2013年01月

ホルモン療法との出会い:国内初のホルモン療法に成功(3)

その年、1970年の冬、スミス博士の治療法:前回のブログ:ホルモン療法との出会い(2)を重症妊娠中毒症患者さんに試す機会が訪れました。

ところが、この治療法を試すまでには、思わぬ障害が待っていました。当時、日本の周産期医療ではエストロゲンとプロゲステロンを妊婦に使うのは一般的ではありませんでした。エストロゲンは現在も禁忌とされています。

そこで、妊婦の同意を取り付けて、父が経営していた産婦人科医院の患者として治療することにしました。

スミス博士の論文を参考にしながら、国内初のホルモン療法(天然型のエストロゲンとプロゲステロン併用療法)を試みました。スミス博士は二つのホルモンを治療中は一定量で継続的に使用していました。しかし、私は、前回のブログで述べましたように、妊婦の血液中の二つのホルモンは妊娠週数の進行とともに、暫増するので、我々のNPOホームページに記載していますように、妊娠中毒症と切迫早産のホルモン投与量を妊娠週数で暫増させる投与法で行いました。不妊治療のなかでも体外受精を行うときは、産婦人科医のみならず、患者さんも、如何に二つのホルモンの血液中のレベルが治療の成功に重要かは理解できることです。言うまでもなく、妊娠の成立にエストロゲンとプロゲステロンの血液中の濃度は重要なのです。正常な妊娠の進行とその結果としての分娩にもエストロゲンとプロゲステロンの血液中の濃度は大変重要であるのは同様です。

Encounter with sex steroid hormone therapy (No 3):  first case in Japan

In 1970 winter, I had a chance to try sex steroid hormone therapy
for severe preeclampsia,
the therapy which was proposed by
Drs. Smith (my previous blog). However my attempt of this plan
was not acknowledged in the treatment of preeclampsia in Japan
at that time. In Japan it was not common to use both sex steroid
hormones for pregnant women at that time. Estradiol administration
for pregnant women is not yet acknowledged except for in vitro
fertilization. Therefore at my hospital (Nagoya  National Hospital)
I could not execute my plan. My father then had his small private
hospital in Kuwana City, Mie Prefecture). I did this treatment at my father 
hospital. With the consent of this trial for severe preeclampsia patient
and her husband I could start this treatment in the end of December 1970.

Dr. Smith administered estradiol and progesterone at the fixed dose and
continued throughout the treatment. However I altered the doses of both
hormones in accordance with advancing gestation (Home page of our NPO,
Natural hormonal therapy for pregnancy induced hypertension and
preterm birth)
During IVF treatment not only obstetricians but also patients
could know that blood levels of both hormones (estradiol and progesterone)
are very important in the prognosis of implantation (pregnancy). Since these
hormone levels in blood are definitive for implantation of
fertilized egg(pregnancy), it is also important as they are essential for
continuation of normal pregnancy.

Encounter with sex steroid hormone therapy in severe preeclampsia (No2):

Encounter with sex steroid hormone therapy in severe preeclampsia (No2):

Blood Sex steroid hormone (estradiol and progesterone) levels in pregnant
women are enormously increased at late stage of pregnancy compared with
those in non-pregnant women.




Female sex hormone is estradiol and progesterone.  Estrogen is secreted
from ovary and its level in blood is increased at maximum just before
ovulation in women suggesting that this hormone is essential for ovum
maturation. Progesterone is secreted just after ovulation and its level in
blood is increased at maximum around 7 day after ovulation suggesting
that this hormone is essential for implantation of ovum: beginning and
continuation of pregnancy. Among estrogen hormones estradiol is the
most bioactive hormone.

Blood estradiol levels in pregnant women
 increase with advancing gestation.  Estradiol levels reach to their
maximum level at late pregnancy. The magnitude of the increase of
estradiol levels are around 100 fold compared with those just before
 ovulation. Blood progesterone levels in pregnant women increase also
with advancing gestation. Progesterone levels reach to their maximum
level at late pregnancy.
The magnitude of the increase of progesterone levels
are around 10 fold compared with those around 7 day after ovulation.

ホルモン療法との出会い(2):妊娠時には、性ホルモンは著しく増加する

エストロゲン(卵胞ホルモン)とプロゲステロン(黄体ホルモン):女性ホルモンとは、この2つのことです。

・・・続きは会員限定です。
また、理事長の著書「
妊娠中毒症と早産の最新ホルモン治療」には、今回の記事の内容が詳しく書いてあります。ぜひ一度ご覧下さい。
アマゾンからお買い求めいただけます


続きを読む

Encounter with sex steroids therapy in severe preeclampsia.

Also some day in summer of 1970 I have been at a loss regarding to how
to treat severe preeclampsia patients. I happened to be focused on some
sentence of Japanese book on steroid hormones. The sentence mentioned
that injection of sex steroid (estradiol plus progesterone ) was effective in
alleviation of severe preeclampsia before world war
in USA.

Since I was fascinated with this evidence, I have searched the original
manuscript on this interesting mentioning. It was difficult to find this
manuscript. However I could find this article at the library of Tokyo University.
The article is as follows: since the levels of both steroids in urine with severe
preeclampsia patients, Dr. Smith and Smith in Boston Lying in Hospital treated
using both steroids by intramuscular injection with severe preeclampsia patients
and they found their treatment was effective in alleviation of severe
preeclampsia(1). At that time it was known that urinary estrogen and
progesterone levels with severe preeclampsia patients was much lower than
normal pregnant women.

The theory by Dr. Smith and Smith on their treatment was very simple:

Decreased both hormones in severe preeclampsia should be supplied.


1.Smith GVS, Smith OW. Estrogen and progestin metabolism in pregnancy . The effect of hormone administration in preeclampsia. J Clin Endocrinol 1941;1:477-484.


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