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At least 1,081 records · Page 60Linked to original sources
PubMed2005

Intermittent pneumatic compression for prevention of pulmonary thromboembolism after gynecologic surgery.

BACKGROUND: To investigate the incidence of pulmonary embolism and risk factors for this condition after obstetric and gynecologic surgery, as well as the efficacy of intermittent pneumatic compression. METHODS: A total of 6,218 patients operated at Keio University Hospital excluding obstetric or infertility-related surgery and uterine cervical conization were evaluated retrospectively to determine the preventive effect of intermittent pneumatic compression on postoperative pulmonary embolism. RESULTS: Pulmonary embolism occurred in 42 patients (0.68%). Multivariate analysis showed that malignancy, blood transfusion, and a body mass index > or =25 kg/m2 or > or =28 kg/m2 were independent risk factors for postoperative pulmonary embolism. A significantly lower incidence of pulmonary embolism occurred in patients receiving pneumatic compression postoperatively versus those without it. Among gynecologic malignancies, endometrial cancer was a significant risk factor for pulmonary embolism. CONCLUSION: Preventive measures, including intermittent pneumatic compression, should be taken to avoid postoperative pulmonary thromboembolism in the gynecology field.

Journal Article↗
PubMed2006

Adenoid basal carcinoma of the cervix in a 20-year-old female: a case report.

BACKGROUND: Adenoid basal carcinoma of the cervix is a rare condition mostly occurring among postmenopausal women. Although it can be confused with adenoid cystic carcinoma of the cervix, adenoid basal carcinoma has several clinicopathologic features that will allow distinction from adenoid cystic carcinoma. CASE PRESENTATION: This is the case of a twenty-year old African-American female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear, with a subsequent cervical LEEP specimen revealing adenoid basal carcinoma. The lesion showed the characteristic histologic features of adenoid basal carcinoma and was positive for the immunohistochemical marker EMA and negative for collagen IV, further defining the tumor while helping to rule out the possibility of adenoid cystic carcinoma. As far as the authors are aware, this is the youngest reported case of adenoid basal carcinoma to date. CONCLUSION: This case shows that adenoid basal carcinoma can deviate markedly from its typical postmenopausal demographics to affect women as young as 20 years of age. In addition, adenoid basal carcinoma has several identifiable features that will differentiate it from adenoid cystic carcinoma including histologic and cellular morphologies, as well as immunohistochemistry. Treatment for most patients involves hysterectomy, LEEP, or a conization procedure which provides a favorable prognosis because of this lesion's low potential for recurrence and metastasis.

Journal Article↗
PubMed1976

Symposium: Methods of reconstruction in tympanoplasty. II. Maintenance of the anterior sulcus-tympanic membrane relationships in tympanoplastic surgery.

A technique for closure of tympanic membrane perforation which preserves the normal anterior sulcus-tympanic membrane relationships is described. This underlay fixation technique provides a high graft take, good conization of the drum, prevention of lateralization of the reconstructed drum and elimination of tenting or blunting of the anterior sulcus. The reconstructed tympanic membrane presents a near normal appearance with good physiological and acoustic properties.

Fascia↗
PubMedDate not supplied

[Treatment protocol for cervical carcinoma].

INTRODUCTION: Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of squamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. THERAPEUTIC MODALITIES: Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation--urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. DISCUSSION AND CONCLUSION: No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.

Antineoplastic Protocols↗
PubMed1979

The cryosurgical treatment of intraepithelial neoplasia.

At the Finseninstituttet and the Radium Centre in Copenhagen, from 1971-1975 inclusive, cryosurgery was carried out altogether 59 times on 57 patients. Only 8 patients showed histopathological changes in the biopsies sufficient to indicate conization. Hysterectomy was carried out on 8 patients. In 7 of these the removed uteri showed either no malignant changes or changpy. Invasive growth was discovered only in 1 patient, who later underwent a total hysterectomy by the Wertheim method. A biopsy on 1 patient with carcinoma in situ, suspected invasive growth, was treated with radium.

Adult↗
PubMed1980

Treatment of cervical intraepithelial neoplasia with local excisional biopsy and cryosurgery.

One hundred and ninety-eight patients with abnormal cytologic smears had extensive diagnostic biopsy of the portio combined with endocervical curettage. Severe dysplasia or cancer in situ was found in 57 per cent of the patients. During a period of observation of 6--42 months (average 18 months) the cervical intraepithelial neoplasia (CIN) regressed in 54 per cent. Cryosurgery was used to treat 93 patients with persistent CIN after biopsy. Treatment was successful in almost 70 per cent after one single application of cryosurgery. The complications were negligible. Treatment was less successful with increasing histological severity as well as with increasing age of the patients; this applies both to biopsy and cryosurgery. Cryosurgery is significantly less effective when the CIN is of both ecto- and endocervical origin. Extensive multiple biopsies of the portio in combination with endocervical curettage performed under general anaesthesia, followed by cryosurgery with persistent cytological abnormalities, are indicated as an alternative to conization, especially in younger patients with ectocervical CIN.

Biopsy↗
PubMed1990

Diagnostic value of an abnormal smear in non-pregnant women. Evaluation of positive smear from the surface of the portio obtained by the cottonswab method or by the dry wooden Ayre spatula and the relevance of positive smear from the endocervix and/or from the surface of the portio.

During a 3-4 year period, 324 women with a positive smear were registered consecutively and prospectively and divided into two groups according to the design of the investigation. In one group the smear was taken with an Ayre spatula and in the other group with a cotton swab. The purpose of this investigation has been to make a comparison between the endocervical smear and the smear taken from the surface of the portio and at the same time between the samples taken with a dry wooden Ayre spatula and with a cotton swab. No differences were found. The cytological findings have been registered and correlated both with the histological findings by colposcopically directed punch-biopsies and endocervical curettings and with the final histological diagnosis obtained by punch-biopsy, conization or hysterectomy.

Adolescent↗
PubMed1990

Second primary cancer after treatment of invasive carcinoma of the uterine cervix, compared with those arising after treatment for in situ carcinomas. An effect of irradiation? A cancer registry study.

A cancer registry cohort of 16,704 cases of invasive carcinoma of the uterine cervix and 56,116 cases of in situ carcinomas of the uterine cervix was followed up and second new primary cancers were recorded. The invasive carcinomas contributed 127,118 woman-years at risk and the in situ carcinomas contributed 453,362 woman-years at risk. The main treatment for the invasive carcinomas had been radiotherapy and for the in situ carcinomas, conization and other types of surgical intervention. 767 new primaries occurred after treatment of invasive carcinoma of the uterine cervix, compared with 644.5 expected. O/E is 1.19. After the in situ carcinomas, 1,421 malignant tumors were observed, vs. 1,188.0 expected (O/E 1.19). If, however, cases of invasive carcinoma of the uterine cervix after in situ carcinomas are excluded, the ratio observed/expected is 1.10. For some sites the increased observed/expected ratios were found after both invasive and in situ carcinomas, which speaks for some common carcinogenic effect other than irradiation (for instance, in bronchus and trachea, pharynx, nose, sinus and larynx, but also in rectum, urinary bladder, other female genital organs, pancreas, lymphosarcoma, as well as acute and non-lymphatic leukemia). A lower risk than expected--after both in situ and invasive carcinoma of the uterine cervix--is observed for breast cancer, cancer of the corpus uteri and for multiple myeloma. However, analyses based on time since treatment provide evidence of a carcinogenic effect of irradiation, especially in intensively irradiated organs such as bladder, rectum, corpus uteri and ovary, and also for acute and non-lymphatic leukemia.

Adult↗
PubMed1997

Epidemiology of endometriosis in a Norwegian county.

OBJECTIVE: To estimate the prevalence and incidence of endometriosis in Norwegian women aged 40 to 42, and to evaluate reproductive events and life-style as risk factors for endometriosis as well as to evaluate related health-problems. MATERIAL AND METHODS: The study was performed partly as a cross-sectional study to estimate occurrence of endometriosis, partly as a case-control study to look for factors associated with endometriosis. The study group consisted of all female inhabitants--born 1950 to 1952--living in the county of Sør-Trøndelag. In connection with a cardiovascular screening program information about reproductive events and gynecological problems including endometriosis and infertility was obtained. RESULTS: Totally 5139 women were asked to participate, and a questionnaire was completed by 4034 (78.5%). Endometriosis was reported by 2.0% of the women. Life-time risk for endometriosis was estimated to 2.2%. The annual incidence of new cases of endometriosis in this age group is less than 0.3%. There was a significant association between endometriosis and menarche before age 13, and frequent menstrual periods. Nulliparity was more common in women with endometriosis as were infertility problems and pelvic pain. No significant association was found between endometriosis and exercise, smoking, body mass index and education. There was a high risk for women with endometriosis having had cervical conization or gynecological laparotomies such as infertility surgery, operations on ovaries as well as hysterectomies. CONCLUSION: In Sør-Trøndelag county the prevalence of endometriosis is 2.0% and the annual incidence is less than 0.3% for women in their early forties. A woman's life-time risk for endometriosis might be 2.2%. Early menarche, frequent menstruations, pelvic pain, infertility and nulliparity are associated with endometriosis.

Age Factors↗
PubMed1980

Diagnosis of cervical epithelial abnormalities from 'routine' uterine curettings.

Fragments of cervical tissue are frequently found in uterine curettings. These may consist of endocervical mucosa, squamous epithelium, or both. To determine the frequency of abnormalities in this epithelium, 4000 consecutive endometrial curettings were examined during the year ending December 1977. Abnormal squamous epithelium was found in 20 cases (0.5%). The abnormalities were defined for the purpose of the study to include dysplasia/carcinoma in situ and warty atypia. Cases in which endometrial curettage was performed during the work-up for known dysplasia or carcinoma in situ were excluded. Subsequent follow-up included cytology, colposcopy, and colposcopically-directed target biopsies; occasionally conization and hysterectomy were performed. The most significant abnormality detected in this way was carcinoma in situ with early stromal invasion. The definitive treatment in most cases was cervical diathermy. As the abnormalities in the initial scrapings were previously unsuspected, it is imperative for the anatomic pathologist to look for and carefully evaluate cervical fragments in all endometrial curettings.

Adult↗
PubMed2005

Atypical Papanicolaou smear in pregnancy.

Atypical glandular cells (AGC) in Papanicolaou (Pap) smears can be associated with premalignant and malignant cervical and endometrial lesions. AGC is difficult to diagnose in pregnancy due to confusion with normal cellular changes that accompany graviditas. While guidelines have been established for management of AGC cases in the non-pregnant patient, special considerations are required when this is discovered during a pregnancy. A routine Pap smear performed on a 29-year-old woman being seen for a history of infertility yielded AGC and a high-grade squamous intraepithelial lesion. The patient achieved pregnancy 1 month later. Satisfactory colposcopic exam was performed with cytobrush sampling of the endocervical canal, in addition to 2 exocervical biopsies at 11 weeks gestation. Positive diagnosis of endocervical adenocarcinoma in situ resulted in a risk-informed decision to proceed with a cold knife conization of the cervix. Final pathology showed complete resection of the lesion with negative margins and an additional area of squamous dysplasia (cervical intraepithelial neoplasia, grade II to III). Appropriate follow-up was recommended. AGC found upon Pap smear during a pregnancy can be associated with significant pathology for which an aggressive management approach is warranted.

Adult↗
PubMed1995

Transrectal and transperineal sonography during guided intrauterine procedures.

Transrectal sonography was used to provide intraoperative guidance for dilatation and curettage and placement of intrauterine tandem apparatus in 20 patients in whom the external cervical os could not be visualized adequately. Transrectal sonography was found to be useful in providing guidance for these procedures and at the same time helped avoid uterine perforation. This method also was used during cerclage placement in two patients who had undergone several conizations. Transperineal sonography was used in three patients whose area of abnormality was best approached transperineally. These cases included transvaginal biopsy of a metastatic trophoblastic tumor and one guided aspiration of a perirectal abscess after pelvic exenteration. The potential advantages and pitfalls in the intraoperative use of transrectal and transperineal sonography for guided intrauterine procedures are discussed and illustrated.

Abscess↗
PubMed1976

Colposcopic evaluation of cervical intraepithelial neoplasia.

Colposcopic examination and directed biopsies were performed on 70 patients with abnormal cerivcal cytology. The correlation of the histology of the directed biopsies with the colposcopic appearance was 80%; it was 86% with the original Papanicolaou smear. In no case was the histology of a subsequent cone biopsy or hysterectomy specimen more advanced than that of the directed biopsy. Conization was avoided in 52 of the 70 patients and could have been avoided in seven others.

Adult↗
PubMed1999

Pregnancy outcome after laser vaporization of the cervix.

BACKGROUND: Treatment of cervical intraepithelial neoplasia (CIN) with cold knife or CO2-laser conization is associated with obstetrical problems in subsequent pregnancies. Little is published about pregnancy outcome after laser vaporization of the uterine cervix. The aim of this study was to determine the risk of preterm delivery and low birth weight in pregnancies following this kind of treatment. METHODS: Two hundred and thirty-six women who during the 11 year period 1982 to 1992 underwent laser vaporization of the uterine cervix and after treatment gave birth were included in this study. For each case two controls matched for parity, age (-/+ 3 years) and year of delivery were identified. The material was analyzed as a matched cohort study. RESULTS: No relationship was found between laser vaporization and preterm delivery or low birth weight. Medial gestational length was in both groups 40 weeks (range 3142 weeks among cases and 2842 weeks among controls). Mean birth weight was 3428 g (range 1370 to 6130 g) among cases and 3407 (range 672 to 5470 g) among controls. CONCLUSION: Laser vaporization of the uterine cervix does not influence the outcome of subsequent pregnancy.

Adult↗
PubMedDate not supplied

[Characterization of major ambulatory surgery in a basic general hospital].

BACKGROUND: Outpatient surgery initially came into being and further developed as a result of the progressive increase in the demand and in hospital expenses. Although it has afforded the possibility of lowering the cost per procedure and of improving the efficiency of the hospitals by maintaining the degrees of patient satisfaction and safety, it has also made it necessary to question the customary activity indicators. This had led us to assess the outpatient surgery units of the recently-opened Algeciras Hospital based on the customary system of payment in other countries, the Related Diagnostic Groups (RDG's). METHODS: Descriptive study regarding 3,051 surgical procedures performed on a scheduled basis in 1997 (not including the minor surgery using a local anesthetic), using as a source of information the minimum basic set of data for hospital discharge, obtaining and analyzing the RDG's. The hospital stays avoided based on the average stay of those patients admitted for the same RDG within the time period under study have been calculated. RESULTS: Major surgery performed on an outpatient basis afforded the possibility of an overall replacement percentage of 50.4% (33.3% of all of the patients who underwent surgery on a scheduled basis, that is, 4.1% of all of this Hospital's admissions), which meant an savings of 2,112 hospital stays. The most frequent RDG's having the greatest impact on stays avoided were the surgical procedures performed on the crystalline lens and the scraping or conization procedures performed for reasons other than malignant neoplasia. The readmission rate was 1.5%. CONCLUSIONS: The overall replacement rate obtained by this major outpatient surgery unit is considered to be acceptable, although it must increase within the next few years. We found differences in the spread of the processes dealt with as compared to other units in our environment, this being explainable due to the difficulties involved in starting up surgery of these characteristics.

Adolescent↗
PubMed1999

Colposcopy, cytology and histology in the diagnosis of squamous intraepithelial lesions of the cervix.

OBJECTIVE: To compare colposcopic findings to cytologic and histological diagnoses in women with colposcopic reports of ANTZ and/or HPV infection. METHODS: Among 791 hospitalized women referred for colposcopic examination, colposcopy showed ANTZ grade 0-2 and/or HPV infection in 271 patients (34.26%). Only 153 were fully investigated by colposcopy, cytology (under colposcopic observation) and histology (target punch biopsy: 109 patients; surgical specimens of hysterectomy: 42 patients; conization: 2 patients). Cytological and histological diagnoses were reported according to the Bethesda System. RESULTS: 132/153 Pap smears were estimable for sampling adequacy; 44/63 resulted as normal and were histologically positive for LSIL [1]. Five LSIL-positive Pap tests were negative on histology (false negative and false positive rate of 33.33% and 3.78%). The pap test was diagnostic for intraepithelial neoplasia in 34/65 cases (53.3%) and for invasive cancer in 6/11 cases (54.5%). In 67/132 cases (50.8%) adequate-for-sampling Pap smears could not predict the exact diagnosis. On the other hand, 108/141 patients with colposcopic evidence of ANTZ/cancer showed histological SIL or invasive neoplasm (76.59%): ANTZ 1 was associated to LSIL and HSIL in 74.1% and 2.4%; ANTZ 2 to LSIL, HSIL and invasive cancer in 41%, 30.76% and 10.3%. Colposcopic suspicion of invasive cancer in 8 patients was histologically demonstrated in 7 (87.5%); colposcopic diagnosis of HPV infection was confirmed in 10/12 (83.4%). CONCLUSION: A better correspondance was shown between colposcopy and histology than between cytology and histology in the diagnosis of SIL. We suggest a routine colposcopy investigation for all patients admitted to a gynecological clinic and we believe it is very important to take Pap smears under colposcopic observation if colposcopy and cervical smears are performed in the same sitting.

Adult↗
PubMed1999

[Histopathological verification of the cervical pap smears based on material of the obstetrical-gynecological department of the provincial hospital in Kielce].

The results of the cervical Pap. smear taken before cold knife conization and the histopathological results of the cones removed in 336 women, were compared. In cytological examination we found 10.8% (13/120) false negative results, which did not confirm of the existence the precancerous lesion within cervical epithelium. The mild dysplasia according to Pap. smears was established among 15.9% (15/94) of women with CIN III and CIN II diagnosed pathologically. In part of the women the histopathological results of the postoperative specimens and bioptic cervical material were compared. Clinical value and correlation between histopathological and cytological results in the estimation of CIN (cervical intraepithelial neoplasia) were discussed with particular regard to CIN I according to Bethesda system.

Adult↗