A Baram

Tel Aviv University, Tel Aviv, Tel Aviv, Israel

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Publications (22)88.92 Total impact

  • Fertility and Sterility 07/2002; 77(6):1302-3. · 4.17 Impact Factor
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    ABSTRACT: To determine the isolated effect of abdominal paracentesis of ascitic fluid in women with severe OHSS on urine production and blood indices. Retrospective interventional study. Gynecology department at the Lis Maternity Hospital, affiliated to Tel Aviv University. Thirty women with severe OHSS. Abdominal paracentesis according to clinical indications. Urinary output, blood urea nitrogen, as well as a complete blood count were measured before and following the procedure. Urinary output increased from 1890 +/- 128 mL per 24 hours on the day before paracentesis to 2,660 +/- 226 mL per 24 hours after the procedure. Blood urea nitrogen values were 8.9 +/- 0.56 mg/dL and 7.8 +/- 0.53 mg/dL on the days before and after paracentesis, respectively. White blood cell count decreased from 15.4 +/- 1.1 (x 10(3) cells/mm(3)) on the days before the paracentesis to 13.3 +/- 0.9 (x 10(3) cells/mm(3)) after the procedure. Hematocrit was reduced significantly from 35.2 +/- 1.0% before the paracentesis to 33.4 +/- 0.8% after paracentesis. Paracentesis of ascitic fluids in women with severe OHSS has an isolated effect in improving renal function, as is evident by the increased urinary output and reduced blood urea nitrogen.
    Fertility and Sterility 06/2002; 77(5):986-8. · 4.17 Impact Factor
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    ABSTRACT: To evaluate the efficacy of methotrexate treatment in selected cases of extrauterine pregnancy (EUP) defined by stable or increasing hCG concentration. Prospective cohort study. Gynecology department of the Lis Maternity Hospital. Fifty women with EUP diagnosed whenever an intrauterine gestational sac was not seen on transvaginal ultrasonography. Women received IM methotrexate at a dose of 50 mg/m(2) of body surface area. Failure of hCG levels to fall by >/=15% during any successive week resulted in repeated administration of methotrexate. Surgical intervention was performed for presumed tubal rupture. Serial hCG measurement was performed weekly until hCG concentration reached 15 mIU/mL. Success was defined as the achievement of hCG concentration of 25 mIU/mL without surgical intervention. Result(S): Forty-four women (88%) were successfully treated. The mean time from first methotrexate injection to success was 34 +/- 2.4 days. Women treated successfully and unsuccessfully differed significantly only with regard to serum hCG levels of 1,876 +/- 243 and 3,489 +/- 376 mIU/mL, respectively. When the initial hCG levels were lower or higher than 2,000 IU/L, the success rate was 97% and 74%, respectively (significant by Fisher's exact test). When methotrexate treatment is administrated in a selected group of EUP defined by stable or increasing hCG, it may fail more frequently (26%) when initial hCG levels are >2,000 mIU/mL.
    Fertility and Sterility 04/2002; 77(4):761-5. · 4.17 Impact Factor
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    ABSTRACT: Objective: To evaluate the efficacy of methotrexate treatment in selected cases of extrauterine pregnancy (EUP) defined by stable or increasing hCG concentration.Design: Prospective cohort study.Setting: Gynecology department of the Lis Maternity Hospital.Patient(s): Fifty women with EUP diagnosed whenever an intrauterine gestational sac was not seen on transvaginal ultrasonography.Intervention(s): Women received IM methotrexate at a dose of 50 mg/m2 of body surface area. Failure of hCG levels to fall by ≥15% during any successive week resulted in repeated administration of methotrexate. Surgical intervention was performed for presumed tubal rupture.Main Outcome Measure(s): Serial hCG measurement was performed weekly until hCG concentration reached 15 mIU/mL. Success was defined as the achievement of hCG concentration of 25 mIU/mL without surgical intervention.Result(s): Forty-four women (88%) were successfully treated. The mean time from first methotrexate injection to success was 34 ± 2.4 days. Women treated successfully and unsuccessfully differed significantly only with regard to serum hCG levels of 1,876 ± 243 and 3,489 ± 376 mIU/mL, respectively. When the initial hCG levels were lower or higher than 2,000 IU/L, the success rate was 97% and 74%, respectively (significant by Fisher’s exact test).Conclusion(s): When methotrexate treatment is administrated in a selected group of EUP defined by stable or increasing hCG, it may fail more frequently (26%) when initial hCG levels are >2,000 mIU/mL.
    Fertility and Sterility - FERT STERIL. 01/2002; 77(4):761-765.
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    ABSTRACT: Endometriosis is a chronic inflammatory disease associated with diverse immunologic disturbances. Cell adhesion molecules are essential for the development of immune and inflammatory reactions. This study was conducted to investigate whether or not serum and peritoneal levels of soluble cell adhesion molecules are altered in women with endometriosis. The study group comprised five women with moderate-to-severe endometriosis. Eight healthy women with a normal diagnostic laparoscopy served as controls. Serum and peritoneal fluid samples from both groups were analyzed for the soluble isoform of intercellular cell adhesion molecule-1 (sICAM-1). vascular cell adhesion molecule-1 (sVCAM-1), endothelial selectin (sES), and platelet selectin (sPS). Serum levels of sICAM-1 were significantly increased in women with endometriosis (median levels: 410.4 ng/mL; range: 233.9 ng/mL 598.4 ng/mL vs. 235.7 ng/mL; range: 187.4 ng/mL -323.7 ng/mL; P = 0.02). Although the levels of sVCAM-1, sES, and sPS in both samples were higher in the study group, the differences did not reach significance. Our results suggest a role of ICAM-1 in the pathophysiology of endometriosis. However. the role of other investigated cell adhesion molecules should be confirmed by further studies.
    American journal of reproductive immunology (New York, N.Y.: 1989) 04/2000; 43(3):160-6. · 3.32 Impact Factor
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    ABSTRACT: To determine whether plasma and peritoneal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) are altered in women with ovarian hyperstimulation syndrome (OHSS). Prospective, case-control study. Lis Maternity Hospital and the Sara Racine IVF Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. The study group comprised 16 women with severe OHSS. The control groups comprised 10 women treated with controlled ovarian hyperstimulation and 8 women with normal findings at diagnostic laparoscopy. Plasma samples were obtained from the study group and the first control group. Peritoneal fluid samples were obtained during paracentesis from the study group and during diagnostic laparoscopy from the second control group. Samples were assayed by specific ELISA for sVCAM-1 and sICAM-1. The mean peritoneal fluid levels of sVCAM-1 and sICAM-1 and the mean plasma levels of sVCAM-1 were significantly higher in the women with OHSS than in the control groups. However, the mean plasma levels of sICAM-1 were comparable. A positive correlation was demonstrated between the levels of sVCAM-1 and plasma E2 at the time of hCG administration and between the levels of sICAM-1 and number of ova retrieved. Our findings suggest that soluble cell adhesion molecules may have a role in the pathogenesis and progression of OHSS.
    Fertility and Sterility 06/1999; 71(5):896-901. · 4.17 Impact Factor
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    ABSTRACT: The study was conducted to determine whether altered plasma levels of soluble intercellular adhesion molecule (ICAM)-1 and soluble vascular cell adhesion molecule (VCAM)-1 are involved in the pathogenesis of preeclampsia. Maternal plasma samples were collected from 20 patients with preeclampsia, 20 matched normotensive patients with uncomplicated pregnancies. and ten healthy nonpregnant women. Samples were assayed for soluble VCAM-1 and soluble ICAM-1 by specific enzyme-linked immunosorbent assay. Both soluble VCAM-1 and soluble ICAM-1 were detectable in the plasma of all preeclamptic, normotensive pregnant, and nonpregnant women. The mean plasma level of soluble VCAM-1 was significantly higher in preeclamptic women compared to normotensive pregnant women (1831 ng/mL +/- 534 ng/mL vs. 1254 ng/mL +/- 386 ng/mL, respectively; P < 0.05). However, the plasma level of soluble VCAM-1 was unchanged during the third-trimester of normal pregnancy compared to nonpregnant women. The mean plasma level of soluble ICAM-1 in preeclamptic and normotensive pregnant women were increased when compared to nonpregnant women. However, the mean plasma level of soluble ICAM-1 was comparable in women with preeclampsia and normotensive pregnancy. The selective increased plasma levels of soluble VCAM-1 in patients with preeclampsia provide evidence for endothelial activation and suggest distinct pathways for neutrophil and endothelial activation in preeclampsia.
    American journal of reproductive immunology (New York, N.Y.: 1989) 06/1999; 41(6):407-12. · 3.32 Impact Factor
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    ABSTRACT: The study was conducted to determine whether altered plasma concentrations of soluble selectins are involved in the pathogenesis of pre-eclampsia. Maternal plasma samples were collected from 20 patients with pre-eclampsia, and from 20 matched normotensive patients with uncomplicated pregnancies. Samples were assayed for soluble endothelial selectin (sES), platelet selectin (sPS) and leukocyte selectin (sLS) by specific enzyme-linked immunosorbent assay. The three soluble selectins were detectable in the plasma of all pre-eclamptic and control patients. The mean plasma concentrations of sPS and sLS were comparable between the groups. However, the mean plasma concentration of sES was significantly higher in the pre-eclamptic group compared with the control group (61 ng/ml +/- 30 ng/ml compared with 40 ng/ml +/- 17 ng/ml; P < 0.01). The selective increased plasma concentrations of sES in patients with pre-eclampsia provide specific evidence for endothelial activation and may reflect distinct pathways for neutrophil activation in pre-eclampsia.
    Human Reproduction 12/1998; 13(12):3537-41. · 4.67 Impact Factor
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    ABSTRACT: Abnormal immune activation has been suggested as a contributor to the development of preeclampsia. We hypothesized that intact interleukin (IL)-12 directly, or through its main mediator, interferon (IFN)-gamma, contributes to the altered immune response observed in preeclampsia. Plasma samples were collected from 20 patients with preeclampsia and 20 normotensive patients with uncomplicated pregnancies who were matched with the preeclamptic patients by age, gestational age, and parity. Samples were collected before the onset of labor, induction, or medical intervention. The samples were assayed for IL-12 and IFN-gamma by specific enzyme-linked immunoassays. IL-12 was detected in 35% of the preeclamptic patients and in 5% of the patients with normal pregnancies (P < 0.01). The detection rate and mean concentration of IFN-gamma were comparable in both groups. Intact plasma IL-12 is detected more frequently in preeclamptic patients, suggesting the involvement of this cytokine in the enhanced immune response observed in preeclampsia.
    American journal of reproductive immunology (New York, N.Y.: 1989) 06/1998; 39(6):376-80. · 3.32 Impact Factor
  • Journal of The Society for Gynecologic Investigation - J SOC GYNECOL INVESTIGATION. 01/1998; 5(1).
  • Journal of The Society for Gynecologic Investigation - J SOC GYNECOL INVESTIGATION. 01/1998; 5(1).
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    ABSTRACT: This study was conducted to determine whether altered levels of vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of preeclampsia. Maternal plasma samples were collected from 19 patients with preeclampsia (group A) either before the onset of labor, or before induction of labor or medical intervention. Plasma samples were also obtained from 19 normotensive patients with uncomplicated pregnancies (group B), who were matched with the patients with preeclampsia for gestational age and parity. Samples were frozen at -70 degrees C until assayed for VEGF by a specific enzyme-linked immunoassay. The mean maternal age was similar in groups A and B. For both groups the VEGF was detectable in all plasma samples. However, the plasma concentrations of VEGF were significantly increased in the group A patients, compared with those in group B (median, 47 ng/ml; range, 10.6-72 ng/ml versus median, 13.6 ng/ml; range, 0.66-20 ng/ml; P < 0.001). In group A, a positive correlation was noted between VEGF concentrations and the systolic and diastolic blood pressure (r = 0.56; P = 0.01 and r = 0.48; P = 0.037, respectively). Maternal plasma VEGF levels were elevated in the patients with preeclampsia and correlated with the severity of hypertension, suggesting a role for VEGF in the pathogenesis of preeclampsia.
    American journal of reproductive immunology (New York, N.Y.: 1989) 10/1997; 38(4):302-6. · 3.32 Impact Factor
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    ABSTRACT: Standard staging and therapeutic approach to endometrial cancer involves lymph node sampling (LNS) at the time of total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Lymphadenectomy prolongs time of surgery and increases the risk of morbidity; where other predictors are available, it may not contribute important supplementary information. 185/247 women with stage I endometrial carcinoma underwent the standard surgery while 62 underwent TAH+BSO. Recurrence and survival were monitored for a mean of 6.5 years and retrospectively reviewed: the rates for groups with and without known lymph node status were alike [13.5% (25/185) recurrence for the former and 12.9% (8/62) for the latter, and 5-year survival rates of 75.7% (140/185) for the former and 74.2 (46/62) for the latter]. Myometrial invasion and histological grade appeared to have been highly accurate predictors without lymph node information. Because information on histological grade is available early and is highly predictive, its use could be incorporated into a revised management algorithm for stage I endometrial cancer which would depend upon ensuring lymphadenectomy for women with low grade histopathology and omitting it for those with high grades on the grounds that no further information is necessary to act appropriately.
    Oncology Reports 09/1997; 4(5):1055-8. · 2.30 Impact Factor
  • Br J Obstet Gynaecol Hum Reprod. 01/1994; 101(13):485-487.
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    ABSTRACT: A woman developed congestive heart failure after a normal delivery. The underlying disease was diagnosed as calcific constrictive pericarditis, and the patient underwent pericardiectomy.
    The Journal of reproductive medicine 08/1987; 32(7):551-2. · 0.75 Impact Factor
  • A. Baram, A. Galon, A. Schachter
    Gynakologisch-geburtshilfliche Rundschau - GYNAKOL GEBURTSHILFL RUNDSCH. 01/1986; 26(1):38-40.
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    ABSTRACT: Two hundred twenty-four patients with stage I endometrial carcinoma were treated between the years 1964 and 1978. One hundred and fifteen patients were classified as clinical stage Ia (51.3%) and 109 patients as clinical state Ib (48.7%). For stage Ia the standard treatment protocol was total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO). In stage Ib disease, preoperative irradiation was performed followed by TAH + BSO after an interval of 4 to 6 weeks. Postoperative irradiation to the pelvis and vaginal vault was given when extrauterine spread was found and in cases of myometrial penetration beyond the inner one-third of the myometrium. At evaluation in May 1983, the rate of disease recurrence in stage Ia was 20% and in stage Ib 9.1%. Five-year survival in stage Ia was 77.3% and 72.4% in stage Ib. Preoperative irradiation was found justified for G3 disregarding the clinical stage, therefore the approach of routine preoperative irradiation in stage Ib is not recommended. The uterine cavity depth was found to be an inaccurate prognostic parameter. According to the data collected in our material the histological grade and myometrial invasion are much better prognostic parameter and should be taken into consideration while planning the treatment regime.
    Gynecologic Oncology 12/1985; 22(3):294-301. · 3.93 Impact Factor
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    ABSTRACT: One hundred and seven patients with epithelial carcinoma of the ovaries were studied in an Israeli population in the Tel Aviv area. The women under study belonged mainly to two ethnic groups: European and North American (Ashkenazi) and Afro-Asian immigrants. The highest incidence of this neoplasm was found in the Ashkenazi group and the lowest in the Afro-Asian (less than 50%). It has been found that there is an age variation in the onset of the disease between the two ethnic groups. The average age of all the patients was 57 years, but in the Afro-Asian group of patients, the malignancy was more commonly found in the 45-54 age group (P less than 0.05). A tendency of a shorter survival rate due to more aggressive disease in the Afro-Asian group was observed. Survival rate for patients with FIGO stages I and II was lower in the Afro-Asian group. These conclusions were supported by the statistical significance of the data.
    Gynecologic Oncology 07/1985; 21(2):155-60. · 3.93 Impact Factor
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    ABSTRACT: A retrospective analysis of 646 consecutive cesarean deliveries during a 1-year period was performed. The indications for cesarean section, techniques of anesthesia, fetal and maternal outcome, and complications were evaluated. Of 646 cesarean deliveries, 153 (23.7%) were elective and 493 (76.3%) nonelective. Regional block was the main anesthetic technique used for the elective (88.3%) and the nonelective (79.3%) operations. Maternal complications were few and reversible. In 96% of the newborns the Apgar score was greater than or equal to 7 at 5 min. These results suggest that regional block is the preferred anesthetic technique for cesarean section.
    Israel journal of medical sciences 02/1985; 21(1):18-21.
  • A Baram, A Galon, A Schachter
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    ABSTRACT: During the years 1979-1982 cervical smears were taken from 3974 women at the cervical pathology unit at the Serlin Maternity Hospital, Tel Aviv Medical Center, Tel Aviv. There were 69 patients with positive cytology who had colposcopic directed biopsies which revealed cervical intraepithelial neoplasia (CIN) or a microinvasive lesion; a prevalence rate of 17 per 1000. Epidemiological characteristics of the 69 patients with CIN and microinvasion revealed that these women were younger than those with negative cytology, had more sexual partners and pregnancies, started their sexual activities earlier, and only half of them were married. In the whole series 57% of the women were of Ashkenazi origin and 43% were of Eastern and Sephardic origin, whereas in the group with positive cytology the proportion of women of Eastern and Sephardic origin was twice that of Ashkenazi origin, 64 and 36%, respectively. Only 4.5% of women in the CIN group declared themselves as religiously observant compared with 9.8% in the control group.
    British Journal of Obstetrics and Gynaecology 02/1985; 92(1):4-8.

Publication Stats

193 Citations
88.92 Total Impact Points

Institutions

  • 1985–2000
    • Tel Aviv University
      • Department of Obstetrics and Gynecology
      Tel Aviv, Tel Aviv, Israel
  • 1998–1999
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1997–1999
    • Tel Aviv Sourasky Medical Center
      • Obstetrics Gynecology
      Tel Aviv, Tel Aviv, Israel