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T he optimal management of women with cervical intraepithelial neoplasia grade 1 (CIN1) diagnosed by colposcopically directed cervical biopsy is not clear. A 1997 survey of Ontario gynecologists confirmed this uncertainty, revealing that 46% of responding physicians immediately would treat the cervix of women with biopsy-proven CIN1 and that 42% would follow such women colposcopically and would treat only if the disease persisted or progressed (Dr. R. Osborne, personal communication).Physicians advocate immediate treatment of CIN1 for two reasons: to prevent persistent or progressive disease [1,2] and to minimize sexual transmission of the virus associated with CIN1 [3]. Only one study in the literature, a case series, describes the long-term results of women treated immediately for biopsy-proven CIN1 [2].We undertook a retrospective cohort study to determine the rates of CIN2, CIN3, and cancer in women who presented with biopsy-proven CIN1 and received Abstract Objective. Our goal was to evaluate, using a retrospective cohort study design, the management and outcome of 403 women with a colposcopic biopsy of cervical intraepithelial neoplasia grade 1 (CIN1).Methods. Patients were identified from a database of 3,782 new colposcopy patients from 1990 to 1996. CIN1 on initial biopsy was identified in 505 women, and inclusion criteria were met by 403. Management and follow-up information was retrieved from the colposcopy record and computerized pathology information system.Results. Management consisted of immediate treatment for 112 women (cone biopsy, 4; cryotherapy, 26; laser ablation, 79; loop electrosurgical excision, 3) and follow-up for 291 women (colposcopy follow-up, 192; cytology follow-up by family doctor, 99). In patients with a CIN1 biopsy and an index Papanicolaou smear no more serious than atypia, 78% had follow-up only. If the index cytology showed CIN1, 51% had immediate treatment.Conclusion. Conservative management of patients with biopsy-proven CIN1 appears to be appropriate, as 64.6% of pa-tients with follow-up reverted to benign cytology. However, compliance with follow-up must be ensured, as the failure rate of immediate treatment is not insignificant at 21%.

Objective: Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP. Methods: We conducted a prospective anatomic study on a convenience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 techniques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV's path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants. Results: We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively. Conclusion: The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.

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