Re: Bilateral dermoids
From: art fougner, md (evsono@pipeline.com)
Fri Mar 9 08:26:19 2007
I actually have to side with Steve on this one ... tortuous
interference has not enhanced clinical acumen.
Art
At Fri, 9 Mar 2007, Andrew Folley wrote:
>
>Stephen,
>as you mature you will come to realize that medicine is both art and science
>and there are often times several right ways to approach a problem. I think
>you misjudge the american system.
>It is still the best medical system in the world. I sense a great deal of
>frustration and anger in your thread. Lets use this wonderful internet
>exchange tool to be gentleman and colleagues. andrew
>
>>From: "Raymond Stephen" <stephen.raymond@dhhs.tas.gov.au>
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: RE: Bilateral dermoids
>>Date: Thu, 8 Mar 2007 15:56:25 -0600
>>
>>There is no doubt from the description that they were dermoids, and
>>washings and other hand-wringing grandma type fussing is just weasel
>>madness from an American system so stuffed up by the fear of litigation
>>that the patients suffer. If you had taken washings and aspirated and then
>>left them and had to go back afterwards for them the patient would have
>>been quite justified if she had sued you for unnecessary surgery!
>>
>>I can't believe the absolute lack of clinical acumen and judgement that
>>seems to have come out of this thread.
>>
>>Steve
>>
>>________________________________
>>
>>________________________________
>>________________________________
>>From: ob-gyn-l@obgyn.net on behalf of Andrew Folley
>>Sent: Fri 9/03/2007 12:12 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: RE: Bilateral dermoids
>>
>>More likely these are theca lutein cysts in light of bilaterality and
>>pregnancy. Low probalbilty for malignancy at her age. I would obtain
>>washings, perhaps biopsy omentum and any nodualrity of peritoneum seen.
>>Possibly aspiration of each cyst with thorough irrigation afterwards. If
>>any
>>hair, teeth present would do cyst resection and preserve ovaries.
>>Otherwise close up and look for resolution of cysts in next 12 weeks. If
>>still persistent could do laparoscopy and resection then.= andy
>>
>> >From: "Elrod, Darryl G Maj 48 MDOS/SGOBO"
>><Darryl.elrod@LAKENHEATH.AF.MIL>
>> >Reply-To: ob-gyn-l@obgyn.net
>> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> >Subject: Bilateral dermoids
>> >Date: Wed, 7 Mar 2007 11:19:21 -0600
>> >
>> >I have just gotten out of the OR with a 26 yo G1 at 39 wks that had a
>> >c-section for failure to progress. At the time of the c-section the
>> >ovaries were both found to be enlarged to 8-9cm. Neither had previously
>> >been noted on her early OB sono nor her anatomy scan at 22 weeks. By
>> >the appearance of the fluid seen through the cyst wall my suspicion was
>> >that this represented bilateral dermoid cysts.
>> >
>> >What are the management options with this patient and which would you
>> >choose and why?
>> >
>>
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
