Assessment of Paracervical Nerve Block Anaesthesia during Labour

An assessment of paracervical nerve block anaesthesia was made in 118 women during labour using 0·5% bupivacaine with 1:200,000 parts of adrenaline added. The 82 multiparae were each given a single block and the 36 primigravidae a continuous block to try to provide the sole means of analgesia throughout the first stage of labour.Only 48% of the primigravidae required no other form of analgesia, as against 72% of the multiparae.Complications included a 17% incidence of maternal haemorrhage during insertion of the continuous needle, an overall fetal bradycardia rate of 11%, and two perinatal deaths following single paracervical block. It is concluded that the use of continuous paracervical block should be discontinued, and that amide-type local anaesthetic agents should not be used for single paracervical block.     

Paracervical Block Anesthesia in Labour

The efficacy and safety of paracervical block anesthesia were studied in 153 patients in the first stage of labour. Transient decrease in uterine activity was noted in 77 patients. There was no acceleration in cervical dilatation following the block. The duration of action of the block in 80 primiparas was 31 to 120 minutes in 69, and over 120 minutes in five. In the 73 multiparas, 53 of the blocks lasted 31 to 90 minutes, eight from 90 to 120 minutes, and two over 120 minutes. The results were good in 66 primiparas and 54 multiparas. The blocks failed in four primiparas and six multiparas. Twenty-six infants had low Apgar scores, but in none could this be related to the paracervical block. There were no significant fetal or maternal complications.     

Le bloc paracervical en obstétrique

Local anesthesia can be very useful in the first stage of labour when a general anesthetic cannot be given during this stage, and it is associated with reduced respiratory depression in the fetus. Paracervical block anesthesia is one such method of local anesthesia. Its successful use depends upon a proper technique, knowledge of the indications and contraindications, appropriate equipment and use of a long-acting anesthetic agent of low toxicity. A series of 90 cases of paracervical block are described in which the success rate was 90 to 95%.     

Implementation of the Abortion Act: Report on a Year's Working of Abortion Clinics and Operating Sessions

The results of the first year''s working of abortion clinics and operating sessions are reported. Seventy-eight per cent. of patients were managed on the basis of day admission and 20% were able to leave the hospital within four hours, operation having been carried out by either Karman catheter or by Bierer suction curette under paracervical block. These results were possible because of quick reference of patients to the clinics and the absence of delay in admission for operation.The measures detailed go some way towards managing the abortion problem within the hospital service; similar arrangements could be instituted elsewhere by the responsible regional hospital boards.     

A paracervical method for non-surgical transfer of bovine embryos

Seventy-six day-8 bovine blastocysts were transferred by a paracervical non-surgical process to determine its feasibility as an alternative method of bovine embryo transfer. Forty-seven of the 76 transfers resulted in pregnancy (62%), as determined by rectal palpation at 45 to 90 days of gestation. This indicates that embryo transfer via the paracervical method is a viable alternative to surgical and non-surgical transfer in cattle.     

Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer: Preliminary analysis of scintigraphic data

PurposeTo evaluate patterns of lymph flow from primary lesions in patients with cervical cancer and to determine how useful for radiotherapy planning this information can be.Materials and methodsSPECT–CT visualization of sentinel (SLN) lymph nodes (LNs) was performed in 36 primary patients with IB-IIB cervical cancer. The acquisition started 120–240 min after 4 peritumoral injections of 99mTc-radiocolloids (150–300 MBq in 0.4–1 ml). We determined localization of LN with uptake of radiocolloids, type of lymph flow (mono-, bi-lateral) and lymph flow patterns (supraureteral paracervical, infraureteral paracervical and directly to para-aortic LNs).ResultsSLNs were visualized in 31 of 36 women. Bilateral lymph-flow was detected in 22 (71%), monolateral – in the other 9 (29%) cases. The distribution of SLNs was as follows: external iliac – 64.5%, internal iliac – 54.8%, obturator – 32.2%, common iliac – 35.5% and pre-sacral 3.2%. Para-aortic LNs were visualized in 5 (16.1%) patients. The supraureteral paracervical pattern of lymph flow was identified in 22, infraureteral paracervical – in 4 and their combination – in the other 5 women.ConclusionVisualization of an individual pattern of lymph flow from primary cervical cancer can be considered as a promising tool for optimization of the volume of irradiated regional LNs.     

Outpatient Termination of Early Pregnancies Using Syringe and Plastic Cannula

Using a 50 ml syringe and a Karman-type cannula-curette, outpatient therapeutic abortions were done in 543 women who were not more than eight weeks pregnant. All patients received paracervical block analgesia and atropine was given intravenously to minimize vagal reactions. In five women (0.9 percent) pregnancies were missed by the procedure, and in 13 women (2.4 percent) abortions were incomplete. In only one patient did a significant postoperative pelvic infection occur. Twenty-seven women (4.9 percent) were not pregnant; the initiation of routine urine pregnancy testing reduced the percentage of those who were nongravid. The procedure using syringe and plastic cannula is safe, well tolerated and has reduced therapeutic abortion costs.     

Galanin-immunoreactive nerves in the female rat paracervical ganglion and uterine cervix: distribution and reaction to capsaicin

Summary The presence and distribution of galanin-immunoreactivity was examined in the uterine cervix and paracervical autonomic ganglia of the female rat. Some animals were treated with capsaicin to determine if galanin-immunoreactivity was present in small-diameter primary afferent nerves. Other animals were treated with the noradrenergic neurotoxin 6-hydroxydopamine to ascertain if galanin-immunoreactivity was present in sympathetic noradrenergic nerves. Galanin-immunoreactive nerve fibers were sparse in the cervical myometrium and vasculature, but numerous in the paracervical ganglion where they appeared to innervate principal neurons. Immunoreactivity was also present in dorsal root ganglia, dorsal horn of spinal cord, and inferior mesenteric ganglia. Capsaicin treatment resulted in a marked reduction of galanin-immunoreactivity in the spinal cord dorsal horn, but not in the dorsal root ganglia, paracervical ganglia, or cervix (although there was a substantial reduction of substance P-, neurokinin A-, and calcitonin gene-related peptide-immunoreactivity in the dorsal horn, dorsal root ganglia, and uterine cervix). 6-Hydroxydopamine treatment did not cause any appreciable change in the galanin-immunoreactivity in any tissues. We conclude that galanin-like immunoreactivity is expressed in nerve fibers innervating the paracervical ganglia and uterine cervix of the female rat. This immunoreactivity is probably present in afferent nerves and could play a role in neuroendocrine reflexes and in reproductive function.     

Cholinergic neurons of the pelvic autonomic ganglia and uterus of the female rat: distribution of axons and presence of muscarinic receptors

Acetylcholine (ACh) stimulates contraction of the uterus and dilates the uterine arterial supply. Uterine cholinergic nerves arise from the paracervical ganglia and were, in the past, characterized based on acetylcholinesterase (AChE) histochemistry. However, the histochemical reaction for acetylcholinesterase provides only indirect evidence of acetylcholine location and is a nonspecific marker for cholinergic nerves. The present study: (1) reevaluated cholinergic neurons of the paracervical ganglia, (2) examined the cholinergic innervation of the uterus by using retrograde axonal tracing and antibodies against molecules specific to cholinergic neurons, choline acetyltransferase and the vesicular acetylcholine transporter, and (3) examined muscarinic receptors in the paracervical ganglia using autoradiography and a radiolabeled agonist. Most ganglionic neurons were choline acetyltransferase- and vesicular acetylcholine transporter-immunoreactive and were apposed by choline acetyltransferase/vesicular acetylcholine transporter-immunoreactive terminals. Retrograde tracing showed that some cholinergic neurons projected axons to the uterus. These nerves formed moderately dense plexuses in the myometrium, cervical smooth muscle and microarterial system of the uterine horns and cervix. Finally, the paracervical ganglia contain muscarinic receptors. These results clearly reveal the cholinergic innervation of the uterus and cervix, a source of these nerves, and demonstrate the muscarinic receptor content of the paracervical ganglia. Cholinergic nerves could play significant roles in the control of uterine myometrium and vasculature.     

The effects of estradiol on beta-endorphin, GnRH and galanin content in the oviduct and the uterus of ovariectomized gilts

Steroid hormones are known to affect synthesis and/or release of some peptides in the central nervous system and peripheral tissues. In the present study we determined changes in beta-endorphin, GnRH and galanin contents in uterine and oviductal tissues of ovariectomized (OVX) gilts following treatment with estradiol benzoate (EB) at a dose inducing a preovulatory-like LH surge. Seven month old gilts (90-100 kg of body weight; BW) were used in the study. Four weeks after ovariectomy, experimental animals were injected intramuscularly with EB (15 microg/kg BW) at 24 h (n=5), 48 h (n=6) or 72 h (n=5) before slaughter. Three control gilts received corn oil vehicle. Tissues were sampled from the ampulla and isthmus of the oviduct and from the perioviductal, middle and paracervical regions of the uterine horn for determination of beta-endorphin, GnRH and galanin content. Significant increases of beta-endorphin content were found in all regions of the uterus either 24 h or 48 h after priming with EB. In oviductal tissue, beta-endorphin concentration only tended to increase in response to EB. GnRH content in tissues originating from gilts receiving EB fluctuated from a stimulation in the ampulla of the oviduct and in the paracervical uterus to an inhibition in the middle part of the uterus. A significantly increased concentration of galanin in response to EB was observed exclusively in the paracervical part of the OVX pig uterus. The results suggest an involvement of beta-endorphin, GnRH and galanin in the regulation of uterine function in pigs during the periovulatory period.     

Origin and distribution of VIP (Vasoactive Intestinal Polypeptide)-nerves in the genito-urinary tract

Summary VIP (Vasoactive Intestinal Polypeptide)-immunoreactive nerves were found throughout the genito-urinary tract of the cat; they were less numerous in the guinea pig and in the rat. In the cat, VIP nerves were particularly numerous in the neck of the urinary bladder and proximal urethra, in the uterine cervix and in the prostate gland. The nerves were found in smooth muscle, around blood vessels and in the connective tissue immediately beneath the epithelium. Ganglia were found below the trigonum area of the bladder, in the wall of the proximal urethra, and in paracervical tissue. VIP-immunoreactive nerve cell bodies occurred in all these ganglionic formations. These ganglia probably represent the origin of the VIP nerves of the genital tract since their removal in the female cat greatly reduced the VIP nerve supply. Transection of the hypogastric nerves had no overt effect. Transection of the cervix eliminated the VIP nerves above the level of the lesion, except those in the ovaries, supporting the view that the VIP nerves of the uterus and the oviduct are derived from a paracervical source.     

Projections of the guinea-pig paracervical ganglion to pelvic viscera

Summary The uterine cervix, urinary bladder and rectum of guinea pigs were injected with Fast Blue dye for retrograde transport studies. Dye-laden neuronal perikarya were detected for each viscus in the paracervical ganglion. These same perikarya also exhibited immunoreactivities for tyrosine hydroxylase, aromatic amino acid decarboxylase, dopamine -hydroxylase, neuropeptide Y, or vasoactive intestinal peptide, though the perikarya projecting to the urinary bladder did not exhibit immunoreactivity for aromatic amino acid decarboxylase. The results of this study indicate that the guinea-pig paracervical ganglion projects to viscera in addition to the uterus, and that the ganglion contains a range of immunoreactivities related to adrenergic and non-adrenergic neurotransmitters.     

Calretinin-immunoreactive nerves in the uterus, pelvic autonomic ganglia, lumbosacral dorsal root ganglia and lumbosacral spinal cord

Nerves containing the calcium-binding protein calretinin have been reported in several organs but not in female reproductive organs and associated ganglia. This study was undertaken to determine if nerves associated with the uterus contain calretinin and the source(s) of calretinin-synthesizing nerves in the rat (are they sensory, efferent, or both?). Calretinin-immunoreactive nerves were present in the uterine horns and cervix where they were associated with arteries, uterine smooth muscle, glands, and the epithelium. Calretinin-immunoreactive terminals were apposed to neurons in the paracervical ganglia; in addition, some postganglionic neurons in this ganglion were calretinin positive. Calretinin perikarya were present in the lumbosacral dorsal root ganglia, no-dose ganglia, and lumbosacral spinal cord. Retrograde axonal tracing, utilizing Fluorogold injected into the uterus or paracervical parasympathetic ganglia, revealed calretinin-positive/Fluorogold-labeled neurons in the dorsal root and nodose ganglia. Also, capsaicin treatment substantially reduced the calretinin-positive fibers in the uterus and pelvic ganglia, thus indicating the sensory nature of these fibers. The presence of calretinin immunoreactivity identifies a subset of nerves that are involved in innervation of the pelvic viscera and have origins from lumbosacral dorsal root ganglia and vagal nodose ganglia. Though the exact function of calretinin in these nerves is not currently known, calretinin is likely to play a role in calcium regulation and their function.     

An immunohistochemical study of the catecholamine synthesizing enzymes and neuropeptides in the female guinea-pig uterus and vagina

Summary The uterus and vagina of the guinea pig have been examined, region by region, for acetylcholinesterase, tyrosine hydroxylase, dopamine -hydroxylase and aromatic amino acid decarboxylase activity, as well as for the neuropeptides, neuropeptide Y, vasoactive intestinal peptide, substance P, enkephalin and somatostatin. No acetylcholinesterase activity was localized in the uterus, though it was present in associated paracervical ganglion tissues. Of the catecholamine-synthesizing enzymes, tyrosine hydroxylase and dopamine -hydroxylase activity was found virtually throughout the reproductive tract, whereas aromatic amino acid decarboxylase activity was restricted in its distribution. Neuropeptide distribution was quite varied. Neuropeptide Y was found throughout the endometrium/submucosa but only in the muscularis of the vagina and not in the myometrium. Substance P was localized in the vagina and uterine horn, though not the body of the uterus. Vasoactive intestinal peptide was present in all regions of the endometrium/submucosa, but not in the myometrium of the uterine horn. Enkephalin and somatostatin were not localized in any part of the reproductive tract examined, apart from paracervical ganglion tissues. The types and significance of the nerves supplying the reproductive tract are discussed.     

Immunocytochemical localization of tissuebound oestradiol in rat paracervical ganglion

Summary The uterine paracervical ganglion (Frankenhauser's ganglion) contains the terminal neurons of the cholinergic sacral parasympathetic, the short adrenergic sympathetic and the peptideric (vasoactive intestinal polypeptide-containing) nerves of the internal genitalia. Previous studies have shown that either the number of cells or transmitter content of each of these neuronal systems is altered by variations in steroid hormones. Furthermore, our recent study showed that some component of the rat paracervical ganglion was capable of metabolizing [³H]oestradiol to oestrone and the 2-OH and 4-OH forms of oestrone and oestradiol. The present study employs the peroxidase-anti-peroxidase immunohistochemical method to localize oestradiol in rat paracervical ganglia. Specific reaction product was identified in (1) cytoplasm and some nuclei of principal ganglion cells, (2) cytoplasm of large vacuolated ganglion cells, (3) cytoplasm of'small intensely fluorescent' cells and (4) some nerve fibres in ganglia from animals in oestrus. The cytoplasm of principal neurons and some nerve fibres exhibited specific staining for oestradiol in dioestrus and pro-oestrus. No oestradiol was localized in ganglia excised from animals in metoestrus. Preincubation in oestradiol before fixation was necessary for specific localization of oestradiol; treatment of tissues with oestradiol after fixation was not required. These results are not consistent with binding of oestradiol to the classical oestrogen receptor. The resistance of oestradiol to organic solvent extraction suggests that oestradiol is covalently bound to tissue proteins. Such covalently bound oestradiol has been reported as a by-product of tissue metabolism of oestradiol via P-450 enzymes.     

Coexistence of calcitonin gene-related peptide and galanin immunoreactivity in female rat pelvic and lumbosacral dorsal root ganglia.

Coexistence of immunoreactivity for calcitonin gene-related peptide (CGRP) and galanin (GAL) was examined in varicose nerve endings in female rat pelvic paracervical ganglia (PG) and in perikarya of lumbosacral dorsal root ganglia (DRG). Varicose peptide-containing nerves were closely adjacent to somata of neurons in the PG, certain somata being virtually surrounded by immunoreactive varicosities. Some nerve endings were immunoreactive for either CGRP or GAL; in others, immunoreactivity for CGRP and GAL coexisted. Likewise, many perikarya in DRG were CGRP immunoreactive, fewer were GAL immunoreactive, and in some immunoreactivity for CGRP and GAL coexisted. The results suggest there are subpopulations of neuropeptide-containing sensory nerve endings in the PG; some contain CGRP, some contain GAL, and in some CGRP and GAL coexist. These substances contained in sensory nerve endings could have important roles in pelvic ganglionic functions.     

Localization of substance P and leucine enkephalin in the nerve terminals of the guinea pig paracervical ganglion

Summary Immunoreactivities (IR) of substance P and leucine enkephalin have been demonstrated in the guinea-pig paracervical ganglion by an immunogold electron microscope method. Both substance P-IR and leucine enkephalin-IR were detected in large synaptic vesicles with electron-dense cores. The former neuropeptide was detected in nerve terminals and varicosities comprised mainly of large vesicles with electron-dense cores; the latter was detected in nerve terminals and varicosities that also included small, clear synaptic vesicles. In a minority of nerve terminals and varicosities coexistence of both immunoreactivities could be demonstrated within vesicles with an electron-dense core. Also present in these nerve terminals and varicosities were small, clear synaptic vesicles, though these were unreactive.     

Sputum cytology for the diagnosis of lung cancer. Comparison of smear and modified cell block methods

OBJECTIVE: To compare the sputum smear cytology and cell block methods for specimen adequacy, cytology quality and diagnostic accuracy in the diagnosis of lung cancer. STUDY DESIGN: We assessed 2,524 sputum specimens from 768 patients. The specimens were prepared as smears and cell blocks for cytopathologic examination between March 1, 1992, and December 31, 1998. The smear and cell block slides were evaluated both separately and together, and the results were compared with radiologic and histopathologic diagnoses. RESULTS: The sensitivity of the smear method was 69.4% and specificity was 99.5%. The sensitivity of the cell block method was 84.4% and specificity, 100%. The sensitivity of the smear and cell block together was 87.6% and specificity, 99.5%. CONCLUSION: The cell block method increases the sensitivity and specificity of sputum cytology, and when smear and cell block slides are evaluated together, sensitivity reaches its highest value. Therefore, application of smear and cell block methods together seems most useful in the diagnosis of lung cancer.     

H3-dopamine and H3-quinuclidinylbenzilate binding by autonomic ganglia tissue in rats of various age

Binding of tritiated ligands of muscarinic and dopamine receptors was analysed in rats 1, 7, 14, 28, 60 days and 24-30 months old. The following ganglia were studied: the nodose ganglion, the lumbar ganglia of sympathetic chain, the main pelvic ganglion in male rats and the paracervical ganglion in female rats. The same level was found for binding of each of ligands for all investigated ganglia. Parameters of postnatal dynamics of development M-cholino- and dopamine reception systems prove to be quite similar, but not identical. Both of the systems reach matured level during first 2 postnatal weeks. In comparison with quinuclidinylbenzilate binding failure of dopamine binding in aged rats is to be more pronounced.