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.     

子宫内膜异位症并发不孕患者子宫内膜超微结构观察

目的：探讨子宫内膜异位症（EM）并发不孕患者围着床期子宫内膜的超微结构。方法：选择轻度子宫内膜异位症并不孕患者10例为研究组，已生育妇女7例作为对照组，选择在月经周期第19－22天刮取少量子宫内膜，进行扫描及透射电镜观察。结果：异位症患者围着床期子宫内膜出现超微结构改变，内膜表面腺体开口数少，纤毛再生不全，分泌细胞表面微绒毛极少，子宫内膜着床窗的形态学标记－细胞表面胞饮小泡减少 或缺失；胞质肿胀疏松，有的细胞出现核固醇，结论：异位症患者围着床期在位子宫内膜出现超微结构改变，细胞出现轻度变性，可能是其不孕的原因之一。     

第2代(温控)射频消融子宫内膜切除术

目的探讨第2代（温度控制）射频消融子宫内膜切除术的疗效、安全性和可行性。方法2004年9月-2006年2月由上海市4家医院联合开展一项多中心、前瞻性研究,完成功能性子宫出血温控射频消融子宫内膜切除术81例。在超声监护下,射频治疗以温度控制模式输出功率50 W、温度设定85℃,按照两侧宫角、宫底、宫体、下段部位顺序射频消融子宫内膜。每个治疗点治疗时间为4 min。结果81例术后随访4-17个月。术后6个月随访70例,其中闭经48.6%（34/70）,点滴状月经41.4%（29/70）,少量月经10%（7/70）,总有效率为100%（70/70）。术后12个月随访67例,其中闭经56.7%（38/67）,点滴状月经29.9%（20/67例）,少量月经9.0%（6/67）,正常月经量3.0%（2/67）,月经量过多1.5%（1/67）,总有效率98.5%（66/67）。结论温控射频消融子宫内膜切除术不仅使患者的异常子宫出血在保留子宫的情况下得到有效的治疗,同时具有操作方便、治疗时间短、并发症少、术后恢复快等特点。     

雌性大鼠、小鼠生殖系统与人子宫内膜甾体激素分泌细胞的研究

对雌性大鼠、小鼠的生殖系统,人的子宫内膜与蜕膜进行了3-β-羟基甾体脱氢酶(3-β-HSDH)和脂类的组织化学研究。结果表明:在大鼠和小鼠的卵巢内,颗粒黄体细胞和膜黄体细胞3-β-HSDH呈强阳性反应,卵泡膜内层细胞与间质细胞呈中等程度阳性反应;大鼠与小鼠子宫内膜的表面上皮与腺上皮呈阳性反应;人早孕期蜕膜中的子宫腺上皮细胞与大蜕膜细胞呈阳性反应:在大鼠与小鼠的输卵中偶尔见到阳性反应物质;在人的子宫内膜中,没有见到阳性反应。本研究证明,雌性大鼠和小鼠除卵巢有分泌甾体素的功能外,子宫也有分泌甾体激素的功能。人早孕期蜕膜组织中的子宫腺与大蜕膜细胞都能分泌甾体激素。     

Saline infusion sonohysterography: technique, indications, and imaging findings.

OBJECTIVE: To review the technique, indications, and common imaging findings regarding saline infusion sonohysterography. METHODS: The literature on saline infusion sonohysterography was reviewed. Pertinent images from our institution are presented to illustrate common imaging findings. RESULTS: From the literature review, we summarize the various clinical scenarios in which saline infusion sonohysterography is useful and give examples from our clinical practice. CONCLUSIONS: Saline infusion sonohysterography is a useful procedure for evaluation of endometrial and subendometrial abnormalities.     

子宫内膜癌术前放疗对Bcl-2,bax表达的影响

目的探讨Bcl-2，bax与子宫内膜癌的相关性及术前放疗对其表达影响。方法从2002年10月-2006年10月在我科住院的子宫内膜癌患者中筛选符合纳入标准的病例50倒。取其刮宫内膜癌组织标本、放疗且术后内膜癌标本。分为放疗前组、放疗后组，采用免疫组织化学方法检测Bcl-2，bax的表达，并观察表达的变化。结果BcL-2表达放疗后（64．0％）较放疗前（82．0％）减弱，差异有显著性（P〈0．01）；bax蛋白表达放疗后（76．0％）较放疗前（62．0％）增强，差异有显著性（P〈0．01），结论①子宫内膜癌的发生过程中与癌基因及抑癌基因Bcl-2,bax有密切的关系。②子宫内膜癌患者放疗前后癌组织中Bcl-2，bax表达水平发生了明显的改变，放射治疗可能是通过诱导细胞凋亡起到抗肿瘤作用的。③子宫内膜癌为放射敏感性肿瘤。     

Effect of exogenous progesterone administration on the morphology of normally developing endometrium in the pre-implantation period

The effects on endometrial morphology of a single, intramuscular dose of 100 mg of progesterone administered in the early luteal phase, between days LH + 1 and LH + 6, were studied in a group (n = 8) of normal, fertile subjects by morphometric techniques and transmission electron microscopy. While the dose of progesterone administered consistently resulted in an increase of salivary progesterone concentration to above the upper limit of the reference range, no significant effect on endometrial development was observed; in particular, endometrial development was not advanced.     

上皮型钙黏蛋白在子宫内膜癌中的表达

目的　探讨上皮型钙粘蛋白 (E cadherin ,E cad)在子宫内膜癌中的表达意义。方法　采用免疫组织化学方法检测 16例子宫内膜癌及 10例子宫肌瘤、卵巢囊肿患者 (对照组 )的E cad表达。结果　子宫内膜癌患者的E cad表达阳性率较对照组显著增高 (P <0 .0 5 )。子宫内膜癌E cad表达水平 :①与临床分期相关 ,临床早期表达显著高于晚期 (P <0 .0 5 ) ;②与肿瘤细胞分化程度相关 ,分化越差 ,表达越低 (P <0 .0 5 ) ;③与子宫肌层浸润深度成反比 ,浸润肌层越深表达越低 (P <0 .0 5 )。结论　E cad在子宫内膜癌的侵袭转移中发挥重要的作用 ,它的丢失是癌细胞发生侵袭性生长过程中的关键环节