Accuracy of colposcopically directed biopsy in diagnosis of cervical pathology at Srinagarind Hospital

Objective: To determine the accuracy of colposcopically directed biopsy (CDB) in diagnosis of precancerous or cancerous lesion of the uterine cervix as a quality index of the institute. Materials and Methods: We retrospectively reviewed the medical records of the women who had colposcopic examination at the Department of Obstetrics and Gynecology, Srinagarind Hospital from January, 2005 to December, 2010. The women with satisfactory colposcopic examination who had CDB and further interventions such asloop electrosurgical excision procedure (LEEP)/conization, and/or hysterectomy were included in study. The pathological reports of the specimens from CDB were analyzed comparing with LEEP/conization or hysterectomy according to the highest degree of abnormalities. Pathological reports of HSIL (high grade squamous intraepithelial lesion) or more severe wereclassified as positive, while LSIL (low grade squamous intraepithelial lesion) or less severe were classified as negative. Results: There were 320 patients included, 259 having highest pathological reports of HSIL or more. The accuracy of CDB to detect HSIL or more of the uterine cervix was 87.8% with sensitivity, specificity, PPV and NPV of 84.9%, 100%, 100%, and 61%, respectively. Conclusions: The accuracy of CDB in diagnosis of cervical pathology in our institute was acceptable and comparable to those of others. CDB is a reliable method to obtain the pathological diagnosis in women with abnormal cervical cytologic screening.     

Effects of posterior condylar osteophytes on gap balancing in computer-assisted total knee arthroplasty with posterior cruciate ligament sacrifice

Objective

Gap planning in navigated total knee arthroplasty (TKA) is a critical concern. Osteophytes are normally removed prior to gap planning, with the exception of posterior condylar osteophytes of the femur, which are removed after posterior condylar resection. This study investigated how posterior condylar osteophytes affect gap balancing during surgery.

Methods

This prospective study was conducted on 40 primary varus osteoarthritic knees with a posterior condylar osteophyte that underwent TKA navigation. For all knees, computed tomography (CT) was performed to evaluate osteophyte position. The extension gap and flexion gap were determined under navigation using a tension device with a distraction force of 44 lb. The extension gap and flexion gap were measured before and after osteophyte removal.

Results

This study revealed that the average osteophyte thickness after removal was 7.75 ± 5.34 mm. The average extension gap change was 0.64 ± 0.80 mm, and the average flexion gap change was 0.85 ± 1.12 mm. With respect to increases in the medial extension gap, lateral extension gap, medial flexion gap and lateral flexion gap, the average effects of posterior condylar osteophyte removal were 0.74 ± 0.81 mm, 0.53 ± 0.96 mm, 0.71 ± 0.97 mm and 1.00 ± 1.41 mm, respectively. Posterior condylar osteophyte thickness was also significantly associated with increases in the lateral extension gap (R² = 0.107, p = 0.03), medial flexion gap (R² = 0.101, p = 0.04) and lateral flexion gap (R² = 0.107, p = 0.04).

Conclusion

These results indicated that posterior condylar osteophytes of the femur affect gap balancing during TKA navigation.