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Levy-Coles M, Erez O, Mizrakli Y, Benshalom-Tirosh N, Rabinovich A. The effect of chorionicity on maternal and neonatal outcomes in triplet pregnancies. Eur J Obstet Gynecol Reprod Biol 2024; 296:200-204. [PMID: 38458036 DOI: 10.1016/j.ejogrb.2024.02.041] [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: 11/04/2023] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Triplet gestations are associated with increased maternal, fetal, and neonatal complications particularly early and extreme preterm delivery. Identifying and interrupting the preterm delivery cascade could prevent the fetal, neonatal, and long-term childhood complications. The shared circulation and placental vascular anastomosis are responsible for the occurrence of twin-to-twin transfusion syndrome, selective fetal growth restriction as well as the higher risk of morbidity and mortality observed in mono and dichorionic compared to trichorionic triplet gestations. Thus, the aim of this study was to determine the effect of chorionicity on maternal, fetal, and neonatal outcomes of triplet pregnancies as it has not been fully ascertained. STUDY DESIGN A retrospective population-based cohort study of 125 parturient with triplets' pregnancy who delivered at a single tertiary hospital. RESULTS 98 trichorionic and 27 dichorionic gestations were included. Maternal demographic and obstetric characteristics as well as pregnancy and postpartum complications were similar in the two study groups. The median gestational age at delivery was lower among dichorionic than trichorionic triplet gestations (median 31 vs 33 weeks, p < 0.046). Early (<32 weeks) and extreme preterm delivery (<28 weeks) were more prevalent in the dichorionic than the trichorionic group (early - 56 % vs 34 %, p < 0.038; extreme - 33.3 % vs 8 %, p < 0.002). We found no difference in fetal or newborns' complications and characteristics between the groups. However, the rate of neonatal death was significantly higher in the dichorionic compared to trichorionic triplet gestations (22 % vs 7 %, p < 0.038). A multivariate logistic regression model to determine the variables that contribute to early preterm delivery in triplet gestations showed that women who experienced a past preterm delivery had an independently higher risk for early preterm delivery in the triplet gestation (adj. OR 5.91, 95 % CI 1.16-30.03). Neither maternal age nor chorionicity were found to be independent risk factors for early preterm delivery. CONCLUSIONS Dichorionic triplet gestations exhibit a higher rate of early (<32 weeks) and extreme (<28 weeks) preterm delivery and are more prone to neonatal death compared to trichorionic gestations. Past preterm delivery is an independent risk factor for early preterm delivery in a triplet gestation.
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Affiliation(s)
- Maya Levy-Coles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Hutzel Women's Hospital, Wayne State University, Detroit, MI, USA.
| | - Yuval Mizrakli
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Neta Benshalom-Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Rabinovich
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Mangiaterra T, Alonso-Alonso R, Rabinovich A, De Dios Soler M, Galluzzo L, Soria M, Colli S, De Matteo E, Rodriguez Pinilla SM, Chabay P. Presence of Epstein-Barr virus (EBV) antigens detected by sensitive methods has no influence on local immune environment in diffuse large B cell lymphoma. Cancer Immunol Immunother 2024; 73:29. [PMID: 38280007 PMCID: PMC10821829 DOI: 10.1007/s00262-023-03617-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 01/29/2024]
Abstract
EBV+ diffuse large B cell lymphoma (DLBCL) not otherwise specified (NOS) is a new entity confirmed by the World Health Organization (WHO) in 2017. In this new entity, the virus may contribute to a tolerogenic microenvironment. Traces of the virus have been described in DLBCL with more sensitive methods, in cases that were originally diagnosed as negative. The aim of this study was to analyze the expression of immune response genes in the tumor microenvironment to disclose the role of the virus and its traces in DLBCL. In 48 DLBCL cases, the expression of immune response genes and the presence of molecules that induce tolerance, such as TIM3, LAG3 and PDL1 by immunohistochemistry (IHC), were studied. To broaden the study of the microenvironment, tumor-associated macrophages (TMAs) were also explored. No significant differences were observed in the expression of immune response genes in the EBV+ DLBCL and those cases that were EBV- DLBCL but that exhibited viral traces, assessed by ViewRNA assay. Only the EBV+ DLBCL cases displayed a significantly higher increase in the expression of CD8 and cytotoxic T cells detected by gene expression analysis, and of PDL1 in tumor cells and in the expression of CD68 in the tumor microenvironment detected by IHC, not observed in those cases with viral traces. The increase in CD8 and cytotoxic T cells, PDL1 and CD68 markers only in EBV+ DLBCL may indicate that traces of viral infection might not have influence in immune response markers.
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Affiliation(s)
- T Mangiaterra
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - R Alonso-Alonso
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Rabinovich
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - M De Dios Soler
- Pathology Division, Marie Curie Hospital, Buenos Aires, Argentina
| | - L Galluzzo
- Pathology Division, Prof. Dr. Juan P. Garrahan Hospital, Buenos Aires, Argentina
| | - M Soria
- Hematology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - S Colli
- Pathology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - E De Matteo
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
- Pathology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | | | - P Chabay
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.
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Kedar T, Erez O, Novak L, Beer Wiesel R, Besser L, Leron E, Rabinovich A. Severe maternal infectious morbidity during the second half of pregnancy is an independent risk factor for a small for gestational age neonate. Eur J Obstet Gynecol Reprod Biol 2022; 274:238-242. [PMID: 35688106 DOI: 10.1016/j.ejogrb.2022.05.032] [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: 02/05/2022] [Revised: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The effect of severe maternal infectious morbidity on fetal growth during the second half of pregnancy is under debate. Preliminary evidence suggests that such association may be plausible. The objectives of this study were to determine: 1) The association between severe maternal infectious morbidity and adverse pregnancy outcome; and 2) The effect of maternal infection during pregnancy on fetal growth. STUDY DESIGN This retrospective population - based cohort study included 4771 women who gave birth at our medical center during the study period. Parturients were allocated into two groups: 1) patients with severe maternal infection during the second half of pregnancy (n = 368); and 2) control group comprised of normal pregnant women who were matched to the study group by maternal age, gravidity and parity (n = 4403). RESULTS The severe maternal infection group included women with pneumonia (n = 198), pyelonephritis (n = 131), and viral pneumonitis (n = 39). In comparison to the normal patients group: 1) having had pneumonia during the second half of pregnancy was associated with increased rates of fetal growth restriction, placental abruption, fetal demise (P < 0.001, for all comparisons) and preeclampsia (P = 0.041); 2) Pyelonephritis during the second half of gestation was associated with higher rates of fetal growth restriction (P < 0.001), placental abruption (P = 0.006) and labor induction (P = 0.039). As a group, women with severe maternal infection had higher rates of small for gestational age neonates compared to normal parturients (P < 0.001). Among women with infections, only those who had pyelonephritis (P = 0.032) or pneumonia (P = 0.008), had a higher rate of small for gestational age neonates than those in the control group. After adjustment to confounding factors, maternal infection (OR = 1.42, 95% CI 1.085-1.85) and previous delivery of a small for gestational age neonate (OR = 2.54, 95% CI 2.02-3.19), were independent risk factors for the delivery of a small for gestational age neonate. CONCLUSION Severe maternal infectious morbidity during the second half of pregnancy is an independent risk factor for the delivery of a small for gestational age neonate and is associated with adverse pregnancy outcomes. Both, pneumonia and pyelonephritis, during the second half of gestation affect fetal growth and are related to higher rates of small for gestational age neonates.
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Affiliation(s)
- Tal Kedar
- Department of Obstetrics & Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel; Department of Obstetrics & Gynecology, Hutzel Women's Hospital, Wayne State University, Detroit, MI, USA.
| | - Lena Novak
- Department of Epidemiology, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ruth Beer Wiesel
- Department of Obstetrics & Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Limor Besser
- Department of Obstetrics & Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Leron
- Department of Obstetrics & Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Rabinovich
- Department of Obstetrics & Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Yagur Y, Weitzner O, Gemer O, Lavie O, Beller U, Bruchim I, Vaknin Z, Levy T, Rabinovich A, Shachar IB, Meirovitz A, Arie AB, Derazne E, Raban O, Eitan R, Kadan Y, Fishman A, Helpman L. Postoperative radiation rates in stage IIA1 cervical cancer: Is surgical treatment justified? An Israeli Gynecologic Oncology Group Study. Gynecol Oncol 2018; 150:288-292. [DOI: 10.1016/j.ygyno.2018.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Rabinovich A, Ducruet T, Kahn SR. Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis. J Thromb Haemost 2018; 16:262-270. [PMID: 29193770 DOI: 10.1111/jth.13909] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 06/22/2017] [Indexed: 11/28/2022]
Abstract
Essentials We developed a prediction model for postthrombotic syndrome (PTS) after deep vein thrombosis (DVT). High risk predictors were iliac vein DVT, BMI>35 and moderate-severe Villalta category. Patients with a score ≥4 had an odds ratio of 5.9 (95% CI 2.1-16.6) for PTS. SOX-PTS score may select DVT patients for close monitoring or aggressive strategies to treat DVT. SUMMARY Background Postthrombotic syndrome (PTS) is a chronic complication that develops in 20-50% of patients after deep vein thrombosis (DVT). Although individual risk factors for PTS have been characterized, the ability to predict which DVT patients are likely to develop PTS remains limited. Objective To develop a clinical prediction score for PTS in patients with DVT. Methods The derivation cohort consisted of participants in the SOX Trial, a randomized double-blind placebo-controlled trial of elastic compression stockings versus placebo stockings worn for 2 years after DVT to prevent PTS in patients with a first proximal DVT, enrolled in 24 community and tertiary-care hospitals from 2004 to 2010. Multivariable logistic regression analysis of baseline characteristics was performed. The outcome was the occurrence of PTS, diagnosed starting from 6 months or later according to Ginsberg's criteria. Results Seven hundred and sixty-two patients were included in the analysis. The median follow-up was 728 days. The model includes three independent predictors, and has a range of possible scores from 0 to 5. High-risk predictors were: index DVT in the iliac vein; body mass index of ≥ 35 kg m-2 ; and moderate-severe Villalta severity category at DVT diagnosis. As compared with patients with a score of 0, those with a score of ≥ 4 had an odds ratio of 5.9 (95% confidence interval 2.1-16.6) for developing PTS. Conclusions To our knowledge, this is the first clinical prediction score for PTS. We identified three independent predictors that, when combined, predicted PTS risk after a first proximal DVT. The SOX-PTS score requires external validation before it can be considered for clinical use.
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Affiliation(s)
- A Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - T Ducruet
- URCA-CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - S R Kahn
- Department of Epidemiology, Biostatistics, and Occupational Health, and Division of Internal Medicine and Department of Medicine, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
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Rabinovich A, Holtzman K, Shoham-Vardi I, Mazor M, Erez O. Oligohydramnios is an independent risk factor for perinatal morbidity among women with pre-eclampsia who delivered preterm. J Matern Fetal Neonatal Med 2017; 32:1776-1782. [DOI: 10.1080/14767058.2017.1417377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alex Rabinovich
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Keren Holtzman
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Epidemiology, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Moshe Mazor
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Offer Erez
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
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Rabinovich A, Vislapu N, Rasooly I, Lerman Y. THE EFFICACY OF A FALLS CLINIC FOR ELDERLY AND THE ADDED ROLE OF THE TILT TABLE
TEST. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Rabinovich
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Tel Aviv University, Tel Aviv, Israel,
| | - N. Vislapu
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | - I. Rasooly
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Israel Ministry of Health, Geriatric Division., Jerusalem, Israel
| | - Y. Lerman
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Tel Aviv University, Tel Aviv, Israel,
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Rabinovich A, Tsemach T, Novack L, Mazor M, Rafaeli-Yehudai T, Staretz-Chacham O, Beer-Weisel R, Klaitman-Mayer V, Mastrolia SA, Erez O. Late preterm and early term: when to induce a growth restricted fetus? A population-based study. J Matern Fetal Neonatal Med 2017; 31:926-932. [PMID: 28277909 DOI: 10.1080/14767058.2017.1302423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/19/2022]
Abstract
PURPOSE (1) Compare fetal and neonatal morbidity and mortality associated with induction of labor (IOL) versus expectant management (EM) in women with isolated fetal growth restriction (FGR) between 340/7 and 386/7 weeks; (2) Determine optimal gestational age for delivery of such fetuses. MATERIALS AND METHODS A retrospective population based cohort study of 2232 parturients with isolated FGR, including two groups: (1) IOL (n = 1428); 2) EM (n = 804). RESULTS IOL group had a lower stillbirth and neonatal death rates (p = .042, p < .001), higher 1 and 5 min Apgar scores and a higher vaginal delivery rate compared to the EM group. In the late preterm period, EM was associated with increased rate of low 1 and 5 min Apgar scores, nonreassuring fetal heart rate tracing (NRFHR), stillbirth and neonatal death rate (p = .001, p = .039). In the early term cohort, EM was associated with a higher rate of NRFHR and low 1 min Apgar scores (p = .003, p = .002). IOL at 37 weeks protected from stillbirth but not from adverse composite neonatal outcomes. CONCLUSIONS IOL of FGR fetuses at 37 weeks had a protective effect against stillbirth. In addition, at late preterm, it is associated with lower rates of stillbirth, neonatal death, and NRFHR.
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Affiliation(s)
- Alex Rabinovich
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Tehila Tsemach
- b Department of Epidemiology, School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Lena Novack
- b Department of Epidemiology, School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Moshe Mazor
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Tal Rafaeli-Yehudai
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Orna Staretz-Chacham
- c Department of Neonatology , Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Ruth Beer-Weisel
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Vered Klaitman-Mayer
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Salvatore A Mastrolia
- d Department of Obstetrics and Gynecology , Fondazione MBBM, San Gerardo Hospital , Monza , Italy
| | - Offer Erez
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
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Abstract
Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.
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Affiliation(s)
- A Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Internal Medicine and Department of Medicine, McGill University, Montreal, Canada
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Chandrananth J, Rabinovich A, Karahalios A, Guy S, Tran P. Impact of adherence to local antibiotic prophylaxis guidelines on infection outcome after total hip or knee arthroplasty. J Hosp Infect 2016; 93:423-7. [DOI: 10.1016/j.jhin.2016.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
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Rabinovich A, Bernard L, Ramanakumar AV, Stroian G, Gotlieb WH, Lau S, Bahoric B. Para-aortic and pelvic extended-field radiotherapy for advanced-stage uterine cancer: dosimetric and toxicity comparison between the four-field box and intensity-modulated techniques. Curr Oncol 2015; 22:405-11. [PMID: 26715873 DOI: 10.3747/co.22.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/25/2022] Open
Abstract
BACKGROUND In patients with advanced-stage endometrial carcinoma (eca), extended-field radiotherapy (efrt) is traditionally delivered by the 3-dimensional conformal (3d-crt) 4-field box technique. In recent years, the use of intensity-modulated radiotherapy (imrt) in gynecologic cancers has increased. We compared the delivery of efrt by the 3d-crt and contemporary imrt techniques. METHODS After surgical staging and adjuvant chemotherapy in 38 eca patients, efrt was delivered by either imrt or 3d-crt. Doses to the organs at risk, side effects, and outcomes were compared between the techniques. RESULTS Of the 38 eca patients, 33 were stage iiic, and 5 were stage ivb. In the imrt group, maximal doses to rectum, small intestine, and bladder were significantly higher, and mean dose to bladder was lower (p < 0.0001). Most acute gastrointestinal, genitourinary, and hematologic side effects were grade i or ii and were comparable between the groups. In long-term follow-up, only grade 1 cystitis at 3 months was statistically higher in the imrt patients. No grade iii or iv gastrointestinal or genitourinary toxicities were observed. No statistically significant differences in overall and disease-free survival or recurrence rates were observed between the techniques. CONCLUSIONS In advanced eca patients, imrt is a safe and effective technique for delivering efrt to the pelvis and para-aortic region, and it is comparable to the 3d-crt 4-field box technique in both side effects and efficacy. For centres in which imrt is not readily available, 3d-crt is a valid alternative.
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Affiliation(s)
- A Rabinovich
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - L Bernard
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - A V Ramanakumar
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC
| | - G Stroian
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - W H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - S Lau
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - B Bahoric
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
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Rabinovich A. Neo-adjuvant chemotherapy for advanced stage endometrial carcinoma: a glimmer of hope in select patients. Arch Gynecol Obstet 2015; 293:47-53. [PMID: 26288978 DOI: 10.1007/s00404-015-3841-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 03/23/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to conduct a critical appraisal of the published literature on the use of neo-adjuvant chemotherapy followed by interval debulking in the treatment of stage IVb endometrial carcinoma patients. METHODS Narrative review of the pertinent literature on the application of neo-adjuvant chemotherapy and interval surgery in the treatment of advanced stage endometrial cancers. RESULTS Advanced stage endometrial carcinoma patients are treated by aggressive cytoreduction followed by adjuvant chemotherapy or by chemotherapy alone. The prognosis of patients that cannot undergo surgery is extremely poor. Preoperative reduction of tumor burden by chemotherapy can facilitate surgery in patients previously considered to have an unresectable disease, identify patients with chemo-sensitive tumors that are more likely to benefit from surgery, and enable a less aggressive surgery thus reducing morbidity. However, only 106 cases of neo-adjuvant chemotherapy were documented in the last two decades, majority (76) were described in retrospective case reports and case series. The available data may indicate feasibility of neo-adjuvant treatment in select patients. Compared to patients that had primary surgery, neo-adjuvant setting was associated with improved or equivalent survival and maximal debulking rates and reduced postoperative morbidity. CONCLUSIONS Until further progress is reached, consideration can be given to recommending neo-adjuvant chemotherapy followed by interval debulking to patients with poor performance status or those patients who the surgeon believes would have suboptimal debulking if surgery was attempted.
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Affiliation(s)
- Alex Rabinovich
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer-Sheva, Israel.
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13
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Rabinovich A. Robotic surgery for ovarian cancers: individualization of the surgical approach to select ovarian cancer patients. Int J Med Robot 2015; 12:547-53. [PMID: 26173832 DOI: 10.1002/rcs.1684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND While well-accepted treatment for endometrial and cervical cancers, the role of robotic surgery in the management of primary and recurrent ovarian cancers remains an area of active study and debate. METHODS Narrative review of the pertinent literature on the use of robotics in the treatment of ovarian cancers. RESULTS The available evidence may indicate the feasibility of robotics for primary and secondary debulking of ovarian cancers. The use of robotics can be considered for the surgical treatment of patients requiring primary tumour excision, alone or with one additional major procedure, and patients with isolated recurrences. However, most of the publications are underpowered, retrospective, fail to provide sufficient data on long-term oncological outcomes and are published by highly skilled minimally invasive surgeons. CONCLUSIONS Robot-assisted surgery may provide a tool to individualize the surgical approach to select ovarian cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alex Rabinovich
- Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, Soroka University Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Rabinovich A, Cohen JM, Kahn SR. Predictive value of markers of inflammation in the postthrombotic syndrome: a systematic review: inflammatory biomarkers and PTS. Thromb Res 2015; 136:289-97. [PMID: 26139086 DOI: 10.1016/j.thromres.2015.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Inflammation may contribute to its pathophysiology. OBJECTIVES We conducted a systematic review of studies that analyzed the association between biomarkers of inflammation and PTS in DVT patients. METHODS The electronic databases PubMed, EMBASE, Medline, Scopus and Web of Science were searched for studies published until March 2015 that measured blood inflammation biomarker levels in adult DVT patients and reported their association with PTS development. Two reviewers independently performed full text assessment and data extraction. RESULTS Ten studies were included. Nine reported on the association between C-reactive protein and PTS; Interleukin (IL)-6 was measured in six studies; IL-8 in four studies; Intracellular adhesion molecule (ICAM)-1 in three studies; IL-10 and vascular cell adhesion molecule-1 in two studies; and monocyte chemotactic protein-1, matrix metalloprotease-9, P-Selectin, tumor necrosis factor α and erythrocyte sedimentation rate were measured in one study. Studies differed in terms of populations included, exclusion criteria, methods used for biomarker measurement and statistical measures of association between biomarkers and PTS. We were able to metaanalyze results only for IL-6 and found no significant association. Descriptively, ICAM-1 was significantly associated with PTS in two out of three studies that measured it. Other biomarkers did not demonstrate a significant association with PTS. CONCLUSIONS Our systematic review found conflicting results regarding the role of inflammatory biomarkers as predictors of PTS. ICAM -1 appears to be a promising marker for further investigation.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - J M Cohen
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Canada.
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15
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Gemer O, Eitan R, Gdalevich M, Mamanov A, Piura B, Rabinovich A, Levavi H, Saar-Ryss B, Halperin R, Finci S, Beller U, Bruchim I, Levy T, Ben-Shachar I, Meirovitz A, Arie AB, Lavie O. Integration of PET/CT into the preoperative evaluation of patients with early cervical cancer does not decrease the proportion of patients with positive lymph nodes found after surgery. Int J Gynecol Cancer 2015; 24:1461-5. [PMID: 25188884 DOI: 10.1097/igc.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate whether preoperative positron emission tomography/computed tomography (PET/CT) in patients with early-stage cervical carcinoma reduced the proportion of patients with metastatic lymph nodes identified after surgery. PATIENTS AND METHODS This is a multicenter case-control study of 599 patients with early cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy at 1 of 10 gynecological oncology units in Israel. The patients were divided into 2 groups according to whether or not they underwent a preoperative PET/CT. The primary outcome was the proportion of patients with nodal involvement. The 2 groups were compared with regard to the clinical and histological variables. RESULTS Of the 599 patients who underwent surgery, 180 (36%) had preoperative PET/CT study. There were no significant differences between the PET/CT and control groups with regard to clinical and histological risk factors. The proportion of patients with involved nodes was similar in the control and PET/CT groups (20.8% vs 19%; P = 0.73) as well as the proportion of patients receiving adjuvant radiotherapy/chemoradiation (58.3% vs 55.1%; P = 0.55). CONCLUSIONS Preoperative PET/CT in patients with early cervical cancer does not reduce proportion of patients with metastatic nodal involvement and the employment of multimodality treatment. Prospective clinical trials comparing management based on PET/CT findings are warranted.
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Affiliation(s)
- Ofer Gemer
- *Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev; †Rabin Medical Center, Petah Tikva, Tel Aviv University; ‡Soroka Medical Center, Beer Sheva, Ben Gurion University of the Negev; §Assaf Harofe Medical Center, Tzrifin, Tel Aviv University; ∥Shaare Zedek Medical Center, Jerusalem, Hebrew University; ¶Meir Medical Center, Kfar Saba, Tel Aviv University; #Wolfson Medical Center, Holon, Tel Aviv University; **Hadassah Medical Center-Mt Scopus, Jerusalem, Hebrew University; ††Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem, Hebrew University; ‡‡Kaplan Medical Center, Rehovot, Hebrew University; and §§Carmel Medical Center, Haifa, Technion Institute, Israel
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Rabinovich A, Bernard L, Niazi TM, Ramanakumar AV, Gotlieb WH, Lau S, Bahoric B. Para-aortic and Pelvic Radiotherapy, an Effective and Safe Treatment in Advanced-stage Uterine Cancer. Anticancer Res 2015; 35:2893-2900. [PMID: 25964573] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The present, was a feasibility study of extended-field (EF) external-beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) given sequentially following complete staging and adjuvant chemotherapy for patients with advanced-stage endometrial carcinoma (EC). PATIENTS AND METHODS A cohort study was carried out in 38 patients with stage IIIC and IVB EC treated by surgery, six cycles of paclitaxel-carboplatin chemotherapy followed by EF EBRT and VBT. RESULTS A total of 60% of the patients had non-endometrioid histology, 45% had both pelvic and para-aortic lymph node metastases. Two patients experienced recurrence in the previously irradiated field. Five-year overall and progression-free survival were 77% and 72.5%, respectively. Grade 1 diarrhea and grade 1 cystitis were the most common acute and delayed side-effects. CONCLUSION EF EBRT and VBT following complete staging and adjuvant chemotherapy is a safe and effective treatment for patients with advanced-stage EC. Compared to historical data, our study suggests an improved progression-free and overall survival with acceptable acute and delayed side-effects.
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Affiliation(s)
- Alex Rabinovich
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Laurence Bernard
- Division of Radiation Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tamim M Niazi
- Division of Radiation Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Agnihotram V Ramanakumar
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Rabinovich A, Ramanakumar AV, Lau S, Gotlieb WH. Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study. Acta Obstet Gynecol Scand 2015; 94:776-780. [PMID: 25923364 DOI: 10.1111/aogs.12642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 01/04/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Abstract
We conducted a proof of concept study evaluating prolonged treatment with pegylated liposomal doxorubicin for recurrent ovarian, tubal and peritoneal carcinoma. Thirteen consecutive patients received an average of 22.6 cycles of pegylated liposomal doxorubicin, with an average cumulative dose of 1409 mg/m(2) . Progression-free survival at 18 months was 61.5%, and was longer than the previous progression-free survival in 10 of the 13 patients. Overall 5-year survival was 78.8%. Despite prolonged use and relatively large cumulative doses of pegylated liposomal doxorubicin, most of the patients had mild to moderate side-effects, none of the patients had detectable cardio-toxic side-effects, and a positive impact on the performance status was noticed. Thus, in our group of patients, continued pegylated liposomal doxorubicin treatment was associated with a longer progression-free interval and allowed improved performance status with manageable toxicity.
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Affiliation(s)
- Alex Rabinovich
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Agnihotram V Ramanakumar
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, Lady Davis Research Institute, Montreal, Quebec, Canada
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18
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Rabinovich A, Witkowski L, Shaco-Levi R, Meirovitz M, Hasselblatt M, Foulkes WD. Primary rhabdoid tumor of the ovary: When large cells become small cells. Gynecol Oncol Rep 2015; 12:64-6. [PMID: 26076162 PMCID: PMC4442655 DOI: 10.1016/j.gore.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/11/2015] [Indexed: 11/03/2022] Open
Abstract
•The third case of pure primary malignant rhabdoid tumor of the ovary (MRTO) is described•SMARCA4 and SMARCB1 genetic analysis and immunohistochemistry are necessary for correct diagnosis of MRTO•MRTO and small cell carcinoma of the ovary, hypercalcemic type are essentially the same and should be treated as such.
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Affiliation(s)
- Alex Rabinovich
- Division of Gynecologic Oncology, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leora Witkowski
- Department of Medical Genetics, Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada ; Department of Human Genetics, McGill University, Montreal, QC, Canada ; Department of Medical Genetics, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Ruthy Shaco-Levi
- Department of Pathology, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mihai Meirovitz
- Division of Gynecologic Oncology, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - William D Foulkes
- Department of Medical Genetics, Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada ; Department of Human Genetics, McGill University, Montreal, QC, Canada ; Department of Medical Genetics, Research Institute, McGill University Health Centre, Montreal, QC, Canada
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19
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Rabinovich A, Cohen JM, Cushman M, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Lazo-Langner A, Solymoss S, Miron MJ, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS, Kahn SR. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post-thrombotic syndrome. J Thromb Haemost 2015; 13:398-408. [PMID: 25495610 DOI: 10.1111/jth.12814] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/09/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.
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Affiliation(s)
- A Rabinovich
- Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Cho YI, Wright KC, Kim HS, Cho DJ, Rabinovich A, Fridman A. Stretched arc discharge in produced water. Rev Sci Instrum 2015; 86:013501. [PMID: 25638080 DOI: 10.1063/1.4905169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
The objective of the present study was to investigate the feasibility of stretching an arc discharge in produced water to increase the volume of produced water treated by plasma. Produced water is the wastewater generated by hydraulic fracturing of shale during the production phase in shale-oil or shale-gas exploration. The electric conductivity of produced water is in the range of 50-200 mS/cm, which provides both a challenge and opportunity for the application of plasmas. Stretching of an arc discharge in produced water was accomplished using a ground electrode and two high-voltage electrodes: one positioned close to the ground electrode and the other positioned farther away from the ground. The benefit of stretching the arc is that the contact between the arc and water is significantly increased, resulting in more efficient plasma treatment in both performance and energy cost.
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Affiliation(s)
- Y I Cho
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - K C Wright
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - H S Kim
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - D J Cho
- Drexel Plasma Institute, Drexel University, Camden, New Jersey 08103, USA
| | - A Rabinovich
- Drexel Plasma Institute, Drexel University, Camden, New Jersey 08103, USA
| | - A Fridman
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Bilavsky E, Temkin E, Lerman Y, Rabinovich A, Salomon J, Lawrence C, Rossini A, Salvia A, Samso JV, Fierro J, Paul M, Hart J, Gniadkowski M, Hochman M, Kazma M, Klein A, Adler A, Schwaber MJ, Carmeli Y. Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres. Clin Microbiol Infect 2014; 20:O804-10. [PMID: 24674024 DOI: 10.1111/1469-0691.12633] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/21/2013] [Revised: 03/17/2014] [Accepted: 03/22/2014] [Indexed: 12/31/2022]
Abstract
Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR=1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR=2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR=2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR=1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR=1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.
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Affiliation(s)
- E Bilavsky
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Piura B, Medina L, Rabinovich A, Dyomin V, Levy RS, Huleihel M. Distinct expression and localization of TNF system in ovarian carcinoma tissues: possible involvement of TNF-α in morphological changes of ovarian cancerous cells. Anticancer Res 2014; 34:745-752. [PMID: 24511008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM It has been previously shown that epithelial ovarian carcinoma tissues express high levels of tumor necrosis alpha (TNF-α), interleukin (IL)-6, IL-1α and IL-1β. The aim of the present study was to evaluate the localization of TNF-α and its receptors (TNFR1 and TNFR2) in different types of ovarian carcinoma tissues and the possible role of TNF in the pathogenesis of epithelial ovarian carcinoma. MATERIALS AND METHODS Total RNA was extracted from normal and cancerous ovarian tissues and mRNA was analyzed with semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Immunohistochemical staining was performed with use of antibodies against human (ah)TNFR1 and TNF2. RESULTS TNF-α mRNA and TNFR2 mRNA levels were significantly higher in ovarian carcinoma tissues than in normal ovarian tissues, whereas TNFR1 mRNA levels were similar. TNFR1 and TNFR2 were mainly localized in the epithelial neoplastic cells of the tumor. Knocking-down TNF-α activity with αhTNF-a altered ovarian carcinoma cell morphology (with more branches) in vitro. CONCLUSION Our study indicates a possible role of TNF-α in epithelial ovarian carcinoma pathogenesis through TNFR2, which affects morphological changes, which may be involved ovarian cancer pathogenesis.
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MESH Headings
- Actins/biosynthesis
- Actins/genetics
- Cell Communication/physiology
- Cell Line, Tumor
- Female
- Humans
- Immunohistochemistry
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Receptors, Tumor Necrosis Factor, Type I/biosynthesis
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type II/biosynthesis
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Tumor Necrosis Factor-alpha/biosynthesis
- Tumor Necrosis Factor-alpha/genetics
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Affiliation(s)
- Benjamin Piura
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Tel: +972 86479959,
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Rabinovich A, Cohen JM, Prandoni P, Kahn SR. Association between thrombophilia and the post-thrombotic syndrome: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:14-23. [PMID: 24406063 DOI: 10.1111/jth.12447] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 10/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), occurring in 20-40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. OBJECTIVE To conduct a systematic review to assess whether, among patients with DVT, inherited and acquired thrombophilias are associated with a risk of PTS. METHODS We searched the electronic databases PubMed, EMBASE, Scopus, and Web of Science for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS. We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta-analysis was performed using the random-effects model. RESULTS Sixteen studies were included: 13 assessed factor V Leiden (FVL), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta-analyses identified any thrombophilia to be predictive of PTS. Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT. CONCLUSIONS Our meta-analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Gemer O, Eitan R, Gdalevich M, Mamanov A, Piura B, Rabinovich A, Levavi H, Saar-Ryss B, Halperin R, Finci S, Beller U, Bruchim I, Levy T, Ben Shachar I, Ben Arie A, Lavie O. Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement. Eur J Surg Oncol 2013; 39:76-80. [DOI: 10.1016/j.ejso.2012.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/07/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
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Rabinovich A, Dagan G, Miloh T. Boundary effects on effective conductivity of random heterogeneous media with spherical inclusions. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 86:046601. [PMID: 23214702 DOI: 10.1103/physreve.86.046601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/11/2012] [Indexed: 06/01/2023]
Abstract
It is common to determine the effective conductivity of heterogeneous media by assuming stationarity of the random local properties. This assumption is not obeyed in a boundary layer of a body of finite size. The effect of different types of boundaries is examined for a two-phase medium with spherical inclusions of given conductivity distributed randomly in a matrix of a different conductivity. Exact solutions are derived for the apparent conductivity and the boundary layer thickness. The interaction between the spheres and the boundaries is fully incorporated in the solutions using a spherical harmonics expansion and the method of images. As applications, the corrections for the effective conductivity are given for two cases of finite bodies: the Maxwell sphere and a cylinder of flow parallel to the axis.
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Affiliation(s)
- A Rabinovich
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
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Barak F, Milgrom R, Laitman Y, Gemer O, Rabinovich A, Piura B, Anteby E, Baruch GB, Korach J, Friedman E. The rate of the predominant Jewish mutations in the BRCA1, BRCA2, MSH2 and MSH6 genes in unselected Jewish endometrial cancer patients. Gynecol Oncol 2010; 119:511-5. [DOI: 10.1016/j.ygyno.2010.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/04/2010] [Accepted: 08/21/2010] [Indexed: 11/25/2022]
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Ronen A, Chassidim HS, Gershon P, Parmet Y, Rabinovich A, Bar-Hamburger R, Cassuto Y, Shinar D. The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks. Accid Anal Prev 2010; 42:1855-1865. [PMID: 20728636 DOI: 10.1016/j.aap.2010.05.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/01/2010] [Accepted: 05/10/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Driving under the influence of drugs (DUID) is one of the main causes of car accidents. Alcohol and marijuana are the most popular drugs among recreational users. Many classify these drugs as "Light" drugs and therefore allow themselves to drive after consuming them. OBJECTIVE The study had two main objectives: 1) to investigate the effect of alcohol (BAC=0.05%), THC (13 mg) and their combination on driving and non-driving tasks. 2) to investigate the extent to which people are willing to drive based on their subjective sensations and their perceived effects of the drugs. METHOD 7 healthy men and 5 healthy women, ages 24-29, all recreational users of alcohol and marijuana, completed 5 experimental sessions. Sessions included: drinking and smoking placebo, drinking alcohol and smoking placebo, drinking placebo and smoking THC, drinking alcohol and smoking THC, drinking placebo and smoking placebo 24 hours after drinking alcohol and smoking THC. Three types of measures were used: subjective perceptions (with questionnaires), performance parameters of the driving and non-driving tasks (arithmetic task and a secondary target detection task) and physiological changes (heart rate). RESULTS Overall, the combination of alcohol and THC had the most intense effect after intake. This effect was reflected in performance impairments observed in the driving and non-driving tasks, in the subjective sensations after intake, and in the physiological measures. Despite significant differences in the size of the effects after the various treatments, there were no differences in the distances subjects were willing to drive while under the influence on each of the treatments.
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Affiliation(s)
- Adi Ronen
- Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Piura B, Rabinovich A, Apel-Sarid L, Shaco-Levy R. Carcinosarcoma of the fallopian tube with metastasis of its epithelial component to the ovary, appendix and omentum. J OBSTET GYNAECOL 2009; 29:566-7. [PMID: 19697224 DOI: 10.1080/01443610902780815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B Piura
- Department of Obstetrics and Gynaecology, Unit of Gynaecologic Oncology, Soroka Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Affiliation(s)
- B. Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - A. Rabinovich
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - R. Shaco-levy
- Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Apel-Sarid L, Shaco-Levy R. Splenic metastasis from endometrial carcinoma: report of a case and review of literature. Arch Gynecol Obstet 2009; 280:1001-6. [DOI: 10.1007/s00404-009-1039-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/05/2009] [Indexed: 10/21/2022]
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Piura B, Rabinovich A, Shaco-Levy R. Squamous cell carcinoma arising in ovarian mature cystic teratoma with isolated metastasis to the appendix. J OBSTET GYNAECOL 2009; 29:71-3. [PMID: 19280511 DOI: 10.1080/01443610802484088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- B Piura
- Department of Obstetrics and Gynaecology, Soroka Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Yavelsky V, Rohkin S, Shaco-Levy R, Tzikinovsky A, Amir T, Kohn H, Delgado B, Rabinovich A, Piura B, Chan G, Kalantarov G, Trakht I, Lobel L. Native human autoantibodies targeting GIPC1 identify differential expression in malignant tumors of the breast and ovary. BMC Cancer 2008; 8:247. [PMID: 18721484 PMCID: PMC2535783 DOI: 10.1186/1471-2407-8-247] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 08/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background We have been studying the native humoral immune response to cancer and have isolated a library of fully human autoantibodies to a variety of malignancies. We previously described the isolation and characterization of two fully human monoclonal antibodies, 27.F7 and 27.B1, from breast cancer patients that target the protein known as GIPC1, an accessory PDZ-domain binding protein involved in regulation of G-protein signaling. Human monoclonal antibodies, 27.F7 and 27.B1, to GIPC1 demonstrate specific binding to malignant breast cancer tissue with no reactivity with normal breast tissue. Methods The current study employs cELISA, flow cytometry, Western blot analysis as well as immunocytochemistry, and immunohistochemistry. Data is analyzed statistically with the Fisher one-tail and two-tail tests for two independent samples. Results By screening several other cancer cell lines with 27.F7 and 27.B1 we found consistently strong staining of other human cancer cell lines including SKOV-3 (an ovarian cancer cell line). To further clarify the association of GIPC1 with breast and ovarian cancer we carefully studied 27.F7 and 27.B1 using immunocytochemical and immunohistochemical techniques. An immunohistochemical study of normal ovarian tissue, benign, borderline and malignant ovarian serous tumors, and different types of breast cancer revealed high expression of GIPC1 protein in neoplastic cells. Interestingly, antibodies 27.F7 and 27.B1 demonstrate differential staining of borderline ovarian tumors. Examination of different types of breast cancer demonstrates that the level of GIPC1 expression depends on tumor invasiveness and displays a higher expression than in benign tumors. Conclusion The present pilot study demonstrates that the GIPC1 protein is overexpressed in ovarian and breast cancer, which may provide an important diagnostic and prognostic marker and will constitute the basis for further study of the role that this protein plays in malignant diseases. In addition, this study suggests that human monoclonal antibodies 27.F7 and 27.B1 should be further evaluated as potential diagnostic tools.
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Affiliation(s)
- Victoria Yavelsky
- Department of Virology, Faculty of Health Sciences, Ben Gurion University of Negev, Beer Sheva 84105, Israel.
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Ronen A, Gershon P, Drobiner H, Rabinovich A, Bar-Hamburger R, Mechoulam R, Cassuto Y, Shinar D. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol. Accid Anal Prev 2008; 40:926-934. [PMID: 18460360 DOI: 10.1016/j.aap.2007.10.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 10/20/2007] [Accepted: 10/29/2007] [Indexed: 05/26/2023]
Abstract
BACKGROUND The effects of marijuana or THC on driving has been tested in several studies, but usually not in conjunction with physiological and subjective responses and not in comparison to alcohol effects on all three types of measures. OBJECTIVE To assess the effects of two dosages of THC relative to alcohol on driving performance, physiological strain, and subjective feelings. METHOD We tested the subjective feelings and driving abilities after placebo, smoking two dosages of THC (13 mg and 17 mg), drinking (0.05% BAC) and 24 h after smoking the high dose THC cigarette, while monitoring physiological activity of the drugs by heart rate. Fourteen healthy students, all recreational marijuana users, participated in the study. RESULTS Both levels of THC cigarettes significantly affected the subjects in a dose-dependent manner. The moderate dose of alcohol and the low THC dose were equally detrimental to some of the driving abilities, with some differences between the two drugs. THC primarily caused elevation in physical effort and physical discomfort during the drive while alcohol tended to affect sleepiness level. After THC administration, subjects drove significantly slower than in the control condition, while after alcohol ingestion, subjects drove significantly faster than in the control condition. No THC effects were observed after 24 h on any of the measures.
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Affiliation(s)
- Adi Ronen
- Work Physiology, Human Factors and Traffic Safety, Department of Industrial Engineering and Management, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Piura B, Rabinovich A, Friger M. Recurrent cervical carcinoma after radical hysterectomy and pelvic lymph node dissection: a study of 32 cases. EUR J GYNAECOL ONCOL 2008; 29:31-36. [PMID: 18386460] [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: 05/26/2023]
Abstract
PURPOSE OF INVESTIGATION To investigate the characteristics of patients with recurrent cervical carcinoma after radical hysterectomy and pelvic lymph node dissection (RHND), and to evaluate the effect of clinical and surgical pathologic factors on the outcome of these patients. METHODS Data from the files of 32 patients with recurrent cervical carcinoma after RHND managed at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS These 32 patients represent a recurrence rate of 25.4%. The median recurrence-free interval was 19.3 (range, 1-106) months. The prevailing signs and symptoms were obstructive nephropathy, sacral pain and bowel obstruction. Sixteen (50%) patients had loco-regional recurrence alone, 12 (27.5%) loco-regional plus distant recurrence, and four (12.5%) distant recurrence alone. Treatment modalities included radiotherapy, chemotherapy and various surgical procedures. The 5-year survival rate was 35%, with 22 (68.7%) of the patients dead of disease at the end of follow-up. Univariate analysis demonstrated a significant worsening in survival with each of the following factors: loco-regional plus distant recurrence (p = 0.010), positive pelvic lymph nodes (p = 0.010), tumor size > or = 3 cm (p = 0.013), positive lymph vascular space involvement (p = 0.017) and RHND without bilateral salpingo-oophorectomy (p = 0.042). In a multivariate analysis, extent of recurrent disease (locoregional alone versus loco-regional plus distant recurrence) and pelvic lymph node status (negative vs positive) at RHND were the only significant predictors of survival. Uremia was the most common cause of death. CONCLUSIONS Recurrent cervical carcinoma after RHND is a grave disease with unfavorable prognosis. In both univariate and multivariate analyses, extent of recurrent disease and pelvic lymph node status at RHND were significant predictors of survival.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Rabinovich A, Medina L, Piura B, Segal S, Huleihel M. Regulation of ovarian carcinoma SKOV-3 cell proliferation and secretion of MMPs by autocrine IL-6. Anticancer Res 2007; 27:267-72. [PMID: 17352242] [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: 05/14/2023]
Abstract
BACKGROUND Cancerous ovarian tissues contain and produce high levels of pro-inflammatory cytokines (IL-1, IL-6 and TNF-alpha). The aim of this study was to assess the mechanisms by which autocrine IL-6 affects the ovarian carcinoma continuous cell line (SKOV-3) tumorigenicity. MATERIALS AND METHODS Autocrine IL-6 was neutralized by the addition of anti-IL-6 antibodies to SKOV-3 cell cultures. The proliferation rate was evaluated by MMT staining and the capacity to produce matrix metalloproteinases (MMPs) 2 and 9 was examined by zymography. RESULTS The SKOV-3 cells secreted IL-6 in a time-dependent manner (24-96 h). The addition of anti-IL-6 antibodies to SKOV-3 cell cultures did not affect their proliferation rate within 96 h of incubation. In addition, SKOV-3 cells secreted MMP-2 and MMP-9 as confirmed by zymography. The MMP-9 levels decreased in a time-dependent manner (3, 8, 24 h) and the addition of anti-IL-6 antibodies to SKOV-3 cell cultures significantly decreased their capacity to secrete MMP-9, particularly after 8 h of incubation. MMP-2 (pro-active and active forms) was also secreted by SKOV-3 cell cultures but could be measured only after 24-96 h of incubation. The levels of MMP-2 increased in a time-dependent manner. The addition of anti-IL-6 antibodies to SKOV-3 cell cultures did not affect their capacity to secrete MMP-2. CONCLUSION Our results suggest that IL-6 secreted by SKOV-3 cells could be involved in their tumorigenic potential, particularly potentiating their capacity to secrete MMP-9.
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Affiliation(s)
- Alex Rabinovich
- Unit of Gynecologic Oncology, Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel
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Abstract
Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum β-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology and Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Landau D, Maor E, Maymon E, Rabinovich A, Piura B. Intraplacental choriocarcinoma metastasizing to the maternal lung. EUR J GYNAECOL ONCOL 2006; 27:29-32. [PMID: 16550964] [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: 05/07/2023]
Abstract
BACKGROUND Although normal pregnancy is the precursor of 25% of cases of maternal choriocarcinoma, intraplacental choriocarcinoma in an otherwise normal placenta associated with viable pregnancy has rarely been reported. CASE Examination of the placenta after delivery of a pale and small-for-date infant at term revealed intraplacental choriocarcinoma. There was no evidence of metastatic disease in the mother or child, but the mother exhibited postpartum rising levels of beta-HCG. The mother refused chemotherapy and disappeared from follow-up. Nine months later, she presented with metastatic choriocarcinoma of the lung. Eleven courses of the multi-drug EMA CO regimen effected a decrease of beta-HCG to normal and disappearance of lung metastases. To date, 28 months after the end of chemotherapy, the patient is alive and without evidence of gestational trophoblastic disease. Moreover, since then she has given birth to an additional two children. CONCLUSIONS This case is an example of natural disease progression of intraplacental choriocarcinoma metastasizing to the mother. Furthermore, it supports common knowledge that the multi-drug EMA CO regimen is effective treatment in poor prognosis metastatic choriocarcinoma.
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Affiliation(s)
- D Landau
- Department of Neonatology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Friger M. Surgical pathologic factors in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection: association with administration of adjuvant radiotherapy and effect on survival. EUR J GYNAECOL ONCOL 2006; 27:573-8. [PMID: 17290585] [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: 05/13/2023]
Abstract
PURPOSE OF INVESTIGATION To identify surgical pathologic factors that best correlate with administration of adjuvant radiotherapy and best predict survival in early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection (RHND). METHODS Data from the files of 126 patients with cervical carcinoma treated by RHND at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS Fifty-four percent of the patients received postoperative adjuvant radiotherapy. In a univariate analysis, each of the following factors: positive pelvic lymph nodes, lower uterine segment involvement, lymph vascular space involvement, penetration > or = 50% of the cervical wall, grade 2+3, parametrial and/or paracervical involvement, vaginal margin involvement, non-squamous histologic type, tumor size > or = 3 cm and Stage IB2 + IIA was significantly associated with administration of radiotherapy. In a multivariate analysis, positiviy of pelvic lymph nodes was persistently the most significant factor associated with administration of radiotherapy. The 5-year survival rate was 82.6% overall. In a univariate analysis, a significant worsening in survival was demonstrated with positivity of pelvic lymph nodes and positivity of lymph vascular space involvement. In a "better fit" model of multivariate analysis, pelvic lymph node status was the strongest and the only significant predictor of survival. CONCLUSIONS In patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection, pelvic lymph node status is the strongest factor affecting administration of adjuvant radiotherapy and the most significant predictor of survival.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Friger M. Number and distribution of pelvic lymph nodes and effect of surgical pathologic factors on pelvic lymph node status in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection. EUR J GYNAECOL ONCOL 2006; 27:463-6. [PMID: 17139979] [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: 05/12/2023]
Abstract
PURPOSE OF INVESTIGATION To report the number and distribution of pelvic lymph nodes and to identify surgical pathologic factors that best predict positive pelvic lymph nodes in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection (RHND). METHODS Data from the files of 126 patients with cervical carcinoma treated by RHND at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS The status of pelvic lymph nodes was known in 114 patients. The exact number of lymph nodes removed from the pelvis of each patient was known in 111 patients. The mean number of lymph nodes removed from the pelvis per patient was 26.6 (median 23; range 1-62). Positive pelvic lymph nodes were found in 35 (30.7%) of the patients with a mean of 3.4 (median 2; range, 1-15) positive pelvic lymph nodes per patient. In a univariate analysis, positive lymph vascular space invasion and positive parametrial and/or paracervical involvement were significant predictors of positive pelvic lymph nodes, whereas penetration > or = 50% of the thickness of the cervical wall and grade 2+3 were of borderline significance. In a multivariate analysis, positive lymph vascular space invasion was the strongest and the only significant predictor of positive pelvic lymph nodes, whereas positive parametrial and/or paracervical involvement was of borderline significance. CONCLUSIONS In patients with early-stage cervical carcinoma treated with RHND, positive lymph vascular space invasion emerged to be the strongest and most significant predictor of positive pelvic lymph nodes.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hadar A, Rabinovich A, Sheiner E, Landau D, Hallak M, Mazor M. Obstetric characteristics and neonatal outcome of unplanned out-of-hospital term deliveries: a prospective, case-control study. J Reprod Med 2005; 50:832-6. [PMID: 16419631] [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: 05/06/2023]
Abstract
OBJECTIVE To describe the obstetric characteristics and neonatal outcomes in unplanned out-of-hospital deliveries. STUDY DESIGN Obstetric characteristics and neonatal outcomes were compared between 151 consecutive parturients with unplanned, out-of-hospital term deliveries and 151 hospital term deliveries. RESULTS Women who delivered out of hospital tended to be older (32 +/- 5.5 vs. 28 +/- 5.0 years, p = 0.046) and less educated (4.4 +/- 5.1 vs. 6.5 +/- 5.0 years, p = 0.005) as compared to women who delivered in the hospital. Unplanned out-of-hospital deliveries resulted in statistically significant higher rate of low-birth-weight newborns (< 2,500 g) (OR= 3.9, 95% CI 2.0-7.7, p<0.001), postpartum hemorrhage (OR = 8.4, 95% CI 1.1-181.1, p = 0.018) and trended for higher rate of manual lysis of retained placenta and membranes (4.0% vs. 0%, p = 0.013). Higher rates of admission to the neonatal intensive care unit due to neonatal complications, such as polycythemia (12.6% vs. 0%, p < 0.001), hypoglycemia (9.3% vs. 0.6%, p = 0.001) and convulsions (3.3% vs. 0%, p = 0.024), were noted in the out-of-hospital delivery group as compared to the controls. Using a multivariable analysis, lower educational level (OR = 0.4, 95% CI 0.3-0.4, p < 0.001), maternal age > 35 (OR = 6.2, 95% CI 2.3-16.7, p < 0.001) and high parity (OR = 7.9, 95% CI 4.9-12.9, p<0.001) were found to be independent risk factors for an unplanned outof hospital delivery. CONCLUSION Unplanned out-of-hospital birth is an important risk factor for such complications as postpartum hemorrhage, low birth weight and adverse neonatal outcome.
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Affiliation(s)
- Amnon Hadar
- 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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Abstract
Topotecan has demonstrated antitumor activity in heavily pretreated patients with ovarian carcinoma. This report examines the activity and toxicity of topotecan in 29 heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma. Topotecan 1.5 mg/m2 was administered intravenously on days 1-5, every 21 days. It was second-line chemotherapy in 6 (20.7%) patients, third-line in 15 (51.7%), fourth-line in 4 (13.8%), fifth-line in 3 (10.3%), and seventh-line in 1 (3.4%). Median dose intensity was 1.667 mg/m(2)/week, and median relative dose intensity was 0.67. Disease complete response was observed in 5 (17.2%) patients, partial response in 1 (3.4%), stable disease in 12 (41.4%), and progressive disease in 11 (37.9%). CA-125 complete response was observed in 3 (10.3%) patients, partial response in 11 (37.9%), stable level in 5 (17.2%), and progressive level in 9 (31%), and no data were available in 1 (3.4%) patient. Toxicity was mainly hematologic: grade 3-4 neutropenia was observed in 20 (69%) patients, grade 3-4 leukopenia in 12 (41.4%), grade 3-4 thrombocytopenia in 9 (31%), and grade 3-4 anemia in 2 (6.9%). It is concluded that topotecan has considerable activity and noncumulative hematologic toxicity in heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Piura B, Rabinovich A, Sinelnikov I, Delgado B. Tailgut cyst initially misdiagnosed as ovarian tumor. Arch Gynecol Obstet 2005; 272:301-3. [PMID: 16041543 DOI: 10.1007/s00404-005-0012-3] [Citation(s) in RCA: 13] [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] [Received: 01/25/2005] [Accepted: 01/31/2005] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Tailgut cyst (retrorectal cystic hamartoma) is an uncommon congenital lesion that arises from remnants of the embryonic post-anal gut. It is usually benign and located in the retrorectal/presacral space. CASE REPORT A 45-year-old woman presented with lower abdominal discomfort, urinary frequency and right-sided pelvic mass. Digital rectal examination and computerized tomography scan demonstrated a multicystic complex mass occupying the region of the right ovary and extending into the retrorectal/presacral space. The initial diagnosis was neoplasm of the right ovary. At laparotomy, the mass was lying free from apparently normal internal genital organs. Excision of the mass from the right pelvis and retrorectal/presacral space and total abdominal hysterectomy were performed. Microscopic examination revealed that the wall of the cystic mass consists of a lining epithelium composed of columnar and squamous epithelium and a stroma composed of fibrous tissue containing scattered discontinuous bundles of smooth muscle fibers. Based on these histological findings, the final diagnosis was tailgut cyst. CONCLUSION Tailgut cyst is an uncommon entity that should be included in the differential diagnosis of retrorectal/presacral mass. The treatment of choice is complete surgical excision.
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Affiliation(s)
- Benjamin Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev, 151, Beer-Sheva, 84101, Israel.
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Piura B, Rabinovich A, Aizenberg N, Wolfson M. [Cadherins in malignancies of the female genital tract]. Harefuah 2005; 144:261-5, 303, 302. [PMID: 15889610] [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: 05/02/2023]
Abstract
Cadherins are a superfamily of adhesion molecules that mediate Ca++ -dependent cell-cell adhesion necessary for normal morphogenesis and maintenance of tissue integrity. A classical cadherin molecule, such as E-cadherin, is a glycoprotein made up of three parts: an extracellular portion composed of five identical domains, a transmembrane portion composed of a single domain and a cytoplasmic portion composed of two domains. The cytoplasmic portion is anchored by means of cytoplasmic catenins to the cytoskeleton. The three amino acids sequence, histidine, alanine and valine (HAV motif) located at the most external domain of the extracellular portion, plays a key role in homophilic recognition between two cadherin molecules and cell-cell adhesion. Loss of cell-cell adhesion may be a prerequisite for malignant transformation and the invasive behavior of malignant tumors. Research of cadherin in malignancies has attracted much attention since cadherins may be proven to be reliable markers of biological behavior and prognosis The studies on cadherin in malignancies of the female genital tract have shown the following results: 1) in malignant transformation of the ovarian surface epithelium (OSE) and in epithelial ovarian carcinoma confined to the ovary (Stage I) there is a switch from N-cadherin expression to E-cadherin expression; 2) In advanced-stage epithelial ovarian carcinoma (Stages II-IV) the results are at odds: some investigators have shown a loss of E-cadherin expression most often because of hypermethylation of the promoter region of the gene, while others have demonstrated an increase in E-cadherin expression; 3) In endometrial carcinoma, E-cadherin expression is decreasing and P-cadherin expression is increasing with worsening of histologic type and differentiation, increased penetration into the myometrium, spread beyond the uterus and involvement of pelvic lymph nodes; 4) In squamous cell carcinoma of the uterine cervix E-cadherin expression is decreasing with tumor progression and in adenocarcinoma of the uterine cervix P-cadherin expression is increasing with tumor progression. It is hoped that the development of drugs that amend cell-cell adhesion will improve the prognosis of patients in whom tumor progression is associated with decrease or loss of cadherin expression.
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Affiliation(s)
- Benjamin Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology Soroka Medical Center and Faculty of Health Sciences, Cancer Research Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Abstract
Topotecan has demonstrated antitumor activity in heavily pretreated patients with ovarian carcinoma. This report examines the activity and toxicity of topotecan in 29 heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma. Topotecan 1.5 mg/m2 was administered intravenously on days 1–5, every 21 days. It was second-line chemotherapy in 6 (20.7%) patients, third-line in 15 (51.7%), fourth-line in 4 (13.8%), fifth-line in 3 (10.3%), and seventh-line in 1 (3.4%). Median dose intensity was 1.667 mg/m2/week, and median relative dose intensity was 0.67. Disease complete response was observed in 5 (17.2%) patients, partial response in 1 (3.4%), stable disease in 12 (41.4%), and progressive disease in 11 (37.9%). CA-125 complete response was observed in 3 (10.3%) patients, partial response in 11 (37.9%), stable level in 5 (17.2%), and progressive level in 9 (31%), and no data were available in 1 (3.4%) patient. Toxicity was mainly hematologic: grade 3–4 neutropenia was observed in 20 (69%) patients, grade 3–4 leukopenia in 12 (41.4%), grade 3–4 thrombocytopenia in 9 (31%), and grade 3–4 anemia in 2 (6.9%). It is concluded that topotecan has considerable activity and noncumulative hematologic toxicity in heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma.
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Piura B, Rabinovich A. Doxorubicin and ifosfamide-mesna in advanced and recurrent uterine sarcomas. EUR J GYNAECOL ONCOL 2005; 26:275-8. [PMID: 15991525] [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: 05/03/2023]
Abstract
PURPOSE OF INVESTIGATION To report the experience of a single institution in the south of Israel with doxorubicin and ifosfamide-mesna in patients with advanced/recurrent uterine sarcomas. METHODS The hospital records of five patients with advanced/recurrent uterine sarcomas who had combination chemotherapy with doxorubicin and ifosfamide-mesna were retrospectively reviewed. Doxorubicin 30 mg/m2 was given on days 1 and 2 and ifosfamide 2000 mg/m2 (+ mesna, W/W 60%) was given on days 1, 2 and 3 of every 21 days. Dose intensity, relative dose intensity and average relative dose intensity (ARDI) of chemotherapy were calculated. Response was determined using clinical evaluation and radiological reports. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS The median ARDI of the combination of doxorubicin and ifosfamide received by the patients was 0.68 (range, 0.53-0.74). One (20%) patient had disease complete response lasting three months and four (80%) patients had progressive disease. Toxicity was mainly hematological with grade 3 or 4 leukopenia--four (80%) patients, neutropenia--four (80%), thrombocytopenia--one (20%) and anemia--one (20%). Non-hematological toxicity was negligible. At follow-up, four (80%) patients had died of disease and one (20%) was alive with disease. CONCLUSION Although the combination of doxorubicin and ifosfamide has certain activity in advanced/recurrent uterine sarcomas, the toxicity is of much concern and the results of treatment in terms of response duration and survival are poor.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Cancer Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Shaco-Levy R, Sukenik S. Vulvar invasive squamous cell carcinoma occurring in a young woman with systemic lupus erythematosus. EUR J GYNAECOL ONCOL 2005; 26:103-5. [PMID: 15755013] [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: 05/02/2023]
Abstract
BACKGROUND Although several studies have demonstrated a possible relationship between systemic lupus erythematosus (SLE) and non-Hodgkin's lymphoma, Hodgkin's lymphoma, leukemia and several solid tumors, it is still debatable whether SLE patients have an increased incidence of cancer overall. CASE We describe a 25-year-old patient with SLE who developed invasive squamous cell carcinoma of the vulva. The patient underwent radical vulvectomy and bilateral groin sentinel lymph node dissection and until to date, one year after surgery, she is alive without evidence of recurrent disease. CONCLUSIONS Only three cases of vaginal/vulvar cancer associated with SLE have previously been mentioned in the literature, but not described in detail. This is the first detailed case report in the literature of vulvar invasive squamous cell carcinoma occurring in a SLE patient. It can only be speculated that the SLE itself and/or the treatment with immunosuppressive drugs provoked malignant transformation and the development of vulvar squamous cell carcinoma in such a young patient.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Rabinovich A, Hadar A, Sheiner E, Landau D, Hallak M, Mazor M. Obstetric characteristics and neonatal outcome of unplanned out of hospital term deliveries. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.584] [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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Agur Z, Arakelyan L, Belilty G, Dahan N, Harpak H, Kogan Y, Merbl Y, Rabinovich A, Shoham M, Ziv I. Application of the Virtual Cancer Patient Engine (VCPE) for improving oncological treatment desig. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Z. Agur
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - L. Arakelyan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - G. Belilty
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - N. Dahan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - H. Harpak
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - Y. Kogan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - Y. Merbl
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - A. Rabinovich
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - M. Shoham
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - I. Ziv
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
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Piura B, Wolak A, Rabinovich A, Yanai-Inbar I. Giant cell arteritis of the female genital tract. CLIN EXP OBSTET GYN 2004; 31:31-3. [PMID: 14998183] [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: 04/29/2023]
Abstract
Giant cell arteritis (GCA) of the female genital tract is rare with only 30 cases, including this case, documented in the literature. We present a patient who had total abdominal hysterectomy and bilateral salpingo-oophorectomy for an ovarian cyst and on histologic examination GCA involving the arteries of the myometrium, cervical stroma, ovaries and tubes was unexpectedly discovered. Upon questioning of the patient and further investigations it became clear that the patient did have symptoms and signs suggestive of systemic GCA including fatigue, low-grade fever, weight loss and elevated erythrocyte sedimentation rate (ESR). Treatment with oral corticosteroids resulted in rapid and complete recovery. It is concluded that an incidental finding of GCA in the genitalia should alert the clinician to the possibility of systemic GCA. If upon questioning of the patient and further investigations the existence of systemic GCA is confirmed, treatment with corticosteroids should be considered.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, 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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