Publications by authors named "Zvi Leibovitz"

38 Publications

Prenatal diagnosis of fetal chest lymphangioma.

J Ultrasound Med 2006 Nov;25(11):1437-40

Department of Obstetrics and Gynecology, Rambam Medical Center, 31096 Haifa, Israel.

Objective: Prenatally diagnosed cystic nuchal hygroma is often associated with chromosomal anomalies and hydrops fetalis. Chest lymphangioma diagnosed later in gestation appears to be a completely different disease, with a low incidence of chromosomal and structural anomalies.

Methods: Two chest cavernous lymphangiomas of the fetus are presented. The sonographic images, chromosomal analyses, and macroscopic and microscopic evaluations are described.

Results: Fetal chest cavernous lymphangiomas were identified at 15 and 22 weeks' gestation. In the first case, the couple decided to interrupt gestation. In the second case, prenatal sonography showed a multilocular, cystic lymphangioma external to the chest wall with no flow on Doppler sonography. Follow-up sonography revealed normal fetal growth and slow enlargement of the cystic mass surrounding the left chest cavity. The neonate was delivered without complications and was treated surgically.

Conclusions: The chest lymphangioma appears to be a lesion usually not associated with other congenital abnormalities. The prenatal diagnosis of chest wall lymphangioma is relatively easy sonographically, and the treatment of choice is surgical excision. The outcome is relatively favorable, with a low incidence of chromosomal and structural anomalies.
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http://dx.doi.org/10.7863/jum.2006.25.11.1437DOI Listing
November 2006

Instability of Doppler cerebral blood flow in monochorionic twins.

J Ultrasound Med 2006 Apr;25(4):449-54

Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion- Institute of Technology, Haifa, Israel.

Objective: The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin-twin transfusion syndrome (TTTS).

Methods: Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA.

Results: Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02).

Conclusions: Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of "hyperperfusion" in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.
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http://dx.doi.org/10.7863/jum.2006.25.4.449DOI Listing
April 2006

Subendometrial arterial spectral doppler assessment during IVF cycles and its correlation with treatment outcome.

Ultrasound Med Biol 2006 Feb;32(2):157-62

Department of Obstetrics and Gynecology, Ultrasound Unit and IVF Unit, Bnai-Zion Medical Center, Haifa, Israel.

The influence of blood flow impedance in subendometrial arteries on embryo implantation rate was investigated by transvaginal sonographic examination in in vitro fertilization (IVF) cycles. A total of 39 women undergoing IVF treatment were evaluated along the treatment cycle. Power and spectral Doppler studies of subendometrial arteries were performed to calculate the pulsatility index (PI), resistance index (RI) and systolic:diastolic ratio (S:D). The correlation between these parameters and pregnancy achievement was analyzed. Patients were grouped according to whether pregnancy was achieved or not. RI and S:D did not differ between the groups along the course of treatment. In pregnant patients, the PI was significantly lower in the beginning of the cycle than on the preovulation day and ovum pickup day. PI in the beginning of the treatment was significantly lower in pregnancy cycles than in nonpregnancy ones. A lower PI on day 1 was correlated with a better chance for pregnancy.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2005.09.012DOI Listing
February 2006

Fetal escape from the amniotic sac: follow-up from first trimester to delivery.

J Ultrasound Med 2005 Dec;24(12):1745-51

Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, PO Box 4940, Haifa 31048, Israel.

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http://dx.doi.org/10.7863/jum.2005.24.12.1745DOI Listing
December 2005

Decidualization of ovarian endometriosis during pregnancy mimicking malignancy.

J Ultrasound Med 2005 Sep;24(9):1289-94

Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, PO Box 4940, Haifa 31048, Israel.

Objective: The purpose of this series is to present deciduosis (the formation of extrauterine decidua) as one of the differential diagnoses of a malignant tumor during pregnancy.

Methods: Two cases are described in which pregnant patients had a pelvic tumor. The lesions, which were diagnosed in the early second trimester, consisted of complex masses with an extensive blood supply and had a sonographic appearance of a malignant tumor. The high suspicion for malignancy necessitated surgical intervention.

Results: During surgery, the lesions were observed to be of an ovarian origin with papillary excrescences covering their exterior. The lesions were excised and sent for histologic examination. The results showed a markedly decidualized endometriotic cyst in both cases.

Conclusions: This phenomenon is a diagnostic challenge and should be considered in the differential diagnosis of a malignant mass during pregnancy.
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http://dx.doi.org/10.7863/jum.2005.24.9.1289DOI Listing
September 2005

Primary ovarian ectopic pregnancy misdiagnosed as first-trimester missed abortion.

J Ultrasound Med 2005 Apr;24(4):539-43; quiz 544-5

Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel.

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http://dx.doi.org/10.7863/jum.2005.24.4.539DOI Listing
April 2005

Extensive hemorrhagic chorion-amnion separation after second-trimester genetic amniocentesis.

J Ultrasound Med 2003 Nov;22(11):1283-8

Department of Obstetrics and Gynecology and Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel.

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http://dx.doi.org/10.7863/jum.2003.22.11.1283DOI Listing
November 2003

Diagnosis of pregnancy-associated uterine venous plexus thrombosis on the basis of transvaginal sonography.

J Ultrasound Med 2003 Mar;22(3):287-93

Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.

Objective: To describe the sonographic signs of uterine venous plexus thrombosis.

Methods: Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration.

Results: All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases.

Conclusions: Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.
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http://dx.doi.org/10.7863/jum.2003.22.3.287DOI Listing
March 2003
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