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Re: Lawson: It ain't there till it ain't there..... From: James S Smeltzer MD (gaperina@mindspring.com) Mon Aug 31 05:56:03 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Todd Moyers: "Re: "patient seeing exam"" Previous message: James S Smeltzer MD: "Re: Lawson: Hysterosonography....." In reply to: MARK LAWSON: "Lawson: It ain't there till it ain't there....." Mark, I'm with you on the 10-12 & 18-20, as these are predictive of severe problems not otherwise detectable. Save the third trimester for those that fail the test of the tape, except in the fat. You are quite correct. IMHO 24 is a bit early to be detecting lissencephaly as an isolated thing. The rich sulcal / gyral pattern is not apparent until 30-36 weeks when it gets very impressive. I am about to look at the films of the first Tri-18 or 13 missed under my supervision in 15 years, with a little dread. The baby had classical signs, including a large VSD, IUGR, the fist & fingers, oligo, low-set malformed ears, micrognathia, webbed neck, unilateral cleft lip, chromosomes pending. Not done by me but signed off. Humbled by a 3# stillborn baby...Jim Smeltzer MD At 11:23 PM 8/27/1998 -0500, you wrote: >LOL..... Jim.... I've had one of those "oh my god, I missed what?" >episodes >Normal looking baby at birth.... dx'ed with Lissencephaly.... What.... >??? Well I'll be darn there it is in most of the books......chrome >dome... no sulci.... yikes.... I took the neuro registry but to tell you >the truth until that baby I never really checked off on fetal sulci..... >you know what I mean???.... Since I read about the exopthalmia case that >the baby had no eye balls, just the sockets, I never really checked off >on the lens before that time.....Now I do.... and now we're suppossed >to be seeing abnomal fetal adrenals.... yikes oh mighty.... I'm still >miffed that someone published fetal horshoe kidneys before me..... (I'm >still looking for my first case) > >So anywho....the sequela with the lissencephaply is similar to the corpus >thang.... it ain't there till it ain't there.... which in this case is >about 24 -26 weeks.... thank god I only saw her once at 17 weeks.... I >hate missing something I don't know about more than I hate missing >something I do know about. dig?? > >About seeing patients at 10-14 weeks... I think it should be routine.... >but so should the 18-22 week scan..... and of course we need the third >trimester scan to R/O the most common of problems...... IUGR.... So >in a capitated system..... three scans....ummmmmm 1000 births a >year..... What price dear sonographers do I charge the insurance >companies.... for that contract...... gotta scan... > >Mark the Lawson, > >Texas America...... > >PS..... what is with the candanian dollar these days ???? > >Or call Juno at (800) 654-JUNO [654-5866] > Next message: Todd Moyers: "Re: "patient seeing exam"" Previous message: James S Smeltzer MD: "Re: Lawson: Hysterosonography....." In reply to: MARK LAWSON: "Lawson: It ain't there till it ain't there....."

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