Amr K. Elfayomy

Morphometric analysis of terminal villi and gross morphological changes in the placentae of term idiopathic intrauterine growth restriction

The aim of this study is to compare the gross morphology of the placentae and the morphometry of terminal villi and terminal villous capillaries in pregnancies complicated by idiopathic intrauterine growth restriction (IUGR) with those of normal pregnancies. 75 placentae were collected between April 2010 and March 2011. 50 placentae were associated with idiopathic IUGR and 25 were from controls. Insertion of cords, placental weights and diameters were noted. Hematoxylin and eosin-stained wax sections were analyzed stereologically. Growth of terminal villi and fetal capillaries was assessed by estimating total and mean surface areas. Villous capillarization was monitored using capillary:villus surface ratio. Measurements were done using image analysis system. In comparison with the control group, idiopathic IUGR placentae are significantly smaller (p=0.000) and lighter (p=0.000). In majority of IUGR (68%) and control (60%) cases, eccentric insertion of cord is noted. In idiopathic IUGR group, there is a significant decrease in the total areas of both terminal villi (p=0.048) and their capillaries (p=0.000) and a significant decrease in number of both terminal villi (p=0.000) and their capillaries (p=0.001), also, capillarization index is significantly smaller (p=0.038). Idiopathic IUGR is associated with reduced growth of placental terminal villi and fetal capillaries and this is accompanied by changes in measures of villous capillarization as compared with those of control placentae. Further investigations of idiopathic IUGR placentae are necessary, especially considering the histopathological changes that could affect the fetomaternal exchange, with a note that strict distinction should be made between idiopathic and nonidiopathic IUGR placentae.

Effects of a single course versus repeated courses of antenatal corticosteroids on fetal growth, placental morphometry and the differential regulation of vascular endothelial growth factor

To investigate the impact of antenatal exposure to a single course or repeated courses of dexamethasone (DEX) on neonatal anthropometrics, placental morphometry and potential effect on maternal plasma levels and placental expression of vascular endothelial growth factor (VEGF).

Regeneration of the Fallopian Tube Mucosa Using Bone Marrow Mesenchymal Stem Cell Transplantation After Induced Chemical Injury in a Rat Model

In this study, we describe a novel insight about the use of bone marrow–derived mesenchymal stem cells (BM-MSCs) for fallopian tube (FT) regeneration. Seventy rats’ tubes were involved in this study and divided into 4 groups: control (15), ethanol injured (20), mesenchymal stem cell (MSC)-recipient without injury (15), and MSC recipient after injury (20). The BM-MSCs were isolated from male rats, and their incorporation into the tissues was confirmed by the detection of Sry gene in MSC-recipient rats using RT-PCR. Histological and immunohistological sections of the 4 groups were comparably evaluated. We found that direct injection of ethanol into FT caused structural impairment, which was restored largely after receiving MSCs. We have revealed for the first time that prominin 1 (Prom1, stem cell marker) was expressed in the fimbriated distal tubal end. The MSC transplantation caused (1) significant increase in the tissue level and immunoexpresstion of Prom1 (P < .001 and P = .017, respectively) and vascular endothelial growth factor (VEGF; vasculogenic marker; P < .001 and P = .004, respectively), (2) significant increase in the immunoexpresstion of proliferating cell nuclear antigen (PCNA; proliferation marker; P < .001), and (3) significant decrease in the immunoexpresstion of caspase 3 (CASP-3; apoptotic marker; P < .001) compared to the injured tissues. In conclusion, MSCs could exhibit its restorative effect on FT through their ability to (1) activate the resident stem cells in the distal tubal end, (2) mediate the expression of VEGF and PCNA, and (3) influence tissue apoptosis. This study laid the foundation for assessing the contribution of stem cells in the distal tubal end in direct repair of the tube when required to assist reproduction.

Carbetocin versus intra-umbilical oxytocin in the management of retained placenta: A randomized clinical study

This study aimed to compare the hemodynamic profile and efficacy of carbetocin versus intra‐umbilical oxytocin in the management of retained placenta following vaginal delivery.

Comparison of colposcopic findings between cytologically screened positive and negative women with postcoital bleeding

Objectives The aim of the study was to compare colposcopic findings between cytologically screened positive and negative women presenting with postcoital bleeding (PCB) to establish the prevalence of underlying cervical pathology. Study design This was a prospective study. Patients and methods Eighty-three consecutive women referred to the colposcopy clinic primarily for PCB were enrolled between January 2011 and April 2012. They underwent a speculum examination, cervical cytological examination, and colposcopy with diagnostic biopsies. Results Of the 83 women, 32 had positive results on cytological examination. These women more likely to have abnormalities on colposcopy (P=0.015) and a high incidence of preinvasive or invasive lesions (P=0.004) compared with women with negative cytological results. The overall incidence of cervical intraepithelial neoplasia (CIN) grade 1 was 13.2%, that of CIN 2 and 3 was 7.2%, and that of squamous cell carcinoma was 2.4%. Of note, of 51 women with a negative cytological result, 7.8% had CIN 1 and 3.9% had CIN 2 or 3; 47.4% of women with high-risk lesions were oral contraceptive pill users. The sensitivity of cervical smear in the diagnosis of high-risk abnormality was 68.4%, specificity was 70.3%, and positive predictive value and negative predictive value were 40.6 and 88.2%, respectively. The same parameters for colposcopy with multiple biopsies were 84.2, 87.5, 66.6, and 94.9%, respectively. Conclusion PCB should be considered an indication for cervical cancer or CIN even with a negative smear, although the majority of women had benign lesions. The diagnostic performance of colposcopy in the detection of high-risk lesions in such patients can be improved by performing multiple biopsies even in those with apparently normal view. This initial finding helps to avoid overtreatment and repeated excisional biopsies.

Cytomorphometric and immunohistochemical study of ampullary mucosa of the human uterine tube during the menstrual cycle and after menopause

Objective To determine the cytomorphometric changes in the ampullary mucosa of the human uterine tube and to study the distribution of intraepithelial lymphocytes (IELs) and macrophages during a natural menstrual cycle and after menopause. Study design A comparative study. Participants and methods Twenty-eight uterine tubes were obtained from women with a normal menstrual cycle at the proliferative or secretory phases and menopausal women who had undergone total abdominal hysterectomy or tubal surgery for benign conditions. Specimens from ampullary regions were processed to prepare sections to be stained with hematoxylin and eosin and to be used for immunohistochemical localization of CD68. An image analysis system was used to measure the epithelial cell height and to count the IELs and CD68+ macrophages. Results Statistical analysis indicated a significant increase in the mean epithelial cell height and the mean number of IELs during the proliferative phase (P=0.000). However, there was a significant increase in the mean number of CD68+ macrophages during the secretory phase (P=0.000). After menopause, there was a significant decrease in cell height, IELs, and CD68+ macrophages. Conclusion According to the menstrual status, the human uterine tube undergoes epithelial morphological changes that aid gamete transport and the reproductive process. Also, changes in IELs and the macrophage pattern might be involved in regulating immune tolerance to spermatozoa during the proliferative phase and the removal of apoptotic epithelial cells during the secretory phase. After menopause, there is a decrease in the number of both IELs and macrophages perhaps as part of age-induced alterations in the immune system that could be attributed to estrogen deprivation.