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Biomedical subjects

D Rabinerson

Publications and source records attributed to D Rabinerson.

At least 91 records · Page 5Linked to original sources
PubMed1995

Membranous dysmenorrhea: the forgotten entity.

BACKGROUND: Membranous dysmenorrhea involves the spontaneous slough of the endometrium in one cylindrical or membranous piece that retains the shape of the uterine cavity. Because this entity is rarely mentioned in the medical literature, the purpose of this report is to describe two such cases. CASES: An 18-year-old nullipara with regular menstrual cycles presented with membranous dysmenorrhea after taking the contraceptive Gynera (Gestodene 0.075 mg, ethinyl estradiol 0.030 mg). Symptoms disappeared when the medication was discontinued. The second patient, a 26-year-old woman, gravida 1, para 1, was on a 10-day monthly regimen of Provera (medroxyprogesterone acetate) 2.5 mg/day for dysfunctional uterine bleeding. When the Provera dose was increased to 10 mg/day, the symptoms disappeared. CONCLUSION: Membranous dysmenorrhea is "a disease of theories" with various recommended medications. When this condition is caused by iatrogenic treatment, the best approach is to discontinue the offending drug or change its dosage.

Adolescent↗
PubMed1995

Cervical polyp in the menopause and the need for fractional dilatation and curettage.

OBJECTIVE: To investigate the need for fractional dilatation and curettage following excision of symptomatic versus asymptomatic cervical polyps. STUDY DESIGN: A prospective study was carried out on 467 women who were referred for treatment of symptomatic (accompanied by vaginal bleeding or discharge) or asymptomatic cervical polyps, from January 1, 1990 to December 31, 1992. Of these, 204 were premenopausal and 263 postmenopausal. Every excision of a cervical polyp was followed by a dilatation and curettage. The histological data were evaluated statistically using the chi 2-test. RESULTS: Postmenopausal women had more asymptomatic than symptomatic cervical polyps (P = 0.004). Cervical polyps were associated with more endometrial polyps in the postmenopausal than in the premenopausal women (P = 0.0009). Postmenopausal women with symptomatic cervical polyps had more endometrial abnormalities on histological examination than those with asymptomatic ones (P < 0.0001); this difference was not significant in the premenopausal group (P = 0.49). CONCLUSIONS: While neither symptomatic nor asymptomatic cervical polyps are an indication for dilatation and curettage (following excision) in women in their reproductive years, and do not affect their management or prognosis, this is not the case in postmenopausal women. Symptomatic cervical polyps after the menopause must be excised and followed by mandatory fractional dilatation and curettage, because there is a marked incidence of associated severe pathological conditions in this age group.

Adult↗
PubMed1995

Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome.

BACKGROUND: Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin-converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects. The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-1), on maternal renal function throughout pregnancy and on the fetomaternal outcome. METHODS: Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was < 500 mg/day and euglycaemia was achieved. At conception captopril was discontinued. RESULTS: At the beginning of captopril treatment, proteinuria was 1633 +/- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day (P = 0.0000) and increased gradually over the three trimesters to 593 +/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2 between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P = 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent. CONCLUSION: Captopril treatment before pregnancy has a prolonged protective effect on maternal renal functions during pregnancy and results in a favourable maternal-fetal outcome.

Adult↗
PubMed1995

Microalbuminuria following gestational diabetes.

BACKGROUND: Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: We examined the presence of MA in 72 women who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was used to compare data within the study group. RESULTS: Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p < 0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found. CONCLUSIONS: MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long-term follow-up of all GDM patients for MA and other markers of renal disease is strongly indicated.

Adult↗
PubMed1995

The management of persistent occipito-posterior position.

Persistent occipito-posterior position (POP) is found in about 1% of labors, and its management is still controversial. A study group of 319 patients with POP deliveries were screened and analyzed for prepartum, intrapartum and postpartum parameters. A control group of the same size was matched for maternal age (mean 27-28 +/- 5.22 yrs), gravidit (mean 2.52 +/- 1.95) and parity (mean 1.13 +/- 1.67). Statistically significant differences were found between the study and the control groups regarding the incidence of instrumental (forceps/vacuum) deliveries, prolonged second stage, pregnancy-induced hypertension, prostaglandin E2 induction, premature rupture of membranes and episiotomy. A discussion is presented evaluating the possible significance of these findings. Although the high rate of instrumental deliveries encourages active management of POP labors, the authors advocate a more conservative approach.

Adult↗
PubMed1995

Intrapartum management of the low-birth-weight breech fetus.

Breech presentation is prevalent among preterm deliveries and contributes to neonatal mortality far beyond its prevalence. The management of a preterm breech delivery is controversial. We present our retrospective experience with 185 consecutive preterm breech deliveries, part delivered by cesarean section and part delivered vaginally as assisted breech delivery or total breech extraction), and compare the perinatal outcome between these two groups in terms of perinatal mortality (PPD) and perinatal morbidity (neonatal asphyxia). No statistically significant difference was found for either variable in the two examined groups. We therefore conclude that the method of delivery of low birth weight (1000-2500) breeches has no effect on perinatal outcome.

Asphyxia Neonatorum↗
PubMed1994

Bacterial vaginosis: drugs versus alternative treatment.

Bacterial vaginosis is one of the most common infectious disorders affecting women. It is caused by several microorganisms, including Gardnerella vaginalis, Bacteroides, beta-streptococci and mobiluncus/falcivibrio sp. Bacterial vaginosis is thought to occur as a result of a change in vaginal pH mediated by the metabolic activity of anaerobic bacteria. This rise in vaginal pH interferes with the activity of vaginal lactobacilli which maintain vaginal acidity. Several types of antibiotics have been used to treat this condition. Although metronidazole was found to be the most effective, none was completely successful in either cure or prevention. Several attempts have recently been made to treat bacterial vaginosis using physiological or 'natural' substances, such as lactate gel and commercial yoghurt, which is acidic and also contains lactobacillus strains. This kind of treatment looks promising and may have a place in certain clinical conditions, including pregnancy, in cases of recurrent inflammation, or as a prophylactic treatment before invasive gynecological procedures or abdominal surgery in patients known to be affected. This issue should be additionally studied and evaluated in light of the relatively little experience with this modality of treatment for bacterial vaginosis.

Anti-Bacterial Agents↗
PubMed1994

Transcutaneous electrical nerve stimulation (TENS) as a relief for dysmenorrhea.

Sixty-one women who suffered from primary dysmenorrhea, were treated with Transcutaneous Nerve Stimulation (TENS) for two menstrual cycles, and reported the effect of the treatment on their pain. Thirty percent of the patients reported marked pain relief, 60% reported moderate pain relief and 10% reported that TENS had no influence on their pain. No side effects were reported. We conclude that TENS is an effective and safe non-pharmacological means for the treatment of primary dysmenorrhea. It could serve as a main treatment modality for women who suffer from primary dysmenorrhea and do not wish to or cannot use the conservative pharmacological agents. In addition TENS can serve as an adjuvant therapy to the conventional pharmacological agent in severe cases of primary dysmenorrhea.

Analgesia↗
PubMed1992

Combined anomalies of the müllerian and wolffian systems.

Combined congenital anomalies of the Müllerian and Wolffian duct systems are a rare phenomenon. We report a case of bicornuate uterus and infected right Gartner duct cyst, associated with agenesis of the left kidney and a left ovarian cyst. The case is discussed in view of its unknown occurrence.

Abnormalities, Multiple↗
PubMed1992

Persistence of a normal pregnancy after an early luteectomy. A report of two cases.

Two cases occurred of early luteectomy/left cystectomy. In one case it resulted from a hemorrhagic corpus luteum at four weeks' gestation. In the second case it resulted from a left adnexectomy at five weeks from torsion of the adnexa. Histologic analysis defined the lesions as a hemorrhagic corpus luteum and necrotic ovary, respectively. Despite the lack of a corpus luteum and the absence of hormonal replacement therapy, both pregnancies developed normally, in the first case for 7 weeks, until it was terminated on the patient's request, and in the second case until 38 weeks, when a normal infant was delivered by cesarean section.

Adnexa Uteri↗
PubMed1986

Macrophage migration inhibition factor test in breast tumors.

Thirty women with breast lumps who attended our outpatient clinic were randomly chosen for this study. The breast tumors were benign in 8 and malignant in 22 patients. Ten healthy women constituted a control group. In 15 of the 22 patients (68%) with malignant lesions, the migration inhibition factor (MIF) test was positive. Only one of the patients with benign lumps had a positive reaction. The MIF test was negative in all women in the healthy control group. It seems reasonable to conclude that the human cell-mediated immunity system is affected by the presence of breast cancer, and that the MIF test aids in the differentiation between benign and malignant breast tumors and has a sensitivity of at least 70%. The test may be of value in the postoperative follow-up of patients with breast cancer.

Adult↗
PubMedDate not supplied

Hereditary ovarian cancer.

Hereditary ovarian cancer occurs rarely in the general population but may appear in up to 85% of the offspring of affected women. Pedigree analysis remains the main diagnostic tool. Aberrations of BRCA-1 gene, located on 17q12-21, are considered to be the reason for the genetic expression of ovarian cancer. Hereditary ovarian cancer is characterized by bilateralism, usually stage III, at operative diagnosis, mostly serous cystadenocarcinoma type and relatively early age at onset. Hence, early follow-up is recommended in high risk patients. Prophylactic removal of the uterus and the adnexae is indicated in patients at risk.

Female↗