Agneta Bergqvist

Interleukin 1β, interleukin-6, and tumor necrosis factor-α in endometriotic tissue and in endometrium

Abstract Objective: To compare the levels of IL-1β, IL-6, and TNFα in endometriotic tissue and in endometrium from women with endometriosis and healthy controls. Design: Open. Setting: Department of Obstetrics and Gynecology at a university hospital. Patient(s): Twenty-six women with endometriosis and 22 controls operated on for clinical indications. Intervention(s): ELISA in homogenized tissue samples collected during surgery. Main Outcome Measure(s): Levels of IL-1β, IL-6, and TNFα in tissue homogenates. Result(s): The three types of tissue differed significantly with respect to all three cytokines. Endometriotic tissue had significantly higher concentrations of IL-1β than endometrium from both patients with endometriosis and healthy controls. Both endometriotic tissue and endometrium from patients had significantly higher concentrations of IL-6, and endometriotic tissue had significantly lower concentration of TNFα than did endometrium from controls. IL-1β showed a cycle phase dependence that was significant in endometrium from patients, being higher in the secretory than in the follicular phase. IL-1β was significantly higher in endometrioma than in lesions of other localizations. Concentrations of IL-1β and IL-6 were positively correlated in endometriotic tissue and in endometrium from controls. No other significant correlations were found. Conclusion(s): This study has shown a significant production of IL-1β, IL-6, and TNFα in endometriotic tissue and endometrium, with significant differences between the tissue types, indicating a deviating cytokine pattern in both endometriotic tissue and endometrium from women with endometriosis compared with that from healthy controls.

Recurrent thromboembolism in pregnancy and puerperium. Is there a need for thromboprophylaxis

By sending a questionnaire (response rate 93%) to 321 women with a history of venous thromboembolism and previous coagulation tests, 72 patients were identified who had a total of 87 pregnancies after the thromboembolic episode. The main aim of the study was to analyze the influence of prophylaxis during pregnancy and delivery on the development of further thromboembolic complications. During pregnancy there was no difference in frequency of thromboses between the group given prophylaxis (n = 20) and the group not receiving it (n = 67). At delivery the frequency of thrombosis was 5.3% among the 57 women given prophylaxis and 11.1% among the 30 without prophylaxis, a difference that is not significant. The implication of these findings is discussed both concerning the indications for giving prophylaxis and concerning the problem of designing relevant prophylactic trials.

A study of estrogen and progesterone cytosol receptor concentration in benign and malignant ovarian tumors and a review of malignant ovarian tumors treated with medroxy-progesterone acetate.

ER and PR were assayed in 13 malignant and 20 benign ovarian tumors of different histologic types. ER was detectable in 67% and PR in 40% of the malignant tumors, compared with 35 and 45% in the benign tumors, respectively. The ER concentration was somewhat higher in the malignant lesions but there was no difference in the PR level.

Vascular Injuries During Gynecologic Surgery

latrogenic vascular injuries are common in the civilian western world. The frequency seen following gynecologic surgery is not known and a questionnaire was therefore sent to all gynecologic clinics in Sweden undertaking surgery, to establish the frequency during a 5‐year period and to analyse the types of injury. Case reports in the literature were also analysed. The frequencies per 10000 operations were: after laparoscopy, 0.93, after laparotomy, 0.76 and after major vaginal surgery, 0.33. All laparoscopic injuries were localized to the iliac arteries, caused bleeding, and were treated with arterial suture without complications or late sequelae. Injuries during laparotomy were most frequently venous and all patients had hemorrhage as the main symptom. In one case the external iliac vein was ligated, with immediate postoperative swelling, and in another case the external iliac artery was ligated, after which the patient developed postoperative ischemia. The internal iliac veins were ligated, and the other vessels reconstructed. There was no mortality, but a high rate of morbidity, also with late sequelae.

Estrogen and progesterone receptors in vessel walls: Biochemical and immunochemical assays

The purpose of the present investigation was to examine the estrogen and progesterone receptor status in arterial and vein walls in women and men. Biopsies from uterine arteries and veins were obtained from 14 fertile and six post menopausal women. Biopsies from saphenous veins were obtained from eight fertile women, 12 post menopausal women and 12 men. Comparative receptor assays were performed with ligand technique and monoclonal antibodies. Immunohistochemical localization of estrogen and progesterone receptors was performed using monoclonal antibodies.

Estrogen and progesterone receptors in endometriotic tissue and endometrium: comparison according to localization and recurrence *

OBJECTIVE To study the hormonal regulation of primary and recurrent endometriosis by comparing the levels of estrogen receptors (ER) and progesterone receptors (PR) with the levels in uterine endometrium obtained simultaneously. DESIGN Tissue samples collected at routine operations. SETTING One university clinic. PATIENTS A total of 69 endometriotic samples were obtained from 61 women, and endometrium was obtained from 54 of the women. Seventeen of the patients (26%) had a recurrent disease; the others (n = 49) were operated on for the first time. MAIN OUTCOME MEASURES Samples from recurrences constituted 18% (6/34) of the endometriomas, 37% (10/27) of the biopsies from ovarian lesions, and 4 of 5 biopsies from peritoneal endometriosis. In primary endometriotic lesions, both ER and PR were significantly lower than in endometrium. In recurrent lesions, ER levels in cytosol were significantly lower than in endometrium, but there was no difference concerning PR. In endometriotic tissue, the PR level was significantly higher in recurrent than in primary tissue, but there was no difference concerning ER. The ER level was significantly lower in ovarian but not in peritoneal endometriosis, compared with endometrium. No difference was seen concerning PR. CONCLUSION This study shows differences in ER and PR levels in primary and recurrent endometriosis and indicates a different hormonal regulation of the two stages of the disease.

Late symptoms after pregnancy‐related deep vein thrombosis

Summary. Thromboembolism during pregnancy is a rare complication with a potential fatal outcome. Very little is known about long‐term effects and therefore 104 women with thrombosis during pregnancy or puerperium were identified and their subjective complaints were assessed in a questionnaire. All had their thrombosis diagnosed by objective methods and the median follow‐up time was 11 years. In spite of anticoagulant treatment only 22% were without complaints; 4% had ulceration, all occurring in the group with thrombosis during pregnancy. Significantly more women who had had their thrombosis during pregnancy used compression bandages than those who had their thrombosis during puerperium. The severity of the symptoms increased with the increasing number of thromboses. Anticoagulant therapy of the acute episode does not appear to alter the degree of long‐term handicap in the lower limbs.

Regression of endometriosis following shorter treatment with, or lower dose of danazol: Comparison of pre‐ and post‐treatment laparoscopic findings in the Scandinavian multi‐center study

Abstract. One hundred and sixteen patients with laparosco‐pically confirmed primary or recurrent endometriosis were treated with danazol, either 600 mg daily for 4 months (group A, n = 76) or 600 mg daily for the first 2 months, followed by 400 mg daily for an additional 4 months (group B, n = 40). The only surgery performed before treatment was biopsies, resection of endometriomas 23 cm and/or adhe‐siolysis. The extent of endometriosis before and after treatment was established laparoscopically and recorded by means of a modified AFS record as mean additive diameter of implants (mean ADI) in millimeters. This provided a uniform and reproducible quantitative registration for each type and location of endometriotic implant.

No transplacental passage of standard heparin or an enzymatically depolymerized low molecular weight heparin.

In 21 women who had an abortion by hysterotomy between the 15th and 23rd week of pregnancy, the possibility that unfragmented heparin or low molecular weight heparin (LMWH) passed the placental barrier to the foetus was studied. Laboratory analyses included amidolytic assays of factor Xa inhibitory activity (XaI), antithrombin III (ATIII) and a direct measurement of heparin-like substances in plasma with a competitive binding assay. The ATIII concentration in foetal plasma was about 20% of that in normal human plasma and varied considerably between individuals (2–27%). The XaI activity did not differ between the two treated groups, but the mean XaI activity of the combined groups differed from zero (P < 0.05). If the XaI activity was corrected for the ATM concentration, the heparin activities no longer differed significantly from zero. As die concentration of heparin-tike substances were above the detection limit (0.35 μg/ml) in 6/16 analysable samples of foetal plasma, a further 15 women who had not received any heparin were included as controls. In 12/14 analysable foetal plasmas heparin-like substances in concentrations above 0.35 μg/ml could be detected. Determination of heparin activity in foetal plasma is thus difficult due to the influence of endogenous ATIII on heparin assays. In conclusion, this study did not demonstrate any evidence for the passage of heparin or LMWH across the placental barrier. No differences were detected whether unfragmented heparin or LMWH had been given to the mothers. Our results also indicate the presence of an endogenous glycosaminoglycan in foetal plasma.

Oral contraceptives and venous thromboembolism

Summary. In 58 patients with phlebographically diagnosed deep vein thrombosis during oral contraception the extension and localization of the thrombotic process was analysed in relation to the coagulation and fibrinolytic system 6 months after thrombosis. Left‐sided thrombi dominated and the thrombi were more extensive and proximal on the left side. This left‐sided dominance was more apparent with higher oestrogen content in the pills. The right‐sided thrombi more often were the source of pulmonary embolism. In 31% of the patients a defective fibrinolytic system was found; this defect was seen more often in patients with right‐sided thrombi. Only very few defects were found in the coagulation system. No patients had an antithrombin III deficiency.