139 results on '"Ofer Gemer"'
Search Results
2. Does sentinel lymph node biopsy in endometrial cancer surgery have an impact on the rate of adjuvant post operative pelvic radiation? An Israeli Gynecologic Oncology Group Study
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Yoav Brezinov, Tamar Katzir, Ofer Gemer, Limor Helpman, Ram Eitan, Zvi Vaknin, Tally Levy, Amnon Amit, Ilan Bruchim, Inbar Ben Shachar, Ilan Atlas, Ofer Lavie, and Alon Ben-Arie
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Endometrial cancer staging ,Adjuvant therapy for endometrial cancer ,Lymph nodes assessment in endometrial cancer ,Sentinel lymph nodes protocol ,External beam radiotherapy for endometrial cancer ,Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objective: To compare the rates of post-operative radiotherapy between two methods of lymph nodes assessment during surgical staging for endometrial cancer (EC). Methods: We conducted a comparative study of all consecutive women with endometrial cancer who underwent sentinel lymph node detection and biopsy using blue dye and isotope scan (SLNB) at Kaplan Medical Center and patients from the IGOG database, who underwent staging lymphadenectomy (PLND). The primary outcome was the rate of adjuvant and therapeutic radiation. The secondary outcome was a comparison of disease-free survival (DFS) and overall survival (OS). Results: There were 138 patients in the SLNB group and 1022 women in the PLND group. The detection rate of SLN was 74% for unilateral detection and 54% for bilateral detection. In the PLND group 57% were high risk patients vs. 47% in SLNB group (p = 0.03). 43% of high-risk patients in the PLND group received adjuvant or therapeutic pelvic radiation vs. 28% of high-risk women in the SLNB arm (p = 0.017). No statistically significant difference in recurrence rates nor in death rates had been observed in the high-risk group patients. The 5-years survival in the high-risk PLND group was 80% and the recurrence rate was 19% vs. 75% 5-year survival and 14% recurrence in high-risk SLNB cohort, log-rank p = 0.82 for survival and long-rank p = 0.25 for recurrence. Conclusion: Endometrial cancer patients undergoing lymph node assessment by sentinel lymph node biopsy, receive less pelvic radiotherapy.
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- 2022
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3. Clinical and Surgical Characteristics of Abdominal Wall Endometriosis: A Multicenter Case Series of 80 Women
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ELVIN PIRIYEV, AHMET NAMAZOV, ISLAM MAHALOV, AYGUL MAMEDOVA, OFER GEMER, SVEN SCHIERMEIER, and THOMAS RÖMER
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Pharmacology ,Cancer Research ,General Biochemistry, Genetics and Molecular Biology ,Research Article - Abstract
Background/Aim: Endometriosis of the abdominal wall (AWE) is poorly understood because of its rarity and heterogeneous nature. The aim of this study was to investigate and present the clinical and surgical characteristics of AWE and to propose its classification. Patients and Methods: This was a multicentric retrospective study. For this analysis, the data from three endometriosis centers were collected. In total 80 patients were included in this study. The Academic Hospital Cologne Weyertal is a certified, level III endometriosis center in Germany with 750-1,000 endometriosis surgeries being performed annually; Barzilai University Medical Center is a certified endometriosis center in Ashkelon, Israel; and Baku Health Center is an endometriosis Center in Baku, Azerbaijan. Results: The size of nodule (histological specimen) was significant larger in women with than those without adenomyosis (3.34±1.4 vs. 2.55±1.33 cm, p=0.016). The incidence of subfascial involvement was also found to be significantly higher in these women (42% vs. 19%, p=0.03). No significant difference was found in patients with and without obesity. In 78% of cases, the proliferation level (Ki67 marker) was less than 30%. Conclusion: AWE has a high prevalence of symptoms such as abdominal wall pain and swelling, as well as bleeding. The strengths of the current study are the investigation of the proliferation marker Ki67 in AWE, the impact of adenomyosis, as well as the suggested classification.
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- 2023
4. Minimally invasive approach in endometrial cancer with lower uterine segment involvement in stage ≥ II: A retrospective study
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Gabriel Levin, A Namazov, T Perri, Tally Levy, Limor Helpman, Ilan Bruchim, Alon Ben Arie, Liron Kogan, Amnon Amit, Ofer Lavie, Ilan Atlas, Zvi Vaknin, Inbar Ben Shachar, Ofer Gemer, and Ram Eitan
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medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Hysterectomy ,Cohort Studies ,Laparotomy ,medicine ,Adjuvant therapy ,Humans ,Minimally Invasive Surgical Procedures ,Progression-free survival ,Neoplasm Staging ,Retrospective Studies ,Univariate analysis ,Proportional hazards model ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,Endometrial Neoplasms ,Log-rank test ,Reproductive Medicine ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Objective To compare oncological outcomes in women with lower uterine segment involvement (LUSI) in endometrial carcinoma (EC) stage ≥ II - staged by a minimally invasive surgery (MIS) versus laparotomy. Study design A retrospective multi-center cohort study. Univariate analysis, Kaplan-Meier survival and Cox proportional hazard analysis were performed to compare between women staged by MIS and those staged by laparotomy. Results Over a median follow-up period of 3 years (interquartile range, 1.5–6 years) 212 women were included, 68 (32.1%) were surgically staged by MIS. Stages of disease did not vary between MIS and laparotomy and were 32.1%, 51.9%, and 16.0%, in stages II, III and IV – respectively. Adjuvant radiation and chemotherapy rate did not differ between groups. Overall recurrence rate was comparable (p = 0.084). Locoregional recurrence rate was higher in the MIS group odds ratio 2.17, 95% confidence interval 1.19–4.20). Overall and progression free survival were similar in both groups (log rank test p = 0.08 and p = 0.912 respectively). In Cox regression model adjusting for age, comorbidities, tumor grade, stage and adjuvant therapy, route of surgery (MIS vs. laparotomy) was not associated with overall survival (p = 0.169). Conclusions In women with advanced EC and LUSI, although MIS is associated with locoregional recurrences, survival is comparable to laparotomy.
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- 2022
5. Prognostic significance of pretreatment thrombocytosis in endometrial cancer: an Israeli Gynecologic Oncology Group study
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Ilan Atlas, Sofia Leytes, Amnon Amit, Ram Eitan, Ahmet Namazov, Ofer Gemer, Ofer Lavie, Inbar Ben Shahar, Limor Helpman, Tally Levy, Ilan Bruchim, Ori Tal, Alon Ben-Arie, and Zvi Vaknin
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medicine.medical_specialty ,Gynecologic oncology ,Gastroenterology ,Risk Factors ,Uterine cancer ,Internal medicine ,medicine ,Humans ,Israel ,Retrospective Studies ,Thrombocytosis ,Proportional hazards model ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Cystadenocarcinoma, Serous ,Endometrial Neoplasms ,Exact test ,Oncology ,Clear cell carcinoma ,Female ,business ,Carcinoma, Endometrioid ,Adenocarcinoma, Clear Cell - Abstract
ObjectiveEndometrial cancer prognosis is related to stage, histology, myometrial invasion, and lymphovascular space invasion. Several studies have examined the association between pretreatment thrombocytosis and patient outcomes with contrasting results regarding prognosis. Our aim was to evaluate the association of pretreatment platelet count with outcomes in endometrial cancer patients.MethodsThis is an Israeli Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer, who underwent surgery between January 2002 and December 2014. Patients were grouped as low risk (endometrioid G1-G2 and villoglandular) and high risk (endometrioid G3, uterine serous papillary carcinoma, clear cell carcinoma, and carcinosarcoma). Those with stage I disease were compared with stages II–IV. Disease stages were reviewed and updated to reflect International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. All patients underwent pelvic washings for cytology and total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Pelvic lymph node assessment was performed in patients with tumors of moderate–high risk histology or deep myometrial invasion. Para-aortic sampling was performed at the surgeon’s discretion. Patients were categorized by pretreatment platelet count into two groups: ≤400×109/L and >400×109/L (defined as thrombocytosis). Clinical and pathological features were compared using Student t-test, χ2 or Fisher’s exact test. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations.ResultsOf the 1482 patients included, most had stage I disease (961; 74.8%) and most had endometrioid histology (927; 64.1%). A total of 1392 patients (94%) had pretreatment platelet counts ≤400×109/L and 90 (6%) had pretreatment thrombocytosis. Patients with thrombocytosis had a significantly higher rate of high-grade malignancy, advanced stage, lymphovascular space invasion, low uterine segment involvement, and lymph node metastases. They also had shorter 5 year disease-free survival (65% vs 80%, p=0.003), disease-specific survival (63% vs 83%, pConclusionsPretreatment thrombocytosis is an independent prognostic factor for decreased disease-specific survival and overall survival among patients with endometrial cancer, and can serve as a predictor of poor outcome.
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- 2021
6. The diagnosis of endometrial cancer in women with asymptomatic endometrial polyp does not increase survival rates: an israel gynecologic oncology group study
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Amnon Amit, Ofer Gemer, Ofer Lavie, Ahmet Namazov, Michael Volodarsky, Tally Levy, Ilan Bruchim, Zvi Vaknin, Alon Ben-Arie, Limor Helpman, Ram Eitan, and Ilan Atlas
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medicine.medical_specialty ,Gynecologic oncology ,Gastroenterology ,Asymptomatic ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Polyps ,0302 clinical medicine ,Internal medicine ,medicine ,Endometrial Polyp ,Humans ,In patient ,030212 general & internal medicine ,Israel ,Aged ,Neoplasm Staging ,Retrospective Studies ,Ultrasonography ,030219 obstetrics & reproductive medicine ,Group study ,business.industry ,Endometrial cancer ,Outcome measures ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,Endometrial Neoplasms ,Survival Rate ,Female ,Neoplasm Recurrence, Local ,medicine.symptom ,business - Abstract
Objective To compare outcomes of symptomatic and asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. Design An Israel Gynecologic Oncology Group multi-center retrospective cohort study. Methods Of 635 patients with endometrial cancer and a preoperative diagnosis of an endometrial polyp who underwent surgery between 2002 and 2014 in one of 11 centers in Israel were divided into two groups according to the presence of bleeding symptoms. Outcome measures included recurrence-free survival, disease-specific survival and overall survival. Survival data were plotted according to the method of Kaplan and Meier and compared using the log-rank test. Results There were 513 symptomatic and 122 asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. The median follow-up was 52 months (range 12-120 months). There were no differences between patients who experienced bleeding and those who did not in 5-year recurrence-free survival (85.2 % vs. 85.7 %; p=0.83, respectively), disease-specific survival (88.2 % vs. 89.2 %; p=0.71, respectively), or overall survival (80.2% vs. 78.4 %; p=0.97, respectively). Conclusion The diagnosis of endometrial cancer in patients with asymptomatic endometrial polyps is not associated with improved outcomes as compared with patients with bleeding. In the absence of factors indicating a high risk of endometrial cancer, clinical and sonographic follow-up is the advised management strategy for these patients.
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- 2021
7. Risk of endometrial cancer in asymptomatic postmenopausal women in relation to ultrasonographic endometrial thickness
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Ofer, Gemer, Ofer, Lavie, and Yakir, Segev
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Obstetrics and Gynecology - Published
- 2023
8. Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study
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Tally Levy, Michael Volodarsky, Nasreen Hag-Yahia, Ofer Gemer, Oded Raban, Ilan Bruchim, Sofia Leytes, Limor Helpman, Zvi Vaknin, Ram Eitan, Amnon Amit, Ilan Atlas, Ahmed Namazov, Yfat Kadan, Ofer Lavie, Inbar Ben-Shachar, and Alon Ben-Arie
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Adult ,Oncology ,medicine.medical_specialty ,Population ,Disease ,Uterine cancer ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Israel ,education ,Pathological ,Aged ,Aged, 80 and over ,education.field_of_study ,Proportional hazards model ,business.industry ,Endometrial cancer ,Age Factors ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Endometrial Neoplasms ,Survival Rate ,Exact test ,Female ,Neoplasm Recurrence, Local ,business ,Cohort study - Abstract
INTRODUCTION Advanced age is considered an adverse factor in endometrial cancers but may be a surrogate for other conditions that impact outcomes. The study objective was to assess the association of age with endometrial cancer features, treatment and prognosis. MATERIAL AND METHODS In this multicenter cohort study, consecutive women with endometrial cancer treated at 10 Israeli institutions between 2000 and 2014 were accrued in an assimilated database. Postmenopausal women were stratified into age groups with a cut-off of 80. Clinical, pathological and treatment data were compared using t test or Mann-Whitney test for continuous variables, and Chi-square Test or Fisher's Exact test for categorical variables. Main outcome measures included disease recurrence and disease-specific and overall survival; these were plotted using the Kaplan-Meier method and compared using the log-rank test. The association between age and recurrence and survival, adjusted for other clinical and pathological factors, was assessed using multivariable Cox regression modeling. RESULTS A total of 1764 postmenopausal women with endometrial cancer were identified. Adverse pathological features were more prevalent in older women, including high-risk histologies (35% vs 27%, P = .025), deep myoinvasion (44% vs 29%, P = .001) and lymphovascular involvement (22% vs 15%, P = .024). Surgical staging was performed less frequently among older women (33% vs 56%; P
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- 2020
9. Prediction of endometrial cancer recurrence by using a novel machine learning algorithm: An Israeli gynecologic oncology group study
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Ohad Houri, Yotam Gil, Ofer Gemer, Limor Helpman, Zvi Vaknin, Ofer Lavie, Alon Ben Arie, Amnon Amit, Tally Levy, Ahmet Namazov, Inbar Ben Shachar, Ilan Atlas, Ilan Bruchim, and Ram Eitan
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Machine Learning ,Reproductive Medicine ,Albumins ,Obstetrics and Gynecology ,Humans ,Female ,Israel ,Neoplasm Recurrence, Local ,Retrospective Studies ,Endometrial Neoplasms - Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries. The overall risk of recurrence is associated with traditional risk factors.Machine learning was used to predict recurrence among women who were diagnosed and treated for endometrial cancer between 2002 and 2012 at elven university-affiliated centers. The median follow-up time was 5 years. The following data were retrieved from the medical records and fed into the algorithm: age, chronic metabolic diseases, family and personal cancer history, hormone replacement therapy use, endometrial thickness, uterine polyp presence, complete blood count results, albumin, Ca-125 level, surgical staging, histology, depth of myometrial invasion, LVSI, grade, pelvic washing cytology, and adjuvant treatment. We used XGBoost algorithm, which fits the training data using decision trees, and can also rate the factors according to their influence on the prediction.1935 women were identified of whom 325 had recurrent disease. On the randomly picked samples, the specificity was 55% and the sensitivity was 98%. Our model showed an operating characteristic curve with AUC of 0.84.A machine learning algorithm presented promising ability to predict recurrence of endometrial cancer. The algorithm provides an opportunity to identify at-risk patients who may benefit from adjuvant therapy, tighter surveillance, and early intervention.
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- 2022
10. Is the extent of pelvic lymphadenectomy in the staging of endometrial cancer associated with the yield of metastatic nodes? An Israeli Gynecologic Oncology Group study
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Tally Levy, Ilan Bruchim, Misgav Rottenstreich, Ram Eitan, Alon Ben Arie, M. Voldarsky, Nasreen Hag-Yahia, Ofer Lavie, Ahmed Namazov, Inbar Ben Shachar, Ilan Atlas, Oded Raban, Zvi Vaknin, Amnon Amit, Ofer Gemer, and Limor Helpman
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Gynecologic oncology ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Aged ,Pelvic Neoplasms ,Retrospective Studies ,Rank correlation ,030219 obstetrics & reproductive medicine ,Sentinel Lymph Node Biopsy ,business.industry ,Endometrial cancer ,Middle Aged ,Sentinel node ,Prognosis ,medicine.disease ,Endometrial Neoplasms ,Log-rank test ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Surgery ,Lymphadenectomy ,Radiology ,Lymph ,business ,Follow-Up Studies - Abstract
Objectives Primary, to explore correlation between the extent of pelvic lymphadenectomy in the surgical staging of endometrial cancer and the number of nodes with metastasis. Secondary, evaluate survival measures in relation to the number of excised nodes. Methods A retrospective multi-center study of prospectively collected information of 2014 women with endometrial cancer, 1032 of whom underwent lymph node staging. Spearman's rank correlation was used to assess the correlation between the number of pelvic nodes excised and the number of metastatic nodes. Women's data were dichotomized by the median number of excised pelvic nodes. Kaplan-Meier and log rank tests were used to examine the effect of the number of pelvic nodes excised on survival. Results There was no significant correlation between the number of pelvic nodes harvested and the number of metastatic lymph nodes (r = 0.301; p = 0.28). The median number of excised pelvic nodes was 9 (range 1–77). There was no difference between women with up to 9 and women with more than 9 lymph nodes excised in the 5-year recurrence-free survival (82.4% vs. 83.9%; p = 0.90), disease-specific survival (83.6% vs. 86.7%; p = 0.37), or overall survival (75.8% vs. 82.8%; p = 0.11). Conclusions The extent of pelvic lymphadenectomy in the surgical staging of endometrial cancer is not associated with a higher yield of metastatic nodes or with longer survival. Current focus should be on sentinel node procedures that offer women the benefit of accurate staging without the complications associated with extensive lymphadenectomy.
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- 2020
11. Routine ultrasonographic and hysteroscopic evaluations of women undergoing postpartum manual removal of placenta: a retrospective cohort study
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Natanel Elkabetz, Victoria Kapustian, Efraim Zohav, Eyal Y. Anteby, Ofer Gemer, Ahmet Namazov, Ela Ivshin, and Simon Shenhav
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Adult ,medicine.medical_specialty ,media_common.quotation_subject ,Fertility ,Hysteroscopy ,Group B ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Retained placenta ,Placenta ,medicine ,Humans ,Retrospective Studies ,Ultrasonography ,media_common ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,postpartum bleeding ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Products of conception ,030220 oncology & carcinogenesis ,Female ,business ,Placenta, Retained - Abstract
This study aimed to assess the rates of retained products of conception (RPOC) after routine postpartum evaluation of patients who underwent post-delivery manual uterine revision due to retained placenta. This is a retrospective cohort study of 599 consecutive women who underwent manual removal of placenta during 2010–2018. Group A comprised 465 women who underwent postpartum symptom-based evaluation (2010–2016). Group B comprised 134 women who were routinely evaluated by ultrasound and subsequently by hysteroscopic examination 6 weeks after delivery (2016–2018). The rates of abnormal postpartum bleeding were similar between groups A and B (12% and 13%, respectively, p = 0.72%). A significantly smaller proportion of women underwent hysteroscopy in group A than group B (12% vs. 37%, p
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- 2020
12. The oncological safety of hysteroscopy in the diagnosis of early-stage endometrial cancer: An Israel gynecologic oncology group study
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Ram Eitan, Ilan Atlas, Tally Levy, Ilan Bruchim, Ahmet Namazov, Amnon Amit, Zvi Vaknin, Limor Helpman, Alon Ben-Arie, Sophia Leytes, Oded Raban, Michael Volodarsky, Nasreen Hag-Yahia, Ofer Lavie, Inbar Ben Shachar, and Ofer Gemer
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medicine.medical_specialty ,Biopsy ,medicine.medical_treatment ,Salpingo-oophorectomy ,Hysteroscopy ,Gynecologic oncology ,Hysterectomy ,Disease-Free Survival ,Curettage ,03 medical and health sciences ,0302 clinical medicine ,Carcinosarcoma ,Humans ,Medicine ,030212 general & internal medicine ,Israel ,Stage (cooking) ,Pathological ,Aged ,Neoplasm Staging ,030219 obstetrics & reproductive medicine ,Group study ,medicine.diagnostic_test ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,Middle Aged ,Prognosis ,medicine.disease ,Endometrial Neoplasms ,Surgery ,Reproductive Medicine ,Female ,Neoplasm Recurrence, Local ,business ,Carcinoma, Endometrioid ,Adenocarcinoma, Clear Cell ,Follow-Up Studies ,Endometrial biopsy - Abstract
Objective To compare survival measures of women with early-stage endometrial cancer who underwent either hysteroscopy or a non-hysteroscopic procedure as a diagnostic procedure. Study design An Israel Gynecologic Oncology Group multicenter study of 1324 patients with stage I endometrial cancer who underwent surgery between 2002 and 2014. Patients were divided into two groups: hysteroscopy and non-hysteroscopy (curettage or office endometrial biopsy). Clinical, pathological, and survival measures were compared between the groups. Results There were 355 patients in the hysteroscopy group and 969 patients in the non-hysteroscopy group. The median follow-up was 52 months (range 12–120 months). There were no differences between the groups in the 5-year recurrence-free survival (90.2% vs. 88.2%; p = 0.53), disease-specific survival (93.4% vs. 91.7%; p = 0.5), and overall survival (86.2% vs. 80.6%; p = 0.22). Conclusion Our findings affirm that hysteroscopy does not compromise the survival of patients with early-stage endometrial cancer.
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- 2019
13. Barbed Versus Conventional Suture for Uterine Repair During Caesarean Section: A Randomized Controlled Study
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Ahmet Namazov, Simon Shenhav, Efraim Zohav, Mark Rabinovich, Victoria Shochat, Ale Ivshin, Eyal Y. Anteby, Ofer Gemer, and Leonti Grin
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Suture (anatomy) ,Pregnancy ,law ,medicine ,Humans ,Caesarean section ,030212 general & internal medicine ,Polyglactin 910 ,030219 obstetrics & reproductive medicine ,Intention-to-treat analysis ,Sutures ,Cesarean Section ,Task force ,business.industry ,Postpartum Hemorrhage ,Suture Techniques ,Obstetrics and Gynecology ,Equipment Design ,University hospital ,Surgery ,Uterine repair ,Treatment Outcome ,Barbed suture ,Female ,business - Abstract
This study sought to compare the short-term outcome of uterine incision repair during a Caesarean section (CS) using a bidirectional knotless barbed suture versus polyglactin suture.A randomized controlled trial was conducted at a university hospital. Participants undergoing a CS were randomly assigned to uterine incision closure by bidirectional knotless barbed suture (group A) or polyglactin (group B). The primary outcome was the time needed to repair the uterine incision. The analysis was by intent to treat. A sample size of 35 per group (n = 70) was planned to detect a 30% reduction in uterine repair time (Canadian Task Force Classification I).From July 2016 through October 2017, 150 women were screened, and 70 were statistically analyzed: group A (n = 35) and group B (n = 35). Time to complete uterine incision repair was 308 ± 57 seconds for group A and 411 ± 74 seconds for group B (P 0.001). Total surgery time (33.4 ± 8.8 minutes vs. 33.2 ± 7.5 minutes; P = 0.64) was not significantly different between groups A and B, respectively.Repair of the CS uterine incision with barbed suture compared with polyglactin suture reduces suturing time.
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- 2019
14. An Israeli Gynecologic Oncology Group study of statin use and endometrial cancer prognosis
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Alon Ben-Arie, Ram Eitan, Amnon Amit, Ilan Atlas, Yakir Segev, Tally Levy, Ofer Gemer, M. Voldarsky, Limor Helpman, Ilan Bruchim, Ahmed Namazov, Inbar Ben Shachar, Zvi Vaknin, Nasreen Hag-Yahia, Oded Raban, and Ofer Lavie
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Adult ,medicine.medical_specialty ,Complete data ,Statin ,medicine.drug_class ,Comorbidity ,Gynecologic oncology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Chart review ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Israel ,Pathological ,Aged ,Proportional Hazards Models ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Group study ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Statin treatment ,medicine.disease ,Endometrial Neoplasms ,Case-Control Studies ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business - Abstract
Objective To assess whether statin use by endometrial cancer patients was associated with a survival advantage. Methods A retrospective chart review study, by the Israeli Gynecologic Oncology Group, of consecutive endometrial cancer patients who underwent surgery in one of 11 medical centers between 2002 and 2014. Clinical and pathological reports, and measures of survival were compared between statin users and nonusers. Kaplan-Meier and Cox proportional hazard models were used to assess the effect of using statins on survival measures. Results Over a mean follow-up period of 6.2 years (range, 1-12 years) for 2017 endometrial cancer patients with complete data, 663 (32.8%) used statins prior to diagnosis and 1354 (67.1%) did not. No statistically significant differences between the groups were observed for most demographic and clinical characteristics. There was no difference between statin users and nonusers in 5-year recurrence-free survival (82% vs 83%; P=0.508), disease-specific survival (86% vs 84%; P=0.549), or overall survival (77% vs 75%; P=0.901). Conclusions In this large cohort of patients with endometrial cancer, no significant associations were found between use of statins and endometrial cancer survival.
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- 2019
15. EPV034/#116 Predicting the rate of adjuvant postoperative chemo/radiation of patients with the recently updated stage IB2 cervical cancer: an Israeli gynecologic oncology group study
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Ofer Lavie, Ram Eitan, A. Ben Arie, Tally Levy, I Ben Shachar, Alex Rabinovich, Ilan Bruchim, Zvi Vaknin, A Namazov, S Armon, and Ofer Gemer
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Oncology ,Cervical cancer ,medicine.medical_specialty ,Group study ,business.industry ,medicine.medical_treatment ,Gynecologic oncology ,medicine.disease ,Chemo radiation ,Internal medicine ,medicine ,Stage (cooking) ,business ,Adjuvant - Published
- 2021
16. EPV133/#555 Minimally invasive approach in endometrial cancer with lower uterine segment involvement in ≥ stage ii: is it safe?
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Ofer Gemer, A Namazov, Ram Eitan, Amnon Amit, Limor Helpman, T Perri, Zvi Vaknin, Ofer Lavie, I Ben Shachar, Liron Kogan, A. Ben Arie, Tally Levy, Ilan Bruchim, Gabriel Levin, and Ilan Atlas
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medicine.medical_specialty ,Lower uterine segment ,business.industry ,Endometrial cancer ,medicine ,Urology ,Stage ii ,medicine.disease ,business - Published
- 2021
17. OP012/#257 Minimally invasive surgery is associated with an increased risk for local recurrence in high-grade endometrial carcinoma
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Ofer Lavie, Ram Eitan, Ilan Atlas, Gabriel Levin, Zvi Vaknin, A. Ben Arie, I Ben Shachar, A Namazov, Amnon Amit, Limor Helpman, Liron Kogan, Ofer Gemer, T Perri, Tally Levy, and Ilan Bruchim
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medicine.medical_specialty ,Increased risk ,business.industry ,Invasive surgery ,medicine ,Carcinoma ,business ,medicine.disease ,Surgery - Published
- 2021
18. EPV136/#605 Metformin use among diabetic women and endometrial cancer survival: an Israeli gynecologic oncology group study
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Tally Levy, Ilan Bruchim, Ofer Lavie, Ilan Atlas, Zvi Vaknin, Limor Helpman, Liron Kogan, A. Ben Arie, Ofer Gemer, B Brandt, I Ben Shachar, Ram Eitan, A Namazov, T Perri, and Amnon Amit
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Oncology ,medicine.medical_specialty ,Group study ,business.industry ,Internal medicine ,Endometrial cancer ,medicine ,Gynecologic oncology ,medicine.disease ,business ,Metformin ,medicine.drug - Published
- 2021
19. EPV131/#545 Lower uterine segment involvement in high-grade endometrial carcinoma is not independently associated with adverse oncological outcome
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Ofer Lavie, Amnon Amit, Gabriel Levin, Ram Eitan, B Brandt, Tally Levy, Ilan Bruchim, I Ben Shachar, Limor Helpman, A. Ben Arie, Zvi Vaknin, Ilan Atlas, Ofer Gemer, A Namazov, and T Perri
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medicine.medical_specialty ,Lower uterine segment ,business.industry ,Internal medicine ,medicine ,Carcinoma ,medicine.disease ,business ,Outcome (game theory) ,Gastroenterology - Published
- 2021
20. EPV132/#552 The prognostic impact of lower uterine segment involvement in women with low-risk endometrial carcinoma: a multicenter study
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Tally Levy, Ilan Bruchim, Ofer Lavie, Ilan Atlas, Ram Eitan, A Namazov, Gabriel Levin, A. Ben Arie, I Ben Shachar, B Brandt, Ofer Gemer, Zvi Vaknin, Limor Helpman, Amnon Amit, and T Perri
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medicine.medical_specialty ,Lower uterine segment ,Multicenter study ,business.industry ,Internal medicine ,medicine ,Carcinoma ,business ,medicine.disease ,Gastroenterology - Published
- 2021
21. O006/#340 Minimally invasive surgery in advanced endometrial carcinoma is associated with an increased risk for local recurrence
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A. Ben Arie, Gabriel Levin, Tally Levy, B Brandt, Ilan Bruchim, Zvi Vaknin, Ram Eitan, Liron Kogan, I Ben Shachar, Amnon Amit, Ofer Gemer, A Namazov, Ofer Lavie, Ilan Atlas, and Limor Helpman
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medicine.medical_specialty ,Increased risk ,business.industry ,Invasive surgery ,medicine ,Carcinoma ,medicine.disease ,business ,Surgery - Published
- 2021
22. The Relation between Head Circumference and Mid-Pelvic Circumference: A Simple Index for Cephalopelvic Disproportion Evaluation
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Gad Liberty, Ofer Gemer, Irena Siyanov, Eyal Y. Anteby, Alona Apter, Sarah M. Cohen, Ilia Bord, and Simcha Yagel
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Embryology ,Infant, Newborn ,Obstetrics and Gynecology ,Cephalopelvic Disproportion ,General Medicine ,Pelvis ,Pregnancy ,Risk Factors ,Pediatrics, Perinatology and Child Health ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Prospective Studies ,Retrospective Studies - Abstract
Introduction: Cephalopelvic disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head circumference (HC) relative to the maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC and pelvic circumference (PC) as a predictor of CPD. Methods: Of 11,822 deliveries, 104 cases that underwent an abdominopelvic CT for any medical indication and who underwent normal vaginal deliveries (NVDs) (n = 84) or cesarean deliveries (CD) due to CPD (n = 20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, was measured. The correlation between cases of CPD and cephalopelvic circumference index (CPCI), which represents the ratio between the HC and PC in percentage (HC/PC × 100), was evaluated. Results: The mid-pelvis CPCI (MP-CPCI) was larger in CD groups as compared to the NVD group: 103 ± 11 versus 97 ± 8%, respectively (p = 0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (adjusted odds ratio [aOR] 1.11, 95% CI, 1.03–1.19, p = 0.004). The aOR for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95% CI, 1.01–12.6) at MP-CPCI of 100 to 5.6 (95% CI, 1.63–19.45) at 105, 21.44 (95% CI, 3.05–150.84) at 110, and 28.88 (95% CI, 2.3–362.27) at MP-CPCI of 115. Conclusions: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.
- Published
- 2021
23. Minimally Invasive Surgery in Advanced Endometrial Carcinoma Is Associated with an Increased Risk for Local Recurrence
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A. Amit, Liron Kogan, Ram Eitan, I. Ben Shachar, Ofer Gemer, B Brandt, A Namazov, Limor Helpman, Ilan Atlas, Ofer Lavie, Alon Ben-Arie, Gabriel Levin, Tally Levy, Ilan Bruchim, and Zvi Vaknin
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Endometrial cancer ,Brachytherapy ,Obstetrics and Gynecology ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Laparotomy ,medicine ,Carcinoma ,Stage (cooking) ,business - Abstract
Study Objective To compare oncological outcomes of women with stage II -IIIc endometrial cancer (EC) who underwent minimally invasive surgery (MIS) versus laparotomy. Design A retrospective cohort study. Setting Academic multi-center. Patients or Participants Consecutive women with EC treated at 11 Israeli institutions between 2002 and 2017 were recorded in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with stage II -IIIc were stratified into groups by intentional route of surgery; MIS vs. laparotomy. Clinical, pathological and outcome data were compared. Interventions MIS and laparotomy. Measurements and Main Results Three hundred and four women met criteria: 200 underwent laparotomy and 104 MIS. Women in the MIS group were younger, had lower rate of diabetes and lower CA-125 level. Women who underwent laparotomy had higher grade EC and more advanced stage disease; Odds Ratio (OR) and 95% Confidence Interval (CI) 0.34 (0.21-0.56) and 0.56 (0.34-0.92), respectively. Brachytherapy rate was comparable between groups (p=0.715). In a multivariable analysis, including age, comorbidities, disease stage, tumor grade and lymph-vascular space invasion, MIS was not associated with an increased risk for recurrence, progression or decreased overall survival. However, patients operated by MIS had higher risk to recur locally (vaginal cuff or pelvic) (26.9% vs. 16.5%, p=0.032, OR, 1.86, 95% CI 1.05-3.30). MIS was the only independent factor associated with local recurrence, adjusted OR, 2.09, 95% CI 1.12-3.90. Conclusion In women with stage II-IIIc EC, MIS was associated with an increased risk for local recurrence compared to laparotomy.
- Published
- 2021
24. Predicting the rate of adjuvant postoperative chemo/radiation in cervical cancer with tumor size ≥2 cm and <4 cm: An Israeli Gynecologic Oncology Group study
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Ofer Gemer, Ahmet Namazov, Alon Ben-Arie, Ram Eitan, Alexander Rabinovich, Zvi Vaknin, Shunit Armon, Ilan Bruchim, Tally Levy, Inbar Ben Shachar, and Ofer Lavie
- Subjects
Male ,Oncology ,Humans ,Lymph Node Excision ,Uterine Cervical Neoplasms ,Female ,Surgery ,Israel ,Hysterectomy ,Neoplasm Staging ,Retrospective Studies - Abstract
Women with cervical cancer who undergo radical hysterectomy are often treated postoperatively with chemoradiation. Patient selection that minimizes adjuvant treatment is valuable. We compared two methods for predicting postoperative adjuvant treatment of women with tumor size ≥2 cm and4 cm.This multicenter retrospective study included 272 women with tumor size ≥2 cm and4 cm. A receiver operating characteristic curve (ROC) analysis was used to determine the optimal tumor cutoff size to predict adjuvant treatment. A second analysis compared the rate of adjuvant treatment between women with and without lymph vascular space involvement (LVSI).According to the ROC, the optimal cutoff value of tumor size for predicting adjuvant treatment was 2.95 cm (sensitivity 0.70, specificity 0.67). Tumors were ≥3.0 cm in 166 (61.0%) women. The rate of adjuvant treatment was higher in women with larger tumor diameter (73.8% vs. 47.9%, p 0.0001). Of the 241 women with a LVSI record, LVSI was present in 81 (34%) women. Among women with LVSI, rates were higher of positive lymph nodes (41.0% vs 14.5%, p 0.0001) and postoperative adjuvant treatment (83.3% vs. 53.7%, p 0.001). Among women with tumor size ≥3.0 cm and LVSI, the rate of adjuvant treatment was 90.0%. In the multivariate analysis, both tumor size ≥3.0 cm and the presence of LVSI were independently associated with adjuvant treatment (OR 3.9, 95% CI 2.1-7.1; p 0.0001 and OR 4.9, 95% CI 2.4-10.0; p 0.0001, respectively).In women with cervical cancer who underwent radical hysterectomy, tumors ≥3 cm were associated with a70% rate of adjuvant treatment, and LVSI was associated with a80% rate. These data should be weighed in multidisciplinary consultation with radiation oncologists when deciding treatment strategy.
- Published
- 2022
25. Should the risk for uterine cancer influence decision making for prophylactic hysterectomy in BRCA1/2 mutated patients- a systematic review and meta-analysis
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Yakir Segev, Ofer Lavie, L. Ostrovsky, M Schmidt, Chen Nahshon, Tomer Bar Noy, and Ofer Gemer
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0301 basic medicine ,medicine.medical_specialty ,endocrine system diseases ,medicine.medical_treatment ,Decision Making ,Genes, BRCA2 ,Genes, BRCA1 ,Hysterectomy ,Cancer syndrome ,03 medical and health sciences ,0302 clinical medicine ,Uterine cancer ,Internal medicine ,medicine ,Humans ,business.industry ,Endometrial cancer ,BRCA mutation ,Obstetrics and Gynecology ,Oophorectomy ,Cancer ,medicine.disease ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Uterine Neoplasms ,Female ,business - Abstract
To study the possible association between uterine cancer and the BRCA1/2 associated cancer syndrome and discuss the implications of such an association on the clinical managment of patients with BRCA1/2 mutations.A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Study protocol was prospectively registered at PROSPERO International prospective register of systematic reviews (registration number CRD42020193496). Considered for inclusion were studies providing the diagnosis rate of uterine cancer in patients with BRCA1/2 mutations by comparing observed and expected rate according to a known disease incidence. The results were measured by standardized incidence ratio (SIR). The primary outcome was defined as any uterine cancer diagnosis and subgroup analyses were conducted for uterine serous papillary cancer (USPC) specifically and for BRCA1 and BRCA2 mutations separately.4591 records were identified through database search; eight studies were finally included, comprising 13,098 patients with BRCA1/2 mutations. BRCA1/2 mutated patients were found to have a significantly higher risk for uterine cancer compared to the general population (SIR = 2.22, 95% CI 1.76-2.8, p 0.001). A higher incidence of USPC was also found in patients with BRCA1/2 mutations (SIR = 17.97, 95% CI 9.89-32.66, p 0.001), as well as in a separate analysis for BRCA1 (SIR = 2.81, 95% CI 2.09-3.79, p 0.001) and BRCA2 (SIR = 1.75, 95% CI 1.09-2.80, p 0.001) mutations.Patients who carry a BRCA1/2 mutation are at a significantly higher risk of developing uterine cancer, specifically USPC, supporting that USPC may be a component of the BRCA1/2 syndrome. The decision to perform concurrent hysterectomy at the time of the risk reduction bilateral salpingo -oophorectomy surgery should be considered individually.
- Published
- 2020
26. Acute Adnexal Torsion: Is Immediate Surgical Intervention Associated with a Better Outcome?
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Odelia Yaakov, Eran Ashwal, Ofer Gemer, Yoav Peled, Victoria Kapustian, Ahmet Namazov, Ram Eitan, and Haim Krissi
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Torsion Abnormality ,Reproductive Medicine ,Ovarian Torsion ,Ischemia ,Adnexal Diseases ,Obstetrics and Gynecology ,Humans ,Female ,Retrospective Studies - Abstract
Objectives: We aimed to investigate whether surgery for adnexal detorsion within 6 h from admission to the hospital was associated with less adnexal ischemia. Design: This is a retrospective cohort study. Participants/Materials, Setting, and Methods: This retrospective study was conducted at two university-affiliated medical centers and assessed women aged 18–45 years with adnexal torsion who were hospitalized within 12 h from the pain onset and underwent surgery for detorsion within 24 h. The study group was divided into 2 groups: early, surgical intervention within less than 6 h and late, surgical intervention between 6 and 24 h. The primary outcome was the rate of macroscopic appearance of ischemic adnexa. Results: Two hundred and twenty women fulfilled the inclusion criteria. In 101 women, the adnexa with the torsion appeared macroscopically ischemic. There was no difference in ischemic adnexa between the early and late intervention groups (48% vs. 40%; p = 0.269). No significant association was found between the physical examination or ultrasonographic findings and the rate of ischemic adnexa within each group. Limitations: The main limitations of our study are its retrospective nature. Much of the clinical and ultrasonographic data are subjective and operator-dependent. The decision to operate may vary from one surgeon to another. Conclusion: Immediate surgical intervention in patients with adnexal torsion is not associated with a lower rate of adnexal ischemia. These findings suggest that in acute adnexal torsion, there is a wider time window for a thorough evaluation before surgery.
- Published
- 2020
27. Increased ultrasonographic endometrial thickness is associated with poor survival in patients with endometrial cancer: An Israel gynecologic oncology group study
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Ofer Gemer, Limor Helpman, Tally Levy, Amnon Amit, Ram Eitan, Ilan Bruchim, Ahmet Namazov, Ilan Atlas, Michael Volodarsky, Alon Ben-Arie, Nasreen Hag-Yahia, Sophia Leytes, Inbar Ben Shachar, Ofer Lavie, Oded Raban, and Zvi Vaknin
- Subjects
medicine.medical_specialty ,Gynecologic oncology ,Endometrium ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Israel ,Pathological ,Aged ,Retrospective Studies ,Ultrasonography ,030219 obstetrics & reproductive medicine ,Proportional hazards model ,business.industry ,Endometrial cancer ,Retrospective cohort study ,General Medicine ,medicine.disease ,Endometrial Neoplasms ,Log-rank test ,Survival Rate ,Exact test ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Surgery ,Female ,business - Abstract
We aimed to assess the association of pre-operatively evaluated ultrasonographic endometrial thickness with outcomes of patients with endometrial cancer.An Israel Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer who underwent surgery between 2002 and 2014 in one of eleven academic centers. Patients were categorized by endometrial thickness into two groups: ≤20 mm and20 mm. Clinical and pathological features were compared using Student T-test for continuous variables and Chi-square or Fisher's exact test for categorical variables. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations.1113 patients in whom endometrial thickness data was recorded were the subject of this study and included 2 groups: ≤20 mm (n = 930),20 mm (n = 183). The median follow-up was 52 months (range 12-120 months). Patients with endometrial thickness20 mm had significantly lower recurrence-free survival (log rank, p .0001), disease-specific survival (log rank, p = .01), and overall survival (log rank, p .0001). On multivariate Cox proportional hazards analysis, endometrial thickness20 mm remained independently associated with an increased hazard of recurrence and death (HR = 1.77, 95% CI 1.07-2.96, p = .03 for recurrence; and HR = 1.68; 95% CI 1.07-2.65; p = .03 for overall survival).In patients with endometrial cancer, endometrial thickness20 mm as measured preoperatively by ultrasound, is independently associated with decreased recurrence-free and overall survival. This finding suggests that thick endometrium may be considered as one of the risk factors for poor prognosis.
- Published
- 2020
28. Postoperative radiation rates in stage IIA1 cervical cancer: Is surgical treatment justified? An Israeli Gynecologic Oncology Group Study
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Tally Levy, Ilan Bruchim, Zvi Vaknin, Inbar Ben Shachar, Ofer Lavie, Yfat Kadan, Amichay Meirovitz, Uziel Beller, Ram Eitan, Yael Yagur, Estela Derazne, Ofer Gemer, Limor Helpman, Alon Ben Arie, Omer Weitzner, Oded Raban, Ami Fishman, and Alex Rabinovich
- Subjects
Stage IIA Cervical Cancer ,medicine.medical_specialty ,Uterine Cervical Neoplasms ,Gynecologic oncology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Risk factor ,Stage (cooking) ,Neoplasm Staging ,Retrospective Studies ,Postoperative Care ,Cervical cancer ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Exact test ,Oncology ,030220 oncology & carcinogenesis ,Relative risk ,Female ,Radiotherapy, Adjuvant ,business - Abstract
Objectives Data on the outcome of stage IIA1 cervical cancer is limited, as these tumors comprise a small percentage of early tumors. NCCN guidelines suggest consideration of surgical management for small tumors with vaginal involvement. Our objective was to evaluate the risk of adjuvant radiotherapy in stage IIA1 cervical cancer and its associated features, in order to improve selection of patients for surgical management. Methods A retrospective cohort study comparing surgically treated cervical cancer patients with stage IB1 and stage IIA1 disease. Women treated between 2000 and 2015 in ten Israeli medical centers were included. Patient and disease features were compared between stages. The relative risk (Fisher's exact test) of receiving post-operative radiation was calculated and compared for each risk factor. A general linear model (GLM) was used for multivariable analysis. Results 199 patients were included, of whom 21 had stage IIA1 disease. Most features were comparable for stage IB1 and stage IIA1 disease, although patients with vaginal involvement were more likely to have close surgical margins (23.8% vs 8.5%, p = 0.03). Patients with stage IIA1 disease were more likely to receive radiation after surgery (76% vs. 46%, RR = 1.65 (1.24–2.2), p = 0.011). Vaginal involvement as well as depth of stromal invasion, LVSI and lymph node metastases were independent predictors of radiation on multivariable general linear modeling. Conclusions Cervical cancer patients with vaginal involvement are highly more likely to require postoperative radiation. We recommend careful evaluation of these patients before surgical management is offered.
- Published
- 2018
29. The association between cervical inflammation and histologic evidence of HPV in PAP smears and adverse pregnancy outcome in low risk population
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Maya Nimrodi, Vered Kleitman, Offer Erez, Tamar Wainstock, Eli Maymon, Michai Meirovitz, Neta Benshalom-Tirosh, and Ofer Gemer
- Subjects
Adult ,medicine.medical_specialty ,Cervical insufficiency ,Placenta ,Population ,Cervix Uteri ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Humans ,education ,Papillomaviridae ,Retrospective Studies ,Inflammation ,Vaginal Smears ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Placental abruption ,Obstetrics ,business.industry ,Papillomavirus Infections ,Pregnancy Outcome ,HPV infection ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,medicine.disease ,female genital diseases and pregnancy complications ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Population study ,Female ,Uterine Cervical Incompetence ,business ,Papanicolaou Test - Abstract
Objective Recent studies suggest an association between Human Papilloma Virus (HPV) infection, cervical inflammation and obstetric complications (i.e. spontaneous preterm parturition and cervical insufficiency). It has been proposed that viral inflammation of the placenta causes changes in the mother's immune reaction to bacterial pathogens, which leads to enhanced inflammatory reaction and preterm delivery. Therefore, the aim of this population-based study was to determine the association between abnormal cervical cytology prior to pregnancy and obstetric outcomes. Study design A Retrospective population-based cohort study was designed, including all women who had a Pap smear up to two years prior to delivery or during first trimester of pregnancy (n = 15,357). Women were divided into the following groups, according to Pap smear results: group 1 – Normal PAP smear (n = 11,261); group 2 – Pap smear with evidence of an inflammatory process (n = 3895); and group 3 – Pap smear with evidence of HPV infection (n = 201). Obstetrical outcomes, gestational age at delivery, and pregnancy complications were compared among the groups. Results The rate of HPV infection in our study population was 1.3%. The rate of preterm delivery (group 1 – 8.5%, group 2 – 8.5%, group 3 – 7%, p = 0.7), preterm PROM (group 1 – 1.7%, group 2–1.6%, group 3 – 2%, p = 0.66) and cervical insufficiency (group 1 – 0.5%, group 2 – 0.7%, group 3 – 1.5%, p = 0.11) did not differ significantly among the study groups. There was no statistical difference in the rate of premature rapture of membranes, newborn small-for-gestational-age, preeclampsia or placental abruption. Women with abnormal cervical cytology, either due to inflammation or HPV infection, had similar obstetric outcome in comparison to those with a normal cervical cytology. Conclusion This population-based retrospective cohort study indicates no association between positive HPV testing with Pap smear and obstetric complications such as preterm delivery, cervical insufficiency, placental abruption, PROM, Preterm PROM, neonatal SGA and preeclampsia, in a population with low prevalence HPV infection.
- Published
- 2018
30. Quantifying the effects of postcesarean adhesions on incision to delivery time
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Michael Gdalevich, Eyal Y. Anteby, Ofer Gemer, Leonti Grin, Simon Shenhav, and Victoria Kapustian
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Operative Time ,Obstetrics and Gynecology ,Postcesarean Section ,Tissue Adhesions ,macromolecular substances ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Secondary analysis ,Pediatrics, Perinatology and Child Health ,Humans ,Medicine ,Female ,Cesarean Section, Repeat ,030212 general & internal medicine ,Cesarean delivery ,business - Abstract
To quantify the effects of postcesarean section adhesions severity on the incision to delivery time.Secondary analysis of data of a prospective randomized controlled trial of women undergoing first repeat cesarean section. The presence and severity of adhesions were reported by surgeons postoperatively and accrued into an adhesion severity score. The primary outcome measure was the correlation between adhesion severity score and incision to delivery time.Of the 97 women analyzed, 47 (48.5%) had an urgent cesarean delivery. Forty-four patients (45.4%) had adhesions. Adhesion score correlated with incision to delivery time (R = .38, p .01). Patients with adhesions had a significantly longer incision to delivery time (10.3 + 5.9 versus 8.2 = 3.7 minutes, respectively; p = .04). In the Kaplan-Meier analysis, more patients with adhesions remained undelivered at any time point after incision (p = .036). The mean delivery time of patients with adhesion score three was significantly longer in comparison with women with no adhesions (13.0 versus 8.2 minutes, respectively; p = .002).Post cesarean adhesions delay delivery of the newborn. There is a linear correlation between adhesion severity and the incision to delivery interval.
- Published
- 2018
31. Minimally Invasive Surgery in High-Grade Endometrial Carcinoma and Risk for Local Recurrence: An Israeli Gynecology Oncology Group Study
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Limor Helpman, A. Amit, Liron Kogan, Alon Ben-Arie, I. Ben Shachar, Ilan Atlas, T. Perri, Gabriel Levin, Zvi Vaknin, Tally Levy, Ilan Bruchim, Ram Eitan, A Namazov, Ofer Lavie, and Ofer Gemer
- Subjects
medicine.medical_specialty ,Intention-to-treat analysis ,business.industry ,medicine.medical_treatment ,Obstetrics and Gynecology ,Cancer ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Confidence interval ,Internal medicine ,Laparotomy ,Carcinoma ,Medicine ,Stage (cooking) ,business - Abstract
Study Objective To compare oncological outcomes of women with high-grade endometrial carcinoma (HGEC) who underwent surgery by minimally invasive surgery (MIS) versus laparotomy. Design A retrospective cohort study. Setting Academic multi-center. Patients or Participants Consecutive women with HGEC cancer treated at 11 Israeli institutions between 2002 and 2017 were accrued in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with HGEC were stratified into two groups by route of surgery; MIS vs. laparotomy by an intention to treat. Clinical, pathological and outcome data were compared. Interventions MIS and laparotomy. Measurements and Main Results Six hundred and seventy-eight women met the inclusion criteria: 160 underwent MIS and 518 laparotomy. The two groups were comparable in demographic and clinical characteristics. Local recurrence was more common in the MIS group, Odds Ratio (OR) 95% Confidence Interval (CI) 2.80 (1.80-4.36). Disease progression rates were comparable (p=0.537). In a multivariable analysis, including age, comorbidities, disease stage, CA-125 and lymph-vascular space invasion, MIS was not associated with an increased risk for either overall recurrence rate, disease progression, or overall survival. Independent risk factors for local recurrence were diabetes, stage III-IV, LVSI and MIS, adjusted OR 95% CI 3.30 (1.69-6.48). Conclusion In women with HGEC, MIS is associated with higher rates of local recurrence as compared to laparotomy.
- Published
- 2021
32. 71 The oncological safety of hysteroscopy in the diagnosis of early-stage endometrial cancer: an israel gynecologic oncology group study
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Tally Levy, Ilan Bruchim, Ofer Lavie, Ram Eitan, I. Ben Shachar, Amnon Amit, Ilan Atlas, Oded Raban, Zvi Vaknin, Sophia Leytes, Ahmet Namazov, Ofer Gemer, Limor Helpman, Alon Ben-Arie, Michael Volodarsky, and Nasreen Hag-Yahia
- Subjects
medicine.medical_specialty ,Group study ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Endometrial cancer ,Gynecologic oncology ,medicine.disease ,Curettage ,Surgery ,Hysteroscopy ,Medicine ,Stage (cooking) ,business ,Pathological ,Endometrial biopsy - Abstract
Objectives To compare survival measures of women with early-stage endometrial cancer who underwent either hysteroscopy or a non-hysteroscopic procedure as a diagnostic procedure. Methods An Israel Gynecologic Oncology Group multicenter study of 1324 patients with stage I endometrial cancer who underwent surgery between 2002 and 2014. Patients were divided into two groups: hysteroscopy and non-hysteroscopy (curettage or office endometrial biopsy). Clinical, pathological, and survival measures were compared between the groups. Results There were 355 patients in the hysteroscopy group and 969 patients in the non-hysteroscopy group. The median follow-up was 52 months (range 12–120 months). There were no differences between the groups in the 5-year recurrence-free survival (90.2% vs. 88.2%; p=0.53), disease-specific survival (93.4% vs. 91.7%; p=0.5), and overall survival (86.2% vs. 80.6%; p=0.22). Conclusions Our findings affirm that hysteroscopy does not compromise the survival of patients with early-stage endometrial cancer.
- Published
- 2019
33. Sentinel Nodes Detection with Near-infrared Imaging in Gynecological Cancer Patients: Ushering in an Era of Precision Medicine
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Ahmet, Namazov, Vladislav, Volchok, Alejandro, Liboff, Michael, Volodarsky, Viki, Kapustian, Eyal Y, Anteby, and Ofer, Gemer
- Subjects
Indocyanine Green ,Lymphatic Metastasis ,Optical Imaging ,Humans ,Uterine Cervical Neoplasms ,Female ,Laparoscopy ,Cervix Uteri ,Middle Aged ,Precision Medicine ,Sentinel Lymph Node ,Endometrial Neoplasms ,Retrospective Studies - Abstract
The sentinel lymph node (SLN) biopsy procedure is a well-known method for identifying solid tumors such as breast cancer, vulvar cancer, and melanoma. In endometrial and cervical cancer, SLN has recently gained acceptance.To evaluate the detection rate of SLN with an indocyanine green and near-infrared fluorescent imaging (ICG/NIR) integrated laparoscopic system in clinically uterine-confined endometrial or cervical cancer.Patients with clinically early-stage endometrial or cervical cancer were included in this retrospective study. ICG was injected into the uterine cervix and an ICG/NIR integrated laparoscopic system was used during the surgeries. The National Comprehensive Cancer Network (NCCN) protocol was followed. SLN and/or suspicious lymph nodes were resected. Side-specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed in patients with high-grade histology or deep myometrial invasion. Enhanced pathology using ultra-staging and immunohistochemistry were performed in all cases.We analyzed 46 eligible patients: 39 endometrial and 7 cervical cancers. Of these, 44 had at least one SLN (93.6%). In 41 patients (89%) we detected bilateral SLN, in 3 (7%) only unilateral, and in 2 (4%) none were detected. Seven patients presented with lymph node metastasis. All were detected by NCCN/SLN protocol. Of these cases, two were detected with only pathological ultra-staging.SLN mapping in endometrial and cervical cancer can easily be performed with a high detection rate by integrating ICG/NIR into a conventional laparoscopic system. Precision medicine in patients evaluated by SLN biopsy changes the way patients with endometrial or cervical cancer are managed.
- Published
- 2019
34. Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer
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Reuvit Halperin, Michael Gdalevich, Amichay Meirovitz, Alex Rabinovich, Ram Eitan, Ela Mamanov, Benjamin Piura, Tally Levy, Ofer Lavie, Alon Ben Arie, Ilan Bruchim, Shachar Finci, Uzi Beller, Bozhena Saar-Ryss, Ofer Gemer, Inbar Ben Shachar, and Hanoch Levavi
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Uterine Cervical Neoplasms ,Antineoplastic Agents ,Adenocarcinoma ,Hysterectomy ,Risk Assessment ,Pelvis ,Stromal Invasion ,Cohort Studies ,Carcinoma, Adenosquamous ,03 medical and health sciences ,0302 clinical medicine ,Carcinoma ,medicine ,Humans ,Neoplasm Invasiveness ,030212 general & internal medicine ,Radical Hysterectomy ,Neoplasm Staging ,Retrospective Studies ,Cervical cancer ,business.industry ,Retrospective cohort study ,Chemoradiotherapy, Adjuvant ,Middle Aged ,medicine.disease ,Tumor Burden ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Lymph Node Excision ,Female ,Radiotherapy, Adjuvant ,Lymph Nodes ,Radiology ,Cisplatin ,business ,Chemoradiotherapy - Abstract
Objective To assess the rate of postoperative adjuvant treatment in patients who underwent radical hysterectomy for early cervical cancer and to suggest criteria for the triage of patients who have a high probability of multimodality treatment. Methods This was a multicenter retrospective study of 514 patients with FIGO stages IA2-IIA cervical cancer who underwent radical hysterectomy between 1999 and 2010. The patients were divided into 2 groups according to whether or not postoperative radiation was administered. The 2 groups were compared with regard to clinical and histopathologic variables divided into major and minor criteria (intermediate risk factors) based on lymph nodes status, parametrial involvement, tumor size, deep stromal invasion, and lymph-vascular space invasion. Results We identified 294 (57.2%) patients who received adjuvant postoperative radiotherapy (RT) or chemoradiation. Fifty-three percent of these patients who were treated by adjuvant radiation had only intermediate risk factors. Combining the various combinations of 2 out of 3 of the following criteria, we found that 89% of patients with tumors ≥2 cm and lymph-vascular space invasion received RT, 76% of patients with tumors ≥2 cm and depth of invasion >10 mm received RT, and 87% of patients with tumors depth of invasion >10 mm and lymph-vascular space invasion received RT. Conclusions This study suggests that in patients with early cervical cancer, clinicopathologic evaluation of tumor size and lymph-vascular space invasion should be undertaken before performing radical hysterectomy. This approach can serve to tailor treatment, reducing the rate of employing both radical hysterectomy and chemoradiation.
- Published
- 2016
35. Is There a Survival Advantage in Diagnosing Endometrial Cancer in Asymptomatic Patients? A Systemic Review and Meta-analysis
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Ofer Lavie, Lena Dain-Sagi, Yakir Segev, Ofer Gemer, and Shlomi Sagi
- Subjects
medicine.medical_specialty ,Disease ,Original research ,Asymptomatic ,Disease-Free Survival ,Endometrium ,03 medical and health sciences ,Polyps ,0302 clinical medicine ,Statistical significance ,Internal medicine ,Humans ,Medicine ,Survival advantage ,030212 general & internal medicine ,Early Detection of Cancer ,Ultrasonography ,030219 obstetrics & reproductive medicine ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,medicine.disease ,Survival Analysis ,Endometrial Neoplasms ,Meta-analysis ,Relative risk ,Asymptomatic Diseases ,Female ,Uterine Hemorrhage ,medicine.symptom ,business - Abstract
Data supporting a survival advantage of endometrial cancer diagnosed before the onset of postmenopausal bleeding are lacking. This study sought to compare overall survival and disease recurrence between women who were asymptomatic at diagnosis and women who were symptomatic at diagnosis. A systemic search was conducted in databases using the terms: "asymptomatic," "ultrasound," "screening," and "endometrial cancer." Only original research studies that compared characteristics of tumour advancement and survival measures were included. The six articles included in the meta-analysis comprised 2961 patients. Data were collected on study design and period, number and characteristics of participants, and outcomes in terms of tumour histology and survival measures. Higher rates of stage I tumours were shown among asymptomatic patients (relative risk 1.19). The proportion of high-grade histology did not differ between the two groups (relative risk 0.92). The crude pooled estimate for overall survival did not yield statistical significance, nor did recurrence-free survival (which was reported by three studies). In conclusion, endometrial cancer diagnosed in asymptomatic women is not associated with higher survival than in symptomatic women. Invasive procedures in asymptomatic women with incidental ultrasonographic findings should be carefully weighed because no survival advantage is expected.
- Published
- 2020
36. Ovarian serous carcinoma in synthetic mesh: A rare case report and review of the literature
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Ahmet Namazov, Ofer Gemer, and Leonti Grin
- Subjects
Ovarian Neoplasms ,Pelvic organ ,medicine.medical_specialty ,Poor prognosis ,endocrine system diseases ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,Surgical Mesh ,medicine.disease ,Polypropylenes ,female genital diseases and pregnancy complications ,Pelvic Organ Prolapse ,Polypropylene mesh ,Gynecologic Surgical Procedures ,Rare case ,medicine ,Ovarian serous tumor ,Humans ,Ovarian Serous Carcinoma ,Epithelial ovarian cancer ,Female ,Radiology ,Ovarian cancer ,business - Abstract
Epithelial ovarian cancer relapse is a devastating condition with a poor prognosis. Synthetic mesh carcinogenicity is an entity scarcely reported in the literature. We present a rare case of an ovarian serous tumor relapsed in a polypropylene mesh previously inserted for pelvic organ prolapse correction and a review of the available literature. Our case report point to a possible association between synthetic mesh and ovarian cancer relapse.
- Published
- 2018
37. Septic Shock and Multiple Organ Failure After Office Endometrial Sampling
- Author
-
Ahmed, Namazov, Joseph, Mishal, Eyal E, Anteby, and Ofer, Gemer
- Subjects
Endometrium ,Pelvic Infection ,Biopsy ,Multiple Organ Failure ,Humans ,Female ,Middle Aged ,Shock, Septic ,Abdominal Pain - Abstract
BACKGROUND: Office endometrial biopsy with a Pipelle cannula is the main method for sampling the endometrial lining. The Pipelle biopsy is safe, efficient, and cost effective. This office endometrial sampling method is also an accurate and safe procedure for endometrial sampling of patients with endometrial carcinoma. It is associated with minimal pain and does not require anesthesia. CASE: Pipelle is the most common method used for sampling the endometrial lining. No data are available of infectious complications related to endometrial biopsy. The incidence is presumed to be negligible. We present an unusual case of a 52-year-old woman who experienced septic shock and multiple organ failure following Pipelle endometrial sampling. CONCLUSION: Lower abdominal pain is the cardinal presenting symptom in woman with pelvic infection. Our case emphasizes that an atypical symptom such as abdominal pain after endometrial biopsy could be a sign of infectious complications.
- Published
- 2018
38. Effect of Menopausal Status on the Diagnosis of Endometrial Polyp
- Author
-
Viki Kapustian, Oshrit Bart, Ahmet Namazov, Alon Ben-Arie, Edi Vaisbuch, Ofer Gemer, and Ornit Cohen
- Subjects
Gynecology ,medicine.medical_specialty ,Postmenopausal women ,Transvaginal ultrasonography ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Uterine bleeding ,Hysteroscopy ,Middle Aged ,medicine.disease ,Menopause ,Postmenopause ,Polyps ,Premenopause ,Predictive Value of Tests ,Uterine Neoplasms ,Endometrial Polyp ,Medicine ,Humans ,Female ,Ultrasonography ,business - Abstract
Objective This study sought to compare the value of transvaginal ultrasonography (TVUS) and hysteroscopy in premenopausal and postmenopausal women in the diagnosis of endometrial polyp. Methods The records of 694 women with an ultrasonographic diagnosis of suspected endometrial polyp who underwent hysteroscopy were studied. Patients were divided into two groups according to menopausal status, and a comparison was made between two groups. Results There were 299 postmenopausal and 395 premenopausal women in the study. Hysteroscopy confirmed the ultrasonographic diagnosis of endometrial polyp in 212 (71%) and 212 (53%) patients in the postmenopausal and premenopausal groups, respectively (P = 0.001). In postmenopausal patients, 94% of the polyps observed by hysteroscopy were confirmed by histology, whereas in premenopausal patients, the percentage was 85% (P = 0.004). Conclusion In premenopausal patients, the diagnostic value of TVUS and hysteroscopy is lower than in postmenopausal patients. The appropriate time for TVUS and hysteroscopy should be scheduled in premenopausal women, especially in women with abnormal uterine bleeding.
- Published
- 2018
39. Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women
- Author
-
Neta Mahler, Viki Kapustian, Tali Silberstein, Ahmet Namazov, Oshra Saphier, Ofer Gemer, Oshrit Bart, Alon Ben-Arie, and Osnat Israeli
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Malignancy ,Asymptomatic ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Polyps ,Risk Factors ,Internal medicine ,medicine ,Endometrial Polyp ,Carcinoma ,Humans ,030212 general & internal medicine ,Israel ,Atypical Endometrial Hyperplasia ,Aged ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Polypectomy ,Postmenopause ,Uterine Neoplasms ,Female ,medicine.symptom ,business - Abstract
Objective The appropriate management of endometrial polyps in asymptomatic postmenopausal patients remains controversial. The aim of the study was to evaluate the relationship between endometrial polyp size and malignancy risk among asymptomatic postmenopausal women. Methods This observational retrospective study investigated 472 postmenopausal asymptomatic women who underwent hysteroscopic polypectomy between 2010 and 2014 (Canadian Task Force Classification II-3). Results Of the 472 women, premalignant and malignant lesions were found in 11 (2.33%) cases; four (0.84%) had endometrial carcinoma, and seven (1.49%) had atypical endometrial hyperplasia. The incidence of premalignant or malignant lesions among various cut-offs of polyp size (10, 15, 20 mm) was not significantly different. Conclusion In the current series no significant risk factor for malignancy was found among different cut-offs of polyp size.
- Published
- 2018
40. Is intrauterine device a risk factor for failure of conservative management in patients with tubo-ovarian abscess? An observational retrospective study
- Author
-
Eyal Y. Anteby, Ofer Gemer, Victoria Kapustian, Michael Volodarsky, Ahmet Namazov, and Odeliya Yaakov
- Subjects
Adult ,medicine.medical_specialty ,Fever ,Intrauterine device ,Conservative Treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Risk Factors ,Pelvic inflammatory disease ,medicine ,Humans ,Ovarian Diseases ,Treatment Failure ,Risk factor ,Abscess ,Device Removal ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,Fallopian Tube Diseases ,Middle Aged ,medicine.disease ,tubo-ovarian abscess ,Surgery ,Anti-Bacterial Agents ,Case-Control Studies ,Observational study ,Female ,business ,Complication ,Intrauterine Devices ,Pelvic Inflammatory Disease - Abstract
Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. In this retrospective case–control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72 h was followed by surgical intervention. The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p = 0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5 ± 6.6 vs. 13.1 ± 4.6, p = 0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6 ± 21.4 vs. 49.6 ± 20.6 mm, p = 0.02). The surgical intervention rate in TOA patients with and without IUD was similar.
- Published
- 2017
41. Ovarian Cancer Relapses in Polypropylene Mesh: A Case Report
- Author
-
Leonti Grin, Ahmed Namazov, Ofer Gemer, and Victoria Kapustian
- Subjects
Gynecology ,medicine.medical_specialty ,Gynecological oncology ,business.industry ,media_common.quotation_subject ,Gynecological problems ,Gynecologic oncology ,medicine.disease ,Polypropylene mesh ,Medicine ,business ,Ovarian cancer ,Menstrual cycle ,media_common - Published
- 2017
42. High Incidence of Carcinosarcoma among Patients Previously Treated with Tamoxifen
- Author
-
Yakir, Segev, Ella, Arnon, Efraim, Siegler, Ofer, Gemer, Yael, Goldberg, Ron, Auslender, Anis, Kaldawy, and Ofer, Lavie
- Subjects
Tamoxifen ,Antineoplastic Agents, Hormonal ,Carcinosarcoma ,Uterine Neoplasms ,Age Factors ,Contraindications, Drug ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Tamoxifen acts as an estrogen antagonist within the breast tissue. In the uterus, tamoxifen is an agonist for some estrogen receptors and therefore can cause hyperplasia or neoplasia in the endometrium.To compare characteristics of patients with uterine sarcoma who were and were not previously treated with tamoxifen.The medical records of all women with uterine sarcoma who had been treated at the Carmel Medical Center in Haifa, Israel, during 2000-2013 were retrospectively reviewed. Disease characteristics, histological type of sarcoma, patient demographics, treatments and final outcomes were compared between patients who had and those who had not been exposed to tamoxifen.Of the 66 patients identified, 14 (21%) had been exposed to tamoxifen, one of them for 3 years and 13 for at least 5 years. Mean ages were 69 ± 8 and 66 ± 12 years for those exposed and those not exposed to the drug, respectively. Rates of uterine carcinosarcoma were 86% (12/14) and 44% (23/52), respectively (P0.006). Patients with carcinosarcoma were older than other sarcoma patients (73 ± 7 vs. 59 ± 11 P0.005).There were no statistically significant differences between the two groups in rates of diabetes mellitus, hypertension, dyslipidemia or heart disease. The mean time from diagnosis to death was 7.37 ± 0.42 years. The overall survival rates of carcinosarcoma patients were not statistically different from that of other sarcoma patients. Tamoxifen exposure was not associated with overall survival among all sarcoma patients, nor among the subgroup of carcinosarcoma patients.Tamoxifen treatment was associated with elevated incidence of carcinosarcoma among women with uterine sarcoma, but was not found to be associated with prognosis or with co-morbidities.
- Published
- 2017
43. The influence of early diagnosis of endometrioid endometrial cancer on disease stage and survival
- Author
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Ofer Gemer, Yael Laitman, Ronny Milgrom, Benjamin Piura, Ofer Lavie, Frida Barak, Michael Gdalevich, and Leonid Kalichman
- Subjects
Adult ,medicine.medical_specialty ,Disease ,Gastroenterology ,Asymptomatic ,Cohort Studies ,Internal medicine ,medicine ,Carcinoma ,Humans ,Vaginal bleeding ,In patient ,Israel ,Stage (cooking) ,Early Detection of Cancer ,Survival analysis ,Aged ,Neoplasm Staging ,Gynecology ,business.industry ,Endometrial cancer ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Endometrial Neoplasms ,Treatment Outcome ,Uterine Neoplasms ,Female ,Uterine Hemorrhage ,medicine.symptom ,business ,Carcinoma, Endometrioid - Abstract
To evaluate whether the presence or duration of uterine bleeding is associated with disease stage, and survival of patients with endometrioid endometrial carcinoma (EEC). The records of 220 patients with EEC who underwent surgery were reviewed. The patients were divided into three groups according to the presence and duration of vaginal bleeding at the time of surgery. Group 1, without vaginal bleeding; group 2, vaginal bleeding up to 3 months; group 3, vaginal bleeding exceeding 3 months prior to surgery. Disease stage and survival were between the three groups. Of the 220 patients, 42 (19 %) were asymptomatic; 95 (43 %) had symptom duration of up to 3 months and 83 (38 %) experienced bleeding for >3 months. There were no significant differences between groups 1, 2 and 3 regarding the proportion of patients with deep invasion in stage I (21, 24, 26 %, p = 0.84; respectively), with grade 3 tumors (10, 13, 14 %, p = 0.42; respectively) or with advanced stage disease (12, 14, 15 %, p = 0.92; respectively). Survival analysis demonstrated a non-significant trend toward better survival in asymptomatic patients and in patients with a shorter duration of symptoms (p = 0.172). Diagnosis of EEC in asymptomatic patients or in patients with a short duration of bleeding is associated with comparable stage and survival.
- Published
- 2013
44. Laparoscopic Management of an Invasive Mole Perforating the Uterus
- Author
-
Ofer Lavie, Ahmed Namazov, Eyal Y. Anteby, Ofer Gemer, Leonti Grin, and Michael Volodarsky
- Subjects
Laparoscopic surgery ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Perforation (oil well) ,Uterine perforation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Uterine Rupture ,Pregnancy ,medicine ,Humans ,Vaginal bleeding ,Chorionic Gonadotropin, beta Subunit, Human ,030212 general & internal medicine ,Hemoperitoneum ,Laparoscopy ,030219 obstetrics & reproductive medicine ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,Hydatidiform Mole, Invasive ,Obstetrics and Gynecology ,medicine.disease ,Surgery ,Uterine rupture ,Methotrexate ,Uterine Neoplasms ,Female ,Uterine Hemorrhage ,medicine.symptom ,business - Abstract
Study Objective To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus. Design Video with explanations. Setting An invasive mole is a potentially life-threatening complication of gestational trophoblastic disease [1]. This is a case of a 24-year-old female presenting with abdominal pain and vaginal bleeding. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [2–7]. To our knowledge, this is the first report of an invasive mole perforation with active bleeding managed by laparoscopy without hysterectomy. Interventions Sonography revealed a large amount of fluid and a 3 × 3-cm heterogeneous lesion next to the posterior uterine wall. Her hemoglobin level dropped from 10.6 mg/dL to 8.6 mg/dL, and her β-human chorionic gonadotropin level was 19,004 mIU/mL. On laparoscopy, ∼2500 mL of hemoperitoneum was found, along with an actively bleeding bulging mass in the posterior uterine wall. This mass was dissected, and hemostasis was secured with sutures and electrocoagulation. Pathology confirmed the diagnosis of a complete mole. After surgery, the patient was treated with 5 courses of a methotrexate-folinic acid regimen. Her recovery was uneventful. Conclusion Uterine perforation by an invasive mole can be managed conservatively with laparoscopic surgery and postoperative chemotherapy. The transmural lesion will increase the risk of future uterine rupture during pregnancy in this patient.
- Published
- 2016
45. Clinical and Pathological Characteristics of Incidental Diagnostic Early Occult Malignancy After Risk-Reducing Salpingo-Oophorectomy in BRCA Mutation Carriers
- Author
-
Grace Younes, Ofer Lavie, Michael G. Moskoviz, Arie Bitterman, Ofer Gemer, Yakir Segev, and Ron Auslender
- Subjects
Oncology ,medicine.medical_specialty ,animal structures ,endocrine system diseases ,Genital Neoplasms, Female ,Ovariectomy ,Population ,Gynecologic oncology ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Adnexa Uteri ,Internal medicine ,medicine ,Humans ,Israel ,skin and connective tissue diseases ,education ,Retrospective Studies ,Gynecology ,education.field_of_study ,Incidental Findings ,030219 obstetrics & reproductive medicine ,business.industry ,Incidence (epidemiology) ,BRCA mutation ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Occult ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Salpingo-Oophorectomy ,Hereditary Breast and Ovarian Cancer Syndrome ,Female ,business ,Fallopian tube - Abstract
Objective Carriers of familial BRCA mutations are at high risk of early development of ovarian tubal or peritoneal cancers. The definite preventative treatment for these cases is early, risk-reducing, bilateral salpingo-oophorectomy (BSO). The aims of the study were to describe the incidence and source of early occult malignancy after risk-reducing salpingo-oophorectomy in carriers of Ashkenazi Jewish BRCA mutations and to characterize the clinical and pathological features of this unique population. Methods Data were collected retrospectively regarding women who underwent BSO in our gynecologic oncology unit from January 2002 through July 2012, after a positive test for a BRCA1 or BRCA2 mutation. Results The following 92 cases of BRCA mutations were included: 53 BRCA1, 37 BRCA2, and 2 with both mutations. After risk-reducing salpingo-oophorectomy, 5 (5.4%) of the patients were found to have early occult adnexal malignancy upon pathology study. All 5 had the BRCA1 185 del-AG mutation. Three of the 5 malignancies originated from the ovaries and 2 in the fallopian tubes with no involvement of the ovaries. Conclusions A 5.4% incidence of early occult malignancy in adnexal pathology of BSO was found in carriers of Ashkenazi Jewish BRCA mutations. Two cases with malignant origins within the fallopian tube, while sparing the ovaries in their entirety, support the fallopian tubes as the originating organ for some ovarian or peritoneal malignancies in BRCA mutation carriers.
- Published
- 2016
46. Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? An Israeli Gynecology Oncology Group study
- Author
-
Tally Levy, Ilan Bruchim, Ilan Atlas, Limor Helpman, Amnon Amit, Michael Volodarsky, Nasreen Hag-Yahia, Yakir Segev, Zvi Vaknin, Alon Ben Arie, Ofer Gemer, Ofer Lavie, Oded Raban, Inbar Ben Shachar, Sophia Leytes, Ahmed Namazov, and Ram Eitan
- Subjects
Oncology ,Biopsy ,medicine.medical_treatment ,Endometrium ,0302 clinical medicine ,Carcinosarcoma ,Cause of Death ,Israel ,Stage (cooking) ,Early Detection of Cancer ,Ultrasonography ,Incidental Findings ,030219 obstetrics & reproductive medicine ,Obstetrics and Gynecology ,Middle Aged ,Curettage ,Postmenopause ,Survival Rate ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Carcinoma, Endometrioid ,medicine.medical_specialty ,Salpingo-oophorectomy ,Hysterectomy ,Asymptomatic ,Disease-Free Survival ,Pelvis ,03 medical and health sciences ,Polyps ,Internal medicine ,medicine ,Endometrial Polyp ,Humans ,Pathological ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Gynecology ,business.industry ,Endometrial cancer ,Histology ,medicine.disease ,Endometrial Neoplasms ,Asymptomatic Diseases ,Lymph Node Excision ,Radiotherapy, Adjuvant ,Uterine Hemorrhage ,Neoplasm Grading ,Neoplasms, Cystic, Mucinous, and Serous ,business ,Adenocarcinoma, Clear Cell - Abstract
Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking.To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer.This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared.There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II-IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P.01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37).Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.
- Published
- 2018
47. Short-term effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: A prospective randomized study
- Author
-
Simon Shenhav, Eyal Y. Anteby, Michael Gdalevich, Ofer Gemer, Jenya Kruchkovich, and Viki Kapustian
- Subjects
Adult ,medicine.medical_specialty ,Narcotic ,medicine.medical_treatment ,Analgesic ,law.invention ,Postoperative fever ,Peritoneum ,Randomized controlled trial ,Pregnancy ,law ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Cesarean Section ,business.industry ,Obstetrics and Gynecology ,Perioperative ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Anesthesia ,Female ,business - Abstract
Aim: To determine the effect of non-closure of the visceral and parietal peritoneum during cesarean section on short-term postoperative morbidity. Methods: A prospective randomized trial was conducted of 533 women undergoing primary cesarean section; 277 were randomized to closure and 256 to non-closure of the peritoneum. Perioperative outcome measures, such as analgesia dosage and morbidly measures were compared. Results: There was no significant difference between the non-closure and closure groups in the mean number of narcotic analgesia doses (1.09 ± 1.2 vs 1.05 ± 1.0, P = 0.63; respectively), mean number of non-narcotic analgesia doses (4.69 ± 2.7 vs 4.65 ± 2.8, P = 0.89; respectively), number of women with postoperative fever >38°C (18 vs 14, P = 0.37; respectively), number of women with wound infection (29 vs 35, P = 0.54; respectively) and mean number of hospitalization days (4.16 ± 0.91 vs 4.14 ± 0.71, P = 0.78; respectively). Conclusion: Closure or non-closure of the peritoneum at cesarean sections has no significant impact on postoperative analgesic usage and short-term morbidity.
- Published
- 2009
48. The reproducibility of histological parameters employed in the novel binary grading systems of endometrial cancer
- Author
-
Ofer Gemer, David Ben-Dor, Ofer Lavie, Eyal Y. Anteby, L. Uriev, M. Voldarsky, Frida Barak, and Michael Gdalevich
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Mitotic index ,Tumor Cell Necrosis ,Hysterectomy ,Infiltrative Growth Pattern ,Mitotic Index ,medicine ,Humans ,Nuclear atypia ,Survival analysis ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Aged, 80 and over ,Reproducibility ,business.industry ,Endometrial cancer ,Reproducibility of Results ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Endometrial Neoplasms ,Survival Rate ,Oncology ,Female ,Surgery ,Nuclear medicine ,business ,Kappa - Abstract
Objective To compare the interobserver reproducibility and prognostic value of the FIGO grading system with the histological parameters employed in the various recently proposed binary grading systems of endometrial cancer. Methods Seventy two consecutive stage I endometrioid endometrial carcinomas from hysterectomy specimens were independently graded by two pathologists. Clinical data and outcome were obtained from the patients' records. The following histological parameters were evaluated: FIGO grade (dichotomized to grades 1and 2 vs. grade 3), nuclear atypia, presence of more than 50% solid growth, diffusely infiltrative rather than expansive growth pattern, presence of tumor cell necrosis, and mitotic count. Interobserver agreement was measured by the kappa ( k ) statistics. Kaplan–Meier survival analysis, log-rank tests and Cox proportional hazard regression were used to evaluate the equality of survival distributions and to model the overall effects of the various predictor variables on survival. Results The interobserver reproducibility was as follows: FIGO grade, k = 0.65; nuclear atypia, k = 0.63; solid growth, k = 0.51; infiltrative growth pattern, k = 0.38; tumor necrosis, k = 0.52; and mitotic index, k = 0.44. In the comparison of the Kaplan–Meier curves, the following parameters were associated with a significantly poorer survival: FIGO grade 3, p = 0.02; presence of more than 50% solid growth, p = 0.01; and a high mitotic index, p = 0.01. The other binary histological parameters were not significantly predictive of survival. Conclusions The proposed novel binary grading parameters are not advantageous in terms of interobserver reproducibility and prognostic significance over dichotomization to FIGO grades 1 and 2 vs. grade 3. A simple binary grade based solely on presence of more than 50% solid growth has a comparable reproducibility and prognostic value.
- Published
- 2009
49. Does day 3 luteinizing-hormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues?
- Author
-
Ravit Nahum, Raoul Orvieto, Simion Meltzer, Jacob Rabinson, Eyal Y. Anteby, and Ofer Gemer
- Subjects
Adult ,Infertility ,Agonist ,endocrine system ,medicine.medical_specialty ,medicine.drug_class ,Stimulation ,Fertilization in Vitro ,Controlled ovarian hyperstimulation ,Sensitivity and Specificity ,Fertility Agents ,Gonadotropin-Releasing Hormone ,Andrology ,Ovulation Induction ,Pregnancy ,Internal medicine ,Humans ,Medicine ,Retrospective Studies ,business.industry ,Pregnancy Outcome ,Antagonist ,Reproducibility of Results ,Obstetrics and Gynecology ,Retrospective cohort study ,Luteinizing Hormone ,Prognosis ,medicine.disease ,Endocrinology ,Reproductive Medicine ,Female ,business ,Luteinizing hormone ,Infertility, Female ,Biomarkers ,hormones, hormone substitutes, and hormone antagonists - Abstract
To examine whether day 3 LH level or FSH-LH ratio predict IVF outcome, we studied patients with a favorable prognosis a priori undergoing controlled ovarian hyperstimulation (COH) with GnRH agonist (agonist group; n = 131) or antagonist (antagonist group; n = 137). Although LH level could not predict IVF outcome, patients undergoing COH using the GnRH antagonist or agonist protocols with FSH-LH ratios >2 or >3, respectively, achieved significantly lower pregnancy rates (11.1% vs. 27.7% and 8.3% vs. 31.9%, respectively).
- Published
- 2008
50. Incidental Uterine Artery Transection at Operative Hysteroscopy
- Author
-
Eyal Y. Anteby, Emil Kovachev, Dov Kroll, and Ofer Gemer
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Uterine perforation ,Perforation (oil well) ,nutritional and metabolic diseases ,Obstetrics and Gynecology ,Operative hysteroscopy ,medicine.disease ,nervous system diseases ,Surgery ,medicine.anatomical_structure ,Hysteroscopy ,medicine.artery ,medicine ,Endometrial Polyp ,False passage ,business ,Uterine artery ,Cervix - Abstract
Background: Uterine perforation and false passage are occasional complications of operative hysteroscopy. Case Report: A 76-year-old woman underwent an operative hysteroscopy owing to postmenopausal bleeding and suspicious ultrasonographic intracavitary findings. A false passage through the wall of the cervix, created by the cervical dilators, was apparent upon the introduction of the hysteroscope. Bipolar coagulation employed to arrest bleedings led to the transection of the uterine artery. As no further bleeding ensued, the procedure was completed by resecting an endometrial polyp. Conclusions: Inadvertent injury to the uterine artery may further complicate false passage or perforation at hysteroscopy, underscoring the cautious usage of electocautery.
- Published
- 2008
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