Intractable postpartum bleeding due to placenta accreta: local vasopressin may save the uterus.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Z Appelman
Publications and source records attributed to Z Appelman.
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↗
The origin of ascites in prune belly syndrome--early sonographic evidence.
Explore the source record for details and available documents.
Adult↗
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↗
Fluorescent in-situ hybridization (FISH) as an aid to marker chromosome identification in prenatal diagnosis.
Five cases of supernumerary marker chromosomes were identified in prenatal diagnosis as derived from chromosomes 18, X, and Y. One unexpected finding was in a case where the PCR was positive for the SRY gene while fluorescence in situ hybridization was positive for two X centromeres. In another case with an X derived supernumerary marker the newborn was phenotypically normal. Two women with fetal mar(18) and mar(Xp) decided to terminate the pregnancy. The fifth pregnancy had a karyotype of 46,XX,-15,+der(15)t(Y:15)(q11,23;p13). A phenotypically normal girl was born at term.
Adult↗
The role of sonography in the detection of vaginal foreign bodies in young girls: the bladder indentation sign.
The cases of four young girls with vaginal foreign bodies, successfully diagnosed by ultrasound, are presented. The sonographic signs include varying echogenicity and acoustic shadowing, but always an indentation of the posterior bladder wall was clearly observed. Sonography should be considered as the first step in the evaluation of suspected vaginal foreign bodies in young girls.
Child↗
Prenatal diagnosis of twin zygosity by DNA 'fingerprint' analysis.
A twin pregnancy with one hydrocephalic fetus with oligohydramnios is presented. Sonographic evaluation could not exclude monochorionicity. Before considering selective feticide, blood samples from both fetuses were examined for DNA 'fingerprint' analysis. The different banding patterns of the blood samples established dizygosity. This procedure is suggested in cases where sonography fails to determine chorionicity.
Abortion, Therapeutic↗
The influence of midtrimester termination of pregnancy on subsequent fertility: four to five years follow-up.
A four to five years follow-up upon subsequent fertility was performed on 46 women who underwent a midtrimester termination of pregnancy. Thirty out of 31 (96.8%) women who wanted to conceive became pregnant. Of those, term delivery rate was 73.3%. Only one woman who desired to conceive could not become pregnant. Her infertility workup revealed bilateral occlusion of tubes. We conclude that termination of pregnancy in midtrimester possibly has little, if any, impact upon subsequent fertility.
Abortion, Induced↗
Ultrasound-directed diagnosis and treatment of pelvic hematoma after therapeutic abortion.
Explore the source record for details and available documents.
Abortion, Therapeutic↗
[Chorionic villi sampling: choice of transcervical or transabdominal routes preferable to use of transcervical route exclusively].
Between November 1985 and June 1990 we performed 400 first trimester chorionic villi samplings (CVS). In the first 107 cases only transcervical CVS was performed, regardless of placental location. Later, 163 transcervical and 130 transabdominal CVS were performed, depending on placental location. Anterior and fundal placentas were approached transabdominally and posterior placentas transcervically. Multiple pregnancies were excluded. Successful results were obtained in 394 out of 400 cases. There were 5 failures in the first set of cases and 1 in the second (p < 0.05). In 14 cases (3.5%) fetuses with normal karyotypes were spontaneously aborted, 5 of these in the first period (4.7%) and 9 (3.1%) in the second. The spontaneous abortions in the second period followed transabdominal CVS in 4 cases out of 130 (3.1%) and the transcervical route in 5 cases out of 163 (3.105%). The average attempts per case in the first period was 1.44 (SD 0.66) while in the second it was 1.17 (SD 0.44, p < 0.0001) for the transcervical route and 1.06 (SD 0.2, p < 0.002) for the transabdominal route. In our experience choosing between transabdominal and transcervical CVS according to placental location is preferable to the sole use of transcervical CVS in terms of lower failure rate and fewer attempts per case. Proficiency in both techniques is mandatory for optimal results.
Abdomen↗
Aspiration of ectopic pregnancy under guidance of vaginal ultrasonography.
This case report describes the treatment of tubal pregnancy by aspiration of the gestational sac content and injection of methotrexate by transvaginal sonographic guidance. The confirmation of the embryo aspiration as indicated by disappearance of the embryo with its heart beat and the resulting 46,XY karyotype, raises the question whether methotrexate injection is necessary.
Abortion, Therapeutic↗
Chorionic villus sampling and selective termination of a chromosomally abnormal fetus in a triplet pregnancy.
Transabdominal chorionic villus sampling (CVS) was performed on a patient with a triplet pregnancy. The karyotypes were as follows: 46,XX; 46,XY; and 46,XY/47,XXY. Selective termination was done on the affected fetus successfully by intrathoracic potassium chloride (KCl) injection. Amniocentesis which was performed at the same time confirmed the CVS results, showing the same mosaic findings. Following the procedure, the pregnancy proceeded uneventfully and two normal newborns were delivered at term.
Abortion, Therapeutic↗
Early pregnancy termination: an improved technique for 'menstrual regulation' with ultrasound assistance.
We performed aspiration of early pregnancy on 100 women requesting termination, using a low caliber angled catheter under sonographic guidance, without analgesia or anesthesia. The sonographic inclusion criteria for the study were: (1) mean gestational sac diameter less than 30 mm, or (2) crown rump length less than 10 mm when an embryo was visualized. The uterine content was successfully evacuated in all cases and none needed an additional curettage. Two women developed mild endometritis which responded to antibiotic therapy. This refinement of this 'menstrual regulation' technique seems to be safer when compared with the reported results of the original technique.
Abortion, Induced↗
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↗
The accuracy of the assessment of normal fetal intestinal echogenicity--electro-optical densitometry versus the ultrasonographer's eye.
Ten plates of normal fetal ultrasonography (at 16-20 weeks' gestation) showing fluid, liver, lung, bone and intestine were submitted to electro-optical transmission surface densitometry. A distinct echogenic gradient has been found and used as an 'internal standard' to evaluate intestinal echogenicity. Intestine had significantly different echogenic properties from bone, liver and fluid but similar to that of lung. Using this echogenicity scale for fetal bowel, observers were correct in 46%, overscored in 32.6% and underscored in 21.4%. These poor results may be due to the significant inconsistency in the interpretation of each plate compared to other plates (about 65%). Although the densitometry-derived grading scale seems valid at these gestational ages, interobserver variation is too large and precludes a simple ultrasonic diagnosis of the hyperechogenic fetal intestine. Densitometric evaluation may be indicated in suspected cases when fetal bowel seems to have increased echogenicity.
Amniotic Fluid↗
Trisomy 9 confined to the placenta: prenatal diagnosis and neonatal follow-up.
Chorionic villus sampling (CVS), performed on a woman in the 23rd menstrual week because of bilateral fetal hydronephrosis and suspected intrauterine growth retardation (IUGR), documented trisomy 9 in all cells examined. Chromosomes of amniocytes and fetal blood lymphocytes were normal. The ongoing pregnancy was monitored closely, and at 37 weeks, a phenotypic normal male infant was delivered. Multiple placental biopsies showed 47,XY,+9, while a repeat chromosome analysis of the infant and biopsies from the amniotic membrane were normal (46,XY). This case further emphasizes the association between placental aneuploidy and IUGR. To our knowledge, nonmosaic trisomy 9 in CVS confined to the chorionic villi and later confirmed in the placenta has not been reported previously.
Amnion↗
Curettage after midtrimester termination of pregnancy. Is it necessary?
We conducted a prospective study to assess the need for curettage after spontaneous expulsion of the placenta in midtrimester termination of pregnancy. The rate of early complications (9.4%) was consistent with previously reported data. A higher incidence of intrauterine adhesions, detected on hysteroscopy, was observed in patients who underwent curettage (38.5% vs. 7.7%, P = .0727). In order to prevent intrauterine adhesions, curettage should be restricted to cases in which retained products of conception are suspected. It should not be performed routinely in every case of midtrimester termination of pregnancy after spontaneous expulsion of the placenta.
Abortion, Spontaneous↗
Nifedipine in the treatment of severe preeclampsia.
We conducted a randomized clinical trial in which patients with severe preeclampsia between 26-36 weeks of gestation received either nifedipine (10-30 mg sublingually, then 40-120 mg/day orally; N = 24) or hydralazine (6.25-12.5 mg intravenously, then 80-120 mg/day orally; N = 25). Effective control of blood pressure was achieved with nifedipine in 95.8% of subjects and with hydralazine in 68%, a statistically significant difference (P less than .05). Maternal side effects were minor in both groups. Acute fetal distress developed in one nifedipine subject and in 11 treated with hydralazine. Mean prolongation of gestation was 15.5 +/- 10 days with nifedipine and 9.5 +/- 11 days with hydralazine, a difference that did not reach statistical significance (P less than .07). Infants born to women treated with nifedipine were delivered at more advanced gestational ages (34.6 +/- 2.3 versus 33.6 +/- 2.4 weeks; statistically not significant), weighed more (1826 +/- 456 versus 1580 +/- 499 g; statistically not significant), and tended to have fewer, mainly minor, complications. The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group (15.1 versus 32.7 days; P less than .005), leading to an average 31% reduction in total (maternal and neonatal) hospitalization-related charges for each nifedipine-treated pregnancy. We conclude that nifedipine is an effective, convenient, and low-cost treatment for patients with severe preeclampsia, and is not associated with undesirable side effects.
Adult↗