Monday, January 30, 2006


8 AM - My first surgical 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%


1. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 719-722.

Tuesday, January 17, 2006

Old Main at Penn State

A picture of Old Main, the administrative building at Penn State with snow on the ground. The color picture was changed using the filter photocopy in Adobe Photoshop.

Monday, January 16, 2006

Pregnancy, Preeclampsia, Severe Preeclampsia, Eclampsia

Normal Pregnancy


Severe Preeclampsia

Blood Pressure

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)

Oliguria <>



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

Prostanoid Changes

Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA


PGI – vasodilator and inhibitor of platelet aggregation

TXA – vasoconstriction and platelet aggregation


Increased sympathetic state – vasoconstriction

Nitric Oxide


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)


pulmonary edema


Cerebral or visual disturbances



Epigastric pain
- 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.

Sunday, January 08, 2006

Thursday, January 05, 2006

First Day of Ob-Gyn

Today was my first day of Ob-Gyn, and I saw two deliveries. One patient was having frequent contractions and she started to have the baby while I was telling a resident about the patient. Actually, she was having such bad contractions, I hurried my interview and told my resident about her. She was rushed into the delivery room, and while my fellow medical student and I were looking for shoe protectors, in two minutes, she had the baby. The second delivery was a caesaraen section which was iminent. The whole process of deciding to do the C-section and taking the baby out took about 15 minutes. It was truly amazing how fast labor and delivery can progress.