- Email: [email protected]
Home Samples to Diagnose Chlamydia
shown in this and other studies, causes a significant increase in circulating estradiol levels in women using oral or transdermal ERT. Blood alcohol levels in this study were typical of moderate social drinking (1.5-2 glasses of wine or 1.5-2 cans of beer per day). The combination of alcohol and ERT may be additive, resulting in elevated estradiol levels, which have been implicated in the induction of breast cancer. The mechanism accounting for alcohol-related increases of estradiol are unclear but point out the need for further study of the effects of alcohol on other estrogen preparations, the appropriate estrogen replacement dosage for women who regularly drink alcohol, and the effects of alcohol on postmenopausal women who do not use estrogen.
Pap Smears After Hysterectomy Pearce KF, Haefner TE. Cytopathological
HK,
Sanvar SF, Nolan findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62.
Synopsis: Since the benefits of vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease are not known, the authors analyzed 9610 smear results obtained from 5682 women who had undergone hysterectomy for benign disease. Women with reproductive tract carcinoma or cervical intraepithelial neoplasia type III were excluded from the study. All abnormal Papanicolaou smears and 1% of the normal slides were reviewed by two pathologists who were unaware of any prior readings. One hundred four abnormal vaginal smears were obtained from 79 women. Categorized according to the Bethesda system, the cytologic findings included atypical squamous cells of undetermined significance (0.5% of all smears), low grade squamous intraepithelial lesion (SIL)(O.S%), high grade SIL (O.l%), and squamous-cell carcinoma (0.02%). In five women, biopsies revealed vaginal intraepithelial neoplasia type I or II; there were no biopsy-proven cases of vaginal cancer. In this retrospective study, the
prevalence of abnormal findings on vaginal smears is low, and the authors state that routine screening by means of vaginal Papanicolaou smears after hysterectomy for benign disease is probably not necessary.
. . . Commentary: Most women continue to have vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. In this study, the positive predictive value of the vaginal smear for detecting cancer was 0%. The mean length of time from hysterectomy to an abnormal vaginal smear was 19 years, regardless of the type of vaginal lesion. Carcinoma in situ and primary invasive carcinoma of the vagina are rare, accounting for <3% ofgenital-tract carcinomas. Cost-effectiveness should be considered in the evaluation of screening tests, and based on the low prevalence of vaginal dysplasia after hysterectomy for benign disease, it is probably not necessary to screen women routinely after such surgery. Papanicolaou smears should be performed for women with a history of genital tract cancer or severe cervical dysplasia because of their increased risk of vaginal dysplasia.
Home Samples to DiagnoseChlomydia 0stergaard L, Moller JK, Andersen B, Olesen F. Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: Multipractice comparative study. BMJ 1996;3 13: 1186-9.
Synopsis: This study of 222 Danish women age 18-25 years compared the efficacy of urine and vaginal flush samples collected by women at home with cervical and urethral swabs obtained by general practitioners in the diagnosis of urogenital Chkunydia trachomatis infection. After gynecologic examination for any reason, during which cervical and urethral swabs were obtained for chlamydia polymerase chain reaction (PCR) amplification testing, study subjects were given a kit comprising two 10 mL sample tubes and a vaginal
pipette containing 5 mL sterile saline. After collecting a urine sample, the pipette was to be inserted into the vagina, the vagina flushed with the saline in the pipette, and fluid sucked back into the pipette. Samples were mailed for PCR and ligase chain testing for C trachomatis. The overall prevalence of chlamydia infection was 11.2%. Test sensitivity in samples obtained by the physicians, home samples subjected to PCR, and home samples subjected to ligase chain reaction were 91%, 96%, and loo%, respectively. The corresponding specificities were lOO%, 92.9%, and 99.5%. The authors concluded that because efficacy of home sampling was as good as that of samples obtained by general practitioners when using ligase chain reaction, home sampling may be practical for screening for this common infection.
. . . Commentary: Because most chlamydia infections initially are asympscreening of clinically tomatic, healthy women is necessary to decrease the number of untreated cases and the prevalence and subsequent complications of this infection. Testing for C trachomatis recently has been improved by the introduction of PCR amplification techniques, particularly the ligase chain reaction assay. Although these tests are expensive, a single ligase chain reaction assay on urine or vaginal fluid may have higher sensitivity and specificity than other available tests. The convenience of home testing may make this method more acceptable to women, minimizing the use of physician time, and may prove cost-effective by decreasing the incidence of fallopian tube disease and its sequelae. Prospective studies are needed to confirm these expectations.
Medroxy rogesterone & Bone Bensity Adachi JD, Sargeant EJ, Sagle MA, Lamonr D, Fawcett PD, Bensen WG, et al. A doubleblind randomised controlled trial of the effects of medroxyprogesterone acetate on
Pap Smears After Hysterectomy Pearce KF, Haefner TE. Cytopathological
HK,
Sanvar SF, Nolan findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62.
Synopsis: Since the benefits of vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease are not known, the authors analyzed 9610 smear results obtained from 5682 women who had undergone hysterectomy for benign disease. Women with reproductive tract carcinoma or cervical intraepithelial neoplasia type III were excluded from the study. All abnormal Papanicolaou smears and 1% of the normal slides were reviewed by two pathologists who were unaware of any prior readings. One hundred four abnormal vaginal smears were obtained from 79 women. Categorized according to the Bethesda system, the cytologic findings included atypical squamous cells of undetermined significance (0.5% of all smears), low grade squamous intraepithelial lesion (SIL)(O.S%), high grade SIL (O.l%), and squamous-cell carcinoma (0.02%). In five women, biopsies revealed vaginal intraepithelial neoplasia type I or II; there were no biopsy-proven cases of vaginal cancer. In this retrospective study, the
prevalence of abnormal findings on vaginal smears is low, and the authors state that routine screening by means of vaginal Papanicolaou smears after hysterectomy for benign disease is probably not necessary.
. . . Commentary: Most women continue to have vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. In this study, the positive predictive value of the vaginal smear for detecting cancer was 0%. The mean length of time from hysterectomy to an abnormal vaginal smear was 19 years, regardless of the type of vaginal lesion. Carcinoma in situ and primary invasive carcinoma of the vagina are rare, accounting for <3% ofgenital-tract carcinomas. Cost-effectiveness should be considered in the evaluation of screening tests, and based on the low prevalence of vaginal dysplasia after hysterectomy for benign disease, it is probably not necessary to screen women routinely after such surgery. Papanicolaou smears should be performed for women with a history of genital tract cancer or severe cervical dysplasia because of their increased risk of vaginal dysplasia.
Home Samples to DiagnoseChlomydia 0stergaard L, Moller JK, Andersen B, Olesen F. Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: Multipractice comparative study. BMJ 1996;3 13: 1186-9.
Synopsis: This study of 222 Danish women age 18-25 years compared the efficacy of urine and vaginal flush samples collected by women at home with cervical and urethral swabs obtained by general practitioners in the diagnosis of urogenital Chkunydia trachomatis infection. After gynecologic examination for any reason, during which cervical and urethral swabs were obtained for chlamydia polymerase chain reaction (PCR) amplification testing, study subjects were given a kit comprising two 10 mL sample tubes and a vaginal
pipette containing 5 mL sterile saline. After collecting a urine sample, the pipette was to be inserted into the vagina, the vagina flushed with the saline in the pipette, and fluid sucked back into the pipette. Samples were mailed for PCR and ligase chain testing for C trachomatis. The overall prevalence of chlamydia infection was 11.2%. Test sensitivity in samples obtained by the physicians, home samples subjected to PCR, and home samples subjected to ligase chain reaction were 91%, 96%, and loo%, respectively. The corresponding specificities were lOO%, 92.9%, and 99.5%. The authors concluded that because efficacy of home sampling was as good as that of samples obtained by general practitioners when using ligase chain reaction, home sampling may be practical for screening for this common infection.
. . . Commentary: Because most chlamydia infections initially are asympscreening of clinically tomatic, healthy women is necessary to decrease the number of untreated cases and the prevalence and subsequent complications of this infection. Testing for C trachomatis recently has been improved by the introduction of PCR amplification techniques, particularly the ligase chain reaction assay. Although these tests are expensive, a single ligase chain reaction assay on urine or vaginal fluid may have higher sensitivity and specificity than other available tests. The convenience of home testing may make this method more acceptable to women, minimizing the use of physician time, and may prove cost-effective by decreasing the incidence of fallopian tube disease and its sequelae. Prospective studies are needed to confirm these expectations.
Medroxy rogesterone & Bone Bensity Adachi JD, Sargeant EJ, Sagle MA, Lamonr D, Fawcett PD, Bensen WG, et al. A doubleblind randomised controlled trial of the effects of medroxyprogesterone acetate on