In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.

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For women with menorrhagia, hysteroscopic resection of endometrial tissue, combined with myomectomy and polypectomy when indicated, offers an alternative to hysterectomy. Favorable short-term results have been documented, but the long-term outcome may be less impressive. This study examined long-term outcomes in 279 women with menorrhagia, seen consecutively in the years 1990-1999, who underwent hysteroscopic endometrial resection with or without myomectomy. Follow-up data were available for 259 women, 93% of those operated on, after a mean postoperative interval of 6 years. More than one-third of the women received hormonal therapy for endometrial suppression preoperatively.Operative complications occurred in 15 women, about 6% of the total group. Eight women with postoperative endometritis responded well to antibiotic therapy. Endometrial abnormalities were identified in 41% of cases. Onefourth of women had hysteroscopic resection of fibroids as well, and 9% had polypectomy. Late complications were recorded in nearly 8% of women who were followed up. A large majority of the 18 patients with hematometra had undergone tubal ligation. More than one-third of women had one or more gynecological procedures during follow-up, and 61 of them underwent hysterectomy. Indications for hysterectomy included, in order of declining frequency, myomas, adenomyosis, persistent menorrhagia or endometrial hyperplasia, and perioperative or postoperative complications. More than 80% of hysterectomies were done within 5 years after hysteroscopic surgery. On multivariate analysis, both past tubal ligation and a uterine cavity measuring 9 cm or more in length were associated with an increased risk of hysterectomy. Half of the women who did not require hysterectomy were amenorrheic on long-term follow-up, and none had more than slight menstrual bleeding.These findings show that hysteroscopic resection of endometrium and fibroids provide lasting benefit to women with menorrhagia and is a suitable alternative to hysterectomy. This approach may prove effective for women who have not been satisfied by use of a levonorgestrel-releasing intrauterine system GYNECOLOGY ABSTRACT Human papilloma virus (HPV) is a key factor in the development of cervical carcinoma. High-risk types of this virus are found in nearly all squamous-cell cervical cancers. HPV infection precedes cervical intraepithelial neoplasia (CIN), and is viewed as the most important factor in both premalignant cell changes and invasive cancer. HPV testing is highly sensitive for CIN lesions. The Pap smear is less sensitive but more specific. Many of the approximately 500 women in Sweden who are found each year to have cervical cancer have chosen not to be screened. A self-sampling device (SSD) for collecting vaginal smears now is available.This study compared the results of three sampling methods in 43 women who previously had abnormal cervical cytology. The women collected vaginal samples by inserting the SSD into the bottom of the vagina and rotating it one turn. The upper part of...

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Colonization by cagA+ H. pylori strains may be protective against the formation of short- and long-segment Barrett's esophagus and its malignant complications.