--
Richard Chudacoff, MD, FACOG
Las Vegas International Center for Advanced Gynecologic Care
(Specializing in minimally and non-invasive surgery)
2481 Professional Court
Las Vegas, NV 89128
TEL: 702-485-8893
FAX: 702-974-0945
www.lasvegasgyncenter.com <http://www.lasvegasgyncenter.com/>
www.exablateoflasvegas.com <http://www.exablateoflasvegas.com/>
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. Daniel
Braun
Sent: Wednesday, October 31, 2007 4:26 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Gyn: Positive margins on a LEEP
there are always exceptions. That is why we have "COMMON" sense.
About 6 C/S.
Dan
On 10/30/07, Joanne Bulley, MD < islesannie@gmail.com
<mailto:islesannie@gmail.com> > wrote:
While I look to do as many hysts as VH as possible ...
I have a VERY similar patient with persistent HPV disease and SIL. Pap
with suggestive of HSIL - it was a very tough Leep due to very narrow
vaginal architecture (C/S x 2).
On the one hadn I can see where doing it as a VH would be great and do
those vaginal margins - but with 2 C/S -AND- really tough access I think
I will decide to go with an "old fashioned" abd TAH. (high probability
of BSO unless she insists on keeping those ovaries (close to or at age
50).
So a question for Y'All : any rule-of-thumb on VH - at how many C/S
would you be hesitant to do a VH?
JB
At Tue, 30 Oct 2007, R. Daniel Braun wrote:
>
>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
--
Joanne Bulley, MD, FACOG
Solo gyn
Keene, NH USA
--
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
