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Re: clinical problem From: art fougner, md (evsono@pipeline.com) Wed Jan 6 09:57:33 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Ultrasound or menstrual dating" Previous message: Ann Polin: "Re: clinical problem" In reply to: Natalie Sohn: "clinical problem" Next in thread: DuBose, Terry: "Re: clinical problem" Hi! first, a question - what was sampled in a pap smear in a patient whose cervix was pushed so far anteriorly that it cannot be visualized on speculum exam? ok, so first get a sono - both TA and TV views. My money's on fibroid - either post lower segment or even a retroverted uterus with an anterior fibroid. with her inaccessible cervix, a sonohysterogram is out of the question. if no bleeding, however, would not pursue this at this time. if the sono is inconclusive, then evaluate the lower bowel. still gotta treat patients according to clinical judgment, NOT insurance dictates. my feeling is that further pre-op w/u would be essential and that surgery not indicated at present time. good luck and happy new year! art At Tue, 5 Jan 1999, Natalie Sohn wrote: > >I would like to hear some expert opinion on the following case: >64 year old post menopausal female in good health getsreferred by her >primary care doc ( actually the nurse practitioner) for post menopausal >spotting. Pap, mammo all normal. My exam reveals a mass which >displaces the cervix way upward ( you cant visualize it at all with the >speculum--and endo biopsy is impossible. Rectal exam reveals the mass ( >and/or uterus?) above the rectum and shes guiac neg. There is no >ascities and ca125 is wnl. The radiologist wanted me to order a ct scan >but I dont feel this is necessary since this most likely uterine or >ovarian neoplasm clearly needs to come out.(Ido these cases with a >gyn-onc who can stage these tumors adequately.)I am not sure if this is >malignat or benign. r/o colon tumor ?-although this seems highly >unlikely. My one reservation about ordering these tests is that the the >hmo medical directors might delay my case ruling out distant spread when >none exists. ( such a thing happened recently to me and there was a 4 >week delay-- that woman had ovarian cancer. Any insights? My point here >is how would additional testing in this case alter management? > >-- >nsohn > -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: art fougner, md: "Re: Ultrasound or menstrual dating" Previous message: Ann Polin: "Re: clinical problem" In reply to: Natalie Sohn: "clinical problem" Next in thread: DuBose, Terry: "Re: clinical problem"

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