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Biomedical subjects

A S Lev-Toaff

Publications and source records attributed to A S Lev-Toaff.

At least 37 records · Page 2Linked to original sources
PubMed1995

Controlled ovarian hyperstimulation and transvaginal intratubal insemination as an alternative to gamete intrafallopian transfer.

OBJECTIVE: To evaluate the efficacy of controlled ovarian hyperstimulation (COH) followed by intratubal insemination in the treatment of infertility. DESIGN: Retrospective analysis of 179 intratubal insemination trials in 78 women over a 48-month period. SETTING: Reproductive endocrinology practice. PATIENTS: Seventy-eight women, 26 to 44 years old (34 +/- 4.3 years; mean +/- SD), classified into subgroups according to diagnosis and age (< 40 or > or = 40 years). INTERVENTIONS: Patients underwent COH and intratubal insemination. MAIN OUTCOME MEASURES: The rates of pregnancy, delivery, spontaneous abortion, ectopic and multiple gestation, and complications were studied and analyzed statistically. RESULTS: Overall, there were 36 pregnancies (20.1% of 179 trials), 29 deliveries (16.2%), 5 of 36 first trimester abortions (13.9%), 2 of 36 ectopic pregnancies (5.6%), and 4 twin gestations. There were no serious complications. In 43 women < 40 years without male factor the first trial resulted in 15 pregnancies (34.9%); in 27 women < 40 years with male factor the first trial resulted in 4 pregnancies (14.8%). Male factor reduced significantly the probability of conception. In 19 women < 40 years of age with either ovarian dysfunction or infertility of unknown cause, the first trial resulted in 9 pregnancies (47.4%), which was significantly better than the 10 pregnancies achieved in the first trial in the remaining 51 women < 40 years of age. Peak serum E2 levels and number of mature follicles had a significant effect on pregnancy rates. CONCLUSIONS: Intratubal insemination yielded pregnancy rates comparable to those published for GIFT at reduced cost and with fewer complications.

Adult↗
PubMed1995

The radiologic and pathologic spectrum of biliary hamartomas.

OBJECTIVE: The purpose of our study was to correlate the spectrum of radiologic and pathologic findings in a series of patients with biliary hamartomas and known extrahepatic malignancy. MATERIALS AND METHODS: Biliary hamartomas were diagnosed in 18 patients with a primary malignant lesion who had liver biopsy for evaluation of possible metastatic disease. Prebiopsy imaging studies included CT in 16 patients and sonography in 11. Imaging studies were reviewed retrospectively and correlated with findings at surgery and on pathologic examination. The hamartomas were classified histologically by the degree of cystic dilatation of bile ducts within the lesion. RESULTS: Radiologically, biliary hamartomas presented a spectrum of findings including one or two circumscribed lesions (5-10 mm in diameter) in four patients; multiple (about five) lesions (approximately 5 mm each) in one patient; innumerable tiny, nearly uniform (2-5 mm) lesions in two patients; and innumerable lesions of varying size (2-15 mm) in three patients. Among the patients with innumerable lesions, the nodules were either uniformly or nonuniformly distributed throughout the liver. In all cases, the lesions were hypodense on contrast-enhanced CT scans and hypoechoic on sonograms. In eight patients, the lesions were not visible by imaging but biopsies were done at surgery when single or multiple tiny nodules were noted on the liver surface. The diagnosis was made by either wedge or core-needle biopsy; fine-needle aspirations were nondiagnostic. Pathologic examination revealed single or multiple hamartomas of varying sizes ranging from solid to largely cystic lesions; the degree of cystic dilatation did not correlate with imaging findings. Visibility on imaging correlated with larger lesion size; small surface lesions were usually occult. CONCLUSION: Biliary hamartomas cause single or multiple nonspecific hepatic lesions that may mimic metastases. This diagnosis should be considered in patients with a primary malignant tumor when single or multiple small hepatic lesions are seen, regardless of uniformity of size or distribution.

Adult↗
PubMed1995

Esophageal strictures: findings on barium radiographs.

An esophageal stricture is a narrowing of the lumen due to inflammation or tumor. Lack of distensibility is characteristic of stricture, which may be diffuse or localized and which may have abrupt or tapered margins. The purpose of this essay is to illustrate the imaging features of various types of strictures, focusing on their value in differential diagnosis.

Barium Sulfate↗
PubMed1994

Stability of malignant breast microcalcifications.

PURPOSE: To determine the frequency of stability in malignant microcalcifications and its relationship to specific histologic diagnoses. MATERIALS AND METHODS: During a 34-month period, microcalcifications were proved malignant in 182 patients referred for needle-guided biopsy. In 105 patients, the mammograms were compared with one or more than one previous mammogram. These patients were classified on the basis of interval change in two groups: those with stable and those with increasing or new microcalcifications. The histologic diagnoses were reviewed. RESULTS: Microcalcifications were stable for 8-63 months (mean, 25.4 months) in 26 patients (24.8%), only three (12%) of whom had invasive ductal carcinoma, which was found in 29 (37%) of the 79 patients with increasing or new microcalcifications. CONCLUSION: The odds for presence of invasive ductal carcinoma are statistically significantly lower (P < .025) among patients with stable microcalcifications than among those with increasing or new microcalcifications. Stability of indeterminate or suspicious microcalcifications is unreliable for exclusion of a diagnosis of malignancy.

Breast Neoplasms↗
PubMed1994

Breast implants: incidental findings on CT.

The mammographic, sonographic, and MR appearances of both normal and abnormal breast implants have been described. Breast implants are occasionally seen on chest CT scans obtained for other reasons; however, we know of no published reports on the CT findings in a series of patients with breast implants. We present a retrospective review of CT findings in 18 patients with 27 breast implants that illustrates the spectrum of findings that can be seen in asymptomatic patients.

Breast↗
PubMed1993

Hysterosalpingography before and after myomectomy: clinical value and imaging findings.

OBJECTIVE: Myomectomy is being performed increasingly for the treatment of menorrhagia and infertility. The purpose of this study was to describe the findings at hysterosalpingography before and after myomectomy and to correlate the findings with the operative technique and observations at surgery. This study also examined the value of hysterosalpingography in planning surgery, as well as in detecting postoperative complications and residual fibroids. MATERIALS AND METHODS: The study group comprised 32 patients who were consecutively referred for hysterosalpingography after myomectomy. The indications for myomectomy were infertility in all cases, associated with menorrhagia in 20, pelvic pain in 15, and urinary frequency in eight. Eighteen of the 32 patients also had hysterosalpingography before surgery. The hysterosalpingographic findings were reviewed without knowledge of the clinical findings and then correlated with surgical and pathologic findings. RESULTS: Preoperative hysterosalpingograms showed enlargement and/or distortion of the uterine cavity in 13 of 14 patients who had submucous fibroids or mural fibroids with a submucous component (mural/submucous fibroid). Cornual asymmetry was seen in seven of 18 patients, the result of an adjacent fibroid deforming one bilaterally in another two. In all four patients, tubal patency was shown after myomectomy. Intracavitary filling defects consistent with submucous or mural/submucous fibroids were found in 12 of 18 patients. After myomectomy, these defects resolved in eight cases; in the remaining four, persistent filling defects suggested residual submucous enlargement of the uterine cavity in only two of 32 patients; in both, residual mural and/or submucous fibroids were shown on sonography after surgery. Major distortion of the cavity after surgery was found in four patients; it was caused by filling defects consistent with residual submucous fibroids in two and by major synechiae in two. Diverticula at the site of resection of submucous fibroids were found in six patients. Major synechiae were found in two patients, resulting in unilateral or bilateral tubal occlusion. CONCLUSION: Hysterosalpingography before myomectomy can assist the surgeon in planning the surgical approach by showing the presence, size, and location of submucous fibroids and concomitant tubal disease. Hysterosalpingography after myomectomy shows residual fibroids and complications of surgery, such as synechiae and diverticula, that may affect further treatment.

Adult↗
PubMed1992

Suprahepatic circumcaval ring: CT finding after orthotopic liver transplantation.

A suprahepatic circumcaval ring or arc was noted on computed tomographic (CT) scans in 20 of 37 patients who had undergone 42 orthotopic liver transplantations. The patients were divided into two groups, depending on the presence or absence of this finding. The amounts of blood products transfused intraoperatively and the levels of serum calcium, phosphate, and calcium phosphate product after transplantation were determined for each group. Liver graft function was evaluated on the basis of postoperative levels of serum bilirubin, albumin, and aminotransferase. The levels of serum calcium and calcium phosphate product were higher in patients with the circumcaval ring. This group had received substantially more fresh frozen plasma and platelets at surgery. There was no difference in liver graft function between the two groups. In one case, pathologic examination demonstrated calcification within circumcaval fibrotic tissue. A suprahepatic circumcaval ring is a common finding at CT performed after liver transplantation and is probably related to elevated perioperative serum calcium levels and tissue injury. Surgeons should be made aware of this finding before performing repeat transplantation, since calcification at a potential anastomotic site may make surgery more difficult.

Adolescent↗
PubMed1992

Imaging of uterine leiomyomas.

Advances in the medical and surgical treatment of uterine leiomyomas have stimulated interest in the imaging of these common tumors. The purpose of this essay is to illustrate the appearance of leiomyomas on images obtained with various techniques. The advantages of each technique in particular clinical circumstances are discussed.

Female↗
PubMed1992

Communicating septate uterus with double cervix: a rare malformation.

The class of uterine malformations known as communicating uteri is characterized by two separate uterocervical cavities connected by an isthmic communication. Nine types have been described. We report the second proven case of a septate communicating uterus with double cervix. Investigation of secondary infertility in a woman with a history of second-trimester spontaneous abortion revealed two cervices on a speculum examination. A work-up for uterine anomaly began with endovaginal sonography, which demonstrated a normal fundal contour. A septum symmetrically dividing the endometrial cavity and two cervical canals were seen. The separated endometrial echoes converged at the isthmus, indicating a communicating uterus. Hysterosalpingography confirmed the diagnosis; injection of each cervix resulted in opacification of both hemicavities via the isthmic defect. Laparoscopy confirmed the normal fundal contour. It is believed that the etiology of this malformation involves failure of fusion of the distal müllerian ducts and arrested septal resorption above the isthmus.

Adult↗
PubMed1991

Diagnostic imaging in puerperal febrile morbidity.

This retrospective study was conducted to assess the value of imaging in patients with refractory puerperal febrile morbidity. During a 36-month period, 31 patients were referred for ultrasound and/or computed tomography or magnetic resonance imaging because of postpartum fever unresponsive to broad-spectrum antibiotic therapy of at least 72 hours' duration. Hematomas were identified in 11 women. Abscesses were diagnosed in seven patients, ovarian venous thrombosis in two, vesicouterine fistula in one, small-bowel obstruction in one, and a subcutaneous seroma in one. Twenty-one women had endomyometritis, 13 of whom also had other extrauterine abnormalities (abscess in six, hematoma in four, and ovarian venous thrombosis, vesicouterine fistula, and small-bowel obstruction in one each). Retained placental tissue was found in two women with endomyometritis. Only two subjects had negative imaging studies. In most patients, imaging led to definitive diagnosis and specific therapeutic measures resulting in resolution of the febrile morbidity. Our experience suggests that these imaging techniques may be helpful in evaluating puerperal fever.

Abdomen↗
PubMed1990

Staging of ureteral transitional cell carcinoma by CT and MRI.

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.

Aged↗
PubMed1989

Ovarian vein thrombosis with atypical presentation: role of sonography and duplex Doppler.

Ovarian vein thrombosis was diagnosed in two patients, one postoperatively and one postpartum, with mild, atypical presentations, using sonography and duplex Doppler. Demonstration of the dilated ovarian vein with internal thrombus, without demonstrable flow by Doppler, was diagnostic. We propose that sonography with duplex Doppler be the initial screening examination in at-risk patients with typical or atypical presentations.

Adult↗
PubMed1988

Esophageal disruption: evaluation with iohexol esophagography.

Twenty-six patients with possible esophageal disruption who were also at risk for aspiration or direct communication of the esophagus with the tracheobronchial tree were examined with iohexol esophagography. Fifteen patients had normal studies confirmed by findings at a barium examination performed immediately after. In 11 patients abnormalities were diagnosed on the basis of iohexol esophagograms; the abnormalities included extraluminal extravasation of contrast material (n = 7), aspiration (n = 1), esophageal stricture with intramural diverticulosis (n = 1), edema of the gastroesophageal junction (n = 1), and epiphrenic diverticulum (n = 1). Eight of these patients were immediately reexamined with barium esophagography, which yielded no additional information. Low-osmolality, water-soluble contrast agents are a safe alternative for patients in whom barium esophagography poses a risk of mediastinitis and esophagography with diatrizoate meglumine and diatrizoate sodium (Gastrografin) poses a risk of pulmonary edema.

Adult↗
PubMed1988

Urachal carcinoma: CT findings.

The computed tomographic (CT) appearance of urachal carcinoma in ten patients was studied and compared with the pathologic findings. Magnetic resonance images were available in one case. All tumors were mucinous adenocarcinomas; four were solid, three were cystic, and three were mixed. The tumor had a characteristic location along the expected midline course of the urachus directly behind the anterior abdominal wall. The main tumor mass was supravesical in eight patients. Seven tumors contained calcification. CT correctly depicted bladder wall involvement and supravesical extent of tumor in all cases. CT provided incorrect information about invasion of the perivesical fat in three patients and about bladder mucosal invasion in two patients.

Adenocarcinoma, Mucinous↗