Z. Levitan

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.

Short-term prophylactic antibiotic for elective abdominal hysterectomy: how short?

A prospective double-blind study was conducted in order to evaluate the effect of antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. In the first stage of the study, 116 patients received, on call to the operating room and subsequently 8 and 16 h post-operatively, cefazolin sodium or placebo. In the second stage of the study, 90 patients received the same antibiotics, but treatment was extended to 6 doses, 8 h apart. Of the 53 women who received placebo, 27 (50.9%) became morbid, while only 15 of the 63 (23.8%) who received 24 h prophylaxis were classified as morbid (p less than 0.005). By extending the prophylactic treatment to 48 h further reduction of the morbidity was achieved. Of the 90 patients only 11 (12.2%) became morbid (P less than 0.005). When morbidity rates were compared between different ethnic groups, over-weight and normal weight patients, pre- and post-menopausal women, it was not possible to define a group which is at a higher risk for post-operative morbidity. It was thus concluded that prophylactic antibiotics should be administered routinely to all patients undergoing abdominal hysterectomy, preferably for 48 h.

Broad spectrum antibiotics as short term prophylaxis for elective abdominal hysterectomy: Comparison of mezlocillin, cefazolin and placebo

A prospective randomized placebo controlled double‐blind study was conducted in order to evaluate the effect of short term perioperative antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. Fifty‐two patients received 3 doses of 0.5 g cefazolin, 54 patients received 3 doses of 1 g mezlocillin and 53 patients received placebo.

Ovarian pregnancy in association with an intrauterine device.

Within a 1‐year period, two cases of primary ovarian pregnancy associated with an intrauterine device (IUD) occurred in our institution. The clinical signs and symptoms were similar to those in any other ectopic pregnancy. Both cases satisfied the criteria of Spiegelberg. The final diagnosis was based on the histopathological findings. A review of the literature is presented summarizing the 53 cases reported until now. The association between IUD, ectopic pregnancy in general, and ovarian pregnancy in particular is discussed.

Early vaginal delivery of hydrocephalus after transabdominal encephalocentesis

Simple and easy transabdominal encephalocentesis with ultrasound control, should be the procedure of choice in huge hydrocephalus, in order to minimize maternal trauma.

The role of the gynecologist in cases of sexual assault in adolescents.

During the period from February 1980 until November 1982 (32 months), Haifa City Medical Center (Rothschild) served as the sole treatment center for all cases of alleged sexual assault in the Haifa area (350,000 inhabitants). Sixty-seven cases were seen, of them 63 females and 4 males. The four males were adolescents, all with alleged rectal sodomy. In the female group, two out of every three alleged victims were adolescent or younger girls, with diagnoses varying from child molestation to rape. The approach to the alleged victims was multidisciplinary, with gynecologists being called to the emergency room in each case. In addition, social workers and police officers were present in most cases to help the victims. Pediatricians, general and orthopedic surgeons were called when necessary. Since the gynecologist in our hospital was the only physician who attended all cases of alleged sexual assault, he had to be familiar with the different aspects of the problem like diagnosis of different kinds of sexual assault, emotional shortand long-term disturbances in the victim, medicolegal implications, postcoital pregnancy interception and prevention of sexually transmitted diseases. It is our impression, that a team approach involving at least a gynecologist, pediatrician and social worker should be used on during the acute crisis. This is especially important when dealing with adolescents in the young age group.

Men’s attitude in Israel towards sterilization by vasectomy

Male sterilization by vasectomy is gaining acceptance throughout the Western world. The procedure is considered convenient, inexpensive and reliable1, but is still not popular in Israel.