Comparison of Uterine Artery Blood Flow Parameters in Women with Dysfunctional Uterine Bleeding, Fibroids and Healthy Controls

BMUS Bulletin ◽  
1997 ◽  
Vol 5 (2) ◽  
pp. 25-26 ◽  
Author(s):  
Kalpani P Lakhani ◽  
Paul Hardiman
Keyword(s):  
Blood Flow ◽  
Vascular Resistance ◽  
Ultrasound Examination ◽  
Resistance Index ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Prospective Clinical Study ◽  
Healthy Controls ◽  
Dysfunctional Uterine Bleeding ◽  
Significant Difference

Objective To assess uterine vascular resistance in women with dysfunctional uterine bleeding (DUB) and to compare parameters of blood flow in women with menorrhagia due to uterine fibroids and healthy controls Design Longitudinal, prospective clinical study. Materials and methods Premenopausal women referred to the gynaecology department with a subjective complaint of menorrhagia. The subjects were 24 women with DUB (mean age 38.8 years; normal ultrasound, hysteroscopy and endometrial biopsy), 16 women (mean age 42.8 years) with at least one fibroid greater than 2.0cm on ultrasound examination and 18 healthy controls (mean age 37.3 years; no evidence of menstrual irregularity). None was taking any hormonal contraception or other medication which could influence vascular resistance. Ultrasound examination was performed using an ALOKA SSD 650 with a 5MHz transvaginal probe. Scans were performed on day 4 or 5 of menstrual cycle using pulsed Doppler ultrasound. Uterine vascular resistance was assessed on both sides using pulsatility index (PI) and resistance index (RI). Results No significant difference in the PI or RI values was observed in women with DUB as compared to age matched healthy controls. Both PI and RI were significantly lower in women with menorrhagia associated with fibroids when compared with healthy controls. Conclusions The results of this study demonstrated significant alteration in uterine vascular resistance in women with fibroids compared to women with DUB.

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

2011 ◽  
Vol 111 (2) ◽  
pp. 443-448 ◽  
Author(s):  
J. T. Groothuis ◽  
R. A. J. Esselink ◽  
J. P. H. Seeger ◽  
M. J. H. van Aalst ◽  
M. T. E. Hopman ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Blood Flow ◽  
Orthostatic Hypotension ◽  
Vascular Resistance ◽  
Plasma Volume ◽  
Venous Pressure ◽  
Dilution Method ◽  
Significant Difference ◽  
Head Up Tilt

The pathophysiology of orthostatic hypotension in Parkinson's disease (PD) is incompletely understood. The primary focus has thus far been on failure of the baroreflex, a central mediated vasoconstrictor mechanism. Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD + OH), 14 PD patients without orthostatic hypotension (PD − OH), and 15 age-matched healthy controls. Leg blood flow was examined using duplex ultrasound during 60° head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD + OH, 9 PD − OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin (125I-HSA). The basal leg vascular resistance was significantly lower in PD + OH (0.7 ± 0.3 mmHg·ml−1·min) compared with PD − OH (1.3 ± 0.6 mmHg·ml−1·min, P < 0.01) and controls (1.3 ± 0.5 mmHg·ml−1·min, P < 0.01). Leg vascular resistance increased significantly during 60° head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD + OH (3,869 ± 265 ml) compared with PD − OH (3,123 ± 377 ml, P < 0.01) and controls (3,204 ± 537 ml, P < 0.01). These results indicate that PD + OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD − OH and controls. Despite the increase in leg vascular resistance during 60° head-up tilt, PD + OH are unable to maintain their blood pressure.

Association of Thr715Pro P-Selectin Gene Polymorphism in Diabetic Retinopathy in North Indian Population: A Prospective Clinical Study

2021 ◽  
Vol 13 (2) ◽  
pp. 145-153
Author(s):  
Ritika Sharma ◽  
Shri Kant ◽  
Deepak Mishra ◽  
Tanmay Srivastav ◽  
Hemendra Singh
Keyword(s):  
Diabetic Retinopathy ◽  
Clinical Study ◽  
Gene Polymorphism ◽  
Indian Population ◽  
Prospective Clinical Study ◽  
Healthy Controls ◽  
Independent Factor ◽  
North Indian Population ◽  
Genotypic Analysis ◽  
Significant Difference

Introduction: The aim of this study was to evaluate the role of Thr715Pro P-Selectin gene polymorphism in patients with Diabetic Retinopathy in North Indian population and establish its role in the pathophysiology as an independent factor. Materials and methods: This is a prospective clinical study conducted on 60 patients at a tertiary care centre in North India over a period of eighteen months. Sixty patients satisfying the inclusion criteria were selected from the Vitreoretina clinic in the department. They were categorised equally in three groups namely Diabetics with diabetic retinopathy (DwDR), Diabetics without diabetic retinopathy (DwoDR), and non diabetics. The non-diabetics group was further divided into healthy controls, Hypertensive Retinopathy (HR) and Non-exudative Age Related Macular Degeneration (NEAMD). All the patients underwent complete ophthalmic evaluation and blood samples were drawn for the genetic study with their informed consent. Data was analysed using SPSS software version 16. Results: The genotypic analysis between DwDR, DwoDR and the three subgroup of controls comprising of healthy controls, HR and NEAMD showed that Thr715Pro (A/C) polymorphism prevalence was significantly high in DwDR (p = 0.003) and DwoDR (p = 0.003) compared to healthy controls. No significant difference was noted between DwDR, DwoDR and the HR and NEAMD groups.  Conclusion: Thr715Pro P-Selectin gene Polymorphism could not be established as an independent factor in the pathogenesis of diabetic retinopathy, as its association is found with other systemic diseases which create a prothrombotic state.

scholarly journals A clinicopathological study of dysfunctional uterine bleeding

2014 ◽  
Vol 4 (8) ◽  
pp. 635-638
Author(s):  
N Katuwal ◽  
G Gurung ◽  
A Rana ◽  
A Jha
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
University Teaching ◽  
Age Group ◽  
Dysfunctional Uterine Bleeding ◽  
Obstetrics And Gynaecology ◽  
Proliferative Endometrium ◽  
One Year ◽  
Complete History

Background: Dysfunctional uterine bleeding is a form of abnormal uterine bleeding when there is absence of organic disease of the genital tract. The objective of this study was to find out the clinical and pathological aspect of women presenting with dysfunctional uterine bleeding.Materials and Methods: A descriptive study was conducted over a period of one year from April 14th 2010 to April 13th 2011 in the Department of Obstetrics and Gynaecology and Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A complete history, clinical examination, pelvic scan, hormonal status if required and endometrial biopsy were done to diagnose dysfunctional uterine bleeding.Results: A total of 120 cases were included. The age of the patients diagnosed dysfunctional uterine bleeding were ranging from 24 -63 years. Dysfunctional uterine bleeding was most common in the age group 40-44 yrs (30%) followed by 45-49 yrs (27.5%). Menorrhagia (41.7%) was the most common presenting sign. Majority histopathology of endometrium revealed anovulatory pattern (61.7%) followed by ovulatory (38.3%). Of the cases with an anovulatory pattern 48.6% was proliferative endometrium, 33.8% disordered proliferative endometrium, 6.8%atrophic, 5.4% weakly proliferative and 2.7% each of simple hyperplasia without atypia and complex hyperplasia with atypia. All cases with ovulatory pattern showed secretory endometrium.Conclusion: Dysfunctional uterine bleeding was the most common in the perimenopausal age group and chiefly in the form of an anovulatory endometrium. . Histopathological evaluation of endometrium helps exclude the local causes and establishes the diagnosis of dysfunctional uterine bleeding, its types, and clinical correlation to histopathological findings and finally helps to determine the mode of management.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11500 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 635-638

scholarly journals Comparison between Ormeloxifene and Norethisterone in reducing menorrhagia in dysfunctional uterine bleeding

2018 ◽  
Vol 7 (12) ◽  
pp. 4966
Author(s):  
Swati Gett ◽  
Shruti Singh
Keyword(s):  
Endometrial Thickness ◽  
Mean Value ◽  
Uterine Bleeding ◽  
The Other ◽  
P Value ◽  
Loss Assessment ◽  
Dysfunctional Uterine Bleeding ◽  
Significant Difference ◽  
Before And After

Background: Dysfunctional Uterine Bleeding (DUB) is a condition that affects nearly every woman at some point in her life. This study aims to compare the efficacy of Ormeloxifene and Norethisterone in reducing menorrhagia in such patients.Methods: This prospective study was done on 100 women presenting with dysfunctional uterine bleeding, of 20-50 years of age, who were ready for follow-up and were allocated into two equal groups, one was given Ormeloxifene and the other was given Norethisterone for a period of 3 months. Haemoglobin levels, endometrial thickness on ultrasound and Pictorial Blood loss Assessment Chart (PBAC) scores were assessed before and after the treatment.Results: It was found that both Ormeloxifene and Norethisterone reduced menorrhagia, with a significant difference in PBAC scores (p value <0.05). There was a notable reduction in PBAC scores in Ormeloxifene group (66.53% change from pretreatment mean value) as compared to Norethisterone group (31.38% change from pretreatment mean value); and same holds true for the change in haemoglobin levels as well as endometrial thickness. Ormeloxifene was found to have a greater effect on heavy menstrual bleeding in comparison to Norethisterone.Conclusions: Ormeloxifene is a new modality and is found to be a better option in reducing menorrhagia in DUB in respect to a greater success rate, better compliance and cost effectiveness.

scholarly journals Losartan does not decrease renal oxygenation and norepinephrine effects in rats after resuscitated hemorrhage

2018 ◽  
Vol 315 (2) ◽  
pp. F241-F246
Author(s):  
Sofia Jönsson ◽  
Jacqueline M. Melville ◽  
Mediha Becirovic-Agic ◽  
Michael Hultström
Keyword(s):  
Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Renal Blood Flow ◽  
Oxygen Tension ◽  
Vascular Resistance ◽  
Renal Vascular Resistance ◽  
Renal Oxygen Consumption ◽  
Significant Difference ◽  
Renal Vascular

Renin-angiotensin-system blockers are thought to increase the risk of acute kidney injury after surgery and hemorrhage. We found that losartan does not cause renal cortical hypoxia after hemorrhage in rats because of decreased renal vascular resistance, but we did not evaluate resuscitation. We aimed to study losartan’s effect on renal cortical and medullary oxygenation, as well as norepinephrine’s vasopressor effect in a model of resuscitated hemorrhage. After 7 days of losartan (60 mg·kg−1·day−1) or control treatment, male Wistar rats were hemorrhaged 20% of their blood volume and resuscitated with Ringerʼs acetate. Mean arterial pressure, renal blood flow, and kidney tissue oxygenation were measured at baseline and after resuscitation. Finally, the effect of norepinephrine on mean arterial pressure and renal blood flow was investigated. As expected, losartan lowered mean arterial pressure but not renal blood flow. Losartan did not affect renal oxygen consumption and oxygen tension. Mean arterial pressure and renal blood flow were lower after resuscitated hemorrhage. A smaller increase of renal vascular resistance in the losartan group translated to a smaller decrease in cortical oxygen tension, but no significant difference was seen in medullary oxygen tension, either between groups or after hemorrhage. The effect of norepinephrine on mean arterial pressure and renal blood flow was similar in control- and losartan-treated rats. Losartan does not decrease renal oxygenation after resuscitated hemorrhage because of a smaller increase in renal vascular resistance. Further, losartan does not decrease the efficiency of norepinephrine as a vasopressor, indicating that blood pressure may be managed effectively during losartan treatment.

Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant

2014 ◽  
Vol 67 (8) ◽  
pp. 673-677 ◽  
Author(s):  
Ayman A A Ewies ◽  
Kadry A A Shaaban ◽  
Reena Merard ◽  
Ulises Zanetto
Keyword(s):  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Median Number ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Initial Finding ◽  
Significant Difference ◽  
The Difference ◽  
Clinical Records

AimsInadequate endometrial biopsy comprises a dilemma for gynaecologists and histopathologists alike. This study was conducted to assess the clinical merit of classifying scant endometrial biopsy into inadequate and unassessable using McCluggage criteria.MethodsWe retrospectively classified 268 endometrial biopsies, initially reported as inadequate, into inadequate (n=74) and unassessable (n=174) using McCluggage criteria after excluding 20 cases; all taken from patients aged ≥50 years with abnormal uterine bleeding attending Sandwell and West Birmingham Hospitals, UK from 1 January 2007 until 30 September 2012. The electronic clinical records were reviewed to find out the consequent clinical decisions and final outcomes. The follow-up period was 15 months after including the last patient.ResultsThe median age was 57 years (range: 50–97), and the median number of visits to hospital till the diagnosis was achieved was 2 (range: 1–4). The final diagnosis of endometrial hyperplasia or cancer was reported in 9 cases; 5 (7.1%) with an initial finding of inadequate and 4 with unassessable (2.4%); the difference was statistically insignificant (p=0.13). More patients in the inadequate category (82.4%) underwent further investigations when compared with the unassessable category (68.4%); the difference was statistically significant (p=0.029). There was no statistically significant difference in the inadequate to unassessable ratio when the endometrial thickness was ≥5 mm or <5 mm within the Pipelle group (p=0.46) or the curettage group (p=0.34).ConclusionsOur findings suggest that categorising scant endometrial specimens into inadequate or unassessable has no clinical implications. The gynaecologist should interpret the histopathology report in the light of clinical scenario.

A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus

2009 ◽  
Vol 111 (3) ◽  
pp. 610-617 ◽  
Author(s):  
Chia-Cheng Chang ◽  
Hiroyuki Asada ◽  
Toshiro Mimura ◽  
Shinichi Suzuki
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Cerebrovascular Reactivity ◽  
Healthy Controls ◽  
Shunt Placement ◽  
Significant Difference ◽  
A Prospective Study

Object Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were investigated prospectively in 162 patients with a proposed diagnosis of idiopathic normal-pressure hydrocephalus (NPH). The aim of this study was to assess the usefulness of the measurement of CBF and CVR in determining which patients would be likely to benefit from shunt placement. Methods The mean CBF of the whole brain was measured according to the Patlak plot method by using technetium-99m hexamethylpropyleneamine oxime. The CVR value was obtained from the response to administration of 500 mg acetazolamide and calculated as the percentage change from the baseline mean CBF value. Results One hundred forty-six patients (90.1%) responded to shunt placement (“responders”), but 16 patients (9.9%) did not (“nonresponders”). No significant difference in preoperative CBF was observed between responders and nonresponders. Preoperative CVR was significantly impaired (p < 0.0025) in responders compared with healthy controls, but not in nonresponders. Responders with the incomplete triad had a significant reduction (p < 0.001) in preoperative CVR, but not in preoperative CBF, compared with healthy controls. Responders with the complete triad had significantly lower preoperative CBF and CVR than those with the incomplete triad (p < 0.01 and p < 0.05, respectively). Postoperative CBF and CVR increased significantly (p < 0.025 and p < 0.001, respectively) in responders. Conclusions Both CBF and CVR decrease with the development of NPH, suggesting that hemodynamic ischemia may be responsible for manifestation of the symptoms. Impaired CVR and reduced CBF with the development of symptoms can be proposed as diagnostic criteria for idiopathic NPH.

scholarly journals Dysfunctional Uterine Bleeding and its Management Strategy

2003 ◽  
Vol 40 (138) ◽  
pp. 98-106
Author(s):  
Ganesh Dangal
Keyword(s):  
Conservative Therapy ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Organic Disease ◽  
Dysfunctional Uterine Bleeding ◽  
Acute Bleeding ◽  
Teenage Girls ◽  
Reproductive Life ◽  
Uterine Curettage

Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion. An adequateexamination of the abdomen and the pelvis and uterine curettage, hysteroscopy or atleast an endometrial biopsy is essential to exclude organic disease of the uterus. Itoccurs most frequently at the extremes of menstrual life, but it can develop at anyintervening time.The objectives of treatment are to control the acute bleeding, avert future episodes,and prevent a serious long-term consequence of anovulation, endometrial cancer. Themainstay of treatment has been medical therapy although surgical intervention isrequired in some cases. If the bleeding is severe and / or recurrent or the medicaltreatment fails, re-evaluation is needed.Adolescent DUB is due to immaturity of the hypothalamus and pituitary and menstrualcycles may be anovulatory. In teenage girls organic disease is rare and DUB usuallygets resolved spontaneously. That's why they are treated expectantly and curettage isoften delayed.In the middle years of reproductive life (20-39yrs), benign organic disease is common,and curettage is usually performed to exclude complications of pregnancy and otherdisease. Conservative therapy is usually indicated, though hysterectomy may beindicated if bleeding is severe or recurrent and patient has completed her family.Perimenopausal DUB is due to the decreased number of ovarian follicles and theirincreased resistance to gonadotrophin stimulation, there is a possibility of malignancy.So, these women should always be investigated by curettage or hysteroscopy withoutdelay. Although conservative therapy may be tried as a temporizing measure,hysterectomy is often indicated.Key Words: Dysfunctional uterine bleeding, curettage, hysteroscopy, and progestogen.

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