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R Achiron

Publications and source records attributed to R Achiron.

At least 109 records · Page 6Linked to original sources
PubMed1995

Endometrial blood flow response to hormone replacement therapy in women with premature ovarian failure: a transvaginal Doppler study.

OBJECTIVE: To evaluate the endometrial blood flow response to hormone replacement therapy (HRT) in women with premature ovarian failure who plan to enter an oocyte donation program. DESIGN: Transvaginal color Doppler ultrasound examinations were performed in women with ovarian failure before and during a cycle of standard HRT and in those with normal menstrual cycles. Blood flow response was assessed by visualization of arterial wave forms in the endometrial region. The transvaginal color flow mapping system was used. Resistance indexes were calculated for analysis and correlated with plasma E2 and P concentrations. PATIENTS: Eighteen women with ovarian failure (study group), and 12 volunteers with normal ovarian cycles (control group). RESULTS: Data for resistance indexes were divided into five phases according to the day of hormonal cycle: 0, pretreatment phase; I, early follicular phase (days 5 to 7); II, late follicular phase (days 11 to 13); III, early luteal phase (days 17 to 21); and IV, late luteal phase (days 23 to 25). All women with ovarian failure demonstrated continuous forward end-diastolic flow velocities at phase I, whereas none showed this pattern during the pretreatment period (phase 0). Women with ovarian failure in the early follicular phase had a significantly higher resistance index (0.85 +/- 0.1; mean +/- SD) than that in the late follicular phase (0.57 +/- 0.1), and the resistance index in the early luteal phase (0.67 +/- 0.1) was significantly higher than that of the late follicular phase. There was no difference in the resistance index between early and late luteal phases. A similar pattern of lower resistance index around midcycle was observed in the control group. However, a comparison of the resistance indexes between ovarian failure and control patients revealed a significant difference between values in the early follicular phase only (0.85 +/- 0.1 versus 0.68 +/- 0.1). In the late follicular phase and during the entire luteal phase, the mean resistance index did not differ between the study and control groups. CONCLUSIONS: The observed data suggest that standard HRT in women with premature ovarian failure enables restoration of endometrial blood flow to normal. This may imply uterine receptivity for oocyte donation.

Diastole↗
PubMed1995

Endometrial blood flow response to estrogen replacement therapy and tamoxifen in asymptomatic, postmenopausal women: a transvaginal Doppler study.

This study was conducted to evaluate endometrial blood flow characteristics in response to estrogen replacement therapy (ERT) and tamoxifen in asymptomatic postmenopausal women, and to correlate the resistance index (RI) with plasma estradiol levels. Transvaginal color Doppler ultrasound examinations were performed in 30 asymptomatic, postmenopausal women who demonstrated thin endometria (< 0.5 cm). Ten healthy women receiving ERT and ten women with breast cancer receiving tamoxifen comprised the study groups. Ten postmenopausal women free of any hormonal treatment comprised the control group. Blood flow response was assessed by visualization of arterial waveforms in the endometrial region. Resistance indices were calculated for analysis and correlated with peripheral blood levels of estradiol. All postmenopausal women treated with tamoxifen or ERT showed continuous forward end-diastolic flow velocities, while the menopausal women without treatment demonstrated partial forward end-diastolic flow. Resistance index values of non-treated women were invariably higher (mean 0.89, range 0.85-0.91) than in those on tamoxifen (mean 0.79, range 0.54-0.90; p < 0.05), while the lowest RI was obtained in women taking ERT (mean 0.66, range 0.54-0.90; p < 0.05). The plasma concentrations of estradiol in women on ERT were found to be significantly higher than those of the tamoxifen and control groups. The observed data suggest that ERT and tamoxifen modify normal postmenopausal endometrial perfusion. Tamoxifen had a weaker estrogenic effect on the endometrial blood flow resistance, and ERT enhanced endometrial blood perfusion through vasodilatation.

Antineoplastic Agents, Hormonal↗
PubMed1995

Fetal lung hyperechogenicity: prenatal ultrasonographic diagnosis, natural history and neonatal outcome.

The ultrasonographic appearance of fetal lung hyperechogenicity is most commonly associated with congenital bronchopulmonary abnormalities, such as cystic adenomatoid malformation or pulmonary lobar sequestration. Spontaneous disappearance of echogenic lung lesions has rarely been reported, mainly due to in utero resolution of cystic adenomatoid malformation. We describe four fetuses with echogenic lungs detected prenatally, none of them having been proved to have adenomatoid malformation or pulmonary sequestration of the lungs. Color Doppler sonography was used prenatally in all cases to rule out pulmonary sequestration. Three of the four fetuses showed complete resolution of the lung lesions during gestation, with normal neonatal outcome, but in one where the lesion decreased in size, intrauterine demise occurred at 28 weeks' gestation before complete resolution, and pneumonia was found at autopsy. We suggest that fetal lung hyperechogenicity may result from in utero bronchial tree obstruction with retention of mucoid fluid distal to the obstruction. With advancing gestation, in some cases the relative obstruction may be relieved, and the sonographic appearance of the lungs may return to normal. A retention of mucus in the bronchial tree should be added to the differential diagnosis of hyperechogenic lung lesions detected by antenatal ultrasound examination.

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↗
PubMed1995

Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal sonography.

The most common anomalies of the fetal ventral abdominal wall include omphalocele and gastroschisis. Umbilical cord hernia is another abdominal wall defect that is poorly defined and usually mistakenly considered as a small omphalocele. The present report describes the sonographic features and clinical significance of four cases of umbilical cord hernia identified transvaginally in the early second trimester of pregnancy. These cases seemed to present a different entity from that of simple omphalocele. The transvaginal sonographic approach provided a clear image of the midgut protruding into the umbilical cord, precise localization of cord insertion in the region of the umbilical ring. Doppler flow evaluation of the umbilical vessels and their relation to the protruding mass. Serial sonographic observations revealed a stable umbilical cord mass in three fetuses, and an enlarging mass in one. Normal karyotype was determined and no associated malformations were detected prenatally. However, in one case that underwent immediate correction of the hernia after delivery at term, the neonate was subsequently found to have pulmonic stenosis and severe neonatal seizures developed at 4 months of age. In two cases, pregnancy was terminated due to parental request. The fourth fetus was delivered vaginally at term and catastrophic division of the umbilical cord containing a loop of small intestine was avoided only by the diligent observation of the midwife. We suggest that umbilical cord hernia is a distinct anomaly originating at a different stage of embryogenesis, thereby having a unique clinical significance, unlike simple omphalocele. Umbilical cord hernia should therefore be defined and considered as a separate entity.

Abdominal Muscles↗
PubMed1995

Intrauterine growth of triplets as estimated from liveborn birth weight data.

This study was conducted to estimate intrauterine growth of triplet pregnancies from liveborn birth weights. During the years 1975-92, 109 sets of triplets were born at our hospital. Ten sets were excluded because of either major fetal anomalies or fetal death of one or more of the fetuses. The remaining 99 sets of triplets consisted of 297 newborns that were weighted immediately after birth. The mean birth weight was plotted against gestational week. The estimated intrauterine growth of triplets, in contrast to singletons, exhibited neither an acceleration phase during the third trimester, nor a flattening of the growth curve during the last few weeks of the third trimester. The mean birth weight of triplets was slightly below the 10th centile for singletons at 38 weeks' gestation or later. We conclude that the growth of triplet fetuses as estimated from liveborn birth weights is slower than that of singletons. The diagnosis of intrauterine growth retardation in triplet pregnancies should be based on growth curves to be devised for triplet pregnancies.

Bias↗
PubMed1995

Fetal lateral neck cysts: early second-trimester transvaginal diagnosis, natural history and clinical significance.

The objective of the study was to explore the natural history and clinical significance of lateral neck cysts during the early second trimester of pregnancy. A survey was conducted of pregnant women at 12-15 weeks' gestation who presented at the ultrasonographic unit between January 1991 and December 1994. During the 4-year period, of the 1500 fetuses scanned, 42 fetuses with lateral neck cysts were detected by high-resolution transvaginal ultrasonography. Twenty-six of the 42 fetuses were seen to have isolated lateral neck cysts, and 16 demonstrated a combination of nuchal thickness of > or = 4 mm and lateral neck cysts. Natural history, fetal karyotype and pregnancy outcome were compared between these two groups. None of the fetuses with isolated neck cysts had an abnormal karyotype, and all cysts resolved spontaneously at 16-20 weeks. No congenital abnormalities were found among the 26 cases. Four chromosomal abnormalities (three trisomy 21 and one monosomy XO) were detected among the 16 fetuses with combined lesions, resulting in termination of pregnancy in all. Among the remaining 12 fetuses, spontaneous resolution of the neck findings occurred between 16 and 20 weeks' gestation. The finding of isolated lateral neck cysts in the early second trimester is not associated with increased risk of aneuploidy. However, the combination with nuchal thickness of > or = 4 mm should prompt genetic counselling and consideration of karyotyping, since this delay in maturation of the cervical jugular lymphatic communication may be associated with chromosomal aberrations.

Adult↗
PubMed1995

The clinical value of umbilical artery Doppler velocimetry in the management of intrauterine growth-retarded fetuses before 32 weeks' gestation.

The objective of this study was to investigate the clinical utility of umbilical artery Doppler velocimetry in the management of very premature growth-retarded fetuses. The study comprised 34 fetuses between 26 and 34 weeks' gestation, diagnosed ultrasonically as suffering from intrauterine growth retardation. Based on the umbilical artery Doppler findings, patients were divided into 3 groups: group 1 (10 fetuses) with normal Doppler systolic/diastolic (S/D) ratios (within 2 SD of the mean for gestational age); group 2 (9 fetuses) with significant abnormal umbilical artery S/D ratios (above 2 SD of the mean for gestational age), and group 3 (15 fetuses) with absent or reverse end-diastolic flow. Fetal outcome was assessed in terms of neonatal mortality and morbidity, i.e. low umbilical artery pH (pH < 7.20) and Apgar scores. In group 1, all fetuses had a stable, normal S/D ratio; in group 2, 2 fetuses (22%) showed deterioration in the Doppler findings and were transferred to group 3, while in group 3, 3 of 15 fetuses (20%) showed improvement in the absence of end-diastolic flow and were thus transferred to group 2. Emergency cesarean section due to antenatal deterioration of the biophysical profile occurred in only 1 patient (10%) in group 1, compared to 33 and 87% in groups 2 and 3, respectively (p < 0.05). The other 9 patients in group 1 had normal vaginal deliveries at 36-37 weeks' gestation, with no perinatal complications. The mean expectant interval from admission to delivery in group 3 was 8.2 days, while in groups 1 and 2 it was 23.8 and 22.2, respectively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Fetal pleural effusion: the risk of fetal trisomy.

Our objective was to review the association between fetal pleural effusion (FPE) and fetal aneuploidy. We conducted a retrospective survey of pregnant women who presented to our ultrasonographic unit between 1990 and 1991, and in whom the diagnosis of FPE was reached. All fetuses had karyotype investigation and a complete ultrasonographic search for associated anomalies. Six cases of FPE were identified. Trisomy 21 was found in 2 (33%). The English literature was reviewed and an additional 147 cases with FPE were collected, among them 6 cases of trisomy 21 and 1 of monosomy 45X. In this accumulated series the risk of aneuploidy in a fetus with an incidental finding of FPE was 5.8% (9 of 153), thus warranting a karyotype study.

Adult↗
PubMed1995

Induced cardioversion of fetal flutter by artificial rupture of membranes at term.

A term fetus with atrial flutter and no signs of cardiac decompensation is described. A trial of pharmacologic cardioversion was unsuccessful, and induction of labor was initiated. Immediately after artificial rupture of the membranes, spontaneous conversion to normal sinus rhythm occurred. The possible mechanism of the cardioverion and the optional treatments for the term fetus with atrial flutter are discussed.

Adult↗
PubMed1995

Sonohysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium.

Most menopausal patients with breast cancer receive tamoxifen therapy. In these patients, TVS may show thickened, irregular cystic endometria. For better visualization of these patients' uterine cavities, we performed transvaginal sonohysterography. During vaginal ultrasonography, sterile saline was introduced by transcervical 8 French Foley catheter into the uterine cavity of 20 women who were referred with tamoxifen-associated cystic thickened endometria. In eight women, transvaginal sonohysterography provided the means to diagnose occult, free-floating endometrial polyps, whereas in 12 women, the fluid contrast augmented the diagnosis of an irregular cystic endometrial-myometrial junction. All 20 patients underwent diagnostic hysteroscopy: eight polyps, none of which were malignant, were confirmed and removed by hysteroscopic resection. Of the remaining 12 patients with an irregular endometrial-myometrial junction, endometrial curettage showed no significant pathologic findings. Transvaginal sonohysterography seems to enhance the differentiation between endometrial polyps that should be resected by operative hysteroscopy and an abnormal endometrial-myometrial junction that may benefit from biopsy sampling only.

Aged↗
PubMed1994

The early prenatal sonographic diagnosis of renal agenesis: techniques and possible pitfalls.

Out of 13,252 cases in which fetal bilateral echogenic kidneys were detected by transvaginal sonography between 12 and 18 weeks' gestation, there were nine fetuses where oval hypoechogenic masses were detected in the renal bed. In five fetuses where hypoechogenic masses in the renal bed were sonographically visualized, postabortal examination was compatible with renal agenesis and the hypoechogenic masses proved to be enlarged adrenals. In three additional cases, unilateral renal agenesis was accompanied by unilateral enlarged adrenals, radiologically confirmed postnatally. In one case, a false-positive sonographic diagnosis of Potter syndrome was made because of bilateral hypoechogenic masses in the renal bed. Postabortal examination detected hypoplastic kidneys, but of normal histology, in a dyskaryotic fetus with trisomy 22. In four cases of renal agenesis, the amniotic fluid was of normal volume until the 17th week. In two of the five cases of Potter syndrome, a cystic structure, compatible with the urinary bladder, was detected in the pelvis at 14 weeks. The diagnostic criteria for renal agenesis in the early fetus differ from those used in the second half of gestation.

Adrenal Glands↗
PubMed1994

Prenatal ultrasonographic diagnosis of fetal cerebral ventriculitis associated with asymptomatic maternal cytomegalovirus infection.

Cytomegalovirus is the most common cause of congenital viral infection. In utero infection is usually suspected in patients with growth-retarded fetuses or when maternal illness precipitates serological investigations. A case is presented where routine ultrasound examination at 30 weeks' gestation in an asymptomatic patient demonstrated mild fetal ventriculomegaly. Transvaginal ultrasound enabled the visualization of intraventricular adhesions and small periventricular cysts. The suspected diagnosis of in utero cytomegalovirus infection was confirmed by the presence of IgM antibodies in fetal blood and subsequently by isolation of the virus from the infant's urine. The presence of mild fetal ventriculomegaly should prompt transvaginal brain imaging.

Adult↗