Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging

ObjectiveThe aims of the present study were to assess the role of magnetic resonance imaging (MRI) in the staging and follow-up of uterine cervical cancers discovered during pregnancy and to evaluate the role of MRI in decision making regarding treatment options for patients with uterine cervical cancer during pregnancy.MethodTwelve pregnant women with cervical cancer were included. Two populations of patients were distinguished: localized cervical cancer discovered on the Pap smear during the first trimester of pregnancy, at an early stage (n=5), and invasive cervical cancer revealed later, during the second or third trimester (n=7). Abdominal and pelvic MRI sequences were acquired with a phased-array coil. Magnetic resonance results were correlated with the physical examination, Pap smear, and pathology.ResultsIn the first population, MRI was normal or detected a small lesion (stage IB1), and pregnancies were allowed to continue. In the second population, MRI detected a lesion in every case (mean size, 62 mm; 30–110 mm), and positive lymph nodes were depicted in 2 cases. The pregnancy was interrupted in four patients: one interruption in localized cervical cancer group and three in invasive cervical group). In all other cases, a cesarean section was done after the 30th week. In one case, MRI assessed response after chemotherapy administered during pregnancy.ConclusionMRI is an essential examination for planning the treatment of cervical cancers diagnosed during pregnancy.     

Spinal motor neurite outgrowth over glial scar inhibitors is enhanced by coculture with bone marrow stromal cells

Background contextTransplantation of bone marrow cells into spinal cord lesions promotes functional recovery in animal models, and recent clinical trials suggest possible recovery also in humans. The mechanisms responsible for these improvements are still unclear.PurposeTo characterize spinal cord motor neurite interactions with human bone marrow stromal cells (MSCs) in an in vitro model of spinal cord injury (SCI).Study design/settingPreviously, we have reported that human MSCs promote the growth of extending sensory neurites from dorsal root ganglia (DRG), in the presence of some of the molecules present in the glial scar, which are attributed with inhibiting axonal regeneration after SCI. We have adapted and optimized this system replacing the DRG with a spinal cord culture to produce a central nervous system (CNS) model, which is more relevant to the SCI situation.MethodsWe have developed and characterized a novel spinal cord culture system. Human MSCs were cocultured with spinal motor neurites in substrate choice assays containing glial scar–associated inhibitors of nerve growth. In separate experiments, MSC-conditioned media were analyzed and added to spinal motor neurites in substrate choice assays.ResultsAs has been reported previously with DRG, substrate-bound neurocan and Nogo-A repelled spinal neuronal adhesion and neurite outgrowth, but these inhibitory effects were abrogated in MSC/spinal cord cocultures. However, unlike DRG, spinal neuronal bodies and neurites showed no inhibition to substrates of myelin-associated glycoprotein. In addition, the MSC secretome contained numerous neurotrophic factors that stimulated spinal neurite outgrowth, but these were not sufficient stimuli to promote spinal neurite extension over inhibitory concentrations of neurocan or Nogo-A.ConclusionsThese findings provide novel insight into how MSC transplantation may promote regeneration and functional recovery in animal models of SCI and in the clinic, especially in the chronic situation in which glial scars (and associated neural inhibitors) are well established. In addition, we have confirmed that this CNS model predominantly comprises motor neurons via immunocytochemical characterization. We hope that this model may be used in future research to test various other potential interventions for spinal injury or disease states.     

Bilateral symmetrical branch retinal artery occlusions.

We present a report of a 52-year-old hypertensive patient with documented bilateral symmetrical branch retinal artery occlusions involving the maculae. The patient presented with no visual symptoms and maintained 6/5 unaided visual acuity in each eye. Although the incidence of retinal artery occlusion in hypertensive patients is well documented, symmetrical bilateral branch retinal artery occlusions suggest a possible anatomical vascular predisposition.     

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Crushed Dreams