Fourth-year medical student rotations and the "pre-residency syndrome".

To assist medical students who wish to pursue a residency training program in obstetrics and gynecology in planning senior-year rotations, a questionnaire was sent to university Department Chairs. Each Chair was asked to construct a curriculum consisting of ten 4-week rotations. The respondents described a balanced general medical education consisting primarily of internal medicine, surgery, and pediatrics. Thirty percent of respondents believed these students should not take any rotations in obstetrics and gynecology, and 47% felt that one rotation in obstetrics and gynecology was sufficient. A "pre-residency syndrome" has been described in the literature, wherein fourth-year medical students take multiple rotations in the specialty in which they are seeking residency training. The majority of university Department Chairs supported a balanced general medical education during the fourth year of medical school rather than a narrow curriculum in which students take multiple electives in obstetrics and gynecology.

Late complications of total hip replacement from bone cement within the pelvis. A review of the literature and a case report involving dyspareunia.

It is not uncommon to observe bone cement in the pelvis on radiographs after total hip replacement, a finding which is generally considered to be benign. This paper reviews some catastrophic late complications from intrapelvic methylmethacrylate. We also describe a case of progressive, unbearable dyspareunia beginning three years after total hip replacement. A possible explanation of the pathophysiology is suggested. Recommendations for prevention, diagnosis, and treatment of these late complications are offered.

Cortical blindness in preeclampsia.

A 15-year-old primigravida with severe preeclampsia at term developed blindness. Following delivery by cesarean section, her visual acuity returned promptly. Computerized tomography demonstrated bilateral cerebral lesions in the occipital cortex, which resolved partially by five days and completely by seven months after delivery. Persistent electroencephalogram abnormalities and transient episodes of blindness suggest the presence of residual cerebral damage.

Colposcopic evaluation of cervical intraepithelial neoplasia.

Colposcopic examination and directed biopsies were performed on 70 patients with abnormal cerivcal cytology. The correlation of the histology of the directed biopsies with the colposcopic appearance was 80%; it was 86% with the original Papanicolaou smear. In no case was the histology of a subsequent cone biopsy or hysterectomy specimen more advanced than that of the directed biopsy. Conization was avoided in 52 of the 70 patients and could have been avoided in seven others.