PubMed Health⌕ Search

Biomedical subjects

I Bukovsky

Publications and source records attributed to I Bukovsky.

At least 37 records · Page 2Linked to original sources
PubMed2000

Ovarian function before and after salpingectomy in artificial reproductive technology patients.

To determine the effect of the removal of the tube on ovarian function we studied 52 artificial reproduction technology cycles in 26 women before and after undergoing laparoscopic salpingectomy for ectopic pregnancy. Ovarian response was measured by the duration and quantity of human menopausal gonadotrophins used in the cycle, the pre-ovulatory concentrations of oestradiol, the number of oocytes retrieved, and the quality of the embryos. All parameters were compared between cycles carried out before and after salpingectomy as well as between affected and unaffected sides. Our findings show no significant difference in any of the parameters studied. We conclude that laparoscopic salpingectomy does not abate ovarian response in artificial reproduction technology cycles that follow the procedure.

Adult↗
PubMed2000

Placental levels of human decidua- associated protein 200 in normal pregnancy and missed abortion.

Levels of human decidua-associated protein (hDP)200 were measured in homogenized placental tissue samples obtained from 26 induced and 24 missed abortions at 8-23 weeks of pregnancy. No significant difference in the level of placental hDP200 was observed comparing normal pregnancies and missed abortions. Moreover, no significant change in the level of placental hDP200 was demonstrated throughout normal pregnancies and those ending with missed abortions. Our results show that the level of hDP200 in placental tissue, measured by double-site ELISA, is probably incompatible with the normal continuation of pregnancy.

Abortion, Missed↗
PubMed2000

Placental apoptosis in normal and abnormal pregnancies.

The aim of this study was to demonstrate apoptosis in the human placenta in normal and abnormal pregnancies. The percentage of apoptotic cells in placental samples was quantified by analyzing the cell cycle of nuclei stained with propidium iodide using a flow cytometer. No significant difference in the percentage of apoptotic cells was observed comparing the group of normal pregnancies (first and second trimesters) with those of missed abortions. There was also no difference in the incidence of apoptosis comparing placental samples obtained from chromosomally normal and abnormal pregnancies. Yet, there was a significant increase in the incidence of apoptosis in placental samples obtained from second and third trimesters as compared with those obtained from the first trimester (p<0.04 and p<0.01, respectively). There was also a significant increase in the incidence of placental apoptosis in the third as compared with the second trimester (p<0.03).

Abortion, Missed↗
PubMed2000

Clinical and sonographic fetal weight estimates in active labor with ruptured membranes.

OBJECTIVE: To determine and compare the accuracy of clinical and sonographic estimates of fetal weight (EFW) in active labor with ruptured membranes. STUDY DESIGN: Clinical and sonographic EFWs were obtained on 107 term patients in active labor, with cervical dilatation of 4 cm or more and ruptured membranes. Accuracy of birth weight was determined by calculating percentage error, absolute percentage error and ratio of estimates within 10% of actual birth weight for all stages of labor. Statistical analysis was by paired t test, Wilcoxon sign test, chi 2 test and Mann-Whitney U test; P < .05 was considered significant. RESULTS: Absolute percentage errors were lower by the sonographic method at all stages. Except for the second stage of labor, the rates of birth weight +/- 10% were higher with the sonographic method than with the clinical method (83.17% vs. 60.75% and 84.9% vs. 63.44%, respectively). Estimations performed in the first stage were more accurate than in the second stage with both methods (absolute error of 7.82 +/- 5.5 vs. 12.38 +/- 4.9 for clinical and 5.44 +/- 5.99 vs. 9.08 +/- 3.19 for sonographic). CONCLUSION: During active labor with ruptured membranes, sonographic EFWs are more accurate than clinical estimations. The accuracy of both methods is reduced during the second stage of labor.

Adult↗
PubMed2000

The existence of insoluble-rheumatoid factor based immune complexes in menstrual fluid.

The aim of this study was to examine the existence of insoluble immune complexes, composed of monoclonal rheumatoid factor (human decidua-associated protein-hDP 200) in the precipitate of menstrual fluid. The identification of precipitable immune aggregates was based on immunofluorescent staining and ELISA. Both assays demonstrated the existence of rheumatoid factor, as well as immunoglobulins IgG, IgM, IgA and IgE. The quantification of immunoglobulins by ELISA demonstrated the predominance of IgG and rheumatoid factor. Furthermore, ELISA was performed to demonstrate the rheumatoid factor activity in the precipitate obtained from menstrual fluid. Thus, the rheumatoid factor, identified by monoclonal antibody DEC 21, was demonstrated to form precipitable immune complexes, which might provide a physiological mechanism to remove the unnecessary antibodies formed due to fetal allograft or intra-uterine infection.

Antigen-Antibody Complex↗
PubMed1999

[Screening for Down's syndrome at week 10-14 by measuring fetal nuchal translucency thickness].

Increased fetal muchal translucency (NT) thickness at 10-14 weeks of gestation may indicate underlying fetal chromosomal abnormalities, anatomical anomalies and genetic syndromes. Between January 1997 and May 1998, 1400 women 10-14 weeks pregnant underwent sonographic screening for detection of Down's syndrome (DS). Follow-up was complete in 1208 (86%). Maternal age ranged from 17-44 years (mean 18.0). 87% were found by screening to have a higher risk (1:380) for DS diagnosed at birth. All these fetuses were karyotyped and 8 had chromosomal abnormalities. 2 fetuses with normal NT were diagnosed later as having DS, 1 by the mid-gestation triple test and 1 by amniocentesis because of advanced maternal age. Thus sonographic screening identified 8 out of 10 fetuses found to have chromosomal abnormalities at birth. Neonates not karyotyped before birth had no traits at birth that justified chromosomal analysis. Results of this study suggest that NT measurement, combined with maternal age, is an effective 1st trimester screening method for DS in an unselected obstetric population.

Adolescent↗
PubMed1999

Comparison of nuchal translucency measurement and second-trimester triple serum screening in twin versus singleton pregnancies.

Maternal serum screening for Down syndrome (DS) in twin pregnancies poses difficulties due to a lack of precise biochemical information about each co-twin. The current study attempts, for the first time, to compare two screening methods: nuchal translucency (NT) measurement and serum screening for DS, in twin pregnancies. 60 women with twin pregnancies (study group) underwent both first-trimester NT scanning and mid-trimester triple-marker serum screening, and were followed throughout their gestation. Nuchal translucency measurements were compared with a matched control of 120 singleton pregnancies with a similar (+/-2 years) maternal age and fetal crown-rump length (CRL) (+/-3 mm). In both analyses, a risk of 1:380, or higher, of having a DS newborn was considered screen positive. Both mean maternal age (31+/-3 years) and CRL (62+/-11 mm) were similar in the study and control groups. The median NT measurement expressed as multiples of the median (MOM) for CRL was similar in the study and control groups (0.85 and 0.88, respectively). Based on NT measurements, 5 per cent of the pregnancies in the study group and 2.5 per cent in the control group were defined as screen positive (p =N. S). Mid-gestation serum screening was associated with 15 per cent and 6 per cent screen-positive rate in study and control groups, respectively (p<0. 05). There was a ratio of 1:3 screen-positive rate between first and second-trimester screening tests within the study group. This high false-positive rate results led to 18.3 per cent amniocentesis rate in the study group compared with 7.5 per cent of the control group (p<0.03). Only one co-twin which was picked up by the NT screen was further diagnosed as trisomy 21, and one co-twin with cardiac and neural tube defect was missed by the two screening tests and was later picked up in an anomaly scan. Although the current series is too small to provoke any changes in screening practice, when twin pregnancies are diagnosed, it seems very reasonable to offer them NT measurement. A larger group may be needed to clarify which approach is the most beneficial screening policy for this highly selected group of pregnant women.

Adult↗
PubMed1999

Omphalocele delivery enigma: the best mode of delivery still remains dubious.

OBJECTIVE: To determine an optimal route of delivery for fetuses with prenatally diagnosed omphalocele. DATA SOURCE: MEDLINE search of years 1966-1996. RESULTS: Descriptive retrospective analyses do not support the idea that cesarean delivery of fetuses with omphalocele is associated with an improved survival rate. However, most of those studies do not control for confounding variables like type and severity of associated anomalies, omphalocele size, prematurity rate, presence of trial of vaginal delivery, rate of intrapartum sac rupture, tertiary treatment centers accessibility, time and type of surgical correction, and postoperative morbidity. There is no evidence that vaginal delivery is safer than cesarean for fetuses with isolated small omphalocele. Fetuses with giant (>5 cm) omphalocele should be delivered by cesarean section. Vaginal delivery at term is offered for fetuses with coexisting life-threatening anomalies. CONCLUSIONS: We propose that until randomized trial of vaginal and cesarean delivery for fetal omphalocele is available, the preferred mode of delivery would be the vaginal route as that is safer for the mother.

Abnormalities, Multiple↗
PubMed1999

Implementation of nuchal translucency image-scoring method during ongoing audit.

OBJECTIVE: The aim of this study was to evaluate the contribution of an ongoing audit, using the image-scoring method, to the quality of nuchal translucency images and to set the basic standards required from the examiners. DESIGN: Evaluation of nuchal translucency images, before, during and after the implementation of an ongoing audit, without knowledge of the time period or the examiner. SUBJECTS: A total of 315 nuchal translucency scans were performed by three examiners. METHODS: Each of the retrospective, intermediate and prospective time periods included blind scoring of 105 images. The effect of the ongoing audit was examined by comparing the distribution of the quality groups and the mean final score between the time periods, for all cases and for each examiner separately. Improvement of the criteria was assessed by comparing the rate of scans meeting the demands between the time periods. RESULTS: The quality of the images improved significantly as the mean final score changed from 4.62 +/- 0.21 to 6.19 +/- 0.19 and to 6.91 +/- 0.16 (p < 0.0001) and the rate of obtaining acceptable scans rose from 72% to 88% and to 92% (p < 0.001), respective to the three time periods. Whereas the three major criteria improved significantly before and after implementation of the audit (mid-sagittal section from 48% to 94%, caliper placement from 60% to 75% and skin line from 19% to 77%), the minor criteria remained unchanged (image size 90%, amnion demonstration 25% and head position 77%). The average scores of two examiners, for whom improvement was more pronounced, were used to determine the basic standards required from examiners subjected to the audit as follows: unacceptable, none; intermediate, 5%; reasonable, 65%; excellent, 30%; with a mean final score of 7.25. CONCLUSIONS: Implementation of an ongoing audit, using the image-scoring method, proved to be an efficient method for surveillance and improving the quality of nuchal translucency images. We recommended centers or individuals practicing first-trimester ultrasound screening to consider its routine utilization, in an unbiased and strict manner.

Analysis of Variance↗
PubMed1999

Characteristics of normal lochia.

The objective of this paper is to determine the characteristics of each phase of lochia and how these may be influenced by a number of obstetric variables. Thirty-nine healthy women who had spontaneous vaginal delivery following uncomplicated pregnancy volunteered to complete a diary sheet immediately postpartum. The women were instructed to assess the color of their lochia by a color slide with differential gradation from dark red to white. The color was labeled as rubra (red, red-brown), serosa (brown-pink, brown), or alba (yellow, white). The overall duration of lochia was 36.0 +/- 7.5 days (range 17 to 51 days, median 37 days). Three types of lochia color patterns were identified: type 1--rubra-->serosa-->alba sequence (n = 20); type 2-rubra-->serosa-->alba sequence with prolonged rubra phase and short serosa and alba phases (n = 11); and type 3-with two rubra phases (rubra-->serosa/alba-->rubra-->serosa/alba sequence with near-equal duration of each phase) (n = 8). The rubra phase lasts 12.1 +/- 6.7 days in type 1, 24.8 +/- 5.0 days in type 2, and 5.5 +/- 2.5 days (the first rubra) in type 3 pattern (p < 0.05). There was a higher proportion of lactating women among women with type 1 pattern as compared with type 2 (11/20 and 2/11, p < 0.05, respectively). Women with type 2 pattern were of higher parity (2.8 +/- 1.3) as compared with those with type 1 (1.8 +/- 0.8) (p < 0.05). There were no significant differences in infants' birth weight between the various color types (3,276.0 +/- 379.8 g, 3,564.4 +/- 737.9 g, and 3,080.0 +/- 180.0 g for type 1, type 2, and type 3, respectively. There were no significant differences in overall duration of lochia or gestational age at delivery between the various color types. The results confirm the clinical impression that lochia persists longer than classically reported and is of diverse patterns. Three unique types of color patterns were identified. Type 1 is the most prevalent and is associated with prolonged breast feeding and thus can be considered as the classic type. Type 2 is associated with short or no breast feeding and higher parity. Type 3 may be a variant of type 2. We suggest that traditional teaching on lochia characteristics needs reappraisal.

Adult↗
PubMed1999

Can nuchal cord cause transient increased nuchal translucency thickness?

When detected in a first trimester scan, an increased thickness of nuchal translucency (NT) may be associated with chromosomal, cardiac or genetic disorders. However, less attention has been devoted to the outcome of those fetuses who have confirmed normal anatomies and karyotyping, but have abnormal first trimester scans. Thus, a challenging new issue is how to counsel such cases of transient increased NT in which the translucency rapidly vanishes with no evidence of other underlying abnormalities. Two cases of transient increased thickness of NT are reported. In both, a nuchal cord was ultrasonographically demonstrated and a thorough work-up revealed chromosomally and anatomically normal fetuses. The pathophysiological theories behind these observations and their significance are discussed. Based on these observations, we suggest that transvaginal sonography combined with Doppler flow studies should be utilized for the presize detection of cord patterns to accomplish the work-up in cases of increased NT.

Adult↗
PubMed1999

Luteal support with micronized progesterone following in-vitro fertilization using a down-regulation protocol with gonadotrophin-releasing hormone agonist: a comparative study between vaginal and oral administration.

This study aimed to compare the efficacy of micronized progesterone administered as luteal support following ovulation induction for in-vitro fertilization (IVF)- embryo transfer in cycles using gonadotrophin-releasing hormone agonist, either orally (200 mgx4/day) or vaginally (100 mgx2/day) and to characterize the luteal phase hormonal profile during such treatments. A total of 64 high responder patients requiring intracytoplasmic sperm injection due to male factor infertility were prospectively randomized into two treatment groups. Patients treated orally or vaginally were comparable in age (31.9 +/- 6.1 versus 30.6 +/- 5.2; mean +/- SD), number of oocytes retrieved (17 +/- 8.2 versus 18 +/- 7.0), and number of embryos transferred (3.1 +/- 1.2 versus 2.7 +/- 0.9) per cycle. Following low dose vaginal treatment, a significantly higher implantation rate (30.7 versus 10.7%, P < 0.01), but similar clinical pregnancy rate (47.0 versus 33.3%) and ongoing pregnancy rate (41.1 versus 20.0%) was observed, compared with oral treatment. In conception cycles, luteal serum progesterone and oestrogen concentrations did not differ between the treatment groups. In non-conception cycles, late luteal progesterone concentrations were significantly lower following vaginal treatment. As low dose micronized progesterone administered vaginally is simple, easy and well tolerated, it could be recommended as the method of choice for luteal support, especially for high responder patients at risk for ovarian hyperstimulation syndrome.

Administration, Intravaginal↗
PubMed1999

The feasibility of nuchal translucency measurement in higher order multiple gestations achieved by assisted reproduction.

Nuchal translucency (NT) measurement for screening chromosomal abnormalities and detecting fetal anomalies is an effective ultrasonographic marker, originally developed for singleton pregnancies. This study sought to evaluate the feasibility of NT measurements in higher order multiple gestations. Pregnant patients who conceived following assisted reproduction and were carrying three or more fetuses were enrolled in the study. Each fetus was ultrasonographically assessed, a NT measurement was obtained, and the findings were used for counselling prior to any invasive procedure. In all, 24 pregnant patients, initially carrying 79 fetuses aged 10-14 weeks of gestation, were compared with 79 consecutively matched, singleton controls, naturally conceived, having similar crown-rump lengths (+/- 3 mm). NT measurements were feasible for both study and control fetuses, which exhibited similar NT measurements for 5th, 50th and 95th centiles. Also, mean NT thicknesses [measurements in mm or multiple of the medians (MOM)] were similar for both groups (1.41 +/- 0.41 and 1.35 +/- 0.39 mm respectively and 0.87 +/- 0.23 and 0.83 +/- 0.25 MOM respectively). Prenatally no chromosomal abnormalities were detected in either group, and, of those infants who had no karyotyping, no traits were observed that warranted chromosomal analysis. NT measurements are feasible in higher order multiple gestations. Since there is no other effective screening modality for these pregnancies, it seems reasonable to recommend NT measurement for antenatal screening services for higher order multiple gestations.

Chromosome Aberrations↗
PubMed1999

The level of human decidua-associated protein (hDP) 200, identified as a monoclonal rheumatoid factor in the fallopian tube.

PROBLEM: The aim of this study was to examine whether ectopic pregnancy is associated with increased levels of human decidua-associated protein (hDP) 200, identified as a monoclonal rheumatoid factor, in the related fallopian tube as compared with normal tubes. METHOD OF STUDY: Tubal fluid samples were obtained prospectively from two groups of patients: group I, 20 patients admitted for total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO); group II, 14 women with ectopic pregnancy, undergoing unilateral salpingectomy by laparoscopy or laparotomy. hDP 200 was assayed using double-site enzyme-linked immunosorbent assay. RESULTS: Very low levels of hDP 200 were found in normal tubes, while tubes with ectopic pregnancy demonstrated significantly higher levels of tubal fluid hDP 200 (P < 0.00001). In addition, in women with ectopic pregnancy, the uterine fluid level of hDP 200 was significantly lower than the level of hDP 200 in the tube containing ectopic pregnancy (P < 0.0001). CONCLUSION: The increased level of hDP 200 (a monoclonal rheumatoid factor) in the tube containing ectopic pregnancy, as compared with uterine cavity and normal tubes, might be associated with the implantation site of the pregnancy.

Adult↗
PubMed1999

Peritoneal fluid analysis in the differentiation of ovarian cancer and benign ovarian tumor.

PURPOSE: The aim of the study was to try to identify the biochemical markers in peritoneal fluid which might be useful in discrimination between ovarian cancer and benign ovarian tumor. METHODS: The study included 75 patients: 43 with invasive ovarian cancer, 6 with borderline ovarian cancer and 26 with benign ovarian tumor. The peritoneal fluid samples from all these patients were subjected to cytologic examination and to analysis of lactate dehydrogenase (LDH), total protein, albumin and cholesterol. In addition, peritoneal fluid to serum ratio of LDH and total protein, as well as serum CA-125 were assayed. The biochemical parameters were compared between cases of ovarian cancer and cases of benign ovarian tumor, as well as between the different histological types and stages of ovarian cancer. RESULTS: All the examined parameters demonstrated a significant difference comparing patients with ovarian cancer and those with benign ovarian tumor (p<0.001). Yet, the greatest diagnostic accuracy was achieved by measuring peritoneal fluid LDH (86%) and cholesterol (93%). Moreover, significant differences in the level of assayed parameters were found when comparing different histological types and stages of ovarian cancer. In order to further corroborate the diagnostic performance, we combined the parameters of LDH and cholesterol with cytology, thus increasing the diagnostic accuracy to 96%. CONCLUSION: The association of peritoneal fluid LDH and cholesterol may represent a primary tool for the discrimination of patients with ovarian cancer (even borderline) from those with benign ovarian tumor, particularly in the presence of negative cytology.

Adult↗
PubMed1999

[Endothelial dysfunction and lipid profiles: analysis of the EDO Study].

On the basis of experimental as well as clinical observations, endothelial dysfunction is (defined as impaired or absent endothelium-dependent relaxation) considered to be an important factor in the atherogenesis. Serum lipids abnormalities have been accepted as an epidemiological risk factor of atherosclerosis. In vitro, experimental as well as epidemiological studies revealed the fact, that lipoprotein oxidation plays an important role in atherogenesis. Recently invented non-invasive methods to test and measure the endothelial function in vivo opened the opportunity to study the influence of different serum lipids on the endothelial function directly. Therefore, we decided to employ this non-invasive method for studying the endothelial function and observe the influence of various levels of plasma lipids and lipoprotein oxidation on the endothelial function of arteries in middle-aged men, since they are the most endangered part of population. In our study we used a method of measuring the diameter of a. radialis by high-resolution ultrasound (Sonoline 450, Siemens, Japan) and further mathematical and statistical analysis of functional as well as relative vasodilation reserve followed these measurements. Blood samples were taken within 24 hours of ultrasonography to study serum lipids (total cholesterol, HDL, triglycerides) and parameters of oxidation/antioxidation (superoxid dismutase--SOD, malondialdehyde--MDA). Sixty men, 25-45 years old, from an area of basically the same level of pollution were examined. We found a negative correlation between FVDR and TCH (p = 0.01), FVDR and Tg (p = 0.002) and FVDR a TCH/HDL (p = 0.015). Positive correlation exists (p < 0.001) between TCH, Tg levels and TCH/HDL ratio and MDA level in all cases. Analysing further data from the EDO Study, we can conclude, that increased plasma lipids are more likely to be oxidized, which, in turn, is the probable reason of endothelium-dependent vasodilation impairment.

Adult↗
PubMed1999

Comparison of nuchal translucency measurement and mid-gestation serum screening in assisted reproduction versus naturally conceived singleton pregnancies.

It has been reported that second-trimester serum markers may be affected by assisted reproduction leading to a higher false-positive rate. The current study compares 10-14 week nuchal translucency (NT) measurement and early mid-trimester serum screening in pregnancies resulting from assisted reproduction versus naturally conceived pregnancies. 75 pregnant women with a singleton pregnancy achieved by assisted reproduction underwent both 10-14 weeks NT measurement and second-trimester triple test and were followed throughout gestation. They were compared with matched controls for gestation and maternal ages. A risk of 1:380 or higher or having a fetus with Down syndrome was considered as screen-positive in both tests. The mean maternal age (30+/-3 years) and crown-rump length (61+/-9 mm) were similar, and there was no difference in NT thickness distribution between the groups. Based on NT measurement, 4 (5 per cent) women in the study and 2 (3 per cent) in the control groups, were defined as screen positive (p=NS). However, 11 (15 per cent) women in the study group and 4 (5 per cent) in the control group were found screen-positive by the triple test (p<0.05). A significantly higher amniocentesis rate of 20 per cent was noted in the study group compared with 8 per cent in the controls (p<0.05). All karyotypes were normal and no miscarriages or structural malformation were diagnosed in either group. We confirm the observation that assisted reproduction may adversely affect second-trimester screening results, which did not affect the NT screening test. Since these series are relatively small, larger series may be needed to clarify the most beneficial screening policy for this highly selected group of pregnant women.

Adult↗