RESUMEN
OBJECTIVE: To use standard molecular methods to define the prevalence and metabolic characteristics of Chlamydia trachomatis during infection of fallopian tubes in women with ectopic pregnancies. DESIGN: Polymerase chain reaction (PCR)- and reverse transcription-PCR (RT-PCR)-based assessment of presence of chlamydial DNA and various RNA species in fallopian tube biopsy samples. SETTING: Hospital and molecular genetics laboratory. PATIENTS: Ten women of varying ages, each presenting with ectopic pregnancy. MAIN OUTCOME MEASURE(S): Positive signal in specific chlamydia-directed PCR and RT-PCR assays. RESULT(S): Nucleic acid preparations from 7 of the 10 fallopian tube patient samples were PCR-positive for C. trachomatis DNA. Each of the 7 PCR-positive samples also showed the presence of several transcripts from the bacterium, including primary transcripts from the ribosomal RNA operons. CONCLUSION(S): A higher proportion of ectopic pregnancies than was believed previously may be attributable to infection of the fallopian tubes by C. trachomatis. The presence of various chlamydial RNA molecules suggests that viable, metabolically active bacteria were present in fallopian tubes of the patients studied.
Asunto(s)
Chlamydia trachomatis/crecimiento & desarrollo , Trompas Uterinas/microbiología , Embarazo Ectópico/microbiología , Adulto , Femenino , Células HeLa , Humanos , Reacción en Cadena de la Polimerasa/métodos , Embarazo , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
OBJECTIVES: New methods for the measurement of the percent free (%FreeP) and percent corticosteroid binding globulin-bound (%CBG-B) fractions of plasma progesterone (P) are described. METHODS: Modifications of previously reported equilibrium dialysis and charcoal adsorption assays were used. P binding was analyzed in single midluteal samples of 16 infertile women with endometrial biopsy proven luteal phase defect (LPD) and 10 infertile women with a normal luteal phase. RESULTS: %FreeP, %CBG-B, percent nonspecific protein-bound P (%NSP), total P and total plasma estradiol (E2) were measured during the normal ovulatory cycles of 5 women. The mean follicular phase %FreeP was found to be lower than in the luteal phase due to a decline in the late follicular phase. This decline correlated with the preovulatory rise in E2. The mean absolute concentration of free P (FreeP) rose significantly in the luteal phase, positively correlating with total P in both phases. Mean %CBG-B and %NSP were unchanged throughout the cycle. P was lower in LPD vs. normal cycles, but %FreeP and %CBG-B were not different. E2 highly correlated with P but not with %FreeP and %CBG-B. CONCLUSIONS: In normal cycles a small but significant decrease in %FreeP occurs in the late follicular phase and is associated with increasing E2. Changes in total P during the ovulatory cycle reflect changes in the concentration of bioactive P. There were no data to support an association of LPD with changes in the bioactive fraction of P.
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Infertilidad Femenina/sangre , Fase Luteínica/sangre , Globulina de Unión a Progesterona/análisis , Progesterona/sangre , Adulto , Análisis Químico de la Sangre/métodos , Femenino , Fase Folicular/sangre , Humanos , Infertilidad Femenina/fisiopatología , Estudios Longitudinales , Fase Luteínica/fisiología , Transcortina/análisisRESUMEN
We have evaluated the clinical utility of the serum chlamydial antibody value by ELISA in predicting the severity of tubal factor infertility quantified by the use of a previously reported pelvic scoring system. Significant differences in salpingitis scores, tubal occlusion scores, adhesion scores, and pelvic stages were found with increasing chlamydia antibody grades. The level of ELISA value strongly correlated with salpingitis, tubal occlusion, and total pelvic scores and pelvic stages. The serum chlamydia antibody level by ELISA now appears to be a useful prognostic tool for predicting the severity of tubal factor infertility in addition to its value in screening for its presence.
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Anticuerpos Antibacterianos/sangre , Chlamydia trachomatis/inmunología , Ensayo de Inmunoadsorción Enzimática , Enfermedades de las Trompas Uterinas/microbiología , Infertilidad Femenina/microbiología , Enfermedades de las Trompas Uterinas/complicaciones , Enfermedades de las Trompas Uterinas/patología , Femenino , Humanos , Infertilidad Femenina/etiología , Enfermedad Inflamatoria Pélvica/microbiología , Pronóstico , Salpingitis/patología , Adherencias Tisulares/patologíaRESUMEN
The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 micrograms/kg, pancuronium 100 micrograms/kg, atracurium 500 micrograms/kg, and vecuronium 100 micrograms/kg were compared in 62 patients under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.
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Anestesia General , Hemodinámica/efectos de los fármacos , Isoflurano , Bloqueantes Neuromusculares/farmacología , Unión Neuromuscular/efectos de los fármacos , Adolescente , Adulto , Androstano-3,17-diol/análogos & derivados , Androstano-3,17-diol/farmacología , Atracurio/farmacología , Presión Sanguínea/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Unión Neuromuscular/fisiología , Pancuronio/farmacología , Pipecuronio , Piperazinas/farmacología , Factores de Tiempo , Bromuro de Vecuronio/farmacologíaRESUMEN
Serum chlamydial antibody (CA), as determined with an enzyme-linked immunosorbent assay (ELISA), was evaluated as a predictor for the presence or absence of tubal factor infertility. Two hundred fifty-eight infertile women had CA drawn at the initial visit of an infertility workup. Of them, 46.3% were CA positive (CA+). One hundred forty-five patients underwent laparoscopy (LPY). Tubal factor was diagnosed in 87.2% of CA+ patients and 13.6% of CA negative (CA-) ones (P less than .001), with a rising frequency by CA positivity. CA correctly predicted the presence or absence of tubal factor in 86.9% of patients. The frequency of abnormal hysterosalpingograms (HSG) was higher in CA+ patients. The predictive values for tubal factor with low, mid and high CA+ were 62.5%, 97.5% and 95.8%, respectively, and for no tubal factor with CA- was 72.3%. Combining HSG with CA- increased that value. Agreement between the LPY and HSG findings by the CA result showed a high correlation. A history of pelvic inflammatory disease (PID) or intrauterine device use was more common in CA+ patients, but only 25.3% of patients with tubal factor had a history of PID. The frequency of positive cervical chlamydial cultures was 0.8%. CA determined with ELISA appears to be an accurate screening test for tubal factor infertility and can be used to reliably select the procedure of choice for tubal evaluation.
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Chlamydia/inmunología , Ensayo de Inmunoadsorción Enzimática/instrumentación , Enfermedades de las Trompas Uterinas/diagnóstico , Infertilidad Femenina/diagnóstico , Anticuerpos Antibacterianos/sangre , Enfermedades de las Trompas Uterinas/complicaciones , Femenino , Humanos , Histerosalpingografía , Inmunoglobulina G/análisis , Infertilidad Femenina/etiología , Dispositivos Intrauterinos/efectos adversos , Laparoscopía , Enfermedad Inflamatoria Pélvica/complicaciones , Valor Predictivo de las PruebasRESUMEN
A pelvic scoring and staging system previously reported was used to evaluate 77 major microsurgical procedures during a 3-year period. Pregnancy rates by clinical assessment groups were (a) surgery indicated for tubo-ovarian adhesions (SGY:F) = 50%; (b) surgery indicated with other pelvic pathology, such as adnexal masses or myoma (SGY:F/etc) = 23%; and (c) surgery questionably indicated (SGY:?) = 18%. Using the scoring system, pregnancy rates by stage were 75%, 41%, and 14% for Stages I, II, and III, respectively. The pregnancy rate was higher in the pure tubal factor group as compared with those with additional infertility factors. Pelvic scores and stages correlated well with clinical expectations. Life-table analysis of cumulative pregnancy rates showed that all subsequent pregnancies occurred within the 24 months following surgery. A significant correlation noted between pelvic scores and cumulative pregnancy rates illustrates the system's usefulness in predicting reproductive potential postoperatively. This method can be used to assist the surgeon in establishing a couple's prognosis and to compare results between surgeons or different surgical techniques.
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Enfermedades de los Anexos/patología , Trompas Uterinas/cirugía , Infertilidad Femenina/cirugía , Enfermedades de los Anexos/complicaciones , Femenino , Humanos , Infertilidad Femenina/etiología , Laparotomía , Microcirugia , Embarazo , Estudios Retrospectivos , Adherencias TisularesRESUMEN
A deficiency in follicle stimulating hormone (FSH) levels during the early follicular phase of the menstrual cycle has been shown to result in luteal phase defect (LPD). A short course of human urinary FSH (uFSH) (Metrodin, Serono Laboratories) was given for a maximum of six cycles to 18 women with endometrial-biopsy-proven (EBX-proven) LPD. Adjunctive therapy in the form of midcycle human chorionic gonadotropin was given after the third therapy cycle. The uFSH therapy reduced the mean EBX lag time (2.0 +/- 0.6 days with therapy vs. 4.1 +/- 0.4 pretherapy, P less than .01), normalized the follicular phase length (15 +/- 0.4 days vs. 17.2 +/- 0.8 pretherapy, P less than .25) and increased the luteal phase length (12.7 +/- 0.4 days vs. 10.8 +/- 0.2 pretherapy, P less than .001). Twelve of 46 cycles (26%) in which uFSH was given without adjunctive therapy were anovulatory. Seven patients conceived; the result was seven viable pregnancies, all delivered at term. The cumulative pregnancy rate approached 48% by the sixth therapy cycle. uFSH therapy is useful for the correction of LPD and yields an acceptable pregnancy rate.
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Hormona Folículo Estimulante/uso terapéutico , Fase Luteínica/efectos de los fármacos , Trastornos de la Menstruación/tratamiento farmacológico , Adulto , Femenino , Hormona Folículo Estimulante/orina , Humanos , Infertilidad Femenina/tratamiento farmacológico , EmbarazoRESUMEN
An integrated luteal progesterone (ILPL) was calculated on the basis of a luteal progesterone (P) level with the assumption that the daily plasma P level in the luteal phase closely approximates a sine curve. The midluteal P-amplitude (K) was also obtained mathematically. Daily luteal P levels from five normal ovulatory cycles were assessed for the biologic variation of ILPL and K, then compiled to construct a normogram of the ILP during the luteal phase. The coefficient of variation of K and total ILPL in each cycle ranged from 9.7% to 24.3% and 3.5% to 13.2%, respectively. Fifty-two infertility patients were evaluated for their luteal function by the luteal P and estradiol (E2) level, K, ILPL, endometrial biopsy (EBX)-lag-day, as well as the lengths of follicular phase, luteal phase (L#), and cycle. Thirty-nine patients had EBX-lag day less than or equal to 2 days and were designated as infertile-normal (INF-NL) luteal phase, while the remaining 13 patients who had EBX-lag day greater than 2 days were considered as luteal phase defect (LPD). Significant (P less than 0.05) differences were observed between INF-NL and LPD in: luteal length (13.2 +/- 0.31 versus 11.0 +/- 0.58 days, respectively), and total ILPL (170 +/- 8.3 versus 113 +/- 8.5 ng/ml-day, respectively). No differences were seen in luteal P, E2 and K levels, nor in follicular and cycle length. Significant (P less than 0.05) correlations were observed between total ILPL and luteal P, E2, L#, and K; while a negative correlation was noted between follicular and luteal length.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cuerpo Lúteo/fisiología , Progesterona/sangre , Biopsia , Endometrio/patología , Femenino , Humanos , Infertilidad Femenina/sangre , Infertilidad Femenina/patología , Fase Luteínica , Matemática , Trastornos de la Menstruación/sangre , Trastornos de la Menstruación/patologíaRESUMEN
Leiomyomatosis peritonealis disseminata is a rare disorder characterized by the presence of multiple small nodules, consisting of benign smooth muscle, scattered over the abdominopelvic viscera and peritoneum. The case described below is the 21st reported in the medical literature to our knowledge. The condition generally occurs in menstruating, parous women in the third decade of life, and the symptoms are similar to those of uterine leiomyomata. There is a very high association with excess exogenous and endogenous female gonadal steroids, specifically estrogen and progesterone. Leiomyomatosis peritonealis disseminata is a benign condition for which conservative management is indicated, particularly if fertility is desired.