Biomedical subjects
Publications and source records attributed to I Bukovsky.
Four cases of erythema nodosum associated with pregnancy are reported and the literature reviewed. Erythema nodosum in pregnancy is a self-limited condition requiring minimal supportive treatment. No adverse effects upon pregnancy course or fetal outcome were noted. It is suggested that pregnancy may serve as an etiological basis for the disease.
In only a few studies of reconstructive surgery for infertility has the importance of periadnexal adhesions been examined with regard to the pregnancy rate. In the present study, 101 patients underwent reconstructive surgery for correction of infertility. Subsequent to surgery, 38.6% of the patients conceived, and 72% of the pregnancies terminated in live births. In analyzing the results, attention was focused upon the correlation between the severity of the periadnexal adhesions and the surgical outcome. By classifying the adhesions into four grades, an inverse relationship was noted between the grade of adhesions and the pregnancy rate. This relationship was consistent regardless of tubal condition, and thus became an important prognostic parameter. In the light of these findings it is felt that, in order to improve the results, more effort should be directed to the prevention of adhesion formation, together with the use of microsurgical technique in this particular field.
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Twenty-four conservative surgical procedures for unruptured tubal pregnancies were performed on 23 patients with poor past obstetric performance. All cases were diagnosed preoperatively by laparoscopy. Salpingotomy was performed in 20 cases and fimbrial expression of the ectopic pregnancy was performed in 4 cases. In the group of conservatively treated patients there were 15 live births in 11 women and 28 intrauterine pregnancies in 14 women. No ectopic pregnancies occurred in the operated tube. Early diagnosis and conservative surgical treatment of unruptured tubal pregnancy is appropriate for patients with poor reproductive histories.
The benefit of fetal heart rate monitoring was evaluated by comparing the perinatal outcome in 1.246 high-risk pregnancies and deliveries--554 monitored and 692 unmonitored. Intrapartum and early neonatal mortality were significantly lower in the monitored group (P less than 0.05). This study provides evidence that fetal heart rate monitoring improves the fetal outcome of high-risk deliveries.
Twenty-four couples facing longstanding primary or secondary infertility underwent semen analysis, PCT, functional evaluation of menstrual cycle, hysterosalpingography and laparscopy. All clinical findings were normal with the exception of PCT which was positive in 13 and negative in 11. All the women underwent a multiple approach investigation of local and circulating antibodies production as well as cell-mediated immunity against live spermatozoa. Sperm Immobilization Test (SIT) and Spermatotoxicity Tests (STT) were performed in a single experimental design on cervical mucus and blood serum. Leucocyte Migration Inhibition Test in presence of sperms (LMIT) was done on peripheral leucocytes. Local antispermatic activity in the cervical mucus was negative in all PCT positive cases, and positive in six out of 11 PCT negative cases. SIT and STT were both positive in cervical mucus and in blood in one case only. No correlation could be found between PCT and serum SIT, STT or LMIT. The fertility pattern expressed by the number of pregnancies per years of exposure, already low in the whole group, was even lower in the sub-groups with positive immunological factors. Positive immunological factors do not exclude the possibility of conception but appear to be associated with a reduced rate of conception.
The effect of dexamethasone on amniotic fluid lecithin-sphingomyelin (L/S) ratio was measured in 15 fetuses of 34 weeks or less of gestation. Six of the patients presented with premature rupture of the membranes. A rise in the L/S ratio is mature levels (two or more) was observed 24 hours to 11 days after the start of treatment in 12 patients. In 2 patients (one second twin and one anencephalic fetus), no rise in L/S ratio occurred. Of 12 cases whch ended in premature delivery (29 to 35 weeks) only one infant, a second twin delivered at the thirtieth week with a posttreatment L/S ration o1.4 weighing 1,240 grams, developed severe respiratory distress syndrome and died. Tt is suggested that dexamethasome accelerates fetal lung maturation by increasing surfactant synthesis or release, and this may be achieved as early as the twenty-eighth week of pregnancy.
Placentas and fetuses from cases of induced midtrimester abortion and fetal loss (13 weeks of pregnancy or more) were examined microbiologically. In the series of midtrimester fetal loss, bacteria were isolated in 14 per cent and genital Mycoplasma in 37 per cent of the placentas. In induced abortion, 18 per cent of the placentas grew bacteria and in only one case out of 27 was a Mycoplasma strain isolated. Fetal organs yielded cultures positive for bacteria in 16 per cent and for genital Mycoplasma in 23 per cent of the spontaneous fetal loss material, whereas pyogenic cocci were isolated from fetal organs in 18 per cent and Mycoplasma in no case of induced abortion. In the positive cases, the fetal lungs were most often infected (in 34 out of 37 positive cases of spontaneous and 4 out of 5 positive cases of induced abortion). On the other hand, microorganisms could be isolated from the brain in only 5 out of 28 cases of spontaneous and none of induced abortion. In the series of fetal loss, positive microbiologic findings from the fetal organs seemed correlated to prolonged bleeding before abortion or labor and to premature rupture of membranes.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A case of an umbilical mass as a primary presenting symptom of otherwise asymptomatic endometrial adenocarcinoma is reported. The pertinent literature is reviewed with regard to the relation of the umbilical mass to metastatic carcinoma.
Benign mixed uterine tumors are very rare. We present a case of angiomyoma of the uterus with unusual gross appearance and diffuse polypoid growth on the uterine serosal surface. We could not find a macroscopic picture like this described in the literature.
The aim of the study was to examine the prevalence of primary peritoneal serous papillary carcinoma (PPSPC) as compared with ovarian serous papillary cancer (OSPC), and to study the clinicopathologic features and the frequency of germline BRCA1 and BRCA2 mutations in patients with PPSPC compared with those with OSPC. The study group included 28 cases of PPSPC. The comparison group included 35 female patients with OSPC, matched for stage, grade, and histologic subtype. All tumors were staged as either IIIB, IIIC or IV according to FIGO criteria. The patient characteristics, family and personal history of malignancies, the prevalence of germline BRCA mutations, clinicopathologic findings, presenting symptoms, pre- and intraoperative findings, and survival were compared in a matched-case retrospective study comparing patients with PPSPC vs. those with OSPC. Statistical analysis was made using Student's t-test, Chi-square, Wilcoxon, Kaplan-Meier and log-rank methods. Women with PPSPC had a significantly earlier menarche (P = 0.037) and a higher number or births (P = 0.03) than women with OSPC. No difference was found with regard to the prevalence of germline BRCA mutations in women with PPSPC compared with women with OSPC (7.1% vs. 25.7%). There was a significant increase (P = 0.02) in the incidence of abdominal distension as reported by PPSPC (64%) vs. OSPC patients (26%). Significantly more women with PPSPC than with OSPC presented with clinical ascites (P = 0.0001) and without palpable pelvic mass (P = 0.000001). On exploratory laparotomy, significantly more women with PPSPC than with OSPC had a minimal disease in the pelvis (P = 0.0087). Three-year survival analysis demonstrated a significantly worse survival rate for the PPSPC group than for the OSPC group (P = 0.017). A significant increase in the prevalence of PPSPC compared with OSPC was observed during the study years (P = 0.00001). We concluded that PPSPC and OSPC might be two distinct cancers, presenting a new epidemiologic trend regarding the increased incidence of PPSPC.
The aim of this study was to perform a clinical and immunohistochemical comparison between simultaneous independent tumors involving endometrium and ovary and metastatic endometrial tumors, and to try to find clinical and /or immunohistochemical parameters differentiating between these two entities. Sixteen cases of simultaneous independent primaries of endometrium and ovary, presenting the same histologic type, were compared with 12 cases of primary endometrial cancer, demonstrating ovarian metastases. The comparison related to patients' characteristics and immunohistochemical expression of estrogen and progesterone receptors (ER,PR), bcl-2, HER-2 /neu, p53, and cell proliferation marker Ki-67 in endometrial and ovarian tumors. The only clinical parameter differentiating significantly between the groups was the prevalence of familial cancer, being more frequent in the group of metastatic tumors (P = 0.03). Immunohistochemical analysis demonstrated the same immunostaining in endometrium and ovary for all immunohistochemical parameters in cases of metastatic endometrial cancer. Conversely, 62.5% of cases with simultaneous tumors of endometrium and ovary could be differentiated from metastatic tumors by distinct immunohistochemical expression of ER and PR in endometrial and ovarian tumors (P = 0.0006), and 31.3% of cases could be differentiated by distinct immunostaining for bcl-2 (P = 0.03). Immunohistochemical parameters HER-2 /neu, p53 and Ki-67 were not appropriate for the distinction between the two study groups. We conclude that the application of immunohistochemical analysis may play an important role in the differentiation between cases of simultaneous independent carcinomas of endometrium and ovary vs. cases of endometrial carcinoma with ovarian metastases.
The wide use of assisted conception methods has risen dramatically. The greater proportion of singletons, twins and high order of multiplicity conceived by those methods have already focused the medical community to various obstetric complications. Recently, there have been suggestions that the levels of mid-gestation serum markers, particularly human chorionic gonadotrophin (HCG), might be affected by assisted conception, leading to higher false-positive results. Furthermore, women who conceived after assisted reproduction methods are on average older, and in many cases their current pregnancy was achieved after long-standing infertility and might even be their last one. This is why they are extremely wary of any invasive fetal karyotyping. Therefore, every effort should be made to provide them with the most accurate screening of Down's syndrome (DS) risk. In this respect, nuchal translucency (NT) measurement, which has been reported to be another effective screening method, might be a more reliable marker in these pregnancies. This review explores the problematic issue of antenatal DS screening in assisted conception pregnancies. For the singletons and twins, a sequential NT and second-trimester serum marker screening can be offered, thus producing a single risk estimation which seems to be more accurate. For the high order of multiplicity, the NT offers additional important data, which can be taken in consideration both as a screening tool for DS and if fetal reduction is planned.
OBJECTIVE: To determine the role of postpartum intrauterine manipulation of the uterine cavity in the formation of intrauterine adhesions. PATIENTS AND METHODS: Diagnostic hysteroscopy was performed following manual removal of the placenta in 48 patients. RESULTS: Intrauterine adhesions were observed in only one case (2%), and an incomplete uterine septum was found in seven cases (15%). CONCLUSIONS: Manual removal of the placenta does not seem to predispose to the formation of uterine adhesions. Incomplete uterine septum may be involved in some of the cases of retained placenta.