Sonia Mendlovic - Academia.edu (original) (raw)

Papers by Sonia Mendlovic

Research paper thumbnail of Characterizing excised breast masses in children and adolescents- can a more aggressive pathology be predicted?

Journal of Pediatric Surgery

Research paper thumbnail of Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge

The Journal of reproductive medicine

To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in rec... more To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in recent years and to compare it to tubal pregnancy. Seven women treated for primary ovarian pregnancy from 2002-2013 were retrospectively identified and compared to 42 women with tubal pregnancies (involving either tubal rupture or tubal abortion) operated on during the same period. In the ovarian pregnancy group the pathology examination confirmed primary ovarian pregnancy according to the Spiegelberg criteria. Seven women underwent surgery for primary ovarian pregnancy during the study period. Five women presented with hemodynamic shock. A ruptured ovarian pregnancy was identified in all cases. Wedge resection was performed by laparotomy in 1 case and by laparoscopy in 6 cases. The mean estimated blood loss was significantly higher in those women with ovarian versus tubal pregnancy (1057.1 ± 472.1 mL vs. 250.2 ± 241.5 mL, respectively, p<0.001). Moreover, a statistically significant dif...

Research paper thumbnail of Role of collagen type IV in the pathogenesis of increased prenasal thickness in Down syndrome fetuses: sonographic and immunohistological findings

Journal of perinatal medicine, Jan 3, 2016

The present study aims to compare the presence and localization of collagen type IV in the prenas... more The present study aims to compare the presence and localization of collagen type IV in the prenasal tissue of fetuses with and without Down syndrome (DS). Products of conception were obtained from mid-gestation uterine evacuations of 14 DS fetuses and 15 unaffected controls. Microdissection of the prenasal area and an analysis of the prenasal tissue specimens were performed by a single pathologist, blinded to the karyotype results. Immunohistological presence and localization of type IV collagen were analyzed in the basement membrane (BM), blood vessels, and stroma of the tissues. There were no statistically significant differences in the presence and localization of antibodies for collagen IV in the blood vessels and stroma between the two groups. However, the presence and localization of type IV collagen in the BM of the prenasal skin were significantly higher in DS specimens compared to the control group (P=0.023). When combining both groups altogether, a significant correlation ...

Research paper thumbnail of Primary Ovarian Pregnancy: 43 Years Experience in a Single Institute and still a Medical Challenge

The Israel Medical Association journal : IMAJ, 2015

Despite awareness regarding tubal pregnancy, ovarian pregnancy still remains a diagnostic challen... more Despite awareness regarding tubal pregnancy, ovarian pregnancy still remains a diagnostic challenge. The correct diagnosis is most frequently made intraoperatively and requires histopathologic confirmation. Therefore, additional diagnostic measurements are needed for earlier and more accurate detection of ovarian pregnancies which will allow more rapid and efficient treatment. To assess the time trends, clinical manifestations, surgical management and post-procedure outcome of 46 primary ovarian pregnancies in a single institution during three time periods. In this retrospective study we compared 20 patients with primary ovarian pregnancy during the years 1971- 1989 (first period), 19 patients in 1990-2001 (second period) and 7 patients in 2002-2013 (third period). In all cases the pathology examination confirmed primary ovarian pregnancy. The number of tubal ectopic pregnancies almost doubled, from 637 in the first period to 1279 in the third period (P < 0.001). However, there w...

Research paper thumbnail of Efficacy of amphotericin B or amphotericin Beintralipid in combination with caspofungin against experimental aspergillosis

J Infection, 2006

Infections caused by Aspergillus species are increasing in importance, especially among immunocom... more Infections caused by Aspergillus species are increasing in importance, especially among immunocompromised hosts. The objective of this study was to evaluate the efficacy of combination treatment consisting of the polyene amphotericin B (AMB) or amphotericin B–intralipid admixture (AMB–IL) and the echinocandin caspofungin (CAS) in experimental murine systemic aspergillosis. Inhibition of synthesis of a major component of the fungal cell wall and an effect on the cell membrane, by combining echinocandin and a polyene, may result in a synergistic interaction in vitro and in vivo against Aspergillus fumigatus.ICR mice were immunosuppressed by intraperitoneal (ip) administration of cyclophosphamide (CY). Three days post-CY administration the mice were inoculated intravenously (iv) with A. fumigatus conidia. Infection and treatment were evaluated during an observation period of 30 days in terms of mortality (survival rate and mean survival time) and morbidity (quantitative determination of fungal burden, histopathology, and detection of serum galactomannan).The data showed that combined CAS and AMB or AMB–IL treatment increased the survival of the mice (up to 69.2%) as compared to those treated with each agent alone (44.4, 40.7 and 50%, respectively), and prolonged their mean survival time to 22.5 days. These combinations also resulted in reduction of fungal burden in organs, and decrease in serum galactomannan.The successful results obtained in the experimental animal model of this study may possibly open the way to more effective management of aspergillosis in humans.

Research paper thumbnail of Campylobacter coli infection causing second trimester intrauterine growth restriction (IUGR): a case report and review of the literature

Prenatal Diagnosis, 2015

Campylobacter is a gram-negative, microaerophilic, curved rod and a normal resident of the gastro... more Campylobacter is a gram-negative, microaerophilic, curved rod and a normal resident of the gastrointestinal flora and may be the cause of disease in animals. Transmission to humans occurs by ingestion of contaminated food or by direct contact with infected animals. In the past few decades, an increasing number of reports have implicated the presence of this organism in human abortions as well. An infectious mechanism due to primary placental inflammatory damage followed by secondary damage to the fetus following placental insufficiency and ischemia was suggested. The most common species of Campylobacter are Campylobacter jejuni and Campylobacter coli, which are classically associated with enteritis in humans. We present a rare case of mid-gestation intrauterine growth restriction (IUGR) associated with maternal bacteremia caused by C. coli infection. Our literature review focuses on Campylobacter infections occurring in the second and third trimesters of pregnancy. In all cases, mild maternal symptoms consisting of fever and weakness were presented. However, associated adverse fetal outcome, including abortions, IUGR or preterm labor may occur more frequently than anticipated. Our report strengthens the importance of awareness to this finding and focuses the need to consume properly cooked meat during pregnancy. © 2015 John Wiley &amp;amp;amp;amp;amp;amp;amp; Sons, Ltd.

Research paper thumbnail of Analysis of Varicella-Zoster Virus in Temporal Arteries Biopsy Positive and Negative for Giant Cell Arteritis

JAMA Neurology, 2015

Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly individuals. Diagnos... more Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly individuals. Diagnosis is confirmed by temporal artery (TA) biopsy, although biopsy results are often negative. Despite the use of corticosteroids, disease may progress. Identification of causal agents will improve outcomes. Biopsy-positive GCA is associated with TA infection by varicella-zoster virus (VZV). To analyze VZV infection in TAs of patients with clinically suspected GCA whose TAs were histopathologically negative and in normal TAs removed post mortem from age-matched individuals. A cross-sectional study for VZV antigen was performed from January 2013 to March 2015 using archived, deidentified, formalin-fixed, paraffin-embedded GCA-negative, GCA-positive, and normal TAs (50 sections/TA) collected during the past 30 years. Regions adjacent to those containing VZV were examined by hematoxylin-eosin staining. Immunohistochemistry identified inflammatory cells and cell types around nerve bundles containing VZV. A combination of 17 tertiary referral centers and private practices worldwide contributed archived TAs from individuals older than 50 years. Presence and distribution of VZV antigen in TAs and histopathological changes in sections adjacent to those containing VZV were confirmed by 2 independent readers. Varicella-zoster virus antigen was found in 45 of 70 GCA-negative TAs (64%), compared with 11 of 49 normal TAs (22%) (relative risk [RR] = 2.86; 95% CI, 1.75-5.31; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Extension of our earlier study revealed VZV antigen in 68 of 93 GCA-positive TAs (73%), compared with 11 of 49 normal TAs (22%) (RR = 3.26; 95% CI, 2.03-5.98; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Compared with normal TAs, VZV antigen was more likely to be present in the adventitia of both GCA-negative TAs (RR = 2.43; 95% CI, 1.82-3.41; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and GCA-positive TAs (RR = 2.03; 95% CI, 1.52-2.86; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Varicella-zoster virus antigen was frequently found in perineurial cells expressing claudin-1 around nerve bundles. Of 45 GCA-negative participants whose TAs contained VZV antigen, 1 had histopathological features characteristic of GCA, and 16 (36%) showed adventitial inflammation adjacent to viral antigen; no inflammation was seen in normal TAs. In patients with clinically suspected GCA, prevalence of VZV in their TAs is similar independent of whether biopsy results are negative or positive pathologically. Antiviral treatment may confer additional benefit to patients with biopsy-negative GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.

Research paper thumbnail of Fetal diagnosis of testicular torsion: what shall we tell the parents?

Prenatal diagnosis, 2015

The objectives of this study are to present our collective experience with the prenatal diagnosis... more The objectives of this study are to present our collective experience with the prenatal diagnosis of testicular torsion and to propose a possible prenatal management scheme. We retrospectively collected and reviewed all medical records of cases that were diagnosed with perinatal testicular torsion in our medical center between the years 2002 and 2013. Prenatal torsion was categorized as torsion diagnosed in utero or on immediate newborn examination. A total of five unilateral prenatal torsions were diagnosed. Two fetuses were diagnosed in the third trimester of pregnancy. In both cases, cesarean section was performed immediately upon diagnosis. One newborn underwent immediate orchiectomy with contralateral orchiopexy. Torsion was confirmed by pathological examination. The other was managed conservatively, just as the three newborns who were diagnosed immediately after birth. On follow-up scan, the affected testicle was found atrophied with lack of blood flow on color Doppler examina...

Research paper thumbnail of Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2011

The purpose of this study was to assess fertility performance and obstetric outcomes after treatm... more The purpose of this study was to assess fertility performance and obstetric outcomes after treatment of cesarean scar pregnancy. We conducted a retrospective study in a large tertiary hospital in Israel. The study included 18 women with a diagnosis of cesarean scar pregnancy between 2000 and 2009. The incidence of cesarean scar pregnancy among our parturient patients was 1 per 3000 for the general obstetric population and 1 per 531 among those with at least 1 cesarean delivery. Sixteen were treated primarily with methotrexate. Two were treated primarily by surgery, and 2 more were treated by surgery after failed methotrexate treatment. After cesarean scar pregnancy treatment, 7 women conceived spontaneously, and 1 conceived by in vitro fertilization-intracytoplasmic sperm injection. The remaining 10 (55%) did not wish to conceive again. Two of the women who became pregnant (25%) had recurrent cesarean scar pregnancy. This study shows encouraging results for fertility performance and...

Research paper thumbnail of Pelvic splenosis--a gynaecological challenge

Reproductive biomedicine online, 2009

Pelvic splenosis is a post-traumatic spleen autotransplantation, which can mimic various gynaecol... more Pelvic splenosis is a post-traumatic spleen autotransplantation, which can mimic various gynaecological diseases. A case of a 39-year-old woman, who underwent partial splenectomy because of a road accident in her childhood, currently presenting with abdominal pain and suspected corpus luteus torsion. Diagnostic laparoscopy was conducted which ruled out twisted ovary. This confirmed disseminated pelvic splenosis as a coincidental finding. Following this procedure, the abdominal pain ceased. The current report aims to raise the awareness of splenosis so that it may be appropriately recognized and differentiated from other pelvic findings.

Research paper thumbnail of Exceptional site of metastatic adenocarcinoma of the lung

The Israel Medical Association journal : IMAJ, 2007

Research paper thumbnail of Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis

Neurology, Jan 18, 2015

Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes gi... more Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA). Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen-positive slides were analyzed by PCR for VZV DNA. VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen-positive TAs. Despite formalin fixation, ...

Research paper thumbnail of Positive Surgical Margins With Renal Cell Carcinoma Have a Limited Influence on Long-term Oncological Outcomes of Nephron Sparing Surgery

Urology, 2010

To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with P... more To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Clinical records of 114 renal units who underwent open NSS for a renal mass between May 1995 and September 2005 were reviewed. PSMs were suspected on frozen section in 17 of 114 renal units (15%). Tumors with suspected PSMs at frozen section were smaller (2.9 +/- 1.6) in comparison to those with negative surgical margins (3.4 +/- 1.8 cm) (P = .001). Nine of 17 (53%) cases underwent total nephrectomy (5 immediately, 4 delayed). In 4 (24%), immediate re-excision of the renal crater was performed. A total of 4 (24%) that were followed up clinically were with no evidence of disease. Therefore, in 13 of 17 (77%) cases, the presence of tumor cells at the remaining side of the kidney could be evaluated histologically. In 2 cases from the immediate response group, tumor cells were found in the side opposite to the resection. There was no residual tumor in any case subjected to delayed nephrectomy. At median follow-up of 71 months, 15 of 17 patients are alive and with no evidence of disease. Two patients died because of unrelated causes. The overall 5-year survival rate is 98.2% and there is no cancer-specific mortality. The true PSM rate is in the range of 1.75%-5.26%. No disease progression or deaths attributable to renal cell carcinoma were associated with PSMs. Total nephrectomy should be avoided as a response to PSMs.

Research paper thumbnail of Sex, Age, and Surgeon Decision on Nephron-sparing Surgery Are Independent Predictors of Renal Masses With Benign Histologic Findings—A Multicenter Survey

Urology, 2010

To define the preoperative independent predictors indicating that renal mass has benign histologi... more To define the preoperative independent predictors indicating that renal mass has benign histologic features.

Research paper thumbnail of Minocycline ameliorates negative symptoms and cognitive deficits in early-phase schizophrenia: A double-blind, randomized placebo-controlled study

Schizophrenia Research, 2008

Background: Schizophrenia is characterized by negative symptoms and cognitive deficits related to... more Background: Schizophrenia is characterized by negative symptoms and cognitive deficits related to rehabilitation outcome and quality of life. Current antipsychotics have a limited effect on these core symptoms, encouraging the development of drugs specifically targeting negative symptoms and cognitive deficits. Minocycline is a second-generation tetracycline, which has a beneficial effect in various neurological disorders. Recent findings from animal models of schizophrenia and case reports of human patients point towards minocycline's potential for the treatment of schizophrenia. Methods: The current study examined the efficacy of minocycline as addon treatment for alleviating negative and cognitive symptoms in earlyphase schizophrenia. A double blind, randomized, placebo-controlled design was used. Consenting schizophrenia patients were randomly allocated to minocycline (n = 36) or placebo (n = 18) treatments. Subjects were followed-up for 6 months during which they underwent clinical and cognitive evaluations using a computerized assessment battery.

Research paper thumbnail of Pelvic splenosis – a gynaecological challenge

Reproductive BioMedicine Online, 2009

Ron Maymon received his MD degree in 1984 from Tel Aviv University, Israel. After completing his ... more Ron Maymon received his MD degree in 1984 from Tel Aviv University, Israel. After completing his OB-GYN residency in 1992, he joined the OB-GYN Ultrasound Unit where he is currently the director. After post-graduate training in UK in fetal medicine and reproductive epidemiology, he was among the pioneers in establishing first trimester screening in Israel. A major interest is the study of placental isoferritin (PLF), an immuno-regulatory protein secreted by the placenta, which is altered in Down's syndrome and other complicated pregnancies. In collaboration with Chaya Moroz and Eric Jauniaux this team has published novel studies on PLF during normal and affected pregnancies.

Research paper thumbnail of Fetal abnormalities leading to third trimester abortion: nine-year experience from a single medical center

Prenatal Diagnosis, 2009

To assess fetal abnormalities and events leading to third-trimester abortion. The study populatio... more To assess fetal abnormalities and events leading to third-trimester abortion. The study population included all parturient women with singleton pregnancy that underwent termination of pregnancy (TOP) in the third trimester in our institute because of fetal indications between 1998 and 2006. There were 777 cases of TOP due to fetal anomalies in our center during the study period, and 52 terminations were carried out in the third trimester. All cases of third-trimester abortions were due to severe malformations with high probability of perinatal death or severe handicap: 65.3% anomalies were structural, and 58.9% of them involved the central nervous system (CNS). Genetic indications included mostly genetic diseases, unlike aneupluidities in earlier terminations. Routine prenatal care raised suspicion of abnormalities in 22 (42.3%) cases, and diagnosis was established by additional tests. Abnormal findings were either missed in 4 (7.7%) cases or developed later in 11 (21.1%) cases. No routine prenatal screening was performed in the remaining 15 (28.8%) cases. Third-trimester abortion may be obviated by timely screening and scanning in some cases. The possibility of late TOP should be considered in malformations occurring late in pregnancy and in cases that require meticulous evaluation and follow-up from earlier stages of gestation.

Research paper thumbnail of Clinical, sonographic, and epidemiologic features of second- and early third-trimester spontaneous antepartum uterine rupture: a cohort study

Prenatal Diagnosis, 2008

To present prenatal findings and maternal and neonatal outcomes following second- and early third... more To present prenatal findings and maternal and neonatal outcomes following second- and early third-trimester spontaneous antepartum uterine rupture events in our institute. Charts of patients with full-thickness second- or early third-trimester symptomatic uterine ruptures locally treated between 1984 and 2007 were evaluated. There were seven events involving six women, all requiring emergency laparotomy, and cesarean section (CS). During the study period in our institute, there were 120 636 singleton deliveries (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =22 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation), including 5 of our cases, while in 2 cases, the rupture occurred earlier (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;22 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation). The rupture occurred after &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1 previous CSs in five cases. Six events were associated with abnormal placentation: placenta previa (n = 3), placenta percreta (n = 1), or both (n = 2). Other associated events included short, interpregnancy (IP) interval (n = 3) and past uterine rupture (n = 2). Pregnant women at gestational age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 22 weeks, who had the combination of placenta previa, and previous CS (n = 3), had a higher chance for spontaneous symptomatic antepartum uterine rupture when compared to women with placenta previa without a previous CS (OR 29.3, 95% CI 1.5-569.3, p = 0.007). There were no maternal deaths. Three of the five viable neonates survived. Spontaneous symptomatic second- or early third-trimester uterine rupture in nonlaboring women is a very rare, obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by awareness of risk factors, recognition of clinical signs and symptoms, and availability of ultrasound to assist in establishing diagnosis, and enabling prompt surgical intervention.

Research paper thumbnail of The Prevalence of Malignancy in Satellite Renal Lesions and its Surgical Implication During Nephron Sparing Surgery

The Journal of Urology, 2007

We examined the prevalence of malignancy in a synchronous ipsilateral renal lesion identified dur... more We examined the prevalence of malignancy in a synchronous ipsilateral renal lesion identified during partial nephrectomy and evaluated its clinical significance. Materials and Methods: We retrospectively reviewed the records of 112 patients (114 renal units) who underwent nephron sparing surgery for a clinically localized sporadic renal mass between May 1995 and September 2005. Results: In 37 patients (32%) an additional lesion was diagnosed and excised intraoperatively, while in 67% these lesions were known before the operation and believed to be simple cysts. During surgery the additional mass was suspicious in 8 cases and in the remainder the mass was described as simple cysts that were excised. The mean size of the primary mass was 3.1 cm (SD 1.4). In 29 (78%) cases the primary mass was malignant, in 23 (79%) of these the second mass was benign and in the remainder renal cell carcinoma was diagnosed. In 8 cases (22%) the primary mass was benign and in 2 (25%) the secondary mass was malignant. Overall 22% of all second masses were malignant, and all were low grade and low stage. We found that 7% of second ipsilateral masses could be expected to harbor malignancy. Conclusions: Based on our data it is questionable whether total nephrectomy is mandatory as an immediate response to an ipsilateral synchronous second renal mass. The present findings may represent an increased appreciation of ipsilateral multicentricity compared to historical data.

Research paper thumbnail of The Incidence of Large (>4 CM) Benign Renal Masses

The Journal of Urology, 2008

Research paper thumbnail of Characterizing excised breast masses in children and adolescents- can a more aggressive pathology be predicted?

Journal of Pediatric Surgery

Research paper thumbnail of Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge

The Journal of reproductive medicine

To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in rec... more To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in recent years and to compare it to tubal pregnancy. Seven women treated for primary ovarian pregnancy from 2002-2013 were retrospectively identified and compared to 42 women with tubal pregnancies (involving either tubal rupture or tubal abortion) operated on during the same period. In the ovarian pregnancy group the pathology examination confirmed primary ovarian pregnancy according to the Spiegelberg criteria. Seven women underwent surgery for primary ovarian pregnancy during the study period. Five women presented with hemodynamic shock. A ruptured ovarian pregnancy was identified in all cases. Wedge resection was performed by laparotomy in 1 case and by laparoscopy in 6 cases. The mean estimated blood loss was significantly higher in those women with ovarian versus tubal pregnancy (1057.1 ± 472.1 mL vs. 250.2 ± 241.5 mL, respectively, p<0.001). Moreover, a statistically significant dif...

Research paper thumbnail of Role of collagen type IV in the pathogenesis of increased prenasal thickness in Down syndrome fetuses: sonographic and immunohistological findings

Journal of perinatal medicine, Jan 3, 2016

The present study aims to compare the presence and localization of collagen type IV in the prenas... more The present study aims to compare the presence and localization of collagen type IV in the prenasal tissue of fetuses with and without Down syndrome (DS). Products of conception were obtained from mid-gestation uterine evacuations of 14 DS fetuses and 15 unaffected controls. Microdissection of the prenasal area and an analysis of the prenasal tissue specimens were performed by a single pathologist, blinded to the karyotype results. Immunohistological presence and localization of type IV collagen were analyzed in the basement membrane (BM), blood vessels, and stroma of the tissues. There were no statistically significant differences in the presence and localization of antibodies for collagen IV in the blood vessels and stroma between the two groups. However, the presence and localization of type IV collagen in the BM of the prenasal skin were significantly higher in DS specimens compared to the control group (P=0.023). When combining both groups altogether, a significant correlation ...

Research paper thumbnail of Primary Ovarian Pregnancy: 43 Years Experience in a Single Institute and still a Medical Challenge

The Israel Medical Association journal : IMAJ, 2015

Despite awareness regarding tubal pregnancy, ovarian pregnancy still remains a diagnostic challen... more Despite awareness regarding tubal pregnancy, ovarian pregnancy still remains a diagnostic challenge. The correct diagnosis is most frequently made intraoperatively and requires histopathologic confirmation. Therefore, additional diagnostic measurements are needed for earlier and more accurate detection of ovarian pregnancies which will allow more rapid and efficient treatment. To assess the time trends, clinical manifestations, surgical management and post-procedure outcome of 46 primary ovarian pregnancies in a single institution during three time periods. In this retrospective study we compared 20 patients with primary ovarian pregnancy during the years 1971- 1989 (first period), 19 patients in 1990-2001 (second period) and 7 patients in 2002-2013 (third period). In all cases the pathology examination confirmed primary ovarian pregnancy. The number of tubal ectopic pregnancies almost doubled, from 637 in the first period to 1279 in the third period (P < 0.001). However, there w...

Research paper thumbnail of Efficacy of amphotericin B or amphotericin Beintralipid in combination with caspofungin against experimental aspergillosis

J Infection, 2006

Infections caused by Aspergillus species are increasing in importance, especially among immunocom... more Infections caused by Aspergillus species are increasing in importance, especially among immunocompromised hosts. The objective of this study was to evaluate the efficacy of combination treatment consisting of the polyene amphotericin B (AMB) or amphotericin B–intralipid admixture (AMB–IL) and the echinocandin caspofungin (CAS) in experimental murine systemic aspergillosis. Inhibition of synthesis of a major component of the fungal cell wall and an effect on the cell membrane, by combining echinocandin and a polyene, may result in a synergistic interaction in vitro and in vivo against Aspergillus fumigatus.ICR mice were immunosuppressed by intraperitoneal (ip) administration of cyclophosphamide (CY). Three days post-CY administration the mice were inoculated intravenously (iv) with A. fumigatus conidia. Infection and treatment were evaluated during an observation period of 30 days in terms of mortality (survival rate and mean survival time) and morbidity (quantitative determination of fungal burden, histopathology, and detection of serum galactomannan).The data showed that combined CAS and AMB or AMB–IL treatment increased the survival of the mice (up to 69.2%) as compared to those treated with each agent alone (44.4, 40.7 and 50%, respectively), and prolonged their mean survival time to 22.5 days. These combinations also resulted in reduction of fungal burden in organs, and decrease in serum galactomannan.The successful results obtained in the experimental animal model of this study may possibly open the way to more effective management of aspergillosis in humans.

Research paper thumbnail of Campylobacter coli infection causing second trimester intrauterine growth restriction (IUGR): a case report and review of the literature

Prenatal Diagnosis, 2015

Campylobacter is a gram-negative, microaerophilic, curved rod and a normal resident of the gastro... more Campylobacter is a gram-negative, microaerophilic, curved rod and a normal resident of the gastrointestinal flora and may be the cause of disease in animals. Transmission to humans occurs by ingestion of contaminated food or by direct contact with infected animals. In the past few decades, an increasing number of reports have implicated the presence of this organism in human abortions as well. An infectious mechanism due to primary placental inflammatory damage followed by secondary damage to the fetus following placental insufficiency and ischemia was suggested. The most common species of Campylobacter are Campylobacter jejuni and Campylobacter coli, which are classically associated with enteritis in humans. We present a rare case of mid-gestation intrauterine growth restriction (IUGR) associated with maternal bacteremia caused by C. coli infection. Our literature review focuses on Campylobacter infections occurring in the second and third trimesters of pregnancy. In all cases, mild maternal symptoms consisting of fever and weakness were presented. However, associated adverse fetal outcome, including abortions, IUGR or preterm labor may occur more frequently than anticipated. Our report strengthens the importance of awareness to this finding and focuses the need to consume properly cooked meat during pregnancy. © 2015 John Wiley &amp;amp;amp;amp;amp;amp;amp; Sons, Ltd.

Research paper thumbnail of Analysis of Varicella-Zoster Virus in Temporal Arteries Biopsy Positive and Negative for Giant Cell Arteritis

JAMA Neurology, 2015

Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly individuals. Diagnos... more Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly individuals. Diagnosis is confirmed by temporal artery (TA) biopsy, although biopsy results are often negative. Despite the use of corticosteroids, disease may progress. Identification of causal agents will improve outcomes. Biopsy-positive GCA is associated with TA infection by varicella-zoster virus (VZV). To analyze VZV infection in TAs of patients with clinically suspected GCA whose TAs were histopathologically negative and in normal TAs removed post mortem from age-matched individuals. A cross-sectional study for VZV antigen was performed from January 2013 to March 2015 using archived, deidentified, formalin-fixed, paraffin-embedded GCA-negative, GCA-positive, and normal TAs (50 sections/TA) collected during the past 30 years. Regions adjacent to those containing VZV were examined by hematoxylin-eosin staining. Immunohistochemistry identified inflammatory cells and cell types around nerve bundles containing VZV. A combination of 17 tertiary referral centers and private practices worldwide contributed archived TAs from individuals older than 50 years. Presence and distribution of VZV antigen in TAs and histopathological changes in sections adjacent to those containing VZV were confirmed by 2 independent readers. Varicella-zoster virus antigen was found in 45 of 70 GCA-negative TAs (64%), compared with 11 of 49 normal TAs (22%) (relative risk [RR] = 2.86; 95% CI, 1.75-5.31; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Extension of our earlier study revealed VZV antigen in 68 of 93 GCA-positive TAs (73%), compared with 11 of 49 normal TAs (22%) (RR = 3.26; 95% CI, 2.03-5.98; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Compared with normal TAs, VZV antigen was more likely to be present in the adventitia of both GCA-negative TAs (RR = 2.43; 95% CI, 1.82-3.41; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and GCA-positive TAs (RR = 2.03; 95% CI, 1.52-2.86; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Varicella-zoster virus antigen was frequently found in perineurial cells expressing claudin-1 around nerve bundles. Of 45 GCA-negative participants whose TAs contained VZV antigen, 1 had histopathological features characteristic of GCA, and 16 (36%) showed adventitial inflammation adjacent to viral antigen; no inflammation was seen in normal TAs. In patients with clinically suspected GCA, prevalence of VZV in their TAs is similar independent of whether biopsy results are negative or positive pathologically. Antiviral treatment may confer additional benefit to patients with biopsy-negative GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.

Research paper thumbnail of Fetal diagnosis of testicular torsion: what shall we tell the parents?

Prenatal diagnosis, 2015

The objectives of this study are to present our collective experience with the prenatal diagnosis... more The objectives of this study are to present our collective experience with the prenatal diagnosis of testicular torsion and to propose a possible prenatal management scheme. We retrospectively collected and reviewed all medical records of cases that were diagnosed with perinatal testicular torsion in our medical center between the years 2002 and 2013. Prenatal torsion was categorized as torsion diagnosed in utero or on immediate newborn examination. A total of five unilateral prenatal torsions were diagnosed. Two fetuses were diagnosed in the third trimester of pregnancy. In both cases, cesarean section was performed immediately upon diagnosis. One newborn underwent immediate orchiectomy with contralateral orchiopexy. Torsion was confirmed by pathological examination. The other was managed conservatively, just as the three newborns who were diagnosed immediately after birth. On follow-up scan, the affected testicle was found atrophied with lack of blood flow on color Doppler examina...

Research paper thumbnail of Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2011

The purpose of this study was to assess fertility performance and obstetric outcomes after treatm... more The purpose of this study was to assess fertility performance and obstetric outcomes after treatment of cesarean scar pregnancy. We conducted a retrospective study in a large tertiary hospital in Israel. The study included 18 women with a diagnosis of cesarean scar pregnancy between 2000 and 2009. The incidence of cesarean scar pregnancy among our parturient patients was 1 per 3000 for the general obstetric population and 1 per 531 among those with at least 1 cesarean delivery. Sixteen were treated primarily with methotrexate. Two were treated primarily by surgery, and 2 more were treated by surgery after failed methotrexate treatment. After cesarean scar pregnancy treatment, 7 women conceived spontaneously, and 1 conceived by in vitro fertilization-intracytoplasmic sperm injection. The remaining 10 (55%) did not wish to conceive again. Two of the women who became pregnant (25%) had recurrent cesarean scar pregnancy. This study shows encouraging results for fertility performance and...

Research paper thumbnail of Pelvic splenosis--a gynaecological challenge

Reproductive biomedicine online, 2009

Pelvic splenosis is a post-traumatic spleen autotransplantation, which can mimic various gynaecol... more Pelvic splenosis is a post-traumatic spleen autotransplantation, which can mimic various gynaecological diseases. A case of a 39-year-old woman, who underwent partial splenectomy because of a road accident in her childhood, currently presenting with abdominal pain and suspected corpus luteus torsion. Diagnostic laparoscopy was conducted which ruled out twisted ovary. This confirmed disseminated pelvic splenosis as a coincidental finding. Following this procedure, the abdominal pain ceased. The current report aims to raise the awareness of splenosis so that it may be appropriately recognized and differentiated from other pelvic findings.

Research paper thumbnail of Exceptional site of metastatic adenocarcinoma of the lung

The Israel Medical Association journal : IMAJ, 2007

Research paper thumbnail of Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis

Neurology, Jan 18, 2015

Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes gi... more Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA). Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen-positive slides were analyzed by PCR for VZV DNA. VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen-positive TAs. Despite formalin fixation, ...

Research paper thumbnail of Positive Surgical Margins With Renal Cell Carcinoma Have a Limited Influence on Long-term Oncological Outcomes of Nephron Sparing Surgery

Urology, 2010

To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with P... more To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Clinical records of 114 renal units who underwent open NSS for a renal mass between May 1995 and September 2005 were reviewed. PSMs were suspected on frozen section in 17 of 114 renal units (15%). Tumors with suspected PSMs at frozen section were smaller (2.9 +/- 1.6) in comparison to those with negative surgical margins (3.4 +/- 1.8 cm) (P = .001). Nine of 17 (53%) cases underwent total nephrectomy (5 immediately, 4 delayed). In 4 (24%), immediate re-excision of the renal crater was performed. A total of 4 (24%) that were followed up clinically were with no evidence of disease. Therefore, in 13 of 17 (77%) cases, the presence of tumor cells at the remaining side of the kidney could be evaluated histologically. In 2 cases from the immediate response group, tumor cells were found in the side opposite to the resection. There was no residual tumor in any case subjected to delayed nephrectomy. At median follow-up of 71 months, 15 of 17 patients are alive and with no evidence of disease. Two patients died because of unrelated causes. The overall 5-year survival rate is 98.2% and there is no cancer-specific mortality. The true PSM rate is in the range of 1.75%-5.26%. No disease progression or deaths attributable to renal cell carcinoma were associated with PSMs. Total nephrectomy should be avoided as a response to PSMs.

Research paper thumbnail of Sex, Age, and Surgeon Decision on Nephron-sparing Surgery Are Independent Predictors of Renal Masses With Benign Histologic Findings—A Multicenter Survey

Urology, 2010

To define the preoperative independent predictors indicating that renal mass has benign histologi... more To define the preoperative independent predictors indicating that renal mass has benign histologic features.

Research paper thumbnail of Minocycline ameliorates negative symptoms and cognitive deficits in early-phase schizophrenia: A double-blind, randomized placebo-controlled study

Schizophrenia Research, 2008

Background: Schizophrenia is characterized by negative symptoms and cognitive deficits related to... more Background: Schizophrenia is characterized by negative symptoms and cognitive deficits related to rehabilitation outcome and quality of life. Current antipsychotics have a limited effect on these core symptoms, encouraging the development of drugs specifically targeting negative symptoms and cognitive deficits. Minocycline is a second-generation tetracycline, which has a beneficial effect in various neurological disorders. Recent findings from animal models of schizophrenia and case reports of human patients point towards minocycline's potential for the treatment of schizophrenia. Methods: The current study examined the efficacy of minocycline as addon treatment for alleviating negative and cognitive symptoms in earlyphase schizophrenia. A double blind, randomized, placebo-controlled design was used. Consenting schizophrenia patients were randomly allocated to minocycline (n = 36) or placebo (n = 18) treatments. Subjects were followed-up for 6 months during which they underwent clinical and cognitive evaluations using a computerized assessment battery.

Research paper thumbnail of Pelvic splenosis – a gynaecological challenge

Reproductive BioMedicine Online, 2009

Ron Maymon received his MD degree in 1984 from Tel Aviv University, Israel. After completing his ... more Ron Maymon received his MD degree in 1984 from Tel Aviv University, Israel. After completing his OB-GYN residency in 1992, he joined the OB-GYN Ultrasound Unit where he is currently the director. After post-graduate training in UK in fetal medicine and reproductive epidemiology, he was among the pioneers in establishing first trimester screening in Israel. A major interest is the study of placental isoferritin (PLF), an immuno-regulatory protein secreted by the placenta, which is altered in Down's syndrome and other complicated pregnancies. In collaboration with Chaya Moroz and Eric Jauniaux this team has published novel studies on PLF during normal and affected pregnancies.

Research paper thumbnail of Fetal abnormalities leading to third trimester abortion: nine-year experience from a single medical center

Prenatal Diagnosis, 2009

To assess fetal abnormalities and events leading to third-trimester abortion. The study populatio... more To assess fetal abnormalities and events leading to third-trimester abortion. The study population included all parturient women with singleton pregnancy that underwent termination of pregnancy (TOP) in the third trimester in our institute because of fetal indications between 1998 and 2006. There were 777 cases of TOP due to fetal anomalies in our center during the study period, and 52 terminations were carried out in the third trimester. All cases of third-trimester abortions were due to severe malformations with high probability of perinatal death or severe handicap: 65.3% anomalies were structural, and 58.9% of them involved the central nervous system (CNS). Genetic indications included mostly genetic diseases, unlike aneupluidities in earlier terminations. Routine prenatal care raised suspicion of abnormalities in 22 (42.3%) cases, and diagnosis was established by additional tests. Abnormal findings were either missed in 4 (7.7%) cases or developed later in 11 (21.1%) cases. No routine prenatal screening was performed in the remaining 15 (28.8%) cases. Third-trimester abortion may be obviated by timely screening and scanning in some cases. The possibility of late TOP should be considered in malformations occurring late in pregnancy and in cases that require meticulous evaluation and follow-up from earlier stages of gestation.

Research paper thumbnail of Clinical, sonographic, and epidemiologic features of second- and early third-trimester spontaneous antepartum uterine rupture: a cohort study

Prenatal Diagnosis, 2008

To present prenatal findings and maternal and neonatal outcomes following second- and early third... more To present prenatal findings and maternal and neonatal outcomes following second- and early third-trimester spontaneous antepartum uterine rupture events in our institute. Charts of patients with full-thickness second- or early third-trimester symptomatic uterine ruptures locally treated between 1984 and 2007 were evaluated. There were seven events involving six women, all requiring emergency laparotomy, and cesarean section (CS). During the study period in our institute, there were 120 636 singleton deliveries (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =22 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation), including 5 of our cases, while in 2 cases, the rupture occurred earlier (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;22 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation). The rupture occurred after &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1 previous CSs in five cases. Six events were associated with abnormal placentation: placenta previa (n = 3), placenta percreta (n = 1), or both (n = 2). Other associated events included short, interpregnancy (IP) interval (n = 3) and past uterine rupture (n = 2). Pregnant women at gestational age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 22 weeks, who had the combination of placenta previa, and previous CS (n = 3), had a higher chance for spontaneous symptomatic antepartum uterine rupture when compared to women with placenta previa without a previous CS (OR 29.3, 95% CI 1.5-569.3, p = 0.007). There were no maternal deaths. Three of the five viable neonates survived. Spontaneous symptomatic second- or early third-trimester uterine rupture in nonlaboring women is a very rare, obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by awareness of risk factors, recognition of clinical signs and symptoms, and availability of ultrasound to assist in establishing diagnosis, and enabling prompt surgical intervention.

Research paper thumbnail of The Prevalence of Malignancy in Satellite Renal Lesions and its Surgical Implication During Nephron Sparing Surgery

The Journal of Urology, 2007

We examined the prevalence of malignancy in a synchronous ipsilateral renal lesion identified dur... more We examined the prevalence of malignancy in a synchronous ipsilateral renal lesion identified during partial nephrectomy and evaluated its clinical significance. Materials and Methods: We retrospectively reviewed the records of 112 patients (114 renal units) who underwent nephron sparing surgery for a clinically localized sporadic renal mass between May 1995 and September 2005. Results: In 37 patients (32%) an additional lesion was diagnosed and excised intraoperatively, while in 67% these lesions were known before the operation and believed to be simple cysts. During surgery the additional mass was suspicious in 8 cases and in the remainder the mass was described as simple cysts that were excised. The mean size of the primary mass was 3.1 cm (SD 1.4). In 29 (78%) cases the primary mass was malignant, in 23 (79%) of these the second mass was benign and in the remainder renal cell carcinoma was diagnosed. In 8 cases (22%) the primary mass was benign and in 2 (25%) the secondary mass was malignant. Overall 22% of all second masses were malignant, and all were low grade and low stage. We found that 7% of second ipsilateral masses could be expected to harbor malignancy. Conclusions: Based on our data it is questionable whether total nephrectomy is mandatory as an immediate response to an ipsilateral synchronous second renal mass. The present findings may represent an increased appreciation of ipsilateral multicentricity compared to historical data.

Research paper thumbnail of The Incidence of Large (>4 CM) Benign Renal Masses

The Journal of Urology, 2008