PubMed Health⌕ Search

Biomedical subjects

G M Lickrish

Publications and source records attributed to G M Lickrish.

16 recordsLinked to original sources
PubMed1999

Patient preference for the management of mildly abnormal Papanicolaou smears.

Our objective was to investigate patient knowledge, desire for participation in medical decision making, and preference for the management of mildly abnormal Papanicolaou (Pap) smears (low-grade squamous intraepithelial lesions [LGSIL]) in the context of the continuing controversy between active (immediate colposcopy and biopsy) and surveillance (repeat Pap smears) management strategies. One hundred thirty-six women referred for a diagnostic colposcopy with a first-time mildly abnormal Pap smear result completed questionnaires before contact with either the nurse or physician. They were given the State-Trait Anxiety Inventory, the CESD Depression scale, and a knowledge about dysplasia quiz. They were then presented with the two management options and asked to state a preference, if any. They then completed the Problem Solving-Decision Making Scale, a measure of desire for involvement in medical decision making. The majority of women in this sample opted for the active management strategy. Management preference was related to anxiety, with the most anxious women more likely to choose the active management strategy. Management preference was not related to knowledge or to desire for an active role in decision making, although the more knowledgeable women also reported a desire for an active role in the decision-making process. Given the current controversy over the management of mildly abnormal Pap smears (LGSIL), as well as the fact that there is no conclusive evidence to support one strategy over another, the informed management preference of women affected by these decisions should be factored into the equation.

Adult↗
PubMed1994

The effect of educational brochures on follow-up compliance in women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether women with abnormal Papanicolaou smears who received educational brochures at the initial booking for colposcopy were more likely to complete recommended treatment and follow-up after 18-24 months than were those who did not receive the brochures. METHODS: One hundred eight women participated in an earlier randomized study of the effect of educational brochures on emotional distress and knowledge about abnormal Papanicolaou smears. Their medical records were reviewed 18-24 months later for completed treatment and follow-up compliance. RESULTS: Women who received the brochure had more completed treatment and follow-up compliance (75.4%) than did those who did not receive the brochure (45.8%). The difference in compliance was 30% (99% confidence interval [CI] 6-54%, P = .002). There were no significant differences in age, education, marital status, or levels of emotional distress between subjects with complete and incomplete follow-up. Knowledge of the recommended number of follow-up visits was greater in women who completed follow-up (difference in frequency 30.4%; 99% CI 7-54%, P = .002). All women with completed treatment and follow-up who had received the brochure found it helpful. CONCLUSIONS: Given the high patient acceptability and demonstrated effectiveness in improving completed treatment and follow-up compliance, educational brochures should routinely accompany, or immediately follow, notification about abnormal Papanicolaou smears.

Adult↗
PubMed1993

Colposcopy of adenocarcinoma in situ and invasive adenocarcinoma of the cervix.

Colposcopy is most useful in evaluating squamous lesions of the lower genital tract. Its usefulness in evaluating glandular abnormalities of the uterine cervix now are limited. There are abnormal features in invasive adenocarcinoma of the cervix that allow the colposcopist to make that diagnosis with directed punch biopsies. The biopsy specimens should be large enough to allow the pathologist to make the diagnosis of invasion. At the present time, the colposcopic features of adenocarcinoma in situ are not well recognized. It must be stressed that where adenocarcinoma in situ is suspected colposcopically or by cytology, the definitive diagnostic procedure remains cone biopsy.

Adenocarcinoma↗
PubMed1993

The effect of educational brochures on knowledge and emotional distress in women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether an educational brochure about abnormal Papanicolaou smears could reduce psychological distress and concerns about cancer and future health, and increase knowledge about dysplasia and the investigation, treatment, and recommended follow-up. METHODS: One hundred twenty-five consecutive women with dysplasia on a Papanicolaou smear referred to a colposcopy clinic for their first examination were alternately assigned to receive a mailed educational brochure the same day or to receive no brochure. At the colposcopy clinic, consenting women were given the Brief Symptom Inventory, specific questions about feelings regarding an abnormal smear, and a knowledge quiz about dysplasia, colposcopy, and the recommended follow-up. RESULTS: Women who received the brochure were significantly less distressed on the Brief Symptom Inventory and were less anxious about the abnormal Papanicolaou smear, the fear of cancer, and their future health than were women not receiving the brochure. Study women also performed significantly better on knowledge questions about dysplasia, colposcopy, and the recommended follow-up. CONCLUSION: Given the low cost, ease of delivery, and usefulness of educational brochures in reducing psychological distress and increasing knowledge specific to the condition, an educational brochure should routinely accompany or immediately follow notification about an abnormal Papanicolaou smear.

Adult↗
PubMed1990

The topography and invasive potential of cervical adenocarcinoma in situ, with and without associated squamous dysplasia.

Thirty-eight cases of cervical adenocarcinoma in situ (ACIS) were studied to see if the topography of the ACIS and any stromal invasion by adenocarcinoma were associated with the presence (22 cases) or absence (16 cases) of squamous cervical intraepithelial neoplasia (CIN). Neither the topography of the ACIS (proximal linear extent, focality, presence of ACIS beneath the transformation zone, and circumferential extent) or the presence of invasive adenocarcinoma was associated with the presence or absence of CIN. We conclude that the course of ACIS, at least as reflected by cervical topography and invasive potential, seems to be unaffected by the coexistence of squamous neoplasia.

Adenocarcinoma↗
PubMed1989

Human papillomavirus infection of morphologically normal cervical epithelium adjacent to squamous dysplasia and invasive carcinoma.

We have begun a systematic study of human papillomavirus (HPV) infection in colposcopically and/or morphologically normal epithelium of the uterine cervix. Paired biopsies were taken from the lesions (cervical intraepithelial neoplasia [CIN], condyloma, invasive carcinoma) and from the normal-appearing adjacent epithelium 3 to 5 mm from the edge of the lesion. Myometrium or ectocervical epithelium from patients who had undergone hysterectomy for reasons other than genital dysplasia or malignancy served as controls. One biopsy was examined histologically. DNA from the second biopsy was digested with Pst I, and the presence or absence of HPV was determined by Southern blotting using HPV-16 DNA as a probe. HPV was not detected in any of the 12 control samples. Of 30 patients with CIN and/or condyloma, five of 18 who were HPV-positive had either HPV-16 (three cases) or virus resembling HPV-31 (two cases) in the lesion and adjacent epithelium. Of seven patients with invasive carcinoma, four had HPV in the lesion and adjacent epithelium; two of these four patients had typical HPV-16. Such infection of apparently normal epithelium has major implications for our understanding of the pathogenesis, treatment, and follow-up of patients with cervical neoplasia.

Blotting, Southern↗
PubMed1987

The anatomic distribution of cervical adenocarcinoma in situ: implications for treatment.

The anatomic distribution of cervical adenocarcinoma in situ was ascertained in 23 cases of adenocarcinoma in situ, 10 of which also had "early" invasive adenocarcinoma. The adenocarcinoma in situ involved both surface and gland epithelia in all cases, involved a variable number of quadrants, involved glands beneath the transformation zone in about two thirds of cases, was multifocal only occasionally, extended up the endocervical canal for a variable distance (up to 30 mm), and was associated with squamous dysplasia in about half of cases. From this topographic outline of adenocarcinoma in situ, it is recommended that if cervical conization is chosen as conservative therapy for adenocarcinoma in situ the "cone" be cylindrical in shape, to include the transformation zone and deep glands, and extend at least 25 mm up the endocervical canal.

Adenocarcinoma↗
PubMed1986

Vaginal intraepithelial neoplasia: biologic aspects and management.

A review of 59 consecutive cases of vaginal intraepithelial neoplasia seen in a colposcopy clinic between 1971 and 1984 was made. All patients presented with an abnormal Papanicolaou smear, and diagnosis was confirmed by colposcopically directed biopsy. The patients ranged in age from 23 to 72 years, with a mean age of 49. Fourteen (24%) patients were less than 40 years of age. A previous hysterectomy had been performed in 68% of patients, 42.5% of these being for benign disease. Forty-two patients (71%) had evidence of multicentric neoplasia of the lower genital tract, and 30 (51%) had been treated previously for cervical neoplasia. Twenty-nine lesions were multifocal and 52 (88%) were located in the upper third of the vagina. The results of the different modes of treatment were reviewed. Surgical extirpation gave the best results. The local ablative techniques used, ie, electrocautery and CO2 laser, were associated with failure rates of 25 and 50%, respectively. Three patients developed invasive carcinoma of the vagina after treatment.

Adult↗
PubMed1985

Cervical dysplasia: association with sexual behavior, smoking, and oral contraceptive use?

Information on possible risk factors of cervical dysplasia, including indices of sexual behavior, smoking habits, and the use of oral contraceptives was obtained from a case-control study in Ontario in which 250 cases of histologically proved cervical dysplasia and 500 age-matched neighborhood controls were interviewed. Initial analysis showed an increased risk associated with more than one sexual partner, an early age at first intercourse, current smoking, the use and duration of use of oral contraceptives, and education. However, the increased risk of use and duration of use of oral contraceptives and education was reduced after adjustment for indices of sexual behavior and smoking. This finding does not confirm previously reported large adverse effects of pill use. The relationship between smoking and cervical dysplasia might be explained by some agent in cigarette smoke which depresses the immune mechanism, thus permitting a sexually transmitted agent to result in abnormal cellular development that leads to the onset of cervical dysplasia.

Adolescent↗
PubMed1985

The treatment of grade 3 cervical intraepithelial neoplasia with cryotherapy: an 11-year experience.

The results of treatment of 453 patients with grade 3 cervical intraepithelial neoplasia by cryotherapy are presented. After excluding 31 patients who were lost to follow-up, the failure rate of primary treatment in the remaining 422 patients was 7.1% (30 patients). Outpatient re-treatment of those with persistent disease achieved an overall cure rate of 98%. Statistical analysis to determine prognostic significance with regard to persistent disease was carried out on the following variables: grade, size, and type of freeze. Type of freeze was the only variable to show statistical significance. Cryotherapy remains an effective outpatient modality for the treatment of grade 3 cervical neoplasia. A rigid protocol of patient selection and meticulous cryotherapy technique play a large role in obtaining the high cure rates reported in this study.

Adolescent↗
PubMed1978

Carcinoembryonic antigen (CEA) and other tumor markers in ovarian and cervical cancer.

Combinations of carcinoembryonic antigen (CEA), gamma glutamyl transpeptidase (GGT), pregnancy-associated macroglobulin (PAM) and placenta-like alkaline phosphatase (PLAP) were studied in groups of patients with ovarian and cervical cancer. In ovarian cancer, only CEA and PLAP levels appeared to reflect tumor burden and were complementary in detecting active disease. In cervical cancer, CEA and GGT reflected tumor burden, while PLAP showed just the reverse--the highest degree of positivity being present in minimal disease. PLAP positivity was even more pronounced in patients with cervical dysplasia and carcinoma in situ while CEA and GGT were negative. The data indicate that the use of marker combinations can improve our capacity to detect minimal disease and provide information regarding tumor biology that may not be available by studying individual markers or by other means. It remains to be determined whether the use of tumor markers can influence existing therapy sufficiently to alter the outcome in cancers which are notoriously difficult to treat.

Alkaline Phosphatase↗
PubMed1977

Conservative management of intraepithelial cervical neoplasia.

In a prospective trial cryotherapy was performed in 164 patients with preinvasive cervical neoplasia, most of whom desired future childbearing. Their disease had been evaluated by repeat cytology, colposcopy and colposcopically directed punch biopsies, with endocervical curettage when necessary. This conservative treatment eradicated the disease in 147 (89.6%) of the patients. The remaining 17 underwent complete reinvestigation. The focal residual disease in 12 was successfully treated by conservative means--repeat cryotherapy, focal electrocautery or punch biopsy. The other five required either cone biopsy or hysterectomy because of more extensive lesions.

Adolescent↗
PubMed1975

Colposcopic evaluation of the abnormal Papanicolaou test in pregnancy.

Colposcopy, including colposcopically directed biopsies in selected cases, was employed to evaluate over 300 pregnant patients with abnormal Papanicolaou tests suggestive of mild dysplasia or worse (Class III to V). Over half of the patients had benign disorders determined by colposcopic examination. All cases of invasive disease were diagnosed by colposcopy and biopsy, and the patients were treated accordingly. Only 3 diagnostic conizations were necessary in the antepartum period. The majority of patients with cervical intraepithelial neoplasia were seen post partum, and appropriate therapy was instituted. In the pregnant patient with an abnormal Papanicolaou test, colposcopy has proved to be a reliable and safe method of evaluation and has virtually eliminated the need for conization.

Biopsy↗