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PubMed1990

Early spontaneous rupture of the post myomectomy gravid uterus.

Rupture of a pregnant uterus is a serious threat to the mother's life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.

Adult↗
PubMed1991

Structure-activity relationships of mammalian bombesin-like neuropeptides in the contraction of rat uterus.

Various peptide derivatives of the C-terminal decapeptide of gastrin releasing peptide (GRP-10) and neuromedin B (NMB), i.e., carboxyl terminal fragments, amino terminal fragments and substituted analogues, were chemically synthesized and the structure-activity relationships of the peptides were investigated by comparing their contractile activities on the rat uterus. Peptides with chain lengths of 8 and 9 amino acid residues from the C-terminus of GRP-10 and NMB, respectively, had considerable contractile activities. At position 6 of both decapeptides, Val seems to be more favourable than Thr for inducing contraction of the rat uterus. The substitution of His at position 3 and Leu at position 9 of GRP-10 by Leu and Phe, as in NMB leads to a decrease in activity. Moreover, Trp at position 4 and -Met-NH2 at the C-terminus are essential for activity. Furthermore, in order to characterize the bombesin-receptor profile of rat uterus, the inhibitory effect of two peptide antagonists, [D-Arg1, D-Pro2, D-Trp7,9, Leu11]-substance P and [Leu13-phi (CH2NH)-Leu14]-bombesin on the contraction of rat uterus were examined.

Amino Acid Sequence↗
PubMed2005

The extracorporeal perfusion of the swine uterus as an experimental model: The effect of tocolytic drugs.

OBJECTIVE: Comparison of the effect of tocolytic drugs on isolated swine uterus preparations. STUDY DESIGN: Forty swine uteri were perfused with the aim to preserve a viable organ, which should be responsive to oxytocic hormones and tocolytic pharmaca. An intrauterine catheter recorded the pressure changes. After initiation of rhythmical uterine contractions we administered known tocolytic drugs (fenoterol, ritodrine, terbutaline, propofol, acetylsalicylic acid, alcohol, atosiban, verapamil, and glyceryl trinitrate) in various concentrations. RESULTS: Perfusate pH and lactate, partial oxygen and carbon dioxide tensions, and oxygen saturation in the perfusate showed good preservation of the organ for up to 8h. All substances showed a tocolytic effect on the swine uterus. The effect varied substantially with regard to the length of the contraction free intervals, which was our main effect parameter. Fenoterol, acetylsalicylic acid, and alcohol showed the most and glyceryl trinitrate the least powerful effect. CONCLUSIONS: A direct comparison of various tocolytic substances in the same experimental model showed the best effect for fenoterol. Furthermore, we could demonstrate that the swine uterus perfusion system is a suitable model to study the influence of various conditions like the administration of drugs or the induction of oxidative stress on the uterus function.

Animals↗
PubMedDate not supplied

Laparoscopic myomectomy: enucleation of the myoma by morcellation while it is attached to the uterus.

STUDY OBJECTIVE: To evaluate the feasibility, blood loss, length of surgery, mean hospital stay, and complications of enucleation of a myoma by morcellation while it is still attached to the uterus and to compare the technique with the standard technique of laparoscopic myomectomy. DESIGN: Randomized study (Canadian Task Force classification II-2). SETTING: Private endoscopy center. PATIENTS: Forty-four patients with symptomatic myomas confirmed by ultrasound examination were included in the study from January 2000 through December 2001 and were randomized into two groups-A and B. The inclusion criteria were the presence of a uterus larger than 12 weeks (on bimanual examination), ultrasound confirmation of the presence of at least one myoma 7 cm or greater in size, and/or presence of three or more myomas greater than 5 cm in size. INTERVENTION: The technique of laparoscopic myomectomy by enucleation of a myoma by morcellation while it is still attached to the uterus was performed in all patients in Group A. The patients in Group B underwent laparoscopic myomectomy by the conventional technique of complete enucleation of the myoma followed by morcellation. MEASUREMENTS AND MAIN RESULTS: Forty-nine myomas were removed in group A and 35 in group B. The mean weight of the myomas removed in each patient was 600.5 +/- 369.1 g in group A (95% CI 452.83-748.17 g) and 584.2 +/- 411.1 g in group B (95% CI 404.05-764.45 g) (p = .706). The mean blood loss was 283.9 +/- 229.3 mL in group A (95% CI 192.20-375.72 mL) and 218.5 +/- 110.7 mL in group B (95% CI 169.96-267.04 mL) (p = .739), the mean hospital stay was 37.91 +/- 5.44 hours in group A (95% CI 35.74-40.10 hours) and 39.5 +/- 3.634 hours in group B (95% CI 37.91-41.09 hours) (p = .236). The mean length of surgery was significantly shorter in group A (97.7 +/- 27.06 min, 95% CI 86.88-108.54 minutes) as compared with that in group B (123 +/- 38.8 min 95% CI 106.93-140.57 minutes), (p = .013). CONCLUSION: Preliminary results suggest that laparoscopic myomectomy employing the technique of enucleation of a myoma by morcellation while it is still attached to the uterus is safe and efficient. It helps to overcome certain technical difficulties inherent in the standard technique of laparoscopic myomectomy. It may help to relax the inclusion criteria of patients with myoma for laparoscopic myomectomy based on the size of the myoma.

Adult↗
PubMedDate not supplied

Specific receptors and growth effects of insulin and insulin-like growth factors in a human cell line derived from mixed mesodermal tumor of the uterus.

OBJECTIVE: Mixed mesodermal tumors of the uterus are highly malignant. The purpose of our present study was to investigate possible roles of insulin and insulin-like growth factors I and II (IGF-I and IGF-II) in the growth and development of these tumors. METHODS: Specific binding and growth effects of insulin, IGF-I, and IGF-II were studied in SK-UT-1 cells, derived from a human mixed mesodermal tumor of the uterus. The receptors were further characterized by competitive binding and chemical cross-linking studies. RESULTS: Binding studies with 125I-insulin, 125I-IGF-I, and 125I-IGF-II revealed the presence of specific binding sites for these three growth factors. Specificity studies revealed that the binding sites for IGF-I and IGF-II are distinct. Binding of IGF-II was much higher than insulin and IGF-I binding. Scatchard analysis of the binding data revealed that the cell line has a higher number of IGF-II receptor (100,000 sites per cell) than insulin (1400 sites per cell) and IGF-1 (1200 sites per cell) receptors. The effect of these growth factors on cell growth was studied by monitoring the cell number and incorporation of [3H] thymidine into the DNA of the cells. Insulin-like growth factor-II was potent in stimulating the growth of these cells, but IGF-I did not have any effect. Insulin stimulated DNA synthesis only at pharmacologic concentrations. CONCLUSION: These results indicate that IGF-II is mitogenic to mixed mesodermal tumors of the uterus. Insulin-like growth factor II may be involved in the growth regulation of mixed mesodermal tumors of the uterus.

Binding, Competitive↗
PubMed2002

Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus.

STUDY OBJECTIVE: To evaluate in a prospective series whether, even in presence of a large uterus, total laparoscopic hysterectomy is feasible and safe, and may be substituted for abdominal hysterectomy. DESIGN: Randomized comparison (Canadian Task Force classification I). Setting. Center for Reconstructive Pelvic Endosurgery, Bologna, Italy. PATIENTS: One hundred twenty-two women with large uterus (>14 wks' gestation) caused by myomas. INTERVENTION: Total laparoscopic hysterectomy and total abdominal hysterectomy. MEASUREMENTS AND MAIN RESULTS: Sixty women underwent laparoscopic hysterectomy (group 1) and 62 abdominal hysterectomy (group 2). Mean longitudinal diameter of the uterus, mean number and diameter of myomas, operating time, and average drop in hemoglobin were similar in the groups. One conversion to laparotomy was necessary because of a bowel injury in a patient with severe pelvic adhesions. Cystotomy occurred in one woman in group 2 and was immediately repaired. Febrile morbidity was statistically more frequent in group 2 than in group 1. Postoperative hospitalization and convalescence were statistically shorter in group 1. CONCLUSION: Laparoscopic hysterectomy is safe and feasible even in the presence of large uterus, and is a valid alternative to abdominal hysterectomy when the vaginal route is contraindicated.

Adult↗
PubMed2003

[Uterine rupture of the unscarred uterus. About 28 cases].

OBJECTIVES: To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS: The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS: Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION: Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.

Adult↗
PubMed1980

[Placenta percreta and rupture of the uterus (author's transl)].

A placenta percreta must be expected in 7% of all cases of abnormal implantation of the placenta. Placenta percreta is therefore a rare but serious complication of pregnancy. In 15% of the cases spontaneous rupture of the uterus occurs. Depending on the type of delivery, the maternal mortality ranges from 6-30%. Early hysterectomy is the method of choice to prevent serious complications of hermorrhage. Since the degree of infiltration of the myometrium with placenta can not be determined with accuracy, excision of the site of perforation to preserve the uterus does not appear to be indicated. The case of a 41 year old primigravida, with a previous history of infertility and myomectomy is described. Following primary Cesarean section for breech presentation an asymptomatic rupture of the uterus from the placenta percreta was detected. The rupture of the uterus was likely asymptomatic because a loop of sigmoid colon was adherent to the site of perforation.

Adult↗
PubMed2006

The role of supracervical hysterectomy in benign disease of the uterus.

The aim of this study was to investigate the type of hysterectomy that gynaecological surgeons and female hospital staff would choose for benign disease of the uterus, and to investigate the most influential factors in that choice. We performed a prospective survey of 369 gynaecological surgeons and 370 female staff members of a large teaching hospital. Our survey found that 88% of UK gynaecological oncologists and 50% of US gynaecological oncologists responding would perform a supracervical hysterectomy (SCH) over a total abdominal hysterectomy (TAH) for benign disease of the uterus. A total of 72% of the female staff surveyed would choose a SCH for benign disease of the uterus. In conclusion, our study has given gynaecological and prospective patient approval to support the idea of replacing total hysterectomy with supracervical hysterectomy for benign disease of the uterus.

Attitude of Health Personnel↗
PubMed1998

Outcome of ruptured uterus at University Teaching Hospital Aleppo, Syria.

A 10-year review of ruptured gravid uterus at the University Teaching Hospital, Aleppo, Syria showed an incidence of one ruptured uterus in 565 deliveries. This is an average figure compared with published studies but is still high compared with developed countries. Sixty-four per cent of the cases of ruptured uterus had no antenatal care. It is no surprise therefore that maternal and fetal mortality was highest amongst the unbooked labouring women. In survivors the morbidity was also higher. Ruptured uterus is therefore a major cause of maternal and perinatal mortality and morbidity in Syria. The overall hospital maternal and perinatal mortalities for the period under review were 4.3% and 2.6% respectively. The main risk factor identified is scarring from previous caesarean sections. Other risk factors are discussed.

Journal Article↗
PubMed2006

Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature.

Primary lymphomas of the cervix and uterus are rare with approximately 150 cases reported in the world literature to date. Appropriate diagnosis is often delayed until the post-operative setting as clinical and radiographic presentations are non-specific. Several sub-types of lymphoma arising primarily in the cervix or uterus have been reported with diffuse large B-Cell lymphoma (DLBCL) being the most frequent. Due to the low incidence of this disease, no randomized clinical trials exist to help guide treatment. This study reports the experience of four patients with primary lymphomas of the uterus and cervix that reflect the heterogeneity of cases reported in the literature to date. The patients had a mean age at diagnosis of 46 (range 35 - 56) and presented with abnormal uterine bleeding. One patient was diagnosed by total abdominal hysterectomy (TAH), two patients were diagnosed by cervical biopsy and one patient was diagnosed by endometrial biopsy. Three patients had DLBCL and one patient had marginal zone lymphoma (MZL). All patients had stage IIE disease. Of the patients with DLBCL, one received chemotherapy followed by TAH and two received TAH followed by chemotherapy. Two of these three patients remain disease-free post-initial therapy with the third now disease-free post-salvage therapy and autologous stem cell transplant. The patient with MZL was treated with TAH alone and remains disease-free. Based on the case series and a review of available literature, primary lymphomas of the uterus or cervix are rare and require an individualized approach to treatment. In general, patients with limited stage disease should be treated with localized and systemic therapy to optimize chances of cure.

Adult↗
PubMed2005

A comparison of estradiol levels between women with a hysterectomy and ovarian conservation and women with an intact uterus.

OBJECTIVES: To compare the distribution of estradiol levels between women with a hysterectomy and ovarian conservation and women with an intact uterus. METHODS: A large cross-sectional study of women aged between 40 and 69 years, residing in Melbourne, Australia. Estradiol levels were available for 152 women with a hysterectomy and ovarian conservation and 1423 women with an intact uterus. All of the women were 'never-users' of hormone replacement therapy. RESULTS: For women under 55 years of age, we observed that those with a hysterectomy and ovarian conservation had slightly higher estradiol levels compared with those with an intact uterus after adjustment for age, body mass index, smoking status and alcohol intake (ratio of geometric means of estradiol levels = 1.24; 95% confidence interval = 1.00-1.53). For women who were 55 years or greater, the distribution of estradiol levels varied little by hysterectomy status. CONCLUSIONS: Our data do not suggest that women with hysterectomy and ovarian conservation have markedly different estradiol levels compared to women with an intact uterus.

Adult↗
PubMed2001

Rupture of an unscarred uterus with misoprostol induction: case report and review of the literature.

Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an unexpected and devastating complication of pregnancy. With the increased use of misoprostol as a labor-inducing agent, cases of rupture of an unscarred uterus following its use have been published in the literature. We report a case of uterine rupture in a multigravid woman with an intrauterine fetal death at 29 weeks' gestation whose labor was induced with misoprostol. A review of all cases of uterine rupture with misoprostol induction is also included. Excessive doses of misoprostol should be used with extreme caution in multiparous women and in patients with a previously scarred uterus even in the context of intrauterine fetal death or termination of pregnancy.

Adult↗
PubMed2005

Carbonic anhydrase regulate endometrial gland development in the neonatal uterus.

Carbonic anhydrases (CAs) are zinc metalloenyzmes that catalyze the reversible conversion of carbon dioxide to carbonic acid and are involved in respiration, calcification, acid-base balance, and formation of fluids. Transcriptional profiling of the developing neonatal mouse uterus detected expression of Car1, Car2, Car11, and Car13 between Postnatal Days (PNDs) 3 and 18. In the neonatal mouse uterus, Car2 and Car11 mRNAs were predominantly localized in endometrial epithelial and stromal cells, respectively, whereas Car13 mRNA was detected in both epithelia and stroma. CAR2 protein was detected primarily in the endometrial epithelia and from PND 3 to PND 18 in the uteri of neonatal mice. To determine whether CA regulated uterine development, neonatal mice were treated s.c. with acetazolamide, a CA inhibitor, from PND 3 to PND 18. Treatment with acetazolamide decreased CA activity in the uterus and the number of endometrial glands without apparent effects on differentiation of the stroma or myometrium. In the neonatal sheep uterus, CA2 mRNA was initially expressed at birth (PND 0) in the endometrial luminal epithelium and was predominantly expressed in the developing glandular epithelium from PND 7 to PND 56. These results support the hypothesis that CA has a functional role in endometrial gland development during postnatal uterine morphogenesis.

Acetazolamide↗
PubMed1989

Müllerian adenosarcomas of the uterus with sarcomatous overgrowth. A clinicopathological analysis of 10 cases.

Ten cases of müllerian adenosarcoma of the uterus with sarcomatous overgrowth are described. The tumors were found in women 32 to 82 years of age (median, 59), most of whom presented with abnormal vaginal bleeding and an enlarged uterus. At the time of abdominal hysterectomy, performed in all the cases, bilateral ovarian and peritoneal metastases were found in one patient. Gross examination of the uterus revealed bulky polypoid masses filling the endometrial cavity. In six cases, these masses invaded the myometrium. In three of them, they reached the serosa. Histological examination in each case revealed typical adenosarcoma overgrown by a pure sarcoma that accounted for 25% to 80% of the tumor. In seven tumors, the pure sarcoma was of higher grade and exhibited a higher mitotic rate than the sarcomatous component of the associated adenosarcoma, whereas in three tumors, the two sarcomatous components were similar in appearance. On follow-up, three patients were alive with no evidence of recurrent tumor at postoperative intervals of 4 to 7 years. Recurrent tumor developed in the other seven patients, including hematogenous metastases in four of them, at intervals of 9 months to 6 years. Six patients died from tumor progression at intervals of 9 months to 10 years. This study indicates that, in contrast to typical müllerian adenosarcomas of the uterus, adenosarcomas with sarcomatous overgrowth are aggressive tumors frequently associated with postoperative recurrence or metastases and a fatal outcome.

Adult↗
PubMedDate not supplied

MR appearance of malignant lymphoma of the uterus.

OBJECTIVE: The uterus is rarely the initial site of malignant lymphoma. The purpose of this article is to present the MRI of malignant lymphoma of the uterus. MATERIALS AND METHODS: Four cases with pathologically proven malignant lymphoma, in which the uterus was the only and the initial site of recognized visceral involvement, are presented; MRI was retrospectively evaluated. RESULTS: All the lesions exhibited homogeneous hypointense signal on T1-weighted imaging and relatively hyperintense signal on T2-weighted imaging. One case exhibited diffuse and uniform enlargement of the uterine corpus and cervix in the presence of preserved endometrium and cervical epithelium. With these findings, a prospective diagnosis of lymphoma was feasible. The three other cases exhibited MR findings that closely resembled those of carcinoma of the cervix. However, in one case, preserved cervical epithelium in the presence of extensive involvement of the cervical stroma may have been a clue to the diagnosis of malignant lymphoma. Involvement of the vagina (three cases) and the urinary bladder (two cases) was clearly identified on MRI. CONCLUSION: Lymphoma of the uterus exhibited various MR appearances; however, specific diagnosis might be feasible in limited cases. In addition, clear visualization of the extent of disease seen on MRI could contribute to clinical decisions about treatment.

Adult↗
PubMedDate not supplied

Undifferentiated endometrial carcinoma of the uterus: marked effect of chemotherapy with tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin.

Undifferentiated endometrial carcinoma of the uterus is rare, and is thought to show a poor prognosis. To date, there is no consensus as to the optimal chemotherapy for this carcinoma. We report a rare case of this carcinoma in a patient who was treated surgically in combination with chemotherapy using a regimen designed by us. This chemotherapy consists of tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin. This regimen is called TTJ [tetrahydropryanyl-adriamycin, taxan (paclitaxel), JM-8 (carboplatin)] chemotherapy and showed a marked effect. The patient was a 52-year-old woman with a giant tumor of the uterus measuring 28 x 18 x 13 cm and weighing 3386 g. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy, but residual carcinoma remained on the surface of the small intestine. Pathologically tumor tissues comprised the whole uterus except for the uterine cervix and there were tumor tissues in the omentum. She was treated with six courses of TTJ chemotherapy without major side-effects. Currently, she remains alive without metastasis 41 months after hysterectomy. This report describes a rare case of undifferentiated endometrial carcinoma of the uterus and introduces TTJ chemotherapy resulting in the remarkable effect on this carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Comparison of the attenuating effects of four beta-adrenoceptor agonists on rat isolated uterus and aorta.

1. The ability of four beta-adrenoceptor agonists to attenuate oxytocin (0.2, 2 and 20 nmol/L) or KCl (20, 40 and 80 mmol/L)-induced contractions of the uterus (n = 5-8 for each agonist) and the KCl (18 mmol/L)-induced contractions of the aorta (n = 9 for each agonist) from rats, pretreated with oestradiol has been compared. 2. Isoprenaline, salbutamol, terbutaline and procaterol (0.1-10 mumol/L) attenuated the contractions of the uterus and the aorta. All four agonists had similar attenuating potencies on the uterus. 3. Procaterol caused the same maximal attenuation (33%) on the aorta as the other beta-adrenoceptor agonists and is thus acting as a full beta 2-adrenoceptor agonist under these experimental conditions. Isoprenaline and procaterol were much more potent than salbutamol and terbutaline in attenuating the aorta responses. 4. This study showed that isoprenaline and procaterol were potent attenuants on both the uterus and aorta whereas salbutamol and terbutaline were potent uterine but only modest aorta attenuants. This preliminary study indicates that the responsiveness of uterine and vascular tissue to certain beta 2-adrenoceptors differs.

Adrenergic beta-Agonists↗