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Biomedical subjects

J Ovadia

Publications and source records attributed to J Ovadia.

At least 37 records · Page 2Linked to original sources
PubMed1995

Yolk sac concentration of prostaglandin E2 in diabetic pregnancy: further clues to the etiology of diabetic embryopathy.

Fetal malformation associated with maternal diabetes occurs before the seventh week of pregnancy. Current hypotheses suggest that the diabetic milieu causes a reduction in phosphatidylinositol turnover, leading to a disruption in the arachidonic acid cascade and resulting in a deficiency of prostaglandins, particularly prostaglandin E2. This in turn results in a wide variety of congenital anomalies. This hypothesis has not been tested experimentally in humans. The yolk sac is thought to be the most important source of nutrition in early pregnancy. We sought to compare yolk sac prostaglandin levels in normal and diabetic women. Under ultrasonographic guidance, yolk sacs were aspirated form 8 normal and 12 diabetic women ranging from 8 to 10 weeks gestational age prior to elective abortion. Prostaglandin E2 levels were determined using RIA. The mean prostaglandin E2 level in normal controls was 3605 pg/mL, and was undetected in all of the yolk sacs aspirated from diabetic women (P < 0.001). Yolk sac diameter in diabetic pregnancies was 1.2 mm larger than that of normal pregnancies. The functional and morphological changes demonstrated in this study may increase our understanding of the pathophysiology of diabetic embryopathy.

Blood Glucose↗
PubMed1995

The grand multipara.

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

Adult↗
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

Assisted hatching by partial zona dissection of human pre-embryos in patients with recurrent implantation failure after in vitro fertilization.

OBJECTIVE: To examine the potential of the partial zona dissection technique to promote successful implantation by assisting embryo hatching after IVF. DESIGN: The study and the control group included 72 and 82 patients, respectively, each had undergone at least three failed IVF-ET attempts. Assisted hatching was performed on four- to six-cell stage embryos by creating a slit in the zona pellucida using the partial zona dissection technique. After 90 minutes incubation (5% CO2, 37 degrees C), the embryos were transferred to the uterus. SETTING: Infertility and IVF Unit of an academic tertiary referral medical center. RESULTS: In the assisted hatching group, 230 micromanipulated embryos were replaced (3 or 4 treated embryos per patient) compared with 295 nonmanipulated embryos in the control group. Clinical pregnancy rates (PRs) were similar in the assisted hatching and control groups (n = 15; 20.8% and n = 12; 14.6%, respectively). However, the contribution of assisted hatching by partial zona dissection to successful implantation was related to the patients's age: patients older than 38 years showed a markedly higher PR after assisted hatching: 23.9% in the study group compared with only 7% of the controls. CONCLUSIONS: These results demonstrate that assisted hatching by partial zona dissection is a quick and efficient method that does not induce any visible damage to the embryos replaced. In a selected group of patients (aged over 38 years, who have failed to conceive in at least three previous IVF attempts) it significantly increases the chances for pregnancy after ET.

Adult↗
PubMed1995

Detection of immunoglobulin A anticardiolipin antibodies in cervical mucus from in vitro fertilization patients and fertile women.

OBJECTIVE: To identify and quantify antiphospholipid autoantibodies of the immunoglobulin (Ig) A isotype in cervical mucus obtained from IVF patients and fertile controls. DESIGN: The study was performed prospectively. Blood and cervical mucus samples were obtained from patients undergoing IVF treatment (n = 27) at the time of expected E2 peak, before administering hCG. Control samples were taken from fertile women (n = 16) around the time of ovulation during a spontaneous nonstimulated menstrual cycle. Anticardiolipin activity was tested using ELISA. SETTING: Infertility and IVF unit of an academic tertiary referral medical center and university-based basic research laboratory. RESULTS: Forty-eight percent (13/27) of the IVF patients and 43.8% (7/16) of the fertile controls exhibited anticardiolipin IgA activity in aspirated cervical mucus. The mean activity measured for the positive cases was similar in both groups. This activity was higher than that measured in peripheral blood of the women studied. No difference was noted between infertile patients undergoing IVF treatment and fertile women in this respect. CONCLUSIONS: In this preliminary work, we demonstrated for the first time anticardiolipin IgA activity in human cervical mucus. These observations have to be substantiated by larger scaled studies to assess their possible clinical significance.

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

Heterotopic abdominal pregnancy following in-vitro fertilization/embryo transfer presenting as massive lower gastrointestinal bleeding.

We present a case that, as far as we know, is the first report of lower gastrointestinal haemorrhage as a complication of heterotopic pregnancy induced by artificial reproductive technology. The heterotopic abdominal pregnancy caused erosion of the intestinal wall and massive rectal bleeding, 8 weeks after in-vitro fertilization/embryo transfer. The source of the bleeding could not be identified despite comprehensive investigation including gastroscopy, ultrasonography, sigmoidoscopy, 99Tc (technetium) scanning and angiography. Tagged-erythrocyte isotope scanning revealed an abnormal concentration in the left lower quadrant, compatible with active bleeding in the area of the terminal ileum. Laparotomy disclosed a heterotopic abdominal pregnancy, causing erosion of the intestinal wall at this site. As assisted reproductive technologies become more and more common this rare complication of intestinal erosion should be kept in mind in case of lower gastrointestinal bleeding.

Abdomen↗
PubMed1995

Laser versus loop electrosurgical excision in vulvar condyloma for eradication of subclinical reservoir demonstrated by assay for 2'5' oligosynthetase human papillomavirus.

We studied, in an open clinical trial, 28 women with giant solitary human papillomavirus (HPV) lesions of the vulva that were treated by both laser and the loop electrosurgical excision procedure (LEEP), and analyzed the biopsy specimens of normal skin adjacent to the lesions for papillomavirus sequences by Southern blot hybridization and 2'-5' oligo-A synthetase (interferon) activity. The patients were reexamined after 3 weeks when a second treatment to the still infected areas was reapplied. They were reexamined for recurrence after 3 months: 4 patients harbored HPV-DNA genomes on the laser-treated side, adjacent to the original lesion, compared to 1 patient who developed recurrence on the LEEP side in a more distant, previously untreated, area. The optimal extent of laser or LEEP treatment necessary to reduce recurrence of vulvar condyloma remains to be established. Good in situ hybridization tests combined with the polymerase chain reaction and measurements of oligosynthetase activity to determine the types of cells involved at different sites of infection and to assess harboring of latent HPV genomes in histologically normal tissue are necessary in order to plan proper HPV treatment modality strategies.

2',5'-Oligoadenylate Synthetase↗
PubMed1995

The outcome of post-term pregnancy. A comparative study.

The aim of this study was to evaluate whether prolonged pregnancy was associated with dangers to the fetus, and to assess the incidence of cesarean section as well as fetal distress. The outcome for mother and baby in both groups of patients with post-term pregnancies was generally good. Furthermore, the improvement of prognosis for postdate pregnancy is due to the availability of electronic fetal monitoring and ultrasound, making possible the identification of fetal distress, as well as the use of prostaglandin to ripen a stubborn cervix, and induce labor successfully in most cases. Consequently, we feel that fetal jeopardy with continued intrauterine existence, as well as the excellent results of induction of labor, justify the active approach. The routine induction of labor in postdate pregnancy may reduce perinatal morbidity, as indicated in previous reports [2], and confirmed in this study.

Case-Control Studies↗
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

External cephalic version at term using broad criteria: effect on mode of delivery.

We sought to determine whether external cephalic version (ECV) with tocolytic agents in term patients with breech presentation could safely reduce the incidence of breech-related cesarean sections and vaginal breech deliveries. Four hundred and thirty-two patients with breech presentation at term who fulfilled broad criteria for attempted ECV and a control group of 330 patients with breech presentation at term in whom ECV was not attempted, were retrospectively reviewed. ECV was attempted following an infusion of ritodrine hydrochloride, using either the back flip of Saling and Muller-Holve or the classic forward roll. Following successful ECV, an infusion of oxytocin was administered to fix the head in the pelvis. Of the 432 patients, 311 (72%) underwent successful ECV; 86% delivered vaginally. Cesarean sections were performed in 76% of the patients with unsuccessful ECV and in 64% in whom the version was not attempted (control group). We conclude that ECV at term, using tocolytic agents, when applied to a broad spectrum of patients, is a safe and useful procedure for reducing the incidence of breech presentation, and as a direct consequence, for reducing the incidence of cesarean sections.

Breech Presentation↗
PubMed1994

Three-dimensional modelling of tumor-induced ovarian angiogenesis.

It is now well established that unrestricted growth of tumors is dependent upon angiogenesis. However, previous studies on tumor growth have not yet revealed how the transition to an angiogenetic state in ovarian malignancy is reflected in the vascular architecture of the ovary. We report here our preliminary observations based upon three-dimensional imaging of normal and tumor-induced ovarian angiogenesis created with a computer-assisted three-dimensional interactive application. The findings suggest that tumor-induced angiogenesis creates a bizarre vascular architecture, with a possible link to chaotic behavior.

Cystadenocarcinoma, Serous↗