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Re: Selective arterial embolizationFrom: dahmd@gate.netFri May 3 12:55:05 1996
In article Carlos Wolff <carwolff@nt.com.ar> writes:
>I'm sorry about my bad english. Gracias, Senor. Your command of english is far superior to my command of Spanish (I once asked a patient if she had a lot of "Sangria de la vagina"). I do enjoy dulce de leche, however.
>I'm not agree with you about the treatment used in this patient. First, the>external version is contraindicated in cesarean sections. While some people will not do external versions in patients with prior c/sections, to my knowledge there has never been a study showing a prior c/section as a contraindication to version. In fact, I, and many others, have done a number of versions in patients with prior low transverse c/sections. I believe we recently discussed this issue on this list. The second>contraindication is the myoma. At least in cesarean section only the>cesarean section, no the myomectomy. If you are saying that the myomectomy was contraindicated in pregnancy, I would usually agree, but not in this lady. I try to stay far away from myomas in pregnancy, but I could not close the incision (I really tried) without the myomectomy. In fact, the myomectomy was the easiest part of the case. I would have done a bilateral hypogastric artery ligation (I know there are wildly differing opinions on the utility of this maneuver) and a hysterectomy, but there was a LOT of adhesions and distorted anatomy, and she was fairly stable in terms of blood loss. In fact, since she was pretty "dry" when I closed her up, it would have required reoperation to do the hysterectomy. Plus, she begged me to do "anything" other than a hysterectomy, and the first thought that came into my head was embolization. I wouldn't try it on someone who was bleeding profusely since it can take 1.0 to 1.5 hours to complete, but in this patient it worked great. Thank you for the opportunity to discuss this case with you. Sincerely, Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net Orlando, Florida (who gets it next, Indiana or Atlanta?!)
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