Publications (29) View all
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Article: Intradermal sex hormone desensitization for relief of premenstrual symptoms may improve the obstetric outcome of women with recurrent pregnancy loss.
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ABSTRACT: The aim of this study was to determine whether women with recurrent pregnancy loss (RPL) and concurrent premenstrual syndrome (PMS) who underwent desensitization with sex hormones had an improved obstetric outcome. This manuscript summarizes a 10 year open label prospective follow up study of 26 women with RPL, aged 25-42 with 3-8 previous miscarriages and PMS, who had hormone hypersensitivity on skin testing. Skin testing was positive to estradiol in 23 women, progesterone in 20 women and to both estrogen and progesterone in 17 women. Amelioration of the symptoms of PMS (according to the VAS) was seen in 21 of 26 patients after desensitization with small doses of sex hormones intradermally. There was long term and stable reduction of severe PMS in 21 of 26 patients after desensitization. Five women conceived after skin testing, prior to desensitization. Sixteen of 26 women (61%) had subsequent live births. Five women had two subsequent live births in the subsequent pregnancy. There were no obstetric complications. Five women had two subsequent pregnancies with live births. It seems that correction of sex hormone hypersensitivity was accompanied by relief of persistent PMS, may have a positive effect on the chances of a successful pregnancy.Gynecological Endocrinology 11/2012; · 1.58 Impact Factor -
Article: Thoracic Endometriosis Syndrome is Strongly Associated With Severe Pelvic Endometriosis and Infertility.
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ABSTRACT: To evaluate the clinical and surgical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax and pelvic endometriosis and to describe their association with infertility. Retrospective clinical study (Canadian Task Force classification: II-2). Academic tertiary referral endometriosis center. Seven patients who had undergone surgery because of thoracic and pelvic endometriosis between 2004 and 2010. Thoracic and pelvic exploration and treatment and fertility treatment. Concurrently, thoracic and pelvic endometriosis, and subsequent fertility were determined during long-term follow-up after combined surgical and pharmacologic interventions. The most frequent thoracic finding was diaphragmatic implants. Except for 1 patient with recurrent pleurodesis at 1 month after video-assisted thoracoscopy, no patients experienced recurrence of thoracic symptoms during a median (range) follow-up of 31.4 (1-61) months. Severe pelvic endometriosis was diagnosed in 6 patients with notable urologic and gastrointestinal tract involvement. Only 1 patient with catamenial pneumothorax had no macroscopic pelvic lesions. There was a considerable delay between the onset of pelvic symptoms and diagnosis. Median postoperative follow-up was 31.5 (7-84) months. Most patients who tried to conceive had primary infertility. Thoracic endometriosis syndrome, represented by catamenial pneumothorax, was strongly associated with severe pelvic endometriosis and a high rate of infertility. Inasmuch as many patients with thoracic endometriosis syndrome are treated by thoracic surgeons using video-assisted thoracoscopy, it is desirable to involve an experienced gynecologist who can diagnose and treat concurrent pelvic endometriosis.Journal of Minimally Invasive Gynecology 11/2012; 19(6):742-8. · 1.74 Impact Factor -
Article: Is there an association between autoimmunity and endometriosis?
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ABSTRACT: Endometriosis is a benign gynecologic disorder that affects 5-10% of women of reproductive age worldwide. It is characterized by the presence of ectopic endometrial cells and stroma in various locations outside the endometrium. In some of these women there are also a chronic local inflammatory process and presence of autoantibodies. It is not known whether this process is part of the etiology or is a secondary response to the ectopic cells. Furthermore, endometriosis shares similarities with several autoimmune diseases, which include elevated levels of cytokines, decreased apoptosis, and cell-mediated abnormalities. Our aim in this paper was to review the association between autoimmunity and endometriosis. For this purpose we conducted a thorough literature review in the MEDLINE/PubMed database using the keyword endometriosis crossed with: autoimmune disease, autoimmune diseases, autoimmunity, autoantibodies, immunity, immune-modulation, endometrial antibodies, etc.Autoimmunity reviews 02/2012; 11(11):806-14. · 6.37 Impact Factor -
Article: Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?
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ABSTRACT: To reevaluate the rate of correct diagnosis of ovarian torsion (OT) in our department. Retrospective computerized chart review. Tertiary referral center. Seventy-eight women who underwent laparoscopy for suspected OT. Laparoscopy. Rate of true diagnosis of torsion, correlation with Doppler studies. The preoperative diagnosis of OT was confirmed in only 36 (46.1%) of the patients. Immediate operation (<10 hours) after admission (n = 48) was associated with a statistically significantly higher likelihood of operatively confirming OT (56.2% vs. 28.6%). We found that the lack of ovarian blood flow on Doppler sonography was a good predictor of OT; women with pathologic flow were statistically significantly more likely to have OT (77% vs. 29%). The sensitivity and specificity of abnormal ovarian flow for OT were 43.8% and 91.7%, respectively, with a positive and negative predictive value of 78% and 71%, respectively. Despite 20 years of research, the accuracy of the preoperative diagnosis of OT remains low. The urge to operate can be attributed to the importance of preserving ovarian function in young women as well as to the availability and the low associated complication rate of laparoscopy.Fertility and sterility 01/2009; 93(6):2012-5. · 3.97 Impact Factor -
Article: Laparoscopic disk resection for bowel endometriosis using a circular stapler and a new endoscopic method to control postoperative bleeding from the stapler line.
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ABSTRACT: Complete laparoscopic excision of endometriosis offers good longterm symptomatic relief, especially for those with severe or debilitating symptoms. Intestinal endometriosis affect between 3% and 36% of women with endometriosis and 50% of women with disease severe enough that intestinal surgery, with or without intestinal segmental resection, may be required. Between January 2003 and September 2006, we performed 35 laparoscopic complete excisions of endometriosis with full thickness disk resections of bowel endometriosis using the CEEA stapler (US Surgical) inserted transanally. The endometriotic nodule of the bowel was completely removed in all patients. No major or minor surgical complications occurred during the primary surgical procedure. One patient underwent a diverting temporary ileostomy because of air loss after insufflation of the rectosigmoid colon, which was closed successfully 1 month after surgery. In three of seven cases of rectal bleeding from the stapler line, for the first time, we successfully used conservative endoscopic management. In properly selected patients, full thickness disk excision using a circular stapler is a feasible procedure that avoids the potential morbidities of a low anastomosis. We suggest conservative management by endoscopic hemostasis before referring patients for a new operation in cases of rectal bleeding from the anastomotic site.Journal of the American College of Surgeons 08/2008; 207(2):205-9. · 4.55 Impact Factor
