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PubMed1992

Identifying human papillomavirus subtypes in cervical biopsies with in situ DNA hybridization with biotinylated probes.

To test the utility of biotinylated DNA probes against various subtypes of human papillomavirus (HPV), we performed in situ DNA hybridization on routinely processed archival material from 30 patients with serial cervical biopsies including conization (group I) and a prospective group of 35 patients whose cervical biopsies showed various degrees of koilocytotic atypia and/or dysplasia (group II). Commercially available biotinylated probe cocktails against HPV types 6 and 11, 16 and 18, and 31, 35 and 51 were detected via the avidin-biotin horseradish peroxidase technique. Virus was found in 87% (26/30) of group I and 57% (20/35) of group II. Almost exclusively, viral types 16, 18, 31, 35 and 51 were detected in group I; 54% (19/35) of group II stained for types 16, 18 or 31, 35 and 51; 2.9% (1/35) stained for types 6 and 11. Nine percent of group II (3/35) showed coinfection with types 16, 18 and 31, 35 and 51. Three of six vulvar condylomata (50%) stained for types 6 and 11. In general, weaker staining was associated with greater dysplasia. In situ hybridization using biotinylated DNA probes is useful in identifying patients infected with dysplasia/carcinoma-associated HPV subtypes and can be performed easily on routine surgical specimens.

Adult↗
PubMed1992

Early-stage squamous cell and adenocarcinoma of the cervix.

Articles on early-stage squamous cell and adenocarcinoma of the cervix published between August 1990 and July 1991 are reviewed. A new monoclonal antibody used to distinguish endocervical from endometrial differentiation is described, as well as a histochemical means of distinguishing in situ from invasive adenocarcinoma. In vitro and in vivo studies of cell lines immortalized with human papillomavirus DNA are described with a discussion of the mechanism of the development of malignancy. An animal model to test and develop an anti-human papillomavirus vaccine is presented. The epidemiology of adenocarcinoma is also reviewed, and the development of invasive carcinoma after conservative therapy or conization for dysplasia is discussed. Computed tomography scanning has been found to be no more accurate than examination for staging of early cervical cancer. Several studies in the review period have evaluated risk factors for recurrent disease in patients treated for early-stage cervical cancer, including a prospective surgical pathologic study by the Gynecologic Oncology Group. The optimal treatment of early stage I adenocarcinoma of the cervix is discussed, comparing the efficacy of primary surgical therapy with the efficacy of radiation therapy. The risk of ovarian metastases in patients with early-stage cervical cancer is very low for both squamous cell and adenocarcinoma. The surgical technique and efficacy of laparoscopic pelvic lymphadenectomy for patients with early-stage cervical cancer are discussed. Lateral transposition of the ovaries at the time of radical hysterectomy for cervical cancer has significant potential benefits but also risks. Finally, surveillance methods that detect recurrent cervical cancer after treatment for early-stage disease are discussed.

Adenocarcinoma↗
PubMed1992

Papillary immature metaplasia of the cervix: a distinct subset of exophytic cervical condyloma associated with HPV-6/11 nucleic acids.

A subset of exophytic cervical precursor lesions are composed of immature metaplastic cells that differ from conventional condylomata by the virtual absence of koilocytotic atypia and the presence of slender filiform papillae. We evaluated a series of exophytic cervical lesions containing this morphology for HPV nucleic acids and compared the associated HPV types with conventional exophytic condylomata of the cervix. Six of six exophytic condylomata and five of six papillary immature metaplasias (PIM), respectively, contained HPV type 6/11 by in situ hybridization. Subtyping of three PIM by polymerase chain reaction combined with direct sequencing revealed nucleic acid sequences consistent with HPV 6/11. PIM were distinguished from high-grade squamous intraepithelial lesions by the rarity of mitoses and by the uniformity of nuclear size and staining intensity with multiple chromocenters. However, these lesions tended to involve the more cephalad region of the cervical transformation zone, and three cases extended deeply into the endocervix with two requiring conization for a definitive diagnosis. Although their bland morphology and association with HPV 6/11 nucleic acids suggest a benign process, their location within the endocervical canal implies that these variants of condyloma may differ biologically from conventional exophytic condylomas of the cervix. The differential diagnosis of PIM and potential explanations for their distinctive morphology, are discussed.

Condylomata Acuminata↗
PubMed1992

Multianalytic study on cervical HPV lesions.

Nowadays new sophisticated techniques of molecular biology based on the principles of hybridization between nucleic acids, allow a correct diagnosis of genital HPV infection. In the present paper, beside traditional diagnostic methods, we used In Situ Hybridization (ISH) and Polymerase Chain Reaction (PCR) to detect the presence of HPV types 6, 11, 16, 18, 31 and 33. We tested ten patients affected by cervical lesions of high histological atypias associated with HPV, who underwent surgical conization. Types 6 and 11, at low risk of evolution, are less frequent than 31 and 33, at medium grade of evolution, and than 16 and 18 which are at high risk of evolution.

Adult↗
PubMed1992

Loop excision for cervical intraepithelial neoplasia.

We report the results of a prospective trial using a loop electrosurgical excision procedure (LEEP) on 97 patients with cervical intraepithelial neoplasia. In the LEEP group the mean cutting time and whole procedure time were 6.2 +/- 1.9 seconds and 12.7 +/- 3.5 minutes, respectively. The average blood loss was 3.6 +/- 1.9 mL. In the control group (39 cases) using laser conization, the mean cutting time and whole procedure time were 11.7 +/- 3.5 minutes and 44.9 +/- 8.9 minutes, respectively. The average blood loss in the control group was 11.2 +/- 3.1 mL. The differences between the two groups were statistically significant. During LEEP surgery, four cases had accidental vaginal excision. There were three cases of late cervical bleeding after surgery; the surface of the cervix was smooth, and no adhesion or crypt formation was noted after re-epithelialization. Eight patients became pregnant after the loop excision and no cervical incompetence was noted during antenatal care. After a one-year follow-up period in the colposcopy clinic, there was no recurrence of cervical intraepithelial neoplasia in either group. We advise that among the modalities of treatment for cervical intraepithelial neoplasia, LEEP appears to offer patients several benefits such as less bleeding, precise specimens, local anesthesia, less cost and less discomfort. It is particularly suitable for treating younger women who have not yet completed their families.

Adult↗
PubMed1992

Management of the patient with an abnormal Papanicolaou smear.

Any patient with an abnormal Papanicolaou smear should undergo colposcopic evaluation. Histologic examination of tissue obtained by biopsy and by endocervical curettage is essential for a proper diagnosis. Conization of the cervix has very well-defined indications.

Female↗
PubMed1992

Observations on prevention and management of vesicovaginal fistula after total hysterectomy.

A retrospective study of genital fistulas of the lower urinary tract revealed 91 percent to be postsurgical. Of these, 91 percent occurred after gynecologic procedures. Total hysterectomy was the most common antecedent procedure (n = 110), and the resulting lesion was the vault fistula. Abdominal total hysterectomy was the most frequent operation to precede a vault fistula (n = 92) and almost 70 percent occurred in the absence of factors identified as placing the patient at risk for injury to the bladder. Such risk factors included prior uterine operation, especially cesarean section, endometriosis, recent cold-knife cervical conization and prior radiation therapy. Twenty-four fistulas occurred despite recognition at the time of hysterectomy of injury to the bladder and its prompt repair. Thirty patients had undergone prior failed attempts at repair elsewhere. Three fistulas closed spontaneously. One hundred and seven were repaired by the Latzko technique. There were nine failures, each of which was successfully repaired by a repeat Latzko operation when vaginal reepithelization was complete. Suggestions to avoid injury to the bladder during abdominal total hysterectomy include use of a two-way indwelling catheter when risk factors are present, use of sharp dissection to isolate the bladder, use of extraperitoneal cystotomy when dissection is difficult, filling the bladder when injury is suspected and repair of an overt bladder injury only after mobilization of the injured area. A Latzko repair of a vault fistula is advised because complications are minimal, the postoperative patient is comfortable and the period of hospitalization is five days or less.

Blood Transfusion↗
PubMed2004

Management and follow-up of abnormal Papanicolaou tests.

Although less prevalent than breast cancer, cervical cancer has a lower 5-year survival rate. Cervical cancer is nearly always due to human papillomavirus (HPV). Increased screening and DNA typing for oncogenic HPV have begun to reduce the number of cases. Interpretation of Papanicolaou test results and disease management decisions require a comprehensive grasp of recent revisions in classification and management practice. This article reviews the recommendations of the multidisciplinary Bethesda 2001 Workshop and the American Society for Colposcopy and Cervical Pathology. Practice changes include: new criteria for using liquid-based collection, a streamlined borderline category of atypical squamous cells (ASC), and a new category of ASC-cannot exclude high-grade lesion (ASC-H). Management includes colposcopy for all categories suspicious for epithelial abnormality and clearer guidelines for diagnostic colposcopy and endocervical sampling for glandular cell abnormalities (AGC, AGC-favor neoplasia). Adolescents and postmenopausal women have some variations from the recommended protocol. Reflex HPV DNA typing reflects the advances in research regarding risks for progression to cervical cancer. Treatment options include surgical removal of the lesions via laser, cryosurgery, loop excision, or cold-knife conization. Medical options include local treatments of cervical condyloma with tricloroacetic acid or 5-fluorouracil. Visible and sometimes functional cervical changes may result. Clinicians now have clearer guidelines with which to manage abnormal Papanicolaou test results, using the latest technology and research. Discussing abnormal results with patients requires great sensitivity.

Adolescent↗
PubMed1992

Survey of colposcopy practices by obstetrician/gynecologists.

A statewide survey to characterize the colposcopy patterns of practicing obstetrician/gynecologists was undertaken. There was a 66.1% response rate, with 98.2% of respondents performing colposcopy. Of those performing colposcopy, nearly all perform biopsies, cryosurgery and conizations; 73.4% perform laser vaporization, 66.7% perform laser cone biopsy and 11% perform laser cone biopsies in their offices. The mean number of colposcopies performed by respondents in a six-month period was 55. Twenty percent performed less than one examination per week and an additional 60% performed two to three examinations per week. Further studies to assess the diagnostic accuracy of those performing greater and lesser numbers of examinations are needed.

Arizona↗
PubMed2004

Regional anesthesia for office procedures: Part II. Extremity and inguinal area surgeries.

The hand can be anesthetized effectively with blocks of the median, ulnar, or radial nerve. Each digit is supplied by four digital nerves, which can be blocked with injections on each side of the digit. Anterior or posterior ankle blocks can be used for regional anesthesia for the foot. The anterior ankle block, which is used for procedures on the dorsum of the foot, involves blocking the saphenous nerve, and superficial and deep peroneal nerves. The posterior ankle block, which is used to anesthetize the sole of the foot, involves blocking the sural and posterior tibial nerves. Paracervical block is used for procedures on the cervix, such as loop electrocauterization or conization. Dorsal penile block has been the most commonly recommended anesthetic technique for neonatal circumcision. A safe and effective alternative is the application of anesthetic cream over the skin to be circumcised.

Ambulatory Surgical Procedures↗
PubMed2004

Fine needle aspiration of the gestational sac for termination of early pregnancy in cervical stenosis: a case report.

BACKGROUND: First-trimester abortion in women with cervical stenosis results in difficult or impossible suction curettage. We present the case of an early pregnancy in a woman with cervical stenosis after cone biopsy in which the pregnancy was terminated by transvaginal needle aspiration of the gestational sac under echographic guidance. CASE: A 31-year-old woman, gravida 6, para 3, abortus 2, with a history of grade 3 cervical intraepithelial neoplasia after cervical conization, presented at 6 weeks' gestation and requested pregnancy termination. A cervical examination disclosed that the cervix was difficult to outline and that the external os could not be identified. Under the guidance of endovaginal sonography, a 16-gauge needle was introduced into the gestational sac through the anterior portion of the vagina. Intracardiac injection of potassium chloride was first attempted to stop fetal cardiac activity. The sac tissue was then aspirated, followed by repeated normal saline irrigation. The patient's postoperative course was smooth and was monitored in the outpatient department. CONCLUSION: For termination of early pregnancy complicated by cervical stenosis, whether due to blighted ovum, intrauterine fetal death or elective abortion, needle aspiration under the guidance of transvaginal sonography is safe and effective.

Abortion, Therapeutic↗
PubMed1992

Contact Nd:YAG laser and CO2 laser for cylindrical excision of the cervix. A comparative study.

An excess of blood loss and persistence of intraepithelial neoplasia after cervical conization occur with some frequency. Contact Nd:YAG laser conical excision of the uterine cervix is a new technique designed to remedy those problems. In this study, 36 women with histologically confirmed cervical intraepithelial neoplasia were treated with cylindrical excision of the uterine cervix with a contact Nd:YAG laser. The results were compared with those in 30 women who had similar lesions and were treated with the CO2 laser. Use of the Nd:YAG laser resulted in less intraoperative blood loss (mean +/- SD, 3.12 +/- 0.28 vs. 30.3 +/- 2.12 mL for the CO2 laser, P less than .01) and less postoperative blood loss. The volume of early bleeding was 6.23 +/- 1.21 vs. 20.13 +/- 2.24 mL for the CO2 laser (P less than .01), and that of late bleeding was 5.22 +/- 2.21 vs. 31.24 +/- 0.05 mL for the CO2 laser (P less than .01). The operative time was similarly less for the contact Nd:YAG laser (6.2 +/- 2.2 vs. 20.2 +/- 1.2 minutes for the CO2 laser, P less than .01). The dimensions of the excised specimens were similar. These findings suggest that the contact Nd:YAG laser offers distinct advantages over the CO2 laser in performing cylindrical excision of the cervix.

Blood Loss, Surgical↗
PubMedDate not supplied

Tubal metaplasia. A frequent potential pitfall in the cytologic diagnosis of endocervical glandular dysplasia on cervical smears.

The detection of endocervical glandular abnormalities has risen in recent years due to the increased clinical use of improved endocervical canal sampling instruments, such as Cytobrushes. From January 1987 through August 1989, a diagnosis of endocervical glandular dysplasia was initially suggested on cervical smears from 50 women for whom histologic follow-up information was available. Retrospective review of the cytologic smears and histologic slides from these patients revealed tubal metaplasia in 19 of 29 (66%) cases evaluated by cervical conization and/or hysterectomy and in 19 of 21 (90%) cases confirmed by cervical biopsy and/or endocervical curettage. Cytologic criteria for the diagnosis of tubal metaplasia on cervical smears are discussed. Inasmuch as adenocarcinoma in situ of the cervix and endocervical glandular dysplasia are not readily discernible by colposcopy, the responsibility for the diagnosis of these lesions lies with surgical pathologists and cytopathologists. Familiarity with the cytologic features of adenocarcinoma in situ and endocervical glandular dysplasia that distinguish these lesions from tubal metaplasia and other potential mimics is essential.

Adenocarcinoma↗
PubMed2004

Management of cervical cytologic abnormalities.

The American Society for Colposcopy and Cervical Pathology developed guidelines in 2001 for the management of cervical cytologic abnormalities. The guidelines incorporate the Bethesda System 2001 terminology and data from randomized studies of atypical squamous cells, low-grade intraepithelial lesions, human papillomavirus testing, and liquid-based cytology to formulate evidence-based recommendations. Each recommendation is graded according to the strength of the recommendation and the quality of the evidence, and specific terminology is added to highlight management options. The effectiveness of each triage recommendation is determined by the percentage of grade 2 and 3 cervical intraepithelial neoplasia it detects. Colposcopy, repeat cytology, and human papillomavirus DNA testing are acceptable options in women with atypical squamous cells of undetermined significance, but human papillomavirus DNA testing is preferred if liquid-based cytology is used. Colposcopy is recommended for women with a diagnosis of "atypical squamous cells-cannot rule out high-grade intraepithelial lesion." Women with low-grade squamous intraepithelial lesions should be referred for colposcopy, and women with high-grade lesions should undergo colposcopy and endocervical assessment. Colposcopy and endocervical sampling are recommended in women with all subcategories of atypical glandular cells. Endometrial sampling and colposcopy are recommended in women older than 35 years with atypical glandular cells and in younger women with unexplained vaginal bleeding. Women with a diagnosis of "atypical glandular cells-favor neoplasia" or adenocarcinoma-in-situ who are not found to have invasive disease on colposcopy should undergo a diagnostic excisional procedure, preferably a cold-knife conization.

Biopsy↗
PubMedDate not supplied

[Cervugid ovules in cervico-vaginal infections and cervix uteri precancerous conditions treatment].

UNLABELLED: This medicine was authorized by the National Drug Agency (ANM, Bucureşti) in 2001. PURPOSE: To evaluate the effectiveness and the tolerance to Cervugid-ovules, a preparation that combines the polyvalent local antiinflammatory action of chloramphenicol, metronidazole and nystatin with the effect of hydrocortisone acetate, an unspecific anti-inflammatory agent; they all are embedded in a Lipex-403, semisynthetic fat. MATERIALS AND METHODS: The evaluation of 500 patients ages between 15 and 85 years with genital infections, registered in the files of "Cl. II Obst. and Gynecology" of the Cuza-Vodă Hospital from Iaşi has been studied. We studied the subjective manifestations (local discomfort and pelvic pains, local burning and dryness,vulvovaginal itching and dyspareunia) and objective manifestations (vaginal and cervical secretion, the cytotest performed and colored though the Papanicolaou method and reported in the Bethesda system). RESULTS AND DISCUSSION: Healing of the subjective symptoms in 98%, healing of the leukorrhea--as a main objective symptom--in 95%; The Bethesda system cytotest was one of the inflammatory type in the most of the cases and there wew found in 85 cases: 6 ASCUS, 41 LSIL, and 37 HSIL. The use of Cervugid had a healing response in most of the cases when used in acute and chronic cervico-vaginal inflammatory processes. Cervugid may be considered as an important agent in the treatment of the precancerous affections af the cervix uteri on the following reasons: zhe cure of the infections caused by chlamydia, involved in the etiology of cervical neoplasms, the cure of the HPV infection under episome form, classified in the Bethesda system within the ASCUS, AGUS or LSIL classes. When the cytotest was in the HSIL class, a conization in the LLETZ method was performed. CONCLUSIONS: Cervugid is conceived for those three main categories of pathogenic factors related to the etiology of cervico-vaginitis: microbia germs, protozoa and mycosis. In addition, it is active on chlamydia and mycoplasms, always sensitive to chloramphenicol therapy. That is why Cervugid with in local administration is indicated in the microbial, trichomoniasis and mycotic vaginitis caused by one category of pathogenic agents or by associated forms, in cervicitis, in the pelvic inflammatory processes (pelvic congestion, metritis, adnexitis, and inflammatory processes associated with benign or malignant tumors of the genital apparatus). The results obtained proved that Cervugid is highly effective medicine.

Administration, Intravaginal↗
PubMed2005

[Cervical dysplasia and cervical carcinoma in pregnant women].

UNLABELLED: Cytological and histopathological examinations performed in pregnant women allow quick for diagnosis of these pathological states. MATERIAL AND METHODS: 35 pregnant women with cervical dysplasia or carcinoma treated in Department of High Risk Pregnancy from 1996 to 2001 were included in the study. Diagnosis was based on the cytological and histological tests. RESULTS: We observed 10 cases of low-grade dysplasia and 8 cases of medium grade dysplasia. Both groups were qualified for vaginal delivery and treatment was started after delivery. In 12 pregnant women high-grade dysplasia was diagnosed (in 6 of them cervical conization between 16 and 26 week of pregnancy was performed). In 5 women cervical carcinoma in pregnancy was diagnosed. In 3 of them we performed cesarean section with radical operation between 34 and 40 week of gestation. CONCLUSION: Cytological and histological examination in pregnant women with cervical abnormalities should be obligatory because of high rate of dysplasia and cancer in pregnant women.

Adult↗
PubMed1992

Fertility and conservative treatment in the early stage of cervical cancer.

The purpose of this study was to check fertility after the conisation of the cervix. Authors followed-up 74 conized women: 24 became pregnant and of the rest of them, 28 used contraceptive methods and 22 never became pregnant again. 76% of the pregnancies were normal. In only one case, in which the pregnancy was twin, was it necessary to use a cervical cerclage for cervical incontinence. Therefore conisation does not seem to be a limiting factor to fertility.

Adult↗
PubMed1992

[Precancerous stages of cervix cancer (CIN)--attitude and coping with the disease].

The subjective reactions and the mental state of 50 patients with a diagnosis CIN I, II and III were studied. The data were gathered after gynaecological follow-up examinations in semistructured interviews and with a list of complaints (B-L) according to Zerssen (1975). Patients with CIN I or II were examined and interviewed 3 months after diagnosis, patients with persistent CIN I or II were studied after 6 months, and patients with CIN III before conization. Patients with CIN reacted to the diagnosis in a similar manner to patients confronted with the diagnosis of cancer. Effective coping with the disease depended on adequate medical information being received by the women. The patients who were satisfied with the medical information had a more positive approach to the course of the disease and found it less life-threatening than those patients who were dissatisfied with the information received. The results of this study indicate that subjective experience of the disease is largely independent of its objective severity.

Adaptation, Psychological↗