Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities

Tubal and peritoneal disease are the main causes of infertility. Tubal pathology can be either congenital malformation or acquired, proximal or distal, unilateral or bilateral and transient or permanent. Several imaging methods such as laparoscopy, fluoroscopy, saline infusion sonography, and hysterosalpingography (HSG) have been used in the assessment of tubal and peritoneal pathology. Although laparoscopy is the modality of choice for investigating tubal patency and pelvic structure in many infertility centers, HSG is usually the initial diagnostic method for infertility workup because of its ease of performance, accuracy, and minimal risk of complications. This method provides useful information about size, contour, and anatomy of the inner surface of the fallopian tubes and is the gold standard for evaluation of tubal lumen. Tubal and peritubal pathology show various imaging manifestations on HSG. This review illustrates the radiographic features of congenital and acquired structural abnormalities of the proximal tubal pathology and along with etiology of proximal obstruction or occlusion will be described.

Utilization potential of intraluminal optical coherence tomography for the Eustachian tube

Imaging the Eustachian tube is challenging because of its complex anatomy and limited accessibility. This study fabricated a fiber-based optical coherence tomography (OCT) catheter and investigated its potential for assessing the Eustachian tube anatomy. A customized OCT system and an imaging catheter, termed the Eustachian OCT, were developed for visualizing the Eustachian tube. Three male swine cadaver heads were used to study OCT image acquisition and for subsequent histologic correlation. The imaging catheter was introduced through the nasopharyngeal opening and reached toward the middle ear. The OCT images were acquired from the superior to the nasopharyngeal opening before and after Eustachian tube balloon dilatation. The histological anatomy of the Eustachian tube was compared with corresponding OCT images, The new, Eustachian OCT catheter was successfully inserted in the tubal lumen without damage. Cross-sectional images of the tube were successfully obtained, and the margins of the anatomical structures including cartilage, mucosa lining, and fat could be successfully delineated. After balloon dilatation, the expansion of the cross-sectional area could be identified from the OCT images. Using the OCT technique to assess the Eustachian tube anatomy was shown to be feasible, and the fabricated OCT image catheter was determined to be suitable for Eustachian tube assessment.

A Rare Case of Intrauterine Adhesion Caused by Intrauterine Fallopian Tube Incarceration

Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion. Such technique, however, sometimes has limitations and even second damages. We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration. A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage. First hysteroscopy created a false passage through the previous uterine perforation, entered into the cavity of incarcerated fallopian tube, and led to iatrogenic hydrosalpinx. Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage, released the adhesion, and reconstructed the uterine cavity. Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.

Uspešnost histeroskopske sterilizacije s sistemom Essure in zadovoljstvo pacientk s posegom

BACKGROUND: Essure is a permanent transcervical sterilisationprocedure. Three months after the procedure a confirmation test is performed to evaluate tubal occlusion or microinsert location. During this period the tubal lumen is occluded by benign tissue ingrowth stimulated by the microinsert. Since 2007, 169 procedures have been performed at University Medical Centre Maribor. The purpose of our study was to evaluate the efficacy, satisfaction, and complications of the procedure.METHODS: Thirty-eight consecutive patients were included in prospective study. All procedures were performed between August 2012 and March 2013 by the same experienced hysteroscopist in an outpatient setting. Transvaginal 2D ultrasound was performed 3 months after the procedure to asses the position of microinserts. Hysterosalpingo foam sonography (HyFoSy) was performed in 5 cases and hysterosalpingography (HSG) was performed once in a total of 6 cases with indeterminate position of microinserts.RESULTS: Thirty-eight patients with 75 Fallopian tubes were included. Essure microinsert was successfully placed in 73 of 75 Fallopian tubes in 37 patients (97,3%). Transvaginal ultrasound demonstrated a correct placement of 67 microinserts (67/73, 91,8%). Tubal occlusion was confirmed in all 6 cases with indeterminate position of microinserts. The overall patient satisfactory rate was 9,92 on a scale from 0 to 10.CONSCLUSION: Essure is a method for permanent female contraception that has a very high rate of success and patient satisfaction, a low rate of complications and is well tolerated. In cases of indeterminate position of microinserts on transvaginal ultrasound, HyFoSy could be an alternative to HSG.

CONTRIBUTION OF LACTIC ACID BY THE AMPULLARY AND ISTHMIC PARTS OF RABBIT FALLOPIAN TUBE UNDER ALTERED HORMONAL CONDITIONS

ABSTRACT The capability of the ampullary and isthmic parts of the rabbit Fallopian tube to contribute lactic acid (LA) to the tubal lumen was examined using an in vitro method of study. In addition concomitant study was also made using the uterus. It was found that in the oestrous rabbit, the isthmus contributed LA at a higher rate than that of the ampulla; the uterine contribution was minimal. Ovariectomy reduced while exogenous oestrogen enhanced this ability in all the three tissues. In mated post-ovulatory rabbits the contributory efficiency of either tubal part changed and appeared to exhibit a peak value in the presence of the ovum; the uterus showed no such changes. This is discussed in relation to the ability of the egg to secure its energy source until it attained morula/the pre-blastocyst stage.

Effect of Steroids on Uterotubal Junction: An Ultrastructural and Cytochemical Study

The morphology, and histology of mammalian uterotubal junction have been extensively studied. Only a limited number of electron microscopic studies on this organ have been published. Furthermore, adequate data on the fine structure and ultracytochemistry of this organ are not available. Investigation of this subject, therefore, was initiated on the tubal junction of the intact prepubertal and ovariectomized rabbit to delineate changes induced by near physiologic levels of exogenous estrogen and progesterone. Experimental procedure is the same as reported previously.Two distinctive cell types, namely ciliated and secretory, are observed in the epithelia. The most obvious change after hormonal stimulation is the regeneration of cilia and basal bodies in the ciliated cells and the frequent extrusion of mucin-like granules into the tubal lumen (Figs. 1,3,4). Polysomal associations and fibrous granules are frequently seen in the cytoplasm of ciliated cells.