Re: OB-GYN-L digest 2215

From: cemayhan@superonline.com
Wed Jul 31 02:56:27 2002

Does anyone has experience on ürinary incontinans following C/section which was performed under epidural anesthesia? Treatment modalities, prognosis etc.? > Cem Ayhan

> Kimden: ob-gyn-l@obgyn.net
> Tarih: 2002/07/30 Tue PM 05:07:59 GMT+03:00
> Kime: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.medispecialty.com>
> Konu: OB-GYN-L digest 2215
>
> OB-GYN-L Digest 2215
>
> Topics covered in this issue include:
>
> 1) Re: endometriosis in C/S scar
> by "Ricardo Savaris" <savaris@orion.ufrgs.br>
> 2) RE: endometriosis in C/S scar
> by "Griffiths Malcolm (RC9) Luton & Dunstable Hospital TR" <Malcolm.
Griffiths@ldh-tr.anglox.nhs.uk> > 3) Re: endometriosis in C/S scar
> by "Gerald P. Rodriguez" <geraldpr@cybermesa.com>
> 4) RE: endometriosis in C/S scar
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 5) RE: endometriosis in C/S scar
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 6) Re: endometriosis in C/S scar
> by "gynendohaiti jean louis" <gynendohaiti@hotmail.com>
> 7) Re: endometriosis in C/S scar
> by "Ricardo Savaris" <ricardosavaris@hotmail.com>
> 8) Re: endometriosis in C/S scar
> by "Gerald P. Rodriguez" <geraldpr@cybermesa.com>
> 9) RE: endometriosis in C/S scar
> by "gynendohaiti jean louis" <gynendohaiti@hotmail.com>
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Tue, 30 Jul 2002 10:28:15 -0300
> ----------------------------------------------------------------------
> From: "Ricardo Savaris" <savaris@orion.ufrgs.br>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: endometriosis in C/S scar
> Message-ID: <000901c237cc$f711f340$a24ffea9@fujitsu>
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> endometriosis in C/S scarDaniel,
>
> Although asymptomatic, I believe that you should burn the endometrial > spots and remove the endometrioma from the scar. I read (don't recall > where) that all GnRH treatment are palliative and surgery seems to be > the best treatment.
>
> That's my opinion
>
> Ricardo Savaris, MD
> Porto Alegre - Brazil
>

>> ----- Original Message -----
> From: Braun, R. Daniel
> To: Multiple recipients of list OB-GYN-L
> Sent: Tuesday, July 30, 2002 10:22 AM
> Subject: endometriosis in C/S scar
>
> Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time > of last section. Presents with a 2X3X4 cm lump at the right end of her > C/S incision. It swells and becomes tender about the time of her period. > No other symptoms at all. The question becomes one of "Since she has > endo in her incision, does she have a likelihood of intraperitoneal > endo, and if so, should we do a diagnostic scope at the time of excision > of the scar endometrioma? If we do and we find endometriosis in this > asymptomatic patient, what should we do about that?
>
> I would like to heart a lot of opinions. We had a bunch in our morning > report.
>
> Dan
>
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> <DIV><FONT face=Arial size=2>Daniel,</FONT></DIV>
> <DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
> <DIV><FONT face=Arial size=2>Although asymptomatic, I believe that > you should
> burn the endometrial spots and remove the endometrioma from the scar. I > read
> (don't recall where) that all GnRH treatment are palliative and surgery > seems to
> be the best treatment.</FONT></DIV>
> <DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
> <DIV><FONT face=Arial size=2>That's my opinion</FONT></DIV>
> <DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
> <DIV><FONT face=Arial size=2>Ricardo Savaris, MD<BR>Porto Alegre -
> Brazil<BR></FONT></DIV>
> <BLOCKQUOTE dir=ltr
> style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; > BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">

>> <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
> <DIV
> style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: > black"><B>From:</B>
> <A title=rbraun@iupui.edu href="mailto:rbraun@iupui.edu">Braun, R. > Daniel</A>
> </DIV>
> <DIV style="FONT: 10pt arial"><B>To:</B> <A
> title=ob-gyn-l@mail.medispecialty.com
> href="mailto:ob-gyn-l@mail.medispecialty.com">Multiple recipients of > list
> OB-GYN-L</A> </DIV>
> <DIV style="FONT: 10pt arial"><B>Sent:</B> Tuesday, July 30, 2002 > 10:22
> AM</DIV>
> <DIV style="FONT: 10pt arial"><B>Subject:</B> endometriosis in C/S > scar</DIV>
> <DIV><BR></DIV><!-- Converted from text/rtf format -->
> <P align=left><SPAN lang=en-us><FONT face=Arial size=2>Patient > is 30 ish G 3 P
> 3003 all cesarean sections. Had tubal at time of last
> section.</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us><FONT
> face=Arial size=2> Presents with a 2X3X4 cm lump at the right end > of her C/S
> incision. It swells and becomes tender about the time of her
> period.</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN lang=en-us> > <FONT
> face=Arial size=2>No other symptoms at all.</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN lang=en-us> <FONT face=Arial > size=2>The question
> becomes one of</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us> <FONT
> face=Arial size=2>“</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN >
> lang=en-us><FONT face=Arial size=2>Since she has endo in her > incision, does
> she have a</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN lang=en-us> > <FONT
> face=Arial size=2>likelihood</FONT></SPAN><SPAN > lang=en-us></SPAN><SPAN
> lang=en-us><FONT face=Arial size=2> of intraperitoneal endo, and > if so, should
> we do a diagnostic scope at the time of excision of the scar > endometrioma? If
> we do and we find endometriosis in this</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN lang=en-us> <FONT face=Arial
> size=2>asymptomatic</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN
> lang=en-us><FONT face=Arial size=2> patient, what should we do > about
> that?</FONT></SPAN></P>
> <P align=left><SPAN lang=en-us><FONT face=Arial size=2>I would > like to heart a
> lot of opinions</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us><FONT
> face=Arial size=2>. We had a bunch in our morning
> report.</FONT></SPAN></P><BR>
> <P align=left><SPAN lang=en-us><FONT face=Arial > size=2>Dan</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN > lang=en-us></SPAN></P></BLOCKQUOTE></BODY></HTML>
>
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> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 14:35:26 +0100
> ------------------------------
> From: "Griffiths Malcolm (RC9) Luton & Dunstable Hospital TR" <Malcolm.
Griffiths@ldh-tr.anglox.nhs.uk> > To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> Subject: RE: endometriosis in C/S scar
> Message-ID: <973556B7BF73B846A63DF3D90A39544F93B812@exchange>
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> I have four cases currently of women with either scar endometriosis post CS
> (three) or one with isolated umbilical endo with no scar.
>
> I have laparoscoped two of the former and found no endo. All three have been
> cured by simple local excision.
>
> The umbilical deposit patient is due surgery under plastic surgeons shortly
> (she is very slim and blonde and works in the sort of job where people often
> see your umbilicus!
>
> Malcolm Griffiths
> Clinical director & consultant - obstetrics & gynaecology
> Luton & Dunstable Hospital NHS Trust, Luton, LU4 0DZ, UK
> Tel:+(44) 1582 497533 Fax: +(44) 1582 497376
>
> -----Original Message-----
> From: Braun, R. Daniel [mailto:rbraun@iupui.edu]
> Sent: 30 July 2002 14:22
> To: Multiple recipients of list OB-GYN-L
> Subject: endometriosis in C/S scar
>
> Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time of
> last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> incision. It swells and becomes tender about the time of her period. No
> other symptoms at all. The question becomes one of "Since she has endo in
> her incision, does she have a likelihood of intraperitoneal endo, and if so,
> should we do a diagnostic scope at the time of excision of the scar
> endometrioma? If we do and we find endometriosis in this asymptomatic
> patient, what should we do about that?
> I would like to heart a lot of opinions. We had a bunch in our morning
> report.
>
> Dan
>
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>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>I> have
> four cases currently of women with either scar endometriosis post CS > (three) or
> one with isolated umbilical endo with no > scar.<o:p></o:p></span></font></span></p>
>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><> ![if > !supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>I> have
> laparoscoped two of the former and found no endo. All three have been > cured by
> simple local excision.<o:p></o:p></span></font></span></p>
>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><> ![if > !supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>T> he
> umbilical deposit patient is due surgery under plastic surgeons shortly > (she is
> very slim and blonde and works in the sort of job where people often > see your
> umbilicus!<o:p></o:p></span></font></span></p>
>
> <p class=MsoNormal><span class=EmailStyle16><font size=2 > color=navy face=Arial><span
> style='font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><> ![if > !supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>>
> <p class=MsoAutoSig><!--[if supportFields]><span > class=EmailStyle16><font
> size=2 color=navy face=Arial><span > style='font-size:10.0pt;mso-bidi-font-size:
> 12.0pt;font-family:Arial'><span > style='mso-element:field-begin'></span><span
> style="mso-spacerun: yes">&nbsp;</span>AUTOTEXTLIST \s &quot;E-mail
> Signature&quot; <span > style='mso-element:field-separator'></span></span></font></span><![end> if]--><b><font
> color=lime><span style='color:lime;font-weight:bold'>Malcolm > Griffiths<o:p></o:p></span></font></b></p>
>
> <p class=MsoAutoSig><font size=3 color=fuchsia face="Times New > Roman"><span
> style='font-size:12.0pt;color:fuchsia'>Clinical director & > consultant -
> obstetrics & gynaecology<o:p></o:p></span></font></p>
>
> <p class=MsoAutoSig><font size=3 color=fuchsia face="Times New > Roman"><span
> style='font-size:12.0pt;color:fuchsia'>Luton & Dunstable Hospital > NHS
> Trust, Luton, LU4 0DZ, UK<o:p></o:p></span></font></p>
>
> <p class=MsoAutoSig><font size=3 color=fuchsia face="Times New > Roman"><span
> style='font-size:12.0pt;color:fuchsia'>Tel:+(44) 1582 497533<span
> style="mso-spacerun: yes">&nbsp;&nbsp; </span>Fax: +(44) 1582 > 497376</span></font><font
> color=navy><span > style='color:navy;mso-color-alt:windowtext'><o:p></o:p></span></font><> /p>
>
> <p class=MsoNormal><!--[if supportFields]><span > class=EmailStyle16><font
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> class=EmailStyle16><font size=2 color=navy face=Arial><span > style='font-size:
> 10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><![if > !supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>>
> <p class=MsoNormal style='margin-left:36.0pt'><font size=2 > color=black
> face=Tahoma><span > style='font-size:10.0pt;font-family:Tahoma;color:black'>-----Original
> Message-----<br>
> <b><span style='font-weight:bold'>From:</span></b> Braun, R. Daniel
> [mailto:rbraun@iupui.edu]<br>
> <b><span style='font-weight:bold'>Sent:</span></b> 30 July 2002 > 14:22<br>
> <b><span style='font-weight:bold'>To:</span></b> Multiple recipients > of list
> OB-GYN-L<br>
> <b><span style='font-weight:bold'>Subject:</span></b> endometriosis > in C/S scar</span></font></p>
>
> <p class=MsoNormal style='margin-left:36.0pt'><font size=3
> face="Times New Roman"><span style='font-size:12.0pt'><![if > !supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>
>
> <p style='margin-left:36.0pt'><font size=2 color=black > face=Arial><span
> lang=EN-US > style='font-size:10.0pt;font-family:Arial;color:black;mso-ansi-languag> e:
> EN-US'>Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at > time of
> last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> incision. It swells and becomes tender about the time of her > period.</span></font><font
> color=black><span lang=EN-US > style='color:black;mso-ansi-language:EN-US'> </span></font><font
> size=2 color=black face=Arial><span lang=EN-US > style='font-size:10.0pt;
> font-family:Arial;color:black;mso-ansi-language:EN-US'>No other > symptoms at
> all.</span></font><font color=black><span lang=EN-US > style='color:black;
> mso-ansi-language:EN-US'> </span></font><font size=2 color=black > face=Arial><span
> lang=EN-US > style='font-size:10.0pt;font-family:Arial;color:black;mso-ansi-languag> e:
> EN-US'>The question becomes one of</span></font><font > color=black><span
> lang=EN-US style='color:black;mso-ansi-language:EN-US'> > </span></font><font
> size=2 color=black face=Arial><span lang=EN-US > style='font-size:10.0pt;
> font-family:Arial;color:black;mso-ansi-language:EN-US'>“Since she > has endo in
> her incision, does she have a</span></font><font color=black><span > lang=EN-US
> style='color:black;mso-ansi-language:EN-US'> </span></font><font > size=2
> color=black face=Arial><span lang=EN-US style='font-size:10.0pt;> font-family:
> Arial;color:black;mso-ansi-language:EN-US'>likelihood of > intraperitoneal endo,
> and if so, should we do a diagnostic scope at the time of excision of > the scar
> endometrioma? If we do and we find endometriosis in > this</span></font><font
> color=black><span lang=EN-US > style='color:black;mso-ansi-language:EN-US'> </span></font><font
> size=2 color=black face=Arial><span lang=EN-US > style='font-size:10.0pt;
> font-family:Arial;color:black;mso-ansi-language:EN-US'>asymptomatic > patient,
> what should we do about that?</span></font><font color=black><span
> style='color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>> </p>
>
> <p style='margin-left:36.0pt'><font size=2 color=black > face=Arial><span
> lang=EN-US > style='font-size:10.0pt;font-family:Arial;color:black;mso-ansi-languag> e:
> EN-US'>I would like to heart a lot of opinions. We had a bunch in our > morning
> report.</span></font><font color=black><span > style='color:black;mso-color-alt:
> windowtext'><o:p></o:p></span></font></p>
>
> <p class=MsoNormal style='margin-left:36.0pt'><font size=3 > color=black
> face="Times New Roman"><span > style='font-size:12.0pt;color:black'><![if > !supportEmptyParas]>&nbsp;<![endif]></span></font><font
> color=black><span > style='color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>> </p>
>
> <p style='margin-left:36.0pt'><font size=2 color=black > face=Arial><span
> lang=EN-US > style='font-size:10.0pt;font-family:Arial;color:black;mso-ansi-languag> e:
> EN-US'>Dan</span></font><font color=black><span > style='color:black;mso-color-alt:
> windowtext'><o:p></o:p></span></font></p>
>
> </div>
>
> </body>
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> ------_=_NextPart_001_01C237CD.F65D53D0--
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 07:38:21 -0600
> ------------------------------
> From: "Gerald P. Rodriguez" <geraldpr@cybermesa.com>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: endometriosis in C/S scar
> Message-ID: <000f01c237ce$5f2d2520$82a354d8@gj1qh01>
> MIME-Version: 1.0
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>
> endometriosis in C/S scarYes, she has a chance of having endometriosis > in the pelvis, appendix, etc. Since you say she has no other symptoms, > I would resect what is likely a endometrioma in her C/S scar under > local, if the patient is amenable to local, and leave well enough > alone.
>
> Gerald P. Rodríguez, M.D., FACOG
> Santa Fe

>> ----- Original Message -----
> From: Braun, R. Daniel
> To: Multiple recipients of list OB-GYN-L
> Sent: Tuesday, July 30, 2002 7:21 AM
> Subject: endometriosis in C/S scar
>
> Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time > of last section. Presents with a 2X3X4 cm lump at the right end of her > C/S incision. It swells and becomes tender about the time of her period. > No other symptoms at all. The question becomes one of "Since she has > endo in her incision, does she have a likelihood of intraperitoneal > endo, and if so, should we do a diagnostic scope at the time of excision > of the scar endometrioma? If we do and we find endometriosis in this > asymptomatic patient, what should we do about that?
>
> I would like to heart a lot of opinions. We had a bunch in our morning > report.
>
> Dan
>
> ------=_NextPart_000_000C_01C2379C.146340B0
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> <DIV><FONT color=#000080>Yes, she has a chance of having endometriosis > in the
> pelvis, appendix, etc.&nbsp; Since you say she has no other symptoms, I > would
> resect what is likely a endometrioma in her C/S scar under local, if the > patient
> is amenable to local, &nbsp;and leave well enough alone.</FONT></DIV>
> <DIV><FONT color=#000080></FONT>&nbsp;</DIV>
> <DIV><FONT color=#000080>Gerald P. Rodríguez, M.D., > FACOG</FONT></DIV>
> <DIV><FONT color=#000080>Santa Fe</FONT></DIV>
> <BLOCKQUOTE dir=ltr
> style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; > BORDER-LEFT: #000080 2px solid; MARGIN-RIGHT: 0px">

>> <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
> <DIV
> style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: > black"><B>From:</B>
> <A title=rbraun@iupui.edu href="mailto:rbraun@iupui.edu">Braun, R. > Daniel</A>
> </DIV>
> <DIV style="FONT: 10pt arial"><B>To:</B> <A
> title=ob-gyn-l@mail.medispecialty.com
> href="mailto:ob-gyn-l@mail.medispecialty.com">Multiple recipients of > list
> OB-GYN-L</A> </DIV>
> <DIV style="FONT: 10pt arial"><B>Sent:</B> Tuesday, July 30, 2002 > 7:21
> AM</DIV>
> <DIV style="FONT: 10pt arial"><B>Subject:</B> endometriosis in C/S > scar</DIV>
> <DIV><BR></DIV><!-- Converted from text/rtf format -->
> <P align=left><SPAN lang=en-us><FONT face=Arial size=2>Patient > is 30 ish G 3 P
> 3003 all cesarean sections. Had tubal at time of last
> section.</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us><FONT
> face=Arial size=2> Presents with a 2X3X4 cm lump at the right end > of her C/S
> incision. It swells and becomes tender about the time of her
> period.</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN lang=en-us> > <FONT
> face=Arial size=2>No other symptoms at all.</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN lang=en-us> <FONT face=Arial > size=2>The question
> becomes one of</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us> <FONT
> face=Arial size=2>“</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN >
> lang=en-us><FONT face=Arial size=2>Since she has endo in her > incision, does
> she have a</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN lang=en-us> > <FONT
> face=Arial size=2>likelihood</FONT></SPAN><SPAN > lang=en-us></SPAN><SPAN
> lang=en-us><FONT face=Arial size=2> of intraperitoneal endo, and > if so, should
> we do a diagnostic scope at the time of excision of the scar > endometrioma? If
> we do and we find endometriosis in this</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN lang=en-us> <FONT face=Arial
> size=2>asymptomatic</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN
> lang=en-us><FONT face=Arial size=2> patient, what should we do > about
> that?</FONT></SPAN></P>
> <P align=left><SPAN lang=en-us><FONT face=Arial size=2>I would > like to heart a
> lot of opinions</FONT></SPAN><SPAN lang=en-us></SPAN><SPAN > lang=en-us><FONT
> face=Arial size=2>. We had a bunch in our morning
> report.</FONT></SPAN></P><BR>
> <P align=left><SPAN lang=en-us><FONT face=Arial > size=2>Dan</FONT></SPAN><SPAN
> lang=en-us></SPAN><SPAN > lang=en-us></SPAN></P></BLOCKQUOTE></BODY></HTML>
>
> ------=_NextPart_000_000C_01C2379C.146340B0--
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 08:46:08 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "Multiple recipients of list OB-GYN-L " <ob-gyn-l@mail.medispecialty.com>
> Subject: RE: endometriosis in C/S scar
> Message-ID: <458AA66139B53F428AA6D091FFCB5E520632B5@iu-mssg-mbx01.ads.iu.edu>
> content-class: urn:content-classes:message
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 8bit
>
> Yes, but should we also look in the peritoneal cavity to see if there is any
there in an assymptomatic patient? >
> Dan
> -----Original Message-----
> From: Ricardo SavarisTo: Multiple recipients of list OB-GYN-L
> Sent: 7/30/2002 8:34 AM
> Subject: Re: endometriosis in C/S scar
>
> Daniel,
>
> Although asymptomatic, I believe that you should burn the endometrial
> spots and remove the endometrioma from the scar. I read (don't recall
> where) that all GnRH treatment are palliative and surgery seems to be
> the best treatment.
>
> That's my opinion
>
> Ricardo Savaris, MD
> Porto Alegre - Brazil
>

>> ----- Original Message -----
> From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> To: Multiple recipients of list
> <mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> Sent: Tuesday, July 30, 2002 10:22 AM
> Subject: endometriosis in C/S scar
>
> Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time of
> last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> incision. It swells and becomes tender about the time of her period. No
> other symptoms at all. The question becomes one of "Since she has endo
> in her incision, does she have a likelihood of intraperitoneal endo, and
> if so, should we do a diagnostic scope at the time of excision of the
> scar endometrioma? If we do and we find endometriosis in this
> asymptomatic patient, what should we do about that?
>
> I would like to heart a lot of opinions. We had a bunch in our morning
> report.
>
> Dan
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 08:50:46 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "Multiple recipients of list OB-GYN-L " <ob-gyn-l@mail.medispecialty.com>
> Subject: RE: endometriosis in C/S scar
> Message-ID: <458AA66139B53F428AA6D091FFCB5E520632B6@iu-mssg-mbx01.ads.iu.edu>
> content-class: urn:content-classes:message
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 8bit
>
> How many of these have you done under local ? My experience is that they
are at least twice as big as thought and require placement of mesh to close. >
> Dan
>
> -----Original Message-----
> From: Gerald P. RodriguezTo: Multiple recipients of list OB-GYN-L
> Sent: 7/30/2002 8:41 AM
> Subject: Re: endometriosis in C/S scar
>
> Yes, she has a chance of having endometriosis in the pelvis, appendix,
> etc. Since you say she has no other symptoms, I would resect what is
> likely a endometrioma in her C/S scar under local, if the patient is
> amenable to local, and leave well enough alone.
>
> Gerald P. Rodríguez, M.D., FACOG
> Santa Fe
>

>> ----- Original Message -----
> From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> To: Multiple recipients of list
> <mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> Sent: Tuesday, July 30, 2002 7:21 AM
> Subject: endometriosis in C/S scar
>
> Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time of
> last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> incision. It swells and becomes tender about the time of her period. No
> other symptoms at all. The question becomes one of "Since she has endo
> in her incision, does she have a likelihood of intraperitoneal endo, and
> if so, should we do a diagnostic scope at the time of excision of the
> scar endometrioma? If we do and we find endometriosis in this
> asymptomatic patient, what should we do about that?
>
> I would like to heart a lot of opinions. We had a bunch in our morning
> report.
>
> Dan
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 13:55:58 +0000
> ------------------------------
> From: "gynendohaiti jean louis" <gynendohaiti@hotmail.com>
> To: ob-gyn-l@obgyn.net
> Subject: Re: endometriosis in C/S scar
> Message-ID: <F196dghC90e823mM5910002778c@hotmail.com>
> Mime-Version: 1.0
> Content-Type: text/html
>
> <html><div style='background-color:'><DIV>
> <P>If there is no contrindication to use the GNRH in this patient I would do
so for a couple of month and then go for a laparoscopic exam and destroy any lesion that can be found- the scar would be removed just after the lap .</P> > <P>actually I do not think there is a better way for endo than surgery</P>
> <P>Garald Jean-Louis , MD<BR>Port au Prince , Haiti<BR></P></DIV>
> <DIV></DIV>
> <DIV></DIV>>From: "Braun, R. Daniel" <RBRAUN@IUPUI.EDU>
> <DIV></DIV>>Reply-To: ob-gyn-l@obgyn.net
> <DIV></DIV>>To: Multiple recipients of list OB-GYN-L <OB-GYN-L@MAIL.
MEDISPECIALTY.COM> > <DIV></DIV>>Subject: endometriosis in C/S scar
> <DIV></DIV>>Date: Tue, 30 Jul 2002 08:21:57 -0500
> <DIV></DIV>>
> <DIV></DIV>>Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal
at time of > <DIV></DIV>>last section. Presents with a 2X3X4 cm lump at the right end
of her C/S > <DIV></DIV>>incision. It swells and becomes tender about the time of her
period. No > <DIV></DIV>>other symptoms at all. The question becomes one of "Since she
has endo > <DIV></DIV>>in her incision, does she have a likelihood of intraperitoneal
endo, and > <DIV></DIV>>if so, should we do a diagnostic scope at the time of excision
of the > <DIV></DIV>>scar endometrioma? If we do and we find endometriosis in this
> <DIV></DIV>>asymptomatic patient, what should we do about that?
> <DIV></DIV>>
> <DIV></DIV>>I would like to heart a lot of opinions. We had a bunch in our
morning > <DIV></DIV>>report.
> <DIV></DIV>>
> <DIV></DIV>>Dan
> <DIV></DIV></div>

>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 10:57:25 -0300
> ------------------------------
> From: "Ricardo Savaris" <ricardosavaris@hotmail.com>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: endometriosis in C/S scar
> Message-ID: <OE648pnidKrlVKvH9oi00001594@hotmail.com>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 7bit
>
> I would scope her after explain her the pro/con, after discuss the pro/con
> with her. She will decide with you
>
> Ricardo
>

>> ----- Original Message -----
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
> Sent: Tuesday, July 30, 2002 10:47 AM
> Subject: RE: endometriosis in C/S scar
>
> >
> > Yes, but should we also look in the peritoneal cavity to see if there is
> any there in an assymptomatic patient?
> >
> > Dan
> > -----Original Message-----
> > From: Ricardo SavarisTo: Multiple recipients of list OB-GYN-L
> > Sent: 7/30/2002 8:34 AM
> > Subject: Re: endometriosis in C/S scar
> >
> > Daniel,
> >
> > Although asymptomatic, I believe that you should burn the endometrial
> > spots and remove the endometrioma from the scar. I read (don't recall
> > where) that all GnRH treatment are palliative and surgery seems to be
> > the best treatment.
> >
> > That's my opinion
> >
> > Ricardo Savaris, MD
> > Porto Alegre - Brazil
> >

>> > ----- Original Message -----
> > From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> > To: Multiple recipients of list
> > <mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> > Sent: Tuesday, July 30, 2002 10:22 AM
> > Subject: endometriosis in C/S scar
> >
> > Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time of
> > last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> > incision. It swells and becomes tender about the time of her period. No
> > other symptoms at all. The question becomes one of "Since she has endo
> > in her incision, does she have a likelihood of intraperitoneal endo, and
> > if so, should we do a diagnostic scope at the time of excision of the
> > scar endometrioma? If we do and we find endometriosis in this
> > asymptomatic patient, what should we do about that?
> >
> > I would like to heart a lot of opinions. We had a bunch in our morning
> > report.
> >
> > Dan
> >
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 08:04:01 -0600
> ------------------------------
> From: "Gerald P. Rodriguez" <geraldpr@cybermesa.com>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: endometriosis in C/S scar
> Message-ID: <001101c237d1$f5313310$82a354d8@gj1qh01>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="utf-8"
> Content-Transfer-Encoding: 8bit
>
> Been doing them for 30 years; occasionally under general if hard to define.
> Try to do them during the luteal phase so that I have a fairly good idea of
> how big they are. Never have used mesh; never had a hernia--that I know of
> (☺).
>
> Gerald P. Rodríguez, M.D., FACOG
> Santa Fe
>

>> ----- Original Message -----
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
> Sent: Tuesday, July 30, 2002 7:54 AM
> Subject: RE: endometriosis in C/S scar
>
> > How many of these have you done under local ? My experience is that they
> are at least twice as big as thought and require placement of mesh to close.
> >
> > Dan
> >
> > -----Original Message-----
> > From: Gerald P. RodriguezTo: Multiple recipients of list OB-GYN-L
> > Sent: 7/30/2002 8:41 AM
> > Subject: Re: endometriosis in C/S scar
> >
> > Yes, she has a chance of having endometriosis in the pelvis, appendix,
> > etc. Since you say she has no other symptoms, I would resect what is
> > likely a endometrioma in her C/S scar under local, if the patient is
> > amenable to local, and leave well enough alone.
> >
> > Gerald P. Rodríguez, M.D., FACOG
> > Santa Fe
> >

>> > ----- Original Message -----
> > From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> > To: Multiple recipients of list
> > <mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> > Sent: Tuesday, July 30, 2002 7:21 AM
> > Subject: endometriosis in C/S scar
> >
> > Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal at time of
> > last section. Presents with a 2X3X4 cm lump at the right end of her C/S
> > incision. It swells and becomes tender about the time of her period. No
> > other symptoms at all. The question becomes one of "Since she has endo
> > in her incision, does she have a likelihood of intraperitoneal endo, and
> > if so, should we do a diagnostic scope at the time of excision of the
> > scar endometrioma? If we do and we find endometriosis in this
> > asymptomatic patient, what should we do about that?
> >
> > I would like to heart a lot of opinions. We had a bunch in our morning
> > report.
> >
> > Dan
> >
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 30 Jul 2002 14:06:09 +0000
> ------------------------------
> From: "gynendohaiti jean louis" <gynendohaiti@hotmail.com>
> To: ob-gyn-l@obgyn.net
> Subject: RE: endometriosis in C/S scar
> Message-ID: <F580ENFrvyQocd1KOsh00019c22@hotmail.com>
> Mime-Version: 1.0
> Content-Type: text/html
>
> <html><div style='background-color:'><DIV>
> <P><BR><BR></P>
> <DIV>
> <DIV></DIV>
> <P>In such a case- <U>a must</U>- I think to look inside the cavity .
<STRONG><U>laparoscopy<BR></U></STRONG><BR></P></DIV></DIV> > <DIV></DIV>
> <DIV></DIV>>From: "Braun, R. Daniel" <RBRAUN@IUPUI.EDU>
> <DIV></DIV>
> <DIV></DIV>>Reply-To: ob-gyn-l@obgyn.net
> <DIV></DIV>
> <DIV></DIV>>To: Multiple recipients of list OB-GYN-L <OB-GYN-L@MAIL.
MEDISPECIALTY.COM> > <DIV></DIV>
> <DIV></DIV>>Subject: RE: endometriosis in C/S scar
> <DIV></DIV>
> <DIV></DIV>>Date: Tue, 30 Jul 2002 08:47:53 -0500
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Yes, but should we also look in the peritoneal cavity to see
if there is any there in an assymptomatic patient? > <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Dan
> <DIV></DIV>
> <DIV></DIV>>-----Original Message-----
> <DIV></DIV>
> <DIV></DIV>>From: Ricardo SavarisTo: Multiple recipients of list OB-GYN-L
> <DIV></DIV>
> <DIV></DIV>>Sent: 7/30/2002 8:34 AM
> <DIV></DIV>
> <DIV></DIV>>Subject: Re: endometriosis in C/S scar
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Daniel,
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Although asymptomatic, I believe that you should burn the
endometrial > <DIV></DIV>
> <DIV></DIV>>spots and remove the endometrioma from the scar. I read (don't
recall > <DIV></DIV>
> <DIV></DIV>>where) that all GnRH treatment are palliative and surgery
seems to be > <DIV></DIV>
> <DIV></DIV>>the best treatment.
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>That's my opinion
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Ricardo Savaris, MD
> <DIV></DIV>
> <DIV></DIV>>Porto Alegre - Brazil
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>

>> <DIV></DIV>>----- Original Message -----
> <DIV></DIV>
> <DIV></DIV>>From: Braun, R. Daniel <?xml:namespace prefix = mailto
/><mailto:rbraun@iupui.edu> > <DIV></DIV>
> <DIV></DIV>>To: Multiple recipients of list
> <DIV></DIV>
> <DIV></DIV>><mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> <DIV></DIV>
> <DIV></DIV>>Sent: Tuesday, July 30, 2002 10:22 AM
> <DIV></DIV>
> <DIV></DIV>>Subject: endometriosis in C/S scar
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Patient is 30 ish G 3 P 3003 all cesarean sections. Had tubal
at time of > <DIV></DIV>
> <DIV></DIV>>last section. Presents with a 2X3X4 cm lump at the right end
of her C/S > <DIV></DIV>
> <DIV></DIV>>incision. It swells and becomes tender about the time of her
period. No > <DIV></DIV>
> <DIV></DIV>>other symptoms at all. The question becomes one of "Since she
has endo > <DIV></DIV>
> <DIV></DIV>>in her incision, does she have a likelihood of intraperitoneal
endo, and > <DIV></DIV>
> <DIV></DIV>>if so, should we do a diagnostic scope at the time of excision
of the > <DIV></DIV>
> <DIV></DIV>>scar endometrioma? If we do and we find endometriosis in this
> <DIV></DIV>
> <DIV></DIV>>asymptomatic patient, what should we do about that?
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>I would like to heart a lot of opinions. We had a bunch in our
morning > <DIV></DIV>
> <DIV></DIV>>report.
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>
> <DIV></DIV>
> <DIV></DIV>>Dan
> <DIV></DIV>
> <DIV></DIV></mailto:ob-gyn-l@mail.medispecialty.com></mailto:rbraun@iupui.edu>
> <DIV></DIV></div>

>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 2215
> ------------------------------
> ***************************
>



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