Monday, January 30, 2006
Sunday, January 29, 2006
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
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
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%
1. Tierney, Jr,
Tuesday, January 17, 2006
Monday, January 16, 2006
Fall in first 24 weeks, rises to baseline by term
140/90 after 20 weeks gestation
GFR increases 50%, renal plasma flow increases
serum urea and creatinine decrease;
enhanced waste metabolite removal;
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)
Presenting sign but 1/3 don’t have it
Venous stasis from hypercoagulable state
Systemic vasospasm, coagulation system activation, abnormal hemostasis
Cycle – endothelial injury, platelet activation, platelet consumption
Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA
TXA > PGI
PGI – vasodilator and inhibitor of platelet aggregation
TXA – vasoconstriction and platelet aggregation
Increased sympathetic state – vasoconstriction
Free radical oxidation products
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
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)|
Cerebral or visual disturbances
- hepatic subcapsular hemorrhage
-stretch or rupture of liver capsule
|Severe cases -> Eclampsia|
HELLP Syndrome - hemolysis, elevated liver enzymes, low platelets - severe preeclampsia.
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.