Recurrent colorectal carcinoma detected by routine cervicovaginal papanicolaou smear testing.

BACKGROUND: We present a case of recurrent colon cancer detected by routine, annual Papanicolaou screening. CASE: A 59-year-old African American woman who had been treated for T2N0M0 (stage II, Dukes A) colon cancer 2 years before to presentation had a Pap smear showing a high-grade squamous intraepithelial lesion with a normal cervical biopsy result. Because of this discrepancy, a loop electrosurgical excision procedure and endocervical curettage were performed and showed atypical glandular cells suspicious for adenocarcinoma. Subsequent colonoscopy showed recurrent adenocarcinoma of the colon. The patient underwent an en-block total abdominal hysterectomy and anterior-perineal resection showing invasion of recurrent colon cancer into the uterus and cervix. CONCLUSION: In patients with a history of extrauterine adenocarcinoma, abnormal Pap screening may indicate recurrent or metastatic carcinoma.

Metastatic uterine serous carcinoma originating in an endometrial polyp: a report of 2 cases.

BACKGROUND: Endometrial carcinoma is the most common cancer of the female genital tract. Two histologic variants have been described: an estrogen-dependent form and a more aggressive, non-estrogen-dependent form, which includes uterine serous carcinoma. CASES: Two cases of uterine serous carcinoma were confined to an endometrial polyp without myometrial invasion and were widely metastatic. One patient presented with abdominal pain and constipation, while the other patient was asymptomatic. Both patients had elevated CA-125 levels. At the time of surgery, these patients were found to have extensive carcinomatosis and underwent surgical staging procedures that required bowel resections. Pathology showed metastatic disease originating in a small focus of serous adenocarcinoma at the tip of an endometrial polyp. Combination chemotherapy was planned; but 1 of the patients died prior to its initiation. CONCLUSION: These cases emphasize the aggressive nature of uterine serous carcinoma despite insignificant myometrial invasion.

Randomized trial of intracervical versus posterior fornix dinoprostone for induction of labor.

OBJECTIVE: To investigate whether intracervical placement of a sustained-release dinoprostone insert decreased the length of time to delivery when compared with placement in the posterior fornix. METHODS: Sixty-three patients were randomized to intracervical (n = 33) or posterior fornix (n = 30) placement of the initial dose. Dinoprostone was placed under direct visualization with a vaginal speculum and packing forceps. The patients and staff were blinded to the site of placement. Multiple end points were examined throughout labor. Student t test, Fisher exact test, Wilcoxon test, Mann-Whitney U test, and chi2 analyses were performed when appropriate. A P value of less than.05 was considered significant. RESULTS: Forty-six patients who required only a single dose of dinoprostone had a reduced time to delivery with intracervical (n = 24; 11.70 hours) compared with intravaginal (n = 22; 16.20 hours) placement (P =.025). There was also a reduced time to active labor (intracervical = 8.25 hours, posterior fornix = 11.50 hours; P =.083), ruptured membranes (intracervical = 10.25 hours, posterior fornix = 12.00 hours; P =.047), and request for initial pain medications (intracervical = 5.00 hours, posterior fornix = 11.25 hours; P =.025) with intracervical placement. There was no difference in number of patients managed with artificial rupture of membranes. There was no difference in maternal age, race, parity, maternal height or weight, or indication for induction. There was also no difference in cesarean delivery rate, antepartum fever, hyperstimulation, Apgar scores, birth weight, or umbilical artery pH. CONCLUSION: In patients who respond to a single sustained-release dinoprostone insert, intracervical placement decreases time to delivery without increasing the cesarean delivery rate, infectious morbidity, or other complications of labor.

Health and wellness in residents who matriculate into physician training programs.

OBJECTIVE: The first objective of this study was to evaluate lifestyle changes that occur during residency. The second objective was to determine whether residents in obstetrics and gynecology perceive greater changes compared with residents in other programs. STUDY DESIGN: Residents in selected obstetrics and gynecology, family practice, internal medicine, pediatrics, and surgery fields received surveys. Characteristics addressed before and after residency included eating habits, sleep hours, recreational time, exercise, and missed significant events. Unbalanced analysis of variance and unpaired Student t test were used when appropriate. RESULTS: All specialties noted a significant reduction in low-fat meals consumed, sleep hours, exercise, family interactions, and television viewing (P<.05). Residents noted a significant increase in missed significant events. Residents in obstetrics and gynecology perceived a greater reduction in television viewing compared with residents who were not in obstetrics and gynecology (P<.05). CONCLUSION: Residents perceive significant changes in many areas of health and wellness during residency training. Overall, residents in obstetrics and gynecology do not perceive greater lifestyle alterations compared with other training programs.