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Noy TB, Tzur Y, Brezinov Y, Matanes E, Lau S, Salvador S, Brodeur MN, Gotlieb W. BPI24-011: Impact of Obesity on Sentinel Lymph Node Mapping in Patients With Endometrial Intraepithelial Neoplasia Undergoing Robotic Surgery. J Natl Compr Canc Netw 2024; 22:BPI24-011. [PMID: 38579771 DOI: 10.6004/jnccn.2023.7280] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Tomer Bar Noy
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
| | - Yossi Tzur
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
| | - Yoav Brezinov
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
| | | | - Susie Lau
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
| | - Shannon Salvador
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
| | | | - Walter Gotlieb
- 1Lady Davis Institute at the Jewish General Hospital, Montreal, Canada
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Akdam A, Van Mil L, Tzur Y, Laskov I, Grisaru D, Schejter E, Michaan N. Human Papilloma Virus Typing as a Triage Tool for Women with Postcoital Bleeding: A Retrospective Cohort Study. J Womens Health (Larchmt) 2024. [PMID: 38502831 DOI: 10.1089/jwh.2023.0616] [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: 03/21/2024] Open
Abstract
Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1-6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies.
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Affiliation(s)
- Amir Akdam
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liel Van Mil
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Nadav Michaan
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levin G, Brezinov Y, Tzur Y, Meyer R. Open access transition in obstetrics and gynecology journals-The international impact. Int J Gynaecol Obstet 2024. [PMID: 38311975 DOI: 10.1002/ijgo.15398] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To study the impact of converting from subscription-based publishing to open access ("flipping") in three obstetrics and gynecology (OBGYN) journals. METHODS We compared original articles in three OBGYN journals during a matched subscription-based and open access publishing period. We analyzed citation metrics and country of authorship. RESULTS Overall, 1522 studies were included; of those, 869 (57.1%) were before flipping and 653 (42.9%) were after flipping. There was a decrease in publications by lower-middle income countries from 7.7% in subscription-based publishing to 1.8% in open access (P < 0.001). There was a decrease in the proportion of articles from South Asia (2.5% vs 0.5%), North America (14.4% vs 9.4%), and the Middle East (7.4% vs 2.5%), and an increase in publications from East Asia and Pacific (17.4% vs 30.9%; P < 0.001). The relative citation ratio was higher in the open access period (median 1.65 vs 0.95, P < 0.001). The number of citations per year was higher in the open access period (median 3.0 vs 2.0, P < 0.001). There was an increase in the proportion of funded studies (from 40.2% to 47.8%; P = 0.003). CONCLUSIONS Flipping to open access in OBGYN journals is associated with a citation advantage with major authorship changes, leading to inequity.
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Affiliation(s)
- Gabriel Levin
- The Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yoav Brezinov
- Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Yossi Tzur
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Cedar Sinai Medical Center, Los Angeles, California, USA
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Bar-On S, Berkovitz Shperling R, Cohen A, Akdam A, Michaan N, Levin I, Rattan G, Tzur Y. Primary Resectoscopic Treatment of First-Trimester Miscarriage. J Obstet Gynaecol Can 2023:102327. [PMID: 38042480 DOI: 10.1016/j.jogc.2023.102327] [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: 09/06/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES To determine the feasibility and safety of resectoscopic treatment for uterine evacuation of first-trimester miscarriage. METHODS A single-centre prospective study performed between April 2021 and October 2021 at a university-affiliated tertiary medical centre. Patients diagnosed with early miscarriage of up to 12 weeks from the last menstrual period were eligible for participation. Recruited patients underwent hysteroscopic uterine evacuation under general anaesthesia by a Versapoint 2 bipolar resectoscope 24Fr (Johnson and Johnson, Germany). RESULTS A total of 15 patients were recruited for the study. The procedural characteristics as well as intra- and postoperative adverse events were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. The achievement of complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post-procedure follow-up 6 weeks after treatment was conducted by office hysteroscopy in 10 women and by ultrasonography in 4 women. One woman had conceived prior to her scheduled follow-up visit. In total, 2 (13.3%) cases of retained products of conception were diagnosed during office hysteroscopy and they were removed by the "see-and-treat" technique without anaesthesia. The diagnosis was confirmed pathologically. No intrauterine adhesions were detected and none of the women required a second hysteroscopy under anaesthesia due to retained products of conception. CONCLUSIONS Hysteroscopic evacuation of first-trimester miscarriage by a standard resectoscope is a safe and feasible technique.
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Affiliation(s)
- Shikma Bar-On
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Roza Berkovitz Shperling
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Aviad Cohen
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Amir Akdam
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Nadav Michaan
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Ishai Levin
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Gilad Rattan
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center (Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel.
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Issakov G, Tzur Y, Friedman T, Tzur T. Abnormal Uterine Bleeding Among COVID-19 Vaccinated and Recovered Women: a National Survey. Reprod Sci 2023; 30:713-721. [PMID: 35986194 PMCID: PMC9390105 DOI: 10.1007/s43032-022-01062-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
The objective of this research was to characterize menstrual changes including amount, duration, and frequency among COVID-19 vaccinated and infected women. We conducted an online nationwide questionnaire survey on premenopausal, non-pregnant women over 18 years of age in Israel, querying about any changes in their menstrual patterns after COVID-19 vaccination or infection. In total, 10,319 women responded, of which 7904 met the inclusion criteria. Changes in menstrual patterns following COVID-19 vaccination or infection were reported in 3689/7476 (49.3%) women compared with 202/428 (47.2%) women, respectively, (P = .387). The most commonly described menstrual disturbance was excessive bleeding (heavy, prolonged, or intermenstrual) in both the vaccinated and infected groups, (80.6% versus 81.4%, respectively, P = .720). Among women who experienced abnormal uterine bleeding (AUB), in most cases (61.1%), it occurred between the vaccination and the ensuing menstrual period. Menstrual disturbances were similar in type among the vaccinated and infected women. In conclusion, AUB emerged as a side effect of the BNT162b2 vaccine and a symptom of the COVID-19 infection and was characterized mainly by excessive bleeding. Although the precise incidence could not be determined in this study, the type of bleeding disorder as well as the characterization of risk factors including increasing age and a baseline menstrual pattern of prolonged, frequent, and heavy menses are well defined. The incidence and the long-term consequences of the BNT162b2 vaccine on uterine bleeding warrant further investigation.
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Affiliation(s)
- Gal Issakov
- Obstetrics Gynecology and IVF Department, Laniado Medical Center, Netanya, Israel. .,Adelson Medical School, Ariel University, Ariel, Israel.
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Friedman
- Obstetrics Gynecology and IVF Department, Laniado Medical Center, Netanya, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Tamar Tzur
- Adelson Medical School, Ariel University, Ariel, Israel
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Tzur Y, Akdam A, Berkovitz Shperling R, Anteby M, Rattan G, Bar-On S. 7984 Primary Hysteroscopic Treatment of First Trimester Miscarriage Using Resectoscope - a Pilot Study. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.357] [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: 11/25/2022]
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Tzur Y, Berkovitz-Shperling R, Laskov I, Grisaru D, Michaan N. Recurrent Dysplasia After a Loop Electrosurgical Excision Procedure: Local Versus General Anesthesia. J Low Genit Tract Dis 2022; 26:315-318. [PMID: 35997172 DOI: 10.1097/lgt.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to compare the rates of positive specimen margins and postconization recurrent dysplasia between loop electrosurgical excision procedures (LEEPs) performed under general anesthesia (GA) and LEEP under local anesthesia (LA). METHODS This retrospective cohort study included all consecutive women who underwent LEEP between 2011 and 2019. Collected data included demographics, LEEP indication, cone dimensions, and margin involvement as well as recurrence rate. Women who had undergone previous conization, cold-knife conization, or those who were lost to follow-up during the first 2 years after the procedure were excluded. RESULTS Overall, 71 women who underwent LEEP under GA and 75 women under LA were included. Demographic characteristics were similar between the groups, as were the rates of preceding abnormal cytology and high-grade dysplasia before conization. Although cone depth and volume were higher for LEEP specimens done under GA compared with LA, the rate of positive specimen margins was comparable both for the endocervical margin (16/71 [22.5%] vs 16/75 [21.3%], respectively; p = .861) and the ectocervical margin (14/71 [19.7%] vs 11/75 [14.7%], respectively; p = .418). During the first 2 years after conization, the rates of high-grade dysplasia (cervical intraepithelial neoplasia ≥ 2) in repeat biopsy and the need for repeat conization were also not significantly different between the GA and LA groups (4.2% vs 1.3%, p = .356; 7.0% vs 9.3%, p = .614, respectively). CONCLUSIONS Anesthesia mode does not seem to affect the rate of positive LEEP margins and the need for repeat conization. Our study findings suggest that LA should be preferred instead of GA in LEEP.
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Michaan N, Loboda N, Ochshorn Y, Tzur Y, Cohen A, Grisaru D, Laskov I. The effect of cervical conization on women’s sexual function and psychological health (341). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01563-3] [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: 11/29/2022]
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Michaan N, Loboda N, Ochshorn I, Tzur Y, Cohen A, Grisaru D, Laskov I. The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study. J Sex Med 2022; 19:257-262. [PMID: 34911661 DOI: 10.1016/j.jsxm.2021.11.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/08/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women's' sexual health. AIM To assess the effect of cervical conization on women's sexual function and psychological wellbeing. METHODS Patients undergoing conization of the cervix were assessed before, and 6 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression, was assessed using the Hospital Anxiety and Depression Scale (HADS). MAIN OUTCOME MEASURES FSDS-r, FSFI and HADS scores before and after conization RESULTS: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, P=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization, (26.8 vs. 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization, P=0.388. A high percent of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization, p=1.0. CLINICAL IMPLICATIONS A high percent of patients undergoing conization suffer from sexual distress, sexual dysfunction and general anxiety, both before and after conization. The conization procedure itself did not seem to effect questionnaire scores. STRENGTHS AND LIMITATIONS This was a prospective cohort, with comprehensive assessment of female sexual and psychological wellbeing after conization. Not all subjects reported sexual intercourse prior to questionnaire completion. CONCLUSION Gynecologists should be aware of the psychological and sexual effect of the diagnosis and treatment of cervical pre-cancerous lesions, patients should be counselled accordingly. Michaan N, Loboda N, Ochshorn I, et al., The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study. J Sex Med 2022;19:257-262.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Loboda
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Ochshorn
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Cohen
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tzur T, Tzur Y, Baruch S, Smorgick N, Melcer Y. Clinical Presentation of Paraovarian Cysts. Isr Med Assoc J 2022; 24:15-19. [PMID: 35077040] [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: 06/14/2023]
Abstract
BACKGROUND A paraovarian cyst (POC) is located between the ovary and the fallopian tube. In many cases POCs are diagnosed and managed as ovarian cysts. But since POC are a distinct entity in their clinical presentation and surgical intervention, they should be better defined. OBJECTIVES To describe the clinical perioperative and operative characteristics of patients with POCs in order to improve pre-operative diagnosis and management. METHODS A retrospective cohort study of patients with an operative diagnosis of POC between 2007 and 2019 in a single university-affiliated tertiary care medical center was included. Demographic characteristics as well as symptoms, sonographic appearance, surgery findings, and histology results were retrieved from electronic medical records. RESULTS During the study period 114 patients were surgically diagnosed with POC, 57.9% were in their reproductive years and 24.6% were adolescents. Most presented with abdominal pain (77.2%). Preoperative sonographic exams accurately diagnosed POC in only 44.7% of cases, and 50.9% underwent surgery due to suspected torsion, which was surgically confirmed in 70.7% of cases. Among women with confirmed torsion, 28.9% involved the fallopian tube without involvement of the ipsilateral ovary. Histology results showed benign cysts in all cases, except two, with a pathological diagnosis of serous borderline tumor. CONCLUSIONS POC should always be part of the differential diagnosis of women presenting with lower abdominal pain and sonographic evidence of adnexal cysts. If POC is suspected there should be a high level of suspicion for adnexal torsion and low threshold for surgical intervention, especially in adolescent, population who are prone to torsion.
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Affiliation(s)
- Tamar Tzur
- Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Baruch
- Department of Obstetrics and Gynecology, Sanz Medical Center-Laniado Hospital
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tzur Y, Berkovitz Shperling R, Levin I, Cohen A. Expectant Versus Medical Management of Retained Products of Conception after Induced Abortion. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.149] [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: 11/29/2022]
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Tzur Y, Michaan N, Laskov I, Cohen A, Grisaru D, Beri A. Does Gas Insufflation during Gynecologic or Urologic Oncologic Laparoscopy Cause Dissemination of Malignant Cells. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.004] [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: 10/20/2022]
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13
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Tzur Y, Rimon E, Geva G, Herzlich J, Kupferminc MJ. Progression from isolated gestational proteinuria to preeclampsia with severe features. Acta Obstet Gynecol Scand 2021; 100:1620-1626. [PMID: 34043807 DOI: 10.1111/aogs.14198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/12/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The association between the degree of isolated gestational proteinuria and preeclampsia with severe features and other placental-mediated complications is controversial. The aim of this study was to evaluate whether a higher isolated proteinuria level is associated with an increased frequency of preeclampsia with severe features. MATERIAL AND METHODS This retrospective cohort study included pregnant women who were past 24 weeks of gestation and were diagnosed as having new-onset proteinuria ≥300 mg in a 24-h urine collection. Exclusion criteria included diagnosis of preeclampsia within 72 h from admission, chronic renal disease or chronic hypertension. The study population was divided into tertiles by proteinuria level and the association with preeclampsia with severe features was assessed in both bivariable and multivariable analysis. The main outcome measures was the development of preeclampsia with severe features. RESULTS Overall, 165 women were diagnosed with isolated gestational proteinuria, and 38 (23.0%) of them developed preeclampsia with severe features. Women in the increasing proteinuria tertile were more likely to develop preeclampsia with severe features (5.5%, 21.8%, 41.8%, respectively; p = 0.004). A multivariable logistic regression model controlling for background characteristics as well as gestational age at diagnosis, blood pressure, and kidney and liver function tests showed an increased risk of 14% to develop preeclampsia with severe features for every 500-mg rise in proteinuria level (adjusted odds ratio = 1.14, 95% confidence interval 1.03-1.27). CONCLUSIONS A higher isolated gestational proteinuria level was associated with an increased risk to develop preeclampsia with severe features among pregnant women past 24 weeks of gestation.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rimon
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Gil Geva
- The Hebrew University Hadassah Medical School, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacky Herzlich
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Michael J Kupferminc
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
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Fan I, Hiersch L, Belov Y, Amikam U, Tzur Y, Hershkovitz G, Sindel O, Alpern S, Segal R, Dangot A, Many A, Yogev Y, Ashwal E. The effects of time and temperature on umbilical cord gas analysis. J Matern Fetal Neonatal Med 2020; 35:4358-4364. [PMID: 33225776 DOI: 10.1080/14767058.2020.1849118] [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: 10/22/2022]
Abstract
OBJECTIVE Our objective was to evaluate the effects of time and temperature on umbilical-cord blood analysis. METHODS This prospective study included the term spontaneous vaginal deliveries. One venous and seven arterial samples were drawn from each umbilical cord within 5 min from delivery. Three samples were immediately refrigerated (3 °C), while all other samples were stored at room temperature (23-26 °C). Samples were analyzed in pairs (refrigerated and room-temperature samples) at 0, 20, 40, and 60 min after delivery for pH and lactate levels. Repeated-measures analysis using a generalized linear model was used to compare the change in pH and lactate values over time. RESULTS 518 samples from 74 women were analyzed. The mean gestational age was 39.1 ± 1.1 weeks. All neonates had an Apgar score of ≥9 in the 1st and 5th minutes. Mean arterial pH and lactate levels at delivery (time 0) were 7.32 ± 0.07 and 4.00 ± 1.36 mmol/L, respectively. Over time, a statistically significant decrease in pH and a reciprocal increase in lactate levels were observed. The mean change in arterial pH following 60 min was 0.021 ± 0.028 (room-temperature) and 0.016 ± 0.023 (refrigerated); p < 0.001. Compared to pH, a greater change was demonstrated in lactate levels over time; the mean change in lactate following 60 min was -0.896 ± 0.535 (room temperature) and -0.512 ± 0.450 mmol/L (refrigerated). Temperature significantly altered both pH and lactate levels, but lactate levels were altered at earlier time points. CONCLUSION Both time and temperature have significant effects on cord blood analysis. Yet, these changes are minor and may not have any clinical significance unless in extreme cases in which medicolegal aspects emerge.
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Affiliation(s)
- Isabella Fan
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Liran Hiersch
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yekaterina Belov
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amikam
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Hershkovitz
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofra Sindel
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Alpern
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Segal
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Dangot
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Ashwal
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tzur Y, Samueloff O, Raz Y, Bar-On S, Laskov I, Tzur T. Conception rates after medical versus surgical evacuation of early miscarriage. Fertil Steril 2020; 115:118-124. [PMID: 32811672 DOI: 10.1016/j.fertnstert.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN Observational cohort study. SETTING Academic tertiary-care medical center. PATIENT(S) A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S) Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S) Conception rates 6 months after miscarriage. RESULT(S) Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S) Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ofri Samueloff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Shikma Bar-On
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Tzur Y, Yogev Y. Prepregnancy counseling in women over 50 years of age. Best Pract Res Clin Obstet Gynaecol 2020; 70:21-27. [PMID: 32773290 DOI: 10.1016/j.bpobgyn.2020.07.003] [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: 05/05/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
Over the past decade, there has been a steep rise in the proportion of women who become pregnant at an advanced maternal age. Personal goals and cultural changes along with the advancement in artificial reproductive therapies have enabled women who wish to defer childbearing when given an opportunity to do so, and pregnancy rates in this age group are not likely to decrease. However, accumulating evidence suggests that pregnancies at an advanced maternal age are associated with an increased risk for maternal and neonatal complications. This review provides an evidence-based view of advanced maternal age pregnancy and focuses on prepregnancy counseling to optimize women's health prior to conception.
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Affiliation(s)
- Yossi Tzur
- Lis Maternity Hospital, Department of Obstetrics & Gynecology, Sourasky Medical Center, Tel Aviv University, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Department of Obstetrics & Gynecology, Sourasky Medical Center, Tel Aviv University, Israel.
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Ashwal E, Salman L, Tzur Y, Aviram A, Ben-Mayor Bashi T, Yogev Y, Hiersch L. Intrapartum fever and the risk for perinatal complications – the effect of fever duration and positive cultures. J Matern Fetal Neonatal Med 2017; 31:1418-1425. [DOI: 10.1080/14767058.2017.1317740] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Eran Ashwal
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lina Salman
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Aviram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yariv Yogev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liran Hiersch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Akavia UD, Litvin O, Kim J, Mozes E, Kotliar D, Tzur Y, Garraway L, Pe'er D. Abstract B70: Conexic: A Bayesian framework to detect drivers and their function uncovers an endosomal signature in melanoma. Cancer Res 2009. [DOI: 10.1158/0008-5472.fbcr09-b70] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Genomics is revolutionizing our understanding of cancer biology. Tumor samples assayed for comprehensive chromosomal and gene expression data are accumulating at a staggering rate. A major challenge involves the development of analysis methods to uncover biological insights from these data, including the identification of the key mutations that drive cancer and how these events alter cellular regulation.
We have developed Conexic, a novel computational framework to integrate chromosomal copy number and gene expression data to detect genetic alterations in tumors that drive proliferation, and to model how these alterations perturb normal cell growth/survival. The underlying assumption to our approach is that significantly recurring copy number change, coinciding with its ability to predict the expression patterns varying across tumors, strengthens the evidence of a gene's causative role in cancer. This method not only pinpoints specific regulators within an a large region of copy number variation, but can shed light on the way in which gene regulation is altered
We applyed our Conexic framework to a melanoma dataset (Lin et al, Cancer Research, 2007) comprising 65 paired measurements of gene expression and copy number, with interesting results. Our analysis correctly identified many known ‘driver’ events, while also connecting these to many of their known targets (e.g. MITF). Our global integrative analysis reveals insight into how the drivers alter transcriptional programs. An interesting recurring characteristic is that there are a number of different ways by which drivers can be altered; e.g., the expression of a driver may be altered through copy number variation or other mechanisms, but its influence downstream remains the same.
In addition to confirming the role of known drivers in melanoma, our analysis suggests a number of novel drivers. Most strikingly, these point to a major role in regulation of protein trafficking and endosome biology in this malignancy. These results have linked endosomal processing and sorting to adhesion and survival. Preliminary experimental validation supports three novel drivers including TBC1D16, RAB7A and RAB27A. Together, these results affirm the potential of Conexic to elaborate novel driver modules with biological and possibly therapeutic importance in melanoma and other cancers.
Citation Information: Cancer Res 2009;69(23 Suppl):B70.
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