abnormal colposcopic findings. Six of the seven were reported to have had complete excision and would therefore not have been selected for more detailed follow up under the authors' revised policy. N. Mahadevan D. H. Horwell Department of Obstetrics and Gynaecology Luton and Dunstable Hospital NHS TrustLuton LU40DZ The recommendations made in the flow chart are the result of continuing evolutionary review using a variety of treatment methods during the last 18 years. The systems that we have recommended depend on high quality cytology and histopathology services which we are fortunate to have available. Our recommendations are made on the basis of extremely careful audit and analysis of information. The experience of Mahadevan and Horwell in in finding that among their own patients six of the 11 patients with histologically proven residual disease detected at four months, had had apparently normal cytology may be a reflection of smear taking technique or reporting, rather than an inadequacy of the system. Similarly in their letter where five of the six of their cases were reported to have had complete excision, this may warrant a careful review of the histopathology techniques used. C O R R E S P O N D E N C E 795 ReferencesWe have no doubt that this paper which is one of many generated from this department's very large long term data base will almost certainly not be the last word on this subject. It is currently our view that this flow chart is the most sophisticated and accurate way of dealing with the problem of CIN enabling us to deal efficiently and rapidly with those patients who have significant lesions and also to deal more conservatively with those patients who have low grade lesions and to reduce the number of stressful colposcopy clinic visits that these patients have to submit to. J. M. Monaghan Prostaglandin prophylaxis and bladder function after vaginal hysterectomy: a prospective randomised studySir, We read the paper by Bergman et al. (1993) and were surprised that a direct comparison was being made between two prostaglandin compounds administered differently. Whilst the molecular weights of the compounds are similar (PGE2-352.5 and PGFza-3545) there are no data regarding the absorption of PGF2, which is not normally administered intravesically and therefore a comparison with the rapid and complete absorption of PGE;? is not possible. As no figures are given for the systemic concentrations of these substances it seems hard to draw the conclusion that one drug is more efficacious than the other when the effect may be dose related, due to differential absorption through the stratified squamous epithelium of the vagina and the transitional epithelium of the bladder.May we also point out that the conclusion in the abstract is erroneous in stating that either intravesical or intravaginal prostaglandins is beneficial in enhancing bladder function after vaginal hysterectomy when the article concludes that vaginal PGE;? is superior. ). Blood concentration was not compared since we studied only the clin...
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