Reuven Kedar | Technion Israel Institute of Technology (original) (raw)
Papers by Reuven Kedar
Journal of Perinatal Medicine, Dec 14, 2023
Sleep, Oct 1, 1999
SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has... more SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has the serious morbidity and excess mortality associated with these disorders. Estimations of the Obstructive Sleep Apnea Syndrome's (OSA) prevalence vary considerably as do its definitive criteria; however it is clear that this condition is very widespread. 1,2 It is well recognized as a major cause of morbidity with a particularly strong association with hypertension, reduced longevity, and as a contributing factor in automotive and industrial accidents. 3-5 Aside from OSAS which, as its name suggests, involves frank cessations in breathing in sleep, an allied condition, the Upper Airway Resistance Syndrome (UARS) has been more recently described. 6 In UARS frequent apneas and hypopneas do not actually occur, but the condition nevertheless results in frequent arousals and sleep fragmentation. UARS could also cause similar cardiac sequelae as OSAS, perhaps due to high levels of airways resistance. 6 The diagnosis of UARS is much more difficult due to the condition's more subtle symptomatology. 6 Upper airway patency during inspiration depends largely on the interaction between UAW anatomical and mechanical factors, on the one hand, and the forces exerted by the UAW dilating muscles that support its walls on the other. 7-9 Methods for determining the presence and severity of OSA have been directed at the combination of standard polysomnographic measurements, and measurements of the respiratory aspects of the disorder, which include monitoring of airflow at nose and mouth, and respiratory movements of the thorax and abdomen by noninvasive means. Apart from the disadvantage of being limited to the sleep laboratory, the traditional approach is likely to underestimate hypopneas and particularly UARS since respiratory parameters are not sufficiently sensitive. 10 Attempting to evaluate OSAS by monitoring blood oxygen saturation using pulse oximetry is liable to result in low specificity since minor variations in SaO 2 accompanying hypopneas and UARS may be missed. 11 A precise but not necessarily accurate way of evaluating UAW obstruction is by the invasive measurement of resistance based on the measurement of the pressure difference between two points within the airway system, together with
Ultrasound in Obstetrics & Gynecology, Sep 21, 2007
Conclusion: Transvaginal ultrasound evaluation of the bladder structures seems to be a promising ... more Conclusion: Transvaginal ultrasound evaluation of the bladder structures seems to be a promising new diagnostic tool in both the urinary incontinence and pelvic floor disorders.
International Journal of Gynecologic Cancer, Sep 1, 2004
American Journal of Obstetrics and Gynecology, 2023
International journal of gynaecology and obstetrics, Dec 13, 2022
ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinate... more ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinated and –unvaccinated pregnant women.MethodRetrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID‐19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery <35 weeks of gestation, intrauterine fetal death >23 weeks of gestation, intrauterine growth restriction defined as birth weight < 10th percentile, 5‐min APGAR score ≤ 7, and neonatal care unit admission.ResultsThe authors found no effect of the COVID‐19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (P = 0.080). The observed proportion difference (unvaccinated minus vaccinated) was 0.024. In the equivalence analysis with a margin of 0.05, the 90% confidence interval (0.01–0.05) was entirely within the equivalence zone (−0.05 to 0.05) with a P value of 0.032.ConclusionThe present study demonstrated an equivalent rate of adverse perinatal outcomes among vaccinated and unvaccinated women, thus supporting vaccine safety during the second and third trimesters of pregnancy. The authors believe this information is useful in counseling pregnant women regarding COVID‐19 vaccination during pregnancy.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2018
Electronic poster abstracts with chemotherapy was offered. Five months after the diagnosis, the p... more Electronic poster abstracts with chemotherapy was offered. Five months after the diagnosis, the patient died. These cases bring up the discussion on requesting ultrasound as screening of endometrial carcinoma. EP18.02 Diffuse pelvic actinomycosis mimicking advanced stage cervical carcinoma: a case report
Ultrasound in Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
International Journal of Gynecology & Obstetrics
ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinate... more ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinated and –unvaccinated pregnant women.MethodRetrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID‐19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery <35 weeks of gestation, intrauterine fetal death >23 weeks of gestation, intrauterine growth restriction defined as birth weight < 10th percentile, 5‐min APGAR score ≤ 7, and neonatal care unit admission.ResultsThe authors found no effect of the COVID‐19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (P = 0.080). The observed proportion difference (unvaccinated minus ...
Sleep, 1999
SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has... more SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has the serious morbidity and excess mortality associated with these disorders. Estimations of the Obstructive Sleep Apnea Syndrome's (OSA) prevalence vary considerably as do its definitive criteria; however it is clear that this condition is very widespread. 1,2 It is well recognized as a major cause of morbidity with a particularly strong association with hypertension, reduced longevity, and as a contributing factor in automotive and industrial accidents. 3-5 Aside from OSAS which, as its name suggests, involves frank cessations in breathing in sleep, an allied condition, the Upper Airway Resistance Syndrome (UARS) has been more recently described. 6 In UARS frequent apneas and hypopneas do not actually occur, but the condition nevertheless results in frequent arousals and sleep fragmentation. UARS could also cause similar cardiac sequelae as OSAS, perhaps due to high levels of airways resistance. 6 The diagnosis of UARS is much more difficult due to the condition's more subtle symptomatology. 6 Upper airway patency during inspiration depends largely on the interaction between UAW anatomical and mechanical factors, on the one hand, and the forces exerted by the UAW dilating muscles that support its walls on the other. 7-9 Methods for determining the presence and severity of OSA have been directed at the combination of standard polysomnographic measurements, and measurements of the respiratory aspects of the disorder, which include monitoring of airflow at nose and mouth, and respiratory movements of the thorax and abdomen by noninvasive means. Apart from the disadvantage of being limited to the sleep laboratory, the traditional approach is likely to underestimate hypopneas and particularly UARS since respiratory parameters are not sufficiently sensitive. 10 Attempting to evaluate OSAS by monitoring blood oxygen saturation using pulse oximetry is liable to result in low specificity since minor variations in SaO 2 accompanying hypopneas and UARS may be missed. 11 A precise but not necessarily accurate way of evaluating UAW obstruction is by the invasive measurement of resistance based on the measurement of the pressure difference between two points within the airway system, together with
Obstetrics & Gynecology, 2003
BACKGROUND: Vaginal evisceration can take place many years after vaginal surgery.
Ultrasound in Obstetrics & Gynecology, 2018
The novel molecular endometrial cancer classifier, ProMisE, provides independent prognostic infor... more The novel molecular endometrial cancer classifier, ProMisE, provides independent prognostic information beyond established clinicopathologic risk factors. The aim of this study was to correlate the ProMisE sub groups to sonographic findings and to correlate preoperative clinical, sonographic, and molecular variables to the risk of recurrence/progression. Methods: We prospectively included 340 women with endometrial cancer undergoing expert ultrasound (US) assessment according to the IETA. All women underwent hysterectomy and were followed-up for at least 26 months. Tumours were graded and staged according to FIGO, and ProMisE (MSI, POLE, p53 abn, p53wt). Univariable and multivariable Cox-regression analysis was used to correlate preoperative parameters to recurrence/progression. Results: Women were followed for in mean 38.3 months (SD 36.8-39.9). Stage A was found in 60%, ≥ IB in 40%. MSI was found in 35%, POLE 9%, p53abn 12%, and p53wt 44%. Recurrence/progression occurred in 13% (among p53abn in 38%, MSI 13%, POLE 13%, p53wt 6%). p53 abn tumours often had uniform echogenicity (60%), colour score 3-4 (78%), and larger tumour AP diameter (p=0.004) compared to other tumours. Preoperative parameters associated with recurrence/progression were age >65 years (OR 2.9, 95%CI 1.4-6.1), waist circumference (WC) > 88cm (OR 2.6, 95%CI 1.2-5.5), p53abn (OR 4.6, 95%CI 2.5-7.7), and deep myometrial/cervical stromal invasion (OR 4.1, 95%CI 2.2-7.7), or tumour AP diameter > 2 cm (OR 7.5, 95%CI 3.3-17.0), according to US. Age > 65, WC > 88cm, tumour AP diameter > 2 cm, and p53 abn remained significant in multivariable analysis. Conclusions: The p53abn subgroup was associated with the highest risk of recurrence/progression. Most p53 abn tumours had a uniform echogenicity, colour score 3-4, and they were significantly larger than other molecular subtypes. In multivariable analysis age, waist circumference, tumour AP diameter and p53 abn tumour type remained important predictors for recurrence/progression. OC08.05 * The efficacy of preoperative ultrasound in detecting uterine sarcoma prior to myomectomy
American Journal of Obstetrics and Gynecology, 2022
, where 49 patients tested positive for SARS-CoV-2 and 49 tested negative via a SARS-CoV-2 PCR te... more , where 49 patients tested positive for SARS-CoV-2 and 49 tested negative via a SARS-CoV-2 PCR test. Controls were matched by age and gestational age and selected sequentially. Placentologists were blinded to SARS-CoV-2 status. Placentas were graded using a placental hypoperfusion composite (PHC) score based on findings of placental hypoperfusion (i.e accelerated villous maturation, distal villous hypoplasia, syncytiotrophoblastic knots, decidual arteriopathy, intervillous fibrin, pseudocyst and decidual necrosis). Significance was defined by p < 0.05 level. Analyses were performed using SAS version 9.4. RESULTS: There were no statistically significant differences in age, race, BMI, mode of delivery, or neonatal outcomes. The median PHC score was 2 and differed significantly between the two groups (p < 0.0001) (table 1). The median score among those who tested negative was significantly lower than those who tested positive (1 vs 3, respectively). A linear regression with square root transformation of PHC score was done to determine the magnitude of the relationship between the score and SARS-CoV-2 status, while adjusting for other covariates. After performing the square root transformation and adjusting for other covariates, the association between PHC score and SARS-CoV-2 PCR test result remained statistically significant (p < 0.0001) (table 2). After adjusting for predetermined covariates, the expected value of the square root of placental hypoperfusion score increased by 0.86 units (95% CI: 0.47, 1.26). CONCLUSION: There is evidence of placental hypoperfusion in placentas from SARS-CoV-2 infected women with no differences in neonatal outcomes. These observations may provide insight into the pathologic effects of SARS-CoV-2 on placentation.
International Journal of Gynecology & Obstetrics
Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
European Journal of Obstetrics & Gynecology and Reproductive Biology
Journal of Perinatal Medicine, Dec 14, 2023
Sleep, Oct 1, 1999
SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has... more SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has the serious morbidity and excess mortality associated with these disorders. Estimations of the Obstructive Sleep Apnea Syndrome's (OSA) prevalence vary considerably as do its definitive criteria; however it is clear that this condition is very widespread. 1,2 It is well recognized as a major cause of morbidity with a particularly strong association with hypertension, reduced longevity, and as a contributing factor in automotive and industrial accidents. 3-5 Aside from OSAS which, as its name suggests, involves frank cessations in breathing in sleep, an allied condition, the Upper Airway Resistance Syndrome (UARS) has been more recently described. 6 In UARS frequent apneas and hypopneas do not actually occur, but the condition nevertheless results in frequent arousals and sleep fragmentation. UARS could also cause similar cardiac sequelae as OSAS, perhaps due to high levels of airways resistance. 6 The diagnosis of UARS is much more difficult due to the condition's more subtle symptomatology. 6 Upper airway patency during inspiration depends largely on the interaction between UAW anatomical and mechanical factors, on the one hand, and the forces exerted by the UAW dilating muscles that support its walls on the other. 7-9 Methods for determining the presence and severity of OSA have been directed at the combination of standard polysomnographic measurements, and measurements of the respiratory aspects of the disorder, which include monitoring of airflow at nose and mouth, and respiratory movements of the thorax and abdomen by noninvasive means. Apart from the disadvantage of being limited to the sleep laboratory, the traditional approach is likely to underestimate hypopneas and particularly UARS since respiratory parameters are not sufficiently sensitive. 10 Attempting to evaluate OSAS by monitoring blood oxygen saturation using pulse oximetry is liable to result in low specificity since minor variations in SaO 2 accompanying hypopneas and UARS may be missed. 11 A precise but not necessarily accurate way of evaluating UAW obstruction is by the invasive measurement of resistance based on the measurement of the pressure difference between two points within the airway system, together with
Ultrasound in Obstetrics & Gynecology, Sep 21, 2007
Conclusion: Transvaginal ultrasound evaluation of the bladder structures seems to be a promising ... more Conclusion: Transvaginal ultrasound evaluation of the bladder structures seems to be a promising new diagnostic tool in both the urinary incontinence and pelvic floor disorders.
International Journal of Gynecologic Cancer, Sep 1, 2004
American Journal of Obstetrics and Gynecology, 2023
International journal of gynaecology and obstetrics, Dec 13, 2022
ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinate... more ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinated and –unvaccinated pregnant women.MethodRetrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID‐19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery <35 weeks of gestation, intrauterine fetal death >23 weeks of gestation, intrauterine growth restriction defined as birth weight < 10th percentile, 5‐min APGAR score ≤ 7, and neonatal care unit admission.ResultsThe authors found no effect of the COVID‐19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (P = 0.080). The observed proportion difference (unvaccinated minus vaccinated) was 0.024. In the equivalence analysis with a margin of 0.05, the 90% confidence interval (0.01–0.05) was entirely within the equivalence zone (−0.05 to 0.05) with a P value of 0.032.ConclusionThe present study demonstrated an equivalent rate of adverse perinatal outcomes among vaccinated and unvaccinated women, thus supporting vaccine safety during the second and third trimesters of pregnancy. The authors believe this information is useful in counseling pregnant women regarding COVID‐19 vaccination during pregnancy.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2018
Electronic poster abstracts with chemotherapy was offered. Five months after the diagnosis, the p... more Electronic poster abstracts with chemotherapy was offered. Five months after the diagnosis, the patient died. These cases bring up the discussion on requesting ultrasound as screening of endometrial carcinoma. EP18.02 Diffuse pelvic actinomycosis mimicking advanced stage cervical carcinoma: a case report
Ultrasound in Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
International Journal of Gynecology & Obstetrics
ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinate... more ObjectiveTo compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinated and –unvaccinated pregnant women.MethodRetrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID‐19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery <35 weeks of gestation, intrauterine fetal death >23 weeks of gestation, intrauterine growth restriction defined as birth weight < 10th percentile, 5‐min APGAR score ≤ 7, and neonatal care unit admission.ResultsThe authors found no effect of the COVID‐19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (P = 0.080). The observed proportion difference (unvaccinated minus ...
Sleep, 1999
SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has... more SLEEP-RELATED BREATHING DISORDERS HAVE COME TO BE INCREASINGLY RECOGNIZED IN RECENT YEARS, as has the serious morbidity and excess mortality associated with these disorders. Estimations of the Obstructive Sleep Apnea Syndrome's (OSA) prevalence vary considerably as do its definitive criteria; however it is clear that this condition is very widespread. 1,2 It is well recognized as a major cause of morbidity with a particularly strong association with hypertension, reduced longevity, and as a contributing factor in automotive and industrial accidents. 3-5 Aside from OSAS which, as its name suggests, involves frank cessations in breathing in sleep, an allied condition, the Upper Airway Resistance Syndrome (UARS) has been more recently described. 6 In UARS frequent apneas and hypopneas do not actually occur, but the condition nevertheless results in frequent arousals and sleep fragmentation. UARS could also cause similar cardiac sequelae as OSAS, perhaps due to high levels of airways resistance. 6 The diagnosis of UARS is much more difficult due to the condition's more subtle symptomatology. 6 Upper airway patency during inspiration depends largely on the interaction between UAW anatomical and mechanical factors, on the one hand, and the forces exerted by the UAW dilating muscles that support its walls on the other. 7-9 Methods for determining the presence and severity of OSA have been directed at the combination of standard polysomnographic measurements, and measurements of the respiratory aspects of the disorder, which include monitoring of airflow at nose and mouth, and respiratory movements of the thorax and abdomen by noninvasive means. Apart from the disadvantage of being limited to the sleep laboratory, the traditional approach is likely to underestimate hypopneas and particularly UARS since respiratory parameters are not sufficiently sensitive. 10 Attempting to evaluate OSAS by monitoring blood oxygen saturation using pulse oximetry is liable to result in low specificity since minor variations in SaO 2 accompanying hypopneas and UARS may be missed. 11 A precise but not necessarily accurate way of evaluating UAW obstruction is by the invasive measurement of resistance based on the measurement of the pressure difference between two points within the airway system, together with
Obstetrics & Gynecology, 2003
BACKGROUND: Vaginal evisceration can take place many years after vaginal surgery.
Ultrasound in Obstetrics & Gynecology, 2018
The novel molecular endometrial cancer classifier, ProMisE, provides independent prognostic infor... more The novel molecular endometrial cancer classifier, ProMisE, provides independent prognostic information beyond established clinicopathologic risk factors. The aim of this study was to correlate the ProMisE sub groups to sonographic findings and to correlate preoperative clinical, sonographic, and molecular variables to the risk of recurrence/progression. Methods: We prospectively included 340 women with endometrial cancer undergoing expert ultrasound (US) assessment according to the IETA. All women underwent hysterectomy and were followed-up for at least 26 months. Tumours were graded and staged according to FIGO, and ProMisE (MSI, POLE, p53 abn, p53wt). Univariable and multivariable Cox-regression analysis was used to correlate preoperative parameters to recurrence/progression. Results: Women were followed for in mean 38.3 months (SD 36.8-39.9). Stage A was found in 60%, ≥ IB in 40%. MSI was found in 35%, POLE 9%, p53abn 12%, and p53wt 44%. Recurrence/progression occurred in 13% (among p53abn in 38%, MSI 13%, POLE 13%, p53wt 6%). p53 abn tumours often had uniform echogenicity (60%), colour score 3-4 (78%), and larger tumour AP diameter (p=0.004) compared to other tumours. Preoperative parameters associated with recurrence/progression were age >65 years (OR 2.9, 95%CI 1.4-6.1), waist circumference (WC) > 88cm (OR 2.6, 95%CI 1.2-5.5), p53abn (OR 4.6, 95%CI 2.5-7.7), and deep myometrial/cervical stromal invasion (OR 4.1, 95%CI 2.2-7.7), or tumour AP diameter > 2 cm (OR 7.5, 95%CI 3.3-17.0), according to US. Age > 65, WC > 88cm, tumour AP diameter > 2 cm, and p53 abn remained significant in multivariable analysis. Conclusions: The p53abn subgroup was associated with the highest risk of recurrence/progression. Most p53 abn tumours had a uniform echogenicity, colour score 3-4, and they were significantly larger than other molecular subtypes. In multivariable analysis age, waist circumference, tumour AP diameter and p53 abn tumour type remained important predictors for recurrence/progression. OC08.05 * The efficacy of preoperative ultrasound in detecting uterine sarcoma prior to myomectomy
American Journal of Obstetrics and Gynecology, 2022
, where 49 patients tested positive for SARS-CoV-2 and 49 tested negative via a SARS-CoV-2 PCR te... more , where 49 patients tested positive for SARS-CoV-2 and 49 tested negative via a SARS-CoV-2 PCR test. Controls were matched by age and gestational age and selected sequentially. Placentologists were blinded to SARS-CoV-2 status. Placentas were graded using a placental hypoperfusion composite (PHC) score based on findings of placental hypoperfusion (i.e accelerated villous maturation, distal villous hypoplasia, syncytiotrophoblastic knots, decidual arteriopathy, intervillous fibrin, pseudocyst and decidual necrosis). Significance was defined by p < 0.05 level. Analyses were performed using SAS version 9.4. RESULTS: There were no statistically significant differences in age, race, BMI, mode of delivery, or neonatal outcomes. The median PHC score was 2 and differed significantly between the two groups (p < 0.0001) (table 1). The median score among those who tested negative was significantly lower than those who tested positive (1 vs 3, respectively). A linear regression with square root transformation of PHC score was done to determine the magnitude of the relationship between the score and SARS-CoV-2 status, while adjusting for other covariates. After performing the square root transformation and adjusting for other covariates, the association between PHC score and SARS-CoV-2 PCR test result remained statistically significant (p < 0.0001) (table 2). After adjusting for predetermined covariates, the expected value of the square root of placental hypoperfusion score increased by 0.86 units (95% CI: 0.47, 1.26). CONCLUSION: There is evidence of placental hypoperfusion in placentas from SARS-CoV-2 infected women with no differences in neonatal outcomes. These observations may provide insight into the pathologic effects of SARS-CoV-2 on placentation.
International Journal of Gynecology & Obstetrics
Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
European Journal of Obstetrics & Gynecology and Reproductive Biology