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Biomedical subjects

M Goldenberg

Publications and source records attributed to M Goldenberg.

At least 37 records · Page 2Linked to original sources
PubMed1999

A randomized, prospective study of endometrial resection to prevent recurrent endometrial polyps in women with breast cancer receiving tamoxifen.

STUDY OBJECTIVE: To assess the role of endometrial resection in preventing recurrence of tamoxifen-associated endometrial polyps in women with breast cancer. DESIGN: Randomized, prospective study (Canadian Task Force classification I). SETTING: Tertiary university-affiliated medical center. PATIENTS: Twenty consecutive women (age range 43-61 yrs). INTERVENTIONS: Hysteroscopic removal of tamoxifen-associated endometrial polyps with or without simultaneous resection of the endometrium. MEASUREMENTS AND MAIN RESULTS: Patients were randomized to undergo (10 women) or not undergo (10) concomitant endometrial resection. They were followed for at least 18 months (range 18-24 mo), including transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps; occurrence of uterine bleeding was also noted. In women who underwent endometrial resection, only one had a 1 x 1-cm endometrial polyp diagnosed and removed during follow-up. Seven women remained amenorrheic, and three experienced spotting for a few days every month. In the control group, six women had recurrent endometrial polyps requiring hysteroscopic removal (two-tail Fisher's exact test p <0.06). CONCLUSION: Recurrence of endometrial polyps, one of the most common problems in patients with breast cancer receiving long-term treatment with tamoxifen, may be reduced by performing endometrial resection at the time of hysteroscopic removal of polyps. The possible risk of occult endometrial cancer is yet to be determined. (J Am Assoc Gynecol Laparosc 6(3):285-288, 1999)

Adult↗
PubMed1999

Laparoscopic detorsion allows sparing of the twisted ischemic adnexa.

STUDY OBJECTIVE: To determine the safety and outcome of laparoscopic detorsion in the management of the twisted ischemic, hemorrhagic adnexa. DESIGN: Retrospective chart review and prospective follow-up (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Fifty-eight women with twisted black-bluish ischemic adnexa encountered at laparoscopy. INTERVENTION: Laparoscopic detorsion with adnexal sparing. MEASUREMENTS AND MAIN RESULTS: All patients had a benign immediate postoperative course. Transient temperature elevation occurred in seven women (12.1%). No signs of pelvic or systemic thromboembolism were detected in any patient. Long-term follow-up included transvaginal ultrasound, which revealed follicular development in the previously twisted adnexa in 54 women; normal macroscopic appearance at incidental subsequent surgery in 9; and in vitro fertilization with retrieval of oocytes from the previously twisted side in 4. CONCLUSION: Laparoscopic detorsion of the twisted ischemic, hemorrhagic adnexa is a safe procedure with minimal postoperative morbidity and a potential for the ovary to recuperate fully with preservation of normal function. Laparoscopic adnexa-sparing procedures should be performed in place of traditional salpingo-oophorectomy in women with this disorder who desire future fertility. (J Am Assoc Gynecol Laparosc 6(2):139-143, 1999)

Adnexal Diseases↗
PubMed1998

A randomized prospective study of the use of endometrial ablation for prevention of recurrent endometrial polyps in breast cancer patients receiving tamoxifen.

Objective: To assess the roles of endometrial ablation in prevention of recurrence of tamoxifen-associated endometrial polyps in breast cancer patients.Design: A randomized prospective study of tamoxifen-treated patients who underwent hysteroscopic removal of endometrial polyps with or without simultaneous resection of the endometrium.Materials and Methods: Twenty consecutive women (aged 43-61 years) undergoing hysteroscopic removal of tamoxifen-associated endometrial polyps were randomized via a computer-generated random table to undergo or not to undergo concomitant endometrial ablation. All patients had undergone endometrial sampling prior to the procedure. The patients were followed for at least 18 months (range 18-24 months). The follow-up included transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps while the occurrence of uterine bleeding was noted.Results: In the 10 study group women, who underwent endometrial ablation, only 1 patient had a 1 x 1 cm endometrial polyp diagnosed and removed during the follow-up period. Seven of the study women remained amenorrheic, and 3 experienced spotting a few days every month. In the control group, a recurrent endometrial polyp, necessitating hysteroscopic removal, was diagnosed postoperatively in 6 women (two-tailed Fisher's Exact test; P <.06).Conclusion: Recurrence of endometrial polyps, one of the most common problems in breast cancer patients receiving long-term treatment with tamoxifen, can be significantly reduced by performing endometrial ablation at the time of hysteroscopic removal of the polyp. The possible risk of occult endometrial cancer is yet to be determined.

Journal Article↗
PubMed1998

Endometrial resectoscopic ablation in patients with menometrorrhagia as a side effect of anticoagulant therapy.

OBJECTIVE: The study was conducted to examine the effect of endometrial ablation therapy for patients suffering from coagulation abnormalities and presenting with failed medical treatment for menometrorrhagia. STUDY DESIGN: Eleven patients with a mean age of 42 years (range 39-45) and with coagulation disorders in whom medical therapy for abnormal uterine bleeding was unsuccessful, were treated by the ablation procedure under video monitoring. Complications, length of hospitalisation and long-term follow-up were noted. The age of the patients ranged from 39-45 years. Menstrual characteristics were scored, but blood loss before and after the procedure was not quantified. RESULTS: Uterine fibroids were found in two patients. The duration of the ablation procedure was 20 min and was prolonged for 30 to 40 min when fibroids were diagnosed. During the operation, no excessive bleeding was noted in ten patients and postoperative recovery was rapid in all. After a one-year follow-up the overall satisfaction of the patients was high (10/11). CONCLUSIONS: Our initial experience with a selected group of patients suffering from coagulation abnormalities is promising. Bearing in mind the risks of a major operation in this group of patients, endometrial ablation should be seriously considered.

Adult↗
PubMed1997

Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock.

STUDY OBJECTIVE: To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital. PATIENTS: Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery. CONCLUSION: The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.

Adult↗
PubMed1997

Kinetics and role of alpha 1-acid glycoprotein-dependent osmotic transport of water and ions in palmitoyl-L-oleoyl phosphatidylcholine liposomes.

alpha 1-Acid glycoprotein isolated from human blood plasma is known to influence cell permeability, although the mechanisms of this process are unclear. Here, the glycoprotein effects on the permeability of osmotically stressed phospholipid liposomes are studied as a model of membrane permeability. Liposomes containing glycoprotein were found to be osmotically sensitive to water and chloride salts of some monovalent (Na+, K+) and bivalent (Mg2+, Ca2+) ions. The permeations of these substances were determined by light-scattering measurements of the volume changes in liposomes after mixing with hyperosmotic solutions of chloride salts. The time courses of scattered light were recorded by means of stopped-flow spectrophotometry. Two processes were studied: the fast water outflow from liposomes and slower ion permeations through the lipid membrane. The second order permeation rate constants were determined at different glycoprotein concentrations for both processes. Values from 66 to 250 x 10(3) for water outflow and 2-500 M-1 sec-1 for the different ion permeations were obtained in order to characterize the permeations of solutes across the lipid membrane. The apparent activation energies also were calculated between 18 and 33 degrees C. The mercurial sulphydryl reagent pCMBS inhibited the ion permeations in the slow phase. When pCMBS was present in this phase, higher activation energies were obtained, indicating more difficult permeations. An interpretation of these results is that membrane permeability is mediated by aqueous pores. Membrane selectivity to monovalent metal ions also was demonstrated, but no correlation was observed between the ion radius of the corresponding metal cation and permeation rate constants. The discovery of non-specific pores in liposomes containing glycoprotein shows that they can serve as vehicles for the water and ions in the processes of passive transport through lipid membranes.

Biological Transport↗
PubMed1997

Managing residual trophoblastic tissue. Hysteroscopy for directing curettage.

OBJECTIVE: To describe our experience with selective removal of residual intrauterine trophoblastic tissue via hysteroscopy. METHODS: This is a descriptive report. Eighteen patients, 16 postabortion and 2 postpartum, underwent a hysteroscopic procedure for removal of residual trophoblastic tissue causing continuous bleeding. At hysteroscopy, a cutting loop was used as a curette for selective removal of the adherent residual tissue, while interference with the rest of the endometrial surface was avoided. RESULTS: Complete removal of the suspected residual tissue was achieved in all patients. Histology confirmed the curettings as trophoblastic remnants. No complications were reported during or immediately after the procedure. The median operative time was 10 minutes (range, 8-20). In all cases the bleeding stopped shortly after the procedure. In each patient, postoperative ultrasonography revealed a uterine cavity free of residual tissue. Five of the patients underwent second-look hysteroscopy several weeks later, and no signs of further residual tissue were observed. CONCLUSION: Selective curettage of residual trophoblastic tissue directed by hysteroscopy is an easy and short procedure and might be preferable to conventional, nonselective, blind curettage.

Abortion, Incomplete↗
PubMed1996

Dexamethasone as an adjuvant therapy for anovulatory, normoandrogenic patients during ovulation induction with exogenous gonadotropins.

OBJECTIVE: The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy. METHODS: The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded. RESULTS: There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups. CONCLUSIONS: The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.

Abortion, Spontaneous↗
PubMed1996

The effect of intracervical vasopressin on the systemic absorption of glycine during hysteroscopic endometrial ablation.

OBJECTIVE: To examine the effect of paracervical injection of vasopressin on the absorption of glycine during transcervical endometrial ablation. METHODS: Thirty-three consecutive women scheduled for elective hysteroscopic endometrial ablation were randomized to either the study or control group. All procedures were performed with a myoma resectoscopy using 1.5% glycine as the irrigating medium at a flow rate of 100 mL/minute. In the study group, a solution of 0.2 mg vasopressin diluted with 20 mL saline was injected paracervically. Blood samples were obtained through an indwelling intravenous catheter every 5 minutes until the completion of the operation. Serum sodium, potassium, and magnesium levels were measured at 20-minute intervals. In addition, glycine concentrations were determined by both rapid screening and quantitative amino acid analysis. RESULTS: Plasma glycine maximal concentrations were significantly lower (P < .001) in patients who received vasopressin, compared with controls (8.8 +/- 4.5 versus 16.0 +/- 6.3 mmol/L, respectively). The calculated extent of glycine absorption within the first 20 minutes of the procedure was 59.6 +/- 30.0 versus 179.8 +/- 66.2 mmol/L.minute in the study and control groups, respectively (P < .001). The differences in plasma sodium, potassium, and magnesium levels were not significant. CONCLUSION: Intracervical vasopressin administration significantly decreased systemic glycine absorption in patients undergoing hysteroscopic endometrial ablation.

Absorption↗
PubMed1996

Intraumbilical vein injection of prostaglandin F2 alpha in retained placenta.

A randomized protocol was used to study the effect of intraumbilical prostaglandin F2 alpha (Hembate, Upjohn) and oxytocin injection in women with retained placenta. Prostaglandin F2 alpha, 20 mg, diluted to 20 ml in normal saline solution (10 women, group 1), 30 IU of oxytocin, diluted to 20 ml in normal saline solution (11 women, group 2), or 20 ml of normal saline solution alone (7 women, group 3), were injected into the umbilical vein 1 h after delivery. Nine women (group 4, controls) underwent manual removal of the retained placenta. In group 1, placental expulsion occurred in all patients and the duration of the placental expulsion after prostaglandin F2 alpha injection was 6.8 +/- 1.36 (mean +/- SE) min: in group 2, six placental expulsions occurred after 13.3 +/- 1.97 min (mean +/- SE); and in group 3, no effect was recorded after intraumbilical saline injection. We suggest that intraumbilical vein injection of prostaglandin F2 alpha might be a beneficial, non-surgical method for treating retained placenta. Oxytocin might reduce the incidence of manual lysis of the placenta and achieve partial success.

Adult↗
PubMed1996

Stretching of the cervix and stripping of the membranes at term: a randomised controlled study.

OBJECTIVE: To determine whether routine antepartum stretching of the cervix and stripping of the membranes at term would shorten the length of pregnancies, and whether this correlated with cervical status and fetal and maternal parameters. DESIGN: A prospective, randomised, controlled study of 293 term gravidas, free of medical complications, divided into two groups: stretching/stripping, and non-stretching/stripping. Digital separation of the fetal membranes from the lower uterine segment, and cervical stretching, were performed during routine vaginal examination of the first group. In the second group, only routine vaginal examination was performed. RESULTS: Of 293 patients, 152 underwent a trial of stretching and stripping; 141 served as a control group. The mean interval (hours to delivery after the procedure) was 136 h (S.D. 10), compared to 161 h (S.D. 11) in the control group (P = 0.095; not significant), but with only a trend towards the shorter interval in the first group. When patients were matched according to weeks of gestation and fetal and maternal parameters, only those at 41 weeks' gestation or more had a significant reduction in the interval from the procedure to delivery (mean 91 h (S.D. 8) compared to mean 125 h (S.D. 10) in the control group; P < 0.007). This observation was independent of cervical status and other maternal or fetal parameters. CONCLUSIONS: Only patients > or = 41 weeks' gestation benefitted from stretching of the cervix and stripping of the fetal membranes. The effect was not dependent on the cervical status or other maternal and fetal parameters.

Adult↗
PubMed1996

Is Operative Laparoscopy Contraindicated in Women with Ectopic Pregnancy and Hypovolemic Shock?

We evaluated the safety of operative laparoscopy for the management of ectopic pregnancy in 119 women with hypovolemic shock. In 19 (16.0%) of these women hypovolemic shock was based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. The table below presents the results (mean &plusmn; SEM; ap <0.01). One case in each group was converted to laparotomy, and all patients made full recovery. Laparoscopy allows rapid diagnosis and control of the source of bleeding, making it highly suitable for the surgical management of a ruptured ectopic pregnancy. The availability of appropriate anesthesia and advanced cardiovascular monitoring, and ability to convert rapidly to a laparotomy if necessary, allow safe performance of operative laparoscopic surgery in women with hypovolemic shock.

Journal Article↗
PubMed1996

Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.

A retrospective, descriptive study was conducted to evaluate the outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence. Thirty-two women with singleton pregnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine activity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (median 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated before 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks for the 19 who achieved viability. The mean birthweight of the live infants was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infants died during the neonatal period. The total survival rate was 47%, and the survival rate corrected for major anomalies was 48.4%. The perinatal mortality rate was significantly higher among patients with membranes protruding through the-cervix on admission, compared to those without (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate. Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.

Adult↗
PubMed1996

Laparoscopic surgical management of ovarian cysts assisted by simultaneous transvaginal ultrasonography.

OBJECTIVE: To assess the use of transvaginal ultrasound guidance during operative laparoscopy. STUDY DESIGN: Five of 98 consecutive cases of operative laparoscopy for benign-appearing ovarian cysts were complicated by extensive intrapelvic adhesions and a distorted anatomy. Following prolonged dissection, simultaneous transvaginal ultrasonography was used in these cases. RESULTS: In all cases we were able to ultrasonographically image and locate the ovarian cyst during the laparoscopic procedure. In four cases this was a significant aid in expediting the procedure and avoiding damage to adjacent pelvic structures. In one case, identification of the ovarian cyst facilitated the decision to resort to laparotomy. CONCLUSION: In selected cases, laparoscopic surgeons should be aware of the feasibility and possible benefits of the use of simultaneous intraoperative transvaginal ultrasonography.

Adnexal Diseases↗
PubMed1996

Endometrial resection vs. abdominal hysterectomy for menorrhagia. Correlated sample analysis.

OBJECTIVE: To compare hysteroscopic endometrial resection with transabdominal hysterectomy in women with menorrhagia who failed to respond to conservative treatment. STUDY DESIGN: In order to attain correlated samples, only patients with a normal-sized or moderately enlarged uterus were included in the study. RESULTS: The operating time, hospital stay and number of women requiring postoperative blood transfusion was significantly lower in the hysteroscopy group. Following hysteroscopy, uterine perforation occurred in three patients, fluid overload in two and dilutional hyponatremia in one. Laparotomy was performed for suspected bowel injury in two cases. The main complication in women undergoing hysterectomy was postoperative fever (36.5%). One case of vesicovaginal fistula was diagnosed seven days postoperatively. CONCLUSION: The results indicate that endometrial resection, with its low cost and prompt recovery, offers a promising alternative treatment for women with abnormal uterine bleeding.

Adult↗
PubMed1995

Outcome of hysteroscopic resection of submucous myomas for infertility.

OBJECTIVE: To examine the reproductive outcome after operative hysteroscopic resection of submucous myomas in women for whom no other infertility factor was identified. DESIGN: Fifteen infertile women with submucous myomas underwent an intensive workup to exclude other causes of infertility. Operative hysteroscopy for resection of the submucous myomas was performed using a rigid 26 French resectoscope (Karl Storz GmbH & Co., Tuttlingen, Germany). SETTING: Academic tertiary referral center. RESULTS: The mean +/- SD duration of the procedure was 25.5 +/- 5.6 minutes. No operative or postoperative complications occurred and all patients were discharged within 6 hours. The follow-up period was 12.0 +/- 4.2 months (mean +/- SD). Seven women conceived (pregnancy rate of 47%) and six of them subsequently delivered at term. CONCLUSION: The results of this study indicate that operative hysteroscopy achieved a pregnancy rate comparable to myomectomy via laparotomy. These results suggest that operative hysteroscopy is the procedure of choice for the resection of submucous myomas in infertile women.

Adult↗
PubMed1995

Changes mimicking endometrial neoplasia in postmenopausal, tamoxifen-treated women with breast cancer: a transvaginal Doppler study.

In menopausal patients with breast cancer who receive tamoxifen therapy, transvaginal sonography may show an abnormal endometrium. Our objective was to evaluate the effects of prolonged tamoxifen therapy on endometrial blood flow in postmenopausal patients with breast cancer, and to correlate blood flow characteristics with the sonographic appearance of the endometrium and its pathology. Transvaginal color Doppler ultrasound examinations were performed on 45 postmenopausal women (age range 54-70 years) with breast cancer, who had been treated with tamoxifen for 1-3 years. Twenty women (Group 1) had a thick, irregular, cystic endometrium of > or = 5 mm, and 25 (Group 2) showed a thin endometrium of < 5 mm. The blood flow response was assessed by visualization of arterial waveforms in the endometrial and subendometrial regions with a transvaginal color flow imaging system. Resistance indexes (RI) were calculated for analysis and correlated with endometrial appearance and histology. The mean RI in Group 1 was 0.39 +/- 0.10 (range 0.32-0.54), while the mean RI in Group 2 was 0.79 +/- 0.10 (range 0.54-0.90; p < 0.001). On histology, 12 patients in Group 1 showed atrophic endometria confirmed by hysteroscopy, while in the remaining eight, endometrial polyps were found. In Group 2, all patients had scanty, atrophic endometria. Six of the eight patients with endometrial polyps had an RI of < 0.4 and none had malignant changes. These data suggest that tamoxifen therapy in women with postmenopausal breast cancer induces endometrial, morphological and blood flow changes, mimicking endometrial neoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗