Partial Hysterectomy Research Articles

Partial Small Bowel Obstruction in a Traveler

A 63-year-old Japanese woman with a remote history of a partial hysterectomy for fibroids was admitted to the general surgery service after 2 days of nausea, nonbloody emesis, and intermittent, crampy, epigastric pain. She denied any fevers, chills, cough, sore throat, dysuria, diarrhea, easy bruising, or rash. Born in Japan, the patient immigrated to the United States in 1973 and has lived in San Diego since that time. Travel history during the past 7 years included urban areas of Egypt, China, India, and Japan. The patient lived with her husband and had 2 cats. She denied any ill contacts. The findings of a physical examination were unrevealing, with the exception of diffuse abdominal tenderness to palpation without peritoneal signs or rebound. The results of laboratory tests performed at admission to the hospital revealed a WBC count of 8100 cells/mm3 with a differential cell count of 90% neutrophils, 6.7% lymphocytes, 2.6% monocytes, and 0% eosinophils; a hematocrit of 41.5%; and a platelet count of 233,000 platelets/mm3. The chemistry panel and liver function test results were normal except for a decreased total protein level of 5.6 g/dL (normal range, 6.1-7.9 g/dL), an elevated lactate dehydrogenase level of 204 IU/L (normal range, 99-192 IU/L), and an elevated amylase level of 494 IU/L (normal range, 36128 IU/L). A series of acute abdominal radiographic images revealed multiple dilated loops of small bowel with air-fluid levels consistent with partial small bowel obstruction. An abdominal and pelvic CT scan revealed the cause of the patient's abdominal complaints (figure 1). What is your diagnosis?

Partial Small Bowel Obstruction in a Traveler: (Answer on pages 256–8)

A 63-year-old Japanese woman with a remote history of a partial hysterectomy for fibroids was admitted to the general surgery service after 2 days of nausea, nonbloody emesis, and intermittent, crampy, epigastric pain. She denied any fevers, chills, cough, sore throat, dysuria, diarrhea, easy bruising, or rash. Born in Japan, the patient immigrated to the United States in 1973 and has lived in San Diego since that time. Travel history during the past 7 years included urban areas of Egypt, China, India, and Japan. The patient lived with her husband and had 2 cats. She denied any ill contacts. The findings of a physical examination were unrevealing, with the exception of diffuse abdominal tenderness to palpation without peritoneal signs or rebound. The results of laboratory tests performed at admission to the hospital revealed a WBC count of 8100 cells/mm3 with a differential cell count of 90% neutrophils, 6.7% lymphocytes, 2.6% monocytes, and 0% eosinophils; a hematocrit of 41.5%; and a platelet count of 233,000 platelets/mm3. The chemistry panel and liver function test results were normal except for a decreased total protein level of 5.6 g/dL (normal range, 6.1-7.9 g/dL), an elevated lactate dehydrogenase level of 204 IU/L (normal range, 99-192 IU/L), and an elevated amylase level of 494 IU/L (normal range, 36128 IU/L). A series of acute abdominal radiographic images revealed multiple dilated loops of small bowel with air-fluid levels consistent with partial small bowel obstruction. An abdominal and pelvic CT scan revealed the cause of the patient's abdominal complaints (figure 1). What is your diagnosis?

Take NOTES (Natural Orifice Transluminal Endoscopic Surgery)

Take NOTES (Natural Orifice Transluminal Endoscopic Surgery)

Peroral transgastric organ resection: a feasibility study in pigs

The feasibility of peroral transgastric peritoneoscopy, liver biopsy, and tubal ligation has been demonstrated in prior animal studies. This approach has the potential to reduce postoperative morbidity. To explore the technical challenges and complications of performing a transgastric organ resection. Two-week animal survival study. Five female Yorkshire pigs underwent peroral transgastric partial hysterectomy. With the animals under general anesthesia, a sterile esophageal overtube was placed and a gastric antibiotic lavage was performed. Subsequently, a needle-knife and through-the-scope dilating balloon were used to make an anterior gastric wall incision through which a therapeutic gastroscope was advanced into the peritoneal cavity. Endoscopes and instruments previously had been disinfected in a 2.4% glutaraldehyde bath or were disposable. An endoloop and polypectomy snare were used to resect a portion of the uterus, which was removed through the mouth. Gastric incision closure was attempted with endoclips. After 2 weeks of observation, necropsy was performed. Transgastric partial hysterectomy was performed on all 5 animals. One animal became lethargic and febrile, so necropsy was performed on day 4. An incompletely closed gastric incision and suppurative peritonitis were found. A second animal developed a fever; necropsy performed on day 14 revealed a gastric abscess at the incision site and scattered abdominal pus. No complications were encountered in the 3 remaining animals, and necropsy revealed well-healed gastric incisions and no evidence of peritonitis. Endoscopic transgastric partial hysterectomy is technically feasible in a porcine model. Strict sterility seems mandatory but cannot always be assured. Incomplete closure of the gastric incision may lead to significant complications.

Transesophageal Echocardiography of Pulmonary Thrombus Causing Complete Left Pulmonary Artery Occlusion

A 36-yr-old female patient was referred to our institution for management of a pulmonary embolism (PE) associated with respiratory failure. Her history was significant for an uncomplicated partial hysterectomy 6 months previously. One month later she presented to an outside hospital with dyspnea and chest pain. Computed tomography of the chest demonstrated a massive PE occluding the left pulmonary artery (LPA). Transthoracic echocardiography (TTE) revealed a moderately enlarged right ventricle (RV) with moderate decrease in contractility and an estimated RV systolic pressure of 58 mm Hg. Left ventricular (LV) function was normal. Her preoperative angiogram at our institution demonstrated complete occlusion of the LPA at its origin. The patient underwent pulmonary thromboendarterectomy with cardiopulmonary bypass (CPB). Intraoperatively, the entire LPA was found to be occluded with organized thrombus that was completely removed. Intraoperative pre-CPB transesophageal echocardiography (TEE) examination revealed signs of combined volume and pressure overload of the RV and moderate to severe RV dysfunction. The right atrium was massively enlarged and the interatrial septum was severely curved towards the left during systole and diastole. The interventricular septum displayed diastolic septal flattening (D-shaped ventricle). The LV function was normal. The modified mid-esophageal ascending aortic short axis (ME asc aortic SAX) view demonstrated a total occlusion of the LPA (Fig. 1) (video loop available at www.anesthesia-analgesia.org). The upper esophageal aortic arch short axis (UE aortic arch SAX) view further defined the contours and echogenic nature of the thrombus (Fig. 2). The post-CPB TEE examination confirmed a patent LPA. The postoperative ventilation/perfusion scan indicated differential perfusion in the left lung of only 3%. On the eleventh postoperative day, repeat TTE revealed a severely enlarged RV with global decrease in contractility with an estimated RV systolic pressure of 55 mm Hg. The LV function was normal. These presented images display thrombus in the LPA, a structure usually difficult to image secondary to interposition of left bronchus between the esophagus (TEE probe) and the LPA (1,2). Standard TEE imaging of the PA includes the UE aortic arch SAX view and the ME asc aortic SAX view, and should be complemented by evaluation for the presence of RV dysfunction and increased PA pressures in patients with suspected PE (1).Figure 1.: Modified mid-esophageal ascending aortic short axis view (probe tip depth: 30–40 cm from incisors) with the probe turned to the left to better visualize the pulmonary artery (PA) shows the pulmonic valve and the main PA (MPA). The left PA (LPA) arises on the right from the MPA. A massive thrombus totally occluding the LPA can be appreciated. Ao, descending thoracic aorta.Figure 2.: Upper-esophageal aortic arch short axis view (probe tip depth: 20–25 cm from incisors) demonstrates the pulmonic valve and the main pulmonary artery (MPA). A large thrombus can be appreciated in the region where the left pulmonary artery arises from the MPA (arrow). AoA, aortic arch.

Endoscopic Transgastric Abdominal Exploration and Organ Resection: Initial Experience in a Porcine Model

The evolution of flexible endoscopes and endoscopic devices has recently enabled per-oral transgastric abdominal exploration in animal models. This study was undertaken to assess the ability to systematically identify abdominopelvic organs and to determine the feasibility of organ resection via the transgastric route. Female Yorkshire pigs were used for the study. Under general anesthesia, a gastroscope was used to place a sterile overtube into the esophagus. After antibacterial lavage, the gastric wall was incised, and a sterile dual-channel endoscope was advanced into the peritoneal cavity. Endoscopic abdominal exploration was then methodically performed in 9 animals with oophorectomy and partial hysterectomy in 6 animals. The gastric incision was closed with endoclips. Of the animals that underwent organ resection, 3 were sacrificed immediately after surgery, and the subsequent 3 survived. The peritoneal cavity was accessed uneventfully, and the stomach, liver, small bowel, colon, urinary bladder, uterus, fallopian tubes, and ovaries were able to be evaluated in all cases. The gallbladder could be visualized in only 5 of the 9 animals, and retroperitoneal structures could not be consistently identified. Oophorectomy with partial hysterectomy was performed in 6 animals. The 3 animals in the survival group did well for 24 hours without sequelae. This study shows the ability of endoscopic transgastric peritoneal exploration to successfully identify most abdominopelvic organs and demonstrates the technical feasibility of transgastric organ resection.

Clinical and Pathological Outcomes After Endoscopic Transgastric Partial Hysterectomy in a Porcine Model

Introduction: Traditionally per-oral endoscopy has been limited to the intestinal lumen. A transgastric approach may allow less invasive means of performing select surgical procedures. This approach could reduce post-operative abdominal wall pain, wound infection, herniation, and adhesions. Methods: Female Yorkshire pigs were kept NPO for 24 hours. Enrofloxacin and Fentanyl were given at surgery. All instruments were sterilized with glutaraldehyde. Animals were intubated, given Isoflourane, and ventilated as needed. A diagnostic gastroscope was used to place the sterile esophageal overtube. The stomach was lavaged with normal saline and Cefazolin solution was instilled into the stomach for 10 minutes. A needle-knife was used to make a sub-centimeter incision through the anterior gastric wall, and a therapeutic gastroscope was pushed through the incision into the peritoneal cavity. An endoscopic grasping forcep was used to pull the uterus into an Olympus Endoloop which was then secured. The uterine horn and portions of the uterine body, broad ligament, and mesosalpinx were resected with a polypectomy snare. The site was inspected for bleeding and damage to adjacent organs. Using the snare, the resected uterus was removed through the mouth via the gastric incision. The gastric incision was closed with Olympus Hemoclip. Post-operative medications included fentanyl, ranitidine, and enterofloxacin. The animals were, given ad libitum food, and monitored twice daily. After two weeks necropsy was performed. Results: Transgastric partial hysterectomy was successfully performed in five pigs without significant bleeding or organ damage. One animal became lethargic and febrile; and a necropsy was performed on post-operative day four. Necropsy revealed an opened gastric incision, and suppurative peritonitis. No complications were encountered in the other four animals during the two-week survival period. These four animals ate and ambulated within one day of surgery. The four animals exhibited no signs of distress, and gained weight during the survival period. Necropsy revealed well-healed gastric incisions in the four animals; no adhesions, hematomas, abscesses, or lacerations, were seen. Conclusion: We demonstrate that endoscopic transgastric partial hysterectomy is technically feasible and short-term survival without clinical or pathologic complications can be achieved. Secure closure of the stomach incision is essential. Introduction: Traditionally per-oral endoscopy has been limited to the intestinal lumen. A transgastric approach may allow less invasive means of performing select surgical procedures. This approach could reduce post-operative abdominal wall pain, wound infection, herniation, and adhesions. Methods: Female Yorkshire pigs were kept NPO for 24 hours. Enrofloxacin and Fentanyl were given at surgery. All instruments were sterilized with glutaraldehyde. Animals were intubated, given Isoflourane, and ventilated as needed. A diagnostic gastroscope was used to place the sterile esophageal overtube. The stomach was lavaged with normal saline and Cefazolin solution was instilled into the stomach for 10 minutes. A needle-knife was used to make a sub-centimeter incision through the anterior gastric wall, and a therapeutic gastroscope was pushed through the incision into the peritoneal cavity. An endoscopic grasping forcep was used to pull the uterus into an Olympus Endoloop which was then secured. The uterine horn and portions of the uterine body, broad ligament, and mesosalpinx were resected with a polypectomy snare. The site was inspected for bleeding and damage to adjacent organs. Using the snare, the resected uterus was removed through the mouth via the gastric incision. The gastric incision was closed with Olympus Hemoclip. Post-operative medications included fentanyl, ranitidine, and enterofloxacin. The animals were, given ad libitum food, and monitored twice daily. After two weeks necropsy was performed. Results: Transgastric partial hysterectomy was successfully performed in five pigs without significant bleeding or organ damage. One animal became lethargic and febrile; and a necropsy was performed on post-operative day four. Necropsy revealed an opened gastric incision, and suppurative peritonitis. No complications were encountered in the other four animals during the two-week survival period. These four animals ate and ambulated within one day of surgery. The four animals exhibited no signs of distress, and gained weight during the survival period. Necropsy revealed well-healed gastric incisions in the four animals; no adhesions, hematomas, abscesses, or lacerations, were seen. Conclusion: We demonstrate that endoscopic transgastric partial hysterectomy is technically feasible and short-term survival without clinical or pathologic complications can be achieved. Secure closure of the stomach incision is essential.

ENDOSCOPIC PARTIAL HYSTERECTOMY IN A PORCINE MODEL USING A NOVEL PER-ORAL TRANSGASTRIC APPROACH

Purpose: Traditionally per-oral endoscopy has been limited to the intestinal lumen. Previous studies have reported transgastric endoscopy howeverthere are no published reports of organ resection using this method. By avoiding abdominal incisions this approach may reduce post-operative abdominal wall pain, wound infection, herniation, and adhesions. We sought to demonstrate the feasibility of performing a per-oral transgastric partial hysterectomy. Methods: Four-month old female domestic pigs had food withheld for 24 hours and were given antibiotics prior to surgery. After induction of anesthesia, the esophagus was intubated, a sterile overtube placed, and an antibacterial gastric lavage performed. Both written and video logs were kept. A sterile therapeutic endoscope was passed through the overtube into the stomach. Before incising the gastric wall an endoscopic ultrasound was performed to avoid blood vessels and intra-abdominal organs. Using a needle-knife, a 1cm incision was made in the gastric wall and the opening was dilated to 15 mm using a Microvasive CRE balloon. The gastroduodenoscope was pushed through the gastric wall and into the peritoneal cavity. The fallopian tubes, uterus, and ovaries were identified. Forceps were used to pull the uterus and portions of the fallopian tubes through an Olympus Endo-Loop. The loop was then tightly closed and secured. Subsequently, a snare was positioned just distal to the Endo-Loop and cautery was used to resect the uterus and portions of the fallopian tubes. The specimen was removed through the mouth via the gastric incision and was sent for pathology. The gastric incision was closed using endoscopically placed clips. Results: Gastric incisions were performed without significant bleeding. The small intestine, fallopian tubes, uterus, and ovaries were readily identified and could be repositioned with standard endoscopic equipment. We were able to perform the partial hysterectomy without visible bleeding. The animals remained stable throughout the procedure and no immediate postoperative complications were encountered. Necropsy confirmed partial hysterectomy with bilateral partial tubectomy. There was no evidence of intra-abdominal or gastric bleeding, hematoma, infection, or organ damage. Conclusions: This study demonstrates the feasibility of per-oral transgastric organ resection, specifically partial hysterectomy. Although in early development this approach may represent a less invasive alternative to traditional surgery.

Long-Term Gynecological Outcome of Patients with Persistent Cloaca

Persistent cloaca is a complex malformation that remains a difficult reconstructive challenge, and data on long-term outcome are scarce. Gynecological abnormalities are common with cloaca but may remain asymptomatic until puberty or adult life. We evaluate long-term gynecological sequelae in these patients with persistent cloaca. The records and radiographs of postpubertal patients (mean age 16.8 years, range 10 to 32) treated for cloacal malformation at 1 institution from 1970 to 2001 were retrospectively reviewed. Outcome data at puberty were available in 41 patients. Of the patients 24 are currently older than 16 years and outcome data for sexual activity were available in 21 with 3 lost to followup. All 41 patients were evaluated at puberty, and 28 (68%) had uterine function, 13 (32%) were menstruating normally and 15 (36%) presented with hematometra/hematocolpos. All 15 girls with an obstructed uterus required surgery, which included hysterectomy in 2, partial hysterectomy with vaginoplasty in 3 and vaginoplasty in 9. There was 1 complex case of fistula. Etiology of the obstructed uterus was vaginal stenosis after reconstruction in 3 cases, stenosis of persistent urogenital sinus (no previous reconstruction) in 11 and cervical stenosis in 1. Ten patients experienced primary amenorrhoea, which was confirmed in 8 (20%) while 2 (5%) continue to be followed for possible cryptic obstruction. In 10 girls the diagnosis of absent/vestigial uterus was made at early laparotomy but this was erroneous in 6 in whom uterine function developed at puberty. Of the 21 older girls (age at review 17 to 32 years, mean 24) 12 are or have been sexually active and 6 have been examined by a gynecologist and have an adequate vagina but are not sexually active. To date 4 patients have required revision vaginal surgery in adulthood to facilitate intercourse (re-do vaginoplasty in 3, introitoplasty in 1). One woman has postponed vaginal reconstructive procedures and 2 others are currently being followed. There have been no pregnancies in this series to date. Patients born with persistent cloaca have a high incidence of gynecological problems at the onset of menses and in early adult life. Therefore, it is necessary to reassess these girls at early puberty by ultrasound/magnetic resonance imaging and vaginoscopy. Additional surgery may then be necessary to create a vagina for menstruation and sexual intercourse.

At Law: Horton Hatches the Egg

A case recently before the courts in Arizona reminds us that, since the time of Abraham and Sarah, one woman agreeing to bear a child for another has engendered problems.[1] For about the last twenty-five years, infertile couples have been able, with the aid of a so-called surrogate mother, to have a child genetically related to the husband, even when die wife is unable to produce ova or carry to term. The practice became news with Baby M, when the New Jersey Supreme Court held surrogacy contracts to be void as against public policy, refused to enforce the contract under which William and Elizabeth Stern claimed the right to be the parents of the girl borne by Mary Beth Whitehead after artificial insemination by Mr. Stern, and awarded visitation privileges to Mrs. Whitehead.[2] Since that decision, lawmakers have struggled with how to regulate the practice. In six states, statutes (some with criminal or civil penalties) declare all surrogacy contracts void, while another nine states prohibit only contracts involving payment and brokers' fees. Four of the latter--along with Arkansas and Tennessee, which have no prohibitions--provide some form of regulation of the terms and procedures to be followed for a valid contract. In most of the remaining states, courts have had to resolve surrogacy disputes by applying constitutional and common law principles and state adoption and parentage acts. To give both partners a genetic link to the potential child, fertility centers over the past decade have increasingly turned to so-called gestational surrogacy, in which artificial insemination is replaced by transfer of an embryo produced through in vitro fertilization using ova recovered from the wife and sperm from the husband. Gestational surrogacy complicates the legal picture because it adds a third dimension to the meaning of motherhood. Like adoption, surrogacy separates the role of rearing mother from what the law has called the natural mother, but gestational surrogacy breaks the latter down into the roles of genetic mother and birth mother, leaving two women with biological connections to the child. The Arizona Case Arizona, one of the six states that prohibits all surrogacy contracts, explicitly includes contracts "in which a woman agrees to implantation of an embryo not related to that woman" as well as contracts in which she "agrees to conceive a child through natural or artificial insemination and to voluntarily relinquish her parental rights to that child."[3] Although the statute prohibits the formation of such a contract, the state apparently realized that the practice would continue, for the statute also declares that the surrogate is the legal mother of a child born pursuant to such a contract and is entitled to custody. If the surrogate is married, her husband is presumed to be the father of the child, but that presumption may be rebutted by proof that another man--the husband in the infertile couple--is the father. In 1992, Ronald and Pamela Soos entered into a surrogacy contract with Debra Ballas because Ms. Soos, who had voluntarily relinquished custody of her children from a previous marriage, was unable to conceive due to a partial hysterectomy. Gametes obtained from the Sooses and fertilized in vitro were implanted in Ms. Ballas, who gave birth to triplets in September 1993. Prior to their birth, however, Pamela Soos, who had left her husband to live with another man, filed for divorce and requested that she and Ronald share custody of the children. He responded that under the Arizona statute, Ms. Ballas would be the legal mother of the children and Ms. Soos lacked standing to request custody. After the triplets' birth, the Maricopa County Superior Court issued an order naming Mr. Soos the natural father, and he took custody. Ms. Soos then filed a paternity action, arguing that Section 25-218(b) of the statute, which declares surrogates the natural mothers of children born under such contracts, is unconstitutional. …

Supravaginal hysterectomy—a less invasive procedure

SummaryA partial hysterectomy technique is described which aims to reduce tissue trauma and speed recovery. The first 50 women who underwent this supravaginal hysterectomy were compared with 50 who had a routine total abdominal hysterectomy. The groups were not allocated at random. The supravaginal hysterectomy involved shorter operating time (45 minutes versus 57 minutes mean), and a shorter stay in hospital. Although no differences in urinary symptoms were noted, sexual satisfaction following the supravaginal procedure was found to be more than after the total abdominal hysterectomy.

Successful pregnancy after partial hysterectomy in two mares

Successful pregnancy after partial hysterectomy in two mares

Incidence, causes and surgical methods for hysterectomy in Finland, 1987-1989.

The objective of our study was to investigate the incidence of hysterectomy by age, indication and surgical method employed during 1987-1989 in Finland, corrected by 'uteri or cervix at risk' population. Three years (1987-1989) of patient discharges from the Finnish Hospital Discharge Register, which covers all Finnish hospitals including the few private ones, was used. Patients represented all Finnish adult women (approximately 2,000,000). Approximately 9000 hysterectomies are performed annually in Finland. The annual incidence of hysterectomy was 348/100,000 women (most among women aged 45-49), and after correction for 'uteri or cervix at risk' this rose by 11% to 390/100,000. The most frequent indications were leiomyoma (50%) and endometriosis (11%). Prolapse, menstrual disorders and cancer each accounted for 7-8% of all hysterectomies. The most common surgical approach was total abdominal hysterectomy (36%), while hysterectomy with bilateral oophorectomy and partial hysterectomy each accounted for 20% of operations. Differences in the rates by indication or surgical approach between 'uteri or cervix at risk' corrected and uncorrected estimates varied between 0% and 22%. The incidence of, and indications for hysterectomy in Finland are approximately the same as in other European countries, but partial hysterectomy is more common in Finland. Because the correction for the 'uteri or cervix at risk' population produced changes in the rates of hysterectomy, correction should be considered when calculating hysterectomy rates or incidences of cervical or endometrial cancer.

Retrospective analysis of 711 patients operated on for pelvic relaxation in 1983–1989

OBJECTIVE: To analyze which factors, including gynecological surgery in particular, contribute to the occurrence of pelvic relaxation. METHOD: A retrospective analysis of 711 consecutive patients treated surgically for pelvic relaxation from 1983 to 1989 at the Department of Obstetrics and Gynecology of Turku University Central Hospital was undertaken. RESULT: The patients who underwent surgery for recurrent pelvic relaxation were significantly older (66.8 vs. 62.1 years) and suffered significantly less (20% vs. 41%) from urinary stress incontinence than patients undergoing primary surgery for pelvic relaxation. Anterior vaginal segment relaxation (i.e. cysto- and urethrocele) was common inpatients undergoing the initial operation (n = 684), and posterior vaginal segment relaxation (i.e. rectocele and perineal laceration) in recurrent operations (n = 58). Of the patients studied, 87 had pelvic relaxation, which had developed after partial (n = 46), total abdomial (n = 16) or vaginal (n = 25) hysterectomy. CONCLUSION: Care must be taken in the treatment of the posterior vaginal segment during the initial operation for pelvic relaxation in order to avoid late sequelae. Moreover, when the removal of the uterus is planned, the matter of a stable vaginal vault must be taken into account especially when partial hysterectomy should be performed.

Placental-ovarian relationship in the control of testosterone secretion in the rat.

Both ovaries and placentae of rats produce androgen in the second half of pregnancy. The objectives of this investigation were to determine whether the pituitary controls both ovarian and placental secretion of testosterone, to find out whether ovarian secretion of testosterone is maintained by the placenta, and to examine whether levels of testosterone produced by the ovaries and placentae depend upon the number of placentae present. Pregnant rats were hypophysectomized with or without hysterectomy in one experiment, and hypophysectomized with or without partial hysterectomy leaving one placenta in situ in another experiment. Testosterone output by the placenta(e) or the ovary was quantified. The results suggest that placental secretion of testosterone is independent of the pituitary between days 12 and 18 of pregnancy, reduction in placental number causes the remaining placenta to compensate by increasing its testosterone output, and ovarian secretion of testosterone may be under placental control between days 12 and 18 of pregnancy.

Local effect of intrauterine injection of iodine solution on the life-span of the corpus luteum of the cow.

In the cow, persistence of the cl follows complete or partial hysterectomy (Wiltbank & Casida, 1956; Anderson, Neal & Melampy, 1962), whereas the oestrous cycle is shortened by endometrial inflammation (Kendrick & McEntee, 1967; Nakahara, Domeki, Inui & Yamauchi, 1967) or by uterine distension with an IUD (Yamauchi & Nakahara, 1958; Hansel & Wagner, 1960) or a gel-like substance (Yamauchi, Nakahara, Kaneda & Inui, 1967). Experiments involving unilateral hysterectomy of the cow have shown that the cl in the ovary adjacent to the remaining uterine horn regressed earlier than that in the opposite ovary (Ginther, Woody, Mahajan, Janakiraman & Casida, 1967). Similar local uterine effects on the cl have been observed following uterine distension (Ginther, Woody, Janakiraman & Casida, 1966). The present study was undertaken to investigate the local inhibitory effects of endometrial inflammation induced by iodine solution on luteal function in the cow. The experiments were conducted to determine: ( 1 ) the relation between the dose of iodine solution and the area of endometrial inflammation, (2) the minimum effective dose of iodine solution for modifying the luteal function, and (3) the unilateral effect of endometrial inflammation on the life-span ofthe

Teratogenesis and inhibition of DNA synthesis induced in rat embryos by cytosine arabinoside.

AbstractPregnant Wistar rats were injected at day 12 of gestation with 25, 50, 100, or 200 mg/kg cytosine arabinoside. One to 27 hours later 3H‐thymidine was also injected followed 2 hours later by surgical removal of one uterine horn. The remaining horn was left in situ until day 20 for evaluation of embryotoxicity (malformation, death, or growth retardation). Half of the embryos in the removed horn were prepared individually for whole‐embryo scintillation counts and the other half were homogenized and treated with perchloric acid, of which the acid‐insoluble fraction was quantitated for 3H‐thymidine incorporation by scintillation counting. Other pregnant rats were treated with cytosine arabinoside and allowed to continue to day 20 without further treatment.Twenty‐day fetuses from females given cytosine arabinoside at day 12 showed dose related malformation and growth retardation but not death following 50 to 200 mg/kg. These effects were more severe when treatment was followed by thymidine injection and partial hysterectomy. The latter procedures revealed striking and dose related suppression of DNA synthesis evidenced by 3H‐thymidine incorporation 1 to 27 hours after cytosine‐arabinoside injection. Embryotoxic effects in 20‐day fetuses were more closely related to the cumulative suppression of DNA synthesis caused by a given dosage than with either the level at any one posttreatment interval or the duration of the suppression. Although all dosages caused reduction in the rate of DNA synthesis to less than 25% of control rate 1 hour following treatment, after the smaller dosages recovery to control rate occurred by 15 hours whereas after 200 mg/kg recovery was not complete even after 27 hours. Surprisingly, 12‐day rat embryos exhibited suppression of DNA synthesis of between 25 and 75% of control rate for up to 9 hours with little effect being apparent in 20‐day fetuses.

Life-span of corpora lutea in ewes with one congenitally absent uterine horn.

It has been postulated that the uterus in the sheep is either directly or indirectly responsible for the regulation of the life-span of the corpus luteum (cl) (see recent reviews by Ginther, 1967; Melampy & Anderson, 1968; Caldwell, Rowson, Moor & Hay, 1969). A local relationship between each uterine horn and the adjacent ovary has been suggested, since the lack of one of the uterine horns, achieved by partial (unilateral) hysterectomy, appears to prolong the life-span of cl in the ipsilateral ovary, but has no such effect on cl in the ovary adjacent to the remaining horn (Inskeep & Butcher, 1966; Moor & Rowson, 1966). An alternative explanation, suggested by Moor & Rowson (1966) and emphasized by Nalbandov & Cook (1968), is that it is the effect of the surgery itself rather

Cervical pregnancy as a possible sequela of induced abortion. Report of 19 cases

Clinical details of 19 cases of cervical pregnancy are presented. None of the women were nulligravida and all had had at least 1 legal abortion. The interval between the last pregnancy and the cervical pregnancy ranged from 2 months to 8 years. 17 of the women were treated with total hysterectomy and 2 with partial hysterectomy. In all cases the vaginal hemorrhage was uncontrollable.

The effect of reducing the number of embryos during early stages of gestation on the maintenance of pregnancy in the pig.

The number of embryos has been experimentally reduced during early stages of gestation in the pig by means of partial hysterectomy (du Mesnil du Buisson & Rombauts, 1963). Pregnancy is maintained in animals in which only one embryo remains so long as all the uterus is removed except that portion occupied by the embryo. By contrast, if the embryos are confined to one of the uterine horns, the unilateral pregnancy so established is not maintained unless the non-pregnant horn is removed before the 14th day of the oestrous cycle (du Mesnil du Buisson, 1961). The absence of embryos in one horn leads to regression of corpora lutea and thus complete failure of pregnancy at an early stage. These observations suggest that the presence of embryos in a large part of both uterine horns is necessary to establish and maintain pregnancy. The normal number of ovulations in the pig is between twelve and eighteen. Fertilization rate is generally high (Hancock, 1957) and although some embryonic loss may occur during the first few weeks of gestation, there is usually a large number of embryos distributed within the uterus by the 14th day of the cycle. Ovulation rate from the two ovaries may be uneven, but embryonic migration within the uterus occurs (Corner, 1921; Dziuk, Polge & Rowson, 1964) and establishes an even number of blastocysts in both uterine horns. Thus by the 13th to 18th day of pregnancy, blastocysts have elongated and occupy almost the entire length of the uterus (Perry & Rowlands, 1962). It would be of interest to know how many embryos are necessary in order to establish and maintain pregnancy in normal intact animals. During the course of experiments in which eggs were being collected from pigs soon after mating in order to examine early stages of embryonic develop¬ ment, there was a number of animals in which complete recovery of the eggs was not achieved. Thus a variable number of fertilized or unfertilized eggs was left behind in the Fallopian tubes. The effect on subsequent establishment of pregnancy or return to oestrus was recorded. The experimental animals were twenty-nine cross-bred Large White gilts.