Biomedical subjects
Publications and source records attributed to E Shalev.
We present a case report of endocardial fibroelastosis combined with atrial septal defect in which the diagnosis was strongly suspected at 25 weeks of gestation. To our knowledge the only previous report of prenatal diagnosis of endocardial fibroelastosis was of one made at 36 weeks of gestation.
A case of fetal persistent cloaca is presented. The intra-uterine sonographic appearance at 30 weeks' gestation is described. The clinical and ultrasonic differential diagnosis is discussed.
Acute renal failure due to ureteral obstruction by the gravid uterus is considered to be a rare complication of late pregnancy. Pleural effusion caused by urinary tract obstruction is also extremely uncommon. This presentation reports what is believed to be the first case in which both these complications appeared at the same time in a pregnant patient.
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The effectiveness of ultrasonic femur length measurement from 12 to 40 week's gestation, as a means of assessing fetal age, was tested and compared with that of biparietal cephalometry. The femur length and biparietal diameter (BPD) were obtained from 471 measurements, from pregnant women with confirmed datings, using real-time scanning with a 3,5 mHz transducer frequency. Using a freeze frame and electronic calipers, the mean value of three consecutive measurements of the femur, when visualized with its characteristic appearance, was recorded. Linear regression analysis with the correlation coefficient of the femur growth-curve (r = 0.989, p less than 0.001) and that of the BPD (r = 0.985, p less than 0.001) showed that the former is as good as the latter. The femur growth-curve from 12 to 40 week's gestation with a mean +/- 2 SD was constructed. Estimation of fetal age by femur length measurement was compared with that assessed by the BPD in a further 54 women. A close correlation was found (r = 0.993, p less than 0.001). Measurement of the fetal femur appears to be a reliable method for assessing gestational age, which can compensate for the limitations of the BPD method.
The influence of fetal heart rate monitoring on endocrinological parameters (growth hormone, insulin, cortisol, dopamine, epinephrine and norepinephrine) for stress was tested in women during pregnancy and in labor. Significant increases in the levels of all hormones except dopamine were found during monitoring in women with the non-stress test in comparison with the control group. Increases of more than 50% in the level of all hormones were found during labor with or without monitoring, reflecting stress during labor. The implication of fetal heart rate monitoring on the emotional state of the pregnant woman must be taken seriously.
Placental hemangioma is considered to be associated with a high rate of maternal and fetal complications. We report a case where ultrasonography revealed the placental tumor at 28 weeks gestation. The patient was kept under strict surveillance which permitted diagnosis of pre-eclampsia at 34 weeks gestation with successful termination of pregnancy at 37 weeks. The ultrasonic features of the tumor are described and the clinical implication discussed.
Estrogen-secreting Sertoli cell tumor of the ovary is rare. The few cases reported were characterized by metrorrhagia suggesting the hyperestrogenic state. An additional case of Sertoli cell tumor is reported in which the clinical picture is of secondary amenorrhea followed by metrorrhagia. The endocrinological status was investigated by hormonal assays showing a high level of estradiol, which was consistent with endometrial biopsy. A review of the literature together with a discussion on the histogenesis and diagnosis of the tumor is presented.
Prematurity still remains one of the unsolved problems in obstetrics and is responsible for a majority of cases of perinatal morbidity and mortality. The use of indomethacin to stop uterine contractions and prevent premature delivery is based on the observation that indomethacin inhibits the release of prostaglandin which is assumed to play a role in the induction and continuation of labor. The effect of indomethacin as an antagonist to prostaglandin was evaluated in a series of 297 women in premature labor. The gestational age at admission varied between 24 and 34 weeks of pregnancy (120 primiparas and 177 multiparas). In 83% of cases there was complete cessation of labor for a period of 1 to 12 weeks, in 10% of cases from 2 to 7 days and in 7% there was no effect. The delay of premature labor for 2 to 7 days allowed the administration of betamethasone in an attempt to improve fetal lung maturity. The total daily dose needed for successful treatment was between 200-300 mg indomethacin. Dilation of cervix beyond 4 cm was associated with successful treatment in 58% compared to 90% if cervix was dilated 3 cm or less. In comparing women with intact membranes to women with ruptured, the success rate in suppressing premature labor was significant; 88% versus 53%. In 49 patients delivery was delayed 11-12 weeks. Fifty-one babies were born in spite of therapy, and of these 15 with birth weights of 700-1500 g suffered from respiratory distress syndrome and died. All the rest (36 premature and 246 mature infants) showed no ill effects related to the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
In the etiology of premature labor prostaglandins fulfill a significant role. It is known that indomethacin is a strong inhibitor of prostaglandin synthesis. The effect of indomethacin on premature labor was studied in a prospective randomized double-blind study in 36 patients. Eighteen patients received indomethacin and eighteen received placebo. 200-300 mg of indomethacin was the total dosage in a 24 hours period. The activity of the uterus was monitored with a cardiotocograph. The mean duration of pregnancy and the mean birth weight in indomethacin group (36.4 weeks, 2833 g) were both significantly greater (p less than 0.001) than that in placebo group (31.2 weeks, 2028 g). In the indomethacin group 3 children weighted less than 2500 g compared with 14 in placebo group. In 15 of 18 indomethacin treated patients (83.3%) premature labor was arrested after indomethacin treatment compared with 4 of 18 in the placebo group (22.2%). The indomethacin group had a mean 1 minute APGAR score of 9.3 +/- 0.2 whereas the placebo group showed a score of 7.8 +/- 0.5 (p less than 0.01). Three infants died from respiratory distress syndrome; one in the indomethacin group (1810 g) and two in the placebo group (600 and 1450 g). Autopsies in the infants demonstrated a typical picture of pulmonary atelectasis and hyaline membranes. There was no evidence of premature closure of the ductus arteriosus or pulmonary hypertension. 2 mothers in the indomethacin group suffered minor discomfort i.e. nausea, vomiting and vertigo.(ABSTRACT TRUNCATED AT 250 WORDS)
Ultrasound diagnosis of bilateral hydronephrosis, hydroureters, and megacystis together with oligohydramnios secondary to urethral stenosis was made in a male fetus at 29 weeks' gestation. In utero decompression of the obstructed urinary tract and expansion of the amniotic fluid was achieved by placing an external bladder-amniotic fluid shunt using two catheters, one inserted into the fetal bladder and the other placed in the amniotic sac. The infant was delivered by cesarean section at 35 weeks' gestation and had a favorable outcome.
The first case of prenatal real-time ultrasonographic diagnosis of micrognathia is presented. Diagnosis was made at 17 weeks' gestation in the fetus of a patient with previous infant affected with the syndrome of thrombocytopenia with absent radii (TAR). Recognition of micrognathia as a part of TAR syndrome and the easy visualization of fetal facial bones in the second trimester made diagnosis possible.
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Epidemiological, clinical and laboratory data were obtained relating to 89 pregnant women who suffered from viral hepatitis during the period 1967-1977 in Israel. The obstetrical data, course of labor and details about the newborn, were all compared with the accepted obstetrical standards in Israel and abroad. A follow-up study was made of the 89 women and 69 of the offspring from these pregnancies, covering a period of from 2 to 10 years. The data of the present study demonstrate that during the last decade, a period of generally rising socio-economic status in Israel, viral hepatitis in pregnant women, ran a more favorable course than that previously reported. The incidence of hepatitis is equal in all trimesters of pregnancy, and a favorable outcome may usually be anticipated for the mother and the newborn.
A case is presented of a patient with xanthogranulomatous pseudotumor in the pelvic region. The pseudotumor was probably the result of inflammatory reaction in both tubes and in the uterine cavity, with pyometra. The condition is very rare and only 5 cases could be found in the literature.