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Biomedical subjects

J A Portuondo

Publications and source records attributed to J A Portuondo.

At least 19 recordsLinked to original sources
PubMed1986

Management of phenotypic female patients with an XY karyotype.

Nine phenotypic female patients with XY karyotype were evaluated through a clinical, cytogenetic, hormonal, endoscopic and histologic diagnostic protocol. Seven patients complained of primary amenorrhea and two patients of abnormal puberal development. The final diagnosis was XY gonadal dysgenesis (n = 5) and testicular feminization syndrome (n = 4). Two patients were less than 155 cm tall, and the remainder were over 155. Minor somatic anomalies were found in two patients with XY gonadal dysgenesis. Patient with testicular feminization syndrome had FSH and LH within the normal range, and patients with XY gonadal dysgenesis had elevated FSH and LH levels. Gonadoblastomas were found in two patients with XY gonadal dysgenesis (one patient with XO/XX/XY mosaicism). Laparoscopy and gonadal biopsy might be useful in some patients to avoid confusion between XY gonadal dysgenesis and testicular feminization syndrome. Early diagnosis of XY gonadal dysgenesis is always desirable, and bilateral gonadectomy is indicated as soon as the diagnosis is made in patients with a Y chromosome and elevated FSH levels. Surgical removal of the gonads from patients with testicular feminization should be delayed until the completion of puberty because of the low risk of malignancy.

Adolescent↗
PubMed1986

Müllerian abnormalities in fertile women and recurrent aborters.

Ninety-six women with recurrent first-trimester spontaneous abortions underwent hysterosalpingography to rule out müllerian abnormalities, both congenital and acquired. Results were compared with those in 96 women who had undergone hysterosalpingography before artificial insemination by donor and subsequently had a full-term, normal delivery. The patients with two recurrent, consecutive abortions had müllerian abnormalities similar to those in women with three consecutive abortions; however, they had different müllerian abnormalities than did the control group. Congenital and acquired malformations seen most often in patients with recurrent abortions were septate, arcuate and bicornuate uteri and incompetent cervical os. Pelvic examination did not discriminate between patients with recurrent abortions and the control group.

Abortion, Habitual↗
PubMed1984

Clinical and pathologic evaluation of 342 benign ovarian tumors.

A series of 289 patients who were diagnosed with 342 benign ovarian tumors (BOT) at laparotomy have been reviewed. Mean age was 36.7 years (S.D. +/- 13.9), mean parity was 1.5 (S.D. +/- 1.6); 236 (81.7%) patients had a single unilateral ovarian tumor; 29 (10%) patients had bilateral ovarian tumors. Benign cyst teratoma was diagnosed in 89 (26%) tumors, and it was the most frequent histological type. In eight patients (2.8%) the post-operative pathologic report was compatible with malignancy, despite the lack of suspicion at laparotomy. Mean maximal diameter of BOT was 9.1 cm, and almost 60% of the mucinous cystoadenomas were larger than 16 cm. Benign cyst teratoma and serous cytoadenoma had a medium size, about 6-10 cm. Lower abdominal-pelvic pain was the symptom most frequently reported by patients with BOT. Calcifications were most frequently seen in benign cyst teratoma. Tumors of 11-15 cm in size were the tumors most frequently torsioned. Twenty four (8.3%) patients had their surgical operation done during pregnancy; benign cyst teratoma was the tumor most frequently associated with pregnancy.

Adolescent↗
PubMed1984

Gonadal dysgenesis and somatic stigmata in patients with 45,X/46,Xr(X) ring chromosome.

Two cases of gonadal dysgenesis and stigmata of Turner's syndrome with ring chromosome X are described. Their features support the idea that ring chromosome X should be considered as a deletion in the genetic sense, affecting both the gonadal and statural determinants. Without knowing the cytogenetic findings, these patients are usually labeled as having Turner's syndrome. Furthermore, endocrine data and histologic examination of the gonads are indistinguishable from those of individuals with 45,X or 46XX gonadal dysgenesis.

Adolescent↗
PubMed1984

Influence of following Green's criteria for urinary stress incontinence surgical procedures.

A series of 161 patients with urinary stress incontinence and who underwent either Kelly urethral plication or Marshall-Marchetti procedures were reviewed in order to evaluate the usefulness of following Green's criteria in the selection of type of surgery for stress incontinence. One-year follow-up failure rate was higher in patients with type I stress incontinence (23%) than in type II stress incontinence (15.5%), and also when the choice of surgical approach did not follow Green's criteria; statistical analysis of these data showed that differences did not reach a significant level (P greater than 0.05).

Female↗
PubMed1984

Periovarian adhesions following ovarian wedge resection or laparoscopic biopsy.

The purpose of this paper is to describe the formation of periovarian adhesions after ovarian bilateral wedge resection or laparoscopic biopsy. Twelve patients with polycystic ovaries and infertility had bilateral ovarian wedge resection and second-look laparoscopy after a mean of 33 months. On the other hand, twenty-four patients with various menstrual disorders had laparoscopic ovarian biopsy and subsequent second-look after a mean of 8.8 months. Ninety-two per cent of the patients who had wedge resection had some periovarian adhesions, and in three cases the adhesions were extensive enough to produce mechanical infertility. Pregnancy occurred in four patients despite the presence of filmy or moderate adhesions. The patients who had laparoscopic ovarian biopsy were found to be free of periovarian adhesions during the second-look ovarian visualization. We conclude that ovarian resection should be reserved for nonresponders to a nonsurgical approach of anovulation, and ovarian biopsy when properly done is not followed by periovarian adhesions.

Adult↗
PubMed1984

Clinical selection of infertile patients for laparoscopy.

For a period of time routine hysterosalpingography and laparoscopy were carried out in every patient complaining of more than 2 years of primary infertility. The records of 433 such patients were retrospectively evaluated according to their clinical aspects. Complete agreement between the two diagnostic methods was found in 70.9% of this unselected population. Almost 50% of the population had some abnormalities in either hysterosalpingography or laparoscopy. According to the patient's past history, pelvic examination, and the duration of infertility, the unselected infertile population was classified into a) high risk infertility and b) low risk infertility. High risk infertility patients had (P less than 0.01) greater abnormal findings at both hysterosalpingography and laparoscopy. In this high risk group we recommend early laparoscopy and the postponement of hysterosalpingographic investigation for patients with suspected cornual occlusion or destruction of ampullary rugae (valuable in assessing tubal damage). Low risk infertility patients had (P less than 0.01) low abnormal findings at both hysterosalpingography and laparoscopy, and in these patients hysterosalpingography does not discriminate the group of higher abnormal laparoscopic findings. Hysterosalpingography can be initially indicated as a less invasive investigation in the low risk group. We conclude that clinical data are very valuable in the selection of infertile patients for early or late laparoscopy.

Fallopian Tube Patency Tests↗
PubMed1984

Clinical selection of infertile patients for laparoscopy.

For a period of time routine hysterosalpingography and laparoscopy were carried out in every patient complaining of more than 2 years of primary infertility. The records of 433 such patients were retrospectively evaluated according to their clinical aspects. Complete agreement between the two diagnostic methods was found in 70.9% of this unselected population. Almost 50% of the population had some abnormalities in either hysterosalpingography or laparoscopy. According to the patient's past history, pelvic examination, and the duration of infertility, the unselected infertile population was classified into a) high risk infertility and b) low risk infertility. High risk infertility patients had (P less than 0.01) greater abnormal findings at both hysterosalpingography and laparoscopy. In this high risk group we recommend early laparoscopy and the postponement of hysterosalpingographic investigation for patients with suspected cornual occlusion or destruction of ampullary rugae (valuable in assessing tubal damage). Low risk infertility patients had (P less than 0.01) low abnormal findings at both hysterosalpingography and laparoscopy, and in these patients hysterosalpingography does not discriminate the group of higher abnormal laparoscopic findings. Hysterosalpingography can be initially indicated as a less invasive investigation in the low risk group. We conclude that clinical data are very valuable in the selection of infertile patients for early or late laparoscopy.

Female↗
PubMed1984

Fertility and contraception of 6 patients with ovarian pregnancy.

A series of 6 ovarian pregnancies out of 369 ectopic (1.65/100 tubal) were selected to evaluate the fertility and contraception of patients with this rare condition. Mean patients' age was 28.5 years, mean previous parity was 1.5 children and all but one were using some sort of contraception (four had an IUD inserted and one had a previous laparoscopic tubal ligation). Clinical features on admission were as reported for the ectopic pregnancy and surgical findings at laparotomy showed an otherwise intact tubes. Postoperative further contraception was used by four patients and the two non-users became pregnant easily within an 18 month period. We conclude that ovarian pregnancy is an accident which occurs in a rather fertile population with an intact genital tract and who were using intrauterine contraceptive devices. Postoperative reproduction performance shows a high fertility rate in those patients who were not using any contraceptives at all.

Adult↗
PubMed1984

Chromosomal complements in primary gonadal failure.

Twenty-nine patients underwent clinical, hormonal, endoscopic, and cytogenetic studies to determine the cause of primary amenorrhea or delayed sexual development. In 19 of them (mean age 17.6 years), the X chromosome was either missing or anomalous. In ten patients (mean age 25.5 years), the chromosomal complement was normal, 46 XX in six patients and 46 XY in four patients. Those with abnormal chromosomal complements were shorter (mean height, 141.9 cm) than patients with normal complements (158.7 cm). Somatic stigmas were observed more frequently in patients with chromosomally abnormal primary gonadal failure. In 23 patients (79.3%), the gonads were streaks, with fibrous stroma devoid of either follicles or tubules containing germ cells. In three patients the ovaries were hypoplastic, with few primordial follicles. Gonadoblastoma was present in two patients with XY and mixed XX/X/XY gonadal dysgenesis. In every patient with streak gonads and lack of germ cells, serum gonadotropin levels were elevated. Karyotype, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) assays, and eventually laparoscopy and gonadal biopsy are important in the management of patients with primary gonadal failure.

Adolescent↗
PubMed1983

Early conception in patients with untreated mild endometriosis.

The purpose of this paper is to report the reproductive experience in 31 infertile patients with mild endometriosis who were not treated by surgery or medication. A series of 31 cases of laparoscopically diagnosed mild endometriosis were followed up without therapy for a period of 36 months. Ten patients received artificial insemination by donor (AID) because of male-related infertility; 21 patients had well-timed postcoital tests and monitored ovulation cycles. Life-table analysis of conceptions was used for presentation of the pregnancy rate. The group of patients whose husbands were azoospermic had a 90% pregnancy rate within 18 months, with a mean of 3.5 treatment cycles for pregnancy. The nonazoospermic couples had a 47.6% pregnancy rate within 18 months, with a mean of 7.2 monitored cycles for pregnancy. The calculated median delays for the series of patients who conceived were 1.9 cycles. The whole series (n = 31) of patients with mild endometriosis had an 8.3% monthly pregnancy rate within 18 months and a 61.2% cumulative pregnancy rate within 18 months. We have come to the conclusion that mild endometriosis does not interfere with female fertility, and patients with this extent of disease should not be treated for a trial period of at least 18 months as an alternative to more aggressive therapy.

Adult↗
PubMed1983

Absence of ovulation stigma in the conception cycle.

The purpose of this paper is to show the incidence of ovulation stigmata (and the so-called luteinized unruptured follicle) in six patients who conceived during the laparoscopy cycle. Only two patients (33.3%) showed ovulation stigmata when their ovaries were visualized 2 to 7 days after the BBT dip, close to the estimated time of ovulation. Four patients (66.6%) whose ovaries were seen 10-12 days after the BBT dip failed to show any ovulation stigmata in spite of the fact that they conceived during that cycle and therefore the ovulation was proven. We have come to the conclusion that the laparoscopic picture of the luteinized unruptured follicle should no longer be considered to contain the trapped ovum and other diagnostic procedures should be used in the diagnosis of the ovum retention syndrome.

Adult↗
PubMed1982

Ectopic pregnancy early diagnosis limitations.

A series of 219 surgically and pathologic proven ectopic gestations are reviewed to emphasize the ectopic pregnancy early diagnosis limitations. A childbearing age, low parity woman is typical of having an ectopic pregnancy. Risk factors in their past history were absent in 52% of patients. Fertility investigations, IUD, PID, and abdominal surgery are often found in their past. Six per cent of patients had a previous ectopic pregnancy. Sixty-one per cent of patients were admitted with a definite ruptured ectopic pregnancy and 37% were admitted to rule out this condition. At surgery 58% had ruptured ectopic pregnancy with intraabdominal hemorrhage. Only 12% were unruptured. The obstetric outcome after surgery was available in 74 patients. Out of these, 40.5% had term pregnancies with live children, repeat ectopic pregnancy occurred in 8.2%, spontaneous first trimester abortion in 4.1%, and subsequent infertility in 16%. Postoperative pelvic adhesions were more frequently seen, at laparoscopy, when the patients were diagnosed at the stage of ruptured ectopic pregnancy with intraabdominal hemorrhage. A diagnostic protocol based on the screening of the patients at risk, correct evaluation of symptom and signs, and liberal use of beta-hCG pregnancy tests, culdocentesis, ultrasound and laparoscopy, is finally proposed.

Adolescent↗
PubMed1982

Peritoneal flushing and biopsy in laparoscopically diagnosed endometriosis.

A series of 74 patients with endoscopically proven endometriosis were selected for evaluation of usefulness of peritoneal flushing and aspiration in the early diagnosis of pelvic endometriosis. Forty-three patients had either an ovarian or a peritoneal biopsy performed after peritoneal lavage. The results indicate that 25% of the washings performed were successful in demonstrating endometrial glands or stroma. On the other hand, 72% of the patients on whom biopsies were performed showed endometrial tissue, and biopsy failures were mainly related to the technical difficulties of the ovarian biopsy. In 46% of the histologically proven cases of endometriosis, peritoneal lavage failed to demonstrate endometrial tissue. Conversely, in 4.6% of the negative biopsy cases, peritoneal lavage showed endometrial glands. We conclude that exfoliative cytology is not a useful tool in the diagnosis of endometriosis. On the other hand, we were able to make the diagnosis by biopsy in more than 70% of the patients on whom biopsies were performed.

Ascitic Fluid↗
PubMed1982

Prognostic value of postcoital test in unexplained infertility.

A series of 70 couples with suspected unexplained infertility and who became pregnant after 262 monitored cycles, were reviewed. In each cycle, the postcoital test was scheduled near ovulation time as judged by prior basal body temperature shifts and by cycle length. Postcoital test was graded as excellent, good, fair, bad, and negative. A mean of 26.7% of pregnancy rate per cycle resulted and a mean of 3.74 cycles were needed to obtain a pregnancy. Pregnancy rate was higher (P less than 0.01) for cycles with excellent postcoital test and lower for cycles with bad test. There were no statistically significant differences (P greater than 0.05) in percentage of pregnancies between cycles with either excellent, good, or fair postcoital test. On the other hand, there was statistically significant decrease (P less than 0.05) in the percentage of pregnancies when cycles had bad postcoital test.

Body Temperature↗