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Re: PMB on coumadin From: Henry Gregor (henrygregor@yahoo.com) Mon Apr 30 17:13:12 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Henry Gregor: "Re: Abortion? ... here we go again! Sheesh! -->ConLaw now!" Previous message: Garry E. Siegel, M.D.: "Re: PMB on coumadin**SBE prophylaxis" In reply to: Atkinson, Samuel M: "Re: PMB on coumadin" Next in thread: Meenan, Anna: "Re: PMB on coumadin" No way to dispute your viewpoint Sam, and in point of fact, there is literature out there, by my recollection, which points out the whole issue of SBE prophylaxis was never vetted, or established, by EB results or gold standard randomized trials. I don't know the literature, but have heard cardiologists make the point. So, like so many other things, it comes down to clinical "judgment" I suppose. I'm gonna' prophylax her, and I can just rx one less abx rx for sinusitis or suspected uti to salve my concious re indiscriminate abx use, hehe. Kinda' like doing a section sometimes...rarely do we ever regret the ones we do, but every once in a while, one of us in the specialty wishes we'd done one we didn't sometime past. "Atkinson, Samuel M" <ATKINSONS@ecu.edu> wrote: v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} st1\:*{behavior:url(#default#ieooui) } 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 ________________________________ 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 ________________________________ Ahhh...imagining that irresistible "new car" smell? ________________________________ Check out new cars at Yahoo! Autos. --------------------------------- Ahhh...imagining that irresistible "new car" smell? --------------------------------- Check out new cars at Yahoo! Autos. --------------------------------- --------------------------------- Ahhh...imagining that irresistible "new car" smell? --------------------------------- Check outnew cars at Yahoo! Autos. --------------------------------- Next message: Henry Gregor: "Re: Abortion? ... here we go again! Sheesh! -->ConLaw now!" Previous message: Garry E. Siegel, M.D.: "Re: PMB on coumadin**SBE prophylaxis" In reply to: Atkinson, Samuel M: "Re: PMB on coumadin" Next in thread: Meenan, Anna: "Re: PMB on coumadin"

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