Gideon Fait

Plasma interleukin-12 is elevated in patients with preeclampsia.

PROBLEM: 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)‐γ, contributes to the altered immune response observed in preeclampsia.

THE SIGNIFICANCE OF THE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX SCORE IN THE EVALUATION OF WOMEN WITH BLADDER OUTLET OBSTRUCTION

PURPOSE The American Urological Association (AUA) symptom index was originally designed to assess the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. Data concerning the clinical application of the AUA symptom index to women are sparse. We evaluated the significance of the AUA symptom index in women with urodynamically defined bladder outlet obstruction. MATERIALS AND METHODS From a urodynamic database of 587 consecutive women 38 (6.5%) were identified with bladder outlet obstruction, defined as a maximum flow rate of less than 12 ml. per second on repeat noninvasive uroflowmetry studies with a detrusor pressure at a maximum flow of greater than 20 cm. water on pressure flow study. All patients underwent a complete clinical and urodynamic evaluation, and completed the AUA symptom index questionnaire. Results in women with urodynamic obstruction were compared with those in 2 control groups, including women without obstruction but with sphincteric incontinence and asymptomatic healthy women. RESULTS Mean symptom score was significantly higher in women with obstruction than in those with sphincteric incontinence or no symptoms (15.8+/-8.4 versus 10.3+/-6.4 and 2.1+/-2.7, respectively). Likewise, scores were classified as severe in 34% of women with obstruction compared with only 7% of those with sphincteric incontinence. However, no correlation was noted between symptom index scores and objective urodynamic parameters, which is similar to data already reported in male populations. CONCLUSIONS The AUA symptom index score may be useful as a bothersomeness index in women with bladder outlet obstruction. However, subjective symptoms associated with bladder outlet obstruction are nonspecific and a complete urodynamic evaluation is essential for making the diagnosis.

Do soluble cell adhesion molecules play a role in endometriosis

PROBLEM: 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.
 METHOD OF STUDY: 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).
 RESULTS: 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.
 CONCLUSIONS: 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.

The possible role of antiovary antibodies in repeated in vitro fertilization failures

Geva E, Fait G, Lerner‐Geva L, Lessing JB, Swart: T, Wolman I, Daniel Y, Amit A. The possible role of antiovary antibodies in repeated in vitro fertilization failures. AJRI 1999; 42:292–296

Umbilical cord blood acid‐base values in uncomplicated termvaginal breech deliveries

Background. This prospective study was conducted to compare the umbilical cord blood acid-base values of uncomplicated, assisted, vaginal-breech-delivery term neonates with those of uncomplicated, cephalic-vaginal delivery term neonates and to determine whether a different metabolic status should be expected in neonates born by way of uncomplicated vaginal breech delivery. Methods. Umbilical cord artery and vein blood samples were obtained from 30 term neonates with frank or complete breech presentations who were born by uncomplicated assisted vaginal breech delivery. All these neonates had an Apgar score of >7 at 5 min and an uneventful neonatal course (study group). For each neonate in the study group the two consecutive term neonates who were delivered by uncomplicated cephalic spontaneous vaginal delivery, and had uneventful neonatal courses, served as controls (control group). Results. The umbilical cord artery blood pH and pO 2 were significantly lower (p<0.001 and <0.01, respectively) and the pCO 2 was significantly higher (p<0.001) in newborns of the study group, compared to the controls. The umbilical cord vein blood pH was significantly lower (p<0.01), and the pCO 2 significantly higher (p<0.01) in the study group. Conclusions. The umbilical cord blood acid-base values of uncomplicated, vaginal-breech-delivery term neonates differ significantly from those of uncomplicated, cephalic-vaginal delivery neonates. These differences may represent a greater degree of acute cord compression that reflects the different mechanisms of labor in vaginal breech delivery.

VASCULARITY INDEX DISTRIBUTION WITHIN THE TESTIS: A TECHNIQUE FOR GUIDING TESTICULAR SPERM EXTRACTION

Azoospermia is defined as the absence of spermatozoa in the ejaculate, although some foci of spermatogenesis may exist in the testes of these men. Currently, there are no clinical, seminal or hormonal parameters for identifying spermatogenesis within the testis sufficient for achieving genetic offspring. As a result, multiple biopsies are performed at several arbitrary sites of both testes in search of spermatozoa. We developed a power Doppler (PD) ultrasound (US) image-based technique that predicts sites with the greatest potential for spermatogenesis. PDUS images of the testes of azoospermic men were acquired at seven cross-sections to reconstruct a 3-D matrix for constructing a spatial map of preferential regions where spermatozoa are most likely to exist. This technique may obviate the need for arbitrary multiple biopsies that inflict some degree of damage upon testicular tissue, and may increase the success rate of identifying viable spermatozoa in testicular biopsies.

Levels of soluble vascular cell adhesion molecule-1 and soluble intercellular adhesion molecule-1 are increased in women with ovarian hyperstimulation syndrome

OBJECTIVE 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). DESIGN Prospective, case-control study. SETTING Lis Maternity Hospital and the Sara Racine IVF Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. PATIENT(S) 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. INTERVENTION(S) 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. MAIN OUTCOME MEASURE(S) Samples were assayed by specific ELISA for sVCAM-1 and sICAM-1. RESULT(S) 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. CONCLUSION(S) Our findings suggest that soluble cell adhesion molecules may have a role in the pathogenesis and progression of OHSS.

A selective increase in plasma soluble vascular cell adhesion molecule-1 levels in preeclampsia.

PROBLEM: 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.

Second-trimester multifetal pregnancy reduction facilitates prenatal diagnosis before the procedure.

OBJECTIVE To evaluate the pregnancy outcome of selective second-trimester multifetal pregnancy reduction (MFPR) compared to first-trimester MFPR. DESIGN Cohort analysis. SETTING In Vitro Fertilization Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. PATIENT(S) The study groups comprised 38 and 70 patients who underwent selective second-trimester MFPR (group 1) and first-trimester MFPR (group 2) at mean gestational ages of 19.7 +/- 3.3 weeks and 11.7 +/- 0.7 weeks, respectively. INTERVENTION(S) Ultrasonographically guided intracardiac injection of potassium chloride (KCl) solution. MAIN OUTCOME MEASURE(S) Pregnancy outcome and obstetric complications. RESULT(S) No statistically significant difference was found between group 1 and group 2 regarding mean gestational age at delivery (35.4 +/- 3.4 weeks and 35.9 +/- 3.1 weeks, respectively); mean birth weight (2,318.9 +/- 565.7 g and 2, 138.1 +/- 529.4 g); and the incidence of obstetric complications. These complications included pregnancy loss (5.2% and 15.7%), pregnancy-induced hypertension (0 and 10%), discordancy (12% and 18. 4%), intrauterine growth restriction (0 and 40%), and gestational diabetes (0% and 6%). However, the rate of all pregnancy complications was lower among second-trimester MFPR patients. CONCLUSION(S) Selective second-trimester MFPR is associated with favorable perinatal outcome and may facilitate detection of structural and chromosomal anomalies before the procedure and selective reduction of the affected fetus.

Can Labor with Breech Presentation Be Induced

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.