Platelet transfusion practice: time for renewed consensus

BACKGROUND: Bilateral tubal pregnancies are rare and are usually confirmed simultaneously during the same operation. We report a case in which the right salpingectomy was performed seven weeks before the left salpingectomy. When the right salpingectomy was done, the left uterine tube appeared entirely normal. CASE: A 38-year-old woman underwent laparoscopic surgery for suspected right tubal pregnancy. A right tubal pregnancy was found to have partially aborted into the peritoneal cavity. The left uterine tube was carefully inspected and appeared normal. Histopathology of the right tube showed products of conception and chorionic tissue. Seven weeks after surgery, the woman presented in hemorrhagic shock necessitating emergency laparotomy and left salpingectomy. Histopathology of the left tube confirmed the presence of chronic tissue. The patient did not have coitus between the two salpingectomies. CONCLUSION: The explanation of the presentation is uncertain. However, this case underscores the importance of careful follow-up of patients after laparoscopic surgery for ectopic pregnancies.     

Activities of enzymes of acetyl-CoA and acetylcholine metabolism in SN56 hybrid cholinergic cell line differentiated by dibutyryl cyclic AMP and all-trans retinoic acid

A case of an extremely rare cancer of the uterine tube in a 43 year old woman is reported. The tumor has been diagnosed as primary giant-cell carcinoma of the uterine tube.     

Ultrasound tracking of the movement of embryo-associated air bubbles on standing after transfer

The aim of this study was to investigate whether standing upright shortly after embryo transfer has any potential to affect the position of embryos transferred to the uterine cavity during treatment with in-vitro fertilization (IVF). This was assessed by ultrasound-guided tracking of embryo-associated air within the uterine cavity. A prospective study of 93 patients undergoing 101 consecutive embryo transfers in an IVF programme was carried out. Transvaginal ultrasound guided embryo transfer was performed with a second ultrasound in standing position immediately after transfer, allowing the movement of embryo-associated air to be assessed. No movement occurred in 94.1% (95/101) of transfers, movement of <1 cm in 4.0% (4/101) of transfers and movement of 1-5 cm in 2.0% (2/101) transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was seen. Standing shortly after embryo transfer does not play a significant role in the final position of embryo-associated air and is unlikely to be a factor in determining the position of embryos transferred to the uterine cavity during treatment with IVF.     

Influence of a progestogen on carbohydrate histochemical and histologic features of the ampulla of the bovine uterine tube

In the present experiment, study was made of the effects of melengestrol acetate given to heifers (0.5 mg for 14 days, starting at day 15 of the estrous cycle) on carbohydrate histochemical and histologic features of the ampulla of the uterine tube (oviduct). Melengestrol acetate-treated animals had significantly (P less than 0.5) fewer fertilized ova at 3 days after mating (50%) as compared with control animals (100%). Estrussynchronization treatment with melengestrol acetate reduced the amount of cytoplasmic and nuclear extrusions from the secretory cells of the uterine tubular ampulla, but did not alter the amount or types of mucosubstances within these cells.     

Primary dedifferentiated leiomyosarcoma of the fallopian tube

Between 1960 and 1995 the University of Leipzig Women's Hospital encountered 44 cases of primary malignant tumors of the Fallopian tube, including four malignant Müller mixed tumors and one sarcoma. The sarcoma, a dedifferentiated leiomyosarcoma, was found incidentally in a 57-year-old woman. Treatment encompassed total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy and pelvic and para-aortic lymph node dissection, followed by telecobalt irradiation of the pelvis (Hd 52 Gy). One year after treatment, no evidence of disease recurrence, is found. Literature documents only 34 cases of a primary uterine tube sarcoma. Even with RO-resection, the early, high rate of local recurrence (most often within the first two years after treatment) and hematogenous metastasis to the lungs, liver and bones compose this tumor's clinical course. The prognosis is poor despite the use of radiotherapy and/or combination chemotherapy.     

Ultrastructural studies of prepubertal porcine uterine tube epithelium

Ultrastructural details of prepubertal porcine uterine tube (oviduct) were studied in normal, growing gilts and compared with observations reported in other species. Tissues from the ampulla region of uterine tube were taken from 6 prepubertal gilts (106 to 139 days old) to determine cytodifferentiation of ciliated and secretory cells. The epithelium consisted of 2 distinctive cells, the ciliated and the secretory cells. Cilia were observed in the uterine tube of prepubertal gilts; however, degeneration of cilia was not observed in the present study. Most prominent observations were the occurrence of fibrous granules in the apical cytoplasm of ciliated cells. These fibrous granules contained electron-dense material and were present near basal bodies. The most unusual feature was the occurrence of procentrioles around a condensation form. These data indicate that ciliated cells are sensitive to estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia and rootlets. The cytoplasm of the secretory cells contained rough endoplasmic reticulum of tubular form and numerous ribosomes. Evidence for synthesis, storage, and release of secretory granules was not apparent. It is suggested that the secretory cells are not sensitive to the low, circulating concentration of plasma estrogen. The ultrastructure of the stromal cells and lymphatic capillary was described for the 1st time. The uterine tube stromal cells were characterized by prominent nucleus and a few cytoplasmic organelles. The lymphatic capillaries were distinguished by the blood capillaries, their much wider lumen, endothelium with an attenuated cytoplasm, absence of basal lamina, and overlapping and interdigitating intercellular junctions. The fine structure of the porcine uterine tube lymphatic capillary generally resembled that of other mammalian species.     

Genomic alterations in fallopian tube carcinoma: comparison to serous uterine and ovarian carcinomas reveals similarity suggesting likeness in molecular pathogenesis

Serous carcinomas of the fallopian tube, uterus, and ovary resemble each other both histologically and in clinical behavior. Comparative genomic hybridization was performed on 20 primary fallopian tube carcinoma specimens to find regions of the genome involved in tubal carcinogenesis and to compare the genomic alterations with those previously detected in serous ovarian and uterine carcinomas. The most frequent changes detected in fallopian tube carcinoma were gains at 3q (70%) and 8q (75%), with high-level amplifications in several cases. Other common gains occurred at 1q, 5p, 7q, 12p, and 20q. The most frequent losses were found at 18q, 8p, 4q, and 5q. The frequency and the pattern of chromosomal changes detected in tubal carcinoma were strikingly similar to those observed in serous ovarian and uterine carcinomas, suggesting common molecular pathogenesis.     

Manual removal of the placenta--its role in intrauterine adhesion formation

OBJECTIVE: To determine the role of postpartum intrauterine manipulation of the uterine cavity in the formation of intrauterine adhesions. PATIENTS AND METHODS: Diagnostic hysteroscopy was performed following manual removal of the placenta in 48 patients. RESULTS: Intrauterine adhesions were observed in only one case (2%), and an incomplete uterine septum was found in seven cases (15%). CONCLUSIONS: Manual removal of the placenta does not seem to predispose to the formation of uterine adhesions. Incomplete uterine septum may be involved in some of the cases of retained placenta.     

Conservative treatment of uterine arteriovenous fistula

A case of a uterine arteriovenous aneurysm in a 20-year-old woman is described. The patients's main symptom was copious uterine bleeding. The diagnostic difficulties are described and the importance of arteriography is emphasized. The aneurysm was occluded at laparotomy by introducing gel-foam into the uterine artery. The patient subsequently became pregnant and after an uneventful pregnancy was delivered of a healthy child. Thus, this type of conservative treatment seems to offer a possible means of avoiding hysterectomy in young patients with this rare condition who wish to retain their fertility.     

Early tracheostomy tube change in children

OBJECTIVE: To review the safety of early tracheostomy tube change in children. DESIGN: Retrospective case series. SETTING: Pediatric tertiary care hospital. PATIENTS: Twenty-one consecutive pediatric patients undergoing routine tracheotomy. INTERVENTION: First tracheostomy tube change performed at patient's bedside at 3 (n = 15) or 4 (n = 5) days after surgery. OUTCOME MEASURE: The ability to safely change a tracheostomy tube at the patient's bedside 3 or 4 days after surgery. RESULTS: The first tracheostomy tube change was safely performed at 3 or 4 days after surgery in 20 patients. All changes were accomplished without complication or difficulty on the first attempt. The patients' ages ranged from 4 days to 16 years. The smallest child weighed 1.6 kg. Early tracheostomy tube change was not attempted in one obese 10-year-old girl whose pediatric tracheostomy tube became dislodged and formed a false tract 2 days after surgery. CONCLUSIONS: Most pediatric tracheostomy tubes can be safely changed at the patient's bedside approximately 3 days after surgery. Clinical applications of early tracheostomy tube change may include facilitating better hygiene, earlier completion of family caregiver tracheotomy education, and shorter hospital stays. It appears safe and advantageous for surgeons to consider early initial tracheostomy tube change for pediatric patients.     

Perineal endometriosis at the site of an episiotomy scar

This study presents a case of vaginoperineal histologically verified endometriosis at the site of episiotomy scar in a 40-year female subject, 17 years after delivery. Apart from episiotomy during delivery manual revision of the uterus was performed and the cervical rupture managed. Residue symptoms occurs 8 months after the first surgical excision. Clinical data indicate that decidua implantation at the site of episiotomy occurred during the manual revision of the uterine cavity during delivery.     

Spontaneous conception and intrauterine pregnancy in a symptomatic missed abortion of ectopic pregnancy conceived in the previous cycle

We encountered a rare case of combined intrauterine and extrauterine pregnancy that occurred following separate spontaneous ovulations. A 33 year old woman visited our hospital with the chief complaint of abdominal pain on April 16, 1993. Her last menstruation was from March 23 for 6 days. However, the urinary human chorionic gonadotrophin (HCG) on April 19 was 1024 IU/l. Pelvic examination and ultrasonography indicated an extrauterine pregnancy, which was confirmed by laparotomy and histological identification of trophoblast cells. The urinary HCG concentration markedly decreased after the operation. However, the HCG level increased again on the fifth post-operative day, and a gestational sac (11 mm) was identified in the uterine cavity on the 11th post-operative day, indicating that this intrauterine pregnancy was established following spontaneous ovulation which occurred before the removal of the extrauterine pregnancy. This case indicates that a combined pregnancy can occur not only after simultaneous multiple ovulations but also after the separate spontaneous ovulations.     

The role of hysteroscopy in the early diagnosis of small, focal endometrial neoplasms

Hysteroscopy is a useful methodology for the diagnosis of uterine intracavitary disorders in women suffering from abnormal uterine bleeding. The authors report a case of small endometrial adenocarcinoma and then they discuss on validity of hysteroscopy in comparison with blind curettage of uterine cavity for the precocious diagnosis of such lesion.     

Cyclic ultrastructural changes in ewe uterine tube (oviduct) infundibular epithelium

Ultrastructural features of the uterine tube (oviduct) infundibulum of ewes have been studied, with special reference to cyclic changes in the ciliated and the secretory cells. Tissue from the uterine tube infundibulum was taken from 12 Rambouillet crossbreed ewes which were killed at intervals (days 1 (or estrus), 3, 9, 10, 12, and 16) throughout the estrous cycle. The presence of cilia was demonstrated throughout the estrous cycle, and true degeneration or loss of cilia was not apparent at any phase of the cycle. Presence of fibrous granules, which are supposedly related to basal body replication, was demonstrated in the apical cytoplasm of ciliated cells on day 1 of the estrous cycle. Small ciliary buds were especially present on day 1, indicating active formation of cilia during the follicular phase of the cycle. The presence of fibrous granules, basal bodies, and ciliary buds at estrus indicates that ciliogenesis in the ewe uterine tube is stimulated by high levels of endogenous estrogen. Rootlets were observed both during the follicular and the luteal phases of the cycle. The rootlets were about 1 mum long, and their fine structure indicates that they might function as anchoring structures for the motile cilia. The most striking feature during estrus was the occurrence of glycogen granules in the cytoplasm of ciliated and secretory cells. These granules were in the apical cytoplasm and basal region of some epithelial cells. They were minimal or absent during the luteal phase of the estrous cycle. The presence of electron-dense glycogen particles was clearly demonstrated within basal bodies. Possibly the glycogen within the basal bodies functions as a source of energy for ciliary movement and the cytoplasmic glycogen as nourishment for the ovum. The secretory cells also showed characteristic cytologic changes which were correlated with the phase of the estrous cycle. Maximal secretory cell differentiation was apparent during the follicular phase, at which time these cells were characterized by well-developed rough endoplasmic reticulum, numerous ribosomes, and secretory granules of varied size, shape, and density. A most remarkable feature of the granules was their membranous structure, consisting of concentric lamellae of equal dimensions. Typical extrusion of secretory granules into the tubal lumen was apparent during the follicular and the luteal phases of the estrous cycle. Cytoplasmic projections containing nuclei protruded into the tubal lumen and some were free in the lumen, especially during the luteal phase of the estrous cycle. The presence of a well-developed endoplasmic reticulum and numerous secretory granules during estrus indicate that secretion in the ewe uterine tube is presumably under the control of circulating high plasma concentrations of estrogen.     

Fine structural changes of the porcine uterine tube epithelium during early and late pregnancy

Ultrastructural changes in the uterine tube (oviduct) of pregnant gilts have been investigated with special reference to the ciliated, secretory, and stromal cells. Tissue from the uterine tube ampulla and infundibulum was taken from 18 gilts at different stages of gestation (days 31, 36, 101, 102, 107, 110, and 112). Cilia were present throughout pregnancy, and deciliation was not apparent at any stage of gestation. The low epithelium of the uterine tube appeared similar to that of the luteal phase of the estrous cycle when corpora lutea were full grown. Prominent features at end of the gestation were numerous fibrous granules and basal bodies, indicating active formation of ciliary precursor organelles. Fibrogranular aggregates were also present in association with the basal bodies. In addition, numerous polyribosomes, mitochondria, and microtubules were encountered in the cytoplasm of ciliated cells at end of the gestation. The appearance of electron-opaque, fibrous granules during late pregnancy probably could be correlated with increasing endogenous levels of plasma estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia or rootlets. Characteristics ultrastructural changes observed in secretory cells during the estrous cycle were not discernible in secretory cells during pregnancy. The secretory cells appeared similar to those of the luteal phase of the estrous cycle. The apocrine secretory cells contained prominent, apical, cytoplasmic projections; pinching-off process of these protrusions was frequently observed during early and term gestation. Extruded nuclei along with other cytoplasmic organelles were also present, lying free in the tubal lumen. The endoplasmic reticulum was predominantly tubular in form. Synthesis, storage, and release of secretory granules were not apparent at early or late pregnancy. It is suggested that progesterone might have an inhibitory effect on the synthesis, storage, and release of secretory granules. Ultrastructural changes in stromal cells were not apparent at any stage of gestation. The stromal cells appeared similar to that of the luteal phase of the estrous cycle.     

Early administration of intrapleural streptokinase in the treatment of multiloculated pleural effusions and pleural empyemas

In the treatment of multiloculated pleural effusions and empyemas tube thoracostomy often fails and more aggressive surgical therapy is required. Intrapleural administration of fibrinolytics is a valuable alternative. Between October 1994 and December 1995 28 patients (aged 22 to 62 years) with multiloculated pleural effusions were treated with intrapleural instillations of streptokinase after unsuccessful conventional chest tube drainage. Twenty-three pleural effusions were grossly purulent, others were loculated effusions with low pH. The most common cause of the pleural effusions was pneumonia. Duration of illness before hospitalization was 3 to 105 (mean 21.8) days. Treatment with streptokinase was started most commonly one day after chest tube placement. Once a day after clamping the chest tube streptokinase was administered intrapleurally for 10-15 minutes as a solution of 250,000 units in 100 ml normal saline. The tube remained clamped for 3 hours. Two to 8 (mean 3.7) instillations per patient were needed. Twenty-one cases (72.4%) showed excellent resolution of pleural effusion and needed no more therapy. However, one patient died in hospital due to purulent meningitis and bilateral pneumonia. Eight patients needed further surgical treatment, e.g. decortication, in 5 cases together with wedge lung resection. Eleven patients experienced some adverse effects of streptokinase therapy, most frequently chest pain and elevation of body temperature in one case pleural effusion became hemorrhagic, and one patient had nasal bleeding. We conclude that usage of intrapleural streptokinase in the treatment of multiloculated pleural effusions (including pleural empyemas) reduces the need for major surgical interventions in quite a large group of patients.     

Respiratory complications in patients with severe burns

The rising emphasis on conservative surgical treatment of the fallopian tube has generated a greater demand for methods of reparative surgery. Thus far, the use of surrogate tubes and allotransplantation of the fallopian tube hae not fulfilled the requirements for success. A case of homotransplantation of the human fallopian tube is presented. At surgery, a midsegment anastomosis was performed by grafting the good portion of the left tube to a viable segment of the right tube. The arteries and veins were then anastomosed with 9-0 silk and a single-layer closure; an operating microscope was used. Patency was documented with chromotubation, and bleeding was controlled with microcautery. Decadron and Phenergan were placed in the patient's abdomen along with 150 ml of saline. She was given systemic Decadron, Phenergan, and antibiotics pre- and postoperatively. Three months after surgery hysterography revealed a viable-appearing fallopian tube. The patient subsequently aborted an 8-week intrauterine gestation. Fallopian tube homotransplantation has a role in the treatment of infertility, but the patient population for which this procedure is applicable is limited.     

Musical auditory hallucinosis from Listeria rhombencephalitis

We present the unusual case of a 27-year-old Japanese woman who exhibited recurrences of metastatic tumors from uterine leiomyosarcoma after five operations. Chemotherapy with cisplatin, pirarubicin, and cyclophosphamide was ineffective. Substituting ifosfamide for cyclophosphamide, we obtained a complete response. The Gynecologic Oncology Group (GOG) in the United States has recognized the efficacy of ifosfamide and mesna in the treatment of patients with advanced or recurrent uterine sarcomas. Here we report on the efficacy of ifosfamide in addition to cisplatin and pirarubicin.     

Isolated tortion of the fallopian tube. Report on a recurrent tortion of a hematosalpinx due to genital tuberculosis (author's transl)

A case of recurrent contralateral isolated tortion of tubercle hematosalpinx four years after the first event is reported. The clinical picture and the pathogenesis of the isolated tortion of the fallopian tube is discussed. This disease is considered to be rare and the etiology of isolated tortion of the tube is largely unknown. As shown in this case, tortion of the tube can occur in cases of genital tuberculosis. Since acute bleeding into the fallopian tube may be pathognomonic for tortion this factor should be considered when the findings at laparotomy are interpreted. Tortion of a hematosalpinx requires additional diagnostic measures to detect the underlying disease.     

Florid cystic endosalpingiosis with tumor-like manifestations: a report of four cases including the first reported cases of transmural endosalpingiosis of the uterus

Four cases of endosalpingiosis presenting as masses that resembled neoplasms are described in women 20, 41, 43, and 74 years of age. Each case was referred in consultation because of difficulties in pathologic diagnosis. In two patients, multiple cysts that involved the serosal surfaces of the uterus and adnexa in one case, and the colon, rectosigmoid, pelvic sidewalls, and the cul-de-sac in the other, were excised. In the other two cases, hysterectomy was performed for an enlarged cystic cervix in one case and presumed uterine leiomyomas in the other. In both of these cases, the uterine cervix and lower part of the uterine corpus were extensively involved by multiple cysts on gross examination, and in one of them, a frozen section of the cervical lesion was initially interpreted as "suspicious for invasive minimal deviation adenocarcinoma." On microscopic examination, benign endosalpingiotic glands and cysts were found in all four cases, with striking transmural involvement of the uterine cervix and lower uterine segment and contiguous corpus in the two cases with uterine involvement. The latter two cases are the first examples, to our knowledge, of endosalpingiosis involving the wall of the uterus; the differential diagnosis in these cases includes minimal deviation adenocarcinoma and florid tubal metaplasia with cystification. The four cases in this report, and rare previously reported cases, indicate that although usually a microscopic finding, endosalpingiosis can rarely present as a clinically or grossly evident mass that can be confused with a neoplasm.