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Biomedical subjects

J Shalev

Publications and source records attributed to J Shalev.

At least 55 records · Page 3Linked to original sources
PubMed1995

Clinical, hormonal and sonographic predictors of successful RU-486-induced abortions.

To evaluate which method, clinical, hormonal or sonographic, can be used as the best predictor of successful RU-486-induced abortions, 20 healthy women with fetal cardiac activity, between 6 and 9 weeks from the last menstrual period and desiring abortion, were studied. Fourteen women (70%) successfully aborted, and 6 (30%) failed to abort within 7 days following therapy. A small hematoma, seen as a localized detachment of the gestational sac, was observed in the decidua capsularis in women who aborted successfully. A significant decrease in plasma levels of estradiol and progesterone (p < 0.04) and significantly increased cortisol levels (p < 0.001) in the plasma of the 14 patients who aborted were noted by the 7th day following treatment. No significant changes were observed in the 6 nonaborting patients. In conclusion, the differences in the early sonographic findings may be helpful in the early prediction of successful RU-486 administration.

Abortifacient Agents↗
PubMed1995

Laparoscopic unwinding of hyperstimulated ischaemic ovaries during the second trimester of pregnancy.

Successful unwinding of large, hyperstimulated, ischaemic-haemorrhagic adnexa by laparoscopy during the second trimester of pregnancy is described. Three women in their second trimester of pregnancy were treated by laparoscopy. In all cases, the ovaries were unwound and replaced in their anatomical position. Shortly after the procedure they became pink. Serial ultrasound examinations showed viable, intrauterine fetuses and ovaries with normal blood flow. Laparoscopic ovarian detorsion is a safe and easy procedure, and can be carried out in advanced gestation until approximately 20th week if special safety measures are adhered to.

Adult↗
PubMed1994

A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins.

OBJECTIVE: Our aim was to compare the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. STUDY DESIGN: From January 1984 through January 1992, 140 triplet gestations were diagnosed before the ninth gestational week. Multifetal pregnancy reduction was performed at the patient's request in 34 women. The remaining 106 triplet pregnancies were managed expectantly. All patients were prospectively followed up and delivered in a single perinatal department. RESULTS: Loss of the entire pregnancy before 25 gestational weeks occurred in 20.7% of the triplet pregnancies managed expectantly as compared with 8.7% in the group with reduction to twins. A successful pregnancy as defined by the discharge home of at least one infant occurred in 88.2% of the group with reduction to twins and 74.5% of the triplets managed expectantly. Fetal reduction to twins was associated with a significantly lower incidence of the following: prematurity (p < 0.001), low-birth-weight infants (p < 0.001), and very-low-birth-weight infants (p < 0.001). Pregnancy complications and neonatal morbidity and mortality were less in the group with reduction to twins. CONCLUSIONS: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in improved pregnancy outcome without an excess loss of the entire pregnancy as compared with the outcome of triplet gestations managed expectantly.

Abortion, Therapeutic↗
PubMed1994

Improved results in multifetal pregnancy reduction: a report of 72 cases.

OBJECTIVE: To evaluate pregnancy outcome after either transabdominal or transvaginal multifetal pregnancy reduction. DESIGN: A study of 72 consecutive multifetal pregnancy reductions. SETTING: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center Tel Hashomer, Israel. PATIENTS: Seventy-two patients with multifetal pregnancies: 2 twins, 27 triplets, 26 quadruplets, 10 quintuplets, 3 sextuplets, 1 septuplet, 2 nontuplets, and one pregnancy with 12 fetuses. INTERVENTION: Multifetal pregnancy reduction was performed at 9 to 13 weeks' gestation by either transabdominal or transvaginal potassium chloride injection. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of pregnancy, and comparison of two periods. RESULTS: Procedures performed between 1984 and 1989 (36 patients) were associated with a 33.3% pregnancy loss, whereas those performed between 1990 and 1992 (36 patients) were associated with no pregnancy loss. Of the 17 patients with quintuplets or more, 10 (59%) delivered live and healthy newborns. No difference was found when comparing the transabdominal and the transvaginal approaches. CONCLUSIONS: Both transvaginal and transabdominal approaches are comparable. There is a remarkable decrease in pregnancy loss with experience.

Abortion, Therapeutic↗
PubMed1994

Acute pelvic inflammatory disease after oocyte retrieval: adverse effects on the results of implantation.

OBJECTIVE: To determine the impact of pelvic inflammation on the results of IVF after oocyte retrieval. DESIGN: Retrospective analysis of IVF cycles. SETTING: IVF Unit, Golda Medical Center, Petah Tikva, Israel. PATIENTS: Twenty-eight women with a diagnosis of pelvic inflammatory disease (PID) during IVF therapy. MAIN OUTCOME MEASURE: The pregnancy rate (PR) of IVF cycles complicated by PID after oocyte retrieval was compared with our ongoing IVF results. RESULTS: All 28 women with PID during IVF treatment did not conceive, despite the high number of oocytes retrieved, fertilized, and transferred. The PR over the same period was 23% to 31%. CONCLUSIONS: Pelvic infection after IVF treatment might have a detrimental effect on the results of treatment. In an effort to maximize the chances for normal implantation, postponement of ET should be considered when pelvic infection or inflammation is diagnosed.

Acute Disease↗
PubMed1994

Minidose gonadotropin-releasing hormone agonist is the treatment of choice in poor responders with high follicle-stimulating hormone levels.

OBJECTIVE: To investigate the effectiveness of minidose GnRH agonist (GnRH-a) + hMG in poor responders with elevated basal level FSH. DESIGN: Retrospective analysis of IVF cycles. SETTING: IVF Unit, Golda Medical Center, Petah Tikva, Israel. PATIENTS: One hundred six patients who were defined as poor responders on two previous IVF attempts. Three treatment protocols of midluteal Decapeptyl (D-Trp6) were compared: [1] a single-dose of 3.75 mg; [2] 0.5 mg daily until menstruation, followed by 0.1 mg daily; and [3] 0.1 mg daily until menstruation, followed by 0.05 mg daily. MAIN OUTCOME MEASURES: Comparisons were made among the three protocols regarding basal FSH levels, number of oocytes retrieved and fertilized, number of days of stimulation, follicular phase, P levels, and pregnancy and miscarriage rates. RESULTS: Treatment with minidose GnRH-a resulted in higher E2 levels and lower P levels on the day of hCG and lower cancellation rates. Furthermore, a higher number of oocytes recovered and fertilized and embryos transferred were recorded. The trend indicated improved pregnancy and implantation rates with a lower miscarriage rate. CONCLUSION: Minidose GnRH-a is a better choice than regular GnRH-a strategies in poor-responder patients undergoing IVF treatment.

Dose-Response Relationship, Drug↗
PubMed1994

Lack of association between ovarian follicular size and number and the occurrence of multiple pregnancies in menotropin cycles.

A high rate of ovarian multifollicular development and resulting multiple pregnancy remains the main problem of ovulation induction with human menopausal gonadotropins. The aim of this study was to examine a possible correlation between the number and size of ovarian follicles at the time of human chorionic gonadotropin (hCG) administration and to find parameters that can predict the occurrence of multiple pregnancies. Sixty-eight intrauterine pregnancies, 53 singletons and 15 multiple pregnancies in 51 patients, were included in this study. We found no significant difference in the mean estradiol levels, the total number of pre-ovulatory follicles, or the mean number of large, intermediate or small follicles at the time of hCG administration between women who had singleton pregnancies and those with multiple pregnancies. Our study demonstrates that estradiol levels and ovarian ultrasonography do not provide criteria for the prediction of the occurrence of multiple pregnancies in menotropin cycles.

Chorionic Gonadotropin↗
PubMed1992

The value of repeat hysteroscopic evaluation in patients with failed in vitro fertilization transfer cycles.

One hundred ten women with normal initial hysteroscopy who failed to conceive during three or more IVF-ET cycles underwent repeat hysteroscopic evaluation. In 20 patients (18.2%), visualization revealed uterine abnormalities, mainly newly added endometrial lesions, i.e., hyperplasia, polyps, endometritis, and synechiae. Our results indicate that repeat hysteroscopic evaluation, in cases of recurrent IVF-ET failure, is an important adjunctive method for further evaluating and possibly optimizing the IVF-ET procedure.

Adult↗
PubMed1992

Recurrence rate after fluid aspiration from sonographically benign-appearing ovarian cysts.

The outcome after fluid aspiration from 41 sonographically benign-appearing ovarian cysts was assessed. The considerable probability of recurrence was significantly higher after ultrasound-guided aspiration than following aspiration via laparoscopy (54% versus 30%, respectively, at 36 months). Although all the recurring cysts were benign, the concern with malignancy and the high recurrence rate seem to indicate that fluid aspiration from sonographically benign-appearing cysts by either method is not the management of choice.

Adolescent↗
PubMed1991

Quintuplet pregnancy and third degree ovarian hyperstimulation despite withholding human chorionic gonadotrophin.

A patient who suffered from polycystic ovarian disease and anovulation, was treated with pure follicle stimulating hormone for induction of ovulation. The treatment was stopped and human chorionic gonadotrophin was not administered because of high serum oestradiol levels and multiple follicular development. Ovulation occurred 11 days after pure follicle stimulating hormone was discontinued, the patient developed third-degree ovarian hyperstimulation syndrome and conceived with a quintuplet pregnancy.

Adult↗
PubMed1991

Hormonal profiles and follicular growth in cycles with imminent ovarian hyperstimulation.

Ovarian hyperstimulation syndrome is a common and serious complication of human menopausal gonadotrophin/human chorionic gonadotrophin treatment. We evaluated the changes in the pituitary and ovarian hormone profiles and ultrasonographic follicular regression in 12 patients in whom human menopausal gonadotrophin was discontinued due to 'imminent' ovarian hyperstimulation. Following discontinuation, three distinct periods were observed: (i) days 1-2, the levels of oestradiol, testosterone and prolactin, and the total number of follicles continued to rise; (ii) days 3-6, the levels of oestradiol, testosterone and prolactin declined sharply and the total number of follicles was reduced significantly, while the large and medium sized follicles continued to increase. Levels of follicle-stimulating hormone and luteinizing hormone gradually declined to reach their lowest levels by days 5-6 and then increased. (iii) Thereafter the number of follicles and steroid output declined to early follicular phase levels. We conclude that discontinuation of human menopausal gonadotrophin and withholding human chorionic gonadotrophin in cycles with laboratory signs of 'imminent' ovarian hyperstimulation syndrome, allows regression of the ovarian ultrasonographic finding and prevents the development of clinical symptoms. However, if rescue of the cycle is attempted, human chorionic gonadotrophin should be given during the first 4 days after discontinuation of stimulation.

Adult↗
PubMed1990

[Cordocentesis for prenatal diagnosis].

Cordocentesis for prenatal diagnosis was being performed in the seventies during the process of fetoscopy. Since then the technique has been used as a diagnostic tool for intrauterine infection, hematological and metabolic disorders and metabolic status of the fetus; and for rapid cytogenic analysis. We report our first 207 cordocenteses performed since December 1985. First puncture was successful in half the cases. The procedure resulted in termination of pregnancy in only 0.96% of cases. Though a new technique, cordocentesis is playing a major role in modern perinatology. The possibility of a direct route to fetal blood vessels early in pregnancy would lead to earlier diagnosis and treatment.

Blood Specimen Collection↗
PubMed1990

Transvaginal sonographic measurement of fetal kidneys in the first trimester of pregnancy.

Fetal renal size late in the first trimester of pregnancy was evaluated by transvaginal ultrasonography in 50 patients not at risk for congenital kidney disease and whose pregnancies resulted in a normal outcome. Both kidneys were reliably identified in all patients scanned at 12 weeks, 13 weeks, and 14 weeks, menstrual age. Kidney diameter measurements obtained in this study are presented for reference in evaluating patients in late first trimester whose fetuses are at risk for kidney abnormalities.

Adolescent↗
PubMed1990

Hydration feature of urinary compounds. Evidence for molecular abnormality in calcium oxalate urolithiasis.

Proton-relaxation-time measurements were performed on lyophilized urine samples collected from 11 recurrent calcium oxalate stone-formers, 9 uric acid stone-formers, 9 patients with various urological disorders, and 20 normal individuals. The T1 and T2 relaxation times were determined using a Bruker PC Multispec at 20 MHz at 37 degrees C for measurements of lyophilized sample and thereafter during gradual controlled rehydration. The prolongation of the relaxation times as a function of rehydration was found to differ significantly (P less than 0.005) between, on the one hand, the calcium oxalate stone-formers and, on the other hand the normal, uric-acid stone-formers, and patients with other urological disorders. Water compartmentalization was then calculated according to the fast proton diffusion model. At most of the experimental points during rehydration process, significantly (P less than 0.001) less water was bound to the compounds of urine from calcium oxalate stone-formers than that obtained from normal individuals. The variations in the bound hydration water may have been associated with possible changes in the structure or configuration of the compounds present in the urine of the different groups. The results reflect differences in the urinary content and/or properties of normal subjects and calcium oxalate stone-formers, and indicate that the mechanism of bound water relaxation is in some way specific to the pathophysiological state of urine.

Adult↗
PubMed1990

Breast stimulation in late pregnancy. Effect on prostaglandin secretion.

The effect of breast stimulation on the prostaglandin secretion was tested in 13 patients at 38-40 weeks of gestation. Uterine contractions following breast stimulation were documented in all cases. There was an increase in prostaglandin metabolite levels 10 min after breast stimulation.

Breast↗
PubMed1990

In vitro fertilization in Kock's ileostomy patients. Prior evaluation by pelvic ultrasonography.

The study describes Kock's continent ileostomy in 2 females, both of whom were suffering from tubal infertility. Appropriate placement of the abdominal pouch, permitting in vitro fertilization embryo transfer treatment, was present in 1 patient. In the other patient, an ultrasonographic examination demonstrated the pouch covering the entire surface area of both ovaries. Oocyte aspiration was thus precluded for fear of penetrating the pouch. Ovum pickup in the presence of a Kock continent ileostomy can be conducted safely and without risk, if the pouch is correctly positioned above the small pelvis. Ultrasonography facilitated the ability to locate the patients' ovaries and precise position of the pouch.

Adult↗