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Transmission electron microscopy indicates that cell connections may be altered in hyperplastic human endometrium, an abnormal but noncancerous growth of the uterine lining. Ten such endometrial samples showed neither the normal connections between cells nor the normal connections to the underlying cell layers. These types of connections are known to be important in regulating and coordinating normal tissue growth. Such growth is crucial in the cyclic endometrial changes of the menstrual cycle. The basal lamina, a layer of noncellular material just under the top layer of skin, also seems to be changed by endometrial hyperplasia. It was thicker in some samples and broken in others.

In the early proliferative phase endometrial capillary basal lamina is loosely formed and discontinuous. It becomes more distinct in the late proliferative phase and develops whorled extensions that include pericytes in the early secretory to midsecretory phase. Throughout the cycle both endothelial cells and pericytes possess cytoplasmic processes that extend through discontinuities in the basal lamina and make contact with each other. These contacts may be simple or complex. They become more elaborate as the cycle progresses to the midsecretory phase. Endothelial cells show progressive but heterogeneous differentiation into the midsecretory phase, with individual cell hypertrophy. In the late-secretory phase the endometrial stroma and the basal lamina are characterized by widespread degeneration, and the cell-to-cell contacts sharply decrease. However, endothelial cells remain relatively intact. (Am J Obstet Gynecol 1992;166:1393-406.)

The use of cautery laparoscopic sterilization procedures has two major disadvantages: (1) occasional inadvertent thermal injury to organ structures other than the Fallopian tube1, 2and (2) the inability to limit the injury to the Fallopian tube in a manner that might allow subsequent reconstructive surgery. In an effort to avoid the use of thermal energy to effect female sterilization, the Falope ring laparoscope was developed.3From October, 1973, through September, 1975, 4,390 sterilization procedures were completed employing this approach; 902 cases have been completed at the Woman's Clinic of the Johns Hopkins Hospital, 1,741 cases were completed by gynecologists in various cities in the United States, and 1,747 procedures were completed by physicians in various locations throughout the world sponsored by the International Fertility Research Program.

The effect of intrauterine injection of 1% silver nitrate on pregnancy was studied in 13 cynomolgus monkeys. The monkeys received, in a random manner, intrauterine injections of 1ml of either 1 % silver nitrate (n=7) or 0.9% NaCl solution (n=6) between days 27 and 43 of pregnancy. Silver nitrate injection resulted in vaginal bleeding, beginning 1 or 2days after treatment, that lasted for an average of 5.3days. In all of these cases, pregnancy was terminated. Injection of normal saline had variable sequelae, but four of six monkeys were delivered of healthy offspring. All of the silver nitrate-treated animals recycled and, after remating, two of the seven subsequently became pregnant again and were delivered of normal healthy infants. This study demonstrates the efficacy of intrauterine injection of 1% silver nitrate in terminating early pregnancy.

The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface.

Histopathologic features, blood chemistry, and hematologic features were studied in cynomolgus monkeys following intravascular or intrauterine administration of a 30-mg solution of quinacrine hydrochloride. Intrauterine quinacrine administration resulted in extensive necrosis of the endometrial surface, and lesions were observed at 24 hours after treatment which obliterated the cornual areas of the uterus. Necrosis was also observed on occasion in the ampulla or isthmic portion of the tube. Evidence of repair of the reproductive tract was seen 7 and 28 days following treatment. No lesions were observed in any nonreproductive organ examined, whether quinacrine was administered by the intrauterine or intravascular route. Blood chemistry data revealed moderate and transient increases in serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and lactic dehydrogenase (LDH). No other blood chemistry or hematologic changes were noted that could be attributed to quinacrine administration. For the conditions described in these studies, intrauterine administration of quinacrine appears to be a safe procedure. However, the potential toxicity of the drug is discussed.

Recent efforts have been made to develop a chemical oviductal occluding agent. Intrauterine quinacrine has been used in certain areas of the world with moderate success in effected tubal closure. This report presents the pharmacokinetics of a quinacrine solution (30 mg) as administered to cynomolgus monkeys via the intrauterine route, compared with intravascular injection. The data show rapid transfer of the drug from the uterine to the vascular compartment and uptake by almost all tissues examined. Although plasma concentrations disappear within 24 hours, levels can be detected in most tissues for at least 1 week following intrauterine injection. After 28 days, however, tissue levels of the drug are absent or near the limit of detection.

Twenty-five of 48 women (52%) sterilized by unipolar cautery techniques conceived following tubal anastomosis, of whom 17 (36%) had a living child. The overall cumulative probability of conception at the end of follow-up as determined by life-table analysis was 76%. Increasing age, parity, and the duration of the interval from sterilization to reversal did not influence pregnancy success. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis; however, a pregnancy was least likely to occur in women with shortened oviducts of ≤ 4 cm (P < 0.01).

Neoplasms arising from the surface or lining cells of the ovary are classically referred to under such general terms as cystadenocarcinoma, papillary carcinoma, and undifferentiated cancer. Evidence is presented in this discussion to support the thesis that such lesions are mesotheliomas, and that such a thesis can be defended embryologically, histologically, and clinically.

This paper describes recent success in performing hysterosalpingography in cynomolgus monkeys. The animals were anesthesized, and a needle was manipulated through the cervical canal into the endometrial cavity for injection of contrast material. Difficulties in threading the needle through the canal were due to several blind pouches formed by folds in the cervical mucosa. The uterine lumen and both tubes could be visualized in over 75% of the cases. The study demonstrates that the hysterosalpingography technique can be performed satisfactorily in cynomolgus monkeys.

This report documents the clinical outcome of 137 consecutive menstrual extractions. The pre- and postprocedural pregnancy testing is correlated with histologic examination of tissue obtained. This report reviews the management of the unsuccessful cases.

Extract: The specific activities of three disease-related lysosomal enzymes were compared in cultured skin fibroblasts from seven normal women (M), their fetuses (F), and cells cultured from corresponding amniotic fluid cells (A). All samples were obtained in weeks 17–21 of pregnancy. Highly significant differences in the mean specific activities of ß-galactosidase (ß-Gal), ß-D-N-acetylglucosaminidase (Hex), and arylsulfatase A (ARA) are evident in control cells developed from each of these sources. In addition, the pattern of differences in the three cell types was dissimilar for each enzyme. The mean activities in nanomoles of product produced per hour per milligram of soluble cell protein were: ß-Gal: F = 248, A = 676, M = 375; Hex: F = 3412, A = 6548, M = 6781; and ARA: F = 143, A = 244, M = 458. The differences in enzyme specific activities between the three cell types studied indicated significant differences in the enzymology of these cells under defined culture conditions. In light of these findings the prerequisites necessary for antenatal diagnosis of inherited metabolic disorders are recommended.Speculation: If quantitative enzymologic data from cultured amniotic fluid cells are to be used for the antenatal diagnosis of specific inherited genetic disorders, it is essential that relative specific activities of the enzymes in question be established in cultured cells from each of the pertinent cell types. This is essential if heterozygous fetuses are to be correctly identified in utero and if fetal tissues are to be used to corroborate intrauterine diagnoses based on amniotic cell analysis.

The specific activities of three disease-related lysosomal enzymes were compared in cultured skin fibroblasts from seven normal women (M), their fetuses (F), and cells cultured from corresponding amniotic fluid cells (A). All samples were obtained in weeks 17–21 of pregnancy. Highly significant differences in the mean specific activities of β-galactosidase (β-Gal), β-D-N-acetylglucosaminidase (Hex), and arylsulfatase A (ARA) are evident in control cells developed from each of these sources. In addition, the pattern of differences in the three cell types was dissimilar for each enzyme. The mean activities in nanomoles of product produced per hour per milligram of soluble cell protein were: β-Gal: F = 248, A = 676, M = 375; Hex: F = 3412, A = 6548, M = 6781; and ARA: F = 143, A = 244, M = 458. The differences in enzyme specific activities between the three cell types studied indicated significant differences in the enzymology of these cells under defined culture conditions. In light of these findings the prerequisites necessary for antenatal diagnosis of inherited metabolic disorders are recommended.

Amniotic fluid was obtained at cesarean section from 5 third-trimester pregnancies and the proportion of orange-staining cells in the amniotic fluid determined using Nile blue sulfate staining. In the freshly obtained fluids 25 to 75 per cent of the cells stained orange. The cells were sedimented and processed for examination in the electron microscope. Virtually all the cells appeared to be squamous epithelial cells of fetal epidermis or mucous membrane. They contained variable numbers of keratin filaments and P.A.S.-positive particles resembling glycogen. No fat-containing cells were found. The presence of the squamous cells appeared to correlate with the thickening of the stratum corneum near term. It is concluded that the orange-staining cell is a cornified fetal squamous cell coated on its exterior surface by lipid material that appears to be intracellular in the light microscope and is removed during processing for electron microscopy.