Uterine Cervical Dysplasia: Abnormal development of immature squamous EPITHELIAL CELLS of the UTERINE CERVIX, a term used to describe premalignant cytological changes in the cervical EPITHELIUM. These atypical cells do not penetrate the epithelial BASEMENT MEMBRANE.Uterine Cervical Neoplasms: Tumors or cancer of the UTERINE CERVIX.Vaginal Smears: Collection of pooled secretions of the posterior vaginal fornix for cytologic examination.Cervical Intraepithelial Neoplasia: A malignancy arising in uterine cervical epithelium and confined thereto, representing a continuum of histological changes ranging from well-differentiated CIN 1 (formerly, mild dysplasia) to severe dysplasia/carcinoma in situ, CIN 3. The lesion arises at the squamocolumnar cell junction at the transformation zone of the endocervical canal, with a variable tendency to develop invasive epidermoid carcinoma, a tendency that is enhanced by concomitant human papillomaviral infection. (Segen, Dictionary of Modern Medicine, 1992)Papanicolaou Test: Cytological preparation of cells collected from a mucosal surface and stained with Papanicolaou stain.Papillomaviridae: A family of small, non-enveloped DNA viruses infecting birds and most mammals, especially humans. They are grouped into multiple genera, but the viruses are highly host-species specific and tissue-restricted. They are commonly divided into hundreds of papillomavirus "types", each with specific gene function and gene control regions, despite sequence homology. Human papillomaviruses are found in the genera ALPHAPAPILLOMAVIRUS; BETAPAPILLOMAVIRUS; GAMMAPAPILLOMAVIRUS; and MUPAPILLOMAVIRUS.Papillomavirus Infections: Neoplasms of the skin and mucous membranes caused by papillomaviruses. They are usually benign but some have a high risk for malignant progression.Tumor Virus Infections: Infections produced by oncogenic viruses. The infections caused by DNA viruses are less numerous but more diverse than those caused by the RNA oncogenic viruses.Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally.Human papillomavirus 16: A type of ALPHAPAPILLOMAVIRUS especially associated with malignant tumors of the CERVIX and the RESPIRATORY MUCOSA.Cervix Uteri: The neck portion of the UTERUS between the lower isthmus and the VAGINA forming the cervical canal.Electrosurgery: Division of tissues by a high-frequency current applied locally with a metal instrument or needle. (Stedman, 25th ed)Human papillomavirus 18: A type of human papillomavirus especially associated with malignant tumors of the genital and RESPIRATORY MUCOSA.Megaloblasts: Red blood cell precursors, corresponding to ERYTHROBLASTS, that are larger than normal, usually resulting from a FOLIC ACID DEFICIENCY or VITAMIN B 12 DEFICIENCY.Fibrous Dysplasia of Bone: A disease of bone marked by thinning of the cortex by fibrous tissue containing bony spicules, producing pain, disability, and gradually increasing deformity. Only one bone may be involved (FIBROUS DYSPLASIA, MONOSTOTIC) or several (FIBROUS DYSPLASIA, POLYOSTOTIC).Ectodermal Dysplasia: A group of hereditary disorders involving tissues and structures derived from the embryonic ectoderm. They are characterized by the presence of abnormalities at birth and involvement of both the epidermis and skin appendages. They are generally nonprogressive and diffuse. Various forms exist, including anhidrotic and hidrotic dysplasias, FOCAL DERMAL HYPOPLASIA, and aplasia cutis congenita.Papillomavirus E7 Proteins: ONCOGENE PROTEINS from papillomavirus that deregulate the CELL CYCLE of infected cells and lead to NEOPLASTIC CELL TRANSFORMATION. Papillomavirus E7 proteins have been shown to interact with various regulators of the cell cycle including RETINOBLASTOMA PROTEIN and certain cyclin-dependent kinase inhibitors.Uterine Cervical Diseases: Pathological processes of the UTERINE CERVIX.Alphapapillomavirus: A genus of DNA viruses in the family PAPILLOMAVIRIDAE. They preferentially infect the anogenital and ORAL MUCOSA in humans and primates, causing both malignant and benign neoplasms. Cutaneous lesions are also seen.Bronchopulmonary Dysplasia: A chronic lung disease developed after OXYGEN INHALATION THERAPY or mechanical ventilation (VENTILATION, MECHANICAL) usually occurring in certain premature infants (INFANT, PREMATURE) or newborn infants with respiratory distress syndrome (RESPIRATORY DISTRESS SYNDROME, NEWBORN). Histologically, it is characterized by the unusual abnormalities of the bronchioles, such as METAPLASIA, decrease in alveolar number, and formation of CYSTS.Oncogene Proteins, Viral: Products of viral oncogenes, most commonly retroviral oncogenes. They usually have transforming and often protein kinase activities.Carcinoma in Situ: A lesion with cytological characteristics associated with invasive carcinoma but the tumor cells are confined to the epithelium of origin, without invasion of the basement membrane.Bone Diseases, DevelopmentalPrecancerous Conditions: Pathological processes that tend eventually to become malignant. (From Dorland, 27th ed)DNA, Viral: Deoxyribonucleic acid that makes up the genetic material of viruses.Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body.Carcinoma, Squamous Cell: A carcinoma derived from stratified SQUAMOUS EPITHELIAL CELLS. It may also occur in sites where glandular or columnar epithelium is normally present. (From Stedman, 25th ed)Papillomavirus Vaccines: Vaccines or candidate vaccines used to prevent PAPILLOMAVIRUS INFECTIONS. Human vaccines are intended to reduce the incidence of UTERINE CERVICAL NEOPLASMS, so they are sometimes considered a type of CANCER VACCINES. They are often composed of CAPSID PROTEINS, especially L1 protein, from various types of ALPHAPAPILLOMAVIRUS.Carotenoids: The general name for a group of fat-soluble pigments found in green, yellow, and leafy vegetables, and yellow fruits. They are aliphatic hydrocarbons consisting of a polyisoprene backbone.Fibromuscular Dysplasia: An idiopathic, segmental, nonatheromatous disease of the musculature of arterial walls, leading to STENOSIS of small and medium-sized arteries. There is true proliferation of SMOOTH MUSCLE CELLS and fibrous tissue. Fibromuscular dysplasia lesions are smooth stenosis and occur most often in the renal and carotid arteries. They may also occur in other peripheral arteries of the extremity.Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships.Osteochondrodysplasias: Abnormal development of cartilage and bone.Fibrous Dysplasia, Monostotic: FIBROUS DYSPLASIA OF BONE involving only one bone.Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group.Fibrous Dysplasia, Polyostotic: FIBROUS DYSPLASIA OF BONE affecting several bones. When melanotic pigmentation (CAFE-AU-LAIT SPOTS) and multiple endocrine hyperfunction are additionally associated it is referred to as Albright syndrome.MassachusettsHospitals, General: Large hospitals with a resident medical staff which provides continuous care to maternity, surgical and medical patients.BostonGynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology.Preconception Care: An organized and comprehensive program of health care that identifies and reduces a woman's reproductive risks before conception through risk assessment, health promotion, and interventions. Preconception care programs may be designed to include the male partner in providing counseling and educational information in preparation for fatherhood, such as genetic counseling and testing, financial and family planning, etc. This concept is different from PRENATAL CARE, which occurs during pregnancy.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Caregivers: Persons who provide care to those who need supervision or assistance in illness or disability. They may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow patients.Hysterectomy: Excision of the uterus.Gynecologic Surgical Procedures: Surgery performed on the female genitalia.Hysterectomy, Vaginal: Removal of the uterus through the vagina.Salpingectomy: Excision of one or both of the FALLOPIAN TUBES.Uterine Neoplasms: Tumors or cancer of the UTERUS.Fallopian Tubes: A pair of highly specialized muscular canals extending from the UTERUS to its corresponding OVARY. They provide the means for OVUM collection, and the site for the final maturation of gametes and FERTILIZATION. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three histologic layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells.Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the UTERUS and the GASTROINTESTINAL TRACT but can occur in the SKIN and SUBCUTANEOUS TISSUE, probably arising from the smooth muscle of small blood vessels in these tissues.New YorkBirthing Centers: Free-standing facilities that provide prenatal, childbirth, and postnatal care and usually incorporate family-centered maternity care concepts and practices.American Medical Association: Professional society representing the field of medicine.Societies, Medical: Societies whose membership is limited to physicians.CD-I: An optical disk storage system used on specialized players that combine the functions of computer and CD player in a self-contained box, designed to be connected to a television set and a home stereo for video and sound output. The player is controlled with a hand-held remote unit resembling a television remote control. (J Allied Health 1993 Winter;22(1):131-8)Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium.

Natural history of dysplasia of the uterine cervix. (1/334)

BACKGROUND: A historical cohort of Toronto (Ontario, Canada) women whose Pap smear histories were recorded at a major cytopathology laboratory provided the opportunity to study progression and regression of cervical dysplasia in an era (1962-1980) during which cervical squamous lesions were managed conservatively. METHODS: Actuarial and Cox's survival analyses were used to estimate the rates and relative risks of progression and regression of mild (cervical intraepithelial neoplasia 1 [CIN1]) and moderate (CIN2) dysplasias. In addition, more than 17,000 women with a history of Pap smears between 1970 and 1980 inclusive and who were diagnosed as having mild, moderate, or severe dysplasia were linked to the Ontario Cancer Registry for the outcome of any subsequent cervical cancers occurring through 1989. RESULTS: Both mild and moderate dysplasias were more likely to regress than to progress. The risk of progression from mild to severe dysplasia or worse was only 1% per year, but the risk of progression from moderate dysplasia was 16% within 2 years and 25% within 5 years. Most of the excess risk of cervical cancer for severe and moderate dysplasias occurred within 2 years of the initial dysplastic smear. After 2 years, in comparison with mild dysplasia, the relative risks for progression from severe or moderate dysplasia to cervical cancer in situ or worse was 4.2 (95% confidence interval [CI] = 3.0-5.7) and 2.5 (95% CI = 2.2-3.0), respectively. CONCLUSION: The risk of progression for moderate dysplasia was intermediate between the risks for mild and severe dysplasia; thus, the moderate category may represent a clinically useful distinction. The majority of untreated mild dysplasias were recorded as regressing to yield a normal smear within 2 years.  (+info)

Mildly dyskaryotic smear results: does it matter what women know? (2/334)

BACKGROUND: As of 1992, all women in the UK who have a first mildly dyskaryotic cervical smear are placed under surveillance for 6 months rather than being referred for immediate colposcopy. OBJECTIVES: We aimed to explore the relationship between anxiety and understanding about mild dyskaryotic, and to propose and discuss a method of analysing free text comments written by participants in studies based on structured questionnaires. METHODS: The freely scripted text of 236 women who had completed a questionnaire as part of a randomized controlled trial to assess the impact of an educational package was analysed. Randomization group status was concealed. Texts expressing similar views were grouped together and categorized. A matrix was drawn up to encompass the categories, and the comments were reallocated accordingly. RESULTS: Examination of the free text revealed two dimensions, concern and knowledge. There were no differences with respect to the apparent level of concern between the two randomization groups. However, comments from the intervention group were significantly more likely to have been classified as expressing good or vague knowledge than those from women in the control group. CONCLUSION: Although the educational intervention improved women's knowledge about the meaning of an abnormal smear result, this better knowledge was not correlated with less anxiety about the result. The free text analysis was a useful supplement to the main trial questionnaires. It demonstrated the existence of a range of understanding about cervical dyskaryosis, of anxieties relating to the receipt of such a result and the degree of interest women showed in acquiring further information.  (+info)

Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. (3/334)

A double-blind, placebo-controlled, randomized, factorial study using a daily oral administration of 30 mg beta-carotene and/or 500 mg vitamin C was conducted in 141 women with colposcopically and histologically confirmed minor squamous atypia or cervical intra-epithelial neoplasia (CIN) I. Over approximately 2 years of follow-up, 43 lesions regressed to normal and 13 progressed to CIN II. The regression rate was slightly higher, but not significantly so, in those randomized to beta-carotene compared to no beta-carotene (hazard ratio = 1.58, 95% CI: 0.86-2.93, P = 0.14) and slightly lower, but not statistically significant, for those randomized to vitamin C compared to no vitamin C (hazard ratio = 0.65, 95% CI: 0.35-1.21, P = 0.17). In a model with no interaction, the progression rate was slightly higher in those randomized to beta-carotene (hazard ratio = 1.75, 95% CI: 0.57-5.36, P = 0.32) and also in those randomized to vitamin C (hazard ratio = 2.40, 95% CI: 0.74-7.80, P = 0.13). Neither of these were statistically significant. However, there was some evidence of an interaction effect of the two compounds on the progression rate (P = 0.052), with seven of the progressed lesions occurring in those randomized to both vitamins compared to a total of six in the three other groups. The currently available evidence from this and other trials suggests that high doses of these compounds are unlikely to increase the regression or decrease the progression of minor atypia and CIN I.  (+info)

Risk factors for cervical dysplasia in Kerala, India. (4/334)

A study in Kerala, India, confirmed the importance of genital hygiene in the fight against infections that have a role in the development of cervical dysplasia and cancer. Many women cannot afford sanitary pads, while adequate facilities for washing after coitus are often unavailable. Health education, satisfactory living standards, and the empowerment of women are prerequisites for reducing the incidence of cervical dysplasia.  (+info)

Immunohistochemical analysis, human papillomavirus DNA detection, hormonal manipulation, and exogenous gene expression of normal and dysplastic human cervical epithelium in severe combined immunodeficiency mice. (5/334)

The cervical squamocolumnar junction of normal and dysplastic human xenografts was maintained in SCID-beige mice. Dysplastic tissue maintained a dysplastic morphology, irregular pattern of keratin expression, elevated levels of cellular proliferation, and human papillomavirus type 16 and/or type 18 DNA. Hyperplastic changes of normal xenografts occurred via high-dose estrogen exposure, and through recombinant adenovirus infection, the introduction and stable expression of an exogenous gene was accomplished.  (+info)

HPV testing in the evaluation of the minimally abnormal Papanicolaou smear. (6/334)

Minor cytologic abnormalities of the cervix, such as atypical squamous cells of undetermined significance (ASCUS), are vastly more common than high-grade squamous intraepithelial lesions or invasive cancer. Current guidelines for the management of ASCUS include repeating the Papanicolaou (Pap) smear at specific intervals, referring all patients for colposcopy or using an adjunctive test such as hybrid capture human papillomavirus (HPV) testing or cervicography. The usefulness of the Pap smear is limited by its considerable false-negative rate and its dependence on clinician and laboratory performance. Colposcopy is a highly sensitive procedure, but many patients with ASCUS have normal colposcopic findings. The hybrid capture test not only measures quantitative HPV load but also detects both oncogenic and nononcogenic HPV types, thereby increasing the probability that serious cervical disease is not missed. Hybrid capture sampling is simple to perform, and positive results are strongly associated with cervical dysplasia. HPV testing in women with ASCUS can be used as an adjunctive test to identify those with HPV-associated disease; it can also serve as a quality assurance measure. Together, repeat Pap smears and HPV testing should identify most patients with underlying cervical dysplasia. Combined testing may also minimize the number of unnecessary colposcopic examinations in women who have no disease.  (+info)

Anxiety amongst women with mild dyskaryosis: costs of an educational intervention. (7/334)

BACKGROUND: A randomized controlled trial in primary care investigated whether a structured educational intervention had an impact on the psychological morbidity associated with a 6-month period of surveillance for mild dyskaryosis. In the context of high levels of sustained distress, and few differences in terms of objective measures of anxiety, the intervention led to a greater proportion of women who were comfortable with a 6-month interval before their next smear test. OBJECTIVE. The aim of this paper is to evaluate the implications to general practices and the NHS, in terms of both costs and numbers of patient contacts, of a change from current policy to one of actively inviting all women with mild dyskaryosis to consult the practice nurse for the intervention. METHODS: We conducted a pragmatic, cluster-randomized controlled trial, comparing the intervention with standard care. The setting was general practices in Avon and South Glamorgan, UK. The subjects were women under surveillance following their first ever mildly dyskaryotic cervical smear result. The main outcome measures were as follows. Costs were reported according to randomization group, from the viewpoint of general practices and the NHS. The main elements which were costed were those attributable to production of the package and training in its use, and the costs of consultations subsequent to the woman receiving her smear test result. In addition, since in practice the intervention might be applied in different circumstances to those prevailing in the trial, a sensitivity analysis was performed to assess the costs of the educational package as realistically as possible. RESULTS: Almost twice as many women in the intervention group compared with the control group visited their practice to discuss their result. From the perspective of the practices, a change from current policy to the intervention policy led to potential (negligible) savings of around pound sterling 3.50 per partner per year. From the NHS perspective, the intervention would lead to slightly increased costs of between pound sterling 1000 and pound sterling 2500 per year for an area performing 60000 tests per year. CONCLUSIONS: It is both feasible and acceptable for practice nurses to deliver the educational package. Moreover, from the perspective of a practice, the policy is effectively cost-neutral. The main implication for general practices is the change in the pattern of care provided: fewer women consulted their GP about their smear result and many more, following active encouragement, consulted the practice nurse.  (+info)

HPV testing in primary screening of older women. (8/334)

Certain types of the human papilloma virus (HPV) are well established as the primary cause of cervical cancer. Several studies have shown that HPV testing can improve the detection rate of high-grade cervical intraepithelial neoplasia (CIN), but these have been carried out primarily in younger women. In this study we evaluated the role of HPV testing as an adjunct to cytology in women aged 35 or over. An additional aim was to evaluate commercially available kits for HPV testing. A total of 2988 eligible women aged 34 or more attending for a routine smear in 40 general practitioner practices received HPV testing in addition to routine cytology, after having given written informed consent. Samples were assayed by polymerase chain reaction (PCR) and two versions of the Hybrid Capture test for HPV, and women were invited for colposcopy if there was any cytological abnormality (including borderline smears) or the PCR test was positive. Any apparent abnormality was biopsied and loop-excision was performed as necessary. CIN was judged by histology; 42 women had high-grade CIN, of which six were cytology negative (86% sensitivity for borderline or worse) and three had a borderline smear (79% sensitivity for mild dyskaryosis or worse). The positive predictive value of a borderline smear was only 3.1%. Eleven high-grade lesions were negative by the PCR HPV test (sensitivity 74%). The first generation Hybrid Capture II test had a similar sensitivity but an unacceptably high false positive rate (18.3%), while the newer Hybrid Capture II microtitre kit had a 95% sensitivity and a 2.3% positivity rate in normal women when used at a 2 pg ml(-1) cut-off (positive predictive value 27%). Cytology performed very well in this older cohort of women. The newer Hybrid Capture II microtitre test may be a useful adjunct, especially if the results reported here are reproducible in other studies. A combined screening test offers the possibility of greater protection and/or longer screening intervals, which could reduce the overall cost of the screening programme.  (+info)

  • A total of 726 subjects were screened, yielding 294 cases of dysplasia and 170 controls defined by coexistent cytologic and colposcopic evidence. (elsevier.com)
  • To investigate that possibility, we collected cervical cytobrush samples from 144 Tanzanian women and performed deep sequencing of bacterial 16S rRNA genes. (nebraska.edu)
  • Had severe dysplasia (had leep) , now breakthough bleeding. (healthtap.com)
  • Treatment for higher grade CIN involves removal or destruction of the neoplastic cervical cells by cryocautery, electrocautery, laser cautery, loop electrical excision procedure (LEEP), or cervical conization. (wikipedia.org)