Re: uterine cysts--Dr. Lyons
From: E.A.Lyons (lyons@Ms.UManitoba.CA)
Sat Feb 16 11:50:00 2002
James et al,
Thanks for your support for the clinical component to the sonogram. You
verbalized exactly what I have been trying to put together for the last few
days. Thank you. I hope others will also begin, or cortinue to assess their
patients using all available information, the physical, lab data AND the
sonogram. The diagnosis is best made with all three and NOT with one alone
or in isolation.
Ted
>----- Original Message -----
From: "James S Smeltzer MD" <gaperina@mindspring.com>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Saturday, February 16, 2002 12:22 PM
Subject: Re: uterine cysts--Dr. Lyons
> Hi,
>
> I know your theory sounds correct, but it is clearly not the result of the
> complete evaluation of thousands of pelvic pain patients like Dr. Lyons.
>
> The observation of tenderness of adenomyosis is also what I have observed
> in dozens of patients with this condition proven on pathological
evaluation
> of hysterectomy. I have trained my sonographers to note tenderness at all
> times but especially in the evaluation of pelvic pain patients. What
hurts
> points to the pathology.
>
> BTW the normal vagina with an uninflamed peritoneal surface and no pelvic
> pathology is virtually NEVER tender to mild or moderate pressure with the
> vaginal probe.
>
> BTW the observation of tenderness is objective data. Asking for the
> patient's help is both appropriate care and good medicine. In general
> medical diagnoses are most likely to be correct when they are based of the
> entire available clinical data. The identification of pain and
tenderness,
> and WHAT is painful and what is tender is overwhelmingly useful in the
> proper clinical diagnosis of conditions in EVERY part of the body,
> especially in the pelvis.
>
> An experienced sonologist is probably somewhat better than an experienced
> gynecologist in identifying the exact source of tenderness. It is not
> optimal practice (IMHO) NOT to provide this vital information to the
> managing physician.
> ;^)
> Jim Smeltzer
>
> At 12:49 AM 2/5/2002 -0600, you wrote:
> > Dear Edward and all, uterine endometriosis by pressing upon pelvic
> >organs with the endovaginal probe is just not serious.. inflamed
> >and affect the feedback. Second, this reaction also depends upon the
> >irritation particularities of the pelvic nervous plexus. Vegetative
> >response might be painful all right in other diseases, also in normal
> >uterus. result of the test in question is also a function of the
highest
> > nervous system, and psychological state of the patient adds a lot to
the
> >final reaction upon the pressure. That is why, extent of the
endometrial
> >foci and dimension of cysts and fibrisis within endometrium does not
have
> >a strict direct relation to the complaints. these have evident signs
> >of endometriosis at echo. compose our diagnosis upon the image. It
> >is objective. of that pressure on the pelvic viscera. Anatoly
> >Garkusha, sonologist. Kiev. Ukraine.
>
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