RESUMEN
Se realizó un estudio cuasiexperimental de 56 pacientes con diagnóstico de hidrosalpinx, que acudieron a la consulta de Medicina Natural y Tradicional del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba - remitidas de las consultas de Ginecología e Infertilidad -, desde septiembre de 2014 hasta diciembre de 2015, para evaluar la respuesta a la terapia Su Jok. Entre las variables analizadas figuraron: edad, factores de riesgo, manifestaciones clínicas, síndromes tradicionales, evolución clínica y respuesta al tratamiento. En la casuística predominaron las féminas de 30-39 años, la enfermedad inflamatoria pélvica y las infecciones de trasmisión sexual como antecedentes patológicos (71,4 por ciento), el dolor y la secreción vaginal como síntomas principales, así como el estancamiento de Qi de hígado, Qi de riñón no firme y frío-humedad en bazo como síndromes más frecuentes. Finalmente, se logró una evolución favorable y una respuesta adecuada al tratamiento(AU)
A quasi-experiment of 56 patients with hydrosalpinx diagnosis that went to the Natural and Traditional Medicine Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba - referred from the Gynecology and Infertility Services -, was carried out from September, 2014 to December, 2015, to evaluate the response to Su Jok therapy. Among the analyzed variables there were: age, risk factors, clinical features, traditional syndromes, clinical course and response to the treatment. In the case material there was a prevalence of women aged 30-39, pelvic inflammatory disease and sexually transmitted infections as pathological history (71.4 percent), pain and vaginal secretion as main symptoms, as well as Qi liver stagnation, not firm Qi kidney and coldness-humidity in spleen as most frequent syndromes. Finally, there was a favorable clinical course and an appropriate response to the treatment(AU)
Asunto(s)
Humanos , Femenino , Enfermedad Inflamatoria Pélvica , Dolor Pélvico , Infección Pélvica , Terapia por Acupuntura , Medicina Tradicional , Salpingitis , Ensayo ClínicoRESUMEN
Se realizó un estudio cuasiexperimental de 56 pacientes con diagnóstico de hidrosalpinx, que acudieron a la consulta de Medicina Natural y Tradicional del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba - remitidas de las consultas de Ginecología e Infertilidad -, desde septiembre de 2014 hasta diciembre de 2015, para evaluar la respuesta a la terapia Su Jok. Entre las variables analizadas figuraron: edad, factores de riesgo, manifestaciones clínicas, síndromes tradicionales, evolución clínica y respuesta al tratamiento. En la casuística predominaron las féminas de 30-39 años, la enfermedad inflamatoria pélvica y las infecciones de trasmisión sexual como antecedentes patológicos (71,4 por ciento), el dolor y la secreción vaginal como síntomas principales, así como el estancamiento de Qi de hígado, Qi de riñón no firme y frío-humedad en bazo como síndromes más frecuentes. Finalmente, se logró una evolución favorable y una respuesta adecuada al tratamiento
A quasi-experiment of 56 patients with hydrosalpinx diagnosis that went to the Natural and Traditional Medicine Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba - referred from the Gynecology and Infertility Services -, was carried out from September, 2014 to December, 2015, to evaluate the response to Su Jok therapy. Among the analyzed variables there were: age, risk factors, clinical features, traditional syndromes, clinical course and response to the treatment. In the case material there was a prevalence of women aged 30-39, pelvic inflammatory disease and sexually transmitted infections as pathological history (71.4 percent), pain and vaginal secretion as main symptoms, as well as Qi liver stagnation, not firm Qi kidney and coldness-humidity in spleen as most frequent syndromes. Finally, there was a favorable clinical course and an appropriate response to the treatment
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Terapias Complementarias , Enfermedad Inflamatoria Pélvica/complicaciones , Enfermedades de las Trompas Uterinas/terapia , Medicina Tradicional China , Salpingitis/terapia , Atención Secundaria de Salud , Dolor Pélvico/terapiaRESUMEN
Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis. An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.
Asunto(s)
Humanos , Femenino , Adulto , Absceso/etiología , Actinomicosis/diagnóstico , Dispositivos Intrauterinos/efectos adversos , Ooforitis/patología , Salpingitis/patología , Cavidad Abdominal/patología , Antiinfecciosos/uso terapéutico , Fístula , Perforación Intestinal , Pelvis/patologíaRESUMEN
A case of extremely rare puerperal sepsis is presented in this paper. Postpartum infection is an entity given in between 0.1% and 10% of postpartum patients and has a mortality rate ranging from 2% to 11%. In this case report, a primigravida patient, age 19, presented hypogastric pain, emesis and fever five days after delivery. Postpartum endometritis and retained products of conception were diagnosed; uterine curettage was performed and antibiotic treatment was formulated with satisfactory outcome. The patient was discharged on the fourth day. The patient was readmitted 27 days after delivery with hypogastric persistent pain and fever, vomiting, hypotension and pulmonary dysfunction; gynecological examination showed findings consistent with salpingitis and a laparotomy was performed to confirm the diagnosis, finding salpingitis along with pelvic peritonitis. An intravenous antibiotic treatment, laparotomy and peritoneal washings were provided with satisfactory evolution. The literature on puerperal sepsis, myometritis and postpartum salpingitis is reviewed because, in order to improve morbidity and mortality, timely diagnosis and treatment are determining.
Se presenta un caso de sepsis puerperal de evolución poco frecuente. La infección pos-parto es una entidad que se da entre el 0.1% y 10% de las pacientes en posparto y tie-ne una mortalidad que varía del 2% al 11%. En este reporte de caso, se presenta una paciente primigestante de 19 años, quién a los cinco días posparto presenta cuadro de dolor en hipogastrio, emesis y fiebre. Se diagnostica endometritis posparto y reten-ción de restos, se realiza legrado uterino y se le formula tratamiento antibiótico con evolu-ción satisfactoria y salida al cuarto día. La paciente reingresó a los 27 días pos-parto con dolor en hipogastrio y fiebre, persis-tencia del dolor, vómito, hipotensión y disfun-ción pulmonar; el examen ginecológico arrojó hallazgos compatibles con salpingitis, por lo que fue llevada a laparotomía confirmándose el diagnóstico de salpingitis con pelvi-perito-nitis. Se comenzó tratamiento antibiótico intra-venoso, laparostomía y lavados peritoneales con evolución satisfactoria. Para mejorar la morbimortalidad, es im-portante un diagnóstico y tratamiento oportu-no, por lo cual se revisa la literatura de sepsis puerperal, miometritis y salpingitis posparto.
Asunto(s)
Humanos , Infección Puerperal , Peritonitis , Salpingitis , Periodo PospartoRESUMEN
To study the effect of Wharton's jelly-derived mesenchymal stem cells (WJMSCs) on the rat salpingitis model, 50 female Wistar rats were randomly divided into one control and five model groups. Mixed bacteria were injected into the oviducts of model groups. The treated acute and chronic groups received intraperitoneal injections of WJMSCs (1 x 10(6)) once a week for three weeks. Serum inflammation factor, collagen fiber content and oviduct-specific glycoprotein (OVGP) levels were detected in control, chronic, ex-treatment acute and chronic, and treated acute and chronic groups (N = 5 for each group). Pregnancy rate and litter size of control, chronic, treated acute and treated chronic groups were compared. Serum TNF-α and INF-γ levels increased in ex-treatment acute and chronic groups, and restored to normal in the acute treated group but not in the treated chronic group. Oviduct collagen fibers did not increase significantly before or after treatment in the acute group, but it increased in the ex-treatment chronic group and did not improve after treatment. After treatment, OVGP levels restored to normal in the acute group but reduced in the ex-treatment and treated chronic groups and chronic group. The pregnancy rate and litter size of the treated acute group recovered to normal, but in the treated chronic group and chronic model group, they decreased significantly. Thus, intraperitoneal injection of WJMSCs could recover the function of the oviduct in acute salpingitis rats, but its effect on chronic salpingitis was poor. Timely treatment of salpingitis is crucial to preserve reproductive function.
Asunto(s)
Fertilidad/fisiología , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/citología , Oviductos/fisiología , Salpingitis/terapia , Gelatina de Wharton/citología , Enfermedad Aguda , Animales , Células Cultivadas , Enfermedad Crónica , Femenino , Humanos , Recién Nacido , Inyecciones Intraperitoneales , Interferón gamma/sangre , Tamaño de la Camada , Masculino , Embarazo , Índice de Embarazo , Distribución Aleatoria , Ratas Wistar , Salpingitis/sangre , Trasplante Heterólogo , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/sangreRESUMEN
Elafin is a natural antimicrobial molecule and a member of the antileukoproteinase (Trappin) family. It is normally expressed in the mucosae of fallopian tubes. Hydrosalpinx is a chronic inflammatory process of the fallopian tubes. The objective of this study is to compare the localization of elafin protein and levels of elafin messenger RNA (mRNA) in the mucosa of oviducts with and without hydrosalpinx. Immunohistochemical analysis was performed on tissue sections of hydrosalpinx (n = 10) and normal tubes (n = 22) from paraffin-embedded blocks, obtained from patients who underwent salpingectomy for benign conditions. The main outcome measure was the intensity of staining with 3,3'-diaminobenzidine calculated by ImageJ software and mRNA expression by real-time polymerase chain reaction. The mean intensity of elafin (mean ± standard deviation) in mucosae of the fallopian tubes was 69.68 ± 24.55 in controls and 32.03±18.16 in patients with hydrosalpinx (P < .0001). Elafin mRNA levels were reduced in hydrosalpinx, although not significantly (P = .05, n = 9 from each group). Therefore, tubal epithelium of women with hydrosalpinx seems to have a lower expression of elafin, an elastase inhibitor and a natural antimicrobial molecule, compared to normal tubes.
Asunto(s)
Elafina/biosíntesis , Trompas Uterinas/metabolismo , Trompas Uterinas/patología , Salpingitis/metabolismo , Salpingitis/patología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Membrana Mucosa/metabolismo , Membrana Mucosa/patologíaRESUMEN
La infección del tracto genital superior (ITGS) femenino o enfermedad inflamatoria pélvica (EIP) comprende una serie de condiciones inflamatorias del tracto reproductivo femenino. La presentación clínica es variada y la mayoría se presenta como un dolor abdominal de cuadrantes inferiores o dolor pélvico, pudiendo ser incluso difuso y muchas veces manifestarse como un dolor abdominal agudo de difícil diagnóstico. Las formas de presentación clínica y el compromiso anatómico son variados. En 1982 Monif diseñó una clasificación que se basa en el compromiso anatómico de las estructuras afectadas, desde una infección localizada como salpingitis, hasta cuadros más graves con riesgo vital como un absceso tubo oválico (ATO) roto. Las imágenes junto a la clínica forman un pilar fundamental para el diagnóstico y así definir una conducta terapéutica. En el siguiente artículo se presenta una serie de casos con sus principales hallazgos a la tomografía computada (TC) clasificados por los estadios de Monif.
Abstract: Upper genital tract infection (UGTI) or female pelvic inflammatory disease (PID) comprises a number of inflammatory conditions of the female reproductive tract. The clinical presentation is varied and most occur as a lower quadrant abdominal pain or pelvic pain, and may even be diffuse and often manifest as an acute abdominal pain difficult to diagnose. The clinical presentation and anatomic involvement are varied. In 1982 Monif designed a classification based on the anatomical commitment of the affected structures, from a localized infection such as salpingitis, to more serious conditions such as life-threatening ruptured tubo-ovarian abscess (TOA). Images together with case history form a fundamental basis for the diagnosis and so define therapeutic management. In the following article a series of cases are presented with their main findings to the computed tomography (CT) classified according to Monifs staging.
Asunto(s)
Humanos , Adulto , Femenino , Enfermedad Inflamatoria Pélvica/patología , Enfermedad Inflamatoria Pélvica , Tomografía Computarizada por Rayos X , Salpingitis/patología , Salpingitis , Índice de Severidad de la EnfermedadRESUMEN
O objetivo deste trabalho é descrever os principais achados em tomografia computadorizada e ressonância magnética em pacientes com dor abdominal aguda decorrente de doença inflamatória pélvica. Dois radiologistas em consenso selecionaram e analisaram exames de tomografia computadorizada e ressonância magnética, realizados entre janeiro de 2010 e dezembro de 2011, de pacientes com quadro comprovado de doença inflamatória pélvica levando a um quadro de abdome agudo. Os principais achados foram coleções líquidas intracavitárias, realce anômalo na escavação pélvica e densificação dos planos adiposos anexiais. A doença inflamatória pélvica é uma das principais causas de dor abdominal em mulheres em idade reprodutiva e tem sido progressivamente diagnosticada mediante uso da tomografia computadorizada e ressonância magnética, que complementam o papel da ultrassonografia. É crucial que os radiologistas se familiarizem com os principais aspectos diagnósticos em imagem seccional desta causa comum de abdome agudo.
The present study was aimed at describing key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain derived from pelvic inflammatory disease. Two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed between January 2010 and December 2011 in patients with proven pelvic inflammatory disease leading to presentation of acute abdomen. Main findings included presence of intracavitary fluid collections, anomalous enhancement of the pelvic excavation and densification of adnexal fat planes. Pelvic inflammatory disease is one of the leading causes of abdominal pain in women of childbearing age and it has been increasingly been diagnosed by means of computed tomography and magnetic resonance imaging supplementing the role of ultrasonography. It is crucial that radiologists become familiar with the main sectional imaging findings in the diagnosis of this common cause of acute abdomen.
Asunto(s)
Humanos , Femenino , Abdomen Agudo/diagnóstico , Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedad Inflamatoria Pélvica/etiología , Dolor Abdominal , Trompas Uterinas , Espectroscopía de Resonancia Magnética , Reacción de Fase Aguda/etiología , Salpingitis , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCCIÓN: La oxiuriasis es una parasitosis causada por Enterobius vermicularis, cuyo ciclo vital es exclusivo en humano. En chile se subestima su prevalencia, debido a su baja notificación, sin embargo es causante de múltiples entidades clínicas como trastornos del sueño, lesiones de la mucosa nasal, vulvovaginitis,salpingitis, ooforitis, enfermedad inflamatoria pélvica, e incluso peritonitis secundaria a perforación de asa intestinal infestada. PRESENTACIÓN DEL CASO: Mujer de 33 años que ingresa al servicio de urgencia del Hospital El Pino, Santiago de Chile, con manifestaciones clínicas compatibles con apendicitis aguda. Se realiza apendicectomía y como hallazgo operatorio se constata tumor de bordes mal definidos en trompa uterina derecha, interpretado como embarazo ectópico, por lo que se realiza salpingectomía unilateral. Sin embargo, en el estudio anatomopatológico posterior se diagnostica enterobiasis tubárica DISCUSIÓN: La infestación por Enterobius vermicularis es considerada endémica en nuestro país, con una prevalencia de hasta un 41por ciento, por lo que es necesario incorporarlo como diagnóstico diferencial de abdomen agudo.
INTRODUCTION: Estrongyloides is a parasitic disease caused by Enterobius vermicularis, Humans are hosts only to this parasite. In Chile, there are an underestimated prevalence due to its low notification, however, it causes many clinical entities as sleep disorder, nasal mucosal damage, vulvovaginitis, salpingitis, oophoritis, pelvic inflammatory disease and even peritonitis due to rupture of infested intestinal loop. CASE REPORT: A 33 years old admitted to the emergency department of Hospital El Pino with clinical manifestations compatible with acute appendicitis. Appendectomy was performed, operative findings suggested an ill-defined tumor in fallopian tube, interpreted as ectopic pregnancy. Then underwent unilateral salpingectomy after pathological examination fallopian tube salpingeal was diagnosed. DISCUSSION: Given the high prevalence and the fact that mimic acute appendicitis it´s a significant part of the differential diagnosis for acute abdomen.
Asunto(s)
Humanos , Adulto , Femenino , Trompas Uterinas , Oxiuriasis/complicaciones , Oxiuriasis/diagnóstico , Salpingitis/diagnóstico , Apendicitis/diagnóstico , Diagnóstico Diferencial , Dolor Abdominal/etiología , Eosinofilia , Embarazo Ectópico/diagnóstico , Enterobiasis/complicaciones , Enterobiasis/diagnósticoRESUMEN
A doença inflamatória pélvica (DIP) consiste em espectro de infecções do trato genital superior que inclui: endometrite, salpingite, abscesso tubo-ovariano e/ou peritonite pélvica. Constitui-se em infecção polimicrobiana do trato genital superior feminino devido à sua contaminação pelos microrganismos do endocérvice e da vagina. São fatores de risco para o desenvolvimento de DIP: idade entre 15-24 anos, vida sexual ativa, múltiplos parceiros, inserção de dispositivo intra-uterino (DIU) há menos de 20 dias e história pregressa de DIP. Procedimentos e cirurgias pélvicos com manipulação de canal cervical podem predispor à infecção por alterarem a barreira cervical protetora. A DIP é um dos processos infecciosos mais frequentes nas mulheres em idade reprodutiva e é entidade de difícil diagnóstico devido às manifestações clínicas diversas. O diagnóstico é muito provável diante de dor à palpação cervical, uterina e/ou de anexos, acompanhados de febre, corrimento vaginal mucopurulento ou leucorreia, sangramento intermenstrual e pós-coito, dispareunia, disúria e polaciúria. O tratamento da DIP deve prover antibioticoterapia empírica de amplo espectro para os patógenos mais prováveis: N. gonorrhoeae e C. trachomatis, pois o rastreamento negativo para esses organismos não exclui infecção do trato reprodutivo superior. A precocidade das medidas terapêuticas é importante na prevenção de sequelas de longo prazo e a opção por tratamento ambulatorial ou hospitalar deve ser baseada no julgamento médico. Parceiros sexuais de mulheres com DIP devem ser examinados e tratados caso tenham tido relação sexual com a paciente nos 60 dias anteriores ao aparecimento dos sintomas. O rastreamento e tratamento da infecção por clamídia em mulheres sexualmente ativas diminui o risco de elas contraírem DIP. Grávidas com suspeita de DIP devem ser internadas para receber tratamento parenteral. Não foram estabelecidas diferenças nas manifestações clínicas da DIP em mulheres soropositivas e negativas para o HIV. Ambos os grupos respondem igualmente bem aos tratamentos parenteral e oral. (AU)
Pelvic Inflammatory Disease (PID) consists in a spectrum of upper genital tract infections including: endometritis, salpingitis, tube-ovarian abscess and / or pelvic peritonitis. It constitutes polymicrobial infection of upper female genital tract because of its contamination by microrganisms from the vagina and endocervix. Risk factors for the development of PID are: aged 15-24 years, sexual activity, multiple partners, insertion of an intrauterine device (IUD) for less than 20 days and a history of PID. Procedures and pelvic surgery with manipulation of the cervical canal may predispose to infection by altering the cervical protective barrier. PID is one of the most common infectious processes in women in reproductive age and it is an entity of difficult diagnosis due to the diverse clinical manifestations. The diagnosis is most likely on painful palpation of the cervix, uterus or attachments, accompanied by fever, depurulent vaginal discharge or leukorrhea, intermenstrual and postcoital bleeding, dyspareunia, dysuria and pollakiuria. The treatment of PID should provide broad-spectrum empiric antibiotic therapy for the most likely pathogens: N. gonorrhoeae and C. trachomatis, because negative screening for these organisms does not exclude infection of the upper reproductive tract. The early therapeutic measures are important in preventing long-term sequelae and the option for outpatient or hospital treatment should be based on medical judgment. Sexual partners of women with PID should be examined and treated if they had sexual relations with the patient 60 days prior to the onset of symptoms. Screening and treatment of chlamydial infection in sexually active women decreases the risk of them contracting PID. Pregnant women with suspected PID should be hospitalized to receive parenteral treatment. No differences were found in clinical manifestations of PID in women seropositive and negative for HIV. Both groups respond equally well to parenteral and oral treatments. (AU)
Asunto(s)
Humanos , Femenino , Enfermedades de Transmisión Sexual/complicaciones , Enfermedad Inflamatoria Pélvica/diagnóstico , Dispositivos Intrauterinos , Peritonitis/complicaciones , Salpingitis/complicaciones , Infecciones por VIH/complicaciones , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Enfermedad Inflamatoria Pélvica/epidemiología , Levonorgestrel , Cobre , Endometritis/complicaciones , Infusiones ParenteralesRESUMEN
Paciente primigestante en el primer trimestre del embarazo que consulta a urgencias por dolor abdominal y síncope. Fue estudiada en ginecología y por los hallazgos imagenológicos sugirieron embarazo ectópico derecho. Se realizó laparotomía encontrando dilatación tubárica bilateral, motivo por el cual se practicó salpingectomía bilateral. El estudio patológico demostró embarazo ectópico bilateral al encontrar vellosidades coriales en ambas luces tubáricas.
A nulliparous woman in the first trimester of pregnancy presented with abdominal pain and syncope to the emergency room. She was studied in the gynecology service and a pelvic ultrasound suggested a right ectopic pregnancy. She underwent a laparotomy which disclosed a bilateral tubal dilation. A bilateral salpingectomy was performed. Histology confirmed a synchronious bilateral ectopic pregnancy by demonstrating chorionic villi in both tubes.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Embarazo Ectópico , Salpingitis , Anticonceptivos , EndometriosisRESUMEN
Objetivos: Avaliar o desempenho da imunofluorescência indireta para Chlamydia trachomatis em rastrear obstrução tubária. Métodos: Este é um estudo retrospectivo com 204 pacientes atendidas em um centro universitário e particular de infertilidade na cidade de Goiânia no período de 2006 a 2009. Para avaliar o risco de obstrução tubária as pacientes foram divididas em dois grupos: pacientes expostas à clamídia (imunofluorescênciaindireta ≥1:16) e não expostas (imunofluorescência indireta <1:16). Verificou-se, então, as pacientes que tiveram a doença (obstrução tubária) e controles (sem obstrução tubária) na histerossalpingografia. Para os cálculos foram utilizados os testes Qui-quadrado (χ2) e Exato de Fisher. O nível de p escolhido foi 0,05. Resultados: Das 72 pacientes com titulação significativa, 34 (47,2%) apresentaram a ocorrência de obstrução tubária. Em relação às 132 pacientes com titulação não significativa, somente 18 (13,7%) apresentaram obstrução tubária (p<0,001). Foi observado também um aumento progressivo entre os níveis de anticorpos e a probabilidade de obstrução tubária (p<0,001). Conclusões: Os resultados deste estudorevelaram que a sorologia para Chlamydia trachomatis é válida para rastreamento de lesão tubária, portanto, pode facilitar decisões naquelas mulheres que devem prosseguir com novas investigações.
Purpose: To evaluate the ability of indirect immunofluorescence for Chlamydia trachomatis to screening tubal occlusion. Methods: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania, in the period of 2006 to 2009. To evaluate the risk of tubal occlusion the patients were divided into two groups: patients exposed to chlamydia (IFI≥1:16) e unexposed (IFI<1:16). It was verified patients who had the disease (tubal occlusion) and control (without tubal occlusion) in the hysterosalpingography. For the calculations the Chi-square (χ2) and Fisher Exact Test were used. The p chosen level was 0,05. Results: Of the 72 patients with significant titers, 34 (47,2%) showed the occurrence of tubal occlusion. Concerning the 132 patients with no significant titers, only 18 (13,7%) had tubal occlusion(p<0,001). We also observed a progressive increase in the levels of antibodies and the likelihood of tubal occlusion (p<0,001). Conclusions: The results indicate that serology for Chlamydia trachomatis is valid for screening of tubal damage and may facilitate decisions on which women should proceed with further investigations.
Asunto(s)
Humanos , Femenino , Adulto , Infecciones por Chlamydia , Chlamydia trachomatis , Infertilidad , Salpingitis , Histerosalpingografía/métodos , Estudios Retrospectivos , Técnica del Anticuerpo Fluorescente Indirecta/métodosAsunto(s)
Quistes/patología , Mesotelioma Quístico/patología , Cavidad Peritoneal/patología , Neoplasias Peritoneales/patología , Adenocarcinoma de Células Claras/diagnóstico , Adulto , Biomarcadores de Tumor/metabolismo , Cistadenocarcinoma Seroso/diagnóstico , Quistes/metabolismo , Diagnóstico Diferencial , Endometriosis/diagnóstico , Femenino , Humanos , Hallazgos Incidentales , Queratina-5/metabolismo , Queratina-6/metabolismo , Linfangioma Quístico/diagnóstico , Mesotelioma/diagnóstico , Mesotelioma Quístico/metabolismo , Conductos Paramesonéfricos/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Peritoneales/metabolismo , Seudomixoma Peritoneal/diagnóstico , Salpingitis/diagnósticoRESUMEN
Se realizó un estudio de cohorte, con el objetivo de evaluar la efectividad del manejo sindrómico en la reducción de las complicaciones producidas por las infecciones de transmisión sexual en el municipio San Cristóbal, durante los meses de enero de 2005 a diciembre de 2006. La muestra estuvo constituida por el total de pacientes que solicitaron atención médica por presentar secreción uretral, flujo vaginal y/o dolor abdominal bajo en este período. Los datos fueron recogidos a través de encuestas, hojas de cargo y registros hospitalarios. Se efectuó el cálculo de por ciento, tasa y pruebas de significación estadística según procedió. Se concluyó que al inicio del estudio el mayor por ciento de los médicos poseía bajos conocimientos sobre el tema. La enfermedad inflamatoria pélvica aguda fue la complicación más frecuente encontrada antes y después de aplicado al estudio, siendo notoria la reducción que experimentaron todas estas patologías al concluir el mismo, resultando significativo los resultados encontrados. La mayoría de los pacientes de la cohorte A (95,8 por ciento) resolvieron su sintomatología antes de los siete días después del tratamiento...(AU)
A cohort study aimed at assessing the effectiveness of the Syndromic Management for the reduction of complications produced by Sexually Transmitted Infections was conducted in San Cristobal municipality during both, January 2005 and December 2006. The sample was comprised of the total of patients requesting medical assistance for presenting urethral discharge, vaginal discharge and/or low-abdominal pain during this period of time. Data were collected by means of surveys, charge-sheet and hospital registers. Percentage calculation, rate and statistical significance testing were applied when proceeding. Concluding that, at the beginning of the research a greater percent of doctors had a low level of knowledge about this topic. Acute Pelvic Inflammatory Disease was the most frequent complication found before and after the study; being noticeable the reduction of all these pathologies when the study was concluded. The majority of the patients included in the cohort-A (95, 8 per cent) solved the symptoms before seven days after the treatment...(AU)
Asunto(s)
Humanos , Adulto , Enfermedades de Transmisión Sexual , Salpingitis , Enfermedad Inflamatoria PélvicaRESUMEN
El objetivo del presente trabajo es revisar algunos aspectos del diagnóstico, manejo y pronóstico de pacientes con infertilidad de origen tubárico, y evaluar el rol de la cirugía tubárica, basados en la evidencia disponible actualmente. Se efectuó una búsqueda bibliográfica en bases de datos electrónicas (Medline, Cochrane) y en libros de texto impresos, seleccionando los artículos considerados de mayor relevancia científica y epidemiológica. Se consultó material publicado entre 1984 y 2008, haciendo énfasis en estudios controlados aleatorizados (ECC). Resultados: El daño de las trompas de Falopio es una causa común en la mujer que tiene dificultad para concebir. La laparoscopia con cromopertubación permanece hoy como la prueba de oro en el diagnóstico de la enfermedad tubárica. Otras modalidades diagnósticas como la histerosalpingografía, sonohisterosalpingografía, salpingoscopia, falloposcopia, y serología para clamidia pueden también evaluar el daño tubárico. Varias opciones de tratamiento están disponibles. Para la obstrucción tubárica proximal, la canulación tubárica transcervical con lavado tubárico es una primera opción razonable. Las técnicas quirúrgicas para reparar las trompas como la salpingostomia o fimbrioplastia para enfermedad tubárica distal pueden dar buenos resultados. Aunque la intervención quirúrgica es efectiva en muchos problemas, el factor tubárico permanece como una de las mayores indicaciones para fertilización in-vitro con transferencia de embriones (FIV-TE). En ciertas situaciones, como embarazo ectópico recurrente o hidrosalpinx, la salpingectomía profiláctica puede ser usada en conjunto con la FIV-TE para mejorar los resultados en embarazos siguientes. Hay limitada evidencia de que haya beneficio o desventaja cuando se compara la microcirugía con técnicas estándar, la laparoscopia con laparotomía, y el uso de láser CO2 en las cirugías para infertilidad tubárica.
The present review is aimed at some aspects of diagnosis, treatment and prognosis of patients with tubal originated infertility, and to assess the role of tubal surgery, based on the available evidence. A reference search was made in electronic databases (Medline, Cochrane) and printed material published from 1984 to 2004, selecting articles considered by the authors to be of an important scientific and epidemiological relevance. Damage to the fallopian tubes is a common cause of infertility in women having difficulty conceiving. The laparoscopic chomopertubation remains as the "gold standard" of the diagnosis of tubal disease. In addition, other diagnostic modalities are available, including hysterosalpingography, sonohysterography, salpingoscopy, falloposcopy, and Chlamydia serology can assess tubal patency. Depending on the nature and degree of tubal dysfunction as well as the age and ovarian reserve of the patient, various approaches to the treatment of tubal infertility are available. For proximal tubal obstruction, transcervical tubal cannulation with tubal "flushing" is a reasonable first approach. Surgical techniques for tubal repair, such as salpingostomy or fimbrioplasty for distal tubal obstruction, can provide good results. While surgical intervention is an effective treatment for most tubal obstructions, tubal factor remains a major indication for in-vitro fertilization and embryo transfer. However, in specific situations, such as recurrent ectopic pregnancy and hidrosalpinx, prophylactic surgery can be used in conjunction with IVF-TE to improve subsequent pregnancy outcomes. There is limited evidence of the benefits or disadvantages of tubal surgery using microsurgery over standard techniques, laparoscopic approach over laparotomy, and the use of CO2 laser.
Asunto(s)
Humanos , Diagnóstico , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/rehabilitación , Salpingitis , Fertilización In Vitro , LaparoscopíaRESUMEN
OBJECTIVE: Evaluation of uteroglobin (UG) expression in the fallopian tube in different tubal diseases. DESIGN: The UG was screened and quantified in samples of fallopian tubes from patients with salpingitis, hydrosalpinx, and ectopic pregnancy by exposing the UG with immunohistochemical techniques. SETTING: University hospital and electron microscopy center. PATIENT(S): Women with pelvic inflammatory disease (PID) and complicated tubal ectopic pregnancy consulting for medical care. INTERVENTION(S): Salpingectomy. MAIN OUTCOME MEASURE(S): Tubal tissues were collected and examined using regular pathologic techniques. The UG immunoreactivity in the tubal epithelium was also assessed. RESULT(S): Fallopian tube epithelium displayed an increased UG expression in patients with PID and complicated tubal pregnancy compared with control patients. CONCLUSION(S): Uteroglobin is present in the human fallopian tube as a secretory protein and appears to be involved in immunosuppressive responses in the fallopian tube.
Asunto(s)
Trompas Uterinas/metabolismo , Inflamación/etiología , Embarazo Ectópico/genética , Uteroglobina/metabolismo , Adulto , Trompas Uterinas/inmunología , Trompas Uterinas/cirugía , Femenino , Humanos , Inmunohistoquímica , Embarazo , Salpingitis/cirugíaRESUMEN
BACKGROUND: Infection of the Fallopian tubes (FT) by Neisseria gonorrhoeae (Ngo) can lead to acute salpingitis, an inflammatory condition resulting in damage primarily to the ciliated cells, with loss of ciliary activity and sloughing of the cells from the epithelium. Recently, we have shown that Ngo infection induced apoptosis in FT epithelium cells by a TNF-alpha dependent mechanism that could contribute to the cell and tissue damage observed in gonococcal salpingitis. AIM: To investigate the apoptosis-related genes expressed during apoptosis induction in cultured FT epithelial cells infected in vitro by Ngo. MATERIALS AND METHODS: In the current study, we used cDNA macroarrays and real time PCR to identify and determine the expression levels of apoptosis related genes during the in vitro gonococci infection of FT epithelial cells. RESULTS: Significant apoptosis was induced following infection with Ngo. Macroarray analysis identified the expression of multiple genes of the TNF receptor family (TNFRSF1B, -4, -6, -10A, -10B and -10D) and the Bcl-2 family (BAK1, BAX, BLK, HRK and MCL-1) without differences between controls and infected cells. This lack of difference was confirmed by RT-PCR of BAX, Bcl-2, TNFRS1A (TNFR-I) and TNFRSF1B (TNFR-II). CONCLUSION: Several genes related to apoptosis are expressed in primary cultures of epithelial cells of the human Fallopian tube. Infection with Ngo induces apoptosis without changes in the pattern of gene expression of several apoptosis-related genes. RESULTS strongly suggest that Ngo regulates apoptosis in the FT by post-transcriptional mechanisms that need to be further addressed.
Asunto(s)
Apoptosis/genética , Células Epiteliales/microbiología , Trompas Uterinas/microbiología , Neisseria gonorrhoeae/fisiología , Salpingitis/microbiología , Células Cultivadas , Células Epiteliales/patología , Trompas Uterinas/patología , Femenino , Regulación de la Expresión Génica , Humanos , Análisis de Secuencia por Matrices de Oligonucleótidos , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Receptores del Factor de Necrosis Tumoral/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Salpingitis/patologíaRESUMEN
Background: Infection of the Fallopian tubes (FT) by Neisseria gonorrhoeae (Ngo) can lead to acute salpingitis, an inflammatory condition resulting in damage primarily to the ciliated cells, with loss of ciliary activity and sloughing of the cells from the epithelium. Recently, we have shown that Ngo infection induced apoptosis in FT epithelium cells by a TNF-alpha dependent mechanism that could contribute to the cell and tissue damage observed in gonococcal salpingitis. Aim: To investigate the apoptosis-related genes expressed during apoptosis induction in cultured FT epithelial cells infected in vitro by Ngo. Materials and Methods: In the current study, we used cDNA macroarrays and real time PCR to identify and determine the expression levels of apoptosis related genes during the in vitro gonococci infection of FT epithelial cells. Results: Significant apoptosis was induced following infection with Ngo. Macroarray analysis identified the expression of multiple genes of the TNF receptor family (TNFRSF1B, -4, -6, -10A, -10B and -10D) and the Bcl-2 family (BAK1, BAX, BLK, HRK and MCL-1) without differences between controls and infected cells. This lack of difference was confirmed by RT-PCR of BAX, Bcl-2, TNFRS1A (TNFR-I) and TNFRSF1B (TNFR-II). Conclusion: Several genes related to apoptosis are expressed in primary cultures of epithelial cells of the human Fallopian tube. Infection with Ngo induces apoptosis without changes in the pattern of gene expression of several apoptosis-related genes. Results strongly suggest that Ngo regulates apoptosis in the FT by post-transcriptional mechanisms that need to be further addressed.
Asunto(s)
Femenino , Humanos , Apoptosis/genética , Células Epiteliales/microbiología , Trompas Uterinas/microbiología , Neisseria gonorrhoeae/fisiología , Salpingitis/microbiología , Células Cultivadas , Células Epiteliales/patología , Trompas Uterinas/patología , Regulación de la Expresión Génica , Análisis de Secuencia por Matrices de Oligonucleótidos , /metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Receptores del Factor de Necrosis Tumoral/metabolismo , Salpingitis/patologíaRESUMEN
Ocorrência dos operons fim, pap e sfa em amostras de Escherichia coli isoladas de reprodutoras com salpingite e pintinhos com onfalite foi avaliada. A análise de 100 amostras através dos testes de hibridização de colônia mostrou que 78 (78%) amostras eram fim+, uma (1%) era sfa+, sete (7%) eram fim+ associada a pap+, oito (8%) eram fim+ e uma (1%) era fim+pap+sfa + e cinco (5%) amostras não hibridizaram com nenhuma sonda. Estes resultados sugerem que o operon fim pode ter um importante papel na patogenia da infecção de Escherichia coli em reprodutoras com salpingite e pintinhos com onfalite.
Asunto(s)
Adhesinas de Escherichia coli , Aves , Escherichia coli , Infecciones por Escherichia coli , Técnicas In Vitro , Operón , Salpingitis , Métodos , VirulenciaRESUMEN
Following infection with Neisseria gonorrhoeae, bacteria may ascend into the Fallopian tubes (FT) and induce salpingitis, a major cause of infertility. In the FT, interactions between mucosal epithelial cells and gonococci are pivotal events in the pathogen's infection cycle and the inflammatory response. In the current study, primary FT epithelial cells were infected in vitro with different multiplicities of infection (MOI) of Pil+ Opa+ gonococci. Bacteria showed a dose-dependent association with cells and induced the secretion of tumor necrosis factor alpha (TNF-alpha). A significant finding was that gonococcal infection (MOI = 1) induced apoptosis in approximately 30% of cells, whereas increasing numbers of bacteria (MOI = 10 to 100) did not induce apoptosis. Apoptosis was observed in only 11% of cells with associated bacteria, whereas >84% of cells with no adherent bacteria were apoptotic. TNF-alpha was a key contributor to apoptosis, since (i) culture supernatants from cells infected with gonococci (MOI = 1) induced apoptosis in naïve cultures, suggesting that a soluble factor was responsible; (ii) gonococcal infection-induced apoptosis was inhibited with anti-TNF-alpha antibodies; and (iii) the addition of exogenous TNF-alpha induced apoptosis, which was inhibited by the presence of increasing numbers of bacteria (MOI = 10 to 100). These data suggest that TNF-alpha-mediated apoptosis of FT epithelial cells is likely a primary host defense mechanism to prevent pathogen colonization. However, epithelial cell-associated gonococci have evolved a mechanism to protect the cells from undergoing TNF-alpha-mediated apoptosis, and this modulation of the host innate response may contribute to establishment of infection. Understanding the antiapoptotic mechanisms used by Neisseria gonorrhoeae will inform the pathogenesis of salpingitis and could suggest new intervention strategies for prevention and treatment of the disease.