A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

The therapeutic effects of curcumin and capsaicin against cyclophosphamide side effects on the uterus in rats

Abstract Purpose: To evaluate the impact of systemic cyclophosphamide treatment on the rat uterus and investigate the potential therapeutic effects of natural antioxidant preparations curcumin and capsaicin against cyclophosphamide side effects. Methods: A 40 healthy adult female Wistar albino rats were used in this study. Rats were randomly divided into four groups to determine the effects of curcumin and capsaicin against Cyclophosphamide side effects on the uterus (n=10 in each group); Group 1 was the control group (sham-operated), Group 2 was the cyclophosphamide group, Group 3 was the cyclophosphamide + curcumin (100mg/kg) group, and Group 4 was the cyclophosphamide + capsaicin (0.5 mg/kg) group. Results: Increased tissue oxidative stress and histological damage in the rat uterus were demonstrated due to the treatment of systemic cyclophosphamide chemotherapy alone. The level of tissue oxidant and antioxidant markers and histopathological changes were improved by the treatment of curcumin and capsaicin. Conclusion: Cytotoxic effects of natural alkylating chemotherapeutic agents like cyclophosphamide on the uterus can be prevented by curcumin and capsaicin.

The comparison of methylene blue and vitamin E in prevention of abdominal postoperative adhesion formation in rat uterine horn models: Biochemical and histopathologic evaluation / Comparação do azul de metileno e vitamina E na prevenção de aderência abdominal pós-operatória em corno uterino de ratos: avalição bioquímica e histopatológica

Purpose: To compare the effects of vitamin E and 1 percent methylen blue solutions on prevention of experimentally induced adhesions in rats. Methods: Thirty seven female Spraque Dawley rats were randomized into four groups. First group was kept as sham operated group. An adhesion model was constituted on the left uterine horn of the other groups. The lesion areas of rats from the second, the third and the fourth groups were coated with 2 ml 0.9 percent saline solution (C group), 10 mg vitamin E (VE group) and 1 percent methylen blue solutions (MB group), respectively. Results: Histopathologically, adhesion scores, mononuclear cell infiltration, oedema and fibrosis were more prominent in the MB group compared with C and VE groups. There were no significant differences between the groups in tissue glutathione peroxidase (GPx), catalase (CAT) activities and glutation (GSH) level, these parameters were slightly increased in group with VE supplementation though. The administration of VE and MB significantly decreased NO (P<0.01) levels when compared to the C group. The level of malondialdehyde (MDA) in the VE group was significantly lower (P<0.05) than those of the Sh and C groups. Conclusion: Intraperitoneal methylen blue solutions treatments were more effective according to vitamin E in preventing the formation of intra-abdominal adhesion in a rat uterine horn model.

Objetivo: Comparar os efeitos da vitamina E e 1 por cento da solução de azul de metileno na prevenção de aderências induzidas em ratos. Métodos: Trinta e sete ratos fêmeas Spraque Dawley foram distribuídos em quatro grupos. O primeiro grupo foi mantido como grupo sham. O modelo de aderência foi realizado no corno uterino esquerdo nos outros grupos. As áreas da lesão dos ratos do segundo, terceiro e quarto grupos foram revestidas com 2 ml de solução salina 0,9 por cento (Grupo C), 10 mg de vitamina E (Grupo VE) e solução de azul de metileno 1 por cento (Grupo MB), respectivamente. Resultados: Histopatologicamente, o escore das aderências, infiltração celular mononuclear, edema e fibrose foram mais proeminentes no grupo MB em comparação aos grupos C e VE. Não houve diferença significante entre os grupos na peroxidase da glutatione do tecido (GPx), atividade da catalase (CAT) e o nível de glutation (GSH). Estes parâmetros foram ligeiramente aumentados no grupo com suplemento da VE. A administração da VE e do MB diminuiu significantemente os níveis quando quando comparada ao Grupo C. O nível de malondialdeído no grupo VE foi significantemente mais baixo do que nos grupos sham e C. Conclusão: A administração intraperitoneal da solução de azul de metileno foi mais eficaz de acordo com a vitamina E na prevenção de aderências intra-abdominais no corno uterino de ratos.

Integralidade na assistência à mulher na prevenção do câncer cérvico-uterino: um estudo de caso / Integrality in women's health in the prevention of cervical uterine cancer: a case study

Realizou-se análise da gestão da atenção, com base na integralidade da assistência à saúde da mulher na prevenção do câncer cérvico-uterino, através de entrevista com duas pacientes atendidas em serviço de saúde da região nordeste do país. Consistiu num estudo de caso onde os dados foram analisados através do Fluxograma Analisador do Modelo de Atenção de um Serviço de Saúde. Em um caso identificou-se a integração dos pontos de atenção, com caráter integral e no outro a fragmentação total desta. No estudo é percebida a importância de maior atenção do gestor no sentido de melhor planejar, organizar e avaliar as ações nos serviços de atenção saúde da mulher, buscando a eficiência, a eficácia e a efetividade, assegurando que os princípios do Sistema Único de Saúde sejam respeitados...

Acute puerperal uterine inversion a rare but life threatening complication of the third stage of labour.

To find out the causes of acute puerperal inversion in the study population so that appropriate preventive measures could be planned. This presentation is based on two studies conducted at two teaching maternity units in Lahore. Duration of the first study was from July 1985 to December 1990 and second one extended from January 1991 to June 1996. Demographic data, details of index labour and placental delivery were collected. An effort was made to determine the cause of inversion. Ten cases of acute uterine inversion were seen among 34293 deliveries during the said period, prevalence was prevalence was 1 in 3429 deliveries. Parity of the parturients ranged from 2-6. Haemorrhage and shock were the commonest presenting features. Six women were delivered by the TBAs. Injudicious traction on the umbilical cord in the presence of a lax uterus was probably the most likely underlying cause. Complete uterine inversion occurred in 6 patients. Nine cases were managed by manual reduction and one required surgical intervention. Three had hysterectomy due to uncontrolled bleeding due to uterine atony after correction. Proper education and training regarding placental delivery must be imparted to the care providers engaged at different levels in maternity healthcare system so as to avoid this fatal but preventable obstetric emergency

Erros em citopatologia ginecológica: por que ocorrem? / Mistakes in gynecologic cytopathology: why do they occur?

O "Papanicolaou" é considerado o mais eficiente teste para prevençäo do câncer cervical uterino, apesar de näo ser infalível. Partindo do pressuposto que o falso negativo (FN) nem sempre é uma falha evitável, temos que ter em mente a maneira de melhorar seu desempenho. Comparando 136 efregaços cervicais com os respectivos prepardos histológicos, obtivemos 104 correlaçÆes satisfatórias. Seis FN, 21 subavaliaçÆes, dois falsos positivos (FP), e três superavaliaçÆes. A revisäo dos 27 esfregaços em que a citologia foi FN ou subavaliada mostrou apenas seis erros de interpretaçäo, os demais foram considerados erros de amostragem. Células endocervicais estavam presentes em 70 por cento dos esfregaços que concordavam com o exame histológico e em apena 41 por cento dos FN e subavaliados. InformaçÆes clínicas eram disponíveis na requisiçäo de exame de 70 por cento das citologias com relaçäo satisfatória e em apenas 33 por cento das FN ou subavaliadas. Comentários e conclusÆes säo tecidos sobre estes resultados, no sentido de alertar para a importância do controle de qualidade dos laboratórios de citopatologia. Inclui-se aí outros importantes elos da cadeia de eventos que leva à prevençäo do câncer cervical, como o clínico, responsável pela amostragem, e o citotécnico, que tem o primeiro contato com o esfregaço