Thomas M. Julian

A comparison of loop electrosurgical excision, laser ablation, and cold-knife conization in relation to precise specimen removal in an inanimate model.

Background. The purpose of this study is to compare loop electrosurgical excision, laser ablation, and coldknife conization for accuracy of excision in a model simulating the nulliparous uterine cervix. Methods. Twenty obstetrics and gynecology residents excised or ablated specimens (n = 300) by using loop electrosurgical excision, laser, and scalpel. Preprepared specimens (bologna) were cut to simulate the adult, nulliparous cervix. These specimens were marked with templates to simulate cervical lesions. The accuracy of excision, time for excision, gender differences, and years in training were compared by using repeated measures from analysis of variance and t tests. Results. Comparisons showed loop electrosurgical excision was more precise than was laser (F = 4.58; df = 1,15; p < .049) or cold‐knife conization (F = 15.63; df = 1,15; p = .001). Laser ablation produced more specimens that were too shallow, and cold‐knife conization resulted in specimens that were too deep. No differences were found among postgraduate years of training, but gender differences were revealed. Loop electrosurgical excision took significantly less time (mean = 23 seconds, standard deviation = 11.4 seconds) than laser ablation (mean = 135 seconds, standard deviation = 55.7 seconds; F = 68.22; df 1,15; p = .0001)) or coldknife excision (mean = 105 seconds; standard deviation = 37.9 seconds; F = 85.48; df = 1,15; p = .0001). Conclusions. Using this model, loop electrosurgical excision is more precise and faster than laser ablation or cold‐ knife conization. Resident surgeons may be more precise in excising cervical lesions with this modality.

Vulvar pain: diagnoses, evaluation, and management.

In 1975, the International Society for the Study of Vulvar Disease recommended the term vulvodynia to describe vulvar pain regardless of its cause. For most clinicians, vulvar pain is, to say the least, confusing. It is not one disease but, in most cases, the manifestation of several diseases often erroneously lumped together because they are uncomfortable and occur on the vulva. Sometimes these diseases have physical findings that are clearly diagnostic, and sometimes there are neither physical findings nor apparent etiology.

Editors report on the Journal of Lower Genital Tract Disease.

The Journal reached another milestone in March. Our publisher, Lippincott Williams & Wilkins (LWW), informed us that the Journal has been accepted by the Institute for Scientific Information (ISI). This will place the Journal under the review of the Institute and a journal Bimpact factor[ will be determined, measuring the frequency our articles are cited in other journals. The impact factor is a measure of a journal’s influence. The impact factor is used by authors to select a journal for submission or readers and libraries subscribe to a journal. It places greater importance on the scope and quality of articles we publish. Articles such as the Consensus Guidelines for the Management of Women with Cervical Cytologic Abnormalities and Vulvodynia Guidelines are frequently cited articles. The importance of these and similar articles that discuss current and challenging subjects cannot be overemphasized. The ISI acceptance is another significant step for the Journal, as was inclusion on Index Medicus. We encourage readers of the Journal to solicit and/or submit articles for the Journal that keep us in the forefront of lower genital tract disease. DISCONTINUING THE REVIEW OF CURRENT LITERATURE SECTION