Salpingitis Impairs Bovine Tubal Function and Sperm-Oviduct Interaction.

Salpingitis is a common cause for subfertility and infertility both in humans and animals. However, the effects of salpingitis on tubal function and reproductive success are largely unknown. Therefore we set out to investigate the effects of inflammation on sperm and oocyte transport and gameto-maternal interaction in the oviduct using the bovine as a model. For this purpose, oviducts revealing mild (n = 45), moderate (n = 55) and severe (n = 45) inflammation were obtained from cows immediately after slaughter and investigated by live cell imaging, histochemistry and scanning electron microscopy. Our studies showed that endometritis was always correlated with salpingitis. Moderate and severe inflammation caused a significant increase in the thickness of tubal folds (p < 0.05). Severe inflammation was characterized by luminal accumulations of mucus and glycoproteins, increased apoptosis, loss of tight junctions and shedding of tubal epithelial cells. The mean ciliary beat frequency (CBF) in the ampulla was significantly reduced as compared to the controls (p < 0.05). The higher the grade of inflammation, the lower was the CBF (p < 0.001). In severe inflammation, spermatozoa were stuck in mucus resulting in decreased sperm motility. Our results imply that tubal inflammation impairs proper tubal function and leads to reduced sperm fertilizing capacity.

A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report.

BACKGROUND: Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria gonorrhea in addition to some Enterobacteriaceae. On the other hand, type 2 diabetes is a disease with a lot of complications such as hyperglycemia, inflammation, and immune disorders. Therefore, patients with type 2 diabetes mellitus have an increased susceptibility to infection especially when glycemic control is poor. CASE PRESENTATION: We experienced a rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus. A 72-year-old Japanese woman with a 10-year history of type 2 diabetes mellitus had symptoms of diarrhea and persistent pain in left lower abdomen. She had mild tenderness to palpation in her abdomen. Inflammation markers were markedly elevated. Her abdominal computed tomography and magnetic resonance imaging on admission revealed a tumor in left side of intrapelvis and we diagnosed her as having pyosalpinx. Pathogenic bacteria were not detected. On admission, her glycemic control was relatively good; in addition, her glycated hemoglobin levels were around 6% for over 1 year. Although pathogenic bacteria were not detected, we started antibiotics therapy. Fourteen days after starting the antibiotics her laboratory data were improved. Three months later, the tumor was markedly smaller compared to that on admission. CONCLUSIONS: We should keep in mind that older patients with type 2 diabetes mellitus are immunocompromised hosts and thereby they could have rare pelvic inflammatory disease such as pyosalpinx even when good glycemic control is obtained for a long period of time.

[THE ROLE OF NO AND MEXIDOL IN CONTRACTILITY OF OVARIAN AND CERVICAL PARTS OF UTERUS UNDER THE CONDITION OF IMMUNE-MEDIATED INJURY IN MICE].

Contractility of ovarian (OP) and cervical parts (CP) of uterus under the condition of immune-mediated injury which was induced by immunization with bovine serum albumin (BSA) was investigated. It was shown that under the activation of energy-synthesizing function of mitochondria with Mexidol the frequency of reductions in both uterine parts decreased, the amplitude and contractility index in the OP and CP as well as the duration of the active state in CP increased. Mexidol under the condition of immunization with BSA leads to the decrease in amplitude in 2,6 time and contractility index in 2,2 time in OP and to the increase of them in CP. It was shown that contractility features of ovarian and cervical parts of uterine under the condition of BSA- induced immunization were caused by changes of mitochondria functional state and were associated with nitric oxide.

[Factors affecting psychological reserves in the patients presenting with chronic somatic diseases].

The present study included 105 patients suffering chronic somatic diseases (CSD). Their health status was estimated based on the brief multifactor questionnaire for personality (BMQP) analysis; Spielberg state trait anxiety inventory (STAI); the Beck depression scale with the use of the "patient's quality of life" method; the well-being, activity, and mood (WAM) self-assessment test, and the stress-tolerance self-assistance test. The impairment of psychological reserve was documented in 85.7% of the patients with CSD. The degree of CSD deterioration was shown to be related to the frequency of exacerbation of clinical conditions, the severity of pain syndrome, the level of anxiety, depression, and hypochondriac mood. The impairment of psychological reserve was accompanied by the deterioration of the quality of life due to constraints imposed by the necessity to undergo medical treatment, avoid situations of emotional stress, restrict the scope of physical and social activities.

Damage to oviduct organ cultures by Gardnerella vaginalis.

Gardnerella vaginalis is a Gram-variable coccobacillus found in the lower genital tract, particularly of women. Very large numbers are found in the vagina in bacterial vaginosis. The pathogenicity of G. vaginalis was studied using fallopian tubes and bovine oviducts in organ culture. Whole organisms, whether piliated or not, from broth cultures caused the cilia on ciliated cells in the mucosa of either human or bovine oviducts to stop beating within 3 days or less. Cilia on control tissues kept beating for at least 5 days. Organism-free filtrates from broth cultures, whether frozen and thawed or heat-treated, caused the same effect, indicating the existence of a soluble toxin. Histological sections revealed little damage, but scanning electron microscopy showed damage to the mucosal surface with some loss of ciliated cells. The toxin is not human tissue specific and, therefore, unlikely to be the same as the cytotoxin with haemolytic properties described by others. The toxin could play a part in the development of salpingitis if G. vaginalis organisms gained access to the upper tract in large numbers.

Contrasting effects of P2 receptor agonists on spontaneous contractility of human fallopian tubes with and without acute inflammation.

Two groups of women were used to compare effects of P2 receptor agonists on the contractile activity of isolated human fallopian tubes with and without acute purulent inflammation. A control group included women with uterine tubes without inflammation (n=15). A study group included women, operated for unsuccessful conservative anti-inflammatory treatment of acute purulent tuboovarial formations (group with acute purulent salpingitis, n=16). Division into two groups was done according to pathohistological diagnosis. Spontaneous contractions of the isolated tubes were registered isometrically with electromechanical transducer before and after incubation of the tissues with agonists of P2 receptors-ATP, UTP, 2-methylthio-ATP and alpha,beta-methylene-ATP. In the control group neither of the agonists produced any significant effect on fallopian tube contractility. In the study group, ATP, 2-methylthio-ATP and alpha,beta-methylene-ATP significantly increased the spontaneous contractility of isolated tubes. It is suggested that higher activity of P2 receptor agonists in the uterine tubes with acute purulent inflammation is due to expression of several subtypes of P2 receptors during inflammation.

[Efficacy of the psychocorrection methods in the medical rehabilitation of patients with chronic salpingoophoritis and chronic pelvic pain syndrome].

Analysis of efficiency of respiratory relaxational training and of the visualization method was performed for 90 women with chronic salpingoophoritis and the syndrome of chronic pelvic pain. Use of psychocorrection made possible to improve efficiency of the treatment significantly decreasing intensity of the pain and improving psychological status of the patients. Predictors of efficiency and indications for differentiated use of these methods for the medical rehabilitation of patients were worked out.

Pharmacological characterization of P2-receptors in human fallopian tubes.

In women with various gynecological disorders, ATP, ADP, and 2-methylthio-ATP dose-dependently potentiated spontaneous contractility of isolated fallopian tubes, while alpha,beta-methylene-ATP and uridine triphosphate were little efficient. Pyridoxal phosphate-6-azophenyl-2',4'-disulphonic acid, a P2-receptor antagonist, inhibited responses to 2-methylthio-ATP, produced no effect on responses to ATP, and potentiated ADP-induced responses in fallopian tubes. During inflammation, sensitivity of fallopian tubes to P2 agonists and antagonists decreased. The data attest to the presence of functionally active P2 receptors in human fallopian tubes probably involved in the regulation of their mechanical activity.

Hydrosalpinx fluid diminishes endometrial cell HOXA10 expression.

OBJECTIVE: To determine the effect of hydrosalpinx fluid on the expression of HOXA10, an essential regulator of endometrial receptivity. DESIGN: In vitro study. SETTING: Academic medical center. PATIENT(S): Patients with unilateral or bilateral hydrosalpinx. INTERVENTION(S): Hydrosalpinx fluid was aspirated from 10 patients at laparoscopy. The fluid was serially diluted in minimum essential medium. Ishikawa cells (an endometrial adenocarcinoma cell line, representative of endometrial epithelium) were incubated with this fluid at concentrations of 10% and 50% for 48 hours. Cells were also incubated in undiluted minimum essential medium (MEM) and in 10% serum as controls. After incubation, the cells were lysed in Trizol, and total RNA was extracted and analyzed by Northern blot using a 32P-labeled HOXA10 riboprobe. A 32P-labeled G3PDH probe was used as a control for loading. MAIN OUTCOME MEASURE(S): HOXA10 mRNA expression. RESULT(S): HOXA10 mRNA expression in endometrial cells decreased with increasing concentrations of hydrosalpinx fluid. Densitometric analysis of the northern blot revealed that HOXA10 mRNA expression was different from control at both concentrations (P<.007). CONCLUSION(S): HOXA10 is necessary for implantation in the murine model. HOXA10 expression is diminished by hydrosalpinx fluid. This effect on HOXA10 is a potential molecular mechanism by which implantation rates are diminished in women with hydrosalpinges.

Chlamydial heat shock protein 60--specific T cells in inflamed salpingeal tissue.

OBJECTIVE: To evaluate the role of chlamydial heat shock protein 60 (CHSP60)-specific T-lymphocytes in tubal factor infertility. DESIGN: Case series of patients with tubal factor infertility. SETTING: Infertility Clinic, Department of Obstetrics and Gynecology, Helsinki University Central Hospital and Laboratory of Cell-Mediated Immunity, National Public Health Institute, Oulu, Finland. PATIENT(S): Five patients with tubal factor infertility who underwent elective salpingectomy because of hydrosalpinges. INTERVENTION: Collection of salpingeal tissue specimens for in vitro culture of T-lymphocytes. MAIN OUTCOME MEASURE(S): Cloning of Chlamydia trachomatis and CHSP60-specific T-lymphocyte lines derived from inflamed salpingeal tissue. Cytokine production analysis of the established T-lymphocyte clones. RESULT(S): Seventy-seven (34%) of the 229 T-lymphocyte clones recognized C. trachomatis and C. pneumoniae elementary bodies as target antigens. One-third of these Chlamydia genus-specific T-lymphocyte clones further recognized CHSP60 as the target antigen. Most of the CHSP60-specific T-lymphocyte clones produced predominantly IL-10. CONCLUSION(S): CHSP60 may be an important T-lymphocyte antigen involved in the immunopathogenesis of tubal damage associated with chronic C. trachomatis infection.

[A comparative assessment of different cryotherapy methods for patients with chronic nonspecific salpingo=oophoritis]. / Sravnitel'naia otsenka razlichnykh metodik krioterapii bol'nykh khronicheskim nespetsificheskim sal'pingooforitom.

97 females at reproductive age with chronic nonspecific salpingo-oophoritis (CNSO) were examined and treated. The results of the treatment (vaginal and external impact) demonstrate positive effects of various cryotherapeutic techniques on CNSO clinical course, on hormonal and immune unbalance, functional activity of the uterine tubes, regional hemodynamics, psychoemotional status. Thus, cryotherapy is an effective adjuvant in combined therapy of CNSO.

Herpetic salpingitis and fallopian tube prolapse.

AIM: We describe the unusual association of fallopian tubal prolapse and herpetic infection, an occurrence not previously reported to our knowledge. METHODS AND RESULTS: A 37-year-old woman presented with a small polypoid mass of the vaginal vault, 3 months after abdominal hysterectomy and abdominoplasty. The vaginal mass proved to be the fimbriated end of a fallopian tube, herniated into the vagina. Reintervention 3 months later with resection of a small vaginal 'polyp' revealed a residual portion of fallopian tube, with superimposed herpes simplex virus (HSV) infection and marked cytological atypia of surface epithelial cells. HSV-2 immunostaining of viral nuclear inclusions and of atypical cells confirmed the herpetic nature of the infection. CONCLUSION: Involvement of the genito-urinary tract by HSV may occur via an ascending infection from the cervix, but the fallopian tube, deeply located in the pelvis, is generally spared from herpetic infection. In the setting of fallopian tubal prolapse, direct exposure of the herniated fallopian tube to various pathogens in the vagina provides an unique clinical model for salpingitis. In herpetic tubal infections, special attention must be paid to cytological atypia of probable viral cytopathogenic origin, to avoid a misdiagnosis of malignancy.

[The combined treatment of patients with chronic nonspecific salpingo-oophoritis using a low-frequency magnetic field and iodobromine water]. / Kompleksnoe lechenie bol'nykh khronicheskimi nespetsificheskimi sal'pingooforitami nizkochastotnym magnitnym polem i iodobromnoi vodoi.

The studies of 116 females with chronic nonspecific salpingo-oophoritis demonstrate that combination of low-frequency magnetic field with iodine-bromine water effectively corrects immunological indices, i.e. improves T- and B-cell immunity, production of IgM and IgA, proportion of immunoregulatory subpopulations of T-lymphocytes.

In vitro fertilization treatment in genital tuberculosis.

PURPOSE: We describe our experience with in vitro fertilization (IVF) treatment in 13 women with histologically proven genital tuberculosis. METHODS: For IVF treatment the above patients had to meet two criteria: normal uterine cavity and functional ovaries. RESULTS: Six intrauterine pregnancies (28.6% success rate) were achieved after 21 IVF treatment cycles in 13 patients with histologically proven diagnoses of genital tuberculosis. This series represents a comparatively encouraging success rate, but these patients were selected carefully before committing them to IVF treatment. CONCLUSIONS: IVF represents a useful treatment and improves the chances of fertility, in what was considered a desperate situation.

Severity of pelvic inflammatory disease as a predictor of the probability of live birth.

OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild (n = 371), moderate (n = 580), or severe (n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease.

[The comparative effect of classic massage of different intensities on patients with chronic salpingo-oophoritis]. / Sravnitel'noe vliianie klassicheskogo massazha razlichnoi intensivnosti na bol'nykh khronicheskim sal'pingooforitom.

Massotherapy in different regimens has been used in 30 patients in remission of chronic salpingo-oophoritis (CSO). The massage produced positive changes in blood coagulation, immune status, regional hemodynamics of the small pelvis, bioelectric activity of the muscles of the anterior abdominal wall and lumbosacral region. A strong anesthetic and antiinflammatory effect of intensive massage in 78%, recovered reproductive function in 33% of the patients allow to recommend intensive massage as possible monotherapy of patients in remission of CSO.

Endometritis, salpingitis and fertilisation rates after mating mares with a history of intrauterine lumenal fluid accumulation.

The occurrence of uterine and oviductal inflammation, and fertilisation rates, were measured on Day 3 post ovulation in inseminated mares that had either exhibited intrauterine lumenal fluid during a previous dioestrus (Experiment 1) or had acute endometritis induced by intrauterine infusion of 1% glycogen (Experiment 2). Endometritis was assessed by uterine cytology and histology whereas oviductal inflammation was measured histologically. Fertilisation rates were calculated from the percentage of cleaved ova recovered by retrograde flushing of the oviducts. Mares with or without pre-existing uterine fluid during dioestrus that were inseminated showed a higher incidence of endometritis than control mares without pre-existing uterine fluid that were not inseminated (n = 7 mares/group). However, inseminated mares with uterine fluid did not show a higher incidence of endometritis than inseminated mares without uterine fluid. Mares with or without pre-existing uterine fluid showed a higher incidence of endometritis than salpingitis and these 2 groups of mares showed equivalent rates of fertilisation and oviductal oocyte recovery. Mares inseminated with semen alone or semen following 1% glycogen treatment had a higher incidence of endometritis than control noninseminated mares (n = 17 mares/group) but mares that received semen plus 1% glycogen did not show a higher incidence of endometritis than mares that received semen alone. Both these groups of mares showed a higher incidence of endometritis than salpingitis and those that received semen plus 1% glycogen showed an equal recovery rate of recently ovulated ova but a lower fertilisation rate than the mares that received semen alone.

[The comparative efficacy of different methods of cryotherapy in patients with chronic salpingo-oophoritis]. / Sravnitel'naia éffektivnost' razlichnykh metodik krioterapii u bol'nykh khronicheskim sal'pingooforitom.

Therapeutic response to treatment (vaginal and external cryotherapy, drugs) in 97 patients with chronic salpingo-oophoritis at reproductive age provides the conclusion on effectiveness of various cryotherapeutic regimens in this disease. Cryotherapy improves regional blood circulation, restores contractility of the uterine tubes.