A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Introduction: The use of cervical cerclage in twin pregnancies is a controversial topic in Obstetrics and Gynecology. It’s use is currently not recommended due to no perceived benefit and potential harm, however recent studies indicate that cerclage may be beneficial.Conclusion: The use of cerclage in twin pregnancies complicated by a TVUS cervical length of 2.0 cm or less prolonged the latency period between diagnosis of short cervix and delivery by 31 days. This data is consistent with other retrospective reviews and indicates the need for a multicenter, prospective randomized control trial.

archives@tulane.edu / Preterm birth (PTB) is a global health concern linked to lifelong health conditions in the mother and child. The etiology of PTB is multifactorial and exact pathways of PTB difficult to elucidate. Cervical insufficiency (CI) is a form of spontaneous PTB in which the cervix dilates in early- to mid-pregnancy without uterine contractions. CI remains difficult to diagnose and treat due to a lack of research into cervical function. During early-pregnancy the cervix must remain stiff to maintain the fetus within the uterus, however, in late-pregnancy the cervix must soften and dilate to allow for the passage of the fetus into the vaginal canal. To accomplish both roles, the cervical extracellular matrix (ECM) remodels during pregnancy. A disruption to the normal remodeling process such as accelerated degeneration of ECM proteins may lead to failure of cervical function. In addition to ECM, cervical smooth muscle cells (cSMCs) work to maintain cervical integrity and assist in physiologic processes such as fertilization and labor. Quantification of microstructural content and mechanical testing permits determination of relationships between ECM, cSMC, and cervical function. Past research quantified microstructural, mechanical, and contractile properties of the cervix; however, mechanical testing and contractility protocols were uniaxial. Uniaxial testing requires disruptive specimen preparation and investigates circumferential and axial properties independently. The cervix, however, is loaded multiaxially in vivo and is anisotropic. Towards this end, biaxial inflation-extension testing of the cervix overcomes these limitations by enabling simultaneous assessment of circumferential and longitudinal mechanical properties and contractility. Determining mechanical properties, contractility, and microstructure of the cervix in the nulliparous and parous state enables the development of computational models of cervical remodeling to better understand the etiology of CI. Therefore, this study sought to characterize cervical remodeling by determining the evolving biaxial mechanical properties, contractility, and microstructural composition of the nulliparous and parous murine cervix. / 1 / Cassandra Conway

Experiments were conducted to determine the effects of a treatment used to dilate the cervix for transcervical AI and embryo transfer on pregnancy or fertilization rates in sheep. Experiment 1 was conducted as a 2 × 2 factorial, with the main effects of estradiol-17β (E2) and oxytocin (OT). On d 6 of pregnancy, ewes received (i.v.) 100 μg of estradiol-17β, or saline; 10 h later, ewes received (i.v.) 400 USP units (20 mL) or saline. Blood samples were collected for progesterone analysis. Transrectal ultrasonography was used to determine pregnancy on d 25. Treatment did not affect (χ² , P > .05) pregnancy rates. For nonpregnant ewes, the period × E2 × OT interaction (P < .01) was significant. Experiments were conducted to evaluate the effects of oxytocin and(or) cervical manipulation on fertilization rates. In Exp. 2, nulliparous ewes were assigned to one of two randomized treatment groups: 1) saline or 2) oxytocin. In Exp. 3, multiparous ewes were assigned to one of two randomized treatment groups: 1) saline-cervical manipulation or 2) oxytocin-cervical manipulation. Ewes in Exp. 2 and 3 were laparoscopically inseminated. In Exp. 2 and 3, ewes received (i.v.) either 400 USP units of oxytocin or 20 mL of saline. In Exp. 2 and 3, oocytes and(or) embryos were collected. Treatment did not affect recovery, fertilization, or pregnancy rates in Exp.2 and 3. In conclusion, the treatment used to dilate the cervix in ewes to facilitate the transcervical AI or ET does not seem to affect fertilization or pregnancy rates. / Master of Science

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Radiation Oncology. May, 2014 / Background: Carcinoma of the cervix is a common cancer among women in developing countries and with the rising HIV environment the burden of cervical cancer might be even greater, stretching the limited resources even further. This retrospective descriptive study evaluates the potential of the hypofractionated departmental protocol for stage 3b carcinoma of the cervix in terms of toxicity, local control, and compares toxicity for HIV negative and positive patients with a mean follow-up of one year. This study also compares the outcome for unilateral to bilateral pelvic sidewall fixed tumours. Methods and Materials Medical records of 104 sequential patients with stage 3b carcinoma of the cervix treated with departmental hypofractionated protocols between 2010/2011 were reviewed. The patients were only sequential after meeting the criterion of being local with a contact telephone number. Patients were treated with two-dimensional standard pelvic portals of external beam radiation therapy of 2.5Gray daily to a total of 40Gray and intracavitary radiotherapy high dose rate of 9Gray weekly to a total of 18Gray. All cases were stratified by HIV status as being HIV positive or negative and by local disease spread as being unilaterally fixed or bilaterally pelvic sidewall fixed tumours. The patient’s treatment duration and vii haemoglobin levels at the start of radiation were also retrieved from her medical records. Outcome was evaluated after six months, using the Papanicolaou smear and clinically, by using the Response Evaluation Criteria In Solid Tumors criteria version 1.1. Toxicity scoring was done by using the Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group criteria. Maximum toxicity information during treatment and follow-up was obtained from patient files. Statistical analysis was done using STATISTICA version 10. The Student’s T-test was used for mean age and toxicity comparison between HIV positive and negative patients. Survival analysis was done using the Kaplan Meier statistical method. Results: The 600 days overall survival and disease free survival were 94.92% and 59.04% respectively. Comparison of unilateral and bilateral pelvic sidewall fixed tumour disease free survival was 63.94% and 48% (p=0.12926) respectively. Seventy one (68.3%) patients were HIV negative while 33 (31.7%) were HIV positive. Human Immunodeficiency Virus positive patients had a mean age of 45.76 years, while the mean age for HIV negative patients were 55.95 years (p=0.000066). There was no statistically significant difference (p=0.49713) in disease free survival between patients completing radiation therapy in ≤24 days (57.03%) versus >24 days (58.76%). There was no statistically significant difference in the outcomes between HIV positive and negative patients for the up to 600 day’s follow-up period. However, haemoglobin levels were prognostic, as the comparison between viii patients with haemoglobin levels of ≤10g/dl and >10g/dl overall survival was 80.05% and 98.81% (p=0.00055), and disease free survival was 0% and 68.57% (p=0.02130) respectively at 470 days. The treatment was well tolerated and there was no difference in toxicity between HIV positive and HIV negative patients. No patient developed acute grade 3-4 skin and genitourinary toxicity. One patient developed acute grade 3 gastrointestinal tract toxicity. Although the follow-up period was rather short to assess late complications, three patients who were HIV negative had late grade 3 skin toxicity, no patient had late genitourinary toxicity and four had late gastrointestinal tract toxicity. Among the four who had late gastrointestinal tract complications, three were HIV negative while one was HIV positive. Conclusion: For this short follow-up study, the departmental hypofractionated protocol has potential and has already reduced long waiting periods for radiotherapy treatment in our department from six months to two to three months. The treatment is tolerable with a comparable outcome as conventional standard fractionation for stage 3b carcinoma of the cervix. However, long follow-up is recommended to ascertain long term outcome and late complications. As other studies have shown, carcinoma of the cervix is seen at an earlier age among HIV positive patients and screening is recommended. Interestingly, haemoglobin levels are prognostic among stage 3b carcinoma of the cervix, in patients treated with hypofractionation.

Thesis (Ph. D.)--University of Missouri-Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 91-113). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 91-113). Also available on the Internet.

Thesis (M.S.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains vii, 70 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 69-70).

published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Doctor of Medicine

Thesis (Ph.D.)--University of Western Australia, 2005.