Monday, January 30, 2006
Incision
Made three incisions in the surgery that totaled less than 3 cm. They were for a suburethral sling. Also got to close in both surgeries.
Sunday, January 29, 2006
Ovarian Tumors
Ovarian Tumors
1. Introduction
a. Malignant ovarian tumors are the leading cause of death from reproductive tract cancer.
b. Majority of ovarian tumors are benign.
c. General lifetime risk is 1.6% and 5% with a first degree family relative.
d. Lifetime risk with BRCA1 gene is 45% and with BRCA2 gene is 25%.
2. Clinical Findings
a. Symptoms and Signs
i. Most patients are asymptomatic.
ii. Mild nonspecific gastrointestinal symptoms or pelvic pressure
iii. Pelvic exam can detect early disease.
iv. Advanced disease can present with bloating, abdominal pain, ascites, and palpable abdominal mass.
b. Lab Findings
i. CA 125 level greater than 35 units can indicate malignancy.
ii. CA 125 elevated in 80% of epithelial ovarian cancer and only 50% in early disease.
c. Imaging Studies
i. Transvaginal Ultrasound for screening
ii. Ultrasound helps differentiate from benign and malignant neoplasm.
3. Differential Diagnosis for an Ovarian Mass
a. Functional
b. Benign Neoplastic
i. Premenopausal woman, asymptomatic, mobile, unilateral, simple cystic mass less than 7.5 cm
c. Potentially Malignant
d. Predictive factors include age, size of the mass, ultrasound configuration, CA 125 levels, symptoms, and symmetry
4. Treatment
a. Malignant neoplasm – surgical staging, abdominal hysterectomy, bilateral salpingo-oophorectomy
i. Advanced disease
1. removal of all visible tumor
2. post-operative chemotherapy
a. cisplatin or carboplatin with paclitaxel
b. Benign neoplasms – tumor removal or unilateral oophorectomy
5. Prognosis (5 yr survival)
a. Distant metastases – 17%
b. Local spread – 36%
c. Early disease – 89%
Source:
1. Tierney, Jr,
Tuesday, January 17, 2006
Old Main at Penn State
Monday, January 16, 2006
Pregnancy, Preeclampsia, Severe Preeclampsia, Eclampsia
Normal Pregnancy | Preeclampsia | Severe Preeclampsia | |
Blood Pressure | Fall in first 24 weeks, rises to baseline by term | 140/90 after 20 weeks gestation | >160/100 |
Kidneys | GFR increases 50%, renal plasma flow increases serum urea and creatinine decrease; enhanced waste metabolite removal; glycosuria | Vasospasm and capillary endothelial swelling -> reduction in GFR Serum uric acid and creatinine increased Proteinuria > 300 mg in a 24 hour collection | proteinuria > 5 g/24h, oliguria (<500cc/24h) Oliguria <> |
Edema | Normal | Presenting sign but 1/3 don’t have it | |
Hemostatic | Venous stasis from hypercoagulable state | Systemic vasospasm, coagulation system activation, abnormal hemostasis Cycle – endothelial injury, platelet activation, platelet consumption | |
Prostanoid Changes | Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA | TXA > PGI PGI – vasodilator and inhibitor of platelet aggregation TXA – vasoconstriction and platelet aggregation | |
Autonomic | Increased sympathetic state – vasoconstriction | ||
Nitric Oxide | Reduced | ||
Free radical oxidation products | Increased | ||
Hematologic | Plasma vol inc, RBC mass inc à “physiologic anemia” of pregnancy Hgb 11.5 mg/dl WBC count increases Hypercoagulable state – inc fibrinogen, factor VII to X increase – venous stasis | - Thrombocytopenia - <100,000 class="MsoNormal">- fibrinogen decreased - coagulation time increased (PT, PTT) -Can progress to DIC | |
Hepatic | Signs of liver disease Spider angiomata and palmar erythema – elev estrogen Serum – dec albumin, elev alk phos, elev cholesterol Estrogen increased proteins – fibrinogen, thyroid hormone binding globulin, ceruloplasmin Hepatic enzymes – AST/ALT, PTT unchanged | 10% - transaminase elevation | impaired liver function (AST/ALT >70) |
Pulmonary | pulmonary edema | ||
Neurological | Cerebral or visual disturbances Headache | ||
GI | Epigastric pain - hepatic subcapsular hemorrhage -stretch or rupture of liver capsule | ||
Seizures | Severe cases -> Eclampsia |
HELLP Syndrome - hemolysis, elevated liver enzymes, low platelets - severe preeclampsia.
Sources:
1. Rubin, Emanuel . Rubin's Pathology: Clinicopathologic Foundations of Medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005 : 986-7.
2. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 747-9.
Sunday, January 08, 2006
Sensitivity Specificity Positive Predictive Value and Negative Predictive Value Calculator
Thursday, January 05, 2006
First Day of Ob-Gyn
Tuesday, January 03, 2006
Nagel's Rule for Pregnancy Due Date
Can calculate a due date based on LMP. Similar to a Pregnancy Wheel and Ovulation Calendar.