ABSTRACT
OBJECTIVE: Endometrial polyp is a common cause of abnormal uterine bleeding, but the etiology and pathogenesis remain unclear. Vascular endothelial growth factor (VEGF) is angiogenic, related to thick walled vessels and transforming growth factor-beta1 (TGF-ß1) is related to fibrotic tissue, which are characteristics of endometrial polyps. The primary objective of this study was to find out if endometrial polyp formation is associated with increased expression of VEGF or TGF-ß1, or both. A secondary objective is to determine if the changes are related to steroid receptor expression. STUDY DESIGN: This prospective study compared VEGF and TGF-ß1 expression of endometrial polyps and adjacent endometrial tissue in 70 premenopausal women. The comparison of results was separately made for endometrium specimens obtained in the proliferative and secretory phases. The results were correlated with the steroid receptors (estrogen receptor and progesterone receptor) expression. RESULTS: The score of VEGF in glandular cells of endometrial polyps was significantly higher than the score in adjacent endometrium, both in the proliferative phase (P<0.001) and the secretory phase (P=0.03); the score of VEGF in stromal cells of endometrial polyps was significantly higher than the score in adjacent endometrium only in proliferative phase (P=0.006). The score of TGF-ß1 in glandular cells of endometrial polyps was significantly higher than the score in adjacent endometrium in proliferative phase (P=0.02); whereas the score of TGF-ß1 in stromal cells of endometrial polyps was significantly higher than the score in adjacent endometrium, both in the proliferative phase (P=0.006) and the secretory phase (P=0.008). There was a significant correlation between the expression of steroid receptors and VEGF and TGF-ß1 (Spearman's correlation P<0.001 and P<0.05, respectively). CONCLUSIONS: There was increased expression of TGF-ß1 and VEGF in polyps compared to adjacent normal endometrial tissue. It suggested that these cytokines might play a role in endometrial polyp formation. In addition, there was a significant correlation between steroid receptor expression and VEGF and TGF-ß1 expression.
Subject(s)
Endometrium/metabolism , Polyps/metabolism , Transforming Growth Factor beta1/metabolism , Up-Regulation , Uterine Diseases/metabolism , Vascular Endothelial Growth Factor A/metabolism , Adult , Biopsy , Endometrium/immunology , Endometrium/pathology , Female , Follicular Phase/metabolism , Humans , Hysteroscopy , Immunohistochemistry , Luteal Phase/metabolism , Middle Aged , Polyps/immunology , Polyps/pathology , Prospective Studies , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Stromal Cells , Uterine Diseases/immunology , Uterine Diseases/pathology , Young AdultABSTRACT
Objective To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. Methods Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. Results Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. Conclusions The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.
