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Department of Obstetrics and Gynecology
Overview of Department
Our Department was founded by Professor Kentaro Kubo in 1948. The position of Head of Department was then held successively by Professor Kihei Ichinohe from 1970, Professor Ryosuke Nakano from 1977, Professor Naohiko Umesaki from 2000, and Professor Kazuhiko Ino from 2010. The Department contributes to local healthcare by providing the highest level, evidence-based obstetric and gynecological services, and is also active in education and research.
The Department is in charge of medical care in the Department of Maternal and Fetal Medicine at the University Hospital General Perinatal Medical Center. This comprises three beds in the Maternal and Fetal Intensive Care Unit (MFICU) and 22 general obstetric beds, and responds to the needs of kinds of expectant mothers brought to the hospital for 24 hours a day, including threatened premature delivery and premature rupture of membrane from 22 weeks of gestation, high risk complications of pregnancy, multiple pregnancy, massive hemorrhage during delivery, and emergency obstetric diseases. Expectant mothers may also be brought to hospital by helicopter ambulance in response to emergency requests for ambulances from distant areas, and a physician from the Department of Obstetrics and Gynecology will accompany physicians and nurses from the Emergency Department in the helicopter. Around 600 births occur in the Department each year and, in response to requests from within the community, we endeavor to accept prefectural resident expectant mothers for natural childbirth as much as possible. We are also striving to nurture doctors specializing in maternal and fetal medicine on the basis of the perinatal (maternal) specialist system launched in 2006, and as of December 2015, there are four maternal and fetal specialists in our Department.
Gynecology and Reproductive Endocrinology
Three specialists in our Department are members of the Japan Society for Gynecologic Oncology, and we are pouring our efforts into the treatment of gynecological malignancies such as cervical cancer, uterine cancer, and ovarian cancer, as well as benign disorders such as uterine myomas, benign ovarian tumors, and endometriosis and reproductive endocrine disorders such as ovarian dysfunction and menopausal symptoms, and we accept numerous patient referrals from both within and outside the prefecture. When it comes to radical surgery for gynecological malignancies, chemotherapy with anticancer drugs, and radiotherapy, we offer treatment based on the latest guidelines and evidence. We perform laparoscopic and hysteroscopic surgeries in patients withbenign gynecological disorders who are eligible for these surgical methods. In addition, many patients with trophoblastic disease typified by hydatidiform mole are referred to and treated in the outpatient clinic of Professor Kazuhiko Ino, a highly experienced clinical practitioner, who has played a central role in the revision to the “Protocol for Handling of Trophoblastic Patients.” The Department does not perform in vitro fertilization and embryo transfer, and refers patients to other specialist institutions for this treatment.
1. Undergraduate Education
As a medical school, student education is considered vitally important. Teachers allot a total of 28 systematic lectures and PBLs to fourth year medical students, and giving lectures enables the acquisition of a medical understanding of perinatal medicine, gynecological oncology, and reproductive endocrinology. Fifth and sixth year medical students gain clinical experience in actual clinical settings such as outpatient clinics, wards, and operating rooms, deepening their understanding of obstetrics and gynecology obtained from the fourth year lectures. They are also provided with the opportunity to read English language papers in the field of obstetrics and gynecology, and cultivate the ability a physician needs to read papers in English. In addition, some lectures in the School of Health and Nursing Science and Midwifery Course related to obstetrics and gynecology are assigned to teachers in the Department of Obstetrics and Gynecology, and so the Department also plays a part in the education and training of nurses, public health nurses, and maternity nurses.
2. Education of Junior Residents, Maternity nurses, and Nurses
Under the current junior resident training system, obstetrics and gynecology has gone from being a compulsory subject to a compulsory elective one, and there has been a decrease in the number of residents rotating through the Department of Obstetrics and Gynecology. Nevertheless, several residents each year do choose the Department for their residencies. During these residencies, they work alongside an advisor to treat obstetric and gynecological patients, and learn the pleasure and importance of obstetrics and gynecology. In order to achieve our mission of a General Perinatal Medical Center, we emphasize on the education and training of maternity nurses regarding high risk pregnancies and deliveries, and of nurses regarding gynecological surgery and chemotherapy. Perinatal and gynecological study meetings, fetal ultrasound practices using ultrasound simulators owned by the Advanced Medical Training Center and Skills Laboratory, and the like are held on a regular basis, and every effort is made to improve the level of team-based medical care. In addition, since 2013, the Department of Obstetrics and Gynecology and the Department of Perinatal Medical Support have together been holding regular ALSO (Advanced Life Support in Obstetrics) (an obstetric emergency simulation course), and we are striving to improve the level of response to obstetric emergencies from gynecologists, emergency room doctors, maternity nurses, and residents in Wakayama Prefecture.
3. Graduate Education
We positively encourage young doctors to enroll in the Graduate School Medical Research Doctoral Course. While enrolled in the Graduate School, students spend about 2 years away from clinical practice, working in a research environment in basic research laboratories within or outside the University, and receive instruction to enable their papers to be published in top journals. We believe that cultivating a research mind and learning how to think and make assessments objectively and scientifically is vitally important to improving the skills of clinical physicians.
Research in the department is mainly in the fields of gynecological oncology, perinatal medicine, and reproductive endocrinology.
1. Gynecological Oncology
- Elucidation of immunotolerance mechanisms and development of new immunotherapies in gynecological cancers
Acquisition of immunotolerance from host immune surveillance mechanisms in the tumor microenvironment is essential for growth and progression of cancer. We are involved in the identification and analysis of molecules that induce this immunotolerance at the molecular and cellular levels and in mouse models using such means as DNA microarrays and cytokine arrays. We aim to develop new immunochemotherapies by coadministration of anticancer drugs and inhibitors of the immunotolerance molecules identified.
- Identification of new prognostic molecular markers and development of new targeted therapies in gynecological cancers
So far, we have reported that indoleamine 2,3-dioxygenase (IDO), inhibin and activin are prognostic factors involved in progression in patients with gynecological cancers. We are working to identify more prognostic factors and develop personalized treatments based on the degree of expression of these factors and new targeted treatments aimed at these factors in gynecological cancers.
- Mechanisms of peritoneal metastasis and drug resistance, and development of new treatments in ovarian cancers
We are engaged in the elucidation of cancer cell and host cell interactions and networks and acquisition mechanisms for anticancer drug resistance, and in the development of new treatments focused on this information in the progression of peritoneal dissemination of ovarian cancer and cancerous peritonitis.
- Studies of trophoblastic tumor diagnosis and development of new chemotherapy regimens
We are engaged in basic and clinical studies of therapies for patients with trophoblastic disorders.
2. Perinatal Medicine
- Basic and clinical studies to elucidate pathology and develop new treatments for pregnancy induced hypertension (PIH) and fetal growth restriction (FGR).
- Based on a large database of PIH cases, we are carrying out classification of subgroups for such factors as timing of onset and presence of complications of fetal growth restriction (FGR), and we are engaged in the study of perinatal risk factors related to outcomes for mother and child, and we are searching for new predictive factors. In addition, we are engaged in the analysis of new molecules that reflect the pathology of PIH or FGR by pathological analysis of placentas, immunohistochemical staining, and molecular analysis in PIH and FGR patients.
- Control of trophoblast invasion during placental formation and elucidation of maternal immunotolerance mechanisms
- We are engaged in the elucidation of control mechanisms dependent on oxygen environment, humoral factors, and maternal immune cells and studies of their involvement in disease pathology using placental trophoblast culture models.
3. Reproductive Endocrinology
Elucidation of the regulatory mechanisms for ovarian function and the endometrium
We are engaged in basic and clinical analysis of control mechanisms mediated by sex hormones, various growth factors (inhibins, activins, etc.), and the extracellular matrix such as collagens, and their role in disease, during periodic changes in the ovaries and endometrium.