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Biomedical subjects

J Ordi

Publications and source records attributed to J Ordi.

At least 55 records · Page 3Linked to original sources
PubMed1997

Pure pleomorphic rhabdomyosarcomas of the uterus.

Pure rhabdomyosarcoma arising in the uterus is a rare tumor currently classified by the World Health Organization (WHO) as a uterine sarcoma. The records of eight women with uterine rhabdomyosarcomas were retrieved from the files of the Armed Forces Institute of Pathology (AFIP). The eight women presented with vaginal bleeding, abdominal enlargement, or acute abdomen. The mean age of the patients was 64.6 years (range 35-87). Macroscopically, 4 tumors were polypoid endometrial masses, 2 were intramyometrial, 1 was located in the cervix, and 1 was a 15-cm mass involving the endometrium and myometrium with direct extension into the small intestine. Microscopically, the tumors consisted of a variable proportion of large rhabdomyoblasts admixed with smaller round, polygonal, and spindle-shaped cells. No epithelial elements were identified on light microscopy. Tissue from the extrauterine and metastatic lesions was available for review in four cases and also showed pure rhabdomyosarcoma. Immunohistochemical assessment of seven tumors supported the sarcomatous nature of the neoplastic cells. Six patients died of disease within 15 months of initial diagnosis and 1 patient died of a pulmonary embolus. The patient whose 15-cm tumor had extended into the small intestine survived 6 years; she died of a presumed pancreatic carcinoma. Presenting mainly in elderly women, uterine pleomorphic rhabdomyosarcomas are rare, highly malignant tumors with frequent extrauterine spread at presentation. Patients rarely survive beyond 15 months.

Actins↗
PubMed1996

Endometrial ossification successfully treated by hysteroscopic resection.

BACKGROUND: Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual therapeutic methods used. Recently, some cases have been treated by means of hysteroscopic resection. CASE: We report a case of endometrial ossification in a woman who presented with dysmenorrhoea, dyspareunia and pelvic pain. The patient had a pregnancy voluntarily terminated at 16 weeks. Five subsequent routine annual gynaecological exams, including ultrasonographies, were normal. A new gestation was also voluntarily terminated at 6 weeks. One month later the patient started with clinical manifestations. Ultrasonograms performed 4 months after the second abortion revealed a strong uterine echogenic band. Bone tissue was successfully removed by hysteroscopic resection. CONCLUSION: This case adds further evidence favouring new bone formation in the uterus as a pathogenic mechanism for endometrial ossification and illustrates the feasibility of hysteroscopic treatment for this condition.

Abortion, Induced↗
PubMed1996

Ovarian dermoid cyst-associated autoimmune hemolytic anemia: a case report with emphasis on pathogenic mechanisms.

Autoimmune hemolytic anemia (AIHA) as a manifestation of ovarian dermoid cyst (ODC) is a rare paraneoplastic syndrome of unknown pathogenesis. Among mechanisms postulated to explain this association, cross-reactivity between cyst and red blood cell (RBC) antigens, and local production of RBC autoantibodies by intracyst B lymphocytes are the most likely. Studies to test these hypothesis were done in a patient diagnosed of AIHA associated with a nonpalpable ODC, in whom the AIHA subsided after tumor excision. The RBC-bound autoantibody was an IgG directed against the Rh complex. The cyst's fluid content lacked detectable RBC autoantibodies or immunoglobulins, the latter being measured by a high-sensitivity assay. It also failed to inhibit the ability of the purified autoantibody to agglutinate RBCs. Ovarian dermoid cyst histology disclosed that (1) the biotin-labelled RBC autoantibody did not bind to ODC structures; (2) scanty amounts of small mature lymphocytes (50% CD45RO+; 50% CD20+) were present only in a few tissue sections; (3) plasma cells producing IgM or IgG were extremely scarce; and (4) deposits of immunoglobulins were not detected into the ODC. These data fail to support any of the aforementioned hypotheses on the pathogenesis of this paraneoplastic syndrome. Other possible mechanisms are discussed, and a wider use of imaging diagnosis to search for ODC in women with AIHA is emphasized.

Adult↗
PubMed1996

Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study.

In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments. Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis. The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease. The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-¿typical') endometriotic peritoneal lesions. Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively. One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy. Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition. In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chronic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an ¿annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a ¿dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.

Adult↗
PubMed1996

Midluteal immunoreactive alpha-inhibin serum concentrations as markers of luteal phase deficiency.

The present prospective clinical study was undertaken to determine the usefulness of midluteal phase serum immunoreactive alpha-inhibin concentrations as markers of luteal phase deficiency and whether they are better indicators of biopsy confirmed luteal phase defect than serum progesterone. Consecutive patients (n = 138) with regular menstrual cycles attending our Infertility Clinic (experimental group) and 15 fertile women who were requesting contraception and had regular menstrual patterns (control group) were included. In all women (patients and controls), basal body temperature, midluteal serum concentrations of oestradiol, prolactin, progesterone and immunoreactive alpha-inhibin, and premenstrual endometrial biopsy were used in the same cycle to assess luteal function. Out-of-phase secretory endometria were detected in 15 of the 138 patients. Thus, hormonal concentrations were compared between the following three groups of women: group 1 (n = 15), infertile patients with defective secretory endometria; group 2 (n = 123), infertile patients with normal secretory endometria; and controls (n = 15), fertile women with normal secretory endometria. Midluteal serum concentrations of progesterone, immunoreactive alpha-inhibin, oestradiol, and prolactin of the two groups studied were similar to those of the control group of fertile women. Our results indicate that midluteal serum inhibin determination does not accurately reflect histological maturation of the endometrium and it is not a better indicator of endometrial luteal phase deficiency than midluteal serum progesterone concentration.

Adult↗
PubMed1996

Further data favoring the hypothesis of the uterine first-pass effect of vaginally administered micronized progesterone.

Ten infertile women, 28 to 36 years of age, with regular menstrual cycles were treated with oral estradiol valerate and intravaginally administered micronized progesterone under pituitary suppression with leuprolide acetate. Patients underwent endometrial biopsies on cycle days 17 and 28 (luteal phase days 3 and 14) and blood sampling for plasma progesterone and estradiol determinations on cycle days 17, 21 and 26 (luteal phase days 3, 7 and 12). All ten endometrial biopsies on cycle day 17 were in-phase and only two out of ten (20%) were out-of-phase on cycle day 28. This produced an incidence of endometrial luteal phase deficiency that was not different from the 14% found among an infertile general population of 300 women. Midluteal estradiol plasma levels in the study group were similar to those found in a control group of fertile women, but progesterone levels were significantly lower on cycle day 21 in the treatment group. As much as 75% (six out of eight patients) of treated women having in-phase late luteal endometrial biopsies had low midluteal plasma progesterone levels, a situation that is found in only 3% of infertile patients (9/300) or 3.5% (9/258) of those infertile women with normal endometria (p = 0.03). Thus, the present study adds further evidence favoring the current postulate that vaginal micronized progesterone enhances hormone delivery to the uterus and this explains the marked discrepancy between the strong uterine effect and the relatively low plasma progesterone levels.

Adult↗
PubMed1995

[Hepatic mesenchymatous hamartoma presenting in an adult patient].

Mesenchymatous hamartoma is a benign liver tumor characteristically found in childhood, particularly during the first two years of life. A case of mesenchymatous hamartoma detected in a 23-year-old female during a study for non specific abdominal disturbances is presented. Imaging techniques showed a large mass in the right hepatic lobe with hypodense areas of cystic appearance. Pathologic study demonstrated the characteristic mixoid mesenchymatous component with areas of cyst formation and rests of liver tissue inside the tumor. Despite its rarity in adults this case demonstrates the need to consider mesenchymatous hamartoma in the differential diagnosis of hepatic masses in adults, particularly when radiologic examination demonstrates cystic components.

Adult↗
PubMed1995

The value of complement activation products in the assessment of systemic lupus erythematosus flares.

Complement activation products (CAP) have been reported as sensitive markers of disease activity in systemic lupus erythematosus (SLE). We have measured seven parameters of the complement system (C3, C4, factor B, C3a, C4a, iC3b, and the terminal complement complex-TCC-) in 61 SLE patients to study their interrelationship and relative efficacy as diagnostic indicators of lupus activity. Disease activity was judged according to a clinical index (SLEDAI) to be active in 22 and inactive in 39 patients. Subjects with active SLE showed increased levels of C3a, C4a, and TCC compared with those of stable lupus and normal controls, and plasma concentrations of these CAP manifested a positive correlation with disease activity scores. However, values of factor B and iC3b did not correlate with lupus flares. Serum C3 levels were a better reflection of the degree of SLE activity than were C4 levels. The anaphylatoxins were extremely sensitive markers of disease activity but they lacked enough specificity, and iC3b was not at all informative for this purpose. On the whole, TCC concentration was the most useful parameter (77% sensitivity, 80% specificity) to monitor lupus activity, correlating the best with the activity scoring system, and thus offers a better laboratory marker of lupus severity than conventional measurements of complement.

Adolescent↗
PubMed1995

Wrist denervation. Anatomical considerations.

In 1966, Wilhelm published a technique of denervation of the wrist joint based on his own anatomical studies of 1958. Other authors have published their experience in wrist denervations with similar results, but there are some discrepancies in descriptions of the innervation of the wrist. We have studied the innervation of the wrist by dissection under magnification on 20 cadaver limbs and by histological examination of five human foetal wrists. Based in our anatomical findings, we have demonstrated that Wilhelm's technique does not achieve total denervation of the wrist.

Cadaver↗
PubMed1995

Wrist denervation. Surgical considerations.

We have analyzed the results of 22 total wrist denervations following Wilhelm's technique and a series of 30 patients treated with denervation of the posterior interosseous nerve alone. Results of denervation have been classified depending on the pain (visual analogue scale) as other parameters (mobility and strength) have not been found to have any statistical significance. Results after partial denervation are worse than results achieved by total denervation.

Adult↗
PubMed1995

High prevalence of platelet autoantibodies in patients with systemic lupus erythematosus.

The aim of this study was to determine the prevalence of platelet autoantibodies (PAA) in patients with systemic lupus erythematosus (SLE) and its correlation with clinical and other laboratory manifestations of the disease, as well as to evaluate the influence of platelet count and disease activity on the result of the test for PAA. Ninety SLE patients, 29 with thrombocytopenia, were evaluated. The presence of PAA was determined using the direct and indirect platelet suspension immunofluorescence test. A total of 166 PAA determinations were performed in the 90 patients upon entry into the study. Fifty-six of the 90 patients (62%) with SLE were positive for PAA. There were no statistically significant correlations between the presence of PAA and the different disease manifestations except for thrombocytopenia (P = 0.0005). The presence of PAA in the same patient was significantly associated with current thrombocytopenia and disease activity. It was concluded that the prevalence of PAA in SLE patients is high. All SLE patients with thrombocytopenia had PAA, although some patients with PAA had a normal platelet count. The presence of PAA in SLE patients is not synonymous with thrombocytopenia but should instead be regarded as one of the multiple serological abnormalities which may develop in these patients.

Adolescent↗