Experimental system design for the integration of trapped-ion and superconducting qubit systems.

We present a design for the experimental integration of ion trapping and superconducting qubit systems as a step towards the realization of a quantum hybrid system. The scheme addresses two key difficulties in realizing such a system: a combined microfabricated ion trap and superconducting qubit architecture, and the experimental infrastructure to facilitate both technologies. Developing upon work by Kielpinski et al. (Phys Rev Lett 108(13):130504, 2012. doi:10.1103/PhysRevLett.108.130504), we describe the design, simulation and fabrication process for a microfabricated ion trap capable of coupling an ion to a superconducting microwave LC circuit with a coupling strength in the tens of kHz. We also describe existing difficulties in combining the experimental infrastructure of an ion trapping set-up into a dilution refrigerator with superconducting qubits and present solutions that can be immediately implemented using current technology.

Dressed-state amplification by a single superconducting qubit.

We demonstrate amplification of a microwave signal by a strongly driven two-level system in a coplanar waveguide resonator. The effect, similar to the dressed-state lasing known from quantum optics, is observed with a single quantum system formed by a persistent current (flux) qubit. The transmission through the resonator is enhanced when the Rabi frequency of the driven qubit is tuned into resonance with one of the resonator modes. Amplification as well as linewidth narrowing of a weak probe signal has been observed. The stimulated emission in the resonator has been studied by measuring the emission spectrum. We analyzed our system and found an excellent agreement between the experimental results and the theoretical predictions obtained in the dressed-state model.

Pregnancy outcome after laparoscopy or laparotomy in pregnancy.

STUDY OBJECTIVE: To assess obstetric performance and fetal outcomes after laparoscopy or laparotomy performed during pregnancy. DESIGN: Nationwide, multicenter, retrospective chart review (Canadian Task Force classification II-2). SETTING: Seventeen hospitals throughout Israel: 12 university or university-affiliated hospitals and 5 general hospitals. PATIENTS: Three hundred eighty-nine pregnant women. INTERVENTION: Laparoscopy or laparotomy for various indications. MEASUREMENTS AND MAIN RESULTS: Of 192 laparoscopies performed, 141 were during the first, 46 during the second, and 5 during the third trimester; respective figures for 197 laparotomies were 63, 110, and 24. No intraoperative complications were reported for either procedure. Six and 25 women had complications after laparoscopy and laparotomy, respectively. There was no significant difference in abortion rates between groups. Mean gestational age at delivery and mean birthweight were comparable between groups. No significant difference was found in frequency of fetal anomalies between groups or when compared with the Israel register of anomalies. CONCLUSION: Operative laparoscopy seems to be as safe as laparotomy in pregnancy.

Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy.

OBJECTIVE: To compare the outcome of pregnancy after operative laparoscopy or laparotomy for the management of adnexal pathology during pregnancy. DESIGN: Retrospective comparative study. SETTING: University tertiary care referral center for endoscopic surgery. PATIENT(S): Eighty-eight pregnant women who underwent 93 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 39 patients. The remaining 54 patients underwent laparotomy, 25 during the first trimester and 29 during the second trimester. INTERVENTION(S): Laparoscopy or laparotomy for the management of adnexal masses during pregnancy. MAIN OUTCOME MEASURE(S): Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. RESULT(S): No operative or postoperative maternal complications occurred in the pregnant women who underwent laparoscopic surgery. In this group of 39 women, 5 women had a first-trimester miscarriage and 2 newborns had congenital malformations (hypospadias and cleft lip and palate). Two miscarriages occurred in the first-trimester laparotomy group, and 1 congenital malformation (transposition of the great vessels) was diagnosed in the second-trimester laparotomy group. CONCLUSION(S): Laparoscopic gynecologic surgery appears to be safe during pregnancy, although prospective controlled studies and national registries encompassing larger numbers of cases are needed.

Laparoscopic detorsion allows sparing of the twisted ischemic adnexa.

STUDY OBJECTIVE: To determine the safety and outcome of laparoscopic detorsion in the management of the twisted ischemic, hemorrhagic adnexa. DESIGN: Retrospective chart review and prospective follow-up (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Fifty-eight women with twisted black-bluish ischemic adnexa encountered at laparoscopy. INTERVENTION: Laparoscopic detorsion with adnexal sparing. MEASUREMENTS AND MAIN RESULTS: All patients had a benign immediate postoperative course. Transient temperature elevation occurred in seven women (12.1%). No signs of pelvic or systemic thromboembolism were detected in any patient. Long-term follow-up included transvaginal ultrasound, which revealed follicular development in the previously twisted adnexa in 54 women; normal macroscopic appearance at incidental subsequent surgery in 9; and in vitro fertilization with retrieval of oocytes from the previously twisted side in 4. CONCLUSION: Laparoscopic detorsion of the twisted ischemic, hemorrhagic adnexa is a safe procedure with minimal postoperative morbidity and a potential for the ovary to recuperate fully with preservation of normal function. Laparoscopic adnexa-sparing procedures should be performed in place of traditional salpingo-oophorectomy in women with this disorder who desire future fertility. (J Am Assoc Gynecol Laparosc 6(2):139-143, 1999)

Cancer incidence in a cohort of infertile women.

Among 2,496 infertile Israeli women treated between 1964 and 1974, 143 cancer cases were observed as compared with 116.1 expected (standardized incidence ratio (SIR) = 1.2, 95% confidence interval (CI) 1.0-1.5) through 1991. Site-specific analysis revealed 12 ovarian cancers versus 7.2 expected (SIR = 1.6, 95% CI 0.8-2.9), 21 endometrial cancers versus 4.3 expected (SIR = 4.85, 95% CI 3.0-7.4), and 59 breast cancers versus 46.6 expected (SIR = 1.3, 95% CI 0.96-1.6). Sensitivity analysis revealed that confounding was unlikely to explain the raised risk of endometrial cancer, but nulliparity might explain the increased risk of ovarian cancer. The excess of endometrial cancer was prominent among patients with normal estrogen production but progesterone deficiency (SIR = 9.4, 95% CI 5.0-16.0). The risk for ovarian cancer was similar among the total groups of treated and untreated patients (SIR = 1.7 vs. 1.6). The standardized incidence ratio for endometrial cancer was higher among the treated group than the untreated group, although not significantly. Treatment with ovulation-inducing drugs does not appear to increase the risk for ovarian cancer, but its role cannot be completely excluded.

Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock.

STUDY OBJECTIVE: To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital. PATIENTS: Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery. CONCLUSION: The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.

Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.

A retrospective, descriptive study was conducted to evaluate the outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence. Thirty-two women with singleton pregnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine activity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (median 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated before 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks for the 19 who achieved viability. The mean birthweight of the live infants was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infants died during the neonatal period. The total survival rate was 47%, and the survival rate corrected for major anomalies was 48.4%. The perinatal mortality rate was significantly higher among patients with membranes protruding through the-cervix on admission, compared to those without (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate. Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.

Is Operative Laparoscopy Contraindicated in Women with Ectopic Pregnancy and Hypovolemic Shock?

We evaluated the safety of operative laparoscopy for the management of ectopic pregnancy in 119 women with hypovolemic shock. In 19 (16.0%) of these women hypovolemic shock was based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. The table below presents the results (mean ± SEM; ap <0.01). One case in each group was converted to laparotomy, and all patients made full recovery. Laparoscopy allows rapid diagnosis and control of the source of bleeding, making it highly suitable for the surgical management of a ruptured ectopic pregnancy. The availability of appropriate anesthesia and advanced cardiovascular monitoring, and ability to convert rapidly to a laparotomy if necessary, allow safe performance of operative laparoscopic surgery in women with hypovolemic shock.

Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?

This study was undertaken to report the results of microsurgical lysis of peri-adnexal adhesions and identify the patients who should be offered surgery and those who should be treated by in-vitro fertilization (IVF). In all, 19 women had filmy adhesions and 32 had dense adhesions; 68.4% of women with filmy adhesions conceived compared with 34.4% of women with dense adhesions (P = 0.02). In patients with filmy adhesions, the cumulative pregnancy rate 2 years after operation (47%) is similar to that reported after five cycles of IVF (52%), leading us to conclude that such patients should be offered surgery first. Dense adhesions are best treated by IVF. Lysis of filmy adhesions produces a similar intra-uterine pregnancy rate whether performed by laparotomy (57.9%) or laparoscopy (56.6%). As operative laparoscopy offers the greatest patient comfort, it is the treatment of choice in these patients.

Transvaginal Doppler sonography for detecting ectopic pregnancy: is it really necessary.

In this prospective study we compared transvaginal duplex Doppler ultrasound with two-dimensional imaging for the diagnosis or exclusion of ectopic pregnancies. The study group comprised 76 stable patients with serum beta-human chorionic gonadotropin (hCG) levels > 100 mIU/ml in whom ectopic pregnancy was clinically suspected. Ectopic pregnancies were verified in 42 patients (60%), intrauterine pregnancies (normal and abnormal) in 19 (27%), and possible complete abortions, either intrauterine or extrauterine, in 9 patients (13%). Based on 2-D imaging alone, the appearance of an adnexal mass separated from the ovaries, and a lack of clear intrauterine gestational sac indicated ectopic pregnancy with a sensitivity of 95%. Intrauterine sac-like structures and absence of adnexal masses excluded ectopic pregnancies with a specificity of 89%. High velocity systolic flow, and low impedance diastolic flow which characterizes trophoblastic tissue when detected outside the uterus, had a sensitivity of 48%, while the presence of trophoblastic signals in the uterus or their absence outside the uterus excluded ectopic pregnancies with a specificity of 89%. The positive predictive values were 91% for Doppler and 95% for 2-D imaging, while the negative predictive values were 89% for imaging alone and 44% for Doppler. These data suggest that transvaginal Doppler ultrasound has significant lower sensitivity and negative predictive value and does not provide more useful diagnostic information than 2-D imaging alone for stable patients with suspected ectopic pregnancies.

Laparoscopic laser surgery of primary ovarian pregnancy.

We present a rare case in which therapy of primary ovarian pregnancy, using laparoscopic laser surgery (videolaseroscopy), was successfully performed without the need of laparotomy. Because operative laparoscopy has the benefits of reduced morbidity, reduced hospitalization and rapid recovery, and because it has the advantage of reducing postoperative adhesions as compared to laparotomy, it is the preferable technique for treatment of ovarian gestation after a laparoscopic diagnosis, especially for a woman who desires to preserve her fertility potential.

Laparoscopic prophylactic oophorectomy in women belonging to ovarian cancer-prone families. Advantages and shortcomings.

Laparoscopic prophylactic oophorectomy was performed on four women who belonged to ovarian cancer prone families. The procedure was of short duration with an uncomplicated intra- and postoperative course and required only brief hospitalization. These merits may outweigh those of prophylactic oophorectomy performed by laparotomy during which hysterectomy is usually also performed. When prophylactic oophorectomy is contemplated, operative laparoscopy should also be considered.

A new approach to ovarian cystectomy: a combined laparoscopic and extra-abdominal microsurgical technique.

Our objective was to apply a new surgical technique to ovarian cystectomy combining the advantages of laparoscopy with the benefits of microsurgical principles, in an attempt to simplify the surgical laparoscopic procedure and reduce postoperative adhesion formation. Between May 1991 and March 1992, extracorporal ovarian cystectomy was performed in 27 patients who presented with persistent ovarian cysts at the department of gynecology of a large teaching hospital that receives primary referrals from public health care patients. Patients were referred with the diagnosis of a persistent ovarian cyst. Diagnosis was confirmed by pelvic bimanual examination, and transvaginal ultrasound. Cases where malignancy was suspected due to the presence of ascites, semi-solid or solid masses, demonstration of papillations within the ovarian cyst on ultrasound, or elevated CA-125 levels (unless endometriosis was suspected) were excluded from the study group. At laparoscopy, after inspection of the abdominal cavity the cyst was aspirated. The ovary was then extracted through a 2- to 3-cm lower-abdominal incision, cystectomy was meticulously performed according to microsurgical principles, and the repaired ovary was then returned into the abdominal cavity. Extracorporal cystectomy was successfully performed in 26 of 27 cases. The mean duration of the operative procedure was 55 min. The postoperative course was uneventful. Mean postoperative hospitalization time was 22.4 h. Over a follow-up period of up to 15 months, ovarian folliculogenesis was confirmed ultrasonographically. In the first 2 patients to undergo second-look laparoscopy, no adhesions were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Salpingectomy by operative laparoscopy and subsequent reproductive performance.

Between January 1984 and August 1991, 511 cases of extrauterine pregnancies were diagnosed by laparoscopy in our department. In 374 cases salpingectomy was performed: 184 by explorative laparotomy, and 190 by operative laparoscopy. Patients were scheduled for salpingectomy if one or more of the following criteria were fulfilled: (i) a ruptured tube which was surgically unsuitable for conservation; (ii) no interest in future fertility; (iii) tubes with ectopic gestation previously operated on; (iv) a previous tubal pregnancy on the same side, which was treated expectantly. Salpingectomy was performed via operative laparoscopy with bipolar diathermy forceps and laparoscopic scissors. Pregnancy rates, i.e. intra-uterine and repeat extra-uterine, were evaluated. The reproductive performance following salpingectomy did not differ significantly, whether by laparotomy or laparoscopy: the intra-uterine pregnancy rate was 78 and 64%, respectively and the repeat ectopic pregnancy rate was 12 and 6%, respectively. Salpingectomy via laparoscopy can be performed safely with a low incidence of complications, with subsequent reproductive performance comparable to laparotomy.

Long-term follow-up of the twisted ischemic adnexa managed by detorsion.

OBJECTIVE: To examine our assumption that although the twisted adnexa appears ischemic-hemorrhagic, it can safely be revived by detorsion with preservation of ovarian function. DESIGN: Patients' records were obtained from a computerized database and reviewed. The preoperative diagnosis of adnexal torsion was based upon patients' symptoms, clinical examination, laboratory investigations, and ultrasound scanning. SETTING: Gynecology department at a large teaching hospital receiving primary referrals of public sector patients. PATIENTS: In 40 patients who presented with signs and symptoms suggestive of ovarian torsion, "black-bluish" ischemic adnexa were encountered at surgery. INTERVENTIONS: All patients were managed by unwinding of the adnexa: laparotomy in 26 cases and operative laparoscopy in 14. In 13 patients detorsion only was performed, in 15 detorsion and cystectomy were carried out, and in 12 patients detorsion was done and ovarian cysts aspirated. MAIN OUTCOME MEASURES: Postoperative course, mean hospitalization period, follow-up pelvic examination, ovarian folliculogenesis on ultrasound examination, and oocyte retrieval and fertilization. RESULTS: The size of the twisted ovary ranged from 4 to 20 cm (mean, 9.5 cm). The postoperative course was uneventful, except for transient temperature elevation in five patients. The mean hospitalization period was 6.5 days (range 5 to 10 days) after laparotomy and 1.8 days (range 1 to 3 days) after laparoscopy. Three patients were lost to follow-up. In 37 patients, pelvic examination was normal. A normal sized ovary, with follicular development, was demonstrated sonographically in 35 of 37 patients. In 6 of 7 patients, macroscopically normal adnexa were visualized at subsequent laparotomy or laparoscopy. In two patients undergoing IVF, oocytes were retrieved and fertilized from the detorted ovary. The patency of the fallopian tube was demonstrated in four cases. CONCLUSIONS: This new "adnexal-sparing" approach should be applied instead of the traditional salpingo-oophorectomy in young women with twisted ischemic adnexa.

Methotrexate therapy of tubal pregnancy.

Reports of successful treatment of ectopic pregnancies by administration of methotrexate have recently attracted a great deal of attention. This review summarizes the results of therapy with methotrexate in tubal pregnancy. Different technical approaches and pharmacological doses have been reported. These methods, however, present various problems, including the occurrence of toxicity, long therapeutic periods and treatment failure. With proper selection of patients, a success rate of approximately 90% has been achieved. Preliminary assessment of subsequent fertility provides promising results. However, the majority of the reports do not include controls.

A new approach for the treatment of interstitial pregnancy.

The surgical treatment of interstitial pregnancy consists of either cornual resection or hysterectomy, which may seriously impair future fertility. We report a new approach that avoids surgical intervention. This presents a major breakthrough in the management of interstitial pregnancy.

Seasonal patterns in tubal pregnancy.

An investigation of possible seasonal patterns in ectopic tubal pregnancies was conducted. The computer data utilized were based on all ectopic pregnancies, abortions and deliveries (total pregnancies) recorded in the Department of Obstetrics and Gynecology at the Chaim Sheba Medical Center, Israel, between the years 1986 and 1989. Composite monthly cohorts of ectopic tubal pregnancies and total pregnancies were constructed for each month of the year, and the probability of an ectopic pregnancy was estimated. A statistically significant increase in the probability of conception rate resulted in ectopic pregnancies which occurred during winter and spring, especially in January to June. The probability of ectopic tubal pregnancies was low (0.50%) in September and high (1.81-1.42%) in December to January. When we studied primigravidae, the same seasonal pattern was observed. The findings of our study suggest, for the first time, that there is an association between meteorological and environmental factors, and ectopic pregnancies. These factors should be considered in the epidemiology of ectopic tubal pregnancies.