Yaron Zalel

Time-dependent effect of tamoxifen therapy on endometrial pathology in asymptomatic postmenopausal breast cancer patients.

Various endometrial lesions were more frequent among asymptomatic postmenopausal breast cancer patients who were treated with tamoxifen for > 48 consecutive months (30.8%) when compared with similar patients who were treated for 6-24 months or for 25-48 months (20.8% and 12.5%, respectively). However, this difference was not statistically significant. There were also no significant differences in the frequency of the various endometrial lesions between these three groups, although endometrial polyps were more frequently found among those treated for > 48 months. Overall, 20.7% of the 164 tamoxifen-treated patients in the study had an endometrial pathology. It can be concluded that there is a slight tendency among those postmenopausal patients who have been treated for > 48 consecutive months to have a higher frequency of endometrial lesions.

Diagnostic value of transvaginal color Doppler flow in ovarian torsion

OBJECTIVEnTo evaluate the role of Doppler flow in the diagnostic process of ovarian torsion.nnnMETHODSnTwenty-two patients who displayed the clinical symptoms of abdominal pain concomitant with an ovarian mass and were scheduled for explorative laparoscopy were enrolled in the study. The cohort was divided into 3 groups: (A) 8 patients with clinical and sonographic evidence of torsion; (B) 8 patients with abdominal pain and sonographic diagnosis of hemorrhagic cyst; and (C) 6 patients with a simple cystic mass who had undergone explorative surgery due to abdominal pain.nnnRESULTSnAfter Doppler flow imaging, Group A displayed no blood flow within the mass, and surgery confirmed the diagnosis of ovarian torsion. Seven of the 8 group B patients showed ovarian vascular flow (RI = 0.472 +/- 0.067). Only 2 of the 6 Group C patients displayed vascular flow (RI = 0.680 +/- 0.129) within an untwisted cyst, confirmed by laparoscopy.nnnCONCLUSIONSnThe combination of Doppler flow imaging with the morphologic assessment improves the diagnostic accuracy of ovarian torsion.

Ovarian volume in postmenopausal women-suggestions to an ovarian sue. nomogram for menopausal age

Background. Transvaginal ultrasonography is an accurate and reliable technique for measuring ovarian size. However, there is no consensus as to the normal ovarian size in postmenopausal women. The purpose of this study was to establish normal values for ovarian volume in postmenopausal age.

Is it necessary to perform a prophylactic oophorectomy during hysterectomy

OBJECTIVEnTo evaluate the subsequent pelvic sonographic characteristics as well as the clinical outcome following hysterectomy with and without oophorectomy.nnnSTUDY DESIGNnA prospective study of sonographic evaluation of 164 women, aged 29-72 years, with a history of hysterectomy was performed. Ninety-one patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and 73 women had either hysterectomy (abdominal or vaginal) only or hysterectomy with unilateral salpingo-oophorectomy.nnnRESULTSnThe mean time interval between surgery and sonographic evaluation was 4.3 years (range, 1-25 years). Out of the 73 women with left ovaries, 37 (50.7%) were found to have pelvic lesions and four women underwent re-operations following these findings. The histologic finding were cystadenoma, hydrosalpinx with periovarian adhesions and two paraovarian cysts. In comparison, only five of the 91 women (5.5%) following bilateral salpingo-oophorectomy were found to have pelvic lesions (P < 0.0005). None of the women with prophylactic oophorectomy were operated upon following these findings.nnnCONCLUSIONSnIn comparison to patients after total hysterectomy and bilateral salpingo-oophorectomy, women with prior hysterectomy and ovarian preservation are prone to subsequent pelvic lesions. They need to be closely followed with clinical, laboratory and sonographic means, and may undergo reoperations in order to rule out the possibility of neoplasia.

Adnexal torison: the contribution of color Doppler sonography to diagnosis and post-operative follow-up

Ovarian torsion is often difficult to diagnose due to non-specific clinical and clinical and ultrasonographic findings. We demonstrated the use of color Doppler for the early diagnosis of ovarian torsion and for post-operative follow-up until the normalization of the preserved ovary was confirmed by subsequent viable pregnancy. Color Doppler flow assessment can be useful as both a diagnostic tool and for evaluating the recovery of the affected ovary after conservative surgical treatment.

Transvaginal sonographic measurements of postmenopausal ovarian volume as a possible detection of ovarian neoplasia

Background. The purpose of our study was to determine whether ovarian volume, as measured by transvaginal ultrasound and plotted on the nomogram of normal postmenopausal ovarian volume, could assist in the diagnosis of ovarian neoplasia.

The resistance index in the fetal middle cerebral artery by gestational age and ventricle size in a normal population.

OBJECTIVE To study the association between fetal middle cerebral artery flow and the lateral cerebral ventricular width throughout gestation. METHODS The study is a prospective cohort evaluation of 430 singleton male and female fetuses between 20 and 40 weeks normal gestation. Abdominal ultrasonography and Doppler measurements were performed to measure the fetal atrial ventricular size and resistance index (RI) of the middle cerebral artery. RESULTS The mean (± standard deviation) ventricular width was 6.2 ± 1.2 mm. The modification in the RI of the middle cerebral artery throughout gestation showed a biphasic mode, increasing gradually to a peak at 30 weeks gestation and decreasing progressively thereafter. No significant correlation was found between the middle cerebral artery flow and the lateral cerebral ventricular width (r = .11). In addition to the 430 cases studied, three cases of mild ventriculomegaly and three cases of hydrocephalus were evaluated. The RI of the middle cerebral artery was within the normal range in all six of these cases. CONCLUSION Fetal middle cerebral artery blood flow is not affected by the width of the lateral ventricles, even in enlarged ventricles.

Sonographic and Doppler flow characteristics of ovarian tumors of low-malignant potential

To outline the sonographic and color Doppler flow imaging characteristics of ovarian tumors of low‐malignant potential (OCLMP).

Management of a triplet pregnancy with two anencephalic fetuses and polyhydramnios

The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the first case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.