Benny Andreasson

Cervical intraepithelial neoplasia in pregnancy

Objective. To determine the progression/regression rate of cervical intraepithelial neoplasia in pregnancy and to describe the number of patients requiring treatment for cervical neoplasia during or following the pregnancy.

Sexual Function and Somatopsychic Reactions in Vulvectomy-Operated Women and their Partners

Sexual function and somatopsychic reactions were examined in 25 women following vulvectomy and in 15 of their partners. More than half of the women had both sexual dysfunction and psychological problems. Their partners had no sexual dysfunction but almost half had psychological problems. An important reason for this seems to be insufficient information and advice both pre‐ and postope‐ratively and failure to recognize a developing stricture of the introitus vaginae. Frequent control and advice to both partners both pre‐ and postoperatively is desirable. Less extensive surgical procedures in selected cases should be considered.

Sexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasia

Eighteen patients, under the age of 60 years, who have been treated with local excision of the vulva, participated in the study in which sexual function and somatopsychic reactions were evaluated by personal interviews. Furthermore both objective and subjective cosmetic results were registered. After this type of operation, fewer than one‐third of the patients had postoperative sexual and somatopsychic problems, whereas more than half of the patients undergoing vulvectomy did report such problems. Fourteen out of 18 patients were satisfied with the cosmetic result and in 12 of the patients no disfiguration was found. This study shows that local excision of intra‐epithelial neoplasia of the vulva is far less sexually traumatic than is vulvectomy.

Intraepithelial neoplasia in the vulvar region

From 1978 to 1982, 49 patients with intraepithelial neoplasia in the vulvar region were included in a prospective investigation. The main purpose was to evaluate the effect of treatment by local excision with a free margin of 2 mm and to estimate the importance of colposcopy. In 28% of the patients, the disease recurred after primary treatment, and in one patient microinvasion was shown. No patients died of cancer. A risk factor of recurrence was involvement of resection margins. Multicentric localization of the vulvar disease was found more frequently among patients treated for intraepithelial neoplasia of the cervix. In 66% of the patients the colposcopic findings were consistent with intraepithelial neoplasia. Local excision represents an improvement in the treatment of intraepithelial neoplasia of the vulva, but frequent follow-up is necessary.

Dermatofibrosarcoma protuberans of the vulva

A woman aged 52 years had a tumor of the mons pubis. The morphologic picture, featuring a whirling of spindle cells with long slender, interdigitating cell processes and so-called labyrinth nuclei, conformed to a dermatofibrosarcoma protuberans. Wide local excision is sufficient therapy, but more experience with this rare sarcoma of the vulva is necessary.

Invasive Cancer in the Vulvar Region

Abstract. During the past 25 years there has been a tenfold increase in the incidence of vulvar cancer in Denmark. For this reason a material of 195 patients treated during the period 1960–77 is reviewed.

Value of prognostic parameters in squamous cell carcinoma of the vulva.

In a series of 137 patients with cancer of the vulva who had undergone radical surgery we investigated, by means of a Cox regression model, which combination of clinical variables and clinical as well as histopathological variables afforded the best prediction of survival/death from cancer and survival/death from other causes. Among clinical variables the best prediction was afforded by a combination of tumor site in the clitoris/not clitoris, tumor size greater or smaller than 40 mm, obesity/not obesity, and age. Among clinical and histopathological variables the best prediction was by a combination of groin node metastases/not groin node metastases, tumor site in the clitoris/not clitoris, degree of differentiation high/moderate + low, and age. The combination of clinical and histopathological variables had a significantly better predictive power than clinical variables alone. The best prognostic group in both combinations had a 5-year-survival for cancer of 98%, while the poorest prognostic group in the two combinations showed a 5-year survival for cancer of 19 and 9%. The best predictors of death from causes other than cancer were age and a poor general health. It is concluded that the poorest prognostic group is definitely under treated and that the best prognostic group is presumably over treated. Patients in poor general health and with a good cancer prognosis should receive a more conservative treatment.

Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

Objective. Iatrogenic ureteral injury during pelvic surgical procedures is a well‐known complication and important cause of morbidity. The authors investigated the circumstances surrounding registered ureteral injuries in order to identify potential opportunities to prevent such injuries. Design. Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. Setting. Danish Patient Insurance Association. Sample. All registered claims for ureteral injuries from 1996 to 2006. Methods. Retrospective study of medical records and data from Danish Patient Insurance Association. Main outcome measures. Preventable ureteral injuries. Results. From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect the ureter despite indications for this procedure was the most common type of negligence. Laparotomy procedures were associated with 107 injuries (79%) and 29 injuries (21%) were caused during laparoscopic procedures. Thirty‐four patients suffered from chronic renal dysfunction on the affected side. Only 17 of the ureteral injuries were discovered during the procedure. Conclusions. Forty‐four ureteral injuries could potentially have been avoided using established surgical practices, most importantly by exposing the ureter via dissection when indicated. Most of the ureteral injuries were discovered postoperatively.

Laser and cryo surgery for cervical intraepithelial neoplasia: A randomized trial with longterm follow-up

In a randomized study, 204 patients with exocervical intra‐epithelial neoplasia were allocated to either laser evaporation (103) or cryocoagulation (101). The patients were treated on an outpatient basis without anesthesia. In the case of initial treatment failure the same method was to be used for retreatment. One hundred and eighty‐seven patients were followed‐up for an average of 50 months (12‐80). Eighty‐six of 94 laser‐evaporated patients (91%) and 89 of 93 cryocoagulated patients (96%) were cured after one treatment. Five of 8 laser failures and 3 of 4 cry0 failures were cured by retreatment. The cure rate after one or two laser evaporations was 97% (91 of 94 patients), and after one or two cryo coagulations, 99% (92 of 93 patients). Eighty per cent of residual or recurrent neoplasia occurred within 15 months and 96% within 2 years of treatment. No invasive neoplasia occurred during the follow‐up period and no tendency was seen towards higher grades of intra‐epithelial neoplasia in the failures compared with the initial diagnoses. It is concluded that laser evaporation and cryocoagulation are equally effective for the treatment of exocervical intra‐epithelial neoplasia.

Outpatient Treatment of Cervical Intraepithelial Neoplasia: The CO2 laser versus cryotherapy, a randomized trial

In a randomized study, 204 patients were allocated to either laser or cryo treatment for cervical intra‐epithelial neoplasia (CIN). The patients were treated on an outpatient basis without anesthesia unless other conditions requiring anesthesia had to be dealt with at the same time. Both the laser and the cryo method were highly acceptable to the patients. Slightly more patients experienced moderate or severe pain during laser treatment, compared with cryo treatment (P=0.05). Peroperative hemorrhage did not exceed 25 cc except for one laser‐treated patient. Postoperative vaginal discharge was more often seen after cryo coagulation, the discharge being malodorous in 36% of cryo‐treated patients and in 17% of laser‐treated patients. Pelvic inflammatory disease was found in one patient in each treatment group. Postoperative spotting occurred more often in laser‐treated patients (49%) than in cryo‐treated patients (22%). At follow‐up colposcopy 3 months after treatment, the squamocolum‐nar junction was fully visible significantly more often in laser‐treated patients (P< 0.001). The cure rates after one laser or cryo treatment were 90% and 91%, respectively. Subsequent to 19 initial treatment failures, 8 patients have at present been retreated with the same method as initially used, and all 8 are cured. The cure rates after one or two treatments are 96% in the laser group and 93% in the cryo group. The rates are preliminary, due to the short observation time. Publications will appear when all patients have been followed for 2 and 5 years.