Klaus Teisala

Increased levels of interleukin-6 and interleukin-10 in the peritoneal fluid of patients with endometriosis ☆ ☆☆ ★

OBJECTIVE The levels of interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-10, and granulocyte-macrophage colony-stimulating factor were measured in the peritoneal fluid of 15 patients with endometriosis to characterize the type of immune response that occurs at the site of endometriosis. STUDY DESIGN Cytokine levels in peritoneal fluid obtained during laparoscopy from 15 patients and 12 controls undergoing tubal ligation were determined by enzyme-linked immunosorbent assay. RESULTS The mean levels of interleukin-6 in patients with endometriosis and controls were 797 +/- 407 pg/ml and 133 +/- 38 pg/ml, respectively (p < 0.02). Similarly, the mean concentration of interleukin-10 in peritoneal fluids of patients with endometriosis was significantly higher than that of controls (241 +/- 38 vs 128 +/- 21, p < 0.05). The levels of interleukin-2, interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor were not significantly different between the two study groups. CONCLUSIONS The levels of interleukin-6 and interleukin-10 are increased in the peritoneal fluids of patients with endometriosis, suggesting enhanced macrophage activity in these patients. Increased interleukin-6 and interleukin-10 production may partially contribute to the disturbed immune regulation observed in patients with endometriosis.

Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease

Twenty-seven women with suspected acute pelvic inflammatory disease were studied by laparoscopy and endometrial biopsy. Overall, 67% (18 of 27) of the women had acute salpingitis at laparoscopy, 70% (19 of 27) had plasma cell endometritis, and 67% (10 of 15) had an inflammatory cytologic pattern of the peritoneal fluid. In comparison to laparoscopically detected salpingitis, endometritis detected with biopsy had a sensitivity of 89%, a specificity of 67%, a positive predictive value of 84%, and a false negative rate of 22% in the diagnosis of pelvic inflammatory disease. The corresponding figures for inflammation of the peritoneal fluid were 75%, 67%, 90%, and 25%. This study demonstrates that nonpuerperal endometritis is an entity associated with pelvic inflammatory disease, most likely representing an intermediate stage between cervicitis and salpingitis. Endometrial biopsy as an office procedure is a good alternative to laparoscopy in the diagnosis of acute pelvic inflammatory disease and may in fact detect early cases not yet visible at laparoscopy.

Serologic evidence for the role of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in the etiology of tubal factor infertility and ectopic pregnancy

&NA; The authors used anzyme immunoassay to determine the prevalence of serum antibodies to the sexually transmitted disease (STD) organisms Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis among 104 infertile women undergoing in vitro fertilization. Altogether, 55 (72%) out of 76 women with tubal abnormalities tested positive for one or more STD organisms, compared with only 6 (21%) out of 28 infertile women with normal tubes (P < .001). The authors obtained positive test results for C. trachomatis, N. gonorrhoeae, and M. hominis in 40%, 14%, and 37% of the patients with tubal abnormalities, respectively; of women without tubal abnormalities, the test results were 7%, 0%, and 14%, respectively. Out of 20 patients with a history of ectopic pregnancy, the authors obtained positive findings for C. trachomatis, N. Gonorrhoeae, and M. hominis in 8 (40%), 1 (5%), and 7 (35%), respectively. These results indicate an independent role for all three STD organisms in the etiology of tubal factor infertility and ectopic pregnancy following both symptomatic and asymptomatic pelvic inflammatory disease (PID). The correlation between positive mycoplasmal serology and secondary infertility and tubal abnormalities may suggest a link between M. hominis infections during pregnancy and delivery complications and consequent development of tubal factor infertility.

Cytokine production profiles in the peritoneal fluids of patients with malignant or benign gynecologic tumors

Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases. Some cytokines have been shown to have potential in the diagnosis of cancer.

Serum C-reactive protein determination in acute pelvic inflammatory disease.

We have studied the role of serum C-reactive protein determination in the diagnosis of acute pelvic inflammatory disease. Acute-phase serum C-reactive protein concentration reflected the extent and the severity of pelvic inflammatory disease more closely than erythrocyte sedimentation rate or white blood cell count determinations. We recommend that both C-reactive protein concentration and erythrocyte sedimentation rate should be routinely used to augment the clinical diagnosis of pelvic inflammatory disease.

Impaired ovarian function and risk factors for atherosclerosis in premenopausal women

OBJECTIVES The aim of the study was to obtain information on the possible relationship between impaired ovarian function and risk factors for cardiovascular disease. MATERIAL AND METHODS Serum lipid levels, plasma fibrinolytic potential and histological and biochemical changes in the intima of the uterine artery were investigated in premenopausal women with irregular menstrual cycles, and the results were compared with those from regularly menstruating women. In addition, the same parameters were studied in postmenopausal women on hormone replacement therapy (HRT) and in postmenopausal women who had never used HRT. In total 64 patients undergoing hysterectomy for benign reasons were included the study. RESULTS Plasma fibrinogen concentration was significantly higher in irregularly menstruating women as compared with women with regular cycles. In women with irregular cycles thickened or sclerotic arterial intima was a significantly more common finding as compared with regularly menstruating women. A significant positive correlation was observed between plasma fibrinogen concentration and intimal esterified cholesterol content in women with thickened or sclerotic uterine artery. CONCLUSIONS These data suggest an important role for normal ovarian function in the prevention of atherosclerosis.

Demonstration of Tumor Necrosis Factor-α in Preovulatory Follicular Fluid: Its Association with Serum 17β-Estradiol and Progesterone

In the present study we have measured the concentrations of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in preovulatory follicular fluid (FF) samples obtained from patients undergoing o

Urethral Closure Function after Total and Subtotal Hysterectomy Measured by Urethrocystometry

Urethral closure function was measured before and 3 months after operation in 18 patients having hysterectomy and 13 patients having supravaginal uterine amputation performed. Sixteen patients had a symptom of mild stress incontinence before and 11 after the operation. The urethral closure function at rest and under stress was measured by urethrocystometry. No operation-induced changes in urethral closure pressure, functional length, pressure transmission, urethral relaxation or urethral resistance to stress were found after either operation.

Impact of Long-term Hormone Replacement Therapy on In vivo and In vitro Markers of Lipid Oxidation

Postmenopausal hormone replacement therapy (HRT) with estrogen has been suggested to inhibit oxidation of low-density lipoprotein (LDL) in vitro, but progestins may oppose this effect. We studied whether estrogen HRT and combined HRT with estrogen and progestin differ in their ability to resist in vivo and in vitro oxidation of lipids. Study group included 15 women on oestradiol valerate (mean age 56 years, treatment duration 10.5 years) and 15 women on combined HRT with oestradiol valerate and levonorgestrel (mean age 58 years, treatment duration 11.3 years). In addition to lipid and apolipoprotein concentrations, the lagtime of LDL to oxidation, the rate of the propagation phase and the maximum concentration of conjugated dienes were recorded as indices of LDL susceptibility to copper-induced oxidation in vitro. As an in vivo marker of oxidative stress we measured 24-h excretion of urinary 8-iso-prostaglandin F2α (8-iso-PGF2α). All measurements were done after long-term HRT (baseline), after 4 weeks pause and again 3 weeks after reintroduction of HRT. High-density lipoprotein (HDL) cholesterol and apolipoprotein AI concentrations were significantly higher and LDL to HDL ratio significantly lower after long-term oestradiol valerate therapy than after combined therapy. Simultaneously, the triglyceride and lipoprotein (a) levels were higher in the estrogen group. Susceptibility of LDL to oxidation and the level of 8-iso-PGF2α were similar in both groups at all measurement points, and treatment group was not a statistically significant determinant of these markers at baseline. According to these results, estrogen and combined HRT do not differ in their abilities to oppose LDL oxidation in vitro or systemic oxidative stress in vivo, but have differential effects on blood lipids.

Endometrial microbial flora of hysterectomy specimens

Microbiological and histopathological specimens were obtained from three levels (fundal, middle and cervical) of the endometrium immediately after removing the uterus. Hysterectomy indication was menometrorrhagia and uterine fibroids in eight cases and chronic pelvic pain in two cases. All cultures for C. trachomatis, N. gonorrhoeae, M. hominis, U. urealyticum, herpes simplex virus, anaerobic and facultative bacteria were negative. Histopathological examination showed few plasma cells in the endometrium in four cases with the presence of uterine fibroids and in one case with adenomyosis. These results suggest that the endometrial cavity of a nonpregnant uterus is sterile.