Tubal Structure Research Articles

Suture Hemostasis - Conservative Management of Ectopic Pregnancy

<h3>Study Objective</h3> The conservation of fertility in spite of recurrent ectopic pregnancy in women who want to continue to have children. This procedure will allow for the regeneration of the tubal structure which will make future pregnancies possible and affordable when compared to other methods such as in vitro fertilization. <h3>Design</h3> Case Study, early first trimester diagnosis of ectopic pregnancy which includes ultrasound and serial serum B-hCG levels will lead to medical or surgical management of the ectopic pregnancy. <h3>Setting</h3> Hospital, operating room. <h3>Patients or Participants</h3> Case Study 28-yo Gravida 4 Para 2 with a previous salpingectomy for and ectopic gestation presents with a recurrent ectopic in her remaining fallopian tube and had failed medical management with methotrexate. She was offered conservative surgical management with suture hemostasis. <h3>Interventions</h3> At laparotomy (in this case) or laparoscopy the ectopic site was identified in the fallopian tube. Overlapping vicryl rapide sutures were placed proximal to the ectopic site and distal to it. An anterolateral incision was made in the ectopic site with removal of the products of conception. The site remained blood less, hemostasis of the surgical site was noted, peritoneal lavage performed and the abdomen closed in layers. <h3>Measurements and Main Results</h3> 1. Hemostatic suture placement. 2. Removal of the products of conception and confirmation of same on histopathology. 3. Hemostasis of the surgical site. 4. Confirmation of a tubal patency by a successful intrauterine pregnancy. <h3>Conclusion</h3> Suture hemostasis must be an option in ectopic pregnancy whether primary or recurrent since the method is cost effective and tubal patency can be confirmed in the post operative recovery phase. It allows for an additional conservative surgical option when hemostasis may be difficult using linear salpingostomy for larger ectopics leading to an unfortunate salpingectomy. A more extensive case series is recommended to further advance the technique and to note its potential benefits and drawbacks.

A two-stage approach to the optimization design of multi-cell square tubal structures

Multi-cell tubal structures have widely been used in the automobile industry due to proven superior crashworthiness performance than single-cell and foam-filled tubes. This superior performance is attributed to the number of corners within the cross-sectional profile of the tube. In this paper, a two-stage optimization design of a multi-cell tubal structure is presented to address an important design problem by combining a discrete and continuous optimization process into a sequential optimization that generates an overall optimum. The first stage entails a configurational optimization which is realized by formulating a discrete topological optimization problem where the webs within the tube configuration are taken as the topological design variables. Each topological configuration is represented using a binary scheme that shows the presence or not of an edge to create different combinations of the corners. The constraints in the first stage are connectivity, mass ratio, and peak crushing force (PCF). The binary genetic algorithm (BGA) is utilized in searching for the optimal configuration in the first stage. The second stage entails parameter optimization where the cell sizes are the design variables. The objective functions in the second stage are defined using meta-models. Multi-objective particle swarm optimization (MOPSO) is employed for Pareto searching and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is used to find the optimal point for each of the mass ratios considered. Compared with the baseline configuration, the optimized tubal structures demonstrated superior crashworthiness performance. The two-stage discrete and continuous optimization approach has demonstrated that it not only provides a systematic approach to searching optimal structure but also creates a series of novel multi-cell topological configurations with enhanced crashworthiness.

Laparoscopic Evaluation of Primary and Secondary Subfertility

Background: Prevalence of subfertility in industrialized countries has been quoted as 20%,and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure andtubal patency was hysterosalphingography but it is now been largely superseded bylaparoscopy and hysteroscopy. With the objective of this study was to highlight the role oflaparoscopy in establishing the diagnosis of primary and secondary female subfertility anddifferent therapeutic procedure done.&#x0D; Method: This cross sectional study was conducted in the Subfertility and ReproductiveMedicine Unit of Gynae and Obstetrics department of Dhaka Medical College Hospital, Dhakafrom January 2015 to June 2018. Total 4256 sub fertile patients attended the Infertility OPD.Out of these 215 patients were selected for laparoscopy. Those patients who hadcontraindication for laparoscopy were excluded from study. Detailed laparoscopic findingswere recorded.&#x0D; Results: Out of 125 selected sub fertile patients 136 (63.26%) patients were in primarysubfertility group while 79 (36.74%) patients were in secondary subfertility group. In primarysubfertility group(n=136), most common laparoscopic finding was PCO in 44 (32.34%) patientsfollowed by peritubal and periovarian adhesions in 24 (17.65%) patients, Bilateral tubalblock in 23(16.91%) patients, Endometriosis in 15(11.03%), Unusual tortuous and lengthytube in 15(11.03%) patients, fibroid in 11(8.09%) patients, Mullerian agenesis and hypoplasiain 3(2.21%) cases. No visible abnormality found in 22(16.18%) cases.The commonest finding by laparoscopy in patients with secondary infertility were PCO in 18(22.78%) patients and peritubal and periovarian adhesions in 18 (22.78%) patients, followedby Bilateral tubal block in 12(15.19%) patients, fibroid uterus in 12(15.19%) patients,Endometriosis in 10(12.66%), Genital tuberculosis in 3(1.40%) cases. No visible abnormalityfound in 12(15.19%) cases.Various laparoscopic procedure like Ovarian drilling. Adhesiolysis, ovarian cystectomy, cystpuncture, salphingostomy, Myomectomy.&#x0D; Conclusion: Laparoscopy helped us to detect and treat important clinical condition in bathprimary &amp; secondary sub fertility.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 143-148

A novel multi-cell square tubal structure based on Voronoi tessellation for enhanced crashworthiness

Abstract In this paper, a novel multi-cell tubal structure with randomized cell sizes is proposed to enhance the energy absorption of the conventional square tubes by utilizing the random nature of Voronoi tessellations. Experiments were conducted to develop and validate finite element models. The crashworthiness of these tubes was demonstrated by applying axial and bending loads using the finite element method. The proposed multi-cell tubal structures exhibit a progressive and stable deformation with the formation of folds in the axial loading case and a local and global deformation for the lateral bending case. The peak crushing force (PCF) and specific energy absorption (SEA) of the proposed multi-cell tubal structures were found to be better than the regular multi-cell square tubes with equal cell sizes when subjected to axial loads. When subjected to lateral bending load, the proposed multi-cell tubal structures have a better PCF while the regular multi-cell square tubes have a better SEA. An optimization problem was formulated to enhance the crashworthiness of the structures. The objective functions were derived using meta-models to speed off the search for optimal structures. The axial crushing and lateral bending cases were optimized separately and combined. Multi-objective particle swarm optimization (MOPSO) was employed to solve the optimization problems. The optimal tubal structures have a crushing efficiency of 87.1% and 85.6% for axial and bending loads, respectively.

Fast Randomized Algorithms for t-Product Based Tensor Operations and Decompositions with Applications to Imaging Data

Tensors of order three or higher have found applications in diverse fields, including image and signal processing, data mining, biomedical engineering, and link analysis, to name a few. In many applications that involve, for example, time series or other ordered data, the corresponding tensor has a distinguishing orientation that exhibits a low tubal structure. This has motivated the introduction of the tubal rank and the corresponding tubal singular value decomposition in the literature. In this work, we develop randomized algorithms for many common tensor operations, including tensor low-rank approximation and decomposition, together with tensor multiplication. The proposed tubal focused algorithms employ a small number of lateral and/or horizontal slices of the underlying third order tensor that come with relative error guarantees for the quality of the obtained solutions. The performance of the proposed algorithms is illustrated on diverse imaging applications, including mass spectrometry data and image and video recovery from incomplete and noisy data. The results show both good computational speed-up vis-a-vis conventional completion algorithms and good accuracy.

A novel multi-cell tubal structure with circular corners for crashworthiness

Multi-cell structures have proven to own excellent energy absorbing capability and lightweight effect in the automotive and aerospace industries. The cross-sectional configuration of the multi-cell structure has a significant effect on crashworthiness. Unlike existing multi-cell tubes, a new type of five-cell profile with four circular elements at the corners (C5C) was proposed in this study. To investigate the crashworthiness of the new C5C tube, finite element (FE) models were first established by using the nonlinear finite element code LS-DYNA and validated with experimental results. Following that, the comparison of the C5C tube and other multi-cell tubes with the same mass was conducted to quantify the relative merits of the C5C tube. Then, a detailed study was performed to analyze the effect of the corner-cell size and wall thickness. Finally, the optimization design was carried out to seek the optimal structure. The results showed that the new multi-cell structure can absorb much more crash energy than other four types of tubes. Moreover, the energy absorption of this new multi-cell tube C5C was affected by the corner-cell size and wall thickness significantly. A proper corner-cell size and slightly thicker internal ribs were recommended. In addition, the multi-objective particle swarm optimization (MOPSO) algorithm and radial basis function (RBF) surrogate model can optimize the structure effectively. The outcomes of the present study will facilitate the design of multi-cell structures with better crashworthiness.

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values.

ObjectiveTo assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy.Materials and MethodsPatients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis.ResultsThe mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10−3 mm2/s vs. 2.42 ± 0.38 × 10−3 mm2/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10−3mm2/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10−3 mm2/s vs.1.18 ± 0.36 × 10−3 mm2/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively.ConclusionsDW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.

管腔構造を有するイカ中骨による咽後膿瘍例

The presence of a fish bone in the aerodigestive tract is a common phenomenon in the ENT Department. It is removed easily by an endoscopic procedure, but sometimes can cause complications such as deep neck infection. Herein, we report the case of a fish bone with a tubal structure stuck in the pyriform sinus. A 71-year-old woman presented with complaints of progressive odynophagia and dysphagia following dinner 1 day earlier. An axial computed tomographic scan of the neck showed a 3-cm-long and linear hyperdense projection pointing to the pyriform sinus and submucosal emphysema. Rigid laryngoscopy with the patient under general anesthesia, which was performed on the day of presentation, showed a fish bone with a tubal structure in the pyriform sinus but no pus-like material. It was removed, but a retropharyngeal abscess was soon formed. The patient recovered fully soon after subsequent surgical drainage through the cervical incision.

Anatomic distortion of clinically normal appearing fallopian tube: to what extent does it contribute to infertility?

We analyzed whether patent but anatomically deranged tubes were more commonly encountered in infertile women than in fertile women. The fertile group consisted of 100 women who were apparently normal with respect to fertility and the infertile group consisted of 100 infertile women with no certain etiology identified. The individual tubal structure was recorded at laparoscopy and the results of the two groups were then compared. Tubal pathology was found to be significantly higher in the infertile group; however, this marked difference arose from the contribution of a significantly higher frequency of peritubal pelvic adhesions because no difference was found between the two groups regarding anatomic variations of the fallopian tube. We conclude that tubal derangement which could only be identified with laparoscopy significantly contributes to infertility.

Sonohysterosalpingography with Transvaginal Color Doppler and Three-Dimensional Ultrasound: State of the Art

The overwhelming majority of asymptomatic patients requiring evaluation for tubal function or tubal patency are women who are experiencing infertility problems. However, not all of them have tubal occlusion or even tubal pathology. There is a need to acquire experience and objective information about the capabilities of newer methods for evaluation of tubal structure and function that are less risky and invasive than those currently available for the growing number of women who require these studies. Several ultrasound techniques, such as transvaginal color Doppler sonography (TCDS), sonohysterosalpingography (SHSG), and three-dimensional sonography (3DS), are capable of providing diagnostic information that, in some cases, is equivalent to the information afforded by established techniques that require exposure to radiation, such as hysterosalpingography (HSG), or that are more invasive, such as hysteroscopy or diagnostic laparoscopy. Our experience, along with that of other investigators who have published reports on their experiences with these techniques, suggests that SHSG and TCDS may become initial diagnostic methods of choice for the growing number of women who have delayed pregnancy until late in their reproductive years or whose fertility is impaired by exposure to sexually acquired tubal pathogens. (J GYNECOL SURG 12:227, 1996)

Morphological Analysis of Neural Tube Defects in Non‐obese Diabetic (NOD) Mouse Embryos

AbstractNeural tube defects (NTDs) were demonstrated to occur at a high rate (29.4%) in non‐obese diabetic (NOD) mouse embryos on day 13 of gestation. Macro‐scopically, three different forms of NTDs were observed: the combined form of exen‐cephaly and myeloschisis, the pure form of exencephaly, and that of myeloschisis. The neural walls of the open tube were everted bilaterally. It was microscopically demonstrated that NTDs were composed of not only the everted neural walls but also voluminous mesenchymal tissue adjacent to the everted neural walls. The everted neural wall had three‐layered structure made up of outer, intermediate, and inner zones. The morphological findings of the intermediate and inner zones were similar to those of mantle and marginal layers in the normally closed neural tube. However, the outer zone, which corresponded to the ependymal layer in the normal neural tube, had characteristic findings. Namely, the cells were small, round and uniform in shape. Almost no mitotic figures were observed in this zone, and electron microscopic investigation revealed few cytoplasmic organelles. Of 9 NOD mouse embryos with NTDs, 2 exhibited duplicated notochords. In one of these two embryos, an aberrant tubal structure was formed of neural tissue. The plausible causes of NTDs in NOD mouse embryos were discussed based on these findings.

Induced hydrosalpinges in rabbits: comparison of hysterosalpingographic media and development of an animal mode

Experiments were conducted in rabbits to test the effect of commonly used hysterosalpingographic media on tubal structure and function. A model of hydrosalpinx was created by ligating both ends of the oviduct, and the lumen was filled with test solutions. Three groups of animals were studied. Group 1 rabbits (operated controls) received Hanks' balanced salt solution or no solution. In the second group (unoperated controls), no solution or occlusive ligature was applied. Group 3 received either Ethiodol (Savage Laboratories, Missouri City, TX), an oil-soluble contrast medium (OSCM), or Sinografin (E.R. Squibb & Sons, Princeton, NJ), a water-soluble contrast medium (WSCM). Histopathologic changes in the endosalpinx were moderate in the doubly ligated oviducts, and no difference was found between the effects of OSCM and WSCM in group 3 or between groups 1 and 3. Ciliary transport rate on the ampullary endosalpinx of group 1 was 0.05 mm/second, i.e., half the normal rate in the unoperated controls (P less than 0.001) and OSCM-filled oviducts (P less than 0.01). The rate in WSCM oviducts was 0.01 mm/second, significantly slower than in the OSCM-filled oviducts (P less than 0.05).

Electron Microscopic Examination of the Rabbit Oviductal Ampulla Following Microsurgical End-to-End Anastomosis

The endosalpinx of both normal and microsurgically reconstructed ampullae in rabbit oviducts was examined by scanning and transmission electron microscopy following ovum transport studies. Tall, longitudinal mucusal folds ran continuously throughout the lumina of normal ampullae and were clearly interrupted at the incision site in the reconstructed oviducts. In both normal and surgically repaired tubes the endosalpinx was covered with long, slender cilia and bulbous processes of secretory cells with microvillous surfaces. Intracellular examination of these epithelial cells suggested no abnormal structure or function. These observations indicate that the epithelium on the severed ends of the endosalpinx healed completely within 1 month following ampullary anastomosis. Since no luminal obstruction was observed, the interruption and misalignment of the mucosal folds appear to be the cause of the impaired ciliary transport of cumulus masses observed in these oviducts. When species differences in tubal structure and function are considered, it appears likely that ampullary-ampullary anastomosis could hinder egg transport and fertility in women.

HYSTEROSALPINGOGRAPHY

The value of hysterosalpingography in gynecologic diagnosis was established soon after the discovery of the x-ray. The severe reactions caused by the occasional use of bismuth paste, isotonic colloidal silver, sodium bromide and thorium citrate spurred investigative efforts toward finding a suitable contrast material. By 1922, Lipiodol* had superseded all other radiopaque media, and for many years it was the drug of choice. As its use increased, pulmonary embolization, foreign body reactions in the peritoneal cavity and sensitivity problems were occasionally reported. After Rubin 5 described the ideal opaque substance as one that had proper viscosity, density sufficient to demonstrate tubal structure, and characteristics not causing foreign body reactions, investigation of other media was stimulated.

The endometrial theory of ectopic pregnancy

Various observers including ourselves, have demonstrated healthy endometrial tissue in tubal lumina. Sampson and Jacobsen, and others have proved beyond doubt that such endometrial tissue can and does implant itself and grow elsewhere displaying a preference for serous surfaces. Cases have been reported in the literature of endometrial tissue in the tubes. We have one such case.Many observers have found decidual tissue in tubes whether or not they were the site of pregnancy. We have found it present at the site of the pregnancy in 62 per cent of casual specimens, in 87½per cent of cases where we made a careful search and believe that it is present at the outset in 100 per cent of cases.In one case we succeeded in finding endometrial glands in this decidual tissue, proving that the decidual reaction was caused by the response of endometrial elements and not the tubal structure itself. The fact that the fibrin layer of Nitabusch can be demonstrated in these ectopic decidual tussues shows that the ectopic endometrium carries out its functions as completely as when it was on the uterine wall.The ectopic endometrial tissue was found in 1 out of 204 cases, an incidence of ½per cent. The ratio of ectopic to intrauterine pregnancy is about 1 to 202 (Schumann's18 series) in Farrar's19 series 4 to 309, a significant correspondence of statistics and the explanation of the frequency of ectopic gestation.