Validation of ThermoFisher's Papspin for human papillomavirus detection in cervicovaginal specimens using PCR with GP5+/GP6+ primers and the Hybrid Capture II assay.

The present study aimed to validate ThermoFisher's (Thermo Fisher Scientific, Runcorn, Cheshire, UK) Papspin (PS) for human papillomavirus (HPV) testing by in-house PCR and by the Hybrid Capture II (HC2) assay and to compare the results with those obtained using Specimen Transport Medium (STM) (Digene Diagnostics, Gaithersburg, MD, USA). Forty-five patients underwent conization for known lesions ranging from atypical squamous cells of undetermined significance (ASC-US) with high-risk HPV (hr-HPV) to high-grade squamous intraepithelial lesion (H-SIL/CIN2+) or adenocarcinoma. Two negative controls were included: one patient with post-menopausal bleeding and another from whom an inflammatory cervical sample was taken without conization. Prior to conization, a gynaecologist collected two cervical samples, fixed in PS or STM, from each patient. All but four cases were tested for panHPV (GP5+/GP6+) and specific hr-HPV subtypes (HPV16, 18, 31,33) by PCR using both media and all were processed for HC2. This study demonstrates that both HPV detection techniques work with PS, showing a specificity of 78.3% for HC2 and 92.8% for PCR compared to 83.8% for HC2 and 92% for PCR using STM. The efficacy of detecting HPV in PS-preserved H-SIL/CIN2+ was very high (96% for PCR using PS and 86% for HC2 using PS), which was in the same range as for PCR using STM, and which was only slightly lower than for HC2 using STM (96% and 89%, respectively). The differences were not statistically significant. It is concluded that ThermoFisher's PS is a valid liquid-based cytology medium for cervical samples, convenient for HPV testing by PCR with GP5+/GP6+ primers and by the HC2 assay.

Laparoscopic myolysis.

This review will focus on the different techniques and the long-term effects of the technique called myolysis on myoma growth. Indications for myolysis are essentially pelvic pain, compression symptoms and global uterine volume in order to avoid hysterectomy. In the late 1980s, myolysis was performed laparoscopically with the help of the neodynium: yttrium aluminium garnet (Nd:YAG) laser. Later, bipolar needles were developed as an alternative to the Nd:YAG laser. Diathermy and cryomyolysis were also proposed but series are small in the literature. Very recently, myoma interstitial thermo-therapy (MITT) was performed using the diode laser and a specific optical light diffuser that is designed to transmit laser light in all directions. Laparoscopic myolysis was proved to be effective in provoking myoma shrinkage, with a dramatic decrease in size and a marked devascularization of the myoma and this technique can be proposed as an alternative to myomectomy in selected patients: only those aged >40 years or those not desiring to bear any more children.

Endometrial laser intrauterine thermotherapy: the first series of 100 patients observed for 1 year.

OBJECTIVE: To describe a new instrument (GyneLase) that offers a new approach (endometrial laser intrauterine thermal therapy [ELITT]) to treatment of menorrhagia and to evaluate the efficacy of ELITT in the management of dysfunctional uterine bleeding. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): 100 premenopausal women with dysfunctional uterine bleeding were observed for 1 year. INTERVENTION(S): Intrauterine laser thermotherapy with a diode laser. MAIN OUTCOME MEASUREMENT(S): Amenorrhea rate after 1 year. RESULT(S): The amenorrhea rate after 1 year of follow-up was 71%, and the rate of amenorrhea/severe hypomenorrhea rate was >90%; these rates are much higher than those in the literature after such procedures as electrosurgery or intrauterine thermal balloon therapy. The ELITT procedure is an inherently safe and simple alternative, providing controlled and effective treatment of the entire endometrium. In contrast to traditional endometrial ablation using a neodymium yttrium-aluminum-garnet laser, the ELITT procedure does not require intensive training or hysteroscopic control; it is also far less risky, because the power used per unit area is 1,000 times lower. CONCLUSION(S): The ELITT procedure is a new nonhysteroscopic technique for endometrial ablation. The technique is very safe and offers the highest amenorrhea rate to date in the literature.

Endometrial laser intrauterine thermo-therapy (ELITT): a revolutionary new approach to the elimination of menorrhagia.

Various non-hysteroscopic procedures have been developed in the attempt to treat dysfunctional uterine bleeding that fails to respond to medical treatment efficiently and easily. Among these procedures is low-dose laser radiation of the endometrium with the diode source, which is characterized by the highest incidence of amenorrhea.

Laparoscopically assisted vaginal hysterectomy (LAVH)--an alternative to total abdominal hysterectomy.

OBJECTIVE: To assess the feasibility of performing laparoscopically assisted vaginal hysterectomy (LAVH) on women referred for total abdominal hysterectomy (TAH). DESIGN: Prospective intervention study on women referred for TAH from a gynaecological outpatient clinic. SETTING: Groote Schuur Hospital, Cape Town. This institution accepts patient referrals from community hospitals and family physicians for hospitalised care. PATIENTS: Forty-one consecutive women referred for TAH were suitable for LAVH. Women able to undergo conventional vaginal hysterectomy, women with uterine fibroids exceeding 14 weeks in size and subjects with malignant disease were excluded. The most common indication for hysterectomy was persistent abnormal bleeding. INTERVENTION: Of the 41 women assessed pre-operatively as suitable for LAVH, the procedure was successfully performed in 40 by means of a bipolar desiccation and scissors transection technique with re-usable equipment. MAIN OUTCOME MEASURES: Assessment of intra-operative and postoperative morbidity, surgical complications, operating time, length of hospitalisation and assessment at postoperative visit 6 weeks after surgery. RESULTS: Only 1 woman was unable to undergo successful LAVH because she had pelvic adhesions and densely adherent loops of bowel; a TAH was performed. No operative complication occurred. One woman had postoperative vaginal bleeding controlled with a vaginal pack, and a diagnosis of von Willebrand's disease was subsequently established. No patient had febrile morbidity and when reviewed at clinic 6 weeks later all women were well. CONCLUSIONS: LAVH is possible in many women in whom hysterectomy is indicated but conventional vaginal hysterectomy is not feasible. In this study LAVH was found to be a safe procedure with minimal complications.

Endometrial laser interstitial hyperthermy: a potential modality for endometrial ablation.

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were treated in vitro with an output power of 30 W for 5 minutes; tissue temperatures, recorded by thermocouples, were plotted to draw time-temperature and time-distance curves. As a preliminary series, ten patients were treated, with the first five subjected to local temperature monitoring; all ten were followed-up for 6-17 months. Immediate and delayed (6 weeks) histologic data were obtained. The intramural temperature at 6 mm from the fibers ranged from 55-60C). In vivo, the cooling effect of the arterial blood flow lowered the serosal temperatures under 41C. The histologic data and the hysterographic pictures suggest that endometrial ablation was effective. This new device does not require distending medium, hysteroscopic control, or high-powered Nd-YAG laser machines. Preliminary long-term results suggest that the device could be used for endometrial ablation.

Hysteroscopic myomectomy.

Transhysteroscopic myomectomy has proved to be safe and effective with experienced operators. The use of the continuous flow hysteroscope and preoperative monitoring of intrauterine pressure has contributed to the prevention of fluid intravasion accidents. Effectiveness has been demonstrated in a number of recently published long-term studies.

Treatment of dysfunctional bleeding and fibroids by advanced endoscopic techniques with the Nd:YAG laser: from the present to the future.

Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2. The use of GnRH-agonists represents an adjunct for preoperative reduction of submucosal myomas so that subsequent hysteroscopic myomectomy is possible. A two-step hysteroscopic therapy combined with GnRH-agonist therapy is performed when the largest portion of the submucosal myoma is located in the uterine wall. In cases of numerous submucosal and intramural myomas, a laparoscopic supracervical hysterectomy is performed because of the high risk of recurrence after the hysteroscopic procedure.

LASH: laparoscopic supracervical (subtotal) hysterectomy.

From July 1990 to December 1993, 156 laparoscopic supracervical hysterectomies (LASH) were performed. No complications occurred. The technique and the advantages are described. Because of the easy feasibility of this technique, the quick recovery of the patients and the absence of complications this strictly laparoscopic approach must be widely proposed when an hysterectomy is indicated and no risk of remaining cervix cancer is assumed.

[Spontaneous rupture of the liver with hemoperitoneum during pregnancy. Apropos of a case, review of the literature]. / Rupture spontanée du foie avec hémopéritoine durant la grossess. A propos d'un cas, revue de la littérature.

We report the case of a patient who, at 28-week amenorrhea, presented with spontaneous hemoperitoneum in a pre-eclamptic syndrome. When caesarean section was performed, abdominal exploration revealed a liver hematoma which caused the rupture of Glisson's capsule. The related literature is reviewed.