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Biomedical subjects

R Maymon

Publications and source records attributed to R Maymon.

At least 73 records · Page 4Linked to original sources
PubMed1997

Hepatic mesenchymal hamartoma: a pediatric tumor that may be diagnosed prenatally.

Hepatic mesenchymal hamartoma is a benign tumor, defined as an excessive focal overgrowth of mature normal cells and stroma native to the liver. The increasing popularity of antenatal scanning has resulted in in utero diagnosis of congenital malformations and anomalies that previously became apparent only after delivery. Herein, we present a rare case of fetal mesenchymal hamartoma of the liver, which was initially sonographically detected at 29 weeks of gestation. A brief literature survey and obstetric recommendations for management and monitoring of such rare cases are included.

Adult↗
PubMed1997

Recurrent heterotopic pregnancy after repeated in-vitro fertilization treatment.

We report a rare clinical case of recurrent heterotopic pregnancy in the same patient following in-vitro fertilization treatments. A 27 year old woman, who suffered from infertility for the last 4 years due to male factor, was being treated by intracytoplasmic sperm injection which resulted in two episodes of combined intrauterine and tubal pregnancy, in a 1 year period. The first ended in emergency salpingectomy by laparotomy and missed intrauterine abortion. The second was managed by laparoscopic salpingectomy and the synchronous pregnancy ended in the delivery of twins. The possibility of heterotopic pregnancy and recurrent heterotopic pregnancy, though rare, should be considered by every gynaecologist, especially those who use infertility treatment on patients.

Adult↗
PubMed1997

Human decidua-associated protein (hDP) 200 identified as a monoclonal rheumatoid factor is not an acute phase reactant.

PROBLEM: The role of human decidua associated protein (hDP) 200, identified as a monoclonal rheumatoid factor, has not been determined yet. This study examines if this protein, being an immunoglobulin, participates in the inflammatory processes involving the uterus. METHOD: Uterine fluid samples were obtained prospectively from two groups of women: the study group, containing 26 women with laparoscopically verified pelvic inflammatory disease (PID), and the control group, containing 34 regularly cycling, fertile women, referred to the Family Planning Clinic. Uterine fluid sampling was performed once in each patient, and the concentration of uterine fluid hDP 200 was determined by double site ELISA, by using the monoclonal antibody DEC 21. RESULTS: A statistically significant decrease in uterine fluid hDP 200 concentration was observed in women with pelvic inflammatory disease as compared to regularly cyclin fertile women (P < 0.00004). The hDP 200 levels in women with PID ranged from 10 to 1,000 mU/ml, with no difference in hDP 200 concentration among intra-uterine device (IUD) users as compared to non-users. CONCLUSION: This study supports the concept that hDP 200, identified as monoclonal rheumatoid factor existing locally in the uterus, is not an acute phase reactant but is probably involved in the reproduction process.

Abdominal Abscess↗
PubMed1997

Low levels of human decidua-associated protein 200 in uterine fluid reflect pathological conditions of the endometrium.

Uterine fluid levels of human decidua-associated protein (hDP) 200 were measured in regularly cycling fertile women, postmenopausal women with normal endometrium and in women with endometrial hyperplasia or endometrial carcinoma. A statistically significant decrease in hDP 200 levels (p < 0.0001) was observed in postmenopausal women and in women with endometrial hyperplasia or carcinoma as compared with regularly cycling women possessing a normal endometrium. Furthermore, a significant increase in the uterine fluid hDP 200 level (p < 0.0008) was observed in women with endometrial hyperplasia following treatment with medroxyprogesterone acetate. These findings suggest that uterine fluid hDP 200 may be a useful marker for screening endometrial pathology as a result of hormonal imbalance or as a result of malignant histological differentiation, and it may also be used to monitor the response of the endometrium to progestogen treatment.

Adult↗
PubMed1997

Localized and diffuse ovarian cancer: is it the same entity?

In order to confront the question whether localized and diffuse ovarian cancers are the extremes of the same disease or two different entities, we compared anamnestic, intraoperative and laboratory findings, as well as the outcome. Sixty-four patients with invasive epithelial ovarian cancer were treated in our department between 1984-1991. After excluding patients with incomplete data, 59 women were finally included in the analysis. The patients were divided retrospectively into two groups according to the extent of the disease observed during the primary surgery. Disease confined to the ovaries was defined as localized form, and any other extraovarian involvement was defined as diffuse form. Twenty patients had localized (Group I), and 39 had diffuse disease (Group II). Comparing the two groups, no difference was observed concerning patient age, the age of menarche and menopause, gravity and parity, the percentage of smoking and hypertensive women, and the histologic type of the ovarian tumor. On the other hand, significant differences were obtained concerning the positive family history of cancer in localized versus diffused disease (10% versus 41%) (p < 0.04), the size of the tumor involving the ovaries (16.2 +/- 5.4 cm versus 7.0 +/- 3.1 cm) (p < 0.0001), the unilateral as opposed to bilateral disease (p < 0.0001), the volume of ascitic fluid (p < 0.002) and the histologic grade (p < 0.02). Laboratory parameters, including CA-125, serum albumin, total protein and lactate dehydrogenase differed significantly comparing the localized and diffused disease (p < 0.04, p < 0.0001, p < 0.003, p < 0.05, respectively). The median survival rate was significantly higher (p < 0.001) in patients with localized versus diffused disease. Our results support the concept that localized and diffused forms of ovarian cancer are probably two different entities.

Adult↗
PubMed1996

Sonographic assessment of cervical changes during pregnancy and delivery: current concepts.

Correct detection of premature contractions and incompetent uterine cervix is still a challenging obstetrical problem since these factors remain a major cause of perinatal loss. Ultrasonography offers additional important data for the prediction of these pathologies which have common sonographic patterns; shortening of the cervical length, funneling of the membranes and dilatation of the endocervical canal. The first section of this review highlights sonography of normal cervical anatomy, while the second section focuses on recent advances in sonographic detection of premature contractions and incompetent cervix. It is believed that due to its accuracy and reproducibility, this noninvasive technique should become more integrated into this aspect of antenatal care.

Cervix Uteri↗
PubMed1996

Three-dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology.

A new technique that combines saline contrast hysterosonography with three-dimensional surface rendering for the visualization of uterine intracavitary pathologies is described. A total of 32 patients suspected of having uterine cavity pathologies on the basis of previous ultrasonography, hysterosalpingography or hysteroscopy were involved in the study. They were examined by three-dimensional high-frequency endovaginal probes (Combison 530, Kretztechnik, Zipf, Austria), with normal saline used as an expander and contrast medium. Three perpendicular planes could be evaluated simultaneous, and surface renderings were readily available. Following the instillation of normal saline, the uterine cavity appears as an echo-free, well-defined structure, and the endometrium appears as an echogenic homogeneous lining around the cavity. Data acquisition time is short and images can be stored for later evaluation. Surface rendering of polypoid structures shows echogenic masses on a pedicle protruding into the uterine cavity. Submucous fibroids appear as mixed echogenic sites bulging into the cavity. Intrauterine synechiae appear as bands of varying thickness traversing the uterine cavity. Simultaneous display of the zone of interest in three perpendicular planes enhances imaging capabilities, while surface rendering provides a comprehensive overview of the surface area of the findings and their topographical orientation. Further research using this new technique is required to document its real contribution to ultrasonographic imaging.

Contrast Media↗
PubMed1996

Abnormal uterine bleeding with normal uterine fluid level of human decidua-associated protein 200 reflects normal endometrial histology.

In the current study, the uterine fluid level of human decidua-associated protein (hDP) 200 was measured in 80 women with abnormal uterine bleeding and normal histology. In 20 women the level of hDP200 was also correlated with the endometrial thickness measured by transvaginal ultrasonography. The results demonstrated the same distribution and similar levels of uterine fluid hDP200 throughout the menstrual cycle as in regularly cycling women, with no correlation between the levels of hDP200 and the endometrial thickness. Thus, the test for uterine fluid hDP200 could serve to discriminate between benign and pathological examinations of endometrial biopsies in women of reproductive age, women with abnormal uterine bleeding and benign conditions of the endometrium. Very low levels of hDP200 are indicative of endometrial hyperplasia or carcinoma.

Adult↗
PubMed1996

Serial color Doppler flow of uterine vasculature combined with serum beta-hCG measurements for improved monitoring of patients with gestational trophoblastic disease. A preliminary report.

Weekly serum beta-hCG measurements and transvaginal ultrasound scans coupled with color Doppler flow were performed on 8 patients with hydatidiform mole. Two patients later developed persistent trophoblastic disease, necessitating chemotherapy. The correlation coefficients between Doppler flow indices, systolic-diastolic (S/D) ratio and pulsatility index (PI) with log beta-hCG were -0.96 and -0.97, respectively. The weekly S/D and PI indices were plotted on an individual curve. Only the 2 patients who developed persistent gestational trophoblastic disease had PI index levels of < or = 1.5 as early as 2 weeks after molar evacuation. At that stage their serum beta-hCG levels were not different from some of the other patients. In this preliminary report, the regression of the disease could be reliably assessed by observing the changes in low resistance flow which paralleled the gradual decrements in serial beta-hCG levels. Thus, the contribution of this noninvasive imaging technique encourages the authors to further investigate Doppler flow monitoring among a larger sample of patients suffering from various gestational trophoblastic diseases.

Adult↗
PubMed1996

Placental isoferritin patterns during first-trimester intrauterine gestation.

In this study, serum placental ferritin (PLF) levels were measured among 33 pregnant women with normal, singleton, ongoing first-trimester gestations and compared with 22 nonbleeding, missed and 14 incomplete abortions. Diagnoses were based on clinical, sonographic, endocrinologic and histopathologic criteria. At admission and before uterine evacuation of the pregnancy products, venous blood was collected from the groups for PLF determination. The mean +/- SD serum PLF levels were 18 +/- 14, 21 +/- 37, and 3.9 +/- 6.2 U/ml in normal gestations, missed and incomplete abortions, respectively. Significant differences in PLF levels were found among normal pregnancies and incomplete abortions (p < 0.05), whereas borderline significance was found in the missed abortion group (p = 0.53). No correlation was found between serum beta hCG and PLF for the various pregnancy groups. Low PLF levels in pathologic gestation may reflect abnormal trophoblastic activity. Whether these play a causal role or are the casual outcome of pathologic gestation should be the subject of further evaluation.

Abortion, Incomplete↗
PubMed1996

Metastatic breast carcinoma manifesting as postmenopausal uterine bleeding in a patient on tamoxifen therapy.

A rare case of breast carcinoma metastasizing to the endometrial and endocervical mucosa during tamoxifen treatment is presented. Routine histologic evaluation has been supplemented by immunohistochemical staining for intermediate filaments. Although the association of tamoxifen therapy for breast carcinoma with the development of endometrial carcinoma is well known, this is, to the best of our knowledge, the first report of metastatic breast carcinoma to the uterus of a patient on tamoxifen therapy.

Aged↗
PubMed1995

Myxoid leiomyosarcoma of the uterus with unusual malignant histologic pattern--a case report.

A case report of myxoid leiomyosarcoma of the uterus is presented as a rare variant of uterine sarcoma. This case, contrary to most of the 11 cases previously described in the literature, is characterized by highly atypical pleomorphic cells and numerous mitoses. Furthermore, myxoid material is also found in the cytoplasm of pleomorphic tumor cells, a feature, that to our knowledge, has not been previously described. All these tumors, no matter what the microscopic appearance is, exhibit a highly malignant behavior. The best therapy for this tumor is unknown, since there are too few cases from which to draw conclusions.

Aged↗
PubMed1995

Placental isoferritin levels during first trimester of normal and complete molar gestations.

Serum placental isoferritin levels (PLF) levels were measured in 33 patients admitted for routine scanning of a first trimester normal singleton pregnancy and six patients who were hospitalized for uterine evacuation of a complete molar gestation. Venous blood was obtained upon admission and before curettage, when necessary. Serum was separated into glass tubes, immediately frozen and stored at -20 degrees C until analysed. The mean serum PLF levels were 18.1 (+/- 14) U/ml and 5.5 (+/- 2) U/ml for normal and molar gestations, respectively, with a significant difference between the two groups (P = 0.001). Sixty-seven per cent of normal pregnancies had serum PLF levels > or = 10 U/ml, whereas none of the molar gestation group reached this threshold level. Furthermore, the molar gestation group's low serum PLF levels remained unchanged throughout the entire follow-up period and until their beta-human chorionic gonadotrophin levels were undetectable. Unlike normal pregnancies, the molar trophoblast does not seem to secrete or synthesize PLF, suggesting that the complete molar placenta has different protein-producing capabilities when compared with those found in normal pregnancies. Further studies, including serum PLF among other categories of gestational trophoblastic neoplasms, are recommended before this data can be integrated into routine clinical work.

Biomarkers↗
PubMed1995

Ectopic pregnancy and laparoscopy: review of 1197 patients treated by salpingectomy or salpingotomy.

The past few decades have witnessed such a rapid rise in the incidence of ectopic pregnancy that it verges on the point of an 'epidemic disease'. Its early detection, with the aid of serum beta-hCG, high resolution ultrasound and the more liberal use of laparoscopy, has dramatically altered the clinical presentation of this disease and permits the use of more conservative methods of management directed towards preserving fertility and reducing morbidity. In this review of 1197 patients, compiled from the English literature, various conservative or tubectomy operative laparoscopic procedures have been employed, with 93% and 98% respectively, being able to avoid further surgery. Among the group treated by the conservative approach, a 6% post-operative complication rate was reported, of which 4% were persistent ectopic, 48% intra-uterine, and 18% repeated ectopic pregnancies. Among the radically treated patients, 2 intra- and 1 post-operative complications necessitated laparotomies. The fertility work-up and performance outcome are less obvious among this group. The benefits, safety and efficacy of each of the laparoscopic options, with appropriate recommendations for their use, are discussed. However, despite the aforementioned dramatic progress, women with previous ectopic pregnancies still have reduced fertility potential. Preventive measures aimed at reducing its overall occurrence therefore seem to be the major factor towards preserving a patient's future fertility potential.

Fallopian Tubes↗
PubMed1995

Human decidua-associated protein hDP200 in menstrual fluid: comparison between fertile women and women after failed in-vitro fertilization/embryo transfer treatment.

The concentration of human decidua-associated protein (hDP) 200 was measured in 238 menstrual fluid samples obtained from normal fertile women and in 26 menstrual fluid samples obtained from infertile women who failed to conceive and menstruated following in-vitro fertilization (IVF)/embryo transfer treatment. A significant association was observed between the concentration of hDP200 and the age of the women. A maximal concentration of hDP200 was observed in women aged 28-30 years, with significantly lower concentrations in those aged 18-20 and 39-41 years. The presence of an intra-uterine device had no effect on menstrual fluid hDP200 concentrations. A significantly lower mean concentration of hDP200 (82 U/ml) was measured in menstrual fluid samples obtained from failed IVF/embryo transfer patients as compared with that in menstrual fluid samples from normal fertile women (191 U/ml). These findings support the concept that adequate endometrial function, as evaluated by menstrual fluid concentration of hDP200, is important for the success of the fertility process.

Adolescent↗
PubMed1995

First trimester embryo reduction: a medical solution to an iatrogenic problem.

The incidence of multiple pregnancies is increasing, mainly as a consequence of the widespread use of various infertility protocols. Since such gestations present a high risk of feto-maternal morbidity and mortality, selective first trimester fetocide remains one of the few reasonable options. We reviewed the literature dealing with the outcome of 804 multiple pregnancies following the use of transcervical, transvaginal or transabdominal approaches. Questions relating to dealing with technical failure, method of fetocide and procedural improvements are examined. In a comparison of the variables: miscarriage, preterm delivery, perinatal and neonatal loss rates, the transvaginal approach fares better, but statistical significance (P < 0.001) is achieved only for preterm delivery. We speculated that this might be attributable to the very early gestational age at which the procedure is usually performed. However, the transabdominal approach offers better results when post-manipulation maternal morbidity is considered, i.e. infection and vaginal bleeding. Since each option offers different advantages and disadvantages, additional experience and larger population samples are required to further clarify this important issue.

Female↗