[The prognostic significance of particular immunological indicators of lachrymal fluid in patients using soft contact lenses].

The study was carried out to identify concentrations of vessel epithelium growth factor (VEGF), souble forms of VEGF receptor type I and II, chemo-toxic protein I and metalloproteinase-9 in lachrymal fluid. The immune enzyme analysis was applied. He sampling included patients with myopia without complications while using silicone hydro-helium and hydro-helium contact lenses and patients with hypoxic complications of contact correction. It is established that application of hydro-helium and silicone hydro-helium contact lenses more than one year is followed by increasing of concentration of detected substances in lachrymal fluid. Under hypoxic complications of contact correction the levels of substances are significantly higher than in cases without complications. This occurrence makes it possible to substantiate possibility of application of immunologic indicators as diagnostic markers.

Manejo del hidrosalpinx en reproducción asistida / Hydrosalpinx management in Assisted Reproduction

La presencia de hidrosalpinx en pacientes sometidas a tratamientos de reproducción asistida empeora los resultados de los mismos. Existe entre los profesionales de la reproducción una amplia gama de diferentes manejos del hidrosalpinx, alguno de los cuales son cuestionables por su falta de base en la medicina de la evidencia. Parece claro que la presencia de hidrosalpinx no interfiere ni en la estimulación ovárica ni en la fecundación de los ovocitos obtenidos pero si en la implantación de los embriones transferidos. Se discutió si el límite para la acción adversa del hidrosalpinx es la detección ultrasonográfica del mismo. El líquido del hidrosalpinx altera el medio y el peristaltismo uterinos. También parece asociarse a abortos y gestaciones ectópicas. El líquido contenido en el hidrosalpinx es embriotóxico . También el endometrio que recibe dicho líquido muestra un desfase y una menor concentración de integrinas así como una menor expresión de HOXA 10. Todos estos efectos sobre el endometrio se corrigen con la salpinguectomía u otras formas de bloqueo del paso del contenido del hidrosalpinx a la cavidad endometrial. El abordaje terapeútico engloba un tratamiento médico con antibióticos y un tratamiento quirúrgico. Se propone un protocolo de abordaje del hidrosalpinx, tanto diagnosticado antes del inicio del tratamiento de reproducción asistida como del diagnosticado en el curso de la misma (AU)

The presence of hydrosalpinges in patients undergoing assisted reproduction treatments impairs their results. There are many different ways of hydrosalpinx management, some of them questionable because of their lack of back up in evidence based medicine. It seems clear that hydrosalpinges do not interfere neither with ovarian stimulation nor with oocyte fertilisation but they do interfere with embryo implantation. In the past, the possibility that only those visible in echography resulted detrimental on the IVF results was discussed. The fluid that replenish the hydrosalpinx harms both, uterine media and peristaltism. Hydrosalpinx is also related with miscarriage and ectopic pregnancies. It was demonstrated that the fluid inside the hydrosalpinx is embryotoxic. The endometriums influenced by this fluid shows differences in development, lower concentration of integrines and lower expression of HOXA 10. All these effects are suppressed by the salpinguectomy or any other form of tubarian blockade. Therapeutic management includes antibiotic and surgical treatments. A management protocol is proposed for two different clinical situations: the diagnostic before starting the assisted reproduction treatment and the diagnostic during the ovarian stimulation (AU)