3D-HyCoSy provided advantages of better assessment of uterine cavity over XHSG. Compared with conventional XHSG, the efficacy of 3D-HyCoSy to assess tubal patency was acceptable. In addition, the procedure of 3D-HyCoSy appears to be better tolerated, requiring no sedation or anesthesia and a reduced examination time. Thus, 3D-HyCoSy with saline as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women.
Intracellular hydroperoxide generation in cultured human placental trophoblastic cells (HPTCs) was quantitatively monitored in the presence or absence of an NO synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME, 1 mM), by digital microfluorography with use of carboxydichlorofluorescein, a hydroperoxide-sensitive fluorogenic probe. In the absence of L-NAME, HPTCs displayed a time-dependent gradual elevation of the fluorescence, suggesting the ability to produce oxidants spontaneously. In the presence of L-NAME, however, the fluorescent response in these cells increased further; the oxidative impact elicited by L-NAME treatment for 30 min was equivalent to that induced by application of 230 microM tert-butyl hydroperoxide for 5 min. This oxidative process was completely blocked by rotenone, a reagent that interferes with electron entry into complex I of the mitochondrial respiratory chain. On the other hand, antimycin A, which blocks mitochondria at the distal site of the ubiquinone pool, potentiated the L-NAME-induced oxidative change. These findings suggest that constitutive levels of nitric oxide production contribute to regulation of mitochondrion-derived intracellular oxidant generation in HPTCs.
An 80-year-old woman, 2 G 2 P, with macrohematuria came to this institution for treatment. On pelvic examination, the uterus was palpated slightly large for her age, slight tenderness and resistance were noted at the uterine corpus, and the adnexa and parametrium were soft. The entire abdomen, including the Douglas pouch and pelvic bottom, were also soft. Examination a the speculum revealed swelling of the vulva and vagina and blood oozing from the entire vaginal wall. There was also a small amount of purulent discharge at the cervical canal. Transvaginal ultrasonography (TVUS) showed the uterine corpus to be small and found no adnexal or pelvic mass. However, the entire uterine cavity was hyperechoic, and these signals were passing through the myometrium near the fundus and ended in a cup-shaped configuration. These features were consistently confirmed on later repeated TVUS examinations. On further interview, the patient disclosed that she had had continual diarrhea and fecal discharges from the vagina for close to one month. The cytology of the smears from both the uterine cervix and cavity were negative, but purulent content was found in the endometrial biopsy specimen. Computed tomography and magnetic resonance imaging revealed no pathologic findings, but a colonic mass lesion adjacent to the uterus was observed although the fistula could not be identified. Innumerable diverticula in the colon and the outlines of barium spillage from the colon were demonstrated on barium enema examination. Colonic fiberscopic examination confirmed the intact colonic mucosa. Of the tumor markers, CA 19-9 and SCC values were normal, while CEA level was elevated (9.8 ng/ml). Surgery revealed a fistula that was perforated from the bottom of the sigmoid diverticulum through the uterine myometrium, and into the uterine cavity. The features of fistulas delineated by the continuous high-echoic signals on TVUS were identical with these pathological findings. The microbubbles of bowel gas in fecal discharges were deemed to be the cause of high echogenicity. These TVUS findings were repeatedly confirmed on later evaluations. A diagnosis of a sigmoidouterine fistula on TVUS should, therefore, be considered when there is fecal discharge. TVUS thus provided crucial and reliable findings of uterine fistula and should warrant use in managing colonic-uterine fistula. The postoperative course was uneventful. CEA concentration decreased to 3.4 ng/ml; cut-off value was 5 ng/ml. J Med Ultrasonics 2001 ; 28 (Summer) : 71-75.
Objectives: This study was aimed to assess the use of three-dimensional hysterosalpingocontrast sonography (3D-HyCoSy) as a routine tool for evaluating infertile women in the office. Methods: In 25 non-selected infertile patients, tubal patency and uterine cavity were investigated by 3D-HyCoSy with saline as a contrast medium. The efficacy of the procedure was evaluated with X-ray hysterosalpingography (XHSG) as reference.Results: The positive predictive value, negative predictive value, sensitivity and specificity of predicting tubal patency by 3D-HyCoSy were 100, 33.3, 84.4 and 100%, respectively. The full contour of uterine cavity was depicted in 96% of cases by 3D-HyCoSy and 64% by XHSG (P < 0.005). The uterine cavity area measured on 3D-HyCoSy correlated well with the volume of contrast media required on XHSG (R 2 ¼ 0.8166). Conclusion: 3D-HyCoSy provided advantages of better assessment of uterine cavity over XHSG. Compared with conventional XHSG, the efficacy of 3D-HyCoSy to assess tubal patency was acceptable. In addition, the procedure of 3D-HyCoSy appears to be better tolerated, requiring no sedation or anesthesia and a reduced examination time. Thus, 3D-HyCoSy with saline as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women. S T A G 0 6 : F E T A L T H E R A P Y STAG-02Impact of sonohysterography on the management of women with uterine myomas D. H. Pretorius, E. Becker & A. S. Lev-ToaffPurpose: Assess the importance of sonohysterography findings in women with suspected/known myomas particularly with regard to location within/near the endometrial cavity and its impact on treatment. Methods: Review of 240 sonohysterograms identified 109 women (age 24-76, mean 42.4; 84.4% pre-menopausal, 15.6% post-menopausal) with suspected/known myomas. Images, reports, pathology/ surgery results, and clinical/imaging follow up were reviewed. Myoma location with respect to the cavity was described and feasibility of hysteroscopic resection assessed. Results: Indications for sonohysterography abnormal bleeding (74.3%), infertility (8.3%), other (17.4%). Five groups were defined (1) normal cavity (19/109 patients, 17.4%); (2) normal but displaced cavity (7/109, 6.4%); (3) myoma with endoluminal component (50/ 109, 45.9%); (4) other endoluminal findings, mostly polyps (25/109, 22.9%); (5) myoma plus other (8/109, 7.3%). An intracavitary myoma(s) (ICM), a submucous myoma >50% within the cavity, was found in 45 patients; submucous -20; mural -71; and subserosal -37 (57 patients had myomas in more than one location). SHG indicated that myomas were amenable to hysteroscopic resection (HR) in 45 women; in 39 others SHG revealed that myoma(s) were not amenable to HR. There was a significant difference in the use of hysteroscopic resection between these two groups; HR was performed in 21/45 (46.7%) of the former but only in 2/39 (5.1%) of the latter (P < 0.01). Other treatments were not significantly different between the two groups: hysterectomy in 7/45(1...
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