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Biomedical subjects

J G Schenker

Publications and source records attributed to J G Schenker.

At least 37 records · Page 2Linked to original sources
PubMed1999

A laparoscopic technique for obtaining ovarian cortical biopsy specimens for fertility conservation in patients with cancer.

OBJECTIVE: To evaluate the efficacy of a newly designed round biopter as a practical and safe method for collecting ovarian tissue for cryopreservation in young women with cancer before chemotherapy. DESIGN: Prospective study of young women volunteering for research (Leeds, United Kingdom) and patients with cancer (Jerusalem, Israel and Leeds, United Kingdom) undergoing laparoscopic ovarian cortical tissue biopsy and cryopreservation before administration of high-dose radiochemotherapy. SETTING: Two university-based tertiary referral centers of oncology and gynecology (Hadassah Medical Center, Israel; Leeds General Infirmary, United Kingdom). PATIENT(S): Twenty female volunteers undergoing routine laparoscopic gynecologic procedures (age, 25-34 years) and 20 young women (age, 11-30 years) with advanced cancer requiring potentially sterilizing radiochemotherapy. INTERVENTION(S): Cortical ovarian tissue biopsies performed under laparoscopy with use of the round biopter. RESULT(S): The laparoscopic sampling procedure was uncomplicated in all cases. In treated patients, five to six samples were obtained (5 mm in diameter; 2-3 mm in depth) using the round biopter, and radiochemotherapy was administered without delay. In volunteers, no adhesions were noted at repeat laparoscopy (9 patients). All biopsy specimens were cryopreserved, and histologic examination confirmed the presence of many primordial follicles. CONCLUSION(S): Laparoscopic ovarian biopsy performed with the round biopter is a safe and efficient method for collecting ovarian tissue for cryopreservation in patients with cancer.

Adolescent↗
PubMed1999

Clinical aspects of ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is characterized by massive transudation of protein-rich fluid (mainly albumin) from the vascular space into the peritoneal pleural and to a lesser extent to the pericardial cavities. The intensity of the syndrome is related to the degree of the follicular response in the ovaries to the ovulation inducing agents. OHSS is still a threat to every patient undergoing ovulation induction. The pathophysiology of OHSS is of extreme importance in the face of the increased use of ovulation induction agents as well as the development of sophisticated assisted reproductive techniques. The correlation found between plasma cytokine activities and the severity of OHSS suggests that plasma cytokines may be involved in the pathogenesis of OHSS and may serve as a means of monitoring the syndrome during the acute phase and throughout convalescence. The interactions between cytokine and non-cytokine mediators of the syndrome, such as the renin-angiotensin system and vascular endothelial growth factor were recently clarified. Awareness of possible mechanisms and factors in the pathophysiology of OHSS will hopefully provide opportunities to design specific treatment regimens effective for both prevention and treatment of this potentially fatal iatrogenic condition. Among IVF patients with severe and critical OHSS, pregnancy rates, multiple gestations, miscarriage, preterm premature rupture of the membranes, prematurity, and low birth weight rates are significantly higher than those reported previously for pregnancies after assisted conception. The incidence of other obstetrical complications, as well as congenital malformations and Cesarean section rates are not significantly different.

Adult↗
PubMed1999

Induction of ovulation and borderline ovarian cancer--the hormonal connection?

While the data regarding the possible association between fertility drugs and invasive ovarian cancer are inconclusive, there is evidence to suggest an association between induction of ovulation and borderline ovarian tumors. The plausibility of these results is heightened by the finding that estrogen receptor expression is a common feature of ovarian borderline tumors. On the other hand, recent data indicate that in contrast to the crucial role of germline mutations in the pathogenesis of invasive ovarian cancer, these mutations play a minor role, if any, in the pathogenesis of borderline ovarian tumors. This evidence suggests that the differences between invasive and borderline ovarian tumors are not based on minor morphological criteria, but that, most probably these represent two different entities, with different clinical behavior, and that borderline tumors might be associated with hormonal factors rather than genetic mutations.

Female↗
PubMed1999

A historical perspective of the clinical evolution of the assisted reproductive technologies.

The practice of assisted reproduction technology today is the result of the dedicated patient care, observation, research, and experimentation undertaken by previous generations of physicians. The building blocks of progress have been assembled over past decades, by scientists whose primary objective has been to push forward the frontiers of knowledge, in order to offer more effective methods of infertility treatment. And fortunately that process continues today. Amongst the many scientific developments that have led to the modern practice in assisted reproductive technology, a small number stand out as having had a unique importance. This historical review redraws the path through which in vitro fertilization went from an experimental to an accepted infertility treatment.

Female↗
PubMed1999

Voluntary and involuntary sterilization: medical, ethical, legal and religious aspects.

Surgical voluntary sterilization has become one of the most widely used methods of contraception, with vasectomy and tubal sterilization being the most commonly employed techniques, associated with a low failure, morbidity, mortality, and long-term sequelae rate. As sterilization is related with the elimination of the possibility for procreation, a number of ethical, legal and religious issues have arisen, leading often to personal misjudgements, legal disputes, and failures in applying family planning. Involuntary sterilization is currently not practiced, except in cases of severely mentally retarded people, who are unable to appreciate the consequences of their acts or care for their children and who may have a high likelihood of propagating hereditary disease.

Ethics, Medical↗
PubMed1998

The incidence of borderline ovarian tumors in Israel: a population-based study.

BACKGROUND: In hospital-based studies, one-eighth of ovarian cancers have been considered borderline ovarian tumors (BOTs). Population-based data regarding the incidence of BOTs are lacking in the international literature. The authors' objectives were to measure the incidence of BOT in Israel and compare rates among ethnic groups (based on ethnic group and country of birth) for the years 1985-1993. METHODS: The authors analyzed data reported to a nationwide cancer registry. Population estimates by subpopulation were derived from census and intercensus estimates, which were based on an updated population registry. RESULTS: The age-adjusted standard rate (ASR) for the entire population was 10.6 per million (95% confidence interval [CI], 9.2-12.0) for the period 1985-1993. Significant differences in ASR were observed among ethnic subgroups, with the lowest incidence among non-Jews (ASR, 5.0 per million; 95% CI, 0.7-9.3) and the highest among new immigrants from the former Soviet Union (FSU) who had been arriving since 1989 (ASR, 22.7 per million; 95% CI: 14.2-31.3). Between the periods 1985-1989 and 1990-1993, the ASR for Jews nearly doubled (rate ratio, 1.86; 95% CI, 1.1-2.5). This near-doubling was influenced, but not wholly accounted for, by the immigration from FSU and was observed in all ethnic subgroups. CONCLUSIONS: The variations in the incidence rates of BOT among ethnic groups may be related to differences in fertility patterns, use of fertility drugs, and genetic predisposition. The pattern of near-doubling in rates may reflect biases caused by increased detection or shifts in the classification of ovarian tumors; if they are real, a biologic explanation is needed.

Adenocarcinoma, Mucinous↗
PubMed1998

Obstetric outcome of in vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study.

OBJECTIVE: To assess the outcome of pregnancies conceived with the use of IVF that are complicated by severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A retrospective nationwide multicenter study. SETTING: Sixteen of 19 tertiary care medical centers in Israel. PATIENT(S): All patients undergoing IVF who were hospitalized for severe OHSS between January 1987 and December 1996. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR) and rates of multiple gestation, miscarriage, ectopic pregnancy, obstetric complications, and intervention. RESULT(S): A total of 163 patients who had severe OHSS after IVF treatment were identified, of whom 142 (87.1%) had undergone ET. The clinical PR was 73.2%; 42.3% were singletons, 33.6% were twins, 17.3% were triplets, and 6.7% were quadruplets. The miscarriage rate was 29.8%, whereas the incidence of ectopic pregnancy was 1.9%. Forty-four percent of all births were premature, and 62.1% of all newborns had low birth weight. The most common antenatal complications were pregnancy-induced hypertension (13.2%), gestational diabetes (5.9%), and placental abruption (4.4%). The rate of cesarean section was 44.1%. CONCLUSION(S): Among patients who have severe OHSS after IVF treatment, the pregnancy rate and the rates of multiple gestation, miscarriage, prematurity, low birth weight, pregnancy-induced hypertension, gestational diabetes, and placental abruption are significantly higher than those reported previously for pregnancies conceived with the use of assisted reproductive techniques.

Adult↗
PubMed1998

Pre-embryo donation: ethical and legal aspects.

Genetic material donation has become an integral part of the management of infertility. Sperm, oocyte and pre-embryo donation are successful both medically and technically. The practice of genetic material donation raises ethical, legal, religious and social issues. The practice of pre-embryo donation raises several unique issues, such as the status of the pre-embryo and its well-being. Medical problems which need to be considered include selection of the donors, evaluation of the recipients and quality control of the genetic material. The relationship between the biological and social parents, and the safeguarding of the interests of the offspring, may be resolved by specific legislation pertaining to each country. Potential pre-embryo banks should be subjected to licensing and should not be run by a commercial system. By practicing pre-embryo donation, the medical profession and society should consider not only the interests of the infertile couple, but also the interests of the offspring.

Bioethics↗
PubMed1998

Violence against women: the physician's role.

Violence against women is one reflection of the unequal power relationship between men and women in societies. Reflections of this inequality include marriage at a very young age, lack of information or choice about fertility control and forced pregnancy within marriage. The different forms of violence against women are: domestic violence and rape, genital mutilation or, gender-based violence by police and security forces, gender-based violence against women during armed conflict, gender-based violence against women refugees and asylum-seekers, violence associated with prostitution and pornography, violence in the workplace, including sexual harassment. Violence against women is condemned, whether it occurs in a societal setting or a domestic setting. It is not a private or family matter. The FIGO Committee for the Study of Ethical Aspects of Human Reproduction released statements to physicians treating women on this issue. Physicians are ethically obliged to inform themselves about the manifestations of violence and recognize cases, to treat the physical and psychological results of violence, to affirm to their patients that violent acts toward them are not acceptable and to advocate for social infrastructures to provide women the choice of seeking secure refuge and ongoing counselling.

Domestic Violence↗
PubMed1998

Gaucher's disease and pregnancy.

Gaucher's disease is an autosomal recessive lysosomal storage disease, resulting from a deficiency of the enzyme glucocerebrosidase, which is required for the lysosomal degradation of glycolipids. The clinical manifestations of the disease show a large heterogeneity, including hepatosplenomegaly, "bone crisis" and fracture, anemia, thrombocytopenia and, in the rarest types II and III, neurological decompensation. Type I, the most common form, usually presents with less severe symptoms and at a more advanced age. More than 30 mutations within the glucocerebrosidase gene have been recognized, and certain mutations seem to be related with a particular phenotype expression of the disease. Modern diagnosis of Gaucher's disease is performed by either determining the enzyme activity in peripheral blood leukocytes or through DNA-based analysis. Pregnancy concurrent with Gaucher's disease has several risks, including an increased severity of anemia and thrombocytopenia that can potentiate postpartum bleeding, and increased risk of infection and possibly an increased spontaneous abortion rate. Nevertheless, the majority of these pregnancies seem to proceed to term without significant complications. The effects that pregnancy might have on the course of the disease are still unresolved. Enzyme replacement therapy with alglucerase is the treatment of choice for patients with Gaucher's disease, but it is yet to be shown whether alglucerase reduces the risk of these complications during pregnancy and whether its use has any adverse effect on fetal development. We present an extensive review of the current literature regarding Gaucher's disease with special emphasis on pregnancies coexistent with this disease and, an analysis of the genetics, relevant prenatal diagnostic issues, and current treatment modalities.

DNA Transposable Elements↗
PubMed1998

Febrile morbidity in severe and critical ovarian hyperstimulation syndrome: a multicentre study.

The objective of this study was to define the incidence of febrile morbidity and its causes in severe and critical ovarian hyperstimulation syndrome (OHSS). For this purpose, we reviewed the medical records of all OHSS patients hospitalized in 16 out of 19 tertiary medical centres in Israel between January 1987 and December 1996. Febrile morbidity was defined as at least one episode of temperature rise above 38 degrees C lasting > or =24 h. A total of 2902 patients (3305 hospitalizations) with OHSS was identified, of whom 196 had severe, and 13 critical, OHSS. Among the 209 patients investigated the incidence of febrile morbidity was 82.3%, of which 20.5% was attributed to urinary tract infection, 3.8% to pneumonia, 3.3% to upper respiratory tract infection, 2.0% to intravenous line phlebitis, 1.0% to cellulitis at an abdominal puncture site, 1.0% to postoperative wound infections and 0.5 % to gluteal abscess at the site of progesterone injection. Non-typical organisms were frequently isolated, such as Pseudomonas, Proteus, Klebsiella and Enterobacter species. No infectious aetiology was found in 105 patients (50.2%). Hypoglobulinaemia was recorded in most patients, while ascitic and pleural fluids aspirated from these patients contained high globulin concentrations. We conclude that infection-related febrile morbidity in severe and critical OHSS is high, and may be attributed to some degree of immunodeficiency associated with loss of plasma globulins to the third space. However, non-infection-related febrile morbidity is even higher and may be attributed to endogenous pyrogenic mechanisms.

Adult↗
PubMed1998

The right to an heir in the era of assisted reproduction.

The latest remarkable technological advances in assisted reproduction, which enable cryopreservation of spermatozoa, embryos and ovarian tissue, raise difficult and debatable legal, social, ethical and moral issues concerning the right to posthumous reproduction. Furthermore, reports on the attitudes of the general public and of centres licensed for infertility treatment in the United Kingdom found that the majority of women and centres support the idea of posthumous reproduction. In this paper we review the data published on this issue, and after considering the various aspects, we conclude that each case should be discussed and authorized by a multidisciplinary committee that includes physicians, clergy, psychiatrists, psychologists, sociologists and other appropriate parties. In our opinion, the main principles that should guide this committee would allow posthumous reproduction in the context of marriage when a prior consent exists. For unmarried persons, post-mortem donation of gametes should be done only anonymously, if they are in agreement with existing laws concerning infertility treatments in every country and after appropriate consent and proper counselling. Moreover, any case which involves consanguinity or a possibility of incest should be forbidden, both for ethical and genetic reasons. In a case of pre-existing siblings, they should be consulted and their informed consent should be granted in advance so as to avoid legal problems in the inheritance of property.

Attitude↗
PubMed1998

A birth in non-mosaic Klinefelter's syndrome after testicular fine needle aspiration, intracytoplasmic sperm injection and preimplantation genetic diagnosis.

Non-mosaic Klinefelter patients are generally azoospermic due to primary testicular failure. Nevertheless, in some cases, testicular spermatozoa may be recovered and utilized to fertilize oocytes via intracytoplasmic sperm injection (ICSI). As the risk for an increased number of gonosomes in these spermatozoa is unclear, preimplantation genetic diagnosis (PGD) may be attempted in the resulting embryos. In the present study, we report our experience with the combined approach of sperm retrieval by testicular fine needle aspiration (FNA), ICSI and PGD in seven consecutive non-mosaic Klinefelter individuals. In four patients, between one and five spermatozoa were retrieved in five out of nine consecutive attempts. In a fifth patient, only 10 round spermatids could be isolated. Mature spermatozoa were injected into a total of 16 metaphase-II oocytes, of which 11 (69%) remained intact. Two distinct pronuclei (2PN) were observed in four oocytes (36%) while a single pronucleus (1PN) was documented in two oocytes. Five cleavage stage embryos developed from the oocytes of two couples. Upon the request of one couple, their three embryos (two derived from 1PN oocytes) were transferred without PGD but pregnancy was not achieved. PGD by fluorescence in-situ hybridization (FISH) was performed in the two embryos of the other couple which were derived from normal fertilization. PGD results of one embryo were 18,18,X,X,Y, the embryo was not transferred and FISH analysis of the remaining blastomeres identified variable chromosome numbers in the nuclei. The second embryo was diagnosed as normal and was transferred, resulting in a successful pregnancy and birth. In conclusion, the results of this report indicate that a pregnancy and birth may be attained in azoospermic non-mosaic Klinefelter individuals by testicular FNA combined with ICSI. Due to the unknown risk of gonosomes aneuploidy in embryos from Klinefelter patients, PGD or prenatal diagnosis should be recommended.

Adult↗