Cervical cytology and other screening methods among women admitted to the medical intensive care unit.

OBJECTIVE: This study was conducted to determine whether routine gynecologic screening is obtained for women admitted to a medical intensive care unit in a large tertiary medical center and whether this history is used to document and update screening for these patients. METHODS: A retrospective chart review of 65 women admitted to the medical intensive care units of Harper Hospital or Detroit Receiving Hospital of the Detroit Medical Center over a period of one month. RESULTS: None of the patients eligible for cervical cytology and pelvic examination had these issues addressed in the intake history or had any of the reviewed examinations done or planned for after discharge from intensive care. CONCLUSIONS: Admission to intensive care is an opportunity to assess and update routine gynecologic health screening. This important function is not routinely addressed in the medical records of women admitted to intensive care.

Secretory endometrial adenocarcinoma in a patient on tamoxifen for breast cancer: a report of a case.

Well-differentiated endometrial adenocarcinoma of the secretory type (FIGO Grade 1) with minimal myometrial invasion occurred in a postmenopausal patient on tamoxifen therapy 5 years after mastectomy for breast carcinoma. We believe that this is the first report of secretory carcinoma of the endometrium associated with tamoxifen use. This unusual pattern of low-grade endometrial carcinoma adds to the spectrum of uterine neoplasia associated with tamoxifen therapy.

Management of persistent lymphocele by sclerotherapy with doxycycline.

Three cases of lymphocele after lymphadenectomy for gynecologic malignancy are presented. These patients had large, symptomatic lymphoceles resistant to percutaneous catheter drainage. Sclerotherapy with a single dose of doxycycline was administered percutaneously to each patient. Single treatment achieved resolution in two patients. The third had a persistent lymphocele requiring excision. To our knowledge, doxycycline has not been used for sclerotherapy for lymphocele following radical gynecologic surgery. It may represent a viable addition to the conservative management of lymphoceles.

Monitoring cancer antigen 125 levels in induction chemotherapy for epithelial ovarian carcinoma and predicting outcome of second-look procedure.

A retrospective analysis of 45 patients with epithelial ovarian carcinoma who underwent second-look procedure after initial cytoreduction and platinum-based combination chemotherapy was undertaken. Each patient was evaluated for the result of CA 125 after a third course of chemotherapy, the result of CA 125 prior to second-look laparotomy, and the calculated slope of regression curve for CA 125. These results were compared for a normal value of CA 125 of < 35 and < 20 IU/ml. Of the 45 patients who underwent second-look procedure, 27 had a positive outcome, while 18 were negative for residual disease. For CA 125 levels obtained after the third course of chemotherapy, a level > or = 35 IU/ml predicted a positive second-look outcome in three patients, but was not statistically significant (P = 0.143) when compared to patients with normal levels. Of patients with CA 125 > or = 35 IU/ml immediately prior to second-look procedure, nine had a positive outcome for second look, a difference that was statistically significant (P = 0.006) when compared to patients with normal levels. For the calculation of the slope of the regression curve, no statistical difference (P = 0.838) was observed between the average of the slopes of the positive-outcome group and that the negative-outcome group. The only useful prediction of second-look procedure outcome identified in this group of patients was an elevated (> or = 35 IU/ml) CA 125 immediately prior to second-look procedure. Elevated levels at this time predicted the presence of disease in 100% of patients. For the other methods of analyzing CA 125 levels during therapy, the outcome of second look could not be predicted in patients with no clinical evidence of disease. Selecting a lower normal level of 20 IU/ml did not increase our ability to predict second-look procedure outcome.