Virtual segmentation of three-dimensional ultrasound images of morphological structures of an ex vivo ectopic pregnancy inside a fallopian tube.

Ex vivo ultrasound (US) of human tissues has been used for decades on the study of the acoustic physical aspects of the US, to the study of the morphology of the organs. Using three-dimensional (3D) US, we demonstrate the possibilities to study surgical specimens from gynecological conditions. 3D images of the surgical specimen were collected and virtually segmented according to the contrast of its images, providing a 3D image of the ectopic pregnancy and its effects on the fallopian tube.

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography.

OBJECTIVE: This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS: A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS: TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION: TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

SUMMARY OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

RESUMO OBJETIVO Este estudo tem como objetivo investigar as causas do diagnóstico equivocado na avaliação da patência tubária por meio da ultrassonografia de contraste histerosalpingo em tempo real transvaginal (TVS RT-3D-HyCoSy), a fim de melhorar a eficiência diagnóstica das TVS RT-3D-HyCoSy. MÉTODOS Um total de 162 ovidutos em 83 pacientes da infertilidade foi examinado por TVS RT-3D-HyCoSy. Esses resultados foram comparados com o padrão ouro para estudos de tintura laparoscópica, e os casos diagnosticados erroneamente foram analisados. RESULTADOS TVS RT-3D-HyCoSy revelaram que 68 ovidutos foram desobstruídos e 94 ovidutos foram obstruídos. Os resultados para os 144 ovidutos estavam em consonância com o padrão ouro, enquanto que aqueles para os 18 ovidutos, não. A taxa de acurácia do TVS RT-3D-HyCoSy foi de 88,9%, e a taxa de erro de diagnóstico foi de 11,1%. As principais causas de erro de diagnóstico incluíram contraponto e difusão do meio de contraste, espasmo do oviduto, forma ou posição anormal do oviduto, adesão pélvica e má operação de imagem. CONCLUSÃO TVS RT-3D-HyCoSy pode bem avaliar a patência tubária, e compreender e melhorar a causa do erro de diagnóstico. Além disso, a eficiência diagnóstica do TVS RT-3D-HyCoSy ainda pode ser melhorada.

Influence of a mannose-binding lectin gene polymorphism and exposure to Chlamydia trachomatis on fallopian tube obstruction in Brazilian woman.

PURPOSE: Factors influencing fallopian tube occlusion in women with a lower genital tract infection remain incompletely elucidated. We evaluated whether a polymorphism in the mannose-binding lectin (MBL) gene at codon 54 influences the occurrence of fallopian tube blockage in relation to exposure to Chlamydia trachomatis. METHODS: In a case-control study at The Hospital das Clínicas, University of São Paulo, Brazil, 75 women with hysterosalpingography-documented tubal occlusion and 75 women with patent fallopian tubes were analyzed for detection of single-nucleotide polymorphism in codon 54 of the MBL gene and for IgG anti-C. trachomatis antibodies in their sera. Both groups were matched for age, race, and sexual variables. RESULTS: Prior exposure to C. trachomatis, as evidenced by the presence of IgG antibodies, was comparable in both groups. Detection of the polymorphic MBL allele was more prevalent in women with blocked tubes (p < 0.01), regardless of whether or not there was evidence of prior chlamydial exposure. CONCLUSION: The level of MBL-related innate immunity influences the consequences of infection by C. trachomatis or other microbes.

Accuracy of Ultrasonography in the Evaluation of Tubal Sterilization Microinsert Positioning: Systematic Review and Meta-analysis.

The current reference standard to check the position of a tubal sterilization microinsert device after its insertion is hysterosalpingography. The objective of this study was to evaluate the accuracy of 2-dimensional (2D) and 3-dimensional (3D) ultrasonography (US) in the positioning of the tubal sterilization microinsert for definitive contraception. We searched MEDLINE, Embase, Cochrane, and Scopus databases through October 2017. Selection criteria included studies that analyzed the accuracy of 2D or 3D US, or both, with respect to the positioning of the microinsert. Data were displayed as forest plots and a summary receiver operating characteristic curves. Values for sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated. The pooled analysis produced sensitivity and specificity values for 2D US in the positioning of the microinsert of 0.88 (95% confidence interval [CI], 0.47-1.0) and 0.92 (95% CI, 0.88-0.95), respectively, with positive and negative LRs of 8.68 (95% CI, 1.63-46.1) and 0.35 (95% CI, 0.11-1.11), respectively. Three studies analyzed the performance of 3D US, showing sensitivity, specificity, and positive and negative LRs of 0.75 (95% CI, 0.35-0.97), 0.82 (95% CI, 0.77-0.87), 3.65 (95% CI, 2.31-5.75), and 0.46 (95% CI, 0.2-1.09). In conclusion, 2D and 3D US are methods that show good accuracy in tubal sterilization microinsert positioning.

Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies.

Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.

Matrix-assisted laser desorption/ionization imaging mass spectrometry for the spatial location of feline oviductal proteins.

With the purpose of identifying factors involved in early stages of embryo development in the domestic cat, matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) was used for the first time to describe the spatial localization of proteins in the oviducts of queens. Oviducts were obtained from two 2 and 4 years old cross-bred queens, divided into three segments, snap-frozen in liquid nitrogen and then stored at -80°C until use. Next, they were sectioned in a cryostat, fixed on ITO (indium tin oxide) conductive glass slides for MALDI-IMS and serial sections were collected on microscope slides for histology. As confirmed by histology, MALDI-IMS was able to show contrasting protein distributions in the oviductal infundibulum, ampulla and isthmus. Mass spectra were characterized by abundant ions of m/z 1,259, 4,939, 4,960 and 10,626, which have been tentatively attributed to keratin, thymosin ß10, thymosin ß4 and S100, respectively. Keratin and thymosins are involved in the biological response to tissue damage. S100 proteins are calcium-modulated proteins implicated in a variety of cellular activities, including cell differentiation and regulation of cell motility. These results suggest that protein composition differs between segments of the cat oviduct, which corresponds to morphological changes within these sections. Further functional studies could elucidate the effects of these proteins on feline reproductive physiology.

Asociación MURCS: reporte de caso / MURCS Association: case report

La asociación MURCS (Mullerian aplasia, Renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) hace referencia a un conjunto de anomalías congénitas, que sin ser debidas al azar, aparecen de forma concomitante en una persona. Se caracteriza por una aplasia Mülleriana, aplasia renal y displasia cérvico-torácica provocadas por alteraciones en los somitas correspondientes, es de etiología heterogénea. Se presenta el caso de una paciente de 9 años de edad, que es diagnosticada con la asociación MURCS, por presentar agenesia uterina, hipoplasia y ectopia renal unilateral y malformación de la 5ta vértebra cervical. Se enfatiza en la importancia de la búsqueda activa de las otras anomalías diferentes a las Müllerianas para lograr el diagnóstico y realizar un manejo integral e interdisciplinario.

The MURCS association (Mullerian aplasia, renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) refers to a set of congenital abnormalities, without being due to chance, they appear concomitantly in a person. It is characterized by Müllerian aplasia, renal aplasia and cervicothoracic dysplasia caused by alterations in the corresponding somites. We describe a case report of a 9-year-old female, who is diagnosed with MURCS association, to present uterine agenesis, hypoplasia and unilateral renal ectopia and deformity of the 5th cervical vertebra. We emphasize the importance of interdisciplinary care, including a clinical geneticist in the care of patients with these characteristics.

[Ultrasonography as a method to determine the correct implantation of intratubaric devices]. / La ecografía como método para determinar la correcta implantación de dispositivos intratubáricos.

BACKGROUND: Essure procedure consists in the placement of two coils in the intramural segment of Fallopian tubes by hysteroscopic causing a fibrosis reaction that unleashes a physiological obstruction. Hysterosalpingography, until today, is the gold standard checking the success of this method of sterilization. OBJECTIVE: Determining if a scan at three months postimplantation is sufficient to confirm the correct positioning of the device. MATERIAL AND METHODS: Descriptive study with 61 patients undergoing definitive hysteroscopic sterilization to validate transvaginal ultrasound as a technique to determine the effectiveness of the method. RESULTS: There were placed 120 devices, of which 117 (97'5%) were visible by ultrasound. Comparing ultrasound findings with gold standard, we obtain that in cases of proper bilateral implantation by hysterosalpingography, with ultrasound we diagnosed the 81 '13%; in cases of correct unilateral implantation we detected 75% with ultrasound, except one patient who was considered proper placement of the coil by ultrasound but hysterosalpingography reported that it was misplaced and the Fallopian tube was permeable. DISCUSSION: Transvaginal ultrasound is an appropriate method to confirm the correct position of intratubaric Essure devices, its safety, low cost and reproducibility. However, our study cannot replace the hysterosalpingography as gold standard.

Association between ultrasound findings and extent of trophoblastic invasion into the tubal wall in ampullary pregnancy.

OBJECTIVE: Predictive factors of damage to the Fallopian tube may guide the treatment of patients with tubal pregnancy. The aim of the present study was to investigate the association between the depth of trophoblastic invasion into the tubal wall, assessed on postoperative histological examination, with the findings obtained on transvaginal sonography (TVS) in women with ampullary pregnancy. METHODS: Women with ampullary pregnancy undergoing salpingectomy were enrolled into the study. Only women with a finding of either an embryo with cardiac activity or a tubal ring on TVS were included in the analysis, a total of 85 patients. Trophoblastic invasion was assessed postoperatively and was histologically classified as Stage I when limited to the tubal mucosa, Stage II when extending to the muscle layer and Stage III in the case of complete tubal wall infiltration. The association between findings on TVS and the stage of trophoblastic invasion was evaluated. RESULTS: There was a significant association between the findings on TVS and the depth of trophoblastic invasion (P < 0.001). All patients in whom an embryo with cardiac activity had been identified were found to have Stage II (17.9%) or Stage III (82.1%) invasion, whereas in those patients who showed a tubal ring on TVS, Stage I invasion was the most frequent finding (41.3%). CONCLUSIONS: In ampullary pregnancy, the finding on TVS of an embryo with cardiac activity is associated with deeper penetration of trophoblastic tissue into the tubal wall than is the finding of a tubal ring.

Inguinal hernias containing the uterus, fallopian tube, and ovary in premature female infants.

Inguinal hernias were diagnosed at 42 and 38 weeks' postconceptional age in 2 premature girls. The hernial sac contained the uterus, one Fallopian tube, and one ovary. The diagnosis was made by physical and sonographic examination and was confirmed during surgical correction. We suggest sonography in the diagnostic workup in (premature) female infants with an inguinal hernia.

[Hysterosonosalpingography and hysterosalpingography in the diagnosis of tubal patency in infertility patients]. / Histerossonossalpingografia e histerossalpingografia no diagnóstico de permeabilidade tubária em pacientes inférteis.

OBJECTIVES: To compare the hysterosonosalpingography(HSS) to the hysterosalpingography(HSG) in the evaluation of the tubal factor in infertility patients. MATERIAL AND METHODS: A transversal study with 30 patients in infertility investigation, with age minor than 38 years was performed. The patients were submitted to HSS, HSG and laparoscopy (LPC) in the first cycle menstrual phase. The evaluation of tubal patency of HSS and HSG, with LPC like gold-standard was compared. It was calculated the negative predictive value (PV-) of the exams. The HSS used Ecovist like contrast agent, the HSG used water soluble contrast media and the LPC used tubal insufflation with methylene blue. It was considered significative a p< 0.05 RESULTS: The final sample was of 26 patients (4 leave the investigation). The mean age was of 30,6 years. The HSS showed tubal patency in at least one of the tubes in 24 patients (92,3%). The HSG showed tubal patency in one of the tubes in 25 patients (96,2%), and the LPC in 25 patients (96,2%). The PV- of the HSS was of 92% and the PV- of HSG was of 100%. The differences were not statistically significant (p=0.996, Yates test). CONCLUSIONS: The HSS is an alternative method in the evaluation of tubal patency in infertility patients.

Methylene blue dyeing of cellular nuclei during salpingoscopy, a new in-vivo method to evaluate vitality of tubal epithelium.

The Fallopian tube can be damaged by different noxious substances that may change cellular ultrastructure and function. Alteration of the cell membrane allows the passage of certain aniline dyes, which can stain the nucleus. A total of 310 Fallopian tubes from 163 patients who underwent a surgical or diagnostic laparoscopy during fertility studies was analysed by salpingoscopy. Cellular nuclei were stained by injection of 20 ml of a 10% solution of methylene blue in saline solution (NaCl 10%) through the cervical cannula prior to salpingoscopy. Evaluation of nuclear staining with methylene blue, adhesions, vascular alterations, and the flattening of folds in relation to pregnancy outcome was undertaken. Quantification of salpingoscopic findings was carried out according to a score. Flattening of folds and vascular alterations showed no difference in the pregnant and non-pregnant groups. On the other hand, adhesions and nuclear dyeing were significantly greater in the non-pregnant group (adhesions 13.6 versus 26.8%, P < 0.004, and nuclear dyeing: 25 versus 41.7%, P < 0.009, pregnant versus non-pregnant). Methylene blue dye is a new tool to evaluate in vivo cyto-histological tubal damage, and is a useful and simple method to provide a prognosis of salpingean function.

Transcervical tubal cannulation, past, present, and future.

OBJECTIVE: To evaluate publications that introduced novel diagnostic and therapeutic transcervical procedures on the fallopian tubes. DESIGN: Major studies that conceptually changed the therapeutic approach to the fallopian tubes were reviewed. Minor publications were also included if they introduced a new concept or contributed to the topic. Clinical publications were selected if they involved transcervical diagnosis and treatment of fallopian tubes. RESULTS: Transcervical tubal catheterization procedures for diagnosis of tubal disease, tubal obliteration, tubal recanalization, and tubal medication are minimally invasive procedures that can improve our understanding and diagnostic accuracy of tubal disease. These procedures allow transcervical treatment of proximal tubal occlusion. Further improvements in equipment and methodology are promising. Transcervical tubal occlusion, gamete and embryo deposition, and treatment of ectopic pregnancy may all be performed using the transcervical approach. CONCLUSION: Transcervical tubal catheterization can replace microsurgery and IVF in selected patients with proximal tubal occlusion, improve the diagnostic accuracy of tubal disease, and deliver medications to the fallopian tubes. Cumulative knowledge suggests that transcervical tubal catheterization should become a universally accepted, taught, and practiced approach in the diagnosis and treatment of the fallopian tubes.

[Evaluation of the radionuclide hysterosalpingography]. / Evaluación de la histerosalpingografía radioisotópica.

In 22 patient in control for sterility and in 6 healthy women the Radionuclide Hysterosalpingography was used and its results were compared to classic Hysterosalpingography and laparoscopy. This new method allows the diagnosis of functional obstructions, reanastomosis and evaluation of the tubal sterilization.