Re: AGUS
From: Rafael Haciski (haciski@earthlink.net)
Fri Apr 29 08:53:28 2005
Because I like to see what I am doing, because I am more comfortable
with that approach, and because I am more comfortable removing ovaries
laparoscopically and not vaginally. You can do it vaginally if you
prefer.
Why should vaginal be the default?
--
Rafael C. Haciski MD FACOG
Bradenton FL
On Apr 29, 2005, at 07:58, R. Daniel Braun wrote:
> Why laparoscopic instead of vaginal?
> Vaginal should be the default with laparoscopic being done only if
> vaginal can't be for some reason.
>
> On 4/28/05, Rafael Haciski <haciski@earthlink.net> wrote:
>> I agree with Dr. Siegel (except for the OR)
>> .. generous LEEP in office
>> .. hysteroscopy through the now open canal, with biopsy as needed
>> .. endocervical curettage
>>
>> And if no cancer found then schedule for hysterectomy (my preference
>> laparoscopic, with BSO)
>>
>> Rafael C. Haciski MD FACOG
>> Bradenton FL
>>
>> On Apr 28, 2005, at 22:10, Garry E. Siegel, M.D. wrote:
>>
>>> Hey, check out the ASCCP guidelines. http://www.asccp.org/
>>>
>>> Before you do a TVH and find an undiagnosed cancer (unlikely, but. .
>>> .), if you cannot access her cervix due to stenosis, why not do an OR
>>> visit:
>>>
>>> 1. Cold knife cone--unless you feel the cervix is "cleared" and it
>>> doesn't need evaulation.
>>> 2. ECC
>>> 3. Hysteroscopy/endometrial curettage
>>>
>>> Unless I'm missing something, you have an unexplained AGUS smear (CIN
>>> doesn't fully cover that) and you've not been able to evaluate the
>>> endometrium or the endocervix.
>>>
>>> Garry
>>>
>>> At Thu, 28 Apr 2005, Joanne Bulley, MD wrote:
>>>>
>>>> My thoughts run the same way as you and Efrain
>>>>
>>>> Joanne
>>>>
>>>> At Thu, 28 Apr 2005, ainsron wrote:
>>>>>
>>>>> Cone or LEEP. Consider TVH.
>>>>>
>>>>> Ronald E. Ainsworth
>>>>>
>>>>> -----Original Message-----
>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>>> Joanne
>>>>> Bulley, MD
>>>>> Sent: Thursday, April 28, 2005 2:36 PM
>>>>> To: Multiple recipients of list OB-GYN-L
>>>>> Subject: AGUS
>>>>>
>>>>> 48 yo G0 s/p Cryosurgery of cervix prior to 1993. (presume CIN)
>>>>> VIN 3 (carcinoma in situ) of vulva at posterior introitus excised
>>>>> 1998.
>>>>> Vulvar coploscopies normal since then.
>>>>>
>>>>> Pap 3/04 AGUS (possible adenocarcinoma in situ)
>>>>> LEEP (cervical stenosis from cryo precluded any office evaluation)
>>>>> path: CIN 1 - mild dysplasia with severe cervicitis, comparison
>>>>> with
>>>>> Pap
>>>>> confirms the same cellular characterisics were present.
>>>>>
>>>>> Pap 10/04 ASCUS negative for high risk HPV subtypes.
>>>>>
>>>>> Pap 3/05 AGUS.
>>>>>
>>>>> Colposcopy - unable to see SCJ. Endocervical curette would not
>>>>> pass
>>>>> through stenotic cervix. Endocervical specimen taken with
>>>>> endocervical
>>>>> brush.
>>>>>
>>>>> Pathology pending.
>>>>>
>>>>> Of course the next step will depend somewhat on the patology, but,
>>>>> what
>>>>> do you think you would do next?
>>>>>
>>>>> Joanne
>>>>>
>>>>> --
>>>>> Joanne Bulley, MD
>>>>> Keene, NH, USA
>>>>>
>>>> --
>>>> Joanne Bulley, MD
>>>> Keene, NH, USA
>>>>
>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>>
>>
>
> --
> R. Daniel Braun
> Kinky for Governor
>
