Follow-up of women with cervical adenocarcinoma in situ treated by conization: A single centre clinical experience

OBJECTIVE

Hysterectomy has been the historical gold standard final step in the treatment algorithm of adenocarcinoma in situ (AIS) recommended by most North American colposcopy guidelines. AIS disproportionately affects young childbearing age women, therefore a fertility sparing treatment option is desirable. Our study examines the impact of conservative treatment of AIS with conization followed by serial surveillance.

METHODS

A retrospective chart review was completed of patients treated for AIS from 2006 to 2020. Charts were identified by pathologic diagnosis of AIS on cervical and uterine specimens. Charts were excluded if AIS was not treated with conization, if AIS was not confirmed on initial conization specimen, or if invasive disease was found at initial conization.

RESULTS

121 patient charts were analyzed. Median age of patients at first conization and hysterectomy was 34.8 and 40.9, respectively. First conization was by Cold Knife Cone in 58% of patients, and by Loop Electrosurgical Excisional Procedure in 42% of patients. Median follow-up period in our study was 609 days. 5% of patients had recurrence, with only one patient who recurred as cancer. One case of recurrence had a positive initial conization margin. Median time to recurrence was 700 days. 47% of patients underwent eventual hysterectomy. Residual AIS was found in 23% of hysterectomy specimens. Adenocarcinoma was diagnosed on hysterectomy specimen in four patients.

CONCLUSION

Our study demonstrates the oncologic safety of treating AIS with conization and serial surveillance. Routine hysterectomy completed as a part of the AIS treatment algorithm, as in current clinical guidelines, is unnecessary.

Psychological Effects of the Allocation Process in Human-Robot Interaction - A Model for Research on ad hoc Task Allocation

Task allocation is immensely important when it comes to designing human–robot interaction (HRI), but although it is the shaping part of the interaction, it is merely regarded as a process with its own effects on human thinking and behavior. This study aims at linking research from different fields like psychological theory, HRI and allocation optimization to create a new process model of ad hoc task allocation in human–robot interaction. It addresses the process characteristics and psychological outcomes of a real-time allocation process that integrates the worker. To achieve this, we structured the process into steps and identified relevant psychological constructs associated with them. The model is a first step toward ergonomic research on the self-organized allocation of tasks in HRI, but may also be an inspiration for practitioners designing HRI systems. To create successful work in HRI, designing the technology is an important foundation, but a participative, thought-out process for allotting tasks could be the key to adequate autonomy, work satisfaction and successful cooperation.

[Diagnostic significance of cholinesterase determination in human serum (author's transl)]

The differential diagnostic importance of CHE determination in searching for and observing the course of liver diseases is emphasized in the literature within the small and large enzyme pattern (eg. Gergs 1976). In chronic hepatitis and cirrhosis normal or almost normal values suggest a favorable prognosis. Greatly reduced CHE points to limitation of liver function and a severe form of the disease suggesting toxic influences and considerable deficiency. Rapidly falling CHE activity both in acute hepatitis and in chronic inflammations of the liver point to the danger of threatening hepatic coma.