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Biomedical subjects

I Bukovsky

Publications and source records attributed to I Bukovsky.

At least 55 records · Page 3Linked to original sources
PubMed1998

Transvaginal drainage of ascites as an alternative to abdominal paracentesis in patients with severe ovarian hyperstimulation syndrome, obesity, and generalized edema.

OBJECTIVE: To describe an alternative technique for transvaginal drainage of ascites in a case of severe ovarian hyperstimulation syndrome (OHSS), generalized edema, and obesity. DESIGN: Case report. SETTING: A university-based hospital IVF and Reproductive Medicine Unit. PATIENT(S): A patient hospitalized with severe OHSS after IVF-ET in whom drainage of large amounts of ascitic fluid was necessary. INTERVENTION(S): Ultrasonographic transvaginal insertion of a wire guide through a standard IVF needle into the Douglas pouch. Placement of a "peel-away" set on the wire, which was replaced with a "pigtail" indwelling catheter. MAIN OUTCOME MEASURE(S): Amount of drained ascitic fluid. RESULT(S): Ascitic fluid was drained efficiently, leading to improvement of the patient's condition. CONCLUSION(S): Transvaginal ultrasonography-guided insertion of a pigtail catheter through the Douglas pouch is an efficacious procedure when the abdominal approach for decompression of ascites is difficult.

Adult↗
PubMed1998

A comparison of clinical and ultrasonic estimation of fetal weight.

OBJECTIVE: To compare the accuracy of routine ultrasonic and clinical birth weight estimation. METHODS: The study sample included 1717 women with singleton pregnancies, admitted in early labor with an ultrasonic estimated fetal weight (EFW) performed during the preceding week. Clinical EFW was obtained before rupture of the membranes by the attending senior resident, who was unaware of the ultrasonic EFW. Accuracy was determined by the percentage error, the absolute percentage error, and the proportion of estimates within 10% of the actual birth weight (birth weight +/- 10%). Statistical analysis was done by the paired t test, the comparison of correlated variances, the Wilcoxon sign test, and the chi2 test. Actual birth weight in the study sample averaged 3334+/-607 g (+/- standard deviation, [SD]) and ranged between 690 and 5320 g. RESULTS: The means of all error terms of the clinical EFW were significantly smaller than those of the ultrasonic EFW. However, the rates of estimates within 10% of birth weight were not significantly different (72 and 69%, respectively). In birth weights less than 2500 g, both methods overestimated the birth weight, but the mean errors of the ultrasonic EFW were significantly smaller than those of the clinical EFW. The ultrasonic EFW had significantly higher rates of birth weight +/- 10% than the clinical EFW (63 compared to 49%, respectively). In the 2500-4000 g birth weight, only the clinical EFW had no systematic error, whereas the ultrasonic EFW underestimated the birth weight. The mean errors of the clinical EFW were significantly smaller and the rate of birth weight +/- 10% significantly higher than those of the ultrasonic EFW. In the birth weight greater than 4000 g, both methods underestimated the birth weight, and the mean errors and the rate of estimates within 10% of birth weight were similar for both methods. CONCLUSION: Clinical estimation of birth weight in early labor is as accurate as routine ultrasonic estimation obtained in the preceding week. In the lower range of birth weight (less than 2500 g), ultrasonic estimation is more accurate; in the 2500-4000 g range, clinical estimation is more accurate. In the higher range of birth weight (greater than 4000 g), both methods have similar accuracy.

Adult↗
PubMed1998

Image magnification does not contribute to the repeatability of caliper placement in measuring nuchal translucency thickness.

The objective of this study was to assess whether nuchal translucency image magnification contributes to the repeatability of caliper placement. Twenty-seven women undergoing first-trimester ultrasound screening at 11-14 weeks were examined by two qualified examiners. Fetal nuchal translucency thickness was measured twice by each examiner on a regular-sized image and subsequently on the same still image magnified. Intraobserver repeatability coefficients of the regular-sized images were 0.28 mm and 0.34 mm for examiners A and B, respectively. Identical intraobserver repeatability coefficients of 0.28 mm were attained for both examiners on the magnified images. Interobserver repeatability of regular-sized image measurements showed a significant difference (p < 0.01) but the mean difference (+/- standard deviation) of 0.10 (0.18) mm was negligible. Similarly, interobserver repeatability of the magnified-image measurements yielded a significant difference (p < 0.02), but again with a small mean difference of 0.13 (0.26) mm. There were also significant differences when regular-sized images and magnified images were compared for both examiners: 0.08 (0.16) mm for examiner A (p < 0.02) and 0.10 (0.17) mm for examiner B (p < 0.01). Our results demonstrate that nuchal translucency image magnification does not contribute to the reproducibility of the measurement. Despite significantly smaller mean values obtained from the magnified images, compared to the regular-sized measurements, those differences do not justify modification of the criteria for caliper placement on magnified images. Blind repeated measurements on a regular-sized and/or magnified image are recommended as a tool for self-assessment, quality control and training.

Female↗
PubMed1998

Nuchal translucency audit: a novel image-scoring method.

OBJECTIVE: The aim of this study was to evaluate the feasibility and reproducibility of a novel image-scoring method of first-trimester nuchal translucency measurement as an objective tool of ongoing audit and training. DESIGN: This was an independent evaluation of nuchal translucency images by three separate reviewers unaware of the examiner. SUBJECTS: There were 105 consecutive singleton pregnancies undergoing first-trimester screening. METHODS: Each image was scored according to the following criteria: section (oblique, 0; mid-sagittal, 2), caliper placing (misplaced, 0; proper, 2), skin line (nuchal only, 0; nuchal and back, 2), image size (unsatisfactory, 0; satisfactory, 1), amnion (not visualized, 0; visualized, 1) and head position (flexion/hyperextension, 0; straight, 1). The final score was categorized into one of four quality groups: excellent (8-9), reasonable (4-7), intermediate (2-3), unacceptable (0-1). RESULTS: The distributions of the four quality groups were similar between the three reviewers: 11.4% were classified as excellent, 57.1% as reasonable, 25.7% as intermediate and 5.7% as unacceptable. Inter-reviewer agreement showed identical classification, by each pair of reviewers, from 65.7% to 74.3%, and partial agreement to neighboring quality groups from 25.7% to 34.3% of the cases. In none of the cases did the reviewers differ in categorizing cases to remarkably different quality groups. Application of the auditing method to the examiners showed similar distribution to the various quality groups and similar mean final score of 4.69 (0.39, SE), 4.54 (0.15, SE) and 4.65 (0.15, SE). CONCLUSIONS: The described image-scoring method represents a new approach towards the evaluation of ultrasound performance as a whole and nuchal translucency measurement in particular. It may be employed by every center in an independent manner with minimal resources and regardless of the method of risk assessment. More studies will be needed to determine the standards required from the examiners and to elucidate the contribution of the proposed auditing method to the examination's quality and the process of training.

Female↗
PubMed1998

Unilateral hydrothorax as a sole and recurrent manifestation of ovarian hyperstimulation syndrome following in-vitro fertilization.

Acute unilateral hydrothorax may appear as the sole extra-ovarian expression of severe ovarian hyperstimulation syndrome (OHSS). This case report describes two such cases, in one of which the patient developed this rare complication in two consecutive ovarian stimulation cycles. Awareness is needed for the timely and appropriate diagnosis of this rare complication that occurs 9-14 days following human chorionic gonadotrophin (HCG) administration and may recur in consecutive stimulation cycles. Thoracocentesis and fluid balance maintenance are efficient modes of therapy resulting in good outcome.

Adult↗
PubMed1998

Pelvic splenosis mimicking endometriosis, causing low abdominal mass and pain.

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. The clinical significance of these splenic implants and the need for surgical removal is debatable. A case of a 35 year old woman, with post-traumatic splenectomy presenting with low abdominal pain and pelvic mass is reported. Laparoscopic removal of the pelvic splenic implants dispelled all complaints.

Abdominal Pain↗
PubMed1998

Measurement of intrauterine human decidua-associated protein 200 and diagnosis of ectopic pregnancy.

The aim of the current study was to examine whether the measurement of intrauterine human decidua-associated protein (hDP) 200 might be of clinical value in the diagnosis of ectopic pregnancy versus early missed abortion. Uterine fluid levels of hDP 200 were measured in two groups of patients: 20 women with ectopic pregnancy, diagnosed by laparoscopy, and 20 women diagnosed (after curettage) as having a missed abortion. No significant difference in hDP 200 levels was observed comparing patients with ectopic pregnancy (mean 114.0+/-58.2 mU/ml) and patients with early missed abortion (mean 222.0+/-116.0 mU/ml), although a trend towards lower levels of uterine fluid hDP 200 was noted in the group of patients presenting with tubal pregnancy. Thus, according to our data, intrauterine hDP 200 is not sufficiently discriminative to be of clinical value in the diagnosis of ectopic pregnancy.

Abortion, Missed↗
PubMed1998

Intrauterine levels of human decidua-associated protein (hDP) 200 in normal pregnancy and missed abortion.

Levels of human decidua-associated protein (hDP) 200 were measured in amniotic fluid samples, obtained from 32 induced and 21 missed abortions at 9-20 weeks of pregnancy. A 3-fold decrease in the hDP 200 level was observed between 9 and 20 weeks of normal pregnancy. Moreover, no significant difference was observed comparing the level of hDP 200 and the pattern of its decrease in missed and induced abortions. Thus, according to our results, hDP 200, being a monoclonal rheumatoid factor, is probably not required for the continuation of normal pregnancy.

Abortion, Missed↗
PubMed1998

Prediction of the survival of patients with advanced ovarian cancer according to a risk model based on a scoring system.

PURPOSE OF INVESTIGATION: The aim of the study was to devise a scoring system based on significantly prognostic parameters which might predict the survival time for each individual patient. METHODS: The study group included 40 patients with stage III or IV invasive ovarian cancer, operated on between 1987 and 1994. Different preoperative and intraoperative parameters were examined and their impact on survival was assessed using the Kaplan-Meier method. Survival rates were compared by the log rank test. The parameters, which have been found to be significant prognostic factors, were incorporated into the final risk model, based on a scoring system. The scores were given according to the cut-off point of each prognostic parameter. A correlation coefficient was calculated from the survival curve, representing the combined scores of individual patients versus their survival. RESULTS: From all studied parameters, only gravidity, the stage of ovarian cancer and the preoperative levels of LDH and CA-125 were demonstrated to have a significant impact on survival. On the basis of these four parameters a scoring system was devised. The scores were given considering the cut-off level of each parameter: gravidity < or = 2 versus > 2; stage of the cancer - IIIA, IIIB and stage IIIC versus stage IV; LDH level < or = 240 versus > 240 U/L; CA-125 < or = 100 versus > 100 U/ml. The average of the combined scores representing the four parameters was the final risk factor, which was plotted against the survival of each individual patient. A correlation coefficient of -0.99 was found. CONCLUSIONS: Our data suggest that the survival of each individual patient with advanced ovarian cancer could be predicted quite accurately considering our risk model based on a scoring system which incorporates four preoperative and intraoperative parameters. This scoring system needs to be validated by larger prospective trials.

Adult↗
PubMed1998

Well-differentiated versus less-differentiated endometrial carcinoma.

The aim of this study was to compare well-differentiated (grade 1) and less-differentiated (grades 2 and 3) endometrial carcinoma, concerning clinical risk factors, presenting symptoms and operative findings. Seventy-one surgically staged endometrial carcinoma cases were reviewed and retrospectively divided according to tumor differentiation into two groups: grade 1 cases (Group I; n=40) and grade 2 and 3 cases (Group II; n=31). No difference was found between the two groups when comparing patient age, gravidity and parity, history of hypertension, diabetes or other malignancies, duration of menopause, number of patients receiving hormonal replacement therapy and histological type of tumor. There was also no difference in presenting symptoms or in duration of uterine bleeding up to the diagnosis of endometrial carcinoma. On the other hand, patients with well-differentiated tumors, as compared to patients with less-differentiated endometrial carcinoma, were significantly more obese (p<0.02), had a smaller uterus (p<0.01) and presented with less advanced stage disease (p<0.0005). The fact that the age of the patients, as well as the duration of uterine bleeding before diagnosis, was similar in both groups may indicate that more advanced cases, as in group II, represent originally a more aggressive tumor rather than progression from a well-differentiated disease. This hypothesis needs further research.

Aged↗
PubMed1997

Peritoneal fluid lactate dehydrogenase in ovarian cancer.

In attempt to identify patients with ovarian carcinoma and differentiate them from patients with benign ovarian tumor or other gynecological malignancies, peritoneal fluid and serum lactate dehydrogenase (LDH) levels were measured in 51 patients: 15 with ovarian carcinoma, 15 with endometrial carcinoma, 4 with cervical carcinoma, and 17 with benign ovarian tumor. Peritoneal fluid and serum LDH levels in ovarian cancer patients were significantly higher than those in patients with benign ovarian tumor (P < 0.001) or other gynecological malignancies (P < 0.001 and P < 0.03, respectively). Yet, peritoneal fluid LDH demonstrated higher diagnostic sensitivity (87%) and greater diagnostic accuracy (90%) than serum LDH (60 and 77%, respectively) or serum CA-125 (73 and 83%, respectively). Comparing the histological types of ovarian cancer, serous cystadenocarcinoma presented higher peritoneal fluid LDH levels than endometrioid or mucinous cystadenocarcinoma. No difference in peritoneal fluid LDH was observed comparing different stages of ovarian cancer. The results suggest that peritoneal fluid LDH may be an efficient biochemical marker in diagnosis of ovarian cancer.

Adolescent↗
PubMed1997

The outcome of in vitro fertilization in unexplained habitual aborters concurrent with secondary infertility.

OBJECTIVE: To compare the IVF-ET reproductive performance of unexplained habitual aborters with nonaborting women with similar characteristics also treated with IVF-ET. DESIGN: Controlled clinical study. SETTING: In Vitro Fertilization Unit, Assaf Harofeh Medical Center, Zerifin, Israel. PATIENT(S): Twenty patients with habitual abortions and secondary infertility were subjected to 42 IVF-ET cycles. Their reproductive performance in IVF-ET was compared with the performance of the next followed nonaborting patients, pulled from a database, based on similar age and IVF indications. INTERVENTION(S): Ovulation induction with IM Depo-triptorelin 3.75 mg and menotropins. Oocyte retrieval, embryo transfer, and luteal supplementation with hCG. MAIN OUTCOME MEASURE(S): Mean number of oocytes and fertilizations, mean number of embryos and their morphology. Pregnancy rates (PRs) and pregnancy outcome. RESULT(S): The mean number of oocytes, fertilizations, and embryos was higher in the aborters compared with the controls. Morphology of the transferred embryos was similar in both groups though in general better quality embryos developed in the aborters group. Pregnancy rates were similar in both groups (32% and 29% per cycle). Pregnancy outcome of the habitual aborting patients in IVF-ET remained unsuccessful, as before treatment: 50% abortions (7/14) compared with only an 8% abortion rate (1/12) in the controls. CONCLUSION(S): Habitual aborters' performance at early stages of IVF-ET is better compared with their controls. Despite similar PRs in IVF-ET cycles, their pregnancy outcome after IVF-ET is unsuccessful, as before IVF-ET.

Abortion, Habitual↗
PubMed1997

Human decidua-associated protein (hDP) 200 identified as a monoclonal rheumatoid factor is not an acute phase reactant.

PROBLEM: The role of human decidua associated protein (hDP) 200, identified as a monoclonal rheumatoid factor, has not been determined yet. This study examines if this protein, being an immunoglobulin, participates in the inflammatory processes involving the uterus. METHOD: Uterine fluid samples were obtained prospectively from two groups of women: the study group, containing 26 women with laparoscopically verified pelvic inflammatory disease (PID), and the control group, containing 34 regularly cycling, fertile women, referred to the Family Planning Clinic. Uterine fluid sampling was performed once in each patient, and the concentration of uterine fluid hDP 200 was determined by double site ELISA, by using the monoclonal antibody DEC 21. RESULTS: A statistically significant decrease in uterine fluid hDP 200 concentration was observed in women with pelvic inflammatory disease as compared to regularly cyclin fertile women (P < 0.00004). The hDP 200 levels in women with PID ranged from 10 to 1,000 mU/ml, with no difference in hDP 200 concentration among intra-uterine device (IUD) users as compared to non-users. CONCLUSION: This study supports the concept that hDP 200, identified as monoclonal rheumatoid factor existing locally in the uterus, is not an acute phase reactant but is probably involved in the reproduction process.

Abdominal Abscess↗
PubMed1997

Low levels of human decidua-associated protein 200 in uterine fluid reflect pathological conditions of the endometrium.

Uterine fluid levels of human decidua-associated protein (hDP) 200 were measured in regularly cycling fertile women, postmenopausal women with normal endometrium and in women with endometrial hyperplasia or endometrial carcinoma. A statistically significant decrease in hDP 200 levels (p < 0.0001) was observed in postmenopausal women and in women with endometrial hyperplasia or carcinoma as compared with regularly cycling women possessing a normal endometrium. Furthermore, a significant increase in the uterine fluid hDP 200 level (p < 0.0008) was observed in women with endometrial hyperplasia following treatment with medroxyprogesterone acetate. These findings suggest that uterine fluid hDP 200 may be a useful marker for screening endometrial pathology as a result of hormonal imbalance or as a result of malignant histological differentiation, and it may also be used to monitor the response of the endometrium to progestogen treatment.

Adult↗
PubMed1997

Localized and diffuse ovarian cancer: is it the same entity?

In order to confront the question whether localized and diffuse ovarian cancers are the extremes of the same disease or two different entities, we compared anamnestic, intraoperative and laboratory findings, as well as the outcome. Sixty-four patients with invasive epithelial ovarian cancer were treated in our department between 1984-1991. After excluding patients with incomplete data, 59 women were finally included in the analysis. The patients were divided retrospectively into two groups according to the extent of the disease observed during the primary surgery. Disease confined to the ovaries was defined as localized form, and any other extraovarian involvement was defined as diffuse form. Twenty patients had localized (Group I), and 39 had diffuse disease (Group II). Comparing the two groups, no difference was observed concerning patient age, the age of menarche and menopause, gravity and parity, the percentage of smoking and hypertensive women, and the histologic type of the ovarian tumor. On the other hand, significant differences were obtained concerning the positive family history of cancer in localized versus diffused disease (10% versus 41%) (p < 0.04), the size of the tumor involving the ovaries (16.2 +/- 5.4 cm versus 7.0 +/- 3.1 cm) (p < 0.0001), the unilateral as opposed to bilateral disease (p < 0.0001), the volume of ascitic fluid (p < 0.002) and the histologic grade (p < 0.02). Laboratory parameters, including CA-125, serum albumin, total protein and lactate dehydrogenase differed significantly comparing the localized and diffused disease (p < 0.04, p < 0.0001, p < 0.003, p < 0.05, respectively). The median survival rate was significantly higher (p < 0.001) in patients with localized versus diffused disease. Our results support the concept that localized and diffused forms of ovarian cancer are probably two different entities.

Adult↗
PubMed1996

Placental-site trophoblastic tumor following metastatic gestational trophoblastic neoplasia.

Placental site trophoblastic tumor generally follows term pregnancy or nonmolar abortion. Thus far, 10 cases of placental site trophoblastic tumor have been described which were preceded by a hydatidiform mole. This is the first reported case where placental site trophoblastic tumor has been preceded by metastatic gestational trophoblastic neoplasia treated by chemotherapy.

Adult↗
PubMed1996

Abortion at 18-22 weeks by laminaria dilation and evacuation.

OBJECTIVE: To evaluate the complications of late second-trimester abortions (18-22 weeks) by laminaria dilation and evacuation, and the obstetric outcome of subsequent pregnancies. METHODS: Dilation of the cervix was achieved by repeated laminaria tent replacement. Evacuation was carried out in the outpatient clinic using general anesthesia. After the first menstrual period, all patients were invited for examination and thereafter were asked to report the outcome of subsequent pregnancies. RESULTS: One hundred seventy-one late second-trimester abortions were performed. Cervical dilation was satisfactory in 158 women (92%). Operative sonography was required in nine (5%) women. One had uterine atony. Follow-up from 150 (88%) women indicated no infection, but one woman required repeat curettage for retained products of conception. There was no indication of cervical injury on cervical internal os measurements remote from abortion. Of the 50 patients who conceived and elected to continue the subsequent pregnancies, two had premature deliveries unrelated to cervical incompetence, and all others reached term. CONCLUSION: Late second-trimester termination by laminaria dilation and evacuation is safe and probably not associated with future adverse pregnancy outcome.

Abortion, Induced↗