T. P. Rollason

Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women.

Objective To investigate the long term outcome of patients with vulvar intraepithelial neoplasia.

Failure of second-look laparotomy to influence survival in epithelial ovarian cancer.

The survival benefit of second-look laparotomy after completion of primary chemotherapy in patients with epithelial ovarian cancer has been assessed in a prospective randomised trial of 166 patients. Patients were randomised into three groups. All were initially treated with cisplatin (100 mg/m2 x 5) after primary laparotomy. Group A (n = 53) was scheduled to have a second-look laparotomy, followed by cyclical oral chlorambucil. Group B (n = 56) was scheduled to have a second-look laparotomy, followed by total abdominal and pelvic irradiation, and group C (n = 57) received oral chlorambucil as for group A but had no second-look operation. With a median follow up of 46 months (range 21-64), no differences in survival were noted between the three groups. The median survival for group A was 21 months (95% CI 11-31 months), for group B 15 months (11-19), and for group C 17 months (8-26). Thus second-look laparotomy after completion of first-line single-agent cisplatin chemotherapy did not confer any survival benefit on patients with epithelial ovarian cancer.

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)—a preliminary report

Objective To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN).

Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities

Objective To compare immediate and deferred treatment in women with cervical smears showing borderline nuclear abnormalities or mild dyskaryosis.

Endometrial hyperplasia and adenocarcinoma during tibolone (Livial) therapy.

duction. Although this would be consistent with the rise in MSAFP that is well described in association with invasive techniques, such as chorion villus sampling, in multifetal pregnancy reduction care was taken to avoid puncture of the placentae of the surviving fetuses. Therefore, the high levels of MSAFP are unlikely to be the consequence of disruption in the feto-maternal barrier and chronic leakage from the live fetuses to the mother across the placenta; the half-life of alpha-fetoprotein in the maternal circulation is only four to five days (Sappala & Ruoslahti 1973). Furthermore, there was a significant association between MSAFP and number of dead fetuses. The most likely explanation for high MSAFP following reduction is increased concentration of alpha-fetoprotein in the amniotic fluid due to tissue breakdown from the dead fetuses; MSAFP returns to the normal range 8 to 12 weeks after the reduction because by this time there is complete resorption of the dead fetuses. Previous studies have reported high levels of alpha-fetoprotein in the amniotic fluid of twin pregnancies after the spontaneous

Is loop excision adequate primary management of adenocarcinoma in situ of the cervix

Objective To assess the efficacy of cervical loop excision as primary management of adenocarcinoma in situ.

Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia)

Summary. Genital papillomatosis accompanied by distressing vulval symptoms is often termed vulvodynia. Common presenting symptoms are vulvar burning, pruritus and dyspareunia. Sixteen patients with vulval papillomatosis (vulvodynia) have been treated by carbon dioxide laser therapy over a 4‐year period. Initial responses at 6 weeks appeared encouraging but with follow‐up it became apparent that the relapse rate was high, with a mean symptom‐free interval of 4–6 months. Of the 16 patients treated, only three remain symptom free. In view of our findings, we recommend that laser therapy should not be offered as a primary procedure, if at all, for patients with vulval papillomatosis.

Binding of anti‐EMA, AGF 4:48 and the lectin UEA‐1 to human ovarian carcinomas: histological and clinical correlations

Summary. The staining reactions of the monoclonal antibodies anti‐EMA, AGF 4:48 and the lectin UEA‐1 from Ulex europaeus were investigated in formalin‐fixed, paraffin‐embedded sections of 36 primary ovarian carcinomas. The staining patterns were graded and related to tumour type, differentiation, FIGO stage and patient survival. Both antibodies and UEA‐1 showed variations in their staining between and within tumours. The staining of mucinous tumours using anti‐EMA was significantly less than in non‐mucinous tumours. No other significant associations were found between staining grade and the different variables under study. The variations in staining were not demonstrated to have any prognostic significance.

How accurate is colposcopy in the diagnosis of cervical human papillomavirus infection

SummaryThe colposcopic and histological characteristics of 152 women referred for evaluation of cytological abnormality were analysed to determine the accuracy of colposcopy in the detection of cervical human papillomavirus infection. Colposcopic examination correctly predicted the presence or absence of histologically diagnosed cervical papillomavirus infection in 91 (60 per cent) but failed to do so in 61 (40 per cent). An analysis of the presence or absence of 15 colposcopic features revealed that the only colposcopic finding significantly associated with this infection was the partial staining of atypical epithelium with iodine (y = 0.427; x2 = 6.765; P < 0.01). We do not believe that colposcopic examination can reliably predict the presence of cervical papillomavirus infection.