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Obstetrician & Gynecologist (OB/GYN), Endocrinologist (diabetes, hormones)
24 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score
Loyola University Chicago (1986)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Obstetrics and Gynecology
American Society for Reproductive Medicine

Affiliations ?

Dr. Bieber is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • UH Conneaut Medical Center
    158 W Main Rd, Conneaut, OH 44030
    • Currently 4 of 4 crosses
    Top 25%
  • Uh Richmond Medical Center
    27100 Chardon Rd, Cleveland, OH 44143
    • Currently 4 of 4 crosses
    Top 25%
  • University Hospitals Geauga Medical Center
  • University Hospitals Case Medical Center
  • UH Case Medical Center
  • Publications & Research

    Dr. Bieber has contributed to 23 publications.
    Title Secondary Amenorrhea Attributed to Occlusion of Microperforate Transverse Vaginal Septum.
    Date June 2010
    Journal Fertility and Sterility
    Excerpt

    To present a case of secondary amenorrhea after occlusion of microperforate transverse vaginal septum.

    Title Venous Thrombosis and Congenital Absence of Inferior Vena Cava in a Patient with Menorrhagia and Pelvic Pain.
    Date June 2010
    Journal Journal of Pediatric and Adolescent Gynecology
    Excerpt

    Agenesis of the inferior vena cava (IVC) is an uncommon congenital vascular malformation. We report a case in a teenage female recently started on oral contraception.

    Title Case of Accessory Ovary in the Round Ligament with Associated Endometriosis.
    Date August 2009
    Journal Journal of Minimally Invasive Gynecology
    Excerpt

    The phenomenon of accessory ovary, initially described in 1864, is extremely rare. We report a case of an accessory ovary in a round ligament with endometriosis. At the time of laparoscopy a firm 2- to 3-cm mass was noted within the round ligament with a normal ovary visualized. Dissection and removal of the mass was performed. Histopathology revealed ovarian stroma and dense connective tissue with endometriosis. This case fulfills the criteria established in 1959 for accessory ovary and is the first case of an accessory ovary reported within the round ligament. A unique finding with the accessory ovary in this case is the presence of endometriosis. No reported cases exist of endometriosis within an accessory ovary. This information may be pertinent for evaluation of dysmenorrhea when no endometrial implants are present, or with the persistence or recurrence of endometriosis and pain after a bilateral salpingo-oophorectomy.

    Title Case of Sisters with Complete Androgen Insensitivity Syndrome and Discordant Müllerian Remnants.
    Date March 2009
    Journal Fertility and Sterility
    Excerpt

    Presentation of complete androgen insensitivity in two members of the same family with differing residual Müllerian tissue.

    Title Modulation of the Expression of Vascular Endothelial Growth Factor in Human Fibroblasts.
    Date April 2005
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To examine the up-regulation of vascular endothelial growth factor (VEGF) expression by hypoxia, a crucial event leading to neovascularization, as the reduction in VEGF expression may facilitate minimization of adhesion development. DESIGN: Prospective experimental study. SETTING: University medical center. PATIENT(S): Five patients with adhesions undergoing laparotomy with excision of adhesions and normal peritoneum. INTERVENTION(S): Adhesion and normal peritoneal fibroblasts were treated with dichloroacetic acid (DCA) or NS-398 (a cyclooxygenase-2 [COX-2] inhibitor) for 24 to 48 hours. MAIN OUTCOME MEASURE(S): A real-time reverse transcriptase polymerase chain reaction (RT-PCR) to quantify relative changes in mRNA levels of VEGF from each treatment. RESULT(S): In both normal peritoneal and adhesion fibroblasts, VEGF mRNA was present with statistically significantly higher levels in adhesion fibroblasts (32%). The DCA treatment resulted in a statistically significant decrease in VEGF mRNA levels in adhesion (20%) and normal peritoneal (18%) fibroblasts. The NS-398 treatment resulted in a statistically significant decrease in VEGF mRNA levels in adhesion (25%) and normal peritoneal (16%) fibroblasts. CONCLUSION(S): Stimulation of aerobic metabolism by DCA or inhibition of COX-2 by NS-398 reduces VEGF expression. Angiogenesis, which is an integral component in the development of dense vascular adhesions, may be reduced by either COX-2 inhibitors or stimulation of aerobic metabolism by DCA.

    Title Laparoscopy: Past, Present, and Future.
    Date August 2003
    Journal Clinical Obstetrics and Gynecology
    Title Estrogens and Hormone Replacement Therapy: is There a Role in the Preservation of Cognitive Function?
    Date January 2002
    Journal International Journal of Fertility and Women's Medicine
    Excerpt

    Alzheimer's disease affects as many as 40% of Americans over the age of 80 and, as such, is a major public health issue. Interestingly, there is a two- to threefold greater prevalence in women than in men. It has been estimated that the prevalence of Alzheimer's disease will quadruple over the next half century. There have been implications of an effect of estrogen on neurological function for many years. As long as 50 years ago a study published in the gerontology literature suggested that the administration of i.m. estrogen in a nursing home population was associated with improvement in memory and a delay in progression of memory loss. Most recently there has been great interest in the effect of estrogen on both neurons and the CNS vasculature. A study evaluating verbal memory and abstract reasoning in over 700 women without dementia demonstrated that women who had used estrogen for as little as 1 year had significant improvements in baseline cognitive testing. The pathogenesis of Alzheimer's disease and neurodementia is better understood today but remains incompletely elucidated. It has been suggested that inflammation exists both within the neurovasculature and the stroma and that beta-amyloid creates an inflammatory reaction. In Alzheimer's patients there are abnormal deposits of proteins such as beta-amyloid, presenelin, and apolipoprotein E-4. Estrogen may act as a protectant against these inflammatory mediating proteins. While a recent trial demonstrated no impact of estrogen in patients diagnosed with mild to moderate Alzheimer's, other studies have suggested that estrogen use significantly delays disease onset. One study followed over 1,100 subjects who were free of disease at trial initiation over a period of 1 to 5 years. Even short-term use of estrogen imparted protection, although longer-term estrogen use was associated with greater protection. Unfortunately, most women are unaware of the potential beneficial effect of estrogen on cognitive function. Prospective studies are under way to try to delineate how estrogen impacts Alzheimer's disease.

    Title Thoracic Endometriosis Syndrome Resembling Pulmonary Embolism.
    Date October 2001
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    A 32-year-old infertility patient with a previous diagnosis of stage IV endometriosis experienced shortness of breath and chest pain. She was diagnosed with a pulmonary embolism by spiral volumetric computed tomography (SVCT) and anticoagulated during hospitalization, although no history of thrombosis was ever identified. She continued to have intermittent symptoms of chest pain, back pain, and shortness of breath for the next 1.5 months. Repeat SVCT revealed a large, right-sided pleural effusion with associated consolidation but no evidence of pulmonary embolism. To obtain a definitive diagnosis, a thoracoscopic pleural biopsy was performed and showed thoracic endometriosis involving the pleura. The patient desired to retain her fertility and opted for treatment with depot medroxyprogesterone. She has been asymptomatic for 2 years with this treatment. This case illustrates the importance of recognizing thoracic endometriosis syndrome and the difficulty diagnosing this condition considering its nonspecific features.

    Title Breast Cancer and Hrt--what Are the Data?
    Date October 2001
    Journal International Journal of Fertility and Women's Medicine
    Excerpt

    Breast cancer remains one of women's greatest concerns. When asked regarding the likelihood of contracting a specific disease, most women believe their greatest risk of death is from breast cancer. Interestingly, we have gone from a time when estrogen was utilized as a treatment regimen in advanced breast cancer, to the current question of hormone replacement therapy increasing the risk of breast cancer. When one searches earlier data, it is noted that estrogen in several different forms, including ethinyl estradiol, as well as DES, was used as a therapeutic agent in the management of advanced breast cancer. Indeed, some of the original trials evaluating tamoxifen for adjunctive treatment of breast cancer used estrogen as the "gold-standard" treatment arm. Numerous publications have attempted to address the relationship between hormone replacement therapy and breast cancer. In the last quarter of a century, at least 50 epidemiological studies have been published, with some studies demonstrating slight increases in patients who used hormone replacement therapy for an extended time, while others demonstrated no evidence of a change in incidence. The "Nurses' Health Study" suggested that current users of hormone replacement therapy of 5 or more years' duration have a relative risk of greater than 1.4. While a well-performed and conceived trial, it suffers from limitations like all other studies. In the same time period, multiple additional studies have cast doubt on the likelihood of hormone replacement therapy markedly increasing the risk of breast cancer. When the multitude of studies is combined, the evidence seems to demonstrate that in ever-use of hormone replacement therapy the increase in relative risk is small. It is interesting that, in almost all studies published (even those demonstrating increases such as the "Nurses' Health Study") discontinuation of 2 to 5 years evaporates the increased risk. This seems biologically implausible, given the prior exposure. A recent study by Sellers et al evaluated over 41,000 patients in a prospective cohort. In this study, they closely evaluated patients who were at a higher risk of breast cancer based on a positive family history in first-degree relatives. Interestingly, they, like others, found that HRT was not associated with a significantly increased incidence of breast cancer, but did note a significantly reduced total mortality rate. When one evaluates the sum total data in the world literature regarding hormone replacement therapy and breast cancer, it is difficult to ascertain that any substantial clinical risk exists with the use of hormone replacement therapy and breast cancer. Multiple ongoing trials, including the Women's Health Initiative-a Prospective Protocol, will help to define better if any appreciable risk exists.

    Title Anterior Abdominal Wall Adhesions After Laparotomy or Laparoscopy.
    Date June 1997
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    STUDY OBJECTIVE: To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect safe placement of the initial laparoscopic umbilical cannula at subsequent procedures. DESIGN: Prospective cohort study. SETTING: Reproductive endocrinology and infertility service of a tertiary care referral hospital. PATIENTS: Two hundred fifteen women, 124 with prior abdominal surgery and 91 with no prior surgery. INTERVENTIONS: Surgical histories were reviewed, abdominal skin scars noted, and extent of anterior abdominal wall adhesions prospectively recorded. Statistical analysis was performed with the chi2 test. MEASUREMENTS AND MAIN RESULTS: No anterior abdominal wall adhesions were present in 91 patients with no previous surgery or 45 patients with previous laparoscopy (12 had more than 1 laparoscopy; p <0.001 vs laparotomy). Seventeen (59%) of 29 patients with a midline vertical incision had anterior wall adhesions (p <0.05 vs suprapubic transverse incision). Eleven (28%) of 39 with a suprapubic transverse incision had anterior wall adhesions (p <0.001 vs no surgery or laparoscopy). Ninety-six percent of adhesions involved omentum and 29% included bowel. CONCLUSION: Prior laparotomy, whether through a midline vertical or suprapubic transverse incision, significantly increased the frequency of anterior abdominal wall adhesions, and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus.

    Title Failed Distal Ulna Resections.
    Date May 1988
    Journal The Journal of Hand Surgery
    Excerpt

    Twenty patients with complaints of pain and limitation of activities for more than 1 year after ulnar head resection (Darrach) were studied. Their ages ranged from 18 to 60 years (mean, 38 years). The initial indications for operation were posttraumatic derangement in 18 patients, radial growth anomaly in 1, and a lesion of the ulna in 1. Follow-up ranged from 29 to 135 months (mean, 61 months). The patients had an average of 2.2 additional operations, with up to seven procedures per patient. Radiographs were compared with those from an equal number of successful Darrach resections chosen randomly, and no significant differences were noted. All 20 patients continue to have difficulties despite several years of treatment. The Darrach resection can result in serious disability, especially in the younger patient and the patient with lax ligaments. Reoperation on these patients is rarely successful.

    Title Thumb Avulsion: Results of Replantation/revascularization.
    Date November 1987
    Journal The Journal of Hand Surgery
    Excerpt

    During a 9-year period, 39 thumb avulsions required emergency replantation/revascularization at our institution. Amputation was complete in 28 (72%) cases and involved the dominant thumb in 31 (80%). Farm machinery was the source of injury in 33 (85%) cases. Follow-up ranged from 7 months to 6 years. Only 10 of the revascularization attempts (26%) were successful; the remaining attempts required amputation at the level of the injury. In two (18%) of the 11 partial amputations and in eight (29%) of the 28 complete amputations, revascularization was successful. In eight (31%) of the 26 thumbs in which vein grafts were used, revascularization was successful, while one of the other two successes involved a transfer of the radial digital artery of the index finger. In six of the ten successful revascularizations, nerve repair was attempted, but without further procedures, none of the six digits regained two-point discrimination of less than 1 cm.

    Title Compartment Syndrome Masked by Epidural Anesthesia for Postoperative Pain. Report of a Case.
    Date January 1987
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Bone Reconstruction.
    Date December 1986
    Journal Clinics in Plastic Surgery
    Excerpt

    The reconstruction of bone defects relies upon the reconstitution of bone in the area. The basic concepts of fracture healing are presented to better understand the mechanism of bone grafting. Conventional bone graft techniques are quite effective in reconstructing defects, including those up to 25 cm in length, provided an adequate vascular bed is available to allow vascularization of the grafts. If an adequate milieu is not available, then the use of a pedicle or free vascular bone graft can be employed. Just as skin and muscle flaps have provided the solution to soft-tissue loss, vascularized bone grafts provide the technique to deal with large bone defects not amenable to conventional treatment. Allografts additionally have a place in skeletal reconstruction but require appropriate management and consideration of host immune response.

    Title Lipomas Compressing the Radial Nerve at the Elbow.
    Date August 1986
    Journal The Journal of Hand Surgery
    Excerpt

    Four patients have been treated for compression of the radial nerve by lipomas at the elbow. The treatment of all cases was surgical excision with complete resolution. Lipomas are a very common tumor but infrequently cause nerve compression symptoms.

    Title Silicone-rubber Implant Arthroplasty of the Metacarpophalangeal Joints for Rheumatoid Arthritis.
    Date March 1986
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Forty-six patients with rheumatoid arthritis underwent metacarpophalangeal-joint arthroplasty of the index through little fingers on 210 joints in fifty-five hands using the Swanson-design silicone-rubber spacer. The patients were followed for two to eight years (average, five and one-quarter years). They were evaluated both preoperatively and postoperatively for range of motion, deformity, subjective sense, grip strength, and prehension. In the initial postoperative evaluation, the majority of patients expressed a strong subjective impression of improvement. Ulnar drift improved from the preoperative average of 25 degrees to less than 5 degrees. The preoperative average extension deficit decreased from 56 to 10 degrees, while the average range of motion increased from 17 to 51 degrees. In the long-term postoperative evaluation, the average ulnar drift had increased to 12 degrees, the average extension deficit had increased to 22 degrees, and the average range of motion had decreased to 39 degrees. Grip strength and prehension did not significantly improve at either evaluation. There were no fractures of the prosthesis and no patient had synovitis. We have found the procedure to be useful for the correction of deformity, increasing range of motion of the fingers, and improving the patient's sense of well-being.

    Title Traumatic Dorsal Dislocation of the Triquetrum: a Case Report.
    Date February 1985
    Journal The Journal of Hand Surgery
    Excerpt

    A case of traumatic dorsal dislocation of the triquetrum associated with direct trauma is reported. Diagnosis was delayed, and open reduction and internal fixation with Kirschner wire was performed 7 days after injury. Eight months afterwards, the patient had good alignment of the carpus assessed radiographically, with full range of motion of the wrist and normal grip strength.

    Title Sodium-dependent Uptake of Taurine in Encapsulated Staphylococcus Aureus Strain M.
    Date April 1984
    Journal Biochimica Et Biophysica Acta
    Excerpt

    A novel uptake system for the unusual sulfonated amino acid taurine was discovered in the prokaryote, encapsulated Staphylococcus aureus strain M. This strain has been shown previously to contain taurine in its capsular polysaccharide. Taurine uptake by whole cells incubated in buffer showed a saturable dependency upon Na+ and taurine uptake was itself a saturable process, stimulated by glucose, and markedly affected by temperature. No evidence was found for the inducibility of taurine uptake. In the presence of 10 mM NaCl Lineweaver-Burk plots revealed a Km of 42 microM and Vmax of 4.6 nmol/min per mg dry weight for taurine uptake at 37 degrees C. Increasing concentrations of Na+ decreased the Km of the system and appeared to increase the Vmax. Of various other cations tested only Li+ supported marked taurine uptake. Excess unlabelled taurine did not cause efflux of radioactivity taken up. Taurine was taken up into cold trichloroacetic acid-soluble material and did not chromatograph as taurine, indicating rapid metabolism during or closely following uptake. Taurine uptake appeared to occur via a highly specific system because amino acids representing the major known groups of amino acid transport systems in S. aureus did not inhibit taurine uptake, and uptake was only slightly diminished by the structurally closely related compounds hypotaurine and 3-amino-1-propane sulfonic acid. Sulfhydryl group reagents, electron transport inhibitors, an uncoupler and inhibitors of Na+-linked transport processes inhibited taurine uptake. A variety of other metabolic inhibitors had little effect on taurine uptake.

    Title An In-vivo Evaluation of the Correlation Between Histologic and Visually Estimated Zones of Tissue Injury Created with Monopolar Electrosurgery
    Date
    Journal
    Excerpt

    It has been postulated that laparoscopic electrosurgery may be a less predictable surgical method than lasers and substantial tissue injury may occur unbeknownst to the surgeon. We proposed to evaluate the correlation of histologic injury to visual estimated injury in a porcine model undergoing laparoscopic electrosurgery. A 25 kg female pig underwent laparoscopy. Using monopolar scissors, "touch cuts" were performed to create a peritoneal defect. Progressive increases in current density where achieved by increasing the pre-calibrated wattage of a Valley Lab Force 2 generator. Both pure cutting and coagulation waveforms were used. An estimate of lateral damage was obtained by using a calibrated probe. At laparotomy, these tissue samples were individually extracted en-bloc, pinned flat and placed in formalin. Multiple sections were taken from each block and stained. A pathologist who was blinded to power settings evaluated the amount of thermal destruction. Thirty evaluable peritoneal sections were multiply examined by the blinded pathologist. A significant correlation was found between the visual estimation of injury and the histologic grading of tissue damage. (Pearson's Correlation Coefficient=0.42, P<0.02). These findings suggest that visual estimation of laparoscopic tissue injury is correlated to the actual histologic tissue damage. These data may aid the laparoscopic surgeon in evaluating the efficacy of the power settings and the need for modification during the operative procedure rather than retrospectively in the pathology laboratory.

    Title The Risk of Anterior Abdominal Wall Adhesions in Patients with Previous Umbilical Hernia Repair
    Date
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    The incidence of umbilical hernia may be increased in certain populations during infancy. Many procedures to repair such defects are thus performed during early childhood. Patients may present for adult surgery with minimal or no recollection of these surgeries and with only a small infra-umbilical incision which appears remarkably similar to an incision for laparoscopy. We proposed to evaluate the risk of adhesions to the area of the umbilicus and anterior abdominal wall in patients presenting for laparoscopic surgery. Eight patients with documentable umbilical hernia repair comprise this study. One patient had undergone two procedures. To best evaluate the umbilicus, initial trocar insertion was made in the left upper quadrant, 2 cm below the costal margin in the mid-clavicular line. Findings demonstrated significant bowel and omental adhesions to the area of the umbilicus in all but one patient. Interestingly, one patient had previously undergone an unsuccessful attempt at Veress needle placement and open laparoscopy. This patient had massive bowel adhesions to the entire umbilical region. In all but the one case, trocar or Veress needle insertion would have likely caused significant tissue or visceral injury. No complications occurred in this series. In conclusion, patients with previous umbilical hernia repair may be at higher risk for adhesive disease to this region. Appropriate bowel preparation prior to surgery and site selection for trocar entry may aid in decreasing the risk of visceral injury.

    Title The Diagnostic Challenge of Identifying Isolated Fallopian Tube Torsion: a Case Report of Laparoscopic Management.
    Date
    Journal Journal of Minimally Invasive Gynecology
    Excerpt

    Torsion of adnexal structures is a relatively uncommon occurrence. Isolated fallopian tube torsion is an even rarer gynecologic cause of acute low abdominal pain. Diagnosis of this condition is frequently delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain on a differential diagnosis. A case of a 32-year-old woman with isolated right fallopian tube torsion managed laparoscopically is presented.

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