Re: Case / question to the list: PLEASE LET ME KNOW YOUR OPNIONS
From: art fougner, md (evsono@pipeline.com)
Sun Dec 21 18:18:50 2003
potentially disastrous - yes. but no harm no foul. perhaps you need to
develop an Atlanta discriminatory zone. Additionally, B-HCG levels tend
to vary even more so when multiple labs ( thanks to our managed care
environment) enter the picture. i have even witnessed "sinusoidal
betas" in a perfectly healthy intrauterine pregnancy. the one healthy
pregnancy situation we all need to keep in mind, especially when
fertility therapies ( better living through chemistry) are involved is
the higher levels of betas generated with multiples. therefore, it
would be expected to not seen an intrauterine pregnancy with a
relatively higher level of HCG and subsequently see a healthy multiple a
bit later.
art
At Sun, 21 Dec 2003, Brickster0@aol.com wrote:
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>Listers: I'm looking for any objective opinion for a difference of agreement
>with another physician / possible lurker on the list:
>
>33 y/o wf G5P2022 with 18mth of unexplained infertility arrives for 1st ob
>visit 8.5 weeks by dates but unsure LMP. Positive home beta about a week ago per
>pt. No risk factors for ectopic except unexplained infertility. Pt arrives
>on a Thursday. Sono by MD on a Medison 530D (a relatively good machine)
>reveals no IUP; adenexal mass by real time sono reveals adenexal mass that
>sonographically is a simple cyst with a sono-dense mass which I responded "did that
>mass have heart beat?". It did not. Quant returns on Friday of 2300.
>
>I will say that in my experience, our labs in Atlanta do not match the
>literature in their discrepancy zone. Thus a quant of 2300 and no gestational sac
>is not unheard of. In my somewhat sue-happy state. I would like to see the pt
>the next day (Friday); my associate states he would ideally see the pt 48hrs
>later, but since that is a Saturday he will wait until Monday.
>
>I don't think that is appropriate. Is there anyone out there that can
>convince me I'm wrong? I have learned a great deal from the list members and I
>would like some objective insight into a possibly disastrous outcome.
>
>Please tell me your opinions; however, I can tell you the outcome. I saw the
>pt the next day in the office (with a GE 730) and saw an IUP with a
>gestational sac, and one week later the IUP had FHTs.
>Thank you all for your insight
>
>Brick BIlls MD
>Alpharetta, GA
>
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>Listers: I'm looking for any objective opinion for a difference o agreement with another physician / possible lurker on the list:
>
>33 y/o wf G5P2022 with 18mth of unexplained infertility arrives for 1s ob visit 8.5 weeks by dates but unsure LMP. Positive home beta about a wee ago per pt. No risk factors for ectopic except unexplained infertility.&nb p; Pt arrives on a Thursday. Sono by MD on a Medison 530D (a relative y good machine) reveals no IUP; adenexal mass by real time sono reveals ade exal mass that sonographically is a simple cyst with a sono-dense mass whic I responded "did that mass have heart beat?". It did not. Quant retu ns on Friday of 2300.
>
>I will say that in my experience, our labs in Atlanta do not match the literature in their discrepancy zone. Thus a quant of 2300 and no ges ational sac is not unheard of. In my somewhat sue-happy state. I woul like to see the pt the next day (Friday); my associate states he would ide lly see the pt 48hrs later, but since that is a Saturday he will wait until Monday.
>
>I don't think that is appropriate. Is there anyone out there tha can convince me I'm wrong? I have learned a great deal from the list members and I would like some objective insight into a possibly disastrous utcome.
>
>Please tell me your opinions; however, I can tell you the outcome.&nbs ; I saw the pt the next day in the office (with a GE 730) and saw an IUP wi h a gestational sac, and one week later the IUP had FHTs.
>Thank you all for your insight
>
>Brick BIlls MDAlpharetta, GA
>
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--
art fougner, md
ich bin ein New Yorker
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