The Experts below are selected from a list of 159 Experts worldwide ranked by ideXlab platform
Oz Harmanli - One of the best experts on this subject based on the ideXlab platform.
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Transvaginal Tubal Sterilization and Hysterectomy
Clinical Gastroenterology, 2017Co-Authors: Oz HarmanliAbstract:In the growing world of ever less invasive surgery, minimalist approaches to hysterectomy have begun to proliferate. Vaginal hysterectomy (VH) is an old operation—dating to antiquity—that was widely used until the advent of laparoscopic surgery, although its use has declined as minimally invasive efforts, including the robotic approach, have grown in popularity. A thorough knowledge of pelvic anatomy and positioning is required to safely perform VH. This understanding of anatomy also allows for the performance of posterior colpotomy, which can be utilized for transvaginal approaches to other abdominal operations, as described in NOTES transvaginal surgery. Other transvaginal procedures, such as Culdocentesis, culdotomy, and culdoscopy, are performed in a similar manner. Strategies for employing these techniques and potential complications to avoid are discussed in detail. Transvaginal sterilization, or tubal ligation, is also described, as are the complications of the procedure.
J E Weaver - One of the best experts on this subject based on the ideXlab platform.
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Sonographic detection of echogenic fluid and correlation with Culdocentesis in the evaluation of ectopic pregnancy.
AJR. American journal of roentgenology, 1998Co-Authors: Phebe Chen, G K Sickler, Ted Dubinsky, Nabil F. Maklad, R L Jacobi, J E WeaverAbstract:Because the presence of echogenic fluid on transvaginal sonography has been shown to correlate well with hemoperitoneum in patients with possible ectopic pregnancy, the aim of this study was to compare echogenic fluid on sonography with the results of Culdocentesis in predicting hemoperitoneum.Free fluid on transvaginal sonography and the results of Culdocentesis were correlated with the presence or absence of hemoperitoneum in 46 patients at surgery. Forty ectopic pregnancies and six nonectopic pregnancies were found. Echogenic fluid was the criterion used to establish hemoperitoneum on sonography. For statistical analysis, negative and nondiagnostic Culdocentesis results were combined. The sensitivity, specificity, and positive and negative predictive values of each diagnostic technique were compared.In 40 of 46 patients with ectopic pregnancy, the sensitivity and specificity of echogenic fluid for establishing hemoperitoneum were 100% and 100%, respectively, compared with 66% and 80%, respectively, for...
Raphael Ron-el - One of the best experts on this subject based on the ideXlab platform.
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Ovarian pregnancy-a 12-year experience of 19 cases in one institution.
European journal of obstetrics gynecology and reproductive biology, 2004Co-Authors: Arieh Raziel, Morey Schachter, Eytan Mordechai, Shevach Friedler, Motti Panski, Raphael Ron-elAbstract:Objectives: To report the prevalence, presentation, diagnostic modalities, and treatment of ovarian pregnancy in one institution. Study design: Retrospective case control study of 19 cases of ovarian pregnancy treated between 1990 and 2001 at Assaf Harofeh Medical Center, Zerifin, Israel. Main outcome measures: Prevalence, presentation, diagnostic modalities, surgical treatment, and relation to intrauterine device (IUD) use. Results: Nineteen ovarian pregnancies, diagnosed between 1990 and 2001, comprised (19/694) 2.7% of all ectopic pregnancies, 1:3000 of all live births leading to a mean ovarian pregnancy per year of 1.6. Presenting symptoms were similar to those of tubal pregnancies including circulatory collapse which was present in 4/19 (21%) of patients. Culdocentesis for diagnostic purposes, has become an unnecessary procedure. Wedge resection by laparotomy was the treatment of choice in the past, and from 1994, it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, intrauterine device was present in 68% of the patients and in 76% of the fertile women. Conclusions: The absolute number of ovarian pregnancies between 1900 and 2001 increased but the prevalence rate per delivery was stable. Despite modern diagnostic modalities patients still present in circulatory collapse-conservative approach may underestimate the potential risk of bleeding. Culdocentesis has no clinical diagnostic benefits. Laparoscopy is invaluable, as diagnosis and treatment can be carried out as a single treatment. Laparoscopic wedge resection is the treatment of choice. The relation between IUD use and ovarian pregnancies is still strong.
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A comparison of the incidence, presentation, and management of ovarian pregnancies between two periods of time.
The Journal of the American Association of Gynecologic Laparoscopists, 2004Co-Authors: Arieh Raziel, Morey Schachter, Eytan Mordechai, Shevach Friedler, Moty Pansky, Raphael Ron-elAbstract:Abstract Study Objective To compare the prevalence, presentation diagnostic modalities, and management of 37 ovarian pregnancies in one institution during two time periods. Design A retrospective study (Canadian Task Force classification II-2). Setting Department of Gynecology in a university-affiliated hospital. Patients Twenty patients with ovarian pregnancy between 1971–1989 compared with 17 patients with ovarian pregnancy between 1990–2000. Measurements and Main Results Seventeen ovarian pregnancies, diagnosed between 1990–2000, comprised 2.6% (17/634) of all ectopic pregnancies, 1:3500 of all live births leading to a mean ovarian pregnancy rate per year of 1.5, as opposed to 3.1% (20/647) of all ectopic pregnancies, 1:3600 of all live births, and a mean ovarian pregnancy rate per year of 1.1 in the previous period. Circulatory collapse was present in 4/17 (23%) patients in the 1990–2000 time period and in 6/20 (30%) in the previous period. Culdocentesis for diagnostic purposes was practically abandoned in the recent decade. Wedge resection by laparotomy was the treatment of choice in the past, and after 1997, it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, an intrauterine device (IUD) was present in 65% of all patients and in 73% of women who had previously conceived in the 1999–2000 time period, compared with higher rates in the previous period (90% and 100%, respectively). Conclusion The absolute number of ovarian pregnancies in the last 11 years increased when compared with the previous 19 years; however, the prevalence rate per delivery was stable. Patients still experienced circulatory collapse despite modern diagnostic modalities. Culdocentesis for diagnostic purposes has become an unnecessary procedure. Laparoscopic wedge resection was the treatment of choice. The relationship between IUD use and ovarian pregnancies was still strong.
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Current management of ruptured corpus luteum
European journal of obstetrics gynecology and reproductive biology, 1993Co-Authors: Arie Raziel, Ian Bukovsky, Raphael Ron-el, Mordechai Pansky, Shlomo Arieli, E. CaspiAbstract:The objectives of the study are to assess current management of the rather frequent event of ruptured corpus luteum. Special emphasis is made on the value of ultrasonography, laparoscopy and Culdocentesis in deciding appropriate treatment. A series of 70 patients with ruptured corpus luteum diagnosed and treated during a period of 6 years in one institution in Israel is reported. Eighteen patients with concurrent ruptured corpus luteum and ectopic pregnancy are included. Abdominal pain, the most prevalent presenting symptom, has no typical characteristics. The correlation between large amount of fluid as observed by ultrasound and the finding of > 250 ml of blood at laparotomy is very high. Culdocentesis was performed in only 21 patients. Surgical intervention (laparoscopy, laparotomy following laparoscopy or direct laparotomy) was carried out in 58 patients (83%). The remaining 12 cases were handled by observation only. Forty patients required laparotomy in whom 17 underwent wedge resection. We conclude that observation is sufficient treatment in hemodynamically stable patients, without severe abdominal pain and in the presence of a small amount of pelvic fluid demonstrated by ultrasound. When a large amount of fluid is observed and/or in the presence of severe abdominal pain laparoscopy should be performed on admission. Direct laparotomy is mandatory in case of circulatory collapse.
Balint Farkas - One of the best experts on this subject based on the ideXlab platform.
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Assessment of cells in the ascitic fluid of women with ovarian hyperstimulation syndrome: the clinical implications for subsequent ovarian malignancy
Reproductive Biology and Endocrinology, 2013Co-Authors: Ioannis Hatzipetros, Peter M Gocze, Katalin Cziraky, Kalman Kovacs, Endre Kalman, Balint FarkasAbstract:Background Although some studies have reported a potential connection between ovulation induction therapy (OIT) and malignant ovarian diseases, the results have been inconclusive. In the present study, we sought to determine whether women undergoing OIT at our in vitro fertilization (IVF) clinic, especially those with severe ovarian hyperstimulation syndrome (OHSS) and suspicious cytologic findings, were at risk for developing malignant ovarian tumours after treatment. Methods Patients who underwent OIT at our IVF clinic were enrolled in this study and assessed for any evidence of malignant ovarian tumours. Patients who developed severe OHSS as a result of OIT were treated with a Culdocentesis. Cells from the ascitic fluid were cytologically scored for abnormality and malignancy. Peripheral blood samples were obtained from patients with severe OHSS to determine serum levels of the tumour markers (CA-125 and HE4) that were used to calculate the Risk for Ovarian Malignancy Algorithm (ROMA) index. Results Follow-up data were available for 1,353 of the 1,587 patients (85%) who underwent OIT at our IVF clinic between January 2006 and December 2012. Twenty-three patients (1.4%) were hospitalized with OHSS. Culdocentesis was performed 16 times in nine patients with severe OHSS (age range, 23–34 years; mean, 27.1 years). Although cytological examination of the ascitic cells of these patients suggested malignant ovarian neoplasia, over the course of the observation period, the ovarian volume gradually decreased and became normal. Subsequent cytological and histological examinations failed to find evidence of any malignant tumours in these nine patients. None of the 1,353 participants who underwent OIT developed any malignant ovarian tumours during the study period. Moreover, none of the 462 patients who were in our ovarian tumour registry were also participants in the IVF program. Conclusions The presence of atypical cells in the ascitic fluid of women with severe OHSS does not likely indicate malignancy; therefore, radical surgical intervention is not justified. The risk of malignancy is minimal shortly after OIT. At our centre, OIT has not been associated with any cases of ovarian tumour.
Phebe Chen - One of the best experts on this subject based on the ideXlab platform.
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Sonographic detection of echogenic fluid and correlation with Culdocentesis in the evaluation of ectopic pregnancy.
AJR. American journal of roentgenology, 1998Co-Authors: Phebe Chen, G K Sickler, Ted Dubinsky, Nabil F. Maklad, R L Jacobi, J E WeaverAbstract:Because the presence of echogenic fluid on transvaginal sonography has been shown to correlate well with hemoperitoneum in patients with possible ectopic pregnancy, the aim of this study was to compare echogenic fluid on sonography with the results of Culdocentesis in predicting hemoperitoneum.Free fluid on transvaginal sonography and the results of Culdocentesis were correlated with the presence or absence of hemoperitoneum in 46 patients at surgery. Forty ectopic pregnancies and six nonectopic pregnancies were found. Echogenic fluid was the criterion used to establish hemoperitoneum on sonography. For statistical analysis, negative and nondiagnostic Culdocentesis results were combined. The sensitivity, specificity, and positive and negative predictive values of each diagnostic technique were compared.In 40 of 46 patients with ectopic pregnancy, the sensitivity and specificity of echogenic fluid for establishing hemoperitoneum were 100% and 100%, respectively, compared with 66% and 80%, respectively, for...