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Biomedical subjects

Z Weiner

Publications and source records attributed to Z Weiner.

47 records · Page 3Linked to original sources
PubMed1993

Uterine artery flow velocity waveforms and color flow imaging in women with perimenopausal and postmenopausal bleeding. Correlation to endometrial histopathology.

We performed Doppler studies of the uterine artery in 85 women with postmenopausal and perimenopausal bleeding. Sixty-six women had non-malignant changes and 19 women had malignant changes on histologic examination of the endometrium. Uterine fibroids were detected in 30 women. When malignant changes were detected in the endometrium, uterine artery resistance index was always below 0.83. The mean uterine artery resistance index was significantly lower in the group of women with pathologic changes of the endometrium (RI = 0.77 +/- 0.03) compared to the group with non pathologic changes (RI = 0.85 +/- 0.08 p < 0.01), excluding the women with uterine fibroids. The lowest mean resistance index in the uterine artery was observed in the group of women with uterine fibroids (RI = 0.60 +/- 0.09 p < 0.001). In five of six patients with endometrial carcinoma blood vessels were detected around the myometrium by using color flow imaging. Their RI was always less than 0.5. In five patients, blood vessels were detected in uterine fibroids but their RI was always more than 0.5. All six women with endometrial carcinoma but only seven of 13 women with endometrial hyperplasia, had endometrial thickness greater than 5 mm. Doppler velocimetry of the uterine artery carries a high sensitivity (100%) in detecting pathological changes of the endometrium in patients presenting with postmenopausal or perimenopausal bleeding. The presence of high resistance in this vessel, may allow a more conservative approach in this group of patients.

Aged↗
PubMed1993

Screening for ovarian cancer in women with breast cancer with transvaginal sonography and color flow imaging.

The aim of the present study was to determine the efficacy of transvaginal color flow imaging as a screening tool for ovarian cancer. Six hundred patients with previous breast carcinoma were screened for ovarian cancer. Screening was performed using transvaginal sonography with color flow imaging. Serum CA 125 levels were measured in patients with abnormal sonographic findings. Eighty-three percent of the ovaries were detected in the premenopausal patients by ultrasonographic scanning and only 26% of the ovaries were detected in the postmenopausal patients. Intraovarian blood vessels were detected in 11% of the premenopausal women. The PI was less than 1 in 80% of these ovaries, but, on repeated examinations, the values of PI increased in all the blood vessels to greater than 1. Intraovarian blood vessels were detected in 1.8% of the normal ovaries observed in the postmenopausal women, but PI was always greater than 1. Eleven women with complex ovarian cysts (not simple) and one woman with enlarged ovaries underwent explorative laparotomy. In three women, primary malignant ovarian tumors were diagnosed and in one woman metastatic ovarian cancer was diagnosed. The specificity of sonography in detecting malignant ovarian tumors was 97.5% and the positive predictive value was 25%. The specificity of color flow imaging in detecting primary malignant ovarian tumors was 99.8% and the positive predictive value was 60%. In selected groups of women, screening for ovarian cancer with transvaginal color flow imaging may be justified.

Adult↗
PubMed1992

Pulmonary complications of antepartum pyelonephritis: more alertness is needed.

Three cases of pulmonary complications associated with antepartum pyelonephritis are presented, in two of them tracheal intubation and mechanical ventilation were required. All three cases were related to recurrent urinary infections with failure of first line antimicrobial therapy and a concomitant usage of tocolytic therapy. The possible etiology, risk factors and clinical approach, aimed to prevent pulmonary complications in antepartum pyelonephritis are discussed.

Adult↗
PubMed1992

Renal artery flow velocity waveforms in normal and hypertensive pregnant women.

Pregnancy is associated with marked changes in renal functions. Hypertensive disorders in pregnancy are frequently accompanied by deteriorated renal functions and by pathological lesions in the glomeruli. Using a pulsed Doppler ultrasound, we measured the resistance to flow in the renal artery in normal and hypertensive pregnant patients. We performed 176 pulsed Doppler ultrasound measurements of the renal arteries at various stages of gestation in 60 low risk pregnant patients. Another 111 Doppler measurements of the same vessels were obtained from 80 hypertensive pregnant patients throughout the third trimester. Twenty-six patients had preeclampsia, 35 patients had pregnancy-induced hypertension, and 19 patients had chronic hypertension. The resistance to flow in the renal arteries (expressed by the resistance index, RI) did not change significantly during pregnancy. The renal artery RI was not significantly different between the hypertensive group (RI = 0.61 +/- 0.06) and the low risk group (RI = 0.605 +/- 0.04). The RI values were also similar in all hypertensive patient categories: preeclampsia (RI = 0.62 +/- 0.07), pregnancy-induced hypertension (RI = 0.60 +/- 0.06), and chronic hypertension (RI = 0.61 +/- 0.05). The renal artery RI did not correlate with the severity of the hypertensive disease or with the status of renal functions. The outcome of pregnancy was worse in patients with abnormally elevated resistance index in the renal arteries. Patients with abnormally elevated resistance to flow in the uterine arteries also had a significant increase in the resistance index in the renal vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1992

Prenatal diagnosis of dilated cava septi pellucidi et vergae: associated anomalies, differential diagnosis, and pregnancy outcome.

OBJECTIVE: To study the significance of dilated cava septi pellucidi et vergae diagnosed prenatally using ultrasonography. METHODS: Sonographic examinations were performed on 11,200 pregnant women. Transabdominal sonographic examinations were done at 24 weeks or later on 3150 pregnant women and transvaginal sonographic examinations were done between 13-17 weeks on 8050 pregnant women. RESULTS: Eight cases of enlarged cava septi pellucidi et vergae were diagnosed prenatally during the second trimester of pregnancy by transvaginal sonography. In only one fetus did dilatation of cava septi pellucidi et vergae disappear during the third trimester. Associated anomalies, three of which were hydrocephalus, were observed in five fetuses. One fetus had chromosomal translocation 11/22 and one was growth-retarded. Pregnancy was terminated in four cases because of associated fetal anomalies or abnormal chromosomal analysis. One of four neonates died of unexplained metabolic acidosis. One neonate demonstrated cava septi pellucidi et vergae communication with the third ventricle and another had mild hydrocephalus on sonographic examination after birth. The three surviving fetuses had normal development during the first months of life. CONCLUSIONS: When dilated cava septi pellucidi et vergae are diagnosed prenatally, attention should be paid to the possible presence of associated fetal malformations. When a cyst of cava septi pellucidi et vergae is the only abnormal finding observed, termination of pregnancy is not justified.

Congenital Abnormalities↗
PubMed1992

Systolic or diastolic notch in uterine artery blood flow velocity waveforms in hypertensive pregnant patients: relationship to outcome.

To identify the relationship between a systolic or diastolic notch in uterine artery flow velocity waveforms and pregnancy outcome, we studied 140 hypertensive pregnant women with transvaginal, image-directed pulsed Doppler ultrasound. The subjects were classified according to the presence or absence of a systolic or diastolic notch. In 14 with a systolic and 25 with a diastolic notch, the resistance indexes in the uterine arteries on both sides of the uterus were significantly higher than in 101 subjects without a notch. Those with notches had significantly higher rates of fetal growth retardation and cesarean delivery because of fetal distress. Significantly more infants born to women with a notch spent longer than 48 hours in the neonatal intensive care unit. Subjects with a systolic notch also had significantly higher rates of abnormal fetal heart rate patterns during labor and low Apgar scores at 5 minutes. Fifty-one women with elevated resistances indexes in both uterine arteries were divided into two groups according to the resistance index in the umbilical artery. Each group was subdivided according to the presence or absence of a systolic or diastolic notch in the uterine artery flow velocity waveforms. In the group with a normal resistance index in the umbilical artery, five women had growth-retarded fetuses when a notch was present (N = 8), compared with none in women without a notch (N = 11) (P less than .005). The respective figures for the group with abnormal umbilical artery resistance indexes were 14 of 19 (73.7%) and two of 13 (15.4%) (P less than .002).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1992

Differentiating malignant from benign ovarian tumors with transvaginal color flow imaging.

The impedance to blood flow was examined by transvaginal color flow imaging in 53 ovarian masses before exploratory laparotomy. Serum CA 125 levels were measured in all subjects. Thirty-six had benign ovarian tumors and 17 had malignant ovarian tumors confirmed by histopathologic examination. Intratumoral blood vessels, detected in 16 of the malignant tumors, consistently demonstrated low impedance to flow, with a pulsatility index (PI) always below 1. The PI of the intraovarian or intratumoral blood vessels was greater than 1 in 35 of the 36 benign tumors, although 11 had suspicious sonographic findings (P less than .01) and 14 had elevated CA 125 levels (P less than .001). The sensitivity and specificity of the preoperative PI in detecting malignant ovarian tumors were 94 and 97%, respectively. The sensitivity and specificity of preoperative suspicious sonographic findings in detecting malignant ovarian tumors were 94 and 69%, and those of elevated preoperative serum CA 125 levels were 82 and 61%, respectively. Our results suggest that transvaginal color flow imaging may be a useful clinical tool in the preoperative evaluation of ovarian masses.

Adult↗
PubMed1991

Anticardiolipin antibodies in patients with recurrent pregnancy wastage: treatment and uterine blood flow.

The interest in autoimmune pregnancy loss has increased recently with the discovery of the association between the presence of antibodies to phospholipids and cardiolipin and habitual abortion. To evaluate the prevalence of anticardiolipin antibodies in patients with recurrent fetal loss and the effect of low-dose aspirin and corticosteroid treatment, we examined 67 women for anticardiolipin antibodies with an enzyme-linked immunosorbent assay. Increased levels of anticardiolipin antibodies were found in 34 of these women (50.7%) and in none of 12 normal pregnant controls. Seventeen of these 34 patients conceived and were treated with aspirin, 100 mg/day, and fluocortolone, 10 mg/day. Twelve gravidas reached term, all delivering live infants with good Apgar scores and normal birth weights. Three others delivered prematurely, two of them because of premature rupture of membranes and the other because of severe fetal growth retardation. This latter woman delivered at 31 weeks, and the 1000-g infant died neonatally. The neonatal survival rate was 82% in the treated patients, versus 18% in the same group of subjects in their previous, untreated gestations. The umbilical artery resistance index of the treated subjects was not different from that of anticardiolipin-negative hypertensive women who did not receive aspirin and corticosteroid therapy. However, the uterine artery resistance index was significantly lower in the hypertensive treated group than in the untreated group. Whether this difference reflected a beneficial effect of low-dose aspirin and corticosteroid therapy on pregnancy outcome and survival rate remains to be evaluated.

Abortion, Habitual↗
PubMedDate not supplied

Umbilical and uterine artery flow velocity waveforms in pregnant women with systemic lupus erythematosus treated with aspirin and glucocorticosteroids.

Pregnancy in systemic lupus erythematosus (SLE) is at high risk to the mother and fetus. Impaired utero-placental perfusion may increase fetal loss and intrauterine growth retardation. We assessed the changes in impedance to blood flow in the umbilical and uterine arteries in five patients with SLE treated with low dose aspirin and corticosteroids, using Doppler ultrasound longitudinally throughout pregnancy. Blood flow velocity waveforms of the umbilical and uterine arteries were studied by transabdominal and transvaginal Doppler ultrasound, respectively. Resistance index (RI) was measured every two to four weeks from week 10 to term, and the values obtained were compared to those of normal pregnancies. All five patients delivered uneventfully. One neonate was delivered at 36 weeks (2550 g) and one neonate was growth retarded (1900 g at 38 weeks). Three women delivered at 39 weeks (3585 g, 2850 g, and 2800 g). Most umbilical artery RI values obtained throughout pregnancy were above the 95th percentile of normal pregnancies. The highest values of RI of the umbilical artery were assessed in the case of fetal growth retardation. However, most measurements of RI of the uterine artery were under the 95th percentile of normal. The improved pregnancy outcome in patients with SLE treated with aspirin and corticosteroids seems to correlate with their normal uterine artery flow velocity wave forms.

Abortion, Habitual↗