Re: PMB on coumadin
From: art fougner, md (evsono@pipeline.com)
Mon Apr 30 14:40:43 2007
Thanks Anna.
Art
At Mon, 30 Apr 2007, Meenan, Anna wrote:
>
>Prohylaxis not recommended for routine gyn procedures such as
>endometrial bx or IUD insertion when no active infection present,
>even in high-risk pts. Per AHA 1998.
>
>Anna Meenan, MD
>
>>I agree Art, I think the no prophylaxis for gyn procedures only applies
>>to people at low risk of endocarditis (ie mitral valve prolapse). I
>>think artificial valves falls into the high risk for infection category.
>>
>>Glen
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>>fougner, md
>>Sent: Monday, April 30, 2007 2:10 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: PMB on coumadin
>>
>>With an artificial heart valve?
>>
>>Art
>>
>>At Mon, 30 Apr 2007, Atkinson, Samuel M wrote:
>>>
>>>I believe you will find that the antibiotic recommendations do not
>>apply
>>>to gyn proc like d&c, cerv bx etc. Of course the last time I pointed
>>it
>>>out to anesthesia they insisted intubation was a risk so my pt got Rxed
>>>for a CKC/D&C. I do not believe Endo bx re quires prophy Rx.
>>>
>>>________________________________
>>>
>>>________________________________
>>>________________________________
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry
>>>
>>>--
>>>________________________________
>>>Gregor
>>>________________________________
>>>________________________________
>>>Sent: Sunday, April 29, 2007 7:12 PM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: PMB on coumadin
>>>
>>>Sam,
>>>
>>>Thanks to you and to all othr respondent listers. Endo bx was my
>>minimum
>>>assessment choice, and I guess, without verbalizing it to myself or
>>>others, I was wondering whether a hysto/D&C would be warranted.
>>However,
>>>I've always felt the literature supports endobx as a very correlative
>>>procedure vis a vis hyto/D&C results, so felt - feel - I should go
>>ahead
>>>with the sampling I'd usually do. Can't find anything definitive re the
>>>abx prophylaxis, so I will go ahead with that.
>>>
>>>In the last ten years, I've had three ca cases whose presentations were
>>>just the scantes amts of pmb...two were localized and WD'd...one was
>>>poorly diff'd and fairly diffuse within the cavity, but with less than
>>>1/3rd penetration. Years ago, when I was a student, there was a fellow
>>>named Fred Hoffmeister (department head, Univ of Wisconsin, I believe)
>>>whom I heard speak...he was adamant about bx'g all PM women before
>>>initiating HRT. Used to say if bx's weren't done then ca's and atypical
>>>aden's hyperplasias would get erroneously attributed to HRT. Most ot
>>the
>>>attendings I came in contact as a student and a resident would indicate
>>>his view was excessive...however, I bet he didn't miss too many, if
>>any,
>>>abnl endometriums.
>>>
>>>Hank
>>>
>>>"Atkinson, Samuel M" <ATKINSONS@ecu.edu> wrote:
>>>
>>> Hank: I have had two patients sinilar to yours, altho a bit
>>>older that i found endo ca by biopsy. I have taught residents that a
>>bad
>>>lesion bleeds earlier on rat poisin and that they all must be biopsied.
>>>I admit that not all have endo ca hower.. for whiw.
>>> sAm
>>>
>>> ________________________________
>>>=09
>>> ________________________________
>>> ________________________________
>>> ________________________________
>>> From: ob-gyn-l@obgyn.net on behalf of Henry Gregor
>>> Sent: Fri 4/27/2007 11:47 AM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: PMB on coumadin
>>>
>>> Listers
>>>
>>> A 53 yo, LMP 4 years ago, presents with two weeks plus heavy
>>>vaginal bleeding, w/o presyncopal sx's. She is on coumadin secondary to
>>>hx of mitral valve replacement. INR is 2.3, and pt is w/o petechiae,
>>>ecchymoses, or hx of epistaxis or bleeding gums, etc.
>>>
>>> PE is unremarkable, and a pap (neg hx abnl past ones) is
>>>pending. Sono with heterogenous endometrial stripe, at 7 mm. I am
>>>planning to do an endometrial pipelle sampling. Comments appreciated.
>>>
>>> Thanks
>>>
>>> Hank
>>>
>>> ________________________________
>>>=09
>>> ________________________________
>>> ________________________________
>>> ________________________________
>>> Ahhh...imagining that irresistible "new car" smell?
>>> Check out new cars at Yahoo! Autos.
>>>
>>>________________________________
>>>
>>>________________________________
>>>________________________________
>>>Ahhh...imagining that irresistible "new car" smell?
>>>_
>>>-
>>>>
>>--
>>art fougner, md
>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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