The evolving role of the Women's Health Specialist in cancer prevention and survivorship.

IMPORTANCE AND OBJECTIVE: This review provides a framework for primary care physicians, internists, family doctors, NP's, PA's, and oncologists caring for women-henceforth referred to as Women's Health Specialists-to identify and screen patients who may be at high risk for inherited cancer syndromes; an intervention referred to as previvorship care. For women who undergo risk-reducing oophorectomy, survivorship care is critical to optimizing quality of life thereafter. In this paper, we review management of the unique survivorship needs and management options for women at risk for or with a cancer diagnosis, highlighting the importance of interdisciplinary care. METHODS: To review the available previvorship and survivorship management strategies, a Pub Med search was performed using keywords "survivorship," "genetics," "cancer," "menopause," "hormone therapy," "screening" in addition to review of guidelines, position statements and expert, and committee opinions from the American College of OBGYN, the American Society of Clinical Oncology, The North American Menopause Society, the National Comprehensive Cancer Network , and the American Society for Reproductive Medicine. DISCUSSION AND CONCLUSION: Women's Health Specialists are in a unique position to identify and screen women who may be at risk for inherited cancer syndromes as well as provide necessary survivorship management following transition from their oncologists' care.

Heterotopic Triplet Pregnancy After Clomiphene Citrate.

Background: Heterotopic pregnancy is an exceedingly rare condition in which an intrauterine and extrauterine pregnancy coexist. Superfetation refers to the coexistence of 2 or more fetuses of different gestational ages as a result of ovulation, fertilization, and implantation during an ongoing pregnancy. We present a case of heterotopic triplet pregnancy with a difference in gestational age by crown rump length of more than 1 week between the twin intrauterine pregnancy and the singleton tubal ectopic. Case Report: A 31-year-old gravida 3, para 2002 presented to the emergency department with abdominal pain at 9 weeks 2 days' gestation dated by last menstrual period, consistent with ultrasound. She was discharged home with a diagnosis of ruptured hemorrhagic cyst but returned 4 days later with ruptured tubal ectopic pregnancy measuring 9 weeks' gestation and ongoing twin gestation measuring 10 weeks 1 day. She was taken to the operating room for laparoscopic salpingectomy, and ectopic pregnancy was confirmed on tissue diagnosis. Conclusion: Heterotopic pregnancy presents a diagnostic challenge for obstetricians/gynecologists. Superfetation has never been demonstrably proven in humans but has been suggested in the literature. This report adds to the literature that perhaps superfetation can be artificially induced in humans in the presence of assisted reproductive technologies.

Patterns of recurrence and role of adjuvant chemotherapy in stage II-IV serous ovarian borderline tumors.

OBJECTIVE: The objective of this study was to evaluate patterns of recurrence and prognostic factors as well as the role of adjuvant chemotherapy in stage II-IV ovarian SBT. METHODS: We performed a retrospective review of all patients with advanced-stage SBT treated at our institution from 1979 to 2008. Advanced stage was defined as FIGO stage II-IV. Progression-free survival (PFS) was defined as the time of diagnosis to time of recurrence/death or last follow-up. Kaplan-Meier method was used to report the PFS rate. RESULTS: A total of 80 stage II-IV patients were identified, of which 15 (19%) were stage II, 63 (79%) were stage III, and 2 (2.5%) were stage IV. The site of metastasis was pelvis in 15 patients (19%), omentum in 29 patients (36%), isolated lymph nodes in 2 patients (2.5%), lung in 1 patient (1%), axilla in 1 patient (1%), and multiple sites in 32 patients (40%). With a median follow-up of 4.8 years, 17 patients (21%) developed recurrent disease. Only patients with metastasis to the omentum or multiple sites developed recurrent disease. Of the 65 stage III/IV patients, 17 patients (26%) received adjuvant chemotherapy following diagnosis. The 3-year progression-free survival (PFS) was 89.9% (95% CI, 77.3-95.7) for patients who did not receive adjuvant chemotherapy compared with 70.6% (95% CI, 43.1-86.6) for patients who received adjuvant chemotherapy. CONCLUSIONS: While advanced-stage ovarian SBT generally has a good prognosis, nearly 21% of patients develop recurrent disease with intermediate follow-up. It is unclear from these data if adjuvant chemotherapy influenced PFS.

Obsessive-compulsive characteristics in women who have recovered from bulimia nervosa.

OBJECTIVE: The goal of this study was to follow up on reports that obsessive-compulsive characteristics, which are commonly elevated in bulimia nervosa (BN), may also be elevated in individuals who have recovered from BN (BN-R). METHOD: Self-ratings on the Maudsley Obsessional-Compulsive Inventory (MOCI), the Restraint Scale (a measure of dieting behavior related to weight concerns), and questionnaires reflecting eating disorder-related symptoms were evaluated for women who met criteria for BN (n = 25) or BN-R (n = 21) and were free of obsessive-compulsive disorder, and for healthy female controls (n = 28). RESULTS: MOCI scores for the BN-R group (5.5 +/- 5.4) were similar to those for the BN group (5.4 +/- 4.4) and were significantly elevated (p < 0.05, p < 0.02, respectively) in comparison to controls (2.5 +/- 1.9). Of note, MOCI scores for the BN-R group were significantly correlated with scores on the Restraint Scale (r = 0.60, p < 0.02). CONCLUSION: Further studies are needed to assess the relationship between elevated obsessive-compulsive characteristics and eating patterns in individuals recovered from BN.

Phosphorylated 1,6-diphenyl-1,3,5-hexatriene.

A lipophilic dye consisting of a (1E,3E,5E)-1,6-diphenyl-1,3,5-hexatriene (DPH) fluorophore attached to a phosphate diester was prepared, and its fluorescence behavior in different solvent systems and in a liposomal membrane bilayer was examined. The key step in the synthesis of the functionalized end of the dye is a Sonogashira coupling of protected iodophenol with propargyl alcohol; the remaining phenyl ring and double bonds of the all-trans polyene core arise from a Wittig reaction with trans-cinnamaldehyde. Like DPH itself, the emission intensity of its phosphorylated derivative is quenched in polar media.