Risto Aine

Microbiological and histopathological findings in acute pelvic inflammatory disease

Upper genital tract infection was investigated in 45 women admitted to hospital for suspected acute pelvic inflammatory disease (PID). Salpingitis was diagnosed by laparoscopy in 30 (67%) women. Histopathological evidence of endometritis was found significantly more often in the 30 women with salpingitis (87%) than in the other 15 women without salpingitis (33%). C. trachomatis or N. gonorrhoeas, or both, were isolated from the upper genital tract in 14 of the 31 women who had both salpingitis and endometritis or endometritis only but in none of the four women who had salpingitis alone and in none of the 10 women who had no evidence of PID. Bacterial vaginosis was associated with histopathological evidence of upper tract infection. Non‐chlamydial nongonococcal organisms were frequently isolated from the upper genital tract. No organisms were isolated from the upper genital tract from 9 of 35 women with laparoscopic or histopathological evidence of PID compared with 7 of 10 women without evidence of PID. C, trachomatis or N. gonorrhoeae in the endometrium was associated with lymphoid follicles comprising transformed lymphocytes, and correlated with the density of plasma cells on biopsy. The microbiological results support the recommendations of broad spectrum antimicrobial therapy for PID.

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.

Frequent loss of the 11q14-24 region in chronic lymphocytic leukemia: A study by comparative genomic hybridization

The genetic basis and molecular pathogenesis of chronic lymphocytic leukemia (CLL) and the molecular mechanisms responsible for its progression remain poorly understood. Here, karyotyping techniques specifically optimized for CLL, comparative genomic hybridization (CGH), and fluorescence in situ hybridization were used to search for CLL‐specific genetic aberrations. CGH and karyotyping both revealed copy number changes in 12 of the 25 CLL cases (48%) analyzed. Loss at 11q emerged as the most common aberration (6 cases), followed by a gain of chromosome 12 (4) and loss at 13q (3). Concordance between CGH and G‐banding was found in 23 of the 25 cases (92%), which is more than reported in a recent similar CGH study of CLL. Owing to the basic differences in G‐banding and CGH, however, their simultaneous clinical application is recommended. The frequent loss of 11q14‐24 suggests that this chromosomal region deserves further attention as a candidate locus involved in the pathogenesis of CLL. Genes Chromosom. Cancer 19:286–290, 1997.

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.

Ovarian testosterone secretion during perimenopause

OBJECTIVE The aim of the study was to investigate ovarian testosterone secretion during the last few years of reproductive life and after menopause. MATERIALS AND METHODS Ovarian and peripheral venous levels of total testosterone were analyzed in 52 women aged 42-69 years (mean 51) undergoing hysterectomy with adnexal removal for benign indications at the Department of Obstetrics and Gynecology at Tampere University Hospital, Finland. The study population was divided into pre- (n = 19), peri- (n = 18) and postmenopausal (n = 15) women in addition to the classical division according to menstrual cycle. Corresponding serum estradiol, progesterone and gonadotropin levels were measured, and the degree of ovarian stromal hyperplasia was analyzed. RESULTS The levels of all steroid hormones were higher in the ovarian vein than in the periphery. A significant positive correlation was found between age and ovarian vein testosterone levels (r = 0.3, P = 0.01). In premenopausal women, it was 1.5 nmol/l (median; range 0.78-6.0), in perimenopausal women 2.2 nmol/l (range 0.9-13.6), and 2.5 nmol/l (range 0.6-26.6) in postmenopause, respectively. Peripheral testosterone level did not increase with age. Ovarian stromal hyperplasia was significantly associated with increased testosterone secretion (P = 0.009). CONCLUSION The ovary seems to increase the secretion of testosterone into circulation during the menopausal transition period, as the highest levels were measured in postmenopausal women. High testosterone levels in the ovarian vein, however, were not reflected in the peripheral venous blood.

Serum CA 125 in acute pelvic inflammatory disease

Summary. Serum levels of CA 125 and other selected tumour markers were measured in 31 patients with proven pelvic inflammatory disease (PID). Ten (32%) of the patients had elevated CA 125, one (4%) had elevated CEA, and none had elevated CA 15–3, AFP or β2‐micro‐globulin. Compared to patients with normal CA 125, patients with elevated CA 125 were older, more often users of intrauterine contraceptive devices, had longer duration of symptoms, higher erythrocyte sedimentation rates, and more often had an adnexal mass on pelvic examination. There was a correlation between CA 125 levels and the severity of adnexal inflammation as defined by laparoscopy. Isolation of specific micro‐organisms from the upper genital tract was not associated with elevated CA 125. In most women serum levels of CA 125 decreased during treatment. PID should be considered as a major cause of positive CA 125 findings among young women.

Depletion of Langerhans cells in cervical HPV infection is associated with replication of the virus

We studied the quantity of Langerhans cells in 36 patients with cervical human papillomavirus (HPV) infection. Significantly fewer Langerhans cells (p<0.05) were found in patients with compared to those without DNA tetraploidy. Similarly, patients positive for HPV 16/18 DNA by in situ hybridization or antipeptide IgA antibodies to HPV 18 tended to have fewer Langerhans cells than those negative for HPV 16/18 DNA or IgA antibodies. Our results suggest that depletion of Langerhans cells is associated with productive HPV 16/18 infection in the cervical epithelium.

abnormal embryogenesis in the etiology of ectopic pregnancy

Flow cytometric measurements of DNA using paraffin-embedded retrospective material were performed on 42 samples of ectopic conceptuses to see whether there were any aberrations from normal DNA. It was found that DNA aneuploidy was associated with tubal implantation in 14 (33%) cases. The range of DNA indices of the DNA aneuploid peaks was from 1.14 to 2.17. Near-diploid karyotype changes were seen in 8 (19%) cases. Six cases were found to be tetraploid. In 18 abortions with known cytogenetic status, all 3 cytogenetically normal cases showed DNA diploidy in flow cytometry. It was also found that 3 out of 10 cases of trisomy 21 were DNA aneuploid. Flow cytometric DNA reflects only chromosomal changes where a significant number of cells have either lost or acquired several chromosomes. DNA aneuploidy of ectopic pregnancies suggests a grave chromosomal aberration in one third of the cases. Abnormal embryogenesis may contribute significantly to the occurrence of ectopic implantation.

Dissemination of endometrial cells during carbon dioxide hysteroscopy and chromotubation among infertile patients

The presence of endometrial cells in PF before and after diagnostic CO2 hysteroscopy and after liquid chromotubation was studied with 51 infertile patients. Cytological samples of PF or washings did not reveal endometrial cells in any case before hysteroscopy. Endometrial cells were found in PF in 16% after CO2 hysteroscopy and in 65% of cases after chromotubation. All (100%) patients with and 49% of those without endometriosis had endometrial cells in PF after liquid chromotubation. We conclude that endometrial cells are disseminated into the peritoneal cavity in a minor degree during CO2 hysteroscopy, whereas more remarkable dissemination of endometrial cells occurs during liquid chromotubation.