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Aim To determine whether dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) quantitative parameters increase the detectability of MRI-invisible residual cervical cancer after conisation. Materials and methods This retrospective study included 59 patients with MRI-invisible cervical cancer, but positive conisation pathology. Thirty-five patients were confirmed to have residual cervical cancer, and 24 patients showed non-residual cervical cancer. DCE-MRI quantitative parameters were calculated in the anterior or posterior cervix according to the conisation position. Receiver operating characteristic (ROC) analysis was used to find the threshold of DCE-MRI parameters in differentiate residual cervical cancer patients from non-residual cervical cancer patients after conisation. Results For patients with residual cervical cancer, the Ktrans and Ve values were significantly higher than in their counterparts with non-residual cervical cancer (0.610±0.395 versus 0.366±0.305/min, p=0.013; and 0.703±0.270 versus 0.540±0.280%, p=0.028; respectively). The Ktrans showed the highest area under the ROC curve (AUC) of 0.705 (p=0.004) with a sensitivity of 67.6% and specificity of 68%. Conclusion DCE-MRI quantitative parameters increased the detectability of MRI-invisible residual cervical cancer after conisation.

Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera. Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated. Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p

Objectives To explore spatial variability within the cervix and the sensitivity of shear wave speed (SWS) to assess softness/stiffness differences in ripened (softened) vs unripened tissue. Methods We obtained SWS estimates from hysterectomy specimens (n = 22), a subset of which were ripened (n = 13). Multiple measurements were made longitudinally along the cervical canal on both the anterior and posterior sides of the cervix. Statistical tests of differences in the proximal vs distal, anterior vs posterior and ripened vs unripened cervix were performed with individual two-sample t-tests and a linear mixed model. Results Estimates of SWS increase monotonically from distal to proximal longitudinally along the cervix, they vary in the anterior compared to the posterior cervix and they are significantly different in ripened vs unripened cervical tissue. Specifically, the mid position SWS estimates for the unripened group were 3.45 ± 0.95 m/s (anterior; mean ± SD) and 3.56 ± 0.92 m/s (posterior), and 2.11 ± 0.45 m/s (anterior) and 2.68 ± 0.57 m/s (posterior) for the ripened group (P

Video Objective The purpose of the video is to describe the surgical technique involved in performing laparoscopic mesh sacrohysteropexy. A brief review of the outcomes from a 10 year retrospective single centre cohort study will be discussed. Setting Laparoscopic mesh sacrohysteropexy is a uterine conserving surgical technique for the management of apical vaginal prolapse. Interventions Laparoscopic mesh sacrohysteropexy involves fixing non-absorbable mesh from the posterior cervix to the sacral promontory. This is then covered with peritoneum from the para-rectal space. Conclusion A ten year retrospective cohort study has demonstrated success in 86% of patients with no further vaginal surgery required during the follow up period. This technique is useful for women wishing uterine preservation or for women who would be unable to tolerate a longer procedure such as a laparoscopic hysterectomy and sacrocolpopexy.

Purpose To assess changes to the brachytherapy target over the course of treatment and the impact of these changes on planning and resources. Methods and Materials Patients undergoing curative treatment with radiotherapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were positioned in the uterine canal while patients were under anesthesia. Images were obtained by MRI and ultrasound at Fraction 1 and ultrasound alone at Fractions 2, 3, and 4. Cervix and uterine dimensions were measured on MRI and ultrasound and compared using Bland–Altman plots and repeated measures one-way analysis of variance. Results Of 192 patients who underwent three fractions of brachytherapy, 141 of them received four fractions. Mean differences and standard error of differences between MRI at Fraction 1 and ultrasound at Fraction 4 for anterior cervix measurements were 2.9 (0.31), 3.5 (0.25), and 4.2 (0.27) mm and for posterior cervix 0.8 (0.3), 0.3 (0.3), and 0.9 (0.3) mm. All differences were within clinically acceptable limits. The mean differences in the cervix over the course of brachytherapy were less than 1 mm at all measurement points on the posterior surface. Replanning occurred in 11 of 192 (5.7%) patients, although changes to the cervix dimensions were not outside clinical limits. Conclusions There were small changes to the cervix and uterus over the course of brachytherapy that were not clinically significant. Use of intraoperative ultrasound as a verification aid accurately assesses the target at each insertion, reduces uncertainties in treatment delivery, and improves efficiency of the procedure benefiting both the patient and staff.

The ligamentous mesometrium is a 3-dimensional structure consisting of a rectouterine/-vaginal part with attachment to the anterior lateral mesorectum and a sacrouterine part surrounding the mesorectum attached to the pelvic fascia and the mesorectum dorsolaterally. The lymphatic network draining the posterior cervix connected caudally ventrally to the deep venous lymph network of the vascular mesometrium is running at the lateral surface of the sacrouterine part and dorsomedially of the inferior hypogastric plexus; it drains to the deep internal iliac, prespinal and preischiadic nodes. OA gold

A case is described where a live baby chooses to come out, tearing apart the posterior cervix as a result of effective uterine contractions in association with closed external cervical os in a prostaglandin E2 induced, postdated pregnancy in a primigravida with neonatal survival. DOI: http://dx.doi.org/10.3126/njog.v3i2.10835 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 57-58

Objective Our aim was to figure out whether volumetric gray-scale histogram difference between anterior and posterior cervix can indicate the extent of cervical consistency. Methods We collected data of 95 patients who were appropriate for vaginal delivery with 36th to 37th weeks of gestational age from September 2010 to October 2011 in the Department of Obstetrics and Gynecology, Korea University Ansan Hospital. Patients were excluded who had one of the followings: Cesarean section, labor induction, premature rupture of membrane. Thirty-four patients were finally enrolled. The patients underwent evaluation of the cervix through Bishop score, cervical length, cervical volume, three-dimensional (3D) cervical volumetric gray-scale histogram. The interval days from the cervix evaluation to the delivery day were counted. We compared to 3D cervical volumetric gray-scale histogram, Bishop score, cervical length, cervical volume with interval days from the evaluation of the cervix to the delivery. Results Gray-scale histogram difference between anterior and posterior cervix was significantly correlated to days to delivery. Its correlation coefficient (R) was 0.500 (P = 0.003). The cervical length was significantly related to the days to delivery. The correlation coefficient (R) and P-value between them were 0.421 and 0.013. However, anterior lip histogram, posterior lip histogram, total cervical volume, Bishop score were not associated with days to delivery (P >0.05). Conclusion By using gray-scale histogram difference between anterior and posterior cervix and cervical length correlated with the days to delivery. These methods can be utilized to better help predict a cervical consistency.

A number of experiments with diluents, cryoprotective agents, dilution rate, equihbration time, and freezing techniques have resulted in freezing methods for ram semen giving fairly good post-thaw sperm survival (9). Despite the acceptabIe post-thaw sperm survival in vitro, frozen-thawed semen usuaIIy yields an unsatisfactory conception rate when inseminated into the posterior cervix, In general, the conception rate appears to be at least 20% Iower than with fresh semen. There are, however, examples in which frozen semen, under ideal conditions, results in a normal conception rate (4). It should be pointed out that in Colas’ study, the insemination dose was high (400 x 10e) and that double inseminations 12 hr apart were used. Thus, only three to five ewes could be inseminated with one ejaculate-a very low efficiency. In this context, it is worthwhile to emphasize that sheep insemination also faces certain problems with fresh semen: Fertility is retained for a rather short storage time (9) and a fairly Iarge number of spermatozoa per insemination dose (100 x 10G) is required. This is about 10 times more than needed to achieve normal ferti,lity in cattle, Intrauterine versus cervical insemination. It has been known for at least 10 years that

Summary A study of the comparative efficiency of intracervical and intrauterine semen deposition in inseminations with dairy cattle was made. Percentage non-returns were significantly higher with the intrauterine method on total services and repeat breedings. The difference on first services was not significant. With semen 24 to 36 hr. old, the intrauterine method showed a significant difference of 13.1 per cent greater non-returns for cows inseminated under field conditions. Intracervical percentage non-returns were significantly lower with semen used 24 to 36 hr. after collection than with semen used within 12 hr. after collection; with intrauterine insemination the decrease was not significant. The data indicate that as a general insemination technique intrauterine breeding gives better results than deposition of semen in the posterior cervix, via the speculum.