Study of the unique cellular molecular characteristics of moderately intrauterine adhesion based on single-cell RNA sequencing / 中华医学遗传学杂志

OBJECTIVE@#To depict the cell landscape and molecular biological characteristics of human intrauterine adhesion (IUA) so as to better understand its immune microenvironment and provide new inspirations for clinical treatment.@*METHODS@#Four patients with IUA who underwent hysteroscopic treatment at Dongguan Maternal and Child Health Care Hospital from February 2022 to April 2022 were selected as the study subjects. Hysteroscopy was used to collect the tissues of IUA, which were graded based on the patient's medical history, menstrual history and status of IUA. Library construction, sequencing, single cell data comparison and gene expression matrix construction were carried out in strict accordance with the single cell RNA sequencing process. Thereafter, the UMAP dimension reduction analysis of cell population and genetic analysis were carried out based on the cell types.@*RESULTS@#A total of 27 511 cell transcripts were obtained from four moderately graded IUA tissue samples and assigned to six cell lineages including T cells, mononuclear phagocytes, epithelial cells, fibroblasts, endothelial cells and erythrocytes. Compared with normal uterine tissue cells, the four samples showed different cell distribution, and the proportions of mononuclear phagocytes and T cells in sample IUA0202204 were significantly increased, suggesting a strong cellular immune response.@*CONCLUSION@#The cell diversity and heterogeneity of moderate IUA tissues have been described. Each cell subgroup has unique molecular characteristics, which may provide new clues for further study of the pathogenesis of IUA and heterogeneity among the patients.

Assessment of the prevalence of abnormal hysteroscopic findings in infertile women undergoing ART

Background: The endometrium plays an important role in implantation of good quality embryos in ART. Many studies have proved the negative impact of intra uterine pathologies on reproductive outcome whether spontaneous pregnancy or ART, because uterine anomalies may be associated with many obstetric complications such as miscarriage, preterm birth, premature rupture of membrane, malpresentation, postpartum bleeding and retained placenta. Aim of the work: This study aims to assess the prevalence of abnormal hysteroscopic findings among infertile women undergoing ART at Ain Shams Maternity University Hospital over the period from January 2007 to January 2017. Patients and Methods: This descriptive retrospective study was carried out on infertile couples planned for ART who were sent to ECDU for hysteroscopy in Early Cancer Detection Unit (ECDU), Ain Shams University Maternity Hospital. Case reports From January 2007 to January 2017 were reviewed. Results: The most prevalent congenital abnormality was endometrial polyp (18.4%) followed by uterine septum (6.9%). Conclusion: This study concluded that the most common uterine abnormality was endometrial polyp (18.4%), followed by uterine septum in 6.9% of patients. Also, thick endometrium was very common with a prevalence of 12.9%. Therefore, based on this high prevalence of abnormalities, this study is in agreement with the opinion that all women should be offered hysteroscopy, even if they have normal vaginal ultrasound and hysterosalpingography, because this is supposed to increase the detection rate of minor abnormalities, which theoretically will improve the reproductive outcome. Still, further interventional randomized controlled trials (RCT) are needed to verify the positive impact of routine use of hysteroscopy prior to ART

Lower Uterine Segment Fibroid Complicating Pregnancy: A Case Report.

Th e uterine fi broids are very common in the reproductive age group. During pregnancy, it may undergo rapid growth and red degeneration. It may get infected during puerperium. Most of the fi broids are asymptomatic. Women with fi broids may have infertility, a tendency for miscarriage, pre-term labor, placental abruption, placenta previa, fetal growth restrictions, fetal anomalies, postpartum hemorrhage, uterine dystocia, malpresentations and increased risk of caesarean. Here, we present 26-year-old primigravida who was admitted with 9 months of amenorrhea and anterior lower uterine segment intramural fi broid of size 7.2 cm × 7.1 cm on the right side. She conceived immediately after marriage. All Investigations were normal. She was delivered by a cesarean section. An alive female baby of 2.5 kg with good Apgar score. Th e indication was lower uterine segment fi broid. Th e liquor was meconium stained. Th ere was no sign of intrauterine growth restriction of the baby. Th e Doppler study, cardio-topography was normal before section. Th e post-operative period was uneventful. Th e patient was discharged and came for follow-up after a month and was found to be alright.

Pólipo endometrial, una causa infrecuente de sangrado genital anormal en la adolescencia / Endometrial polyp, a rare cause of abnormal genital bleeding in adolescence

Antecedentes: El sangrado genital anormal es una causa frecuente de consulta en la adolescencia. En este período, la principal causa de sangrado es la metrorragia asociada a ciclos anovulatorios producto de la inmadurez del eje hipotálamo-hipofisario-gonadal. Dentro de las causas infrecuentes de sangrado genital anormal en ese período está el pólipo endometrial. Caso clínico: Presentamos el caso de una niña de 13 años cuya causa de sangrado correspondió a un pólipo endometrial, sospechado por ultrasonografía, resecado mediante histeroscopia y confirmado mediante estudio histológico. Discusión: Pese a su baja incidencia, los pólipos endometriales deben ser considerados como parte del diagnóstico diferencial en adolescentes que consultan por trastorno menstrual, particularmente en aquellos casos sin respuesta a la terapia hormonal y donde la ultrasonografía muestra engrosamiento endometrial.

Background: Abnormal genital bleeding is a common cause of medical consultation in patients during adolescence. In this period, the main cause of genital bleeding is metrorrhagia in relation to anovulatory cycles due to immaturity of hypothalamus- pituitary-gonadal axis. Among the uncommon causes of bleeding at this age is the endometrial polyp. Case report: We report a 13 year old girl with abnormal uterine bleeding due to endometrial polyp, suspected during a pelvic ultrasound, removed by hysteroscopy, and confirmed by histological analysis. Discussion: Despite its low incidence, endometrial polyps should be included in the differential diagnosis of adolescents presenting menstrual disorders, particularly in those with no response to hormonal therapy and endometrial thickness in ultrasound.

Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section / Achados histeroscópicos em pacientes com sangramento pós-menstrual tipo escape com cesárea anterior

Objective: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.

Objetivo: Identificar os achados histeroscópicos uterino em grupo de pacientes com operação cesariana anterior e sangramento pós-menstrual tipo escape. Métodos: Foi realizado um estudo descritivo e prospectivo, com mulheres que compareceram em consultório em Ji-Paraná (RO), entre junho de 2008 e dezembro de 2009, com queixa de sangramento genital prolongado tipo escape após período menstrual. Destas, foram selecionadas 20 mulheres que apresentavam, simultaneamente, as seguintes características: ao menos uma cesárea prévia; idade entre 18 e 45 anos; sem uso de método anticoncepcional hormonal; e ausência de qualquer outra cirurgia uterina capaz de alterar a anatomia da cavidade. As pacientes selecionadas foram submetidas a exame histeroscópico. Resultados: À histeroscopia, em 90% das pacientes, observou-se, no terço final do colo, a presença da cicatriz de cesárea. Essa cicatriz causa, no interior da cavidade uterina, uma anomalia em sua anatomia, caracterizada pela visualização, na parede anterior, de uma dilatação seguida de retração, que proporciona a presença de pseudocavidade com profundidade e oclusão da luz em graus variáveis. Já em duas pacientes, não foi detectada a pseudocavidade. Conclusão: A pseudocavidade na cicatriz da cesariana é o achado mais freqüente à observação histeroscópica em pacientes com cesárea prévia e sangramento uterino anormal pós-menstrual tipo escape.

Patología uterina y su impacto en la fertilidad / Impact of uterine diseases on fertility

El útero es un órgano fundamental dentro del proceso reproductivo y participa en eventos claves, como el transporte espermático, la implantación y la nutrición fetal. Los miomas uterinos, las anomalías congénitas, los pólipos endometriales y las sinequias uterinas son las principales patologías uterinas en mujeres en edad reproductiva, y pueden ser causa de infertilidad, aborto recurrente o parto prematuro. De acuerdo a la evidencia, el tratamiento quirúrgico de miomas uterinos submucosos e intramurales (que distorsionan la cavidad uterina), pólipos endometriales y sinequias se asocia a un aumento significativo en las tasas de embarazo. El tratamiento quirúrgico del septum uterino disminuye significativamente la probabilidad de aborto a repetición y puede incrementar la probabilidad de embarazo en pacientes sin otra causa aparente de infertilidad. El tratamiento quirúrgico de miomas intramurales y subserosos (que no comprometen la cavidad endometrial) es controvertido y su indicación depende de la evaluación de cada caso en particular.

The uterus exerts an important role in the reproductive process and participates in key events, including sperm migration, embryo implantation and fetal nourishment. Uterine myomas, congenital anomalies, endometrial polyps and uterine synechia are the main diseases affecting women in reproductive age, and display a significant impact as asource of infertility, recurrent abortion or preterm labour. According to evidence, surgical treatment of submucous and intramural myomas (associated to uterine cavity distortion), endometrial polyps and uterine adhesions significantly improves pregnancy rates. Surgical treatment of uterine septum significantly decreases recurrent miscarriage rate and can increase odds of pregnancy in patients with no apparent cause of infertility. Surgical treatment in patients with intramural and subserous myomas (without endometrial cavity distortion) is controversial and treatment should be based on an individual basis.

Malformaciones uterinas en el Hospital Central de Maracay: revisión de 1999 a 2007 / Uterine malformations in the Hospital Central of Maracay: review of 1999-2007

Conocer la incidencia de malformaciones uterinas y describir las características clínicas asociadas. Estudio descriptivo, retrospectivo y epidemiológico de 24 pacientes egresadas con el diagnóstico de malformación uterina entre los años de 1999 a 2007. Departamento de Obstetricia y Ginecología del Hospital Central de Maracay. Las pacientes en 70,8 por ciento tenían edades comprendidas entre 16 y 25 años. El 50 por ciento eran primigestas. El 33,3 por ciento presentaba diagnóstico de ingreso por presentación fetal anómala. En el 66,6 por ciento de los casos el diagnóstico se realizó por visualización directa de la estructura. En el 62,5 por ciento la malformación más frecuente fue el útero didelfo. En 50 por ciento de los casos el resultado obstétrico fue la cesárea segmentaria. En cuanto al diagnóstico de ingreso el útero didelfo registra el 62,5 por ciento de los casos ingresados. Las mujeres con anomalías uterinas se reproducen normalmente. Las malformaciones uterinas por defectos de fusión de los ductos müllerianos son las más frecuentes. Esporádicamente pueden ser sintomáticas ameritando diagnóstico diferencial y tratamiento

To know the incidence of congenital uterine anomalies and the clinical presentations. Retrospective, epidemiological, descriptive study of 24 cases of patients with congenital uterine anomalies. Department of Obstetric and Gynecology, Hospital Central de Maracay. In the 70.8 percent the age was between 16 and 25 years. The 50 percent were primipara. The 33.3 percent had personal history of abnormal fetal positions. The 66.6 percent were detected by visualization of the uterus. In 62.5 percent the most frequent malformation was the uterus didelphys. In 50 percent the obstetric performance was the cesarean section. The reproductive performance didelphic reported 62.5 percent of patients. Women’s with Müllerian anomalies demonstrate no problems with conception. However comes to medical attention when become symptomatic because of poor obstetric performance

Laparoscopic evaluation in infertility

To describe the different causes of infertility based on findings of diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A cross-sectional study. Obstetrics and Gynaecology Unit of Hayatabad Medical Complex, Peshawar, from January to December 2005. All patients undergoing diagnostic laparoscopy for primary or secondary infertility were included. Male factor infertility cases was excluded. Frequency of the causes and finding was determined. One hundred and thirty six [70.46%] patients with primary and 57 [29.54%] with secondary infertility underwent diagnostic laparoscopy. Seventy [51.47%] with primary and 26 [45.51%] with secondary infertility had no visible abnormality. Bilateral tubal blockage was found in 32 [23.53%] primary and 16 [28.07%] cases of secondary infertility. Dense pelvic adhesions forming adnexal mass were found in 9 [6.61%] and 6 [10.5%] of primary and secondary respectively. Two cases each of bicornuate uterus and double uterus in primary infertility patients. Ovarian pathology was found in 18 [13.23%] primary and 4 [7.01%] cases of secondary infertility. PCO [polycystic ovaries] were detected in 12 [8.82%] and 2 [3.5%] cases of primary and secondary infertility respectively. Endometriotic cysts and deposits were found in 15 [10.29%] cases of primary and 3 [5.26%] cases of secondary infertility. Tubal disease is a common factor responsible for infertility and diagnositc laparoscopy is a valuable technique for complete assessment of female infertility and making treatment decisions according to the cause

Youssef's syndrome--report of 7 cases and review of literature.

Seven patients in their thirties presented with cyclical haematuria, apparent amenorrhoea and urinary continence following lower segment caesarean section. Investigations confirmed the diagnosis of Youssef's syndrome. Four patients who had 2 children each opted for hysterectomy. The remaining 3 patients had excision of the fistula with repair of uterus and bladder. In this group, at 6 years follow-up, in spite of conceiving, 2 patients aborted with no further pregnancy reported.

Metaplasia ósea del endometrio como causa de infertilidad / Bone metaplasia of the endometrium as a cause of infertility

Se presentan dos casos de Metaplasia ósea del endometrio en pacientes infértiles que son sometidas a Resección histeroscópica de fragmentos óseos con embarazo posterior.

Two cases of endometrial osseous metaplasia of the endometrium in infertile patients with ressection of bony tissue by histeroscopy, followed by pregnancy.

Uterine factor in repeated abortion, hysteroscopic, hysterographic and ultrasonographic study

Recurrent abortion is a frustrating problem due to the despair of being unproductive in spite of conception. Uterine factor represents a contributing element in that problem. This work comprised 120 patients presenting with history of recurrent abortion. All patients were subjected to careful history taking and clinical examination. Hysterography, ultrasonography and hysteroscopy were performed for all cases. It was revealed that hysteroscopy and hysterography were nearly equal in diagnosing uterine anomalies and both methods were superior to ultrasonogrphy. However, hysterography can not precisely differentiate bicornuate from septate uterus, whereas hysteroscopy was more informative about extent and thickness of the septum. As regard fibroid uterus, both hysteroscopy and hysterography were equal in diagnosing submucos myomata, whereas ultrasonography was much more superior in diagnosing intra-mural and subserous myomata. Operative hysteroscopy resulted in successful division of uterine septum in 89% of cases and incomplete procedure in 11% of cases. Hysteroscopic adhesiolysis of synechiae resulted in successful procedure in 55% of cases, incomplete procedure in 13% and failed procedure in 32% of cases

Pap smear examination of patients with leiomyoma.

The Pap smears of 309 patients with leiomyoma were examined at Siriraj Hospital between August 1983 and April 1984. Most of the smears were taken by VCE technique (vaginal scraping, ectocervical scraping and endocervical swabbing); the remainder, by CE or C only. The patients ranged in age from 23 to 66 years, the mean age +/- the standard deviation being 42.1 +/- 7.6 years. The cytological diagnoses were: a) 34.0 per cent abnormal smears, 62.4 per cent infection and 3.6 per cent abnormal cells of the uterine cervix and the endometrium; b) 34.6 per cent normal hormonal evaluation, 8.4 per cent high estrogen; and 5.2 per cent low estrogen with 51.8 per cent having no hormonal evaluation.

Patologia associada ao leiomioma uterino: revisäo de 600 casos / Pathology associated with uterine leiomyoma: review of 600 cases

Foram analisadas 600 pacientes com leiomioma uterino (LU), atendidas na Escola Paulista de Medicina, que se submeteram a terapêutica cirúrgica entre 1976 e 1987. O exame histopatológico das peças cirúrgicas confirmou a presença de neoplasia benigna e, na maioria das vezes, surpeendeu outras patologias associadas. Estudaram-se também, como grupo controle, 150 úteros (de histerectomias), procurando-se conhecer a freqüência dessas entidades patológicas associadas em näo portadoras de LU. As principais associaçöes encontradas foram: cervicite crônica, adenomiose, cistos foliculars, alteraçöes tubárias - congestäo, edema e processo inflamatório -, pólipos uterinos, hiperplasia endometrial, endometriose, neoplasias do ovário e do endométrio. A coexistência dessas condiçöes patológicas ocorreu em 71,17% dos casos. O leiomioma é a neoplasia mais freqüente do útero e da pelve (18,19). A coexistência do tumor com outras entidades patológicas é pouco citada na literatura, assim como suas possíveis inter-relaçöes. Por causa da alta freqüência do leiomioma na populaçäo, poder-se ia associa-lo, apenas de forma fortuita, a outras entidades nosológicas do trato genital. Interessados em saber se haveria patologias secundárias ao leiomioma ou coexistência meramente casual, e também se as associaçöes teriam o mesmo denominador comum, fizemos o presente estudo

Actinomicosis uterina causante de ureterohidronefrosis: reporte de un caso / Uterine actinomycosis causing hydroureteronephrosis: report of a case

Se realiza un recuento de las causas en la actinomicosis, su modo de trasmisión, período de incubación, diagnóstico y tratamiento de la misma. Se destaca la rareza de la afección, con la aparición de algunos órganos infectados. Presentamos un infrecuente caso de actinomicosis uterina confundida en el diagnóstico con una litiasis ureteral radiotransparente

Lochiauria: a new entity--(a case report).

Passage of menstrual blood only in the urine is termed as menouria, which is due to a supraisthmic utero-vesical fistula. Passage of lochia in the urine, instead of through the cervix has not been described in the literature. A case is described, and has been labelled lochiauria.

Uterine ballooning: an unusual hysterosalpingographic finding in cases of infertility

On interpretation of the hysterosalpingographic studies for cases of infertility three types of uterine ballooning were observed. These functional uterine lesions include; the diffuse regular, diffuse irregular and corneal types. A trial therapy with methergine tablets daily during the five fertile days around the mid-cycle resulted in three pregnancies, an observation which suggests the hypotonicity of uterus resulting in such ballooning