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Biomedical subjects

M Glezerman

Publications and source records attributed to M Glezerman.

At least 55 records · Page 3Linked to original sources
PubMed1999

Metastatic trophoblastic disease following partial hydatidiform mole: case report and literature review.

A patient with a triploid partial hydatidiform who had lung metastasis is presented. Complete response was achieved with methotrexate chemotherapy. A review of the literature revealed only 11 previously reported cases. In many of them clinical data are missing. All had lung metastasis and 1 had in addition a metastasis in the vagina. Only 1 of these patients died of disease. The others responded well to chemotherapy. Metastatic trophoblastic disease following partial mole is very rare but the exact prevalence is not known. Since risk factors for developing metastatic trophoblastic disease subsequent to partial mole are not known, all patients should be followed.

Abortion, Missed↗
PubMed1999

Midtrimester maternal serum screening after multifetal pregnancy reduction in pregnancies conceived by in vitro fertilization.

PURPOSE: Data about the effect of multifetal pregnancy reduction on midtrimester maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) are scarce and contradictory. Differing gestational ages at fetal reduction, transvaginal versus transabdominal needle insertion, and injection of different feticidal agents compound the analysis of published data. METHODS: We examined clinical and laboratory data about 27 high-order gestations that were reduced to twins in the first trimester. Fetal reductions were performed transabdominally at 11.41 +/- 1.15 weeks' gestation by fetal intrathoracic injection of KCl, and maternal blood sampling was performed at 16.48 +/- 1.05 weeks. "Pseudo-risks" for singleton pregnancies were calculated by correcting serum analyte levels for twins. RESULTS: Twenty-four (88.9%) of 27 patients had maternal serum AFP levels above 2.0 MoM (mean, 4.60 +/- 3.48 MoM; range, 1.49-14.85 MoM), however, none of the newborns had structural anomalies. AFP serum levels did not correlate with the number of reduced fetuses or with adverse obstetric outcome. The mean hCG levels were 1.22 +/- 0.49 MoM (range, 0.14-2.47), and the mean uE3 levels were 1.15 +/- 0.31 MoM (range, 0.56-1.84). Based on maternal age alone, seven patients (25.9%) would have been offered amniocentesis for a term Down syndrome risk greater than 1:384, whereas combined risk calculations with hCG and uE3 levels resulted in 1 (3.7%) screen-positive case (P < 0.01).

Adult↗
PubMed1999

Expression of IL-12, IL-10, PGE2, sIL-2R and sIL-6R in seminal plasma of fertile and infertile men.

The involvement of cytokines and other immunoregulatory factors in male infertility is still unclear. In the present study we compared the levels of IL-12, IL-10, PGE2, sIL-2R and sIL-6R in the seminal plasma (SP) of fertile and infertile men. Four groups were included: fertile donors (FERT), infertile men with azoospermia (AZOO), and infertile men with either oligoterato-asthenoazoospermia (OTA), or OTA with genital infection (OTA-INF). Cytokines and cytokine-soluble receptors in semen were evaluated by specific ELISA commercial kits. The levels of IL-12, sIL-2R and sIL-6R were similar in SP of fertile and infertile men. The mean levels of IL-10 in the SP of FERT, OTA and AZOO were 5.6 +/- 0.9, 4 +/- 2.8 and 8 +/- 3.5 pg ml-1, respectively, and did not differ significantly. The mean level of IL-10 in SP from OTA-INF (0.9 +/- 0.5 pg ml-1) was significantly lower than that for FERT (5.6 +/- 1.9 pg ml-1; P = 0.02) and AZOO (8.2 +/- 3.4 pg ml-1; P = 0.05), but not significantly different from that for OTA (3.7 +/- 2.1 pg ml-1). The mean SP level of PGE2 was significantly lower in SP of OTA-INF than FERT (7.67 +/- 2.26 and 19.67 +/- 3.69 micrograms ml-1, respectively; P < 0.02). In conclusion, the seminal plasma from fertile and infertile men contained similar levels of IL-12, sIL-2R and sIL-6R. However, the levels of IL-10 were significantly lower in SP from OTA-INF compared to FERT and AZOO. Our results indicate that specific cytokines and their soluble receptors are involved in the male reproductive system.

Dinoprostone↗
PubMed1999

Screening efficacy of the subcutaneous tissue width/femur length ratio for fetal macrosomia in the non-diabetic pregnancy.

BACKGROUND: Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non-diabetic population at term. STUDY DESIGN: Intrapartum sonographic measurements were performed in 178 well-dated gravidas at 37-41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut-off points of the examined parameters or estimated fetal weights. RESULTS: Macrosomia occurred in 27 newborns (15.1%). The SCT/FL ratio was independent of gestational age (r = -0.017). Maternal age, gravidity, parity, gestational age and the ratio of male-to-female infants were similar in pregnancies resulting in appropriate-for-gestational-age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (theta) revealed that the abdominal circumference had the best sensitivity-specificity trade-off (theta = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (theta = 0.8773; p < 0.0005), the Shepard formula (theta = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (theta = 0.6872; p < 0.01) and the SCT/FL ratio (theta = 0.6303). CONCLUSIONS: We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non-diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters.

Adolescent↗
PubMed1999

Prenatal diagnosis of interrupted inferior vena cava as an isolated finding: a benign vascular malformation.

We report two cases of interrupted inferior vena cava with azygous continuation diagnosed as an isolated finding during routine prenatal scans. Visualization of the venous vasculature of the abdomen and thorax in the mid-sagittal plane failed to visualize the segment of the inferior vena cava between the kidneys and the liver. A vessel with venous flow was observed parallel, adjacent and posterior to the aorta between the kidney and the right atrium. This blood vessel connected with the superior vena cava. Axial planes of the thorax confirmed the presence of two vessels running paravertebrally. A detailed ultrasound examination of the fetal anatomy failed to demonstrate other anomalies. The neonatal course of both fetuses was uneventful. Isolated interruption of the inferior uena cava can be a vascular malformation without known pathological consequences.

Adult↗
PubMed1999

A model of efficient and continuous quality improvement in a clinical setting.

OBJECTIVE: To establish a system of Continuous Quality Improvement (CQI) which does not require substantial resources in a clinical setting. SETTING: A busy department of obstetrics and gynaecology. METHODS: The system is based on seven elements: (i) comprehensive accumulation of data; (ii) involvement of all faculty members and the majority of residents; (iii) continuous monitoring of processes within the organization; (iv) application of clinical indicators; (v) file review system; (vi) task force approach for evaluation of processes within the organization; and (vii) intervention measures. MAIN OUTCOME MEASURES: Quality of contents of files and documentation, satisfaction of customers (patients, family members), trends of clinical indicators, effect of task force work, incidence of complaints. RESULTS: Inadequate documentation was noted in 14.6% before, and 4% 1 year after the initiation of the CQI program. Task force work in a variety of projects led to a substantial improvement in measured outcome. The absolute and relative numbers of complaints against the department decreased from 44 in 1993, to 27 in 1994, 20 in 1995 and 16 in 1996. In terms of the percentage of complaints directed against the hospital these figures represent 12.4, 9.6, 6.9 and 5.4% for 1993, 1994, 1995 and 1996 respectively. CONCLUSION: Our proposed CQI system has proved to be highly efficient and requires only minimal additional resources.

Data Collection↗
PubMed1999

Hypersensitivity reaction to carboplatin. Results of skin tests.

Four patients with hypersensitivity reaction to carboplatin of variable severity, after previous uneventful cisplatin and carboplatin treatment, are described. Skin testing performed in two of the patients suggests a cross-reaction with cisplatin but was negative with carboplatin in one of them. The mechanism of hypersensitivity reaction to carboplatin is poorly understood and the issue of retreatment with carboplatin is controversial. Physicians should be aware of the possible hypersensitivity reaction to carboplatin and appropriate precautions should be taken.

Adult↗
PubMed1999

The effect of antenatal steroid administration on the fetal response to vibroacoustic stimulation.

BACKGROUND: Betamethasone transiently suppresses multiple fetal biophysical activities, including breathing movements, limb and trunk movements, heart rate variability, and heart rate accelerations. Unnecessary iatrogenic delivery of preterm fetuses due to the false diagnosis of fetal compromise has been described in this setting. The sonographically observed startle response of the fetus to vibroacoustic stimulation has been described as another modality to provide reassurance about fetal well-being. It is unknown, however, whether the startle response is also suppressed by betamethasone. The purpose of this study was to examine the effect of betamethasone on this biophysical parameter. METHODS: A prospective cohort study. Vibroacoustic stimulation was applied to the maternal abdomen and fetal movement responses were sonographically observed prior to (0 hours), 48 hours after, and 96 hours after betamethasone administration. We recorded the presence or absence of the fetal startle response, and, if a response was present, graded semi-quantitatively the intensity of the movements (vigorous versus sluggish). RESULTS: Twenty-two of 26 fetuses (84.6%) displayed a vigorous vibroacoustic startle response prior to betamethasone administration, in comparison to three of 26 fetuses (11.5%) at 48 hours after exposure (p<0.0001). Eleven fetuses and eight fetuses displayed no startle response at all (p<0.0005), or a sluggish response only (p<0.0005) at 48 hours, respectively. At 96 hours after betamethasone exposure, no differences in the number of fetuses with a vigorous, sluggish, or absent response were observed in comparison to 0 hours. Stratification of cases by gestational age groups of 28-30 weeks versus 31-34 weeks showed similar response patterns. CONCLUSION: Antenatal betamethasone exposure transiently suppresses the sonographically observed fetal startle response to vibroacoustic stimulation. Accordingly, this modality cannot be used for the ascertainment of fetal well-being of steroid exposed fetuses. Betamethasone seems to suppress central nervous system dependent biophysical activities. including the brain-stem dependent vibroacoustic startle reflex.

Acoustic Stimulation↗
PubMed1998

Squamous cell carcinoma of the vulva in the south of Israel: a study of 50 cases.

BACKGROUND AND OBJECTIVES: Vulvar carcinoma accounts for 4.9% of all female genital tract malignancies in the south of Israel. The most common histologic type is squamous cell carcinoma (82%). The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with vulvar squamous cell carcinoma in the south of Israel. METHODS: Data from the files of 50 patients with vulvar squamous cell carcinoma who were managed at the Soroka Medical Center between January 1961 and December 1996 were evaluated. RESULTS: Mean age at diagnosis was 67.1 years. The most prevailing presenting symptoms were vulvar lump, ulcer, and itching. Mean patient delay in seeking medical help was 48.2 months. Clinical palpation as a test for detecting groin lymph node metastases had a sensitivity and specificity of 57.1% and 61.5%, respectively. The 5-year survival rate was 60.3% overall. By means of univariate analysis, a significant worsening in survival was demonstrated with advancing stage of disease (P < 0.001), tumor >4 cm (P < 0.001), and positivity of surgical margins (P < 0.0001). In a multivariate analysis (Cox proportional hazards model) in a group of 45 patients, stage of disease was the strongest and the only significant predictor of survival (P = 0.0098). CONCLUSIONS: Vulvar squamous cell carcinoma predominantly affects older women. Stage of disease, tumor size, and status of surgical margins are sensitive predictors of survival. The treatment of choice for most patients is surgery consisting of radical vulvectomy and bilateral groin lymphadenectomy.

Adult↗
PubMed1998

Clinical-pathological study of uterine leiomyomas with high mitotic activity.

OBJECTIVE: To evaluate clinical-pathological aspects of mitotically active leiomyomas. STUDY DESIGN: Twenty patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10 high power fields and without atypia or necrosis were studied. The clinical and pathological characteristics of these tumors were reviewed and analyzed. RESULTS: Patients' ages ranged from 33 to 63 years (mean 42.5 years). The size of the tumors ranged from 1.5 to 9.5 cm (mean 5.4 cm). On gross examination all tumors appeared as typical leiomyomas. Treatment included hysterectomy in 16 patients and myomectomy in four. Follow-up periods ranged from 1.5 to 11 years (mean 6.8 years). None of the patients developed a recurrent tumor. CONCLUSION: The benign clinical behavior of such tumors supports their current designation as mitotically active leiomyomas, thus deleting the previous misnomer 'smooth muscle tumors of uncertain malignant potential'. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.

Adult↗
PubMed1998

Influence of asthma in pregnancy on labor and the newborn.

Asthma in pregnancy has been associated with maternal and fetal morbidity and mortality. This study examines the relations of asthma in pregnancy, its severity and its treatment to the labor process, maternal and fetal parameters. Hundred and one consecutive asthmatic women, who gave birth to single babies between November 1993 and November 1994 at the Soroka Medical Center were studied. A group of 77 nonasthmatic women, matched for age and ethnic origin, who gave birth to single babies during the same period served as controls. A larger percentage of asthmatic women suffered from respiratory and urinary tract infections than in the control group (p < 0.001). Severe asthma was associated with a higher rate of infections than milder asthma (p = 0.01). The incidence of smoking was higher among asthmatic women than among controls (p = 0.037). No association was found between socioeconomic status and smoking or infections. No association was found between maternal asthma or maternal use of corticosteroids and the following: maternal hypertension, maternal diabetes, low birth weight (< 2,500 g), preterm delivery (< 37 weeks), adequacy of weight to gestational age and Apgar scores. Three infants with congenital heart defects were born to asthmatic mothers. When the presentation of the fetus was not cephalic, all the asthmatic women were delivered by cesarean section, versus only 60% in the control group (p = 0.08). Labor was induced with oxytocin more often in the asthma group than in the control group (p = 0.07). We conclude that the labor and neonatal outcome in pregnant asthmatic women treated medically is good, even when asthma is severe and when the patient is treated with corticosteroids. There is, however, a relation between asthma in pregnancy, especially if severe, and predisposition to infections.

Adrenal Cortex Hormones↗
PubMed1998

Primary squamous cell carcinoma of the vagina: report of four cases and review of the literature.

Four patients with primary vaginal invasive squamous cell carcinoma are reported. They accounted for 0.3% of all females with genital tract malignancies diagnosed in the south of Israel between 1961 and 1996. One patient had Stage I disease, one--Stage II, one--Stage III and one--Stage IV. One patient was treated with external radiotherapy followed by intracavitary brachytherapy, one patient was treated with external radiotherapy followed by interstitial brachytherapy, one patient had systemic chemotherapy and one patient had no treatment. At the time of writing, one patient was alive without disease, one was alive with progressive disease, one had died of disease and one had died of intercurrent disease. It is concluded that primary vaginal carcinoma is a very rare entity with an estimated incidence of about 0.1-0.2/100,000 women. Most patients present with tumor extending beyond the vaginal wall (Stage II, III and IV) and the mainstay of treatment for these patients is radiotherapy. The overall 5-year survival rate is about 50%.

Adult↗
PubMed1998

Primary sarcoma of the ovary: report of five cases and review of the literature.

Primary ovarian sarcomas are rare and usually behave very aggressively. Over a ten-year period (1987-1996) five cases of primary ovarian sarcoma were managed at the Soroka Medical Center, Beer-Sheva, Israel. Four patients had malignant mullerian-mixed mesodermal tumor (MMMMT): two had Stage IIIC tumor with chondrosarcoma being the predominant sarcomatous element, one had Stage IIIC tumor with high-grade endometrioid stromal sarcoma (ESS) being the predominant sarcomatous element and one had Stage IC tumor with rhabdomyosarcoma being the predominant sarcomatous element. One patient had Stage IA leiomyosarcoma (LMS). All four patients with MMMMT received postoperative adjuvant chemotherapy, whereas the patient with LMS did not. The four patients with MMMMT died of their disease 10, 10, 13 and 25 months, respectively, after initial surgery. The patient with LMS died of intercurrent disease 21 months after initial surgery. It is concluded that most patients with primary ovarian sarcoma present with extraovarian disease and the prognosis is poor. The mainstay of treatment is debulking surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy and extirpation of tumor masses. The benefit of postoperative adjuvant chemotherapy and/or radiotherapy is still a subject of debate and has yet not been established.

Aged↗
PubMed1998

Tumor necrosis factor-alpha and interleukin-6 are differently expressed by fresh human cancerous ovarian tissue and primary cell lines.

The expression levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were evaluated in normal and cancerous ovarian tissue and primary cell lines (PCL). Seven normal and 10 cancerous, formalin-fixed ovarian samples were examined for TNF-alpha and IL-6 expression by immunohistochemical staining using polyclonal rabbit anti-human TNF-alpha and IL-6 antibodies. Fresh normal and cancerous specimens were also examined for TNF-alpha and IL-6 secretion by bioassay and immunoassay prior to and following in vitro stimulation with lipopolysaccharide (LPS). The levels of IL-6 and TNF-alpha were higher in cancerous tissues than in normal specimens. In vitro stimulation of normal and cancerous ovarian tissues and PCL revealed their capacity to secrete IL-6. Cancerous tissue and PCL secreted higher levels than normal tissue and PCL. Stimulation of both groups with LPS increased their capacity to secrete IL-6. Optimal secretion of IL-6 by the cancerous tissue was observed after 72 hours with or without LPS (10 microg/ml). Normal tissue secreted maximal levels of IL-6 after 96 hours with or without LPS. PCL from normal ovarian tissue secreted IL-6 constitutively and optimal expression was detected after 96 hours. Carcinoma PCL from cancerous ovarian tissue demonstrated optimal secretion of IL-6 after 24 hours. Stimulation of both types of cells with LPS, IL-1 or TNF-alpha increased their capacity to secrete IL-6. TNF-alpha activity was detected in vitro only in supernatants of ovarian cancerous tissue and only after LPS stimulation; optimal levels were detected after 48 hours and 1 microg/ml LPS. Our results indicate that IL-6 and TNF-alpha are expressed in cancerous ovarian tissue at a higher level than in normal ovarian tissues. Carcinoma cells of ovarian tissues are the main cellular source of these cytokines. The conditions controlling the secretion of these cytokines, under in vitro conditions, are different in cancerous and normal ovarian tissues.

Cell Line↗
PubMed1997

Uterine sarcoma in the south of Israel: study of 36 cases.

BACKGROUND: Uterine sarcomas are rare, charaterized by rapid clinical progression and poor prognosis, and their management has been a challenge. The purpose of this study was to investigate the clinical and histologic findings, treatment, and outcome of patients with uterine sarcoma in the south of Israel. METHODS: Data from the files of 36 patients with uterine sarcoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: The 5-year survival rate was 32% overall; 63% for 9 patients with endometrial stromal sarcoma (ESS). 30% for 14 patients with mixed mesodermal sarcoma (MMS) and 18% for 13 patients with leiomyosarcoma (LMS): 41% for 22 patients with Stage I and 19% for 14 patients with Stages II, III, and IV. Only the difference in the 5-year survival rate between ESS and LMS was statistically significant (P < 0.05). Eleven patients (30.6%) were treated with surgery alone, 4 (11.1%) with surgery followed by pelvic radiotherapy, 11 (30.6%) with surgery followed by chemotherapy, 8 (22.2%) with surgery followed by pelvic radiotherapy and chemotherapy, one (2.8%) with chemotherapy alone, and one (2.8%) had no treatment. CONCLUSIONS: Uterine sarcomas are aggressive tumors with a poor prognosis. The treatment is surgery generally followed by adjuvant pelvic radiotherapy and/or systemic chemotherapy.

Adult↗
PubMed1997

Endometrial carcinoma in the south of Israel: study of 231 cases.

BACKGROUND AND OBJECTIVES: Endometrial carcinoma is the commonest female genital tract malignancy in the south of Israel. The purpose of this study was to investigate the clinical and histologic findings, treatment and outcome of patients with endometrial carcinoma in the south of Israel. METHODS: Data from the files of 231 patients with endometrial carcinoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: Endometrial carcinoma was more prevalent among Jewish as compared to Arab-Beduin women, and among Ashkenazi as compared to Sephardic Jewish women. The prevailing presenting symptom was postmenopausal bleeding and most patients (68.8%) had Stage I disease. Most patients (209/225, 92.9%) underwent surgery, 131/222 (59%) had radiotherapy and 15/214 (7%) received chemotherapy. The 5-year survival rate was 79.1% overall; 89% for Stage I, 71.7% for Stage II, 21.6% for Stage III and 0% for Stage IV; 89.8% for Grade 1, 70% for Grade 2 and 60.9% for Grade 3; 100% for adenoacanthoma, 82% for endometrioid carcinoma, 65.8% for adenosquamous carcinoma and 51.6% for papillary serous carcinoma. CONCLUSIONS: Endometrial carcinomas are characterized by a relatively favorable prognosis with a 5-year survival of about 80%. Surgical stage, histologic differentiation and histologic subtype are sensitive predictors of survival. The mainstay of treatment is surgery with adjuvant pelvic radiotherapy when necessary.

Adult↗
PubMed1997

Distinct expression of cytokines and mitogenic inhibitory factors in semen of fertile and infertile men.

PROBLEM: To assess the effect of seminal plasma (SP) of fertile and infertile men on leukocyte mitogenic response, and the capability of sperm cells to produce IL-1. METHODS: This study included four groups: fertile men (donors, normal), infertile men with azoospermia (azoo), oligo-terato-asthenozoospermia (OTA), and OTA with genital infection (OTA-inf). Mouse spleen cell proliferation in response to lipopolysaccharide (LPS) or Concanavalin-A (Con-A) was examined in the presence of SP from the above four groups. Supernatants (sup) and lysates (lys) of sperm cells from fertile and oligoteratoasthenospermic (OTA) men were evaluated for IL-1 bioactivity by specific bioassay. RESULTS: Seminal plasma (SP) of the four groups were shown to inhibit the mitogenic response of mouse spleen cells to LPS and Con-A. SP of fertile men was significantly more inhibitory than SP from infertile men. Sperm cells from fertile and OTA infertile men constitutively produced IL-1. Sperm cells of both groups produced similar levels of IL-1 as examined in the supernatants and lysates. CONCLUSIONS: Seminal plasma of fertile men had more inhibitory mitogenic activity than that of OTA. Sperm cells constitutively produce IL-1. It is possible that the factors involved in this inhibition are not only anti-proliferative immune factors. Cytokines and inhibitory factors of mitogenesis in the seminal plasma may be involved in the physiology and pathophysiology of sperm functions and thus affect male fertility.

Animals↗