Re: 19mm endometrial stripe : follow up
From: art fougner, md (evsono@pipeline.com)
Sun Jan 2 12:29:14 2005
Regarding pipelle and polyps, Karadadas et al found -
"Standard endometrial sampling failed to detect almost half of the
cases."
Clin Exp Obstet Gynecol. 2004;31(2):137-8.
art
At Sun, 2 Jan 2005, Henry Gregor wrote:
>
>Good point. Also, cost of a Pipelle endobx procedure vs. a sonohysterogram?
>
>Hank
>
>"Joanne Bulley, MD" <islesannie@yahoo.com> wrote:
>If the sonohysterogram had shown global thickening -- recall she is
>postmenopausal and bleeding while on Vivelle 0.025 and 50 mg
>progesterone QD ... you still need tissue -- and she has just had an
>episode of saturating pads every 1-2 hours in early December (while
>driving to and moving into her place in Florida) -- is there anyone here
>who would not have decided to do a hysteroscopy / D&C to remove the
>endometrium?
>
>If there is anyone who would have just left a thickened endometrium in
>situ -- let me know your thinking!
>
>Joanne
>
>At Wed, 29 Dec 2004, art fougner, md wrote:
>>
>>But, had the sonohysterogram shown a global thickening of the
>>endometrium, the trip to the OR would have possibly been unnecessary.
>>And so it goes ...
>>
>>art
>>
>>At Tue, 28 Dec 2004, Joanne Bulley, MD wrote:
>>>
>>>Thanks Robert. It is nice to know that I am not the only one who
>>>resorts to look - grab - look again - grab some more - eventually
>>>yanking it out!
>>>
>>>Final path -- just a totally benign polyp. She is glad I insisted on
>>>doing her ultrasound during the 5 days she was home (3 days before Xmas
>>>- and Xmas and the 26th!) She ended up staying 3 more days so she could
>>>get ikt taken care of here before returning to her winter abode in
>>>Florida.
>>>
>>>The sonhysterography would have showed the polyp ... and she'd have
>>>gone to the OR for removal -- and the hospital and radiologist would
>>>have gotten more $$$$ than I get for taking care of the problem! (They
>>>probably already get more for the US they did than I will get for the OR
>>>procedure!) When they do a transabdominal and transvaginal ultrasound
>>>... they already charge for 2 ultrasounds and 2 reading fees ... so if
>>>they did the sonohysterogram -- they'd charge for a third imaging and
>>>charge for inserting the catheter to do it! And it would not have
>>>changed my procedure or the outcome -- so why suggest another imaging?
>>>
>>>It'd be different if it was in my office and I would only charge for one
>>>thing ... but the radiologists already self refer for mor images all
>>>the time. There is a time to see the 19 mm lining and go after it!
>>>
>>>Joanne
>>>
>>>At Tue, 28 Dec 2004, RModugno@aol.com wrote:
>>>>
>>>>I'm sometimes pretty gross about getting out polyps - I look in with the
>>>>hysteroscope, then get out my trusty Corson myoma grasper - put it in through
>>>>the cervix and with luck, pull out the polyp. Can always look back in later to
>>>>see if I got it all.
>>>>
>>>>Pity sonohysterography is not an option - if they do hysterosalpingograms,
>>>>then this should be a "piece of cake".
>>>>
>>>>Robert Modugno MD MBA FACOG
>>>>Marietta, GA
>>>>_www.novaobgyn.yourmd.com_ (http://www.novaobgyn.yourmd.com)
>>>
>>>--
>>>Joanne Bulley, MD
>>>Keene, NH, USA
>>>
>>>"Every gun that is made, every warship launched, every rocket fired,
>>>signifies in the final sense a theft from those who hunger and are not fed,
>>>those who are cold and are not clothed."
>>>
>>>President Dwight D. Eisenhower
>>>April 16, 1953
>>>
>>--
>>art fougner, md
>>May the Joy of this Holiday Season Be with You
>>and Yours throughout the New Year.
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
>"Every gun that is made, every warship launched, every rocket fired,
>signifies in the final sense a theft from those who hunger and are not fed,
>those who are cold and are not clothed."
>
>President Dwight D. Eisenhower
>April 16, 1953
>
--
art fougner, md
May the Joy of this Holiday Season Be with You
and Yours throughout the New Year.
