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Bloopers, bags, and pessaries.

Longtime readers of this column know that, in addition to clinical pearls, we may sometimes include clinical "bloopers." Bloopers are humorous grammar or spelling errors that occasionally occur in transcriptions. They also pop up at times when using voice-recognition or spelling-checker software. This month's column offers both laughs and learning--two bloopers and three clinical pearls. I hope you enjoy them!

Testicle Blooper

Dr. Charles Hermes of Bloomfield Hills, Mich., is retired, but several years ago, he delivered a male infant with some minor genital issues. Eventually, he saw a note that documented that the little fellow had undergone an operation to correct an "undefended" left testicle. Dr. Hermes wondered what type of operation was required.

Gender Blooper

Jennifer Hepp, D.O., of Littleton, Colo., uses an electronic medical records system. She tried to document the fact that her patient had been "counseled regarding osteopenia," but the system typed out that her patient had been, "counseled regarding osteopenis." I don't think I'll comment on this one!

'Stack Pack' Pessary

Dr. Bruce L Hilger of Marysville, Calif,, sent us a pearl on vaginal hysterectomy that we published about 4 years ago. Now, he has come up with something I've never heard of before. He has been in practice for about 40 years and has a vast amount of experience using pessaries for relief of pelvic organ prolapse. He recently had several ring pessary failures and that gave him the interesting idea of putting in two pessaries. He chooses the ring size that is the best fit for the patient and then uses one size smaller to be the bottom of the pair. Dr. Hilger says these elderly patients are happy with the "stack pack" and none have had to go to surgery. Has anyone else ever heard of this?

It's in the Bag

Dr. Michael J. Wolpmann of Venice, Fla., has a trick that he "learned through exasperation." When performing laparoscopic surgery and using an endoscopic bag for specimen retrieval, he occasionally experienced equipment failure, that is, the bag is inserted through the port but will not unfold, no matter what you try. To avoid removing and ruining the expensive bag device and starting over, he devised a true "solution." Next time this happens to you, grab your suction irrigator and fill the bag with saline, which will expand it nicely. Then suction the saline out of the bag and use it as intended.

Leak Technique

Dr. Mark P. Trolice of Winter Park, Fla., is a reproductive endocrinologist who has performed many office hysteroscopies with a 2- to 3-mm diameter flexible tip. When a woman has a parous cervix, distension of the uterine cavity becomes challenging because of leakage at the os. His pearl is to place a ring forceps vertically across the external os and gently squeeze as the scope is intrauterine. Distension improves, allowing adequate visualization. Mark also recommends that a hys-teroscopy should be performed during cycle days 6-12 when the endometrium is more optimal or anytime if your patient is on oral contraceptives.

BY BRUCE L. FLAMM, M. D.

Dr. Flamm is clinical professor of obstetrics and gynecology at the University of California, Irvine, and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif.
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Title Annotation:CLINICAL PEARLS
Author:Flamm, Bruce L.
Publication:OB GYN News
Date:May 15, 2008
Words:539
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