The vascular cast of the human uterus: from anatomy to physiology.

The blood supply to the uterus originates mainly from the uterine artery. However, the uterine and ovarian arteries form anastomoses bilaterally. Controversy exists about the direction of the flow in the anastomoses and thus the origin of the arterial supply to the tube and tubal part of the uterus.

Placement of the vaginal 17beta-estradiol tablets in the inner or outer one third of the vagina affects the preferential delivery of 17beta-estradiol toward the uterus or periurethral areas, thereby modifying efficacy and endometrial safety.

Objective: The purpose of this study was to investigate whether the effects of 17beta-estradiol tablets that are designed for the treatment of postmenopausal urovaginal atrophy are influenced by the site of placement into the vagina.

Study Design: In this controlled crossover trial, 10 postmenopausal women received a single 17beta-estradiol tablet in the outer or inner one third of the vagina. Before and 3 hours after treatment, the pulsatility index, resistance index, and blood flow were evaluated in the uterine and periurethral vessels by Doppler examination.

Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases.

Objective: To assess the reliability, feasibility, and safety of lens-based minihysteroscopy.

Design: Retrospective comparative study.

Setting: Academic research environment.

Uterine first pass effect in postmenopausal women.

Background: Vaginally administered drugs distribute preferentially to the uterus; counter-current transfer from the vaginal veins to the uterine artery probably plays a pivotal role. In each side, the ovarian and uterine arteries form arterial anastomoses and controversy exists regarding the origin of the arterial supply to the Fallopian tube and tubal part of the uterus, and consequently whether these tissues can be reached through vaginal administration.

Methods: A thermocatheter with four measurement points, each separated by 5 mm, was inserted under endoscopic control into the tubal corner of uterus in 10 conscious, menopausal women and the temperatures registered every 2 s.

Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: a 1-year prospective study.

Objective: The purpose of this study was to evaluate the acceptability and endometrial safety of a twice-weekly administration of transdermal estradiol (0.05 mg) systems and vaginal progesterone gel (Crinone [Serono, Rome, Italy] 4%, 45 mg/d) as a continuous combined nonoral hormone replacement therapy regimen.

Study Design: Thirty-five postmenopausal women took part in this 1-year prospective observational trial.

Effects of tibolone on plasma levels of nitric oxide in postmenopausal women.

Objective: To determine the effects of tibolone on nitric oxide (NO) plasma levels in postmenopausal women.

Design: Randomized, double-blind, placebo-controlled, cross-over trial.

Setting: Healthy volunteers in an academic research environment.

Model of counter-current transfer from vagina to urethra in postmenopausal women.

Background: Low-dose vaginal oestrogens are effective in treating post-menopausal urogenital atrophy without inducing endometrial proliferation. We aimed to assess whether this dichotomic effect could be the result of a preferential vagina-to-urethra transfer via a counter-current transfer of oestrogens from vagina to the arterial blood supplying the urethra. Due to the impossibility of obtaining blood samples from urethral arteries, and since the nature of counter-current exchange of substances is similar to the transfer of heat, we investigated cold transfer throughout the anterior vaginal wall to the vesical trigone and urethra.

Tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation.

Objective: To compare the acceptance and tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy [THL] combined with minihysteroscopy) versus hysterosalpingography (HSG) for evaluating tubal patency and the uterine cavity in an outpatient infertility investigation.

Design: Randomized controlled study.

Setting: University hospital.

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.

Effects of estrogen therapy on arterial resistance and pulsatility in postmenopausal women.

The hypothesis of this study was that changes in arterial determinants of afterload due to static muscular contraction can be modified, in postmenopausal women, by estrogen replacement therapy. Two groups of 14 postmenopausal and 15 premenopausal women were enrolled. Hemodynamic changes induced by right handgrip were recorded between days 7 and 10 of the menstrual cycle in premenopausal women.

Mechanisms of uterine specificity of vaginal progesterone.

Endometrial transformations achieved by vaginal progesterone exceed those normally expected from the circulating concentrations obtained, this suggests some degree of direct vagina to uterus transport. We speculate on the different mechanisms involved in uterine specificity of vaginal progesterone and report data of a preliminary randomized study comparing progesterone concentrations in serum and endometrial tissue obtained from hysterectomy specimens after vaginal or i.m.

Beneficial effects of postmenopausal hormone replacement therapy with transdermal estradiol on sensitivity to activated protein C.

Many hemostatic and fibrinolytic parameters have been evaluated following hormone replacement therapy (HRT) but little is known about its influence on the anticoagulant response to activated protein C (APC-sensitivity). For this purpose, we studied the effect of transdermal 17-beta-estradiol (50 microg/24 h) by a continuous regimen on the APC-sensitivity, in 28 postmenopausal hysterectomized women (mean age, 47 years; range, 44-65 years). We also measured the plasma proteins directly involved in the protein C anticoagulant pathway, such as activities of factor VIII (VIII:C), factor V and free protein S.

Direct transport of progesterone from vagina to uterus.

Objective: To compare progesterone concentrations in serum and endometrial tissue from hysterectomy specimens after vaginal or intramuscular (IM) administration of progesterone gel.

Methods: This was a randomized open study of 14 post-menopausal women undergoing transabdominal hysterectomies. Participants received either vaginal progesterone gel, 90 mg, or IM progesterone, 50 mg, at 8:00 AM and 8:00 PM on the day before surgery and at 6:00 AM on the day of surgery.

Resectoscopic treatment of uterus didelphys with unilateral imperforate vagina complicated by hematocolpos and hematometra: case report.

Objective: To describe a technique for treating hematocolpos and hematometra in patients with uterus didelphys and unilateral imperforate vagina involving the use of resectoscopy under ultrasonographic control.

Design: Case report.

Setting: University hospital.

Different plasma levels of nitric oxide in arterial and venous blood.

Experimental investigations suggest that a basal release of nitric oxide (NO) occurs in arterial but not in venous endothelium. We therefore decided to compare plasma levels of NO in the arterial and venous circulation. Parallel blood samples were drawn from the radial artery and brachial vein in 15 healthy drug-free women.

Effects of estrogen replacement therapy on plasma levels of nitric oxide in postmenopausal women.

Objective: Our purpose was to assess the effects of estrogen replacement therapy on plasma levels of nitric oxide in postmenopausal women.

Study Design: The study, designed as a randomized, double-blind placebo-controlled crossover trial, involved 28 healthy postmenopausal women who had previously undergone hysterectomy. Women received either transdermal estradiol (50 g/day) (estradiol group) or placebo (placebo group) for 6 months continuously.

Effects of short-term transdermal estradiol administration on plasma levels of nitric oxide in postmenopausal women.

Objective: To assess the effects of short-term transdermal E2 administration on nitric oxide (NO) plasma levels in postmenopausal women.

Design: Randomized, placebo-controlled trial.

Setting: Healthy volunteers in an academic research environment.

Circulating levels of nitric oxide in fertile women in relation to the menstrual cycle.

Objective: To investigate nitric oxide (NO) production in the two phases of normal menstrual cycle.

Design: Prospective clinical study.

Setting: Normal human volunteers in an academic research environment.

Effects of continuous percutaneous estradiol administration on skeletal turnover in postmenopausal women: a 1-year prospective controlled study.

The aim of this study was to investigate the short and long term effects of continuous percutaneous administration of estradiol (E2) cream on skeletal turnover in women in surgical postmenopause. Forty women were randomly divided into two groups, one treated with a single daily application of 3 mg/day E2 cream continuously for 12 months, the other receiving placebo cream. Forearm densitometry was performed before and at the end of treatment.

Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas.

Objective: To assess the usefulness of transabdominal sonohysterography in the diagnosis and evaluation of submucous myomas.

Methods: Fifty-two premenopausal women hospitalized for hysterectomy for benign gynecologic indications underwent preoperative conventional transvaginal sonography, transabdominal sonohysterography, and hysteroscopy. The results of the three techniques in terms of diagnosis, size, intracavitary growth, and location of the submucous myomas were compared with those revealed by direct inspection of the surgical specimens.

Bone metabolism changes after transdermal estradiol dose reduction during estrogen replacement therapy: a 1-year prospective study.

Twenty-four surgically menopausal women were randomly allocated to one of two transdermally-administered estrogen replacement therapies (ERT): Group A was administered Estradiol (E2) TTS 0.05 mg/day for 6 months and 0.025 mg/day for the following six months and group B, E2 TTS 0.

Sonohysterography versus hysteroscopy for diagnosing endouterine abnormalities in fertile women.

Objectives: To evaluate the usefulness of abdominal and vaginal sonohysterography (SHG) (considered both singly and in combination) for the diagnosis of intrauterine abnormalities.

Methods: At the Department of Obstetrics and Gynecology, University of Bari, Italy, the results of the abdominal and vaginal SHG were retrospectively compared with those of conventional transvaginal sonography and hysteroscopy in 35 fertile women in whom a hysteroscopy was indicated. The sensitivity and specificity for the diagnosis of intrauterine abnormalities of both kinds of SHG (considered both singly and in combination), transvaginal sonography and hysteroscopy were compared; the predictive values of abnormal and normal SHG were determined by a 2 x 2 table relating the test results to the patients' abnormalities shown at hysteroscopy.

Nasal spray administration of unmodified progesterone: evaluation of progesterone serum levels with three different radioimmunoassay techniques.

A 11.20 mg dose of progesterone was administered by nasal spray (NS) to six healthy postmenopausal women. Serial blood samples were collected and plasma progesterone was assayed by radioimmunoassay (RIA) according to three different procedures.