Continuing problems with diethylstilboestrol.
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Adenocarcinoma, Clear Cell↗
Biomedical subjects
J M Emens
Publications and source records attributed to J M Emens.
Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.
OBJECTIVE: To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN: Prospective programme trial with six month follow up. SETTING: Two hospital based colposcopy clinics. PATIENTS: 616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS: After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES: Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS: Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION: Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.
Adolescent↗
Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment.
A retrospective study of the complications of cone biopsy showed that among 915 women examined between the years 1976 and 1982, 121 (13%) had primary or secondary haemorrhage, 153 (17%) cervical stenosis and 39 (4%) subsequent infertility or an abnormal pregnancy. Cervical stenosis was commonest among women who had had long cones removed. Stenosis occurred more often in the group of women who had been assessed by colposcopy before operation but this was due to the fact that prior colposcopy selected a favourable group of patients with lesions of limited extent that were susceptible to treatment by local destructive therapy, so that prior colposcopic assessment resulted in the removal of longer cones.
Adult↗
The treatment of cervical intraepithelial neoplasia by laser vaporization.
Of 711 women with cervical intraepithelial neoplasia (CIN) treated by laser vaporization 675 (95%) remain colposcopically and cytologically free from disease after a median follow-up of 20 months. Thirty-six patients needed other forms of treatment to eradicate suspected residual disease. One patient presented with invasive carcinoma of the cervix 34 months after treatment with the carbon dioxide laser. It is concluded that in selected cases laser vaporization is an effective method of treating pre-invasive disease of the cervix.
Adolescent↗
The congenital cervicovaginal transformation zone in young women exposed to diethylstilboestrol in utero.
Twenty-seven young women exposed in utero to diethylstilboestrol have been studied for greater than 24 months. Serial study of the cervi-covaginal transformation zone has been by the non-invasive techniques of cytology, colposcopy and scanning electron microscopy. Minimal change has been noted in aceto-white areas within the transformation zone and, although some progressive glycogenation has been observed, this has never been to the stage of fully glycogenated epithelium. Scanning electron microscopy has shown maturation of the epithelium although there has been some slowing or arrest of the process at the stage of immature squamous epithelium. The neoplastic potential of this epithelium is discussed.
Abnormalities, Drug-Induced↗
The congenital cervicovaginal transformation zone in sexually active young women.
A total of 110 sexually active teenage girls was screened cytologically and colposcopically; 71 of them had areas of aceto-white epithelium within the cervicovaginal transformation zone. Of these 54 had long-term follow-up and over a mean period of 36 months the aceto-white epithelium was observed to disappear in 26. In the remaining 28 girls aceto-white areas persisted largely unchanged over the period of follow-up. The characteristics of these persistent aceto-white areas are documented and suggestions with regard to their origins and significance are made.
Adolescent↗
Early postpartum insertion of the Multiload Cu250 intrauterine device.
The Multiload Cu250 intrauterine device was inserted in the early postpartum period, most often between day 2 and 5. In 74% of 86 patients the device was found correctly placed at postnatal examination at 6 weeks. The 26% expulsion rate was unacceptably high and it is concluded that no intrauterine device, including the Multiload, should be fitted in postpartum women, less than 1 week after delivery.
Clinical Trials as Topic↗
Letter: Postpartum sterilization.
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Female↗
Psychiatric aspects of female sterilization.
Follow-up of 151 women who had been sterilized for social or gynaecological reasons one to three years earlier showed that 146 were completely satisfied with the results of the operation on their health and on their sexual relationships with their husbands. The five who were dissatisfied either wished they could still conceive or found the operation had not produced the effect hoped for. On the basis of this study we believe that adverse psychiatric sequelae of sterilization can be kept to a minimum with careful selection of patients. Women should be over 30 or if younger should have had two or more children, and the operation should not be performed at childbirth, in the neonatal period, or during a postabortive depression.
Abortion, Induced↗