A blood-based marker of mitochondrial DNA damage in Parkinson's disease

Parkinson's disease (PD) is the most common neurodegenerative movement disorder, and neuroprotective or disease-modifying interventions remain elusive. High-throughput markers aimed at stratifying patients on the basis of shared etiology are required to ensure the success of disease-modifying therapies in clinical trials. Mitochondrial dysfunction plays a prominent role in the pathogenesis of PD. Previously, we found brain region-specific accumulation of mitochondrial DNA (mtDNA) damage in PD neuronal culture and animal models, as well as in human PD postmortem brain tissue. To investigate mtDNA damage as a potential blood-based marker for PD, we describe herein a PCR-based assay (Mito DNADX) that allows for the accurate real-time quantification of mtDNA damage in a scalable platform. We found that mtDNA damage was increased in peripheral blood mononuclear cells derived from patients with idiopathic PD and those harboring the PD-associated leucine-rich repeat kinase 2 (LRRK2) G2019S mutation in comparison with age-matched controls. In addition, mtDNA damage was elevated in non-disease-manifesting LRRK2 mutation carriers, demonstrating that mtDNA damage can occur irrespective of a PD diagnosis. We further established that Lrrk2 G2019S knock-in mice displayed increased mtDNA damage, whereas Lrrk2 knockout mice showed fewer mtDNA lesions in the ventral midbrain, compared with wild-type control mice. Furthermore, a small-molecule kinase inhibitor of LRRK2 mitigated mtDNA damage in a rotenone PD rat midbrain neuron model and in idiopathic PD patient-derived lymphoblastoid cell lines. Quantifying mtDNA damage using the Mito DNADX assay may have utility as a candidate marker of PD and for measuring the pharmacodynamic response to LRRK2 kinase inhibitors.

Newly Revised Quantitative PCR-Based Assay for Mitochondrial and Nuclear DNA Damage

Given the crucial role of DNA damage in human health and disease, it is important to be able to accurately measure both mitochondrial and nuclear DNA damage. This article describes a method based on a long-amplicon quantitative PCR-based assay that does not require a separate mitochondrial isolation step, which can often be labor-intensive and generate artifacts. The detailed basic protocol presented here is newly revised, with particular attention to application in Homo sapiens, Rattus norvegicus, and Caenorhabditis elegans resulting from changes in availability of PCR reagents. Optimized extraction support protocols are also described for high-quality DNA from multiple rat tissues for which these procedures had not previously been described. © 2018 by John Wiley & Sons, Inc.

Human-chimpanzee differences in a FZD8 enhancer alter cell-cycle dynamics in the developing neocortex

The human neocortex differs from that of other great apes in several notable regards, including altered cell cycle, prolonged corticogenesis, and increased size [1-5]. Although these evolutionary changes most likely contributed to the origin of distinctively human cognitive faculties, their genetic basis remains almost entirely unknown. Highly conserved non-coding regions showing rapid sequence changes along the human lineage are candidate loci for the development and evolution of uniquely human traits. Several studies have identified human-accelerated enhancers [6-14], but none have linked an expression difference to a specific organismal trait. Here we report the discovery of a human-accelerated regulatory enhancer (HARE5) of FZD8, a receptor of the Wnt pathway implicated in brain development and size [15, 16]. Using transgenic mice, we demonstrate dramatic differences in human and chimpanzee HARE5 activity, with human HARE5 driving early and robust expression at the onset of corticogenesis. Similar to HARE5 activity, FZD8 is expressed in neural progenitors of the developing neocortex [17-19]. Chromosome conformation capture assays reveal that HARE5 physically and specifically contacts the core Fzd8 promoter in the mouse embryonic neocortex. To assess the phenotypic consequences of HARE5 activity, we generated transgenic mice in which Fzd8 expression is under control of orthologous enhancers (Pt-HARE5::Fzd8 and Hs-HARE5::Fzd8). In comparison to Pt-HARE5::Fzd8, Hs-HARE5::Fzd8 mice showed marked acceleration of neural progenitor cell cycle and increased brain size. Changes in HARE5 function unique to humans thus alter the cell-cycle dynamics of a critical population of stem cells during corticogenesis and may underlie some distinctive anatomical features of the human brain.

Dynamics of survival of motor neuron (SMN) protein interaction with the mRNA-binding protein IMP1 facilitates its trafficking into motor neuron axons

Spinal muscular atrophy (SMA) is a lethal neurodegenerative disease specifically affecting spinal motor neurons. SMA is caused by the homozygous deletion or mutation of the survival of motor neuron 1 (SMN1) gene. The SMN protein plays an essential role in the assembly of spliceosomal ribonucleoproteins. However, it is still unclear how low levels of the ubiquitously expressed SMN protein lead to the selective degeneration of motor neurons. An additional role for SMN in the regulation of the axonal transport of mRNA-binding proteins (mRBPs) and their target mRNAs has been proposed. Indeed, several mRBPs have been shown to interact with SMN, and the axonal levels of few mRNAs, such as the β-actin mRNA, are reduced in SMA motor neurons. In this study we have identified the β-actin mRNA-binding protein IMP1/ZBP1 as a novel SMN-interacting protein. Using a combination of biochemical assays and quantitative imaging techniques in primary motor neurons, we show that IMP1 associates with SMN in individual granules that are actively transported in motor neuron axons. Furthermore, we demonstrate that IMP1 axonal localization depends on SMN levels, and that SMN deficiency in SMA motor neurons leads to a dramatic reduction of IMP1 protein levels. In contrast, no difference in IMP1 protein levels was detected in whole brain lysates from SMA mice, further suggesting neuron specific roles of SMN in IMP1 expression and localization. Taken together, our data support a role for SMN in the regulation of mRNA localization and axonal transport through its interaction with mRBPs such as IMP1.

[MRI in static and dynamic disfunction of the female floor]

MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.

Fistule artério-veineuse utérine acquise : à propos d’une observation

A case of acquired uterine arteriovenous fistula in a 28 Year old patient is reported that probably is secondary to a "difficult" delivery. Sono-graphic, MRI and angiographic findings are reported, before and after endovascular management.

Magnetic resonance imaging of the pelvic floor

Magnetic resonance imaging is a novel noninvasive imaging modality for the assessment of pelvic floor dysfunction. It relies on static sequences with a high spatial resolution to study muscle morphology (levator ani) and fast imaging dynamic sequences during contraction, rest, and straining. Prolapse of the various pelvic compartments is detected with respect to organ position relative to the pubococcygeal line during dynamic phases. Compared with clinical examination, its input appears to be especially invaluable in the posterior compartments (peritoneal and digestive) and to assess complex prolapses involving more than one pelvic compartment. It is also useful for understanding postsurgical recurrences.

High signals in the uterine cervix on T2-weighted MRI sequences

The aim of this pictorial review was to illustrate the normal cervix appearance on T2-weighted images, and give a review of common or less common disorders of the uterine cervix that appear as high signal intensity lesions on T2-weighted sequences. Numerous aetiologies dominated by cervical cancer are reviewed and discussed. This gamut is obviously incomplete; however, radiologists who perform MR women's imaging should perform T2-weighted sequences in the sagittal plane regardless of the indication for pelvic MR. Those sequences will diagnose some previously unknown cervical cancers as well as many other unknown cervical or uterine lesions.

Imaging of membranous dysmenorrhea

Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.

[Tubal diseases: from diagnosis to intervention]

Ninety years after it was first performed, hysterosalpingography remains one of the most important tests in helping an infertile couple decide between numerous treatment options. The application of angiographic techniques to hysterosalpingography has revolutionized diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical catheter recanalization of proximally obstructed tubes can be accomplished in up to 90% of patients using standard techniques. Pregnancy incidence in a population who was recommended for tubal microsurgery or in vitro fertilization, but who underwent catheter tubal recanalization instead without any other therapy, was 58% at one year and all pregnancies were intrauterine. Fluoroscopic fallopian tube catheterization should be the first treatment for proximal tubal obstruction, with the more expensive and invasive procedures reserved for the small number of women who fail the radiologic procedure.

[Imaging of gynecologic malformations]

Female genital tract anomalies are common (1 to 2% of the female population), and may lead to multiple clinical manifestations: amenorrhea, infertility, spontaneous repeated miscarriage, pelvic pain, endometriosis. They are caused by intra-uterine insults between weeks 6 and 18 of gestation. They are classified according to their embryologic origin. Imaging relies essentially on ultrasound and MRI, and indications for hysterosalpingography are less common. Imaging must classify the malformation and detect complications in order to assess the fertility prognosis and treat complications.

[Imaging of the cervix and the vagina]

US and MRI currently are the best imaging modalities to evaluate pathology of the uterine cervix and vagina. Carcinoma of the cervix is the most frequent indication for imaging. MRI allows preoperative staging of cervical carcinoma based on FIGO classification, and post treatment follow-up. Other uterine cervix diseases are less frequently imaged and include a wide range of entities that most frequently cause increased T2W signal at MR imaging. Pathology of the pelvic floor, vagina, vulva, and perineum also includes a wide range of entities that have seldom been described in the imaging literature.

[A case of muscular and canal of nuck involvement by endometriosis]

Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity and having the functional property of menstrual bleeding. We report a case of endometriosis involving the abdominal wall muscles and canal of Nuck in a 28 year old woman. Abdominal wall sonography showed a hypoechoic lesion at the rectus abdominis insertion. T1W and T2W MRI images showed a hemorrhagic high signal intensity lesion in the muscle. MRI also showed a similar lesion in the canal of Nuck.

Interventional radiology in female infertility: technique and role

The purpose of this paper is to describe the modifications in the radiologic approach to female infertility. The role of hysterosalpingography (HSG) has evolved from being the only source of information about the uterus to a more minor role, after ultrasound, that essentially deals with the morphology of the fallopian tubes. But if its diagnostic yield in the uterus is challenged by ultrasound and hysterosonography, it retains a major impact in the work-up of female infertility. Hysterosalpingography brings decisive diagnostic information concerning the state of the tubes and peritoneum. The interventional procedures of selective salpingography and tubal recanalization have a definite therapeutic effect and allow numerous pregnancies that would otherwise have required in vitro fertilization or tubal microsurgery.

[Imaging of benign ovarian tumors]

A positive diagnosis of benign ovarian tumor indicates a laparoscopic approach or a conservative treatment. Benign ovarian tumors are often easy to recognize with non ionizing modalities such as US and MRI. The most common benign ovarian tumors are: mature teratomas including dermoid cysts, tumors in the fibro-thecal group including fibromas and thecomas, benign serous and mucinous tumors (cystadenomas). Apart from ovarian tumors, endometriomas are more commonly extra ovarian, but may involve the ovarian stroma.

[Static and dynamic magnetic resonance imaging of the pelvic floor]

MRI assessment of pelvic floor dysfunction is still fairly recent. It is a fast expanding field, owing to its safety and simplicity when compared to other imaging modalities. The possibility of direct dynamic imaging is a decisive input, and it can be coupled to a clinical examination at the magnet. The most widely used sequences are T2 weighted fast TSE or fast gradient echo, in the sagittal and frontal planes. Dynamic MRI of the pelvic floor allows pre-operative staging of prolapse, detection of hidden prolapses and assessment of muscle trophicity. Post-operatively it allows assessment of surgical results and failures or recurrences.

A review of selective salpingography and fallopian tube catheterization

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.

[Static and dynamic MRI of the normal and pathological female pelvic floor]

Static and dynamic MRI of the female pelvic floor is a new application of this technology. The capability of MRI to assess cavities and muscles on the same exploration is an important improvement. The authors describe successively: MRI is nowadays a decisive tool in the preoperative work-up of pelvic floor dysfunctions.

Static and dynamic MRI of a urinary control intra-vaginal device

The aim of this study was to describe by MRI, in dynamic conditions at rest and straining, the anatomical modifications induced by a commercially available intravaginal device (IVD) aimed at relieving female stress urinary incontinence. Ten female patients complaining of stress urinary incontinence (SUI) had pelvic MRI with static and dynamic sequences, without and with a self-inserted IVD. We studied positions and angulations of the IVD in the pelvis. Paired t-test allowed comparisons of: position of the bladder neck; urethral angulation with the pubis axis; position of the urethra; and posterior urethro-vesical angle (PUVA) without and with IVD. At rest, in ten of ten cases IVD laid cranial to the pubo-rectal muscle; with an average angulation of 95 +/- 10 degrees with the pubis axis, laterally tilted in three of ten cases. In maximum straining with IVD bladder neck descent was lower by an average of 5.2 +/- 3.1 mm (p = 0.001), pubo-urethral angle opening was smaller by an average of 22 +/- 20 degrees (p = 0.015), and bladder neck to pubis distance was shorter by an average of 5.7 +/- 4 mm. Posterior urethro-vesical angle was not significantly modified. Dynamic MRI allowed a non-invasive assessment of the mode of action of an IVD. The main modifications were a support of the bladder base and bladder neck, with a superior displacement of the urethra toward the pubis.

Effect of field strength on MR images: comparison of the same subject at 0.5, 1.0, and 1.5 T

To assess the effect of field strength on magnetic resonance (MR) images, the same healthy subject was imaged at three field strengths: 0.5, 1.0, and 1.5 T. Imaging was performed with three similarly equipped MR imagers of the same generation and from the same manufacturer. The same imaging sequences were used with identical parameters and without repetition time correction for field strength. Imaging was performed in four anatomic locations: the brain, lumbar spine, knee, and abdomen. Quantitative image analysis involved calculation of signal-to-noise ratio, contrast-to-noise ratio, and relative contrast; qualitative image analysis was performed by four readers blinded to field strength. The results of all of the examinations were considered to be of diagnostic value. In general, signal-to-noise ratio and contrast-to-noise ratio were lowest at 0.5 T and highest at 1.5 T; relative contrast was not related to field strength. At qualitative analysis, images obtained at 1.0 and 1.5 T were superior to images obtained at 0.5 T; qualitative differences were less important in locations where there is motion or high magnetic susceptibility differences between tissues (e.g., the spine and abdomen). However, excellent image quality was obtained with all three field strengths.

[Abdominal and pelvic segmented T1-weighted echo-planar imaging and MRI. Comparison with T1-TSE and T2-UTSE sequences]

PURPOSE

To assess, quantitatively and qualitatively, the diagnostic value of a segmented EPI T1W sequence compared to T1W and T2W TSE sequences.

MATERIAL AND METHODS

A prospective analysis of abdominal and pelvic MRI examinations of 70 patients (44 women, 26 men, mean age of 61 years), was performed on a 0.5 T supraconductive magnet with 15 mT/m gradients. The sequences were randomized and compared in a blinded fashion by 3 independent reviewers: TSE T1W (TR/TE = 500/12 ms, NSA = 6, turbo factor 5, 3:49 min), EPI T1W (TR/TE = 500/30 ms, NSA = 6, EPI factor = 7, 2:13 min) and UTSE T2W (TR/TE = 1600-2500/100, NSA = 6, turbo factor = 31, 2:20 min).

RESULTS

Quantitatively, no significant difference was found between T1W sequences for signal to noise ratio. The EPI T1W sequence had lower signal but stronger enhancement after gadolinium injection. Qualitatively, EPI T1W had significantly less flow artefacts (p < 0.001, wilcoxon test), and more chemical shift artifact (p < 0.01). For lesion detection, differences were not statistically significant between T1W sequences or between paired T1W and T2W sequences (sensitivity and specificity 84 and 86% for TSE T1W 76 and 86% for EPI T1W, 78 and 79% for UTSE T2W, 90 and 65% for TSE T1W-UTSE T2W, 88 and 65% for EPI T1W-UTSE T2W). Kappa concordance test (0.686) and Mac Nemar symmetry test (3.55) were high between T1W sequences.

CONCLUSION

The segmented EPI T1W sequence used had equivalent results compared to the TSE T1W sequence, it allows a 40% reduction in acquisition time and this without difference in the diagnostic performances of the reviewers.

Direct percutaneous approach to the upper pole of the kidney: MRI anatomy with assessment of the visceral risk

PURPOSE

In an attempt to determine the visceral risk secondary to a direct percutaneous puncture of the upper renal calix, the anatomic relations of the upper pole of the kidney were studied by magnetic resonance imaging.

METHODS

Examination was performed on 25 normal volunteers placed successively in the right and left prone oblique position. The kidney axis and minimal distances from the cutaneous plane at the level of the upper and lower poles were measured. Axial and tangential simulated percutaneous approaches to the upper renal calix were compared in term of risk of damage to the pulmonary, splenic, and hepatic parenchyma.

RESULTS

The transversal anteversion angle was statistically comparable for right and left kidneys, but the sagittal anteversion angle was significantly higher for right kidneys (p = 0.05). The minimal distance from the cutaneous plane was statistically comparable for the upper and lower poles. The lower pole was significantly deeper for left than right kidneys (p = 0.01). The visceral risk was statistically comparable for left and right kidneys and was significantly higher in case of an approach in the axis of the upper renal calix or through the 10th intercostal space compared to a puncture via the l1th space (p = 0.0001).

CONCLUSION

A percutaneous puncture of the upper pole of the kidney above the 11th rib increases the risk of visceral damage. Preoperative evaluation, with the aid of CT scan or MRI, of the risk of pulmonary, splenic, or hepatic injury could be carried out in these cases.

Unselected brain 0.5-T MR imaging: comparison of lesion detection and characterization with three T2-weighted sequences

PURPOSE

To compare the diagnostic values of three T2-weighted sequences in unselected brain 0.5-T magnetic resonance (MR) imaging examinations.

MATERIALS AND METHODS

MR imaging was performed in 102 patients because of neurologic symptoms or the follow up "previously known disease." The protocol comprised three T2-weighted sequences: turbo spin-echo (SE), turbo fluid-attenuated inversion-recovery (FLAIR), and gradient and SE (GRASE) sequences. In a prospective, blinded analysis, sequences were compared quantitatively and qualitative by three independent readers for lesion detection and characterization.

RESULTS

Twenty-four patients had normal findings, and 78 had abnormal findings, with 121 final diagnoses. Quantitatively, the "white" cerebrospinal fluid (CSF) sequences, turbo SE and GRASE, had higher contrast-to-noise ratios (CNRs) than the "black" CSF sequence, FLAIR, with respect to the signal intensity of white manner, but lower CNRs than FLAIR with respect to the signal intensity of CSF. Qualitatively, for lesion detection, sensitivity and accuracy were significantly higher for FLAIR than for turbo SE or GRASE (P < .05); there was no statistically significant difference between turbo SE or GRASE. FOR lesion characterization, FLAIR was significantly superior to GRASE and turbo SE for white matter disease (P < .05), superior to only turbo SE (P < .05) for vascular disease, and not superior to GRASE or turbo SE for tumors.

CONCLUSIONS

The black CSF T2-weighted turbo FLAIR sequence is a useful adjunct to the usual white CSF T2-weighted sequences in unselected brain 0.5-T MR imaging.

Penile fracture: MRI demonstration of a urethral tear associated with a rupture of the corpus cavernosum

We report a case of traumatic urethral tear associated with a rupture of the corpus cavernosum, demonstrated on MRI. We discuss the potential role of a non-invasive preoperative assessment by MRI.

Endoscopic transvaginal approach to the rabbit uterine cervix: improvement in the technique of selective tubal catheterization

RATIONALE AND OBJECTIVES

The authors compared two methods of selective fallopian tube catheterization in female rabbits.

METHODS

Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance.

RESULTS

The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques.

CONCLUSION

The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.

[Left ovarian vein syndrome]

Ovarian vein syndrome is classically described on the right side. Patients present with lumbar pain or renal colics due to a compression of the ureter between the external iliac artery and a dilated ovarian vein. We report an unusual case of left ovarian vein syndrome between a dilated ovarian vein and the psoas muscle, with a similar clinical presentation.

Tubal sterilization by means of selective catheterization: comparison of a hydrogel and a collagen glue

PURPOSE

To test, in an animal model, two potentially suitable materials for nonsurgical selective tubal sterilization.

MATERIALS AND METHODS

A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed in four rabbit fallopian tubes, and a proprietary collagen glue was placed into three rabbit fallopian tubes by means of transvaginal fluoroscopic fallopian tube catheterization. As controls, 11 tubes were catheterized without sterilization material injection. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Histologic analysis was performed.

RESULTS

The short-term contraception rate was 100% in the hydrogel group, 33% in the collagen glue group, and 0% in the control group (P < .001 hydrogel group, P not significant in collagen group). Inflammation was minimal in the three groups (P not significant).

CONCLUSION

The collagen glue had an insufficient contraceptive effect and should be abandoned. The hydrogel used proved effective and biocompatible, and long-term studies of this compound are warranted.

[Magnetic resonance imaging of the pelvis]

Magnetic resonance imaging (MRI) is particularly well suited to pelvic explorations. Normal uterine zonal anatomy and its variations within the menstrual cycle are well codified. MRI is the best preoperative imaging modality for the localization of fibroids. MRI allows a good approach to tissue characterization in benign ovarian tumors and a precise loco-regional assessment in malignant tumors. It could eventually replace the surgical second look after therapy. In prostate cancer, MRI is the most accurate imaging modality to assess capsular invasion.

[Bladder adenomyomatosis. Apropos of a case of segmental involvement. Correlation ultrasonography-MRI]

Adenomyomatosis of the gall bladder is a classical but seldom recognized cause of gallbladder wall thickening. The authors review the imaging features of this disease and emphasize the value of ultrasound and MRI. Although considered a benign disease, some recently described cases of neoplastic transformation may warrant surgery.

Selective tubal sterilization in rabbits: experience with a hydrogel combined with a sclerosing agent

PURPOSE

To test a method of nonsurgical sterilization.

MATERIALS AND METHODS

A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed into fallopian tubes of eight rabbits by means of transvaginal rabbits by means of transvaginal fluoroscopic fallopian tube catheterization. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy.

RESULTS

Seven of the eight rabbits became pregnant. Six of these rabbits contained embryos in the control uterus but not in the uterus on the side of the hydrogel injection. The seventh rabbit had embryos in both uteri, but the hydrogel had been expelled. All seven tubes that contained hydrogel showed evidence of acute and chronic salpingitis and a foreign-body reaction. The tube from which hydrogel had been expelled and the eight control tubes were not inflamed.

CONCLUSION

Transcervical catheter methods of tubal occlusion and sterilization are promising, but a non-reactive material is needed.

Tubal sterilization by selective catheterization in an animal model

RATIONAL AND OBJECTIVES

The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application.

METHODS

Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated.

RESULTS

Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted.

CONCLUSION

Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.

Fallopian tube recanalization by selective salpingography: an alternative to more invasive techniques?

Selective salpingography was used in a total of 64 patients, engaged in evaluation for infertility and in whom standard hysterograms showed no tubal passage of contrast medium. Fallopian tube catheterization was successful in 92% of the cases; a peritoneal spill of contrast medium was obtained in 74% of the cases by manual injection. Recanalization of an obstructed oviduct was successful in 61% of the cases. Thus, after the procedure, 82% of the patients had at least one patent tube. We conclude that selective tubal catheterization, and recanalization when needed, should be included in the therapeutic procedures for tubal infertility, prior to in-vitro fertilization or tubal microsurgery.

Trans-uterine venography. Normal anatomy and pathologic appearances

From a series of 110 trans-uterine venographies, the authors present the normal radiological anatomy of the uterine venous vascularization and of its efferent venous drainage. They also present the most frequent variations from normal and examples of the pathologies encountered.

[Pelvic endometriosis of urinary and digestive sites. Apropos of 7 cases]

Seven cases of pelvic endometriosis of the urinary or digestive tracts are reported: 4 cases of vesical endometriosis, 1 case of ureteral involvement, 1 rectal case and 1 sigmoid location. The authors point out the difficulty of the clinical preoperative diagnosis--in despite of cyclic troubles--and underline the interest of complementary explorations performed at the time of periods: ultrasound, cystoscopy, rectosigmoidoscopy and coelioscopy. The MR imaging, showing high intensity a T1-weighted images and prominent high intensity on T2-weighted images, is very suggestive of an endometrial lesions. A joint medical and surgical treatment is required. Endoscopic excision, endoprosthetic tube, excision-suture, resection-anastomosis and a complementary medical treatment using Danazol. Decapeptyl or progestational agents have to be proposed. Per-operative microscopy is advised as routine procedure in order to avoid excessive surgery.

Gynecologic interventional radiology

Interventional radiology now finds a wide range of applications in the gynecologic area. They can be divided in general procedures applied to gynecology and procedures specific to gynecology.