Histomorphometric evaluation of cannabinoid receptor and anandamide modulating enzyme expression in the human endometrium through the menstrual cycle.

Plasma anandamide (AEA) levels fluctuate throughout the menstrual cycle and in early pregnancy in a pattern suggesting its involvement in implantation and early pregnancy maintenance through mechanisms that might involve its binding to cannabinoid receptors CB1 and CB2. Plasma AEA levels are maintained by the actions of the enzymes fatty acid amide hydrolase (FAAH) and N-acylphosphatidylethanolamine-phospholipase D (NAPE-PLD). All of these component parts of the 'endocannabinoid system' have been demonstrated in rodent but not in human uteri. This study aimed to demonstrate the presence of the endocannabinoid system in the human uterus and catalogue its modulation. Immunohistochemical techniques were employed to localise and determine the distribution of immunoreactive CB1, CB2, FAAH, and NAPE-PLD in well-characterised menstrual cycle biopsy samples. Immunoreactive CB1 and CB2 were widely distributed throughout the uterine tissue. In the myometrium and endometrium, smooth muscle cells were immunoreactive, although the vascular smooth muscle cells in both tissues were more so. In the endometrium, CB1 and CB2 immunoreactivity was primarily restricted to the glandular epithelium and expression was unrelated to the phase of the cycle. FAAH immunoreactivity in the endometrium was highest in the mid-proliferative gland and mid-secretory stroma, whilst NAPE-PLD immunoreactivity was down-regulated in the secretory epithelial gland compared to the proliferative epithelial gland and unaffected in the stroma. These data indicate that elements of the 'endocannabinoid system' coexist in many cell types within the uterus and may provide insight into the sites of action of endogenous and exogenous cannabinoids during endometrial transformation.

Uterine adenomyosis is associated with ultrastructural features of altered contractility in the inner myometrium.

OBJECTIVE: To study the ultrastructure of the inner and outer myometrium, in the presence and absence of uterine adenomyosis. DESIGN: Case control blinded comparison. SETTING: University departments. PATIENT(S): Four premenopausal women with and six without uterine adenomyosis as the sole pathology. INTERVENTION(S): Multiple samples were studied using transmission electron microscopy. MAIN OUTCOME MEASURE(S): Ultrastructure feature of the myometrium. RESULT(S): In uteri with adenomyosis, the myocytes exhibited cellular hypertrophy. The cytoplasmic myofilaments were less abundant. Abundant intermediate filaments formed cytoplasmic aggregates. The nuclei had a smooth outline with a clear ground substance, prominent nucleoli and peripherally arranged nuclear chromatin. There was occasional infolding of the nuclear envelope with entrapment of cytoplasmic organelles. The sarcolemmal bands were significantly longer and there were fewer caveolae. The perinuclear cell organelles were more distinct. The rough endoplasmic reticulum and Golgi apparatus were more prominent, denoting active protein synthesis, consistent with the observed cellular hypertrophy. All features were more prominent at the junctional zone. CONCLUSION(S): Smooth muscle cells from uteri with adenomyosis are ultrastructurally different from smooth muscle cells of normal uteri. These distinct features suggest a possible effect on myometrial contractility, together with hypertrophy.

Patient initiated home blood pressure recordings are accurate in hypertensive pregnant women.

OBJECTIVE: We undertook this study to determine the accuracy and reliability of patient initiated blood pressure measurement and recording. METHODS: We recruited 72 women from the antenatal hypertension clinic in a university teaching hospital. All were at high risk for preeclampsia and were asked to measure and record their blood pressure three times per day at home using a validated blood pressure device with an internal memory. RESULTS: From 979 measurements taken only 28 (2.9% were inaccurate). The inaccurate readings were restricted to three women. On further questioning two women admitted that the device had been used by other family members thus making comparison with the memory impossible. Thus the true nonconcordance rate amongst participants was 1/72 (1.4%). CONCLUSIONS: We conclude that blood pressure recordings taken and documented by high-risk women at home are accurate. This allows more frequent measurements to be taken without the inconvenience of additional visits to hospital and may therefore lead to the earlier detection of preeclampsia.