WILTIMS #291-2: ♪♫ mOlé! mOlé, mOlé, mOlé... ♫♪

MondayIL: A whole new kind of mole. No, not this one or this one or this one or even this one. Complete or partial moles are types of abnormal pregnancy caused either by a sperm (or two) fertilizing a genetically empty egg or two sperm fertilizing the same egg. The latter can result in a 69 chromosome fetal mass. As we went over recently, humans can survive with a select few trisomies (an extra copy of a chromosome) but if every chromosome is duplicated, the embryo can't even develop. The resulting "pregnancy" consists of, essentially, a blob of undifferentiated cysts and must be aborted.

Diethylstilbestrol (DES) is an old drug that was used as a prenatal drug but was later found to caused clear cell carcinoma of the vagina, both in the pregnant women that took the drug and in the female children born of these women. DES was restricted from this use in 1971.

Placental invasion of the myometrium (the muscle layer of the uterus) is classified according to the depth of the invasion. Placenta accreta is attachment, increta is invasion and percreta is completely breaking through the myometrium.

Schober's test measures the ability to bend the lower back and is useful in diagnosis diseases like ankylosing spondylitis. To do it, you note the position of the 5 lumbar vertebra and, with the patient standing straight, place one finger 5cm below and one finger 10cm above. When the patient bends to touch their toes, that 15cm distance should increase to 20cm or more. If not, something's wrong.

TuesdayIL: A pessary is essentially a plug that can be used to keep the uterus from prolapsing in patients where surgical repair is contraindicated.

There's a nifty memory tool for remembering the difference between the main  adrenal enzyme deficiencies (see the diagram to the right). With 11β-hydroxylase deficiency, both blood pressure and virility increase; with 17-hydroxylase deficiency, BP goes up but virility decreases; and with 21-hydroxylase deficiency, the BP goes down and virility goes up. All you have to remember is that ones point up!