Current therapies for actinic keratosis.

Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.

Evaluation of endocervical curettage with conization in diagnosis of endocervical lesions.

AIM: Endocervical curettage (ECC) at the time of conization has been reported to be effective for diagnosing cervical intraepithelial neoplasia and/or early stage cervical cancer. We aimed to verify the accuracy of ECC with conization. METHODS: We retrospectively analyzed the records of 540 patients with suspected neoplastic cervical lesions who underwent conization at the Yokohama City University Hospital from January 2008 to December 2015. To validate the effectiveness of ECC for evaluating endocervical lesions, histopathologic findings from ECC samples were compared with those from endocervical specimens obtained by conization. In patients who subsequently underwent hysterectomy, specimens of residual endocervical stump lesions were compared with the specimens obtained by ECC. RESULTS: ECC was performed in 58.9% of patients who underwent conization. Positive findings were only observed in 7.9%, while negative findings were found in 67.3% of ECC samples; however, 24.8% of the samples were inadequate for diagnosis. None of the patients had an upgraded diagnosis according to ECC results. The sensitivity of ECC in predicting endocervical stump lesions that were identified by conization specimens was 25.0%, the specificity was 94.2% and the positive predictive value was 55.0% (κ = 0.238; P < 0.001). ECC samples yielded a sensitivity of 42.9%, a specificity of 83.9%, and positive predictive value of 54.5% (κ = 0.284; P = 0.053) in predicting residual endocervical lesions in the uterus. CONCLUSIONS: As it offers low sensitivity and positive predictive value, ECC at the time of conization is of limited benefit for evaluating endocervical lesions.

Unicameral (simple) and aneurysmal bone cysts: the effect of insufficient curettage on recurrence.

INTRODUCTION: Curettage of the cyst and bone grafting are the most common methods used in the treatment of unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC). Recurrence of these cysts is often associated with insufficient curettage of the cyst during surgery. In this study, we aimed to evaluate the effect of insufficient curettage on recurrence in patients with UBC and ABC. METHODS: The retrospective study included 18 patients with UBC and 14 patients with ABC that were surgically treated by curettage and bone grafting in our clinic between 2006-2013. Mean age was 19.80 (range, 4-50) years in the patients with UBC and 21.76 (range, 4-56) in the patients with ABC. The diagnosis of the cysts was established both clinically and radiologically. Mean follow-up period was 36 (range, 6-60) months both in the patients with UBC and ABC. The patients with recurrence underwent a second curettage and grafting procedure. Healing and recurrence were evaluated according to modified Neer's scale. RESULTS: Recurrence occurred in 8 patients. Of these, 5 patients underwent a second curettage and grafting procedure and 3 patients were lost to follow-up. Complete healing occurred in all the patients that underwent a second curettage and grafting procedure. CONCLUSION: The achievement of complete healing in the patients that underwent a second curettage and grafting procedure indicates that the recurrence of UBC and ABC is associated with insufficient curettage.

[Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion]. / Tratamento do abortamento incompleto por aspiração manual ou curetagem.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Tratamento do abortamento incompleto por aspiração manual ou curetagem / Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion

OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU) com curetagem uterina (D&C) em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento), tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71), espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65). Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p < 0,001) (14,18; 23,06 h, p 0,03). O decréscimo nos níveis de hemoglobina após o procedimento cirúrgico foi maior no grupo D&C (p= 0,02). CONCLUSÃO: A AMIU possibilita menor perda sangüínea, requer menor tempo de realização do procedimento e menor tempo de internação hospitalar. Entretanto, ambos os procedimentos cirúrgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestação, não havendo complicações após a realização dos tratamentos.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 ± 2.40 vs 9.73 ± 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 ± 4.80 vs 22.68 ± 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

The pre-operative identification of low-risk endometrialcancer: an audit of women treated in the South Island of New Zealand 1998-2000.

OBJECTIVE: To determine whether pre-operative investigations identify a group of patients with low-risk endometrial cancer, who do not require tertiary referral for surgical staging or pelvic radiotherapy. DESIGN: Retrospective chart review. SETTING: South Island of New Zealand gynaecological oncology services. SAMPLE: One hundred and forty consecutive patients with newly diagnosed endometrial cancer from 1988 to 2000. METHODS: The results of preoperative investigations were compared with the final pathology. MAIN OUTCOME MEASURES: Correlation of preoperative investigations with low risk disease. For the purpose of the study, women with grade 1 or 2 endometrioid tumours confined to the uterine body and less than 50% myometrial invasion were considered to have low risk disease. RESULTS: In total, 50 women had low risk disease. Only 53% of patients with grade 1 tumours on initial biopsy had low risk disease. Women who had a grade 1 tumour at biopsy and, an ultrasound report with an endometrial thickness of less than 20 mm, and no evidence of myometrial invasion, cervical involvement or adnexal metastasis had a 76% chance of having low risk disease. CONCLUSION: We were unable to accurately define the low risk group from pre-operative assessment.

[Long term progress of low-grade intraepithelial lesions after a smear and colposcopy, directed biopsies and/or normal endocervical curettage]. / Evolution à long terme des patientes avec une lésion intra-épithéliale de bas grade au frottis et une colposcopie, des biopsies dirigées et/ou un curetage endocervical normaux.

Low-grade squamous intraepithelial lesions and atypical squamous cells of undetermined significance are the most frequent cytologic abnormalities. Their management is still highly controversial because of the many uncertainties associated with them concerning their histology and their natural history. Cervical smears HPV testing were proposed as an alternative to colposcopy. Neither have a sensitivity equivalent to that of colposcopy. The diagnosis of these abnormalities could be delayed, and a severe lesion may even remain undetected because the cytologic surveillance is frequently omitted, smear sensitivity is far from being perfect and correlation is poor between cytology and histology. The combination of smears with the detection of high risk HPV types increases the triage sensitivity before colposcopy to the detriment of specificity and predictive value, and, therefore, of cost. With colposcopy the histologic diagnosis is rapidly reached and therapeutic management becomes easier because the size and location of the lesion are precisely known. However, the long-term outcome of patients with a normal colposcopy is very poorly known. Our study including 212 patients with a mean follow-up of 79 months, showed an incidence of lesions similar to that found in a control group; 12 CIN (5.7%) were identified, but no cancer. The prevalence of CIN was significantly lower in patients whose initial colposcopy was normal or became normal within the first six months that in patients whose control smear was normal or became normal within six months (1/81 = 1.2% versus 8/143 = 5.6%; P > 0.05). No lesions were observed in patients whose colposcopy and control smear were normal. These results confirm the reliability of colposcopy in patients with minor cytologic abnormalities.

Routine endometrial curettage is not indicated at the time of cervical cone biopsy.

Endometrial currettage is commonly performed after cervical cone biopsy to detect occult endometrial abnormalities. Recently, this practice has been questioned and specific criteria promulgated to reduce the number of concomitant endometrial curettages performed at the time of cone biopsy. To investigate the reliability of these criteria, we reviewed the records of 370 women who underwent cold-knife cervical cone biopsy, 323 (87.3 percent) of whom underwent concomitant endometrial curettage. Significant endometrial abnormalities were present in only 18 women, each of whom met at least one specific criterion for endometrial currettage. In contrast, 23 endometrial currettings either contained cervical tissue (five patients) or were insufficient for diagnosis (18 patients). The incidence of complications directly attributable to endometrial curettage was 1.6 percent. We conclude that limiting endometrial curettage at the time of cone biopsy to those women meeting specific criteria would significantly reduce the number of endometrial currettings performed, without hindering the ability to detect significant endometrial abnormalities. Such a reduction would minimize surgical morbidity and could save $13 million annually in the United States.

Critical review of infantile fibrous dysplasia: surgical treatment.

A critical review of the surgical treatment of 65 patients with infantile fibrous dysplasia demonstrated that "circumscribed" types of the disease generally do not require surgical treatment, while "extended" types, as well as Albright's syndrome, require early surgical treatment aimed at preventing development of skeletal deformities which are difficult to correct later. Prophylactic intramedullary nailing with nails of suitable caliber is most effective.

Suction curettage with a tissue trap compared with sharp curettage for tissue sampling.

Recent reports have shown that various endometrial sampling techniques are comparable to each other. This study showed that suction curettage utilizing tissue traps is superior to sharp curettage in terms of adequacy of sampling. The results show that adequate tissue was obtained in all 114 cases, regardless of which type of curettage was utilized first. However, when sharp curettage was the second procedure, only 43 of 57 procedures yielded adequate tissue, whereas when suction curettage was the second procedure, 56 of 57 procedures yielded adequate tissue. Suction curettage utilizing tissue traps was more thorough than sharp curettage.

[Endocervical curettage. Its use in the colposcopic assessment of a patient who has an abnormal cervico-vaginal smear]. / Le curetage endocervical. Son utilité dans le bilan colposcopique d'une patiente ayant un frottis cervico-vaginal anormal.

Endocervical curettage (ECC) is a simple way of exploring the endocervical canal and is useful for the management of a patient with an abnormal smear. If colposcopy is satisfactory, ECC is usually negative confirming that the canal is free of disease and out-patient treatment can be used. A positive ECC warrants conization. If colposcopy is not satisfactory, ECC is usually positive, confirming extension of the disease in the canal, and sometimes the presence of an invasive lesion requiring a radical treatment right away. An endocervical adenocarcinoma alone or associated with an epidermoid lesion may also be identified. Post cone ECC confirms the absence of residual disease. Follow-up of patients after treatment and/or the menopause with an ECC is helped, especially when the squamocolumnar junction is not seen.

Lack of efficacy of prehysterectomy curettage as a diagnostic procedure.

From January 1, 1972, until December 31, 1980, 181 patients who underwent hysterectomy for benign disease at the Newton-Wellesley Hospital had uterine curettage performed immediately prior to the procedure. Of five endometrial carcinomas subsequently demonstrated in the hysterectomy specimens, only one had been discovered via the curettage. Even in this one case, the planned hysterectomy was not postponed or altered. Prehysterectomy curettage in patients without symptoms of uterine disease is a low-yield, inaccurate, time-consuming procedure which has little or no effect on intra-operative management and which should be replaced by preoperative endometrial evaluation by either office sampling techniques or formal curettage.