ART COURSES& DEGREES
From: Ashraf Abuali (abuali@shabakah.com)
Thu Oct 14 06:26:50 1999
CAN I HAVE ANY INFORMATION ABOUT ART DEGREES OR
COURSES AVAILABLE IN SOME CENTRES.
DRA AMINA MD.
>----- Original Message -----
From: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
Sent: 13 October 1999 19:23
Subject: OB-GYN-L digest 606
> OB-GYN-L Digest 606
>
> Topics covered in this issue include:
>
> 1) Re: endometriosis and polycystic ovaries
> by garrys@mindspring.com (Garry E. Siegel, M.D.)
> 2) Re: OB:Cesarean for anencephaly
> by tstork2@cecc.net (Dr. Roger Klam)
> 3) Re: Asherman's Syndrome
> by "Rafael Haciski MD" <haciski@earthlink.net>
> 4) Re: Gyn: Saline Ultrasound
> by "Rafael Haciski MD" <haciski@earthlink.net>
> 5) Re: Ovulation vs. luteinization
> by "Rafael Haciski MD" <haciski@earthlink.net>
> 6) Re: TAH for no reason (was Re: OB:Cesarean for anencephaly)
> by "Rafael Haciski MD" <haciski@earthlink.net>
> 7) Re: Women Want Pain Relief During Labor
> by "Rafael Haciski MD" <haciski@earthlink.net>
> 8) American Academy of Pediatrics Policy Statements (Baby Doe, etc.)
> by "Chris Roberts" <chrisroberts@mindspring.com>
> 9) Re: endometriosis and polycystic ovaries
> by "Dan Logen" <pdl@whidbey.net>
> 10) Re: TAH for no reason (was Re: OB:Cesarean for anencephaly)
> by DoctorJoe@aol.com
> 11) Re: FRI Women Want Pain Relief During Labor
> by DoctorJoe@aol.com
> 12) Re: endometriosis and polycystic ovaries
> by Mark Perloe <mperloe@ivf.com>
> 13) BMI May Predict C-Section Risk
> by "Geffrey Klein, MD" <gklein@icsi.net>
> 14) Re: breast cancer in pregnant women
> by Dib Abdalla Chacur <chacur@rol.com.br>
> 15) Re: BMI May Predict C-Section Risk
> by jhellrie@pce.net (J. Hellriegel)
> 16) Re: breast cancer in pregnant women
> by Gail Waldby <gwaldby@willinet.net>
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Tue, 12 Oct 1999 20:15:01 -0500 (CDT)
> ----------------------------------------------------------------------
> From: garrys@mindspring.com (Garry E. Siegel, M.D.)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: endometriosis and polycystic ovaries
> Message-ID: <199910130115.UAA09160@talk.obgyn.net>
>
> >The patient is upset, stopped her hormones and now maintains I should
have never
> >done her surgery and should have never started her on hormone therapy.
> >I think she has chronic pain, irritable bowel syndrome, and depression.
I know
> >you can't make everyone happy,
> >but I am concerned about how people are utilizing HRT or SERM medication
in
> >patients who have been
> >hysterectomized for endometriosis.
> >
> >Doug;las Krell MD
>
> I start estrogen immediately postop. Your surgery sounds appropriate,
> and her reaction is not. She may have problems, but they shouldn't be
> as a result of the TAH/BSO.
>
> Garry
>
> --
> Garry E. Siegel, M.D., FACOG
> Private Practice
> Roswell, Ga.
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 12 Oct 1999 20:56:30 -0500
> ------------------------------
> From: tstork2@cecc.net (Dr. Roger Klam)
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: OB:Cesarean for anencephaly
> Message-ID: <000c01bf151e$3519f900$0201a8c0@ramphome.com>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 7bit
>
> Because of all the messages stating that the neonatolgist attending the
c/s
> or at the delivery would wrap the child and give it to the parents, I felt
> perhaps I was incorrect with the situation in my area. I brought up the
> subject to 2 midwives, who then reminded me that what I had said was
> correct. They also reminded me of situations where this had occured. A
> number of nurses who work in l&d and in the NICU feel that if everything
is
> not done for a child, then it is neglect and I was reminded that in the
> past theyc have notified the state about such a case and the hospital was
> investigated.Most nurses would give the child to the parents; but there is
> always some that feel that this is murder and act accordingly.
>
> Roger Klam, M.D.
>> ----- Original Message -----
> From: Betsy Hyde <elishyde@connix.com>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> Sent: Tuesday, October 12, 1999 5:08 PM
> Subject: Re: OB:Cesarean for anencephaly
>
> > At 10:06 PM 10/11/99, Dr. Roger Klam wrote:
> > >I asked my wife and she wondered who would pay the NICU costs while the
> > >child was still alive. The child ,by law would have to go to the
NICUor
> > >else the hospital could be charged with malpractice.
> >
> > I don't think this is a law, Roger, and it is certainly not what happens
> at
> > my hospital...assuming the parents desire contact with their baby
between
> > birth and death.
> >
> > Babies born alive with abnormalities incompatible w/ life have a *brief*
> > check by the neonatologists to confirm the diagnosis, and then get
wrapped
> > and go to their parents, where they stay as long as the parents want. An
> > example is a fetus who was a thanatophoric dwarf. Delivered by c/s
because
> > his head was just too big for vaginal birth without destructive
procedure.
> > Went to peds for less than 5 minutes, and then to his father's arms
while
> > the c/s was completed.
> >
> > Ditto with previable fetuses.
> >
> > Betsy Hyde CNM
> > Branford, CT
> >
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 12 Oct 1999 23:41:46 -0400
> ------------------------------
> From: "Rafael Haciski MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Asherman's Syndrome
> Message-ID: <199910130342.UAA08592@swan.prod.itd.earthlink.net>
> Mime-version: 1.0
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>
> If you have documented ovulation, and she does not desire pregnancy, I
would
> not do anything at this time.
>
> Sonographically it is hard to visualize adhesions - best done with
> sonohysterography (thin IUI catheter inserted with sterile warm saline
> instilled while observing ultrasonographically) where you will note the
> cavity, with bands of tissue extending from side to side.
>
> However, this does require that some cavity be present, and if the
scarring
> is so severe that there is no cavity left, then I doubt that anything can
be
> seen. This is very much what we achieve with endometrial ablation - the
> endometrium has been replaced with scar.
>
> When ready to conceive, she should see a GYN who is experienced in repair
of
> Asherman's; she will need to undergo repeated cycles of
> ..hysteroscopic resection of adhesions, followed by
> ..high dose estrogen treatment, and
> ..culminating in progesterone withdrawal
> Repeat hysteroscopy is then done to assess the progress and the process is
> repeated until cavity is open. This may take several such cycles, much
time
> and agrevattion, but I do not think that much risk, beyond the usual
> hysteroscopic (and laparoscopic, if needed) complications, as well as the
> possible ill effects of high does estrogen.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Associates
> Baltimore MD
> http://www.ivf-md.com
>
> ----------
> >From: "Dr Siri Karunatilleka" <drsirind@x-stream.co.uk>
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> >Subject: Asherman's Syndrome
> >Date: Tue, Oct 12, 1999, 17:55
> >
>
> > To: ob-gyn-l@obgyn.net
> > From: Dr S De Silva FRCOG [drsirind@x-stream.co.uk]
> > Subject: Asherman's Syndrome
> >
> > 12th October 1999
> >
> > Primigravida,34yrs, had a SVD 18 months ago. Postnatal she had heavy
loss
> > from six weeks onwards for four weeks. US pelvic scan showed no
placental
> > remnants; beta-HCG negative; she was given a course of antibiotics, on
> > presumption of sepsis. Bleeding abated, but recurred heavier four weeks
> > later; a different antibiotic was given inspite of negative clinical
signs
> > and symptoms.
> > Bleeding continued heavier than before.
> > She saw a second gynaecologist and had a curettage done at 12 weeks
> > postnatal. Bleeding stopped
> > within a week. Has not resumed menses since, though breast-feeding
stopped
> > at twelve weeks postnatal. Hormone profile confirms regular ovulation;
> > prolactin and thyroid hormones normal;
> > Pelvic scan shows ?thin endometrium,not diagnostic of Asherman's.
Attempt
> > at salpingogram failed due to stenosis of cervical canal.
> > She has seen a third gynaecologist, experienced in TCR and intra-uterine
> > surgery. He confirms Asherman's,
> > But has advised IU surgery is hazardous and complication rate could be
high.
> > She is symptomless
> > apart from the amenorrhoea,which does not worry the patient. She is not
keen
> > on a pregnancy at present, but future desires not well defined.
> > Are the risks of IU adhesiolysis worth taking in her situation? She is
not
> > sure whether she will
> > desire another pregnancy later. What are the chances of regrowth of
> > endometrium after 12 months
> > of amenorrhoea? What are US scan feautures diagnostic of IU adhesions?
How
> > will you manage this patient? Shall be very grateful for your views.
> >
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 00:37:03 -0400
> ------------------------------
> From: "Rafael Haciski MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Gyn: Saline Ultrasound
> Message-ID: <199910130437.VAA28420@swan.prod.itd.earthlink.net>
> Mime-version: 1.0
> Content-type: text/plain; charset="US-ASCII"
> Content-transfer-encoding: 7bit
>
> Ideally, all the diagnostic tests and evaluation should be done by the
> physician doing (managing) the evaluation. While this is not possible in
> such cases as CAT scans, MRIs, or even x-rays, primarily due to
specialized
> and expensive equipment requirements, sonography is both easy and
relatively
> inexpensive equipment-wise. Hence I look at sonography as an extension of
> my pelvic exam, and sonohysterography is no different.
>
> I can not imagine sending a patient to another physician for the pelvic
> exam, while I do the history taking and decision making alone. Neither
can
> I imagine referring a patient for sonogram, sonohysterogram, etc since it
> all can be done right away in my office. While hysterosalpingograms
require
> X-ray equipment which I do not have, I refer the patient to the local
> radiologist office, but with me in tow, so that I can perform the
procedure
> - I have always felt that half of the information obtained from the
> hysterosalpingogram is obtined from the "feel" of the procedure.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Associates
> Baltimore MD
> http://www.ivf-md.com
>
> ----------
> >From: dahmd@mpinet.net (D. Ashley Hill, M.D.)
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> >Subject: Re: Gyn: Saline Ultrasound
> >Date: Mon, Oct 11, 1999, 23:28
> >
>
> > At Mon, 11 Oct 1999, Paul Prior MD wrote:
> >
> >>
> >>Ummm, isn't that the whole idea of saline infusion sonography in the
> >>first place??? I'm missing their argument here....
> >
> > No offense to any radiologists lurking on the list, but I have not been
> > impressed with saline sonography performed by non-gynecologists. Since
> > we're the ones performing the hysteroscopy for any polyps, fibroids, or
> > lost IUDs identified by saline sonography, we should be the ones
> > performing the procedure.
> >
> >>From an economic standpoint it's probably much more cost-effective to
> > simply let the gynecologist do the vaginal ultrasound, rather than the
> > radiologist. There is no interpretation fee, and the diagnosis and
> > treatment plan can be made right in the gyn's office.
> >
> > Ashley
> >
> > --
> > David Ashley Hill, M.D.
> > Associate Director
> > Department of Obstetrics and Gynecology
> > Florida Hospital Family Practice Residency
> > Orlando, FL
> > http://home.mpinet.net/dahmd
> >
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 01:46:08 -0400
> ------------------------------
> From: "Rafael Haciski MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Ovulation vs. luteinization
> Message-ID: <199910130546.WAA15768@swan.prod.itd.earthlink.net>
> Mime-version: 1.0
> Content-type: text/plain; charset="US-ASCII"
> Content-transfer-encoding: 7bit
>
> You are absolutely correct - progesterone is only a chemical indication
that
> the hormonal process has progressed along the intended path. It says
> nothing about the physical release of the egg. The presumption is that
non
> release is a very rare event (you quote Kerin's 4.5%, in actuality it is
> probably much lower) and thus we clinicians use it as a sign of ovulation,
> not distniguishing between the physical event of egg release (with is
taken
> as a given) and the hormonal event.
>
> In reality, there are only three ways to "prove" egg release:
> ..CONTINUOUS sono monitoring demonstrates deflation of the follicle;
> ..egg removal in course of IVF (follicle puncture)
> ..presence of a pregnancy (outside the ovary, of course)
>
> The first of these is just plain impractical.
> The second is actually a therapeutic modality, but not a diagnostic test
of
> ovulation.
> And in the third case, having achieved the pregnancy, the information
about
> ovulation is outdated and useless.
>
> So we have to make the assumption, since the alternatives are slim, as are
> the chances of egg non-release.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Associates
> Baltimore MD
> http://www.ivf-md.com
>
> ----------
> >From: "Jeffrey W. Clemens" <clemens@duq.edu>
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> >Subject: Ovulation vs. luteinization
> >Date: Tue, Oct 12, 1999, 08:05
> >
>
> > Steve,
> >
> > I think that I understand why progesterone levels are investigated
in
> > infertility workups. Thank you for your explanation. However, I still
> > maintain that progesterone levels only PROVE luteinization and will
concede
> > that in most cases that they are highly suggestive of OVULATION.
> > Whether luteinized unruptured follicles actually occur clinically I
> > will leave at this time to my medical colleagues. Samuel Yen (in Yen,
> > Jaffe, and Barbieri's Reproductive Endocrinology, 4th edition)
references
> > the study of Kerin et al (1983, Fertil Steril 40:260) that LUF has an
> > occurrence rate of 4.5%.
> > I would like to add the following few comments. Transgenic mice
> > lacking a functional progesterone receptor (PRKO) will fail to ovulate
or
> > normally luteinize in response to high level exogenous gonadotropins
(Lydon
> > et al., Mice lacking progesterone receptor exhibit pleiotropic
reproductive
> > abnormalities. Genes & Development 9:2266-2278, 1995). Other transgenic
> > animals with ovulatory defects usually have associated luteinization
defects.
> > However, there is no evidence at present that at the level of gene
> > transcription that COMMON regulatory elements and transcription factors
are
> > involved in the LH-surge induced up-regulation of three genes involved
in
> > luteinization (P450scc) and ovulation (Progesterone receptor and
> > cyclooxygenase-2(a.k.a. Prostaglandin synthetase-2; I can give
references
> > if any are interested). The signaling pathway (LH receptor, G protein,
> > adenylyl cyclase, cAMP production, etc.) are the same, but at some point
> > they do diverge. Patients with defects in one but not the other
pathway(s)
> > could luteinize, yet not ovulate and vice versa.
> >
> > Jeff
> > ----------
> >>From: Steve <Steve@dhngwe2.db.healthlink.org.za>
> >> The reason why progesterone levels are measured in investigating
fertility is
> >> that the follicle doesn't luteinise until LH (Luteotropic Hormone)
surges to
> >> produce ovulation. Without the LH surge there is no ovulation and
without
> >> ovulation there is no progesterone production because the follicle
doesn't
> >> luteinise. It is possible to have an "unruptured luteinised follicle"
> >> (so-called) but these are rare. I have always believed that ovulation
is an
> >> esssential prerequisite for progesterone production.
> >
> >>> From: "Jeffrey W. Clemens" <clemens@duq.edu>
> >>> Wouldn't progesterone levels prove luteinization and not ovulation?
> >>> Jeff
> >
> > Original poster lost to cut and paste
> >>> >> Progesterone - 53 (25-87 nmom/l) day 20
> >>> > The Progesterone level on day 20 proves ovulation despite what your
temp
> >
> > Jeffrey W. Clemens, Ph.D.
> > Assistant Professor, Biological Sciences
> > Duquesne University
> > Pittsburgh, PA 15282
> > 412-396-4597
> > fax-5907
> > http://www.home.cc.duq.edu/~clemens/
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 02:01:23 -0400
> ------------------------------
> From: "Rafael Haciski MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: TAH for no reason (was Re: OB:Cesarean for anencephaly)
> Message-ID: <199910130601.XAA07991@swan.prod.itd.earthlink.net>
> Mime-version: 1.0
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>
> If you do not understand why an informed consent may be of little help,
just
> talk to some lawyers, they will find creative ways, for example: "I did
not
> read the papers, just signed a bunch of papers that were placed before
me."
>
> I have been there, information properly given, consents obtained and forms
> signed, all to no avail. But we continue to get these consents because it
> is worse without them. Perhaps the only better method would be a
> video-taped consent session - but that is cumbersome, impractical and can
> also play against the physician is some minor ommission is demonstrated.
>
> And as far a time limit, they will move away from malpractice claim, and
try
> the "assault and battery" approach or other such twist, venturing into the
> criminal realm, while the hospital is brought in as the "negligent" deep
> pocket for allowing the MD to perform such "outrageous and criminal"
> activities.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Associates
> Baltimore MD
> http://www.ivf-md.com
>
> ----------
> >From: Paul Prior MD <pprior@earthlink.net>
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> >Subject: Re: TAH for no reason (was Re: OB:Cesarean for anencephaly)
> >Date: Tue, Oct 12, 1999, 18:34
> >
>
> > On Tue, 12 Oct 1999 15:50:58 -0500, "Ricardo Savaris"
> > <savaris@orion.ufrgs.br> wrote:
> >
> >>7 years later she found a incredible nice guy who wanted a baby.
> >>7.1 years later she sued the doctor for an unnecessary surgery. Informed
> >>consent did not count on this case...
> >
> > I don't see why informed consent should not be valid in this case.
> > This is a case of "cosmetic" surgery done for a patients request, not
> > due to a medical need. While I don't agree with doing it necessarily,
> > I don't see why it should be any different from any other cosmetic or
> > elective surgery.
> >
> > --
> > Paul Prior MD Get rebates on online purchases - up to 25% cash back.
> > Ashland, KY USA Including Disney,Borders,DVDexpress,800.com,Dell,
petstore
> > Using Spamkiller iBaby, etoys, JCrew,800-flowers,PlanetRX,Avon & many
more.
> > so spam away... try:
http://www.ebates.com/index.jhtml?referrer=pprior
> >
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 02:14:10 -0400
> ------------------------------
> From: "Rafael Haciski MD" <haciski@earthlink.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Women Want Pain Relief During Labor
> Message-ID: <199910130614.XAA26104@swan.prod.itd.earthlink.net>
> Mime-version: 1.0
> Content-type: text/plain; charset="US-ASCII"
> Content-transfer-encoding: 7bit
>
> jeepers, must be a real "slow news" day.
>
> I guess tomorrow they will tell us that Earth orbits around the Sun.
>
> Rafael Haciski, MD FACOG
> Gynecology & Infertility Associates
> Baltimore MD
> http://www.ivf-md.com
>
> ----------
> >From: "Geffrey Klein, MD" <gklein@icsi.net>
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
> >Subject: Women Want Pain Relief During Labor
> >Date: Tue, Oct 12, 1999, 12:03
> >
>
> > Tuesday October 12 9:31 AM ET
> >
> > Women Want Pain Relief During Labor
> >
> > By SUSAN PARROTT Associated Press Writer
> >
> > DALLAS (AP) - In about two weeks, Wendy McGahey is due to have her
third
> > child.
> >
> > But for the first time, she'll go to the hospital knowing what to
expect -
> > a relatively pain-free delivery, thanks to anesthesia.
> >
> > Like Mrs. McGahey, more women are opting for pain relief during labor
and
> > delivery. Doctors say they have refined painkilling techniques, and
women
> > are feeling less pressure from society to tough out the pain.
> >
> > Researchers at the University of Colorado School of Medicine found that
in
> > large hospitals, the use of regional anesthesia - epidurals and other
> > spinal techniques - tripled from 22 percent in 1981 to 66 percent in
1997.
> >
> > Mrs. McGahey said that when she went into labor five years ago with her
> > first son, she decided against anesthesia - until it was too late to
change
> > her mind.
> >
> > ``My biggest fear was getting a needle in my back,'' she said. But
before
> > long, ``they could have put a pitchfork in my back. It was intense
misery
> > and I couldn't see an end in sight.''
> >
> > Two years later, the Hurst, Texas, woman entered the hospital to give
> > birth again, and wary from her first delivery, asked for an epidural.
> >
> > ``It was instant euphoria,'' she said. ``There was no pain. And when
the
> > baby came I felt rested.''
> >
> > Mrs. McGahey, 28, said the experience was so enjoyable that she has no
> > fears about giving birth to her next child - due on Halloween.
> >
> > ``This time I'm not afraid,'' she said.
> >
> > The survey results, gathered from 750 hospitals around the nation, were
to
> > be presented in Dallas today during the annual meeting of the American
> > Society of Anesthesiologists.
> >
> > The survey found that in midsize hospitals, those with between 500 and
> > 1,499 births per year, 55 percent of women opted fo regional anesthesia
in
> > 1997, compared with 13 percent in 1981.
> >
> > A huge increase was also reported at hospitals with fewer than 500
births
> > per year. The percentage of women receiving regional anesthesia went
from 9
> > percent in 1981 to 42 percent in 1997, the survey found.
> >
> > Dr. Joy L. Hawkins, who led the research, said the increase at small
> > hospitals partly can be attributed to an increased number of
> > anesthesiologists on staff in obstetrical units. In the past, some
> > obstetricians provided anesthesia.
> >
> > Many patients in the survey also opted for narcotics to ease the pain
> > during labor and delivery, she said.
> >
> > Only 11 percent of obstetrical patients at large and midsize hospitals
> > opted for no analgesia of any kind in 1997. In small hospitals, 17
percent
> > of women had no pain relief.
> >
> > But some doctors and mothers-to-be believe epidurals and other
> > pain-relievers greatly raise the chances of a Caesarean section by
slowing
> > labor and inhibiting the mother's ability to push.
> >
> > Amy Miller, a certified birthing assistant, or doula, says her clients
> > ``have a strong belief in the natural process.''
> >
> > ``They believe it's safer for their babies and safer for them,'' she
said.
> >
> > Childbearing techniques like Lamaze and the Bradley method first gained
> > popularity in the 1960s and 1970s, advocating relaxation techniques and
> > abdominal breathing to ease pain.
> >
> > Ms. Hawkins said medical advances have made anesthesia safer. The
> > development of ultrafine needles reduces the incidence of headaches to
less
> > than 1 percent, she said.
> >
> > ``We have better needles and better drugs. We can provide pain relief
> > where you can still walk around.''
> >
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 02:29:06 -0400
> ------------------------------
> From: "Chris Roberts" <chrisroberts@mindspring.com>
> To: ob-gyn-l@obgyn.net
> Subject: American Academy of Pediatrics Policy Statements (Baby Doe, etc.)
> Message-ID: <199910130633.CAA19012@smtp7.atl.mindspring.net>
> MIME-Version: 1.0
> Content-type: text/plain; charset=US-ASCII
> Content-transfer-encoding: 7BIT
>
> American Academy of Pediatrics Policy Statements
>
> http://www.aap.org/policy/01460.html
>
> Ethics and the Care of Critically Ill Infants and
> Children (RE9624)
>
> http://www.aap.org/policy/01093.html
>
> Perinatal Care at the Threshold of Viability
> (RE9541)
>
> http://www.aap.org/policy/00921.html
>
> The Initiation or Withdrawal of Treatment for
> High-Risk Newborns (RE9532)
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 04:49:32 -0700
> ------------------------------
> From: "Dan Logen" <pdl@whidbey.net>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: endometriosis and polycystic ovaries
> Message-ID: <199910131134.EAA01419@islander.whidbey.net>
> MIME-Version: 1.0
> Content-Type: text/plain; charset=ISO-8859-1
> Content-Transfer-Encoding: 7bit
>
> > > How do the listmembers feel about starting patients on Premarin after
> TAH/BSO
> > > for endometriosis.
> >
>
> I also start immediately post op. Estrogen can always be discontinued
> later if there is suspicion of activation of endometriosis.
>
> Dan Logen
> Private Practice OB-GYN
> Mt. Vernon, WA
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 08:11:28 EDT
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: TAH for no reason (was Re: OB:Cesarean for anencephaly)
> Message-ID: <0.91866f35.2535d0f0@aol.com>
> MIME-Version: 1.0
> Content-Type: text/plain; charset="us-ascii"
> Content-Transfer-Encoding: 7bit
>
> In a message dated 10/13/99 1:03:23 AM, haciski@earthlink.net writes:
>
> << And as far a time limit, they will move away from malpractice claim,
and
> try
> the "assault and battery" approach or other such twist, venturing into the
> criminal realm, while the hospital is brought in as the "negligent" deep
> pocket for allowing the MD to perform such "outrageous and criminal"
> activities. >>
>
> Well, here in Louisiana this is pretty much a dead issue. The State
Supreme
> Court effectively destroyed the "medical battery" angle on these kind of
> suits. In fact, if an doctor actually DID do something bad to a patient on
> purpose, he'd probably get off with only the malpractice ruling, which has
a
> cap of $100,000 for him and another $400,000 for the Patients'
Compensation
> Fund. It's scary in the reverse.
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 08:12:14 EDT
> ------------------------------
> From: DoctorJoe@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: FRI Women Want Pain Relief During Labor
> Message-ID: <0.706efba9.2535d11e@aol.com>
> MIME-Version: 1.0
> Content-Type: text/plain; charset="us-ascii"
> Content-Transfer-Encoding: 7bit
>
> In a message dated 10/13/99 1:15:15 AM, haciski@earthlink.net writes:
>
> << jeepers, must be a real "slow news" day.
>
> I guess tomorrow they will tell us that Earth orbits around the Sun. >>
>
> Well, actually it only does in a relative sense. They both are... Oh never
> mind. It's not THAT slow today.
>
> Joe P.
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 10:54:05 -0400
> ------------------------------
> From: Mark Perloe <mperloe@ivf.com>
> To: ob-gyn-l@obgyn.net
> Subject: Re: endometriosis and polycystic ovaries
> Message-ID: <4.2.0.58.19991013105039.009910d0@pop.mindspring.com>
> Mime-Version: 1.0
> Content-Type: text/plain; charset="us-ascii"; format=flowed
>
> At 10/12/99 09:17 PM , you wrote:
> > >The patient is upset, stopped her hormones and now maintains I should
> > have never
> > >done her surgery and should have never started her on hormone therapy.
>
> I frequently see women who present with recurrent endometriosis after
> TAH-BSO who when estrogen only HRT is switched to prempro, or
discontinued,
> have experienced dramatic relief in symptoms. The problem with the present
> SERM's is that while they will spare bone and avoid endometrial
> stimulation, the menopausal flush may actually be increased compared to no
> therapy. Tibulone, available in Europe as Livial, seems to be well
> tolerated and effective in these patients. Zeneca has a new SERM
undergoing
> European trials that avoids endometrial stimulation, yet provides
> symptomatic relief.
> Mark Perloe, M.D. http://www.ivf.com 404-265-3662
> 285 Boulevard NE, Suite 320, Atlanta GA 30312
> Online Chat Monday Evenings 8-9:30pm ET http://www.ivf.com/chat.html
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 10:30:24 +0000
> ------------------------------
> From: "Geffrey Klein, MD" <gklein@icsi.net>
> To: ob-gyn-l@obgyn.net, ob-gyn-l-two@onelist.com
> Subject: BMI May Predict C-Section Risk
> Message-ID: <v03007800b42a0f695117@[208.2.63.38]>
> Mime-Version: 1.0
> Content-Type: text/plain; charset="us-ascii"
>
> Tuesday October 12 7:05 PM ET
>
> BMI May Predict C-Section Risk
>
> By SUSAN PARROTT Associated Press Writer
>
> DALLAS (AP) - Though doctors have long known that obese women have
> difficult pregnancies, a pregnant woman's risk for a Caesarean section can
> now be predicted by determining her body mass index, a ratio of weight to
> height.
>
> Knowing a patient's BMI would allow an anesthesiologist to prepare early
> and more safely for the possibility of an emergency Caesarean, according
to
> researchers who presented the study Tuesday at the annual meeting of the
> American Society of Anesthesiologists.
>
> In the general population, a BMI of 30 or more is considered obese -
> roughly a person who is 5-feet-1 and weighs 158 pounds. No BMI standards
> have been set for pregnant women.
>
> A survey of 2,500 women who delivered babies at Duke Medical Center found
> that mothers who had C-sections had an average BMI of 53 at the time of
> delivery, compared to a BMI of 31 for those who had vaginal deliveries.
>
> While the BMI varied greatly, the average weight of patients ranged only
> from 191 pounds for patients that had C-sections to 182 for those with
> normal deliveries.
>
> ``Weight is not the best description of obesity. Tall people can weigh
> more than short people without being obese,'' she said.
>
> Those with a BMI of 40 or more at the time of delivery are considered at
> greatest risk for Caesareans, said lead researcher Dr. Elizabeth Bell.
>
> Knowing there was a greater risk would allow an anesthesiologist to
> prepare for an emergency C-section by inserting an epidural catheter into
> the patient's back so regional anesthesia could be administered quickly.
> Regional anesthesia generally is considered safer than general anesthesia
> for obese women, whose airways can become obstructed by excess fat tissue.
>
> Overweight pregnant women are at greater risk of gestational diabetes and
> tend to have larger babies. Fat tissue also can hinder the baby's ability
> to pass through the birth canal, Bell said.
>
> The study found that 98 percent of women with a BMI of 60 or greater had
a
> C-section, while none of the women with a BMI of 20 or less had a
> C-section.
>
> The rate was 0.3 percent for women with a BMI of 21 to 30, 32 percent
with
> a BMI of 31 to 40, 78 percent with a BMI of 41 to 50, and 94 percent with
a
> BMI of 51 to 60.
>
> Of the 2,500 deliveries studied, about one-third, or 833, were
C-sections.
>
> Body mass index gives obstetricians another tool, though doctors already
> knew that overweight women have more difficult deliveries, said Dr. Ron
> Ramus, who was not involved in the study.
>
> About 20 to 25 percent of U.S. pregnancies end up in Caesarean sections,
> said Ramus, the assistant professor of obstetrics and gynecology at the
> University of Texas Southwestern Medical Center.
>
> Ramus said that doctors don't recommend dieting for pregnant women but
> those already overweight should be careful not to gain even more weight
> during pregnancy.
>
> In another study released Tuesday, researchers found that the percentage
> of women getting regional anesthesia during childbirth has tripled since
> 1981 at the nation's busiest hospitals, and quadrupled at small and
midsize
> hospitals.
>
> Epidurals and spinal analgesia were received by 66 percent of women who
> delivered in 1997 at hospitals with at least 1,500 deliveries a year, up
> from 55 percent in 1992 and 22 percent in 1981.
>
> Researchers from the University of Colorado School of Medicine in Denver
> studied 750 U.S. hospitals. They attributed the increase to better drugs
> and new technology.
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 13:30:58 -0300
> ------------------------------
> From: Dib Abdalla Chacur <chacur@rol.com.br>
> To: ob-gyn-l@obgyn.net
> Subject: Re: breast cancer in pregnant women
> Message-ID: <3804B3C2.F8328440@rol.com.br>
> MIME-Version: 1.0
> Content-Type: text/plain; charset=iso-8859-1
> Content-Transfer-Encoding: 8bit
>
> Gabriela Torres Cerino wrote:
>
> > Nice to meet you: My name is Gabriela Torres Cerino,I'm argentine, I'm
> > 26 and I got my degree in medicine last year.
> > I contact you because I'm writting a monography about breast cancer in
> > pregnant women and I would apreciate any help from you.
> > Sorry if my request is not formal but this is the first time I do this.
> > Thank you.
> > Dr. Torres Cerino.
>
> Dear colleague Gabriela,
>
> 1. I had15 days ago a patient with breast cancer, 35 y. o., with 16 weeks
> of pregnacy. It was a T3N1M0 ( stage III ).
>
> 2. In stage III I usually do Qt pre-op., after that I do a radical
modified
> mastectomy (Patey ), and after the surgery Qt again and Irradiation.
>
> 3. In this case I have decided to do first surgery( during the surgery I
> saw that the tumor infiltrated the pectoralis major, and then I had to do
a
> Halsted surgery). Macroscopically there was several axillar linfonodes
with
> metastasis.
> I did not receive yet the histopathology.
>
> 4. The pregnancy, BY ITSELF, does not worsen the prognostic of breast
> cancer. In fact, these cases have a bad prognostic due the age of the
> patient. As you know, in this age breast cancer is more agressive, and has
> bad prognostic factors.
>
> 5. I will talk with the patient about Qt in third trimester.
>
> What is your opinion?
> Do you agree with me?
> What think the members of the list ?
> Best regards
> Dib
>
> --
> DIB ABDALLA CHACUR
> Gynecology - Mastology
> Teacher of Gynecology and Head of Gynecology and Obstetrics Dpto.
> CAMPOS SCHOOL OF MEDICINE
> Campos - RJ - Brazil
>
> chacur@rol.com.br
>
> Rua Barão de Miracema, 237
> Fone (024) 7231759
> Campos, RJ
> Brazil
> CEP 28.030-360
>
> CLÍNICA FEMINA
> Rua Ovidio Manhães,127
> Fone (024) 7332424
> Fax (024) 7330361
> Campos, RJ
> Brazil
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 11:09:09 -0500 (CDT)
> ------------------------------
> From: jhellrie@pce.net (J. Hellriegel)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: BMI May Predict C-Section Risk
> Message-ID: <199910131609.LAA04448@talk.obgyn.net>
>
> Does BMI predict size of baby, size of pelvis?
> --
>
> At Wed, 13 Oct 1999, Geffrey Klein, MD wrote:
> >
> >Tuesday October 12 7:05 PM ET
> >
> > BMI May Predict C-Section Risk
> >
> > By SUSAN PARROTT Associated Press Writer
> >
> > DALLAS (AP) - Though doctors have long known that obese women have
> >difficult pregnancies, a pregnant woman's risk for a Caesarean section
can
> >now be predicted by determining her body mass index, a ratio of weight to
> >height.
> >
> > Knowing a patient's BMI would allow an anesthesiologist to prepare early
> >and more safely for the possibility of an emergency Caesarean, according
to
> >researchers who presented the study Tuesday at the annual meeting of the
> >American Society of Anesthesiologists.
> >
> > In the general population, a BMI of 30 or more is considered obese -
> >roughly a person who is 5-feet-1 and weighs 158 pounds. No BMI standards
> >have been set for pregnant women.
> >
> > A survey of 2,500 women who delivered babies at Duke Medical Center
found
> >that mothers who had C-sections had an average BMI of 53 at the time of
> >delivery, compared to a BMI of 31 for those who had vaginal deliveries.
> >
> > While the BMI varied greatly, the average weight of patients ranged only
> >from 191 pounds for patients that had C-sections to 182 for those with
> >normal deliveries.
> >
> > ``Weight is not the best description of obesity. Tall people can weigh
> >more than short people without being obese,'' she said.
> >
> > Those with a BMI of 40 or more at the time of delivery are considered at
> >greatest risk for Caesareans, said lead researcher Dr. Elizabeth Bell.
> >
> > Knowing there was a greater risk would allow an anesthesiologist to
> >prepare for an emergency C-section by inserting an epidural catheter into
> >the patient's back so regional anesthesia could be administered quickly.
> >Regional anesthesia generally is considered safer than general anesthesia
> >for obese women, whose airways can become obstructed by excess fat
tissue.
> >
> > Overweight pregnant women are at greater risk of gestational diabetes
and
> >tend to have larger babies. Fat tissue also can hinder the baby's ability
> >to pass through the birth canal, Bell said.
> >
> > The study found that 98 percent of women with a BMI of 60 or greater had
a
> >C-section, while none of the women with a BMI of 20 or less had a
> >C-section.
> >
> > The rate was 0.3 percent for women with a BMI of 21 to 30, 32 percent
with
> >a BMI of 31 to 40, 78 percent with a BMI of 41 to 50, and 94 percent with
a
> >BMI of 51 to 60.
> >
> > Of the 2,500 deliveries studied, about one-third, or 833, were
C-sections.
> >
> > Body mass index gives obstetricians another tool, though doctors already
> >knew that overweight women have more difficult deliveries, said Dr. Ron
> >Ramus, who was not involved in the study.
> >
> > About 20 to 25 percent of U.S. pregnancies end up in Caesarean sections,
> >said Ramus, the assistant professor of obstetrics and gynecology at the
> >University of Texas Southwestern Medical Center.
> >
> > Ramus said that doctors don't recommend dieting for pregnant women but
> >those already overweight should be careful not to gain even more weight
> >during pregnancy.
> >
> > In another study released Tuesday, researchers found that the percentage
> >of women getting regional anesthesia during childbirth has tripled since
> >1981 at the nation's busiest hospitals, and quadrupled at small and
midsize
> >hospitals.
> >
> > Epidurals and spinal analgesia were received by 66 percent of women who
> >delivered in 1997 at hospitals with at least 1,500 deliveries a year, up
> >from 55 percent in 1992 and 22 percent in 1981.
> >
> > Researchers from the University of Colorado School of Medicine in Denver
> >studied 750 U.S. hospitals. They attributed the increase to better drugs
> >and new technology.
>
> --
> John Hellriegel, Jr., MD, PhD
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 13 Oct 1999 10:59:56 -0500
> ------------------------------
> From: Gail Waldby <gwaldby@willinet.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: breast cancer in pregnant women
> Message-ID: <3804AC7C.7388630@willinet.net>
> MIME-Version: 1.0
> Content-Type: text/plain; charset=iso-8859-1
> Content-Transfer-Encoding: 8bit
>
> I usually and I think this is the common approach in the US, only resect
> the apparently involved pectoralis muscle with an adequate rim of
> apparently normal muscle, instead of removing the entire pectoral
> muscles.
>
> Chemotherapy has been given during pregnancy, except I think for
> alkylating agents, which are contraindicated. (I may have the wrong
> agent here, so check this.) Of course, there may always be effects on
> the baby, but it is within the standard of care to give chemo needed by
> the mother, except for the class of agents above.
>
> For a better discussion of these issues, see Bland and Copeland's 2
> volume set of Breast Cancer books published last year or early this
> year--wel worth reading--I just finished them this summer.
> Gail Waldby, MD
> Huron Clinic SD
>
> Dib Abdalla Chacur wrote:
> >
> > Gabriela Torres Cerino wrote:
> >
> > > Nice to meet you: My name is Gabriela Torres Cerino,I'm argentine, I'm
> > > 26 and I got my degree in medicine last year.
> > > I contact you because I'm writting a monography about breast cancer in
> > > pregnant women and I would apreciate any help from you.
> > > Sorry if my request is not formal but this is the first time I do
this.
> > > Thank you.
> > > Dr. Torres Cerino.
> >
> > Dear colleague Gabriela,
> >
> > 1. I had15 days ago a patient with breast cancer, 35 y. o., with 16
weeks
> > of pregnacy. It was a T3N1M0 ( stage III ).
> >
> > 2. In stage III I usually do Qt pre-op., after that I do a radical
modified
> > mastectomy (Patey ), and after the surgery Qt again and Irradiation.
> >
> > 3. In this case I have decided to do first surgery( during the surgery I
> > saw that the tumor infiltrated the pectoralis major, and then I had to
do a
> > Halsted surgery). Macroscopically there was several axillar linfonodes
with
> > metastasis.
> > I did not receive yet the histopathology.
> >
> > 4. The pregnancy, BY ITSELF, does not worsen the prognostic of breast
> > cancer. In fact, these cases have a bad prognostic due the age of the
> > patient. As you know, in this age breast cancer is more agressive, and
has
> > bad prognostic factors.
> >
> > 5. I will talk with the patient about Qt in third trimester.
> >
> > What is your opinion?
> > Do you agree with me?
> > What think the members of the list ?
> > Best regards
> > Dib
> >
> > --
> > DIB ABDALLA CHACUR
> > Gynecology - Mastology
> > Teacher of Gynecology and Head of Gynecology and Obstetrics Dpto.
> > CAMPOS SCHOOL OF MEDICINE
> > Campos - RJ - Brazil
> >
> > chacur@rol.com.br
> >
> > Rua Barão de Miracema, 237
> > Fone (024) 7231759
> > Campos, RJ
> > Brazil
> > CEP 28.030-360
> >
> > CLÍNICA FEMINA
> > Rua Ovidio Manhães,127
> > Fone (024) 7332424
> > Fax (024) 7330361
> > Campos, RJ
> > Brazil
>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 606
> ------------------------------
> **************************
