Electrosurgical loop excision/conisation for cervical intraepithelial neoplasia in an algorithm that excludes punch biopsy--a study of 210 cases.

UNLABELLED: This study aims to evaluate the use of LLETZ/conisation in an algorithm that excludes the colposcopically guided biopsy. MATERIAL AND METHODS: The study was carried out on 210 patients with LLETZ/conisation, performed in our service in 2 years. They were selected by pap smear, colposcopy, HPV genotyping, without punch biopsy. RESULTS: The pathological results on the excision specimen showed: benign lesion 10%, CIN 1/condyloma 58%, CIN 2 18%, CIN 3/CIS 11%, microinvasion 2% and invasion 1%. The Pap test showed: HGSIL 27%, LGSIL 56%, ASCUS 13%, and normal/benign in 4%. The therapeutic efficiency of the excisional treatment showed that there was a 9.5% excessive treatment, 14.8 residual lesions, 3 cases of hemorrhage, 2 cervical stenosis, and 7 cases with specimen alteration that made the pathological diagnostic difficult or impossible. In conclusion, the LLETZ/conisation are ambulatory procedures with an acceptable rate of over-treatment and residual lesions, and reduced rate of complication.

[The use of hysteroscopy in the diagnostic on perimenopausal metrorrhagia. A study of 35 cases]. / Utilizarea histeroscopiei in diagnosticul hemoragiilor perimenopauzale. Studiu clinic pe 35 cazuri.

UNLABELLED: We have retrospectively evaluated the role of hysteroscopy for the diagnostic of the peri-menopausal metrorrhagia. METHODS: The cases included represented patients of more than 45 years, with persistent bleeding, from 2 gynecological hospitals (one public and one private), during one year, that were submitted to hysteroscopy for clarifying the diagnostic. The hysteroscopic endometrium descriptions were categorized as: atrophy, normal, simple or suspect hypertrophy, polyp, and adenocarcinoma, and they were compared to the pathological exam results. RESULTS: The descriptions were distributed among the categories: atrophy (8 cases), simple hypertrophy (17), suspect hypertrophy (3), polypoid (5), endometrial cancer (2) or normal (4). The correlation to pathological results was good, with only 14% of hysteroscopic underestimation of lesions. The sensitivity according to type of pathology, was 50 to 100%, specificity between 84% - 100%. CONCLUSION: Hysteroscopy is better than "blind" curettage in clarifying perimenopausal hemorrhagic endometrial pathology.

Laparoscopy versus laparotomy for pelvic and lumbar-aortic lymphadenectomy. A 11-year experience.

UNLABELLED: This study is a retrospective comparison of laparoscopy and laparotomy lymphadenectomy (pelvic and lumbar-aortic) in cervical cancer stage IA1 and more, in a gynaecological service in Lyon, France. MATERIAL AND METHODS: During 11 years, there were 126 cases of cervical cancer patients in which lymphadenectomy was performed, either by laparoscopy or laparotomy. We analysed if there were significant differences regarding the 2 accesses in terms of stage, tumour size, surgical interventions associated, number of lymph nodes extracted, and outcome. RESULTS: Regarding the stage of our cases, 3 of them were IB1, IB2 and IIB; the more advanced the stage, the fewer lymphadenectomies were performed by laparoscopy. As for the tumour size, the smaller tumour was statistical significantly associated with pelvic laparoscopic lymphadenectomy (p = 0.01) while the tumours larger than 4 cm mean lumbar-aortic lymphadenectomy by laparotomy (p = 0.006). Regarding the associated surgical interventions, the laparoscopic lymphadenectomies were associated to low-stage operations: conisation/trachelectomy, vaginal or abdominal simple hysterectomy, or extra-fascial hysterectomy (type 1 or 2). There was no significant difference between laparoscopy and laparotomy ways regarding the number of lymph nodes extracted (median 13.5 vs 11, p = 0.45 for pelvic nodes, and 8 vs 4 for lomb-aortic nodes, p = 0.43, for laparoscopy vs laparotomy). CONCLUSION: Laparoscopic lymphadenectomy is as effective as the laparotomy procedures, and the training of young gynaecologic oncologists should not ignore laparoscopy as an alternative technique for nodes sampling.

[Use of slings in vaginal surgery]. / Protezele în chirurgia vaginala.

The use of slings in the cure of genital prolapse and urinary stress incontinence is justified by the large number of relapses after the classical surgical procedures, especially due to the poor quality of the perineal connective tissue. The ideal sling for vaginal surgery should have certain characteristics, i.e., resistance to infection, bio-stability, bio-compatibility, solidity, interstitial texture, porosity, elasticity, non-aggressive margins. The discussed techniques used in the cure of the stress urinary incontinence are the Tension-free Vaginal Tape (TVT), the Sparc-sling System, the Intra-vaginal sling-plasty tunneller (IVS), and Trans-obturator Tape (TOT). For the cystocele, the under-bladder meshes, either free or fixed to the abdominal wall or to TVT is recommended. For the rectocele, a posterior IVS with a tension-free inter-recto-vaginal prosthesis is suitable, while for the vaginal vault prolapse, hysterocele or isolated elitrocele we discuss the posterior IVS.

[Malignancy of uterine sarcoma in comparison with suspect leiomyoma. An anatomo-clinical study of 16 cases]. / La malignité du sarcome utérin, par comparaison avec les léiomyomes suspects. Etude anatomo-clinique sur seize cas.

Sarcoma of the uterus accounts for less than 1 per cent of uterine neoplasms but is responsible for more than 15 per cent of deaths. However, histological or clinical malignancy features are poorly understood, in particular those which differentiate sarcomas from leiomyomas. This study involved 16 cases, seen during 8 years in two gynecology clinics in Iasi (Rumania) and chosen according to histological diagnosis. Ten leiomyomas were also chosen for comparison of symptomatology. The malignancy criteria studied--vascular invasion, cellular density, number of mitoses and histological type (most often leiomyosarcoma: 8 out of 16)--were used to compare sarcomas with suspect leiomyomas. The mean age was 50, 7 cases being diagnosed after the menopause. The commonest symptom was metromenorrhagia (11 cases out of 16), but pain was more frequent in leiomyomas (9 out of 10). Treatment was above all surgical, total hysterectomy having the best prognosis (3 deaths out of 8 patients operated upon). Other methods (in particular radiotherapy) not being used immediately after surgery, they could not be studied. In terms of its difficult diagnosis and its high degree of malignancy (9 deaths out of 16), sarcoma must remain an argument in favour of total hysterectomy.