PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 9003949

Laser miniconization procedure.

Z Békássy
View original source ↗Export metadata ↓

Abstract

OBJECTIVE: To describe the outpatient procedure of minimal conization with free-hand guided high power density carbon dioxide laser for simultaneous diagnosis and treatment of CIN producing a one-piece tissue specimen for histological examination. MATERIAL AND METHODS: 3100 non-pregnant patients with mild, moderate or severe dysplasia in pap smear, having colposcopically proved ectocervical lesions but without evidence of invasive carcinoma, or 85 pregnant patients with severe dysplasia in pap smear having extensive colposcopic signs of at least carcinoma in situ were admitted for this treatment. This outpatient procedure including cervical curettage is performed under local anesthesia to excise a one-piece 5 mm (during pregnancy 7 mm) deep minicone. RESULTS: The degree of patient discomfort, bleeding complications, postoperative pain, infection or vaginal discharge were all minimal. The procedure was fast, causing minimal thermal damage of resection lines of the minicone specimen. Histopathological examination of the non-pregnant minicones revealed microinvasive or invasive carcinoma in 1.2%, the primary cure rate was 96.1%. During pregnancy, 13.3% malignancy was found. No unexpected sudden onset of invasive carcinoma was recorded during the 15-year follow-up and the cumulative risk of recurrence for all forms of CIN was 3.02% CONCLUSIONS: The outpatient miniconization procedure, performed with a free-hand guided 60-W high power density CO2 laser is a reliable method for simultaneous diagnosis and treatment of CIN. Because of the paucity of complications, this procedure may also be appropriate during pregnancy.

Explore related subjects

Ambulatory Surgical ProceduresCarbon DioxideConizationEvaluation Studies as TopicFemaleFollow-Up StudiesHumansLaser TherapyPregnancyPrognosisSwedenUterine Cervical NeoplasmsUterine Cervical DysplasiaJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Z Békássy. 1996. Laser miniconization procedure.. https://doi.org/10.1016/s0020-7292(96)02767-1

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2001

[Premedication in ambulatory surgery].

UNLABELLED: A substantive amendment to this systematic review was last made on 3 January 2000. Cochrane reviews are regularly checked and updated if necessary. OBJECTIVES: To assess the effect of anxiolytic remedication on time to discharge in adult patients undergoing day case surgery under general anaesthesia. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, by checking the reference lists of trials and review articles, by handsearching three main anaesthesia journals and by contacting five researchers active in the field and the Product Information departments of the manufactures of five commonly used premedicants. SELECTION CRITERIA: All randomised controlled trials comparing an anxiolytic drug(s) with placebo before general anaesthesia in adult day case surgical patients. DATA COLLECTION & ANALYSIS: We collected data on anaesthetic drugs used, results of tests of psychomotor function where these were used to assess residual effect of premedication, and on times from end of anaesthesia to ability to walk unaided or readiness for discharge from hospital. Formal statistical synthesis of individual trials was not performed in view of the variety of drugs studied. MAIN RESULTS: Searching identified twenty-nine reports; fourteen studies, with data from a total of 1263 patients, were considered eligible for analysis. Only two studies specifically addressed the discharge question; both found no delay in premedicated patients. Three other studies used clinical criteria to assess fitness for discharge, though times were not given. Again, there was no difference from placebo. Four studies used both clinical measures and tests of psychomotor function as tests of recovery from anaesthesia. In none of these studies did the premedication appear to delay discharge, although performance on tests of psychomotor function was sometimes still impaired. Of the four studies which used tests of psychomotor function to assess recovery, three showed impaired recovery (after midazolam 7.5 mg, midazolam 15 mg or diazepam 15 mg) which might possibly interfere with discharge from hospital. REVIEWERS' CONCLUSIONS: We have found no evidence of a difference in time to discharge from hospital in patients who received anxiolytic premedication. However, in view of the age and variety of anaesthetic techniques used, inferences for current day-case practice should be made with caution.

Ambulatory Surgical Procedures↗
PubMed2001

Alternative approaches to obtain optimal bid values in contingent valuation studies and to model protest zeros. Estimating the determinants of individuals' willingness to pay for home care services in day case surgery.

The use of day case surgery has increased rapidly as an alternative to inpatient surgery. Little is known, however, about the value of day case surgery to patients. The aim of this paper was to develop a contingent valuation survey to investigate how individuals value the costs of shifting from inpatient to day case surgery based on home care services. Using the willingness to pay (WTP) approach, two kinds of sequential experiments are compared: the maximum likelihood recursion (MLR) method and the C-optimal sequential procedure. The goal of sequential experimentation is to find bid values that provide the maximum possible information about the parameters of the WTP distribution, especially when the sample size is small. The C-optimal sequential procedure is shown to be an improvement, in terms of the statistical precision in small samples, over the MLR method. In addition, the paper presents a double hurdle (DH) approach for modelling the determinants of individuals' WTP. Using data from a contingent valuation survey conducted in 1996 on patients selected from the Day Case Surgery Unit in a hospital in the region of Catalonia, we argue that participation in the market offered and the level of consumption, that is, people's WTP, should be treated as individual choices. The results show that income and sex are related to WTP. Also, in this study, a clear presence of starting-point bias, introduced by the bid offered, was found. It is concluded that the WTP technique is potentially useful in evaluating health care programmes, although it is important to note that the criteria used to find an optimal design (in our model to minimize the asymptotic variance of the estimator used) may be restrictive from an economic point of view.

Ambulatory Surgical Procedures↗