Biomedical subjects
Publications and source records attributed to L R Malinak.
A study of 53 individuals failed to reveal an association between any HLA antigen and endometriosis. Division of the sample into those having a relative affected with endometriosis (N = 11) and those not having such a relative (N = 42) similarly failed to reveal significant associations.
Solutions of sodium carboxymethylcellulose (SCMC) were studied in rats to determine their longevity within the peritoneal cavity and their potential for prevention of postoperative intraperitoneal adhesions. In 18 rats, test solutions of SCMC and 10% dextran 40 were instilled at laparotomy. At 48 hours copious amounts of SCMC remained, whereas no 10% dextran 40 could be detected. In addition, standardized surgical injury was produced on the ceca of 100 rats at laparotomy. All control animals had significant adhesions at 2 weeks. Eighty-two percent of the 10% dextran 40 group had significant adhesions, while only 16% of the 0.9 wt% SCMC and 17% of the 1.0 wt% SCMC groups had significant adhesions. Solutions of SCMC were significantly more effective than 10% dextran 40 in the prevention of adhesions (P less than 0.001). Properties of SCMC and a possible mechanism for its striking effectiveness in adhesion prevention in this study are discussed.
In a rat model, sodium carboxymethylcellulose (SCMC) was compared with normal saline and 32% dextran 70 in the prevention of surgically induced intraperitoneal adhesions. The 32% dextran 70 was similar to normal saline in the initial prevention of adhesions, and both appeared less effective than SCMC. After lysis of the initial adhesions, SCMC was significantly more effective than 32% dextran 70 in the prevention of the reformation of adhesions. Possible mechanisms of action, complications of SCMC, and the need for further research in finding an ideal solution for use in adhesion prevention are discussed.
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A retrospective study of 68 female patients with sonographic diagnoses of genital tract anomalies was done. Corroboration by hysterosalpingography and/or surgery was available in 47 cases (69 per cent) and by visualization of two cervices on physical examination in three cases (4 per cent). Scan results are categorized as diagnostic, confirmatory, and incorrect. The 50 patients were placed in the following proposed categories: segmental mullerian agenesis (four cases); "peculiar appearing" uterus (three cases); uterus didelphys (19 cases); bicornuate and septate uterus (22 cases); obstructed lower with normal upper genital tract (two cases).
No formal genetic studies of incomplete müllerian fusion anomalies have been conducted previously, despite several reports of familial aggregates. Accordingly, the authors sought to determine the frequency with which symptomatic müllerian fusion anomalies occurred in relatives of a small but genetically unbiased sample of 24 probands. Only one of 37 (2.7%) female sibs over age 16 appeared to have a symptomatic uterine anomaly; none of 24 mothers, none of 45 maternal aunts, and none of 50 paternal aunts appeared affected. Such a low frequency of affected relatives is more consistent with polygenic/multifactorial etiology than with other genetic etiologies.
The rate of recurrence of endometriosis after treatment has varied from 2% to 47% in published reports. In order to determine whether a meaningful prognosis for recurrence can be rendered, 423 patients treated with conservative surgical procedures from 1967 to 1982 were followed as outpatients. From among these, 62 patients underwent reoperation. Annual rates of recurrence based on findings at reoperation ranged from 0.9% in the first postoperative year to 13.6% in the eighth postoperative year. The cumulative 3- and 5-year recurrence rates were 13.5% and 40.3%, respectively. Severity of disease was not predictive of recurrence. Pregnancy did not preclude, but did delay, recurrence. Forty-seven percent of infertile patients with recurrent endometriosis conceived after a second conservative operation. Of 20 patients who had a second conservative operation for endometriosis, 20% required a third laparotomy. This is the first study of postoperative recurrent endometriosis to utilize a control group and the first to report annual rates of recurrence and reoperation.
Seventy-seven of 226 pregnancies (34%) conceived prior to conservative surgical treatment of endometriosis ended in first-trimester spontaneous abortion. Mild endometriosis was associated with a significantly greater proportion of abortions (49% in 87 pregnancies) than moderate (25% in 32 pregnancies) or severe disease (24% in 107 pregnancies). Following operation, only 7 of 76 pregnancies (9%) conceived by the same group of patients ended in spontaneous abortion. In primary infertility patients, 17 of 128 pregnancies (13%) ended in abortion following operation. The postoperative abortion rates were not significantly different between degree of severity of endometriosis. Speculation is presented on the mechanism of the increased preoperative abortion rate in patients with mild endometriosis.
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The genetics of Müllerian aplasia (absent fallopian tubes, absent or rudimentary uterine corpus and cervix, absent upper vagina) has never been investigated systematically. Some investigators believe the disorder is inherited in female-limited autosomal dominant fashion, males transmitting the mutant gene but, of course, not manifesting the trait. To investigate this possibility, we obtained pedigrees in 23 probands with Müllerian aplasia. None had an affected relative. The absence of affected individuals among 30 postpubertal sisters, 31 paternal aunts, and 40 maternal aunts makes it unlikely that a sex-limited autosomal dominant gene is a common cause of Müllerian aplasia in our population. Dominant genes might exist in other populations, and fresh dominant mutations cannot be excluded. However, polygenic/multifactorial inheritance is perhaps more plausible.
During an 8-year period, the records of 90 patients with mild pelvic endometriosis diagnosed by endoscopy were reviewed to determine whether conservative surgical treatment resulted in higher pregnancy rates than expectant management. Forty-five patients were found to have mild endometriosis as the only abnormality in a complete fertility workup. Sixteen patients were managed expectantly, and 75% became pregnant in 1 year. Twenty-nine patients had conservative surgery, and 72.4% conceived in 1 year. This surgery-to-pregnancy interval was similar in both groups. Sixty patients had mild endometriosis only or mild endometriosis and anovulation corrected by clomiphene citrate. The pregnancy rate in 1 year was 72.2% in 18 patients managed expectantly and 76.2% in 42 patients treated with conservative surgery. The surgery-to-pregnancy interval was 5 and 6 months, respectively. These results suggest that expectant management should be considered prior to medical or surgical treatment of infertile patients with mild endometriosis.
The value of perioperative medical therapy in the management of infertility patients with severe endometriosis is uncertain. Previous reports of pre- or postlaparatomy danazol provide no clear direction regarding efficacy. Of 200 consecutive cases of severe endometriosis, 138 infertility patients were selected for study. One hundred nineteen patients, the control group, had laparotomy alone; 19 had laparotomy followed immediately by danazol therapy. The pregnancy rate in the control group was 30% (36/119) versus 79% (15/19) in the study group, (P less than 0.001). The results of this preliminary report indicate that danazol treatment in the immediate postlaparotomy period of patients with severe endometriosis significantly improves the pregnancy rate over comparable patients treated with surgery alone. It is hoped that these results will encourage other surgeons to implement a prospective surgical-medical approach, so that the most efficacious treatment for infertile patients with severe endometriosis can be determined.
Systematic genetic studies in endometriosis apparently have not been conducted; therefore, we studied 123 patients with histologically proved endometriosis. Nine of 153 (5.8%) female sibs (over age 18) of patients with histologically proved endometriosis were considered similarly affected; 10 of 123 mothers (8.1%) were affected; 19 of 276 (6.9%) of all first-degree relatives were affected. By contrast, only one of 104 (1.0%) female sibs of their husbands and only one of 107 (0.9%) mothers of their husbands were affected, significantly (p less than 0.05) less for both sibs and mothers. Several genetic etiologies can be postulated, but polygenic/multifactorial inheritance seems most likely because of (1) the 6.9% recurrence risk for all first-degree relatives and (2) observations that the 18 patients with an affected first-degree relative were more likely to have severe endometriosis than those without an affected first-degree relative.
Clinical characteristics of patients with histologically confirmed pelvic endometriosis who had an affected first-degree relative (N = 18) were compared to those who had no such affected relative (N = 105). The only significant difference was that 61% of individuals in the former group had severe endometriosis, compared to only 24% in the latter group. This observation is most consistent with a polygenic/multifactorial etiology, although other genetic mechanisms cannot be excluded. Our observations carry several important practical implications. First, an apparently unaffected patient with an affected first-degree relative should be counseled that her risk of developing endometriosis is 7%. This might influence the choice of contraception, the timing of pregnancy, and the extent to which aggressive diagnostic approaches (e.g., laparoscopy and curettage) would be appropriate.
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Explore the source record for details and available documents.