Preferential vascular-based transfer from vagina to the corpus but not to the tubal part of the uterus in postmenopausal women.

BACKGROUND: Vaginal administration of progesterone during infertility treatment has therapeutic advantages over oral administration. However, the reasons for this are poorly defined. To demonstrate a preferential vagina-to-uterus distribution of substances, we investigated cold distribution from vagina to the uterus and rectum. METHOD: In 10 postmenopausal women, thermoprobes were inserted into the uterine cavity and in the rectum at <9 cm or at >9 cm from the anus; temperatures were subsequently measured during 10 min flushing of vagina with cold saline. RESULTS: After 10 min, temperature decreased as follows: uterus, tubal angle: -0.22 +/- 0.07 degrees C, 10 (mean +/- SEM, n); uterus, middle cavity: -1.26 +/- 0.34 degrees C, 9; rectum, <9 cm insertion: -3.69 +/- 0.68 degrees C, 3; rectum, >9 cm insertion: -0.51 +/- 0.19 degrees C, 6. CONCLUSIONS: Despite obviously different distances to the vagina of the uterine and the low rectal probes (<9 cm) the temperature decrease occurred at the same time. Cold transfer from vagina to the uterus and rectum is probably not the result of simple diffusion but of a vascular counter-current transfer. Differential cooling of corpus and tubal angles suggests a different arterial supply; while uterine corpus is supplied from the uterine artery, the tubal angles seem to be mainly supplied from the ovarian artery via the tubal arcade.     

Preferential transfer of endogenous ovarian steroid hormones to the uterus during both the follicular and luteal phases

BACKGROUND: Ovarian steroids are thought to be released into the systemic circulation and reach the uterus via the uterine arteries. However, results of experimental and clinical studies suggest the existence of local transfer of steroids from the ovary to the uterus. This study aimed to verify the existence of preferential distribution of ovarian steroids to the uterus in the two phases of the menstrual cycle. METHODS: We performed parallel measurements of serum levels of estradiol and progesterone in the systemic circulation (arterial and venous) and in the uterine vessels in two groups of cycling women; one group were in the follicular phase (six women) and the other group were in the luteal phase (10 women) of the menstrual cycle. RESULTS: Both in the follicular phase and in the luteal phase groups, mean estradiol levels in the uterine blood were significantly higher than in both sides of the systemic circulation (F = 7.30, df = 15, P < 0.006; and F = 4.70, df = 27, P < 0.02). Similar results were obtained in the luteal phase group for progesterone (F = 9.38, df = 27, P < 0.0001). Both estradiol and progesterone levels in arterial and venous systemic blood were similar. CONCLUSIONS: The results of this study demonstrate that ovarian steroid levels are significantly higher in the uterine vessels than in both sides of the systemic blood circulation, and strongly suggest the existence in the female pelvis of mechanisms of local distribution of ovarian hormones.     

Effect of pituitary downregulation on antral follicle count, ovarian volume and stromal blood flow measured by three-dimensional ultrasound with power Doppler prior to ovarian stimulation

BACKGROUND: Despite the extensive use of gonadotrophin releasing hormone agonists (GnRH ag) for pituitary downregulation, the literature regarding their effect on ultrasound parameters for predicting ovarian responses are few and conflicting. The aim of this prospective study was to compare antral follicle count (AFC), ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasound before and after pituitary downregulation. METHODS: All patients received a long protocol of intranasal Buserelin from the mid-luteal phase of the cycle. In the early follicular phase of the preceding cycle before downregulation and on the second day of the treatment cycle after downregulation, patients underwent a blood test for serum FSH, LH and estradiol and a transvaginal scanning with 3D power Doppler to determine AFC, ovarian volume and ovarian 3D power Doppler flow indices. RESULTS: Out of 104 women scanned, 85 women were analysed. Polycystic ovaries were encountered in 14 (16.5%) women. No significant differences in any of the ultrasound parameters were demonstrated before and after downregulation, in patients with normal ovaries or in those with polycystic ovaries. CONCLUSION: AFC, ovarian volume and ovarian 3D power Doppler flow indices did not significantly change after a short-term treatment of GnRH agonist for pituitary downregulation.     

Doppler colour flow analysis of uterine and ovarian arteries prior to and after surgery for tubal sterilization: a prospective study

Female sterilization by tubal ligation is a very common methodof birth control. A relationship between tubal sterilizationand subsequent development of menstrual disorders has been describedin the literature but a biological mechanism explaining suchan association has not yet been demonstrated. The aim of thisstudy was to evaluate the influence of tubal ligation by thePomeroy technique on ovarian and uterine artery blood flow usingpre- and post-surgical Doppler assessments. We studied prospectively20 patients undergoing laparotomy for tubal ligation. All patientshad a Doppler blood flow assessment before and after surgery,conducted in the mid-foUicular phase of their cycle. The pulsatilityindex (PI) of the right uterine artery ranged from 1.44 to 3.86(mean 2.23) when measured prior to surgery and from 136 to 2.85(mean 2.13) when measured after surgery. In the left uterineartery, the PI ranged from 1.67 to 3.17 (mean 2.17) and from1.69 to 2.88 (mean 2.22) before and after surgery respectively.The difference was not statistically significant The PI of theright ovarian artery ranged from 138 to 3.48 (mean 2.41) priorto surgery and from 1.48 to 3.23 (mean 2.29) after surgery.In the left ovarian artery, the PI ranged from 1.36 to 3.62(mean 234) and from 1.85 to 4.00 (mean 2.61) before and aftersurgery respectively. Again, the difference was not statisticallysignificant Our results suggest that tubal sterilization performedby Pomeroy‘s technique does not induce immediate alterationsin the vascular flow of either ovarian or uterine arteries.     

Ovarian stromal blood flow in the prediction of ovarian response during in vitro fertilization treatment

BACKGROUND: This study evaluated the role of ovarian stromal blood flow in the prediction of the ovarian response of infertile women by comparing age of women, body mass index (BMI), basal FSH concentration, antral follicle count (AFC) and ovarian stromal blood flow indices measured by power Doppler in two-dimensional ultrasound. Patients were aged <40 years with basal FSH <10 IU/l on recruitment for IVF treatment. METHODS: All received a standard regimen of ovarian stimulation in their first IVF cycle. AFC, pulsatility index, resistance index and peak systolic blood flow velocity of ovarian stromal vessels were determined on the second day of the treatment cycle prior to ovarian stimulation. Ovarian response was represented by the number of oocytes, serum oestradiol, and the duration and dosage of gonadotrophins. RESULTS: A total of 136 women were included in the analysis. Basal FSH concentration achieved the best predictive value in relation to the number of oocytes obtained, followed by AFC and BMI. AFC was the only predictive factor of serum oestradiol concentration on the day of HCG while BMI was predictive of the gonadotrophin dosage. CONCLUSION: Ovarian stromal blood flow indices measured by power Doppler ultrasound had no predictive value for the ovarian response.     

Unravelling the blood supply to the zebrafish pharyngeal jaws and teeth

We describe the vascular supply to the pharyngeal jaws and teeth in zebrafish, from larval stages to juveniles, using serial high quality semithin sections and 3D reconstructions. We have identified that the arterial blood supply to the last pair of branchial arches, which carries the teeth, issues from the hypobranchial artery. Surprisingly, the arteries supplying the pharyngeal jaws show an asymmetric branching pattern that is modified over ontogeny. Moreover, the blood vessel pattern that serves each jaw can best be described as a sinusoidal cavity encircling the bases of both the functional and replacement teeth. Capillaries branching from this sinusoidal cavity enter the pulp and constitute the intrinsic blood supply to the attached teeth. The role of these blood vessels during tooth development (whether instructive or nutritive) remains to be determined and requires further study. However, we have provided a firm morphological basis that will aid in the interpretation of experiments addressing this question.     

Pregnancy: A challenge to the concept of tubal reflux to explain the rise and fall of CA125 in serum during the first trimester

Although amniotic fluid concentrations of cancer antigen (CA)125 rise during the first two trimesters of pregnancy, the serumconcentrations of CA125 peak during the first trimester anddrop to non-pregnant values in the second and third trimester.A previous hypothesis to explain this phenomenon was that inthe early first trimester decidual CA125 gains access to thematernal compartment via ‘tubal reflux’ and subsequentabsorption by peritoneal lymphatics. However, as pregnancy advances,the decidua capsularis fuses with the decidua parietalis, thusobliterating the endometrial cavity at 10–12 weeks; theFallopian tubes thus become functionally obstructed. To testthis hypothesis, we evaluated early first trimester CA125 concentrationsin women conceiving by in-vitro fertilization (IVF) and embryotransfer with patent tubes (group 1) and in those conceivingby IVF and embryo transfer with bilateral tubal occlusion (group2). We also compared those conceiving with human menopausalgonadotrophin therapy for ovulation induction without assistedreproduction (group 3) and those conceiving without fertilitydrugs in assisted reproduction (group 4). Mean CA125 concentrationswere similar in groups 1–3; the mean CA125 concentrationin group 4 was lower but this difference was not statisticallysignificant, probably due to the small sample size. These datado not support the concept that tubal reflux explains the riseand fall of serum concentrations of CA125, since these wereequal in IVF conceptions with or without tubal patency.     

Physiology: Description of circadian rhythm in uterine artery blood flow during the peri-ovulatory period

Uterine artery blood flow was assessed by transvaginal colourand pulsed Doppler ultrasound prospectively in six women duringthe peri-ovulatory period. All patients had regular ovulatorymenstrual cycles and a mid-luteal serum progesterone consistentwith spontaneous ovulation in the preceding cycle. Each patientunderwent serial transvaginal ultrasound examination and Dopplerassessment of blood flow in the uterine arteries. When the meanfollicular diameter was >16 mm or day –2 from the estimatedday of ovulation was reached, patients were scanned at 6 hourlyintervals at 0600, 1200, 1800 and 2400 h until follicular rupture.The pulsatility index (PI) and time averaged maximum velocity(TAMX) were calculated as Doppler indices of impedance to bloodflow and velocity respectively. A venous blood sample was takenat each visit for subsequent hormonal analysis. The mean uterineartery PI showed a marked daily fluctuation with a nadir occurringmost commonly at 0600 h. A comparison between the mean PI valuesat 0600 and 1800 h showed significantly lower results at 0600h in both dominant (P < 0.05) and non-dominant (P < 0.02)uterine arteries. Furthermore, mean uterine artery TAMX showeddaily fluctuations with peak values most commonly occurringat 0600 h with the nadir occurring during the afternoon andlate evening. There was no temporal relationship between thefluctuations in PI and changes in luteinizing hormone, folliclestimulating hormone, oestradiol or progesterone concentrations.These observations suggest that there is a circadian rhythmin uterine artery blood flow during the peri-ovulatory periodwhich appears to be independent from the hormonal changes.     

Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF

Endometrial growth is thought to depend on uterine artery blood flow and the importance of endometrial development on in-vitro fertilization (IVF) outcome has been previously reported. Nitric oxide (NO) relaxes vascular smooth muscle through a cGMP-mediated pathway and NO synthase isoforms have been identified in the uterus. Sildenafil citrate (Viagra), a type 5-specific phosphodiesterase inhibitor, augments the vasodilatory effects of NO by preventing the degradation of cGMP. In this preliminary report we describe the use of vaginal sildenafil to improve uterine artery blood flow and sonographic endometrial appearance in four patients with prior failed assisted reproductive cycles due to poor endometrial response. The uterine artery pulsatility index (PI) was measured in a mock cycle after pituitary down-regulation with Lupron. The PI was decreased after 7 days of sildenafil (indicating increased blood flow) and returned to baseline following treatment with placebo. The combination of sildenafil and oestradiol valerate improved blood flow and endometrial thickness in all patients. These findings were reproduced in an ensuing gonadotrophin-stimulated cycle. Three of the four patients conceived. Although greater numbers of patients and randomized evaluation are needed to validate this treatment, vaginal sildenafil may be effective for improving uterine artery blood flow and endometrial development in IVF patients with prior poor endometrial response.     

Colour Doppler analysis of ovarian and uterine arteries in women with hypoestrogenic amenorrhoea

BACKGROUND: This is a clinically-controlled study designed to investigate uterine and ovarian blood flow in patients with hypoestrogenic amenorrhoea. METHODS: Twelve women with hypoestrogenic amenorrhoea and 13 eumenorrhoeic subjects (controls) were enrolled. Colour and pulsed Doppler was used to visualize the uterine and ovarian arteries and the blood vessels within the ovarian stroma in both groups. Four blood flow indices were calculated: the pulsatility index, the resistance index, the peak systolic velocity and the end-diastolic velocity. RESULTS: Peak systolic velocity underwent the most significant change in amenorrhoeic patients, being significantly lower in comparison with that of controls, both in the uterine (P = 0.0009) and ovarian (P = 0.001) arteries. Compared with controls, the end-diastolic velocity of the ovarian artery was significantly lower (P = 0.039) in amenorrhoeic patients, and was also lower in the uterine artery (though not statistically significantly so). A reduction in blood flow was also evident in the ovarian stroma in amenorrhoeic patients. CONCLUSIONS: The significant reduction in blood flow observed in hypoestrogenic amenorrhoea suggests that estrogens play an important role in regulating both uterine and ovarian blood flow.     

Pregnancy: Ultrasonographic features of uterine blood flow during the first 16 weeks of pregnancy

Uterine blood flow volume has been thought to increase in alinear fashion throughout pregnancy, but previous studies inearly pregnancy may have not been performed often enough orin sufficient numbers of patients. We measured uterine arteryblood flow volume, average velocity, vessel cross-sectionalarea, resistance index, and spiral artery resistance index withDoppler ultrasound at 1–3 week intervals from gestational(post-menstrual) weeks 5–6 to week 16 in 44 normal, spontaneous,single pregnancies. Uterine artery blood flow volume and velocityincreased gradually until the end of week 9, and then rapidlyfrom weeks 10–16. Uterine artery vessel size increasedlinearly. The uterine artery resistance index was the inverseof volume and velocity, in contrast to the spiral artery resistanceindex, which decreased linearly. These findings indicate thatearly pregnancy changes in uterine and spiral artery blood flowoccur by different mechanisms, and that when investigating uterineblood flow in early pregnancy, studies need to begin by week6 and need to be performed at least biweekly.     

The value of basal serum follicle stimulating hormone, luteinizing hormone and oestradiol concentrations following pituitary down-regulation in predicting ovarian response to stimulation with highly purified follicle stimulating hormone.

The value of gonadotrophin and oestradiol concentrations following pituitary down-regulation with leuprolide acetate in predicting ovarian response to stimulation was evaluated in three groups of women undergoing ovarian stimulation for in-vitro fertilization with highly purified follicle stimulating hormone (FSH). Leuprolide acetate was started in the midluteal phase, and either stopped at menses (IVF-SL group, n = 3), or continued throughout stimulation (IVF-LL group, n = 38; oocyte donors, n = 58). Ovarian stimulation was started on cycle day 3, after blood was drawn for down-regulated FSH, luteinizing hormone (LH) and oestradiol. Higher down-regulated LH was predictive of higher oestradiol on day 5 of stimulation in both IVF groups, and of need for fewer ampoules in the IVF-LL group, but not of oestradiol on day of human chorionic gonadotrophin (HCG) administration or number of oocytes retrieved. Higher FSH after down-regulation predicted yield of fewer oocytes in the donor and IVF-LL groups, and higher oestradiol on day 5 of stimulation, need for fewer ampoules and a shorter duration of therapy in both IVF groups. Higher oestradiol after down-regulation was associated with higher oestradiol on day 5 of stimulation and on day of HCG administration, a shorter duration of therapy and need for fewer ampoules in all groups. Whereas these results do not ascribe any predictive significance to LH, they suggest that oestradiol and FSH concentrations after down-regulation are predictive of the pattern of ovarian response to stimulation and of oocyte yield.     

Doppler ultrasound investigation of uterine and ovarian blood flow in infertility and early pregnancy

This review describes the current use of Doppler ultrasoundto examine blood flow in the uterus and ovaries in infertilepatients and during early pregnancy. The basics of Doppler ultrasoundand the different methods of measuring blood flow are discussedfrom the viewpoint of the clinician who may be unfamiliar withDoppler physics and terminology. Normal values in the menstrualcycle and the relationship of uterine and ovarian blood flowto infertility and to implantation following in-vitro fertilizationare presented. Normal values for uterine blood flow in the first16 weeks of pregnancy and the effect of sex steroids and ovulationinduction on their values are described. The possible relationshipof defective uterine blood flow, and the effect of drugs areexplored. The findings of this review indicate that Dopplerblood flow studies may provide significant information aboutpossible causes of some disorders of infertility and early pregnancyand methods of treatment for the same.     

Risk of benign gynaecological diseases and hormonal disorders according to responsiveness to ovarian stimulation in IVF: a follow-up study of 8714 women

BACKGROUND: Over the past decade, attention has been focused increasingly on the long-term health effects of IVF in women. Assuming that hormonal changes due to stimulation regimens for IVF are strongest among 'high' responders, we evaluated whether responsiveness to ovarian stimulation in IVF is predictive of the risk of benign gynaecological disorders >12 months after the last IVF cycle. METHODS: A nationwide historical cohort study of women who underwent IVF treatment was conducted. After a median time of 4.6 years following the last IVF treatment cycle, 8714 cohort members completed a health survey questionnaire that inquired about reproductive variables and the occurrence and age at onset of specific medical conditions including uterine leiomyoma, surgically removed ovarian cysts and thyroid disorders. Detailed data on cause of subfertility and IVF treatment were collected from the medical records. Women were included in the 'high responders' group when on average >/=14 oocytes were retrieved per IVF cycle (n = 1562), in the 'normal responders' group when they had a mean number of 4-13 retrieved oocytes (n = 6033), and in the 'low responders' group when they had a mean number of 0-3 retrieved oocytes per cycle (n = 1119). RESULTS: Among women with a high response to ovarian stimulation, we found a borderline significantly decreased risk of uterine leiomyoma [relative risk (RR) = 0.6; 95% confidence interval (CI) 0.4-1.0] and surgically removed ovarian cysts (RR = 0.6; 95% CI 0.3-1.0) in comparison with 'normal responders'. After OHSS, the age-adjusted RRs were 1.8 (95% CI 0.9-3.8) for having surgically removed ovarian cysts and 1.0 (95% CI 0.4-2.2) for uterine leiomyoma (both not significant). CONCLUSIONS: Despite the small number of events observed, highly elevated risks of gynaecological disorders and hormonal diseases in women undergoing IVF treatment can be excluded based on the present data and this follow-up period. Women with a low response to ovarian stimulation tended to have higher risks of benign gynaecological diseases than high responders.     

上下唇血液供应及其临床意义

目的：研究上下唇的血液供应,为新的组织瓣设计提供解剖学基础。方法：对10具从面动脉灌注红色乳胶的成年新鲜尸体标本的口周区域进行解剖研究,在2具尸体标本的面静脉内注入兰色乳胶。在3.5倍的手术放大镜下解剖显著血管。结果：上唇动脉发生浅隔支与深隔支,向上走行进入鼻中隔前下部参与克氏动脉丛的组成。观察到2种新的下唇动脉的分布情况。下唇动脉沿途发出唇颏支,与进入颏部的其它血管分支相互吻合。结论：上下唇血供丰富,可设计含浅、深隔支的上唇岛状组织瓣、含鼻隔支的岛状鼻中隔软骨粘膜瓣及含颏唇支的颏唇瓣;了解下唇动脉的解剖变异,对成功地施行一期下唇动脉岛状瓣手术是很重要的。     

Controlled ovulation of the dominant follicle: a critical role for LH in the late follicular phase of the menstrual cycle

BACKGROUND: A method was sought to control ovulation of the dominant follicle and to test the importance of LH during the late follicular phase of the menstrual cycle. Menstrual cycles of rhesus monkeys were monitored, and treatment initiated at the late follicular phase (after dominant follicle selection, before ovulation). METHODS: The 2-day treatment consisted of GnRH antagonist plus either r-hFSH and r-hLH (1:1 or 2:1 dose ratio) or r-hFSH alone. In addition, half of the females received an ovulatory bolus of hCG. RESULTS: When treatment was initiated at estradiol levels >120 pg/ml, neither the endogenous LH surge, ovulation nor luteal function were controlled. However, when treatment was initiated at estradiol levels 80-120 pg/ml using either 1:1 or 2:1 dose ratios of FSH:LH, the LH surge was prevented, and ovulation occurred following hCG treatment. FSH-only treatment also prevented the LH surge, but follicle development appeared abnormal, and hCG failed to stimulate ovulation. CONCLUSIONS: Control over the naturally dominant follicle is possible during the late follicular phase using an abbreviated GnRH antagonist, FSH+LH protocol. This method offers a model to investigate periovulatory events and their regulation by gonadotrophins/local factors during the natural menstrual cycle in primates.     

Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture

In order to assess whether electro-acupuncture (EA) can reducea high uterine artery blood flow impedance, 10 infertile butotherwise healthy women with a pulsatility index (PI) 3.0 inthe uterine arteries were treated with EA in a prospective,non-randomized study. Before inclusion in the study and throughoutthe entire study period, the women were down-regulated witha gonadotrophin-releasing hormone analogue (GnRHa) in orderto exclude any fluctuating endogenous hormone effects on thePL The baseline PI was measured when the serum oestradiol was0.1 nmol/1, and thereafter the women were given EA eight times,twice a week for 4 weeks. The PI was measured again closelyafter the eighth EA treatment, and once more 10–14 daysafter the EA period. Skin temperature on the forehead (STFH)and in the lumbosacral area (STLS) was measured during the first,fifth and eighth EA treatments. Compared to the mean baselinePI, the mean PI was significantly reduced both shortly afterthe eighth EA treatment (P < 0.0001) and 10–14 daysafter the EA period (P < 0.0001). STFH increased significantlyduring the EA treatments. It is suggested that both of theseeffects are due to a central inhibition of the sympathetic activity.     

A reappraisal of the blood supply of the pectoralis minor muscle

Recently the pectoralis minor muscle has been introduced as a free muscle transplant for facial reanimation in peripheral facial paralysis. However, reports on the vascular supply of this muscle are incomplete or contradictory. Therefore the pectoral region was examined in 57 human cadavers. A complex pattern of variations in the arterial supply was found: it was, however, systematically arranged and limited to a small part of the arterial tree. A topographical classification was made, based on the dominant muscle artery, to provide a useful orientation during reconstructive surgery. Related to the origin of this dominant artery, three main patterns are distinguished. In the most frequent pattern a major role is played by an artery not mentioned in Nomina Anatomica (Edinburgh: Churchill Livingstone, 1989). This artery usually arises directly from the axillary artery, accompanies the medial pectoral nerve, and supplies the major lateral part of the muscle from its deep surface. For topographical reasons we propose the name “lateral pectoral artery.” The classification, presented in this study, may provide a better insight for the reconstructive surgeon working in this area. © 1994 Wiley-Liss, Inc.     

半月板的相关结构及其血供的临床意义

57例膝半月板相关结构的观察结果显示:膝横韧带出现率为50%,呈粗大、中等和线状三种类型。该韧带可使内、外侧半月板形成一个功能整体以防损伤。半月板股骨韧带出现率为70%,长3.6cm,横径4.3mm,其存在可能是外侧半月板易损伤的原因之一。外侧半月板前角与前交叉韧带之间的纤维束出现率为70%,纤维稀疏。上三种结构含丰富的血管,具有修复损伤的良好条件。半月板滑膜缘覆于半月板上、下两面的周边,宽1～2mm,其组织疏松,血管丰富,有助于伤裂半月板的修复。