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Re: Gyn: Positive margins on a LEEP From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au) Tue Oct 30 21:08:46 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" Previous message: Joanne Bulley, MD: "Re: AF-AFP 16MoM, U/S, Echo, and AF-AchE negative- what next?" In reply to: R. Daniel Braun: "Re: Gyn: Positive margins on a LEEP" Next in thread: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" While I don't disagree entirely with those who have said do a Hyst., I have wondered all along whether there is really any need. With the diathermy that is done after a LLETZ, I have found that the remaining margin has rarely had any abnormality, and it should be reasonable just to re-colp after 4 months and see what is left. Seems a whole lot easier and less invasive to check before subjecting someone to major surgery. On the other hand in this patient it may still be a good thing to do a hysterectomy for her other symptoms anyway. In which case why, when you found HgSIL, didn't you just go straight for the "Big Biopsy", and shortcut this whole colp and LEEP, and worry about what to do next? Steve ________________________________ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. -- ________________________________ Daniel Braun Sent: Wednesday, 31 October 2007 1:20 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Gyn: Positive margins on a LEEP In my mind, this is one of those INDICATIONS for a vaginal approach. Dan On 10/30/07, Douglas Krell <dkrell@msn.com > wrote: Garry, I agree hysterectomy would be fine and likely to be best for her given the multiple complaints as well as the cervical disease. I think LAVH, TLH, TAH would give you a good chance too evaluate everything. Is her insurance company balking at this? Douglas Krell MD >From: garrys@mindspring.com (Garry E. Siegel, M.D.) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L < ob-gyn-l@dns.obgyn.net <mailto:ob-gyn-l@dns.obgyn.net> > >Subject: Gyn: Positive margins on a LEEP >Date: Mon, 29 Oct 2007 20:16:57 -0500 > >33 YO P2002 S/P TL, originally came in for dysmenorrhea and dyspareunia. > >Her intial exam was normal, but her pap was HGSIL. Directed biopsies at >satisfactory colposcopy showed moderate dysplasia. > >LEEP in the OR--CIS with positive endo and ectocervical margins, and >extensive glandular involvement. > >What's next? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA -- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine R. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. Next message: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" Previous message: Joanne Bulley, MD: "Re: AF-AFP 16MoM, U/S, Echo, and AF-AchE negative- what next?" In reply to: R. Daniel Braun: "Re: Gyn: Positive margins on a LEEP" Next in thread: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP"

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