HIROO NARUSE - Academia.edu (original) (raw)

Papers by HIROO NARUSE

Ultrasound in Obstetrics and Gynecology, 2005

Clinical Chemistry, 1992

We measured the concentration of zinc coproporphyrin I (ZnCP-I), a characteristic component of me... more We measured the concentration of zinc coproporphyrin I (ZnCP-I), a characteristic component of meconium, in maternal plasma by fluorometry after HPLC. We obtained plasma samples from 89 women: 35 at weeks 10-40 of normal pregnancy, 41 shortly after normal delivery, 4 from patients with amniotic fluid embolism (AFE), and 9 from non-AFE patients with intra- or postpartum shock caused by genital bleeding. The plasma ZnCP-I concentration was 97 (SD 83, range 38-240) nmol/L in the AFE patients, 11 (SD 9.2) nmol/L in the non-AFE patients, 12 (SD 7.9) nmol/L during normal pregnancy, and 26 (SD 10) nmol/L shortly after normal delivery. We suggest that measuring ZnCP-I in maternal plasma by fluorometry on HPLC is a rapid, noninvasive, and sensitive method for diagnosing AFE and propose 35 nmol/L as the cutoff value for the ZnCP-I concentration in maternal plasma for the diagnosis of AFE.

Journal of public health (Oxford, England), Jan 24, 2016

The adverse effects of maternal and paternal smoking on child health have been studied. However, ... more The adverse effects of maternal and paternal smoking on child health have been studied. However, few studies demonstrate the interaction effects of maternal/paternal smoking, and birth outcomes other than birth weight have not been evaluated. The present study examined individual effects of maternal/paternal smoking and their interactions on birth outcomes. A follow-up hospital-based study from pregnancy to delivery was conducted from 1997 to 2010 with parents and newborn infants who delivered at a large hospital in Hamamatsu, Japan. The relationships between smoking and growth were evaluated with logistic regression. The individual effects of maternal smoking are related to low birth weight (LBW), short birth length and small head circumference. The individual effects of paternal smoking are related to short birth length and small head circumference. In the adjusted model, both parents' smoking showed clear associations with LBW (odds ratio [OR] = 1.64, 95% confidence interval ...

Ultrasound in Obstetrics & Gynecology, 2011

, 54 pairs of MCDA twins and 2 triplets were delivered in 3 tertiary care centers. All pregnancie... more , 54 pairs of MCDA twins and 2 triplets were delivered in 3 tertiary care centers. All pregnancies were followed with a weekly fetal surveillance for fetal weight discordance and twin-to-twin transfusion syndrome (TTTS). After birth, placentas were observed and stained to search type and number of vascular anastomoses, type and distance between cord insertions and placental distribution. Birth weights as fetal and neonatal mortality and early morbidity were recorded from clinic charts. Placental characteristics were analized in relation to perinatal outcome. Triplets were analized separately. Results: Anastomoses were detected in all placentas with fetal growth alterations in 44% of the studied pregnancies. Between fetuses with growth disturbances 12 pairs were diagnosed as TTTS, 9 pairs as selective intrauterine growth restriction (IUGR) and 3 pairs as growth discordances without IUGR. Eight fetal deaths were recorded, in 2 pregnancies a single fetal death occurred and in other 3 pregnancies both fetuses died in spite of fetal therapy. Relation between abnormal cord insertions and smaller placental territories were seen in all abnormal growth pregnancies and in 50% of pregnancies without growth disturbances. Between discordant growth pregnancies, only all TTTS cases had unequal shared territories and neonatal weight discordance more than 20%. There were 3 cases of severe early morbidity and 6 babies died during the early neonatal period, most in relation to mayor malformations. Conclusions: Placental characteristics are closely related to perinatal outcome, mainly with the presence of TTTS and fetal growth disturbances. Prenatal identification of these characteristics in this group of pregnancies may change parent counselling as surveillance and intrauterine therapy program.

Choonpa Igaku, 2008

小腸閉鎖は胎児腹部超音波検査によって拡張した腸管が多発性の嚢胞として観察されることが多い．我々は胎児超音波検査にて，渦巻き状の形態でかつ腸管襞を伴う嚢胞を含む多発性の嚢胞を観察し，胎児腹水，腹腔... more 小腸閉鎖は胎児腹部超音波検査によって拡張した腸管が多発性の嚢胞として観察されることが多い．我々は胎児超音波検査にて，渦巻き状の形態でかつ腸管襞を伴う嚢胞を含む多発性の嚢胞を観察し，胎児腹水，腹腔内石灰化の経過を示した2症例を経験したので報告する．症例1は27歳，妊娠25週に胎児腸管のループ状の拡張像を指摘された．当院入院時には，腸管拡張像は高輝度の塊をループ状に取り囲む腸管襞を伴う多発性嚢胞として観察され，胎児腹水の貯留を認めた．妊娠37週には胎児腹水の消失，腸管拡張，高輝度腸管像，胎児腹腔内石灰化を認めたため小腸閉鎖，穿孔に続く胎便性腹膜炎を疑った．妊娠38週4日に帝王切開にて2,270gの男児を娩出した．出生後，児は小腸捻転，小腸閉鎖，胎便性腹膜炎と診断された．症例2は30歳，妊娠29週時に胎児腹腔内に渦巻き状の腸管拡張像と胎児腹水を認めた．妊娠36週には胎児腹水の消失，腸管拡張，高輝度腸管像，胎児腹腔内石灰化を認めたため小腸閉鎖，穿孔に続く胎便性腹膜炎を疑った．妊娠38週6日に2,958gの女児を経膣分娩した．出生後，児は小腸閉鎖，胎便性腹膜炎と診断された．胎児超音波検査において，渦巻き状に拡張した腸管を認めた場合には，胎児小腸閉鎖，腸穿孔に続き胎便性腹膜炎を呈する可能性を考慮に入れ，胎児超音波所見の変化に注意し慎重に観察する必要がある．

Journal of Korean medical science, 2016

Anthropometry measurements, such as height and weight, have recently been used to predict poorer ... more Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0-151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0-157.9 cm) and the third shortest maternal height quartiles (158.0-160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admiss...

The Open Medical Devices Journal, 2012

Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal ... more Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal treatment choice since the release of the Eurofetus randomized clinical trial. These techniques have been adopted throughout the globe, and many institutions have instituted or will soon institute fetoscopic laser surgery procedures; however, laser surgery has a steep learning curve because of the following: challenging placental location, complex and unexpected communicating anastomoses, residual anastomoses after surgery, or discolored amniotic fluid. We have been performing laser surgery since 2002 in Japan; to date, we have compiled a series of 170 cases. Our data indicates a 78% of overall survival with 5% neonatal morbidity, 63% of survival of both twins, and 93% survival of at least one twin. The recurrent TTTS rate was 1% and the residual vessel rate was 3%. To improve the learning curve of laser surgery, the employment of various techniques is recommended to achieve a successful surgical outcome: (1) Mapping: before laser ablation, a very thorough mapping of vascular anastomoses should be done, and should be repeated after ablation; (2) Sequential order: obliteration of arterio-venous anastomoses from donor to recipient should be done first to avoid donor hypotension and/or anemia; (3) Trocar (cannula) assisted technique: Trocar assisted technique: Using gentle indent the trocar to the placenta by withdrawing the scope shortly, then anastomoses could be ablated easily; (4) Line method: to avoid residual anastomoses, the laser should draw a virtual line at the hemodynamic equator; The operator must be careful not to miss small anastomoses. These techniques can help achieve a successful outcome for fetoscopic laser surgery and improve the outcome for cases of severe TTTS.

Journal of Health & Medical Informatics, 2013

Aims: Fetoscopic laser surgery has been widely accepted of optimal treatment for Twin-Twin Transf... more Aims: Fetoscopic laser surgery has been widely accepted of optimal treatment for Twin-Twin Transfusion Syndrome (TTTS) in monochorionic twin pregnancies. To avoid surgical complication and to improve the outcome, various techniques employed in our institution. The aim of our study is to assess the clinical outcomes of TTTS after laser surgery with combined various techniques. Methods: We performed 171 cases of fetoscopic laser surgery for TTTS from 2002 to 2011 in our institution. Various techniques employed in our studies to improve the learning of laser surgery and to achieve successful outcome were; (1) A very thorough mapping of vascular anastomoses before and after ablation; (2) Obliteration of arterio-venous anastomoses from donor to recipient should be done first, (3) Trocar assisted technique using gentle indent the trocar withdrawing the scope shortly, to ablate anastomoses easily, (4) A virtual line was drawn by laser at the hemodynamic equator to avoid residual anastomoses, and not to miss small anastomoses. Results: Laser photocoagulation was performed since 2002 in our institute, compiling 171 cases. Overall survival was 78% with 5% neonatal morbidity. Both twins survived for 64%, and the survival of one twin was 93%. The recurrent TTTS rate was 1%, and the residual vessel rate was 2%. Conclusion: A successful outcome for fetoscopic laser surgery is achievable and the outcome is improved in severe TTTS cases by these techniques.

Ultrasound in Obstetrics & Gynecology, 2013

THE JOURNAL OF JAPAN SOCIETY FOR LASER SURGERY AND MEDICINE, 1995

Croatian medical journal, 2000

This report describes 3 cases of pulmonary stenosis in the recipient twin in twin-twin transfusio... more This report describes 3 cases of pulmonary stenosis in the recipient twin in twin-twin transfusion syndrome. Fetal echocardiography showed cardiomegaly, tricuspid valve regurgitation, and increased reverse flow in the inferior vena cava, as signs of congestive heart failure in all 3 cases. We diagnosed 2 cases of pulmonary stenosis by fetal echocardiography prenatally and confirmed our findings in all 3 cases postnatally. Two cases underwent postnatal balloon valvuloplasty to release the pulmonary valvular stenosis in neonatal period. The third one died soon after delivery and autopsy showed a slightly thickened pulmonary valve. One of the cases was diagnosed in the early second trimester (20 weeks of pregnancy), the earliest detection of fetal pulmonary stenosis reported in literature. The presence of high peak velocity of the pulmonary artery at 20 weeks of pregnancy preceded the development of pulmonary stenosis in this case. This supports the hypothesis that alterations in fetal...

The Science of the total environment, 2015

Exposure to air pollution is linked with an increased risk of preterm births. To provide further ... more Exposure to air pollution is linked with an increased risk of preterm births. To provide further evidence on this relationship, we evaluated the association between proximity to major roads--as an index for air pollution exposure--and various obstetrical complications. Data were extracted from a database maintained by the perinatal hospital in Shizuoka, Japan. We restricted the analysis to mothers with singleton pregnancies of more than 22 weeks of gestation from 1997 to 2012 (n=19,077). Using the geocoded residential information, each mother was assigned proximity to major roads. We then estimated multivariate adjusted odds ratios and their 95% confidence intervals (CIs) for the effects of proximity to major roads on various obstetrical complications (preeclampsia, gestational diabetes mellitus, placenta abruption, placenta previa, preterm premature rupture of membrane (pPROM), preterm labor, and preterm births). We found positive associations of proximity to major roads with preec...

The Science of the total environment, 2012

Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low bir... more Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight. We examined whether proximity to major roads (as a marker of exposure to air pollution) is associated with increased placenta/birth weight ratio (as a biomarker of the placental transport function). Data on parental characteristics and birth outcomes were extracted from the database maintained by a major hospital in Shizuoka Prefecture, Japan. We restricted the analysis to mothers who delivered liveborn single births from 1997 to 2008 (n = 14,189). Using geocoded residential information, each birth was classified according to proximity to major roads. We examined the association between proximity to major roads and the placenta/birth weight ratio, using multiple linear regression. Proximity to major roads was associated with higher placenta/birth weight ratio. After adjusting for potential confounders, living within 200 m of a major road increased the ratio by 0.48% (95% CI = ...

Ultrasound in Obstetrics and Gynecology, 2002

... Design and methods: The cervical length was measured by trans-vaginal ultrasound in ... above... more ... Design and methods: The cervical length was measured by trans-vaginal ultrasound in ... above the upper 95% confidence interval, one of them developed neonatal Grave's of ... WS03-03 Three-dimensional digital imaging for assessing oogenesis and follicular development as ...

Ultrasound in Obstetrics and Gynecology, 2007

The formula to predict outcome was calculated as Y = −1.8004 + (0.1423 × CRL) + (0.1170 × AC) − (... more The formula to predict outcome was calculated as Y = −1.8004 + (0.1423 × CRL) + (0.1170 × AC) − (0.8229 × amniotic fluid), where the probability for complicated outcome is 1/(1+exp(−Y)). With '> 50% chance of complicated outcome' as cutoff , the sensitivity was 52% with a PPV of 75%. Conclusions: The survival rate was 89%, with most losses at ≤ 24 weeks. TTTS occurred in 8.8%, whereas 4.2% had severe hemoglobin discordances at birth. Combined first-and early secondtrimester scan identified 52% of cases with a complicated outcome. OC113 Amniotic fluid discordance in monochorionic twin pregnancies: how harmful is it?

Ultrasound in Obstetrics and Gynecology, 2008

Objective To validate the Quintero stage III subclassification for twin-twin transfusion syndrome... more Objective To validate the Quintero stage III subclassification for twin-twin transfusion syndrome (TTTS) based on visibility of the bladder of the donor twin. Methods Between July 2002 and August 2006, there were 131 pregnant Japanese women affected by severe TTTS before 26 weeks' gestation, treated with fetoscopic laser surgery at five centers in Japan, whose pregnancies continued beyond 22 weeks. Outcome data were available in all cases and surviving infants were followed up for at least 6 years. This study focused on the Stage III TTTS patients. These were subclassified into Stage III atypical (abnormal Doppler flow with visible donor bladder) and Stage III classical (abnormal Doppler flow with nonvisible donor bladder) groups. Perioperative data and postnatal outcomes were compared between the groups. Results Seven Stage I, 22 Stage II, 82 Stage III and 20 Stage IV pregnancies continued beyond 22 weeks. There was a significantly higher incidence of absent or reversed end-diastolic velocity in the umbilical artery (UA-AREDV) of the donor in Stage III atypical than in Stage III classical patients (83.8% vs. 53.3%, P = 0.004). Stage III atypical cases also had a significantly higher incidence of arterioarterial (AA) anastomoses (72.9% vs. 17.8%, P < 0.001) and intrauterine fetal demise (IUFD) of the donor (43.2% vs. 13.3%, P = 0.002). However, there were no differences in overall survival or in abnormal brain scans of surviving infants. Donors with both UA-AREDV and AA anastomoses had a significantly higher incidence of IUFD compared with the others (53.3%, P < 0.001). Conclusions Quintero stage III atypical was characterized by a high incidence of AA anastomoses and UA-AREDV of the donor, resulting in IUFD. Subclassification of Stage III based on visibility of the bladder of the donor twin was adequate for and compatible with differentiating prognosis and pathophysiology.

Seminars in Thrombosis and Hemostasis, 2002

Severe preeclampsia is a pathophysiological disorder specific to pregnancy and characterized by v... more Severe preeclampsia is a pathophysiological disorder specific to pregnancy and characterized by vasoconstriction and hypercoagulability. Eclampsia (convulsion associated with preeclampsia) and hemolysis, elevated liver enzymes, and low platelet count associated with preeclampsia (HELLP syndrome) are serious complications in patients with severe preeclampsia. They are thought to be characterized by generalized vasoconstriction and reduction in blood flow to various organs that may be explained by increased sensitivity of the vascular smooth muscles and increased vasopressors. Liver involvement in eclampsia and preeclampsia is referred to as HELLP syndrome, and epigastric and right upper quadrant pain is often a symptom of severe preeclampsia and may be indicative of imminent convulsions. In addition, marked dilatation of the stomach and the colon is often demonstrated in these patients. These phenomena result from the hyperactivity of the sympathetic nervous system but are not caused by the hyperactivity of the parasympathetic nervous system. The authors experienced two cases of eclamptic seizures after the administration of an anticholinergic (scopolamine butylbromide) in patients with severe preeclampsia complicated by HELLP syndrome. Anticholinergics, blocking agents of the parasympathetic nervous system, can enhance the hyperactivity of the sympathetic nervous system; therefore, vasospasms of the vessels may be easily aggravated, and eclamptic seizures may be induced in patients with severe preeclampsia, especially in those complicated by HELLP syndrome. The administration of anticholinergics should be avoided in patients with severe preeclampsia, especially when there is epigastralgia.