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Biomedical subjects

A Shushan

Publications and source records attributed to A Shushan.

At least 37 records · Page 2Linked to original sources
PubMed1997

Pregnancy associated with colon carcinoma overexpressing p53.

The development of colon carcinoma during pregnancy is a rare event. However, when colon carcinoma develops during pregnancy it is considered a lethal coincidence due to rapid progression. We report two rare cases of colon adenocarcinoma diagnosed during gestation. Both tumors displayed increased nuclear immunostaining for p53. The increased expression of p53 in tumor cells could indicate that the p53 gene is either mutated or stabilized or alternatively overexpressed as a responses to DNA damage. It is hypothesized that the development of colon carcinoma during pregnancy can be attributed to alterations of the p53 tumor suppressor gene or gene product on one hand and a maternal immune-tolerant state on the other.

Adenocarcinoma↗
PubMed1997

High risk pregnancy outcome following induction of labour.

OBJECTIVE: To evaluate whether induction of labour, performed in a high risk obstetric population, when medically indicated, carries an increased risk for operative delivery and maternal and fetal complications. The secondary goal was to study the effect of the various induction methods used on these outcomes and labour time. STUDY DESIGN: This study was carried out at a level [1] university hospital. A group of 210 women who were induced for various indications, were compared to our general parturient population. Main outcome measures were cesarean section (CS) and instrumental delivery rates, intra-partum and post-partum complications, APGARs 1' and 5' and labour time by induction method. RESULTS: No significant increase in the rates of primary CS (8.6 vs. 7.1%) and instrumental delivery (15.7 vs. 12.7%), were found in the induction high risk group as compared to our general obstetric population. Intra-partum complications and fetal outcome were comparable in both groups. A comparison of methods of induction used (oxytocin, PgE2, Amniotomy) revealed a less favorable outcome with the oxytocin induction method which showed an elevated intra-partum complication rate (P < 0.01) and a tendency toward lower Apgar scores and higher CS rate. CONCLUSIONS: Induction of labour performed in a high-risk obstetric population is safe, carrying no significant increase in CS and neonatal complication rates. Of the three methods of induction used, oxytocin induction showed the least favorable outcome for both mother and her offspring.

Adult↗
PubMed1997

Doppler findings in chronic ectopic pregnancy: case report.

Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. For this reason, most of the reported cases have been diagnosed only after explorative laparotomy. The value of Doppler ultrasonography for preoperative diagnosis of this entity has not yet been established. We report on a 36-year-old patient who was admitted for intermittent right lower quadrant abdominal pain of 3 months' duration, and a right adnexal mass found on pelvic examination. On Doppler ultrasonography, a right complex adnexal mass was demonstrated, characterized by extensive external vascularization, aberrant vessels and arteriovenous shunting, but with no internal blood flow. Explorative laparotomy revealed a right tubal mass adherent to the omentum, and covered by numerous enlarged and tortuous blood vessels originating in the omentum. Pathological examination of the mass revealed a chronic ectopic pregnancy. The possible contribution of Doppler-specific characteristics for the diagnosis of chronic ectopic pregnancy is described and discussed.

Adnexa Uteri↗
PubMed1997

Early treatment of gestational diabetes reduces the rate of fetal macrosomia.

This study tested the hypothesis that to reduce the rate of macrosomic infants in gestational diabetes cases, good glycemic control should be initiated before 34 completed gestational weeks. The study population included 84 women with gestational diabetes, ascertained by universal screening of all women attending the antenatal clinic of the Hadassah Medical Center, over a 2-year period. The 60 women (71%), who initiated treatment before 34 completed weeks, composed the "early" group. The 24 women (29%), who initiated treatment after the 34th week, composed the "late" group. All patients were managed by an intensified protocol, including stringent glycemic control. In the "early" and "late" groups, mean gestational age at the beginning of treatment was 30.0 +/- 3.8 and 36.2 +/- 1.2 weeks, and duration of treatment was 9.6 +/- 4.1 and 3.7 +/- 1.8 weeks, respectively. Maternal characteristics were similar in the two groups. The rate of macrosomic and large-for-gestational-age infants were 5 and 11%, respectively, in the early group as compared to 25 and 29% in the "late" group (p < 0.05). No significant differences were found between the two groups in the mode of delivery or Apgar scores. We conclude that to reduce the rate of macrosomic infants in gestational diabetes cases, good glycemic control should be initiated before 34 completed gestational weeks.

Adult↗
PubMed1996

Therapeutic approach to ovarian cysts in tamoxifen-treated women with breast cancer.

OBJECTIVES: To present our clinical experience with gonadotropin-releasing hormone agonist (GnRHa) treatment of tamoxifen-treated women who had developed ovarian cysts, and to discuss the diagnostic and therapeutic options in such cases. METHODS: The study included six tamoxifen-treated premenopausal women with breast cancer who developed ovarian cysts and were followed up by our outpatient clinic. Tamoxifen was administered orally (20 mg/day). All patients underwent a pelvic examination and vaginal ultrasound using a 5-MHz vaginal probe. Blood samples for serum gonadotropins, estradiol (E2) and CA 125 levels were collected at the time of the ovarian cyst detection and every month thereafter. After detection of an ovarian cyst, the women were treated by monthly injections of GnRHa. RESULTS: The patients' mean age was 44 years (range 37-51 years) and all had stage-II or -III breast cancer. The mean duration of tamoxifen administration at the time of ovarian cyst detection was 15 months (range 3-40 months). All six ovarian cysts were found to be simple cysts, measuring more than 30 x 30 mm. Serum E2 levels of the six patients at the time of ovarian cyst detection were between 939 and 1796 pg/ml and were suppressed to less than 25 pg/ml after GnRHa therapy. After between three and six monthly injections of GnRHa all six ovarian cysts disappeared. On follow-up 6 months later, all patients had a normal pelvic examination. CONCLUSION: The findings of this preliminary report suggest that GnRHa might be an appropriate treatment for tamoxifen-treated women who develop ovarian cysts. It was demonstrated that the GnRHa caused regression of the ovarian cysts and enabled continuation with the adjuvant tamoxifen treatment.

Adult↗
PubMed1996

Ovarian cysts in premenopausal and postmenopausal tamoxifen-treated women with breast cancer.

OBJECTIVE: Our purpose was to investigate the frequency of ovarian cysts in tamoxifen-treated breast cancer patients. STUDY DESIGN: The study population included 95 consecutive tamoxifen-treated premenopausal and postmenopausal women with breast cancer who were followed up by the outpatient clinic at the Hadassah University Hospital between September 1990 and June 1992. Tamoxifen was administered orally (20 mg/day). All patients underwent a pelvic examination and vaginal ultrasonography with a 5 MHz vaginal probe. RESULTS: During the study 11 of 95 tamoxifen-treated breast cancer patients (11%) had ovarian cysts. Five cysts were detected in postmenopausal women (6.3% of the postmenopausal women) and six in premenopausal women (37.5% of the premenopausal women). In postmenopausal and premenopausal women the mean tamoxifen treatment interval was 19.4 +/- 7.8 months (range 4 to 48 months) and 28 +/- 6.1 months (range 12 to 54 months), respectively (p = 0.41). In 8 of the 11 patients the ovarian cystic enlargement disappeared after cessation of tamoxifen treatment. Two patients underwent laparotomy because of persistent cysts and the third because of a rapidly growing myoma. The three cysts were found to be benign. CONCLUSION: Ovarian cysts are a common side effect of tamoxifen treatment. The ovarian cysts can develop in tamoxifen-treated premenopausal as well as postmenopausal women with breast cancer. Most of the tamoxifen-associated cysts disappear after tamoxifen treatment is abandoned.

Adult↗
PubMed1996

Ethical and legal aspects of assisted reproduction practice in Asia.

This report describes the ethical and legal aspects of assisted reproduction technology (ART) that have been instituted in Asian countries. The data were collected by a questionnaire circulated to ART units in Asia. These are Taiwan, Singapore, Korea, Indonesia, Thailand, Japan, Iran, India, Jordan, Malaysia, China, Israel, Hong Kong, Pakistan, Lebanon, Saudi Arabia, and Persian Gulf countries. According to the survey, there are approximately 260 ART centers in Asia (half of which are in Japan). On a global basis each ART centre in Asia serves an average population of 13 million people. On the other hand, in those Asian countries where the standards of living are relatively high, the availability of ART services, including the more sophisticated and costly ART procedures like micromanipulation, is similar to that in the Western world. In most of the Asian countries practising ART, however, no state registry exists. Taiwan is the only country that has specific legislation, and in six other countries some kind of ministerial regulations are practised. We conclude that ART is now practised in 20 countries in Asia. The prevailing rules and cultural heritage in many of these Asian countries has a major influence on the implementation of ART in Asia. However, in view of the complicated and sensitive issues involved, and as no supervision on ART clinics exists in most of the Asian countries, we advocate that some kind of quality control should be urgently instituted in all centres practising ART. In this way, it is hoped that the highest standards be attained for all parties concerned.

Asia↗
PubMed1996

Human menopausal gonadotropin and the risk of epithelial ovarian cancer.

OBJECTIVE: To determine whether women with epithelial ovarian cancer are more likely to have been exposed to fertility drugs, and in particular hMG, than healthy population controls. DESIGN: A nationwide case-control study. PATIENTS: Two hundred living women 36 to 64 years of age, with a histologically confirmed diagnosis of primary invasive or borderline epithelial ovarian cancer that was first diagnosed and reported to the Israel Cancer Registry between January 1, 1990 and September 1, 1993 were enrolled. There were 164 (82%) invasive and 36 (18%) borderline epithelial ovarian tumors among the 200 cases. The controls were 408 women from the same dialing areas selected by random digit dialing. Cases and controls were interviewed using a standard questionnaire. A multivariate logistic model was used to assess the association of fertility drug use and ovarian cancer, controlling for variables found to be statistically associated with this outcome on univariate analysis. RESULTS: Twenty-four women with epithelial ovarian cancer (12%) and 29 healthy controls (7.1%) reported that they had used any fertility drug (adjusted odds ratio [OR] 1.31; 95% confidence interval [CI] 0.63 to 2.74). Among cases and controls, respectively, 22 and 24 reported that they had used hMG alone or in combination with clomiphene citrate (adjusted OR 1.42, 95% CI 0.65 to 3.12), and 11 and 6 reported that they had used hMG alone (adjusted OR 3.19, (95% CI 0.86 to 11.82). The risk was increased particularly in the subgroup of women with borderline ovarian tumors who had used hMG (adjusted OR 9.38, 95% CI 1.66 to 52.08). CONCLUSIONS: We conclude that the use of ovulation induction agents, in particular hMG, may increase the risk of epithelial ovarian tumors.

Adult↗
PubMed1995

Comparison between nafarelin acetate and D-Trp6-LHRH for temporary pituitary suppression in in vitro fertilization (IVF) patients: a prospective crossover study.

PURPOSE: Nafarelin acetate is a new gonadotropin releasing (GnRH) agonist analogue with unique potency, intranasal administration, and convenient storage. Hence, nafarelin was considered as an alternative for temporary pituitary suppression in patients undergoing ovulation induction in IVF. A crossover treatment in a prospective study was performed including 40 women with bilateral obstructed tubes and normal ovarian function, treated in 80 ovulation induction cycles using the long protocol. Twenty patients used nafarelin acetate 600 micrograms/daily in their first cycle and received D-Trp6-LHRH, 0.5 mg/daily, in their following cycle. The other 20 women used decapeptyl in their cycle and received nafarelin in the second. RESULTS: Estradiol suppression was achieved by both D-Trp6-LHRH and nafarelin at equal time intervals. The average total number of ampoules (P = 0.0005) and the length of administration of hMG required for ovarian stimulation (P = 0.0002) and the time interval between GnRHa initiation to oocyte retrieval (P = 0.04) was significantly lower in nafarelin cycles. The number and the distribution between large and small follicles as well as the average number of oocytes retrieved did not differ between the two GnRH analogues. CONCLUSION: Our results demonstrate that nafarelin acetate is comparable to D-Trp6-LHRH for temporary pituitary suppression used for controlled ovarian stimulation in IVF patients. However, using nafarelin ovarian stimulation was achieved with few ampoules of hMG, administered for a shorter period of time, thus with a lesser cost.

Adult↗
PubMed1995

Ovulation induction with clomiphene citrate complicated by deep vein thrombosis.

A case of recurrent deep vein thrombosis following standard clomiphene citrate treatment, in a patient with a history of a previous episode of deep vein thrombosis, is described. This case indicates that deep vein thrombosis might be a rare but hazardous complication of clomiphene citrate treatment in patients with certain risk factors. We recommend that the use of clomiphene citrate in such cases be undertaken with caution and under close surveillance.

Adult↗
PubMed1995

Subfertility in the era of assisted reproduction: changes and consequences.

OBJECTIVE: To review the major changes that have occurred during the last decade of assisted reproduction technology (ART) practice, looking at the various conditions that cause subfertility. DESIGN: A short review describing the progress that has been made during the last decade of ART practice, analyzing the various conditions that cause subfertility, is presented. The efficacy of ART as a treatment of these conditions is discussed. CONCLUSIONS: Assisted reproductive technology currently is used for a wide range of indications and has become an acceptable tool in the treatment of subfertile couples. Yet, there is an ongoing debate regarding the effectiveness of ART versus conventional treatment for the various conditions that cause subfertility. The effectiveness of IVF in terms of pregnancy rate (PR) was demonstrated only for patients with severe bilateral tubal disease and male subfertility. For couples with other causes of infertility the differences in PRs do not reach statistical significance, and the efficacy of IVF has not been demonstrated clearly to date. Moreover, much of the discussion about management of subfertility has centered on costs of ART and the cost-benefit of ART versus conventional therapy for subfertility. It has been shown that, in women with unexplained infertility, menotropin treatment is as successful, less expensive, and carries a smaller risk than the surgical approach used in ART. However, the exact role of ART in the management of polycystic ovarian syndrome, immunological infertility, and endometriosis still is to be determined. Yet, as embryo implantation after ART still is considerably lower than that of fertile couples who conceive naturally, we expect that the next major thrust improving the effectiveness of ART will occur after future elucidation of factors influencing embryonic implantation.

Anovulation↗
PubMed1995

Umbilical cord blood for use in transplantation.

Bone marrow transplantation has rapidly progressed over the last two decades offering cure and prolonged disease-free survival for patients suffering from certain hemato-oncological malignancies or metabolic disorders. However, bone marrow transplantation is limited by the paucity of major histocompatibility loci antigen (HLA)-matched donors, and the morbidity and mortality due to graft-versus-host disease. Recently it has been shown, that umbilical cord blood represents a unique source of transplantable hematopoietic progenitor cells. Currently, human umbilical cord blood from a newborn sibling has been used successfully for hematopoietic reconstitution of approximately 40 children with congenital or malignant diseases. Establishment of umbilical cord blood banks might alleviate some of the problems associated with bone marrow transplantation. The developments in this field which have occurred during the last decade, as well as the importance of cooperation between the obstetric and transplantation staff, are discussed in this review. Certain ethical problems remain surrounding the issue of using human umbilical cord blood for allogeneic transplantation which must be addressed.

Aborted Fetus↗