Papanicolaou Smear: An Update on Classification and Management

Current research has caused us to reconsider the factors associated with cervical dysplasia. New recommendations for the collection of cervical specimens, interpretation of the Papanicolaou smear, and patient management have also evolved. Research findings and a discussion of the classifications to be used when reporting the results of the smear are updated in this paper. Interpretation and nurse-practitioner management of the normal and mildly abnormal Pap result is included.     

Use and Abuse of the Papanicolaou Smear

The Papanicolaou smear is a useful screening procedure. Most investigation of abnormal epithelial activity can be done as an office procedure. Cold conization of the cervix is not often required to make the final diagnosis and initiate treatment.     

The Papanicolaou test: its utility and efficacy in cancer detection.

The Papanicolaou (PAP) test is one of the simplest tests in the detection of cancer. This article addresses the concerns/fears women have surrounding the PAP test and why it is not more widely used.     

Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial

BACKGROUND AND STUDY AIMS: The effect on abdominal pain of using carbon dioxide (CO2) for insufflation during endoscopic retrograde cholangiopancreatography (ERCP) has not been investigated. The present study aimed to compare CO2 insufflation with standard air insufflation with respect to the pain experienced during and after ERCP. In addition, we investigated the effect of CO2 insufflation on the partial pressure of CO2 (Pco2). PATIENTS AND METHODS: A total of 118 consecutive patients who were undergoing ERCP were randomized to CO2 insufflation or to air insufflation during the procedure. Both the endoscopists and the patients were blinded with regard to the gas used. Patients rated the intensity of pain experienced on a 100-mm visual analogue scale (VAS) during ERCP and at 1 hour, 3 hours, 6 hours, and 24 hours after the procedure. Transdermal Pco2 was measured continuously in all patients during the procedure. RESULTS: Altogether, 116 patients were eligible for analysis, 58 in each treatment group, and 91 patients responded to the questionnaire (78 %). The mean severity of postprocedure pain was significantly reduced in the CO2 group compared with the air group at 1 hour (5 mm vs. 19 mm on the VAS, P < 0.001), at 3 hours (7 mm vs. 21 mm, P < 0.001), at 6 hours (10 mm vs. 22 mm, P = 0.006), and at 24 hours (4 mm vs. 20 mm, P < 0.001) after the procedure. Radiographs taken 5 minutes after the procedure showed that abdominal distension was more pronounced in patients in the air insufflation group. There were no differences in Pco2values between the two treatment groups. CONCLUSIONS: Carbon dioxide insufflation during ERCP significantly reduces postprocedural abdominal pain. No side effects were observed. Carbon dioxide should be the standard gas used for insufflation in ERCP.     

Smear test from the point of view of women who undergo it

This research is the result of my experience with women in cervical cancer prevention at the Gynecology and Obstetrics National Health Clinic of the Federal University of Minas Gerais. I tried to understand what it means to women who are submitted to a smear test. To achieve this, I have used a qualitative research, in a phenomenological approach. I gathered the data from interviews about the main subject. The analysis of those eleven interviews have helped me to build three analytical categories that are the located structure of the phenomenon, as follows: A--The preventive cervical cancer examination: a woman as a human being conscious of the world; B--Facing the smear test: manifestation of the existence; C--Working with the health professional during the examination: as interfaces of the attendance.     

Planning for a more comfortable stay. Setting up a pre-admission visiting service.

Pre-admission hospital visiting gives people an ideal opportunity to discuss with nursing staff what their hospital stay will entail. Such preparation has been shown to improve patients' recovery and enhance the overall quality of care.     

Blood Smear Examination: Abnormal Cells

Following on from last issue's article on normal blood cells, this article illustrates some of the morphological changes that can affect erythrocytes and leucocytes and which may be noted on examination of canine and feline blood smears     

Blood Smear Examination: Normal Cells

It is essential to be able to recognise and differentiate between what is normal and what is abnormal when examining a blood smear. This article illustrates normal erythrocytes and leucocytes of the dog and cat. A forthcoming article will feature cells that have undergone morphological changes     

Papanicolaou test and enzyme-linked in-situ hybridization. A combined diagnostic system for papilloma virus infections with high prognostic value.

A combined diagnostic system for human papilloma virus (HPV) infections comprising the Papanicolaou test and in-situ hybridization assay was evaluated. Cervical smears from 259 women obtained with a "Cytobrush" were screened. Human papilloma virus genotypes 6/11, 16/18, 31/35/51 were detected by biotin in-situ hybridization in conjunction with a streptavidin-alkaline phosphatase detection complex. The diagnostic sensitivity of this assay was tested by human papilloma virus-DNA-positive human cervical carcinoma cell lines. According to the cytological (Bethesda system) and colposcopical criteria a random control group (n = 80) and prevention (n = 179) were chosen. Compared with Papanicolaou tests the frequency of human papilloma virus-DNA-positive cervices rose with the severity of cell abnormalities. The detection rate of human papilloma viruses-16/18 and human papilloma viruses-31/35/51 and of concomitant infections with human papilloma viruses-6/11 and human papilloma viruses-16/18 and/or human papilloma viruses-31/35/51 increased with the severity of cell dysplasia, whereas the rate of human papilloma virus-6/11 DNAs decreased. The incidence of oncogenic human papilloma virus types 16/18 and 31/35/51 rose with the age of the patients. A follow-up study by Papanicolaou tests of patients with mild (slight) and moderate dysplasias six months after human papilloma virus-DNA-hybridization indicates that human papilloma virus-16/18 DNA-positive lesions are more likely to persist or to progress than human papilloma virus-6/11 DNA-positive cell changes. Human papilloma virus-31/35/51 DNA-positive cell smears exhibited persistent behaviour. Our findings demonstrate that the Papanicolaou test combined with in-situ hybridization is suitable for early diagnosis and prevention of intraepithelial neoplasias and carcinomas of the uterine cervix.     

脑卒中患者步行功能恢复的客观依据:自由和最大步行速度测量的信度和同时效度研究

目的:步行速度是反映脑卒中患者功能恢复的重要指标。研究采用自由和最大步行速度测量法进行脑卒中患者步行能力评定时的信度和同时效度,为临床评定提供客观依据。方法:解放军总医院康复医学科收治脑卒中偏瘫患者55例,符合第四届全国脑血管病会议通过的诊断标准,意识清晰,可接受动作行指令,患者可独立或在监视下步行20m以上,排除下肢全关节置换术后、严重关节炎而影响步行者,以及存在其他限制下肢活动的并发症者。有5位医师参与,其中2位医师评估55例脑卒中偏瘫患者的10m自由和最大步行速度,作为评测者间信度研究,患者在同一时间段内被同一医师再评估1次,以作为评测者内信度研究。由另3位医师共同利用下肢Fugl-Meyer评价、Berg平衡量表和功能独立性测量作效标尺度进行同时效度的研究。结果:在信度方面,10m自由和最大步行速度的测量在同一评定者的两次评定结果之间高度相关(ICC=0.912～0.937),不同评定者的同一次评定结果之间也高度相关(ICC=0.961～0.972),在同时效度方面,自由和最大步行速度与Fugl-Meyer评价,Berg平衡量表和功能独立性测量有较好的相关性(r=0.595～0.693,P<0.001)结论:自由和最大步行速度测量法评定具有良好的信度与同时效度,推荐在临床结局评价中使用。     

慢性肝炎病人的舒适护理研究

[目的]探讨慢性肝炎病人舒适护理的效果。[方法]针对慢性肝炎病人的护理特点,对其进行心理、生理的全方位舒适护理,并与未进行舒适护理的病人进行比较。[结果]实施舒适护理的慢性肝炎病人的满意度显著提高。[结论]舒适护理可提高临床慢性肝炎病人的满意度,从而使其身心处于最佳状态。