Objective To identify differences in the peri‐operative outcome of women undergoing hysterectomy with bilateral salpingo‐oophorectomy performed either by abdominal hysterectomy and bilateral salpingo‐oophorectomy or by laparoscopic‐assisted salpingo‐oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations. Subjects and methods Eighty women undergoing hysterectomy and bilateral salpingo‐oophorectomy for benign gynaecological conditions were prospectively randomised to have the procedure by laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy or total abdominal hysterectomy and bilateral salpingo‐oophorectomy. The peri‐operative and post‐operative courses of both groups were compared. Results Although laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy took longer (100 (SD 5.6) versus 57 (SD 4.7) min, P < 0.0001), the women undergoing this procedure had a shorter time in hospital (3.5 versus six days, P < 0.0001) quicker recovery (three versus six weeks, P < 0.0001) and returned to work earlier. There were minimal complications in both groups and they were not significantly different. The cost of the laparoscopic‐assisted procedure was greater during the operation with longer operating time and cost of disposable instruments. However, the total cost of treatment was less in this group because of shortened post‐operative stay. Conclusion The study shows laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy is a safe and cost‐effective procedure for women requiring a hysterectomy and bilateral salpingo‐oophorectomy.

Perinatal transmission of genital human papillomaviruses (HPVs), including HPV-16 and -18 which are associated with anogenital carcinomas have been described previously [Pakarian et al. (1994): British Journal of Obstetrics and Gynaecology 101:514-517; Kaye et al. (1994) Journal of Medical Virology 44:415-421]. A study was undertaken to investigate whether HPV-16 and -18 DNA in infants contaminated at delivery persists until they are 6 months of age. Of 61 pregnant women recruited, 42 (68.8%) were HPV-16 and 13 (21.3%) were HPV-18 DNA positive. At 24 hr there were transmission rates from HPV DNA positive mothers to their infants of about 73% (HPV-16: 69%; HPV-18: 76.9%). Ten mothers who were both HPV-16 and -18 DNA positive produced six (60%) infants who were also doubly positive at 24 hr. HPV DNA persisted to 6 weeks in 79.5% (HPV-16: 84%; HPV-18: 75%) of those infants who were positive at birth. At 6 months of age, persistent HPV-16 DNA was detected in 83.3% of cases, but HPV-18 DNA persistence at this time was 20%. To extend these observations over a greater age range of children HPV-16 L1 and L2 proteins were expressed in insect cells via recombinant baculoviruses and sera from 229 children were examined to determine at what age IgM antibodies to HPV were acquired. There was a bimodal distribution of IgM seropositivity which peaked between 2 and 5 and 13 and 16 years of age, suggesting that two distinct modes of transmission may occur. The observation that infection with high cancer risk genital HPVs may occur in early life and persist is of considerable importance for HPV vaccine strategies.

Objective. To determine rates of human papillomavirus (HPV) infections, abnormal cervical smears, and squamous intraepithelial lesions (SIL) among women with systemic lupus erythematosus (SLE). Methods. We investigated 30 women with SLE, 67 with abnormal smears from colposcopy clinics, and 15 community subjects with normal smears. Polymerase chain reaction results for viral DNA and HPV-16 sequencing data were correlated to cytology and colposcopic findings. . SLE patients were also more likely to be HPV-16 DNA positive than colposcopy patients (P < 0.05). SLE patients with a high HPV-16 viral load more frequently had SIL (n ‫؍‬ 6) than those with a low HPV-16 viral load (n ‫؍‬ 1; P < 0.05). HPV and HPV-16 DNA positivity were not associated with previous or current drug therapy for SLE patients. All HPV-16 DNA sequences from 6 SLE and 5 colposcopy patients were the European-type variant. Eighteen (60%) SLE patients had a previous or current cervical abnormality. At the time of study, 5 (17%) SLE patients had an abnormal cervical smear and 8 (27%) had SIL. For those diagnosed with SLE for >10 years, the rate of SIL was 44% lower than those with SLE for <5 years (odds ratio 0.56, 95% confidence interval 0.1-3.5). Conclusion. UK women with a recent SLE diagnosis had disturbingly elevated levels of HPV infections (particularly with European HPV-16 variants at a high viral load), abnormal cervical cytology, and SIL. KEY WORDS. Systemic lupus erythematosus; Human papillomavirus infection; Cervical squamous intraepithelial lesions.

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Objectives To assess the value of pattern recognition for the preoperative ultrasound diagnosis of borderline ovarian tumors (BOTs). Methods 0.812 (standard error 0.049; 95% CI, sensitivity 0.69 (95% CI, specificity 0.94 (95% CI, positive likelihood ratio 11.3 (95% CI,