Métodos de estudio de pacientes con sangrado uterino posmenopáusico: recomendaciones prácticas / Study methods of patients with postmenopausal uterine bleeding: practical recommendations

Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Histo-pathological pattern of endometrial biopsy in females with abnormal uterine bleeding: a retrospective study in tertiary care hospital of Haryana

Background: This study aimed to know the various histo-pathological patterns of endometrial biopsy and their incidence in patients of AUB.Methods: Patients in the age group between 21-75 years who had presented with AUB and underwent endometrial biopsy from 1st January 2017 to 31st December 2019 were included. The endometrial biopsy specimens which were already taken from patients with AUB were scrutinized for histopathological pattern. Various patterns of histo-pathology of endometrial biopsy were noted and studied.Results: Most common age group which was affected was between 36-40 years. The endometrial biopsies and curetting’s on histopathology revealed various patterns ranging from normal endometrium to malignancy. Patterns of normal cyclical endometrium (proliferative and secretory phases) were the most common patterns.Conclusions: Evaluation of women with AUB is important around the perimenopausal age group to detect any atypical and malignant changes and intervene early. Histopathological examination in correlation to radiological findings remain the standard procedures for diagnosis.

A study to compare the diagnostic accuracy of GeneXpert MTB/RIF/assay and its comparison with liquid culture in clinically suspected cases of genital tuberculosis attending outpatient department of tertiary center

Background: Tuberculosis is a major health issue globally despite a declining trend in mortality with effective diagnosis and treatment, an estimated 10.4 million persons developing active TB each year with 1.33 million deaths. Objective of this study was to evaluate role of GeneXpert MTB/RIF/assay in diagnosis of female genital tuberculosis in suspected cases of tuberculosis.Methods: It was a cross sectional study done in department of obstetrics and gynecology in S. N. Medical college Agra for a period of 2 year (July 2017 to October 2019). 70 cases were selected from OPD of department of obstetrics and gynecology, S. N. Medical College Agra who met the inclusion and exclusion criteria after taking proper consent. In all selected cases endometrial biopsy sample was taken using endometrial biopsy curette in premenstrual period. All samples of endometrial biopsy were taken under all aseptic precaution from both corneal ends, anterior and posterior wall and lower part of uterus using endometrial biopsy curette and sample was collected in two separate sterile vials having normal saline and was sent for GeneXpert MTB/RIF/assay and liquid culture simultaneously.Results: Out of total 70 clinically suspected cases of female genital tuberculosis in between 20-45 years of age cough with expectoration 94% was the most common respiratory symptom followed by fever 81%, weight loss 56% and anorexia 54%. Prevalence of genital tuberculosis in active pulmonary tuberculosis patients was 30%. Irregular menstruation, vaginal discharge and pelvic pain were present in 69%, 60% and 52% patients respectively.Conclusions: The overall sensitivity of CBNAAT was 22% and specificity was 77%. The overall sensitivity of liquid culture was 28% and specificity was 71%.

Prevalence of uterine lesions associated with leiomyomas and role of endometrial biopsy in management

Background: Present study highlights association between symptomatic patients of fibroids and its coexistence with pathologies like endometriosis, adenomyosis, polyp, endometrial hyperplasia and carcinoma. The aim was evaluating role of endometrial biopsy before surgery.Methods: The study was observational cohort, conducted on women operated for fibroid or recently diagnosed with fibroid. 150 women were included. Histopathology reports of already operated were analysed for association between uterine pathology and fibroid. In prospective cases ultrasonography findings was noted and patients having leiomyoma underwent biopsy and reports studied for association. Chi-square test done to find association between qualitative variable and p value <0.05 considered significant.Results: Out of 150, 24.6% had adenomyosis, 14% had endometrial hyperplasia in which 2% had atypia and 12% without atypia, 8.6% had cervical polyp, 5.33% had endometrial polyp, 4% had endometriosis while 42.7% had no association.Conclusions: This study revealed increasing trend of coexistence of leiomyomas with uterine pathologies. Early identification of endometrial pathologies on clinical history and imaging helps in selection of high-risk patients who need biopsy to rule out malignancy thus avoiding routine D and C which is done for every case.

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation.

Retrospective study of histopathological pattern of endometrium in abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint associated with considerable morbidity. It significantly affects the patient’s family personal and social life. The aim of this study was to analyse the histopathological patterns of endometrium in patients presenting with AUB.Methods: This is a retrospective study conducted in the teaching hospital in the department of obstetrics and gynecology along with the pathology department. All patients with AUB were included in the study. This study of 138 samples both from hysterectomy specimens and endometrial biopsy were included.Results: The specimen obtained for examination of the endometrial samples 86 comprised from dilatation and curettage and rest 52 samples were obtained from hysterectomy specimens. Most common histopathological pattern was found to be proliferative endometrium, followed by disordered proliferative endometrium and atropic endometrium.Conclusions: Study of the histopathological pattern of the endometrial biopsies can be included in the initial evaluation of women with AUB when the cause of bleeding is not known along with ultrasound examination, then using it as the last modality for diagnostic and therapeutic purposes, irrespective of age group.

Histological Correlation of Karmans Endometrial Sampling with Dilation and Curettage in Abnormal Uterine Bleeding

The study was done to compare the diagnostic efficacy of endometrial biopsy obtained by Karman suctioncannula with conventional D&C following TVS in patients with AUB. 100 patients of AUB presenting ingynaecology OPD were studied with history, examination, laboratory investigations, TVS, endometrial aspirationusing Karman cannula and endometrial curettage. It is concluded that endometrial aspiration is an effective,useful and minimally invasive procedure and can be used for the primary investigation of women with AUBalong with TVS.

Accuracy of transvaginal sonography in evaluation of abnormal uterine bleeding in perimenopausal women

Background: AUB is a commonly encountered complaint in peri- and postmenopausal women visiting OBG OPDs and accounts for about 70% of all gynaecological complaints. Key to management depends on the cause of AUB. Protocol has changed over the years from performing investigations randomly to a condition specific approach. This study aims to evaluate and compare the efficacy of transvaginal sonography and hysteroscopy in perimenopausal women with AUB and note its relation with histopathology.Methods: A prospective study was conducted on 103 women of 40-55 years presenting to the OBG OPD of Father Muller Medical College Hospital, Mangalore. All patients underwent a transvaginal scan to note the endometrial thickness followed by a hysteroscopy and biopsy. Endometrium was sent for histopathology. Findings of these modalities were correlated.Results: The diagnostic value of transvaginal sonography in relation to histopathology had a sensitivity and specificity of 33.33% and 95.95% for atrophic endometrium, 52.5% and 62.9% for proliferative, 29.41% and 79.41% for secretory, and 55.55% and 74.19% for hyperplastic. When compared to histopathology, hysteroscopy had a sensitivity and specificity of 100% and 92.3% for atrophic, 26.19% and 96.96% for proliferative, 27.07% and 98.59% for secretory, and 100% and 64.94% for hyperplastic endometrium. It had a sensitivity of 77.77% and a specificity of 92.92% for endometrial polyps. Agreement between TVS and histopathology based on kappa co-efficient was fair for atrophic endometrium but poor for proliferative, secretory and hyperplastic endometrium. Agreement between hysteroscopy and histopathology was moderate for atrophic endometrium and for endometrial polyps. It was fair for proliferative, secretory and hyperplastic endometrium.Conclusions: TVS seems to be a good initial method for evaluation of AUB. However, a subsequent hysteroscopy with biopsy is advisable to evaluate the cause of AUB.

Clinico histopathological evaluation of abnormal uterine bleeding in women of reproductive and perimenopausal age group

Background: Abnormal uterine bleeding constitutes a significant proportion of cases attending gynaecology outpatient department. It affects woman’s physical, emotional, social and maternal well-being, and hence it demands adequate management. It is a multifactorial entity; presented in various patterns, signs and symptoms. The PALM COEIN classification is the most recent method of categorizing AUB (abnormal uterine bleeding) based on structural and non-structural causes. The treatment of AUB depends on age, parity, symptom severity, investigation findings and cause. Various invasive and non-invasive investigations including USG, endometrial biopsy and hysteroscopy helps find different causes. Whatever be the etiology endometrium gets affected; hence AUB is likely managed through hormonal preparations, LNG-IUS, endometrium ablation/resection and ultimately hysterectomy as the last resort.Methods: A retrospective study comprising 216 patients in the age group of 30-50 years with complaints of AUB were recorded as per a structured proforma at department of obstetrics and gynaecology, MGM MCH over a period of one year (January 2018-19). The results of investigations, ultrasound scans, endometrial biopsy and histopathology of hysterectomised specimens were correlated. The endometrial biopsy and histopathology of the specimens was done at department of pathology, MGM MCH.Results: The most common age group showing AUB lies under 35-40 years (40.2%) and 40-45 years (33.7%). Menorrhagia was found to be the most common symptom (66.2%). As per PALM COEIN classification, the most common type in our study was of AUB-L (33.7%) and the associated histopathological pattern was of secretory type (50.4%).Conclusions: The features and patterns of AUB differ according to the age of patient, affecting mostly women in perimenopausal and late reproductive age group. There are various modalities for its diagnosis and management and PALM COEIN classification helps better understand the disease etiology.

A prospective study on the efficacy of Pipelle biopsy to diagnose endometrial pathology in patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common problem encountered in gynaecology clinics. Assessment of endometrial pathology is recommended to rule out malignancy and premalignant conditions. Endometrial sampling can be done by Pipelle biopsy in outpatient units as well as by conventional dilatation and curettage in an operation theatre setup. Our study aims to find out the efficacy of office endometrial biopsy in terms of its sample adequacy, diagnostic accuracy and patient acceptability.Methods: 120 women presenting with abnormal uterine bleeding were included. A detailed history along with clinical examination findings are entered in the proforma. Ultrasound scan was done for all of them to identify pelvic pathology and endometrial thickness. Endometrial sampling was then done with Pipelle without anaesthesia. Histopathology reports are collected and sample adequacy and pattern were analysed. Patients are subsequently followed up for a period up to one year. Those who underwent hysterectomy are analysed for the endometrial pathology in hysterectomy specimen which is used as gold standard and compared with Pipelle endometrial sampling histopathology.Results: Sample adequacy for Pipelle biopsy was found to be 96%. Diagnostic accuracy for atypical hyperplasia and adenocarcinoma is 92.5% and 94% respectively. In hysterectomy specimens, carcinoma endometrium coexisted with atypical hyperplasia in 40% of cases with atypical hyperplasia in pipelle biopsy report.Conclusions: Thus, Pipelle endometrial biopsy is a cost-effective method for endometrial sampling except for focal lesions.

Discrepency in grade between preoperative biopsy and final specimen in stage I carcinoma endometrium: an institutional review

Background: Most endometrioid endometrial cancer are well differentiated (Grade I). Grade of the tumor is an important predictor of nodal metastasis and the discordance in histological grade of endometrial cancers between diagnostic biopsy and definitive surgery specimen was analyzed in our Institute.Methods: Around 221 patients diagnosed with carcinoma endometrium between 2006 and 2014 were taken into study. Histologic differentiation of the tumour between diagnostic biopsy and definitive surgery were analysed. All demographic data, tumor factors, follow up and recurrence were recorded.Results: Of the 221 patients taken into consideration for analysis, median age of presentation was 57 years with range between 38-77 years. The overall median body mass index was 27.70kg/m2. 66 % of patients had comorbid illness, with 33% having both diabetes and hypertension. Open staging was performed in 150 patients and laparoscopic staging in 71 patients. Mean duration of surgery was 3.06 hrs in laparoscopic staging and 2.74hrs in open staging. The median tumour size was 4cm.The median number of nodes dissected were 13. Discordance in the grade of tumour between diagnostic biopsy and surgical biopsy were 58.8% of grade 1 tumour, 16.2% of grade 2 tumours and 18.9% of grade 3 tumours.Conclusions: Discrepancies in correlation of the grade of tumour in diagnostic biopsy and tissue obtained at surgery supports the need for surgical staging in all patients.

Histopathological analysis of Abnormal uterine bleeding

Introduction: Abnormal Uterine Bleeding is one of the commonest presentations of patients in gynecology OPD (Outdoor patient department). Abnormal uterine bleeding is a common sign of a number of different uterine disorders ranging from dysfunctional (non-organic) abnormalities or complications of pregnancy to organic lesions such as polyps, hyperplasia, or carcinoma. Materials and methods: Present study included 200 patients who attended OPD of Gynecology Department, with complaints of abnormal uterine bleeding. All the biopsy specimens were sent to Pathology Department. We had made an appropriate histopathological diagnosis for each case. The data was collected and analyzed statistically. Results: Out of 200 cases studied, 21% were found out to be secretory endometrium, 30% proliferative endometrium, 9% simple hyperplasia without atypia, 5% complex hyperplasia without atypia, 8% endometrial hyperplasia with atypia, 3% endometrial polyp, 8% chronic nonspecific endometritis, 2% tuberculous endometritis, 1% Arias-stella reaction, 10% products of conception, 1% complete and partial hydatidiform mole, 1% endometrial carcinoma and 1% squamous cell carcinoma of cervix. Conclusion: Endometrial biopsy is a safe, reliable and less time consuming outpatient procedure which can be used as an initial diagnostic tool in the patients with abnormal uterine bleeding.

Consecuencias oncológicas y perinatales del tratamiento conservador de la fertilidad en pacientes con cáncer endometrial tratadas con progestinas / Oncological and perinatal results of conservative treatment of fertility in patients with endometrial cancer treated with progestins

Resumen OBJETIVO: Estimar la tasa de respuesta completa y de embarazo en mujeres con cáncer endometrial en tratamiento conservador con progestinas. MATERIALES Y MÉTODOS: Estudio de cohorte, retrolectivo y transversal efectuado en el Instituto Nacional de Perinatología en mujeres con cáncer endometrial, en estadios tempranos, atendidas entre 2007 y diciembre de 2016. Criterios de inclusión: pacientes con límites de edad de 18 y 40 años, nulíparas, con deseo de fertilidad, haber sido tratadas con megestrol, DIU-levonorgestrel o progesterona micronizada durante seis meses. A todas las pacientes se les tomó una biopsia endometrial a los 6 y 12 meses. Se utilizó estadística descriptiva y comparaciones entre mediciones, χ2 o t de Student según la distribución de cada variable. RESULTADOS: Se incluyeron 11 pacientes con cáncer endometrial con edad promedio de 32 ± 2.4 años. La biopsia tomada a los seis meses fue: respuesta completa en 6/11, respuesta parcial en 2/11 y persistencia en 2/11; en una paciente no se tomó la biopsia a los seis meses por embarazo, no hubo casos de progresión. A los 12 meses de seguimiento hubo 5 respuestas completas, 2 parciales, 2 persistencias, 1 caso de progresión de la enfermedad y otro que suspendió el tratamiento. Se efectuaron 8 ciclos de FIV en 6 pacientes con tasa de embarazo de 25%. La duración del tratamiento fue de 19.3 ± 8 meses, el seguimiento total fue de 31.6 ± 13 meses. CONCLUSIONES: El tratamiento conservador de la fertilidad con progestinas en pacientes con cáncer endometrial, en etapas tempranas, es factible y seguro. El embarazo debe intentarse inmediatamente después de una respuesta completa.

Abstract OBJECTIVE: To estimate the complete response rate and pregnancy in women with endometrial cancer who have received conservative treatment with progestins. MATERIALS AND METHODS: Cohort, retrolective and transversal study carried out in the National Institute of Perinatology, in women with endometrial cancer in early stages between 2007 and December 2016. Including patients between 18-40 years, nulliparous, with desire for fertility. The progestins used were megestrol, IUD-levonorgestrel and micronized progesterone for six months. Endometrial biopsy was performed at 6 and 12 months; The result was classified as a complete, partial response, persistence or progression of the disease. Descriptive statistics and comparisons between baseline measurements at six and 12 months are used using student grid and / or t tests according to the distribution of each variable. It is a statistical program SPSS version 23 for Windows (Chicago, USA). RESULTS: 11 women with endometrial cancer were included. The average age of the women was 32 ± 2.4 years. Morbidity associated with hypothyroidism and type 2 diabetes mellitus. Six-month biopsy was: complete response 6/11 partial response 2/11 and persistence 2/11, in one patient the biopsy was not performed at 6 months by pregnancy, there were no cases of progression. At 12 months of follow-up, there were 5 complete responses, 2 partial responses, 2 persistences, 1 case of disease progression and one case that discontinued treatment. Eight cycles of IVF were performed in 6 patients with a pregnancy rate of 25%, the duration of treatment was 19.3 ± 8 months, the total follow-up was 31.6 ± 13 months. CONCLUSIONS: Conservative fertility therapy with progestins in women younger than 40 years old with early-stage endometrial cancer is feasible and secure in our institution. Pregnancy must be sought immediately after a full response to the cancer treatment. Our findings are similar to the ones found in our systematic review of the international bibliography.

Factores de riesgo para cáncer de endometrio en premenopáusicas con hemorragia uterina disfuncional / Risk factors for endometrial cancer in pre-menopausal women with dysfunctional uterine hemorrhage

El objetivo de la investigación fue establecer los factores de riesgo para cáncer de endometrio en premenopáusicas con diagnóstico de hemorragia uterina disfuncional. Se realizó un estudio observacional en mujeres con diagnóstico de hemorragia uterina disfuncional. Se evaluaron la asociación entre la histología endometrial y los factores de riesgo para el cáncer de endometrio, de ellos se analizaron: irregularidades del ciclo menstrual, diabetes mellitus, nuliparidad, hipertensión, obesidad y edad mayor de 40 años. La regresión logística se utilizó para investigar la importancia relativa de cada factor de riesgo. El estudio incluyó 266 mujeres con edad promedio de 41 años. La prevalencia de los factores de riesgo fue la siguiente: edad mayor de 40 años (67,2 %), menstruaciones irregulares (22,1 %), nuliparidad (16,9 %), obesidad (10,1 %), hipertensión (8,6 %) y diabetes (2,2 %). Los resultados de la biopsia endometrial incluyeron: 14 casos (5,2 %) de hiperplasia simple, 16 casos (6,0 %) de hiperplasia compleja y 4 casos (1,5 %) de hiperplasia con atipia. No se observaron casos de adenocarcinoma de endometrio. Se encontró que las menstruaciones irregulares eran el único factor de riesgo estadísticamente significativo asociado a alteración de la histología endometrial (p = 0,0132). En el grupo de pacientes con menstruaciones regulares y sin factores de riesgo, la incidencia de biopsia anormal observada fue inferior al 1 %. Las irregularidades del ciclo menstrual aumentan la probabilidad de un resultado anormal de la biopsia a un 14,2 %. Se concluye que las mujeres premenopáusicas diagnosticadas con hemorragia uterina disfuncional cuyos ciclos menstruales son regulares tienen un riesgo insignificante de desarrollar hiperplasia endometrial.

The objective of the research was to establish risk factors for endometrial cancer in pre-menopausal women with a diagnosis of dysfunctional uterine hemorrhage. An observational study was conducted in women with a diagnosis of dysfunctional uterine bleeding. The association between endometrial histology and risk factors for endometrial cancer analyzed were menstrual cycle irregularities, diabetes mellitus, nulliparity, hypertension, obesity and age over 40 years. Logistic regression was used to investigate the relative importance of each risk factor. The study included 266 women with an average age of 41 years. The prevalence of risk factors was the following: age over 40 years (67,2 %), irregular menses (22,1 %), nulliparity (16,9 %), obesity (10,1 %), hypertension (8,6 %) and diabetes (2,2 %). The results of the endometrial biopsy included: 14 cases (5,2 %) of simple hyperplasia, 16 cases (6,0 %) of complex hyperplasia and 4 cases (1,5 %) of complex hyperplasia with atypia. No cases of endometrial adenocarcinoma were observed. It was found that irregular menses were the only statistically significant risk factor associated with alteration of endometrial histology (p = 0.0132). In the group of patients with regular menses and without risk factors, the incidence of abnormal biopsy observed was less than 1 %. The irregularities of the menstrual cycle increases the probability of an abnormal result of the biopsy to 14,2 %. It is concluded that premenopausal women diagnosed with dysfunctional uterine bleeding whose menstrual cycles are regular have a negligible risk of developing endometrial hyperplasia.

Endometrial transcription of microbial molecular patterns receptors in Gyr and F1 Holstein x Gyr postpartum cows / Transcrição endometrial de receptores de padrões moleculares microbianos em vacas Gir e F1 Holandês x Gir após o parto

Zebu and Holstein x Zebu crossbred have low incidence of uterine infection when compared to Holstein cows. Resistance to uterine infections may be associated with the ability to recognize invading microorganisms. Endometrial transcription of microbial molecular patterns receptors has been investigated in the postpartum period of Holstein cows, but it is completely unknown in Zebu or Holstein x Zebu cows. In this study, 9 Gyr and 12 F1 Holstein x Gyr cows were submitted to endometrial biopsies at the first and seventh days postpartum, with the objective to measure transcription levels of toll-like receptors (TLRs) 1/6, 2, 4, 5, and 9; nucleotide-binding oligomerization domain (NOD)-like receptors 1 and 2; and coreceptors cluster of differentiation 14 (CD14) and myeloid differentiation protein-2 (MD-2). There was a significant (P<0.05) decrease in transcription of TLR5 in Gyr, and an increase in transcription of TLR9 in F1 cows, between the first and seventh day postpartum. Both groups had low incidences of uterine infections up to 42 days postpartum. Uterine involution completed at 27.7 ± 10.1 and 25.1 ± 4.7 days postpartum for Gyr and F1 cows, respectively. In Gyr cows, higher transcription levels of TLR1/6 and NOD1 correlated to a longer period required for uterine involution. In F1 cows, lower levels of TLR1/6, TLR2 and NOD2 correlated to a longer period required for uterine involution. In conclusion, some pathogen recognition receptors associated significantly with the time required for uterine involution in Gyr and F1 cows.(AU)

Vacas Zebu e mestiças Holandês x Zebu apresentam baixas incidências de infecções uterinas quando comparadas às Holandesas. A resistência às infecções uterinas pode estar relacionada com a capacidade de reconhecimento dos microrganismos invasores. A transcrição endometrial de receptores de padrões moleculares microbianos tem sido investigada em vacas Holandesas recém-paridas, porém ainda é desconhecida em vacas Zebu e mestiças Holandês x Zebu. No presente estudo, nove vacas Gir e 12 F1 Holandês x Gir foram submetidas a biópsias endometriais no primeiro e no sétimo dia após o parto, com o objetivo de mensurar os níveis de transcrição gênica dos receptores tipo Toll (TLRs) 1/6, 2, 4, 5 e 9; receptores tipo NOD 1 e 2; e dos coreceptores CD14 e MD-2. Houve diminuição significativa (P < 0,05) do nível de transcrição de TLR5 em vacas Gir e aumento da transcrição de TLR9 em vacas F1, entre o primeiro e o sétimo dia após o parto. Os dois grupos apresentaram baixas incidências de infecções uterinas até 42 dias pós-parto. O período de involução uterina foi de 27,7 ± 10,1 e 25,1 ± 4,7 dias pós-parto, para vacas Gir e F1, respectivamente. No grupo de vacas Gir, altos níveis de transcrição de TLR1/6 e NOD1 tiveram correlação significativa com o prolongamento do período de involução uterina. No grupo de vacas F1, baixos níveis de transcrição de TLR1/6, TLR2 e NOD2 foram associados a maiores períodos de involução uterina. Portanto, os níveis de transcrição endometrial de alguns receptores de padrões moleculares microbianos na primeira semana após o parto podem estar relacionados com o tempo requerido para ocorrência da involução uterina em vacas Gir e F1.(AU)

Efficacy of TVS colour doppler in comparison of primary infertility with endometrial biopsy

Background: Accurate prediction and diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities Transvaginal ultrasonography (TVS) is one among all. Aim: To determine the efficacy of TVS ultrasonography in screening for endometrial disease and studied the concordance of abnormal endometrial thickness, as measured by ultrasonography, with diagnoses based on histopathological examination of endometrial biopsy specimens. Materials and methods: A total 200 Subjects were elected from OPD of ESIC Hospital, Hyderabad. All subjects were undergone to the routine clinical and blood investigation, ultrasound, transvaginal and colour doppler investigations. Results: Study of primary infertility the diagnosis by transvaginal ultrasound and histopathology matched in 82% cases, while in 18% cases there was a disparity among the two modes of investigation. Conclusion: TVS can play an effective role in diagnosis and management of primary infertility, as it has a greater patient compliance with non-invasive technique and without necessitating full bladder. It can replace the EB in the diagnostic work up of female infertility.

HISTOPATHOLOGICAL STUDY OF ENDOMETRIUM IN ABNORMAL UTERINE BLEEDING IN REFERENCE TO DIFFERENT AGE GROUPS, PARITY AND CLINICAL SYMPTOMATOLOGY

Background: Abnormal uterine bleeding is the commonest presenting symptom and major gynecological problem responsible for as many as one-third of all out patient gynecologic visit. An understanding of the varieties in the normal morphological appearance of the endometrium provides an essential background for the evaluation of endometrial pathology. Aims: To study the histopathology of endometrial biopsies in patients presenting with abnormal uterine bleeding and its correlation with age, parity and bleeding pattern Methods: This was a study done at tertiary care hospital from 2012-2014. Endometrial biopsies obtained from 100 cases of patients presenting with abnormal uterine bleeding were studied followed by correlation of endometrial histopathology with parity, age and bleeding pattern. Results: The most common age group presenting with abnormal uterine bleeding was 41-50 years (31%).The commonest pathology was proliferative endometrium (29%).The commonest bleeding pattern was menorrhagia (88%) and highest incidence was seen in multiparous women(58%).Conclusion: Endometrial biopsy should be recommended during the workup of patients presenting with abnormal uterine bleeding to exclude organic pathology of endometrium.

Clinical value of disposable uterine cavity tissue suction tube in diagnosing abnormal uterine bleeding / 重庆医学

Objective To explore the clinical value of the disposable uterine cavity tissue suction tube in diagnosing abnormal u‐terine bleeding .Methods Seventy‐five patients ,who needed an endometrial biopsy because of abnormal uterine bleeding ,were se‐lected for this study .An endometrial biopsy was performed by a disposable uterine cavity tissue suction tube before the conventional suction dilatation and curettage (D&C) .The sample satisfactory rate and the diagnose accordance rate of the two methods were compared .Results The sample satisfactory rate of the disposable uterine cavity tissue suction tube and of the D&C was 85 .3%(64/75) and 94 .7% (71/75) respectively .The difference was not statistically significant(P>0 .05) .The diagnose accordance rate of the disposable uterine cavity tissue suction tube and the D&C was 90 .3% (56/62) and 93 .5% (58/62) respectively .The differ‐ence was not statistically significant(P>0 .05) .Conclusion To a certain extent ,endometrial biopsy performed by disposable uter‐ine cavity tissue suction tube can be a substitute for D&C as the initial inspection to assess abnormal uterine bleeding ,for its econo‐my ,efficiency and safety .

Endometrite fúngica em éguas: diagnóstico e implicações clínico-patológicas / Fungal endometritis in mares: diagnosis and clinicopathological aspects

Este estudo objetivou estabelecer a etiologia e achados clínico-patológicos das endometrites fúngicas. Para tal, realizou-se anamnese, exame ginecológico, cultura, citologia e biópsia endometriais em 85 éguas em idade reprodutiva e que não pariam havia um ano ou mais. Das 85 éguas, 24 (28%) apresentaram exames compatíveis com endometrite infecciosa. Destas, em 20% (5/24), confirmou-se endometrite com envolvimento fúngico. Os fungos isolados foram: Candida guilliermondii, C. tropicalis, C. pseudotropicalis associadas ao Bacillus sp. em uma égua; C. albicans em duas fêmeas (uma associada a Escherichia coli); um caso de Trichosporon penicillatum e um de T. capitatum. Todos animais diagnosticados com endometrite fúngica apresentaram inflamações endometriais moderadas, nos exames de citologia e no histopatológico, sendo estes achados compatíveis com o histórico e o exame reprodutivo destes animais. Destacou-se a presença constante de linfócitos e plasmócitos nos dois exames, assim como das lesões degenerativas no endométrio através da biópsia endometrial. Em 80% (4/5) constataram-se estruturas fúngicas na citologia endometrial, porém no exame histopatológico, não foi possível detectar tais estruturas. Após o estudo pode-se afirmar que a metodologia utilizada foi eficiente para diagnosticar a endometrite fúngica, com destaque para o exame de citologia endometrial, e que este tipo de endometrite teve caráter crônico em todos os animais.

The aim of the present study was to determine the causes and clinical findings of endometritis. The history, reproductive examination and endometrials culture, uterine cytology and biopsy from 85 mares in reproductive age that did not foal a year or more were performed. Twenty four (28%) out of 85 mares had signals compatible with infectious endometritis. From those, 20% (5/24) had fungal involvement, and the agents were: Candida guilliermondii, C. tropicalis, C. pseudotropicalis, in association to Bacillus sp. in one mare; two mares had C. albicans, and one of them associated with Escherichia coli; a case of Trichosporon penicillatum and another of T. capitatum. All animals with fungal endometritis presented moderate endometrial inflammation, at cytology and uterine biopsy, which was compatible with the animal's history and reproductive exam. The endometrial cytology and biopsy revealed numerous lymphocytes and plasmocytes as well as the degenerative lesions in the endometrial biopsy. Fungal structures were presented at the endometrial cytology smears in 80% (4/5) of the mares, however those structures were not detected in the biopsy. In conclusion, the methodology used was efficient to diagnose fungal endometritis, with standing for the examination of endometrial cytology, and the fungal endometritis had chronic character in all animals.