Re: OB-GYN-L digest 281
From: Larry Glazerman (glazerman@enter.net)
Sun Feb 28 19:39:54 1999
IF less than 5 cm and Ca125 normal, watch for 6 months and repeat
ultrasound, as long as it's asymptomatic.
At 04:54 PM 2/28/99 -0600, you wrote:
>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
>> ------------------------------
>> **************************
>
>
>
--
Larry R. Glazerman, MD
Valley Ob-Gyn Associates
glazerman@enter.net
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