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Ureteral substitute by fallopian tube. Experimental study.

Experimental substitution of a long segment of ureter by a fallopian tube was performed in dogs. Three different techniques of proximal and distal anastomosis for reconstruction of the urinary tract were used in three groups of animals. Based on this, it is believed that the fallopian tube, as a pedicle graft, could serve in female dogs as the most approximate ideal substitute for ureter because of (a) anatomic proximity to the ureter permitting blood supply to the tube, (b) the fallopian tube's mucosa lining is not affected by urinary excretions, (c) does not allow absorption of electrocytes, (d) has a muscular wall with peristaltic activity, and (e) avoids the problems of antigenicity and/or foreign body reaction.

Animals↗

Periovulatory glycoprotein secretion in the macaque fallopian tube.

Anatomic demonstration of a specific midcycle fallopian tube secretion has been sought by transmission electron microscopy in the Macaca mulatta fascicularis with a method of in vivo perfusion-fixation that includes the polycation alcian blue (plus glutaraldehyde) to precipitate and stabilize anionic extracellular secreted glycoproteins. Of nine monkeys entered into the study, six ovulated regularly. With the help of daily plasma total estrogen radioimmunoassays and serial laparoscopies, these six monkeys were killed and the pelvic organs were perfused at specific times in the menstrual cycle: the midfollicular phase (one), during the midcycle estrogen peak immediately before ovulation (one), 24 hours after ovulation (one), 2 to 4 days after ovulation (two), and premenstrually (one). The other three monkeys were oophorectomized and were treated with estradiol benzoate, 10 micrograms/kg/day for 7 days (two), or with estradiol benzoate, 10 micrograms/kg/day for 7 days, and progesterone in oil, 1 mg/kg/day from day 3 to day 7. Evenly distributed, granular, precipitated material was found in the isthmic lumen both immediately before and 24 hours after ovulation (and in the two oophorectomized, estrogen-treated monkeys, both of which had plasma total estrogen levels that exceeded those of preovulatory monkeys); this would coincide with times of sperm ascent through the isthmus, ovulation, and fertilization and with the time of temporary impedance of the ovum's normal transport to the uterus, known to occur at the ampullary-isthmic junction. No substantial precipitable secretion was found in the ampulla at any stage of the cycle, in the isthmus before the midcycle estrogen rise, or 48 hours or more after either ovulation or initiation of progesterone treatment. These observations indicate that, in the primate fallopian tube, the unique ability of the isthmus to transport spermatozoa and ova in opposite directions sequentially is related temporally (and perhaps causally) to the presence and absence, respectively, of specific isthmic luminal secretions. The biochemical basis for this isthmic property may lie in the expected highly expanded state of acid mucus glycoproteins in the secretions.

Animals↗

Endocrine modulation of gamma-aminobutyric acidergic innervation in the rat fallopian tube.

The present study investigates the effect of different endocrine manipulations on the gamma-aminobutyric acid (GABA)-ergic system in the rat fallopian tube. Either hypophysectomy or ovariectomy induced a significant decrease of glutamic acid decarboxylase (GAD) activity and of GABA levels in in situ tubes. This effect was completely reversed by either gonadotropins or combined estrogen-progesterone administration, respectively. Estrogen or progesterone alone proved less effective than the administration of both steroids in counteracting the effect of ovariectomy on GAD activity. The in vitro incubation of ovariectomized rat fallopian tubes with estrogen-progesterone for 1 h failed to counteract the reduction of the GAd activity induced by surgical manipulation. The in vivo effect of estrogen-progesterone administration on the GABA-ergic system seems to be specific since steroid treatment induced the synthesis of an enzyme which was immunologically identical to the GAD present in the fallopian tube and brain of normal diestrous rat. Autotransplantation of the fallopian tube under the skin brought about a decrease of GAD activity similar to that obtained after ovariectomy. In this situation, however, estrogen-progesterone administration did not counteract the decrease of GAD activity induced by fallopian tube deafferentation. The present results demonstrate that an interaction between the GABA-ergic system and the hypothalamo-pituitary-gonadal axis seems to be operative at the level of the rat fallopian tube. However, the physiological meaning of this interrelationship between the endocrine and the peripheral nervous systems remains to be clarified.

Animals↗

Prognostic impact of DNA content and AUER classification in primary fallopian tube carcinoma.

DNA ploidy has been studied in 61 primary fallopian tube carcinomas using image-cytometry. The investigation also included survival analysis, and ploidy classification according to AUER was performed in order to evaluate its prognostic impact for fallopian tube carcinoma. A high number of aneuploid cases were observed (79% aneuploid vs. 21% euploid tumors). The high incidence of aneuploid tumors was consistently observed among all FIGO-stages as well as all groups of histologic grading. There was no correlation between ploidy and FIGO-stage or histologic grading. Patients with euploid DNA content showed a median survival of 34 months compared to 24 months for aneuploid cases (log-rank, P = 0.83). No correlation between the AUER classification and FIGO-stage or histologic grading could be observed. Tumors with an AUER type I and II (75th quantile 41 months) showed a better outcome than tumors with AUER III and IV (75th quantile 19 months). Although these results did not reach statistical significance (P = 0.07), a trend could be observed. Therefore AUER classification may be useful as an objective prognostic parameter. The high incidence of aneuploid tumors could be an expression of the high biologic aggressiveness of primary fallopian tube cancer which has been repeatedly mentioned in the past.

Adenocarcinoma↗

Mucinous lesions of the fallopian tube. A report of seven cases.

Mucinous lesions of the fallopian tube mucosa are extremely rare and are of interest because of their association with other mucinous lesions of the female genital tract and with Peutz-Jeghers syndrome. Seven women with mucinous lesions of the fallopian tube were studied. Three had mucinous metaplasia alone, two had mucinous cystadenomas, one had bilateral mucinous neoplasms resembling ovarian mucinous tumors of low malignant potential, and one had mucinous adenocarcinoma in situ. Two patients had Peutz-Jeghers syndrome. Five patients had two or more mucinous lesions, and two of these patients had multiple in situ or invasive adenocarcinomas involving the genital tract. One patient had a mucinous cystadenoma of the appendix 12 years prior. Although it is difficult to be certain that these lesions are not metastatic, the view that these are primary lesions of the tubal mucosa is favored. Mucinous metaplasia and neoplasia of the fallopian tube may be markers for multifocal mucinous neoplasia.

Adenocarcinoma, Mucinous↗

Torsion of the fallopian tube.

Isolated torsion of the Fallopian tube is an uncommon condition. It occurs at all ages, though most frequently at the menstruating age, in normal as well as diseased tubes, in pregnancy and even after tubal sterilization. A cases is reported and the symptoms, differential diagnoses, etiology and diagnostic procedures are discussed. Early diagnosis and treatment is necessary if a twisted tube or a part of it is to be preserved; especially early laparoscopy may be a momentous diagnostic tool in these cases.

Adult↗

Torsion of the fallopian tube: progression of sonographic features.

Isolated torsion of the fallopian tube is a rare gynecologic condition that is difficult to diagnose preoperatively. We present the sonographic and CT findings over a 48-hour period in a case of isolated torsion of the fallopian tube. The radiologic features of isolated torsion have been described previously; however, to our knowledge, the progressive findings have not been previously reported.

Adult↗

[Fallopian tube recanalization with a catheter system--experience in the use of a balloon catheter].

Fallopian tube obstruction is one of the most difficult problems in the treatment of infertility. This report gives the results of a pilot study on the transcervical recanalization of the occlusive fallopian tube. Selective catheterization of the uterine cornu was applied through a balloon catheter, which was wedged at the internal uterine os. In 16 occlusive fallopian tubes of 11 cases, the catheterization procedure was attempted and accomplished with a 87.5% success rate. Recanalization was successful in 75.0% of the affected tubes. Subsequent pregnancy was confirmed in three cases. This convenient technique is safe and effective and it will be accepted as the first choice in the diagnosis and treatment of fallopian tube obstruction.

Adult↗

Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.

OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.

Adult↗

Carcinoma of the fallopian tube.

Primary adenocarcinoma of the fallopian tube is a rare neoplasm that constitutes less than 1% of gynecologic malignancies. Although the triad of menorrhagia, leukorrhea, and pain is said to be pathognomonic, preoperative diagnosis of this lesion is most unusual. The radiographic appearance at hysterosalpingography has only rarely been described in the English literature previously. This therefore is an unusual documentation of the preoperative appearance of fallopian adenocarcinoma by hysterosalpingography and sonography.

Adenocarcinoma↗

Primary adenosquamous carcinoma of the fallopian tube.

The first reported case of primary adenosquamous carcinoma of the fallopian tube is presented. Primary carcinoma of the fallopian tube and adenosquamous lesions of the endometrium and ovary are discussed. The aggressive potential and increasing frequency of adenosquamous carcinoma in the female genital tract are emphasized.

Adenocarcinoma↗

Post-hysterectomy fallopian tube prolapse.

Post-hysterectomy fallopian tube prolapse is a rare complication with only 80 cases described since 1902. Symptoms are non-specific and often of delayed onset. Final diagnosis is confirmed by vaginal biopsy with salpingectomy being the treatment of choice, preferably performed laparoscopically. Following surgery, complete symptom resolution is usually observed and no recurrence has been reported.

Fallopian Tube Diseases↗

Primary adenocarcinoma of the fallopian tube.

Primary carcinoma of the Fallopian tube is one of the rarest malignancies of the female genital tract. The Authors report a case of primary carcinoma of the uterine tube and review the treatment of this disease reported in literature. Since this tumor is so rare, debatable viewpoints remain and thus new proposals and modifications of methods of staging continue to emerge. The Authors conclude by suggesting that the setting up of a National Registry for collection of data available in Italy should be organized.

Adenocarcinoma↗

Laparoscopic management of fallopian tube prolapse.

Sporadic cases of fallopian tube prolapse and various methods of management have been reported since the initial case described in 1902. Two cases were managed recently by a combined vaginal and laparoscopic approach. Total salpingectomy was accomplished with minimal difficulty and limited invasiveness. A brief summary of each case and detailed description of the operative technique are presented.

Adult↗

Primary cancer of the fallopian tube. Report of 26 patients.

BACKGROUND: Due to rarity of fallopian tube cancer most series on this tumor are small and many problems have remained unsolved. The aim of this report is to review our experience with this neoplasm and to compare it with previously published data. METHODS: Retrospective study of 26 patients with fallopian tube cancer treated in one institution between 1974 and 1994. All patients underwent primary surgical treatment and 18 received adjuvant therapy including pelvic irradiation in 14 cases and chemotherapy in four. RESULTS: Relapse occurred in 18 out of 25 followed up patients. Upper abdominal component of relapse was encountered in 12 patients (67%), pelvic component - in eight (44%) and extraperitoneal component - six (33%). Pelvic relapse occurred in two out of 13 followed up patients treated with postoperative irradiation and in six out of 12 who did not receive postoperative radiotherapy. Survival ranged from 6 to 218+ months (median 23 months). Five-year actual survival was 33%. There were no 2-year survivors in patients presenting with stage II-IV disease. No correlation was found between tumor grade and survival. CONCLUSIONS: Fallopian tube cancer is a treatable disease but cure can be only achieved in patients with early tumor. Postoperative radiotherapy may result in better local control but does not preclude extrapelvic dissemination, therefore adjuvant chemotherapy should be considered in high risk patients. Registration of all new cases as well as prospective multicenter studies are warranted to establish optimal management.

Age Factors↗

Importance of sperm-to-epithelial cell contact for the capacitation of human spermatozoa in fallopian tube epithelial cell cocultures.

OBJECTIVE: To investigate the mechanisms involved in the stimulatory effect of fallopian tube epithelial cell coculture on sperm movement characteristics. DESIGN: Human spermatozoa were cultured with human fallopian tube epithelial cell monolayers. A microporous membrane was used to prevent sperm-to-epithelial cell contact. Sperm movement characteristics were measured at 4 and 24 hours. SETTING: University hospital and fertility center. PATIENT(S): Voluntary donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Movement characteristics of human spermatozoa. RESULT(S): Fallopian tube epithelial cell coculture increased sperm motility, curvilinear velocity, amplitude of lateral head displacement, and hyperactivated motility, mainly at 24 hours, compared with controls. These stimulatory effects were inhibited when a microporous membrane prevented cell-to-cell contact between sperm and fallopian tube epithelial cells. CONCLUSION(S): Physical contact between sperm and epithelial cells in coculture systems seems to be the main factor in stimulating sperm movement characteristics, and this could be the main mechanism of in vivo sperm capacitation.

Adult↗

Primary carcinoma of the fallopian tube. A report of 19 cases with literature review.

Primary carcinoma of the fallopian tube is the rarest cancer of the female genital tract with an incidence of 0.5% of all gynecologic tumors. Since the first report in 1847 about 1,500 cases have been published. Due to similarity of the clinical presentation the staging and therapeutic management have been adapted to that of ovarian cancer. We retrospectively evaluated all the 19 patients who had been diagnosed with primary carcinoma of the fallopian tube at the Department of Obstetrics and Gynecology of the University of Zurich between 1977 and 1998. All lesions were staged according to the rules of FIGO adopted in 1991. At the time of diagnosis the median age was 62 (46-87) years. Twelve (63%) women revealed FIGO stage III-IV, whereas four (21%) and three (16%) patients were diagnosed in stage I and stage II, respectively. Eight (42%) women were nullipara. Histology showed serous-papillary carcinoma, in ten (53%) cases. The 5-year survival rate was 22% for all FIGO stages and 80% for stage I. None of the patients with stage III and IV survived 5 years. Ovarian cancer and primary carcinoma of the fallopian tube are similar in many aspects. Both carcinomas have a similar age distribution, show an increase among nulliparous women, are often of serous papillary histology, have a poor prognosis with stage and residual tumor size as important prognostic factors, and respond initially well to platinum-based chemotherapy. Nevertheless, there appears to be a difference between the two diseases: primary carcinoma of the fallopian tube is more often diagnosed in an earlier stage. This many be due to lower abdominal pain resulting from tubal dilatation and to abnormal bloody-watery discharge.

Adult↗

Diagnosis of primary adenocarcinoma of the fallopian tube.

Primary carcinoma of the fallopian tube is rare, but still occurs frequently enough to warrant consideration when certain specific symptoms are present. It is also possible to diagnose the tumor correctly if, in the presence of certain symptoms, the following diagnostic tools are used in addition to repeated Pap smears and dilatation and curettage: hysteroscopy, cervical biopsy, colposcopy, laparoscopy, laparotomy, and pathological examination of every tubal specimen.

Adenocarcinoma↗