Biomedical subjects
Publications and source records attributed to A Weissman.
A case of preoperative diagnosis of cervical pregnancy by transvaginal sonography is presented. The widespread use of transvaginal sonography facilitates earlier detection of this kind of ectopic gestation, thus improving the prospects for conservative treatment with preservation of fertility.
BACKGROUND: Cavernous hemangioma of the uterus is a rare but serious condition, especially during pregnancy. Most reported cases ended with hysterectomy in an attempt to control profuse bleeding, and only one of four resulted in a live birth. We describe the sonographic differential diagnosis of this condition and propose management of these patients. CASE: Cavernous hemangioma of the uterus was diagnosed sonographically at 33 weeks' gestation. Conservative management resulted in a favorable outcome for both mother and child. CONCLUSION: Ultrasound is helpful in the prenatal diagnosis of cavernous hemangioma of the uterus; however, other uterine or placental abnormalities with similar sonographic appearances should be considered in the differential diagnosis.
We present a case in which the evaluation of a bladder mass revealed a leiomyosarcoma of the bladder. The ultrasonographic appearance of this tumor is described for the first time. Leiomyosarcoma of the bladder, although rare, should be considered in the differential diagnosis of pelvic masses.
The prognosis of clinically diagnosed periventricular, intraventricular hemorrhage on the survival and long-term outcome of 169 infants delivered at 24 to 30 weeks gestation who survived more than 48 hours was evaluated. Periventricular, intraventricular hemorrhage was confirmed by ultrasound in 37.9% of the survivors. In this group the survival rate was 64% and the major handicap rate was 14.6%. In contrast, the survival of infants who did not have a clinical diagnosis of periventricular, intraventricular hemorrhage was greater than 90% with a major handicap rate of only 3.2% (P < 0.0001 and P < 0.03, respectively). Infants with clinical diagnosis of periventricular, intraventricular hemorrhage who were found to have grades 1-2 by ultrasound had the same survival rate as those without a clinical diagnosis of periventricular, intraventricular hemorrhage (90.5%), while infants with grades 3-4 had a survival rate of only 51.2% (P < 0.01). We conclude, that preterm infants who survive longer than 48 hours and do not have a clinical suspicion of periventricular, intraventricular hemorrhage, have an excellent prognosis. In these circumstances brain sonography can be deferred without jeopardizing the infants' health.
A case of uterine rupture following conservative surgery for interstitial pregnancy is presented. Even though the uterine cavity was not opened during removal of the ectopic pregnancy, attenuation of the muscle lead to subsequent rupture of the uterus in the second trimester. The option for medical termination of ectopic pregnancies located in the cornual portion of tubes is discussed.
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A new immigrant from Romania tried to induce abortion by intrauterine self-administration of hypertonic sucrose at 7 weeks' gestation. Complete abortion did not occur and bleeding, infection and pregnancy residua persisted for 13 weeks. Evacuation by uterine curettage had failed, but a second curettage under real-time sonographic guidance was successful. Self-induced chemical abortions are rarely encountered in modern medicine. However, elevation of the iron curtain and mass immigration may increase the frequency of self-induced abortions in Western countries. Since the management, course, and outcome of each type of self-induced abortion are somewhat different, the pertinent differentiation is between chemical and mechanical and between various agents used for chemical-induced abortions. Mechanical abortions are best treated 12 to 24 hours after antibiotic therapy, while in chemically-induced abortion early evacuation of the uterus is indicated.
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A case of fetal death due to an amniotic band and an umbilical cord true knot is presented. To the best of our knowledge the simultaneous occurrence of true knot of cord and amniotic band has never been previously reported and may shed light on the possible time of true knot formation in this case.
The appearance of free digoxinlike immunoreactive factor in pregnancy and its rapid disappearance after delivery is well documented. The protein-bound fraction, a common component of plasma, does not change during pregnancy. We investigated the peripartum changes in both free and protein-bound fractions of digoxinlike immunoreactive factor and observed different peripartum patterns of those fractions. While the disappearance of the free fraction after delivery was reconfirmed, the protein-bound fraction exhibited a biphasic pattern: a rapid decrease after delivery with a slow increase to predelivery levels seven weeks later. The disappearance of free digoxinlike immunoreactive factor after delivery may reflect the elimination of the fetal source. The changes in the protein-bound fraction imply that the fraction may also vary in certain clinical situations and may be produced in response to certain homeostatic changes and suggest a possible interaction between fetal and maternal systems that produce digoxinlike immunoreactive factor during pregnancy.
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The perinatal characteristics of 16 vaginal-abdominal deliveries of twins were evaluated. The primary indication for the cesarean delivery was compound vertex presentation (n = 4), prolapsed umbilical cord (n = 4), transverse lie (n = 7), and mentoposterior face presentation (n = 1). Ther outcome of Twin A was not different from that of Twin B. About 90% of the twins were eventually discharged on time. A significant correlation (R = 0.9722, p less than 0.0003) was found between the reported rates of combined deliveries and cesareans in twins. The data suggest that a higher rate of combined deliveries is expected in practices where abdominal deliveries are performed more often in twin gestations, while in obstetric services with low cesarean rates in twins, combined deliveries seem to be unfortunate occurrences dictated by unexpected intrapartum events.
The incidence of triplet pregnancies has increased with the introduction of ovulation induction agents and is expected to further increase with the implementation of multiple embryo transfer in the in vitro fertilization programs. We review our experience with 29 triplet pregnancies in the last 10 years. Despite early sonographic diagnosis, close follow-up, increased use of tocolytics, and prophylactic cervical suture, we could not document prolongation of pregnancy, increased infants' weight, or a significantly decreased perinatal mortality, which still remains about 14%. Furthermore, the use of cesarean section as the delivery method of choice did not change the well-documented unfavorable relationship between birth order and fetal outcome. There is an urgent need for prospective assessment of the value of different treatment modalities, which nowadays becomes possible with the increasing incidence of triplet pregnancies. The prevention of triplet pregnancies or treatment by selective fetal reduction deserves a second thought.
Changing levels of sex hormones have been previously associated with clinical symptoms due to alterations of the respiratory mucosa. Aural manifestations, however, have not yet been studied in this regard. Eustachian tube swallow test and blood levels of estrogen were evaluated daily in 25 women undergoing induction of ovulation. Most women showed a near stable eustachian tube performance over a wide range of estrogen levels, particularly in the physiologic range. However, there is a moderate decrease in eustachian tube function with increasing estrogen levels in some women, manifested mainly at levels beyond that of the normal menstrual cycle.
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We studied 153 consecutive twin pairs of unlike sex. Comparison of 71 male-female pairs with 82 female-male pairs showed similar mean twin birth weight and rate of discordance. However, males were significantly heavier (p less than 0.04) compared with females in the male-first but not in the female-first combination. The rate of female discordance was significantly higher compared with male discordance in both fetal sex combinations. It is concluded that females of unlike-sexed pairs are at greater risk to be growth discordant. Fetal sex, therefore, should be included as one of several factors that produce divergent twin growth.
We evaluated 56 twin pregnancies representing the tenth decile of the mean twin birth weight distribution to investigate whether larger twins face the same increased perinatal risk as do macrosomic singletons. Compared with pregnancies in the ninth decile, no significant difference was found between the means of maternal age, parity, and gestational age; between the rates of presentation combinations and cesareans; or between the neonatal sex ratios. However, the incidence of growth-discordant pairs was significantly higher in the heavier group (P = .034). Compared with the general twin population, the tenth-decile group contained significantly fewer primiparas (P = .0023). Maternal obesity and diabetes were infrequent and could not explain the increased birth weight. The neonatal outcome was excellent. Although the comparison revealed insignificant differences, it is possible that the combination of higher parity, malpresentation rate, and male-to-female ratio may be operative in the genesis of large twins.