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Silberstein T, Freud A, Baumfeld Y, Sheiner E, Weintraub AY, Mastrolia SA, Trojano G, Bernstein EH, Schwarzman P. Influence of ovarian torsion on reproductive outcomes and mode of delivery. Front Med (Lausanne) 2024; 11:1370409. [PMID: 38601114 PMCID: PMC11005820 DOI: 10.3389/fmed.2024.1370409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose To investigate differences in reproductive outcomes among patients before and following ovarian torsion. Study design In this retrospective cohort study, we investigated the reproductive outcomes of patients who underwent surgery for ovarian torsion between 1988 and 2015 in a tertiary medical center. Data on deliveries before and after ovarian torsion were compared. Results During the study period, 199 women underwent surgery due to ovarian torsion. The majority (91.4%; n = 182) underwent detorsion, and 8.6% (n = 17) underwent unilateral adnexectomy. At the time of the torsion, 27.6% (n = 55) of patients were pregnant. Among women who suffered from ovarian torsion, about half (52%) of the deliveries occurred before the torsion and 48% following the torsion. No significant difference in the live birth rate was noted (p = 0.19). The fertility treatment rate in our cohort was 7.5% before and 5% after the torsion (p = 0.01). In addition, live birth, cesarean delivery, and fertility treatment rates were similar in women who underwent detorsion vs. those who had adnexectomy. Conclusion Surgically treated ovarian torsion does not appear to negatively influence fertility and live birth potential.
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Affiliation(s)
- Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Freud
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
| | - Eli Harris Bernstein
- The Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Borochov Hausner N, Baumfeld Y, Yaniv-Salem S, Hamou B, Silberstein T. The impact of cerclage placement on gestational length in women with premature cervical shortening. J Perinat Med 2023:jpm-2022-0444. [PMID: 37062595 DOI: 10.1515/jpm-2022-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES Cervical insufficiency (CI) is a condition consistent with painless cervical dilatation that can lead to preterm delivery. Cervical cerclage is a procedure in which cervical suture is performed for preventing preterm labor in several indications. Late emergency cerclage is technically more challenging compared to elective cerclage, performed earlier during pregnancy, prior to cervical changes. Pregnancy outcomes with emergency cerclage were found to be improved in previous reports, but there is still inconclusive data. To assess the effectiveness and safety of emergency cerclage vs. conservative management with progesterone and/or bed resting, in preventing preterm birth and improving neonatal outcomes in women with clinically evident cervical insufficiency. METHODS This is a retrospective cohort study conducted on all women diagnosed with cervical insufficiency between the 16th and 24th gestational week who met the inclusion criteria, from January 2012 to December 2018. Obstetric and neonatal outcomes: time from diagnosis to delivery, duration of pregnancy, birth weight and Apgar score, were compared between women who underwent cerclage and those who treated conservatively. RESULTS Twenty eight women underwent emergency cerclage (cerclage group) and 194 managed with a conservative therapy, progesterone and/or bed rest (control group). Time from diagnosis to delivery 13 weeks vs. 8 weeks and birth weight 2,418 g vs. 1914 g were significantly higher in the first cohort. Average pregnancy duration was three weeks longer in the cerclage group, but that was not significant. No complications occurred in the cerclage group and no difference in mode of delivery were found. CONCLUSIONS Emergency cerclage is an effective and safe procedure in preventing preterm birth and prolongation of pregnancy, in women with cervical insufficiency in the late second trimester.
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Affiliation(s)
| | - Yael Baumfeld
- Department of Obstetrics & Gynecology, Soroka Medical Center, Beer Sheva, Israel
| | - Shimrit Yaniv-Salem
- Department of Obstetrics & Gynecology, Soroka Medical Center, Beer Sheva, Israel
| | - Batel Hamou
- Assuta Ashdod Medical Center, Beer Sheva, Israel
| | - Tali Silberstein
- Department of Obstetrics & Gynecology, Soroka Medical Center, Beer Sheva, Israel
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Schwarzman P, Baumfeld Y, Mastrolia SA, Yaniv-Salem S, Leron E, Silberstein T. Obstetric Outcomes after Perforation of Uterine Cavity. J Clin Med 2022; 11:jcm11154439. [PMID: 35956056 PMCID: PMC9369682 DOI: 10.3390/jcm11154439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries.
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Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Department of Obstetrics and Gynecology, Ospedale Civile Umberto I, Via Ruvo, 108, 70033 Corato, Italy
- Correspondence:
| | - Shimrit Yaniv-Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
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Namazov A, Gemer O, Ben-Arie A, Israeli O, Bart O, Saphier O, Mahler N, Kapustian V, Silberstein T. Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women. Journal of Obstetrics and Gynaecology Canada 2019; 41:912-915. [DOI: 10.1016/j.jogc.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/28/2018] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
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Zilberman A, Sheiner E, Barrett O, Hamou B, Silberstein T. Correction to: Once episiotomy, always episiotomy? Arch Gynecol Obstet 2019; 300:489. [PMID: 31062147 DOI: 10.1007/s00404-019-05143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original article can be found online.
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Affiliation(s)
- Ayala Zilberman
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Orit Barrett
- Department of Medicine and Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Batel Hamou
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel.
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6
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Amitai E, Lior Y, Sheiner E, Saphier O, Leron E, Silberstein T. The impact of hymenectomy on future gynecological and obstetrical outcomes. J Matern Fetal Neonatal Med 2018; 33:1400-1404. [PMID: 30173591 DOI: 10.1080/14767058.2018.1519539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis, and infertility. The accepted surgical treatment for imperforate hymen and some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood.Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy.Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988 and 2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy.Results: During the study period, 56 of 74,598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, cesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p = .01) as were infertility treatments (10.7 versus 4.4% p = .04) and dyspareunia (42.9 versus 0.2% p <.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; p = .001).Conclusions: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.
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Affiliation(s)
- Eitan Amitai
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yotam Lior
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Soroka Clinical Research Center, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Eyal Sheiner
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Oshra Saphier
- Department of Chemical Engineering, Sami Shamoon College of Engineering, Be'er-Sheva, Israel
| | - Elad Leron
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Tali Silberstein
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
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7
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Hamou B, Sheiner E, Coreanu T, Walfisch A, Silberstein T. Intrapartum cervical lacerations and their impact on future pregnancy outcome. J Matern Fetal Neonatal Med 2018; 33:883-887. [PMID: 30189764 DOI: 10.1080/14767058.2018.1505852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To investigate the significance of intrapartum cervical lacerations on subsequent pregnancies.Study design: A retrospective cohort analysis was conducted, comparing outcomes of subsequent singleton pregnancies, in women with and without a history of cervical lacerations in a previous delivery. Deliveries occurred between the years 1991-2014 at the Soroka University Medical Center. Multiple logistic regression models were constructed to control for clinically significant confounders.Results: During the study period 187,162 deliveries met the inclusion criteria. Of them, 429 (0.2%) occurred in women with a history of cervical lacerations in the previous pregnancy (study group). The study group exhibited significantly higher rates of recurrent cervical lacerations (21/429, 4.9% versus 275/187 162,0.1%, p value = .001), cerclage (13/429, 3% versus 260/187 162, 0.1% p value = .001), cervical incompetence (8/429, 1.9% versus 609/187 162, 0.3% p value = .001) cesarean delivery (CD) (97/429, 22.6% versus 26 280/187 162,14%, p value = .001), severe perineal tears (third or fourth degree; 2/429, 0.5%, versus 164/187 162, 0.1%, p value = .056) and blood transfusion (11/429, 2.6% versus 2448/187 162, 1.3%, p value = .022) as compared with the comparison group. Using a multivariable logistic regression model, history of cervical laceration in a previous pregnancy was found to be an independent risk factor for subsequent CD (OR 1.4, 95% CI 1.1-1.9), recurrent cervical laceration (OR 29.3, 95% CI 17.7-48.5), severe perineal lacerations (OR 11.7, 95% CI 5.1-27.2), and preterm delivery (OR 1.8, 95% CI 1.1-2.8) in the subsequent pregnancy.Conclusions: A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.
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Affiliation(s)
- Batel Hamou
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tara Coreanu
- Department of Medicine and Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kreinin A, Saphier O, Silberstein T. Methotrexate Treatment for Retained Placental Tissue after Second Trimester Termination of Pregnancy. Isr Med Assoc J 2018; 20:388-390. [PMID: 29911763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Andrey Kreinin
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Oshra Saphier
- Department of Chemical Engineering, Sami Shamoon College of Engineering, Beer Sheva, Israel
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Silberstein E, Shir-Az O, Reuveni H, Krieger Y, Shoham Y, Silberstein T, Bogdanov-Berezovsky A. Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel. Aesthet Surg J 2016; 36:NP299-NP304. [PMID: 27277272 DOI: 10.1093/asj/sjw094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Defensive medicine (DM) includes medical practices that are aimed at avoiding liability rather than benefitting the patient. DM has not been well characterized among plastic surgeons. OBJECTIVES The authors examined the extents of intended and unintended DM among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) and identified risk factors for DM. METHODS A total of 108 ISPAS members were asked to complete a questionnaire that addressed physician attitudes toward DM and intended or unintended DM practices. RESULTS Seventy-eight surgeons (72.2% response rate) returned the questionnaire, although some questionnaires were returned incomplete. Forty respondents acknowledged practicing DM (ie, DM group), and 33 respondents did not (ie, non-DM group). There were no between-group differences in gender, years of practice, or number of previous litigations. Thirty-one percent of respondents in the DM group indicated that they avoid certain surgical procedures, compared with 6% of respondents in the non-DM group (P = .008). In private practice, 66.2% of respondents stated that they obtain written informed consent twice before surgery, and 100% request preoperative blood-coagulation testing. In contrast, 40% and 74% of respondents in public practice, respectively, acknowledged these behaviors (for consent, P = .027; for testing, P = .0059). Sixty-three percent of respondents prescribe antibiotics for more than 24 hours postoperatively, and this practice was slightly more common in the DM group (34 prescribe antibiotics vs 21 in the non-DM group; P = .079). CONCLUSIONS DM is highly integrated into the daily medical practices of plastic surgeons in Israel.
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Affiliation(s)
- Eldad Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Ofir Shir-Az
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Haim Reuveni
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yuval Krieger
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yaron Shoham
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Tali Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Alexander Bogdanov-Berezovsky
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
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Silberstein T, Sheiner E, Salem SY, Hamou B, Aricha B, Baumfeld Y, Yohay Z, Elharar D, Idan I, Yohay D. Fetal heart rate monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis. J Matern Fetal Neonatal Med 2016; 30:257-260. [DOI: 10.3109/14767058.2016.1172064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Batel Hamou
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Barak Aricha
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Debora Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
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11
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Saphier O, Silberstein T, Yardeni G, Blumenfeld J, Zilbermann I, Burg A. Role of lycopene in preventing lipid peroxidation products, in commercial infant milk formula. J Matern Fetal Neonatal Med 2015; 29:2865-9. [PMID: 26592530 DOI: 10.3109/14767058.2015.1107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of the study was to investigate whether lycopene from natural sources (tomato extract) is able to protect newborns milk formula, against oxidative damage caused by exposure to hydroxyl radicals, and is there a difference between milk substitutes from various sources. METHODS Four commercial brands of infant milk formula: two of the formulas were dairy milk (A-d and B-d) and two were based on soy bean vegan milk (A-s and B-s), were exposed to ionizing radiation radical (·OH). Lipid peroxidation was determined by measuring malondialdehyde (MDA) using thiobarbituric acid reactive substance test (TBARS). RESULTS When suspensions containing the four brands of formula were subjected to oxidizing media produced by ionizing radiation (hydroxyl radicals), lipid peroxidation increased linearly as a function of the irradiation dose (R = 0.99). It was found that lycopene in a concentration of 0.6 mM, reduced the radiation damage only in the soy-based formula; decrease of ∼40% of the damage achieved in B-s, and ∼20% reduction in the damage caused to A-s, significantly p < 0.01. CONCLUSIONS Lycopene in dairy milk did not protect against hydroxyl radicals; however, lycopene found to protect against hydroxyl radicals in soy milk. This result suggests different mechanisms of radical production that arises from high iron levels present in the soy milk and involving the high-valent iron peroxo species.
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Affiliation(s)
- Oshra Saphier
- a Department of Chemical Engineering , Sami Shamoon College of Engineering , Beer-Sheva , Israel
| | - Tali Silberstein
- b Department of Gynecology and Obstetrics , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel , and
| | - Guy Yardeni
- c Department of Chemistry , Nuclear Research Center-Negev , Beer-Sheva , Israel and Department of Chemistry , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Jeanine Blumenfeld
- a Department of Chemical Engineering , Sami Shamoon College of Engineering , Beer-Sheva , Israel
| | - Israel Zilbermann
- c Department of Chemistry , Nuclear Research Center-Negev , Beer-Sheva , Israel and Department of Chemistry , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Ariela Burg
- a Department of Chemical Engineering , Sami Shamoon College of Engineering , Beer-Sheva , Israel
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Tsesis S, Silberstein T, Zlotnik A, Boyko M, Kuts R, N. Azab A. A Lack of Association Between Blood Glutamate and Anxiety Levels in Pre- delivery Pregnant Women. CURR PHARM ANAL 2015. [DOI: 10.2174/1573412911666150421225230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Yohay D, Silberstein T, Aricha-Tamir B, Yaniv-Salem S, Hamou B, Elharar D, Idan I, Yohay Z, Sheiner E. 788: Fetal heart rate (FHR) monitoring during the 2nd stage of labor: can categorization predict adverse neonatal outcome while adding specific FHR patterns? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE Knowledge about levels of toxic and non-toxic elements in amniotic fluid is limited. The aims of this study were: (1) to measure levels of trace elements Cu, Fe, Zn, B, Sr and Co in amniotic fluid and maternal serum during second trimester of pregnancy; and (2) to determine what correlations exists between elements levels in amniotic fluid and maternal serum. METHODS The levels of, iron, copper, zinc, cobalt, strontium and boron were measured in blood and amniotic fluid during genetic amniocentesis using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS Concentrations of the elements: Fe, Cu, Zn, Co, Sr and B in amniotic fluid were significantly lower than in maternal blood. For iron, zinc, cobalt, strontium and boron there was a linear correlation between levels in amniotic fluid and maternal serum. CONCLUSIONS The concentration of trace elements in amniotic fluid was found to be lower than maternal serum and linearly correlated to its level.
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Affiliation(s)
- Tali Silberstein
- Department of Gynecology and Obstetrics, Soroka University Hospital , Beer-Sheva , Israel
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15
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Silberstein T, Sheiner E, Levy A, Harlev A, Saphier O. 520: Perinatal outcome of pregnancies following in vitro fertilization and ovulation induction. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silberstein T, Levy A, Harlev A, Saphier O, Sheiner E. Perinatal outcome of pregnancies following in vitro fertilization and ovulation induction. J Matern Fetal Neonatal Med 2013; 27:1316-9. [PMID: 24175873 DOI: 10.3109/14767058.2013.856415] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate pregnancy outcome in patient who conceived by assisted reproductive techniques. METHODS A retrospective population-based study was conducted, comparing obstetrical complications and neonatal outcomes of singleton pregnancies conceived by in vitro fertilization (IVF; n = 1296) and ovulation induction (n = 1988) as compared to singleton pregnancies conceived spontaneously (n = 172 288). Multivariable models were constructed to control for confounders. RESULTS A significant linear association (using the chi-square test for trends) was documented among the three groups in adverse outcomes such as gestational diabetes mellitus (17.3% in the IVF, 14.2% in the ovulation induction, 6.6% in the comparison group, p < 0.001), severe preeclampsia (2.7% in the IVF, 1.8% in the ovulation induction, 1.1% in the comparison group, p < 0.001) and perinatal mortality (3.3% in the IVF, 2.1% in the ovulation induction, 1.3% in the comparison group, p < 0.001). In vitro fertilization and ovulation induction treatments were found to be independent risk factors for gestational diabetes mellitus, using two different multiple logistic regression models controlling for confounders such as maternal age (adjusted OR = 1.77, 95% CI:1.52-2.07, p < 0.001 and adjusted OR = 1.93, 95% CI:1.69-2.21, p < 0.001; respectively). CONCLUSIONS Pregnancies conceiving following assisted reproductive techniques are at an increased risk for adverse obstetrics outcomes. The risk is higher for pregnancies following IVF compared with these conceived following ovulation induction.
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Affiliation(s)
- Tali Silberstein
- Department of Gynecology and Obstetrics, Soroka University Hospital
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Silberstein T, Silberstein E, Saphier O. [Lycopene and tomatoes--their effect on prevention of prostatic cancer]. Harefuah 2013; 152:461-499. [PMID: 24167930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Prostate cancer is one of the most common types of cancer and it is the second most common cause of cancer-related death among men in the western world. Microscopic prostate cancer was found in up to 30% of men as early as 20-40 years old of age. Lycopene is a lipid soluble carotenoid molecule. It is found in high concentration in red fruit and vegetables. Lycopene has a significant anti-oxidative activity. There is laboratory evidence that explain it's function as an inhibitor of various tumors as well as epidemiological evidence that shows that lycopene-rich foods reduce the incidence of a few types of cancer and especially prostate cancer. This paper reviews the evidence that explain lycopene activity, its biological effect and availability and its effect on the prevention of prostate cancer.
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Affiliation(s)
- Tali Silberstein
- Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Silberstein T, Burg A, Blumenfeld J, Sheizaf B, Tzur T, Saphier O. Saturated fatty acid composition of human milk in Israel: a comparison between Jewish and Bedouin women. Isr Med Assoc J 2013; 15:156-159. [PMID: 23781748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Breast milk is well established as the ideal source of nutrition for infants. Mature human breast milk generally contains 3.5-4.5% lipids comprising mostly triacylglycerols. In general, the fat composition of maternal human milk in developing countries shows higher levels of saturated fats, reflecting diets rich in carbohydrates. OBJECTIVES To determine the profile of unsaturated fatty acids in the breast milk of two populations in southern Israel--urban Jewish and rural tent-dwelling Bedouin women. METHODS This study involved 48 lactating Israeli mothers, 29 Jewish and 19 Bedouin (16-20 weeks postpartum), whose full-term infants were fed exclusively with breast milk. Total milk lipid extracts were transmethylated and analyzed by using an improved gas chromatographic method. RESULTS The breast milk of the Bedouin women contained significantly higher levels of total major saturated fatty acids, lauric acid and palmitic acid (45.2 +/- 4.7% vs. 41.0 +/- 5.6%, P = 0.005; 5.2 +/- 2.1 vs. 6.8 +/- 2.0%, P = 0.03; and 22.7 +/- 2.4 vs. 20.6 +/- 3.8%, P = 0.02) respectively. No difference was found in the myristic acid level between the groups. The level of stearic acid was significantly higher in the Jewish group compared to the Bedouin group (5.7 +/- 1.1 vs. 5.1 +/- 1.1%, P = 0.04). There was a linear correlation between the levels of C14:0 and C12:0 in the Bedouin and lewish groups respectively (R = 0.87, R = 0.82, P < 0.001). CONCLUSIONS Higher levels of saturated fatty acids were measured in the breast milk of Bedouin women, an economically weaker population. The results emphasize the importance of diet among lactating women and its influence on milk quality.
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Affiliation(s)
- Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Silberstein E, Silberstein T, Elhanan E, Bar-Droma E, Bogdanov-Berezovsky A, Rosenberg L. Epidemiology of cleft lip and palate among Jews and Bedouins in the Negev. Isr Med Assoc J 2012; 14:378-381. [PMID: 22891400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Clefts of the lip and palate are the most common significant congenital birth anomaly of the orofacial region. The condition may vary from a minor easily correctable cleft to a significant functional and cosmetic incapacitation. This is the first epidemiological study of orofacial clefts in the Negev region in Israel. OBJECTIVES To establish the frequency of cleft lip and palate in the population of the Negev, characterize the demographic features of affected individuals and find possible risk factors, compare the risk in two major population groups: Bedouin and Jewish in a well-defined geographic area, and determine whether there is a change overtime in the birth of babies with facial clefts. METHODS We conducted a retrospective survey of the Soroka Medical Center archives. The sample population comprised all 131,218 babies born at Soroka during the 11 year period 1 January 1996 to 31 December 2006. Statistical tests used Pearson's chi-square test, Student's t-test and Spearman's correlation coefficient test according to the type of parameter tested. RESULTS During the study period 140 babies were born with orofacial cleft. The overall incidence of cleft lip and palate was 1.067/1000. The incidence of facial clefts was 1.54/1000 among Bedouins and 0.48/1000 among Jews (P < 0.001). Cleft palate was significantly more frequent in female than male babies (P = 0.002). Over the study years we found a significant decrease in the incidence of facial clefts in the Bedouin population, with Spearman's correlation coefficient rank -0.9 (P < 0.01). CONCLUSIONS A significant decrease occurred in the incidence of facial clefts among Bedouin. This change may be attributed to prenatal care in the Bedouin Negev population as part of social and health-related behavior changes. The reduction in rates of congenital malformations, however, does not mean a reduction in the number of cases in a growing population. Also, with a modern western lifestyle, the expectancy and demand for reconstructive facial surgery and comprehensive care for these children are on the rise.
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Affiliation(s)
- Eldad Silberstein
- Center of R&D in Plastic Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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20
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Lazer T, Paz-Tal O, Katz O, Aricha-Tamir B, Sheleg Y, Maman R, Silberstein T, Mazor M, Wiznitzer A, Sheiner E. Trace elements' concentrations in maternal and umbilical cord plasma at term gestation: a comparison between active labor and elective cesarean delivery. J Matern Fetal Neonatal Med 2011; 25:286-9. [PMID: 21557694 DOI: 10.3109/14767058.2011.574297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements' concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD). STUDY DESIGN A prospective case-control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements' concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS). RESULTS Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD. CONCLUSION Trace elements' concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.
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Affiliation(s)
- Tal Lazer
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
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21
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Leibenson L, Banani S, Borer A, Meirovitz M, Avni YS, Singer D, Schlaeffer F, Leibenson M, Silberstein T, Wiznitzer A, Riesenberg K. The prevalence of human papillomavirus and cervical cytology abnormalities in women infected with human immunodeficiency virus in southern Israel. Isr Med Assoc J 2011; 13:34-38. [PMID: 21446234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Concomitant human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection increases both HPV persistence and the risk of invasive cervical cancer. An estimation of HPV prevalence among HIV-positive women in Israel would contribute to improving care for this population and preventing morbidity and mortality related to cervical cancer. OBJECTIVES To determine the prevalence of HPV infection and cervical cytology abnormalities, and to assess the possible influence of HIV infection on HPV carriage in HIV-positive women attending the Infectious Disease Clinic at Soroka University Medical Center. METHODS The study population included 84 HIV-seropositive women. They were examined by a gynecologist and screened for HPV genotyping, and Pap smears were obtained for cervical cytology. Demographic, behavioral, and HIV infection variables were also recorded and analyzed. RESULTS Forty-nine (58.3%) of the study participants were HPV-positive; 34 of them had oncogenic genotypes. Young age (< 16 years) at first sexual intercourse was the only variable significantly associated with HPV infection (P < 0.05). Abnormal cervical cytology was present in 17 women (20.3%); 21 women were referred to colposcopy, which was abnormal in 9 (10.7%). CONCLUSIONS The prevalence of HPV carriage among HIV-positive woman in our study was slightly higher than published elsewhere. The prevalence of pathological cervical cytology was much higher than in the general population. An extremely high prevalence of pathological colposcopies requiring further treatment was found. Screening for HPV and premalignant changes in the uterine cervix is highly recommended in the HIV-seropositive population. We suggest that colposcopy be considered part of the routine workup in HIV-seropositive woman.
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Affiliation(s)
- Lilach Leibenson
- Division of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Burg A, Silberstein T, Yardeni G, Tavor D, Blumenfeld J, Zilbermann I, Saphier O. Role of radicals in the lipid peroxidation products of commercial infant milk formula. J Agric Food Chem 2010; 58:2347-2350. [PMID: 20112911 DOI: 10.1021/jf903764d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Four commercial brands of infant milk formula were investigated, and the amount of shelf lipid peroxidation was determined by measuring malondialdehyde (MDA) or, more exactly, thiobarbituric acid reactive substance (TBARS) levels, which are the end products of lipid peroxidation. TBARS level, indicated by MDA concentration, was higher in the vegetarian brands. The vegetarian brands are, as expected, more prone to oxidation than dairy brands, as they contain more unsaturated fats. The introduction of formate anion diminishes the peroxide amounts initially present in the milk samples as well as those induced by radiation-induced oxidation.
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Affiliation(s)
- Ariela Burg
- Department of Chemical Engineering, Sami Shamoon College of Engineering, Beer-Sheva, Israel
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Tzur T, Sheiner E, Weintraub AY, Mazor M, Wiznitzer A, Silberstein E, Holcberg G, Silberstein T. "At fingers' ends": risk factors and perinatal outcome of pregnancies complicated by digital malformations. Arch Gynecol Obstet 2009; 283:47-52. [PMID: 19890655 DOI: 10.1007/s00404-009-1275-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 10/20/2009] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify the incidence, risk factors, and perinatal outcome of newborns with congenital finger or toe (digital) anomalies. METHOD A retrospective study including all neonates born at a tertiary medical center during 2001-2006 with congenital digital anomalies was conducted. The comparison group consisted of newborns without such anomalies born during the same period. RESULTS Of 115,876 newborns delivered during the study period, 360 (31 per 10,000) were diagnosed with digital anomalies. Polydactyly was the most common diagnosis (n = 263; 73% of digital anomalies). Associated anomalies in these patients were congenital heart malformations (n = 93; 25.8% of the newborns with congenital digital anomalies), central nervous system anomalies (n = 17; 4.7%), and musculoskeletal anomalies (n = 13; 3.6%). Newborns with congenital digital anomalies were more likely to be males (62.2 vs. 37.8%; P < 0.001), and of a Bedouin Arab descent compared to Jewish ethnicity (61.4 vs. 38.6%; P = 0.004). Significantly higher rates of severe pre-eclampsia, recurrent abortions, transverse lie, and low birth-weight (<2,500 g) infants were found among newborns with digital anomalies. CONCLUSIONS The incidence of digital anomalies can vary according to the population characteristics. It may be associated with other skeletal and non-skeletal malformations as well as with certain adverse obstetrical and perinatal outcomes. If a fetal digit anomaly is suspected, a detailed assessment of fetal anatomy is mandatory to exclude other malformations.
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Affiliation(s)
- Tamar Tzur
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ohel I, Sheiner E, Aricha-Tamir B, Piura B, Meirovitz M, Silberstein T, Hershkovitz R. Three-dimensional power Doppler ultrasound in ovarian cancer and its correlation with histology. Arch Gynecol Obstet 2009; 281:919-25. [DOI: 10.1007/s00404-009-1269-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 10/13/2009] [Indexed: 11/30/2022]
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Silberstein T, Saphier O, Paz-Tal O, Gonzalez L, Keefe DL, Trimarchi JR. Trace element concentrations in follicular fluid of small follicles differ from those in blood serum, and may represent long-term exposure. Fertil Steril 2009; 91:1771-4. [DOI: 10.1016/j.fertnstert.2008.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 02/04/2008] [Accepted: 02/05/2008] [Indexed: 11/16/2022]
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Tzur T, Sheiner E, Silberstein E, Silberstein T. 639: Congenital anomalies of the fingers and toes: Incidence, risk factors and associated malformations. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Silberstein T, Mankuta D, Shames AI, Likhtenshtein GI, Meyerstein D, Meyerstein N, Saphier O. Neonatal blood is more resistant to oxidative stress induced by stable nitroxide radicals than adult blood. Arch Gynecol Obstet 2007; 277:233-7. [PMID: 17713779 DOI: 10.1007/s00404-007-0439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
Neonate erythrocytes are more susceptible to oxidizing drugs than adults; however, there are controversial reports in the literature regarding the total antioxidant capacity of neonate blood. Stable nitroxide radicals (NRs) are reduced by blood and some other biological materials to the corresponding hydroxylamines. The kinetics of the nitroxide's disappearance using electron paramagnetic resonance (EPR) spectroscopy, provides useful biochemical and biophysical information about the antioxidant properties of biological systems. In order to investigate the antioxidant properties in the newborn's blood, we applied this novel method on 38 umbilical vein blood samples and 40 healthy adults. The NR, 5-Dimethylaminonaphthalene-1-sulfonyl-4-amino-2,2,6,6,-tetramethyl-piperidine-oxyl (R), was used for this purpose. Ascorbate is the only known natural antioxidant that reduces R. We found that the reduction rates of R in neonate's whole blood are significantly higher (P < 0.001) than the reduction rates of R in adult's whole blood. However, there were no significant differences in the antioxidant capacity between the two groups. Newborn's blood has significantly higher ability to deal with oxidative stress, caused by R, in comparison with adult blood. We suggest that the system that responds to the recycling of ascorbate is more efficient in neonate blood than in adult's blood.
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Affiliation(s)
- Tali Silberstein
- Department of Gynecology and Obstetrics, Soroka University Hospital, Ben-Gurion University of the Negev, Beersheba, Israel
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Paamoni-Keren O, Silberstein T, Burg A, Raz I, Mazor M, Saphier O, Weintraub AY. Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery. Arch Gynecol Obstet 2007; 276:43-6. [PMID: 17333227 DOI: 10.1007/s00404-006-0304-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. STUDY DESIGN Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. RESULTS Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). CONCLUSION Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.
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Affiliation(s)
- Orit Paamoni-Keren
- Department of Obstetrics and Gynecology, Soroka University Medical center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Paamoni-Keren O, Silberstein T, Burg A, Raz I, Mazor M, Saphier O. Oxidative stress as indicated by gluthatione (GSH) levels is higher in elective cesarean delivery than in uncomplicated vaginal delivery. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E. Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy. J Matern Fetal Neonatal Med 2006; 19:305-8. [PMID: 16753771 DOI: 10.1080/14767050600590573] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The study was designed to investigate obstetric risk factors and pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy (PUPPP). METHODS A population-based study comparing all pregnancies of women with and without PUPPP was conducted. Deliveries occurred during the years 1988-2002 at the Soroka University Medical Center. A multivariable logistic regression model was constructed in order to find independent risk factors associated with PUPPP. RESULTS During a 15-year period, 159 197 deliveries took place. PUPPP complicated 42 (0.03%) of all pregnancies. Using a multivariable analysis, the following conditions were significantly associated with PUPPP: multiple pregnancies (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7-14.1), hypertensive disorders (OR = 2.2, 95% CI 1.1-4.7), and induction of labor (OR = 7.6, 95% CI 4.0-14.5). Higher rates of 5-minute Apgar scores lower than 7 (OR = 8.0, 95% CI 4.4-14.9) and of cesarean deliveries (OR = 2.9, 95% CI 1.5-5.6) were noted in the PUPPP as compared to the comparison group. While investigating other perinatal outcome parameters such as oligohydramnios, intrauterine growth restriction, meconium-stained amniotic fluid and perinatal mortality, no significant differences were observed between the groups. CONCLUSION Pruritic urticarial papules and plaques of pregnancy is a condition significantly associated with multiple pregnancies, hypertensive disorders, and induction of labor. Perinatal outcome is comparable to pregnancies without PUPPP.
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Affiliation(s)
- Iris Ohel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
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Silberstein T, Saphier O, van Voorhis BJ, Plosker SM. Endometrial polyps in reproductive-age fertile and infertile women. Isr Med Assoc J 2006; 8:192-5. [PMID: 16599056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Endometrial polyps are a frequent finding in infertile patients. Little is known about the true prevalence of polyps in infertile patients. It is unproved whether polyps are causative of infertility, or whether surgical polypectomy by hysteroscopy improves the likelihood of successful conception. This article reviews endometrial polyps in reproductive-age fertile and infertile women.
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Affiliation(s)
- Tali Silberstein
- Division of Biology, Women and Infants' Hospital of Rhode Island, Brown Medical School, Providence, USA.
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Bentov Y, Levitas E, Silberstein T, Potashnik G. Cullen’s sign following ultrasound-guided transvaginal oocyte retrieval. Fertil Steril 2006; 85:227. [PMID: 16412762 DOI: 10.1016/j.fertnstert.2005.06.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 06/19/2005] [Accepted: 06/19/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe two cases of periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval. DESIGN Case report. SETTING University-affiliated teaching hospital. PATIENT(S) Two patients, 34 and 32 years old, who developed Cullen's sign following ultrasound-guided transvaginal oocyte retrieval. INTERVENTION(S) Workup for pancreatitis and coagulopathies. Laparoscopy was preformed in one patient. MAIN OUTCOME MEASURE(S) Resolution of the symptoms. RESULT(S) Pancreatitis, coagulopathy, and massive hemoperitoneum were ruled out. Symptoms resided within two weeks. CONCLUSION(S) The appearance of a periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval reflects a retroperitoneal hematoma of a benign course.
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Affiliation(s)
- Yaakov Bentov
- Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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33
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Silberstein T, Saphier O, Paz-Tal O, Trimarchi JR, Gonzalez L, Keefe DL. Lead concentrates in ovarian follicle compromises pregnancy. J Trace Elem Med Biol 2006; 20:205-7. [PMID: 16959598 DOI: 10.1016/j.jtemb.2006.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 05/21/2006] [Indexed: 11/23/2022]
Abstract
Following absorption, lead can concentrate in bodily compartments where it disrupts cellular processes and can result in detrimental health consequences. The concentration and impact of lead within follicular fluid has not been characterized and we used inductively coupled plasma mass spectroscopy (ICP-MS) to determine lead levels in blood and follicular fluid from nine patients undergoing in vitro fertilization (IVF) treatment. Lead levels within follicular fluid were found to be significantly higher in non-pregnant patients compared to pregnant patients suggesting that elevated concentrations of the environmental toxicant lead adversely affect female reproduction.
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Affiliation(s)
- Tali Silberstein
- Division of Reproductive Endocrinology, Women and Infants' Hospital of Rhode Island Brown Medical School Providence, Rhode Island 02905, USA.
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Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 2005; 274:81-3. [PMID: 16374604 DOI: 10.1007/s00404-005-0110-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 11/24/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study was aimed at evaluating the outcome of pregnancies with nuchal cord. METHODS A retrospective population-based study of all deliveries during the years 1988-2003 in a tertiary medical center was conducted. Immediate perinatal outcome of patients with and without nuchal cord was compared. RESULTS Of 166,318 deliveries during the study period, 14.7% had a nuchal cord, documented at birth (n=24,392). Higher rates of labor induction and non-reassuring fetal heart rate patterns were noted among pregnancies with nuchal cord as compared with the control group (30.1% vs. 24.2%; OR=1.3, 95% CI 1.3-1.4, P<0.001 and 4.5% vs. 2.6%; OR=1.8, 95% CI 1.6-1.9, P<0.001; respectively). The cesarean delivery rate was significantly lower among pregnancies with nuchal cord (11.5% vs. 12.7%; OR=0.9, 95% CI 0.8-0.9, P=0.001). Although 1 min Apgar scores lower than 7 were more common in pregnancies with nuchal cord (4.8% vs. 4.4%; OR=1.1, 95% CI 1.01-1.2, P=0.008), these pregnancies actually had lower rates of 5 min Apgar scores less than 7 (0.5% vs. 0.7%; OR=0.8, 95% CI 0.6-0.9, P=0.004). Likewise, the perinatal mortality rate was significantly lower in pregnancies with nuchal cord as compared with the comparison group (11/1,000 vs. 16/1,000; OR=0.7, 95% CI 0.6-0.8, P=0.001). CONCLUSIONS Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.
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Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Silberstein T, Trimarchi JR, Shackelton R, Weitzen S, Frankfurter D, Plosker S. Ultrasound-guided miduterine cavity embryo transfer is associated with a decreased incidence of retained embryos in the transfer catheter. Fertil Steril 2005; 84:1510-2. [PMID: 16275257 DOI: 10.1016/j.fertnstert.2005.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 06/03/2005] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
After initiating a policy of ultrasound-guided miduterine cavity embryo transfer (ET) on August 1, 2001, the incidence of retained embryos in the transfer catheter declined significantly from 4.2% (46 of 1,101 ETs) during the time interval January 1, 2000 to July 31, 2001, to 0.7% (6 of 908 ETs) during the time interval August 1, 2001 to December 31, 2002. Blood on the transfer catheter (38% vs. 19%) occurred with significantly greater frequency at ET in which embryos were retained; ETs of > or =4 embryos were more likely to be associated with retained embryos than ETs of <4 embryos (3.7% vs. 2.2%), and both the clinical pregnancy rate (PR) and implantation rate (IR) were lower when embryo retention occurred at ET than they were when embryos were not retained (25% vs. 34% clinical PR; 12% vs. 19% IR).
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Affiliation(s)
- Tali Silberstein
- Division of Biology and Medicine, Brown Medical School, Providence, Rhode Island, USA
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Silberstein T, Trimarchi JR, Gonzalez L, Keefe DL, Blazar AS. Pregnancy outcome in in vitro fertilization decreases to a plateau with repeated cycles. Fertil Steril 2005; 84:1043-5. [PMID: 16213871 DOI: 10.1016/j.fertnstert.2005.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 04/12/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022]
Abstract
Clinical pregnancy rate (CPR) and implantation rate (IR) in 1,177 patients who had 1,788 fresh, nondonor, nonPGD IVF cycles were highest in cycle 1, significantly declined in cycle 2, and reached a plateau for cycles 3-5 at a rate lower than in cycle 2. In patients >38 years of age CPR and IR in cycles 1 and 2 were significantly lower than in younger patients, but there was no decline in CPR or IR with advancing IVF attempts.
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Affiliation(s)
- Tali Silberstein
- Division of Reproductive Medicine and Infertility, Women and Infants' Hospital of Rhode Island, Brown Medical School, Providence, Rhode Island, USA
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Silberstein T, MacLaughlin DT, Shai I, Trimarchi JR, Lambert-Messerlian G, Seifer DB, Keefe DL, Blazar AS. Mullerian inhibiting substance levels at the time of HCG administration in IVF cycles predict both ovarian reserve and embryo morphology. Hum Reprod 2005; 21:159-63. [PMID: 16123085 DOI: 10.1093/humrep/dei270] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pre-antral and early antral follicles secrete Müllerian inhibiting substance (MIS), suggesting that MIS may directly reflect ovarian reserve. Since little is known about how ovarian reserve affects oocyte quality, we attempt here to assess the predictive value of MIS on embryo morphology and IVF outcome. To do so, we measured MIS at the time of HCG administration 36 h prior to oocyte retrieval. METHODS A total of 257 patients undergoing IVF were prospectively recruited. We measured MIS levels by enzyme-linked immunosorbent assay at the time of HCG, and compared the MIS values to day 3 FSH levels in the prediction of embryo morphology and IVF outcome. RESULTS The distribution of MIS levels was skewed, with a median of 2.7 ng/ml (range 0 to 28.5 ng/ml). MIS values at the time of HCG administration inversely correlated with basal FSH levels (P = 0.002), and both correlated significantly with patient age, number of mature follicles, number of oocytes retrieved and serum estradiol levels. MIS levels correlated significantly with a greater number of 6-cell embryos and better embryo morphology score, while basal FSH levels did not correlate with these outcome variables. MIS levels > or =2.7 ng/ml portended improved oocyte quality as reflected in a higher implantation rate (P = 0.001) and a trend toward a better clinical pregnancy rate (P = 0.084). CONCLUSIONS MIS levels seem to predict not only ovarian reserve, but also embryo morphology. Measurement of MIS at the time of HCG administration may, therefore, in the future improve management of patients undergoing treatments with assisted reproductive technology.
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Affiliation(s)
- T Silberstein
- Women and Infants' Hospital of Rhode Island, Brown University Division of Biology and Medicine, Providence, Rhode Island 02905, USA
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38
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Silberstein T, Weitzen S, Frankfurter D, Trimarchi JR, Keefe DL, Plosker SM. Cannulation of a resistant internal os with the malleable outer sheath of a coaxial soft embryo transfer catheter does not affect in vitro fertilization–embryo transfer outcome. Fertil Steril 2004; 82:1402-6. [PMID: 15533367 DOI: 10.1016/j.fertnstert.2004.04.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 04/06/2004] [Accepted: 04/06/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the impact of cannulation of a resistant cervical os with the outer malleable sheath of a double-lumen, soft ET catheter on IVF-ET outcomes. DESIGN Retrospective cohort study. SETTING University-based IVF center. PATIENT(S) One hundred forty-two patients undergoing 142 ETs. INTERVENTION(S) Trial ultrasound-guided ET at all transfers, leaving the malleable outer sheath in situ when the soft inner catheter could not negotiate the internal os. MAIN OUTCOME MEASURE(S) Implantation rate and clinical pregnancy rate. RESULT(S) In 102 ETs (71.8%), the soft inner sheath easily negotiated the internal os (group 1). Forty ETs (28.2%) required cannulation of resistant internal ora with the outer sheath of the trial catheter (group 2). Implantation rates (35% vs. 32% in groups 1 and 2, respectively) and clinical pregnancy rates (50% vs. 45%) were not significantly different between groups. Blood was present on the transfer catheter after ET more frequently in group 2 than in group 1 (55% vs. 15%); however, neither the implantation rate nor the clinical pregnancy rate were affected by the presence of blood. CONCLUSION(S) Cannulation of a resistant internal os by the malleable outer sheath and blood on the transfer catheter after ET do not have an adverse effect on implantation rate or clinical pregnancy rate.
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Affiliation(s)
- Tali Silberstein
- Division of Biology and Medicine, Women and Infants' Hospital of Rhode Island, Brown Medical School, Providence 02905, USA
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Silberstein T, Trimarchi J, Keefe D, Blazar A. Pregnancy outcome in fertilization (IVF) with repeated cycles. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Saphier O, Silberstein T, Shames AI, Likhtenshtein GI, Maimon E, Mankuta D, Mazor M, Katz M, Meyerstein D, Meyerstein N. The reduction of a nitroxide spin label as a probe of human blood antioxidant properties. Free Radic Res 2003; 37:301-8. [PMID: 12688425 DOI: 10.1080/1071576021000050410] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The kinetics of reduction of the radical R*, 5-dimethylaminonaphthalene-1-sulfonyl-4-amino-2,2,6,6-tetramethyl-1-piperidine-oxyl by blood and its components were studied using the EPR technique. The results demonstrate that R* is adsorbed to the outer surface of the membrane and does not penetrate into the erythrocytes. A series of control experiments in PBS demonstrate that ascorbate is the only natural reducing agent that reacts with R*. The observed first order rate of disappearance of the nitroxide radical k, is: k(blood) > k(eryth) > k(plasma) and k(blood) approximately = k(eryth) + k(plasma). The results demonstrate that: a. The erythrocytes catalyze the reduction of R* by ascorbate. b. The rate of reduction of the radical is high though it does not penetrate the cells. c. In human erythrocytes there is an efficient electron transfer route through the cell membrane. d. The study points out that R* is a suitable spin label for measuring the reduction kinetics and antioxidant capacity in blood as expressed by reduction by ascorbate.
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Affiliation(s)
- O Saphier
- Department of Chemistry, Faculty of Natural Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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42
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Treger M, Hallak M, Silberstein T, Friger M, Katz M, Mazor M. Post-term pregnancy: should induction of labor be considered before 42 weeks? J Matern Fetal Neonatal Med 2002; 11:50-3. [PMID: 12380609 DOI: 10.1080/jmf.11.1.50.53] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor. STUDY DESIGN A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves. RESULTS The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section. CONCLUSIONS The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.
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Affiliation(s)
- M Treger
- Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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43
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Shoham I, Wiznitzer A, Silberstein T, Fraser D, Holcberg G, Katz M, Mazor M. Gestational diabetes complicated by hydramnios was not associated with increased risk of perinatal morbidity and mortality. Eur J Obstet Gynecol Reprod Biol 2001; 100:46-9. [PMID: 11728656 DOI: 10.1016/s0301-2115(01)00426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether gestational diabetes (GDM) complicated with hydramnios is associated with higher rates of perinatal morbidity and mortality than those with normal amniotic fluid (AFI). STUDY DESIGN A case control study of 368 pregnant women with GDM was conducted between January 1995 and December 1996. The study group consisted of 184 women with hydramnios (AFI>25 cm) that were matched for maternal age, parity, and gestational age to 184 women with gestational diabetes and normal AFI. A Student's t-test, McNemar test and logistic regression test were used to compare the two groups. RESULTS Both groups were under strict metabolic control; mean glucose levels of 5.2+/-2.4 mmol/l in the study group and 5.5+/-2.4 mmol/l in the controls (P>0.05). There were no significant differences between groups in the rates of severe preeclampsia, premature rupture of membranes (PROM), cesarean section rate, intrauterine growth restriction (IUGR), antepartum fetal death, fetal distress, prolapse of umbilical cord and placenta abruption. Even though the prevalence of large for gestational age (LGA) and birth weight were significantly higher in the study group (31 versus 19% and 3441+/-477 versus 3232+/-554 g, respectively), the prevalence of neonatal trauma was the same in both groups (2.6%). There was no significant difference in the Apgar scores (1 and 5 min), newborn hypoglycemia, metabolic acidosis and hyperbilirubinemia. CONCLUSIONS Hydramnios in women with GDM was not associated with increased risk of perinatal morbidity and mortality.
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Affiliation(s)
- I Shoham
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel
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Ben-Aroya Z, Yochai D, Silberstein T, Friger M, Hallak M, Katz M, Mazor M. Oxytocin use in grand-multiparous patients: safety and complications. J Matern Fetal Med 2001; 10:328-31. [PMID: 11730496 DOI: 10.1080/714904358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To determine whether the use of oxytocin for the augmentation of labor in grandmultiparous women increases the risk of peripartum complications. STUDY DESIGN During the years 1989-97, 11 075 grand-multiparous women delivered at our institution. In 424 grand-multiparous women, intravenous oxytocin was used for augmentation of labor. The control group consisted of the other 10 651 grand-multiparous women. All women were monitored for fetal heart rate and uterine contractions. We compared the rates of maternal and perinatal complications in these two groups by using chi(2) analysis and Fisher's exact test when appropriate. RESULTS No significant differences were found between the oxytocin and the control groups in the rates of placental abruption, intrapartum fetal death, postpartum hemorrhage, uterine rupture, fetal distress, meconium-stained amniotic fluid, an Apgar score of less than 7 at 5 min, Cesarean section, retained placenta and vaginal and cervical lacerations. In contrast, a significant increase in the rate of vacuum deliveries was observed in patients given oxytocin as compared to controls (3.5% vs. 1.4%, respectively; p = 0.001). CONCLUSIONS The use of oxytocin in the grand-multiparous parturient was a safe procedure with no significant increase in peripartum complications. However, a higher rate of vacuum deliveries was found.
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Affiliation(s)
- Z Ben-Aroya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel
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45
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Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, Mazor M. Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol 2001; 98:36-9. [PMID: 11516797 DOI: 10.1016/s0301-2115(01)00312-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine obstetrical risk factors and pregnancy outcome of fetuses with true knot of the umbilical cord. METHODS Study population included 69,139 singleton deliveries occurring between the years 1990-1997. Data were retrieved from the database of the Soroka University Medical Center. Fetuses with malformations were excluded. RESULTS The incidence of true knots was 1.2% (841/69,139). In a multivariate analysis the following factors were found to be significantly associated with true knot of cord: grandmultiparity, chronic hypertension, hydramnios, patients who undergone genetic amniocentesis, male gender and cord problems (prolapse of cord and cord around the neck). The incidence of fetal distress and meconium stained amniotic fluid was significantly higher among patients with true knots of cord (7% versus 3.6%, P<0.001 and 22% versus 16%, respectively, P<0.0001). Moreover, there was a four-fold higher rate of antepartum fetal death among those fetuses (1.9% versus 0.5%, P<0.0001). In addition, fetuses with true knots of the umbilical cord were more often delivered by a cesarean section (130/841 versus 711/68,298, P<0.0001). The following obstetrical factors were found to be significantly correlated to true knots of the umbilical cord in a multiple logistic regression model: gestational diabetes, hydramnios, patients undergoing genetic amniocentesis, male fetuses. CONCLUSIONS Patients with hydramnios, who underwent genetic amniocentesis and those carrying male fetuses are at an increased risk for having true knots of the umbilical cord. Thus, careful sonographic and Doppler examinations should be seriously performed in these patients for detection of the complication of the umbilical cord.
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Affiliation(s)
- R Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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46
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Sheiner E, Shoham-Vardi I, Silberstein T, Hallak M, Katz M, Mazor M. Failed vacuum extraction. Maternal risk factors and pregnancy outcome. J Reprod Med 2001; 46:819-24. [PMID: 11584484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate obstetric risk factors associated with a failed trial of vacuum extraction and to assess its pregnancy outcome. STUDY DESIGN All attempted vacuum extractions between the years 1990 and 1998 were identified, and a comparison of successful and failed trials of vacuum extraction in singleton, vertex deliveries was performed. RESULTS Of 2,111 trials of vacuum extraction, 113 (5.4%) cases were complicated by failed extraction and underwent cesarean section. Those neonates were significantly more likely to be large for gestational age, specifically to weigh > 4,000 g as compared to the controls. Patients lacking prenatal care had significantly higher rates of failed vacuum extraction trials. While cervical and uterine tears were rather rare, parturients who had failed trials of vacuum extraction had significantly higher rates of cervical and uterine tears as compared to those with successful vacuum extractions. This association remained significant after controlling for a previous cesarean section using the Mantel-Hanszel technique. Women from the failed vacuum extraction group had significantly higher rates of postpartum anemia. Pregnancies complicated by failed vacuum extraction had significantly higher rates of intrapartum and postpartum fetal death. Those neonates had significantly higher rates of Apgar scores < 7 at one and five minutes. CONCLUSION Failed trial of vacuum extraction is associated with adverse maternal and fetal outcomes. Risk factors associated with such failures are fetal weight and lack of prenatal care. Thus, careful estimation of fetal weight should be performed before the procedure, and estimated fetal weight > 4,000 g might be considered a relative contraindication to vacuum extraction, especially among patients who did not have prenatal care.
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Affiliation(s)
- E Sheiner
- Departments of Obstetrics and Gynecology and of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Ben-Haroush A, Silberstein T, Halak M, Kaplan B. [Active management of labor and cesarean section rate]. Harefuah 2001; 140:164-8. [PMID: 11242926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Ben-Aroya Z, Yochai D, Silberstein T, Friger M, Hallak M, Katz M, Mazor M. Oxytocin use in grand-multiparous patients: safety and complications. J Matern Fetal Neonatal Med 2001. [DOI: 10.1080/jmf.10.5.328.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Silberstein T, Kivilevitz T, Press F, Goldstein D, Hallak M. Dual distant uterine placental insertion connected by a placental band. A case report. J Reprod Med 2000; 45:1000-2. [PMID: 11153252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND There are several types of intrauterine membranes; most are not associated with any deleterious effect on fetal outcome. CASE An unusual placental insertion was diagnosed sonographically at 23 weeks of gestation. It consisted of two distant placental insertions into the uterine wall, with a large placental mass between them floating freely in the uterine cavity. Normal fetal growth pattern and blood flow indices were found. A normal female neonate was delivered via low transverse cesarean section. There were no macroscopic or microscopic placental anomalies. CONCLUSION This case raises several questions: the right mode of delivery, frequency of ultrasound follow-up and possibility of placental band rupture and hemorrhage during vaginal delivery.
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Affiliation(s)
- T Silberstein
- Department of Obstetrics and Gynecology, Ben-Gurion University Soroka Medical Center, Beer-Sheva, Israel
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50
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Pribush A, Mankuta D, Meiselman HJ, Meyerstein D, Silberstein T, Katz M, Meyerstein N. The effect of low-molecular weight dextran on erythrocyte aggregation in normal and preeclamptic pregnancy. Clin Hemorheol Microcirc 2000; 22:143-52. [PMID: 10831064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Erythrocyte aggregation was determined by a novel method enabling the quantification of the aggregation process in whole blood. Blood samples of 47 healthy pregnant women and 39 preeclamptic patients were examined. Subjects within each group were matched for the gestational age. It was found that RBC aggregation increases with the gestational age in healthy pregnancy and further increases in preeclampsia. Addition of low-molecular weight dextran (MW = 9300) to blood samples of both healthy pregnant women and preeclamptic patients reduces RBC aggregation in a concentration-dependent manner. The obtained results indicate alterations in plasma composition as the primary factor for the increased RBC aggregation in both normal and pathological pregnancy. It is suggested that adsorption of low-molecular weight dextran on the RBC membrane reduces the surface concentration of plasma bridging molecules thereby reducing RBC aggregation toward normal.
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Affiliation(s)
- A Pribush
- Physiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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