Re: You've done enough surgery when...
From: R. Daniel Braun (rd.braun@gmail.com)
Sun Feb 25 14:12:35 2007
Ef,
IUP's can occur with no pregnancy seen on US and an hCG of 2800 or even
higher.
Keep your eye on the "Green" J in a few months.
Dan
On 2/25/07, Efrain Ramirez <eramirezt@coqui.net> wrote:
>
> My understanding that an US was done with 2,800.. however I admit that
> it won't be a waste of time too take a second look ...
>
> Ef
>
> >At Sun, 25 Feb 2007, Richard Kaplan wrote:
> >
> >My premise was that the rise from 500 to 2800 in 3 days was greater than
> the
> >usual doubling time and therefore there was a possibility of lab
> error. In
> >this clinical situation I would repeat the repeat ultrasound today or
> >tommorrow (26 Feb.) to confirm the absence of a normal, early IUP.
> > Richard Kaplan
> >
>> >>----- Original Message -----
> >From: "Efrain Ramirez" <eramirezt@coqui.net>
> >To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
> >Sent: Sunday, February 25, 2007 4:09 AM
> >Subject: Re: You've done enough surgery when...
> >
> >> With 2,800 hCG and no GS seen?
> >>
> >> Ef
> >>
> >> -At Sun, 25 Feb 2007, Richard Kaplan wrote:
> >>>
> >>>It is possible that this is an IUP. The HCG value was only 500 on 2/19
> >>>and
> >>>maybe the second value of 2800 only 3 days later was a lab error and it
> is
> >>>still too early to see the IUP. I suspect that by the time you read
> this
> >>>you have either already repeated her ultrasound or have removed her
> >>>"hydrosalpinx.
> >>>
> >>>--
> >>>Richard Kaplan
> >>>Greensboro, NC
> >>>
>> >>>>>----- Original Message -----
> >>>From: "Dr Eberhard Lisse" <el@lisse.NA>
> >>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
> >>>Sent: Saturday, February 24, 2007 1:06 PM
> >>>Subject: Re: You've done enough surgery when...
> >>>
> >>>> G4P2M0 2* previous C/S
> >>>> T/L separately
> >>>> Reversal of T/L
> >>>> Ectopic Right tube 2007-01-17 (Appendix also removed but nil of note)
> >>>>
> >>>> Complains about amenorrhea since ectopic.
> >>>>
> >>>> Seen by by colleague in a rural hospital (90km from the capital,
> where I
> >>>> work) 2007-02-19, b-HCG 500
> >>>>
> >>>> Seen by me on 2007-02-22 in the same rural setting on my monthly
> visit,
> >>>> Clinically nil of note, a bit tender on the right side, perhaps.
> >>>>
> >>>> Ultrasound on the same day shows no intrauterine pregnancy, no free
> >>>> fluid. Vaginal Ultrasound shows no intruterine pregnancy, right
> adnexa
> >>>> nil of note, left adnexa, perhaps a hydrosalpingx. b-HCG 2800.
> >>>>
> >>>> You have a list of two total abdominal hysterectomies scheduled for
> the
> >>>> following day in that hospital.
> >>>>
> >>>> So, bogs, girls and witches, what's the plan and what happened next
> >>>> :-)-O?
> >>>>
> >>>> And, puleeze, we don't have Methrotrexate.
> >>>>
> >>>> greetings, el
> >>>>
> >> --
> >> " The greatest obstacle to knowledge is not ignorance,
> >> it is the illusion of knowledge." Daniel J. Boorstin - Historian
> >>
>
> --
> " The greatest obstacle to knowledge is not ignorance,
> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday".
Hippocrates
