Volume 10, Number 02

"ADEQUATE" SAMPLING IN PAP SMEARS With special reference to the endocervical brush technique Some confusion and controversy regarding proper sampling techniques recurs from time to time, often originating from purveyors of particular sampling devices on the market. This problem is now under review prior to the provisions of a comprehensive assessment in a pamphlet on recommended sampling. Meanwhile, we recommend "direct" endocervical sampling under the following circumstances: as initial sampling in a poorly everted or indrawn type of cervix. as a part of the follow-up sampling in cases with minor dysplastic epithelial abnormality that is not referred directly for colposcopy. as a follow-up sampling after a report of atypia of endocervical cells. as a part of the follow-up sampling of any case previously treated by cautery, laser therapy or cryotherapy. In the frequently encountered significantly everted cervix with a broad "transformation" zone, a routine scrape of the everted area is usually more representative than a direct sample from the endocervix area. In those circumstances when one chooses to use direct endocervical "brush" sampling, one should be aware that it is an invasive technique that often opens up superficial capillaries, particularly with over-rotation on sampling. This has two possible sequelae: a subsequent complaint from the patient of spotting or bloody discharge is to be expected more frequently than with other sampling and the risk of sexually transmitted disease is temporarily enhanced under these circumstances.

HEPATITIS VACCINATION When should you test for seroconversion Hepatitis B remains a constant risk to health care workers particularly those who deal with "hands-on" care involving blood, excreta, mucous membranes or surgical procedures. International travel to endemic areas also places an even wider segment of the population at risk. There has been a vaccine available for several years, but many health-care workers are reluctant to use it because of its human origin. (It should be noted, however, that no infections of any nature have been attributable to that product.) There is now a recombinant vaccine produced by yeast biomanipulation which provides excellent protection and removes the faintest doubts about safety that might have applied to the older product. We feel that Hepatitis B immunization should receive your serious consideration. Prior to vaccination, the Hepatitis B serology should be performed to determine if there is natural immunity. A small percentage of those tested will have equivocal results on the standard surface Ag, Ab and core Ab test. If so, the test should be repeated with a request for the "E" marker determinants. This usually sorts out the problem. The vaccine is administered in 3 doses at 0, 1, and 6 months. Approximately 2 weeks after the last dose, testing should be done to assure seroconversion. About 15% of patients immunized will not have a detectable antibody titre. It is advisable to retest seronegative vaccinations in another 6 weeks, and if still negative, to give them a reinforcing dose of the vaccine. Retest again about 3 months after the 4th dose. Some will convert; some will not but evidence suggests that even those who are seronegative at this point will be protected.

ASSESSMENT OF PATIENTS WITH HYPERCHOLESTEROLEMIA A schematic guide An expert panel of the National Cholesterol Education Program recently reported new guidelines for the treatment of high blood cholesterol in adults 20 years of age and over.1 The report states that a total serum cholesterol less than 5.2 mmol/L needs only periodic re-evaluation. Levels over this value suggest excess LDL-Cholesterol, the principal-defined causal element in Coronary Heart Disease (CHD). further action is required as described by the flow chart below. Additional coronary risk factory (CRF), are also shown below along with their impact on assessment. Patients with cholesterol values of 5.2 mmol/L or greater are advised to have the value confirmed by repeating the test. The average of the two test results is then used to guide subsequent decisions.

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