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Biomedical subjects

S Lipitz

Publications and source records attributed to S Lipitz.

At least 127 records · Page 7Linked to original sources
PubMed1993

Cyst fluid CA 125 levels in ovarian epithelial neoplasms.

OBJECTIVE: To assess the feasibility of using cyst fluid CA 125 levels to distinguish between benign and malignant ovarian cystic neoplasms. METHODS: CA 125 levels were measured in ovarian cyst fluid and in serum obtained at surgery in 44 women with ovarian cystic tumors of epithelial origin (25 benign, 12 malignant, and seven borderline). RESULTS: The median cyst fluid CA 125 level in malignant neoplasms (671 U/mL) was higher than in benign tumors (175 U/mL), and 86% of the malignant tumors contained levels higher than 100 U/mL in the cyst fluid, compared with only 62% of the benign tumors. However, these differences were not statistically significant. CONCLUSION: Cyst fluid levels of CA 125 cannot be used to distinguish between benign and malignant ovarian cysts of epithelial origin.

Adolescent↗
PubMed1993

Transvaginal duplex Doppler ultrasonography in bleeding patients suspected of having residual trophoblastic tissue.

OBJECTIVE: To evaluate the diagnostic accuracy and clinical usefulness of high-resolution transvaginal duplex Doppler ultrasound in postpartum and post-abortion patients with excessive hemorrhage who are suspected of having residual trophoblast. METHODS: Forty-eight women with excessive hemorrhage referred for possible residual trophoblastic tissue were evaluated by transvaginal duplex Doppler ultrasonography. Based on two-dimensional imaging, the patients were divided prospectively into groups: women who had an empty uterus with a normal uterine cavity, those with a pure endometrial fluid collection and no echogenic foci, those who had a mixed endometrial fluid collection with foci of echogenicity, and those with intracavitary heterogeneous material with mixed echo patterns of fluid and solid components. In each group, Doppler studies were performed and the resistance index (RI) was calculated. The two-dimensional patterns and Doppler results were correlated with clinical and pathologic follow-up. RESULTS: Twenty-eight subjects had a normal uterine cavity and seven had a pure endometrial fluid collection; all were treated conservatively and none showed later clinical evidence of residual trophoblastic tissue. In 13 women, residual trophoblast was strongly suggested from the images of two-dimensional ultrasonography: Five showed an endometrial fluid collection with some echogenic foci, and eight exhibited intracavitary mixed echogenic material. All underwent curettage, and residual trophoblastic tissue was found in ten of the 13. The mean (+/- standard deviation) RI to flow in the myometrial arteries was 0.54 +/- 0.15 in women without residual trophoblast and 0.35 +/- 0.1 in those with residual trophoblastic tissue (P < .01). CONCLUSION: Our experience suggests that transvaginal duplex Doppler ultrasonography is an effective noninvasive method for evaluating patients with excessive postpartum and post-abortion hemorrhage who are suspected of having residual trophoblastic tissue. Its use enhances the positive preoperative diagnosis of residual trophoblastic tissue and may reduce unnecessary curettage procedures.

Abortion, Spontaneous↗
PubMed1992

Neonatal alloimmune thrombocytopenia due to anti-P1A1 (anti-HPA-1a): importance of paternal and fetal platelet typing for assessment of fetal risk.

Neonatal alloimmune thrombocytopenia (NAIT), which usually involves sensitization to P1A1 (HPA-1a), may have devastating complications for the fetus. These may be prevented by antenatal treatment of severe cases with either maternally administered high-dose gamma-globulin and/or repeated intrauterine platelet transfusions. Determination of the paternal platelet phenotype is useful for counseling parents who have had one or more affected pregnancies. This report of an unaffected pregnancy in a woman with a history of previous pregnancies complicated by NAIT illustrates the role of paternal and fetal platelet phenotyping in managing existing pregnancies at risk of NAIT.

Adult↗
PubMed1992

Successful pregnancy in a patient with polycystic kidney disease and advanced renal failure: the use of prophylactic dialysis.

Adult polycystic kidney disease is an inherited disease that is transmitted as an autosomal dominant trait. The clinical manifestations, which develop during the third or fourth decade of life, usually do not affect women during childbearing age and thus do not affect fertility or pregnancy outcome. The patient presented here had polycystic kidney disease and advanced renal failure, and was treated with meticulous fetal surveillance and prophylactic hemodialysis during pregnancy. The successful outcome strengthens the trend to perform prophylactic dialysis in pregnancies with advanced renal failure, despite the lack of controlled studies.

Adult↗
PubMed1992

Acoustic stimulation as a diagnostic test: comparison with oxytocin challenge test.

The usefulness of an acoustic stimulation test as a marker of fetal well-being was evaluated in a randomized controlled study of 121 pregnant women exhibiting a non-reactive fetal non-stress test at term. The women were randomly divided into two groups; those in the first group (n = 62) underwent an acoustic stimulation test immediately prior to an oxytocin challenge test, while those in the second (n = 59) underwent an oxytocin challenge test only. Fetal response to the acoustic stimulation was non-reactive in 22.5% of the women tested in the first group. The incidence of abnormal oxytocin challenge test among the women who were previously subjected to an acoustic stimulation was somewhat lower than among those who did not (14.5% vs. 23.7%), but the difference was not significant. In the prediction of an abnormal oxytocin challenge test, a non-reactive acoustic stimulation test had a sensitivity of 100%, a positive predictive value of 64% and a specificity of 91%. As a single test for the prediction of fetal distress in labor (n = 62), the acoustic stimulation test had a specificity and a positive predictive value similar to those of the oxytocin challenge test (n = 121), and its sensitivity was even higher (88% vs. 71%). We conclude that the acoustic stimulation test is at least as reliable as the oxytocin challenge test in the evaluation of fetal well-being in women exhibiting a non-reactive non-stress test at term.

Acoustic Stimulation↗
PubMed1992

Recurrence rate after fluid aspiration from sonographically benign-appearing ovarian cysts.

The outcome after fluid aspiration from 41 sonographically benign-appearing ovarian cysts was assessed. The considerable probability of recurrence was significantly higher after ultrasound-guided aspiration than following aspiration via laparoscopy (54% versus 30%, respectively, at 36 months). Although all the recurring cysts were benign, the concern with malignancy and the high recurrence rate seem to indicate that fluid aspiration from sonographically benign-appearing cysts by either method is not the management of choice.

Adolescent↗
PubMed1992

Cervical cerclage for anomalous uteri.

The role of cervical cerclage was evaluated in 54 pregnant women with anomalous uteri. Forty-six of them delivered live neonates, and eight aborted. The success rate was 85.2% as compared to 22% in previous pregnancies. The mean gestational age was 38 weeks (range, 32-42). The average birth weight was 3,150 g. Complications from the cerclage procedures were minor. Our results support the trend toward the use of cervical cerclage in pregnant women with anomalous uteri.

Adult↗
PubMed1991

Ovarian hyporesponsiveness in combined gonadotropin-releasing hormone agonist and menotropin therapy is associated with low serum follicle-stimulating hormone levels.

The study was designed to evaluate if ovarian hyporesponsiveness, which is associated with combined gonadotropin-releasing hormone agonist (GnRH-a) and human menopausal gonadotropin (hMG) therapy is because of suboptimal serum follicle-stimulating hormone (FSH) levels. Two groups of 12 patients each were suppressed with GnRH-a and stimulation with a fixed dose of hMG. The control group (n = 10) received equal doses of hMG only. The follicular phase and the number of hMG ampules was significantly higher in the study group. Basal FSH levels and FSH levels during hMG treatment were significantly lower in patients treated with GnRH-a. Peak estradiol levels and the outcome of in vitro fertilization treatment were similar in the three groups. We suggest that the delay in ovarian response in patients treated with a combination of GnRH-a and hMG is because of lack of endogenous contribution of FSH, resulting in low circulating levels of FSH. An increase of serum FSH levels by administration of higher doses of hMG can reverse this effect.

Adult↗
PubMed1991

Quintuplet pregnancy and third degree ovarian hyperstimulation despite withholding human chorionic gonadotrophin.

A patient who suffered from polycystic ovarian disease and anovulation, was treated with pure follicle stimulating hormone for induction of ovulation. The treatment was stopped and human chorionic gonadotrophin was not administered because of high serum oestradiol levels and multiple follicular development. Ovulation occurred 11 days after pure follicle stimulating hormone was discontinued, the patient developed third-degree ovarian hyperstimulation syndrome and conceived with a quintuplet pregnancy.

Adult↗
PubMed1991

The effect of smoking on the outcome of in-vitro fertilization--embryo transfer.

This study investigated the influence of cigarette smoking on the outcome of in-vitro fertilization-embryo transfer. Forty-one women under the age of 37 years, suffering from mechanical infertility, were suppressed with gonadotrophin releasing analogue from day 21 of the cycle. Twenty women were smokers and 21 women were non-smokers. Gonadotrophin releasing analogue was injected daily before ovarian stimulation with gonadotrophin was begun. The follicular phase was longer and the number of human menopausal gonadotrophin ampoules required to reach adequate stimulation were higher in smokers. The peak serum oestradiol level was not significantly different in smokers compared to non-smokers. However, follicular fluid levels of oestradiol were significantly lower in smokers than in non-smokers (657 +/- 367 versus 1077 +/- 786 ng/ml) respectively. Furthermore, the fertilization rate was also lower in smokers than in non-smokers (40.9 versus 61.7%) respectively. Four pregnancies were achieved in the non-smokers group, while only one ectopic pregnancy was diagnosed in the smokers group. These findings suggest that cigarette smoking has a detrimental effect on the outcome of in-vitro fertilization and embryo transfer.

Adult↗
PubMed1991

Hormonal profiles and follicular growth in cycles with imminent ovarian hyperstimulation.

Ovarian hyperstimulation syndrome is a common and serious complication of human menopausal gonadotrophin/human chorionic gonadotrophin treatment. We evaluated the changes in the pituitary and ovarian hormone profiles and ultrasonographic follicular regression in 12 patients in whom human menopausal gonadotrophin was discontinued due to 'imminent' ovarian hyperstimulation. Following discontinuation, three distinct periods were observed: (i) days 1-2, the levels of oestradiol, testosterone and prolactin, and the total number of follicles continued to rise; (ii) days 3-6, the levels of oestradiol, testosterone and prolactin declined sharply and the total number of follicles was reduced significantly, while the large and medium sized follicles continued to increase. Levels of follicle-stimulating hormone and luteinizing hormone gradually declined to reach their lowest levels by days 5-6 and then increased. (iii) Thereafter the number of follicles and steroid output declined to early follicular phase levels. We conclude that discontinuation of human menopausal gonadotrophin and withholding human chorionic gonadotrophin in cycles with laboratory signs of 'imminent' ovarian hyperstimulation syndrome, allows regression of the ovarian ultrasonographic finding and prevents the development of clinical symptoms. However, if rescue of the cycle is attempted, human chorionic gonadotrophin should be given during the first 4 days after discontinuation of stimulation.

Adult↗
PubMed1991

Midtrimester bleeding--variables which affect the outcome of pregnancy.

A prospective study of 65 women with midtrimester bleeding was undertaken in order to assess the outcome of pregnancy and to determine variables which significantly affect it. Of the entire group, 48 (73.8%) delivered after 26 weeks of gestation (39 of them at term). The total fetal loss (abortions plus perinatal deaths) was 31.8%. Three patients who needed blood transfusions subsequently required immediate termination of pregnancy due to severe bleeding. Discriminant analysis revealed that three independent variables had a significantly unfavorable effect on the outcome of the pregnancies: a decrease in hemoglobin of more than 1 g%, duration of hospitalization (reflecting duration of bleeding) of more than 1 week and the presence of a previous uterine scar.

Abortion, Spontaneous↗
PubMed1991

A simple scoring system for the treatment of cervical incompetence diagnosed during the second trimester.

Twenty-four women with second-trimester cervical incompetence underwent emergency cerclage. The appropriateness of cervical cerclage was analyzed according to a scoring system (Cervical Incompetence Scale; CIS) which measures the degree of cervical effacement, cervical dilatation and protrusion of fetal membranes into the cervical canal. Patients with low CIS (0-3 points) were found to have a more favorable pregnancy outcome than patients with high-score cervical incompetence (5-8 points), i.e. fewer complications following the procedure, 33.3 and 87.5%, respectively, fewer pregnancy losses (22.2 and 75%, respectively) and a significantly prolonged postoperative pregnancy course (mean gestation 33.2 and 24.4 weeks at delivery, respectively). The chances of a successful pregnancy outcome were evaluated at 87.5%; the outcome was successful in patients with low CIS presenting with effacement of the uterine cervix of less than 50%, cervical dilatation of less than 1.5 cm and with fetal membranes remaining in the cervical canal. On the basis of these results, we conclude that the emergency cerclage operation in carefully selected patients with midtrimester cervical incompetence may improve the outcome of pregnancy. This selection is facilitated by the use of a new cervical incompetence scoring system described herein.

Emergencies↗
PubMed1991

Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women.

A series of 101 patients with adnexal torsion during a 12 year period are reviewed. Twenty patients were pregnant at the time of diagnosis and underwent surgical treatment. Preoperatively, the correct diagnosis was not established in four pregnant patients and in 30 nonpregnant patients. An operation was usually delayed for more than 24 hours. Unwinding of the twisted adnexa, regardless of its appearance, was the main surgical procedure in both groups. The outcome of the pregnancies was favorable. The main histopathologic findings in both groups were cysts of the follicular or corpora lutea.

Adnexal Diseases↗
PubMed1991

Midtrimester abortion induction with intraamniotic prostaglandin F2 alpha in women with previous uterine surgery.

Of 207 women who underwent midtrimester induced abortion with intraamniotic prostaglandin F 2 alpha instillation, 30 (14.5%) had had one or more previous uterine operations. Multivariate analysis showed no correlation between a previous uterine operation and the hospitalization length, procedure complication rate or length of the injection-delivery interval (IDI). The IDI was similar in patients with and without a previous uterine operation. No case of uterine rupture occurred. Intraamniotic prostaglandin instillation for midtrimester abortion induction seems to be an effective procedure without severe complications in women with previous uterine operations.

Abortion, Induced↗
PubMed1990

[Rh, Du phenotype in the pregnant woman].

The Rh, Du blood phenotype occurs rarely in the white population (0.23-0.60%). Its clinical significance is whether it should be considered it as Rh positive or negative. A pregnant woman with blood type Rh, Du (+), who delivered an Rh D (+) baby and was not given Rh immune globulin is presented. The Du antigen is manifested by weak expression of the D gene on the RBC envelope, and therefore Rh Du (+) is considered Rh (D) positive. An exception to this rule is the occurrence of transplacental fetomaternal bleeding in an Rh negative mother carrying an Rh positive fetus, when blood is typed close to the time of hemorrhage. In addition, there are other rare phenotypes, such as the D variant and the Du variant, in which there is alloanti-D present in the serum of Rh (D) positive or Rh Du positive patients, causing mild hemolytic disease of the newborn in rare instances.

Female↗
PubMed1990

Ovarian stimulation with gonadotropin-releasing hormone (GnRH) analogue improves the in vitro fertilization (IVF) pregnancy rate with both transvaginal and laparoscopic oocyte recovery.

The relative impact of ovarian stimulation protocol and oocyte retrieval technique on success rates of in vitro fertilization program was studied in 200 patients. Sixty-three patients received gonadotropin-releasing hormone analogue (GnRHa) with human menopausal gonadotropin (hMG), and 137 received hMG only. The GnRHa + hMG protocol resulted in higher pregnancy rates than the hMG-only protocol (19.0 vs 9.5%, respectively; P less than 0.01) despite a lower cleavage rate. Oocyte retrieval was performed via laparoscopy in 100 patients and transvaginally in 100 patients. The number of oocytes recovered per cycle was 6.1 +/- 3.9 with laparoscopy and 7.0 +/- 3.1 transvaginally. Pregnancy rates were similar for both retrieval techniques (13 and 12%, respectively). A breakdown of these results showed that the advantage for the GnRHa + hMG protocol was not affected by the oocyte retrieval technique. A comparison of simultaneous blood and follicular fluid pH measured every 10 min during laparoscopy and transvaginal oocyte recovery revealed a constant decline in follicular fluid pH during laparoscopy, while no changes were observed during the vaginal procedure. We conclude that the improvement in in vitro fertilization results during the period of our study is due primarily to the introduction of GnRHa + hMG protocol rather than the method of oocyte retrieval.

Biopsy, Needle↗