Clinical significance of atypical glandular cells in cervical Papanicolaou smears.

OBJECTIVE: To determine the prevalence and the rate of clinically significant lesions in women with atypical glandular cells in cervical Papanicolaou smears. MATERIAL AND METHOD: A retrospective study was performed from the cytologic database of Charoenkrung Pracharak Hospital. All cervical cytologic examinations with a diagnosis of atypical glandular cells (AGC) between January 2002 and December 2009 were identified. Medical records were reviewed to determine the clinical data. Cytologic and histologic follow-up was obtained to establish the presence of clinically significant lesions. RESULTS: One hundred eleven AGC Pap smears were identified from 47,347 Pap smears. The prevalence of AGC was 0.23% over the eight years of the period studied. Clinically significant lesions were diagnosed in 32.4% of the women, including invasive cancer in 18.3%. Women with AGC favor neoplasia were more likely to have clinically significant lesions (53.8%) than women with AGC not otherwise specified (20%, p = 0.003). The rate of clinically significant lesions in women aged 35 years or older (35.7%) was not statistically significant different from women younger than 35 years of age (20%, p = 0.356). All cases of invasive cancer were found in women aged 35 years or older Cervical adenocarcinoma was the most common invasive cancer found in the present study. CONCLUSION: Women with atypical glandular cells on Papanicolaou smears were correlated with significant risk for clinically significant lesions, including invasive cancer Initial evaluation should include colposcopy, directed biopsy, and endocervical curettage. Women with risk factors for endometrial cancer should have an endometrial sampling.

Postoperative color Doppler sonography of the ureteral jets to detect ureteral patency in laparoscopic hysterectomy.

OBJECTIVE: To assess the accuracy of color Doppler sonography of the ureteral jets in detecting ureteral injury for gynecologic patient who had undergone laparoscopic hysterectomy. MATERIAL AND METHOD: A prospective study was performed on 170 patients scheduled for laparoscopic hysterectomy. The operations were performed for benign gynecologic disease. All patients had pre-and post-operative color Doppler sonography of the ureteral jets to determine ureteral patency. Transabdominal color Doppler sonography was used to evaluate the presence or absence of the ureteral jets from both ureteric orifices. The time for detection of the first jet and the number of jets in five minutes were recorded separately for each side. Preoperative assessment was used as control. Statistical analysis was performed by using Wilcoxon signed ranks test, considering p < 0. 05 as significant. If there was absence of the ureteral jet on one or both sides, the patient was sent to repeat color Doppler sonography on the next day Intravenous pyelography was performed to confirm ureteral injuries when the repeat examination was still found abnormal. RESULTS: Bilateral ureteral jets were demonstrated by color Doppler sonography in 168 of the 170 patients. In two patients, postoperative examination demonstrated the absence of the ureteral jet on the left side. Intravenous pyelography was performed and confirmed left ureteral obstruction. They underwent left ureteroneocystostomy. In 168 patients, bilateral ureteral jets were demonstrated in either preoperative or postoperative examination. The time for detection of the first jet was not significantly different between preoperative and postoperative examination of either the right side (p = 0.189) or the left side (p = 0.694). The number of jets in five minutes was not significantly different between preoperative and postoperative examination of either the right side (p = 0.854) or the left side (p = 0.675). CONCLUSION: Color Doppler sonography is a simple and reliable technique that may be used to evaluate ureteral jets into the bladder in patients who underwent laparoscopic hysterectomy. The time for detection of the first jet and the number of jets in five minutes are not affected by the postoperative status. The presented test may be a good screening test to detect ureteral injuries following laparoscopic hysterectomy.