Yair Daniel

Vascular endothelial growth factor is increased in patients with preeclampsia.

PROBLEM: This study was conducted to determine whether altered levels of vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of preeclampsia.

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.

Prednisone and aspirin improve pregnancy rate in patients with reproductive failure and autoimmune antibodies : A prospective study

PROBLEM: The study was conducted to investigate the efficacy of prednisone and aspirin in autoantibody seropositive patients with repeated in vitro fertilization–embryo transfer (IVF–ET) failure. METHODS OF STUDY: The study group comprised 52 consecutive patients seropositive for non‐organ‐specific autoantibodies, i.e., anti‐cardiolipin antibodies (ACA), anti‐nuclear antibodies (ANA), anti‐double‐stranded (ds) DNA, rheumatoid factor (RF), and lupus anti‐coagulant (LAC). These patients were treated with prednisone, 10 mg per day, and aspirin, 100 mg per day, starting 4 weeks before induction of ovulation in 52 IVF cycles. RESULTS: The clinical pregnancy rate per cycle was 32.7% (17/52). No increased incidence of pregnancy complications, including premature labor, gestational diabetes mellitus, and pregnancy‐induced hypertension, were found. CONCLUSIONS: Combined treatment of prednisone for immunosupression and aspirin as an anti‐thrombotic agent, starting before ovulation induction, may improve pregnancy rate in autoantibody seropositive patients who have had repeated IVF–ET failures.

Levels of vascular endothelial growth factor are elevated in patients with ectopic pregnancy: is this a novel marker?

OBJECTIVE To determine serum levels of vascular endothelial growth factor (VEGF) and evaluate their capacity to serve as a marker for the diagnosis of ectopic pregnancy (EP). DESIGN Prospective, case-controlled study. SETTING A tertiary care center. PATIENT(S) Twenty women with EP, 10 women with normal intrauterine pregnancy, and 10 women with abnormal intrauterine pregnancy, all at comparable stages of gestation. INTERVENTION(S) Serum samples were obtained from all women. MAIN OUTCOME MEASURE(S) All samples were analyzed for VEGF, progesterone, and beta-hCG by specific methods. RESULT(S) Women with EP had higher serum levels of VEGF than women with normal intrauterine pregnancy and women with abnormal intrauterine pregnancy (median levels, 226.8 pg/mL, 24.4 pg/mL, and 59.4 pg/mL, respectively). With a cutoff level of 200 pg/mL, serum VEGF could distinguish intrauterine from extrauterine pregnancy with a sensitivity of 60%, specificity of 90%, and positive predictive value of 86%. CONCLUSION(S) The increased serum VEGF levels in women with EP may facilitate this challenging diagnosis and reduce maternal morbidity and mortality.

The effects of tamoxifen treatment on the endometrium

OBJECTIVE To investigate the association between tamoxifen and endometrial cancer. BACKGROUND Tamoxifen is a nonsteroidal antiestrogenic drug that has been used successfully for 15 years in the treatment of all stages of breast carcinoma. In light of the positive results, several studies are now being conducted to test prolonged tamoxifen treatment as a prophylaxis against breast cancer in high-risk women. Although tamoxifen was thought to have only a few side effects, reports indicate that it is associated with an increased incidence of proliferative and neoplastic changes in the endometrium. As the current trend is to administer tamoxifen for prolonged periods and for more indications, the detrimental effects on the endometrium have vast implications. METHODS Review of the current literature. RESULTS Tamoxifen treatment is associated with an increased incidence of proliferative and neoplastic changes in the endometrium, with a 1.3 to 7.5 relative risk of developing endometrial carcinoma. CONCLUSIONS The results of tamoxifen treatment in breast carcinoma override the risk of developing endometrial carcinoma. Any vaginal bleeding in women treated with tamoxifen should be investigated carefully and promptly. In the future it may be necessary to advise these women to undergo routine uterine cavity examination.

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

Congenital cytomegalovirus infection

OBJECTIVE Congenital cytomegalovirus is the most common viral infection affecting approximately 1% of newborns. The virus can be transmitted to the fetus during both primary and recurrent infection. Although most of the infants are asymptomatic at birth, up to 15% develop late complications. The annual cost of treating cytomegalovirus infection complications in the USA is two billion US dollars. Many issues regarding cytomegalovirus infection such as routine screening, antenatal diagnosis and vaccination during pregnancy are unsettled and disputed. The aim of this article is to review the current literature on the subject and to draw some conclusions. DESIGN Review of the current literature. CONCLUSIONS At present, it appears that there is no indication for routine prenatal screening, while other issues, such as the most accurate method for antenatal diagnosis and the indications for pregnancy termination are, as yet, unsettled.

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.

Intrauterine irrigation with prostaglandin F2‐α for management of severe postpartum hemorrhage

BACKGROUND Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding. METHODS After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours. RESULTS In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects. CONCLUSIONS Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.