Re: OB-GYN-L digest 281
From: Dr. Strahimir Banoviæ (strahimir.banovic@zg.tel.hr)
Sun Feb 28 15:47:39 1999
I have 65yrs old patient with postmenopusal bleeding.On TVS she has simple cyst on
the left ovary.If endometrial biopsy and Ca 125 are negativ whot would you do next?
S Banovic
b-gyn-l@obgyn.net wrote:
> OB-GYN-L Digest 281
>
> Topics covered in this issue include:
>
> 1) RE: pregnancy and condyloma
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 2) Re: Don't know where to turn anymore..
> by "Kathy Williams" <WilliamK@methodisthealth.org>
> 3) Re: Cervical stenosis 8 months post conization
> by marcop@agoron.com (Marco A. Pelosi, III, MD)
> 4) RE: Cervical stenosis 8 months post conization
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 5) Re: follow this...
> by LMontgomery <lmontgomery@communitymed.org>
> 6) Re: follow this...
> by Bernard Cristalli <bcrist@club-internet.fr>
> 7) Medical terminology
> by Gloria Lemay <gloria_lemay@ultranet.ca>
> 8) Re: mislav ladach method
> by Gail Waldby <gwaldby@willinet.net>
> 9) RE: mislav ladach method
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 10) RE: mislav ladach method
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 11) Re: mislav ladach method
> by Gail Waldby <gwaldby@willinet.net>
> 12) GYN: Initiation of ERT after OCPs
> by garrys@mindspring.com (Garry E. Siegel, M.D.)
> 13) Re: misgav ladach method
> by jane@seasonedsystems.com (Jane Helwig, MD)
> 14) Re: GYN: Initiation of ERT after OCPs
> by James Connerth <babydoc@apex.net>
> 15) Re: pregnancy and condyloma
> by "Rafael Haciski, MD" <haciski@earthlink.net>
> 16) RE: mislav ladach method
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 17) RE: Initiation of ERT after OCPs
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 18) Re: thrombocytopenia
> by DoctorJoe@aol.com
> 19) Re: Mammogram in young women
> by DoctorJoe@aol.com
> 20) Re: Nifedipine/Mag/Terb interactions
> by DoctorJoe@aol.com
> 21) Re: Mammogram in young women
> by "Gail Waldby, MD" <gwaldby@willinet.net>
> 22) Re: RE: mislav ladach method
> by DoctorJoe@aol.com
> 23) Stripping of the membranes
> by Dr Paul-André
> 24) Re: GYN: Initiation of ERT after OCPs
> by john.robertson@obgyn.net (John Robertson M.D.)
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Wed, 24 Feb 1999 10:04:56 -0500
> ----------------------------------------------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: pregnancy and condyloma
> Message-ID: <9D916278299FD111A7E100805FA7C2BA06146001@cheetah.uits.iupui.edu>
>
> Rafael
> you missed part of the question. It was "Since Progesterone is a Class X
> drug, then why do many IVF programs use it.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: Rafael Haciski, MD [SMTP:haciski@earthlink.net]
> Sent: Tuesday, February 23, 1999 11:23 PM
> To: Multiple recipients of list
> Subject: Re: pregnancy and condyloma
>
> Roger Klam, M.D. wrote:
> >
> > Then why do many IVF programs use progesterone in the luteal phase
> of the
> > cycle and continue for 12 weeks of pregnancy?
>
> Two main reasons:
>
> 1... with such a gargantuan effort as IVF, you do not want any
> surprises, even minor ones, which may negatively
> affect the
> outcome; administering progesterone suplementation
> is a form
> of insurance against such impediments;
>
> 2... strong follicular stimulation seems to be frequently
> associated with a sudden, premature, and precipitous
>
> drop in progesterone production by the resultant
> corpus
> luteum (or lutea) - replacement with natural
> progesterone
> does not add any risk (same progesterone as is
> secreted by
> corpus luteum) while preventing the possible adverse
> effect
> on the pregnancy by too low progesterone levels;
>
> Supplementation is continued beyond the 8th week at which time (+ or
> - a
> week or two) the corpus lutem normally ceases production of
> progesterone
> and placenta begins its own progesterone production.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Assoc.
> Baltimore MD
> http://www.ivf-md.com
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 09:09:58 -0600
> ------------------------------
> From: "Kathy Williams" <WilliamK@methodisthealth.org>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: Don't know where to turn anymore..
> Message-ID: <s6d3c20b.035@smtp.methodisthealth.org>
>
> Is hysterectomy an option?
> Kathy
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 09:34:00 -0600 (CST)
> ------------------------------
> From: marcop@agoron.com (Marco A. Pelosi, III, MD)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Cervical stenosis 8 months post conization
> Message-ID: <199902241534.JAA27132@talk.obgyn.net>
>
> At Wed, 24 Feb 1999, Myer S. Bornstein wrote:
> >
> >I attended a conference in Atlanta where the GYN-ONC advised following, in
> >compliant Patients, CIN 1 with paps only. Use informed consent. If it is
> >CIN a cone is not needed.
> >Myer
> >
>
> Long time, no surf this site.
>
> As a politician might phrase it, I agree and I disagree.
> Anything uttered by anyone at a conference should be regarded with
> extreme skepticism and until backed by solid, non-anecdotical evidence
> should be labeled an Opinion.
>
> The issue at hand is an assessment of ENDOCERVICAL CIN in the absence of
> an adequate colposcopic evaluation. This finding creates a diagnostic
> catch-22 as regards conization...
>
> If I do the cone and nothing worse than LSIL turns up, then I shouldn't
> have done the cone.
>
> If I do the cone and something worse than LSIL turns up, then I should
> have done the cone.
>
> If I don't do the cone, I won't risk cervical stenosis, but I also won't
> have a solid, reliable diagnosis (-and we've all seen anecdotical
> teenagers with cervical ca).
>
> --
> Marco A. Pelosi, III, MD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 11:10:53 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: Cervical stenosis 8 months post conization
> Message-ID: <9D916278299FD111A7E100805FA7C2BA06146008@cheetah.uits.iupui.edu>
>
> That is what makes us necessary and irreplaceable by computers.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: marcop@agoron.com [SMTP:marcop@agoron.com]
> Sent: Wednesday, February 24, 1999 10:35 AM
> To: Multiple recipients of list
> Subject: Re: Cervical stenosis 8 months post conization
>
> At Wed, 24 Feb 1999, Myer S. Bornstein wrote:
> >
> >I attended a conference in Atlanta where the GYN-ONC advised
> following, in
> >compliant Patients, CIN 1 with paps only. Use informed consent. If
> it is
> >CIN a cone is not needed.
> >Myer
> >
>
> Long time, no surf this site.
>
> As a politician might phrase it, I agree and I disagree.
> Anything uttered by anyone at a conference should be regarded with
> extreme skepticism and until backed by solid, non-anecdotical
> evidence
> should be labeled an Opinion.
>
> The issue at hand is an assessment of ENDOCERVICAL CIN in the
> absence of
> an adequate colposcopic evaluation. This finding creates a
> diagnostic
> catch-22 as regards conization...
>
> If I do the cone and nothing worse than LSIL turns up, then I
> shouldn't
> have done the cone.
>
> If I do the cone and something worse than LSIL turns up, then I
> should
> have done the cone.
>
> If I don't do the cone, I won't risk cervical stenosis, but I also
> won't
> have a solid, reliable diagnosis (-and we've all seen anecdotical
> teenagers with cervical ca).
>
> --
> Marco A. Pelosi, III, MD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 09:09:36 -0700
> ------------------------------
> From: LMontgomery <lmontgomery@communitymed.org>
> To: ob-gyn-l@obgyn.net
> Subject: Re: follow this...
> Message-ID: <004a01be6010$13d4a9c0$3a11830a@lmontgomery.communitymed.org>
>
> Geff,
> When I was a senior resident at Baylor, Bonita Kolrud (3rd year), had to
> call for lifting help to get a fibroid out. As I recall is weighed about 80
> pounds. It extended up under the costal margins.
> Lynn
>
> Lynn D. Montgomery, M.D.
> Director, Maternal-Fetal Medicine
> Rocky Mountain Perinatal Center
> 2825 Fort Missoula Rd., Suite 130
> Missoula, Montana
> 406-327-4094
> Fax: 406-327-4154
> e-mail: lmontgomery@communitymed.org
> -----Original Message-----
> From: Geffrey H. Klein, MD <gklein@icsi.net>
> To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
> Date: Friday, February 19, 1999 9:02 PM
> Subject: GYN: follow this...
>
> >http://dailynews.yahoo.com/headlines/ap/ap_us/story.html?s=v/ap/19990219/us
> /tumor_removed_2.html
> >
> >Geffrey H. Klein, MD
> >geffrey.klein@obgyn.net
> >2200 Nasa Rd 1 #200
> >Houston, Texas 77058
> >(713) 741 2273 ext 2628
> >
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 21:00:07 +0100
> ------------------------------
> From: Bernard Cristalli <bcrist@club-internet.fr>
> To: ob-gyn-l@obgyn.net
> Subject: Re: follow this...
> Message-ID: <36D45A41.6588C3E3@club-internet.fr>
>
> How can things like that happen in a developped country? We had those things 30
> years ago, it does belong to medical history now.
>
> --
> LMontgomery wrote:
>
> > Geff,
> > When I was a senior resident at Baylor, Bonita Kolrud (3rd year), had to call
> > for lifting help to get a fibroid out. As I recall is weighed about 80
> > pounds. It extended up under the costal margins.
> >
>
> --
> Bernard Cristalli MD CNGOF
> AIHP - ACCA
> Paris - France
> http://www.obgyn.net/corresp/cristalli.htm
> http://www.cliniquedelessonne.fr/
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 23 Feb 1999 22:16:57 -0800
> ------------------------------
> From: Gloria Lemay <gloria_lemay@ultranet.ca>
> To: ob-gyn-l@obgyn.net
> Subject: Medical terminology
> Message-ID: <36D39959.1F88@ultranet.ca>
>
> anally- occurring yearly
> artery-- boutique of paintings
> bacteria--back door to cafeteria
> barium -what must be done to patients when treatment fails
> c-section-cheap seats at the hockey game
> Cesarean section-a district in Rome
> Catarrh- a stringed instrument
> CAT scan--searching for kitty
> cauterize--made eye contact with her
> colic -a sheep dog
> coma -a punctuation mark
> congenital -friendly
> crowning -big event for a queen
> D & C -where Washington is
> Diarrhea -journal of daily events
> Dilate -to live long
> Enema -not a friend
> Fester -quicker
> Fetoscope--instrument to measure shoe size
> Fibula -a small lie
> Genital -non-Jewish
> G. I. series -soldiers' ball game
> High Colonic -Jewish religious service
> Impotent -distinguished, well known
> Intense pain -torture in a teepee
> lie -where your golf ball lands
> labour pain- got hurt at work
> Medical staff -what a physician uses for a cane
> morbid -higher offer
> Nitrate -cheaper than the day rate
> Node -was aware of
> outpatient -person who has fainted
> pap smear -fatherhood test
> Pelvis -cousin of Elvis
> Post Operative -mail man
> Prostate -flat on your back
> Post partum -problem with your back yard fence
> protein -favouring young people
> recovery room -place to do upholstery
> rectum -damn near killed em
> Rheumatic -amorous
> Scar -rolled tobacco leaf; presidential dildoe
> secretion -hiding anything
> seizure -Roman emperor
> serology -study of Knighthood
> tablet -small table
> terminal illness -sick at the airport
> testicle -examination for ticklishness
> Tibia -country in N. Africa
> Tumour -an extra pair
> Urine -opposite of you're out
> Varicose -located nearby
> Vein -conceited
>
> Send me yours and I'll expand my list. gloria_lemay@ultranet.ca
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 15:09:34 -0600
> ------------------------------
> From: Gail Waldby <gwaldby@willinet.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: mislav ladach method
> Message-ID: <36D46A8E.C6A8F39B@willinet.net>
>
> This is a nice article about the advantages but it doesn't describe
> exactly the method used. Can anyone provide a step by step description
> (just curious, as I am not currently doing C-sections, but will share
> this info with local doctors who do perform sections). Also, anyone
> care to describe Joel Cohen's approach to hysterectomy?
> Gail Waldby, MD
> Huron Clinic SD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 17:06:39 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: mislav ladach method
> Message-ID: <9D916278299FD111A7E100805FA7C2BA0614600B@cheetah.uits.iupui.edu>
>
> Try : http://www.medsite.co.il/doctors/hospitals/Misgav_L/pages/Caesa3.htm
> <http://www.medsite.co.il/doctors/hospitals/Misgav_L/pages/Caesa3.htm>
> That gives a fair description of the technique.
> With the exception of the Joel-Cohen incision and the "Nesta" Stitch, I have
> done them that way for years.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: Gail Waldby [SMTP:gwaldby@willinet.net]
> Sent: Wednesday, February 24, 1999 4:08 PM
> To: Multiple recipients of list
> Subject: Re: mislav ladach method
>
> This is a nice article about the advantages but it doesn't describe
> exactly the method used. Can anyone provide a step by step
> description
> (just curious, as I am not currently doing C-sections, but will
> share
> this info with local doctors who do perform sections). Also, anyone
> care to describe Joel Cohen's approach to hysterectomy?
> Gail Waldby, MD
> Huron Clinic SD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 17:09:29 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: mislav ladach method
> Message-ID: <9D916278299FD111A7E100805FA7C2BA0614600C@cheetah.uits.iupui.edu>
>
> For the Joel-Cohen hysterectomy technique, you really should get a copy of
> his book and read it. It is very detailed. BTW, his last name is
> "Joel-Cohen" I am not sure what his first name is except for "Doctor". I
> know there is a copy in the Indiana U. School of Medicine Library. I doubt
> that you could buy one.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: Gail Waldby [SMTP:gwaldby@willinet.net]
> Sent: Wednesday, February 24, 1999 4:08 PM
> To: Multiple recipients of list
> Subject: Re: mislav ladach method
>
> This is a nice article about the advantages but it doesn't describe
> exactly the method used. Can anyone provide a step by step
> description
> (just curious, as I am not currently doing C-sections, but will
> share
> this info with local doctors who do perform sections). Also, anyone
> care to describe Joel Cohen's approach to hysterectomy?
> Gail Waldby, MD
> Huron Clinic SD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 16:20:23 -0600
> ------------------------------
> From: Gail Waldby <gwaldby@willinet.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: mislav ladach method
> Message-ID: <36D47B27.546BAFCA@willinet.net>
>
> So I need to come to Indianapolis if I want to read about this?? :-)
> Thanks for the reference to the Internet site.
> Gail Waldby, MD
>
> "Braun, R. Daniel" wrote:
> >
> > For the Joel-Cohen hysterectomy technique, you really should get a copy of
> > his book and read it. It is very detailed. BTW, his last name is
> > "Joel-Cohen" I am not sure what his first name is except for "Doctor". I
> > know there is a copy in the Indiana U. School of Medicine Library. I doubt
> > that you could buy one.
> > Dan
> >
> > R. Daniel Braun, MD FACOG
> > Clinical Professor
> > Department of Obstetrics and Gynecology
> > Indiana U. School of Medicine
> > Indianapolis, IN
> >
> > -----Original Message-----
> > From: Gail Waldby [SMTP:gwaldby@willinet.net]
> > Sent: Wednesday, February 24, 1999 4:08 PM
> > To: Multiple recipients of list
> > Subject: Re: mislav ladach method
> >
> > This is a nice article about the advantages but it doesn't describe
> > exactly the method used. Can anyone provide a step by step
> > description
> > (just curious, as I am not currently doing C-sections, but will
> > share
> > this info with local doctors who do perform sections). Also, anyone
> > care to describe Joel Cohen's approach to hysterectomy?
> > Gail Waldby, MD
> > Huron Clinic SD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 18:30:32 -0600 (CST)
> ------------------------------
> From: garrys@mindspring.com (Garry E. Siegel, M.D.)
> To: OB-GYN-L@OBGYN.net
> Subject: GYN: Initiation of ERT after OCPs
> Message-ID: <199902250030.SAA03373@talk.obgyn.net>
>
> Dear listers:
>
> I'm interested in how everyone starts folks on ERT in certain
> circumstances. I'm especially interested in how the private practice
> folks do it, even those who don't post much these days (Harvey, Ashley,
> Kelly, Ricky--hope I didn't forget anyone).
>
> Anyway, the circumstances:
>
> 1. Perimenopausal, irregular cycles with symptoms amenable to ERT, ie
> hot flashes, approximately age 50.
>
> Generally, I am reluctant to go straight to a continous combined method
> because the breakthrough bleeding takes forever to resolve, and these
> patients are impatient. I usually start cyclic therapy, and after one
> or two years, offer continous combined.
>
> I especially am reluctant to use continous combined therapy in the
> younger (45) folks.
>
> 2. Menopausal for several years, late 50s, not on ERT.
>
> Generally, I'll go straight to the continous combined method.
>
> 3. Someone on a low dose OCP nearing 50, who has a screening FSH after
> the skipped week of pills that clearly is menopausal.
>
> Would you go continous combined, or cyclic? Again, I tend to go cyclic
> for a year or two.
>
> Garry
>
> --
> Garry E. Siegel, M.D., FACOG
> Private Practice
> Roswell, Ga.
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 19:54:41 -0600 (CST)
> ------------------------------
> From: jane@seasonedsystems.com (Jane Helwig, MD)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: misgav ladach method
> Message-ID: <199902250154.TAA08981@talk.obgyn.net>
>
> This method seems very similar to that described by Marco Pelosi in a
> Contemporary OB-GYN article in 1995. He did not do Joel Cohen, but used
> a Bovie to open the subcutaneous tissue as well as the fascia. As is
> Misgav Ladach, no dissection of the fascia off the rectus muscles, just
> bluntly separate rectus muscles, bluntly open and extend the peritoneal
> incision. No bladder flap--make the uterine incision above the
> reflection of the bladder peritoneum and extending incision bluntly or
> sharply. No exteriorization of uterus. One-layer uterine closure. No
> closure of peritoneum.
>
> I hope I'm getting all this right as my copy of the article is at the
> office. I have used the Pelosi technique (except for opening the subcu
> with the Bovie--I go down to the fascia in the midline sharply and then
> open subcu bluntly) for the last couple of years with excellent results.
> No randomized controlled trials yet, but subjectively patients who don't
> have the fascia dissected off the rectus muscles seem to recover faster
> than those who don't. I can't think of any reason to do it in primary
> sections.
>
> All this blunt dissection would horrify the gyn oncs who taught me that
> surgeons use instruments and not fingers to operate, but it seems to
> work just as well if not better for this purpose.
>
> Dr. Pelosi cited an average time around 15 minutes. It takes me longer
> but I do subcuticular skin suture.
>
> --
> Jane Helwig, MD
> Private practice
> Nassawadox, VA
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 24 Feb 1999 20:29:52 -0600
> ------------------------------
> From: James Connerth <babydoc@apex.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: GYN: Initiation of ERT after OCPs
> Message-ID: <36D4B59F.82C77678@apex.net>
>
> "Garry E. Siegel, M.D." wrote:
>
> > Dear listers:
> >
> > I'm interested in how everyone starts folks on ERT in certain
> > circumstances. I'm especially interested in how the private practice
> > folks do it-
>
> Agree with 1,2,and 3--very often too much BTB on continuous combined in
> younger women--less compliance.Very much favor lowdose (20mcg)BCP for
> perimenopause and early menopausal.
>
> >
> > Private Practice
> > Roswell, Ga.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 00:13:44 -0500
> ------------------------------
> From: "Rafael Haciski, MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: pregnancy and condyloma
> Message-ID: <36D4DC00.5FC@earthlink.net>
>
> Jeffrey W. Clemens wrote:
> > Re:point 2 from Rafael Haciski in response to Roger Klam's question.
> > Is it also true that follicular aspiration may be removing many of the
> > cells that would form the corpora lutea? This makes sense to me. In my own
> > experience (n=2 so far) in purifying human granulosa cells from IVF
> > aspirates, there are many more cells than I would expect from the cumulus
> > complex alone.
>
> Jeff,
>
> That's a very good point, for when I aspirate the follicle it is not
> just a minimal aspiration, but a vigourous, complete aspiration, almost
> a curettage, accompanied by flushing the follicle (refilling it with
> media, and re-aspirating, sometimes several times), all in an effort to
> retrieve the egg, which sometimes does not come out readily. So this
> may indeed reduce the mass of granulosa cells, and thus result in
> deficient progesterone production.
>
> However, I have also seen precipitous and premature progesterone drops
> in late luteal phase in patients who underwent ovulation induction with
> human menopausal gonadotropins, without egg retrieval (as in patients
> who are anovulatory, or those undergoing IUIs). These patients have not
> suffered a dramatic loss of their granulosa cell mass. Yet their
> progesterone still drops and requires supplementation.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Assoc.
> Baltimore MD
> http://www.ivf-md.com
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 06:00:52 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: mislav ladach method
> Message-ID: <9D916278299FD111A7E100805FA7C2BA0614600D@cheetah.uits.iupui.edu>
>
> No but you might try your local medical school library. In Vermilion, I
> think. If they don't have it, they can get it on Inter Library Loan for you.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: Gail Waldby [SMTP:gwaldby@willinet.net]
> Sent: Wednesday, February 24, 1999 5:16 PM
> To: Multiple recipients of list
> Subject: Re: mislav ladach method
>
> So I need to come to Indianapolis if I want to read about this?? :-)
>
> Thanks for the reference to the Internet site.
> Gail Waldby, MD
>
> "Braun, R. Daniel" wrote:
> >
> > For the Joel-Cohen hysterectomy technique, you really should get a
> copy of
> > his book and read it. It is very detailed. BTW, his last name is
> > "Joel-Cohen" I am not sure what his first name is except for
> "Doctor". I
> > know there is a copy in the Indiana U. School of Medicine Library.
> I doubt
> > that you could buy one.
> > Dan
> >
> > R. Daniel Braun, MD FACOG
> > Clinical Professor
> > Department of Obstetrics and Gynecology
> > Indiana U. School of Medicine
> > Indianapolis, IN
> >
> > -----Original Message-----
> > From: Gail Waldby [SMTP:gwaldby@willinet.net]
> > Sent: Wednesday, February 24, 1999 4:08 PM
> > To: Multiple recipients of list
> > Subject: Re: mislav ladach method
> >
> > This is a nice article about the advantages but it doesn't
> describe
> > exactly the method used. Can anyone provide a step by
> step
> > description
> > (just curious, as I am not currently doing C-sections, but
> will
> > share
> > this info with local doctors who do perform sections).
> Also, anyone
> > care to describe Joel Cohen's approach to hysterectomy?
> > Gail Waldby, MD
> > Huron Clinic SD
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 06:15:39 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: Initiation of ERT after OCPs
> Message-ID: <9D916278299FD111A7E100805FA7C2BA06146010@cheetah.uits.iupui.edu>
>
> If I am not excluded from answering, I concur with the way you do it. It
> seems to work that way.
> Dan
>
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN
>
> -----Original Message-----
> From: garrys@mindspring.com [SMTP:garrys@mindspring.com]
> Sent: Wednesday, February 24, 1999 8:28 PM
> To: Multiple recipients of list
> Subject: GYN: Initiation of ERT after OCPs
>
> Dear listers:
>
> I'm interested in how everyone starts folks on ERT in certain
> circumstances. I'm especially interested in how the private
> practice
> folks do it, even those who don't post much these days (Harvey,
> Ashley,
> Kelly, Ricky--hope I didn't forget anyone).
>
> Anyway, the circumstances:
>
> 1. Perimenopausal, irregular cycles with symptoms amenable to ERT,
> ie
> hot flashes, approximately age 50.
>
> Generally, I am reluctant to go straight to a continous combined
> method
> because the breakthrough bleeding takes forever to resolve, and
> these
> patients are impatient. I usually start cyclic therapy, and after
> one
> or two years, offer continous combined.
>
> I especially am reluctant to use continous combined therapy in the
> younger (45) folks.
>
> 2. Menopausal for several years, late 50s, not on ERT.
>
> Generally, I'll go straight to the continous combined method.
>
> 3. Someone on a low dose OCP nearing 50, who has a screening FSH
> after
> the skipped week of pills that clearly is menopausal.
>
> Would you go continous combined, or cyclic? Again, I tend to go
> cyclic
> for a year or two.
>
> Garry
>
> --
> Garry E. Siegel, M.D., FACOG
> Private Practice
> Roswell, Ga.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 08:11:33 EST
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: thrombocytopenia
> Message-ID: <95460889.36d54c05@aol.com>
>
> In a message dated 2/23/99 2:01:05 PM, imstorkrnc@aol.com writes:
>
> << we had a pt come in 39+ weeks in early labor. she had received gamma
> globulin for thrombocytopenia earlier in the day. would there be any
> medical/obstetrical reason to give the patient brethine sub-q to delay
> labor unitl the next day that is related to the gamma globulin? >>
>
> No reason that I can think of. Are you theorizing that you want it to have
> time to cross the placenta?
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 08:13:40 EST
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: Mammogram in young women
> Message-ID: <ac0eddc7.36d54c84@aol.com>
>
> In a message dated 2/23/99 4:54:31 PM, babydoc@apex.net writes:
>
> << 25yo female on BCP's c/o tender l breast.No masses,nodes,skin
> changes,nipple discharge.Dense ropy tissue in UOQ bilat--mom had breast
> ca at age 33;what is value of mammogram in this pt?How would you
> followup?? >>
>
> She's got a complaint... I would do a mammogram (since her mother had CA so
> young). You could also stop the BCP's for a month and see if that helped. (But
> still get a mammogram, as well as accurately document your findings so you'll
> be able to tell if things change over time...)
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 08:15:41 EST
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: Nifedipine/Mag/Terb interactions
> Message-ID: <b455c19c.36d54cfd@aol.com>
>
> In a message dated 2/23/99 5:11:34 PM, dlaxague@snowcrest.net writes:
>
> << A Medline search mentioned MgSo4 and nifedipine mostly with respect to
> controlling B/P in PIH. A pharmacist at a recent seminar cited incidences of
> profound hypotensive reactions with MgSO4 and nifedipine, but this was only a
> personal observation. >>
>
> I thought there was at least one published OB-GYN paper on something "bad"
> happening with the combination. A calcium channel drug on top of Mg++
> (essentially a calcium antagonist) supposedly has the potential for doing
> grave cardiovascular mischief. However, I forget what that mischief is...
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 06:56:52 -0600
> ------------------------------
> From: "Gail Waldby, MD" <gwaldby@willinet.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Mammogram in young women
> Message-ID: <36D54894.5B3B9C57@willinet.net>
>
> I don't think mammograms are going to tell you much since the breast
> tissue will be too dense for adequate mammo interpretation.
>
> I would consider fine needle aspiration biopsies of the area most
> worrisome to the patient. If you could get her to pin down her
> complaints to at most one quadrant of the breast, you could adequately
> sample it with fine needle aspiration biopsies (21 or 22 gauge needle,
> Cameco type syringe holder, multiple passes with the needle each of 6
> times to obtain 12 good slides of cells).
>
> I would follow her closely, at least annually. I would make sure she can
> adequately examine her own breasts.
>
> I would recommend she at least talk to a geneticist about BRCA testing.
> Gail Waldby, MD
> Huron Clinic SD
>
> DoctorJoe@aol.com wrote:
> >
> > In a message dated 2/23/99 4:54:31 PM, babydoc@apex.net writes:
> >
> > << 25yo female on BCP's c/o tender l breast.No masses,nodes,skin
> > changes,nipple discharge.Dense ropy tissue in UOQ bilat--mom had breast
> > ca at age 33;what is value of mammogram in this pt?How would you
> > followup?? >>
> >
> > She's got a complaint... I would do a mammogram (since her mother had CA so
> > young). You could also stop the BCP's for a month and see if that helped. (But
> > still get a mammogram, as well as accurately document your findings so you'll
> > be able to tell if things change over time...)
> >
> > Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 08:41:15 EST
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: RE: mislav ladach method
> Message-ID: <c70a24cb.36d552fb@aol.com>
>
> In a message dated 2/24/99 4:07:56 PM, rbraun@iupui.edu writes:
>
> << Try : http://www.medsite.co.il/doctors/hospitals/Misgav_L/pages/Caesa3.htm
> <http://www.medsite.co.il/doctors/hospitals/Misgav_L/pages/Caesa3.htm>
> That gives a fair description of the technique.
> With the exception of the Joel-Cohen incision and the "Nesta" Stitch, I have
> done them that way for years.
> Dan >>
>
> I've been doing the cut/finger tear stuff for a while and it works fine. I
> still close all the layers individually, however, but that's sort of academic.
> By then the baby's out, everyone's calm (even bored) and if you're
> experienced, all those layers take about 2 minutes to close...
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 10:21:20 -0500
> ------------------------------
> From: Dr Paul-André
> To: ob-gyn-l@obgyn.net
> Subject: Stripping of the membranes
> Message-ID: <3.0.3.32.19990225102120.0069d4ec@pop1.sympatico.ca>
>
> Dear colisters,
>
> I saw a few day ago, a post who was talking about the opportunity to strip
> the membranes for a parturient at 38 weeks.
>
> This is the result of a little search about that.
>
> ~~~~~~~~~~~~~~~~~~
>
> Référence: Boulvain M, Irion O. Stripping/sweeping of the membranes to
> induce labour or to prevent post-term pregnancy (Cochrane Review). In:
> The Cochrane Library, Issue 4, 1998. Oxford: Update Software.
>
> Email address of the first author: michel.boulvain@hcuge.ch
>
> Cochrane extracts
> 1) " Sweeping the membranes in women at term generally reduces the
> delay between randomisation and spontaneous onset of labour, or
> between randomisation and delivery, by a mean of four days. This
> intervention also increased the likelihood of either spontaneous
> labour within 48 hours or of delivery within one week. Sweeping
> the membranes, performed as a general policy from 38-40 weeks
> onwards, decreased the frequency of 'post-term' pregnancy defined
> as pregnancy continuing beyond 42 weeks and beyond 41 weeks. "
>
> 2) "A reduction in the frequency of using other methods to induce
> labour in women allocated to 'sweeping' was reported in most
> trials. The overall risk reduction in the available trials was
> 17%. The available evidence suggests that sweeping of the membranes
> reduces the duration of pregnancy. For women thought to require
> induction of labour, a reduction in the use of more 'formal'
> methods of induction could be expected."
>
> 3)"No major side effect was reported, but women in the 'sweeping' group
> reported significant discomfort during the intervention and some 'minor'
> side effects such as bleeding or irregular contractions. This must
> be taken into account while discussing management options with
> women for whom induction of labour is decided. No increase in premature
> rupture of membranes or in infection.
>
> 4)"However, no clear benefits on substantial outcomes (eg Caesarean
> section) were reported. The intervention was not shown to be associated
> with substantial benefits on maternal or neonatal outcomes.
>
> In summary: If you do it you don't hurt... and if you don't do it, you are
> not in the false.
>
> Dr Paul-André Latulippe MD FRCCP(s) Ob/Gyn
> 111 Rang 9
> St-Christophe d'Arthabaska
> Québec,Canada
> G6P 6S1
>
> Paul-Andre.Latulippe@sympatico.ca
>
> tel:(819) 357-1784
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 25 Feb 1999 08:55:17 -0600 (CST)
> ------------------------------
> From: john.robertson@obgyn.net (John Robertson M.D.)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: GYN: Initiation of ERT after OCPs
> Message-ID: <199902251455.IAA01940@talk.obgyn.net>
>
> At Wed, 24 Feb 1999, Garry E. Siegel, M.D. wrote:
> >
> >Dear listers:
> >
> >I'm interested in how everyone starts folks on ERT in certain
> >circumstances. I'm especially interested in how the private practice
> >folks do it, even those who don't post much these days (Harvey, Ashley,
> >Kelly, Ricky--hope I didn't forget anyone).
> >
> >Anyway, the circumstances:
> >
> >1. Perimenopausal, irregular cycles with symptoms amenable to ERT, ie
> >hot flashes, approximately age 50.
> >
> >Generally, I am reluctant to go straight to a continous combined method
> >because the breakthrough bleeding takes forever to resolve, and these
> >patients are impatient. I usually start cyclic therapy, and after one
> >or two years, offer continous combined.
> >
> >I especially am reluctant to use continous combined therapy in the
> >younger (45) folks.
> >
>
> Cycle one year then continuous combined
>
> >2. Menopausal for several years, late 50s, not on ERT.
> >
> >Generally, I'll go straight to the continous combined method.
> >
>
> ditto
>
> >3. Someone on a low dose OCP nearing 50, who has a screening FSH after
> >the skipped week of pills that clearly is menopausal.
> >
> >Would you go continous combined, or cyclic? Again, I tend to go cyclic
> >for a year or two.
> >
>
> Cycle one year then continuous combined
>
> >Garry
> >
> >--
> >Garry E. Siegel, M.D., FACOG
> >Private Practice
> >Roswell, Ga.
> >
>
> John
>
> --
> J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9, Canada
> (604) 793-9988 e-mail john.robertson@obgyn.net
> Who is wise and understanding among you? Let him show it by his good life,
> by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 281
> ------------------------------
> **************************
