Objective: Insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) have been shown to be involved in ovarian follicular growth, corpus luteum formation and steroidogenesis. The present study was undertaken to investigate the correlation between IGFBP secretion and luteal function in cultured human granulosa-lutein cells. Methods: After informed consent, human granulosa-lutein cells were collected from follicular fluid at the time of oocyte retrieval from 10 patients who underwent in-vitro fertilization program by long protocol. The cells were cultured for 216 hours and the conditioned medium (containing 10 % fetal bovine serum) was changed every 24 hours. Concentrations of estradiol (E2) and progesterone (P4) in the media were measured by RIA. Forty eight hours after culture start, another group of human granulosa-lutein cells was cultured in the presence of human chorionic gonadotropin (hCG) at the concentration of 0, 30, 300, 3000mIU/ml for 48 hours. Ninety six hours after culture start, the cells were cultured in serum-free medium without hCG for 48 hours. Those serum-free media were stored and used for E2 and P4 assays and for IGFBP analysis by Western ligand blot using ¹²⁵I-IGF-II. The intensity of Western ligand blot was assessed quantitatively by bioimage analyser.Results: While no significant changes were noted in E2 concentrations in the media of granulosa-lutein cells throughout the culture period, the P4 concentrations gradually increased from 48 hours until 96 hours, decreased dramatically from 120 hours until 144 hours, and gradually declined thereafter. No significant differences were noted in E2 concentrations in the serum-free media after 48 hours cultures in the presence or absence of hCG. By contrast, the P4 concentrations in the media of cells cultured in the presence of hCG (300mIU/ml or 3000mIU/ml) were significantly higher than those cultured without hCG. Two bands representing IGFBP-2 and IGFBP-3 were shown in Western ligand blot of those serum-free media of cultures. Quantitative analysis revealed that IGFBP-2 and IGFBP-3 levels in the serum-free media became lower in a reciprocally dose-dependent manner with the increased hCG concentrations. Particularly, IGFBP-2 levels in serum-free media incubated without hCG was higher than those incubated with either 300mIU/ml hCG or 3000mIU/ml hCG.Conclusions: It seems likely that IGFBP-2 and IGFBP-3 secreted by cultured human granulosa-lutein cells may be involved in luteal regression and that hCG may prevent IGFBPs production and secretion by granulosa-lutein cells. [Adv Obstet Gynecol, 55(3) : 281-287, 2003(H.15.8)]

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Pentalogy of Cantrell is a rare disorder showing a combination of congenital abnormalities consisting of defects in the lower sternum, deficiencies of the anterior diaphragm, and diaphragmatic pericardium, intracardiac and midline abdominal wall defects. We present a case of pentalogy of Cantrell with prenatally diagnosed ectopia cordis. The patient was a 31-year-old primipara woman, in the 34th GW. She was referred to our hospital by her attending physician who pointed out cardiac malformations in the fetus from ultrasonographic examination. After admission for perinatal management, real time and color Doppler ultrasonography revealed ectopia cordis in the abdominal cavity and pentalogy of Cantrell. In the 36th GW, emergent cesarean section was performed for fetal distress, and the patient was delivered of a 2369g female infant, Apgar score 3/7. At the age of 4 days, the infant had an omphalocele surgical corrected. Because the infant had cardiac malformations including single atrium-single ventricle, pulmonary artery stenosis and patent ductus arteriosus (PDA), Blalock-Taussig shunt procedures were performed at a 3 and 5 months of age to maintain blood flow volume to the lungs. Thromboembolectomy was performed in the bypass at 11 months but the infant died of hemorrhagic shock. The prenatal diagnosis of pentalogy of Cantrell was comparatively easy in this case due to the complication of ectopia cordis. However, because this disease has a poor prognosis, it is important that intensive perinatal management in collaboration with neonatal treatment be implemented. [Adv Obstet Gynecol, 55(3) : 288-292, 2003 (H15. 8)]

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Most intrapelvic tumors of female are of gynecological origins. However, in some case reports, tumors from digestive organs or from retroperitoneal organs are diagnosed as gynecological tumors. Here we report two cases of retroperitoneal tumors that were hard to distinguish from gynecological tumors before conducting surgery. The first patient was a 29-year-old nulliparous woman. Preoperative imaging pointed out a tumor of 6cm in diameter adjacent to the dorsal side of the uterus, accompanied by bilateral ovarian tumors. Therefore, the tumor was diagnosed as a subserous myoma. The second patient was a 47-year-old 2-parous woman. The patient was pointed out the existence of a right ovarian fibroma two years ago and she had been examined at the outpatient clinic. During this period, the tumor became enlarged. Finally, operations were performed for these two patients, and in both cases, it was shown that the tumors were grown in the retroperitoneal space. Only biopsies could be performed in both cases because the tumors were proven to be schwannomas. Then we consulted orthopedicians for further treatment of these patients.
One should keep it in mind that CT scan or MRI findings, such as medial or anterior shift of the ureter(s), or external iliac vessels, signs of unusual compression of pelvic wall muscles, or extramucosal compression of the rectum, suggest the existence of retroperitoneal tumors. In conclusion, it should be noted that gynecologists as well as patients should always be aware of a possibility that there are some non-gynecological retroperitoneal tumors, when considering a surgery of intrapelvic tumors.[Adv Obstet Gynecol, 55(3) : 293-298, 2003 (H15. 8)]

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When drugs are used for pregnant women, close attention should be usually paid to their teratogenicity and possible effects on intrauterine fetal development, because some drugs can pass through the placenta. Traditional herbal medicines are often prescribed pregnant women to reduce their side effects and in response to patients' request. Herbal preparations (mixtures) are most frequently used to deal with common cold, hyperemesis, threatened abortion and premature labor, pregnancy induced edema and hypertension, constipation and anemia. Traditional Chinese medicine (TCM) views pregnancy as unphysiological and classified as In-Ketsu-Sho (Yin blood symptom). TCM considers that the complication by Hi-I-Kyo (spleen-stomach deficiency) and Ki-Kyo (Qui deficiency) leads to various symptoms. There are different types of toxemia. The severity of vomiting in pregnancy varies greatly among individuals. These facts are compatible with the various conditions categorized by TCM. Therefore, these conditions associated with pregnancy are likely to be indicated for treatment with herbal preparations.
Representative herbal drugs used for pregnant women are Toki-san and Byakujutsu-san. Herbs used for pregnant women include Ginseng Radix, Astragali Radix, Artemisiae Folium, Cyperi Rhizoma, Eucommiae Cortex and Cordyceps (vegetable wasps and plant worms). The herbal preparations such as Toki-shakuyaku-san and Kyuki-kiyogai-to are often used to treat threatened abortion or premature labor. Kishi-bukuryou-san and Sairei-to are indicated for toxemia. Koso-san and Jinso-in are indicated for common cold, Keishi-ka-shakuyaku-to for constipation, and Toki-Shakuyaku-San for anemia in pregnant patients.
Kyuki-chouketsu-in is recommended for the subinvolution of the uterus and disturbed milk secretion in puerperium.
Accurate and adequate knowledge of the favorite effects of traditional herbal medicines on pregnancy-associated conditions and using them appropriately to treat such conditions might improve in the QOL of pregnant women, especially in the era of low birth rate. [Adv Obstet Gynecol, 55(3) :299-321, 2003(H.15.8)]

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