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The aim of this study is to evaluate the short and long-term results of hysteroscopic sterilization in an outpatient setting. Sixty-one women underwent hysteroscopic sterilization. At follow-up, all of the women were asked to complete a questionnaire concerning possible pregnancy, bleeding patterns, side-effects, or need for further therapy after sterilization. Technical feasibility, complications, patient satisfaction, and tubal occlusion based on X-ray or ultrasound were measured. Fifty-eight (95%) women were sterilized according to this method. Successful bilateral device placement was achieved in 52 women (85%) during the first attempt and in six (9.8%) during the second. A total of 50 (81.9%) women submitted completed outcome questionnaires. The mean follow-up period was 23 (range 7-67) months. No pregnancies were reported. All questionnaire respondents expressed overall satisfaction with the procedure. To conclude, Essure sterilization is a safe effective method for female sterilization that is feasible in the outpatient setting.

Background: Excessive menstrual bleeding, menorrhagia, is a common gynecological problem in women of reproductive age. Since 1994, thermal balloon ablation has become the treatment of choice for women with menorrhagia. The aim of this study was to evaluate the short- and long-term results of thermal balloon ablation for the treatment of menorrhagia in an outpatient setting., Methods: Fifty-six women with menorrhagia had undergone a balloon ablation in an outpatient setting at the Gynecological Departments at Karolinska University Hospital, Huddinge. At follow-up, all of the women were requested to complete a questionnaire concerning bleeding patterns, the degree of dysmenorrhea, side effects, or a need for further therapy after balloon ablation., Results: Thermal balloon ablation was successfully completed in 54 (97%) women. The two unsuccessful procedures consisted of one case, in which the woman had an allergic reaction to a paracervical block, and another case in which the balloon catheter could not be inserted into the uterine cavity. In three cases, short-term complications occurred: an allergic reaction to a paracervical block, endometritis, and abdominal cramps. Completed outcome questionnaires were submitted by 42 (75%) of the women. The mean follow-up period was 31 months. A reduction of menorrhagia was experienced by 34 (81%) of the women. One woman had undergone a hysterectomy and three had a hysteroscopical endometrial resection within two years after the ablation due to persistent menorrhagia., Conclusion: Thermal endometrial ablation is a safe and effective treatment for menorrhagia and is feasible in an outpatient setting.

Background: Since 1989 large loop excision of the transformation zone (LLETZ) has become the treatment of choice for cervical intraepithelial neoplasia in many colposcopy clinics. This method has limitations however, in that the resection margins of the cone produced by LLETZ cannot give conclusive histological reassurance, because of thermal injury in 5 30% of the specimens. Furthermore, LLETZ are often taken in several sections, which makes the histopathological examination unnecessarily difficult. As a new and single treatment without these limitations, conization with the contoured loop excision of the transformation zone (C-LETZ) electrode was investigated in the present study. Material and methods. One hundred and seventy-four patients with CIN were treated with the C-LETZ electrode during 12 months at the Gynaecological Department, Karolinska University Hospital, Huddinge. The inclusion criteria were a histological diagnosis of CIN II-III, or persistent CIN I., Results: Eighty-six per cent of the patients had a complete excision according to histological findings, and 12% had an incomplete excision. The frequency of incomplete excisions increased with the severity of the CIN but were found in all groups of patients: 1 (3%) in CIN I, 5 (12%) in CIN II, and 12 (17%) in CIN III. The resection margins and histological diagnoses were certain in 98% of the cases. A cure rate of 90% was observed. Conclusions. Miniconization with the C-LETZ electrode makes it possible to individualize the size of the minicones and produce the minicones as one-piece specimens for histopathological assessment. Our findings confirm that this method is a reproducible, safe, and economical way to treat CIN with a low rate of morbidity in a hospital outpatient setting.

Background: Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4-6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2-3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear., Methods: Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used., Results: The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2-3 was 61 (95% CI = 45-74) and 82% (95% CI = 67-91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18-35) and 89% (95% CI = 80-97), respectively., Conclusions: In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.

Objective: A retrospective study of short and long term results of transcervical endomyometrial resection for menorrhagia., Material and Methods: Patient data were collected from all 104 premenopausal women who had undergone a transcervical endomyometrial resection due to severe menorrhagia in 1990-95. Almost 40% had submucous fibromas that were resected together with the endometrium. A questionnaire about gynecological symptoms was mailed to all 104 women. Ninety-seven (93%) women answered the questionnaire., Results: The mean follow-up period was 29 months. The following short-term complications were encountered: fluid overload in four, one uterine perforation and one major bleeding. The long-term complications included: three hematometra and one pregnancy ending in a spontaneous abortion. Glandular hyperplasia of the endometrium without atypia was found in two cases, and adenomyosis in 31 (29%) cases. Twenty-one women (21%) became amenorrhoic after the treatment, whereas forty-nine (51%) had minimal menstrual bleeding. Eleven women (11%) suffered from dysmenorrhea. Due to dysmenorrhea and/or persistent menorrhagia thirteen (12.5%) underwent a hysterectomy, generally within one year after the resection. The histological examinations showed adenomyosis in three cases, fibromas in four and fibromas and adenomyosis in three cases., Conclusions: In our hands hysteroscopic transcervical endomyometrial resection was a safe and effective treatment for menorrhagia in spite of the fact that amenorrhea was not always achieved. However, dysmenorrhea appeared in 11% of the women. The reason for this remains to be studied. Correct selection criteria is important to get optimal results and reduce the treatment failure.