Asking for Malcon, Dan, Rick's opinion (was Re: Abdominal pain)
From: Ricardo Savaris (savaris@orion.ufrgs.br)
Fri Dec 12 04:03:57 1997
> Date: Thu, 11 Dec 1997 18:49:56 +0100
> From: Bernard Cristalli <bcrist@club-internet.fr>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Abdominal pain
> Message-ID: <349027C0.2A01@club-internet.fr>
>
> Ricardo Savaris wrote:
> >
> > 32 y-old, gesta 3 para 2 , 1 abortion, started yesterday morning with
> > intense colic pain starting on her back and goes to the front. The pain
> > moved, afterwords to the supra pubic region. The pain is like labour
pain,
> > no relief position, last for few minutes and disapear. At the same time
she
> > started with an abnormal uterine bleeding, not intense. No use of drugs
or
> > fever. Her menses are regular 28 days cicles, 7 days of menses.
> > LMP: November, 20th no contraceptive method since quimioterapy
> > Medical past history: Breast cancer 6 years ago, sectorectomy +
radioterapy
> > + quimioterapy.
> > No history of urinary stones
> > On the physical exam:
> > No tenderness on her back.
> > Abdominal defense, and rebound tenderness.
> > Vaginal examination: pain in uterine mobilization, no adnexial pain,
uterus
> > in normal size. After the exam she started with the pain.
> > Ordered FBC, Urine analisis and Sedimentaion Rate (I sent her to E.R.)
> > FBC: Hb 13 Leucocytes: 4.800 (no infection)
> > Urine analisys: all in normal range, 1-2 leuc/field, no bacteria, 1
blood
> > cell/field
> > At the E.R. they asked for a pregnancy test and discharge to home. No
> > chance for nephrolithiasis. She is still with this ciclic pain.
> >
> --
>
> Other exams? US ? X-rays ?
> Looks like 'good-old-times-home-made-abortion' Any chance for it?
I'm afraid not, mainly because I just received her beta-hcg: negative. I
will ask for a US today and X-Ray, the adnexial torsion must be considered.
> If not I would vote for a adnexal torsion, but what about the bleeding?
That's my question as well, from the start I was thinking about IPD, but
with that FBC, I changed my mind.
I would like to hear the opinion of our friends, Malcon, Dan, Rick, Zach
and Bob of Borgs (BB) [resistence is futile] (dont get me wrong, just
kidding :-)
--
Ricardo Savaris, MD, TEGO, MSc
Porto Alegre, Brazil
55 51 3301354
Ricardo Savaris wrote:
>
> --
> Bernard Cristalli MD CNGOF
> AIHP - ACCA
> Paris - France
> http://www.obgyn.net/corresp/cristalli.htm
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 18:04:10 +0000
> ------------------------------
> From: Malcolm Griffiths <Malcolm@mgriff22.demon.co.uk>
> To: ob-gyn-l@obgyn.net
> Subject: Re: treatment of mild preeclampsia
> Message-ID: <P$vZsTAasCk0EwrX@mgriff22.demon.co.uk>
>
> In message <01BD05B8.B4B00DC0@lp15-22.redrose.net>, tpcanavan
> <tpcanavan@redrose.net> writes
> >Have an 18 yo woman G1P0 found to have BP of 150/100 which didn't
resolve with
> >rest and 2+ protein at 34 weeks 3 days by 21 week US (LMP unknown first
visit at
> >20 weeks). On admission BP's slowly improve with bed rest and run
130's/80's,
> >LFT's WNL platlet count 150K, NST reactive, US measures fetus at 30
weeks 3
> >days, AFI of 10.6, EFW 1750 gms (11%). Patient covered by HMO and they
called
> >to state they will authorize only one day stay. 24 hour urine protein
on day 2
> >is 1450 gms/24 hrs repeat platlet count 120 K. Their OB states patient
should
> >be discharged and monitored as an outpatient.
> >
> >How would other members of the list follow this patient?
> >
> >Anyone agree with the HMO's OB?
> >
> I think regulation of clinical practice by your HMO's stinks. In fact
> though I'd be willing to manage her as an outpatient if she was happy
> and provided she was seen at least daily.
> Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
> Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
> Tel: 01582-497459 (office) Fax: 01582-497376
> 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk
> http://www.obgyn.net/board/griffith.htm
> "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!"
> (Someone [1997])
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 18:00:37 +0000
> ------------------------------
> From: Malcolm Griffiths <Malcolm@mgriff22.demon.co.uk>
> To: ob-gyn-l@obgyn.net
> Subject: TAKE ME OFF YOUR MAILING LIST (was Re: TAKE ME OFF YOUR MAILING
LIST (was Re: Iran representative))
> Message-ID: <PPoZQGAFpCk0EwIe@mgriff22.demon.co.uk>
>
> For some unknown reason I got a mail from mark Perloe asking me to take
> him off the list. The message seemed quite offensivfely worded. I mailed
> him back (a few days ago attaching Geff's monthly mailing) and since
> have received yet another offensive response. Anyone know thius guy? His
> posts previously seemed fine!
>
> ------- Forwarded message follows -------
>
> -----------------------------(+vy'wL(2/a)-----------------------------
>
> -----------------------------(+vy'wL(2/a)-----------------------------
> Return-Path: <mperloe@ivf.com>
> -----------------------------(+vy'wL(2/a)-----------------------------
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> Date: Wed, 10 Dec 1997 19:12:25 -0500
> To: Malcolm Griffiths <Malcolm@mgriff22.demon.co.uk>
> From: "Mark Perloe, M.D." <mperloe@ivf.com>
> Subject: TAKE ME OFF YOUR MAILING LIST (was Re: TAKE ME OFF YOUR
> MAILING LIST (was Re: Iran representative))
> In-Reply-To: <DiDYKqBt$aj0Ewyp@mgriff22.demon.co.uk>
> References: <3.0.5.32.19971208195738.00906740@pop.mindspring.com>
> Mime-Version: 1.0
> Content-Type: text/plain; charset="us-ascii"
>
> At 08:54 PM 12/9/97 +0000, you wrote:
> >In message <3.0.5.32.19971208195738.00906740@pop.mindspring.com>, "Mark
> >Perloe, M.D." <mperloe@ivf.com> writes
> >>At 09:57 PM 12/8/97 +0000, you wrote:
> >>>In message <c=US%a=_%p=Americal_Medical%l=AMM1EXCH-971208191102Z-
> >>>15778@amm2mg1.americanmed.com>, Geffrey Klein <GK6972@americanmed.com>
> >>>writes
> >>>>must be nice to get out of residency and then be the head of the
> >>>>department.....
> >>>>
> >>>
> >>>Over here it always seems to me that some guys get to be Professors
> >>>before they can walk. The rest of us never get to be boss :-(
> >>>Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
> >>>Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
> >>>Tel: 01582-497459 (office) Fax: 01582-497376
> >>> 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk
> >>>http://www.obgyn.net/board/griffith.htm
> >>>"CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!"
> >>>(Someone [1997])
> >>>
> >>Please do not waste my time anylonger. Take me off your mailing list.
> >>
> >Try this - and don't get so cross!
> >
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> >----------------------------------
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> >----------------------------------
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> >Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
> >Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
> >Tel: 01582-497459 (office) Fax: 01582-497376
> > 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk
> >http://www.obgyn.net/board/griffith.htm
> >"CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!"
> >(Someone [1997])
> >
> Please do not waste my time anylonger. Take me off your mailing list.
>
> -----------------------------(+vy'wL(2/a)-----------------------------
>
> -----------------------------(+vy'wL(2/a)-----------------------------
> Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
> -----------------------------(+vy'wL(2/a)-----------------------------
> Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
> Tel: 01582-497459 (office) Fax: 01582-497376
> 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk
> http://www.obgyn.net/board/griffith.htm
> "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!"
> (Someone [1997])
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 11:42:00 -0800
> ------------------------------
> From: "Grove,James" <James.Grove@kp.org>
> To: OB-GYN-L <OB-GYN-L@obgyn.net>
> Subject: FW: treatment of mild preeclampsia
> Message-ID: <01BD0621.603CD9D0@gren-exch-1.kpscal.org>
>
> >From the facts presented, it sounds like the patient is decompensating
> on bedrest as manifested by dropping platelet count and significant
> proteinuria on 24 hr. specimen as well as having a significantly
> elevated BP on admission and evidence of at least mild IUGR. I feel
> delivery is indicated--hopefully induction . Transfer to a tertiary
> facility may be warranted depending on the quality of the NICU where she
> currently is.
>
> James Grove MD
> Bellflower, CA.
> ----------
> From: tpcanavan
> To: Multiple recipients of list
> Subject: treatment of mild preeclampsia
> Date: Wednesday, December 10, 1997 7:13PM
>
> Have an 18 yo woman G1P0 found to have BP of 150/100 which didn't
> resolve with
> rest and 2+ protein at 34 weeks 3 days by 21 week US (LMP unknown first
> visit
> at 20 weeks). On admission BP's slowly improve with bed rest and run
> 130's/80's, LFT's WNL platlet count 150K, NST reactive, US measures
> fetus at
> 30 weeks 3 days, AFI of 10.6, EFW 1750 gms (11%). Patient covered by
> HMO and
> they called to state they will authorize only one day stay. 24 hour
> urine
> protein on day 2 is 1450 gms/24 hrs repeat platlet count 120 K. Their
> OB
> states patient should be discharged and monitored as an outpatient.
>
> How would other members of the list follow this patient?
>
> Anyone agree with the HMO's OB?
>
> Any thoughts?
>
> Timothy Canavan, MD, FACOG
> Lancaster, PA
> tpcanavan@redrose.net
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 14:21:53 +0000
> ------------------------------
> From: "George M. Grunert" <grunert@ICSI.Net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: ovulation inductors recombinants
> Message-ID: <199712112019.OAA25666@ICSI.Net>
>
> Correction: the October issue of Human Reproduction.
>
> > Look at multiple articles in Human Reproduction this year on
> > milti-center European trials comparing rFSH, FSH, Metrodin, and HMG
> > in IVF patients where oocyte quality, fertilization rates, pregnancy
> > rates, etc were compared. The August issue contains several articles
> > alone. Most found essentially similar results with several finding
> > slightly lower doses with rFSH.
> >
> > FYI: All you need to do is see Pergonal being made to change to rFSH.
> >
> > > Does any one can help me +? , I am trying to find out if there is
some
> > > data in the literature( medical articles) about the impact in the
oocyte
> > > (it self) with the use of new recombinant inductors of ovulation in
> > > assisted reproductive medicine.
> > >
> > > Manuel R. Garcia MD
>
> George M. Grunert, M.D.
> Director ART Program, Woman's Hospital of Texas
> 7550 Fannin
> Houston, TX 77054
> 713-512-7851
> fax 713-512-7853
> grunert@icsi.net
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 16:12:50 -0500 (EST)
> ------------------------------
> From: rbraun@iupui.edu
> To: ob-gyn-l@obgyn.net
> Subject: Re: DRUG QUESTION
> Message-ID: <Pine.HPP.3.96.971211161210.4815B-100000@ruby.iupui.edu>
>
> My understanding is that there is no evidence of teratogenesis, but it
> just doesn't work in pregnant patients.
>
> R. Daniel Braun, MD FACOG
>
> On Wed, 10 Dec 1997, Bryan S. Jick, M.D., F.A.C.O.G. wrote:
>
> > Can glucophage, a non-sulfonylurea oral hypoglycemic agent be safely
used in pregnancy?
> >
> > Thanks.
> >
> > Sincerely,
> >
> > Bryan S. Jick, M.D., F.A.C.O.G.
> >
> > Board Certified Ob/Gyn
> >
> > Pasadena, California
> >
> > <color><param>0000,0000,ffff</param>drbryan@earthlink.net</color>
> >
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 16:41:43 -0500 (EST)
> ------------------------------
> From: rbraun@iupui.edu
> To: ob-gyn-l@obgyn.net
> Subject: Re: Elective Pitocin Induction of a patient in breech
presentation.
> Message-ID: <Pine.HPP.3.96.971211163257.4815D-100000@ruby.iupui.edu>
>
> Andy,
> It went up this AM. You may not like what I said.
> My summation was "Is a 3.3% incdience of traumatic fetal injury and a
> 2.5% incidence of birth asphyxia more or less worrisome than the
> increased maternal morbidity and mortality of C/S??" I don't know the
answer,
> and I think it needs to be left up to the individual patient after
> informed consent.
> I also am an advocate of vaginal breech delivery. I also think we need to
> preserve these skills. I don't think there is a single answer to this
> question. I think it depends on what risk is the patient willing to
> accept.
> Dan
>
> R. Daniel Braun, MD FACOG
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 16:52:06 -0500 (EST)
> ------------------------------
> From: rbraun@iupui.edu
> To: ob-gyn-l@obgyn.net
> Subject: Re: treatment of mild preeclampsia
> Message-ID: <Pine.HPP.3.96.971211164251.4815E-100000@ruby.iupui.edu>
>
> I would keep this patient in house until she either reaches 37 weeks,
> starts labor, or develops severe pre-eclampsia. Then I would deliver her.
> I would send them a copy of page 785 of the 19th edition of Williams
> Obstetrics. I don't have the 20th ed. but I bet it says the same thing.
If
> they have an objection to managing the patient in the manner recommended
> by this hallowed text, Ask them to find your patient an Obstetrician who
> will be their flunky and accept the risk involoved in this kind of
> management, because you won't.
> Over the years, I have seen several patients who when hospitalized
> completely normalized their BP and lost their proteinuria. When they were
> sent home by their doc, tehy came back in 3 days or less convulsing. Your
> patient hasn't even done as well as those did before they convulsed.
> Dan
>
> R. Daniel Braun, MD FACOG
>
> On Wed, 10 Dec 1997, tpcanavan wrote:
>
> > Have an 18 yo woman G1P0 found to have BP of 150/100 which didn't
resolve with rest and 2+ protein at 34 weeks 3 days by 21 week US (LMP
unknown first visit at 20 weeks). On admission BP's slowly improve with
bed rest and run 130's/80's, LFT's WNL platlet count 150K, NST reactive, US
measures fetus at 30 weeks 3 days, AFI of 10.6, EFW 1750 gms (11%).
Patient covered by HMO and they called to state they will authorize only
one day stay. 24 hour urine protein on day 2 is 1450 gms/24 hrs repeat
platlet count 120 K. Their OB states patient should be discharged and
monitored as an outpatient.
> >
> > How would other members of the list follow this patient?
> >
> > Anyone agree with the HMO's OB?
> >
> > Any thoughts?
> >
> > Timothy Canavan, MD, FACOG
> > Lancaster, PA
> > tpcanavan@redrose.net
> >
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 17:06:59 -0500 (EST)
> ------------------------------
> From: rbraun@iupui.edu
> To: ob-gyn-l@obgyn.net
> Subject: Re: FRI Topical sweets
> Message-ID: <Pine.HPP.3.96.971211170507.4815G-100000@ruby.iupui.edu>
>
> Que es "maracones"??
>
> My contribution: What do you call 4 Mexicans in quicksand ? Cuatro
> sinko.
>
> R. Daniel Braun, MD FACOG
>
> On Thu, 11 Dec 1997, DoctorJoe wrote:
>
> >
> > In a message dated 12/10/97 10:55:30 PM, you wrote:
> >
> > <<For you non-portuguese speakers, the word for sink is "pia" and the
word
> > for joke is piada. Bilingual puns aren't much funnier than unilingual
> > ones.>>
> >
> > The two best stories I have were Spanish.
> >
> > 1) A class mate of mine married a Panamanian girl. He was having dinner
with
> > her familia and wanted to order "camarones fritos"... instead, he
ordered
> > "maracones fritos".
> >
> > 2) An exchange student was in Monterrey, living with a Mexican family.
At a
> > fancy party, mostly in honor of the various exchange students, she
wanted to
> > say that she was embarassed to speak Spanish to the group. So she said
"Yo soy
> > muy embarasada".
> >
> > Jose P.
> >
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 17:17:17 -0500 (EST)
> ------------------------------
> From: rbraun@iupui.edu
> To: ob-gyn-l@obgyn.net
> Subject: RE: Re: GEN from ARNP: 2 vessel cord
> Message-ID: <Pine.HPP.3.96.971211171322.4815H-100000@ruby.iupui.edu>
>
> Renal agenesis or hypoplasia, renal dysgenesis, horseshoe kidney, pelvic
> kidney, and hydro ureeter and hydronephrosis.
> Ref. Heifetz Perspect. Pediatr. Pathol 8:345,1984
> These have been associated with, but not caused by or even necesarily
> related to, SUA.
>
> R. Daniel Braun, MD FACOG
>
> On Thu, 11 Dec 1997 wagedj@ctrvax.Vanderbilt.Edu wrote:
>
> > This just came up in our chart review with a colleagues' patient. The
perinatologist recommended serial USGs for possible associated IUGR. What
are the anomalies associated with a single umbilical artery?
> >
> > Deborah Wage FNP,CNM
> >
> > ==========================
> > >From: rbraun@iupui.edu
> > >To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
> > >Subject: Re: GEN from ARNP: 2 vessel cord
> > >Date: Wednesday, December 10, 1997
> > >
> > >If a good cross section of the cord was seen, the diagnosis should
be 100%
> > >accurate. There is an associated 5-10% incidence of anomalies. The
correct
> > >terminology for this is "Single Umbilical Artery".
> > >
> > >R. Daniel Braun, MD FACOG
> > >
> > >On Wed, 10 Dec 1997, Susan Mcniel wrote:
> > >
> > >> I have a 2nd tri pt who recently had an US. Report returned c
"probable 2
> > >> vessel cord, otherwise normal". How often are the US reports on
cords
> > >> correct (the
> > >> ultrasonographer told the pt that most of the time there are
three, we
> > >> just cannot see the other artery for some reason)? I know there
is a
> > >> genetic risk c 2 vessel cords, but what are the risks and how
high are
> > >> they? In my experience, most of these kids are just fine, I
don't know
> > >> the percent of risk.....
> > >> TIA
> > >> Susan McNiel, MN, ARNP
> > >> Women's Health and Adult Primary Care
> > >>
> > >
> >
>
> ------------------------------
>
> ------------------------------
> Date: 11 Dec 1997 13:13:34 -0800
> ------------------------------
> From: Terrence.Jones@ncal.kaiperm.org
> To: ob-gyn-l@obgyn.net
> Subject: SCTp/TTTS
> Message-ID: <nY5f4f8b.rsp-3cad3b3c@Tao.ncal.kaiperm.org>
>
> Dr. Bui, thanx for the update. Read of the importance of timing in
thymic
> presentation for immunotolerance (Flake & Zanjani O/G Clin N Am 3/97).
Know
> there's alot of important structures in the vicinity that could be easily
> disturbed in the first trimester, but has anyone done direct thymic
presenta-
> tion in the sheep model, or is this beyond technical constraints?
> You're probably already intimately familiar with this info, but Nov
'97
> JRM (edited by one monozygotic and one dizygotic twin!) is a symposium on
> multiple preg. There's a WONDERFUL article by Dr Machin on zygosity, and
He
> is extensively cited (Am J Med Gen (96) 61:229-36) in Gemert's
presentation
> on models of TTTS. If interested, will fax (tho I guess this info was
already
> presented in Brussels (June).
> Malcolm, Mark (Perloe) has posted extensively on REI issues (most
recently
> -- 'the magnificent seven') including concerns re: the value of DS
(DHEAS) and
> first on the list to point out Metformin use in PCOS (6/97). (Still
wonder
> about the Ehrmann & A:cbay studies...) Hmmm Maybe that placental surprise
> fruit-cake Laurie sent him didn't travel well to Atlanta? :) tj.
>
> ------------------------------
>
> ------------------------------
> Date: Thu, 11 Dec 1997 17:17:20 -0500
> ------------------------------
> From: Allen Gardner <allen.gardner@utoronto.ca>
> To: Ob-gyn listserv <ob-gyn-l@obgyn.net>
> Subject: question from the class (fwd)
> Message-ID: <ECS9712111720A@utoronto.ca>
>
> Greetings Gurus,
> My daughter is the instructer in a combined cytogenetic/molecular genetic
lab
> tech course at the Michener Institute in Toronto. She was asked the
following
> question by one of her students (this is a post diploma course so these
are
> mature students).
> Can anyone offer an answer she can give?
> Thanks.
> Allen.
>
> Allen Gardner MD, Director of Genetic Services
> Oshawa General Hospital, Oshawa, Ontario, L1G 2B9, Canada
> Associate Professor, Department of Laboratory Medicine and Pathobiology,
> University of Toronto
> 905 433 2733 phone
> 905 721 4757 fax
>
> ==========================================================
> On Tue, 2 Dec 1997 21:34:30 -0500 grosenberg@staff.michener.on.ca wrote:
>
> > From: grosenberg@staff.michener.on.ca> Date: Tue, 2 Dec 1997 21:34:30
-0500
> > Subject: question from the class
> > To: Dad <allen.gardner@utoronto.ca>
> >
> > This issue came up. Is it possible for someone who is pregnant to
get
> > pregnant again, within the first couple of months gestation? I
never
> > heard of that and don't see how it could possibly happen, but I
said
> > I'd ask.
>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 1395
> ------------------------------
> ***************************
