Rami Aviram

Primary peritoneal papillary serous adenocarcinoma: Clinical and management aspects

From January 1, 1984 to April 30, 1990, 38 patients were surgically found to have an intraabdominal disease resembling epithelial ovarian cancer. This diagnosis was confirmed in 31 patients; the remaining 7 met the criteria of primary peritoneal papillary serous carcinoma. Five of these were diagnosed retrospectively and two during surgery. The mean age at diagnosis was 61.2 years. Tumor histology revealed papillary serous carcinoma in six and mixed (papillary serous and papillary clear cell carcinoma) in one patient. Optimal debulking was achieved in three of seven cases (42.8%). Cisplatin-based combination chemotherapy was administered to all in the study group. Complete response was obtained in four patients, with one surviving for 76 months. The median survival in these patients was 34.5 months (range 6-76 months). Currently, three patients with complete response are alive with clinically undetectable disease. CA-125 assays were available in three cases and blood levels corroborated the clinically determined status of the disease. Tumor steroid hormone receptor status was determined in one case and revealed low levels of estrogen and progesterone receptors. To the best of our knowledge, the usefulness of CA-125 in the diagnosis, management, follow-up, and determination of tumor steroid hormone receptor status, mixed papillary serous and clear cell subtype histological patterns for primary peritoneal papillary serous carcinoma are first described in this report. It seems that this neoplasm may be treated and followed up as in epithelial ovarian cancer, obtaining long-term survival; however, the biologic behavior and management problems of this relatively new entity deserve further clinical experience.

Placental aetiologies of foetal growth restriction: Clinical and pathological differences

BACKGROUND Placental morphology and pregnancy outcome differ between normal pregnancies and those with foetal growth restriction (FGR). Most reports do not differentiate among different placental injury patterns related to foetal growth restriction. AIMS To evaluate placental and perinatal findings in growth restricted pregnancies based on three placental injury patterns: maternal and foetal blood supply abnormalities, and villitis of unknown aetiology, compared to those of preeclampsia (PE) and normal pregnancies. STUDY DESIGN Retrospective review. SUBJECTS 65 growth restricted newborns and their placentas. OUTCOME MEASURES Comparison of the clinical perinatal characteristics and outcomes, placental pathology and the number of syncytiocapillary membranes in the terminal villi, of the 65 FGR cases with 13 pregnancies complicated with preeclampsia (PE), and 25 uncomplicated pregnancies as controls, at 34-40weeks gestation. RESULTS The most common injury patterns of FGR placentas were maternal underperfusion (66%) (group 1), foetal blood supply abnormality (17%) (group 2), and villitis of unknown aetiology (17%) (group 3). The rate of induced labours was the highest in group 1 but the rate of operative deliveries due to suspected foetal asphyxia was the highest in group 2 (p<0.05). In the FGR cases, inverse relationship was found between birth weight and the number of syncytiocapillary membranes (r=-0.31, p<.05) in the maternal underperfusion FGR cases (group 1) only. CONCLUSIONS The different injury patterns in placentas of FGR patients may be correlated to different clinical outcomes. Placental examination in FGR pregnancies can provide a specific pathophysiologic explanation that may recur in subsequent pregnancies and lead to changes in follow-up and management.

Prenatal diagnosis of fetal cerebellar lesions: a case report and review of the literature.

The fetal cerebellar structure, size and consistency are looked at in every system survey. Among the acquired cerebellar events that might change the cerebellar consistency are haemorrhage, infections in utero and neoplasia. Additional fetal malformations, if present, assist in making the final diagnosis. We present a case of an isolated echogenic mass in one of the cerebellar hemispheres along with the differential diagnosis. Copyright

Microhysteroscopy and endometrial biopsy results following failed diagnostic dilatation and curettage in women with postmenopausal bleeding

OBJECTIVE: The aim of this study was twofold: firstly to evaluate and compare the diagnostic precision of the microhysteroscopy (MH) and endometrial biopsy in a group of menopausal women in whom D&C had failed to obtain an adequate endometrial sample, and secondly to quantitate the value of a hysteroscopy in determining endometrial sampling in these patients.

Doppler flow characteristics in patients with pelvic inflammatory disease: Responders versus nonresponders to therapy

The objective of this retrospective study was to evaluate the role of Doppler flow studies in predicting the response to antibiotic treatment in patients with pelvic inflammatory disease (PID).

Postmenopausal Endometrial Pathologies with Tamoxifen Treatment: Comparison between Hysteroscopic and Hysterectomy Findings

Histological findings of endometrial specimens collected by hysteroscopy from 261 postmenopausal breast cancer patients with tamoxifen treatment (group I) and from endometrial specimens obtained following hysterectomy from 40 similar patients (group II) were compared. This comparison was performed in order to assess whether endometrial pathologies are more frequently diagnosed in specimens collected by hysterectomy than by those collected during hysteroscopy in such patients. Overall positive endometrial histological findings were significantly more common in group II patients than in group I patients (82.5 and 24.5%, respectively; p < 0.0001). Atrophic endometrium was significantly more common in group I patients than in group II patients (75.5 and 15.0%, respectively; p < 0.0001). All other different endometrial pathologies, except for proliferative endometrium, were significantly more common in group II patients than in group I patients (endometrial hyperplasia = 17.5 and 4.2%, respectively; p < 0.0003; endometrial polyps = 30.0 and 11.5%, respectively; p < 0.006; endometrial polyps with hyperplasia = 17.5 and 4.2%, respectively; p < 0.0003; endometrial carcinoma = 15.0 and 0.4%, respectively; p < 0.0001). These findings suggest that in postmenopausal breast cancer patients treated with tamoxifen, the frequency of various endometrial histological findings and of overall positive endometrial histological findings were significantly higher in specimens collected by hysterectomy than in specimens obtained by hysteroscopy.

P09.08: Three dimensional first trimester fetal volumetry; comparison with crown-rump length

Background: Ultrasonographic volumetry measurements of human fetus have become possible using three-dimensional ultrasound systems. Objective: To evaluate the weekly increase of fetal volume during the first trimester of normal pregnancies compared to the crown rump length and creating a first trimester fetal volume nomogram. Methods: Crown rump length and threedimensional ultrasonographic volumetry measurements performed on 72 first trimester fetuses using virtual organ computer aided analysis (VOCAL). Results: A significant direct correlation (r=0.939) was found between the calculated fetal volumes and crown rump lengths. A 6–12 weeks gestation fetal volume nomogram was proposed. Conclusion: Fetal volume database in the first trimester may serve as a reference table for diagnosis of early pregnancy failure. D 2004 Published by Elsevier Ireland Ltd.

Congenital short‐bowel syndrome: Prenatal sonographic findings of a fatal anomaly

The sonographic findings in a fatal case of congenital short‐bowel syndrome are reported. Sonography at 11 weeks of gestation showed a 11 × 6 mm hyperechoic mass interpreted to be a midgut umbilical hernia. A repeat scan 2 weeks later showed an intact anterior abdominal wall, no umbilical herniation, and appropriate fetal growth. Forty‐eight hours after full‐term, vaginal delivery, the infant began vomiting bile and passing blood rectally. Imaging studies showed distended bowel loops without air‐fluid levels and incomplete bowel obstruction. Laparotomy showed malrotation and short small bowel without volvulus. The infant died at 9 weeks of age. When delayed return of the midgut to the abdominal cavity is noted on prenatal sonograms, follow‐up sonograms should be done throughout the second trimester, especially in patients with a family history of short‐bowel syndrome, to search for dilated short bowel loops. If such loops are found, patients should be given options for pregnancy termination.

Prenatal sonographic detection of a lipomeningocele as a sacral lesion.

We present a case of a lipomeningocele in a newborn. Prenatal sonography revealed dysraphia and a 3.8 × 4.3 cm, semisolid, echogenic mass that was continuous with the sacral area and bulged posteriorly under the skin. The mass was diagnosed after birth as a lipomeningocele based on the results of MRI. This diagnosis was confirmed histologically.

The effect of a policy change on late termination of pregnancy in Israel

To compare approval rates of late termination of pregnancy (LTOP) requests before and after a policy change in Israel in late 2007.