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Re: GYN: Pelvic Mass (long--good case) From: Garry E. Siegel, M.D. (garrys@mindspring.com) Mon Mar 30 20:36:09 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: J. Hellriegel: "Re: Circs - Peds or OB? (no politics please...)" Previous message: Hugo D. Ribot Jr.: "Re: Circs - Peds or OB? (no politics please...)" In reply to: John Robertson M.D.: "Re: Fw: A lesson in humility? (funny)" Next in thread: Calvin J. Siegers, MD FACOG: "Re: GYN: Pelvic Mass (long--good case)" Reply: Calvin J. Siegers, MD FACOG: "Re: GYN: Pelvic Mass (long--good case)" Thanks to all (Dan, Cal, Gail, William, etc): I left your posts below for convenience. This morning, she continued to get "sicker," and her WBC, platelets, and Hct all dropped just as they did preop. It was my gut to go back in and remove that which I left (thanks to William, who pointed out the quick in and out when the patient is sick). I felt as if the "too many cooks" concept was coming into play, and decided to go ahead today, as opposed to letting her get any worse. On the brink of the OR, the pulmonologist wondered why I was going back (she was new on the case, as her partner had been covering the weekend) now. She felt as though the ARDS was by itself accounting for her picture, yet we couldn't explain why her counts weren't better after the infected focus had been removed. Furthermore, it was logistically difficult to re-CT her. So. . . I went back in and did a TAH (I was able to get the cervix, but would have left it if needed), and Right oophorectomy. There was no obvious pus, her subphrenic spaces were ok. Calvin, I hope that you are wrong about her not surviving another OR trip. After the surgery, the pathologist called to say that her smear may represent some pre-leukemia, so now the Heme Onc wants to do a bone marrow!!!! Glad they jumped on that one pre-op. I'll keep ya'll posted. Garry t Mon, 30 Mar 1998, R. Daniel Braun, M.D. wrote: > >Calvin speaks wisely. Once you get in on these ladies, clean them out. Also >you have a case of lots of cooks. Is it too many?? I don't know. Not having >been there in the OR, I can't make any blanket statement, but unless the >patient is in severe shock get the adnexa and the corpus. You will get by >99.9% of the time leaving the cervix. Definitely the flora you are dealing >with in these patients is from the intestine. Her ultimate outcome now will >rest on her ARDS. >I was out of town over the weekend, so I am responding late. >Dan >-----Original Message----- >From: Calvin J. Siegers, MD FACOG <csiegers@hayburn.com> >To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> >Date: Monday, March 30, 1998 5:44 AM >Subject: Re: GYN: Pelvic Mass (long--good case) > >>At Sun, 29 Mar 1998, Garry E. Siegel, M.D. wrote: >>> >>>At Sun, 29 Mar 1998, Calvin J. Siegers, MD FACOG wrote: >>>> >>>>At Sat, 28 Mar 1998, Garry E. Siegel, M.D. wrote: >>>>> >>Garry, >>Go with what your "gut" is telling you on this case: you're getting no >>help from ID (any coliform-anaerobe combo works) or heme/onc(she needed >>whole blood then and probably now) or radiology(can they tell you ARDS v >>cardiogenic shock?) or your partner (YOU knew what to do when you were >>looking right at it). Does her wedge pressure R/O cardiogenic shock? if >>so, she has ARDS and be VERY careful with maintenace fluids and vent >>setting--real delicate remaining alveoli. What is her hgb and how much >>blood has she gotten? No one cares as much about this patient as you do, >>no one knows as much about her disease as you do, so please do not stand >>down to your expert consultants.... Recommendation: do NOT take this >>women back to the OR unless she has a huge new abscess or hematoma(which >>still would be better managed by CT drainage) because if you do she will >>not survive. Cal >> >>-- >>Calvin J. Siegers, MD FACOG...private practice, 20 yr veteran, Holland, MI >> -- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga. Next message: J. Hellriegel: "Re: Circs - Peds or OB? (no politics please...)" Previous message: Hugo D. Ribot Jr.: "Re: Circs - Peds or OB? (no politics please...)" In reply to: John Robertson M.D.: "Re: Fw: A lesson in humility? (funny)" Next in thread: Calvin J. Siegers, MD FACOG: "Re: GYN: Pelvic Mass (long--good case)" Reply: Calvin J. Siegers, MD FACOG: "Re: GYN: Pelvic Mass (long--good case)"

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