Tubo-ovarian abscess containing tapeworm proglottids and ova: a case report.

We report a case of pelvic inflammatory disease complicated by a tubo-ovarian abscess containing Taenia spp. proglottids and ova which migrated through a fistula with the sigmoid colon.

Changing terminology and screening recommendations in cervical cytology screening programs.

In summary, we have presented proposed new diagnostic terminology and screening frequencies for cervical cytology with some of the surrounding debate. As Thailand develops its own cervical screening program for squamous cell carcinoma, an awareness of these new recommendations may help in the design of a local program in the most cost effective manner.

Pap smear examination of patients with leiomyoma.

The Pap smears of 309 patients with leiomyoma were examined at Siriraj Hospital between August 1983 and April 1984. Most of the smears were taken by VCE technique (vaginal scraping, ectocervical scraping and endocervical swabbing); the remainder, by CE or C only. The patients ranged in age from 23 to 66 years, the mean age +/- the standard deviation being 42.1 +/- 7.6 years. The cytological diagnoses were: a) 34.0 per cent abnormal smears, 62.4 per cent infection and 3.6 per cent abnormal cells of the uterine cervix and the endometrium; b) 34.6 per cent normal hormonal evaluation, 8.4 per cent high estrogen; and 5.2 per cent low estrogen with 51.8 per cent having no hormonal evaluation.

Results of Pap smear examinations in women with abnormal ovaries.

Using the VCE technique, the Pap smears of 249 women with abnormal ovaries were examined at the Cytological Laboratory, Siriraj Hospital. The cases, ranging in age from 15 to 85 years (the mean age being 42.1 +/- 14.7 years), were diagnosed as follows: 49 cases with cysts, 89 cases with tumours and 111 cases with cancer. The mean ages of the women with cysts, tumours and cancer of the ovaries were 34.0 +/- 8.6, 37.2 +/- 12.8 and 49.5 +/- 14.8 years, respectively. The percentages of women with cysts, tumours and cancer diagnosed cytologically as having a normal smear were 44.9, 28.1 and 23.4; and infection and inflammation of abnormal ovaries 49.0, 49.4 and 41.5, respectively. The percentages of those with abnormal cells at the uterine cervix were 6.1, 21.4, and 31.5; endometrial adenocarcinoma 0, 1.1 and 0; and ovarian adenocarcinoma 0, 0 and 3.6, respectively. Although Pap smear examination using the VCE technique is sensitive in the early detection of cervical cancer, it is not a sensitive method in the detection of ovarian cancer.

Pap smear examinations in women with near-term pregnancy.

Between November 28, 1983 and August 20, 1985 the Pap smears of 263 pregnant women at Siriraj Hospital were examined. They ranged in age from 15 to 40 years, with the mean age being 24.2 +/- 4.9 years. Pre-term pregnancies (24-37 weeks, 127 cases), at-term (38-42 weeks, 115 cases) and post-term (43-44 weeks, 21 cases) had inflammation and/or infection in 26.8, 40.0 and 23.8 per cent of each period, respectively; however, hormonal evaluation could not be carried out no matter what the period of pregnancy. More than half (60.6%) of the women with pre-term pregnancy determined by history showed a pre-term cell pattern, 10.2 per cent at-term and 2.4 per cent post-term. Forty-two point six per cent of the women with at-term pregnancy determined by history showed the at-term cell pattern, 13.0 per cent showed the post-term pattern and 4.4 per cent the pre-term pattern; and 28.6 per cent of the women with post-term pregnancy determined by history showed the cell post-term pattern, 38.1 per cent the at-term pattern and 9.5 per cent the pre-term pattern.

False-negative Papanicolaou smears from women with cancerous and precancerous lesions of the uterine cervix.

The occurrence from 1980 to 1989 of false-negative Papanicolaou smears in women with cancerous and precancerous lesions of the uterine cervix was studied. The 4,781 cases of cancer (2,814 invasive carcinomas and 593 carcinomas in situ) and precancerous lesions (418 severe dysplasias, 748 moderate dysplasias and 208 mild dysplasias) included 70 cases (1.5%) with false-negative smears. These 70 cases included 43 invasive carcinomas (61.4%), 17 carcinomas in situ and adenocarcinomas in situ (24.2%), and 10 dysplasias (14.4%); all were diagnosed histologically. The mean age of women with false-negative smears was 44.1 +/- 13.7 years. Review of the original cytologic samples showed a screening error in 41 cases (58.5%), an interpretation error in 2 cases (2.9%) and a sampling error in 27 cases (38.6%). Methods for eliminating false-negative smears are discussed.

Results of Pap smear examinations in 1989.

Results of Pap smear examinations in 1989 for disease detection in the female reproductive tract were compiled at Siriraj Hospital. The major technique was VCE. A total of 34,884 Pap smears were taken from females ranging in age from one day to 90 years; the mean age was 36.7 +/- 11.5 years. The percentage of the cytological diagnoses were: 51.6 normal smears, 45.3 infection and inflammation, 0.4 few abnormal cells, 1.1 dysplasia, 0.4 carcinoma in situ, 1.0 invasive carcinoma (0.1 keratinizing squamous cell carcinoma of the cervix, 0.4 large cell nonkeratinizing, 0.1 small cell nonkeratinizing and 0.1 adenocarcinoma; 0.1 adenocarcinoma of the corpus; and 0.2 adenocarcinoma of the ovary) and 0.2 unsatisfactory smears. Of the total number of women who underwent Pap smear examination only 5.0 per cent did so more than once a year. Hence, there should be appropriate treatment and/or sufficient investigation in women with infection and with abnormal smears.

Pap smear examinations of infertile women.

Pap smear examinations of 139 infertile women taken between June 19, 1983 and December 26, 1983 were studied at the Cytological Room, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. The range of age was 17 to 44 years, the mean age being 28.2 +/- 4.9 years. The percentage of cytological findings were: 84.9 normal women, 10.1 hormonal abnormality (of those with non-normal hormone, 7.2 of the total had a mild degree of abnormality), 5.0 no hormonal evaluation, 1.4 few abnormal cells and 0.7 folic acid deficiency.

Pap smear examinations in women post-treated for genital organ diseases by operation and radiation.

A total of 846 Pap smears in women post-treated for genital organ diseases by operation and radiation (1.7% of all those made) at the Cytological Unit, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital between April 4, 1983 and July 4, 1984, were examined. The women were aged 21-75 years (mean age 43.1 +/- 9.7 years). Sixty-seven point two per cent of the women had Wertheim operations and 30.1 per cent total abdominal hysterectomies, due to invasive carcinoma (68.1% of cases) and carcinoma in situ of the uterine cervix (15.2%). Cytological findings revealed 72.8 per cent normal smears, 26.0 per cent infections (17.7% with mixed bacteria), one case of carcinoma in situ and one case of postirradiation dysplasia (both cases were post Wertheim operation). Hormonal conditions were 53.2 per cent in early menopause, 11.7 per cent in crowded menopause, 11.9 per cent in late menopause and 23.2 per cent had no hormonal evaluation. Pap smears of women post-treated for genital organ diseases by operation and radiation were examined for consideration of treatment of choice.

Pap smear examinations of women at the out-patient department of Siriraj Hospital.

Pelvic examinations in 1,906 women at the Gynaecological Room, Out-Patient Department, Siriraj Hospital, in June 1990 were studied. The range of ages was between 14 and 85 years, the mean age being 34.5 +/- 11.5 years. Almost three-quarters (74.7%) of the cases had undergone Pap smear examinations; of these, 36.5 per cent followed up on the results and 6.7 per cent were sent the results by postcard as requested by the patients. The percentage of the clinical diagnoses in women who underwent pelvic and Pap smear examinations (Pap smear data are within the parentheses) were: 36.6 (29.0) no abnormal findings, 14.9 (10.5) vulvovaginitis and leukorrhea, 10.1 (9.7) cervicitis and cervical erosion, 5.6 (1.9) bleeding per os, 3.4 (0.3) abortion, and 3.3 (1.3) adnexitis. The mean age of the women with various diseases were: 27 years in cases of abortion; 30-34 years in women with inflammation of the vulva, vagina, cervix and adnexa, including bleeding per os; 41-45 years in women with cervical polyps, suspected carcinoma, precancer and carcinoma of the cervix, combined with myoma uteri; 48 years in women with relaxation of the genital organ. Every woman who underwent pelvic examination should have a Pap smear and VCE technique performed for the early detection of cervical carcinoma. Health care workers should also ensure that every patient follows up on the results.