OBJECTIVETo evaluate the clinical value of domestically manufactured digital colposcope system (SLC-2000) in the detection of early cervical lesions.

METHODSDuring a follow-up study of patients in Xiangyuan county, Shanxi, a high risk area for cervical cancer, a digital colposcope and an optical colposcope were randomly used for diagnosis, with pathology as the gold standard.

RESULTSIn 163 cervical biopsy specimens, 103 were diagnosed as chronic inflammation by histologic examination. Among 60 specimens which gave abnormal pathology, there were papilloma 1, cervical intra-epithelial neoplasia (CIN) I 37, CIN II 18 and CIN III 4. In 33 endocervical curettage specimens, 3 were pathologically positive. Comparing the digital and optical colposcope in diagnosing the positive lesions of > or = CIN I, the sensitivity of the former and latter were 83.3% and 95.0%, the difference without being statistically significant (P = 0.075). The specificity, positive predictive value, and accuracy of these two instruments were 61.2%, 21.4%, 55.6% and 41.3%, 69.3% 48.5%, with significant difference (P = 0.000, P = 0.035, and P = 0.000). In diagnosing > or = CIN II cervical lesions, these three results of the two instruments did not show any significant difference either. The negative predictive value of the digital and optical colposcope were 86.3% and 88.0%, also showing no significant difference (P = 0.075).

CONCLUSIONThe specificity, positive predictive value, and accuracy of the digital colposcope in diagnosing cervical lesions > or = CIN I are all superior to those of the traditional optical colposcope, even though the sensitivity of the latter is higher. There is no difference between the two instruments in diagnosing lesions > or = CIN II. Not only is domestic digital colposcope (SLC-2000) effective, but feasible and practical in the diagnosis, research and follow-up of cervical lesions.

Colposcopes ; Female ; Humans ; Predictive Value of Tests ; Sensitivity and Specificity ; Uterine Cervical Diseases ; diagnosis ; Uterine Cervical Neoplasms ; diagnosis ; Uterine Cervicitis ; diagnosis

By spectrometry, in 78 patients with uterine servical cancer and a control group of 45 healthy person, the activity of erythrocyte antioxidant enzymes and plasma total antioxidant was determined. Results showed a significant decrease of SOD enzyme and blood red cell GPX in cervical cancer patients versus that of the controls. There is a light decrease of total antioxidant state of plasma in patients with cervical cancer versus the controls, and of Hb level in patients with cervical cancer versus the controls. The results suggests a relation between the activity of antioxidant enzyme in cervical cancer patients and DNA damage due to oxygene stress
Uterine Cervical Neoplasms ; Uterine Cervical Diseases ; Patients

Hysteroscopy is utilized for making the diagnosis and treating a series of uterine disease. It's advantages are more accurate removal of lesion, a short operating time, low morbidity and rapid postoperative recovery. However, serious complications can happen following hysteroscopic surgery. The complications can be divided into the procedure-related, media-related and postoperative events. The procedure-related complications include cervical laceration, uterine perforation, bowel and bladder injury, and hemorrhage. The media-related complications include hyponatremia, gas embolism and excessive fluid absorption. The postoperative events include endometritis and postoperative synechiae. We experienced hyponatermia with pulmonary edema due to excessive fuid absorption in a 52-year-old woman who underwent elective hysteroscopic myomectomy under general anesthesia. She was treated with oxygen therapy, normal saline and furosemide and she recovered without sequelae.
Absorption ; Anesthesia, General ; Embolism, Air ; Endometritis ; Female ; Furosemide ; Hemorrhage ; Humans ; Hyponatremia ; Hysteroscopy ; Lacerations ; Middle Aged ; Oxygen ; Pulmonary Edema ; Urinary Bladder ; Uterine Diseases ; Uterine Perforation

OBJECTIVES: Dysfunctional uterine bleeding(DUB) is defined as abnormal bleeding from the uterine endometrium unrelated to anatomic lesions of the uterus, and its incidence is 10-15% among gynecologic diseases. We conducted this study for understanding correlation between clinical aspecets and pathological findings of DUB. Methods: We conducted a retrospective review of 599 women with DUB who underwent endometrial biopsy with special regard to the relation between pathologic findings and presenting symtoms or complaints from Jan. 1988 to Dec. 1997. RESULTS: Age distribution of DUB was mainly 5th decade, mean age was 44.1years, among various bleeding patterns, intermenstrual bleeding was the most common pattern(31.6%) and the next was menorrhagia(25.0%). Histologic findings of endometrium were proliferative phase, 327 cases(54.6%), hyperplasia, 139 cases(23.2%), secretory phase, 74 cases(12.4%) in order of frequency, and there was no difference in distribution of histologic findings among various bleeding patterns. CONCLUSION: Compared to other previoius studies, our study showed more incidence of endometrial hyperplasia, especially at age group of 40 or more. So patients aged more than this age with abnormal uterine bleeding must undergo emdometrial biopsy for pathologic diagnosis. Patients who are diagnosed endometrial hyperplasia must be carefully followed up because there are possibilities of progression to endometrial carcinoma.
Age Distribution ; Biopsy ; Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Genital Diseases, Female ; Hemorrhage ; Humans ; Hyperplasia ; Incidence ; Metrorrhagia* ; Retrospective Studies ; Uterine Hemorrhage ; Uterus

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.
Adult ; Constriction, Pathologic ; complications ; diagnosis ; Endometrium ; pathology ; Female ; Hematometra ; complications ; diagnostic imaging ; surgery ; Humans ; Infertility ; Pelvic Pain ; Recurrence ; Risk ; Rupture, Spontaneous ; complications ; Tomography, X-Ray Computed ; Uterine Cervical Diseases ; complications ; diagnosis ; Uterine Diseases ; complications ; diagnosis ; Uterine Hemorrhage ; complications ; diagnosis ; Uterine Rupture ; diagnostic imaging ; etiology ; surgery

OBJECTIVES: To investigate correlation between risk factors of endometrial carcinoma and histopatholgic findings of endometrium. METHODS: We reviewed medical records of 148 postmenopausal women with abnormal uterine bleeding, who underwent endometrial biopsy from January 2009 to April 2010. Women who had hematologic disease, or had non-uterine pelvic diseases were excluded. Hormone therapy was performed in indicated subjects. Age, body mass index (BMI), associated diseases, endometrial thickness checked by transvaginal sonography, whether hormone therapy was used were reviewed according to endometrial histopathology. RESULTS: Mean age of the subjects was 58.9 +/- 8.4years old. Among the endometrial histopathologic findings, atrophic endometrium was the most common finding (32.7%), followed by hyperplastic endometrium (17.8%), endometrial carcinoma (10.4%), and endometrial polyp (9.2%). BMI was not correlation of the prevalence of endometrial carcinoma and endometrial hyperplasia. Mean endometrial thickness was 9.8 +/- 5.56 mm, while it was 14.0 +/- 5.89 mm in endometrial hyperplasia, and 16.0 +/- 6.56 mm in endometrial carcinoma. The prevalence of endometrial cancer was high in those whose endometrial thickness was more than 10 mm (P < 0.001). The prevalence of endometrial hyperplasia in those whose postmenopausal bleeding was related to hormone therapy was higher than of women in whom hormone therapy was not performed. However, there were no statistical significance. CONCLUSIONS: Postmenopausal bleeding must be considered as indicative of malignant disease until proven otherwise. Endometrial biopsy should be performed to exclude endometrial carcinoma in postmenopausal women whose endometrial thickness measured by transvaginal sonography is thick.
Biopsy ; Body Mass Index ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Hematologic Diseases ; Hemorrhage ; Humans ; Medical Records ; Polyps ; Prevalence ; Risk Factors ; Uterine Diseases ; Uterine Hemorrhage

OBJECTIVE: Tamoxifen is a nonsteroidal hormone that functions as a selective estrogen-receptor (ER) modulator in breast tissue. It is the first-choice drug for the postoperative treatment of ER-positive breast cancer patients. However, tamoxifen, if administered for a prolonged duration, has estrogen-like effects on the uterus, leading to an increased risk for the development of endometrial diseases such as endometrial hyperplasia, endometrial polyp, and endometrial cancer. This study was designed to investigate the effects of tamoxifen treatment on endometrium in breast cancer patients. METHODS: Fifty-five tamoxifen-treated breast cancer patients visited an outpatient gynecology clinic. We analyzed the endometrial pathology with consideration to the duration of tamoxifen treatment the patient symptoms and the endometrial thickness, as measured by transvaginal ultrasonography. Endometrial polypectomy was performed to obtained polyps from women presenting with abnormal bleeding (17 polyps from postmenopausal women who had not been treated with tamoxifen and 14 from women who had been treated with this drug). To investigate the effects of tamoxifen treatment on the endometrial polyps, we performed immunohistochemical staining for ER, the progesterone receptor (PR), and Ki67 on the polyps obtained from both groups of women. RESULTS: In 29 (52.7%) of 55 tamoxifen-treated breast cancer patients, the endometrium was more than 10 mm thick, and in 19 (65.5%) of these patients, the abnormalities noted comprised 11 endometrial polyps, 5 endometrial carcinomas, 2 submucosal myomas, and 1 endometrial hyperplasia. The incidence of endometrial proliferation was significantly higher in patients who had been treated with tamoxifen for less than 1 year (P=0.037) than in those who had been treated for more than 1 year. Although the endometrial carcinomas, submucosal myomas, and endometrial hyperplasia were found in the patients who had been treated for more than 1 year, this result was not statistically significantwhen compared with the other group. As compared to the endometrial polyps obtained from women who had not received tamoxifen treatment, those obtained from patients who had received the treatment exhibited significantly lower levels of ER expression (P=0.000) in the glands and increased levels of PR (P=0.031) and Ki-67 expression (P=0.000) in the stroma. CONCLUSIONS: During tamoxifen treatment for breast cancer, the endometrial pathology should be investigated if transvaginal ultrasonography reveals the tissue to be more than 10 mm thick. Although tamoxifen has significant effects on the expression of hormone receptors, the mechanism underlying the development of endometrial polyps does not appear to be mediated by the ER.
Breast ; Breast Neoplasms ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Myoma ; Outpatients ; Polyps ; Receptors, Progesterone ; Tamoxifen ; Uterine Diseases ; Uterine Hemorrhage ; Uterus

OBJECTIVE: This is a prospective case control study which aimed to determine the correlation of ovarian volume measurements with endometrial tissue diagnosis such as benign, premalignant and malignant conditions in women with postmenopausal bleeding.

METHODS: Thirty four postmenopausal women with bleeding underwent transvaginal ultrasound for ovarian volume measurements prior to dilatation and curettage. The presence of benign (Group I), premalignant and malignant endometrial. conditions (Group II) were correlated with ovarian volume.

RESULTS: Mean endometrial stripe thickness for group I (N= 19; 1.16ml+/- SD 0.88ml) was not significantly different from group II (N = 15; 1.58ml +/- SD 0.53ml). Mean ovarian volume among patients with premalignant and malignant histology (5.70ml +/- SD 1.91ml) was significantly higher than those with benign histology (2.04ml +/- SD?1.10ml) (P = 0.023). Linear regression analysis showed an association between ovarian volume and premalignant and malignant endometrial conditions (P=0.000). Using the mean ovarian volume cut-off of 5.8ml for postmenopausal women with bleeding, the sensitivity, specificity, positive predictive value and negative predictive value for premalignant and malignant endometrial conditions were 100%, 67.87%,40% and 100%,respectively.

CONCLUSION: Large ovaries among postmenopausal women may represent a marker of risk for endometrial cancer and may be used as an adjunct to endometrial thickness in ruling endometrial malignancy.

Human ; Female ; Aged ; Middle Aged ; Adult ; Postmenopause ; Ovary ; Dilatation And Curettage ; Uterine Hemorrhage ; Endometrial Neoplasms ; Uterine Diseases

BACKGROUND: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis. METHODS: We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014. RESULTS: The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise. CONCLUSION: In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.
Abdominal Pain ; Abscess ; Aged* ; Cervical Intraepithelial Neoplasia ; Comorbidity ; Diabetes Mellitus ; Diagnosis ; Drainage ; Endometrial Neoplasms ; Female ; Fever ; Genital Diseases, Female ; Gynecologic Surgical Procedures ; Humans ; Hypertension ; Labor Stage, First ; Mortality ; Myoma ; Ovarian Neoplasms ; Peritonitis ; Polyps ; Postmenopause ; Pregnancy ; Pyometra* ; Retrospective Studies ; Sepsis ; Uterine Hemorrhage ; Uterine Prolapse ; Vaginal Discharge

OBJECTIVE: Abnormal uterine bleeding is one of the most common disorder in gynecologic department. Organic causes of abnormal uterine bleeding are chronic cervicitis, submucosal myoma, endometrial polyp, endometrial malignancy. To find the exact cause of uterine bleeding and rule out the organic uterine disorder in the patients who considered dysfunctional uterine bleeding, hysteroscopic examination and endometrial biopsy were used. METHODS: Study group were 106 patients, who received hysteroscopic endometrial biopsy from 2. 2000 to 8. 2001.with abnormal uterine bleeding, negative in urine pregnancy test, normal in cervix cytology, and without organic lesion causing uterine bleeding in pelvic exam and ultrasonography. Age, parity, hysteroscopic biopsy result were analyzed retrospectively. RESULTS: Mean age of the study group was 43 and mean parity was 2.6. When final hysteroscopic biopsy histology were analysed, proliferative phase was most common (28.3%). Next were secretory phase (17.9%), simple hyperplasia (13.2%), endometrial polyp (10.6%), chronic endocervicitis (4.7%). Submucosal myoma, endometrial cancer, complex hyperplasia were detected in 3.8% each one. Of 106 patients, who considered dysfunctional uterine bleeding, only 63 (59.4%) patients were proved true DUB on hysteroscopic biopsy. Remainder had organic disorder (40.6%). CONCLUSION: When patients visited the hospital with abnormal uterine bleeding, doctors should be suspicious of endometrial organic disease and treat the patients with exact diagnosis. In these patients, hysteroscopic examination and biopsy were very useful and safe method to determine exact diagnosis and treatment plan.
Biopsy ; Cervix Uteri ; Diagnosis ; Endometrial Neoplasms ; Female ; Gynecological Examination ; Humans ; Hyperplasia ; Hysteroscopy ; Metrorrhagia ; Myoma ; Parity ; Polyps ; Pregnancy ; Pregnancy Tests ; Retrospective Studies ; Ultrasonography ; Uterine Cervicitis ; Uterine Hemorrhage