Vicki Seltzer

Patient-Controlled Analgesia for Cancer Pain: A Long-Term Study of Inpatient and Outpatient Use

The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.

Second-effort surgical resection for bulky ovarian cancer

Eighteen women with bulky ovarian cancer at the start of chemotherapy were brought to second laparotomy after 6 months of combination chemotherapy in an effort to resect previously unresectable tumor masses. Only one of 18 had significant resection of bulk tumor such that no gross tumor was remaining, although 8 of 15 had the residual uterus removed and 6 of 10 had resection of residual ovary or ovaries. Failure to resect tumor was due to absence of any gross tumor (33%), presence of myriad small seedlings not amenable to resection (22%), or massive residual tumor (18%). Partial resection was accomplished in 22%, but all relapsed promptly in spite of continued aggressive therapy with drugs and whole abdominal irradiation. It is concluded that 6‐month “second‐effort” surgical resection is unlikely to benefit many women with bulky ovarian cancer, and that surgical resection must be attempted early in the course of the disease if it is to be effective.

Sister Joseph's nodule: Seven cases of umbilical metastases from gynecologic malignancies

Seven cases of patients with gynecologic cancer and Sister Josephs nodule, umbilical metastases from intraabdominal malignancy, are presented, making a total of 44 such cases in the literature. One such case, uterine leiomyosarcoma with umbilical metastases, is the first such lesion reported. Although the prognosis is generally poor, a few long-term survivors have been reported, and aggressive therapy may be warranted, particularly in patients with ovarian malignancy.

Adriamycin and cis-diamminedichloroplatinum in the treatment of metastatic endometrial adenocarcinoma

Adriamycin (50 mg/m2) and cis-diamminedichloroplatinum (50 mg/m2) were administered every 21 days to treat metastatic endometrial adenocarcinoma. This regimen resulted in three responses (one complete and two partial) in nine women (33%). Most patients had moderate or severe hematologic and gastrointestinal toxicity. One patient experienced moderate neurotoxicity. This combination of drugs did not appear effective in the treatment of recurrent endometrial adenocarcinoma, but may have a role in the therapy of primary widespread disease.

Psammoma Bodies in Papillary Adenocarcinoma of the Endocervix

Psammoma bodies have never previously been noted in conjunction with cervical cancer. This paper presents a case of endocervical adenocarcinoma with psammoma bodies. Malignant and benign lesions which have previously been associated with psammoma bodies are reviewed. The proposed mechanisms of psammoma body formation are considered. The appropriate action upon finding psammoma bodies on cervicovaginal cytology is discussed.

The Long Term Benefits of a Comprehensive Teenage Pregnancy Program

A comprehensive program was founded in 1982 to provide adolescents with prenatal and family planning care. The programs impact through its first five years of operation on medical aspects of pregnancy course and fetal outcome will be the subject of a separate report. This study examines subsequent maternal and infant health of the patients attending the program compared to a control group. Four hundred ninety-eight adolescents and their newborns attending the programs mother-baby family planning clinic from 1982 to 1989 (subject group) were compared to ninety-one adolescents and their newborns receiving postpartum family planning and pediatrics clinics from 1980 through 1989 (control group). Seventy-five percent of the subject group regularly attended mother-baby clinic, compared to 18% of the control group attending family planning and pediatric clinics (P≤.0001). The subject group experienced less maternal and infant morbidity, greater school attendance, graduation, employment, and contraceptive use than the control group (P<.0001). Many parameters improved with each program year indicating continued wide acceptance of our program by area adolescents.

The fourth-year medical school curriculum: Recommendations of the association of professors of gynecology and obstetrics and the council on resident education in obstetrics and gynecology

OBJECTIVES The Association of Professors of Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology have proposed a fourth-year medical school curriculum for a student interested in pursuing a residency in obstetrics and gynecology. STUDY DESIGN Faculty members and residents in North Carolina, Illinois, and Michigan were surveyed as to the ideal curriculum that they would recommend for fourth-year students. The committee members representing the Council on Resident Education in Obstetrics and Gynecology and the Association of Professors of Gynecology and Obstetrics then reviewed these surveys and proposed a final curriculum. RESULTS A core curriculum of general medicine as an acting internship, an intensive care unit rotation, neonatology, and emergency medicine was recommended. Additional courses strongly considered were ambulatory obstetrics-gynecology, acting internship in obstetrics-gynecology, endocrinology, and general surgery. CONCLUSION The committee recommends a curriculum that is broad and balanced in general medical education.

Resident attrition in obstetrics and gynecology

OBJECTIVE Our goal was to determine the rate of attrition from obstetrics and gynecology residency programs. STUDY DESIGN The Council on Resident Education in Obstetrics and Gynecology sent questionnaires to all 295 obstetrics and gynecology residency program directors in the United States and Canada. These programs represent 4306 postgraduate-year 1 through 4 (or 5) resident positions each year. The program directors were asked the number of residents who left voluntarily or were dismissed in a 2-year period and the reasons they left. RESULTS In a 2-year period 299 residents left or were dismissed (6.94% over 2 years, or 3.47% per year). Only 88 (1% per year) left specifically because they decided they preferred a different discipline. CONCLUSION The rate of attrition from obstetrics and gynecology residency programs is not excessively high.

Breast Cancer in Pregnant and Postpartum Women

Breast cancer is reported to occur in from 1 in 3000 to 1 in 10,000 pregnancies worldwide. In the United States, 10% to 20% of breast cancers occur in women of childbearing age. Diagnosis and treatment of breast cancer during pregnancy present many additional challenges.

Natural cytotoxicity in malignant and premalignant cervical neoplasia and enhancement of cytotoxicity with interferon

Natural cytotoxicity was measured in 70 women with cervical dysplasia or invasive cervical cancer and in 13 controls, using a short-term chromium release assay. A significant diminution in mean cytotoxicity was found in women with CIN III and with advanced cervical carcinoma. When the peripheral blood leukocytes of patients and controls were pretreated with interferon, there was significant enhancement of the mean cytotoxicity for all groups except those with advanced cervical carcinoma (stage IIB or worse). Our results have shown a significant defect in a potentially important immune surveillance mechanism in a group of patients with premalignant disease at risk for the development of invasive cancer. A possible role for interferon in the treatment of cervical intraepithelial neoplasia is suggested.