No abstract

Clinical evaluation of lysuride in the management of hyperprolactinaemia Bromocriptine is a semisynthetic ergot alkaloid that acts as a dopamine agonist and is highly effective in achieving normoprolactinaemia in most patients with raised serum prolactin concentrations. Some patients, however, may have unacceptable side effects. Lysuride hydrogen maleate (lisuride; Revanil, Schering UK) is an 8-a-ergolene which has potent dopamine agonist activity both in vitro and in vivo'; currently there are few data available about the incidence of side effects with lysuride in relation to its clinical efficacy. We have therefore assessed the efficacy of lysuride in 24 consecutive women presenting with hyperprolactinaemia. Patients, methods, and results All 24 patients (age range 19-42) presented with a serum prolactin concentration (mean of three estimations) above 360 mU/I, which is the upper limit of normal in on 17 October 2020 by guest. Protected by copyright.

One hundred seven teenage women were referred to the colposcopy clinic in Ninewells Hospital over an 11-year period from 1976 to 1987. Ninety-five were referred with abnormal cytology and 12 with vulval warts. One hundred patients had a colposcopically directed cervical biopsy taken. Of these, 49 had no dysplasia, 10 had CIN 1,19 had ON II, and 22 had CIN HI. There was no case of microinvasion or invasive carcinoma of the cervix in this age group over the 11 years studied. Obstetric and contraceptive histories are reviewed, and the value of colposcopy in this age group is discussed. (J GYNECOL SURG 5:385,1989) Address reprint requests to:

SUMMARY Of 59 women referred with vulval warts whose cervices were assessed colposcopically for the presence of cervical intraepithelial neoplasia (CIN) before local treatment of the wart lesions, 17 had histologically proved CIN, 12 had histologically proved cervical wart virus infection, and 30 had abnormality on colposcopy or cytology. Seven of the 17 with CIN had no abnormality on cervical cytology.No differences in sexual behaviour, smoking habit, or oral contraceptive use were seen between women with CIN and those with no cervical abnormality. Viral DNA typing ofthe vulval lesions was carried out, but there were no differences in the distribution of viral types between the three different histological groups.Of the 30 women with no abnormality at the initial visit, 23 were followed up colposcopically and cytologically for one to two years. Three of them developed CIN after adequate treatment of the vulval lesions despite the absence of cervical abnormalities on colposcopy at the time of treatment.Studying the known factors linked with CIN failed to show why some women with vulval warts develop CIN, even after treatment of the warts, and others do not. The large number of false negative results on cervical cytology in our patients suggests that women presenting with vulval warts should be screened colposcopically in the first instance. Close follow up of women whose warts are treated and who are thought to have no cervical abnormality at that assessment is essential.Despite the circumstantial evidence implicating genital warts and infection with human papillomavirus (HPV) in the aetiology of cervical cancer,'2 not all women with genital warts develop cervical cancer. Prospective studies of women with cervical HPV infection have indicated that 12. 1% to 13.4% of these lesions will progress to cervical intraepithelial neoplasia (CIN) over a variable time,34 but there is little information on the risk of developing CIN in women presenting with overt vulval wart infection whose cervices are not affected, and no data are available about the possible effects of treatment of the vulval lesions on the subsequent risk of CIN.Walker et al showed that almost one third ofwomen presenting with vulval warts would have histological evidence of CIN at initial assessment or within six Address for reprints: Dr S A Walkinshaw, Department of Obstetrics and Gynaecology, Princess Mary Maternity Hospital, Newcastle upon Tyne NE2 3BD Accepted for publication 28 April 1988 months of presentation.5 Although follow up was short, three of the 22 women colposcopically healthy at their first visit developed colposcopic abnormalities within six months. Francheschi et al indicated that in women with genital warts who had normal cervical cytology and for whom further cervical smears were available, 10% developed an abnormal smear at a mean of three to four years.6The progression of genital warts to cervical premalignant disease must therefore largely depend on other factors. Such external factors interact in other animal papillomaviruses, ...