Objective
A long term review of women after hysterectomy with a history of pre‐invasive carcinoma of the cervix.
Design
193 women had cervical intra‐epithelial neoplasia and two had adenocarcinoma in situ either at hysterectomy or at previous cone biopsy. These were followed up by annual cytology.
Setting
South Glamorgan Health Authority.
Subjects
Of 195 women who had a hysterectomy, 143 have been followed up cytologically for more than 10 years and 43 for more than 20 years: a total of 2800 women years of experience.
Main outcome measures
Timing of abnormal smears.
Results A detailed reviw of the five women with abnormal smears. The estimated percentage of women who remain negative is 98% at five years, 98.4%, at 10 years and 96.5 % at 20 years.
Conclusion
Cytological screening ofall women who had a hysterectomy with a history of CIN is indicated for the first two years after hysterectomy. Thereafter the estimated incidence of 0.7 per 1000 women years is higher than the general population but it is not a sufficient reason to screen more frequently. We recommend screening for the carcinoma of the vagina to be every three years which is the same screening frequency as for cervical carcinoma in the general population.
S.S. is a healthy, 29‐year‐old nulligravida who comes to the clinic with her female partner, M.S., seeking advice on becoming pregnant through the use of donor sperm from a cryobank. S.S. has been charting her fertility signs for 3 months, and both she and her partner are very excited about the prospect of becoming parents. They have done some research into donor sperm, but have questions about the different types of donor sperm available, whether to pursue intracervical or intrauterine insemination, and if the insemination should be done at home or in the clinic. They report that they have been to an obstetrician‐gynecologist seeking care. The physician was unfamiliar with donor insemination and referred them to a fertility clinic for preconception counseling. The physicians at the fertility clinic recommended that the couple pursue pregnancy using ultrasound to detect follicle growth, followed by a human chorionic gonadotropin trigger shot and then intrauterine insemination in the clinic 24 hours later. The couple felt that these interventions were unnecessary at this point, because they did not have a known fertility problem.
SUMMARY The Cardiff Cervical Cytology Study showed a prevalence of carcinoma-in-situ that rose to a peak of 6. 1/1000 in age group 35-44 and then decreased. Prevalence of microinvasive and occult invasive carcinoma rose to peaks of 1 8/1000 and 1 1/1000 respectively in age group 45-54 and then declined. Epidemiological analysis was based on comparison of three groups-dysplasia, carcinoma-in-situ and microinvasive carcinoma combined, and occult and clinical invasive carcinoma combined. For all groups prevalence increased with lower social class, was higher in widowed, divorced and separated women than in married women, and increased with decreasing age at first marriage and at first pregnancy and with increasing number of pregnancies. The magnitude of these associations was remarkably similar for all three histological groups. Screening for cervical neoplasia is based on the belief that the various histological categories are part of a continuum, a spectrum of disease, and the existence of a common epidemiological pattern for the three histological groups is consistent with such a hypothesis.
Pseudomyxoma peritonei (PMP) is a rare condition complicated by intra-abdominal spread that can cause multilevel gastrointestinal (GI) obstruction. Parenteral nutrition (PN) use in the context of palliative care and malignancy remains controversial. We describe the use of palliative PN in three patients with progressive PMP causing multilevel GI obstruction and intestinal failure. All patients received > 90 days of PN. PN was safe in this cohort of patients. However, patient selection and the timing of intervention are important factors when considering the initiation of PN.
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