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Biomedical subjects

E Shalev

Publications and source records attributed to E Shalev.

At least 73 records · Page 4Linked to original sources
PubMed1995

Decreased incidence of severe ovarian hyperstimulation syndrome in high risk in-vitro fertilization patients receiving intravenous albumin: a prospective study.

The administration of human serum albumin has been reported to prevent severe ovarian hyperstimulation syndrome (OHSS) while undergoing ovarian stimulation protocols for in-vitro fertilization (IVF). This prospective, randomized study investigated the effectiveness of a single dose of human serum albumin (20 g) administered i.v. immediately after oocyte retrieval. Women enrolled in the IVF programme were treated with long gonadotrophin-releasing hormone agonist, triptorelin, and an individually-adjusted human menopausal gonadotrophin protocol. The criteria for inclusion in the study were young age, non-obesity, oestradiol concentration > 9200 pmol/l on the day of human chorionic gonadotrophin administration and > 20 follicles > 14 mm diameter as observed by transvaginal sonography. The treatment group (n = 22) received albumin while the control group (n = 18) did not. Patients were followed-up using ultrasound every 3 days. There was a significantly higher number of severe OHSS cases in the control group (n = 4) than in the treatment group (n = 0) (P = 0.035). Where the data base was restricted to patients with an oestradiol concentration > 15,000 pmol/l, the difference between control and treatment groups was highly significant (P = 0.008). These findings support the use of i.v. albumin in preventing severe OHSS during IVF treatment.

Adult↗
PubMed1995

Gonadotrophin-releasing hormone agonist compared with human chorionic gonadotrophin for ovulation induction after clomiphene citrate treatment.

The objective of this study was to compare hormonal response, luteal phase adequacy and pregnancy and abortion rates in patients randomized to receive human chorionic gonadotrophin (HCG) or gonadotrophin-releasing hormone agonist (GnRHa) during ovulation cycles stimulated by clomiphene citrate. Anovulatory patients received either one s.c. dose of tryptorelin (0.1 mg; n = 104) or one i.m. dose of HCG (10,000 IU; n = 106) after clomiphene citrate stimulation had induced enlarged ovarian follicles (> 17 mm in diameter). A short-lived, transitory increase in serum luteinizing hormone (98 +/- 9 IU/l) and follicle-stimulating hormone (30 +/- 5 IU/l) concentrations was measured at 12 h following the injection of GnRHa, and these concentrations returned to baseline levels by 36 h post-injection. Midluteal progesterone concentrations were similar in both groups (> 10 ng/ml), and the mean luteal phase duration was also not significantly different (13 days). There were no significant differences in the mean number of pregnancies (12.0 versus 12.6% per cycle) and the abortion rate (18.2 versus 12.5%) between the GnRHa- and HCG-treated groups respectively. There were no complications related to treatment in either group. The results show that a relatively low dose of GnRHa can be used in place of HCG to induce ovulation in clomiphene citrate-treated patients.

Abortion, Spontaneous↗
PubMed1995

Recovery of ovarian function after laparoscopic detorsion.

In an attempt to preserve ovarian function, we managed 58 women with adnexal torsion by laparoscopic detorsion. Follow-up ultrasound examinations were performed on 54 of the women. Follicular development was evident in 49 of 52 (94.2%) women with normal-sized ovaries. We conclude that ovarian function returns in the majority of women with adnexal torsion managed conservatively.

Adnexal Diseases↗
PubMed1995

Induction of pre-ovulatory gonadotrophin surge with gonadotrophin-releasing hormone agonist compared to pre-ovulatory injection of human chorionic gonadotrophins for ovulation induction in intrauterine insemination treatment cycles.

The clinical outcome of intrauterine insemination (IUI) treatment cycles employing a gonadotrophin-releasing hormone agonist [GnRHa, triptorelin (Decapeptyl)] or human chorionic gonadotrophin (HCG) for ovulation induction was compared. A group of 48 patients presenting with amenorrhoea, oligomenorrhoea or unexplained infertility were all treated with human menopausal gonadotrophins (HMG) from day 5 of the cycle, on an individualized schedule. They were then randomly divided into two groups to receive either a single s.c. injection of 0.1 mg triptorelin or a single i.m. injection of 10,000 IU HCG after follicular maturation. IUI was performed approximately 24 and 48 h following the injection. A transitory increase in serum luteinizing hormone and follicle stimulating hormone concentrations was achieved following injection of GnRHa. A total of 24 patients received 72 treatment cycles with GnRHa, producing 11 conceptions (15.3%) and two abortions (18.2%), resulting in a term pregnancy rate of 13.6%. There were four cases of grade 3-4 ovarian hyperstimulation syndrome (OHSS), two of which were conception cycles. In all, 24 patients underwent 68 cycles treated with HCG, producing 18 conceptions (26.5%) and six abortions (33.3%), resulting in a term pregnancy rate of 19.0%. There were eight cycles of grade 3-4 OHSS, two of which were conception cycles. These results show that an s.c. injection of a relatively low dose of GnRHa can be as effective as HCG in producing pregnancy in IUI treatment cycles.

Abortion, Spontaneous↗
PubMed1995

Use of cordocentesis in the management of preterm or growth-restricted fetuses with abnormal monitoring.

The dilemma of when to deliver preterm or growth-restricted fetuses with abnormal monitoring is faced by all those treating such patients. Current noninvasive tests for fetal well-being have relatively high false-positive rates. Cordocentesis allows the clinician to directly analyze fetal blood and determine whether the fetus is truly in distress, is suffering from aneuploidy, or is plagued by infection. However, with improved neonatal care, otherwise normal infants of birth weight greater than 1500 gm have very low morbidity and mortality rates and any delay in delivery offered by cordocentesis is probably not justified. It is in the fetus whose estimated weight is below 1500 gm that cordocentesis should be used. If the results are normal, expectant management and the administration of corticosteroids will allow for pulmonary maturation and a more favorable outcome.

Cordocentesis↗
PubMed1995

Superovulation and intrauterine insemination in the treatment of male factor infertility.

Recent studies report that superovulation combined with intrauterine insemination (IUI) is more successful than superovulation alone, IUI alone or superovulation with intracervical insemination in couples with male subfertility. Our study evaluated two superovulation protocols in the management of male factor infertility using IUI: (A) clomiphene citrate and human chorionic gonadotropin (HCG) and (B) human menopausal gonadotropin and HCG. Fifteen couples with severe oligoasthenozoospermia (OAS) were treated with protocol A in 54 cycles, and no pregnancies were achieved. Eight of the 15 couples with severe OAS subsequently received protocol B for 24 cycles and elicited no pregnancies. Thirty-seven couples with moderate OAS received protocol A for 169 cycles, and 2 pregnancies ensued (5.4% per couple and 1.12% per cycle). Twelve of the 35 nonpregnant couples with moderate OAS then received protocol B for 31 cycles, and 4 pregnancies were recorded (33.3% per couple and 12.9% per cycle).

Adult↗
PubMed1994

[Neonatal alloimmune thrombocytopenia].

Neonatal alloimmune thrombocytopenia (NAIT) was first described in the 1950s. The disease results from maternal antiplatelet antibodies against surface antigens on fetal platelets due to feto-maternal platelet incompatibility. Although NAIT is transient, during its active phase thrombocytopenia can cause intracranial hemorrhage with grave neurological sequelae or death. We characterized the alloimmune antibodies in 29 mothers and found anti-HPA-1a (in 11 cases), anti-HPA1b (1), anti-HPA-5a (1) and anti-HPA-5b (5). In 11 women no specific antibodies were identified despite characteristic disease in the newborns. 3 neonates in the anti-HPA-1a, and 1 in the anti-HPA-1b groups were born with intracranial hemorrhage and are severely disabled. We described a case of successful prenatal treatment by a combination of steroids, high-dose immunoglobulins and intraumbilical platelet transfusion in a mother known to have anti-HPA-1, whose previous child was severely affected. It is important to examine antibodies in any woman whose neonate has thrombocytopenia of unknown etiology.

Antigens, Human Platelet↗
PubMed1994

[Colonic carcinoma during pregnancy].

A case of adenocarcinoma of the splenic flexure during pregnancy is reported. A 27-year-old woman was admitted at 34 weeks of pregnancy with abdominal pain and vomiting. 36 hours after normal delivery an emergency exploratory laparotomy was performed for intestinal obstruction. A huge tumor of the splenic flexure with retroperitoneal extension was found. She died 1 year later of metastatic disease. Delay in diagnosis and complications of colonic cancer are more prevalent in pregnancy. While colonic carcinoma during pregnancy is extremely rare, it should be included in the differential diagnosis of colonic symptoms. The 24th case of this type is reported.

Adenocarcinoma↗
PubMed1994

Comparison of first-trimester transvaginal amniocentesis with chorionic villus sampling and mid-trimester amniocentesis.

Between August 1989 and December 1991, 356 patients underwent first-trimester transvaginal amniocentesis (10-12 weeks). The same number of patients referred in the same period for mid-trimester amniocentesis (14-21 weeks) was matched also for maternal age and indication. A third group consisted of the first 356 cases in which chorionic villus sampling (CVS) was attempted. The overall success rate was 99.7 and 100 per cent for early and mid-trimester amniocentesis, respectively, and 97.2 per cent for CVS. The mean harvesting time was 12.8, 11, and 7.9 days, respectively. The percentage of patients rescheduled was 3.4 per cent in first-trimester amniocentesis, 1.7 per cent in mid-trimester amniocentesis, and 6.2 per cent in the CVS group. The early (less than 2 weeks) pregnancy loss was 1.7 and 0.6 per cent in early and mid-trimester amniocentesis, respectively, and 1.7 per cent in CVS. The total pregnancy loss was 3.2, 0.9, and 2.9 per cent, respectively. The rate of preterm birth was 6.0, 5.2 and 6.9 per cent, respectively. The results indicate that CVS has the shortest procedure-result interval, but the highest rescheduling rate. First-trimester amniocentesis has a higher procedure and laboratory success rate but, until otherwise proved, mid-trimester amniocentesis is the most efficient and safest procedure.

Abortion, Spontaneous↗
PubMed1994

Sonographic presentation of Hirschsprung's disease. A case of an entirely aganglionic colon and ileum.

Prenatal sonographic presentation of Hirschsprung's disease has been considered non-specific and uncommon. This report presents a second-trimester fetus with an aganglionic colon and ileum diagnosed by the sonographic presentation of dilated fetal bowel loops, increased abdominal circumference, and mild polyhydramnios. The prenatal sonographic diagnosis of Hirschsprung's disease helped to expedite early neonatal treatment.

Adult↗
PubMed1994

Routine thyroid function tests in infertile women: are they necessary?

To investigate the yield of routine thyroid function testing in infertile women, the records of 444 infertile women were categorized to standard infertility groups. Thyroid function was evaluated by measuring plasma free thyroxine and thyroid-stimulating hormone. All free thyroxine values were in the normal range (0.8 to 1.8 ng/ml), and only three thyroid-stimulating hormone values were higher than the normal range (0.15 to 4.5 mIU/L). The three women had ovulatory dysfunction. Thyroid function testing is more prudent in screening the subset of infertile women with ovulatory dysfunction and not as a routine measure in the infertile population.

Female↗
PubMed1994

Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin.

We present a case in which a pregnant woman was seen at 27 weeks' gestation with premature rupture of membranes and intraamniotic infection with Candida albicans, which was treated with transcervical amnioinfusion of amphotericin B. After 7 days of treatment spontaneous vaginal labor developed. A female newborn of 1030 gm was delivered. The infant was normal and did well.

Adult↗
PubMed1994

Induction of pre-ovulatory luteinizing hormone surge by gonadotrophin-releasing hormone agonist for women at risk for developing the ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a major risk in patients undergoing ovulation induction protocols. Withholding injection of human chorionic gonadotrophin (HCG) may prevent the development of OHSS, but can also result in failure to ovulate and conceive. We have used a gonadotrophin-releasing hormone agonist (GnRHa) as an alternative to HCG in women not undergoing in-vitro fertilization in an attempt to prevent OHSS. The study included 12 cycles in 12 women scheduled for ovulation induction with human menopausal gonadotrophin (HMG) who were at risk of developing OHSS (oestradiol > 3500 pg/ml, number of follicles > 20). GnRHa was injected to induce the pre-ovulatory, luteinizing hormone surge which triggers follicular maturation. Progesterone was administered for luteal support. Six pregnancies were achieved, and none of the 12 women developed OHSS. Since the pregnancy rate in this study was acceptable, we can recommend the use of GnRHa instead of HCG in any case at risk of developing OHSS.

Estradiol↗
PubMed1994

Laparoscopic management of adnexal cystic masses in postmenopausal women.

OBJECTIVE: To evaluate laparoscopic treatment of postmenopausal women with an adnexal cystic mass predicted to be benign. METHODS: Selection criteria were transvaginal sonographic appearance other than a complex cyst and a normal serum CA 125 level. During the period May 1988 to June 1993, 55 women fulfilled the criteria and underwent operative laparoscopy. During the same period, 75 postmenopausal women underwent exploratory laparotomy for an adnexal cystic mass that was complex in appearance or associated with elevated serum CA 125. RESULTS: Laparoscopic bilateral oophorectomy was performed in all 55 women. All had benign masses (positive predictive value 100%). Malignant tumors were found in 23 of the 75 women undergoing laparotomy (negative predictive value 30.7%). There was no significant difference in size of the tumors between women undergoing laparoscopy or laparotomy. CONCLUSION: Because of its safety and efficacy, laparoscopic management is the preferred procedure in postmenopausal women with a non-complex adnexal mass and a normal CA 125 level.

Adnexal Diseases↗