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Biomedical subjects

Lior Lowenstein

Publications and source records attributed to Lior Lowenstein.

15 recordsLinked to original sources
PubMed2005

Does hysterectomy affect genital sensation?

OBJECTIVES: To evaluate vaginal and clitoral sensation before and after hysterectomy and to assess pre- and post-surgery changes in sexual function. STUDY DESIGN: Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day prior to and 3 months following surgery. A survey was performed 18 months following operation to evaluate long-term changes in sexual function. PARTICIPANTS: Twenty-seven women, aged 30-57 years, who were admitted for elective hysterectomy. MAIN OUTCOME MEASURES: Genital sensation and reported sexual function. RESULTS: There was significant deterioration in sensation to cold and warm stimuli at the anterior and posterior vaginal wall after surgery. Vaginal vibratory sensation thresholds tended to increase. Clitoral thermal and vibratory sensation thresholds remained unchanged before and after surgery. Of the 22 patients who participated in the follow-up survey, 17 did not report any decline in sexual function, while 4 patients reported deterioration in genital sensation and in sexual function. CONCLUSION: The results demonstrate quantifiable sensory loss in the vagina after hysterectomy, with preservation of clitoral sensation. Only a minority of patients reported a decline in their sexual function. These findings highlight the relative importance of clitoral as compared to vaginal sensation in sexual function.

Adult↗
PubMed2005

[Spontaneous umbilical cord hematoma].

BACKGROUND: Spontaneous umbilical cord hematoma is rare and might be associated with fetal death. CASE: An emergency cesarean section was performed on a woman during the 41st week of gestation due to fetal distress. A stretched umbilical cord with hematoma was evident. The infant had tachypnea without any other physical or neurological damage. We speculate that traction of the cord led to a tear of an umbilical vessel, cord hematoma, compression of cord vessels and fetal compromise. CONCLUSION: In case of early prenatal diagnosis of spontaneous umbilical hematoma accompanied with signs of fetal distress, labor should be considered.

Adult↗
PubMed2005

[Cystic degeneration of placental subchorionic intervillous thrombi].

This is a case study of a 31 year-old woman who presented for a routine follow-up examination at 33 weeks of gestation. A 9-cm intrauterine membranous cystic structure, floating in the amniotic fluid, with 3 internal round structures attached on a stalk in close proximity to the placental insertion of the umbilical cord was demonstrated in sonography. A color Doppler study of the cyst was normal and also revealed a normal systolic/diastolic flow ratio in the umbilical arteries. The cyst was not reported on extended sonographic scans at 15 weeks and 24 weeks gestation. The patient delivered spontaneously at term giving birth to a 3300 grams healthy newborn. The pathologic diagnosis was cystic degeneration of subchorionic intervillous thrombi.

Adult↗
PubMed2005

[Insemination from HIV-positive males].

INTRODUCTION: Discordant couples, in which the man is HIV positive and the woman is HIV negative, face limited options when they wish to produce healthy children whilst practicing safe sex. In order to conceive they must abandon unprotected sex, which carries high risk of HIV infection to the woman. OBJECTIVE: To develop a method for removing the HIV from semen and then perform intra uterine insemination, following verification of the HIV-negative spermatozoa fraction by PCR. METHODS: Motile spermatozoa were isolated from semen samples by the gradient and "swim-up" techniques. HIV-RNA was tested before and after the procedure in both the semen and the purified spermatozoa fraction. Insemination was performed on ovulation day only when the absence of any viral particles was verified by PCR. RESULTS: Four couples underwent a total of 8 cycles of intra uterine insemination (IUI). Presently, two healthy babies were born. The two mothers and newborn were found to be HIV negative following the delivery. CONCLUSION: We report a safe procedure which enables biological parenthood for HIV-1 discordant couples without the risk of infecting the female partner. Our clinical data corroborate with the collaborative European data on this subject.

Adult↗
PubMed2005

[Episiotomy as a risk factor for early perineal trauma].

OBJECTIVE: To assess the association between medio-lateral episiotomy and early perineal trauma. STUDY DESIGN: A prospective observational cohort study of 667 consecutive vaginal deliveries was conducted over a 10-week period. On the day following delivery, all women were examined for the extent of early perineal trauma (swelling, oedema, haematoma), in addition to the episiotomy or lacerations. The demographic and clinical variables (age, parity, gestational age, birthweight, length of second stage, operative delivery, epidural, seniority of the obstetrical provider, episiotomy) and the post-partum treatment given for the perineum were retrieved from the hospital records. RESULTS: The overall episiotomy rate was 37.6%. Significant early perineal trauma was found in 9.9% of the women, more so in the episiotomy group (17.1% vs 5.5%, p < 0.001). In the episiotomy group, a larger number of women received more than routine treatment for the perineum (6.4% vs 2.9%, p < 0.05). Episiotomy was found to be the major independent predictor for perineal trauma (OR: 4.5, 95% CI: 2.4-8.5, p < 0.001), followed by epidural analgesia (OR: 2.4, CI: 1.3-4.3, p < 0.05) and birth weight >3700 g (OR: 2.1, CI: 1.1-4.1, p < 0.05). CONCLUSION: Episiotomy does not prevent immediate postpartum perineal trauma; rather, it is a major independent risk factor associated with significant early perineal trauma.

Adult↗
PubMed2004

Association between quantitative sensory testing, treatment choice, and subsequent pain reduction in vulvar vestibulitis syndrome.

UNLABELLED: The chronic pain syndrome of vulvar vestibulitis is a major cause of sexual dysfunction, and complete cure is not always achieved. The aim of the study was to determine whether the psychophysical characteristics of systemic pain perception predict treatment choice and outcome. Ninety women with vulvar vestibulitis syndrome were evaluated by using quantitative sensory testing with heat pain threshold measurements and pain scores for suprathreshold stimuli applied to the forearm, blood pressure measurements, and an assessment of the number of other pain disorders. Women were free to choose a surgical procedure (ie, vestibulectomy), one of the possible nonsurgical treatments (eg, biofeedback, cognitive-behavioral therapy, or hypoallergic agents), or to avoid treatment entirely. Eight months later, women reported the success of the treatment on the basis of reduction in the level of vulvar pain. Vestibulectomy demonstrated the best therapeutic effectiveness (chi2, 26.4; P <.0001). Women who chose this type of treatment had lower pain scores (P =.038) and fewer pain syndromes other than the vulvar pain (P =.025). Logistic regression analysis, controlling for the effect of vestibulectomy, indicated that lower experimental pain scores (P =.044), fewer pain disorders (P =.023), and higher systolic blood pressure (P =.039) are predictive variables for reduction of vulvar pain. An assessment of systemic pain perception might be helpful in choosing the optimal treatment and in predicting its success. PERSPECTIVE: The present study suggests that pain perception variables might be of value in the prediction of treatment choice and outcome among women with vulvar vestibulitis.

Adolescent↗
PubMed2004

Vulvar vestibulitis severity--assessment by sensory and pain testing modalities.

Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Previous quantitative sensory test (QST) studies have demonstrated reduced vestibular pain thresholds in these patients. Here we try to find whether QST findings correlate to disease severity. Thirty-five vestibulitis patients, 17 with moderate and 18 with severe disorder, were compared to 22 age matched control women. Tactile and pain thresholds for mechanical pressure and thermal pain were measured at the posterior fourcette. Magnitude estimation of supra-threshold painful stimuli were obtained for mechanical and thermal stimuli, the latter were of tonic and phasic types. Pain thresholds were lower and supra-threshold magnitude estimations were higher in VVS patients, in agreement with disease severity. Cut-off points were defined for results of each test, discriminating between moderate VVS, severe VVS and healthy controls, and allowing calculation of sensitivity and specificity of the various tests. Our findings show that the best discriminative test was mechanical pain threshold obtained by a simple custom made 'spring pressure device'. This test had the highest kappa value (0.82), predicting correctly 88% of all VVS cases and 100% of the severe VVS cases. Supra-threshold pain magnitude estimation for tonic heat stimulation also had a high kappa value (0.73) predicting correctly 82% overall with a 100% correct diagnosis of the control group. QST techniques, both threshold and supra-threshold measurements, seem to be capable of discriminating level of severity of this clinical pain syndrome.

Adult↗
PubMed2004

A life-threatening event: uterine cervical arteriovenous malformation.

BACKGROUND: Uterine cervical arteriovenous malformation is a rare cause of vaginal bleeding. CASE: A 32-year-old multigravida presented with severe vaginal bleeding originating in the cervix, which resulted in a hypovolemic shock. Attempts to control the bleeding included hysterectomy, pelvic arterial embolization, and upper vaginectomy. Each proved unsuccessful. Histopathologic examination revealed an arteriovenous malformation. Despite local packing, suturing of the vault area, and brachytherapy to the vaginal vault, bleeding persisted. Treatment with GnRH agonist and tranexamic acid stopped the bleeding. CONCLUSION: Severe vaginal bleeding can be the result of cervical arteriovenous malformation, and GnRH agonist may be used for treatment.

Adult↗
PubMed2004

[Prenatal imaging of the Meckel-Gruber syndrome].

A 32 years old woman, gravida 2 para 1, presented at 27 + 5 weeks' gestation with a large fetal head for the gestational age, an occipital encephalocele and ventriculomegaly. Both fetal kidneys were large, echogenic and multicystic, but oligohydramnion was not observed. Post-axial polydactyly of the fetal feet was demonstrated. The Meckel-Gruber syndrome was diagnosed, but termination of pregnancy was declined. Three weeks later, the patient spontaneously delivered an 1890 grams live-born female. The newborn died 2 days later in the neonate intensive care unit.

Adult↗
PubMed2004

[Prenatal diagnosis of fetal neoplasms].

A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by ultrasonographic examination. Cancer appearing either at birth or within the first month of life occurs in 36.5 per million liveborn infants. The death rate is 6.24-7.6 per million live births. This article briefly reviews the sonographic findings in the most common fetal neoplasms and presents the authors' experience in the prenatal ultrasonographic diagnosis of fetal neoplasms: intracranial fetus-in-fetu, adrenal neuroblastoma and mesoblastic nephroma.

Female↗
PubMed2004

[Is there an association between PUPPP and preeclampsia, abruptio placentae and fetal death?].

This is a case study of a 28-year old woman, gravida 1 para 0, presented at 37+4 weeks gestation due to purpura and fetal death. A 3700 gram dead male fetus without gross malformation was delivered by forceps. Post delivery abruptio placentae, diffuse intravascular coagulation, fulminant preeclampsia and acute renal failure followed. Skin biopsy revealed pruritic urticarial papules and plaques of pregnancy. The patient fully recovered one week postpartum. This case report discusses a possible association between pruritic urticarial papules, plaques of pregnancy and severe preeclampsia with fetal death.

Abruptio Placentae↗
PubMed2003

Effect of the 100-g oral glucose tolerance test on fetal acid-base balance.

OBJECTIVE: Previous studies have shown that maternal hyperglycemia may lead to fetal hypoxia and acidosis. The aim of the present study was to examine the impact of an oral 100-g glucose tolerance test on the fetal acid-base balance at mid-gestation. METHODS: The study was conducted in healthy women who were scheduled for termination of pregnancy. The study group (n = 18) received an oral solution containing 100-g glucose and the control group (n = 18) received only water 1 h prior to termination of pregnancy. Termination of pregnancy was performed by fetal intracardiac injection of potassium chloride (KCl) and intraamniotic instillation of PGF2alpha. Acid-base variables were evaluated in the fetal blood and the amniotic fluid. RESULTS: The glucose levels differed significantly between the study group and the control group with regard to maternal blood (127 +/- 28 versus 69 +/- 11 mg/dL, p < 0.001), fetal blood (128 +/- 24 versus 71 +/- 17 mg/dL, p < 0.001) and amniotic fluid (39 +/- 13 versus 28 +/- 5 mg/dL, p < 0.006). A linear relationship was found between maternal, fetal and amniotic fluid levels of glucose after maternal glucose ingestion. No significant changes were observed in the acid-base balance variables (pH, base excess, bicarbonate, lactate) in the fetal blood and the amniotic fluid of the study and control groups. CONCLUSION: The 100-g oral glucose tolerance test has no adverse effect on the fetal acid-base balance when glucose levels reach a peak 1 h after the test in normal pregnancies.

Abortion, Legal↗
PubMed2003

Postcesarean section pain prediction by preoperative experimental pain assessment.

BACKGROUND: Postcesarean section pain is a common cause of acute pain in obstetrics, yet pain relief and patient satisfaction are still inadequate in many cases. The present study was conducted to determine whether preoperative assessment of experimental pain perception by quantitative sensory tests could predict the level of postcesarean section pain. METHODS: Fifty-eight women who were scheduled for elective cesarean section were enrolled in the study. Heat pain threshold and magnitude estimation of suprathreshold pain stimuli at 44 degrees-48 degrees C were assessed for both algosity (the sensory dimension of pain intensity) and unpleasantness 1 or 2 days before surgery. The day after the operation, the women reported the level of pain at the surgical wound on a visual analog scale at rest and during activity. Regression analysis was performed to evaluate the usefulness of preoperative scores in predicting postcesarean section pain. RESULTS: Postoperative visual analog scale scores at rest and during activity significantly correlated with preoperative suprathreshold pain scores at 44 degrees-48 degrees C (r = 0.31-0.58 for algosity and r = 0.33-0.74 for unpleasantness). The stimulus of 48 degrees C was found to be the best predictor of postoperative pain for both conditions (r = 0.434-0.527; P < 0.01). In contrast to suprathreshold pain stimuli, pain threshold was not correlated with postoperative pain. CONCLUSIONS: The results show that a simple and quick preoperative test is useful in identifying those women who will experience greater pain after a cesarean section. This test may be suggested for caregivers to tailor the postoperative treatment to specific patient needs and to improve postoperative outcome and patient satisfaction.

Adult↗