[Management of endometriosis of adnexa uteri in women of reproductive age].
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A case of torsion of the normal left-hand appendage in a girl of 7 yrs associated with sacral ectopia of the left kidney is reported. The aetiopathogenesis, symptomatology and problems involved in reaching precise preoperative diagnosis are considered and stress laid on the importance of early operation for the purpose of conserving the ovary and tube from resection.
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Clinical and immunological studies were carried out in 60 patients with tubal pyoinflammatory diseases and in 20 healthy controls of a reproductive age. The immunity status was studied using IKO monoclonal antibodies to differentiation antigens of peripheral blood mononuclears. An acute purulent process was found to be characterized by an adaptive increase in the count of mononuclears carrying the markers of B lymphocytes (CD22, IgM mu-chain), of activated cells (CD38, HLA-D(r)), and of the total number of positive correlations between immunocompetent cells. A persistent course of tubal inflammation is connected with hyperproduction of antibodies and immune complexes, increased expression of HLA-Dr antigens in combination with congenital or acquired insufficiency of T-helper/inductors and suppressors/cytotoxic T-cells. An important factor in the development of a chronic suppurative process is triggering of immunocomplex mechanisms associated with fixation of IgG, IgM, and the complement in the walls of small vessels in the uterine tubes, with a high level of circulating immune complexes, and appearance of plasma cells containing IgG and IgM in the tissues of uterine tubes.
The uterine appendages in 87 females aged from 17 to 53 years were surgically removed because of inefficacy of conservative treatment for purulent inflammation. There were signs of chronic recurrent inflammation in the uterine tubes or in the tubes and ovaries as shown by the operative material studied light and electron microscopically, immunomorphologically. Immune mechanisms as well as structural changes (reduction, vasculitis) of the vascular bed and muscular layer (sclerosis) of the tubes played a role in the pathogenesis of chronic inflammation. The detection of the antibodies against Chlamydobacterials in 60% of the patients implies their role in pathogenesis of chronic inflammation of the uterine appendages.
One of the major factors of nonspecific immunity i.e. the state of the host interferon system was studied with a purpose of its correction in the treatment of inflammatory diseases of the uterine appendages of the chlamydial etiology. In all the female patients with chronic inflammatory diseases of the uterine appendages of the chlamydial etiology there was observed a disorder in the function of the interferon system link: a decrease in the concentration of blood serum interferon and a lower capacity of the blood cells to produce alpha- and gamma-interferons. The findings were used as a theoretical ground for the inclusion of neovir, an inductor of alpha-interferon to the treatment of such patients. After the completion of the treatment course with the use of neovir the index of the serum interferon proved to be higher than the normal by 2.4 log2IU and the indices of alpha- and gamma-interferons were lower than the normal only by 0.1 and 1.3 log2IU respectively. Therefore, the mechanism of the neovir action included activation of the function of the interferon endogenic system. The morphometrical analysis of the number of the cytoplasmic granules of the polymorphonuclear leukocytes in the peripheral blood before, during and after the therapy with neovir and pefloxacin showed that neovir not only promoted restoration of the digestion function of the neutrophilic leukocytes but also markedly activated it which provided a success of the phagocytic attack.
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The authors describe their experiences with treatment of 128 girls with a nonfrequent pathology, among them there were 3 girls with the pathology at the neonatal and baby age. Special attention is given to differential diagnostic problems in making diagnosis of cysts, cystomas, ovarian apoplexies and other pathologies. The volume of operative interventions should be determined individually with special reference to the pathological process, with maximum orientation to organ-preserving operations.
The immune status of 130 patients with acute inflammatory diseases of uterine appendages was studied. As etiologically associated infective agents detected in these patients were opportunistic microorganisms (group 1), Neisseria gonorrhoeae in combination with opportunistic microorganisms (group 2) and Chlamydia trachomatis in combination with opportunistic microorganisms (group 3). In all three groups of patients the response of T lymphocytes to PHA and hyperactivation of the B-cell element of immunity (an increase in the relative number of B-lymphocytes and the content of IgA and IgM in the serum) was found to be suppressed. In addition, in groups 1 and 3 an increase, and in group 2 a decrease in IgG were detected. In the mucus of the cervical canal in the patients of groups 1, 2 and 3 IgM was detected, while in patients of groups 2 and 3 a decrease in sigA was established.
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