PubMed · 647239
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M E Paterson, D W Sturdee, M Thom, J W Studd. 1978-05-13. Endometrial assessment.. https://doi.org/10.1136/bmj.1.6122.1282
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Until now, endometrial ablation (EA) included at least three steps: (1) D & C or hysteroscopic endometrial sampling; (2) Danazol treatment; and (3) the ablation. We have found that step (2) can be omitted if EA is performed between days 2-7 of the menses. This permits to combine steps (1) and (3) into a single stage EA which is a very simple, feasible, efficient and safe treatment for dysfunctional bleeding. Simple: because one stage without hormonal pretreatment, causing almost no pain and only a minimal time off work. It is not more of a burden than D & C with hysteroscopy. General anaesthesia is used in 94% of our patients. Feasible: in one case only (GOPO) the cervix could not be dilated wide enough. Efficient: good results in 97.5%: 67% complete amenorrhea, 24% slight menstrual spotting for a maximum of 2 days, 6% reduced flow and 0.5% normal flow. There are 2.5% failures. When menorrhagia is accompanied by otherwise unexplained dysmenorrhea, the pain is completely cured in 73%, unchanged in 7% and greatly improved in 20%. Safe: mild complications in 2.5% only. We have also combined the two main methods of endometrial destruction: electrocoagulation and Nd/Yag laser. Our 97.5% good results, however, is not a definite proof that a combination of these two techniques is better than either technique alone.
Nucleolar organizer regions demonstrable by silver staining technique (AgNORs) are loops of nucleolar DNA transcribing to ribosomal RNA. This report quantifies AgNORs in normal endometrium and myometrium, and in leiomyomas and homologous sarcomas of the uterus. The mean AgNOR number in leiomyosarcomas was significantly higher than that in normal myometrium and that in leiomyomas, whereas no significant difference was observed between normal myometrium and leiomyomas. The mean AgNOR count in low-grade endometrial stromal sarcomas was significantly higher than that in normal endometrial stroma, and significantly lower than that in the high-grade variant of the same tumour. The epithelial component of malignant mixed müllerian tumours exhibited a significantly higher mean AgNOR number than normal endometrial epithelium, and the stromal component of these tumours showed a significantly higher mean AgNOR count than normal endometrial stroma and normal myometrium, respectively. The AgNOR count was significantly correlated with the mitotic rate in leiomyosarcomas, in high-grade endometrial stromal sarcomas, and in the epithelial and mesenchymal portions of mixed müllerian tumours, whereas no statistically significant correlation was observed in low-grade endometrial stromal sarcomas. Increased AgNOR counts have been reported for some kinds of malignant tumours in various organs, compared with normal tissues and benign tumours. This study demonstrates a similar increase when homologous uterine sarcomas are compared with histogenetically related normal and neoplastic tissues. AgNOR counting might be a useful adjunct in the classification and grading of uterine tumours.
The sex steroid-binding protein (SBP) receptor was solubilized from the membranes of human premenopausal endometrium with the zwitterionic detergent CHAPS. The binding activity of the soluble receptor was studied, allowing it to interact with [125I]SBP and precipitating the complex with polyethylene glycol 8,000. The interaction of SBP with the soluble receptor was specific, saturable, and at high affinity. Indeed, the specific binding was definitely improved on the solubilized form of the receptor. The effect exerted by sex steroids on the interaction of SBP with receptor was also examined on both the soluble and membrane-bound forms. At physiologic doses (10(-8) M) estradiol inhibits the binding at a significant extent on the soluble receptor, but not on membrane-bound form. The dose of estradiol required to significantly inhibit the SBP-specific binding was dependent on the form of receptor. In membrane-bound receptor the inhibiting dose of estradiol was higher than its physiologic concentration. Thus, it is likely that, while soluble receptor cannot recognize the complex steroid-SBP, membrane-bound receptor can interact both with "unliganded" SBP and with the estradiol-SBP complex (but not with androgen-SBP complexes) in an estrogen-dependent tissue like human endometrium.