Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery

In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%–92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective.     

宫腔镜联合腹腔镜在女性不孕症诊治中的应用

摘要目的：探讨宫腔镜联合腹腔镜在女性不孕诊断及治疗中的临床应用价值。方法：回顾性分析60 例我院收治的采用宫腔镜联 合腹腔镜进行诊断和治疗的女性不孕症患者为研究对象,对其临床资料进行分析。结果：宫腔镜联合腹腔镜检查发现,60 例不孕 症患者中,56.7 %的患者患有慢性盆腔炎,16.7 %的患者为子宫内膜异位症,11.7 %的患者为多囊卵巢综合征;单纯腹腔镜检查的 阳性检出率为60.0 %,单纯宫腔镜检查的阳性检出率为28.3 %,宫腔镜联合腹腔镜检查的阳性检出率高达91.7 %,宫腔镜联合腹 腔镜镜检阳性发现率明显高于前二者(P < 0.05)。治疗前,双侧不通、一侧通畅和双侧输卵管通畅的患者分别为38.3 %、48.3 %和 13.3 %,经宫腔镜联合腹腔镜治疗后分别为11.7 %、50.0 %和38.3 %,差异均有统计学意义(P<0.05)。34 例原发性不孕患者,术后 13例妊娠,妊娠率38.2 %;26 例继发性不孕患者,术后15 例妊娠,妊娠率57.7 %;总妊娠率为46.7 %,其中宫外孕2例。结论：宫 腔镜联合腹腔镜检查可帮助明确女性不孕症患者明确原因及发病部位,并可针对病因进行治疗,提高女性不孕症的病因诊断准 确率及治愈率。     

妇科肿瘤患者术后盆腔感染情况调查、 病原菌分布及其危险因素分析

目的调查妇科肿瘤患者术后盆腔感染的情况以及病原菌分布,并探讨术后发生盆腔感染的危险因素。方法回顾性分析自2013年1月到2017年1月在东南大学附属中大医院接受妇科肿瘤手术治疗的384例患者的临床资料。统计妇科肿瘤术后盆腔感染的发生率及病原菌的分布情况。将发生盆腔感染的患者分为感染组,未发生盆腔感染的患者分为未感染组,对比两组的临床资料,并通过多因素Logistic回归分析,归纳妇科肿瘤患者术后发生盆腔感染的危险因素。结果术后发生盆腔感染41例,感染率为10.68%,培养出病原菌54株,其中革兰阳性菌14株,占25.93%,革兰阴性菌35株,占64.81%,真菌5株,占9.26%。感染组患者年龄60岁的比例、手术持续时间2h的比例、合并慢性基础疾病的比例、开放手术的比例、术前化疗的比例、术后留置引流管的比例和术后卧床时间7d的比例均显著高于未感染组(均P0.05);多因素Logistic回归分析结果显示,年龄大、手术持续时间长、合并慢性基础疾病、开放手术、术前化疗、术后留置引流管、术后卧床时间长均是妇科肿瘤患者术后盆腔感染的危险因素(均P0.05)。结论妇科肿瘤患者术后较容易并发盆腔感染,病原菌主要为革兰阴性菌。多种因素可增加术后盆腔感染的风险,临床应加强防控措施,降低妇科肿瘤患者术后盆腔感染的发生率。     

Informativeness of angiography in trophoblastic tumors of the uterus

A study was made of the resolving power of general and selective pelvic angiography with regard to specified diagnosis of trophoblastic tumors of the uterus. The informative value of general pelvic angiography was estimated by the results of angiomorphological correlations in 81 operated patients. The significance of selective pelvic angiography performed in 152 women was based on comparison of its results with those of pharmacoangiography supplemented by hysterography in 86 patients. The correctness of diagnosis in 26 of them was confirmed by operative findings. Analysis of the investigations has shown that general pelvic angiography allowed the detection of a tumor, its size and site in the uterus in 48% of the patients only. Selective pelvic angiography combined with pharmacoangiography was shown to be a method extending the diagnostic potentialities of pelvic angiography. In the authors' experience, it permitted obtaining a direct contrast image of a trophoblastic tumor or excluding its presence in the uterus of 85% of the examinees.     

The case of asymptomatic primary actinomycosis of the greater omentum in the patient with intrauterine contraceptive device

This paper describes a case of asymptomatic multifocal actinomycosis of the greater omentum which was detected accidentally in a patient who was suspected of uterus myoma. The patient was a 40 year old woman who had a copper intrauterine contraceptive device (IUCD) for three years. After the gynecological examination and pelvic ultrasound she was diagnosed with sub serous myoma of uterus. Since she did not give a birth it was suggested to have myoma enucleating. However during the surgery a dermoid teratoma of the right ovary was detected so it was removed together with tumor and there were two thickenings on the greater omentum, suspicious of inflammation, whereas one grew together with the front abdominal wall. Due to these conditions, she had partial omentectomy done and omentum was sent for path histological examination. The path histological examination confirmed it to be actinomycosis. The patient had an intensive antibiotic therapy prescribed (Penicillin) in order to prevent a disease relapse because we could not be sure whether the remaining part of omentum was affected by microscopic actinomycosis.     

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.     

Hysterosalpingography: a technique to aid in assessment of reproductive fitness of female squirrel monkeys (Saimiri sciureus)

A hysterosalpingography method was developed to examine the uterine cavity and oviducts of potential additions to our squirrel monkey breeding colony and those animals within the colony with a history of infertility. Females to be examined were anesthetized and placed in dorsal recumbency. A needle was inserted transabdominally into the body of the uterus, the cervix was sealed with a clamp applied vaginally, and water soluble contrast media was infused into the uterine cavity with sufficient pressure to fill the oviducts. Radiographs were obtained during infusion resulting in visualization of the uterine cavity and the lumina of the oviducts. The ovaries were visualized as they were surrounded by contrast media draining from the fimbriae of the oviducts. Hysterosalpingography proved to be a useful method for clinical evaluation of reproductive potential of female squirrel monkeys. It also has provided a means to diagnose causes of infertility associated with dysfunction of the oviducts.     

Isolation, immortalization, and initial characterization of uterine cell lines: An in vitro model system for the procine uterus

Summary The aim of this study was to develop immortalized cell lines from porcine uterus. Endometrial cells including luminal epithelium (LE), glandular epithelium (GE), stroma (ST), and myometrium (MYO) were enzymatically isolated from the uterus of a day 12 pregnant gilt. Primary cultures were immortalized by transduction with a retroviral vector containing the E6 and E7 open reading frames of human papillomavirus type 16 (LXSN-16E6E7) packaged by the amphotropic fibroblast line PA-317. Cells having integrated the vector were selected by resistance to the neomycin analog G418 (0.4–1.5 mg/ml). Surviving cells were maintained in complete culture medium containing G418 (0.1 mg/ml) and subcultured for 1 yr. Expression of the E7 protein was confirmed in all cell lines by Western blotting. Phase contrast microscopy revealed that LE and GE cells exhibited cobblestone morphology, whereas ST and MYO cells exhibited spindle-shaped morphology. The epithelial origin of LE and GE was confirmed by positive immunostaining for cytokeratin. Stromal and MYO cells were vimentin-positive, but cytokeratin-negative. The MYO cell lines were positive for smooth muscle α-actin staining, whereas LE, GE, and ST cell lines were negative for α-actin. Western blotting indicated that all cell lines expressed both estrogen and progesterone receptors, but only GE cells secreted uteroferrin (UF). Collectively, these porcine uterine cell lines provide an in vitro model for studying cell type-specific actions of hormones and cytokines, signal transduction pathways, cell-cell interactions, and gene expression.     

经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床疗效

目的:探讨经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床效果。方法:选取2013年1月-2015年3月我院妇科收治的以前中盆腔联合缺陷为主的盆底障碍性疾病患者39例(POP-Q分度III-IV度)。实施经阴道Avaulta前盆腔重建术,24例切除子宫,9例保留子宫,其中6例因中盆腔重度脱垂联合行阴道残端骶棘韧带固定术,2例合并尿失禁同时行经尿道无张力悬吊术。术后随访12-25月,根据盆腔脏器脱垂评分(POP-Q)测量及PFIQ-7评分进行客观评价及主观感受评价进行中短期的临床效果分析。结果:39例患者手术过程顺利,术后无严重并发症,POP-Q评分均较术前显著降低,客观疗效理想。术后阴道前壁及子宫、阴道穹窿脱垂等症状显著改善;到目前为止无一例复发。结论:经阴道前盆腔重建术治疗前盆腔重度盆腔脱垂为主以及合并尿失禁等复杂情况的并发症少,治愈率高,复发率低,临床效果好。     

Nitric oxide nerves in the uterus are parasympathetic,sensory, and contain neuropeptides

Nitric oxide (NO) is synthesized in neurons and is a potent relaxor of vascular and nonvascular smooth muscle. The uterus contains abundant NO-synthesizing nerves which could be autonomic and/or sensory. This study was undertaken to determine: 1) the source(s) of NO-synthesizing nerves in the rat uterus and 2) what other neuropeptides or transmitter markers might coexist with NO in these nerves. Retrograde axonal tracing, utilizing Fluorogold injected into the uterine cervix, was employed for identifying sources of uterine-projecting neurons. NO-synthesizing nerves were visualized by staining for nicotinamide adenine dinucleotide phosphate (reduced)-diaphorase (NADPH-d) and immunostaining with an antibody against neuronal/type I NO synthase (NOS). NADPH-d-positive perikarya and terminal fibers were NOS-immunoreactive (-I). Some NOS-I/NADPH-d-positive nerves in the uterus are parasympathetic and originate from neurons in the pelvic paracervical ganglia (PG) and some are sensory and originate from neurons in thoracic, lumbar, and sacral dorsal root ganglia. No evidence for NOS-I/NADPH-d-positive sympathetic nerves in the uterus was obtained. Furthermore, double immunostaining revealed that in parasympathetic neurons, NO-I/NADPH-d-reactivity coexists with vasoactive intestinal polypeptide, neuropeptide Y, and acetylcholinesterase and in sensory nerves, NOS-I/NADPH-d-reactivity coexists with calcitonin generelated peptide and substance P. In addition, tyrosine hydroxylase(TH)-I neurons of the PG do not contain NOS-I/NADPH-d-reactivity, but some TH-I neurons are apposed by NOS-I varicosities. These results suggest NO-synthesizing nerves in the uterus are autonomic and sensory, and could play significant roles, possibly in conjunction with other putative transmitter agents, in the control of uterine myometrium and vasculature.     

1.5T磁共振不同序列用于检出妇科肿瘤盆腔淋巴结转移的比较

目的:比较1.5T磁共振(MRI)不同序列条件下对妇科肿瘤盆腔淋巴结转移的检出情况,探讨最佳检出序列条件。方法:选取2015年5月-2017年5月初诊为卵巢癌、宫颈癌、子宫内膜癌的患者78例作为研究对象,均行盆腔淋巴结清扫术。所有患者术前均行T1加权序列(T1WI)、T2加权序列(T2WI)、增强扫描(T1WI+C)、弥散加权成像(DWI)检查,记录每个序列检查条件下检出的盆腔转移淋巴结个数及分布。以病理结果作为判断的"金标准"进行对比。结果:对比病理检查结果,应用DWI序列对妇科肿瘤盆腔淋巴结转移的检出率(95.8%)显著高于T2WI-MRI序列(85.8%)和T1WI-MRI序列(75.0%)(P0.05);DWI序列与T1WI+C序列(90.8%)相比差异无统计学意义(P0.05);DWI阈值法与DWI短径法相比,淋巴结的检出率差异无统计学意义(P0.05)。结论:应用1.5T磁共振检查妇科肿瘤盆腔淋巴节转移时,采用DWI序列扫描对于转移淋巴结的具有较高的检出率,显著优于其他序列扫描;在进行阳性淋巴结判断中,ADC阈值法和短径法均可选用。     

宫腔镜联合腹腔镜在女性不孕症诊治中的应用

目的：探讨宫腔镜联合腹腔镜在女性不孕诊断及治疗中的临床应用价值。方法：回顾性分析60例我院收治的采用宫腔镜联合腹腔镜进行诊断和治疗的女性不孕症患者为研究对象,对其临床资料进行分析。结果：宫腔镜联合腹腔镜检查发现,60例不孕症患者中,56．7％的患者患有慢性盆腔炎,16．7％的患者为子宫内膜异位症,11．7％的患者为多囊卵巢综合征;单纯腹腔镜检查的阳性检出率为60．0％,单纯宫腔镜检查的阳性检出率为28．3％,宫腔镜联合腹腔镜检查的阳性检出率高达91．7％,宫腔镜联合腹腔镜镜栓阳性发现率明显高于前二者（P〈0．05）。治疗前,双侧不通、一侧通畅和双侧输卵管通畅的患者分别为38．3％、48．3％和13．3％,经宫腔镜联合腹腔镜治疗后分别为11．7％、50．o％和38．3％,差异均有统计学意义（P〈0．05）。34例原发性不孕患者,术后13例妊娠,妊娠率38．2％;26例继发性不孕患者,术后15例妊娠,妊娠率57．7％;总妊娠率为46．7％,其中宫外孕2例。结论：宫腔镜联合腹腔镜检查可帮助明确女性不孕症患者明确原因及发病部位,并可针对病因进行治疗,提高女性不孕症的病因诊断准确率及治愈率。     

Mapping histological levels of 8-hydroxy-2′-deoxyguanosine in female reproductive organs

Oxidative stress is associated with many disease states including gynecologic disease. This process can damage lipids, proteins and DNA. The present study highlights the role of oxidative stress induced DNA damage as measured by 8-hydroxy-2-deoxyguanosine in development of benign gynecological conditions (BGC). Our aim was to map the oxidative DNA damage on female reproductive organs and highlight the high amount found in a variety of benign gynecologic disorders. Seventeen biopsy specimens from female pelvic organs were divided in two groups: healthy organs tissue and BGC tissue. Healthy organs biopsy tissue included the cervix, tubes, uterus, peritoneum, and topic endometrium in secretory phase. Benign gynecological biopsy tissue included hydrosalpinges, leiomyoma, adenomyosis and tubal cysts. Immunohistochemical staining showed significantly higher levels of DNA damage between BGC and healthy organs [19.36 % (6.20; 32.51) vs. 4.61 % (0.63; 8.53); P < 0.0344]. Our results highlight the involvement of oxidative stress DNA damage in female benign pelvic disease. Hydrosalpinges, leiomyoma, and adenomyosis exhibit the highest amounts of oxidative DNA damage in the pelvic cavity.     

Effect of trifluoperazine, a calmodulin antagonist, on prostaglandin output from the guinea-pig uterus

Trifluoperazine, a calmodulin antagonist, inhibited the A23187-induced increase in outputs of prostaglandin (PG) F-2 alpha and 6-oxo-PGF-1 alpha from the Day 7 and Day 15 guinea-pig uterus superfused in vitro. The basal outputs of, and the arachidonic acid-induced increase in outputs of PGF-2 alpha, PGE-2 and 6-oxo-PGF-1 alpha from the guinea-pig uterus were not inhibited by trifluoperazine. In contrast, indomethacin inhibited A23187-stimulated, arachidonic acid-stimulated and the basal outputs of PGs from the guinea-pig uterus, indicating that trifluoperazine was not inhibiting cyclo-oxygenase. Since the action of A23187 is dependent upon extracellular Ca2+, the present findings provide evidence that calmodulin is involved in Ca2+-induced increases in uterine PG output from the guinea-pig uterus. Trifluoperazine, but not indomethacin, inhibited A23187-induced contraction of the guinea-pig uterus, which is consistent with calmodulin being involved in smooth muscle contraction. Arachidonic acid treatment did not contract the guinea-pig uterus. These findings indicate that PGs are not involved in the contraction induced by A23187. Other findings of interest were (i) trifluoperazine caused a small, sometimes significant (P less than 0.05), increase in uterine PG output, (ii) exogenous arachidonic acid failed to increase PGF-2 alpha output from the Day 15 uterus in contrast to the stimulant action of A23187, and (iii) exogenous arachidonic acid caused a fairly large increase in uterine PGE-2 output in contrast to the small effect with A23187.     

In vitro study of rat uterus after chronic formaldehyde exposure.

To measure cholinergic, adrenergic and tryptaminergic receptor activity of formaldehyde (HCHO) in rat uterus, albino rats were treated with 5 and 10 mg/kg, ip HCHO for 30 days. Acetylcholine (ACh) in doses 1.33, 2 and 3 micrograms/ml produced mild to moderate contraction of isolated rat uterus in control group. HCHO had no effect on isolated rat uterus per se, however it reduced ACh and carbachol induced contraction and presence of adrenaline influences in respect of ACh and carbachol activity. Adrenaline per se had no effect in control preparations, but reduced carbachol induced contraction. Propranolol had no effect on rat uterus; but its presence in the bathing medium increased activity of adrenaline. 5-Hydroxytryptamine (5-HT) had no effect of its own on isolated rat uterus but its presence in the bathing medium enhanced contractions of carbachol and oxytocin.     

The Indications for Dilatation and Curettage

Historical aspects of dilatation and curettage are discussed and the indications reviewed for this procedure in three major age-groups: (1) childhood and adolescence, (2) maturity and reproductive period, (3) menopause and post-menopause. As the most frequently performed obstetrical and gynecological procedure, it is not an innocuous operation, and clear-cut indications for its use are presented with reference to abnormal vaginal bleeding in all age groups, infertility, functional ovarian tumours, neoplasia of the uterus, cervical biopsy, and major pelvic surgery. It is concluded that dilatation and curettage has a major place in the diagnostic and the therapeutic armamentarium of the thorough obstetrician and gynecologist.     

Spasmogenic effects of the anti-fertility agent,zoapatanol

The oxepane-containing diterpenoid (±)-zoapatanol, prepared by total chemical synthesis, was evaluated for its biological effects on human blood platelets, guinea-pig ileum, rabbit and rat uterus, and cat coronary artery. It had potent activity comparable to prostaglandin endoperoxide analogs in constricting coronary arteries or contracting the ileum but in contrast to the prostaglandins had no effect on platelet aggregation or the uterus. Antagonists of other known vasoactive substances had little or no effect on zoapatanol-induced constriction of coronary arteries. Zoapatanol appears to interact with yet unidentified receptors on vascular smooth muscle.     

乌鲁木齐市及阿克苏地区早发性卵巢功能不全影响因素的多中心研究

摘要 目的：分析新疆乌鲁木齐市及阿克苏地区早发性卵巢功能不全（POI）影响因素。方法：选取2019年1月~2021年12月期间新疆典型地域分布代表的乌鲁木齐市及阿克苏地区不同等级医院妇科收治的POI患者确定为病例组,共计186例。同时选取同期来新疆典型地域分布代表的乌鲁木齐市及阿克苏地区不同等级医院进行体检的200例无POI健康育龄期妇女志愿者作为对照组。采用本次研究自制的调查量表搜集患者的一般资料,采用单因素及多因素Logistic回归分析POI的影响因素。结果：病例组血清基础卵泡刺激素（FSH）、促黄体生成素（LH）水平高于对照组、雌二醇（E2）水平低于对照组（P<0.05）。单因素的研究结果显示,对照组、病例组在民族、居住地、文化水平、是否经常锻炼/劳动、月经量、月经周期是否有规律、是否存在内分泌疾病、是否存在妇科疾病（除POI）、是否盆腔手术、月经天数、月经周期、Zung抑郁自评量表（SDS）得分方面具有统计学差异（P<0.05）。多因素Logistic回归分析结果显示,民族为汉族、学历为大学及以上、月经周期一直无规律、进行过盆腔手术、SDS得分偏高、月经量很少是POI发生的危险因素（P<0.05）,而经常锻炼/劳动是POI发生的保护因素（P<0.05）。结论：新疆乌鲁木齐市及阿克苏地区的POI患者体内性激素紊乱,且其POI的发生受到民族、学历、是否经常锻炼/劳动等多种因素的影响。     

Mechanical responses of the rat uterus, cervix, and bladder to stimulation of hypogastric and pelvic nerves in vivo

Mechanical activities of the uterus, cervix, and bladder were recorded in vivo in anesthetized rats during electrical stimulation of either the hypogastric or pelvic nerve. Ovariectomized controls and hormone-treated groups were used as well as pregnant and postpartum rats. Stimulation of either hypogastric or pelvic nerve produced voltage- and frequency-dependent contractions of the three organs with no evidence of apparent inhibition. All evoked responses were completely abolished by tetrodotoxin, suggesting that these nerves are common pathways of innervation to the three organs. Atropine abolished uterine and cervical responses to both hypogastric and pelvic nerve stimulation, whereas bladder responses were only partly reduced. Hexamethonium almost totally blocked the evoked responses of the uterus and cervix. Phentolamine partly blocked uterine and cervical responses, and propranolol or physostigmine enhanced uterine and cervical responses to both hypogastric and pelvic nerve stimulation. These results suggest that motor innervation to the rat uterus and cervix is predominantly postganglionic cholinergic, with some alpha- and beta-adrenergic components, and that the bladder is innervated by mainly cholinergic and also noncholinergic nerves. Estrogen and estrogen-plus-progesterone pretreatment significantly increased the responses of uterus and cervix but not bladder. Uterine and cervical responses to either hypogastric or pelvic nerve stimulation were markedly reduced late in pregnancy and reappeared within 7 days after delivery.