[Contemporary model for treatment of erythroplakia]. / Wspólczesny model postepowania w przypadkach erytroplakii.

In literature worldwide is still commonly used the term erosion to describe red areas within cervix around the external orifice. In such cases with negative cytology result, for cervical cancer prevention, the electrocoagulation or electro-conisation or other destructive operations are routinely used. Without colposcopy verification such management is inappropriate. The physician treats but does not know what he treats. It may be both common ectopy or regeneration zone so physiologic cervical states but it may be also CIN or even early cervical cancer, however cytologically negative. The first group of lesions is effectively diagnosed with colposcopy without additional diagnostic procedures and the CIN lesions are diagnosed in high percentage of accuracy. Not all of these lesions should be treated. In the group of colposcopically and cytologically unsuspected lesions just very extensive lesions with active mucous glands should be treated. Such lesions cause recurrent cervical inflammation. All other erythroplakia type lesions demand no treatment. The presence of ectopy around the external cervical orifice is just profitable for diagnosis of epithelial changes and cervical physiologic processes observation. All cases of abnormal colposcopy or cytology results, suspected of CIN should be treated as prevention of cervical cancer. In lower CIN grades electroresection (LEEP) is recommended, while in higher grades the cervical conisation is the appropriate mode of treatment.

[The role of phase contrast microscopy in the evaluation of cervix neck and vaginal biocenosis]. / Rola mikroskopii kontrastowo-fazowej w ocenie biocenozy szyjki macicy i pochwy.

The aim of our study was to evaluate and compare the possibility of germ identification in cervico-vaginal infections of different origin by Ph cytology and classic fixated and stained (H-E) smears. We identified Lactobacillus vag., Gardnerella vag., short bacilli (Escherichia coli, Proteus, Klebsiella), mixed Coccus flora (diplococci, small and large cocci), Trichomonas vag., and Candidia alb. in cervico-vaginal smears. In endocervical, mature metaplastic or parabasal cells the elementary and cocoid bodies of Chlamydia trachomatis were possible to observed. The cytopathic effects caused by viral infections (HPV, HSV, CMV) were detected. The classic (koilocytosis, dyskeratosis) and discrete (binucleation, cracked cells, ghost cells, tadpole cells and large cytoplasmatic hyaline granulations) morphological changes must be confirmed by colposcopy and Digene Hybryde Capture analysis. The results of identification of vaginal biocenosis in Ph microscope and H-E smears were similar. The main benefit of Ph cytology is accuracy, speed and reliability of comprehensive information.

[Integrated colposcopy and phase contrast microscopy for diagnosis of squamous intraepithelial lesions and invasive cervical neoplasms]. / Skojarzone badanie kolposkopowe i mikroskopia kontrastowo-fazowa w diagnostyce sródnablonkowych zmian przednowotworowych i raka inwazyjnego szyjki macicy.

Colposcopy or cytology examinations alone allows to obtain diagnostic concordance with histopathological examination between 74-89% and 68-86%, respectively in SIL and cervical cancer detection. Both methods used simultaneously allow increase concordance with histopathology up to 95-100%. Cytological examination may be used simultaneously with colposcopy when Ph microscopy is used. The aim was to estimate benefits of conjunction of colposcopy and Ph cytology in SIL and cervical cancer detection in daily gynecological practice. Integrated colposcopy and cytology examinations were performed in 200 patients. Cervico-vaginal smears were obtained from the patient before Acetic-Acid Test and Lugol-Solution-Test were performed. Wet smears (Ph) were made. Results of integrated colposcopy and cytology were verified by histopathological examination. Diagnostic specificity, sensitivity, and Youden's value were estimated for Ph cytology, H-E cytology, and colposcopy alone and for integrated colposcopy and Ph cytology. Simultaneous colposcopy and Ph cytology reveal specificity 97.1% sensitivity 94.6% and Youden's value 91.8% thus provide fast, reliable and comprehensive information for accurate diagnosis in daily gynecological practice.

[Colposcopic verification of cytologic smears containing atypical squamous cells of undetermined significance]. / Kolposkopowa weryfikacja rozmazów cytologicznych z obecnoscia atypowych komórek plaskonablonkowych o nieokreslonym znaczeniu.

The aim of the study was the estimation of significance of smears containing Atypical Squamous Cells of Undetermined Significance (ASCUS) and presentation the own management of that cases. The study group consisted of 73 non-pregnant women (aged from 21 to 54 years) with ASCUS. The control group included 113 non-pregnant patients (aged between 20 and 57 years) with unsuspected cytology findings. Chi square test and Fisher test were used to compare the colposcopy findings in the two groups. Colposcopic pictures indicating a presence of dysplasia were significantly more often in study group. 14 cases (19.18%) of mild dysplasia and 8 cases (10.96%) of moderate and severe dysplasia were found in the group of patients with ASCUS. During the 18 month follow-up of the remaining patients in that group persistence of ASCUS was found in 2 cases (3.92%), progression to mild and moderate dysplasia was observed in 6 women (11.76%). Regression to normal smear occurred in 43 women (84.31%). Progression to dysplasia referred to women with suspected colposcopy findings. Until further research resolve all the questions regarding ASCUS smears or new more precise diagnostic methods are invented, colposcopy remains the method of choice in verification of ASCUS smears. Colposcopy together with cytology is the optimal mode of observation of such patients.

[Appearance and evolution of cytologic changes of squamous epithelial cervical cells during the course of human papillomavirus infection. I. Progression of cervical dysplasia]. / Powstawanie i ewolucja zmian cytologicznych nablonka plaskiego szyjki macicy w przebiegu zakazenia wirusem ludzkiego brodawczaka. I. Progresja zmian dysplastycznych nablonka.

There was planed a cycle of works devoted to the title problem. The aim of the first of them was evaluation in our material influence of HPV infection on dysplasia progression of cervical squamous epithelium in correlation to the detected HPV type.

[Human papilloma virus (HPV) infections of the uterine cervix, vagina and vulva in women of childbearing age]. / Zakazenie wirusem ludzkiego brodawczaka (HPV) szyjki macicy, pochwy i sromu u kobiet w okresie prokreacji.

An analysis of the frequency of HPV infections and their clinical course within the uterine cervix, vagina and vulva with regard to the intraepithelial neoplasia in pregnant and non pregnant women was performed. The material consists of 484 women (181 pregnant and 303 non pregnant women). The evaluation of a clinical course of overt and subclinical HPV infection was carried out in 47 pregnant and 34 non pregnant women. In the group with CIN concomitant HPV infection concerned 71.4% of pregnant and 61.4 of non pregnant women. In the group without CIN in 4.8% was found subclinical form and in 2.0% latent form of HPV infection in pregnant and accordingly in 4.6% and 6.0% of non pregnant women. In pregnant women in comparison with non pregnant patients overt form of HPV infections was observed more frequently. Pregnancy seems to have no effect upon the frequency of HPV infections of the cervix, vagina and vulva. On the other hand it modifies the development and course of the infections.

[Occult cervical cancer developing after diagnostic-therapeutic conization of CIN 3]. / Ukryty rak szyjki macicy (occult cancer) rozwijajacy sie po konizacji diagnostyczno-terapeutycznej z powodu CIN 3.

A case of the so called occult cervical cancer which developed 2 years after the conisation performed in a 45-year old woman on account of CIN 3 has been described. Cancer was detected in the operative specimen of the removed uterus. Hysterectomy was performed on account of the progressive form of the myomas. The multiple colposcopy and cytological follow-up examination after conisation was always negative, just as the histological examination of the tissue specimen of the cervical canal. The hypothetical course of the development of the cancer has been discussed. In connection with the above findings a modification of the conisation technique, especially in older women, is suggested.

[The significance of colposcopy in surgical gynecologic emergent situations]. / Znaczenie kolposkopii w ginekologii operacyjnej z naglych wskazan.

There has been described the case of coexistence of ruptured extra-uterine cysts and cancer of cervix uteri diagnosed by preliminary colposcopic examination confirmed by cytology and the directed biopsy specimen what enabled simultaneous surgical treatment. The presented paper is sufficient example that the colposcopy protects a woman requiring surgical treatment caused by the emergent gynecologic reasons from further surgical interventions in cases of simultaneous malignant changes of cervix uteri.

Colposcopy staging and treatment of papillomavirus infection of the cervix.

The specificity of colposcopy findings in HPV infections allows the colposcopic differentiation of these lesions. In all of these colposcopically selected cases, additional tests included cytology with immunoperoxidase reaction (IPR), and, recently, virus typing with the use of ViraPap HPV DNA Detection test and ViraType HPV DNA Typing test became also available. When needed, histological examination of the specimen was carried out. In 202 detected and treated cases of HPV infections in females, and in 5 in males, four groups of lesions have been colposcopically distinguished. Group I contains early and fully developed, unsuspected typical papillomas; Group II--atypical papillomas which are usually colposcopically suspected of CIN and/or cancer; Group III--the so-called subclinical forms, i.e. cases with secondary diminution of epithelial transparency, i.e. acetic acid white epithelium, secondary simple punctuation and/or mosaic (flat condylomas) that are visible only in colposcopic magnification and usually suspected of CIN; and Group IV--the so-called latent lesions without any colposcopic findings and only with positive IPR. CIN 3 (including CIS) was determined histologically in five cases of Group II, and CIN 1-2 in ten cases of Group III. HPV virus type 16/18 was found only in cases of CIN 3. The cases of atypical papilloma (Group II) and recently those containing HPV virus type 16/18 were treated by means of surgical conisation or cryosurgery. The remaining cases (Groups I, II, IV) were treated with orally administered Tetracycline and Vitamin A. The effectiveness of this antibiotic/vitamin therapy in the group of typical papilloma and subclinical HPV lesions amounted to 75%.(ABSTRACT TRUNCATED AT 250 WORDS)