Hysteroscopic findings in patients with a cervical polyp.

OBJECTIVE: Our objective was to determine the presence of intrauterine lesions in patients with a cervical polyp. STUDY DESIGN: We performed a retrospective analysis to determine the influence of hormonal treatment and age on 165 patients with a cervical polyp and bleeding on admission. All 165 patients underwent a diagnostic hysteroscopy to rule out intrauterine lesions, including polyps, fibroids, hyperplasia, and adenocarcinoma. RESULTS: Endometrial polyps were found in up to 26.7% of patients who had a cervical polyp. In patients undergoing a combined pill treatment this incidence was much lower (8.3%). Menopausal patients had a 56.8% incidence of cervix-related endometrial polyps, and hormone replacement therapy did not significantly increase (45.7% vs 28.6%) the incidence of coexisting polyps. All cervical polyps present during tamoxifen treatment were associated with endometrial polyps. Abnormal vaginal bleeding was of no clinical significance in excluding concomitant endometrial polyps. CONCLUSIONS: All menopausal patients with a cervical polyp could benefit from a diagnostic hysteroscopy. Premenopausal patients receiving a combined pill treatment are the least likely to have coexistent endometrial polyps.

Endometrial lesions in patients undergoing tamoxifen therapy.

Forty-six nonhysterectomized women treated with tamoxifen during 6-36 months as adjuvant therapy for breast cancer underwent a hysteroscopy to assess the endometrial effects of this drug. Whereas the endometrium was normal among 23 patients, 13 presented with endometrial polyps, 8 with hyperplasia and 2 with adenocarcinoma. The rate of endometrial lesions was directly related to the cumulative dose of tamoxifen but it was not statistically different among patients receiving progestational therapy compared to patients who did not receive this therapy.

Hysteroscopic follow-up during tamoxifen treatment.

In order to study the action of Tamoxifen upon the uterus, 16 breast cancer patients were prospectively evaluated by means of an hysteroscopy before Tamoxifen therapy and again after 6 to 36 months of treatment. The results show the occurrence of an endometrial polyp in four cases and of an adenocarcinoma in one case. Moreover, the previously atrophic mucosa became mildly proliferative in seven of the patients who were evaluated.

[Early detection of ureteral injuries associated with hysterectomy. A prospective echographic study]. / Dépistage précoce du traumatisme urétéral associé à l'hystérectomie. Etude échographique prospective.

Among ureteral injuries that occur during hysterectomy some are neglected and remain asymptomatic. They occur even, although not particularly, during so-called easy operations. Their severity and their need for early treatment point to the use of effective screening. It is not possible to carry out intravenous urography routinely. Searching, however, for pyelo-calyceal dilatation by ultrasound of the kidneys can show ureterohydronephrosis and can detect ureteral trauma. The authors carried out such ultrasound controls in 150 consecutive patients the day before, and the fourth and ninth days after hysterectomy. On the fourth day pyelo-calyceal dilatation is seen more frequently but is not large. Large dilatation appearing on the fourth postoperative day may be considered an early and reliable sign of suspect injury. The authors suggest that renal ultrasound should be carried out routinely on the day before and the fourth day after hysterectomy. The authors feel that when dilatation of the pyelo-calyceal area increases by 12 mm or more between the two examinations major ureteral injury must be suspected and urography carried out intravenously.

[Renal ultrasonic diagnosis in pregnancy. Prospective study of pyelo-calyceal changes in the mother and their obstetric implications]. / Echographie rénale durant la grossesse. Etude prospective des modifications pyélo-calicielles maternelles et de leurs implications obstétricales.

An acute pyelonephritis is still a serious complication of pregnancy. Urinary stasis plays an important role in the pathogenicity of this infection. 232 patients without symptoms were studied to find out how much urinary stasis occurred by measuring dilatations of the pyelo-calices by ultrasound. The authors suggest that a correlation between the bacteriological examination of the urine and the ultrasound appearance of the kidney can be established. Asymptomatic urinary infection occurs more frequently when there is dilatation of the pelvis of the kidney greater than 12 mm in the right kidney and 7 mm in the left. This is why they suggest that an ultrasound examination of the hilum of the kidney should be carried out routinely to screen for patients who are at risk of having pyelonephritis in pregnancy.

Carbon dioxide laser vaporization of cervical subclinical papillomaviral infection and intraepithelial neoplasia: short-term effectiveness.

134 patients with biopsy-proved cervical subclinical papillomaviral infection (SPI) (the so-called 'flat condylomas'), or with associated intraepithelial neoplasia (also called 'atypical condyloma' or 'CIN with features of condyloma'), or with isolated, apparently 'non-warty' intraepithelial neoplasia were treated by means of the carbon dioxide laser between July, 1982, and January, 1985, following a planned approach and on an outpatient clinic basis, without the use of anesthesia or analgesia. The complication rate was extremely low. The overall cure rate was 91.0%. This confirms that laser surgery, combined with colposcopic expertise, can offer acceptable treatment effectiveness, comparable to other techniques of local destruction. Moreover, rapid tissue healing allows early identification of persistent disease. Converging cytological, histopathological, immunochemical and serological evidence has established human papillomavirus - belonging as a subgroup to the papovavirus family - as an important etiologic factor in female genital tract carcinogenesis. The marked increase in prevalence of these mainly sexually transmitted cervical SPI lesions creates a growing problem of their management and/or follow-up.

[Uterine rupture. Reflections apropos of a spontaneous case in mid-pregnancy]. / Rupture utérine. Réflexion à propos d'un cas spontané à mi-grossesse.

A case of spontaneous uterine rupture is reported occurring in the midtrimester of pregnancy in a patient who had benign signs of tuberous sclerosis. There was no placenta increta but the myometrial thickness, at the site of placental insertion, was only 160 microns. This finding is discussed. On this occasion, the authors review the aetiology and signs of uterine rupture, its treatment and prevention, especially before the third trimester of pregnancy.

Long-term progestogen treatment and bone remodelling in peri-menopausal women: a longitudinal study.

In view of the potential adverse consequences of oestrogen treatment, the effects of a progestogen on bone mass and bone remodelling have been evaluated in a longitudinal study. Bone mass and bone remodelling were measured radiogrammetrically in 39 peri-menopausal women who participated in an earlier cross-sectional study and continued to receive progestogen treatment, viz. lynestrenol, 5 mg daily, for 4.5 yr after the first assessment. Follow-up data obtained in untreated peri-menopausal and post-menopausal women and in oestrogen-treated post-menopausal women were used for comparison purposes. Pairs of hand films were measured blind by the same observer. For each pair of films, the average over six metacarpals of periosteal and endosteal width, cortical thickness and cortical area was calculated. In the progestogen-treated group a slight increase in periosteal diameter occurred, comparable to the untreated and oestrogen-treated groups. The increase in endosteal diameter in the progestogen-treated group is half that in the untreated groups, with a resultant smaller loss in cortical thickness in the lynestrenol group as compared with the untreated controls. Although lynestrenol's effectiveness in inhibiting bone resorption seems to be similar to that of oestrogen, the effect is less than that observed in post-menopausal women treated with conjugated equine oestrogens (1.25 mg) or ethinyl oestradiol (0.025 mg).

Ovarian morphology during and after lynestrenol treatment around menopause.

In this histological study, the inhibition of continuous oral administration of lynestrenol 5 mg/day on the ovarian follicle and corpus luteum development was found to be extremely pronounced. Known estrogen - producing structures such as antral, mature follicles and corpora lutea were completely absent during treatment. Structures devoid of cystic function however, as persistent and cystic follicles and follicular cysts, seemed not to be influenced in their histological appearance and frequency. As the recovery of the cyclic ovarian function after cessation of the medication compares favorably with the spontaneous cycle, a continuous lynestrenol treatment of 5 mg/day can be regarded as a safe endocrinological regimen.