Experience in IVIg therapy for selected women with recurrent reproductive failure and NK cell expansion.

PROBLEM: Recurrent reproductive failure (RRF) has been associated with expansion of circulating NK cells, key cells for maternal tolerance, decidual vasculogenesis and embryo growth. This study reports our experience in intravenous immunoglobulin (IVIg) therapy of a large cohort of women with RRF with expanded circulating NK and/or NKT-like cells (blood NKT cells are a heterogeneous subset of T cells that share properties of both T cells and NK cells). METHOD OF STUDY: Observational study of RRF women with NK or NKT-like expansion (>12% or 10% cutoff levels of total lymphocytes, respectively), treated with IVIg for the next gestation. RESULTS: By multivariant logistic regression analysis after adjusting for age, NK cells subsets and other therapies, IVIg significantly improved the live birth rate to 96.3% in women with recurrent miscarriage (RM) compared with 30.6% in case not receiving IVIg (P < 0.0001). In women with recurrent implantation failure (RIF), in comparison with women not receiving IVIg, treatment increased the pregnancy rate from 26.2 to 93.8% (P ≤ 0.0001) and the live birth rate from 17.9 to 80.0% in RIF (P ≤ 0.0001). CONCLUSIONS: Immunomodulation with IVIg in our selected group of RRF patients with immunologic alterations enhanced clinical pregnancy and live birth rates. Our results may facilitate the design of future clinical trials of IVIg in this pathology.

Histerectomía radical laparoscópica en la cerda utilizada como modelo animal experimental / Laparoscopic radical hysterectomy in the sow used as an experimental animal model

Objetivo: Adiestramiento en la cirugía laparoscópica, utilizando la cerda como modelo animal experimental. Material y método: Se emplea la cerda para la práctica de una histerectomía radical. Se describen los «hitos» anatomoquirúrgicos que hemos de seguir para completar este tipo de cirugía. Conclusiones: Antes de realizar una cirugía laparoscópica en una mujer tenemos que desarrollar un aprendizaje «por pasos» que nos dé confianza y seguridad. Estos pasos pueden aprenderse en modelos animales. Así, cuando se ayude a un cirujano oncólogo o se llegue a actuar como cirujano, se habrá adquirido previamente una experiencia en manejo de aparato genitourinario y vascular pélvico que será muy importante para poder enfrentarnos a esas estructuras (AU)

Objectives: To gain practice in laparoscopic surgery, using the sow as an experimental animal model. Material and method: The sow was used to practice radical hysterectomy, describing the anatomic-surgical «landmarks» that must be followed to complete this kind of surgery. Conclusions: Before performing laparoscopic surgery in a woman, surgeons must follow a step-by-step training period that provides confidence and security. These steps can be learnt using animal models. Thus, when helping an oncological surgeon or when performing surgery, surgeons will have already acquired the experience in handling the genitourinary and pelvic-vascular systems. This experience will be highly useful when performing surgery involving these structures (AU)