[Laser therapy of the uterine cervix]. / Lasertherapie der Portio.

Within a period of 2 years 103 patients have been treated with a 50 Watt CO2-Laser because of chronic fluor (20 patients), condylomatous or dysplastic lesions of the portio (39 patients) or after conisation (44 patients). All patients have been treated as outpatients without any local anesthesia. We didn't observe severe complications. 2 times we had to stop laser vaporisation because of bleeding of the portio and had to begin once more after an interval. The patients had been controlled by cytology and colposcopy. The shortest observation time was 6 months. All cytologically controlled patients had a negative PAP-smear. 17 of the 20 patients with chronic fluor mentioned improvement or missing symptoms.

Primary chylocolporrhea successfully managed by division and ligation of retroperitoneal lymphatics.

Chylocolporrhea or chylous vaginal discharge is a rare manifestation of the primary chylous reflux syndrome. We describe its occurrence in a young child successfully treated by ligation of retroperitoneal, groin, and vaginal megalymphatics.

Chylous metrorrhea.

A nine-year-old girl with primary (idiopathic) chylous metrorrhea is described. Extravasation from retroperitoneal lymphatics into the vaginal vault was seen on dorsal pedal lymphangiography. Bony abnormalities were also present in the lumbosacral vertebrae. Nineteen months after transperitoneal lymphangiectomy she is asymptomatic.

Treatment of cervical ectropion by cryosurgery: effect on cervical mucus characteristics.

Eighteen women with cervical ectropion and 12 women with ectropion and vaginal discharge were treated by cryosurgery. Evaluation of the cervical mucus characteristics by cervical score and in vitro penetration test was performed before treatment and 2 months later. In the group with ectropion only (group A) the total cervical score was 5.7 +/- 0.4 and 11.9 +/- 0.06 (P less than 0.001) (mean +/- standard error) before treatment and 2 months later, respectively. In the group with ectropion and vaginal discharge (group B) the total cervical score before and after cryosurgery was 3.8 +/- 0.4 and 11.8 +/- 0.1 (P less than 0.001), respectively. In vitro penetration tests in group A before and after treatment were 0.72 +/- 0.1 and 2.9 +/- 0.08 (P less than 0.001), respectively. In group B, in vitro penetration tests before and after cryosurgery were 0.25 +/- 0.1 and 2.8 +/- 0.1 (P less than 0.001), respectively. It appears that cryosurgery improves the cervical mucus characteristics. It is recommended that infertile patients with hostile cervical mucus and ectropion will be treated by cryosurgery.

[CO2 laser coagulation of benign changes of the portio vaginalis in comparison with the endocoagulation technic (Semm's method)]. / Die CO2-Laserkoagulation gutartiger Veränderungen der Portio vaginalis im Vergleich zur Endokoagulationstechnik (nach Semm).

The CO2-COHERENT laser was therapeutically used by the authors on 31 cases of extensive erythroplakia associated with recurrent and therapy-resistant fluor formation and on cases of highly vascularised transformation zones with contact bleeding. The benign nature of the findings first had been established by repetitive Pap smears and thorough colposcopic examination. The authors suggest that for the time being the CO2 laser is not suitable yet for the treatment of dysplasia or carcinoma in situ, since no material for histological testing is obtainable from that therapeutic approach, and the presence of microcarcinoma with invasive growth cannot be ruled out with absolute safety. CO2 laser treatment was undertaken without hospitalisation of patients, just as endocoagulation of the vaginal portio was carried out on an outpatient basis. Postoperative follow-up checks have been made one, three, and six weeks as well as three and six months from treatment. The therapeutic results obtained from CO2 laser therapy were compared with those recorded from patients who had undergone endocoagulation of the vaginal portio, with the view to checking the advantages claimed for laser therapy in the literature [1, 4, 11, 12, 23, 24], such as no need for anaesthesia, effective destruction of much of the pathological tissue, high-accuracy identification of tissue for destruction by means of colposcopy, low rate of postoperative complications, soon healing, and good haemostatic action. All these advantages were found to be obtainable just as well from the technique of endocoagulation without the need for the great amount of technical input and equipment definitely required for laser therapy [16, 18, 19, 20, 21].