Re: OB-GYN-L digest 4037
From: Deborah Syden (dsyden@gmail.com)
Wed Jul 27 08:42:26 2005
Hi,
I apologize for the intrusion as I'm not a doctor. I realize this is
not the appropriate forum to discuss questions pertaining to an
individual's personal questions, as such, please feel free to respond
to my personal email address at DSYDEN@GMAIL.COM.
My inquiry pertains to any doctors treating patients with Ehlers
Danlos Syndrome. Personally, I have EDS Type III. Although rather
unexpected, I am 9 weeks into my first pregnancy. I've been rather
hard pressed to find detailed research pertaining to pregnancy and
EDS. I have found only a few research articles pertaining to this
subject. Most of which are from overseas and date back quite some
time.
I ask this not only to gather information for myself but for my pain
clinic doctor. He plans on using presenting my symptoms as a case
study. (I'm extremely advanced and symptoms are very pronounced.) I
in turn, am conducting as much research as possible for this
presentation. Ultimately I plan on developing a matrix pertaining to
methods of treatment and relief. Now that I'm pregnant and discovered
the minute availability of research, I've learned this too must be
explored prior to our presentation. Any information you might have
pertaining to the treatment of pregnancy and EDS would be greatly
appriected.
Please bear with me for one additional question. Have you treated a
patient who used a MEDTRONIC pain pump during the entire pregnancy? If
so, were there any complications? I ask as I have a surgically
implanted intrathecal pump with SuFentinal. I've had the pump for five
years and this particular dosage regime for approximately 2 years.
Thank you for your patience. Please feel free to email your reponse
to DSYDEN@GMAIL.COM.
Have a great day,
Deborah
On 7/26/05, ob-gyn-l@obgyn.net <ob-gyn-l@obgyn.net> wrote:
> OB-GYN-L Digest 4037
>
> Topics covered in this issue include:
>
> 1) RE: Vulvar MRSA
> by "Robert J. Carpenter, Jr. MD" <zygote@icsi.net>
> 2) Re: Vulvar MRSA
> by evsono@pipeline.com (art fougner, md)
> 3) RE: Vulvar MRSA
> by "ainsron" <ainsron@sbcglobal.net>
> 4) RE: Re: Vulvar MRSA
> by "ainsron" <ainsron@sbcglobal.net>
> 5) Endometrial hyperplasia
> by henrygregor@yahoo.com (Hank Gregor)
> 6) Re: Vulvar MRSA
> by evsono@pipeline.com (art fougner, md)
> 7) RE: Endometrial hyperplasia
> by "benjamin sharp" <sharp_benjamint@hotmail.com>
> 8) RE: Endometrial hyperplasia
> by Henry Gregor <henrygregor@yahoo.com>
> 9) RE: Re: Vulvar MRSA
> by "ainsron" <ainsron@sbcglobal.net>
> 10) Re: Endometrial hyperplasia
> by "R. Daniel Braun" <rd.braun@gmail.com>
> 11) Re: Endometrial hyperplasia
> by <l.glazerman@rcn.com>
> 12) Re: Endometrial hyperplasia
> by Henry Gregor <henrygregor@yahoo.com>
> 13) Re: Vulvar MRSA
> by eramirezt@coqui.net (Efrain Ramirez)
> 14) Re: Endometrial hyperplasia
> by eramirezt@coqui.net (Efrain Ramirez)
> 15) Re: Endometrial hyperplasia
> by dmecnm@aol.com
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Tue, 26 Jul 2005 06:40:20 -0500
> ----------------------------------------------------------------------
> From: "Robert J. Carpenter, Jr. MD" <zygote@icsi.net>
> To: ob-gyn-l@obgyn.net
> Subject: RE: Vulvar MRSA
> Message-ID: <42E5DAD4.20059.4E83E37@localhost>
> MIME-Version: 1.0
> Content-type: text/plain; charset=US-ASCII
> Content-transfer-encoding: 7BIT
> Content-description: Mail message body
>
> Treatment with Bactrim DS, Cleocin, before delivery are reasonable. Postdelivery
> depending on degree of infection then Tetracyclines work. What is her gestational
> age.
>
> You can call Seb FAro at 713-799-8994. What are the in vitro sensis
>
> On 25 Jul 2005 at 13:55, ainsron wrote:
>
> > I haven't even had a chance to talk to her yet, I was gone the end of
> > last week and the culture was sitting on my desk today. She had an
> > appointment today, but cancelled it because she had to go out of town.
> > I'll have her call me when she gets back. I wish an ID consult was
> > an option, there are none in Northern CA, she would have to go 90+
> > miles to Sacramento.
> >
> > Ronald E. Ainsworth, MD, FACOG
> >
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> > RModugno@aol.com Sent: Monday, July 25, 2005 11:39 AM To: Multiple
> > recipients of list OB-GYN-L Subject: Re: Vulvar MRSA
> >
> > In a message dated 7/25/2005 12:43:34 PM Eastern Standard Time,
> > ainsron@sbcglobal.net writes:
> >
> > I saw a OB patient last week with a markedly erythematous vulva with
> > multiple excoriations and linear ulcerations. She was positive for
> > trichomonas and treated with Flagyl. I also did a routine vaginal
> > culture that came back positive for MRSA. How would you treat it,
> > Vancomycin? The hospital will go crazy unless I document clearance
> > before labor. Would you do vaginal and nasal cultures?
> >
> > This patient needs hospitalization, aggressive IV antibiotics, with
> > I.D. consultation.
> >
> > Know of 2 patients at our hospital with MSRA secondarily infectied
> > vulvar ulcerative disease ( one from HSV) She subsequently had to have
> > a hindquarter amputation!
> >
> > Is your patient doing OK?
> >
> > Robert Modugno MD MBA FACOG
> >
> > Marietta, GA
> >
>
> Robert J. Carpenter, Jr. MD
> 6624 Fannin, #2720
> St. Luke's Medical Tower
> Houston,TX 77030-2339
> 713-795-4600
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 07:34:41 -0500 (CDT)
> ------------------------------
> From: evsono@pipeline.com (art fougner, md)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Vulvar MRSA
> Message-ID: <200507261234.j6QCYfZ26187@dns.obgyn.net>
>
> Do you think that MSRA is the causal agent of this patient's vulvitis or
> a fellow traveller?
>
> art
>
> At Tue, 26 Jul 2005, Robert J. Carpenter, Jr. MD wrote:
> >
> >Treatment with Bactrim DS, Cleocin, before delivery are reasonable. Postdelivery
> >depending on degree of infection then Tetracyclines work. What is her gestational
> >age.
> >
> >You can call Seb FAro at 713-799-8994. What are the in vitro sensis
> >
> >On 25 Jul 2005 at 13:55, ainsron wrote:
> >
> >> I haven't even had a chance to talk to her yet, I was gone the end of
> >> last week and the culture was sitting on my desk today. She had an
> >> appointment today, but cancelled it because she had to go out of town.
> >> I'll have her call me when she gets back. I wish an ID consult was
> >> an option, there are none in Northern CA, she would have to go 90+
> >> miles to Sacramento.
> >>
> >> Ronald E. Ainsworth, MD, FACOG
> >>
> >> -----Original Message-----
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> >> RModugno@aol.com Sent: Monday, July 25, 2005 11:39 AM To: Multiple
> >> recipients of list OB-GYN-L Subject: Re: Vulvar MRSA
> >>
> >> In a message dated 7/25/2005 12:43:34 PM Eastern Standard Time,
> >> ainsron@sbcglobal.net writes:
> >>
> >> I saw a OB patient last week with a markedly erythematous vulva with
> >> multiple excoriations and linear ulcerations. She was positive for
> >> trichomonas and treated with Flagyl. I also did a routine vaginal
> >> culture that came back positive for MRSA. How would you treat it,
> >> Vancomycin? The hospital will go crazy unless I document clearance
> >> before labor. Would you do vaginal and nasal cultures?
> >>
> >> This patient needs hospitalization, aggressive IV antibiotics, with
> >> I.D. consultation.
> >>
> >> Know of 2 patients at our hospital with MSRA secondarily infectied
> >> vulvar ulcerative disease ( one from HSV) She subsequently had to have
> >> a hindquarter amputation!
> >>
> >> Is your patient doing OK?
> >>
> >> Robert Modugno MD MBA FACOG
> >>
> >> Marietta, GA
> >>
> >--
> >Robert J. Carpenter, Jr. MD
> >6624 Fannin, #2720
> >St. Luke's Medical Tower
> >Houston,TX 77030-2339
> >713-795-4600
> >
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
> Lawrence Peter Berra
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 07:13:48 -0700
> ------------------------------
> From: "ainsron" <ainsron@sbcglobal.net>
> To: <ob-gyn-l@obgyn.net>
> Subject: RE: Vulvar MRSA
> Message-ID: <000501c591ec$4217e9e0$418dec45@DOCTOR>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="US-ASCII"
> Content-Transfer-Encoding: 8bit
>
> She is 15 weeks. It is sensitive to Bactrim and that is what I plan to
> treat with. It's also sensitive to Gentamycin, Rifampin, Vancomycin,
> Linezolid and Moxifloxacin. Resistant to TCN, Cefazolin, Emycin, Oxacillin,
> and intermediate to Levofloxacin. Is Faro an OB/Gyn ID specialist? Where's
> he at? Thanks for the suggestions.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Robert J.
> Carpenter, Jr. MD
> Sent: Tuesday, July 26, 2005 4:33 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Vulvar MRSA
>
> Treatment with Bactrim DS, Cleocin, before delivery are reasonable.
> Postdelivery
> depending on degree of infection then Tetracyclines work. What is her
> gestational
> age.
>
> You can call Seb FAro at 713-799-8994. What are the in vitro sensis
>
> On 25 Jul 2005 at 13:55, ainsron wrote:
>
> > I haven't even had a chance to talk to her yet, I was gone the end of
> > last week and the culture was sitting on my desk today. She had an
> > appointment today, but cancelled it because she had to go out of town.
> > I'll have her call me when she gets back. I wish an ID consult was
> > an option, there are none in Northern CA, she would have to go 90+
> > miles to Sacramento.
> >
> > Ronald E. Ainsworth, MD, FACOG
> >
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> > RModugno@aol.com Sent: Monday, July 25, 2005 11:39 AM To: Multiple
> > recipients of list OB-GYN-L Subject: Re: Vulvar MRSA
> >
> > In a message dated 7/25/2005 12:43:34 PM Eastern Standard Time,
> > ainsron@sbcglobal.net writes:
> >
> > I saw a OB patient last week with a markedly erythematous vulva with
> > multiple excoriations and linear ulcerations. She was positive for
> > trichomonas and treated with Flagyl. I also did a routine vaginal
> > culture that came back positive for MRSA. How would you treat it,
> > Vancomycin? The hospital will go crazy unless I document clearance
> > before labor. Would you do vaginal and nasal cultures?
> >
> > This patient needs hospitalization, aggressive IV antibiotics, with
> > I.D. consultation.
> >
> > Know of 2 patients at our hospital with MSRA secondarily infectied
> > vulvar ulcerative disease ( one from HSV) She subsequently had to have
> > a hindquarter amputation!
> >
> > Is your patient doing OK?
> >
> > Robert Modugno MD MBA FACOG
> >
> > Marietta, GA
> >
>
> Robert J. Carpenter, Jr. MD
> 6624 Fannin, #2720
> St. Luke's Medical Tower
> Houston,TX 77030-2339
> 713-795-4600
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 07:15:23 -0700
> ------------------------------
> From: "ainsron" <ainsron@sbcglobal.net>
> To: <ob-gyn-l@obgyn.net>
> Subject: RE: Re: Vulvar MRSA
> Message-ID: <000b01c591ec$7bbde8c0$418dec45@DOCTOR>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="US-ASCII"
> Content-Transfer-Encoding: 7bit
>
> I think it is probably simply one of her skin flora.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
> fougner, md
> Sent: Tuesday, July 26, 2005 5:36 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: [Norton AntiSpam] Re: Vulvar MRSA
>
> Do you think that MSRA is the causal agent of this patient's vulvitis or
> a fellow traveller?
>
> art
>
> At Tue, 26 Jul 2005, Robert J. Carpenter, Jr. MD wrote:
> >
> >Treatment with Bactrim DS, Cleocin, before delivery are reasonable.
> Postdelivery
> >depending on degree of infection then Tetracyclines work. What is her
> gestational
> >age.
> >
> >You can call Seb FAro at 713-799-8994. What are the in vitro sensis
> >
> >On 25 Jul 2005 at 13:55, ainsron wrote:
> >
> >> I haven't even had a chance to talk to her yet, I was gone the end of
> >> last week and the culture was sitting on my desk today. She had an
> >> appointment today, but cancelled it because she had to go out of town.
> >> I'll have her call me when she gets back. I wish an ID consult was
> >> an option, there are none in Northern CA, she would have to go 90+
> >> miles to Sacramento.
> >>
> >> Ronald E. Ainsworth, MD, FACOG
> >>
> >> -----Original Message-----
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> >> RModugno@aol.com Sent: Monday, July 25, 2005 11:39 AM To: Multiple
> >> recipients of list OB-GYN-L Subject: Re: Vulvar MRSA
> >>
> >> In a message dated 7/25/2005 12:43:34 PM Eastern Standard Time,
> >> ainsron@sbcglobal.net writes:
> >>
> >> I saw a OB patient last week with a markedly erythematous vulva with
> >> multiple excoriations and linear ulcerations. She was positive for
> >> trichomonas and treated with Flagyl. I also did a routine vaginal
> >> culture that came back positive for MRSA. How would you treat it,
> >> Vancomycin? The hospital will go crazy unless I document clearance
> >> before labor. Would you do vaginal and nasal cultures?
> >>
> >> This patient needs hospitalization, aggressive IV antibiotics, with
> >> I.D. consultation.
> >>
> >> Know of 2 patients at our hospital with MSRA secondarily infectied
> >> vulvar ulcerative disease ( one from HSV) She subsequently had to have
> >> a hindquarter amputation!
> >>
> >> Is your patient doing OK?
> >>
> >> Robert Modugno MD MBA FACOG
> >>
> >> Marietta, GA
> >>
> >--
> >Robert J. Carpenter, Jr. MD
> >6624 Fannin, #2720
> >St. Luke's Medical Tower
> >Houston,TX 77030-2339
> >713-795-4600
> >
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
> Lawrence Peter Berra
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 10:30:40 -0500 (CDT)
> ------------------------------
> From: henrygregor@yahoo.com (Hank Gregor)
> To: OB-GYN-L@OBGYN.net
> Subject: Endometrial hyperplasia
> Message-ID: <200507261530.j6QFUeE17473@dns.obgyn.net>
>
> I have a 68 yo patient who presented with postmenopausal bleeding, with
> a large endocervical polyp. Clinical includes several years of E/P HRT.
> She stopped the P at the time of the WHI out of concern re the prempro
> reports. Unfortunately, she kept on with E alone these last several
> years.
>
> At hysto d&c a benign endocx polyp was removed, an abundant amount of
> endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> w/o atypia being read on final path.
>
> I propose to treat for endometrial regression, with sustained
> progesteron alone, and interval followup sampling. Any comments re
> choice of P, either micronized or synthetic (?Megace?) and dosage?
>
> Thanks,
>
> Hank
> Gregor
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 11:29:37 -0500 (CDT)
> ------------------------------
> From: evsono@pipeline.com (art fougner, md)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Vulvar MRSA
> Message-ID: <200507261629.j6QGTbM24956@dns.obgyn.net>
>
> Regardless of her prenatal course, alert the neonates to isolate the
> baby.
>
> art
>
> At Tue, 26 Jul 2005, ainsron wrote:
> >
> >I think it is probably simply one of her skin flora.
> >
> >Ronald E. Ainsworth, MD, FACOG
> >
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
> Lawrence Peter Berra
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 16:44:30 +0000
> ------------------------------
> From: "benjamin sharp" <sharp_benjamint@hotmail.com>
> To: ob-gyn-l@obgyn.net
> Subject: RE: Endometrial hyperplasia
> Message-ID: <BAY101-F65920CD178406FEC426C194CD0@phx.gbl>
> Mime-Version: 1.0
> Content-Type: text/plain; format=flowed
>
> In the UK we are trying levonorgestrel releasing intrauterine system for
> this with good tolerance, avoiding the systemic effeects that other delivery
> systems give. If, at rescan, 4/12 later the endometrium is thinned down to
> less than 5mm( as is usually the case),there is no requirement for
> resampling. If it is greater than 5mm you could use a pipelle with the IUS
> in situ - still get a good sample.
>
> >From: henrygregor@yahoo.com (Hank Gregor)
> >Reply-To: ob-gyn-l@obgyn.net
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >Subject: Endometrial hyperplasia
> >Date: Tue, 26 Jul 2005 10:32:29 -0500
> >
> >I have a 68 yo patient who presented with postmenopausal bleeding, with
> >a large endocervical polyp. Clinical includes several years of E/P HRT.
> >She stopped the P at the time of the WHI out of concern re the prempro
> >reports. Unfortunately, she kept on with E alone these last several
> >years.
> >
> >At hysto d&c a benign endocx polyp was removed, an abundant amount of
> >endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> >w/o atypia being read on final path.
> >
> >I propose to treat for endometrial regression, with sustained
> >progesteron alone, and interval followup sampling. Any comments re
> >choice of P, either micronized or synthetic (?Megace?) and dosage?
> >
> >Thanks,
> >
> >Hank
> >Gregor
> >
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 09:55:25 -0700 (PDT)
> ------------------------------
> From: Henry Gregor <henrygregor@yahoo.com>
> To: ob-gyn-l@obgyn.net
> Subject: RE: Endometrial hyperplasia
> Message-ID: <20050726165525.72112.qmail@web30815.mail.mud.yahoo.com>
> MIME-Version: 1.0
> Content-Type: multipart/alternative; boundary="0-2127830297-1122396925=:61617"
> Content-Transfer-Encoding: 8bit
>
> --0-2127830297-1122396925=:61617
> Content-Type: text/plain; charset=iso-8859-1
> Content-Transfer-Encoding: 8bit
>
> Thanks. I suspect the limitation here would be getting coverage for the IUS for this indication. That would be very important for the patient, as she is the main caregiver for a forty years plus son with developmental abnormalities keeping in very dependent status.
>
> Hank
>
> benjamin sharp <sharp_benjamint@hotmail.com> wrote:
> In the UK we are trying levonorgestrel releasing intrauterine system for
> this with good tolerance, avoiding the systemic effeects that other delivery
> systems give. If, at rescan, 4/12 later the endometrium is thinned down to
> less than 5mm( as is usually the case),there is no requirement for
> resampling. If it is greater than 5mm you could use a pipelle with the IUS
> in situ - still get a good sample.
>
> >From: henrygregor@yahoo.com (Hank Gregor)
> >Reply-To: ob-gyn-l@obgyn.net
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Endometrial hyperplasia
> >Date: Tue, 26 Jul 2005 10:32:29 -0500
> >
> >I have a 68 yo patient who presented with postmenopausal bleeding, with
> >a large endocervical polyp. Clinical includes several years of E/P HRT.
> >She stopped the P at the time of the WHI out of concern re the prempro
> >reports. Unfortunately, she kept on with E alone these last several
> >years.
> >
> >At hysto d&c a benign endocx polyp was removed, an abundant amount of
> >endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> >w/o atypia being read on final path.
> >
> >I propose to treat for endometrial regression, with sustained
> >progesteron alone, and interval followup sampling. Any comments re
> >choice of P, either micronized or synthetic (?Megace?) and dosage?
> >
> >Thanks,
> >
> >Hank
> >Gregor
> >
>
> --0-2127830297-1122396925=:61617
> Content-Type: text/html; charset=iso-8859-1
> Content-Transfer-Encoding: 8bit
>
> <DIV>Thanks. I suspect the limitation here would be getting coverage for the IUS for this indication. That would be very important for the patient, as she is the main caregiver for a forty years plus son with developmental abnormalities keeping in very dependent status.</DIV>
> <DIV> </DIV>
> <DIV>Hank<BR><BR><B><I>benjamin sharp <sharp_benjamint@hotmail.com></I></B> wrote:</DIV>
> <BLOCKQUOTE class=replbq style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">In the UK we are trying levonorgestrel releasing intrauterine system for <BR>this with good tolerance, avoiding the systemic effeects that other delivery <BR>systems give. If, at rescan, 4/12 later the endometrium is thinned down to <BR>less than 5mm( as is usually the case),there is no requirement for <BR>resampling. If it is greater than 5mm you could use a pipelle with the IUS <BR>in situ - still get a good sample.<BR><BR>>From: henrygregor@yahoo.com (Hank Gregor)<BR>>Reply-To: ob-gyn-l@obgyn.net<BR>>To: Multiple recipients of list OB-GYN-L <OB-GYN-L@DNS.OBGYN.NET><BR>>Subject: Endometrial hyperplasia<BR>>Date: Tue, 26 Jul 2005 10:32:29 -0500<BR>><BR>>I have a 68 yo patient who presented with postmenopausal bleeding, with<BR>>a large endocervical polyp. Clinical includes several years of E/P HRT.<BR>>She stopped the P at the time of the WHI out o!
> f concern
> re the prempro<BR>>reports. Unfortunately, she kept on with E alone these last several<BR>>years.<BR>><BR>>At hysto d&c a benign endocx polyp was removed, an abundant amount of<BR>>endometrial tissue was sampled, with a complex adenomatous hyperplasia,<BR>>w/o atypia being read on final path.<BR>><BR>>I propose to treat for endometrial regression, with sustained<BR>>progesteron alone, and interval followup sampling. Any comments re<BR>>choice of P, either micronized or synthetic (?Megace?) and dosage?<BR>><BR>>Thanks,<BR>><BR>>Hank<BR>>Gregor<BR>><BR><BR><BR></BLOCKQUOTE><p>
> <hr size=1> <a href="http://us.rd.yahoo.com/evt4442/*http://www.yahoo.com/r/hs">Start your day with Yahoo! - make it your home page </a>
> --0-2127830297-1122396925=:61617--
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 10:08:55 -0700
> ------------------------------
> From: "ainsron" <ainsron@sbcglobal.net>
> To: <ob-gyn-l@obgyn.net>
> Subject: RE: Re: Vulvar MRSA
> Message-ID: <002001c59204$b8426290$418dec45@DOCTOR>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="US-ASCII"
> Content-Transfer-Encoding: 7bit
>
> Its already on the top of her problem list and they will be aware. I'm also
> checking with the hospital's infection control nurse to see what they need
> to "clear her" to be on the Ob unit for L&D.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
> fougner, md
> Sent: Tuesday, July 26, 2005 9:32 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: [Norton AntiSpam] Re: Vulvar MRSA
>
> Regardless of her prenatal course, alert the neonates to isolate the
> baby.
>
> art
>
> At Tue, 26 Jul 2005, ainsron wrote:
> >
> >I think it is probably simply one of her skin flora.
> >
> >Ronald E. Ainsworth, MD, FACOG
> >
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
> Lawrence Peter Berra
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 13:20:25 -0500
> ------------------------------
> From: "R. Daniel Braun" <rd.braun@gmail.com>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Endometrial hyperplasia
> Message-ID: <259b461f0507261120127568e4@mail.gmail.com>
> Mime-Version: 1.0
> Content-Type: multipart/alternative;
> boundary="----=_Part_13565_26823722.1122402025955"
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> Vaginal Hyst?????
> Dan
>
> On 7/26/05, Hank Gregor <henrygregor@yahoo.com> wrote:
> >
> > I have a 68 yo patient who presented with postmenopausal bleeding, with
> > a large endocervical polyp. Clinical includes several years of E/P HRT.
> > She stopped the P at the time of the WHI out of concern re the prempro
> > reports. Unfortunately, she kept on with E alone these last several
> > years.
> >
> > At hysto d&c a benign endocx polyp was removed, an abundant amount of
> > endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> > w/o atypia being read on final path.
> >
> > I propose to treat for endometrial regression, with sustained
> > progesteron alone, and interval followup sampling. Any comments re
> > choice of P, either micronized or synthetic (?Megace?) and dosage?
> >
> > Thanks,
> >
> > Hank
> > Gregor
> >
>
> --
> R. Daniel Braun
> Kinky for Governor
>
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> <div>Vaginal Hyst?????</div>
> <div> </div>
> <div>Dan<br><br> </div>
> <div><span class="gmail_quote">On 7/26/05, <b class="gmail_sendername">> Hank Gregor</b> <<a href="mailto:henrygregor@yahoo.com">henrygregor@ya> hoo.com</a>> wrote:</span>
> <blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0> px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">I have a 68 yo patient who prese> nted with postmenopausal bleeding, with<br>a large endocervical polyp. > ; Clinical includes several years of E/P HRT.
> <br>She stopped the P at the time of the WHI out of concern re the prempro<> br>reports. Unfortunately, she kept on with E alone these last s> everal<br>years.<br><br>At hysto d&c a benign endocx polyp was removed,> an abundant amount of
> <br>endometrial tissue was sampled, with a complex adenomatous hyperplasia,> <br>w/o atypia being read on final path.<br><br>I propose to treat for endo> metrial regression, with sustained<br>progesteron alone, and interval follo> wup sampling. Any comments re
> <br>choice of P, either micronized or synthetic (?Megace?) and dosage?<br><> br>Thanks,<br><br>Hank<br>Gregor<br><br></blockquote></div><br>
> "all"><br>-- <br>R. Daniel Braun<br> Ki> nky for Governor
>
> ------=_Part_13565_26823722.1122402025955--
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 14:49:00 -0400
> ------------------------------
> From: <l.glazerman@rcn.com>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Endometrial hyperplasia
> Message-ID: <47qfdc$1s4eor@smtp04.mrf.mail.rcn.net>
> Mime-Version: 1.0
> Content-Type: text/plain; charset="ISO-8859-1"
> Content-Transfer-Encoding: 8bit
>
> I agree with hyst, by whatever means.
>
> -----Original Message-----
>
> From: "R. Daniel Braun" <rd.braun@gmail.com>
> Subj: Re: Endometrial hyperplasia
> Date: Tue Jul 26, 2005 2:22 pm
> Size: 1K
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>
> Vaginal Hyst?????
>
> Dan
>
> On 7/26/05, Hank Gregor <henrygregor@yahoo.com> wrote: I have a 68 yo patient who presented with postmenopausal bleeding, with
> a large endocervical polyp.Clinical includes several years of E/P HRT.
> She stopped the P at the time of the WHI out of concern re the prempro
> reports.Unfortunately, she kept on with E alone these last several
> years.
>
> At hysto d&c a benign endocx polyp was removed, an abundant amount of
> endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> w/o atypia being read on final path.
>
> I propose to treat for endometrial regression, with sustained
> progesteron alone, and interval followup sampling.Any comments re
> choice of P, either micronized or synthetic (?Megace?) and dosage?
>
> Thanks,
>
> Hank
> Gregor
>
> --
> R. Daniel Braun
> Kinky for Governor
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 12:00:20 -0700 (PDT)
> ------------------------------
> From: Henry Gregor <henrygregor@yahoo.com>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Endometrial hyperplasia
> Message-ID: <20050726190020.69082.qmail@web30808.mail.mud.yahoo.com>
> MIME-Version: 1.0
> Content-Type: multipart/alternative; boundary="0-1588193237-1122404420=:68450"
> Content-Transfer-Encoding: 8bit
>
> --0-1588193237-1122404420=:68450
> Content-Type: text/plain; charset=iso-8859-1
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>
> Good choice, however she has a forty plus son who functions at 3-4 year old level, for whom she is primary caregiver, hx which I didn't give. Though, absent atypia demonstrated on a very thorough multiple pass curettage, assessed hyspteroscopically pre and post curettage, I would think progesterone reasonable under other circumstances as well.
>
> Hank
>
> "R. Daniel Braun" <rd.braun@gmail.com> wrote:
> Vaginal Hyst?????
>
> Dan
>
> On 7/26/05, Hank Gregor <henrygregor@yahoo.com> wrote: I have a 68 yo patient who presented with postmenopausal bleeding, with
> a large endocervical polyp. Clinical includes several years of E/P HRT.
> She stopped the P at the time of the WHI out of concern re the prempro
> reports. Unfortunately, she kept on with E alone these last several
> years.
>
> At hysto d&c a benign endocx polyp was removed, an abundant amount of
> endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> w/o atypia being read on final path.
>
> I propose to treat for endometrial regression, with sustained
> progesteron alone, and interval followup sampling. Any comments re
> choice of P, either micronized or synthetic (?Megace?) and dosage?
>
> Thanks,
>
> Hank
> Gregor
>
> --
> R. Daniel Braun
> Kinky for Governor
> Tired of spam? Yahoo! Mail has the best spam protection around
> --0-1588193237-1122404420=:68450
> Content-Type: text/html; charset=iso-8859-1
> Content-Transfer-Encoding: 8bit
>
> <DIV>Good choice, however she has a forty plus son who functions at 3-4 year old level, for whom she is primary caregiver, hx which I didn't give. Though, absent atypia demonstrated on a very thorough multiple pass curettage, assessed hyspteroscopically pre and post curettage, I would think progesterone reasonable under other circumstances as well.</DIV>
> <DIV> </DIV>
> <DIV>Hank<BR><BR><B><I>"R. Daniel Braun" <rd.braun@gmail.com></I></B> wrote:</DIV>
> <BLOCKQUOTE class=replbq style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">
> <DIV>Vaginal Hyst?????</DIV>
> <DIV> </DIV>
> <DIV>Dan<BR><BR> </DIV>
> <DIV><SPAN class=gmail_quote>On 7/26/05, <B class=gmail_sendername>Hank Gregor</B> <<A href="mailto:henrygregor@yahoo.com">henrygregor@yahoo.com</A>> wrote:</SPAN>
> <BLOCKQUOTE class=gmail_quote style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">I have a 68 yo patient who presented with postmenopausal bleeding, with<BR>a large endocervical polyp. Clinical includes several years of E/P HRT. <BR>She stopped the P at the time of the WHI out of concern re the prempro<BR>reports. Unfortunately, she kept on with E alone these last several<BR>years.<BR><BR>At hysto d&c a benign endocx polyp was removed, an abundant amount of <BR>endometrial tissue was sampled, with a complex adenomatous hyperplasia,<BR>w/o atypia being read on final path.<BR><BR>I propose to treat for endometrial regression, with sustained<BR>progesteron alone, and interval followup sampling. Any comments re <BR>choice of P, either micronized or synthetic (?Megace?) and dosage?<BR><BR>Thanks,<BR><BR>Hank<BR>Gregor<BR><BR></BLOCKQUOTE></DIV><BR>
> Braun<BR> Kinky for Governor </BLOCKQUOTE><p>__________________________________________________<br>Do You Yahoo!?<br>Tired of spam? Yahoo! Mail has the best spam protection around <br>http://mail.yahoo.com
> --0-1588193237-1122404420=:68450--
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 16:44:08 -0500 (CDT)
> ------------------------------
> From: eramirezt@coqui.net (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Vulvar MRSA
> Message-ID: <200507262144.j6QLi8S20649@dns.obgyn.net>
>
> Did you received the lit I sent?
>
> Ef
>
> At Tue, 26 Jul 2005, ainsron wrote:
> >
> >I think it is probably simply one of her skin flora.
> >
> >Ronald E. Ainsworth, MD, FACOG
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
> >fougner, md
> >Sent: Tuesday, July 26, 2005 5:36 AM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: [Norton AntiSpam] Re: Vulvar MRSA
> >
> >Do you think that MSRA is the causal agent of this patient's vulvitis or
> >a fellow traveller?
> >
> >art
> >
> >At Tue, 26 Jul 2005, Robert J. Carpenter, Jr. MD wrote:
> >>
> >>Treatment with Bactrim DS, Cleocin, before delivery are reasonable.
> >Postdelivery
> >>depending on degree of infection then Tetracyclines work. What is her
> >gestational
> >>age.
> >>
> >>You can call Seb FAro at 713-799-8994. What are the in vitro sensis
> >>
> >>On 25 Jul 2005 at 13:55, ainsron wrote:
> >>
> >>> I haven't even had a chance to talk to her yet, I was gone the end of
> >>> last week and the culture was sitting on my desk today. She had an
> >>> appointment today, but cancelled it because she had to go out of town.
> >>> I'll have her call me when she gets back. I wish an ID consult was
> >>> an option, there are none in Northern CA, she would have to go 90+
> >>> miles to Sacramento.
> >>>
> >>> Ronald E. Ainsworth, MD, FACOG
> >>>
> >>> -----Original Message-----
> >>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> >>> RModugno@aol.com Sent: Monday, July 25, 2005 11:39 AM To: Multiple
> >>> recipients of list OB-GYN-L Subject: Re: Vulvar MRSA
> >>>
> >>> In a message dated 7/25/2005 12:43:34 PM Eastern Standard Time,
> >>> ainsron@sbcglobal.net writes:
> >>>
> >>> I saw a OB patient last week with a markedly erythematous vulva with
> >>> multiple excoriations and linear ulcerations. She was positive for
> >>> trichomonas and treated with Flagyl. I also did a routine vaginal
> >>> culture that came back positive for MRSA. How would you treat it,
> >>> Vancomycin? The hospital will go crazy unless I document clearance
> >>> before labor. Would you do vaginal and nasal cultures?
> >>>
> >>> This patient needs hospitalization, aggressive IV antibiotics, with
> >>> I.D. consultation.
> >>>
> >>> Know of 2 patients at our hospital with MSRA secondarily infectied
> >>> vulvar ulcerative disease ( one from HSV) She subsequently had to have
> >>> a hindquarter amputation!
> >>>
> >>> Is your patient doing OK?
> >>>
> >>> Robert Modugno MD MBA FACOG
> >>>
> >>> Marietta, GA
> >>>
> >>--
> >>Robert J. Carpenter, Jr. MD
> >>6624 Fannin, #2720
> >>St. Luke's Medical Tower
> >>Houston,TX 77030-2339
> >>713-795-4600
> >>
> >--
> >art fougner, md
> >
> > "If you don't know where you are going, you will wind up somewhere else."
> >Lawrence Peter Berra
> >
>
> --
> "Character may be manifested in the great moments, but it is made in the
> small ones."
>
> - Phillip Brooks
>
> ~walt whitman~
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 16:45:40 -0500 (CDT)
> ------------------------------
> From: eramirezt@coqui.net (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Endometrial hyperplasia
> Message-ID: <200507262145.j6QLjeK22086@dns.obgyn.net>
>
> Vag hyst. if possible.
>
> At Tue, 26 Jul 2005, Hank Gregor wrote:
> >
> >I have a 68 yo patient who presented with postmenopausal bleeding, with
> >a large endocervical polyp. Clinical includes several years of E/P HRT.
> >She stopped the P at the time of the WHI out of concern re the prempro
> >reports. Unfortunately, she kept on with E alone these last several
> >years.
> >
> >At hysto d&c a benign endocx polyp was removed, an abundant amount of
> >endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> >w/o atypia being read on final path.
> >
> >I propose to treat for endometrial regression, with sustained
> >progesteron alone, and interval followup sampling. Any comments re
> >choice of P, either micronized or synthetic (?Megace?) and dosage?
> >
> >Thanks,
> >
> >Hank
> >Gregor
>
> --
> "Character may be manifested in the great moments, but it is made in the
> small ones."
>
> - Phillip Brooks
>
> ~walt whitman~
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 26 Jul 2005 17:45:29 -0400
> ------------------------------
> From: dmecnm@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: Endometrial hyperplasia
> Message-ID: <8C760427984E7EB-AD8-3B10@mblk-d34.sysops.aol.com>
> Content-Type: multipart/alternative;
> boundary="--------MailBlocks_8C760427984E7EB_AD8_37C7_mblk-d34.sysops.aol.com"
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>
> ----------MailBlocks_8C760427984E7EB_AD8_37C7_mblk-d34.sysops.aol.com
> Content-Type: text/plain; charset="us-ascii"
>
> Dr. Gregor,
>
> Mirena has a program where women with "need" can get their Mirena for free or for a very reduced cost. I think you just need to contact them, possibly through their website, to get more information about this program. This way the only cost to her is for insertion.
>
> Denise, CNM
> So Cal
>
> -----Original Message-----
> From: Henry Gregor <henrygregor@yahoo.com>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Sent: Tue, 26 Jul 2005 11:56:24 -0500
> Subject: RE: Endometrial hyperplasia
>
> Thanks. I suspect the limitation here would be getting coverage for the IUS for this indication. That would be very important for the patient, as she is the main caregiver for a forty years plus son with developmental abnormalities keeping in very dependent status.
>
> Hank
>
> benjamin sharp <sharp_benjamint@hotmail.com> wrote:
> In the UK we are trying levonorgestrel releasing intrauterine system for
> this with good tolerance, avoiding the systemic effeects that other delivery
> systems give. If, at rescan, 4/12 later the endometrium is thinned down to
> less than 5mm( as is usually the case),there is no requirement for
> resampling. If it is greater than 5mm you could use a pipelle with the IUS
> in situ - still get a good sample.
>
> >From: henrygregor@yahoo.com (Hank Gregor)
> >Reply-To: ob-gyn-l@obgyn.net
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Endometrial hyperplasia
> >Date: Tue, 26 Jul 2005 10:32:29 -0500
> >
> >I have a 68 yo patient who presented with postmenopausal bleeding, with
> >a large endocervical polyp. Clinical includes several years of E/P HRT.
> >She stopped the P at the time of the WHI out o! f concern re the prempro
> >reports. Unfortunately, she kept on with E alone these last several
> >years.
> >
> >At hysto d&c a benign endocx polyp was removed, an abundant amount of
> >endometrial tissue was sampled, with a complex adenomatous hyperplasia,
> >w/o atypia being read on final path.
> >
> >I propose to treat for endometrial regression, with sustained
> >progesteron alone, and interval followup sampling. Any comments re
> >choice of P, either micronized or synthetic (?Megace?) and dosage?
> >
> >Thanks,
> >
> >Hank
> >Gregor
> >
>
> Start your day with Yahoo! - make it your home page
>
> ----------MailBlocks_8C760427984E7EB_AD8_37C7_mblk-d34.sysops.aol.com
> Content-Type: text/html; charset="us-ascii"
>
> <HTML><BODY><DIV style='font-family: "Verdana"; font-size: 10pt;'><DIV>
> <DIV>Dr. Gregor, </DIV>
> <DIV> </DIV>
> <DIV>Mirena has a program where women with "need" can get their Mirena for free or for a very reduced cost. I think you just need to contact them, possibly through their website, to get more information about this program. This way the only cost to her is for insertion.</DIV>
> <DIV> </DIV>
> <DIV>Denise, CNM</DIV>
> <DIV>So Cal </DIV> <BR>-----Original Message-----<BR>From: Henry Gregor <henrygregor@yahoo.com><BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net><BR>Sent: Tue, 26 Jul 2005 11:56:24 -0500<BR>Subject: RE: Endometrial hyperplasia<BR><BR>
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> <DIV id=AOLMsgPart_2_0a7eb6f4-c3ca-47eb-aeab-38cf5331a328>
> <DIV>Thanks. I suspect the limitation here would be getting coverage for the IUS for this indication. That would be very important for the patient, as she is the main caregiver for a forty years plus son with developmental abnormalities keeping in very dependent status.</DIV>
> <DIV> </DIV>
> <DIV>Hank<BR><BR><B><I>benjamin sharp <sharp_benjamint@hotmail.com></I></B> wrote:</DIV>
> <BLOCKQUOTE class=replbq style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">In the UK we are trying levonorgestrel releasing intrauterine system for <BR>this with good tolerance, avoiding the systemic effeects that other delivery <BR>systems give. If, at rescan, 4/12 later the endometrium is thinned down to <BR>less than 5mm( as is usually the case),there is no requirement for <BR>resampling. If it is greater than 5mm you could use a pipelle with the IUS <BR>in situ - still get a good sample.<BR><BR>>From: henrygregor@yahoo.com (Hank Gregor)<BR>>Reply-To: ob-gyn-l@obgyn.net<BR>>To: Multiple recipients of list OB-GYN-L <OB-GYN-L@DNS.OBGYN.NET><BR>>Subject: Endometrial hyperplasia<BR>>Date: Tue, 26 Jul 2005 10:32:29 -0500<BR>><BR>>I have a 68 yo patient who presented with postmenopausal bleeding, with<BR>>a large endocervical polyp. Clinical includes several years of E/P HRT.<BR>>She stopped the P at the time of the WHI out o!
> ! f concern re the prempro<BR>>reports. Unfortunately, she kept on with E alone these last several<BR>>years.<BR>><BR>>At hysto d&c a benign endocx polyp was removed, an abundant amount of<BR>>endometrial tissue was sampled, with a complex adenomatous hyperplasia,<BR>>w/o atypia being read on final path.<BR>><BR>>I propose to treat for endometrial regression, with sustained<BR>>progesteron alone, and interval followup sampling. Any comments re<BR>>choice of P, either micronized or synthetic (?Megace?) and dosage?<BR>><BR>>Thanks,<BR>><BR>>Hank<BR>>Gregor<BR>><BR><BR><BR></BLOCKQUOTE>
> <DIV>
> <HR SIZE=1>
> <A href="http://us.rd.yahoo.com/evt4442/*http://www.yahoo.com/r/hs" target=_blank>Start your day with Yahoo! - make it your home page </A></DIV><!-- end of AOLMsgPart_2_0a7eb6f4-c3ca-47eb-aeab-38cf5331a328 --></DIV></DIV></BODY></HTML>
>
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>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 4037
> ------------------------------
> ***************************
>
