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A Shushan

Publications and source records attributed to A Shushan.

At least 19 recordsLinked to original sources
PubMed2006

Infertility, ovulation induction treatments and the incidence of breast cancer--a historical prospective cohort of Israeli women.

CONTEXT: Ovulation induction drugs may be associated with increased breast cancer risk. Results so far have been inconclusive. OBJECTIVE: To evaluate the association between infertility, exposure to ovulation induction drugs and the incidence of breast cancer. DESIGN: Historical prospective cohort and nested case-control study. SETTING: Institutional practice PATIENTS: About 5,788 women attending five infertility centers in Israel between 1964 and 1984. INTENTION: Abstracting of medical records and telephone interviews. MAIN OUTCOME MEASURE: Breast cancer incidence was determined through linkage with the National Cancer Registry database. Standardized incidence ratios (SIRs) and 95% confidence intervals were computed by comparing the observed to the expected cancer rates in the general population. In addition, a nested case-control study within the cohort was performed with interviews of breast cancer cases and two matched controls. RESULTS: The study cohort included 120,895 women years of follow-up. Compared to 115.2 expected breast cancer cases, 131 cases were observed (SIR = 1.1; 95% CI 0.9-1.4). Risk for breast cancer was significantly higher for women treated with clomiphene citrate (SIR = 1.4; 95% CI 1.0-1.8). Similar results were noted when comparisons were carried out between treated and untreated women, and when multivariate models were applied. In the nested case-control study, higher cycle index (OR = 2.2; 95% CI 1.0-4.8) and treatment with clomiphene citrate (OR=2.7; 95% CI 1.3-5.7) were associated with higher risk for breast cancer. CONCLUSION: Infertility and usage of infertility drugs in general are not associated with increased risk for breast cancer. However, for infertile women treated with clomiphene citrate, breast cancer risk is elevated.

Adult↗
PubMed2004

In vitro maturation and fertilization of oocytes from an intact ovary of a surgically treated patient with endometrial carcinoma: case report.

Polycystic ovary syndrome (PCOS) with prolonged anovulation had resulted in endometrial carcinoma in a 43-year-old woman. Since she and her husband did not share common biological children, they requested fertility preservation. Due to the woman's age, high dose progesterone and postponing surgery were both considered inappropriate. We therefore proposed oocyte retrieval from the ovaries removed by staging laparotomy followed by in vitro maturation and ICSI. Surrogacy could then enable a future pregnancy. Fourteen of 17 (82%) retrieved oocytes matured in vitro. Following ICSI, eight embryos (two at the pronuclear stage and six cleaved) were cryopreserved. To the best of our knowledge, this is the first report of oocyte aspiration, maturation and fertilization from an ovary removed by laparotomy.

Adult↗
PubMed2001

Diagnostic and therapeutic advantages of hysteroscopic surgery in management of intrauterine lesions in postmenopausal women.

STUDY OBJECTIVE: To determine the value of hysteroscopic surgery in the management of intrauterine lesions in postmenopausal women. DESIGN: Descriptive study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. Patients. Fifty postmenopausal women, most with vaginal bleeding, all with intrauterine lesions (leiomyomas, polyps, adhesions) on hysteroscopy or ultrasound. INTERVENTION: Hysteroscopic operations consisting of myomectomy, polypectomy, and adhesiolysis. MEASUREMENTS AND MAIN RESULTS: Forty-seven procedures were completed successfully by hysteroscopy; partial myomectomies were performed in three women for large or deeply embedded leiomyomas. The only complication was one case of fluid overload. Median operating time was 20.0 minutes (range 5.0-60.0 min) and median postoperative hospital stay was zero days (range 0-2 days). Eight patients (16%) subsequently underwent hysterectomy, mostly for uterine malignancy or premalignancy. In two cases, the operative specimen included malignant elements that were not evident on preoperative endometrial biopsy. During mean follow-up of 33.1 months (range 6-72 mo), 95.2% of women without hysterectomy were free of symptoms. CONCLUSION: Hysteroscopic surgery is an effective and safe option for postmenopausal women with intrauterine lesions. It allows the correct diagnosis to be made, reduces the need for major and unnecessary surgery, and is therapeutic in most patients. (J Am Assoc Gynecol Laparosc 8(1):87-91, 2001)

Female↗
PubMed2001

Laparoscopic 'oophorectomy-in-a bag'--an alternative to laparotomy for the evaluation of suspicious ovarian masses.

A prospective observational study was performed to assess the feasibility of the technique of laparoscopic 'oophorectomy-ina bag' for the safe removal of ovarian masses that do not meet the standard guidelines for laparoscopic management of adnexal pathology. Ovarian lesions were selected preoperatively by: age of the patient, ultrasound appearance, bilaterality and size. None of the women had ascites or matted bowel on ultrasound, and all had normal serum tumour markers. There were no stigmata of malignant disease in any of the cases at the time of surgery. Twenty women were recruited. Eighteen procedures (90.0%) were completed successfully laparoscopically. In two cases the bag could not be removed laparoscopically and minilaparotomy was performed. Nineteen of the tumours (95.0%) were removed without intra-abdominal spillage; the bag ruptured in one case. There were no major complications. One case of borderline ovarian tumour (stage Ia) was discovered. We conclude that laparoscopic 'oophorectomy-in-a bag' allows for the safe removal of suspicious ovarian tumours. The advantages of this approach are that women can be treated locally, a laparotomy is avoided, and the subgroup with ovarian malignancy can be identified to be referred to an oncological centre.

Journal Article↗
PubMed2001

[Residents training in gynecologic operative endoscopy: a review of Israeli and world experience].

Two decades ago, Gynecologic procedures performed by endoscopy were basically limited to diagnostic procedures. Since 1990, operative endoscopy is increasingly used to treat a growing variety of gynecologic conditions, resulting in shorter hospital stay and smaller, less painful incisions. One of the greatest tasks facing today's academic gynecologic surgeons is training residents and attendant physicians to perform endoscopic surgery adequately and safely. Clearly, there is a need to provide basic knowledge of endosurgical principles, and understanding of equipment and technologies used in operative endoscopy. Also, information on minimization, early recognition and treatment of endoscopic complications is of great importance as well as hands-on experience in these new procedures. We have reviewed the world as well as the Israeli experience in the field and out of this growing base of knowledge we have tried to delineate and forge guidelines for adequate teaching, training and accreditation.

Education, Medical, Graduate↗
PubMed1999

Induction of ovulation and borderline ovarian cancer--the hormonal connection?

While the data regarding the possible association between fertility drugs and invasive ovarian cancer are inconclusive, there is evidence to suggest an association between induction of ovulation and borderline ovarian tumors. The plausibility of these results is heightened by the finding that estrogen receptor expression is a common feature of ovarian borderline tumors. On the other hand, recent data indicate that in contrast to the crucial role of germline mutations in the pathogenesis of invasive ovarian cancer, these mutations play a minor role, if any, in the pathogenesis of borderline ovarian tumors. This evidence suggests that the differences between invasive and borderline ovarian tumors are not based on minor morphological criteria, but that, most probably these represent two different entities, with different clinical behavior, and that borderline tumors might be associated with hormonal factors rather than genetic mutations.

Female↗
PubMed1999

How long does laparoscopic surgery really take? Lessons learned from 1000 operative laparoscopies.

The purpose of this study was to assess the operating time of the most common gynaecological laparoscopic procedures. We analysed retrospectively 1000 consecutive operative laparoscopies on a procedure-by-procedure basis. Diagnostic laparoscopy and laparoscopic sterilization were specifically excluded from the analysis. The various laparoscopic procedures were grouped and analysed under six major categories. The average operating time for all cases was 76.9 min (range 10-400). In 38 cases (3.8%) the laparoscopic procedure was converted to laparotomy. The average operating time for treating ectopic pregnancy and tubal disease was approximately 60 min (range 13-240). Surgery for endometriosis and ovarian cysts averaged 72 min (range 10-240). Laparoscopic myomectomy and hysterectomy averaged 113 and 131 min respectively (range 25-400). Our results show that while the operating time for most operative laparoscopies is less than 75 min, the range of operating times is great. The relative lack of predictability in procedure times means that the efficient utilization of fixed theatre sessions is difficult.

Adolescent↗
PubMed1999

A case-control study to compare the variability of operating time in laparoscopic and open surgery.

The purpose of this study was to compare the variability of operating times for some of the most common gynaecological procedures performed laparoscopically and by open surgery. The case notes of 60 women randomly selected from a cohort of 600 who had undergone laparoscopic surgery for ectopic pregnancy, ovarian cysts, leiomyoma and hysterectomy were reviewed. These patients were matched with an equal number of women who had been treated by open surgery for similar indications. Additional matching criteria included age (+/-2 years), size of the lesion in cases of ovarian cysts and fibroids (+/-3 cm), the period of amenorrhoea in ectopic pregnancies, and uterine size and pelvic pathology in women undergoing hysterectomy. Comparison of laparoscopy and laparotomy showed that the mean procedure times were similar for the two routes of surgery, with the exception of hysterectomy which took significantly longer if done laparoscopically. The duration of laparoscopic surgery for ectopic pregnancy, ovarian cystectomy and hysterectomy was significantly less predictable than at laparotomy. These data indicate that with the exception of hysterectomy, the average operating time for laparoscopic procedures is comparable to that for laparotomy. In contrast, the variability of duration of laparoscopic surgery tends to be much greater than with laparotomy for all procedures considered.

Adult↗
PubMed1998

The incidence of borderline ovarian tumors in Israel: a population-based study.

BACKGROUND: In hospital-based studies, one-eighth of ovarian cancers have been considered borderline ovarian tumors (BOTs). Population-based data regarding the incidence of BOTs are lacking in the international literature. The authors' objectives were to measure the incidence of BOT in Israel and compare rates among ethnic groups (based on ethnic group and country of birth) for the years 1985-1993. METHODS: The authors analyzed data reported to a nationwide cancer registry. Population estimates by subpopulation were derived from census and intercensus estimates, which were based on an updated population registry. RESULTS: The age-adjusted standard rate (ASR) for the entire population was 10.6 per million (95% confidence interval [CI], 9.2-12.0) for the period 1985-1993. Significant differences in ASR were observed among ethnic subgroups, with the lowest incidence among non-Jews (ASR, 5.0 per million; 95% CI, 0.7-9.3) and the highest among new immigrants from the former Soviet Union (FSU) who had been arriving since 1989 (ASR, 22.7 per million; 95% CI: 14.2-31.3). Between the periods 1985-1989 and 1990-1993, the ASR for Jews nearly doubled (rate ratio, 1.86; 95% CI, 1.1-2.5). This near-doubling was influenced, but not wholly accounted for, by the immigration from FSU and was observed in all ethnic subgroups. CONCLUSIONS: The variations in the incidence rates of BOT among ethnic groups may be related to differences in fertility patterns, use of fertility drugs, and genetic predisposition. The pattern of near-doubling in rates may reflect biases caused by increased detection or shifts in the classification of ovarian tumors; if they are real, a biologic explanation is needed.

Adenocarcinoma, Mucinous↗
PubMed1998

Myometrial scoring: a new technique for the management of severe Asherman's syndrome.

OBJECTIVE: To describe a new hysteroscopic technique for the management of severe Asherman's syndrome. DESIGN: Prospective observational study. SETTING: Volunteers in an academic research environment. PATIENT(S): Seven patients with secondary infertility associated with amenorrhea or oligomenorrhea secondary to severe Asherman's syndrome. INTERVENTION(S): Six to eight longitudinal incisions were made into the myometrium extending from the uterine fundus to the isthmus with a resectoscope fitted with a Collins knife electrode. MAIN OUTCOME MEASURE(S): Restoration of menses, symptomatic relief, and postoperative reproductive performance. RESULT(S): The amount of menstrual bleeding increased in all cases, including two women who were amenorrheic before their surgery. Pelvic pain decreased in two of the four symptomatic cases. Three to four months after surgery, hysteroscopy showed a normal sized uterine cavity in five cases. After a median follow-up of 12 months, three women conceived four pregnancies, including a missed abortion, a tubal abortion, an ongoing pregnancy currently at 7 weeks' gestation, and one child delivered at 36 weeks gestation after premature rupture of the membranes. CONCLUSION(S): Hysteroscopic myometrial scoring enlarges uterine cavity size in cases of severe Asherman's syndrome and improves menstrual function. Reproductive performance seems to be improved also, but longer follow-up is required.

Adult↗
PubMed1998

Correlation between fasting glucose in the first trimester and glucose challenge test in the second.

OBJECTIVE: To determine if there is a statistically significant correlation between the plasma glucose level obtained following a glucose challenge test at 24-28 weeks' gestation and the fasting plasma glucose level in the first trimester. METHODS: The study population included 621 healthy women with singleton pregnancies followed in the antenatal clinic of the Hadassah Medical Center, with a fasting plasma glucose level performed during the first trimester. Nine women had fasting blood glucose levels above 105 mg/dL and were excluded from the study. Of the remaining 612 women, 425 (69%) had 50-g glucose challenge tests at 24-28 weeks' gestation. RESULTS: The mean (+/-standard deviation [SD]) first-trimester fasting glucose level was 77.8+/-9.7 mg/dL and the mean (+/-SD) glucose level 1 hour after the second-trimester glucose challenge test was 109.1+/-29.8 mg/dL. The fasting plasma glucose level and the glucose level following the glucose challenge correlated significantly but not strongly (=.26, P < .001). However, using a linear regression model in which fasting plasma glucose level and maternal weight were explanatory variables and glucose level following the glucose challenge test was the dependent variable resulted in a very low r2 (.10). CONCLUSION: The correlation between the plasma glucose level obtained following a glucose challenge test and the fasting plasma glucose level in the first trimester is low, indicating that fasting glucose measurement early in pregnancy has no clinical benefits.

Adolescent↗