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Transformation Zone (transformation + zone)
Selected AbstractsThe treatment of CIN: what are the risks?CYTOPATHOLOGY, Issue 3 2009W. Prendiville The treatment of squamous cervical intraepithelial neoplasia is to remove or destroy the transformation zone (TZ). It is likely that no method of treatment is superior to another if it is performed properly and the limited available evidence supports this view. The significant advantages of excision (simplicity, cost, outpatient procedure, histological examination of the entire TZ) mean that treatment thresholds may have lowered over the last decade. Long-term pregnancy-related morbidity associated with excision has been reported recently. The evidence would suggest that this increase equates to a genuine increase in serious adverse outcome for cone biopsy but not large loop excision of the transformation zone (LLETZ). The available data also point to an increase in both incomplete excision and premature labour associated with the excision of large endocervical TZs. The clinical implications arising from this are firstly that women with large type 2 and 3 TZs need appropriate counselling before treatment and that the threshold for treating young women with mild abnormalities needs review. [source] O-11 Proposal for extending the role Of ABMSPS in reporting cervical loopsCYTOPATHOLOGY, Issue 2007K. Ellis Introduction:, The advanced biomedical scientist practitioner (ABMSP) in Cervical Cytology was established in the NHS cervical screening programme (NHSCCSP) in 2001 and there are approximately 60 ABMSPs in post. The aim of this study was to explore the potential for further expansion of their role in the NHSCSP by reporting the histology of loop excision biopsies of the cervical transformation zone (LLETZ). Methods:, The initial study included LLETZ specimens from 55 sequential patients, which, according to standard local practice had the diagnosis of CIN confirmed by cervical punch biopsy prior to the procedure. All the cases were independently examined by an ABMSP and a consultant histopathologist and reports complying with the Royal College of pathologists (RCPath) minimum data sets were assembled. The cases were reviewed at the discussion microscope and ABMSP reports were compared to the final reports issued by the histopathologist. Results:, In the preliminary findings, total agreement between ABMSP and consultant histopathologist was reached on just under 90% of cases. Of those cases that did not reach total agreement, none varied by more than one grade. There was agreement on other parameters from the RCPath minimum data sets. Discussion:, Based on our preliminary findings, it appears there may be scope for extending the role of ABMSPs to report LLETZ samples under the supervision of a histopathologist. We plan to increase the number of cases both in our department and through collaboration with other UK centres and to present evidence to the RCPath, with a view to adoption of this role by ABMSPs and development of an appropriate training scheme. [source] Physics-based GPS data inversion to estimate three-dimensional elastic and inelastic strain fieldsGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 2 2010Akemi Noda SUMMARY The Earth's crust is macroscopically treated as a linear elastic body, but it includes a number of defects. The occurrence of inelastic deformation such as brittle fracture at the defects brings about elastic deformation in the surrounding regions. The crustal deformation observed through geodetic measurements is the sum of the inelastic deformation as source and the elastic deformation as effect. On such a basic idea, we created a theory of physics-based strain analysis with general source representation by moment tensor, and developed an inversion method to separately estimate 3-D elastic and inelastic strain fields from GPS data. In this method, first, the optimum distribution of moment density tensor is determined from observed GPS data by using Akaike's information criterion. Then, the elastic and inelastic strain fields are obtained from the optimum moment tensor distribution by theoretical computation and direct conversion with elastic compliance tensor, respectively. We applied the inversion method to GPS horizontal velocity data, and succeeded in separately estimating 3-D elastic and inelastic strain rate fields in the Niigata,Kobe transformation zone, central Japan. As for the surface patterns of total strain, the present results of 3-D physics-based inversion analysis accord with the previous results of 2-D geometric inversion analysis. From the 3-D patterns of the inverted elastic and inelastic strain fields, we revealed that the remarkable horizontal contraction in the Niigata,Kobe transformation zone is elastic and restricted near the surface, but the remarkable shear deformation is inelastic and extends over the upper crust. [source] The role of genotype-specific human papillomavirus detection in diagnosing residual cervical intraepithelial neoplasiaINTERNATIONAL JOURNAL OF CANCER, Issue 2 2002Ruud LM Bekkers Abstract We assessed prospectively whether residual cervical intraepithelial neoplasia (CIN) after treatment for high-grade CIN can be predicted by genotype-specific high-risk HPV (HR-HPV) detection in follow-up cervical scrapes. A broad spectrum, highly sensitive SPF10 -LiPA-PCR HPV detection technique was used on cervical scrapes before large loop excision of the transformation zone (LLETZ), on the LLETZ biopsy and on follow-up scrapes of 90 patients treated for high-grade CIN. HR-HPV was detected in the biopsies of 93% (n = 84) of the patients and in the follow-up scrapes of 48% (n = 43) of the patients. In 12 patients, genotype-specific HR-HPV persistence was detected in both follow-up scrapes. In 10 patients, residual CIN was detected. In 5 of these patients (including all patients with residual CIN 3), the follow-up scrapes showed genotype-specific HR-HPV persistence. In 2 patients, a different HR-HPV was detected, and 3 patients had HR-HPV-negative follow-up scrapes. Conventional cytologic follow-up was abnormal in 13 patients including all 10 patients with residual CIN. The negative predictive value (NPV) of HR-HPV detection on follow-up scrapes was high (94%). Repeat detection of genotype-specific HR-HPV showed a lower sensitivity and NPV than repeat detection of any HR-HPV, but its specificity was higher. Repeat conventional cytologic follow-up showed the highest sensitivity and NPV. In conclusion, the presence of HR-HPV in cervical scrapes after LLETZ for high-grade CIN is a risk factor for the presence of residual CIN. HR-HPV genotype-specific persistence is specifically present in patients with residual CIN 3. However, HR-HPV detection cannot predict or exclude the presence of residual CIN in the individual patient and additional procedures remain necessary. © 2002 Wiley-Liss, Inc. [source] High-risk HPV presence in cervical specimens after a large loop excision of the cervical transformation zone: Significance of newly detected hr-HPV genotypesJOURNAL OF MEDICAL VIROLOGY, Issue 3 2007Maaike A.P.C. van Ham Abstract Large loop excision of the cervical transformation zone (LLETZ) is a well-established treatment for high-grade cervical intraepithelial neoplasia. It has even been postulated that LLETZ is responsible for the elimination of the infectious agent, human papillomavirus (HPV), causing the lesion. Most studies on HPV detection after LLETZ have focused on the persistence of high-risk (hr-) HPV to identify women at risk for residual or recurrent disease. Therefore, the appearance and significance of hr-HPV types newly detected after surgical treatment has not been studied extensively so far. The presence of hr-HPV in 85 high-grade squamous cervical LLETZ biopsies and in the first follow-up smear was determined. In 80 (94%) of the LLETZ biopsies hr-HPV was detected in contrast to 30 (35%) hr-HPV positive follow-up scrapes. Twenty of the 80 hr-HPV positive women (25%) had the same hr-HPV genotypes in their follow-up cervical smears as was found in the corresponding biopsies. In the follow-up smear of 13 women a new hr-HPV genotype was detected and HPV 18 was newly detected in 8 of them. The remarkably high presence of newly detected HPV 18 genotypes may argue for a release or re-activation of this virus from proximal layers of the cervical canal incised during surgery. J. Med. Virol. 79:314,319, 2007. © 2007 Wiley-Liss, Inc. [source] Gliosarcoma with chondroid and osseous differentiationNEUROPATHOLOGY, Issue 1 2007Jens Schittenhelm We present the case of a 65-year-old woman with a short-term history of cognitive decline and neuropsychiatric symptoms. Neuroradiological examinations revealed a large left temporo-occipital cystic and calcified tumor mass measuring 6 cm in diameter, which was suspicious for an oligodendroglioma or a choroid plexus carcinoma. Neuropathological investigations finally revealed a gliosarcoma with extensive mesenchymal differentiation. The tumor demonstrated a biphasic pattern consisting of focal anaplastic glial components with vascular proliferation and necrosis. Adjacent sarcomatous tissue displayed pleomorphic fibroblastic cells surrounding metaplastic cartilage and osseous formation. Accounting for only approximately 2% of glioblastomas, gliosarcomas represent a rare entity of intrinsic CNS neoplasms. Exceedingly rare, the mesenchymal part of the gliosarcoma undergoes metaplastic transformation. Interestingly, in our case, the tumor exhibited features of both cartilaginous and osseous differentiation and multifocally showed a sharp transformation zone between highly malignant gliosarcomatous tumor areas and well-differentiated non-proliferative metaplastic regions. [source] A randomised controlled trial to evaluate the effect of self-administered analgesia on women's experience of outpatient treatment at colposcopyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2005M.E. Cruickshank Objective To evaluate the effect of self-administered isoflurane and desflurane on women's experience of outpatient treatment at colposcopy. Design A prospective double-blinded randomised controlled trial. Setting A colposcopy clinic serving a regional population. Population Three hundred and ninety-six women scheduled for treatment of cervical intraepithelial neoplasia (CIN) by large loop excision of the transformation zone (LLETZ). Methods Self-administration of trial gas during a LLETZ procedure. One hundred and ninety-eight women were randomised to use isoflurane and desflurane and 198 to use placebo. Main outcome measures Patient satisfaction, pain and anxiety. Results The mean pain score for cervical surgery was significantly lower for women using isoflurane and desflurane (22.4) than the placebo arm (29.6) (P= 0.003). There was no significant difference between arms in anxiety levels before or after treatment. More women using isoflurane and desflurane (78%) reported ,total helpfulness' of the trial gas than those using placebo (67%) (P= 0.012). A subgroup analysis of trial participants classified as anxious by Hospital Anxiety and Depression Scale (HADS) score at recruitment showed that using isoflurane and desflurane significantly increased total treatment acceptability, helpfulness of the gas and willingness to undergo a similar procedure at six-month follow up. Conclusion Satisfaction with outpatient treatment at colposcopy is generally high. The main effect of isoflurane and desflurane evaluated in this trial was to reduce pain. It appeared to be effective for women with clinically significant anxiety and could be offered as an alternative to general anaesthesia. [source] Improving the quality of cervical screeningBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2004Samuel George Objective To compare the adequacy of cervical cytology sampling by a newly designed cervical cell sampler (the implement) with a commonly used, extended tip cervical scraper, namely the Jordan's spatula, by assessing the quality of cervical smears obtained. Design Prospective randomised controlled trial, with the approval of the local Ethics Committee after informing the Medical Devices Agency in the UK. Setting Colposcopy Clinic in a District General NHS Trust Hospital in London. Population Women attending the Colposcopy Clinic and having a good command of the English language (to avoid any misinterpretation of the information and enabling them to give informed consent) were invited to take part. Two hundred and twenty patients were recruited. Methods The women were randomised into two groups, each of them having two smears at the same time, half of them having their first smear with the Jordan's spatula and the other half having the first smear with the new implement. Main outcome measure Good quality smears, assessed by evidence of effective sampling of the transformation zone, including immature metaplastic cells and also endocervical cells. Results Fifty-four percent of smears taken by the new implement showed good quality smears, compared with 37% taken by Jordan's spatula, a statistically significant result with P value <0.001. Conclusion A larger number of good quality smears, judged by evidence of sampling of transformation zone and presence of endocervical cells, were obtained with the new implement. The difference was statistically significant. This would enhance the ability to detect dyskaryosis and increase adequate smear rates, reducing unnecessary recall of patients for repeat smears. [source] The effect of local anaesthetic spray on the pain associated with local anaesthetic injection, prior to biopsy or loop diathermy to the cervix in the outpatient colposcopy clinicBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2000R. J. Connell Clinical Research Fellow We evaluated the effectiveness of local anaesthetic spray prior to injection of local anaesthetic before biopsy or large loop excision of the transformation zone of the cervix at colposcopy. This was a prospective, randomised, double-blind placebo-controlled study involving 51 women. Pain or discomfort was measured using a four-point categorical scale and a visual analogue score. Our results show that the use of local anaesthetic spray has no effect on the pain or discomfort experienced by patients having local anaesthetic injections to the cervix, and cannot be recommended. [source] | ||||||||||