Cytokines of Cervical Mucosa and Human Papilloma Virus Infection of the Cervix: A Descriptive Study.

OBJECTIVE: The production of cytokines by various cervical cells can be triggered by antigenic stimuli, including human papilloma virus (HPV) infection. The aim of the present study was to evaluate differences in cytokine levels between various intraepithelial cervical lesions. STUDY DESIGN: A total of 97 women participated in this descriptive study. Within our study population, 27 subjects presented with high-grade squamous intraepithelial lesions (HSIL), 48 with low-grade squamous intraepithelial lesion (LSIL) and 22 with a normal smear. Colposcopy and directed biopsy were performed as needed. To confirm the presence of HPV, an HPV-DNA test was performed using polymerase chain reaction. Using flow cytometry to ThinPrep cervical samples, we assessed the family of interleukins (ILs), including IL-1α, IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF)-α and TNF-ß and transforming growth factor-ß1. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS for Windows; version 20.0). RESULTS: Significantly lower levels of IL-1α, IL-2, IL-4 and TNF-α were detected in cervical samples obtained from the LSIL group when compared to samples obtained from the HSIL group. CONCLUSION: Significant differences in tissue cytokine levels exist between intraepithelial cervical lesions obtained from patients presenting with HSIL versus LSIL.

Minimally invasive techniques for female stress urinary incontinence, how, why, when.

AIM: The main purpose of this paper is to summarize the recent experience that has been obtained till now in the surgical treatment of urinary stress incontinence with less invasive techniques. MATERIALS AND METHODS: We used current literature and papers published in MEDLINE and Cochrane library. The keywords used for this review were Stress urinary incontinence, Tension-free vaginal tape (TVT), Transobturator tape (TOT, TVT-O), and Single-incision mini-slings (SIMS). RESULTS: Tension-free vaginal tape and the transobturator urethral suspension are the most commonly used surgical approach for women who suffer from stress urinary incontinence, with long-term success rates ranging from 84 to 95 %. TVT is shown to be as effective as the older colposuspension, associated with less post-operative complications, shorter hospital stay and shorter recovery period. Bladder perforations that have been mentioned with the TVT inserter apparently do not result in any clinically significant morbidity. Major vascular and bowel injuries have been reported at rates of 0.07 and 0.04 %, respectively. Studies between TVT-O and TOT show equal effectiveness with slightly lower cure rates than TVT group, but TOT had a significant lower risk of bladder and vaginal perforations. There were no significant differences in objective cure rates between 'inside-out' and 'outside-in' transobturator tapes. Very recently a meta-analysis does not support routine use of SIMS in clinical practice, moreover suggested the retropubic TVT as the preferred choice for the management of stress urinary incontinence due to familiarity, its effectiveness, minimal invasiveness and low complication and morbidity rates as a primary procedure. Similar results have been announced in a randomized control trial in USA. CONCLUSIONS: Certainly, larger randomized clinical trials with longer follow-up about the mentioned techniques are needed to accurately determine the efficacy and safety of the mentioned minimally invasive techniques.

Current caesarean delivery rates and indications in a major public hospital in northern Greece.

BACKGROUND: Over the past 25 years, there has been a sustained increase in caesarean section (CS) rates around the world. However, there is a paucity of data regarding the current CS rates and particularly the trends of CS indications in Greece. AIM: To assess the overall CS rates and indications in a major Greek teaching hospital over the last five years. METHODS: All deliveries that took place in our Department between January of 2002 and December of 2006 were retrospectively analysed through manual medical chart review to record CS rates and indications. RESULTS: During the study period, 4964 deliveries took place in our department; among them, 1831 were CS (36.9%). The overall caesarean delivery rate has remained stable during these five years (36.7% during 2002 vs 35.5% during 2006; P = 0.633). The primary indications were previous caesarean delivery (30.9%), non-reassuring or pathological fetal heart rate trace by cardiotocography (12.3%) and dystocia (10.4%). The only indication whose rate significantly increased was previous caesarean delivery (+47.3%; P = 0.002), whereas a significant decrease was found for non-reassuring or pathological fetal heart rate trace by cardiotocography (-39.1%; P = 0.008). CONCLUSIONS: It is quite difficult to reduce the proportion of caesarean deliveries, particularly in a teaching hospital with a considerable number of high-risk pregnancies. The dominant role of previous caesarean delivery among CS indications stresses the importance of performing more vaginal birth after CS if we are to avoid the self-perpetuation of the CS epidemic.