Uterus Arteries Research Articles

Application of Uterus Manipulator in Total Abdominal Hysterectomy for Benign Diseases.

Pelvic access is a challenging matter in abdominal hysterectomy especially in obese patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases. Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy - 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH. The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications. The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss.

Uterus transplant graft's arterial atherosclerotic remodeling veracity.

Background:Uterus transplantation is a complex, multi-step experimental procedure used for the treatment of uterus absence or uterus anomaly that prevents embryo implantation or pregnancy completion.Method:To date, only 51 uterus transplants worldwide had been performed. When simplified, it is vascularized composite allograft transplantation. While it is still an experimental procedure with encouraging results for the future, there are still many issues that have to be clarified. The most serious complications of uterus transplantation are graft rejection or grafts vascular failure.Results:So far, no reference to the atherosclerotic arterial infiltration of the uterus arteries was suggested and studied as one of the main causes of graft's failure.Conclusion:In this review we summarized current knowledge and possible role of uterus arterial damage, including atherosclerotic changes on the graft's survival.

Value of the CT Angiography in Displaying the Anatomical Variations of the Origin of Uterus Artery

Objective To study the anatomical variations of the origin of uterine artery(UA)by three-dimensional(3D)reconstructed computed tomography angiography(CTA)and facilitate the preoperative evaluation for gynecological surgeries or interventional therapies. Method The CTA findings of 112 patients with an average age of(31.4±6.6)years old who had received a pelvic CTA and undergone 3D reconstruction of the uterine artery were retrospectively analyzed. Results The average uterine volume was(95.6±26.8)cm 3.Of the UA 224 sides,144 sides(64.3%)arose from the interior gluteal artery and 51(22.8%)from internal iliac artery;in 29 sides(12.9%),the uterine artery,the inferior gluteal and the superior gluteal arteries arising as a trifurcation.The origin of UA was consistent between left and right sides in 68 patients(60.7%)and not in 44 patients(39.3%). <b>Conclusion</b> As a rapid,noninvasive,and economic technique,CTA can effectively display the anatomical variations of the origin of UA and thus can be used to guide interventional therapies and gynaecological surgeries.

The auto-transplantation of uterus in swine: surgical techniques and long-term graft survival

Objective: Uterus transplantation (UTx) provides a available treatment for women with absolute uterus-related infertility. The aim of this study was to develop surgical techniques for UTx and to observe the long-term graft survival in the swines. Materials and Methods: Ten female swines received uterus auto-transplantation surgery after general anesthesia. The operative time, ischemic time, and vascular injury in each swine were recorded. The bicornual uterus with vaginal canal and main vessel were removed, bake-table preparation was performed with cooled at 4°C, and perfused with heparin saline with continuous flushing. The uterus was placed in original pelvic position. The uterus arteries and veins were end-side anastomosed with external iliac arteries and veins in the host swines. Results: One case was randomly selected as the preliminary experiment. The remaining nine cases showed that the uterine arteries and veins were anastomosed successfully and only eight cases attained long-term survival. The host in another case died four days after surgery from suspicious embolism postoperation. The blood flow of uterus arteries was observed by Doppler ultrasonography at four days after the operation and no congestion was found. The second-look laparotomy at six months after surgical was subsequently performed and the uterus showed a normal morphology and size. However, the pregnancy was unsuccessful due to the shorter observation time, and the severe adhesion and tubal obstruction after surgery may have affected pregnancy of those swines. Conclusion: These preliminary experiences suggest that the uterine auto-transplantation using the end-side vascular anastomosed method is feasible. The accumulation of basic data and experiences from swine experiments can provide important guidance for establishment of UTx in humans.

RISK GROUPS FOR PREGNANCY HYPERTENSIVE DISORDERS DEVELOPMENT

Aim. Development of clinical, anamnestic, immunological and instrumental prognostic markers of high and low risk of gestational hypertensive disorders.Material and methods. A range of risk factors was assessed in 220 pregnant women with hypertensive states (main group) and 50 healthy pregant women (control group). In the pregnant, clinical and anamnestic risk factors of preeclampsia were assessed (age, parity, anamnesis of hypertensive disorders, extragenital diseases, etc.), autoantibodies to 12 antigenes (by ELI-P test), placental growth factor (PGF) and resistance index (RI) in uterus arteries, by Doppler.Results. During the study, it was found that clinical and anamnestic factors of high risk of pre-eclampsia are: first pregnancy, chronic hypertension, extragenital pathology in woman, anamnesis of pre- and eclampsia, combination of three and more factors. Preclinical immunological predictors of high risk of pre-eclampsia in the 1st trimester are high titre of autoantibodies to S-100, B-2QP, ANCA (range -65 to +94 units), combined raise of three kinds of antibodies, immunity suppression, PGF level in the blood 50-100 pg/mL — for pre-eclampsia, up to 50 pg/mL — for fetal development delay. Doppler markers of high risk of pre-eclampsia: increase of RI up to 0,60 and dicrotic notch in both uterine arteries; RI increase 0,61-0,70 with one dicrotic notch only in one uterine artery; increase of RI more than 0,70 and no dicrotic notch.Conclusion. The most useful and predictive for pre-eclampsia are clinical and anamnestic, as immunological predictors that are revealed within 15 weeks of pregnancy. Instrumental prognostic markers that are explored after 20 weeks are useful for prognosis prediction on possible pre-eclampsia development and for control of treatment efficacy.

Impact of prostaglandin F2α and endothelin, pulsation index and resistance index of uterine artery blood flow on dysmenorrhea patients of cold stagnation and blood stasis syndrome with Dingkun Dan

This research apply Dingkun Dan to treat patients with dysmenorrhea of cold stagnation and blood stasis syndrome. This study observed its effectiveness and safety of the treatment of the disease and its influence on the serum prostaglandin F2α, endothefin, pulsatility index and resistant index of uterine artery blood, to explore the possible mechanism of effect of Dingkun Dan in the treatment of dysmenorrhea and provide scientific basis for clinical application. The 75 patients with dysmenorrhea of cold stagnation and blood stasis who met the inclusion criteria, were divided into treatment group (n=37) and control group (n=38) by using random number remainder grouping method. In the treatment group patients were treated with Dingkun Dan, the other group were given Fuke Zaizao Jiaonang. Two groups have same time to take the medicine, three days prior to the menstruation for ten days. Medication for three menstrual cycles was seen as a course of treatment. To observe and compare the two groups of patients before and after treatment VAS score, syndrome integral, serum levels of prostaglandin F2α and endothelin, pulsation index and resistance index of uterine artery blood flow and related safety index changes. Finally makes statistical analysis. It has been identified that, Treatment group and control group can reduce pain symptom of dysmenorrhea patients and improve the syndromes scores, compare with control group, effect of the treatment group is more significant(P<0.01). VAS pain curative effect: the treatment group and control group total effective rate respectively were, 97.22%, 69.44%, markedly effective rate were 83.33%, 30.56%, comparison between two groups, treatment group is better than that of control group(P＜0.01). Syndromes curative effect: the treatment group and control group total effective rate respectively were 97.22%, 94.44%, markedly effective rate was 66.67%, 2.78%, respectively. The comparison between two groups, the total effective rate has no obvious difference, but markedly effective rate of treatment group is better than that of control group(P＜0.01). The treatment group can significantly reduce the patients' serum level of prostaglandin F2α(P<0.01), but no obvious difference was found in the control group before and after treatment. Both groups can significantly reduce the serum level of endothelin(P<0.01), comparison between two groups, the treatment group is more significant(P<0.01).Both treatment group and control group were significantly lower left and right pulsation index and resistance index of uterus artery blood flow(P<0.01). Between groups to compare the effect, the treatment group is more significant(P<0.01). Both treatment group and control group in the security check before and after treatment found no significant anomalies. Dingkun Dan in treating dysmenorrhea with cold stagnation and blood stasis syndrome seems to have remarkable clinical curative effect and safety, which may be achieved by significantly reducing the serum level of prostaglandin F2αand endothefin of the patients, and reducing the pulsation index and resistance index of uterine artery blood flow of the patients, to improve uterine artery condition of blood, and correcting local tissue ischemia to relieve pain.

The possibilities of color Doppler in the monitoring of the uterus body choriocarcinoma chemotherapy

Objective: The incidence of gestational trophoblastic neoplasm in Ukraine, especially of choriocarcinoma—the most malignant form—increased from 1993 from 1.5 to 1.7. At present time, it consists of 1:20000–1:50000 pregnancies. The purpose of the present study was to evaluate the possibilities of transvaginal color Doppler sonography (TVCDS) in choriocarcinoma chemotherapy monitoring. Methods: TVCDS was performed at Siemens, “Elegra,” and ATL HDI 3000 units with a 6.0-MHz transducer. 53 patients, 15–47 years old, were examined using TVCDS. All diagnoses were established histologically. Results: At the beginning of the treatment, TVCDS demonstrated the change of PI from 0.9 to 1.2, and RI, from 0.67 to 0.73 in uterus vessels and low-level resistance of blood flow inside the choriocarcinoma nodules (RI, 0.25– 0.57; PI, 0.3–0.7; PSV, 97 cm/s) with the presence of arteriovenous bypasses. Choriocarcinomous tumor nodes were of solid structure with dilated tumor vessels on periphery in 42 (79.3%) cases and of mixed type, when the vascular component of a tumor was enough expressed, in 11 (20.7%) cases. After chemotherapy at positive dynamics, parameters of a blood flow in uterus arteries correspond to average for women of reproductive age. Some heterogeneity of myometrium was retained for a long time on the place of tumor node at choriocarcinoma, and cicatrical changes in the projection of tumor node can be observed in 6 months. Close to cicatrix, TVCDS determined only venous vessels of insignificant caliber. Conclusions: TVCDS is a high-informative method in choriocarcinoma chemotherapy monitoring. Thus, TVCDS can be recommended for wide application in patients with uterus body choriocarcinoma.

CLINICAL STUDIES ON CEFOTAXIME (CTX, HR 756) IN OBSTETRICS AND GYNECOLOGY

In vivo transfer and therapeutic efficacy of a new cephalosporin derivative, cefotaxime, which is stable against beta-lactamase hydrolysis, have studied in gynecology field. The following results have been obtained. (1) The level of cefotaxime transferred to uterus artery and to uterus was higher than its MIC against majority of Gram-negative bacilli, such as E. coli. (2) Transfer of this drug to umbilical blood was also satisfactory. (3) This drug as demonstrated its efficacy in treating 8 infection cases refractory to CET, CEZ and ABPC, out of which 3 had 'excellent' and 5 had 'good' results. (4) No side effect was evidenced in any of our patients. In conclusion, this drug has satisfactory tissue transfer as well as sufficient safety and excellent efficacy in treatment of gynecological infection cases.