Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees Centigrade using the Semm cold coagulator: 14 years experience
Article Abstract:
Cervical intraepithelial neoplasia (CIN) is an advanced grade of cervical cancer that overlaps with the category of carcinoma in situ. CIN is treated either by excision (removal) or destruction of diseased tissue. The most common destructive approach in Britain is the carbon dioxide laser, and cold coagulation is the next most common. The latter method, in spite of its name, uses temperatures as high as 120 degrees Centigrade to destroy abnormal tissue. To evaluate the effectiveness of cold coagulation for CIN 3 (the highest grade, indicating invasion of much or all of the cervical epithelium), a total of 1,661 women with abnormal cervical smears (Pap smears) and certain changes on colposcopic examination (inspection of cervix and vagina with a brightly lighted magnifying lens) were treated. The cold coagulation treatment required less than two minutes, and follow-up consisted of cervical smears at regular intervals. Results from the 1,628 patients who were reevaluated showed that cervical cells appeared normal after one treatment (primary success) in 93 percent of the cases, a rate that was similar for all age groups treated. The primary success rate fell as time went on, to 92 percent 5 years later, probably due to persistent, rather than recurrent, disease. Miscarriage or premature delivery rates were not increased after cold coagulation. The method is comparable with others, including laser treatment, in the proportion of treated patients who later develop invasive cancer. Although side effects and complications were not formally evaluated, few patients mentioned them. Treatment soon after receiving an abnormal pathology report reduces anxiety in patients, and this method, in the hands of an experienced clinician who can accurately diagnose CIN, leads to little inappropriate treatment. The coagulating device itself is described. Cold coagulation carried out in the manner described offers important advantages over more expensive approaches to treating CIN (such as the laser) and over approaches that require several clinic visits (repeat colposcopy). (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0306-5456
Year: 1991
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A multi-centre collaborative study into the treatment of menorrhagia by Nd-YAG laser ablation of the endometrium
Article Abstract:
Several modern surgical techniques have been developed for treating menorrhagia (excessive bleeding at the time of the menstrual period) that eliminate the need for hysterectomy (surgical removal of the uterus). They include selective destruction of affected regions of the endometrium (uterine lining) by means of electrical, laser, or radiofrequency energy. These approaches carry risks as well as benefits, all of which have not been completely evaluated. To learn more about the safety and effectiveness of one technique, endometrial laser ablation with the Nd-YAG laser (tissue removal using the neodymium-yttrium aluminum garnet laser), a study involving 859 women with menorrhagia was carried out in the US and Great Britain. The patients had menorrhagia that was resistant to conventional treatment, and were considered candidates for hysterectomy. The operative procedure, which required 24 minutes, on average, is described; most US patients went home the same day, while most patients in Great Britain remained in the hospital overnight. Results showed that, of 479 women followed for at least six months, 288 (60 percent) developed amenorrhea (cessation of menstrual bleeding) and 162 (34 percent) experienced a significant reduction in menstrual flow. Twenty-six of the 39 patients who did not improve after a first treatment, did so after a second. Hence, of the 479 women who were followed-up, 466 were effectively treated by laser therapy and only 13 required hysterectomy. No major complications were associated with the procedure, and none of the patients developed major bleeding or required blood transfusion or abdominal surgery. The findings, from the largest study yet performed of the treatment of menorrhagia with the Nd-YAG laser, demonstrate that this approach is safe and effective. Wider application of such minimally invasive surgery could lead to major changes in operative gynecology. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0306-5456
Year: 1991
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Patient acceptability of laser and cold coagulation therapy for pre-malignant disease of the uterine cervix
Article Abstract:
The acceptability to patients of two treatments for pre-malignant disease of the cervix, or cervical intraepithelial neoplasia, was compared in this study of 155 women. The patients were randomly assigned to receive either laser treatment (77 women) or cold coagulation (78), the more traditional and less expensive approach. All procedures were performed under local anesthesia. Subjects completed a scale indicating the extent of associated pain and anxiety, as well as the acceptability of the procedure after its conclusion. Cold coagulation treatment and laser treatment required about the same time to perform, but the laser treatment was reported to be more painful. Anxiety levels were similar for both treatments, and no differences were seen in the duration of bleeding or vaginal discharge. Four months later, both groups had similar acceptability scores. Between 18 and 20 percent of the subjects in both groups had positive cytology results on four-month follow-up, indicating a disappointingly low cure rate. Lasers appear to offer no advantages over cold coagulation for treating pre-malignant disease of the cervix, and may, in fact, be less acceptable to patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0306-5456
Year: 1991
User Contributions:
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