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Re: 4D ultrasound From: Charlie Chambers (cchamber@gorge.net) Wed Dec 24 13:57:26 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charlie Chambers: "Re: 4D ultrasound" Previous message: Charlie Chambers: "Re: 4D ultrasound" >From cchamber@gorge.net Wed Dec 24 14:57:23 2003 Received: from gndata.private.gnet (mail7.gorge.net [209.216.160.99]) by dns.obgyn.net (8.11.6/8.11.6/dsb-1.1) with ESMTP id hBOKvE724105 for <ob-gyn-l@obgyn.net>; Wed, 24 Dec 2003 14:57:18 -0600 Received: from gorge.net (unverified [209.216.166.90]) by gorge.net (Rockliffe SMTPRA 5.3.4) with ESMTP id <B3020523631@gndata.private.gnet> for <ob-gyn-l@obgyn.net>; Wed, 24 Dec 2003 12:57:13 -0800 Date: Wed, 24 Dec 2003 12:57:10 -0800 Subject: Re: Residual uterine tissue after subtotal hysterectomy Content-Type: text/plain; delsp=yes; charset=ISO-8859-1; format=flowed Mime-Version: 1.0 (Apple Message framework v553) From: Charlie Chambers <cchamber@gorge.net> To: ob-gyn-l@obgyn.net In-Reply-To: <000701c3ca5d$ef3d7f20$83a354d8@gj1qh01> Message-Id: <BE2D8504-3653-11D8-935C-000393530A36@gorge.net> X-Mailer: Apple Mail (2.553) Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by dns.obgyn.net id hBOKvE724105 Had something similar when I was a resident. We had a patient with a subtotal hyst and complications. Imaging showed for all intents and purposes, a uterus. We elected to do a laparotomy to find a large supracervical necrotic myoma. Removed the myoma and cervix. With that in mind, I'd be concerned about trying to sound or biopsy the "mass". Any consideration for a sonohysterography? Put the balloon in the cervix only and then do the ultrasound. Could be helpful? Let us know what happens. On Wednesday, December 24, 2003, at 12:40 PM, Gerald P. Rodríguez wrote: > > The "5.9 X 3.7 X 3.0 cm" measurement--it that the "residual uterus" > plus the > " 'long cervix,' " or, is that just the "residual" uterus. If it's the > latter then she had a "subtotal hysterectomy" in name only and > probably has > a lot of residual endometrium. I would first review the U/S films and > if > she has what I think she has (at lot of myometrium/endometrium), then I > would do a careful D & C under an anesthetic to adequately evaluate the > endometrium. Once assured that her endometrial status is OK, I would > offer > hormonally controlled bleeding vs. vaginal surgical approach to > complete her > "hysterectomy." I certainly would not offer further hormonal therapy > until > her endometrium is certified to be benign. > > Some "subtotal" hysterectomies are less subtotal then some. > > Gerald P. Rodríguez, M.D., FACOG > Santa Fe > >> ----- Original Message ----- > From: "Garry E. Siegel, M.D." <garrys@mindspring.com> > To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> > Sent: Wednesday, December 24, 2003 12:55 PM > Subject: GYN: Residual uterine tissue after subtotal hysterectomy > >> 39 YO P3103, old patient years ago, returned for a second opinion. >> >> 11/02 underwent subtotal hyst/BSO for fibroids, done with local good >> gyn >> onc and regular gyn. Since then, she has had been on Premarin 1.25 >> mg. >> daily for menopausal symptoms, but has bleed pretty much continously. >> >> Original gyn suggested OCPs; patient didn't try them. >> Another gyn did exam, ECC (inflammed endocervical tissue), and while I >> don't have records, the patient said the gyn said she only went in 2.5 >> somethings--I assume cm. >> >> Her internist ordered a pelvic ultrasound, which showed a "long >> cervix" >> and residual uterus 5.9 X 3.7 X 3.0 cm. >> >> Ideally, I would like to sample her endometrium, or even look at it >> with >> a scope, but I'm none too keen on going up her cervix and into her >> abdominal cavity! >> >> Thus, I've proposed to simply cycle her as if she were menopausal >> with a >> uterus (she sort of is) with daily Premarin 1.25 mg, and Provera 10 >> mg. >> for 12 days/month, and see how she responds. >> >> She is pretty much ready to have another surgery, but I've suggested >> the >> above first. >> >> Any thoughts? >> >> Garry >> >> -- >> Garry E. Siegel, M.D. >> Private Practice >> Roswell, GA >> > ************************************************************************ * Charlie Chambers -- Hood River, OR cchamber@alumni.rice.edu "No matter where you go... there you are." Dr. Buckaroo Banzai ************************************************************************ Next message: Charlie Chambers: "Re: 4D ultrasound" Previous message: Charlie Chambers: "Re: 4D ultrasound"

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