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A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.
This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour. PMID:16530816
Hildebrandt, T B; G—ritz, F; Boardman, W; Strike, T; Strauss, G; Jewgenow, K
A comparison of the cytobrush and uterine lavage techniques to evaluate endometrial cytology in clinically normal postpartum dairy cows
Abstract This study compares cytobrush and lavage techniques for the assessment of endometrial cytology (EC) in clinically normal postpartum dairy cows. The EC samples were collected from Holstein cows (n = 35) during visit 1 (V1) at 20 to 33 d in milk (DIM) and 2 wk later during visit 2 (V2) at 34 to 47 DIM by using both techniques. A minimum of 100 cells were counted to determine the percentage of cells that were neutrophils (%PMN). The mean %PMN was significantly different between the techniques at V1 (P = 0.001), but not at V2 (P = 0.474). Overall, the %PMN decreased with time postpartum (r2 = 0.36; P = 0.001), but not within V1 (P > 0.05) or V2 (P > 0.1). Uterine diameter was negatively correlated with fluid recovery by the lavage technique (r2 = 0.41; P = 0.002). The mean %PMN was not influenced by the volume of fluid recovered in successful attempts, but 17% (12/70) of attempts yielded no fluid. In conclusion, the cytobrush technique is a consistent and reliable method for obtaining endometrial samples for cystologic examination from postpartum dairy cows.
Determination of presence of Tritrichomonas foetus in uterine lavages from cows with reproductive problems.
The aim of this study was to determine the presence of Tritrichomonas foetus in two dairy herds on the Altiplano Cundiboyacense. Twenty-one low-volume uterine lavages from cows with a history of reproductive problems in two dairy herds located in the municipality of SibatÕ (Cundinamarca) and Ventaquemada (BoyacÃ) were evaluated. In the first herd, 10 cows were sampled and in the second, 11 cows, based on three inclusion criteria. The uterine lavages were obtained through infusion of physiological saline solution into the uterine body. The samples were centrifuged and seeded in Tritrichomonas basal medium for 10-15 days at 37 ¤C. The protozoa were evaluated on the day of sampling and 10 and 15 days after incubation by means of direct viewing under a dark-field microscope. Positive samples were stained with Wright and Lugol to identify the morphological characteristics. This study showed that T. foetus was present in 61.8% of the animals sampled. The determination that T. foetus was present in 61.8% of the samples analyzed is a significant finding given that in the herds evaluated, this agent had not previously been diagnosed. PMID:23070427
GonzÃlez-Carmona, Lady Carolina; SÃnchez-Ladino, Milena Jineth; Castaþeda-Salazar, Rubiela; Pulido-VillamarÚn, Adriana Del Pilar; GuÃqueta-Munar, Humberto; Aranda-Silva, MoisÕs; Rueda-Varµn, Milton Januario
Bronchoalveolar lavage cell differential on microscope glass cover. A simple and accurate technique
We describe a quick and easy technique to perform cell differentials on bronchoalveolar lavage: the microscope glass cover. Lavage fluids of 72 subjects were analyzed by 3 techniques: glass cover, filter, and cytocentrifuge preparations. Seventy-seven other lavages were analyzed by glass cover and cytocentrifuge preparations alone. Data for the 72 subjects studied by all 3 techniques showed that the cell counts on glass cover and filter preparations were similar, e.g., lymphocytes, 19.2% (range, 0.5 to 94%) and 20.9% (range, 3 to 95%), respectively (Spearman's correlation coefficient, 0.98). However, on cytocentrifuge preparations, lymphocyte counts were lower (8.3%; range, zero to 87%) and macrophage counts were higher (p less than 0.005). Comparison of glass cover and cytocentrifuge preparation mixtures with varying amounts (20 to 80%) of purified blood leukocytes labeled with 51Cr (greater than or equal to 72% lymphocytes) showed that a significant amount of radioactive cells was lost during the cytocentrifuge technique in contrast to the glass cover technique. Because neutrophils represented a low proportion of lavage cells, we also evaluated cell suspensions with known neutrophil contents (10 to 70%); we found no difference in neutrophil counts obtained with the 3 techniques. Lavage data analysis of 40 young nonsmoking volunteers showed that glass cover lymphocyte count was also higher than counts on cytocentrifuge preparations: 16.5% (range, 3 to 45%) and 8.2% (range, 2.5 to 35%), respectively. In this group, the distribution of glass cover lymphocyte percentages was normal (p = 0.21, chi 2 test), and the one-tailed 95% confidence interval was 18.6 to 34.7% (mean plus 1.65 standard deviation).
Laviolette, M.; Carreau, M.; Coulombe, R.
Hemostatic suturing technique for uterine bleeding during cesarean delivery
Background: If medical management is unsuccessful in controlling postpartum hemorrhage, conservative surgical intervention or cesarean hysterectomy is required.Technique: Hemostatic multiple square suturing using a straight number 7 or number 8 needle and number 1 chromic catgut is a new surgical technique to approximate anterior and posterior uterine walls, especially in areas where there is heavy bleeding. It controls postpartum hemorrhage
Jin Ho Cho; Hye Sun Jun; Chung No Lee
A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy.
Calcific rotator cuff tendinopathy caused by symptomatic calcium hydroxyapatite crystal deposition is a well-established cause of shoulder pain. In refractory or acutely symptomatic cases, sonographically guided percutaneous lavage and aspiration can significantly reduce pain in approximately 60%-92% of cases. Although the complication rate of sonographically guided percutaneous lavage and aspiration is apparently low, needle clogging attributable to impacted calcific debris has been described by several authors and in our experience can occur in daily practice. Traditionally, an inability to relieve the obstruction via needle repositioning or increased syringe plunger pressure has required needle removal and replacement. In this article, we outline a simple technique that can be used to restore patency of the obstructed lavage needle without necessitating needle removal and replacement. PMID:23399296
Jelsing, Elena J; Maida, Eugene; Smith, Jay
ELISA technique for quantification of surfactant protein B (SP-B) in bronchoalveolar lavage fluid.
Surfactant protein B (SP-B) is one of the essential constituents of the alveolar surfactant system, presenting mainly in the form of SP-B dimer. The measurement of this molecule in biologic samples has been hampered by its extreme hydrophobicity and intimate association with surfactant lipids. We developed a solid-phase, adsorption-based enzyme-linked immunosorbent assay (ELISA) technique for the quantification of SP-B in aqueous solutions. The ELISA employs the hydrophobicity of SP-B for direct binding of this compound to polystyrol immunosorbent plates. Samples are mixed with propanol (1:1 vol/vol) to achieve a homogeneous dispersion of their lipophilic constituents prior to adsorption to the wells. After fluid removal by evaporation, trifluoroethanol is added to optimize SP-B-polystyrol binding, and is then removed, again by evaporation. Subsequent washing procedures (diisopropyl-ether/butanol; Tween 20 in phosphate buffered saline [PBS]) selectively remove phospholipids. Solid phase-bound SP-B is detected by a monoclonal mouse antibody against porcine SP-B, cross-reacting with the apoprotein of human origin. For amplification, a biotinylated anti-mouse antibody and the avidin/biotin-peroxidase technique are used. Steep calibration curves with an excellent reproducibility are obtained for SP-B dimer (range: 0.3125 to 40 ng/well), either introduced directly into the immunosorbent-plate wells or previously admixed with synthetic phospholipid mixtures. SP-B monomer is detected with approximately 10% efficiency as compared with the dimer (wt/wt). Cross-reactivities with human SP-A and SP-C or albumin are negligible. Experiments with spiking of human bronchoalveolar lavage fluid (BAL) samples with different quantities of SP-B dimer revealed virtually complete apoprotein recovery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7582290
Krðmer, H J; Schmidt, R; G■nther, A; Becker, G; Suzuki, Y; Seeger, W
A new surgical technique of uterine auto-transplantation in cynomolgus monkey: preliminary report about two cases
Objective Uterine transplantation experiments have been performed in various animal species for future clinical applications of uterine\\u000a transplantation for permanent uterine factor infertility in humans. The aim of this study was to confirm the feasibility of\\u000a uterine auto-transplantation in cynomolgus monkeys by developing new surgical techniques.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Two female cynomolgus monkeys underwent surgery under general anesthesia. The uterus with vascular grafts and
Iori Kisu; Makoto Mihara; Kouji Banno; Hisako Hara; Takumi Yamamoto; Jun Araki; Takuya Iida; Yohei Hayashi; Hisashi Moriguchi; Daisuke Aoki
Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique.
The advised treatment for severe adenomyosis is hysterectomy, but for patients wishing to preserve their uterus, novel conservative surgery, adenomyomectomy, can be performed. The technique needs to be developed to reduce spontaneous uterine rupture, adhesion and recurrence rates. This study aimed to investigate the safety and therapeutic outcomes of adenomyomectomy. Prospectively, 103 Iranian patients with documented severe adenomyosis were candidates for adenomyomectomy over a period of 7years (from April 2004 to March 2011). The surgical procedure involved resection of adenomatosis lesions with a thin (?0.5cm) margin (wedge-shaped removal) after sagittal incision in the uterine body. Reconstruction of the layers was performed and inverted sutures were used for the serosal layer ends. Of 103 patients, 55.34% presented with infertility, 16.50% with IVF failure, 8.74% with recurrent abortion and 19.42% with abnormal uterine bleeding. Of 70 patients who attempted pregnancy, naturally (n=21) or by assisted reproduction treatment (n=49), 30% achieved a clinical pregnancy, and 16 resulted in a full-term live birth. Dysmenorrhoea and hypermenorrhoea were reduced post surgery. Only one patient had relapsed adenomyosis. Adenomyomectomy is a conservative and effective treatment for adenomyosis. This study describes an efficient procedure to treat severe adenomyosis. Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus. The advised treatment for the severe forms of adenomyosis is hysterectomy (removal of the patient's uterus), but for the patient who wishes to preserve her uterus, a novel conservative surgery referred to as 'adenomyomectomy' (removal of the abnormal tissues) can be performed. This technique must be developed for reduction of spontaneous uterine rupture, adhesions and recurrence rate. This study aims to investigate the safety and therapeutic outcomes of adenomyomectomy. Prospectively, 103 Iranian patients with documented severe adenomyosis were candidates for adenomyomectomy over a period of 7years (from April 2004 to March 2011). The surgical procedure was resection of adenomatosis lesions with a thin margin. Of 103 patients, 55.34% presented with infertility, 16.50% with IVF failure, 8.74% with recurrent abortion and 19.42% with abnormal uterus bleeding. Of 70 patients who attempted pregnancy either naturally (n=21) or using assisted reproduction technology (n=49), 30% became pregnant, and 16 pregnancies reached full term. There was a significant reduction in dysmenorrhoea and hypermenorrhoea. Only one patient had relapsed adenomyosis. Based on these results, we conclude that adenomyomectomy is the conservative and effective option to treat adenomyosis with preservation of the uterus. The procedure described in this study can be an efficient procedure to treat severe adenomyosis. PMID:24768558
Saremi, AboTaleb; Bahrami, Homa; Salehian, Pirooz; Hakak, Nasrin; Pooladi, Arash
\\u000a Uterine rupture may be defined as a disruption of the uterine muscle extending to and involving the uterine serosa or disruption\\u000a of the uterine muscle with extension to the bladder or broad ligament [1]. Uterine dehiscence is defined as disruption of\\u000a the uterine muscle with intact uterine serosa [1]. Uterine rupture is associated with severe maternal and perinatal morbidity\\u000a and
Sharon R. Sheehan; Deirdre J. Murphy
Focused ultrasound treatment of uterine fibroid tumors: Safety and feasibility of a noninvasive thermoablative technique
Objective: The purpose of this study was to determine the safety and efficacy of focused ultrasound surgery with magnetic resonance imaging guidance for the noninvasive treatment of uterine leiomyomas. Study Design: Fifty-five women with clinically significant uterine leiomyomas were treated. Pain and complications were assessed prospectively, and posttreatment magnetic resonance imaging was used to measure the treatment effects. Patients in
Elizabeth A. Stewart; Wladyslaw M. W. Gedroyc; Clare M. C. Tempany; Bradley J. Quade; Yael Inbar; Tilman Ehrenstein; Asher Shushan; Jonathan T. Hindley; Robert D. Goldin; Matthias David; Miri Sklair; Jaron Rabinovici
A new nasal lavage technique was used to compare the washout curves and total lavagable amounts (per kg body wt) of protein, ascorbate, glutathione and uric acid in guinea pigs, rats and mice. Washout curves were usually observed with sequential lavage volumes of saline of 1.0 ml...
... Information Clinical Trials Resources and Publications En Espaþol Uterine Fibroids: Condition Information Skip sharing on social media links Share this: Page Content What are uterine fibroids? Uterine fibroids are growths made of smooth muscle ...
Bronchoalveolar Lavage in Malignancy
Bronchoalveolar lavage is a useful diagnostic tool in diffuse or disseminated lung malignancies that do not involve the bronchial structures visible by endoscopy. The neoplastic histotype and the intraparenchymal neoplastic growth pattern are good pre- dictors for diagnostic yield; adenocarcinoma, and tumors with lymphangitic or lepidic growth patterns more easily diagnosed by bronchoalveolar lavage; in these cases the diagnostic yield
Venerino Poletti; Giovanni Poletti; Bruno Murer; Luca Saragoni; Marco Chilosi
B-Lynch: A Technique for Uterine Conservation or Deformation? A Case Report with Literature Review
Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and nonmedical interventions fail. Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.
Pallave, P.; Ghose, Seetesh
Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique?
Among 23 women who underwent diagnostic hysteroscopy after triple uterine artery ligation with or without hemostatic multiple square suturing for the management of postpartum hemorrhage (PPH), five had abnormal findings. Endometritis was statistically significantly associated with abnormal diagnostic hysteroscopy findings. Twelve patients developed subsequent pregnancies, and four had abnormal obstetric outcomes: one placenta percreta, one placenta accreta, one recurrent postpartum hemorrhage, and one intrauterine growth retardation. PMID:21315337
Blanc, Julie; Courbiere, Blandine; Desbriere, Raoul; Bretelle, Florence; Boubli, LÕon; d'Ercole, Claude; Carcopino, Xavier
Uterine artery embolization using a transradial approach: initial experience and technique.
This study investigates the feasibility of performing uterine artery embolization (UAE) via transradial access (TRA). Growing evidence demonstrates significant benefits of TRA versus standard transfemoral access during percutaneous coronary intervention, now making it the preferred approach at many centers worldwide. At a single institution from March 2013 to October 2013, 29 consecutive patients were treated by transradial UAE. Technical success rate was 100%, with no immediate major or minor complications. The radial artery was patent at 1-month follow-up evaluation in all cases. These preliminary data suggest that transradial UAE is feasible and safe. PMID:24581468
Resnick, Neil J; Kim, Edward; Patel, Rahul S; Lookstein, Robert A; Nowakowski, F Scott; Fischman, Aaron M
A rare cancer, uterine carcinosarcoma makes up less than five percent of all uterine cancers.2 In the U.S., about two per 100,000 women develop uterine carcinosarcoma annually.3 Roughly only 35 percent of patients survive five years after diagnosis.
Embolization of uterine arteriovenous malformation
Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage. Case: We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully. Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment
Chen, Yan; Wang, Guoyun; Xie, Fubo; Wang, Bo; Tao, Guowei; Kong, Beihua
Uterine fibroids: current perspectives.
Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate and Acessa) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge. PMID:24511243
Khan, Aamir T; Shehmar, Manjeet; Gupta, Janesh K
Laparoscopic surgical staging for uterine malignancies using harmonic shears (UltraCision) in comparison to electrosurgery: operative technique, feasibility and complications
This retrospective study assesses and compares perioperative parameters in two groups of patients treated by different operative\\u000a techniques of laparoscopic surgical staging (LASS) for uterine cancer. Between April 1996 and May 2005, 119 consecutively\\u000a selected women with cervical cancer (n=30) or clinical stage I endometrial cancer (n=89) underwent laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) or radical laparoscopic
Zdenek Holub; Antonin Jabor
Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: diagnosis and management. In: ...
Abdominal disimpaction with lower uterine segment support as a novel technique to minimize fetal and maternal morbidities during cesarean section for obstructed labor: a case series.
Cesarean section for obstructed labor remains a difficult procedure that may be associated with serious fetal and maternal injuries. In this case series, we evaluated the use of abdominal disimpaction with lower segment support as a novel technique to minimize morbidities. Eight patients who underwent cesarean section for obstructed labor were recruited. Impacted fetal head was delivered using this technique and uterine extensions, bladder injury, vaginal injury, and intraoperative bleeding were reported. Maternal and neonatal outcomes were observed postoperatively. No major morbidities were reported. Accordingly, we consider this technique as a promising step to minimize complications during cesarean section for obstructed labor. PMID:23271386
Shazly, Sherif A M; Elsayed, Ahmed H; Badran, Sherif M A; Abdel Badee, Ahmed Y; Ali, Mohammed K
Dysfunctional uterine bleeding.
Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in whom no clear etiology can be identified. DUB has been observed in both ovulatory and anovulatory cycles. Medical treatments include nonsteroidal anti-inflammatory drugs, oral contraceptive pills, progestins, danazol (a synthetic androgen), GnRH agonists, and antifibrinolytic drugs. The drawback to medical therapy, in addition to side effects, is that the benefit lasts only while the patient takes the medication. Surgical options have concentrated mainly on endometrial ablation and hysterectomy, and it is unclear whether one is superior to the other in terms of long-term outcome and patient satisfaction. Newer and less invasive ablation techniques, such as thermal balloon ablation, offer more treatment alternatives.
Chen, B H; Giudice, L C
Dysfunctional uterine bleeding.
Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in whom no clear etiology can be identified. DUB has been observed in both ovulatory and anovulatory cycles. Medical treatments include nonsteroidal anti-inflammatory drugs, oral contraceptive pills, progestins, danazol (a synthetic androgen), GnRH agonists, and antifibrinolytic drugs. The drawback to medical therapy, in addition to side effects, is that the benefit lasts only while the patient takes the medication. Surgical options have concentrated mainly on endometrial ablation and hysterectomy, and it is unclear whether one is superior to the other in terms of long-term outcome and patient satisfaction. Newer and less invasive ablation techniques, such as thermal balloon ablation, offer more treatment alternatives. PMID:9830356
Chen, B H; Giudice, L C
MENU Return to Web version Abnormal Uterine Bleeding Overview What is abnormal uterine bleeding? Abnormal uterine bleeding is any bleeding from the uterus (through your vagina) other than your normal monthly ...
Bronchoalveolar lavage cytokine profiles in acute asthma and acute bronchiolitis
Background: The pathogenetic basis for the relationship between acute bronchiolitis and asthma has not yet been completely elucidated. Objective: The aim of this study was to compare these 2 diseases in terms of their patterns of airway cytokine response (TH1 or TH2). Methods: By using a bronchoalveolar lavage (BAL) technique, this study investigated the cytokine levels of BAL fluid in
Chang Keun Kim; Sang Woo Kim; Choon Sik Park; Beyong Il Kim; Hee Kang; Young Yull Koh
Uterine fibroids, benign tumors of the human uterus, are the most common indication for hysterectomy. They are clinically apparent in 20-25% of women and cause significant complaints, like prolonged and heavy menstruation, pelvic pressure or pain, sometimes reproductive dysfunction. Though surgery has been the mainstay of fibroid treatment, various minimally invasive procedures have been developed in addition to hysterectomy and abdominal myomectomy. Formation of new leiomyomas after these conservative therapies remains a substantial problem. Also drug-therapy methods are available, but the possible side-effects limit their long-term use. Authors attempt to give an overview of this common gynecological disease, yielding a new insight into the basic biology and genetics of fibroids, with the hope of new and effective methods of therapy in the future. PMID:20889441
Csatlµs, Eva; Rigµ, JÃnos; Szabµ, IstvÃn; Nagy, Zsolt; Joµ, Jµzsef GÃbor
The uterine fibroid is a benign tumour. The prevalence, in all the population, is 50% for european women and 80% for black women. 30% of fibroids are symptomatic. The new FIGO classification gives 7 positions (0 to 7), submuccus (0, 1, 2), interstitial (3, 4, 5), subserous (6, 7). Diagnosis is performed by 2D and 3D ultrasound which could be associated by hysterosonography. Hysteroscopy and MRI could be proposed. Hysterectomy is the main treatment, if possible by vaginal or laparoscopic way. Conservative treatment (myomectomy) could be realized by hysteroscopic, laparoscopic way or laparotomy for patients who desire to preserve fertility. Arteries embolisation is an alternative to hysterectomy or myomectomy for patients without desire of pregnancy. Preoperative treatments by GnRH agonist or SPRM like ulipristal acetate treat anaemia, decrease the myoma volume and could modify the therapeutic strategy. PMID:24855792
Fernandez, HervÕ
Bronchoalveolar lavage: role in the pathogenesis, diagnosis, and management of interstitial lung disease
Bronchoalveolar lavage has emerged as a useful technique for the study of pulmonary interstitial disorders. Several types of information are provided by the evaluation of lavage fluid. First, the identification of cellular constituents helps to separate inflammatory processes in which lymphocytes predominate (for example, sarcoidosis, hypersensitivity pneumonitis, and berylliosis) from those in which neutrophils or macrophages predominate (for example, idiopathic pulmonary fibrosis and histiocytosis X). Second, the cells removed during lavage can be studied for their immune properties and function; tested with specific antigens, in diseases such as berylliosis and hypersensitivity pneumonitis; and examined for the presence of unique surface antigens with monoclonal antibodies (for example, histiocytosis X). Third, in conjunction with scanning electron microscopy and electron probe analysis, lavage makes possible the identification of inorganic particles in alveolar macrophages of patients with pneumoconiotic lung disease. Finally, although lavage is still an investigative procedure for most pulmonary disorders, it has an established role in the diagnosis of opportunistic infections in the immunocompromised patient.
Daniele, R.P.; Elias, J.A.; Epstein, P.E.; Rossman, M.D.
Uterine blood flow and uterine renin secretion
Experiments were carried out in pregnant nephrectomized rabbits to determine the relationship between uterine blood flow and uterine renin secretion. Uterine blood flow was measured by the percentage distribution of radioactive microspheres injected into the left ventricle which lodged in uterus and placenta, and cardiac output was measured by dye dilution. In 40 animals, 24 hr after nephrectomy, uterine blood flow was 4.7Ý0.4% of cardiac output and absolute flow 32.4Ý3 ml/100 g per min. Plasma renin activity (PRA) in uterine vein, 994Ý182 ng/100 ml per hr, was higher than in carotid artery, 832Ý143 (P < 0.025). With reduction of uterine blood flow from 4.7Ý0.5 to 1.95Ý0.3% of cardiac output and absolute flow from 30.8Ý4.6 to 8.8Ý2 ml/100 g per min, uterine vein PRA rose from 1434Ý234 to 4430Ý300 (P < 0.001), and carotid artery PRA from 1009Ý200 to 2300Ý350 (P < 0.01). Hemorrhagic hypotension caused uterine vein PRA to increase from 913Ý293 to 3638Ý1276 (P < 0.001) and carotid artery PRA from 774Ý252 to 1730Ý433 (P < 0.01). Uterine blood flow expressed as a percentage of cardiac output remained constant after hemorrhage, 5.5Ý0.9 and 6.3Ý0.8%, although absolute flow fell from 37Ý7.7 to 29Ý3.6 ml/100 g per min because of the large fall in cardiac output which occurred. Angiotensin, 10 ng/kg per min, caused no significant change in blood pressure or cardiac output but increased uterine blood flow from 4.1Ý0.6 to 8.4Ý1% (P < 0.005) of cardiac output with absolute flow increasing from 37.4Ý7 to 73.2Ý10 ml/100 g per min (P < 0.001). The increase in uterine blood flow during angiotensin was abolished by the prior administration of propranolol. Isoproterenol, 0.5 ?/min, increased uterine blood flow from 3.5Ý0.6 to 6.4Ý1.2% of cardiac output (P < 0.02) with absolute flow increasing from 25Ý5 to 51Ý12 ml/100 g per min (P < 0.05). Norepinephrine, 500 ng/min, caused no significant change in uterine blood flow. These findings suggest that uterine renin might be involved in regulating uterine blood flow, secretion being increased in response to a reduction in flow with the resultant rise in circulating or local angiotensin, through beta adrenergic stimulation, increasing uterine blood flow.
Ferris, Thomas F.; Stein, Jay H.; Kauffman, Jeffrey
Uterine leiomyomas (fibroids or myomas), benign tumours of the human uterus, are the single most common indication for hysterectomy. They are clinically apparent in up to 25% of women and cause significant morbidity, including prolonged or heavy menstrual bleeding, pelvic pressure or pain, and, in rare cases, reproductive dysfunction. Thus, both the economic cost and the effect on quality of life are substantial. Surgery has been the mainstay of fibroid treatment, and various minimally invasive procedures have been developed in addition to hysterectomy and abdominal myomectomy. Formation of new leiomyomas after these conservative therapies remains a substantial problem. Although medications that manipulate concentrations of steroid hormones are effective, side-effects limit long-term use. A better approach may be manipulation of the steroid-hormone environment with specific hormone antagonists. There has been little evidence-based evaluation of therapy. New research into the basic biology of these neoplasms may add new treatment options for the future as the role of growth factors and genetic mutations in these tumours are better understood. PMID:11214143
Stewart, E A
... Use Social Media Poster Presentation Buttons and Badges Statistics for Other Types of Cancer Breast Cervical Colorectal ( ... Lung Ovarian Prostate Skin Cancer Home Uterine Cancer Statistics Uterine cancer is the fourth most common cancer ...
Appraisal of gut lavage in the study of intestinal humoral immunity.
Direct investigation of intestinal humoral immunity requires collection of intestinal secretions or mucosal biopsy specimens, or both. A non-invasive technique of gut lavage, with a polyethyleneglycol electrolyte lavage solution as a means of collecting intestinal secretions for immunoglobulin and antibody studies, was evaluated. Fifty patients were studied--25 immunologically normal patients or volunteers, 15 patients with untreated coeliac disease, and 10 patients with active Crohn's disease. Protease inhibitors were added promptly to samples to prevent proteolysis of immunoglobulin content. Treated lavage samples were assayed by enzyme linked immunosorbent assay for immunoglobulin and antibody content. Studies of serial lavage specimens showed that early, faecally contaminated specimens contained negligible quantities of immunoglobulin, but once the specimens became clear a steady state was reached, with little variation in immunoglobulin content between serial specimens and with a uniform dilution (around 20%) of the ingested polyethyleneglycol. Gut lavage fluid IgA was predominantly secretory, comprising 92%, 81.6%, and 76.7% respectively of the total IgA gut lavage fluid content in the control, coeliac, and Crohn's groups. High values of total IgM and IgA and IgM antigliadin antibodies were detected in the coeliac group, and high values of IgG in the Crohn's disease group. This method of gut lavage is not only an effective bowel cleanser, but also a noninvasive means of obtaining intestinal secretions for the study of humoral immunity in gastrointestinal disease.
O'Mahony, S; Barton, J R; Crichton, S; Ferguson, A
Bronchoalveolar lavage versus bolus administration of lucinactant, a synthetic surfactant in meconium aspiration in newborn lambs.
This study was designed to study effects of lung lavage versus the classical bolus instillation with a peptide-based synthetic surfactant (lucinactant) in a model of Meconium Aspiration Syndrome (MAS). Eighteen newborn lambs received meconium and were randomized to: the experimental meconium installation (eMAS) group-lambs with eMAS kept on conventional mechanical ventilation (control); the SF-Bolus group-eMAS receiving a lucinactant bolus (30?mg/ml); or the D-SF-Lavage group-eMAS treated with dilute lucinactant bronchoalveolar lavage (10?mg/ml). Systemic and pulmonary arterial pressures, blood gases, and pulmonary mechanics were recorded for 180?min. In addition, the intrapulmonary distribution of the lucinactant was determined using dye-labeled microspheres. Following meconium instillation, severe hypoxia, hypercapnia, acidosis, and pulmonary hypertension developed, and dynamic compliance decreased (50% from baseline). After lung lavage with dilute lucinactant, gas exchange significantly improved versus bolus instillation (P?0.05). Further, only in the lavage group did pulmonary arterial pressure return to basal values and dynamic compliance significantly increased. Both lung lavage and bolus techniques for the administration of lucinactant resulted in a non-uniform lung distribution. In conclusion, in newborn lambs with respiratory failure and pulmonary hypertension induced by meconium, lung lavage with dilute lucinactant seems to be an effective and safe alternative for treatment for MAS. PMID:21520434
Rey-Santano, C; Alvarez-Diaz, F J; Mielgo, V; Murgia, X; Lafuente, H; Ruiz-Del-Yerro, E; Valls-I-Soler, A; Gastiasoro, E
Colonoscopy following intraoperative lavage in the management of severe colonic bleeding.
Intraoperative lavage of the colon through a catheter inserted into the caecum provides a rapid means of cleansing the bowel of blood and clots to enable thorough colonoscopy in cases of severe colonic bleeding. This permits diagnosis of the site and cause of haemorrhage in those cases in which neither arteriography, conventional colonoscopy, nor laparotomy alone are helpful. Four cases are presented in which the technique of colonoscopy following intraoperative lavage allowed diagnosis and treatment in massive large bowel bleeding.
Campbell, W. B.; Rhodes, M.; Kettlewell, M. G.
Congenital uterine malformations.
With the advent of newer imaging techniques, the radiologist is now able to make very precise and accurate diagnoses of congenital uterine malformations and their complications. Because these anomalies are associated with reproductive dysfunction, they are often discovered during an infertility evaluation. By imaging parallel to the long axis of the uterus, the external contour can be evaluated, obviating laparoscopy for differentiating septate from bicornuate uteri. Obstructed uterovaginal anomalies (e.g., hematometros, hematometrocolpos), an important complication of abnormal m■llerian duct development, can occur at any time from the newborn period to adulthood. Determining the site of obstruction is imperative for planning the proper surgical approach. To understand these malformations better, we review the relevant embryology. The most widely accepted classification scheme is discussed in detail, with an emphasis on diagnosis, prognosis, and therapeutic options. PMID:8536487
Woodward, P J; Sohaey, R; Wagner, B J
The Hormonal Control of Uterine Luminal Fluid Secretion and Absorption
The secretion of uterine luminal fluid initially provides a transport and support medium for spermatozoa and unimplanted embryos,\\u000a while the absorption of uterine luminal fluid in early pregnancy results in the closure of the lumen and allows blastocysts\\u000a to establish intimate contact with the uterine epithelium. We have established an in vivo perfusion technique of the lumen\\u000a to study the
N. Salleh; D. L. Baines; R. J. Naftalin; S. R. Milligan
Sonographic and Histological Morphometry of the Uterine Cervix--An Assessment of Laparoscopic and Other lntrafascial Hysterectomy Techniques
New abdominal and vaginal hysterectomy techniques, such as classic intrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH), by pelviscopy/laparoscopy or laparotomy, and intrafascial vaginal hysterectomy (IVH), are both essentially supravaginal techniques. It has been claimed that they give a prophylaxis against cervical stump carcinoma by coring out the cervix with the SEMM. We set out to answer two questions: 1) How can vaginosonography help to choose an adequate SEMM diameter so that the cervical mucosa and transformation zone are completely removed, and 2) How often do cervical glands remain after the coring out procedure? We were able to show a good correlation between sonographic and histological morphology by giant and serial sections. In 253 CISH operations, resection of both endocervix and transformation zone was complete in 92.9%. Dysplasias were always removed completely; only 18 cervical cores exhibited healthy glands (retention cysts) in the resection margin. Therefore, CISH procedures should be able to prevent most of the cervical stump carcinomata that follow traditional supravaginal hysterectomy, but only long-term follow-up will give the final proof.
Semm, Kurt; Luttges, Jutta; Mettler, Lieselotte
CT features in uterine necrosis of unknown cause: a case report.
Uterine necrosis is a rare life-threatening condition known to be related to cesarean section, endometritis or uterine artery embolization. We present a case of uterine necrosis not preceded by common causative factors, diagnosed by computed tomography (CT) in a 64-year-old woman with myelodysplastic syndrome. A gas-filled, nonenhancing uterus was noted, diagnostic of uterine necrosis. At laparotomy, a nonvital uterus was removed. Imaging findings of uterine necrosis have sparsely been reported and mostly focus on magnetic resonance imaging technique. In this report, we describe the CT findings of uterine necrosis. PMID:24735683
Melenhorst, Marleen; Hehenkamp, Wouter; de Heer, Koen; Berger, Ferco
Uterine leukocytes and decidualization
The transformation of endometrium into decidua is an essential feature of normal implantation and pregnancy. There is a close association with an unusual leukocyte population, uterine natural killer (NK) cells, and onset of decid- ualization. These uterine NK cells are seen in close contact with stromal cells ultrastructurally and are also seen encir- cling vessels and glands. The possibility that
Ashley King
A survey on bacterial contamination of lavage water in electric warm-water lavage toilet seats and of the gluteal cleft after lavage.
Electric warm-water lavage toilet seats are in wide use as an appliance beneficial for the maintenance of hygiene and the prophylaxis and improvement of conditions such as constipation and hemorrhoids. In this study, we surveyed the bacterial content in the lavage water of warm-water lavage toilet seats, and fecal bacterial contamination of the gluteal and genital regions due to droplet infection from post-defecation lavage, to examine the problems inherent to the use of such lavage units. The presence of viable bacteria in lavage water was confirmed in this survey. Viable bacterial counts in lavage water were 3-times higher in household units compared to units in public facilities, suggesting a correlation with the replenishment of lavage tank water with fresh water containing residual free chlorine. PMID:24930878
Katano, Hideki; Yokoyama, Kumi; Takei, Yasushi; Tazume, Seiki; Tsukiji, Mami; Matsuki, Hideaki
Diagnosis and Nonsurgical Management of Uterine Arteriovenous Malformation
Uterine arteriovenous malformation (AVM) is an uncommon problem and traditional treatment by hysterectomy excludes the possibility of future pregnancy. Developments in interventional techniques make transcatheter embolization of the feeding vessel(s) a therapeutic alternative, potentially preserving the patient's fertility. We present a case of successful endovascular treatment of uterine AVM.
Rangarajan, R. D.; Moloney, J. C.; Anderson, H. J. [Eastbourne District General Hospital, Department of Radiology (United Kingdom)], E-mail: firstname.lastname@example.com
Pleural lavage cytology: where do we stand?
Although a malignant pleural effusion is considered a manifestation of an advanced stage disease not amenable to curative resection in patients with non-small cell lung cancer, the same is not true in the case of the presence of malignant cells in the pleural cavity without an accompanying effusion, discovered incidentally during the operation with pleural lavage cytology (PLC). PLC is a diagnostic technique used to detect tumor cells and translate this finding to a prognostic index. Various reports have attempted to utilize the results of PLC and draw inferences regarding the origins of malignant cells in the pleural cavity, the association of these results with various disease characteristics and, most importantly, their impact on disease recurrence and survival. However, due to non-consistent techniques and protocols used to acquire the samples for cytological evaluation and assess their significance, results are inhomogeneous. Nevertheless, the entrance of malignant cells in the pleural cavity follows the rules posed by the natural disease process when discovered before pulmonary resection takes place, while surgical manipulations certainly play an important role in the case malignant cells are checked over after pulmonary resection. In addition, although the prognostic significance of a positive PLC result is indisputable and significantly decreases long-term survival in the majority of studies, this factor has not yet been incorporated into the TNM staging system. Lastly, some authors have advocated the use of some form of adjuvant treatment for those patients found with positive PLC results, based on the assumption that a curative resection followed by multiple pleural washings will not remove the entirety of the population of malignant cells present in the pleural space. PMID:24238496
Toufektzian, Levon; Sepsas, Evangelos; Drossos, Vasileios; Gkiozos, Ioannis; Syrigos, Konstantinos
Recurrent uterine rupture after hysterescopic resection of the uterine septum
INTRODUCTION Uterine rupture after hysteroscopic septum resection is a rare complication, and its frequency is reported to be approximately 12.7%. Uterine perforation and monopolar resection during hysteroscopy are well-known risk factors for subsequent uterine rupture during pregnancy. PRESENTATION OF CASE We present a case of recurrent uterine ruptures during consecutive pregnancies in a patient who had undergone hysteroscopic septum resection for recurrent pregnancy loss. DISCUSSION Recurrent uterine rupture due to hysteroscopic septum resection in pregnancy is a very rare condition. In the present case we noted that the first two uterine ruptures resulted from uterine contractions; however, the third rupture occurred spontaneously and earlier in gestation. As each uterine rupture occurred earlier than the rupture in the previous gestation, a history of uterine rupture during pregnancy should raise provider suspicion about the possibility of earlier uterine rupture recurrence. CONCLUSION Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. However, if a patient has a history of uterine rupture during previous pregnancies, the risk of uterine rupture may increase for earlier gestational ages in subsequent pregnancies. The patient must be informed about both the risks of uterine rupture during pregnancy after hysteroscopic septum resection and that recurrent ruptures may occur at earlier gestational weeks than during previous pregnancies.
Ergenoglu, Mete; Yeniel, Ahmet Ozgur; Y?ld?r?m, Nuri; Akdemir, Ali; Yucebilgin, Sait
Oral bowel lavage preparation for colonoscopy.
Colonoscopy is a commonly performed diagnostic and therapeutic procedure in most general hospitals, which requires effective bowel preparation to be worthwhile. We report the effect of replacing a diet, laxative and bowel washout preparation with oral bowel lavage using a balanced electrolyte formulation, in our unit. The preparation was acceptable to patients, medical and nursing staff, generally preferred to previous preparations by those who had experienced them, allowed a more complete colonoscopy with an excellent quality of view, and was less expensive in nursing time. We regard oral bowel lavage as currently the method of choice for bowel preparation prior to colonoscopy in the majority of patients.
Burke, D. A.; Manning, A. P.; Murphy, L.; Axon, A. T.
Penetrating torso injuries: the role of paracentesis and lavage.
Controversy still exists regarding the proper approach to patients with penetrating torso injuries. Mandatory immediate celiotomy and selective observation both have associated risks. Paracentesis with lavage is a rapid, easily performed and readily available technique which can, with a high degree of accuracy, differentiate on initial evaluation those patients with penetrating visceral injuries from those without such injuries. Complications are minimal. The use of these two procedures in evaluating penetrating torso injuries has led to improved patient care and produced major lowering of medical and socioeconomic costs. PMID:842966
Danto, L A; Thomas, C W; Gorenbein, S; Wolfman, E F
Uterine Fibroid Embolization (UFE)
... variety of medications and synthetic materials, called embolic agents , are used. The equipment typically used for this ... inch in diameter. Several different types of embolic agents are used for uterine fibroid embolization. They act ...
The Center for Uterine Fibroids represents a longstanding collaboration between researchers at Brigham and Womens Hospital and Mayo Clinic. Join us in our collaboration to search for the causes of and treatments ...
... Announcements Radio Public Service Announcements Print Materials Campaign Research Doctors Who Use Social Media Poster Presentation Buttons and Badges Related Resources Gynecologic Cancer Symptoms Diary [PDF-503KB] Uterine Cancer fact sheet [PDF-622KB] ...
Gut lavage IgG and interleukin 1 receptor antagonist:interleukin 1 beta ratio as markers of intestinal inflammation in children with inflammatory bowel disease
BACKGROUND: Whole gut lavage is currently used as preparation before radiological or endoscopic examination of the large bowel. AIM: To validate the gut lavage technique for the assessment of mucosal inflammation, by measuring intestinal IgG and interleukin 1 beta (IL-1 beta) in the fluid obtained. PATIENTS: Sixteen children with Crohn's disease (CD), 14 with ulcerative colitis (UC), and 22 age
R Troncone; N Caputo; A Campanozzi; M Cucciardi; V Esposito; R Russo; B De Vizia; L Greco; S Cucchiara
Uterine cirsoid aneurysm: MRI and MRA
Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm. 28 refs., 7 figs
Joja, Ikuo; Asakawa, Mari; Motoyama, Kazumi [Okayama Univ. (Japan)] [and others] [Okayama Univ. (Japan); and others
Image-guided thermal therapy of uterine fibroids
Thermal ablation is an established treatment for tumor. The merging of newly developed imaging techniques has allowed precise targeting and real-time thermal mapping. This article provides an overview of the image-guided thermal ablation techniques in the treatment of uterine fibroids. Background on uterine fibroids, including epidemiology, histology, symptoms, imaging findings and current treatment options, is first outlined. After describing the principle of magnetic resonance thermal imaging, we introduce the applications of image-guided thermal therapies, including laser ablation, radiofrequency ablation, cryotherapy and particularly the newest, magnetic resonance-guided focused ultrasound surgery, and how they apply to uterine fibroid treatment.
Shen, Shu-Huei; Fennessy, Fiona; McDannold, Nathan; Jolesz, Ferenc; Tempany, Clare
Rapid (0.5¯C\\/min) minimally invasive induction of hypothermia using cold perfluorochemical lung lavage in dogs
Objective: Demonstrate minimally invasive rapid body core and brain cooling in a large animal model. Design: Prospective controlled animal trial. Setting: Private research laboratory. Subjects: Adult dogs, anesthetized, mechanically ventilated. Interventions: Cyclic lung lavage with FC-75 perfluorochemical (PFC) was administered through a dual-lumen endotracheal system in the new technique of gas\\/liquid ventilation (GLV). In Trial-I, lavage volume (V-lav) was 19
Steven B. Harris; Michael G. Darwin; Sandra R. Russell; Joan M. O'Farrell; Mike Fletcher; Brian Wowk
Successful robotically assisted laparoscopic correction of chronic uterine inversion.
We report a successful robotically assisted repair of a chronic uterine inversion. A modified Spinelli technique was used. The patient was discharged home after an uncomplicated postoperative course. PMID:21872174
Zechmeister, J R; Levey, K A
How Are Uterine Fibroids Diagnosed?
... Trials Resources and Publications En Espaþol How are uterine fibroids diagnosed? Skip sharing on social media links Share ... you probably wont know that you have uterine fibroids. Sometimes, health care providers find fibroids during a ...
Effect of polyethylene glycol-electrolyte lavage solution on intestinal microflora.
The bacterial flora of colonic aspirates taken after oral administration of a polyethylene glycol-electrolyte lavage solution to patients undergoing colonoscopy was analyzed by standard bacteriological methods and DNA hybridization techniques. The data were compared with those for normal feces collected from the same patients the day before treatment. The results indicate that the bacterial composition of feces differs from individual to individual but is not altered by the oral intake of a polyethylene glycol-electrolyte lavage solution. This pilot study demonstrates that routine colonoscopy aspirates taken after standard colonoscopy preparation accurately reflect the microflora of feces and therefore may be used in large-scale epidemiological studies.
Morotomi, M; Guillem, J G; Pocsidio, J; LoGerfo, P; Treat, M; Forde, K A; Weinstein, I B; Watanabe, I; Mutai, M
Ovarian cyclicity in a number of laboratory species can be monitored easily and noninvasively by observing changes in the vaginal cytology. his chapter describes the techniques used to collect data in the laboratory rat and mouse and how to interpret the lavages as they are obtai...
Lipomatous tumors of the uterus are unusual, benign neoplasms seen in postmenopausal women. Although many of the mixed-type cases such as lipoleiomyoma and fibrolipoma have been reported, pure uterine lipomas are extremely rare. In the literature, a few cases with pure uterine lipoma have been reported. We first present the advanced magnetic resonance findings of pure uterine lipoma, followed by those of ultrasonography (US) and computed tomography (CT). We markedly detected lipid peaks on the magnetic resonance spectroscopy (MRS) and the apparent diffusion coefficient value to be 0.00 due to chemical-shift effects with diffusion-weighted imaging (DWI). Although pelvic lipomatous tumors can be diagnosed with US and CT, in some cases, further workup may be required to localize the lesion. MRI may yield more valuable data for differential diagnosis. MRS and DWI findings provide additional clues on the nature of the lesion. PMID:17905250
Erdem, Gulnur; Celik, Onder; Karakas, Hakki Muammer; Alkan, Alpay; Hascalik, Seyma
Galactomannan detection in bronchoalveolar lavage fluid
Prompt diagnosis of invasive pulmonary aspergillosis (IPA) remains a challenge. Galactomannan (GM) assay in serum has been\\u000a incorporated into diagnostic criteria for IPA, but its performance varies depending on the population in which the test is\\u000a used. GM assay on bronchoalveolar lavage (BAL) fluid aims to improve upon the test by applying it directly on samples from\\u000a the target organ.
Eun Jeong Kwak; M. Hong Nguyen
Bronchoalveolar lavage in pulmonary mycotoxicosis (organic dust toxic syndrome).
Two cases of pulmonary mycotoxicosis (organic dust toxic syndrome) are described in which bronchoalveolar lavage was undertaken during the acute phase and after recovery. Both cases occurred after exposure to mould dust in a silo in the course of removing the top mouldy layer of silage or oats at the start of unloading. The workers suffered an acute febrile illness accompanied by cough and dyspnoea. One patient had impaired ventilatory function and both had arterial desaturation in the acute phase. There was mild impairment of diffusing capacity (transfer factor). Bronchoscopy showed inflammation of the bronchial mucosa in one patient. Fungal spores were cultured from the lavage fluid in both patients. In both patients there was an increase in the percentage of neutrophils in the lavage fluid without increase in lymphocytes. The immunoglobulin concentration in the lavage fluid was normal. At the follow up lavage the neutrophils had returned to normal while a mild lymphocytosis of the lavage fluid was seen in both patients.
Lecours, R; Laviolette, M; Cormier, Y
Novel Image-Guided Management of a Uterine Arteriovenous Malformation
The investigators present a novel image-guided embolization, not previously described, of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The uterus was exposed surgically, and Histoacryl (Braun, Fulda, Germany) was injected directly into the nidus using ultrasound guidance and fluoroscopy. The patient had a successful full-term pregnancy after this procedure. This technique may be a useful alternative management strategy in patients with uterine AVM who fail traditional endovascular embolization and who still desire fertility.
Przybojewski, Stefan J., E-mail: firstname.lastname@example.com; Sadler, David J. [University of Calgary, Diagnostic Imaging Department, Foothills Hospital (Canada)
A Comparative Study between Use of Arthroscopic Lavage and Arthrocentesis of Temporomandibular Joint Based on Computational Fluid Dynamics Analysis
Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.
Zhu, Ping; Zhou, Wenyan; Han, Yi; Zheng, Youhua; Zhang, Zhiguang
Ultrastaging of lymph node in uterine cancers
Background Lymph node status is an important prognostic factor and a criterion for adjuvant therapy in uterine cancers. While detection of micrometastases by ultrastaging techniques is correlated to prognosis in several other cancers, this remains a matter of debate for uterine cancers. The objective of this review on sentinel nodes (SN) in uterine cancers was to determine the contribution of ultrastaging to detect micrometastases. Methods Review of the English literature on SN procedure in cervical and endometrial cancers and histological techniques including hematoxylin and eosin (H&E) staining, serial sectioning, immunohistochemistry (IHC) and molecular techniques to detect micrometastases. Results In both cervical and endometrial cancers, H&E and IHC appeared insufficient to detect micrometastases. In cervical cancer, using H&E, serial sectioning and IHC, the rate of macrometastases varied between 7.1% and 36.3% with a mean value of 25.8%. The percentage of women with micrometastases ranged from 0% and 47.4% with a mean value of 28.3%. In endometrial cancer, the rate of macrometastases varied from 0% to 22%. Using H&E, serial sectioning and IHC, the rate of micrometastases varied from 0% to 15% with a mean value of 5.8%. In both cervical and endometrial cancers, data on the contribution of molecular techniques to detect micrometastases are insufficient to clarify their role in SN ultrastaging. Conclusion In uterine cancers, H&E, serial sectioning and IHC appears the best histological combined technique to detect micrometastases. Although accumulating data have proved the relation between the risk of recurrence and the presence of micrometastases, their clinical implications on indications for adjuvant therapy has to be clarified.
Uterine arteriovenous malformation.
Uterine arteriovenous malformation (AVM) is a little known condition of which, to date, very few cases have been described. It has a very diverse symptomatology, even though in most cases, it is diagnosed during a severe and acute haemorrhagic event. Its treatment can vary from expectant management to hysterectomy; however, current evidence suggests that the embolisation of uterine arteries is the most effective approach, especially if fertility is to be preserved. We present a case report classified as AVM, with additional images that show the appearance of this pathology in a short span of time. This case has a number of peculiarities: unusual persistence of human chorionic gonadotropin hormone (?-HCG), asymptomatic patient, quick establishment of the lesion and its duration with unchanging characteristics and finally its spontaneous resolution without further consequences. This entity shows an aetiopathogenesis, that is, not well established or described. We discuss its physiopathology and aetiopathogenesis. PMID:23396842
Sellers, Francisco; Palacios-MarquÕs, Ana; Moliner, Belen; Bernabeu, Rafael
[Uterine collagens. General review].
Several collagen types (mainly types I, III, V and VI), elastin, fibronectin and some proteoglycans are active constituents of uterine myometer. They surround and associate smooth muscle cells. The type I collagen biosynthesis in the uterus is under the positive control of estrogens that in addition repress the collagenase secretion and in this way prevent collagen from degradation. The cervical softening and dilation are caused by a progressive degradation of collagen and by the synthesis of an additional proteoglycan that separates and disorganizes the collagen fibres. Prostaglandin E2 and relaxin participate in the activation of collagenases. After delivery, the drop in estrogens and progesterone permits collagenases to rapidly degrade uterine collagen in excess. PMID:1663655
Borel, J P
Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature.
Uterine necrosis is one of the rarest complications following pelvic arterial embolization for postpartum hemorrhage (PPH). With the increasing incidence of cesarean section and abnormal placental localization (placenta previa) or placental invasion (placenta accreta/increta/percreta), more and more cases of uterine necrosis after embolization are being diagnosed and reported. Pelvic computed tomography or magnetic resonance imaging provides high diagnostic accuracy, and surgical management includes hysterectomy. We performed a Medline database query following the first description of uterine necrosis after pelvic embolization (between January 1985 and January 2013). Medical subheading search words were the following: "uterine necrosis"; "embolization"; "postpartum hemorrhage". Seventeen citations reporting at least one case of uterine necrosis after pelvic embolization for PPH were included, with a total of 19 cases. This literature review discusses the etiopathogenesis, clinical and therapeutic aspects of uterine necrosis following pelvic arterial embolization, and guidelines are detailed. The mean time interval between pelvic embolization and diagnosis of uterine necrosis was 21 days (range 9-730). The main symptoms of uterine necrosis were fever, abdominal pain, menorrhagia and leukorrhea. Surgical management included total hysterectomy (n=15, 78%) or subtotal hysterectomy (n=2, 10%) and partial cystectomy with excision of the necrotic portion in three cases of associated bladder necrosis (15%). Uterine necrosis was partial in four cases (21%). Regarding the pathophysiology, four factors may be involved in uterine necrosis: the size and nature of the embolizing agent, the presence of the anastomotic vascular system and the embolization technique itself with the use of free flow embolization. PMID:23932304
Poujade, Olivier; Ceccaldi, Pierre FranÓois; Davitian, Carine; Amate, Pascale; Chatel, Paul; Khater, Carine; Aflak, Nizar; Vilgrain, ValÕrie; Luton, Dominique
Modi?ed anchored B-Lynch uterine compression suture for post partum bleeding with uterine atony.
A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B-Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200-3300 ml). This newly modified anchor B-Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH. PMID:21306313
Marasinghe, Jeevan P; Condous, George; Seneviratne, Harshalal R; Marasinghe, Upali
Validity of Markers of Dilution in Small Volume Lung Lavage
Definitive analysis of solute concentrations in lung lavage fluid involves the use of a marker of di- lution to correct for variable recovery of epithelial lining fluid (ELF), but the question of the most appropriate dilutional marker remains unresolved. In lavage fluid collected from infants with lung disease and healthy control subjects, we examined ELF concentration of protein, albumin, sphingo-
Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review
Aim This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage for patients with perforated diverticulitis. Method We searched PubMed, EMBASE, Web of Science, the Cochrane Library and CINAHL databases, Google Scholar and five major publisher websites without language restriction. All articles which reported the use of laparoscopic peritoneal lavage for patients with perforated diverticulitis
B. R. Toorenvliet; H. Swank; J. W. Schoones; J. F. Hamming; W. A. Bemelman
Malignant transformation of uterine leiomyoma
A rare case of malignant transformation of uterine leiomyoma is reported. A 54 year old lady, nulliparous and 2 years postmenopausal presented to gynecology clinic with a pelvi abdominal mass and ultrasound scan suggestive of multiple uterine fibroid. Total abdominal hysterectomy performed. Histopathology report showed leiomyosarcomative changes from benign leiomyoma within the huge mass.
Al Ansari, Afaf A.; Al Hail, Fatima A.; Abboud, Emad
Microwave occlusion of the rabbit uterine horn
NASA Astrophysics Data System (ADS)
A microwave applicator was developed and tested in a rabbit model, with the goal of developing a system to sterilize a human female through a transvaginal-transcervical- transuterine retrograde technique. The clinical procedure wold create an occluding lesion in the isthmic portion of the human fallopian tube in an out-patient procedure. The microwave applicator consisted of a flexible coaxial cable from which the inner conductor was extended to form a resonant monopole antenna. The coaxial cable and monopole were placed within a sealed teflon catheter of 3 mm diameter. A second parallel catheter of 1 mm diameter was secured to the first to provide guidance for a microwave- immune thermometry probe. Following laparotomy exposure, the applicator was placed with a transvaginal-transcervical retrograde technique in each uterine horn in succession. The temperature was elevated to 65 degree(s)C for 5 minutes. Thirty days following treatment, there was marked constriction and discoloration of the treated site as well as significant architectural effacement of the tissue composing the uterine wall. In some cases, the uterine lumen was completely occluded. Future experiments will assess the tissue response to smaller thermal doses.
Trembly, B. Stuart; Manganiello, Paul D.; Hoopes, P. Jack
Radiation Therapy, Paclitaxel, and Carboplatin in Treating Patients With Uterine Cancer
Stage IA Uterine Sarcoma; Stage IB Uterine Sarcoma; Stage IC Uterine Sarcoma; Stage IIA Uterine Sarcoma; Stage IIB Uterine Sarcoma; Stage IIIA Uterine Sarcoma; Stage IIIB Uterine Sarcoma; Stage IIIC Uterine Sarcoma; Stage IVA Uterine Sarcoma; Stage IVB Uterine Sarcoma; Uterine Carcinosarcoma
Special precautions reduce oropharyngeal contamination in bronchoalveolar lavage for bacteriologic studies
Despite the use of quantitative culture, oropharyngeal contamination of bronchoalveolar lavage (BAL) specimens is still a\\u000a factor that limits the usefulness of this technique in the diagnosis of lower respiratory tract infection. To investigate\\u000a whether special precautions could reduce contamination, 20 noninfected patients undergoing diagnostic bronchoscopy were randomized\\u000a into 2 groups of 10 patients: BAL was performed routinely in group
J. A. Pang; A. F. B. Cheng; H. S. Chan; G. L. French
Peritoneal Lavage Efficiently Eliminates Protease-Alpha-2Macroglobulin Complexes and Components of the Contact System from the Peritoneal Cavity in Patients with Severe Acute Pancreatitis
Trypsin (Try), plasma kallikrein (KK) and plasmin activities together with coagulation factor XII (F XII, Hageman factor), high-molecular-weight kininogen (HMWK), plasma prekallikrein (PKK), ?2-macroglobulin (c?2-M), C1 inhibitor (C1Inh), and functional plasma kallikrein inhibition (KKI) values were studied in peritoneal fluid and lavage taps of 9 patients with severe acute pancreatitis treated with peritoneal lavage. Both immunochemical methods and functional techniques
A. O. Aasen; T. E. Ruud; O. Roeise; B. N. Bouma; J. O. Stadaas
Magnetic Resonance Elastography of Uterine Leiomyomas: A Feasibility Study
Objective To determine the feasibility of performing in vivo magnetic resonance elastography (MRE) for uterine leiomyoma. Design Pilot study Setting Academic Medical Center Patients Six subjects planning surgical excision of uterine leiomyomas. Intervention MRE prior to planned surgery Main Outcome Measures Achieving an appropriate phase signal to noise ratio (PSNR) in the leiomyoma to allow assessment of leiomyoma elasticity in kilo pascals (kPa). Results MRE was successful in all subjects for uteri ranging from 100 to over 1000 grams. Subjects had body mass indices (BMIs) ranging from 23.0 to 38.0 kg/m2. Appropriate PSNR ranging from 5.45 to 42.28 were achieved for leiomyomas in all subjects. Mean elasticity of uterine leiomyomas ranged from 3.95 to 6.68 kPa. Conclusion(s) MRE is a feasible technique for studying the in vivo mechanical properties of uterine leiomyomas and demonstrates significant heterogeneity in elasticity between lesions. Further work is necessary to optimize the technique and understand the clinical utility of this technique for women with uterine leiomyomas.
Stewart, Elizabeth A.; Taran, F. Andrei; Chen, Jun; Gostout, Bobbie S.; Woodrum, David A.; Felmlee, Joel P.; Ehman, Richard L.
Dealing with uterine fibroids in reproductive medicine.
Women who wish to conceive are nowadays more likely to present with uterine fibroids, mainly because of the delay in childbearing in our society. The relationship between uterine fibroids and human reproduction is still controversial and counselling patients might sometimes be challenging. This paper is to assist those involved in the management of patients of reproductive age presenting with uterine fibroids. The interference of fibroids on fertility largely depends on their location. Submucous fibroids interfere with fertility and should be removed in infertile patients, regardless of the size or the presence of symptoms. Intramural fibroids distorting the cavity reduce the chances of conception, while investigations on intramural fibroids not distorting the cavity have so far given controversial results. No evidence supports the systematic removal of subserosal fibroids in asymptomatic, infertile patients. Myomectomy is still the 'gold standard' in fibroid treatment for fertility-wishing patients. In experienced hands, hysteroscopic myomectomy is minimally invasive, safe, and effective. Abdominal and laparoscopic myomectomy might be challenging, but potential risks could be reduced by new strategies and techniques. PMID:22369390
Gambadauro, P
Granulomatous Pneumocystis carinii pneumonia: DNA amplification studies on bronchoscopic alveolar lavage samples.
Three HIV positive subjects presented with symptoms and radiographic changes suggestive of Pneumocystis carinii pneumonia. Methenamine silver staining of bronchoscopic alveolar lavage (BAL) fluid was negative (from one sample in one patient and two samples in the other two patients). Open lung biopsy was performed because of uncertain clinical progress and diagnosis; all three patients were found to have multiple pulmonary granulomata encasing numerous P carinii organisms. DNA amplification, using P carinii specific oligonucleotides, was performed on stored bronchoscopic BAL samples. P carinii specific amplification product was detected by ethidium bromide staining after electrophoretic separation on agarose gel in one case, and by the more sensitive technique of oligohybridisation in all three cases. In granulomatous P carinii pneumonia organisms are rarely identified in bronchoscopic alveolar lavage samples using histochemical staining, but are detectable by DNA amplification, although not at levels which can be readily distinguished from low, subclinical infection.
Wakefield, A E; Miller, R F; Guiver, L A; Hopkin, J M
Evaluation of stomach tubes and gastric lavage for sampling diets from blue catfish and flathead catfish
We compared the ability to extract all stomach contents by using stomach tubes or gastric lavage to sample diets from blue catfish Ictalurus furcatus and flathead catfish Pylodictus olivarus. Pulsed gastric lavage (PGL) removed a significantly greater proportion of stomach content mass (95.6%) from blue catfish than did stomach tubes (14.6%). Percent mass of flathead catfish contents removed with PGL (96.0%) was not significantly different from that removed with stomach tubes (86.9%). Based on the greater effectiveness of PGL for blue catfish, combined with a shorter mean time required per sample (69 versus 118 s) and the better preservation of extracted diet material, we recommend using PGL as a nonlethal technique to collect diet samples from large catfishes.
Waters, D. S.; Kwak, T. J.; Arnott, J. B.; Pine, III, W. E.
Uterine Cancer Prevention Clinical Trials
Programs and Projects Uterine Cancer Prevention Clinical Trials Ongoing Phase I/II Prevention Trials Funded and Monitored by the Breast and Gynecologic Cancer Research Group (BGCRG) Principal Investigator Funding Mechanism Title of Award
The analysis of airway fluid, as sampled by bronchoalveolar lavage (BAL), provides a minimally invasive route to interrogate lung biology in health and disease. Here, we used immunodepletion, coupled with gel- and label-free LC-MS/MS, for quantitation of the BAL fluid (BALF) proteome in samples recovered from human subjects following bronchoscopic instillation of saline, lipopolysaccharide (LPS) or house dust mite antigen into three distinct lung subsegments. Among more than 200 unique proteins quantified across nine samples, neutrophil granule-derived and acute phase proteins were most highly enriched in the LPS-exposed lobes. Of these, peptidoglycan response protein 1 was validated and confirmed as a novel marker of neutrophilic inflammation. Compared to a prior transcriptomic analysis of airway cells in this same cohort, the BALF proteome revealed a novel set of response factors. Independent of exposure, the enrichment of tracheal-expressed proteins in right lower lung lobes suggests a potential for constitutive intralobar variability in the BALF proteome; sampling of multiple lung subsegments also appears to aid in the identification of protein signatures that differentiate individuals at baseline. Collectively, this proof-of-concept study validates a robust workflow for BALF proteomics and demonstrates the complementary nature of proteomic and genomic techniques for investigating airway (patho)physiology.
Foster, Matthew W.; Will Thompson, J.; Que, Loretta G.; Yang, Ivana V.; Schwartz, David A.; Arthur Moseley, M.; Marshall, Harvey E.
Physiology and Electrical Activity of Uterine Contractions
Presently, there is no effective treatment for preterm labor. The most obvious reason for this anomaly is that there is no objective manner to evaluate the progression of pregnancy through steps leading to labor, either at term or preterm. Several techniques have been adopted to monitor labor, and/or to diagnose labor, but they are either subjective or indirect, and they do not provide an accurate prediction of when labor will occur. With no method to determine preterm labor, treatment might never improve. Uterine EMG (electromyography) methods may provide such needed diagnostics.
Garfield, Robert E.; Maner, William L.
Diagnosis of subclinical cryptosporidiosis in captive snakes based on stomach lavage and cloacal sampling.
The applicability of stomach lavage and cloacal swab techniques for diagnosis of subclinical cryptosporidiosis were tested in eight captive snakes subclinically infected with Cryptosporidium serpentis. Two feeding regimes were employed. The snakes were first fed 7 days prior to stomach and cloaca sampling, and then 3 days prior to sampling, and the oocysts were detected by fluorescein labeled monoclonal antibody (mAb) and by acid-fast stained (AFS) direct wet smear (DWS). The overall sensitivity of AFS DWS was 95% for stomach samples and 57% for cloacal samples, with false-negativity of 5% and 43%, respectively. A significant relationship (P < 0.01) was found between stomach and cloacal samples when mAb were used for oocyst detection. Stomach sampling was diagnostically superior to cloacal sampling for identifying snake subclinical cryptosporidiosis. Based on gastric aspirates, cryptosporidial infection was diagnosed in all eight animals, and only in two or four snakes when cloacal swab material was processed by AFS or by mAb, respectively. Feeding snakes 3 days prior to sampling facilitated diagnosis based on stomach samples; however, it did not improve diagnosis when cloacal samples were used. The fraction of oocyst-positive stomach samples was significantly higher (P < 0.05) for snakes fed 3 days prior to gastric lavage when compared with the fraction of positive samples of snakes fed 7 days prior to lavage. If subclinical cryptosporidiosis is suspected in a non-eating snake patient, force-feeding and stomach lavage, 3 days after the meal, is recommended. PMID:9017862
Graczyk, T K; Owens, R; Cranfield, M R
Modified Uterine Allotransplantation and Immunosuppression Procedure in the Sheep Model
Objective To develop an orthotopic, allogeneic, uterine transplantation technique and an effective immunosuppressive protocol in the sheep model. Methods In this pilot study, 10 sexually mature ewes were subjected to laparotomy and total abdominal hysterectomy with oophorectomy to procure uterus allografts. The cold ischemic time was 60 min. End-to-end vascular anastomosis was performed using continuous, non-interlocking sutures. Complete tissue reperfusion was achieved in all animals within 30 s after the vascular re-anastomosis, without any evidence of arterial or venous thrombosis. The immunosuppressive protocol consisted of tacrolimus, mycophenolate mofetil and methylprednisolone tablets. Graft viability was assessed by transrectal ultrasonography and second-look laparotomy at 2 and 4 weeks, respectively. Results Viable uterine tissue and vascular patency were observed on transrectal ultrasonography and second-look laparotomy. Histological analysis of the graft tissue (performed in one ewe) revealed normal tissue architecture with a very subtle inflammatory reaction but no edema or stasis. Conclusion We have developed a modified procedure that allowed us to successfully perform orthotopic, allogeneic, uterine transplantation in sheep, whose uterine and vascular anatomy (apart from the bicornuate uterus) is similar to the human anatomy, making the ovine model excellent for human uterine transplant research.
Yang, Hong; Zhao, Guang-Yue; Zhang, Geng; Lu, Zhi-Hong; Huang, Yan-Hong; Ma, Xiang-Dong; Liu, Hai-Xia; Liang, Sheng-Ru; Yang, Fang; Chen, Bi-Liang
Detection of human papillomavirus DNA in cervical lavage specimens by a nonisotopic consensus PCR assay.
A gene amplification method that combines PCR with an enzyme immunoassay (PCR-EIA) for quantitation of amplified DNA was developed for the detection of human papillomavirus (HPV). Samples were amplified with consensus primers MY09 and MY11. Amplified DNA products were reacted in solution with type-specific nested RNA probes labelled with digoxigenin-11-UTP. Hybrids were captured on a microtiter plate coated with an antidigoxigenin antibody. Bound DNA-RNA hybrids were quantitated by the addition of an alkaline phosphatase-labelled monoclonal antibody directed against DNA-RNA hybrids and a fluorogenic substrate. The detection limit of PCR-EIA was six copies of HPV type 18 DNA in the original specimen. The assay was used to assess HPV infection of the uterine cervixes of 65 women referred to a colposcopy clinic. In 66 cervicovaginal lavage specimens, all 23 HPV strains detected by a standard isotopic PCR assay were also detected by the PCR-EIA (sensitivity, 100%; 95% confidence interval, 85.2 to 100%). Forty-two of the 43 samples that did not contain HPV types 6/11, 16, 18, 31, 33, 35, and 45 were also negative by PCR-EIA, for a specificity of 97.7%. Low-level cross-reactivity was encountered between HPV types 18 and 45 as well as between types 33 and 58. PCR-EIA provides a convenient means of objectively measuring PCR-amplified HPV DNA from common genital HPV types.
Coutlee, F; Provencher, D; Voyer, H
Uterine Activity Patterns: Definition with Home Monitor.
National Technical Information Service (NTIS)
The project was conceived in response to an urgent need for definitive information about uterine contractile activity in normal human pregnancy. The purpose of the study was to describe uterine activity in normal signleton gestations. 109 women from three...
R. K. Creasy
Bronchoalveolar lavage cell pattern from healthy human lung
Bronchoalveolar lavage (BAL) is widely accepted as a key diagnostic procedure in interstitial lung diseases (ILD). We performed a study to obtain reference intervals of differential cell patterns in BAL fluid with special attention to the origin of lavage fluid, e.g. bronchial/alveolar, to atopy and smoking status and to age of the healthy people. We performed bronchoalveolar lavage in 55 healthy subjects with known atopy status (age: 1864 years, non-smokers/smokers: 34/21) and determined differential cell counts and lymphocyte subsets in BAL fluid and blood. Moreover, in a subgroup of non-smoking healthy individuals we measured the expression of the regulatory T cell marker forkhead box protein 3 (FoxP3) on blood and BAL fluid lymphocytes in addition to a comprehensive set of activation markers. Differential cell counts from the alveolar lavage fraction differed significantly from calculated pooled fractions (n = 11). In contrast, marginal differences were found between atopic and non-atopic subjects. Interestingly, the BAL fluid CD4+/CD8+ ratio correlated strongly with age (r2 = 0ñ50, P < 0ñ0001). We consider the bronchial and alveolar fraction to be lavage fluid from fundamentally different compartments and recommend analysis of the alveolar fraction in diagnostic work-up of ILD. In addition, our data suggest that age corrected BAL fluid CD4+/CD8+ ratios should be used in the clinical evaluation of patients with interstitial lung diseases.
Heron, M; Grutters, J C; ten Dam-Molenkamp, K M; Hijdra, D; van Heugten-Roeling, A; Claessen, A M E; Ruven, H J T; van den Bosch, J M M; van Velzen-Blad, H
Ventriculoperitoneal shunt infection following uterine instrumentation for dysfunctional uterine bleeding.
Shunt infections are most common within the first 6months following implantation. A shunt infection 19years after implantation secondary to uterine ablation has not been reported to our knowledge. Office hysteroscopic procedures have become commonplace in gynecologic practice. Infectious complication rates are low, but peritonitis has been described. We present a patient with a ventriculoperitoneal shunt infection following a uterine ablation for dysfunctional uterine bleeding. Three days following the ablation she developed abdominal pain. CT scan of the abdomen 5months after the procedure revealed a pseudocyst. She then underwent removal of her shunt with intra-operative cultures revealing Streptococcus agalactiae. Definitive treatment consisted of shunt explantation and antibiotic treatment with complete resolution of her pain and pseudocyst. Consideration for prophylactic antibiotics should be made when a patient with a ventriculoperitoneal shunt undergoes any transvaginal procedure. PMID:24656752
Shaw, Andrew B; Marlin, Evan S; Ikeda, Daniel S; Ammirati, Mario
First trimester spontaneous uterine rupture in a young woman with uterine anomaly.
Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies. PMID:24551467
Tola, Esra Nur
Medical Treatment of Uterine Leiomyoma
Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail.
Sabry, Mohamed; Al-Hendy, Ayman
Analysis of lung injury in humans by bronchoalveolar lavage after exposure to 0. 60 ppm nitrogen dioxide
Animal studies have shown the utility of bronchoalveolar lavage in investigating responses of the lung to inhaled toxins. To investigate low-level nitrogen dioxide (NO/sub 2/) inhalation in humans, 6 healthy, asymptomatic, non-smoking volunteers were exposed to air or 0.60 ppm NO/sub 2/ by double-blind randomization for 3 hours in a 45 m/sup 3/ environmental chamber. Subjects exercised for 10 minutes every 30 minutes on a bicycle ergometer at a workload sufficient to quadruple minute ventilation. Pulmonary function parameters including FVC, FEV/sub 1/, and airway resistance did not change during or after exposure to NO/sub 2/. 3 1/2 hours after exposure subjects underwent bronchoalveolar lavage. No differences in lavage return volume, total cell recovery, cell viability, or differential cell counts were observed after NO/sub 2/ exposure. Recovery of total protein (14.31 +/- 2.08 (SE) vs 14.72 +/- 1.73 mg) was unchanged. After NO/sub 2/ there was a modest but significant increase in total recovery of aryl sulfatase (964 +/- 188 vs 825 +/- 186 units, 0.01 < p < 0.02) suggesting possible cell injury. Other enzymes including lactate dehydrogenase and malate dehydrogenase did not change. Their results indicate that bronchoalveolar lavage is a sensitive technique for evaluating early injury induced by inhaled toxicants in humans.
Smeglin, A.M.; Utell, M.J.; Finkelstein, J.; Mavis, R.; Roberts, N.J. Jr.; Morrow, P.E.
Inorganic particles in bronchoalveolar lavage fluids from nonoccupationally exposed subjects.
This study comprised 30 patients who had not been exposed occupationally to dusts, but for whom a diagnosis of suspected pulmonary carcinoma had been made. Bronchoalveolar lavage fluids from these patients were analyzed by transmission electron microscopy and by energy-dispersive x-ray microanalysis in an effort to study the mineral particulate present in the alveolar region. Particles of silica, silicates, oxides, sulphates, and metal alloys were detected in various percentages in each subject. The smoking habits of two groups of patients that were defined by their bronchoalveolar lavage particulate concentrations (i.e., lower or higher than the median of the distribution) differed significantly. PMID:8638968
Falchi, M; Biondo, L; Conti, C; Cipri, A; de Marinis, F; Gigli, B; Paoletti, L
Herbal preparations for uterine fibroids
Background Uterine fibroids are the most common non-malignant growths in women of childbearing age. They are associated with heavy menstrual bleeding and subfertility. Herbal preparations are commonly used as alternatives to surgical procedures. Objectives To assess the benefits and risks of herbal preparations for uterine fibroids. Search strategy Authors searched following electronic databases: the Trials Registers of the Cochrane Menstrual Disorders and Subfertility Group and the Cochrane Complementary Medicine Field, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, the Chinese Biomedical Database, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), AMED, and LILACS. The searches ended on 31st December 2008. Selection criteria Randomised controlled trials comparing herbal preparations with no intervention, placebo, medical treatment or surgical procedures in women with uterine fibroids. We also included trials of herbal preparations with or without conventional therapy. Data collection and analysis Two review authors collected data independently. We assessed trial risk of bias according to our methodological criteria. We presented dichotomous data as risk ratios (RR) and continuous outcomes as mean difference (MD), both with 95% confidence intervals (CI). Main results We included two randomised trials (involved 150 women) with clear description of randomisation methods. The methodological risk of bias of the trials varied. There were variations in the tested herbal preparations, and the treatment duration was six months. The outcomes available were not the primary outcomes selected for this review, such as symptom relief or the need for surgical treatment; trials mainly reported outcomes in terms of shrinkage of the fibroids. Compared with mifepristone, Huoxue Sanjie decoction showed no significant difference in the disappearance of uterine fibroids, number of patients with shrinking of uterine fibroids or average volume of uterine fibroids, but less effective than mifepristone on reducing average size of uterus (mean difference 23.23 cm3, 95% confidence interval 17.85 to 28.61). There was no significant difference between Nona Roguy herbal product and GnRH agonist in average volume of uterine fibroids or size of uterus. No serious adverse effects from herbal preparations was reported. Authors conclusions Current evidence does not support or refute the use of herbal preparations for treatment of uterine fibroids due to insufficient studies of large sample and high quality. Further high quality trials evaluating clinically relevant outcomes are warranted.
Liu, Jian Ping; Yang, Hong; Xia, Yun; Cardini, Francesco
Electric suction-lavage device for video-assisted thoracoscopic surgery treatment of empyema and hemothorax.
We describe the use of an electric trigger-controlled suction-lavage device for the evacuation of empyema or clotted hemothorax. Wound debridement systems provide efficient irrigation and debris removal. It is frequently used for orthopedic procedures or infected wound rinsing. Internet search of the literature did not result in any paper describing the use of this technique for thoracic surgery. We present our experience with an electrical wound-washing device in video-assisted thoracoscopic surgery for thoracic empyema or clotted hemothorax. PMID:24580938
Ben-Nun, Alon; Waknin, Avi; Soudack, Michalle
Bronchoalveolar lavage, serum angiotensin-converting enzyme, and /sup 67/Ga scanning in extrathoracic sarcoidosis
Results of bronchoalveolar lavage (BAL), 67Ga scanning, and serum angiotensin-converting enzyme (SACE) assay are compared in the assessment of pulmonary involvement in ten cases of extrathoracic sarcoidosis. Standard clinical, radiologic, and pulmonary function tests detected no pulmonary changes in these patients, but BAL demonstrated an increased alveolar lymphocytosis in eight of ten cases. SACE levels were increased in two cases, and the thoracic gallium uptake was normal in all cases. BAL appears to be the best technique for diagnosing latent pulmonary involvement in extrathoracic sarcoidosis.
Wallaert, B.; Ramon, P.; Fournier, E.; Tonnel, A.B.; Voisin, C.
Surgical management of neurovascular bundle in uterine fibroid pseudocapsule.
The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes. PMID:22906340
Tinelli, Andrea; Malvasi, Antonio; Hurst, Brad S; Tsin, Daniel A; Davila, Fausto; Dominguez, Guillermo; Dell'edera, Domenico; Cavallotti, Carlo; Negro, Roberto; Gustapane, Sarah; Teigland, Chris M; Mettler, Liselotte
Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule
The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes.
Malvasi, Antonio; Hurst, Brad S.; Tsin, Daniel A.; Davila, Fausto; Dominguez, Guillermo; Dell'edera, Domenico; Cavallotti, Carlo; Negro, Roberto; Gustapane, Sarah; Teigland, Chris M.; Mettler, Liselotte
Hysterosalpingography Finding in Intra Uterine Adhesion (Asherman' s Syndrome): A Pictorial Essay
Destruction of the endometrium due to trauma to the basal layer of endometrium may cause intra uterine adhesions, known as Ashermans syndrome (AS). There are various types of imaging method for diagnosis of the intra uterine adhesion such as hysterosalpingography, sonohysterography, ultrasonography, and hysteroscopy which is considered as the gold standard approach. Hysterosalpingogram may suggest the presence of intrauterine adhesions, and may reveal the extent of the scar formation. Knowing different images in each technique is helpful in detection of intra uterine adhesion.
Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz; Eslami, Bita; Vosough, Ahmad
Species comparisons of bronchoalveolar lavages from guinea pigs and rats exposed in vivo to diesel exhaust for one year
Male Hartly guinea pigs and Fischer rats 344 were exposed to diesel exhaust (DE) concentrations at 0, 250, and 1500 micrograms/m3 in short terms, as well as long term experiments up to one year. The effects of inhaled DE on these rodents were evaluated using bronchoalveolar lavage technique. Both the morphological and functional studies of free lung cells and the biochemical and immunologic studies of the supernatant lavage fluid provided the basis for a quantitative species comparison of the pulmonary responses of exposed guinea pigs and rats versus age matched controls. Following inhalation of 250 micrograms DE/m3, there were little or no significant changes in either species. In contrast, at higher DE concentration, leukocytic infiltration and elevation of specific proteins in lavage fluids were observed in both species. The findings occurred and persisted in both species. Some of the responses were species specific (e.g., the specific type of exudative leukocytes, appearance of reactive monocytes, and different amounts of free DE particles and debris in the lavage fluid). Other responses were similar in both species. Among them, the emergence and increase of lymphocytes was evidence of immunologic responses. Biochemical data from the supernatant fluid correlates with the changes in cellular population in the lavage. The responses appear to be dose and duration dependent. These data indicate that species differences occur. However, it is clear that the alveolar macrophage and granulocytic leukocytes continue to exert effective defense at the DE dose-durations studied. In general, rats appeared more resistant to DE exposure than guinea pigs.
Chen, S.; Weller, M.A.; Barnhart, M.I.
Ductal Lavage Findings in Women With Mammographic Microcalcifications Undergoing Biopsy
Background: We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL). Methods: Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject
Seema A. Khan; Judy A. Wolfman; Lewis Segal; Stephanie Benjamin; Ritu Nayar; Elizabeth L. Wiley; Michele Bryk; Monica Morrow
Stomach lavaging was used to study the feeding habits of northern elephanr seals (Mirounga angustirostris) found on San hliguel Island, California, during the spring of 1984. Fifty-nine elephant seals were chemically immobilized with an intramuscular injection of ketamine hydrochloride. Once immobilized, an animal's stomach was intubated, filled nith 3-4 liters of water to create a slurry of the undigested food
George A. Antonelis; Mark S. Lowry; Douglas P. DeMaster; Clifford H. Fiscus
Semiquantitative technique for estimating Pneumocystis carinii burden in the lung.
We developed a technique to estimate the amount of Pneumocystis carinii found in bronchoalveolar lavage fluid. P. carinii associated with 500 nucleated cells in the bronchoalveolar lavage fluid had little between-observer and within-observer variation. Varying the technique of the lavage did not change the amount of P. carinii recovered. This technique was used in patients treated for P. carinii pneumonia. Those patients who did not respond to treatment had more P. carinii in their bronchoalveolar lavage fluid than those who responded.
Baughman, R P; Strohofer, S; Colangelo, G; Frame, P T
A low-sodium solution for gastrointestinal lavage.
Golytely is a sodium sulfate-based solution used for lavage cleansing of the colon. Although most patients and physicians prefer Golytely lavage over other methods of bowel cleansing, its highly salty taste is a drawback. This report describes the development of a modified lavage solution that has a barely perceptible salty taste. This solution was developed by removing sodium sulfate, increasing the concentration of polyethylene glycol, and making minor adjustments in the concentration of other salts. Golytely, reduced sodium sulfate Golytely (Golytely-RSS), and a balanced electrolyte solution were infused into the stomachs of normal subjects. After steady-state lavage conditions were established, the rates of fluid and electrolyte absorption were measured. Average fluid absorption rate was 791 ml/h with the balanced electrolyte solution, compared with only 63 and 45 ml/h with Golytely and Golytely-RSS, respectively. Golytely-RSS was studied at 3 infusion rates, from 0.9-1.8 L/h, and the time and volume of solution required for colon cleansing was determined; the lower infusion rate (0.9 L/h) took longer but required less solution to cleanse the colon. In conclusion, Golytely-RSS has the essential feature of Golytely; i.e., lavage is associated with negligible salt and water absorption. The less-salty taste of Golytely-RSS may make it less difficult to drink and thereby enhance patient compliance; the total volume of solution required for cleansing is less when the solution is ingested at 0.9 L/h than when the ingestion rate is 1.8 L/h. PMID:2293568
Fordtran, J S; Santa Ana, C A; Cleveland MvB
Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach
Objective To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. Methods A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. Results Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. Conclusion Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.
Kim, Myo Sun; Uhm, You Kyoung; Kim, Ju Yeong; Kim, Yong Beom
[Uterine artery embolization for the conservative management of leiomyoma].
Uterine leiomyoma, a benign, monoclonal tumor derived from a single myometrial cell, is one of the most frequent diseases in the female reproductive system. However, the factors involved in its initiation and growth remain poorly understood. Most commonly, it results in dysmenorrhea, menorrhagia, urinary tract and neurological symptoms, and abdominal distension. Additionally, it may cause infertility, late miscarriage or other severe complications in pregnancy. The conventional treatment for fibroids has been hysterectomy. However, many women do not like to lose their uterus and potential fertility. Myomectomy and medical treatment with GnRH analogue are accepted as alternative organ-conserving methods with limited efficacy. Selective embolization of uterine arteries might therefore have a significant role in the management of the disease. The purpose of this study was to determine the effectiveness of uterine embolization as primary therapy in the management of myomas. Uterine arterial embolization was performed in 3 patients with symptomatic leiomyomas. The uterus and fibroids were objectively evaluated with ultrasound and MRI. The efficacy and safety convinced the authors that this promising technique is at present the only reasonable alternative method in organ-conserving therapy. It is less invasive than surgery, it can restore fertility, it is well tolerated and the recovery time is shorter than that following surgical procedures. This preliminary experience is sufficient to encourage gynecologists to introduce the method in Hungary. PMID:11338571
Szabµ, E; Nagy, E; Morvay, Z; Palkµ, A; Csernay, L
Clinical approach for the classification of congenital uterine malformations.
A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field. PMID:22611348
Grimbizis, Grigoris F; Campo, Rudi
Biological roles of uterine glands in pregnancy.
All mammalian uteri contain glands in the endometrium that synthesize or transport and secrete substances essential for survival and development of the conceptus (embryo/fetus and associated extraembryonic membranes). This review summarizes information related to the biological roles of uterine glands and their secretions in blastocyst/conceptus survival and implantation, uterine receptivity, and stromal cell decidualization in humans and animal models. The infertility and recurrent pregnancy loss observed in the ovine uterine gland knockout (UGKO) model unequivocally supports a primary role for uterine glands and, by inference, their secretions present in uterine luminal fluid in survival and development of the conceptus. Further, studies with mutant and progesterone-induced UGKO mice found that uterine glands and their secretions are required for establishment of uterine receptivity and blastocyst implantation as well as stromal cell decidualization. Similarly in humans, uterine glands and their secretory products are likely critical regulators of blastocyst implantation, uterine receptivity, and conceptus growth and development during the first trimester. Circumstantial evidence suggests that deficient glandular activity may be a causative factor in pregnancy failure and complications in humans. Thus, an increased understanding of uterine gland biology is important for diagnosis, prevention, and treatment of fertility and pregnancy problems in mammals. PMID:24959816
Spencer, Thomas E
Arthroscopic Lavage and Debridement for Osteoarthritis of the Knee
Executive Summary Objective The purpose of this review was to determine the effectiveness and adverse effects of arthroscopic lavage and debridement, with or without lavage, in the treatment of symptoms of osteoarthritis (OA) of the knee, and to conduct an economic analysis if evidence for effectiveness can be established. Questions Asked Does arthroscopic lavage improve motor function and pain associated with OA of the knee? Does arthroscopic debridement improve motor function and pain associated with OA of the knee? If evidence for effectiveness can be established, what is the duration of effect? What are the adverse effects of these procedures? What are the economic considerations if evidence for effectiveness can be established? Clinical Need Osteoarthritis, the most common rheumatologic musculoskeletal disorder, affects about 10% of the Canadian adult population. Although the natural history of OA is not known, it is a degenerative condition that affects the bone cartilage in the joint. It can be diagnosed at earlier ages, particularly within the sports injuries population, though the prevalence of non-injury-related OA increases with increasing age and varies with gender, with women being twice as likely as men to be diagnosed with this condition. Thus, with an aging population, the impact of OA on the health care system is expected to be considerable. Treatments for OA of the knee include conservative or nonpharmacological therapy, like physiotherapy, weight management and exercise; and more generally, intra-articular injections, arthroscopic surgery and knee replacement surgery. Whereas knee replacement surgery is considered an end-of-line intervention, the less invasive surgical procedures of lavage or debridement may be recommended for earlier and more severe disease. Both arthroscopic lavage and debridement are generally indicated in patients with knee joint pain, with or without mechanical problems, that are refractory to medical therapy. The clinical utility of these procedures is unclear, hence, the assessment of their effectiveness in this review. Lavage and Debridement Arthroscopic lavage involves the visually guided introduction of saline solution into the knee joint and removal of fluid, with the intent of extracting any excess fluids and loose bodies that may be in the knee joint. Debridement, in comparison, may include the introduction of saline into the joint, in addition to the smoothening of bone surface without any further intervention (less invasive forms of debridement), or the addition of more invasive procedures such as abrasion, partial or full meniscectomy, synovectomy, or osteotomy (referred to as debridement in combination with meniscectomy or other procedures). The focus of this health technology assessment is on the effectiveness of lavage, and debridement (with or without meniscal tear resection). Review Strategy The Medical Advisory Secretariat followed its standard procedures and searched these electronic databases: Ovid MEDLINE, EMBASE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and The International Network of Agencies for Health Technology Assessment. The keywords searched were: arthroscopy, debridement, lavage, wound irrigation, or curettage; arthritis, rheumatoid, osteoarthritis; osteoarthritis, knee; knee or knee joint. Time frame: Only 2 previous health technology assessments were identified, one of which was an update of the other, and included 3 of 4 randomized controlled trials (RCTs) from the first report. Therefore, the search period for inclusion of studies in this assessment was January 1, 1995 to April 24, 2005. Excluded were: case reports, comments, editorials, and letters. Identified were 335 references, including previously published health technology assessments, and 5 articles located through a manual search of references from published articles and health technology assessments. These were examined against the criteria, as described below, which resulted in the in
Gut lavage IgG and interleukin 1 receptor antagonist:interleukin 1 beta ratio as markers of intestinal inflammation in children with inflammatory bowel disease.
BACKGROUND: Whole gut lavage is currently used as preparation before radiological or endoscopic examination of the large bowel. AIM: To validate the gut lavage technique for the assessment of mucosal inflammation, by measuring intestinal IgG and interleukin 1 beta (IL-1 beta) in the fluid obtained. PATIENTS: Sixteen children with Crohn's disease (CD), 14 with ulcerative colitis (UC), and 22 age matched controls. METHODS: Isotonic, non-absorbable polyethylene glycol based lavage solution was given orally or by nasogastric tube. Clear fluid was collected, filtered, and treated with protease inhibitors. IgG, IL-1 beta and IL-1-receptor antagonist (IL-1-ra) were measured by sandwich enzyme linked immunosorbent assay (ELISA). RESULTS: In patients with UC and CD, IgG and IL-1 beta levels were significantly (p < 0.001) higher than in controls. A positive correlation (p < 0.05) was found with disease activity scores. IL-1-ra levels were not significantly different in UC and CD, when compared with controls, but the IL-1-ra:IL-1 beta ratio was significantly (p < 0.01) lower in patients with UC and CD, and negatively (p < 0.001) correlated with IgG levels in lavage fluid. CONCLUSIONS: Gut lavage fluid IgG and IL-1 beta levels and IL-1-ra:IL-1 beta ratio may provide objective discrimination between active and inactive disease in children with inflammatory bowel disease.
Troncone, R; Caputo, N; Campanozzi, A; Cucciardi, M; Esposito, V; Russo, R; De Vizia, B; Greco, L; Cucchiara, S
Innovative Oral Treatments of Uterine Leiomyoma
Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail.
Sabry, Mohamed; Al-Hendy, Ayman
Uterine diseases in cattle after parturition
Bacterial contamination of the uterine lumen is common in cattle after parturition, often leading to infection and uterine disease. Clinical disease can be diagnosed and scored by examination of the vaginal mucus, which reflects the presence of pathogenic bacteria such as Escherichia coli and Arcanobacterium pyogenes. Viruses may also cause uterine disease and bovine herpesvirus 4 (BoHV-4) is tropic for endometrial cells, causing a rapid cytopathic effect. The elimination of pathogens by the innate immune system is dependent on pattern recognition receptors binding pathogen-associated molecules. Uterine epithelial and stromal cells express receptors such as Toll-like Receptor 4 that binds E. coli lipopolysaccharide. The infertility associated with uterine disease is caused by damage to the endometrium and disruption of ovarian cyclic activity. Bacteria modulate endometrial prostaglandin secretion, and perturb ovarian follicle growth and function. Understanding the molecular basis of uterine disease will lead to novel approaches to treating infertility.
Sheldon, I. Martin; Williams, Erin J.; Miller, Aleisha N.A.; Nash, Deborah M.; Herath, Shan
Innovative oral treatments of uterine leiomyoma.
Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail. PMID:22518167
Sabry, Mohamed; Al-Hendy, Ayman
Autofluorescent particles of human uterine muscle cells.
Smooth muscle tissue collected from the uterine fundus of 24 patients undergoing hysterectomy was examined for chromolipoid pigments by histochemical and electron microscopic techniques. Certain cytoplasmic particles were found, mainly in smooth muscle cells, which exhibited characteristic autofluorescence, sudanophilia, and acid phosphatase activity but did not correspond to any typical pigment described previously. These particles were present in all subjects and they tended to increase in number with age. Chemical tests on tissue lipid extracts failed to prove that vitamin A was responsible for the fluorescence. The ultrastructural appearance of the particles somewhat variable, but most particles were rounded and of low electron density, with a lucent central space and dense bodies, probably lysosomes, at the periphery. The whole complex was enclosed by a single trilaminar membrane. Images Figure 5 Figure 1 Figure 2 Figure 6 Figure 7 Figure 3 Figure 8 Figure 4
Gosden, R. G.; Hawkins, H. K.; Gosden, C. A.
Utility of gastric lavage in vigorous neonates delivered with meconium stained liquor: a randomized controlled trial.
Objective. To determine the incidence of feed intolerance in vigorous babies with meconium stained liquor (MSL) who received prophylactic gastric lavage as compared to those who were not subjected to this procedure. Design. Randomized controlled trial. Setting. Tertiary care teaching hospital. Participants/Intervention. 330 vigorous babies delivered with MSL and satisfying the predefined inclusion criteria were randomized either to receive gastric lavage (group A, n = 165) or to not receive gastric lavage (group B, n = 153). Clinical monitoring was subsequently performed and recorded in prestructured proforma. Results. There was no significant statistical difference (P > 0.05) in incidence of feed intolerance in "lavage" and "no lavage" groups. Secondary Outcome. There was no evidence of secondary respiratory distress in either group. None of the patients in the lavage group exhibited adverse effects owing to the procedure. Conclusions. There is no role of prophylactic gastric lavage in neonates born with MSL. PMID:24868210
Garg, Jatin; Masand, Rupesh; Tomar, Balvir Singh
Utility of Gastric Lavage in Vigorous Neonates Delivered with Meconium Stained Liquor: A Randomized Controlled Trial
Objective. To determine the incidence of feed intolerance in vigorous babies with meconium stained liquor (MSL) who received prophylactic gastric lavage as compared to those who were not subjected to this procedure. Design. Randomized controlled trial. Setting. Tertiary care teaching hospital. Participants/Intervention. 330 vigorous babies delivered with MSL and satisfying the predefined inclusion criteria were randomized either to receive gastric lavage (group A, n = 165) or to not receive gastric lavage (group B, n = 153). Clinical monitoring was subsequently performed and recorded in prestructured proforma. Results. There was no significant statistical difference (P > 0.05) in incidence of feed intolerance in lavage and no lavage groups. Secondary Outcome. There was no evidence of secondary respiratory distress in either group. None of the patients in the lavage group exhibited adverse effects owing to the procedure. Conclusions. There is no role of prophylactic gastric lavage in neonates born with MSL.
Tomar, Balvir Singh
Uterine artery embolization for adenomyosis without fibroids
AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids.MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250710 mm was performed in 43 patients (mean; 40.3 years, range; 3152 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids.
M. D Kim; J. W Won; D. Y Lee; C.-S Ahn
Application of 3D Ultrasonography in Detection of Uterine Abnormalities
Structural pathologies in the uterine cavity such as m■llerian duct anomalies (MDAs) and intrauterine lesions (fibroids, polyps, synechiae) may have important roles in subinfertility, implantation failure and pregnancy outcome. Various imaging modalities such as hysterosalpingography (HSG), sonography, laparoscopy and hysteroscopy are used in the evaluation of MDAs and intrauterine lesions. Recently, three-dimensional ultrasound (3DUS) has been introduced as a non-invasive, outpatient diagnostic modality. With increased spatial awareness, it is superior to other techniques used for the same purpose.
Ahmadi, Firoozeh; Zafarani, Fatemeh; Haghighi, Hadieh; Niknejadi, Maryam; Vosough Taqi Dizaj, Ahmad
[Chronic renal failure secondary to uterine prolapse].
Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs. PMID:15912657
Peces, R; Canora, J; Venegas, J L
Maternal Uterine Vascular Remodeling During Pregnancy
Sufficient uteroplacental blood flow is essential for normal pregnancy outcome and is accomplished by the coordinated growth and remodeling of the entire uterine circulation, as well as the creation of a new fetal vascular organ: the placenta. The process of remodeling involves a number of cellular processes, including hyperplasia and hypertrophy, rearrangement of existing elements, and changes in extracellular matrix. In this review, we provide information on uterine blood flow increases during pregnancy, the influence of placentation type on the distribution of uterine vascular resistance, consideration of the patterns, nature, and extent of maternal uterine vascular remodeling during pregnancy, and what is known about the underlying cellular mechanisms.
Osol, George; Mandala, Maurizio
Uterine leiomyosarcoma metastasizing to the heart.
Uterine leiomyosarcoma is an uncommon and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the heart are extremely rare, and only a few case reports have been published so far. Herein we present the case of 57 years old female, who had undergone total abdominal hysterectomy with salpingo-oophorectomy 10 years back for uterine leiomyosarcoma, she presented with dyspnea, dizziness, fever, and tachycardia, subsequently was found to have interventricular septum cardiac as well extensive system metastasis and recurrent pelvic mass. Patient's symptoms responded to palliative radiotherapy followed by chemotherapy. PMID:24717993
Tunio, Mutahir Ali; Al-Asiri, Mushabbab; Fareed, Muhammad Mohsin
Maternal Uterine Vascular Remodeling During Pregnancy
NSDL National Science Digital Library
Sufficient uteroplacental blood flow is essential for normal pregnancy outcome and is accomplished by the coordinated growth and remodeling of the entire uterine circulation, as well as the creation of a new fetal vascular organ: the placenta. The process of remodeling involves a number of cellular processes, including hyperplasia and hypertrophy, rearrangement of existing elements, and changes in extracellular matrix. In this review, we provide information on uterine blood flow increases during pregnancy, the influence of placentation type on the distribution of uterine vascular resistance, consideration of the patterns, nature, and extent of maternal uterine vascular remodeling during pregnancy, and what is known about the underlying cellular mechanisms.
Maurizio Mandala (University of Calabria)
Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.
The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation. PMID:23680518
Tower, Amanda M; Frishman, Gary N
Primary Anastomosis Without Colonic Lavage for the Obstructed Left Colon
INTRODUCTION Resection, on-table lavage (OTL) and primary anastomosis is the treatment of choice for the obstructed left colon. OTL is time-consuming, requires considerable mobilisation/bowel handling, an enterotomy and potentially exposes the patient to mesenteric vascular injury, faecal contamination and a prolonged ileus. We have assessed outcome following primary resection and anastomosis without prior lavage. PATIENTS AND METHODS Twenty-four consecutive, obstructed patients underwent splenic flexure mobilisation and high anterior resection (concomitant small bowel resection in 2) with primary side-to-side colorectal anastomosis without either prior lavage or covering stoma. Outcome was audited. RESULTS Twenty-four patients, 17 female aged 4892 years (median. 76 years) presented with left-sided obstruction due to carcinoma (Dukes' B [3], C [6], D [1]) or chronic diverticulitis (14). Median operative time was 85 min (range, 40105 min). Colonic ileus resolved on day 2 (29%) and day 3 (58%). Median hospital stay was 7 days (range, 672 days); 92% discharged by day 10. There were no deaths or re-admissions. A return to theatre followed a reactionary haemorrhage in one. This latter patient's anastomosis leaked on day 4 (no faecal contamination) and was converted to an end stoma. Urinary and wound infections were seen in two. Late complications comprised two anastomotic strictures; both responded to balloon dilatation at 5 months. CONCLUSIONS Resection and primary anastomosis without on-table lavage is an easy, practical, predictable and safe treatment option for left-sided colonic obstruction with minimal complications.
Cross, KLR; Rees, JR; Soulsby, RHR; Dixon, AR
Gallium-67 activity in bronchoalveolar lavage fluid in sarcoidosis
Roentgenograms and gallium-67 scans and gallium-67 counts of BAL fluid samples, together with differential cell counts, have proved to be useful in assessing activity and lung involvement in sarcoidosis. In active pulmonary sarcoidosis gallium-67 scans are usually positive. Quantitation of gallium-67 uptake in lung scans, however, may be difficult. Because gallium-67 uptake and cell counts in BAL fluid may be correlated, we set out to investigate gallium-67 activity in BAL fluid recovered from patient of different groups. Sixteen patients with recently diagnosed and untreated sarcoidosis, nine patients with healthy lungs, and five patients with CFA were studied. Gallium-67 uptake of the lung, gallium-67 activity in the lavage fluid, SACE and LACE levels, and alpha 1-AT activity were measured. Significantly more gallium-67 activity was found in BAL fluid from sarcoidosis patients than in that from CFA patients (alpha = .001) or patients with healthy lungs (alpha = .001). Gallium-67 activity in BAL fluid could be well correlated with the number of lymphocytes in BAL fluid, but poorly with the number of macrophages. Subjects with increased levels of SACE or serum alpha 1-AT showed higher lavage gallium-67 activity than did normals, but no correlation could be established. High gallium-67 activity in lavage fluid may be correlated with acute sarcoidosis or physiological deterioration; low activity denotes change for the better. The results show that gallium-67 counts in BAL fluid reflects the intensity of gallium-67 uptake and thus of activity of pulmonary sarcoidosis.
Trauth, H.A.; Heimes, K.; Schubotz, R.; von Wichert, P.
Serial lobar lung lavage in pulmonary alveolar proteinosis.
Pulmonary alveolar proteinosis (PAP) is a rare disease with worldwide distribution and an estimated incidence of 0.36 cases per million. We report a case of a PAP coexisting with Pneumocystis jiroveci pneumonia and Mycobacterium tuberculosis infection. The patient was treated with serial lobar lung lavages, GM-CSF, cotrimoxazole, and antituberculosis drugs. His PaO2 on room air improved from 45.7 to 63.8 torr and pulmonary functions normalized (FVC 81.2%, FEV1 95.3%, FEV1/FVC 91.8). A high-resolution computed tomography scan of the thorax showed clearing of both lower lobes. Whole-lung lavage is used in the treatment of PAP, but it may worsen the hypoxemia and lead to hemodynamic instability during the procedure. To the best of our knowledge, there are no reports of bronchoscopic serial lobar lung lavages in cases of PAP performed in India. This method can be performed in bronchoscopic suites having general anesthesia facilities without the requirement of special gadgets. PMID:24162118
Baldi, Milind M; Nair, Jairaj; Athavale, Amita; Gavali, Varun; Sarkar, Manjula; Divate, Smita; Shah, Unmil
Relaxin mediates uterine artery compliance during pregnancy and increases uterine blood flow
Normal pregnancy involves dramatic remodeling of the uterine vasculature, with abnormal vascular adaptations contributing to pregnancy diseases such as preeclampsia. The peptide hormone relaxin is important for the renal and systemic hemodynamic adaptations to pregnancy, and has been shown to increase arterial compliance and outward hypertrophic remodeling. Therefore, we investigated the possibility that relaxin acts on its receptor, RXFP1, to mediate uterine artery compliance in late pregnancy and increase uterine blood flow velocity in rats. RXFP1 was predominantly localized to the tunica media vascular smooth muscle cells in the uterine artery, although receptors were also detected in endothelial cells. Highest expression of Rxfp1 in the uterine artery occurred in estrus and early pregnancy. Isolated uterine arteries from late pregnant rats treated with a monoclonal antibody against circulating relaxin (MCA1) had significantly increased vessel wall stiffness compared with controls, with no reduction in wall thickness. Chronic infusion of relaxin (4 ?g/h, osmotic minipump) for 5 d in nonpregnant rats significantly increased uterine artery blood flow velocity. Overall, these data demonstrate a functional role for relaxin in mediating uterine artery compliance in pregnant rats, which may be necessary to maintain adequate uterine blood flow to the uterus and placenta.Vodstrcil, L. A., Tare, M., Novak, J., Dragomir, N., Ramirez, R. J., Wlodek, M. E., Conrad, K. P., Parry, L. J. Relaxin mediates uterine artery compliance during pregnancy and increases uterine blood flow.
Vodstrcil, Lenka A.; Tare, Marianne; Novak, Jacqueline; Dragomir, Nicoleta; Ramirez, Rolando J.; Wlodek, Mary E.; Conrad, Kirk P.; Parry, Laura J.
Ductal Lavage in Women from BRCA1/2 Families: Is There a Future for Ductal Lavage in Women at Increased Genetic Risk of Breast Cancer?
Purpose Ductal lavage has been used for risk stratification and biomarker development and to identify intermediate endpoints for risk-reducing intervention trials. Little is known about patient characteristics associated with obtaining nipple aspirate fluid (NAF) and adequate cell counts (?10 cells) in ductal lavage specimens from BRCA mutation carriers. Methods We evaluated patient characteristics associated with obtaining NAF and adequate cell counts in ductal lavage specimens from the largest cohort of women from BRCA families yet studied (BRCA1/2 = 146, mutation-negative = 23, untested = 2). Fishers exact test was used to evaluate categorical variables; Wilcoxon nonparametric test was used to evaluate continuous variables associated with NAF or ductal lavage cell count adequacy. Logistic regression was used to identify independent correlates of NAF and ductal lavage cell count adequacy. Results From 171 women, 45 (26%) women had NAF and 70 (41%) women had ductal lavage samples with ?10 cells. Postmenopausal women with intact ovaries compared with premenopausal women [odds ratio (OR), 4.8; P = 0.03] and women without a prior breast cancer history (OR, 5.2; P = 0.04) had an increased likelihood of yielding NAF. Having breast-fed (OR, 3.4; P = 0.001), the presence of NAF before ductal lavage (OR, 3.2; P = 0.003), and being premenopausal (OR, 3.0; P = 0.003) increased the likelihood of ductal lavage cell count adequacy. In known BRCA1/2 mutation carriers, only breast-feeding (OR, 2.5; P = 0.01) and the presence of NAF (OR, 3.0; P = 0.01) were independent correlates of ductal lavage cell count adequacy. Conclusions Ductal lavage is unlikely to be useful in breast cancer screening among BRCA1/2 mutation carriers because the procedure fails to yield adequate specimens sufficient for reliable cytologic diagnosis or to support translational research activities.
Loud, Jennifer T.; Thiebbaut, Anne C.M.; Abati, Andrea D.; Filie, Armando C.; Nichols, Kathryn; Danforth, David; Giusti, Ruthann; Prindiville, Sheila A.; Greene, Mark H.
A new look at abnormal uterine bleeding.
New universal terminology, classifications, and definitions recommended by the International Federation of Gynecology and Obstetrics and supported by the American College of Obstetricians and Gynecologists to describe abnormal uterine bleeding abnormalities in reproductive women are presented. Identification and management of anovulatory and ovulatory uterine bleeding are explored. PMID:24177024
Twiss, Janice J
Operative and Conservative Treatment of Uterine Sarcomas
Uterine sarcomas are rare, aggressive mesenchymal tumours with a relatively poor prognosis. The term comprises various histological subtypes, such as leiomyosarcoma, endometrial stromal sarcomas as well as undifferentiated uterine sarcomas, which require different operative and systemic/radiation therapy strategies accordingly. The evidence on operative, adjuvant and palliative treatment currently available is presented here.
Harter, P.; El-Khalfaoui, K.; Heitz, F.; du Bois, A.
Current concepts in uterine fibroid embolization.
Uterine fibroid embolization (UFE) has become established as an accepted minimally invasive treatment for uterine fibroids and should be considered a treatment option for patients with symptomatic uterine fibroids. It is important for diagnostic radiologists to understand the procedure, since imaging is a key component in the evaluation and care of these patients. Both the interventional radiologist and the gynecologist must fully evaluate a patient before recommending UFE as a treatment for symptomatic fibroids. However, relatively few absolute contraindications exist (pregnancy, known or suspected gynecologic malignancy, and current uterine or adnexal infection). A thorough evaluation includes a medical history, menstrual history, physical examination, and discussion of fertility goals. In almost all cases, bilateral uterine artery catheterization and embolization are needed, since most uterine fibroids, whether single or multiple, receive blood supply from both uterine arteries. After UFE, patients can reasonably expect resolution of symptoms such as menorrhagia, pelvic pressure, and pelvic pain. Although infrequent, major adverse events can occur and include ovarian failure or amenorrhea, fibroid expulsion, and rarely venous thromboembolism. Hysterectomy remains the definitive and most common treatment for uterine fibroids, but less-invasive approaches such as UFE are becoming of greater interest to both patients and physicians. PMID:23065167
Bulman, Julie C; Ascher, Susan M; Spies, James B
Lymphatic Vessel Dynamics in the Uterine Wall
During pregnancy, maternal uterine blood vessels undergo dramatic vascular remodeling. However, until now, little was known about whether the lymphatic circulation experiences similar changes and whether these vessels interact with placental cells that invade maternal tissue. Recent studies demonstrate that lymphatic vessels in the uterine wall are highly compartmentalized where their presence is mostly restricted to the deeper layers. In
K. Red-Horse
Acute Renal Failure after Uterine Artery Embolization
Renal failure is a potential complication of any endovascular procedure using iodinated contrast, including uterine artery embolization (UAE). In this report we present a case of acute renal failure (ARF) following UAE performed as a treatment for uterine fibroids. The likely causes of ARF in this patient are explored and the possible etiologies of renal failure in patients undergoing UAE are reviewed.
Rastogi, Sachin [University of Pennsylvania Medical Center, Department of Radiology, Division of Interventional Radiology (United States); Wu, Yu-Hsin [University of Pennsylvania Medical Center, Department of Obstetrics and Gynecology (United States); Shlansky-Goldberg, Richard D.; Stavropoulos, S. William [University of Pennsylvania Medical Center, Department of Radiology, Division of Interventional Radiology (United States)], E-mail: email@example.com
Polyarteritis nodosa with uterine involvement.
Polyarteritis nodosa (PAN) is characterized by multisystem necrotizing vasculitis, primarily affecting small-to-medium-sized muscular arteries, and it is typically found in middle-aged men. PAN is rarely found in the female genital tract (including the uterus), and imaging of the uterus with PAN has not previously been reported. Reported is a case of a 78-year-old patient with uterus enlargement who was diagnosed with PAN through clinical findings and images. Computed tomography and magnetic resonance imaging findings of a uterus affected by PAN are presented and reviewed, and potential characteristic findings of the uterine with PAN are discussed. PMID:23986829
Hirai, Chihiro; Koike, Shigeomi; Hirano, Motoharu; Nishimura, Junichi; Akashita, Shiho; Ohkoshi, Takahumi; Katsumata, Yasushi
Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas
Laparoscopic bipolar coagulation of uterine vessels was performed in three women with symptomatic myomas who required conventional surgical treatment. Uterine size and dominant myoma size were assessed by ultrasonography before and after surgery. Both uterine arteries, as well as anastomosis zone of uterine arteries with ovarian arteries, were occluded in all three women. Surgery was uneventful, and patients were hospitalized
Wei-Min Liu
Bronchoalveolar lavage and technetium-99m glucoheptonate imaging in chronic eosinophilic pneumonia
A patient with chronic eosinophilic pneumonia was evaluated using bronchoalveolar lavage, technetium-99m glucoheptonate, and transbronchial lung biopsy. Bronchoalveolar lavage revealed 43 percent eosinophils and correlated well with results of transbronchial lung biopsy. Technetium-99m glucoheptonate lung imaging demonstrated intense parenchymal uptake. After eight weeks of corticosteroid therapy, the bronchoalveolar lavage eosinophil population and the technetium-99m glucoheptonate uptake had returned to normal. We suggest that bronchoalveolar lavage, with transbronchial lung biopsy, is a less invasive way than open lung biopsy to diagnose chronic eosinophilic pneumonia. The mechanism of uptake of technetium-99m glucoheptonate in this disorder remains to be defined.
Lieske, T.R.; Sunderrajan, E.V.; Passamonte, P.M.
Uterine Artery Embolization to Treat Uterine Adenomyosis with or without Uterine Leiomyomata: Results of Symptom Control and Health-Related Quality of Life 40 Months after Treatment
Purpose To evaluate the clinical outcome for uterine adenomyosis with or without uterine leiomyomata 40 months after uterine artery\\u000a embolization (UAE).\\u000a \\u000a \\u000a \\u000a \\u000a Methods Forty women aged 3956 years (median 46 years) with symptomatic uterine adenomyosis and magnetic resonance imaging findings\\u000a of uterine adenomyosis with or without combined uterine leiomyomata underwent UAE. Self-perceived changes in clinical symptoms\\u000a were assessed, and residual symptom severity and health-related quality of
V. Froeling; C. Scheurig-Muenkler; B. Hamm; T. J. Kroencke
Uterine contractility in intrahepatic cholestasis of pregnancy.
This study aims to compare uterine activity in intrahepatic cholestasis of pregnancy (ICP) patients vs normal pregnancies, and to determine the relevance of ICP and excessive uterine activity. A total of 59 patients with ICP and 89 with normal pregnancies were selected. Liver function, total bile acids and uterine activity were evaluated; uterine contraction parameters were compared at the specified range of gestational age. Uterine contraction frequency was significantly higher in the third trimester patients with ICP. Aspartate transaminase (AST) appeared to correlate with contraction frequency (r = 0.357, p = 0.006) and Montevideo units (MVUs) (r = 0.349, p = 0.007). For each 50 U/l increase in AST, the hazard ratio of excessive uterine activity was increased by 1.31-fold (95% CI = 1.034-1.663, p = 0.025). The present study demonstrates that third trimester uterine contractility increases in patients with ICP. These findings should be of note, given what is known about obstetric cholestasis, and should prompt further research. PMID:24484433
Zhao, P; Zhang, K; Yao, Q; Yang, X
[Diagnostic possibilities of the flexible hysteroscopy in irregular uterine bleeding].
The aim of the present study was to evaluate the possibilities of diagnostic flexible hysteroscopy for women with irregular uterine bleeding. The study was based on 569 women aged between 26 and 72 years (mean age 46.78 years) with weak to moderate irregular uterine bleeding who had given agreement for invasive investigations. To all patients initially was performed diagnostic hysteroscopy with the help of a panoramic fibrohysteroscope Pentax LH-150 II (with 5 mm diameter), followed by classical endometrial curettage. The performed hysteroscopies found phase or other normal endometrium at 208 women (36.56%), hyperplasia and poliposis at 258 (45.34%), changes, suspected for atypia and neoplasia at 77 (13.53%) and other different findings at 26 women (4.57%). The following curettage showed the lack of adequate material from uterine cavity at 24 women (4.2%). From the rest patients, at 466 (81.9%) the morphological findings were due to the dysfunctional reasons, other 51 (8.9%) were with different precancer and cancer lesions and at 28 cases, clinically and morphologically was found that the bleeding was due to the presence of sub mucous nodules, intrauterine devices, residua and pathology of the chorion. The comparison of the hysteroscopy results with the clinical and histological findings from the curettage of 454 women, showed good diagnostic possibilities (sensitivity of 78.4% and specificity of 92.5%) of the flexible hysteroscopy for evaluation of women with irregular uterine bleeding. This examination is relatively simple and save endoscopic technique, which require simultaneously performance of a direct biopsy, in order to improve its diagnostic accuracy. PMID:16637317
Zlatkov, V; B?rzakov, G; Cholakova, A; Miloshov, V; Radeva, V; Velinov, E; Mikhova, A
Neonatal uterine prolapse - a case report.
Uterine prolapse is commonly seen in the geriatric age group. Congenital vaginouterine prolapse is a rare condition occurring in neonates and is usually associated with spinal cord malformations in about 85% of cases. Several modalities of treatment have been described for neonatal uterine prolapse. Conservative treatment in the form of simple digital reposition, use of pessary or other self-retaining device is usually sufficient to treat this condition, which is self-limiting and regressive. Here we report our first case of neonatal uterine prolapse, managed successfully with simple digital reposition. PMID:24858176
Saha, D K; Hasan, K M; Rahman, S M; Majumder, S K; Zahid, M K; Chakraborty, A K; Bari, M S
Unilateral radiation pneumonitis in sheep: Physiological changes and bronchoalveolar lavage
Radiation pneumonitis is a life-threatening result of therapeutic thoracic irradiation, yet its mechanisms are poorly understood. We studied the effects of unilateral lung irradiation (3,000 rad) in sheep from the immediate response to the later development of radiation pneumonitis. We defined radiation pneumonitis by its diagnostic clinical feature, radiographic infiltration of the irradiated zone with a straight margin corresponding to the radiation port. The immediate response in the few hours after irradiation was characterized by cough, labored respiration, hypoxemia (arterial PO{sub 2} decreased 19 Torr), mild pulmonary hypertension (pulmonary arterial pressure increased 20%), and lymphopenia. Hemodynamics and gas exchange returned to normal by day 2 but became abnormal again before or during radiation pneumonitis at 32 +/- 2 days. Respiratory distress, hypoxemia, and pulmonary hypertension recurred during radiation pneumonitis. Bronchoalveolar lavage during radiation pneumonitis contained increased neutrophils (19 +/- 4%, control = 7%), increased protein (0.27 +/- 0.1 g/dl, control = 0.12 +/- 0.03), and severely impaired ability to lower surface tension. Alveolar macrophages from both lungs during unilateral radiation pneumonitis exhibited impaired generation of superoxide after phorbol myristate (only a 30% increase). Normal control alveolar macrophages increased superoxide production after stimulation greater than 400%. We conclude that unilateral lung irradiation in sheep causes a mild immediate response followed by radiation pneumonitis at 1 mo. Unilateral radiation pneumonitis in this model is associated with ipsilateral neutrophilic alveolitis, increased bronchoalveolar lavage protein, and impaired surfactant function, as well as bilateral functional abnormalities of alveolar macrophages.
Tillman, B.F.; Loyd, J.E.; Malcolm, A.W.; Holm, B.A.; Brigham, K.L. (Vanderbilt Univ. School of Medicine, Nashville, TN (USA))
[Bronchoalveolar lavage in pneumoconiosis of coal miners. Biochemical aspects].
Broncho-alveolar lavage (LBA) was performed in 17 pneumoconiotics. The liquid obtained was analysed after gentle centrifugation to remove the cellular element, so that biochemical factors might be sought contribution to the evolution and progressive transformation to fibrosis. The percentage of liquid gathered was generally greater. Among the glycosidases found in all the 17 LBA analysed, the beta-D-glucuronidase, which was not detected in the LBA control subjects, was also found during the course of other pulmonary disorders. The elastolytic activity was characterized in 12 out of 17 LBA. In part it could originate from alveolar macrophages. An elevated number of macrophages (greater than 20 X 10(6) for the whole lavage) allied to the presence of elastolytic activity was found in 7 of 8 patients presenting with a pneumoconiosis and signs of progressive pulmonary disease. The collagenase and cathepsin B were present in the LBA of certain pneumoconiotics, but the significance of their presence is still unknown. The three major antiproteases of the serum exist in the LBA of pneumoconiosis. The quantity of alpha 1-antiprotease has identified a group of 6 patients whose LBA showed raised alpha 1-antiprotease, an elastolytic activity and for 5 of them progressive outcome. PMID:6308731
Hayem, A; Scharfman, A; Laine, A; Lafitte, J J; Degand, P
[Intraoperative anterograde lavage of the occluded left colon].
The management of patients presenting with acute organic obstruction of the left colon remains controversial. The traditional three stages procedure (transverse colostomy, resection and anastomosis, closure of colostomy) leads to a long and expensive postoperative hospital stay and to additional risks due to the multiple surgical treatments, despite involving a minor operation at the first stage. In selected patients, requiring emergency colonic resection, intraoperative antegrade colon lavage with primary anastomosis, as described by Dudley in 1983, represents a safe alternative to the stage procedure, achieving an excellent mechanical bowel toilette that allows a safe anastomosis and avoids the disadvantages associated with the multiple stages operations. During a 5 years period 13 large bowel resections with antegrade colonic irrigation and primary anastomosis were performed for acute left sided colonic obstruction requiring emergency surgery. The postoperative mortality rate was 0%; anastomosis leakage rate was 7.6% and would infections occurred in 7.6% of patients. The mean hospital stay was 15 days. Our results confirm that selected patients can be safely submitted to emergency colonic resection, on table lavage and primary anastomosis for acute left colonic obstruction without preoperative bowel preparation. PMID:8929031
Fabiani, P; Maghetti, F
Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and marrow content?
The use of unprocessed bone carries a risk of transmission of blood borne diseases. Although models of infectivity are unproven, a theoretical risk of transmission of variant Creutzfeld-Jakob Disease, a human prion disease, exists as probable blood borne transmission has been reported in three cases. The aim of our study was to determine the effectiveness of standard operating theatre pulse lavage in removing protein, fat and double stranded Deoxyribonucleic acid (dsDNA) from morcellised bone allograft. Twelve donated femoral heads were divided into halves and milled into bone chips. One half of the bone chips were washed with pulse lavage, whereas, the other half acted as control. In order to determine the amount of protein, fat and dsDNA present in the washed and unwashed samples, a validated multistep washing protocol was used. Using the validated technique, simple intra-operative washing of morcellised unprocessed bone allograft removed a significant amount of the protein (70.5%, range: 39.5-85%), fat (95.2%, range: 87.8-98.8%) and DNA (68.4%, range: 31.4-93.1%) content. Intra-operative washing of morcellised bone allograft with pulse lavage may thereby reduce the theoretical risk of prion and other blood borne disease transmission. Combined with the known improved mechanical characteristics of washed allograft, we would recommend pulse lavage as a routine part of bone allograft preparation. PMID:21336569
Ibrahim, T; Qureshi, A; McQuillan, T A; Thomson, J; Galea, G; Power, R A
CT-monitored percutaneous cryoablation of uterine fibroids after uterine artery embolization
Objective To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic (CT) guidance after\\u000a uterine artery embolization.\\u000a \\u000a \\u000a \\u000a Methods Twelve patients who failed to respond to uterine artery embolization were treated using percutaneous cryoablation. All patients\\u000a had undergone previous uterine artery embolization an average of 1.2 years (0.71.6 years) ago. Two cases had abnormal bleeding,\\u000a and the other 10 suffered
Zizhuo Zhao; Zhi Guo; Hong Ni; Fang Liu; Baoguo Li
Treatment of Uterine Artery Vasospasm with Transdermal Nitroglycerin Ointment During Uterine Artery Embolization
Uterine artery vasospasm can complicate uterine artery embolization (UAE) by prolonging procedure times or even causing treatment failure. Embolization must be delayed until the spasm improves and adequate antegrade flow in the vessel is restored. Vasospasm can also produce a 'false endpoint' to the procedure, where stasis of flow in the vessel is falsely attributed to successful embolization but is actually the result of vasospasm, leading to undertreatment or treatment failure. Traditional treatments for uterine artery vasospasm have included transcatheter intra-arterial vasodilators and catheter withdrawal from the vessel, both of which can yield mixed results. We report a case of uterine artery vasospasm during UAE successfully treated with transdermal nitroglycerine ointment.
Denison, Gregory L., E-mail: firstname.lastname@example.com; Ha, Thuong Van; Keblinskas, Darius [The University of Chicago Hospitals, Department of Radiology, Section of Interventional Radiology (United States)
Uterine artery embolisation: an alternative to surgery?
According to comparative evaluation in about 900 patients, uterine artery embolisation may expose patients to a lower risk of serious complications than surgery. But it reduces fertility. PMID:24926521
Metastatic calcaneal lesion associated with uterine carcinosarcoma.
Metastatic lesions of uterine carcinosarcoma most commonly occur in the abdomen and lungs and less frequently in highly vascularized bone. We report a rare case of an 86-year-old female with uterine carcinosarcoma with metastasis to the left calcaneus. The patient had a history of uterine carcinosarcoma with hysterectomy and bilateral salpingo-oophorectomy, along with bilateral pelvic and aortic lymphadenectomy, with no adjuvant therapy. The initial pedal complaint was that of left foot pain. The initial radiographic findings were negative; however, magnetic resonance imaging scans revealed a substantial area of marrow edema in the calcaneus. An excisional biopsy was performed, and histopathologic analysis revealed adenocarcinoma with features consistent with the patient's previous uterine tumor specimen. The patient was given one treatment of chemotherapy and was discharged to a hospice, where she died of her disease 2 weeks later. PMID:23871174
Rice, Brittany M; Todd, Nicholas W; Jensen, Richard; Rush, Shannon M; Rogers, William
Efficacy of gut lavage, hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication
Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.
S. Okonek; A. Hofmann; B. Henningsen
Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury
Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. The pathophysiology of ARDS includes abnormalities of surfactant function as well as pulmonary inflammation. Immunomodulating drugs, like Lidocaine, have shown some success in decreasing inflammation in ARDS. We attempted to combine surfactant lavages ability to reverse the surfactant dysfunction, while acting as a vehicle to deliver Lidocaine. Gravity-driven
T. K. Huang; C. F. T. Uyehara; V. Balaraman; C. Y. Miyasato; D. Person; E. Egan; D. Easa
Electron Microscopic Study of the Effect of Water Jet Lavage Devices on Dental Plaque
The maxillary posterior teeth of nine rhesus monkeys were treated with a pulsating water lavage instrument at 70 psi (high setting). Electron microscopic studies of pre- and post-lavage plaque samples showed that water jet devices as used in this experiment either removed the plaque completely or caused irreversible damage to the microbial forms in the plaque matrix.
John M. Brady; Walter A. Gray; Surindar N. Bhaskar
Collagenase and fibronectin in bronchoalveolar lavage fluid in patients with sarcoidosis
Bronchoalveolar lavage fluid from 43 patients with biopsy proved sarcoidosis and 10 control subjects were assayed for fibronectin and collagenase activity. Fibronectin was significantly increased in the group with sarcoidosis and was found to be positively correlated with angiotensin converting enzyme activity, protein concentration, percentage of T cells and helper:suppressor ratios in the lavage fluid. Increased fibronectin in the bronchoalveolar
C OConnor; C Odlum; A Van Breda; C Power; M X Fitzgerald
Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation
There has been considerable disagreement about the prognostic value of bronchoalveolar lavage lymphocyte measurements in patients with sarcoidosis. This study looks at the influence of the type of disease presentation and the time since onset of symptoms on lavage fluid lymphocyte profiles in 99 patients studied at the time of their initial diagnosis. Patients who had an acute inflammatory onset
K Ward; C OConnor; C Odlum; M X Fitzgerald
Prognostic Significance of Tumor Markers in Peritoneal Lavage in Advanced Gastric Cancer
Objective: Predicting peritoneal dissemination of cancer is very difficult whatever method of examination is used. Recently, a cytological examination of peritoneal lavage has been shown to be a feasible measure to predict an early state of peritoneal seeding. The predictive value of the levels of tumor markers in peritoneal lavage for peritoneal metastasis from gastric carcinoma was thus studied. Methods:
Manabu Yamamoto; Hideo Baba; Yoshihiro Kakeji; Kazuya Endo; Yasuharu Ikeda; Yasushi Toh; Shunji Kohnoe; Takeshi Okamura; Yoshihiko Maehara
Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopytiming is the key!
PURPOSE: Polyethylene glycol gut lavage is an effective bowel preparation for colonoscopy. The quality of the preparation is not uniform however, and most studies report a rate of suboptimal cleansing of 10 percent or more. One of the possible reasons for a poor preparation is the length of time between the lavage and the examination. The aim of this study
James M. Church
Hysteroscopic Transcervical Resection of Uterine Septum
Objective: To explore the method of diagnosis for uterine septum and the clinical effect of hysteroscopic transcervical resection of the septum. Methods: One-hundred ninety cases of patients with uterine septum who were diagnosed and treated at our hospital during 20072011 were selected, and their general information, perioperative status, postoperative recovery treatment, and postoperative pregnancy rates were statistically analyzed. Results: All 190 patients were cured with one surgery, with an average hysteroscopic operating time of 22.60 Ý 10.67 minutes and intraoperative blood loss of 15.74 Ý 9.64 mL. There were no complications such as uterine perforation, water intoxication, infection, or heavy bleeding. Among the 115 patients that we followed up, 86 became pregnant and delivered infants, 81 of which were born at term and 5 that were born premature. Conclusion: The combination of hysteroscopy and laparoscopy is still the most reliable method for the diagnosis of uterine septum. With a shorter operative time, less blood loss, a significantly increased postoperative pregnancy rate and live birth rate, and a significantly lower spontaneous abortion rate, transcervical resection of the septum was the preferred method for the treatment of uterine septum, and surgical instruments and skills were critical to the prognosis of uterine septum.
Shi, Xiaoyan; Hua, Xiangdong; Gu, Xiaoyan; Yang, Dazhen
Interstitial laser photocoagulation of uterine leimyoma
NASA Astrophysics Data System (ADS)
Uterine leiomyomas (fibroids) are common benign tumors which may cause heavy or painful periods, may present as a pelvic mass and are associated with infertility. Local excision of symptomatic lesions can be difficult and hazardous, and the alternative is hysterectomy. We are investigating interstitial laser photocoagulation (ILP) as a less invasive alternative. Initial experiments were undertaken on 40 fibroids after surgical removal. One or two bare tipped, precharred fibers from a 25 W semiconductor laser (805 nm) were inserted into the center of the fibroid and treatment delivered with 2 - 10 W for 100 - 1000 sec. Specimens were subsequently sectioned perpendicular to the fiber track. Fibroids are very pale and apart from occasional charred tracts there was little evidence of thermal coagulation macroscopically or after haematoxylon and eosin staining. However, using a diaphorase stain technique we were able to demonstrate ellipsoid zones of devitalized tissue up to 20 mm across (15 mm for single fibers). These results suggest that ILP is producing gentle, uniform coagulation which could lead to resorption of treated areas. With appropriate numbers of treatment sites, this could permit minimally invasive management of clinically significant lesions. Clinical studies have commenced treating fibroids with ILP at the time of surgical excision by myomectomy or hysterectomy.
Gordon, Alastair D.; Buonaccorsi, Giovanni A.; Patel, Bipin L.; Broadbent, Jeff J.; Thurrell, Wendy; Bown, Stephen G.
Therapeutic management of uterine fibroid tumors: updated French guidelines.
The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids. When pregnancy is desired, whether or not infertility is being treated by assisted reproductive technology, hysteroscopic resection in one or two separate procedures of submucosal fibroids less than 4 cm in length is recommended, regardless of whether they are symptomatic. Interstitial, also known as intramural, fibroids have a negative effect on fertility but treating them does not improve fertility. Myomectomy is therefore indicated only for symptomatic fibroids; depending on their size and number, and may be performed by laparoscopy or laparotomy. Physicians must explain to women the potential consequences of myomas and myomectomy on future pregnancy. For perimenopausal women who have been informed of the alternatives and the risks, hysterectomy is the most effective treatment for symptomatic fibroids and is associated with a high rate of patient satisfaction. When possible, the vaginal or laparoscopic routes should be preferred to laparotomy for hysterectomies for fibroids considered typical on imaging. Because uterine artery embolization is an effective treatment with low long-term morbidity, it is an option for symptomatic fibroids in women who do not want to become pregnant, and a validated alternative to myomectomy and hysterectomy that must be offered to patients. Myolysis is under assessment, and research on its use is recommended. Isolated laparoscopic ligation of the uterine arteries is a potential alternative to uterine artery embolization; it also complements myomectomy by reducing intraoperative bleeding. It is possible to use second-generation techniques of endometrial ablation to treat submucosal fibroids in women whose families are complete. Subtotal hysterectomy is a possible alternative to total hysterectomy for fibroid treatment, given that by laparotomy the former has a lower complication rate than the latter, while by laparoscopy, these rates are the same. In each case, the patient is informed about the benefit and risk associated with each therapeutic option. PMID:22939241
Marret, Henri; Fritel, Xavier; Ouldamer, Lobna; Bendifallah, Sofiane; Brun, Jean-Luc; De Jesus, Isabelle; Derrien, Jean; Giraudet, GÕraldine; Kahn, Vanessa; Koskas, Martin; Legendre, Guillaume; Lucot, Jean Philippe; Niro, Julien; Panel, Pierre; Pelage, Jean-Pierre; Fernandez, HervÕ
Enrichment and characterization of dendritic cells from human bronchoalveolar lavages.
In the present study about 0.3% to 1.6% of human bronchoalveolar lavage (BAL) cells were identified as typical dendritic cells (DC), having an irregular outline, lobulated nucleus, and clear distinguishable acid phosphatase activity or EBM11 (anti-CD68) reactivity in a spot near the nucleus. After DC enrichment, using transient adherence to plastic, FcR-panning, and a density metrizamide gradient, a population containing 7-8% typical DC was obtained. This DC-enriched low density fraction, containing the highest percentages of DC, very strongly induced T cell proliferation in an allogeneic mixed leucocyte reaction (MLR), which was significantly higher than that induced by other partly (un)fractionated BAL cells. These data indicate that DC seem to be the major accessory cells in the BAL fluid, and therefore may be important in the regulation of T cell immune responses in the lung.
Havenith, C E; van Haarst, J M; Breedijk, A J; Betjes, M G; Hoogsteden, H C; Beelen, R H; Hoefsmit, E C
Angiotensin receptor subtypes in the uterine artery during ovine pregnancy
This study was undertaken to determine if changes in receptor density or affinity could account for the reduced vascular sensitivity to angiotensin II seen during pregnancy. Angiotensin receptor subtypes in the uterine arteries of non-pregnant, pregnant and postpartum ewes were investigated using saturation and competition receptor binding techniques with the specific receptor antagonists, losartan (DuP-753) and PD-123319 (S)1-[[4-(dimethylamino)-3-methylphenyl]-methyl]-5-(diphenylacetyl)-4,5,6,7-tetrahydro-1H-imidazo(4,5-c)pyridine-6-carboxylic acid, ditrifluoroacetate,
Judith H Burrell; Eugenie R Lumbers
Pregnancy Following Uterine Artery Embolization with Polyvinyl Alcohol Particles for Patients with Uterine Fibroid or Adenomyosis
Purpose: To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy. Methods: Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 2040 years. The data were collected through review
Man Deuk Kim; Nahk Keun Kim; Hee Jin Kim; Mee Hwa Lee
Comparison of reduced volume versus four liters sulfate-free electrolyte lavage solutions for colonoscopy colon cleansing
ObjectiveIn an attempt to improve patient tolerance for colonoscopy cleansing, a reduced volume lavage regimen with 2 L sulfate-free electrolyte lavage solution (SF-ELS, NuLYTELY, Braintree Laboratories, Braintree, MA) plus 20 mg p.o. bisacodyl (Half Lytely, Braintree Laboratories) was compared with standard 4 L SF-ELS lavage for safety and efficacy.
Jack A. DiPalma; Bruce G. Wolff; Alan Meagher; Mark v B. Cleveland
Molecular Cytogenetic Analysis of Uterine Leiomyoma and Leiomyosarcoma by Comparative Genomic Hybridization
Uterine leiomyomata are among the most common of human neoplasms and are associated with abnormal uterine bleeding, infertility, and abdominal pain. Uterine leiomyosarcomata are presumed to be the malignant counterpart to uterine leiomyomata and are very rare. Transformation of uterine leiomyoma (ULM) into uterine leiomyosarcoma (ULMS) is yet to be conclusively confirmed, and each type of tumor may represent a
Brynn Levy; Tanmoy Mukherjee; Kurt Hirschhorn
Comparison of outcome of pregnancy after intra-uterine insemination (IUI) and IVF
INTRODUCTION: Pregnancy outcome after IVF has been shown to be worse than after spontaneous conception. There is discussion as to whether this results from the technique itself or the patient characteristics. This study compares pregnancy outcome after IVF and intra-uterine inemination (IUI) in a matched patient group. METHODS: Data were obtained from our IVF and IUI databases (1997- 2001). Matching
Petra De Sutter; Liv Veldeman; Pascale Kok; Nathalie Szymczak; Josiane Van der Elst; Marc Dhont
Colloidal iron hydroxide staining of surface carbohydrates after glycerol treatment of uterine epithelial cells
The structural relationships between intramembranous particles (IMPs) and surface carbohydrates has been studied in uterine epithelial cells with a colloidal iron hydroxide (CIH) technique. To aggregate IMPs, glycerol treatment of unfixed cells was used and this treatment also caused some patching of CIH deposits on the cell surface. We conclude that some of the CIH receptors may be the surface
C. R. Murphy; S. Bradbury
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids
Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Abdullah, BJJ; Subramaniam, RV; Omar, SS; Wragg, P; Ramli, N; Wui, AL; Lee, CC; Yusof, Y
Nanomedicine for Uterine Leiomyoma Therapy
Aims The purpose of this work was to engineer polymeric nanoparticles to encapsulate and deliver 2-methoxyestradiol, a potential antitumor drug for treatment of uterine leiomyoma (fibroids), the most common hormone-dependent pathology affecting women of reproductive age. Materials & Methods Encapsulation efficiency and drug release from the nanoparticles were monitored by HPLC. Cell morphology and in vitro cytotoxicity experiments were carried out in a human leiomyoma cell line (huLM). Results The nanoparticles displayed high encapsulation efficiency (>86%), which was verified by differential scanning calorimetry and X-ray diffraction. Excellent long-term stability of the nanoparticles and gradual drug release without burst were also observed. Cellular uptake of fluorescent nanoparticles was confirmed by confocal imaging. The drug-loaded poly(lactic acid) and poly(lactic-co-glycolic acid) nanoparticles induced cytotoxicity in huLM cells to a significantly greater extent than the free drug at 0.35 ?M. Conclusion This novel approach represents a potential fertility-preserving alternative to hysterectomy.
Ali, Hazem; Kilic, Gokhan; Vincent, Kathleen; Motamedi, Massoud; Rytting, Erik
What Are the Key Statistics about Uterine Sarcoma?
... factors for uterine sarcoma? What are the key statistics about uterine sarcoma? The American Cancer Society's estimates ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...
21 CFR 884.2730 - Home uterine activity monitor.
Code of Federal Regulations, 2010 CFR
...2009-04-01 2009-04-01 false Home uterine activity monitor...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL...and Gynecological Monitoring Devices ôÏ 884.2730 Home uterine activity monitor....
21 CFR 884.2730 - Home uterine activity monitor.
Code of Federal Regulations, 2010 CFR
...2010-04-01 2010-04-01 false Home uterine activity monitor...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL...and Gynecological Monitoring Devices ôÏ 884.2730 Home uterine activity monitor....
Cohort Study of Uterine Contractions in Black Women.
National Technical Information Service (NTIS)
The prospective cohort study examined uterine activity in 89 black inner city women without major medical risks for preterm labor. The objective of the study was to describe the participants' uterine activity during the second and third trimesters of preg...
D. Main J. A. Grisso
What's New in Uterine Sarcoma Research and Treatment?
... Next Topic Additional resources for uterine sarcoma What`s new in uterine sarcoma research and treatment? Molecular pathology ... the chromosomes leads to the formation of a new gene, called JAZF1/JJAZ. This gene may help ...
Uterine biology in pigs and sheep
There is a dialogue between the developing conceptus (embryo-fetus and associated placental membranes) and maternal uterus which must be established during the peri-implantation period for pregnancy recognition signaling, implantation, regulation of gene expression by uterine epithelial and stromal cells, placentation and exchange of nutrients and gases. The uterus provide a microenvironment in which molecules secreted by uterine epithelia or transported into the uterine lumen represent histotroph required for growth and development of the conceptus and receptivity of the uterus to implantation. Pregnancy recognition signaling mechanisms sustain the functional lifespan of the corpora lutea (CL) which produce progesterone, the hormone of pregnancy essential for uterine functions that support implantation and placentation required for a successful outcome of pregnancy. It is within the peri-implantation period that most embryonic deaths occur due to deficiencies attributed to uterine functions or failure of the conceptus to develop appropriately, signal pregnancy recognition and/or undergo implantation and placentation. With proper placentation, the fetal fluids and fetal membranes each have unique functions to ensure hematotrophic and histotrophic nutrition in support of growth and development of the fetus. The endocrine status of the pregnant female and her nutritional status are critical for successful establishment and maintenance of pregnancy. This review addresses the complexity of key mechanisms that are characteristic of successful reproduction in sheep and pigs and gaps in knowledge that must be the subject of research in order to enhance fertility and reproductive health of livestock species.
Recent time trends in uterine cancer.
Recent trends in corpus uterine cancer incidence rates were explored using 1979-86 data from the Surveillance and End Results Program (SEER); recent trends in hospitalizations for corpus uterine cancer were explored using 1979-86 data from National Hospital Discharge Surveys (NHDS); and recent trends in exogenous hormone use were delineated using data from the 1980, 1981, and 1985 National Ambulatory Medical Care Surveys (NAMCS). Uterine cancer incidence rates using SEER data have continued to decline since 1979. An acceleration in the decline since 1983-84 is suggested in all women and in women with intact uteri ages 45-64. Hospitalizations for uterine cancer have also declined since 1979, with a marked acceleration in the decline since 1983-84 for all women and for women ages 40-79 has increased 22 percent and use of unopposed exogenous estrogens in women of similar age has increased 7 percent, while use of exogenous progesterones have shown much more substantial increases of approximately 700 percent. Possible relationships between trends in exogenous hormone use and incidence rates of corpus uterine cancer are discussed.
Persky, V; Davis, F; Barrett, R; Ruby, E; Sailer, C; Levy, P
Uterine artery embolization immediately preceding laparoscopic myomectomy
Objective To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids. Methods In a retrospective casecontrol study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test. Results Twelve women underwent laparoscopic myomectomy within 169Ý16 minutes (meanÝSEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications. Conclusion UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.
Goldman, Kara N.; Hirshfeld-Cytron, Jennifer E.; Pavone, Mary-Ellen; Thomas, Andrew P.; Vogelzang, Robert L.; Milad, Magdy P.
Therapeutic hypothermia for severe cerebral air embolism complicating pleural lavage for empyema
Cerebral air embolism during pleural lavage is a rare, but potentially fatal complication. We present a case of severe cerebral air embolism that developed during pleural lavage for empyema and was successfully treated by therapeutic hypothermia. A 77-year old male patient with empyema developed severe cerebral air embolism during pleural lavage via a chest tube. Cranial computed tomography and cranial magnetic resonance imaging showed many small bubbles and widespread infarction in the territory of the right middle cerebral artery. The patient received therapeutic hypothermia maintained at 33¯C for 24 h and could leave the hospital without delayed sequelae.
Inoue, Seiya; Takizawa, Hiromitsu; Yamamoto, Yota; Tangoku, Akira
Cytology of peritoneal lavage performed during staging laparoscopy for gastrointestinal malignancies: is it useful?
OBJECTIVE: To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA: Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid are thought to indicate intraperitoneal tumor seeding and to have a negative effect on survival. For this reason, peritoneal lavage is frequently added to diagnostic laparoscopy for staging GI malignancies. METHODS: Patients who underwent peritoneal lavage during laparoscopic staging for GI malignancies between June 1992 and September 1997 were included. Lavage fluids were stained using Giemsa and Papanicolaou methods. Cytology results were correlated with the presence of metastases and tumor ingrowth found during laparoscopy and with survival. RESULTS: Cytology of peritoneal lavage was performed in 449 patients. Tumor cells were found in 28 patients (6%): 8/87 with an esophageal tumor, 2/32 with liver metastases, 11/72 with a proximal bile duct tumor, 7/236 with a periampullary tumor, and none in 7 and 15 patients with a primary liver tumor or pancreatic body or tail tumor, respectively. In 19 of the 28 patients (68%) in whom tumor cells were found, metastatic disease was detected during laparoscopy, and 3 of the 28 patients had a false-positive (n = 1) or a misleading positive (n = 2) lavage result. Therefore, lavage was beneficial in only 6/449 patients (1.3%); in these patients, the lavage result changed the assessment of tumor stage and adequately predicted irresectable disease. Univariate analysis showed a significant survival difference between patients in whom lavage detected tumor cells and those in whom it did not, but multivariate analysis revealed that these survival differences were caused by metastatic or ingrowing disease. CONCLUSION: Cytology of peritoneal lavage with conventional staining should no longer be performed during laparoscopic staging of GI malignancies because it provides an additional benefit in only 1.3% of patients and has limited prognostic value for survival in this group of patients. Images Figure 1.
Nieveen van Dijkum, E J; Sturm, P D; de Wit, L T; Offerhaus, J; Obertop, H; Gouma, D J
Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: A case report?
INTRODUCTION Uterine inversion is an un-common complication of parturition which often occurs in the immediate postpartum period. The chronic (non-puerperal) uterine inversion is rarer and most times tumour associated. PRESENTATION OF CASE A 51-year old grand multiparous lady presented with a month history of abnormal vaginal bleeding associated with offensive vaginal discharge, lower abdominal pain and dizziness. The initial evaluation suggested severe anaemia secondary to advanced cervical cancer. Examination under anaesthesia (EUA), staging and biopsy was attempted but this was however inconclusive due to profuse haemorrhage. A repeat EUA revealed chronic uterine inversion secondary to fundal submucous uterine leiomyoma. Myomectomy was done with tissue histology confirming benign uterine leiomyoma. Two weeks later, a modified Haultain's procedure was done followed by simple hysterectomy and posterior colpoperineorrhaphy. She had satisfactory recovery. DISCUSSION This is the first reported case of chronic non-puerperal uterine inversion in our hospital. When it occurs, it is usually tumour associated with the commonest tumour being prolapsed myoma and leiomyosarcoma. The diagnosis is based on high index of suspicion. CONCLUSION Chronic uterine inversion is a rare gynaecological condition and can be misdiagnosed as advanced cervical cancer or other causes of severe genital haemorrhage in women. A high index of suspicion is needed for its proper diagnosis. Sometimes, an EUA and biopsy was required to determine the cause here and conveniently it could be described as a gynaecolological near miss.
Umeononihu, Osita Samuel; Adinma, Joseph Ifeanyi; Obiechina, Nworah J.; Eleje, George Uchenna; udegbunam, Onyebuchi Izuchukwu; Mbachu, Ikechukwu Innocent
Clinical efficiency investigation of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids
To investigate the effectiveness of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids. From August 2008 to August 2009, forty-eight women with uterine fibroids desiring to preserve their uteri underwent laparoscopic myomectomy. Among them, 18 women received laparoscopic uterine artery occlusion before uterine myomectomy while the others received laparoscopic myomectomy only. All of the 48 cases with uterine fibroids underwent laparoscopic myomectomy successfully, and no patient developed Intraoperative or postoperative complications. The average operation time was (105.6Ý27.6) min, and the average surgical blood loss was (87.52Ý18.35) ml. Blocking uterine artery before laparoscopic myomectomy is valuable and feasible for the management of women with symptomatic fibroids. Adopting this method can obtain pleasing therapeutic effect. The method can reduce blood loss thus make the surgical field clean and clear, and it can reduce the operating time and recurrence rate. It can also reduce electro-coagulation on the surgical surface and therefore cause less tissue necrosis and lower incidence of complications.
Yin, Xiang-Hua; Gao, Ling-Ling; Gu, Yang; Song, Jing-Zhe; Gao, Jing; Ji, Xiao-Ping
Cellular and molecular mechanisms underlying plasticity in uterine sympathetic nerves
Dynamic responses of uterine sympathetic nerves to changes in the circulating levels of sex hormones represent one of the most remarkable examples of physiological plasticity in the adult autonomic nervous system. The density of uterine sympathetic nerves is markedly and irreversibly reduced following puberty, and shows phases of degeneration and regeneration during the natural oestrous cycle. Even more remarkable, uterine
M. Mµnica Brauer
Purpose Lavage of the ductal systems of the breast provides fluid (DLF) containing hormones and products of hormone actions that may represent more accurately the composition of the breast than samples collected from blood or urine. The present study was undertaken to assess the presence of potential cancer biomarkers, their variation among individuals at high risk for breast cancer, and differences associated with menopause and tamoxifen treatment. Methods Seventy seven tamoxifen-eligible subjects with a 5-year breast cancer risk estimate (Gail > 1.6%)(N = 53) or recently diagnosed breast cancer (N = 24) were offered tamoxifen therapy; those not accepting tamoxifen were under observation only. After six months, all subjects underwent ductal lavage (DL) in an unaffected breast. Estradiol (E2), estrone sulfate, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate, progesterone, cathepsin D and epidermal growth factor (EGF) were measured in DLF by immunoassays. Data were expressed as the mass of analyte per mg of protein in DLF and normalized by natural log transformation. Results With the exception of DHEA, none of the analytes measured were significantly lower in postmenopausal women than in premenopausal women. The mean loge concentration difference in estradiol was 10.9%. Tamoxifen treatment for 6 months did not result in a significantly greater concentration of E2 or in any of the other analytes in DLF of pre- or postmenopausal women. The between-duct variance of the concentration of free steroids within the same breast averaged 51% less than that between subjects, and was similar to that of non-diffusible proteins. Conclusions The maintenance of estradiol concentrations in the breast after menopause demonstrates the importance of local biosynthesis. The fact that DLF E2 does not reflect the high serum concentrations of E2 during tamoxifen treatment indicates that breast concentrations of estradiol may be under feedback control. Unlike studies of low risk populations, progesterone concentrations were not significantly less in postmenopausal than in premenopausal women. The similarity in variance of free steroids and protein analytes between ducts of a breast indicates little transfer of steroids between lobules.
Chatterton, Robert T.; Parker, Noah P.; Habe-Evans, Mito; Bryk, Michele; Scholtens, Denise M.; Khan, Seema A.
Bronchoalveolar Lavage as a Tool to Predict, Diagnose, and Understand Bronchiolitis Obliterans Syndrome
Bronchiolitis obliterans syndrome (BOS), a condition of irreversible small airway fibrosis, is the principal factor limiting long-term survival after lung transplantation. Bronchoscopy and bronchoalveolar lavage (BAL), techniques central to lung transplant clinical practice, provide a unique opportunity to interrogate the lung allograft during BOS development and identify potential disease mechanisms or biomarkers. Over the past twenty years, numerous studies have evaluated the BAL cellular composition, cytokine profiles, and protein constituents in lung transplant recipients with BOS. To date, however, no summative evaluation of this literature has been reported. We developed and applied objective criteria to qualitatively rank the strength of associations between BAL parameters and BOS in order to provide a comprehensive and systematic assessment of the literature. Our analysis indicates that several BAL parameters, including neutrophil count, interleukin-8, alpha defensins, and MMP-9, demonstrate highly replicable associations with BOS. Additionally, we suggest that considerable opportunity exists to increase the knowledge gained from BAL analyses in BOS through increased sample sizes, covariant adjustment, and standardization of BAL technique. Further efforts to leverage analysis of BAL constituents in BOS may offer great potential to provide additional in-depth and mechanistic insights into the pathogenesis of this complex disease.
Kennedy, Vanessa E.; Todd, Jamie L.; Palmer, Scott M.
Flow Cytometry Increases the Sensitivity of Detection of Leukemia and Lymphoma Cells in Bronchoalveolar Lavage Specimens
Background Recent studies have definitively determined that Flow Cytometry (FC) is significantly more sensitive than cytomorphology (CM) in detection of hematolymphoid neoplasms (HLN). However, its utility in paucicellular bronchoalveolar lavage (BAL) specimens has not been established. Methods FC was performed on BAL specimens submitted from 44 patients with a prior diagnosis of HLN. Panels chosen were based upon cellularity of specimen and patient history. FC results were compared with concurrent CM evaluations. Results All 44 BALs were deemed satisfactory for FC and yielded informative results that assisted in diagnosis. Diagnoses included 22/44 B-cell neoplasms, 16/44 T-cell neoplasms, 4/44 myeloid neoplasms, and 2/44 plasma cell neoplasms. Overall concordance was demonstrated between FC and CM in 77% (34/44) of cases. In 9/44 cases (20%), one technique (FC or CM) clearly detected malignant cells when the other did not. FC was more sensitive than CM in detecting a HLN in 8/9 discordant cases. In only one case (1/44, 2%) were malignant HLN cells suspected by CM, but not identified by FC (1/44, 2%). Conclusion We demonstrate, in the largest series published to date, that FC can be performed on BAL specimens. FC is indicated in evaluation of BAL for HLN and improves sensitivity of detection of HLN over CM alone. An integrated FC and CM approach is superior to either technique alone in diagnostic evaluation of BAL.
Song, Joo Y.; Filie, Armando C.; Venzon, David; tevenson, Maryalice Stetler-S; Yuan, Constance M.
Use of Cyclosporine in Uterine Transplantation
Uterine transplantation has been proposed as a possible solution to absolute uterine factor infertility untreatable by any other option. Since the first human attempt in 2000, various teams have tried to clarify which immunosuppressant would be most suitable for protecting the allogeneic uterine graft while posing a minimal risk to the fetus. Cyclosporine A (CsA) is an immunosuppressant widely used by transplant recipients. It is currently being tested as a potential immunosuppressant to be used during UTn. Its effect on the mother and fetus and its influence upon the graft during pregnancy have been of major concern. We review the role of CsA in UTn and its effect on pregnant transplant recipients and their offspring.
Saso, Srdjan; Logan, Karl; Abdallah, Yazan; Louis, Louay S.; Ghaem-Maghami, Sadaf; Smith, J. Richard; Del Priore, Giuseppe
Uterine hemangioma: a rare pathologic entity.
Uterine hemangioma is a rare benign tumor usually presenting with menorrhagia or pregnancy-associated complications. Although the current literature identifies fewer than 50 cases, we in our institution identified 5 similar cases among 3700 patients undergoing total hysterectomy from January 2006 to December 2010. Adenomyosis was the most common preoperative diagnosis among our patients. Vaginal examination, uterine curettage specimens, ultrasonography, and hysterography are usually uninformative, and the definitive diagnosis relies on the final histologic examination. The differential diagnosis includes adenomatoid tumor, lymphangioma, and arteriovenous malformation. Uterine hemangiomas are classified into congenital and acquired. The former is believed to be associated with some hereditary diseases, while the latter is associated with both physical changes and hormone alteration, especially high estrogen level. The best treatment for hemangiomas is unclear. However, it is very important to obtain an accurate diagnosis to prevent overtreatment among reproductive-age women. The prognosis is excellent after hysterectomy. PMID:22540306
Chou, Wan-Yi; Chang, Hui-Wen
Uterine cervical malignant granular cell tumor.
Malignant granular cell tumor is relatively uncommon, constituting only 1-2% of all granular cell tumors. It is a rare and unusual tumor, especially in non-typical sites, such as the uterine cervix, and grows more rapidly than benign granular cell tumor. It can be treated with surgical excision, but recurrence is possible and prognosis can be poor. A malignant granular cell tumor in the uterine cervix of a 37-year-old woman was incidentally diagnosed. The patient has a history of irregular vaginal bleeding. Uterine cervical biopsy under colposcope revealed a malignant granular cell tumor. After isophosphamide, etoposide, and cisplatin neoadjuvant chemotherapy, surgery was performed on the lesion, which approximately involved half the depth of cervical stroma. Computed tomography examination showed no local recurrence or distant metastasis during the 26-month follow-up period. PMID:22414028
Guo, Na; Peng, Zhilan; Yang, Kaixuan; Lou, Jiangyan
Multispectral imaging of organ viability during uterine transplantation surgery
NASA Astrophysics Data System (ADS)
Uterine transplantation surgery has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of loss of the uterus. Due to the complexity of the vasculature correct reanastomosis of the blood supply during transplantation surgery is a crucial step to ensure reperfusion and viability of the organ. While techniques such as fluorescent dye imaging have been proposed to visualise perfusion there is no gold standard for intraoperative visualisation of tissue oxygenation. In this paper results from a liquid crystal tuneable filter (LCTF)-based multispectral imaging (MSI) laparoscope are described. The system was used to monitor uterine oxygen saturation (SaO2) before and after transplantation. Results from surgeries on two animal models (rabbits and sheep) are presented. A feature-based registration algorithm was used to correct for misalignment induced by breathing or peristalsis in the tissues of interest prior to analysis. An absorption spectrum was calculated at each spatial pixel location using reflectance data from a reference standard, and the relative contributions from oxy- and deoxyhaemoglobin were calculated using a least squares regression algorithm with non-negativity constraints. Results acquired during animal surgeries show that cornual oxygenation changes are consistent with those observed in point measurements taken using a pulse oximeter, showing reduced SaO2 following reanastomosis. Values obtained using the MSI laparoscope were lower than those taken with the pulse oximeter, which may be due to the latter's use of the pulsatile arterial blood signal. Future work incorporating immunological test results will help to correlate SaO2 levels with surgical outcomes.
Clancy, Neil T.; Saso, Srdjan; Stoyanov, Danail; Sauvage, Vincent; Corless, David J.; Boyd, Michael; Noakes, David E.; Thum, Meen-Yau; Ghaem-Maghami, Sadaf; Smith, J. R.; Elson, Daniel S.
Foetal heart rate power spectrum response to uterine contraction.
Cardiotocography is the most diffused prenatal diagnostic technique in clinical routine. The simultaneous recording of foetal heart rate (FHR) and uterine contractions (UC) provides useful information about foetal well-being during pregnancy and labour. However, foetal electronic monitoring interpretation still lacks reproducibility and objectivity. New methods of interpretation and new parameters can further support physicians' decisions. Besides common time-domain analysis, study of the variability of FHR can potentially reveal autonomic nervous system activity of the foetus. In particular, it is clinically relevant to investigate foetal reactions to UC to diagnose foetal distress early. Uterine contraction being a strong stimulus for the foetus and its autonomic nervous system, it is worth exploring the FHR variability response. This study aims to analyse modifications of the power spectrum of FHR variability corresponding to UC. Cardiotocographic signal tracts corresponding to 127 UC relative to 30 healthy foetuses were analysed. Results mainly show a general, statistically significant (t test, p<0.01) power increase of the FHR variability in the LF 0.03-0.2 Hz and HF 0.2-1 in correspondence of the contraction with respect to a reference tract set before contraction onset. Time evolution of the power within these bands was computed by means of time-varying spectral estimation to concisely show the FHR response along a uterine contraction. A synchronised grand average of these responses was also computed to verify repeatability, using the contraction apex as time reference. Such modifications of the foetal HRV that follow a contraction can be a sign of ANS reaction and, therefore, additional, objective information about foetal reactivity during labour. PMID:16937160
Romano, M; Bifulco, P; Cesarelli, M; Sansone, M; Bracale, M
Uterine Prolapse: From Antiquity to Today
Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse. He who cannot render an account to himself of at least three thousand years of time, will always grope in the darkness of inexperience Goethe, Translation of Panebaker
Downing, Keith T.
Percutaneous cavitary lavage in the diagnosis of pulmonary cavities
Objective To investigate diagnostic significance of percutaneous cavitary lavage (PCL) in differential diagnosis of benign and malignant pulmonary cavitary lesions. Methods An alternative diagnostic method called PCL was performed on 16 patients having peripherally located pulmonary cavitary lesions with thin walls which were not suitable for tissue biopsy and whose diagnosis could not be made by sputum examination and bronchoscopic procedures. A 22-gauge needle was inserted into the cavity under computed tomography (CT) guidance. Saline was injected through the needle and then aspirated. The specimen was examined cytologically and microbiologically. Results PCL could make a correct diagnosis in 12 of 16 patients (75%). In three patients (18.7%) appropriate specimen could not be taken. Diagnostic sensitivity and specificity of PCL for malignant-benign differentiation was 80% and 100%, respectively. The accuracy of PCL for this differentiation was 92.3%. There was only one complication, a small pneumothorax resolved without any intervention. Conclusions PCL is an alternative method in the differential diagnosis of thin walled pulmonary cavitary lesions especially for patients whose diagnosis could not be made by sputum and bronchoscopic procedures and who are not suitable for cutting needle biopsy.
Findik, Serhat; Ozmen, Zafer; Atici, Atilla Guven; Akan, Huseyin
Characterization of the Phosphoproteome in Human Bronchoalveolar Lavage Fluid
Global-scale examination of protein phosphorylation in human biological fluids by phosphoproteomics approaches is an emerging area of research with potential for significant contributions towards discovery of novel biomarkers. In this pilot work, we analyzed the phosphoproteome in human bronchoalveolar lavage fluid (BAL) from nondiseased subjects. The main objectives were to assess the feasibility to probe phosphorylated proteins in human BAL and to obtain the initial catalog of BAL phosphoproteins, including protein identities and exact description of their phosphorylation sites. We used a gel-free bioanalytical workflow that included whole-proteome digestion of depleted BAL proteins, enrichment of phosphopeptides by immobilized metal ion affinity chromatography (IMAC), LC-MS/MS analyses with a linear ion trap mass spectrometer, and searches of a protein sequence database to generate a panel of BAL phosphoproteins and their sites of phosphorylation. Based on sequence-diagnostic MS/MS fragmentation patterns, we identified a collection of 36 phosphopeptides that contained 26 different phosphorylation sites. These phosphopeptides mapped to 21 phosphoproteins including, for example, vimentin, plastin-2, ferritin heavy chain, kininogen-1, and others. The characterized phosphoproteins have diverse characteristics in terms of cellular origin and biological function. To the best of our knowledge, results of this study represent the first description of the human BAL phosphoproteome.
Giorgianni, Francesco; Mileo, Valentina; Desiderio, Dominic M.; Catinella, Silvia; Beranova-Giorgianni, Sarka
Characterization of the phosphoproteome in human bronchoalveolar lavage fluid.
Global-scale examination of protein phosphorylation in human biological fluids by phosphoproteomics approaches is an emerging area of research with potential for significant contributions towards discovery of novel biomarkers. In this pilot work, we analyzed the phosphoproteome in human bronchoalveolar lavage fluid (BAL) from nondiseased subjects. The main objectives were to assess the feasibility to probe phosphorylated proteins in human BAL and to obtain the initial catalog of BAL phosphoproteins, including protein identities and exact description of their phosphorylation sites. We used a gel-free bioanalytical workflow that included whole-proteome digestion of depleted BAL proteins, enrichment of phosphopeptides by immobilized metal ion affinity chromatography (IMAC), LC-MS/MS analyses with a linear ion trap mass spectrometer, and searches of a protein sequence database to generate a panel of BAL phosphoproteins and their sites of phosphorylation. Based on sequence-diagnostic MS/MS fragmentation patterns, we identified a collection of 36 phosphopeptides that contained 26 different phosphorylation sites. These phosphopeptides mapped to 21 phosphoproteins including, for example, vimentin, plastin-2, ferritin heavy chain, kininogen-1, and others. The characterized phosphoproteins have diverse characteristics in terms of cellular origin and biological function. To the best of our knowledge, results of this study represent the first description of the human BAL phosphoproteome. PMID:22997577
Giorgianni, Francesco; Mileo, Valentina; Desiderio, Dominic M; Catinella, Silvia; Beranova-Giorgianni, Sarka
Bronchoalveolar lavage in farmers' lung disease: diagnostic and physiological significance.
A group of 92 farmers had clinical evaluation, pulmonary function tests, and bronchoalveolar lavage (BAL). There were 12 patients with acute farmers' lung disease (FLD) (group 1) and 37 farmers who had had acute FLD, of whom 22 were still on their farm (group 2) and 15 had ceased contact (group 3); others were normal dairy farmers, 23 serology positive to Micropolyspora faeni (group 4), 20 serology negative (group 5), and 42 normal controls (group 6). Of the 134 subjects, 59 had an increase in alveolar lymphocytes (greater than 22% lymphocytes in BAL) (12 in group 1, 19 in group 2, six in group 3, 14 in group 4, five in group 5, and three in group 6). Within each group there was no correlation between BAL lymphocytes (% and absolute number) and most pulmonary function tests. It is concluded that although an increase in BAL lymphocytes is always seen in acute FLD it may also be seen in the absence of clinically evident disease and that BAL lymphocytosis does not correlate with physiological changes in FLD.
Cormier, Y; Belanger, J; LeBlanc, P; Laviolette, M
Abnormal bronchoalveolar lavage in asymptomatic dairy farmers. Study of lymphocytes.
Bronchoalveolar lavage (BAL) was performed on 24 asymptomatic dairy farmers. Thirteen had serum precipitins to Micropolyspora faeni (MF) antigens (Group 1), and 11 were seronegative control subjects (Group 2). All were nonsmokers and had no history of previous lung disease. Thirteen of 24 subjects (9 in Group 1 and 4 in Group 2) had a high percentage of lymphocytes (greater than or equal to 20%) in their BAL. The T-lymphocyte subpopulations as estimated by OKT3, OKT4, and OKT8 monoclonal antibody reactivity were measured in peripheral blood lymphocytes; OKT3 = 58.5 +/- 15.6% for Group 1, and 58.5 +/- 8.7% for Group 2; OKT4 = 40.6 +/- 10.7% and 39.9 +/- 10.0%; OKT8 = 21.5 +/- 10.6% and 22.4 +/- 8.0%, respectively (p = NS). These lymphocyte characteristics were also similar when subjects with a high percentage of lymphocytes in BAL were compared to those with a normal percentage. Specific (MF-coated) chicken erythrocyte lymphocytotoxicity (Group 1, 45.2 +/- 29.5%, Group 2, 49.2 +/- 23.4%), and nonspecific lymphocytotoxicity (Group 1, 43.9 +/- 28.6%, Group 2, 37.9 +/- 18.0%) were also similar. We conclude that a large number of asymptomatic dairy farmers have an increased percentage of lymphocytes in their BAL ("alveolitis") and that peripheral blood lymphocytes in these subjects have normal subpopulations, as assessed by monoclonal antibodies, and normal lymphocytotoxicity. PMID:6508002
Cormier, Y; BÕlanger, J; Beaudoin, J; Laviolette, M; Beaudoin, R; Hebert, J
Bronchoalveolar lavage in farmers' lung disease: diagnostic and physiological significance.
A group of 92 farmers had clinical evaluation, pulmonary function tests, and bronchoalveolar lavage (BAL). There were 12 patients with acute farmers' lung disease (FLD) (group 1) and 37 farmers who had had acute FLD, of whom 22 were still on their farm (group 2) and 15 had ceased contact (group 3); others were normal dairy farmers, 23 serology positive to Micropolyspora faeni (group 4), 20 serology negative (group 5), and 42 normal controls (group 6). Of the 134 subjects, 59 had an increase in alveolar lymphocytes (greater than 22% lymphocytes in BAL) (12 in group 1, 19 in group 2, six in group 3, 14 in group 4, five in group 5, and three in group 6). Within each group there was no correlation between BAL lymphocytes (% and absolute number) and most pulmonary function tests. It is concluded that although an increase in BAL lymphocytes is always seen in acute FLD it may also be seen in the absence of clinically evident disease and that BAL lymphocytosis does not correlate with physiological changes in FLD. PMID:3426661
Cormier, Y; BÕlanger, J; LeBlanc, P; Laviolette, M
Uterine artery embolization for treatment of symptomatic fibroids: a review of the evidence.
Fibroids are the most common benign tumors of the uterus during female reproductive age. Uterine artery embolization (UAE) using embolic particles (PVA, Gelfoam) to occlude the uterine arteries, have been reported as a relatively safe, effective, and durable nonsurgical alternative to hysterectomy in diminishing fibroid-related symptoms. To block the arterial blood supply to the fibroid completely, UAE is typically performed in both uterine arteries by an experienced interventional radiologist. Reduction in menorrhagia has been reported as 80-93 percent and the mean decrease in fibroid size varies from 50-78% in the literature. In our center improvement in menstrual bleeding after 6 months was 80.3%, and uterine fibroids underwent shrinkage of 63.7Ý33.7% after12 months. Complication rate including amenorrhea ranges from 1% - 7% in the literature. UAE may be followed by menopause in 1% of cases. Nevertheless, it is usually encountered in women in their late 40s. It seems that the future of UAE depends on optimal selection of patients according to volume-shrinkage prediction and fertility outcome. Although pregnancy is possible after embolization, however neither fertility preservation nor improvement can be guaranteed following UAE. Indeed, Women who desire to become pregnant should be cautioned about potential complications during pregnancy. The aim of this review is to discuss about the efficacy, safety, technique, and choice of embolic agent. Also we present the effects of this technique on fertility and pregnancy outcome and also methods for dose reduction during this procedure. PMID:24693405
Firouznia, Kavous; Ghanaati, Hossein; Jalali, Amir Hossein; Shakiba, Madjid
Uterine closure with unlocked suture in cesarean section: Safety and Quality
Objective: Comparing locked and unlocked uterine closure techniques in terms of bleeding control and uterine incision healing. Methods: The patients undergoing cesarean section in Sifa University Hospital between May - October 2012 were accepted to this prospective controlled study. Primarily, safety was evaluated. The hemoglobin count (HC) and serum creatine kinase (CK) levels of the patients in the locked (n = 47) and unlocked (n = 35) groups were measured just before and 24 hours after operation. Hemoglobin deficit, increase in CK and the additional hemostatic sutures were compared. Secondly, uterine scar healing was evaluated three months later. Scar thickness, niche and percentage of thinning of the scar region of the locked (n = 27) and unlocked (n = 32) groups were calculated and compared. Results: The hemoglobin deficit was similar in two groups. CK rise was less in the unlocked group but it was not significant (P = 0.082). Unlocked group needed more additional sutures (P = 0.016). The thickness of the niche and the percentage of thinning of the scar region were significantly less in the unlocked group (P= 0.002, P=0.000). Conclusions: Unlocked uterine closure technique is safe and has less damage to the myometrium.
Turan, Guluzar Arzu; Gur, Esra Bahar; Tatar, Sumeyra; Gokduman, Ayse; Guclu, Serkan
Rationale: The presence of inflammatory cells on bronchoalveolar lavage is often used to predict disease activity and the need for therapy in systemic sclerosis-associated interstitial lung disease. Objectives: To evaluate whether lavage cellularity identifies distinct subsetsofdiseaseand\\/orpredictscyclophosphamideresponsiveness. Methods:Patientsunderwentbaselinelavageand\\/orhigh-resolution computed tomography as part of a randomized placebo-controlled trialofcyclophosphamideversusplacebo(SclerodermaLungStudy) to determine the effect of therapy on forced vital capacity. Patients with 3% or
Charlie Strange; Marcy B. Bolster; Michael D. Roth; Richard M. Silver; Arthur Theodore; Jonathan Goldin; Philip Clements; Joanie Chung; Robert M. Elashoff; Daniel E. Furst; Donald P. Tashkin
Comparison of three methods for protein measurement: application to bronchoalveolar lavage fluids.
The protein contents of bronchoalveolar lavage fluids from normal subjects and patients were estimated by three methods: LOWRY's assay, Coomassie blue method and the automatic laser nephelometric assay. The assays were carried out with native fluids and human serumalbumin as the standard. The lowest values were usually obtained with the dye-binding method. The best correlation coefficients between the assays were obtained from the pulmonary lavage of patients. PMID:7448468
Scharfman, A; Hayem, A; Lebas, J; Laine, A; SablonniÒre, B
Thermal Balloon Endometrial Ablation for Dysfunctional Uterine Bleeding
Executive Summary Objectives The objective of this review was to evaluate the effectiveness and cost-effectiveness of thermal balloon endometrial ablation (TBEA) for dysfunctional uterine bleeding (DUB). Background: Condition and Target Population Abnormal uterine bleeding is defined as an increase in the frequency of menstruation, duration of flow or amount of blood loss. (1) DUB is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause for the increased bleeding. (1) It is characterized by heavy prolonged flow with or without breakthrough bleeding. It may occur as frequent, irregular, or unpredictable bleeding; lengthy menstrual periods; bleeding between periods; or a heavy flow during periods. Menorrhagia, cyclical HMB over several consecutive cycles during the reproductive years, is the most frequent form of DUB. The incidence of DUB has not been reported in the literature. For Ontario, an expert estimated that about 15% to 20% of women over 30 years have DUB. The prevalence increases with age and peaks just before menopause. (1) Using 2001 Ontario census-based population estimates, there are about 2 million women between the ages of 30 and 49 years; therefore, of these, about 290,965 to 387,953 may have DUB. The Technology Being Reviewed: Thermal Balloon Endometrial Ablation Since the 1990s, second-generation endometrial ablation (EA) techniques developed, the aim to provide simpler, quicker, and more effective treatment options for menorrhagia compared with first-generation EA techniques and hysterectomy. (2) Compared with first-generation techniques these depend less on the people operating them and more on the actual devices to ensure safety and efficacy. TBEA relies on the transfer of heat from heated liquid within a balloon that is inserted into the uterus. (2) It does not require a hysteroscope for direct visualization of the uterus and can be performed under local anesthesia. In order to use TBEA, patients with DUB cannot have a long (>1012 cm) or irregularly shaped uterine cavity, because the balloon must be in direct contact with the uterine wall to cause ablation. For Ontario, an expert estimated that about 70% of patients with DUB considered for EA would have a uterus suitable for TBEA based on these criteria. If 70% of Ontario women between 30 and 49 years of age with DUB have a uterus suitable for TBEA, then about 203,675 to 271,567 women may be eligible. However, some of these women will be successfully treated by drugs or will want amenorrhea (the cessation of their periods) and therefore choose to have a hysterectomy. Review Strategy The standard Medical Advisory Secretariat search strategy was used to locate international health technology assessments and English-language journal articles published from January 1996 to June 2004. A Cochrane systematic review from 2004 was identified that examined the effectiveness and cost-effectiveness of TBEA for heavy menstrual bleeding. (2) Another literature search was done to update information from the systematic review. Summary of Findings A 2004 systematic review of the literature by Garside et al. (2) in the United Kingdom, found that overall, there were few significant differences between outcomes for first-generation techniques and TBEA. The outcomes were bleeding, postoperative complications, patient satisfaction, quality of life, and repeat surgery rates. Significant differences were reported most often by one study by Pellicano et al., (3) but this was a level 2 study with methodological weaknesses. Furthermore, according to Garside et al., there was considerable clinical and methodological heterogeneity among the studies in the systematic review. Therefore, a quantitative synthesis using meta-analysis was not done. In Garfield and colleagues review: TBEA had significantly shorter operating and theatre times (P < .05, < .01, and .0001). TBEA had fewer intraoperative adverse effects (e.g., reported rates of uterine perforation with RB ablation: from 1% to 5%; TBEA: 0%; rates of cervical laceratio
Sonohysterography is a useful diagnostic approach for uterine arteriovenous malformation.
Uterine arteriovenous malformation (AVM) is a rare cause of abnormal uterine bleeding; nevertheless, it is a potentially life-threatening condition when the diagnosis is not made. We report a case of uterine AVM with a secondary uterine hematoma diagnosed 2 weeks after curettage due to spontaneous abortion. Ultrasound examination revealed a mixed echogenic mass of approximately 4?cm?æ?1.5?cm with no blood flow and an additional contiguous heterogeneous mass with turbulent blood flow depicted by color Doppler. Transvaginal sonohysterography enabled us to exclude residual chorionic tissues and to make precise diagnosis of uterine AVM with a secondary hematoma. PMID:24888955
Mishina, Miyuki; Hasegawa, Junichi; Nakamura, Masamitsu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi
Comparison of reduced volume versus four-liter electrolyte lavage solutions for colon cleansing.
In an attempt to improve patient tolerance for colon cleaning, a reduced-volume regimen with a 2-liter electrolyte lavage solution plus 20 mg of oral bisacodyl was compared with the standard 4-liter lavage for efficacy and safety. Three hundred patients were prospectively randomized into two study groups. One group of 150 patients was given four tablets of 5 mg bisacodyl at 12:00 PM the day before their colonoscopy, followed by 2 liters of electrolyte lavage by mouth at 6:00 PM the evening before their colonoscopy. Another group of 150 patients were given 4 liters of electrolyte lavage at 6:00 PM the evening before their colonoscopy. All patients were on a clear liquid diet the day before their colonoscopy. No enema was given in either groups. The bowel cleanliness was accessed by one colonoscopist. One registered nurse accessed the comfort of patient. In the 2-liter group, only one (0.6%) patient could not finish the laxative. Colon cleanliness was 80 per cent to 100 per cent, with an average of 95.9 per cent. In the 4-liter group, 11 (7.3%) patients could not finish the laxative preparation. Colon cleanliness was 78 per cent to 100 per cent, with an average of 95.3 per cent. The study that found the 2-liter electrolyte lavage solution with four tablets of bisacodyl can achieve equally good results in bowel preparation and favorable acceptance by patients compared with the 4-liter lavage. PMID:17058733
Ker, Tim S
Differences in uterine innervation at hysterectomy
Objective: Our purpose was to identify patterns of uterine innervation in normal uteri and selected clinical conditions including adenomyosis and chronic pelvic pain. Study Design: A retrospective survey was performed of stored uteri removed at hysterectomy for a variety of clinical conditions, including 8 uteri from nulliparous subjects (group 1, mean age 40.0 years, range 30-52 years), 21 uteri with
Martin J. Quinn; Nick Kirk
Cytologic findings of acute leukemia in bronchoalveolar lavage fluid.
Bronchoalveolar lavage (BAL) is often performed in patients with acute leukemia developed with respiratory failure or pulmonary infiltrates. Patients usually undergo BAL to rule out infection. Occasionally, however, leukemic infiltrate may be detected. We present a series of 11 cases in which the diagnosis of leukemia was made on the BAL material. We retrospectively reviewed all BAL samples from January 1, 2006 to December 31, 2008. There were a total of 1,130 cases, of which 139 showed malignant cytology, including 10 with leukemia. Sixteen samples were unsatisfactory and 904 were benign, of which 32 had identifiable microorganisms. In additional to the 10 leukemia cases identified, two more were reviewed after the search criteria. The 12 patients (seven men, five women) ranged from 22 to 75 years old. All patients had previously biopsy-proven leukemia [two acute myelomonocytic leukemia, two acute promyelocytic leukemia, two acute myeloid leukemia (AML) with inv16, two therapy-related AML, one acute monocytic leukemia, one chronic myeloid leukemia in blast face, one AML with maturation, one myelodysplastic syndrome with excess blasts, and one large granular leukemia]. Four had a prior diagnosis of myelodysplastic syndrome. The time from initial diagnosis of leukemia to BAL ranged from 1 to 233 days, with 8 of 10 occurring within 8 days of diagnosis. Symptoms that prompted BAL included shortness of breath/hypoxia (8), fever (3), chest pain (2), and cough (2). Chest X-rays in all cases revealed opacities or consolidations mimicking an inflammatory process. Seven patients subsequently died, while three were alive, and, in remission, and two were lost to follow-up. The presence of a leukemic infiltrate can mimic infection. BAL is a relatively safe and useful diagnostic tool in this setting for differentiating a leukemic infiltrate from an infection/inflammatory infiltrate. The prognosis of patients with lung involvement of acute leukemia is poor. PMID:23161838
O'Leary, Michelle; Cantley, Richard L; Kluskens, Larry; Gattuso, Paolo
Apoptosis resistant bronchoalveolar lavage (BAL) fluid lymphocytes in sarcoidosis
Background: Sarcoidosis is a chronic granulomatous lung disease of unknown origin. The accumulation of activated T cells at sites of inflammation represents an early stage in granuloma formation. Since mechanisms governing the normal resolution of inflammatory processes are poorly understood, this study aimed to investigate the apoptotic phenotype of peripheral blood and lung T lymphocytes from patients with sarcoidosis. Methods: Bronchoalveolar lavage (BAL) was performed in 10 patients with active sarcoidosis and five healthy controls. Results: Virtually no lymphocyte apoptosis, as determined by annexin V or Hoechst staining, was seen in either patients or controls. Sustained caspase-3 activity in non-apoptotic BAL fluid lymphocytes of the patients was detected, however, in agreement with in vitro studies demonstrating caspase activation after T cell receptor (TCR) triggering as a physiological response required for efficient T cell activation. Only 11.0% (range 7.717.6) of the BAL lymphocytes from sarcoidosis patients were annexin V positive after exposure to the apoptotic stimulus tributyltin compared with 55.0% (range 42.062.0) of BAL lymphocytes from healthy controls (p<0.001). After anti-Fas treatment only 8.5% (range 610) of BAL fluid lymphocytes from patients but 45.5% (range 3862) from healthy controls were apoptotic. Conclusion: BAL fluid lymphocytes from patients with sarcoidosis display a non-apoptotic morphology associated with endogenous caspase-3 activity. They seem to be resistant to apoptosis, which might contribute to the accumulation of inflammatory cells in the lungs, persistence of inflammation, and the development and maintenance of granuloma.
Stridh, H; Planck, A; Gigliotti, D; Eklund, A; Grunewald, J
Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP) a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning
BACKGROUND: Organophosphorus (OP) pesticide poisoning is the most common form of pesticide poisoning in many Asian countries. Guidelines in western countries for management of poisoning indicate that gastric lavage should be performed only if two criteria are met: within one hour of poison ingestion and substantial ingested amount. But the evidence on which these guidelines are based is from medicine
Yi Li; XueZhong Yu; Zhong Wang; HouLi Wang; XiangHuai Zhao; YuPing Cao; WeiZhan Wang; Michael Eddleston
Bronchoalveolar lavage via a modified stomach tube in intubated patients with the acquired immunodeficiency syndrome and diffuse pneumonia.
A simple non-bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure. A modified Argyle Levin stomach tube was passed via the endotracheal tube and lavage performed. The lavage was well tolerated and performed quickly and easily, required little training, and had a high degree of sensitivity (73%--a diagnosis in 22 of the 30 cases). PMID:2247870
Minutoli, R; Eden, E; Brachfeld, C
Bronchoalveolar lavage via a modified stomach tube in intubated patients with the acquired immunodeficiency syndrome and diffuse pneumonia.
A simple non-bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure. A modified Argyle Levin stomach tube was passed via the endotracheal tube and lavage performed. The lavage was well tolerated and performed quickly and easily, required little training, and had a high degree of sensitivity (73%--a diagnosis in 22 of the 30 cases). Images
Minutoli, R; Eden, E; Brachfeld, C
Changes in uterine protein secretion during luteal and follicular phases and detection of phosphatases during luteal phase of estrous cycle in buffaloes (Bubalus bubalis).
Changes in uterine proteins during different reproductive states and their functional significance though known in other species have not been established in buffaloes. An attempt has been made to unravel the changes in composition of buffalo uterine secretion with growth and regression of corpora-lutea during early, mid and late luteal and follicular phase of estrous cycle using gel filtration and electrophoresis techniques. Also the phosphatases activities in luteal phase uterine secretions have been studied. Gel filtration chromatography analysis revealed a protein peak in void volume of the column, the intensity of which was more in all the luteal phase samples than follicular phase samples. Alkaline phosphatase was also found eluted in the void volume. The other three uterus-specific peaks (Peaks V-VII) were detected below 13.7 kd molecular weight. There were at least five peaks of acid phosphatases activity in chromatogram. Silver staining of SDS-PAGE gel detected as many as 40 protein bands in the uterine fluid of which nine proteins were glycoproteins. Molecular weight (MW) comparison revealed the major protein band at 66 kd which could be serum albumin. Comparison of uterine proteins with serum protein bands revealed a 93.5 kd glycoprotein in buffalo serum that did not appear in uterine fluid and at least 11 uterus-specific protein bands (506, 470, 241, 114, 49, 38, 33, 26, 19.2, 16, and 14.3 kd). The 38 and 19.2 kd bands were luteal-stage specific. Intense periodic acid Schiff's (PAS) stained bands in uterine proteins compared to serum indicated glycosylation process in endometrial epithelial cells. The study suggested that buffalo uterine secretion contained mainly serum and several uterus-specific proteins of which few were luteal phase specific. Further study on characterizing the unique or most abundant proteins and defining their role in uterine functions would help to address the cause of low reproduction rate in buffaloes. PMID:16213013
Chandra Roy, Sudhir; Uma Suganthi, R; Ghosh, Jyotirmoy
Bronchoalveolar lavage fluid findings in patients with chronic hepatitis C virus infection.
BACKGROUND: Hepatitis C virus (HCV) infection has recently been incriminated as an aetiological agent in idiopathic pulmonary fibrosis. This study was performed to determine the cellularity and lymphocyte phenotypes of bronchoalveolar lavage (BAL) fluid in patients with chronic hepatitis C. METHODS: BAL fluid and lavage lymphocyte subsets from 13 patients (10 men) with active chronic hepatitis C, diagnosed by sustained elevated serum glutamic pyruvic transaminase and typical histological findings in the liver, were analysed. Lavage findings in these patients were compared with those from 13 healthy volunteers (eight men) as controls. RESULTS: There was no difference in total cell counts in lavage fluid between the two groups. Lavage lymphocyte and eosinophil numbers were increased in patients with chronic hepatitis C. Surface marker analysis of the lymphocyte populations showed increases in CD2, CD3, CD4, and HLA-DR. CD4/CD8 ratios were not different. CONCLUSIONS: The numbers of lymphocytes and eosinophils in BAL fluid are increased in patients with chronic hepatitis C. These findings suggest that HCV infection may trigger alveolitis.
Kubo, K.; Yamaguchi, S.; Fujimoto, K.; Hanaoka, M.; Hayasaka, M.; Honda, T.; Sodeyama, T.; Kiyosawa, K.
Relationships between radiographic change, pulmonary function, and bronchoalveolar lavage fluid lymphocytes in farmer's lung disease.
Ninety four dairy farmers were investigated by chest radiography, pulmonary function tests, and bronchoalveolar lavage. They were divided into five groups--1: 11 subjects with acute farmer's lung; 2: 25 subjects with previously diagnosed farmer's lung who had stayed on their farm; 3: 15 farmers with previously diagnosed farmer's lung who had left the farm; 4: 23 precipitin positive symptomless farmers; 5: 20 precipitin negative symptomless farmers. The study evaluated the relationships between radiographic changes measured with a scoring system derived from the International Labour Office (ILO) classification, the results of pulmonary function tests, and bronchoalveolar lavage fluid. Thirty eight subjects had radiographic evidence of interstitial pulmonary infiltrates. Group 1 had the highest percentage of lymphocytes recovered by bronchoalveolar lavage (mean 66.3 (SD 19.2]. For all subjects carbon monoxide transfer factor (TLCO) and total lung capacity were negatively correlated with radiographic changes (r = -0.45 and -0.30; p less than 0.001 and less than 0.01 respectively). TLCO was also negatively correlated with radiographic change in group 2 (r = -0.59, p less than 0.005). The percentage of lavage lymphocytes was correlated with radiographic changes for all subjects (r = 0.36, p less than 0.001), but this correlation was not seen within groups. This study shows good correlation between radiographic abnormalities, pulmonary function changes and the cellular composition of bronchoalveolar lavage fluid.
Cormier, Y; Belanger, J; Tardif, A; Leblanc, P; Laviolette, M
Sonographic and MR features of puerperal uterine inversion.
Puerperal uterine inversion is a rare and potentially life-threatening complication of a mismanaged third stage of labour. Early diagnosis is mandatory for proper management of the patient. Complete uterine inversion is a clinical diagnosis. However, incomplete uterine inversion is difficult to identify and warrants further workup. Sonographic evaluation, although a bedside procedure, may be confusing. The conspicuity of findings is much greater on MR examination than on ultrasound. Only a few diagnostic imaging findings in uterine inversion have been described in previous reports. We present the case of a 26-year-old woman who had a full-term vaginal delivery and presented after 20 days with acute urinary retention and mild vaginal bleeding. She was diagnosed as a case of neglected subacute incomplete uterine inversion. Both greyscale and Doppler sonographic and MR features of the case are described with an emphasis on better delineation of uterine and adnexal anatomy on MR imaging. PMID:24619161
Thakur, Shruti; Sharma, Sanjiv; Jhobta, Anupam; Aggarwal, Neeti; Thakur, Charu S
Mathematical Approach for Modeling the Uterine Electrical Activity
NASA Astrophysics Data System (ADS)
The aim of physiological modeling of the uterine electrical activity generated at cellular level is to understand the main physiological uterine contractile mechanisms, in particular, the propagation mechanisms and their relationship with the uterine EMG signal recorded externally from the abdominal wall of the pregnant women. In this present paper, we model the electrical activity simulated at its cellular level. This model is built in three steps: first we built a model based on the formulation of Hodgkin and Huxley and adapted to the specificities of the uterine cell. The second step was the integration of the cellular model in a two-dimensional propagation model by using the reactiondiffusion equations in order to simulate the propagation of the uterine activity at the tissue level. Finally, a simplified version of the space-time integration of the electrical activity was used to build a first example of the uterine EMG.
Chkeir, Aly; Moslem, Bassam; Rihana, Sandy; Germain, Guy; Marque, Catherine
Smooth muscle differentiation in human myometrium and uterine leiomyoma.
Smooth muscle differentiation has been analysed in human myometrium and leiomyoma by Western blotting with antibodies to smooth muscle specific proteins. No differences in the expression of h-caldesmon, metavinculin, desmin, alpha-smooth muscle actin and calponin were observed. The technique of two-dimensional gel electrophoresis was used, therefore, to further analyse differences between normal smooth muscle cells and their neoplastic counterparts. By comparing the protein patterns of normal myometrium and leiomyoma, it was possible to identify a protein with a molecular weight of approximately 27 kD that is selectively expressed in normal uterine smooth muscle cells. This protein proved to be a low molecular weight variant of calponin, a smooth muscle specific protein of as yet unknown function. Its immediate downregulation in tissue culture of normal myometrium points to a possible role in the process of dedifferentiation. PMID:8401813
Draeger, A; Graf, A H; Staudach, A; North, A J; Small, J V
Imaging for uterine myomas and adenomyosis.
Uterine myomas and adenomyosis are common findings, in particular in patients with symptoms of abdominal enlargement, pelvic pressure, abnormal uterine bleeding, dysmenorrhea, and dyspareunia. Diagnosis and differentiation between the 2 entities are critical in establishing treatment options and the operative approach for surgical management. Herein are reviewed diagnostic options, their relative accuracy, and the effect of accurate diagnosis on treatment. A review was performed using PubMed, MdConsult, OVID, and reviews including cross-referenced articles and prospective and retrospective studies published from 1980 to 2013. Also reviewed are use of ultrasound with its various methods, magnetic resonance imaging, computed tomography, and positron emission tomography in the diagnosis, pretreatment evaluation, and differentiation of myomas and adenomyosis. PMID:24316138
Shwayder, James; Sakhel, Khaled
Isolated Uterine Metastasis of Invasive Ductal Carcinoma
Introduction. Most common metastasis sites of breast cancer are the lungs, bones, liver, and brain, whereas uterine involvement by metastatic breast disease is rare. Metastatic carcinoma of the uterus usually originates from other genital sites, most commonly being from the ovaries. Invasive lobular carcinoma spreads to gynecologic organs more frequently than invasive ductal carcinoma. Case Report. A 57-year-old postmenopausal woman was diagnosed with breast carcinoma 2 years ago and modified radical mastectomy was performed. Pathological examination of tumor revealed invasive ductal carcinoma, stage IIIc. She presented with abdominal pain and distension. Diagnostic workup and gynecologic examination revealed lesions that caused diffuse thickening of the uterus wall. Endometrial sampling was performed for confirmation of the diagnosis. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Breast carcinoma metastases in endometrium and myometrium were confirmed histopathologically and immunohistochemically. Conclusion. We herein report the first case of isolated uterine patient who had invasive ductal carcinoma of breast.
Arslan, Deniz; Tural, Deniz; Tatl?, Ali Murat; Akar, Emre; Uysal, Mukremin; Erdogan, Gulgun
Etiology, diagnosis, and management of uterine leiomyomas.
Uterine leiomyomas are the most common benign gynecologic tumors. While the true etiology of leiomyomas remains unknown, their origin is thought to be multifactorial including genetic, hormonal, and tissue growth factor variations. Leiomyomas are predominantly found in women of reproductive age and are the leading indication for hysterectomy worldwide. Menstrual irregularities, pain, and fertility difficulties may arise from leiomyoma presence, although many women remain asymptomatic. Diagnosis can be made via ultrasound or magnetic resonance imaging, when precise mapping of the tissue is needed. Many treatment options are available ranging from surgical to medical and should be chosen depending on symptom severity, number and size of leiomyomas, patient age, fertility desires, and patient preferences. The objective of this article is to present a practical clinical perspective on uterine leiomyomas and an overview of contemporary treatment options. PMID:22587581
Rice, Kate E; Secrist, Jenny R; Woodrow, Elizabeth L; Hallock, Laura M; Neal, Jeremy L
Microarray Analysis of Gene Expression in the Uterine Endometrium during the Implantation Period in Pigs
During embryo implantation in pigs, the uterine endometrium undergoes dramatic morphological and functional changes accompanied with dynamic gene expression. Since the greatest amount of embryonic losses occur during this period, it is essential to understand the expression and function of genes in the uterine endometrium. Although many reports have studied gene expression in the uterine endometrium during the estrous cycle and pregnancy, the pattern of global gene expression in the uterine endometrium in response to the presence of a conceptus (embryo/fetus and associated extraembryonic membranes) has not been completely determined. To better understand the expression of pregnancy-specific genes in the endometrium during the implantation period, we analyzed global gene expression in the endometrium on day (D) 12 and D15 of pregnancy and the estrous cycle using a microarray technique in order to identify differentially expressed endometrial genes between D12 of pregnancy and D12 of the estrous cycle and between D15 of pregnancy and D15 of the estrous cycle. Results showed that the global pattern of gene expression varied with pregnancy status. Among 23,937 genes analyzed, 99 and 213 up-regulated genes and 92 and 231 down-regulated genes were identified as differentially expressed genes (DEGs) in the uterine endometrium on D12 and D15 of pregnancy compared to D12 and D15 of the estrous cycle, respectively. Functional annotation clustering analysis showed that those DEGs included genes involved in immunity, steroidogenesis, cell-to-cell interaction, and tissue remodeling. These findings suggest that the implantation process regulates differential endometrial gene expression to support the establishment of pregnancy in pigs. Further analysis of the genes identified in this study will provide insight into the cellular and molecular bases of the implantation process in pigs.
Kim, Mingoo; Seo, Heewon; Choi, Yohan; Shim, Jangsoo; Kim, Heebal; Lee, Chang-Kyu; Ka, Hakhyun
Disseminated peritoneal leiomyomatosis coexisting with leiomyoma of the uterine body
The authors present an extremely rare case of disseminated peritoneal leiomyomatosis (DPL) coexisting with leiomyoma of the\\u000a uterine body in a 32-year-old woman. The patient had undergone a caesarean section 12 years ago and used oral contraceptives\\u000a since then. Before the present surgery leiomyoma of the left corner of the uterine body was diagnosed. DPL was found on the\\u000a uterine serous
Piotr Surmacki; Stanis?aw Sporny; Arkadiusz Tosiak; Janusz Lasota
Intrauterine Growth Retardation Associated with Uterine Malformations
Intrauterine growth retardation is caused by factors that prevent adequate fetal nourishment or by factors that intrinsically affect the fetus. Limited available space due to a congenitally malformed uterus may prevent normal intrauterine development. Two cases are presented here. A review of the available literature confirms the tendency of women with congenital uterine malformations to have smaller offspring. Intrauterine growth retardation should be added to the more commonly known complications associated with a congenitally malformed uterus. ImagesFigure 1Figure 2
Poma, Pedro A.
[Uterine sarcoma--diagnostic and therapeutic problems].
A retrospective analysis dealt with 28 cases of uterine sarcoma treated in a ten-year period (1975-1984). The most common histological type was leiomyosarcoma. Thirteen patients underwent surgery alone, a combination of surgery and irradiation was performed in 9 patients, surgery + irradiation + chemotherapy in 2 patients, and surgery + chemotherapy in 2 patients. Sixteen patients are alive and well during a follow-up of 5 years. PMID:2273905
Chylak, V; Delac, J; Krusi?, J
Uterine leiomyosarcoma metastatic to the thyroid
BACKGROUND:Uterine leiomyosarcoma is an aggressive tumor that has a propensity for distant metastasis. Distant sites of spread include the lung, liver, brain, and bone.CASE:A woman in her 5th decade was diagnosed with stage IV leiomyosarcoma of the uterus. Distant metastasis in the chest was confirmed by thoracotomy at the time of her original diagnosis. She subsequently experienced multiple episodes of
Charles A Leath; Warner K Huh; J. Michael Straughn; Michael G Conner
Serum profile in preeclampsia and intra-uterine growth restriction revealed by iTRAQ technology
In order to identify new protein markers modified in placental diseases, high-throughput analysis of proteins in the plasma of pregnant women was carried out for normal and pathological pregnancies (Preeclampsia and\\/or Intra-Uterine Growth Restriction) using iTRAQ technology. We could identify 166 proteins that were modified (p<0.05) and the technique used allowed the detection of previously undetected factors, such as various
Jana Auer; Luc Camoin; FranÓois Guillonneau; Virginie Rigourd; Sonia T. Chelbi; Marjorie Leduc; JÕr¶me Laparre; ThÕrÒse-Marie Mignot; Daniel Vaiman
Gallium-67 scintigraphy, bronchoalveolar lavage, and pathologic changes in patients with pulmonary sarcoidosis
The intensity of gallium-67 scintiscans, lymphocyte counts in bronchoalveolar lavage fluid, and pathologic changes were studied in 26 patients with untreated pulmonary sarcoidosis. Noncaseating granulomas were recognized with significantly greater frequency in stage 2 (80 percent; 8/10 cases) than in stage 1 (43 percent; 6/14 cases). Alveolitis showed little relation to the roentgenographic stage. There was a strong correlation between the intensity of gallium uptake in pulmonary parenchyma and the detection rate of granuloma; however, the detection rate of alveolitis was not statistically different from the intensity of gallium uptake. A highly significant correlation was revealed between the lymphocyte counts in bronchoalveolar lavage fluid and the intensity of alveolitis. These observations suggest that the gallium uptake reflects mainly the presence of granuloma, and the lymphocyte count in bronchoalveolar lavage fluid reflects the intensity of alveolitis in patients with pulmonary sarcoidosis.
Abe, S.; Munakata, M.; Nishimura, M.; Tsuneta, Y.; Terai, T.; Nakano, I.; Ohsaki, Y.; Kawakami, Y.
Uterine cervical tubulosquamous polyp resembling a penis.
This case report describes a tubulosquamous polyp resembling a penis in the uterine cervix. A 34-yr-old, gravida 0, para 0, woman showed an 18 æ 8 æ 5 mm polypoid lesion in the uterine ectocervix. The polyp had a penis-like appearance; the tip looked like glans penis and the middle portion resembled the shaft of the penis. Its surface was covered by squamous epithelium, and tissues resembling those of a urethra, corpus spongiosum penis, and external orifice urethra were observed. Foreskin-like tissues were also observed, although a corpus cavernosum penis was not seen. Skene glands and Cowper glands were also observed. Immunohistochemically, Skene glands and the urethra-like epithelium were focally positive for prostate-specific antigen and/or prostatic acid proteins. Histologically and immunohistochemically, the polypoid lesion overlapped with a tubulosquamous polyp of the vagina and ectopic prostatic tissue of the uterine cervix and encompassed these lesions in the lower female genital tract. The most likely theory of histogenesis is a developmental anomaly and misplacement of Skene glands. PMID:23722517
Fukunaga, Masaharu
Undifferentiated uterine sarcoma metastatic to the brain
Background: Undifferentiated uterine sarcoma (UUS) is a rare tumor with an aggressive growth pattern. They occur in women from 40 to 60 years and are generally characterized by poor prognosis, a high rate of local recurrence, and distant metastases. UUS accounts for 0.2% of all gynecological malignancies. Possible treatments include surgery, radiotherapy, and chemotherapy. Case Description: A 65-year-old female with postmenopausal bleeding was found to have a uterine mass for which she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The pathologic evaluation was consistent with undifferentiated endometrial sarcoma. She began experiencing headaches with associated visual disturbances. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 æ 1.8 æ 1.7 cm. Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Histopathology confirmed UUS metastases. Conclusion: Randomized trials analyzing these treatment options are limited due to the rarity of this disease; therefore, a standard therapy is not established. Based on a review of the literature, this is only the fourth case reported of UUS metastatic to the brain.
Stofko, Douglas L
Uterine-sparing surgery for adenomyosis and/or adenomyoma.
Adenomyosis of the uterus is defined as the presence of endometrial tissue, including glands and stroma, situated at least 2.5 mm below the endometrial-myometrial junction and widely distributed within the myometrium layer of the uterus. There is no consensus on the appropriate treatment for symptomatic uterine adenomyosis in women who want to preserve their uterus, partly because adenomyosis is somewhat enigmatic in diagnosis and owing to its clinical significance. Hysterectomy, through either exploratory laparotomy or minimally invasive procedures, is a definite treatment for uterine adenomyosis, once the women have completed childbirth or do not require future fertility. However, many women with a uterine pathology still have a strong desire to preserve the uterus, for which conservative and uterine-sparing procedures are increasingly used, and with which fertility preservation or quality-of-life improvement can be achieved. Although medical management can be effective, similar to the management of uterine fibroids (myoma), its effect is often transient and rapid regrowth of adenomyosis and relapse of symptoms and signs always occur once the treatment is stopped. Therefore, other strategies should be selected. Conservative and uterine-sparing surgery might be one of the most familiar procedures of these uterine-sparing procedures. In this article, the latest knowledge and research evidence on uterine-sparing surgery for uterine adenomyosis are reviewed. PMID:24767637
Horng, Huann-Cheng; Chen, Ching-Hui; Chen, Chih-Yao; Tsui, Kuan-Hao; Liu, Wei-Min; Wang, Peng-Hui; Chang, Wen-Hsun; Huang, Ben-Shian; Sun, Hsu-Dong; Chang, Ting-Chang; Chang, Wei-Chun; Yen, Ming-Shyen
Uterine artery Doppler flow studies in obstetric practice
In women who develop preeclampsia there is a pathological increase in placental vascular resistance should be detectable by abnormal Dopplerf low studies of the maternal uterine vessels. In women considered at low risk with abnormal early pregnancy uterine artery Doppler studies are needed. Until such time as these are available, routine uterine artery Doppler screening of women considered at low risk is not recommended. Uterine artery Doppler screening of high-risk women appears to identify those at substantially increased risk for adverse pregnancy outcomes and interventions that might improve clinical outcomes. Abnormal testing in these women could potentially lead to increased surveillance and interventions that might improve clinical outcomes.
Giordano, Rosalba; Cacciatore, Alessandra; Romano, Mattea; La Rosa, Beatrice; Fonti, Ilenia; Vigna, Roberto
[Role of oxytocin in activation of spontaneous electrical activity of uterine body and uterine tubes in non-pregnant rats].
The work studies effects of various doses of oxytocin (0.01, 0.1, 1 and 10 microg/kg) on duration of discharges of spontaneous electrical activity and frequency of spikes in various parts of uterine tubes and of uterine body of non-pregnant rats. Under these conditions, changes in these parameters for ovarian parts of the uterine tubes had similar character unlike those in cervical parts of the tubes and in the middle part of the uterine body, so the latter parts can be grouped together owing to peculiarities of their changes. The longest duration of genesis of electric discharges has been shown for the ovarian part of uterine tubes at a concentration of 10 microg/kg of oxytocin. Morphological experiments revealed that among all studies areas the ovarian parts of uterine tubes were characterized by the highest amount of atypical cells that have the maximally pronounced functional activity. PMID:21780644
Kazarian, K V; Unanian, N G; Meliksetian, I B; Akopian, R R; Saakian, A A
Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift procedure.
The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented. PMID:21360218
Bartelink, Lidewij R; Feitz, Wouter F; Kluivers, Kirsten B; Withagen, Mariella I J; Vierhout, Mark E
[Non-invasive thermoablation of symptomatic uterine fibroids with magnetic resonance-guided high-energy ultrasound].
Uterine fibroids are the most common benign tumors in postmenopausal women which can cause severe symptoms and considerably reduce the quality of life. Patients are requesting minimally invasive, organ-saving therapies increasingly more often and magnetic resonance-guided focused ultrasound is a promising new technology which even surpasses these requirements as it is a totally non-invasive approach. The possibility of real-time temperature mapping allows a safe and precise thermal ablation of uterine fibroids. The rate of adverse events is low and safety and efficiency have been proven in several clinical studies. Further studies will have to be carried out to demonstrate long-term success and comparability to the established therapies and clarify if focused ultrasound is a safe treatment for women with the desire for future pregnancy. The MR-guided focused ultrasound technique is an effective and gentle treatment for uterine fibroids and holds a great potential for further indications. PMID:21660621
Eckey, T; Neumann, A; Bohlmann, M K; Barkhausen, J; Hunold, P
Lung lavage therapy to lessen the biological effects of inhaled sup 144 Ce in dogs
To evaluate the therapeutic effects of removal of an internally deposited radionuclide on long-term biological effects, lung lavage was used to treat dogs that had inhaled 144Ce in a relatively insoluble form, in fused aluminosilicate particles. Either 10 lung lavages were performed between Days 2 and 56 after exposure or 20 lung lavages were performed between Days 2 and 84 after exposure. Approximately one-half of the 144Ce was removed by the lavages, resulting in a corresponding reduction in the total absorbed beta dose to lung. The mean survival time of the treated dogs was 1270 days compared to 370 days for untreated dogs whose initial pulmonary burdens of 144Ce were similar. Treated dogs died late from cancers of the lung or liver, whereas the untreated dogs died at much earlier times from radiation pneumonitis. Dogs treated with lung lavage but not exposed to 144Ce had a mean survival of 4770 days. We concluded that removal of 144Ce from the lung by lavage resulted in increased survival time and in a change in the biological effects from inhaled 144Ce from early-occurring inflammatory disease to late-occurring effects, principally cancer. In addition, the biological effects occurring in the treated dogs could be better predicted from the total absorbed beta dose in the lung and the dose rate after treatment rather than from the original dose rate to the lung. Therefore, we concluded that prompt treatment to remove radioactive materials could be of significant benefit to persons accidentally exposed to high levels of airborne, relatively insoluble, radioactive particles.
Muggenburg, B.A.; Boecker, B.B.; Hahn, F.F.; McClellan, R.O. (Lovelace Inhalation Toxicology Research Institute, Albuquerque, NM (USA))
MR Reproducibility in the Assessment of Uterine Fibroids for Patients Scheduled for Uterine Artery Embolization
Magnetic resonance imaging (MRI) is increasingly applied in the evaluation of uterine fibroids. However, little is known about the reproducibility of MRI in the assessment of uterine fibroids. This study evaluates the inter- and intraobserver variation in the assessment of the uterine fibroids and concomitant adenomyosis in women scheduled for uterine artery embolization (UAE). Forty patients (mean age: 44.5 years) with symptomatic uterine fibroids who were scheduled for UAE underwent T{sub 1}- and T{sub 2}-weighted MRI. To study inter- and intraobserver agreement 40 MR images were evaluated independently by two observers and reevaluated by both observers 4 months later. Inter- and intraobserver agreement was calculated using Cohen's {kappa} statistic and intraclass correlation coefficient for categorical and continuous variables, respectively. Inter-observer agreement for uterine volumes ({kappa} = 0.99, p < 0.0001), dominant fibroid volumes ({kappa} = 0.98, p {<=} 0.0001), and number of fibroids ({kappa} = 0.88; CI, 0.77-0.93; p < 0.0001) was excellent. For the T{sub 1}- and T{sub 2}-weighted signal intensity of the dominant fibroid there was good agreement between the observers (87%; 95% CI, 71.9%-95.6%) and the intraobserver agreement was good for observer A (95%; 95% CI, 83.1%-99.4%) and moderate for observer B ({kappa} = 0.47). The interobserver agreement with respect to the presence of adenomyosis was good ({kappa} = 0.73, p < 0.0001), while both intraobserver agreements were fair to moderate (observer A, {kappa} = 0.55, p = 0.0003; and observer B, {kappa} = 0.66, p < 0.0001). In conclusion, MRI criteria used for the selection of suitable UAE patients show good inter- and intraobserver reproducibility.
Volkers, Nicole A. [Academic Medical Centre, Department of Radiology (Netherlands)], E-mail: email@example.com; Hehenkamp, Wouter J. K. [Department of Gynaecology (Netherlands); Spijkerboer, Anje M. [Academic Medical Centre, Department of Radiology (Netherlands); Moolhuijzen, Albert D. [Waterland Hospital, Department of Radiology (Netherlands); Birnie, Erwin [Amsterdam, and Erasmus Medical Centre, Institute of Health Policy and Management, Academic Medical Centre, Department of Public Health Epidemiology (Netherlands); Ankum, Willem M. [Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands)
[Significance of bronchoalveolar lavage in demonstrating previous exposure to asbestos].
A study was made via a clinical approach in the absence of environmental data with the aim of demonstrating a possible past exposure to asbestos in a working population that had never been examined before nor had ever undergone any specific health checks. It was deemed useful to compare this working population with a control population not exposed to asbestos. The population under study consisted of 126 employees of a single (thermonuclear) department of a metal engineering industry who reported having used asbestos as insulation material in all heat processes up to the beginning of the 1980's. Pleural plaques were observed in 13 workers that were also confirmed by high resolution TC (HRTC) except in one case. The control group consisted of subjects seen at the Clinica del Lavoro of Milan for non-asbestos related diseases in whom a fibrobronchoscopy with broncho-alveolar lavage (BAL) was performed for diagnostic purposes. In each group asbestos bodies were counted in the BAL liquid using a method with a detection limit of 0.1 bodies/ml. The asbestos bodies detected in the alveolar liquid of subjects in the control group were between a maximum of 0.25 and a minimum of 0 bodies/ml of liquid (mean = 0.03; SD = 0.64) whereas in the sample of subjects from the population under study who underwent BAL the results gave a concentration of asbestos bodies in the BAL liquid between a maximum of 9.0 and a minimum of 0.15 bodies/ml of liquid (mean = 2.38; SD = 2.72). In order to obtain a statistically significant difference between the control population, which was certainly not exposed, and the sample of subjects undergoing BAL from the population for which an occupational exposure was assumed, we applied the non-parametric Wilcoxon-Mann-Whitney test for independent samples in view of the asymmetric distribution of the values of asbestos body concentration in the alveolar liquid: the result was a statistically significant difference (p < 0.001) between the two populations. We also calculated the total asbestos bodies recovered in the BAL liquid of subjects from both populations. In the control group total asbestos bodies were between a maximum of 15 and a minimum of 0 (mean = 1.8; SD = 3.9) while in the group under study the concentration of total asbestos bodies recovered in BAL liquid was between a maximum of 990 and a minimum of 12.7 (mean = 206.5; SD = 270). The Wilcoxon-Mann-Whitney test was also applied to these data, the result of which was that the difference in exposure between the two populations was statistically significant (p < 0.001). Concluding, the study demonstrates the importance of asbestos body count in BAL liquid as an objective indicator of past occupational exposure to asbestos, thus providing documented proof that overcomes any doubts arising from case history and any lack of environmental data that could prove exposure. PMID:11515149
Rivolta, G; Prandi, E; Sogliani, M; Picchi, O
Midterm Clinical Results and Patient Satisfaction After Uterine Artery Embolization in Women with Symptomatic Uterine Fibroids
Purpose To evaluate the mid-term clinical results and patient satisfaction following uterine artery embolization (UAE) in women with\\u000a symptomatic fibroids.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Between August 1998 and December 2002, 135 patients had UAE for symptomatic uterine fibroids. All patients were asked to fill\\u000a in a questionnaire. Questions were aimed at changes in bleeding, pain, and bulk-related symptoms. Symptoms after UAE were\\u000a scored as disappeared,
Albert J. Smeets; Paul N. M. Lohle; Harry A. M. Vervest; P. Focco Boekkooi; Leo E. H. Lampmann
Intraoperative use of a chest physiotherapy system during whole lung lavage for pulmonary alveolar proteinosis.
Pulmonary alveolar proteinosis (PAP) is a rare condition caused by the excessive alveolar accumulation of surfactant proteins. The current standard of care for removing these secretions is through therapeutic whole lung lavage (WLL). We describe two successful cases of bilateral WLL involving the novel use of the Vest chest physiotherapy system thereby avoiding the need for extensive changes in patient position in the intraoperative period. In brief, it involves the induction of general anesthesia followed by single-lung ventilation while simultaneously performing large volume lavages on the nonventilated lung. The washout was enhanced using the Vest system. PMID:22495262
Kumar, Avinash B; Schweiger, Hans W
Proteomic Analysis of Bronchoalveolar Lavage Fluid: Effect of Acute Exposure to Diesel Exhaust Particles in Rats
Background Inhalation of diesel exhaust particles (DEPs) is characterized by lung injury and inflammation, with significant increases in the numbers of polymorphonuclear leukocytes and alveolar macrophages. This influx of cellular infiltrates is associated with the activation of multiple genes, including cytokines and chemokines, and the production of reactive oxygen species. Objective The pathogenesis of the lung injury is not fully understood, but alterations in the presence or abundance of a number of proteins in the lung have been observed. Our objective in this study was to further characterize these changes and to ask whether additional changes could be discerned using modern proteomic techniques. Methods The present study investigates global alterations in the proteome of bronchoalveolar lavage fluid taken from rats 1, 7, or 30 days after exposure to 5, 35, or 50 mg/kg of animal weight of DEPs. Results Analysis by surface-enhanced laser desorption/ionizationtime of flight mass spectrometry identified two distinct peaks that appeared as an acute response postexposure at all doses in all animals. We identified these two peaks, with mass to charge ratios (m/z) of 9,100 and 10,100, as anaphylatoxin C3a and calgranulin A by additional mass spectral investigation using liquid chromatography coupled to mass spectrometry. Conclusions With this approach, we found a number of inflammatory response proteins that may be associated with the early phases of inflammation in response to DEP exposure. Further studies are warranted to determine whether serum levels of these proteins could be markers of diesel exhaust exposure in workers.
Lewis, John A.; Rao, K. Murali Krishna; Castranova, Vince; Vallyathan, Val; Dennis, William E.; Knechtges, Paul L.
"Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children"
Background Diagnosis of pulmonary tuberculosis (PTB) is difficult in infants and young children. For microbiological confirmation of PTB children, sequential gastric lavage (GL) is recommended. Induced sputum (IS) may be an alternative or complementary tool, but the information is limited in children in developed countries. The aim of this study is to assess the safety and diagnostic yield from IS combined with GL for PTB diagnosis in non-HIV infected children. Methods The study involved 22 children with suspected PTB admitted to the Getafe Hospital from January 2007 to May 2011. IS and GL were performed on three consecutive days, according to a standardized protocol. In all samples, BK staining, culture and PCR were carried out, including Genotype MTBDR plus for resistance to INH-RIF (Isoniazid-Rifampin) since 2008. A preliminary analysis of an ongoing prospective study is presented. Results Median age was 72 months (range 1 month to 14 years of age). Seven (33%) were???5 years of age. Seventeen were clinically diagnosed of PTB based on positive PPD and radiological criteria. Microbiological confirmation was achieved in 10 (58.8%) by either GL or IS. M. tuberculosis was identified by GL in 8 children (47.1%) and by IS in 7 (41.2%). One infant (2 IS samples) had transient oxygen desaturation recovered spontaneously. Conclusions IS appears to be safe and well tolerated by children for diagnosis of PTB and is more convenient. Increasing the diagnostic yield of PTB in children with PTB may be a complementary technique. Largest studies are necessary to define the role of IS in paediatric PTB.
Increased collagenase activity in macrophages from bronchial lavage as a diagnostic marker of non-small cell lung cancer
Background: The roles of matrix metalloproteinases (MMPs) in cancer metastasis have been studied. Macrophages are considered to release MMPs in the tissues of patients with lung cancer.Methods: Intracellular collagenase activity was measured in CD14+ CD45+ cells from bronchial lavage fluid to establish a new diagnostic tool for lung cancer. Between August 2000 and November 2001 bronchoscopy and bronchial lavage were
Y Hakoda; Y Ito; A Nagate; K Minemura; K Utsumi; M Aoshima; K Ohyashiki
Heterogeneity of alveolar surfactant in the rabbit: composition, morphology, and labelling of subfractions isolated by centrifugation of lung lavage.
Rabbit alveolar saturated phosphatidylcholine (SPC) can be separated by differential and density gradient centrifugation of lung lavage into three fractions. One fraction ('B'), which is analogous to conventionally prepared alveolar surfactant, contains 46.0 +/- 5.9% (SD) of lavage SPC, and is made of large multilamellar vesicles or sheet-like structures. A second fraction ('C') does not sediment after centrifugation at 80 000 g for 90 min, contains 29.8 +/- 14.0% of lavage SPC, and a uniform population of small vesicles. This fraction incorporates 3H-palmitate administered intravenously with a small delay with respect to fraction 'B'. A third fraction ('D') contains almost all the cells of lavage and less than 5% of lavage SPC. We conclude that alveolar SPC consists of more than one compartment. The possible significance of isolated fractions is discussed. PMID:6421597
Baritussio, A; Bellina, L; Carraro, R; Rossi, A; Enzi, G; Magoon, M W; Mussini, I
Indocyanine Green Fluorescence Imaging for Evaluation of Uterine Blood Flow in Cynomolgus Macaque
Background Uterine blood flow is an important factor in uterine viability, but the number of blood vessels required to maintain viability is uncertain. In this study, indocyanine green (ICG) fluorescence imaging was used to examine uterine hemodynamics and vessels associated with uterine blood flow in cynomolgus macaque. Methods The uterus of a female cynomolgus macaque was cut from the vaginal canal to mimic a situation during trachelectomy or uterine transplantation surgery in which uterine perfusion is maintained only with uterine and ovarian vessels. Intraoperative uterine hemodynamics was observed using ICG fluorescence imaging under conditions in which various nutrient vessels were selected by clamping of blood vessels. A time-intensity curve was plotted using imaging analysis software to measure the Tmax of uterine perfusion for selected blood vessel patterns. Open surgery was performed with the uterus receiving nutritional support only from uterine vessels on one side. The size of the uterus after surgery was monitored using transabdominal ultrasonography. Results The resulting time-intensity curves displayed the average intensity in the regions of the uterine corpus and uterine cervix, and in the entire uterus. Analyses of the uterine hemodynamics in the cynomolgus macaque showed that uterine vessels were significantly related to uterine perfusion (P?=?0.008), whereas ovarian vessels did not have a significant relationship (P?=?0.588). When uterine vessels were clamped, ovarian vessels prolonged the time needed to reach perfusion maximum. Postoperative transabdominal ultrasonography showed that the size of the uterus was not changed 2 months after surgery, with recovery of periodic menstruation. The cynomolgus macaque has got pregnant with favorable fetus well-being. Conclusion Uterine vessels may be responsible for uterine blood flow, and even one uterine vessel may be sufficient to maintain uterine viability in cynomolgus macaque. Our results show that ICG fluorescence imaging is useful for evaluation of uterine blood flow since this method allows real-time observation of uterine hemodynamics.
Kisu, Iori; Banno, Kouji; Mihara, Makoto; Lin, Li-Yu; Tsuji, Kosuke; Yanokura, Megumi; Hara, Hisako; Araki, Jun; Iida, Takuya; Abe, Takayuki; Kouyama, Keisuke; Suganuma, Nobuhiko; Aoki, Daisuke
Postpartum haemorrhage continues to be the most important cause of maternal mortality in developing countries and in several developed ones. Between the different causes of postpartum haemorrhage, uterine atony is the most important, specially in those settings were active management of the 4th stage of labour is not performed. In the Obstetrics Service of the Institut Univaersitari Dexeus, uterine atony
B. Serra
Diagnostic use of immunohistochemistry in uterine mesenchymal tumors.
Immunohistochemistry may be helpful in the diagnosis of mesenchymal uterine tumors. This article reviews the immunoreactions used most frequently in the diagnosis of uterine smooth muscle tumors, endometrial stromal tumors, undifferentiated endometrial sarcomas, UTROSCTs, PEComas, adenomyomas, adenosarcomas and carcinosarcomas. PMID:24863031
D'Angelo, Emanuela; Prat, Jaime
Cellular and molecular mechanisms underlying plasticity in uterine sympathetic nerves.
Dynamic responses of uterine sympathetic nerves to changes in the circulating levels of sex hormones represent one of the most remarkable examples of physiological plasticity in the adult autonomic nervous system. The density of uterine sympathetic nerves is markedly and irreversibly reduced following puberty, and shows phases of degeneration and regeneration during the natural oestrous cycle. Even more remarkable, uterine sympathetic nerves degenerate during normal pregnancy and regenerate following delivery. Plasticity in uterine sympathetic nerves was initially interpreted as a selective effect of sex hormones on the system of paracervical short adrenergic neurons supplying the uterus. In the last decade, the alternative explanation that sex hormones might alter the ability of the uterine tissue to support its innervation began to be explored and current evidence indicates that oestrogen and pregnancy elicit changes in the neuritogenic properties of the target uterine tissue. In addition, there are indications that sex hormones may also affect the receptivity of uterine-related sympathetic neurons to target-derived signals. Although the nature of these signals is still fragmentary, there is evidence for the contribution of a range of molecules, including neurotrophins, pro-neurotrophins and chemorepulsive signals of the semaphorin family. This review summarizes some general features of plasticity in uterine sympathetic nerves and highlights recent investigations of the cellular and molecular mechanisms underlying this dramatic model of natural plasticity. PMID:18403274
Brauer, M Mµnica
Uterine Carcinosarcomas: Incidence and Trends in Management and Survival
Our study's aim was to determine the incidence of uterine sarcomas in New York City (NYC) and evaluate trends in frequency, treatment, and survival of carcinosarcomas in two Brooklyn hospitals. Population-based cancer registry data for 19761985 were used to calculate the incidence of uterine sarcomas in NYC women. Medical records and histology slides of carcinosarcomas at two central Brooklyn hospitals
Concepcion D. Arrastia; Rachel G. Fruchter; Melissa Clark; Mitchell Maiman; Jean Claude Remy; Milagros Macasaet; E. Jason Gates; Theresa Di Maio; Tomasz Marzec
Uterine clearance and resistance to persistent endometritis in the mare
The objective of this article is to review the role of uterine defense mechanisms in natural resistance to chronic or persistent endometritis. A breakdown of uterine physical clearance mechanisms is currently believed to play a major role in susceptibility to persistent endometritis. Mares with increased susceptibility to persistent endometritis have impaired myometrial contractility in response to an acute inflammation, resulting
M. H. T. Troedsson
Failed transarterial embolization of subserosal uterine arteriovenous malformation
Uterine arteriovenous malformation (AVM) is rare but potentially life-threatening from excessive vaginal bleeding. All uterine AVMs reported to date have been found in the endometrial or myometrial layers. Here we present a patient with a subserosal type AVM on the fundus of uterus, which spontaneously ruptured.
Seo, Kyung Jin; Kim, Jin; Sohn, In Sook; Kwon, Han Sung; Park, Sang Woo
Sonohysterographic evaluation of uterine abnormalities noted on hysterosalpingography
Transvaginal sonohysterography was performed on 40 consecutive patients with infertility or recurrent pregnancy loss and uterine abnormalities on hysterosalpingography. The findings were correlated with the hysterosalpingogram and subsequent diagnostic and\\/or operative hysteroscopy. Hysterosalpingography was incorrect in nine cases. Sono- hysterography was more accurate than hysterosalpingo- graphy and provided more information about uterine abnormalities. Sonohysterography was in complete agree- ment with
J. M. Goldberg; T. Falcone; M. Attaran
Vaginal birth after cesarean and uterine rupture rates in California
Objective: To describe attempted and successful vaginal birth after cesarean (VBAC) rates and uterine rupture rates for women with and without prior cesareans, and compare delivery outcomes in hospitals with different attempted VBAC rates.Methods: We used California hospital discharge summary data for 1995 to calculate attempted and successful VBAC rates and uterine rupture rates. We used multivariate logistic regression models
Kimberly D Gregory; Lisa M Korst; Patricia Cane; Lawrence D Platt; Katherine Kahn
Regulation of bronchoalveolar lavage fluids cell function by the immunomodulatory agents from Cordyceps sinensis
Cordyceps sinensis (C. sinensis) is one of the well known fungi used in traditional Chinese medicine for treatment asthma and bronchial and lung inflammation. In this study, effects of C. sinensis methanolic extracts on bronchoalveolar lavage fluids (BALF) cells proliferation, inflammatory cytokines production, and genes expression were evaluated. The proliferative response of BALF cells to lipopolysaccharide (LPS) was determined by
Yuh-Chi Kuo; Wei-Jern Tsai; Jir-Yenn Wang; Shi-Chung Chang; Ching-Yuang Lin; Ming-Shi Shiao
Nasal Lavage Biomarkers: Effects of Water Damage and Microbial Growth in an Office Building
Selected nasal symptoms were studied in personnel who worked in a damp office building that had microbial growth (including Stachybotrys sp.) in mineral fiber insulation and gypsum board. There were also signs of dampness in the floor. Clinical examinations included nasal lavage and peak expiratory flow measurements in 12 subjects in the damp building; an additional 8 subjects in a
Robert WÍlinder; Gunilla Wieslander; Dan Norbðck; Bengt Wessen; Per Venge
Elevated concentrations of defensins in bronchoalveolar lavage fluid in diffuse panbronchiolitis
Human neutrophils contain three isoforms of antimicrobial and cyto- toxic peptides in the azurophil granules, which belong to a family of mammalian neu- trophil peptides named defensins. Here we investigate the role of these peptides in diffuse panbronchiolitis (DPB). Defensins (human neutrophil peptide-1,-2 and -3) were measured by radioimmu- noassay in bronchoalveolar lavage fluid (BALF) of 30 patients with DPB,
J. Ashitani; H. Mukae; M. Nakazato; T. Ihi; H. Mashimoto; J. Kadota; S. Kohno; S. Matsukura
Bronchoalveolar lavage in pulmonary fibrosis: comparison of cells obtained with lung biopsy and clinical features
Bronchoalveolar lavage, open lung biopsy, and cell extraction from the biopsy material have been studied in 21 symptomatic patients with progressive pulmonary fibrosis (18 with cryptogenic fibrosing alveolitis, fulfilling also the criteria for usual interstitial pneumonia (UIP), and three with rapidly progressive disease probably related to asbestos exposure). The total and differential cell counts between the three different samples have
P L Haslam; C W G Turton; B Heard; A Lukoszek; J V Collins; A J Salsbury; M Turner-Warwick
Increased Release of Matrix Metalloproteinase-9 in Bronchoalveolar Lavage Fluid and by Alveolar Macrophages of Asthmatics
In order to determine whether matrix metalloproteinases (MMPs) contribute to inflammation in asthma, we have examined the release of MMPs in bronchoalveolar lavage (BAL) fluids and their production and regulation by alveolar macrophages (AM), in short-term culture. BAL was collected from 38 asthmatic subjects (24 untreated and 14 treated with inhaled corticosteroids), 26 healthy nonsmokers, and 18 patients with chronic
GisÒle Mautino; Nicolas Oliver; Pascal Chanez; Jean Bousquet; FranÓoise Capony
Ductal Lavage for Detection of Cellular Atypia in Women at High Risk for Breast Cancer
Background: Breast cancer originates in breast epithelium and is associated with progressive molecular and morpho- logic changes.Women with atypical breast ductal epithelial cells have an increased relative risk of breast cancer.In this study, ductal lavage, a new procedure for collecting ductal cells with a microcatheter, was compared with nipple aspi- ration with regard to safety, tolerability, and the ability to
William C. Dooley; Britt-Marie Ljung; Umberto Veronesi; Massimiliano Cazzaniga; Richard M. Elledge; Joyce A. O'Shaughnessy; Henry M. Kuerer; David T. Hung; Seema A. Khan; Rogsbert F. Phillips; Patricia A. Ganz; David M. Euhus; Bruce G. Haffty; Bonnie L. King; Mark C. Kelley; Maxine M. Anderson; Paul J. Schmit; Ramona R. Clark; Frederic C. Kass; Benjamin O. Anderson; Susan L. Troyan; Raquel D. Arias; John N. Quiring; Susan M. Love; David L. Page; Eileen B. King
Bronchoalveolar lavage galactomannan in the diagnosis of invasive pulmonary aspergillosis among solid organ transplant recipients
We review the experience at our institution with galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid in the diagnosis of invasive pulmonary aspergillosis (IPA) among solid-organ transplant recipients. Among 81 patients for whom BAL GM testing was ordered (heart, 24; kidney, 22; liver, 19; lung, 16), there were five cases of proven or probable IPA. All five patients had BAL
Cornelius J. Clancy; Reia A. Jaber; Helen L. Leather; John R. Wingard; Benjamin Staley; L. Joseph Wheat; Christina L. Cline; Kenneth H. Rand; Denise Schain; Maher Baz; M. Hong Nguyen
Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates.
Object Neonatal intraventricular hemorrhage (IVH) may evolve into posthemorrhagic hydrocephalus and cause neurodevelopmental impairment. In this study, an endoscopic surgical approach directed toward the removal of intraventricular hematoma was evaluated for its safety and efficacy. Methods Between August 2010 and December 2012 (29 months), 19 neonates with posthemorrhagic hydrocephalus underwent neuroendoscopic lavage for removal of intraventricular blood remnants. During a similar length of time (29 months) from March 2008 to July 2010, 10 neonates were treated conventionally, initially using temporary CSF diversion via lumbar punctures, a ventricular access device, or an external ventricular drain. Complications and shunt dependency rates were evaluated retrospectively. Results The patient groups did not differ regarding gestational age and birth weight. In the endoscopy group, no relevant procedure-related complications were observed. After the endoscopic lavage, 11 (58%) of 19 patients required a later shunt insertion, as compared with 100% of infants treated conventionally (p < 0.05). Endoscopic lavage was associated with fewer numbers of overall necessary procedures (median 2 vs 3.5 per patient, respectively; p = 0.08), significantly fewer infections (2 vs 5 patients, respectively; p < 0.05), or supratentorial multiloculated hydrocephalus (0 vs 4 patients, respectively; p < 0.01). Conclusions Within the presented setup the authors could demonstrate the feasibility and safety of neuroendoscopic lavage for the treatment of posthemorrhagic hydrocephalus in neonates with IVH. The nominally improved results warrant further verification in a multicenter, prospective study. PMID:24702621
Schulz, Matthias; B■hrer, Christoph; Pohl-Schickinger, Anja; Haberl, Hannes; Thomale, Ulrich-Wilhelm
Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation
Background: Although polyethylene glycol lavage solutions are widely used for colonoscopy preparation, evidence suggests that sodium phosphate is better tolerated and has similar efficacy. The purpose of this study was to compare compliance with and efficacy of polyethylene glycol and sodium phosphate using meta-analysis and to compare the cost of colonoscopy with both methods. Methods: We used Medline to identify
Chia-Wen Hsu; Thomas F. Imperiale
Local activation of uterine Toll-like receptor 2 and 2/6 decreases embryo implantation and affects uterine receptivity in mice.
Embryo implantation is a complex interaction between maternal endometrium and embryonic structures. Failure to implant is highly recurrent and impossible to diagnose. Inflammation and infections in the female reproductive tract are common causes of infertility, embryo loss, and preterm labor. The current work describes how the activation of endometrial Toll-like receptor (TLR) 2 and 2/6 reduces embryo implantation chances. We developed a morphometric index to evaluate the effects of the TLR 2/6 activation along the uterine horn (UH). TLR 2/6 ligation reduced the endometrial myometrial and glandular indexes and increased the luminal index. Furthermore, TLR 2/6 activation increased the proinflammatory cytokines such as interleukin (IL)-1beta and monocyte chemotactic protein (MCP)-1 in UH lavages in the preimplantation day and IL-1 receptor antagonist in the implantation day. The engagement of TLR 2/6 with its ligand in the UH during embryo transfer severely affected the rate of embryonic implantation (45.00% Ý 6.49% vs. 16.69% Ý 5.01%, P < 0.05, control vs. test, respectively). Furthermore, this interference with the embryo implantation process was verified using an in vitro model of human embryo implantation where trophoblast spheroids failed to adhere to a monolayer of TLR 2- and TLR 2/6-activated endometrial cells. The inhibition of TLR receptors 2 and 6 in the presence of their specific ligands restored the ability of the spheroids to bind to the endometrial cells. In conclusion, the activation of the innate immune system in the uterus at the time of implantation interfered with the endometrial receptivity and reduced the chances of implantation success. PMID:24621922
Sanchez-Lopez, Javier Arturo; Caballero, Ignacio; Montazeri, Mehrnaz; Maslehat, Nasim; Elliott, Sarah; Fernandez-Gonzalez, Raul; Calle, Alexandra; Gutierrez-Adan, Alfonso; Fazeli, Alireza
Subretinal lavage: a technique of continuous subretinal irrigation for removal of traumatic submacular hemorrhage.
A 12-year-old female patient suffered a horse kick to her face, resulting in various orbital fractures and blunt eye trauma. Upon ophthalmoscopy, an extensive subretinal hemorrhage was revealed under the macula, reaching to both vascular arcades. The visual acuity was 20/300. Five days after the accident, the patient was referred for vitreoretinal surgery. After standard vitrectomy, a small retinotomy was made at the temporal raphe. A second infusion was directed under the retina, thereby separating it carefully from the clot. The blot clot was exposed to tissue plasminogen activator (0.012 mg/0.1 ml) for 30 min. The liquefied blood was then washed out by continuous irrigation with buffered saline solution. The procedure was terminated by gas tamponade. Eleven days after surgery, the patient's vision had returned to 20/60. At 10 months after surgery, her vision was 20/30. No new hemorrhage was observed, nor did any fibrovascular proliferation occur from choroidal rupture. Continuous infusion instead of use of syringes for irrigation reduces the frequency of instrument passages through the pars plana and vitreous base, which may help reduce the risk of iatrogenic ora lesions. Surgery should be performed within 7 days to avoid toxic or metabolic retinal damage. PMID:9380364
Steinhorst, U H; Theischen, M; Winter, R
Subretinal Lavage: A Technique of Continuous Subretinal Irrigation for Removal of Traumatic Submacular Hemorrhage
A 12-year-old female patient suffered a horse kick to her face, resulting in various orbital fractures and blunt eye trauma. Upon ophthalmoscopy, an extensive subretinal hemorrhage was revealed under the macula, reaching to both vascular arcades. The visual acuity was 20\\/300. Five days after the accident, the patient was referred for vitreoretinal surgery. After standard vitrectomy, a small retinotomy was
Ulrich H. Steinhorst; Marc Theischen; Rolf Winter
CDB-2914 for Uterine Leiomyomata Treatment
OBJECTIVE To evaluate whether 3-month administration of CDB-2914, a selective progesterone receptor modulator, reduces leiomyoma size and symptoms. METHODS Premenopausal women with symptomatic uterine leiomyomata were randomly assigned to CDB-2914 at 10 mg (T1) or 20 mg (T2) daily or to placebo (PLC) for 3 cycles or 90102 days if no menses occurred. The primary outcome was leiomyoma volume change determined by magnetic resonance imaging at study entry and within 2 weeks of hysterectomy. Secondary outcomes included the proportion of amenorrhea, change in hemoglobin and hematocrit, ovulation inhibition, and quality-of-life assessment. RESULTS Twenty-two patients were allocated, and 18 completed the trial. Age and body mass index were similar among groups. Leiomyoma volume was significantly reduced with CDB-2914 administration (PLC 6%; CDB-2914 ?29%; P=.01), decreasing 36% and 21% in the T1 and T2 groups, respectively. During treatment, hemoglobin was unchanged, and the median estradiol was greater than 50 pg/mL in all groups. CDB-2914 eliminated menstrual bleeding and inhibited ovulation (% ovulatory cycles: CDB-2914, 20%; PLC, 83%; P=.001). CDB-2914 improved the concern scores of the uterine leiomyoma symptom quality-of-life subscale (P=.04). One CDB-2914 woman developed endometrial cystic hyperplasia without evidence of atypia. No serious adverse events were reported. CONCLUSION Compared with PLC, CDB-2914 significantly reduced leiomyoma volume after three cycles, or 90102 days. CDB-2914 treatment resulted in improvements in the concern subscale of the Uterine Fibroid Symptom Quality of Life assessment. In this small study, CDB-2914 was well-tolerated without serious adverse events. Thus, there may be a role for CDB-2914 in the treatment of leiomyomata.
Levens, Eric D.; Potlog-Nahari, Clariss; Armstrong, Alicia Y.; Wesley, Robert; Premkumar, Ahalya; Blithe, Diana L.; Blocker, Wendy; Nieman, Lynnette K.
Uterine Rotation: A Cause of Intestinal Obstruction
Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.
Gonzalez-Mesa, Ernesto; Narbona, Isidoro; Cohen, Isaac; Villegas, Emilia; Cuenca, Celia
[Uterine cervical carcinoma and pericardial effusion].
A 64-year-olf woman has been treated by chemotherapy for a uterine cervical carcinoma with known pathological lymph nodes in the abdomen and in the thorax. She is admitted in our Intensive Care Unit for fever and cardiac tamponade attributed to a large pericardial effusion. No diagnostic could be concluded from the analysis of the liquid or the pericardial biopsy. Complementary investigations are performed and the differential diagnosis of pericardial effusion is discussed in the context of a neoplastic disease. PMID:18069518
Vokaer, B; Machiels, J P; Vansnick, F; Castaigne, C; Feoli, F; Dediste, A; Sculier, J P
Ovine surgical model of uterine space restriction: interactive effects of uterine anomalies and multifetal gestations on fetal and placental growth.
Intrauterine growth restriction (IUGR) is observed in conditions with limitations in uterine space (e.g., uterine anomalies and multifetal gestations). IUGR is associated with reduced fetal weight, organ growth, and a spectrum of adult-onset diseases. To examine the interaction of uterine anomalies and multifetal gestations, we developed a surgical uterine space restriction model with a unilateral uterine horn ligation before breeding (unilateral surgery). Placentas and fetuses were studied on Gestational Day (GD) 120 and GD 130 (term = 147 days). Unilateral surgery decreased placentome numbers in singleton and twin pregnancies (25% and 50%, respectively) but not unilateral triplets. Unilateral surgery decreased total placentome weight in twin pregnancies (decreased 24%). Fetuses categorized as uterine space restricted (unilateral twin and both groups of triplets) had 51% fewer placentomes per fetus and a 31% reduction in placentomal weight per fetus compared to the nonrestricted group (control singleton, unilateral singleton, and control twin). By GD 130, uterine space-restricted fetuses exhibited decreased weight, smaller crown-rump, abdominal girth, and thoracic girth as well as decreased fetal heart, kidney, liver, spleen, and thymus weights. Lung and brain weights were unaffected, demonstrating asymmetric IUGR. At GD 130, placental efficiency (fetal weight per total placentomal weight) was elevated in uterine space-restricted fetuses. However, fetal arterial creatinine, blood urea nitrogen, and cholesterol were elevated, suggesting insufficient placental clearance. Maternal-to-fetal glucose and triglycerides ratios were elevated in the uterine space-restricted pregnancies, suggesting placental nutrient transport insufficiency. This model allows for examination of interactive effects of uterine space restriction-induced IUGR on placental adaptation and fetal organ growth. PMID:20574052
Meyer, Katie M; Koch, Jill M; Ramadoss, Jayanth; Kling, Pamela J; Magness, Ronald R
[Uterine artery embolization--clinical problems].
The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects. PMID:24505954
Wo?niakowska, Ewa; Milart, Pawe?; Paszkowski, Tomasz; Palacz, Tomasz; Wo?niak, S?awomir; Wrona, Wojciech; Szkodziak, Piotr; Paszkowski, Maciej; Czuczwar, Piotr
The biology of uterine sarcomas: A review and update
Uterine sarcoma is a rare neoplasm, accounting for only 5% of uterine malignancies. The pathogenesis of uterine sarcoma remains largely unknown, although recent basic science and pre-clinical animal models have provided a better understanding of tumor biology. The aim of this study was to review the clinical features, imaging characteristics, genetic aberrations and therapeutic approaches in uterine sarcoma. This study reviewed the English-language literature on clinical and basic studies on uterine sarcoma. The common variants of uterine sarcoma are carcinosarcoma, leiomyosarcoma and endometrial stromal sarcoma (ESS). Genetic profiling efforts have identified amplification, overexpression and mutation, while the molecular mechanisms of tumorigenesis driven by these genomic and genetic aberrations have yet to be fully elucidated yet. Recent genome-wide studies have also identified complex chromosomal rearrangements as oncogenic mechanisms. The cell cycle regulators, p16 and p53, are frequently over-expressed and appear to be involved in key modifications of sarcomagenesis. Molecular-targeted therapy has now been evaluated in clinical trials for certain subtypes. In conclusion, aberrations of cell cycle control would be a critical step in the development of uterine sarcoma. This review has provided new areas of study targeting molecular and genetic pathways.
Delayed uterine fluid clearance and reduced uterine perfusion in bitches with endometrial hyperplasia and clinical management with postmating antibiotic.
In many species a transient uterine inflammatory response follows mating and is proposed to remove excess spermatozoa, bacteria, and other contaminants from the uterus. Similar events have been documented in the bitch involving increased uterine contractions, polymorphonuclear neutrophil influx and uterine artery vasodilation. Some healthy bitches with endometrial hyperplasia have increased numbers of uterine luminal polymorphonuclear neutrophils after mating and reduced fertility; it is purported that this represents a presumed postmating endometritis. This study used B-mode and Doppler ultrasonography at the time of mating to measure uterine contractions, clearance of ejaculated fluid, and uterine artery velocity in normal bitches and those with endometrial hyperplasia. Mating resulted in an increase in the number of uterine contractions, although fewer mating-induced contractions were noted in bitches with endometrial hyperplasia. Interestingly, uterine fluid cleared significantly more slowly after mating from the bitches with endometrial hyperplasia than the normal bitches (P = 0.01). In a further study, Doppler ultrasonography showed that in normal bitches there was a significant increase in uterine artery blood velocity (P = 0.04) and a decrease in the resistance index after mating (P = 0.04), indicating vasodilation. In bitches with endometrial hyperplasia the baseline resistance index was significantly higher than normal bitches (P = 0.05), and furthermore, although there was a significant decrease in resistance index after mating, in the bitches with endometrial hyperplasia this was of a smaller magnitude that in normal bitches. These findings indicate lower baseline uterine perfusion, and a blunted vasodilation response to mating in bitches with endometrial hyperplasia. Short-duration postmating administration of systemic antibiotic increased pregnancy rates in bitches with endometrial hyperplasia (P < 0.01). Litter sizes in bitches with endometrial hyperplasia were lower than those of normal bitches both before and after treatment with postmating antibiotic (P = 0.04 and < 0.01, respectively). Mating-induced endometritis in bitches with endometrial hyperplasia appears to affect fertility by reducing the uterine vasodilatory response to mating and delaying clearance of uterine fluid as a result of decreased uterine contractions but the effect can be ameliorated in part by the postmating administration of antibiotic. PMID:22980089
England, G C W; Moxon, R; Freeman, S L
Effect of exposure to swine dust on levels of IL-8 in airway lavage fluid
BACKGROUND: Inhalation of swine dust causes airway inflammation with influx of inflammatory cells, predominantly neutrophils, into the lungs. A study was undertaken to determine whether or not exposure to swine dust induces release of interleukin 8 (IL-8) into upper and lower airways and how this possible release is related to cellular influx. A further aim was to study the relationship between the inflammatory response and swine dust exposure. METHODS: Thirty one healthy, non- smoking, previously unexposed subjects were exposed to swine dust during three hours work in a swine house. Bronchoalveolar lavage (BAL) was performed two weeks before and 24 hours after the exposure (n = 16). Nasal lavage and acoustic rhinometry were carried out 1-2 hours before and seven hours after the start of the exposure (n = 31). Exposure measurements were performed with personal sampling equipment. RESULTS: The exposure led to 19-fold and 70-fold increases in the neutrophil concentrations in nasal lavage and BAL fluid, respectively (p < 0.001). In BAL, fluid macrophages, lymphocytes and eosinophils increased significantly. The IL-8 levels in BAL fluid increased from < 31.3 ng/l to 63 (43-109) ng/l (median (25-75th percentile), p < 0.001), and in nasal lavage fluid the concentrations increased from 144 (97- 227) ng/l to 1064 (864-1437) ng/l (p < 0.001). IL-8 levels showed a significant correlation with the increase in neutrophils in the nasal lavage fluid but not in the BAL fluid. Acoustic rhinometry demonstrated significant swelling of the nasal mucosa. The air concentration of inhalable dust was 23.3 (20.0-29.3) mg/m3, endotoxin 1.3 (1.1-1.4) micrograms/m3, and muramic acid 0.99 (0.78-2.1) microgram/m3. CONCLUSIONS: The concentration of IL-8 increases in BAL fluid and nasal lavage fluid following exposure to swine dust and may be one of the chemoattractants contributing to the recruitment of neutrophils to the nasal cavity and the alveolar space. ???
Larsson, B. M.; Palmberg, L.; Malmberg, P. O.; Larsson, K.
Measurement of Phenolic Environmental Estrogens in Women with Uterine Leiomyoma
Objectives To investigate the effect of phenolic environmental estrogens on uterine leiomyoma from the perspective of clinical epidemiology. Methods Urine and blood samples were collected from Han women with uterine leiomyoma and women without uterine leiomyoma, living in Nanjing, China, between September 2011 and February 2013. A total of 156 urine samples and 214 blood samples were collected from the uterine leiomyoma group and 106 urine samples and 126 blood plasma samples from the control group. Bisphenol A (BPA), nonylphenol (NP) and octylphenol (OP) concentrations were determined by solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Results Phenolic environmental estrogens in the uterine leiomyoma and control groups were compared based on: gravida>3 and gravida ? 3. In participants with gravida>3, urine OP concentration was significantly (P<0.05) higher in the uterine leiomyoma group than in the control group. In participants with gravida ? 3, urine NP concentration was significantly (P<0.05) higher in the uterine leiomyoma group compared to controls. Despite obstetric history, urine BPA mean exposure concentration was significantly (P<0.05) different between uterine leiomyoma group and control group. The urine BPA concentration was not significantly (P>0.05) different between gravida>3 and gravida ? 3 patients. There was no significant (P>0.05) difference in plasma concentrations of BPA, OP and NP between the leiomyoma group and control group. Mean exposure concentration and range of distribution of BPA, OP and NP plasma concentration differed between the uterine leiomyoma and control group. Conclusion Exposure level of phenolic environmental estrogens in human was related with leiomyoma tumorigenesis.
Shen, Yang; Xu, Qian; Ren, Mulan; Feng, Xu; Cai, Yunlang; Gao, Yongxing
Methylene blue: how to visualize the endometrium in uterine morcellation material.
The aim of the study was to evaluate whether the preoperative intrauterine injection of methylene blue could help in visualizing the endometrium of uterine morcellation specimens. A total of 48 laparoscopic subtotal hysterectomies using the uterine morcellation technique were used for the study. In 19 of these cases, a preoperative intrauterine administration of methylene blue had been performed (study group). The total number of slides for each group, without and with methylene blue, was counted. Moreover, the number of slides comprising endometrial tissue was evaluated. The number of sections included in the control group to adequately assess the endometrium ranged from 6 to 95 (mean 27.24Ý4.01), whereas the respective number for the study group ranged from 4 to 10 (mean 7.21Ý0.44). The efficacy of recognizing adequate endometrial tissue (defined by the percentage of slides with adequate endometrial tissue over the overall slides requested to evaluate complete uterine histology) was significantly higher in the study group compared with that in the control group (67.05%Ý2.36% vs. 17.46%Ý2.66%, respectively; P<10(-3)). The preoperative intrauterine methylene blue administration when programming a uterine morcellation is an easy, cheap, harmless, and quick procedure that has many advantages. It reduces the time of gross handling and the number of tissue blocks submitted for examination without harming the morphologic appearance of the endometrial tissue. Moreover, it helps pathologists in identifying areas with endometrial pathology that would have probably escaped from attention in conventionally handled material. PMID:24487467
Pavlakis, Kitty; Vrekoussis, Thomas; Pistofidis, George; Gavresea, Theofani; Panoskaltsis, Theodoros
Spontaneous Uterine Rupture in the First Trimester: A Case Report
Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. Most of the cases have various risk factors and mainly occur during the second or third trimester. However, spontaneous uterine rupture during the first trimester is extremely rare. We experienced a case of spontaneous uterine rupture in a 36-yr-old multiparous woman without definite risk factors. The initial impression was a hemoperitoneum of an unknown origin with normal early pregnancy. Intensive surgical method would be needed for accurate diagnosis and immediate management in bad situation by hemoperitoneum even though a patient was early pregnancy.
Ryu, Ki-Young; Lee, Jong-In; Park, Moon-Il
Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas.
Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma. Distinction of osteosarcoma from the more common carcinosarcoma is important due to the worse prognosis impacting on treatment decisions. In addition, synchronous presentation of this unusual tumour with bilateral breast carcinomas raises the possibility of a mutual genetic pathogenesis. PMID:24898994
Powell, George; Barth, Laura; Todd, Richard; Ganesan, Raji
Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report
Introduction Uterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture. Case presentation A 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34th week due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed. Conclusion Intestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.
Neuroectodermal immunophenotype in uterine malignant mullerian tumors (MMT): comparative immunohistochemical analysis with embryonal uterine development.
Multidirectional differentiation of neoplastic cells in uterine MMT is still a subject of controversy. The present study was designed to assess the immunophenotype of 15 uterine MMT paying special attention to the markers of neural (neuroendocrine) differentiation. In addition, the same immunohistochemical study was performed on 20 human fetal specimens in order to establish possible relationships between the immunophenotype of MMT and the expression of the corresponding antigens in the fetal tissues of the embryonal female genital tract. Besides the typical immunohistochemical patterns in three cases the epithelial component showed simultaneous coexpression of vimentin and desmin. EMA and cytokeratin, whereas epithelial markers were coexpressed with vimentin in the sarcomatous component of one adenosarcoma. Moreover, both components were immunoreactive to the markers of neural differentiation (PGP 9.5, GFAP, HNK-1, N-CAM, HBA71). This aberrant expression was not correlated with morphological signs of neural differentiation at either light microscopy or ultrastructural levels. Regarding the analysis of fetal tissues, both epithelial and mesenchymal elements in the fetal genital tract expressed the above-mentioned neural markers at different dates of gestation. The intensity of this expression diminishes as the fetus matures and at the end of antenatal life the immunophenotype characteristic for adult life is established. Taking into consideration the capacity of uterine tissue to reproduce embryonal phenotype during neoplastic transformation, we studied this abnormal immunoprofile and its hypothetic value for the diagnosis and prognosis of MMT. PMID:15053066
Karseladze, A; Perevoshchikov, A; Navarro, S; Llombart-Bosch, A
Evaluation of a colonic lavage solution to prepare the colon of the dog for colonoscopy.
Ten dogs were given 3 different doses (60, 80, and 100 ml/kg of body weight) of a commercial colonic lavage solution in 2 equally divided doses, 2 to 4 hours apart. The degree of colonic cleanliness was evaluated subjectively, using a numbered scoring system (1 = clean to 4 = excessive fecal material). Systemic and metabolic effects were assessed by comparing body weight, PCV, total protein concentration, serum osmolality, and urine specific gravity before and 24 hours after administration of the high-dose solution. The lowest mean cleanliness score (1.6) was obtained with the 80 ml/kg dose (P less than 0.001). The solution had no effect on any measurement except urine specific gravity (P = 0.036). Oral administration of a colonic lavage solution in a divided total dose of 80 ml/kg is a safe and effective method of large-intestine preparation in the dog. PMID:2599958
Burrows, C F
Manual and automated leukocyte differentiation in bronchoalveolar lavage fluids from rodent models of pulmonary inflammation
Manual total and differential leukocyte counting in bronchoalveolar lavage fluids (BALF) by visual microscopy is a standard\\u000a means of evaluating airway inflammation and the anti-inflammatory properties of therapeutics in various animal models of lung\\u000a disease. The manual cell counting method derives total leukocyte counts from BALF with a hemocytometer, and cell differentials\\u000a (mononuclear, neutrophil, eosinophil) are calculated from the percentage
Michelle Natiello; George Kelly; James Lamca; David Zelmanovic; Richard W. Chapman; Jonathan E. Phillips
Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs
Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical\\u000a concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure\\u000a and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional\\u000a open repair of gastric perforation and abdominal lavage
C. Bloechle; A. Emmermann; T. Strate; U. J. Scheurlen; C. Schneider; E. Achilles; M. Wolf; D. Mack; C. Zornig; C. E. Broelsch
Use of Bronchoalveolar Lavage in HumansPast Necessity and Future Imperative
. Limited bronchoalveolar lavage (BAL) as an extension of fiberoptic bronchoscopy has permitted the recovery of airway-alveolar\\u000a space cells and soluble substances in the extracellular lining fluid that have been used diagnostically and as research specimens\\u000a in patients with a variety of lung diseases and in normal subjects for the study of lung host defenses. During the past three\\u000a decades,
H. Y. Reynolds
Bronchoalveolar Lavage and Other Methods to Define the Human Respiratory Tract Milieu in Health and Disease
During fiber-optic bronchoscopy (FOB), surface sampling of the human respiratory airways and alveolar unit can be done with\\u000a bronchoalveolar lavage (BAL), plus selective sites can be brushed for cells and transbronchial biopsies made in adjacent tissue.\\u000a This permits analysis of the respiratory tracts milieu in healthy normals, in those with disease, and in control subjects.\\u000a These combined procedures have been
Herbert Y. Reynolds
Prospective randomized comparison of oral sodium phosphate and polyethylene glycol lavage for colonoscopy preparation
AIM: To compare the effectiveness, patient acceptability, and physical tolerability of two oral lavage solutions prior to colonoscopy in a Taiwanese population. METHODS: Eighty consecutive patients were random- ized to receive either standard 4 L of polyethylene glycol (PEG) or 90 mL of sodium phosphate (NaP) in a split regimen of two 45 mL doses separated by 12 h, prior
Kai-Lin Hwang; William Tzu-Liang Chen; Koung-Hong Hsiao; Hong-Chang Chen; Ting-Ming Huang; Chien-Ming Chiu; Ger-Haur Hsu
Trace and Major Elements Status in Bronchoalveolar Lavage Fluid in Dogs with or without Bronchopneumonia
The aim of this study was to investigate the relationships between the bronchopneumonia and mean concentrations of those trace\\u000a elements in bronchoalveolar lavage fluid (BALF). Twenty-nine dogs were included this study (17 healthy dogs and 12 dogs with\\u000a respiratory disease). Each BALF sample had been obtained during bronchoscope examination by use of a standardized method.\\u000a The concentrations of Al, Br,
Kazuyuki Suzuki; Yoshiki Yamaya; Noriko Kanzawa; Momoko Chiba; Kouichiro Sera; Ryuji Asano
Rewarming a patient with accidental hypothermia and cardiac arrest using thoracic lavage.
The optimal treatment for severe accidental hypothermia is cardiopulmonary bypass because this offers the most rapid rate of rewarming. However, cardiopulmonary bypass therapy is not available in every hospital. In these circumstances, rewarming has to be achieved with other methods. We present a patient who was successfully rewarmed with thoracic lavage after he had been found with a core temperature of 21¯C and asystole. PMID:24882294
Turtiainen, Johanna; Halonen, Jari; Syvðoja, Sakari; Hakala, Tapio
Analysis of Trace and Major Elements in Bronchoalveolar Lavage Fluid of Mycoplasma Bronchopneumonia in Calves
The aim of this study was to evaluate the reliability and effectiveness of direct determination of trace and major element\\u000a concentrations in bronchoalveolar lavage fluid samples from Holstein calves with Mycoplasma bronchopneumonia (n?=?21) and healthy controls (n?=?20). The samples were obtained during bronchoscopy using a standard examination method. A total of 18 elements (aluminum,\\u000a bromine, calcium, chlorine, chromium, copper, iron,
Kazuyuki Suzuki; Hidetoshi Higuchi; Hidetomo Iwano; Jeffrey Lakritz; Kouichiro Sera; Masateru Koiwa; Kiyoshi Taguchi
Late leiomyoma expulsion after uterine artery embolization.
A case of late expulsion of a leiomyoma after uterine artery embolization (UAE) is reported in a 49-year-old woman who underwent UAE for a huge (13 cm x 12 cm; 1,061 cm(3)) bleeding- and bulk-related intramural leiomyoma diagnosed with ultrasonography. Free-flow embolization was performed with 150-400-microm polyvinyl alcohol particles and absorbable particle sponge. Symptoms and myoma size were successfully controlled until 44 months, at which time the patient reported vaginal discharge. A 7-cm necrotic, partly submucosal leiomyoma was detected. The patient refused hysterectomy and spontaneously expelled the leiomyoma through the cervix 6 months later. In conclusion, UAE necessitates long-term follow-up and women should be warned of late complications. PMID:15590809
Marret, Henri; Keris, Yann Le Brun; Acker, Olivier; Cottier, Jean Philippe; Herbreteau, Denis
A better way to manage perinephric abscesses: percutaneous ultrasonography-guided endoscopic lavage.
Purpose: To report the efficacy and safety of percutaneous ultrasonography-guided endoscopic lavage in the management of perinephric abscesses. Patients and Methods: This is a retrospective review of patients in a single center who had perinephric abscesses and were treated by percutaneous ultrasonography-guided endoscopic lavage during the period of March 2001 to March 2013. Information including the demographics, comorbid medical conditions, presenting symptoms, size of abscesses, operation information, and postoperative information were retrieved for review. Results: There were 37 patients (40 operations) identified during the study period. The mean age was 56.8 years (21-91 years). Eighteen (48.9%) patients presented with loin pain (48.6%) and/or fever (18, 48.6%), and the mean diameter of the abscesses was 10.8?cm (5-22?cm). Thirty-one (77.5%) procedures were performed under general anesthesia. The mean operative time was 49.4 minutes (15-140?min). Thirty-one (77.5%) patients had their percutaneous track dilated to 32F. Only two of 37 (5.4%) patients needed repeated drainage. The average postoperative drainage time was 8.35 days (3-21 days). The median postoperative hospital stay for our patients was 10 days (4-101 days). There was no mortality related to the abscess in this cohort. Conclusion: Percutaneous Ultrasonography-guided endoscopic lavage was shown to be an effective and safe approach for patients with perinephric abscesses. PMID:24372374
Ng, Chi-Fai; Liong, Yee Vonne; Leong, Wai Shing; Harris, David F; Lau, Ban Eng; Liong, Men Long
Measurement of interleukin 10 in bronchoalveolar lavage from preterm ventilated infants
BACKGROUNDInterleukin 10 (IL-10) is a cytokine that downregulates inflammation, in part by reducing the production of the proinflammatory cytokines IL-1? and IL-8. It has been suggested that an inability to produce IL-10 might predispose preterm infants to develop chronic lung disease.?AIMTo measure IL-10, IL-1?, and IL-8 in bronchoalveolar lavage fluid from ventilated preterm infants in a prospective cohort study.?PATIENTS17 consecutive newborn infants ? 29 weeks' gestational age (median, 25; 9 boys) who were ventilated from birth underwent daily bronchoalveolar lavage sampling.?RESULTS102 samples were collected, of which 57 contained IL-10 in amounts that were comparable with those found previously in ventilated term infants with respiratory failure. Chronic lung disease developed in 9 of the 11 survivors and all 9 infants had produced IL-10. IL-1? and IL-8 were detected in nearly all samples and were raised throughout the course of sample collection.?CONCLUSIONIL-10 is readily detectable in early bronchoalveolar lavage samples from ventilated preterm infants, although it remains unclear whether this cytokine has any influence on the development of chronic lung disease.??
McColm, J.; Stenson, B.; Biermasz, N.; McIntosh, N.
Latent pulmonary involvement in Crohn's disease: biological, functional, bronchoalveolar lavage and scintigraphic studies.
We have investigated the following pulmonary related parameters in 22 patients with Crohn's disease who were free of clinical pulmonary symptoms and had normal chest roentgenograms and in 25 controls: serum angiotensin converting enzyme, pulmonary function tests, bronchoalveolar lavage (lymphocyte count and subpopulations, macrophage viability and superoxide anion release by macrophages) and pulmonary scannings. Serum angiotensin converting enzyme was lower in Crohn's disease (14.1 +/- 5.1) than in controls (25.2 +/- 4.7) (p less than 0.001). Twelve of 22 Crohn's disease (54%) had a bronchoalveolar lavage lymphocytosis (greater than 18% alveolar lymphocytes). Bronchoalveolar lavage lymphocytes subpopulations were quite variable. Twelve of 17 Crohn's disease (71%) had an increase spontaneous and/or stimulated superoxide anion production by alveolar macrophages. Six of 12 Crohn's disease (50%) had an increase physiologic dead space in the upper part of their lung against one of 11 controls (9%). These data suggest that most patients with Crohn's disease have a latent pulmonary involvement.
Bonniere, P; Wallaert, B; Cortot, A; Marchandise, X; Riou, Y; Tonnel, A B; Colombel, J F; Voisin, C; Paris, J C
Utility of Gastric Lavage for Diagnosis of Tuberculosis in Patients who are Unable to Expectorate Sputum
Background: There are number of patients who are unable to expectorate sputum specimens. In this study, we used gastric lavage (GL) test for diagnosis of tuberculosis (TB) in patients who were unable to produce sputum. Materials and Methods: Patients who were unable to produce sputum specimens were included in the study to confirm TB disease. Gastric lavage sampling was performed and sent for acid fast bacillus smear and culture under special laboratory conditions and sterilized methods. Further bronchoscopy for broncho-alveolar lavage was done on patients with negative GL smear results. Drug susceptibility tests were performed on 48 GL culture positive cases. Results: Eighty-five patients were included in the study; who were hospitalized at our referral center for suspected TB. GL smears were reported to be positive in 37 cases (66.07%) and culture in 85.7%. The total number of smear and culture-positive cases in this study was 48 (85.7%). Forty cases (87%) of drug-sensitive, 1 case (2.2%) of isoniazid and rifampin-resistant TB (multi-drug resistant; MDR), and 5 cases of resistant to one drug were detected. There have not been observed any complications after the GL method. Conclusion: It seems that regarding the high number of positive GL cultures (85.7%), GL can be effective for diagnosis of patients who have suspicious tuberculosis symptoms and are unable to produce sputum especially in resource limited areas.
Baghaei, Parvaneh; Tabarsi, Payam; Farnia, Parisa; Radaei, Amir Hoseyn; Kazempour, Mehdi; Faghani, Yazdan Ali; Mirsaeidi, Mehdi; Novin, Atieh; Chitsaz, Ehsan; Mansouri, Davoud; Masjedi, Mohammad Reza; Velayati, Ali Akbar
Molecular characterization of uterine clear cell carcinoma.
Clinicopathological studies support a broad classification of endometrial carcinoma into two major types, designated as type I and type II, which correlate with their biological behavior. More recently, molecular studies have provided further insights into this classification scheme by elucidating the genetic events involved in the development and progression of endometrial carcinoma. Microsatellite instability and mutations in the PTEN gene have been widely associated with type I (endometrioid) endometrial carcinoma, while p53 mutations have been identified in the majority of type II endometrial carcinoma, of which uterine serous carcinoma is the prototype. Uterine clear cell carcinoma (UCC) is an uncommon variant of endometrial carcinoma, and clinicopathological studies have produced conflicting results regarding its biological behavior with 5-year survival ranging from 21 to 75%. The molecular characteristics of endometrioid and serous carcinoma have been studied extensively; however, there have been few molecular genetic studies of the clear cell subtype. In this study, we evaluated 16 UCCs (11 pure and 5 mixed) for mutations in the p53 gene, PTEN gene and for microsatellite instability. Although we found that these alterations were uncommon in pure clear cell carcinomas, all three were identified. In addition, two cases of mixed serous and clear cell carcinoma showed an identical mutation of the p53 gene in the histologically distinct components and one case of mixed clear cell and endometrioid carcinoma had identical mutations in the PTEN and p53 genes, and microsatellite instability in both components. Our data suggest that UCC represent a heterogeneous group of tumors that arise via different pathogenetic pathways. Additional molecular studies of pure clear cell carcinoma are required to further elucidate the genetic pathways involved in its development and progression. PMID:14976538
An, Hee-Jung; Logani, Sanjay; Isacson, Christina; Ellenson, Lora H
Characterization of two glycoproteins isolated from lung lavage fluid of normal human and from patients with two pulmonary diseases
Two glycoproteins of M1 62,000 and 36,000 have been isolated and purified from lung lavage of normal human and patients with sarcoidosis and bibasilar fibrosis. The two glycoproteins contained hydroxyproline, high amounts of glycine, and other amino acids in amounts comparable to those present in the same two glycoproteins isolated from lung lavage of patients with alveolar proteinosis. The antibody
S. N. Bhattacharyya; D. Y. Bell
Placenta percreta and uterine rupture at 16 weeks.
Placenta percreta is a complication of pregnancy with significant morbidity and mortality rates. Spontaneous uterine rupture in early pregnancy due to placenta percreta is rare. We report a case of this life-threatening complication occurring at the sixteenth week of gestation. The patient presented with signs of shock, acute abdomen, and evidence of hemoperitoneum. The pregnancy was viable with a normal ultrasound appearance that created some confusion and there was a dilemma in the diagnosis of this case. Various obstetric and surgical causes were taken into consideration. The patient was taken to the operating room immediately for exploratory laparotomy. She was found to have fundal uterine rupture, which was managed by uterine repair. This patient had prior cesarean section and dilatation and curettage; factors well known to predispose for placenta percreta. Here, we emphasize the importance of a fast decision and surgical intervention to save a patient's life in cases of uterine rupture. PMID:23860897
Neyazi, Salwa M
Uterine contractility patterns after an episode of preterm labor.
Uterine contractility patterns were studied in an attempt to identify those women on tocolytic therapy at risk for preterm delivery. One hundred sixteen women treated successfully after an episode of preterm labor were followed with an ambulatory tocodynamometer system. Contractions were monitored twice daily for 1 hour until delivery or until 36 completed weeks of gestation. In this group, 52 women (45%) delivered preterm and 64 (55%) delivered at term. The analysis revealed that 1) from 24-29 weeks' gestation, there was no significant difference in the uterine activity between the two groups; and 2) beginning at 30 weeks' gestation and continuing until the end of the 36th week of gestation, uterine activity was significantly greater in women destined to deliver preterm. These observations suggest that the patterns of daily uterine contractility observed in patients after an episode of preterm labor can identify those at greater risk for a preterm delivery. PMID:2406657
Brustman, L E; Langer, O; Damus, K; Anyaegbunam, A; Merkatz, I R
Surgical Alternatives to Hysterectomy for Abnormal Uterine Bleeding. Physician Report.
National Technical Information Service (NTIS)
The purpose of this report is to prevent physicians with several surgical alternatives to hysterectomy for women experiencing menorrhagia and dysfunction uterine bleeding. Approximate 8700 hysterectomies are performed annually in Minnesota. Due to its inv...
Ultrasound-Guided Unification of Noncommunicating Uterine Cavities
Background: The benefits of ultrasound-guided hysteroscopic metroplasty have been well described in the management of the partial septate uterus. The use of ultrasonography at the time of hysteroscopy provides visualization of the intrauterine instruments within the uterine cavity. This report describes a case where ultrasound-guidance was used to enter a noncommunicating uterine cavity hysteroscopically. Methods: A 22-year-old female after her third miscarriage experienced worsening dysmenorrhea. The patient underwent a laparoscopy and hysteroscopy to further evaluate the cause of pelvic pain and to treat the M■llerian anomaly. Under ultrasound-guidance, the 2 uterine cavities were unified by hysteroscopic metroplasty. Results: Postoperative sonohysterography demonstrated unification of the 2 cavities. Conclusions: This unique application of ultrasound-guidance in hysteroscopic surgery may aid the surgeon in entering a noncommunicating uterine cavity.
Mullesserill, Bijoy T.; Dumesic, Daniel A.; Damario, Mark A.
Unusual case of uterine stump pyometra in a cat.
This report describes an unusual case of uterine stump pyometra in a cat whose main clinical sign at presentation was abdominal straining. At the time of ovariohysterectomy, the surgeon reported that the uterine body had a purulent content. Nearly a month after the surgery the cat showed abdominal straining. The enlarged uterine stump, filled with purulent fluid, had caused a compression of the rectum and secondary intestinal sub-occlusion. Surgical revision consisted of draining the purulent content of the remnant of the uterine body and ablating as much of it as possible; checking of the ovarian pedicles revealed the presence of a small fragment of whitish tissue on the right side, which was shown to contain, by means of histological observation and immunohistochemical staining, ovarian tissue. Four months after surgical revision the queen did not show any pathological signs and 1 year later she is still in good health. PMID:21256784
Rota, Ada; Pregel, Paola; Cannizzo, Francesca T; Sereno, Alessandra; Appino, Simonetta
Dysfunctional Uterine Bleeding: Questions to Discuss with Your Doctor
... Dysfunctional Uterine Bleeding Questions to Discuss with Your Doctor: Do you have regular menstrual cycles? Is your ... Do you have kidney or liver disease? Your Doctor Might Examine the Following Body Structures or Functions: ...
Genetic Cause of Infertility Associated with Uterine Fibroids
... Advances Supported Networks, Programs & Initiatives Genetic Cause of Infertility Associated with Uterine Fibroids Skip sharing on social ... To determine whether TSC genes were involved in infertility related to fibroids, scientists funded by the Fertility ...
A rare case of uterine adenomyosis in a Siamese cat
A 12-year-old, female Siamese cat with a long-term history of megestrol acetate treatment for suppression of estrus was presented with vomiting and abdominal pain. Uterine adenomyosis was diagnosed after an ovariohysterectomy.
Bulman-Fleming, Julie
A Subset of Human Uterine Endometrial Macrophages is Alternatively Activated
Problem Human uterine macrophages must maintain an environment hospitable to implantation and pregnancy and simultaneously provide protection against pathogens. Although macrophages comprise a significant portion of leukocytes within the uterine endometrium, the activation profile and functional response of these cells to endotoxin is unknown. Method of Study Flow cytometric analysis of surface receptors and intracellular markers expressed by macrophages isolated from human endometria was performed. Uterine macrophages were stimulated with LPS. Cytokines, chemokines, and growth factors expressed by these cells were analyzed using Bio-Plex analysis. Results CD163high human endometrial macrophages constitutively secrete both pro- and anti-inflammatory cytokines as well as pro-angiogenic factors and secretion of these factors is LPS-inducible. Conclusions A major population of human uterine macrophages is alternatively activated. These cells secrete factors in response to LPS that are involved in the activation of immune responses and tissue homeostasis.
Jensen, Amy L.; Collins, Jane; Shipman, Emilie P.; Wira, Charles R.; Guyre, Paul M.; Pioli, Patricia A.
Uterine rupture following termination of pregnancy in a scarred uterus.
We present a series of two cases complicated by uterine rupture following termination of pregnancy (TOP) in the 1st and 2nd trimesters using misoprostol in women with caesarean section scar. Current literature and practise have also been reviewed on ruptured uterus in women with caesarean section scar undergoing TOP using misoprostol; the diagnosis of adherent placenta in the 1st and 2nd trimesters in women with previous caesarean uterine scar; and likely implications of a ruptured uterus. PMID:24456452
Bika, O; Huned, D; Jha, S; Selby, K
Endoscopic OCT for imaging of uterine body and cervix pathologies
NASA Astrophysics Data System (ADS)
First results of endoscopic applications of optical coherence tomography (OCT) in gynecology are presented. We have studied mucosa of uterus, uterine cervix and vagina in vivo. Images of healthy endometrium in different stages of menstrual cycle have been recorded. For uterine cervix not only OCT data of normal state but some kids of pathology have been analyzed. Capability of OCT to identify alterations of mucosa makes this method promising for early diagnosis of tumors and precise guiding of excisional biopsy.
Shakhova, Natalia; Kuznetzova, Irina N.; Gladkova, Natalia D.; Snopova, Ludmila; Gelikonov, Valentin M.; Gelikonov, Grigory V.; Feldchtein, Felix I.; Kuranov, Roman; Sergeev, Alexander M.
[Role of pelvic endoscopy in diagnosing congenital uterine malformations].
The role of pelvic endoscopy in diagnosing uterine abnormalities, considering material of 1170 patients, is presented in this paper. It has been documented that pelviscopy together with hysterosalpingography play basic role in determining type of uterine abnormality. In 20 cases pelvic endoscopy enabled verification of the primary diagnosis set by hysterosalpingography. Pelvic endoscopy is a method by choice in the diagnostics of the Rokitansky-K■ster-Hauser syndrome. PMID:1305571
Korzon, T; Mielnik, J; Adamcio-Deptulska, M; Go?ciniak, W; Lozyk, J
Antepartum uterine relaxation with nitroglycerin at Caesarean delivery
In this case report, NTG provided sufficient uterine relaxation to allow difficult twin extraction at Caesarean delivery.\\u000a Administration of NTG in this situation was controversial, and if it had not been effective, time may have been lost before\\u000a general anaesthesia could have been induced. Nitroglycerin merits further evaluation as an antepartum uterine relaxant, but\\u000a the initial experience is encouraging.
David C. Mayer
Education does not improve patient perception of preterm uterine contractility.
In this prospective study, we sought to compare pregnant women's self-perception of their preterm uterine contractility versus electronically obtained data and to evaluate the impact of intensive patient education on increasing awareness of the presence of uterine contractions. Thirty-eight women each monitored their uterine activity at home for two 60-minute periods daily during a 21-day sequence. An event marker was used to document perceived contractions and after a 3-day baseline interval, an intensive nursing-service educational intervention was initiated for all subjects. Thirty-five percent of women underreported uterine contractions, whereas only 5% overreported their uterine activity during the study. Derived patient scores of underreporting and overreporting of contractions did not vary among seven consecutive 3-day study intervals. Analysis of the data revealed that patients perceived fewer than 10% of all contractions documented electronically. No improvement in the reliability of patient perception of preterm uterine contractility was obtained after the educational intervention. PMID:2359589
Brustman, L E; Langer, O; Anyaegbunam, A; Belle, C; Merkatz, I R
Obstructive small bowel metastasis from uterine leiomyosarcoma: a case report.
Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents. PMID:24716034
Tunio, Mutahir A; Alasiri, Mushabbab; Saleh, Rasha M; Akbar, Shomaila Amir; Ali, Nagoud M; Senosy Hassan, Mohamed Abdalazez
Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report
Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.
Tunio, Mutahir A.; AlAsiri, Mushabbab; Saleh, Rasha M.; Akbar, Shomaila Amir; Ali, Nagoud M.; Senosy Hassan, Mohamed Abdalazez
A rare case of uterine leiomyosarcoma: a case report
Introduction Malignant change in a leiomyoma or uterine fibroid is termed leiomyosarcoma. It arises from smooth muscle of the uterus and is a rare tumor that accounts for 2% to 5% of all uterine malignancies. Very few cases are reported in the literature. Our patient did not have any history of genital bleeding, which is the usual presentation in uterine sarcoma. We report an original case report of an unusual presentation of this rare tumor arising from the uterus. Case presentation A 40-year-old nulliparous woman of South Indian origin presented with a mass in her abdomen for one year with a rapid increase in size over the previous three months. Tumor marker CA-125 was raised, and a computed tomography scan showed a mass arising from the pelvis. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. Conclusion Because of their rarity, uterine sarcomas are not suitable for screening. Diagnosis is by histopathologic examination and surgery is the only treatment. The prognosis for women with uterine sarcoma primarily depends on the extent of disease at the time of diagnosis and the mitotic index.
Cystic Rete Ovarii and Uterine Tube Adenoma in a Rabbit
ABSTRACT A 6-year-old female rabbit was presented to a veterinary clinic, and the result of ultrasound examination suggested a tumor in the uterine tube. Subsequently, both ovaries and uterus were surgically removed. In gross, a single large cyst in the right ovary and enlargement of the left uterine tube were observed. Histological examination revealed that the cyst had developed in the hilus of the ovary and was lined by single-layered cuboidal cells. In the left uterine tube, a tumor composed of epithelial cells arranged in tubular structures and pleomorphic cells between the tubular structures was observed. Immunohistochemically, the epithelial cells of the cyst were positive for pan-cytokeratin, cytokeratin 18, CD10, E-cadherin, calretinin and estrogen receptor; the tumor cells of the left uterine tube were positive for pan-cytokeratin, cytokeratin 18, E-cadherin, vimentin, calretinin and estrogen receptor. From these results, the cyst was diagnosed as cystic rete ovarii, and the tumor was diagnosed as adenoma of the uterine tube. This case is the first to demonstrate cystic rete ovarii and uterine tube adenoma in rabbits.
CHAMBERS, James K.; UCHIDA, Kazuyuki; ISE, Kenichiro; NAKAYAMA, Hiroyuki
Surgical management of leiomyomas for fertility or uterine preservation.
Leiomyomas are the most common pelvic tumors in women. These tumors are not always symptomatic but can cause abnormal uterine bleeding and anemia, pelvic pressure and pain, urinary frequency, and adverse reproductive outcomes-symptoms that can diminish the quality of life of women. Myomectomy is the primary treatment modality for women with symptomatic leiomyomas who are of reproductive age and desire future fertility. Myomectomy can significantly improve symptoms and quality of life and, in some clinical situations, improve reproductive outcomes. There are robust surgical outcome data supporting the use of a minimally invasive approach such as laparoscopy and hysteroscopy over laparotomy. Perioperative outcomes and return to normal activity are significantly better with a minimally invasive approach. Reproductive outcomes are not adversely affected. Detailed preoperative imaging is required for minimally invasive procedures to be successful. There are several evidence-based techniques that can be used to reduce blood loss during surgery. The role of robotic technology in enhancing surgical outcomes has not been clearly defined. PMID:23635687
Falcone, Tommaso; Parker, William H
Tissue doses from radiotherapy of cancer of the uterine cervix
For use in an epidemiologic study of subsequent tumors, absorbed doses from brachytherapy and external beam radiotherapy were measured and calculated for various tissues of patients treated for cancer of the uterine cervix. External beams included orthovoltage x rays (1.9 and 3.0 mm Cu half-value layer), cobalt-60 gamma rays, 2 MV x rays, and 25 MV x rays. The brachytherapy sources were encapsulated radium. Measurements were made in an Alderson anthropomorphic phantom and a water phantom; calculations were made using a Monte Carlo technique or standard radiotherapy methods. Depending upon stage of disease and radiation energy, the absorbed doses (cGy) from typical treatment regimes to tissues of interest were: ovaries, 1400--5200; stomach, 130--320; kidneys, 120--310; pancreas, 100--260; lungs, 22--48; breasts, 19--52; thyroid, 6--17; salivary glands, 4--11; brain, 2--7, and total active bone marrow, 320--1100. The lower values of each range were for stage I of the disease.
Stovall, M.; Smith, S.A. (Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030 (US)); Rosenstein, M. (Center for Devices and Radiological Health, Food and Drug Administration, Public Health Service, Rockville, Maryland 20857)
Upper airway response in workers exposed to fuel oil ash: nasal lavage analysis.
OBJECTIVES--Among other constituents, fuel oil ash contains vanadium pentoxide, a known respiratory irritant. Exposure to ambient vanadium pentoxide dust has been shown to produce irritation of the eyes, nose, and throat. The usefulness of nasal lavage in detecting an inflammatory response to exposure to fuel oil ash among 37 boilermakers and utility workers was investigated. METHODS--A baseline lavage was performed on the morning of the first day back to work after an average of 114 days away from work (range 36 hours to 1737 days). A lavage was performed after exposure on the morning three days after the baseline lavage. Exposure to respirable particulate matter of diameter < or = 10 microns (PM10) and respirable vanadium dust were estimated with daily work diaries and a personal sampling device for respirable particulates. These estimates were made for each subject on each workday during the three days between lavages. For each subject, the adjusted change in polymorphonuclear cells was calculated by dividing the change in polymorphonuclear cell counts by the average of the counts before and after exposure. The association between the adjusted polymorphonuclear cell counts and exposure was assessed with multiple linear regression, adjusted for age and current smoking. RESULTS--Personal sampling (one to 10 hour time weighted average) showed a range of PM10 concentrations of 50 to 4510 micrograms/m3, and respirable vanadium dust concentration of 0.10 to 139 micrograms/m3. In smokers the adjusted polymorphonuclear cell count was not significantly different from zero (-0.1%, P > 0.5), but in nonsmokers it was significantly greater than zero (+50%, P < 0.05). In both non-smokers and smokers, there was considerable variability in adjusted polymorphonuclear cell counts and a dose-response relation between these adjusted cell counts and either PM10 or respirable vanadium dust exposure could not be found. CONCLUSION--A significant increase in polymorphonuclear cells in non-smokers but not smokers was found. This suggests that in non-smokers, exposure to fuel oil ash is associated with upper airway inflammation manifested as increased polymorphonuclear cell counts. The lack of an increase in polymorphonuclear cells in smokers may reflect either a diminished inflammatory response or may indicate that smoking masks the effect of exposure to fuel oil ash.
Hauser, R; Elreedy, S; Hoppin, J A; Christiani, D C
Cytomorphology as a risk predictor: experience with fine needle aspiration biopsy, nipple fluid aspiration, and ductal lavage.
Primary prevention of breast cancer requires identification and elimination of cancer-causing agents, which is an incredibly difficult task to follow. Secondary prevention involves screening individuals who are at increased risk for breast cancer in hopes that early intervention will affect survival. In the 1980s, chemoprevention received serious attention. This approach was aimed at reducing cancer risk by administration of natural or synthetic clinical compounds that prevent, reverse, or suppress carcinogenesis in individuals at increased risk for cancer. It was not until 1998, however, when the first report from the National Surgical Adjunct Breast and Bowel Project (Breast Cancer Prevention Trial BCPT; P-1) randomized clinical trial appeared in the literature supporting the hypothesis that breast can-cer can be prevented. This study showed that administration of tamoxifen reduced the risk for invasive and noninvasive breast cancer by almost 50% in all age groups. With the current availability of tamoxifen as a chemopreventive agent and with the increasing emphasis on early breast cancer detection and prevention, more women seek consultation to determine their risk for breast cancer. However, in the absence of any detectable breast lesion, clinically and mammographically, only a few women may volunteer to have their breasts sampled by surgical biopsy for risk assessment. Other non-surgical procedures include fine needle aspiration biopsy (FNAB), nipple aspirate fluid (NAF), and the recently introduced procedure, ductal lavage. These techniques may provide better alternatives. These minimally invasive procedures are capable of recruiting cellular material for cytomorphologic interpretation and biomarker studies. PMID:16308095
Masood, Shahla
Management of pregnancy in woman with suspected malignant deep infiltrating endometriosis fistulised to the uterine cervix.
Deep infiltrating endometriosis (DIE) is a well-known cause of pelvic pain and infertility. Malignant transformation of DIE is rare but can be suggested by MRI. We report a case of a spontaneous pregnancy in a woman with suspicion of malignant transformation of DIE with fistulisation to the posterior uterine isthmus through to the cervical canal. The pregnancy was closely monitored and an uneventful caesarian section was performed at 34?weeks of gestation. This case raises the issue of the relevance of imaging techniques and management of pregnancy. PMID:24899016
Richard, Frederic; Canlorbe, Geoffroy; Bazot, Marc; Daraÿ, Emile
Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift procedure
The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse\\u000a may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift\\u000a procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented.
Lidewij R. Bartelink; Wouter F. Feitz; Kirsten B. Kluivers; Mariella I. J. Withagen; Mark E. Vierhout
Colpocleisis and Tension-Free Vaginal Tape Sling for Severe Uterine and Vaginal Prolapse and Stress Urinary Incontinence under Local Anesthesia
Study ObjectiveTo describe the technique, complications, and outcomes of vaginal repair of concomitant advanced uterine and vaginal prolapse and stress urinary incontinence using colpocleisis and tension-free vaginal tape (TVT) and pubovaginal sling under intravenous sedation and local anesthesia in elderly and\\/or medically compromised patients.
Robert D. Moore; John R. Miklos
Regional hyperthermia combined with radiotherapy for uterine cervical cancers: A multi-institutional prospective randomized trial of the international atomic energy agency
PurposeHyperthermia can be used to enhance the effects of radiation, and a combined treatment may, in some circumstances, be an advantage. Uterine cervical cancer is very common in developing countries. The control of locally advanced pelvic tumors is difficult with conventional treatment modalities. Based upon the biologic rationale and in view of the recent advances in heating and thermometry techniques,
Arumugam Vasanthan; Michihide Mitsumori; Jeong Ho Park; Zeng Zhi-Fan; Zhong Yu-Bin; Praskovya Oliynychenko; Hideo Tatsuzaki; Yoshiaki Tanaka; Masahiro Hiraoka
Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial
Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).
Mara, Michal; Kubinova, Kristyna, E-mail: firstname.lastname@example.com [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Maskova, Jana [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Horak, Petr [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Belsan, Tomas [Central Military Hospital, Department of Radiology (Czech Republic); Kuzel, David [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic)
Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report?
INTRODUCTION Adequate exposure is a vital factor in total laparoscopic hysterectomy, and uterine manipulators have been used in achieving that. The Hohl uterine manipulator has been considered to be one of the safer manipulators. Beside adequate exposure, it is associated with lower intraoperative complications. However, we report a case of iatrogenic uterine rupture with the Hohl manipulator which also caused bowel penetration. PRESENTATION OF CASE A 52-year-old woman with endometrial hyperplasia was scheduled for total laparoscopic hysterectomy. Prior to entering into the abdomen, the Hohl uterine manipulator was introduced into the uterine cavity without force. During the laparoscopic exploration, we noted that the tip of the Hohl manipulator had perforated the posterior uterine fundus and penetrated the bowel. Therefore, laparotomy was performed, and the bowel injury was repaired by a colorectal surgeon. DISCUSSION The Hohl uterine manipulator is safe and easy to use, and is associated with decreased intraoperative injuries. However, the complications observed due to the improper use of an uterine manipulator can overshadow any advantages of manipulator. In the present report, we describe a case of uterine perforation and bowel penetration caused by the Hohl uterine manipulator during total laparoscopic hysterectomy, which required conversion to laparotomy. The cause for this complication is associated with improper usage of the uterine manipulator. CONCLUSION Uterine manipulator may cause uterine perforation and bowel penetration at the beginning of the hysterectomy procedure. These types of complications can be prevented by proper application of the Hohl manipulator into the uterus under direct pelvic visualization.
Akdemir, Ali; Cirpan, Teksin
Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage
Clinically, the displacement of intravertebral fat into the circulation during vertebroplasty is reported to lead to problems in elderly patients and can represent a serious complication, especially when multiple levels have to be treated. An in vitro study has shown the feasibility of removing intravertebral fat by pulsed jet-lavage prior to vertebroplasty, potentially reducing the embolization of bone marrow fat from the vertebral bodies and alleviating the cardiovascular changes elicited by pulmonary fat embolism. In this in vivo study, percutaneous vertebroplasty using polymethylmethacrylate (PMMA) was performed in three lumbar vertebrae of 11 sheep. In six sheep (lavage group), pulsed jet-lavage was performed prior to injection of PMMA compared to the control group of five sheep receiving only PMMA vertebroplasty. Invasive recording of blood pressures was performed continuously until 60 min after the last injection. Cardiac output and arterial blood gas parameters were measured at selected time points. Post mortem, the injected cement volume was measured using CT and lung biopsies were processed for assessment of intravascular fat. Pulsed jet-lavage was feasible in the in vivo setting. In the control group, the injection of PMMA resulted in pulmonary fat embolism and a sudden and significant increase in mean pulmonary arterial pressure. Pulsed jet-lavage prevented any cardiovascular changes and significantly reduced the severity of bone marrow fat embolization. Even though significantly more cement had been injected into the lavaged vertebral bodies, significantly fewer intravascular fat emboli were identified in the lung tissue. Pulsed jet-lavage prevented the cardiovascular complications after PMMA vertebroplasty in sheep and alleviated the severity of pulmonary fat embolism.
Benneker, Lorin M.; Krebs, Jorg; Boner, Vanessa; Boger, Andreas; Hoerstrup, Simon; Heini, Paul F.
Automated image analysis of uterine cervical images
NASA Astrophysics Data System (ADS)
Cervical Cancer is the second most common cancer among women worldwide and the leading cause of cancer mortality of women in developing countries. If detected early and treated adequately, cervical cancer can be virtually prevented. Cervical precursor lesions and invasive cancer exhibit certain morphologic features that can be identified during a visual inspection exam. Digital imaging technologies allow us to assist the physician with a Computer-Aided Diagnosis (CAD) system. In colposcopy, epithelium that turns white after application of acetic acid is called acetowhite epithelium. Acetowhite epithelium is one of the major diagnostic features observed in detecting cancer and pre-cancerous regions. Automatic extraction of acetowhite regions from cervical images has been a challenging task due to specular reflection, various illumination conditions, and most importantly, large intra-patient variation. This paper presents a multi-step acetowhite region detection system to analyze the acetowhite lesions in cervical images automatically. First, the system calibrates the color of the cervical images to be independent of screening devices. Second, the anatomy of the uterine cervix is analyzed in terms of cervix region, external os region, columnar region, and squamous region. Third, the squamous region is further analyzed and subregions based on three levels of acetowhite are identified. The extracted acetowhite regions are accompanied by color scores to indicate the different levels of acetowhite. The system has been evaluated by 40 human subjects' data and demonstrates high correlation with experts' annotations.
Li, Wenjing; Gu, Jia; Ferris, Daron; Poirson, Allen
[Intra-uterine device and nulliparous women].
Intra-uterine device (IUD) is one of the birth control methods, which is available for nulliparous women, even though misconceptions still remain in medical or popular opinion. Only 1.3 % of nulliparous have a IUD as contraception in France while it is the second methods used by all women, after pill. The best contraception is the one chosen by women; however, the choice for a nulliparous of an IUD may be really difficult, despite the increasing number of women wishing to use it. Long-acting reversible contraceptives utilization, including IUD, is probably one of the issues to decrease the unintended pregnancies. An exhaustive and clear information about IUD is necessary to allow an informed and real choice. This prescription must consider contraindications and medical conditions for safe insertion, especially to avoid infection by screening STD (Chlamydia trachomatis and Nesseria gonorrhoeae) in nulliparous women<25years old. Insertion must be effected with usual precautions and short or SL IUD preferred. Even if side effects such as expulsion, pelvic pains or dysmenorrhea are more frequent by nulliparous, IUD is a first intention choice for contraception to be consider, that women could obtain easily, including in emergency contraception situation. PMID:24861439
Trignol-Viguier, N; Blin, E; Marret, H
A Mouse Model of Uterine Leiomyosarcoma
We are using an approach that is based on the cre/loxP recombination process and involves a binary system of Cre-producing and Cre-responding transgenic mice to achieve ubiquitous or tissue-specific expression of oncoproteins. To develop mouse models of tumorigenesis, Cre-producers are mated with responder animals carrying a dormant oncogene targeted into the 3? untranslated region of the locus encoding cytoplasmic ?-actin (actin cassette). Production of oncoprotein from a bicistronic message is accomplished in bitransgenic progeny by Cre-mediated excision of a segment flanked by loxP sites that is located upstream from the oncogenic sequence. Widespread Cre-dependent activation and expression of an actin-cassette transgene encoding the T antigens of the SV40 early region (SVER) commencing in embryos was compatible with normal development and did not impair viability. However, at ?3 months of age, all female animals developed massive uterine leiomyosarcomas, whereas practically all males exhibited enormously enlarged seminal vesicles because of pronounced hyperplasia of the smooth muscle layers. In addition, because of smooth muscle hyperproliferation, marked dilation of the gallbladder was observed in mice of both sexes. To begin exploring aberrant signaling events in the SVER-triggered tumorigenic pathways, we analyzed the expression profile of leiomyosarcomas by DNA microarray analysis.
Politi, Katerina; Szabolcs, Matthias; Fisher, Peter; Kljuic, Ana; Ludwig, Thomas; Efstratiadis, Argiris
DEK overexpression in uterine cervical cancers.
The purpose of the present paper was to investigate the significance of DEK protein expression in uterine cervical lesions and its relationship with HPV infection status. DEK protein expression was studied in 253 cervical lesions, including 30 non-neoplastic cervix with or without squamous metaplasia, 64 cervical intra-epithelial neoplasias (CIN; CIN-1, n = 28; CIN-2, n = 17; CIN-3, n = 19), 102 squamous cell carcinomas (SCC), 51 adenocarcinomas, and six adenosquamous cell carcinomas (adenoSCC) on immunohistochemistry. For comparison, HPV-positive and -negative cervical cancer cell lines were also included. The HPV screening was performed using TaKaRa polymerase chain reaction. On immunohistochemistry DEK was found to be negative in all 30 non-neoplastic cervical epithelia, but it was positive in 96.1% of SCC (98/102), 92.2% of adenocarcinomas (47/51), 100% of adenoSCC (6/6), 85.7% of CIN-1 (24/28), 94.1% of CIN-2 (16/17), and 89.5% of CIN-3 (17/19). There was no significant difference between HPV-positive and -negative cervical lesions. Also, strongly positive staining was observed in all aforementioned cervical cancer cell lines regardless of HPV infection, according to immunocytochemistry. In summary, DEK plays an important role in the carcinogenesis of cervical cancers, and can be helpful for early diagnosis, and is a potential therapeutic target. PMID:18477217
Wu, Qunying; Li, Zhuhu; Lin, Hai; Han, Longzhe; Liu, Shuangping; Lin, Zhenhua
[Uterine myomas in pregnancy, childbirth and puerperium].
Fibroids are the most common benign tumors of the genital organs of women in reproductive age. Achieving reproductive function later in life, with more frequent use of assisted reproductive technologies, leads to an increased number of pregnancies complicated with fibroids. Their size may change during pregnancy, but the changes are mostly individual. Most fibroids stop growing or decline during the puerperium. The effect of fibroids on pregnancy depends on their number, size and location. The mechanisms bringing about perinatal complications are not fully understood. Fibroids during pregnancy can cause many perinatal complications, such as bleeding in pregnancy, miscarriage, pain due to red degeneration, malpresentation, preterm labor, premature rupture of membranes, placental abruption and obstruction of delivery and are associated with higher incidence of cesarean section, operative vaginal delivery, uterine atony and postpartum hemorrhage. Postpartum hysterectomy in these women is also more likely than in general population. Postpartum infections are more common in patients with fibroids, and myomas may also cause retained placenta. The most common cause of neonatal morbidity is prematurity, due to pregnancy ending in an earlier gestational age. Monitoring of pregnancies complicated with fibroids is essentially indistinguishable from monitoring normal pregnancies. Therapy includes only bed rest and observation, symptomatic therapy in case of pain and intensive fetal surveillance, and surgery in the acute situations. PMID:24684044
Spari?, Radmila
Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial
Background Perforated diverticulitis is a condition associated with substantial morbidity. Recently published reports suggest that laparoscopic lavage has fewer complications and shorter hospital stay. So far no randomised study has published any results. Methods DILALA is a Scandinavian, randomised trial, comparing laparoscopic lavage (LL) to the traditional Hartmann's Procedure (HP). Primary endpoint is the number of re-operations within 12 months. Secondary endpoints consist of mortality, quality of life (QoL), re-admission, health economy assessment and permanent stoma. Patients are included when surgery is required. A laparoscopy is performed and if Hinchey grade III is diagnosed the patient is included and randomised 1:1, to either LL or HP. Patients undergoing LL receive > 3L of saline intraperitoneally, placement of pelvic drain and continued antibiotics. Follow-up is scheduled 6-12 weeks, 6 months and 12 months. A QoL-form is filled out on discharge, 6- and 12 months. Inclusion is set to 80 patients (40+40). Discussion HP is associated with a high rate of complication. Not only does the primary operation entail complications, but also subsequent surgery is associated with a high morbidity. Thus the combined risk of treatment for the patient is high. The aim of the DILALA trial is to evaluate if laparoscopic lavage is a safe, minimally invasive method for patients with perforated diverticulitis Hinchey grade III, resulting in fewer re-operations, decreased morbidity, mortality, costs and increased quality of life. Trial registration British registry (ISRCTN) for clinical trials ISRCTN82208287http://www.controlled-trials.com/ISRCTN82208287
Pulse Lavage is Inadequate at Removal of Biofilm from the Surface of Total Knee Arthroplasty Materials.
In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty. PMID:24439797
Urish, Kenneth L; DeMuth, Peter W; Craft, David W; Haider, Hani; Davis, Charles M
Identification of heptanal and nonanal in bronchoalveolar lavage from rats exposed to low levels of ozone
Heptanal and nonanal are identified from in vitro studies as potential biomarkers of exposure to ozone, the former resulting from ozonation of palmitoleic acid and the latter from oleic acid. An analytical method is developed based on derivatization using O-pentafluorobenzylhydroxylamine HCl and gas chromatography. These molecules also are present in the lung lavage of Sprague-Dawley rats exposed to 1.3 ppm ozone for 10 hr. These results suggest aldehydes may be useful dosimeters for ozone and indicate that unsaturated fatty acids in the lung lining fluid layer undergo ozonation in vivo.
Cueto, R.; Squadrito, G.L.; Bermudez, E.; Pryor, W.A. (Biodynamics Institute, Louisiana State University, Baton Rouge (United States))
Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases.
The purpose of this study was to evaluate the use of a broad panel of antibodies used as diagnostic markers for abdominal mesenchymal tumors in uterine sarcomas. The expression of vimentin, AE1/AE3, smooth muscle actin (SMA), desmin , h-caldesmon, actin, Myf4, CD10, CD31, CD68, CD117, factor VIII, HMB-45, and S-100 protein was studied in 397 uterine sarcomas. SMA was positive in 90% of the ordinary leiomyosarcomas and when combined with desmin or h-caldesmon, a positivity of 96% and 92%, respectively, was achieved. Actin and Myf4 were positive in 4 of 5 rhabdomyosarcomas. Endometrial stromal sarcomas reacted positive with CD10 in 62 of 84 tumors and negative with h-caldesmon in 75 of 84 tumors. CD10 was the most frequent positive marker in adenosarcoma. Most tumor markers stained negative in undifferentiated uterine sarcoma, but 12 of 21 tumors reacted positive for SMA. A few focally HMB-45-positive cells were found within all tumor groups, except in rhabdomyosarcomas and giant cell tumors. Endothelial markers, S-100 protein, and CD117 do not seem to be of any diagnostic value in uterine sarcomas. In conclusion, when immunohistochemistry is used diagnostically in uterine sarcomas, a broad panel of markers provides better information than reliance on a single antibody. PMID:21464730
Abeler, Vera M; Nenodovic, Maja
Uterine and umbilical artery velocimetry during normal labor.
Twelve normal parturients were studied with a continuous wave Doppler unit to assess changes in uterine and umbilical velocity waveforms during labor. The analysis of these waveforms included the peak systolic/end-diastolic ratio and the evaluation of a diastolic notch. Each woman served as her own control, and all fetal heart rate tracings were normal. In latent phase labor and intact membranes, the umbilical artery systolic/end diastolic ratios before, during, and after a contraction were 2 +/- 0.2, 2 +/- 0.3 and 1.95 +/- 0.3 (N.S.). Similar results were obtained in the active phase, after rupture of membranes, or during oxytocin stimulation. This stability of the fetal cardiovascular system ensures an uninterrupted gas exchange process during the contractions (on the fetal side), enabling the great majority of term fetuses to tolerate labor with minimal if any metabolic changes. The uterine artery end-diastolic velocity fell progressively during the contraction, reaching 0 when the intrauterine pressure exceeded 35 mm Hg. Despite intrauterine pressure of greater than 60 mm Hg, the diastolic notch did not appear. Thus at term, the umbilical artery velocity waveform does not change over a wide range of uterine pressures. The changes seen in the uterine artery waveforms suggest that the end-diastolic component is primarily determined by changes in the arcuate and spiral arteries, both of which are affected during the uterine contraction. PMID:2955700
Fleischer, A; Anyaegbunam, A A; Schulman, H; Farmakides, G; Randolph, G
Extramedullary hematopoiesis in uterine leiomyoma associated with numerous intravascular thrombi.
We report a case of extramedullary hematopoiesis (EMH) in uterine leiomyoma and associated numerous intravascular thrombi. A 29-year-old nulliparous female presented with heavy vaginal bleeding and a hematocrit of 22%. No bone marrow biopsy has been performed. She had a history of uterine leiomyomata and menorrhagia for a year. A transvaginal ultrasound confirmed the presence of a uterine leiomyoma. The patient was treated conservatively with oral contraceptive pills due to desire for fertility. However, she continued to have heavy vaginal bleeding and developed bilateral upper extremity deep vein thrombosis and multiple superficial vein thromboses after two months. An exploratory laparotomy with uterine myomectomy was performed. Gross examination of the specimen revealed a single nodular mass measuring 10.0 æ 9.5 æ 7.5?cm with a white-tan swirling cut surface. Microscopic examination revealed benign smooth muscle consistent with leiomyoma and numerous intravascular thrombi both with areas of EMH. Immunohistochemical stains confirmed the presence of all three benign lineages of hematopoietic cells. Occurrence of EMH in uterine leiomyoma and intravascular thrombi is very rare. It may be related to systemic hematopoietic stimulation due to severe chronic anemia and local presence of hematopoietic growth factors and/or cytokines. PMID:24711952
Cui, Xiaoyan; Peker, Deniz; Greer, Heather O; Conner, Michael G; Novak, Lea
Extramedullary Hematopoiesis in Uterine Leiomyoma Associated with Numerous Intravascular Thrombi
We report a case of extramedullary hematopoiesis (EMH) in uterine leiomyoma and associated numerous intravascular thrombi. A 29-year-old nulliparous female presented with heavy vaginal bleeding and a hematocrit of 22%. No bone marrow biopsy has been performed. She had a history of uterine leiomyomata and menorrhagia for a year. A transvaginal ultrasound confirmed the presence of a uterine leiomyoma. The patient was treated conservatively with oral contraceptive pills due to desire for fertility. However, she continued to have heavy vaginal bleeding and developed bilateral upper extremity deep vein thrombosis and multiple superficial vein thromboses after two months. An exploratory laparotomy with uterine myomectomy was performed. Gross examination of the specimen revealed a single nodular mass measuring 10.0 æ 9.5 æ 7.5?cm with a white-tan swirling cut surface. Microscopic examination revealed benign smooth muscle consistent with leiomyoma and numerous intravascular thrombi both with areas of EMH. Immunohistochemical stains confirmed the presence of all three benign lineages of hematopoietic cells. Occurrence of EMH in uterine leiomyoma and intravascular thrombi is very rare. It may be related to systemic hematopoietic stimulation due to severe chronic anemia and local presence of hematopoietic growth factors and/or cytokines.
Cui, Xiaoyan; Peker, Deniz; Greer, Heather O.; Conner, Michael G.; Novak, Lea
Diagnostic challenge of lipomatous uterine tumors in three patients
Lipomatous uterine tumors are uncommon benign neoplasms, with incidence ranging from 0.03% to 0.2%. They can generally be subdivided into two types: pure or mixed lipomas. A third group of malignant neoplasm has been proposed, which is liposarcoma; however, this is very rare. In this article, we report three patients having lipomatous uterine tumors, including one uterine lipoma and two uterine lipoleiomyomas. All our patients are postmenopausal women, which is the typical presenting age group. They did not have any symptoms and the tumors were only found incidentally on imaging. However, in some patients, symptoms may uncommonly occur. If symptoms occur, these are similar to those of leiomyoma. We illustrate the imaging features of the tumors in our patients with ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI). The tumor typically appears as a well-defined homogenously hyperechoic lesion on ultrasound. It shows fat density on CT scan and signal intensity of fat on MRI. MRI is the modality of choice because of its multiplanar capability and its ability to demonstrate fat component of the lesion, as illustrated in our cases. We also discuss the importance of differentiating lipomatous uterine tumors from other lesions, especially ovarian teratoma which requires surgical intervention. Despite the rarity and the common asymptomatic nature of the tumors, we believe that this series of three cases demonstrates a review of a rare tumor which provides important knowledge for patient management.
Chu, Chi-Yeung; Tang, Yip-Kan; Chan, Tin-Sang Augustine; Wan, Yu-Hon; Fung, Kai-Hung
Cine MR imaging of uterine peristalsis in patients with endometriosis.
Endometriosis is one of the most important causes of infertility; however the precise mechanism by which it affects female fertility is unclear. The objective of this study was to study the functional aspects of the uterus by evaluating uterine contractility in patients with endometrial cysts of the ovary. The study population was recruited from two institutes and consisted of 26 women (periovulatory (10), luteal (13), and menstrual phase (3); age range: 19-51 years) with untreated endometriosis; the control group consisted of 12 healthy women (age range: 22-41 years). Cine MR imaging obtained by a 1.5T magnet was visually evaluated at 12x faster than real speed, focusing on the presence of uterine peristalsis, the direction and frequency of peristalsis, and the presence of sustained uterine contractions. Uterine peristalsis was identifiable in 3/10, 3/13, and 3/3 of the endometriosis patients in each menstrual cycle, respectively, and in 11/12, 3/12, and 5/12 of their control subjects. Peristaltic detection rate and frequency were significantly less for the endometriosis group than for the controls in the periovulatory phase only (p<0.05). Sustained contractions were recognized in 19/36 control subjects and in 13/26 endometriosis patients, but the difference was not significant. Uterine peristalsis appears to be suppressed during the periovulatory phase in patients with endometriosis, which may have an adverse effect on sperm transport. PMID:17119973
Kido, Aki; Togashi, Kaori; Nishino, Mizuki; Miyake, Kanae; Koyama, Takashi; Fujimoto, Ryota; Iwasaku, Kazuhiro; Fujii, Shingo; Hayakawa, Katsumi
Proteomic Profile of Uterine Luminal Fluid from Early Pregnant Ewes
Embryonic development is a time-sensitive period that requires a synchronized uterine environment, which is created by the secretion of proteins from both the embryo and uterus. Numerous studies have identified uterine luminal proteins and related these to specific adaptations during early pregnancy (EP). However, no study has yet utilized LC-MS/MS to identify the signature profile of proteins in the uterine lumen during EP. In this study, uterine luminal fluid from nonpregnant (NP; n = 3) and EP (n = 3; gestational day 16) ewes were analyzed by LC-MS/MS and validated by Western immunoblotting. We identified a unique signature profile for EP luminal fluid; 15 proteins related to specific aspects of embryonic development including growth and remodeling, immune system regulation, oxidative stress balance, and nutrition were significantly altered (up to 65-fold of NP) in EP profile. Specific uterine remodeling proteins such as transgelin (P = 0.008) and placental proteins like PP9 (P = 0.02) were present in EP luminal fluid but were barely detectable in the NP flushings. Direct correlations (R2 = 0.84, P = 0.01) were observed between proteomics and immunoblotting. These data provide information on dynamic physiological processes associated with EP at the level of the uterus and conceptus and may potentially demonstrate a signature profile associated with embryonic well-being.
Koch, Jill M.; Ramadoss, Jayanth; Magness, Ronald R.
Diagnostic and prognostic markers for uterine diseases in dogs.
Common uterine diseases in female dogs include cystic endometrial hyperplasia (CEH), mucometra, hydrometra and pyometra. It is important in clinical practice to recognize pyometra because it is potentially life-threatening due to the systemic illness induced by bacterial infection of the uterus. In contrast, the uterine content is sterile in CEH and mucometra/hydrometra, and clinical signs are mostly mild or absent. Optimal treatment depends on the type of uterine disease and its severity, but diagnosis and prognosis determination may be challenging and the diseases difficult to separate clinically. Diagnostic findings or biomarkers that may aid in the differentiation of the diseases are valuable, especially when several bitches are admitted with a fluid-filled uterus during night-time, and it has to be decided which patient to operate on first. Additionally, some variables may indicate outcome as measured by mortality or morbidity. If the uterus is not enlarged or fluid-filled, detection of uterine disease can be even more difficult. In this study, clinically useful variables with possible diagnostic or prognostic value for uterine diseases in dogs are discussed. PMID:24947856
Hagman, R
Bronchoalveolar lavage of cranial and caudal lung regions in selected normal calves: cellular, microbiological, immunoglobulin, serological and histological variables.
Of a group of 30 clinically normal male Holstein calves two to eight weeks of age, six two week old and six four week old calves met various radiographical and clinicopathological criteria for normality. Bronchoalveolar lavage was performed by fiberoptic bronchoscopy on cranial and caudal lung regions in all 30 calves and samples analyzed for free cells, microorganisms, and immunoglobulins. Lateral chest radiographs and lung biopsies were also conducted on each calf. Calves were euthanized and necropsied ten days after bronchoalveolar lavage was conducted. Reported in this paper are results from the 12 normal calves. Microorganisms were present in small numbers in the lower respiratory tract of some normal calves. There were no differences in the above parameters between cranial and caudal lobes. There were statistically significant changes in bronchoalveolar lavage cell proportions with age although there were no detectable differences in clinical signs. Four week old calves had a lower percentage of macrophages and a higher percentage of epithelial cells than two week old animals (p less than 0.05). There was also a trend toward an increased percentage of neutrophils in older calves but this was not significant (p greater than 0.05). Total bronchoalveolar lavage protein also appeared to increase with age (p less than 0.05). In both groups a higher proportion of IgG2 in bronchoalveolar lavage compared to serum was found, suggesting the presence of a local selective transfer mechanism into respiratory secretions. Images Fig. 2. Fig. 3. Fig. 4.
Pringle, J K; Viel, L; Shewen, P E; Willoughby, R A; Martin, S W; Valli, V E
Effect of corticosteroid treatment on cell recovery by lung lavage in acute radiation-induced lung injury
The purpose of this study was to quantitate cell populations recovered by lung lavage up to 6 weeks following thoracic irradiation (24 Gy) as an index of the acute inflammatory response within lung structures. Additionally, rats were treated five times weekly with intraperitoneal saline (0.3 cc) or methylprednisolone (7.5 mg/kg/week). Lung lavage of irradiated rats recovered increased numbers of total cells compared to controls beginning 3 weeks after irradiation (P less than 0.05). The initial increase in number of cells recovered was attributable to an influx of neutrophils (P less than 0.05), and further increases at 4 and 6 weeks were associated with increased numbers of recovered macrophages (P less than 0.05). Lung lavage of steroid-treated rats at 6 weeks after irradiation recovered increased numbers of all cell populations compared to controls (P less than 0.05); however, numbers of recovered total cells, macrophages, neutrophils, and lymphocytes were all significantly decreased compared to saline-treated rats (P less than 0.05). The number of inflammatory cells recovered by lung lavage during acute radiation-induced lung injury is significantly diminished by corticosteroid treatment. Changes in cells recovered by lung lavage can also be correlated with alteration in body weight and respiration rate subsequent to treatment with thoracic irradiation and/or corticosteroids.
Wesselius, L.J.; Floreani, A.A.; Kimler, B.F.; Papasian, C.J.; Dixon, A.Y. (Kansas City Veterans Administration Medical Center, MO (USA))
Uterine cavity matrix metalloproteinases and cytokines in patients with leiomyoma, adenomyosis or endometrial polyp
Objective: To determine whether leiomyoma, adenomyosis and endometrial polyps are associated with changes in uterine cavity matrix metalloproteinases (MMP-2 and MMP-9) and cytokines. Study design: Uterine cavity irrigation was performed in women with leiomyoma, adenomyosis and endometrial polyps, and in women with a normal uterus. MMP-2 and MMP-9 were assayed in the uterine washings by gelatin zymography. For individual subjects,
Noboru Inagaki; Linh Ung; Tetsuo Otani; David Wilkinson; Alex Lopata
Maternal Death After Uterine Rupture in an Unscarred Uterus: A Case Report
Spontaneous uterine rupture is a life-threatening obstetrical emergency encountered infrequently in the Emergency Department. Emergency Physicians must consider this diagnosis when presented with a pregnant patient in shock with abdominal pain. We present the case of a multigravid woman who had a spontaneous uterine rupture after induction with oxytocin, followed by a discussion of uterine rupture with special emphasis on
Banu Dane; Cem Dane
Change in Morphology and Oxytocin Receptor Expression in the Uterine Blood Vessels during the Involution Process
Background: The histological changes in uterine blood vessels during pregnancy have been well investigated, but there have been few reports focusing on the changes in blood vessels during the involution process, especially within the first 24 h. We observed the process of uterine involution, focusing on the vessels of the resected uterus. Methods: Paraffin-embedded uterine samples from 15 patients who
Tomoko Wakasa; Kenichi Wakasa; Masahiro Nakayama; Yuko Kuwae; Keiko Matsuoka; Makoto Takeuchi; Noriyuki Suehara; Tadashi Kimura
Reproducibility of Doppler blood flow velocity measurements in the uterine and ovarian arteries of postmenopausal women
Objective: To assess the reproducibility of transvaginal Doppler measurements in the uterine and ovarian arteries of postmenopausal women. Methods: Intra-observer repeatability of Doppler measurements of the pulsatility index (PI) and time-averaged maximum velocity (TAMXV) in the uterine arteries was assessed in examinations of 22 postmenopausal women, three replicate Doppler measurements being made by one observer from one of the uterine
Povilas Sladkevicius; Lil Valentin
Regulation of uterine immune function by progesteronelessons from the sheep
Survival of the fetal allograft results from orchestrated adjustments in activity of maternal lymphoid cells as well as in trophoblast gene expression. One molecule that regulates uterine immune responsiveness is progesterone. In fact, uterine skin graft survival and susceptibility to bacterial infections are increased by progesterone. This review focuses on the role of progesterone in regulation of uterine immune function
P. J. Hansen
Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: A case-matched comparison
BackgroundUterine sarcomas are rare among all uterine malignancies, and frequently misdiagnosed as benign uterine diseases such as leiomyoma and adenomyosis because of lack of feasible tools for the preoperative diagnosis. Although some studies have suggested the role of serum CA-125 levels for the preoperative diagnosis, the efficacy is controversial. Since malignancy is known to be associated with systemic inflammation which
H. S. Kim; K. H. Han; H. H. Chung; J. W. Kim; N. H. Park; Y. S. Song; S. B. Kang
[Advanced uterine prolapse during pregnancy: pre- and postnatal management].
Pelvic organ prolapse is a common pelvic floor disorder in postmenopausal women. The literature is quite poor concerning the management of prolapse during pregnancy in young women. We report the case of a 39-year-old multiparous woman referred for the treatment of an exteriorized uterine prolapse at 13 weeks of gestation. The management of cervical prolapse depends on its stage, its evolution and on gestational age. It combines local antiseptics, rest and manual reintegration or reduction of the prolapsus using a pessary to prevent ulceration of the cervix. In case of stage IV (POP-Q) uterine prolapse, vaginal delivery may be compromised. No recommendation is actually available about route of delivery in case of exteriorized uterine prolapse. It should be clearly discussed regarding the potential risk of cesarean section for dystocia. Surgical repair of the prolapse will be discussed after childbirth according to functional impairment and women's desire for pregnancy. PMID:23867760
Pizzoferrato, A-C; Bui, C; Fauconnier, A; Bader, G
Diagnostic value of transcervical endometrial biopsies in domestic dogs compared with full-thickness uterine sections.
Transcervical endometrial biopsy is a useful tool for obtaining information about uterine health in some species. The clinical application of information gained from histopathological interpretations of endometrial biopsies in the bitch has not been validated. We hypothesized that transcervical endometrial biopsy samples would be as diagnostic as full-thickness uterine sections in identifying cystic endometrial hyperplasia (CEH), inflammation and periglandular fibrosis. Endometrial biopsies were obtained from 20 female adult dogs. Vaginal swabs, gross appearance of the vulva and vaginal tract, and serum progesterone values were used to determine the stage of the oestrous cycle at the time of sampling. The uteri were removed between 1 and 6 days after the biopsy procedure, and full-thickness sections were collected from each uterine horn and ovary and processed for histopathology. Two pathologists, blinded to the origin of each sample, compared full-thickness sections from the excised uteri to the biopsy samples collected via the transcervical technique. Pathologic features noted included: CEH, inflammation and periglandular fibrosis. Pathological diagnoses obtained from the biopsy sections were compared with those obtained from the full-thickness sections, as well as comparing diagnoses between the two pathologists, using McNemar's test. Of the 59 total biopsy samples obtained, 54 were considered diagnostic. All stages of the canine oestrous cycle were represented (anoestrus, proestrus, oestrus and dioestrus). Pyometra was not noted in any of the transcervical biopsy sections, but was noted in many of the full-thickness sections collected from dogs in dioestrus, suggesting either that biopsy is not a sensitive indicator of pyometra or that the procedure may induce pyometra in dioestrous dogs. Transcervical endometrial biopsy showed similar sensitivity as full-thickness sections in detecting CEH, inflammation and fibrosis. No differences in describing lesions were detected between pathologists. PMID:23279534
Christensen, B W; Schlafer, D H; Agnew, D W; Wang, C; Kozlowski, C; Asa, C S
Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids
Objectives: The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States. Methods: We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis. Results: UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy. Conclusions: Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.
O'Sullivan, Amy K.; Thompson, David; Chu, Paula; Lee, David W.; Stewart, Elizabeth A.; Weinstein, Milton C.
GnRH agonists and uterine leiomyomas.
Gonadotrophin-releasing hormone (GnRH) agonists are widely used in the treatment of women with symptomatic leiomyomas. The effectiveness of this treatment, as far as symptoms are concerned, is well established, and in recent years many studies have contributed to defining the optimal role for GnRH agonists. Side-effects and health risks prohibit the long-term use of these compounds. The combined use of high-dose agonists and steroids in the so-called 'add back' schedules reduces many of the disadvantages of the monotherapy. However, it is still an expensive alternative when compared with definitive surgery, and therefore should only be used in women who insist on preservation of the uterus. Low-dose agonist therapy ('draw back') has not yet been proven to be suitable for clinical application. The use of GnRH agonists and steroids in sequential schedules seems to result in a loss of both the volume reduction as well as the reduction in clinical symptoms. The use of GnRH agonists prior to myoma surgery should not become a routine measure and should be limited to cases where the size of the uterus is > 600 ml. Hysterectomy should only be preceded by GnRH agonist treatment if uterine volume decrease is expected to facilitate either the abdominal or vaginal procedure. For both operative procedures the presence of myoma-related anaemia is an indication for pretreatment. The use of GnRH agonists before endoscopic surgery is widely accepted on the basis of assumptional advantages; however, definite proof of these advantages is not yet available. PMID:9147098
Broekmans, F J
Doppler velocimetry of the uterine arteries in nulliparous women.
The aim of this study was to evaluate the role of uterine artery Doppler velocimetry performed at 20 and 24 weeks gestation in predicting gestational hypertension and small-for-gestational age babies in a population of nulliparous women. Four hundred and fifty-six patients without risk factors for pregnancy complications and with fetuses free from structural abnormalities at ultrasonographic examination at 20 weeks gestation were considered in the study. During the routine 20 weeks ultrasound a continuous-wave Doppler examination of the uterine arteries was performed. The patients with abnormal uterine Resistance Index (RI) repeated the Doppler evaluation at 24 weeks by means of Colour Doppler equipment. Among the 419 women who completed the study an abnormal Doppler uterine arteries velocimetry was found in 8.6% of the patients. Pregnancy complications (gestational hypertension and/or small-for-gestational age babies) were observed in 56% of the patients presenting high uteroplacental RI versus 10% of those with normal uterine artery velocimetry (P = 0.0001). In the group of patients with an abnormal RI value, the presence of a diastolic notch in one or both of the uterine arteries identified a population of pregnant women at higher risk for pregnancy complications when compared with patients without notch (78% vs. 33%, P = 0.007). The knowledge of the uteroplacental resistance can help in identifying a subgroup of patients at higher risk of hypertensive disorders and small-for-gestational age babies that could benefit from prophylaxis with low dose aspirin. PMID:9131318
Frusca, T; Soregaroli, M; Valcamonico, A; Guandalini, F; Danti, L
Changes in Mouse Uterine Transcriptome in Estrus and Proestrus1
ABSTRACT Changes in the CD-1 mouse uterine transcriptome during proestrus and estrus were investigated to help elucidate mechanisms of uterine tissue remodeling during the estrus cycle and their regulation by estrogen and progesterone in preparation of the uterus for pregnancy. Mice were staged beginning at 6 weeks of age, and uterine horns were harvested after monitoring two estrus cycles. Microarray analysis of whole uterine horn RNA identified 2428 genes differentially expressed in estrus compared to proestrus, indicating there is extensive remodeling of mouse uterus during the estrus cycle, affecting ?10% of all protein-encoding genes. Many (?50%) of these genes showed the same differential expression in independent analyses of isolated uterine lumenal epithelial cells. Changes in gene expression associated with structural alterations of the uterus included remodeling of the extracellular matrix, changes in cell keratins and adhesion molecules, activation of mitosis and changes in major histocompatibility complex class II (MHCII) presentation, complement and coagulation cascades, and cytochrome P450 expression. Signaling pathways regulated during the estrus cycle, involving ligand-gated channels, Wnt and hedgehog signaling, and transcription factors with poorly understood roles in reproductive tissues, included several genes and gene networks that have been implicated in pathological states. Many of the molecular pathways and biological functions represented by the genes differentially expressed from proestrus to estrus are also altered during the human menstrual cycle, although not necessarily at the corresponding phases of the cycle. These findings establish a baseline for further studies in the mouse model to dissect mechanisms involved in uterine tissue response to endocrine disruptors and the development of reproductive tract diseases.
Yip, Kerri Stanley; Suvorov, Alexander; Connerney, Jeannette; Lodato, Nicholas J.; Waxman, David J.
Bmp2 Is Critical for the Murine Uterine Decidual Response?
The process of implantation, necessary for all viviparous birth, consists of tightly regulated events, including apposition of the blastocyst, attachment to the uterine lumen, and differentiation of the uterine stroma. In rodents and primates the uterine stroma undergoes a process called decidualization. Decidualization, the process by which the uterine endometrial stroma proliferates and differentiates into large epithelioid decidual cells, is critical to the establishment of fetal-maternal communication and the progression of implantation. The role of bone morphogenetic protein 2 (Bmp2) in regulating the transformation of the uterine stroma during embryo implantation in the mouse was investigated by the conditional ablation of Bmp2 in the uterus using the (PR-cre) mouse. Bmp2 gene ablation was confirmed by real-time PCR analysis in the PR-cre; Bmp2fl/fl (termed Bmp2d/d) uterus. While littermate controls average 0.9 litter of 6.2 Ý 0.7 pups per month, Bmp2d/d females are completely infertile. Analysis of the infertility indicates that whereas embryo attachment is normal in the Bmp2d/d as in control mice, the uterine stroma is incapable of undergoing the decidual reaction to support further embryonic development. Recombinant human BMP2 can partially rescue the decidual response, suggesting that the observed phenotypes are not due to a developmental consequence of Bmp2 ablation. Microarray analysis demonstrates that ablation of Bmp2 leads to specific gene changes, including disruption of the Wnt signaling pathway, Progesterone receptor (PR) signaling, and the induction of prostaglandin synthase 2 (Ptgs2). Taken together, these data demonstrate that Bmp2 is a critical regulator of gene expression and function in the murine uterus.
Lee, Kevin Y.; Jeong, Jae-Wook; Wang, Jinrong; Ma, Lijiang; Martin, James F.; Tsai, Sophia Y.; Lydon, John P.; DeMayo, Francesco J.
Glutathione and GSH-dependent enzymes in bronchoalveolar lavage fluid cells in response to ozone
The purpose of this study was to determine if in vivo ozone exposure results in elevations in the levels of glutathione and glutathione-dependent enzymes in cells derived from bronchoalveolar lavage fluid (BALF). Our hypothesis was that, as part of a defense mechanism against oxygen toxicity, such cells would have increased levels of glutathione (GSH) in response to an oxidant stress. Female F344/N rats were exposed to 0.8 ppm ozone, 6 hr/day, for 1, 3, or 7 days, after which cells were collected by lung lavage. The GSH and GSH-peroxidase activity per milligram of protein in the cellular fraction, both necessary for reducing cellular peroxides, were elevated after 3 days of ozone exposure. After 7 days of exposure, cellular GSH had returned to control values, but the activity of glutathione reductase, the enzyme that reduces oxidized glutathione to GSH, was increased. Extracellular GSH concentration and glutathione reductase activity in BALF were also increased after 7 days of exposure. The total glutathione equivalents (GSH and GSSG, both cellular and extracellular) in BALF increased throughout the 7-day exposure, with GSH increasing first in the cells, and then in the extracellular fluid. This study demonstrated that the glutathione anti-oxidant system of BALF cells is stimulated by exposure to ozone. This response may serve to protect cells from the toxic effects of oxidant stress.
Boehme, D.S.; Hotchkiss, J.A.; Henderson, R.F. (Inhalation Toxicology Research Institute, Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM (United States))
Nasal lavage biomarkers: effects of water damage and microbial growth in an office building.
Selected nasal symptoms were studied in personnel who worked in a damp office building that had microbial growth (including Stachybotrys sp.) in mineral fiber insulation and gypsum board. There were also signs of dampness in the floor. Clinical examinations included nasal lavage and peak expiratory flow measurements in 12 subjects in the damp building; an additional 8 subjects in a control building (i.e., no signs of dampness or microbial growth) were also examined. Hygienic air measurements of microorganisms and volatile organic compounds were performed in both buildings. The concentrations of eosinophil cationic protein, myeloperoxidase, and albumin, and the number of subjects with eosinophils in lavage fluid, were higher among office workers in the damp building than among controls. The damp biiilding had greater amounts of total molds and bacteria in its construction than the building materials in nondamp buildings. In addition, an increase of 2-ethyl-1-hexanol in the indoor air was detected in the damp building-a sign of dampness-related alkaline degradation of diethyl-hexyl phthalate in polyvinyl chloride floor coatings. In conclusion, the results of this study indicate that exposures in a damp office building may cause an inflammatory nasal mucosal response. The results also support conclusions of earlier studies, indicating that building dampness is related to respiratory inflammation. PMID:11256854
WÍlinder, R; Norbðck, D; Wessen, B; Venge, P
Bronchoalveolar Lavage Fluid IFN-?+ Th17 Cells and Regulatory T Cells in Pulmonary Sarcoidosis
In sarcoidosis, increased Th17 cell fractions have been reported in bronchoalveolar lavage fluid, and elevated numbers of Th17 cells producing IFN-? have been observed in peripheral blood. The balance between Th1, Th17, and FoxP3+ CD4+ T cell subsets in sarcoidosis remains unclear. Bronchoalveolar lavage fluid cells, from 30 patients with sarcoidosis, 18 patients with other diffuse parenchymal lung diseases, and 15 healthy controls, were investigated with flow cytometry for intracellular expression of FoxP3. In a subset of the patients, expression of the cytokines IL17A and IFN-? was investigated. The fractions of FoxP3+ CD4+ T cells and Th17 cells were both lower in sarcoidosis compared to controls (P = 0.017 and P = 0.011, resp.). The proportion of Th17 cells positive for IFN-? was greater in sarcoidosis than controls (median 72.4% versus 31%, P = 0.0005) and increased with radiologic stage (N = 23, rho = 0.45, and P = 0.03). IFN-?+ Th17 cells were highly correlated with Th1 cells (N = 23, rho = 0.64, and P = 0.001), and the ratio of IFN-?+ Th17/FoxP3+ CD4+ T cells was prominently increased in sarcoidosis. IFN-?+ Th17 cells may represent a pathogenic subset of Th17 cells, yet their expression of IFN-? could be a consequence of a Th1-polarized cytokine milieu. Our results indicate a possible immune cell imbalance in sarcoidosis.
T?ndell, Anders; Moen, Torolf; B?rset, Magne; Salvesen, ?yvind; R?, Anne Dorthea; Sue-Chu, Malcolm
Identification of inorganic dust particles in bronchoalveolar lavage macrophages by energy dispersive x-ray microanalysis
This study shows that energy dispersive x-ray microprobe analysis to identify and quantify intracellular particles in macrophages obtained by the minimally invasive method of bronchoalveolar lavage (BAL) can detect inorganic dust exposures of many different kinds. Bronchoalveolar lavage macrophages from 22 patients have been examined. Twelve patients had occupational exposure to asbestos, talc, silica, hard metal or printing ink, while 10 had no known history of dust exposure. X-ray microprobe analysis identified particles which related to the known exposures, superimposed on a background of other particles related to smoking (kaolinite and mica) or to the general environment (silicon, titanium, and iron). The particle identification provided useful objective confirmation of the known exposures, except for silica, which could not be distinguished from the general background levels. X-ray microanalysis using BAL macrophages can be helpful for clarification of mixed dust exposures, to identify particles when light microscopy indicates retained dust in patients with no known history of exposure, and to monitor retained particles after removal from exposure.
Johnson, N.F.; Haslam, P.L.; Dewar, A.; Newman-Taylor, A.J.; Turner-Warwick, M.
Pleural lavage with distilled water during surgery for esophageal squamous cell carcinoma.
This study aimed to investigate cytocidal effects of hypotonic shock on esophageal squamous cell carcinoma (ESCC) cell lines, and to apply pleural lavage with distilled water to surgery for ESCC. Three human ESCC cell lines, TE5, TE9 and KYSE170 were exposed to distilled water, and morphological changes in ESCC cells were closely observed under a differential interference contrast microscope connected to a high-speed digital video camera. Further, serial cell volume changes after hypotonic shock were measured using a high-resolution flow cytometer. To investigate the cytocidal effects of hypotonic shock on ESCC cells, re-incubation of ESCC cells was performed after hypotonic shock. Additionally, the effects of 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB), a Cl- channel blocker, during hypotonic shock were analyzed. Video recordings by high-speed digital camera demonstrated that hypotonic shock with distilled water induced cell swelling followed by cell rupture. Measurements of cell volume changes using a high-resolution flow cytometer indicated that severe hypotonicity with distilled water increased broken fragments of ESCC cells within 5 min. Re-incubation experiments demonstrated cytocidal effects of hypotonic shock on ESCC cells. Treatment of cells with NPPB increased cell volumes by the inhibition of regulatory volume decrease, which is observed during hypotonic shock, and enhanced cytocidal effects. These findings demonstrated the cytocidal effects of hypotonic shock on ESCC cells, and clearly support the efficacy of pleural lavage with distilled water during surgery for ESCC. PMID:21567108
Kosuga, Toshiyuki; Shiozaki, Atsushi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Komatsu, Shuhei; Iitaka, Daisuke; Tsujiura, Masahiro; Morimura, Ryo; Takeshita, Hiroki; Nagata, Hiroaki; Okamoto, Kazuma; Nakahari, Takashi; Marunaka, Yoshinori; Otsuji, Eigo
[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis].
The treatment of peritonitis complicating diverticular disease of the colon is yet to be universally regarded as established practice and major differences in management are to be noted in the various surgical institutions. In the emergency setting, the minimally invasive approach is used by few surgeons and the most frequent therapeutic options are sigmoid resection with primary anastomosis (with or without a diverting stoma) and Hartmann's procedure. The Authors report their preliminary experience (13 cases) with laparoscopic lavage and drainage without colonic resection in diverticulitis complicated by peritonitis and describe the technical details of the surgical procedure. They conduct a systematic review of the literature and, on the basis of their latest experience, compare the results of the traditional resective operations (resection with primary anastomosis and Hartmann's procedure) with those of laparoscopic conservative and non-resective treatment. Laparoscopic non-resective procedures reduce the frequency and severity of the surgical complications, as well as the hospital stay and costs of treatment. In conclusion, laparoscopic lavage and drainage can be used in the majority of patients, with excellent prospects of recovery, without disabling stomas, in a single operative stage. PMID:19845268
Lippi, Carlo Ettore; Beatini, Luca; Cervia, Silvio; Fabbricotti, Alaido; Miaruelli, Piero Antonio; Spessa, Elisabetta; Sturlese, Ivarco; Braini, Andrea
Comparison of 14 molecular assays for detection of Mycobacterium tuberculosis complex in bronchoalveolar lavage fluid.
We compared 14 molecular assays for their ability to detect the Mycobacterium tuberculosis complex in bronchoalveolar lavage fluid samples. Three approaches were followed. First, by using DNA from Mycobacterium bovis BCG, we determined the detection limits of the assays using routine molecular methods. Second, in order to determine the analytical sensitivities of the assays, we added one of four M. tuberculosis isolates with various numbers of the insertion sequence IS6110 to N-acetyl-l-cysteine (NALC)-NaOH-treated bronchoalveolar lavage fluid samples in dilutions of 1:10 to 1:10,000,000. Third, intertest variabilities were measured and defined by the standard deviations for the quantitation cycle (Cq) values of three positive test results per dilution per assay. The 14 assays tested had similar analytical sensitivities, except for GeneXpert, which had an analytical sensitivity that was 10- to 100-fold lower than that of the other assays. The MP MTB/NTM test and the in-house TaqMan-10 revealed the best performances for the detection limit and had the highest analytical sensitivities. Most of the tests performed well regarding detection limit and analytical sensitivity for the detection of the M. tuberculosis complex in serial dilutions, and the differences were small. The MP MTB/NTM and the in-house TaqMan-10 assays revealed the best, and GeneXpert the worst, overall performances. PMID:23966510
Akkerman, Onno W; van der Werf, Tjip S; de Boer, Maria; de Beer, Jessica L; Rahim, Zeaur; Rossen, John W A; van Soolingen, Dick; Kerstjens, Huib A M; van der Zanden, Adri G M
Comparison of 14 Molecular Assays for Detection of Mycobacterium tuberculosis Complex in Bronchoalveolar Lavage Fluid
We compared 14 molecular assays for their ability to detect the Mycobacterium tuberculosis complex in bronchoalveolar lavage fluid samples. Three approaches were followed. First, by using DNA from Mycobacterium bovis BCG, we determined the detection limits of the assays using routine molecular methods. Second, in order to determine the analytical sensitivities of the assays, we added one of four M. tuberculosis isolates with various numbers of the insertion sequence IS6110 to N-acetyl-l-cysteine (NALC)-NaOH-treated bronchoalveolar lavage fluid samples in dilutions of 1:10 to 1:10,000,000. Third, intertest variabilities were measured and defined by the standard deviations for the quantitation cycle (Cq) values of three positive test results per dilution per assay. The 14 assays tested had similar analytical sensitivities, except for GeneXpert, which had an analytical sensitivity that was 10- to 100-fold lower than that of the other assays. The MP MTB/NTM test and the in-house TaqMan-10 revealed the best performances for the detection limit and had the highest analytical sensitivities. Most of the tests performed well regarding detection limit and analytical sensitivity for the detection of the M. tuberculosis complex in serial dilutions, and the differences were small. The MP MTB/NTM and the in-house TaqMan-10 assays revealed the best, and GeneXpert the worst, overall performances.
van der Werf, Tjip S.; de Boer, Maria; de Beer, Jessica L.; Rahim, Zeaur; Rossen, John W. A.; van Soolingen, Dick; Kerstjens, Huib A. M.; van der Zanden, Adri G. M.
Four-dimensional Transcatheter Intra-arterial Perfusion MR Imaging Before and After Uterine Artery Embolization in the Rabbit VX2 Tumor Model
Purpose To test the hypothesis that four-dimensional (4D) transcatheter intra-arterial perfusion (TRIP) MR imaging can measure uterine fibroid perfusion changes immediately before and after uterine artery embolization (UAE) in the rabbit VX2 tumor model. Materials and Methods Eight VX2 uterine tumors were grown in 6 rabbits. After positioning a catheter within the uterine artery, we performed 4D TRIP-MRI measurements with 3 mL injections of 2.5% gadopentetate dimeglumine. We used a dynamic 3D spoiled-GRE sequence with in vivo B1-field correction for improved accuracy during perfusion quantification. We performed UAE using 1 mL of gelatin microspheres (2æ106 particles; diameter 40-120 ?m). Two regions-of-interest were drawn within each tumor upon perfusion maps. Functional embolic endpoints were reported as the mean percent reduction in fibroid tumor perfusion. Measurements before and after UAE were compared using paired t-tests (? = 0.05). Results VX2 uterine tumor perfusion decreased significantly from 27.1 at baseline to 7.09 after UAE (mL/min/100 mL tissue, p < 0.0001). Overall perfusion reduction was 76.3% (95% CI: 66.3%-86.3%). Conclusion 4D TRIP MRI can objectively quantify uterine fibroid perfusion reductions during UAE in VX2 rabbits. This technique could be used clinically to potentially determine an optimal embolic endpoint with the long-term goals of improving UAE success rates and minimizing procedure-related ischemic pain.
Chung, Johnathan C.; Wang, Dingxin; Lewandowski, Robert J.; Tang, Richard; Chrisman, Howard B.; Vogelzang, Robert L.; Woloschak, Gayle E.; Larson, Andrew C.; Omary, Reed A.; Ryu, Robert K.
Extramedullary Hematopoiesis in the Uterine Cervix Associated with Tissue Repair
Extramedullary hematopoiesis (EMH) is the presence of hematopoietic precursors outside the bone marrow. This condition is usually associated with hematologic disorders. Although EMH can be found in almost every site in the body, female genital tract involvement is rare. The authors report EMH in the uterine cervix from a 64-year-old patient following cervical biopsy due to abnormal cervical cytology. Neither neoplasm nor hematologic disorder was detected before the diagnosis and after 1 year of follow up. To the best of our knowledge, this is the first reported case of EMH involving the uterine cervix which showed an association with tissue repair.
Hanamornroongruang, Suchanan; Neungton, Chanon; Warnnissorn, Malee
Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol.
Autopsy findings suggest that lung surfactant is damaged in the adult respiratory distress syndrome. In the present study 225 bronchoalveolar lavage specimens (78 from 36 patients, 1-78 yr old with respiratory failure, 135 from another 128 patients with other respiratory disease, and 12 from healthy controls) were assayed for the lung profile [lecithin/sphingomyelin (L/S) ratio, saturated lecithin, phosphatidylinositol, and phosphatidylglycerol]. Bronchoalveolar lavage fluid was further analyzed for phospholipids and for phosphatidic acid phosphohydrolase, phospholipase A2, and phosphatidylinositol phosphodiesterase activities. A lipid-protein complex was isolated and analyzed for surface activity, and plasma was measured for myoinositol. There were only small differences seen in the recovery of total phospholipid between respiratory failure patients and normal controls. However, in respiratory failure, phospholipids in bronchoalveolar lavage were qualitatively different from those recovered either from normal controls or from patients with other lung disease: the LO/S ratio, phosphatidylglycerol, and disaturated lecithin were low, whereas sphingomyelin and phosphatidylserine were prominent. These abnormalities were present early in respiratory failure and tended to normalize during recovery. Low L/S ratio (less than 2), and low phosphatidylglycerol (1% or less of glycerophospholipids) in bronchoalveolar lavage was always associated with respiratory failure. Abnormal lavage phospholipids were not due to plasma contamination. The phospholipase studies revealed little evidence of increased catabolism of phospholipids. In respiratory failure, the lipid-protein complexes from lung lavage were not surface active, whereas that from healthy controls had surface properties similar to lung surfactant. Phospholipids from patients with respiratory failure were similar to those from respiratory distress syndrome in the newborn. However, the latter condition is characterized by fast recovery of surfactant deficiency and by high plasma myoinositol that suppresses the synthesis of surfactant phosphatidylglycerol and increases phosphatidylinositol (Pediatr. Res. 1981. 15: 720). On the other hand, in adult respiratory distress syndrome, the abnormality in surfactant phospholipids may last for weeks and in most cases is associated with low phosphatidylinositol, low phosphatidylglycerol, and low plasma myoinositol.
Hallman, M; Spragg, R; Harrell, J H; Moser, K M; Gluck, L
Primary screening for high risk HPV by home obtained cervicovaginal lavage is an alternative screening tool for unscreened women
Background/Aims: Self sampling is considered an adjuvant tool to facilitate the participation of women in cervical cancer screening programmes. This study aimed to evaluate whether cervicovaginal lavage could be an alternative for the cervical smear in cytology and human papillomavirus (HPV) testing and to assess the acceptance of the self sampling device by women. Methods: Fifty six women with abnormal cervical cytology (very mild dyskaryosis or worse) and 15 women with normal cervical cytology obtained a self collected cervicovaginal lavage at home and filled in a questionnaire on the use of the device. At the colposcopy clinic the gynaecologist performed the same procedure followed by a cervical smear for cytology and HPV DNA testing. Results: The self sampling device was acceptable to 88% of the women. The concordance between the cytology results in the smear and the lavage by the doctor and the patient was 54% and 41%, respectively (? = 0.28 and 0.14). The concordance between high risk HPV detection in the smear and the lavage by the doctor and the patient was 93% and 78%, respectively (? = 0.82 and 0.53). Ninety one per cent of the women with high grade cervical intraepithelial neoplasia (CIN) had a high risk HPV positive test in the smear, compared with 91% and 81% in the lavages taken by the doctor and the patient, respectively. Conclusions: HPV DNA testing by home obtained samples is useful as a screening tool for cervical cancer, whereas cervical cytology by self sampling is not. Although the sensitivity for high grade CIN by high risk HPV testing in the lavage by the patient is not significantly lower than that in the cervical smear, self sampling for HPV DNA is a feasible alternative method in women who decline to participate in population based cervical cancer screening programmes. However, participation in the screening programme remains the best option.
Nobbenhuis, M A E; Helmerhorst, T J M; van den Brule, A J C; Rozendaal, L; Jaspars, L H; Voorhorst, F J; Verheijen, R H M; Meijer, C J L M
Effect of sex, age, number of bronchoalveolar lavages and quantitation methods on the bronchoalveolar cell counts in rats.
This study was conducted to investigate the effect of sex, age, number of bronchoalveolar lavages and method of quantitation on the number of bronchoalveolar cells in rats. Forty Long Evans rats were divided into four age-sex subgroups of ten animals each. Nine consecutive bronchoalveolar lavages were done in every rat and the number of bronchoalveolar cells/mL in lavages 1-3 (L1), 4-6 (L2) and 7-9 (L3) were determined by hemocytometer and electronic cell counts (Coulter Counter). The sex or age of the rats did not show a significant effect (p less than 0.05) in the number of bronchoalveolar cells recovered from the lungs; however, there was a significant difference (p less than 0.05) in the number of cells/mL among lavages 1-3, 4-6 and 7-9 (L1 approximately equal to L2 greater than L3). A discrepancy of approximately 8% in the counts of bronchoalveolar cells was found between the hemocytometer and the Coulter Counter; however, these two methods of cell quantitation showed a significant (p less than 0.01) positive correlation (r = 0.89). No significant (p greater than 0.05) differences were found in the percentage of fluid recovery (overall mean = 94.5%) among lavages L1, L2 and L3. It was concluded that the electronic cell counting of bronchoalveolar cells is as reliable as manual counting. Although sex or age did not significantly affect the number of cells recovered from the lung, caution should be used in the number of lavages done per rat since this variable may significantly affect the results.
Lopez, A; Yong, S; Sharma, A; Bailey, D
Successful Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for Recurrent Uterine Fibroid Previously Treated with Uterine Artery Embolization
A 45-year-old premenopausal woman was referred to our clinic due to recurring symptoms of uterine fibroids, nine years after a uterine artery embolization (UAE). At the time of screening, the patient presented with bilateral impairment and narrowing of the uterine arteries, which increased the risk of arterial perforation during repeated UAE procedures. The patient was subsequently referred for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) treatment. Following the treatment, the patient experienced a significant improvement in symptoms (symptom severity score was reduced from 47 to 12 by 1 year post-treatment). MR images at 3 months showed a 49% decrease in fibroid volume. There were no adverse events during the treatment or the follow-up period. This case suggests that MRgFUS can be an effective treatment option for patients with recurrent fibroids following previous UAE treatment.
Yoon, Sang-Wook; Kim, Kyoung Ah; Kim, Sang Heum; Lee, Jong Tae
Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest.
We present the case of a 37-year-old nulliparous woman in whom acute massive uterine bleeding during dienogest therapy was successfully treated using intrauterine balloon tamponade. Abnormal uterine bleeding and several cases of profuse bleeding causing severe anemia in association with dienogest therapy have been reported, but this is the first reported case involving hypovolemic shock. While successful control of postpartum hemorrhage with intrauterine balloon tamponade has been well described, applications for non-obstetric bleeding, particularly in the presence of underlying diseases, such as adenomyosis, have only rarely been reported. This procedure can be easily, promptly, and safely implemented without analgesia, anesthesia, or laparotomy; it can be used with a minimally dilated external cervical os or narrow uterine cavity; and it can preserve fertility. PMID:23003209
Nishino, Kimihiro; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu
Review: Human uterine stem/progenitor cells: Implications for uterine physiology and pathology.
The human uterus is composed of the endometrial lining and the myometrium. The endometrium, in particular the functionalis layer, regenerates and regresses with each menstrual cycle under hormonal control. A mouse xenograft model has been developed in which the functional changes of the endometrium are reproduced. The myometrium possesses similar plasticity, critical to permit the changes connected with uterine expansion and involution associated with pregnancy. Regeneration and remodeling in the uterus are likely achieved through endometrial and myometrial stem cell systems. Putative stem/progenitor cells in humans and rodents recently have been identified, isolated and characterized. Their roles in endometrial physiology and pathophysiology are presently under study. These stem/progenitor cells ultimately may provide a novel means by which to produce tissues and organs in vitro and in vivo. PMID:23332213
Maruyama, T; Miyazaki, K; Masuda, H; Ono, M; Uchida, H; Yoshimura, Y
Pregnancy Following Uterine Artery Embolization with Polyvinyl Alcohol Particles for Patients with Uterine Fibroid or Adenomyosis
Purpose:To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy.Methods:Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 20-40 years. The data were collected through review of medical records and telephone interviews. Mean duration of follow-up duration was 35 months (range 22-60 months). Patients using contraception and single women were excluded, and the chance of infertility caused by possible spousal infertility or other factors was disregarded. Contrast-enhanced magnetic resonance imaging was performed in all patients before and after UFE, and the size of PVA particles used was 255-700 {mu}m.Results:Among 94 patients who underwent UFE with PVA, 74 were on contraceptives, 6 had been single until the point of interview, and 8 were lost to follow-up. Of the remaining 6 patients who desired future pregnancy, 5 (83%) succeeded in becoming pregnant (1 patient became pregnant twice). Of a total of 8 pregnancies, 6 were planned pregnancies and 2 occurred after contraception failed. Five deliveries were vaginal, and 2 were by elective cesarean. Artificial abortion was performed in 1 case of unplanned pregnancy. There was 1 case of premature rupture of membrane (PROM) followed by preterm labor and delivery of an infant who was small-for-gestational-age. After UFE, mean volume reduction rates of the uterus and fibroid were 36.6% (range 0 to 62.6%) and 69.3% (range 36.3% to 93.3%), respectively.Conclusion:Although the absolute number of cases was small, UFE with PVA particles ultimately did not affect fertility in the women who underwent the procedure.
Kim, Man Deuk [Bundang CHA General Hospital, College of Medicine, Pochon CHA University, Departments of Diagnostic Radiology (Korea, Republic of)], E-mail: email@example.com; Kim, Nahk Keun [Bundang CHA General Hospital, College of Medicine, Pochon CHA University, Departments of Obstetric and Gynecology (Korea, Republic of); Kim, Hee Jin [Bundang CHA General Hospital, College of Medicine, Pochon CHA University, Departments of Diagnostic Radiology (Korea, Republic of); Lee, Mee Hwa [Bundang CHA General Hospital, College of Medicine, Pochon CHA University, Departments of Obstetric and Gynecology (Korea, Republic of)
Dissecting the pelvic retroperitoneum and identifying the ureters. A laparoscopic technique.
A technique for dissecting the pelvic retroperitoneum and identifying the ureters and uterine arteries is described that makes use of the obliterated hypogastric arteries. The obliterated arteries are readily identified laparoscopically and, as relatively fixed structures, are easily dissected free of the bladder and surrounding areolar tissues. Once freed by blunt dissection, they are traced proximally to where they are joined by the uterine arteries to form the internal iliac arteries. Blunt dissection just proximal and medial to the uterine artery will open the pararectal space, the medial border of which is bounded by the ureter. The uterine arteries are then traced to where they cross the ureters and are freed from them by blunt dissection. The site at which the uterine arteries are divided and the extent to which the extraperitoneal spaces are developed and ureters mobilized off the medial leaf of the broad ligament are tailored to the operation performed. PMID:7738920
Kadar, N
Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study
Introduction Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified. Methods We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria. Results We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications. Conclusions FODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases. See related letter by Sircar et al.,http://ccforum.com/content/17/2/428
Assessment of pregnancy-associated, within-woman change in uterine length.
Abstract Objective: To evaluate how absolute uterine length changes as a result of pregnancy. Methods: Longitudinal repeated-measures study of all women presenting to a university-affiliated clinic for uterine sounding prior to in vitro fertilization (IVF) who went on to deliver at term and return for repeat measurement from 2002 to 2012. Change in uterine length was assessed by the Wilcoxon signed-rank test. Results: Among 495 women, mean pregnancy-associated change in uterine length was 0.0?cm (SD?Ý?0.7, p?=?0.84), with 31% of women experiencing no change and 75% of women experiencing a change ?0.5?cm. Mean uterine lengths at pre-cycle and repeat measurement were 7.2?cm (SD?Ý?0.7) and 7.2?cm (SD?Ý?0.7) with medians of 7.0?cm (IQR 7.0-7.5) and 7.0?cm (IQR 6.8-7.8), respectively. Change in uterine length did not vary by gestational number or within time interval between measurements (all p?>?0.5). Conclusions: There was no difference in uterine length before and after term pregnancy. The finding of minimal variation in uterine length both across and within women suggests uterine length may be relatively stable such that patients undergoing IVF after term IVF pregnancy may not require repeat measurement. Future studies might assess pregnancy-associated sonographic changes in uterine volume and the relationship between uterine length and IVF outcomes. PMID:24106808
Hawkins, Leah K; Missmer, Stacey A; Correia, Katharine F; Hornstein, Mark D
Does Size Really Matter? Analysis of the Effect of Large Fibroids and Uterine Volumes on Complication Rates of Uterine Artery Embolisation
The purpose of this study was to determine whether there is a correlation between large uterine fibroid diameter, uterine volume, number of vials of embolic agent used and risk of complications from uterine artery embolisation (UAE). This was a prospective study involving 121 patients undergoing UAE embolisation for symptomatic uterine fibroids at a single institution. Patients were grouped according to diameter of largest fibroid and uterine volume. Results were also stratified according to the number of vials of embolic agent used and rate of complications. No statistical difference in complication rate was demonstrated between the two groups according to diameter of the largest fibroid (large fibroids were classified as {>=}10 cm; Fisher's exact test P = 1.00), and no statistical difference in complication rate was demonstrated according to uterine volume (large uterine volume was defined as {>=}750 cm{sup 3}; Fisher's exact test P = 0.70). 84 of the 121 patients had documentation of the number of vials used during the procedure. Patients were divided into two groups, with {>=}4 used defined as a large number of embolic agent. There was no statistical difference between these two groups and no associated increased risk of developing complications. This study showed no increased incidence of complications in women with large-diameter fibroids or uterine volumes as defined. In addition, there was no evidence of increased complications according to quantity of embolic material used. Therefore, UAE should be offered to women with large fibroids and uterine volumes.
Parthipun, A. A., E-mail: email@example.com; Taylor, J. [St. George's Hospital, Department of Radiology (United Kingdom); Manyonda, I. [St. George's Hospital, Department of Obstetrics and Gynaecology (United Kingdom); Belli, A. M. [St. George's Hospital, Department of Radiology (United Kingdom)
Effects of smoking and irradiated volume on inflammatory response in the lung of irradiated breast cancer patients evaluated with bronchoalveolar lavage
Quantitative measurements of the effects of irradiation on normal tissues in humans have been hard to obtain because most tissues are inaccessible and/or direct responses are difficult to quantify in a nondestructive manner. Pneumonitis and fibrotic lung disease are adverse effects seen in varying intensity in patients treated with radiotherapy for carcinomas of the thorax, e.g., breast cancer. In the present study the aim was to evaluate the inflammatory reaction in the underlying parenchyma following postoperative irradiation with bronchoalveolar lavage technique. Twenty-one patients with breast cancer stage T1N0M0 received radiotherapy with photons to a target dose of 56 Gy following breast conservative surgery. Nineteen healthy controls were also included. The results showed a clear elevation of neutrophils, mast cells, eosinophils, and lymphocytes in the total irradiated groups, compared to controls. When subclassifying the material according to smoking habit, it was obvious that the smokers displayed a significantly decreased inflammatory reaction, i.e., reduced levels of mast cells and lymphocytes, compared to both nonsmoking controls and patients. Eosinophils were seen in an elevated number in all irradiated patients. Radiological signs of pneumonitis were observed in three patients, all in the nonsmoking group. No correlation was found between the volume of lung irradiated and the inflammatory response. It is concluded that bronchoalveolar lavage is a suitable and sensitive method for investigating radiotherapy-induced reactions in the human lung. Furthermore, ongoing smoking during the treatment depressed the inflammatory response in the lung parenchyma induced by irradiation. The present study as well as earlier observations justify further studies concerning the possibility of interaction of smoking with cancer treatment.
Bjermer, L.; Franzen, L.; Littbrand, B.; Nilsson, K.; Angstroem, T.H.; Henriksson, R. (University Hospital, Umea (Sweden))
Cerebral Venous Sinus Thrombosis following Diagnostic Curettage in a Patient with Uterine Fibroid
Cerebral venous sinus thrombosis (CVST) is a relatively rare cerebrovascular disease, of which the risk has been documented in patients with numerous conditions. However, CVST has never been previously described in association with the use of a diagnostic curettage in patient with uterine fibroid. Herein, we described a 43-year-old woman who presented with recurrent convulsive seizures and severe and progressive headache 1 day after a diagnostic curettage of the uterus, which was confirmed to be uterine fibroid pathologically later, and her condition subsequently progressed to confusion. Brain magnetic resonance imaging (MRI) revealed an acute extensive thrombosis of the left transverse and sigmoid sinus and the ipsilateral cerebellum infarction. Evaluation for primary thrombophilia revealed that an iron deficiency anemia (IDA) due to the fibroid bleeding induced menorrhagia together with a diagnostic curettage might be the sole hypercoagulable risk factor identified. Treatment with anticoagulation led to full recovery of her symptoms and recanalization of the thrombosis was proven on magnetic resonance venography (MRV) 2 months later. We suggest that CVST should be recognized as a potential complication related to this diagnostic technique, especially in patient with IDA. The early diagnosis and timely treatment would be of significance in improving the prognosis of this potentially lethal condition.
Zhu, Xiao-Qun; Cao, Li
Laparoscopic management of a cavitated noncommunicating rudimentary uterine horn of a unicornuate uterus: a case report
Introduction A unicornuate uterus with a rudimentary horn is the most uncommon uterine anomaly of the female genital tract. It has an estimated frequency of one in 100,000 among the fertile female population. This anomaly results from the abnormal maturation of one M■llerian duct with the normal development of the contralateral one. Case presentation We report here the case of a 14-year-old Caucasian girl who came to our hospital with intense dysmenorrhea. Imaging techniques revealed a unicornuate uterus with a rudimentary horn and a large hematosalpinx. We performed a laparoscopic removal of this uterine anomaly without any complication in the postoperative period. Conclusion In our case report, we demonstrate that laparoscopy is the best approach for the treatment of IIb M■llerian abnormalities. Laparoscopy resulted in anatomical and reproductive results equivalent to those offered by a laparotomic approach, but with the additional advantages of minimally invasive surgery, such as better cosmetic results and postoperative period, which are essential for very young patients.
Novel use of a tracheobronchial stent in a patient with uterine didelphys and obstructed hemivagina
Objective: To describe a novel use for a tracheobronchial stent to maintain patency after vaginal septum excision in a patient with an obstructed hemivagina and uterine didelphys. Design: Description of a novel technique Setting: University-affiliated Childrens Hospital Patient: One patient with an obstructed hemivagina and uterine didelphys who presented with hematometria and hematocolpos. Intervention: In order to maintain patency and decrease stenosis risk after vaginal septum excision, a coated tracheobronchial stent was deployed and left in place for 6 weeks. Main Outcome Measure: To evaluate ease of stent placement and removal, re-epithelialization and patency of the neo-vagina, and post-operative assessment of pain and recurrent obstruction. Results: The tracheobroncheal stent was easily positioned and deployed with vaginoscopic guidance. Six weeks later it was removed without any tissue in-growth or granulation tissue noted. The vaginal walls were nicely epithelialized. Twelve months post-operatively the patient remained pain free with regular cycles and no evidence of obstruction or abnormality on ultrasound. Conclusion: Use of a coated tracheobronchial stent to maintain patency after septum excision in a patient with an obstructed hemivagina presents a safe, easy and effective option to diminish stenosis risk and avoid infectious complications or hysterectomy.
Cooper, Amber R.; Merritt, Diane F.
Development of morphological and functional polarity in primary cultures of immature rat uterine epithelial cells
The present study describes a culture environment in which luminal epithelial cells isolated from immature rat uteri and cultured on a matrix-coated permeable surface, with separate apical and basal secretory compartments, proliferate to confluence. Subsequently the cells undergo a process of differentiation accompanied by progressive development of functional polarity. Ultrastructural and immunocytochemical evidence verifies the ability of these primary cultures to regain polar organization, separate membrane domains, and form functional tight junctions as demonstrated by the development of transepithelial resistance. The appearance of uvomorulin is restricted to the lateral cell surface. Coordinated indices of functional polarity that develop progressively in post-confluent cultures include the preferential uptake of [35S]methionine from the basal surface and a rise in uterine epithelial cell secretory activity characterized by a progressive preference for apical secretion. The time dependent development of polarity was characterized by differences in the protein profiles of the apical and basolateral secretory compartments. The maintenance of hormone responsiveness by the cultured cells was validated by the secretion of two proteins identified as secretory markers of estrogen response in the intact uterus. The technique of culturing the cells on a matrix-coated permeable surface with separate secretory compartments produces a uterine epithelial cell that morphologically and functionally resembles its in situ equivalent. The culture method and analytical approach used in this present study may be applied to primary cultures of a variety of natural epithelia, which have hitherto proven resistant to more conventional culture methodologies.
The Genetic Bases of Uterine Fibroids; A Review
Uterine leiomyomas/fibroids are the most common pelvic tumors of the female genital tract. The initiators remaining unknown, estrogens and progesterone are considered as promoters of fibroid growth. Fibroids are monoclonal tumors showing 40-50% karyo-typically detectable chromosomal abnormalities. Cytogenetic aberrations involving chromosomes 6, 7, 12 and 14 constitute the major chromosome abnormalities seen in leiomyomata. This has led to the discovery that disruptions or dysregulations of HMGIC and HMGIY genes contribute to the development of these tumors. Genes such as RAD51L1 act as translocation partners to HMGIC and lead to disruption of gene structure leading to the pathogenesis of uterine fibroids. The mechanism underlying this disease is yet to be identified. The occurrence of PCOLCE amid a cluster of at least eight Alu sequences is potentially relevant to the possible involvement of PCOLCE in the 7q22 rearrangements that occur in many leiomyomata. PCOLCE is implicated in cell growth processes. Involvement of Alu sequences in rearrangements can lead to the disruption of this gene and, hence, loss of control for gene expression leading to uncontrolled cell growth. This can also lead to the formation of fibroids. Though, cytogenetics provides a broad perspective on uterine fibroid formation, further molecular analysis is required to understand the etiopathogenesis of uterine fibroids.
Medikare, Veronica; Kandukuri, Lakshmi Rao; Ananthapur, Venkateshwari; Deenadayal, Mamata; Nallari, Pratibha
Molecular diagnosis of endometrial cancer from uterine aspirates.
Rapid and reliable diagnosis of endometrial cancer (EC) in uterine aspirates is highly desirable. Current sensitivity and failure rate of histological diagnosis limit the success of this method and subsequent hysteroscopy is often necessary. Using quantitative reverse transcriptase-polymerase chain reaction on RNA from uterine aspirates samples, we measured the expression level of 20 previously identified genes involved in EC pathology, created five algorithms based on combinations of five genes and evaluated their ability to diagnose EC. The algorithms were tested in a prospective, double-blind, multicenter study. We enlisted 514 patients who presented with abnormal uterine bleeding. EC was diagnosed in 60 of the 514 patients (12%). Molecular analysis was performed on the remnants of aspirates and results were compared to the final histological diagnoses obtained through biopsies acquired by aspiration or guided by hysteroscopy, or from the specimens resected by hysterectomy. Algorithm 5 was the best performing molecular diagnostic classifier in the case-control and validation study. The molecular test had a sensitivity of 81%, specificity of 96%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 97%. A combination of the molecular and histological diagnosis had a sensitivity of 91%, specificity of 97%, PPV of 79% and NPV of 99% and the cases that could be diagnosed on uterine aspirate rose from 76 to 93% when combined with the molecular test. Incorporation of the molecular diagnosis increases the reliability of a negative diagnosis, reduces the need for hysteroscopies and helps to identify additional cases. PMID:23649867
Perez-Sanchez, Cristina; Colas, Eva; Cabrera, Silvia; Falcon, Orlando; Sanchez-del-RÚo, Angel; GarcÚa, Enrique; FernÃndez-de-Castillo, Luis; Muruzabal, Juan Carlos; Alvarez, Elena; Fiol, Gabriel; GonzÃlez, Carmen; Torrejµn, Rafael; Moral, Eloy; Campos, Miriam; RepollÕs, Manuel; Carreras, Ramon; JimÕnez-Lµpez, Jesus; Xercavins, Jordi; Aibar, Elena; Perdones-Montero, Alvaro; Lalanne, Eric; Palicio, Marta; Maes, Tamara; Rosell-Vives, Elisabet; Nieto, Carlos; Ortega, Alicia; Pedrola, Nuria; Llauradµ, Marta; Rigau, Marina; Doll, Andreas; Abal, Miguel; Ponce, Jordi; Gil-Moreno, Antonio; Reventµs, Jaume
The diagnosis of trophoblastic tumours from uterine curettings
The reliability of the diagnosis of choriocarcinoma from uterine curettings is still a matter for debate, and few pathologists see enough material for an objective clinico-pathological study. In the present survey curettings from 54 patients were examined, 38 during follow up of a hydatidiform mole, 12 following a normal pregnancy and four after a spontaneous abortion. Four histological categories were
C. W. Elston; K. D. Bagshawe
Uterine carcinosarcomas: incidence and trends in management and survival.
Our study's aim was to determine the incidence of uterine sarcomas in New York City (NYC) and evaluate trends in frequency, treatment, and survival of carcinosarcomas in two Brooklyn hospitals. Population-based cancer registry data for 1976-1985 were used to calculate the incidence of uterine sarcomas in NYC women. Medical records and histology slides of carcinosarcomas at two central Brooklyn hospitals from 1960 to 1995 were reviewed. The incidence of uterine sarcomas in black and white women in NYC was 33.4 and 17.0 per million (P < 0.01). Among 97 women with carcinosarcomas diagnosed in 1960-1995, 75% were diagnosed preoperatively, 82% had a hysterectomy, and 45% of those in clinical stage I were upstaged. Predictors of mortality included the presence of extrauterine extension, deep myometrial invasion, vascular space invasion, and gross residual disease, with only the first two being independent predictors of survival in a multivariate analysis. Adjunctive therapy shifted from radiation in 1960-1969 to cisplatin-based chemotherapy after 1980. In surgical stage III, survival increased significantly between 1960-1979 and 1980-1995, but improvement could not be ascribed to particular therapies. The incidence of uterine sarcomas in black women was twice that in white women. Surgical staging including omentectomy is recommended in the management of carcinosarcomas. Modern medical care may have improved the short-term prognosis of carcinosarcomas. PMID:9103406
Arrastia, C D; Fruchter, R G; Clark, M; Maiman, M; Remy, J C; Macasaet, M; Gates, E J; Di Maio, T; Marzec, T
Clostridium hathewayi bacteraemia and surgical site infection after uterine myomectomy.
A 42-year-old woman with uterine fibroids underwent myomectomy. She developed postoperative sepsis and bloodstream infection with Clostridium hathewayi secondary to an infected haematoma. The patient was readmitted after failure of oral antibiotic therapy and underwent intrauterine drainage followed by prolonged parenteral antibiotic therapy. The patient was followed for 1 year and did not have any relapse of infection. PMID:24596408
Dababneh, Ala S; Nagpal, Avish; Palraj, Bharath Raj Varatharaj; Sohail, M Rizwan
Improvement in uterine artery doppler indices via hysteroscopic metroplasty
Summary Objective the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. Materials and Methods a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to premetroplasty levels. Results all pregnant women in the study group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean in-tervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. Conclusion metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy.
Pace, Sebastiano; Cerekja, Albana; Dillon, Kathleen Comalli; Pace, Giulia; Piazze, Juan
A case of uterine endometritis caused by Atopobium vaginae.
Although Atopobium vaginae has been reported as a causative organisms in patients with bacterial vaginosis and/or tubo-ovarian abscess, clinical significance of Atopobium species has not been defined to date. Here we report the case of uterine endometritis caused by A. vaginae. PMID:20706763
Yamagishi, Yuka; Mikamo, Hiroshige; Tanaka, Kaori; Watanabe, Kunitomo
A case of uterine endometritis caused by Atopobium vaginae
Although Atopobium vaginae has been reported as a causative organisms in patients with bacterial vaginosis and\\/or tubo-ovarian abscess, clinical significance\\u000a of Atopobium species has not been defined to date. Here we report the case of uterine endometritis caused by A. vaginae.
Yuka Yamagishi; Hiroshige Mikamo; Kaori Tanaka; Kunitomo Watanabe
The risk of developing uterine sarcoma after tamoxifen use
Int J Gynecol Cancer 2008, 18, 352356 The risk of developing uterine sarcoma after tamoxifen use O. LAVIE*, O. BARNETT-GRINESSy, S.A. NARODz & G. RENNERTy *Department of Obstetrics & Gynecology, Division of Gynecology & Oncology, Carmel Medical Center,
Cerebral metastasis of cervical uterine cancer: report of three cases
Cervical uterine cancer (CUC) spreads locally (pelvis and paraortic lymphnodes) or distantly (lungs, liver and bones). Metastasis to central nervous system (CNS) are rare. There are about 80 cases re p o rted in the literature. Outcome is poor and survival varies from 3 to 6 months. Three cases of CNS metastasis from CUC are reported, one infratentorial and two
Joacir Graciolli Cordeiro; Daniel Monte-Serrat Prevedello; LÕo Fernando da Silva Ditzel; Carlos Umberto Pereira; JoÐo Cãndido Araºjo
Adenomyosis interferes with accurate ultrasonographic detection of uterine leiomyomas
Objective: To evaluate the accuracy of pelvic ultrasonography, and the characteristics of women with inaccurate ultrasonographic diagnosis for uterine leiomyomas. Materials and methods: Preoperative pelvic ultrasonographic and postoperative pathologic findings of all women, who underwent hysterectomies for pelvic pain, menorrhagia and\\/or leiomyomas between December 1995 and July 2002, were evaluated. Three hundred thirty-three women, who had a transabdominal or transvaginal
Ozgur H. Harmanli; Silvia A. Bevilacqua; Vani Dandolu; Ashwin J. Chatwani; Enrique Hernandez
Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis
OBJECTIVE: To clarify histologic localization of estrone sulfatase in normal uterine endometrium and adenomyotic tissue and to confirm that estrone sulfatase is one of the enzymes that supplies estrogen to adenomyotic tissue.METHODS: Specimens from 21 patients who had undergone hysterectomy were obtained from uteri with histopathologically proven adenomyosis. Specimens from 28 patients who had undergone hysterectomy for a disease of
Kei Ezaki; Hiroshi Motoyama; Hiroshi Sasaki
Gene expression signatures of primary and metastatic uterine leiomyosarcoma.
Leiomyosarcoma (LMS) is the most common uterine sarcoma. Although the disease is relatively rare, it is responsible for considerable mortality due to frequent metastasis and chemoresistance. The molecular events related to LMS metastasis are unknown to date. The present study compared the global gene expression patterns of primary uterine LMSs and LMS metastases. Gene expression profiles of 13 primary and 15 metastatic uterine LMSs were analyzed using the HumanRef-8 BeadChip from Illumina. Differentially expressed candidate genes were validated using quantitative real-time polymerase chain reaction (PCR) and immunohistochemistry. To identify differently expressed genes between primary and metastatic tumors, we performed one-way analysis of variance with Benjamini-Hochberg correction. This led to identification of 203 unique probes that were significantly differentially expressed in the 2 tumor groups by greater than 1.58-fold with P < .01, of which 94 and 109 were overexpressed in primary and metastatic LMSs, respectively. Genes overexpressed in primary uterine LMSs included OSTN, NLGN4X, NLGN1, SLITRK4, MASP1, XRN2, ASS1, RORB, HRASLS, and TSPAN7. Genes overexpressed in LMS metastases included TNNT1, FOLR3, TDO2, CRYM, GJA1, TSPAN10, THBS1, SGK1, SHMT1, EGR2, and AGT. Quantitative real-time PCR confirmed significant anatomical site-related differences in FOLR3, OSTN, and NLGN4X levels; and immunohistochemistry showed significant differences in TDO2 expression. Gene expression profiling differentiates primary uterine LMSs from LMS metastases. The molecular signatures unique to primary and metastatic LMSs may aid in understanding tumor progression in this cancer and in providing a molecular basis for prognostic studies and therapeutic target discovery. PMID:24485798
Davidson, Ben; Abeler, Vera Maria; F½rsund, Mette; Holth, Arild; Yang, Yanqin; Kobayashi, Yusuke; Chen, Lily; Kristensen, Gunnar B; Shih, Ie-Ming; Wang, Tian-Li
Determination of free ertapenem in plasma and bronchoalveolar lavage by high-performance liquid chromatography with ultraviolet detection
A sensitive assay for the determination of unbound ertapenem in human plasma and bronchoalveolar lavage (BAL) was developed using ultrafiltration of plasma and BAL samples. A rapid HPLC method was used with ultraviolet detection set at a wavelength of 305nm and a separation on a Prontosil AQ C18 column, with imipenem used as internal standard. This assay was linear over
Jean-Baptiste Gordien; Emmanuel Boselli; Catherine Fleureau; Bernard Allaouchiche; GÕrard Janvier; Olivier Lalaude; Marie-Claude Saux; Dominique Breilh
Oral colon lavage solutions containing polyethylene glycol may interfere with ELISA detection of tumor-associated antigens in colonic effluent
Immunologic methods for detection of colorectal neoplasia based on examination of stool or colonic effluent are being developed. Most current oral lavage preparations contain polyethylene glycol (PEG), and if PEG adversely interferes with immunologic testing these tests may become less useful. We describe a decrease in sensitivity of ELISA for tumor-associated antigens (TAA) when effluent samples are diluted in PEG-electrolyte
Martin Tobi; Elisabeth Darmon; Paul Rozen; Nava Epstein; Fred Konikoff; Jona Stadler; Nurit Harpaz; Aron Fink; Zvi Bentwich; Benedict Maliakkal; Gordon D. Luk
Gene promoter hypermethylation in ductal lavage fluid from healthy BRCA gene mutation carriers and mutation-negative controls
INTRODUCTION: Female germline BRCA gene mutation carriers are at increased risk for developing breast cancer. The purpose of our study was to establish whether healthy BRCA mutation carriers demonstrate an increased frequency of aberrant gene promoter hypermethylation in ductal lavage (DL) fluid, compared with predictive genetic test negative controls, that might serve as a surrogate marker of BRCA1\\/2 mutation status
Imogen Locke; Zsofia Kote-Jarai; Mary Jo Fackler; Elizabeth Bancroft; Peter Osin; Ashutosh Nerurkar; Louise Izatt; Gabriella Pichert; Gerald PH Gui; Rosalind A Eeles
Comparison of DNA Extraction Methods for Microbial Community Profiling with an Application to Pediatric Bronchoalveolar Lavage Samples
Barcoded amplicon sequencing is rapidly becoming a standard method for profiling microbial communities, including the human respiratory microbiome. While this approach has less bias than standard cultivation, several steps can introduce variation including the type of DNA extraction method used. Here we assessed five different extraction methods on pediatric bronchoalveolar lavage (BAL) samples and a mock community comprised of nine
Dana Willner; Joshua Daly; David Whiley; Keith Grimwood; Claire E. Wainwright; Philip Hugenholtz
Questions of the adequacy of existing ozone (O3) standards prompted an examination of relationships between concentration (C) and exposure time (T) and the impact of changes in the C x T product on toxic responses. sing protein concentration of bronchoalveolar lavage fluid (BALP)...
Evaluation of suitable reference genes for gene expression studies in bronchoalveolar lavage cells from horses with inflammatory airway disease
BACKGROUND: The stability of reference genes has a tremendous effect on the results of relative quantification of genes expression by quantitative polymerase chain reaction. Equine Inflammatory Airway Disease (IAD) is a common condition often treated with corticosteroids. The diagnosis of IAD is based on clinical signs and bronchoalveolar lavage (BAL) fluid cytology. The aim of this study was to identify
Laura Beekman; Triin Tohver; Rkia Dardari; Renaud LÕguillette
Formalin-inactivated bovine RSV vaccine influences antibody levels in bronchoalveolar lavage fluid and disease outcome in experimentally infected calves
Respiratory syncytial virus (RSV) causes severe respiratory disease in calves and human infants. In response to outbreaks, formalin inactivated (FI)-RSV vaccines were developed and found to exacerbate disease following a live RSV infection. We have reproduced vaccination induced disease enhancement in calves and screened various antibody isotypes in bronchoalveolar lavage fluid (BALF) from two studies: one with disease enhancement and
Warren V. Kalina; Amelia R. Woolums; Laurel J. Gershwin
Performance Characteristics of the Platelia Aspergillus Enzyme Immunoassay for Detection of Aspergillus Galactomannan Antigen in Bronchoalveolar Lavage Fluid
We have evaluated the Platelia Aspergillus enzyme immunoassay for detection of galactomannan in bron- choalveolar lavage (BAL) specimens in solid organ transplant patients with aspergillosis. The precision and reproducibility in serum or BAL to which galactomannan was added were similar. Sensitivity was 81.8% in patients with aspergillosis, and specificity was 95.8% in lung transplant patients who underwent BAL for surveillance
S. Husain; C. J. Clancy; M. H. Nguyen; S. Swartzentruber; H. Leather; A. M. LeMonte; M. M. Durkin; K. S. Knox; C. A. Hage; C. Bentsen; N. Singh; J. R. Wingard; L. J. Wheat
Acute lung inflammation: Neutrophil elastase versus neutrophils in the bronchoalveolar lavage neutrophil elastase reflects better inflammatory intensity
Objective: To test the hypothesis whether PMN-Elastase in bronchoalveolar lavage fluid (BALF) could reflect neutrophil activity in the lower respiratory tract. Design: Prospectively, morphologic findings of acute and chronic inflammation in the transbronchial lung biopsy specimens were compared with the numbers of neutro- phils in the BALF and the concentration of PMN- Elastase in the same. Setting: Ambulatory outpatient service
A. Lengas; V. Poletti; L. Pacifico; C. di Domizio; M. Patelli; L. Spiga
Changes in pulmonary lavage fluid of guinea pigs exposed to ultrafine zinc oxide with adsorbed sulfuric acid
Ultrafine metal oxide particles (diameters less than 0.1 ?m) and sulfur dioxide are important products of coal combustion. Interaction of these products in the effluent stream results in formation of ultrafine particles with adsorbed sulfur compounds, including sulfuric acid. The toxicity of ultrafine zinc oxide particles with adsorbed sulfuric acid was evaluated by comparing pulmonary lavage fluid from guinea pigs
Michael W. Conner; William H. Flood; Adrianne E. Rogers; Mary O. Amdur
Byssinosis: Release of prostaglandins, thromboxane, and 5-hydroxytryptamine in bronchopulmonary lavage fluid after inhalation of cotton dust extracts.
New Zealand White rabbits were exposed intratracheally to aerosolized cotton dust extract (CDE) for 5 minutes of tidal breathing and lavaged 15 minutes 1, 4, and 6 hours after exposure. Bronchoalveolar lavage cells were counted, and the number of macrophages and polymorphonuclear leukocytes (PMNs) was determined. Cell recruitment, which began 1 hour after exposure to CDE and plateaued at 6 hours, consisted of both mononuclear cells and PMNs. Lavage fluid was analyzed for concentrations of prostaglandin F2 alpha (PGF2 alpha), prostaglandin E1 and E2 (PGE), thromboxane B2 (TxB2), and 5-hydroxytryptamine (5-HT). PGF2 alpha, PGE, TxB2, and 5-HT were maximally increased in the lavage 4 hours after exposure to CDE. This is the first study to demonstrate the in vivo release of arachidonic acid metabolites and 5-HT in the lung in response to CDE inhalation. This study also demonstrates that maximum mediator release occurs at 4 hours after exposure to aerosolized CDE. These findings strongly suggest that arachidonic acid metabolites are available to mediate either totally or partially the pathogenic mechanism(s) of bronchoconstriction seen in the acute byssinotic reaction of man.
Mundie, T. G.; Whitener, C.; Ainsworth, S. K.
Independent contribution of bronchoalveolar lavage and serum galactomannan in the diagnosis of invasive pulmonary aspergillosis.
The optimal combination of galactomannan index (GMI) testing for the diagnosis of invasive pulmonary aspergillosis (IPA) remains unclear. For diagnostic approaches that are triggered by clinical signs and symptoms in high-risk patients, institutional variation remains, with some centers routinely relying on only serum GMI or bronchoalveolar lavage (BAL) GMI testing. In addition, use of mold-active agents before diagnosis of IPA is becoming increasingly common, and understanding the effect of these drugs on test yield is important when making time-critical treatment decisions. In a single-center cohort of 210 allogeneic hematopoietic cell transplant recipients, we found that serum and BAL GMI testing contributed independently to IPA diagnosis, supporting the practice of sending both tests simultaneously to ensure a timely diagnosis of IPA. BAL GMI sensitivity was not affected by receipt of mold-active therapy in our cohort. PMID:24725139
Fisher, C E; Stevens, A M; Leisenring, W; Pergam, S A; Boeckh, M; Hohl, T M
An important problem in realizing personalized medicine is the development of methods for identifying disease subtypes using quantitative proteomics. Recently we found that bronchoalveolar lavage (BAL) cytokine patterns contain information about dynamic lung responsiveness. In this study, we examined physiological data from 1048 subjects enrolled in the US Severe Asthma Research Program (SARP) to identify four largely separable, quantitative intermediate phenotypes. Upper extremes in the study population were identified for eosinophil- or neutrophil- predominant inflammation, bronchodilation in response to albuterol treatment, or methacholine sensitivity. We evaluated four different statistical (machine) learning methods to predict each intermediate phenotypes using BAL cytokine measurements on a 76 subject subset. Comparison of these models using area under the ROC curve and overall classification accuracy indicated that logistic regression and multivariate adaptive regression splines produced the most accurate methods to predict intermediate asthma phenotypes. These robust classification methods will aid future translational studies in asthma targeted at specific intermediate phenotypes.
Brasier, Allan R.; Victor, Sundar; Ju, Hyunsu; Busse, William W.; Curran-Everett, Douglas; Bleecker, Eugene; Castro, Mario; Chung, Kian Fan; Gaston, Benjamin; Israel, Elliot; Wenzel, Sally E.; Erzurum, Serpil C.; Jarjour, Nizar N.; Calhoun, William J.
Preliminary studies on the fibrogenic effects of silicotic pulmonary lavage in normal rat lung
The biological activity of silica free broncho-pulmonary lavage (BPL) obtained from silicotic rats was determined by injecting intratracheally into fresh group of rats or by exposure to a suspension of sheep erythrocytes. The BPL obtained at 8, 16 and 45 days after silica inoculation, revealed no hemolytic action on sheep red blood corpuscles. However, when injected intratracheally into fresh rats, the BPL caused mild exudative and cellular changes into the alveolar spaces at early periods. At later periods, marked interstitial thickening due to infiltration by mononuclear cells, foamy macrophages and fibroblasts resulted. The 16 day old silicotic BPL involved larger areas of pulmonary parenchyma and caused more fibroblastic proliferation as compared to BPL obtained at other periods.
Dogra, S.; Dogra, R.K.S.; Kaw, J.L.
Detection of Mycoplasma sp. in bronchoalveolar lavage of AIDS patients with pulmonary infiltrates.
We examined 486 bronchoalveolar lavages (BAL) including 32 from AIDS patients with pulmonary infiltrates and 20 from patients with leukemia or after transplantation. Mycoplasmas were found in 4/32 (12.5%) HIV-positive patients compared to 4/454 (< 0.9%) HIV-negative patients (p < 0.001). All of these four HIV-positive patients suffered from advanced infection (CD4 counts < 100/microL) and developed complications (Pcp, n = 2, recurrent bacterial pneumonia, n = 1, pulmonary Kaposi sarcoma, n = 1). No mycoplasmas were detected in 20 immunosuppressed patients with leukemia or after transplantation. Our data indicate that AIDS patients may be more often colonised or infected by mycoplasmas than HIV-negative patients or other immunocompromised persons. Although the etiological role of mycoplasmas for pulmonary infections in these patients remains unclear, the finding of mycoplasmas was associated with rapid progress and development of severe complications in our study. PMID:8837371
Sloot, N; Hollandt, H; Gatermann, S; Dalhoff, K
Bronchoalveolar Lavage Fluid IFN-? (+) Th17 Cells and Regulatory T Cells in Pulmonary Sarcoidosis.
In sarcoidosis, increased Th17 cell fractions have been reported in bronchoalveolar lavage fluid, and elevated numbers of Th17 cells producing IFN- ? have been observed in peripheral blood. The balance between Th1, Th17, and FoxP3(+) CD4(+) T cell subsets in sarcoidosis remains unclear. Bronchoalveolar lavage fluid cells, from 30 patients with sarcoidosis, 18 patients with other diffuse parenchymal lung diseases, and 15 healthy controls, were investigated with flow cytometry for intracellular expression of FoxP3. In a subset of the patients, expression of the cytokines IL17A and IFN- ? was investigated. The fractions of FoxP3(+) CD4(+) T cells and Th17 cells were both lower in sarcoidosis compared to controls (P = 0.017 and P = 0.011, resp.). The proportion of Th17 cells positive for IFN- ? was greater in sarcoidosis than controls (median 72.4% versus 31%, P = 0.0005) and increased with radiologic stage (N = 23, rho = 0.45, and P = 0.03). IFN- ? (+) Th17 cells were highly correlated with Th1 cells (N = 23, rho = 0.64, and P = 0.001), and the ratio of IFN- ? (+) Th17/FoxP3(+) CD4(+) T cells was prominently increased in sarcoidosis. IFN- ? (+) Th17 cells may represent a pathogenic subset of Th17 cells, yet their expression of IFN- ? could be a consequence of a Th1-polarized cytokine milieu. Our results indicate a possible immune cell imbalance in sarcoidosis. PMID:24882950
T½ndell, Anders; Moen, Torolf; B½rset, Magne; Salvesen, Oyvind; R½, Anne Dorthea; Sue-Chu, Malcolm
Gene expression fingerprint of uterine serous papillary carcinoma: identification of novel molecular markers for uterine serous cancer diagnosis and therapy
Uterine serous papillary cancer (USPC) represents a rare but highly aggressive variant of endometrial cancer, the most common gynecologic tumour in women. We used oligonucleotide microarrays that interrogate the expression of some 10 000 known genes to profile 10 highly purified primary USPC cultures and five normal endometrial cells (NEC). We report that unsupervised analysis of mRNA fingerprints readily distinguished
A D Santin; F Zhan; S Bellone; M Palmieri; M Thomas; A Burnett; J J Roman; M J Cannon; J Shaughnessy; S Pecorelli
Prompt diagnosis and treatment of uterine arcuate artery pseudoaneurysm: a case report and review of literature.
Post-partum haemorrhage is a major determinant of maternal mortality. Traditionally, cases of post-partum haemorrhage caused by arterial injuries were managed by caesarean hysterectomies or bilateral internal iliac artery ligations. The diagnosis of aneurysms or arteriovenous malformations of uterine artery are often missed. Uterine curettage, caesarean section or vaginal delivery can result in uterine vascular anomalies like pseudo aneurysms, arteriovenous malformations, arteriovenous fistula and rupture of uterine vessels. Colour Doppler ultrasound pelvis allows detection of these vascular abnormalities. It helps in differentiating the vascular abnormalities that require embolization from non-vascular abnormalities which can be managed by uterine curretage. Vessel malformations can be treated safely with transcatheter uterine artery embolization, but they can develop disastrous consequences with inadvertent uterine curettage. Transcatheter uterine artery embolization after pelvic angiography is the treatment of choice for uterine artery malformations and it has the advantage of preserving the reproductive capacity. We recommend a routine use of colour Doppler ultrasound pelvis for evaluation of abnormal uterine bleeding. PMID:24298511
Sharma, Nidhi; Ganesh, Deepa; Devi, Lakshmi; Srinivasan, Jayashree; Ranga, Upasana
Prompt Diagnosis and Treatment of Uterine Arcuate Artery Pseudoaneurysm: A Case Report and Review of Literature
Postpartum haemorrhage is a major determinant of maternal mortality. Traditionally, cases of postpartum haemorrhage caused by arterial injuries were managed by caesarean hysterectomies or bilateral internal iliac artery ligations. The diagnosis of aneurysms or arteriovenous malformations of uterine artery are often missed. Uterine curettage, caesarean section or vaginal delivery can result in uterine vascular anomalies like pseudo aneurysms, arteriovenous malformations, arteriovenous fistula and rupture of uterine vessels. Colour Doppler ultrasound pelvis allows detection of these vascular abnormalities. It helps in differentiating the vascular abnormalities that require embolization from nonvascular abnormalities which can be managed by uterine curretage. Vessel malformations can be treated safely with transcatheter uterine artery embolization, but they can develop disastrous consequences with inadvertent uterine curettage. Transcatheter uterine artery embolization after pelvic angiography is the treatment of choice for uterine artery malformations and it has the advantage of preserving the reproductive capacity. We recommend a routine use of colour Doppler ultrasound pelvis for evaluation of abnormal uterine bleeding.
Sharma, Nidhi; Ganesh, Deepa; Devi, Lakshmi; Srinivasan, Jayashree; Ranga, Upasana
Successful treatment of submucosal myoma with acute severe uterine hemorrhage by emergency uterine arterial embolization followed by early hysteroscopic myomectomy: a report of two cases
Two submucosal myoma cases with acute severe uterine hemorrhage were initially treated by emergency uterine arterial embolization for hemostasis. Then, after improvement of the general condition, early hysteroscopic myomectomy was performed. In one patient, complete resection was achieved. In another patient, the initial resection was incomplete because of the large tumor size. However, the remaining myoma tissue was spontaneously expelled
Akihiro Takeda; Shuichi Manabe; Satoyo Hosono; Hiromi Nakamura; Kayoko Kato; Kazuyuki Koyama
Comparison of tissue damage, cleansing and cross-contamination potential during wound cleansing via two methods: lavage and negative pressure wound therapy with instillation.
The use of lavage was compared to negative pressure wound therapy (NPWT) with instillation (NPWTi) to assess extent of soft tissue damage, debris removal and environmental cross-contamination susceptibility in three distinct models. Scanning electron microscopy in an ex vivo model showed increased visible tissue trauma from lavage treatment at low and high pressures versus NPWTi, with the degree of trauma relative to the pressure of the irrigant. These results were corroborated in granulating full-thickness excisional swine wounds coated with dextran solution to simulate wound debris. Both low-pressure lavage and NPWTi demonstrated effective cleansing in this model, reducing debris by >90%. However, using three-dimensional photography to evaluate tissue damage by measuring immediate tissue swelling (changes in wound volume and depth) showed significantly greater (P < 0.05) swelling in low-pressure lavage-treated wounds compared with NPWTi-treated wounds. Lastly, bench top wound models were inoculated with fluorescent bacterial particles to assess environmental cross-contamination potential and collected at measured distances after treatment with low-pressure lavage and NPWTi. No evidence of cross-contamination was found with NPWTi, whereas one-half of the particles became 'aerosolised' during low-pressure lavage (P < 0.05). Collectively, these studies demonstrate the effective wound cleansing capabilities of NPWTi without the tissue damage and environmental contamination associated with lavage. PMID:22905800
Allen, Diwi; Labarbera, Lori A; Bondre, Ioana L; Lessing, M Christian; Rycerz, Anthony M; Kilpadi, Deepak V; Collins, Barbara A; Perkins, Joanna; McNulty, Amy K
Measuring the volume of uterine fibroids using 2- and 3-dimensional ultrasound and comparison with histopathology.
The aim of this study was clinical testing of the reliability and usability of three-dimensional (3D) and two-dimensional (2D) ultrasound (US) technology. The ultimate aim and purpose of this study was to establish ultrasound methods, standards and protocols for determining the volume of any gynecologic organ or tumor. The study included 31 women in reproductive age and postmenopause. All patients were examined with a RIC 5-9 3D-endovaginal probe (4.3-7.5 MHz) on a Voluson 730 Pro ultrasound device. The volume of myomas was measured by using the existing 2D and 3D ultrasound methods on the above mentioned device. All patients underwent myomectomy or hysterectomy due to clinically and ultrasonographically diagnosed uterine myomas indicating operative intervention. After the operation, the pathologist determined the volume of removed myomas by measuring them in a gauge bowl containing water, i.e. using Archimedes' principle (lift), serving as the control group with histopathologic diagnosis. A total of 155 myoma volumes were processed on 2D display, 31 myoma volumes were preoperatively measured on 3D display and 31 myoma volumes were measured by the pathologist. The values of US measurements for each US method were expressed as mean value of all measurements of myoma volumes. Statistical processing of the results and Student's t-test for independent samples revealed that the 2nd examined US method (measuring of myoma by using an ellipse and the longer tumor diameter) and 4th examined US method (measuring of myoma by using the longer and shorter tumor diameters together with establishing their mean values) in 2D US technique, as well as the 6th examined US method in 3D US technique showed no significant measurement differences in comparison with control measurement in a gauge bowl containing water (p < 0.05), indicating acceptability of the US methods for verifying tumor volumes. The standard error in determining the volume of myomas by the above US methods varied between 15% and 25%, so it is concluded that these three methods can be used in clinical practice to determine tumor volumes, in this case uterine myomas. The 3D MultiPlane method proved to be the most reliable method of determining the volume of uterine myomas. PMID:23540166
Zivkovi?, Nikica; Zivkovi?, Kreiimir; Despot, Albert; Pai?, Josip; Zeli?, Ana
Incidentally discovered uterine sarcoma in a premenopausal patient after hysterectomy for postembolization endometritis.
Uterine leiomyomas (fibroids) are the most common benign tumor of the female reproductive system. Fibroids can become symptomatic with symptoms such as menorrhagia and menometrorrhagia, pelvic pain, and reproductive dysfunction. Hysterectomy, myomectomy, and the less invasive uterine artery embolization are now commonly performed if conservative management of symptomatic fibroids fails. Moreover, uterine artery embolization (UAE) is the preferred minimally invasive procedure for the treatment of symptomatic fibroids. Major complications of UAE are extremely rare but well known. Additionally, there is a risk of undiagnosed uterine sarcoma found post embolization, which has been reported in literature during the past 12 years. Herein, we describe a case of an incidentally discovered uterine sarcoma in a premenopausal female after hysterectomy for post uterine artery embolization endometritis and sepsis. PMID:24310827
Chu, Edwin C; Santos, Ernesto; McCluskey, Kevin
Potential role of LMP2 as tumor-suppressor defines new targets for uterine leiomyosarcoma therapy
Although the majority of smooth muscle neoplasms found in the uterus are benign, uterine leiomyosarcoma (LMS) is extremely malignant, with high rates of recurrence and metastasis. We earlier reported that mice with a homozygous deficiency for LMP2, an interferon (IFN)-?-inducible factor, spontaneously develop uterine LMS. The IFN-? pathway is important for control of tumor growth and invasion and has been implicated in several cancers. In this study, experiments with human and mouse uterine tissues revealed a defective LMP2 expression in human uterine LMS that was traced to the IFN-? pathway and the specific effect of JAK-1 somatic mutations on the LMP2 transcriptional activation. Furthermore, analysis of a human uterine LMS cell line clarified the biological significance of LMP2 in malignant myometrium transformation and cell cycle, thus implicating LMP2 as an anti-tumorigenic candidate. This role of LMP2 as a tumor suppressor may lead to new therapeutic targets in human uterine LMS.
Hayashi, Takuma; Horiuchi, Akiko; Sano, Kenji; Hiraoka, Nobuyoshi; Kasai, Mari; Ichimura, Tomoyuki; Sudo, Tamotsu; Tagawa, Yoh-ichi; Nishimura, Ryuichiro; Ishiko, Osamu; Kanai, Yae; Yaegashi, Nobuo; Aburatani, Hiroyuki; Shiozawa, Tanri; Konishi, Ikuo
Rectus abdominalis muscle metastasis from uterine leiomyosarcoma: An unusual case and review of the literature
Uterine leiomyosarcoma is an aggressive malignancy. Spread to the lung, thyroid, liver, brain, pancreas, heart, duodenum, breast, vagina, submandibular gland, and bone has been reported. We describe a case of metastatic uterine leiomyosarcoma to the rectus abdominalis muscle as the first case in the literature. A 39-year-old nulligravid woman presented with a history of pelvic pain. Physical examination discovered about a 6-cm mass in the suprapubic region. She had previously undergone a hysterectomy for uterine leiomyosarcoma. Operative findings had revealed a mass measuring 4æ5æ6 cm located in the rectus abdominalis muscle. Abnormal mitotic figures and necrosis were evident, and uterine leiomyosarcoma was diagnosed. Uterine leiomyosarcomas are malignancies of the smooth muscle arising from the myometrium. Skeletal muscle is an uncommon site of metastasis by hematogenous spread. In conclusion, we have described a case of skeletal muscle metastasis (first case of rectus abdominalis muscle metastasis) secondary to uterine leiomyosarcoma.
Gungor, Tayfun; Akbay, Serap; Aksut, Hayri; Y?lmaz, Bulent
Microsatellite instability analysis in uterine cavity washings to detect endometrial cancer in lynch syndrome.
Aim: To assess the feasibility of Microsatellite Instability (MSI) analysis in uterine cavity washings for detecting endometrial cancer in Lynch syndrome. Materials and Methods: This was a proof-of-concept study in Lynch syndrome patients, scheduled for hysterectomy. At the beginning of surgical procedure, uterine cavity washings were performed, and sent for MSI analysis. Pathological examination of the uterus was associated with mismatch repair protein expression and MSI analysis. Results; Nine patients were included in the study. Uterine cavity washings were feasible and interpretable in all cases. Final histological report identified 2 endometrial cancers and 7 benign specimens. There was no atypical hyperplasia. Sensitivity, specificity, positive predictive value, and negative predictive value of MSI analysis in uterine washings reached 100% in all cases. Concordance of MSI presence or absence was absolute between uterine washings and final histology. Conclusion; MSI analysis in uterine cavity washings may be a promising screening tool for Lynch syndrome-associated endometrial cancer diagnosis. PMID:24922696
Bats, Anne-Sophie; Blons, Helene; Narjoz, Celine; LE Frere-Belda, Marie-Aude; Laurent-Puig, Pierre; Lecuru, Fabrice
Magnetomyographic recording and identification of uterine contractions using Hilbert-wavelet transforms.
We propose a multi-stage approach using Wavelet and Hilbert transforms to identify uterine contraction bursts in magnetomyogram (MMG) signals measured using a 151 magnetic sensor array. In the first stage, we decompose the MMG signals by wavelet analysis into multilevel approximate and detail coefficients. In each level, the signals are reconstructed using the detail coefficients followed by the computation of the Hilbert transform. The Hilbert amplitude of the reconstructed signals from different frequency bands (0.1-1 Hz) is summed up over all the sensors to increase the signal-to-noise ratio. Using a novel clustering technique, affinity propagation, the contractile bursts are distinguished from the noise level. The method is applied on simulated MMG data, using a simple stochastic model to determine its robustness and to seven MMG datasets. PMID:19738317
Furdea, A; Eswaran, H; Wilson, J D; Preissl, H; Lowery, C L; Govindan, R B
Intramyocardial Transplantation and Tracking of Human Mesenchymal Stem Cells in a Novel Intra-Uterine Pre-Immune Fetal Sheep Myocardial Infarction Model: A Proof of Concept Study
Although stem-cell therapies have been suggested for cardiac-regeneration after myocardial-infarction (MI), key-questions regarding the in-vivo cell-fate remain unknown. While most available animal-models require immunosuppressive-therapy when applying human cells, the fetal-sheep being pre-immune until day 75 of gestation has been proposed for the in-vivo tracking of human cells after intra-peritoneal transplantation. We introduce a novel intra-uterine myocardial-infarction model to track human mesenchymal stem cells after direct intra-myocardial transplantation into the pre-immune fetal-sheep. Thirteen fetal-sheep (gestation age: 7075 days) were included. Ten animals either received an intra-uterine induction of MI only (n?=?4) or MI+intra-myocardial injection (IMI;n?=?6) using micron-sized, iron-oxide (MPIO) labeled human mesenchymal stem cells either derived from the adipose-tissue (ATMSCs;n?=?3) or the bone-marrow (BMMSCs;n?=?3). Three animals received an intra-peritoneal injection (IPI;n?=?3; ATMSCs;n?=?2/BMMSCs;n?=?1). All procedures were performed successfully and follow-up was 79 days. To assess human cell-fate, multimodal cell-tracking was performed via MRI and/or Micro-CT, Flow-Cytometry, PCR and immunohistochemistry. After IMI, MRI displayed an estimated amount of 1æ1055æ105 human cells within ventricular-wall corresponding to the injection-sites which was further confirmed on Micro-CT. PCR and IHC verified intra-myocardial presence via detection of human-specific ?-2-microglobulin, MHC-1, ALU-Sequence and anti-FITC targeting the fluorochrome-labeled part of the MPIOs. The cells appeared viable, integrated and were found in clusters or in the interstitial-spaces. Flow-Cytometry confirmed intra-myocardial presence, and showed further distribution within the spleen, lungs, kidneys and brain. Following IPI, MRI indicated the cells within the intra-peritoneal-cavity involving the liver and kidneys. Flow-Cytometry detected the cells within spleen, lungs, kidneys, thymus, bone-marrow and intra-peritoneal lavage, but not within the heart. For the first time we demonstrate the feasibility of intra-uterine, intra-myocardial stem-cell transplantation into the pre-immune fetal-sheep after MI. Utilizing cell-tracking strategies comprising advanced imaging-technologies and in-vitro tracking-tools, this novel model may serve as a unique platform to assess human cell-fate after intra-myocardial transplantation without the necessity of immunosuppressive-therapy.
Wolint, Petra; Frauenfelder, Thomas; Zeisberger, Steffen M.; Behr, Luc; Sammut, Sebastien; Scherman, Jacques; Brokopp, Chad E.; Schwartlander, Ruth; Vogel, Viola; Vogt, Peter; Grunenfelder, Jurg; Alkadhi, Hatem; Falk, Volkmar; Boss, Andreas; Hoerstrup, Simon P.
Benign and malignant tumor of the uterine body with broccoli sign: MR imaging features for differential diagnosis.
The characteristic morphology called broccoli sign combines a stalk and prolapsed tumor and is a useful diagnostic indicator of prolapsed tumor of the uterine body. Magnetic resonance (MR) imaging findings of broccoli sign are common for uterine submucosal leiomyomata but not well described for other tumors of the endometrial cavity, such as endometrial polyp, atypical polypoid adenomyoma, endometrial carcinoma, carcinosarcoma, and adenosarcoma. Both benign and malignant masses of the uterine body can show broccoli sign. The MR imaging features of prolapsed uterine tumor with broccoli sign resemble those of usual uterine body tumors, but the location is different. We describe the MR imaging features of prolapsed uterine tumors with broccoli sign. PMID:23719762
Kozawa, Eito; Takahashi, Masahiro; Meguro, Shiori; Yasuda, Masanori; Iwasa, Norihiro; Fujiwara, Keiichi; Kimura, Fumiko
[The clinical characteristics of women with uterine hemorrhages in premenopause].
The clinical characteristics was studied on 431 women with uterine bleedings during the premenopaussal phase of the climacterium. The author established that menarche, duration of menstrual interval and the menstruation itself before the bleeding did not differ from those of female population in the country. The same was referred to the reproductive characteristics. Premenopausal bleeding reached its peak between 46 and 48 years of age as its duration was relatively great. It was connected with frequent neuro-endocrine and metabolic pathology. The most frequent manifestations were obesity and hypertension. The number of the former hepatitis patients was comparatively large. Diseases of the uterine body were frequent in the structure of genital pathology. The frequency of benign, precancerous and malignant neoplastic processes (without myoma) was high-12.7%. PMID:2802100
Rachev, E
Management of Uterine Bleeding During Hematopoietic Stem Cell Transplantation
BACKGROUND Hematopoietic stem cell transplant is an effective treatment strategy for a variety of hematologic disorders, but patients are at risk for dysfunctional coagulation and abnormal bleeding. Gynecologists are often consulted before transplant for management of abnormal uterine bleeding, which may be particularly challenging in this context. CASE A premenopausal woman with MonoMAC (a rare adult-onset immunodeficiency syndrome characterized by monocytopenia and Mycobacterium avium complex infections resulting from mutations in GATA2, a crucial gene in early hematopoiesis) presented with pancytopenia, evolving leukemia, and recent strokes, necessitating anticoagulation. During preparation for hematopoietic stem cell transplant, she experienced prolonged menorrhagia requiring transfusions. Surgical therapy was contraindicated, and medical management was successful only when combined with balloon tamponade. CONCLUSION Balloon tamponade may be a potentially life-saving adjunct to medical therapy for control of uterine hemorrhage before hematopoietic stem cell transplant.
Purisch, Stephanie E.; Shanis, Dana; Zerbe, Christa; Merideth, Melissa; Cuellar-Rodriguez, Jennifer; Stratton, Pamela