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Biomedical subjects

Z Ben-Rafael

Publications and source records attributed to Z Ben-Rafael.

At least 199 records · Page 11Linked to original sources
PubMed1991

Intravenous immunoglobulin treatment for recurrent abortions caused by antiphospholipid antibodies.

There is an association between the presence of antibodies that bind to anionic phospholipids and the occurrence of repeated spontaneous abortion. Many uncontrolled studies have reported favorable pregnancy outcome in women treated with steroids, low-dose aspirin, heparin, or their combination. Similarly, treatment failures have been reported with most of these therapeutic regimens. Immunoglobulins play a central role in immune regulation. A wide spectrum of human diseases are associated with decreased or abnormal regulation of Ig levels. Recently, IV preparations of Ig have become available for clinical use, including treatment of patients with recurrent abortions and high levels of antiphospholipid antibodies. The effectiveness of this new mode of therapy can be related to several immunological mechanisms such as blockade of antibody binding to receptors on macrophages, increase in T suppressor cells, or decrease in antibody synthesis. The latter effect may be mediated by anti-idiotypic antibodies in the Ig preparation. Determination of dosage of IV Ig, duration of treatment, and treatment intervals are all empirical in patients with recurrent abortions and high levels of antiphospholipid antibodies because antiphospholipid antibody levels are not useful for monitoring therapy. Although the data available at present are promising, additional randomized trials are needed to determine the efficacy of IV Ig in patients with immunological recurrent abortions.

Abortion, Habitual↗
PubMed1991

Aging of endometrium and oocytes: observations on conception and abortion rates in an egg donation model.

OBJECTIVE: To assess the comparative contribution of endometrial and oocytic aging to the decline in fertility with age. DESIGN: Retrospective analysis of conception and abortion rates in an egg donation program, with respect to donor and recipient ages. PATIENTS: All oocyte recipients had ovarian failure. Donors were women undergoing in vitro fertilization who contributed up to a third of retrieved oocytes. INTERVENTIONS: None. RESULTS: Thirty pregnancies (28 intrauterine) were recorded in 169 reception cycles originating from 91 donation cycles. Women who conceived were younger than those who did not (median age 31 versus 37; P less than 0.046), with no difference in age of donors. There was a significant difference in spontaneous abortion rate by age of donor rather than by age of recipient. Donors to successful pregnancies were younger than donors to aborted pregnancies (median age 27.5 versus 33; P less than 0.0211), but the 11 women with aborted pregnancies did not differ in age from the 17 women with successful pregnancies. CONCLUSIONS: In women, endometrial function as expressed by conception rate in the recipients declines with age, whereas it is oocyte age that primarily influences risk of abortion.

Abortion, Spontaneous↗
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

Renal and ocular manifestations of hypertensive diseases of pregnancy.

Hypertensive diseases of pregnancy are commonly manifested in renal and ocular changes. Proper evaluation of findings provided by urine analysis, renal biopsy and examination of the optic fundi, visual acuity, and visual fields may help in assessing the severity of the disease and the need for obstetric intervention. Furthermore, renal and ocular changes are important guides in the differential diagnosis of hypertensive disorders of pregnancy. Renal and ocular lesions have also been found to have important prognostic implications. Review of the current knowledge on renal and ocular pathophysiologic changes induced by hypertension in pregnancy, may in addition shade light on the obscure etiology of this common entity.

Eye Diseases↗
PubMed1991

Meteorological factors in hypertensive disorders, vaginal bleeding and premature rupture of membranes during pregnancy.

In order to determine whether there is a correlation between meteorological factors and the occurrence of hypertensive disorders, vaginal bleeding during pregnancy and premature rupture of the fetal membranes, we stratified all the patients hospitalized with such complications between the years 1984 and 1988 by the months of occurrence, weather, humidity and heat. During this period, there were 276 women hospitalized with exacerbation of hypertension and toxemia, 349 because of vaginal bleeding during pregnancy and 35 women following premature rupture of the fetal membrane between 30 and 33 weeks of gestation. The occurrence of pre-eclampsia and exacerbation of pregnancy-induced hypertension was significantly increased in the winter months (p less than 0.001).

Female↗
PubMed1991

Oxytocin or saline injected intra-umbilically did not influence the third stage of labor.

The injection of varying volumes of normal saline solution, alone or with oxytocin, into the umbilical vein immediately after delivery was studied in 125 normal women delivered at term. Thirty seconds after cord clamping, either 20 ml (group 1, n = 25 women), 30 ml (group 2, n = 25) or 40 ml (group 3, n = 25) of normal saline solution alone, or oxytocin 10 units in 20 ml saline solution (group 4, n = 25) or oxytocin 10 units in 40 ml saline solution (group 5, n = 25) were injected into the umbilical vein 1 cm from the introitus just proximal to the umbilical clamp. The mean (+/- SD) duration of placental expulsion was similar in the five study groups. We conclude that neither the volume of the solution nor the oxytocin injected intra-umbilically has any effect on the duration of the third stage of normal labor.

Adult↗
PubMed1991

Endocrine and biological factors influencing implantation of human embryos following cryopreservation.

Several parameters affecting survival and implantation of frozen-thawed embryos were studied. Of 386 embryos frozen in dimethylsulfoxide (DMSO) or in 1,2 propanediol (PROH), the survival rate was 63.5% (245/386). Three different methods of cycle preparation were compared prior to thawed embryo replacement. The pregnancy rate was 16.1% (9/56) in spontaneous cycles; 11.4% (5/44) in an ovarian stimulation protocol; and 9.5% (4/42) with estrogen and progesterone substitutional therapy (p = NS). There was no difference in the estradiol/progesterone ratio among the three different protocols during the early luteal phase of the cycle, which may indicate that implantation of thawed embryos could be related to their developmental potential rather than to the endometrial environment. In the spontaneous cycles, when endometrium was synchronized or advanced to embryonic stage up to 32h, implantation rate was 29.2%.

Adult↗
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

The role of cervical cerclage in the management of uterine anomalies.

The effect of cervical cerclage on the survival rate of the fetus was studied in 86 pregnancies of women with congenital uterine anomalies and a random group of 106 pregnancies in women with normal shaped uteri. The uterine morphologic factors were determined in all by hysterosalpingography, and when necessary, hysteroscopy and laparoscopy were combined. The incidence of hysterosalpingography-proved cervical incompetence (23 per cent) was similar in both groups. Sixty-seven and 29 pregnancies were managed with cervical cerclage in each group, respectively. The fetal outcome was stratified by cervical incompetence and obstetric history. The percentage of viable newborns was significantly higher in women with malformed uteri who underwent cerclage (88 per cent) compared with those without cerclage (47 per cent). No statistically significant beneficial effect of cerclage was found for normal uteri, even when only those with a history of recurrent fetal loss were considered.

Female↗
PubMed1991

Uterine anomalies. A retrospective, matched-control study.

The obstetric risk associated with congenital uterine malformations was studied in a group of 67 women who had undergone hysterosalpingography (HSG) during an eight-year period. HSG was performed to investigate primary (21% of the cases) and secondary (19%) infertility (group 1) or recurrent early fetal loss (60%) (group 2). The study group was compared with a random control group of 130 patients with HSG-proven normal uteri, matched for the presenting symptom. Prematurity and intrauterine fetal death were found to be significantly more common (P less than .05) for women in group 1 with uterine anomalies. The mean birth weight for preterm infants (less than 37 weeks) was significantly lower (P less than .01) for women with malformed uteri. The incidence of antepartum bleeding during pregnancy (P less than .01), breech presentation and cesarean section (P less than .001) was significantly higher for the study group. Premature rupture of the membranes was diagnosed more frequently (P less than .05) only in group 1. Patients with congenital uterine anomalies are a high-risk obstetric group. Primary infertility may be a more common presenting complaint in women with uterine anomalies than previously recognized.

Abortion, Habitual↗
PubMed1990

Pregnancy potential of human oocytes--the effect of cryopreservation.

BACKGROUND: In vitro fertilization, sometimes involving the cryopreservation of human embryos, has become a routine procedure for the treatment of infertility. Even though there are embryos available for transfer in about 85 percent of the treatment cycles, the rate of pregnancy rarely exceeds 25 percent per cycle. We designed this study to investigate two questions: Does this high rate of failure result from inadequate technique, or does it simply reflect the maximal potential of a cohort of aspirated eggs to produce a pregnancy? And to what extent does cryopreservation affect the capacity for implantation of embryos? METHODS: The study was conducted among patients enrolled in an egg-donation program. Aspirated eggs from a given cohort were distributed to the donor herself and a few recipients. The recipients were prepared by a standard protocol of hormone replacement and were assigned at random to the transfer of either fresh or frozen and thawed embryos. The donors received only fresh embryos. RESULTS: Forty cycles of donation were studied. In 25 cycles (63 percent) pregnancy was established in the donor, in the recipient (or recipients), or in both. Of the fresh embryos that were transferred to the recipients, 24 percent were successfully implanted, as compared with only 7.7 percent of the frozen and thawed embryos (P less than 0.01). A pregnancy success rate of 37 percent per recipient cycle was observed in the recipients of fresh embryos, as compared with a rate of only 16 percent in those receiving frozen and thawed embryos (P less than 0.05). CONCLUSIONS: The majority of egg cohorts evidently possess the potential to produce a pregnancy, but cryopreservation of human embryos significantly reduces their capacity for implantation.

Adult↗
PubMed1990

Transvaginal sonographic measurement of fetal kidneys in the first trimester of pregnancy.

Fetal renal size late in the first trimester of pregnancy was evaluated by transvaginal ultrasonography in 50 patients not at risk for congenital kidney disease and whose pregnancies resulted in a normal outcome. Both kidneys were reliably identified in all patients scanned at 12 weeks, 13 weeks, and 14 weeks, menstrual age. Kidney diameter measurements obtained in this study are presented for reference in evaluating patients in late first trimester whose fetuses are at risk for kidney abnormalities.

Adolescent↗
PubMed1990

Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy.

A series of 201 cycles of ovarian hyperstimulation syndrome (OHSS) in 154 women were reviewed. Pregnancy occurred in 75 of 201 cycles. Twelve pregnant women (16%) presented with torsion of hyperstimulated ovary, but only 3 out of 126 patients (2.3%) who did not conceive had torsion. Because diagnosis of adnexal torsion is usually uncertain and surgical intervention is likely to be delayed, these infertile women risk losing their ovaries. The clinical picture of torsion of adnexa in patients with OHSS is presented here. The combination of ovarian enlargement, abdominal pain, nausea, progressive leukocytosis, and anemias might indicate torsion of adnexa. Although during operation the adnexa appears dark, hemorrhagic and ischemic, we suggest that it can be saved by simply unwinding it. In 11 such cases intraoperative unwinding of the adnexa was performed, and in 8 patients it was the only operative procedure. No postoperative complications were noted and in all the cases the ovaries were proven functional by ultrasonography. We concluded that torsion of hyperstimulated adnexa in patients who conceived after gonadotropin therapy, is a special entity that requires more attention to achieve early diagnosis. Nevertheless even with delayed diagnosis, the ovary can still be saved.

Adnexal Diseases↗
PubMed1990

Laparoscopic unwinding of twisted ischemic hemorrhagic adnexum after in vitro fertilization.

We present a case where, for the first time, unwinding of ischemic hemorrhagic adnexum was performed successfully through the laparoscope without the need to operate. Aspiration of ovarian fluid before detorsion facilitates the procedure; follow-up showed spontaneous follicular growth. We conclude that laparoscopic detorsion of ischemic adnexum is feasible. Apparently, oocytes are not damaged by the torsion and the ovary resumes normal function. This procedure should be considered in women during the reproductive age and in every case where malignancy can be ruled out.

Adnexal Diseases↗
PubMed1990

Follicular and luteal cysts after treatment with gonadotropin-releasing hormone analog for in vitro fertilization.

Ovarian cysts are a common complication of GnRH-a administration. We followed 98 patients who were suppressed with GnRH-a before ovarian stimulation with hMG for IVF treatment. Approximately 20% of the patients receiving GnRH-a during the follicular or luteal phase had developed ovarian cysts. However, the number of cysts per patient was significantly higher in the follicular phase compared with luteal phase. Systematic aspiration of those cysts under local anesthesia permitted the start of ovarian stimulation with hMG as scheduled on day 16 after GnRH-a administration. Follicular fluid content of the cysts revealed similar levels of steroids to those in normal follicles. These cysts contained few cells and no egg. In vitro fertilization treatment was more successful in patients whose cysts were aspirated during the luteal phase than in those with cysts during the follicular phase. We concluded that luteal phase cysts are more benign than follicular phase cysts, and it is possible that they represent an enlargement of pre-existing corpora lutea.

Adult↗