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Biomedical subjects

A Bar-Am

Publications and source records attributed to A Bar-Am.

At least 19 recordsLinked to original sources
PubMed1999

Increased frequency of genetic thrombophilia in women with complications of pregnancy.

BACKGROUND: Obstetrical complications such as severe preeclampsia, abruptio placentae, fetal growth retardation, and stillbirth are associated with intervillous or spiral-artery thrombosis and inadequate placental perfusion. Whether these complications are associated with an increased frequency of thrombophilic mutations is not known. METHODS: We studied 110 women who had one of the above-mentioned obstetrical complications and 110 women who had one or more normal pregnancies. The women were tested several days after delivery for the mutation of guanine to adenine at nucleotide 1691 [corrected] in the factor V gene (factor V Leiden), the mutation of cytosine to thymine at nucleotide 677 in the gene encoding methylenetetrahydrofolate reductase, and the mutation of guanine to adenine at nucleotide 20210 in the prothrombin gene. Two to three months after delivery the women were tested for deficiency of protein C, protein S, or antithrombin III and for the presence of anticardiolipin antibodies. RESULTS: The mutation at nucleotide 1691 [corrected] in the factor V gene was detected in 22 of the women with obstetrical complications and in 7 of the women with normal pregnancies (20 percent and 6 percent, respectively; P=0.003). Twenty-four women with complications, as compared with nine women without complications, were homozygous for the C677T mutation in the gene encoding methylenetetrahydrofolate reductase (22 percent and 8 percent, respectively; P=0.005). The G20210A mutation in the prothrombin gene was found in 11 women with complications as compared with 3 women without complications (10 percent and 3 percent, respectively; P=0.03). Overall, 57 women with obstetrical complications had a thrombophilic mutation, as compared with 19 women with normal pregnancies (52 percent and 17 percent, respectively; P<0.001). Deficiency of protein S, protein C, or antithrombin III or anticardiolipin antibodies were detected in an additional 14 women with complications, as compared with 1 woman with a normal pregnancy (13 percent and 1 percent, respectively; P<0.001). CONCLUSIONS: Women with serious obstetrical complications have an increased incidence of mutations predisposing them to thrombosis and other inherited and acquired forms of thrombophilia.

Abruptio Placentae↗
PubMed1999

Phase II study of carboplatin and etoposide as salvage treatment for patients with metastatic breast cancer.

A phase II study of carboplatin and etoposide as salvage polychemotherapy in metastatic, infiltrating breast carcinoma was carried out with 25 multiply pretreated patients. Six of 25 patients (24%) had a partial response that lasted an average of 3.5 months; of the six responders, four had undergone either four or five previous chemotherapeutic treatments. Eight of 25 patients (32%) had stable disease, and 11 (44%) manifested disease progression. The median survival from time of entry to the salvage protocol was 8 months. There were treatment responses in lung, chest wall, liver, and skeleton. The most common side effects were leukopenia (68% of 25 patients), thrombocytopenia (56%), anemia (40%), fever (28%), and weakness (16%). Carboplatin combined with etoposide may be an effective and tolerable salvage regimen in advanced breast cancer.

Adult↗
PubMed1998

Does typing of human papillomavirus assist in the triage of women with repeated low-grade, cervical cytologic abnormalities?

OBJECTIVE: To evaluate the ability of testing for high-risk human papillomavirus (HPV) using the hybrid capture technique to detect cervical intraepithelial neoplasia (CIN) in patients with repeated low-grade cervical cytologic abnormalities and an adequate and normal colposcopy. METHODS: Hybrid capture testing and LEETZ were performed on 166 women with repeated low-grade cervical cytologic abnormalities who were referred for colposcopy which was to be adequate and normal. RESULTS: A highly significant correlation (P < 0.0001) was found between a positive test for high-risk HPV types and the finding of CIN II,III. In 67 women with atypical squamous cells of undetermined significance on repeated cytologic studies, a positive test for high-risk HPV types had a sensitivity and specificity of 90 and 96.5%, respectively, for detecting CIN II,III. In 99 patients with low-grade squamous intraepithelial lesions found on repeated cytologic study, a positive test for high-risk HPV types identified all patients as having CIN II,III on cone biopsy (sensitivity, 100%), with a specificity of 86.4%. Restriction of tissue sampling to women who were positive for high-risk HPV types would have reduced the number of tissue samplings performed to 20.4%, while identifying 20 of 21 patients with biopsy-confirmed CIN II, III. CONCLUSION: A positive hybrid capture test for high-risk HPV types is highly sensitive and specific for detecting CIN II,III in patients with repeated low-grade cervical cytologic abnormalities and an adequate and normal colposcopy and may be used in the triage of these women before performing tissue sampling.

Adolescent↗
PubMed1998

Breech delivery: the value of X-ray pelvimetry.

OBJECTIVE: The study was conducted to compare maternal and neonatal outcome of two groups of nulliparae with breech presentations, who were selected for vaginal delivery by protocols differing only in their use of X-ray pelvimetry. STUDY DESIGN: We reviewed all term singleton breech deliveries of nulliparous patients who were eligible for vaginal trial of labour in our Centre between 1992 and 1994. In Group A (n=85) X-ray pelvimetry was performed, and in Group B (n=70) it was not. Obstetric management was otherwise similar. Admission to the two departments was on alternate days. RESULTS: The rate of caesarean section was similar in both groups (Group A, 36.4% vs. Group B, 42.8%; P>0.05), however, the indications for caesarean section differed. Neonatal outcome was similar in both groups. Maternal febrile morbidity was higher in Group B patients, especially those who underwent caesarean section after a trial of labour. CONCLUSION: X-ray pelvimetry in nulliparae with breech presentation is associated with reduced maternal febrile morbidity, but does not improve neonatal outcome.

Birth Injuries↗
PubMed1998

Can labor with breech presentation be induced?

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Adult↗
PubMed1998

The role of routine pelvic lymph node sampling in patients with stage I endometrial carcinoma: second thoughts.

BACKGROUND AND METHODS: The cases of 245 patients diagnosed during 1980-1989 with stage I endometrial carcinoma were retrospectively reviewed in order to assess the contribution of lymph node sampling (LNS) to both course of treatment and outcome. The 183 women treated by gyneco-oncologic surgeons had undergone the standard surgical procedure of total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) and pelvic lymph node sampling (LNS). Sixty-two other women, treated by gynecologists, received only TAH and BSO. Of women who had received TAH+BSO+LNS, 105 (57.4%) were referred for adjuvant radiotherapy on the basis of one or any combination of high grade histology (G2 or G3), myometrial invasion to a depth of 50% or more and LNS positivity. Of the group who had not had LNS, 37 (59.7%) likewise received adjuvant radiotherapy but on the bases of histology and/or depth of invasion. RESULTS AND CONCLUSIONS: Recurrence and survival over a mean follow-up period of 7.5 years (range 5-15 years) showed no significant differences between the patients who underwent LNS and those who did not. Of 43 recurrences, six were among 'low risk' women (those with both minimal invasion and low grade histology), suggesting a special need among this group for the additional staging information which LNS may provide.

Carcinoma↗
PubMed1998

Intrauterine irrigation with prostaglandin F2-alpha for management of severe postpartum hemorrhage.

BACKGROUND: Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding. METHODS: After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours. RESULTS: In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects. CONCLUSIONS: Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.

Dinoprost↗
PubMed1996

The effects of tamoxifen treatment on the endometrium.

OBJECTIVE: To investigate the association between tamoxifen and endometrial cancer. BACKGROUND: Tamoxifen is a nonsteroidal antiestrogenic drug that has been used successfully for 15 years in the treatment of all stages of breast carcinoma. In light of the positive results, several studies are now being conducted to test prolonged tamoxifen treatment as a prophylaxis against breast cancer in high-risk women. Although tamoxifen was thought to have only a few side effects, reports indicate that it is associated with an increased incidence of proliferative and neoplastic changes in the endometrium. As the current trend is to administer tamoxifen for prolonged periods and for more indications, the detrimental effects on the endometrium have vast implications. METHODS: Review of the current literature. RESULTS: Tamoxifen treatment is associated with an increased incidence of proliferative and neoplastic changes in the endometrium, with a 1.3 to 7.5 relative risk of developing endometrial carcinoma. CONCLUSIONS: The results of tamoxifen treatment in breast carcinoma override the risk of developing endometrial carcinoma. Any vaginal bleeding in women treated with tamoxifen should be investigated carefully and promptly. In the future it may be necessary to advise these women to undergo routine uterine cavity examination.

Antineoplastic Agents, Hormonal↗
PubMed1996

A case of severe hyperandrogenism, acanthosis nigricans and over diabetes: the use of non-invasive methods for diagnosis, pathogenesis and management.

Hyperandrogenism is characterized clinically by hirsutism, acne, androgens-dependent alopecia and elevated serum concentrations of androgens (testosterone and androstenedione). Polycystic ovary syndrome is the most frequent cause of hyperandrogenism. Nevertheless, the differential diagnosis includes androgen-secreting tumors of the ovary or adrenal gland. Although rare, it is important to consider this diagnosis in patients with serum testosterone concentrations greater than 7 nmol/l. A 35-year-old woman who presented with hirsutism, amenorrhea and acanthosis nigricans is described. The endocrine abnormalities included a serum testosterone concentration of 9 nmol/l and overt type II diabetes mellitus. Imaging studies, including magnetic resonance imaging and Doppler ultrasonography, did not disclose a secreting tumor. After cyproterone acetate was prescribed the serum testosterone concentration returned to normal. The recent application of modern, high-resolution diagnostic ultrasonography and magnetic resonance imaging enabled a morphologically based diagnosis in a case of severe hyperandrogenism, with no need for invasive procedures. The therapeutic response to antiandrogens is reassuring.

Acanthosis Nigricans↗
PubMed1996

Sensitivity and specificity of sonohysterography for the evaluation of the uterine cavity in perimenopausal patients.

Sonohysterography is a technique for evaluating the uterine cavity by the instillation of sterile saline solution through an 8 Fr Foley catheter, before performing an ultrasonographic evaluation. The sensitivity and specificity of the procedure were evaluated in comparison to hysteroscopy. In a prospective double-blind study, 47 postmenopausal patients were evaluated first by sonohysterography, and within 1 week by hysteroscopy. After comparing the hysteroscopic and sonohysterographic results, sonohysterography showed a sensitivity of 86% and specificity of 100%. Sonohysterography is an accurate mode of diagnosis for pathologic intrauterine processes in perimenopausal patients.

Adult↗
PubMed1995

Are Israeli women in a low risk group for developing squamous cell carcinoma of the uterine cervix?

OBJECTIVE: Invasive cervical squamous cell carcinoma is not a common disease among Jewish women. In the present study an attempt was made to find what is the distribution of the known risk factors in this population. METHODS: Three hundred and ninety-one patients with various cervical cytological abnormalities comprised the study group. They were compared to 350 Israeli women with negative cytology. The risk factors were extracted from an anonymous questionnaire. The results were statistically analyzed and compared to the equivalent figures published in the literature pertaining to non-Jewish women. RESULTS: The prevalence of abnormal cytology among the Israeli women was almost the same as that of the non-Jewish group: 24/1000 and 26/1000, respectively. Significant statistical differences were found between the following risk factors: number of sexual partners, age at first intercourse, age at first pregnancy. Women in the study group were younger when they became sexually active and at first pregnancy, they had a larger number of sexual partners, fewer of them were married and fewer of them were observant of Jewish ritual practices. In addition, they had achieved higher academic levels than the women in the control group. CONCLUSIONS: It was found that the distribution of the known risk factors among the study group was practically the same as those in the non-Jewish population. Moreover, it was found that there was an increase of 29.2% (from 17/1000 to 24/1000) in the prevalence of cervical premalignant lesions among the Israeli women. We believe that this population can no longer be considered as being at low risk for this disease.

Adolescent↗
PubMed1995

Prevalence of human papillomavirus infection and HPV DNA among male partners of Israeli women with genital premalignant and human papillomavirus lesions.

The role of the males who are sexual partners of females with genital human papillomavirus (HPV) infection and premalignant lesions is explored in the present study. Within a period of 3 years, 391 females with genital premalignant and HPV-associated lesions were examined and treated at the Cervical Pathology Unit of the Tel Aviv Medical Center. The male partners of all the women were asked to attend this unit, and 322 of them responded. All participants underwent colposcopic examination of the anogenital area followed by colposcopically guided biopsies from the most representative lesions, when present, part of which included in situ hybridization (ISH) of HPV DNA sequences 6/11 and 16/18. The histological prevalence of HPV among the male partners was 86.6% (185 of 213 biopsies). Of the 48 couples who had ISH evaluations, the ISH could not identify any copy of HPV DNA in 58.3% of the males (28 cases) and 41.6% of the females (20 cases). Among the males, HPV 6/11 and 16/18 were found in 17 (35.4%) and 3 cases (6.2%), respectively, and among the females there were 23 (48.0%) and 5 cases (10.4%), respectively. Correlation of HPV DNA sequences 6/11 and 16/18 between the couples was found in six (12.5%) and in one (2.0%), respectively. These data do not support a direct contamination by the current male partner. The question of treating the male partner of a woman with genital HPV and premalignant lesions remains to be evaluated.

Condylomata Acuminata↗
PubMed1993

A second thought on second look laparotomy.

Between 1982 and 1987, 43 patients with epithelial ovarian carcinoma, identified as International Federation of Gynaecology and Obstetrics Stages I-IV, underwent second-look laparotomy as a part of their treatment protocol. Twenty-nine patients (67%) had no evidence of residual disease, five (11.6%) had residual disease < or = 1 cm, and nine patients (20%) had residual disease > or = 1 cm at re-exploration. Persistent disease at the second operation was positively correlated with the initial clinical stage, and negatively correlated with the extent of the original cytoreductive surgery. Fifteen of 29 patients with negative findings (52%) developed recurrent disease within two years. All recurrences were limited to the abdominal cavity only. Three and five years survival, for the patients with negative findings, was 62% and 48% respectively. No documented benefit to the patients could be demonstrated by adopting second-look laparotomy as a routine procedure in the management of patients with epithelial ovarian carcinoma. In view of our data, as well as that of others, such operations cannot be considered a valuable routine procedure. At this point, second-look laparotomy may have a role in evaluating the efficacy of a post-surgical new chemotherapy treatment regimen.

Adult↗
PubMed1993

High- and low-power CO2 lasers. Comparison of results for three clinical indications.

In this prospective study, three groups of patients were enrolled: group 1, patients with high grade squamous intraepithelial lesions (CIN 2 and 3) and carcinoma in situ (n = 56); group 2, patients with benign vulvar and perineal human papillomavirus lesions (n = 83); and group 3, patients with disseminated foci of penile shaft condylomatous lesions (n = 65). Each of the groups was randomly equally divided into two subgroups. One subgroup was treated with a laser beam with an output of 60 W and a spot size of 1-1.5 mm, creating high power density (HPD) ranging between 3,4000 and 7,640 W/cm2, while the other was treated with low power density (LPD) with an output of 20 W and the same spot sizes, creating an LPD ranging between 1,136 and 2,547 W/cm2. In group 1, the time to complete treatment was shorter using the HPD technique (P < .0003), and more satisfactory histologic edges were available (P < .007). HPD was also associated with a significantly shorter healing time and improved cosmetic results in groups 2 and 3 (P = .001). No difference was found in the time to complete therapy or the occurrence of infection when the different modalities were compared. The results of this study suggest that for specific disease entities, HPD is associated with better treatment outcomes than is LPD.

Carcinoma in Situ↗
PubMed1978

Cervical adeno-carcinoma and partial hydatidiform mole.

Partial hydatidiform mole was found in a 39-year-old grand-multiparous Jewish woman, having a polypoid cervical adeno-carcinoma. The patient was treated by surgery followed by internal and external pelvic irradiation, with excellent results. Four and a half years after the initial diagnosis she is very well. This is the first reported case of a rare combination. The literature regarding the association between pregnancy and cervical malignancies is reviewed briefly and the possible pathogenetic relationship between hydatidiform mole and carcinoma of the cervix is discussed.

Adenocarcinoma↗