The presence of endometrial cells in cervical smears in relation to the day of the menstrual cycle and the method of contraception.

The presence of endometrial cells in cervical smears was studied in a large series of women participating in a population screening program for cervical cancer, in relation to different time periods of the menstrual cycle and to the method of contraception practiced. In the total group of women studied, endometrial cells were present in an average of 12% of the cervical smears. In women who were menstruating cyclically, the percentage of cervical smears containing endometrial cells was not age dependent. Only in women over 52 years was a lower number of endometrium-positive cervical smears found: in postmenopausal women, 0.6% of smears were found to contain endometrial cells. In menstruating women, the frequency of endometrial cells in cervical smears was highest during the menses. After day four, through the proliferative phase, the percentages of cervical smears containing endometrial cells markedly decreased. During the secretory phase, an average of 2% of the smears contained endometrial cells; in the premenstrual phase (after day 25), the percentages of endometrial cell-positive smears rose again. When related to the method of contraception practiced, significant differences in the percentages of cervical smears with endometrial cells appeared. In women using oral hormonal contraceptives, the average numbers of smears containing endometrial cells for the whole cycle as well as for each period of the cycle were significantly lower. This phenomenon might be due to endometrial atrophy on the basis of prolonged use of oral hormonal contraceptives. In women wearing an intrauterine device, at any moment the frequencies of smears with endometrial cells present were significantly higher than the values found in women using any other method of contraception or not using contraceptives. The evaluation of cells originating from the endometrium requires considerable experience. The identification of endometrial cells can be made with greater confidence when the cytologist is aware of the exact date of the menstrual cycle and of the impact on the presence of endometrial cells in cervical smears caused by different methods of contraception.

Assessment of uterine shape by geometric means.

PIP: A uterine measuring device, Wing Sound II, was developed to determine uterine shape and dimensions. The device is a winged sound capable of successively holding stable wing spreads possessing transverse dimensions of 12 and 20 mm, respectively. 3 experiments were performed with this device to test the geometric concept of the application and to determine the device's potential usefulness. A total of 34 hysterectomy specimens were used; all uteri were sectioned transversely. The uteri used in Experiments 2 and 3 were suspended in a stable state; however, those examined in Experiment 1 were not. In the first phase of the study, the cross-sectional geometry of 8 uteri was examined. Analysis revealed that the uterus consists of 3 distinct geometric zones: a lower canal-like structure with an essentially constant normal cross section, the cervix; a transitional zone, the isthmus; and an upper segment with a transverse cross-sectional configuration of an isosceles trapezoid, the endometrial cavity. This general geometric configuration was noted in the remaining 26 uteri in the study. 3 direct measurements, duplicating those obtainable by the Wing II device, were made on 13 uteri in the second experiment. In this group the fundal transverse dimension and the uterine base angles were also measured directly and later computed on the basis of axial measurements using the mathematical equations that define an isosceles trapezoid. Good correlation was noted verifying that the isosceles trapezoid is an apt endometrial cavity model. The Wing Sound II was used in 13 uteri of the final group to determine measurements of total uterine legnth as well as uterine depths corresponding to the 12 and 20 mm uterine width levels. These data were used to compute the uterine fundal transverse dimension and angles. These findings were compared with direct measurements, and again good correlation between the Wing Sound II and direct measurements was found, suggesting that it is possible to determine the general shape and dimensions of the endometrial cavity through the use of this new Wing Sound II device.^ieng

Changes in the glycosaminoglycans distribution pattern in the human uterine cervix during pregnancy and labor.

The glycosaminoglycans distribution pattern of uterine cervix samples obtained from 42 women of reproductive age was determined by means of proteolytic digestion and subsequent chromatographic separation. The following glycosaminoglycans were detected: chondroitin 4- and 6-sulfates, dermatan sulfate, hyaluronate, chondroitin, and keratan sulfate. The connective tissue of the uterine cervix shows a characteristic distribution pattern with regard to glycosaminoglycans which does not correspond to that found in any other tissue studied so far. Based on dry weight, the content of keratan sulfate increases during pregnancy while the concentration of chondroitin remains unchanged. The chondroitin sulfates and dermatan sulfate drop simultaneously. During labor chondroitin increases threefold. The hyaluronate content of the postpartum cervix is higher than that of the cervix in nonpregnant women. Both changes in the solubility of collagen as well as in the distribution pattern of the glycosaminoglycans seem to be related to cervical dilatation.

PIP: This study attempted to quantitate the presence of glycosaminoglycans in the uterine cervix during pregnancy and labor. Distribution patterns, within the cervical samples, of the glycosaminoglycans were determined by proteolytic digestion and subsequent chromatographic separation. Cervical samples studied were from 42 women of reproductive age. During pregnancy, the keratan sulfate content increased significantly; the chondroitin concentration remained unchanged; and the contents of the chondroitin sulfates and dermatan sulfate decreased. During labor, a considerable rise of chondroitin was noted, whereas the concentrations of keratan sulfate, chondroitin 4- and 6-sulfates, and dermatan sulfate did not change. Hyaluronate content of a postpartum cervix was significantly higher than in nonpregnant women. The total glycosaminoglycans content (related to dry weight of the cervix) was not larger during pregnancy as compared with samples of nonpregnant women. During labor, however, there was an increase from 8.57 mcmol/gm of dry weight. The hydroxyproline content dropped during pregnancy and labor. The ratio of total glucosaminoglycans content to that of hydroxyproline changed in favor of the glycosaminoglycans during pregnancy, and it became more pronounced during labor. Distribution patterns of serial transverse cervical sections showed an increasing content of hyaluronate from the external os upward to the lower uterine segment. The other glucosaminoglycans did not show any definite trend. Both the changes in the solubility of collagen as well as glycosaminoglycans distribution patterns were related to cervical dilatation.

Histologic and chemical studies of the smooth muscle in the human cervix and uterus.

PIP: This study compared chemical and histological measurements of the amount of smooth muscle in the human cervix to determine the extent of correlation of the 2 types of quantifications. Macroscopically normal uteri and cervical specimens from 31 nonpregnant women, aged 21-55 years, were studied. Histological estimates were made of muscle amount, and chemical measurements of actomyosin were made. It was seen that the mean muscle content of the cervix increased from the lower to the upward part. The smallest amount (6.4%) was in the lower cervix; midcervix muscle content increased to 18%; and upper was 28.8%. Chemically, the mean actomyosin content of the uterus was significantly greater than that of the cervix (7.54 vs. 3.72 mg/gm) (P=.01). The 2 types of measurements were correlated in their ability to quantitate muscle mass and amount in the human cervix.^ieng

Carcinoma in situ specimen classification based on intermediate cell measurements.

In this study the possibility of classifying carcinoma in situ and normal specimens by measuring normal-appearing intermediate cells was explored. Twenty-five histologically verified carcinoma in situ specimens and 99 normal specimens, matched with the abnormal specimens for age and use or nonuse of an oral hormonal contraceptive, were examined. The smears were monolayer preparations stained with Thionin-Feulgen Congo red. Twenty-one nuclear features were measured. A discrimination among the experimental groups could be made on the basis of the relationship between two features, area and average optical density (AOD). A regression of AOD on area for each smear was performed. The correlation, coefficient of variation, slope, intercept, as well as the mean of the AOD level and the age of the subject were used in a discriminant analysis. This resulted in a smear classification with a false-positive rate of 14% and a missed-positive rate of 32%. When contraceptive use was taken into account the overall classification was improved with a false-positive rate of 12% and a missed-positive rate of 20%.

Peptide-containing nerves in the human pregnant uterine cervix: an immunohistochemical study exploring the effect of RU 486 (mifepristone).

The presence of several neuropeptides (neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), substance P (SP), galanin (GAL), enkephalin (ENK), somatostatin (SOM) was established in the early pregnant human cervix using indirect immunofluorescence immunohistochemistry. Several peptides (VIP, NPY, CGRP, GAL) were present both in free nerves among smooth muscle cells and around blood vessels. Others (SP, SOM) were only seen as single varicosities among smooth muscle cells. Randomized treatment of patients with RU 486 (mifepristone) prior to surgical sampling revealed no clearcut differences in peptide immunoreactivities. After RU 486 treatment, however, there was a tendency towards a decrease of NPY- and VIP-immunoreactivity, and an increase of CGRP-immunoreactivity.

Anaerobic bacteria in uterine infection following first trimester abortion.

Samples of uterine fluid and cervical mucus for bacterial culture were obtained from 23 patients with endometritis following first trimester abortion. Uterine samples were obtained via a sheathed system which minimizes contamination by the cervical flora. A mean of 3.4 isolates were identified in cervical samples as compared to 1.8 in uterine samples. Anaerobic bacteria were found in 57% of the uterine samples and dominated in both uterine and cervical samples. Peptostreptococcus species dominated in cervical samples and Bacteroides species in uterine samples. Significantly more bacterial species were found in uterine samples from patients with a high erythrocyte sedimentation rate. Since no bacteria were found in 39% of uterine samples a possible role of nonmicrobial pyrogenic substances is suggested.