[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.

Endometrial Ablation with the EnAbl System

We assessed the safety of a new method of endometrial ablation using heated saline in 11 patients who were undergoing elective hysterectomy. The EnAbl system consists of a controller, computer, and disposable, flexible probe that provides in situ heating and circulation of the saline while maintaining a tight seal at the internal os. The system's low pressure precluded ligation of the oviducts. Temperatures of the saline, uterine serosa, subserosa, and oviducts were monitored throughout the 15-minute procedure in all 10 treatments and 1 control. Histology revealed an average depth of treatment of 4 mm, including necrosis of the surface myometrium. Average depth of necrosis was consistent throughout the cavity regardless of the presence of insignificant myomas. Serosal, subserosal, and oviduct temperatures remained low (<e;45° C) during the 10 treatments of 70 to 85° C. We believe that this method provides an efficacious depth of treatment while maintaining safe serosal temperatures.

[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.

[Endometrial aspiration biopsy]. / Biopsia endometrial por aspiración.

The factuality and diagnostic accuracy of aspiration endometrial biopsy with Karman's cannula, as compared with the curetted sample with Novak's cannula, were evaluated. Two hundred and thirty endometrial biopsies, were taken, as part of the study in women with fertility problems, at the Assisted Reproduction Clinic and Sterility Clinic, Instituto Nacional de Perinatología. The samples taken with Karman's cannula, Group I (n = 115); and with Novak's cannula, Group II (n = 115), were compared: procedure's time, pain intensity, quantity and quality of samples, macro and microscopically. In 92.2% of group I, tissue adequate for diagnosis, was obtained, as compared with 84.4% in Group II; likewise, the sample was better quantitatively and qualitatively, in Group I; and required time was less than one minute in 90% in Group I, an 83% in Group II. With the use of Karman's cannula, 20% of the patients had no pain, and 0.9% with the use of Novak's cannula. So, it can be concluded that endometrial aspiration with Karman's is reasonable and reliable in the functional histological diagnosis; it permits the obtention of adequate samples, in quantity and quality, and offering as advantages less pain and more security for the patients.