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To make the most out of the PDF (Portable Document File) format, you must be aware of the best PDF compression software . The PDF format is extremely useful ... Initial laboratory testing should include a complete blood count to evaluate for anemia or leukocytosis, and a urine or serum beta-human chorionic gonadotropin ( -hCG) measurement to exclude a pregnancy-related etiology. Elevated hCG can also indicate gestational trophoblastic disease or a gem cell tumor. Assessment of germ cell tumor markers, including -hCG, alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), is indicated when imaging shows a solid or complex adnexal mass in an adolescent or young woman. In a 45-year-old patient, obtaining germ cell tumor markers would be inappropriate. If this patient has ovarian cancer, it is most likely epithelial in origin. CA-125 and CEA would be the two tumor markers that might be considered useful in the evaluation of this patient. It must always be remembered that only 80% of ovarian cancers will have an elevated CA-125 value (20% false negative), and that CA125 is only elevated in from 25% to 50% of stage I ovarian cancers. Conversely, there are a host of benign conditions that will falsely elevate CA-125 (Table 8.3). Therefore, the CA-125 value must be interpreted in the context of the patient s age, symptoms, and ultrasound characteristics of the mass. The patient s serum CA-125 is 12 U/mL (normal is 35 U/mL) and her ultrasound shows a 5-cm cystic left adnexal mass that is predominantly cystic but has a solid area without increased ow on Doppler (Fig. 8.4). Ascites is not present, and the right ovary and uterus are normal. Given these ndings, the patient would like to know the probability that she has cancer. pdf compressor software free download for windows 10: Free PDF Compressor - Free download and software reviews ... pdf compressor software free download for windows 7 64 bit Reduce PDF Size
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