OB-GYN-L Messages for August, 2005: Complications

Complications

From: Henry Gregor

henrygregor@yahoo.com

Wed Aug 24 08:21:19 2005

Another one I worry about was covered in about "'98 lin a Green Journal article from Scandinavia in which the use of LSIL and HGSIL findings were followed with the conclusion that slipping into a mindset that LSIL or CIN ! categorizations tend to suggest a more indolent or lower potential for progression into higher grade lesions was not supported and that such lesions occur frequently enough in the presumptive "lesser risk" category that it would be a mistake to take much comfort in approaching lower grade lesions less vigilantly than higher grade lesions.....now, I haven't seen anyone suggest anything less than vigilance, what with repeated paps, colpo's, bx's etc....howevery, issues of patient compliance occur across all lines of medical treatments, drugs and procedures. So, to my mind, a recurring cycle of surveillance procedures has a potential for the complication of failure of followup, among other things. Also, in the US, insurance coverage occurs often, and patients have been known to cut corners on drugs, followup, etc. once such economic changes occur.

'course we're all shaped by anecdotal experience, but I did get called once to remove a young (late 20's, early 30's) woman's retained placental products after presentation to the er as an incomplete ab....however, the placental tissue was a large fungating invasive CA. She went into DIC and subsequently expired. She had stopped cx followup, per her family, since all those tests (that she used to get every few months) "had been ok."

Since the patient in question is showing dysplastic changes on bx's but not paps, I'm not too reassured to go with serial paps, and if it's a small uterus and she is without high surgcial risk medical morbity I persaonally feel ia VH would be reasonable for the patient to be aware of the option.

Hank

"art fougner, md" <evsono@pipeline.com> wrote: Unless there are complications ...

art

At Tue, 23 Aug 2005, Henry Gregor wrote: >
>Very reasonable Joanne, IMHO. Add up travel, reception room waits, lost time from other activities and time involved with paps, colpos, discussions, etc. and one probably has a distinct time advantage for a 23 hour vag hys hospital experience.
>
>Hank
>
>"Joanne Bulley, MD" wrote:
>It is always interesting to see how many ways we would treat things! We
>have here Pap Q 6 months, Cryo and LEEP. Did I miss anything? Did
>anyone say Vag Hyst?
>
>Joanne
>
>At Tue, 23 Aug 2005, Gerald P. Rodríguez wrote:
>>
>>LEEP with ECC.
>>
>>Gerald P. Rodríguez, M.D., FACOG
>>Santa Fe
>>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>>
>>Sent: Tuesday, August 23, 2005 11:20 AM
>>Subject: Re: HR HPV in 51 yo
>>
>>> But her Paps are NEGATIVE - the colpo biopsies are CIN 1 ...
>>>
>>> Joanne
>>>
>>> At Tue, 23 Aug 2005, Joe wrote:
>>>>
>>>>Pap every 6 months. Joe C
>>>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
>"Love is indescribable and unconditional.
>I could tell you a thousand things that it is not, but not one that it is."
>— Duke Ellington, American jazz artist (1899-1974).
>

-- art fougner, md

"If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra

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