Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas.

Background: Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches.

Objective: To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis.

Human papillomavirus vaccination history and diagnosis of cervical intraepithelial neoplasia grade ≥2 severe lesions among a cohort of women who underwent colposcopy in Kaiser Permanente Southern California.

Background: The risk of a high-grade lesion in women undergoing colposcopy following an abnormal screening result may be different by human papillomavirus vaccination status, because women who are vaccinated are presumably less likely to harbor human papillomavirus types 16 and 18.

Objective: This study aimed to evaluate whether the risk of high-grade cervical lesion diagnosed through colposcopy is lower in women with human papillomavirus vaccination than in women without vaccination referred to colposcopy based on equal abnormal screening findings.

Study Design: Kaiser Permanente Orange County female patients between ages 21 and 38 years were included following an abnormal screening if they had ≥1 colposcopies between July 2017 and August 2018 and had at least 1 pathology diagnosis from the colposcopy visits.

Adherence to Cervical Cancer Screening Guidelines Among Women Aged 66-68 Years in a Large Community-Based Practice.

Introduction: The 2012 national cervical cancer screening guidelines recommended cessation of screening after age 65 years in women with adequate prior screening. In this retrospective cohort study, adherence to these screening exit guidelines was examined.

Methods: Women who turned age 66 years in 2012-2013 at Kaiser Permanente Southern California were followed through age 68 years for cervical cancer screening uptake.

Patterns and correlates of cervical cancer screening initiation in a large integrated health care system.

Background: The latest 2012 US Preventive Services Task Force cervical cancer screening guidelines recommended screening initiation at age 21 years. Little is known about the cervical cancer screening initiation practices in the community and whether there are critical gaps with respect to adherence to current clinical guidelines. Despite an overall decline in cervical cancer incidence across women of all ages, the incidence rate has not declined among 24-25 year olds between 2000 (2.

Social selection favours offspring prone to the development of androgenetic alopecia.

In recent years, dermatologists have observed an increase in the incidence of male androgenetic alopecia (AGA). In a survey of 41 dermatologists, 88% reported an increase in incidence of AGA in men younger than 30 years. This phenomenon has no apparent explanation.

Potential risk of developing herpes simplex encephalitis in patients treated with sildenafil following primary exposure to genital herpes.

Herpes simplex encephalitis (HSE) is associated with significant mortality and morbidity. As a consequence of HSE, up to 75% of infected individuals die or experience irreversible neurological damage. While the pathogenesis of the disease is unknown, it is traditionally hypothesized that the viral infection occurs by neuronal transmission directly from peripheral sites.

Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.

Objective: To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery.

Methods: We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011.

Prevalence of hair shedding among women.

Hair shedding in female patients is a frequent complaint in dermatological, endocrinological, and gynecological consults. Previously, the Sinclair Hair Shedding Scale was developed to assess normal versus excessive hair shedding in female pattern hair loss (FPHL) subjects. However, the prevalence of hair shedding in females not suffering from FPHL is unknown.

Size matters in planning hysterectomy approach.

Hysterectomy is the second most common gynecologic surgery; approximately 600,000 women undergo hysterectomies each year in the United States. Estimated uterine size, either by bimanual examination, ultrasonography, or both, is one of the major factors in evaluating the need for hysterectomy and in selecting the surgical approach. In this article, we review how physician-estimated uterine size can be confidently used in providing optimal hysterectomy care, as data indicate estimation is closely correlated with actual post-surgical pelvic specimen weight.

Do colposcopically directed biopsy and endocervical curettage serve to induce regression of cervical intraepithelial neoplasia?

Objective: We investigated the clinical and demographic characteristics that could influence regression of cervical intraepithelial neoplasia (CIN) from colposcopy to excision, and evaluated the association of the performance of multiple biopsies and endocervical curettage (ECC) with regression of high-grade (CIN2+) by the time of excisional therapy.

Materials And Methods: This was an institutional review board-approved retrospective analysis of 555 patients who had abnormal screening and who underwent colposcopy followed by cervical excision procedures for CIN2+ or high-risk status. We assessed demographic variables, referral reason, colposcopic findings, and the latency between colposcopic biopsy and excision to which we correlated the likelihood of regression of disease on the excisional specimen.

Secondary prevention of cervical cancer part 1: screening for cervical cancer and its precursors.

Discussion of screening for cervical cancer and it precursors, management of abnormal cervical cancer screening test, and evidence-based management of women with cervical intraepithelial neoplasia.

Secondary prevention of cervical cancer part 3: evidence-based management of women with cervical intraepithelial neoplasia.

The management of cervical intraepithelial neoplasia has evolved over the last 20 years. Observation has replaced aggressive therapy in many cases. Evidence based guidelines now guide therapy.

Current aims and challenges associated with cervical cancer prevention.

This chapter will review the current modalities available to the clinician to screen for premalignant and malignant cervical lesions, which cast a broad net. The majority who test positive are not destined to suffer from or die from cervical cancer. Many who undergo screening and are triaged are young and subsequently face a number of aggressive and destructive therapies.

Contribution of Exocervical Biopsy, Endocervical Curettage, and Colposcopic Grading in Diagnosing High-Grade Cervical Intraepithelial Neoplasia.

Objective: To determine the utility of random biopsy and endocervical curettage (ECC) during colposcopy among women who ultimately underwent cervical excisional biopsy.

Materials And Methods: In a retrospective observational study, the charts were reviewed of every patient who underwent cervical excisional procedure performed between June 2010 and August 2011, including the antecedent colposcopic examination and any pathological specimens. A random sample of 15% all pathologic specimens was reviewed.

Evaluation of the clinical performance of high-risk human papillomavirus testing for primary screening: a retrospective review of the Southern California Permanente Medical Group experience.

Objective: We investigated the potential impact of using the high-risk human papillomavirus (HPV) test as a primary screening tool for the detection of cervical cancer and its precursor lesions.

Materials And Methods: From October 2005 to March 2006, conventional cervical cytological samples and Hybrid Capture II HPV tests were cocollected from all patients. Human papillomavirus tests were processed in all women aged 30 years and older and women younger than 30 years with a cytological finding of atypical squamous cells of undetermined significance.

Cost-effectiveness of adding human papilloma virus testing to a managed care cervical cancer screening program.

Objective: The purpose of this study was to demonstrate a methodology for auditing the impact of HCII testing on the direct cost of cervical cancer cytological screening, where the test is collected in all women screened and processed routinely in women age 30 years and older.

Materials And Methods: After a policy change to screen all patients 30 years or older with both Pap smears and high-risk human papillomavirus (HR-HPV), as well as cocollection of HR-HPV in women younger than 30 years, all cytological, HPV, and histological data pertaining to cervical screening was collected retrospectively during a 2-month period. We documented the direct costs of performing these tests and estimated the necessary compliance rate for balanced cost-effectiveness.

False-negative hybrid capture II results related to altered adhesion molecule distribution in women with atypical squamous cells pap smear results and tissue-based human papillomavirus-positive high-grade cervical intraepithelial neoplasia.

Objective: We investigated the detection of high-risk human papillomavirus DNA with the Hybrid Capture II test (HCII; Digene Corporation, Beltsville, MD) and the presence and pattern of distribution of adhesion molecules in biopsy-proven high-grade neoplastic lesions containing high-risk HPV-DNA from women with ASC cytology results.

Materials And Methods: We screened 4,600 women and performed colposcopy in 278 women with atypical squamous cells cytologic results. All women underwent HCII and tissue-based polymerase chain reaction analysis for high-risk HPV subtypes.

Transepithelial sampling of the uterine ectocervix with a stiff-bristled, spiral-shaped brush.

Objective: To measure the depth of sampling of the uterine ectocervix with the use of a stiff-bristled, spiral-shaped brush (SpiraBrush Cx; Trylon Corporation, Torrance, CA).

Materials And Methods: Eligible hysterectomy specimens were identified. The ectocervix was brushed with an inked SpiraBrush Cx in four quadrants with either light (gentle) or heavy (forceful) pressure.

Evidence supporting the current management guidelines for high-grade squamous intraepithelial lesion cytology.

Objective: The study was undertaken to provide consensus guidelines for the management of women with a cytologic interpretation of high-grade squamous intraepithelial lesion (HSIL) on cytologic examination. This review article presents relevant literature supporting the proposed guidelines.

Participants: An independent panel of 121 experts in various aspects of the diagnosis and management of cervical cancer precursors, including representatives from 29 participating professional organizations, federal agencies, national and international health organizations, and others were invited by the American Society for Colposcopy and Cervical Pathology.

Triage of atypical squamous cells of undetermined significance with hybrid capture II: colposcopy and histologic human papillomavirus correlation.

Objective: To estimate the effectiveness of Hybrid Capture II to predict high-grade cervical intraepithelial neoplasia (CIN) from a cytological cervical sample. Evidence of high-risk human papillomavirus (HPV) was also determined from biopsy samples using the polymerase chain reaction (PCR) for women referred with atypical squamous cells of undetermined significance (ASCUS) Papanicolaou smears.

Methods: We screened 8170 women with Papanicolaou smears, of whom 278 (3.