[Intensive obstetric management of pregnant diabetics].
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Female↗
Biomedical subjects
D Feldberg
Publications and source records attributed to D Feldberg.
Ovarian melanoma. An interesting case.
A rare case of metastatic melanoma of the ovary and extension to the omentum is reported. The tumor was discovered 25 years following enucleation of one eye for malignant melanoma of the choroid.
Choroid Neoplasms↗
The antenatal diagnosis of Potter syndrome (Potter sequence). A lethal and not-so-rare malformation.
Bilateral renal agenesis (BRA) or Potter syndrome is a relatively rare congenital defect in which agenesis of the kidneys is associated with oligohydramnios, pulmonary hypoplasia, characteristic facial features and other abnormalities. The etiology is unknown. While the possibility of autosomal recessive inheritance has been suggested in familial cases, the syndrome most probably develops as a pattern of multiple anomalies derived from one single, mechanical factor. The initiating event of this syndrome is oligohydramnios. This condition in the neonate is incompatible with life. Unfortunately, these infants are often delivered by caesarean section, as it is usually associated with premature delivery, and breech presentation is a frequent finding. Consequently the prenatal diagnosis of BRA is important in order to avoid unnecessary operations. The antepartum diagnosis is possible in most cases by means of ultrasound scanning, and should be made in the second trimester, when therapeutic abortion is still possible. We have reviewed the obstetric course of 10 women who delivered such babies in recent years in our department. In 4 out of 6 cases of premature labor and breech presentation the diagnosis was made predelivery, and caesarean section was avoided.
Abnormalities, Multiple↗
Infected ectopic pregnancy presenting as unilateral tubo-ovarian abscess.
Ectopic pregnancy may be a dramatic occurrence, such as in the acutely ruptured extrauterine entity, or diagnosis may be delayed in the chronic ectopic gestation. Eight cases of infected ectopic pregnancy simulating tubo-ovarian abscess are reported; the diagnosis may be difficult and misleading. Symptoms and signs include abdominal pain and vaginal bleeding following a period of amenorrhea, usually accompanied by fever. All patients in our series presented with a picture of tubo-ovarian or pelvic abscess; however, the diagnosis of infected ectopic pregnancy was made preoperatively in all due to a positive beta-hCG test. Surgery in our cases included unilateral salpingo-oophorectomy in 7, and salpingectomy in one. Attention was drawn to the fact that, in the case of unilateral tubo-ovarian abscess, infected ectopic pregnancy should be suspected whenever preoperative beta-hCG is positive.
Abscess↗
Case report. Torsion of pregnant fallopian tube--a rare case.
A case of torsion of the pregnant fallopian tube is presented. Although uncommon, this entity should be considered in the differential diagnosis of abdominal pain in a young female patient. Early surgical intervention is recommended in order to salvage the affected tube by microsurgical techniques.
Adult↗
Ultrasound diagnosis and management of fetal intestinal obstruction and volvulus in utero.
A case has been described in which the diagnosis of acute intestinal obstruction of the fetal small bowel was made antenatally with the aid of ultrasonography. Cesarean section was done in the 34th week of pregnancy. One hour after birth ileostomy and colostomy were performed after resection of a volvulus in the terminal ileum. Two months later the ileostomy and colostomy were closed, and the baby is doing well. The importance of precise diagnosis of the anomaly in utero is emphasized to avoid unjustified termination of pregnancy.
Adult↗
Dietary adjustment during self-blood-glucose monitoring in pregnant women with insulin-dependent diabetes mellitus.
The interaction between the daily distribution of carbohydrates and frequent self-blood-glucose monitoring (SBGM) was studied in 13 pregnant women who had had diabetes for 4 to 19 years. Before and during SBGM, data were obtained on dietary history, daily blood glucose levels, and HbA1C. Optimal control was found with 3 main meals and 5 snacks. The total daily caloric intake decreased without change in the proportions of protein, fat, and carbohydrate. Consumption of starch increased, and that of simple sugars decreased. Although no changes were made in the daily amount of insulin, the women's diabetic control improved significantly.
Adult↗
Massive hemoperitoneum due to IUD.
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Adult↗
Holoacardius: radiologic investigation.
A case of holoacardius is presented from a monozygotic twin pregnancy of 20 weeks, in which the other twin was normal. The classification is reviewed. While the physiology and anatomy of these malformations are known, the etiology remains obscure. Theories of etiology may be divided in two groups: that the primary deficiency is a failure of the parts to develop; and the belief that the acardius is due to an abnormal vascular communication with secondary atrophy of the formed parts. The abnormal twin in the case studied was diagnosed by ultrasound prenatally and investigated radiologically post-mortem.
Abnormalities, Severe Teratoid↗
Effect of intracranial pressure changes on the fetal heart rate. Study of a hydrocephalic fetus.
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Adult↗
FHR patterns in Potter's Syndrome.
The antenatal diagnosis of POTTER's Syndrome (bilateral renal agenesis) is important in order to avoid delivery by cesarean section of newborns with congenital anomalies incompatible with life. In seven cases of this syndrome delivered at the Hasharon Hospital, a similar FHR pattern was retrospectively observed in pregnancy and labor suggesting that electronic fetal monitoring (EFM) may possibly contribute to the diagnosis of this condition in utero. Nevertheless, it must be emphasized, that similar cardiotocographic alterations may result from umbilical cord and/or placental compression in the presence of severe oligohydramnios. The latter may, concurrent with POTTER's Syndrome, predispose to changes in intraamniotic pressure transmitted to fetal autonomic centers. Thus, these variations in FHR pattern may be of value only if the presence of other signs of POTTER's Syndrome is confirmed by a reliable ultrasound examination. Further observations of antenatal FHR patterns in a large number of cases of this syndrome may establish their value in the antenatal diagnosis of POTTER's Syndrome.
Female↗
The Neugebauer-Le Fort operation: a review of 118 partial colpocleises.
The Neugebauer-Le Fort operation or partial colpocleisis is a safe, simple and rapid procedure for the repair of uterine prolapse in elderly women who are poor surgical risks. The operation was performed in 188 women with total procidentia. Good anatomic results were obtained in 90.7% of the women. Late complications were rare, including recurrence of prolapse (3 patients), and urinary incontinence (12 patients). Immediate postoperative complications were not common. The main disadvantage is the inaccessibility of the uterus in case of postmenopausal bleeding (2 patients). Partial colpocleisis has a place in the armamentarium of the gynecologist treating isolated cases of prolapse of the uterus, and may be indicated in the elderly women with total procidentia who is a poor surgical risk an in whom general anesthesia is contraindicated, and who is certain she wants to forego sexual intercourse.
Aged↗
Ovarian pregnancy: association with IUD, pelvic pathology and recurrent abortion.
Six cases of ovarian pregnancy were reviewed and their relationship with the IUD, fibromyoma of the uterus and previous spontaneous abortion was examined. In fact, 5 patients had an IUD in situ, in 2 women fibroids were found; 4 of the women had spontaneous abortions in their past history. The latter fact has been discussed, and it is suggested that this association may possibly contribute to an early diagnosis of ectopic pregnancy resulting in improved chances for conservative microsurgery. Attention is drawn to the fact that the diagnosis of ovarian pregnancy is often made only on microscopic examination. Thus, it is concluded that the true incidence of ovarian pregnancy may be higher than is apparent.
Abortion, Habitual↗
Reinsemination in human IVF with fresh versus initial semen: a comparative study.
In the event of non-fertilization of oocytes at the first insemination, repeat insemination is often successful in the IVF procedure. Nevertheless, the value of reinsemination is still controversial. In 56 out of 132 (42%) women treated in our IVF-ET Unit for mechanical infertility by identical induction and aspiration protocols, reinsemination of one or more ova was required. They were divided into two groups. Group I: 79 oocytes from 32 women who were reinseminated with initial semen 24 hours following primary insemination. Group II: 57 oocytes from 24 patients who were reinseminated with fresh semen 24 hours following primary insemination. Fertilization, cleavage and pregnancy rates differed significantly in group I as compared to group II (21.2%, 37.3%, p less than 0.005; 18.6%, 31.9%, p less than 0.001; 18.4%, 29.1%, p less than 0.001). We conclude that reinsemination is a beneficial procedure in cases of non-fertilization of oocytes at the first insemination. Furthermore, the use of fresh semen is preferred to achieve higher fertilization, cleavage and pregnancy rates.
Evaluation Studies as Topic↗
The value of GnRH agonists in the treatment of failed cycles in an IVF-ET program: a comparative study.
Occasionally, menotropins fail to induce ovulation for IVF-ET, due to early luteinization resulting in high cancellation rates of 15-40% of cycles. The efficacy of GnRH agonists in reducing these problems was prospectively studied in 91 women undergoing repeated IVF-ET, after desensitization with GnRH agonists. In all patients, the cycles that had been induced by menotropins alone failed due to early luteinization. By comparing these patients to a control group with significantly lower cancellation rates as well as significantly higher fertilization, the cleavage and pregnancy rates were achieved for the former group (p less than 0.001 in all parameters). Pituitary down-regulation by means of GnRH agonists prior to the induction of ovulation seems to be an effective and rewarding method for minimizing cancellation rates, and for achieving improved results in IVF-ET therapy.
Adult↗
Prolactin secretion in adolescent boys with hypogonadism.
Basal and TRH stimulated plasma prolactin levels were determined in 24 pubertal boys with hypogonadism (Primary: n = 10; secondary: n = 4; tertiary (hypothalamic): n = 10) and controls matched for pubertal stage (n = 12). The differentiation between secondary and tertiary hypogonadism was made with the help of a prolonged LRH test. The TRH test was performed by injecting 200 mcg i.v. in one bolus and taking plasma samples at 0, 15, 30, 60 and 90 minutes. No statistically significant differences were found between any of the groups. It is concluded that determination of basal or TRH stimulated prolactin does not contribute to clarify the etiology of hypogonadism or to determine the grade of damage or dysfunction in the hypogonadic testes.
Adolescent↗
The use of fibrin sealant in in vitro fertilization and embryo transfer.
OBJECTIVE: To evaluate the role of fibrin sealant for embryo transfer (ET) and the effect of patient mobilization after ET on pregnancy rates. DESIGN: A prospective, randomized, controlled study. METHODS: Two hundred eleven patients who were admitted to the IVF Unit over a period of 6 months participated in the study. Patients who had three or more embryos were randomly divided into two groups: group 1 (study group), in which ET was performed using fibrin sealant, and group 2, who served as the controls. Ovulation induction was carried out using the long GnRH-a suppression protocol. RESULTS: Comparison of the results regarding the implantation and pregnancy rates and ectopic pregnancy rate revealed a nonsignificant difference between the two groups. However, analysis of the results according to the patients' age revealed a significant increase in pregnancy (P < .05) and implantation (P < .01) rate in elderly patients (aged 39-42) using fibrin sealant for ET as compared with controls. Furthermore, we found that bed rest has no advantage over patient mobilization after ET. CONCLUSION: The use of fibrin sealant for ET is advantageous in elderly women, but has no apparent effect on the success rate or ectopic pregnancy rate in younger patients. Immediate mobilization does not jeopardize the results of IVF-ET.
Adult↗