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Biomedical subjects

Marek Glezerman

Publications and source records attributed to Marek Glezerman.

At least 37 records · Page 2Linked to original sources
PubMed2004

Comparison between primary peritoneal and epithelial ovarian carcinoma: a population-based study.

OBJECTIVE: This study was undertaken to characterize primary peritoneal carcinoma (PPC) compared with ovarian carcinoma (OvC). STUDY DESIGN: Within the framework of a nationwide epidemiologic Israeli study, 95 PPC patients were identified and compared with 117 FIGO stage III-IV epithelial OvC patients matched by age and continent of birth. Data were abstracted from medical records and personal interviews. RESULTS: Our data confirm the similarities between PPC and OvC. A higher rate of abdominal distention, volume of ascites, and malignant cells in ascitic fluid and lower rate of pelvic palpable mass and personal breast cancer history were found in the PPC compared with the OvC group. The overall survival was similar in both groups (30-33 months). In optimally cytoreduced patients, survival was better in the OvC group. Diameter of residual disease was associated with better survival only in the OvC group. CONCLUSION: The clinical differences do not enable a preoperative distinction between the neoplasms.

Adult↗
PubMed2004

Phase II study of weekly topotecan in patients with recurrent or persistent epithelial ovarian cancer.

OBJECTIVE: To assess the toxicity and effectiveness of once-weekly administration of topotecan (Hycamtin; GlaxoSmithKline) for relapsed ovarian and primary peritoneal cancer. METHODS: Twenty-three patients with recurrent or persistent epithelial ovarian cancer (EOC) and primary peritoneal carcinoma (PPC) previously exposed to at least one line of platinum-based chemotherapy were treated with IV weekly topotecan as a 30-min bolus at a starting dose of 4 mg/m(2) administered weekly for 3 weeks in a 28-day cycle. RESULTS: The patients' median age was 62 years (42-83). Thirteen women (56.5%) were defined as having platinum-sensitive and 10 (43.5%) as having platinum-resistant disease. Altogether, 88 cycles were administered for a total of 264 weekly treatments, with a median of four courses (range 2-6). There were no treatment delays. The main bone marrow toxicity was grade II and III thrombocytopenia, necessitating dose reduction in four patients (17.4%) and treatment cessation in one patient. The most frequent nonhematologic toxicity was fatigue (nine patients, 39.1%). There were four complete responses (17.4%, three in the platinum-sensitive and one in the platinum-resistant patients) and seven (30.4%) partial responses, for an overall response rate of 47.8%. The ORR was similar in platinum-sensitive and platinum-resistant patients (47.8% and 52.2%, respectively). The median progression-free survival was 4.9 months with a mean survival time of 11.59 months. Two women sustained complete response lasting >6 months. CONCLUSION: Topotecan given as a weekly bolus is a highly active and well-tolerated treatment regimen for relapsed ovarian and primary peritoneal cancer and thus deserves further evaluation.

Adult↗
PubMed2004

Patient-controlled epidural analgesia for labor pain: effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine.

The objective was to evaluate the influence of patient-controlled epidural analgesia (PCEA) using low doses of bupivacaine vs. ropivacaine, on labor pain, motor blockade, progression of labor, delivery and neonatal outcome. This randomized double blind study included 565 parturients. All received a 5-mL/h infusion and PCEA (5-mL boluses with a 20-min lockout, maximum volume 20 mL/h) of either 0.125% bupivacaine (n = 313: 165 nulliparous, 148 parous) or 0.2% ropivacaine (n = 252: 113 nulliparous, 139 parous). Pain score, lower limb motor block, sensory levels, local analgesic doses required, hemodynamic parameters, side effects and complications were assessed. Obstetric variables included cervical dilation at epidural insertion, incidence of ruptured membranes and their duration, use of oxytocin, fetal heart rate changes, duration of labor, mode and outcome of delivery, and use of invasive and non-invasive fetal monitoring. Neonatal characteristics included birth weight, Apgar scores, umbilical artery pH, serum bilirubin, hypoglycemia, need for assisted ventilation, sepsis or sepsis study, feeding difficulties and respiratory distress syndrome. Ropivacaine 0.2% was equianalgesic with 0.125% bupivacaine, but produced less motor block (P < 0.0001). There were no significant differences, however, in duration of labor, delivery type or neonatal outcome.

Adult↗
PubMed2004

Pseudocholinesterase deficiency associated with HELLP syndrome.

We report a case of decreased plasma pseudocholinesterase activity in a patient with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The pseudocholinesterase activity returned to normal with concomitant recovery of HELLP syndrome. This possible association is significant when general anesthesia is provided to patients with HELLP syndrome.

Adult↗
PubMed2004

Human immunodeficiency virus: anesthetic and obstetric considerations.

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.

Adult↗
PubMed2004

Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine.

The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P < 0.001). More patients from the air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P < 0.02). The incidence of accidental dural puncture was greater in the air group (1.7% versus 0% in the other two groups; P < 0.02). Pain scores, time to onset of analgesia, upper sensory level, motor blockade, and the incidence of hypotension, transient neurological deficits, postpartum urinary retention, and postdural puncture headache were comparable. Identification of the epidural space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.

Adolescent↗
PubMed2004

Atosiban treatment for uterine hyperactivity during active labor: a pilot study.

OBJECTIVE: A preliminary assessment of the ability of Atosiban to alleviate uterine hyperactivity during active labor. METHODS: Fifteen consecutive women with uterine hyperactivity during active labor were included in this prospective observational study. Atosiban was given as a single or repeated intravenous bolus dose (6.75 mg in 0.9 mL NaCl solution) if hyperactivity was not alleviated within 5 minutes with "intrauterine resuscitation" measures. RESULTS: Alleviation of uterine activity was achieved in 14 out of 15 cases and was almost immediate in the responders. Alleviation of accompanying fetal heart rate abnormalities was achieved in 13 out of 14 cases. In 7 of 15 women a cesarean section was performed, eventually. Atosiban was well tolerated by all women and no side effects were noted. There were no 5 minutes Apgar scores of less than 7. There were no cases of neonatal asphyxia or neonatal mortality. CONCLUSION: Atosiban may be an effective treatment of uterine hyperactivity during active labor.

Adult↗
PubMed2004

Role of sonography in the diagnosis of retained products of conception.

OBJECTIVE: To present our experience with clinical and sonographic diagnosis of retained products of conception and to evaluate its correlation with histopathologic findings. METHODS: This was a retrospective study on 156 patients admitted for retained products of conception. Women were referred because of 1 or more of the following: abdominal pain, bleeding, and fever. The status of the cervix was evaluated by bimanual examination. The diagnosis of retained products of conception was made when a sonographic finding of hyperechoic or hypoechoic material was seen in any part of the uterine cavity or the presence of a thickened endometrial stripe greater than 8 mm and an irregular interface between the endometrium and myometrium was found. One hundred twenty-one women (77.6%) were admitted after dilation and curettage for abortion, and 35 (22.4%) were admitted after spontaneous labor. RESULTS: Histopathologic reports confirmed the diagnosis of retained products of conception in 86 (71%) of 121 women in the postabortion group and in 17 (48.5%) of 35 women in the postpartum group. The overall false-positive rate for sonographic diagnosis was 34%. For women after abortion and after delivery, the false-positive rates were 28.9% and 51.5%, respectively. CONCLUSIONS: Reliance on common signs and symptoms to diagnose retained products of conception as well as the use of sonography is associated with an unacceptably high false-positive rate, mainly after delivery. A more conservative approach to the treatment of retained products of conception is suggested.

Abortion, Incomplete↗
PubMed2004

Male fetuses and the risk of cesarean delivery.

OBJECTIVE: To assess the reported increased rate of cesarean sections in women carrying male fetuses. STUDY DESIGN: A retrospective analysis of all deliveries in 2001 was performed. All singleton deliveries were enrolled. We compared fetal sex distribution in cesarean ased risk of cesarean sections performed for various indications. The study had 80% power to detect a explained by different parturient difference in the cesarean section rate in women carrying male and female fetuses. RESULTS: The overall cesarean section rate was similar in women with male or female fetuses, 19.7% and 19.1%, respectively. This lack of association was also found in specific subgroups of cesarean indications: non-reassuring fetal heart rate pattern, fetal distress, nonprogressive labor, elective cesarean, suspected macrosomia, abnormal lie and severe preeclampsia. CONCLUSION: In contrast with previous investigators, we did not find an increased risk of cesarean section in women carrying male fetuses.

Adolescent↗
PubMed2003

Midtrimester abortion in patients with a previous uterine scar.

OBJECTIVE: To investigate whether extraamniotic prostaglandin E2 (PGE2) for midtrimester pregnancy interruption in women with a scarred uterus has any adverse effects compared to those without an uterine scar. STUDY DESIGN: Two hundred and sixty-two women who underwent second trimester (16-27 gestational weeks) termination of pregnancy were enrolled in this study. Thirty-one women with a uterine scar were compared with 231 patients without a scarred uterus. Extraamniotic PGE2 was applied in serial doses of 200 mcg every 2 h up to 20 doses. Intravenous infusion of oxytocin was added in cases when the fetus was not expelled. Curettage was performed in the majority of the patients. RESULTS: The two groups were similar for indications for pregnancy termination, maternal age and gestational age. Gravidity and parity were significantly higher in the group with an uterine scar. The mean induction to abortion time and the complication rate were similar in both groups. No uterine rupture was observed. CONCLUSION: Extraamniotic PGE2 for midtrimester termination of pregnancy is a safe procedure with a low complication rate, even in patients with an uterine scar.

Abortifacient Agents↗
PubMed2003

The duration of the third stage of labor is subject to the location of placental implantation.

We evaluated the association between placental location and length of the third stage of labor in normal term singleton pregnancies. Two hundred consecutive singleton term live vaginal deliveries following uncomplicated pregnancies were included in a retrospective study. The mean maternal age was 27.5 +/- 5.2 years, and the mean parity was 2.2 +/- 1.4. Patients' charts were reviewed in order to determine the placental implantation site. Anterior location of the placenta was noted in 96 women (48%), posterior in 66 (33%), fundal in 26 (13%), and lateral in 12 (6%). The duration of the third stage was 9.5 +/- 5.5, 9.4 +/- 5.3, 12.8 +/- 9.5, and 7.6 +/- 3.5 min in anterior, posterior, fundal, and lateral groups, respectively (p < 0.05). The duration of the third stage of labor is statistically significantly longer, if the placenta is located in the fundal area of the uterus. Therefore, we believe that the placental location may be important in managing the third stage of labor.

Adult↗
PubMed2003

Vacuum application through a nonfully dilated cervix: a viable option.

The aim of this cross-sectional study was to assess the feasibility of vacuum delivery through a nonfully dilated cervix. The study group consisted of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. These were compared to a control group of 215 vacuum deliveries at a fully dilated cervix and 46 women who underwent cesarean section at a nonfully dilated cervix larger than 9 cm. The main indication for vacuum extraction in the study group was fetal distress and in the control groups prolonged 2nd stage, dysfunctional labor and fetal distress. Maternal and neonatal morbidity was low and not different between the groups. Neonatal well being, evaluated by cord pH and 5-min Apgar score, was not different. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Apgar Score↗
PubMed2003

Positive serology for Helicobacter pylori and vomiting in the pregnancy.

INTRODUCTION: Recently, several investigators have suggested that H. pylori may be a contributory factor in hyperemesis gravidarum. The purpose of this study was to evaluate whether seropositivity for IgG antibodies to H. pylori may also be related to nausea, vomiting, heartburn and epigastric pain in pregnancy. MATERIALS AND METHODS: One hundred and eighty-five women, at term pregnancy, were included in the study. All women completed a questionnaire regarding information on the number of pregnancies and deliveries, weight gain, smoking and gastrointestinal complaints before and during pregnancy. The presence of H. pylori infection was determined by serology. RESULTS: The overall prevalence rate of H. pylori seropositivity was 45.9%. Women positive for H. pylori IgG were older (28.7+/-4.5 vs. 27.0+/-4.5, p=0.02), had more prior pregnancies (3.2+/-2.1 vs. 2.6+/-1.6, p=0.02) and deliveries (2.6+/-1.6 vs. 2.0+/-1.1, p=0.006) and reported vomiting in the first trimester more frequently than H. pylori negative patients (81.2% vs. 65%, p=0.004). On the other hand vomiting in the second trimester was reported more frequently among smokers during pregnancy compared to non-smokers. CONCLUSIONS: H. pylori seropositivity is significantly associated with emesis gravidarum but not with gastro-intestinal symptoms later in pregnancy. First trimester vomiting more than doubles the likelihood that the gravida is H. pylori IgG positive.

Adult↗
PubMed2003

What to do after a failed attempt of vacuum delivery?

OBJECTIVES: To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery. STUDY DESIGN: A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4). RESULTS: Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups. CONCLUSIONS: If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.

Adult↗
PubMed2003

The history of cesarean technique.

Cesarean section has been practiced since ancient times. Unfortunately, no ancient medical documents describing the techniques for cesarean section are extant. In the early medieval period, cesarean section was usually performed by midwives. One of the first explicit instructions in medical literature on cesarean technique dates from about 1480 ce from southern Germany. We discuss the evolution of cesarean surgical technique and point up the contribution of many giants in the field of obstetrics and gynecology, such as Blundell, Frank, Harris, Joel-Cohen, Kehrer, Kerr, Lebas, Levret, Maylard, Pfannenstiel, Porro, Portes, and Sanger.

Cesarean Section↗
PubMed2003

Prospective evaluation of two stimulation protocols for low responders who were undergoing in vitro fertilization-embryo transfer.

OBJECTIVE: To compare two stimulation protocols designed for low responders undergoing IVF. DESIGN: Randomized, prospective study. SETTING: University hospital IVF unit. PATIENT(S): Sixty low responders who were recruited on the basis of results in previous cycles. INTERVENTION(S): Modified flare protocol in which a high dose of GnRH agonist was administered for the first 4 days, followed by a standard agonist dose, or a modified long protocol in which a standard agonist dose was used until pituitary down-regulation, after which the agonist dose was halved during stimulation. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved. RESULT(S): Twenty-nine cycles were performed with the modified flare protocol and 31 were performed with the modified long protocol. Significantly more oocytes were obtained with the modified long protocol than the modified flare protocol (4.42 +/- 2.6 vs. 3.07 +/- 2.15). The number and quality of embryos available for transfer was similar in both groups. One clinical pregnancy (3.4%) was achieved with the modified flare protocol, and 7 pregnancies (22.5%) were achieved using the modified long protocol. CONCLUSION(S): These preliminary results substantiate the poor prognosis and outcome for low responders undergoing IVF. A modified long "mini-dose" protocol appears to be superior to a modified mega-dose flare protocol in terms of oocyte yield and cycle outcome.

Adult↗
PubMed2003

Changes in platelet function, volume and count during labor and 24 hours postpartum.

Increased platelet activation has been reported during labor. We evaluated changes in platelet count, volume and function during labor and 24 hours postpartum. Platelet function during labor was not previously evaluated. Twenty-five healthy women in labor, subsequently having singleton spontaneous vaginal delivery following uncomplicated pregnancy at term were recruited for this prospective study. Blood was withdrawn during latent phase, active phase, second stage of labor, and 24 hours postpartum. Platelet function was assessed by hemoSTATUS2 test (Hepcon, Medtronic, USA). Twenty-five healthy non-pregnant volunteers served as controls. Platelet count and volume did not change significantly throughout labor and 24 hours postpartum. Platelet function was 120.8 +/- 26.9 %, 106.8 +/- 24.6 % (p = 0.06), 105.2 +/- 30.9 % (p < 0.05), and 117.6 +/- 21.5 % during latent phase, active phase, second stage of labor, and 24 hours postpartum, respectively. Platelet function was altered during labor while platelet count and volume did not change significantly. Platelet function remained increased when compared to non-pregnant controls.

Blood Platelets↗