Hydatid disease, also called hydatidosis or echinococcosis, is a cyst-formingdisease resulting from an infection with the metacestode, or larval form, of parasiticdog tapeworms from the genus Echinococcus. To date, five species of Echinococcus have been characterized. The vast majority of human diseases are from Echinococcusgranulosus and Echinococcus multilocularis which cause cystic echinococcosis and alveolar echinococcosis, respectively.Echinococcus infections are estimated to affect between 2-3 million peopleworldwide with endemics located primarily in regions of North and SouthAmerica, Europe, Africa and Asia associated with the widespread raising of sheepand other livestock 2 . The unusual localization of hydatid cyst in the brain, heart, pericardium, kidney, intraperitoneum, retroperitoneum, bone, soft tissue and breast as rare sites has been discussed in the literature. The localization of the hydatid cyst in the uterus is an extremely rarely encountered entity and highly interesting. Hydatid cyst in the pelvic cavitycan be considered primary when no other cysts are present in the common sites of occurrence. In such a case, a hydatid embryo gains access to the pelvis by either haematogenous or lymphatic routes 3 .The incidence of hydatid cyst formation in the female reproductive system constitutes about 0.5% of all hydatid cyst cases 4 . Gueddana and colleagues reported a case with intrauterine hydatidosis whose hydatid vesicles were found in the vagina and a total hysterectomy was carried out. Okumus and co-workers also reported a case in which the primary involvement was uterus and the diagnosis was confirmed by microscopic studies after the surgery 1 . C.J.Hagberg and G.Maizels reported a case of solitary hydatid cyst of uterus which clinically was diagnosed first as intramural myoma 5 . Ishraq Dhaifalah reported a case of hydatid disease of the cervix which was misdiagnosed as an ovarian cyst 6 . Similar few other cases have also been reported 1,3,7-10 .
In the current International Federation of Obstetrics and Gynecology (FIGO) grading system of endometrioid adenocarcinoma, tumors are graded by the proportion of solid components within a tumor, without further details on the histologic features of solid areas, resulting in misdiagnosis of DEAC as FIGO grade 2 or 3 endome- trioid carcinoma. However, differentiating between the two is important in providing appropriate treatment options for patients. The present study reports four cases diagnosed with DEAC and reviews the literatures updated on the clinical, radiological, and pathological DEAC characteristics of the uterus.
Laparatomy was planned on the basis of this diagnosis. After the peritoneal washing, a total abdominal hysterectomy-bilateral salpingo-oophorectomy was performed along with extirpation of the parametrium and pelvic- para-aortic lymph node sampling. At laparotomy, the uterus was fist size. On opening in lower segment of uterus a small polypoid lesion measuring 2×0.5×0.5 cm was seen. On microscopic examination the tumor showed glandular epithelium with little atypia and proliferation of atypical mesenchymal cells. Mitosis exceeded 2 per 10 high power fields. No myometrial invasion or lymph node metastasis was seen. The lesion was confined to the uterus. no serosal invasion was observed. Both ovaries were intact. Peritoneal cytology revealed no malignant cells. Histopathological final diagnosis was adenosarcoma.
surveillance of organ functionality, particularly to detect the onset of rejection, is a crucial task for the long-term viability of the graft. Usually, diagnosis of acute rejection relies on clinical signs, but laboratory data such as blood markers (lipase/amylase in pancreas transplantation, creatinine in kidney transplantation, and liver enzymes in liver trans- plantation) are invaluable tools to monitor graft function. There is no specific blood marker for the uterus that reveals a decline in uterine function or rejection, and rejection might thus not be clinically detected until significant graft damage has occurred. As subclinical rejection episodes may occur, a noninvasive graft monitoring is desirable in all organ trans- plantation. These subclinical episodes of uterus rejection can only be detected with acute or protocol biopsies. The uterine graft is, unlike other solid organs, easily accessible from the vagina, and cervical tissue biopsies are, if not noninvasive, at least minimally invasive and provide an ample surveillance option of rejection. Unlike an endometrial biopsy, the cer- vical biopsy does not interfere with the cavity of the uterus and can therefore also function as surveillance of rejection during pregnancy.
Aplin and coworkers analyzed the expression of eleven different lectins and two monoclonal antibodies di- rected against carbohydrate sequences (keratan sulfate, sialyl-Tn antigen) to investigate glycan expression in the oviduct and the endometrium during the luteal phase of Cebus apella, a New World monkey . Jones et al. recently employed a panel of twenty-four different lectins to investigate the glycosylation of the placenta and the uterus in a marsupial, the tammar wallaby Macropus eugenii . Feline decidual cells displayed weak bind- ing for GS-I, ConA, DBA, DSA, PNA, RCA-I, SBA and SJA in another study . ConA, LCA, SNA, RCA-I, PNA, SBA and HPA were among the lectins that were shown to bind to normal rat endometrium . Several groups have analyzed the binding of a panel of lectins to canine endometrial mucosa that in some cases displayed variation depending on the stage Table 2 Lectin binding to human uterine tissues
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may exert negative effects in the breast and the endome- trium. However, a clear advantage of GEN is that it may behave as an oestrogen receptor antagonist in both of these tissues. Along this line, in a previous study, we did not observe any oestrogenic-like effects of GEN in the uterus, as assessed by the expression of the insulin-like growth factor 1 (Igf1) gene (Nguyen et al. 2012). This indeed supports the notion that genistein is not an oestrogen receptor agonist in the uterus, whose inner cell layer is the endometrium. In addition, the incidence of uterine dys- plasia was low in ovariectomized rats fed GEN, suggesting a weak oestrogen receptor agonist role of GEN also in the rat uterus (Aidoo et al. 2005).
sound through the cervix, the catheter is inserted into the uterine cavity. Once the catheter is in place, the balloon is inflated; the speculum is carefully removed so as not to dislodge the catheter. The vaginal probe is then re – inserted. The position of the catheter is then reassessed. The catheter is then pulled back gently to the level of the internal os under real time ultrasound monitoring. Sterile saline (about 5 to 20 ml) is infused through the catheter under real time ultrasound observation. Even a small amount of fluid allows adequate evaluation of the anterior and posterior walls of the uterus in long axis. Saline is injected at a slow rate to prevent patient discomfort (5 – 10 ml / min as a function of uterine size and amount of backflow). Gaucherand et al (1995) described a total volume of 5 – 30 ml of normal saline to provide high quality imaging without provoking pain. (22) When the uterus has been completely surveyed from cornua
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The reason for the presentation of separate tumors at the uterine fundus and lower uterine segment is unknown. Histopathological analysis of both tumors showed similar findings; thus, we concluded that the tumor presented as 2 separate growths at the aforemen- tioned sites owing to enlargement of the uterus during pregnancy (although this remains speculative). Other possibilities considered were metastasis or multi-site in- volvement of EC. Myometrial invasion was insignificant; thus, we excluded metastasis as a possible etiology. The
The condition of a gravid uterine incarceration has no clearly identifiable causes, but is strongly corre- lated to malposition of the nonpregnant uterus, which is typically retroversion. In most cases, the gravid uterus transforms from a pelvic organ to an abdom- inal organ and the retroverted uterus corrects itself as the fundus rising out of the pelvis between 12 and 14 weeks of gestation and spontaneously falling for- ward to its normal anatomical position. On rare occa- sions, the uterus remains in a retroverted position and is trapped in the pelvic cavity. Multiple factors have been identified to prevent the uterus from enter- ing the abdominal cavity, including tumor, uterine malformation, pelvic adhesions secondary to abdom- inal surgery, inflammation in the pelvis, and endomet- riosis. Among the 136 patients reviewed, 3 patients had uterine anomalies (didelphic uterus 2 [18, 69] and bicornuate uterus 1 ); 1 had abdominal sur- gery and presented with serious pelvic adhesion ; 1 had a deep sacral concavity ; and 1 had a his- tory of cystitis . Two patients reported no special history [62, 80] and the risk information was not available for 2 patients [33, 82]. Uterine prolapse, deep sacral concavity, and uterine fibroids are also identified as significant risk factors for a gravid uterus to develop incarceration [68, 77, 80]. It is noteworthy that there were 10 cases of recurrent incarceration [18, 27, 33, 52, 59, 62, 69, 77, 80, 82]. It appears that pregnant women who had experienced incarceration, especially those with known risk factors discussed above are likely to develop recurrent incarceration during the subsequent gestation.
Operating time for vaginal hysterectomy was calculated from incision at cervicovaginal junction to the completion of closure of vault. Operating time for abdominal hysterectomy was calculated from incision on the abdomen to closure of skin incision. Vaginal hysterectomy was done by Haeney’s technique and for abdominal hysterectomy, Richardsons method was used. All the pedicles were doubly clamped. Blood loss was estimated by preoperative and postoperative (day 2) haemoglobin and haematocrit measurement. Intra operative complications such as injury to bowel/bladder or ureter and haemorrhage was noted. Any difficulty in performing hysterectomy was noted. Any method for removal of large uterus like morcellation, bisection, coring if used were noted. Post operatively all patients were followed up for complications like wound infection, vault haematoma, febrile morbidity, haemorrhage, death. The term haemorrhage was used to define those cases requiring laparotomy, laparoscopy and/or blood transfusion post operatively. Duration of hospital stay was noted and calculated as number of days in hospital after the surgery including the day of surgery. The uterus, after weighing on scale was sent for histopathological examination.
2.4.3 Sub-cellular Studies: Mice were sacrificed from each group for histological analysis. The uterus is dissected out and washed three times in isotonic saline (0.85 w/v %) and then fixed in 10% neutral formalin solution and the tissue was processed. Slides were stained with Hematoxylene-Eosin (H & E) and examined morphometrical under Light Microscope.
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The mutation carrier was 36 years old and had spon- taneous abortion four times. She had been diagnosed with secondary infertility. Her menstrual cycle was nor- mal. She had normal body mass index (19.9 kg/m 2 ) and blood pressure (110/76 mmHg) according to a recent physical examination. Her laboratory tests showed normal levels of total testosterone (0.974 nmol/l), follicle-stimulating hormone (FSH) (9.8 U/l), luteinizing hormone (LH) (5.05 U/l), and estradiol (288.25 pmol/l). Abdominal and pelvic ultrasound ex- aminations and hysteroscopy revealed a septum filling >50% of the uterus. The maximum thickness of her endometrium was only 6.5 mm. The patient did not show any anomalies in the limbs, kidneys, ureters, or central nervous system.
The aqueous extract was non-specific antagonists. This property might have given rise to the use of the plant to treat ailments such as false labour, dysmenorrhoea, pains and epilepsy. The non-specificity of the plant activity implied interaction with muscarinic, adrenergic, histaminergic, serotonergic, oxytocic (12) and prostanoid (13) receptors located on the uterus. These interactions could lead to reduction in intracellular calcium through several molecular mechanisms such as ion channels (14), second messengers and intracellular calcium stores (15).
Two cows (Nos. 1 and 2) were identified during another study on pp uterine infections performed in a Danish dairy herd with 1230 Holstein cows. Herd data, meth- odology and overall findings have been reported previ- ously . The third case was an infertile cow in the same herd that was examined due to a request from the farmer. The cows were of parity 4, 2 and 1, respectively, and had calved with viable calves and had had an uncomplicated pp course. Cow Nos. 1 and 2 had been examined 6 and 8 days pp, respectively, as part of the overall study and an endometrial biopsy and a uterine lavage sample had been taken and examined as previously reported . Cow No. 1 was diagnosed with a uterine T. pyogenes infection at 6 days pp, but fungi were not observed in the uterus of neither of the two cows at that stage. The results of the laboratory examinations are reported in Additional file 1.
. There is a greater need to both maintain a margin from the vascular cervical-placental mass and protect the ureters and vesical. The region of PP will most often involve the lower uterine segment and mid posterior fundus of the bladder. It is important that the uterus is devascularized as much as possible before this region is approached . DI should give surgeons sufficient time for segmental resection, and all of these interventions might be performed to prevent massive haemorrhage.
Figure 6. Hysterosalpingogram (USG) (top) is the primary imaging modality for making the diagnosis of Uterine Didelphys. With HSG the uterus is filled with water-soluble dye and a spot radiograph is taken. Notable complications of HSG include bleeding and in- fection. Ultrasound is a cost-effective and readily available method of imaging Uterine Didelphys but the diagnosis is more difficult to appreciate than that visualized with HSG and MRI. MRI has become the gold standard technique for diagnosis. Here the MRI shows two symmetric, widely divergent uterine horns and two cervixes, with an enlarged cavity filled by bloody/proteinaceous fluid due to haematocolpos are seen above. HSG: https://www.slideshare.net/airwave12/hysterosalpingography-33184676/22; US:
Table 2 depicts all defects observed in infants born to mothers with a bicornuate uterus and their RF, in relation to the infants of mothers without a bicornu- ate uterus. Table 2 indicates that five congenital anomalies (nasal hypoplasia— or flat nasal bridge, omphalocele, limb deficiencies, teratoma, and acar- dia-anencephaly) were significantly more frequent in infants born to mothers with a bicornuate uterus. Other defects, such as microcephaly, microtia, esoph- ageal atresia, syndactyly, limb contractures, scoliosis, and micrognathia, presented a RF . 1 but did not reach the level of statistical significance. The fre- quency of the rest of studied defects had a RF of nearly 1, indicating that their frequencies were sim- ilar in both study groups of mothers, suggesting that these defects were not related to the mother’s uterine malformation.
14) In case of HWWS type 1.2 functional rudimentary non-communicating horn which had hematocervix (cervical atresia) and hematometra was separated from its cervical connection (In didelphys variety horns are connected at cervix) with another hemi-uterus. In these cases, there was only a potential vaginal space which may be difficult to identify located above oblique vaginal septum. Interrupted sutures were taken at this place of separation    (ESHRE ESGE class U3bC3V2) (Figure 11(a), Figure 11(b)).
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In the present series of six cases, four women survived, as three of them received prompt attention and one was brought to tertiary care hospital within one hour of occurrence. Two cases were brought after 2-3 hours of delivery in government hospitals. There was delay in recognition as well as transfer of the women to tertiary care hospital. Both the women were in severe haemorrhagic shock at the time of arrival to hospital emergency room. The haemoglobin had fallen to 3-4 grams indicating they had lost more than 2000 ml blood. One of the cases was taken to operation theatre immediately and reposition was done by Haultains method. As there was severe uterine atony, abdominal hysterectomy was performed, and patient was kept in intensive care unit. Sufficient blood and blood products were transfused, but she could not be revived back from irreversible shock. Second case had delivered in government rural hospital and had complete inversion of uterus. Immediate reposition was tried but failed at the hospital. She had severe post-partum haemorrhage. She was shifted to tertiary care centre, but she had gone into severe haemorrhagic shock. Manual reposition was done in intensive care unit. Blood and blood products were administered, but she did not recover from the shock and died. Both the women, who later died, were delivered by nursing personnel at government hospitals. It was doubtful whether AMTSL was practiced at these hospitals or not. The placenta had delivered before the inversion occurred, ruling out possibility of adherent placenta in these two cases. There was one case of incomplete fundal inversion during caesarean section due to haste by junior obstetrician during placental removal. The condition was immediately identified, and uterus was reposited back to its normal position. Four women who survived following acute inversion, had normal postpartum course. They were given one or two units of blood and were discharged. These women were debriefed about the acute uterine inversion in them and were also informed that it may recur and, therefore, there is a need for hospital delivery and active management of the third stage of labour. They were reassured that fertility and reproductive outcome are not compromised following surgical correction. 4,33
We found PPARG and IRF4 mutations in the ESSs. PPARG encodes peroxisome proliferator-activated receptor gamma (PPAR-γ/PPARG)  that has tumor suppressor functions in many endocrine organs including breast, prostate and pituitary gland [33–35]. In uterus, PPARG activation inhibits growth and survival of human endometriosis cells by suppressing estrogen biosynthesis . IRF4 encodes a transcription factor in interferon regulatory factor family. A chromosomal translocation involving IRF4 and the IgH locus, t(6;14)(p25;q32) is considered a cause of multiple myeloma . IRF4 is required for endometrial decidualization . Together, these data suggest a possible rationale that PPARG and IRF4 mutations might be involved in ESS development.
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