PubMed Health⌕ Search

Biomedical subjects

M M Gelfand

Publications and source records attributed to M M Gelfand.

At least 37 records · Page 2Linked to original sources
PubMed1985

Benign cystic teratoma of the ovary: a 6-year review.

Benign cystic teratoma of the ovary was diagnosed histologically in 118 patients over 6 years at the Sir Mortimer B. Davis-Jewish General Hospital in Montreal. The charts were reviewed with respect to population distribution, symptomatology, diagnostic procedures and treatment. Of the 118 patients, 85.6% were younger than 40 years. Only 3.4% had documented recurrence and 6.8% were pregnant. Roentgenograms of the pelvis revealed calcification in 64.1% of cases. Ultrasonography of the pelvis failed to make the diagnosis in 19.4%. The majority of patients had a Pfannenstiel incision (78.8%) and underwent oophorectomy (55.3%). In half the patients the contralateral ovary was only palpated.

Adolescent↗
PubMed1984

Care in a birth room versus a conventional setting: a controlled trial.

A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns. Of the 163 low-risk women enrolled, 49 (30%) manifested some prenatal risk and were excluded. The remaining 114 were allocated by strict alternation to a birth room or a conventional setting. Of the 56 women allocated to the birth room, 63% of the primiparas and 19% of the multiparas were later transferred. The numbers in the two settings who had oxytocin stimulation, epidural anesthesia, forceps delivery or cesarean section did not show statistically significant differences. The episiotomy rates were slightly lower in the birth room than in the conventional setting, and the rates of an intact perineum were higher in the birth room. Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated, although more infants from the conventional setting were admitted to a special care unit. Both "experimental" groups of women less often received routine perineal shaving, enemas or intravenous infusions than did an obstetrically similar nonexperimental comparison group. Despite the apparent inability in this setting for the birth room to influence the rate of major obstetric procedures (except for episiotomy) and outcomes, the authors believe that a birth room is desirable in tertiary care centres as well as in community hospitals.

Adult↗
PubMed1984

Effects of parenteral administration of estrogen and androgen on plasma hormone levels and hot flushes in the surgical menopause.

In a prospective, double-blind, crossover study, it was found that surgically menopausal women who received an estrogen drug alone and those who were given a combined estrogen-androgen preparation reported a significantly reduced frequency of hot flushes compared to a placebo group (p less than 0.01) coincident with their higher total plasma estrogen levels (p less than 0.01). The administration of testosterone alone, however, was ineffective in alleviating hot flushes, even though these patients had plasma estrogen values that were not different from those of women with intact ovaries. It was proposed that, in women with very low levels of endogenous estrogens, changes in sex hormone-binding globulin (SHBG) concentrations induced by exogenous testosterone may reduce the amount of non-SHBG-bound estrogens, thereby obviating estrogenic effects on hot flushes.

Adult↗
PubMed1984

Reconstructive surgery of hydrosalpinx with and without the carbon dioxide laser.

Pregnancy rates and surgery-conception intervals were determined in 91 women operated on for bilateral terminal tubal occlusion with different techniques. The intrauterine pregnancy rate following salpingostomy utilizing the CO2 laser was 21.7% (n = 23) and following salpingostomy with the microdiathermy needle was 22.7% (n = 22) at 1 year's follow-up. The pregnancy rate following conventional surgery was 17.4% (n = 46) at 5 years' follow-up. The surgery-conception interval was shorter in the laser group than in the other two groups. This preliminary report suggests that there is no difference between the pregnancy rate following salpingostomy with CO2 laser or microdiathermy needle; however, the surgery-conception interval is shorter. This might reflect the rapid healing of the tube after laser surgery.

Adult↗
PubMed1984

Outpatient endometrial sampling with Endocyte: comparative study of its effectiveness with endometrial biopsy.

The endometrium was sampled in the office with the Endocyte, a disposable plastic brush. The aim of the study was to assess its clinical characteristics and diagnostic yield with respect to cytology and histology. One hundred eighty of the 200 women sampled were 46 years and older, and 65.5% of them were asymptomatic but at risk for corpus carcinoma. In every case, brushing was controlled by subsequent biopsy. Brushing was safe, fast, and simple. Patient acceptance for future tests with Endocyte was 100%, compared to 40% with biopsy. Satisfactory samples for cytologic diagnosis were obtained in 92% of the patients with brushing and in 90% with biopsy-obtained histology. Endocyte cytology confirmed biopsy-proved hyperplasia (36 cases) and carcinoma (two cases) in 80.5 and 100% of the cases, respectively; 19.5% of hyperplasias were underdiagnosed as normal endometrium. No false-positive diagnosis was made. Fifty percent of mini-biopsies with the Endocyte were unsatisfactory for diagnosis. The results indicate that, provided endometrial cytologic expertise is available, the Endocyte is useful for screening asymptomatic women at risk for endometrial carcinoma and its precursors.

Adult↗
PubMed1983

The cytodynamics of endometrial hyperplasia and carcinoma. A review.

Current evidence suggests that endometrial hyperplasia represents a spectrum of increasingly atypical proliferation of glands and their lining epithelium that is correlated with increasing persistence, recurrence and progression rates, to carcinoma following curettage and/or progestagen therapy. Hyperplasia can be divided into two phases of pathogenetic development. An initial proliferative phase leading to hypertrophy and a second or remodelling phase, characterized by increasing morphokinetic and biochemical alterations of gland cells. Histologically, the proliferative phase is classified into anovulatory, persistent proliferative endometrium and cystic glandular hyperplasia and the remodelling phase, into adenomatous hyperplasia without and with significant cytologic atypia. The histologic subsets can further be classified as mild, moderate and severe hyperplasia according to their respective clinical behaviour. The data suggest, furthermore, that endometrial C.I.S. represents a transitional state between severe hyperplasia and early, invasive adenocarcinoma. From a pathogenetic standpoint, hyperplasia is induced by longstanding, unopposed estrogenic stimulation and its early phase is made of estradiol-sensitive cells. Paralleling the gradual increase in architectural and cytologic atypia, clones of cells are produced that are relatively insensitive to estradiol and have impaired response to growth-control mechanisms. These estradiol-independent cells are presumably susceptible to malignant transformation.

Adenocarcinoma↗
PubMed1982

Mid-trimester abortions: a decade in review.

At the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, the total number of abortions increased over the 10-year period Jan. 1, 1970 to Dec 31, 1979 but the percentage of mid-trimester abortions performed fell after 1974 to 2.1% at the end of the study period. The authors reviewed the records of 1422 patients who underwent mid-trimester abortions over the 10 years of the study to determine which technique was the safest, the quickest and the most commonly performed. Initially, saline instillation was the commonest method but this has been replaced by injection of prostaglandin F2 alpha, which was found to be the quickest acting of the fluids used. Hysterotomy and hysterectomy were associated with higher complication rates than other methods, confirming the authors' belief that they should be used only under exceptional circumstances.

Abortion, Induced↗
PubMed1981

Incidence of respiratory distress syndrome following antenatal betamethasone: role of sex, type of delivery, and prolonged rupture of membranes.

Premature male infants have a higher incidence of respiratory distress syndrome (RDS) than female infants (male/female = 1.7:1.) With the demonstration that antenatal use of betamethasone significantly reduces the incidence of RDS, a proportional reduction or possibly a complete elimination of the discrepancy between the two sexes might be expected. The role that sex, type of delivery, and prolonged rupture of membranes (PROM) may play in the development of RDS was tested in a prospective study of RDS prevention with betamethasone. A full course of betamethasone, ie, 12 mg, 24 hours apart, was given antenatally to 94 infants of 27 to 34 weeks gestation. The incidence of RDS in male infants was 29.1% vs 8.6% in female infants (P less than .02). The incidence of RDS among male babies delivered by cesarean section (30.3%) or vaginally (29.7%) was not statistically different, nor was there a difference between those with PROM greater than 24 hours (26.9%) and those without PROM (31.8%). The same was true of the incidence of RDS among female infants: cesarean section (14.2%) vs vaginal delivery (6.2%) and PROM greater than 24 hours (8%) vs (9.5%) without PROM. We conclude that: (1) Prevention of RDS with betamethasone is far more effective in female infants. The natural ratio of male/female of 1.7:1 becomes 3.4:1. (2) Once lung maturity has been achieved with betamethasone, the type of delivery plays no role in the development of RDS. (3) PROM does not add extra protection from RDS in the 27- to 34-week gestational age range.

Betamethasone↗
PubMed1979

Studies on the cytodynamics of human endometrial regeneration. III. In vitro short-term incubation historadioautography.

The proliferation kinetics of endometrial regeneration were assessed by tracing nucleoprotein precursor, radiothymidine. Increased isotope uptake occurred by cycle day 3 and was confined to the gland cells of denuded stratum basale (basal layer) and persistent uterine lining, bordering peripheral areas of denudation. This increase resulted in the formation of flattened surface epithelial cells, which initially were devoid of significant deoxyribonucleic acid synthesis. Such alterations are consistent with changes in cells involved in ameboid migration. Maturation of migrating cells was accompanied by a significant rise in labeling indices and replication at cycle days 3 and 4. By cycle day 5, endometrial repair was complete. The findings indicate that, following physiologic loss of stratum functionale, endometrial healing involves both migration and replication of surface cells, which originate from the gland stumps of the residual basal layer and the persistent surface epithelium adjacent to the periphery of denuded endometrium.

Adult↗
PubMed1979

Proliferation kinetics of human endometrium during the normal menstrual cycle.

A radioautographic analysis of the number and distribution of labeled nuclei after in vitro incorporation of radiothymidine was carried out in human endometrium during the normal menstrual cycle. The highest rates of proliferation were recorded on cycle days 8 to 10 in the upper one third of the functionalis layer. Coinciding with intraglandular secretory activity on cycle day 19, the rate of proliferation of gland cells decreased near zero levels and remained unchanged thereafter. Midsecretory phase arteriolar coiling and stromal predecidualization were associated with increased isotope incorporation. DNA synthesis in premenstrual endometrium was limited to the surface epithelium, predecidua, and vascular endothelium. The endometrium of the isthmus and cornual regions and of the basalis zone demonstrated relatively constant and comparatively lower rates of proliferation throughout the cycle. Regional and cellular variations in nucleic acid synthesis in cyclic endometrium are likely to reflect differences in physiologic functions in target cells in response to cyclic hormonal stimuli.

Adult↗
PubMed1979

The antenatal use of betamethasone in the prevention of respiratory distress syndrome: a controlled double-blind study.

One hundred forty-six pregnant women were enrolled in a prospective double-blind study to assess the effectiveness and side-effects of antenatal administration of betamethasone in the prevention of respiratory distress syndrome (RDS) in potentially premature infants. On admission to the study, the women were given, at random, either 12 mg of betamethasone or placebo. The same dose was repeated 24 hours later and then weekly up to 34 weeks of gestation. Gestational age of the infants ranged from 25 to 34 weeks, and birth weights ranged between 730 and 2,650 gm. Statistically significant differences in favor of the infants in the betamethasone group were found in the incidence of RDS, 20.7% in the betamethasone group compared with 59.5% in the control group (P less than .005); in the severity of RDS (P less than .05); and in the death rate (P less than .05). A higher incidence of hypoglycemia was found among infants in the betamethasone group (P less than .05). Prolonged rupture of the membranes played no protective role against RDS, and the incidence of infection was similar in both groups.

Betamethasone↗
PubMed1979

The Kevorkian curette. An appraisal of its effectiveness in endometrial evaluation.

Office endometrial biopsy with the Kevorkian curette was performed in 400 patients presenting with abnormal uterine bleeding or other endometrial cancer-risk indicators. The use of this instrument has proved to be a safe, simple, inexpensive, and highly reliable outpatient procedure with excellent patient acceptance. It has provided tissue for adequate diagnosis in 91.8% of the cases, and the diagnostic accuracy when controlled by D&C and/or total abdominal hysterectomy (TAH) was 96.2%. As a result, 73.5% of the women required no further surgical procedures for either diagnostic or therapeutic purposes. In the postmenopausal age group, adenocarcinoma was diagnosed in 7 of 177 (3.9%) women. This procedure is highly recommended for early office diagnosis of uterine pathology and, in particular, endometrial adenocarcinoma and its presumed precursor lesion, adenomatous hyperplasia.

Adenocarcinoma↗
PubMed1979

Effect of single and multidose cephradine prophylaxis on infectious morbidity of vaginal hysterectomy.

The administration of cephradine prophylactically to patients who were undergoing vaginal hysterectomies resulted in a marked and significant reduction in the incidence of postoperative infections when compared to a placebo group. Cephradine was the cephalosporin studied because of its unique pharmacodynamic properties, which result in high uterine tissue levels. The protective effect was similar whether 1 g was given preoperatively followed by 500 mg IV q. 6 hours for 4 doses, or a single dose of 2 g IV given approximately 1 hour before surgery. Uterine tissue and serum levels of antibiotic were high and correlated with the degree of protection noted.

Adult↗
PubMed1977

Specialized perinatal care: impact on perinatal mortality.

A neonatal intensive care unit was established at one hospital in 1972 when the neonatal mortality was 7.6 and the perinatal mortality 20.9 per 1000 deliveries. In 1973, with full operation of that unit and partial introduction of a high-risk pregnancy unit for fetal monitoring, the rates decreased to 6.4 and 14.9, respectively. With full operation of both units the rates decreased further, to 3.4 and 9.0 in 1974 and 3.8 and 8.9 in 1975. The frequency of cesarean section was 10.1% in 1972-73 and 11.6% in 1974-75. It is concluded that the centralization of obstetric and neonatal care, together with the development of qualified medical and nursing teams, had a major impact in reducing perinatal mortality, and that the frequency of cesarean section was not affected by the introduction of fetal monitoring, although the indications for this precedure became more specific.

Birth Weight↗