Re: Bilateral dermoids
From: Efrain Ramirez (eramirezt@coqui.net)
Fri Mar 9 14:21:24 2007
Me too - leaving bilateral dermoids makes no sense - as I said - another
anesthesia, etc... I don't see Andy's point about "keep in mind that
you are setting this patient up for a potentially devastating infection
with tubo ovarian abcess formation and hysterectomy." ??
And I am not sure about USA having the best "medical system" in the
world..
>Ef
>At Fri, 9 Mar 2007, art fougner, md wrote:
>
>I actually have to side with Steve on this one ... tortuous
>interference has not enhanced clinical acumen.
>
>Art
>
>At Fri, 9 Mar 2007, Andrew Folley wrote:
>>
>>Stephen,
>>as you mature you will come to realize that medicine is both art and science
>>and there are often times several right ways to approach a problem. I think
>>you misjudge the american system.
>>It is still the best medical system in the world. I sense a great deal of
>>frustration and anger in your thread. Lets use this wonderful internet
>>exchange tool to be gentleman and colleagues. andrew
>>
>>>From: "Raymond Stephen" <stephen.raymond@dhhs.tas.gov.au>
>>>Reply-To: ob-gyn-l@obgyn.net
>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>Subject: RE: Bilateral dermoids
>>>Date: Thu, 8 Mar 2007 15:56:25 -0600
>>>
>>>There is no doubt from the description that they were dermoids, and
>>>washings and other hand-wringing grandma type fussing is just weasel
>>>madness from an American system so stuffed up by the fear of litigation
>>>that the patients suffer. If you had taken washings and aspirated and then
>>>left them and had to go back afterwards for them the patient would have
>>>been quite justified if she had sued you for unnecessary surgery!
>>>
>>>I can't believe the absolute lack of clinical acumen and judgement that
>>>seems to have come out of this thread.
>>>
>>>Steve
>>>
>>>________________________________
>>>
>>>________________________________
>>>________________________________
>>>________________________________
>>>From: ob-gyn-l@obgyn.net on behalf of Andrew Folley
>>>Sent: Fri 9/03/2007 12:12 AM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: RE: Bilateral dermoids
>>>
>>>More likely these are theca lutein cysts in light of bilaterality and
>>>pregnancy. Low probalbilty for malignancy at her age. I would obtain
>>>washings, perhaps biopsy omentum and any nodualrity of peritoneum seen.
>>>Possibly aspiration of each cyst with thorough irrigation afterwards. If
>>>any
>>>hair, teeth present would do cyst resection and preserve ovaries.
>>>Otherwise close up and look for resolution of cysts in next 12 weeks. If
>>>still persistent could do laparoscopy and resection then.= andy
>>>
>>> >From: "Elrod, Darryl G Maj 48 MDOS/SGOBO"
>>><Darryl.elrod@LAKENHEATH.AF.MIL>
>>> >Reply-To: ob-gyn-l@obgyn.net
>>> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>> >Subject: Bilateral dermoids
>>> >Date: Wed, 7 Mar 2007 11:19:21 -0600
>>> >
>>> >I have just gotten out of the OR with a 26 yo G1 at 39 wks that had a
>>> >c-section for failure to progress. At the time of the c-section the
>>> >ovaries were both found to be enlarged to 8-9cm. Neither had previously
>>> >been noted on her early OB sono nor her anatomy scan at 22 weeks. By
>>> >the appearance of the fluid seen through the cyst wall my suspicion was
>>> >that this represented bilateral dermoid cysts.
>>> >
>>> >What are the management options with this patient and which would you
>>> >choose and why?
>>> >
>>>
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>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
