involved in regression and progression of CIN 1/2. The primary endpoint is progression to CIN 3 and the secondary endpoint is regression to normal cervix. The second aim is to make a guideline of management of CIN 1/2 based on the data from the cohort study. [Methods] The study subjects consisted of 570 women aged 54 or younger with cytologically and histologically confirmed CIN 1/2. CIN cases included 479 CIN 1 and 91 CIN 2. They were followed up at 4 month-interval and received cervical cytology and colposcopy at each visit. The study methods included a self-administered questionnaire, detection and typing of HPV, detection of serum antibody against HSV, CMV and Chlamydia trachomatis, and analysis of HLA class II alleles. A self-administered questionnaire were composed of 10 study variables including smoking, marital status, number of births, use of contraceptives and lifetime number of sexual partners. We used the HPV risk categories based on the meta-analysis of 14 Japanese reports; high-risk (HPV16/18/31/33/35/52/58), intermediate-risk (HPV39/45/51/56/59/68) and low-risk (other types of HPV) groups. [Results] The median follow-up time was 38.1 months. The 570 subjects were divided into 361 (63.3%) patients with regression, 172 (28.6%) patients with persistence and 46 (8.1%) patients with progression. The median regression time was 6.5 months and the median progression time was 17.9 months, suggesting that regression is an early event and progression is a late event in the national history of CIN 1/2. We used hazard ratio after adjustment of Age, CIN grade and HPV category to evaluate various prognostic factors, because the three factors were closely associated with both regression and progression in the univariate analysis. Age, CIN grade, HPV risk category, smoking, marital status, and number of sexual partners were significantly associated with CIN persistence, whereas CIN grade, HPV risk category and HLA class II allele (HLA DRB1*1302) had significant association with CIN progression. Based on these data, we proposed 'The Prognostic Scoring System for CIN 1/2' using three prognostic factors such as age (thirties; 1, others; 0), CIN grade (grade 2; 3, grade 1; 1, no histological confirmation; 0) and HPV risk category (high 3, intermediate; 1, low; 0). When the CIN 1/2 patient has 5 or higher points in this scoring system, the treatment of CIN 1/2 (LEEP, lasar vaporizaion or conization) is recommended. According to the decision rule, we need to treat most of CIN 2 patients and a part of CIN 1 patients. To compare with the ACOG guideline, this system can more accurately identify higher-risk group as target for treatment. [Conclusion] These data suggest that HPV type and CIN grade are the highest determinants of both regression and progression of CIN and host environmental factors (age, smoking, marital status, and number of sexual partners) may correlate with CIN regression and host genetic variations (HLA class II allele) may be associated with CIN progression. The new prognostic scoring system based on the data from the cohort study can be a new guideline for management of CIN 1/2.
著者
浜西 正三 Shozo HAMANISHI 神戸大学医学部産科婦人科学教室:神戸大学医学部解剖学第二講座 Department of Obstetrics & Gynecology Kobe University School of Medicine:Department of Anatomy Division 2 Kobe University School of Medicine
出版者
日本産科婦人科学会
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.29, no.5, pp.500-506, 1977-05-01

ラットの着床周辺期における胚と内膜の表面構造の変化について,走査型電顕的観察を行ない,次の成績を得た. 1) 正常着床期の子宮内膜上皮表面では,規則正しく配列する微絨毛は,長短不整となり,先端部が風船状に膨化した後,急激に屈曲,短小,不整化する.細胞質突起はこぶし状,入道雲状で,数が増えた後,壁が増し,縮小扁平化して,adhesion stageに微絨毛の原形消失と相呼応し,不整粗大な鋸歯状・海草状突起へ移行する. 2) 遅延着床時内膜では,比較的繁茂する微絨毛と巨大細胞質突起を認めるが,これは妊卵(原胚子)や卵管液の作用にもよるものではなく,progesteroneの作用による.またそのestrogenによる着床誘導時には,早期(4~8時間)に一過性の分泌亢進像を呈した後,後期(16~24時間)に平低下する. 3) 微絨毛先端部の風船状膨化はestrogen作用下に生ずるmicroapocirine像と考えられる. 4) 腺開口部構造が反間膜側内膜の側壁部に,孤立した1細胞面積分の陥凹や,舟底状の斜坑状の陥,裂隙として認められる.一方,上皮細胞がロゼット状に集合した所で,細胞間隙からの分泌を示唆する所見が得られた,これら2者ともにestrogenの作用下で顕著となる. 5) 胚の透明帯の表面は,素焼の陶器様で粗〓である.透明帯消失後,胚の表面に均等に生えていた微絨毛は,胚自体の増大や栄養膜細胞の増数に伴い消失してゆき,胚の表面は平滑となる. これら一連の所見は,胚と内膜が三次元的な観点からも,互いにより平滑な面で最初の接触を遂行していることを示すものである.The structural changes of the surfaces of the endometrium and the blastocyst during the implantation in rats were studied scanning electron microscopically. Findings obtained were as follows: 1) In the pre-attachment stage, the microvilli of the endometrial luminal epithelium lose their distal ends. Thereafter they shorten rapidly and become bent irregularly. Cellular protrusions are nodular at first, then increase in number with multiple folds and flanges, subsequently become small and flattened. In the adhesion stage, they become serrated and show seaweed-like appearance. 2) During delayed implantation, caused by dosing of progesterone, relatively abundant microvilli and giant cellular protrusions are observed. During the induction of implantation with estrogen, the endometrium assumes transiently the secretory phase, and then becomes flattened. 3) Many structures suggesting the glandular orifice an also that seeming to the intercellular secretion are observed, especially under the influence of estrogen. 4) After the shedding of zona pellucida, the microvilli of the trophoblast gradually disappear. In the adhesion stage, the surface of the blastocyst become smooth.
著者
野口 有生 平戸 久美子 斉藤 裕 高崎 克哲 矢内原 巧 中山 徹也 Yusei NOGUCHI Kumiko HIRATO Hiroshi SAITO Katsunori TAKASAKI Takumi YANAIHARA Tetsuya NAKAYAMA 昭和大学医学部産科婦人科学教室 昭和大学医学部産科婦人科学教室 昭和大学医学部産科婦人科学教室 昭和大学医学部産科婦人科学教室 昭和大学医学部産科婦人科学教室 昭和大学医学部産科婦人科学教室 Department of Obstetrics and Gynecology Showa University School of Medicine Department of Obstetrics and Gynecology Showa University School of Medicine Department of Obstetrics and Gynecology Showa University School of Medicine Department of Obstetrics and Gynecology Showa University School of Medicine Department of Obstetrics and Gynecology Showa University School of Medicine Department of Obstetrics and Gynecology Showa University School of Medicine
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.40, no.3, pp.359-364, 1988-03-01
被引用文献数
1

分娩時ヒト子宮頚部組織における遊離アラキドン酸生成能と, それに及ぼす妊娠性ステロイドの影響を調べる目的で次の実験を行ない, 以下の成績を得た. 1) 正常分娩のヒト子宮頚部組織800g上清を酵素源とし, L-3-phosphatidylcholine, 1-stearoyl-2-[1-^<14>C]arachidonylを基質とし, インキュベーションを行ない, 遊離されたアラキドン酸産生量よりphospholipase A_2活性を測定し, 更に各種のkineticsを行ない, ヒト子宮頚部組織内でリン脂質より遊離アラキドン酸産生に介在するphospholipase A_2活性が存在することを示した. 2) 培養液中に妊娠中増加する各種の妊娠性ステロイド(cortisol, pregnenolone, 20α-dihydroprogesterone, pregnenolone-sulfate, DHA, DHA-sulfate, estrone, estradiol, estriol)を添加し, 本酵素活性に及ぼす影響を検討した. 各種妊娠性ステロイド添加では, 本酵素活性に対し, 明らかに影響を示すものはなかつた. 3) 分娩第1期に母体にDHA-sulfate (マイリス) 600mgを2時間で点滴静注した後, 分娩に至つたDHA-sulfate投与群と非投与正常分娩例との本酵素活性の比較では, 投与群40±13pmoles/mg protein であり, 非投与正常分娩例の39±7pmoles/mg proteinと比し差はみられなかつた. 以上のことよりヒト妊娠子宮頚部に, phospholipase A_2活性が存在することが明らかとなり, また, 本実験条件下ではprostaglandin合成機構の一過程であるphospholipase A_2活性に対する妊娠性ステロイドの関与は認められなかつた.Prostaglandins (PGs) play an important role in cervical ripening. It is known that the hydrolytic release of arachidonic acid from phospholipids regulates the rate of PG formation. To study the PG biosynthesis in cervical tissue, phosphatidylcholine containing ^<14>C-arachidonic acid in Sn-2 position was incubated with the 800 × g supernatant of cervical tissue obtained from pregnant women at delivery. The only recognizable radiolabeled metabolite, ^<14>C-arachidonic acid, was found on an autor-adiogram of TLC, which corresponded to authentic arachidonic acid. Therefore, phospholipase A_2 activity was calculated as the rate of the release of arachidonic acid from phosphatidylcholine under the conditions used. The optimal pH of phospholipase A_2 activity in 800 × g supernatant was found to be 7.0. It was found that the addition of Ca^<2+> increased the enzyme activity. It was demonstrated that the concentrations of DHA-sulfate (DHA-S) and conjugated estrogens were higher in ripened cervical tissue than in non-ripened tissue and that PGI_2 and PGE_2 production increased following the addition of DHA-S. The effects of steroids mainly derived from feto-placental unit, cortisol, pregnenolone, 20α-dihydroprogesterone, pregnenolone-sulfate, DHA, DHA-S, estrone, estradiol and estriol on arachidonic acid release were also studied in vitro. After the onset of labor, DHA-S was administered to the patients in vivo and their cervical tissues were collected at delivery. It was found that steroids including DHA-S did not affect phospholipase A_2 activity under the conditions used. These results indicate that cervical tissue posseses the ability to release arachidonic acid from phospholipid, although this step in PG formation might not be affected by steroids including DHA-S.
著者
大蔵 健義 一瀬 邦弘 渡部 秀樹 瀬川 裕史 三ツ矢 和弘 榎本 英夫 林 雅敏 矢追 良正 Takeyoshi OHKURA Kunihiro ISSE Hideki WATABE Yushi SEGAWA Kazuhiro MITSUYA Hideo ENOMOTO Masatoshi HAYASHI Yoshimasa YAOI 獨協医科大学越谷病院産婦人科 東京都多摩老人医療センター精神科 獨協医科大学越谷病院産婦人科 獨協医科大学越谷病院産婦人科 獨協医科大学越谷病院産婦人科 獨協医科大学越谷病院産婦人科 獨協医科大学越谷病院産婦人科 獨協医科大学越谷病院産婦人科 Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Psychiatry Tokyo Metropolitan Tama Geriatric Hospital Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine Department of Obstetrics and Gynecology Koshigaya Hospital Dokkyo University School of Medicine
雑誌
日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
巻号頁・発行日
vol.46, no.3, pp.271-276, 1994-03-01
被引用文献数
4

更年期以後の婦人は, 種々な程度の物忘れを訴える。エストロゲンが女性の記憶機能に影響を与えるという報告がある。しかし, 女性の更年期に関連して年齢層別に記憶検査を行って, 記憶力低下があるかどうかを報告した文献はない。本研究は, 次の二つを主な目的とした。更年期及びその周辺婦人に関して, 1) 記憶力低下があるかどうか。2) もし記憶力低下があるとすると, それは, 卵巣からのエストロゲン分泌が減少する更年期開始の年齢層やエストロゲン分泌が消失する閉経期の年齢層と関係があるかどうか。1), 2) を明らかにするために, 獨協医科大学越谷病院産婦人科外来受診中でかつ通常の日常生活を送っている, 31~65歳の婦人200名について三宅式記銘力検査を行って検討した。200名を5歳ごとに年齢層で区分して, A~G群に分けた。A~F群は各群30名で, G群は20名であった。各群の記憶力は, 無関係対語3回目の正答数を代表値として, 分散分析後多重比較した。A群 (31~35歳) とB群 (36~40歳) の正答数 (平均±SD) は, それぞれ8.0±2.0, 8.2±1.7で, 有意差は認められなかった。この両群は, 残りのいずれの群よりも高値であった (p<0.01)。C群 (41~45歳) とD群 (46~50歳) の正答数は, それぞれ5.9±2.1, 5.6±2.4で, 両群間に有意差はなかった。E (51~55歳), F (56~60歳), G (61~65歳) の各群の正答数は,それぞれ4.5±2.4, 4.2±2.2, 3.3±1.6であった。C群は, E~Gの各群より有意に高かった (p<0.05)。D群は, F, Gの両群より有意に高かった (p<0.05)。E群はG群より有意に高かった (p<0.01)。以上をまとめると次のようになる。B群からC群に移行するところで記憶力低下は最大であった。更年期には, C群とE群で記憶力低下が認められた。前者は, 血中エストロゲンの周期的変化が減少ないし停止して, 更年期が開始する年齢層に一致していた。後者は, 閉経期の年齢層に一致していた。更年期以後も緩徐に記憶力低下が進行した。This study was designed to investigate memory function in climacteric and periclimacteric women who lived a normal, ordinary life. Two hundred women treated at the gynecological outpatient clinic of Koshigaya Hospital were divided into 7 groups: groups A (31~35yr), B (36~40yr), C (41~45yr), D (46~50yr), E (51~55yr), F (56~60yr) and G (61~65yr). Each group consisted of 30 women except group G (n=20). The memory function of each group was determined and the mean scores for 10 paired hard-associates after three trials of presentation were compared. The mean scores (±SD) for groups A and B were 8.0±2.0 and 8.2±1.7, respectively, which were not statistically different. The scores for both groups were significantly higher than those for the other groups (p<0.01). The mean scores for groups C and D were 5.9±2.1 and 5.6±2.4, respectively, which were not statistically different. The score for group C was significantly higher than those for groups E (4.5±2.4), F (4.2±2.2), and G (3.3±1.6) (p<0.05). The score for group D was significantly higher than those for groups F and G (p<0.05). The score for group E was significantly higher than that for group G (p<0.01). The decrease in memory function was the greatest in group C. In the climacterium, memory impairment was also observdd in group E. The former corresponds to the climacteric commencement age group where cyclic changes in serum estrogen levels decrease or cease, and the latter corresponds to the age group for menopause. Memory impairment progressed gradually in postclimacteric women.