Relação entre fatores de risco e lesão precursora do câncer do colo do útero em mulheres com e sem ectopia cervical / Relation between risk factors and cervical cancer precursor lesion in women with and without cervical ectopy

A ectopia cervical, uma condição fisiológica do organismo da mulher, pode favorecer infecções genitais, até mesmo pelo papilomavírus humano, que é o principal fator de risco envolvido na carcinogênese cervical. O objetivo deste estudo foi relacionar alguns fatores de risco para lesão precursora de câncer de colo de útero com resultados de exames citopatológicos de mulheres com e sem ectopia cervical. Foi realizado um estudoobservacional descritivo transversal com mulheres que realizaram exame de rotina em um consultório médico privado no município de São Borja, entre janeiro e junho de 2009. O estudo constou de exame clínico e exame citológico. Pelo exame citológico de Papanicolaou foi determinada a presença de lesões precursoras do câncer de colo deútero, e pela inspeção visual foi identificada a ectopia cervical. Das 57 mulheres, 29 apresentaram ectopia e 28 não apresentaram ectopia. Entre os resultados citológicos com células epiteliais atípicas, 10,7% (3/28) das mulheres sem ectopia e 17,1% (5/29)das mulheres com ectopia apresentaram células epiteliais atípicas. Quando foram relacionados os fatores de risco entre as mulheres com ectopia e sem ectopia, o uso de anticoncepção oral (p = 0,007) e o número de filhos (p = 0,021) estiveram associados com a ectopia cervical.

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 / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and differential diagnosis of lymphoma-like lesions and lymphoma of uterine cervix.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Improvement of cervical microenvironment after treatment of chronic cervicitis with focused ultrasound in infertility women / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of focused ultrasound (FUS) treatment on cervical microenvironment in infertility women with chronic cervicitis.</p><p><b>METHODS</b>A total of 10 women treated in Infertility Clinic of Obstetrics and Gynecology Hospital of College of Medicine of Zhejiang University were assessed. The women aged from 25 to 34 with normal menstrual cycles had moderate or severe cervical erosion. Ultrasound showed they had normal ovulation. The sperms of their husbands had normal motility and number. The FUS they received had a focal depth range of 4 - 6 mm, a resonant frequency of 9 - 11 MHz, and an output power of 3.5 W. The follow-up time was three months. The changes of cervical mucus and the results of postcoital test were evaluated. The clinical effects on cervical erosion and complications were also evaluated.</p><p><b>RESULT</b>In 6 cases of severe cervical erosion, 2 were cured, 2 were improved significantly (more than 50 % reduction of erosion area) and 2 were improved (less than 50 % reduction of erosion area). In 4 cases of moderate cervical erosion, 2 were cured, 2 were improved significantly. After the treatment, the median of cervical mucus score during LH peak were increased from 11 to 13 (Wilcoxon test, P=0.014). Postcoital test showed that the median of highly motile sperm (grade III and grade II) of 5 high-power field were increased from 22 to 52 (Wilcoxon test, P=0.015). Mild side effects without medical intervention included vaginal fluid in all 10 women, vaginal spotting in 2 women. No serious side effects were observed.</p><p><b>CONCLUSION</b>The focused ultrasound therapy can help to improve the cervical microenvironment for infertility women with moderate or severe cervical erosion without serious side effects.</p>

Recombinant human epithelial growth factor accelerates healing of cervical erosion / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of recombinant human epithelial growth factor (rhEGF) in promoting the healing of cervical erosion.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>rhEGF can obviously accelerate the healing of cervical erosion.</p>

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.

Lesöes cervicais näo cariosas: condutas clínicas / Non carious cervical lesions: clinical procedures

As lesöes cervicais näo cariosas constituem o grupo de lesöes de maior complexidade na prática clínica odontológica, principalmente no que se refere à identificaçäo do agente etiológico e ao tratamento proposto. Estas lesöes têm sido pesquisadas com maior interesse em decorrência da perda excessiva de tecido dentário na regiäo cervical (junçäo amelo-cementária) causar sensibilidade dentinária, problemas funcionais e/ou estéticos. A literatura as classifica em: erosäo, abrasäo, atriçäo e afraçäo. Este artigo apresenta uma revisäo da literatura a respeito das lesöes cervicais näo cariosas, com o objetivo de auxiliar o cirurgiäo dentista na identificaçäo e remoçäo dos agentes etiológicos envolvidos, recuperar a integridade funcional do elemento dentário por meio de procedimentos reabilitadores e prevenir o desenvolvimento de novas lesöes ou recidivas

Alteraciones bucales en pacientes con trastornos de alimentación / Oral alterations in patients with feeding disorders

El presente trabajo describe algunos procesos de etiología no bacteriana: abrasión, atrición y erosión que afectan la integridad de los tejidos dentarios relacionados con los trastornos de la alimentación. La erosión dental, patología que aparece como secuela frecuente en pacientes con vómitos autoinducidos, es definida y clasificada. Son enumeradas las manifestaciones bucales y las medidas para prevenir la progresión de la lesión. La presencia de signos dentarios de la enfermedad permite al odontólogo identificar una patología que muchas veces es ocultada por la paciente, cumpliendo un importante rol en el equipo terapéutico

Bleeding cervices: the microbial, cytologic, colposcopic and histopathologic evaluation.

This study was conducted to evaluate microbial, preneoplastic and neoplastic lesions and other risk factors associated with bleeding cervices and to determine the association between specific lower genital tract infections and cytologic, colposcopic and histopathologic findings in the same group of patients. Over a period of 3 years, 76 patients in sexually active reproductive age [18-48] with bleeding cervices were evaluated by microbiologic, cytologic, colposcopic and histopathologic examination. Current infection with Neisseria gonorrhoea, Chlamydia trachomatis and Trichomonas vaginalis and serologic evidence of past infection with herpes simplex virus type 2 [HSV-2] and C. trachomatis were tested

Erosión cervical y trauma oclusal / Cervical erosion and occlusal trauma

Durante largo tiempo se ha observado la aparición de erosiones cervicales en los dientes. Algunas de ellas es posible asociarlas a factores mecánicos, cepillado, o químicos, dieta ácida, pero otras se apartan, totalmente, de estos factores etiológicos. La literatura se refiere poco a este tipo de lesiones, y no se han realizado estudios para buscar otras etiologías. Sólo Lee y Eakle, 1983, asocian la aparición de estas lesiones con trauma oclusal, específicamente con fuerzas laterales que producen tensión durante la masticación y movimientos parafuncionales, ocasionando interrupción de las uniones químicas entre los prismas del esmalte. El resultado es una estructura dentaria más susceptible al trauma, abrasión y disolución química. El presente es un estudio piloto que busca una asociación causal entre las fuerzas tensoras producidas por el trauma oclusal y la aparición de lesiones cervicales.

Cervical erosions have been associated to multiple etiologic factors such as oral hygiene techniques, dietary, bulimic behavior, but some of them are different and cannot be related to those causes. Lee and Eakle (1983) associate cervical erosions to lateral forces fram occlusal trauma, creating tensile and compressive stresses, affecting enamel and dettin while peripheral enamel in dento enamel junction demostrated low tensile and high compressive stresses, dentin demostrated a reverse trend. The result is a tooth structure more susceptible to trauma, abrasion and acid dissolution.

Abnormal cervical lesions detected at a Colposcopy Clinic

A coloposcopy clinic was established in February 1988. An analysis of 300 cases seen at this clinic (over a 20 month period) is presented. The procedure consisted of taking a history, taking a cervical smear, perfoming colposcopy and colposcopy directed biopsy in the majority of cases (260 cases 86.67 per cent). The cases were referred for clinically suspicious cervices, abnormal bleeding per vaginam, abnormal cervical smears or self referral for check-up. The age of the patients ranged from 16 to 74 years, with the majority in the 35-44 age group (137 patients 45.67 per cent). The parity was from nulliparous to parity 14+2.37 of the patients were menopausal. Colposcopy could be satisfactorily performed in 286 patients. Most of the cases seen were colposcopically and histologically normal. Pathological lesions detected were squamous metaplasia (15), cervical intra epithelial neoplasis (14), coexistent cervical carcinoma and cervical intra-epithelial neoplasia (2) and inflammatory lesions (79).

Vaginal and cervical cytology in cervical eversion [cervical erosion] and suspicious cervix

This study was carried out on 200 non-pregnant women, with ages ranging from 18 up to 48 years. They attended the gynaecologic outpatient clinic, at Mansoura University Hospital. They include 150 women with cervical erorsion and suspicious cervix and 50 women with clinically healthy cervices as controls. A posterior vaginal pool and cervical scraps smears were obtained from each woman using the plastic spatula and stained by Papanicolaou stain. There was an increased incidence of dysplasia among parous women than nulliparous women. Also we found 3 cases of invasive carcinoma of the cervix among the suspicious cervix group and this was proved histopathologically. The chief complaint of cases with cervical erosion was excessive vaginal discharge [57%]. The incidence of dysplasia among cervical erosion groups was 34% [41 out of 120 cases], while the incidence in the suspicious cervix group 52% [14 out of 27 cases] no cases of dysplasia had been found in the control group. We can recommend that each woman during her reproductive period must be checked up by routine cervico-vaginal cytology every 6 months to detect and early lesion which could be easily dealt with as early as possible and abort it before it grows up

Effect of cervical erosion and the method of contraception on the incidence of cervical chlamydial infections

One hundred and fifty patients with cervicitis were divided equally into three groups. One group was using combined oral pills, the second were applying Lippes loops and the third were not using any contraceptive method. A cervical swab was taken from each patient and inoculated on tissue culture for detection of chlamydial infection. There were no statistical differences in chlamydial isolation rate between the three groups and between patients with and without cervical erosion