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PubMed1992

Loop electrosurgical excision procedure for CIN.

The loop electrosurgical excision procedure, also referred to as large loop excision of the transformation zone, is gaining acceptance in the United States as a method for treating cervical intraepithelial neoplasia. Loop excision of cervical tissue is accomplished using a high-frequency alternating current (radiofrequency) and thin wire loop electrodes. Loop excision may be in the form of simple excision of the transformation zone or electrosurgical loop conization. The specimens obtained using this technique are suitable for histologic evaluation. Loop excision, which is usually performed under local anesthesia, is associated with minimal short-term and long-term morbidity. Patient acceptance is high. Family physicians who perform colposcopy should consider using loop electrosurgical excision to treat cervical intraepithelial neoplasia in the outpatient setting.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

[Using ketoprofen in gynaecological practice].

Prophylaxis and treatment of pain syndrome in gynaecology is connected with surgical intrusions. The article presents a critical analysis on characteristics of Ketoprofen, the use of this medication in perspective. The medication had been prescribed in doses 100.00 mg per rectum two hours and 100.00 mg intramuscularly 30 minutes before small-invasive operations (electrocauterizing conization of cervix uteri, diagnostic curettage of the uteri, and abortion in small pregnancy term) started. Ketoprofen has been revealed to have characteristics of adequate analgesia before an operation and prevents the development of pain syndrome in patients after they are operated.

Administration, Rectal↗

PubMed2006

Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection--case report.

OBJECTIVE: The aim of this study was to describe the first robotic-assisted radical hysterectomy (Piver type III) and bilateral pelvic lymph node dissection for a patient with Stage Ib1 cervical carcinoma. CASE: A 43-year-old woman G1, P1, previously operated on due to endometriosis with removal of the left ovary and fallopian tube, came under our care. In addition, hysteroscopic myomectomy had been done two years before. Otherwise the patient was healthy. Preoperative conization histology revealed 6 mm of stromal infiltration. The patient was offered the da Vinci robotic Wertheim operation for the first time which was well accepted and she was discharged uneventfully on the 4th day postoperatively. Four months later at a routine check-up we found asymptomatic bilateral lymphocysts but otherwise normal status. CONCLUSION: It is fully possible to perform Piver type III laparoscopic radical hysterectomy using the da Vinci robotic system and it seems that radical dissection is much more precise than the conventional laparoscopic radical hysterectomy.

Adult↗

PubMed1991

Hysteroscopy.

This review discusses advances in hysteroscopy in the past decade, including the introduction of small-caliber endoscopes, microhysteroscopy, the flexible steerable hysteroscope, and the use of video systems in monitoring hysteroscopic evaluations. Media for uterine distension are reviewed and possible complications of the use of dextran 70 are discussed. Hysteroscopy is superior to curettage for evaluating abnormal uterine bleeding. Hysteroscopy can be used as an adjunct to hysterosalpingography, endometrial biopsy, and laparoscopy in evaluating infertility, and in detecting and treating intrauterine adhesions. The method has also been applied to the division of uterine septa, the removal of submucous leiomyomas, and tubal cannulation both for treating tubal obstruction at the cornual areas and in conjunction with new reproductive technologies. The use of the microcolpohysteroscope to tailor the size and extension of a cervical conization is described. Finally, hysteroscopy permits evaluation of the extension and involvement of the endocervical canal in patients with endometrial neoplasia and offers an important guide in staging and planning treatment for this condition.

Female↗

PubMed1991

Improving the Cytobrush as an aid in the evaluation of the abnormal Papanicolaou test.

In a series of 39 patients undergoing cervical conization, the Cytobrush was used to determine whether dysplasia involved the endocervical canal. To improve the specificity of the Cytobrush for this purpose, a sleeve was designed to guide the brush into the endocervical canal in order to minimize contamination from ectocervical lesions. Both the unsleeved and sleeved Cytobrush demonstrated good sensitivity for detecting dysplasia within the endocervical canal (89 and 95%, respectively). The sleeved Cytobrush demonstrated greater specificity than the unsleeved Cytobrush (90 versus 60%; P less than .05). Compared with endocervical curettage, the Cytobrush used in conjunction with the described "cytosleeve" offers an inexpensive, less painful, and accurate method of determining endocervical involvement of dysplasia.

Adult↗

PubMed1991

Distinguishing tubal metaplasia from endocervical dysplasia on cervical Papanicolaou smears.

Tubal metaplasia is a benign endocervical lesion. There may be confusion, however, in distinguishing tubal metaplasia from endocervical gland dysplasia on Papanicolaou smear. We present a case in which a cervical smear diagnosis initially reported as endocervical atypia was corrected to a diagnosis of tubal metaplasia upon cytologic review, thus altering patient management. The presence of terminal bars and cilia are the most helpful features in the cytologic recognition of tubal metaplasia. The evaluation of endocervical gland dysplasia suggested by Papanicolaou smear may include diagnostic conization; therefore, to prevent unnecessary intervention, it is important to distinguish endocervical gland dysplasia from tubal metaplasia.

Adult↗

PubMed1991

Transvaginal cerclage under ultrasound guidance in cases of severe cervical hypoplasia.

Transabdominal cervical cerclage has been advocated for patients with cervical incompetence whose cervix is flush against the vaginal wall. Although several series of successful transabdominal cerclage have been reported, the morbidity of this technique precludes its routine use. We describe five pregnancies in four patients with extreme cervical hypoplasia who underwent successful prophylactic transvaginal cerclage placement at 12-13 weeks' gestation. All patients had a history of intrauterine diethylstilbestrol exposure, and three patients had also undergone cervical conization. In each case, using continuous transabdominal ultrasound guidance, the supravaginal cervix was dissected and two nonabsorbable sutures were placed through the cervix at right angles at the level of the anatomical internal os. There were no perioperative complications, and except for one patient who developed severe preeclampsia at 33 weeks, all patients delivered at term. We believe that the use of ultrasound in cases of severe cervical hypoplasia allows safe transvaginal cerclage placement, obviating the need for abdominal cerclage.

Abnormalities, Drug-Induced↗

PubMed1991

Evaluating cervical cone biopsy specimens with frozen sections at hysterectomy.

Frozen section evaluations of cervical cone biopsy specimens were performed at the time of hysterectomy to exclude invasive cervical cancer. During a two-year period we prospectively evaluated 43 cone biopsy specimens. We found all the diagnoses made with frozen sections to be accurate when compared with prospective permanent sections, and all patients received appropriate therapy. Thirty-eight cases showed no evidence of invasion. Two patients had invasive squamous cell cervical cancer, one had invasive cervical adenocarcinoma extending to the endometrial cavity, and two had microinvasion. All invasive cancers were diagnosed correctly with frozen sections and confirmed with permanent sections. When hysterectomy immediately followed conization, no complications occurred, and no significant increase in blood loss was noted. We found frozen section evaluation of a cone biopsy specimen at the time of hysterectomy to be a reliable procedure that saves time, eliminates the risk of additional anesthesia and decreases patients' costs.

Adult↗

PubMed1990

[Studies on Nd:YAG laser therapy for cervical intraepithelial neoplasia].

Basic and clinical studies were performed to establish the value of Nd:YAG laser therapy for treating cervical intraepithelial neoplasia (CIN) with preservation of the uterus. The basic studies revealed that application of a surgical rod with a 0.4 mm tip at an output of 20 watts was the most suitable. Its use produced an excellent cone specimen, and there was no difficulty in making a histopathological diagnosis of the lesion. The layer of coagulation produced by the contact laser with microchip at a 20 watt output was 0.36 mm thick with 1 second of irradiation. This layer became thicker as the coagulation time became longer. Thus, necrosis of the residual lesion could be produced together with hemostasis. A clinical study was performed in 329 patients with CIN who were treated from September 1983 through December 1988 with Nd:YAG laser therapy. The preoperative diagnosis was mild dysplasia in 94 patients, severe dysplasia in 97, and carcinoma in situ in 138. Contact Nd:YAG laser conization (method A) was used in 272 cases, and Nd:YAG laser vaporization (method B) in 57 cases. After a single treatment, the overall cure rate was 97.6%. This high cure rate was obtained because irradiation technique most suitable for each lesion was chosen from among five techniques at the time of colpo.cervicoscopy. The cure rate was 98.9% with method A, and 91.2% with method B. Using method A, a deeper layer of coagulation necrosis was produced in the cone bed so that any residual was eliminated. In addition, using method A a cone specimen could be obtained to facilitate the histological diagnosis after operation and to determine the adequacy of excision. Accordingly, when there was incomplete excision, the prognosis could still be judged from histological examination of the lesion. The histological appearance of the cone specimen was valuable in planning the follow-up and further treatment where necessary. There were no serious side effects with either method. The average time required for therapy was 11.4 minutes with method A and 12.2 minutes with method B. From the review of the incompletely excised cases using method A, the uterus-preserving therapy is recommended when preoperative biopsy findings agree with or overestimate cytologic and colpo.cervicoscopic findings. Neither method A nor B affected fertility. Cervical healing and the incidence of subsequent pregnancies were very satisfactory with both methods. These results show that Nd:YAG laser therapy is very effective in CIN and can allow the uterus to be preserved.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1990

[Endocervical curettage. Its use in the colposcopic assessment of a patient who has an abnormal cervico-vaginal smear].

Endocervical curettage (ECC) is a simple way of exploring the endocervical canal and is useful for the management of a patient with an abnormal smear. If colposcopy is satisfactory, ECC is usually negative confirming that the canal is free of disease and out-patient treatment can be used. A positive ECC warrants conization. If colposcopy is not satisfactory, ECC is usually positive, confirming extension of the disease in the canal, and sometimes the presence of an invasive lesion requiring a radical treatment right away. An endocervical adenocarcinoma alone or associated with an epidermoid lesion may also be identified. Post cone ECC confirms the absence of residual disease. Follow-up of patients after treatment and/or the menopause with an ECC is helped, especially when the squamocolumnar junction is not seen.

Biopsy↗

PubMed1990

[Intra-lesional beta-interferon in combination with systemic thymopentin. Evaluation of results in 35 cases of CIN III and 2 cases of VAIN associated with HPV].

We performed an open study on 37 patients (average age 35 years), with CIN III or VAIN III and Viral Cytopatic Effects (VCE), who underwent a new standardized bifasic therapy by means of intralesional beta-interferon, topic beta-interferon and subcutaneous timopentine injection. Each therapeutic and checking step was made by colposcopic and microcolpohysteroscopic inspection, which showed spreading necrotic zones in the dysplastic places and peripheral typical epithelium replacement. Microcolpohysteroscopy allowed us to obtain correct diagnosis of the lesion and its location, to discriminate each pathologic aspects (CIN, VAIN, VCE), to perform an adeguated biopsy and intralesional therapy and to follow-up lesion course without repeated biopsies. After two months of therapy as maximum safety limit, we performed conization (in CIN case) in order to confirm the effects of therapy by hystology and especially to evaluate the deep lesional border. The istologic examination underlined the previous microcolpohysteroscopic report of dysplastic regression until its disapperance, with lasting VCE in all the cases.

Adjuvants, Immunologic↗

PubMed1990

[The management of pregnant women presenting with genital HPV infections].

The number of genital HPV infections has increased these past few years and, at present, 1 to 3% of pregnant women are infected. Before all treatment, a precise evaluation of the lesions is essential. The condylomata acuminata, and the plane condylomata associated or not to a slightly atypical lesion can be treated by CO2 laser spraying. This treatment is not recommended in cases of severe dysplasia because of possible adjacent micro-invasion. The questionable conization during the first trimester is not recommended after the latter. Systematic prophylactic caesarian section is indicated only in voluminous and diffuse florid condylomata which have not been treated or which persist after treatment.

Condylomata Acuminata↗

PubMed1990

[The demonstration of human papillomavirus DNA in genital lesions with and without colposcopic atypism].

34 cellular suspensions from the vaginal part of women were examined for presence of HPV DNA of the types: 6, 11, 16 and 18--from a lesion and a healthy area--by filter in situ hybridization. The women were examined by colposcopy because of cervical lesions established macroscopically as well as for other various complaints. Cells were also investigated from women after undergone ablation treatment: diathermy coagulation, conization and hysterectomy on account of CIN. The data were compared with cytological, colposcopic and histological findings. The established presence of HPV DNA of high risk type 16 and 18 in some of the patients after operative treatment required continuous control of these women as well as examination of lower genital tract because of the discovered multicentricity of HPV infection.

Adolescent↗

PubMed1990

Studies on the transmission of viral disease via the CO2 laser plume and ejecta.

While recent reports have noted the presence of viral DNA sequences in the laser plume, no significant effort has been made to study transmission of the virus in vivo via airborne laser debris. Studies were undertaken to identify potential hazards to operating room occupants in gynecologic laser surgery. ACO2 laser in the continuous wave mode using a power density of 666 W/cm2 was fired through a 5-cm metal cylinder at virus-infected tissues. Airborne particulate debris, 100-200 microns, was removed from the cylinder's inner surfaces. In one instance, deposition of the debris was found on the surgeon's eyeglasses 1 m from the site of impact despite the use of a smoke evacuator. The first set of studies involved confirmed human papillomavirus (HPV) lesions of the human female lower genital tract. Specimens were collected for electron microscopy and Southern Blot viral hybridization. Additional cervical electron microscopy specimens were recovered from the speculum during pulsed CO2 laser treatment at 13 W average power during conization. Electron microscopy of the vulvar debris revealed only anucleate keratinized squamous epithelial cells. Cervical specimens demonstrated similar cells with nearly instantaneous vaporization of intracellular water and apparent condensation of cellular carbon. HPV Southern Blot testing revealed insufficient quantities of DNA for that technique. The second set of studies involved bovine papillomavirus lesions from dairy cattle. The debris was transmitted to susceptible animals. The bovine studies failed to demonstrate the transmission of disease in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Characterization of AIDS-associated tumors in Italy: report of 435 cases of an IVDA-based series.

The Italian Cooperative Group on AIDS-related tumors has collected 435 cases of HIV-associated tumors since December 1986. The following conclusions can be drawn from this IVDA-based series: (1) at least 15% of AIDS cases are associated with tumors; (2) the number of malignant lymphomas (high-grade non-Hodgkin's lymphoma [NHL], Hodgkin's disease [HD] is comparable to that of Kaposi's sarcoma (KS) (188 vs. 198); (3) KS among AIDS patients is less common than in countries where homosexual men are the main group affected by AIDS. However, KS also affects intravenous drug abusers (IVDA) almost exclusively males, with characteristics similar to those observed among homosexual men; (4) HD is associated with an aggressive course; (5) anal and oral primary tumors as well as oral and anal involvement of NHL are very rare; (6) testicular cancers occur in patients mainly with early HIV infection, without adversely affecting the dosage of radiotherapy and chemotherapy; (7) cervical cancer successfully treated with conization suggests that PAP test screening in young IVDA women is warranted; (8) lung cancer occurs in a young age group with rapid progression and death.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Squamous cell carcinoma of the uterine cervix--a review with emphasis on prognostic factors and unusual variants.

Although the incidence of squamous cell carcinoma of the cervix has declined in recent years, it remains the most common type of cervical cancer in our society. In this review, the salient pathologic features of squamous cell carcinoma are discussed. Early invasive, International Federation of Gynecology and Obstetrics (FIGO) stage la carcinoma has been a source of controversy in diagnosis and therapy for many years. Specific requirements must be met in order to make this diagnosis. Most importantly, the cervical conization specimen must be handled properly, so that the features of tumor dimensions, vascular involvement, and completeness of excision can be correctly evaluated. Important diagnostic and prognostic pathologic findings of early invasive carcinoma are discussed. The risk of lymph node metastasis in lesions with depths of invasion up to 3 mm is less than 1%. This risk increases significantly with deeper levels of invasion. In the area of frankly invasive squamous cell carcinoma of the cervix, certain pathologic features have been shown to be clinically relevant. These include the extent of local disease, cell type, and the presence of vascular or lymphatic invasion. Regarding cell type, it is critical to distinguish between poorly differentiated small cell squamous carcinoma and small cell undifferentiated carcinoma, as the prognosis for these tumors may differ. Finally, several rare but pathologically distinct variants of squamous cell carcinoma of the cervix are reviewed, with emphasis on differential histologic features. As they often have different natural histories than typical squamous cell carcinoma, correct diagnosis of these lesions is vital.

Carcinoma, Papillary↗

PubMedDate not supplied

Immediate transposition of a latissimus dorsi muscle for correcting a postquadrantectomy breast deformity in Japanese patients.

With the aim of improving cosmetics after quadrantectomy, an immediate transposition of latissimus dorsi muscle was carried out. Cosmetic breast changes in transposed and non-transposed patients were evaluated by a Moire topography camera. To date, the breast deformity in five patients has been corrected only by conization of the residual breast tissue, and the breast deformity in the other five patients has been corrected by transposed latissimus dorsi muscle. Postoperative appearance and topography showed satisfactory symmetry of breasts in the transposed patients, when compared with the non-transposed patients. We conclude that the immediate transposition of latissimus dorsi muscle is useful for preventing post-quadrantectomy breast deformity.

Adult↗

PubMed1990

[Use of lasers in the treatment of diseases of the cervix uteri and vulva].

The results of laser treatment of 215 outpatients with cervical and vulval pathology are discussed. An unfocused high-energy CO2 laser was used to irradiate large areas of the vulva whereas a focused one--for treating precancer and early cancer of the uterine cervix by evaporation and conization. A low-energy helium-neon laser was used for the treatment of concomitant and precancerous lesions of the organs either alone or in combination with the CO2 laser. Said combination proved the most effective.

Adult↗