Ligneous cervicitis and endometritis: A gynaecological presentation of congenital plasminogen deficiency.

BACKGROUND: Congenital plasminogen deficiency is a rare autosomal recessive condition. Plasminogen deficiency is thought to result in an inability of fibrin breakdown and therefore accumulation of fibrin and formation of ligneous changes. Ligneous lesions can form on a number of mucosal membranes including the cervix and endometrium. METHODS: We report the case of a 25-year-old woman with type 1 plasminogen deficiency with ligneous cervicitis and endometritis and her treatment and clinical course over the last few years. We then review the current literature of ligneous cases of the female genital tract and discuss available treatment options. KEY RESULTS: We found 30 reported cases of ligneous lesions affecting the female genital tract, with the cervix being the most affected part. A number of treatment options have been tried by our patient and other cases in the literature. These include use of the combined oral contraceptive pill, fresh frozen plasma infusion, topical plasmin and plasminogen and trial use of plasminogen concentrate. CONCLUSIONS: This is a chronic condition requiring a multidisciplinary approach. There is currently no definitive treatment for the condition, current trials with plasminogen concentrate replacement therapy may provide a promising option for these patients in the future.

Smoking and multicentric vulval intraepithelial neoplasia.

This study was carried out in order to analyse the multicentric nature and anatomical distribution of vulval intraepithelial neoplasia Grade 3 (VIN3) and to assess the relationship between smoking and VIN3. This is a retrospective study of 80 women with a histologically confirmed diagnosis of VIN3. This study was carried out at a large district general and teaching hospital in North London in a dedicated vulval clinic. A total of 52 (65%) women were smokers and 54 out of the 80 (67.5%) women were diagnosed to have multicentric disease in the form of intraepithelial neoplasia in at least one other lower genital tract site (cervix, vagina or perianal region). Microinvasion at first excision was detected in 20/80 women (25%). Labia minora and fourchette were the commonest sites affected by VIN3. Only 22/80 women were cured with a single treatment, while 58 (72.5%) women needed multiple sessions of treatment. Multiple logistic regression analysis showed that smokers and women who had extensive vulval disease were also likely to have multicentric genital tract neoplasia. Women who continued to smoke after treatment were 30 times more likely to have persistent vulval disease. Women who smoke are statistically more likely to have multicentric genital tract neoplasia and a complete assessment of these cases should include proctoscopy in addition to the colposcopic examination of the cervix and vagina.

Identifying the performance criteria for appraisal of colposcopists: benchmarking Delphi.

BACKGROUND: Colposcopy forms an essential part of National Health Service Cervical Screening Programme (NHSCSP). With an increased emphasis on accountability and improved performance, there is a need to identify the performance criteria that are essential to be satisfied by the colposcopists at the time of appraisal. OBJECTIVE: To identify the performance criteria essential for appraisal of colposcopists by two-generational Delphi survey. DESIGN: Delphi survey. SETTING: Annual British Society for Colposcopy and Cervical Pathology conference (BSCCP 2005, Edinburgh, UK). POPULATION: Four hundred and ninety-nine delegates attending the above conference. METHOD: A two-generational Delphi survey was undertaken to identify the criteria needed for appraisal. The participants were asked to rate the relevance of quality items that might be considered necessary for appraisal of performance of colposcopists. After the first round, the results were presented, and the respondents were given the chance to reflect on their response and change it if necessary. MAIN OUTCOME MEASURES: Criteria considered to be essential for appraisal of colposcopists in areas of training, diagnostic and therapeutic aspects and communication. RESULTS: In the first round, 306/499 (61%) participants returned the completed questionnaire. Sixty percent (187/306) of participants returned their questionnaire in the second round. In addition to BSCCP certification, four other criteria were identified, which were quality of recorded findings, biopsy rate when atypia noted, proportion of biopsies histologically adequate and proportion of normal initial posttreatment follow-up smears. CONCLUSION: This Delphi survey has been the first to identify criteria to be used in the annual appraisal of professionals. It has resulted in a number of criteria that could be considered for the appraisal and possible revalidation of colposcopists practising in UK.

Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information.

OBJECTIVE: To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics. DESIGN: An observational study followed by a randomised trial. SETTING: Colposcopy Clinic, Royal Free Hospital, London. PARTICIPANTS: Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis. MAIN OUTCOME MEASURE: The level of anxiety measured by the Spielberger State Anxiety Inventory. CONCLUSION: Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one-stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.