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Biomedical subjects

R Tepper

Publications and source records attributed to R Tepper.

At least 73 records · Page 4Linked to original sources
PubMed1996

Flow limitation in normal infants: a new method for forced expiratory maneuvers from raised lung volumes.

Forced expiratory maneuvers generated by rapid thoracic compression have been used to assess airway function in infants. It remains unclear whether flow limitation can be achieved in healthy infants because low pressure transmission across the chest wall and inspiratory effort may limit the maximum transpulmonary pressure developed during the maneuver. We have found that several rapid inflations to a lung volume set at an airway pressure of 30 cmH2O (V80) briefly inhibit respiratory effort and allow forced expiration to proceed from V80 to residual volume. We used a water-filled esophageal catheter to measure isovolume pressure-flow curves in seven healthy infants (3-88 mo). Forced vital capacity (FVC) was defined as the volume between V80 and residual volume. Pressure transmission between the compression jacket and the esophagus decreased with decreasing lung volume and averaged 60 and 37% at 50 and 75% of expired FVC, respectively. Subjects demonstrated plateaus in their isovolume pressure-flow curves at 50% of expired FVC and lower lung volumes. We conclude that this new methodology enables forced expiratory maneuvers to achieve flow limitation in healthy infants over at least the lower portion of their lung volume.

Child Development↗
PubMed1996

Transvaginal sonographic measurements of postmenopausal ovarian volume as a possible detection of ovarian neoplasia.

BACKGROUND: The purpose of our study was to determine whether ovarian volume, as measured by transvaginal ultrasound and plotted on the nomogram of normal postmenopausal ovarian volume, could assist in the diagnosis of ovarian neoplasia. METHODS: A retrospective study was undertaken, in which the ovaries of 85 postmenopausal women were examined by transvaginal ultrasonography prior to laparotomy. Three dimensions of each ovary were measured and ovarian volume was calculated. The results were plotted on the nomogram of normal postmenopausal ovarian volume. RESULTS: Eighty-five ovarian tumors were diagnosed. The range of the mean ovarian volume varied between 98.15 cm3 to 161.81 cm3 from perimenopausal age to > 15 postmenopausal years, as compared to 2.2 +/- 1.4 - 8.6 +/- 2.8 cm in the normal postmenopausal women. The deviation from the normal volume was more striking in the malignant tumors group (100%) than in the benign group (86%). When plotted on the nomogram, these values showed significant deviation (above 2 s.d.) from the norm for each group of neoplasms in every menopausal age. CONCLUSIONS: Sonographic detection of abnormal postmenopausal ovarian volume and the demonstration of the deviation from the ovarian volume nomogram, could assist the physician in early diagnosis of ovarian neoplasia. Ovarian volume measurements can serve as the primary method leading to diagnosis of ovarian cancer.

Age Factors↗
PubMed1996

Clinical significance of endometrial fluid collections in asymptomatic postmenopausal women.

Routine vaginal ultrasonographic evaluation of pelvic organs was performed in asymptomatic postmenopausal women to evaluate the diagnostic significance of sonographic findings of endometrial fluid collections in the presence of a thin endometrium in postmenopausal women. The study included nine women aged 61 to 79 years who had been postmenopausal for 7 to 30 years, and in whom endometrial fluid collections were incidently demonstrated. Endometrial samplings followed the ultrasonographic examinations in all nine patients, and the correlation between the histologic report and the endometrial ultrasonographic thickness was evaluated. The diameter of the endometrial fluid collections varied from 3 to 12 mm. The thickness of the endometrium surrounding the fluid ranged from 1 to 3 mm. Of the nine endometrial samples examined, five revealed atrophic endometrium, three had insufficient material for histologic evaluation, and one specimen revealed well-differentiated adenocarcinoma. The woman in whom endometrial carcinoma was diagnosed underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymph node sampling. The pathologic examination confirmed the previous histologic finding, and deep penetration into the myometrium was noticed with intact lymph nodes. Endometrial fluid collections found in asymptomatic postmenopausal patients still may be associated with endometrial malignancy, even in the presence of thin endometrium.

Adenocarcinoma↗
PubMed1996

Physiological outcomes.

The degree of airway obstruction, as well as airway responsiveness, can be quantified in infants and pre-school children by several different physiological measurements. These measurements include forced expiratory flows, resistance, tidal flow volume indices, transcutaneous oxygen, and lung sounds. These different measurements have been applied to assess lung growth, respiratory epidemiology, airway reactivity, and the effectiveness of therapeutic interventions. Additional research is required to establish normative data, to relate physiological measurements to clinical symptoms, and to compare the information obtained from the different measurements. In addition, there is a need to develop alternative methodologies that avoid sedation of infants and minimise the degree of cooperation required of preschool children.

Airway Resistance↗
PubMed1995

Adenomyosis in postmenopausal breast cancer patients treated with tamoxifen: a new entity?

Between September 1, 1989 and October 31, 1994, 173 postmenopausal breast cancer women on tamoxifen treatment were followed up in the authors' institutions. During this period, 14 (8.1%) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for various indications. Eight (57.1%) were found to have adenomyosis, of whom one had a large fundal adenomyotic lump and the other seven patients had two to four small microscopic foci of adenomyosis. In this study, the rate of adenomyosis described among those postmenopausal breast cancer patients treated with tamoxifen is nearly three to four times higher than the rate reported in the literature for pre- and postmenopausal women. There is no previous reported increased incidence of adenomyosis in postmenopausal breast cancer patients treated with tamoxifen. Thus, it is suggested that the prolonged and unopposed estrogen-like stimulation by tamoxifen may play a causal role rather than be a casual factor in the development of this pathologic entity.

Adult↗
PubMed1995

Superficial hemosiderosis in a second trimester fetus: pathological and clinical manifestations.

Prenatal brain hemorrhages are associated with considerable morbidity and mortality in neonates. They appear predominantly as bleeding into periventricular germinal matrix with subsequent hemorrhages into lateral ventricles and subarachnoid space. Other patterns of brain hemorrhage are not widely documented in second trimester fetuses. We report a case of hemorrhage presenting as extensive hemosiderin deposits in leptomeninges and adjacent brain parenchyma, as observed in superficial hemosiderosis. The lesion was associated with substantial tissue damage. Clinically, it was diagnosed during the second half of second trimester by successive ultrasound examinations. If differs from germinal matrix hemorrhage and other forms of hemorrhage in origin, pathogenesis, morphology, and probably in clinical manifestations.

Adult↗
PubMed1995

Adnexal torsion: the contribution of color Doppler sonography to diagnosis and post-operative follow-up.

Ovarian torsion is often difficult to diagnose due to non-specific clinical and clinical and ultrasonographic findings. We demonstrated the use of color Doppler for the early diagnosis of ovarian torsion and for post-operative follow-up until the normalization of the preserved ovary was confirmed by subsequent viable pregnancy. Color Doppler flow assessment can be useful as both a diagnostic tool and for evaluating the recovery of the affected ovary after conservative surgical treatment.

Adnexal Diseases↗
PubMed1995

Ovarian volume in postmenopausal women--suggestions to an ovarian size nomogram for menopausal age.

BACKGROUND: Transvaginal ultrasonography is an accurate and reliable technique for measuring ovarian size. However, there is no consensus as to the normal ovarian size in post-menopausal women. The purpose of this study was to establish normal values for ovarian volume in postmenopausal age. METHODS: A prospective study was undertaken, in which the ovaries of 311 healthy post-menopausal women were examined by transvaginal ultrasonography. Menopausal age ranged from one to more than 15 years. Three dimensions of each ovary were measured and ovarian volume of every menopausal year was calculated. RESULTS: Curvilinear relationships were found between ovarian volume and menopausal age. Ovarian volume (as plotted on the nomogram) shows a progessive decrease from 8.6 +/- 2.3 cm3 in the first menopausal year, to 2.2 +/- 1.4 cm3 after more than 15 years after the menopause. CONCLUSIONS: These data represent a comprehensive characterization of normal ovarian volumes related to postmenopausal age. These baseline values provide the data which will assist the physician to obtain the sonographic diagnosis of abnormal ovarian size, thus eventually establishing early diagnosis of ovarian tumors.

Aged↗
PubMed1995

Transvaginal color flow imaging in the diagnosis of ovarian tumors.

Transvaginal ultrasonography and color flow imaging, performed to investigate whether there is any diagnostic advantage, were assessed over a 3 year period in 217 patients with adnexal masses prior to explorative laparotomy. Gray scale sonography and color Doppler flow were performed 1 day prior to surgery. Benign tumors were found in 165 patients and flow was detectable in 82 (49.7%); 14 patients had tumors of low malignant potential, 12 (85.7%) of whom showed detectable flow, and 38 had malignant tumors, in 25 (65.8%) of whom flow was detectable. Blood flow velocity was evaluated by the calculation of the resistance index prior to surgery. Mean resistive index was 0.39 +/- 0.05 for malignant tumors, compared with 0.49 +/- 0.06 and 0.55 +/- 0.07 for the low malignant potential and benign tumors, respectively. These differences were statistically significant (P < 0.01). When a resistive index of 0.47 was considered the cut-off value, the sensitivity was 88% and the specificity was calculated to be 85% (using color Doppler flow as the only diagnostic method). With our large cohort of patients, we demonstration the contribution of color Doppler flow examination in differentiating benign from malignant ovarian tumors prior to surgery.

Adolescent↗
PubMed1994

Continuous tamoxifen treatment in asymptomatic, postmenopausal breast cancer patients does not cause aggravation of endometrial pathologies.

Adjuvant tamoxifen therapy for breast cancer patients has been found to be associated with various endometrial pathologic conditions, including endometrial cancer. This preliminary case control study evaluated whether prolonged and continuous exposure to tamoxifen in the menopause may aggravate existing endometrial pathologies. Two vaginal ultrasound evaluations of endometrial thickness and histologic findings of two endometrial biopsies, performed 18 months apart, were evaluated for 25 asymptomatic, postmenopausal breast cancer patients who were continuously treated with tamoxifen. In the first endometrial biopsy, 4 patients (16.0%) were found to have endometrial pathologies: 2 patients had proliferative endometrium, 1 had hyperplastic endometrium, and 1 had an endometrial polyp. In the second endometrial biopsy, none of these patients showed any endometrial pathologies. Another patient (4.0%) with no endometrial pathology in the first visit had endometrial hyperplasia in the second visit. None of the patients developed endometrial cancer, and generally there was no increase in ultrasonographically-measured endometrial widths. The results of this preliminary study may suggest that there is no increased risk of development of endometrial pathologies during an additional 18 months of continuous tamoxifen therapy nor is there aggravation of already existing endometrial pathologies.

Aged↗
PubMed1994

Ovarian endometrioid carcinoma and endometriosis developing in a postmenopausal breast cancer patient during tamoxifen therapy: a case report and review of the literature.

We present the first case of ovarian endometrioid carcinoma and endometriosis in a postmenopausal patient who was treated with tamoxifen for breast cancer. The association with prolonged unopposed estrogen-like stimulation with tamoxifen as a possible factor in the development of ovarian endometrioid carcinoma is discussed.

Aged↗
PubMed1994

Laparoscopic Resection of a Cornual Pregnancy: A First Case Report

Laparoscopic surgery is currently the preferred diagnostic and treatment modality for ectopic pregnancy (EP). Cornual pregnancy, a rare and dangerous form of EP, is usually treated by cornual resection or hysterectomy. We report the first case to be treated by laparoscopic surgery. A 27 year old, gravida 3 para 2, was diagnosed with a nine week right cornual pregnancy. Laparoscopy revealed a 3 x 4 cm bulge into the right cornual area. Both fallopian tubes were otherwise normal. The uterus was fixed by a grasping forceps and the right tube and ovarian ligament were coagulated to reduce the blood supply. The gestational area was entered via a 1 cm incision using unipolar scissors and electrocoagulation. The pregnancy contents were suctioned; cavity margins and placental bed were coagulated until hemostasis was secured. The uterus contracted. The posterior leaf of the broad ligament was flapped over the incision site and attached by coagulation points. Postoperative course was uneventful. A hysterosalpingogram performed 4 months post surgery revealed a normal uterine cavity and blocked right tube.

Journal Article↗
PubMed1994

Ovarian cyst formation in two pre-menopausal patients treated with tamoxifen for breast cancer.

Pre-menopausal tamoxifen treatment causes hyperoestrogen production and ovarian cyst formation. Two pre-menopausal breast cancer patients who were treated with tamoxifen developed both permanent supraphysiological oestrogen concentration and ovarian cysts. Serum oestrogen decreased to post-menopausal concentrations and ovarian cysts completely resolved during and following simultaneous treatment with tamoxifen and gonadotrophin-releasing hormone agonist (GnRHa). In pre-menopausal breast cancer patients, GnRHa may prevent possible side-effects of tamoxifen, such as ovarian cysts and supraphysiological oestrogen production.

Adult↗
PubMed1994

Postmenopausal tamoxifen treatment and endometrial pathology.

Tamoxifen is widely used as adjuvant therapy for postmenopausal breast cancer patients with positive estrogen receptors. Data on a possible association of endometrial pathologies with tamoxifen treatment have been accumulating. In this review, we examine the current literature and include our own experience with this occurrence. We recommend close supervision of these patients.

Breast↗