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Re: Granulation tissue From: Rafael Haciski (haciski@earthlink.net) Wed Sep 22 15:48:25 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Terrence.Jones@kp.org: "Re: Granulation tissue" Previous message: Steve & Eryl Raymond: "Re: Granulation tissue" In reply to: Steve & Eryl Raymond: "Re: Granulation tissue" Next in thread: Terrence.Jones@kp.org: "Re: Granulation tissue" Thanks for your thoughts, however this is a frail 93 year old lady, and was reluctant to be taking any ERT, and I am not comfortable placing her under anesthesia risks for surgery (yes we could try it under local or spinal or epidural). Not having had the pleasure of seeing many patients with this problem, I was also concerned what would I do if she developed bleeding problems after the leFort - you really have no direct means of access and evaluation. -- Rafael C. Haciski MD FACOG Bradenton FL On Sep 22, 2004, at 16:27, Steve & Eryl Raymond wrote: > 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: Terrence.Jones@kp.org: "Re: Granulation tissue" Previous message: Steve & Eryl Raymond: "Re: Granulation tissue" In reply to: Steve & Eryl Raymond: "Re: Granulation tissue" Next in thread: Terrence.Jones@kp.org: "Re: Granulation tissue"

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