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Query: UMLS:C0009443 (cold)
 92,137 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In recent years a variety of conservative treatment modalities are being used to remove Cervical Intraepithelial Neoplasia (CIN). A series of 568 cases of patients affected by CIN, detected in our Department over a period of 10 years and treated following a balanced use of colposcopy guided cryosurgery and cold knife conization, has been reviewed. One-hundred-fifty-three patients, 111 with CIN 1 and 42 with CIN 2, were treated by the use of a nitrous oxide cryoprobe. The remaining 415 patients underwent cold knife conization, under general anesthesia and hospitalization. Routine follow-up for all cases included cytology, colposcopy and aimed biopsy when required. Cryotherapy had a success-rate of 90.1% (CIN 1-CIN 2 only) and "complete" conization 94.6% (included CIN 3 cases). Complications of conization, such as late haemorrhage and cervical stenosis, were more frequent with the "open technique" than the "suture technique". Nine pregnancies after cryotherapy and 34 after conization have been reported, no significant differences were noted in the pregnancy outcome following either treatment.
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PMID:Rational use of cryosurgery and cold knife conization for treatment of cervical intraepithelial neoplasia. 147 32

A chart review of 112 patients who underwent cold knife conisation was performed. Records showed that 73.5% of the patients smoked cigarettes and 26.5% were using oral contraception. In 85.7% of cases pre-operative cytology/colposcopy findings were within one grade of the cone histology. The majority of lesions were CIN III (59.9%). Only 4.5% were normal. Human papilloma virus infection was detected histologically in 26.8% of patients. Pre-operative punch biopsy was undertaken in only five cases. Post-operative haemorrhage (9.0%) and genito-urinary infection (9.0%) were the main complications seen. The incidence of residual disease and post-cone hysterectomy was significantly higher if the margins of resection of the cone were unclear. Large-loop excision of the transformation zone (LLETZ) has now replaced cold knife conisation in both study centres due to its lower morbidity and reduced demand on hospital resources.
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PMID:Cone biopsy: a review of 112 cases. 129 72

A total of 1628 women with CIN 3 treated with the Semm cold coagulator between 1975 and 1989 was followed primarily by cytology. The standard suitability criteria for ablation were adhered to except that patients were treated at their first visit when the colposcopist expected that the diagnosis would be no worse than CIN 3. Overall 97% of the women were treated at their first visit. In 30 women (2%) the histology was glandular or worse than expected, but 22 of these showed no persistent cervical disease subsequently. Follow-up was achieved for 87% at 10 years. In actuarial terms the primary success rate was 95% at 1 year and 92% at 5 years, it was similar for all age groups. Repeat cold-coagulation for persistent/recurrent CIN 3 was less successful and is not advised. The outcome for 226 pregnancies established after treatment is known. The rates for miscarriage, preterm or operative delivery were not increased. Cold-coagulation of CIN 3 at 100 degrees C as performed by us is as effective as any other treatment and calls into question the need for more expensive practices.
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PMID:Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. 199 29

The authors present a retrospective study of 42 cases of conization carried out between January 1987 and October 1989 in the Department of Gynaecology 1 of Dupuytren University Hospital in Limoges. The average age of the population was 42 years and 7 months, with an average parity of 1.9 children per woman. Conization was carried out using either a cold knife (37 cases) or an electric knife (5 cases). Complications consisted of 4 stenoses, 2 secondary haemorrhages and 1 perineal burn. 4 microinvasive cancers, 7 CIN III, 10 CIN II, 4 CIN I and 3 pieces of tissue free from any dysplastic lesion were found on histological examination of the conization tissue. 17 patients (40.4%) had flat condylomas. There was perfect agreement between the diagnoses from the smears and biopsies in 82.1 p. cent of cases; there was 57.1 p. cent agreement when the smear result was compared with the histological study of the conization tissue, and 39.2 p. cent agreement when the latter was compared with biopsy results. On the other hand, false diagnosis due to overevaluation of the severity of the dysplasia was predominant using the least invasive examination (42.8 p. cent when comparing the smear results with those from the study of conization tissue, and 39.2% for biopsies with respect to the conizations). According to the authors, the therapeutic strategy to be used in treating dysplasia must take the severity of the dysplasia, the presence of infection due to HPV and its serotyping, the location and size of the dysplasia, the visibility of the endo-exocol junction line and the psychological context of the patient into consideration.
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PMID:[Diagnosis and treatment of cervical dysplasia. Report of 42 cases]. 228 Dec 55

During nearly 40 years of using colposcopy, an original management strategy in CIN and early cervical cancer was developed and confirmed in 2 study groups of cervical lesions containing respectively 1228 and 6001 cases. This approach is based on colposcopy as the main method in early detection of CIN and cancer, with supplementary cytology in necessary cases, and on a coloposcopic-histological staging of these lesions for treatment qualification. Colposcopy alone is a fairly adequate method for diagnosis of 60% of examined cases, and coloscopy with directed biopsy in the next 20% of colposcopically highly suspect findings. Only in the remaining 20% of colposcopically less suspect findings and in the cases of "unsatisfactory colposcopy", supplementary was cytology required. In this study colposcopy findings connected with histological evaluation of the specimens provided a basic way for determining the advancement of processes and the selection method for the appropriate type and extent of treatment. CIN 1 and 2 and small focuses of CIN 3 including CIS entirely visible on the ectocervix, in childless young women were treated by cryosurgery. In all remaining cases of CIN 3, the basic therapeutic method was cold-knife conization. In exceptional cases simple hysterectomy can be a more adequate treatment. Depending on our colposcopic-histological staging, in Stage IA1--conization, whereas in Stage IA2--a moderately extended hysterectomy should be optionally performed. The management strategy introduced is an economical, fully effective and quick way of detection and selection of the method for the treatment of CIN and early cervical cancer.
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PMID:Colposcopy as a method of management strategy in CIN and microinvasive cancer. 237 10

The vaginal smear reveals a spectrum of borderline lesions of the uterine cervix. This spectrum is the source of new clinical problems involving both the recognition and treatment of these various entities. A review of the literature of the past decade indicates that vaginal smears should be obtained regularly every year or two in all women beginning at the onset of sexual activity, but the initial smear may be falsely negative in 10 to 30 percent of cases. When patients have abnormal smears, the precise diagnosis can be established more accurately by cold-knife conization than by multiple punch biopsy. While hysterectomy has been considered "definitive treatment," late recurrence in the vagina occurs in 1.24 percent of patients so treated. A compilation of 1,100 patients with carcinoma in situ of the cervix treated by conization and follow-up smear reveals that in over 90 percent the disease was controlled by the cone alone, and the remainder by repeat cone or hysterectomy. Precise definition is required in treatment decisions concerning micro-invasive lesions, but these may be well treated by non-radical measures. In almost 500 patients so treated, no death occurred from therapy or tumor metastasis.When carcinoma in situ is found during pregnancy, a coexisting invasive carcinoma must be excluded by appropriate conization or punch biopsy and definitive therapy completed after vaginal delivery.
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PMID:Carcinoma in situ of the uterine cervix. A review of some present clinical problems. 488 82

In 1907 innovations in optics and illumination made by Maximilian Nitze were applied to hysteroscopy by Charles David, who wrote a treatise of hysteroscopy. David improved illumination by placing an electric incandescent bulb at the intrauterine end of his endoscope and also sealed the distal end of the tube with a piece of glass. The history of the contact endoscope that the authors personally used is connected to the invention by Vulmiere (1952) of a revolutionary illumination process in endoscopy--the "cold light" process. The components of cold light consist of a powerful external light source that is transmitted via a special optical guide into the endometrial cavity. The 1st application of his principle (1963) was an optical trochar contained in a metallic sheath. This simple endoscope was perfected, and in 1973 Barbot and Parent, in France, began to use it to examine the uterine cavity. Discussion focuses on methods, instrumentation, method for examination (grasping the instrument, setup, light source, anesthesia, dilatation, technique, and normal endometrium); cervical neoplasia; nonneoplastic lesions of the endometrium (endometrial polyp, submucous myoma, endometrial hyperplasia); intrauterine device localization; neoplastic lesions of the endometrium; precursors (adenocarcinoma); hysteroscopy in pregnancy (embryoscopy, hydatidiform mole, postpartum hemorrhage, incomplete abortion, spontaneous abortion, induced abortions, and amnioscopy); and examinations of children and infants. The contact endoscope must make light contact with the structure to be viewed. The principles of contact endoscopy depend on an interpretation of color, contour, vascular pattern, and a sense of touch. These are computed together and a diagnosis is made on the basis of previously learned clinical pathologic correlations. The contact endoscope is composed of 3 parts: an optical guide; a cylindric chamber that collects and traps ambient light; and a magnifying eyepiece. The phase of the menstrual cycle may be identified on the basis of the endometrial pattern. This pattern diagnosis is dependent on color, contour, and physical adhesiveness of the tissue. Cervical intraepithelial neoplasia (CIN) is the most common neoplastic lesion of the cervix. When atypical epithelium extends into the cervical canal beyond the view of the colposcope, the 6 mm contact hysteroscope has been helpful in determining the extent and severity of the lesion as well as to direct biopsy equipment to the site of the pathologic condition.
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PMID:Contact hysteroscopy. 660 24

One hundred and sixty-eight cases of cervical conization were performed for cervical intraepithelial neoplasia (CIN) in a 32-month study. The indications for conization were unsatisfactory colposcopic finding, abnormal epithelium that extended into the endocervical canal, a microinvasive cervical cancer, and significant discrepancy among cytology, colposcopy, and/or punch biopsy histology. In the early period of the study, conization was done by the cold-knife method (N = 107), whereas loop diathermy was used in the latter part of the study (N = 61). Both groups were similar in terms of age, indications for conization, and size of cervical cone specimens. Loop diathermy conization was done in a significantly shorter time (5.7 +/- 1.8 minute vs 15.2 +/- 6.1 minute)(P < 0.05) than cold-knife conization. However, the difference in the postoperative complications between loop diathermy(3.0%) and cold-knife conization(4.7%) was not significant. The incidence rate of residual CIN III lesions in the subsequent hysterectomy specimens, found by histological documentation on these specimens was 25.0 and 26.1 percent after loop diathermy and cold-knife conization respectively. These results suggest that loop diathermy is much easier to perform and a more time-conserving treatment modality than cold-knife conization in the management of patients with cervical intraepithelial neoplasia.
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PMID:Loop diathermy and cold-knife conization in patients with cervical intraepithelial neoplasia: a comparative study. 859 9

The results of the cervical Pap. smear taken before cold knife conization and the histopathological results of the cones removed in 336 women, were compared. In cytological examination we found 10.8% (13/120) false negative results, which did not confirm of the existence the precancerous lesion within cervical epithelium. The mild dysplasia according to Pap. smears was established among 15.9% (15/94) of women with CIN III and CIN II diagnosed pathologically. In part of the women the histopathological results of the postoperative specimens and bioptic cervical material were compared. Clinical value and correlation between histopathological and cytological results in the estimation of CIN (cervical intraepithelial neoplasia) were discussed with particular regard to CIN I according to Bethesda system.
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PMID:[Histopathological verification of the cervical pap smears based on material of the obstetrical-gynecological department of the provincial hospital in Kielce]. 1049 26

Conization, as a surgical treatment for cervical intraepithelial neoplasm (CIN), is a good method that preserves reproductive functions. Technological developments have introduced a wide variety of energy sources for surgical procedures. Traditional cold knife conization has been replaced by laser conization and by the loop electrosurgical excisional procedure (LEEP). However, laser conization and LEEP have some disadvantages. Laser conization requires expensive equipment. LEEP induces electrocautery artifacts and cannot excise the cervical tissue as a single-piece, because of the various extensions and depths of lesion, so that evaluation of the margins is sometimes not possible. Laser conization and LEEP both generate smoke. The presence of smoke is not only inconvenient, but also dangerous. Harmonic Scalpel (HS), ultrasonic cutting and coagulation system, is a new surgical tool that cuts and coagulates using ultrasonic mechanical vibrations. Eleven women with CIN III underwent conization using HS. HS eliminated the major disadvantages of electrosurgery and laser surgery. No complications during conization were observed. Postoperative hemorrhage was noted in only one patient. Histological diagnosis was not affected by heat or ultrasound. This surgical method using HS is characterized by negligible bleeding, a good visual field not obscured by smoke and resection of an ideal shape that fits the size of the lesion. It is concluded that this method overcomes most problems associated with conization using conventional methods.
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PMID:Conization of the cervix using harmonic scalpel. 1067 19


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