Clinical significance of amphiregulin and epidermal growth factor in colostrum.

BACKGROUND: Colostrum contains a wide variety of crucial nutritional elements including growth factors for newborn infants to adapt to the extrauterine environment. OBJECTIVE: To investigate the clinical significance of epidermal growth factor receptor ligands in milk during the first month of lactation. METHODS: The concentrations of epidermal growth factor (EGF), amphiregulin (AR) and transforming growth factor-α (TGF-α) in milk sampled from a total of 31 normal mothers at days 1-3, 5, and 30 postpartum were examined using ELISA. RESULTS: At days 1-3, the concentration of EGF was extremely high [131.6 ± 20.4 (mean ± SEM) ng/ml] compared to that of AR (4,197.2 ± 1,055.2 pg/ml) or TGF-α (261.7 ± 33.6 pg/ml), while the concentration of AR was significantly elevated compared to that of TGF-α. At days 5 and 30, the concentration of EGF was significantly elevated compared to that of AR or TGF-α. In 16 mothers among the same 31 subjects, samples were longitudinally obtained on days 1, 2, 5, and 30 postpartum. Concentrations of AR were higher on days 1 and 2 and rapidly declined to below 1 ng/ml on day 5, and were maintained at lower levels on day 30. Concentrations of EGF were high on day 1 (greater than 10 ng/ml) but gradually declined by days 2, 5, and 30. Concentrations of TGF-α remained at lower levels of below 1 ng/ml throughout the lactation period from days 1 to 30. CONCLUSION: These results suggested that EGF and amphiregulin in colostrum might contribute to the early stage of development of neonatal gastrointestinal function.

Acute inflammatory syndrome and intrahepatic cholestasis caused by an interleukin-6-producing pheochromocytoma with pregnancy.

We herein describe the case of a 30-year-old woman who experienced high fever during the puerperal period and was diagnosed with pheochromocytoma. Acute inflammatory syndrome, as indicated by the elevated serum levels of interleukin-6 (IL-6), and cholestatic liver dysfunction were observed. Since this condition resolved before the operation, it was probably caused by massive central necrosis within the tumor. The IL-6 production from the tumor cells was confirmed by immunohistochemistry. When a case of pheochromocytoma accompanied with acute inflammatory syndrome is encountered, the possibility that the tumor itself might produce some cytokines should be considered, even in the presence of massive necrosis within the tumor.

Change in cervical length in cases resulting in threatened preterm labor.

PURPOSE: To determine the predisposing changes in cervical length (CL) and the critical range of CL in which significant uterine contractions emerge resulting in threatened preterm labor (TPL). METHODS: Sixty-eight uncomplicated singleton pregnancies where the CL was <25 mm before 31 weeks were divided into cases with TPL (n = 23) or without (n = 45). CL and uterine contractions were monitored sequentially starting between 16 and 20 weeks. The gestational ages when a CL of <25 or <15 mm was first observed, the interval between these two measurements, and the CL value at TPL diagnosis were analyzed retrospectively. RESULTS: (1) The gestational ages when a CL of <25 and <15 mm was first detected were lower in the TPL group (25 (median); 18-30 (range) and 28; 25-33 weeks, respectively) than in the non-TPL group (27; 20-30 and 33; 26-35 weeks; P = 0.030 and P < 0.001). (2) The interval between the two measurements was shorter in the TPL group (2.5; 0-15 weeks) than in the non-TPL group (5.5; 0-13 weeks, P = 0.034). (3) The CL value at TPL diagnosis was 13 mm (median), ranging from 7 to 18 mm. CONCLUSION: Cases with early onset and subsequent rapid CL shortening before 31 weeks resulted in TPL when CL decreased below the range 7-18 mm.

Proposal of a new parameter for diagnosing a low-lying placenta in the third trimester: The distance between the external os and placental edge.

OBJECTIVE: To validate a new parameter of the distance between the external os (EO) and placental edge (PE) to diagnose a low-lying placenta in the third trimester. MATERIALS AND METHODS: The study participants included 94 uncomplicated singleton pregnant women with cephalic presentation. These women were cared for in our hospital in 1998-2011, with a posterior low-lying placenta, which was diagnosed as the distance between the internal os (IO) and a PE of 0-3.0 cm at 34-36 weeks' gestation. Measurements of cervical length (CL) and the distances of IO-PE and EO-PE were performed using transvaginal ultrasonography at least twice at 28-30 weeks, 31-33 weeks, and 34-36 weeks. Changes in CL, and the IO-PE and EO-PE distances were analyzed. RESULTS: CL and the IO-PE and EO-PE distances did not change prior to 31-33 weeks. CL was shortened and the IO-PE distance was increased after 31-33 weeks (p = 0.0001), but the EO-PE distance was unchanged. CONCLUSION: The EO-PE distance is a promising parameter for diagnosis of low-lying placenta in the third trimester up to 36 weeks' gestation.

Clinical significance of cervical length shortening before 31 weeks' gestation assessed by longitudinal observation using transvaginal ultrasonography.

AIM: To elucidate the clinical significance of progressive cervical length (CL) shortening before 31 weeks' gestation. METHODS: Transvaginal ultrasonography was used for longitudinal measurements of CL in 114 singletons. CL shortening groups were defined as having a CL of <25 mm at <26 weeks (early shortening group, 20 cases) and <31 weeks (late shortening group, 19 cases). The control group (75 cases) was defined as having a CL of >or=25 mm at <31 weeks. The CL values at 16-20, 21-25, 26-30 and 31-35 weeks, the age-related CL changes, the treatments for preterm labor, and the outcomes were compared between groups. In 78 cases with spontaneous delivery at >or=36 weeks, we investigated cervical dilatation velocity in the active phase of labor. RESULTS: At 16-20 weeks, CL values for the early group were smaller than those of the late and control groups. Rapid CL shortening occurred between 16-20 and 21-25 weeks in the early group and between 21-25 and 26-30 weeks in the late group. In the early group, all cases received cerclage and/or tocolysis or bedrest, and one case delivered prematurely. In the late group, 10 cases required tocolysis or bedrest, and one case delivered prematurely. In nulliparous women, cervical dilatation velocity in the early and late groups was more rapid than in the controls. CONCLUSIONS: CL shortening to <25 mm before 31 weeks is a risk factor for preterm delivery, as well as for preterm labor in cases who had tocolysis and bedrest, and precipitate delivery.