Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear

OBJECTIVE

To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti-inflammatory therapy.

METHOD

A prospective randomized study.

RESULT

2798 premenopausal non-pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as 'inflammatory cellular changes'. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti-inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 +/- 6.3 (18-46) and 1.7 +/- 2.3 (0-6), respectively. When these patients underwent colposcopically-directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences.

CONCLUSION

Colposcopically-directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

The effects of hormone replacement therapy on uterine fibroids in postmenopausal women

OBJECTIVE

To evaluate and compare the effects of two different modalities of hormone replacement therapy (HRT) on the size of uterine fibroids.

DESIGN

Randomized clinical study.

SETTING

The Menopause Center of a public hospital.

PATIENTS

Postmenopausal women with small asymptomatic uterine fibroids were selected.

INTERVENTIONS

One group was treated with 50 micrograms transdermal E2 plus 5 mg medroxyprogesterone acetate (MPA) continuously, whereas the second group was given 0.625 mg conjugated equine estrogen plus 2.5 mg MPA continuously.

MAIN OUTCOME MEASURE

The size of the uterine fibroids was measured before and after the first year of HRT.

RESULTS

At the end of the first year on HRT, the size of the uterine fibroids was re-evaluated sonographically and no significant difference was found with the oral group, whereas there was a significant increase in the transdermal group.

CONCLUSION

Hormone replacement therapy with 50 micrograms transdermal E2 plus 5 mg MPA increases the size of the uterine fibroids.

Fetal methemoglobinemia: a cause of nonimmune hydrops fetalis

A case of nonimmune hydrops fetalis resulting from fetal methemoglobinemia is presented. A woman with a pregnancy at 17 weeks' gestation was admitted after combustion gas intoxication. Although the mother totally recovered, the fetus showed signs of nonimmune hydrops fetalis at follow-up. Fetal methemoglobin levels were very high.

Umbilical cord blood erythroblast count as an index of intrauterine hypoxia

The relation of umbilical cord blood arterial pH, Apgar score, leucocyte count, and erythroblast count at delivery with the diagnosis of fetal distress in labour was studied prospectively in three groups of singleton pregnancies delivering at term vaginally (55 infants), by elective caesarean section (39 infants), or by emergency caesarean section for abnormal intrapartum fetal heart rate patterns (55 infants). In the emergency caesarean section group the umbilical cord blood arterial pH was significantly lower and the leucocyte and erythroblast counts were higher than in the elective caesarean section group. Comparison of the emergency caesarean section and spontaneous vaginal delivery groups showed significant differences for pH and erythroblast count, but not for leucocyte count. In the spontaneous vaginal delivery group erythroblastosis was associated with umbilical cord blood pH, whereas leucocytosis was associated with the length of labour. The five minute Apgar score was > or = 7 in all infants. This study suggests that leucocytosis is a non-specific response of the fetus to labour, whereas erythroblastosis reflects fetal tissue hypoxia.

Ectopic pregnancy: transvaginal sonographic findings of 152 cases

In a retrospective study performed on 152 cases of verified ectopic pregnancy, the features at transvaginal sonography were evaluated. A total of 146 (96%) of the patients had at least one abnormal sonographic feature and pelvic/cul-de-sac fluid was the most common finding, detected in all of the 146 patients. Pelvic/cul-de-sac fluid was particulate in 103 patients and simple in 43. Pelvic/cul-de-sac fluid together with extrauterine findings were found to be present in 93.8% (137/146) of the patients, suggesting the fact that if pelvic/cul-de-sac fluid was detected, every effort should be made to image the tube. The extrauterine transvaginal sonographic features included 102 (63.0%) patients with a mass, 60 (41.1%) with a gestational sac (with or without yolk sac or embryo), and eight (5.3%) with a living embryo. Comparison of the sonographic findings according to the status of the ectopic pregnancy revealed that particulate fluid (98.9%), and an extra-uterine mass (88.2%) were the features that aided in the diagnosis of ruptured and aborted ectopic pregnancies, whereas an extrauterine gestational sac (72.9%), and a living embryo (11.9%) were associated with intact ectopic pregnancies. Our findings support the practice of using transvaginal sonography, and ss-human chorionic gonadotropin measurements in the diagnosis and prediction of the status of ectopic pregnancy.