Cervical Erosion Research Articles

Results from phase III clinical trials with radachlorine for photodynamic therapy of pre-cancer and early cancer of cervix

The results of clinical study for efficacy of photodynamic therapy (PDT) with radachlorine in patients with pre-cancer and cancer of cervix are represented. The study enrolled 30 patients including 4 patients with cervical erosion, 5 patients with cervical intraepithelial neoplasia II, 13 patients with cervical intraepithelial neoplasia III, 4 patients with carcinoma in situ and 4 patients with cervical cancer stage Ia. Radachlorine was administrated as single 30 minute intravenous injection at dose of 1,0 mg/kg of body weight 3 h before irradiation (wavelength of 662 nm, light dose of 300–350 J/cm 2 ). The results of treatment in 26 (86,7%) patients was assessed as complete tumor regression and in 4 (13,3%) patients — as partial regression. In cervical erosion, intraepithelial neoplasia II and carcinoma in situ groups total regression was in all cases. In the cervical intraepithelial neoplasia III group total regression after first course of PDT was achieved in 77% of patients, in cervical cancer stage Ia group – in 75% of patients. From 3 to 6 months after first course of treatment all patients with partial tumor regression underwent the second course of PDT with complete regression. There were no side-effects due to radachorine or PDT in the course of treatment and during follow-up. Thus, PDT with Russian photosensitizer radachlorine showed high efficiency for treatment of pre-cancer and cancer of cervix.

Comparative Inhibition Study of Compounds Identified in the Methanolic Extract of Apamarga Kshara Against Trichomonas vaginalis Carbamate Kinase (TvCK): An Enzoinformatics Approach.

In the present study, we have identified ten compounds, namely dodecanol acid, myristic acid, neophytadiene, palmitic acid, heptadecanoic acid, linoleic acid, elaidic acid, 3-7-dimethyl acid, stearic acid and methyl eicos acid, of the methanolic extract of Apamarga Kshara by GC-MS analysis. Apamarga Kshara has been reported to be active against cervical erosion. Major causal organism for cervical erosion is Trichomonas vaginalis. However, there is a paucity of information about the mechanism of action and inhibitory effect of the biologically active natural compounds presented in A. Kshara against this organism (T. vaginalis). Therefore, present investigation was conducted to observe possible interactions of these compounds on T. vaginalis carbamate kinase using molecular docking software 'AutoDock 4.2.' Identification of the amino acid residues crucial for the interaction between T. vaginalis carbamate kinase and these natural compounds is of due scientific interest. The study will aid in efficacious and safe clinical use of the above-mentioned compounds.

Erosión cervical. Etiopatogenia, aspecto colposcópico estadístico

Con un criterio eminentemente clínico, podemos definir la erosión cervical como una mancha roja, que aparece en las aproximidades del orificio cervical externo y que contrasta del color rosa pálido de la portio normal.

The relationship between cervical and lumbar spine lesions in rheumatoid arthritis with a focus on endplate erosion.

A cross-sectional imaging study. To investigate the relationship between cervical and lumbar spine lesions in patients with rheumatoid arthritis (RA), and to analyze associated factors in those with concurrent cervical and lumbar endplate erosion (EE). Both the lumbar and cervical spines are often involved in RA, but little is known about the relationship between cervical and lumbar lesions. EE is often found in the spine of RA patients, but its prevalence and associated factors have not been well studied. We enrolled 201 RA patients in this study. Cervical lesions (horizontal and vertical atlantoaxial dislocation, subaxial subluxation) and lumbar lesions (vertebral fracture, scoliosis, spondylolisthesis) were evaluated on plain radiographs. EE was evaluated on sagittal T1-weighted magnetic resonance images, and graded into 4 categories. The prevalence of each lesion was calculated, and correlations between general cervical and lumbar lesions and between cervical and lumbar EE were analyzed. To assess the clinical condition of RA, we evaluated disease duration, Steinbrocker stage, modified Stanford Health Assessment Questionnaire results, and Disease Activity Score for 28 joints with the erythrocyte sedimentation rate. Factors associated with concurrent lumbar and cervical EE were analyzed using multiple logistic regression analysis. Cervical lesions were found in 42.3% of patients and lumbar lesions in 56.2%. There was no significant correlation between the presence of cervical and the presence of lumbar lesions, but patients with cervical subaxial subluxation were significantly more likely to have lumbar spondylolisthesis. Cervical EE (≥1 points) was found in 61.2% of patients and lumbar EE in 39.3%. Total cervical EE score was significantly correlated with lumbar EE score. Moderate/high disease activity, Steinbrocker stage IV, and severe cervical or lumbar disk degeneration were associated with concurrent cervical and lumbar EE. Some cervical lesions are significantly associated with lumbar spinal lesions. Concurrent cervical and lumbar EE are related to RA disease activity and peripheral joint deterioration, suggesting that RA activity may play an important role in total spinal involvement.

Infection status of cervical human papilloma virus in patients with cervical intraepithelial neoplasia

To explore the human papilloma virus (HPV) infection and genotypes distribution in female patients with cervical intraepithelial neoplasia so as to provide rationales for preventing and treating HPV and developing HPV vaccine. Polymerase chain reaction (PCR) amplification, flow-through hybridization and gene chip were used to identify 23 HPV genotypes in cervical cells collected from 823 female patients with cervical intraepithelial neoplasia at Third Municipal People's Hospital and Central Municipal Hospital during January 2011 and December 2013. Among them, HPV infections were detected in 47.51% (391/823). From 2011 to 2013, there was a trend of increase year by year and the difference was statistically significant (P < 0.05). With the greater degree of cervical intraepithelial neoplasia, LR-HPV and HR-HPV infection rate increased. And there were statistically significant differences (P < 0.05). And single or double genotype infection dominated (86.19%). Multiple genotype infection accounted for 0.51%. And 76.21% of HPV infections were high-risk genotypes and most of them belonged to HPV16. Otherwise, most low-risk genotypes were HPV6. Besides, HPV39 and HPV82 were not detected. HPV infections, particularly high-risk ones, are widespread among female patients with condyloma acuminatum or cervical erosion in Qingdao. Thus active clinical therapy should be provided.

Role of PAP smear N cervical biopsy in unhealthy cervix

Carcinoma of cervix is the third most common cancer in women worldwide &amp; most common female cancer in many developing countries like India. The present study was done with an objective to correlate the finding in women with unhealthy cervix by cytology and cervical biopsy and to assess the utility of these in detecting the premalignant and malignant lesions of the cervix. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Pap smear were compared with cervical biopsy which was taken as confirmatory. Majority of patients were from age group of 31- 40 years (41%). The mean age of cervical intraepithelial neoplasia (CIN) and invasive carcinoma are 50.6% and 49.37%. Majority of cases with abnormal cervical lesion were in the multiparous women (parity from 2 to 4) which constituted 88 (73.34%) cases out of 120 cases. The mean parity of neoplastic lesions was around 3.35 and for invasive carcinoma it was around 4.42 in the present study. The incidence of CIN (45%) and invasive carcinoma (77.14%) was found to be higher among the low socio- economic group. CIN and invasive carcinoma was more prevalent among the illiterates, in the study 50% of CIN and 57.15% of invasive carcinoma cases was found among the illiterates. The incidence of CIN was 40% and of invasive carcinoma was 67.18% in women who were married before 20 years of age. Majority of women complained of excessive white discharge per vaginum (68.34%) and among them 13.12% (16/82) of women had CIN. In the present study 94% cases of postmenopausal bleeding were diagnosed to have CIN and invasive carcinoma and 51.54% cases of irregular bleeding were diagnosed to have CIN and invasive carcinoma. The gross appearances of cervix revealed cervical erosion in 38.34% (46/120) of cases, rest of the cases showed growth in 27.5%, congestion in 10%, Hypertrophy with congestion seen in 5.84%, Hypertrophy with erosion was seen in 11.66% and polyp was found in 4.16% of cases. Majority of cases with invasive carcinoma showed growth in the cervix (94.2% cases). In the present study pap test revealed inflammatory smears in 55% of cases, mild dysplasia in 5.84%, moderate dysplasia in 6.66%, severe dysplasia in 5.84% and invasive carcinoma was seen in 22.5% of cases. Sensitivity of pap smear was 86.5% and specificity was 92.18% in the present study. The positive predictive value was 90.7% and the negative predictive value 89.4 %. The accuracy of pap smear was found to be 90%.

Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer

Background:Cervical cancer is the second most common among women globally. In most cases of Assam, Ca Cervix is detected late due to lack of effective screening programme.Aim:To screen the patient at Gynaecology OPD at the age 18-60 yrs by doing pap smear, VIA (Visual Inspection with Acetic Acid) and to detect sensitivity and specificity for detecting CIN and early Ca Cervix.Material and Method:It is a cross sectional study of 300 women (18- 60 yrs) who fulfill selection criteria. The pap smear and VIA are done in these cases. In positive cases, cervical biopsy and histopathological studies are done, The sensitivity and specificity of each test are determined and compared.Result and observation:The positive result detected from cytology are 22, VIA was positive in 52 cases. The histology of 19 cases are suggestive of CIN and Ca Cervix.Discussion:The findings were compared with other studies and evaluated.Summary:The most common finding in per speculum examination is cervical erosion. The sensitivity of VIA is 89% (versus pap smear-52%) the specificity of VIA is 87% (versus pap smear-95%). The accuracy VIA is 87% compared to pap smear-93%.Conclusion:The lack of effective and implementable screening programme lead to reporting of advanced cases of Ca Cervix. If detected at CIN or early Ca cervix stage, effective treatment can be provided with encouraging results. Therefore effective & implementable Ca Cervix screening need to be provided in our country.

Indications for hospitalization of young girls and adolescent girls – clinical work-up in the selected case

The aim of the study was to analyze the clinical reasons for hospitalization due to gynecological causes of adolescent girls and young women. We reviewed clinical data on reasons for hospitalization, treatment methods, and histopathological diagnosis in adolescent girls and young women hospitalized at the Second Department of Gynecology Medical University of Lublin, between January 2003 and December 2012. Methods of conservative or surgical treatment, as well as their clinical effectiveness, have been discussed. Over the analyzed period of time, we identified 334 patients at the age between 8 and 20 years, which accounted for 1.61% of all hospitalized women during that time. Rating these patients by age, we found the following: 1 patient < 9 years old, 2 patients aged 10-11 years, 38 patients aged 12-14 years, 128 patients aged 15-17 years and 165 patients aged 17-19 years old. The main clinical reasons for hospitalization of adolescents and young women due to gynecological causes were: ovarian cysts (138 cases; 41.3%), menstrual disorders (46 cases; 13.7%), pregnancy complications (35 cases; 10.5%), and congenital Müllerian anomalies (33 cases; 9.9%). The remaining patients (24.6%) were admitted due to suspicion of ovarian cyst (22 cases; 6.6%), cervical erosion (15 cases; 4.5%), juvenile metrorrhagia (15 cases; 4.5%), and vulvar diseases (8 cases; 2.4%). Adolescent girls and young women are rarely admitted to gynecological departments. Nevertheless, they present a clinical challenge. Proper diagnosis using advanced visualization methods, along with modern pharmacotherapy accounts for the final therapeutic success.

Clinical observation of electrocauterization alone and post-electrocauterization MEBO application therapy in the treatment of cervical erosion

Clinical observation of electrocauterization alone and post-electrocauterization MEBO application therapy in the treatment of cervical erosion

Features of bacterial-mycotic dysbiosis in women with high oncogenic risk human papillomavirus suffering from cervicitis, erosion and cervical dysplasia

Aim. A possible relationship between the uterine neck dysplasia and vaginal microbiocenosis has been subject for broad discussions for many years. Hence, research devoted to the study of the problem of cervical lesions, in particular the progression of cervicitis, cervical erosion and cervical dysplasia depending on the ratio of obligate, opportunistic pathogenic and pathogenic microorganisms is of particular importance and relevance today.Methods and results. To address the problem, we have conducted a complete examination and studied the peculiarities of the opportunistic and pathogenic microflora spectrum in the urogenital tract microbiota in case of 120 female patients of reproductive age suffering from cervicitis, cervical erosion or cervical dysplasia on the background of Papilloma Viral Infection. The control group included 30 apparently healthy women. Conclusion. It was set, that dysbiosis forms in 52,1% women, in this 38,8% patients have moderate and 13,3% patients have severe dysbiosis. Anaerobic type of dysbiosis was verified in 22,9% women and in 29,2% it was mixed aerobic-anaerobic type. Gardnerella vaginalis/Prevotella bivia/Porphiromonas spp., Eubacterium spp., Megasphaera spp./Veilonella spp./Dialister spp., Peptostreptococcus spp. were prevalent urogenital microbiota. Ureaplasma (urealiticum parva) was verified in 23,8% patients and diagnostically meaningful it was in 20,0%, Candida spp. was 64,6 and 54,6% accordingly.

Maternal risk factors in the origin of isolated hypospadias: A population-based case-control study

The birth prevalence of hypospadias increased in Hungary during the last decades, thus the aim of this study was to analyze the possible role of maternal risk factors in the origin of isolated hypospadias (IHS). The incidence/prevalence of acute and chronic maternal diseases with related drug treatments were compared in the mothers of cases with IHS, population controls without defect and malformed controls affected with other isolated abnormalities in the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities including 3038 cases with IHS, 24 814 population male controls without any defects and 11 096 malformed male controls with other isolated defect. Among exposures, prospective medically recorded chronic diseases and medically recorded or retrospective maternal information regarding acute diseases and drug treatments were evaluated in the study groups. Maternal epilepsy due to the treatment of valproate (odds ratio [OR] with 95% confidence interval [CI]: 1.97, 1.07-3.61) and cervical erosion (4.09, 1.84-9.12) were associated with a higher risk of IHS. In addition, there was an association of oral nystatin (1.94, 1.22-3.09), lynestrenol (26.66, 8.69-81.80) and ethynilestradiol (3.51, 1.61-7.67) treatments in the mothers of cases with a higher risk for IHS. In conclusion, maternal cervical erosion, valproate, nystatin, lynestrenol and ethynilestradiol associated with a higher risk for IHS.

Study on infection condition of chlamydia trachomatis and ureaplasma urealyticum in patients with cervical erosion

Objective To investigate the current situation of infection of chlamydia trachomatis (CT) and ureaplasma urealyticum (UU) in patients with cervical erosion,and explore the relationship between the infection of CT and UU and cervical erosion.Methods Immunochromatography and culturing method were used to detect the cervical secretion obtained from 562 cases of cervical erosion patients (the observation group) and 218 healthy controls (the control group) for the CT and UU.The drug susceptibility testing was performed for the patients' with mycoplasma tested positive.Results In the observation group,the positive rates of CT,UU and both were 20.11％,42.35％ and 9.61％ respectively,which were higher than 6.42％,12.39％ and 0.92％ in the control group,the difference was significantly different (P ＜ 0.05).The difference of the positive rate between moderate cervical erosion and severe cervical erosion was not significantly different (P ＞ 0.05),while the positive rates of CT,UU and both were significantly different (P ＜ 0.05) when mild cervical erosion respectively compared with moderate cervical erosion and severe cervical erosion.The highest susceptibility rate of UU to 9 kinds of antimicrobial agents was josamycin (91.78％),the second was pristinamycin (84.25％); the highest resistant rate of UU was ciprofloxacin (85.96％),the second was ofloxacin (73.29％).Conclusion The infection of CT and UU has intimate correlation with the occurrence of cervical erosion and the extent of erosion.Varying degrees of drug resistance of UU can be found in clinical common use antibiotics,and the sensitive and effective antibiotics should be chosen to treat cervical erosion infection of UU. Key words: Cervical erosion; Chlamydia trachomatis; Ureaplasma urealyticum; Infection; Drug susceptibility testing

Comparative Study of Efficacy of Cryosurgery and Albothyl Solution in the Management of Cervical Erosion in a Rural Hospital

prevention of carcinoma cervix is one of the most successful strategy of cancer control and prevention. In developing countries still carcinoma cervix is one of the most common cause of death, the incidence being 99/100000 in India.Hence the importance of screening and treatment of benign cervical lesions like cervical erosion ,a common gynaecological finding which has inflammatory or neoplastic origin . In 2009 WHO updated the recommendation of cryosurgery in CIN and cervical erosion. AIMS AND OBJECTIVES: To compare the effect of cryosurgery and albothyl solution in cases of cervical erosion after ruling out CIN3 and malignancy by Pap smear .To study the efficacy and time taken for healing of the lesion and the number of applications required.MATERIAL AND METHODS :60 cases attending the gynaec OPD at Adichunchangiri institute of medical sciences , Bellur over a period of one year were included in this study. After exclusion of malignancy by Pap smear 30 cases were treated with cryo and 30 cases with albothyl solution.CONCLUSION :Cervical erosion which is one of the commonest gynaecological problem characterised by vaginal discharge, post coital bleeding , low backache can be maximally benefited by cryo as well as local appliction of albothyl solution . cryo has 90% success rate whereas albothyl solution scores over cryo in being cheap and accessible to patients. Keywords: Cervical erosion , Carcinoma , Cryosurgery , Albothyl solution.

Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria.

BackgroundCervical ectropion (also known as cervical erosion) is a common finding on routine pelvic examination during the fertile years. The decision to treat or not remains controversial. According to studies in support of routine treatment of cervical erosion, there is a possible relationship between squamous metaplasia and squamous cell carcinoma of the cervix. To determine the prevalence of cervical ectropion and associated risk factors among clients with intra-uterine contraceptive devices (IUCDs) attending a family planning clinic of a tertiary health institution in Lagos, Nigeria.MethodsA 5-year retrospective study was conducted by assessing existing clinic records from years 2007–2011. Clients with IUCDs undergo routine pelvic examination during check-up visits. A total of 628 clients’ records were seen within the stated time frame. This study was approved by the ethical committee of the Lagos State University Teaching Hospital (LASUTH) and the collected data were analyzed using SPSS version 19.0.ResultsThe mean age of the IUCD users was 34.7 ± 6.52 years, while 517 (82.3%) had secondary education. On routine pelvic examination, seventy-nine clients (12.6%) had cervical ectropion. Thirty-nine (6.2%) clients had presented with a history of abnormal vaginal bleeding while 12.1% had vaginal discharge. Treatments offered to cases of cervical ectropion include cervical painting with gentian violet (89.9%) and antibiotics prescription (58.2%). On bivariate analysis, previous hormonal contraceptive use (P = 0.041) and vaginal discharge (P < 0.001) were significantly associated with developing cervical ectropion. Clients with ectropion were significantly more likely to receive prescriptions for antibiotics (P < 0.001).ConclusionLess than one fifth of the clients had cervical erosion. However, routine pelvic examination could aid the detection and control of latent reproductive health problems such as cervical ectropion which may require further investigations for example, pap smears, to exclude potentially lethal conditions and to determine appropriate treatment modality.

A preliminary physicochemical evaluation of Darvyadi Yoni Varti: A compound Ayurvedic formulation.

Background:Darvyadi Yoni Varti is an Ayurvedic formulation indicated for the management of Garbhasaya Grivamukhagata Vrana (cervical erosion). Though a number of drugs are available in modern medicine, interest towards Ayurveda is gaining. Drugs with Vranasodhana, Ropana and Prasadana properties like Sphatika, Darvi, Haridra, and Lodhra are useful in this situation and are selected to prepare Yoni Varti.Aim:To standardize and evaluate preliminary pharmacognostical as well as physicochemical profiles of Darvyadi Yoni Varti.Materials and Methods:Raw material was analyzed in the Pharmacognostical Laboratory for genuinity before converting into Varti. Finished product was analyzed by following pharmacopoeial standards.Results:The pH value of Darvyadi Yoni Varti was 5.0, water soluble extract was 23.3%w/w, alcohol soluble extract was 8.7%w/w, ash value was 5.16%w/w, loss on drying was 71.73%w/w. High performance thin layer chromatography was carried out; in which maximum 10 spots at 254 nm and 3 spots at 366 nm were distinguished.Conclusion:Pharmacognostical study of raw drug revealed the quality and genuineness of all the constituents of Darvyadi Yoni Varti.

A Survey of Management Strategies for Noncarious Cervical Lesions

Both causation and management of noncarious cervical lesions (NCCLs) (abfractions, wedge-shaped defects, stress-induced cervical lesions, and cervical erosion) remain debatable. A survey of clinicians' perceptions was therefore conducted at a recent professional meeting to determine optimal approaches to NCCL management. Examples of lesions differing in depth (1, 2, and 3 mm) were presented as being either sensitive or nonsensitive, and participants recorded their responses to the presented individual scenarios. This report provides information regarding correlations between increases in lesion depth, lesion sensitivity, and professionals' willingness to restore them. It was also noted that decisions to ensure mechanical retention positively influenced estimates for restoration longevity.

Medical Management of Dysfunctional Menorrhagia: Is Ormeloxifene a Safe and Efficacious Therapeutic Choice?

ABSTRACT Objective To assess the efficacy and safety of ormeloxifene (centchroman) in the medical management of menorrhagia. Materials and methods One hundred and twenty women with menorrhagia were recruited for the study. One hundred women were analyzed. Ormeloxifene was given to each patient— 60 mg twice a week for 3 months and then once a week for 1 month. Patients were followed up at 2, 4, 6 months of therapy, then at 6 months after treatment was stopped. Menstrual blood loss (MBL) was measured objectively by a pictorial blood loss assessment chart (PBAC) score and subjectively by a visual analog scale (VAS). Results The mean age of the patients was 38.2 years with a mean parity of 2.4. The mean duration of menorrhagia was 13 months with 8 days as mean duration of bleeding and a mean cycle length of 26 days. 58.7% of the patients had bulky uterus on per vaginum examination done by the same observer. The mean endometrial thickness on transvaginal scan was 8.7 mm. The different study parameters were evaluated in patients treated with ormeloxifene and it showed a significant reduction in median PBAC score from 252 to 102.8, presence of clots from 64 to 12%, incidence of dysmenorrhea from 22 to 8% and mean endometrial thickness from 9.7 to 6.7 mm. There was also a significant elevation in the mean hemoglobin levels from 8.85 gm/dl to 10.6 gm/dl. The menstrual pattern of patients treated with ormeloxifene were encouraging. Eight percent of the women became ammenorhoeic after 6 months of therapy, 22% had scanty period, 56% had average flow, 12% had heavy from and only 2% had very heavy flow. It was further seen, that even though the PBAC score increased to 112.7 after stopping treatment for 6 months, but still it was lower than the pretreatment level (252). The percentage of patients who had an initial history of passage of clots during periods decreased from 64 to 12% and also 22% of patients who complained of mild to severe dysmenorrhea improved and only 8% of the patients complained of mild dysmenorrhea. Adverse effects Included ovarian cyst (14%), cervical erosion and discharge (11%), gastric upset (9%), headache (5%) and weight gain (3%). Conclusion Ormeloxifene is an effective and safe therapeutic option for the medical management of menorrhagia. How to cite this article Gupta N. Medical Management of Dysfunctional Menorrhagia: Is Ormeloxifene a Safe and Efficacious Therapeutic Choice? J South Asian Feder Menopause Soc 2014;2(2):65-70.

Infrared Coagulation of Benign Erosions of Cervix

ABSTRACT Cervical erosion is the commonest problem encountered in gynecological practice. Various methods have been used uptil now to treat benign cervical erosion, such as electrocautery, cryotherapy and laser. All have some advantages and disadvantages. Aim: To evaluate the utility of infrared coagulator in conservative treatment of benign cervical erosions. Methods and results This is a study of 1000 cases. Nine hundred and seventy cases (97%) were done on outpatient basis. Healing was much faster and postprocedure discharge was minimal. Out of above cases only 20 (2%) required repeat procedure due to polyp like ectopias. In 30 cases (3%) of cases concomitant endocervical erosion was treated with electrocautery under short GA. Conclusion Infrared coagulation is at the moment the best suited method. In this necrosis is not caused by electric current but rather by heat of infrared light energy. This treatment is practically painless, does not require anesthesia and can be performed on outpatient basis. Healing time is short and postprocedure secretions are minimal. How to cite this article Sortey K. Infrared Coagulation of Benign Erosions of Cervix. J South Asian Feder Obst Gynae 2014;6(2):104-106.

RESEARCH PROGRESS ON NIDUS VESPAE, A TRADITIONAL CHINESE MEDICINE DERIVED FROM INSECTS

Nidus vespae is a drug derived from insec ts that is commonly used in traditional Chinese medicine (TCM). No syste m atic review has previously been made about this drug. This paper summarizes previous investigations about the 49 identified chemical constituents and clinical app lication of Nidus ves pae , and explores its pharmacological mechanism of treating disease. Nidus vespae has been reported to be effective in the treatment of rheumatoid arthritis and psor iatic arthritis, intractable skin diseases, dental disease, rhinitis, respiratory disor d ers , cervical erosion etc. Nidus vespae can be used alone or in combination with other drugs and compounds for a wide range of clinical applications. The objective of t his review is to provide a comprehensive reference for further deve l opment and utilization of Nidus vespae . K eywords : Nidus vespae; insect drug; structure; chemical composition; bioactivity; clinical applic a tion; review

Cervical vertebral erosion caused by bilateral vertebral artery tortuosity, predisposing to spinal, sprain: A medieval case study

Bone resorption within the cervical spine due to vertebral arterial tortuosities is rarely observed in medical practice because the condition often lacks clinical symptoms. Traumatic complications involving the vertebral arteries are relatively common and occasionally very serious, but very few affect bone, appearing only when survival has been sufficiently long for a pseudoaneurysm to form. CT scans and MRI screening, practised increasingly today following traffic and sports accidents, incidentally show that arterial tortuosities that had stimulated bone resorption are relatively frequent. Only rarely do such tortuosities cause nerve compression or trigger orthopaedic problems, while large pseudoaneurysms and congenital absence of a vertebral pedicle may require surgery to stabilize the spine. There are few publications by palaeopathologists reporting such conditions of the cervical vertebrae. This contribution reports a case of a tiered bilateral tortuosity of the vertebral artery dating from the Early Middle Ages; it provides a basis by which to recognize this type of lesion in osteoarchaeology, and it attests to the fact that multiple tortuosities may lead to spinal instability in the form of spine sprain.