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Objective To prospectively evaluate a new non invasive device that combines fluorescence and reflectance spectroscopy in a population in women at risk for cervical dysplasia. Methods A total of 1607 women were evaluated with multimodal hyperspectroscopy (MHS), a painless test with extremely high spectral resolution. Subjects who were referred to colposcopy based on abnormal screening tests or other referral criteria underwent the MHS test and also had a sample taken for additional cytology and presence of high risk human papilloma virus (HPV) prior to undergoing biopsy. Results Sensitivity of MHS for cervical intraepithelial neoplasia (CIN) 2+ was 91.3% (252/276). Specificity, or the potential reduction in referrals to colposcopy and biopsy, was 38.9% (222/570) for women with normal or benign histology and 30.3% (182/601) for women with CIN1 histology. Two year follow-up data, collected for a subgroup of 804 women, revealed 67 interval CIN2+ that originally were diagnosed at enrollment as normal or CIN1. MHS identified 60 of these (89.6%) as positive for CIN2+ prior to their discovery during the two year follow-up period. Conclusions MHS provides an immediate result at the point of care. Recently, the limitations of cytology have become more obvious and as a consequence greater emphasis is being placed on HPV testing for cervical cancer screening, creating a need for an inexpensive, convenient and accurate test to reduce false positive referrals to colposcopy and increase the yield of CIN2+ at biopsy. MHS appears to have many of the attributes necessary for such an application.

Objective. The objective of the study was to evaluate the potential safety and effectiveness of tissue spectroscopy for the diagnosis of cervical cancer in a prospective multicenter study of women scheduled for colposcopy on the basis of an abnormal Pap test or other risk factor. Materials and Methods. Five hundred seventy-two women underwent spectroscopy of the cervix during their colposcopy visit. Spectroscopy measurements taken over a scan period of 4 minutes and 30 seconds were integrated by a cross-validated pattern recognition model and compared with biopsy results to yield sensitivity and specificity of cervical spectroscopy. Results. The median age of subjects enrolled in the study was 27.7 years. The sensitivity of cervical spectroscopy was 95.1% with a corresponding 55.2% specificity for benign lesions. Several potential confounding factors (eg, mucous, blood, patient motion, ambient light) were examined to determine their potential impact on the accuracy of the test. Ambient light seemed to have the greatest effect, but no single factor contributed significantly to the results. The subjects did not experience any adverse events from undergoing the test. Conclusions. Spectroscopy of the cervix has the potential to accurately detect cervical moderate and high-grade dysplasia while also reducing the false-positive rate for benign cervices. The test is relatively simple to implement and was well accepted by subjects enrolled in the study.

Ectopic pregnancy after total hysterectomy represents an unusual occurance. This article reviews the literature and represents an additional case of abdominal gestation following tubal ligation and vaginal hysterectomy. Pregnancy should be considered in the differential diagnosis of pelvic mass in any woman of childbearing age who had total hysterectomy without bilateral salpingo-oophorectomy. (J GYNECOL SURG 7:251, 1991)

To determine antenatal complications, mode of delivery, and birth outcomes for Saint Francis Hospital and Medical Center and Burgdorf Obstetric clinic patient population based on their body mass index (BMI).This is a retrospective cohort study of 2,270 women who delivered at our institution from 1996 to 2002. Our patient population ranged from ages 23.8 to 26.6 years. The majority of the patients in the study were Black or Hispanic. BMI at delivery was calculated. Maternal data were obtained from our computerized obstetrical database. Exclusion criteria included: nonviable fetus, no recorded maternal height or other incomplete data. For statistical analysis we used a one-way analysis of variance (ANOVA) and a post-hoc Tukey's test, using a computer statistics program (Statmost, Datamost Crop., Salt Lake City, UT), with, P0.05 considerd significant.This study revealed that those patients with a higher BMI had greater weight gain during pregnancy. Operative delivery rates were also higher with increasing BMI, as was the infant birth weight. Diabetes and hypertension were directly related to the BMI; the higher the BMI the higher their prevalence. The low number of events recorded did not allow a statistical comparison to determine any increase in shoulder dystocia.A statistically significant increase in rate of operative delivery, hypertension, diabetes and a trend toward higher birth weight are associated with increased maternal BMI.

The ovary is a relatively frequent site of metastasis from malignant neoplasia arising elsewhere in the body, the majority of these originating from the GI tract. The best known tumor of this type is signet-ring cell adenocarcinoma (Krukenberg tumor) of gastric origin. The gall bladder and bile ducts are rare sources of these metastases. Asymptomatic carcinoma of the cystic duct metastasizing to the ovary is extremely rare. We are reporting such a case in which the patient presented with no GI or hepatic symptoms. The cystic duct carcinoma was an incidental finding from routine and careful examination of the abdominal viscera.

Thirty patients with histologically confirmed high-grade squamous intraepithelial lesions (SIL) were treated by either cold knife, laser, or electrosurgical loop conization, all of which were performed under general anesthesia. The three methods were compared with respect to the immediate surgical complications, ease of performance, delayed complications, and quality of histologic specimens. The electrosurgical loop conization had decreased blood loss and reduced operative time and proved to be tissue sparing. There were no significant differences in the three groups in the persistence rates of cervical intraepithelial neoplasia (CN) after treatment. Histologic analysis revealed comparable coagulation artifact in the laser and electrosurgical loop groups that the cold knife group did not have. The endocervical component of the electrocautery showed extensive denudation and coagulation artifact that made recognition of CIN extremely difficult. We conclude that the electrocautery should be used only as an excisional method of the transformation zone for lesions well defined on the ectocervix, since it is unreliable if the lesion extends into the endocervix.

It is well accepted that proper microsurgical techniques (which include gentle handling of tissues, precise aposition, and constant irrigation) improve pregnancy success rates in tubal rea...

Molluscum contagiosum infection of the genital area is not common but is increasing in frequency. The lesion is small, usually asymptomatic, caused by a DNA virus of the pox group. The infection is spread only by direct contact and inoculation of the virus into the adjacent skin. The infection is limited to the epidermis, and most lesions heal spontaneously in 2-12 months. However, the infection may persist for many years in some people or their sexual partner. The carbon dioxide laser is a promising treatment alternative; this method is easy and fast and creates minimum discomfort. The lesion heals without scar formation and with no recurrence.

Leiomyomas are the most common benign tumors of the uterus during the reproductive age. Whereas some myomas remain asymptomatic, many cause infertility, habitual abortion, pregnancy complications, menometrorrhagia, and pelvic pain and pressure. Myomectomy is the treatment of choice during the reproductive age in order to preserve fertility. This procedure can be accomplished by many methods. We have used carbon dioxide lasers combined with microsurgical techniques to excise or vaporize the myomas directly or indirectly. The advantages are improved hemostatis, greater precision–thus removing only abnormal tissue–the ability to remove fibroid from inaccessible areas, decreased normal tissue injuries, and less adhesion for formation.

A variety of methods have been used to treat cystic enlargement of the duct of the Bartholin gland. However, a good percentage of patients treated with these methods experience recurrence, hemorrhage, drainage, and considerable scarring. The CO2 laser offers a simple and effective means of treating cystic Bartholin ducts. In this study, 28 patients were treated with the CO2 laser. The cyst was incised with the laser, and the cyst wall was vaporized from the inside. In a follow-up period of 1–8 years, there were only 2 recurrences, which responded to a second treatment. Surgery was rapid and uncomplicated in all cases, and healing occurred without noticeable scar formation. The CO2 laser offers some advantages over conventional methods of treatment for Bartholin duct cysts, and if readily available, it should be the treatment of choice. (J GYNECOL SURG 5:381, 1989)

Many methods have been used to treat cystic enlargement of the duct of the Bartholins gland. Widely used methods have the disadvantage of recurrence, hemorrhage, persistent drainage, or considerable scarring. The carbon dioxide laser offers a simple and effective means of treating cystic Bartholin ducts. Ten patients were treated with the CO2 laser. The cyst was incised with the laser and the cyst wall was vaporized from the inside. In a follow-up period of one to four years, there were only two recurrences, and these responded to a second treatment. Surgery was rapid and uncomplicated in all cases, and healing occurred without scar formation. The CO2 laser offers several advantages over conventional methods for treating cysts of the Bartholin duct.