Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women.

AIM: To study the outcome of biopsy-diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC). MATERIAL AND METHODS: Patients (n = 131) were analyzed for histological results on LEEP/CKC specimen. Demographic and risk factors, referral cytology, high risk human papilloma virus (HR HPV) test and follow-up colposcopic clinic visits were studied. RESULTS: Excisional specimens from LEEP/CKC demonstrated no CIN in 20 (15%), CIN 1 in 17 (13%), CIN 2 in 57 (44%) and CIN 3 in 37 (28%). No invasive cancers were identified. The referral Pap smear was high grade or possible high grade in 52 (40%), low grade in 59 (45%) and inconclusive in 20 (15%). Fourteen patients (11%) had positive excisional margins, eight of the 14 were tested for HR HPV infection before LEEP, and all were positive. Post-treatment HPV testing was performed at the 12-month visit in 6 of the 14 patients who had positive excision margins, and all 6 tested were negative. Two women (1.5%) with clear margins had recurrence of CIN 2, both tested positive for HR HPV after treatment. CONCLUSION: Our data showed that a significant number of women (28%) with biopsy-diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2.

A prospective study assessing patient satisfaction at a large tertiary gynecologic oncology/dysplasia unit.

BACKGROUND: Patient satisfaction is an important quality assurance measure in the delivery of health care. We conducted a prospective study to assess patient satisfaction at a large tertiary oncology/dysplasia unit. AIMS: To assess current patient satisfaction at a large tertiary oncology/dysplasia unit and identify potential areas for improvement. METHODS: This was a prospective study of patients attending a tertiary oncology/dysplasia unit. Patients were invited to participate and, if they agreed, were given a validated questionnaire to complete at the end of their consultation. Descriptive statistics were then used to analyze the data and identify potential areas of improvement. RESULTS: One hundred eighty-seven patients were recruited, and 96% of patients were satisfied with the overall level of care received. Significant positive features of the service included helpfulness of the staff, cleanliness of the facility, and measures implemented to respect patient privacy. Lack of patient parking, waiting times in the clinic, difficulties in contacting the service, and locating the building were identified as areas for improvement. CONCLUSION: Patients attending our facility were largely satisfied with the overall level of care received. Nonclinical factors including parking, waiting times, and access to the service were identified as areas for improvement.

Patient satisfaction with inpatient care provided by the Sydney Gynecological Oncology Group.

PURPOSE: Patient satisfaction with the provision of hospital oncology services can have a significant impact on their overall treatment experience. AIMS: To assess patient satisfaction with the inpatient hospital services in the gynecological oncology setting using the IN-PATSAT32 questionnaire developed by the European Organization for Research and Treatment of Cancer (EORTC). METHODS: A modified version of the IN-PATSAT32 questionnaire with additional 16 items was administered to 52 adult surgical inpatients admitted with the Sydney Gynecological Oncology Group. All participants were provided with an information leaflet regarding the survey and written consent obtained. RESULTS: A high response rate (100%) from patients with varied social, ethnic, and educational backgrounds confirmed the acceptability of the survey. Standard of medical care provided, frequency of doctors' visits, exchange of information with doctors, friendliness of the staff, and state of the room ranked highly (>95%) on the patient satisfaction scales. Problems were identified with ease of access to and within the hospital, quality of food, and exchange of information with other hospital staff. CONCLUSIONS: Overall the satisfaction with inpatient care was rated very highly in most areas. Deficiencies in certain elements of provision of medical care to the patients were identified and steps have been taken to improve upon these shortcomings.

Secondary malignancies in ovarian dermoid cyst.

OBJECTIVE: To review our local experience with mature cystic ovarian teratoma, and describe our treatment modality regarding this uncommon condition. METHODS: The databases of the Sydney Gynecologic Oncology Group at Royal Prince Alfred and Liverpool Hospital, Sydney, Australia, were reviewed from 1987 to 2007. A retrospective chart review, and analysis of patient's data were conducted. RESULTS: Eleven cases of ovarian dermoid cyst with secondary malignancy were identified. Six out of eleven (54.5%) of the cases were carcinoid tumor, 4/11 (36%) squamous cell cancer, and one case (9%) transitional cell carcinoma. The median age of cases was 47 years (range of 28-74). Stage I-II was recorded in 8/11 (73%) of the cases, while stage III-IV was found in 3/11 (27%). The initial treatment ranged from unilateral cystectomy to hysterectomy, and bilateral salpingo-oophorectomy, and debulking surgery. All patients with stage I disease showed more than 5 years survival (100%). The survival for late staged disease (III-IV) ranged from 2.5 months to 18 months with an average of 8 months. CONCLUSION: Carcinoid tumor is the most common malignancy noticed. Survival is related mainly to tumor stage, and optimal debulking procedure. However, further studies are needed to study the effect of other factors on survival.

Not all ovarian cysts in young woman are benign: a case series and review of the management of complex adnexal masses in young women.

While ovarian cancer is a disease that predominately affects postmenopausal women, up to 13% of affected patients are indeed less than 45 years of age. The diagnosis is often delayed because of the non-specific nature of symptoms and a lack of specific and accurate diagnostic tests, that is, CA125 and ultrasound. In premenopausal women these issues are compounded, further reducing the likelihood of an accurate and early diagnosis. It is important for gynaecologists to have a high index of suspicion and appropriately investigate symptomatic patients and interpret test results critically. Not all ovarian cysts in young women are benign, and a low threshold for surgical evaluation is warranted.

Recurrence after treatment for high-grade dysplasia: should we modify our post-treatment surveillance protocols?

A cohort of women, having undergone an excisional procedure for high-grade cervical dysplasia, was studied to identify those patients who developed recurrent high-grade cervical dysplasia post-treatment. We have confirmed that recurrent histologically confirmed high-grade cervical dysplasia is uncommon after complete excision and appears not to occur within the first 6 months post-treatment. Post-treatment surveillance protocols should incorporate these findings.

Synthesis and molecular structures of mononitrosyl (N2S2)M(NO) complexes (M = Fe, Co).

A series of tetragonally distorted square pyramids of formula N2S2M(NO) (M = Fe, Co) is prepared and characterized by nu(NO) IR and EPR spectroscopies, magnetism and electrochemical properties, as well as solid-state crystal structure determinations. While the nu(NO) IR frequencies and the angleM-N-O angles indicate differences in the electronic environment of NO consistent with the Enemark-Feltham notation of [Fe(NO)]7 and [Co(NO)]8, the reduction potentials, assigned to [Fe(NO)]7 + e- <==> [Fe(NO)]8 and [Co(NO)]8 + e- <==> [Co(NO)]9 respectively, are very similar, and in cases identical, for most members of the series. Coupled with the potential for the M(NO) units to breathe out of and into the N2S2 core plane are unique S-M-N-O torsional arrangements and concomitant pi-bonding interactions which may account for the unusual coherence of reduction potentials within the series.

The site of infection and ethnicity of the patient influence the biological pathways to HPV-induced mucosal cancer.

High-risk human papillomaviruses are the causative agents of cervical cancer and are also believed to be aetiologically involved in a subset of squamous cell carcinomas of the head and neck region, especially the tonsil. Cervical cancers arise through disruption of the pathways of p53 and the product of the retinoblastoma gene by the human papillomavirus oncoproteins E6 and E7. It is generally assumed that the same pathways are involved in human papillomavirus-induced carcinogenesis at other mucosal surfaces. However, the patterns of expression of cell cycle proteins targeted by human papillomavirus E6 and E7 in cancers from different anatomic sites have been inconsistent, due to either biologic or technological factors. In this study, 73 human papillomavirus, 16-positive cervical squamous cell carcinomas (35 from Australian and 38 from Chinese women) were analysed for the expression of p53, pRb, p16(INK4A), p21(CIP1/WAF1), p27(KIP1) and cyclin D1 by semiquantitative immunohistochemistry. Cervical cancers from Chinese women were found to be significantly more likely to overexpress p53, pRb, p21 and p27 than their Australian counterparts. These findings were compared with those from 31 human papillomavirus 16-positive tonsillar squamous cell carcinomas, all of Australian origin, tested using the same methodology. Comparisons of the tonsillar and combined cervical data showed that tonsillar cancers were significantly more likely to be p53-positive, whereas cervical cancers were significantly more likely to overexpress pRb, p16 and p27. When the tonsillar data were compared with cervical data from Australian women, the associations for p53 and pRb remained. These findings represent new evidence that the molecular pathways to human papillomavirus-induced mucosal cancer may be influenced by anatomic location and ethnicity.

Malignant mixed mullerian tumour of the ovary: prognostic factor and response of adjuvant platinum-based chemotherapy.

OBJECTIVES: The purpose of the present study was to analyse retrospectively the data of a series of patients presenting to our unit with malignant mixed mullerian tumour (MMMT) of the ovary to identify the prognostic factors and relate them to survival. The role of platinum-based chemotherapy in the adjuvant treatment of this tumour was also evaluated. METHODS: All patients diagnosed with MMMT of the ovary from 1987 to 2000 were identified from the gynaecological tumour registry of King George V Hospital, Australia. The effect of clinical and histopathological variables on survival was analysed. The response of platinum-based adjuvant chemotherapy after surgery was also evaluated. RESULTS: Twenty patients with MMMT of the ovary were identified. Of the six patients with measurable disease, two (33%) had complete response after adjuvant platinum-based chemotherapy. The median survival of all patients was 8 months, while that of the patients receiving adjuvant platinum-based chemotherapy was 23 months. Women who were older (> 65 years) had a significantly worse survival rate than those who were younger (P = 0.02). The patients with optimal debulking had a better median survival than those with suboptimal debulking, but this difference was not statistically significant (P = 0.21). Sarcomatous component (homologous vs heterologous) was not found to be a significant prognostic factor for predicting survival. CONCLUSIONS: Malignant mixed mullerian tumour of the ovary is a rare and aggressive gynaecological tumour. The current study indicates that patient age was a significant prognostic factor for survival and surgical cytoreduction combined with platinum-based chemotherapy is the most effective management regimen identified to date to treat MMMT of the ovary.

Management of large bowel obstruction in advanced ovarian cancer with intraluminal stents.

BACKGROUND: While most patients with advanced ovarian cancer can achieve prolonged remission with surgery and chemotherapy, eventually most will recur. Commonly bowel obstruction will complicate their recurrence, usually heralding the terminal phase of their disease. Standard management of bowel obstruction has involved surgical intervention after a period of conservative medical management. Unfortunately, many patients submitted for surgery do not derive benefit from such an approach, spending the majority of their remaining life in the hospital or recovering from the surgery. CASES: Two cases of patients with large bowel obstruction resulting from advanced and recurrent ovarian cancer are presented. In the first case, a rectal stent was decided upon as the appropriate management as she was failing first-line therapy, with little likelihood of recovering from a laparotomy. In the second case a large recurrent infected tumor mass had already been debulked, but was continuing to cause obstructive symptoms. In both cases immediate relief of their gastrointestinal symptoms was achieved. CONCLUSIONS: In patients with large bowel obstruction secondary to extrinsic compression, useful palliation can be achieved with a colonoscopically placed endoluminal stent.