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PubMed1996

[Cerclage of the cervix in pregnant women with cervix incompetence in the Department of Obstetrics and Pathology of Pregnancy, School of Medicine in Lublin during the years 1982-188].

We have retrospectively analyzed 77 cases of pregnant patients with cervical incompetence in which we performed cervical cerclage. These cases were 0.65% of all deliveries. The age was 20-41 years (mean 28.5). They were in second or third pregnancy. 62 women delivered by vaginal way and 15 by cesarean section. Only 5 newborn had small weight for age. We discussed our results with data from other authors.

Adult↗
PubMed2005

[Expression of human telomerase reverse transcriptase in cervix cancer and its significance].

OBJECTIVE: To investigate the expression of human telomerase reverse transcriptase (hTERT) mRNA and protein in cervix cancer, cervical intraepithelial neoplasia (CIN) and normal cervix. METHODS: Expression of hTERT mRNA and the other two subunits of telomerase, human telomerase RNA component (hTR), human telomerase-associated protein (hTP1) was determined by RT-PCR in 3 cervix cancer cell lines, 2 diploid cell lines, 38 cases of cervix cancer, 16 cases of CIN and 20 cases of normal cervix. Telomerase activity was also examined by telomeric repeat amplification protocol enzyme-linked immunosorbent assay (TRAP-ELISA). Expression of hTERT protein was detected in all the cell lines and 101 cases of paraffinized cervix tissue sections. RESULTS: hTERT mRNA expression was detected in all of the three cervix cancer cell lines, 81.6% of cervix cancer, 37.5% of CIN, 5.0% of normal cervix, while in neither of the two diploid cell lines. The other two subunits of telomerase were prevalently expressed in all of the cell lines and most cervix tissues. There was a strong correlation between hTERT mRNA expression and telomerase activity. Immunostaining also revealed that hTERT protein was expressed in all three cervix cancer cell lines, 65.5% of cervix cancer, 28.0% of CIN and 4.8% of normal cervix. CONCLUSION: Up-regulation of hTERT may play an important role in the development of CIN and cervix cancer, hTERT could be used as an early diagnostic biomarker for cervix cancer.

Carrier Proteins↗
PubMed2004

Rapid involution and mobility of carcinoma of the cervix.

PURPOSE: To quantitatively describe the involution and mobility of carcinoma of the cervix while under treatment with chemoradiotherapy (both with external beam radiation [EBRT] and high-dose-rate [HDR] intracavitary therapy). These data have implications for conformal or intensity modulated radiation therapy boost to the cervix. METHODS AND MATERIALS: Seventeen patients underwent HDR brachytherapy boost to the cervix and were evaluated by repeat clinical examinations. In most cases, 5 weekly HDR brachytherapy insertions were performed after approximately 2 to 3 weeks of the initiation of EBRT. Sequential clinical tumor sizes were recorded in the chart for each patient under treatment. Linear regression analyses were performed to analyze tumor size as a function of total dose of external beam plus brachytherapy and number of elapsed days during the treatment course. In addition, the mobility of the cervix was documented by placement of a uterine sleeve for HDR brachytherapy before the initiation of therapy, and changes in sleeve position were identified on portal films relative to the midline of the pubic symphysis, in three dimensions. The anatomic position of the cervix was also identified at the time of simulation for HDR brachytherapy. RESULTS: Seventeen patients were identified and selected to receive HDR brachytherapy at our institution. Sixteen of the 17 patients received concurrent chemotherapy. The median dose at which tumor was no longer clinically evident was 61.5 Gy (95% confidence interval [CI]: 50.7-72.3 Gy) by linear regression analysis. This indicates that the median dose to achieve a 50% reduction in tumor size is approximately 30.8 Gy. Similarly, the median number of elapsed days for a complete response was 42 days (95% CI: 34-50 elapsed days). This indicates that it takes 21 days to achieve a 50% clinical complete response for patients undergoing concurrent cisplatin-based chemoradiotherapy and HDR brachytherapy. In addition, the mobility of the cervix during EBRT was noted by serial measurements of the location of a metallic ring in the uterine sleeve, as seen on port films. The median and maximum ranges for change in the position of the cervix in the lateral (x), superior/inferior (y), and anterior/posterior (z) planes were 10, 8, and 16 mm and 24, 36, and 23 mm, respectively. Also, 85 brachytherapy procedures were performed, and the positions of the cervix on 170 orthogonal films were evaluated. The median and maximum ranges for the position of the cervix at the time of HDR brachytherapy in the lateral (x), superior/inferior (y), and anterior/posterior (z) planes were 5, 12, and 10 mm and 11, 25, and 32 mm, respectively. CONCLUSIONS: Carcinoma of the cervix involutes rapidly with EBRT, concurrent cisplatin-based chemotherapy, and HDR brachytherapy. The time for 50% tumor regression was calculated to be 21 days and occurs after 30.8 Gy. In addition, uterine sleeve placement allowed us to document the median and maximum ranges of cervical mobility during the treatment course of EBRT to be 8-16 mm and 23-36 mm, and at the time of HDR brachytherapy to be 5-12 mm and 11-32 mm, respectively. These data indicate that the cervix gross tumor volume changes rapidly in a systematic fashion during chemoradiotherapy and, together with the mobility of the cervix, urge caution in nonbrachytherapy boost planning.

Adenocarcinoma↗
PubMedDate not supplied

Control and assessment of the uterus and cervix during pregnancy and labour.

Preterm labour and resultant preterm birth are the most important problems in perinatology. Countless efforts have failed to establish a single effective treatment of preterm labour, partly because the mechanisms regulating the uterus and cervix during pregnancy are not well understood. New knowledge is needed to inhibit early progression of labour (uterine contractility and cervical ripening), and adequate quantitative tools to evaluate the uterus and cervix during pregnancy are lacking. In this review, we outline studies showing that the uterus (myometrium) and cervix pass through a conditioning step in preparation for labour. This step is not easily identifiable with present methods to assess the uterus or cervix. In the uterus, this seemingly irreversible step consists of changes in the electrical properties to make muscle more excitable and responsive to produce forceful contractions. In the cervix, the step consists of softening of the connective tissue components. Progesterone appears to have a dominant role in controlling both the uterus and cervix, as antiprogestins induce early, preterm conditioning leading to preterm labour. Apparently, nitric oxide (NO) also controls conditioning of the uterus and cervix. In the uterus, NO, in concert with progesterone, inhibits uterine contractility. At term, NO production by the uterus and placenta are decreased and allow labour to progress. In contrast, NO in the cervix increases at the end of pregnancy and it may be the final pathway for stimulating cervical ripening by activation of metalloenzymes. The progress of labour can be assessed non-invasively using electromyographic (EMG) signals from the uterus (the driving force for contractility) recorded from the abdominal surface. Uterine EMG bursts detected in this manner characterize uterine contractile events during human and animal pregnancy. A low uterine EMG activity, measured transabdominally throughout most of pregnancy, rises dramatically during labour. EMG activity also increases substantially during preterm labour in humans and rats. This method may be used one day to predict impending preterm labour and identify control steps and treatments. A quantitative method also assesses the cervix, using an optical device which measures collagen fluorescence in the cervix. The collascope estimates cervical collagen content from a fluorescent signal generated when collagen cross-links are illuminated with excitation light of about 340 nm. The system has proved useful in rats and humans at various stages of pregnancy, and indicates that cervical softening occurs progressively in the last one-third of pregnancy. In rats, collascope readings correlate with resistance measurements made in the isolated cervix, which may help to assess cervical function during pregnancy, and indicate control and treatments.

Animals↗
PubMed1984

[Role of prostaglandin I2 (prostacyclin) on the maturation of human and rabbit uterine cervix].

It is important to demonstrate the function of prostaglandins (PG) in the ripening mechanism in the human uterine cervix at term. We have examined PG synthesizing activity in both human and rabbit ripening cervix at delivery and non-pregnant cervix. Microsomal fractions of uterine cervix were incubated with radioactive arachidonic acid. The major product was 6-keto PGF1 alpha (the stable metabolite of prostacyclin, PGI2) in both human and rabbit cervix. The conversion rate of 6-keto PGF1 alpha in ripening cervix was about 20% and the production in ripening cervix was more than 37 times as much per DNA as that in non-pregnant cervix. However, no significant increase in PGE2, F2 alpha or Thromboxane B2 production was observed. We found that the production of 6-keto PGF1 alpha increased significantly from the 20th day of gestation and reached its maximum at delivery in rabbit uterine cervix. Dehydroepiandrosterone sulfate treatment for 5 consecutive days from the 20th day of gestation stimulated the production of 6-keto PGF1 alpha in the cervix. These results suggest that PGI2 is one of the important factors in the ripening of uterine cervix during pregnancy.

6-Ketoprostaglandin F1 alpha↗
PubMed1994

Individual and combined effects of relaxin, estrogen, and progesterone in ovariectomized gilts. I. Effects on the growth, softening, and histological properties of the cervix.

Marked growth and softening of the uterine portion of the cervix occur during the last third of the 115-day gestation period in the gilt. These changes in the cervix are temporally correlated with elevated blood levels of relaxin, estrogen, and progesterone. We recently demonstrated that relaxin plays a major role in promoting both the growth and softening of the cervix that occur in pregnant gilts. The roles of estrogen and progesterone in these cervical changes remain poorly understood. Accordingly, this study determined the influence of relaxin, estrogen, and progesterone, individually and in combination, on cervical growth and softening in gilts. Fifteen days after ovariectomy, six to nine nonpregnant, sexually mature gilts were assigned to one of the following eight treatment groups: ovariectomized controls, relaxin treated, estrogen treated, progesterone treated, estrogen plus relaxin treated, progesterone plus relaxin treated, estrogen plus progesterone treated, and progesterone plus estrogen plus relaxin treated. Treatment was given for 10 days, with doses of relaxin (0.5 mg, four times daily), estradiol benzoate (1 mg, twice daily), and progesterone (50 mg, twice daily) selected to provide blood levels resembling those between days 100-110 of gestation. The growth, softening, and histological characteristics of the cervices were determined. Treatment with relaxin significantly increased the growth and softening and altered the histological characteristics of the uterine portion of the cervix in the absence of steroid treatment. Estrogen treatment alone increased cervical growth, but when given in combination with relaxin, estrogen did not augment relaxin's ability to increase either cervical growth or softening. Progesterone alone had little or no effect on the growth or softening of the uterine portion of the cervix. Unexpectedly, when given in combination with relaxin, progesterone augmented markedly relaxin's effects on softening and alteration of the histological characteristics of the cervix. In conclusion, this study is consistent with recent reports that relaxin promotes both the growth and softening of the cervix in the pig. Additionally, this study provides evidence that estrogen and relaxin act independently to promote the growth of the cervix in gilts, whereas progesterone acts in concert with relaxin to promote softening of the cervix and a reduction in the organization and density of cervical collagen fibers. This study provides evidence that relaxin, estrogen, and progesterone all very likely play important roles in the modifications of the cervix that occur during late pregnancy in the gilt.

Animals↗
PubMed2007

A radiological study on the anatomical proximity of the ureters and the cervix.

In order to evaluate risk factors for anatomical proximity between the cervix and the ureters the distance between the ureters and the cervix was measured in 499 computerized tomography (CT) studies at the most dorsal reflection of the ureters. The relationship between the ureter-cervical distance and the presence of pelvic pathology was assessed by correlation tests and regression analysis. Of the 499 CT studies, 252 demonstrated radiographic pathologies. Among abnormal scans, 126 (50%) involved cervical pathology. At least one ureter was within 0.5 cm of the cervix in 3.6% of patients with normal CT scans and in 10.3% of patients with cervical pathology. Overall, the right ureter was significantly closer to the cervix than the left (2.0 +/- -0.8 cm vs. 2.2 +/- 1.0 cm, p < 0.05). In cases were the pathology was limited to the cervix, the right ureter was more distant than the left (2.0 +/- 0.6 cm vs. 1.7 +/- 0.6 cm, p < 0.05). The distance between the ureters and the cervix was inversely correlated with the lateral diameter of the cervix (r = 0.18, p < 0.001) and its anterior-posterior diameter (r = 0.11, p < 0.001). Age did not correlate with the distance of the ureters from the cervix (r = 0.002, p = N.S). In conclusion, approximately 10% of patients with cervical pathology can be expected to have a ureter proximate less than 5 mm from the cervix. For patients with cervical pathology undergoing a planned hysterectomy, preoperative measurement of cervical-ureteric distance may be warranted. In these circumstances intra-operative measures to protect the ureter and ascertain its integrity may be invaluable.

Adult↗
PubMed2001

Classification for endoscopic treatment of mullerian anomalies with an obstructive cervix.

STUDY OBJECTIVE: To describe our classification according to severity of developmental mullerian anomalies with obstructed cervix. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-based, tertiary-level center for endoscopic surgery. PATIENTS: Ten women with developmental mullerian anomalies with obstructed cervix. INTERVENTION: Patients with didelphic uterus with a rudimentary nonfunctional horn and hypoplastic cervix (type 1) underwent hemihysterectomy or diagnostic endoscopy. Those with agenesis of cervix with normal uterus (type 2) had uterovaginal canalization or neocervix with full-thickness skin graft. Women with identical didelphic uteri and hypoplastic cervix (type 3) underwent uterovaginal canalization with or without endometrial ablation or hemihysterectomy. Patients with didelphic uterus with a rudimentary horn and hypoplastic cervix (type 4) had laparoscopic hemihysterectomy. Those with agenesis of the vagina and cervix but with functional endometrium (type 5) had laparoscopic-assisted full-thickness skin graft. MEASUREMENTS AND MAIN RESULTS: Average duration of surgery was 60 to 210 minutes. There were no intraoperative complications. Patients with type 1 anomaly are continuing infertility treatment. All three patients in type 2 continue to have regular menses without dysmenorrhea. In those with type 3 conditions, hemihysterectomy was performed in one woman and uterovaginal canalization was performed on the hypoplastic cervix in another. After the neocervix was created, endometrial ablation was performed. No evidence of cervical obstruction or hematometra was found in either patient. The patient with type 4 anomaly continues to have regular menstrual periods without dysmenorrhea. Women with type 5 disorder had good healing of vaginal skin grafts. CONCLUSION: This classification helps identify mullerian anomalies in relation to obstructive cervix. It is useful in categorizing the disorders and determines management strategies and prognosis.

Adolescent↗