The aquaporins (AQ-s) are a group of intrinsic membrane proteins which facilitate movement of water across cell membranes; their recent identification in the kidney has led to the reappraisal of the mechanisms and pathways of water movement across epithelia. Aquaporin-1, (CHIP-28) is reported distributed in cardiac myocytes and vascular smooth muscle cells of large arteries. A related protein, AQ-4, has been identified in the sarcolemma of skeletal muscle fibres. We report aquaporin expression in the cell membrane of smooth muscle cells of the rat genital tract; fluorescence immunohistochemistry of rat uterine (fallopian) tube and vagina demonstrated AQ-1 in visceral smooth muscle of these tissues. In the uterine tube, AQ-1 labelling is most pronounced in the innermost longitudinal and the inner cells of the circular muscle layer and is absent from the outer longitudinal muscle layer of the myosalpinx. The possibility of a specific role for AQ-1 in tubal transport by altering the tubal luminal diameter during the estrus cycle is suggested.

This study investigated variations in microvascular perfusion of human endometrium across the menstrual cycle, using a laser Doppler technique to assess red blood cell (RBC) flux. Endometrial RBC flux was monitored by laser Doppler fluxmetry via a fibre optic probe inserted transvaginally into the uteri of 19 conscious normal volunteer women, on four occasions at weekly intervals over one menstrual cycle. Regional variation in RBC flux was investigated in 16 surgical patients under general anaesthesia and in five excised uteri. Endometrial perfusion exhibited short-term temporal variations consistent with the cardiac cycle and often also showed vasomotion (5-12 cycles/min). Mean endometrial perfusion differed between phases of the menstrual cycle in conscious women, being highest during early proliferative and early follicular phases. There were no significant regional differences in local mean endometrial perfusion in anaesthetized patients. No evidence of endometrial ischaemia/reperfusion episodes was found in any subject using this technique. This study provides benchmark data of variations in RBC flux per unit volume of tissue in the luminal approximately 1 mm of endometrium, across the normal human menstrual cycle. Flux values were highest at times associated with endometrial growth and preparation for implantation, indicating that RBC flux may be a useful parameter for assessment of endometrial physiology.

Summary, the microvascular architecture of rabbit Fallopian lube isthmic, ampuliary and fimbrial regions was examined by the corrosion vascular caslscanning electron microscope method. The aorla and inferior vena cava of virgin adult female rabbits (25-3-5 kg) were cannulated; after blood wash oul. methacrylate casting medium was infused via the aorta. After plastic hardening. Fallopian lubes were excised, tissues corroded and casts prepared for scanning electron microscopy. The isthmic myosalpinx is encircled subserosally by an interlocking venous plexus. We suggest that a rise in pelvic venous pressure could lead to a decrease in isthmic luminal diameter nnd thus act as a sphincter contributing to the known delay in ovum transport at the ampuliary isthmic junction. Stereo pairs of photomicrographs showed that isthmic plicae are supplied by arterioles which change little in diameter passing through the tubal wall. Near the apex of a fold, these arterioles terminate in a subepithelial capillary plexus which drains to deep mucosal and plical core venules. In contrast, the ampulla is supplied by smaller and less frequent arterioies. Frequent large venules extending high into the plicae drain the subepithelial capillary plexus. Based on this microvascular architecture, we suggest that the subepithelial capillary plexus of the apical region of the plicae probably contains high pressure blood in the isthmus and lower pressure blood in the ampulla. Therefore, plicae in these regions may be specialised for net luminal fluid secretion and absorption respectively, implying a role for the microvasculature in tubal transport by initiation or modification of fluid flow along the lumen.

Objective  To compare outcomes in women undergoing total laparoscopic hysterectomy performed with the assistance of a colpotomizing tube (TLTH), with those in women in whom a laparoscopically assisted hysterectomy (LAH) procedure was performed. Design  A retrospective review of consecutive patients. Setting  State health service patients were treated at Flinders Medical Centre, Adelaide, South Australia, and private patients were treated by the same surgeons in three private hospitals in metropolitan Adelaide. Subjects  A total of 227 women who underwent operation between January 1996 and August 1999. Interventions  The women involved in the first two years of this study exclusively underwent an LAH, whilst those in the latter 18 months underwent a TLTH. Main outcome measures  These included intraoperative complications, including significant haemorrhage, ureteric, bladder, vascular and bowel injury; postoperative complication rates for vault infection, late bowel and ureteric injury, and miscellaneous febrile morbidity. Also documented were the operating time, nonautologous blood transfusion, operation–discharge interval, and readmission with a complication. Results  The women having the TLTH procedure had significantly fewer intraoperative complications (χ2 = 8.07, P = 0.004) in comparison with the LAH group; postoperative complications were not statistically different. The mean operating times and readmission rates with surgical complications were equivalent for the two groups. The hospital stay was shorter by 1.5 days for the women having a TLTH (t = 8.39, P < 0.001), and the estimated blood loss was less than half of that for the LAH patients (t = 8.94, P < 0.001); nonautologous blood transfusion was not needed in either group. Conclusion  Total laparoscopic hysterectomy utilizing the nondisposable colpotomizing tube and uterine manipulator has both fewer intraoperative complications and reduced blood loss when compared with laparovaginal hysterectomy, and is a safe alternative to LAH.

We examined variations in human endometrial microvascular perfusion across one menstrual cycle in women who had undergone tubal ligation and did not report unusual menstruation. Endometrial red blood cell flux was monitored by laser Doppler fluxmetry via a fibreoptic probe atraumatically inserted transvaginally into the uterus of each of 13 conscious volunteers. The observations obtained have been compared with those previously reported from a matched control group of women [B.J. Gannon et al., Hum. Reprod., 12, 132-139 (1997)]. Women who had undergone tubal occlusion for sterilization exhibited greater endometrial perfusion during menstruation (cycle days 0-5), at the time of ovulation (cycle days 13-16) and in the late secretory phase (cycle days 23-28) than occurred in controls. In addition, vasomotion in the study group was lower than that in controls in the early and late secretory phase (cycle days 17-22 and 23-28). Tubal occlusion appeared to alter endometrial perfusion. It is possible that the reported menstrual changes in women following tubal ligation are a consequence of altered endometrial perfusion; a possible causative relationship is discussed.

The documentation of consent is an important component of the clinical encounter. This study assesses the quality of documentation of that consent for a common surgical procedure, caesarean section, in an obstetric unit at a major teaching hospital and compares this quality between elective and emergency cases. There was a significant difference in the quality of documentation between the elective and emergency groups in some, but not all, categories assessed. Overall, the standard of consent documentation in the obstetric unit was less than desired. A proforma was designed to be included in the case notes of women undergoing caesarean section to improve the efficient and thorough documentation of consent.

An unusual case is presented in which a term monoamniotic monochorionic twin pregnancy was complicated by a massive fetal-maternal haemorrhage resulting in the simultaneous death of both twins. Monoamniotic monochorionic twins and massive fetal-maternal haemorrhage are reviewed and discussed.

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