Cervical factor in fertility.
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One hundred and eighty-two women treated with cryotherapy were included in the study. In cases of chronic cervical inflammation full recovery was observed in 86% of subjects. In cases of Naboth cysts full recovery was observed within 6 to 8 weeks in 89% of women. In cases of cervical erosions full recovery was observed within 6 to 9 weeks in 84.9% of women. In women, with cervical epithelium dysplasia full recovery was observed within 7 to 11 weeks in treated subjects. Renewal of the pathology was observed in 15% of the women with treated cervicitis and in one of the women with cervical dysplasia within 2 to 5 years of follow-up.
Follow-up results of 329 cases, who were recommended for colposcopy and biopsy after uterine cervical cytologic tests among 38,610 screenees in Shiga Prefecture 1986, were studied. 41 cases (12.8%), including 26 CIS cases, were diagnosed as cervical cancer. 102 cases (30.7%) belonged to dysplasia and other lesions, such as erosion and chronic cervicitis, were 155 cases (47.1%). Only 8 screenees (2.4%) were lost in follow-up. Close follow up for borderline cases may be enough if dysplastic lesions do not progress for over 3 years.
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Chemokines play a central role in the chemotactic activation of immunological effector cells. One of the currently best characterized chemokines is the monocyte-chemo-attractant protein-1 (MCP-1), which is involved in the cross-talk with cells of the monocyte-macrophage lineage. Since macrophages and macrophage-derived cytokines appear to be important in the transcriptional regulation of "high-risk" types of human papillomaviruses (HPV), we monitored MCP-1 expression by in situ hybridization (ISH) in histologically distinct stages of cervical intra-epithelial neoplasms (CIN), cervical cancer and non-HPV-associated cases of erosive endocervicitis. Here, we demonstrate that high-grade dysplasia (CIN III, n = 9) completely lacks both MCP-1 expression and CD68+-macrophage infiltration, while MCP-1-specific signals were occasionally detectable in one out of 5 CIN-II and in one out of 3 CIN-I lesions. Inspection of hyperplastic squamous epithelium adjacent to cervical carcinomas reveals high MCP-1 expression and accumulation of infiltrating macrophages. In contrast, no macrophages could be detected in corresponding hyperplastic tissue areas surrounding CIN-II and CIN-III lesions, although MCP-1 was found to be highly expressed. Finally, in agreement with our earlier in vitro data, invasive carcinomas of the cervix uteri showed MCP-1-specific hybridization signals and macrophage infiltration only in the stroma surrounding the carcinoma cells and in endothelial cells of capillaries, especially at the invasion front of the tumor, while the inner mass of the carcinomas was completely negative. On the other hand, ISH and histochemical evaluation of inflammatory, non-HPV-associated cases of erosive endocervicitis indicate strong MCP-1 expression, which is regularly accompanied by chemotactic appearance of macrophages. These observations indicate that dysregulation of MCP-1-gene expression may represent an important step during HPV-linked carcinogenesis, allowing the escape of virus-positive cells from local immune response.
Pelvic examinations in 1,906 women at the Gynaecological Room, Out-Patient Department, Siriraj Hospital, in June 1990 were studied. The range of ages was between 14 and 85 years, the mean age being 34.5 +/- 11.5 years. Almost three-quarters (74.7%) of the cases had undergone Pap smear examinations; of these, 36.5 per cent followed up on the results and 6.7 per cent were sent the results by postcard as requested by the patients. The percentage of the clinical diagnoses in women who underwent pelvic and Pap smear examinations (Pap smear data are within the parentheses) were: 36.6 (29.0) no abnormal findings, 14.9 (10.5) vulvovaginitis and leukorrhea, 10.1 (9.7) cervicitis and cervical erosion, 5.6 (1.9) bleeding per os, 3.4 (0.3) abortion, and 3.3 (1.3) adnexitis. The mean age of the women with various diseases were: 27 years in cases of abortion; 30-34 years in women with inflammation of the vulva, vagina, cervix and adnexa, including bleeding per os; 41-45 years in women with cervical polyps, suspected carcinoma, precancer and carcinoma of the cervix, combined with myoma uteri; 48 years in women with relaxation of the genital organ. Every woman who underwent pelvic examination should have a Pap smear and VCE technique performed for the early detection of cervical carcinoma. Health care workers should also ensure that every patient follows up on the results.
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Uterine cervix biopsies from 20 women, in whom cell cultures were chlamydia-positive, were compared with 20 biopsies from chlamydia-negative women on the basis of inflammatory changes and proliferative epithelial reactions. There was a tendency towards severe chronic lymphocytic inflammations, especially those associated with the rare clinical picture of follicular cervicitis, and towards acute erosive forms and microabscesses to be found more frequently among the chlamydia-positive women. Hyperplasia of the reserve cells, which was probably connected with the more severe inflammatory reactions, with normotypical and dysplastic proliferations, was also seen more frequently in the chlamydia-positive group. The difficulty of distinguishing hyperplastic reserve cells from dysplastic squamous epithelia in cytological smears offers an explanation why such cases are relatively frequently overrated in cytological diagnosis. No chlamydia-typical changes of the cell nuclei or of the cytoplasm were found. It thus appears impossible to detect chlamydia in routine histological diagnosis.
Emission spectrum analysis was used for measuring the levels of such trace elements as copper, manganese, zinc, nickel and silver in blood serum and tissues of the diseased organs in female patients with certain precancerous and precursor lesions of genital tract. It was found that such changes as an increase in serum copper, a decrease in zinc concentration in blood cells and a rise in the levels of zinc and silver in the affected tissues were more pronounced in cases of precancerous lesions than in those of precursor pathology.
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