Ultrasound and the postpartum uterus

Five case reports illustrate the spectrum of ultrasound findings in the postpartum period. When examining patients with symptoms of secondary haemorrhage, the ultrasonographer may find: (i) an empty uterus (no retained tissues): (ii) blood clots which will pass spontaneously; or (iii) retained tissues, which are an indication for evacuation of the uterus. The importance of grey-scale assessment of symptomatic patients is stressed.     

Uterus unicornis with uterus solidaris

Five patients are presented who manifested a heretofore unreported uterine anomaly: uterus unicornis with uterus solidaris. The condition is illustrated and described in detail. Patients with this anomaly have a good fertility potential, although they may expect a high fetal wastage, frequent premature labor and delivery, increased complications of pregnancy and delivery, and an increased incidence of infants that are small for the pregnancy duration. The importance of laparoscopy in diagnosing this anomaly is emphasized.     

Brenner tumor of the uterus

Extraovarian Brenner tumors are extremely rare. Three paratesticular lesions have been observed in men. The only extraovarian Brenner tumor in a woman previously reported was located in the broad ligament. This paper describes a small tumor with histologic features of Brenner tumor within the wall of the uterus. The possible histogenesis is briefly discussed.     

Pure pleomorphic rhabdomyosarcomas of the uterus

Pure rhabdomyosarcoma arising in the uterus is a rare tumor currently classified by the World Health Organization (WHO) as a uterine sarcoma. The records of eight women with uterine rhabdomyosarcomas were retrieved from the files of the Armed Forces Institute of Pathology (AFIP). The eight women presented with vaginal bleeding, abdominal enlargement, or acute abdomen. The mean age of the patients was 64.6 years (range 35-87). Macroscopically, 4 tumors were polypoid endometrial masses, 2 were intramyometrial, 1 was located in the cervix, and 1 was a 15-cm mass involving the endometrium and myometrium with direct extension into the small intestine. Microscopically, the tumors consisted of a variable proportion of large rhabdomyoblasts admixed with smaller round, polygonal, and spindle-shaped cells. No epithelial elements were identified on light microscopy. Tissue from the extrauterine and metastatic lesions was available for review in four cases and also showed pure rhabdomyosarcoma. Immunohistochemical assessment of seven tumors supported the sarcomatous nature of the neoplastic cells. Six patients died of disease within 15 months of initial diagnosis and 1 patient died of a pulmonary embolus. The patient whose 15-cm tumor had extended into the small intestine survived 6 years; she died of a presumed pancreatic carcinoma. Presenting mainly in elderly women, uterine pleomorphic rhabdomyosarcomas are rare, highly malignant tumors with frequent extrauterine spread at presentation. Patients rarely survive beyond 15 months.     

Vaginal hysterectomy for the large uterus

OBJECTIVE: To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size. DESIGN: A prospective observational study. SETTING: The Royal Free Hospital, London. PARTICIPANTS: Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size. INTERVENTIONS: Vaginal hysterectomy with or without bilateral salpingo-oophorectomy or oophorectomy. MAIN OUTCOME MEASURES: Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra- and post-operative complications, duration of hospitalisation. RESULTS: The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n = 6) and superficial vaginal grazes (n = 5). One of the women required a blood transfusion. The mean post-operative hospital stay was 3.7 days (range 2 to 9 days). CONCLUSION: Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.     

Cholinergic receptors in the rat uterus

Natural anti-tumor antibodies (NAA) were revealed, by a complement-dependent cytotoxicity test on el4 lymphoma cells, in the serum of C3Hf but not of C57BL mice. Hybrids between the positive C3Hf and the negative C57Bl mice were NAA producers. Individual variability of NAA level was found in C3Hf and in the hybrids. The study of mice housed in the same or in different cages and of mice belonging to the same or to different litters demonstrated a randomly distributed variability. These observations seem to exclude environmental influences on the natural immune response or genetic mutations in the C3Hf strain with the appearance of variants with different NAA content. The NAA level was age-dependent with a peak around 20-24 weeks of age. Inoculum of lymphoma cells induced an increase in the NAA level both in C3Hf and in the hybrids but not in C57Bl mice which seem therefore incapable of making guinea-pig complement-fixing NAA. The individual variability of NAA level and the stimulating effect of tumor cells support a potential role of NAA in immunosurveillance of oncogenesis.     

Reproductive performance in women with bicornuate uterus

The medical records of 21 patients with bicornuate uterus were analyzed. Thirteen patients did not undergo corrective surgery, whereas eight underwent metroplasty. The pregnancies in patients who did not undergo surgery, and the outcome evaluated. The outcome of pregnancies after corrective surgery was also analyzed. The cumulative pregnancy rates at 12 and 24 months were 67% and 95% in patients without surgical correction and 63% and 88% in patients after surgical correction. The probability of giving birth to a live-born infant with no corrective surgery was 30%, 58% and 79% for the first, second and third pregnancy respectively; the probability of giving birth to a live-born infant after corrective surgery was 71% for the first and 86% for the second pregnancy. Fertility is not impaired in patients with bicornuate uterus, but gestational capacity is. A prognostic estimate of the likelihood of giving birth to a live-born infant can be formulated according to the number of pregnancies and/or surgical correction.     

A subcutaneous uterus with unusual presenting features

A 32 year old female, para 2 + 0 presented with a hard lump in the scar of a lower midline incision. She had had a myomectomy 2 years previously and subsequently noticed the lump 3 months later. Her only complaints were urinary frequency during menstruation and the suprapubic mass. Surgery was performed for what was initially thought to be a desmoid tumour. At surgery the uterus was found to be lying in the subcutaneous position with no peritoneal sac. The uterus was dissected free of the sheath and reduced into the pelvis, uneventfully. This rare occurrence of a subcutaneous non-gravid uterus in the absence of a hernial sac is reported and its clinical features and possible preventative measures are discussed.     

Epidemiology of malignant tumors of the uterus

The authors describe the frequency, incidence, number of deaths and mortality from malignant tumours of the uterine corpus in the Czech Republic in 1961-1988. The mean incidence of 13.06 during the five-year period 1961-1965 rose to a mean incidence of 25.12 during the five-year period 1984-1988, while during this period a paradoxical decline of the mortality from 9.00 to 6.7 occurred. This implies a decline of the lethality during 1961-1965 from 76.56% to 28.98%, i.e. to 37.85% of the original value. The reasons of the decline in lethality may be earlier detection of the disease and possibly a rise in the incidence of less aggressive forms of hormone-dependent carcinomas only, because therapy did not change essentially during the mentioned period.     

Supracervical uterus amputation via the vaginal route

A new method of supracervical amputation of the uterus (with or without extirpation of the adnexae) is presented. The operation is performed using a, the through vaginal route, opening the Douglas cavity through posterior coeliotomy. The advantages of the method, compared with Semm's laparoscopy operation, are discussed.     

Müllerian adenosarcoma of the uterus

Interest in biodiversity has spawned international actions both political and scientific, many of which are relevant to mycologists. The political initiatives include the Convention on Biological Diversity and Biodiversity Action Plans, and the scientific: the Global Biodiversity Assessment, Species 2000, Systematics Agenda 2000 International, BioNet International, Diversitas, All Taxa Biodiversity Inventory, and Biodiversity Methods Manuals. Mycologists need to contribute to such programmes, maintain an enhance profile, and remain flexible to respond to new challenges.     

The water channel gene in human uterus

The cDNA coding the water channel was isolated from a human uterus cDNA library template by a one-step polymerase chain reaction (PCR). The oligonucleotide primers corresponding to the 5' untranslated nucleotide sequence and complementary to the 3' untranslated nucleotide sequence of the cDNA coding the 28 kDa erythrocyte integral membrane protein (CHIP28) were synthesized and used to initiate the reaction. A 1340 bp cDNA coding the human uterine water channel (hUWC) was cloned and sequenced. The hUWC showed 99.8% and 99% identity with the nucleotide and amino-acid sequences of CHIP28, respectively. The deduced hUWC polypeptide is composed of 269 amino acid residues with a single amino acid variant from CHIP28 protein at position 45, where valine replaces alanine. The hUWC cDNA translated in a prokaryotic protein expression system produced a protein with an estimated Mr of 28 kDa, equivalent to the size of the human red cell CHIP28 protein. The present results suggest that the human uterus contains water channels that may play an important role in regulating water transport and imbibition in the uterus.     

Magnetic resonance staging of neoplasms of the uterus

The treatment of patients with uterine neoplasms may be significantly altered by the stage of disease at the time of diagnosis. A noninvasive and accurate means of staging these tumors is therefore desirable. This article discusses the magnetic resonance imaging techniques and findings that are essential for the accurate staging of uterine neoplasms. The imaging findings are presented following a discussion of the histopathologic findings, clinical presentation, diagnosis and staging, pathways of tumor spread, and treatment of each neoplasm. A comparison of magnetic resonance and other imaging techniques is also provided.     

MRI of primitive neuroectodermal tumor of the uterus

PURPOSE: The aim of this study was the assessment of atresia formation after syngeneic fetal small bowel transplantation (SBTx) to clarify its pathogenesis. METHODS: Seventy Lewis rat fetuses (gestational age, 18 to 19 days) were obtained by hysterotomy, and a 30-mm long section of small bowel was excised from each fetus. Each bowel graft was then transplanted into the space between the peritoneum and the rectus abdominis in 70 adult Lewis rats to expose the grafts to ischemic stress. Transplantation was successful in 63 of 70 grafts (90%). Successfully transplanted bowel grafts were harvested for macroscopic and microscopic examination 10 days posttransplantation. RESULTS: Of the successfully transplanted grafts, only two (3%) were atresia free; 127 atretic segments were found in the remaining 61 grafts. Twenty-four grafts (38%) had a single atresia comprised of membranous stenosis (MS) in two, membranous atresia (MA) in 10, and blind ends (BEs) with or without a connecting tissue remnant in 12. Thirty-seven grafts (59%) had multiple atresias, comprised of MS, MA, or both in six, BEs alone in seven, and a combination of BEs with MS or MA in 24. CONCLUSIONS: Our model is the first to succeed in inducing experimentally membranous stenosis and a high incidence (59%) of multiple atresias. These results suggest that bowel ischemia is responsible for multiple bowel atresia formation.