Biomedical subjects

I Bukovsky

Publications and source records attributed to I Bukovsky.

At least 73 records · Page 4Linked to original sources

PubMed1996

Female urinary stress incontinence--does it have familial prevalence?

OBJECTIVE: Many factors have been suggested to contribute to the development of urinary stress incontinence in women. One of the suggested factors has been attributed to a genetic defect in the connective tissue in such patients. The purpose of this study was to evaluate the prevalence of urinary stress incontinence among relatives of patients with urinary stress incontinence. STUDY DESIGN: The prevalence of urinary stress incontinence among first-degree relatives was investigated in 259 females with urinary stress incontinence. A control group comprising 165 women without micturition disorders was randomly selected from our gynecologic outpatient clinic. The two groups were matched according to age, parity, maximal birth weight, and percentage of first-degree relatives on whom information was obtained. RESULTS: Data from 780 first-degree relatives in the study group and 474 in the control group were evaluated. We found that there was an overall prevalence of 20.3% (178/780) first-degree relatives in the study group compared with 7.8% (37/474) in the relatives of the control group (p<0.05). Among the mothers we found the prevalence of urinary stress incontinence to be 34.9% (71/203) in the study group compared with 12.7% (19/149) of mothers in the control group (p<0.005). Among the sisters in the study group the prevalence of urinary stress incontinence was 19.9% (73/367) compared with 6.8% (15/220) of sisters in the control group (p<0.005). Among the daughters we found the prevalence in the study group (6.7%) to be twice as high as in the control group (2.9%), but the difference did not reach statistical significance. CONCLUSIONS: The results of this study indicated a three-fold prevalence of urinary stress incontinence among first-degree relatives of female patients with urinary stress incontinence. This finding may support the theory of a genetic factor in the cause of urinary stress incontinence.

Adult↗

PubMed1996

Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation.

OBJECTIVE: Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. STUDY DESIGN: Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration of hospital stay, decrease in levels of beta-human chorionic gonadotropin, and fertility outcome were compared between the two groups. RESULTS: The salpingostomy group had a longer operative time (p < 0.0001) but a shorter hospital stay (p < 0.01) and a lower incidence of persistent trophoblastic activity (5% vs 14%), although this difference did not reach statistical significance. The time interval until beta-human chorionic gonadotropin disappearance was similar (13.9 and 13.7 days), and the subsequent intrauterine pregnancy rate was similar in the two groups (83.5% and 81%). One repeat tubal pregnancy occurred in the salpingostomy group. CONCLUSIONS: Both these methods of conservative management are equally effective and each one has its merits.

Chorionic Gonadotropin, beta Subunit, Human↗

PubMed1996

Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions.

Intravenous immunoglobulins, first given to recurrent aborters with anti-phospholipid syndrome, have been administered to unexplained aborters since 1986. They probably have immunomodulatory properties beyond supplying blocking antibodies. When pregnancy was confirmed, women were started with a loading dose which was repeated every 3-4 weeks until the second trimester. Dosages were empirical. Pregnancy rates ranged between 50 and 82%. The main maternal complications, i.e. allergic reactions and infections, were rare.

Abortion, Habitual↗

PubMed1996

The benefits of mid-luteal addition of human chorionic gonadotrophin in in-vitro fertilization using a down-regulation protocol and luteal support with progesterone.

Luteal support is essential in in-vitro fertilization (IVF) when long-acting gonadotrophin-releasing hormone agonist (GnRHa) is used. Because progesterone lacks luteotrophic stimulation, it seems to be the drug of choice in cases with an increased risk of ovarian hyperstimulation syndrome (OHSS). The aim of this study was to assess the beneficial effect of the mid-luteal addition of human chorionic gonadotrophin (HCG) in IVF, using a down-regulation protocol and luteal support with progesterone, in a prospective randomized study. The study included 170 IVF cycles down-regulated with long-acting GnRHa which were supported with 50 mg/day progesterone i.m. during the luteal phase. Patients were evaluated in the mid-luteal period. Those without clinical signs of OHSS, oestradiol concentrations <1000 pg.ml and progesterone concentrations <50 ng/ml were randomly allocated to either the addition of 2500 IU HCG (HCG+ group) or no HCG (HCG- group). End luteal phase progesterone concentrations among non-pregnant patients were used to assess the contribution of exogenous progesterone and to categorize pregnancies according to their corpus luteum function. Similar low OHSS (2.7 and 1.8%) and pregnancy (30 and 29%) rates were observed in the HCG+ and HCG-groups respectively. Of the 26 pregnancies in the HCG+ cases, there was only one case with reduced corpus luteum function, compared with 12 or the 25 pregnancies among HCG-patients. Cases with reduced corpus luteum function required continuous progesterone support and presented lower betaHCG concentrations and a higher rate of adverse pregnancy outcome. We conclude that mid-luteal HCG addition does not affect pregnancy rate, but in fact helps to preserve corpus luteum function and avoids the need for further supplementation during early pregnancy.

Adult↗

PubMed1996

Ripening of the unfavorable cervix with extraamniotic catheter balloon: clinical experience and review.

The use of an extraamniotic catheter balloon, inflated above the internal cervical os, has been advocated as a nonpharmacological, mechanical method of cervical ripening before induction of labor. Additional measures may include applying traction on the catheter, or the infusion of normal saline (1 ml/min) via the catheter's port into the extraamniotic space. The results of catheter balloon cervical ripening are reviewed from 13 published reports and a departmental series of 190 pregnancies with unfavorable cervix, encompassing nearly 1000 patients. A mean change in cervical score of at least 3 points, was noted in most studies after balloon expulsion or removal. The present series and other studies suggest that oxytocin use for induction and/or augmentation of labor is increased after balloon ripening, compared with its use in spontaneous labor or after cervical ripening by prostaglandins. In 11 studies, catheter balloon ripening was compared with cervical ripening by other mechanical, or pharmacological (i.e., oxytocin or prostaglandins) methods. Of these, eight were prospective and randomized-controlled and three were case-controlled studies. It is suggested that ripening efficacy by catheter balloon is similar, or better, than other methods; but there is no significant difference in the mode of delivery or perinatal outcome. This review also suggests that cervical ripening with extraamniotic catheter balloon has the advantages of simplicity, low cost, reversibility, and lack of systemic or serious side effects.

Adult↗

PubMed1996

Sequential measurements of human decidua-associated protein (hDP) 200 in the uterine fluid during the menstrual cycle.

PROBLEM: To examine the relationship between the concentration of uterine fluid human decidua-associated protein (hDP) 200, identified as a monoclonal rheumatoid factor, and different phases of the menstrual cycle. METHODS: Sequential measurements of hDP 200 concentration in uterine fluid were performed in 11 normal ovulatory women, aged 22-36 years. The samples were collected in early proliferative phase, late proliferative phase, periovulatory period, early secretory phase, and late secretory phase. RESULTS: Consistent fluctuations of hDP 200 levels in uterine fluid were found throughout the menstrual cycle. High levels were found during early proliferative phase and periovulatory period related to significantly lower levels during late proliferative and early luteal phases. CONCLUSION: There is menstrual phase dependent variation in the uterine fluid levels of hDP 200.

Adult↗

PubMed1996

Abnormal uterine bleeding with normal uterine fluid level of human decidua-associated protein 200 reflects normal endometrial histology.

In the current study, the uterine fluid level of human decidua-associated protein (hDP) 200 was measured in 80 women with abnormal uterine bleeding and normal histology. In 20 women the level of hDP200 was also correlated with the endometrial thickness measured by transvaginal ultrasonography. The results demonstrated the same distribution and similar levels of uterine fluid hDP200 throughout the menstrual cycle as in regularly cycling women, with no correlation between the levels of hDP200 and the endometrial thickness. Thus, the test for uterine fluid hDP200 could serve to discriminate between benign and pathological examinations of endometrial biopsies in women of reproductive age, women with abnormal uterine bleeding and benign conditions of the endometrium. Very low levels of hDP200 are indicative of endometrial hyperplasia or carcinoma.

Adult↗

PubMed1996

Placental isoferritin patterns during first-trimester intrauterine gestation.

In this study, serum placental ferritin (PLF) levels were measured among 33 pregnant women with normal, singleton, ongoing first-trimester gestations and compared with 22 nonbleeding, missed and 14 incomplete abortions. Diagnoses were based on clinical, sonographic, endocrinologic and histopathologic criteria. At admission and before uterine evacuation of the pregnancy products, venous blood was collected from the groups for PLF determination. The mean +/- SD serum PLF levels were 18 +/- 14, 21 +/- 37, and 3.9 +/- 6.2 U/ml in normal gestations, missed and incomplete abortions, respectively. Significant differences in PLF levels were found among normal pregnancies and incomplete abortions (p < 0.05), whereas borderline significance was found in the missed abortion group (p = 0.53). No correlation was found between serum beta hCG and PLF for the various pregnancy groups. Low PLF levels in pathologic gestation may reflect abnormal trophoblastic activity. Whether these play a causal role or are the casual outcome of pathologic gestation should be the subject of further evaluation.

Abortion, Incomplete↗

PubMed1996

Immunosuppressive effect of uterine fluid on spermatozoa-stimulated mixed lymphocyte cultures.

Spermatozoa, obtained from 20 healthy individuals, were incubated with crude uterine fluid or with a purified IgG fraction obtained from uterine fluid before adding them to cultures with allogeneic lymphocytes. Untreated spermatozoa induced a proliferative 1.5- to 6-fold increase, while the spermatozoa treated with crude uterine fluid or with purified IgG fraction caused 84-100% suppression of lymphocyte blastogenesis. These results suggest the existence of an endogenous uterine fluid factor, apparently IgG, which causes inhibition of lymphocyte proliferation induced by spermatozoa in the uterine lumen.

Adult↗

PubMed1996

Hysteroscopy is superior to hysterosalpingography in infertility investigation.

BACKGROUND: The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examination over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical investigation of the ovulatory infertile patient, the role of intrauterine endoscopy in comparison to hysterosalpingography (HSG) needs to be reevaluated. METHODS: Four hundred and sixty-four infertile women had undergone both hysterosalpingography and a diagnostic hysteroscopy and the findings were analysed. RESULTS: Compared to hysteroscopy the sensitivity of HSG was 98%, but its specificity only 15%, the positive predictive value 45%, and negative predictive value 95%. On hysteroscopy a normal uterine cavity was found in 53% of the cases with a filling defect and in 56% of those with uterine wall irregularity on HSG. CONCLUSIONS: Hysteroscopy, a safe and rapid direct visualisation of the uterine cavity, is superior to HSG in the identification of intrauterine pathology. In view of the low positive predictive value and the low specificity of the HSG, we believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.

Female↗

PubMed1996

Metastatic breast carcinoma manifesting as postmenopausal uterine bleeding in a patient on tamoxifen therapy.

A rare case of breast carcinoma metastasizing to the endometrial and endocervical mucosa during tamoxifen treatment is presented. Routine histologic evaluation has been supplemented by immunohistochemical staining for intermediate filaments. Although the association of tamoxifen therapy for breast carcinoma with the development of endometrial carcinoma is well known, this is, to the best of our knowledge, the first report of metastatic breast carcinoma to the uterus of a patient on tamoxifen therapy.

Aged↗

PubMed1996

The use of scopolamine in the treatment of detrusor instability.

PURPOSE: A prospective randomized double-blind study was done to evaluate the efficiency of transdermal scopolamine in the treatment of detrusor instability. MATERIALS AND METHODS: A total of 20 female patients with detrusor instability was assigned randomly into 2 groups of 10 each. The study group received 4 transdermal scopolamine dermal patches postauricularly, while in the control group placebo patches were applied. Both groups were similar regarding patient age, parity, duration of symptoms and previous anti-incontinence surgery. RESULTS: The patients were reassessed after 14 days. Improvement in complaints of diurnal frequency (p < 0.05), nocturia (p < 0.005), urgency (p < 0.05) and urge incontinence (p < 0.05) was noted in the study group and not in the control group. A significantly (p < 0.05) less pressure increase on filling and a decreased volume at which pressure exceeded 15 cm. water (p < 0.05) were noted on cystometry in the study group only. No significant side effects were reported and no patient discontinued treatment. CONCLUSIONS: Transdermal scopolamine was effective and safe in the treatment of female patients with detrusor instability.

Administration, Cutaneous↗

PubMed1995

Myxoid leiomyosarcoma of the uterus with unusual malignant histologic pattern--a case report.

A case report of myxoid leiomyosarcoma of the uterus is presented as a rare variant of uterine sarcoma. This case, contrary to most of the 11 cases previously described in the literature, is characterized by highly atypical pleomorphic cells and numerous mitoses. Furthermore, myxoid material is also found in the cytoplasm of pleomorphic tumor cells, a feature, that to our knowledge, has not been previously described. All these tumors, no matter what the microscopic appearance is, exhibit a highly malignant behavior. The best therapy for this tumor is unknown, since there are too few cases from which to draw conclusions.

Aged↗

PubMed1995

Conservative management of interstitial pregnancy using operative laparoscopy.

Interstitial pregnancy has been treated so far mainly by either resection of the cornu or hysterectomy. In this article, two patients with cornual pregnancy were operated upon laparoscopically with an uneventful postoperative recovery. This laparoscopic treatment is simple, does not require extensive operative laparoscopic expertise, and is relatively short and less expensive than laparotomy. We suggest that laparoscopic conservative repair be used to replace cornual resection by laparotomy or hysterectomy in cases of early diagnosed interstitial pregnancy.

Adult↗

PubMed1995

Ovarian function following abdominal hysterectomy with and without unilateral oophorectomy.

There is no consensus concerning optimal adnexal surgery during abdominal hysterectomy, when continued hormonal function is desired, associated with reduced sequelae in the future. The aim of the study was to compare residual ovarian function following abdominal hysterectomy with preservation of one or both ovaries, in a prospective randomized study. Forty patients were allocated randomly and sequentially into two groups: those undergoing abdominal hysterectomy with unilateral oophorectomy, and those undergoing abdominal hysterectomy only. Ovarian function was evaluated by measuring FSH, TLH and E2 before, and 1 week, 1 month, 3 months and 6 months after the operation. Thirty-five percent of the patients undergoing abdominal hysterectomy with unilateral oophorectomy demonstrated impaired ovarian function 6 months after the operation. None of the patients with both preserved ovaries showed impaired ovarian function 6 months later. Therefore, when continued ovarian function following abdominal hysterectomy is desired, preservation of both ovaries seems to be more beneficial.

Adult↗

PubMed1995

Placental isoferritin levels during first trimester of normal and complete molar gestations.

Serum placental isoferritin levels (PLF) levels were measured in 33 patients admitted for routine scanning of a first trimester normal singleton pregnancy and six patients who were hospitalized for uterine evacuation of a complete molar gestation. Venous blood was obtained upon admission and before curettage, when necessary. Serum was separated into glass tubes, immediately frozen and stored at -20 degrees C until analysed. The mean serum PLF levels were 18.1 (+/- 14) U/ml and 5.5 (+/- 2) U/ml for normal and molar gestations, respectively, with a significant difference between the two groups (P = 0.001). Sixty-seven per cent of normal pregnancies had serum PLF levels > or = 10 U/ml, whereas none of the molar gestation group reached this threshold level. Furthermore, the molar gestation group's low serum PLF levels remained unchanged throughout the entire follow-up period and until their beta-human chorionic gonadotrophin levels were undetectable. Unlike normal pregnancies, the molar trophoblast does not seem to secrete or synthesize PLF, suggesting that the complete molar placenta has different protein-producing capabilities when compared with those found in normal pregnancies. Further studies, including serum PLF among other categories of gestational trophoblastic neoplasms, are recommended before this data can be integrated into routine clinical work.

Biomarkers↗

PubMed1995

Ectopic pregnancy and laparoscopy: review of 1197 patients treated by salpingectomy or salpingotomy.

The past few decades have witnessed such a rapid rise in the incidence of ectopic pregnancy that it verges on the point of an 'epidemic disease'. Its early detection, with the aid of serum beta-hCG, high resolution ultrasound and the more liberal use of laparoscopy, has dramatically altered the clinical presentation of this disease and permits the use of more conservative methods of management directed towards preserving fertility and reducing morbidity. In this review of 1197 patients, compiled from the English literature, various conservative or tubectomy operative laparoscopic procedures have been employed, with 93% and 98% respectively, being able to avoid further surgery. Among the group treated by the conservative approach, a 6% post-operative complication rate was reported, of which 4% were persistent ectopic, 48% intra-uterine, and 18% repeated ectopic pregnancies. Among the radically treated patients, 2 intra- and 1 post-operative complications necessitated laparotomies. The fertility work-up and performance outcome are less obvious among this group. The benefits, safety and efficacy of each of the laparoscopic options, with appropriate recommendations for their use, are discussed. However, despite the aforementioned dramatic progress, women with previous ectopic pregnancies still have reduced fertility potential. Preventive measures aimed at reducing its overall occurrence therefore seem to be the major factor towards preserving a patient's future fertility potential.

Fallopian Tubes↗

PubMed1995

First trimester embryo reduction: a medical solution to an iatrogenic problem.

The incidence of multiple pregnancies is increasing, mainly as a consequence of the widespread use of various infertility protocols. Since such gestations present a high risk of feto-maternal morbidity and mortality, selective first trimester fetocide remains one of the few reasonable options. We reviewed the literature dealing with the outcome of 804 multiple pregnancies following the use of transcervical, transvaginal or transabdominal approaches. Questions relating to dealing with technical failure, method of fetocide and procedural improvements are examined. In a comparison of the variables: miscarriage, preterm delivery, perinatal and neonatal loss rates, the transvaginal approach fares better, but statistical significance (P < 0.001) is achieved only for preterm delivery. We speculated that this might be attributable to the very early gestational age at which the procedure is usually performed. However, the transabdominal approach offers better results when post-manipulation maternal morbidity is considered, i.e. infection and vaginal bleeding. Since each option offers different advantages and disadvantages, additional experience and larger population samples are required to further clarify this important issue.

Female↗