Preparation, property of the complex of carboxymethyl chitosan grafted copolymer with iodine and application of it in cervical antibacterial biomembrane.

Cervical erosion is one of the common diseases of women. The loop electrosurgical excisional procedure (LEEP) has been used widely in the treatment of the cervical diseases. However, there are no effective wound dressings for the postoperative care to protect the wound area from further infection, leading to increased secretion and longer healing time. Iodine is a widely used inorganic antibacterial agent with many advantages. However, the carrier for stable iodine complex antibacterial agents is lack. In the present study, a novel iodine carrier, Carboxymethyl chitosan-g-(poly(sodium acrylate)-co-polyvinylpyrrolidone) (CMCTS-g-(PAANa-co-PVP), was prepared by graft copolymerization of sodium acrylate (AANa) and N-vinylpyrrolidone (NVP) to a carboxymethyl chitosan (CMCTS) skeleton. The obtained structure could combine prominent property of poly(sodium acrylate) (PAANa) anionic polyelectrolyte segment and good complex property of polyvinylpyrrolidone (PVP) segment to iodine. The bioactivity of CMCTS could also be kept. The properties of the complex, CMCTS-g-(PAANa-co-PVP)-I2, were studied. The in vitro experiment shows that it has broad-spectrum bactericidal effects to virus, fungus, gram-positive bacteria and gram-negative bacteria. A CMCTS-g-(PAANa-co-PVP)-I2 complex contained cervical antibacterial biomembrane (CABM) was prepared. The iodine release from the CABM is pH-dependent. The clinic trial results indicate that CABM has better treatment effectiveness than the conventional treatment in the postoperative care of the LEEP operation.

Uterine cervical ectopy during reproductive age: cytological and microbiological findings.

Cervical ectopy is common in adolescents, pregnant women, and those taking high doses of estrogen-containing contraceptives. The majority of cases have spontaneous reversion, but some cases can be persistent. Studies suggested that the adequacy of a Pap smear could be affected and there is an increased risk cervical infections. This study is a cross-sectional study conducted from December 2009 to February 2011 with 457 women with cervical ectopy and 736 without ectopy. Cervical samples were collected in vials for analysis by ThinPrep cytology (Hologic, Marlborough, MA). The Mann-Whitney test and Fisher's exact test (95% CI) were applied. The study was approved by the ethics committee of the Federal University of Ceará. The mean ages of the study group and control group were 28.7 (±14.8) and 33.6 (±7.5) years old, respectively (P < 0.0001). Negative diagnosis for malignancy and intraepithelial lesion was present in 399 (87%) cases and 705 (96%) in the study and control groups, respectively (P < 0.0001). Shift in the flora suggestive of bacterial vaginosis (BV) was observed more frequently in the study group: 74 (16.2%) than in the control group: 86(11.7%) (P = 0.017). The differences among the other morphotypes showed no significance. The smears were atypical in 12.7% (58/457) of the patients from the study group and in 4.2% (31/736) in the control group (P < 0.001; RR = 3 [2.033-4.712]). The association between ectopy and inflammatory cytology, the presence of the shift in the flora suggestive of BV and cytological atypia is evident.

Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical erosion.

Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs.

[Cytogenetic characteristics of the uterine cervical epithelium in inflammatory diseases].

Functional status of epithelial cells at inflammatory cervical pathologies has been studied with the use of cytogenetic method of detection of chromosome nucleolar organizer regions. The highest level of rRNA proliferation and synthesis has been detected in cylindrical epithelial cells using the indexes of compact and transitional nucleolonemic types of nucleolar organizer regions, a higher level--in squamous cells of intermediate type, and the lowest one in squamous epithelium of superficial type.

[Morphological observation of cone biopsy and hysterectomy specimens of high-grade cervical intraepithelial neoplasia].

OBJECTIVE: To study the histopathological features, growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia (CIN). METHODS: Cone biopsy and hysterectomy specimens of 592 women with high-grade CIN (CIN II or III) were reviewed morphologically. Of all cases, the gross appearance of the external os was recorded, and the frequency of cervical quadrants involved in high-grade CIN was assessed. Two hundred specimens were selected randomly to observe micrographical changes, including the extent, depth, growth pattern and cell types of high-grade CIN and the alteration of stroma surrounding CIN. RESULTS: Of 592 specimens, external os showed smoothness in 46 cases (7.8%), mild erosion in 151 cases (25.5%), moderate or severe erosion in 395 cases (66.7%), hypertrophy in 48 cases (8.1%), and neoplasm in 4 cases (0.7%). High-grade CIN involvement was equally frequent on each quadrant of cervix (P>0.05). Of 200 cases of high-grade CIN reviewed micrographically, the depth of the deepest involved crypt was less than 3 mm in 188 specimens (94.0%), between 3 to 5 mm in 12 specimens (6.0%), and more than 5 mm in none. High-grade CIN with isolated endocervical crypt involvement was detected in 77 cases (38.5%), multiple crypt involvement in 143 cases (71.5%), and confluent crypt involvement in 73 cases (36.5%). High-grade CIN showed explanate in 81.0% (162/200) of cases, endophytic in 49.0% (98/200) of cases, and exophytic in 6. 5% (13/200) of cases. Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%), whereas gradual transition in 66 specimens (33.0%). A variety of cell types, but basaloid type predominantly, were observed in high-grade CIN. In 28.5%-45.0% of cases, the stroma surroundin CIN displayed oedema, desmoplastic and lymphocytic responses. CONCLUSIONS: Our data suggest that gross examination is of little importance for diagnoses of CIN. CIN trend to spread horizontally and along the endocervical crypts, and are mainly distributed to a depth less than 3 mm. These data also suggest that there are a variety of cell types of CIN, and stroma responses to CIN may exist in part of high-grade CIN.

Evidence for benefits from treating cervical ectopy: literature review.

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.

[Distinction between lymphoma-like lesions and lymphoma of uterine cervix: a clinicopathologic study of 26 cases].

OBJECTIVE: To study the clinicopathologic features and differential diagnosis of lymphoma-like lesions and lymphoma of uterine cervix. METHODS: Clinical data and hematoxylin and eosin-stained slides of 10 cases of lymphoma-like lesion and 16 cases of lymphoma of uterine cervix were reviewed. Immunohistochemical study for B- and T-cell markers and light chains (kappa, lambda) were performed on paraffin sections. The rearrangement status of immunoglobulin heavy chain (IgH) gene was analyzed with semi-nested polymerase chain reaction in 4 cases lymphoma-like lesion and 4 cases of lymphoma of uterine cervix. RESULTS: The age of patients with lymphoma-like lesion ranged from 24 to 54 years (medium = 43 years). The lesion generally presented with cervical erosion or polyp. Microscopically, it is characterized by focal or diffuse superficial infiltration of immunoblast-like large B cells intermingled with a polymorphic population of inflammatory cells, including plasma cells, eosinophils and neutrophils. Maturation of the transformed large B cells was also noticed. On the other hand, the age of the patients with lymphoma of uterine cervix varied from 28 to 78 years (medium = 58 years). Cervical mass or diffuse enlargement of cervix were the commonest clinical findings. The cases included 12 examples of diffuse large B-cell lymphoma and 4 examples of follicular lymphoma. The former was characterized by a diffuse monomorphic population of large atypical lymphoid cells, while neoplastic follicles were identified in the latter. Neither polymorphic inflammatory infiltrates nor maturation phenomenon was found. The immunostaining for kappa and lambda light chains was inconclusive. Molecular study showed clonal rearrangement of IgH gene in all cases of cervical lymphoma, as well as 2 cases of lymphoma-like lesion. CONCLUSIONS: The distinction between lymphoma-like lesion and lymphoma of uterine cervix depends primarily on the clinical and histopathologic features. Assay for rearrangement of IgH gene may be helpful in differential diagnosis, though monoclonality can be detected in some benign lesions as well.

[Therapeutic effects of focused ultrasound on chronic cervicitis and the influencing factors].

OBJECTIVE: To explore the therapeutic effect of focused ultrasound (FU) on chronic cervicitis unitarily and its influential factors. METHODS: Three hundred and thirteen patients of chronic cervicitis were treated with the device of CZF model focused ultrasound. The therapeutic effects in 300 cases with complete records, as well as the relationship between the diameter of cervical erosion and the exposure time to FU were analyzed. RESULTS: The effective rates of FU in treatment of chronic cervicitis unitarily were 100.0% (53/53), 95.2% (120/126) and 91.7% (111/121), respectively, for mild, moderate and severe cases. The overall effective rate was 94.7% (284/300). With other parameters of FU unchanged, the exposure time to FU showed an exponential relationship with the diameter of erosion, and the regression equation was D = 31.71e(0.4808t) (R(2) = 0.9966). CONCLUSIONS: The controllability and achievement ratio of FU to treat cervical erosion could be enhanced when exposure time and manners were fully considered based on the diameter and type of cervical erosion. A satisfactory therapeutic efficacy could be achieved with FU to treat cervical erosion unitarily.

Assessment of cervical erosion in Hamedan city, Iran.

The purpose of this study was to determine the role of socio-economic factors and cytology in cervical erosion. A cross-sectional study involving 410 females in the reproductive age group was conducted in urban health centers in Hamedan city, Iran. Data were collected through interviews with women, gynecological examination in the clinics in the health centers and laboratory tests. Cervical erosion was detected in 68 (16.6%) females. Out of these mild dysplasia was seen in (8.8%) females. High percentages of inflammatory smears (58.8%) were obtained in women with cervical erosion. Cervical erosion was more common in illiterate and women with low literacy status as compared to women with higher education. Majority of cases of cervical erosion were detected in women with high parity. A statistically significant relationship was found between lower socio-economic status and cervical erosion (p < 0.05). Regular cytological screening by Pap smear will help in early detection of carcinoma cervix.

[Recombinant human epithelial growth factor accelerates healing of cervical erosion].

OBJECTIVE: To observe the effect of recombinant human epithelial growth factor (rhEGF) in promoting the healing of cervical erosion. METHODS: Forty-eight patients with cervical erosion were treated with rhEGF and 30 with 500 kHz high-frequency electromagnetic wave, and the effects of the therapies were compared in terms of healing of the cervical wound, healing time, volume of vaginal discharge and bleeding and the lasting time. RESULTS: In comparison with radiofrequency therapy, the healing of the lesion took significantly shorter time with rhEGF therapy, which also resulted in less vaginal discharge that lasted for shorter time without causing vaginal bleeding. CONCLUSION: rhEGF can obviously accelerate the healing of cervical erosion.

[Clinical and pathological peculiarities of cervix in young women not giving birth with pseudo-erosions during hormonal contraception].

An early initiation of sexual life as the cause of problem concerning hormonal contraception with young women not given birth acquires a special actuality. It is known that no matter how carefully the operation of abortion is held, it is inevitably accompanied by the traumatization of cervix, especially in women with first pregnancy. According to the reference data the consequences of the first abortion in every third woman are the inflammatory diseases of reproductive organs, the infringement of menstruation, infertility, ectopic pregnancy, endometriosis, etc. It is known that the most effective method of avoiding the first pregnancy and in particular the first abortion is the hormonal contraception (HC). It is necessary to mention that there are numerous and diverse investigations dedicated to the study of condition of the cervix in the process of hormonal contraception. The detailed analysis of the literature in last 5-8 years show that the frequency of cervical cancer in women who use HC does not exceed the overall rate in the population. Besides the right choice of oral contraception (OC) for present contingent of women promotes the epithelization of the pseudo-erosions of the cervix.

Role of socio-economic factors and cytology in cervical erosion in reproductive age group women.

A cross-sectional study involving 357 females in the reproductive age group (15-44) was conducted in an urban community of Nagpur with the objective of studying the role of socio-economic factors & cytology in cervical erosion. Cervical erosion was detected in 82 (22.96%) females. Out of these mild dysplasia was seen in 9.75% females & moderate dysplasia in 2.43% females. High percentages of inflammatory smears i.e. (75.68%) were obtained in women with cervical erosion. Cervical erosion was more common in illiterate & women with low literacy status as compared to women with higher education. Majority of cases of cervical erosion (75.6%) were detected in women with high parity. A statistically significant association was found between lower socio-economic status, early age at marriage & ocurrence of cervical erosion (p<0.001 & p<0.01 respectively). The study concludes that socio-economic factors such as illiteracy and low literacy status, lower socio-economic status, early age at marriage and high parity are contributory for the occurrence of cervical erosion and regular cytological screening by Pap smear will help in early detection of carcinoma cervix and thereby reduce the morbidity and mortality caused by the same.

Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching.

OBJECTIVE: Our purpose was to assess determinants of cervical ectopia and cervicitis, specifically after adjustment for cervical infection. STUDY DESIGN: A cross-sectional study was conducted with colposcopic, cytologic, and microbiologic examination of 764 randomly selected women attending a sexually transmitted disease clinic and 819 consecutive college students undergoing routine annual examination. RESULTS: After we controlled for potential confounders, cervical ectopia was positively associated with oral contraception and Chlamydia trachomatis infection and negatively associated with aging in both populations, with recent vaginal douching in patients with sexually transmitted diseases, and with current smoking in college students. Oral contraception wa also associated with the radius of ectopia, and among users of oral contraception ectopia was associated with duration of oral contraception. Cervicitis (evaluated by Gram stain, Papanicoloau smear, and colposcopy) was associated with cervical infection by C. trachomatis and cytomegalovirus (both populations) and with gonorrhea and cervical herpes simplex virus infection (patients with sexually transmitted diseases). Cervicitis was independently associated with ectopia but not with oral contraception after we adjusted for these four cervical infections. However, oral contraception was associated with edema and erythema of the zone of ectopia among women without cervical infection. CONCLUSIONS: Oral contraception, aging, cervical infection, smoking, and douching have effects on cervical ectopia that may influence the acquisition, transmission, or effects of sexually transmitted agents. Ectopia is associated with young age, oral contraception, and cervical infection; cervicitis is associated with ectopia and cervical infection by C. trachomatis, Neisseria gonorrhoeae, herpes simplex virus, and cytomegalovirus. In women without cervical infection, edema and erythema of the zone of ectopia are associated with oral contraception.

[The cytopathologic diagnosis of cervical lesions and uterocervical carcinomas].

Fifty one cases of Papanicolaou grade, I, II, III and 49 of IV, V were studied for cytopathologic diagnosis in cervical and uterine curet smears. The cervical glandular erosion, metaplasia and cervical intraepithelial neoplasia, as well as histologic types of carcinomas, which were not distinguished by diagnosis of Papanicolaou grades, were determined by cytopathologic diagnosis. Therefore, the papanicolaou method of cytologic diagnosis should be gradually replaced by cytopathologic diagnosis.

[The clinico-morphological and cytological characteristics of the ecto- and endocervix with the use of the oral contraceptive triregol]. / Kliniko-morfologicheskie i tsitologicheskie osobennosti ékto- i éndotserviksa pri primenenii oral'nogo kontratseptiva triregol.

Cervix uteri status was examined in 55 young nulliparous women in the course of triphasic oral contraception. The status of the cervix uteri was assessed on the basis of clinical, colposcopic, cytologic, and morphofunctional examinations. Triphase oral contraception with triregol was found conducive to the formation of squamous-cell metaplasia in ectopic sites, this promoting epithelialization of the cervix uteri.

PIP: The objective of this investigation was the study of clinical-morphological characteristics of the ecto- and endocervix in young nulliparous women with pseudoerosions in the course of using the 3-phase oral contraceptive (OC) Triregol made by Gedeon Richter Inc. of Hungary, which contains ethinyl estradiol and levonorgestrel. 55 healthy women, 17-30 years old, were observed. In the anamnesis of these women there was 1 instance of induced abortion and 1 instance of self-induced abortion. 22 women were married, and the rest were not. 2 patients had a history of inflammatory disease of the uterus and of the adnexa. In addition to routine clinical examination, echographic and dilatational colposcopy was performed in all women before starting them on the preparation. The observation was performed every 3, 6, 9, and 12 months and in the course of 1-2 months after taking the OC. A piece of tissue was taken by biopsy from the cervix and scrapings from the mucous membrane of the cervical canal for morphological examination. In 11 patients (27.5%) ectopia of varying extent was diagnosed by colposcopy, and in 27 patients (67.5%) ectopia in the transformation phase was discovered. Leukoplakia occurred in 2 patients (5%). Cervical biopsies were taken from 40 patients, and glandular pseudoerosion was discovered in 36, of whom in 18 patients fulminating and/or diffusive infiltration of lymphocytes were found in the subepithelial tissues, whereas papillary pseudoerosion was found in 2 cases. After 3 months of OC use in 2 patients full epithelization of the cervix was detected with multilayered flat epithelia. In the 2 patients with leukoplakia neither positive nor negative changes were observed. In 2 out of 40 patients a section of ripe or not ripe flat celled metaplasia in the mucous of the cervical canal and in 1 patient hyperplasia of the reserve cells were discovered. It must be underlined that in none of the observations was there a progressive pathological process nor the genesis of dysplasia detected.

'Erosion' of the uterine cervix; an anachronism.

The conclusion arrived at after a review of the relevant literature, coupled with current knowledge of the morphophysiological changes which take place in the transformation zone of the cervix, is that the term cervical erosion is an anachronism. The term should therefore be abandoned. More appropriate terms for the clinical appearance of the cervix are ectropion or ectopy. The metaplastic process and its role in neoplasia is also discussed.

Desquamative inflammatory vaginitis. A case report.

The differential diagnosis of noninfectious desquamative inflammatory vaginitis includes pemphigus vulgaris, erosive lichen planus and benign mucous membrane pemphigoid. A 32-year-old woman had persistent, noninfectious, erosive vaginitis and linear deposits of IgA in the vaginal epithelial basement membrane zone. The differential diagnosis should be expanded to include mucosal involvement by linear IgA disease, a cutaneous vesiculobullous disorder.

[Comparative studies of 2 systems of early cyto-oncologic diagnosis of cervix erosion]. / Badania porównawcze dwóch systemów wczesnej diagnostyki cytoonkologicznej nadzerki szyjki macicy.

In the years 1979-1980 screening examinations (by the open method) were given to 51232 women, that is 85.3% of the female population of Bytom at risk for cervical cancer. Grade I and II cytological smears were found in 46320 (98.52%) of women. Papanicolau grade III was found in 201 (1.12%), and grade IV-V in 64 (0.12%). At the same time, in the years 1978-1984 in the closed health service institutions 19968 women were examined, and suspected smears (grade III-IV) were noted in 368 cases (1.8%). Histological verification showed cervical dysplasia in 184 (0.36%) and 106 (0.53%) respectively, and cervical carcinoma grade 0-IV 52 (10%) and 156 (0.94%). The author compared the results with similar ones obtained in various regions of Poland and in foreign countries. The author failed to find greater detectability of cervical dysplasia and carcinoma in Silesia in comparison with certain, less industrialized, regions of Poland. The author thinks that the stationary system of cervical cancer prevention has a greater chance of being introduced on condition of reorganization of this system, introduction of training of cytological technicians and organization of centres of cytooncological examinations.