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Chen J, Sun L, Qian H, Wu C, Jiang J, Guo X, Gao S. Hysteroscopic Fenestration with Precise Incision of the Cavity Septum: A Novel Minimally Invasive Surgery of Complete Septate Uterus with Double Cervix. J Minim Invasive Gynecol 2023; 30:716-724. [PMID: 37196886 DOI: 10.1016/j.jmig.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
STUDY OBJECTIVE This study aimed to develop and describe a novel surgical procedure that involves hysteroscopic fenestration with precise incision of the complete uterine septum and double cervix preservation after magnetic resonance imaging (MRI) evaluation in patients and to evaluate its efficacy. DESIGN A prospective consecutive clinical study. SETTING A university teaching hospital. PATIENTS Twenty-four patients with complete septate uterus and double cervix. INTERVENTIONS Three-dimensional reconstruction of uterus was performed with pelvic MRI and three-dimensional SPACE sequence scanning. Hysteroscopic fenestration with precise incision of the cavity septum and double cervix preservation was performed in patients. Three months after operation, follow-up pelvic MRI and second-look hysteroscopy were performed conventionally. MEASUREMENTS AND MAIN RESULTS Operating time, blood loss, operative complications, MRI and hysteroscopic changes of uterus, symptoms improvement, and reproductive outcomes were assessed. The surgery was successfully completed without any intraoperative complications in all patients. Operating time was 21.71 ± 8.28 minutes (range, 10-40 minutes) and blood loss was 9.92 ± 7.14 mL (range, 5-30 mL). Postoperative MRI showed the uterine anteroposterior diameter (3.66 cm vs 3.92 cm; p <.05) was increased. Postoperative MRI and the second-look hysteroscopy showed the cavity shape and uterine volume were expanded to the normal. Symptoms of dysmenorrhea, abnormal uterine bleeding, and dyspareunia were ameliorated after the surgery in 70% of patients (7 of 10), 60% of patients (3 of 5), and 1 patient, respectively. The preoperative spontaneous abortion rate was 80% (4 of 5) and the postoperative spontaneous abortion rate was 11.11% (1 of 9). After the surgery, there were 2 ongoing pregnancies and 6 pregnancies ended in term births. Two live births were delivered by cesarean section and 4 by vaginal delivery without cervical incompetence during pregnancy. CONCLUSIONS Hysteroscopic fenestration with precise incision of the uterine septum and double cervix preservation is an effective surgical procedure.
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Affiliation(s)
- Jialing Chen
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lin Sun
- Department of Gynecology (Dr. Sun), Lianshui County People's Hospital, Kangda College of Nanjing Medical University, Huai'an, China
| | - Huijun Qian
- Departments of Radiology (Dr. Qian), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Congquan Wu
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiqin Jiang
- Department of Gynecology (Dr. Jiang), Shaoxing Central Hospital, Shaoxing, China
| | - Xiaolan Guo
- Department of Surgery, Obstetrics and Gynecology (Dr. Guo), Hospital of Fudan University, Shanghai, China
| | - Shujun Gao
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease (Dr. Gao), Fudan University, Shanghai, China..
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Buskmiller C, Bergh EP, Brock C, Miller J, Baschat A, Galan H, Behrendt N, Habli M, Peiro JL, Snowise S, Fisher J, Macpherson C, Thom E, Pedroza C, Johnson A, Blackwell S, Papanna R. Interventions to prevent preterm delivery in women with short cervix before fetoscopic laser surgery for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2022; 59:169-176. [PMID: 34129709 DOI: 10.1002/uog.23708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Preoperative short cervical length (CL) remains a major risk factor for preterm birth after laser surgery for twin-twin transfusion syndrome (TTTS), but the optimal intervention to prolong pregnancy remains elusive. The objective of this study was to compare secondary methods for the prevention of preterm birth in twin pregnancies with TTTS undergoing fetoscopic laser photocoagulation (FLP), in the setting of a short cervix at the time of FLP, in five North American Fetal Treatment Network (NAFTNet) centers. METHODS This was a secondary analysis of data collected prospectively at five NAFTNet centers, conducted from January 2013 to March 2020. Inclusion criteria were a monochorionic diamniotic twin pregnancy complicated by TTTS, undergoing FLP, with preoperative CL < 30 mm. Management options for a short cervix included expectant management, vaginal progesterone, pessary (Arabin, incontinence or Bioteque cup), cervical cerclage or a combination of two or more treatments. Patients were not included if the intervention was initiated solely on the basis of having a twin gestation rather than at the diagnosis of a short cervix. Demographics, ultrasound characteristics, operative data and outcomes were compared. The primary outcome was FLP-to-delivery interval. Propensity-score matching was performed, with each treatment group matched (1:1) to the expectant-management group for CL, in order to estimate the effect of each treatment on the FLP-to-delivery interval. RESULTS A total of 255 women with a twin pregnancy complicated by TTTS and a short cervix undergoing FLP were included in the study. Of these, 151 (59%) were managed expectantly, 32 (13%) had vaginal progesterone only, 21 (8%) had pessary only, 21 (8%) had cervical cerclage only and 30 (12%) had a combination of treatments. A greater proportion of patients in the combined-treatment group had had a prior preterm birth compared with those in the expectant-management group (33% vs 9%; P = 0.01). Mean preoperative CL was shorter in the pessary, cervical-cerclage and combined-treatment groups (14-16 mm) than in the expectant-management and vaginal-progesterone groups (22 mm for both) (P < 0.001). There was no significant difference in FLP-to-delivery interval between the groups, nor in gestational age at delivery or the rate of live birth or neonatal survival. Vaginal progesterone was associated with a decrease in the risk of delivery before 28 weeks' gestation compared with cervical cerclage and combined treatment (P = 0.03). Using propensity-score matching for CL, cervical cerclage was associated with a reduction in FLP-to-delivery interval of 13 days, as compared with expectant management. CONCLUSIONS A large proportion of pregnancies with TTTS and a short maternal cervix undergoing FLP were managed expectantly for a short cervix, establishing a high (62%) risk of delivery before 32 weeks in this condition. No treatment that significantly improved outcome was identified; however, there were significant differences in potential confounders and there were also likely to be unmeasured confounders. Cervical cerclage should not be offered as a secondary prevention for preterm birth in twin pregnancies with TTTS and a short cervix undergoing FLP. A large randomized controlled trial is urgently needed to determine the effects of treatments for the prevention of preterm birth in these pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Buskmiller
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - E P Bergh
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - C Brock
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J Miller
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Galan
- Department of Obstetrics and Gynecology, University of Colorado Denver, Colorado Fetal Care Center, Children's Hospital of Colorado, Denver, CO, USA
| | - N Behrendt
- Department of Obstetrics and Gynecology, University of Colorado Denver, Colorado Fetal Care Center, Children's Hospital of Colorado, Denver, CO, USA
| | - M Habli
- Cincinnati Children's Fetal Care Center, Cincinnati, OH, USA
| | - J L Peiro
- Cincinnati Children's Fetal Care Center, Cincinnati, OH, USA
| | - S Snowise
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, MN, USA
| | - J Fisher
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, MN, USA
| | - C Macpherson
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - E Thom
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - C Pedroza
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - A Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - S Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Di Spiezio Sardo A, Giampaolino P, Manzi A, De Angelis MC, Zizolfi B, Alonso L, Carugno J. The Invisible External Cervical Os. Tips and Tricks to Overcome this Challenge during In-Office Hysteroscopy. J Minim Invasive Gynecol 2020; 28:172-173. [PMID: 32526381 DOI: 10.1016/j.jmig.2020.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" patients in 1 session if desired [1-3]. Pain and the inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in an office setting [4-7]. Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with a history of cervical procedures such as cone biopsy [8]. It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than facing the obliteration of the internal os. The aim of this video article is to illustrate the use of simple techniques that allow the hysteroscopist to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in-office hysteroscopy in patients with severe cervical stenosis including those with complete obliteration of the external cervical os. These techniques are easy to adopt and can be used in different clinical situations in which the hysteroscopic evaluation of the uterine cavity is needed in women with severe cervical stenosis. DESIGN A series of videos of challenging cases with severe cervical stenosis with complete obliteration of the external cervical os are presented that demonstrate maneuvers to properly identify and enter the cervical canal, unfolding key aspects of the procedure. Tips and tricks to facilitate the adoption of these useful maneuvers into clinical practice are highlighted. SETTING In-office diagnostic hysteroscopy was performed using a 5-mm rigid continuous flow operative hysteroscope. Patients were placed in a dorsal lithotomy position. The vaginoscopy "no touch" technique was used [9]. No anesthesia or sedation was administered to any of the patients. Normal saline was used as distention media. INTERVENTIONS Taking advantage of the magnification provided by the hysteroscope, the location of the external cervical os was determined. In cases in which the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper, or scissors (Fig. 1). Recognition of the landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates the use of the correct plane of dissection that leads into the uterine cavity (Fig. 2). Additional maneuvers that are useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. CONCLUSION The combination of a delicate technique and operator experience aids in overcoming the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures, decreasing the need to take patients to the operating room and the use of general anesthesia.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Alfonso Manzi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Maria Chiara De Angelis
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Brunella Zizolfi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Luis Alonso
- Department of Gynecologic Endoscopy, Centro Gutenberg, Malaga, Spain (Dr. Alonso)
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida (Dr. Carugno).
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Di Pietro M, Filardo S, Porpora MG, Recine N, Latino MA, Sessa R. HPV/Chlamydia trachomatis co-infection: metagenomic analysis of cervical microbiota in asymptomatic women. New Microbiol 2018; 41:34-41. [PMID: 29313867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 06/07/2023]
Abstract
HPV and Chlamydia trachomatis are the most common causes of sexually transmitted diseases worldwide. Most infections are asymptomatic and left untreated lead to severe reproductive tract sequelae such as cervical cancer and infertility. Interestingly, C. trachomatis may also increase the susceptibility to HPV infection as well as contribute to viral persistence. Recently, a growing body of evidence has suggested that the composition of the cervico-vaginal microbiota plays a key role in the susceptibility and outcome of genital infections caused by several pathogens, including HPV and C. trachomatis. The aim of our study was to undertake a metagenomic analysis of sequenced 16s rRNA gene amplicons to characterize the cervical microbiota from asymptomatic women with HPV/C. trachomatis co-infection. The composition of the cervical microbiota from HPV-positive or C. trachomatis-positive women was also analysed. The main finding of our study showed that the cervical microbiota in HPV/C. trachomatis co-infected women had a higher microbial diversity than the cervical microbiota in healthy controls (p<0.05). In addition, Aerococcus christensenii was associated with C. trachomatis infection. In conclusion, the increased cervical microbial diversity observed in HPV/C. trachomatis co-infected women and the detection of potential microbiological biomarkers of C. trachomatis infection will open the way to innovative approaches that may be helpful to identify women at risk of co-infection.
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Affiliation(s)
- Marisa Di Pietro
- Section of Microbiology, Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Simone Filardo
- Section of Microbiology, Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynecology, Obstetrics and Urology, University of Rome "Sapienza", Rome, Italy
| | - Nadia Recine
- Department of Gynecology, Obstetrics and Urology, University of Rome "Sapienza", Rome, Italy
| | - Maria Agnese Latino
- Unit of Bacteriology, STIs Diagnostic Centre, Sant'Anna Hospital, Turin, Italy
| | - Rosa Sessa
- Section of Microbiology, Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
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Muslimova S. [THE ROLE OF PAPILLOMAVIRUS INFECTION IN THE DEVELOPMENT OF BACKGROUND DISEASE OF THE CERVIX]. Georgian Med News 2017:90-94. [PMID: 28820421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Papillomavirus infection is one of the most common sexually transmitted infections. The aim of the study was to study the etiologic significance of the papillomavirus infection in the development of background diseases of the cervix and neoplasia. Under observation were 62 patients aged 18 to 55 years infected with human papillomavirus. All patients underwent complex clinical and anamnestic, laboratory and instrumental examination. Also, a review and advanced colposcopy was performed. As a result of the study, 53 (85.4%) women under observation were found to have various pathologies of the cervix. Dysplasia of mild degree (CIN 1 degree) was found in 12 (57.1%), moderate dysplasia (CIN 2 degree) - in 9 (42.9%) women. With further examination, it was found that patients along with dysplasia of varying severity had concomitant pathology of the cervix uteri. Cervical dysplasia was most often diagnosed in combination with another pathology of the cervix, which accounted for 85.7% of cases. It has been established that squamous epithelial lesion of the cervix is most often a consequence of late diagnosis and an untreated background process. At the same time, modern diagnostics requires a whole range of diagnostic measures to establish a diagnosis in the early stages of development and conduct differential diagnosis of a benign or malignant process.
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Affiliation(s)
- S Muslimova
- Azerbaijan Medical University, Department of Obstetrics-Gynecology II, Baku
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Davies BM, McHugh M, Elgheriani A, Kolias AG, Tetreault L, Hutchinson PJA, Fehlings MG, Kotter MRN. The reporting of study and population characteristics in degenerative cervical myelopathy: A systematic review. PLoS One 2017; 12:e0172564. [PMID: 28249017 PMCID: PMC5332071 DOI: 10.1371/journal.pone.0172564] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/07/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECT Degenerative cervical myelopathy [DCM] is a disabling and increasingly prevalent condition. Variable reporting in interventional trials of study design and sample characteristics limits the interpretation of pooled outcomes. This is pertinent in DCM where baseline characteristics are known to influence outcome. The present study aims to assess the reporting of the study design and baseline characteristics in DCM as the premise for the development of a standardised reporting set. METHODS A systematic review of MEDLINE and EMBASE databases, registered with PROSPERO (CRD42015025497) was conducted in accordance with PRISMA guidelines. Full text articles in English, with >50 patients (prospective) or >200 patients (retrospective), reporting outcomes of DCM were deemed to be eligible. RESULTS A total of 108 studies involving 23,876 patients, conducted world-wide, were identified. 33 (31%) specified a clear primary objective. Study populations often included radiculopathy (51, 47%) but excluded patients who had undergone previous surgery (42, 39%). Diagnositic criteria for myelopathy were often uncertain; MRI assessment was specified in only 67 (62%) of studies. Patient comorbidities were referenced by 37 (34%) studies. Symptom duration was reported by 46 (43%) studies. Multivariate analysis was used to control for baseline characteristics in 33 (31%) of studies. CONCLUSIONS The reporting of study design and sample characteristics is variable. The development of a consensus minimum dataset for (CODE-DCM) will facilitate future research synthesis in the future.
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Affiliation(s)
- Benjamin M. Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - M. McHugh
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - A. Elgheriani
- Division of Neurosurgery and Spine Program Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Lindsay Tetreault
- Division of Neurosurgery and Spine Program Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Peter J. A. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- John van Geest Brain Repair Centre, University of Cambridge, Cambridge, United Kingdom
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Mark R. N. Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery and Spine Program Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, United Kingdom
- John van Geest Brain Repair Centre, University of Cambridge, Cambridge, United Kingdom
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Chen F, Duan H, Zhang Y, Liu Y, Wang X, Guo Y. A giant nabothian cyst with massive abnormal uterine bleeding: a case report. CLIN EXP OBSTET GYN 2017; 44:326-328. [PMID: 29746052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors describe a rare case of a giant nabothian cyst in a 52-year-old woman. The patient had a history of massive abnormal uterine bleeding after heavy physical work. A giant cystic mass, originating from the cervix, was found completely filling the upper third of the vagina. The authors combined hysteroscopy examination with ultrasound to assess the cystic mass' localization, origin, and relationship with other organs. With the tentative diagnosis of a giant nabothian cyst, the patient was treated with a simple cervical incision and local drainage. The patient recovered well postoperatively and the diagnosis was confirmed through pathological examination.
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Shuter J, Kalkut GE, Pinon MW, Bellin EY, Zingman BS. A computerized reminder system improves compliance with Papanicolaou smear recommendations in an HIV care clinic. Int J STD AIDS 2016; 14:675-80. [PMID: 14596771 DOI: 10.1258/095646203322387938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Current guidelines call for Papanicolaou (Pap) smear screening of HIV-infected women at least annually. After the initiation of a weekly computer based Pap smear reminder list in an HIV care clinic, the prevalence of scheduled women with up-to-date Pap smears was calculated for the one-year project period and was compared to the prevalence preceding the project. The prevalence of scheduled women with up-to-date Pap smears increased from 61.4% to 73.2% ( P <0.001) during the project period. Including Pap smears that were performed elsewhere, the final up-to-date Pap smear rate was 82.7%. The improved rate of up-to-date Pap smears showed no sign of attenuation over time. A computerized report generated from data in the hospital information system increased rates of compliance with Pap smear screening recommendations. Creative utilization of hospital data environments may be an inexpensive route to improved compliance with practice guidelines.
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Affiliation(s)
- Jonathan Shuter
- Montefiore Medical Center, Department of Medicine, Division of Infectious Diseases, Bronx, NY 10467, USA.
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Abstract
Women seeking sexually transmitted disease (STD) services are at high risk of human papillomavirus infections. Cervical cytological screening with Papanicolau staining (Pap smear) is not consistently offered at public STD clinics. We reviewed Pap smear results on a series of 1000 female STD clinic attendees, abstracted demographics, risk behaviours and STD diagnosis from the clinical record and tested for associations with abnormal Pap smear. In all, 5.7% of the satisfactory specimens (56/993) were abnormal; increasing age category, genital warts, and chlamydia infections were independently associated with an abnormal Pap smear in multivariate analysis. Routine Pap smear screening provided satisfactory results in the STD clinic and, where population-based programmes are not available, should be fully integrated into public STD care, (particularly in settings serving younger women).
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Affiliation(s)
- M B Kanno
- University of Maryland, Division of Infectious Diseases, Institute of Human Virology, 725 West Lombard Street, Baltimore, MD 21201, USA.
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Giordano G, Manuguerra R, Varotti E, Brigati F. A case of placental site nodule associated with cervical high-grade squamous intraepithelial lesion. EUR J GYNAECOL ONCOL 2016; 37:259-261. [PMID: 27172758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION A placental site nodule (PSN) is a remnant of intermediate trophoblast (extravillous trophoblast, EVT) from a previous pregnancy. Usually, this a benign lesion, which once removed, does not require any treatment and does not recur. Although this lesion is related to pregnancy, it may be detected many months or several years after the pregnancy from which it resulted. The lesion represents a degenerative process of EVT. Especially in tissue obtained from curettage, can microscopically mimic aggressive lesions of intermediate trophoblast, such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT), and in an unusual location can pose problems in differential diagnosis with other malignancies, as in the present cervical example. CASE REPORT A 36-year-old female, gravida 2, para 1, with a history of early spontaneous abortion two years prior, was submitted to a cervical smear for abnormal uterine bleeding, which showed a cervical high squamous intraepithelial lesion (HSIL) with extension to the endocervical cells. Histologic examination of the endocervical curettage revealed haphazardly distributed fragments of tissue, showing extensive hyalinization and cells of different size with indistinct outlines, organized in small groups, singly, or in cords. Mitotic figures were absent. Immunohistochemical analysis revealed focal positivity to cytokeratin 8 (CK8) and placental alkaline phosphatase and negativity to high molecular weight cytokeratin. The Ki-67 index was low. As a result, the morphological and immunohistochemical findings led to the diagnosis of a PSN. CONCLUSION Diagnosis of a PSN in an unusual location also can pose problems in differential diagnosis with other malignancies, as in the present cervical example. In the present case, the cervical location and the association with HSIL might suggest an erroneous diagnosis of cervical invasive squamous carcinoma. Clinical and pathological data, with immunohistochemical study, are mandatory for a correct diagnosis of this lesion.
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Bysaha NY. Specific features of cytological and colposcopical pattern in pregnant women with benign cervix uteri pathology in anamnesis. Wiad Lek 2016; 69:219-222. [PMID: 27487537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION a tendency of increasing incidence of the cervix uteri precancer and cancer in women of reproductive age is noticed recently being related to the growth of number of the sexually-transmitted infections. The cervix uteri pathology incidence in women of fertile age is 20-25%. AIM to study the specific features of the cytological and colposcopical pattern in pregnant patients with benign cervix uteri pathology in the anamnesis and the character of its change post partum. MATERIAL AND METHODS we have examined 195 women during their pregnancy and 3-5 months post partum. All pregnant women, alongside with generally accepted clinical and laboratory examinations, were subjected to the simple and extended colposcopy, cytology of the targeted smears and, according to indications, the histological studies of bioptate. RESULTS according to the results of the colcoscopical studies and the signs of the cervix uteri pathology found, the patients were divided into several groups. A control group included 49 pregnant women. The clinical and instrumental examination of 146 women with cervix uteri pathology has been carried out both during pregnancy and post partum. CONCLUSIONS the structure of the clinical forms of benign and premalignant changes in the cervix uteri epithelium in pregnant patients has been found. Specific features of the cytological and colposcopical pattern in pregnant patients with benign cervix uteri pathology in anamnesis have been studied. The relationship between the parity of pregnancy, delivery, route of delivery and regress of both benign and premalignant changes in the cervix uteri epithelium 3-5 months post partum has been determined.
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Affiliation(s)
- Nataliya Yu Bysaha
- Uzhgorod National Univesity, Medical Faculty, Department of Obstetrics and Gynecology, Uzhgorod, Ukraine, +380506715683.
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Garcia-Simon R, Figueras F, Savchev S, Fabre E, Gratacos E, Oros D. Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late-onset small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 2015; 46:713-717. [PMID: 25670681 DOI: 10.1002/uog.14807] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To estimate the combined value of fetal cerebral Doppler examination and Bishop score for predicting perinatal outcome after labor induction for small-for-gestational-age (SGA) fetuses in the presence of normal umbilical artery Doppler recordings. METHODS We conducted a cohort study in two tertiary centers, including 164 women with normal umbilical artery Doppler recordings who underwent induction of labor because of an estimated fetal weight < 10(th) percentile. The fetal middle cerebral artery pulsatility index and cerebroplacental ratio (CPR) were obtained in all cases within 24 h before induction. Cervical condition was assessed at admission using the Bishop score. A predictive model for perinatal outcomes was constructed using a decision-tree analysis algorithm. RESULTS Both a very unfavorable cervix, defined as a Bishop score < 2, (odds ratio (OR), 3.18; 95% CI, 1.28-7.86) and an abnormal CPR (OR, 2.54; 95% CI, 1.18-5.61) were associated with an increased likelihood of emergency Cesarean section for fetal distress, but only the latter was significantly associated with the need for neonatal admission (OR, 2.43; 95% CI, 1.28-4.59). In the decision-tree analysis, both criteria significantly predicted the likelihood of Cesarean section for fetal distress. CONCLUSION Combined use of the Bishop score and CPR improves the ability to predict overall Cesarean section (for any indication), emergency Cesarean section for fetal distress, and neonatal admission after labor induction for late-onset SGA in the presence of normal umbilical artery Doppler recordings.
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Affiliation(s)
- R Garcia-Simon
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | - F Figueras
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - S Savchev
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Fabre
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | - E Gratacos
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - D Oros
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
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Di Spiezio Sardo A, Giampaolino P, Scognamiglio M, Varelli C, Nazzaro G, Mansueto G, Nappi C, Grimbizis GF. An Exceptional Case of Complete Septate Uterus With Unilateral Cervical Aplasia (Class U2bC3V0/ESHRE/ESGE Classification) and Isolated Mullerian Remnants: Combined Hysteroscopic and Laparoscopic Treatment. J Minim Invasive Gynecol 2015; 23:16-7. [PMID: 26391060 DOI: 10.1016/j.jmig.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/15/2015] [Accepted: 09/05/2015] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To report the combined hysteroscopic and laparoscopic treatment of a complete septate uterus with unilateral cervical aplasia (class U2bC3V0/ESHRE/ESGE classification) and isolated mullerian remnants. DESIGN Step-by-step presentation of the surgical treatment (Canadian Task Force classification 4). SETTING Complete septate uterus with unilateral cervical aplasia (formally Robert's uterus) is characterized by the presence of a uterine septum completely dividing the endometrial cavity into an obstructed hemicavity and a contralateral nonobstructing hemicavity connected normally to the existing cervix. It has always been described as isolated without any associated anomaly. PATIENT A 30-year-old woman was referred to our department for dysmenorrhea and primary infertility. Hysterosalpingography showed the presence of a right (RT) hemiuterus with a patent fallopian tube; further evaluation with 2- and 3-dimensional ultrasound and magnetic resonance imaging showed an externally normal-appearing uterus, a right normal hemicavity connected normally with the existed cervix and, a left hemicavity fully divided from the right one by a complete septum and not connected with the cervix. Interestingly, a peculiar complex mass with cystic areas, attached posterolaterally from the left side to the uterine wall at the level of the isthmus and the upper cervix, was also diagnosed. INTERVENTIONS The study protocol was approved by our local institutional review board. During outpatient hysteroscopy, a right uterine hemicavity with a single ostium was identified without any communication with the left hemicavity. The patient was then scheduled for combined laparoscopic and hysteroscopic treatment. During laparoscopy, a normal uterine body with multiple myomas and a pseudocystic lesion attached posteriorly and left laterally to the uterus at the level of the isthmus and the upper cervix were shown; no communication between the cystic part of that lesion and the isthmus or the cervicovaginal canal was observed. During hysteroscopy, a longitudinal incision of the septum with a 5F bipolar electrode was performed; the left hemicavity was opened, and the corresponding tubal ostium was identified. The pseudocystic lesion was then excised after opening and sent for pathological analysis; the defect was closed with interrupted intracorporeal knots. MEASUREMENTS AND MAIN RESULTS A single normal endometrial cavity with both tubal ostia was obtained, thus restoring obstruction by unification of the uterine cavity. A histologic report of the removed pseudocystic lesion was compatible with the diagnosis of mullerian remnants. A follow-up hysteroscopy 3 months after showed a normal uterine cavity without postsurgical adhesions. CONCLUSION The use of 3-dimensional ultrasound and magnetic resonance imaging in combination with the new ESHRE/ESGE classification system gives the opportunity to obtain a precise representation of the female genital anatomy even in the presence of complex anomalies. Although a septate uterus with unilateral cervical aplasia has been already described, the presence of mullerian remnants is a rare entity associated with cyclic pelvic pain, thus needing adequate recognition and treatment. The combined hysteroscopic and laparoscopic approach offers a unique opportunity for the treatment of complex anomalies.
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Affiliation(s)
| | - Pierluigi Giampaolino
- Department of Obstetrics and Gynecology, University of Naples "Federico II", Naples, Italy.
| | - Marianna Scognamiglio
- Department of Obstetrics and Gynecology, University of Naples "Federico II", Naples, Italy
| | - Carlo Varelli
- Varelli Diagnostic Institute of Naples, Naples, Italy
| | - Giovanni Nazzaro
- Department of Obstetrics and Gynecology, University of Naples "Federico II", Naples, Italy
| | - Gelsomina Mansueto
- Section of Pathology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmine Nappi
- Department of Obstetrics and Gynecology, University of Naples "Federico II", Naples, Italy
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Minim Invasive Gynecol 2015; 23:18-27. [PMID: 26272688 DOI: 10.1016/j.jmig.2015.08.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/09/2015] [Accepted: 08/01/2015] [Indexed: 12/23/2022]
Abstract
We conducted a systematic review and meta-analysis to assess the safety and effectiveness of robotic vs laparoscopic hysterectomy in women with benign uterine disease, as determined by randomized studies. We searched MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and Controlled-Trials.com from study inception to October 9, 2014, using the intersection of the themes "robotic" and "hysterectomy." We included only randomized and quasi-randomized controlled trials of robotic vs laparoscopic hysterectomy in women for benign disease. Four trials met our inclusion criteria and were included in the analyses. We extracted data, and assessed the studies for methodological quality in duplicate. For meta-analysis, we used random effects to calculate pooled risk ratios (RRs) and weighted mean differences. For our primary outcome, we used a modified version of the Expanded Accordion Severity Grading System to classify perioperative complications. We identified 41 complications among 326 patients. Comparing robotic and laparoscopic hysterectomy, revealed no statistically significant differences in the rate of class 1 and 2 complications (RR, 0.66; 95% confidence interval [CI], 0.23-1.89) or in the rate of class 3 and 4 complications (RR, 0.99; 95% CI, 0.22-4.40). Analyses of secondary outcomes were limited owing to heterogeneity, but showed no significant benefit of the robotic technique over the laparoscopic technique in terms of length of hospital stay (weighted mean difference, -0.39 day; 95% CI, -0.92 to 0.14 day), total operating time (weighted mean difference, 9.0 minutes; 95% CI, -31.27 to 47.26 minutes), conversions to laparotomy, or blood loss. Outcomes of cost, pain, and quality of life were reported inconsistently and were not amenable to pooling. Current evidence demonstrates neither statistically significant nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic hysterectomy for benign disease. The role of robotic surgery in benign gynecology remains unclear.
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Affiliation(s)
- Benjamin B Albright
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Yale University School of Medicine, New Haven, CT.
| | - Tilman Witte
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Alena N Tofte
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jeremy Chou
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jonathan D Black
- Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Vrunda B Desai
- Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Elisabeth A Erekson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, NH
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15
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León M, Alcazar JL. High sliding sign: a new soft marker of uterine fundus compromise in deep infiltrating endometriosis. Ultrasound Obstet Gynecol 2015; 45:624. [PMID: 25417925 DOI: 10.1002/uog.14731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Affiliation(s)
- M León
- Department of Obstetrics and Gynecology, Ultrasound Unit, Clínica Indisa, Santiago, Chile
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16
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Garvey TD, Evensen AE. Increased patient communication using a process supplementing an electronic medical record. WMJ 2015; 114:21-25. [PMID: 25845132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Importance: Patients with cervical cytology abnormalities may require surveillance for many years, which increases the risk of management error, especially in clinics with multiple managing clinicians. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification requires tracking of abnormal results and communicating effectively with patients. OBJECTIVES The purpose of this study was to determine whether a computer-based tracking system that is not embedded in the electronic medical record improves (1) accurate and timely communication of results and (2) patient adherence to follow-up recommendations. METHODS Design: Pre/post study using data from 2005-2012. Intervention implemented in 2008. Data collected via chart review for at least 18 months after index result. Participants: Pre-intervention: all women (N = 72) with first abnormal cytology result from 2005-2007. Post-intervention: all women (N = 128) with first abnormal cytology result from 2008-2010. Patients were seen at a suburban, university-affiliated, family medicine residency clinic. Intervention: Tracking spreadsheet reviewed monthly with reminders generated for patients not in compliance with recommendations. Main Outcome and Measures: (1) rates of accurate and timely communication of results and (2) rates of patient adherence to follow-up recommendations. RESULTS Intervention decreased absent or erroneous communication from clinician to patient (6.4% pre- vs 1.6% post-intervention [P = 0.04]), but did not increase patient adherence to follow-up recommendations (76.1% pre- vs 78.0% post-intervention [ P= 0.78]). CONCLUSIONS Use of a spreadsheet tracking system improved communication of abnormal results to patients, but did not significantly improve patient adherence to recommended care. Although the tracking system complies with NCQA PCMH requirements, it was insufficient to make meaningful improvements in patient-oriented outcomes.
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Canham M, Charsou C, Stewart J, Moncur S, Hoodless L, Bhatia R, Cong D, Cubie H, Busby-Earle C, Williams A, McLoughlin V, Campbell JDM, Cuschieri K, Howie S. Increased cycling cell numbers and stem cell associated proteins as potential biomarkers for high grade human papillomavirus+ve pre-neoplastic cervical disease. PLoS One 2014; 9:e115379. [PMID: 25531390 PMCID: PMC4274002 DOI: 10.1371/journal.pone.0115379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/22/2014] [Indexed: 12/27/2022] Open
Abstract
High risk (oncogenic) human papillomavirus (HPV) infection causes cervical cancer. Infections are common but most clear naturally. Persistent infection can progress to cancer. Pre-neoplastic disease (cervical intraepithelial neoplasia/CIN) is classified by histology (CIN1-3) according to severity. Cervical abnormalities are screened for by cytology and/or detection of high risk HPV but both methods are imperfect for prediction of which women need treatment. There is a need to understand the host virus interactions that lead to different disease outcomes and to develop biomarker tests for accurate triage of infected women. As cancer is increasingly presumed to develop from proliferative, tumour initiating, cancer stem cells (CSCs), and as other oncogenic viruses induce stem cell associated gene expression, we evaluated whether presence of mRNA (detected by qRT-PCR) or proteins (detected by flow cytometry and antibody based proteomic microarray) from stem cell associated genes and/or increased cell proliferation (detected by flow cytometry) could be detected in well-characterised, routinely collected cervical samples from high risk HPV+ve women. Both cytology and histology results were available for most samples with moderate to high grade abnormality. We found that stem cell associated proteins including human chorionic gonadotropin, the oncogene TP63 and the transcription factor SOX2 were upregulated in samples from women with CIN3 and that the stem cell related, cell surface, protein podocalyxin was detectable on cells in samples from a subset of women with CIN3. SOX2, TP63 and human gonadotrophin mRNAs were upregulated in high grade disease. Immunohistochemistry showed that SOX2 and TP63 proteins clearly delineated tumour cells in invasive squamous cervical cancer. Samples from women with CIN3 showed increased proliferating cells. We believe that these markers may be of use to develop triage tests for women with high grade cervical abnormality to distinguish those who may progress to cancer from those who may be treated more conservatively.
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Affiliation(s)
- Maurice Canham
- Human Papillomavirus Group, University of Edinburgh, Edinburgh, United Kingdom
- Medical Research Council Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Chara Charsou
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - June Stewart
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Moncur
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Hoodless
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Ramya Bhatia
- Human Papillomavirus Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Duanduan Cong
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather Cubie
- Human Papillomavirus Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Camille Busby-Earle
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Alistair Williams
- Simpson Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Victoria McLoughlin
- Scottish National Blood Transfusion Service National Science Laboratory, Edinburgh, United Kingdom
| | - John D. M. Campbell
- Medical Research Council Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, United Kingdom
- Scottish National Blood Transfusion Service National Science Laboratory, Edinburgh, United Kingdom
| | - Kate Cuschieri
- Scottish Human Papillomavirus Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Howie
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
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Yang Z, Cuzick J, Hunt WC, Wheeler CM. Concurrence of multiple human papillomavirus infections in a large US population-based cohort. Am J Epidemiol 2014; 180:1066-75. [PMID: 25355446 PMCID: PMC4239798 DOI: 10.1093/aje/kwu267] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/01/2014] [Indexed: 11/14/2022] Open
Abstract
We examined the concurrence of multiple human papillomavirus (HPV) infections in 47,617 women who underwent cervical screening in New Mexico between December 2007 and April 2009 using the LINEAR ARRAY HPV Genotyping Test (Roche Diagnostics, Indianapolis, Indiana), which detects 37 different types of HPV. Our primary goal was to examine the distributions of multiple HPV types with a special interest in negative interactions, which could signal the possibility of type replacement associated with a common niche if some HPV types were prevented by vaccination. Multiple infections were found to be more common than expected under independence, but this could largely be accounted for by a woman-specific latent heterogeneity parameter which was found to be dependent on age and cytological grade. While multiple infections were more common in young women and in those with abnormal cytology, greater heterogeneity was seen in older women and in those with normal cytology, possibly reflecting greater variability in exposure due to current or past HPV exposure or due to heterogeneity in related HPV reactivation or in immune responses to HPV infection or persistence. A negative interaction was found between HPV 16 and several other HPV types for women with abnormal cytology but not for those with normal cytology, suggesting that type replacement in women vaccinated against HPV 16 is unlikely to be an issue for the general population.
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Affiliation(s)
| | - Jack Cuzick
- Correspondence to Dr. Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom (e-mail: )
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Arowojolu AO, Ogunbode OO. Cervical ectopic pregnancy managed with methotrexate and tranexamic acid: A case report. Afr J Med Med Sci 2014; 43:361-364. [PMID: 26234125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cervical pregnancy is a rare life-threatening form of ectopic pregnancy and when it occurs, it is challenging to decide the management options. Surgical intervention has been documented to be complicated by intractable haemorrhage and most often necessitating hysterectomy. We hereby report a case of cervical pregnancy managed conservatively with medical agents prior to surgical intervention. CASE PRESENTATION AND MANAGEMENT: A 29 year old primiparous woman with gestational diabetes mellitus who presented at 10 weeks gestation with 5 days history of brownish vaginal discharge and 2 days history of painless vaginal bleeding. On pelvic examination the cervix was disproportionately larger than the uterus with a closed internal os. Transvaginal and abdominal ultrasound scanning confirmed a live cervical pregnancy. She had intramuscular methotrexate and tranexamic acid followed by suction evacuation combined with balloon tamponade. Examination at 6 weeks post procedure revealed a normal cervix. CONCLUSION Cervical pregnancy still occurs in this environment despite its rarity. Surgical intervention usually results in hysterectomy and adopting medical management as a first line treatment option offers the benefit of uterine preservation.
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Nessa A, Roy JS, Chowdhury MA, Khanam Q, Afroz R, Wistrand C, Thuresson M, Thorsell M, Shemer I, Wikström Shemer EA. Evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary colposcope and Gynocular in a low-resource setting. BMJ Open 2014; 4:e005313. [PMID: 25366674 PMCID: PMC4225233 DOI: 10.1136/bmjopen-2014-005313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary colposcope or a portable, hand-held colposcope; the Gynocular, as compared to doctors. DESIGN A crossover randomised clinical trial. SETTING The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. PARTICIPANTS 932 women attending the clinic as either screening naïve for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region. INTERVENTION VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor. PRIMARY AND SECONDARY OUTCOME MEASURES Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves. RESULTS The Swede scores obtained by nurses and doctors using the Gynocular and stationary colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women. CONCLUSIONS Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings. TRIAL REGISTRATION NUMBER ISRCTN53264564.
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Affiliation(s)
- Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Joya Shree Roy
- Department of Obstetrics and Gynaecology, Green life Medical College Hospital, Dhaka, Bangladesh
| | - Most Afroza Chowdhury
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Quayuma Khanam
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Romena Afroz
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Charlotte Wistrand
- Departments of Obstetrics and Gynecology and Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Malin Thorsell
- Departments of Obstetrics and Gynecology and Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Isaac Shemer
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Tawfik O, Davis M, Dillon S, Tawfik L, Diaz FJ, Fan F. Whole Slide Imaging of Pap Cell Block Preparations versus Liquid-Based Thin-Layer Cervical Cytology: A Comparative Study Evaluating the Detection of Organisms and Nonneoplastic Findings. Acta Cytol 2014; 58:388-97. [PMID: 25033897 DOI: 10.1159/000365046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical cancer is one of the most common malignancies worldwide, yet it is preventable by population screening. In a previous study, we confirmed the feasibility of utilizing whole slide imaging (WSI) of cell block (CB) preparations to overcome the limitations of digitizing cytologic samples. In this study, we evaluated the accuracy of WSI in identifying various organisms and nonneoplastic findings. STUDY DESIGN A total of 335 WS images from Pap CB preparations were analyzed using the Aperio system. The test performance characteristics of ThinPrep (TP) and WSI samples were compared for adequacy, for the presence of bacterial vaginosis (BV), fungi, Trichomonas vaginalis (TV) and herpes simplex virus (HSV) and for nonneoplastic findings. RESULTS The WSI samples contained optimal material from all preparations. BV was diagnosed in 33 WSI versus 36 TP samples. Budding yeasts and/or pseudohyphal forms were noted in 18 WSI versus 19 TP samples. TV organisms (10 of 11 samples) and 1 HSV case were accurately identified in the WSI and TP samples. Squamous metaplasia, keratosis and reactive/reparative and inflammatory changes were easily identified by WSI. CONCLUSIONS The concept of WSI from Pap CB preparations is potentially feasible for adoption. Digital remote web-based technology eliminates the need for an individual on site, saving time and resources.
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Affiliation(s)
- Ossama Tawfik
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, Kans., USA
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Ramogola-Masire D, Russell AH, Dryden-Peterson S, Efstathiou JA, Kayembe MKA, Wilbur DC. Case records of the Massachusetts General Hospital. Case 16-2014. A 46-year-old woman in Botswana with postcoital bleeding. N Engl J Med 2014; 370:2032-41. [PMID: 24849087 DOI: 10.1056/nejmcpc1400839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Marongiu L, Godi A, Parry JV, Beddows S. Human papillomavirus type 16 long control region and E6 variants stratified by cervical disease stage. Infect Genet Evol 2014; 26:8-13. [PMID: 24823962 PMCID: PMC4150919 DOI: 10.1016/j.meegid.2014.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
We sequenced HPV16 LCR–E6 variants in cervical disease samples from England. 98% of variants were of the EUR lineage. Site-specific entropy identified several variable sites in the LCR and E6. No single or combination of sites were associated with disease, including E6 T350G.
Objective Certain intra-type variants of HPV16 have been shown to be associated with an increased risk of developing high grade cervical disease, but their potential association is confounded by apparent geographic and phylogenetic lineage dependency. The objective of this study was to evaluate the relationship between HPV16 sequence variants and cervical disease stage in monospecific infection samples from a single lineage (European, EUR) in England. Methods One hundred and twelve women singly infected with HPV16 and displaying normal and abnormal cytology grades were selected. An 1187 bp fragment encompassing the entire LCR and a portion of the E6 open reading frame was sequenced to identify intra-type variants. Intra-type diversity was estimated using Shannon entropy. Results Almost all samples (110/112; 98%) were assigned to the EUR lineage, one sample was classified as European-Asian (EAS) and another African (Afr1a). The mean pairwise distance of the EUR sequences in this study was low (0.29%; 95%CI 0.13–0.45%) but there were nevertheless several sites in the LCR (n = 5) and E6 (n = 2) that exhibited a high degree of entropy. None of these sites, however, including the T350G non-synonymous (L83V) substitution in E6, alone or in combination, were found to be associated with cervical disease stage. Conclusions Despite using single infection samples and samples from a single variant lineage, intra-type variants of HPV16 were not differentially associated with cervical disease. Monitoring intra-lineage, site-specific variants, such as T350G, is unlikely to be of diagnostic value.
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Affiliation(s)
- Luigi Marongiu
- Virus Reference Department, Public Health England, London, UK
| | - Anna Godi
- Virus Reference Department, Public Health England, London, UK
| | - John V Parry
- Virus Reference Department, Public Health England, London, UK
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK.
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Crowe E, Pandeya N, Brotherton JML, Dobson AJ, Kisely S, Lambert SB, Whiteman DC. Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia. BMJ 2014; 348:g1458. [PMID: 24594809 PMCID: PMC3942076 DOI: 10.1136/bmj.g1458] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure the effectiveness of the quadrivalent human papillomavirus (HPV) vaccine against cervical abnormalities four years after implementation of a nationally funded vaccination programme in Queensland, Australia. DESIGN Case-control analysis of linked administrative health datasets. SETTING Queensland, Australia. PARTICIPANTS Women eligible for free vaccination (aged 12-26 years in 2007) and attending for their first cervical smear test between April 2007 and March 2011. High grade cases were women with histologically confirmed high grade cervical abnormalities (n = 1062) and "other cases" were women with any other abnormality at cytology or histology (n = 10,887). Controls were women with normal cytology (n = 96,404). MAIN OUTCOME MEASURES Exposure odds ratio (ratio of odds of antecedent vaccination (one, two, or three vaccine doses compared with no doses) among cases compared with controls), vaccine effectiveness ((1-adjusted odds ratio) × 100), and number needed to vaccinate to prevent one cervical abnormality at first screening round. We stratified by four age groups adjusted for follow-up time, year of birth, and measures of socioeconomic status and remoteness. The primary analysis concerned women whose first ever smear test defined their status as a case or a control. RESULTS The adjusted odds ratio for exposure to three doses of HPV vaccine compared with no vaccine was 0.54 (95% confidence interval 0.43 to 0.67) for high grade cases and 0.66 (0.62 to 0.70) for other cases compared with controls with normal cytology, equating to vaccine effectiveness of 46% and 34%, respectively. The adjusted numbers needed to vaccinate were 125 (95% confidence interval 97 to 174) and 22 (19 to 25), respectively. The adjusted exposure odds ratios for two vaccine doses were 0.79 (95% confidence interval 0.64 to 0.98) for high grade cases and 0.79 (0.74 to 0.85) for other cases, equating to vaccine effectiveness of 21%. CONCLUSION The quadrivalent HPV vaccine conferred statistically significant protection against cervical abnormalities in young women who had not started screening before the implementation of the vaccination programme in Queensland, Australia.
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Affiliation(s)
- Elizabeth Crowe
- The University of Queensland, School of Population Health, Brisbane, Australia
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Fawaz ZS, Barkati M, Beauchemin MC, Sauthier P, Gauthier P, Nguyen TV. Cervical necrosis after chemoradiation for cervical cancer: case series and literature review. Radiat Oncol 2013; 8:220. [PMID: 24053332 PMCID: PMC3850955 DOI: 10.1186/1748-717x-8-220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the management of cervical necrosis (CN) following radiotherapy (RT) and the impact of smoking status. This rare complication mimics a neoplastic recurrence, and causes concern among attending physicians. METHODS Between July 2008 and March 2013, 5 women on 285 with localized cervical cancer had a CN following RT. Patients were treated with concomitant chemoradiation. The medical records were reviewed to abstract demographic and clinical information until March 2013. RESULTS 1.75% (95% confidence interval: 0.23 to 3.28%) developed CN. All patients were smokers with a mean of 19.5 pack-years (range: 7.5-45 pack-years). All patients were treated with weekly Cisplatin chemotherapy and external beam radiation to the pelvis, 45 Gy in 25 fractions. Four patients received an extra boost with a median dose of 7.2 Gy (range: 5.4-10 Gy). All patients had intracavitary brachytherapy (range: 27.9 to 30 Gy). Clinical presentation was similar for all the cases: vaginal discharge associated with pain. Mean time for time post-radiation therapy to necrosis was 9.3 months (range: 2.2-20.5 months). Standard workup was done to exclude cancer recurrence: biopsies and radiologic imaging. Conservative treatment was performed with excellent results. Resolution of the necrosis was complete after a few months (range: 1 to 4 months). Median follow-up until March 2013 was 19 months. All the patients were alive with no clinical evidence of disease. CONCLUSIONS This study, the largest to date, shows that conservative management of CN after RT is effective, and should be attempted. This complication is more common in smokers, and counseling intervention should result in fewer complications of CN.
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Affiliation(s)
- Ziad Simon Fawaz
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Maroie Barkati
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Marie-Claude Beauchemin
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Philippe Sauthier
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Philippe Gauthier
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Thu Van Nguyen
- Department of Radiation Oncology and Gynecologic Oncology, Notre-Dame Hospital, University of Montreal Hospital Center (CHUM), Montreal, Canada
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Oliveira FAS, Soares VL, Dacal ARC, Cavalcante FGT, Mesquita AM, Fraga F, Lang K, Feldmeier H. Absence of cervical schistosomiasis among women from two areas of north–eastern Brazil with endemicSchistosoma mansoni. Annals of Tropical Medicine & Parasitology 2013; 100:49-54. [PMID: 16417713 DOI: 10.1179/136485906x78490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genital manifestations in schistosomiasis haematobium are common and are associated with considerable morbidity. Although Schistosoma mansoni may also cause genital disease, the frequency of this complication is not known. Cervical biopsies (N=401) and Pap smears (N=981) were therefore collected from women living in two S. mansoni-endemic areas (in the states of Alagoas and Ceará, in north-eastern Brazil). The women were screened for the presence of sexually transmitted diseases and for the presence, in their cervical smears and/or biopsies, of S. mansoni eggs. Attempts at schistosomiasis control, which began in both study areas in 1977, have led to generally low intensities of infection (<30 eggs/g faeces in 99% of infections) and community prevalences of infection that range between 1% and 52%. As no schistosome ova were detected in any of the biopsies or smears, it appears that the risk, among women, of genital manifestations of S. mansoni infection is small in areas where the parasite load in the population is low (as the result of interventions to control intestinal schistosomiasis).
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Affiliation(s)
- F A S Oliveira
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Donnelly SM, Nguyen BT, Rhyne S, Estes J, Jesmin S, Mowa CN. Vascular endothelial growth factor induces growth of uterine cervix and immune cell recruitment in mice. J Endocrinol 2013; 217:83-94. [PMID: 23386058 DOI: 10.1530/joe-12-0469] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Knowledge of uterine cervical epithelial biology and factors that influence its events may be critical in understanding the process of cervical remodeling (CR). Here, we examine the impact of exogenous vascular endothelial growth factor (VEGF) on uterine cervical epithelial growth in mice (nonpregnant and pregnant) treated with VEGF agents (recombinant and inhibitor) using a variety of morphological and molecular techniques. Exogenous VEGF altered various uterine cervical epithelial cellular events, including marked induction of growth, edema, increase in inter-epithelial paracellular space, and recruitment of immune cells to the outer surface of epithelial cells (cervical lumen). We conclude that VEGF induces multiple alterations in the uterine cervical epithelial tissues that may play a role in local immune surveillance and uterine cervical growth during CR.
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Affiliation(s)
- Siobhan M Donnelly
- Department of Biology, Appalachian State University, Rankin Science North Building N219, 572 River Street, Boone, North Carolina 28608, USA
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Oliveira-Filho M, Rao VS, Eleutério J, Medeiros FC. Fine needle aspiration cytology: a tool to diagnose cervical and vaginal endometriosis in low-income places. Acta Cytol 2013; 57:203-6. [PMID: 23406608 DOI: 10.1159/000345898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/13/2012] [Indexed: 11/19/2022]
Abstract
Regarded as infrequent, vaginal and cervical endometriosis is probably more common than is generally realized. The apparent rarity of the lesion may be ascribed to the limited awareness of its clinical appearance, combined with technical difficulty in obtaining suitable biopsy material for confirmation. Thus, clinical recognition and tissue confirmation become essential. This paper focuses on vaginal and cervical endometriosis, documenting the clinical, macroscopic, cytological and colposcopic findings in 4 cases seen at a single physical vaginal examination. Diagnosis in these patients was facilitated and improved by fine needle aspiration cytology and confirmed by histology. This technique, which is not used for the diagnosis of endometriosis, could be an option in low-income areas.
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Affiliation(s)
- Manoel Oliveira-Filho
- Maternal and Child Health Department, Federal University of Ceará, Fortaleza, Brazil
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Sweeney BJ, Wilbur DC. Effects on cervical cytology screening productivity associated with implementation of the BD FocalPoint™ Guided Screener Imaging System. Acta Cytol 2013; 57:147-52. [PMID: 23406848 DOI: 10.1159/000345569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Automated screening will become important due to an aging workforce, declining numbers of new cytotechnologists, and the need for increased screening sensitivity in the vaccine era, where high-grade abnormalities will decline. This study documents workload in gynecologic cytology throughput before and after the implementation of the BD FocalPoint™ Guided Screener (GS) System. STUDY DESIGN We collected daily screening data from 3 time periods: the 12 months prior to GS implementation, the 6 months immediately after implementation, and the ensuing 7-18 months after implementation. Data was tabulated at the individual and total laboratory levels. RESULTS In the 6-month period immediately following implementation, productivity increased in 3 of 5 cytotechnologists, as compared to the figures 12 months before implementation. The laboratory increased productivity slightly (+2.4%), with individual changes ranging from -6.9 to +14.7%. In the 7- to 18-month 'mature' period after implementation, productivity increased in all 5 cytotechnologists with an average of +15.4%. Individual increases ranged from +6.1 to +26.9%. CONCLUSIONS Overall productivity increased in the period beyond 6 months, and this increase was eventually noted in all personnel. Increased productivity was associated with a short period of learning in which the magnitude of the effect was less than in the mature period.
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Tao Z, Duan H. [Expression of adhesion-related cytokines in the uterine fluid after transcervical resection of adhesion]. Zhonghua Fu Chan Ke Za Zhi 2012; 47:734-737. [PMID: 23302729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the concentration of adhesion-related cytokines, transforming growth factor (TGF) β(1), platelet-derived growth factor (PDGF) BB, b-fibroblast growth factor (bFGF) in intrauterine fluid and their roles in the intrauterine-adhesion reformation. METHODS From August 2009 to February 2010, 18 patients with moderate or severe intrauterine adhesions underwent transcervical resection of intrauterine adhesion as study group, in the mean time, 20 patients with incomplete septate uterus underwent transcervical resection of septum as control group. The charge of each patient's intrauterine fluid was collected at the time of 3, 6, 9, 12, 24, 48 and 72 hours, respectively, then the concentration of the three cytokines was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS The concentration of the expression of TGF-β(1) in the intrauterine fluid at 3, 6, 9, 12 hours after operation in study group was (3.6 ± 0.9), (10.4 ± 1.1), (7.6 ± 1.2), (7.2 ± 1.3) ng/ml, respectively; PDGF-BB was (2.6 ± 0.6), (3.5 ± 0.5), (5.4 ± 1.0), (5.7 ± 0.8) ng/ml, respectively; bFGF was (16.9 ± 1.3), (95.8 ± 17.8), (330.9 ± 70.5), (1303.3 ± 117.4) ng/ml, respectively. The expression of TGF-β(1) in control group was (3.0 ± 0.6), (7.5 ± 0.6), (5.4 ± 0.6), (4.6 ± 0.8) ng/ml, respectively; PDGF-BB was (2.5 ± 0.4), (2.6 ± 0.5), (4.7 ± 0.6), (4.4 ± 0.4) ng/ml, respectively; bFGF was (19.1 ± 2.4), (82.9 ± 21.8), (249.0 ± 54.2), (775.6 ± 178.8) ng/ml, respectively. The concentration of TGF-β(1), PDGF-BB and bFGF reached the peak during the time of 3 - 24 hours, 6 - 48 hours, 6 - 72 hours after surgery, respectively. The concentration of TGF-β(1), PDGF-BB and bFGF in study group were significantly higher than that in control group (P < 0.05). CONCLUSIONS Concentration of TGF-β(1), PDGF-BB and bFGF was positively associated with area of transcervical resection of intrauterine adhesion, those cytokines might be involved in reformatin of intrauterine-adhesion.
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Affiliation(s)
- Zhi Tao
- Centre of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
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Mandato VD, Sacchetti F, Gelli MC, La Sala GB. A hard cervix: Microscopic examination revealed that a rare transformation had occurred. Am J Obstet Gynecol 2012; 206:362.e1-3. [PMID: 22356821 DOI: 10.1016/j.ajog.2012.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 12/22/2011] [Accepted: 01/19/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Vincenzo Dario Mandato
- Department of Obstetrics and Gynecology, IRCCS-Arcispedale S. Maria Nuova di Reggio Emilia, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Setse R, Siberry GK, Moss WJ, Gravitt P, Wheeling T, Bohannon B, Dominguez K. Cervical pap screening cytological abnormalities among HIV-infected adolescents in the LEGACY cohort. J Pediatr Adolesc Gynecol 2012; 25:27-34. [PMID: 22088311 PMCID: PMC4152823 DOI: 10.1016/j.jpag.2011.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/02/2011] [Accepted: 09/10/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. DESIGN Cross-sectional. SETTING LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (<age 24 years) managed in 22 HIV specialty clinics in the United States. PARTICIPANTS Sexually active females aged 13-24 years in the LEGACY cohort. MAIN OUTCOME MEASURES CPAP-S and abnormal cervical cytology. RESULTS Of 231 sexually active female LEGACY participants 13-24 years of age 49% had documentation of CPAP-S between 2001 and 2006. Fifty-eight percent of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45-0.96 and APR 0.74, 95% CI 0.56-0.96, respectively). Presence of any sexually transmitted infection (STI) was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI diagnosis were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26-3.78 and APR 1.94, 95% CI 1.29-2.92, respectively). CONCLUSIONS Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to improve CPAP-S in HIV-infected young women, especially those with perinatally acquired HIV infection.
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Affiliation(s)
- Rosanna Setse
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Boon ME, Holloway PA, Breijer H, Bontekoe TR. Gardnerella, Trichomonas and Candida in cervical smears of 58,904 immigrants participating in the Dutch national cervical screening program. Acta Cytol 2012; 56:242-6. [PMID: 22555524 DOI: 10.1159/000336992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 01/31/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the prevalence of Gardnerella, Trichomonas and Candida in the cervical smears of 9 immigrant groups participating in the Dutch national cervical screening program. STUDY DESIGN Cervical smears were taken from 58,904 immigrant participants and 498,405 Dutch participants. As part of the routine screening process, all smears were screened for the overgrowth of Gardnerella (i.e. smears with an abundance of clue cells) and for the presence of Trichomonas and Candida. The smears were screened by 6 laboratories, all of which use the Dutch KOPAC coding system. The odds ratio and confidence interval were calculated for the 9 immigrant groups and compared to Dutch participants. RESULTS Immigrants from Suriname, Turkey and the Dutch Antilles have a 2-5 times higher prevalence of Gardnerella and Trichomonas when compared to native Dutch women. Interestingly, the prevalence of Trichomonas in cervical smears of Moroccan immigrants is twice as high, yet the prevalence of Gardnerella is 3 times lower than in native Dutch women. CONCLUSIONS Immigrants with a high prevalence of Gardnerella also have a high prevalence of Trichomonas. In the context of the increased risk of squamous abnormalities in smears with Gardnerella, such slides should be screened with extra care.
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Affiliation(s)
- Mathilde E Boon
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
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Ramalingam P, Zoroquiain P, Valbuena JR, Kemp BL, Medeiros LJ. Florid reactive lymphoid hyperplasia (lymphoma-like lesion) of the uterine cervix. Ann Diagn Pathol 2011; 16:21-8. [PMID: 22056039 DOI: 10.1016/j.anndiagpath.2011.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022]
Abstract
Lymphoma-like lesion (LLL) of the female genital tract is an older term in the literature that describes a florid reactive lymphoid proliferation that can be misinterpreted as lymphoma. Multiple causes of LLL have been suggested but most cases remain unexplained. We describe the clinicopathologic features of 6 patients with LLL involving the uterine cervix. Five patients presented with abnormal Papanicolaou test (Pap smear), and 3 patients had a biopsy procedure performed prior to detection of LLL in a loop electrosurgical excision procedure (LEEP). In each specimen, surface epithelial erosion was associated with a superficial, polymorphous lymphoid infiltrate with numerous scattered large cells, without cellular necrosis or sclerosis. Squamous dysplasia was present in 4 patients. Immunohistochemical studies revealed a mixed population of B- and T-lymphoid cells. T-cells were more numerous but B-cells and formed aggregates or sheets in areas. The large cells were predominantly B-cells positive for CD20 and negative for CD3 in all cases. CD30 was positive 3 cases, and Epstein-Barr virus-encoded RNA was positive in 3 cases. Assessment for clonality in 1 patient using polymerase chain reaction (PCR) methods revealed monoclonal immunoglobulin heavy chain (IgH) gene rearrangements. At last clinical follow-up there was no evidence of progressive or systemic disease. We conclude that LLL of the cervix has a number of etiologies and that a prior surgical procedure, present in 3 patients in this study, is another possible etiology. As has been reported by others, monoclonal IgH gene rearrangements can be detected in this entity which has a benign clinical course.
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Affiliation(s)
- Preetha Ramalingam
- Department of Pathology and Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
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Kim TH, Lee HH, Chung SH, Koh ES. What is the red round ulcer in the cervix? Arch Gynecol Obstet 2011; 285:277-8. [PMID: 21947339 DOI: 10.1007/s00404-011-2087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
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Jiang GQ, Gao YN, Gao M, Zheng H, Yan X, Wang W, An N, Cao K, Sun Y. [Diagnosis and treatment of complicated deep infiltrated endometriosis: a case report and literature review]. Beijing Da Xue Xue Bao Yi Xue Ban 2011; 43:603-607. [PMID: 21844977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore diagnostic and therapeutic methods of patients with deep infiltrating endometriosis. METHODS Clinical data of a case of complicated deep infiltrating endometriosis were analyzed retrospectively. RESULTS A 39-year-old female patient with deep infiltrating endometriosis involving the cervix, bilateral parametrium, uterosacral ligaments, left ureter, left ovary, pouch of Douglas, rectovaginal septum, and vagina, presented as the advanced cervical cancer. She went through initial manifestation of hypogastralgia, irregular vaginal bleeding and left hydronephrosis. Cervical biopsy and embolism of bilateral uterine artery, cervical conization and laparoscopic approach and biopsy confirmed the diagnosis. After being treated with gosereline acetate for three months, she received a radical removal and ureterolysis. She had no evidence of recurrence after two years' follow-up. CONCLUSION When gynecologists make a differential diagnosis of the cervical malignancy, if the clinical manifestations are inconsistent with histopathologic examination, possibility of deep infiltrating endometriosis should be considered and diagnosed by histopathologic examination.
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Affiliation(s)
- Guo-qing Jiang
- Department of Gynecologic Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100142, China
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Kim JH, Bae SN, Lee CW, Song MJ, Lee SJ, Yoon JH, Lee KH, Hur SY, Park TC, Park JS. A pilot study to investigate the treatment of cervical human papillomavirus infection with zinc-citrate compound (CIZAR®). Gynecol Oncol 2011; 122:303-6. [PMID: 21605892 DOI: 10.1016/j.ygyno.2011.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/15/2011] [Accepted: 04/17/2011] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In the present study the potential therapeutic effects of zinc-citrate compound (CIZAR®) in women infected with high-risk human papillomavirus (HR-HPV) was investigated. METHODS A total of 194 women diagnosed with HR-HPV infection using the Hybrid capture (HC) II assay with no evidence of high grade squamous intraepithelial lesions (HSIL) or worse by Pap smear and colposcopy were enrolled. Among them, 76 women were treated by twice weekly self administered intra-vaginal infusion of 0.5 mM zinc citrate solution containing CIZAR® for 12 weeks and were evaluated for clearance of the HR-HPV infection compared to 118 women without treatment (Control group). RESULTS The 12 weeks zinc citrate solution treatment resulted in the elimination of HR-HPV in 49/76 (64.47%) patients compared to the spontaneous clearance of 15.25% (18/118) in the control group (p=0.000). By logistic regression analysis, the 12 week zinc citrate solution treatment reduced the risk of persistent HR-HPV infection significantly (OR 0.079; 95% CI 0.039-0.165; p=0.000). CONCLUSION The results of this study showed for the first time that treatment with intra-vaginal infusion of a zinc-citrate compound (CIZAR®) can result in elimination of HR-HPV infection from the uterine cervix.
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Affiliation(s)
- Jin Hwi Kim
- Department of Obstetrics Gynecology, School of Medicine, Catholic University, Seoul, Republic of Korea
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Ortega-González P, González-Bravo MS, Jiménez-Muñoz-Ledo G, Macías AE. [Abnormalities in cervical smears stored in plastic bags: potential cause of false negatives]. Rev Invest Clin 2011; 63:263-267. [PMID: 21888290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Cervical smear is the most economic and efficient diagnostic tool for the screening of cervical cancer. However, since plastic bags have been used in Guanajuato to transport and store smears, we have observed cytological abnormalities which difficult the diagnosis and lead to false negatives. OBJECTIVE To describe those abnormalities. METHODS Out of 340 women registered in a primary care center in Mexico, 68 were selected through systematic random sampling during 2007. A cervical smear was obtained and placed on two slides. The first sample was allowed to dry but the second one was placed into the plastic bag immediately after fixation. After 15 days all the smears were stained with the Papanicolaou technique. A certified pathologist, blinded about the variable of study, interpreted the samples according to the Bethesda system, and evaluated the presence of necrosis, edema, holes, and opportunistic microorganisms. RESULTS Of the 68 smears exposed to a humid storage, 36 (53%) were inadequate for diagnosis (Fisher's exact probability < 0.001). From them, 36 (53%) had holes or lagoons, 34 (50%) had edema, 31 (46%) had necrosis, and 15 (22%) had fungus. On the other hand, the 68 dried cervical smears were all adequate for diagnosis and none had the changes or cytological abnormalities. CONCLUSION The humid transport and storage of cervical smears produced abnormalities in the normal morphology that could lead to false negative results. The guideline for the handling of cervical smears must stress the importance of allowing the smears to dry completely after fixation and before storing them in plastic bags.
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Bian LH, Li Y, Wang XL, Wu XZ, Song L, Liu HT. [Study for association between high risk human papillomavirus and cervical lesions in the samples from opportunistic screening]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2011; 25:89-91. [PMID: 21863625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the association between HPV genotypes and cervical lesion in Hybrid Capture 2 (HC2) HPV test positive samples. METHODS 602 cervical samples randomly obtained detected as HPV positive by the HC2 high-risk probe cocktail were determined by polymerase chain reaction (PCR)-reverse dot blot (RDB), among them 344 participated Thinprep Cytology test. RESULTS 569 (94.5%) samples were successfully amplified. The most common HPV genotypes were HPV16 (31.6%), 52 (16.7%), 58 (15.1%), 56 (8.1%), 39 (7.9%); HPV16 or HPV16/18 infection was significantly related to ASCUS, LSIL and HSIL; 24 samples suggested single HPV infection with the genotypes not available for HC2. CONCLUSION The most common HPV genotypes in random screening were HPV16, 52 and HPV58; Our data demonstrated the pseudo-positivity of HC2 test was 4.0%; HPV16 was a index for progression of HSIL.
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Affiliation(s)
- Li-hua Bian
- Department of Obstetrics and Gynaecology, Chinese PLA General Hospital, Beijing 100853, China
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Abstract
Many clinicians encounter cervical lesions that may or may not be associated with cytologic abnormalities. Such abnormalities as ectropion, Nabothian cysts, and small cervical polyps are quite benign and need not generate concern for patient or clinician, whereas others, including those associated with a history of exposure to diethylstilbestrol, cervical inflammation, abnormal cervical cytology, and postcoital bleeding, should prompt additional evaluation. Further, in some patients, the cervix may be difficult to visualize. Several useful clinical suggestions for the optimal examination of the cervix are presented.
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Affiliation(s)
- Petra M Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Jin Y, Li JP, He D, Tang LY, Zee CS, Guo SZ, Zhou J, Chen JN, Shao CK. Clinical significance of human telomerase RNA gene (hTERC) amplification in cervical squamous cell lesions detected by fluorescence in situ hybridization. Asian Pac J Cancer Prev 2011; 12:1167-1171. [PMID: 21875260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Genomic amplification of the human telomerase RNA gene (hTERC), located in the chromosome 3q26 region, has been documented in tumorigenesis. The present study was designed to detect hTERC amplification in cervical lesions and evaluate whether this might serve as a supportive biomarker to cytopathology or histopathology in the diagnosis of cervical lesions. METHODS Liquid-based thin-layer cytopathologic examination and detection of amplification by fluorescence in situ hybridization (FISH) was conducted in 130 women, along with assessment of human papillomavirus DNA, colposcopy with biopsy, and histopathologic examination. RESULTS In cytopathologic examinations, hTERC amplification rates for negative for intraepithelial lesion or malignancy (NILM),atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) cases were 0% (0/10), 4% (1/25), 20% (6/30), 77% (27/35), and 100% (10/10), respectively. The difference among abnormal cellular change groups was statistically significant (P< 0.05). In histopathologic examinations, hTERC amplification rates in normal squamous cell with or without inflammatory, cervical intraepithelial neoplasia 1 (CIN 1), CIN 2, CIN 3 and SCC cases were 3.8% (2/52), 18.2% (6/33), 66.7% (6/9), 84.6% (22/26), 100% (10/10), respectively. There were significant differences among CIN1, CIN2, CIN3 and SCC cases (P< 0.05). The hTERC amplification was more specific than HPV positivity in differentiating lowgrade from high-grade cervical disorders (specificity: 88.5% vs. 70.8%, P< 0.05). CONCLUSIONS FISH detection of hTERC amplification could be an effective adjunct to cytopathologic or histopathologic examination for differential diagnosis of low- and high-grade cervical squamous cell disorders.
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Affiliation(s)
- Yi Jin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Fatima S, Arshad S, Ahmed Z, Hasan SH. Spectrum of cytological findings in patients with neck lymphadenopathy--experience in a tertiary care hospital in Pakistan. Asian Pac J Cancer Prev 2011; 12:1873-1875. [PMID: 22126582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Lymph adenopathy is of great clinical significance as underlying diseases may range from a treatable infectious etiology to malignant neoplasms. In fact it is also essential to establish that the swelling in question is a lymph node. Fine needle aspiration cytology (FNAC) plays a vital role in solving these issues, nowadays being recognized as a rapid diagnostic technique because of its simplicity, cost effectiveness, early availability of results, accuracy and minimal invasion. FNAC is particularly helpful in the work-up of cervical masses and nodules because biopsy of cervical adenopathy should be avoided unless all other diagnostic modalities have failed to establish a diagnosis. OBJECTIVE To determine the epidemiological and cytomorphological patterns of enlarged neck nodes. STUDY DESIGN This retrospective observational study was performed at the Section of Histopathology, Aga Khan University Hospital (AKUH), Karachi, Pakistan. MATERIALS AND METHODS Three Hundred and seventy seven (377) neck swelling specimens obtained over a period of two and a half years registered from different regions of Pakistan were selected. Data were analyzed using SPSS 17. RESULTS Of a total of 377 cases of FNAC performed on neck nodes, the most frequent cause of lymphadenopathy was found to be tuberculosis with 199 cases (52.7%), followed by reactive lymphoid hyperplasia with 61 cases (16.1%). Metastatic carcinoma was found to be the third most common cause with 33 cases (8.7%). A diagnosis of lymphoproliferative disorder was rendered in 21 cases (5.5%). Acute and chronic non-specific inflammation was seen in 16 cases (4.2%). In 47 cases (12%) FNAC was inconclusive. CONCLUSION In our study, the predominant cause of enlarged neck nodes was tuberculous lymphadenitis, followed by reactive lymphadenitis and malignant neoplasm, especially metastatic carcinoma and lymphoma. FNAC was helpful in establishing the diagnosis in approximately 98% of the cases.
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Affiliation(s)
- Saira Fatima
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
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Jiménez-Ayala M, Jiménez-Ayala Portillo B. Cytopathology of the benign glandular lesions of the cervix and glandular cytopathology of the vagina. Monogr Clin Cytol 2010; 20:15-25. [PMID: 21160244 DOI: 10.1159/000319845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jiménez-Ayala M, Jiménez-Ayala Portillo B. Ancillary techniques for the diagnosis of glandular lesions of the female genital tract. Monogr Clin Cytol 2010; 20:101-106. [PMID: 21160253 DOI: 10.1159/000319911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gao M, Long J, Li Y, Shah W, Fu L, Liu J, Wang Y. Mitochondrial decay is involved in BaP-induced cervical damage. Free Radic Biol Med 2010; 49:1735-45. [PMID: 20851761 DOI: 10.1016/j.freeradbiomed.2010.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 08/24/2010] [Accepted: 09/03/2010] [Indexed: 12/13/2022]
Abstract
Benzo[a]pyrene (BaP) is a polycyclic aromatic hydrocarbon and a potent inducer of carcinogenesis. Many studies have reported that the carcinogenic effects of BaP might be due to its intermediate metabolites and to reactive oxygen species (ROS) that cause oxidative damage to the cells. However, the mechanisms of BaP-induced oxidative damage in cervical tissue are still not clear. We studied these mechanisms in female ICR mice treated with BaP either orally or intraperitoneally by measuring (1) several general biomarkers of oxidative stress in serum, (2) mitochondrial function in the cervix, and (3) the morphology of mitochondria in cervical tissue. BaP treatment (1) significantly lowered levels of vitamins A, C, and E and of glutathione; (2) reduced activities of superoxide dismutase, catalase, glutathione peroxidase, and glutathione S-transferases; and (3) significantly increased lipid peroxidation levels. In addition, significant increases in the levels of superoxide anion, hydrogen peroxide, and hydroxyl radical were observed. These results were confirmed by morphological changes in mitochondria and by decreases in membrane potential levels and in succinate dehydrogenase and malate dehydrogenase activities. The changes in these biomarkers and mitochondrial damage were BaP-dose-dependent and eventually induced both cell apoptosis and necrosis in cervical tissue. As mitochondria are the major sites of ROS generation, these findings show that mitochondrial decay greatly contributes to BaP-induced cervical damage.
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Affiliation(s)
- Meili Gao
- Institute of Cancer Research, Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Hao H, Torii Y, Yamamoto T, Hirota S. Cytologic features of urinary bladder endocervicosis. Acta Cytol 2010; 54:1061-1063. [PMID: 21053603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Zhang WY, Ma CB, Xiao JY, Zhou HR. [Spontaneous clearance of high risk human papillomavirus infection]. Zhonghua Fu Chan Ke Za Zhi 2010; 45:515-518. [PMID: 21029604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the clearance of high risk human papillomavirus (HPV) infection among the women with normal cervical pathologic diagnosis. METHODS One hundred and seventy-two HPV-positive cases with normal cervical pathologic diagnosis were enrolled in the study. The infection status of HPV was monitored during follow-up from Aug 2006 to Aug 2008. The time of HPV infection spontaneous clearance, as well as effect factors, were analyzed. RESULTS During follow-up, there were 62.2% (107 cases, 107/172) of the HPV infection cleared. The medium clearance time was 11.3 months (95%CI: 10.6 - 16.6 months). The medium clearance time of aged < 30 years, 30 - 39 years, 40 - 49 years and > 49 years were 11.3, 12.0, 10.9 and 8.5 months, respectively. There were not significant difference among aged intervals (P = 0.384). The virus copies of HPV-clearance cases and persistent-infection were 22.6 and 95.0, respectively. There was not significant difference between groups (P = 0.061). CONCLUSIONS Most of the high risk HPV infection with normal cervical pathologic diagnosis would spontaneously cleared. Age and HPV copies may play little role in the HPV clearance.
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Affiliation(s)
- Wen-ying Zhang
- Department of Gynecology, Changning Maternity and Infant Health Hospital, Shanghai, China
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Mercado U. [Abnormal cervicovaginal cytology in women with rheumatoid arthritis]. Ginecol Obstet Mex 2010; 78:94-98. [PMID: 20939210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at increased risk of infections and cancer. A link between RA and abnormal cervicovaginal cytology has rarely been reported. OBJECTIVE The aim of this study was to review cervicovaginal cytology results in women with RA and compare them with a control population. Sexual behavior also was investigated. MATERIAL AND METHOD Cervicovaginal cytology results of 95 women with RA were compared to those of a control population of 1,719 women attending at the same hospital and followed until June 2009. Records of RA patients were reviewed to obtain clinical data, particularly sexual behavior. RESULTS Of 95 RA patients, 13/95 had an abnormal cervicovaginal cytology result, compared with 120/1,719 controls. Twelve/13 had squamous intraepithelial lesions (SIL), compared with 27/120 controls. There was no significant difference in sexual partners between women with RA and controls. Women with RA without abnormal cervicovaginal cytology had less sexual partners than those with RA and abnormal cytology. Two women with RA and abnormal cervicovaginal cytology had a history of condylomata and herpes genital. Three/13 women with RA developed abnormal cervicovaginal cytology after 12 to 36 months initiating their illness. None from them had ever received immunosuppressants. CONCLUSIONS Women with RA have an increased prevalence of abnormal cervical cytology, compared with a control population. It may be related to chronic inflammatory disease and sexual behavior.
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Affiliation(s)
- Ulises Mercado
- Hospital General, Mexicali, ISESALUD y Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali.
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Solis MT, Aguayo F, Vargas M, Olcay F, Puschel K, Corvalán A, Ferreccio C. [Risk factors associated with abnormal cervical cytology among Chilean women: a case control study]. Rev Med Chil 2010; 138:174-180. [PMID: 20461305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cervical cancer is the third cause of cancer death among Chilean women, affecting mainly women from low socioeconomic status. AIM To determine main risk factors (RF) including human papiloma virus (HPV) types associated with abnormal cervical cytology (Atypical Squamous Cells of Undetermined Significance or ASCUS) among Chilean women from low socioeconomic status in Santiago, Chile. MATERIAL AND METHODS A random population based sample of 616 women from La Pintana (a low-income district in Santiago) participated in 2001 in a HPV prevalence study and were re-evaluated in 2006 through a risk factors questionnaire, Papanicolaou test and DNA detection for HPV. The Papanicolaou test was analyzed in Santiago and HPV analysis (PCR_GP5+/GP6+) was conducted in Vrije University, Amsterdam. Cases included 42 women with cervical lesions and controls included 574 women with normal cytology during the period 2001-2006. Logistic regression with uni and multivariate analysis was performed to identify RF for cervical lesions. RESULTS During the study period, there was a significant increase in the proportion of single women, from 8.3 to 14.8% (p < 0.05), of women with 3 or more sexual partners from 8.9 to 13.3 and of women high risk HPV, from 9.1 to 14.3%. The proportion of abnormal Papanicolaou tests remained stable (3.08 and 3.9% > ASCUS). High risk HPV was the most significant factor associated with cervical lesions (odds ratio (OR) = 9.695% > confidence intervals (CI) = 4.4-21.1) followed by oral contraceptive use (OR = 2.58 95% > CI = 1.2-5.7). Among women infected by high risk HPV, the use of oral contraceptives was a risk factor while compliance with screening was protective for cervical lesions. CONCLUSIONS From 2001 to 2006, there was an increase in the proportion of women with high-risk HPV infections.
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Affiliation(s)
- María Teresa Solis
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
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González CA, Salas Guerra A, Arroyo Llano R. [Behavior of cervix during pregnancy, labor and puerperium]. Ginecol Obstet Mex 2010; 78:132-137. [PMID: 20939217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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