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Re: Adnexal Mass (Peri and Postmenopausal group) From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu) Sun Jul 13 22:53:02 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey H. Klein, MD: "Adnexal Mass (Reproductive group)" Previous message: freda seddon: "subchorionic hemorrhage" In reply to: Zach Newton: "Re: Your chance to make me look good.." Next in thread: jay kulkin: "Re: Your chance to make me look good.." >You will save a lot of misery by going with age brackets. I understand what you are saying. Perhaps we can compromise and just use 45 years of age as the cutoff. 45 and older is "menopausal". But there will have to be a different terminology as all women at or over the age of 45 are not menopausal... Any suggestions? >You're rolling! Add on simple cyst 10 cm. or greater. Pre-op GI w/u. >Surgeon with delineation of privileges including ovarian ca procedures >or with onc back-up posted with case. Good points.. noted.. I would add that conservative ovarian surgery is probably not indicated for these patients. Ovariectomy would be my choice. Any suggestion for management of the contralateral adnexa? >> Menopausal patients who might be candidates for observation include those >> with unilocular, unilateral masses of less than 3 and probably up to 5 cm >> (I know.. there is overlap) We should probably agree on 3 or 5 cm as the upper end of normal. >This group is menopausal. There needs to be an end point available on >observation for those patients with a mass and without major >co-morbidity. Offer of surgery in Very Low Risk group if persistence for >at least 16 weeks. This is something that could be studied. ie what is the natural history of lesions in this age group that are observed for up to 16 weeks. I see where you are going.. A persistent 5 cm mass after 2 follow-up scans 8 wks apart in this age group should be investigated.. By laparoscopy with ovariectomy, I presume. For those patients with major medical problems and stable masses, might we dare continue observation? Perhaps some wording like, "..continued observation vs. operative removal after medical risk assessment and patient counseling." -- Geffrey H. Klein, MD listowner: OB-GYN-L Advisory Board Chairman, OBGYN.net < http://www.obgyn.net > Co-moderator: sci.med.obgyn gklein@bcm.tmc.edu gklein@icsi.net http://members.aol.com/gklein01/geff.html 2200 Nasa Road 1, Suite 200 Houston, Texas 77058 office 713 741 2628 Next message: Geffrey H. Klein, MD: "Adnexal Mass (Reproductive group)" Previous message: freda seddon: "subchorionic hemorrhage" In reply to: Zach Newton: "Re: Your chance to make me look good.." Next in thread: jay kulkin: "Re: Your chance to make me look good.."

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