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The purpose of this report is to highlight the early clinical signs and management of ocular surface neoplasia following penetrating keratoplasty in xeroderma pigmentosa. A 14-year-old girl reported increased conjunctival hyperemia, tearing, photophobia in the right eye at 6 months after penetrating keratoplasty that worsened rapidly over the subsequent 2 weeks. Slit lamp examination showed increased vascularity, epithelial haze and raised whitish lesions at the graft–host junction. Alcohol keratoepithelectomy was performed for confirming the diagnosis. Histology of the sample revealed severe dysplasia. The lesion resolved after surface plaque brachytherapy. The graft clarity was restored and maintained until the last follow-up of 15 months following brachytherapy. Exacerbated symptoms and clinical signs of increased vascularisation and epithelial lesions should arouse the suspicion of ocular surface neoplasia in grafted eyes. Early diagnosis and management can salvage the graft clarity.

Introduction Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC). Methods Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings. Results Fifty‐two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%‐99.4%) and 83.3% (CI, 51.6%‐97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease. Conclusions NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer. Level of Evidence: Level IV.

Precancer cervix lesion High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe Dysplasia (CIN II and III) is cervical Intraepithelial Neoplasia (CIN) which changes cervix epithelial cells without invasive to basalis membrane cells. This change step cervical epithelial cells through high-risk Human Papilloma Virus (HPV) infection such are HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70. Precancer cervix lesion HSIL could cause erosion of the cervix and cause post coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) treatment could cure HSIL or moderate and severe dysplasia (CIN II and III). Therefore, it relieves post coital bleeding disorders to the patients. Cervical precancerous lesions High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe dysplasia (CIN II and III) are Cervical Intraepithelial Neoplasia (NIS) or Cervical Intraepithelial Neoplasia (CIN) where changes in cervical epithelial cells occur without penetrating the basement membrane. The stages of normal cervical epithelial changes begin with high-risk Human Papilloma Virus (HPV) infection, namely HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70 The HSIL cervical precancerous lesion could cause erosion of the cervix and cause complaints of post-coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) therapy could cure HSIL or moderate and severe dysplasia (CIN II and III) which could eliminate post-coitus bleeding disorders that suffered by patients.

OBJECTIVE: The aim of this study was to determine the center-edge angle (CEA) values according to age, gender and side in healthy children between 5 and 14 years old in Turkey and to find out the angular limit values for mild and severe dysplasia. METHODS: The data pool that was gathered to investigate the frequency of hip dislocation in children between 6 months and 14 years old in Turkey was used. The data pool consists of pelvis and lower abdomen radiographs obtained for reasons other than hip dysplasia. Lower abdomen/pelvis radiographies of children between 5 and 14 years old were extracted from the data pool and were evaluated. Distribution of CEA values according to age, gender and side was examined. Measurements were performed by a single investigator on computer by using a standard method. Reliability of the measurements was tested by three different investigators on randomly selected films by using the standard method. RESULTS: CEA values of 3192 hips of 1596 children, who had no hip pathology, were measured. Mean CEA value was found as 26.2°±5.5°. The mean CEA was 26.2°±5.3° in males (%54) and 26.2°±5.7° in females (%46) (p=0.224). Mean values for the right and left hips were 25.7°±5.4° and 26.6°±5.6°, respectively. CEA value of 449 (14%) hips of 333 (20.8%) children was at the limit of mild dysplasia and CEA value of 70 (2.2%) hips of 58 (3.6%) children was at the limit of severe dysplasia. CEA values had increased by age and mild and severe dysplasia limits were determined for every age group. CONCLUSION: The mild and severe dysplasia values that are defined according to ages in Turkish population will guide the investigators in the diagnosis, follow-up and treatment planning of developmental dysplasia. LEVEL OF EVIDENCE: Level IV, Diagnostic Study

AimsActinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation.MethodsFiles of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured.ResultsAll AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs.ConclusionsOur result suggests malignant progression potential of AKs regardless of thickness.

Randomized clinical trials using human papillomavirus (HPV) DNA testing have found increased protection against cervical cancer and HPV-based screening is globally recommended for women ≥30 years of age. HPV-mRNA is a promising alternative target for cervical screening tests, but assessing equivalence requires longitudinal evaluation over at least the length of a screening interval. Our aim is to analyze the longitudinal sensitivity of HPV-mRNA and HPV-DNA in cervical samples taken up to 7 years before severe cervical intraepithelial neoplasia or worse (CIN3+). From a population-based cohort of 95,023 women in Sweden, cervical samples were frozen at -80°C between May 2007 and January 2012. Registry linkages identified that 1,204 of these women had CIN3+ 4 months to 7 years after enrolment. Baseline samples were analyzed for HPV-mRNA (Aptima, Hologic) and for HPV-DNA (Cobas 4800, Roche) and results from both tests obtained for 1,172 women. For both women

Objective To provide a reference for classification and treatment of vocal cords leukoplakia. Methods 640 cases of patients with vocal cords leukoplakia were divided into three groups based on the appearances. There were respectively 81 smooth flat lesions, 155 smooth hypertrophy lesions and 13 rough lesions were treated with conservative methods and 26, 153 and 212 cases were resected surgically for biopsy. Results A majority of smooth flat leukoplakia lesions were cured by non-operational methods and no atypical hyperplasia. Most of rough lesions were invalid and even progressed treated with conservative therapy and were severe dysplasia or canceration. Although 67.6% smooth hypertrophy lesions were cured or improved by conservative methods and 47% lesions had no or mild dysplasia, over 30% of lesions were still invalid or progressed and over 50% had moderate, severe dysplasia and canceration. By statistical analysis, the appearance of leukoplakia was concordant with pathological changes. Conclusions It is suggested that smooth flat vocal cords leukoplakia could be treated with conservative methods and rough lesions should be resected operationally, while for smooth hypertrophy vocal cords leukoplakia could be first followed-up and then adopt measures based on the appearance changes.

The objective of the present study was to investigate whether deep learning could be applied successfully to the classification of images from colposcopy. For this purpose, a total of 158 patients who underwent conization were enrolled, and medical records and data from the gynecological oncology database were retrospectively reviewed. Deep learning was performed with the Keras neural network and TensorFlow libraries. Using preoperative images from colposcopy as the input data and deep learning technology, the patients were classified into three groups [severe dysplasia, carcinoma in situ (CIS) and invasive cancer (IC)]. A total of 485 images were obtained for the analysis, of which 142 images were of severe dysplasia (2.9 images/patient), 257 were of CIS (3.3 images/patient), and 86 were of IC (4.1 images/patient). Of these, 233 images were captured with a green filter, and the remaining 252 were captured without a green filter. Following the application of L2 regularization, L1 regularization, dropout and data augmentation, the accuracy of the validation dataset was ~50%. Although the present study is preliminary, the results indicated that deep learning may be applied to classify colposcopy images.

Background According to recent estimates, 500 000 women have or are at risk of Female Genital Mutilation (FGM) in Europe and 14 700 in Switzerland.In Geneva, 6% of the population are asylum seekers, mainly from African countries where FGM is prevalent. No study exists on cervical dysplasia prevalence after FGM. Prevalence of severe dysplasia (HSIL+) in sub-Sahara African countries is estimated at 2.5%–3%; in Switzerland it's 0.58%. Objective To assess the prevalence of HSIL+ among women with FGM at at the Department of Gynecology of the Geneva University Hospitals. Methods Retrospective review of 619 consecutive medical files of the outpatients' clinic for women with FGM between 2010 and 2016. FGM type were recorded after gynecological exam and cervical screening performed. Results 368 women were included, average age 34.3 years old, mainly from Eritrea and Somalia (n=225, 61.14%). Most have FGM type 3 (n=205, 55,87 %). The prevalence of (HSIL+) was 2.98%. Conclusions Migrant women with FGM, who are known to be at risk of long term urogynecological, sexual and obstetric negative consequences, seem also to have a significant high prevalence of cervical dysplasia HSIL.

While most patients with signs of mild hip instability in the first weeks of life resolve spontaneously, those with more severe dysplasia will have significantly worse outcomes if not diagnosed and treated early. This creates a dilemma for the clinician who must depend on physical findings, aided by imaging studies that are relatively nonspecific in their ability to detect hip dysplasia. This chapter will present an approach to the newborn with abnormal hip findings or significant risk factors.

Background:In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of its surgical management.Hypothesis:Deepening trochleoplasty for severe dysplasia in patellofemoral instability improves function and increases sports participation.Study Design:Case series; Level of evidence, 4.Methods:Between 1995 and 2010, deepening trochleoplasty with a thick flap was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data were collected prospectively preoperatively, at 6 weeks, and at 1-year follow-up. The patients were surveyed retrospectively to determine the clinical and functional outcomes including sports and exercise participation at a minimum of 2 years, with complete data available in 92%.Results:The average follow-up was 6 years (range, 2-19 years). The median Kujala score was 63 (interquartile range [IQR], 47-75) preoperatively, rising to 79 (IQR, 68-91) at 1-year follow-up and 84 (IQR, 73-92) at final follow-up ( P < .05). Seventy-two percent were satisfied with their knee function at 1-year follow-up, rising to 83% at final follow-up ( P < .0001). Sports and exercise participation increased from 36 patients (40%) preoperatively to 60 (67%) at final follow-up. The number of patients involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (eg, soccer, cricket, badminton), the number of patients participating increased from 16 (18%) to 22 (24%), whereas in nontwisting sports (eg, running, swimming, cycling), it increased from 24 (27%) to 47 (52%), of whom 12 (16%) used walking as exercise. Two patients who had undergone medial patellofemoral ligament (MPFL) reconstruction as the index operation needed the MPFL revised, and a further 8 patients needed MPFL reconstruction subsequently for instability symptoms and a mediolateral glide in extension of more than 2 quadrants’ displacement. At final follow-up, no patient had mechanical patellofemoral instability.Conclusion:Deepening trochleoplasty with a thick flap improves clinical and functional outcomes for patients with symptomatic patellar instability with severe trochlear dysplasia. These results improve over time and beyond 1-year clinical follow-up. However, trochleoplasty does not lead to a significant improvement in sports participation at a competitive level. It does improve patient participation in sports and exercise, principally in nontwisting sports activities.

Se recomienda para una mejor correlación en los diagnósticos citológicos e histológicos agrupar las diferentes formas de enfermedad neoplásica cervical entre categorías: a) Displasia leve moderada. b) Displasia severa carcinoma in-situ y c) Carcinoma Infiltrante. Se hace un análisis de la incidencia y distribución por edades de la enfermedad neoplásica cervical en 3,000 mujeres sometidas al estudio citológico cérvico-vaginal. Los hallazgos demuestran una edad promedio y una distribución coincidente con lo observado en otros países, reafirmándose el carácter potencialmente progresivo de las lesiones atípicas menores. Llama la atención la menor edad promedio del carcinoma invasivo cervical en Lima en relación con lo observado en otros países.

Deepening trochleoplasty is a technically demanding operation that is rarely required for most of the patients presenting with recurrent dislocation of the patella. However, in the presence of significant trochlear dysplasia, standard extensor mechanism realignment techniques can fail. A deepening trochleoplasty using a thick osteochondral flap technique is a logical solution for severe dysplasia and does not rely on the presence of normal articular cartilage in the trochlea. Satisfactory outcomes, including returning to sports for those who actively participate is usual. Theoretical complications such as chondrolysis and progression of patellofemoral osteoarthritis have not been found. This article describes the step-by-step operative technique with illustrations.

Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing primary hip arthroscopic surgery between February 2008 and September 2011. Exclusion criteria were acetabular or femoral head Outerbridge grade 4 chondral damage, preoperative Tnnis grade ≥2, workers’ compensation claims, previous hip conditions, severe dysplasia (lateral center-edge angle 2, sex, and Seldes tear type. Results: One hundred twenty-five hips were eligible for inclusion, of which 101 (80.8%) hips had a minimum 5-year follow-up. All PRO scores were significantly improved ( P < .001) at latest follow-up (mHHS, 63.4 to 82.4; NAHS, 57.4 to 83.6; HOS-SSS, 44.2 to 74.5). The mean VAS score decreased from 5.8 to 2.3 ( P < .001). The mean patient satisfaction score was 8.1. Four (4.0%) patients underwent second-look arthroscopic surgery (mean, 18.5 months), and 14 (13.9%) patients converted to total hip arthroplasty (mean, 46.9 months). In the matched-pair comparison, 69 in the SDLP group were matched 1:1 with those undergoing labral repair. Outcomes at latest follow-up of the SDLP group were comparable with those of the control group, respectively: mHHS, 83.0 vs 86.1 ( P = .084); NAHS, 85.0 vs 85.4 ( P = .415); HOS-SSS, 74.8 vs 76.8 ( P = .219); VAS, 2.3 vs 2.0 ( P = .277); international Hip Outcome Tool–12 (iHOT-12), 73.8 vs 76.4 ( P = .136); Short Form Health Survey–12 (SF-12) mental, 57.4 vs 55.1 ( P = .031); SF-12 physical, 48.7 vs 48.9 ( P = .357); Veterans RAND Health Survey–12 (VR-12) mental, 61.6 vs 59.8 ( P = .160); VR-12 physical, 50.1 vs 50.2 ( P = .340); and patient satisfaction, 8.0 vs 8.3 ( P = .211). Conclusion: In select cases of stable labral tears, SDLP may allow the preservation of a functional labrum. At a minimum 5-year follow-up, SDLP using narrow indications produced favorable outcomes comparable with a matched-pair labral repair group.

A 41-year-old male patient, a white farmer, was referred to the stomatology clinic diagnosed as having actinic cheilitis. Clinically, atrophic and leukoplastic areas were observed throughout the lower lip, and loss of the border between the red lip skin and the cutaneous portion. An incisional biopsy was performed in the leukoplastic area, and histopathologic examination showed atrophic and atypical stratified orthokeratinized pavement epithelium with severe oral epithelial dysplasia. The therapeutic approach was the removal of all leukoplastic areas using the high-intensity diode laser for re-epithelialization of the affected mucosa. Proper follow-up is being performed every 3 months, and after 9 months, no signs of relapse were observed. Because of the potential for malignancy of actinic cheilitis and the presence of dysplastic epithelial alterations, an early approach is justified. The vaporization of the labial tissues with high-intensity diode laser was effective in superficial removal of affected tissues.

Background : Patellofemoral replacements are used to treat isolated patellofemoral arthritis in carefully selected patients. The Kinematch ® custom-designed implant is placed directly on subchondral bone, leading critics of the device to believe that this results in overstuffing and limitation of flexion in cases of trochlear dysplasia; the current study aims to evaluate this premise. Methods : A retrospective analysis of a consecutive series of 24 patients (32 knees) was conducted. Trochlear dysplasia was evaluated using pre-operative axial CT scans, and knees were categorized as having minimal or moderate/severe dysplasia (moderate = flat trochlea, severe = convex trochlea). The primary outcome was post-operative knee flexion. Results : There was no statistical or clinical difference in post-operative knee flexion between the minimal (120°+12) and the moderate/severe dysplasia (117°+9) groups (p=.34). Conclusions : Use of the Kinematch ® patient-specific custom trochlear component does not significantly limit flexion in cases of trochlear dysplasia, and although the surgeon has the ability to deepen the trochlea by way of the pre-operative model, this is not necessary. Keywords : Patellofemoral replacement; custom; flexion; trochlear dysplasia Level of Evidence : III, Case-control study

WOS: 000319232000008, PubMed: 23549316, Objective: The aim of this study was to determine the normal acetabular index values in children between 6 months and 8 years of age based on sex, age and side and to define the cutoff values for mild and severe acetabular dysplasia. Methods: The records collected from the data pool that was gathered to define the prevalence of untreated congenital hip dislocation in Turkish children between 6 months and 14 years of age was used. The acetabular index was measured on pelvic and abdominal radiographs of children between 6 months and 8 years of age, taken in 19 different cities for non-dysplasia related causes. The distribution of the index values based on age, sex and side. Results: Thirty-three hips of 21 children (0.75%) out of 2788 children were found to be subluxated or luxated. Acetabular index values of 5534 hips of 2767 children were measured. Acetabular index values of 723 (13%) hips of 493 children (17.8%) were found to be between 1 and 2 standard deviations. Acetabular index values of 147 hips (2.65%) of 118 children (4.3%) were calculated to be above 2 standard deviations. There was a negative correlation between the acetabular index and age. Conclusions: The study defines the normal acetabular index values in healthy Turkish children between 6 months and 8 years of age and the expected acetabular index values for mild and severe dysplasia.

Aim The purpose of this study was to analyse the extent of surgical correction and the early clinical results obtained using periacetabular osteotomy with allogenic bone grafting in patients with severe acetabular dysplasia. Methods 44 hips in 38 patients were confirmed to have severe acetabular dysplasia and underwent this procedure. The mean follow-up period was 4.2 (range 1.5-8.2) years. Severe acetabular dysplasia was defined as a centre-edge angle less than 0°, an acetabular-head index less than 50% and an acetabular roof obliquity greater than 30°. Periacetabular osteotomy was performed with transpositional osteotomy of the acetabulum. The patients were divided into 2 groups according to the radiographic appearance: 34 hips in the early stage group and 10 hips in the advanced stage group. Postoperatively, the hips were radiographically assessed for dysplasia correction. The clinical results and hip function were measured using the Harris Hip Score. Results The average pre-operative Harris Hip Score improved from 70 to 91 points at the latest follow-up. The average centre-edge angle, acetabular-head index and acetabular roof obliquity improved from −9° to 36°, 41% to 91% and 31° to 2°, respectively. Continuity of the Shenton line improved from 15 to 35 hips. No instances of nonunion or of transported segment collapse were encountered in this series; however, a grafted allogenic bone was absorbed in 1 case. Conclusions The usage of allogenic bone grafting combined with periacetabular osteotomy is an effective technique for treating severe acetabular dysplasia. In this series, the early clinical and radiographic results were excellent.

Objective: In this study, anticancer effects of mirtazapine on rats were investigated in an adenocarcinoma model induced by N-methyl-N-nitro-N-nitrosoguanidine (MNNG) and compared with those of cisplatin. Materials and Methods: For this purpose, 10 mg/kg doses of mirtazapine were administered orally to one group of rats, while 1 mg/kg doses of cisplatin were administered intraperitoneally to another group. At 1 hour after administration, 200 mg/kg doses of MNNG were given orally to both groups. MNNG administration was repeated once every 10 days through 3 months, after which period, gastric tissue was taken and pathologically evaluated. Results: Mirtazapine prevented adenocarcinoma induction by MNNG in rats to a greater extent than cisplatin. Some of the rats receiving cisplatin demonstrated severe dysplasia in gastric samples and others exhibited mild dysplasia. Rats given mirtazapine were not observed to suffer severe dysplasia, only mild dysplasia being observed. Conclusion: For adenocarcinoma induced by MNNG on rats, mirtazapine was determined more effective than cisplatin. In order to make statement about mechanism of anticancer activity of mirtazapine, wider studies are required.

Fourteen hips in 14 patients (all female; average age, 64 years) with severe bone defects due to developmental dysplasia of the hip or migration of the socket were treated with hydroxyapatite block with impacted morselized bone graft in conjunction with a cemented socket. All patients were followed clinically in a prospective fashion, and radiographs were analyzed retrospectively. One initial patient had 17-year follow-up, whereas the remaining 13 patients had follow-up between 4 and 6.5 years. No acetabular components were revised, including the socket of a 17-year postoperative case that remains rigidly fixed and supported by the graft and hydroxyapatite block with only mild polyethylene wear and minor osteolysis. Osteointegration and good clinical outcome were achieved in all cases by reconstruction with this technique in total hip arthroplasty.

Special attention was given to the appearance of nucleoli in the cytological samples of 21 cases of severe dysplasia, 25 cases of carcinoma in situ and 23 cases of microinvasive carcinoma. Studies showed that the lowest occurrence of nucleoli was in carcinoma in situ, and that when present they tended to be single rather than multiple. Further, the nucleoli of carcinoma in situ were usually larger than those of severe dysplasia, but smaller than those of microinvasive carcinoma. These findings suggest that it would be cytologically possible during the follow-up, by observing the nuclear appearance, to determine whether severe dysplasia would progress to carcinoma in situ and carcinoma in situ would progress to microinvasive carcinoma, or whether there would be regression.

Introduction Colorectal adenomas which are discovered simultaneously or 6 months after the diagnosis of primary adenoma or colorectal cancer (CRC) are called synchronous adenomas. The presence of synchronous adenomas increases the probability of adenomas with severe dysplasia as well as CRC. Objective The aim of the study is to show the characteristics of synchronous colorectal adenomas and to present the relation between the index rectal adenoma and the proximal synchronous tumours. Methods The research included 114 synchronous colorectal adenomas diagnosed in 58 patients. Total colonoscopy was performed on all patients. Results The largest number of patients had two adenomas (p

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

BACKGROUND AND OBJECTIVE Complete removal of tumours of the ampulla (papilla) of Vater is generally recommended, because of the known adenoma-carcinoma sequence yet the uncertainty regarding diagnosis of dignity of such tumours. The aim of this study was tho analyse different treatment concepts on the basis of data from a personal series of cases. PATIENTS AND METHODS Clinical, laboratory and histological data as well as treatment and course in nine patients (three women, six men; mean age 62 [46-82] years) with ampulla of Vater adenoma, treated at one hospital, were analysed retrospectively. The patients had been followed for 6-36 months. RESULTS All tumours had been removed endoscopically. Partial duodenopancreatectomy had subsequently been performed in two patients because of severe dysplasia. One tumour with moderately severe dysplasia had recurred locally within two months of endoscopic removal and was resected transduodenally. There had been no further recurrences 3 to 36 months later. CONCLUSION If there is no evidence of malignity and frequent follow-up can be ensured, endoscopic removal of a tumour of the ampulla of Vater is justified. Otherwise transduodenal excision of the ampulla or partial duodenopancreatectomy should be undertaken.

Instability of the patella occurs when it fails to track fully in the femoral groove during knee movement. The groove begins at the metaphysis of the distal femur and extends on its anterior surface inferiorly to the femoral notch. It is normally present at birth and the cartilaginous shape is similar to that of the adult. An abnormal trochlea may be shallow. In extreme cases it may be dome-shaped, where it is associated with recurrent subluxation or dislocation of the patella. In these cases it is logical to consider fashioning a groove as part of a realignment procedure. This study reports the operative technique and early clinical and radiological results of a consecutive case series of the first 15 patients (17 knees) who underwent a deepening trochleoplasty for severe dysplasia developed from that described by Dejour. The follow-up was for a minimum of 1 year (average 3 years, range 1 to 9 years). The boss height was reduced from an average of 7.5 mm (range 6 to 11 mm) to 0.7 mm (range -1 to 3 mm). Tracking became normal in 11 knees and had a slight J-shaped in six. Seven knees had mild residual apprehension. Seven patients were very satisfied, six were satisfied, and two were disappointed. The Kujala score improved from an average of 48 (range 13 to 75) to 75 (range 51 to 98) out of 100 (p

The operative procedures chosen to treat arthrosis in patients with severe acetabular dysplasia vary among orthopaedic surgeons, particularly in younger patients. We operated on 450 hips with acetabular dysplasia by using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa by Ninomiya (Clin Orthop 247:127-137, 1989). In this report, we describe our technique of performing RAO with hydroxyapatite tricalcium phosphate-composite (HAP-TCP) blocks to achieve good acetabular coverage and the results of this procedure in 16 hips with severe dysplasia, including nine with advanced arthrosis. Adequate coverage of the osteotomized acetabulum was maintained and symptoms, especially pain, showed marked improvement at the latest follow up.

Background/Purpose Because severe dysplasia and carcinoma in children with familial adenomatous polyposis (FAP) younger than 18 years is rare, earlier surgical intervention is not common. The purpose of this study is to report the prevalence of dysplasia and carcinoma among children with FAP in our institution. Methods From 1998 through 2004, children 18 years or younger with FAP that underwent total proctocolectomy at a large children's hospital were retrospectively reviewed. Results Eleven children underwent surgery for FAP. The mean age at surgery was 13 ± 3.2 years. Approximately half of the patients who underwent preoperative endoscopy had evidence of dysplasia. Nine (82%) patients had dysplasia on preoperative biopsy and/or operative specimen, and 3 (27%) of these patients had severe dysplasia or carcinoma in situ. Four of the 5 patients without symptoms had evidence of dysplasia. No patients had invasive carcinoma. Conclusion We observed a higher incidence of severe colonic dysplasia in young children with FAP compared with the current literature. A significant number of patients with dysplasia at surgery had no symptoms and no evidence of dysplasia on preoperative endoscopic biopsies. These data suggest that earlier intervention in children with FAP may be beneficial and should be investigated further.

Recent revisions of the Bethesda System (TBS III) did not modify the original two-tiered low-grade and high-grade squamous intraepithelial lesion (LSIL/HSIL) terminology and continued to offer the option of subclassifying HSIL into moderate dysplasia/cervical intraepithelial neoplasia (CIN II) and severe dysplasia/CIN III. The purpose of this study is to evaluate the significance of the HSIL moderate dysplasia/CIN II subclassification and the causes of Pap test-biopsy discordance for this subclassification. HSIL/moderate dysplasia/CIN II Pap tests were identified from the University of California Davis Medical Center laboratory file for a 5-yr period (1997-2001) and correlated with follow-up cervical biopsies. Cervical biopsies with CIN II diagnoses were identified from the laboratory file for the same time period, and correlated with their preceding Pap test. Discordant Pap test-biopsy pairs from either group were reviewed by two pathologists for the following causes for discordance: cytologic overcall or undercall, biopsy overcall or undercall, and sampling error or possible lesion regression. During the review period, 161 of 378 total HSIL Pap tests had a HSIL/CIN II result (42%), and 81/161 (50%) had a follow-up cervical biopsy. 38/81 (47%) were concordant, and 43 (53%) were discordant; 39/43 discordant cases had both Pap test and biopsy slides available for review. CIN I was the most common discordant biopsy diagnosis. Sampling error was the most common cause of discordance and was three times more common than the other causes; 536 CIN cervical biopsies with CIN were identified in the laboratory files during this review period, and 108/536 (20%) received a diagnosis of CIN II. Sixty-seven of 108 (62%) had a preceding Pap test result available; 32 of the 67 (48%) had a concordant preceding Pap test with a HSIL/CIN II result, and 35 (52%) were discordant; 32/35 discordant cases had both Pap test and biopsy slides available for review. LSIL was the most common discordant Pap test diagnosis. Sampling error was also the most common cause of discordance, and was also three time more frequent than any other cause for discordance. HSIL/CIN II is a meaningful subclassification in our laboratory. We support the TBS III recommendation for optional subclassification of HSIL and suggest that individual laboratories may wish to monitor use of this subclassification through internal correlation studies.

OBJECTIVE. This study was to evaluate the benefit of using autofluorescence bronchoscopy for the detection and localization of endobronchial carcinoma. MATERIALS AND METHODS. During January 2007 till December 2011; 350 patients, aged 35 to 90 years old, who were smokers or ex-smokers were examined by autoflorescent bronchoscopy. All cases were suspected to have lung cancer. RESULTS. Premalignant, endobronchial cancer was found in 3 patients. Follow ups over the next four years discovered one patient developing severe dysplasia. CONCLUSION. Autofluorescence bronchoscopy is able to enhance early detection in case of endobronchial lesion.

We developed a multifiber optical probe for oblique polarized reflectance spectroscopy (OPRS) in vivo and evaluated its performance in detection of dysplasia in the oral cavity. The probe design allows the implementation of a number of methods to enable depth resolved spectroscopic measurements including polarization gating, source–detector separation, and differential spectroscopy; this combination was evaluated in carrying out binary classification tasks between four major diagnostic categories: normal, benign, mild dysplasia (MD), and severe dysplasia (SD). Multifiber OPRS showed excellent performance in the discrimination of normal from benign, MD, SD, and MD plus SD yielding sensitivity/specificity values of 100%/93%, 96%/95%, 100%/98%, and 100%/100%, respectively. The classification of benign versus dysplastic lesions was more challenging with sensitivity and specificity values of 80%/93%, 71%/93%, and 74%/80% in discriminating benign from SD, MD, and SD plus MD categories, respectively; this challenge is most likely associated with a strong and highly variable scattering from a keratin layer that was found in these sites. Classification based on multiple fibers was significantly better than that based on any single detection pair for tasks dealing with benign versus dysplastic sites. This result indicates that the multifiber probe can perform better in the detection of dysplasia in keratinized tissues.

Background: To study appropriateness of hysterectomy for various indications by evaluating the referred cases for hysterectomy as per standard norms and calculating number of hysterectomies which were not indicated.Methods: A prospective study consist of analysis of 110 cases which were advised hysterectomies in different hospitals due to various indications and number of cases who were managed conservatively in these 110 cases and did not required hysterectomy ultimately.Results: There was significant difference in number of cases who were advised hysterectomies and number of cases who actually needed a hysterectomy. Most of cases were advised hysterectomy just on the basis of patient’s complaints with no consideration to age, parity and without proper evaluation as per standard norms.Conclusions: It was found that only 27.27% of cases who were advised hysterectomies actually needed hysterectomy for indications like symptomatic fibroid, severe dysplasia, resistant cases of AUB and intractable pain due to adenomyosis and 72.73% of cases were managed conservatively and indications for which hysterectomy was advised in such cases were inappropriate.

Objectives:Recent progress in phonomicrosurgical technique and equipment enabled one to precisely differentiate the subepithelial (type1) and subligamental (type2) cordectomy concept as needed. The purpose of this study was to compare postoperative glottal function and voice-related quality of life (QOL) between these 2 surgical concepts against laryngeal leukoplakia.Methods:From January 2007 to August 2013, 42 consecutive laryngeal leukoplakia patients had excisional biopsies using type1 procedures. Of these, cancer patients (n = 10) had additional type2 laser surgeries. Furthermore, some severe dysplasia/carcinoma in situ patients (n = 11) preferred additional type2 surgery aiming at relatively safe surgical margins. Sequential pre- and postoperative measurements of Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale and evaluations of laryngeal videostroboscopic images were performed. Acoustic measurements and voice-related QOLs (VHI and V-RQOL) were examined at the patients’ last visits. All...

In the model of chemically induced bladder carcinoma in mice following application of betahydroxylbutylnitrosamine (BBN) we could not detect a therapeutic influence of systemic treatment with intraperitoneal injection of interferon-alpha2b (10x3x10(5) IU IFN-alpha2b) on the rate of locally advanced bladder carcinoma (IFN-alpha2b 37% versus control 41%) nor on the development of tumor precursors (severe dysplasia 100% in both groups).

We describe 10 patients with villous tumors of the rectum. Seven tumors showed severe dysplasia but only one invasion of the muscularis propria of the bowel wall. All patients underwent a sphincter-conserving operation. There was one local recurrence which was treated by further local excision. One patient died of other causes, but the remainders recovered.

子宮頸部の高度異形成を伴った体部原発同所性癌肉腫症例を経験したので, 内膜擦過細胞像を中心に報告する.患者は53歳, 女性.不正性器出血と下腹部痛を主訴に来院し, 内膜増殖症ないし体部癌の疑いで内膜ならびに内頸部擦過細胞診が施行された.頸部i擦過では高度異形成が疑われたが, 癌の存在の可能性を完全には否定できなかった. 一方, 内膜擦過細胞診では扁平上皮様分化を一部に伴う腺癌要素に加え, 比較的小型の未分化細胞集簇や短紡錘形核を有する異型細胞が混在することから癌肉腫が疑われた.子宮頸部病変と体部病変の関係については出現細胞像の違いから, 独立病変の存在が考えられたが確定は困難であった.その後, 自然排出された腫瘍塊ならびに手術材料の組織学的検索から, 子宮頸部の高度異形成を伴った体部原発同所性癌肉腫の診断が確定した.

Objectives The objective of current study was to determine the p16 mRNA level in cervical cells by relative quantification (RQ) and to test viral E6 expression in human papillomavirus (HPV) -16 or -18-positive specimens by widely used methods. We targeted the pivotal mRNA level associated with severe dysplasia or worse. Materials and methods Cervical specimens were taken from 134 women with cervical disease and 132 women with normal cytologic results. The presence of HPV was analyzed by sequencing. The results of p16 and E6 analyses were statistically processed in receiver operating characteristic curve analysis to predict severe dysplasia or worse. Results The HPV DNA was detected in 81.4% (109/134) of women with cervical disease and in 27.3% (36/132) of women with normal cytologic results. HPV-16 or -18 were present in 59.7% (80/134) of abnormal specimens. p16 and E6 mRNA expression was increasing with severity of cervical dysplasia. p16 mRNA expression was found 4.35-fold and 13.15-fold increased in high-grade squamous intraepithelial lesions and squamous cell carcinomas, respectively. E6 mRNA expression was significantly increased (p = .0038) in severe dysplasias or worse. The RQ method achieved better sensitivity (82.6%), and E6 mRNA got better specificity (80.6%) for the prediction of severe dysplasia or worse. Conclusions An increasing level of p16 and E6 mRNA transcripts could mean the potential of cervical dysplasia progression to cancer, but further studies should be done to confirm this proposition. Nevertheless, we consider using both tests to improve the sensitivity and specificity for prediction of severe dysplasia or worse.

With the exception of the trochleoplasty, the management of episodic patellar dislocation (EPD) has been described in the previous chapter. The Lyon school believes that although trochlear dysplasia is the primary problem in EPD addressing the principal factors of a high TT-TG, patella alta and patellar tilt is usually sufficient to obtain stability. Trochleoplasty is a technically demanding procedure that is rarely required. Its indications include patients with habitual dislocation of the patella (Fig. 31.1) and abnormal tracking of the patella or in revision surgery. It can also correct a severe dysplasia with a femoral groove prominence of >6 mm. It is always combined with another surgical procedure to correct the other contributing factors of the instability.

espanolObjetivo: identificar los factores asociados a displasia en mujeres que asisten al Hospital Central de la Policia Nacional o a diferentes dispensarios, cuya citologia cervicovaginal presentaba atipias de celulas escamosas de significado indeterminado (ASC-US). Materiales y metodos: estudio de prevalencia en el cual se identificaron los factores asociados a displasia de cuello uterino por medio de la correlacion de las diferentes variables, por el servicio de Patologia del Hospital Central de la Policia Nacional. Las diferentes variables fueron extraidas de las historias clinicas. Se realizo un reporte descriptivo de las prevalencias y se calcularon OR por medio de regresion logistica para establecer la asociacion entre las variables. Resultados: se encontraron porcentajes de distribucion de displasia asi: Sin displasia: 8.6%; Displasia leve: 80.2%; Displasia moderada: 8.2%; Displasia severa: 3.0%. La edad en la poblacion tuvo una mediana de 47.87 anos. La poblacion sin displasia fue de 8.6% y con displasia 91.4%. La asociacion entre ciclos y displasia fue de 0.008 y entre antecedente personal de cancer y displasia fue de 0.005. En la regresion logistica, la edad mostro asociacion con una p Conclusiones: la importancia de la toma de la citologia cervicovaginal cobra un papel cada vez mas relevante en nuestra poblacion, dado el aumento de la prevalencia de displasia. Las principales recomendaciones son: adecuada toma de la citologia y tener en cuenta la edad como factor importante para la asociacion de displasia cervicovaginal sobre los ASC-US, ya que en muchas ocasiones se pueden pasar por alto en la consulta diaria. EnglishObjective: to identify factors associated with dysplasia in women attending the Central Hospital of the National Police or different clinics whose cervico-vaginal cytology presented atypia squamous cell of undetermined significance (ASC-US). Materials and methods: prevalence study of what is intended to identify the factors associated with dysplasia of the cervix through the correlation of different variables, for the service of Pathology of the Central Hospital of the National Police. The variables were obtained through to medical records. It performs a report describing the prevalence�s were calculated OR through logistic regression was used to establish the association between the variables. Results: the percentage of the distribution of dysplasia: Without dysplasia: 8.6%; Mild dysplasia: 80.2%; Moderate dysplasia: 8.2%; Severe dysplasia: 3.0%. The population has an average of 47 years. The percentage of people without dysplasia was 8.6% and 91.4% dysplasia. The analysis showed that divariado. The partnership between cycles and dysplasia was between 0,008 and personal history of cancer and dysplasia was 0005. For Multivariate logistic regression analysis age showed partnership with p Conclusions: the importance of making the cervicovaginal cytology charged an increasingly important role in our population, given the increased prevalence in dysplasia. Our main recommendation is, in addition to adequate and accurate making cytology, keep in mind that age is an important factor for the association cervico-vaginal dysplasia. And the ASC-US, as many times can be overlooked in the daily consultations.

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient’s unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

The nomenclature in use in the past was mild, moderate, and severe dysplasia, these were the terms used to describe premalignant squamous cervical cellular changes. Although still in use by some, it has generally been replaced by the term Cervical Intraepithelia Neoplasia(CIN), which is used to describe histologic changes on the uterine cervix. The trend is now tending towards the use of Squamous Intraepithelia Lesions(SIL).

Background: With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations. Aim: To analyse the impact of manipulating digital images on their diagnosis. Design: Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted k statistics was used to measure and assess the levels of agreement between observers. Results: Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade. Conclusion: Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible.

The authors report a case of spontaneous uterine rupture in a patient with no risk factor. The break was initially silent and incomplete. Then, because of profuse bleeding was subjected to subtotal hysterectomy and is now in good health. Histological examination revealed severe dysplasia with necrosis of the coating of the esocervix . The authors conclude by stressing the importance of diagnostic assessment of the cervix in pregnancy is to prevent cervical cancer, to eliminate a rare risk factor for uterine rupture during labor.

過去8年間に当科で施行した妊婦に対する子宮頸部擦過細胞診より異常細胞診率, 子宮頸部初期病変発見率を検討した. また, 子宮頸部高度異形成および上皮内癌症例について症例を呈示するとともに, 妊娠中の子宮頸部初期病変の診断上の注意点やfollow up成績について検討した.1. 過去8年間の妊婦における異常細胞診発見率は, 1.5%であった.また, コルポスコピーおよび生検による精査で子宮頸部初期病変と診断されたのは, 0.82%であった.2. 子宮頸部高度異形成および上皮内癌の症例は8例みられたが, 7例において組織診が, 細胞診に対してover diagnosisであった. また, 5例に多数の腺管侵襲が認められた.3. 子宮頸部高度異形成および上皮内癌の8例中6例が分娩後に消失した. 消失の原因については種々の要因が考えられるが, 生検のover diagnosisが最も大きな要素ではないかと考えている.4.妊婦に子宮頸部初期病変が検出される率は, 非妊婦と比較してほぼ同等である. よって, 妊婦検診においても子宮癌検診を徹底し, 異常細胞診症例に対しては, コルポスコピー下に生検を施行し, 精査・厳重な管理が必要である.

The records of 167 patients who underwent both cone biopsy and hysterectomy at the University of Michigan Medical Center between 1974 and 1989 were reviewed. The presence or absence of neoplasia at the cone biopsy margins was able to be correlated with the extent of residual disease in the hysterectomy specimens for 138 patients. When all patients were evaluated, residual disease was found in 64 of 82 cases (78%) when the cone biopsy margins were involved and in 14 of 56 cases (25%) when the cone margins were free. Among patients with preinvasive disease on cone biopsy, 37 of 50 (74%) had residual disease when the cone margins were involved and 11 of 48 (23%) had residual disease when the cone margins were free. No patient with mild to moderate dysplasia on cone biopsy had residual disease more advanced than moderate dysplasia, regardless of margin status. When the margins were free on cone biopsy, there was no residual disease in 12 of 15 patients (80%) with severe dysplasia and no residual dise...