[Induction of nitric oxide synthesis in mononuclear cells in culture using peritoneal fluid from women with endometriosis, in relation to the percentage of T lymphocytes and NK cells identified in an such environment]. / Inducción de la síntesis de óxido nítrico en células mononucleares en cultivo utilizando líquido peritoneal de mujeres con endometriosis, en relación al porcentaje de linfocitos T y células NK identificado en dicho ambiente.

UNLABELLED: Even though endometriosis represents a reproductive health problem of the greatest importance due to the fact that it is one of the most common benign gynecological conditions, its aetiology is still unknown. The most accepted hypothesis is the one proposed by John Sampson, suggesting that the endometrial cells and tissues derived from menstrual flow during uterine scaling reach the peritoneum through the tubes by reversed flow and, under the specific conditions of the peritoneal microenvironment, they are able to implant and proliferate in an ectopic manner. Some evidence shows that the number and activation of macrophages are increased in the peritoneal medium of women with endometriosis. It is known that the activation of this cell group leads to a greater synthesis of diverse molecules associated with this condition. OBJECTIVE: Evaluating the association between the nitric oxide (NO) synthesis induction capacity of the peritoneal fluid, the percentage of cooperative T lymphocytes and NK cells present in the peritoneal medium of women with different stages of endometriosis, as compared to fertile and healthy women. We also tried to find the correlation between the concentration of TNF-alpha identified in the peritoneal fluid of both groups with the NO synthesis induction that was carried out. Material and methods. The study group was formed by women with endometriosis (WEN) from the National Institute of Perinatology, and the control group was formed by patients attending the Family Planning Clinic of the Northeast Regional Unit (Culiacán, Sin.) (HFW). A NO synthesis induction was performed using lymphocytes stimulated with peritoneal fluid from WEN and HFW in order to measure the concentration of cooperative T lymphocytes and NK cells, the TNF-alpha of the peritoneal fluid was also measured. RESULTS: The NO synthesis induction capacity of peritoneal fluid observed with lymphocytes from a culture was greater than the one presented by healthy women. CONCLUSION: Nitric oxide was recently described as a potent inhibitor of effector cytotoxic activity associated to the immunological response of cooperative T lymphocytes of the TH-1 type promoting cytotoxic activity on different cell strains. Evidence suggests that NO inhibits INF-alpha synthesis, the later being a potent proliferation and cytotoxic activity inducer in NK cells, cytotoxic T lymphocytes, and cooperative T lymphocytes. A role of NO as a regulator of NK cell activity has also been described.

[Methods of pedicle hemostasis in laparoscopically-assisted vaginal hysterectomy (VAVH). Evaluation of results]. / Métodos para la hemostasia de pedículos en histerectomía vaginal asistida laparoscópicamente (LAVH). Evaluación de resultados.

The objective was to evaluate whether use of different techniques of hemostasia have effect on laparoscopically assisted vaginal hysterectomy (LAVH) morbidity. Was performed a review of 53 LAVH cases, parameters analyzed were type of hemostasia method and surgical complications. There were five patients with transoperative bleeding and two with incidental bladder lesion, that were managed successfully without complications. There were no significant differences between types of hemostasia with respect to transoperative bleeding. There were no mayor surgical complications in the studied patients. As conclusion LAVH allows patients a expedite recovery with low postoperative complications. All the methods used in this work to perform hemostasia in LAVH are safe and effective for patients with habitual hysterectomy indications.

[Antibodies against prolactin in patients with systemic lupus erythematosus and hyperprolactinemia]. / Autoanticuerpos dirigidos contra prolactina en pacientes con lupus eritematoso sistémico e hiperprolactinemia.

We investigated patients with lupus erythematosus to detect the presence of hyperprolactinemia and to determine it's origin. From the seric specimens obtained in 225 patients with LES, we found 37 (14.5%) with hyperprolactinemia and they were trated with polyethylenglicol, in 11 of 37 patients (29.7%) had a high significance of prolactin precipitation (PRL). The test in gel filtration shown the big-big PRL (Molecular weight > 100 kDa) was the predominant form from PRL seric in these patients and no woman had clinic effects of hyperprolactinemia as galactorrhea and/or amenorrhea. The big-big PRL essence was due to an antibody, with it was found like a immune complex (Ig-PRL). This evidence suggest the patients with LES and hyperprolactinemia have a very high incidence of macroprolactinemia relationated to antibodies anti-PRL, and in spite of the hyperprolactinemia not have clinical effects like amenorrhea and/or galactorrhea, and it is other cause to explain the high incidence of hyperprolactinemia in patients with LES.

[Epidemiologic characteristics in women with sterility and cervical lesions with and without human papilloma virus infection. Comparative study]. / Características epidemiológicas en mujeres con esterilidad y lesiones cervicales con y sin infección por virus de papiloma humano (VPH). Estudio comparativo.

Human papilloma virus (HPV) infections frequently cause cervical lesions of different morphologies. We have previously reported a 53.5% pregnancy rate after treatment in a group of women with infertility associated to HPV infection of the cervix uteri. In that paper it was stated that a controlled study should be conducted in order to confirm this finding. Present work was aimed to find if there is any correlation between HPV infections of the cervix uteri and infertility in a retrospective design using an historical cohort of patients studied between 1991 and 1996 in our clinic. A total of 61 women attending the Infertility Clinic at the Instituto Nacional de Perinatología were included into two group. Group 1 (n = 45) included women with HPV lesions of the cervix and group II (n = 16) was formed by women with other type of cervical lesions who had no evidence of HPV infections on colposcopy. Cervico-vaginal citology, colposcopyc study and biopsy specimens were evaluated in all this medical records and the patients status (pregnant-not pregnant) at one year after treatment was registered. The mean duration time of infertility was 4.86 in group I and 3.5 in group II. Pregnancy rate was 16/45 (35.55%) in group I and 6/16 (37.5%) in group II. Seventy five percent of patients in group I and 66% in group II achieved a spontaneous pregnancy after specific treatment of cervical lesions whereas 25% and 33.3% required only ovarian stimulation with clomiphene or hMG. Pregnancies occurred approximately at 9 months after treatment in group I and at 7 months in group II. An association of cervical lesions and a tuboperitoneal factor (excluding endometriosis) was found on 53.57% of women in group I and on 46.66% of women in group II. Cervico-vaginal cytology was suspicious of HPV infection in less than 25% of cases. Present study emphasizes the need for a colposcopic study for the diagnosis of HPV infection in infertile women with cervical lesions even in cases with a negative cervico-vaginal cytology; because specific treatment of these lesions may yield spontaneous pregnancies. It also demonstrates that around 50% of patients with cervical lesions have an associated tuboperitoneal factor, which indicates that it is mandatory to study the possible participation of viral infections on tubal pathology.

[Conservative laparoscopic treatment of bilateral ectopic pregnancy. 2 case reports and review of the literature]. / Tratamiento laparoscópico conservador del embarazo ectópico bilateral. Informe de dos casos y revisión de la literatura.

Ectopic pregnancy is a frequent clinic entity, with an incidence from 4.5 to 16.8 for 1000 pregnancies. The frequency of ectopic pregnancy has been triplicated in the last years, mainly owed to increase of sexual transmitted diseases, increase in salpinges' surgery and in assisted reproductive medicine. The ectopic pregnancy is also the most frequency cause of maternal death during the first trimester of pregnancy. The frequency of bilateral tubal ectopic pregnancy is extremely rare, it is reported from 1:125 to 1:1580 of all ectopic pregnancies. The first case of bilateral tubal ectopic pregnancy was reported n 1918 by Bledsoe. In Mexico, Molina described the first case in 1993, with conservative laparoscopic treatment. Two clinic cases are presented of bilateral ectopic pregnancy, treated conservatively by laparoscopy. The first one with background of sterility because of anovulation, receiving treatment with menotropins for ovarian hyperstimulation, the other one. In the second case, was a spontaneous pregnancy, in a patient with a history of several pelvic surgeries. In this case a bilateral salpingostomy was realized. In both cases was demonstrated chorionic villi by histopathology. These cases are a model of nature to evaluate the real utility of several diagnostic and therapeutic methods which are available nowadays for the treatment of ectopic pregnancy.

Assessment of the safety of intrauterine instillation of heated saline for endometrial ablation.

OBJECTIVE: To evaluate the safety of pressure, temperature-controlled, continuously circulating hot saline (EnAbl system, InnerDyne Medical, Sunnyvale, CA) for endometrial ablation using the in vivo human uterus. DESIGN: Clinical safety study. SETTING: An academic research environment. PATIENTS: Eleven women undergoing abdominal hysterectomy because of abnormal uterine bleeding. INTERVENTION: Before uterine removal, endometrial cavities were exposed to 15 minutes of recirculatory normal saline heated to 70-85 degrees C. MAIN OUTCOME MEASURE(S): The uteri were analyzed for extent of thermal damage using standard histopathological techniques and tissue viability histochemical staining. Intrauterine pressures and serosal and subserosal temperatures were continuously monitored by computer. RESULT(S): In each treated specimen, histochemical staining demonstrated a depth of necrosis that extended through the entire endometrium and approximately 1-2 mm into the myometrium. The control specimen showed no thermal or mechanical damage. There were no observed negative effects or related complications with this system. CONCLUSION(S): The computer-controlled system employing continuously circulating hot saline is an effective method to destroy the endometrium. In four cases with clearly patent tubes, no spill was observed. In all 11 patients, serosal and subserosal temperatures were within safe levels (mean temperature, 37 degrees C).

[Endometrial ablation by liquid heat using the EnAbl system in patients after abdominal hysterectomy. Study of safety]. / Ablación endometrial por medio de calor líquido usando el sistema EnAbl, en pacientes sometidas a histerectomía abdominal. Estudio de seguridad.

Security and efficacy of an EnABL, were evaluated; this system had been designed for endometrial ablation by liquid heat in uterine cavity. Eleven patients were included, from the Outpatient Department (INP), programmed for different causes that objectives of this study for abdominal hysterectomy due to abnormal uterine bleeding. The study was approved by Ethical and Scientific Committees. Each patient had preoperative studies, endometrial biopsy, PAP, and ultrasound, in series. The patients with uterus larger than 14 cm, possible cancer; younger than 18 year, or with active bleeding at the time of hysterectomy, were excluded. Each patient received a schema of standard endometrial suppression. The system was applied previously to TAH; 2271 measurements of temperature at one minute intervals were done during liquid heat application. Surgical pieces were sent to histology to analyze the thermic damage through macroscopic aspect, HE tinction and an immunohistochemical cellular viability of NADH test. The thermal damage by macroscopic appearance was 4.33 +/- 1.03 mm, with HE of 4.15 +/- 0.75 mm and with the tinction of NADH of 4.25 mm +/- 0.79. The maximal damage by macroscopic appearance was 4.33 +/- 1.03 mm, with HE of 4.15 +/- 0.75 mm, and with NADH it was 4.25 mm +/- 0.79. The maximal damage was by macroscopic appearance was 6.0 mm and the minimal one was 2.0 mm. In evaluation by H/E, maximal was 5.1 mm and the minimal one was 2.3 mm. In NADH tinction maximal was 4.25 and minimal 2.4 mm. Horizontal analysis showed eight patients with major thermal damage at 4 mm; and two patients with lesser damage at 4 mm. Sub-serous temperatures measured with thermopairs, were done 1504 times, in total. Average was 36.28 degrees C, ranging 35 to 37 degrees C. Maximal temperature was 45 degrees C, 1-2 mm, bellow from serous surface of uterus, and the last one was 28 degrees C. The serous temperatures measured by infrared radiation were done 767 times with an average temperature of 34.6 degrees C. Average was 34-35 C, with standard deviation of 1-2 degrees C. Maximal temperature was 40 degrees C and minimal 29 degrees C. There were no adverse effects. This study shows that EnAbl system is an efficacious method.

[Recurrent fetal death and antiphospholipid antibody syndrome. A case report]. / Muerte fetal repetida y síndrome de anticuerpos antifosfolípidos. Presentación de un caso.

Antiphospholipid Antibodies has been associated with severe maternal and fetal sequels, like recurrent miscarriage, death, intrauterine growth retardation, pregnancy-induced hypertensive disease, thromboembolic phenomena and thrombocytopenia. Pathogenesis has been explained reporting that IgG from women with antiphospholipid antibodies increases placenta thromboxane production without affecting prostacyclin production, which conducts to thrombosis of placenta uterus junction. In 1982, it was suggested for the first time low doses of aspirin and prednisone for treatment of recurrent fetal death associated to this syndrome, heparin therapy was reported in 1984, recommended a doses of 15,000 U/day during first pregnancy trimester and 20,000 U/day posteriorly. The objective of this report, is the description a clinic case of a patient with recurrent fetal death and antiphospholipid antibodies syndrome, discussing a prenatal and obstetric treatment model, including diagnosis and final therapeutic, which includes the participation of some other specialists, the national experience in diagnosis and treatment is initial, and also because it has been reported a rate of fetal death in those patient with no treatment, almost of 90%. The importance of identify this syndrome is not based on its prevalence but on its maternal complications and that it is a cause of fetal death potentially treatable.

[Peritoneal immune response in endometriosis]. / Respuesta inmune peritoneal en endometriosis.

The systematic analysis of immunity status in the peritoneum of women with endometriosis, is presented. Twenty five patients were studied, distributed as follows: A. Endometriosis, B. Sterility of non identified cause. In all the patients, peritoneal fluid was obtained (PF) during diagnostic laparoscopy, and a sample of peripheral blood was taken simultaneously. Both samples were processed analysis of lymphocytes subpopulations (ALS) by flux cytometry using monoclonal antibodies with reactivity to lymphocytes T total (CD+), lymphocytes B (CD19+), auxiliatory/inductory (CD3+CD4+), suppressor/cytotoxic (CD3+CD8+) and NK (CD3+CD16+ + 56+). The peritoneal ALS of both groups were characterized by a clear lymphocyte B diminution, moderate diminution of activators; a considerable increase of suppressors; altered CD4+/CD8+ relation in favour of suppression and NK diminution when comparing with its own blood compartment. All of these values were identical for both groups, and the only significant difference was found when comparing activated lymphocytes T subpopulation that was lesser in PF of women with endometriosis. This is the only fact that backs up the existence of altered immunity in the peritoneum of these patients, that affects the expression of activated lymphocytes. However, taking as a criterium the rest of subpopulations, in endometriosis as well as in ECNI the microenvironment goes for suppression and they are not distinguishable among them. On other side, it started signal characterization that conditions suppression induction for lymphocytes activation in peritoneal environment of women with endometriosis. Ten samples of PF of patients using peripheral purified lymphocytes by density gradient of voluntary donnors, normal, fertile, were analyzed. Cells were cultivated and stimulated in vitro with concanavaline A in presence of timidine 3H. In experimental holes PF was added at dose-response concentration, and it was evaluated as the difference in synthesis of radioactive ADN against the incubated cells in absence of PF. It was possible to demonstrate the presence of associated factors in PF of patients with endometriosis that inhibit proliferation of lymphocytes stimulated by Con A, and not so in samples of ECNI. With these factors one supposes the presence of soluble signals that condition local immunological suppression.

[Preoperative management of uterine leiomyomatosis using pituitary gonadotropin-releasing hormone analogues]. / Tratamiento médico preoperatorio de leiomiomatosis uterina con análogos de hormona liberadora de gonadotropinas hipofisarias.

Uterine leiomyomatosis shows a frequency from 25 to 30% in reproductive age women. Traditional treatment is hysterectomy or myomectomy independently from fertility wishes of the woman. Its growth has been associated to estrogenic activity. Because of this, several substances have been used to diminish tumour size, pre-operatively. The use of analogues of liberating hormone of hypophysiary gonadotropins (GnRH), given to favor surgical technique, to diminish trans-operative bleeding and to avoid blood transfusions. Clinical efficiency of the use of nafarelin acetate in women with uterine leyomiomatosis, pre-operatively during three months, was studied in this paper. The study was prospective, comparative, blind and with longitudinal measurements. Twenty eight women were included. Group I (n = 13) and Group II (n = 15) control without treatment. Observation units included FSH, LH, E2, BHC, HCT, USG basal, 30, 60, 90 days. Results showed a diminution of more than 80% of the initial uterine volume, and of 30% of the myomas independently measured. Side effects, tolerance and efficacy of the used compound, are mentioned.

[Use of a diagnostic prospective algorithm for patients with recurrent miscarriage]. / Aplicación de un algoritmo diagnóstico prospectivo para pacientes con pérdida fetal recurrente.

The application of a diagnostic algorithm to couples with recurrent pregnancy loss, was evaluated in this descriptive, prospective, clinical trial, at Infertility Clinic and Assisted Reproduction Unit, Instituto Nacional de Perinatología (INPer), México City. Fifty couples with primary or secondary recurrent pregnancy loss, were studied. A study protocol was applied to evaluate the following factors of miscarriage: anatomic, endocrine, infectious, genetic and immunologic. The frequency of altered factors was determined in the couples including in this trial. There were no cases of diabetes mellitus or impaired glucose tolerance in the studied group. The most common abnormal findings were: luteal phase defects; genital infections (Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) and; an elevated frequency of chromosomal abnormalities. In addition, in 16% of the couples there was not an identified cause of their problem. The applied algorithm find the etiology of the recurrent pregnancy loss in the 84% of the couples studies. The method included new technologies (detection of anti-immunity, allo-immunity and infectious diseases), however, need corrections to increase its diagnostic and prognosis accuracy.

[The neuroendocrinological and histopathological assessment of normogonadotropic azoospermic patients: the usefulness of the GnRH stimulation test]. / Evaluación neuroendocrinológica e histopatológica de pacientes azoospérmicos normogonadotrópicos: utilidad de la prueba de estimulación con GnRH.

This study evaluates the effect of gonadotropin releasing hormone (GnRH) administration on serum levels of FSH and LH. Also, relate those results with histopathologic findings of testicular biopsies. This was a prospective, clinical trial with a control group. It was done at Department of Reproductive Biology "20 de Noviembre" Hospital, ISSSTE, México City. Fifteen azoospermic, normogonadotropic patients without testicular atrophy and ten normal men use as control group. A GnRH challenge test was made in both groups, two days after we perform a testicular biopsy in patients with azoospermia. There was no significant difference in serum LH concentrations between the two groups, neither before or after GnRH challenge test. There was a statistical difference between serum FSH values of azoospermic patients, than those of control group, the former with higher values than those of the latter. As worst testicular damage was, we found also a higher FSH value on the GnRH challenge test. The GnRH challenge test perform in azoospermic, normogonadotropic patients is very helpful to detect those patients with gonadal damage. As higher the FSH values were, we found that an abnormal testicular biopsy was also more common.

[Chemotactic factor for spermatozoa: a new biological function of progesterone]. / Factor quimiotáctico para espermatozoides: una nueva función biológica de la progesterona.

Our group has recently described the existence of a chemoattractant factor for spermatozoa contained in the mature follicles fluid. Simultaneously it was possible to develop a new method that permits to evaluate the chemotactic capacity of spermatozoa and that due to its simplicity makes possible the systematic study of CFS features. This study considered CFS molecular characterization from follicular fluid (FF). The FF of women was studied in an Assisted Fertilization Program, that were qualified as mature according to different criteria. The FF were fractioned with different techniques that permitted to separate an active fraction with lipid physicochemical characteristics. The fine layer chromatography showed the presence of different steroids, that were individually assayed for chemotactic activity. Only progesterone showed that activity and its effect showed a dose-response curve within physiological values. Our study permitted to identify progesterone as CFS previously described. This steroid's function is rather new and its action mechanism is being studied in our laboratory.

[Spontaneous pregnancy, independent of treatment, in sterile couples]. / Embarazo espontáneo independiente de tratamiento entre parejas estériles.

The spontaneous pregnancy independent of treatment in sterility is a frequently observed event in this group of couples. The spontaneous pregnancy appears up to 61% of women with antecedents of sterility and in selected populations of healthy women; a third of them experience, once in their lives a subfertility episode. The characterization of this event in a population with sterility, will help to define the capacity of different diagnostic methods, as well as therapeutic methods in terms of efficacy. The objective of this study was to identify women with diagnosis of sterility and spontaneous pregnancy; to describe the main characteristics: clinical, of laboratory, of gabinet, and to discuss some implications of biological variability useful in the interpretation of these tests. One hundred and eleven patients with sterility and spontaneous pregnancy, in a descriptive and retrospective design, were analyzed. Operational definitions for the main factors related with sterility, were used, as tuboperitoneal, endocrine-ovarian, cervico-vaginal and masculine. The pregnant patients related to any type of treatment, were excluded. Two study groups were established: Group I (n-46) and Group II (n = 65) with primary sterility and secondary sterility, respectively. Average age for both groups was similar (mean = 29 years old). The time of sterility was 46.52 and 43.52 months, for Group I and II, respectively. The time of pregnancy from the point zero (admission), was, in average 6.21 and 4.9 months for Group I and II. The following factors were identified as abnormal: endocrine-ovarian 28.60 by menstrual pattern, progesterone and endometrial biopsy: tuboperitoneal 12.67% by hysterosalpingography and laparoscopy; masculine 12.67 by direct spermatobioscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Novel model for study of human sperm chemotaxis.

OBJECTIVE: To develop and test an adequate method for the study of sperm chemotaxis. DESIGN: A model based on a double-chamber design and a matrix of 0.5% hyaluronic acid was used to test the response of human sperm to chemotactic signals from follicular fluid (FF). RESULTS: A plateau of migration was reached at 10 minutes of incubation; under this condition, 70% of sperm migrated toward chambers with FF, less than 20% to the opposite side, and the rest remained at the site of application. Intra-assay and interassay coefficients of variation using pools of FFs were 17.2% and 23%, respectively. CONCLUSION: These data confirm previous findings and support the use of this novel model for the study of chemotaxis on human gametes.

[Role of metalloproteases of extracellular matrix in the premature rupture of fetal membranes: a novel physiopathogenic model]. / Participación de las metaloproteasas de matriz extracelular en la ruptura prematura de membranas fetales: un modelo fisiopatogénico novedoso.

Experimental proofs are presented, that involve the participation of the metalloproteinases family, of extracellular matrix in the genesis of premature rupture of membranes. The expression of this group of enzymes, which presents in normal conditions of labor appears in the RPM without relation with gestational age. This phenomenon is not presented as an isolated example of participation of metalloproteinases in events related to labor and delivery, as is very well known its participation in maturation of uterine cervix preceding product expulsion, and that consists in similar mechanisms to the ones now chosen for the maturation of fetal membranes. The working hypothesis in pathologic conditions, implies, then, the activation of a normal system in an inadequate moment that results in premature rupture of membranes.

[Glucose determination as prognosis index of intra-amniotic infection]. / Determinación de glucosa como indice pronóstico de infección intraamniótica.

Intraamniotic infection is a frequent problem in Obstetrics, and is related with an important maternal and fetal impact, being important pre-term delivery and premature rupture of membranes. The "golden" test for this entity is bacteriological culture. Its use is limited in function of time (more than two days) and disponibility. The rapid diagnosis of infection in vital to start antimicrobial management and evaluation of uterine evacuation. Low concentrations of glucose (G) have been used as prognostic of infection in different biological compartments. The objective of this study is to evaluate the usefulness of G as prognostic index of intraamniotic infection (PIIAI) as compared with Gram tincture (GT) and bacteriological culture. Sixty four patients were included. Group I (n = 33) with infection, and group II (n = 31) without infection. Average of G for group I was 19.96 +/- 07.61 ES and 114.46 +/- 20.09 ES for the group II, with p less than 0.001. The sensitivity (S), specificity (Sp), positive predictive value (+PV) and negative (-PV) for a concentration of G in amniotic fluid less than 15 mg/dl was 72, 77, 77 and 72% respectively. The S, Sp +PV and -PV for G minor than 10 mg/dl was 69, 87, 85 and 73%. Gram tinction had a S, Sp +PV and -PV of 57, 83, 79, 65%. If both determinations are put together (G and GT), one sees and S of 88%, Sp 77% +PV 80% and -PV 85%.(ABSTRACT TRUNCATED AT 250 WORDS)