Re: PMB on coumadin
From: art fougner, md (evsono@pipeline.com)
Mon Apr 30 08:09:49 2007
With an artificial heart valve?
Art
At Mon, 30 Apr 2007, Atkinson, Samuel M wrote:
>
>I believe you will find that the antibiotic recommendations do not apply
>to gyn proc like d&c, cerv bx etc. Of course the last time I pointed it
>out to anesthesia they insisted intubation was a risk so my pt got Rxed
>for a CKC/D&C. I do not believe Endo bx re quires prophy Rx.
>
>________________________________
>
>________________________________
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry
>
>--
>________________________________
>Gregor
>________________________________
>Sent: Sunday, April 29, 2007 7:12 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: PMB on coumadin
>
>Sam,
>
>Thanks to you and to all othr respondent listers. Endo bx was my minimum
>assessment choice, and I guess, without verbalizing it to myself or
>others, I was wondering whether a hysto/D&C would be warranted. However,
>I've always felt the literature supports endobx as a very correlative
>procedure vis a vis hyto/D&C results, so felt - feel - I should go ahead
>with the sampling I'd usually do. Can't find anything definitive re the
>abx prophylaxis, so I will go ahead with that.
>
>In the last ten years, I've had three ca cases whose presentations were
>just the scantes amts of pmb...two were localized and WD'd...one was
>poorly diff'd and fairly diffuse within the cavity, but with less than
>1/3rd penetration. Years ago, when I was a student, there was a fellow
>named Fred Hoffmeister (department head, Univ of Wisconsin, I believe)
>whom I heard speak...he was adamant about bx'g all PM women before
>initiating HRT. Used to say if bx's weren't done then ca's and atypical
>aden's hyperplasias would get erroneously attributed to HRT. Most ot the
>attendings I came in contact as a student and a resident would indicate
>his view was excessive...however, I bet he didn't miss too many, if any,
>abnl endometriums.
>
>Hank
>
>"Atkinson, Samuel M" <ATKINSONS@ecu.edu> wrote:
>
> Hank: I have had two patients sinilar to yours, altho a bit
>older that i found endo ca by biopsy. I have taught residents that a bad
>lesion bleeds earlier on rat poisin and that they all must be biopsied.
>I admit that not all have endo ca hower.. for whiw.
> sAm
>
> ________________________________
>=09
> ________________________________
> ________________________________
> From: ob-gyn-l@obgyn.net on behalf of Henry Gregor
> Sent: Fri 4/27/2007 11:47 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: PMB on coumadin
>
> Listers
>
> A 53 yo, LMP 4 years ago, presents with two weeks plus heavy
>vaginal bleeding, w/o presyncopal sx's. She is on coumadin secondary to
>hx of mitral valve replacement. INR is 2.3, and pt is w/o petechiae,
>ecchymoses, or hx of epistaxis or bleeding gums, etc.
>
> PE is unremarkable, and a pap (neg hx abnl past ones) is
>pending. Sono with heterogenous endometrial stripe, at 7 mm. I am
>planning to do an endometrial pipelle sampling. Comments appreciated.
>
> Thanks
>
> Hank
>
> ________________________________
>=09
> ________________________________
> ________________________________
> Ahhh...imagining that irresistible "new car" smell?
> Check out new cars at Yahoo! Autos.
>
>________________________________
>
>________________________________
>Ahhh...imagining that irresistible "new car" smell?
>_
>-
>>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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