Arterial Blood Supply of the Mesosalpinx Appears Segmentally Organized in Absence of Uterine Tubes Arteries.

Arterial branches to the uterus and ovaries that pass through the mesosalpinx contribute significantly to the maintenance of the ovarian reserve. Especially arterial supply of the uterine tube is provided by a number of anastomoses between both the uterine and ovarian vessels. Knowledge on the morphologic peculiarities will allow to identify main contributors especially blood flow ultrasound examination for the purpose of ovary preserving surgery. This study aimed at identifying landmarks especially for so-called low-flow tubal vessels. Arteries of 17 female Thiel-embalmed bodies were studied along three preselected paramedian segments and measurements taken. A section was made through the center of the ovary perpendicular to uterine tube, then the mesosalpinx tissue distance was divided into 3 equivalent zones: upper, middle and lower thirds. The surface area of the mesosalpinx averaged 1088 ± 62 mm2. 47.7 ± 7.1 % of the mesosalpinx zones included macroscopically visible vessels. The lower third segment of mesosalpinx was the thickest averaging 2.4 ± 1.5 mm. One to three tubal branches were identified in the middle third of the mesosalpinx. Arterial anastomoses were found in the upper segment of the mesosalpinx, but no presence of a marginal vessel supplying the fallopian tube could be found. Statistically significant moderate positive correlations were established between the diameters of the mesosalpingeal arteries between the three zones. The mesosalpinx, uterine tube and the ovary form areas of segmental blood supply. Variants of tubal vessels appear to be a sparse source of blood supply.

Effect of nano-particles on MHD flow of tangent hyperbolic fluid in a ciliated tube: an application to fallopian tube.

This study shows the effects of magnetic field and copper nanoparticles on the flow of tangent hyperbolic fluid (blood) through a ciliated tube (fallopian tube). The present study will be very helpful for those patients who are facing blood clotting in fallopian tube that may cause for infertility or cancer. The nanoparticles and magnetic field are very helpful to break the clots in blood flowing in fallopian tube. Since blood flows in fallopian tube due to ciliary movement, therefore medicines containing copper nanoparticles and magnetic field with radiation therapy help to improve the patient. Ciliary movement has a particular pattern of motion i.e., metachronal wavy motion which helps to fluid flow. For the forced convective MHD flow of tangent hyperbolic nano-fluid, momentum and energy equations are solved by the small Reynolds' number approximation and Adomian decomposition method by constructing the recursive relation of ADM and solved by software "MATHEMATICA". The effects of parameters such as nanoparticle volume fraction, Hartmann number, entropy generation and Bejan's number have been discussed through graphs plotted in software "MATHEMATICA". It is found that blood flow is accelerated and heat transfer enhancement is maximum in the presence of nano particles, also magnetic effects accelerates the blood flow and help to enhance the heat transfer whereas the presence of porous medium increases the fluid's velocity and reduce the transfer of heat through fluid flow.

Partial tubal devascularisation: a novel procedure for tubal conservation in ectopic pregnancy.

Ectopic pregnancy is a serious condition that complicates 1-2% of pregnancies. Using surgical management is efficient, but may have an impact on future fertility. Although conservative tubal surgery has not been shown to have a significant advantage over a salpingectomy in terms of the future fertility potential, the conservative surgical techniques remain widely-utilised, particularly in the context of a contralateral diseased or absent tube. We hereby report a case series of a novel procedure to conserve the fallopian tube with the minimal risk of an incisional site bleeding through a partial segmental devascularisation. This technique seems to be an efficient method to minimise the intraoperative bleeding, limit the need for a blood transfusion, and yields a higher success rate of the procedure without jeopardising the blood supply and vitality of the tubes. Impact Statement What is already known on this subject? Conservative surgery has a significant value in women with a contralateral absent or diseased tube. However, a conservative management could be challenging due to the significant bleeding which can be encountered during the surgery. What the results of this study add? The partial devascularisation technique could achieve an adequate haemostasis by blocking the ascending blood supply only to the affected segment of the fallopian tube. What the implications are of these findings for clinical practice and/or further research? A partial devascularisation is a successful conservative surgical treatment option in most patients when the procedure is indicated.

Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl.

Atici A, Yilmaz E, Karaman A, Apaydin S, Afsarlar ÇE. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr 2017; 59: 90-92. Ovarian auto-amputation is an extremely rare condition commonly encountered in the perinatal period. Spontaneous or secondary torsion of the ovary caused by an ovarian lesion may result in infarction and subsequent auto-amputation of the ovary. This paper demonstrates a case that underwent laparoscopic appendectomy with an incidental calcified auto-amputated right ovary. A 16-year-old adolescent girl was admitted to our department with a history of one-day abdominal pain. Physical examination of the patient revealed abdominal tenderness and rigidity on right lower quadrant. Her white blood cell count was 11x103/mL, and C-reactive protein was 69 mg/L. The patient underwent a laparoscopic appendectomy with a provisional diagnosis of acute appendicitis, and further exploration revealed a 2x2 cm white ovoid mass floating freely in the pelvis. The left ovary was clearly identified in its usual localization, but the right tuba was blindly ending without any fimbria or ovary. Postoperative course of the patient was uneventful, and she was discharged on postoperative day 2. The histopathological examination revealed a necrotic calcified ovarian teratoma. Auto-amputated ovary is a rare occasion mostly encountered during perinatal period, and it may be unilateral or bilateral. An auto-amputated ovarian mass may rarely be a teratoma although the most common cause of auto-amputation during perinatal and adolescent period is ovarian torsion due to an ovarian cyst.

Quantitative evaluation of the vasculature supplying the oviduct in pre-pubertal and sexually mature sows.

The present work was aimed at characterizing the regional vascularization of the oviduct in the pig to ascertain whether the number of terminal mesosalpingeal arterioles supplying the isthmus and ampulla is influenced by reproductive maturity and state of the estrous cycle. The total number of terminal arterioles (NTA) in the mesosalpinx was quantified under a stereomicroscope in latex injected ex-vivo reproductive tracts from pre-pubertal (n = 10) and mature sows (n = 34), the latter allocated into three phases of the estrous cycle: follicular (n = 12); early luteal (n = 11); and late luteal (n = 11). The NTA and density of terminal arterioles (DTA) changed little between pre-pubertal and mature sows or among sows of different reproductive status (P > 0.05). Conversely, both in pre-pubertal and mature sows the isthmus showed higher DTA (P < 0.001) than the ampulla. It is concluded that the pattern of vascularization supplying the porcine oviduct is essentially established before the onset of puberty so that neither cyclical changes coupled with the estrous cycle nor regional variations between the isthmus and ampulla are likely at the level of the terminal arterioles supplying the oviduct during the reproductive life.

Enhanced beta-catenin expression and inflammation are associated with human ectopic tubal pregnancy.

STUDY QUESTION: Is there a molecular link between Wnt signaling in fallopian tube inflammation and ectopic tubal implantation? SUMMARY ANSWER: Enhanced beta-catenin expression, reduced E-cadherin expression and glycogen accumulation in the tubal epithelia and hyperplasia in tubal arteries were found in ectopic tubal pregnancy, consistent with the effects induced by Wnt signaling and inflammation. WHAT IS KNOWN ALREADY: Chronic inflammation caused by infection can alter gene expression in the fallopian tube cells possibly leading to the development of ectopic pregnancy. Knockout mouse models have shown a relationship between Wnt/beta-catenin signaling and predisposition to tubal ectopic pregnancy. STUDY DESIGN, SIZE, DURATION: Women with ectopic tubal pregnancy (n = 18) were included in the case group, while women with chronic salpingitis (n = 13) and non-pregnant women undergoing sterilization procedures or salpingectomy for benign uterine disease (n = 10) were set as the controls. This study was performed between January 2012 and November 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: The ampullary segments of fallopian tubes were collected from patients. Tissues of tubal pregnancy were separated into implantation sites and non-implantation sites. Beta-catenin and E-cadherin expression were determined using immunohistological and immunofluorescence staining. Glycogen production was measured with periodic acid Schiff by staining. The diameter and wall thickness of tubal arteries were evaluated by histological analysis method. MAIN RESULTS AND THE ROLE OF CHANCE: Immunohistological staining revealed that beta-catenin protein expression was 100% positive in the ectopic pregnant and inflamed tubal tissues, and the staining intensity was significantly higher than in non-pregnant tubal tissues. In contrast, E-cadherin expression was reduced in ectopic pregnant fallopian tubes, possibly as a consequence of increased Wnt signaling. Moreover, glycogen accumulated in the tubal cells, and hyperplasia was observed in the tubal arteries with ectopic pregnancy, which is consistent with the effects induced by Wnt signaling and inflammation. All these changes could create the permissive environment that promotes embryos to ectopically implant into the fallopian tube. LIMITATIONS, REASONS FOR CAUTION: This finding requires a further confirmation about what activates Wnt signaling in ectopic tubal pregnancies. Also, it is generally recognized that Chlamydia infection is associated with ectopic pregnancy, and disturbs tubal epithelia via the Wnt signaling. However, the infection type in the samples used was salpingitis. WIDER IMPLICATIONS OF THE FINDINGS: A better understanding of the underlying mechanisms leading to ectopic pregnancies may contribute to our knowledge of the pathogenesis of tubal disorders and infertility and to the prevention of tubal ectopic pregnancy.

Sprouting angiogenesis in human midterm uterus and fallopian tube is guided by endothelial tip cells.

Five samples of human midterm fetal uterus and fallopian tube (four donor bodies) were used to assess whether or not processes of angiogenesis are guided by endothelial tip cells (ETCs), and if cytokine-receptors, such as CD117/c-kit and PDGFR-α, are expressed in the microenvironment of the endothelial tubes. CD34 labeled microvessels in the uterine wall (myometrium and endometrium) and in the wall of the uterine (fallopian) tube, and accurately identified ETCs in both organs. We conclude that sprouting angiogenesis in the developing human female tract is guided by ETCs. Moreover, CD117/c-kit antibodies labeled mural networks of pericytes, α-SMA-positive and desmin-negative, related to the endometrial (but not myometrial) microvessels, and similar labeling was identified in the wall of the uterine tube. PDGFR-α positive labeling, stromal and pericytary, was also found. Thus, sprouting angiogenesis in human fetal genital organs appears to be guided by tip cells and is influenced by tyrosine kinase receptor signaling.

Fertility after autologous ovine uterine-tubal-ovarian transplantation by vascular anastomosis to the external iliac vessels.

BACKGROUND: Transplantation of the uterus has been suggested as a treatment of uterine factor infertility. This study investigates whether the sheep uterus can resume its capacity to harbour normal pregnancies after autotransplantation by vascular anastomosis. METHODS: From 14 ewes, the uterus, excluding one uterine horn, was isolated along with its oviduct and ovary and preserved ex vivo and then transplanted back with end-to-side anastomosis of the vessels of the graft to the external iliac vessels. After recovery, the ewes underwent surgical examination and serum progesterone measurements to ascertain healing and ovarian activity. Afterwards, five autotransplanted and five control ewes were placed with a ram for mating. Caesarean sections were performed before the estimated term of pregnancy and data on fetal measures were compared. RESULTS: Of the 14 ewes, seven survived surgery with ovarian activity intact and grafts showing normal appearance. Mating occurred in four of five transplanted ewes and in five out of five controls, and three transplanted animals and five control animals conceived. In one transplanted ewe, torsion of the uterus was observed after spontaneous initiation of labour. Foeti from transplanted mothers were comparable in size to those of controls. CONCLUSIONS: Despite the encountered complications, this is the first report to demonstrate fertility and pregnancies going to term after autotransplantation of the uterus in an animal of a comparable size to the human.

Uterus transplantation in the baboon: methodology and long-term function after auto-transplantation.

BACKGROUND: Techniques for uterus transplantation (UTx) have been developed in rodent/domestic animals towards future clinical introduction of UTx to treat uterine factor infertility. The aim of this study was to extend the UTx research into a non-human primate species by developing surgical techniques for uterus retrieval and transplantation in the baboon. METHODS: Female baboons (n = 15) underwent surgery, with the initial five animals used for studies of pelvic vascular anatomy. Retrieval surgery included isolation of the ovarian veins and the uterine arteries together with the anterior branches of the internal iliacs. The utero-tubal-ovarian specimen was removed, flushed and kept ex vivo for 2 h when the two arterial ends and two venous ends were anastomosed side-to-side to construct one arterial and one venous end. These were, at auto-transplantation, anastomosed end-to-side to the external iliacs and the animals (n = 10) were evaluated concerning cyclicity and later by laparoscopy/laparotomy. RESULTS: The total duration of organ retrieval, backtable preparation and transplantation was around 6 h with an overall ischaemic time of the specimen of about 3 h. One animal died due to cardiomyopathy. Five out of the nine surviving animals resumed cyclicity, as a sign of re-established ovarian function. Only two out of these five animals exhibited resumed menstruation, indicating re-established ovarian and uterine function. Laparoscopy confirmed normal-sized uteri in these two animals. CONCLUSIONS: This study demonstrates the feasibility of UTx by vascular anastomosis in a non-human primate species. The low success rate demonstrates the complexity involved in UTx surgery and the need for further methodological developments.

[Fallopian tube torsion--a rare complication in the reproductive age].

Isolated fallopian tube torsion (ITT) is a rare condition defined as a total or partial rotation of the fallopian tube around its vascular axis. The torsion initiaLLy interferes with the venous and lymphatic circulation. If unrelieved in time, rapid progression occurs, occluding the arterial circulation and Leading to gangrene and hemorrhagic necrosis. The cLinicaL appearance usually includes sharp lower abdominal pain, with or without peritoneal signs. Urinary and gastrointestinal signs might also occur. isolated fallopian tube is a rare condition; the incidence s estimated to be 1:500,000 mostly in reproductive age women. ITT is most common in the right side, although several reports claim that there is no difference between the sides. The etiology is not completely understood, but tubal anomalies (anatomic or physiologic) as well as trauma or pelvic inflammation are predisposing factors. The clinical appearance and the imaging in these cases are not pathognomonic, and many cases are delayed by means of diagnosis and treatment. The treatment is surgical. Detorsion or salpingectomy is usually performed by laparoscopy. Three cases that were treated lately at the Department of Obstetrics and Gynecology at the Hadassah Medical Center are presented together with a review of the literature.

Immunolocalization of aquaporin 1, 5, and 9 in the female pig reproductive system.

Thirteen mammalian aquaporin (AQP) isoforms have been identified, and they have a unique tissue-specific pattern of expression. AQPs have been documented in the reproductive system of both male and female humans, rats, and mice. However, tissue expression and cellular and subcellular localization of AQPs are unknown in the female reproductive system of pigs. In this study, AQP1 immunoreactivity was detected in the capillary endothelium of the ovary. Distinct immunolabeling of capillary endothelium was also observed in the oviduct and uterus. AQP5 was expressed in flattened follicle cells of primordial follicles, granulosa cells of developing ovarian follicles, and muscle cells of the oviduct and uterus. Staining of AQP5 was also observed in the epithelial cells of the oviduct and uterine epithelium. AQP9 immunoreactivity was observed in granulosa cells of developing follicles. AQP9 was also localized in the luminal epithelial cells of the oviduct and uterine epithelia cells. This is, to our knowledge, the first study that shows tissue expression and cellular and subcellular localization of AQPs in the reproductive system of the female pig. Moreover, these results suggest that several subtypes of the AQPs (AQP1, 5, and 9) are involved in regulation of water homeostasis in the reproductive system of gilts.