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Biomedical subjects

Z Ben-Rafael

Publications and source records attributed to Z Ben-Rafael.

At least 127 records · Page 7Linked to original sources
PubMed1996

A new procedure for removal of a "lost" intrauterine device.

OBJECTIVE: To evaluate the efficacy of removal of a "lost" intrauterine device (IUD) with the use of a cylindrical brush. METHODS: Women aged 25-43 years with so-called "lost" IUD, in whom the string was indiscernible, were enrolled in the study. During gynecologic examination, a cylindrical brush was rotated in the cervical canal until the device was extracted by a rotating motion. No antibiotics were used after removal of the IUD with the cylindrical brush. RESULTS: Twenty-seven women whose IUD could not be removed from the uterine cavity because of an indiscernible string were referred for a trial of IUD removal. All patients had used a plastic, copper-releasing IUD. Before admission, they had undergone an attempt at IUD removal by their physician using either a hook or clamp. In 24 patients who were referred to our center, the IUD was removed by using a cylindrical brush to view the string. The IUD was removed by hysteroscopy in three cases, in two of which no string was found. CONCLUSION: A cylindrical brush can be used safely as an adjunct to remove an IUD and is a simple method that may be performed before another invasive procedure is attempted.

Adult↗
PubMed1996

The residual ovary syndrome: a 20-year experience.

OBJECTIVE: To address the controversy of ovarian preservation during a hysterectomy for benign indications by using our experience with residual ovary syndrome (ROS). STUDY DESIGN: Over a period of 20 years, 2561 hysterectomies (during which one or both ovaries were preserved) were performed at the Golda Medical Center, Israel. A retrospective, quasi, case-control analysis was undertaken. RESULTS: The incidence of ROS was 2.85%. While chronic pelvic pain was the principle indication for subsequent reexploration in 52 patients (71.3%), an asymptomatic pelvic mass noted during routine follow-up examination accounted for 24.6% of operations for ROS. The majority (75.4%) of patients underwent surgery during the first 10 years, while the highest incidence occurred within the first 5 years (46.6%). Furthermore, histological examination revealed functional cysts, benign neoplasm and ovarian carcinoma in 50.7%, 42.6% and 12.3% of the cases, respectively (in nine patients more than one pathology was observed). CONCLUSIONS: Since ROS was found to occur in 1/35 women who had undergone previous hysterectomies mainly due to physiologic ovarian function and benign cyst formation, but not malignancy, we believe that routine oophorectomy is justified in premenopausal women over 45 years of age. However, the final decision to perform elective oophorectomy at the time of hysterectomy for benign disease should be established on an individual basis, taking into consideration age, individual and family risk factors, the patient's preference and ability to ensure long-term compliance to exogenous hormone replacement therapy.

Adult↗
PubMed1996

The impact of woman's age and sperm parameters on fertilization rates in IVF cycles.

OBJECTIVE: To examine the predictive value of different sperm parameters and the age of a couple on fertilization rate. MATERIAL AND METHODS: One-hundred six consecutive sperm samples were analysed before insemination of oocytes in IVF cycles. Sperm count and motility were examined with the Makler Counter Chamber. Morphology was evaluated by the eosin nigrosin and giemsa stains. Membrane integrity was evaluated by the hypoosmotic swelling test (HOST). RESULTS: Using a step-wise logistic regression test the following parameters were all significantly correlated with the fertilization rates: sperm concentration after a 3-h layering (chi 2 = 15.85, P < 0.001), sperm motility index (chi 2 = 6.12, P < 0.0134), woman's age (chi 2 = 6.25, P < 0.012), and the hypoosmotic test (chi 2 = 6.63, P < 0.01). A fertilization capacity formula was established by using these four parameters to predict the fertilization capacity of a couple. Significantly lower fertilization rates were detected in elderly women with the partner sperm concentration of 7 x 10(6)/ml after 3-h layering, < 30% swollen spermatozoa in the HOST and motility index score of < 50. CONCLUSIONS: By the aforementioned formula, sperm fertilization capacity can be predicted by using simple sperm parameters and women's age. Elderly women with partners who have suboptimal sperm parameters reflected by low fertilization capacity scores may benefit from micro-manipulation procedures.

Adult↗
PubMed1996

Uterine activity after betamethasone administration for the enhancement of fetal lung maturation.

OBJECTIVE: To assess the effect of steroids administered for the enhancement of fetal lung maturation on uterine activity. DESIGN: A retrospective analysis. SETTING: High-risk Pregnancy Unit, Golda Medical Center, Petah Tikvah, Israel. PATIENTS: Fifty-nine courses of betamethasone therapy prescribed for various indications other than premature contractions were studied in 29 pregnant women at 26-34 weeks' gestation. MEASUREMENTS: Uterine activity was monitored on the day of the first (but prior to) beta-methasone injection, then daily for the next 3 consecutive days. The number of uterine contractions during the first 30 min of each tocodynamometric tracing was assessed. RESULTS: The frequency of uterine activity after steroid administration is significantly higher in multiple pregnancies as compared to singletons, and significantly increases as the duration of pregnancy increases. However, labor was not induced and all women delivered at least 1 week after the last betamethasone injection. CONCLUSIONS: Since the increased uterine activity after administration of steroids for the enhancement of fetal lung maturation does not provoke labor, it is suggested that this increase in uterine activity seems to act as a temporary phenomenon. Therefore conservative management, rather than tocolysis, would seem appropriate.

Adult↗
PubMed1996

Nicked free beta-subunit of human chorionic gonadotropin: a potential new marker for Down syndrome screening.

OBJECTIVE: Our purpose was to investigate maternal serum levels of nicked free beta-subunit in normal and Down syndrome pregnancies. STUDY DESIGN: Serum specimens were obtained from 64 karyotypically normal and 6 Down syndrome pregnancies before amniocentesis. Two immunoenzymometric assays for the beta- subunit of human chorionic gonadotropin were used to determine the level of free beta-subunits with peptide linkage breaks ("nicks") between residues 43 to 48. RESULTS: The mean level of nicked free beta-subunit in Down syndrome was 4.76 multiples of the median, which was significantly elevated compared with normal controls (1.07 multiples of the median, p<0.05). In 5 of 6 cases levels were > or = 2 multiples of the median, with a range of 1.96 to 15.43 multiples of the median, which was 2- to 3-fold higher than the regular free beta-subunit assay (mean level 1.53 multiples of the median, range 0.70 to 3.10 multiples of the median). In one case no nicked free-beta subunits were detectable. CONCLUSION: Our preliminary data indicate that nicked free beta-subunit of human chorionic gonadotropin might be a sensitive marker for Down syndrome screening.

Biomarkers↗
PubMed1996

Doppler velocimetry of the uterine and fetal circulations during prostaglandin E2 cervical ripening.

The objective of the study was to investigate flow characteristics of the maternal uterine and fetal umbilical and middle cerebral arteries following intracervical administration of prostaglandin E2 (PGE2). Doppler velocimetry of uterine, umbilical and middle cerebral arteries was performed immediately before and 2 h after PGE2 administration in 28 women with uncomplicated post-term pregnancy and an unfavorable cervix. Placental position was determined in all cases. When all patients were considered jointly, regardless of placental position, the mean uterine artery resistance index (RI) values were 0.41 +/- 0.07 before and 0.48 +/- 0.13 2 h after PGE2 administration (p < 0.05). When patients with lateral placentas (n = 20) were analyzed separately, only the non-placental uterine artery showed a significant increase 2 h after PGE2 administration, whereas no significant differences were found in the placental uterine artery. No changes were observed in uterine RI values of patients with central placentas. No significant differences were observed for umbilical artery and middle cerebral artery before and after PGE2 administration. It is concluded that intracervical PGE2 administration increases uteroplacental resistance but probably does not substantially affect placental perfusion; that the umbilical circulation is not affected; and that there were no signs of redistribution of fetal blood flow.

Adult↗
PubMed1996

Cumulative pregnancy rate following in-vitro fertilization: the significance of age and infertility aetiology.

During the years 1984-1992, 951 couples completed 2252 in-vitro fertilization (IVF) treatment cycles at the In-Vitro Fertilization Unit of The Chaim Sheba Medical Centre. This study was conducted to evaluate the success of IVF using the cumulative pregnancy rate (CPR), with special emphasis on the optimal number of treatment cycles, the age of the patients and female infertility factors. It was found that the CPR showed a constant rise during the six initial IVF treatments (56% CPR), and plateaued in the subsequent three cycles (63% CPR). Various female infertility factors did not influence this rate. Women > or = 40 years of age have a significantly lower CPR. Thus, it was concluded that the CPR in IVF declined after the sixth initial treatment cycle, and in women > or = 40 years of age. The infertility factor did not significantly influence CPR.

Adult↗
PubMed1996

Hyaluronan, CD44 and its variant exons in human trophoblast invasion and placental angiogenesis.

Both hyaluronan and one of its receptors, CD44, can be demonstrated in the early human conceptus and in placental stroma. The variants of CD44 resulting from variable exon splicing are found in metastasizing human malignancies and are also involved in hyaluronan uptake and degradation. The resulting hyaluronan fragments are known to be highly angiogenic. We postulated that the self-limited process of trophoblast invasion of the uterine decidua results in part from the strategy of alternative splicing of CD44, similar to that used by invasive cancer cells in the course of metastatic spread and possibly angiogenesis. Monoclonal antibodies specific for CD44s and for an exon expressed during metastatic tumour progression, CD44v7, were used to examine this hypothesis. In this study we found human trophoblasts, for the first time, to express CD44. Intermediate trophoblasts of first and second trimester exhibited the standard form of CD44 while extravillous trophoblasts, which are responsible for the invading characteristics of the placenta, were positive for the alternatively spliced form, the CD44v7-8. Moreover, in the case of placenta accreta there was a prominent membrane staining of the trophoblasts that were embedded in the fibrin layer over the myometrium. The highly metastatic choriocarcinoma cells also expressed CD44v7-8. We propose, therefore, that the invading trophoblasts utilize the alternatively splicing machinery. These cells retain their invasive capabilities through the permissive ECM by carrying the CD44v7-8 isoform, which binds weakly to hyaluronan and thus prevents it from being degraded by intracellular hyaluronidase.

Alternative Splicing↗
PubMed1996

Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome.

In order to determine which factors influence the large variations in sensitivity to gonadotrophins witnessed in women with polycystic ovary syndrome (PCOS), a prospective study was conducted of the correlation between basal clinical and endocrinological features and gonadotrophin requirements of 20 women with clomiphene-resistant PCOS undergoing ovulation induction. Baseline evaluation of serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, fasting insulin, insulin-like growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP-1) and sex hormone-binding globulin (SHBG) were performed before administering gonadotrophin-releasing hormone agonist (GnRHa). Two weeks later, human menopausal gonadotrophin (HMG) was given in a standard individualized protocol according to ovarian response, until human chorionic gonadotrophin (HCG) was given. Serum concentrations of insulin, IGF-1, and IGFBP-1 were unaffected by GnRHa. The BMI correlated positively with insulin and inversely with IGFBP-1 serum concentrations and insulin and IGFBP-1 were inversely correlated. The amount of HMG required correlated positively with BMI and insulin concentrations and inversely with IGFBP-1 in the whole group and these correlations were maintained in the sub-group of lean women. No correlation was observed between HMG requirements and IGF-1 or other hormones. Women with hyperinsulinaemia and low IGFBP-1 concentrations required significantly more HMG. Multiple regression analysis revealed that insulin concentration is the most significant determinant of HMG requirement even when dissociated from BMI. We concluded that requirements of HMG in PCOS is not merely determined by obesity but by a cardinal role of insulin concentrations which, when high, induce, hypothetically, a hyperandrogenic intrafollicular milieu.

Adult↗
PubMed1996

The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilization abortions.

The study was conducted on 144 women who experienced preclinical abortions, i.e. a transitory rise in beta-human chorionic gonadotrophin (HCG) without any clinical or sonographic evidence of pregnancy, to identify the relationship between preclinical abortions and intrauterine pathology. Hysteroscopy was performed 1-2 weeks after the decline of beta-HCG concentrations to negative values. Intrauterine adhesions were detected in three patients (2.1%), most of these being of the mild type. Concomitant intrauterine abnormalities, mainly uterine septa, were found in 14 (9.7%) cases. We believe that preclinical abortions do not predispose intrauterine adhesions and curettage is superfluous. An incomplete uterine septum seems to be the major factor predisposing this early pregnancy wastage. Hysteroscopy following this condition is an easy and efficient means for both identifying intrauterine pathology and excluding adhesions.

Abortion, Spontaneous↗
PubMed1996

Severe ovarian hyperstimulation syndrome despite low plasma oestrogen concentrations in a hypogonadotrophic, hypogonadal patient.

Ovarian hyperstimulation syndrome (OHSS) is the most serious, life-threatening, iatrogenic complication of ovulation induction. The importance of excessive oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration as a predictor and factor in the pathophysiology of OHSS has been extensively studied and discussed. We present the case report of a woman with hypogonadotrophic hypogonadism who developed severe OHSS during ovulation induction with urinary human follicle stimulating hormone (FSH) and HCG in the presence of low circulating oestradiol concentrations. The implication of FSH treatment and complications in hypogonadotrophic hypogonadal patients, and the role of preovulatory oestradiol concentrations in the prediction of OHSS, are discussed.

Adult↗
PubMed1996

Mixed maternal-paternal lymphocyte cultures before and after immunotherapy for recurrent spontaneous abortions.

PROBLEM: The increased reactivity of maternal lymphocytes in reciprocal mixed-maternal-paternal lymphocyte cultures (MMPLC), observed in the presence of control serum after immunotherapy, suggests that immunization with paternal lymphocytes may induce a highly significant cell mediated immune response in specifically alloactivated maternal lymphocytes. METHOD: Reciprocal one-way MMPLC were set up with responding maternal or paternal lymphocytes and mitomycin C-treated stimulating lymphocytes. Cultures were set up for 6 days in the presence of 15% maternal or control serum. The degree of lymphocyte stimulation was measured by tritiated thymidine uptake. RESULTS: In maternal serum, after immunotherapy, a highly significant blocking effect on MMPLC was observed in both directions. The extent of the blocking effect in maternal serum and the stimulation in control serum was much higher, after immunotherapy, in two cases of abortions, as compared to cases with normal pregnancy outcome. CONCLUSIONS: Although the number of cases is very small, it may be that in abortions, in the presence of maternal serum, disturbances in the balance of cytokines or/and specific antibodies could have cytotoxic effects on MMPLC and down regulate, or "block" the specific response. For a possibly better utilization of the MMPLC test in the prediction of pregnancy outcome after immunotherapy, it may be important to examine specific antibodies in maternal serum, to investigate specifically induced cytokines in MMPLC and to evaluate T cell subsets in MMPLC in the presence of maternal and control serum.

Abortion, Habitual↗
PubMed1996

A delayed starting schedule of oral contraception: the effect on the incidence of breakthrough bleeding and compliance in women.

OBJECTIVES: To assess the effect of oral contraception started on the first day of menses and the fifth day following its onset, on women's compliance and the incidence of early breakthrough bleeding. METHODS: Oral contraceptives (OCs) containing 30 micrograms ethinylestradiol and 75 micrograms gestodene were prescribed to 100 consecutive, healthy women for whom OCs were found to be the most suitable method of contraception. In the first 50 women, OCs were started on the first day of menses (day 1 group), while in the remaining 50 women, OCs were started on the fifth day after the onset of menses (day 5 group). RESULTS: The day 5 group had better compliance and a reduced incidence of breakthrough bleeding. No differences were observed between the two groups regarding age, parity and gravity. CONCLUSION: Starting an OC regimen should include initiation on the fifth day following the onset of menses. This regimen might increase patient compliance and lower the incidence of breakthrough bleeding.

Adolescent↗
PubMed1996

The immune system in severe ovarian hyperstimulation syndrome.

Recently, evidence has accumulated concerning the interaction between the immune and reproductive systems that results from sharing certain lymphohematopoietic cytokines and their receptors. Furthermore, several cytokines have been implicated as having a role in the prediction and pathophysiology of ovarian hyperstimulation syndrome (OHSS). The hitherto known studies concerning the role of the immune system in OHSS, together with a hypothesis regarding the role of interleukin-2 as a possible culprit of this complication, are presented.

Cytokines↗