Biomedical subjects

Arie Herman

Publications and source records attributed to Arie Herman.

27 records · Page 2Linked to original sources

PubMed2004

[Intravenous leiomyomatosis].

Intravenous leiomyomatosis is a rare tumor described only in women, in which benign smooth muscle cells grow into the pelvic venous channels. The tumor may cause life-threatening symptoms if there is involvement of the inferior vena cava or the right atrium. This is a case study of intravenous leiomyomatosis with left ovarian extension in a 42 years old woman. The patient was admitted for total abdominal hysterectomy due to uterus myomatosus and menorrhagia. During the operation a frozen section was sent for examination revealing intravenous leiomyomatosis. Thereupon, bilateral salpingo-oophorectomy was also performed. This article reviews the cause, disease, presentation, diagnosis, treatment and recurrence of intravenous leiomyomatosis.

Adult↗

PubMed2004

[Early stage fallopian tube carcinoma--diagnosis, staging and treatment].

Fallopian tube carcinoma is one of the rarest malignancies of the female genital tract. It is often diagnosed incidentally at an advanced stage. In recent years, an increase was observed in early stage fallopian tube carcinoma diagnosis. Such early diagnosis challenges the current FIGO staging system, as well as treatment recommendations, due to its limitations in precise discrimination between early stages. This is a case study of a 42 year-old woman, admitted for bilateral salpingo-oophorectomy due to bilateral ovarian cysts. Pathological examination incidentally revealed early staged fallopian tube carcinoma, which had invaded the lamina propria only, with no muscularis penetration. Due to the limited data regarding the efficacy of adjuvant chemotherapy at this early stage, only CA-125 levels follow-up was recommended.

Adult↗

PubMed2003

Chorioangioma and its severe infantile sequelae: case report.

OBJECTIVE: This case report describes a rare clinical presentation of chorioangioma diagnosed prenatally because of raised-maternal serum (MS) alpha-fetoprotein. METHODS: A thirty-year-old woman gravida 2, para 1 was referred to the ultrasound unit at 18 weeks of gestation because of abnormal MS triple-test results. This included AFP level of 14.9 MoM; hCG of 3.42 MoM and uE3 of 1.01 MoM. A detailed anomaly scan revealed a singleton fetus with no sonographically detectable malformations and normal amniotic fluid. The placenta was posterior. A well-circumscribed, rounded, predominantly hypoechoic lesion near the chorionic surface measuring 5 x 5 cm and protruding into the amniotic cavity was detected. Color Doppler sonogram showed no blood flow within the mass, but clear fetal waveforms in its periphery were demonstrated, and the diagnosis of chorioangioma was made. The pregnancy was followed uneventfully until 35 weeks of gestation when polyhydramnios and severe fetal cardiomegaly developed. Labor was therefore induced. RESULTS: A euploid female, who had multiple diffuse cutaneous and liver angiomatosis was born. She died at the age of one month because of cardiac failure and infection. CONCLUSIONS: The present case alerts to the interrelationship between placental and fetal angiomas. This may lead to severe infantile sequelae because of similar lesions.

Adult↗

PubMed2003

Conservative management of ectopic pregnancy with fetal cardiac activity by combined local (sonographically guided) and systemic injection of methotrexate.

OBJECTIVE: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate. STUDY DESIGN: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time. RESULTS: The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of beta-human chorionic gonadotrophin (BHCG; 40 +/- 2 and 34 +/- 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 +/- 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 +/- 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate. CONCLUSION: The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.

Abortifacient Agents, Nonsteroidal↗

PubMed2003

[Fetal abnormalities leading to termination of pregnancy: the experience at the Assaf Harofeh Medical Center between the years 1999-2000].

OBJECTIVES: To assess the distribution of fetal indications leading to termination of pregnancy. DESIGN: A retrospective study. METHODS: The study included all parturient women with singleton pregnancy, who underwent termination of pregnancy due to fetal abnormalities (structural, chromosomal/genetic, infections). The women were subdivided into two groups according to their gestational age, i.e. early termination (gestational period < 23 weeks) and late termination (gestational period > 23 weeks). RESULTS: A total of 137 terminations of pregnancies were performed, including 102 early terminations and the rest--late terminations. The mean maternal age was 31 +/- 5 years. The termination procedures were performed at a mean gestational age of 20 +/- 5 weeks. The main indications in the early-termination subgroup were structural and chromosomal/genetic (n = 45, 44% for each subgroup). Multiple abnormalities were more common in the early-termination group (18% versus 7%). In the late-termination subgroup the leading indications were structural anomalies (n = 29, 83%) that were subdivided into neurological defects (31%) followed by skeletal deformities (23%). In addition, in the late-termination subgroup there were more cardiac and urinary tract defects (17% versus 11% and 14% versus 9%, respectively). Among the chromosomal aneuploidies, trisomy 21 was diagnosed in 24 cases (53%). Fetal infections were diagnosed in 13 pregnancies (9%), with only one of these detected in advanced gestation. The leading infectious agent was cytomegalovirus. CONCLUSIONS: In the early-termination subgroup the main indications were equally divided between structural and chromosomal/genetic defects while in the late-termination subgroup the leading cause was structural defects.

Abortion, Induced↗

PubMed2002

Wiedemann-Beckwith syndrome: further prenatal characterization of the condition.

We describe three unrelated cases of Wiedemann-Beckwith syndrome (WBS). Two of them were diagnosed postnatally while the third was detected during pregnancy that resulted in elective termination. Amniotic karyotypes were normal in all. PCR amplification of polymorphic loci mapping to 11p15.5 region documented partial trisomy of 11p15.5 due to paternal translocation in one, and segmental and mosaic segmental unipaternal disomy (UPD) in the second and third cases, respectively. Based on findings documented in these cases and the literature, we tabulated the anomalies that might be detected prenatally by ultrasound and that may suggest the syndrome. Constant findings included fetal overgrowth, polyhydramios, enlarged placenta, and specifically a distended abdomen. As most described signs developed after 22 weeks of gestation, a careful follow-up should be carried on until late stages of pregnancy. An amniotic karyotype might not detect subtle chromosomal rearrangements. We therefore recommend utilizing PCR of polymorphic loci on 11p15.5, in addition to conventional cytogenetic analysis of the fetus and both parents to detect possible maternal deletions or inversions, paternal duplications, and UPD that may account for the largest subset of sporadic WBS reaching 25% of cases. An early diagnosis of WBS is important for counseling the parents concerning potential risk for developing embryonic tumors, selection of the mode of delivery due to potential adrenal cysts that might bleed during labor, and prevention of neonatal hypoglycemia.

Adult↗

PubMed2002

Comparison between disclosure and non-disclosure approaches for trisomy 21 screening tests.

BACKGROUND: First-trimester nuchal translucency (NT) and second-trimester triple test (TT) are common screening programmes for trisomy 21. The aim of this study was to compare disclosure and non-disclosure approaches of combining those tests. METHODS: Likelihood ratios of both NT and TT tests, among 508 normal and 23 trisomy 21-affected pregnancies, were used for calculating population-adjusted risks. Disclosure approach incorporated all cases which, by either NT or TT, exhibited a risk > or = 1:250 whereas non-disclosure approach generated a new integrated figure > or = 1:250. RESULTS: Among women aged < or = 34 years, the disclosure and non-disclosure approaches were associated with false positive rates of 4.3 and 1.1%, detection rates of 76.4 and 61.2%, positive predictive value (PPV) of 1:53 and 1:17, and false negative rate of 1:3129 and 1:1985 respectively. CONCLUSIONS: The disclosure approach resulted in considerably higher detection rates. The non-disclosure approach, however, was four times better regarding the number of invasive procedures required to detect one case of trisomy 21. However, the positive predictive value associated with the disclosure policy was still much more beneficial than that obtained in women aged > or = 37 years, who are routinely referred to fetal karyotyping.

Adult↗

PubMedDate not supplied

Correlation and overlapping between nuchal translucency and triple test among Down syndrome-affected pregnancies.

OBJECTIVES: To examine the correlation and extent of overlapping between first-trimester nuchal translucency (NT) and second-trimester triple test (TT) results in Down syndrome (DS)-affected pregnancies. METHODS: Results of both tests were obtained in 28 cases with DS. Inter-test correlation was performed by comparing the likelihood ratios (LRs). Screen-positive rates (risk >1:380) were calculated for different age groups by adjusting age-dependent background risk and tests' LRs. Overlapping referred to ratio between screen-positive cases by both tests simultaneously and total screen-positive cases by either one or both tests. RESULTS: No correlation was found between the tests' LRs (Pearson correlation test, r = 0.0487). The overlapping between the tests was 25% and 38.5% among young patients of 20 and 35 years of age, respectively. The average overlapping among patients between 25 and 35 years of age was approximately 33%. Only 3 of the 28 DS cases demonstrated LRs <1 by both tests and moreover none exhibited LRs <0.2 by both tests. CONCLUSIONS: The degree of overlapping of one third, between NT and TT, confirms the assumption that both tests utilized together improves DS detection. Screen- negative result, by both tests simultaneously, may reassure low-risk population and aid to reduce the number of non-indicated invasive tests.

Adult↗

PubMedDate not supplied

Diagnostic hysteroscopy as a primary tool in a basic infertility workup.

OBJECTIVE: To assess the value of diagnostic hysteroscopy in a primary workup of infertility. METHODS: We performed a retrospective analysis (Canadian Task Force Classification II-2) of 221 infertile patients referred to the Outpatient Center for Uterine Cavity Evaluation and the Tel-Aviv University affiliated Assaf Harofe Medical Center for evaluation of the uterine cavity. Patients underwent a diagnostic office hysteroscopy. RESULTS: Hysteroscopy revealed an abnormal uterine cavity in 30% of women evaluated for either primary or secondary infertility. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. CONCLUSION: Routine diagnostic hysteroscopy should be part of an infertility workup in primary and secondary infertility.

Adolescent↗