Biomedical subjects

P R Broso

Publications and source records attributed to P R Broso.

10 recordsLinked to original sources

PubMed2000

Tubaric pregnancy - an excellent idea?

Until now, the treatment in cases of tubal pregnancy has been focused on the patient and has not been concerned with saving the embryo. We consider a hypothetical operation: the transfer of the tube, the seat of developing pregnancy, with its vascularization, to the inside of the uterus cavity by an incision in the myometrium, and binding of the breach. In order to support this hypothesis, a review has been made of the literature on surgical treatments of transplantation of the ovary into the uterus at the beginning of the century.

Female↗

PubMed1997

[Good rules for cervical cytologic sampling].

There are still many little problems concerning methods about cervical cytology sampling. Are there some risks of teaching Papanicolaou smear technique? In which day of the cycle is it better to do sampling? How long in advance is it better to avoid sexual relations, and do not use any vaginal douching? Is it better to remove in advance cervical mucus? When should the sampling be done if the colposcopy is made in the same time? How should you behave if the cervix is not exposed? How many slides have to be spreaded? Which is better, the fixation with alcohol or aerosol? Where should the sampling be repeated? Is the patient anamnesis reliable? What should it mean the presence of some parasites and some foreign bodies manifested on the slide? Different answers have been given to reply to these questions and to some others. Smear's collecting is a simple method, but it needs an exact manual skill and an adherence to some precise rules. A relevant part of the final result depends how sampling has be done. Improvements must be done in every link of chain events.

Colposcopy↗

PubMed1995

[Is it possible to screen for endometrial carcinoma? Incidence and risk factors].

Endometrial cancer affects 2-3% of American women. It is more common in obese, postmenopausal women with diabetes, hypertension, low parity, and late menopause. The prevalence of endometrial cancer among women who present with postmenopausal bleeding varies from 1.50-90%, most textbooks report a rate of 20%. Endometrial cancer is common, and although mortality rates relatively low, there are theoretical reasons suggesting that it could become a more serious problem in the future. The decreasing use of hysterectomy may leave more women at risk for endometrial cancer in future years. In contrast to cervical cancer, no routine mass screening programs for the early detection of endometrial cancer have been organized. It is of primary importance to define risk groups when designing mass screening programs. All of the methods used by cytologists for studying endometrial changes have limitations. Cervicovaginal smears allows diagnosis of, at best, 60% to 70% of carcinomas of the endometrium. Intrauterine sampling is another possible method. It consists of direct aspiration of the uterine cavity, scraping or brushing of the mucosa or uterine washing. Any method of endometrial sampling is imperfect, even dilatation and curettage has been shown to miss endometrial carcinoma. The quality of evidence supporting screening for endometrial cancer is of a low level. The lack of an effective, inexpensive and easy-to-use sampling method is the reason for the non-existent decline in the incidence of invasive endometrial carcinoma.

Adenocarcinoma↗

PubMed1994

[The age for beginning and the frequency for performing the Pap test].

The increase in sexual activity among teenagers has been well documented. One apparent result is the increasing prevalence of cervical cytological abnormalities in this age group over the last 20 years. The adolescent cervix appears to be especially vulnerable to the initiation of carcinogenesis. Consequently, the significance of early age at first coitus is thought to be related to the biologic changes that occur in the cervix during puberty. Large epidemiologic studies have implicated sexuality as the initiator of a sequence of multistage events that destabilize the healthy cervix and culminate in cervical cancer. The median interval between age at first coitus and the development of CIN1 is 9 years, with a progressive 2.5 year increase for each degree of progression from CIN 1 through 3. Unfortunately, the precise mechanism by which that biologic variable, early age at first coitus, predisposes to CIN remains enigmatic. Nevertheless, there is no doubt that the earlier the age at first coitus, the higher the risk factor. Among virgins the incidence of cervical cancer is essentially zero. Among sexually active adolescent girl no cases of invasive carcinoma have been found, but carcinoma in situ had a prevalence rate of 2.6 per 1,000 15-19 years old, whereas cervical dysplasia ranges from 0.8 to 3.5% of screened sexually active teenagers populations. Adolescents who have never been sexually active clearly do not need to be screened for cervical cancer. On the contrary teenagers with the risk factors of sexually transmitted disease or multiple sex partners should be annually screened soon after onset of sexual activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

[The IUD and uterine perforation].

The intrauterine device (IUD) is an effective and relatively safe contraceptive. Approximately 15% of women of child-bearing age in Italy use the IUD. The major health risks associated with IUD use are perforation of the uterus, pregnancy (both intrauterine and ectopic), and pelvic inflammatory disease. Perforation of the uterus by an IUD is a serious complication and this is possible both during the insertion and later. Perforation of the uterus is rare, but potentially fatal. The incidence is of 0.12-0.68/1000 insertion. Although some patients have signs and symptoms suggestive of perforation (pain or bleeding), many are apparently asymptomatic at the time the diagnosis of perforation is made. Perforation is often suspected or diagnosed when the IUD string is no longer visible at the external os. A patient who has sustained a perforation is not protected against pregnancy. Numerous factors affect perforation: the type of IUD, the uterine size and position, timing of the insertion in relation to the last delivery or abortion and the experience of the clinical. Serious consequences have been described, such as severe damage to the viscera (i.e. bowel, kidney) and/or peritonitis. The diagnosis is clinical, ultrasonic, radiological and coelioscopic. Coelioscopic diagnosis makes it possible to choose the method of treatment. In experienced hands, this method is rapid, the hospitalization required short and the sequelae simple.

Adolescent↗

PubMed1993

[The Papanicolaou classification in the Bethesda system (National Cancer Institute, Bethesda, Maryland)].

In December of 1988, the National Cancer Institute in Bethesda, Maryland (USA), held a workshop that produced published guidelines for reporting the results of cervical and vaginal cytology. A second workshop was held in April 1991 to discuss the initial proposal and suggest modifications. The final recommendations are the following: the Papanicolaou classification for reporting consultation is not acceptable in the modern practice of diagnostic cytopathology (because it does not reflect current understanding of cervical/vaginal neoplasia--has no equivalent in diagnostic histopathologic terminology--does not provide diagnoses for non-cancerous entities and, as a result of numerous modifications, the specific Papanicolaou classes no longer reflect diagnostic interpretations uniformly). The cytologic report is a medical consultation in the same manner as is the histomorphologic report. Clinical information is absolutely essential for making the diagnosis. (A cytopathologic diagnosis should be an interpretation of morphologic findings, but this interpretation is best made in the context of the patient's clinical situation). The cytopathologist should determine whether the specimen is adequate for diagnostic evaluation. If unsatisfactory or satisfactory for evaluation but limited by ..., this should be noted in the report. The use of precise diagnostic terms to facilitate unambiguous communication between cytopathologist and clinician. The terminology for squamous epithelial lesions includes: 1) Atypical squamous cells of undetermined significance. 2) Squamous intraepithelial lesion (SIL), which encompass the spectrum of squamous cell carcinoma precursors, divided into low-grade SL (HPV-associated cellular changes, mild dysplasia and CIN1) and high-grade SIL (moderate dysplasia, severe dysplasia and carcinoma in situ and CIN2 and CIN3).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗

PubMed1993

[George Nicholas Papanicolaou].

G. N. Papanicolaou was born on May the 13, 1883 in the city of Kymi on the Greek island of Euboea. He received his MD degree from the University of Athens in 1904 and a PhD from the University of Munich in 1910. After service as a medical officer in the Balkan War of 1912-1913, he came to New York with Mary (for over 50 years Dr Pap's life companion). George's violin playing at restaurants and coffee-shops supplied them with a few extra cents. Papanicolaou was appointed assistant in the Pathology Laboratory at the New York Hospital. In 1928 he presented his work "New Cancer Diagnosis" to the third race betterment conference (Battle Creek, Michigan). But the work was met with scepticism. The now famous monograph "The Diagnostic Value of Vaginal Smears in Carcinoma of the Uterus" was published in 1941 in the Am J Obst Gyn. During this time, he developed his method of preservation of these cells by wet fixation and precise staining. Papanicolaou persisted with his ideas, and finally cytologic examination of the cervix was accepted. The power of Papanicolaou screening for uterine cancer was remarkable. The first National Cytology Congress, held in 1948, hailed this new diagnostic tool for carcinoma of the cervix as unique because it could detect cancer before it was visible. He described the importance of a distinct cellular pattern corresponding to cervical intraepithelial neoplastic lesions. The value of this pattern, expressing evolutionary steps in the development of cancer at individual cell levels, was not appreciated.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyprus↗

PubMedDate not supplied

The unicum and cytobrush plus spatula for cervical cytologic sampling: a comparison.

OBJECTIVE: To compare the efficacy of the Unicum, a new ectocervical-endocervical nylon brush, with that of the Cytobrush plus wooden spatula in the collection of cervical-endocervical material. STUDY DESIGN: Thirty-eight patients who underwent routine gynecologic examinations agreed to have a smear taken with the wooden spatula plus Cytobrush and the Unicum. RESULTS: The two methods were equally effective in collecting endocervical-ectocervical smears. CONCLUSION: With our method, sampling is done with only one device; the ectocervix and endocervix are sampled simultaneously, and adequate sampling of the transformation zone must be achieved.

Cervix Uteri↗

PubMedDate not supplied

[The Pap test in women after hysterectomy].

Neoplasm of the vaginal vault may occur up to years after a hysterectomy for CIN in 0.9-6.8% It is less commonly observed following hysterectomy for benign disease. The explanations for the pathogenesis of dysplastic abnormalities in the vaginal epithelium after hysterectomy are: residual disease indicating inadequate excision of the original lesion; multicentre focus of origin; new or recurrent lesion due to persistent carcinogenic stimulus. The subsequent development of VAIN justified the intensive cytology follow-up after hysterectomy? The general population are not screened for vaginal carcinoma, but they are screened for cervical carcinoma. The risk of vaginal carcinoma after hysterectomy for pre-invasive carcinoma of the cervix is similar to the incidence of pre-invasive carcinoma of the cervix in the general population. In the absence of any definite evidence that the natural history of the two diseases is different, most authorities recommend that vault cytology must be continued for life, although some people think that screening for vaginal carcinoma in women who have had CIN completely excised at hysterectomy is not an efficient use of resources. There is a need for continuing cytological follow-up, even after hysterectomy for benign conditions.

Adult↗

PubMedDate not supplied

[Paget disease of the vulva].

The question of whether vulvar Paget's disease is an intraepidermal disease with potential to invade the underlying dermis or a tumor of adnexal origin with spread to the overlying epidermis remains to be resolved. The most common complaint is pruritus. The lesion is described as red, inflamed or erythematous. The delay in diagnosis is considerable in most cases. The disease can be diagnosed only by biopsy. The lesion frequently extends beyond the clinically apparent borders. The disease without underlying invasive carcinoma appears to remain as an intraepithelial malignancy for a long time. The high incidence of other malignancies (breast, colon, cervix, ovary) warrants careful examination in patients with Paget's disease of the vulva. Close follow-up for a longer period of time will be necessary before excluding recurrence. A major goal of conservative surgery is to preserve sexual function, normal anatomy and body image.

Adult↗