The use of Magnetic Resonance Imaging (MRI) as a prenatal and gestational imaging modality supple... more The use of Magnetic Resonance Imaging (MRI) as a prenatal and gestational imaging modality supplementary to ultrasound has become widespread with the advent of rapid MR sequences in the last few years. These sequences allow acquisition of high-resolution images of the fetus in a single breath-holding period of the mother, with minimal fetal motion artifacts. We describe our experience with this modality in the diagnosis of prenatal and gestational abnormalities. The study population consisted of 39 pregnant women who had a total of 40 MRI examinations from 7/1998 to 7/2000. The indication for all examinations was a suspected fetal or gestational abnormality as suggested by ultrasound scan, laboratory tests or by family history. In 31 cases (77.5%) a correlation was found between the ultrasound findings and the MR imaging, of which in 6 cases (15%) the MRI added new valuable information. In 9 cases (22.5%) the MRI ruled out findings suspected by ultrasound. The prenatal findings were...
Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional pr... more Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.
To determine whether women with epithelial ovarian cancer are more likely to have been exposed to... more To determine whether women with epithelial ovarian cancer are more likely to have been exposed to fertility drugs, and in particular hMG, than healthy population controls. A nationwide case-control study. Two hundred living women 36 to 64 years of age, with a histologically confirmed diagnosis of primary invasive or borderline epithelial ovarian cancer that was first diagnosed and reported to the Israel Cancer Registry between January 1, 1990 and September 1, 1993 were enrolled. There were 164 (82%) invasive and 36 (18%) borderline epithelial ovarian tumors among the 200 cases. The controls were 408 women from the same dialing areas selected by random digit dialing. Cases and controls were interviewed using a standard questionnaire. A multivariate logistic model was used to assess the association of fertility drug use and ovarian cancer, controlling for variables found to be statistically associated with this outcome on univariate analysis. Twenty-four women with epithelial ovarian ...
Plasmodium falciparum malaria is infrequently recognized in Israel as a cause of infection during... more Plasmodium falciparum malaria is infrequently recognized in Israel as a cause of infection during pregnancy. We expect that with increasing frequency physicians in Israel will confront patients with malaria. Special concern should be given to malaria in pregnancy because of its serious complications. Thus, prompt diagnosis and treatment are essential. While chloroquine is safe for use in pregnancy, drug resistance is common, especially with Plasmodium falciparum. There is concern about the safety of other antimalarial agents during pregnancy. We recently observed a case of chloroquine-resistant Plasmodium falciparum malaria during pregnancy in a new immigrant primigravida from Ethiopia. Malaria in patients from endemic regions is less severe than in nonimmune hosts. Therefore, we elected to follow the patient's parasitemia periodically without additional antimalarial treatment until after delivery.
The great variability in the sonographic appearance of ovarian cystic teratomas poses difficultie... more The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 115 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition.
Oral communication abstracts the presence of a supernumerary vessel to the left of the pulmonary ... more Oral communication abstracts the presence of a supernumerary vessel to the left of the pulmonary trunk in the 3-vessel view, a 'cyst' at the lateral wall of the left atrium or a dilated coronary sinus in the 4-chamber view. A meticulous inspection of the fetal anatomy was performed for detection of associated anomalies. Postnatal follow-up was available for all surviving patients. Prenatal diagnosis was confirmed by neonatal echocardiography or at autopsy. Results: Of 1155 cardiac referrals, 231 had a CHD (20%). A PLSVC was detected in 15 fetuses (1.2% of population at risk for CHD; 4.3% of fetuses with CHD). In 5 cases PLSVC had no associated condition. In 10 cases it was associated with CHD (6 with an isolated cardiac malformation, 3 with complex malformations syndromes and one with associated extracardiac anomalies). The most frequent CHD were ventricular septal defects and left ventricular outflow tract obstructions. The outcome of PLSVC was determined solely by the associated conditions. All cases with isolated PLSVC or associated correctable extracardiac malformations were alive and well at birth or after surgery. Conclusions: PLSVC is easily recognised on standard cardiac screening. Its detection in fetal life has to be followed by a meticulous inspection of fetal anatomy for its frequent association with cardiac/extracardiac malformations that determine the outcome. Isolated PLSVC is a benign vascular anomaly and may not affect the outcome.
The use of Magnetic Resonance Imaging (MRI) as a prenatal and gestational imaging modality supple... more The use of Magnetic Resonance Imaging (MRI) as a prenatal and gestational imaging modality supplementary to ultrasound has become widespread with the advent of rapid MR sequences in the last few years. These sequences allow acquisition of high-resolution images of the fetus in a single breath-holding period of the mother, with minimal fetal motion artifacts. We describe our experience with this modality in the diagnosis of prenatal and gestational abnormalities. The study population consisted of 39 pregnant women who had a total of 40 MRI examinations from 7/1998 to 7/2000. The indication for all examinations was a suspected fetal or gestational abnormality as suggested by ultrasound scan, laboratory tests or by family history. In 31 cases (77.5%) a correlation was found between the ultrasound findings and the MR imaging, of which in 6 cases (15%) the MRI added new valuable information. In 9 cases (22.5%) the MRI ruled out findings suspected by ultrasound. The prenatal findings were...
Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional pr... more Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.
To determine whether women with epithelial ovarian cancer are more likely to have been exposed to... more To determine whether women with epithelial ovarian cancer are more likely to have been exposed to fertility drugs, and in particular hMG, than healthy population controls. A nationwide case-control study. Two hundred living women 36 to 64 years of age, with a histologically confirmed diagnosis of primary invasive or borderline epithelial ovarian cancer that was first diagnosed and reported to the Israel Cancer Registry between January 1, 1990 and September 1, 1993 were enrolled. There were 164 (82%) invasive and 36 (18%) borderline epithelial ovarian tumors among the 200 cases. The controls were 408 women from the same dialing areas selected by random digit dialing. Cases and controls were interviewed using a standard questionnaire. A multivariate logistic model was used to assess the association of fertility drug use and ovarian cancer, controlling for variables found to be statistically associated with this outcome on univariate analysis. Twenty-four women with epithelial ovarian ...
Plasmodium falciparum malaria is infrequently recognized in Israel as a cause of infection during... more Plasmodium falciparum malaria is infrequently recognized in Israel as a cause of infection during pregnancy. We expect that with increasing frequency physicians in Israel will confront patients with malaria. Special concern should be given to malaria in pregnancy because of its serious complications. Thus, prompt diagnosis and treatment are essential. While chloroquine is safe for use in pregnancy, drug resistance is common, especially with Plasmodium falciparum. There is concern about the safety of other antimalarial agents during pregnancy. We recently observed a case of chloroquine-resistant Plasmodium falciparum malaria during pregnancy in a new immigrant primigravida from Ethiopia. Malaria in patients from endemic regions is less severe than in nonimmune hosts. Therefore, we elected to follow the patient's parasitemia periodically without additional antimalarial treatment until after delivery.
The great variability in the sonographic appearance of ovarian cystic teratomas poses difficultie... more The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 115 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition.
Oral communication abstracts the presence of a supernumerary vessel to the left of the pulmonary ... more Oral communication abstracts the presence of a supernumerary vessel to the left of the pulmonary trunk in the 3-vessel view, a 'cyst' at the lateral wall of the left atrium or a dilated coronary sinus in the 4-chamber view. A meticulous inspection of the fetal anatomy was performed for detection of associated anomalies. Postnatal follow-up was available for all surviving patients. Prenatal diagnosis was confirmed by neonatal echocardiography or at autopsy. Results: Of 1155 cardiac referrals, 231 had a CHD (20%). A PLSVC was detected in 15 fetuses (1.2% of population at risk for CHD; 4.3% of fetuses with CHD). In 5 cases PLSVC had no associated condition. In 10 cases it was associated with CHD (6 with an isolated cardiac malformation, 3 with complex malformations syndromes and one with associated extracardiac anomalies). The most frequent CHD were ventricular septal defects and left ventricular outflow tract obstructions. The outcome of PLSVC was determined solely by the associated conditions. All cases with isolated PLSVC or associated correctable extracardiac malformations were alive and well at birth or after surgery. Conclusions: PLSVC is easily recognised on standard cardiac screening. Its detection in fetal life has to be followed by a meticulous inspection of fetal anatomy for its frequent association with cardiac/extracardiac malformations that determine the outcome. Isolated PLSVC is a benign vascular anomaly and may not affect the outcome.
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Papers by U. Elchalal