***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve , r and omized clinical trial was conducted to study the safety and efficacy of the Cytobrush for Papanicolaou smear screens in 252 pregnant women . Two groups-Ayre spatula plus Cytobrush and Ayre spatula plus cotton swab-were compared . There was a higher incidence of spotting with each of the three devices as compared with studies of nonpregnant women . The highest incidence of spotting at time of exam occurred with the Cytobrush ; however , this spotting was not clinical ly significant . Eleven first-trimester women experienced a pregnancy loss ; five of these losses were due to a hydatidiform mole or missed abortion that occurred before the exam . Six women ( 2 % ) aborted spontaneously compared with a 10 % incidence reported in the literature . It was concluded that all three devices are safe for use in pregnancy . In addition , the most adequate screen for retrieval of squamous epithelial cells was found to be the Ayre spatula , while the Cytobrush proved most effective for retrieval of endocervical epithelial cells A double-blind trial of nystatin , amphotericin B , and a placebo was carried out in fifty-two cases of denture-related c and idiasis and /or angular cheilitis . The drugs effected a significant clinical cure , but recurrence of the signs was common after withdrawal of the drugs . Concurrent bacteriologic examination showed few cures and continued presence of C and ida albicans during the trial . A specimen from a red palate was examined histologically Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy BACKGROUND There have been few studies documenting the optimal cervical cytologic technique in pregnancy . This study was initiated to investigate the effectiveness and safety of two st and ard techniques . METHODS Two hundred twenty-two new obstetrical patients at a family practice residency program signed informed consent , were enrolled , and were r and omized for cervical cytologic screening using either Zelsmyr Cytobrush and Ayre spatula or Dacron swab and Ayre spatula . The pathologists were blinded to the study , and results were reported with st and ard Bethesda System nomenclature . Patients were asked about complications at follow-up visits . Statistical analysis was performed using Fisher 's exact test and the two- sample t test , with statistical significance set at P < .05 . RESULTS The Cytobrush-spatula technique yielded 95.6 % ( 108/113 ) smears with adequate endocervical cells , as compared with 69.7 % ( 76/109 ) of smears obtained with the Dacron swab and spatula ( P = < .0001 , odds ratio 9.38 ) . Cytologic atypia , defined as noninflammatory cellular abnormalities , was uncovered on 15.9 % ( 18/113 ) of the smears obtained with the Cytobrush and spatula technique and on 13.8 % ( 15/109 ) of the smears obtained with the Dacron swab and spatula ( P = .7082 ) . The complication rate , which included spot bleeding and spontaneous abortion , occurred in 6.5 % ( 7/108 ) of the smears obtained with the Cytobrush and 3.8 % ( 4/105 ) of the smears obtained with the Dacron swab ( P = .54 ) . CONCLUSIONS The Cytobrush-spatula technique significantly increased endocervical cell yield , did not increase detection of cytologic atypia , and did not increase the risk of adverse maternal or fetal outcomes when used for cervical cytologic screening during pregnancy . These results support the use of the Cytobrush-spatula technique over the swab and spatula for obtaining cervical cytologic smears in pregnancy Use of the nylon endocervical brush has been shown to increase the proportion of Papanicolaou smears with endocervical cells in a variety of population s. Each endocervical brush is approximately 100 times more expensive than the cotton swab that has been used routinely for cervical cytology collection . We sought to determine prospect ively whether the endocervical brush would be cost effective by reducing the need for repeat sampling due to Papanicolaou smears ' lacking endocervical cells . Cervical cytology specimens showed no endocervical cells in 114 ( 20 % ) of 561 women sample d with a cotton swab and Ayre spatula . In contrast , 37 ( 7 % ) of 511 women sample d with the endocervical brush and Ayre spatula had no endocervical cells in their specimens . A cost analysis showed that at our clinic , where approximately 3,300 Papanicolaou smears are performed annually , annual savings of > $ 22,000 would be realized by use of endocervical brushes PURPOSE To evaluate the sonohysterography ( SHG ) for the diagnosis of intrauterine abnormalities and describe complications and failure rate . STUDY DESIGN A prospect i ve survey on 81 patients , ( 44 patients with menometrorrhagia , 30 with postmenopausal bleeding and 7 with infertility ) was conducted . Histopathology and clinical survey , if sonohysterography was normal , were the gold st and ards . RESULTS Pathology has been performed in 55 cases . There were four failures ( cervical stenosis ) , one severe complication ( endometritis ) , one pelvic pain . Sensitivity and specificity of sonography  were 56 and 83 % ; for sonohysterography 88 and 98 % ; and for hysteroscopy 78 and 97 % . Sonohysterography was accurate for the diagnosis of the submucous myoma component . CONCLUSION Sonohysterography is available in uterine pathology , easy , safe and cheap , but sonographists and patients should be informed of the little risks of such examination technique OBJECTIVES To determine the effects of a medicated chewing gum on the oral health of frail older people . DESIGN A controlled , double-blind trial using three groups based on r and om allocation of residential homes . SETTING Sixteen residential homes in West Hertfordshire , Engl and . PARTICIPANTS One hundred eleven dentate subjects aged 60 and older who completed the 12-month study . INTERVENTION Subjects were assigned to a chlorhexidine acetate/xylitol gum ( ACHX ) group , a xylitol gum ( X ) group , or a no-gum ( N ) group . Subjects in the gum groups chewed two pellets for 15 minutes twice daily for 12 months . MEASUREMENTS Primary outcome measures were salivary flow rate , denture debris score , prevalence of angular cheilitis , and denture stomatitis ; secondary outcome measures were salivary levels of caries-associated microorganisms . A single examiner , who was blinded to group allocation , made all measurements at baseline before gum usage and at subsequent examinations after 3 , 6 , 9 , and 12 months . Separate analyses were performed for subjects with dentures . RESULTS Subjects in the three groups were similar in most of their baseline characteristics . The stimulated whole saliva flow rate + /- st and ard deviation increased significantly for the ACHX ( 1.4 + /- 0.7 mL/min ) and X ( 1.6 + /- 0.9 mL/min ) groups ( P < .01 ) over baseline ( ACHX = 0.9 + /- 0.6 mL/min , X = 0.8 + /- 0.6 mL/min ) and N group levels ( 0.6 + /- 0.9 mL/min ) . The levels of mutans streptococci , lactobacilli , and yeasts significantly increased ( P < .05 ) in the X and N groups . Denture debris status was significantly lower in the ACHX and X groups than at baseline or in the N group ( P < .01 ) . The reductions of 91 % and 75 % in denture stomatitis and angular cheilitis prevalence , respectively , that occurred in the ACHX group were significantly greater ( P < .01 ) than the reductions in the X group ( denture stomatitis 62 % , angular cheilitis 43 % ) . Prevalence of denture stomatitis and angular cheilitis were not significantly changed in the N group . CONCLUSION The use of a medicated chewing gum significantly improved oral health in older occupants of residential homes .  Chewing gums should be considered as a potential adjunct to other oral hygiene procedures in older subjects This prospect i ve study evaluated the significance of microbial analysis and  antimicrobial treatment  for the cure of angular cheilitis .  Furthermore , various etiologic factors were investigated for their relative effect on the healing process . The study included 1 ) an open trial with 50 patients infected by C and ida albicans and /or Staphylococcus aureus , and 2 ) an intraindividual comparison of eight patients with bilateral lesions infected by C and ida albicans as the only detected pathogen . After a base-line examination the patients received ointments containing nystatin and /or fusidic acid , on the basis of the outcome of an initial microbial analysis . The patients were evaluated clinical ly , photographed , and examined for microorganisms at different time intervals . Ninety-six per cent of the patients who participated in the open trial had no sign of infection after 42 days of treatment . Lesions in the double-blind study , treated with nystatin , were healed after 28 days , whereas lesions that received placebo persisted throughout the treatment period . Increasing age , dry skin , and extended skinfolds at the corner of the mouth were factors closely related to the length of the healing process Objective : To compare , in pregnant women , the endocervical cell yield of the Cytobrush Cell Collector and the Cervex-Brush Cell Sample r with the st and ard cotton swab , and to determine the incidence of serious adverse events associated with the collection techniques . Methods : In a r and omized , controlled clinical trial , 352 pregnant women undergoing initial obstetric evaluation were r and omly assigned to either the cotton swab and modified Ayers spatula , Cytobrush and modified Ayers spatula , or Cervex-Brush . The cytopathology laboratory , blinded to the Papanicolaou smear method , screened the smears using the Bethesda System guidelines . Statistical analyses were performed using the Pearson x2 and analysis of variance tests . Results : There was an increased detection of endocervical cells in pregnant patients with both the Cytobrush and modified Ayers spatula  ( 90.7 % ) and the Cervex-Brush ( 83.3 % ) methods , compared with the cotton swab and modified Ayers spatula ( 70.8 % ) ( P = .0001 and P = .0233 , respectively ) . There was no statistically significant difference between the Cytobrush-spatula and Cervex-Brush groups ( P = .0956 ) . Although there were more bloody Papanicolaou smears in the study groups , this was neither clinical ly nor statistically significant because all the sample s were interpretable and repeat sample s due to bloody specimens were not required . There were no serious adverse events associated with the study group methods . Conclusion : Performance of Papanicolaou smears using the Cytobrush and modified Ayers spatula and with the Cervex-Brush improved Papanicolaou smear adequacy as compared with the cotton swab and modified Ayers spatula . Despite an increased incidence of spotting following collection , these techniques were not associated with an increase in serious adverse events . Based on the cost per item and a clinical ly significant increase in endocervical cell yield , we recommend the Cytobrush and modified Ayers spatula for cytologic screening in pregnant women OBJECTIVE The purpose of this study was to compare smear quality and endocervical cell recovery of four cervical smear sampling devices . STUDY DESIGN Two thous and fifteen patients undergoing routine cervical smears at the University of Tennessee Obstetrics and Gynecology clinics were r and omly assigned to a cotton swab-spatula , Cytobrush-spatula , Cervex-Brush , or Bayne Pap Brush . The cytopathology laboratory , blind to method , used specific criteria to grade smears as being optimal , adequate , marginal , or inadequate . Statistical analysis was by the chi 2 and analysis of variance tests . RESULTS No statistical differences occurred among the groups for nonpregnant patients . For pregnant patients  smear quality was improved with both Cytobrush-spatula and Bayne Pap Brush versus cotton swab-spatula ( p = 0.0301 and 0.0004 , respectively ) ; cotton swab-spatula had fewer endocervical cells than the Cytobrush-spatula ( p = 0.0001 ) , Cervex-Brush ( p = 0.0288 ) , and Bayne Pap Brush ( p = 0.0081 ) . CONCLUSIONS The cotton swab-spatula and Cytobrush-spatula appear to be the most effective screening methods for nonpregnant and pregnant patients , respectively 
    Output:
    
If the patient presents with symptoms of abnormal bleeding , pelvic pressure , or adnexal findings on exam , the review suggests that further workup may be indicated .
However , the sonogram remains a very useful initial test even in this case .
Sonohysterography ( SHG ) and  hysteroscopy  have superior sensitivity , specificity , and more discriminating positive and negative likelihood ratios for diagnosing fibroids than does TVS ( SOR : B , systematic review ) .
SHG is less painful , less invasive , and more cost-effective than  hysteroscopy  ( SOR : B ; single , prospect i ve comparative study and cost comparison ) .