European journal of obstetrics, gynecology, and reproductive biology, 2016
Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian can... more Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian cancer. Retrospective studies suggested that the use of statins, metformin and beta blockers is associated with improved prognosis in these patients. Patients with diabetes often suffer from hypertension and are usually treated concomitantly by several classes of drugs. Our aim was to assess the independent contribution of diabetes mellitus and hypertension and of the use of aspirin, statins, metformin and beta blockers on the risk of ovarian cancer recurrence and mortality. Files of ovarian cancer patients treated between 2000 and 2012 were retrospectively reviewed. Data regarding disease characteristics, presence of diabetes mellitus and hypertension, recurrence and death were extracted. The use of drugs was assessed using the Clalit Health Services (CHS) pharmacy records. 143 patients treated by debulking surgery and platinum based chemotherapy were included. Median age was 62.5, 22 (15....
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting... more Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication. Until March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010. We identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001). A significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.
To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight ga... more To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes. Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS. A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06-1.44) in overweight women, OR = 1.86 (1.51-2.31) in obese women and in severe obesity OR = 2.97 (2.15-4.11). Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR = 1.46 (1.20-1.79), impaired glucose tolerance OR = 1.65 (1.14-2.4) and GDM OR = 1.56 (1.16-2.10). Women with GWG above recommended had OR = 1.58, (1.37-1.81) for composite outcome. Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.
This review describes the history and the evolvement of prenatal genetic screening tests. We star... more This review describes the history and the evolvement of prenatal genetic screening tests. We start in the era prior to the understanding that certain syndromes are genetic, continue through the identification of their genetic basis and the changes in markers in the pregnant woman's serum and conclude in the present when assays such as cell free D.N.A are offered to high risk women.
Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers... more Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients' symptoms and quality of life (QoL). Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI-6 and IIQ-7 scores. Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73-0.88. Construct validity was high with good correlation between the SOPSETO and the UDI-6 and IIQ-7 questionnaires. The triggers which had the highest correlation with the total UDI-6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ-7 scores. Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.
European journal of obstetrics, gynecology, and reproductive biology, 2016
Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian can... more Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian cancer. Retrospective studies suggested that the use of statins, metformin and beta blockers is associated with improved prognosis in these patients. Patients with diabetes often suffer from hypertension and are usually treated concomitantly by several classes of drugs. Our aim was to assess the independent contribution of diabetes mellitus and hypertension and of the use of aspirin, statins, metformin and beta blockers on the risk of ovarian cancer recurrence and mortality. Files of ovarian cancer patients treated between 2000 and 2012 were retrospectively reviewed. Data regarding disease characteristics, presence of diabetes mellitus and hypertension, recurrence and death were extracted. The use of drugs was assessed using the Clalit Health Services (CHS) pharmacy records. 143 patients treated by debulking surgery and platinum based chemotherapy were included. Median age was 62.5, 22 (15....
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting... more Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication. Until March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010. We identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001). A significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.
To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight ga... more To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes. Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS. A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06-1.44) in overweight women, OR = 1.86 (1.51-2.31) in obese women and in severe obesity OR = 2.97 (2.15-4.11). Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR = 1.46 (1.20-1.79), impaired glucose tolerance OR = 1.65 (1.14-2.4) and GDM OR = 1.56 (1.16-2.10). Women with GWG above recommended had OR = 1.58, (1.37-1.81) for composite outcome. Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.
This review describes the history and the evolvement of prenatal genetic screening tests. We star... more This review describes the history and the evolvement of prenatal genetic screening tests. We start in the era prior to the understanding that certain syndromes are genetic, continue through the identification of their genetic basis and the changes in markers in the pregnant woman's serum and conclude in the present when assays such as cell free D.N.A are offered to high risk women.
Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers... more Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients' symptoms and quality of life (QoL). Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI-6 and IIQ-7 scores. Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73-0.88. Construct validity was high with good correlation between the SOPSETO and the UDI-6 and IIQ-7 questionnaires. The triggers which had the highest correlation with the total UDI-6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ-7 scores. Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.
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