Review of outcomes of atypical squamous cells of undetermined significance papanicolaou smears for 1991 and 1992, with follow-up through 1995.

OBJECTIVES: Our aim was to review 1,754 consecutive Papanicolaou (Pap) smears from 1991 to 1992 to evaluate initial findings and disease progression through December of 1995. METHODS: The study used analysis of data in the Gundersen Lutheran Medical Center Colposcopy Clinic's computerized registry. A total of 1,754 patients were followed, and findings were analyzed for progression and age-related outcomes. RESULTS: At initial evaluation by a trained ACOG member colposcopist, 11% of patients with atypical squamous cells of undetermined significance (ASCUS) Pap smears had histologically confirmed cervical intraepithelial neoplasia (CIN) I lesion and 7% a CIN II or III lesion. After a negative initial evaluation for an ASCUS Pap smear, an additional 8.4% smears went on to to demonstrate histologically confirmed CIN II or III, and an additional 4.7% revealed a CIN I. CONCLUSIONS: An ASCUS Pap smear requires evaluation by a care provider trained in colposcopy and management of abnormal Pap smears.

LEEP: early experience with a new approach to cervical lesions.

The loop electrosurgical excision procedure (LEEP) is a new diagnostic and therapeutic approach for the management of cervical lesions found during the evaluation of abnormal findings from Papanicolaou smears. The procedure may be an alternative to laser therapy, cold knife conization, cryotherapy or hot cautery. The first 235 consecutive LEEPs performed at the Gundersen Clinic were reviewed 6 months after the last procedure was done. Twelve of 187 patients with follow up Papanicolaou smears and clinic visits had persistent disease. Nine of 187 patients had a repeat LEEP. LEEP was found to be a highly effective means for diagnosis and treatment as 98% of the patients were free of evidence of recurrent cervical lesions 6 months after the initial LEEP.

Evaluation of patients with atypical results of a Papanicolaou smear.

One hundred women with atypical Papanicolaou smear results were examined in a protocol of colposcopy, cervicography, cervical cultures, and wet preparations of vaginal secretions. Infections of the vagina and cervix were rare and often found in patients with coexistent cervical dysplasia. Cervicography identified many of the patients who ultimately were found to have cervical dysplasia but had high false positive and false negative rates. Forty-seven percent of the patients had cervical dysplasia or cervical condyloma. Based on this high rate of dysplasia, treatment of vaginitis and repeated cervical cytology cannot be recommended. Colposcopy represents the most appropriate approach to the patient with atypical cytology.

Cervical screening with cervicography and the Papanicolaou smear in women with genital condylomata.

Cervicography has been shown to be a very sensitive screening tool in the general population. Its value in screening a high-risk population was explored. One hundred five women seen with vulvar condylomata or a history thereof were offered a cervigram and Papanicolaou smear. Twelve patients had abnormal smears, whereas 53 had abnormal cervigrams. Colposcopically directed biopsies in the abnormal Papanicolaou group revealed cervical intraepithelial neoplasia (CIN) I in six patients and III in two. Cervicography-positive patients exhibited CIN I in 9 cases, II in 1 and III in 2. There was some overlap. Twelve patients had cervical condylomata without dysplasia. Cervicography, in addition to cervical cytology, should be considered for all women with vulvar condylomata.

[Psychosis and involuntary admission of patients with anorexia nervosa. A questionnaire study among 123 Norwegian psychiatrists]. / Psykose og tvangsinnleggelse ved anorexia nervosa. En spørreundersøkelse blant 123 norske psykiatere.

According to Norwegian law, one of the conditions of involuntary admission is that the patient must be psychotic at time of admission. The therapeutic benefits of involuntary admission of anorectic patients in a life-threatening phase of the illness have been discussed for quite some time, as well as whether the conditions for such admission may be fulfilled by this kind of patient. The authors have conducted a nationwide survey among the 57 psychiatrists in private practice and the 66 chief psychiatrists at adult psychiatric institutions in Norway, asking them to answer a questionnaire on these issues. The findings may point to a need for more specific guidelines on how to handle such patients, and for further analyses on the meaning and fruitfulness of the concept of psychosis in general, and related to anorexia nervosa in particular.

Psychometric features related to the acute phase and final outcome of anorexia nervosa.

The MMPI responses of a poor and good final outcome group from a follow-up study of anorexia nervosa were compared with responses of a group of anorexic patients in the acute phase. The poor outcome group produced elevated scores in the psychopathological range except on scales 4, 5 and 9. No elevations occurred in the good outcome group and the MMPI thus discriminated significantly between different kinds of final outcome of anorexia nervosa. The profile of the patients in the acute phase at time of testing was not significantly different from the poor outcome group profile. In order to improve the predictive validity of the MMPI related to anorexia nervosa, the paper points to possible directions for further research.

The Papanicolaou smear and the cervigram. A preliminary report.

We reviewed the results of Papanicolaou smears and cervigrams obtained at the same session from 250 patients. Seven Papanicolaou smears were abnormal, and 56 cervigrams were abnormal. Fourteen cases of cervical intraepithelial neoplasia I and two cases of cervical intraepithelial neoplasia III were missed by the Papanicolaou smear but identified by cervicography.

Ovarian twin pregnancy.

A case of ovarian twin pregnancy is reported. Three other cases have been previously reported. All 4 cases were in parous women in their thirties.

Early pregnancy on the diaphragm with endometriosis.

The source of hemorrhage in a young woman who required emergency laparotomy for intraabdominal bleeding was found to be a very early primary pregnancy implanted on the undersurface of the right diaphragm, far behind the dome of the liver. Immediately adjacent to this lesion were three tiny foci of endometriosis. This coincidence suggests that the site of nidation may have been a focus of ectopic endometrium rather than peritoneum.