Biomedical subjects

R Achiron

Publications and source records attributed to R Achiron.

At least 91 records · Page 5Linked to original sources

PubMed1996

Second-trimester ultrasonographic diagnosis of segmental vertebral abnormalities associated with neurological deficit: a possible new variant of occult spinal dysraphism.

Sonographic evaluation of the fetal spine in a second-trimester, low-risk patient revealed segmentary, low thoracic vertebral abnormalities, including hemi- and butterfly vertebrae, resulting in severe fetal scoliosis with fetal paraplegia and bilateral club-feet. X-ray and magnetic resonance imaging studies of the abortus confirmed the prenatal vertebral findings in addition to rib defects and transection of the spinal cord. We believe that these findings which, to the best of our knowledge, have not been previously reported, represent a new variant of occult spinal dysraphism.

Adult↗

PubMed1996

Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study.

Acute exacerbations frequently occur after childbirth in patients with relapsing-remitting multiple sclerosis (MS). The present pilot study was initiated in an attempt to reduce the number of childbirth-associated acute exacerbations in the postpartum period. We treated nine MS patients with a history of 12 childbirth-associated acute exacerbations that had occurred 2-9 weeks after previous deliveries. The patients were administered intravenous immunoglobulin (IVIg) at a dose of 0.4 g/kg per day for 5 consecutive days during the 1st week after childbirth and at 6 and 12 weeks thereafter. None of the treated patients relapsed during the 6-month period after delivery. However, three patients had a remote relapse, two at 8 months and one at 10 months after childbirth, but these probably represented the natural course of disease and were not associated with childbirth. We conclude that IVIg treatment may prevent acute childbirth-associated exacerbations in relapsing-remitting MS patients.

Adult↗

PubMed1996

Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations.

OBJECTIVE: To compare the outcome of triplet pregnancies reduced to twins who reached 24 weeks' gestation with the outcome of twin pregnancies managed in the same perinatal department. METHODS: The study group included 43 triplet pregnancies reduced to twins who reached 24 weeks' gestation and were delivered between January 1989 and December 1993. The complications and outcomes of these pregnancies were compared with all 134 bichorionic twin pregnancies delivered during 1993. RESULTS: In general, the outcome of triplet pregnancies reduced to twins was not significantly different from that of twin pregnancies. Both pregnancy-induced hypertension and premature contractions were similar in the two groups. The higher incidence of premature rupture of membranes (PROM) in the reduced cases compared with nonintervention twins (18.6 versus 8.2%) was of borderline significance (relative risk [RR] 2.27, 95% confidence interval [CI] 0.98-5.27). Although premature delivery occurred in 30% of patients in both groups, 20.9% of patients in the reduction group delivered before 35 weeks' gestation, compared with 10.4% in the nonintervention group (RR 2.0, 95% CI 0.93-4.30). The mean gestational age was similar in the two groups, as was the risk of low birth weight and respiratory disorders. Differences in the proportion of patients with PROM, low gestation duration, and very low birth weight, although not quite statistically significant, are probably because of the relatively small numbers and, hence, of low power (50-55%), but may be of clinical importance. CONCLUSION: The outcome of triplet pregnancies reduced to twins did not differ substantially from that of nonreduced twin pregnancies.

Female↗

PubMed1996

Hyperechogenic fetal bowel and elevated serum alpha-fetoprotein: a poor fetal prognosis.

OBJECTIVE: To evaluate the clinical significance of increased fetal bowel echogenicity in women with elevated maternal serum alpha-fetoprotein (MSAFP) during the second trimester. METHODS: The study group comprised six pregnant women with elevated second-trimester MSAFP (greater than 2.5 multiples of the median), whose ultrasonographic evaluations indicated hyperechogenic fetal bowel. They were compared with six pregnant women whose fetuses, during routine second-trimester ultrasonographic screening for fetal anomalies, were found to have a hyperechogenic bowel without elevated MSAFP, according to natural history, pregnancy outcome, and associated features. RESULTS: All six fetuses with the combination of elevated MSAFP and echogenic bowel were growth-restricted; four died in utero and one of the two live-born infants died during the neonatal period. The single survivor in this group was born prematurely; necrotizing enterocolitis was diagnosed at 30 days of life and surgery was performed. None of the cases had associated congenital anomalies. Only one of the six controls had associated anomalies (trisomy 21), and this pregnancy was terminated. The pregnancy course of the remaining five fetuses was normal; all were appropriate for gestational age and were delivered at term. No perinatal mortality occurred in this group; however, in one infant, cerebral palsy was diagnosed at 10 months of age. CONCLUSION: Fetal bowel hyperechogenicity found in women with elevated second-trimester MSAFP levels is associated with poor fetal outcome, particularly fetal growth restriction with fetal and neonatal death, and should be considered an ominous prenatal finding.

Adult↗

PubMed1996

Pregnancy outcome after early amniotic fluid leakage after transabdominal multifetal reduction.

OBJECTIVE: To assess the importance of amniotic fluid leakage in the early period ( < 14 days) after the fetal reduction procedure. DESIGN: Prospective clinical study. SETTING: Pregnant women who underwent fetal reduction to twins in an academic, tertiary perinatal department. PATIENTS: Sixty triplet and 31 quadruplet pregnancies were identified before the ninth postmenstrual week of gestation. All patients underwent transabdominal multifetal pregnancy reduction was performed within 14 days of the procedure. INTERVENTIONS: Transabdominal multifetal pregnancy reduction from triplets and quadruplets to twins. MAIN OUTCOME MEASURE: Amniotic fluid leakage in the early period after fetal reduction. RESULTS: Early PROM occurred in eight (13.3%) patients from the triplets group and in six (19.3%) patients in the quadruplet group. Three of 60 (5.0%) patients from the triplet group and 1 of 31 (3.2%) patients from the quadruplet group miscarried before 24 weeks gestation. However, none of these patients had had PROM during the early period after the procedure. Early PROM did not influence the incidence of premature contractions of delivery and the reduction procedure, and 59% (99/169) of those who completed 24 gestational weeks delivered between 25 and 37 weeks. CONCLUSION: The presence of amniotic fluid leakage in the period close to the multifetal reduction procedure, although alarming, is not ominous for the remaining fetuses. We see no reason for any intervention in these patients.

Abortion, Spontaneous↗

PubMed1996

Prenatal sonographic diagnosis of upper airway obstruction: a challenge that can be achieved.

Congenital upper airway obstruction presents a life-threatening situation when encountered in the delivery room. We present a case in which in utero diagnosis of this malformation was suspected, but unfortunately the neonate did not survive due to the inability to provide adequate ventilation. The prenatal sonographic features of this rare malformation are outlined, and the literature reviewed.

Adult↗

PubMed1996

Prenatal ultrasonographic diagnosis of fetal hydrocephalus due to infection with parainfluenza virus type 3.

Parainfluenza virus type 3 is one of the most common causes of respiratory infection in infants. No complications of pregnancy or fetal anomalies have been reported in association with parainfluenza virus infection. A pregnancy was terminated at 22 weeks' gestation due to ultrasonographic diagnosis of hydrocephalus. Pathological examination was consistent with viral encephalitis, ventriculitis and pneumonia. Serological investigation demonstrated a significant rise in maternal antibody titers for parainfluenza virus type 3. Parainfluenza virus type 3 may be associated with severe fetal infection in the first half of pregnancy. Serological studies for this virus should be considered in cases of fetal hydrocephalus.

Abortion, Therapeutic↗

PubMed1996

Prenatal ultrasonographic diagnosis of fetal hepatic hyperechogenicities: clinical significance and implications for management.

The clinical significance of sonographically detected fetal hepatic hyperechogenicities has not been fully established. The aim of this study was to assess various aspects of fetal hepatic hyperechogenicities detected in utero, including natural history, prenatal investigation and pregnancy outcome. In a retrospective survey of pregnant women presenting to the ultrasonographic unit, five fetuses with a mean gestational age of 20 weeks (range 14-24 weeks) were antenatally diagnosed as having hepatic hyperechogenicities. All cases underwent extensive investigation to establish the etiology and to determine the spectrum of ultrasonographic presentation. In three fetuses, only parenchymal lesions were found, while two had combined lesions: parenchymal and peritoneal. The earliest prenatal ultrasonographic diagnosis was made at 14 weeks' gestation in a fetus with combined hyperechogenic lesions, which, at 12 weeks' gestation, demonstrated unexplained fetal ascites. Associated abnormalities were found in only one fetus in which a solitary parenchymal lesion was associated with direct communication of the intrahepatic portion of the umbilical vein with the right atrium, and high output cardiac failure. In this case, termination of pregnancy confirmed ischemic hepatic necrosis. In the other four cases, no direct etiology could be determined, and all four pregnancies continued to term with normal neonatal follow up until 12 months of age. The present data suggest that in cases of fetal hepatic hyperechogenicities, where apparent intrauterine infection or neoplasia can be ruled out, a vascular disruption phenomenon is a putative etiology. If there are no associated morphological abnormalities or abnormal karyotypes, the prognosis may be favorable.

Adult↗

PubMed1996

Tamoxifen and the uterus: an old drug tested by new modalities.

Tamoxifen has been widely used in the treatment of breast cancer. The effects on the uterus include epithelial metaplasia, hyperplasia and even carcinoma. Transvaginal sonography has been used for visualization of endometrial changes during tamoxifen treatment. However, its use has disclosed that the drug may cause cystic changes in the subendometrial zone without epithelial pathology. Therefore, other sonographic techniques have been suggested for the evaluation of the patient receiving tamoxifen treatment, among them saline contrast hysterosonography and endometrial blood flow studies. These new modalities provide us with tools to evaluate the effect of tamoxifen on the endometrium, prior to the decision to perform invasive procedures.

Antineoplastic Agents, Hormonal↗

PubMed1996

Antenatal sonographic findings associated with scimitar syndrome.

Scimitar syndrome is a rare congenital anomaly that consists of secondary dextroposition in situs solitus, due to right pulmonary hypoplasia. The prenatal sonographic findings of this abnormality have not been previously described. We describe early sonographic findings in a fetus that included isolated cardiac dextroposition with normal abdominal situs, hydramnios and mild narrowing of the right pulmonary artery. Postnatally, the infant developed heart failure, and a right hypoplastic lung was found. Catheterization revealed collateral supply to the right lung arising from the descending aorta and anomalous drainage of right pulmonary veins to the inferior vena cava. The diagnosis of scimitar syndrome was therefore established. A coil embolization of arterial collaterals to the right lung was performed. Scimitar syndrome should be considered in a fetus with the sonographic findings of a right shift of the mediastinal structures, an intact diaphragm and narrow right pulmonary artery. This may allow early neonatal stabilization and treatment.

Adult↗

PubMed1996

Spontaneous ovarian hyperstimulation mimicking an ovarian tumour.

Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy is exceedingly rare. We report a case of ovarian hyperstimulation presenting as bilateral ovarian masses in association with spontaneous pregnancy, occurring in a woman with disturbed liver function. A possible mechanism is discussed.

Adult↗

PubMed1996

Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report.

OBJECTIVE: To evaluate the outcome of late selective fetal termination based on combined data from eight tertiary perinatal centres. DESIGN: Israeli law requires institutional committee approval for pregnancy termination. Moreover, after 24 weeks only a district superior committee can approve the termination. A total of 36 bichorionic twin pregnancies who underwent selective fetal termination after 24 complete gestational weeks were identified in eight Israeli centres. RESULTS: In 23 women (63.9%) the indication for selective termination was structural anomaly, and in 13 (36.1%) the indication was chromosomal abnormality. The mean gestational age at the time of diagnosis was 24.1 +/- 1.9 weeks. The termination procedure was performed at a mean gestational age of 25.5 +/- 2.0 weeks (median 25, range 24-33 weeks). There was one case of immediate procedure-related complication (i.e. amnionitis) and the unaffected infant died, which was the only perinatal death in this series. No evidence of coagulopathy was reported. Only five women (13.8%) delivered before 34 completed weeks. The mean gestational age at delivery was 36.9 +/- 2.9 weeks (28-41 weeks), and the mean procedure-to-delivery interval was 11.8 +/- 3.2 weeks (median 13, range 3-17 weeks). CONCLUSIONS: Late (> 24 weeks) selective termination in twin pregnancies is associated with favourable perinatal outcome of the healthy twin. In countries where the law permits late pregnancy termination, the parents should be informed of that possibility.

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↗

PubMed1995

Macroglossia: prenatal ultrasonographic diagnosis and proposed management.

A case in which macroglossia was the sole unusual prenatal sonographic finding in a fetus affected with trisomy 21 is presented. The differential diagnosis of fetal macroglossia is given, emphasizing its strong relationship to fetal aneuploidy, together with the principles for evaluation and management.

Adult↗

PubMed1995

The development of the fetal eye: in utero ultrasonographic measurements of the vitreous and lens.

Our objective was to establish nomograms for fetal eye measurements from 12 weeks' gestation by using transvaginal and transabdominal high-resolution ultrasound techniques. A prospective cross-sectional study was performed on 450 normal singleton pregnancies between 12 and 37 weeks' gestation. Vitreous and lens circumferences were measured by transvaginal ultrasonography until 17 weeks, and by abdominal ultrasound between 18 and 37 weeks' gestation. Regression analyses were used to create nomograms, and several transformations were done to obtain linearity. Eye measurements of 12 fetuses at risk for ocular disturbances were plotted on the constructed nomograms. Linear relationships were fitted between vitreous (r2 = 0.79) and lens (r2 = 0.88) circumferences and gestational age. In addition, there was a significant correlation between these measurements and the biparietal diameter. Data of the fetuses at risk showed that disturbances in ocular growth were associated mainly with abnormal cerebral development. These normative data may be helpful in the prenatal diagnosis of suspected congenital syndromes that include, among their manifestations, ocular growth disturbances such as microphthalmos and anophthalmos.

Cross-Sectional Studies↗

PubMed1995

Transvaginal ultrasonography at early pregnancy cannot be used alone for targeted organ ultrasonographic examination in a high-risk population.

OBJECTIVE: A study was performed to evaluate whether early second-trimester (13 to 16 weeks) transvaginal scan can be used alone for structure evaluation of the fetus or whether it should be followed by a transabdominal scan performed at 18 to 20 weeks of gestation. STUDY DESIGN: A total of 536 pregnant women at high risk for birth defects were examined by transvaginal ultrasonography at 13 to 16 weeks' gestation. This was followed by a transabdominal scan at 18 to 20 weeks of pregnancy. Aborted specimens were examined by a pediatric pathologist in terminated pregnancies, and newborn babies were examined by a pediatrician to detect congenital anomalies. RESULTS: Transvaginal ultrasonography performed at 13 to 16 weeks' gestation identified 42 structural anomalies. Of these, 24 pregnancies were terminated and one fetus died. The other 17 fetuses and the rest of the population underwent a second transabdominal survey at 18 to 20 weeks' gestation, which identified eight structural anomalies that were not diagnosed by the previous examination. In five cases the diagnosed anomaly disappeared. Together, the scans brought about the detection of 41 of 46 abnormal fetuses (89%). CONCLUSIONS: Because a significant number of birth defects (17.4%) was not detected by early second-trimester vaginal scan, we recommend that whenever early transvaginal ultrasonographic examination is performed it should be followed by a transabdominal scan at the most advanced stage of pregnancy at which an abortion is still feasible.

Adult↗

PubMed1995

Treatment of pelvic peritoneal cysts by drainage and ethanol instillation.

We performed this study to assess the feasibility and effectiveness of ultrasound-guided drainage and ethanol instillation for the treatment of pelvic peritoneal cysts. Six women had pelvic peritoneal cysts after previous pelvic surgery; when the cysts recurred after simple drainage, the patients underwent transvaginal ultrasound-guided drainage and instillation of 20-30 mL of ethanol into the cyst cavity. All patients except one presented with abdominal pain. All cysts had clinical and ultrasonic benign characteristics. Drainage and ethanol instillation were performed successfully in all patients without severe side effects or complications. After a mean follow-up time of 13.6 months, a recurrence was found in only one patient, who was successfully retreated. These preliminary results indicate that transvaginal ultrasound-guided fluid drainage and ethanol instillation is an effective treatment for pelvic peritoneal cysts.

Adult↗

PubMed1995

Expectant management of twin pregnancies discordant for anencephaly.

OBJECTIVE: To study the clinical course and perinatal outcome of twin pregnancies discordant for anencephaly, without selective termination. METHODS: We conducted a descriptive retrospective study of 14 cases of dichorionic twin pregnancies discordant for anencephaly, which were managed expectantly in five Israeli perinatal centers. RESULTS: None of the patients miscarried. The mean gestational age at delivery was 35.9 +/- 2.8 weeks (range 29-39). Only three patients (21%) delivered before 35 weeks' gestation. Polyhydramnios occurred in six of the anencephalic amniotic sacs. Nevertheless, most occurrences were mild and none necessitated therapeutic amniocentesis. The mean birth weight of the normal fetus was 2610 +/- 690 g (range 1100-3200). One apparently normal twin had a cardiac anomaly and died shortly after birth, and one was electively delivered at 33 weeks because of severe intrauterine growth retardation and subsequently developed cerebral palsy. The rest had normal short- and long-term outcomes. CONCLUSION: Expectant management of a twin gestation discordant for anencephaly diagnosed at the second trimester is associated with a favorable outcome for the unaffected fetus.

Adult↗