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Biomedical subjects

I Bar-Hava

Publications and source records attributed to I Bar-Hava.

At least 73 records · Page 4Linked to original sources
PubMed1997

A new concept of cotreatment with human growth hormone and menotropins in ovulation induction protocols.

Follicular development in the primordial and preantral stages is almost completely independent of gonadotrophins or steroids and is mainly dependent on growth factors and local regulators. Since human growth hormone (hGH) was found to facilitate ovarian response to gonadotrophin stimulation, we hypothesized that the administration of hGH in an hypogonadotrophic state and prior to ovarian stimulation with menotropins, may initiate or facilitate the propagation of the primordial and preantral follicles to the gonadotrophin-dependent stages. We suggest that treatment with hGH prior to menotropin administration may be useful to improve results for poor responders to gonadotrophins.

Clinical Protocols↗
PubMed1997

Ovarian cysts and cyclic hormone replacement therapy: is there an association?

OBJECTIVES: To evaluate whether there may be an association between postmenopausal ovarian cysts and hormone replacement therapy. METHODS: The study comprised 564 consecutive, asymptomatic, postmenopausal women who were referred for routine, transvaginal ultrasound examinations between January 1 and December 31, 1995. Various demographic and ultrasonographic parameters were recorded on a prospectively-created, computerized data base. RESULTS: There was no difference in the prevalence of ovarian cysts with or without hormone replacement therapy (10.5% vs. 12.5%, respectively). However, in the subgroup of early postmenopausal women (40-55 years), the use of hormone replacement therapy was associated with a significantly reduced prevalence of ovarian cysts (10.4% vs. 28.6%; p < 0.05). CONCLUSIONS: Hormone replacement therapy is associated with a reduced prevalence of ovarian cysts in early postmenopause.

Analysis of Variance↗
PubMed1997

Interleukin-2 production by human pre-implantation embryos.

The study was conducted to determine whether pre-implantation embryos secrete interleukin-2. Conditioned media of 27 embryos derived from women during in vitro fertilization (IVF) cycles were analyzed for interleukin-2 concentration. The results showed that conditioned embryo medium from the two pronuclei stage to 24 hours later contains interleukin-2. Endometrial large granular lymphocytes, which are probably involved in placentation, replicate in response to interleukin-2. It may therefore be speculated that interleukin-2 secreted by human embryos may modulate the function and replication of large granular lymphocytes.

Blastocyst↗
PubMed1997

Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in utero visualization of transient and late-onset clubfoot. Early (13-16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow-up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow-up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late-onset (22-24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in utero clubfoot can be both a transient and a late-onset phenomenon. Over- and under-diagnosis are potential hazards in these situations.

Clubfoot↗
PubMed1996

[Surgical treatment of extrauterine pregnancy: end of the era of laparotomy?].

Ectopic pregnancies can now be recognized very early, and in most cases, before the appearance of dramatic symptoms. This can be attributed mainly to improved diagnostic methods, such as endovaginal sonography and serial determinations of human, chorionic gonadotropin and progesterone. For this reason, extrauterine pregnancies can currently be treated by several methods, and emergency laparotomy is seldom indicated. Advances in treatment modalities, including tubal-conserving operations, laparoscopic approaches, medical treatment with methotrexate, and expectant management have all been proved to be safe and effective. Between January 1994 and June 1995, 166 patients were treated surgically for extrauterine pregnancy. Of these, 94.6% were treated by laparoscopy; laparotomy was required in only 9 (5.4%). Fecundity rates after laparoscopic treatment for ectopic pregnancy are comparable, if not better, than in those treated by laparotomy. Laparoscopic surgery offers advantages, such as reduction in operating time and shorter hospital stay and convalescence, as compared to conventional abdominal surgery. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be performed safely by laparoscopy.

Female↗
PubMed1996

Doppler study of the fetal cardiac function in prolonged pregnancies.

OBJECTIVE: To evaluate the association between fetal cardiac function and amniotic fluid index (AFI) in postterm fetuses, and to determine if changes in fetal cardiac function precede the occurrence of nonreassuring intrapartum fetal heart rate (FHR) patterns. METHODS: Forty-five otherwise low-risk pregnant women between 41 and 43 weeks' gestation were studied longitudinally. Gestational age was confirmed in all patients by ultrasound before 20 weeks' gestation. Each subject had two or three tests performed every 3-4 days, including a non-stress test, a biophysical profile, and Doppler studies of the aortic and pulmonic outflow tracts. Aortic and pulmonic artery flow velocity waveforms were recorded slightly distal to the valves. Peak velocity, velocity time integral, and heart rate were calculated from the flow velocity waveforms we obtained. The change in AFI and aortic and pulmonic peak velocity and [velocity time integral] x [heart rate] were calculated for each fetus. RESULTS: Labor was induced at 42 weeks' gestation in 20 patients, and 17 entered labor spontaneously. Changes in AFI, observed during the follow-up period, correlated significantly with changes in aortic peak velocity (r = 0.54, P < .01) and with aortic outflow [velocity time integral] x [heart rate] (r = 0.60, P < .001) but not with pulmonic peak velocity and [velocity time integral] x [heart rate]. The decrease in aortic peak velocity and aortic and pulmonic [velocity time integral] x [heart rate] was significantly higher (P < .01) in eight fetuses that developed a nonreassuring intrapartum FHR (reduced FHR variability, late decelerations, and severe variable decelerations) than in those who had an uneventful labor. CONCLUSION: In prolonged pregnancies, cardiac function deteriorates in fetuses that develop a nonreassuring intrapartum FHR, and the changes in the left cardiac function correlate with changes in AFI.

Adult↗
PubMed1996

Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome.

In order to determine which factors influence the large variations in sensitivity to gonadotrophins witnessed in women with polycystic ovary syndrome (PCOS), a prospective study was conducted of the correlation between basal clinical and endocrinological features and gonadotrophin requirements of 20 women with clomiphene-resistant PCOS undergoing ovulation induction. Baseline evaluation of serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, fasting insulin, insulin-like growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP-1) and sex hormone-binding globulin (SHBG) were performed before administering gonadotrophin-releasing hormone agonist (GnRHa). Two weeks later, human menopausal gonadotrophin (HMG) was given in a standard individualized protocol according to ovarian response, until human chorionic gonadotrophin (HCG) was given. Serum concentrations of insulin, IGF-1, and IGFBP-1 were unaffected by GnRHa. The BMI correlated positively with insulin and inversely with IGFBP-1 serum concentrations and insulin and IGFBP-1 were inversely correlated. The amount of HMG required correlated positively with BMI and insulin concentrations and inversely with IGFBP-1 in the whole group and these correlations were maintained in the sub-group of lean women. No correlation was observed between HMG requirements and IGF-1 or other hormones. Women with hyperinsulinaemia and low IGFBP-1 concentrations required significantly more HMG. Multiple regression analysis revealed that insulin concentration is the most significant determinant of HMG requirement even when dissociated from BMI. We concluded that requirements of HMG in PCOS is not merely determined by obesity but by a cardinal role of insulin concentrations which, when high, induce, hypothetically, a hyperandrogenic intrafollicular milieu.

Adult↗
PubMed1996

A delayed starting schedule of oral contraception: the effect on the incidence of breakthrough bleeding and compliance in women.

OBJECTIVES: To assess the effect of oral contraception started on the first day of menses and the fifth day following its onset, on women's compliance and the incidence of early breakthrough bleeding. METHODS: Oral contraceptives (OCs) containing 30 micrograms ethinylestradiol and 75 micrograms gestodene were prescribed to 100 consecutive, healthy women for whom OCs were found to be the most suitable method of contraception. In the first 50 women, OCs were started on the first day of menses (day 1 group), while in the remaining 50 women, OCs were started on the fifth day after the onset of menses (day 5 group). RESULTS: The day 5 group had better compliance and a reduced incidence of breakthrough bleeding. No differences were observed between the two groups regarding age, parity and gravity. CONCLUSION: Starting an OC regimen should include initiation on the fifth day following the onset of menses. This regimen might increase patient compliance and lower the incidence of breakthrough bleeding.

Adolescent↗
PubMed1996

Can fetal renal artery Doppler studies predict postnatal renal function in morphologically abnormal kidneys? A preliminary report.

PURPOSE: The diagnosis of multicystic kidney in utero can be made with reasonable reliability with real-time sonography. However, a cystic hydronephrotic kidney may be difficult to distinguish from a multicystic kidney, necessitating postnatal renography. We report our preliminary observations of Doppler waveform variation in normal and cystic fetal kidneys. MATERIALS AND METHODS: Five consecutive fetuses with a unilateral cystic kidney, and one with a unilateral hydronephrotic duplex kidney and cystic upper moiety were evaluated in utero with color Doppler renal sonography. RESULTS: Doppler signal on serial ultrasound was consistently absent in the ipsilateral cystic kidney, while normal renal artery Doppler waveforms with a systolic and diastolic component were obtained from the contralateral and unaffected moieties. Postnatal renography confirmed nonfunction in all cystic moieties. The hydronephrotic noncystic moiety of the duplex kidney showed a normal Doppler waveform and good function. CONCLUSIONS: Absence of renal artery Doppler waveforms in fetal cystic kidneys correlates with renal nonfunction. If this observation can be further confirmed by additional cases, fetal Doppler sonography would become an additional tool to diagnose confidently a multicystic kidney in utero, which may allow us to dispense with postnatal renography.

Female↗
PubMed1996

Accuracy of intrapartum estimates of fetal weight. Effect of oligohydramnios.

OBJECTIVE: To study the effect of oligohydramnios on the accuracy of intrapartum clinical and sonographic estimates of fetal weight (EFWs). STUDY DESIGN: Intrapartum clinical and sonographic EFWs and an amniotic fluid index (AFI) were obtained on 124 term patients. Oligohydramnios was defined as an AFI < or = 5 cm. RESULTS: Clinical and sonographic EFWs in women with oligohydramnios were significantly less accurate than estimates derived in patients with normal amniotic fluid: P = .03 and .02, respectively. The incidence of clinical and sonographic EFWs within +/-10% of the actual birth weight were 70.1% and 68.4%, respectively (P = NS). CONCLUSION: In term patients, intrapartum sonographic prediction of birth weight offers no advantage over estimated fetal weight obtained by abdominal palpation. The presence of oligohydramnios significantly reduces the accuracy of intrapartum clinical as well as sonographic EFWs. Therefore, we suggest that intrapartum EFWs be obtained prior to artificial rupture of the membranes.

Amniotic Fluid↗
PubMed1995

The significance of early second-trimester sonographic detection of minor fetal renal anomalies.

A study of 6350 consecutive transvaginal ultrasound examinations was performed as part of a routine fetal evaluation. Twenty-one cases (0.33 per cent) of early second-trimester sonographic detection of minor renal abnormalities (unilateral renal agenesis, pelvic kidney, and double collecting system) are presented. The sonographic diagnosis was made at 14-18 weeks of pregnancy and confirmed, in all of the 21 fetuses, postnatally or by post-mortem. A high incidence of associated fetal anomalies (24 per cent) and parental renal abnormalities (14 per cent) was demonstrated. Transvaginal sonography was found to be a useful tool for diagnosing these renal anomalies as early as 14 weeks of pregnancy. The likelihood of various associated anomalies and long-term implications on renal function raise questions concerning the prenatal management of such patients.

Female↗
PubMed1995

Is oligohydramnios in postterm pregnancy associated with redistribution of fetal blood flow?

OBJECTIVE: Our purpose was to determine whether postterm patients with oligohydramnios differ in their fetal and umbilical blood flow distribution from those with a normal volume of amniotic fluid. STUDY DESIGN: Pulsed-wave Doppler imaging was used prospectively to determine the resistance index in the fetal middle cerebral, renal, and umbilical arteries in 57 postterm (i.e., > 41 weeks' gestation) pregnancies. Semiquantitative assessment of amniotic fluid volume was obtained by use of the ultrasonographically determined amniotic fluid index. RESULTS: Oligohydramnios (amniotic fluid index < 5 cm) was detected in 15 patients; 42 patients with a normal amniotic fluid index served as a control group. The various resistance index values and the ratio s among them were not significantly different when patients with oligohydramnios were compared with controls (0.51 +/- 0.1 vs 0.52 +/- 0.06, 0.63 +/- 0.1 vs 0.64 +/- 0.08, and 0.71 +/- 0.08 vs 0.73 +/- 0.05 for the umbilical, middle cerebral, and renal arteries, respectively). However, the mean birth weight (in grams) was significantly lower (3297 +/- 438 vs 3742 +/- 448, p < 0.003), in the oligohydramnios group. CONCLUSION: Oligohydramnios was not associated with a major redistribution of blood flow in postterm patients, suggesting that the cause of oligohydramnios in these patients is related to birth weight rather than to renal perfusion.

Amniotic Fluid↗
PubMed1995

Is polyhydramnios in an ultrasonographically normal fetus an indication for genetic evaluation?

OBJECTIVE: Our purpose was to determine the frequency of fetal chromosomal anomalies in pregnancies complicated by polyhydramnios. STUDY DESIGN: Between Jan. 1, 1992, and July 31, 1993, an amniotic fluid index was measured prospectively in 2730 third-trimester pregnant women. Polyhydramnios was defined as an amniotic fluid index > or = 24 cm. A computer search identified all infants born with structural or chromosomal anomalies. RESULTS: Polyhydramnios was detected in 49 of 2730 women (1.7%). The incidence of chromosomal anomalies was two in 49 (4.1%) compared with three in 2681 (0.12%) among women with normal fluid (p < 0.05). Six of the 49 newborns had structural anomalies (12.2%), whereas 48 of 2681 (1.8%) structural anomalies occurred in the control group (p < 0.05). Among study patients both fetuses with chromosomal anomalies were growth retarded; four of the six structural anomalies were associated with an amniotic fluid index > 30 cm. CONCLUSIONS: (1) Polyhydramnios is associated with an increased incidence of congenital fetal anomalies. (2) Growth-retarded fetuses with polyhydramnios warrant genetic evaluation. (3) A genetic study is not absolutely indicated for patients with polyhydramnios and a sonographically normal fetus.

Amniocentesis↗
PubMed1995

A severe case of ovarian hyperstimulation syndrome despite the prophylactic administration of intravenous albumin.

OBJECTIVE: To evaluate the role of the recently suggested IV administration of human albumin solution as an effective preventive measure of severe ovarian hyperstimulation in high-risk patients. CASE: Presented here is, to the best of our knowledge, the first case of early severe ovarian hyperstimulation necessitating early transabdominal aspiration of ascites and intensive fluid and colloid (dextran and albumin) replacement, which developed despite administration of IV human albumin solution in an attempt to prevent severe ovarian hyperstimulation. CONCLUSIONS: Because IV albumin does not prevent severe ovarian hyperstimulation in absolute terms, its use in high-risk patients should not lead one astray. Further research should be directed at investigating the fundamental cause of ovarian hyperstimulation syndrome and developing a reliable predictive test for this complication.

Adult↗
PubMed1994

Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.

OBJECTIVE: Our purpose was to determine the association between amniotic fluid volume and recent glucose status in gestational diabetes. STUDY DESIGN: Serial amniotic fluid index values, mean blood glucose levels, and percent hyperglycemia (> or = 120 mg/dl) 1 day and 1 week before the ultrasonographic examinations were prospectively collected in 399 gestational diabetics. Patients demonstrating at least one amniotic fluid index measurement within the normal range (i.e., 5 cm < amniotic fluid index < or = 20 cm) and at least one elevated measurement (i.e., amniotic fluid index > 20 cm) formed the study group. With each patient serving as her own control, glucose index values preceding normal and elevated amniotic fluid index values were compared. RESULTS: Significantly higher mean blood glucose values 1 day (114.7 mg/dl vs 102.8 mg/dl, p < 0.01) and 1 week before (111.0 mg/dl vs. 102.0 mg/dl, p < 0.05) were calculated for examinations resulting in elevated amniotic fluid index values compared with normal amniotic fluid index values, respectively. Similarly, significantly higher percents of hyperglycemia 1 day (32% vs 16.5%, p < 0.05) but not 1 week (30.8% vs 21.7%, p > 0.05) before the elevated amniotic fluid index were documented. CONCLUSION: Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.

Adult↗
PubMed1994

Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy.

Cervical pregnancy is a rare form of EP often resulting in an obstetric catastrophe. We report a case of a combined viable IUP and cervical pregnancy resulting from IVF-ET treatment and which was diagnosed during the 7th week of gestation. Nonsurgical treatment consisting of selective intra-arterial catheterization and administration of MTX directly into the uterine arteries was carried out successfully. Complications were avoided, and the patient's reproductive capability was preserved.

Adult↗