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Evaluates the efficacy of gamolenic acid by evening primrose oil in treating hot flushes and sweating related to menopause. Use of placebo in the study; Analysis of data; Improvements on the reduction of night time flushes. INSET: Clinical implications.

Objective: To evaluate the incidence of underlying serious gynaecological pathology in women referred to colposcopy with post-coital bleeding., Main Outcome Measures: Incidence of precancer and cancer., Methods: A retrospective cohort study of women referred to colposcopy at a London hospital from January 2008-March 2015. Inclusion criteria are women with post-coital bleeding and the following cervical cytology history: negative; inadequate; never had. Multinomial logistic regression was used to assess for significant risk factors for cervical dysplasia and cancer., Results: Overall, 635 women with either negative cytology (n = 436/68.7%), no previous cytology (n = 175/27.6%), or inadequate cytology (n = 24/3.8%) were referred to colposcopy for post-coital bleeding. The median age is 35 years (S.D. = 9.7 years). In 256 (40.3%) women, no cause was detected, and 322 (50.7%) women had a benign cause. Overall, 42 (6.6%) women had low-grade dysplasia, and eleven women had high-grade dysplasia (1.7%). Four women (0.6%) had cervical cancer; clinically evident cancer on speculum examination (n = 3); micro-invasive cancer (n = 1). Current smokers were significantly more likely to have HPV atypia (p = 0.015) or cervical intraepithelial neoplasm grade 1 (CIN1) p = 0.003. Advancing age was a significant risk factor for cervical cancer (p = 0.037)., Conclusion: All women with post-coital bleeding need an urgent speculum examination to rule out frank cervical cancer. Although most women had a benign cause for post-coital bleeding, around 2% had a colposcopy-aided diagnosis of either cervical precancer or cancer; therefore, referral of symptomatic women deserves consideration. HPV testing may reduce referrals to colposcopy for post-coital bleeding due to non-significant pathology in the future., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Salpingectomy is recommended as a risk-reducing strategy for epithelial tubo-ovarian cancer. The gold standard procedure is complete tubal excision., Objective: The purpose of this study was to assess the presence of residual fimbrial/tubal tissue on ovarian surfaces after salpingectomy., Study Design: Prospective analysis of patients who underwent salpingo-oophorectomy with or without hysterectomy for benign indications, early cervical cancer, or low-risk endometrial cancer at a UK National Health Service Trust. Salpingectomy with or without hysterectomy was performed initially, followed by oophorectomy within the same operation. Separately retrieved tubes and ovaries were sectioned serially and examined completely histologically. The main outcome measure was histologically identified fimbrial/ tubal tissue on ovarian surface. Chi-square/Fisher's exact tests were used to evaluate categoric variables., Results: Twenty-five consecutive cases (mean age, 54.8 ± 5.0 years) that comprised 41 adnexae (unilateral, 9; bilateral, 16) were analyzed. Seventeen (68.0%), 5 (20.0%), and 3 (12.0%) procedures were performed by consultant gynecologists, subspecialty/specialist trainees, and consultant gynecologic oncologists, respectively. Twelve of 25 procedures (48.0%) were laparoscopic, and 13 of 25 procedures (52.0%) involved laparotomy. Four of 25 patients (16.0%; 95% confidence interval, 4.5-36.1%) or 4 of 41 adnexae (9.8%; 95% confidence interval, 2.7-23.1%) showed residual microscopic fimbrial tissue on the ovarian surface. Tubes/ovaries were free of adhesions in 23 cases. Two cases had dense adnexal adhesions, but neither had residual fimbrial tissue on the ovary. Residual fimbrial tissue was not associated significantly with surgical route or experience (consultant, 3/20 [15%]; trainee, 1/5 [20%]; P=1.0)., Conclusion: Residual fimbrial tissue remains on the ovary after salpingectomy in a significant proportion of cases and could impact the level of risk-reduction that is obtained., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Endometriosis and infertility are known to be associated, but it is unclear whether endometriosis causes infertility. We used contrast analogue enhancement to study the effect of peritoneal fluid from women with early stage endometriosis on the ciliary beat frequency of human fallopian tube epithelium. We obtained peritoneal fluid from six women with early stage endometriosis and from six fertile women with no evidence of endometriosis to use as controls. Fallopian tubes from hysterectomy specimens were collected from 17 women. The difference in ciliary beat frequency between fallopian tubes exposed to peritoneal fluids of women with and without endometriosis increased with the duration of incubation (mean difference at 24 h 1.35 Hz, 95% CI 0.94-1.75, p=0.01). At 24 h, ciliary beat frequency was significantly lower in the incubations with peritoneal fluid from women with endometriosis than controls (4.29 [0.15] vs 5.64 Hz [0.15], respectively, p=0.001). Impairment of ciliary action in women with endometriosis might reduce fertility.

Objective: To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual morbidity by providing information., Design: Prospective randomised study., Setting: Colposcopy clinic of a large district general hospital., Sample: Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis., Methods: Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a State/Trait Anxiety Inventory (StAI/TrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six-month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet., Main Outcome Measures: Differences of anxiety and psychosexual scores between leaflet and control groups., Results: The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant., Conclusions: This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.

Objective: To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones., Design: A prospective randomised clinical trial., Setting: Academic Unit colposcopy clinics in Birmingham., Participants: One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis., Methods: Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy., Results: No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy., Conclusions: The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.

Objective: To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone., Design: Prospective programme study of all patients undergoing colposcopy for cytological abnormalities., Setting: Dudley Road Hospital, Birmingham., Subjects: Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group., Main Outcome Measures: Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone., Results: Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness., Conclusion: Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.

Objective: To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co-existent koilocytosis., Design: Multivariate analysis of prospective programme trial., Setting: Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK., Subjects: One hundred and sixty-seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone., Main Outcome Measures: Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone., Results: Forty-seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease., Conclusion: These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.

Objective: To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups., Design: Prospective randomized controlled study., Setting: A busy referral maternity hospital in Kathmandu, Nepal., Subjects: 101 women were assigned to delivery with the Silc-cup and 98 to delivery with the metal cup., Main Outcome Measures: Success rate at achieving delivery with the assigned instrument and incidence of neonatal trauma. Analysis was by 'intention to deliver' with women remaining in their original group regardless of the eventual mode of delivery., Results: Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc-cup 85% and metal cup 87%). The Silc-cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc-cup group (22%), compared with the metal cup group (37%)., Conclusions: The data indicate a greater tendency for the Silc-cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.