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Biomedical subjects

I Meizner

Publications and source records attributed to I Meizner.

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

Sonographic visualization of normal-size ovaries during pregnancy.

OBJECTIVE: To assess the ability of ultrasound to detect ovaries of normal size during pregnancy METHODS: A prospective study of 329 women with a normal pregnancy course was undertaken; 68 were excluded from analysis because of an enlarged, cystic ovary. Of the remainder, 60 pregnancies were examined in the first trimester and 201 in the second or third trimester. The first group underwent transvaginal (TVS) and transabdominal (TAS) scanning. The second group underwent TAS examination only. RESULTS: In the first-trimester group, TVS identified both ovaries in 57 patients (95%) and transabdominal ultrasound in 20 (33.3%). In the second- and third-trimester patients, TAS visualized both ovaries in 33 patients (16.4%), and neither ovary in 120 (59.7%). Both ovaries were less visible with advancing gestational age. The right ovary showed a significant change in position during pregnancy, from about 1 cm (at 15-24 weeks) to 2.5 cm (at 30-41 weeks) cranial to the iliac spine. The left ovary was found 1 cm above the iliac spine throughout pregnancy. CONCLUSIONS: Transvaginal sonography is adequate for the visualization of both ovaries in the first trimester of pregnancy. With advanced gestational age, the ovaries were significantly less visible by TAS. Sonographic scanning of the ovaries in second and third trimester should be concentrated mainly at the level of the iliac spine. Poor sonographic visualization of both ovaries in late gestation may mandate the use of other imaging modalities.

Analysis of Variance↗
PubMed2000

Prenatal ultrasound diagnosis of infantile myofibromatosis--a case report.

Infantile myofibromatosis, the most common soft tissue tumor of infancy, was diagnosed at 30 weeks of gestation. The tumor presented on ultrasound as a large mass measuring 42 mm x 75 mm x 35 mm located on the fetal back. The ultrasound diagnosis was further validated by MRI. Termination of pregnancy was carried out, and a multicentric visceral type of the tumor was diagnosed at autopsy.

Adult↗
PubMed1999

Elective cytogenetic amniocentesis in the third trimester for pregnancies with high risk factors.

The aim of the present study was to report the findings in 14 women with extremely high risk ('precious') pregnancies, 5 of whom had twins, who underwent elective third-trimester cytogenetic amniocentesis. There were no procedure-related complications, and all newborns weighed more than 2000 g and showed normal development. This practice is accepted under Israeli law and our institutional policy. This preliminary work does not attempt to answer the moral and ethical questions surrounding the use of third (versus second) trimester amniocentesis in either 'precious' or normal pregnancies. We do show, however, that the procedure is safe and may constitute a good alternative for patients who are unwilling to accept the risks of early fetal karyotyping.

Adult↗
PubMed1999

Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester.

OBJECTIVE: To examine the course of pregnancy and fetal outcome in patients with twin gestations in which one abnormal fetus underwent selective feticide in the third trimester of pregnancy. DESIGN: A study of 23 consecutive late selective feticide procedures. SETTING: Department of Obstetrics and Gynecology, Rabin Medical Center, Israel. PATIENT(S): Twenty-three patients with twin pregnancies with one malformed fetus. INTERVENTION(S): Selective feticide with intracardiac injection of KCl was performed at 28-33 weeks of gestation after the diagnosis of fetal genetic (56.5%) or structural (43.5%) malformations made in the second trimester (18-24 weeks). All procedures were performed at the patient's request and on approval of a committee for fetal termination late in pregnancy. Betamethasone treatment was initiated to enhance lung maturity 3 weeks before selective feticide. All patients were placed on complete bed rest until 35 weeks' gestation. MAIN OUTCOME MEASURE(S): Early and late complications related to the procedure; outcome of pregnancy and fetal survival. RESULT(S): All 23 twin pregnancies had an uneventful course after selective feticide performed at 28-33 weeks. All birth weights were > 2,000 g (mean +/- SD, 2,628 +/- 646 g), indicating an excellent chance of survival. CONCLUSION(S): Our results suggest that late selective feticide in twin gestations is safe and efficient and results in a favorable outcome for the surviving fetus. This procedure should be performed at 28-30 weeks after treatment for enhancement of lung maturity.

Birth Weight↗
PubMed1999

Multifetal pregnancy reduction in cases of threatened abortion of triplets.

OBJECTIVE: To investigate the course of pregnancy and fetal outcome after first-trimester multifetal pregnancy reduction (MFPR) in patients with triplet pregnancies and uterine bleeding. DESIGN: Case series of patients with threatened triplet pregnancies considered for MFPR. SETTING: Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tiqva, Israel. PATIENT(S): Forty-two patients with triplet pregnancies and first-trimester uterine bleeding. INTERVENTION(S): At 10-15 weeks' gestation, MFPR with intracardiac injection of potassium chloride was performed. The procedures were performed 7-10 days after cessation of bleeding (9-13 weeks) or in the presence of minimal uterine bleeding (14-15 weeks). In patients with heavy uterine bleeding, MFPR was postponed. MAIN OUTCOME MEASURE(S): Early- and late-pregnancy complications related to the procedure, pregnancy outcome, and fetal survival. RESULT(S): Performance of MFPR at 14-15 weeks was associated with a higher abortion rate (38.5%), lower mean gestational age at delivery (30.6 weeks), and lower mean twin birth weight (1,376+/-218 g and 1,014+/-202 g) than was performance of MFPR at 10-13 weeks (18.8%, 33.2 weeks, and 1,720+/-245 g and 1,596+/-170 g, respectively). Abortion occurred in four of the five patients with moderate to heavy uterine bleeding who did not undergo MFPR; the fifth patient gave birth prematurely at 28 weeks, and two of the newborns died. CONCLUSION(S): Pregnancy outcome and fetal mortality and morbidity in triplet pregnancy after MFPR are directly correlated with duration and amount of first-trimester bleeding.

Abortion, Threatened↗
PubMed1999

Transducer user syndrome: an occupational hazard of the ultrasonographer.

Since no study to date has assessed the prevalence of scanning-related disorders amongst sonographers in Obstetrics and Gynecology, we distributed a survey to all trained personnel in our ultrasound division. We evaluated the correlation between injuries sustained in the workplace, and factors such as age, gender, work load and intensity, scanning techniques, previous medical problems, and physical activity. Injuries included one or more of the following: carpal tunnel syndrome; carpal instability; tendinitis; back, shoulder, and neck pain; tingling and/or numbness in the extremities; weakness; and motion restriction. Of the 44 respondents, 29 (65%) have experienced some type of injury or symptom over the course of their scanning career. Five (12%) reported having missed work because of their symptoms, 15 (34%) have received orthopedic treatment (medication or physiotherapy), two (4.5%) have been diagnosed with carpal tunnel syndrome, and one (2.3%) with carpal instability based on electrophysiological examinations. These results demonstrate that ultrasound scanning in Obstetrics and Gynecology may pose an occupational risk for doctors and technicians.

Adult↗
PubMed1999

Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions.

OBJECTIVES: To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second- and third-trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery. METHODS: The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internal os, were assessed by endovaginal ultrasonography. In 120 women with normal pregnancy (43 of which with premature contractions), cervical dilatation and effacement were determined by digital examination. The correlation of cervical variables with the course of pregnancy was analyzed by the Wilcoxon test. RESULTS: The mean lengths of the upper and lower cervix were 15.9 +/- 1.7 mm (median 16.0 mm) and 26.4 +/- 3.7 mm (median 27.0 mm), respectively, in patients without premature contractions and 6.9 +/- 3.7 mm (median 6.0 mm) and 24.7 +/- 4.7 mm (median 25.0 mm), respectively, in patients with premature contractions. In the latter subgroup, the upper cervix was significantly shorter (p = 0.0001) but the lower cervix remained almost unchanged. Digital palpation was less accurate than transvaginal sonography for evaluating total cervical length. CONCLUSIONS: Transvaginal sonography is the method of choice for assessing cervical changes during pregnancy. In this prospective study, upper cervical length was the best predictor of preterm labor of all cervical parameters studied. Its length could be accurately determined by the location of the lowermost edge of the urinary bladder (vesicocervical fold of the bladder).

Adult↗
PubMed1998

Outcome of fetuses with isolated borderline unilateral ventriculomegaly diagnosed at mid-gestation.

OBJECTIVE: To evaluate the outcome of fetuses with isolated borderline, unilateral ventriculomegaly. DESIGN: A retrospective survey was conducted at four perinatal centers in Israel. SUBJECTS AND METHODS: Only fetuses with one ventricular width of > or = 11 mm and the other < 10 mm were included in the study. In all cases, the difference of the ventricular width between the two ventricles was > 2.4 mm (two standard deviations). Fetuses with other malformations, chromosomal abnormalities, or those with evidence of in utero infection, were not included in the study. RESULTS: Unilateral ventriculomegaly was found in 27 subjects (after excluding one case with unilateral ventriculomegaly and Down's syndrome). The mean width of the enlarged ventricle was 11.7 +/- 0.9 mm, while the other normal ventricle was 7.2 +/- 0.9 mm. The mean gestational age at diagnosis of the unilateral ventriculomegaly was 23.6 +/- 2.7 weeks. In one case, pregnancy was terminated, and pathological examination of the fetal brain failed to detect any structural abnormality. Twenty-five patients delivered at term and only one at 34 weeks' gestation. The neurological development in all 25 fetuses was normal, and one fetus had petit mal seizures. CONCLUSION: Fetuses with isolated, borderline unilateral ventriculomegaly, but without other abnormalities, have a good neurological outcome.

Cerebral Ventricles↗
PubMed1998

Doppler parameters of uterine and ovarian stromal blood flow in women with polycystic ovary syndrome and normally ovulating women undergoing controlled ovarian stimulation.

OBJECTIVE: To test the hypothesis that the increased ovarian sensitivity to gonadotropins observed in women with polycystic ovary syndrome (PCOS) may be due to changes in ovarian stromal blood flow in these patients. DESIGN: Uterine and ovarian stromal arterial blood flow (with transvaginal color Doppler ultrasound) were measured in ten women with PCOS and 12 normo-ovulatory women (control group), undergoing gonadotropin stimulation before in vitro fertilization. METHODS: A careful ovarian stimulation strategy was adopted for the study group in order to avoid ovarian hyperstimulation syndrome and achieve an ovarian response which was comparable to that of the control group. Resistance and pulsatility indices (RI and PI) of the uterine and ovarian stromal arteries were calculated before the onset of gonadotropin treatment, on cycle day 5 (after commencing treatment), day of human chorionic gonadotropin injection, day of ovum pick-up as well as on the day of embryo transfer, and 7 and 12 days later. RESULTS: No significant differences were found in RI and PI between the study and control groups throughout the treatment cycle. CONCLUSIONS: It seems that polycystic ovaries do not bear an inherent disturbance in blood flow dynamics of the uterine and ovarian arteries, as measured by color Doppler, which would explain the increased sensitivity of polycystic ovaries to stimulation with gonadotropins.

Adult↗
PubMed1998

Prenatal diagnosis of crossed ectopic multicystic kidney.

The combination of multicystic kidney and crossed ectopia is very rare. In most of the affected children, diagnosis has been made postnatally by ultrasonographic examination to evaluate a palpated abdominal mass. We describe the third male newborn reported in the literature with a prenatally diagnosed crossed ectopic multicystic dysplastic kidney. As with isolated multicystic kidney, crossed ectopic multicystic kidney should be followed closely after birth by repeated ultrasound for spontaneous regression. Only in cases of anomalies of the contralateral (uncrossed) kidney should the question of surgical intervention be raised.

Diagnosis, Differential↗
PubMed1998

Laparoscopic management of rudimentary horn pregnancy.

A unicornuate uterus with rudimentary horn is a rare Müllerian abnormality. This uterine anomaly may cause many gynaecological and obstetric complications, including infertility, recurrent abortions, preterm deliveries and rupture of the uterus, especially when the pregnancy implants in the rudimentary horn. To date, laparotomy has been the treatment of choice when resection of a rudimentary horn was indicated. We report on the case of a woman who benefited from laparoscopic surgery of a rudimentary horn pregnancy. Laparoscopy, in these exceptional cases, is the most accurate diagnostic tool that carries significant advantages in effective surgical management, thereby avoiding laparotomy.

Adult↗
PubMed1997

Effect on fetal circulation of low-dose aspirin for prevention and treatment of pre-eclampsia and intrauterine growth restriction: Doppler flow study.

The use of low-dose aspirin for the prevention and treatment of pre-eclampsia and intrauterine growth restriction has been studied extensively during the last 10 years. The large clinical trials do not support routine prophylaxis or therapeutic administration of low-dose aspirin in high-risk pregnant patients. We report on 87 Israeli women who were recruited for the CLASP study (a collaborative trial for the prevention and treatment of pre-eclampsia and intrauterine growth restriction). Of these women, 41 were treated with 60 mg aspirin daily, and 46 with placebo. The fetal circulation was evaluated by repeated Doppler flow waveform measurements of the umbilical artery and descending aorta from 20 to 34 weeks of gestation. The peak-systolic/ lowest-diastolic velocity ratio, pulsatility index and resistance index were calculated. No significant differences in Doppler measurements were observed for any of the indices between the aspirin and placebo groups. There were no statistically significant changes in the flow parameters during the course of pregnancy in any of the women studied, nor was there a correlation between waveform analysis and pregnancy outcome. Thus, based on the present results, it appears that low-dose aspirin does not improve fetal circulation parameters.

Adult↗