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Y Zalel

Publications and source records attributed to Y Zalel.

At least 37 records · Page 2Linked to original sources
PubMed2000

Contribution of color Doppler flow to the ultrasonographic diagnosis of tubal abnormalities.

Our objective was to characterize tubal abnormalities with color Doppler ultrasonography. We evaluated 25 women with adnexal masses suggestive of tubal masses using gray scale sonography. Color Doppler flow was added to further characterize the adnexal lesion. Of 18 women diagnosed as having hydrosalpinx, in 6 cases the diagnosis was tuboovarian abscess and in 1 case the diagnosis was tubal torsion. In the periphery of the hydrosalpinx, color Doppler flow revealed a mean resistive index of 0.752 +/- 0.04. In the periphery of the tuboovarian abscess, an abundant flow with reduced resistance to flow (mean resistive index = 0.448 +/- 0.04) was seen. The difference was statistically significant (P < 0.0001). In the case of adnexal torsion, no blood flow was detected in the lesion. All cases but one were confirmed in either laparoscopy or laparotomy or during colpotomy and drainage of the abscess. For adnexal masses suggestive of tubal lesions, color Doppler flow can further characterize the masses by detecting a significantly richer and low resistant blood flow in cases of tuboovarian abscess in comparison to hydrosalpinx.

Adult↗
PubMed1999

The development of the fetal sternum: a cross-sectional sonographic study.

OBJECTIVE: To assess the relationship between gestational age and sonographic appearance of the various sternal components and establish growth during human gestation. DESIGN: A prospective cross-sectional study. METHODS: The study was performed on 252 consecutive normal singleton pregnancies from 19 weeks of gestation until term, using transabdominal high-resolution ultrasound techniques. The sternal length, as well as the number of ossification centers at each gestational age, were recorded. RESULTS: The first occasion at which a fetal human sternum could be visualized with two to three ossification centers was at 19 weeks' gestational age. The fifth ossification center was first visualized at 29 weeks' gestation. The mean +/- SE of sternal length varied from 15 +/- 0.98 mm (95% confidence interval (CI) 12.79-17.21) at 19-20 weeks, to 36.50 +/- 0.29 mm (95% CI 35.58-37.42) at 37-38 weeks' gestation. Sternal length as a function of gestational age was expressed by the regression equation: sternal length (mm) = -11.06 + 1.39 x gestational age (weeks). The correlation coefficient, r = 0.924 for sternal length, was found to be highly statistically significant (p < 0.0001). CONCLUSIONS: The presented data offer normative measurements of the fetal sternum which may be helpful in the prenatal diagnosis of congenital syndromes that include, among other manifestations, abnormalities of sternal development.

Confidence Intervals↗
PubMed1999

[Sonographic demonstration of a levonorgestrel-releasing IUD (Mirena)].

Mirena, a new intra-uterine device (IUD) introduced in Israel during the past year, releases 20 mcg/day of levonorgestrel for 5 years. It has the advantages of reduced pregnancy rates and diminished menstrual blood loss, together with a low risk of pelvic inflammatory disease compared with current IUD's. It has a typical sonographic appearance, differing from that of regular IUD's, which was demonstrated in all 15 women examined in this study. Its sonographic appearance includes both proximal and distal ends of the vertical arm of the device, which extend into the internal cervical os and fundal region, respectively. Acoustic shadowing between both ends defines the location of the device, which should help avoid consultations due to "lost IUD's."

Contraceptive Agents, Female↗
PubMed1998

Ovarian stimulation and in vitro fertilization in women with mature cystic teratomas.

OBJECTIVE: To report the results of ovulation induction and in vitro fertilization-embryo transfer (IVF-ET) in patients with ovarian cystic teratomas. METHODS: Six women with ultrasonographically diagnosed ovarian cystic teratomas (mean diameter 2.4 cm) who presented with infertility underwent IVF-ET (n = 4) or ovulation induction (n = 2). Serial ultrasound examinations were used to determine the size of the cystic teratomas during therapy and throughout pregnancy. RESULTS: Ovarian stimulation was successful, as evidenced by the serum estradiol concentration on the day of hCG administration (mean in IVF-ET patients, 3558+/-1319 pg/mL) and the number of oocytes retrieved (10+/-4.24). Three patients having IVF-ET and both patients having ovulation induction conceived, and six healthy infants were born. Cyst sizes remained unchanged throughout treatment and pregnancy. There were no cyst-related complications during ovulation induction or IVF-ET, or during the entire course of pregnancy, labor, and delivery. CONCLUSION: The presence of ovarian cystic teratoma should not be considered a contraindication for therapy in women undergoing ovulation induction and IVF-ET.

Adult↗
PubMed1998

Unsuspected uterine leiomyosarcoma discovered during treatment with a gonadotropin-releasing hormone analogue: a case report and literature review.

We report a case of a 37-year-old woman who had received five courses of gonadotropin-releasing hormone (GnRH) agonist (Decapeptyl) for presumed uterine leiomyomata associated with episodes of uterine bleeding. Submucous myoma (histologically proven) was partially removed on the first visit. After a period of significant reduction in the tumor size and cessation of uterine bleeding, the symptoms recurred along with rapid re-growth of the uterus. Total abdominal hysterectomy was performed and the pathologic evaluation revealed leiomyosarcoma with a high mitotic rate. This case and the literature review emphasize the problems encountered with the early diagnosis of uterine leiomyosarcoma during GnRH agonist therapy.

Adult↗
PubMed1998

Development of fetal male gender: prenatal sonographic measurement of the scrotum and evaluation of testicular descent.

The study was conducted to construct a centile chart of fetal scrotal size and to determine gestational age at testicular descent. A prospective, cross-sectional study was performed on 210 fetuses of normal, singleton pregnancies between 14 and 37 weeks' gestation. Scrotal circumference was measured by transvaginal ultrasonography and abdominal ultrasound between 14 and 17 weeks' and 18 and 35 weeks' gestation, respectively. The regression equation for scrotal circumference (SC) modelled as a function of gestational age (GA) was: SC (mm) = exp (1.05 + 0.09 GA (weeks)) The correlation r = 0.96 was found to be highly statistically significant (p < 0.0001). The prediction of scrotal circumference per week and the 95% confidence interval (CI) were defined. Testicular descent was not observed prior to 2.5 weeks' gestation, with 30% of the fetuses having one or both testes descended at 25 weeks (p < 0.001) and 97% after 32 weeks. The presented normative data may be helpful in the prenatal diagnosis of suspected congenital syndromes that include, among their manifestations, scrotal abnormalities and early detection of cryptorchidism.

Cross-Sectional Studies↗
PubMed1998

Outcome of fetuses with isolated borderline unilateral ventriculomegaly diagnosed at mid-gestation.

OBJECTIVE: To evaluate the outcome of fetuses with isolated borderline, unilateral ventriculomegaly. DESIGN: A retrospective survey was conducted at four perinatal centers in Israel. SUBJECTS AND METHODS: Only fetuses with one ventricular width of > or = 11 mm and the other < 10 mm were included in the study. In all cases, the difference of the ventricular width between the two ventricles was > 2.4 mm (two standard deviations). Fetuses with other malformations, chromosomal abnormalities, or those with evidence of in utero infection, were not included in the study. RESULTS: Unilateral ventriculomegaly was found in 27 subjects (after excluding one case with unilateral ventriculomegaly and Down's syndrome). The mean width of the enlarged ventricle was 11.7 +/- 0.9 mm, while the other normal ventricle was 7.2 +/- 0.9 mm. The mean gestational age at diagnosis of the unilateral ventriculomegaly was 23.6 +/- 2.7 weeks. In one case, pregnancy was terminated, and pathological examination of the fetal brain failed to detect any structural abnormality. Twenty-five patients delivered at term and only one at 34 weeks' gestation. The neurological development in all 25 fetuses was normal, and one fetus had petit mal seizures. CONCLUSION: Fetuses with isolated, borderline unilateral ventriculomegaly, but without other abnormalities, have a good neurological outcome.

Cerebral Ventricles↗
PubMed1997

Sonographic and Doppler flow characteristics of ovarian tumors of low-malignant potential.

OBJECTIVE: To outline the sonographic and color Doppler flow imaging characteristics of ovarian tumors of low-malignant potential (OCLMP). METHODS: Fourteen women with ovarian tumors of low-malignant potential were compared with 26 women with ovarian cystadenomas and 23 with ovarian carcinomas. RESULTS: Sonographically, more complex structures and echogenic lesions were found in the OCLMP and malignant tumors than in the cystadenomas, and the difference was statistically significant. Color blood flow imaging revealed a similar resistant index (RI) in the OCLMP (0.487 +/- 0.07) and cystadenomas (0.489 +/- 0.09) when compared with statistically significant lower RI in the ovarian carcinomas (0.391 +/- 0.05) (P < 0.001). CONCLUSIONS: Among young women, the combination of a complex ovarian mass with turbid fluid and echogenic lesions whose color Doppler flow imaging registers in the low range (RI < 0.5) should raise the suspicion of an ovarian tumor of low-malignant potential.

Adult↗
PubMed1997

Ovarian volume in postmenopausal breast cancer patients treated with tamoxifen.

BACKGROUND: Postmenopausal breast cancer patients treated with tamoxifen have been found to have a high incidence of ovarian tumors. Transvaginal ultrasonography is an accurate and reliable method for measuring ovarian size. The purpose of this study was to establish normal values for basal ovarian volume in postmenopausal tamoxifen-treated patients and compare them with those established for healthy, postmenopausal women in the same population with no exposure to hormone treatment. METHODS: In a prospective open pilot study, the ovaries of 65 postmenopausal breast cancer patients treated for at least 6 months with tamoxifen were measured by transvaginal ultrasonography. From the same population, 311 healthy postmenopausal women with no exposure to hormone therapy were examined and served as controls. After matching for menopausal age, ovarian volume was compared between groups. RESULTS: Mean ovarian volume of postmenopausal tamoxifen-treated patients was persistently low through the menopause, whereas the mean ovarian volume of the controls was large, gradually decreasing up to the 10th menopausal year (8.6 +/- 2.3 and 2.8 +/- 2.1 cm3, respectively). Mean ovarian volume of the tamoxifen-treated patients was significantly lower than that of the controls during the initial menopausal years. CONCLUSIONS: An ovarian volume that is considered within normal range for a specific menopausal age in a healthy postmenopausal woman is abnormal for a postmenopausal tamoxifen-treated patient.

Aged↗
PubMed1997

Value of sonohysterography in asymptomatic postmenopausal tamoxifen-treated patients.

A prospective study was performed to assess the efficacy of sonohysterography (SHG) in identifying endometrial pathologies among asymptomatic, postmenopausal breast cancer patients treated with tamoxifen. In this study the uterine cavity of 68 such patients with endometrial thickness of > or = 8 mm was prospectively evaluated by SHG. Forty-six (67.6%) patients in whom SHG did not identify any findings in the uterine cavity (negative group) were followed by diagnostic hysteroscopy. Another 22 (32.4%) who were identified by SHG to have abnormal endometrial findings, such as an echogenic or polypoid mass (positive group), were followed by operative hysteroscopy and by postoperative SHG. In the positive group the basal transvaginal sonogram revealed an endometrial echogenic mass in only 10 (45.5%). In the remaining 12 (54.5%) patients, the transvaginal sonogram identified only thick endometrium. In these latter 12 patients, histological assessment confirmed endometrial polyps in 8 (66.7%) and fibroid in 1 (8.3%). Four (18.2%) patients in the positive group had no histological endometrial pathology. Two (50%) of them had a uterine septum as diagnosed during hysteroscopy, in one (25%) operative hysteroscopy failed to resect the endometrial polyp, and in another (25%) there was a false-positive SHG diagnosis. Overall, SHG accurately diagnosed endometrial and/or other intrauterine pathology in 95.5% of these patients. In the 46 patients with "negative" basal SHG features, diagnostic hysteroscopy confirmed this diagnosis. Thus, there was no SHG false-negative diagnosis. Comparing the results of the basal SHG with those of operative hysteroscopy and/or the histopathological findings in the positive group, the sensitivity of SHG was 1.0, the specificity 0.0, positive predictive value 95.5%, and negative predictive value 0.0. It is suggested that SHG is a useful diagnostic tool for the assessment of specific endometrial pathologies in asymptomatic postmenopausal breast cancer patients treated with tamoxifen who were diagnosed by transvaginal sonography to have thick endometrium.

Antineoplastic Agents, Hormonal↗
PubMed1997

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women.

OBJECTIVE: To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women. DESIGN: A prospective study. SETTING: Tertiary hospital-based ultrasonographic unit. PATIENT(S): Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel. INTERVENTION(S): Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered. MAIN OUTCOME MEASURE(S): Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up. RESULT(S): For the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases. CONCLUSION(S): Premenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

Adolescent↗
PubMed1997

Gestational trophoblastic disease following the evacuation of partial hydatidiform mole: a review of 66 cases.

OBJECTIVE: The current study was undertaken in order to identify the clinical characteristics and natural history, as well as methods of investigation and available therapy, of persistent gestational trophoblastic disease (GTD) following the evacuation of partial hydatidiform mole (PM). METHODS: Case reports of persistent GTD following the evacuation of partial mole, were searched using the Medline computerized retrieval system. There were 66 such cases (including 4 cases treated at our department), representing 2.9% of GTD following PM. RESULTS: The mean age of the women at diagnosis was 28.4 years and mean gravidity was 2.99. The mean gestational age at diagnosis was 15.5 weeks and the mean uterine size was 13.6 weeks. The most common presenting symptom was vaginal bleeding. In the majority of the patients, the pre-evacuation diagnosis was incomplete or missed abortion. CONCLUSIONS: Although the malignant potential of PM is low, persistent GTD may develop after PM and may even metastasize, it is usually responsive to single agent chemotherapy but may require combination chemotherapy. Therefore, after evacuation of PM, these women should be followed with serial serum b-hCG. Further research is needed to enable earlier identification of PM that eventually will develop persistent GTD.

Adult↗
PubMed1997

Is it necessary to perform a prophylactic oophorectomy during hysterectomy?

OBJECTIVE: To evaluate the subsequent pelvic sonographic characteristics as well as the clinical outcome following hysterectomy with and without oophorectomy. STUDY DESIGN: A prospective study of sonographic evaluation of 164 women, aged 29-72 years, with a history of hysterectomy was performed. Ninety-one patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and 73 women had either hysterectomy (abdominal or vaginal) only or hysterectomy with unilateral salpingo-oophorectomy. RESULTS: The mean time interval between surgery and sonographic evaluation was 4.3 years (range, 1-25 years). Out of the 73 women with left ovaries, 37 (50.7%) were found to have pelvic lesions and four women underwent re-operations following these findings. The histologic finding were cystadenoma, hydrosalpinx with periovarian adhesions and two paraovarian cysts. In comparison, only five of the 91 women (5.5%) following bilateral salpingo-oophorectomy were found to have pelvic lesions (P < 0.0005). None of the women with prophylactic oophorectomy were operated upon following these findings. CONCLUSIONS: In comparison to patients after total hysterectomy and bilateral salpingo-oophorectomy, women with prior hysterectomy and ovarian preservation are prone to subsequent pelvic lesions. They need to be closely followed with clinical, laboratory and sonographic means, and may undergo reoperations in order to rule out the possibility of neoplasia.

Adult↗
PubMed1997

Different coexisting endometrial histological features in asymptomatic postmenopausal breast cancer patients treated with tamoxifen.

In an attempt to assess the hypothesis that different endometrial sites may respond differently to tamoxifen exposure in postmenopausal women, hysteroscopic selected endometrial histology was investigated in 175 postmenopausal breast cancer patients who received continuous treatment with tamoxifen, and in 27 similar patients not treated with tamoxifen who served as controls. In the tamoxifen-treated patients 14 (8.0%) developed endometrial polyps. Of 14 patients, 8 (57.2%) each displayed atrophic endometrium in the same histologic specimen, 5 (35.7%) each had coexisting simple hyperplasia, and 1 (7.1%) other had complex hyperplasia. Another 21 (12.0%) developed simple or complex hyperplasia. The endometrial hyperplasia coexisted with atrophic endometrium in all these patients. All these lesions were selectively identified by hysteroscopic examination prior to the endometrial biopsy. In the control group 3 (11.0%) had simple hyperplasia and 2 (7.4%) had endometrial polyps. The above results support the hypothesis that the endometrium of postmenopausal breast cancer patients on tamoxifen treatment may possess different responses to tamoxifen exposure.

Aged↗
PubMed1997

Doppler flow characteristics of dermoid cysts: unique appearance of struma ovarii.

The purpose of our study was to evaluate the Doppler flow characteristics of ovarian dermoid cysts. In 70 women (mean age, 38.7 +/- 14.6 years), 78 ovarian lesions with mean diameter of 48.9 +/- 28.4 mm and preoperative sonographic diagnosis of dermoid cyst of the ovary were evaluated prospectively by Doppler flow sonography; these cysts were eventually removed surgically. The findings were compared to the postoperative histologic results. In 74 lesions (eight cases were bilateral), when blood flow patterns were detected (detection rate of 24.3%) they were obtained only from the ovarian tissue surrounding the dermoid cavity, with a mean resistive index of 0.6 +/- 0.1 (range, 0.4 to 0.76). In four cases, which were proved postoperatively to be struma ovarii, blood flow was detected not only from the cyst capsule but also from the centrally positioned solid area (dermoid tissue), with a mean RI of 0.565 +/- 0.08 (range, 0.509 to 0.667). Dermoid cysts of the ovary are devoid of blood flow, with flow detection rate being only 24.3% from the cyst capsule. When apparently vascularized solid tissue is detected in the central part of a sonographically suspected benign cystic teratoma, struma ovary is highly suspected.

Adolescent↗