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Re: Gyn: Positive margins on a LEEP From: Douglas Krell (dkrell@msn.com) Wed Oct 31 06:11:45 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Douglas Krell: "Vag hyst after C/S ... was Positive margins." Previous message: Efrain Ramirez: "Re: Gyn: Positive margins on a LEEP" In reply to: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP" Sure a good old fashioned CKC would be perfect if the patient didn't have the dyspareunia or the dysmenorrhea. If she was on the oral boards she would turn out to have Stage IV endometriosis. For persistent cervical disease I actually prefer doing cones once or even twice to preserve the cervical /vaginal architecture, rather than jumping right into a hysterectomy. There's nothing worse than having to chase down dysplasia in the folds of a vaginal cuff. But I think Gary's point was that this lady has indications for hysterectomy other than just the HGSIL and of course, if I could get her past our local BC/BS guidelines compliance officer, I would make certain that all the cervical disease was included in the hysterectomy specimen. -- Douglas Krell MD >From: islesannie@gmail.com (Joanne Bulley, MD) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: Gyn: Positive margins on a LEEP >Date: Tue, 30 Oct 2007 22:25:24 -0500 > >Ditto > >As the eldest Gyn in this county - I think I am the ONLY one who does >any "cold knife cones" I do them for almost anything where I suspect CIN >3 or CIS. > >I want my pathologist to get a decent look at the margins. > >JB > >At Tue, 30 Oct 2007, Richard Chudacoff wrote: > > > >Okay, but if invasion cannot be ruled out, then I would do a cold knife >cone > >rather than a LEEP. I would not want to burn the margins > > > >-- > >Richard Chudacoff, MD, FACOG > > > >-- >Joanne Bulley, MD, FACOG >Solo gyn >Keene, NH USA Next message: Douglas Krell: "Vag hyst after C/S ... was Positive margins." Previous message: Efrain Ramirez: "Re: Gyn: Positive margins on a LEEP" In reply to: Joanne Bulley, MD: "Re: Gyn: Positive margins on a LEEP"

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