Pharmacodynamics of combined estrogen–progestin oral contraceptives: 4. Effects on uterine and cervical epithelia

ABSTRACT

Introduction: Steroid hormones are responsible for specific changes in the endometrium during the menstrual cycle, when they are sequentially secreted and, because of this, in the early days sequential combined oral contraceptive regimens were utilized. The same basic concept has been utilized with multi-phasic regimens, in order to produce endometrial pictures mimicking the normal cycle.

Areas covered: The Endometrial effects of progestins and estrogens; combined monophasic high- (50 μg), medium- (30 μg), low- (20 μg), ultralow- (15 μg) estrogen content; sequential regimens; multiphasic combinations; treatment schedules.

Cervical effects of combined high-dose and sequential combinations, including evidence for an increase in malignant lesions.

Expert opinion: Overall, combined oral contraceptives (COCs) inhibit normal proliferative changes and the endometrium becomes thin, narrow, with widely spaced glands and pre-decidual changes in the stroma. During the first few cycles the progestin induces a coexistence of proliferative and secretory features; with time, the picture changes because the progestin induces a down-regulation of estrogen receptors, resulting in tortuous glands similar to those in the secretory phase, but characterized by a quiescent, atrophic glandular epithelium.

In the cervical epithelium, under the influence of high-dose COCs, endocervical glands became hypersecretory and in some instances, distinctive type of atypical polypoid endocervical hyperplasia is found.     

Principles of chemotherapy and radiotherapy

The current management of all gynaecological malignancy requires complex multidisciplinary investigation and discussion, leading to multi-modality treatment. The delivery of systemic therapy or radiotherapy can have different aims depending on the type of cancer, clinical context and patient wishes. This review explores the systemic treatment options and radiotherapy that form part of the standard management of this group of tumours and looks at current research that may help shape the treatment of the future.     

人乳头瘤病毒在宫颈癌前病变诊断中的意义

目的用人乳头瘤病毒杂交捕获法（hc2 HPV DNA）监测宫颈癌前病变，提高诊断率。方法hc2 HPV DNA和TCT两种方法并用检测1231例宫颈外口及颈管脱落细胞。结果1231例样本中，HPV感染率34．0％，而21～40岁年龄段略高于其他年龄段；宫颈鳞状上皮正常HPV感染率23．2％。在细胞学诊断为ASC-us、ASC-h、LSIL和HSIL组中，HPV感染率依次为50．0％、58．8％、76．7％和93．3％。TCT检测：正常＋炎症1077例；asc-us 32例；ASC-h 34例；LSIL 73例，HSIL 15例。ASC-us、ASC-h、LSIL和HSIL检出率分别为2．6％、2．8％、5．9％和1．2％。统计学检验表明：HPV感染与细胞形态和结构的异常具有高度相关性（P〈0．01）。结论在宫颈鳞状上皮正常时HPV感染率最低，重度炎症时HPV感染率出现增高的趋势；当细胞形态和结构出现异常时，HPV的感染率明显增加，即HSIL〉15IL〉ASC-h〉ASC-us〉正常＋炎症。     

子宫颈上皮不典型增生与宫颈癌细胞超微结构的观察比较

光镜和电镜观察慢性宫颈炎上皮不典型增生42例,宫颈癌21例,正常对照7例。上皮不典型增生之一是位于深部的储备细胞增生,细胞的核质比大,细胞器少,分化较低。鳞状上皮不典型增生细胞特点是核质比增大,核形不整,核膜内陷,细胞器增多,桥粒和张力原纤维减少。鳞癌细胞的核质比更大,核膜内褶深,细胞器更多,桥粒和张力原纤维很少或消失,分化低的癌细胞尤明显。粘液性腺癌腺上皮深部可见储备细胞转化的癌细胞。     

Sexual risk behavior in women with cervical human papillomavirus infection

In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad, oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI, i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI shows most of the epidemiological characteristics of a sexually transmitted disease.     

螺旋藻多糖对人宫颈癌Hela细胞体外生长的影响

目的：探讨螺旋藻多糖（PSP）对体外培养的Hela细胞生长的影响。方法：采用MTT法测定 PSP的抗肿瘤活性，并观察其对Hela细胞形态学的影响。结果：随PSP浓度的升高，Hela细胞存活率逐渐降低，抑制率逐渐增加；光镜下观察显示，PSP作用24-48h后，细胞出现明显的形态学改变。结论：PSP能抑制Hela细胞增殖。     

腹壁下动脉插管化疗在子宫颈及阴道恶性肿瘤的应用

我科6年中对子宫颈及阴道恶性肿瘤施行腹壁下动脉插管化疗共34例,作为配合放疗及争取手术的综合疗法之一,提高晚期宫颈癌的放疗效果,对Ⅱ期早宫颈癌施行根治术者6例,但对腺癌、肉瘤及恶性黑色素瘤等效果差。     

宫颈癌细胞中DAPK1基因CpG岛甲基化及其表达

目的 :探讨宫颈癌细胞中凋亡相关蛋白激酶 1(DAPK1 )基因CpG岛甲基化及其表达与宫颈癌的相关性 .方法 :应用甲基化特异性PCR和SABC免疫组化方法 ,检测 32(鳞癌 1 8,腺癌 1 4 )例宫颈癌组织DAPK1基因CpG岛甲基化修饰及蛋白表达 .结果 :宫颈癌中DAPK1基因甲基化扩增阳性率明显增高 5 6 .3% ,与正常宫颈比较有显著性差异 (P <0 .0 5 ) ,鳞癌与腺癌甲基化扩增阳性率无显著差异 (P >0 .0 5 ) ;宫颈癌中DAPK1蛋白表达阳性率降低 1 5 .6 3% ,与正常宫颈比较有显著性差异 (P <0 .0 5 ) ,鳞癌和 7例与腺癌无显著性差异 (P >0 .0 5 ) .结论 :DAPK1基因CpG岛异常甲基化修饰能抑制DAPK1的转录 ,使DAPK1蛋白不表达 ,丧失抑癌作用 ,是促进正常宫颈上皮细胞癌变的一个重要因素     

子宫颈癌手术前放疗28例临床分析

我院１９８９年至１９９４年共行子宫颈癌广泛切除术和盆腔淋巴结清扫术３９例，其中２８例行术前放射治疗，１９例临床诊断为Ⅱｂ，随着手术技术的提高和术前放射治疗的配合，子宫颈癌的手术适应症的选择，可以扩大至Ⅱｂ，不增加手术的并发症，并具有一定的优点。