Re: You've done enough surgery when...
From: Richard Kaplan (rkaplan@triad.rr.com)
Sun Feb 25 08:47:05 2007
My premise was that the rise from 500 to 2800 in 3 days was greater than the
usual doubling time and therefore there was a possibility of lab error. In
this clinical situation I would repeat the repeat ultrasound today or
tommorrow (26 Feb.) to confirm the absence of a normal, early IUP.
Richard Kaplan
>----- Original Message -----
From: "Efrain Ramirez" <eramirezt@coqui.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Sunday, February 25, 2007 4:09 AM
Subject: Re: You've done enough surgery when...
> With 2,800 hCG and no GS seen?
>
> Ef
>
> -At Sun, 25 Feb 2007, Richard Kaplan wrote:
>>
>>It is possible that this is an IUP. The HCG value was only 500 on 2/19
>>and
>>maybe the second value of 2800 only 3 days later was a lab error and it is
>>still too early to see the IUP. I suspect that by the time you read this
>>you have either already repeated her ultrasound or have removed her
>>"hydrosalpinx.
>>
>>--
>>Richard Kaplan
>>Greensboro, NC
>>
>>>>----- Original Message -----
>>From: "Dr Eberhard Lisse" <el@lisse.NA>
>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>Sent: Saturday, February 24, 2007 1:06 PM
>>Subject: Re: You've done enough surgery when...
>>
>>> G4P2M0 2* previous C/S
>>> T/L separately
>>> Reversal of T/L
>>> Ectopic Right tube 2007-01-17 (Appendix also removed but nil of note)
>>>
>>> Complains about amenorrhea since ectopic.
>>>
>>> Seen by by colleague in a rural hospital (90km from the capital, where I
>>> work) 2007-02-19, b-HCG 500
>>>
>>> Seen by me on 2007-02-22 in the same rural setting on my monthly visit,
>>> Clinically nil of note, a bit tender on the right side, perhaps.
>>>
>>> Ultrasound on the same day shows no intrauterine pregnancy, no free
>>> fluid. Vaginal Ultrasound shows no intruterine pregnancy, right adnexa
>>> nil of note, left adnexa, perhaps a hydrosalpingx. b-HCG 2800.
>>>
>>> You have a list of two total abdominal hysterectomies scheduled for the
>>> following day in that hospital.
>>>
>>> So, bogs, girls and witches, what's the plan and what happened next
>>> :-)-O?
>>>
>>> And, puleeze, we don't have Methrotrexate.
>>>
>>> greetings, el
>>>
>
> --
> " The greatest obstacle to knowledge is not ignorance,
> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
