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PubMed2006

The Z technique: an easy approach to the display of the mid-coronal plane of the uterus in volume sonography.

OBJECTIVE: The purpose of our study was to evaluate the ease of learning and clinical applicability of a technique (Z technique) for display of the mid-coronal plane of the uterus in volume sonography. METHODS: Eight physicians were randomly assigned to 2 groups, A and B, after being instructed on the basic principles of post processing of sonographic volumes. Physicians in group A were asked to individually display the mid-coronal plane of the uterus in each of five 3-dimensional volumes of uteri. Physicians in group B were instructed on the Z technique and were then asked to individually display the mid-coronal plane of the uterus in the same volumes as group A. The time needed for display of the mid-coronal plane of the uterus and the quality of the mid-coronal plane image retrieved were recorded for each volume. RESULTS: The mean time required to display the mid-coronal plane of the uterus for all volumes was 47.7 seconds in group B compared with 110.7 seconds in group A (P=.002). Furthermore, a significant improvement in time performance was seen for physicians in group A after learning the Z technique (23.2 seconds after compared with 110.7 seconds before; P=.0001). The quality of the image produced was notably better for all physicians after learning the Z technique. CONCLUSIONS: The Z technique is an easy technique to learn. Physicians who learn this technique are able to retrieve the mid-coronal plane of the uterus faster and improve its image quality in volume sonography.

Computer Graphics↗

PubMed2001

Septate uterus with double cervix and longitudinal vaginal septum. A case report.

BACKGROUND: Congenital uterine anomalies in the general population are estimated to have an incidence of 0.001-10%. The septate uterus, the most common form of structural uterine anomaly, has the highest reproductive failure rate. A rare developmental variant is a septate uterus with cervical duplication and a complete longitudinal vaginal septum. The existence of this anomaly challenges classical müllerian developmental theory. Traditional transabdominal metroplasty has been replaced by operative hysteroscopy in the surgical correction of a septate uterus, with laparoscopy aiding in the diagnosis and contributing to the safety and efficiency of the procedure. CASE: A 28-year-old, nulliparous woman with a septate uterus with cervical duplication and complete longitudinal vaginal septum was diagnosed by combined laparoscopy and hysteroscopy. Excision of the complete longitudinal vaginal septum followed by hysteroscopic partial resection of a thick uterine septum with laparoscopic assistance was performed. However, because of the septum's broad base and the rigidity of the operative resectoscope, we opted to proceed with transabdominal metroplasty. CONCLUSION: Only six cases of septate uterus with cervical duplication and complete longitudinal vaginal septum have been reported. Although its counterpart, the septate uterus, has effects on preterm labor, fetal presentation, infertility and spontaneous abortion, its reproductive outcome has not been assessed. Review of the literature suggests that surgical correction in the setting of poor reproductive outcome has been beneficial. Laparoscopically assisted hysteroscopic resection of the uterine septum is a safe, effective surgical technique of uterine reunification and is preferable to transabdominal methods. However, in certain cases, conventional transabdominal metroplasty may still be required.

Adult↗

PubMed2002

[Study on the expression of vascular endothelial growth factor in patients with adenomyosis of the uterus].

OBJECTIVE: To investigate the role of angiogenesis and expression of vascular endothelial growth factor (VEGF) in the pathophysiology of adenomyosis of the uterus. METHODS: The study included 32 patients with histologically proven adenomyosis and 30 patients with asymptomatic leiomyoma of the uterus. Immunohistochemical staining was used to detect VEGF expression in different parts of the uterus. A computerized morphometric study on the VEGF expression was performed. RESULTS: The VEGF H-Score of glandular cells in the endometrium of adenomyosis uterus [proliferative phase (9.6 +/- 1.4), secretory phase (11.7 +/- 1.6)] was much higher than that of leiomyoma uterus [proliferative phase (8.3 +/- 1.7), secretory phase (10.2 +/- 1.5)] (P < 0.05), and increased in the secretory phase (P < 0.05). Compared with eutopic endometrium, the VEGF H-Score in ectopic endometrium [proliferative phase (11.9 +/- 1.8), secretory phase (13.0 +/- 1.7)] increased significantly (P < 0.05), but showed no cyclic change (P > 0.05). The VEGF H-Score of myometrium around the ectopic lesions [proliferative phase (9.5 +/- 1.3), secretory phase (8.7 +/- 1.3)] was higher than that of normal myometrium [proliferative phase (4.8 +/- 1.9), secretory phase (4.5 +/- 1.4)] (P < 0.01). CONCLUSION: The angiogenesis activity of the endometrium and myometrium of adenomyosis uterus was markedly increased.

Adult↗

PubMed2003

[Action of galanin on smooth muscle strips isolated from rat and human uterus].

OBJECTIVE: Galanin (Gal), a 29 amino-acid, peptide was isolated from porcine intestine extracts. Gal and its receptors are widely distributed in central and peripheral nervous systems, urogenital and gastrointestinal tracts of several mammalian species including the human. The study was undertaken to characterise the effects of Gal on uterus smooth muscle. MATERIAL AND METHODS: Smooth muscle strips were isolated from human uterus excised in perimenopausal age because of fibroids and prolapse. Another strips were taken from the uterus of a pregnant female rat a week before delivery. Muscle strips were suspended in the organ bath. Their spontaneous contractions and responses to Gal and oxytocin were recorded isometricaly. The changes in frequency and amplitude of smooth muscle contraction were analysed. RESULTS: Characteristics of smooth muscle stripes isolated from human uterus did not changed in the presence of Gal in concentration of 300 nM. Spontaneous contractions of smooth muscle stripes from the uterus of pregnant female rat were not affected in the presence of Gal in the concentration showed above, furthermore Gal did not alter contractions provoked by oxytocin. CONCLUSIONS: Gal has no influence on uterus smooth muscle function within perimenopausal age and the second half of pregnancy. The study does not exclude possibilities of Gal influence in other sex hormones profiles e.g. in young women or during labour.

Adult↗

PubMed2006

A study on the etiology of uterine pressure rise on semen deposition in the vagina or uterus.

PURPOSE OF INVESTIGATION: In a recent study we have demonstrated that semen deposition into the vagina or uterus effects uterine pressure rise which is suggested to assist in "sucking" semen into the uterine cavity. The purpose of this study was to investigate whether the uterine pressure rise is effected by the sperm or the substances contained in the seminal plasma, and to test the response of the vagina and uterus to abnormal semen deposition. METHODS: Semen was obtained from 60 men divided into four groups: A) obstructive azoospermia, B) Sertoli cell-only syndrome, C) oligozoospermia and D), fertile subjects. Before and after semen deposition into the vagina and uterus both vaginal and uterine pressure were recorded. RESULTS: Semen from groups A and B produced no significant vaginal or uterine pressure changes (p > 0.05) when it was deposited into either the vagina or uterus. Group C and D semen when placed in the vagina or uterus separately effected significant intrauterine pressure rise (p < 0.05) but no vaginal pressure changes (p > 0.05). The pressure rise was higher when the semen was deposited in the uterus than in the vagina (p < 0.05) and with the normospermic than oligozoospermic semen (p < 0.05). In groups C and D, the seminal plasma produced no vaginal or uterine pressure changes (p > 0.05), whereas the sperm effected intrauterine pressure rise (p < 0.05) which was more elevated with sperm from normospermic than oligozoospermic semen (p < 0.05). CONCLUSIONS: Aspermic semen did not effect vaginal or uterine pressure rise, while oligozoospermic and normospermic semen produced rise of uterine but not vaginal pressure. Uterine pressure rise was induced by the sperm and not the seminal plasma. Further studies are required to define the sulstances secreted by the sperm which produce this increased uterine pressure.

Adult↗

PubMed1977

Characterization of oxytocin receptors in the uterus and mammary gland.

High affinity binding sites for 3[H] oxytocin have been demonstrated in particulate fractions from rat uterus and oviduct, myometrium from the sow, ewe and human, ewe endometrium, and mammary gland from the lactating rat. The binding activity has been localized to enriched plasma membrane fractions from the rat uterus and mammary gland; cells isolated from the mammary gland also bind oxytocin. The apparent dissociation constant (Kd) for the interaction of oxytocin with its binding sites in a variety of tissue preparations is in the nanomolar range. The concentration of oxytocin eliciting half-maximal contraction of the rat isolated uterus corresponds to the apparent Kd of oxytocin interaction with uterine particulate fractions. Binding is specific with respect to the target tissue or cell, as well as to the ligand. The affinity of binding sites for oxytocin analogues corresponds generally to their potencies as agonists or antagonists. Factors that affect the binding of oxytocin affect the biological response in the same way. For example, certain divalent metal ions, which increase oxytocin binding activity, enhance the sensitivity of the contractile response of the uterus and mammary gland to oxytocin. Estrogen administration, which increases the uterine binding of oxytocin, increases the sensitivity of the myometrium to oxytocin. The myometrium binds the most oxytocin at estrus and is most sensitive to oxtocin at that time. The dgree of stimulation by oxytocin of prostaglandin F2alpha synthesis by ewe endometrium is paralleled by an increased concentration of oxytocin binding sites. The marked increase in sensitivity to oxytocin of the rat uterus occurring on the day of parturition also is reflected by the amount of oxytocin bound by the uterus. Because of the many correlations between oxytocin binding and bioactivity, it appears that oxytocin binding sites on the plasma membrane of target cells constitute the recognition part of oxytocin receptors.

Animals↗

PubMed1990

Mechanism of estrogen-induced 17-beta-hydroxysteroid dehydrogenase in ovariectomized rat uterus.

Estradiol (E2), progesterone or medroxyprogesterone acetate can induce biosynthesis of the 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD) in the mammalian uterus. For further understanding the 17-beta-HSD induction which may be mediated by the conjugation of the E2 to its receptor, premature ovariectomized rats were treated with E2, or with a synthetic steroid, diethylstilbestrol (DES), an agonist for the E2 receptor but not a substrate for 17-beta-HSD. Histological observation and uterus weight were examined as parameters to evaluate uterine response to those hormones at different durations of treatment. The 17-beta-HSD in ovariectomized rat uterus of each group was also examined by histochemical and biochemical assays. The results showed that the 17-beta-HSD activity in the uterus can be induced by E2 or DES, after daily treatment for 1, 14 and 28 days, but much higher in DES treated animals. The uterus weight demonstrated a "negative linear correlation" to the enzyme activity in all E2 treated groups, but not in DES or control rats. Accordingly, it was indicated that the 17-beta-HSD induction was regulated by conjugation of E2 or DES to its receptor. Therefore, we believe that the 17-beta-HSD gene in the rat uterus is another estrogen responsive gene.

17-Hydroxysteroid Dehydrogenases↗

PubMed1990

[Characteristics of the course and outcome of pregnancy in developmental anomalies of the uterus].

Ultrasonographic follow-up of 311 pregnant women with a history of habitual abortion has revealed uterine malformations in 61 (19.6%) women. An arcuate uterus was found in 25, bicornuate and duplex uterus in 20, septate uterus in 15 and unicornuate uterus in 1 women. The paper presents ultrasonographic criteria for the identification of uterine malformations and certain pregnancy complications. The study showed pregnancy outcomes to be correlated to malformation severity. The outcomes were satisfactory in the presence of the arcuate uterus and poor in the presence of the bicornuate and septate uterus. The findings suggest that all women with uterine malformations require a close follow-up throughout the pregnancy to make an earlier diagnosis and to remedy the abnormalities detected.

Abortion, Spontaneous↗

PubMed1986

Concerning the immunology of the uterus.

As a mucosal organ, the uterus is unique in being subject to exposure to three types of antigen: chronically to micro-organisms, episodically to sperm bearing both auto- and alloantigens as well as soluble antigens in seminal plasma, and to conceptuses--nature's allografts--expressing transplantation antigens. That the uterus is effective in handling pathogens is evidenced by the rarity of infections. Local macrophages, immunocytes, and a secretory immune system, most evident in the cervix, probably underlie this attribute. Mammals' reproductive success hints that the uterus is immunologically discriminating toward the nonharmful but biologically important antigens of classes 2 and 3. Why sperm are not normally destroyed immunologically in the female prior to fertilization and why conceptuses are not rejected are central unresolved questions in reproductive immunology. Undoubtedly, important immunoregulatory principles are operating in this remarkable organ and its decidua. Better to understand antigenic exposure in the rat uterus, we have reinvestigated its lymphatic drainage using labeled cell injection and microanatomical procedures. Despite abundant lymphatics in the myometrium, cells placed in the uterine lumen did not readily gain access to the lymphatic system. There was a paucity of lymphatics in the endometrium, but Ia-positive dendritic cells were abundant. Soluble antigen exposure via the uterus failed to evoke a primary antibody response yet did prime the host for a secondary response. This restriction of systemic antigen presentation from the uterus, in conjunction with both cellular and noncellular immunoregulatory principles acting locally, may be important to ensure maternal hyporesponsiveness to paternal alloantigens.

Animals↗

PubMed1987

Rupture of the uterus: a changing picture.

Eighty nine cases of rupture of the gravid uterus occurring over a period of 15 years with 77,133 deliveries, were analysed. The overall incidence of ruptured uteri was 1 per 866 deliveries. The patients were divided into two groups, those with a scarred uterus (47) and those with an unscarred uterus (42). Distinct differences in terms of parity, age, aetiology and pathogenesis, the clinical picture, pathology, type of surgery and outcome were seen between the two groups. Most pronounced was the difference in symptoms and signs. Lower abdominal tenderness (38.2%), and vaginal exploration after delivery (44.6%) were the clinical hallmarks in the scarred uterus group, compared to shock (33.3%), uterine bleeding (30.9%) and severe abdominal pain (23.8%) in the unscarred group. Moreover, conservative surgery was possible in 72.3% of the scarred group against 14.3% in the other group. A maternal mortality of 5.6% and fetal mortality of 52.8% was seen. All maternal deaths and 71.4% of fetal losses occurred in the unscarred group. Fortunately, the number of ruptures clearly decreased over the study period, and furthermore the ratio between spontaneous and traumatic ruptures of an unscarred uterus and ruptures of a scarred uterus increased.

Adult↗

PubMed2006

Mitotically active leiomyoma of the uterus in a postmenopausal breast cancer patient receiving tamoxifen.

OBJECTIVE: Mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding has never been reported in Taiwan. Here, we present a case of mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding in a breast cancer patient who had been receiving tamoxifen for 2 years. CASE REPORT: A 56-year-old woman visited our clinic due to abnormal vaginal spotting for 3 months. This patient had been menopausal for about 6 years without hormone replacement therapy. She had been suffering from breast cancer, had undergone conservative breast surgery, and had been taking tamoxifen (20 mg/day) for 2 years. Pelvic ultrasound was performed and revealed an 8.9 x 7.7 cm uterine mass. After simple total hysterectomy, we found an enlarged uterus with a mass over the posterior wall. Final pathology demonstrated a mitotically active leiomyoma, adenomyosis of the uterus, and proliferation of the endometrium. CONCLUSION: Endometrial cancer is rarely noted in breast cancer patients taking tamoxifen. Further, none have reported mitotically active leiomyoma of the uterus. From this case, endometrial proliferation and mitotically active leiomyoma of the uterus may be related to tamoxifen therapy, and should not be neglected in breast cancer patients.

Antineoplastic Agents, Hormonal↗

PubMed2006

Induction of labor: comparison of a cohort with uterine scar from previous cesarean section vs. a cohort with intact uterus.

OBJECTIVE: To compare the risk of uterine rupture between a cohort of women with previous low-transverse cesarean section (CS) and a cohort with intact uterus. METHODS: All women with a singleton pregnancy and previous low-transverse CS requiring induction of labor from January 1, 1992 to December 30, 2001 (n = 310) were compared with a cohort of women with intact uterus undergoing induction of labor during the same study period (n = 5420). Protocols of induction using prostaglandin E2 gel and oxytocin infusion were consistent within groups, but differed between the previous CS and the intact uterus group. RESULTS: Uterine rupture occurred in 0.3% in the previous CS group vs. 0.03% in the intact uterus group (p = 0.37). Logistic regression analysis showed no significant difference in rate of uterine rupture between the previous CS vs. intact uterus group (p = 0.16) after controlling for maternal age, parity, gestational age at delivery, Bishop score on admission, use of prostaglandin and oxytocin, and birth weight. Our study had adequate power to detect a 0.38% difference in rate of uterine rupture between the two groups (alpha = 0.05, beta = 0.80). CONCLUSION: Induction of labor is not associated with significantly higher rates of uterine rupture among women with previous low-transverse CS compared with women with intact uterus provided a consistent protocol with strict intervention criteria is adopted.

Adult↗

PubMed2001

[Clinical pathological analysis of adenomatoid tumor in uterus and ovaries].

OBJECTIVE: To study the immunohistochemical feature and the differential diagnosis of adenomatoid tumors in uterus and ovaries. METHODS: Clinical pathological analysis and immunohistochemical studies were performed on 24 cases of adenomatoid tumors in the uterus and ovaries. RESULTS: Of the 24 cases, 21 cases were in the uterus, 2 cases in the ovaries and 1 cases in both the uterus and the ovary. Grossly, the mean diameter of the 22 uterus tumors was 2.2 cm, ranging from 0.2 - 5.5 cm. 14 (63.6%) were located in the subserosa or near by the subserosa of the uterine cornua. The other 8 tumors located in the myometrium. The cut surface presented a nodular pattern with grayish white or yellowish in color, partially cystic. 3 ovarian tumors became all cystic, without a clear-cut margin from the surroundings. Microscopically, the tumor consisted of various gland-like structure or luminal spaces lined with flat, cuboidal or low columnar cells, similar to blood vessels in structure. Among the tumor cells, there were scattered vesicular cells with large or small vacuoles, but no nuclear atypia and mitotic figures detected. Immunohistochemical staining showed the tumor cells positive for vimentin, AE(1)/AE(3) and calretinin, but negative for F VIII-Rag. S-100 and EMA were positive in 20 (83.3%) and 4 (16.7%) cases respectively. CONCLUSION: Adenomatoid tumor of the female genital tract is mesothelial in origin and uterus was considered as the most common site of occurance. Immunohistochemical phenotypes can be used as an important evidence for differential diagnosis. The biological behavior of adenomatoid tumor is benign and with a good prognosis.

Adenomatoid Tumor↗

PubMed2005

[Nitroglycerin to relax the uterus during cesarean delivery for the low birthweight baby].

BACKGROUND: The uterus at premature birth being thick and sensitive, we applied nitroglycerin (NTG) to relax the uterus during cesarean delivery for the low birthweight baby. METHODS: Twelve parturients of impending premature birth and nine of severe intoxication were included. General anesthesia was induced with thiamylal, and maintained with 5% inhaled sevoflurane. NTG was injected in an intermittent dose of 500 microg. The relative hardness of the uterus at delivery was evaluated by obstetricians in four ranks of categories. RESULTS: The mean gestation period was 27.4 weeks (24 weeks at the minimum-33 weeks at the maximum) and the mean birthweight was 986 g (561-1518 g). The mean time elapsed from induction of anesthesia to delivery was 8.3 min (2-14 min) while NTG was injected for the mean 1.8 times that reflected a total dose of 900 microg (500-1500 microg). The mean endtidal concentration of sevoflurane at delivery reached 3.8% (3.4-4.3%). The uterus was evaluated as "very soft" in 15 out of 21 cases, and all babies were extracted easily without injury through the lower J-shaped section of the uterus. The mean Apgar score was 2.9 points at 1 minute and 6.3 points at 5 minutes. No adverse effect of NTG on the mothers or babies was noticed. CONCLUSIONS: NTG relaxes the uterus effectively and facilitates cesarean delivery for the low birthweight baby.

Anesthesia, General↗

PubMed2006

[Torsion of a nongravid leiomyomatous uterus].

The torsion of a nongravid uterus is not of frequent occurence. The leading reasons are a presence of an adnexial formation or leiomyomas. In this case report it has been presented a 65-year old patient with a hard abdominal pain. After the gynecologic and ultrasound examination it has been found an uterus myomatosus with three intramural-subseros leiomyomas. By the following laparotomy was confirmed the ultrasound results - the uterus with big intramural-subserous leiomyoma 8-9 cm in a diameter, and two more leiomyomas - 5 cm, a torsion of the body uterus at 180 degree above the vaginal part of the cervix. The adnexes were rotated around the supravaginal (isthmic) part of the uterus, the uterine tubes were hyperemic, swollen, with livid color, and the ovarian were atrophic. Total hysterectomy with bilateral adnexectomy was performed. We suggested that the main reason for this torsion of the uterus was the presence of leiomyomas and the genital descensus played a role as a predisposition.

Aged↗

PubMed1986

Retroverted impacted gravid uterus with acute urinary retention: report of two cases and a review of the literature.

Two cases of acute urinary retention in association with a retroverted impacted gravid uterus are described. Manual replacement of the uterus into an anterior position resolved the urinary retention in both cases. A review of the literature for retroverted impacted gravid uterus and related disorders is given. Successful treatment of retroverted impacted gravid uterus can usually be performed by initial bladder catheterization followed by manual replacement of the uterus, or by chronic bladder drainage until the uterus ascends out of the pelvis.

Adult↗

PubMed1978

[Arguments for a hesitamt attitude in the management of retroflexion of the pregnant uterus].

Among 5036 pregnant patients under prenatal care of a gynecologist, a retroflexion of the pregnant uterus was found in 438 cases (8.7%). The incidence of spontaneous abortion in the cases with retroflexion was 10.4%. This corresponds to the expected mean incidence of spontaneous abortion. In a control group of 1000 pregnancies without retroflexion of the uterus, the incidence of spontaneous abortion was 9.2%. The rate of premature delivery in cases with retroflexion was 5.3% and showed no difference to the control group without retroflexion (5.5%). Spontaneous anteflexion was awaited in all cases with retroflected pregnant uterus. Because of overflow incontinence manual anteflexion of the uterus at 15 weeks of gestation became necessary in one case. This pregnancy went to term. Because of our good results, we make a plea for expectant management of retroflexion of the pregnant uterus. Regular control examinations are necessary so that the lack of spontaneous anteflexion is not overlooked. Among 378 cases with a retroflected pregnant uterus which were followed to term, manual anteflexion became necessary in only one case.

Female↗

PubMed1997

Apoptotic cell death during the estrous cycle in the rat uterus and vagina.

BACKGROUND: Rodent uterus and vagina show marked histological changes during the estrous cycle. Apoptotic cell death has been demonstrated in hamster and rat uterine epithelium during the estrous cycle by electron microscopy: numerous epithelial cells undergo apoptosis at estrus. We examined cell death and cell proliferation in rat uterus and vagina during estrous cycle. METHODS: To examine the rate of proliferation in uterine and vaginal cells at each estrous stage, the numbers of cells at metaphase were counted separately in epithelial and stromal cells. We identified the apoptotic cells in uterus and vagina at each estrous stage by using DNA fragmentation, in situ DNA 3'-end labeling, and electron microscopy. RESULTS: Mitotic rates in uterine luminal and glandular epithelial cells were low at metestrus and estrus, respectively. Intense fragmentation was found in the uterus at metestrus and in the vagina at proestrus and metestrus. In uterine luminal and glandular epithelial cells, apoptotic index showed peaks at metestrus and estrus, respectively. In vaginal epithelial cells, many apoptotic cells were encountered in the superficial layer at proestrus, which may contribute to keratinization. In the middle and basal layer of vaginal epithelial cells, apoptotic index was high at metestrus, when mitotic rate was low. Electron microscopy confirmed the results of the labeling studies. CONCLUSIONS: Apoptotic cell death was encountered in the uterus and vagina during estrous cycle in rats. There is an inverse correlation between cell death and cell proliferation in rat uterine and vaginal epithelial cells during the estrous cycle.

Animals↗