Re: baffling case
From: Dr Eberhard W Lisse (el@lisse.NA)
Tue May 31 15:02:39 2005
I don't see the results of a Full Blood Count and Differential. But then
these are probably too cheap, when we can spend 10 Million USD.
greetings, el
--
Dr. Eberhard W. Lisse \ / Managing Member, NA-NiC (cc)
dns-admin@na-nic.com.NA /* | Telephone: +264 81 124 6733 (cell)
PO Box 1342 \ / Please do NOT send e-mail to el@lisse.NA
Swakopmund Namibia ;____/ if it is in ANY way DNS/NA-NiC related
In message <259b461f05053110095b2674ad@mail.gmail.com>, "R. Daniel Braun" write
s:
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> D&C ???????
> Imaging does not rule out retained material with 100% accuracy.
> What does the wound look like?
>
> On 5/31/05, Richard Chudacoff, MD <rchudacoff@mylinuxisp.com> wrote:
> >
> > 21 yo G1, GBS negative, admitted through the midwife service 12 days ago> .
> > She arrested in dilation, after IUPC and FSE, and underwent an unremarkab> le
> > low transverse c-section via Pfannenstiel skin incision 10 days ago. 36>
> > hours post-op she spike to 103 degrees F and hand a tender uterus, and wa> s
> > started on Ampicillin, gentamycin and clindamycin (by the resident on cal> l)
> > for post partum endomyometritis. 48 hours post op she was still febrile. > ID
> > was consulted, after another exam which noted a still tender uterus and s> he
> > was switched to vancomycin and meropenem to cover MRSA as well as the
> > usually culprits. She has a history of IBD and grew out C. diff on stool>
> > culture and was started on Flagyl. She also started taking scheduled Motr> in
> > and Tylenol. She defervesced for 36 hours and the antibiotics were stoppe> d,
> > except for the Flagyl, as were the anti-pyretics. 4 hours later she spike> d
> > to 103. Antibiotics and anti-pyrectis were restarted. Pelvic U/S was
> > negative. KUB to r/o foreign body was negative. CT of pelvis was negative> ,
> > as was chest x-ray, blood cultures and urine culture (from the original>
> > workup) and all subsequent cultures have been negative. She defervesed, a> nd
> > was stable for 24 hours. Anti-pyrectics were stopped 48 hours ago, and sh> e
> > then spiked again, despite being on anti-biotics. Repeat CT is negative, > as
> > is repeat CXR. Doppler studies of the lower extremities are negative, wit> h
> > great flow bilaterally. GI consults negative. No evidence of cardiac valv> e
> > abnormalities ruling out SBE.
> >
> > I'm thinking that the only thing left to try is heparin for septic pelvi> c
> > thrombophelbitis or septic gonadal thrombophelbitis. I thought she might>
> > have a drug fever, however she did spike after discontinuation of the won> der
> > drugs.
> >
> > Any thoughts, pearls, questions, and acceptance of transfer to your
> > service would be appreciated.
> >
> > Richard Chudacoff, MD, FACOG
> >
> > Women's Specialists of Houston
> >
> > 6624 Fannin Suite 1800
> >
> > Houston, TX, 77030
> >
> > 713-797-1144
> >
> > 713-425-3071
> >
> > Email: Richard.Chudacoff@obgyn.net
> >
> > rchudacoff.md@womenspecialists.com
> >
> > This message is confidential, intended only for the named recipient(s)>
> > and may contain information that is privileged or exempt from disclosure>
> > under applicable law. If you are not the intended recipient(s), you are>
> > notified that the dissemination, distribution or copying of the messages > is
> > strictly prohibited. If you receive this message in error, or are not the>
> > named recipient(s), please notify the sender at either the e-mail address> or
> > telephone number above and delete this e-mail from your computer.
> >
>
> --
> R. Daniel Braun
> Kinky for Governor
>
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> <div>D&C ???????</div>
> <div>Imaging does not rule out retained material with 100% accuracy.</div>
> <div>What does the wound look like?<br><br> </div>
> <div><span class="gmail_quote">On 5/31/05, <b class="gmail_sendername">> Richard Chudacoff, MD</b> <<a href="mailto:rchudacoff@mylinuxisp.com">> rchudacoff@mylinuxisp.com</a>> wrote:</span>
> <blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0> px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">
> <div>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">21 yo G1, GBS negative, admitted through the midwife service 12> days ago. She arrested in dilation, after IUPC and FSE, and underwent an u> nremarkable low transverse c-section via
> <font color="black"><span style="COLOR: black">Pfannenstiel</span></fon> t> skin incision 10 days ago. 36 hours post-op she spike to 103 degrees F a> nd hand a tender uterus, and was started on Ampicillin, gentamycin and clin> damycin (by the resident on call) for post partum endomyometritis. 48 hours> post op she was still febrile. ID was consulted, after another exam which > noted a still tender uterus and she was switched to vancomycin and meropene> m to cover MRSA as well as the usually culprits. She has a history of IBD a> nd grew out C. diff on stool culture and was started on Flagyl. She also st> arted taking scheduled Motrin and Tylenol. She defervesced for 36 hours and> the antibiotics were stopped, except for the Flagyl, as were the anti-pyre> tics. 4 hours later she spiked to 103. Antibiotics and anti-pyrectis were r> estarted. Pelvic U/S was negative. KUB to r/o foreign body was negative. CT> of pelvis was negative, as was chest x-ray, blood cultures and urine cultu> re (from the original workup) and all subsequent cultures have been n> egative. She defervesed, and was stable for 24 hours. Anti-pyrectics were s> topped 48 hours ago, and she then spiked again, despite being on anti-bioti> cs. Repeat CT is negative, as is repeat CXR. Doppler studies of the lower e> xtremities are negative, with great flow bilaterally. GI consults negative.> No evidence of cardiac valve abnormalities ruling out SBE.
> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">I'm thinking that the only thing left to try is heparin for sep> tic pelvic thrombophelbitis or septic gonadal thrombophelbitis. I thought s> he might have a drug fever, however she did spike after discontinuation of > the wonder drugs.
> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">Any thoughts, pearls, questions, and acceptance of transfer to > your service would be appreciated.</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">Richard Chudacoff, MD, FACOG</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">Women's Specialists of Houston</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">6624 Fannin Suite 1800</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">Houston</span></font><font face="Arial" size="2"><span styl> e="FONT-SIZE: 10pt; FONT-FAMILY: Arial">, TX, 77030</span></font><font fa> ce="Arial" size="2">
> <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"></span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">713-797-1144</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">713-425-3071</span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">Email: <a onclick="return top.js.OpenExtLink(window,event,thi> s)" href="mailto:Richard.Chudacoff@obgyn.net" target="_blank">Richard.C> hudacoff@obgyn.net
> </a></span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> <a> onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:rc> hudacoff.md@womenspecialists.com" target="_blank">rchudacoff.md@womenspec> ialists.com
> </a></span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"> </span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial"><img height="172" src="cid:image001.jpg@01C565C0.980AD4A0" > width="241"></span></font></p>
> <p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAM> ILY: Arial">This message is confidential, intended only for the named recip> ient(s) and may contain information that is privileged or exempt from discl> osure under applicable law. If you are not the intended recipient(s), you a> re notified that the dissemination, distribution or copying of the messages> is strictly prohibited. If you receive this message in error, or are not t> he named recipient(s), please notify the sender at either the e-mail addres> s or telephone number above and delete this e-mail from your computer.
> </span></font></p>
> <p><font face="Times New Roman" size="3"><span style="FONT-SIZE: 12pt> "> </span></font></p></div></blockquote></div><br><br><br>-- <br>R. Da> niel Braun<br> Kinky for Governor
>
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> ------=_Part_16601_13252069.1117559378936--
>
![cid:image001.jpg@01C565C0.980AD4A0"](mailto:cid:image001.jpg@01C565C0.980AD4A0"?subject=Re:%20baffling%20case){kind=link}
