Congenital cervical atresia: Report of seven cases and review of the literature

OBJECTIVE: Our aim was to evaluate the clinical course and management of congenital cervical atresia. STUDY DESIGN: This retrospective analysis included 7 patients referred to our clinic and a review of the medical literature. RESULTS: Including this case series, 58 cases of congenital cervical atresia have been reported in the literature. Forty-eight percent of patients had isolated congenital cervical atresia with a normal vagina whereas the remainder had either complete or partial vaginal atresia (“shortened blind vaginal pouches”). Surgical management has included abdominal hysterectomy or uterovaginal cannulation with or without vaginoplasty. In 59% of patients who underwent uterovaginal canalization procedures (23/39), normal menstrual bleeding was achieved. Four of these patients subsequently became pregnant and were delivered at term. CONCLUSION: Surgical canalization in selected patients with congenital cervical atresia can be successfully performed to provide patients an opportunity for conservative management, resulting in normal menstrual bleeding, resolution of cyclic pelvic pain, and some potential (albeit limited) for fertility.(Am J Obstet Gynecol 1997;177:25)     

Patterns of angiogenesis in neural transplant models: I. Autonomic tissue transplants

Functional vascular connections must form rapidly to prevent ischemic damage to grafted neural tissues. The temporal sequence by which transplant circulation is re-established provides information about the angiogenic capacity of either intact or damaged CNS blood vessels. This study compares the time course and mechanism of vascular reperfusion in allografts of superior cervical ganglia or adrenal medulla inserted either into the fourth ventricle or directly into the parietal cortex of perinatal rats. Tritiated thymidine was administered to recipients to determine angiogenic patterns at various postoperative time periods. After processing for light microscopic autoradiography, host and graft endothelial labelling indices were determined in order to establish the temporal sequence and location of vascular proliferation. Correlative electron microscopy depicted the morphological changes in transplant vasculature. Some recipients were prelabelled with 3H thymidine prior to transplantation to determine if host vessels invaded the grafts. Intraventricular graft vessels initially collapsed but sustained minimal ischemic damage and were completely reperfused by 24 hours postoperative. Adjacent intact host vessels attained peak 3H thymidine incorporation at 20 hours. Intrinsic graft vessels were radioactively labelled only after 48 hours. Intraparenchymal transplants surrounded by minimal trauma exhibited a similar temporal sequence of reperfusion and host endothelial proliferation. Intrinsic graft vessels in intraparenchymal grafts sustained more severe damage. With increased trauma, a concomitant delay in graft reperfusion time was observed. Grafts within prelabelled hosts rarely contained any labelled endothelium, indicating that anastomotic connections were made between original, intrinsic graft vessels and nearby host vascular sprouts. This study demonstrates that mature autonomic tissue stimulates the growth of adjacent host vessels when transplanted to undamaged brain surfaces. The anastomosis of nascent host vessels with pre-existing graft vessels is responsible for the rapid re-establishment of circulation within the transplants. A similar mechanism occurs within intraparenchymal grafts, although the rapidity of reperfusion appears to be predicated on the amount of trauma present at the graft site.     

Pregnancy: Oral misoprostol versus placebo for cervical dilatation before vacuum aspiration in first trimester pregnancy

Intravaginal misoprostol has been shown to be effective forcervical priming before a surgically induced abortion. The objectivewas to investigate the effectiveness of oral misoprostol incervical dilatation prior to vacuum aspiration between the 6thand 12th weeks of pregnancy. The results showed that in nulliparouspatients, the median cervical dilatation in the treatment group(7.8 mm) was significantly greater than that in the placebogroup (3.7 mm). In multiparous patients, the difference wasalso statistically significant (9.8 versus 6.0 mm). The easeof dilatation, assessed subjectively by the operating surgeons,was significantly improved in the treatment group. There wasalso a significant reduction in the duration of the operationand in the mean blood loss in the treatment group. The side-effectsencountered in the treatment group were mild and well acceptedby the women. Oral misoprostol is an effective and safe methodfor cervical dilatation prior to vacuum aspiration in firsttrimester pregnancy.     

以循证医学的理念观察颈椎综合征的MRI图像

目的鉴于MRI对组织的高分辨性能,利用该图像观察颈椎综合征患者的椎管外组织的病理状况.方法54例患者,其中男30例,女24例,分为2组.观察组44例颈椎综合征患者,对照组10例颈部外伤和三叉神经痛患者.通过常规的MRI矢状位及横轴位颈椎图像,比较两组软组织增生情况.结果与结论在颈椎综合征MRI的颈椎及上段胸椎棘突后侧,均可观察到不同程度的慢性纤维性变化,与对照组比较,有可比性.提示临床上颈椎综合征多与颈肩区筋膜炎、棘突炎相关,属于无菌性炎症,其慢性阶段,局部发生了纤维增生性改变.建议在观察分析此种病症的颈椎骨质及椎间盘改变的同时,宜重视棘突后侧的纤维性变化,有利于病理病因的研究.     

Fetal cervical hyperextension in arthrogryposis

Perhaps the most dramatic position of a newborn after delivery is when there is hyperextension of the neck and spine. It will have been presented in utero and today, almost always, such babies will have been delivered by C‐section. The associated anomalies are variable. The process(es) that can lead to cervical hyperextension is/are largely unknown. The outcome is variable from lethal to completely resolve. Individuals with arthrogryposis and in particular with Amyoplasia appear to have an increased frequency of neck, cervical, and spine hyperextension at birth. We present here 41 cases of arthrogryposis (mainly Amyoplasia) with fetal cervical hyperextension. The outlook is surprisingly good if spinal cord trauma does not occur. Ultrasound late in pregnancy when arthrogryposis is recognized prenatally should determine whether cervical hyperextension has developed, so that appropriate preventive measures can be taken.     

Biochemical and morphological characterization of sympathetic neurons grown in a chemically-defined medium

Previous studies have demonstrated that individual neurons from neonatal rat superior cervical ganglion express a mixed adrenergic-cholinergic phenotype when grown under certain tissue culture conditions.^{9,14,15,29,30} The expression of this phenotype is critically influenced by a number of undefined components present in the culture medium.^18,23,33 In the present study, we have examined whether superior cervical ganglion neurons grown on a chemically defined serum-free medium similarly develop dual transmitter expression, or if under these conditions, neurons express only those properties characteristic of their adrenergic heritage. To address this issue, we established that superior cervical ganglion neurons could be maintained in culture for extended periods on the defined medium described by Bottenstein & Sato⁴ in the absence of supporting cells. We then studied the biochemical, immunocytochemical and ultrastructural characteristics of these neurons. We found that in defined medium, superior cervical ganglion neurons continued to express, in a modified form, certain of their expected adrenergic properties, including the development of tyrosine hydroxylase and dopamine-β-hydroxylase activities, stores of endogenous norepinephrine, synaptic vesicles with dense cores and tyrosine hydroxy lase-immunoreactive staining properties. Superior cervical ganglion neurons grown on a defined medium did not, however, acquire cholinergic traits in culture. In this paper we show that choline acetyltransferase activity did not reach detectable levels; the companion paper¹³ documents that cholinergic synapses were not formed.We conclude that superior cervical ganglion neurons, grown under serum-free culture conditions, develop certain properties characteristic of adrenergic neurons and do not express a mixed adrenergic cholinergic phenotype. A companion paper¹³ describes the electrophysiological properties of these neurons and demonstrates the frequent occurrence of electrotonic synapses in these cultures.     

Intraepithelial neoplasia, human papilloma virus infection and argyrophilic nucleoprotein in cervical epithelium

A silver colloid technique was applied to 50 colposcopic biopsies of cervix. These comprised nine cases of wart virus infection of the cervix, 11 cases of cervical intraepithelial neoplasia (CIN) I, nine cases of CIN II, eight cases of CIN III, seven normal biopsies and six cases showing only incomplete squamous metaplasia. The mean numbers of argyrophilic nucleolar organizer regions (AgNORS) increased from CIN I to CIN III. Statistically significant differences for AgNORs were found in comparisons between CIN III, normal basal cells, human papilloma virus-infected basal cells and incomplete squamous metaplasia, and in comparisons between normal basal cells and human papilloma virus-infected basal cells. CIN III could be distinguished from incomplete squamous metaplasia and from basal cells and from human papilloma virus-infected basal cells. The latter could be distinguished from normal basal cells on the basis of their AgNORs. It is suggested that this simple technique is diagnostically useful and has considerable clinicopathological potential in cervical pathology and cytology.     

Metastatic prostatic carcinoma presenting as left-sided cervical lymphadenopathy: a series of 11 cases

Eleven cases of metastatic prostatic carcinoma in cervical lymph nodes as a primary presenting sign were identified in a survey of 250 cervical lymph node biopsies from men. The diagnosis was clinically unsuspected in all cases. All occurred on the left side of the neck. These 11 cases represented 11% of all metastatic carcinomas in the neck and 20% of those with left-sided involvement. The diagnosis was readily confirmed by immunostaining for prostate specific antigen and prostate specific acid phosphatase. Six patients are alive and well at an average of 25.8 months and five others survived for an average of 34.4 months, the combined survival being 29.7 months. This contrasts with the dismal fate of patients with metastatic adenocarcinoma from other sites who all died at an average of 2 months from diagnosis. Prostatic carcinoma should always be considered in the differential diagnosis of metastatic carcinoma in cervical lymph nodes in elderly men, as appropriate treatment results in worthwhile prolongation of life.     

Sensory and autonomic innervation of the rat eyelid: Neuronal origins and peptide phenotypes

Neuronal origins, peptide phenotypes and target distributions were determined for sensory and autonomic nerves projecting to the eyelid. The retrograde tracer, Fluoro-Ruby, was injected into the superior tarsal muscle and meibomian gland of Sprague-Dawley rats. Labelled neurons were observed within the pterygopalatine (31 ± 6 of a total of 8238 ± 1610 ganglion neurons), trigeminal (173 ± 43 of 62 082 ± 5869) and superior cervical ganglia (184 ± 35 of 21 900 ± 1741). Immunostaining revealed vasoactive intestinal polypeptide immunoreactivity (VIP-ir) in nearly all Fluoro-Ruby-labelled pterygopalatine ganglion neurons (86 ± 5%) but only rarely in trigeminal (0.3 ± 0.3%) or superior cervical (1.4 ± 1.4%) ganglion neurons. Calcitonin gene-related peptide (CGRP)-ir was not observed in pterygopalatine or superior cervical ganglion somata, but was present in 24 ± 4% of trigeminal neurons. Bright dopamine β-hydroxylase (DBH) immunofluorescence was observed in the majority of eyelid-projecting neurons within the superior cervical ganglia (65 ± 5%) and lighter staining was detected in pterygopalatine neurons (63 ± 3%), but no DBH-ir was observed in trigeminal neurons. Examination of eyelid sections revealed dense VIP-ir innervation of meibomian gland acini and vasculature and modest distribution within tarsal muscle. CGRP-ir fibers surrounded ductal and vascular elements of the meibomian gland and the perimeter of tarsal muscle. DBH-ir fibers were associated with meibomian gland blood vessels and acini, and were more densely distributed within tarsal muscle. This study provides evidence for prominent meibomian gland innervation by parasympathetic pterygopalatine ganglion VIP-ir neurons, with more restricted innervation by sensory trigeminal CGRP-ir and sympathetic neurons. Tarsal muscle receives abundant sympathetic innervation, as well as moderate parasympathetic and sensory CGRP-ir projections. The eyelid contains substantial non-CGRP-ir sensory innervation, the targets of which remain undetermined. The distribution of identified autonomic and sensory fibers is consistent with the idea that meibomian gland function, as well as that of the tarsal muscle, is regulated by peripheral innervation.