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Biomedical subjects

Arie Herman

Publications and source records attributed to Arie Herman.

At least 19 recordsLinked to original sources
PubMed2006

Ultrasonographic-guided percutaneous transabdominal puncture for oocyte retrieval in a rare patient with Rokitansky syndrome in an in vitro fertilization surrogacy program.

OBJECTIVE: To describe the option of ultrasonographic-guided percutaneous transabdominal puncture for ovum pickup in a rare case of Rokitansky syndrome with subcostal located ovaries and a right single kidney. DESIGN: Technique and instrumentation. SETTING: A university-based hospital IVF and Reproductive Medicine Unit. PATIENT(S): A woman with congenital agenesis of the uterus in a surrogate gestation program. INTERVENTION(S): Ultrasonographic-guided percutaneous transabdominal puncture for oocyte retrieval. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and fertilized. RESULT(S): Oocyte retrieval was feasible in four treatment cycles with subsequent embryo transfer to the surrogate mother. CONCLUSION(S): Ultrasonographic-guided percutaneous transabdominal oocyte collection is a feasible and efficacious procedure for IVF in a case of Rokitansky syndrome with elevated subcostal ovaries and a single kidney.

Abdomen↗
PubMed2006

Maternal serum inhibin levels in twin and singleton pregnancies conceived by assisted reproduction.

BACKGROUND: To investigate whether second trimester serum inhibin levels differ in pregnancies conceived by assisted reproduction technology (ART). METHODS: In Israel, serum samples from twin pregnancies were obtained for inhibin testing from women either referred for routine ultrasound monitoring, follow up after multi-fetal reduction or amniocentesis, largely for advanced maternal age. In the UK, inhibin had been tested prospectively in singleton and twin pregnancies of women having routine Down's syndrome (DS) screening. Results were available from 207 ART pregnancies: 170 singletons and 37 twins. This includes 15 twins from Israel, known to have been reduced from triplets to twins. Comparison was made with 4384 spontaneous pregnancies: 4334 singletons and 50 twins. Results were expressed in multiples of the gestation-specific median (MoM) for normal spontaneous pregnancies. RESULTS: In ART singletons, the median maternal inhibin level was higher (1.11 MoM) than in spontaneous singletons (0.99 MoM, P < 0.001, two-tail Wilcoxon Rank Sum Test). In twins, there was no material difference between ART and spontaneous pregnancies with medians of 1.98 and 2.18 MoM, respectively (P = 0.62). There was no effect of multi-fetal reduction, with medians of 1.76 and 1.81 MoM in reduced and non-reduced twins, respectively (P = 0.46). CONCLUSION: It appears that serum inhibin levels are increased on average in ART singletons but not in ART twin pregnancies. More data will be needed before deciding whether risk calculation parameters need to be altered when using inhibin for DS screening in pregnancy.

Down Syndrome↗
PubMed2006

Fetal abnormalities leading to termination of singleton pregnancy: the 7-year experience of a single medical center.

OBJECTIVE: To assess the distribution of fetal indications leading to termination of pregnancy (TOP) in our institute. METHODS: All pregnant women with singleton pregnancies who underwent TOP due to fetal abnormalities in our institute between January, 1998 and December, 2004 were divided between early TOP (<23 weeks' gestation) and late TOP (> or =23 weeks' gestation). RESULTS: There were 328 (71%) and 134 (29%) early and late TOPs, respectively. The TOPs were performed at a mean gestational age of 20.1 +/- 4.8 weeks. The groups varied significantly in the indications for TOP (p = 0.04), which were primarily structural abnormalities (mostly CNS) followed by chromosomal/genetic defects. Fetal structural abnormalities were more common in the late TOP group (62.7% vs 54.2%) while chromosomal-genetic defects were more common in the early TOP group (40% vs 29.1%, respectively). Fetal infection (mostly cytomegalovirus) was similar ( approximately 4%) for both groups. The early TOP group had significantly more hydrops, gastrointestinal, face and neck abnormalities, while the late TOP group had significantly more cardiovascular abnormalities (p < 0.01). CONCLUSIONS: The impact of early chromosomal/genetic screening contributes to early TOPs, while midgestation anomaly and cardiac scanning significantly contribute to late TOPs. Fetal infection contributes equally to both categories of TOPs.

Abortion, Eugenic↗
PubMed2006

Normal sonographic values of maternal spleen size throughout pregnancy.

This study aims to establish normal range of sonographically measured maternal spleen size throughout pregnancy. Currently, 288 healthy pregnant women between 6 and 42 weeks' gestation underwent ultrasonographic measurements of spleen length and width. The relationships between ultrasound measurements with prepregnancy body mass index (BMI) and gestational age were assessed using the Pearson correlation coefficient. A linear regression model was applied to construct the appropriate equation for measuring the spleen area relative to BMI and gestational age. A significant correlation (R) was found between gestational age and spleen dimensions length (R = 0.486; p < 0.001), width (R = 0.455; p < 0.001) and area (R = 0.522; p < 0.001)) as well as between prepregnancy BMI and spleen length [(R = 0.314; p < 0.001), width (R = 0.380; p < 0.001) and area (R = 0.413; p < 0.001)]. We divided the spleen area by the BMI, thus enabling to perform a linear regression analysis with gestational age (weeks) as an independent continuous variable. A high multiple correlation (R) between spleen area and this variable was found (R(2) = 0.47; p < 0.001). The equation [spleen area/BMI = 1.598 + 0.032 x gestational age in weeks] was performed for calculating the spleen area throughout pregnancy. A significant overall growth pattern of spleen area in pregnancy with increasing gestational age was found. Normograms from these data can be used to evaluate splenomegaly throughout pregnancy.

Adolescent↗
PubMed2006

Adnexal torsion involving hydatids of Morgagni: a rare cause of acute abdominal pain in adolescents.

OBJECTIVE: Hydatids of Morgagni are common embryonal remnants of the müllerian duct and among the infrequent causes of adnexal torsion. The purpose of this study was to investigate the occurrence of adnexal torsion involving hydatids of Morgagni, as well as its possible mechanisms. METHODS: A database search was conducted for cases of adnexal torsion treated in our institution from January 2002 to July 2005. These cases were analyzed, focusing on a subgroup of adolescents with adnexal torsion involving the hydatids of Morgagni. RESULTS: There were 76 patients with adnexal torsion. The rate of hydatid of Morgagni torsion was 26% (4 of 15 cases, 95% confidence interval [CI] 0.15-0.51) in the adolescent subgroup (10-19 years old), compared with 0% (0 of 61 cases, 95% CI 0-0.048) in the adult subgroup. The difference between the hydatid torsion rates in the two subgroups was statistically significant (P = .01, 95% CI 0.001-0.532). The four patients with hydatid torsion (postmenarchal girls, aged 13-18 years) were managed with laparoscopic adnexal detorsion and cystectomy of the affected hydatid of Morgagni. At surgery, we noted three different mechanisms of hydatid torsion: torsion of the adnexa together with torsion of the hydatid of Morgagni, torsion of the hydatid of Morgagni with intact adnexa (n = 2), and entanglement of the hydatid's pedicle around the distal fallopian tube. The hydatids of Morgagni were observed on the preoperative transabdominal ultrasonogram in only one patient and appeared as a simple cyst. CONCLUSION: Adnexal torsion involving the hydatids of Morgagni appears to be more common in adolescents than previously thought. LEVEL OF EVIDENCE: III.

Abdominal Pain↗
PubMed2006

Hyperemesis gravidarum and nonspecific abnormal EEG findings: a preliminary report.

OBJECTIVE: To evaluate central nervous system abnormalities in a group of otherwise healthy pregnant women with hyperemesis gravidarum (HG) during the first trimester. STUDY DESIGN: In a case-control study, 17 pregnant women with HG during the first trimester (study group) were compared with 18 pregnant women without nausea and vomiting in pregnancy (NVP). The latter group included women who were planning first-trimester termination of pregnancy for reasons other than health (control group). All the pregnant women enrolled in the study answered a questionnaire and underwent a physical examination, blood tests, urinalysis, EEG, and visual evoked potential (VEP) and brainstem auditory evoked response (BAER) tests. RESULTS: An abnormal EEG was found in 5 of the 17 women in the study group (29.4%), whereas none of the 18 women in the control group had an abnormal EEG (p = 0.013). The VEP and BAER tests were normal among the women in both groups. There were no clinically significant differences between the 2 groups with regard to maternal age, gravidity, parity, weeks of gestational age, blood count, renal function, liver function or electrolytes. Low thyroid stimulating hormone levels were found in 6 of the 17 women in the study group (35.3%) as compared to 1 of the 18 in the control group (5.5%) (p = 0.028). None of the women in either group had hyperthyroidism. HG in previous pregnancies was a significant risk factor for HG in the present pregnancy. CONCLUSION: In pregnant women with HG during the first trimester, the frequency of abnormal EEG findings is significantly higher as compared to that in pregnant women without NVP. However, the mechanism and implications of these findings are yet to be clarified.

Adult↗
PubMed2005

Sonographic versus clinical evaluation as predictors of residual trophoblastic tissue.

BACKGROUND: The study aims to compare the diagnostic accuracy of sonographic evaluation versus clinical estimation in women suspected to have retained trophoblastic fragments. METHODS: The study group consisted of 68 consecutive patients admitted to our department due to suspected residual trophoblastic tissue. Each woman underwent ultrasound and physical examination by expert clinicians. The clinicians performing the physical examination were not informed of the sonographic findings, and vice versa. RESULTS: Patients were divided into three subgroups: clinical suspicion only of residual trophoblastic tissue (n = 8), sonographic suspicion only (n = 44) and combined sonographic and clinical suspicion of residual trophoblastic tissue (n = 16). In the latter group, in 14 out of 16 women (87.5%) retained trophoblastic tissue was confirmed by histological examination, a significantly higher rate compared to ultrasonographic (45.5%, P < 0.002) or clinical suspicion only (62.5%, P = 0.07). The specificity and positive predictive value of the clinical examination were significantly higher compared to ultrasonographic evaluation (P < 0.05), while the sensitivity of the ultrasonographic evaluation was higher than the clinical estimation (P < 0.05). There was no statistically significant difference in the negative predictive value or in diagnostic accuracy between the two methods. CONCLUSIONS: Based on our current experience, it seems that the combination of both clinical and ultrasonographic evaluation is recommended before uterine curettage is performed, thus lowering the rate of unnecessary invasive procedures.

Abdominal Pain↗
PubMed2005

Second trimester ultrasound prenasal thickness combined with nasal bone length: a new method of Down syndrome screening.

OBJECTIVE: To evaluate ultrasound prenasal thickness (PT) as a way of enhancing the Down syndrome (DS) screening performance of second-trimester nasal bone (NB) length measurement. METHODS: Twenty-one DS and 500 normal fetuses were scanned at 14-27 weeks' gestation. The affected karyotype was known to the person performing the scan. Both PT and NB were measured in a mid-sagittal position and results were expressed in multiples of the normal gestation-specific median (MoM). Gaussian modelling was used to predict the performance of routine screening. RESULTS: Among DS fetuses, the PT median was 1.35 MoM, a highly statistically significant increase compared with the unaffected pregnancies (p < 0.0001, Wilcoxon Rank Sum Test, two-tailed). The NB median was 0.87 MoM (p < 0.0005) and the ratio PT/NB median was 1.51 MoM (p < 0.0001). In the normal fetuses, the two markers were positively correlated (0.25, p < 0.0001), whereas in the DS fetuses there was a non-significant negative correlation (-0.24, p = 0.33). For a 5% false-positive rate, the model predicted detection rate was 70% for PT and NB compared with 43% for NB alone. CONCLUSION: In the second trimester, PT is increased on average in DS fetuses. Combining PT and NB measurement could yield a higher screening detection rate than NB alone. Confirmation of our findings in a series of women scanned before the karyotype was known is needed before the method can be clinically implemented.

Down Syndrome↗
PubMed2005

Is there an increased rate of anencephaly in twins?

BACKGROUND: The Israeli Ministry of Health reported an increased rate of twin pregnancies among all cases locally diagnosed as having open neural tube defects. The current study aimed to evaluate whether the etiology of this phenomenon could be attributed either to the twinning or to the mode of conception. METHODS: Women admitted to our hospital between January 1997 and July 2004 for termination of pregnancy because of severe fetal abnormality enrolled into this retrospective case series study. They were further subdivided according to mode of conception (spontaneous, in vitro fertilization (IVF) or intracytoplasmic sperm injection (IVF-ICSI) pregnancies). RESULTS: Three-hundred and eighty consecutive pregnancies, of which 340 (89%) were singletons, participated in our study. Anencephaly was diagnosed in 26 cases: 19 singletons and 7 twins. In the entire twin population, they were all dichorionic twins and only one co-twin was affected. Five of the twins were conceived by IVF-ICSI. All the anencephalic IVF-ICSI twins had normal karyotypes. All IVF-ICSI study women had taken folic acid 400 mcg/day 3 months before conception and throughout the first trimester of pregnancy. In order to find out the cause of the high rate of anencephaly found in IVF-ICSI pregnancies (33.3%), either the twinning or the IVF-ICSI process, a logistic regression analysis was used. A significant correlation was found only between anencephaly and twinning (p = 0.001, CI = 1.86-12.63), with a risk ratio of 4.85. CONCLUSIONS: Our case series data suggest a comparatively higher rate of anencephaly in IVF-ICSI pregnancy secondary to twinning and not because of the assisted reproductive technology. It is suggested that larger epidemiologic studies are conducted to validate our preliminary results.

Anencephaly↗
PubMed2005

Predicting the result of additional second-trimester markers from a woman's first-trimester marker profile: a new concept in Down syndrome screening.

OBJECTIVE: To describe a method for deciding whether an individual's first-trimester Down syndrome screening test result justifies further testing in the second trimester. METHODS: Statistical modelling was used to estimate the distribution of second-trimester marker profiles for a given first-trimester profile and hence the probability of a final positive result, using a 1 in 250 term cut-off. A multi-variate log Gaussian model was used with published parameters. Markers were maternal serum pregnancy-associated plasma protein-A and free beta-human chorionic gonadotrophin (hCG) at 10 weeks, nuchal translucency at 11 weeks, and second-trimester maternal serum alpha-fetoprotein, total hCG, unconjugated estriol and inhibin-A. To illustrate the method, the model was applied to a published series of 24 Down syndrome and 367 unaffected pregnancies. RESULTS: Modelling predicts that for 63% Down syndrome and 0.4% unaffected pregnancies having first-trimester tests, there is a 50% or more probability of a final positive result. A step-wise sequential screening policy based on immediate prenatal diagnosis for those with high probability and second-trimester testing for the remainder would have a 90% detection rate and 1.7% false-positive rate. Modelling also predicts 8.0% Down syndrome and 89% unaffected pregnancies with probabilities below 3%. A contingent screening policy restricting second-trimester testing to those with 3-49% probabilities would have an 88% detection rate and 1.4% false-positive rate. CONCLUSION: Predicting the probability of a positive final result from the first-trimester marker profile has potential utility, either as a decision aide for individual women or as a formal part of screening policy in selecting a subset of women for second-trimester testing.

Adult↗
PubMed2005

Current concepts of Down syndrome screening tests in assisted reproduction twin pregnancies: another double trouble.

Assisted reproductive technologies (ART) have increased both the number of pregnancies in women beyond the age of 35 and the incidence of multiple pregnancies. Various methods of screening for Down syndrome (DS) were introduced in clinical practice during the last two decades, and specific problems were encountered when they were applied for twin pregnancies. The current review aims to explore the problematic issue of prenatal DS screening in ART twins. Overall, more women with twin pregnancies (mainly those who conceived via assisted reproduction) are found to be false positive for DS. This is because mid-trimester maternal serum screening is associated with a higher false-positive rate secondary to changes in the feto-placental endocrinologic metabolism, reflected mainly in high human chorionic gonadotrophin (hCG) levels in the ART pregnancies. First-trimester nuchal translucency (NT) measurement in twin pregnancies is not affected by the problems encountered in serum screening. This sonographic screening approach enables a fetus-specific identification of those fetuses at high risk of DS and is associated with a lower false-positive rate than mid-trimester serum screening. DS screening in ART twins presents several challenges in determining the most appropriate screening test modality. Whether there is any significant benefit of adding first-trimester biochemistry or nasal bone scanning in screening ART-conceived twins awaits further investigation.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed2005

Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center.

BACKGROUND: Descriptions of the rarely occurring condition of conjoined twins are sparse. METHODS: We report a case series of four conjoined twin pregnancies diagnosed up to 16 weeks of gestation. One was in a quadruplet in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) pregnancy of cryopreserved embryos and the others were spontaneous conceptions. Three were thoracopagus and had increased nuchal translucency (NT) or big nuchal cysts and one was omphalopagus. RESULTS: All the three affected twin pregnancies were terminated by cervical dilatation and uterine evacuation. In another case, selective fetal reduction, shortly followed by embryo reduction to singleton was performed. Histological analysis of one case revealed dissimilar gender. No further cytogenetic or molecular studies were conducted by parental request. The pathophysiology of increased NT, subcutaneous edema or nuchal cysts in thoracopagus conjoined twins, the possible embryonic events that may lead to dizygotic conjoined twins and the clinical management of conjoined twins in sets of multiple gestation are discussed. CONCLUSIONS: The current case series illustrates that there are many problems related to this rare, but intriguing, accident of nature that still need to be overcome.

Abortion, Induced↗
PubMed2005

Pregnancy outcome of euploid fetuses with increased nuchal translucency: how bad is the news?

AIMS: The number of fetuses with an abnormal increased first trimester nuchal translucency (NT), but confirmed normal karyotype and anatomy is relatively small and therefore a challenge for prenatal counseling. Universal guidelines are still needed for a systematic work-up, how to decide on the rewarding cut-off for this policy as well as how to counsel patients with an increased NT but with euploid fetuses. The current review aims to address some of these issues. RESULTS: Eleven studies reporting on the pregnancy outcome of 2,128 euploid fetuses with increased NT (>or=3 mm or >or=95 centile) were retrieved by our previously reported literature search. 2.2-10.6% of the fetuses has miscarried and 0.5-15.8% ended in perinatal death. There was an overall rate of 0.5-13% neurodevelopmental problems, and 2-8% of the malformations were undiagnosed before birth, the most common being cardiac anomalies. Nevertheless, 70-90% fetuses had normal outcomes. CONCLUSION: For those euploid fetuses with increased NT>2 MoM or >or=1.5 mm delta NT we recommend a detailed two-step anomaly scan including midgestation fetal echocardiography. Maternal age as well as data on relevant family history and persistence of nuchal edema provides additional relevant information for counseling and planning pregnancy management.

Congenital Abnormalities↗
PubMed2005

The best marker combination using the integrated screening test approach for detecting various chromosomal aneuploidies.

AIMS: To evaluate the cross-trimester multiple marker correlation and the minimum marker combination needed for detecting various chromosomal aneuploidies. MATERIALS AND METHODS: Parturient women with singleton pregnancies who underwent non-interventional sequential screening test and followed prospectively were recruited. They all underwent first trimester combined nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), and free beta-human chorionic gonadotrophin (f-betahCG), followed by second trimester measurement of unconjugated estriol (uE3), human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP). Pearson correlation was applied to compute any cross-trimester marker correlation and logistic regression analysis was used to determine the minimum marker combination for detecting various categories of chromosomal aneuploidies. RESULTS: The current study included 552 normal and 43 chromosomal-affected pregnancies (24 Down's syndrome [DS], 7 Turner's syndrome, 8 Edward's syndrome, 4 Klinefelter syndrome and 5 triploidy) for which the results of both the screening tests and the pregnancy outcome were available. In the normal cases, a significant correlation was found between f-betahCG and hCG (r=0.52), as well as between PAPP-A and uE3 (r=0.174). In DS pregnancies, the NT correlated with both hCG (r=0.45) and uE3 (r=-0.39). In Turner's syndrome, uE3 correlated both with PAPP-A (r=0.97) and f-betahCG (r=0.97). No other significant correlations were found. Furthermore, with the exception of f-betahCG and hCG in the unaffected cases, all other markers correlation appeared very weak. For detecting all the above categories of aneuploidies, the combination of NT, PAPP-A and uE3 and the maternal age background risk were found adequate, with a 74% detection rate (DR) for a 5% false positive rate (FPR). For DS only, the combination of maternal age-related background risk and the combination of NT, PAPP-A, hCG and AFP yielded a 79% DR for a 5% FPR. CONCLUSIONS: The current study agrees with a previous report that, overall, there is no strong correlation between first and second trimester markers. The extension of the integrated test for detecting various categories of common chromosomal aneuploidies using NT, PAPP-A and uE3 deserves further evaluation.

Adult↗
PubMed2004

The three-vessel and tracheal view of the fetal heart: an in utero sonographic evaluation.

OBJECTIVES: To establish a nomogram for fetal cardiac three-vessel view diameter changes during gestation. METHODS: The study is a prospective cross-sectional evaluation of 338 male and female fetuses between 14 and 38 weeks of normal singleton pregnancies. Measurements of fetal pulmonary artery, aorta and superior vena cava diameters, performed on a transverse view of the upper mediastinum were conducted using transvaginal ultrasonography between 14 to 18 weeks and transabdominal after 19 weeks' gestation. RESULTS: Adequate measurements of the three cardiac vessels were obtained in 338 fetuses. The regression equations for vessel diameters modeled as function of gestational age were pulmonary artery diameter (mm) = -2.275 + 0.273 x gestational age (week), aorta diameter (mm) = -1.77 + 0.227 x gestational age (week), and SVC diameter (mm) = -0.98 + 0.142 x gestational age (week). The correlation coefficients between gestational age and the diameter of the vessels were, r = 0.93, r = 0.93 and r = 0.86 for pulmonary artery, aorta and SVC respectively (all found to be highly statistically significant, p < 0.0001). The normal mean and 90% prediction limits were defined. CONCLUSION: Our data present the normal range of fetal heart three-vessel diameters during gestation. They may allow intrauterine assessment of their development and an adjunct in the detection and evaluation of great vessel pathology.

Aorta↗
PubMed2004

Congenital hypofibrinogenemia in pregnancy: report of two cases and review of the literature.

Fibrinogen abnormalities have been implicated in many adverse pregnancy outcomes, mainly spontaneous abortion, placental abruption, and postpartum hemorrhage. Two new cases of congenital hypofibrinogenemia in pregnancy are reported detailing their obstetric course and management. The relevant obstetric and hematologic literature is reviewed, including previous case reports and studies concerning the mechanisms of pregnancy complications. Suggestions for treatment guidelines and management strategies are detailed.

Adult↗
PubMed2004

The onion skin sign: a specific sonographic marker of appendiceal mucocele.

OBJECTIVE: To evaluate the association of the onion skin sign as a sonographic marker for appendiceal mucocele. METHODS: The sonographic onion skin sign was considered specific for the preoperative diagnosis of appendiceal mucocele. Therefore, detection of this sign in a mass located in the right lower abdomen, unrelated to the female reproductive organs, indicated surgical intervention with a presumptive diagnosis of appendiceal mucocele. From 1998 through 2001, female patients who were found to have atypical cysts containing this sign underwent surgery. The cases were closely followed, and intraoperative findings and final histologic diagnoses were recorded. RESULTS: Appendiceal mucocele was the final diagnosis in all 7 patients in whom the onion skin sign was observed. One additional patient had an appendiceal mucocele with a sonographic picture of a clear tubular cystic structure. CONCLUSIONS: A sonographically layered cystic mass in the right lower quadrant of the abdomen in the presence of a normal ovary strongly suggests the diagnosis of appendiceal mucocele. Recognition of the sonographic onion skin sign in a cystic mass in the right lower quadrant may facilitate the accurate preoperative diagnosis of appendiceal mucocele.

Adult↗