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Re: Gyn: Positive margins on a LEEP From: R. Daniel Braun (rd.braun@gmail.com) Wed Oct 31 05:23:02 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: Gyn: Positive margins on a LEEP" Previous message: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" In reply to: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" Next in thread: Richard Chudacoff: "Re: Gyn: Positive margins on a LEEP" Reply: Richard Chudacoff: "Re: Gyn: Positive margins on a LEEP" there are always exceptions. That is why we have "COMMON" sense. About 6 C/S. Dan On 10/30/07, Joanne Bulley, MD <islesannie@gmail.com> wrote: > > While I look to do as many hysts as VH as possible ... > > I have a VERY similar patient with persistent HPV disease and SIL. Pap > with suggestive of HSIL - it was a very tough Leep due to very narrow > vaginal architecture (C/S x 2). > > On the one hadn I can see where doing it as a VH would be great and do > those vaginal margins - but with 2 C/S -AND- really tough access I think > I will decide to go with an "old fashioned" abd TAH. (high probability > of BSO unless she insists on keeping those ovaries (close to or at age > 50). > > So a question for Y'All : any rule-of-thumb on VH - at how many C/S > would you be hesitant to do a VH? > > JB > > At Tue, 30 Oct 2007, R. Daniel Braun wrote: > > > >In my mind, this is one of those INDICATIONS for a vaginal approach. > >Dan > > > >On 10/30/07, Douglas Krell <dkrell@msn.com> wrote: > >> > >> Garry, > >> I agree hysterectomy would be fine and likely to be best for her given > the > >> multiple complaints as well as the cervical disease. I think LAVH, TLH, > >> TAH > >> would give you a good > >> chance too evaluate everything. > >> Is her insurance company balking at this? > >> Douglas Krell MD > > -- > Joanne Bulley, MD, FACOG > Solo gyn > Keene, NH USA > -- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine R. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 Next message: Efrain Ramirez: "Re: Gyn: Positive margins on a LEEP" Previous message: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" In reply to: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" Next in thread: Richard Chudacoff: "Re: Gyn: Positive margins on a LEEP" Reply: Richard Chudacoff: "Re: Gyn: Positive margins on a LEEP"

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