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Re: Gyn: Cervical DysplasiaFrom: Andrew Folley (agfolley@hotmail.com)Fri Mar 14 15:39:56 2008
Joanne It has been 6 months since the leep with CIN 2-3 and margins clear and ECC negative. I suggest that it is quite reasonable to simply repeat the colposcopy, pap and ecc now or in 3 months. If she is asking for a hysterectomy that is one thing, but this lady wants and expects conservative management. A plausible expanation is that the leep excised the majority of the CIN. However there may have been one or more focal areas in the outer transformation zone outside the cone that were missed on leep. In addition I would like to know her HPV status before I became overly aggressive with talk of hysterectomy. Besides she probably will sustain hep fracture in the stirrups in light of her t-scores. agf Date: Fri, 14 Mar 2008 15:05:40 -0500From: ainsron@sbcglobal.netTo: ob-gyn-l@mail.obgyn.netSubject: RE: Gyn: Cervical Dysplasia It’s not adequate treatment if the F/U pap showed HGSIL. Cone biopsy if she wants conservative Rx, but I would try to convince her to go with a hysterectomy. It doesn’t sound like you think a TVH is possible, but I would probably try a LAVH. I don’t do Total laparoscopic hysterectomies. Ronald E. Ainsworth, MD, FACOG -----Original Message-----From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. Daniel BraunSent: Friday, March 14, 2008 12:13 PMTo: Multiple recipients of list OB-GYN-LSubject: Re: Gyn: Cervical Dysplasia Repeat pap in 6 months.You have already provided adequate treatment with the LEEP.Dan On Fri, Mar 14, 2008 at 3:03 PM, Joanne Bulley, MD <islesannie@gmail.com> wrote: What would you do next?53yo G4P3013 S/P SVD x 3 (but very narrow pelvis) LMP 7/02Pap 12/06 LSIL "possible CIN 1"Colpo 1/07 no lesion, ECC scantPap 7/07 LSIL "possible CIN 2"Colpo 7/07 no lesion, can't visualize SCJRecommend LEEP (surgery rescheduled due to the death of her mom)9/07 LEEP: CIN 2-3, resection margins clear ECC: superfical atypical cells, no definitive dysplasiaEndometrial curettage: (vigorous curettage) : detached glands & bstroma,no intact endometrium; one fragment squamous epithelium with mildlyatypical parakeratosisPap 3/2008 HSIL c/w CIN 2Patient very into the "complementary and alternative" therapy - optingfor homeopathic treatment of hypothyroidism (with elevated TSH andpositive thyroid antibodies) and of osteoporosis (BMD T scores startedout at -4.0 for spine and -3.2 for hip and are now -4.5 and -3.1)--Joanne Bulley, MD, FACOGSolo gynKeene, NH USA -- R. Daniel Braun, MD FACOG(L) ABMP CMThProfessor EmeritusDept. of Obstetrics and GynecologyIndiana U. School of MedicineR. Daniel Braun"Science without Religion is LAME; Religion without Science is BLIND"Einstein 1941 _________________________________________________________________ Climb to the top of the charts!=A0Play the word scramble challenge with sta= _________________________________________________________________ r power. http://club.live.com/star_shuffle.aspx?icid=starshuffle_wlmailtextlink_jan
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