Ariel Aharoni

Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study

Summary. In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3–8 weeks. Each patient had hetween 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 4 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.

Early spontaneous rupture of the post myomectomy gravid uterus

Rupture of a pregnant uterus is a serious threat to the mothers life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.

Decidualization of Ovarian Endometriosis During Pregnancy Mimicking Malignancy

The purpose of this series is to present deciduosis (the formation of extrauterine decidua) as one of the differential diagnoses of a malignant tumor during pregnancy.

Prospective randomized comparison between an open and closed vaginal cuff in abdominal hysterectomy.

Objective: To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery. Participants: One‐hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique. Results: The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P<0.05, t‐test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P<0.01, t‐test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar. Conclusions: Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.

Ultrasound Assessment of the Bladder Volume after Anterior Colporrhaphy

In 40 gynecological patients 44 different determinations of the bladder volume were made using ultrasonic methods. The product of bladder depth, height, and width, as determined from transverse and sagittal scans, showed the best correlation with the bladder volume measured by urethral catheter (r = 0.981). For 73% of the measurements the error was under 20% when the true bladder volume was greater than 100 cm3. This method gives a reasonable assessment of the bladder residual volume. It is quick, safe, and repeatable and, therefore, useful in postoperative clinical practice.

Kallmann syndrome: a case of twin pregnancy and review of the literature.

In order to evaluate the possibilities for induction of ovulation, the functional competence of the pituitary gland of a woman with Kallmann syndrome was examined by two consecutive dynamic GnRH tests. The second test was conducted after 1 weeks treatment by a GnRH pump. The results, which showed some rise of LH but no response of FSH, favored induction by hMG/hCG therapy. Three treatment cycles resulted in a twin pregnancy which was normal and was carried to term. Review of the literature shows only six previously reported pregnancies in women with Kallmann syndrome. Five of them were treated by hMG/hCG, and one by pulsatile GnRH. The two methods of induction are discussed in relation to the heterogeneity of the pituitary and ovarian function in Kallmann syndrome. We show that this heterogeneity dictates that the treatment for induction of ovulation should be individually adjusted according to the pituitary and ovarian competence.

Prolactin response to electroconvulsive shock in anesthetized rats

Serum prolactin level (SPL) of anesthetized rats was measured in response to electroconvulsive shock (ECS). This measurement served as an indicator of dopaminergic and serotonergic activity. Such neurotransmitter activity was modulated by pretreatment with cyproheptadine, parachlorophenylalanine (PCPA), pimozide, bromocriptine or L-dopa. A statistically significant lowered SPL was found in rats given ECS plus antiserotonergic agents, in comparison with animals receiving antiserotonergic agent or ECS alone. When ECS was administered to rats pretreated with the dopaminergic blocker, pimozide, there was a significant decrease in SPL, compared with animals receiving pimozide alone. When the dopaminergic system was stimulated by dopamine agonists, there was no elevation of SPL in response to ECS. Thus, there may be a balance between serotonergic and dopaminergic systems. The agents used in the experiment may upset this balance and produce a change in prolactin response to a given ECT stimulus.