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Biomedical subjects

D Bider

Publications and source records attributed to D Bider.

At least 55 records · Page 3Linked to original sources
PubMed1994

Transient blood oxygen desaturation, hypercapnia, and coagulopathy after operative hysteroscopy with glycine used as the distending medium.

OBJECTIVE: Our purpose was to report transient complications associated with operative hysteroscopy with glycine used as the distending medium. STUDY DESIGN: All the operative hysteroscopies performed over a 6-month period by a single operator were examined. The blood oxygenation and end-tidal carbon dioxide concentrations were monitored in all cases with a pulse oximeter and a capnograph. Blood samples were obtained during the operation and over the next day to determine coagulation functions, sodium levels, and a complete blood cell count. RESULTS: Oxygen desaturation accompanied by a simultaneous increase in blood carbon dioxide levels occurred in six of the 46 patients. In addition, four of these patients were found to have a significant blood coagulopathy. Hyponatremia was observed in only two of the latter patients. CONCLUSION: Patients undergoing transcervical resection of the endometrium or submucous myomectomy must be closely monitored because disturbances in oxygenation and coagulation functions are not rare. The possibility of avoiding these complications by careful control of intrauterine pressure and the absorption of glycine should be further examined.

Adult↗
PubMed1994

Complete failure of fertilization in couples with mechanical infertility: implications for subsequent in vitro fertilization cycles.

OBJECTIVE: To determine whether complete failure of fertilization of oocytes in couples with mechanical infertility during the first IVF cycle indicates a poor prognosis for subsequent IVF cycles. DESIGN: A retrospective study of 172 cycles of IVF in 50 couples with mechanical infertility and complete failure of fertilization during their first IVF trial. SETTING: In vitro fertilization unit of the Sheba Medical Center. PATIENTS: Fifty couples undergoing one to eight cycles of IVF for mechanical infertility. MAIN OUTCOME MEASURE(S): Fertilization rate of retrieved oocytes and pregnancy rate. RESULTS: Of the initial 50 couples, 44 underwent additional IVF cycles, and 43 (97.7%) achieved fertilization during the second or third cycle. Twenty-four patients conceived during the study period as a result of IVF. CONCLUSIONS: Complete failure of fertilization in couples with mechanical infertility does not necessarily persist during subsequent IVF cycles. Therefore, at least two more IVF cycles should be attempted before reverting to other therapeutic options. Complete failure of fertilization during the first cycle of IVF in couples with mechanical infertility is accompanied by a good prognosis for subsequent cycles.

Female↗
PubMed1994

Laparoscopic laser surgery of primary ovarian pregnancy.

We present a rare case in which therapy of primary ovarian pregnancy, using laparoscopic laser surgery (videolaseroscopy), was successfully performed without the need of laparotomy. Because operative laparoscopy has the benefits of reduced morbidity, reduced hospitalization and rapid recovery, and because it has the advantage of reducing postoperative adhesions as compared to laparotomy, it is the preferable technique for treatment of ovarian gestation after a laparoscopic diagnosis, especially for a woman who desires to preserve her fertility potential.

Adult↗
PubMed1994

A new approach to ovarian cystectomy: a combined laparoscopic and extra-abdominal microsurgical technique.

Our objective was to apply a new surgical technique to ovarian cystectomy combining the advantages of laparoscopy with the benefits of microsurgical principles, in an attempt to simplify the surgical laparoscopic procedure and reduce postoperative adhesion formation. Between May 1991 and March 1992, extracorporal ovarian cystectomy was performed in 27 patients who presented with persistent ovarian cysts at the department of gynecology of a large teaching hospital that receives primary referrals from public health care patients. Patients were referred with the diagnosis of a persistent ovarian cyst. Diagnosis was confirmed by pelvic bimanual examination, and transvaginal ultrasound. Cases where malignancy was suspected due to the presence of ascites, semi-solid or solid masses, demonstration of papillations within the ovarian cyst on ultrasound, or elevated CA-125 levels (unless endometriosis was suspected) were excluded from the study group. At laparoscopy, after inspection of the abdominal cavity the cyst was aspirated. The ovary was then extracted through a 2- to 3-cm lower-abdominal incision, cystectomy was meticulously performed according to microsurgical principles, and the repaired ovary was then returned into the abdominal cavity. Extracorporal cystectomy was successfully performed in 26 of 27 cases. The mean duration of the operative procedure was 55 min. The postoperative course was uneventful. Mean postoperative hospitalization time was 22.4 h. Over a follow-up period of up to 15 months, ovarian folliculogenesis was confirmed ultrasonographically. In the first 2 patients to undergo second-look laparoscopy, no adhesions were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Lack of association between ovarian follicular size and number and the occurrence of multiple pregnancies in menotropin cycles.

A high rate of ovarian multifollicular development and resulting multiple pregnancy remains the main problem of ovulation induction with human menopausal gonadotropins. The aim of this study was to examine a possible correlation between the number and size of ovarian follicles at the time of human chorionic gonadotropin (hCG) administration and to find parameters that can predict the occurrence of multiple pregnancies. Sixty-eight intrauterine pregnancies, 53 singletons and 15 multiple pregnancies in 51 patients, were included in this study. We found no significant difference in the mean estradiol levels, the total number of pre-ovulatory follicles, or the mean number of large, intermediate or small follicles at the time of hCG administration between women who had singleton pregnancies and those with multiple pregnancies. Our study demonstrates that estradiol levels and ovarian ultrasonography do not provide criteria for the prediction of the occurrence of multiple pregnancies in menotropin cycles.

Chorionic Gonadotropin↗
PubMed1993

Complete failure of fertilization in couples with unexplained infertility: implications for subsequent in vitro fertilization cycles.

OBJECTIVE: To determine whether complete failure of fertilization of oocytes in couples with unexplained infertility persists during subsequent in vitro fertilization (IVF) cycles. DESIGN: A retrospective study of 120 cycles of IVF in 44 couples with unexplained infertility and complete failure of fertilization during their first IVF trial. SETTING: In vitro fertilization unit of the Sheba Medical Center. PATIENTS: Forty-four couples undergoing IVF for unexplained infertility. MAIN OUTCOME MEASURE(S): Fertilization rate of retrieved oocytes and pregnancy rate. RESULTS: Of the initial 44 couples, 37 underwent additional IVF cycles and 30 (81.1%) achieved fertilization. Seven patients conceived during the study period as a result of IVF and two conceived spontaneously. CONCLUSIONS: Complete failure of fertilization does not necessarily persist during subsequent IVF cycles. Therefore, at least two more IVF cycles should be attempted before reverting to other therapeutic options. However, although fertilization can be achieved in most couples, the mean oocyte fertilization rate during subsequent cycles in this group is low. This suggests an underlying undiagnosed pathology of oocyte/sperm interaction in some of these patients.

Female↗
PubMed1993

Long-term follow-up of the twisted ischemic adnexa managed by detorsion.

OBJECTIVE: To examine our assumption that although the twisted adnexa appears ischemic-hemorrhagic, it can safely be revived by detorsion with preservation of ovarian function. DESIGN: Patients' records were obtained from a computerized database and reviewed. The preoperative diagnosis of adnexal torsion was based upon patients' symptoms, clinical examination, laboratory investigations, and ultrasound scanning. SETTING: Gynecology department at a large teaching hospital receiving primary referrals of public sector patients. PATIENTS: In 40 patients who presented with signs and symptoms suggestive of ovarian torsion, "black-bluish" ischemic adnexa were encountered at surgery. INTERVENTIONS: All patients were managed by unwinding of the adnexa: laparotomy in 26 cases and operative laparoscopy in 14. In 13 patients detorsion only was performed, in 15 detorsion and cystectomy were carried out, and in 12 patients detorsion was done and ovarian cysts aspirated. MAIN OUTCOME MEASURES: Postoperative course, mean hospitalization period, follow-up pelvic examination, ovarian folliculogenesis on ultrasound examination, and oocyte retrieval and fertilization. RESULTS: The size of the twisted ovary ranged from 4 to 20 cm (mean, 9.5 cm). The postoperative course was uneventful, except for transient temperature elevation in five patients. The mean hospitalization period was 6.5 days (range 5 to 10 days) after laparotomy and 1.8 days (range 1 to 3 days) after laparoscopy. Three patients were lost to follow-up. In 37 patients, pelvic examination was normal. A normal sized ovary, with follicular development, was demonstrated sonographically in 35 of 37 patients. In 6 of 7 patients, macroscopically normal adnexa were visualized at subsequent laparotomy or laparoscopy. In two patients undergoing IVF, oocytes were retrieved and fertilized from the detorted ovary. The patency of the fallopian tube was demonstrated in four cases. CONCLUSIONS: This new "adnexal-sparing" approach should be applied instead of the traditional salpingo-oophorectomy in young women with twisted ischemic adnexa.

Adnexal Diseases↗
PubMed1993

Methotrexate therapy of tubal pregnancy.

Reports of successful treatment of ectopic pregnancies by administration of methotrexate have recently attracted a great deal of attention. This review summarizes the results of therapy with methotrexate in tubal pregnancy. Different technical approaches and pharmacological doses have been reported. These methods, however, present various problems, including the occurrence of toxicity, long therapeutic periods and treatment failure. With proper selection of patients, a success rate of approximately 90% has been achieved. Preliminary assessment of subsequent fertility provides promising results. However, the majority of the reports do not include controls.

Chorionic Gonadotropin↗
PubMed1993

Seasonal patterns in tubal pregnancy.

An investigation of possible seasonal patterns in ectopic tubal pregnancies was conducted. The computer data utilized were based on all ectopic pregnancies, abortions and deliveries (total pregnancies) recorded in the Department of Obstetrics and Gynecology at the Chaim Sheba Medical Center, Israel, between the years 1986 and 1989. Composite monthly cohorts of ectopic tubal pregnancies and total pregnancies were constructed for each month of the year, and the probability of an ectopic pregnancy was estimated. A statistically significant increase in the probability of conception rate resulted in ectopic pregnancies which occurred during winter and spring, especially in January to June. The probability of ectopic tubal pregnancies was low (0.50%) in September and high (1.81-1.42%) in December to January. When we studied primigravidae, the same seasonal pattern was observed. The findings of our study suggest, for the first time, that there is an association between meteorological and environmental factors, and ectopic pregnancies. These factors should be considered in the epidemiology of ectopic tubal pregnancies.

Analysis of Variance↗
PubMed1992

Unsuccessful methotrexate treatment of a tubal pregnancy with a live embryo.

Two cases with unsuccessful local and systemic methotrexate (MTX) therapy of tubal pregnancy with fetal heart rate activity are reported. The three modes of therapy, the first with local potassium chloride solution injection, the second with local MTX injection, and the third with systemic MTX injection, failed in the resolution of viable ectopic pregnancy. Therapy of MTX in cases of tubal pregnancy with demonstrable fetal heart rate beats, should be reconsidered.

Adult↗
PubMed1992

The effect of gonadotropin-releasing hormone agonist on the ovarian response and in vitro fertilization results in polycystic ovarian syndrome: a prospective study.

OBJECTIVE: To assess the effect of gonadotropin-releasing hormone agonist (GnRH-a) on pituitary suppression, subsequent ovarian response, and results of in vitro fertilization (IVF) treatments in polycystic ovarian syndrome (PCOS) patients. DESIGN: Randomized prospective study. SETTING: In vitro fertilization program and endocrinologic institute. PATIENTS: Thirty patients with PCOS; 16 received GnRH-a, and 14 did not receive GnRH-a. INTERVENTIONS: Ovum pick-up and embryo transfer. MAIN OUTCOME MEASURES: Response to GnRH-a test, serum and follicular fluid (FF) hormonal measurements, steroid levels, and aromatse activity in granulosa cell (GC) culture, and results of IVF. RESULTS: Pituitary responsiveness was abolished in all patients 14 days after GnRH-a administration, and early luteinization was prevented. Steroid levels in FF did not differ between the two groups. In GC culture, progesterone (P) levels were higher in patients without the GnRH-a (3,704 +/- 1,232 nmol/L versus 2,117 +/- 235 nmol/L; P less than 0.05) as were androstenedione (A) levels (5.3 +/- 1.0 nmol/L versus less than 3.5 nmol/L; P less than 0.05). However, aromatase activity and IVF results were similar in the two groups. CONCLUSIONS: Administration of GnRH-a in patients with PCOS decreases P and A production by the GC cells and prevents early luteinization. It does not affect the IVF results.

Female↗
PubMed1992

Cytokine levels in follicular fluid of polycystic ovaries in patients treated with dexamethasone.

OBJECTIVE: To assess the levels of cytokines in the follicular fluid of stimulated ovaries. DESIGN: The study included two groups of four patients with polycystic ovarian disease. These were diagnosed by clinical and ultrasonic features and characteristic hormonal profiles, treated with gonadotropin-releasing hormone-analogue and human menopausal gonadotropin. One group received dexamethasone (DEX). MAIN OUTCOME: Dexamethasone is capable of directly affecting granulosa and immune cells. It was also expected to affect cytokine production of granulosa and immune cells of the ovary. RESULTS: This study demonstrates that FF from patients treated with DEX has reduced tumor necrosis factor (TNF) activity and elevated colony-stimulating factor levels. Regardless of the treatment with DEX, the follicles with high levels of TNF contained minimal concentrations of estradiol. Interleukin-6 did not differ between the FF samples. CONCLUSIONS: These results suggest a role for cytokines in the process of folliculogenesis and ovarian maturation. Modification of cytokines by DEX might explain the beneficial effect of fertility.

Colony-Stimulating Factors↗
PubMed1992

Failure to fertilize in vitro in couples with male factor infertility: what next?

OBJECTIVE: To assess the predictive value of a failure to fertilize in vitro in couples with sperm abnormalities on future fertility. DESIGN: Retrospective file review. SETTING: In vitro fertilization and embryo transfer (IVF-ET) program in the Sheba Medical Center during the years 1983 to 1990. PATIENTS: Seventy-six couples with sperm abnormalities who had at least one IVF cycle during which fertilization did not occur. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Occurrence of fertilization, percentage of fertilization, and pregnancies in additional IVF-ET cycles. RESULTS: Of 44 couples who underwent an additional IVF attempt with husband's sperm, 36 (81.2%) fertilized, with a mean fertilization rate of 47.7% +/- 26.6%. Of 17 couples who failed twice, 11 attempted IVF again with husband's sperm and 7 fertilized, with a median rate of 33%. A higher sperm concentration was found on the cycles during which fertilization occurred. Men with single parameter abnormalities did not fertilize better than those with two or three defective parameters. CONCLUSIONS: Failure to fertilize in vitro in couples with male factor infertility does not seem to predict future fertilization in IVF. At least two cycles of IVF should be tried before reverting to other options such as insemination by donor sperm or gamete micromanipulation.

Embryo Transfer↗
PubMed1992

Treatment of interstitial pregnancy with methotrexate via hysteroscopy.

We present a case in which treatment of interstitial pregnancy with local MTX administration was performed successfully through hysteroscopic vision, without the need to operate. Decreased gestational sac dimension and increased or low beta-hCG level ( < 1,400 mIU/mL) facilitates the success rate. The follow-up showed disappearance of the gestational sac and decrease of beta-hCG levels to < 10 mIU/mL. We conclude that local MTX administration via hysteroscopy after tubal ostium visualization is feasible. The procedure should be considered in women during the reproductive age, especially in rare cases of interstitial pregnancy.

Adult↗
PubMed1992

Recurrence rate after fluid aspiration from sonographically benign-appearing ovarian cysts.

The outcome after fluid aspiration from 41 sonographically benign-appearing ovarian cysts was assessed. The considerable probability of recurrence was significantly higher after ultrasound-guided aspiration than following aspiration via laparoscopy (54% versus 30%, respectively, at 36 months). Although all the recurring cysts were benign, the concern with malignancy and the high recurrence rate seem to indicate that fluid aspiration from sonographically benign-appearing cysts by either method is not the management of choice.

Adolescent↗
PubMed1992

Cervical cerclage for anomalous uteri.

The role of cervical cerclage was evaluated in 54 pregnant women with anomalous uteri. Forty-six of them delivered live neonates, and eight aborted. The success rate was 85.2% as compared to 22% in previous pregnancies. The mean gestational age was 38 weeks (range, 32-42). The average birth weight was 3,150 g. Complications from the cerclage procedures were minor. Our results support the trend toward the use of cervical cerclage in pregnant women with anomalous uteri.

Adult↗