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ABSTRACT: Adenomyosis is characterized by the presence of ectopic endometrial tissue within the myometrium. Treatment options range from use of non-steroidal anti-inflammatory drugs and hormonal suppression for symptomatic relief, to endometrial ablation or even hysterectomy. We report a case of successful ultrasound-guided aspiration of focal adenomyosis with intracavitary alcohol instillation in a patient with a recurrent intramural uterine lesion. This is the first report of the treatment of sclerotherapy by alcohol instillation, which may be considered as a reasonable alternative modality in treating rare cases of symptomatic adenomyosis. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics and Gynecology 04/2007; 29(4):460-2. · 3.01 Impact Factor
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ABSTRACT: Intestinal obstruction is not a rarity in the newborn. Its etiology is diverse. Superior mesenteric artery syndrome (SMAS) is a phenomenon in which the duodenum is obstructed by the SMA. This causes bowel obstruction accompanied by duodenal dilatation. It has previously been described in adults and children but rarely in infants. We report for the first time on an intrauterine manifestation of SMAS.
Prenatal Diagnosis 12/2003; 23(11):932-4. · 2.11 Impact Factor
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ABSTRACT: To assess the contribution of transvaginal and transabdominal sonography in the diagnosis of acute appendicitis.
The study group included female patients in whom acute appendicitis was diagnosed preoperatively by ultrasound and confirmed by histology. Each patient was examined by transabdominal (TAS) and transvaginal (TVS) sonography. The contribution of both approaches to the diagnosis of acute appendicitis was assessed.
Acute appendicitis was diagnosed sonographically in 38 women. In all of them the diagnosis was confirmed histologically. All patients had both TAS and TVS. In 16 (42%) patients the inflamed appendix was detected by both approaches, in 13 (34%) only by the transabdominal route and in nine (24%) only transvaginally. Thus, TAS detected only 76% of the cases and TVS added 24%.
The use of TVS in conjunction with TAS seems to improve the detection rate of acute appendicitis.
Ultrasound in Obstetrics and Gynecology 04/2003; 21(3):273-6. · 3.01 Impact Factor
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ABSTRACT: This study was undertaken in order to evaluate a possible genetic influence on the pathogenesis of ovarian dermoid cysts. We have performed a case-control study comparing the prevalence of a history of dermoid cysts in first-degree relatives of women with dermoid cysts and among first-degree relatives of women without dermoid cysts. The study group included 285 women with an established diagnosis of ovarian dermoid cysts. The control group included 378 women with sonographically normal ovaries. To assess the relationship between a first-degree family history of dermoid cysts and the diagnosis of ovarian dermoid cysts, a multivariate stepwise logistic regression model was applied. In 28 families of the study group (9.8%), a dermoid cyst was found in at least 1 first-degree relative as compared with only eight families (2%) among the controls (adjusted odds ratio -5.60; 95% CI 2.24-14.2). The data suggest a genetic predisposition towards dermoid cysts which merits further exploration.
Gynecologic and Obstetric Investigation 02/2003; 56(4):203-6. · 1.28 Impact Factor
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ABSTRACT: Laparotomy and laparoscopy have been used for biopsy of pelvic masses in the differential diagnosis between abdominal tuberculosis and ovarian cancer. We suggest the use of transabdominal needle biopsy under ultrasound guidance in such cases. Two women developed abdominal distention, one of whom had been receiving medical treatment for known tuberculosis. In both cases, ultrasonography showed a pelvic mass and ascites associated with high levels of CA 125. A transabdominal ultrasonographically-guided biopsy of the masses with a trucut needle established their tuberculous origin. The transabdominal sonographic needle biopsy is a reliable diagnostic procedure in the differential diagnosis between abdominal tuberculosis and ovarian malignancy. This minimally invasive procedure saves the patient with tuberculosis from unnecessary laparotomy.
Ultrasound in Obstetrics and Gynecology 12/2000; 16(6):569-70. · 3.01 Impact Factor
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Acta Obstetricia Et Gynecologica Scandinavica 10/2000; 79(9):796-7. · 1.77 Impact Factor
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ABSTRACT: To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted 'the bright edge of the polyp'.
The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis.
In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities.
The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound.
Ultrasound in Obstetrics and Gynecology 05/2000; 15(4):327-30. · 3.01 Impact Factor
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ABSTRACT: Traditional management of persistent ovarian cysts in pregnancy is explorative laparotomy at 16-20 weeks of gestation and resection of the tumor. Scheduling surgery to this time of pregnancy is accepted in order to prevent abortions that are common whenever surgery is done in the first trimester, without delaying treatment of ovarian tumors which harbor a malignant potential. In the following article we report of 10 cases where simple ovarian cysts diagnosed during pregnancy were successfully treated by sonographically guided cyst aspiration. This new approach is justified with no fear of missing a malignant ovarian tumor due to strict ultrasonic characteristics of benign cysts that include unilocular simple appearing cyst with no solid echogenic parts, septations or papillary structures. For 5 of the 10 women undergoing aspiration, this constituted the definitive treatment, while the remaining 5 were later operated. We conclude that aspiration of simple cysts during pregnancy is safe, may save surgical intervention and in some cases this will be the definitive treatment.
Gynecologic and Obstetric Investigation 02/2000; 49(2):102-5. · 1.28 Impact Factor
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ABSTRACT: To evaluate the accuracy and risk of chorionic villus sampling (CVS) for prenatal diagnosis in multiple pregnancies.
Twenty-eight chorionic villus samplings were carried out in a group of women with twin pregnancies. A transabdominal route was chosen in 24 samplings and the rest (four samplings) were carried out in a transcervical route. In the group of women with triple pregnancies, 14 tests were performed in a transabdominal route and one in a transcervical route.
No sampling failure occurred. One laboratory failure occurred in a triplet pregnancy, and one abnormal karyotype (47,xy+18) was found in the group of 28 twin fetuses. The rest of the fetuses in this group had normal karyotypes. Of the five triplets, two chromosomal abnormalities were diagnosed: a mosaic 46,xy/47,xxy was found in both cases. One fetus was affected by fragile -x syndrome. Selective reduction of the affected fetuses was carried out. There was no spontaneous fetal loss. Fetuses which were found to have normal prenatal tests were also found to be normal when born.
In this relatively small series of CVS in twins and triplets, the procedure has been proven to be safe and reliable for prenatal diagnosis.
European Journal of Obstetrics & Gynecology and Reproductive Biology 08/1999; 85(1):97-9. · 1.97 Impact Factor
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Ultrasound in Obstetrics and Gynecology 05/1998; 11(4):303-4. · 3.01 Impact Factor
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ABSTRACT: We sought to demonstrate the usefulness of ultrasonography for the in utero identification of different types of intrauterine contraceptive devices.
We used sonography to differentiate among types of intrauterine contraceptive devices.
Each type of intrauterine contraceptive device had typical sonographic characteristics, in most cases, best demonstrated in the axial plane. Photographs of each type are shown and their sonographic appearance is discussed.
Sonographic identification of intrauterine contraceptive devices is accurate and specific. Sonography may serve as a useful method for determining the time to change the device and to identify those types that are more prone to complications.
The European Journal of Contraception and Reproductive Health Care 04/1998; 3(1):35-9. · 1.46 Impact Factor
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ABSTRACT: We report a case of a 37-year-old woman who had received five courses of gonadotropin-releasing hormone (GnRH) agonist (Decapeptyl) for presumed uterine leiomyomata associated with episodes of uterine bleeding. Submucous myoma (histologically proven) was partially removed on the first visit. After a period of significant reduction in the tumor size and cessation of uterine bleeding, the symptoms recurred along with rapid re-growth of the uterus. Total abdominal hysterectomy was performed and the pathologic evaluation revealed leiomyosarcoma with a high mitotic rate. This case and the literature review emphasize the problems encountered with the early diagnosis of uterine leiomyosarcoma during GnRH agonist therapy.
European Journal of Obstetrics & Gynecology and Reproductive Biology 03/1998; 76(2):237-40. · 1.97 Impact Factor
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ABSTRACT: To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women.
A prospective study.
Tertiary hospital-based ultrasonographic unit.
Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel.
Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered.
Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up.
For the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases.
Premenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.
Fertility and Sterility 09/1997; 68(3):501-5. · 3.56 Impact Factor
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ABSTRACT: The purpose of our study was to evaluate the Doppler flow characteristics of ovarian dermoid cysts. In 70 women (mean age, 38.7 +/- 14.6 years), 78 ovarian lesions with mean diameter of 48.9 +/- 28.4 mm and preoperative sonographic diagnosis of dermoid cyst of the ovary were evaluated prospectively by Doppler flow sonography; these cysts were eventually removed surgically. The findings were compared to the postoperative histologic results. In 74 lesions (eight cases were bilateral), when blood flow patterns were detected (detection rate of 24.3%) they were obtained only from the ovarian tissue surrounding the dermoid cavity, with a mean resistive index of 0.6 +/- 0.1 (range, 0.4 to 0.76). In four cases, which were proved postoperatively to be struma ovarii, blood flow was detected not only from the cyst capsule but also from the centrally positioned solid area (dermoid tissue), with a mean RI of 0.565 +/- 0.08 (range, 0.509 to 0.667). Dermoid cysts of the ovary are devoid of blood flow, with flow detection rate being only 24.3% from the cyst capsule. When apparently vascularized solid tissue is detected in the central part of a sonographically suspected benign cystic teratoma, struma ovary is highly suspected.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/1997; 16(5):355-8. · 1.25 Impact Factor
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ABSTRACT: Prenatal genetic diagnosis is recommended in multiple pregnancies because of the increased prevalence of genetic abnormalities in such fetuses. It can be done early by chorionic villus sampling or later by amniocentesis. Several studies have demonstrated the efficacy and safety of chorionic villus sampling in multiple pregnancies. Our study describes the results of this method in a twin pregnancy and in 3 triplet pregnancies, which represent 3% of the chorionic villus samplings performed in our ultrasound unit during 1989-95. All genetically deformed fetuses in these pregnancies were identified by chorionic villus sampling and the method was not associated with fetal loss. Our results confirm the safety and efficacy of chorionic villus sampling as expressed in the world literature.
Harefuah 12/1996; 131(9):297-9, 374.
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ABSTRACT: The intrauterine contraceptive device (IUCD) is the most popular, reversible contraceptive method, worldwide. Leaving an IUCD in-utero even beyond the time recommended by the manufacturer has been found both safe, and effective in terms of contraceptive ability. In 1995 we screened the medical records of the gynecologic infirmaries of 4 agricultural settlements (kibbutzim) and found 78 women who had worn an IUCD continuously for more than 5 years. All had been regularly examined every 6 months. Most of the IUCDs (63, 80.7%) were copper-containing. Mean IUCD wear was 7.9+/- 2.6 years (range, 5-17 years). At the time of the study, 38 (48.7%) of the IUCDs were still in utero. Related complications were 3 cases of dysmenorrhea (3.8%) and 20 of metrorrhagia. No pregnancies or pelvic infections were recorded. This study also shows that wearing an IUCD beyond the time recommended by the manufacturer is not associated with loss of contraceptive effectiveness. Furthermore, the rate of IUCD-related complications after 5 years of wear was not higher than during the first 5 years. To support these findings further studies with larger samples are needed.
Harefuah 12/1996; 131(10):391-3, 455, 456.
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ABSTRACT: Tamoxifen is known to exert agonist estrogenic effects on the uterus. Its use in postmenopausal women has also been associated with various endometrial and uterine abnormalities that can be detected by endovaginal sonography.
To study postmenopausal patients receiving tamoxifen who were referred for evaluation following the detection of abnormal uterine findings by endovaginal sonography.
Fifty-two women treated with tamoxifen for breast cancer who were found to have an abnormal uterine sonogram constituted the study population. Uterine sonograms were reviewed and clinical and sonographic data were correlated with the results of the histologic examinations.
Forty-five women demonstrated a thickened mid-uterine structure. Of these, in thirty-nine patients (87%) either no tissue of scant fragments of normal endometrium were obtained on curettage, and six women (13%) had endometrial hyperplasia. Seven women had fluid loculation lined by thin endometrium. Their subsequent histologic examination was normal. The sonograms of the women who demonstrated an appearance of a thickened endometrium but no neoplasia, characteristically demonstrated hyperechogenic cystic area with no midline echo.
Among 52 postmenopausal patients receiving tamoxifen presented with an abnormal uterine sonogram, 39 (75%) women were found to have a thick mid-uterine structure resembling a thickened endometrium without histologic evidence of neoplasia. This phenomenon can be characterized by typical sonographic features, and may be differentiated from other uterine abnormalities.
European Journal of Obstetrics & Gynecology and Reproductive Biology 12/1996; 69(2):115-9. · 1.97 Impact Factor
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ABSTRACT: We describe a case of penetration of the urinary bladder by an intrauterine contraceptive device with perforation of the uterine wall. This finding was discovered incidentally during an ultrasound examination for an earlier nonspecific mild abdominal pain of short duration. No abnormality had been noted on pelvic examination, during which the device's strings were found to protrude through the patient's cervix; a short laboratory workup including urinalysis, urine culture, blood count and blood sedimentation rate was also negative. The sonographic diagnosis was confirmed by cystoscopy. The device was retrieved transcervically. No complications were observed on follow-up. Bladder perforation by an intrauterine contraceptive device is very rare, and only a handful of such cases have been described. In all previous cases, the diagnosis followed a rather prominent clinical presentation, whereas, in this case, the patient complained of intermittent low abdominal pain of short duration. We therefore suggest that pelvic ultrasound examination be performed in every patient with unexplained low abdominal pain who is known to carry an intrauterine contraceptive device.
Ultrasound in Obstetrics and Gynecology 07/1996; 7(6):458-60. · 3.01 Impact Factor
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ABSTRACT: Our objective was to evaluate the role of single-step ultrasound-guided aspiration in conjunction with intracavitary antibiotic instillation for the treatment of tubo-ovarian abscess. Ten women with the clinical and sonographic diagnosis of tubo-ovarian abscess, who failed to respond to systemic antibiotic therapy, were treated by ultrasound-guided aspiration of the abscess followed by intracavitary instillation of a combination of antibiotics. All ten women improved clinically and none required surgery. The mean time from aspiration to hospital discharge was 3.1 days with mean duration of hospitalization 7.8 days. No major complications were observed. The average time interval between aspiration of the lesion and resolution on sonographic follow-up was 9.5 weeks. In three cases, pelvic inflammatory disease recurred, but none needed surgical intervention. The average follow-up period of the patients was 12 months. One-step sonographically guided aspiration of tubo-ovarian abscess followed by intracavitary antibiotic instillation may serve as an easy and safe alternative therapy in patients in whom treatment with systemic antibiotics has failed.
Ultrasound in Obstetrics and Gynecology 07/1996; 7(6):439-42. · 3.01 Impact Factor
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ABSTRACT: We present a case of a female patient with right lower quadrant abdominal pain, in whom transvaginal ultrasound facilitated the diagnosis of acute appendicitis. The insertion of the appendix into the cecum was demonstrated with direct continuity between the cecal lumen and the appendix. The inflamed appendix was in close proximity to the right ovary and was distinguished by a thick edematous wall and fluid in the lumen. This combination of findings may comprise a new sonographic sign for the diagnosis of acute appendicitis, particularly when performed by transvaginal sonography.
Ultrasound in Obstetrics and Gynecology 06/1996; 7(5):359-60. · 3.01 Impact Factor
