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PubMed1976

In vivo motility of the unobstructed fallopian tube.

Current methods of recording the fallopian tube motility in vivo essentially measure the intraluminal pressure. Diametral change is another parameter which can provide additional useful information related to tubal function. A method for in vivo monitoring of diametral change without obstructing the lumen and based on the impedance measurement technique has been proposed. An in vitro comparison of wall displacement with transtubal electrical impedance change shows that the impedance changes reflect diametral changes. Another in vitro experiment in which the autorhythmicity of contractions was maintained by means of a perfusion bath indicates that the impedance changes are primarily due to the contraction of the circular muscles of the fallopian tube. These studies were followed up with long-term chronic implantations with dual probes on the isthmic and ampullar regions of the tube in female rabbits. Inpedance changes over periods as long as 6 mo could be readily obtained. Histological observations as well as fertility studies support the conclusion that the tube is minimally affected by the placement of the probes.

Animals↗

PubMed1980

Homotransplantation of the human fallopian tube: report of a successful case and description of a technique.

The rising emphasis on conservative surgical treatment of the fallopian tube has generated a greater demand for methods of reparative surgery. Thus far, the use of surrogate tubes and allotransplantation of the fallopian tube hae not fulfilled the requirements for success. A case of homotransplantation of the human fallopian tube is presented. At surgery, a midsegment anastomosis was performed by grafting the good portion of the left tube to a viable segment of the right tube. The arteries and veins were then anastomosed with 9-0 silk and a single-layer closure; an operating microscope was used. Patency was documented with chromotubation, and bleeding was controlled with microcautery. Decadron and Phenergan were placed in the patient's abdomen along with 150 ml of saline. She was given systemic Decadron, Phenergan, and antibiotics pre- and postoperatively. Three months after surgery hysterography revealed a viable-appearing fallopian tube. The patient subsequently aborted an 8-week intrauterine gestation. Fallopian tube homotransplantation has a role in the treatment of infertility, but the patient population for which this procedure is applicable is limited.

Adult↗

PubMed1982

Neurogenic relaxation mediated by vasoactive intestinal polypeptide (VIP) in the isthmus of the human fallopian tube.

The smooth musculature of the Fallopian tube is important for normal ovum transport, fertilization and implantation. Little is known about the factors controlling the motor activity of the isthmic sphincter. Studies were performed on smooth muscle preparations from the human tube in vitro. Electrical field stimulation of the nerves in the isthmic region reduced the motor activity, particularly in the circular muscle. The response was unaffected by adrenergic and cholinergic antagonists, but blocked by tetrodotoxin, suggesting a neural involvement. Vasoactive intestinal polypeptide (VIP) was considered a likely candidate for the neural mediation of this response in view of the high density of VIP-containing nerve fibres in this region, and in view of the fact that exogenous VIP causes a marked reduction of the tubal motor activity. To test whether VIP might be the endogenous mediator of this effect, nerve stimulation was carried out in the presence of large amounts of exogenous VIP in order to occupy all VIP receptors; the motor inhibitory action of VIP was counteracted by vasopressin. Under these conditions, nerve stimulation failed to reduce isthmic motor activity. This was not due to vasopressin since reduction occurred in the presence of this peptide alone. The results suggest that VIP is responsible for the neurogenic inhibition of motor activity in the isthmus region of the human Fallopian tube.

Atropine↗

PubMed1993

Radical lymphadenectomy in the primary carcinoma of the fallopian tube.

The primary carcinoma of the Fallopian tube is a highly aggressive tumor which can spread by the lymphatic route. The object of the present study was to evaluate the impact of radical pelvic and para-aortic lymphadenectomy on overall survival. Radical lymphadenectomy was performed on twelve patients in addition to hysterectomy and bilateral adnexectomy (group I). Twenty-eight patients subjected only to hysterectomy and adnexectomy formed the control group (group II). On average 47.6 lymph nodes were excised per patient. As long as the carcinoma was limited to adnexa and uterus (stages I and II), no lymph node metastases were found, only in stages III and IV were lymph node metastases detectable. Even though the median survival time of group I was considerably higher than of group II (43 versus 35 months), there was no statistically significant difference between the two groups (P < 0.65). Patients with stage III and stage IV disease had relatively longer median survival times if they had a lymphadenectomy. However, the difference was not statistically significant (P < 0.91). We cannot therefore recommend routine radical lymphadenectomy for primary Fallopian tube carcinoma. Whether or not lymph node dissection would lead to better results from rational selection of patient for adjuvant therapy is not known.

Fallopian Tube Neoplasms↗

PubMed1992

Expression of epidermal growth factor (EGF) receptor and its ligands, EGF and transforming growth factor-alpha, in human fallopian tubes.

Although human uterus is known to contain epidermal growth factor (EGF) and its receptors, it is virtually unknown whether human fallopian tubes, which are an anatomical continuation of the uterus, also contain them. Therefore, the present studies investigated whether EGF and its structural and functional homolog, i.e. transforming growth factor-alpha (TGF-alpha), and their common receptor are expressed in human fallopian tubes. Human fallopian tubes contain major 10.5-kilobase (kb) and minor 6.0-kb receptor messenger RNA (mRNA) transcripts, a single 5.0-kb EGF mRNA transcript, and a single 170-kilodalton receptor protein. The transcripts, along with their corresponding proteins and TGF-alpha protein, are present in ciliated and nonciliated epithelial cells, tubal smooth muscle, vascular smooth muscle, and endothelium. The cellular distribution and reproductive state dependency of these three regulatory molecules varied. For all of them, however, ampullary segments contained more than isthmus; proliferative phase and/or postpartum specimens contained more than secretory phase; and postmenopausal specimens contained the lowest amounts. The cell periphery and nuclear/perinuclear area of the cells contained EGF, TGF-alpha, and their receptors. Immunogold electron microscopy showed the receptors to be present in cell membranes, cilia, basal bodies which control ciliary activity, endoplasmic reticulum, nuclear membranes, and chromatin. In summary, human fallopian tubes contain EGF, EGF/TGF-alpha receptor mRNA and protein, and TGF-alpha protein. The expression of all these regulatory molecules was dependent on anatomical region, cell type, and reproductive state of the fallopian tubes. These findings suggest that EGF and TGF-alpha may regulate numerous tubal functions, thus potentially influencing fertility in women.

Blotting, Western↗

PubMed1993

Torsion of accessory fallopian tube: ultrasound findings in two premenarchal girls.

The ultrasound findings of two cases of fallopian tube duplication, both of which had undergone torsion, are described. Two premenarchal girls were examined with ultrasound because of clinical evidence of pelvic pathology. Both were found to have complex cystic structures that on surgery and subsequent pathological examination were shown to be twisted accessory fallopian tubes. Accessory fallopian tubes have been reported to occur in 6-13% of selected patient groups. To our knowledge, torsion of an accessory tube has not been reported in the literature.

Child↗

PubMed1978

Torsion of the fallopian tube.

Although an infrequent cause of acute lower abdominal pain, fallopian tube torsion should be considered whenever a woman presents with this complaint. Early diagnosis and surgical intervention may save a tube that has not yet infarcted, yet initial presentation may give little indication of the seriousness of the condition until peritonitis develops. Definitive treatment is removal of the affected adnexa. Diminished fertility and an increased incidence of ectopic pregnancy in the remaining fallopian tube follows unilateral salpingectomy. A case history of fallopian tube torsion is presented.

Abdomen, Acute↗

PubMed1997

Comparison of fallopian tube sperm perfusion with intrauterine insemination in the treatment of infertility.

OBJECTIVE: To compare the efficacy of fallopian tube sperm perfusion utilizing a Foley catheter technique with standard IUI. DESIGN: Randomized controlled study. SETTING: The infertility units of the University Central Hospital and the Family Federation of Finland, Oulu, Finland. PATIENT(S): One hundred infertile women with unexplained factor, minimal to mild endometriosis, mild male factor, or ovarian dysfunction, undergoing 50 IUI and 50 fallopian tube sperm perfusion cycles stimulated by clomiphene citrate and hMG. INTERVENTION(S): Thirty-six hours after hCG administration, patients were randomized to either the IUI group (group 1, 50 patients and cycles) or the fallopian tube sperm perfusion group (group 2, 50 patients and cycles). Intrauterine insemination was performed using a standard method and fallopian tube sperm perfusion with a pediatric Foley catheter, which prevents the reflux of sperm suspension. MAIN OUTCOME MEASURE(S): Number of clinical pregnancies. RESULTS(S): The fallopian tube sperm perfusion method using a Foley catheter technique was easy to perform and convenient for the patients. The overall pregnancy rate per cycle was 8% for fallopian tube sperm perfusion and 20% for IUI, a difference that was not significant. CONCLUSION(S): The fallopian tube sperm perfusion method using a Foley catheter offers no advantage in comparison with the conventional IUI technique.

Adult↗

PubMed1996

Ultrastructural study on the epithelium of ligated fallopian tubes in women of reproductive age.

The epithelium of normal and ligated Fallopian tubes in nine women of reproductive age was studied by using scanning electron microscopy (SEM). The results were as follows: at a distance of 0.5 cm from the ligated scar, numerous cilia of the epithelium were twisted and adhered, the shape of the epithelial cells was irregular, and even many microvilli and cilia lost from the local epithelium. However, the microvilli and cilia of the epithelium were normal on the mucosa at 1.0 cm from the ligated scar. This may account for the continued infertility following re-anastomosis of the ligated Fallopian tubes, due to the ultrastructural changes of oviducts and inability to convey the ova. Thus, at the Fallopian tube re-anastomosis, it is recommended that the removal of the mucosa should be at least 0.5 cm away from the ligated scar so as to increase the success rate of the fertilization. On the epithelium of the hydrosalpinx, Fallopian tube stomata located among the secretory cells were found for the first time. These stomata are small openings of lymphatic capillaries with a diameter of 3.25 microns to 4.25 microns. They are likely to be connected between the lumen of the Fallopian tube and subserous lymphatic vessels, and also involved in the drainage of the hydrosalpinx. Most or all cilia were lost from the ciliated cell surface on the epithelium of the hydrosalpinx, whereas the microvilli were flourishing. Therefore, many ciliated cells turned into secretory cells. In addition, a new pathogenesis of the hydrosapinx is discussed.

Adult↗

PubMed1997

Retained trophoblastic tissue in fallopian tubes: a consequence of unsuspected ectopic pregnancies.

Five patients had retained trophoblastic tissue within the Fallopian tubes, which suggested remote ectopic pregnancies. Four remote ectopic pregnancies were identified in patients after delivery. One patient underwent salpingo-oophorectomy after the identification of a small ovarian mass and 1.0 cm "necrotic area" in the fallopian tube at cesarean section. The other three patients underwent tubal ligation, and one was noted to have a 1.0 cm "calcified" nodule in the distal fallopian tube. The fifth patient underwent laparotomy and was found to have an acute ectopic pregnancy in one fallopian tube and a clinically unsuspected 3.0 cm mass in the other, which proved to be an ectopic pregnancy with ghost outlines of chorionic villi and trophoblast. Histopathologically, all five patients showed foci of viable-appearing intermediate trophoblast and surrounding abundant eosinophilic hyalinized material in the fallopian tubes; four patients also had hyalinized ghost outlines of chorionic villi. None of the mothers had a history of previous ectopic pregnancy. The natural history of clinically unsuspected ectopic tubal pregnancies is not well understood, but these cases illustrate that trophoblast may persist in fallopian tubes and potentially result in clinical confusion as well as tubal pathology.

Adult↗

PubMed1990

Secretory immune system of the female reproductive tract. II. Local immune system in normal and infected fallopian tube.

The existence of a secretory immune system in the female genital tract has been demonstrated by the predominance of immunoglobulin (Ig)A-producing plasma cells in human fallopian tube, uterine cervix, and vagina. Epithelium lining fallopian tubes expresses a receptor for IgA, secretory component (SC), and thus resembles other secretory tissues such as intestine, mammary, lacrimal, and salivary glands. The present study extends the characterization of the local immune system in the fallopian tube and assesses its response to infection. We examined normal and infected fallopian tubes from surgical specimens, obtained at tubal ligation and abdominal hysterectomy, for the presence of Ig-producing cells, T cells, and natural killer cells. All tubular segments contained a predominance of IgA plasma cells in the subepithelial lamina propria. The epithelial cells were strongly positive for SC. Luminal contents stained positively for IgA, SC, and J chain, suggesting that this material contained secretory IgA. Submucosal plasma cells of IgM and IgG classes were less frequent than IgA. T cells were present in numbers approximately twofold greater than plasma cells in normal fallopian tubes. T-suppressor (CD8+) cells, which may function in the induction of immune tolerance, were present in the intraepithelial spaces. Infected segments of fallopian tubes demonstrated six- to tenfold increased numbers of plasma cells of all classes. These data suggest that a local immune system is functioning in the human fallopian tube and may provide a first line of defense against tubal infection and the prevention of tubal factor infertility.

Epithelium↗

PubMed1990

Assisted fertilization in infertile women with patent fallopian tubes. A comparison of in-vitro fertilization, gamete intra-fallopian transfer and tubal embryo stage transfer.

A comparison of the relative efficacy of in-vitro fertilization with uterine embryo transfer (IVF), tubal embryo stage transfer (TEST) and gamete intra-Fallopian transfer (GIFT) was performed in infertile patients with patent Fallopian tubes. A total of 150 couples with unexplained infertility, peritoneal endometriosis or reduced semen quality were included in the study. The three groups were comparable with regard to age distribution, indications, semen parameters, stimulation regimens, response to stimulation and numbers of oocytes retrieved. In the IVF and TEST groups there was no cleavage in 24% and a cleavage rate of only 47.6%. The highest cleavage rate was obtained in the endometriosis patients. The pregnancy rate was highest in the two groups in which in-vitro fertilization was performed, IVF = 45.7%, TEST = 37.9%, GIFT = 26.2%. To obtain one live intrauterine fetus, more oocytes had to be transferred in the GIFT group compared to the number of embryos in the IVF group, 14.4 versus 6.2, P less than 0.05. Due to a high success rate of IVF but at the same time a high frequency of no cleavage in cases of unexplained infertility or male subfertility, we recommend IVF as the primary procedure in infertile couples with patent Fallopian tubes.

Adult↗

PubMed1996

Tumor necrosis factor-alpha response to infection with Chlamydia trachomatis in human fallopian tube organ culture.

OBJECTIVE: Our purpose was to determine whether tumor necrosis factor-alpha is produced in response to infection with Chlamydia trachomatis in the fallopian tube. STUDY DESIGN: Fallopian tubes were harvested at the time of abdominal hysterectomy and processed by standard tissue culture techniques. Tubal segments were inoculated with Chlamydia trachomatis serotype E/UW-5/CX. At 48 hours of incubation supernatant fluid was assayed for tumor necrosis factor-alpha. Tubal segments were stained for chlamydial inclusions and tumor necrosis factor-alpha by use of immunohistochemical techniques. RESULTS: Mean tumor necrosis factor-alpha levels for infected segments were 92.1 +/- 21.3 pg/ml (mean +/- SEM) and for control segments were 61.9 +/- 13.9 pg/ml (p = 0.03 by paired t test). Tumor necrosis factor-alpha was predominantly localized in the tubal epithelium. CONCLUSIONS: Tumor necrosis factor-alpha is produced in response to chlamydial infection by the human fallopian tube. It is an important proinflammatory cytokine and may promote the production of other cytokines and immune-mediated damage of the fallopian tube.

Chlamydia Infections↗

PubMed1988

Selective transcervical fallopian tube catheterization: technique update.

A technique of transcervical fallopian tube catheterization involving use of a new vacuum hysterograph and coaxial catheter set is described. In 25 women, selective catheterization of the uterine cornua was accomplished with a 94% success rate. Ostial salpingography permitted visualization of 26% of the 46 tubes found to be obstructed or poorly visualized with conventional hysterosalpingography. Recanalization was successful in 96% of 28 proximal tubal obstructions and in 33% of six midisthmic obstructions unrelated to surgery. Recanalization attempts resulted in tubal perforations without apparent clinical effects in four tubes, one with proximal and three with midisthmic postsurgical obstructions. The new hysterograph with coaxial catheter set is more suitable for recanalization of the obstructed fallopian tubes than is the previously used balloon catheter set.

Adult↗

PubMed1987

Isolated torsion of the normal fallopian tube.

Isolated torsion of the fallopian tube is a rare disease of unknown etiology. Pathological conditions often pre-dispose to torsion. The correct diagnosis is usually not established until the operation and it is almost always necessary to remove the tube. Awareness of this condition and early laparoscopy in case of unexplained acute low abdominal pain may result in early diagnosis and possible preservation of the affected tube.

Adult↗

PubMed1995

Noncanalization of the fallopian tube. A case report.

Anomalous development of the fallopian tubes is an uncommon occurrence, and only a few types of structural changes have been described. A woman with a unicornuate uterus and noncanalized contralateral fallopian tube with absence of the proximal segment is described. This condition has not been reported previously.

Abnormalities, Multiple↗

PubMed1989

Incidence of malignant fallopian tube tumors.

Incidence rates were examined for epithelial malignant fallopian tube neoplasms diagnosed between 1973 and 1984 and reported to nine population-based cancer registries in the United States. The average annual incidence was 3.6 per million women per year and there was no evidence of a change in the rate during the study period. Age-specific incidence followed a pattern similar to that observed for ovarian and endometrial neoplasms, rising rapidly during the reproductive years and flattening out thereafter. The incidence rate varied only slightly by race, with whites having a higher rate than blacks. Considerable variation in incidence was observed among the registries. While this could have been due to true regional differences in incidence, we cannot rule out the possibility that misclassification of fallopian tube tumors as ovarian tumors was responsible. Further investigations into the etiology of fallopian tube neoplasms should focus on the role of reproductive factors that have previously been reported as risk factors for ovarian and endometrial neoplasms.

Adult↗

PubMed1993

Primary carcinoma of the fallopian tube.

BACKGROUND: Because of the rarity of fallopian tube cancer, clinical approaches have changed during the last 18 years. METHODS: Twenty-nine patients with fallopian tube cancer were treated at the Gynecologic Oncology Department of Milan University from 1970 to 1988. The mean patient age was 59 years. Parity, symptomatology and histology were considered. Distribution by stage was as follows: I, 11 (37%); II, 10 (34%); III, 8 (27%) according to the Dodson classification. Twenty patients (69%) underwent surgery followed by pelvic irradiation. Adjuvant chemotherapy was performed in the treatment of 5 women with stage I disease, 6 with stage II, and all 8 with stage III. RESULTS: Five-year overall survival was 41.38%: 47.6% at stages I and II, 25% at stage III. Radiotherapy has not been replaced by cisplatin-based multiagent chemotherapy. Optimal surgical debulking combined with accurate lymph node sampling are not followed by systematic use of repeat laparotomy. CONCLUSIONS: The procedures described in this work improve the clinical assessment and patient survival, and make different series comparable.

Adult↗