A 41-year-old woman, gravid 3, para 3, was admitted to the Department of Obstetrics and Gynecology at Tsuchiura Kyodo General Hospital, complaining of a tender, gradually enlarging mass in the right inguinal region during menses. Examination found the mass was about 2 cm in diameter, which protruded slightly (on lying position?). During menstrual periods, the mass enlarged and the pain intensified, but between menses, the mass decreased in size and the pain subsided. The case was diagnosed as inguinal endometriosis and then a preoperative GnRH analog therapy was given for six weeks to make a good operative local condition. Surgery was performed under general anesthesia and a mass about 4.0×3.0 cm in diameter near inguinal ligament was removed. The cut surface revealed small hemorrhagic areas or spaces. Microscopic examination of the dissected mass confirmed the diagnosis of inguinal endometriosis. It was found that the patient had a moderate inguinal swelling on the first visit to the hospital as an outpatient 7 days after operation, but the swelling disappeared shortly afterword. She has been receiving a post-operative GnRH analog therapy for 3 months to maintain a good local condition. The authors concluded thatthe appearance of a lump in the inguinal region and objective changes of the lesion in relation to the menstrual cycle should be considered as the symptoms of endometriosis.

  We report a case of new-onset depressive disorder in a patient with a history of rectal endometriosis treated with GnRH analog and no previous psychiatric history. This medical history allowed us to suspect the possibility of a link between GnRH analog and depression. It also highlighted the need to screen patients treated with GnRH analog for depression.
  The patient was 41-year-old woman who had been diagnosed with rectal endometriosis. She was referred to the Gynecology Department of Tsuchiura Kyodo General Hospital. The subjective symptoms included cyclic abdominal pains and rectal bleedings. The patient had undergone total abdominal hysterectomy and left salpingo-oophorectomy for endometriosis two years before. She was started by her first gynecologist on GnRH agonist (nafarelin acetate) and the symptoms disappeared soon. But several weeks after the initiation of the GnRH agonist treatment, she began to feel depressed and hopeless. She visited a psychiatric hospital and diagnosed as having depression. She was given anti-depressive drugs and inpatient treatment at the psychiatric hospital. Her clinical course was reviewed by her second gynecologist, and she was suspected to have developed depressive disorder by GnRH analog treatment. She stopped taking GnRH analog medication and started progestin (Dinagest) therapy. She became soon free of depressive disorder and then anti-depressive drugs with rectal endometriosis well controlled. This case also suggested Dinagest is a recommended drug for rectal endometriosis.

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.

Objectives  High gestational weight gain (GWG) is associated with perinatal risks to mother and child. Research shows that non-Japanese Asian women have higher GWG than Japanese women. However, no studies have compared GWG in these two populations using GWG recommendations in accordance with Japanese and Institute of Medicine (IOM) guidelines. The study aim was to compare GWG in non-Japanese Asian and Japanese pregnant women.Methods  This was a retrospective observational study. All participants were aged ≥20 years and gave birth between September 2019 and the end of October 2020 at one perinatal medical center in Japan. Medical record data were analyzed for 170 non-Japanese Asian and 316 Japanese pregnant women. We used t-tests and chi-square tests to examine differences in age, parity, smoking status, antenatal checkups, pre-pregnancy body mass index, and GWG. Logistic regression analysis was used to estimate odds ratios (95% confidence intervals) for above- and below-recommended GWG by non-Japanese Asian and Japanese status. We also analyzed differences in delivery type, abnormal blood loss, and birth size according to GWG.Results  After adjustment for confounding factors, the multivariable-adjusted OR and 95% CI for GWG above the Japanese guidelines recommendations was 1.86 (1.23-2.81) and that for GWG above IOM guidelines recommendations was 2.46 (1.45-4.16) for non-Japanese Asian women, as compared with Japanese women. Conversely, the multivariable-adjusted OR and 95% CI for GWG below Japanese guidelines recommendations was 1.55 (1.03-2.32) and that for GWG below IOM guidelines recommendations was 1.87 (1.26-2.76) for Japanese women, compared with non-Japanese Asian women. Conclusion  Because Japanese women tend to be below recommended GWG and non-Japanese Asian women tend to be above recommended GWG, midwives need to provide careful guidance to reduce perinatal risks.