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Re: TOA and HIV From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com) Fri Mar 26 10:03:15 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lynn D. Montgomery, M.D.: "Re: Hospital Liability Requirement" Previous message: Dr. Ainsworth: "TOA and HIV" In reply to: Dr. Ainsworth: "TOA and HIV" Next in thread: DoctorJoe@aol.com: "Re: TOA and HIV" If she has defervesced and clinically improved, why not a two week course of antibiotics before surgery? Surgical planes will probably be better with less collateral bleeding. Of course, in my practice I'd transfer her to the university service and let the residents take care of her postoperatively -- Richard Chudacoff, MD As Mankind becomes more liberal, they will be more apt to allow that all those who conduct themselves as worthy members of the community are equally entitled to the protections of civil government. I hope ever to see America among the foremost nations of justice and liberality. George Washington If the freedom of speech is taken away then dumb and silent we may be led, like sheep to the slaughter. George Washington -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Ainsworth Sent: Friday, March 26, 2004 10:18 AM To: Multiple recipients of list OB-GYN-L Subject: TOA and HIV 42 yo patient, known HIV positive, admitted through ER with sepsis and pelvic mass, blood cultures positive for E.coli, cervical cultures - normal vaginal flora. Placed on triple antibiotics on admission by Hospitalist. Two days into therapy, CT scan showed a nonspecific pelvic mass, Sonogram the next day showed a 13x9x9 cm pelvic mass. When I examined her the same day she had a very obvious pelvic mass, palpable above the pelvic brim, very tender. No free fluid on the sonogram. She is now still symptomatic with pelvic pain, decreased abdominal tenderness, afebrile, WBC has come down from 26,000 on admission with a marked left shift, now 14,400 with no bands. Where would you go from here? 1- ultrasound or CT guided drainage of the mass 2- OR for vaginal drainage of mass / colpotomy 3- OR for Abdominal drainage of mass 4- OR for TAH/BSO My feeling is that she is clinically stable enough at this time for definitive surgical treatment and to approach it abdominally with plans to back off and simply drain it if there is too much phlegmon to safely remove it. Next message: Lynn D. Montgomery, M.D.: "Re: Hospital Liability Requirement" Previous message: Dr. Ainsworth: "TOA and HIV" In reply to: Dr. Ainsworth: "TOA and HIV" Next in thread: DoctorJoe@aol.com: "Re: TOA and HIV"

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