Tumor necrosis factor in peritoneal fluid from asymptomatic infertile women.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is a cytokine that can be found in the peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response to inflammatory disorders and infections. The cytotoxic effect of this cytokine could be a factor participating in the pathology of various gynecological diseases, and could also be accountable for the high immunological response and damage to the tubal epithelium. The objective of this study was to establish the presence of TNF-alpha in asymptomatic infertility and its association with various isolated bacteria. METHODS: Ten milliliters of PF were collected from each of 73 patients by means of laparoscopy and cultured in synthetic medium and McCoy cells for the isolation of aerobic and anaerobic bacteria, as well as for Chlamydia trachomatis. The activity of TNF-alpha was determined by means of a bioassay using L-929 cells. RESULTS: Forty-three percent of the PFs showed positive TNF-alpha activity, while the laparoscopic evaluation showed that 32 patients had Fallopian tube occlusion (FTO), 7 had endometriosis, 30 had PID, and 4 had myomas and adhesions. TNF-alpha activity was found to be high in FTO patients (p < 0.05). Positive cultures were found in 50.7% of patients; of these, 31.5% had PID (p < 0.05), and only 20.5% of positive cultures were TNF-alpha positive. Chlamydia trachomatis (16%) was the most frequently isolated bacteria in these patients. CONCLUSIONS: The detection of TNF-alpha could be useful in the diagnosis of active infectious and inflammatory diseases in asymptomatic infertile patients.

[Determination of the tumor necrosis factor in the peritoneal fluid of gynecologic patients with intraperitoneal infections and endometriosis]. / Determinación del factor de necrosis tumoral en líquido peritoneal de pacientes ginecológicas con infecciones intraperitoneales y endometriosis.

Tumor necrosis factor (TNF-alpha) is a cytokine which can be found in peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response of inflammatory disorder and infections diseases. The cytotoxic effect of this cytokine could be participating in the pathology of different gynecologic problem and be accountable of the high immunological response and damage on the tubal epithelium. The objective of this study was determinate the presence of TNF-alpha in PF of endometriosis patients, fallopian tube occlusion (FTO) and PID and their correlation with different isolated bacteria. Ten mililiter PF were collected and cultured in antificial medium and Mc Coy culture cells for isolation of acrobic, and anaerobic bacteria and Chlamydia trachomatis from 73 patients by laparoscopy. The TNF-alpha activity was determined by L-929 cells endometriosis, 30 PID and 4 had miomas and adherences. The 50.7% of patients were cultive positive, fom these, 31.5% were PID. Chlamydia trachomatis (16%) was the most frecuenty isolated bacteria in these patients. 59.4% of FTO patients displayed TNF-alpha activity. However, only 4% showed positive isolation, in conclusion the detection of TNF-alpha could be useful in active infectious and inflammatory diseases in patients which not present simptomatologic characteristic of these illnesses and plus being attended at for sterility clinical as a result of their incapacity to get pregnant.

Vitamin C status, cervico-vaginal infection and premature rupture of amniotic membranes.

A prospective study to evaluate the role of vitamin C and cervico-vaginal infection in the premature rupture of amniotic membranes (PROM) was designed. The leukocyte vitamin C levels of 44 pregnant women that did not consume vitamin supplements was evaluated at weeks 20, 28 and 32 of pregnancy. On each evaluation the presence of cervico-vaginal infection was diagnosed and treated. The leukocyte vitamin C level throughout gestation showed a decrease towards week 28 and then it recovered at the end of pregnancy. Six of every ten women had normal flora in their vaginal secretion cultures. Eleven cases had PROM (0.24), no association was found between cervico-vaginal infection and PROM. The leukocyte vitamin C levels on week 20 of gestation showed an association with PROM. (chi 2 = 6.34, p < 0.05, odds ratio 6.75 [CI 1.26-26.03]).

[Utility of the Papanicolaou smear in the diagnosis of bacterial vaginosis]. / Utilidad del frotis de Papanicolaou en el diagnóstico de vaginosis bacteriana.

In 200 studied patients there was a sensitivity of 49% and specificity of 100%; bacterial vaginosis incidence was 17.7%; the probability of false negatives was 73%. So, Papanicolaou's smear is not an adequate method for bacterial vaginosis diagnosis, but the negative result, excludes the possibility of disease.

[Sexually transmitted diseases (STDs) in a group of adolescents attending a perinatal care institute]. / Enfermedades transmitidas sexualmente (ETS) en un grupo de adolescentes que asisten a un Instituto de Atención Perinatal.

To start an active sexual activity at an earlier age and with a larger number of partners, has arousen the frequency of sexually transmitted diseases (STS). The teenagers are a group particularly affected. The objective of this article is to report the etiology of STD in a group of teenagers, out-patients at the Instituto Nacional de Perinatologia (INPer). The study includes 1360 patients at the clinic of STD at the INPer, 8.5 percent were less than 20 years old; 18.9 percent of them had previously a STD. The most frequent pathology was cervicovaginitis and the most frequently isolated pathogens were Candida sp, Gardnerella vaginalis and Ureaplasma urealyticum. There were no cases of gonorrhea. Three patients had Immunodeficiency Syndrome.

[Etiology of cervicovaginal infection in pregnant and non-pregnant patients]. / Etiología de la infección cervicovaginal en pacientes embarazadas y no embarazadas.

A prospective study to evaluate the prevalence of specific microorganisms in pregnant and nonpregnant women with cervicovaginitis attended at the Instituto Nacional de Perinatología, was done; Candida sp, Gardnerella vaginalis, Replasma urealitycum, Chlamydia trachomatis, Group B Streptococcus, Trichomonas vaginalis, Neisseria gonorrhoeae were investigated. Two hundred thirty four patients were studied, 105/234 (44.9%) pregnant and 129/234 (55.1%) nonpregnant women, with a mean age of 26.5 years (range 14 to 44 years). One hundred eighty one (77.5%) women had only one sexual partner. The most common microorganisms seen were Candida sp (31.6%), Gardnerella vaginalis (27.7) and Ureaplasma urealyticum (15.8%). Infection by Chlamydia trachomatis was documented in 9.8% of the population. Trichomonas vaginalis was identified in 1.7%, there was not any case of Neisseria gonorrhoeae infection. Candida sp and Ureaplasma urealyticum were founded more frequent in the pregnant women than nonpregnant women, 41.9% vs. 24.8% (p less than 0.01) and 20% vs. 12.4% (p less than 0.05) respectively. Group B Streptococci was isolated as a single agent in 4.8% in pregnant women. There were not found any pathogenic microorganisms in 29.9% of the cases, as a causal agent of symptomatic cervicovaginitis.