Outcome after treatment of high-grade squamous intraepithelial lesions: relation between colposcopically directed biopsy, conization and cervical loop excision.

PURPOSE OF INVESTIGATION: The hypothesis that cold-knife conization performed in women with high-grade squamous intraepithelial lesions (HSIL) and unsatisfactory colposcopy is a better procedure than the loop electrosurgical procedure (LEEP) is tested. METHODS: A retrospective study was conducted in conization specimens of women submitted to LEEP (n = 102) or conization (n = 245) due to HSIL. Age, biopsy, compromised surgical margins in conization, and recurrence were analysed. RESULTS: The frequency of invasion, non-compromised margins, and recurrence in conization and LEEP were, respectively, 7.7% versus 2.9%, 64.1% versus 48% (p = 0.008), and 33.8% versus 24.1%. Eight (42.1%) and five (26.3%) of 19 women submitted to conization where invasion was found in surgical specimens were, respectively, menopausal or had unsatisfactory colposcopy. Twenty-five (96.2%) of 26 and 23 (95.8%) of 24, respectively, undergoing conization and LEEP had recurrence in the first five years. CONCLUSION: We recommend the use of cold-knife conization in cases where the lesion is located deep in the cervical canal.

[Influences and psychological structures in breast cancer]. / Influências e estruturas psicológicas no cancer da mama.

A sample of 16 patients with malignant breast tumors were examined by means of an interview, a questionnaire, and the Szondi Test together with a comparison group of 56 patients with benign breast tumors. The patients were divided into two age groups, those below and above 40 years of age. In this way studies done in other countries to investigate the personality structure of cancer patients were replicated. Emphasis was given to the following issues: self-destructive and/or masochistic tendencies, attitudes of depressive resignation, and conflicts with respect to femininity and motherhood. The results showed several significant differences by which benign tumor patients can be better characterized. These patients presented symptoms, experiences and structures of the neurotic type. The cancer patients presented structures closer to the psychosomatic type, with rigid negation of conflicts (in relation to sex, identification, violence and aggression), and with an unreal insertion in the world. Their somatizations are not conversive; they are interpreted as effects of the destructive and violent tendencies which, without release for the lack of adequate contacts with objects, are directed toward themselves. However, this cannot properly be called a masochistic structure because the destructive tendencies do not have a sexual origin, rather they are part of a vehement negation of others and of life itself, in the sense of a primary death drive. It is impossible to tell, however, to what point these characteristics are already the effects of the breast problems, or whether they have more causal relevance as certain previous personal experiences indicate.

InfluÛncias e estruturas psicológicas no cancer da mama. / [Influences and psychological structures in breast cancer]

A sample of 16 patients with malignant breast tumors were examined by means of an interview, a questionnaire, and the Szondi Test together with a comparison group of 56 patients with benign breast tumors. The patients were divided into two age groups, those below and above 40 years of age. In this way studies done in other countries to investigate the personality structure of cancer patients were replicated. Emphasis was given to the following issues: self-destructive and/or masochistic tendencies, attitudes of depressive resignation, and conflicts with respect to femininity and motherhood. The results showed several significant differences by which benign tumor patients can be better characterized. These patients presented symptoms, experiences and structures of the neurotic type. The cancer patients presented structures closer to the psychosomatic type, with rigid negation of conflicts (in relation to sex, identification, violence and aggression), and with an unreal insertion in the world. Their somatizations are not conversive; they are interpreted as effects of the destructive and violent tendencies which, without release for the lack of adequate contacts with objects, are directed toward themselves. However, this cannot properly be called a masochistic structure because the destructive tendencies do not have a sexual origin, rather they are part of a vehement negation of others and of life itself, in the sense of a primary death drive. It is impossible to tell, however, to what point these characteristics are already the effects of the breast problems, or whether they have more causal relevance as certain previous personal experiences indicate.