Characterization and localization of estrogen and progesterone receptors of human fallopian tube.

The cellular distribution of estrogen and progesterone receptors (ER and PR) in the human fallopian tube was investigated by immunohistochemical localization with specific monoclonal antibodies. Nuclear immunostaining was observed. Intense PR immunostaining was seen in tissues obtained at mid cycle and luteal stages of the normal menstrual cycle. On the other hand, enhanced staining for ER was seen in early follicular phase and mid cycle. Menopausal tissues showed negligible staining for both ER and PR. The ER and PR were characterized for their molecular size, anatomical distribution and levels during the menstrual cycle and in menopause. ER protein was present throughout the cycle and also during menopause. Western blot analysis revealed two forms of ER approximately 66 kDa and a truncated from approximately 49 kDa in hFT. Presence of A [approximately 90 kDa] and B [approximately 120 kDa] isoforms of human PR was detected. Follicular and early luteal tissue possessed relatively high concentration of immunoreactive PR whereas it was almost undetectable in menopausal tissues. These results suggests that ER and PR are regulated by the changing ovarian steroid hormones.

Effect of estrogen and progesterone on newly synthesised and released human fallopian tube specific proteins.

Current study was carried out to identify the profile of newly synthesized and released proteins by human fallopian tube (hFT). Results indicated that hFT during menopause synthesised and released only 2-3 proteins as against several proteins ranging from molecular weight (MW) approximately 20 to approximately 130 kD during normal menstrual cycle. In vitro addition of estradiol-17 beta (E2) resulted in synthesis and release of a number of proteins including specific protein of MW 110-130 kD. Addition of progesterone (P) however, led to inhibition of protein synthesis and a combination of E2 and P negated the effect of the latter. An alteration in oviductal secretory protein-profile following addition of E2 in vitro were similar to that observed during normal menstrual cycle.

Isthmico-cervical ectopic pregnancy following caesarean section.

A 30 year old woman (gravida 4, para 2) presented with 2 1/2 mth amenorrhoea and vaginal spotting. On bimanual pelvic examination, an old tear was felt on posterior cervical lip with enlarged cervix and normal sized uterus. Ultrasonography revealed ectopic pregnancy with placenta implanted on isthmus and upper cervix. Dilatation and curettage was done with cervical packing.

A multiple dose comparison of ketorolac tromethamine with ibuprofen for analgesic activity.

This study was done to compare a new analgesic ketorolac with ibuprofen in post-operative and post-laparoscopy pain. A total of 40 patients were recruited for the study of which 20 were post-operative and 20 were post-laparoscopy cases. Medication was given over a period of 48 hours after surgery and a pain score based on subjective symptoms was monitored at fixed intervals after each dose. The analgesic efficacy of ketorolac was found to be comparable to that of ibuprofen and the drug was well tolerated in the doses used without any extra medication being required.

Hemihaematometra with persistent undeveloped Wolffian duct.

A case of hemihaematometra in a non-communicating rudimentary horn of the uterus in a 14 year old girl is presented. Exploratory laparotomy revealed a persistent undeveloped Wolffian duct. This is the second case in world literature where a persistent mesonephric duct without any development is reported.

Enhancement of colposcopic image by sulphosalicylic acid.

Acetic acid is used conventionally for enhancement of the colposcopic image. We used sulphosalicylic acid instead of acetic acid in 50 normal cases. The normal appearance was enhanced in all cases. The image was also enhanced in 70% cases of cervical intraepithelial neoplasia and 90% cases of cervical condyloma accuminata. The image was not inferior to that with acetic acid in any of the cases.

Significance of negative hysteroscopic view in abnormal uterine bleeding.

Ninety six cases of abnormal uterine bleeding were evaluated by both panoramic hysteroscopy and dilatation and curettage. The indications for hysteroscopy included postmenopausal bleeding, infertility with abnormal bleeding, abnormal bleeding and suspected leiomyoma with bleeding. Twenty three patients had abnormal hysteroscopy findings. Hysteroscopy diagnosed endometrial polyp and submucus leiomyoma with 100% accuracy. In 17 cases, the results of hysteroscopy and curettage were in agreement and hysteroscopy revealed more information than curettage in 6 cases. Among the remaining 73 cases with 'negative' hysteroscopic view, an abnormality was detected by tissue sampling in only 2 patients. The specificity and positive predictive value of hysteroscopy is 100%. The sensitivity of hysteroscopy was greater (92%) than that of curettage (76%) and the negative predictive value of hysteroscopy was 2.8%. Thus, panoramic hysteroscopy may prove to be superior to curettage in making an accurate diagnosis of intrauterine pathology.

Recurrent hydramnios as a result of fetal Bartter's syndrome (a case report).

Bartter's syndrome has been reported as a rare case of hydramnios. A unique case of recurrent hydramnios in pregnancy as a result of fetal Bartter's syndrome on both occasions is presented.

Ectopic pregnancy after tubal sterilization.

We report 13 cases of ectopic pregnancy following tubal ligation out of 287 ectopic pregnancies seen during a six year period (1984-1989). These findings suggest that tubal sterilization does not invariably confer infertility. Ectopic pregnancy must not be disregarded in women who have undergone tubal ligation, especially if two or more years have elapsed since the sterilization.

PIP: This study of ectopic pregnancy reports an incidence of 13 (4.53%) out of 287 ectopic pregnancies between 1984-89 in a Bombay hospital which occurred after tubal sterilization. 6 had a ruptured ectopic pregnancy, 5 unruptured, and 2 with a chronic ectopic gestation. Bilateral salpingectomy should be performed when exploring for an ectopic pregnancy after sterilization. Although the failure of voluntary sterilization is small, 15-20% are likely to be ectopic pregnancies. In this study, 84.6% occurred 1 year after sterilization. Physicians should be alerted to the possibility of ectopic pregnancy, particularly if 2 or more years have elapsed, because of the maternal mortality risk. The risk of ectopic pregnancy is 12.5% for women undergoing tubal ligation had they continued previous contraception, which is less than observed among normal women. An uncorrected incidence rate of .64/10,000 sterilizations has been reported and 7.7/100 pregnancies conceived after tubal ligation. The explanation given is that recanalization or formation of a tuboperitoneal fistula occurs. The opening is small enough for sperm to pass through but too small for the fertilized ovum, which results in implantation in the distal tubal segment. Another possibility is the formation of blind pouches or slitlike spaces in the abnormal reconstitution of the tubal lumen, which increases the likelihood of ectopic implantation. There may also be development of tuboperitoneal fistulas associated with endometriosis, particularly when the site is within 4 cm of the cornua, which is a probable point of implantation. Fluid movement within the remaining tubal segments may influence implantation. Sterilization was performed in 92.3% of the study patients in conjunction with medical termination of pregnancy or puerperium. When sterilization is performed during the postpartum period, the incidence of ectopic pregnancy is higher because of incomplete occlusion of the tubal lumen due to the edematous, friable, and congested fallopian tubes. A recommended procedure in laparoscopic sterilization to avoid failure of silastic band application is to "milk" the fallopian tube several times by drawing it in and out of the applicator sheath before applying the band. Then, examine carefully for a vertical crease between the 2 limbs of the loop and blanching of the banded tubal segment. Extra caution and meticulous technique are required to avoid failure. Physician and patients awareness about the possibility and risk of extra- and intrauterine gestation following all methods of sterilization is necessary.

Cystic degeneration in an adenomyoma (a case report).

Cystic degeneration though often seen in a leiomyoma, has not been reported so far in an adenomyoma. Hence, a unique case of cystic degeneration in an adenomyoma of the uterus is presented.

Persistent undeveloped mesonephric duct (a case report).

The mesonephric duct may fail to develop, resulting in congenital absence of the kidney and ureter. A unique case of persistence of the mesonephric duct without development into the kidney and ureter is presented.

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.

Post-hysterectomy broad ligament haematoma: a complication of vaginal packing? (A case report).

With meticulous surgical technique, bleeding following vaginal hysterectomy and colporrhaphy is an unusual complication. With exteriorization of the stumps, any such haemorrhage is revealed in the form of vaginal bleeding. Two unusual cases of perivesical and broad ligament hematoma are presented and the possible role of vaginal packing in the development of such bleeding is discussed.

Early puerperal laparoscopic sterilization--a new technique.

PIP: This paper describes the results of 23 cases of puerperal laparoscopic sterilization performed within 72 hours of delivery. A new method was employed to avoid injury to the uterine fundus and to make the tubes more accessible. Before insertion of the Veress needle, the anterior and posterior lips of the cervix were held with forceps and Hulka's uterine manipulator was introduced into the uterine cavity. The uterus was pulled down toward the introitus by applying traction to the sponge-holding forceps. Pneumoperitoneum of 3-4 liters was induced through use of a Veress needle, followed by introduction of a Storz single puncture operative laparoscope through an incision in the lower umbilical fold. Tubal occlusion was achieved with silastic bands. The average time required for sterilization from induction of general anesthesia was 6 minutes. There was no instance of injury to the uterine fundus, nor were there any cases of uterine perforation, injury to other pelvic structures, laceration of the cervix, or puerperal sepsis. At the time of follow-up 15 days after the procedure, all patients were in satisfactory condition. It is concluded that this method can enhance postpartum family planning programs. Since it can be carried out within the 1st 48 hours after delivery, the routine hospital stay of 3 days does not have to be prolonged as a result of sterilization.^ieng