P. De Grandi

Colposcopic evaluation after a repeat atypical squamous cells of undetermined significance (ASCUS) smear

Objectives: Management of patients with atypical squamous cells of undetermined significance (ASCUS) remains controversial. We chose to repeat the Pap smear after four months. If ASCUS persisted in this second test, the patient was advised to undergo colposcopy. Our objective is to determine the clinical significance and the prediction of neoplasia among these patients through a colposcopic examination. Methods: Of 29 827 patients who had a Pap smear, ASCUS were detected in 1387 (5%) and persisted in the repeat smear of 225 (16%). Colposcopy and an additional Pap smear were performed on 186 patients. Results: Out of 186 colposcopic evaluations, 91 (49%) were normal and the patients had a negative Pap smear. Colposcopy was abnormal in 95/186 patients (51%) ( Table 1 ). Histology of the directed biopsies revealed 38 (21%) low‐grade squamous intraepithelial lesions (LSIL) and 17 (9%) high‐grade squamous intraepithelial lesions (HSIL). Forty patients (21%) with normal biopsies had ASCUS for the third time in the Pap smear. Conclusions: Colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost‐effective management. Finding 30% of LSIL or HSIL justifies this additional investigation.

Radiation therapy duration influences overall survival in patients with cervical carcinoma.

Objective: This article analyses the influence of treatment duration on survival in patients with invasive carcinoma of the cervix treated by radical radiation therapy. Method: Three hundred and sixty patients with FIGO stage IB–IIIB carcinoma of the cervix were treated in Lausanne (Switzerland) with external radiation and brachytherapy as first line therapy. Median therapy duration was 45 days. Patients were classified according to the duration of the therapies, taking 60 days (the 75th percentile) as an arbitrary cut‐off. Results: The 5‐year survival was 61% (S.E. = 3%) for the therapy duration group of less than 60 days and 53% (S.E. = 7%) for the group of more than 60 days. In terms of univariate hazard ratio (HR), the relative difference between the two groups corresponds to a 50% increase of deaths (HR = 1.53, 95% CI = 1.03–2.28) for the longer therapy duration group (P = 0.044). In a multivariate analysis, the magnitude of estimated relative hazards for the longer therapies are confirmed though significance was reduced (HR = 1.52, 95% CI = 0.94–2.45, P = 0.084). Conclusion: These findings suggest that short treatment duration is a factor associated with longer survival in carcinoma of the cervix.

A New Uterine Manipulator for Gynecologic Laparoscopy

The various disadvantages of the uterine manipulators currently used for gynecologic laparoscopy are reviewed. A new, reliable and atraumatic manipulator is presented.

Thermal endometrial ablation with cavaterm: Clinical results

pare&ml. Our aim of this study was to evaluate the possibility of materno-infantile transmission of lTV. Methods: Serum samples which were collected from 36 healthy and 8.5 hepatitis C virus (HCV) / hepatitis B virus (HBV) carrier pregnant women were screened for ‘lTV DNA. ‘lTV DNA was detected by seminested PCR using the primers detecting genotype .Pa. Twenty one infants who were born from ‘lTV carrier mothers were followed for 1 to 37months. Results: The detection rates of ‘lTV were 27% (10/36) and 26% (22/85) in non-pathological and HCV/HBV carrier pregnant women, respectively. The vertical transmission frequency of TTV was 43% (9/21) and the positive seroconversion occurred after the age of 5 months without an exception. In addition, breast feeding periods correlated positively with the frequency of TTV materno-infantile transmission, which suggests the significance of breast milk as one of infectious routes. Conclusion: ‘lTV is transmitted very highly from carrier mothers to their respective offsprings. Based on the infantile age of TTV-positive seroconversion, intrauterine or birth canal infection takes places less frequently. Breast feeding seems, so far, to be one of the most possible infectious routes.