Virological and cytological clearance in laser vaporization and conization for cervical intra-epithelial neoplasia grade 3.

AIM: Cervical intra-epithelial neoplasia (CIN) is the precancerous stage of cervical cancer. Standard treatment for high-grade CIN is conization of the cervix. The risk of preterm birth following conization has been discussed recently. In contrast, laser vaporization is believed not to affect perinatal outcome, but the long-term effectiveness of each surgical procedure is still unclear. The aim of this prospective unmatched-cohort study was therefore to compare virological and cytological clearance and recurrence risk between conization and vaporization for CIN3. METHODS: Subject consisted of CIN3 patients treated at the present hospital between 2007 to 2011 and followed up until December 2014. One hundred and one patients were treated with laser conization, and 137 with vaporization. The surgical procedure was selected on the basis of colposcopy, pathological grade and patient's hope for pregnancy. RESULTS: There were no significant differences in cure rate, human papilloma virus (HPV) clearance rate or recurrence rates between the conization and vaporization groups. Risk ratio of recurrence for each surgical procedure adjusted for age and HPV persistence status were analyzed on Cox proportional hazards modeling. Recurrence risk ratio for patients treated by vaporization was 6.21 (95%CI: 0.65-59.19; P = 0.111) compared with conization and there were no significant differences. No adverse pregnancy outcome was observed in the vaporization group compared with conization. CONCLUSIONS: Laser vaporization is useful for young patients with CIN3 who hope for pregnancy in the future.

A case of congenital toxoplasmosis whose mother demonstrated serum low IgG avidity and positive tests for multiplex-nested PCR in the amniotic fluid.

We encountered a woman whose infant developed congenital toxoplasmosis. Serum Toxoplasma gondii antibody titers (320x) at 12 weeks of gestation increased to 5120x at 25 weeks. Toxoplasma immunoglobulin M was 2.8 index, and immunoglobulin G avidity index was 23%. Cyclic administration of acetylspiramycin was maintained from 22 weeks until delivery. Multiplex-nested polymerase chain reaction of maternal blood and amniotic fluid at 28 weeks both tested positive for Toxoplasma DNA. A male neonate weighing 2916 g was born at 38 weeks via cesarean section. No abnormalities were detected by physical and funduscopic examinations, whereas a head computed tomography of the neonate revealed three independent intracranial calcifications. The infant underwent therapy with pyrimethamine and sulfadiazine for one year. Serum titers of Toxoplasma gondii antibodies were all less than cut-off values between 5 and 12 months after birth, but all increased up to positive levels 18 months after birth.