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Re: TOA and HIV From: Steve & Eryl Raymond (eryl@intekom.co.za) Fri Mar 26 13:23:36 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Steve & Eryl Raymond: "Re: DVT risk" Previous message: Steve & Eryl Raymond: "Re: Version at 37wks" In reply to: Dr. Ainsworth: "TOA and HIV" Next in thread: RModugno@aol.com: "Re: TOA and HIV" We see this a lot here. I am tending to be more conservative and would want to wait a few more days to see if the improvement will continue. My experience has been that a good proportion of these will take up to five days to become asymptomatic. Those who don't get a laparotomy then. At laparotomy I just take out the affected adnexum or adnexa, as I think a hysterectomy provides too much opportunity for a major cuff infection. What is her CD4? and is she on HAART? Steve Dr. Ainsworth wrote: > 42 yo patient, known HIV positive, admitted through ER with sepsis and > pelvic mass, blood cultures positive for E.coli, cervical cultures - > normal vaginal flora. Placed on triple antibiotics on admission by > Hospitalist. Two days into therapy, CT scan showed a nonspecific pelvic > mass, Sonogram the next day showed a 13x9x9 cm pelvic mass. When I > examined her the same day she had a very obvious pelvic mass, palpable > above the pelvic brim, very tender. No free fluid on the sonogram. She > is now still symptomatic with pelvic pain, decreased abdominal > tenderness, afebrile, WBC has come down from 26,000 on admission with a > marked left shift, now 14,400 with no bands. Where would you go from > here? > 1- ultrasound or CT guided drainage of the mass > 2- OR for vaginal drainage of mass / colpotomy > 3- OR for Abdominal drainage of mass > 4- OR for TAH/BSO > > My feeling is that she is clinically stable enough at this time for > definitive surgical treatment and to approach it abdominally with plans > to back off and simply drain it if there is too much phlegmon to safely > remove it. > Next message: Steve & Eryl Raymond: "Re: DVT risk" Previous message: Steve & Eryl Raymond: "Re: Version at 37wks" In reply to: Dr. Ainsworth: "TOA and HIV" Next in thread: RModugno@aol.com: "Re: TOA and HIV"

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