RESUMO
The aim of this study was to compare the clinical characteristics of patients with tubo-ovarian abscess (TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Patient age, TOA diameter, WBC count, CRP, and ESR were significantly different between the groups. On multiple regression analysis, significant correlations were identified between age (p = .001), ESR (p = .045), and failure of medical treatment. TOA diameter (p = .065) showed a borderline association with surgical intervention. The risk of needing surgical intervention in TOA patients can be predicted using ESR in addition to age and TOA size as risk factors.IMPACT STATEMENTWhat is already known on this subject? For patients diagnosed with a tubo-ovarian abscess (TOA), the size of TOA and the patient's age are helpful for early identification of patients who are likely to need surgical treatment. Inflammatory markers such as C-reactive protein and white blood cell are also associated with the risk of surgical intervention.What do the results of this study add? Erythrocyte sedimentation rate (ESR) in addition to the size of TOA and the patient's age is a useful marker in determining whether to undergo surgery in patients with TOA.What are the implications of these findings for clinical practice and/or further research? ESR combined with the patient's age and the size of TOA is clinically useful in predicting the need for early surgical intervention in patients with TOA. Large prospective controlled studies are required to establish relationship between inflammatory markers and the risk of surgical intervention.
Assuntos
Abscesso Abdominal/cirurgia , Doenças das Tubas Uterinas/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Testes Hematológicos/estatística & dados numéricos , Doenças Ovarianas/cirurgia , Abscesso Abdominal/sangue , Adulto , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Doenças das Tubas Uterinas/sangue , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Testes Hematológicos/métodos , Humanos , Contagem de Leucócitos , Doenças Ovarianas/sangue , Seleção de Pacientes , Valor Preditivo dos Testes , Análise de Regressão , Estudos Retrospectivos , Fatores de RiscoRESUMO
STUDY OBJECTIVE: To evaluate the clinical parameters of hospitalized patients with pelvic inflammatory disease (PID) for the presence of tubo-ovarian abscess (TOA) and predict the need for intervention. DESIGN: A prospective cohort study. SETTING: A tertiary care university medical center. PATIENTS: Ninety-four patients were diagnosed with complicated PID and hospitalized between 2015 and 2017. INTERVENTIONS: Patients with PID were treated with parenteral antibiotics according to Centers for Disease Control guidelines. Demographic, clinical, sonographic, and laboratory data for patients with PID were analyzed. Inflammatory markers including C-reactive protein (CRP), white blood cells (WBCs), erythrocyte sedimentation rate (ESR), and clinical parameters were collected at admission and during hospitalization. MEASUREMENTS AND MAIN RESULTS: Forty-eight of 94 patients (51.1%) hospitalized with complicated PID were diagnosed with TOA sonographically. CRP levels were the strongest predictor of TOA, followed by WBC count, ESR, and fever on admission. The areas under the receiver operating characteristic (ROC) curve for CRP, WBC, ESR, and fever were .92, .75, .73 and .62, respectively. CRP specificity was 93.4% and sensitivity was 85.4% for predicting TOA, with cutoff value of 49.3 mg/L. Twelve patients (25%) failed conservative management and underwent surgical intervention including laparoscopy (nâ¯=â¯7), computed tomography (CT)-guided drainage (nâ¯=â¯4), and laparotomy (nâ¯=â¯1). In this group, CRP levels significantly increased from admission to day 1 and day 2 during hospitalization (128.26, 173.75, and 214.66 mg/L, respectively; p < .05 for both). In the conservative management group, CRP levels showed a plateau from admission to day 1 and then a decrease until day 3 (110, 120.49, 97.52, and 78.45 mg/L, respectively). CONCLUSION: CRP is a sensitive, specific inflammatory marker for predicting TOA in patients with complicated PID, and levels >49.3 mg/L suggest the presence of TOA. In the TOA group, CRP level trends correlated well with success or failure of conservative management. Increasing CRP levels during treatment may be used as an indicator of the need for invasive intervention, and daily CRP measurements can help predict the need for invasive intervention.
Assuntos
Abscesso/diagnóstico , Proteína C-Reativa/análise , Doenças das Tubas Uterinas/diagnóstico , Procedimentos Cirúrgicos em Ginecologia , Doenças Ovarianas/diagnóstico , Doença Inflamatória Pélvica/diagnóstico , Abscesso Abdominal/sangue , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/cirurgia , Abscesso/sangue , Abscesso/complicações , Abscesso/cirurgia , Adulto , Biomarcadores/sangue , Proteína C-Reativa/fisiologia , Estudos de Coortes , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparotomia/métodos , Pessoa de Meia-Idade , Doenças Ovarianas/sangue , Doenças Ovarianas/complicações , Doenças Ovarianas/cirurgia , Doença Inflamatória Pélvica/sangue , Doença Inflamatória Pélvica/complicações , Doença Inflamatória Pélvica/cirurgia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
AIM: We aimed to compare the neutrophil-to-lymphocyte ratio (NLR) in tubo-ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure. METHODS: The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin-clindamycin-ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups. RESULTS: There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment. CONCLUSION: Neutrophil-to-lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.
Assuntos
Abscesso/sangue , Abscesso/terapia , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/terapia , Linfócitos , Neutrófilos , Doenças Ovarianas/sangue , Doenças Ovarianas/terapia , Falha de Tratamento , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Fatores Etários , Antibacterianos , Doenças das Tubas Uterinas/tratamento farmacológico , Doenças das Tubas Uterinas/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgiaRESUMO
OBJECTIVE: To investigate the clinical results and prognostic factors of multiple dose methotrexate (Mtx) treatment of ectopic pregnancy patients with high initial serum (human chorionic gonadotropin [hCG]). DESIGN: Retrospective cohort study. PATIENTS: Twenty-six ectopic pregnancy patients with serum (ßhCG) > 5,000 mIU/mL who received multiple doses of Mtx (1 mg/kg) with folinic acid rescue on the alternating days. RESULTS: Success rate was 88.5%. All failures were tubal ruptures in those who underwent surgery. Median initial hCG values of the success and the failure patients were 8,582 (5,058-31,114) and 5,280 (5,042-13,563) mIU/mL respectively (p > 0.05). Side effects were seen in 18 patients (69.2%, one bone marrow suppression and 17 minor side effects). The number of Mtx injections (7.04 ± 1.71), Mtx dose (71.35 ± 13.16 mg) and follow-up period (42.04 ± 23.77 days) did not differ between groups. Body mass index (BMI), Mtx dose, number of Mtx and change in ßhCG levels between the initials and the levels measured 2 days after the 3rd, 4th, and 5th Mtx injections were found to be highly predictive for tubal rupture. CONCLUSIONS: Multiple-dose Mtx treatment of ectopic pregnancies with high initial hCG is safe and effective. BMI, Mtx dose, number of Mtx injections and the decrement of ßhCG levels were found as highly predictive for the success of the treatment.
Assuntos
Abortivos não Esteroides/administração & dosagem , Gonadotropina Coriônica Humana Subunidade beta/sangue , Doenças das Tubas Uterinas/sangue , Metotrexato/administração & dosagem , Gravidez Tubária/sangue , Gravidez Tubária/tratamento farmacológico , Abortivos não Esteroides/uso terapêutico , Adulto , Doenças das Tubas Uterinas/etiologia , Feminino , Humanos , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Ruptura Espontânea/sangue , Ruptura Espontânea/etiologia , Falha de Tratamento , Adulto JovemAssuntos
Primeiro Trimestre da Gravidez/sangue , Gravidez Ectópica/sangue , Progesterona/sangue , Proteína ADAM12/sangue , Ativinas/sangue , Adrenomedulina/sangue , Biomarcadores/sangue , Antígeno Ca-125/sangue , Gonadotropina Coriônica Humana Subunidade beta/sangue , Creatina Quinase/sangue , Desintegrinas/sangue , Doenças das Tubas Uterinas/sangue , Feminino , Glicodelina/sangue , Humanos , Fator Inibidor de Leucemia/sangue , Proteínas de Membrana/sangue , Lactogênio Placentário/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Gravidez Ectópica/diagnóstico , Proteína Plasmática A Associada à Gravidez/metabolismo , Glicoproteínas beta 1 Específicas da Gravidez/metabolismo , Fator A de Crescimento do Endotélio Vascular/sangue , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangueRESUMO
OBJECTIVES: The aim of this study was to investigate the relationship between 25-hydroxyvitamin-D [25(OH)D] and female infertility and to further explore the role of inflammatory cytokines. METHOD: We recruited 356 infertile women diagnosed with tubal factor infertility (TFI) or polycystic ovary syndrome (PCOS) or endometriosis, as well as 180 fertile women. Serum concentrations of 25(OH)D, interleukin (IL)-6, IL-1 ß, and interferon-α were measured. RESULTS: The 25(OH)D concentration in TFI women was the lowest (16.9 ng/mL) and was significantly different from that in the fertile women (19.4 ng/mL; P <0.05)]; whereas women with TFI had higher IL-6 concentrations. After adjusting for confounders, 25(OH)D deficiency presented a risk factor for TFI (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.5-11.3). There was a dose-effect relation between IL-6 tertiles and TFI: the higher the IL-6, the higher the risk for TFI (middle versus low: OR, 3.7; 95% CI, 1.5-9.5; high versus low: OR, 13.2; 95% CI, 4.8-36.4). IL-6 showed a negative correlation with 25(OH)D (r = -0.19). Women with both high IL-6 and low 25(OH)D had the highest risk for TFI (OR, 10.6; 95% CI, 4.2-26.3). CONCLUSIONS: Both vitamin D deficiency and high serum IL-6 concentration are risk factors for TFI. Serum 25(OH)D concentration was significantly and negatively correlated with serum IL-6. There was an interaction between IL-6 and 25(OH)D for the risk for TFI-related infertility. We hypothesized that vitamin D might reduce the risk for TFI through suppressing the production of IL-6.
Assuntos
Doenças das Tubas Uterinas/sangue , Infertilidade Feminina/etiologia , Interleucina-6/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , China , Endometriose/sangue , Endometriose/complicações , Doenças das Tubas Uterinas/complicações , Feminino , Humanos , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
Tubo-ovarian abscess (TOA) coexists in 15% of cases with pelvic inflammatory disease. Medical treatment is the first line of approach in women with TOA, however, 25% of cases fail to respond to antibiotics, therefore, these cases need to undergo surgical intervention. We aimed to determine factors leading to failure of medical treatment in women diagnosed with TOA. According to our results among 144 women, 27 cases required surgical intervention for full recovery. None of the demographic, sonographic or laboratory findings, including procalcitonin level, had significant predictive value for the failure of medical treatment in women with TOA. Impact statement What is already known on this subject? Tubo-ovarian abscess (TOA) coexists in 15% of cases with pelvic inflammatory disease. Medical treatment is the first line approach in women with TOA, however, 25% of cases fail to respond to antibiotics, therefore, these cases need to undergo surgical intervention. Several risk factors have been evaluated in order to predict the failure of medical treatment. What do the results of this study add? None of the variables, including age, parity, mass diameter, serum CRP, procalcitonin levels and sedimentation rate had significant value for predicting TOA cases that required surgical intervention for full recovery. What are the implications of these findings for clinical practice and/or further research? In clinical practice, identification of risk factors leading to the failure of medical treatment helps clinicians to inform patients and help surgeons predict those who need surgical intervention.
Assuntos
Abscesso/sangue , Calcitonina/sangue , Doenças das Tubas Uterinas/sangue , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Doenças Ovarianas/sangue , Abscesso/etiologia , Abscesso/terapia , Adulto , Idoso , Biomarcadores/sangue , Doenças das Tubas Uterinas/etiologia , Doenças das Tubas Uterinas/terapia , Feminino , Humanos , Mediadores da Inflamação/sangue , Pessoa de Meia-Idade , Doenças Ovarianas/etiologia , Doenças Ovarianas/terapia , Seleção de Pacientes , Doença Inflamatória Pélvica/sangue , Doença Inflamatória Pélvica/complicações , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.
Assuntos
Abscesso/sangue , Calcitonina/sangue , Doenças das Tubas Uterinas/sangue , Doenças Ovarianas/sangue , Doença Inflamatória Pélvica/complicações , Adulto , Biomarcadores/sangue , Feminino , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/sangue , Doença Inflamatória Pélvica/diagnóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To explore the potential damaging effect of chronic pelvic inflammation on ovarian reserve. DESIGN: Case-control study. PATIENTS: A total of 122 women with bilateral tubal occlusion, diagnosed by hysterosalipingography (HSG) and 217 women with normal fallopians were recruited. MEASUREMENTS: Serum anti-Mullerian hormone (AMH), basic follicle-stimulating hormone (FSH), luteining hormone (LH), estradiol (E2), and testosterone (T) were measured; and antral follicle counts (AFCs) were recorded. RESULTS: Significantly lower level of AMH was observed in women with bilateral tubal occlusion compared to control group [2.62 (2.95) ng/ml vs. 3.37 (3.11) ng/ml, P = 0.03], and the difference remained after adjustment of BMI (Padjust = 0.04). However, no statistical difference was found in the levels of FSH [7.00 (2.16) IU/L vs. 6.74 (2.30) IU/L], LH [4.18 (1.52) IU/L vs. 4.63 (2.52) IU/L], E2 [35.95 (20.40) pg/ml vs. 34.90 (17.85) pg/ml], T [25.07±11.46 ng/dl vs. 24.84±12.75 ng/dl], and AFC [6.00 (4.00) vs. 7.00 (4.00)] between two groups (p>0.05). CONCLUSIONS: Women with bilateral tubal occlusion showed decreased AMH level, suggesting that chronic pelvic inflammation may diminish ovarian reserve. More caution should be paid when evaluating the detriment of PID on female fertility.
Assuntos
Hormônio Antimülleriano/sangue , Dor Crônica/sangue , Reserva Ovariana , Doença Inflamatória Pélvica/sangue , Doença Inflamatória Pélvica/complicações , Adulto , Estudos de Casos e Controles , Dor Crônica/fisiopatologia , Constrição Patológica/sangue , Constrição Patológica/complicações , Estradiol/sangue , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/complicações , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Doença Inflamatória Pélvica/fisiopatologia , Insuficiência Ovariana Primária/sangue , Insuficiência Ovariana Primária/etiologia , Fatores de Risco , Testosterona/sangueRESUMO
Gynceological involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides is rare. We describe a case of ANCA-associated vasculitis in an elderly woman presenting with fevers, cough and a rash. Further investigations revealed vasculitic involvement of the ovaries, fallopian tubes, uterus and omentum with an eosinophil-rich infiltrate.
Assuntos
Síndrome de Churg-Strauss/diagnóstico , Eosinófilos/imunologia , Doenças das Tubas Uterinas/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Omento/imunologia , Doenças Ovarianas/diagnóstico , Doenças Uterinas/diagnóstico , Idoso de 80 Anos ou mais , Anticorpos Anticitoplasma de Neutrófilos/sangue , Biomarcadores/sangue , Biópsia , Síndrome de Churg-Strauss/sangue , Síndrome de Churg-Strauss/imunologia , Síndrome de Churg-Strauss/cirurgia , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/imunologia , Doenças das Tubas Uterinas/cirurgia , Feminino , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/imunologia , Granulomatose com Poliangiite/cirurgia , Humanos , Imunossupressores/uso terapêutico , Doenças Ovarianas/sangue , Doenças Ovarianas/imunologia , Doenças Ovarianas/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças Uterinas/sangue , Doenças Uterinas/imunologia , Doenças Uterinas/cirurgiaRESUMO
Aim of this study is to investigate the diagnostic role of serum D-dimer levels for tubo-ovarian abscess (TOA). Patients diagnosed with TOA (n = 36) and matched controls with ovarian cysts (n = 39) were collected prospectively. Patients in the 2 groups were compared on the basis of size of TOA or cyst, demographic characteristics, and serum d-dimer levels. Baseline characteristics of both groups were comparable. Mean D-dimer levels were significantly higher (P < .0001) in patients with TOA (1870.6 ± 2401.7 ng/mL) when compared to adnexal cyst group (164.4 ± 81.1 ng/mL). D-Dimer had a diagnostic value of 99.9%, specificity of 100.0%, and sensitivity of 97.4% based on a cutoff value 314 ng/mL for predicting TOA. In conclusion, serum d-dimer level was significantly elevated in women with TOA compared with benign adnexal cysts. Thus, this inexpensive, feasible, and reproducible marker can be used for differential diagnosis of TOA.
Assuntos
Abscesso/sangue , Doenças das Tubas Uterinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Doenças Ovarianas/sangue , Abscesso/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Diagnóstico Diferencial , Doenças das Tubas Uterinas/diagnóstico , Feminino , Humanos , Cistos Ovarianos/sangue , Cistos Ovarianos/diagnóstico , Doenças Ovarianas/diagnóstico , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Regulação para CimaRESUMO
OBJECTIVES: In Assisted Reproductive Technologies (ART), impaired ovarian reserve represents a therapeutic challenge. The Anti-Mullerian Hormone (AMH) serum level would be a good marker of ovarian reserve and a predictor of response to stimulation. The objective of this study is to assess into a population of infertile couples where the woman has at least one patent tube and where the man has sperm parameters compatible with insemination, whether AMH level less than 12pmol/L can be used to establish a strategy supporting the couple's infertility by comparing their chances of pregnancy after Intra-uterine insemination (IUI) or in vitro fertilization (IVF). MATERIALS AND METHODS: This single-center retrospective study of 1012 patients over 28months compared the pregnancy rates of 2011 ART attempts (1385 IUI and 626 IVF, ICSI excluded) according to the value of serum AMH, either reduced if≤12pmol/L or non-reduced if greater. RESULTS: In IVF, a low AMH reduced pregnancy rate (18.4% vs. 32.9% in the normal AMH group, P<0.0001). Conversely, the AMH value did not influence the success in IUI cycles (14.2% vs. 14.5%, respectively, NS). In cases with low AMH, the pregnancy rate per initiated cycle in IVF (18.4%) was not significantly greater than in IUI cycles (14.2%). Converting an IVF attempt in IUI did not impair the pregnancy rate (13.5% vs. 14.5% after immediate IUI, NS). CONCLUSION: When the serum AMH level is less than 12pmol/L, IUI may be an interesting option in case of IVF failure. However, its place remains to be defined: converting IVF in IUI, IUI in relay of failed IVF, or even as first line therapy when the chances with IVF appear to be minimal.
Assuntos
Hormônio Antimülleriano/sangue , Infertilidade/diagnóstico , Infertilidade/terapia , Técnicas de Reprodução Assistida , Adulto , Doenças das Tubas Uterinas/sangue , Feminino , Humanos , Infertilidade/sangue , Infertilidade/epidemiologia , Masculino , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Prognóstico , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Injeções de Esperma IntracitoplásmicasRESUMO
OBJECTIVE: To investigate the correlation of two important inflammatory biomarkers, plasma osteopontin and neutrophil gelatinase-associated lipocalin (NGAL), with the severity and outcome of pelvic inflammatory disease (PID). MATERIALS AND METHODS: Sixty-one patients with PID, including 25 patients with tubo-ovarian abscess (TOA), were consecutively recruited. Their blood samples were tested for the concentrations of plasma osteopontin and NGAL using enzyme-linked immunosorbent assay. The associations of these biomarkers with TOA, length of hospitalization, and incidence of surgery were also analyzed. RESULTS: Plasma osteopontin level was significantly increased in PID patients with TOA compared to PID patients without TOA (median 107.77 ng/mL vs. 72.39 ng/mL, p = 0.004). However, there was no significant difference for plasma NGAL. If the cutoff level of plasma osteopontin was set at 81.1 ng/mL, there was a 76.0% sensitivity and a 24.0% false negative rate in predicting TOA in PID patients. Plasma osteopontin significantly correlated with length of hospital stay (r = 0.467, p < 0.001), and this correlation was better than that of NGAL. However, neither biomarker was associated with incidence of surgery. CONCLUSION: Plasma osteopontin has a better correlation with TOA and length of hospitalization compared to NGAL. If plasma osteopontin level falls below 81.1 ng/mL, PID patients will have about a 20% chance of developing TOA. Incorporating plasma osteopontin, but not NGAL, will allow for an adjuvant diagnostic biomarker for TOA and predictor of length of hospital stay.
Assuntos
Abscesso Abdominal/sangue , Doenças das Tubas Uterinas/sangue , Lipocalinas/sangue , Osteopontina/sangue , Doenças Ovarianas/sangue , Doença Inflamatória Pélvica/sangue , Proteínas Proto-Oncogênicas/sangue , Abscesso Abdominal/complicações , Abscesso Abdominal/cirurgia , Proteínas de Fase Aguda , Adulto , Biomarcadores/sangue , Doenças das Tubas Uterinas/complicações , Feminino , Humanos , Tempo de Internação , Lipocalina-2 , Pessoa de Meia-Idade , Doenças Ovarianas/complicações , Doença Inflamatória Pélvica/complicações , Doença Inflamatória Pélvica/cirurgia , Valor Preditivo dos Testes , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To investigate the effect of enoxaparin on ovarian reserve and serum antimüllerian hormone (AMH) levels in a rat ovarian torsion model. DESIGN: Experimental study. SETTING: Experimental surgery laboratory in a training and research hospital. ANIMAL(S): Fourteen female Wistar Hannover rats. INTERVENTION(S): 1) Control group received no special treatment other than abdominal exposure; 2) detorsion-only group received bilateral adnexal torsion (3-hour ischemia), and then after 3-hour torsion period, detorsion (reperfusion) was performed; and 3) detorsion-enoxaparin group received 0.5 mg/kg enoxaparin subcutaneously 2 hours before the same surgery as the detorsion-only group and a second 0.5 mg/kg dose of enoxaparin 24 hours after the first surgeries. Apart from the surgeries, preoperative and postoperative 1-mL blood samples were drawn from the right jugular vein of each rat. MAIN OUTCOME MEASURE(S): Preoperative and postoperative serum AMH levels, histopathologic damage scores, and follicle counts in the ovarian tissue of the rats. RESULT(S): Vascular congestion and hemorrhage scores were higher in the detorsion-enoxaparin group than in the detorsion-only and control groups. The number of small antral follicles was smaller in the detorsion-only group than in the control group. The difference in the pre- and postoperative AMH levels was higher in the detorsion-only group than in the control and detorsion-enoxaparin groups. CONCLUSION(S): The combination of enoxaparin therapy with conventional ovarian detorsion is more effective in protecting the ovarian reserve than detorsion alone.
Assuntos
Hormônio Antimülleriano/sangue , Enoxaparina/uso terapêutico , Doenças das Tubas Uterinas/tratamento farmacológico , Doenças das Tubas Uterinas/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Ovário/citologia , Anormalidade Torcional/tratamento farmacológico , Anormalidade Torcional/cirurgia , Animais , Contagem de Células , Terapia Combinada , Modelos Animais de Doenças , Doenças das Tubas Uterinas/sangue , Feminino , Ovário/efeitos dos fármacos , Ratos , Ratos Wistar , Traumatismo por Reperfusão/prevenção & controle , Anormalidade Torcional/sangueRESUMO
OBJECTIVE: To evaluate whether size of tuboovarian abscess (TOA) and other clinical characteristics were associated with the need for surgical intervention. STUDY DESIGN: A retrospective chart review of patients hospitalized at an inner city hospital between January 1998 and December 2007 with the diagnosis of TOA. Demographics, medical history, clinical markers of infection, radiology, pathology, and operative reports were examined. Student's t test and Fisher's exact test were utilized to analyze differences between groups. Multiple logistic regression analysis was performed to identify significant predictors of surgery. Receiver operating characteristic (ROC) analysis was used to assess how well TOA size and other significant variables were associated with the need for operative or procedural intervention. RESULTS: A total of 163 patients with TOA were identified; 41 patients were excluded based on specific criteria. Of the remaining 122 women, 65.6% responded to antibiotic therapy, and 34.4% had surgery or ultrasound-guided drainage. Mean TOA size in the medical group was 4.4 cm as compared to 7.3 cm in the surgical group (p < 0.0001). Maximal leukocyte count, older age, and parity were associated with significantly higher risk of surgery. The significant univariate variables remained significant after multivariate analysis. ROC curve analysis revealed an excellent discrimination of the need for surgical treatment as predicted by TOA size, with increased likelihood of surgical or procedural intervention with increasing TOA size. CONCLUSION: Radiographic size, leukocyte count, age, and parity are associated with operative or procedural treatment of tuboovarian abscess.
Assuntos
Abscesso/terapia , Doenças das Tubas Uterinas/terapia , Doenças Ovarianas/terapia , Abscesso/sangue , Abscesso/patologia , Adulto , Fatores Etários , Antibacterianos/uso terapêutico , Drenagem , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Histerectomia , Contagem de Leucócitos , Modelos Logísticos , Doenças Ovarianas/sangue , Doenças Ovarianas/tratamento farmacológico , Ovariectomia , Paridade , Curva ROC , Estudos Retrospectivos , Salpingectomia , Falha de TratamentoRESUMO
OBJECTIVE: To compare the influence of various tubal surgeries to ovarian reserve via serum level of antimullerian hormone (AMH) and the subsequent in vitro fertilization and embryo transplantation (IVF-ET) outcome in patients with simple tubal infertility. STUDY DESIGN: A prospective cohort study was conducted on 134 IVF cycles undegone by 26 and 34 cases with bilateral and unilateral salpingectomy, respectively, 23 cases with bilateral oviducts interrupted in the proximal and 51 cases with bilateral oviducts obstruction without intervention as controls. RESULTS: Serum AMH displayed its great superiority to traditional markers of ovarian reserve in correspondence with antral follicles count and decisive effect for the number of oocytes retrieved after stimulation in each group. No significant differences on ovarian reserve and responsiveness or IVF-ET outcome existed among four groups comparable on essential characteristics, except for numerically higher clinical pregnancy rate and live birth rate after various tubal surgeries versus no intervention for bilateral oviducts obstruction. Especially, bilateral salpingectomy precursed the statistically highest implantation rate (51.0% versus 28.0%, 39.1%, 30.4%) and numerically best IVF outcome. CONCLUSION: Tubal surgical procedures have some beneficial effect for improving IVF outcome without significant impact on ovarian reserve or responsiveness. Bilateral salpingectomy appears to be an appropriate procedure before IVF treatment for bilateral salpingitis, especially hydrosalpinx.
Assuntos
Hormônio Antimülleriano/sangue , Doenças das Tubas Uterinas/cirurgia , Fertilização in vitro , Infertilidade Feminina/terapia , Adulto , Implantação do Embrião , Doenças das Tubas Uterinas/sangue , Tubas Uterinas/cirurgia , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/cirurgia , Ovário/cirurgia , Indução da Ovulação , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Salpingectomia , Resultado do TratamentoRESUMO
OBJECTIVE: To compare patients with tubo ovarian abscess (TOA) and non-TOA acute pelvic inflammatory disease (PID) and to determinate admitted day laboratory cut-off values for the TOA. MATERIALS AND METHODS: Files of inpatients admitted to our clinic with the diagnoses of PID and/or TOA between the years of 2006 and 2011. Laboratory and culture results were obtained from the database of hospital. A total of 73 patients diagnosed with PID and/or TOA were evaluated. Patients who were diagnosed with TOA and PID by physical and sonographic examination were assigned to group 1 and group 2, respectively. Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. RESULTS: Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. Mean age of patients was determined as 41.4 ± 7.7 in group 1 and as 35.1 ± 6.8 in group 2. Abscess was detected more frequently in patients with low socio-cultural level, and this was found to be statistically significant. The diameter of abscess was found to be ≥5 cm in 39 (88.6 %) patients and <5 cm in 5 (11.4 %) patients. The average length of hospital stay was statistically significantly increased in patients with an abscess of ≥5 cm in size compared to patients with an abscess of <5 cm. When C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte counts were statistically evaluated by ROC curves, diagnostic ability of CRP, ESR and leukocyte count was found to be 73, 87, and 58 %. CRP has a specificity of 63 % and a sensitivity of 72 % if cut-off value is considered as 11.5 mg/L whereas ESR has a specificity of 83 % and a sensitivity of 79 % if cut-off value is considered as 19.5 mm/1/2 h. CONCLUSION: ESR >19.5 mm/1/2 h and CRP >11.5 mg/L were the best predictors of TOA. The high level of CRP and ESR was associated with longer duration of hospitalization and disease severity, and these levels were statistically significantly associated with TOA size of ≥5 cm.
Assuntos
Abscesso/sangue , Doenças das Tubas Uterinas/sangue , Doença Inflamatória Pélvica/sangue , Abscesso/complicações , Abscesso/diagnóstico , Doença Aguda , Adulto , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/diagnóstico , Feminino , Humanos , Tempo de Internação , Contagem de Leucócitos , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/complicações , Doença Inflamatória Pélvica/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To try putting the ß-hCG level as a reliable predictor for tubal patency for women, who had previously undergone expectant treatment or who had received systemic methotrexate injection because of tubal pregnancy, and to simply check their tubal patency using a newly proposed procedure, a transvaginal ultrasound guided selective salpingography (TVSSG). METHODS: One hundred and sixty patients were submitted to TVSSG after tubal pregnancy treatment. TVSSG was subsequently performed in the follicular phase of the menstrual cycle after the clinical treatment of tubal pregnancy. One hundred patients received expectant management and 60 were treated with single-dose methotrexate (50 mg/m(2) intramuscularly). RESULTS: Of 160 patients (235 fallopian tubes examined), the affected tube was observed to be patent by TVSSG in 84 and 78%, respectively (P > 0.05). The contralateral tube was patent in 93%. Forty patients became pregnant and were thus not subsequently assessed with laparoscopy. Ten of these pregnancies ended in a miscarriage and five in a recurrent tubal pregnancy. The concordance of 86% for Fallopian tubes was achieved between the TVSSG and laparoscopy by the gold standard method. After the logistic regression was performed, it was observed that the levels of ß-hCG > 5,000 mUI/ml were directly related to the tubal obstruction risk, odds ratio = 11.7 (95% CI = 2.27-61.32). CONCLUSIONS: In the current study, the probability of ipsilateral tubal obstruction depends on the ß-hCG levels. The increase in ß-hCG levels is followed by an enhancement in tubal obstruction risk. Therefore, assessment of the ß-hCG may be an effective tool for the prognosis of the reproductive future of these patients.
Assuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Doenças das Tubas Uterinas/diagnóstico , Tubas Uterinas/diagnóstico por imagem , Histerossalpingografia/métodos , Gravidez Tubária/terapia , Abortivos não Esteroides/administração & dosagem , Adulto , Doenças das Tubas Uterinas/sangue , Feminino , Humanos , Injeções Intramusculares , Metotrexato/administração & dosagem , Valor Preditivo dos Testes , Gravidez , Prognóstico , Estudos Prospectivos , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To investigate in the natural cycle just before IVF, whether glycodelin levels in endometrial flushing fluid obtained days LH+1 and LH+7 can be used in predicting pregnancy in the following IVF cycle, and whether there are differences in women with tubal factor infertility compared to women with unexplained infertility and fertile controls. STUDY DESIGN: A prospective observational multicentre study of 21 fertile and 75 infertile women (25 showed abnormal tubes with no signs of hydrosalpinges, 18 had uni- or bi-lateral hydrosalpinges, 17 were salpingectomised because of hydrosalpinges, and 15 women had unexplained infertility). Endometrial flushing at days LH+1 and LH+7, endometrial biopsy, and blood sampling at day LH+7 were performed before down-regulation for IVF. Glycodelin levels in endometrial flushing fluids (EFF), biopsies, and plasma samples were related to tubal pathology, endometrial dating and IVF outcome. Furthermore, total protein concentration was measured in EFF to investigate the influence of normal endometrial maturation on protein concentrations from days LH+1 and LH+7. RESULTS: At day LH+1, EFF glycodelin levels were higher in infertile women with abnormal tubes compared to fertile women, particularly in women conceiving after the following IVF. For women with unexplained infertility, a higher level at day LH+1 was present only in women not conceiving after the following IVF. ROC curve analysis showed that at day LH+1 EFF glycodelin levels had no predictive value for IVF outcome. At day LH+7, glycodelin levels in endometrial flushing fluids and biopsies depended on endometrial dating. CONCLUSIONS: At day LH+1, glycodelin concentration is increased in endometrial flushing fluid from infertile women with abnormal tubes compared to fertile controls without being a valuable predictor of subsequent pregnancy. At day LH+7 the glycodelin level depends on endometrial dating.
Assuntos
Endométrio/metabolismo , Endométrio/patologia , Glicoproteínas/metabolismo , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologia , Ciclo Menstrual/metabolismo , Proteínas da Gravidez/metabolismo , Adulto , Biópsia , Estradiol/sangue , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/metabolismo , Doenças das Tubas Uterinas/patologia , Feminino , Fertilização in vitro/métodos , Glicodelina , Glicoproteínas/sangue , Humanos , Imuno-Histoquímica , Infertilidade Feminina/sangue , Infertilidade Feminina/diagnóstico , Ciclo Menstrual/sangue , Ovulação/sangue , Ovulação/metabolismo , Proteínas da Gravidez/sangue , Progesterona/sangue , Prognóstico , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Irrigação Terapêutica , Adulto JovemRESUMO
OBJECTIVES: To compare the expression of pinopodes, LIF, integrin beta(3) and MUC1 in the peri-implantation endometrium of women with and without hydrosalpinx. STUDY DESIGN: A prospective observational study in an assisted reproductive unit in a university teaching hospital, including 20 women with hydrosalpinx and 21 women without hydrosalpinx. Endometrial biopsies were performed on day LH+7 or +8. The proportion and density of pinopodes were assessed by scanning electron microscopy. LIF, integrin beta3 and MUC1 were evaluated with immunohistochemical staining. RESULTS: The proportion and the density of pinopodes were not significantly different between the hydrosalpinx and control groups. The LIF, integrin beta(3), and MUC1 expression were significantly reduced in both glandular epithelial cells and endometrial lumen of the hydrosalpinx group when compared with those of the control group. The expression of integrin beta(3) in stromal cells was also significantly lower in the hydrosalpinx group. CONCLUSIONS: The proportion and the density of pinopodes in the peri-implantation endometrium were not affected by the presence of hydrosalpinx while LIF, integrin beta(3) and MUC1 were significantly reduced in patients with hydrosalpinx.