Discrepancy of cervical cytology and colposcopic biopsy: is cervical conization necessary?
Article Abstract:
The Papanicolaou test ('Pap smear') is used to screen for cancer cells in the cervix and vagina. Tissue from the cervix is obtained during a routine pelvic examination, and microscopically examined after staining. Colposcopy is the examination of the tissue in the vagina and cervix using a device fitted with a magnifying lens. Biopsies can be obtained during colposcopic examination. When the results of the Pap smear are inconsistent with the findings of colposcopic biopsy, the patient can be further assessed by cervical conization, in which a cone of mucous membrane tissue from the cervix is cut out for analysis. The necessity for cervical conization was assessed in 65 patients with discrepancies in results from Papanicolaou smears and colposcopic biopsies. Of the 65 patients, 20 received medical treatment; nine underwent cryotherapy, or treatment with extreme cold; and 36 underwent cervical conization. Cervical cancer was detected in three patients examined by cervical conization. Of the 20 women treated medically, two had no evidence of cervical cell abnormalities; two were diagnosed with stage 1 cervical intraepithelial neoplasia (CIN), characterized by the development of new growths within the cervical epithelium, the outer tissue layer; and five received further treatment. Additional information could not be obtained for the remaining 11 patients, including seven who did not return after medical treatment, and four with persistent abnormalities of cervical cells. Six of nine patients treated by cryotherapy had negative results from the initial Papanicolaou smear. These findings suggest that cervical conization should be performed in patients with discrepancies in results from the Papanicolaou smear and colposcopic biopsy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1991
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Hysterectomy for chronic pelvic pain of presumed uterine etiology
Article Abstract:
Chronic pelvic pain can be difficult to treat and is responsible for 10 percent of all hysterectomy cases (removal of the uterus), according to one report. For this reason, determination of the effectiveness of this dramatic procedure on pelvic pain is important. To address this issue, a follow-up study was performed on 99 women, with an average age of 34, who had undergone hysterectomy for chronic pelvic pain. The patients had disease apparently confined to the uterus and pain of at least six months' duration. Twelve were found to have leiomyomata (a tumor of muscle cell origin), 20 had adenomyosis (benign ingrowth of tissue lining the uterus into the uterine muscle), and two had both conditions. However, on examination of the uteri no histopathology was found for the majority of women, nor did they have abnormalities of the other female reproductive organs. During an average follow-up period of approximately 22 months, 77 women had no significant pain, while 22 had persistent pain. The pain was not related to the extent of histopathology. Thus, hysterectomy for the treatment of chronic pelvic pain leaves approximately 22 percent of patients with no real relief. Patients with this complaint should be thoroughly evaluated to see whether their symptoms are the result of disease in other organs. Certainly the possibility that pain relief will not be obtained should be included in the considerations leading to informed consent. Diagnostic laparoscopy (viewing the reproductive organs through a fiber optics tube) is advisable before hysterectomy; it was performed in only 12 of the 99 women who were studied. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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Serial endovaginal sonography of ectopic pregnancies treated with methotrexate
Article Abstract:
Tubal pregnancies are a type of ectopic pregnancy, in which the embryo becomes attached to an area other than inside the uterus, specifically the fallopian tube. These pregnancies have traditionally required surgery for effective treatment (termination of the pregnancy), but recently, an alternative non-surgical drug therapy using methotrexate has been developed. This new method is appealing because treatment can be performed on an outpatient basis, which can reduce costs; more importantly, the technique may better protect the patient's ability to conceive in the future. Sonography, an imaging technique utilizing sound waves, was used to monitor treatment of unruptured ectopic pregnancies in 18 women who received methotrexate therapy. The sonograms continued until the mass was no longer visible and blood levels of the hormone that indicates pregnancy (hCG) returned to normal. Enlargement of the mass over time was observed in 10 patients, but only two of those patients required surgical treatment for rupture of the mass. The mass disappeared between 5 and 108 days, but in seven cases, the mass remained visible even after blood levels of hCG returned to normal, which did not indicate failure of the drug treatment. In this study, no correlation between the initial size of the mass and the time it took to disappear could be made because the exact time of disappearance was unknown in some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1991
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