Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

Objective To investigate the relationship between estradiol, progesterone and endothelin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant Materials & methods A prospective self-control clinical trial was conducted in 29 women in the self-control group. Blood samples were obtained on four occasions across the different phases of menstrual cycle before and after using implant. A blood sample was taken for a single determination in another 59 women in the already-use implant group. Plasma of estradiol, progesterone and endothelin were determined by using radioimmunoassays (RIA) in both groups.Results The level of estradiol and progesterone had no significant differences in women before and after using implant in self-control group. The level of estradiol,progesterone had no differences between women with normal and abnormal menstrual cycle in both groups. The levels of plasma endothelin (ET) in women with abnormal bleeding pattern were higher than women with normal bleeding pattern, but difference was not significant. Women with abnormal bleeding pattern had significantly higher ET level than that in women with normal bleeding pattern before using implants,especially in early-proliferative phase and mid-proliferative phase. the level of plasma endothelin was significantly higher in women with disturbed bleeding pattern than that in normal women in the already-use group.Conclusion High serum concentrations of ET are likely to be correlated with abnormal uterine bleeding in long-term subdermal contraceptive implants users.     

当归油对大鼠离体子宫平滑肌收缩功能的影响

当归油（含藁本内酯ｌｉｇｕｓｔｉｌｉｄｅ〉７０％）,ｅｔ １％吐温－８０助溶,无论对正常未孕离体子宫还是对经缩宫素处理的离体子宫,者可剂量依赖性（浴槽终浓度为１ｍｇ／１００ｍＬ～３２ｍｇ／１００ｍＬ）地抑制子宫平滑肌的收缩功能,其性质与妇痛宁滴丸相似,但作用稍强,表明其有抗子宫平滑肌痉挛作用。     

彩色多普勒能量图对不孕症妇女子宫动脉血流变化的观察

利用彩色多普勒能量图测定子宫的血流 ,即血流的脉冲指数 (pulsative index,PI)及阻力指数 (resistantindex,RI)来探索不同原因的女性不孕症。 6 7例不孕症妇女经腹腔镜诊断确诊不孕原因后 ,于月经周期第 2 0～ 2 3d作腹部 B超彩色多普勒能量图 (CDE)检查。其结果两侧子宫动脉 PI、RI可因各种不孕原因不分侧别平均 PI、RI均高于正常组 (P<0 .0 1) ,而且不受病情轻、中、重所影响。反映了子宫周围血管阻力较高所致子宫动脉血流灌注不足是引起不孕症的基础 ,可能也干扰孕卵着床而致不孕。     

子宫肿瘤表皮生长因子及其受体与C-erbB-2的表达

①目的 观察子宫肿瘤组织表皮生长因子（ＥＧＦ）及其受体（ＥＧＦＲ）和Ｃ－ｅｒｂＢ－２癌基因蛋白的表达及其意义。②方法 采用免疫组化方法检测了７３例子宫颈组织（１０例正常宫颈、１８例ＣＩＮ组织、４５例子宫颈癌组织）及７２例子宫内膜组织（增殖期内膜７例、分泌期内膜１０例、子宫肌腺病１０例、子宫内膜癌４５例）ＥＧＦ,ＥＧＦＲ及Ｃ－ｅｒｂＢ－２表达。③结果 子宫颈组织和子宫内膜组织中ＥＧＦ表达均为阴性。子     

子宫腺肌病误诊原因分析及术前诊断临床探讨

目的;探讨子宫腺肌病误诊原因及近年术前诊断研究进展,方法;对我院近１０年收治的１９７例腺肌病患者的临床资料进行回顾性分析。结果：１９９０年元月至１９９７年１２月１２８例腺肌病患者术前,术后诊断符合率仅为２９．７％,术后误诊,漏诊率达７０．３％,１９９８年元月至１９９９年１２月６９例术前经测定血清ＣＡ１２５及 腔双氧水造影后误诊,漏诊率降为２７．５％术前主要误诊为子宫肌瘤或（和）子宫内膜异位症,结论     

GnRHa对子宫肌瘤雌孕激素和表皮生长因子受体的影响

目的　探讨促性腺激素释放激素激动剂(GnRHa)对子宫肌瘤内雌、孕激素受体(ER、PR)、表皮生长因子受体(EGF-R)的影响。方法　测定13例子宫肌瘤患者经GnRHa治疗3月后肌瘤内雌、孕激素受体和EGF-R水平,并以28例未用药肌瘤作对照。结果　 GnRHa治疗组肌瘤内ER、PR、EGF-R水平明显低于对照组。结论　GnRHa除减少肌瘤内ER、PR外,使肌瘤内EGF-R的水平下降可能是GnRHa治疗子宫肌瘤的一个重要机制。     

基因p16及Cyclin D1在子宫内膜癌中的表达及意义

探讨抑癌基因Ｐ１６及细胞周期素Ｄ（ＣｙｃｌｉｎＤ１）在子宫内膜癌,交界性子宫内膜组织及正常子宫内膜组织中的表达规律及其与子宫内膜癌的关系。方法应用免疫组化ＳＡＢＣ法检测３８例子宫内膜癌,１９例子宫内膜增生过长及不典型增长,１０例正常子宫内膜组织中基因ｐ１６,ＣｙｃｌｉｎＤ１的表达。     

Color-doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF

Objectives To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attendingin vitro fertilization (IVF) cycles.Patients Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred.Results In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negativein vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful.Conclusions Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values 3 can be considered a favorable prognostic factor for future IVF cycles.Presented at the 49th Annual Meeting of the American Fertility Society, Montreal, 1993 and the 50th Annual Meeting of the American Fertility Society, November 5–10, 1994, San Antonio, Texas.     

Regression of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue triptorelin: a prospective study

Endometrial hyperplasia is thought to be caused by the prolonged, unopposed oestrogenic stimulation of the endometrium. The regression of hyperplastic back to normal endometrium is the main purpose of any conservative treatment in order to prevent development of adenocarcinoma. The aim of this study was to evaluate the regression of hyperplastic to normal endometrium in patients with various forms of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue (GnRHa) triptorelin for 6 months. Fifty-six patients with endometrial hyperplasia were enrolled in this trial; 39 patients (group I) presented simple hyperplasia, 14 (group II) complex hyperplasia and three (group III) atypical complex hyperplasia. All patients were treated with triptorelin for 6 months. Bleeding control during treatment was excellent. A post-treatment curettage for estimation of endometrial histology was performed on 54 out of 56 patients 100.1 +/- 44.7 days after the last triptorelin dose, following the restoration of pituitary function. Regression of hyperplastic to normal endometrium was observed in 32 (86.5%) out of 37 patients in group I and in 12 (85.7%) out of 14 in group II. Persistence of simple hyperplasia was found in five (14.5%) out of 37 patients in group I. Persistence of complex hyperplasia was found in 1 (7.1%) out of 14 patients and progression to atypical complex hyperplasia in another one (7.1%) woman in group II. In some of these cases, the presence of risk factors such as obesity, diabetes mellitus and ovulatory disturbances may contribute to the disease persistence despite therapy. On the other hand, in group III, none of the three patients had normal post-treatment endometrial histology. It seems, therefore, that in cases of endometrial hyperplasia without atypia, the administration of the GnRHa triptorelin is associated with high regression rates to normal endometrium. Conversely, the presence of atypia seems to be a poor prognostic factor. Treatment tolerance and bleeding control during therapy is excellent.     

Endometrial pinopodes indicate a shift in the window of receptivity in IVF cycles

The formation of endometrial pinopodes detected by scanning electron microscopy may be a specific marker for uterine receptivity. Aiming to assess the effects of ovarian stimulation on pinopode formation, we examined sequential endometrial biopsies from 17 oocyte donors. Seven normally menstruating women served as controls. Up to four samples were taken from each woman at 24-72 h intervals between days 14 and 24, giving a total of 69 samples. The day of oocyte retrieval was designated day 14 in ovarian stimulation cycles and the day of luteinizing hormone surge was designated day 13 in natural cycles. Endometrial morphology and pinopode numbers were similar in both groups. Fully developed pinopodes appeared in only one sample per cycle, indicating their short life span. However, the cycle day these structures appeared varied up to 5 days between women and the distribution was as follows: day 18 (n = 2), day 19 (n = 7), day 20 (n = 4), day 21 (n = 3), day 22 (n = 1) in ovarian stimulation cycles, and day 20 (n = 2), day 21 (n = 2), day 22 (n = 3) in natural cycles. Furthermore, accelerated pinopode formation in ovarian stimulation cycles was positively correlated with day 13 progesterone. Our findings show that ovarian stimulation does not affect endometrial pinopode formation in terms of quantity and life span. The cycle days when pinopodes form are specific to the individual, being on average 1-2 days earlier in ovarian stimulation than in natural cycles. These changes in pinopode expression may reflect shifts in the window of receptivity, resulting in ovo-endometrial asynchrony and limiting implantation success in in-vitro fertilization.