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Biomedical subjects

J W Malo

Publications and source records attributed to J W Malo.

9 recordsLinked to original sources
PubMed1997

Multicenter feasibility study of a new coaxial falloposcopy system.

We compared falloposcopy employing a new coaxial system with traditional laparoscopic chromotubation and hysterosalpingography in a prospective, multicenter clinical trial at five tertiary infertility centers. Based on findings at hysterosalpingography or laparoscopic chromotubation, the 16 women (22 tubes) in group 1 had a presumed diagnosis of proximal tubal obstruction, and the 4 (7 tubes) in group 2 had unexplained infertility. Cannulation was successfully achieved in 83.3% of tubes. In group 1, 85% (17/20) of visualized tubes were patent and 35% (7/20) were normal. In group 2, 40% (2/5) of visualized tubes were abnormal. Management was changed in 52.4% of women as a result of falloposcopic findings. Falloposcopy with this new coaxial system allows improved visualization with less bulky and less traumatic instruments. The system provides valuable information regarding the fallopian tube lumen that correlates poorly with that obtained with more traditional techniques.

Adult↗
PubMed1997

Oophoropexy to prevent sequential or recurrent torsion.

Laparoscopic oophoropexy may prevent recurrent (repeat torsion of the same ovary) or sequential (subsequent torsion of the contralateral ovary) ovarian torsion. Two adolescent girls with sequential ovarian torsion underwent laparoscopic plication of utero-ovarian ligaments. Neither patient has had recurrence in the 6. 5 and 2 years, respectively, since surgery. Sequential ovarian torsion has been described,1-8 and in almost every instance the authors raised the question of whether or not oophoropexy should have been done at the time of the initial episode of torsion. In virtually every instance the second ovary was removed and the patient rendered menopausal. In two patients with sequential ovarian torsion the ovary was saved and oophoropexy performed laparoscopically in an effort to prevent recurrence.

Adolescent↗
PubMed1995

Hysteroscopic cannulation for proximal tubal obstruction: a change for the better?

OBJECTIVE: To compare overall the results of hysteroscopic tubal cannulations and resection anastomosis for proximal tubal occlusion. DESIGN: Nonrandomized retrospective analysis of patients operated on by two surgeons. SETTING: University and large tertiary referral private practice. PATIENTS: Seventy-four patients over a 10-year period, with bilateral or unilateral proximal occlusion of a single tube. INTERVENTIONS: Hysteroscopic cannulation, resection anastomosis, or both. MAIN OUTCOME MEASURES: Intrauterine and ectopic pregnancy rates, long-term tubal patency, and pathology of tubal segments. RESULTS: In patients with normal distal tubes, intrauterine pregnancy rates were similar (12/21, 57% versus 12/24, 50%) and ectopic pregnancy rates were lower (0/21, 0% versus 7/24, 29.1%) in the cannulation group. One-year patency rates in nonpregnant patients was higher in the anastomosis group (12/15, 80% versus 3/8, 33%). CONCLUSIONS: Hysteroscopic cannulation should be first choice in the management of proximal tubal obstructions in selected patients. It may be a treatment option for delayed occlusion after successful cannulation or resection anastomosis.

Anastomosis, Surgical↗
PubMed1993

Hysteroscopic metroplasty in the diethylstilbestrol-exposed uterus and similar nonfusion anomalies: effects on subsequent reproductive performance; a preliminary report.

OBJECTIVE: To determine the feasibility of correcting the uterine abnormalities seen in diethylstilbestrol (DES)-exposed women and similar anomalies. DESIGN: Patients served as their own controls. SETTING: University based and private practice tertiary referral practice. PATIENTS: Eight patients referred for infertility, recurrent pregnancy loss, or both with an abnormal uterine contour as seen by hysterosalpingogram. INTERVENTION: Hysteroscopic metroplasty. OUTCOME MEASURES: Ability to conceive and carry pregnancy to livebirth. RESULTS: Three of five patients with secondary infertility and recurrent pregnancy losses had livebirths as did a patient with secondary infertility. Two patients with primary infertility failed to conceive. CONCLUSION: Metroplasty may decrease pregnancy loss in these patients but may not enhance fertility.

Abnormalities, Drug-Induced↗
PubMed1986

Secondary amenorrhea. A protocol for pinpointing the underlying cause.

Secondary amenorrhea presents the primary care physician with a diagnostic challenge because of the many disorders that can cause it. Thus, its evaluation warrants a systematic approach to avoid unnecessary and expensive diagnostic procedures. By using the step-by-step protocol outlined in this article, the clinician can isolate the dysfunctional compartment--outflow tract, ovary, anterior pituitary, CNS, or hypothalamus--and then pursue a more specific workup to pinpoint the cause. Treatment depends on the patient's desire for pregnancy, and the need for long-term follow-up is dictated by the specific diagnosis.

Adult↗
PubMed1985

Ovulation induction with pulsatile intravenous GnRH.

Human menopausal gonadotropin has been the treatment of choice for hypogonadotropic hypogonadism patients who fail ovulation induction with clomiphene citrate. Several authors have reported successful ovulation induction with the use of gonadotropin releasing hormone (GnRH). We used commercially available GnRH (Factrel, Ayerst Laboratories) and the Auto Syringe AS6H Infusion Pump for ovulation induction in such patients. Eight patients completed 15 cycles of pulsatile intravenous GnRH therapy. A mean of 12.2 days of therapy was required per cycle. Basal body temperatures and ultrasound documented ovulation of a single, dominant follicle in 12 cycles (80%). There were four singleton pregnancies. The overall corrected pregnancy rate was four pregnancies for ten cycles (40%) in six patients (67%). No complications were observed, and the cost of care was one-third that of human menopausal gonadotropin at our institution.

Amenorrhea↗
PubMed1984

Ovarian ectopic pregnancy.

We present the case of a 27-year-old woman with left lower quadrant pain, tenderness, and rebound tenderness. Culdocentesis demonstrated non-clotting blood, and exploratory laparotomy showed an ovarian ectopic pregnancy. A wedge resection of the ovary was accomplished and the patient recovered completely. Ovarian ectopic pregnancy is an uncommon presentation of ectopic pregnancy.

Adult↗
PubMed1980

Rapid gentamicin elimination in obstetric patients.

Wide interpatient variation in gentamicin elimination rates and dosage requirements was demonstrated in 67 obstetric patients with normal serum creatinine levels. A poor correlation occurred between the elimination rate of gentamicin and creatinine clearance (r = .23). A higher correlation was found between the drug's elimination rate and distribution volume (r = -.62), which suggests that the changing fluid status associated with pregnancy affects the kinetic parameters of gentamicin. Gentamicin dosage regimens were systematically calculated for each patient from serum concentration-time data to obtain desired serum levels. These individualized regimens demonstrated considerable variability, ranging from 3.0 to 11.6 mg/kg/day. Clinical ototoxicity and nephrotoxicity were not observed. Because of the wide interpatient variation, these increased dosages are not routinely suggested unless serum concentrations are previously measured and each patient's regimen is calculated. These results emphasize the need to measure serum concentrations and make necessary dosage adjustments to ensure therapeutic levels in obstetric patients.

Adolescent↗