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Re: AGUS From: Joanne Bulley, MD (islesannie@yahoo.com) Sun May 1 19:20:52 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "FRI: Keeping it Simple" Previous message: Robert J. Carpenter, Jr. MD: "Re: Fri: What do you read?" Just got back for a weekend at Lake Winnepesaukee. So - in answer to several of those commenting: If I recall correctly, I still had one heck of a time getting an ECC when I did the LEEP. So I think I will plan on the cold knife cone (in the OR, thank you very much) and see if I can get into the uterus to check all the glandular tissue out (endocervical and endometrial). Then next step - probably straight vag hyst. I don't do LEEPs in the office. 1 - because I have no RNs and do no local =/- sedation etc in the office. (well I do local for vulvar biopsies - but not cervical blocks) 2 - and the reason I have not seen fit to go for #1 - is that I have had too many women come to me with their horror stories of their in office LEEPs in nearby gyn offices. 3. This patient is nullip and I have one heck of a time getting the stretch of the vagina just right to do a LEEP on nullip patients AND ... last but not least 4. I would not let someone do that to me without something for relaxation and knock out those old whort term memory synapses! 5. The numbers for me and me alone do not justify the cost of buying the equipment Joanne At Thu, 28 Apr 2005, Rafael Haciski 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 > >>>>> -----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 Next message: Joanne Bulley, MD: "FRI: Keeping it Simple" Previous message: Robert J. Carpenter, Jr. MD: "Re: Fri: What do you read?"

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