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This observational study was conducted on the adolescents referred to a colposcopy clinic in a UK general hospital over a period of 10 years (1996 - 2005). It included 155 newly referred adolescents (age < or = 20 years) with abnormal smear results. The aim of the study was to define the demographic risk factors associated with the development of abnormal cervical smears and identify the incidence of high-grade cervical lesions in this age group. All the risk factors associated with development of HPV infection were found among this group, particularly early age of sexual contact and number of sexual partners. A total of 52.9% of the cases had a smear showing moderate or severe dyskaryosis. The incidence increased to 66.7% among those who had their first sexual contact before the age of 16. Colposcopy and histology confirmed the presence of CIN II and CIN III in 40.6% of cases. The study showed that patients can develop high-grade cervical lesions in their early teens. Delaying the age of onset of cervical screening to 25, as it is currently recommended in UK, will delay the detection and treatment of these cases. A new approach is required to deal with this problem.

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OBJECTIVE: Comparison of the demographic criteria and management of adolescents and other age groups referred to a colposcopy clinic with abnormal smears. METHODS: Retrospective study of newly referred cases to a colposcopy clinic in a UK district general hospital between 1996 and 2005. RESULTS: Most of the sociodemographic and sexual factors associated with HPV infection and cervical cancer were more obvious among adolescents than older women. There was a comparable incidence of high-grade cervical lesions in the two groups. CONCLUSIONS: A policy is needed to deal with adolescents who are exposed to all the risk factors associated with the development of HPV infection and high-grade cervical lesions. This has become an important issue for discussion recently in the UK after raising the age of onset of cervical screening to 25.

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Angiomyofibroblastoma is a rare tumour of the superficial soft tissue of the pelvis and perineum. It is considered to be a slowly growing benign tumour. In the literature no evidence of recurrence has been reported up to eight years following local excision. We report a recurrent case of this tumour with no evidence of malignant transformation.

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Rochdale Infirmary serves a population of 210804, and the obstetric unit delivers approximately 1500 babies every year. There were 655 female sterilisation procedures performed here during 1997 - 2001, of which 134 were those performed at the time of caesarean section (20.5%). An audit of women undergoing sterilisation at caesarean section was undertaken in our unit over a 1-year period in 2001. The auditable standards used for benchmarking were the guidelines published by the Royal College of Obstetricians and Gynaecologists' (RCOG) Clinical Audit and Effectiveness Support Unit on female sterilisation, although other literature has been drawn in for the discussion. The results of the audit highlighted the gaps between rhetoric and reality in many of the standards, and offered a practical solution through recommendations based on the audit process.

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The initial experience in 25 patients of using the Koh Colpotomiser System in conjunction with the RUMI Manipulator, a new modified technique for performing total laparoscopic hysterectomy, is presented. Of 25 operations, 23 (92%) were completed successfully. Complications were limited to minor pre-operative haemorrhage in two patients and post-operative bleeding in another. The Koh Colpotomiser System successfully maintained a pneumoperitoneum following colpotomy, giving the operator improved visibility and access to the pelvic organs. This resulted in greater efficiency, while eliminating the difficulties of vaginal access.

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The aim of this retrospective study is to determine the rate of reduction in the number of Down's syndrome babies delivered in two hospitals having different screening strategies. The total number of Down's syndrome babies during the study period was 0.6/1000 births at Birch Hill Hospital and 1.9/1000 births at Oldham Hospital. Antenatal diagnosis of Down's syndrome was made in 1/4 of women (25%) at Birch Hill and 7/19 of women (37%) in Oldham. The reduction rate of Down's syndrome was similar in both hospitals (25 and 26%). This retrospective analysis and comparison between two neighbouring units, highlights the fact that there is little standardisation of screening policies and screening programmes have not resulted in a substantial reduction in Down's syndrome babies.

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A total of 258 women requiring assisted delivery where vacuum extraction was thought to be suitable were randomly allocated to delivery with a new silicone rubber cup or metal vacuum extractor cups. There was a tendency for the silicone rubber cup to effect delivery more quickly and to cause less scalp trauma, but to fail to effect delivery on more occasions than metal cups. However, none of these differences was statistically significant. There were no statistically significant differences in the rates of birth canal trauma, maternal blood loss, or neonatal jaundice. The silicone rubber cup produced a cosmetically more acceptable chignon than the metal cups. The introduction of vacuum extractors with silicone rubber cups into obstetric units should be encouraged.

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A survey of 748 Army women showed an excellent screening rate for cervical cytology without the use of a screening programme. The women's knowledge regarding results of smears was, however, poor, even in cases with proven carcinoma. Frequent movement of the women because of postings makes follow-up cytology difficult, and a proposal is put forward for a positive reporting system. In this survey severe dyskaryosis suggestive of carcinoma of the cervix was seen presenting under the age of 35 years.

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Male weanling rats were fed a 72% rice diet containing no detectable carnitine and limiting in threonine and lysine. Such dietary conditions may simulate protein malnutrition in man. Under these conditions growth impairment, anemia, hypoproteinemia, and fatty liver developed. The study focused principally on the fatty liver syndrome which was corrected to varying extents depending on degrees of supplementation with carnitine, lysine, threonine, and appropriate combinations of these nutrients. Such reduction in fatty liver accumulation was accounted for principally by the lowering of triglycerides, but also in part of total cholesterol levels. All the data, which also included monitoring carnitine uptake by the tissues and measurement of plasma triglycerides, were consistent with the view that fatty liver accumulation occurs in amino acid deficient diets because (a) of an impairment in the synthesis of the lipoprotein complex mandatory for triglyceride secretion from the liver and (b) from a deficiency of carnitine needed for the intramitochondrial transport of fatty acids prerequisite for their oxidation.

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