A Comparative Study of Clinical Outcomes in Locally Advanced Cervical Cancer: External Beam Radiotherapy (EBRT) and Sequential High Dose Rate Intracavitary Brachytherapy (HDRICBT) with or without Concurrent Cisplatin on the Day of ICBT Insertion - A Tertiary Care Center Randomized Controlled Trial in India.

OBJECTIVE: The current study aimed to delve into the comparative clinical outcomes between external beam radiation therapy (EBRT) and sequential High Dose Rate Intracavitary Brachytherapy (HDRICBT) with or without concurrent cisplatin administration on the day of intracavitary brachytherapy (ICBT) insertion in women with locally advanced cervical cancer. METHODS: In this study, conducted between January 2017 and July 2018 at a leading institute in India, diagnosed and untreated patients of locally advanced carcinoma cervix were randomized into two groups. Arm 1 received concurrent cisplatin before each course of brachytherapy, while Arm 2 underwent brachytherapy alone. The outcomes were compared in terms of acute and late toxicities, treatment response, and follow-up. Data analysis was performed using SPSS 16, with statistical significance set at p < 0.05. RESULTS: Both study arms showed similar complete response (CR) rates of 73.3%, with no significant advantage of concurrent cisplatin before brachytherapy. However, a noteworthy trend emerged during follow-up. In the concurrent cisplatin group, the CR rate increased from 73.3% post 1 month of brachytherapy to 86.7% at 3 months and 83.3% at 6 months. Contrastingly, the control group showed CR rates of 73.3% post 1 month, 80% at 3 months, and 76.6% at 6 months. While not statistically significant, this observation suggests a possible enhancement in response rates with concurrent cisplatin and ICBT. CONCLUSIONS: Future studies focusing on the optimal drug, dosage, scheduling, and combining cisplatin with other agents are recommended to further explore the potential benefits observed in this study.

Clinicopathological study of role of CD34 expressions in the stroma of premalignant and malignant lesions of uterine cervix.

CD34 is a transmembrane glycoprotein that is thought to be involved in the modulation of cell adhesion and signal transduction. The connective tissue stroma of virtually all human organs contain large amounts of resident CD34+ fibrocytes, which are involved in multiple functions such as wound healing, secretion of cytokines and also participate in stromal remodeling. It has been seen in various studies that absence of CD34+ fibrocytes within the stroma is associated with invasive carcinomas. In our study, we also investigated the presence and distribution of CD34+ fibrocytes in cervical intraepithelial neoplasia, invasive cervical carcinoma and adjacent normal cervical stroma. It was seen that normal cervical stroma and the stroma adjacent to cervical intra epithelial lesions harbours a dense meshwork of CD34+ fibrocytes, whereas the stroma of invasive carcinoma was nearly devoid of this cell population. Early stromal invasion by squamous carcinoma was characterized by a focal loss of CD34+ fibrocytes. This can be used as a sensitive tool in detecting tiny foci of stromal invasion in early cancer.

Comparative Study of Ormeloxifene and Medroxyprogesterone Acetate in Abnormal Uterine Bleeding.

PURPOSE: The purpose of this study was to compare the effects of ormeloxifene with medroxyprogesterone acetate in patients with abnormal uterine bleeding. MATERIAL AND METHOD: 440 Patients were divided into two groups. In group A, ormeloxifene was given at the dosage of 60 mg twice a week for 3 months followed by 60 mg once a week for 1 month. In group B, medroxyprogesterone acetate was given at the dosage of 10 mg twice a day from day 5 to day 25 of the menstrual cycle. At follow-ups, patients were assessed for PBAC score, endometrial thickness by USG, hemoglobin level, and the side effects of drug therapy. RESULTS: There were 240 patients in group A and 200 in group B. Reduction in median PBAC score was 79.4 % in group A and 75 % in group B after 4 months of treatment. The mean duration of bleeding reduced to 4.8 from 9 in group A and 5 from 8.7 in group B. Mean hemoglobin was increased from 8.6 to 9.8 g % in group A and from 8.7 to 9.9 g % in group B; endometrial thickness was reduced from 7.7 mm to 6.8 mm in group A and from 7.4 mm to 6.9 mm in group B. CONCLUSION: We conclude from this study that ormeloxifene should be considered the first choice in the management of AUB, especially in the perimenopausal age group where amenorrhea is acceptable.

Clinco-Pathological Patterns in Women with Dysfunctional Uterine Bleeding.

BACKGROUND: The term dysfunctional uterine bleeding (DUB) refers to any abnormal bleeding from the uterus, unassociated with tumour, inflammation and pregnancy. The histological diagnosis of DUB is very essential for adequate management especially in perimenopausal and postmenopausal females. The present study was undertaken with the aim of evaluating DUB in various age groups, carry out histopathological study of the endometrium and analyze its clinic-pathological patterns. METHODS: The study included 500 cases of atypical uterine bleeding, out of which 120 cases of DUB were included based on clinical features and detailed investigations. Study was conducted in Jawaharlal Nehru Medical College, Aligarh Muslim University, between March 2003 to December 2004 Endometrial tissue was collected by D&C procedure and the samples were sent for histopathological evaluation by pathologist. RESULT: Hyperplasia was the commonest endometrial pathology (20.5%) followed by luteal phase insufficiency (15.6%) and secretory endometrium (13.7%). Endometritis including tubercular endometritis (12.7%), post abortal (5.8%), proliferative (6.8%), polyp (3.9%), atrophic (3.9%), exogenous hormone changes (2.9%) and anovulatory cycles (6.8%) made up for the remaining lesions. CONCLUSION: DUB occurs secondary to a wide variety of functional and structural abnormalities, warranting a thorough evaluation especially in perimenoupausal females. Menorrhagia is a common symptom and the most likely etiology relates to the patient's age. Significant number of endometrial samples revealed pathology rendering endometrial curetting and biopsy an important procedure. Cervical cytology is a valuable adjunct however histopathology remains the gold standard in diagnosis.

Endometrial osseous metaplasia-a rare presentation of polymenorrhagia: a case report.

Endometrial ossification is a rare entity in which bones are found in the uterus. Exact aetiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells result in the formation of bones. The possibility of malignant mixed mullerian tumour should be in the mind of clinician and pathologist while making diagnosis. We hereby report an extremely rare case, which is among very few reported cases in the world, in which endometrial ossification presented in a perimenopausal female with polymenorrhagia. A 41-year-old multiparous patient presented with irregular bleeding per vaginum for the past two years. She was found to be a case of endometrial calcification with osseous metaplasia with presence of bones varying from 7mm - 1.5 cms size in the uterine cavity. She was successfully managed by total abdominal hysterectomy.

Gossypiboma mimicking as dermoid cyst of ovary: a case report.

Gossypiboma is a rare condition caused by retained postoperative foreign bodies. The condition is under reported because of diagnostic difficulties and medicolegal implications associated with it. It may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 22-year-old woman presented with non specific symptoms and was referred to us with radiological diagnosis of dermoid cyst. On laparotomy the mass was proved to be a gossypiboma resulted from gauze which was retained in caesarean section done two years back. Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of postoperative patients presenting with non specific complains and lump abdomen. Despite thorough history, physical examination, laboratory, and radiographical findings, usually gossypibomas are not suspected and remain an accidental finding. Employment of all preventive measures during surgical procedures and high index of suspicion in post operative patients are the key stones in its management.

Retinal tissue in mature cystic teratoma of ovary presenting with full-term pregnancy.

Mature cystic teratomas are benign ovarian neoplasms which account for around 95% of all ovarian germ cell tumours and contain tissues derived from two or three embryonic germ layers. These tumours are frequently diagnosed in women of reproductive age group and can result in fetomaternal distress if concurrent pregnancy occurs. The authors describe a case of successful natural pregnancy in a 30-year-old woman with coexisting mature cystic teratoma of ovary that culminated in viable childbirth at term. Subsequent histopathological examination of the tumour revealed a mature teratoma composed predominantly of ectodermal elements along with retinal tissues--a rare finding that prompted this case report.

The transcervical foley catheter versus the vaginal prostaglandin e2 gel in the induction of labour in a previous one caesarean section - a clinical study.

OBJECTIVE: To compare the effectiveness and the safety of the transcervical Foley catheter and the prostaglandin E2 (PGE2) gel for the induction of labour in women with a previous one caesarean section with an unfavourable cervix at term. METHOD: This study was conducted in the Department of Obstetrics and Gynaecology, J.N. Medical College, Aligarh, (U.P),India. Seventy women with singleton pregnancies at term, with previous one lower segment caesarean sections with a cephalic presentation and a Bishop's score of ≤ 6, who required induction at term were included in the study. Group A had 35 women in whom the transcervical Foley catheter was inserted and Group B included 35 women in whom the PGE2 gel was inserted vaginally for the induction of labour.The Bishop's score after 12 hours of induction, the oxytocin requirement, the induction to delivery interval, the mode of delivery, the maternal complications and the neonatal outcome were compared. RESULTS: The Foley catheter and the PGE2 gel had a comparable effect on the Bishop's score after 12 hours and the induction to the delivery interval was slightly shorter with the Foley catheter (18.15 hours) as compared to 21.06 hours with the PGE2 gel. There was no case of uterine rupture or scar dehiscence. CONCLUSION: In this study, both the modes of induction in women with previous one caesarean sections were safe, simple and effective. The main advantages of the cervical ripening with the Foley catheter over the Prostaglandin E2 gel are the low cost, reversibility and the lower risk of systemic and serious side effects like uterine hyperstimulation and rupture, as well as it induces a significant ripening and dilatation of the cervix and a shorter induction to the delivery interval. So, the cervical ripening effect of the Foley catheter is as good as that of the Prostaglandin E2 gel in women with previous one caesarean sections.

Mature embryoid teratoma in the wall of a mucinous cyst adenoma of ovary in multiparous female.

A collision tumour in ovary comprising a small ovoid embryoid mature teratoma in the surface wall of large mucinous cyst adenoma is reported in a 36-year-old female and its pathogenesis is discussed. The oval teratoid mass externally to the mucinous cyst lining did not show any columnar epithelial or mucin-secreting cyst. Findings suggested that the mature embryoid teratoma originated from ovarian germ cell rest in the surface wall of the cyst adenomatous neoplasm. Another possibility could be that the mature embryoid teratoma resulted from parthenogenesis of ovum together with the mucinous adenoma cysts by epithelial metaplasia of the follicular lining.

Chlamydia trachomatis infection in women with secondary infertility.

OBJECTIVE: To assess the role of Chlamydia in secondary infertility in a prospective study. DESIGN: Forty women with secondary infertility and 30 healthy term pregnant women of similar age composition were studied for past and present Chlamydia trachomatis infection. SETTING: Women attending the outpatient Department of Obstetrics and Gynaecology with complaint of secondary infertility were enrolled as patients in the study. PATIENT(S): Forty women with secondary infertility formed the study group, and 30 healthy women served as the controls. INTERVENTION(S): Chlamydia IgG was detected by ELISA; titers of 1:320 or more were considered positive. Endocervical swabs were collected for culture on cycloheximide-treated McCoy cell lines, and ELISA was used to detect Chlamydia antigen. Hysterosalpingography was performed to assess tubal patency. MAIN OUTCOME MEASURE(S): A difference was expected between the prevalence of C. trachomatis infection in the infertile study subjects and fertile control group. RESULT(S): Immunoglobulin G antibodies were present in 22 (55%) women with secondary infertility, whereas positivity was seen among 2 (5.5%) controls. Tubal occlusion occurred in 16 (63.6%) cases positive for chlamydial antibody. Sensitivity of chlamydial IgG antibody as a diagnostic marker for infertility was 72.7%, and specificity was 44.4%. The majority of Chlamydia IgG antibody-positive cases, 17 (77.2%), were symptomatic. Unfavorable obstetric history was found in 16 (72.7%) cases. Active infection was found in 12 (30%) cases with one (3.3%) case of current infection occurring in the controls. CONCLUSION(S): Prevalence of past chlamydial infection is strongly statistically significant in women with secondary infertility. Current infection was also found statistically significantly in these women. Immunoglobulin G antibody detection is an effective and noninvasive tool for detection of Chlamydia and a more viable option than HSG in a developing country such as India. Screening of women with secondary infertility for C. trachomatis is strongly recommended to allow early therapeutic interventions.

Potential of diallyl sulfide bearing pH-sensitive liposomes in chemoprevention against DMBA-induced skin papilloma.

Diallyl sulfide (DAS), an active component of garlic, possesses strong anti-neoplastic properties against various forms of cancer. In the present study, we have evaluated chemo-preventive effects of liposomized DAS (conventional egg PC and pH-sensitive liposomes) against DMBA-induced skin papilloma. Various liposome-based novel formulations of DAS (250 microg/mouse) were applied topically, after one hour of exposure to DMBA (52 microg/mouse/dose), to the animals. The animals were treated thrice weekly for the total period of 12 weeks. The efficacy of the various liposomal formulations of DAS was evaluated on the basis of parameters such as incidence of tumorogenesis and total numbers and sizes of induced tumor nodules. The liposomized DAS formulations also were assessed for their effect on the expression of p53wt, p53mut, and p21/Waf1. The results of the present study showed that liposomized DAS could effectively delay the onset of tumorogenesis and reduce the cumulative numbers and sizes of tumor papillomas in treated mice. Treatment of DMBA-exposed animals with the liposomal formulation of DAS ensued in upregulation of p53wt and p21/Waf1, while levels of p53mut expression reduced down. The promising chemo-preventive nature of liposomal DAS may form the basis for establishing effective means of controlling various forms of cancer, including skin papilloma.