Objective To quantify and analyse the influence of a histological report of incomplete excision of CIN after LLETZ on frequency of detection of residual CIN. Design Review of a computerised database of sequential women treated by LLETZ. Initial follow‐up was three months post‐treatment. Setting The Colposcopy Clinic, Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK. Subjects 721 women with CIN diagnosed histologically on LLETZ specimens. Results In spite of a first time treatment success rate of 95% at 3 months, only 56% of the women were reported to have complete histological excision of CIN. A report suggesting incomplete excision was more likely with more severe CIN, extensive lesions and involvement of the endocervical canal. Furthermore, 21 % with residual CIN had apparent complete excision of CIN at LLETZ. Conclusions A histological report of incomplete excision of CIN at LLETZ does not equate with residual disease. The high treatment success rate of LLETZ means that a report of incomplete excision should stimulate close colposcopic and cyt‐ologic follow‐up to identify the small number of women with residual CIN after therapy.

No abstract

A small percentage of patients with acute frontal or ethmoid sinusitis develop orbital, cranial or CNS complications. At selected University of Tennessee affiliated hospitals, from 1974 to 1978, there were 14 such cases which required major surgical intervention in addition to intensive medical therapy. The most common complication in this series was subperiosteal orbital abscess. The most common bacterial isolates were streptococcus and staphylococcus. A discussion of complications associated with frontal and ethmoid sinusitis is included as well as recommendations for medical and surgical management.

No abstract

Large loop excision of the transformation zone (LLETZ) allows complete histologic assessment of cervical neoplasia. However, selective colposcopically directed punch biopsy followed by local ablation allows the possibility of inappropriate local ablation of early invasive lesions missed at punch biopsy. The onus of accurate diagnosis lies on the colposcopist. We have studied 1143 patients managed with loop diathermy and identified 35 invasive squamous carcinomas and 9 invasive adenocarcinomas. The data show that the cut-off for accurate colposcopic detection of invasive squamous lesions is not breach of the basement membrane but invasion up to a depth of 1 mm. On the other hand, colposcopy is an unreliable guide for the diagnosis of early adenocarcinoma. Diagnosis based on loop excision allows accurate, rational individualization of management for the unexpected diagnosis of colposcopically occult early invasive disease whilst retaining the logistic benefits of a 'see and treat' policy.