Comparison of visual inspection of cervix and PAP smear for cervical cancer screening

To evaluate the performance of visual inspection of cervix [VIA] after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear. Design: Comparative study. Place and Duration of Study: This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999. Subjects and Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test. Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA[28.9%] while Pap smear was positive in seventy-eight subjects [14.4%]. The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value [PPV] of both test [p < 0.05]. The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant [p < 0.01]. These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear

Analysis of tubal pregnancy

This study was carried out to determine the frequency, etiological factors, modes of presentation, accuracy of diagnostic modalities, operative findings and surgical treatment of tubal pregnancies. Design: Observational study. Place and Duration of Study: This study was conducted in gynae unit III, Sir Ganga Ram Hospital, Lahore from January 1995 to December 1996. Subjects and All the patients diagnosed as a case of tubal pregnancy in two years period were included in the study. Detailed history regarding the symptoms and risk factors of tubal pregnancy was taken followed by clinical examination. The diagnostic and treatment modality used and operative findings were also recorded. All the data was recorded on a proforma and finally the results were analysed. Incidence of tubal pregnancy was found out to be 1:305 deliveries. Out of these, 70% of the cases occurred in the age group of 21-30 years and in patients with low parity [in para 0-2] 65% of the patients had high risk factor e.g. previous abdominopelvic surgery PID or history of infertility. Pain was the commonest symptom [90% of cases] followed by vaginal bleeding [80%] adnexal masses [70%] and amenorrhea [65%]. Acute tubal pregnancy was found in 85% of the cases while 15% of cases had chronic tubal pregnancy. Tubal pregnancy in the ampullary region was detected in 65% patients. Previous abdominopelvic surgery, PID, history of infertility and use of intra-uterine contraceptive device are the main etiologic factors. Most of the patients present at a very late stage with ruptured tubal pregnancy followed by salpingostomy in 95% of cases. Only 5% of cases had conservative surgical treatment i.e. salpingostomy. Culdocentesis ultrasonography and laparoscopy were good diagnostic modalities