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Compatibility of the thinprep pap test and the LCX probe system chlamydia trachomatis assay∗
lesion. The purpose of this study was to objectively measure the intercapillary distance in different grades of cervical intraepithelial neoplasia. Methods: We studied 40 patients with a fully visualized squamocolumnar junction and a histopathologic diagnosis of CIN II (n ⫽ 24) and CIN III (n ⫽ 16). All patients had computer-assisted measurements of the farthest two intercapillary points within each single mosaic as well as the mosaic perimeter (P), and mosaic surface area (SA). The mean intercapillary distance, P, and SA for each patient were calculated by adding all intercapillary distances, Ps, and SAs of the whole mosaic pattern divided by the number of mosaics. A colposcopically directed biopsy was obtained from the same studied area. Results: The mean intercapillary distance in CIN II was 0.064 mm (SD ⫾ 0.023) and in CIN III was 0.117 mm (SD ⫾ 0.062). The difference was statistically significant (P ⬍0.001). In addition, the mean mosaic P in CIN II and CIN III was 0.251 mm (SD ⫾ 0.112) and 0.439 mm (SD ⫾ 0.242), respectively, and the mean mosaic SA was 0.004 mm2 (SD ⫽ 0.001) and 0.011 mm2 (SD ⫾ 0.002), respectively. The difference was statistically significant (P ⬍0.05). Conclusions: The results demonstrate increased intercapillary distance, mosaic perimeter, and mosaic surface area with increasing severity of CIN. The increase in intercapillary distance may reflect insufficient vascular adaptation to an accelerated cellular growth rate.
Comparison of Preoperative and Postoperative Pressure Transmission Ratio and Urethral Pressure Profilometry in Patients with Successful Outcome Following Vaginal Patch Sling for Genuine Stress Incontinence Magdy S. Mikhail, MD Bronx–Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY
Hector Rosa, MD Introduction: Pressure transmission ratio (PTR) determination allows for the quantitative measurement of the relative efficiency with which intraabdominal pressure increases are transmitted to the bladder and urethra. We studied preoperative and postoperative PTR in patients undergoing vaginal patch sling for the primary treatment of genuine stress incontinence (GSI). Methods: Forty-four patients with a clinical and urodynamic diagnosis of GSI were studied. The PTR for each cough was calculated by dividing the amplitude of the urethral pressure spike by the amplitude of the corresponding bladder pressure spike and multiplying the quotient by 100. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length designated Q1 through Q4, respectively.
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
PTR (%)
Q1 Q2 Q3 Q4
Preoperative
Postoperative
P value
70 SD ⫾ 13 72 SD ⫾ 16 76 SD ⫾ 18 68 SD ⫾ 22
104 SD ⫾ 12 102 SD ⫾ 20 80 SD ⫾ 16 72 SD ⫾ 14
⬍0.01 ⬍0.001 NS NS
Conclusion: PTR in the two proximal quartiles of the urethra were significantly improved postoperatively, which suggests that the vaginal patch sling technique restores continence by repositioning the proximal urethra into the intraabdominal pressure zone, thus enhancing pressure transmission to the proximal urethra.
Compatibility of the ThinPrep Pap Test and the LCX Probe System Chlamydia trachomatis Assay* Brian B. Lentrichia, PhD Cytyc Corporation, Boxborough, MA
Menashi Cohenford, PhD, and Roberta A. McDonald, BS Objective: To determine the compatibility of sensitiveamplified DNA laboratory testing for Chlamydia with fluidbased cytological specimens collected for Pap testing. Methods: Cervical scrapes were collected from 443 subjects into liquid preservative for the ThinPrep Pap Test using the cytobrush and spatula collection technique. After a thin layer slide was prepared for cytological evaluation, a second slide was prepared for Chlamydia detection by direct fluorescence assay (DFA). The thin layer slide result was blinded and compared to a conventional slide prepared using a swab specimen from the same subjects. One milliliter was then removed from each vial of remaining specimen and processed for the Ligase Chain Reaction (LCR) Chlamydia assay by using a slight modification of the routine procedure used for urine specimens. Vials determined to have inadequate endocervical components by either ThinPrep or conventional DFA were excluded from the study. LCR results from the adequate vials were then compared with the DFA results from subjects for whom both ThinPrep and conventional DFA results agreed. Results: Of 410 adequate specimens, a statistically significant increase was observed in the positive rate of LCR (59/410 or 14.4%) with respect to consensus DFA (38/410 or 8.8%). Only 2 consensus DFA-positive specimens (0.5%) were negative by LCR and remained negative upon retesting. Of the 8 specimens that were DFA discrepant, the LCR results favored ThinPrep 50% of the time. * This document includes a discussion of use of a product that is unapproved by the U.S. Food and Drug Administration.
Monday Papers 3S
Conclusions: LCR testing for Chlamydia is compatible with specimens collected for the ThinPrep Pap Test with an expected increase in sensitivity. This feasibility study provides the impetus for a blind comparison trial between direct LCR swab and ThinPrep Pap Test collections.
Is There an Association Between Vulvodynia and Interstitial Cystitis? Jennifer Gunter, MD University of Kansas Medical Center, Kansas City, KS
Margaret Clark, MS, and John Weigel, MD Objective: To prospectively evaluate the relationship between vulvodynia and interstitial cystitis (IC). Methods: Patients who were referred to a tertiary care clinic with vulvodynia refractory to standard therapies were evaluated for interstitial cystis (IC) via history, physical examination, and cystoscopy with hydraulic bladder dilation. Patients diagnosed with IC were offered treatment. Primary outcome measures were a change in average daily pain score based on 11-point Likert scale, and an investigator-rated clinical impression of pain at 6 months. Results: Twenty-five patients were evaluated for IC. Seventeen patients (68%) were diagnosed with IC, three patients (12%) had equivocal findings, and five patients (20%) had no evidence of IC. Therapy was initiated for the 17 patients diagnosed with IC, with a reduction in average daily pain score from 7.5 to 2.9 at 6 months. Using the investigator-rated impression of pain, 7/17 patients (41%) had significant improvement in their pain, 8/17 patients (47%) were moderately improved, and 2/18 (12%) were minimally improved. Conclusions: Sixty-eight percent of women with refractory vulvodynia were found to have IC. Therapy for IC improved pain scores at 6 months for vulvodynia patients with coexisting IC; 41% were significantly improved and 47% moderately improved. These findings suggest an association between vulvodynia and IC. Assessment for IC is warranted for patients with vulvodynia refractory to other therapies.
primary care office. At our institution, over a 2-year period, 1,400 endometrial biopsies were performed with three cases of endometrial cancer diagnosed and one case of complex endometrial hyperplasia. Our objective was to devise a key clinical pathway for the evaluation of the patient with abnormal uterine bleeding that would decrease cost, decrease the number of endometrial biopsies, and improve the evaluation of women with abnormal uterine bleeding. The pathway divided women into the categories of premenopausal, postmenopausal, low risk and high risk. Methods: One hundred of our patients with the complaint of abnormal uterine bleeding were enrolled. All of these women would have undergone endometrial biopsy based on older recommendations. The patients then followed a clinical pathway to determine if an endometrial biopsy was performed. If the patients were postmenopausal, the majority of the patients underwent endometrial biopsy or ultrasound evaluation. If the patients were premenopausal, then risk factors were ascertained. These risk factors were obesity, nulligravidy— never using a hormonal contraceptive— history of annovolation, and a history of breast cancer. If one risk factor was present, then the patient underwent endometrial biopsy. If there were no risk factors present, then the patient continued down the pathway with medical therapy as treatment. The charts were then reviewed subsequently to determine patient outcome. Results: Forty-five endometrial biopsies were performed. One case of endometrial cancer and one case of complex atypical hyperplasia, both in the postmenopausal high-risk group were discovered. Subsequent reviews revealed that no cases of endometrial cancer were missed or developed in the year following the initial complaint in any of the patients whether they were biopsied or not. Conclusions: The utilization of a clinical pathway reduced the number of endometrial biopsies by greater than one half with no adverse outcomes. The introduction of clinical pathways at our institution was done successfully in the evaluation of abnormal uterine bleeding.
A Key Clinical Pathway for the Evaluation of Women with Abnormal Uterine Bleeding
Return of Normal Voiding Function After Vesica BoneAnchored Sling Procedure for Stress Urinary Incontinence
Terry S. Dunn, MD
Charles J. Ascher-Walsh, MD
Denver Health Medical Center, Denver, CO
Carol Stamm, MD, Michelle Delorit, MD, and Gail Golberg, RN, MS Objective: The condition of abnormal uterine bleeding is one of the most frequent problems encountered in an ob/gyn or
4S Monday Papers
New York-Presbyterian Hospital, New York, NY
Eileen DeMarco, MD, and Jody S. Blanco, MD Objective: To present initial data of return to normal voiding function after vesica-bone anchoring sling for stress urinary incontinence.
Obstetrics & Gynecology
Comparison of Preoperative and Postoperative Pressure Transmission Ratio and Urethral Pressure Profilometry in Patients with Successful Outcome Following Vaginal Patch Sling for Genuine Stress Incontinence Magdy S. Mikhail, MD Bronx–Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY
Hector Rosa, MD Introduction: Pressure transmission ratio (PTR) determination allows for the quantitative measurement of the relative efficiency with which intraabdominal pressure increases are transmitted to the bladder and urethra. We studied preoperative and postoperative PTR in patients undergoing vaginal patch sling for the primary treatment of genuine stress incontinence (GSI). Methods: Forty-four patients with a clinical and urodynamic diagnosis of GSI were studied. The PTR for each cough was calculated by dividing the amplitude of the urethral pressure spike by the amplitude of the corresponding bladder pressure spike and multiplying the quotient by 100. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length designated Q1 through Q4, respectively.
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
PTR (%)
Q1 Q2 Q3 Q4
Preoperative
Postoperative
P value
70 SD ⫾ 13 72 SD ⫾ 16 76 SD ⫾ 18 68 SD ⫾ 22
104 SD ⫾ 12 102 SD ⫾ 20 80 SD ⫾ 16 72 SD ⫾ 14
⬍0.01 ⬍0.001 NS NS
Conclusion: PTR in the two proximal quartiles of the urethra were significantly improved postoperatively, which suggests that the vaginal patch sling technique restores continence by repositioning the proximal urethra into the intraabdominal pressure zone, thus enhancing pressure transmission to the proximal urethra.
Compatibility of the ThinPrep Pap Test and the LCX Probe System Chlamydia trachomatis Assay* Brian B. Lentrichia, PhD Cytyc Corporation, Boxborough, MA
Menashi Cohenford, PhD, and Roberta A. McDonald, BS Objective: To determine the compatibility of sensitiveamplified DNA laboratory testing for Chlamydia with fluidbased cytological specimens collected for Pap testing. Methods: Cervical scrapes were collected from 443 subjects into liquid preservative for the ThinPrep Pap Test using the cytobrush and spatula collection technique. After a thin layer slide was prepared for cytological evaluation, a second slide was prepared for Chlamydia detection by direct fluorescence assay (DFA). The thin layer slide result was blinded and compared to a conventional slide prepared using a swab specimen from the same subjects. One milliliter was then removed from each vial of remaining specimen and processed for the Ligase Chain Reaction (LCR) Chlamydia assay by using a slight modification of the routine procedure used for urine specimens. Vials determined to have inadequate endocervical components by either ThinPrep or conventional DFA were excluded from the study. LCR results from the adequate vials were then compared with the DFA results from subjects for whom both ThinPrep and conventional DFA results agreed. Results: Of 410 adequate specimens, a statistically significant increase was observed in the positive rate of LCR (59/410 or 14.4%) with respect to consensus DFA (38/410 or 8.8%). Only 2 consensus DFA-positive specimens (0.5%) were negative by LCR and remained negative upon retesting. Of the 8 specimens that were DFA discrepant, the LCR results favored ThinPrep 50% of the time. * This document includes a discussion of use of a product that is unapproved by the U.S. Food and Drug Administration.
Monday Papers 3S
Conclusions: LCR testing for Chlamydia is compatible with specimens collected for the ThinPrep Pap Test with an expected increase in sensitivity. This feasibility study provides the impetus for a blind comparison trial between direct LCR swab and ThinPrep Pap Test collections.
Is There an Association Between Vulvodynia and Interstitial Cystitis? Jennifer Gunter, MD University of Kansas Medical Center, Kansas City, KS
Margaret Clark, MS, and John Weigel, MD Objective: To prospectively evaluate the relationship between vulvodynia and interstitial cystitis (IC). Methods: Patients who were referred to a tertiary care clinic with vulvodynia refractory to standard therapies were evaluated for interstitial cystis (IC) via history, physical examination, and cystoscopy with hydraulic bladder dilation. Patients diagnosed with IC were offered treatment. Primary outcome measures were a change in average daily pain score based on 11-point Likert scale, and an investigator-rated clinical impression of pain at 6 months. Results: Twenty-five patients were evaluated for IC. Seventeen patients (68%) were diagnosed with IC, three patients (12%) had equivocal findings, and five patients (20%) had no evidence of IC. Therapy was initiated for the 17 patients diagnosed with IC, with a reduction in average daily pain score from 7.5 to 2.9 at 6 months. Using the investigator-rated impression of pain, 7/17 patients (41%) had significant improvement in their pain, 8/17 patients (47%) were moderately improved, and 2/18 (12%) were minimally improved. Conclusions: Sixty-eight percent of women with refractory vulvodynia were found to have IC. Therapy for IC improved pain scores at 6 months for vulvodynia patients with coexisting IC; 41% were significantly improved and 47% moderately improved. These findings suggest an association between vulvodynia and IC. Assessment for IC is warranted for patients with vulvodynia refractory to other therapies.
primary care office. At our institution, over a 2-year period, 1,400 endometrial biopsies were performed with three cases of endometrial cancer diagnosed and one case of complex endometrial hyperplasia. Our objective was to devise a key clinical pathway for the evaluation of the patient with abnormal uterine bleeding that would decrease cost, decrease the number of endometrial biopsies, and improve the evaluation of women with abnormal uterine bleeding. The pathway divided women into the categories of premenopausal, postmenopausal, low risk and high risk. Methods: One hundred of our patients with the complaint of abnormal uterine bleeding were enrolled. All of these women would have undergone endometrial biopsy based on older recommendations. The patients then followed a clinical pathway to determine if an endometrial biopsy was performed. If the patients were postmenopausal, the majority of the patients underwent endometrial biopsy or ultrasound evaluation. If the patients were premenopausal, then risk factors were ascertained. These risk factors were obesity, nulligravidy— never using a hormonal contraceptive— history of annovolation, and a history of breast cancer. If one risk factor was present, then the patient underwent endometrial biopsy. If there were no risk factors present, then the patient continued down the pathway with medical therapy as treatment. The charts were then reviewed subsequently to determine patient outcome. Results: Forty-five endometrial biopsies were performed. One case of endometrial cancer and one case of complex atypical hyperplasia, both in the postmenopausal high-risk group were discovered. Subsequent reviews revealed that no cases of endometrial cancer were missed or developed in the year following the initial complaint in any of the patients whether they were biopsied or not. Conclusions: The utilization of a clinical pathway reduced the number of endometrial biopsies by greater than one half with no adverse outcomes. The introduction of clinical pathways at our institution was done successfully in the evaluation of abnormal uterine bleeding.
A Key Clinical Pathway for the Evaluation of Women with Abnormal Uterine Bleeding
Return of Normal Voiding Function After Vesica BoneAnchored Sling Procedure for Stress Urinary Incontinence
Terry S. Dunn, MD
Charles J. Ascher-Walsh, MD
Denver Health Medical Center, Denver, CO
Carol Stamm, MD, Michelle Delorit, MD, and Gail Golberg, RN, MS Objective: The condition of abnormal uterine bleeding is one of the most frequent problems encountered in an ob/gyn or
4S Monday Papers
New York-Presbyterian Hospital, New York, NY
Eileen DeMarco, MD, and Jody S. Blanco, MD Objective: To present initial data of return to normal voiding function after vesica-bone anchoring sling for stress urinary incontinence.
Obstetrics & Gynecology