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Re: Granulation tissue From: Steve & Eryl Raymond (eryl@intekom.co.za) Wed Sep 22 15:26:32 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Rafael Haciski: "Re: Granulation tissue" Previous message: Rafael Haciski: "Granulation tissue" In reply to: Rafael Haciski: "Granulation tissue" Next in thread: Rafael Haciski: "Re: Granulation tissue" Reply: Rafael Haciski: "Re: Granulation tissue" This is not going to get better until the ring has been out for about 4 to 6 weeks. She really should have adequate oestrogenisation of her vagina before it is put back. Twice weekly Premarin cream is insufficient 0- should be daily. In fact for a month a course of oral Premarin would be a better idea. I think you should do a cystocoele repair or a LeFort procedure and dispense with the ring altogether. Steve Rafael Haciski wrote: > Question for the listers: > > I have an elderly pt. with post hysterectomy (many years ago) vaginal > prolapse, who until now was satisfied with ring pessary. > Over the course of last year she has developed sporadic vaginal > bleeding - granulation tissue by appearance and biopsy. Initially > cauterized with silver nitrate, but today a much greater area is seen > (on both sides of vaginal walls, an at top of vault). > > The question concerns both treating the granulation tissue and vaginal > prolapse. > .. it seems too great an area for silver nitrate cauterization (prob. > ~6 square cm) > .. my concern in this frail pt. in using cautery (or cryo) is > collateral injury to adjacent organs (rectum, bowel) and indeed poor > healing leading to fistula formation. > .. due to atrophy, her introitus is getting too painful for pessary > removal and cleaning (lacerates each time, and she is using Premarin > cream on the introitus 2-3 times weekly) > .. LeFort procedure may be acceptable to her - she is thinking about this > > Any thoughts? > > Rafael C. Haciski MD FACOG > Bradenton FL > Next message: Rafael Haciski: "Re: Granulation tissue" Previous message: Rafael Haciski: "Granulation tissue" In reply to: Rafael Haciski: "Granulation tissue" Next in thread: Rafael Haciski: "Re: Granulation tissue" Reply: Rafael Haciski: "Re: Granulation tissue"

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