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Re: Your chance to make me look good.. From: Bernard Cristalli (bcrist@club-internet.fr) Sun Jul 13 13:42:20 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: agustin olmos: "Re: REAL TIME PROGRAMING talk@OBGYN.net" Previous message: Bernard Cristalli: "Pregnancy end surveillance" Maybe in reply to: Geffrey H. Klein, MD: "Your chance to make me look good.." Next in thread: jay kulkin: "Re: Your chance to make me look good.." Geffrey H. Klein, MD wrote: > > Hi all.. > I was assigned to research and write a protocol for management of adnexal > masses. > > 1) When to observe, when to operate Always operate except if enough arguments for a functional cyst. > a) if operating, l-scope vs. laparotomy Scope always except if technical contraindications (multiple laparotomies...) &/or signs of suspected malignancy. > b) cystectomy vs. oophorectomy Cystectomy except in post meopausal women &/or signs of malignancy. > c) choice of incision in laparotomy (vertical or pfannensteil) Pfann for a cyst, vertical for a nearly sure Ca. > d) frozen sections vs. permanent sections No frozen sections > e) oncology back-up (ie if carcinoma encountered.. immediate lap vs. close and refer) No need for an oncologist, I got the qualification. > > 2) Imaging techniques > a) color flow doppler no proven interest for the moment > b) MRI, CT scan for pre op evaluation of a malignant tumor. > c) transvaginal sonography King exploration for pelvic masses IMHO > 3) Important factors to use in deciding approach > a) age, family history, character and size of the mass, > signs of malignancy, pain, bilateral vs. unilateral - Mass in an old woman: more likly to be malignant, - 2 or more history of ovarian Ca (+/- breast ?) is a risk factor for malignancy - mass more than 6 cms must be considered as organic => surgery - Signs of malignancy: age of the pt, size of the tumor, inner cloisons &/or mumps, heterogenous US aspect. Pain: no discriminative value. An acute pain means an acute complication that's all... ! Bilateral: dermoid tumors, cancer ? Ascites = cancer till proof of the contrary > 4) Role of tumor markers Only post op interest. Weak diagnostic value. > 5) Patient desire for conservation of fertility must be taken in acount with informed consent -- Bernard Cristalli MD CNGOF AIHP - ACCA Paris - France http://www.obgyn.net/corresp/cristalli.htm Next message: agustin olmos: "Re: REAL TIME PROGRAMING talk@OBGYN.net" Previous message: Bernard Cristalli: "Pregnancy end surveillance" Maybe in reply to: Geffrey H. Klein, MD: "Your chance to make me look good.." Next in thread: jay kulkin: "Re: Your chance to make me look good.."

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