Uterine changes in transgender men receiving testosterone therapy.

OBJECTIVES: Despite regular gender-affirming hormone therapy (GAHT), the presence of uterine bleeding can occur occasionally and cause profound discomfort. This study aimed to evaluate the histologic features and immunohistochemical expression of estrogen (ER), progesterone (PR), and androgen receptors (AR) in the endometrium and myometrium of transgender men receiving testosterone therapy and relate them to clinical and hormonal characteristics. DESIGN: Retrospective cross-sectional study. METHODS: Thirty-four transgender men undergoing gender-affirming surgery were included. Clinical, sociodemographic, and laboratory data as well as anatomopathological and immunohistochemical findings were evaluated. RESULTS: The participants' mean age was 42.35 (SD, 10.00) years, and body mass index was 28.16 (SD, 5.52) kg/m2. The mean GAHT duration before surgery was 5.36 (SD, 3.24) years. The mean testosterone levels were 814.98 (SD, 407.13) ng/dL, and estradiol levels were 55.22 (SD, 25.27) pg/mL. The endometrium was atrophic in 61.8%, proliferative in 17.6%, and secretory in 20.6%. Immunohistochemical receptor analysis revealed that endometrial epithelial cells expressed ER (90%) and PR (80%), with a lower expression of AR (30%). In stromal tissue, the median ER, PR, and AR expression was lower than that in the epithelium (60%, 70%, and 25%, respectively). The myometrium showed high expression of PR (90%) and ER (70%), with the highest expression of AR (65%) being localized to this region. CONCLUSIONS: In the present study, GAHT induced an atrophic condition of the endometrium in two-thirds of the transgender men, with a limited AR expression in the endometrial region. The present results suggest that testosterone-based GAHT for a mean of 5 years is safe in transgender men achieving amenorrhea.

Características en resonancia magnética de la degeneración de leiomiomas / Characteristics in magnetic resonance of the degeneration of leiomyomas

Resumen La neoplasia ginecológica más frecuente son los leiomiomas uterinos, tumores benignos hormonodependientes que se generan del músculo liso del miometrio. Presentan una alta incidencia en mujeres en edad reproductiva entre la cuarta y quinta década de la vida y suelen disminuir con la menopausia. Generalmente son asintomáticos, pero a menudo se pueden acompañar de dismenorrea, metrorragia o infertilidad. El estudio inicial para su caracterización es la ecografía transvaginal; sin embargo, la resonancia magnética tiene un alto valor diagnóstico, ya que permite una evaluación más específica sobre el tipo, ubicación y número de leiomiomas, así como también permite identificar el tipo de degeneración y diferenciar entre leiomiomas y sus lesiones imitadoras. El objetivo principal de este manuscrito es abordar las principales características en resonancia magnética entre los distintos tipos de degeneración leiomiomatosa, siendo esta una causa de posible dolor abdominal y pélvico agudo.

Abstract The most common gynecological neoplasm is uterine leiomyomas, these are benign hormone-dependent tumors that are generated from the smooth muscle of the myometrium. They have a high incidence in women of reproductive age between the fourth and fifth decades of life and usually decrease with menopause. They are generally asymptomatic, but can often be accompanied by dysmenorrhea, metrorrhagia, or infertility. The initial study for its characterization is transvaginal ultrasound, however, magnetic resonance imaging has a high diagnostic value since it allows a more specific evaluation of the type, location and number of leiomyomas, as well as allowing the identification of the type of degeneration and differentiation. between leiomyomas and their mimic lesions. The main objective of this manuscript is to address the main characteristics in magnetic resonance between the different types of leiomyomatous degeneration, this being a cause of possible acute abdominal and pelvic pain.

Papel de las hormonas progesterona, estradiol y oxitocina en la función del miometrio durante el embarazo y el trabajo de parto / Role of progesterone, estradiol and oxytocin hormones in myometrial function during pregnancy and labor

Resumen El trabajo de parto es la transición de un estado de inactividad y relajación muscular a un estado de excitación, en el cual la capa muscular del útero (miometrio) realiza crecientes contracciones coordinadas para llevar a cabo la expulsión del feto y la placenta. Durante el inicio del trabajo de parto, el miometrio experimenta una serie de cambios fisiológicos, bioquímicos y moleculares, pasando de un estado de quiescencia a un fenotipo contráctil que inducirá el parto. En parte, esto es provocado por la acción de las hormonas progesterona, estradiol y oxitocina. En general, la progesterona mantiene la quiescencia del miometrio durante el embarazo al inhibir la expresión de moléculas proinflamatorias y proteínas asociadas a la contracción, mientras que al término del embarazo, el estradiol induce la expresión de dichas moléculas. Por su parte, la oxitocina induce un aumento en la concentración de calcio intracelular para llevar a cabo las contracciones de los miocitos uterinos. El objetivo del presente trabajo es presentar un resumen acerca de los mecanismos moleculares involucrados en la regulación de la actividad de las células miometriales por medio de las hormonas progesterona, estradiol y oxitocina, así como discutir las perspectivas de esta interesante área de investigación.

Abstract Labor is the transition from a state of inactivity and muscle relaxation to a state of muscle excitation, in which the muscular layer of the uterus (myometrium) performs increasingly coordinated contractions to deliver the fetus and expel the placenta. During the onset of labor, the myometrium undergoes a series of physiological, biochemical, and molecular changes, allowing the tissue to transition from a quiescent state to a contractile phenotype that will support labor. This is partly caused by the action of the hormones progesterone, estradiol, and oxytocin. In general, progesterone maintains the quiescence of the myometrium during pregnancy by decreasing the expression of proinflammatory molecules and contraction-associated proteins. In contrast, at the end of pregnancy, estradiol induces the expression of these molecules. For its part, oxytocin induces an increase in intracellular calcium concentration to carry out the contractions of uterine myocytes. The objective of this review is to present a summary of the molecular mechanisms involved in regulating myometrial cell activity through the hormones progesterone, estradiol and oxytocin, as well as to discuss the perspectives of this exciting area of research.

Aplicación de un balón de contrapulsación intraaórtico en procedimientos obstétricos. Reporte de caso / Use of an intra-aortic balloon pump in Obstetrics. Case report

Resumen ANTECEDENTES: Las anomalías en la inserción placentaria son cada vez más frecuentes en nuestro medio. En la atención de la paciente embarazada es importante la prevención de la pérdida hemática con balones de contrapulsación intraaórticos, como una opción útil. CASO CLÍNICO: Paciente de 38 años, embarazada, con antecedente de parto eutócico y sin enfermedades de interés, ni intervenciones quirúrgicas previas. El seguimiento prenatal se inició a las 17 semanas, con retraso diagnóstico debido a que continuaba en tratamiento anticonceptivo. La invasión trofoblástica estaba limitada al miometrio, sin evidencia de invasión a los órganos vecinos. Se le expusieron a la paciente las posibles complicaciones a fin de minimizar los riesgos de hemorragia masiva, potencialmente mortal en el momento del parto. Puesto que la paciente expresó no desear volver a embarazarse, se le recomendó la histerectomía poscesárea, dejando la placenta in situ. CONCLUSIONES: La oclusión endovascular con balón de contrapulsación intraaórtico es una opción segura y eficaz para minimizar la pérdida de sangre en casos de anomalías en la inserción placentaria. Además del clásico acceso por vía femoral es posible colocarlo por vía axilar, con igual efectividad. La baja tasa de complicaciones maternas y la seguridad, en términos de irradiación fetal, la convierten en una opción razonable en la atención de pacientes embarazadas en quienes se espera una alta pérdida sanguínea.

Abstract BACKGROUND: Anomalies of placental insertion are becoming increasingly common. Prevention of blood loss with intra-aortic counterpulsation balloons is a useful option in the care of pregnant patients. CLINICAL CASE: 38-year-old pregnant woman with a history of euthyroid delivery and no medical or surgical history. Prenatal follow-up was initiated at 17 weeks, with a delay in diagnosis due to the fact that she was still on contraceptive treatment. Trophoblastic invasion was limited to the myometrium with no evidence of invasion into adjacent organs. The patient was counseled on the potential complications to minimize the risk of massive, potentially fatal hemorrhage at delivery. As the patient did not wish to become pregnant again, a post-cesarean hysterectomy was recommended, leaving the placenta in situ. CONCLUSIONS: Endovascular occlusion with intra-aortic balloon counterpulsation is a safe and effective option to minimize blood loss in cases of placental insertion anomalies. In addition to the classical femoral approach, the axillary route can be used with equal efficacy. The low rate of maternal complications and the safety with respect to fetal irradiation make it a reasonable option in the management of pregnant patients in whom high blood loss is expected.

Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer?

SUMMARY OBJECTIVE: The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. METHODS: This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. RESULTS: The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. CONCLUSION: Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

Angiotensin-converting enzyme 2, the SARS-CoV-2 cellular receptor, is widely expressed in human myometrium and uterine leiomyoma.

OBJECTIVE: Angiotensin-converting-enzyme 2 (ACE2), the cell surface receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is found in a variety of reproductive tissues. The present study evaluated whether uterine fibroids and normal myometrium express ACE2 and, if so, at which tissue compartments. METHODS: We included 13 premenopausal women (age range 33-50 years, median 40 years) with uterine fibroids undergoing elective hysterectomy or myomectomy. Samples of leiomyoma (n = 12) and normal myometrial tissue (n = 8) were analyzed by immunohistochemistry for protein localization or by real time PCR for mRNA detection. RESULTS: In normal myometrium, ACE2 immunoreactivity was localized in smooth muscle fibers, arteriolar walls, and endothelial cells. In uterine leiomyoma, ACE2 staining was more intense in smooth muscle cells than in the extracellular matrix, and was also present in vascular endothelium. ACE2 mRNA was detected in myometrium as well as in fibroid samples. CONCLUSION: Human myometrium and uterine leiomyoma express ACE2 mRNA and have abundant distribution of ACE2 protein in their smooth muscle cells and microvasculature.

Evaluation of vitamin D receptor expression in uterine leiomyoma and nonneoplastic myometrial tissue: a cross-sectional controlled study.

BACKGROUND: Uterine myomas are the most frequent benign solid pelvic tumors in women of reproductive age. At present, uterine myomas are the most common indication for hysterectomy because of the morbidity they cause, including intense bleeding, compression of adjacent organs, pain, and infertility. Some studies show that vitamin D receptor (VDR) expression is correlated with the etiology of uterine leiomyomas. This study aimed to assess the expression of VDR in uterine leiomyoma and nonneoplastic myometrial tissue. METHODS: A controlled cross-sectional study involving 40 women who underwent abdominal hysterectomy the Department of Gynecology of the Getúlio Vargas Hospital of Federal University of Piauí, Brazil, was performed to compare the immunohistochemical expression of VDR in samples of uterine leiomyoma tissue with adjacent nonneoplastic myometrial tissue. The mean percetages of stained nuclei in the two groups was compared by Student's t teste, with significance established at p < 0.05. RESULTS: The percentage of cells with nuclei stained by anti-VDR in the myometrial and leiomyoma tissue was 79.52 % (± 4.32) and 60.22 % (± 7.24), respectively (p < 0.0001). CONCLUSIONS: The mean percentage of nuclei expressing VDR was significantly lower in the uterine leiomyoma than in nonneoplastic myometrial tissue.

The Myometrium in Pregnant Women with Obesity.

Obesity is a worldwide public health problem, affecting at least one-third of pregnant women. One of the main problems of obesity during pregnancy is the resulting high rate of cesarean section. The leading cause of this higher frequency of cesarean sections in obese women, compared with that in nonobese women, is an altered myometrial function that leads to lower frequency and potency of contractions. In this article, the disruptions of myometrial myocytes were reviewed in obese women during pregnancy that may explain the dysfunctional labor. The myometrium of obese women exhibited lower expression of connexin43, a lower function of the oxytocin receptor, and higher activity of the potassium channels. Adipokines, such as leptin, visfatin, and apelin, whose concentrations are higher in obese women, decreased myometrial contractility, perhaps by inhibiting the myometrial RhoA/ROCK pathway. The characteristically higher cholesterol levels of obese women alter myometrial myocyte cell membranes, especially the caveolae, inhibiting oxytocin receptor function, and increasing the K+ channel activity. All these changes in the myometrial cells or their environment decrease myometrial contractility, at least partially explaining the higher rate of cesarean of sections in obese women.

Mioma intraligamentario de gran tamaño en una adolescente / Intra-ligamentary leiomyoma of giant elements in adolescent patient

Resumen ANTECEDENTES: Los leiomiomas uterinos son los tumores benignos ginecológicos más frecuentes en las mujeres en edad reproductiva; por tanto, son extremadamente raros en las adolescentes (menos de 1%) y solo se encuentran reportes de caso en la bibliografía. CASO CLÍNICO: Paciente de 16 años, con tumor suprapúbico de rápido crecimiento, acompañado de dolor abdominal generalizado, enviada a la unidad médica con diagnóstico de miomatosis uterina para descartar su malignidad. El ultrasonido pélvico reportó múltiples lesiones hipoecoicas diseminadas en el miometrio, similares a metástasis. La tomografía abdomino-pélvica informó hepatomegalia, a expensas del lóbulo izquierdo y leiomiomas intramurales de medianos y grandes elementos; los marcadores tumorales se encontraron en límites normales. En la laparotomía se encontró una tumoración interligamentaria izquierda de 25 cm; el estudio histopatológico reportó: leiomioma uterino de patrón histológico convencional. CONCLUSIONES: El cuadro clínico de los leiomiomas en adolescentes representa un reto clínico por la edad, signos, síntomas y necesidad de preservación de la función reproductiva, aspectos decisivos a la hora de decidir el tratamiento.

Abstract BACKGROUND: The uterine leiomyomas are the most common gynecological benign tumors in fertile females; however, they are very rare in adolescents (less than 1%) and there are only a few reports in the literature. CLINICAL CASE: A 16-year-old patient with a fast-growing suprapubic tumor, accompanied by generalized abdominal pain, sent to the hospital with diagnosis of pelvic tumor probable uterine miomatosis, to rule out malignant tumor. Pelvic ultrasound was performed with a report of multiple disseminated hypoechoic lesions in myometrium giving appearance of metastasis, without being the characteristic images of myomas, pelvic abdominal tomography reported hepatomegaly of the left lobe, intramural leiomyomas of medium and large elements, tumor markers within normal limits. The laparotomy was performed, left intraligamentary myoma of giant elements was located; and the histopathological study reported uterine leiomyoma of conventional histological pattern. CONCLUSIONS: The clinical of leiomyomas in adolescent patients represents a challenge for the gynecologist. The age, symptomatology, and preservation of reproductive function are important aspects to decide the therapeutic regimen.

Evaluation of KI-67 expression in uterine leiomyoma and in healthy myometrium: a pilot study

SUMMARY OBJECTIVE Evaluate the expression of KI-67 in uterine leiomyomas and adjacent myometrial tissue and verify the existence of a correlation between clinical parameters and KI-67 expression in tumors. METHODS This is a cross-sectional, controlled, analytical study. Samples of leiomyomas and myometrium were obtained from patients who underwent hysterectomy. The samples were processed by immunohistochemistry using KI-67 antibody, and the expression was evaluated by two blinded observers. Student›s T-test was used for comparison of means, and Pearson›s P test for correlation with clinical parameters. RESULTS A total of 9 patients were included in the study. The mean age was 40.7 years, ranging from 35 to 44 years. The mean expression of KI-67 in myometrium was 1.63%, and, in leiomyomas, 5.96% (p <0.001). The highest expression of KI-67 was moderately related to the severity of anemia, bleeding, and pain level. CONCLUSION The expression of KI-67 in normal myometrium was significantly lower than in leiomyomas. The highest expression of KI-67 was moderately related to the severity of anemia, bleeding, and pain level in the patients of this study.

RESUMO OBJETIVO Avaliar a expressão do KI-67 em leiomiomas uterinos e tecido miometrial adjacente e verificar a existência de correlação entre parâmetros clínicos e expressão do KI-67 em tumores. MÉTODOS Estudo transversal, controlado e analítico. Amostras de leiomiomas e miométrio foram obtidas de pacientes que realizaram histerectomia. As amostras foram processadas por imuno-histoquímica utilizando anticorpo para KI-67 e a expressão avaliada por dois observadores cegos. O teste t de Student foi utilizado para comparação de médias e o teste P de Pearson para correlação com parâmetros clínicos. RESULTADOS Um total de 9 pacientes foi incluído no estudo. A idade média foi de 40,7 anos, variando de 35 a 44 anos. A expressão média do KI-67 no miométrio foi de 1,63% e nos leiomiomas de 5,96% (p <0,001). A maior expressão do KI-67 foi moderadamente relacionada com a gravidade da anemia, sangramento e nível de dor. CONCLUSÃO A expressão do KI-67 no miométrio normal foi significativamente menor que nos leiomiomas. A maior expressão do KI-67 foi moderadamente relacionada à gravidade da anemia, sangramento e nível de dor nos pacientes deste estudo.

Effect of neonatal exposure to endosulfan on myometrial adaptation during early pregnancy and labor in rats.

Proper myometrial adaptation during gestation is crucial for embryo implantation, pregnancy maintenance and parturition. Previously, we reported that neonatal exposure to endosulfan alters uterine development and induces implantation failures. The present work investigates the effects of endosulfan exposure on myometrial differentiation at the pre-implantation period, and myometrial activation during labor. Newborn female rats were s.c. injected with corn oil (vehicle) or 600 µg/kg/day of endosulfan (Endo600) on postnatal days (PND) 1, 3, 5 and 7. On PND90, the rats were mated to evaluate: i) the myometrial differentiation on gestational day 5 (GD5, pre-implantation period), by assessment myometrial histomorphology, smooth muscle cells (SMCs) proliferation, and expression of proteins involved in myometrial adaptation for embryo implantation (steroid receptors, Wnt7a and Hoxa10); ii) the timing of parturition and myometrial activation during labor by determining the uterine expression of contraction-associated genes (oxytocin receptor, OTXR; prostaglandin F2α receptor, PTGFR and connexin-43, Cx-43). Endosulfan decreased the thickness of both myometrial layers, with a concomitant decrease in the collagen remodeling. Blood vessels relative area in the interstitial connective tissue between muscle layers was also decreased. Endo600 group showed lower myometrial proliferation in association with a downregulation of Wnt7a and Hoxa10. Although in all females labor occurred on GD23, the exposure to endosulfan altered the timing of parturition, by inducing advancement in the initiation of labor. This alteration was associated with an increased uterine expression of OTXR, PTGFR and Cx-43. In conclusion, neonatal exposure to endosulfan produced long-term effects affecting myometrial adaptation during early pregnancy and labor. These alterations could be associated with the aberrant effects of endosulfan on the implantation process and the timing of parturition.

Útero de Couvelaire, consecuencia del desprendimiento prematuro de placenta normoinserta. Reporte de un caso / Couvelaire uterus, consequence of premature placental detachment. A case report

Resumen ANTECEDENTES El útero de Couvelaire, o apoplejía uteroplacentaria, es una infiltración hemática del miometrio uterino debida a la formación de un hematoma retroplacentario masivo. El útero de Couvelaire es una de las complicaciones más severas del desprendimiento prematuro de placenta; aparece en 0.4 a 1% de los embarazos. CASO CLÍNICO Paciente de 26 años de edad, primigesta, con 37 semanas de gestación y seis días establecidos por la fecha de la última menstruación, procedente de La Esperanza, Intibucá, Honduras. La paciente llegó al hospital con amaurosis, cifras tensionales elevadas, preeclampsia atípica y óbito extrahospitalario, con grado de maceración I. La paciente tuvo convulsiones, sin mayores datos. Al examen físico tuvo: presión arterial de 130-100 mmHg, Glasgow 10-15, frecuencia cardiaca fetal 0 lpm, altura de fondo uterino de 34 cm, dilatación del cuello uterino de 10 cm, altura de presentación +1 y presentación cefálica. Exámenes de laboratorio: proteinuria cualitativa +++, leucocitosis con predominio neutrofílico y creatinina aumentada. Los tiempos de coagulación se reportaron anormales. La paciente se recibió inestable en el servicio de Urgencias, por útero hipotónico. En la laparotomía exploradora se encontró al útero aumentado de tamaño, flácido, con infiltración de 90%, con predominio del lado izquierdo, diagnóstico compatible con útero de Couvelaire. CONCLUSIÓN Los hallazgos de útero de Couvelaire son excepcionales y deben tenerse en cuenta porque pueden resultar en mortalidad materna o fetal.

Abstract BACKGROUND Couvelaire uterus or uteroplacental apoplexy is a blood infiltration of the uterine myometrium due to the formation of a massive retroplacental hematoma. Couvelaire uterus is one of the most severe complications in placental detachment occurring in 0.4 to 1% of pregnancies. CLINIC CASE 26-year-old female patient, primigravida, with 37 weeks and six days given by her last menstruation day, from La Esperanza, Intibucá, Honduras. The patient presented amaurosis, high tension figures and extrahospitalary fetal death with maceration grade 1. Her mother refers the patient had seizures but she doesn't know the data. In the physical examination the patient had a blood pressure of 130/100 mmhg, glasglow 11/15, fetal heart rate of 0 bpm, uterine fundus height of 34 cm, cervix dilation of 10 cm, presentation height +1, and cephalic presentation. Laboratory tests included qualitative proteinuria +++, leukocytosis with neutrophilic predominance and increased creatinine levels. Coagulation times were reported abnormal. The patient was unstable so she was received in cubicle of severes by a hypotonic uterus. An exploratory laparotomy was performed by which the results were an enlarged flaccid uterus with 90% of infiltration with predominance in the left side, a diagnosis compatible with Couvelaire Uterus. CONCLUSION The findings of Couvelaire Uterus are infrequent, so we must take into account this pathology because it can lead to maternal and fetal mortality.

Morphological features of the uterus during postnatal development in the West African Dwarf goat (Capra hircus)

The knowledge of the age at which the West African Dwarf (WAD) goat attains puberty could be exploited to improve this breed of goat and intensify production. The objective of this study was to highlight the postnatal developmental morphology of the uterine tissues of the WAD goat from birth to 28 weeks of age. Fifty WAD goat kids were obtained and grouped into 10 groups of 5 goats per group from day old to week 28. The uterine tissues of euthanized goats were dissected out and examined grossly. Thereafter fixed uterine tissues were prepared for light microscopy and stained with haematoxylin and eosin. Histological images of the uterine tissues were captured with a moticam camera. The length and weight of the uterine horns increased significantly (P < 0.05) from birth to week 28 respectively. The uterine horn was shaped like a ram’s horn. Internally, caruncles were prominent at birth and were regularly arranged in the uterine horn but irregularly arranged in the uterine body. Caruncles were absent in the cranial one third of the uterine horns. Histologically, the uterine horn and uterine body were similar. The endometrium was very cellular at birth without any form of glandular development, while the myometrium and the stratum vasculare were ill defined. Endometrial glands were first observed at week 1. The pseudostratified columnar epithelium of the mucosa at birth changed to simple columnar by week 12. The endometrium and the myometrium were well developed by week 12. In conclusion, the uterus of WAD goat at week 12 appeared similar to the uterus of an adult WAD goat indicating that this goat probably attains puberty earlier than the five - seven months previously reported.

Morphological features of the uterus during postnatal development in the West African Dwarf goat (Capra hircus)

The knowledge of the age at which the West African Dwarf (WAD) goat attains puberty could be exploited to improve this breed of goat and intensify production. The objective of this study was to highlight the postnatal developmental morphology of the uterine tissues of the WAD goat from birth to 28 weeks of age. Fifty WAD goat kids were obtained and grouped into 10 groups of 5 goats per group from day old to week 28. The uterine tissues of euthanized goats were dissected out and examined grossly. Thereafter fixed uterine tissues were prepared for light microscopy and stained with haematoxylin and eosin. Histological images of the uterine tissues were captured with a moticam camera. The length and weight of the uterine horns increased significantly (P < 0.05) from birth to week 28 respectively. The uterine horn was shaped like a rams horn. Internally, caruncles were prominent at birth and were regularly arranged in the uterine horn but irregularly arranged in the uterine body. Caruncles were absent in the cranial one third of the uterine horns. Histologically, the uterine horn and uterine body were similar. The endometrium was very cellular at birth without any form of glandular development, while the myometrium and the stratum vasculare were ill defined. Endometrial glands were first observed at week 1. The pseudostratified columnar epithelium of the mucosa at birth changed to simple columnar by week 12. The endometrium and the myometrium were well developed by week 12. In conclusion, the uterus of WAD goat at week 12 appeared similar to the uterus of an adult WAD goat indicating that this goat probably attains puberty earlier than the five - seven months previously reported.(AU)

The Synergic In Vitro Tocolytic Effect of Nifedipine Plus Ritodrine on Human Myometrial Contractility.

Many pharmacological agents have been investigated to manage preterm labor; we postulate that a combination of tocolytic drugs may achieve a better effect in the prevention of uterine contractions without dose-dependent adverse effects. The aim of this study was to evaluate the inhibitory effect of dual combinations of tocolytics in vitro. Human myometrium was obtained during elective cesarean sections (term without labor; n = 40). Myometrial strips were placed in organ baths for the measurement of isometric tension. Contractile activity was induced by oxytocin (10-8 mol/L), then a concentration-response curve to single or dual combinations of tocolytics was started. All studied tocolytics (nifedipine, ritodrine, nitroglycerin, atosiban, and NS-1619), when used alone, significantly inhibited myometrial contractions. When combined, nifedipine plus ritodrine produced a significantly greater inhibition of contractility than each drug alone in the midrange of concentrations. The combination of nifedipine plus nitroglycerin or nifedipine plus atosiban produced a significantly greater inhibition than nitroglycerin or atosiban alone but not greater than nifedipine. The combination of nifedipine plus NS-1619 (Ca+2-activated K+ [BKCa] channel opener) reduced the inhibitory effect of each drug. We concluded that a selected combination of tocolytics (nifedipine plus ritodrine) produced a significantly greater inhibitory effect on contractility than each drug alone at intermediate concentrations. Thus, specific combinations of tocolytics with different intracellular signaling pathways may have a synergic effect constituting a provocative new option for preterm labor treatment.

ATP-binding cassette transporters in reproduction: a new frontier.

BACKGROUND: The transmembrane ATP-binding cassette (ABC) transporters actively efflux an array of clinically relevant compounds across biological barriers, and modulate biodistribution of many physiological and pharmacological factors. To date, over 48 ABC transporters have been identified and shown to be directly and indirectly involved in peri-implantation events and fetal/placental development. They efflux cholesterol, steroid hormones, vitamins, cytokines, chemokines, prostaglandins, diverse xenobiotics and environmental toxins, playing a critical role in regulating drug disposition, immunological responses and lipid trafficking, as well as preventing fetal accumulation of drugs and environmental toxins. METHODS: This review examines ABC transporters as important mediators of placental barrier functions and key reproductive processes. Expression, localization and function of all identified ABC transporters were systematically reviewed using PubMed and Google Scholar websites to identify relevant studies examining ABC transporters in reproductive tissues in physiological and pathophysiological states. Only reports written in English were incorporated with no restriction on year of publication. While a major focus has been placed on the human, extensive evidence from animal studies is utilized to describe current understanding of the regulation and function of ABC transporters relevant to human reproduction. RESULTS: ABC transporters are modulators of steroidogenesis, fertilization, implantation, nutrient transport and immunological responses, and function as 'gatekeepers' at various barrier sites (i.e. blood-testes barrier and placenta) against potentially harmful xenobiotic factors, including drugs and environmental toxins. These roles appear to be species dependent and change as a function of gestation and development. The best-described ABC transporters in reproductive tissues (primarily in the placenta) are the multidrug transporters p-glycoprotein and breast cancer-related protein, the multidrug resistance proteins 1 through 5 and the cholesterol transporters ABCA1 and ABCG1. CONCLUSIONS: The ABC transporters have various roles across multiple reproductive tissues. Knowledge of efflux direction, tissue distribution, substrate specificity and regulation of the ABC transporters in the placenta and other reproductive tissues is rapidly expanding. This will allow better understanding of the disposition of specific substrates within reproductive tissues, and facilitate development of novel treatments for reproductive disorders as well as improved approaches to protecting the developing fetus.

Histologia e morfometria em cornos uterinos de cadelas nulíparas, multíparas e tratadas com contraceptivos / Histology and morphometry in uterus horns of nulliparous bitches, multiparous ones and bitches treated with contraceptives

Dados histológicos e morfométricos foram obtidos de útero de cadelas nulíparas (n=6), multíparas (n=6) e de cadelas tratadas com contraceptivo (n=6). Para esse fim foram usadas seis amostras de cornos uterinos, em corte médio, para cada grupo. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, miométrio externo, estrato vascular e diâmetro das glândulas endometriais normais não foram estatisticamente significantes entre as cadelas multíparas e tratadas, com exceção para a altura do epitélio de glândulas normais. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, diâmetro das glândulas normais e altura do epitélio glandular foram significantes, comparando cadelas nulíparas com as multíparas e/ou tratadas, com exceção para as espessuras do miométrio externo e estrato vascular. Diante dos resultados obtidos, pode-se concluir que os dados numéricos confirmam que (1) o uso de anticoncepcionais e sucessivas gestações afetam a estrutura uterina em seu total; (2) o miométrio externo e estrato vascular foram as regiões que menos sofreram alterações comparando-se os 3 grupos; (3) as variações morfológicas ocorreram com a mesma intensidade no endométrio e miométrio totais para as cadelas tratadas e multíparas, e (4) a presença de glândulas endometriais dilatadas foi o diferencial encontrado nas cadelas tratadas, pois as mesmas estavam ausentes nas multíparas e nulíparas.

Histological and morphometric data were obtained from uterus of nulliparous bitches (n=6), multiparous ones (n=6), and bitches treated with contraceptive (n=6). Six samples of uterine horns, cut in average for each group. Measurements of the thickness of the uterine wall, total endometrium, total myometrium, internal myometrium, external myometrium, vascular layer and diameter of normal endometrial glands were not statistically significant between the treated and multiparous bitches, except for the height of the epithelium of normal glands. Measurements of thickness of the uterine wall, total endometrium, total myometrium, myometrium internal diameter and height of the glands of normal glandular epithelium were significant, comparing nulliparous with multiparous bitches and/or treated, except for thickness of the myometrium and vascular outer layer. It can be concluded that (1) the use of contraceptives and successive pregnancies affected uterine structures in its full, (2) the vascular layer and external myometrium were the regions with less variation, (3) morphological changes occurred with the same intensity in the total endometrium and myometrium of treated and multiparous bitches; and (4) the presence of dilated endometrial glands was the difference found in the treated bitches, because they were absent in nulliparous and multiparous ones.

Histologia e morfometria em cornos uterinos de cadelas nulíparas, multíparas e tratadas com contraceptivos / Histology and morphometry in uterus horns of nulliparous bitches, multiparous ones and bitches treated with contraceptives

Dados histológicos e morfométricos foram obtidos de útero de cadelas nulíparas (n=6), multíparas (n=6) e de cadelas tratadas com contraceptivo (n=6). Para esse fim foram usadas seis amostras de cornos uterinos, em corte médio, para cada grupo. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, miométrio externo, estrato vascular e diâmetro das glândulas endometriais normais não foram estatisticamente significantes entre as cadelas multíparas e tratadas, com exceção para a altura do epitélio de glândulas normais. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, diâmetro das glândulas normais e altura do epitélio glandular foram significantes, comparando cadelas nulíparas com as multíparas e/ou tratadas, com exceção para as espessuras do miométrio externo e estrato vascular. Diante dos resultados obtidos, pode-se concluir que os dados numéricos confirmam que (1) o uso de anticoncepcionais e sucessivas gestações afetam a estrutura uterina em seu total; (2) o miométrio externo e estrato vascular foram as regiões que menos sofreram alterações comparando-se os 3 grupos; (3) as variações morfológicas ocorreram com a mesma intensidade no endométrio e miométrio totais para as cadelas tratadas e multíparas, e (4) a presença de glândulas endometriais dilatadas foi o diferencial encontrado nas cadelas tratadas, pois as mesmas estavam ausentes nas multíparas e nulíparas.(AU)

Histological and morphometric data were obtained from uterus of nulliparous bitches (n=6), multiparous ones (n=6), and bitches treated with contraceptive (n=6). Six samples of uterine horns, cut in average for each group. Measurements of the thickness of the uterine wall, total endometrium, total myometrium, internal myometrium, external myometrium, vascular layer and diameter of normal endometrial glands were not statistically significant between the treated and multiparous bitches, except for the height of the epithelium of normal glands. Measurements of thickness of the uterine wall, total endometrium, total myometrium, myometrium internal diameter and height of the glands of normal glandular epithelium were significant, comparing nulliparous with multiparous bitches and/or treated, except for thickness of the myometrium and vascular outer layer. It can be concluded that (1) the use of contraceptives and successive pregnancies affected uterine structures in its full, (2) the vascular layer and external myometrium were the regions with less variation, (3) morphological changes occurred with the same intensity in the total endometrium and myometrium of treated and multiparous bitches; and (4) the presence of dilated endometrial glands was the difference found in the treated bitches, because they were absent in nulliparous and multiparous ones.(AU)

Gravidez ectópica na cicatriz uterina de cesárea: relato de caso / Cesarean scar ectopic pregnancy: a case report

Gravidez ectópica na cicatriz de cesárea é a forma mais rara de gravidez ectópica e provavelmente uma das mais perigosas em função dos riscos de ruptura e hemorragia volumosa. Essa situação deve ser diferenciada da gravidez cervical e de abortamento em curso, para que o tratamento apropriado seja imediatamente oferecido. Desde o advento da ultra-sonografia transvaginal, a gravidez ectópica na cicatriz de cesárea pode ser diagnosticada precocemente na gestação e, para isso o ultra-sonografista deve estar familiarizado com e atento aos critérios diagnósticos, especialmente em mulheres com cicatriz de cesárea prévia. Descrevemos aqui um caso de gravidez ectópica em cicatriz de cesárea, cujo diagnóstico foi tardio, havendo apresentação de involução espontânea.

Ectopic pregnancy in a cesarean scar is the rarest form of ectopic pregnancy and probably the most dangerous one because of the risk of uterine rupture and massive hemorrhage. This condition must be distinguished from cervical pregnancy and spontaneous abortion in progress, so that the appropriate treatment can be immediately offered. Since the advent of endovaginal ultrasonography, ectopic pregnancy in a cesarean scar can be diagnosed early in pregnancy if the sonographer is familiarized with the diagnostic criteria of this situation, especially in women with previous cesarean scar. Here we describe a case of ectopic pregnancy in a cesarean scar in which the diagnosis was considerably late, with presentation of spontaneous regression.

Studies on zoapatle, II. Leucanthanolide, a novel sesquiterpene lactone from Montanoa leucantha ssp. leucantha.

PIP: A sesquiterpene lactone given the trivial name leucanthanolide, from the Mexican zoapatle plant (Montanoa leucantha), long used as an herbal remedy, was isolated and was found to have cytotoxicity but no uterine activity. The compound was isolated from the fraction containing zoapatanol, a substance being investigated for its ability to induce menses, abortion and labor. The compound has a molecular formula of C19H2606, a 5-membered lactone ring, an ester group, and a germacradienolide skeleton. It was evaluated for abortifacient activity in pregnant guinea pigs by intraperitoneal injection on day 22 of gestation. 3 of 5 animals had abnormal fetuses, but there was no evidence of early uterine activity. Cytotoxic testing in vitro was done on KB and P-388 test systems in cell culture. The ED50 of leucanthanolide was 0.57 mcg/ml (KB) and 0.93 (P-388). In comparison, the ethyl acetate fraction had an ED50 of 1.35 mcg/ml and 5.2 mcg/ml respectively.^ieng