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Re: Change of management? From: Jim Christman (jcleb@earthlink.net) Sat May 3 13:16:30 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Marking surgical site for c/s and BTL" Previous message: Ricardo Savaris: "Re: lawsuit resulting from cesarean" We have a patient very similar to yours. She came to us in early pregnancy with LGSIL followed for about 2 yrs after confirming colposcopy/bx (done at an outside practice - conventional Paps). Our Thin Prep Pap was returned HGSIL. F/U colposcopy by myself returned CIN 3, possible CIS. Now we are staring at a cone biopsy in pregnancy - not a pleasant undertaking. The presence of high risk HPV DNA makes me a bit nervous, especially in a pt. with documented abn Paps for 4 yrs. I would tend to favor eradication of this lesion with a repeat colposcopy and gentle LEEP. I know that might not eradicate the virus from her system, but at least it gets you back to square 1 with regards to cervical dysplastic cells. We have not seen infertility or cervical incompetence as a complication, although I suppose it must be discussed with the pt. I also strongly encourage pts. that smoke to stop immediately, as I think this is a serious risk factor in inhibiting the body's immune response to HPV. -- Jim Christman, MD, FACOG Lebanon, PA I have been following this patient for 4 years. She initially came to see me and had a LGSIL on conventional Pap smear. Colposcopy directed findings confirmed the diagnosis, and she elected to be followed every 6 months, rather than have a LEEP. Every six months she returns, and every time her pap smear is LGSIL. The most recent pap, also LGSIL, somehow got reflexive HPV testing, and high risk HPV was noted in the liquor. So, patient managed appropriately for a conventional pap, but now has new finding on the liquid based Pap smear, without change in clinical appearance. Would anyone change his or her management? Richard Chudacoff, MD, FACOG Next message: DoctorJoe@aol.com: "Re: Marking surgical site for c/s and BTL" Previous message: Ricardo Savaris: "Re: lawsuit resulting from cesarean"

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