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PubMed2003

Expression of proinflammatory cytokines and receptors by human fallopian tubes in organ culture following challenge with Neisseria gonorrhoeae.

Infection of the Fallopian tubes (FT) by Neisseria gonorrhoeae can lead to acute salpingitis, an inflammatory condition, which is a major cause of infertility. Challenge of explants of human FT with gonococci induced mRNA expression and protein secretion for the proinflammatory cytokines interleukin (IL)-1alpha, IL-1beta, and tumor necrosis factor alpha (TNF-alpha) but not for granulocyte-macrophage colony-stimulating factor. In contrast, FT expression of IL-6 and of the cytokine receptors IL-6R, TNF receptor I (TNF-RI), and TNF-RII was constitutive and was not increased by gonococcal challenge. These studies suggest that several proinflammatory cytokines are likely to contribute to the cell and tissue damage observed in gonococcal salpingitis.

Cytokines↗
PubMed1984

Serum specific IgA antibody to Chlamydia trachomatis in patients with chlamydial infections detected by ELISA and an immunofluorescence test.

Sera obtained from 34 men with Chlamydia trachomatis positive non-gonococcal urethritis, 34 men with C trachomatis negative non-gonococcal urethritis, 42 women with acute salpingitis, 38 healthy women, and 34 healthy men were studied for the presence of specific serum C trachomatis IgA and IgG antibodies. Serological results were correlated with C trachomatis isolation in cell culture. An enzyme linked immunosorbent assay (ELISA) for C trachomatis specific serum IgA was employed using highly purified elementary bodies of C trachomatis serotype L2 grown in LLC-MK2 cells. Results obtained for C trachomatis IgA antibody by the ELISA test were compared with results obtained for the same sera by a single antigen immunofluorescence technique. A good correlation (r = 0.91) was found between two methods. Serum IgG antibody was also determined in the same sera by the immunofluorescence technique. Patients with C trachomatis positive non-gonococcal urethritis had a significantly (p less than 0.0005) higher prevalence (94.1%) of serum IgA antibody by ELISA compared with patients with C trachomatis negative non-gonococcal urethritis (20.5%) or healthy men (5.9%). Similarly, women with acute salpingitis had a significantly (p less than 0.005) higher prevalence of serum IgA antibody (45.2%) compared with healthy controls (5.2%). Comparable results were obtained for C trachomatis serum IgA antibody using the immunofluorescence technique. The prevalence of C trachomatis IgG antibody was significantly higher in patients with C trachomatis positive non-gonococcal urethritis (97.0%) compared with those with C trachomatis negative non-gonococcal urethritis (33.3%) and healthy controls (23.5%). The importance of using specific C trachomatis serum IgA in the identification of chlamydial infection is discussed.

Adult↗
PubMed1980

Prevalence of cervical gonorrhoea in women with unwanted pregnancies.

Cervical specimens were collected from 1688 women attending a gynaecological clinic for induced abortion between February and December 1978. Thirteen (0.77%) women had positive culture results for Neisseria gonorrhoeae. Among those women who had a completed family or who came from outside Rotterdam or from outside the neighboring Rijnmond area, the isolation rate was very low. None of the women with positive culture results developed salpingitis after abortion; all of them had been treated prophylactically with tetracycline. No reasons appear to exist for considering women who seek abortions to be in a high-risk group for cervical gonorrhoea. Whether or not antibiotic prophylaxis should be given for the prevention of salpingitis following abortion requires further study of potentially pathogenic micro-organisms inhabiting the vagina and cervix for women applying for abortion.

Abortion, Induced↗
PubMed1981

Chlamydia trachomatis as a cause of acute perihepatitis associated with pelvic inflammatory disease.

Of four cases of acute salpingitis and perihepatitis confirmed by laparoscopy Chlamydia trachomatis was cultured from the cervix only in two and from both the cervix uteri and the Fallopian tubes in two; the latter finding has not been reported from cases with combined salpingitis and perihepatitis (Fitz-Hugh-Curtis syndrome). Since gonococci, other aerobic, or anaerobic bacteria were not isolated from the Fallopian tubes, an aetiological relationship between C trachomatis and the Fitz-Hugh-Curtis syndrome is suggested.

Acute Disease↗
PubMed1981

Endometritis caused by Chlamydia trachomatis.

Chlamydia trachomatis was found to be the aetiological agent of endometritis in three women with concomitant signs of salpingitis. All patients developed a significant antibody response to the organism. Chlamydia were recovered from aspirated uterine contents of two patients and darkfield examination of histological sections showed chlamydial inclusions in endometrial cells in one patient. Thus, C trachomatis can be recovered from the endometrium of patients in whom the cervical culture result is negative. In one patient curettage showed endometritis with a characteristic plasma-cell infiltration. The occurrence of chlamydial endometritis may explain why irregular bleeding is a common finding in patients with salpingitis. It also suggests a canalicular spread of chlamydia from the cervix to the Fallopian tubes.

Adolescent↗
PubMedDate not supplied

[The role of parasites and fungi in secondary infertility].

INTRODUCTION: Parasite-host relationships can cause diminished or absent ability to conceive, ectopic pregnancy or pregnancy with undesired course. LITERATURE REVIEW: There are reports that some protozoa, helminths and fungi may impair women's reproductive capacity, causing deformities of genital tract, so that conception is impossible, or, if it does occur, normal implantation and development of placenta are impossible. Schistosoma haematobium may cause vulvar papule, swelling, tumors, irregular vaginal hemorrhage, tubular infertility and ectopic pregnancies. Patients with cirrhosis caused by schistosomas have gonadal dysfunction and schistosomiasis itself can lead to tubular infertility. Some authors found microfilaria of Mansonella perstans in follicular aspirates in patients with tubular adhesions. Chronic Entamoeba histolytica infection can cause pelvic pain and dyspareunia in some patients. Although Trichomonas vaginalis is a common cause of tubal inflammation, this protozoa affects semen quality and leads to secondary infertility. Soluble parasite extract of T. vaginalis can lead to impaired motility of 50% spermatozoa in vitro and affects semen quality by increased viscosity and amount of debris, or damage spermatozoid membrane. In enterobiosis, presence of adult worms and eggs in fallopian tube, can be followed by chronic salpingitis and tubal occlusion. Also in ascariosis, presence of adult forms and eggs can lead to acute colpitis. chronic endometritis, salpingitis or ovarian abscess. The consequence of fungal infections, such as colpitis and endometritis, caused by Candida albicans, may be infertility. Also, according to some reports, C. albicans leads to decreased spermatozoan motility. CONCLUSION: Hence parasites and fungi can cause infertility, we recommend examination of both partners in treatment of infertility.

Female↗
PubMed1983

Levels of ampicillin and doxycycline in human oviduct mucosa and serum.

A common treatment for salpingitis today includes ampicillin (AMPI) and doxycycline (DC), the former against Neisseria gonorrhoeae and the latter against Chlamydia trachomatis. The concentrations of doxycycline in oviduct mucosa were found about equal to that of serum and well above the minimum inhibitory concentrations (MIC's) for the bacteriae in question. The concentration of AMPI in the oviduct mucosa was only about 1/40 of that in serum, i.e. 1/10 of the MIC, which jeopardizes the effectivity of AMPI in the treatment of salpingitis.

Adult↗
PubMed1995

Cytogenetic study employing chorionic villi in ectopic pregnancy.

Maternal factors such as salpingitis and peritubal adhesion are known to be associated with ectopic pregnancy; however, a few studies have considered the chromosomal complements of ectopic conceptuses. We studied 16 ectopic conceptuses obtained by surgical resection. The karyotyping of chorionic villi was performed using direct and culture technique. Among 16 studied cases, 14 cases showed normal karyotype (nine with 46, XY; five with 46, XX). One case showed trisomy 16(47, XY, + 16) and another showed variation from normal chromosomal complement (46, XY, 14s+), resulting in 6.3% incidence of the structural abnormalities of the chromosome. On the basis of our study, we determined the possibility of chorionic villi karyotyping in ectopic pregnancy. This ectopic conceptuses are no more likely to show chromosomal abnormalities than in utero conceptuses of comparable gestational age. Therefore, maternal factors such as salpingitis and peritubal adhesion are the most likely explanations for ectopic pregnancy.

Adult↗
PubMed2002

Right lower quadrant pain in females. Is it appendicitis or gynecological?

OBJECTIVE: To determine if a gynecological consultation is needed for patients who are labeled to have acute appendicitis. METHODS: A retrospective study carried out in Assir Central Hospital, Abha, Kingdom of Saudi Arabia. Fifteen female patients who were clinically diagnosed and operated upon for acute appendicitis were discovered intra-operatively to have unrelated gynecological lesions, are presented. RESULTS: Histopathological reports on the removed appendices revealed 80% "normal" and 20% "mildly inflamed". Seven (46.7%) of the patients had right ovarian cysts (one of them, bilateral); 4 (26.7%), corpus luteum cysts, and 4 had bilateral salpingitis, bilateral pyosalpinx, right ovarian cyst with bilateral salpingitis and ruptured right tubal pregnancy each. The majority (60%) of the women were in the 20-30-year-age bracket. CONCLUSION: The need for gynecological review of female patients of childbearing age presenting with lower abdominal pain is stressed. Ultrasonography is an important adjunct in improving diagnostic accuracy in such cases.

Abdominal Pain↗
PubMedDate not supplied

Efficacy and tolerability of imipenem-cilastatin versus clindamycin+gentamicin for serious pelvic infections.

A multicenter, prospective, open-label, randomized trial compared imipenem-cilastatin (I-C) monotherapy with the combination of clindamycin+gentamicin (C+G). Efficacy and tolerability in the treatment of serious pelvic infections were evaluated in 94 female patients with acute salpingitis, pelvic abscess, or postoperative pelvic cellulitis. Duration of therapy averaged 5.4 days for treatment successes and ten days for treatment failures. The overall treatment success rate was 98% (43 of 44 patients) in the I-C group, compared with 92% (46 of 50 patients) in the C+G group (P = NS). Adjunct therapy for two treatment successes in the I-C group included laparoscopy and surgical removal of a pelvic abscess without change in antibiotics. Both I-C and C+G were highly effective and generally well tolerated for the treatment of salpingitis, pelvic abscess, and postoperative pelvic cellulitis.

Adult↗
PubMed1992

Infertility surgery: microsurgery.

Tubal and peritoneal factors continue to be a leading cause of infertility. In vitro fertilization, operative laparoscopy, and microsurgery are alternatives, but they are frequently complimentary therapeutic approaches. Proper investigation is the key to select the primary treatment modality. A well-performed hysterosalpingography is most valuable in the initial assessment of the tubes and uterus. Hysterosalpingosonography, radionuclide hysterosalpingography, and falloposcopy are experimental investigative tools that may be useful in selected circumstances. Effective adjuvants to reduce postoperative adhesions continue to elude the surgeon and new substances are being experimented with. In proximal tubal obstruction, selective salpingography and tubal catheterization may differentiate cornual spasm from pathologic tubal occlusion and may be therapeutic when viscous material or endotubal synechia are the cause of obstruction. Microsurgery remains the effective approach for significant lesions such as salpingitis isthmica nodosa, endometriosis, obliterative fibrosis, and chronic follicular salpingitis. Distal tubal occlusion is amenable to treatment via either laparoscopy or microsurgery. The functional status of the oviduct appears to be the most important prognostic factor in subsequent pregnancy outcome.

Fallopian Tube Diseases↗
PubMed1991

Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization.

OBJECTIVE: To determine possible etiologies of unsuccessful fluoroscopically guided tubal canalization, we studied the histology of tubal segments in cases of failed canalization for proximal tubal obstruction. Factors contributing to cases of unsuccessful fluoroscopically guided tubal canalization remain unclear. DESIGN: Prospective. SETTING: Reproductive Endocrinology Clinic. MATERIALS: Twenty-seven cornual and/or isthmic tubal segments from 15 patients who underwent proximal tubal surgery after fluoroscopically guided tubal canalization were studied. Specimens were prepared with hemotoxylin-eosin and Masson trichrome stains. RESULTS: Histologic examination of excised cornual and isthmic tubal segments revealed abnormalities in 93% of specimens. Obliterative fibrosis (61%), chronic salpingitis (57%), and salpingitis isthmica nodosa (42%) were the most commonly found histologic tubal abnormalities. One case of complete tubal occlusion and tubal schistosomiasis was also detected. CONCLUSIONS: These data suggest that cases of failed fluoroscopically guided tubal canalization may be secondary to severe intrinsic tubal disease and tubal occlusion and not to the technique. Fluoroscopically guided tubal canalization may provide a means of differentiating a functional obstruction amenable to conservative management from true occlusion requiring management by microsurgical techniques or in vitro fertilization.

Adult↗
PubMed1991

Chronic asymptomatic Chlamydia trachomatis colonization of the fallopian tubes during the peripartum period.

Antepartum cervical Chlamydia trachomatis infection is associated with an increased risk of peripartum maternal and neonatal morbidity. Chronic chlamydial salpingitis has been described in asymptomatic women. We studied the incidence of asymptomatic chlamydial colonization of the fallopian tubes during pregnancy, and the influence of such infection on the patients' clinical course, by culturing the fallopian tubes of 53 asymptomatic women who underwent tubal ligation in the immediate postpartum period. One patient had a positive chlamydial culture in one of her tubes, and two others had histologic evidence of acute and chronic salpingitis. These patients had no infectious morbidity during the antepartum, intrapartum, or postpartum periods. Our findings suggest that asymptomatic chlamydial colonization and inflammatory processes may exist in the fallopian tubes during the peripartum period.

Adolescent↗
PubMed1990

Ticarcillin/clavulanate for the treatment of female genital tract infections. Efficacy, safety and comparative microbiology.

In an open study, ticarcillin/clavulanate was used to treat upper genital tract infections in 91 women. The clinical success rate was 92% in outpatient-acquired salpingitis (pelvic inflammatory disease), 50% in salpingitis with tuboovarian abscess, 85% in postpartum endometritis, 87% in endometritis after chorioamnionitis and 90% in postoperative parametritis. The primary adverse reaction was diarrhea, in 10 patients. Among the 129 aerobes isolated, 18 (14%) were beta-lactamase positive, as were 32% (20/63) of the anaerobes.

Abortion, Septic↗
PubMed1990

Falloposcopy. A microendoscopic transvaginal technique for diagnosing and treating endotubal disease incorporating guide wire cannulation and direct balloon tuboplasty.

Direct visualization of the entire length of the fallopian tube lumen, from the uterotubal ostium to the fimbria, using a transvaginal approach, has been achieved. Small, flexible hysteroscopes with outside diameters (ODs) ranging from 3.3 to 4.5 mm and operating channel diameters of 1.5 to 1.8 mm were used to pass guide wires, over-the-wire catheters and a falloposcope with an OD of 0.5 mm safely along the fallopian tube lumen. Forty-three falloscopy procedures were performed. The normal falloposcopic appearance of the fimbrial, ampullary, isthmic and intramural tubal epithelium was characterized in eight cases. In 35 falloposcopies, endotubal lesions were found and characterized. They included 5 cases of intramural stenosis; 10 of isthmic stenosis; 5 of isthmic obstruction; 2 of salpingitis isthmica nodosa; 10 of nonobstructive endotubal disease from intraluminal adhesions, associated devascularization and epithelial atrophy in the intramural, isthmic and ampullary segments; 2 of hydrosalpinx; and 1 of an intratubal polyp. A technique of guide wire cannulation and balloon tuboplasty under hysteroscopic-falloposcopic-laparoscopic control was developed for attempting to dilate a stenotic tube, open up an obstruction or break down intraluminal adhesions. A combination of 32 guide wire cannulation and direct balloon tuboplasty (DBT) procedures was performed. Guide wire cannulation and DBT were effective in breaking down non-obstructive intraluminal adhesions in 6/10 cases (60%), dilating intramural or isthmic stenoses in 6/15 cases (40%) and negotiating an isthmic stricture secondary to salpingitis isthmica nodosa in 1/2 cases (50%). Those procedures failed to bypass complete fibrotic obstructions in 5/5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1987

[Genital Mycoplasma infections--clinical aspects, diagnosis and therapy].

Ureaplasma urealyticum und Mycoplasma hominis are frequently isolated from the urogenital tract of sexually active persons. Their pathogenetic role in urogenital infections and infertility are still controversial. U. urealyticum can cause urethritis and most likely also chronic prostatitis. M. hominis can cause cystitis, salpingitis, and postpartal fever in women and meningitis in newborns. M. genitalium was recently isolated from patients with urethritis and salpingitis. The diagnosis is made by the cultivation of mycoplasmas in high concentrations and rising antibody titers in the serum. As in chlamydial infections, the therapy of first choice is tetracyclin. M. hominis can also be treated with clindamycin, U. urealyticum with erythromycin.

Anti-Bacterial Agents↗
PubMed1983

Will progesterone save the IUD?

In 1971 we began studying pelvic inflammatory disease (PID) in IUD users by examining fallopian tube specimens obtained after elective female sterilization. We studied four groups: 175 nonhormonal-IUD users, 22 Progestasert users, 1,500 non-IUD users and 100 non-IUD users who had had IUDs in the past. We found histologically detectable salpingitis in 49% of the nonhormonal-IUD users, none of whom had symptoms of PID. Culture of 100 specimens from these nonhormonal-IUD specimens proved to be sterile. Viewing the inflammation as predisposing the tissues to bacterial infection would help explain the higher frequency of PID among IUD users than among nonusers. All the Progestasert users lacked histologically detectable salpingitis; the difference was statistically significant (p < 10(-6). This finding suggests that women using progesterone-releasing IUDs have a lower risk of developing PID than do users of other kinds of IUDs.

Adult↗
PubMed1993

[Pharmacokinetic and clinical studies on DQ-2556 in the gynecological field].

Pharmacokinetic and clinical studies on DQ-2556, a new cephem antibiotic, in obstetrics and gynecology were performed and following results were obtained. Concentrations of DQ-2556 were determined in serum, internal genital organs and retroperitoneal exudate after single intravenous administration (i.v.) or drip infusion (d.i.v.) of 1.0 g. Serum levels following i.v. were approximately 30 micrograms/ml at 1 hour, 14 micrograms/ml at 3 hours 30 minutes, and concentrations in internal genital organs including oviduct, ovary, endometrium, myometrium, cervix uteri and portio vaginalis reached approximately 50% to 70% levels of serum concentration. The mean concentration (n = 6) in the retroperitoneal exudate after d.i.v. of 1.0 g following radical hysterectomy were about 20 micrograms/ml, 23 micrograms/ml, 14 micrograms/ml and 8 micrograms/ml at 1 hour, 2 hours 30 minutes, 4 hours 30 minutes and 6 hours 30 minutes, respectively. In clinical trials, DQ-2556 (2.0 g b.i.d. for daily dose) was given in 5 patients with gynecological infections such as pyometra (1 case), salpingitis (1), retroperitoneal space infection (2), pelvic peritonitis (1). The clinical results were evaluated as good in 3 cases and poor in 2 cases including a case with salpingitis infected by Pseudomonas aeruginosa and the other with pelvic peritonitis caused by Methicillin-resistant Staphylococcus aureus. Bacteriologically, 11 organisms were isolated from patients, and eradication rate was 54.5%. Neither side effect nor abnormal laboratory test result was observed. Thus, DQ-2556 appears to be effective for gynecological infections, and the good results were supported by good penetration of the compound into tissues of internal genital organs and retroperitoneal exudate after i.v. or d.i.v.

Adult↗