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E Shalev

Publications and source records attributed to E Shalev.

At least 19 recordsLinked to original sources

First-trimester ultrasonic diagnosis of twin reversed arterial perfusion sequence.

Twin reversed arterial perfusion (TRAP) syndrome sequence is a rare specific anomaly of twin gestation with fused placentae and umbilical anastomosis. This syndrome occurs once in very 35,000-48,000 births and has been described in the second trimester (23-29 weeks of gestation). We report on early sonographic diagnosis (10 and 12 weeks' gestation) of two cases of TRAP sequence, together with their umbilical cord Doppler studies.

Adult

High levels of maternal serum alpha-fetoprotein and human chorionic gonadotrophins leading to the diagnosis of combined neural tube defect and partial mole.

A case of combined partial mole and neural tube defect is presented. The detection of high levels of both maternal serum (MS) alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG) during the second trimester led to the ultrasonic demonstration of anencephaly, omphalocele, and partial mole. This is the first report of combined elevation of MSAFP and MShCG.

Adult

Ultrasonic diagnosis of mediastinal cystic hygroma.

The incidence of cystic hygroma, which represents dilated obstructed jugular lymph sacs, is 1 in 6000 pregnancies. Cystic hygromas can be located in the nuchal area or in any other location. The prenatal ultrasonic diagnosis of a cystic hygroma in the mediastinum is presented.

Adult

Retrograde seeding of endometrial carcinoma during hysteroscopy.

Fractional dilatation and curettage remain the most reliable methods in the diagnosis of endometrial carcinoma in the symptomatic patient. In the past few years hysteroscopy has become a helpful method, improving the specificity of the diagnosis of this pathology. We report a case of clinical stage IA grade 2 endometrial adenocarcinoma diagnosed by hysteroscopy and endometrial biopsy. Surgical staging revealed positive cytology. We suggest that irrigation of the endometrial cavity during the hysteroscopic procedure with saline may disseminate the disease to the abdominal cavity and may change the prognosis and the course of treatment.

Adenocarcinoma

Relapsing thymic carcinoma during pregnancy.

A 23 year old woman, who was known to be in remission from thymic carcinoma, presented in her first trimester. She had previously been treated with radiation and chemotherapy. Her pregnancy was complicated by fever and contractions at 30 weeks and ended with the birth of a live preterm male infant. Subsequent investigation revealed a massive relapse of her mediastinal tumor. This case reinforces the devastating consequences that pregnancy has on thymic hyperplasia. Of nine previously reported cases, five of the women died either during pregnancy or within six months and only one was alive longer than five years. Therapeutic abortion should be considered in the pregnant woman with known thymic neoplasia.

Adult

[Ultrasonic estimation of fetal weight].

To generate formulas to estimate fetal weight on the basis of sonographic measurements, 226 pregnant women were scanned within 3 days of delivery. Measurements included: biparietal diameter, head circumference and area, abdominal circumference and area, and femoral length. The contribution of each parameter to the estimation of fetal weight was tested by stepwise regression analysis. The best dependent variable was found to be the log of weight. The formula based on cranial and abdominal parameters proved to be inaccurate, especially when fetal weight was less than 2500 g. The addition of femoral length improved weight estimation, with a multiple r of 0.95174. The addition of gestational age led to even more accurate formulas. The most accurate found was based on biparietal diameter, abdominal circumference, femoral length and gestational age, with a multiple r of 0.95651 and an absolute mean error of 7.976 +/- 5.657%. It also produced better weight estimates at the 2 extremes of fetal weight.

Anthropometry

Laparoscopic detorsion of adnexa in childhood: a case report.

A case of adnexal torsion in premenarchal child is presented. Prompt diagnosis was made with the use of pelvic ultrasound and laparoscopy. The later was used for establishing the diagnosis and furthermore for untwisting the adnexa. We suggest that laparoscopy should precede laparotomy and that conservative detorsion should be done more liberally in the young patient.

Abdominal Pain

Duplex Doppler ultrasound in the evaluation of pregnancies complicated by pregnancy-induced hypertension.

Umbilical artery velocimetry using pulsed Doppler technique was carried out in 49 pregnancies complicated by pregnancy-induced hypertension (PIH). Outcome of the pregnancies was evaluated after delivery. We found the systolic to diastolic ratio of the umbilical artery to be highly sensitive and specific in predicting abnormal outcome in pregnancies complicated by PIH. In our opinion, the pulsed Doppler technique can be a useful adjunct to other methods for evaluation of fetal well-being in patients with PIH.

Blood Flow Velocity

Sonography-guided fetal blood sampling for pH and blood gases in premature fetuses with abnormal fetal heart rate traces.

In nine pregnancies, remote from term, with an abnormal Non-Stress Test (NST) and Bio-Physical Profile (BPP) of 3 or above, cordocentesis for fetal blood gas analysis was performed. In seven cases an immediate post-partum blood sample was taken from the fetal cord for a similar analysis. The two tests gave very similar results. The results showed fetal acidemia (pH 7.09-7.19 and B.E. -10-15) in 4 cases, followed by immediate delivery. In the remaining 5 cases, normal blood gases were evident (pH 7.28-7.35); despite the abnormal NST, pregnancy was allowed to continue for 2 to 7 weeks, under close supervision. At birth, 2 out of 9 newborns were deemed by the neonatologist suffering from asphyxia. Both belonged to the acidemic group of women who were managed by immediate cesarean section. The other 5 fetuses, which were managed expectantly, had normal post-partum blood gases or Apgar score; none had asphyxia. Fetal blood gas analysis, on samples obtained by cordocentesis, provides useful information that can assist in the management of premature fetuses suspected of being distressed, according to their heart traces. Normal fetal blood gases can identify those fetuses falsely identified by the NST as in distress and thereby spare them unnecessary premature birth with its known complications.

Acidosis

Pseudomonoamniotic twins with cord entanglement following genetic funipuncture.

Amniocentesis was performed twice on a twin gestation, and twice there was cell growth failure in one of the twins. Therefore, funipuncture was attempted at 24 weeks. The anatomical relationship and position of the fetuses, placental cord insertion, and membranous septum dictated needle entry into the cord of the lower left fetus through the sac of the upper right fetus and the septum. The procedure was uneventful and the pregnancy was carried to 39 weeks. However, the septum between the twins had been disrupted, creating a pseudomonoamniotic pregnancy. This was noticed only after delivery of the first fetus, when it was found that the two umbilical cords were entangled. We believe that, whenever possible, puncture of the membrane between twins should be avoided. Should puncture be necessary, the possibility of pseudomonoamniotic twins must be considered.

Adult

Predictive value of the femur length to abdominal circumference ratio in the diagnosis of intrauterine growth retardation.

The ratio between sonographically measured fetal femur length to abdominal circumference (F/A) was studied in 471 consecutive normal singleton pregnancies from 18 to 40 weeks' gestation. The 90th (0.2715) percentile of this ratio was evaluated as a predictor for intrauterine growth retardation (IUGR) in an additional 1,502 pregnant women; 146 fetuses were found to be above the 90th percentile, of which 20 were born growth retarded. A total of 69 fetuses was found post partum to be small for date; 44 were asymmetrically growth retarded and 25 were symmetrically growth retarded. Of the 20 growth-retarded fetuses, which were correctly diagnosed in utero, 19 were asymmetrically growth retarded. The additional 49 growth-retarded newborns were not detected using the F/A ratio as a diagnostic parameter. Low sensitivity (29.98%) together with low positive predictive value (13.69%) rendered the parameter unsuitable for screening IUGR. Nevertheless, the high specificity (91.20%), together with the high negative predictive value (96.38%), makes it a useful age-independent parameter in high risk pregnancies, where asymmetric IUGR is suspected.

Abdomen

[Pseudocyesis].

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Female