Re: AGUS
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Apr 29 10:31:39 2005
Less morbidity and less expensive and usually quicker.
On 4/29/05, Rafael Haciski <haciski@earthlink.net> wrote:
> Because I like to see what I am doing, because I am more comfortable
> with that approach, and because I am more comfortable removing ovaries
> laparoscopically and not vaginally. You can do it vaginally if you
> prefer.
>
> Why should vaginal be the default?
>
> Rafael C. Haciski MD FACOG
> Bradenton FL
>
> On Apr 29, 2005, at 07:58, R. Daniel Braun wrote:
>
> > Why laparoscopic instead of vaginal?
> > Vaginal should be the default with laparoscopic being done only if
> > vaginal can't be for some reason.
> >
> > On 4/28/05, Rafael Haciski <haciski@earthlink.net> wrote:
> >> I agree with Dr. Siegel (except for the OR)
> >> .. generous LEEP in office
> >> .. hysteroscopy through the now open canal, with biopsy as needed
> >> .. endocervical curettage
> >>
> >> And if no cancer found then schedule for hysterectomy (my preference
> >> laparoscopic, with BSO)
> >>
> >> Rafael C. Haciski MD FACOG
> >> Bradenton FL
> >>
> >> On Apr 28, 2005, at 22:10, Garry E. Siegel, M.D. wrote:
> >>
> >>> Hey, check out the ASCCP guidelines. http://www.asccp.org/
> >>>
> >>> Before you do a TVH and find an undiagnosed cancer (unlikely, but. .
> >>> .), if you cannot access her cervix due to stenosis, why not do an OR
> >>> visit:
> >>>
> >>> 1. Cold knife cone--unless you feel the cervix is "cleared" and it
> >>> doesn't need evaulation.
> >>> 2. ECC
> >>> 3. Hysteroscopy/endometrial curettage
> >>>
> >>> Unless I'm missing something, you have an unexplained AGUS smear (CIN
> >>> doesn't fully cover that) and you've not been able to evaluate the
> >>> endometrium or the endocervix.
> >>>
> >>> Garry
> >>>
> >>> At Thu, 28 Apr 2005, Joanne Bulley, MD wrote:
> >>>>
> >>>> My thoughts run the same way as you and Efrain
> >>>>
> >>>> Joanne
> >>>>
> >>>> At Thu, 28 Apr 2005, ainsron wrote:
> >>>>>
> >>>>> Cone or LEEP. Consider TVH.
> >>>>>
> >>>>> Ronald E. Ainsworth
> >>>>>
> >>>>> -----Original Message-----
> >>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> >>>>> Joanne
> >>>>> Bulley, MD
> >>>>> Sent: Thursday, April 28, 2005 2:36 PM
> >>>>> To: Multiple recipients of list OB-GYN-L
> >>>>> Subject: AGUS
> >>>>>
> >>>>> 48 yo G0 s/p Cryosurgery of cervix prior to 1993. (presume CIN)
> >>>>> VIN 3 (carcinoma in situ) of vulva at posterior introitus excised
> >>>>> 1998.
> >>>>> Vulvar coploscopies normal since then.
> >>>>>
> >>>>> Pap 3/04 AGUS (possible adenocarcinoma in situ)
> >>>>> LEEP (cervical stenosis from cryo precluded any office evaluation)
> >>>>> path: CIN 1 - mild dysplasia with severe cervicitis, comparison
> >>>>> with
> >>>>> Pap
> >>>>> confirms the same cellular characterisics were present.
> >>>>>
> >>>>> Pap 10/04 ASCUS negative for high risk HPV subtypes.
> >>>>>
> >>>>> Pap 3/05 AGUS.
> >>>>>
> >>>>> Colposcopy - unable to see SCJ. Endocervical curette would not
> >>>>> pass
> >>>>> through stenotic cervix. Endocervical specimen taken with
> >>>>> endocervical
> >>>>> brush.
> >>>>>
> >>>>> Pathology pending.
> >>>>>
> >>>>> Of course the next step will depend somewhat on the patology, but,
> >>>>> what
> >>>>> do you think you would do next?
> >>>>>
> >>>>> Joanne
> >>>>>
> >>>>> --
> >>>>> Joanne Bulley, MD
> >>>>> Keene, NH, USA
> >>>>>
> >>>> --
> >>>> Joanne Bulley, MD
> >>>> Keene, NH, USA
> >>>>
> >>>
> >>> --
> >>> Garry E. Siegel, M.D.
> >>> Private Practice
> >>> Roswell, GA
> >>>
> >>
> >
> > --
> > R. Daniel Braun
> > Kinky for Governor
> >
>
--
R. Daniel Braun
Kinky for Governor
