Ultrasound characteristics of uterine myoma before and after uterine artery embolization

The diagnosis and treatment of uterine leiomyoma are topical problems of modern gynecology and radiodiagnosis. Organ-saving treatments for uterine myoma, one of which is uterine artery embolization, are gaining wide acceptance now. The objective of the study was to increase the informative value of ultrasound study to predict the uterine myoma after uterine artery embolization. One hundred uterine myoma patients aged 20 to 52 years were examined. Small pelvic Doppler ultrasonography was carried out in all the patients. The reduction of myomatous nodules was estimated after uterine artery embolization. The decrease in uterine myoma sizes was found to be due to the reduction in their vascularization and the occurrence of ischemia with degeneration in the myoma. Ultrasonography was found to be most accessible and informative in the prognostic and postoperative evaluation of the efficiency of X-ray endovascular treatment for uterine myoma.     

Uterovaginal packing with rolled gauze in postpartum hemorrhage

Management options for postpartum hemorrhage (PPH) include oxytocics, prostaglandins, genital tract exploration, ligation or angiographic embolization of uterine/internal iliac arteries, and hysterectomy. After excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and oxytocics. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged. Uterovaginal packing may sometimes obviate the need for surgery altogether. Two cases, a primary and a secondary PPH, managed recently with uterovaginal packing are reported. Despite concerns about concealed hemorrhage or the development of infection with this intervention, none of these problems were encountered, and uterine packing was successful even in the case of secondary PPH with documented infection.     

子宫动脉栓塞治疗子宫肌瘤伴月经过多的临床研究

目的：回顾分析24例子宫肌瘤伴月经过多患者入介治疗疗效和子宫动脉栓塞安全性。方法：选择24例子宫肌瘤伴月经过多患者进行子宫肌瘤供血动脉的栓塞。结果：插管栓塞动脉率100％,随访20年。治疗后1月,24例患者经月经明显减少,B超随访,3个月子宫肌瘤体积平均缩小30％,随访2年,其中2例行腹腔镜下子宫肌瘤经阴道摘除术,6例子宫肌瘤消失,16例子宫肌瘤体积平均缩小80％,结论：子宫肌瘤行介入治疗疗效肯定,对粘膜下子宫肌瘤及子宫肌瘤伴月经过多患者尤为适宜。     

Uterine artery embolization for the treatment of uterine fibroids

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens' opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery.     

High accumulation of calcium in human uterine artery with aging

To elucidate compositional changes of the rami of the internal iliac artery with aging, the authors investigated age-related changes of the calcium content in the uterine, internal pudendal, umbilical, and obturator arteries by inductively coupled plasma-atomic emission spectrometry. After an ordinary dissection was finished, the uterine, internal pudendal, umbilical, and obturator arteries were resected from 10 female subjects, and the internal pudendal, umbilical, and obturator arteries were resected from 10 male subjects. The female subjects ranged in age from 52 to 96 yr, and the male subjects ranged in age from 63 to 88 yr. The calcium content in the uterine artery began to increase in the seventies and increased markedly in the nineties. In the internal pudendal artery, the calcium content hardly increased up to the eighties and increased significantly in the nineties. In contrast, the calcium content did not change in both the umbilical and obturator arteries with advancing age. It was found that the average content of calcium was the highest in the uterine artery and decreased in the order internal pudendal, umbilical, and obturator arteries. The average content of calcium in the uterine arteries corresponded to 46-fold the amount of the women's obturartor arteries, in which it was the lowest. In the cases of men, the average content of calcium was higher in the order of the internal pudendal, umbilical, and obturator arteries. Regarding the average content of calcium, the order internal pudendal, umbilical, and obturator arteries of the men was consistent with that of the women.     

超选择子宫动脉栓塞治疗子宫肌瘤

目的探讨超选择子宫动脉栓塞治疗子宫肌瘤的方法及疗效。方法子宫肌瘤65例采用Seldinger技术经皮股动脉插管至双侧髂内动脉,造影了解肿瘤的血供来源后,超选至两侧子宫动脉,缓慢注入平阳霉素碘油乳剂或PVA微粒栓塞治疗。结果患者症状缓解率为93．2％,月经增多,痛经,尿频、尿急,贫血等1-3个月内恢复正常。并发症：除栓塞综合征外,可见阴道不规则流血,腰腿痛,可自行恢复。治疗后3-6个月肌瘤缩小率在30％-68％之间。中短期疗效较稳定,末见复发。治疗前后性激素水平变化无明显差异。结论子宫动脉栓塞术治疗子宫肌瘤操作简单安全,疗效好。超选择子宫动脉插管其分支栓塞,并发症少,具有较大的临床应用价值。     

Urogenital vasculature and local steroid concentrations in the uterine branch of the ovarian vein of the female tammar wallaby (Macropus eugenii)

The urogenital vasculature of the tammar comprises 4 major paired arteries and veins: the ovarian, the cranial urogenital, the caudal urogenital and the internal pudendal artery and vein. The ovarian artery and vein and their uterine branches which supply the ovary, oviduct and uterus, ramify extensively. Each anterior urogenital artery and vein supplies the caudal regions of the ipsilateral uterus, lateral and median vagina and cranial parts of the urogenital sinus. The caudal urogenital arteries and veins supply the urogenital sinus and caudal regions of the bladder. The internal pudendal artery and vein vascularize the cloacal region, with some anastomoses with branches of the external pudendal vessels. Anastomoses connect the uterine branch of the ovarian artery with the uterine branch of the cranial urogenital and cranial branches of the caudal urogenital arteries, and connect the caudal urogenital and the internal pudendal arteries. Anastomotic connections between the left and right arterial supply also occur across the midline of the cervical regions of the uteri and the anterior lateral vaginae. Similar connections are seen in the venous system. The uterine branch of the ovarian artery ramifies extensively very close to the ovary, giving a plexiform arrangement with the ovarian veins, and also with the uterine venous system on the lateral side of each uterus. This plexiform structure provides an anatomical arrangement which could allow a local transfer of ovarian hormones from ovarian vein into the uterine arterial supply, and thence to the ipsilateral uterus. Progesterone concentrations in plasma from the mesometrial side of the uterine branch of the ovarian vein are markedly higher than in tail vein plasma, especially during the 'Day 5 peak' early in pregnancy, and also at full term. There is also a marked decrease in progesterone concentration from all sites immediately before birth as previously reported for peripheral plasma. These results support the suggestion of a countercurrent transfer mechanism, at least for progesterone, and possibly other hormones, between the ovarian vein and uterine artery. Such a local transfer could explain the different morphological responses of the endometria of the two adjacent uteri during pregnancy in macropodid marsupial species.     

Acute embolization of the uteroplacental circulation: uterine blood flow and placental CO diffusing capacity

In an effort to determine to what extent the fetal sequalae following repeated embolization result from decreased area of placental exchange or from decreased uterine blood flow, we injected microspheres into the uterine circulation of the pregnant ewe. We measured total UBF continuously and sampled fetal blood gases in 6 chronically instrumented ewes following repeated injections of 1 to 2 million 25 mu microspheres into the common internal iliac artery at 30 min intervals. Embolization resulted in an immediate 25 to 30% drop in uterine flow, with partial recovery to about 85% of its control value within 30 min after injection. A linear relation existed between uterine blood flow and fetal O2 tension. A slightly accelerated decrease in O2 content with a more rapid increase in CO2 tension and [H+] was seen when uterine flow decreased below 150 ml X min-1 X kg fetal wt-1. Following repeated injections fetal descending aortic O2 tension and content decreased 34 and 82% respectively, while PCO2 and [H+] increased 28 and 84% respectively. Placental diffusing capacity for CO increased 117% after repeated embolization. Most of this increase could be accounted for by the fetal hypoxia and acidosis, although some of it may have resulted from distension or recruitment of vessels in the placental exchange area, or a more uniform distribution of placental blood flows. These studies suggest that the acute changes in fetal blood gas values following embolization result from a reduction in blood flow rather than from a reduced placental exchange area.     

Reliability of recording uterine cancer in death certification in France and age-specific proportions of deaths from cervix and corpus uteri

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening.     

Ultrasound-guided transfundal uterine sperm recovery from Macaca fascicularis

Previous studies from this center have indicated that the cynomolgus macaque (Macaca fascicularis) may serve as a model for human sperm interaction with the cervix and uterus. In some macaque species, transcervical aspiration of the uterine contents carries a significant risk of disturbing the cervical milieu due to the serpentine nature of the cervix. The only alternatives have been surgical procedures such as laparotomy or laparoscopy. In this paper, we report our experience with a new technique for ultrasound-guided sampling of spermatozoa in the macaque uterus. Twenty adult female cynomolgus macaques were monitored for menses (first day of menses = day l), and one mating per cycle was allowed on day 10, 11, or 12. In one group of ten animals, cervical mucus was sampled at 3 or 18 hr postcoitus (pc) and ultrasound-guided uterine aspiration was performed at 24 hours pc. In a second group of ten monkeys, uterine aspiration was at six hr pc and sperm numbers and motility were counted in the uterine fluid. Uterine fluid was obtained from fourteen of twenty monkeys. Pregnancy occurred in ten of the twenty experimental cycles. Ultrasound-guided uterine aspiration appears to be a reliable method for the evaluation of sperm transport in female macaques. The correlations between uterine sperm recovery and cervical mucus sperm populations arc discussed. The high conception rate in treatment cycles indicates that this procedure can be performed without apparent risk to pregnancy.     

Arterial embolization in the treatment of bleeding uterine and bladder neoplasms

We evaluated effectiveness of transcatheter embolization for control of bleeding complicating bladder and uterine neoplasms in 60 patients. Post embolization, bleeding was completely controlled in 95% patients. Complications occurred in 5% of cases. Within 6 months interval haemorrhage recurred in 22% after embolization and its rate depended on selectivity of the procedure (14% vs 60% for proximal embolization). Arterial embolization is safe and effective for control of bleeding from bladder and uterine cancer.     

PVA颗粒与中药白芨栓塞犬子宫动脉的对比研究

目的:研究PVA微粒、中药白芨颗粒栓塞犬子宫动脉所引起的子宫病理变化,观察两者之间对子宫影响有无差别;探讨中药白芨作为血管栓塞剂的有效性、安全性及相关特性。方法:先结扎8例犬双侧子宫动脉,病理证实子宫组织无坏死。然后采用Seldinger技术,对16例犬进行选择性子宫动脉栓塞。分别向子宫动脉注入PVA微粒、中药白芨颗粒阻断供血,观察子宫病理变化。将病理结果予以定量,综合评价脏器损伤。结果:双侧子宫动脉栓塞后,各栓塞组之间样本均数两两比较,均为P>0.05,即三种处理对于子宫组织损伤无统计学差异。白芨主要栓塞末梢小动脉,栓塞牢靠,不易形成侧支循环,未出现细胞坏死。结论:选择上述栓塞剂,对子宫组织损伤效果一致,中药白芨颗粒具有良好的血管栓塞作用和载体特性,使用方便、安全,是一种较理想的末梢型血管栓塞剂。     

子宫动脉栓塞术治疗子宫肌瘤的临床应用价值

目的：研究子宫动脉栓塞术（UAE）治疗子宫肌瘤的安全性和临床应用价值,材料和方法：25例经临床,B超证实的子宫肌瘤患者,平均年龄43．5岁,主要临床表现为月经量增多21例,贫血16例,有压迫症状4例,选择性双侧子宫动脉插管造影,用聚己烯已醇海绵（PVA）颗粒栓塞该动脉。结果：UAE后第3,6个月随访,所有患者月经量均恢复正常,15例贫血,4例压迫症状者均缓解,第3,6个月B超复查子宫肌瘤体积分别缩小47．37％和51．31％,与UAE产比较有显著差异（P＜0．01）,缺血性盆腔疼痛（92％）是最常见的副反应,UAE后卵巢体积均无显著缩小（P＞0．05）,结论：介入性双侧子宫动脉栓塞术治疗子宫肌瘤是一种微创,安全的手术,可保留子宫及其功能,其近期疗效显著,子宫动脉栓塞治疗子宫肌瘤具有重要的临床应用价值。     

介入栓塞术在急诊难治性医源性肾出血中的临床应用价值

摘要 目的：探讨介入栓塞术在急诊难治性医源性肾出血中的临床应用价值。方法：收集2012年6月至2021年6月南京医院大学第一附属医院收治的72例急诊难治性医源性肾出血的患者。所有患者在保守治疗无效的情况下,行介入下肾动脉血管造影,根据造影表现确定出血责任动脉,并行栓塞治疗,术后观察临床止血的有效性及安全性。结果：72例患者,介入血管造影呈阳性结果64例,包括血管出现单纯造影剂外溢12例,单纯假性动脉瘤19例,单纯动静脉瘘8例,9例患者合并两种造影表现,以及16例患者呈现动脉出血的一些间接征象。阳性出血患者介入栓塞技术成功率及临床止血率为100%。72例患者介入术后3 d血白细胞、血中性粒细胞比率、血红蛋白、血细胞比容及血小板较术前明显升高（均P＜0.05）,血肌酐及尿素氮较介入术前轻度升高（均P＞0.05）;其中30例患者介入术后7 d再次检测血肌酐及尿素氮,较介入术前基本恢复正常（均P＞0.05）。住院期间所有患者未出现肾衰等严重的术后并发症。结论：介入栓塞术治疗急诊难治性医源性肾出血患者,具有安全、高效、并发症少等优点,临床上值得推广应用。     

Progesterone in uterine and arterial tissue and in jugular and uterine venous plasma of sheep

Concentrations of progesterone in uterine and arterial tissue and in uterine and jugular venous plasma were determined. Blood was collected on Days 4 and 9 postestrus from the jugular vein and the first and last venous branches draining each uterine cornu; uterine tissue and arteries were subsequently collected. Progesterone was greater (p less than 0.05) in the cranial third than in the middle or caudal thirds of the uterine horn adjacent to the corpus luteum (CL)-bearing ovary or in any third of the contralateral horn. Progesterone in uterine arterial segments adjacent to the CL-bearing ovary was higher (p less than 0.05) than in contralateral segments. Progesterone was higher (p less than 0.05) in blood from the first venous branch of the cranial third of the uterine cornu adjacent to the ovary with the CL, than in the last branch of the caudal third, or contralateral horn, or in jugular blood. When oviductal veins were resected on Day 9 postestrus, progesterone in the first vein draining the cranial third of the uterine cornu adjacent to the CL-containing ovary was not different (p greater than 0.05) 48 h after resection than in the same vessel in the opposite horn or in jugular blood. We concluded that progesterone and other ovarian products may be delivered to the uterus locally.     

Serum and tissue levels of six trace elements and copper/zinc ratio in patients with cervical cancer and uterine myoma

The aim of this study is to investigate the relationship between trace elements and the incidence of cervical cancer. Tissue and serum levels of six elements (Cu, Zn, Fe, Mn, Ca, and Se) and the Cu/Zn ratio in 40 cases of patients with cervical cancer, 30 cases of uterine myoma, and 50 healthy subjects were measured by atomic absorption spectrophotometry; the selenium content was determined by atomic fluorescence spectrometry. The results showed that the tissue contents of Zn, Se, and Ca were significantly lower and the Cu and Fe concentrations and Cu/Zn ratio were significantly higher in cervical cancer tissue than that for paired nonlesion tissue (p<0.02 and p<0.001, respectively). The serum levels of Zn, Se, Ca, and Fe were lower and Cu and Mn levels and Cu/Zn ratio were higher in patients with cervical cancer than in healthy subjects (p<0.01 and p<0.001, respectively) and in the uterine myoma group compared with healthy subjects (p< 0.05–0.001). There are no significant differences in the contents of six elements and the Cu/Zn ratio between uterine myoma tissue and paired nonlesion tissue. The results showed also that the Fe level and Cu/Zn ratio were significantly higher and the Zn and Se levels were significantly lower in cervical cancer tissue than in uterine myoma tissue (p<0.01 and p<0.001, respectively). The serum Cu level and Cu/Zn ratio were significantly higher in the cervical cancer group than the uterine myoma group (p<0.01). Data were also analyzed using multivarate logistic regression. After adjustment for age, occupation, life habit, and other covariates for the development of cervical cancer, the odds ratios were 22.64 (95% confidence interval [CI]: 5.64–90.88, p=0.001) for Cu, 0.11 (95% CI: 0.034–0.373; p=0.005) for Zn, and 0.60 (95% CI: 0.36–0.99, p=0.01) for Se. Thus, the serum and tissue levels of Cu increase and the deficiency of Zn and Se may be risk factors for the development of cervical cancer.     

Differences in uterine position of reproductively normal mares and those with delayed uterine clearance detected by scintigraphy

The position of the uterus within the abdomen may affect a mare's ability to rapidly clear the uterine lumen of contamination. In this study, the position of the uterus was determined from left and right lateral flank scintigrams taken 1 and 2 h after intrauterine infusion of radiocolloid. Scintigraphy was performed during estrus in 44 mares, 24 were reproductively normal and 20 exhibited a delay in uterine clearance. Reproductively normal mares were nulliparous (n = 14) or pluriparous (n = 10), 3 to 21 yr of age, had no history of persistent uterine infections and cleared > 50% of a radiocolloid within 2 h of infusion into the uterus. Mares that exhibited a delay in uterine clearance were pluriparous (n = 18) or nulliparous (n = 2), 12 to 24 yr of age, had a history of endometritis and cleared < 30% of a radiocolloid within 2 h. The angle between the caudal-ventral aspect of the uterine image and cervix relative to horizontal as visualized on the scintigram was measured with a protractor. Results were analyzed by the General Linear Model System. The uterine-cervical angle relative to horizontal was more ventral in mares with delay in uterine clearance and was more horizontal in reproductively normal mares (mean +/- SEM-111.6 +/- 3.6 for delay in uterine clearance mares; 147.6 +/- 3.9 for reproductively normal mares; P < 0.0001). The mean angle for reproductively normal, pluriparous mares was steeper than that for nulliparous mares (141.1 +/- 2.9, 152.3 +/- 2.44 respectively; P = 0.004). There were no differences in angles between left and right lateral views within individuals. We conclude that a uterus that tilts ventrally in relation to the pelvic brim may contribute to the inability of delay in uterine clearance mares to rapidly clear their uterine lumen of contamination. Parity may contribute to the more ventral orientation of the uterus.     

Age-related changes of elements in thoracic and abdominal aortas and coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries and relationships in elements among their arteries

To elucidate whether the accumulation of elements occurred simultaneously in the various arteries with aging, the authors investigated age-related changes of elements in the eight arteries, such as the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries, and the relationships in the element contents among their arteries. After ordinary dissection by medical students was finished, the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries were resected from the subjects, who ranged in age from 58 to 94 yr. The element contents were analyzed by inductively coupled plasma-atomic emission spectrometry. It was found that the accumulation of Ca was the highest in the common iliac artery and decreased in the order of the uterine artery, abdominal aorta, coronary artery, thoracic aorta, splenic artery, common carotid artery, and pulmonary artery. Regarding the relationships in the element contents among the eight arteries, it was found that there were significant direct correlations in the contents of Ca, P, Mg, Zn, Fe, and Na between the coronary and splenic arteries, and there were significant correlations in the contents of Ca, P, and Mg between the abdominal aorta and pulmonary artery.     

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.     

Processes of apoptosis and cell proliferation in uterine myomas originating from reproductive and perimenopausal women

We studied uterine myomas originating from females of reproductive age and from females of perimenopausal age. Uterine myomas represent benign tumors of the myometrium, and they develop frequently in women of reproductive age. The frequency of uterine myomas increases with age until women reach the menopause. The study included patients with a myomatous uterus, in the reproductive age or peri-menopausal age, independently evaluating small and large myomas. Myometrial alterations in their direct vicinity were evaluated independently of the myomas. The study included evaluation of immunolocalization of two index proteins which participate in myoma cells growth control: Ki-67 nuclear antigen and caspase 3. In women of reproductive age, both in small and large myomas, elevated immunostaining of Ki-67 was noted in parallel to low levels of caspase 3 staining, which indicated the ongoing process of proliferation. In women of peri-menopausal age with small or large myomas, no Ki-67 immunostaining was detected, while staining of caspase 3 manifested low levels. Proliferation in reproductive age women myomas is higher than in the peri-menopausal age.