Jack Lippes

Cytokines of the human reproductive tract

PROBLEM: How is it possible that the female genital tract immunologically does not reject spermatooa nor the preimplantation and nidating embryo?

The collection and analysis of human fallopian tubal fluid

Abstract A technique for the collection of Human Tubal Fluid (HTF) has been presented. It is a one-time procedure, coincident to other adominal surgery. The procedure has shown itself to be safe on 37 consecutive cases. The greatest quantity of HTF was obtained near the day of ovulation from patients with long fallopian tubes. A specimen with little or no turbidity usually could be withdrawn from the collection bag 24 hours after surgery. Electrophoresis of HTF in agarose resulted in patterns different from those found with the patients serum. An altered albumin peak was noted in 2 cases, while in a third case, the HTF exhibited an increase in the s globulin fraction. Immunoelectrophoresis demonstrated that many serum constituents are present in HTF. The immunoglobulin content presented a distribution similar to that which occurs in serum. Unlike other external secretions, γ G is the major immunoglobulin constituent present in HTF. The sodium, phosphorus and magnesium content of HTF was similar to that of serum. In comparison with patients serum, the potassium and chlorides of HTF were augmented while there was a diminution of HTF calcium. Glucose in tubal fluid was usually a half to a third of the patients serum level. Marked elevations of amylase and lactic dehydrogenase (LDH) were noted in HTF.

The human female reproductive tract: Immunohistological localization of γA, γG, γM, secretory “piece,” and lactoferrin

Abstract The tissue localization of immunoglobulins G, A, and M, secretory “piece” (SP), and lactoferrin (LF) in tissue comprising the human female reproductive tract, including nine uterine tubes, forty endometrial, three cervical, and three vaginal specimens, was investigated by means of the direct fluorescent antibody technique. γG was the predominant immunoglobulin in all the tissues studied and was localized primarily in the interstitial connective tissue as diffuse noncellular staining. γG fluorescence was also observed along the basement membrane beneath the epithelium, in lymphoid cells, and in the luminal contents of many endometrial and cervical glands. The intensity of γA staining was less in most specimens; however, the tissue localization of γA was the same as γG. γM staining was very light in most tissues. Only minimal intercellular γA staining was observed between the cells of the mucous membrane of the uterine tube and the glandular epithelium of the endometrium. SP staining was localized inside the epithelial cells lining the villi of the uterine tube, glandular epithelium of the endometrium, and cervix, but not in the squamous epithelium of the vagina. The luminal contents of many endometrial and cervical glands stained brilliantly with SP antiserum. Lactoferrin was localized in the glandular epithelium of the endometrial specimens and in the luminal contents of endometrial glands, particularly during the secretory phase of the menstrual cycle. Similar staining was observed in the cervical glands. Lactoferrin was also localized in leukocytes that were dispersed in the interstitium of nearly all the tissue specimens examined.

Pelvic actinomycosis: A review and preliminary look at prevalence

A review of the literature on pelvic actinomycosis reveals that actinomycetes normally reside in the female genital tract. Therefore the identification of actinomycetes in the vagina or cervix by any laboratory technique, including Papanicolaou smears with specific immunofluorescence or culture, is not diagnostic of any disease and is not predictive of any disease. The evidence strongly suggests that removal of the intrauterine contraceptive device of a patient with a positive culture is not necessary and that, in the absence of evidence for pelvic infection, antibiotics are not required. Pelvic actinomycosis is a rare disease whose pathogenesis is poorly understood.

Human oviductal fluid proteins

The popularity of mini-laparotomy provided an opportunity to easily collect human oviductal fluid (HOF). Volumes of HOF produced by two oviducts per 24 hours correlated positively with serum estradiol determinations, while protein concentration in HOF was inversely proportional to estrogen levels. Estrogen appeared to stimulate the production of oviductal fluid in women. The greatest volumes of HOF were observed at midcycle, coincident with the estrogen peak. Protein concentration was lowest at the time of ovulation and highest immediately before and after menstruation. In a large percentage of patients, certain proteins made their appearance at the time of ovulation and receded or disappeared within three to five days thereafter. By electrophoresis, these proteins were seen in the albumin region and in the beta globulin region.

Laparoscopic findings in patients with pelvic pain

We have reviewed 1,194 charts of consecutive patients who had a diagnostic laparoscopy for pelvic pain from January 1, 1972, to December 31, 1980, at the Deaconess Division of the Buffalo General Hospital. A total of 749 of these patients had normal pelvic examinations prior to the diagnostic laparoscopy; 479 (63%) had abnormal findings on diagnostic laparoscopy. Of the 445 patients with abnormal pelvic examinations, 78 (17.5%) had normal findings on diagnostic laparoscopy. The laparoscopic findings and ovarian pathology are reviewed. These results are substantiated by other reports in the literature and certainly justify the increasing use of the laparoscope as a diagnostic tool in the gynecologists armamentarium.

Prostaglandins in the human fallopian tube.

The concentration of prostaglandin (PG) F2 alpha in human oviductal fluid was determined, and the histological localization of PGF2 alpha was correlated with the menstrual cycle to illuminate possible roles of oviductal PGF2 alpha in human luteolysis. Human oviductal fluid was collected preovulatorily, ovulatorily, and postovulatorily. PGF2 alpha was radioimmunoassayed and it was found that the levels in oviductal fluid were higher (5-7.1 ng/ml) than those normally found circulating in serum (5 ng/ml, but these authors did not test sera for PGF2 alpha levels). Using immunofluorescence of biopsy material from patients undergoing elective tubal ligations, PGF2 alpha could be histologically localized in the human oviductal mucosal surface before ovulation; after ovulation, the PG was found in oviductal lamina propria, but no PHF2 alpha was found in any portion of a postpartum or postmenopausal oviduct in this study.

Contraception with intrauterine plastic loops

Intrauterine plastic loops were inserted 2179 times into 1713 patients of the Planned Parenthood Center of Buffalo, New York and from the authors private practice between November 1, 1961 and June 30, 1964 to evaluate the acceptability, effectiveness, reversibility, and side effects of this contraceptive method. Median age of the patients was 26 and their median parity 3. At the Planned Parenthood Center, patients are offered a choice of oral contraception (OC), condoms, diaphragms, jellies, rhythm, and the loop. During 1962, 30% of the new patients chose the loop. In 1963, 48% of new patients chose intrauterine contraception, and this proportion continued through June 1964. It rose to 55% early in 1965. 41 pregnancies occurred giving an overall pregnancy rate of 2.2/100 woman years for all loops. Loop D had a rate of 1.0/100 woman years. The pregnancy rate was calculated according to Potters life table procedure. These rates compared favorably with a diaphragm failure rate of 4/100 woman years reported in the Indianapolis study or the diaphragm failure rate of 14.4 reported by Westoff and Potter, as well as with the rate of 2.1 for OC reported by Cook, Gamble, and Satterthwaite. 23 patients became pregnant with a loop in situ. There were 20 loop failures where location of the device was undetermined. Before November 30, 1964, 32 patients had discontinued intrauterine contraception because they wanted a child. All but 3 became pregnant. There were no abortions. The devices are not tolerated by all patients. Side effects consisted primarily of expulsions and bleeding, but pain and the possibility of infection were sometimes present. The monthly expulsion rate decreased with continued use. Most expulsions occurred in the 1st 6 months of use, and the largest and heaviest device had the lowest expulsion rate. 90% of the patients exhibited some alteration of their menstrual pattern. Cramps or pain were only a minor reason for terminating intrauterine contraception. Other side effects included fainting. Subsequent contacts made with 94% of those who had worn their loop for 1 or more months revealed that 23 patients had tentative diagnoses or histories of pelvic inflammatory disease. Endometrial biopsies and Papanicolaou smears gave no evidence that the method induced carcinoma.

Immunohistologic Localization of Immunoglobulins, Secretory Component, and Lactoferrin in the Developing Human Fetus

Summary Immunohistological localization of γG, γA, γM, secretory component (SC) and lactoferrin (LF) in various tissues of 8–22 week human fetuses was studied, using direct immunofluorescent staining technique. No immunoglobulin-containing cells have been detected in various tissues studied. However, SC was found in the lungs of the earliest fetuses studied (8 weeks) and is readily recognized in most secretory tissues by 18–22 weeks of gestation. The role SC may play in the intrauterine development of the immune system is not known but it is present at a time when immunoglobulins (specifically γA) are not detectable. Lactoferrin was found regularly in the older fetuses (18–22 weeks) only in polymorphonuclear leukocytes. Epithelial cells such as those of the kidney tubules which contain this protein in the adult, were apparently not synthesizing lactoferrin in sufficient quantity to be detectable by the fluorescent antibody method.

INFECTION AND THE IUD A Preliminary Report

Abstract This is a preliminary report to answer the question: “Does the IUD increase the incidence of pelvic infection?” From one hospital, the percentage of young women with a discharge diagnosis of Pelvic Inflammatory Disease (PID) who were wearing an IUD at the time of admission was calculated. With precisely the same definitions, the percentage of young women utilizing an IUD who were discharged from the same hospital as having had appendicitis was determined. Thus far, a statistically significant correlation between IUD usage and P.I.D. could not be demonstrated. A larger study is current.