Treatment failure following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia at Rajavithi Hospital.

OBJECTIVE: To evaluate the treatment failure rate of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and the risk of persistence or recurrence depending on the clinicopathologic factors. MATERIAL AND METHOD: Retrospective case-record review of 250 women who had a final diagnosis of CIN and underwent LLETZ in Rajavithi Hospitalfrom June 1st, 1998 to December 31st, 2003. Computerized files of these patients were then reviewed for clinicopathological follow-up results. RESULTS: Success rate of 86.8% was obtained. The incidence of treatment failure was 13.2%. The clinicopathologic factor associated with the persistence or recurrence was the presence of CIN at the margin of excision. Of 69 cases with incomplete excision (positive margin), treatment failure developed in 29.0%, compared to 5.2% in patients with complete excision (negative margins) (p < 0.001). Using multivariate analysis, incomplete excision and endocervical margin involvement of specimen were independent risk factors for the treatment failure of CIN. CONCLUSION: LLETZ is an effective treatment for CIN. Treatment failure rate is low. Positive surgical margin is a predictor of persistence or recurrence after LLETZ. Incomplete excision and endocervical margin involvement of specimen are significant independent risk factors.

Satisfaction and tolerability of combination of lactoserum and lactic acid on the external genitalia in Thai women.

OBJECTIVE: The aims of this study were to assess the user satisfaction and tolerability of a combination of lactoserum and lactic acid on the external genitalia of Thai women. MATERIAL AND METHOD: Women who were over 18 years of age who came to gynecologic outpatient unit at Rajavithi Hospital from November 2004 to January 2005, without clinical manifestations of vulvovaginal irritation or infection were included. The exclusion criteria were women who had allergy to a combination of lactoserum and lactic acid, or any of the components of this product. Clinical history was taken and gynaecological examination was performed. Those who met the eligible criteria were assigned to use one bottle of 150 ml combination of lactoserum and lactic acid on the external genitalia. Fisher's Exact test was used to compare the satisfaction between each group. RESULTS: There were 300 patients equally dividing in 3 groups. Average age was 42.2 +/- 9.8 years. The satisfaction percentage was more than 90 percent according to the evaluation criteria. There was no statistically significant difference between products. The tolerability were high percentage, only 3.3% of the patients used these products less than 7 days. 6 patients (2%) experienced discomfort resulting from these products and no statistically significant difference between products. CONCLUSION: The combination of lactoserum and lactic acid demonstrated the high percentage of satisfaction and tolerability. Only 2% of patients experienced discomfort without any serious discomfort effects.