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Biomedical subjects

Z Appelman

Publications and source records attributed to Z Appelman.

At least 19 recordsLinked to original sources
PubMed2000

The bright edge of the endometrial polyp.

OBJECTIVE: To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted 'the bright edge of the polyp'. METHODS: The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis. RESULTS: In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities. CONCLUSION: The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound.

Case-Control Studies↗
PubMed2000

Conservative management of ovarian cystic teratoma during pregnancy and labor.

OBJECTIVE: Our goal was to evaluate the adequacy of conservative management during pregnancy and labor in women with an ultrasonographically diagnosed ovarian cystic teratoma. STUDY DESIGN: Forty-nine women with ultrasonographically diagnosed ovarian cystic teratoma <6 cm were followed for detection of possible complications through pregnancy and labor. Serial ultrasonographic examinations before pregnancy, during pregnancy, and after delivery were performed to detect changes in the size of the cystic teratoma. RESULTS: In a group of 49 women with dermoid cysts (mean age, 30 years), 68 pregnancies resulted. Of the 68 pregnancies, 4 ended in miscarriages, 1 was electively terminated, and in the remaining 63 pregnancies, a total of 64 healthy infants were delivered. Five patients needed treatment with assisted reproductive techniques. Fifty-five pregnancies ended in normal vaginal deliveries and 8 were delivered by cesarean (cesarean delivery rate of 16%). None of the classical complications attributed to dermoid cysts such as torsion, dystocia, or rupture occurred in the study group. In a follow-up of 56 dermoid cysts throughout pregnancy, cyst size remained unchanged. CONCLUSIONS: Ovarian dermoid cysts <6 cm are not expected to grow during pregnancy or to cause complications in pregnancy and labor.

Adult↗
PubMed2000

A 47,XXY fetus conceived after ICSI of spermatozoa from a patient with non-mosaic Klinefelter's syndrome: case report.

The birth of 12 healthy infants to fathers with non-mosaic Klinefelter's syndrome has been reported so far. The spermatozoa for these pregnancies was obtained from frozen-thawed ejaculate in one pregnancy (twins) and from the testis in the remaining 10 infants. All of them had a normal karyotype. We describe a patient with non-mosaic Klinefelter's syndrome from whom a testicular biopsy was obtained and motile spermatozoa were collected. Of 16 oocytes that were injected, 14 fertilized and cleaved. Three embryos were transferred, resulting in a triplet pregnancy. Karyotype analysis from chorionic villous sampling revealed 46,XX, 46,XY and 46,XXY from the three fetuses. The affected 46,XXY fetus was reduced on the 14th gestational week. The pregnancy culminated with the birth of a healthy male and female, on the 36th gestational week, weighing 3600 and 2660 g respectively. This case report proves the presence of hyperploid spermatozoa in the seminiferous lumen, and strengthens the necessity of genetic diagnosis of the embryos or fetuses in such pregnancies to fathers with non-mosaic Klinefelter's syndrome.

Adult↗
PubMed2000

Aspiration of simple pelvic cysts during pregnancy.

Traditional management of persistent ovarian cysts in pregnancy is explorative laparotomy at 16-20 weeks of gestation and resection of the tumor. Scheduling surgery to this time of pregnancy is accepted in order to prevent abortions that are common whenever surgery is done in the first trimester, without delaying treatment of ovarian tumors which harbor a malignant potential. In the following article we report of 10 cases where simple ovarian cysts diagnosed during pregnancy were successfully treated by sonographically guided cyst aspiration. This new approach is justified with no fear of missing a malignant ovarian tumor due to strict ultrasonic characteristics of benign cysts that include unilocular simple appearing cyst with no solid echogenic parts, septations or papillary structures. For 5 of the 10 women undergoing aspiration, this constituted the definitive treatment, while the remaining 5 were later operated. We conclude that aspiration of simple cysts during pregnancy is safe, may save surgical intervention and in some cases this will be the definitive treatment.

Adult↗
PubMed1999

Chorionic villus sampling in multiple pregnancies.

OBJECTIVE: To evaluate the accuracy and risk of chorionic villus sampling (CVS) for prenatal diagnosis in multiple pregnancies. METHOD: Twenty-eight chorionic villus samplings were carried out in a group of women with twin pregnancies. A transabdominal route was chosen in 24 samplings and the rest (four samplings) were carried out in a transcervical route. In the group of women with triple pregnancies, 14 tests were performed in a transabdominal route and one in a transcervical route. RESULTS: No sampling failure occurred. One laboratory failure occurred in a triplet pregnancy, and one abnormal karyotype (47,xy+18) was found in the group of 28 twin fetuses. The rest of the fetuses in this group had normal karyotypes. Of the five triplets, two chromosomal abnormalities were diagnosed: a mosaic 46,xy/47,xxy was found in both cases. One fetus was affected by fragile -x syndrome. Selective reduction of the affected fetuses was carried out. There was no spontaneous fetal loss. Fetuses which were found to have normal prenatal tests were also found to be normal when born. CONCLUSION: In this relatively small series of CVS in twins and triplets, the procedure has been proven to be safe and reliable for prenatal diagnosis.

Adult↗
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↗
PubMed1996

[Chorionic villus sampling in multiple pregnancies].

Prenatal genetic diagnosis is recommended in multiple pregnancies because of the increased prevalence of genetic abnormalities in such fetuses. It can be done early by chorionic villus sampling or later by amniocentesis. Several studies have demonstrated the efficacy and safety of chorionic villus sampling in multiple pregnancies. Our study describes the results of this method in a twin pregnancy and in 3 triplet pregnancies, which represent 3% of the chorionic villus samplings performed in our ultrasound unit during 1989-95. All genetically deformed fetuses in these pregnancies were identified by chorionic villus sampling and the method was not associated with fetal loss. Our results confirm the safety and efficacy of chorionic villus sampling as expressed in the world literature.

Chorionic Villi Sampling↗
PubMed1996

Sonographic evaluation of the uterus in postmenopausal women receiving tamoxifen: characterization of mid-uterine abnormalities.

BACKGROUND: Tamoxifen is known to exert agonist estrogenic effects on the uterus. Its use in postmenopausal women has also been associated with various endometrial and uterine abnormalities that can be detected by endovaginal sonography. OBJECTIVE: To study postmenopausal patients receiving tamoxifen who were referred for evaluation following the detection of abnormal uterine findings by endovaginal sonography. METHODS: Fifty-two women treated with tamoxifen for breast cancer who were found to have an abnormal uterine sonogram constituted the study population. Uterine sonograms were reviewed and clinical and sonographic data were correlated with the results of the histologic examinations. RESULTS: Forty-five women demonstrated a thickened mid-uterine structure. Of these, in thirty-nine patients (87%) either no tissue of scant fragments of normal endometrium were obtained on curettage, and six women (13%) had endometrial hyperplasia. Seven women had fluid loculation lined by thin endometrium. Their subsequent histologic examination was normal. The sonograms of the women who demonstrated an appearance of a thickened endometrium but no neoplasia, characteristically demonstrated hyperechogenic cystic area with no midline echo. CONCLUSIONS: Among 52 postmenopausal patients receiving tamoxifen presented with an abnormal uterine sonogram, 39 (75%) women were found to have a thick mid-uterine structure resembling a thickened endometrium without histologic evidence of neoplasia. This phenomenon can be characterized by typical sonographic features, and may be differentiated from other uterine abnormalities.

Adult↗
PubMed1996

Pathognomonic echo patterns of benign cystic teratomas of the ovary: classification, incidence and accuracy rate of sonographic diagnosis.

The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 115 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition.

Adolescent↗
PubMed1996

Sonographically guided aspiration: an alternative therapy for tubo-ovarian abscess.

Our objective was to evaluate the role of single-step ultrasound-guided aspiration in conjunction with intracavitary antibiotic instillation for the treatment of tubo-ovarian abscess. Ten women with the clinical and sonographic diagnosis of tubo-ovarian abscess, who failed to respond to systemic antibiotic therapy, were treated by ultrasound-guided aspiration of the abscess followed by intracavitary instillation of a combination of antibiotics. All ten women improved clinically and none required surgery. The mean time from aspiration to hospital discharge was 3.1 days with mean duration of hospitalization 7.8 days. No major complications were observed. The average time interval between aspiration of the lesion and resolution on sonographic follow-up was 9.5 weeks. In three cases, pelvic inflammatory disease recurred, but none needed surgical intervention. The average follow-up period of the patients was 12 months. One-step sonographically guided aspiration of tubo-ovarian abscess followed by intracavitary antibiotic instillation may serve as an easy and safe alternative therapy in patients in whom treatment with systemic antibiotics has failed.

Abscess↗
PubMed1996

Penetration of the bladder by a perforating intrauterine contraceptive device: a sonographic diagnosis.

We describe a case of penetration of the urinary bladder by an intrauterine contraceptive device with perforation of the uterine wall. This finding was discovered incidentally during an ultrasound examination for an earlier nonspecific mild abdominal pain of short duration. No abnormality had been noted on pelvic examination, during which the device's strings were found to protrude through the patient's cervix; a short laboratory workup including urinalysis, urine culture, blood count and blood sedimentation rate was also negative. The sonographic diagnosis was confirmed by cystoscopy. The device was retrieved transcervically. No complications were observed on follow-up. Bladder perforation by an intrauterine contraceptive device is very rare, and only a handful of such cases have been described. In all previous cases, the diagnosis followed a rather prominent clinical presentation, whereas, in this case, the patient complained of intermittent low abdominal pain of short duration. We therefore suggest that pelvic ultrasound examination be performed in every patient with unexplained low abdominal pain who is known to carry an intrauterine contraceptive device.

Adult↗
PubMed1996

Sonographically guided aspiration of ovarian cyst with simple appearance.

The objective of this study was to evaluate the role of sonographically guided aspiration of simple ovarian cysts. During the period from 1985 through 1992, 107 ultrasonographically guided punctures of apparently simple ovarian cysts were performed. The group included 76 premenopausal and 31 postmenopausal women who were followed for 1 to 6 years (mean, 2.7 years) after initial cyst puncture. In 42 cases, cyst aspiration constituted the definitive therapy. In 65 cases the cyst recurred and in this group, 38 women (with complete recurrence) were operated on whereas 27 women with a cyst less than 5 cm (incomplete recurrence) were allocated to a follow-up group. Overall, in 69 cases (65%) surgery was avoided. No major complications were encountered. In our experience, aspiration of simple ovarian cysts is a suitable alternative in the management of this problem. Close follow-up is necessary to detect recurrence and perform surgical intervention when indicated.

Adolescent↗
PubMed1995

Preoperative sonography in detecting small benign cystic teratomas.

Identification of small ovarian benign cystic teratomas (dermoid cysts) is difficult and sometimes impossible by clinical findings alone. They may be missed even on direct inspection during laparotomy or laparoscopy. There are several typical ovarian sonographic signs which are known to occur frequently in women with benign ovarian cystic teratomas. High-resolution sonography can identify the cysts based on their typical sonographic signs. Since these very small dermoid cysts are sometimes undetected by the naked eye during the operation, ultrasonography with particular attention to the signs is very important. We present three cases reports that illustrate the problem and stress the contribution of preoperative sonography in the diagnosis and treatment of such cases.

Abdominal Pain↗