Good Samaritan Hospital Medical Center

The lifetime risk of ovarian cancer is 1 in 75, and it is often diagnosed at an advanced stage due to the lack of effective screening. Epithelial ovarian cancer (EOC) is the most common type of ovarian cancer in older patients, with borderline ovarian tumors (BOTs) accounting for 15% of EOC cases. BOTs are usually of low malignant potential. Since platinum-based chemotherapy has not been shown to improve survival rates, cytoreductive surgery (CRS) is recommended as a treatment option. Additionally, endometriosis affects 10.5% of patients with EOC. It often progresses to clear cell and endometrioid ovarian cancer. This progression is believed to result from repetitive cycles of inflammation, mutations in multiple pathways, and microsatellite instability. While other types of cancers, such as BOTs, can arise in cases of endometriosis, they are less common. This case report describes an unusual case of a 62-year-old female patient who appeared to present with advanced-stage epithelial ovarian cancer (EOC) but was unexpectedly diagnosed with a borderline ovarian tumor (BOT) accompanied by extensive endometriosis. The patient’s history of endometriosis, infertility, and low parity increased her risk of developing a BOT; however, her age at presentation was unusual. The key clinical feature of this case that contributes to the existing literature is the vital role of pathology in guiding chemotherapy decisions, particularly when there is disease progression despite ongoing treatment. This highlights the necessity of a thorough history and physical examination, as several aspects in the patient’s medical history were suggestive of a BOT. The patient initially presented with emesis, abdominal distention, postmenopausal bleeding, and a large, rapidly growing pelvic mass, which raised the initial suspicion of advanced EOC. However, she was unable to undergo surgery due to supraventricular tachycardia and venous thromboembolism (VTE) caused by the mass effect of the tumor. Despite being medically unstable, an exploratory laparotomy with resection of the mass was performed. Pathology revealed a stage 1C3 serous BOT within a large endometrioma. Chemotherapy was not required postoperatively. The patient remained under close observation by gynecologic oncology for surveillance, hematology for managing her VTE, and cardiology for monitoring her supraventricular tachycardia (SVT).

We report a case of a young male patient presenting with accidental carbon monoxide poisoning leading to pulmonary embolism, acute myocardial infarction, right and left ventricular thromboses, acute limb ischemia, and acute renal failure. We review clinical aspects of carbon monoxide poisoning with a specific focus on cardiovascular and systemic thrombotic complications.

This article describes an interactive heparin drip learning exercise for nurse residents using concepts similar to "The Amazing Race." The goal of the exercise was to strengthen critical thinking related to heparin drip setup and maintenance in the acute care setting. The game consisted of a start line and five pit stops to solve a puzzle, perform a skill, perform a medication calculation, perform an intervention, and complete a short quiz.

High-energy blunt thoracic trauma is a highly morbid condition. When a pneumonectomy is required in such a setting, the mortality rate increases significantly. Here, we present a case of a motor vehicular crash (MVC) in which the patient suffered bilateral bronchial injuries requiring emergent thoracotomy, pneumonectomy, bronchial stenting, and initiation of venovenous extracorporeal membrane oxygenation (VV ECMO). The patientultimately survived his injuries and was able to fully recover. We review the relevant literature in regard to the use of pulmonary stenting and VV ECMO in the setting of thoracic trauma management.