Objective To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics. Design An observational study followed by a randomised trial. Setting Colposcopy Clinic, Royal Free Hospital, London. Participants Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis. Main outcome measure The level of anxiety measured by the Spielberger State Anxiety Inventory. Conclusion Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one‐stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.

Abstracts: Autumn 2001The following abstracts are taken from journals of interest to our readers and are reviewed by Thomas M. Julian (TMJ), Daron G. Ferris (DGF), and L. Stewart Massad (LSM). The Prognosis in Cervical Epithelial Changes of Uncertain Significance is Similar to that of Cervical Intraepithelial Neoplasia Grade 1 MK Heatley J Clin Pathol 2001;54:474-75Background: The phrase epithelial changes of uncertain significance (ECUS) describes a minor degree of nuclear pleomorphism limited to the basal layers of cervical epithelium in the absence of severe inflammation and with associated normal mitoses, koilocytosis, or koilocytosis associated features. This study investigated the long-term prognosis of this lesion. Methods: Consecutive slides from 128 women with low-grade cervical abnormalities were reviewed. Results: In 43 women, the initial diagnosis of ECUS was confirmed, and the initial diagnosis of cervical intraepithelial neoplasia grade 1 (CIN1) was confirmed in 30 women. Comparison of follow up data from these 73 women revealed a similar prognosis in the two groups in terms of regression to normal, persistence of low-grade disease, or progression to high-grade CIN. Conclusions: Low-grade cervical disease (ECUS and CIN1) should be managed according to similar treatment protocols.Comment: It appears that our British colleagues were not satisfied with ASCUS and AGUS to confuse cytology, and low-grade and high-grade lesions to mix up histology and cytology, but now suggest ECUS as a histologic classification to further cloud the koilocytotic changes and CIN1 diagnoses. The problem with taxonomies is that they are endless and do not always provide better definitions. (TMJ)Objective: To assess the effectiveness of video teaching in reducing the level of anxiety in women attending colposcopy clinics. Design: An observational study followed by a randomized trial was performed in the colposcopy clinic of the Royal Free Hospital, London. Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis had their levels of anxiety measured by the Spielberger State Anxiety Inventory. Conclusion: Women attending colposcopy clinics for either diagnosis or treatment experience a high level of anxiety. The highest levels occur in women attending a one-stop or "see-and-treat" clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety. Comment: It seems logical that the more people know about their health care, the less likely they are to fear it. The unknown is the greatest fear for most people. This study points out that the one-stop or "see-and-treat" approach to the abnormal Pap smear might have psychological drawbacks that we had not previously considered. This questionnaire lacks follow up asking whether the patient was glad to have diagnosis and treatment all accomplished in one visit. I would think that once the process is completed, they might find the approach preferable. (T...

The fresh frozen cadaver is an excellent teaching model highly representative of the living open surgical scenario where advanced trainees and newly qualified consultants can improve their operative confidence and consequently patient safety in vascular surgery. An efficient fresh frozen cadaver teaching programme can benefit many health professionals simultaneously maximizing the use of donated human tissue.

Oxidative stress imposed by reactive oxygen species is now believed to contribute to hypertension, atherosclerosis and ageing of the vasculature all involving a loss of relaxation. The antioxidant enzymes glutathione peroxidase, superoxide dismutase and catalase play a crucial role in defending against the ravages of oxidative stress. Our purpose was to characterize age-related changes in glutathione peroxidase, superoxide dismutase and catalase in the rat aorta. Aortas were extracted from seven young (4 months), seven middle aged (18 months) and seven old (24 months) animals. Analysis of variance was used with Fisher-LSD post hoc to determine mean differences among glutathione peroxidase, superoxide dismutase and catalase. Aortic glutathione peroxidase activities rose steadily with age expressed in micromol mg protein-1 min-1 +/- SEM (young: 141 +/- 22; middle aged: 198 +/- 18; old: 229 +/- 26) reaching significance between young and old. Superoxide dismutase activities significantly decreased in middle aged when compared with young (young: 22 +/- 2 vs. middle aged: 15 +/- 2 U mg protein-1) before trending upward again in old age (19 +/- 2). Catalase activities dropped significantly between young and old when expressed in mU mg protein-1 (young: 230 +/- 30; middle aged: 173 +/- 18; old: 144 +/- 23). Ratios for the various enzymes indicate a shrinking contribution of catalase with ageing, with an enhanced role for glutathione peroxidase in the antioxidant defence. These data in aortas of ageing rats show a complex alteration of the antioxidant profile.

Nitric oxide (NO) production is increased in the human colonic mucosa in intestinal inflammation. We examined the effect of corticosteroids and the role of mononuclear cells in this production. Colonic biopsies from patients with ulcerative colitis and normal controls were cultured with either budesonide or prednisolone in the presence of proinflammatory cytokines. Human mixed mononuclear cells (MMCs) were cocultured with HT-29 cells stimulated with IFN-gamma and LPS in the presence or absence of corticosteroids. Nitrite production was measured in supernatants by a modification of the Griess reaction, and inducible NO synthase (iNOS) mRNA expression was studied in colonic tissue by RT-PCR. Both steroids significantly suppressed the nitrite production and iNOS mRNA expression in inflamed colonic biopsies from ulcerative colitis patients and in cytokine-stimulated normal colonic biopsies but not in cytokine-stimulated HT-29 cells. Nitrite production by HT-29 cells was significantly increased (P < 0.01) in cocultures with MMCs stimulated with IFN-gamma and LPS. The presence of either prednisolone or budesonide significantly (P < 0.01) suppressed nitrite production from cocultures of HT-29 cells and MMCs but not from cultures of HT-29 cells stimulated with conditioned media from activated MMCs. Interestingly, stimulation of HT-29 with conditioned media from MMCs pretreated with steroids before stimulation with LPS and IFN-gamma induced a significantly (P < 0.01) lower nitrite production. These results suggest that the inhibitory effect of corticosteroids on the NO production in the intestinal inflammation might be via the inhibition of MMC-produced mediators responsible for NO production by colonic epithelial cells.