The paper describes the technique of 'LLETZ' (large loop excision of the transformation zone), a new method of management for women with an abnormal cervical smear which offers the advantages of conization with those of local destruction. A large loop of thin wire forms a diathermy electrode that allows deep excision of the transformation zone with minimal tissue damage. The tissue removed can be examined histologically. The technique was used to investigate and treat 111 women with abnortnal sinears referred to the Bristol Royal Infirmary during 1986, Microinvasive disease was rcvcalcd in onc woman where it was not suspected by cytology or colposcopic examination. Of 102 women followed up for at least 1 year by cytology, colposcopy and, where appropriate, histology, two women were found to have residual/recurrent cervical intraepithelial neoplasia.Women with a dyskaryotic smear should have a colposcopic examination (Jordan et a / . 1982). Subsequently the transformation zone in women with cervical intraepithelial neoplasia (CIN) may be managed either by excision or by dcstruction. Traditionally excision has been equated with cone hiopsy (or rarely hystcrcctomy). Cone biopsy achicvcs complete removal of thc transformation zone and the dysplastic tissue within it. This has the distinct advantage over destructive techniques in that the specimen may be examined histologically; microinvasivei invasive disease can be excluded with confidence 6008 95, 1206-1208. S~r g 1, 276-281. 86, 913-916. GyFlueCOl 93, 773.776. ,4171 58, 97-108. -.. vix-an enigma of diagnosis. Br J Obstet Gynaecol 91, 1150-1160. Claman A. D. Xr Lee N. (1074) Factors that relate t o

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Summary These guidelines for the management of vulvodynia have been prepared by the British Society for the Study of Vulval Diseases Guideline Group. They present evidence‐based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines.

No abstract

We report a case of hemoperitoneum in pregnancy that resulted from spontaneous rupture of the uterine vessels associated with decidualized endometriosis.

Objective-To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. Design-Prospective programme trial with six month follow up. Setting-Two hospital based colposcopy clinics. Patients-616 Patients aged 16-60 with abnormal cervical smears. Interventions-After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. Main outcome measures-Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. Results-Treatment was completed in a mean of 3-47 minutes (SD 1-99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4-4%. Conclusion-Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.

Objective To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). Design A multicentre prospective cohort study. Setting CRC Clinical Trials Unit, Birmingham. Subjects 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. Intervention/Protocol Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. Main outcome measures Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. Results Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow‐up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. Conclusions Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

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