Dehaeck K

Acetic acid visualization of the cervix: an alternative to cytologic screening.

Objective To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening. Methods A prospective study was conducted in a squatter area in Cape Town, South Africa, on 2426 women who underwent speculum examination, naked-eye inspection of the cervix after application of acetic acid, and cytologic smear. The smears were stained and processed at the screening site. Patients with a positive reading after acetic acid or a smear indicating a high-grade squamous intraepithelial lesion (SIL) were referred for immediate colposcopy, biopsy, and when indicated, treatment by large loop excision of the transformation zone. Therefore, histology was obtained on all patients with a positive acetic acid test or a positive cytology. Results Seventy-six women with positive reactions to acetic acid. Among the 2350 women with negative reactions, 254 had positive cervical smears; only 11 of these had histologic high-grade SIL. In contrast, 20 of the 61 women with positive cytology and positive acetic acid test had high-grade SIL on histology. Therefore, the acetic acid reaction enabled the observer to detect 20 of the 31 women (64%) who exhibited a high-grade SIL both on cytology and histology. Conclusion In locations where access to cytopathology is limited, naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions.

Peutz‐Jeghers syndrome in association with adenoma malignum (minimal deviation adenocarcinoma) of the cervix. Case report

A 44-year-old woman was admitted to the Gynaecological Oncology and Radiotherapy unit of the Groote Schuur Hospital in Cape Town for persistent dysuria and a vaginal tumour. At the age of 16 the diagnosis of PeutzJeghers syndrome (PJS) had been made after she had presented with rectal bleeding and was found to have melanin pigmentation around the mouth and on her fingers. At the time she underwent surgery twice to relicvc intestinal obstruction due to duodenal intussusception. Two ycars later she had a bowel resection at which time duodenal hamartomatous polyps were found confirming the diagnosis of PJS. At the agc of 19 several anal polyps were removed. At the age of 40 she underwent a total abdominal. hysterectomy with bilateral salpingooophorectomy for menorrhagia. Histological examination of the cervix was thought to show adenosis. Three years later she presented to her gynaecologist with persistent dysuria, when the

Ultrasonography of pelvic masses

29 Romero R, Avila C, Brekus C et al. The role of systemic and intrauterine infection in preterm parturition in uterine contractility. In: Garfield R, editor. Mechanism of Control. Norwell, Massachusetts: Serono Symposia, 1990: 319-353. 30 Romero R, Quintero R, Nores J et al. Amniotic fluid white blood count: a rapid and simple test to diagnose microbial invasion of the amniotic cavity and predict preterm delivery. Am J Obstet Gynecol