Polypeptides synthesized and released by human endometriosis differ from those of the uterine endometrium in cell and tissue explant culture.

OBJECTIVE: To identify and compare the pattern of polypeptide synthesis and release of endometriosis with that of the normal endometrium in culture. DESIGN: Endometriosis and endometrial biopsy specimens were obtained from women presenting for a variety of diagnostic and therapeutic examinations. Specimens were cultured as isolated epithelial and stromal cells and tissue explants with L-[35S]methionine. De novo synthesized proteins were identified by two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis, fluorography, and Western blot analysis. RESULTS: Five major deviations in protein synthesis and secretion were noted when comparing endometriotic and endometrial culture media. Endometriosis synthesized and secreted two proteins of stromal cell origin that were not produced by normal endometrium: endometriosis protein group I (M(r) 40,000 to 55,000; pI 4.0 to 5.2) and endometriosis protein group II (M(r) 30,000 to 32,000; pI 7.0 to 9.0). Conversely, endometriosis lacked the ability to secrete or asynchronously secreted three groups of secretory phase endometrial proteins in culture: endometrial protein group I (M(r) 25,000 to 27,000; pI 4.5 to 5.5) and endometrial protein group II (M(r) 68,000 to 72,000; pI 3.0 to 3.2) were endometrial epithelial cell products whereas endometrial protein group III (M(r) 70,000; pI 5.7) was of endometrial stromal cell origin. CONCLUSIONS: Unique characteristics in endometriosis protein synthesis and secretion as compared with the endometrium indicate biochemical dissimilarities between these tissues, which may be used to develop diagnostic markers and gain insight into the etiology and/or pathophysiology of the disease.

Choledochoscopy.

Experience has shown the rigid choledochoscope to be a valuable instrument in the exploration of the common bile duct. It has provided a means for removal of difficult to remove calculi from the common bile duct.

Surgical reconstruction of the congenitally atretic cervix: two cases.

Two patients diagnosed at the University of Missouri Hospital underwent reconstructive surgery utilizing the atretic cervix as a conduit for the formation of an endometrial-vaginal fistula. A total of three surgeries was performed with both patients experiencing the onset of cyclic menses. One patient, followed for 22 years, never attempted to conceive and eventually succumbed to hysterectomy for pelvic pain and endometriosis. The other has been followed for 44 months and continues to have regular menses with mild dysmenorrhea. Less than 50 cases of congenital cervical atresia have been reported in the literature. The operative procedures and literature experience are provided.

Spring clip sterilization: long-term follow-up.

Between 1978 and 1984, 186 women had interval laparoscopic and postpartum Hulka clip sterilization at the University of Missouri Health Sciences Center. We reached 109 (58%) of these women for follow-up. All had had their sterilization procedures at least one year earlier, and the average duration of follow-up was 3 1/2 years. The procedure failed in four patients, for a failure rate of 3.7%; three of these failures occurred more than 12 months after sterilization. These data suggest that long-term (more than 12 months) follow-up studies may be necessary to document more accurately the failure rate of Hulka clip sterilization.

Distal tuboplasty: is it appropriate?

We retrospectively analyzed the results of distal tuboplasty (fimbrioplasty, salpingostomy, and salpingoneostomy) in 64 patients who had 70 operations from 1974 to 1984. The postoperative pregnancy rate was 19%, and the ectopic pregnancy rate 21%. It is difficult to compare results obtained in this study with those reported in previous studies. The average term pregnancy rate for those studies was 21%, with an ectopic pregnancy rate of 5.7%. The appropriateness of distal tuboplasty has been questioned because of the low rate of success of the procedure and the increasing rate of success of in vitro fertilization (IVF). Because of the current economic burden and technical difficulties associated with IVF, distal tuboplasty appears to remain an appropriate operation.

Cesarean hysterectomy: a procedure for modern obstetrics?

The indications for emergency and elective cesarean hysterectomy have remained controversial throughout modern obstetric history. In an attempt to clarify the role of cesarean hysterectomy in today's practice, we retrospectively studied 216 peripartum hysterectomies done at our institution from 1956 to 1988. We analyzed indications, surgical procedures, and intraoperative and postoperative complications in an attempt to illustrate evolving obstetric trends.