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Biomedical subjects

U Elchalal

Publications and source records attributed to U Elchalal.

At least 73 records · Page 4Linked to original sources

Persistent gestational trophoblastic disease following evacuation of a tetraploid partial hydatidiform mole.

A 31-year-old woman at 11 weeks gestation with ultrasonographic demonstration of partial mole had markedly elevated serum bHCG levels (458,000 mIU/ml). The patient underwent a vacuum curettage with pathological confirmation of the diagnosis, and cytogenetic analysis revealed a tetraploid karyotype (92,XXXX). The patient developed persistent gestational trophoblastic disease and was successfully treated with two courses of actinomycin D. Persistent trophoblastic disease after evacuation of a tetraploid partial mole was not reported previously.

Adult↗

Aggressive angiomyxoma of the vulva.

A case of aggressive angiomyxoma (AAM) of the vulva is presented. The tumor presented as a slowly growing polypoid mass in the right labium minus near the clitoris. The tumor was treated by wide local excision. The microscopic appearance was that of spindle-shaped neoplastic cells widely separated by a loose myxoid stroma rich in collagen fibers, hyaluronic acid, and prominent irregular-shaped blood vessels. Aggressive angiomyxoma of the vulva must be distinguished from the more common benign and malignant myxoid tumors including myxoma, myxoid liposarcoma, myxoid variant of malignant fibrous histiocytoma, sarcoma botryoides, nerve sheath myxoma, and other soft tissue tumors with secondary myxoid changes. Local recurrence of AAM may be avoided by wide local excision.

Adult↗

The importance of the endopelvic fascia repair during vaginal hysterectomy.

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.

Aged↗

Chorionic villus sampling for fetal karyotyping in missed abortions.

Chorionic villus sampling (CVS) was performed in 12 pregnant women (9-25 gestational weeks) with ultrasonographic evidence of missed abortion. An ultrasonographically guided transabdominal (eight cases) or transcervical (four cases) approach was used. Fetal karyotyping was successful in all cases; in five, chromosomal aberrations were found and in seven, chromosome analyses revealed normal karyotypes. Tissue culture for fetal karyotyping was successful in only 72.5 per cent of 40 live pregnancies which were electively interrupted because of abnormal ultrasonographic findings or an abnormal fetal karyotype, and in 57 per cent of seven missed abortions. CVS is suggested as a feasible and effective method for fetal karyotyping in missed abortions and it seems to be superior to post-abortion tissue culture.

Abortion, Missed↗

Malignant fibrous histiocytoma of the vagina and vulva successfully treated by combined chemotherapy and radiotherapy.

Combined vaginal and vulvar malignant fibrous histiocytoma has not been reported previously. Radical vulvectomy with node dissection is the currently recommended therapy for a vulvar lesion of this type. We present a case with complete tumor regression after combined chemotherapy and radiotherapy. The surgical approach in our patient was inappropriate due to advanced disease. Follow-up examinations for 6 years after initiation of therapy showed no evidence of local recurrence or distant metastasis. Chemotherapy followed by radiotherapy should be considered as an alternative to surgery in patients with advanced vaginal and vulvar involvement and in patients in whom complex medical problems preclude extensive surgical procedures.

Aged↗

Placental abruption associated with air travel. A case report and an overview on safety of air travel in pregnant women.

A case of placental abruption during air travel is described. None of the known predisposing factors could be demonstrated. Although it may be a true coincidence, the connection between the abruption and the flight could not be totally excluded. Safety of air travel in pregnant women is discussed, and it may be summed-up that flying is not contraindicated in uncomplicated pregnancy.

Abruptio Placentae↗

[Treatment of hyperprolactinemia and acromegaly with lisuride].

17 hyperprolactinemic and 2 acromegalic patients, aged 19-73, and 47 and 59 years, respectively, were treated with Lisuride (dopergin). 12 of the hyperprolactinemic patients were treated with Lisuride because they could not tolerate the side effects of bromocriptine (Group A), and the other 5 because large doses of bromocriptine failed to reduce their plasma prolactin to normal (Group B). The 2 acromegalic men, were treated with Lisuride because of persistently high levels of growth hormone after hypophysectomy and irradiation of the sella turcica, and because of intolerance to bromocriptine. Lisuride reduced prolactin to normal in 11 of the 12 in Group A (from 217 +/- 175 to 27 +/- 10 micrograms/l, p less than 0.01) and reduced it in the last patient from 3900 to 270 micrograms/l. The prolactin-lowering effect of Lisuride was unsatisfactory in Group B since like bromocriptine, it failed to reduce prolactin levels. One of the acromegalics improved both clinically and biochemically and growth hormone levels were reduced from 56 to 18 ng/ml, while the other did not respond to Lisuride. Its main side effects were somnolence, nausea, and increased appetite (4 patients). These effects lasted only a few weeks. One patient stopped Lisuride because of severe constipation, which had been caused by bromocriptine as well. Lisuride is an effective drug in hyperprolactinemia, especially in those with severe side effects after other dopaminergic drugs. It is effective in some cases of acromegaly, but has little to offer to those resistant to bromocriptine.

Acromegaly↗

Prenatal diagnosis of cystic fibrosis: ultrasonographic appearance of meconium ileus in the fetus.

Four of ten fetuses carrying a risk of 1:4 for cystic fibrosis were found to have low levels of microvillar enzymes in the amniotic fluid obtained between 17 and 18 weeks' gestational age. On sonography performed prior to the amniocentesis, three fetuses showed enlarged bowel loops. At autopsy, meconium ileus was detected. Enlarged bowel loops are a sign which has not been described previously so early in pregnancies.

Cystic Fibrosis↗

Expectant management of post-term patients: observations and outcome.

Post-term pregnancy is associated with increased perinatal mortality. In a retrospective study based on our post-term protocol from 1990 until May 1995 1,798 post-term pregnant women with reliable dating were evaluated for expectant management. A group of 2,633 pregnant women who delivered between 37 and 41 weeks during 1994 served as a control group. The perinatal mortality (0.56 per 1,000 vs. 0.75 per 1,000 in the control group) was similar in both groups. The incidence of induction of labor (7.45% vs. 7% in the control group), meconium of more than +1 (5.2% vs. 4% in the control group), shoulder dystocia (0.33% vs. 0.19%), high birthweight (> 4,500 g) (1% vs. 1%), and cesarean section rates (7.5% vs. 7% in the control group) were similar. However the fetal distress rates (11.6% vs 16%; P = .004), instrumental deliveries (10.1% vs. 13%, P = .002), and the rate of 5-minute Apgar score of less then 7 (1.1% vs. 5%, P = .000001) were found to be significantly lower in the post-date group than in the control group. We conclude that the expectant management and our intensive observation and follow-up in post-term is indicated for both mother and fetus.

Apgar Score↗

Sonographically thick placenta: a marker for increased perinatal risk--a prospective cross-sectional study.

The aim of this study was to determine placental thickness by ultrasound examination throughout pregnancy and establish the correlation of sonographically thick placenta with perinatal mortality and morbidity. Placental thickness was determined by routine sonographic examination throughout pregnancy in 561 normal singleton pregnancies. Thick placenta was determined as placenta that was above the 90th percentile. Gravidae between 20-22 weeks' gestation (n=193) and 32-34 weeks (n=73) were then divided into two groups according to placental thickness. The study group consisted of 44 gravidae with thick placenta. The control group included 151 gravidae with placental thickness between the 10th and 90th percentile. A comparison of perinatal mortality and morbidity rates as well as the incidence of small and large for gestational age neonates was conducted.A linear increase of placental thickness was found to correlate with gestational age throughout pregnancy. No statistical differences were observed between the two groups with regard to obstetrical variables such as maternal age, parity and gestational age at delivery. No correlation was found between placental thickness and maternal age or parity. The incidence of perinatal mortality was significantly higher among gravidae with thick placentae (6.82% versus 0.66 per cent, P=0.037, 95 per cent confidence interval 1.71-70.29). Birthweight at term was found to be above 4000 g in 20.45 per cent of the thick-placenta group as compared to 5.3 per cent in the control group (P=0.001, 95 per cent CI 2.08-13.85), and birthweight of less than 2500 g was found in 15. 9 per cent of the thick-placenta group as compared to 7.3 per cent in the control group (P=0.03, 95 per cent CI 1.11-8.14). The incidence of fetal anomalies was 9.1 per cent in the thick-placenta group and 3.97 per cent in the control group (not significant). Sonographically thick placenta is associated with increased perinatal risk with increased mortality related to fetal anomalies and higher rates of both small for gestational age and large for gestational age infants at term.

Birth Weight↗