Osama Shawki

The possible role of cell cycle regulators in multistep process of HPV-associated cervical carcinoma

BackgroundHuman papillomavirus (HPV) 16 and 18 are associated with cervical carcinogenesis through an interaction between HPV oncogenic proteins and cell cycle regulatory genes. However, the exact pathogenetic mechanisms are not determined yet.MethodsWe investigated 43 invasive squamous cell carcinoma (ISCC), 38 CIN III, 11 CINII and 18 CINI for cyclin D1, cyclin E, CDK4, p53, mdm-2, p21waf, p27, p16INK 4A, Rb and Ki-67 aberrations using immunohistochemistry and molecular techniques. Twenty samples of normal cervical tissues (NCT) were taken as a control.ResultsThere was a significant increase in the expression of Ki-67, cyclin E, CDK4, p16INK 4A, Rb (p= 0.003, 0.001, 0.001, 0.01) and a significant decrease in p27KIP 1from NCT to ISCC (p = 0.003). Increased cyclin D1, p21waf, p53, mdm-2 expression, homozygous deletion (HZD) and promoter methylation (PM) of the Rb were detected in CINIII and ISCC only. On univariate analysis; tumor size, differentiation, lymph node status, FIGO stage, Ki- 67, cyclin D1, p53 and p27KIP 1are significantly associated with reduced overall survival (OS) while on multivariate analysis; only FIGO stage, Ki-67, cyclin D1, p53 and p27KIP 1were significant.Conclusion1) Aberrations involving p27KIP 1, cyclin E, CDK4, p16INK 4Aare considered early events in HPV 16 and 18-associated cervical carcinoma, whereas cyclin D1 and p53 pathway abnormalities are considered late events. 2) Immunohistochemical tests for p16INK 4Aand cyclin E, could help in early diagnosis of cervical carcinoma. 3) Only FIGO stage p53, cyclin D1, p27KIP 1and Ki-67 are independent prognostic factors that might help in predicting outcome of cervical cancer patients.

Abnormal uterine bleeding in midlife: The role of levonorgestrel intrauterine system

Abnormal uterine bleeding is a common gynecological complaint affecting 10-30% of women in midlife and constitute about one-third of all outpatient gynecological visits. It adversely affects the quality of womans life and can lead to psychological, social, medical, and sexual problems and thus necessitating appropriate and adequate management. Different treatment modalities for such problems are available, yet the levonorgestrel intrauterine system (LNG-IUS) has recently provided a good treatment option effective in treating such complaints and at the same time, having a reliable contraceptive effect which is desired by such age group. For women in their reproductive years, the LNG-IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists, and decreasing the recourse to operative treatments. It is easy to insert, has a sustained effect, cost-effective, and well tolerated besides providing reliable contraception.

Histological Structure and Vascularity of Hysteroscopically Removed Uterine Septa in Patients With Primary Infertility and Patients With Recurrent Pregnancy Loss

OBJECTIVE To examine the histological structure and vascularity of uterine septa in patients with unexplained primary infertility and patients with recurrent pregnancy loss (RPL). DESIGN Case-control study (Canadian Task Force classification II-2). SETTING Kasr Al Aini Hospital, Cairo University, Egypt. PATIENTS AND INTERVENTIONS A total of 41 patients with uterine septa presenting with either unexplained primary infertility or RPL underwent 3-dimensional (3D) and power Doppler (PD) ultrasound to calculate the septum volume, septal vascularization index (VI), and myometrial VI. Hysteroscopically removed septa were examined histologically for myometrial and fibrous tissue content. MEASUREMENTS AND MAIN RESULTS Septal characteristics differed between the primary infertility group (24 patients) and the RPL group (17 patients). Mean septal VI was significantly higher in the RPL group compared with the infertility group (18.39% ± 7.57% vs 11.67% ± 4.56%; p = .003), as was septal myometrial area (20.74% ± 5.97% vs 13.57% ± 5.55%; p < .001). In both groups, septal VI was strongly correlated with myometrial VI and myometrial content, but not with fibrous tissue content. CONCLUSION Uterine septa of patients with RPL are more vascularized and contain more muscular tissue compared with those of patients with primary unexplained infertility.

Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility

Abstract It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI. Impact statement What is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012). What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.

Laparoscopy and the anterior abdominal wall: a guide to vascular mapping for safe entry

Laparoscopy is an invaluable diagnostic and therapeutic tool. Unfortunately, the introduction of trocars into the abdominal cavity is not without certain specific inherent dangers, such as injury to the vasculature of the anterior abdominal wall. This article assesses the normal vasculature of the anterior abdominal wall during laparoscopy as well as various methods, such as pneumoperitoneum pressure and patient positioning, for improving the safety margins for the insertion of umbilical as well lateral trocars.